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Introduction Disruption to clinical services, triggered by the COVID-19 pandemic, led to extended intervals between ocrelizumab treatments for some patients. Objectives To assess the rates of developing low immunoglobulin levels and timing of CD19+ B-cell count repopulation in a real-world clinical population. To assess for evidence of clinical or radiological MS disease activity with extended interval dosing of ocrelizumab. Methods We audited 712 patients given ocrelizumab by our seven clinical services. All monitoring of immunoglobulin levels and CD19+ cell counts were recorded. Disease activity was defined as on treatment clinical relapse, radiological activity, and EDSS progression. Results Low immunoglobulin levels developed in 102 patients, the odds ratio for developing hypogam- maglobulinaemia comparing extended to standard interval dosing was 0.42 (CI 0.22-0.81). Disease activity included 20 participants with clinical relapses and 72 with new MRI lesions. There was no evidence of excess clinical or radiological disease activity on switching to extended interval dosing. 38 had EDSS progression, giving an odds ratio comparing extended to standard interval dosing of 0.77 (CI 0.38-1.56). Conclusions This real-world data of extended interval dosing of ocrelizumab indicates lower rates of hypogammaglobulinaemia and no detrimental effect on short-term treatment efficacy.
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Introduction: People with multiple sclerosis (PwMS) treated with anti-CD20 therapies and fingolimod are less likely to successfully produce a humoral response to COVID-19 vaccines 1 and 2. Objective(s): To measure the humoral and/or cellular response to COVID-19 booster vaccinations in a cohort of PwMS who were previously seronegative after their initial COVID vaccine course. Aim(s): To determine whether there is a benefit of COVID-19 booster vaccinations for people with MS who are known to have had an attenuated response to initial vaccines. Method(s): We studied a cohort of PwMS all of whom were seronegative for anti-SARS-CoV-2 spike protein IgG after the 1st and 2nd COVID-19 vaccines, including PwMS treated with ocrelizumab (n=53), fingolimod (n=15), other DMTs (n=9) and no DMT (n=2). Dried blood spot +/- whole blood samples were obtained from participants at 2-8 weeks after their 3rd (n=79) and 4th (n=40) COVID-19 vaccines. Samples were used to measure anti-SARS-CoV-2 spike protein IgG (ELISA) and T-cell response (IFN-g release assay measured on whole blood). Result(s): Overall 27/79 (34%) who were seronegative after COVID vaccine 2 seroconverted after vaccine 3. Seroconversion rates were 17% for PwMS treated with ocrelizumab, 47% for fingolimod and 100% for other DMTs. A further 2/30 (7%) of those who remained seronegative after vaccine 3 seroconverted after vaccine 4. Anti-SARS-CoV-2 T-cell responses were measurable in 26/40 (65%) after vaccine 3 and 13/19 (68%) after vaccine 4 but were conspicuously absent in people treated with fingolimod. Overall, 75% of participants showed either humoral or cellular response after receiving 4 COVID vaccinations. PwMS with laboratory evidence of prior COVID-19 infection had higher measurable T-cell responses. Conclusion(s): Booster vaccinations for COVID-19 are associated with incremental benefits in measurable immunity in those with attenuated responses to the initial vaccine course. Overall, three quarters of those who were seronegative after COVID vaccines 1 & 2 had a measurable immune response after COVID vaccine 4. This data supports the use of booster vaccinations in pwMS at risk of attenuated vaccine response.
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Background: The immune response to COVID-19 vaccines varies between people with multiple sclerosis (pwMS) receiving different disease-modifying therapies (DMTs). Objective(s): To assess the clinical effectiveness of COVID-19 vaccines in preventing infections and their severe outcomes among pwMS receiving DMTs. Method(s): National Health Service England and United Kingdom Health and Security Agency datasets were used to analyse data on all COVID-19 tests, outcomes, and vaccines among the total population of pwMS receiving DMTs in England. Publicly available data were used for the general population. Monthly COVID- 19 incidence was compared between pwMS receiving DMTs and the general population. COVID-19 related hospitalisation and in-hospital mortality following full vaccination, with at least two doses, were compared between pwMS receiving different DMTs. These results are from March 2020 to December 2021 and will be updated. Result(s): A mean (standard deviation) of 44,170 (4,951) pwMS taking DMTs per month were included. Monthly COVID-19 incidence among pwMS receiving all DMTs, except for fingolimod and ocrelizumab, followed the pattern among the general population, before and after mass vaccination. COVID-19 incidence in pwMS on fingolimod and ocrelizumab compared to the general population increased despite mass vaccination (incidence rate ratio [95% confidence interval]: from 0.50 [0.37-0.66] to 0.91 [0.80-1.03] for fingolimod, and from 1.01 [0.79-1.26] to 1.57 [1.44-1.72] for ocrelizumab, in January 2021 [when vaccination started] to December 2021 [when over 80% of the populations were vaccinated]). COVID-19 related hospitalisation (per 10,000 people) was higher among vaccinated pwMS on fingolimod (94) and ocrelizumab (140) than other DMTs (ranging from 0 to 37). COVID-19 related in-hospital mortality (per 1,000 people) was 0.3 for fingolimod, 2 for ocrelizumab, and 0-1.2 for other DMTs. Conclusion(s): PwMS taking ocrelizumab and fingolimod are at increased risk of contracting COVID-19 and hospitalisation due to COVID-19 compared to the general population and other DMTs using current vaccination protocols.
