Author Of 1 Presentation
SS02.04 - First results of the COVID-19 in MS Global Data Sharing Initiative suggest anti-CD20 DMTs are associated with worse COVID-19 outcomes
- S. Simpson-Yap
- E. De Brouwer
- T. Kalincik
- N. Rijke
- J. Hillert
- C. Walton
- G. Edan
- Y. Moreau
- T. Spelman
- L. Geys
- T. Parciak
- C. Gautrais
- N. Lazovski
- A. Pirmani
- A. Ardeshirdavani
- L. Forsberg
- A. Glaser
- R. McBurney
- H. Schmidt
- A. Bergmann
- S. Braune
- A. Stahmann
- R. Middleton
- A. Salter
- A. Van Der Walt
- J. Rojas
- I. Van Der Mei
- R. Ivanov
- G. Sciascia Do Olival
- A. Dias
- M. Magyari
- D. Brum
- M. Mendes
- R. Alonso
- R. Nicholas
- J. Bauer
- A. Chertcoff
- A. Zabalza
- G. Arrambide
- G. Comi
- L. Peeters
Abstract
Background
As the COVID-19 pandemic amplifies, efforts to minimise the risk on vulnerable people are essential. People with multiple sclerosis (MS) may be a vulnerable group due to the high proportion taking long-term immunosuppressive disease-modifying therapies (DMTs). Studies from Italy and France suggest older age, higher disability and progressive MS are associated with severe COVID-19, yet there remains uncertainty around the influence of DMTs.
Objectives
Given the many approved MS DMTs and the relatively low frequency of COVID-19 in MS patients per country, international data sharing is desirable to examine the impact of DMTs on COVID-19 severity. Here, we present the first results of the COVID-19 in MS global data sharing initiative of the MS International Federation and MS Data Alliance and many other data partners to inform MS clinical management during the COVID-19 pandemic.
Methods
Clinician-reported data from 21 countries were aggregated into a dataset of 1540 patients. Characteristics of admission to hospital, admission to intensive care unit (ICU), need for artificial ventilation, and death, were assessed in patients with confirmed or suspected COVID-19 infection using log-binomial regression. Adjusted prevalence ratios (aPR) were calculated adjusting for age, sex, MS type, and Expanded Disability Status Scale (EDSS).
Results
Of 1540 patients, 476 (30.9%) with suspected and 776 (50.4%) with confirmed COVID-19 were included in the analysis. Older age, progressive MS and higher EDSS were associated with higher frequencies of severe outcomes. Anti-CD20 DMTs, ocrelizumab and rituximab, were positively associated with hospital admission (aPRs=1.19 & 1.58), ICU admission (aPRs=3.53 & 4.12), and the need for artificial ventilation (aPRs=3.17 & 7.27) compared to dimethyl fumarate. Higher frequencies of all three outcomes were associated with combined anti-CD20 DMT use compared to all other DMTs (hospitalisation aPR=1.49; ICU aPR=2.55; ventilation aPR=3.05) and compared to natalizumab (hospitalisation aPR=1.99; ICU aPR=2.39; ventilation aPR=2.84). Importantly, associations persisted on restriction to confirmed COVID-19 cases and upon exclusion of each contributing data source in turn. No associations were observed between DMTs and death.
Conclusions
This study used the largest federated international cohort of people with MS and COVID19 currently available. We demonstrate a consistent association of anti-CD20 DMTs with hospitalisation, ICU admission and use of artificial ventilation suggesting their use among MS patients at risk for COVID-19 exposure may be a risk factor for more severe COVID-19 disease. To address study limitations, further research incorporating comorbidities, smoking and body mass index is required. Alternative study designs are needed to address questions on COVID-19 susceptibility among people with MS.
Author Of 1 Presentation
LB1255 - Influence of social isolation measures due to Covid-19 on the quality of life of people with Multiple Sclerosis (ID 2151)
Abstract
Background
People with Multiple Sclerosis (MS) are often treated with immunosuppressants or immunomodulators and are more susceptible to worsening in the course of COVID-19 if they get infected with the SARS-CoV-2 virus. Social isolation is necessary to minimize the risk of infection.
Objectives
To analyze the influence of social isolation measures on the quality of life of people with MS during the COVID-19 pandemic period.
Methods
41 people with MS participated (22RR, 14PP, 5SP), 25 females and 16 males, aged between 18 and 70 years, EDSS from 0 to 8.5. All of them answered a structured questionnaire containing 15 questions about patients perception in the physical, communicative and psychological domains during social isolation.
Results
According to the domains: In physical: changes in daily life (n = 37/90%), fatigue (n = 22/54%), difficulty in walking (n = 28/68%), pain (n = 23/56%) and decreased muscle strength (n = 24/58%). In communicative it was identified difficulty in verbal communication (n = 13/32%), change in activity and communicative frequency (n = 31/76%), with reduced face-to-face communication and increased use of video calls by cell phone. In psychological terms, perception of vulnerability (n = 20/49%), sadness (n = 27/66%), concern / fear (n = 31/75%) and impact on quality of life (n = 33/80%), with the support of family / friends, online treatments, leisure and religiosity, helping to deal with the social isolation.
Conclusions
During the social isolation in Brazil, due to the COVID-19 pandemic, the majority of respondents in this cross-sectional study revealed a moderate to severe impact on quality of life in all domains. In the face of uncertainties, MS specialists must adapt to monitoring for complications in the spheres of physiotherapy, psychology and speech therapy, as well as adopt rehabilitation options applicable to the moment.