Columbia University Irving Medical Center
Neurology

Author Of 4 Presentations

COVID-19 Late Breaking Abstracts

LB1188 - Epidemiology of COVID-19 among persons with neuroimmunological disorders at the Columbia University MS Center in New York City (ID 1987)

Speakers
Presentation Number
LB1188
Presentation Topic
COVID-19

Abstract

Background

The 2019 coronavirus (COVID19) is a novel infectious entity that has incited a global pandemic. Most infected patients experience mild to moderate upper respiratory symptoms but up to 20% have severe pulmonary and multisystem organ involvement. Few studies have assessed the risk for severe COVID19 infection among persons with multiple sclerosis (MS) or other neuroimmunological disorders, many of whom are treated with disease-modifying therapy (DMT).

Objectives

To describe the baseline clinico-sociodemographic characteristics and recent COVID19 epidemiology of patients managed at our center.

Methods

The electronic medical record was queried for patients evaluated at our center with at least two clinical visits within the past 2 years from censure date 1 March 2020. Variables of interest were collected from 1 March to 31 July 2020, and descriptive statistics were obtained.

Results

717 patients were included in the study, comprising 90.7% MS, 5.6% neuromyelitis optica spectrum disorder (NMOSD), 2.0% autoimmune encephalitis (AE), and 1.7% other neuroinflammatory. Median age was 43 (range 14-80), and 69.5% were women. The most commonly reported race and ethnic identities were 14.8% Black, 50.9% Caucasian, and 16.2% Hispanic. The most frequent DMT regimens were anti-CD20 therapy (38.5% ocrelizumab [OCV], 19.8% rituximab [RTX]), dimethyl fumarate (9.8%), and no DMT (8.9%). We found a 9.9% (n=71) report rate of symptoms suspicious for COVID19 of whom 37% (n=26) had confirmatory viral PCR testing. Two subgroups were compared: COVID19 asymptomatic (n=79) and COVID19 symptomatic PCR confirmed. PCR confirmed cases had statistically significant higher rates of Black race (26.9%, p=0.000), Hispanic ethnicity (26.9%, p=0.042), and multiple medical co-morbidities (42%, p=0.002). Most COVID19 symptomatic patients were managed at home (86%). Serious COVID19 infection necessitating hospitalization occurred rarely in patients treated on glatiramer acetate (1), natalizumab (1), OCV (3), or RTX (5). Of those hospitalized (n=10), 4 were admitted to ICU and 5 died (3 MS, 1 NMOSD, 1 AE).

Conclusions

Among a diverse population of patients with neuroimmunological disorders on various DMT regimens residing in one of the epicenters of the COVID19 pandemic, our retrospective observational study found lower rates of hospitalization and mortality compared to the general population of New York City. Significantly higher rates of Black and Hispanic patients tested positive for COVID19 compared to a subgroup who denied symptoms.

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Clinical Trials Late Breaking Abstracts

LB1200 - The SUNLIGHT Study: A telehealth intervention to address mental health in persons with MS during COVID-19  (ID 2034)

Speakers
Presentation Number
LB1200
Presentation Topic
Clinical Trials

Abstract

Background

The arrival of the Covid-19 pandemic in the United States brought a heightened level of anxiety to the general population. Individuals with chronic diseases such as multiple sclerosis (MS) were expected to be particularly affected. To address mental health needs safely and immediately, we conducted a trial of a group-based telehealth treatment of professional online support groups to reduce anxiety in persons with MS, the SUNLIGHT study.

Objectives

To determine feasibility and initial efficacy of a pilot trial of online structured, moderated professional support groups to reduce anxiety in persons with MS during the US outbreak of Covid-19. Trial was registered at clinicaltrials.gov (NCT04379661).

Methods

All procedures were conducted remotely. Thirty-two patients with MS were recruited in March-April 2020 at an MS Center in New York City. Consent was obtained via eConsent. 21 received active treatment: 1 hour/week online structured group therapy; 11 served as an inactive control group (i.e., treatment as usual, TAU). Baseline measures were collected from all participants: anxiety (Stait-Trait Anxiety Inventory, primary efficacy outcome), stress (Perceived Stress Scale), distress (Impact of Event Scale), mood (Patient Health Questionnaire), loneliness (UCLA Loneliness Scale), self-efficacy (General Self-Efficacy Scale), quality of life (Functional Assessment of Multiple Sclerosis).

Results

Sample was diverse: 83% female; 23.3% Hispanic / Latino, 10% Black, 3.3% Asian; age range: 24-72 years; disease duration: .25 -38 years. 30% Major Depressive Disorder, 30% anxiety disorder. At baseline, 36.6% had an anxiety attack within past 4 weeks.

Feasibility: Completion and adherence for treatment group were high; 80.9% completed the intervention; average adherence was 75%.

Efficacy results: Anxiety decreased in the treatment group after 12-weeks (STAI mean change = -2.7 points; p=.09).

