Background

The first case of COVID-19 was reported in the United States on January 19^th, 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.

Background

There have been >1.8 million cases of Sars-CoV-2 (Covid19) in the USA. and >100,000 deaths reported as of June 2020. Immunosuppression is reported as a risk factor for developing Covid19. Amidst this pandemic and declared national emergency in the USA, with a parallel response in Canada, neuroimmunologists are making important decisions and adjudicating complex situations of risk for their patients living with MS. No synthesized study of North American neuroimmunologists’ perceptions has been conducted.

Objectives

To report the experiences, opinions, and decision-making of U.S. and Canadian neuroimmunologists as they relate to the treatment of patients with multiple sclerosis (MS) during the Covid19 pandemic of 2020.

Methods

A new survey instrument was designed and distributed electronically. Invitations were sent via a known panel of MS neurologists and to publicly available e-mail addresses of MS-focused U.S. and Canadian neurologists, April 14-May 3, 2020. Inclusion criteria included treating at least 10 MS patients in the prior 6 months.

Results

243 respondents (average 197 MS patients seen in the prior 6 months (i.e. pre-Covid19); average practice duration 16 years; 92% USA, 8% Canada; 5% rural, 17% small city, 38% large city, 40% highly urbanized) met our inclusion criteria.

MS patient volume dropped by 79% on average (from 53 to 11 patients per month) during the time of Covid19. 23% of neurologists were aware of patients self-discontinuing a DMT due to fear of Covid19 with 43% estimated to be doing so against medical advice. 65% of respondents reported deferring >=1 doses of a disease modifying therapy (DMT) (49%), changing the dosing interval (34%), changing to home infusions (20%), switching a DMT (9%), and discontinuing DMTs altogether (8%) due to Covid19. Changes in DMT administration were most common among the higher-efficacy therapies alemtuzumab, cladribine, ocrelizumab, rituximab, and natalizumab; however, 35% of neurologists reported making no changes to DMT prescribing.

98% of respondents expressed worry about their patients contracting Covid19 and 78% expressed the same degree of worry about themselves. >50% reported believing that high-efficacy DMTs prolong viral shedding of SARS-CoV-2 and that B-cell therapies might prevent protective vaccine effects. Accelerated pace of telemedicine was identified as a major shift in practice.

Conclusions

Reported prescribing changes and practice disruptions due to Covid19 may be temporary but are likely to have a long-lasting influence on MS patients and their care.

Background

The Sars-CoV-2 (Covid19) pandemic has caused >100,000 deaths in the USA and has the potential to disrupt the care of NMO patients to a great extent. A unified and thorough set of guidelines for NMO management across countries has yet to be established.

Objectives

To document the prescribing and treatment patterns of North American neurologists with expertise in NMO patient care during the Covid19 pandemic.

Methods

We created a new survey instrument to query the practices, decision-making, and perspectives of a group of neuroimmunology-focused neurologists who actively care for patients with NMO in the USA or Canada. Survey responses included rating of statements for agreement, open-ended questions, multiple choice, and estimates of current practices in gradient forms. The survey was circulated from April 14, 2020 to May 4, 2020.

Results

192 neurologists met our inclusion criteria and were most often from academic hospitals (51%), followed by single specialty groups (21%). The volume of in-person NMO visits declined from 4 NMO patients per typical month pre-Covid19 to <1 patient in the prior month (approximately April 2020). More than half of neurologists indicated NMO patients were delaying their scheduled MRIs (57%), two-thirds indicated patients were delaying clinical visits (67%) and roughly half indicated patients were delaying laboratory testing (52%) due to fear of contracting Covid19. Seventeen percent of neurologists have deferred one or more doses of NMO patients’ immunosuppressive drug, 16% changed the dosing interval, and 15% switched health facility-based infusions to home-based infusions. Roughly half of all neurologists were uncomfortable with prescribing tocilizumab (48%), though 19% of neurologists anticipated using tocilizumab more often for their NMO patients given its current investigation as a treatment for Covid19.

