Hospital da Restauração

Author Of 1 Presentation

COVID-19 Late Breaking Abstracts

LB1241 - Incidence and clinical outcome of COVID-19 in a cohort of 11.560 Brazilian patients with Multiple Sclerosis (ID 2127)

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.

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