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Objective: To compare the risk of SARS-CoV-2 infection before and after mass vaccination among patients with multiple sclerosis (pwMS) taking different disease-modifying therapies (DMTs) compared to the general population (GP). Background: Real-world data in the GP show that SARS-CoV-2 vaccines are effective in preventing infections, but it is still unclear whether vaccination offers the same level of protection for pwMS taking immunomodulatory DMTs. Design/Methods: National Health Service (NHS) England and NHS Improvement (NHSE/I) hold prescribing data on all MS DMTs in England. Public Health England (PHE) collected data on all SARS-CoV-2 tests in England. Datasets of NHE/I and PHE were merged to estimate the monthly rates of SARS-CoV-2 infections in the entire population of pwMS taking DMTs in England. Publicly available data were used for the same analysis in the GP. The relative risk (RR) of infection in pwMS taking DMTs compared to the GP was calculated during two waves of the pandemic: before (November 2020-January 2021) and after (July-September 2021) mass vaccination. Results: All 42,402 pwMS taking DMTs in England were included. A total of 28,113 (66.3%) patients were tested for SARS-CoV-2 out of whom 4,104 (14.6%) tested positive. Pre-vaccination, the RR (95%CI) of infection was beta-interferon: 0.75(0.65-0.87), cladribine: 0.93(0.75-1.14), dimethyl fumarate: 1.15(1.05-1.25), fingolimod: 0.88(0.76-1.02), glatiramer acetate: 1.05(0.93-1.19), natalizumab: 1.08(0.96-1.21), ocrelizumab: 1.20(1.07-1.34), teriflunomide 0.79(0.63-0.99). Post-vaccination, it was beta-interferon: 0.73(0.63-0.85), cladribine: 1.21(1.02-1.45), dimethyl fumarate: 1.34(1.24-1.45), fingolimod: 1.63(1.47-1.82), glatiramer acetate: 0.85(0.74-0.98), natalizumab: 1.22(1.10-1.36), ocrelizumab: 2.18(2-2.36), teriflunomide: 1.04 (0.85-1.27). Conclusions: The risk of SARS-CoV-2 infection in patients taking ocrelizumab and fingolimod substantially increased compared to the general population following vaccination which agrees with the suppressed humoral immune response observed with these DMTs. The changes associated with other DMTs are less clear. Further analysis of data collected longitudinally over a longer period will reveal their impact on the effectiveness of SARS-CoV-2 vaccines.
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Background The UK MS Register (UKMSR) has been capturing longitudinal clinical and patient reported outcomes (PROs) since 2011. As the UK population 'locked-down' in March 2020 it became important that clinicians could record hospitalised MS patients due to COVID-19 and record outcome. The UKMSR provided an electronic case return form, designed collaboratively by the community. Aim Impacts of disability, age and treatment on mortality in pwMS with COVID-19 Method Linear modelling and standardised hypothesis testing were performed on an outcome of died or not, impact of disability (EDSS), disease modifying therapies and age. Results N=132 PCR confirmed COVID-19 patients submitted, 14 missing EDSS, leaving n=118. Female n=80, n relapsing =74, n progressive = 44, mean age 49.2. Median EDSS = 5.0. Linear regression for age was found to be most significant for outcome (p=0.002). Univariate analysis found that the outcome was not independent of EDSS (ChiSq p=0.0008), DMT (ChiSq p=0.006) and MSType (ChiSq p=0.0006). In the multivariate model only, age remained significant. Conclusions Only age remained as a marker of poor outcome multivariate analysis. No MS Specific characteristics were found to be significant. We would encourage continued data collection from UK neurology centres to increase the utility of this data.
