Author Of 7 Presentations
LB1166 - Risk and outcomes of COVID-19 in patients with multiple sclerosis in Madrid Spain (ID 1480)
- V. Meca-Lallana
- L. Costa-Frossard
- C. Oreja-Guevara
- C. Aguirre
- E. Alba Suárez
- M. Gómez Moreno
- L. Borrega Canelo
- J. Sabín-Muñoz
- Y. Aladro
- A. Cárcamo Fonfría
- E. Rodríguez García
- J. Cuello
- E. Monreal
- S. Sainz de la Maza
- F. Perez Parra
- F. Valenzuela
- C. Lopez De Silanes
- L. Casanova Peño
- M. Martínez-Ginés
- M. Blasco Quílez
- A. Orviz García
- L. Villar
- C. Santiuste
- M. Espiño
- G. Fernandez-Dono
- V. Elvira
- I. Moreno-Torres
Abstract
Background
Infections are an important cause of hospitalization in patients with MS. Data on outcomes of COVID-19 in patients with MS are limited
Objectives
To quantify the risks of infection, hospitalization, admission to intensive care and death due to SARS-CoV-2 infection among patients with MS relative to the general population, and to identify factors associated with risk of hospitalization
Methods
A regional registry was created to collect data on incidence, hospitalization rates, intensive care unit (ICU) admission and death in patients with MS and COVID-19. National government outcomes and seroprevalence data were used for comparison.
Results
Two-hundred nineteen patients with MS were included in the registry, 51 of whom were hospitalized. The infection incidence rate (IR) was lower in patients with MS than the general population (adjusted IR ratio 0.78; 95% confidence interval: 0.70–0.80), but hospitalization rates were higher (adjusted relative risk 6.52 [6.13–7.04]). Disease severity was generally low, with only one ICU admission and five deaths. Males with MS had higher incidence rates and risk of hospitalization than females. No association was found between the use of any disease-modifying therapy (DMT) and hospitalization risk.
Conclusions
Patients with MS do not appear to have greater risks of SARS-CoV-2 infection or severe COVID-19 outcomes compared with the general population. The decision to start or continue DMT should be based on a careful risk-benefit assessment.
P0025 - Analysis fo the results of the establishment of a SARS-CoV-2 safety protocol for Multiple Sclerosis patients (ID 1512)
Abstract
Background
The SARS-CoV-2 infection has spread worlwide becoming a pandemic never before seen. Immunosuppressive (IS) treatments used in Multiple Sclerosis (MS) patients could activate the infection in asymptomatic carriers or reactivate COVID-19 in apparently recovered cases. Our similar experience in some MS patients during the pandemic lead us to design a safety protocol at our MS Unit. It was based on epidemiological data and testing for PCR in nasopharyngeal swabs and serology before administration of monoclonal antibodies, doses of pulsed disease modifying therapies (DMTs), new starts of oral DMTs and methylprednisolone pulses.
Objectives
To describe our experience in the establishment of a SARS-CoV-2 safety protocol in MS patients. We analyze its utility to prevent COVID-19 complications
Methods
Observational, prospective and clinical practice study in the establishment of a multidisciplinary safety protocol (MS Unit – Neurology/Microbiology/Preventive Medicine). Sequential protocol over time adapted to the different pandemic phases and levels of available resources.
Results
152 PCR and 140 serology tests were performed in 90 patients over 3 months. They were performed preceding the treatment with Natalizumab (96 tests), Ocrelizumab (36 tests), Rituximab (3 tests), Methylprednisolone (7 tests), Cladribine (4 tests) and Dimethyl Fumarate (3 tests). 7 asymptomatic carriers were diagnosed (7,8%), 5 of them with positive IgM+IgG serology (5,6%). 5 patients with positive IgM+IgG serology post-infection were confirmed. No COVID-19 reactivation was detected after the establishment of the protocol.
