Author Of 1 Presentation
SS02.02 - Comparison of COVID-19 outcomes between racial groups in the COViMS registry
Abstract
Background
Risk factors previously identified for worse outcomes with SARS-CoV-2 infections include older age, male sex and specific comorbid conditions. An increased risk for poorer COVID-19 outcomes in people with multiple sclerosis (MS) are similar to the general population, but less is known about outcomes in minority groups with MS.
Objectives
To evaluate differences in outcomes of SARS-CoV-2 infection in non-Hispanic White and Black persons with multiple sclerosis.
Methods
COViMS is a North American registry for health care providers to report persons with MS who are infected with SARS-CoV-2, the virus that causes COVID-19 (cases). Cases are reported after 7 days and when the outcome of infection is reasonably certain. MS and clinically isolated syndrome cases were categorized using the Center for Disease Control and Prevention races (non-Hispanic Whites, and Black). Comorbidities related to COVID-19 outcomes were collected. Clinical outcomes examined were mortality alone, mortality and/or admissions to the intensive care unit (ICU) and mortality, ICU admissions and/or hospitalization. Age-adjusted mortality rates as of August 3, 2020 and 95% confidence intervals (CI) were calculated. Multivariable logistic regression was used to assess adjusted differences between races using odds ratios (OR) and 95% CIs. Covariates included sex, age, smoking (current, past, never), MS clinical course (relapsing, progressive), disease duration, ambulation (fully ambulatory, walks with assistance, non-ambulatory), individual comorbidities (cardiovascular disease, cerebrovascular disease, chronic kidney disease, chronic lung disease, diabetes, hypertension, morbid obesity), and disease modifying therapy use (yes vs no).
Results
Of 734 patients reported, 421 (57.4%) Whites, and 194 (26.5%) Black patients were reported. Black cases were more likely to be younger (p=0.002), never smokers (p=0.002), have shorter MS duration (p<0.001), a relapsing MS course (p=0.03) and have comorbidities (p<0.001) compared to Whites. A higher proportion of Black patients had hypertension (40.2% vs 19.5%, p<0.001), and morbid obesity (17.0% vs 9.5%, p=0.007). Mortality rates increased with age and were not statistically different between Whites and Blacks (p=0.156). Black race was associated with increased odds of mortality and/or ICU admission (OR 3.8 [95%CI: 1.60, 8.96], p=0.002) and mortality, ICU admission and/or hospitalization (OR 2.0 [95%CI: 1.14, 3.54], p=0.016) after adjustment for covariates.
Conclusions
Within the COViMS registry, Black MS patients were younger and more likely to have comorbidities than White MS patients. Black MS patients had an increased risk for poorer outcomes compared to Whites even after adjusting for comorbidities at the time of COVID-19.
Author Of 4 Presentations
LB1172 - MS and COVID-19: A Webinar Series for Healthcare Providers (ID 1746)
Abstract
Background
Background: MS is a complex disease that requires a well- educated workforce. The COVID-19 pandemic added to that complexity- from the lack of knowledge of viral behavior, to the possible impact of disease modifying therapy on the susceptibility of contracting COVID-19, to the prognosis of MS patients with COVID-19. To help meet the educational needs of MS healthcare professionals during the unprecedented pandemic, the National MS Society (NMSS) and the Consortium of MS Centers (CMSC) collaborated to develop a professional educational program to provide emerging, evidence-based information on MS and COVID-19.
Objectives
Objectives: Participants will 1) have easy access to emerging, evidence-based content on COVID-19 and the impact on people living with MS, 2) gain knowledge about MS and COVID-19.
Methods
Methods: An educational program entitled MS and COVID-19: A Webinar for Healthcare Providers was initiated on March 19, 2020. The series has consisted of 1-hour webinars (six as of July 1) on topics identified by healthcare providers including: overview of COVID-19; infection risk for people living with MS; impact of disease modifying therapies on infection and prognosis of MS patients; and outcomes from the COViMS data registry. Each webinar included a 50-minute town-hall style presentation based upon questions submitted by webinar registrants followed by a 10-minute facilitated question and answer session. Participants had the option to attend a live webinar or view a recorded presentation. Following the live webinars, all registrants were sent a link to the webinar recording and a program evaluation survey.
