Icahn School of Medicine at Mount Sinai

Author Of 2 Presentations

COVID-19 Late Breaking Abstracts

LB1205 - Covid-19 Infection in Patients with Multiple Sclerosis: an observational study by The New York COVID-19 Neuro-Immunology Consortium (NYCNIC) (ID 2054)

Abstract

Background

New York became one of the first epicenters of the COVID-19 pandemic in the United States and many neurologists were faced with the unprecedented challenge of providing medical advice to patients with multiple sclerosis (MS) without the support of evidence-based scientific data. Large collaborative studies are needed to determine whether MS itself, or associated disease-modifying therapies (DMT), increase the risk of acquiring COVID-19 or worsen its course.

Objectives

We aim to characterize the patterns of COVID-19 infection in patients with MS and to identify risk factors for severe infection.

Methods

Demographics, MS and COVID-19 clinical features were collected on patients currently followed at 5 large MS Centers in New York City and the tri state area (MSSM, Columbia, Northwell, NYU, and Neurological Associates Of Long Island). Patients with MS or related disorders, who self-identified as diagnosed with COVID-19 by a healthcare provider (based on characteristic symptoms, radiographic findings and/or positive COVID-19 PCR/serology when available) were included. The severity of COVID-19 infection was measured by a 4-point ordinal scale (home care, hospitalization, ICU, death). Univariate and multivariate logistic regression models were used to assess associations of demographic variables with hospitalization.

Results

Our cohort included 349 patients with median age of 45 (range 13-76), 70.8% female, 25.3% African-American, 23.7% Hispanic. Mean disease duration was 11.5y [SD 9.1]. The prevalence of DMT use was 87.2%, and 80.2% were ambulatory without assistance. Forty-eight (14.2%) patients were hospitalized, and 13 (3.9%) patients died. Multivariate logistic regression models showed associations between EDSS ≥6 (OR 3.9 [95% CI, 1.7-8.8]), obesity (OR 2.4 [95% CI, 1.1-4.9]) and age (OR per 10 year increase: 1.5 [95% CI, 1.1-2.2]) with hospitalization for COVID-19. There were no significant associations between race, ethnicity, comorbidities (cardiac, pulmonary or diabetes), smoking status, or specific DMT and severe COVID-19 infection requiring hospitalization.

Conclusions

Age, obesity, and higher EDSS independently predicted severe COVID -19 infection necessitating hospitalization. This is in agreement with COVID -19 outcome predictors in the general population and other MS cohorts. Older patients with limited mobility should be counseled to maintain increased vigilance during the ongoing pandemic.

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Clinical Outcome Measures Poster Presentation

P0166 - Sociodemographic features and disability in African-American and Caucasian patients with Multiple Sclerosis (ID 1282)

Speakers
Presentation Number
P0166
Presentation Topic
Clinical Outcome Measures

Abstract

Background

A more severe disease course has been reported in African-American (AA) in comparison with Caucasian (CA) MS patients. Sociodemographic differences and limited access to treatment have been often used to explain the different disability profile in the two groups. To date, an objective assessment of disability in AA and potential differences with CA patients is still lacking.

Objectives

Here, we characterized sociodemographic, motor and neuropsychological features of AA and CA patients with multiple sclerosis.

