Background

Risk factors associated with the severity of COVID-19 in patients with multiple sclerosis (MS) begin to be identified from several cohort studies. Disease modifying therapies (DMTs) may modify the risk of developing a severe COVID-19 infection, beside identified risk factors such as age and comorbidities.

Objectives

The objective was to describe the clinical characteristics and outcomes in patients with COVID-19 and to identify the factors associated with COVID-19 severity.

Methods

This multicenter, retrospective, observational cohort study (COVISEP registry, NCT04355611) included patients with MS presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020 and July 14, 2020. The main outcome was COVID-19 severity assessed on a 7-point ordinal scale (ranging from 1: not hospitalized, no limitations on activities, to 7: death; cutoff at 3: hospitalized, not requiring supplemental oxygen). We collected demographics, neurological history, Expanded Disability Severity Score (EDSS), comorbidities, COVID-19 characteristics and outcome. Univariate and multivariate logistic regression models were used to estimate the influence of collected variables on COVID-19 outcome.

Results

A total of 405 patients (mean age: 44.7 years, female/male: 293/112, mean disease duration: 13.4 years) were analyzed. Seventy-eight patients (19.3%) had a COVID-19 severity score ≥ 3, and 12 patients (3.0%) died from COVID-19. Median EDSS was 2.0 (range: 0-9.5), 326 patients (80.5%) were on DMT. There was a higher proportion of patients with COVID-19 severity score ≥ 3 among patients with no DMT relative to patients on DMTs (39.2% versus 14.4%, p<0.001). Multivariate logistic regression models determined that age (OR for 10 years: 1.8, 95% CI: 1.4-2.4), EDSS (OR for EDSS ≥ 6: 4.5, 95% CI: 2.0-10.0) were independent risk factors for COVID-19 severity score ≥ 3 (hospitalization or higher severity) while immunomodulatory treatment (interferon or glatiramer acetate) was associated with lower risk of COVID-19 severity score ≥ 3 (OR: 0.2, 95% CI: 0.05-0.8). EDSS was associated with the highest variability of COVID-19 severe outcome (R²= 0.18), followed by age (R²= 0.06) and immunomodulatory treatment (R²= 0.02).

Conclusions

EDSS and age were independent risk factors of severe COVID-19, while exposure to immunomodulatory DMTs (interferon and glatiramer acetate) were independently associated with lower COVID-19 severity. We did not find an association between other DMTs exposure (including immunosuppressive therapies) and COVID-19 severity. The identification of these risk factors should provide the rationale for an individual strategy regarding clinical management of MS patients during the COVID-19 pandemic.

Background

Fatigue is one of the most frequent reported symptoms in Multiple Sclerosis (MS) and is usually considered to be one of the three worst symptoms with gait and genito-sphincteral disorders. Fatigue, an invisible symptom, affects social and professional relationships and decreases quality of life.

Pharmacological and non-pharmacological therapies are available, but evidences for effectiveness are limited. To date, three RCTs using cognitive-behavioral approaches (CBT) in the context of MS have been conducted (Van Kessel, 2007; Grossman, 2010, Thomas et al., 2013). Nevertheless, the positive effect of treatment wears off over time. Thus, booster session might enhance the benefits on the long term by reinforcing the internalizations processes. FACETS, developed by Thomas and al in 2013, is promising. It is a six once-weekly sessions program focused on CBT and energy conservation, delivered in small groups, easy to implement in medical services or associations.

Objectives

1. Demonstrate the effectiveness of the FACETS program in a French context

2. To assess the effect of 4 booster sessions to the FACETS program to obtain a long-term effect (1 year).

Methods

Multicentric RCT comparing FACETS versus local practice in pwMS. Six once-weekly sessions followed by 4 booster sessions at regular intervals. The main criteria is the impact of CBT on fatigue evaluated by the Modified Fatigue Impact Scale (MFIS) at 1 year.

Results

N=105 patients recruited (F=89 VS M=16). Mean âge (years) = 46 (9,99), Mean EDSS = 2.61 (1,45). The MFIS Score mean is 54,59 (14,16), a score above 45 means that fatigue. Results at 6 weeks, 6 and 12 months will be presented during congress.

Conclusions

The programme is designed to facilitate use within health services. Thus, if the results from this trial are positive on the long term, there is potential for directly adding to the treatment options available to people with MS who have troublesome fatigue and improving the services available to them.