Conclusions
The combined analysis of PCR and serology increased the sensitivity of the SARS-CoV-2 infection diagnosis during the pandemic peak of cases phase. However, this does not happen at pandemic phases with less daily cases, when testing PCR alone detected the same number of cases than testing combined PCR and serology. The safety protocol reaches its objective of avoiding disease reactivation and clinical activation in asymptomatic carriers.
P0043 - Clinical practice experience with Cladribine in Multiple Sclerosis (ID 1499)
Abstract
Background
There are different disease-modifying therapies (DMTs) for treating patients with Relapsing-Remitting Multiple Sclerosis (RRMS). Oral Cladribine was commercialized in 2018.
Objectives
To analyze the first year of treatment with Cladribine in RRMS patients: tolerability, security and initial approach to its effectiveness.
Methods
Retrospective, longitudinal and unicenter study in RRMS patients treated with Cladribine. We analyzed its security measuring overall lymphocyte count by Friedman Test and time to appearance of lymphopenia by Kaplan-Meier. We studied its effectiveness by comparing the following variables with the Wilcoxon Test: relapses, Expanded Disability Status Scale (EDSS) score and gadolinium enhancing lesions before and one year after starting Cladribine (statistically significant p<0’05).
Results
53 patients were studied. 88,7% were women with a mean age of 44,8 years old (DS10,25). 56,6% of the patients had a RRMS evolution of less than 10 years, 32,1% between 10 and 20 years, and 9,4% between 20 and 30 years. 64,1% had been previously treated with one or two DMTs. Patients were exposed to Cladribine for 8 months as a median (percentiles P15=2 months, P85=15 months): 36,4% patients for 6 months, 34,1% between 6-12 months and 29,5% for more than 12 months. The overall lymphocyte count reduction regarding the basal level after starting the drug was statistically significant (p<0’05). The lymphocyte count reduction rate was 52,89% during the first year of treatment and 58,99% during the second one. Tolerability was good in 93,02% of the patients. We observed significant reduction of the relapses rate after one year of treatment.
Conclusions
Cladribine seems to be a secure treatment. The most common adverse effect was lymphopenia (81,8%) but it was severe only in 9,09% of the patients and not associated with severe infections. Its tolerability was very good. Effectiveness results are positive, but, to date, they are preliminary.
P0079 - Experience in Multiple Sclerosis Patients with SARS CoV-2 Infection (ID 1508)
Abstract
Background
The new coronavirus SARS-CoV-2 infection has spread worlwide becoming a pandemic never before seen. Multiple Sclerosis (MS) patients in a state of immunosuppression (IS) may be exposed to a greater risk of COVID-19 complications, although there is increasing evidence postulating a possible protective role of selective IS.
Objectives
To describe the real-world experience in MS patients with SARS-CoV-2 infection at a MS Unit of a hospital in Madrid, Spain. We describe clinical evolution and MS treatment actions
Methods
Observational, prospective and usual clinical practice study in MS patients affected by SARS-CoV-2 infection with clinical diagnosis (at least three of the following: fever, anosmia, cough, diarrhea, myalgia) and/or microbiological diagnosis (PCR in nasopharyngeal swabs and/or serology).
Results
41 SARS-CoV-2 infection cases were registered. 21 were women with a mean age of 39,4 years old (DS10,3). 38 were relapsing-remitting MS patients and 3 had a progressive MS. The mean MS time course was nine years (DS1,4). 39 patients were treated with disease-modifying therapies (DMTs): 46,3% with oral agents, 39% with monoclonal antibodies and 10% with injectable agents. 27 patients were previously treated with other DMTs. The median Expanded Disability Status Scale (EDSS) was 2,5 (DS0,7). 11 patients had clinical activity the previous year. 18 cases were confirmed by PCR and/or serology and 23 were clinically diagnosed. 17% of the patients were admitted to hospital (6 were diagnosed with pneumonia) and none required admission to the intensive care unit. There were no deaths.Three patients had other comorbidities. Admitted patients were older and had higher EDSS score without statistical significance. MS got worse in 7 patients. DMTs were stopped or delayed in 10 patients due to the SARS-CoV-2 infection.