Results
Results: As of July 1, 2020, 4,763 healthcare providers attended the live or recorded webinars and 273 responded to the program evaluation survey which included topic specific and non-topic related survey questions. Survey results indicated 78% of respondents reported improved knowledge of COVID-19 and 73% reported improved confidence in discussing COVID-19 with their MS patients. Additionally, 72% reported they planned to make a change in their practice as a result of webinar participation and 86% would recommend the National MS Society to a colleague.
Conclusions
Conclusions: The MS and COVID-19 webinar series is an important collaborative effort between the NMSS and CMSC, engaging a wide variety of healthcare providers including pioneers in specialized MS care, and introduced the MS community to providers and researchers at the forefront of COVID research and care. The series provided healthcare providers with timely, free, and easily accessible professional education in a time of crisis. Survey results indicate that the webinar provided much needed information on COVID-19 and its impact on patients living with MS to participants.
LB1242 - COViMS Registry: Clinical Characterization of SARS-CoV-2 Infected Multiple Sclerosis Patients in North America (ID 2128)
Abstract
Background
Emergence of SARS CoV-2 causing COVID-19 provoked the need to gather information on the overall outcomes and potential risks associated with morbidity and mortality in multiple sclerosis (MS) patients with COVID-19 infections. The COViMS registry was initiated as a rapid and efficient means to collect this data from North American health care providers.
Objectives
To describe the spectrum of outcomes in SARS CoV-2 infected North American MS patients and to ascertain characteristics associated with severe COVID-19 outcomes.
Methods
The COViMS registry requested that MS, neuromyelitis optica (NMO), myelin oligodendrocyte glycoprotein antibody disease (MOGAD), and radiographically isolated syndrome (RIS) patients with SARS-CoV-2 infection be reported after the outcome was reasonably certain. Data were de-identified and cross-sectional. Effort was made to harmonize with other international registries for COVID-19. Poor clinical outcomes assessed were: mortality, mortality and/or admission to the intensive care unit (ICU), and mortality, ICU admission and/or hospitalization. Associations between patient characteristics and these outcomes were evaluated using multivariable logistic regression. Covariates included sex, age, race, smoking, MS clinical course (relapsing, progressive), MS disease duration, ambulation (fully ambulatory, walks with assistance, non-ambulatory), individual comorbidities (cardiovascular disease, cerebrovascular disease, chronic kidney disease, chronic lung disease, diabetes, hypertension, morbid obesity), and disease modifying therapy (DMT) use.
Results
As of Aug 3, 2020, 764 patients from over 140 different practices were reported; 734 MS, 21 NMO, 4 MOGAD, and 5 RIS. MS patients were 73.4% female (73.4%), 65.2% Caucasian, with mean (SD) age of 48.2 (±13.5) years. Mean disease duration was 13.8 (±9.9) years. 70.9% were fully ambulatory. Ocrelizumab and dimethyl fumarate (DMF) were the top two DMTs used. Most (77.1%) were laboratory confirmed for SARS-CoV-2. Of MS cases, 6.1% died, 13.8% were admitted to the ICU and/or died, and 31.2% were either hospitalized, admitted to the ICU or died. Older age, non-ambulatory status and cardiovascular disease were associated with increased risk of poor outcomes. No specific DMT was associated with increased odds of mortality and mortality and/or ICU admission. Anti-CD20 DMT use showed an increased odds of mortality, ICU admission and/or hospitalization compared to DMF (OR: 2.53 95%CI [1.17, 5.50]).
Conclusions
The data provide reassurance that the MS registry population aligns with reported COVID-19 outcomes in the general North American population. While reported deaths are few, no clear association between a specific therapy and mortality has been seen after adjustment for age, sex, ambulatory status and comorbidities. Data collection continues.
P0588 - Implementation strategy of an international standardized MRI protocol for the diagnosis and follow-up of MS patients (ID 1905)
Abstract
Background
Standardized magnetic resonance imaging (MRI) protocols are important for the diagnosis and monitoring of patients with multiple sclerosis (MS). The Consortium of Multiple Sclerosis Centers (CMSC) convened an international panel of MRI experts to review and update the current guidelines.
Objectives
The goal is to update the standardized MRI protocol and clinical guidelines for diagnosis and follow-up of MS and develop strategies for advocacy, dissemination and implementation.
