Author Of 2 Presentations
LB1247 - Clinical features of COVID-19 in patients with neuromyelitis optica spectrum disorders (ID 2133)
- S. Apóstolos-Pereira
- L. Ferreira
- N. Sousa
- G. Martins
- J. D’almeida
- M. Pitombeira
- L. Mendes
- T. Fukuda
- L. Rocha
- H. Cabeça
- B. Oliveira
- C. Vieira Stella
- E. Oliveira
- L. Amorim
- A. Castro
- A. Gomes Neto
- G. Silva
- L. Bueno
- M. Machado
- R. Dias-Carneiro
- R. Dias
- A. Moreira
- A. Piccolo
- A. Grzesiuk
- A. Muniz
- C. Disserol
- C. Vasconcelos
- D. Diniz
- D. Kaimen-Maciel
- E. Comini-Frota
- F. Rocha
- G. Sciascia Do Olival
- G. Santos
- H. Ruocco
- H. Siqueira
- H. Sato
- H. Soares Neto
- J. Figueiredo Jr
- L. Calia
- L. Scolari
- L. Melges
- M. Gonçalves
- M. Pimentel
- M. Dourado Junior
- M. De Castro Ribeiro
- O. Arambula
- P. Gama
- R. Menon
- R. Thomaz
- R. Morales
- S. Gomes
- S. Sobreira
- S. Alves-Leon
- S. Machado
- T. Ribeiro
- V. Pereira
- V. Costa
- M. Perin
- A. Nóbrega Junior
- Y. Fragoso
- E. Donadi
- T. Adoni
- M. Ferreira
- D. Callegaro
- M. Mendes
- D. Brum
- F. Von Glehn
Abstract
Background
Brazil is currently considered one of the main epicenters of the coronavirus disease 2019 (COVID-19). There are many concerns related to neuromyelitis optica spectrum disorders (NMOSD) patients. In addition to the older age of onset, higher disability and the higher rate of hospitalization compared to MS, many of the commonly used preventive therapies for NMOSD are cell depleting immunosuppressants with increased risk of viral and bacterial infections.
Objectives
To describe the frequency and clinical characteristics of COVID-19 in neuromyelitis optica spectrum disorder (NMOSD) patients in Brazil.
Methods
The Brazilian Study Group NMOSD of the Brazilian Academy of Neurology has set up the registration of COVID-19 cases in NMOSD patients, using a designed web-based case report form, encompassing neuroimmunology centers and individual neurologists across the country. Data collected between March 19thand July 31th 2020 were uploaded at the REDONE.br platform. Inclusion criteria were: (i) NMOSD diagnosis according to 2015 International Panel; (ii) confirmed SARS-Cov-2 infection (RT-PCR or serology) or clinical suspicion of COVID-19 diagnosed according to CDC/CSTE case definition. Demographic data, NMOSD clinical characteristics pre and post infection, comorbidities, immunosuppressive treatment, COVID-19 clinical features and severity were described.
Results
Among the 2,061 NMOSD patients inscribed at the REDONE.br platform, 34 patients (29 women) aged 37.1 years (range 8-77), with disease onset at 31.2 years (range 4-69) and disease duration of 5.9 years (range 0.2-20.5), developed COVID-19 (18 confirmed and 16 probable cases). Most patients exhibiting mild disease was treated at home (76.5%) and 4 patients needed treatment at intensive care units (severe cases); one patient died. Four patients had NMOSD relapse during the infection; one with partial recovery.
Conclusions
The clinical features of COVID-19 in NMOSD patients were described, stressing the combination of comorbidities and immunosuppression. Mild COVID-19 was the main presentation. Collaborative studies using shared NMOSD data are needed to suitably define factors related to COVID-19 outcome.
P0018 - Variability of the response to immunotherapy among sub-groups of patients with multiple sclerosis (ID 1239)
- I. Diouf
- C. Malpas
- D. Horakova
- E. Kubala Havrdová
- F. Patti
- V. Shaygannejad
- S. Ozakbas
- G. Izquierdo
- S. Eichau
- M. Zakaria
- M. Onofrj
- A. Lugaresi
- R. Alroughani
- A. Prat
- M. Girard
- P. Duquette
- M. Terzi
- C. Boz
- F. Grand'Maison
- S. Hamdy
- P. Sola
- D. Ferraro
- P. Grammond
- R. Turkoglu
- H. Butzkueven
- B. Yamout
- A. Altintas
- V. Van Pesch
- D. Maimone
- J. Lechner-Scott
- R. Bergamaschi
- R. Karabudak
- F. Giuliano
- C. McGuigan
- E. Cartechini
- M. Barnett
- S. Hughes
- M. Sa
- L. Kappos
- C. Ramo-Tello
- E. Cristiano
- S. Hodgkinson
- D. Spitaleri
- A. Soysal
- T. Petersen
- M. Slee
- E. Butler
- F. Granella
- F. Verheul
- P. McCombe
- R. Ampapa
- O. Skibina
- J. Prevost
- L. Sinnige
- J. Sánchez-Menoyo
- S. Vucic
- G. Laureys
- L. Van Hijfte
- D. Khurana
- R. Macdonell
- T. Castillo-Trivino
- O. Gray
- E. Agüera
- I. Kister
- C. Shaw
- N. Deri
- T. Al-Harbi
- Y. Fragoso
- T. Csepany
- A. Sempere
- T. Kalincik
Abstract
Background
Our current understanding of demographic and clinical modifiers of the effectiveness of multiple sclerosis (MS) therapies is limited.
Objectives
To assess whether patients’ response to disease modifying therapies (DMT) in MS varies by disease activity (annualised relapse rate, presence of new MRI lesions), disability, age, MS duration or disease phenotype.
Methods
Using the international MSBase registry, we selected patients with MS followed for ≥1 year, with ≥3 visits, ≥1 visit per year. Marginal structural models (MSMs) were used to compare the hazard ratios (HR) of 6-month confirmed worsening and improvement of disability (EDSS), and the incidence of relapses between treated and untreated periods. MSMs were continuously re-adjusted for patient age, sex, pregnancy, date, time from first symptom, prior relapse history, disability and MRI activity.
Results
Among 23 687 patients with relapsing MS, those on DMT experienced 20% greater chance of disability improvement [HR 1.20 (95% CI 1.0-1.5)], 47% lower risk of disability worsening [HR 0.53 (0.39-0.71)] and 51% reduction in relapses [HR 0.49 (0.43-0.55)]. The effect of DMT on relapses and EDSS worsening was attenuated with longer MS duration and higher prior relapse rate. The effect of DMT on EDSS improvement and relapses was more evident in low EDSS categories. DMT was associated with 51% EDSS improvement in patients without new MRI lesions [HR 1.51 (1.00-2.28)] compared to 4% in those with MRI activity [HR 1.04 (0.88-1.24)]. Among 26329 participants with relapsing or progressive MS, DMT was associated with 25% reduction in EDSS worsening and 42% reduction in relapses in patients with relapsing MS [HR 0.75 (0.65-0.86) and HR 0.58 (CI 0.54-62), respectively], while evidence for such beneficial effects of treatment in patients with progressive MS was not found [HR 1.11 (0.91-1.46) and HR 1.16 (0.91-1.46), respectively].
Conclusions
DMTs are associated with reduction in relapse frequency, progression of disability, and increased chance of recovery from disability. In general, the effectiveness of DMTs was most pronounced in subgroups with shorter MS duration, lower EDSS, lower relapse rate and relapsing MS phenotype.