University of Chile
Neurology

Author Of 1 Presentation

Disease Modifying Therapies – Risk Management Poster Presentation

LB1150 - Multiple sclerosis during COVID-19 pandemic  in Santiago, Chile (ID 932)

Speakers
Presentation Number
LB1150
Presentation Topic
Disease Modifying Therapies – Risk Management

Abstract

Background

Although non-pharmaceutical measures have been able to reduce the instantaneous reproduction number (R) of SARS-CoV-2 to less than 1 in some countries, the easing of control measures and the absence of herd immunity against coronavirus disease 2019 (COVID-19) may accumulate cases resulting in a substantial increase in R, leading to a second wave. This causes a decision-making problem for immunosuppressed patients due to disease modifying treatment as neither aggressive countermeasures nor treatment deferment can be indefinitely lengthened. In patients with multiple sclerosis (pwMS) expert recommendations consider safe to start or continue interferons β, glatiramer acetate, fingolimod and natalizumab. In relation with lymphodepleting drugs (e.g., alemtuzumab, ocrelizumab), the recommendations are less straightforward. In the real clinical practice, for instance, neurologists have stopped or postponing re-doses of alemtuzumab. However, emerging case reports suggest that lymphodepleting drugs may be safe during the COVID-19 pandemic.

Objectives

To report our initial experience on fifty-two pwMS from one clinical centre during COVID-19 pandemic in Santiago, Chile.

Methods

This is a prospectively-followed cohort (from February to mid-July 2020) of 52 pwMS at the University of Chile Hospital. pwMS treated with alemtuzumab were included if they have had infusions within 12 months prior to or during the COVID-19 pandemic.

Results

The mean age was 34 years (SD ±11), 69% were women, mean disease duration was 3 years and mean EDSS 1.6. 85% pwMS (45/52) have followed a preventine quarantine. 19 pwMS receiving fingolimod, 11 interferons, 4 glatiramer acetate (GA) and 3 natalizumab continued their treatments without changes. Ocrelizumab treatment (n: 6) was postponed in three patients while it continued in three other patients with severe disease. The last infusions of alemtuzumab (n: 9) took place at the end of February when two patients with severe disease received their second cycle. Alemtuzumab re-dosings were postponed in two patients. COVID-19 diagnosis was confirmed by RT-PCR in five patients, 10% of this cohort: two treated with GA, one with fingolimod and two with alemtuzumab. All pwMS with COVID-19 were a contact of a confirmed case of COVID-19. Two patients -one on fingolimod and one on GA- required hospitalization, but not intensive care, for mild pneumonia. Both patients on alemtuzumab had severe depletion of circulating T lymphocytes, but mild COVID-19 disease.

Conclusions

Lymphodepleting DMTs seem to be safe during the COVID-19 pandemic with self-limiting infections. The decision to start, continue or stop treatment with a given DMT should be strongly influenced by whether pwMS do follow recommendations or not to prevent exposure to the virus.

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