Methods
The CMSC convened an expert panel in October 2019 to update the standardized MRI protocol. Conference attendees included neurologists, radiologists, magnetic resonance technologists, and imaging scientists with expertise in MS. Representatives from CMSC, Magnetic Resonance Imaging in MS (MAGNIMS), North American Imaging in Multiple Sclerosis Cooperative, National MS Society, Multiple Sclerosis Association of America, MRI manufacturers, and commercial image analysis companies were present. Before the meeting, CMSC members were surveyed about standardized MRI protocol, gadolinium, diffusion weighted imaging, and the central vein sign.
Results
95 neurologists completed the survey. 34% use the CMSC protocol. 48% use a standardized MRI protocol but are uncertain if it is similar to CMSC guidelines. 51% continue to use gadolinium for routine imaging. 58% wanted the central vein sign to be included in the diagnostic work up of MS. 87% were interested in monitoring brain volume and 10% were doing it routinely. The panel worked to harmonize CMSC and MAGNIMS MRI protocols so the updated guidelines could ultimately be accepted by international consensus. Advocacy efforts will promote the importance of standardized MRI protocols. Dissemination will include publications, meeting abstracts, educational programming, webinars, “meet the expert” teleconferences and exam cards. Implementation will require comprehensive and coordinated efforts to make the protocol easy to access and use.
Conclusions
The international expert group developed revised clinical MRI guidelines with the vision and action plans for them to be universally useful and useable and become the standard of care for patients with MS.
P0882 - Motor Impairment in Multiple Sclerosis: Analysis from the North American Registry for Care and Research in Multiple Sclerosis (ID 1759)
Abstract
Background
North American Registry for Care and Research in Multiple Sclerosis (NARCRMS) is a longitudinal registry studying the course of MS in the disease-modifying era.
Objectives
To examine motor performance metrics of upper and lower extremity function in NARCRMS participants at enrollment, using the Expanded Disability Status Scale (EDSS) and 25-foot walk times.
Methods
Recruitment began in 2016 and by June 24, 2020, 737 patients were enrolled at 25 MS sites across the US and Canada. People with any sub type of MS within 15 years of disease onset and an EDSS of up to 6.5 are eligible for enrollment. Various clinical metrics are collected including motor performance for upper and lower extremities. Our initial observations about EDSS, 25-foot timed walk and the 9-hole peg test are reported below
Results
EDSS and 25-foot walk times were available in 632 patients and upper extremity function in 609 patients. A mean walking speed of 4.96 seconds was recorded in patients with an EDSS of 0 (n=105). 5.11 was the mean speed until an EDSS of 3.0 (n=39) where a mean speed of 5.41 seconds was recorded. Walking truly became affected at an EDSS of 3.5 (n=27) where a mean speed of 6.48 seconds was recorded. Thereafter mean speed progressively declined at every EDSS increase. For an EDSS of 4.0 (n=28), mean speed was 7.78 seconds; for an EDSS of 4.5 (n=6), mean speed was 9.16 seconds and continued to increase until an EDSS of 6.5 (n=11) where mean speed was 19.1 seconds. For the 9-hole peg test, patients with an EDSS of 0 (n=101) had a mean speed of 20.3 seconds in the dominant and 21 seconds in the non-dominant hand. Hand function remained unimpaired until an EDSS of 2.0 and significant slowing occurred in patients with EDSS ranging from 2.5 to 6.5. For an EDSS of 2.5 (n=44), mean speed was 25.3 seconds in the dominant and 24.4 seconds in the non-dominant hand. For an EDSS of 4.0 (n=26), mean speed was 26.3 seconds in the dominant and 26.0 seconds in the non-dominant hand. For an EDSS of 6.5 (n=11), hand function had declined to a mean speed of 40.1 seconds for the dominant and 56.4 seconds for the non-dominant hand.
Conclusions
A linear correlation of the 25-foot walk speed to EDSS increases was remarkable, reiterating the commonly held belief that the EDSS is a “walking scale”. Decline in hand function at an EDSS of 2.5 was unexpected since hands are often perceived to be unaffected early in MS and seldom observed as impaired by patients. Progressive decline of hand function at every EDSS increase would suggest that the 9-HP test is a good marker of declining hand function and should be included in clinical monitoring of patients.