Accelerated Cure Project

Author Of 1 Presentation

COVID-19 Late Breaking Abstracts

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

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.

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Author Of 1 Presentation

Patient-Reported Outcomes and Quality of Life Poster Presentation

LB1145 - The 2020 COVID-19 pandemic and multiple sclerosis: Health behavior and lifestyle impacts in >1,000 people with MS  (ID 402)

Speakers
Presentation Number
LB1145
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

The first case of COVID-19 was reported in the United States on January 19th, 2020. By June 2020, >1.8 million people had been reported infected and >100,000 had died. Due to the COVID-19 pandemic, many MS physicians and patient advocacy organizations have recommended delaying or modifying treatment dosages for patients on high efficacy disease modifying therapies (DMTs). The wider impact of COVID-19 on people with MS (PwMS) has not been well characterized.

Objectives

To determine how PwMS navigated the initial phase of the COVID-19 pandemic with an emphasis on changes in health behavior, access to MS care, and employment.

Methods

A cross-sectional survey of adult PwMS was performed online, using the iConquerMS™ platform, between April 3 and April 30, 2020.

Results

The response rate was 20%. 1,019 PwMS responded completely (average age: 54.2 years, range: 20-81; 79% female; 88% from the USA). 64% had relapsing remitting MS; 22% had secondary progressive MS; and 12% had primary progressive MS. The most frequent comorbidities were: depression (41%), hypertension (26%), and asthma (12%). 748 (73%) used a DMT in the last year, primarily higher-efficacy therapies: ocrelizumab (n=238), dimethyl fumarate (n=85), fingolimod (n=80).

Women were more worried than men about COVID-19 (p=0.001); non-white-identifying PwMS believed it was a greater danger to their health than white-identifying PwMS (p=0.002). 10% (n=98) made changes to their DMT regimen because of COVID-19, most commonly delaying at least one dose (n=65). 26% of those who made changes reported doing so without the input of their neurologist or physician

11% had difficulties and delays accessing DMTs, most commonly ocrelizumab (n=42). 18% had difficulties in non-MS related medical procedures. 64% (n=650) canceled or postponed medical visits and 37% (n=382) had telemedicine visits due to COVID-19.

4% (n=43) of PwMS were tested for SARS-CoV-2: 7 were positive (5 female; age range:29-64 years). Their DMTs were dimethyl fumarate (n=2), ocrelizumab (n=1), rituximab (n=1), and an unstated clinical trial drug (n=1). 128 PwMS (13%) wanted to be tested but were not; 395 (39%) knew somebody exposed to SARS-CoV-2 and 38 (4%) were aware of a personal exposure.

37% (n=374) experienced employment changes, most commonly working from home (n=194) and having work hours reduced (n=65). 32 PwMS lost their jobs.

Conclusions

Although most PwMS expressed worry about COVID-19, only 4% were tested for SARS-CoV-2 and 1% tested positive. Due to COVID-19, PwMS are experiencing changes to their care that could impact their long-term health.

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