Author Of 1 Presentation
P0421 - SARS-CoV-2 infection in multiple sclerosis patients: a single center experience in the province of Bergamo, Italy (ID 1461)
Abstract
Background
In Europe, the first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was reported in Lombardy region; the highest number of cases identified was in Eastern Lombardy , in particular in Bergamo’s province with 11,313 confirmed COVID19 patients up to April 30th 2020. The pandemic represents a challenge for neurologists treating Multiple Sclerosis (MS) because of the higher risk of infections of this population and for disease modifyng treatment (DMT) used. We report the experience of the MS center of Papa Giovanni XXIII Hospital in Bergamo, Italy.
Objectives
To evaluate the risk of SARS-CoV-2 infection and the outcome of the disease in MS patients treated with first and second line DMT.
Methods
We retrospectively and prospectively collected all MS patients who reported symptoms suggestive of SARS-CoV-2 infection since the beginning of February 2020. We considered for the analysis patients with a diagnosis confirmed by real-time reverse-trascriptase polymerase-chain-reaction (RT-PCR) on nasopharyngeal specimens as well as patients with suggestive symptoms and signs of SARS-CoV-2 infection who did not performed swab test and/or serological test. Since the begnning of pandemic , according to Italian reccomandation, we postponed the majority of treatment with depleting therapies whereas all the other drugs were usually continued.
Results
Between February 1st and and June 30, 153 patients with suspected SARS-CoV-2 infection were identified, which represent the 18% of the whole population regoularly followed at our MS center. The mean age was 45 years (range 20-71) and the mean EDSS was 2,5 ( range 1-8,5). The 81% of patients were female. A first line DMT was used in 92 patients (60%) while 51 patients (33%) were treated with second line DMT. Overall only 11 patients performed a nasopharyngeal swab during the symptomatic phase and a positivity was found in 7 patients. In an additional patient the diagnosis was confirmed on bronchoalveolar lavage fluid obtained by bronchoscopy. Only 3 patients (2%) presented a severe distress respiratory syndrome and were hospitalized in Intensive Care Unit. Two of these patients were female of 43 and 46 years old treated with Natalizumab and Ocrelizumab respectively both with mild disability (EDSS 2,5). The third patient was a disabled male of 56 years with a progressive form of MS (EDSS of 6.5). None of these patients had additional comorbidities and they all showed a complete recovery without sequaele.
Conclusions
In our experience the course of infection was mild in the large majority of patients independently of the ongoing DMT and no deaths were reported . The good outcome observed in our cohort might support a possible protective role of immunomodulation during SARS-CoV-2 infection. However, the diagnosis was confirmed only in a minority of our patients, therefore we cannot draw definitive conclusion and more data are needed to confirm our results.