Methods

Fifty-seven AA patients (43F, mean age 37.84 ± 10.54 yrs, mean disease duration 5.64 ± 5.74 yrs, median EDSS 2, EDSS range 0-6.5), 37 AA healthy controls (HC) (25F, mean age 35.97 ± 12.44 yrs), 50 CA patients (36F, mean age 39.02 ± 10.83 yrs, mean disease duration 5.90 ± 5.94 yrs, median EDSS 1.5, EDSS range 0-6) and 28 CA HC (17F, mean age 35.57 ± 11.77 yrs) were prospectively enrolled. In all subjects, an extensive neuropsychological and sensory-motor evaluation was performed. The sensory-motor evaluation included 9-hole peg test (9-HPT), grooved pegboard test (GPT), finger tapping test (FTT), 25-foot walk test (25-FWT), 2-minutes walk test (2-MWT), evaluation of segmental strength, grip strength, vibration sensitivity (VS) and standing balance (theta score from NIH toolbox). The neuropsychological evaluation included Symbol Digit Modalities Test (SDMT), California Verbal Learning Test-II (CVLT), Brief Visuospatial Memory Test–Revised (BVMT), Stroop Color and Word Test (SCVT), Controlled Oral Word Association Test (COWAT) and a multitasking attention-memory test (MAMT). Each patient’s group was compared with a race-matched HC group via ANCOVA analysis, accounting for age, gender, years of education and socioeconomic status expressed as yearly income (9 categories with 1 = less than $5,000 and 9 = $100,000+). In the comparison of cognitive performance, years of education, premorbid intelligence estimated with the Wechsler Test of Adult Reading (WTAR) and depressive symptoms evaluated via Beck Inventory were also included as covariates of no interest.

Results

AA and CA patients did not differ in age, gender, disease duration, while they did differ in total years of education (p<0.001) and yearly income (p=0.001). When compared to their matched HC group, AA and CA patients showed similar deficits in information processing speed, ambulation, manual dexterity, sensitivity and balance (p ranging from 0.029 to <0.001). While CA showed an additional impairment of verbal memory (p=0.009), AA patients showed additional involvement of verbal fluency (p=0.005), multitasking capability (p=0.024), motor speed and coordination (p=0.048) and grip strenght (p=0.041).

Conclusions

Even when accounting for sociodemographic features, AA patients show more severe and widespread disability than CA patients with MS.

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Presenter Of 1 Presentation

COVID-19 Late Breaking Abstracts

LB1205 - Covid-19 Infection in Patients with Multiple Sclerosis: an observational study by The New York COVID-19 Neuro-Immunology Consortium (NYCNIC) (ID 2054)

Abstract

Background

New York became one of the first epicenters of the COVID-19 pandemic in the United States and many neurologists were faced with the unprecedented challenge of providing medical advice to patients with multiple sclerosis (MS) without the support of evidence-based scientific data. Large collaborative studies are needed to determine whether MS itself, or associated disease-modifying therapies (DMT), increase the risk of acquiring COVID-19 or worsen its course.

Objectives

We aim to characterize the patterns of COVID-19 infection in patients with MS and to identify risk factors for severe infection.

Methods

Demographics, MS and COVID-19 clinical features were collected on patients currently followed at 5 large MS Centers in New York City and the tri state area (MSSM, Columbia, Northwell, NYU, and Neurological Associates Of Long Island). Patients with MS or related disorders, who self-identified as diagnosed with COVID-19 by a healthcare provider (based on characteristic symptoms, radiographic findings and/or positive COVID-19 PCR/serology when available) were included. The severity of COVID-19 infection was measured by a 4-point ordinal scale (home care, hospitalization, ICU, death). Univariate and multivariate logistic regression models were used to assess associations of demographic variables with hospitalization.

Results

Our cohort included 349 patients with median age of 45 (range 13-76), 70.8% female, 25.3% African-American, 23.7% Hispanic. Mean disease duration was 11.5y [SD 9.1]. The prevalence of DMT use was 87.2%, and 80.2% were ambulatory without assistance. Forty-eight (14.2%) patients were hospitalized, and 13 (3.9%) patients died. Multivariate logistic regression models showed associations between EDSS ≥6 (OR 3.9 [95% CI, 1.7-8.8]), obesity (OR 2.4 [95% CI, 1.1-4.9]) and age (OR per 10 year increase: 1.5 [95% CI, 1.1-2.2]) with hospitalization for COVID-19. There were no significant associations between race, ethnicity, comorbidities (cardiac, pulmonary or diabetes), smoking status, or specific DMT and severe COVID-19 infection requiring hospitalization.

Conclusions

Age, obesity, and higher EDSS independently predicted severe COVID -19 infection necessitating hospitalization. This is in agreement with COVID -19 outcome predictors in the general population and other MS cohorts. Older patients with limited mobility should be counseled to maintain increased vigilance during the ongoing pandemic.

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