Esclerosis Múltiple Argentina (EMA)

Author Of 1 Presentation

COVID-19 Late Breaking Abstracts

SS02.04 - First results of the COVID-19 in MS Global Data Sharing Initiative suggest anti-CD20 DMTs are associated with worse COVID-19 outcomes

Abstract

Background

As the COVID-19 pandemic amplifies, efforts to minimise the risk on vulnerable people are essential. People with multiple sclerosis (MS) may be a vulnerable group due to the high proportion taking long-term immunosuppressive disease-modifying therapies (DMTs). Studies from Italy and France suggest older age, higher disability and progressive MS are associated with severe COVID-19, yet there remains uncertainty around the influence of DMTs.

Objectives

Given the many approved MS DMTs and the relatively low frequency of COVID-19 in MS patients per country, international data sharing is desirable to examine the impact of DMTs on COVID-19 severity. Here, we present the first results of the COVID-19 in MS global data sharing initiative of the MS International Federation and MS Data Alliance and many other data partners to inform MS clinical management during the COVID-19 pandemic.

Methods

Clinician-reported data from 21 countries were aggregated into a dataset of 1540 patients. Characteristics of admission to hospital, admission to intensive care unit (ICU), need for artificial ventilation, and death, were assessed in patients with confirmed or suspected COVID-19 infection using log-binomial regression. Adjusted prevalence ratios (aPR) were calculated adjusting for age, sex, MS type, and Expanded Disability Status Scale (EDSS).

Results

Of 1540 patients, 476 (30.9%) with suspected and 776 (50.4%) with confirmed COVID-19 were included in the analysis. Older age, progressive MS and higher EDSS were associated with higher frequencies of severe outcomes. Anti-CD20 DMTs, ocrelizumab and rituximab, were positively associated with hospital admission (aPRs=1.19 & 1.58), ICU admission (aPRs=3.53 & 4.12), and the need for artificial ventilation (aPRs=3.17 & 7.27) compared to dimethyl fumarate. Higher frequencies of all three outcomes were associated with combined anti-CD20 DMT use compared to all other DMTs (hospitalisation aPR=1.49; ICU aPR=2.55; ventilation aPR=3.05) and compared to natalizumab (hospitalisation aPR=1.99; ICU aPR=2.39; ventilation aPR=2.84). Importantly, associations persisted on restriction to confirmed COVID-19 cases and upon exclusion of each contributing data source in turn. No associations were observed between DMTs and death.

Conclusions

This study used the largest federated international cohort of people with MS and COVID19 currently available. We demonstrate a consistent association of anti-CD20 DMTs with hospitalisation, ICU admission and use of artificial ventilation suggesting their use among MS patients at risk for COVID-19 exposure may be a risk factor for more severe COVID-19 disease. To address study limitations, further research incorporating comorbidities, smoking and body mass index is required. Alternative study designs are needed to address questions on COVID-19 susceptibility among people with MS.

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Author Of 2 Presentations

Epidemiology Poster Presentation

P0459 - Factors associated with access to disability certificate in patients with MS and NMOSD in Argentina (ID 1156)

Speakers
Presentation Number
P0459
Presentation Topic
Epidemiology

Abstract

Background

Disability certificate (DC) is a free public document valid throughout Argentina. DC offers economic and social benefits to people with disabilities and improves barriers to accessing health services. Multiple sclerosis (MS) and neuromyelitis optic spectrum diseases (NMSD) are disabling diseases that affect economically active people.

Objectives

To analyze access to DC in patients with MS (PwMS) and NMOSD (PwNMOSD) in patients included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177).

Methods

Demographical, clinical and social data from RelevarEM were analyzed. Parametric and nonparametric statistics were performed, to define significance a p value <0.05 was accepted.

Results

2979 patients were included (2814 MS and 165 NMOSD). For PwMS 80.7% were relapsing remitting MS, female 65.2%, mean age 43.5±12.9 years, mean EDSS 2.8, mean disease evolution 10.8±8.9 years, 33.9% unemployed and 43.1% had DS. For PwNMOSD 77% were female, mean age 44.7 ± 14.8 years, mean EDSS 3.3 mean disease evolution 7.3±5.9 years, 43.6% unemployed and 41.2% had DC. Overall, 11.8% of patients had public health insurance. When comparing the demographic and clinical variables of PwMS and PwNMOSD between those with and without DC, statistically significant differences were found (p≤0.05). For PwMS Multivariate analysis showed that EDSS (OR=1.60, p<0.01), time to treatment (OR=1.06, p=0.01), comorbidity index (OR=3.19, p<0.01), place of residence (OR=0.66, p<0.01), healthcare insurance (OR=1.36, p=0.02), and employment status (OR=0.41, p<0.01) were independently associated with access to DC. In PwNMOSD it was associated with EDSS (OR=1.57, p<0.01), place of residence (OR=0.34, p=0.03), healthcare insurance (OR=5.72, p=0.01), and employment status (OR=0.22, p=0.01)

Conclusions

this research is the largest to explore DC access and related factors in Argentinian PwMS and PwNMOSD. Future research should explore which factors affect the decisions of individuals to seek DC and how neurologists can assist in that process.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1014 - Decision Making Process in Argentinian Patients with Multiple Sclerosis (ID 1223)

Speakers
Presentation Number
P1014
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Considering the complexity of the disease and its treatment, patients with multiple sclerosis (PwMS) need up-to-date evidence-based information in order to make an informed decision together with their physicians based on their preferences. There is scarce information regarding decision-making-process (DMP) in PwMS from Latin America.

Objectives

We aimed to evaluate DMP in Argentinian PwMS and to assess its relationship with patient preferences and clinical-demographic characteristics.

Methods

Twelve hundred seventy-five PwMS from the patient organization Esclerosis Múltiple Argentina (EMA) were invited to participate in a self-administered web-based survey. Participants were asked to provide clinical-demographic information and to complete a questionnaire assessing perceived information provision, the Control Preference Scale, the Satisfaction with the Decisions and Care questionnaire, and were inquired on preferred sources of information about MS. Descriptive analyses, parametric and nonparametric statistics were performed, p value <0.05 was accepted.

Results

Three hundred seventy-nine PwMS completed the survey. Most were females (67%); mean age was 40.3 (SD=11.1) years; mean disease duration was 7.9 (SD= 7.2) years. The majority of PwMS were satisfied with information provision from their neurologist on MS characteristics, prognosis, complementary studies and treatment. Patients decisional control preference role was active in 47%, shared in 27%, and passive in 26%. A moderate agreement (weighted kappa 0.55) was observed between patients’ preferences and self-reported DMP. Seventy-two percent of the PwMS participated in the DMP according to their preferences (concordance rates: active 66%, shared 87%, passive 51%). Most patients (83%) declared receiving information from their neurologists, matching their preferences (94%). Social networks were the least preferred source of information (40%).

Conclusions

Argentinian PwMS have distinctive preferences regarding information management and decision-making compared to other populations. This may be probably due to cultural, religious, or idiosyncratic issues, among others. More studies are needed to corroborate our findings in order to improve understanding of patients’ needs.

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