Conclusions
All the MS patients studied had a good outcome of the SARS-CoV-2 infection. Only 17% of them required admission to hospital and 14,6% of the cases were asymptomatic. 95% of the patients were treated with DMTs. From our experience, the SARS-CoV-2 infection does not seem to entail a more aggressive form of the disease in this group of patients. Selective IS may favor the good evolution. Larger clinical registers are needed to establish solid conclusions.
P0288 - Analysis of CD3 T lymphocyte count in patients under treatment with Ocrelizumab regarding development of infections (ID 1840)
Abstract
Background
Ocrelizumab is a monoclonal antibody approved for relapsing-remitting primary progressive multiple sclerosis (MS) acting against B lymphocytes that expresses CD20. The CD 20 antigen is a cell surface antigen found on pre-B lymphocytes, mature B lymphocytes, memory B lymphocytes, and a T cell subtype (CD3+ CD20+) that also expresses CD20. Clinical trials have shown that the use of this drug can produce a reduction in immunoglobulin levels which might be related to infections; however, there is little data about the influence of this immunomodulatory treatment on CD3+ T lymphocytes.
Objectives
To analyze differences in CD3+ T lymphocyte counts in patients under treatment with Ocrelizumab and their relationship with the development of infections.
Methods
We performed an observational retrospective case-control study nested in a cohort of MS patients under treatment with Ocrelizumab. Cases were patients who developed infections and controls were patients who did not develop any type of infection during treatment.
Results
We included 33 patients, mean age 39 years old (SD:9.6), mean MS duration 9 years (SD:5.8), 66.7% women, 38.7% developed infections during treatment. Mean CD3+ T lymphocytes count was 1157.6 (SD:498) at baseline, 1373 (SD:621.9) CD3+ T lymphocytes at 3 months, 1221 (SD:439) CD3+ T lymphocytes at 6 months and 1405 (SD:836) at 12 months. We did not find statistical differences between groups, although there was a tendency towards a higher mean CD3+ T lymphocyte count at three months (1781.2;SD:399.9) in patients who did not develop infections as compared to the mean CD3+ T lymphocytes count at three months (1047.1; SD: 595.1) in patients who developed infections (p=0.064).
Conclusions
Our preliminary data did reveal statistical differences in the total CD3+ T lymphocyte count between patients under Ocrelizumab treatment, although there was a tendency towards a higher count at 3 months in patients who did not develop infections. Weather the putative effect of Ocrelizumab on T cell subtype (CD3+ CD20+) might be related to the development of infections needs further research.
P0796 - Cognitive differences in aging patients with multiple sclerosis compared to healthy controls (ID 1851)
Abstract
Background
It´s stated that as we get older, cognitive processes change. Healthy control (HC) and people with multiple sclerosis (MS) share a decrement in speed of processing with age. Nevertheless, demyelinating and neurodegenerative characteristics of MS may implicate neuropsychological differences when analyzing aging.
Objectives
To study the differences in cognitive processes between MS patients and HC when considering two age groups: yound adults and older ones.
Methods
We had two groups: MS from 45 to 55 years old (MS1) and from 56 to 70 (MS2) and a HC group (HC1 and HC2) paired in age and years of education (YoE). We applied a neuropsychological comprehensive battery including Symbol Digit Modality Test (SDMT), PASAT 3”, Spanish California Verbal Learning Test (TAVEC), Spatial Recall Test (SPART), Brief Visual Memory Test (BVMT-R), Five Digit Test (5DT), WAIS-Digits and Corsi and verbal fluency (letter, category and exclusion). Mild (MCI) and moderated (ModCI) cognitive impairment was based on Z scores for the following cognitive domains: speed of processing (SP), attention, working memory, verbal and visual memory and executive functions.
