Author Of 2 Presentations
LB1188 - Epidemiology of COVID-19 among persons with neuroimmunological disorders at the Columbia University MS Center in New York City (ID 1987)
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.
P0190 - ASPIRE Study: Protocol for a double-blind RCT of aspirin for overheating during exercise in MS (ID 666)
Abstract
Background
Background Exercise holds many benefits for persons with multiple sclerosis (MS), yet many MS patients are heat sensitive and therefore avoid exercise due to overheating and exhaustion that result. The exercise literature in MS to date is likely subject to bias by predominant representation of patients who are not heat sensitive and may not be a representative sample. Finding ways to facilitate comfortable engagement in exercise for persons with MS is a key priority. Our pilot trial of aspirin as a cooling pretreatment for exercise in MS showed favorable results: after aspirin, participants who experience overheating during exercise were able to exercise longer and the amount of body temperature increase they experienced was reduced by 56%.
Objectives
Objective Conduct a large-scale double-blind randomized controlled trial of aspirin (acetylsalicylic acid, ASA) pretreatment as a convenient and inexpensive method to prevent overheating and improve exercise performance in persons with MS, compared to placebo and acetaminophen.
Methods
Methods Participants are seen for three separate sessions (separated by at least one week) for a laboratory maximal exercise test. At each session, body temperature is measured tympanically before oral administration of a standard adult dose (650 mg) of aspirin, acetaminophen (APAP), or placebo. Participants then perform a maximal ramp test on a cycle ergometer. Primary outcomes are (a) time to exhaustion (TTE, i.e., time spent cycling to peak exertion) and (b) body temperature change. Secondary outcomes include patient reported outcomes including pain, fatigue, and mood. Cross-over analyses will include tests for effects of treatment, period, treatment–period interaction (carryover effect) and sequence.
Results
Results Enrollment in the ASPIRE trial was begun in February 2019. Adherence and acceptability of the treatment are high. To date, 35 participants have been enrolled; of these, 16 have completed all 3 study visits. There have been 6 drop-outs and 7 non-serious adverse events. Heterogeneity of sample is notable, with 26% men, 9% Black, 6% Hispanic/Latinx. Study data will not be unblinded until completion of all participants (target N=60).
Conclusions
Conclusions Exercise is highly beneficial for persons with MS, but only if they do it. Positive findings from this trial would yield an effective, inexpensive, readily available, unobtrusive treatment to allow many more persons with MS access to the benefits of exercise via a cooling mechanism. Thus far, enrollment and adherence in the ASPIRE trial, as well as diversity of our sample suggest good acceptibiliity of aspirin as a treatment, and favorable generalizability of trial results.