Author Of 2 Presentations
LB1241 - Incidence and clinical outcome of COVID-19 in a cohort of 11.560 Brazilian patients with Multiple Sclerosis (ID 2127)
- M. Mendes
- M. Ferreira
- N. Sousa
- R. Thomaz
- S. Apóstolos-Pereira
- S. Alves-Leon
- A. Piccolo
- E. De Oliveira
- C. Vasconcelos
- A. Muniz
- A. Gomes Neto
- B. De Oliveira
- F. Da Rocha
- G. Martins
- G. Dos Santos
- H. Ruocco
- H. Soares Neto
- M. De Vecino
- M. Boaventura
- R. Dias
- S. Gomes
- A. Castro
- J. D'Almeida
- L. Rocha
- M. Pimentel
- M. Pitombeira
- O. Arambula
- V. Pereira
- H. Cabeça
- M. Gonçalves
- R. Dias-Carneiro
- L. Ferreira
- R. Guimarães
- C. Fortaleza
- D. Diniz
- A. Grzesiuk
- D. Kaimen-Maciel
- E. Comini-Frota
- G. Do Olival
- H. Siqueira
- H. Sato
- L. Calia
- L. Melges
- M. Dourado Junior
- M. Ribeiro
- M. Sousa
- M. Parolin
- P. Da Gama
- R. Morales
- S. Sobreira
- S. Machado
- T. Ribeiro
- T. Fukuda
- V. Costa
- V. Vieira
- M. Perin
- A. Da Nóbrega Junior
- A. Moreira
- C. Disserol
- C. De Oliveira E Silva
- C. Peixoto
- E. Pugliesi
- H. Miot
- J. Figueiredo Junior
- L. Amorim
- L. Scolari
- L. Feo
- L. Mendes
- M. Machado
- R. Catão
- R. Menon
- E. Donadi
- D. Callegaro
- Y. Fragoso
- T. Adoni
- F. Von Glehn
- D. Brum
Abstract
Background
Little information is available regarding the incidence and clinical outcome of the SARS-CoV-2 infection in patients with multiple sclerosis (pwMS).
Objectives
To determine incidence and severity of COVID-19 among pwMS, and to describe the impact of COVID-19 on MS clinical features.
Methods
This observational study was prospectively performed on a cohort of 11.560 Brazilian pwMS from 47 MS referral centers that registered patients with flu-like symptoms at the REDONE.br platform, from March 13th to June 4th 2020. Inclusion criteria were: i) MS diagnosis according to revised McDonald criteria and ii) clinical symptoms compatible with COVID-19 (cough, fever and asthenia). It was considered COVID-19 confirmed cases those with positive serological or SARS-CoV-2 polymerase chain reaction (PCR) test. Disease severity was classified as mild (home treatment), moderate (hospitalization) and critical (intensive care unit admission). Data related to demographic profile, comorbidity, COVID-19 symptoms, MS treatment and relapse were collected. Univariate and multi-variable regression logistic analysis were performed to identify the variables associated with a higher severity risk in COVID-19 patients.
Results
The incidence of COVID-19 for pwMS patients was 27.7/10.000 patients and for the general Brazilian population was 29.2/10.000 inhabitants at the same time interval (Risk Ratio [RR] 0.92, Confidence Interval (CI) 0.65-1.31, P=0.64). A total of 94 patients (82% female), aged 40 ±10.25 years, presenting 9.9±8.6 years of MS disease duration, developed COVID-19, 66% of them were classified as probable and 34% as confirmed cases by RT-PCR or antibody testing. Most pwMS presented mild (87%) COVID-19 form, that did not require hospitalization, whereas the remaining patients exhibited moderate (11%) and critical (2%) forms. Among critical patients, two developed sepsis and one pwMS (also diagnosed with cancer) died. Eighty (85%) patients maintained MS disease modifying treatment (DMT) during COVID-19 pandemic, and 14 (15%) patients were not in use of any DMT. New neurological manifestations included headache (54%) and anosmia or ageusia (46%). Thirteen (14%) patients evolved with worsening of previous MS symptoms, and a single case had MS relapse five days after infection. Age over 50 years (P=0.024), hypertension (P=0.036) and chronic pulmonary disease (P=0.021) were associated with COVID-19 severity at the univariate analysis. Applying multi-variable analyses, age over 50 years (P=0.010, OR 3.922, 95%CI 1.383-11.121) and the presence of more than one comorbidity (P=0.011; OR 37.329; 95%CI 2.279-611.445) were associated with unfavorable COVID-19 outcome.
Conclusions
Incidence of COVID-19 in Brazilian pwMS was not different from that observed for the general Brazilian population. Most pwMS exhibited mild COVID-19, despite the maintenance of MS treatment. There was MS relapse in only one patient.