Conclusions

The prescribing patterns and treatment decisions of NMO care providers during the Covid19 pandemic indicate a need for evidence-based, comprehensive guidelines for treating NMO patients amid healthcare crises moving forward.

Background

Seroepidemiology is an important tool to characterize the epidemiology and immunobiology of SARS-CoV-2. Most people with multiple sclerosis (MS) are treated with immunomodulators or immunosuppressants, so it is crucial to understand the immune response to the novel SARS-CoV-2 in people with MS.

Objectives

To investigate the prevalence and persistence of the SARS-CoV-2 antibody response in MS and how this relates to MS phenotype and treatment.

Methods

227 consecutive people with MS residing in MA and receiving care at Massachusetts General Hospital or Brigham and Women’s Hospital and 143 of their cohabitants were enrolled May 29-July 23, 2020. In addition, 8 people with MS receiving care elsewhere who tested positive for SARS-CoV-2 nasal swab PCR and 7 cohabitants of that group were enrolled to enrich the sample for select analyses. Each participant remotely submitted a dried blood card for in-house MGH SARS-CoV-2 IgG ELISA assay testing. The assay displays 99.7% sensitivity and 100% specificity >14 days from symptom onset. Participants completed a REDCap questionnaire covering demographics, MS history and treatments, comorbidities, and COVID-19 symptoms and exposure. Antibody prevalence in MS participants will be compared to that in their cohabitants using Pearson’s Chi-squared tests.

Results

The majority of MS participants were characterized as relapsing/remitting (76.8%) and were taking disease modifying therapies (72.6%) at the time of collection. SARS-CoV-2 antibodies were detected in 3.5% of people with MS residing in MA and 6.3% of their cohabitants (X²=1.54, p=0.22). For comparison, ~1.5% of the MA population had tested positive by PCR in this date range. Exposure and treatment data will be presented in 13 cases of antibody discordance between the person with MS and his/her cohabitant; the person with MS was antibody-negative in 10 cases and antibody-positive in 3 cases with discordance. In total there were 6 MS participants and no cohabitants who previously tested positive by nasal swab PCR but lacked antibodies at follow-up. Of the COVID-positive participants (by PCR or antibody), 54.5% (6 of 11) of MS and 88.9% (8 of 9) of cohabitants were asymptomatic (p=0.16).

Conclusions

Antibody prevalence was low overall in people with MS residing in MA. Discordance between MS participants and their cohabitants and lack of detectable antibodies in some people with MS with prior nasal swab PCR positivity suggest SARS-CoV-2 antibodies may be less persistent in people with MS.

Background

The uncertainty of multiple sclerosis (MS) disease progression can affect the psychological well-being of patients.

Objectives

To study possible changes in general mental health and its domains in a sample of people with MS (PwMS) over a period of time.

Methods

We prospectively studied 314 PwMS outpatient of Virgen Macarena University Hospital (213 women; 101 men, ages 19-78 years old (mean 45.3 years, SD 10.8 years). At baseline, Relapsing-Remitting MS was the predominantly reported MS subtype (n=272), followed by Secondary Progressive (n=34), and Primary Progressive (n=8) MS subtypes. The Expanded Disability Status Scale (EDSS) mean score was 3.17 (SD=1.93) and mean MS duration was 145.68 months since diagnosis (SD= 89.56). Mental health was measured using General Health Questionnaire-28 (GHQ-28) at baseline (T1), 2017-2018, and 18 months later (T2), 2018-2019. Changes in Mental Health from T1 to T2 were tested with the Wilcoxon Signed-Rank Test.

Results

Somatic symptoms (p<0.0001), anxiety and insomnia (p=0.001), and severe depression (p<0.0001) subscales significantly decreased from T1 to T2. The social dysfunction subscale increased but did not reach statistical significance (p=0.649). General GHQ-28 score significantly decreased from T1 to T2 (p<0.0001).

Conclusions

PwMS reported a decrease in emotional distress symptoms over time. Despite MS progression, improvement in psychological well-being suggests a possible gradual adaptation to the disease. Further longitudinal research is needed to better understand mental health evolution in MS.