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1.
Multiple Sclerosis Journal ; 28(4 Supplement):4, 2022.
Article in English | EMBASE | ID: covidwho-2224049

ABSTRACT

Background: People with multiple sclerosis (MS) are a vulnerable group for severe COVID-19, particularly those taking immunosuppressive disease-modifying therapies (DMTs). Objective(s): To assess characteristics of COVID-19 severity in an international sample of people with MS, including hospitalisation, ICU admission, requiring artificial ventilation, and death. Method(s): Data from 12 data-sources in 28 countries were aggregated. Demographic and clinical covariates were queried, alongside COVID-19 clinical severity outcomes, hospitalisation, admission to ICU, requiring artificial ventilation, and death. Characteristics of outcomes were assessed in patients with suspected/ confirmed COVID-19 using multilevel mixed-effects logistic regression. Result(s): 657 (28.1%) with suspected and 1,683 (61.9%) with confirmed COVID-19. Older age, progressive MS-phenotype, and higher disability associated with worse COVID-19 outcomes. Ocrelizumab and rituximab associated with hospitalisation (aOR=1.75,95%CI=1.29-2.38;aOR=2.76,95%CI=1.87-4.07) and ICU admission (aOR=2.55,95%CI=1.49-4.36;aOR=4.32, 95%CI=2.27-8.23) vs pooled-other-DMTs but only rituximab with artificial ventilation (aOR=6.15,95%CI=3.09-12.27). Similar associations seen compared to dimethyl fumarate and to natalizumab. No associations observed between DMTs and death. Conclusion(s): Using the largest cohort of people with MS and COVID-19 available, we demonstrated consistent associations of rituximab and ocrelizumab with worse COVID-19, suggesting their use may be a risk factor for more severe COVID-19.

2.
Multiple Sclerosis Journal ; 28(3 Supplement):681-682, 2022.
Article in English | EMBASE | ID: covidwho-2138873

ABSTRACT

Introduction: The patient's care experience is a crucial factor to consider in order to improve the quality of care and the quality of life in multiple sclerosis (MS). In the context of COVID-19 pandemic, the French health authorities allowed the administration of natalizumab at home by at-home health service. Objective(s): The main objective was to evaluate the quality of care from the point of view of the patients when moving from hospital to at home natalizumab administration. Aim(s): Improve quality of care and quality of life in multiple sclerosis. Method(s): Thirty relapsing remitting MS patients treated with natalizumab since more than 6 months were prospectively recruited to benefit from an at home procedure that was evaluation during 1 year by using the following questionnaires: MusiCare, the first specific MS patient's experience, was filled out at baseline, 6 and 12 months ;MusiQol (to assess quality of life), ExPerf (adapted from the PPE15 to assess practice experience) and a satisfaction scale were filled out every months. The primary endpoint was the mean difference of MusiCare scores between Baseline and 12 months. Result(s): From June 2020 to November 2021, 306 infusions were performed at home. Three patients stopped the study (one loss of follow-up, two preferred to move back to hospital's procedure). No worsening of patients experience or quality of life was observed. One dimension of MusiCare was significantly improved at 12 months compared with baseline (91.5 versus 81.8, p=0.0203): relationship with healthcare professionals. The MusiQol global score remained stable (75.5 vs 72.4) but coping and friend's relationship dimensions were significantly improved at M12 versus baseline (respectively p=0.0491 and p=0.0478). Answers to the ExPerf questionnaire show some pain during infusion (21.8%) and some contradictions between health professionals (17.2%). The mean satisfaction about the care was 9.1/10. MS activity remained low. There was no serious adverse event. Conclusion(s): Positive patient's experience of at home natalizumab administration gives an important opportunity to improve patient's quality of care.

3.
Multiple Sclerosis Journal ; 27(2 SUPPL):741-743, 2021.
Article in English | EMBASE | ID: covidwho-1496078

ABSTRACT

Background: As the COVID-19 pandemic continues, evidencebased clinical guidance for managing the care of people with multiple sclerosis (MS) is an ongoing concern. In recent months, data from cohorts of people with MS has indicated that certain demographic and clinical characteristics, including use of some disease- modifying therapies (DMTs), leads to worse outcomes from SARS-CoV-2 infection. The COVID-19 in MS global data sharing initiative, which now includes over 4,500 confirmed COVID- 19 cases in people with MS, gives the opportunity to corroborate previous findings with greater certainty. Methods: Clinician-reported data from 32 countries were aggregated into a dataset of 5,543 patients who had suspected or confirmed COVID-19. Demographic and clinical covariates were queried, alongside COVID-19 clinical severity outcomes. These outcomes (hospitalisation, admission to ICU, requiring artificial ventilation, and death) were assessed in patients with suspected/ confirmed COVID-19 using multilevel mixed-effects logistic regression. All models were corrected for age, sex, EDSS, and MS type. DMTs were individually compared to glatiramer acetate (GA), as well as to pooled other DMTs and natalizumab. Results: Of 5,543 patients in the clinician-reported dataset, 909 with suspected and 4,634 with confirmed COVID-19 were included in the analysis. Previous demographic findings were confirmed: male sex, older age, progressive MS, and higher disability were associated with worse outcomes from SARS-CoV-2 infection. Use of anti-CD20 DMTs (ocrelizumab and rituximab) was associated with worse COVID-19 outcomes. Compared to GA, ocrelizumab and rituximab were associated with increased risk of hospitalisation (aOR=1.61(95%CI=1.06-2.43);aOR=2.42(95%CI=1.54-3.81) and ICU admission (aOR=3.13(95%CI=1.22-8.00);aOR=4.46 (95%CI=1.64-12.09)). Rituximab was associated with increased risk of artificial ventilation (aOR=3.57(95%CI=1.38-9.20));ocrelizumab showed a positive trend (aOR=1.86(95%CI=0.76-4.55). Rituximab showed a positive trend with increased risk of death (aOR=2.74(95%CI=0.68-11.09). Associations persisted on restriction to confirmed COVID-19 cases. Conclusions: Analysing the largest international real world dataset of people with MS who have suspected or confirmed COVID- 19 confirms previous findings that male sex, older age, progressive MS, higher disability, the use of anti-CD20 medication (ocrelizumab and rituximab) are associated with worse COVID-19 outcomes.

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