Results
We assessed 137 MS patients, 62,7% women with a mean age of 52.7, secondary education (M=14.3) with a mean Expanded Disability Status Scale (EDSS) of 3.3 (Mode=6), relapsing-remitting MS (82,5%) after a mean of 14,3 years having MS. We also evaluated 34 matching HC. MS patients were MCI (43.1%) followed by no impairment (33.6%) and they were equivalent in age, YoE or EDSS. When comparing groups, HC1 scored higher than HC2 in SDMT (p<0.001), SPART-recall (p=0.21) and they retrieved more words in TAVEC when cued were offered short-term (p=0.024), long-term (p=0.034) and free long-term recall (p=0.043). When MS group was analyzed, MS1 performed better than MS2 in SDMT (P=0.004), total learning in TAVEC (p=0.026 list A and p=0.004 list B), hits and dyads in PASAT (p=0.004 and P=0.01), digits-forward (p=0.035) and exclusion fluency (p=0.014). When comparing the same age group, MS1 scored lower in SMDT, SPART learning and recall compared to HC1. In older group, MS2 showed less hits and dyads in PASAT with higher interference errors and less fluency in exclusion trial compared to HC2.
Conclusions
Cognitive ageing for MS patients is different: as HC, they get slower when processing information but they also perform worse in verbal and visual learning tasks together with executive functioning, whereas for HC the cognitive deficit is more memory-specific related. When younger, MS were equal to HC but slower. When older, MS displayed dysexecutive aspects instead of mainly amnesic ones. The added cognitive features of the older MS group support the idea of an added subcortical damage, responsible of a frontal-like neuropsychological profile.
P0814 - Is Trait anxiety a predictor of dysexecutive complaints in multiple sclerosis? (ID 1908)
Abstract
Background
Background: Cognitive complaints have been previously related to depressive symptoms in multiple sclerosis (MS), whereas self-reported executive performance has been postulated as generally reliable. Nevertheless, little is known about dysexecutive complaints (DC) and its relationship with depression and anxiety.
Objectives
Objective: (i) Study self-reported dysexecutive symptoms in attention, motivation, executive control, social behavior and emotional regulation in MS compared to control group (HC). (ii) Analyse the relation between cognitive complaints and emotional symptoms.
Methods
Methods: We collect 30 MS patients from the clinic (63% women; mean age, 43.93 y.o.; 10 years of evolution of the disease; EDSS mean 2.4; 16.6 years of schooling) and 30 healthy controls (HC) (58% women; mean age, 39.6. y.o.; 15.03 years of schooling). Participants are requested to complete the Inventory of Prefrontal Symptoms (IPS), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Statistical analysis was performed.
Results
Results: Significant differences were found in the IPS sub-scales: attention (p<0.00), Motivation (p<0.00) and social behavior (p<0.00) between MS and HC; no differences were found in executive control and emotional regulation. Significant differences were also found in BDI and Trait Anxiety (TA) between both groups, but not in state anxiety (SA). Significant correlations (p<0.05) were found between emotional symptoms and IPS Subscales. A linear regression was performed finding that BDI and trait anxiety explained 87.3% of variance for IPS total score; in addition, TA explained 38.7% of the variance of motivation, 38.5% of executive control, 26.5% of social behavior and 42.3% of emotional regulation for MS group, while SA explained 26% of the attention complaints.
Conclusions
Conclusion: MS report more subjective complaints of attention, motivation and social behavior than HC and more TA and depression symptoms. Whereas SA significantly predicts a high percentage of attention symptoms, TA predicts social inadequacy, emotional regulation problems, lack of motivation for action and difficulties in executive control. These results consider the extent to which DC are related to emotional problems, objective cognitive deficits or personality factors and whether anxious personality in MS is as an emotional consequence of the disease or whether this pattern is related to structural changes that affect the tools to deal with stressful situations.