P0045 - Comorbidities present before the MS diagnosis are not predictors for progression (ID 1539)
Abstract
Background
Comorbidities are common in multiple sclerosis (MS) population and have been associated with the course of the disease, delays and greater disability in diagnosis, the progression of disability, higher risk of hospitalization, and shorter life expectancy. Predicting functional status and identifying potentially modifiable risk factors early in the course of the disease can help to guide the patient’s treatment.
Objectives
This study evaluated the association between the presence of comorbidities before MS diagnosis and the progression of the disease.
Methods
A retrospective cohort was performed in a reference center for MS care located in Porto Alegre – RS, Brazil. The patients were included between January 1, 2016, and December 30, 2019. A review was conducted on medical records accessing clinical and demographic data regarding age, gender, initial EDSS (EDSSi), current EDSS (EDSSc), and comorbidities before MS onset. The correlation between EDSSi, EDSSc, and the Charlston Comorbidity Index (CCI) and the Elixhauser Comorbidity Measure (ECM) was assessed.
Results
The study included 213 relapsing-remitting MS patients, 77% were females. At the time of diagnosis, 99 patients (46%) presented at least one comorbidity. Throughout the follow-up 128 patients (60%) had progression of EDSS, from whom 59 (46%) had some comorbidity prior to diagnosis, and 69 (54%) were healthy. There was no significant difference between patients with and without comorbidities in the distributions by gender (χ2 = .52; p = .46), but patients with comorbidities were significantly older (Mann-Whitney test z-score = - 3.09, p = .002). There was no significant difference between the groups in EDSSi (z-score = - 1.44, p = .14), EDSSc (z-score = - 0.02, p = .98), and in the progression of EDSS during follow-up (z-score = 0.37, p = .71). The correlation of CCI with EDSSi and EDSSc were not significant (rs = -0.02, p = 0.79 and rs= - 0.149, p = 0.14), as well as that of ECM (rs = 0.07, p = 0.45, and rs = 0.16, p = 0.10).
Conclusions
The presence of comorbidities before the MS diagnosis did not influence the disease's progression in the studied sample. The scores of the tools for measuring comorbidities have no significant association with the disability at the time of diagnosis of MS and also do not impact the worsening of EDSS. Other factors, possibly genetic and environmental, must be evaluated as causal for the progression of MS in the local population.
Presenter Of 1 Presentation
P0045 - Comorbidities present before the MS diagnosis are not predictors for progression (ID 1539)
Abstract
Background
Comorbidities are common in multiple sclerosis (MS) population and have been associated with the course of the disease, delays and greater disability in diagnosis, the progression of disability, higher risk of hospitalization, and shorter life expectancy. Predicting functional status and identifying potentially modifiable risk factors early in the course of the disease can help to guide the patient’s treatment.
Objectives
This study evaluated the association between the presence of comorbidities before MS diagnosis and the progression of the disease.
Methods
A retrospective cohort was performed in a reference center for MS care located in Porto Alegre – RS, Brazil. The patients were included between January 1, 2016, and December 30, 2019. A review was conducted on medical records accessing clinical and demographic data regarding age, gender, initial EDSS (EDSSi), current EDSS (EDSSc), and comorbidities before MS onset. The correlation between EDSSi, EDSSc, and the Charlston Comorbidity Index (CCI) and the Elixhauser Comorbidity Measure (ECM) was assessed.
Results
The study included 213 relapsing-remitting MS patients, 77% were females. At the time of diagnosis, 99 patients (46%) presented at least one comorbidity. Throughout the follow-up 128 patients (60%) had progression of EDSS, from whom 59 (46%) had some comorbidity prior to diagnosis, and 69 (54%) were healthy. There was no significant difference between patients with and without comorbidities in the distributions by gender (χ2 = .52; p = .46), but patients with comorbidities were significantly older (Mann-Whitney test z-score = - 3.09, p = .002). There was no significant difference between the groups in EDSSi (z-score = - 1.44, p = .14), EDSSc (z-score = - 0.02, p = .98), and in the progression of EDSS during follow-up (z-score = 0.37, p = .71). The correlation of CCI with EDSSi and EDSSc were not significant (rs = -0.02, p = 0.79 and rs= - 0.149, p = 0.14), as well as that of ECM (rs = 0.07, p = 0.45, and rs = 0.16, p = 0.10).
Conclusions
The presence of comorbidities before the MS diagnosis did not influence the disease's progression in the studied sample. The scores of the tools for measuring comorbidities have no significant association with the disability at the time of diagnosis of MS and also do not impact the worsening of EDSS. Other factors, possibly genetic and environmental, must be evaluated as causal for the progression of MS in the local population.