Qualitative results: 100% responded YES to 'did you find the SUNLIGHT study to be worth your time,' and 'would you recommend SUNLIGHT study to a friend with MS;' 95% responded YES to 'if it were possible to continue your participation in the SUNLIGHT study, would you choose to do so;' 53% responded YES to 'do you think participation in the SUNLIGHT study contributed to a decrease in any of your MS symptoms?'

Conclusions

Telehealth provides an acceptable, accessible, safe vehicle for delivering mental health treatment to chronic disease populations during Covid-19. High adherence and completion, and initial evidence showing reduced anxiety bolster professional support groups as a promising treatment option for individuals with MS. Low cost, high return solutions such as online support groups should be further explored in future large-scale trials. Rigorous clinical trail evidence is needed to elevate the priority given to telehealth behavioral treatments.

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COVID-19 Late Breaking Abstracts

LB1244 - Manifestations and Impact of the COVID-19 Pandemic in Neuroinflammatory Diseases (ID 2130)

Abstract

Background

We have limited understanding of the risks and impact of COVID-19 in neuroinflammatory diseases (NID) of the central nervous system, particularly among patients receiving disease modifying therapies (DMTs).

Objectives

To report initial results of a planned multi-center year-long prospective study examining the risk and impact of COVID-19 among persons with NID.

Methods

In April 2020, we deployed online questionnaires to individuals in their home environment to assess the prevalence and potential risk factors of COVID-19 symptoms in persons with and without NID.

Results

Our cohort included 1,115 participants (630 NID, 98% MS; 485 reference) as of April 30, 2020. 202 (18%) participants, residing in areas with high COVID-19 case prevalence, met the April 2020 CDC symptom criteria for suspected COVID-19, but only 4% of all participants received testing given testing shortages. Among all participants, those with suspected COVID-19 were younger, more racially diverse, and reported more depression and liver disease. Persons with NID had the same rate of suspected COVID-19 as the reference group. Early changes in disease management included telemedicine visits in 21% and treatment changes in 9% of persons with NID. After adjusting for potential confounders, increasing neurological disability was associated with a greater likelihood of suspected COVID-19 (ORadj=1.45, 1.17-1.84).

Conclusions

Our study of real-time, patient-reported experience during the COVID-19 pandemic complements physician-reported MS case registries that capture an excess of severe cases. Overall, persons with NID seem to have a risk of suspected COVID-19 similar to the reference population.

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Disease Modifying Therapies – Risk Management Poster Presentation

P0374 - Progressive MS patients of older age on ocrelizumab: real-world experience at Columbia University Irving Medical Center (ID 1059)

Speakers
Presentation Number
P0374
Presentation Topic
Disease Modifying Therapies – Risk Management

Abstract

Background

Seminal trials evaluating ocrelizumab in multiple sclerosis (MS) have primarily shown benefit in patients with younger age, lower baseline EDSS, shorter disease duration, and evidence of higher inflammatory disease activity. The risk/benefit profile in patients who do not fit this description, accounting for a significant proportion of patients with progressive MS on this therapy, is unknown.

Objectives

To describe our experience with older primary progressive MS (PPMS) and secondary progressive MS (SPMS) patients on ocrelizumab.

Methods

The Genentech My Patient Solutions® online database was queried for patients at our center at least 55 years old at the time of ocrelizumab enrollment. Patients with PPMS or SPMS were entered into a database for retrospective chart review. Descriptive statistics were performed.

Results

A total of 56 patients with progressive forms of MS (33% PPMS, 66% SPMS) ages 55 years and older (median 64, range 56-77) at the time of ocrelizumab initiation were identified. At baseline, 46% of patients had more than three documented comorbidities, median EDSS was 6.0 (range 2 - 7.5) and disease duration was 17.7 years. 87% of patients had exposure to at least one prior DMT (most commonly rituximab n=27; glatiramer acetate n=18; interferon beta-1a n=17). At two years, 44% of patients with a baseline EDSS < 5.5 had >1-point increase (n=4, delta-EDSS 1.5) and 39% with a baseline EDSS >5.5 had >0.5-point increase (n=11; delta-EDSS 0.5) confirmed on sequential visits >12 weeks apart. EDSS remained stable in 57% (n=21) and improved in 3.0% (n=1). T25FW increased by >20% in 21% of patients (n=8; delta-T25FW 33%); though data was limited by ambulatory status and variable testing. Subjectively, 46% of patients reported feeling worse, 17% stable, 13% equivocal, and 5% improved at two years. Infections were reported in 27% (n=15) of patients, 2 of which were severe. No neoplasms were diagnosed during treatment. 13 patients discontinued therapy due to progression of disease (n=4), infection (n=4), clinical trial enrollment (n=2), hypogammaglobulinemia (n=1), infusion-related reaction (n=1), and poor venous access (n=1).

Conclusions

In this small, retrospective study of older progressive patients on ocrelizumab, 40% (n=15) had clinically meaningful disability progression at two years. This is a higher rate than reported in younger, less disabled patients with PPMS in clinical trials. More research is still needed to clarify the risk/benefit profile in this understudied MS subpopulation with a high rate of comorbidities and unique disease trajectory contributing to functional decline.

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