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COVID-19 is a concern in people with multiple sclerosis (MS), mostly because of their long-term physical disabilities and immunomodulatory disease-modifying therapies (DMTs). In this community-based pro-spective longitudinal study, we have been monitoring a cohort of people with MS via the web-based platform of the UK MS Register since the start of the COVID-19 outbreak. We report our findings from 17/03/2020 to 15/01/ 2021. Out of 7344 participants, 883 (12%) have reported a selfdiagnosis of COVID-19 of whom 211 had a confirmed clinical or laboratory-based (n=114) diagnosis. No individual DMT increased the likelihood of contracting COVID-19 (with any of the diagnoses as the outcome). Gender (male: female, adjusted OR: 95% CI [0.94: 0.68'1.3]), web-based Expanded Disability Status Scale score (webEDSS;one-point increase, 0.92: 0.84'1.01), and MS duration (one-year increase, 1: 0.98'1.02) were not associated with contracting COVID-19. Younger age (one-year decrease, 1.04: 1.03'1.06), ethnicities other than white (1.95: 1.13'3.34), and relapsing-remitting MS (versus progressive, 1.72: 2.56'1.16) increased the likelihood of contracting COVID-19. Within a median (interquartile range) of 26 (0'72) days follow-up of participants with COVID-19 (n=532), 69% reported full recovery. A higher webEDSS (one-point increase, 0.84: 0.74'0.96) lowered the likelihood of full recovery. Overall, MS-specific factors do not predispose people with MS to contracting COVID-19, but physical disability can delay recovery.
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The COVID-19 study (clinicaltrials.gov:NCT04354519) is a prospective observational cohort launched on 17 March 2020 as part of the UKMSR. As of 24 April, out of 3910 participants, 237 (6.1% (95% CI 5.3% to 6.8%)) reported self-diagnosed COVID-19 among whom 54 (22.8% (17.5% to 28.2%)) also had a diagnosis by a healthcare professional based on symptoms and 37 (15.6% (11.2% to 20.6%)) a confirmed diagnosis by testing. Three participants reported hospitalisation due to COVID-19. No deaths were reported. Among 1283 siblings without MS, 79 (6.2%) had a reported diagnosis of COVID-19. Adjusting for age and gender, the likelihood of contracting COVID-19 in pwMS was similar to siblings (OR 1.180 (0.888 to 1.569)). Seven hundred and fifty-nine of 3812 participants reported that they were self-isolating and that they had been self-isolating for at least 2 weeks before symptom onset if they had COVID-19. Of these, 2 (0.3% (0% to 0.7%)) had self-diagnosed COVID-19 whereas 137 of 3053 participants not self-isolating (4.5% (3.8% to 5.2%)) had the disease. Participants on DMTs were less likely to have self-diagnosed COVID-19 (OR 0.640 (CI 0.428 to 0.957)), which remained significant after removing self-isolating participants (OR 0.633 (0.402 to 0.998)). High-efficacy DMTs reduced the likelihood of self-diagnosed COVID-19 compared with no DMTs (OR 0.540 (0.311 to 0.938)) but not compared with moderate-efficacy DMTs. Including webEDSS (n=2808) and physical MSIS-29v2 (n=3192) as additional predictors in the analysis showed no significant association with the likelihood of contracting COVID-19. The gender distribution was similar between participants with and without COVID-19. More participants with self-diagnosed COVID-19 reported themselves as having any ethnicity other than white compared with those without the disease (6.9% (3.9% to 10.1%) vs 3.8% (3.2% to 4.4%), p=0.019). Gender and ethnicity did not affect the likelihood of having COVID-19.
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Introduction: Annualized relapse rate (ARR) is routinely used as the primary outcome measure in MS clinical trials and is important in service planning. Most disease modifying therapies (DMTs) are prescribed in people with relapsing remitting MS (RRMS) and the ARR of secondary progressive MS (SPMS) and RRMS has not been accurately described in a modern clinical cohort. Recent treatment advances have led to more people with MS being effectively managed with early intensive medications, reducing the frequency of reported relapse rates in RRMS. Aims: To facilitate MS service planning and improve the feasibility estimations for clinical trials in MS. Objectives: To establish a current estimated ARR observed in a contemporary MS clinic in the UK. Methods: A retrospective cohort study examined all relapses recorded in a university hospital serving the local MS population. A random sample of 812 MS Nottingham patients from our database were reviewed for reported relapses from April 1 to June 30, 2020 and the same period in 2019, to account for potential reporting bias during the COVID-19 pandemic. The MS clinical database, nurse and admin registries, medical and telephone records for those individuals were reviewed at the end of 2020 for possible relapses during the study periods. Results: Among MS patients followed up in clinic, 60% had RRMS, 23% SPMS, 14% PPMS and 4% CIS. We identified 30 clinician confirmed relapses during the study period equating to an ARR of 0.15 for all MS patients treated and untreated. 70% of RRMS and 18% of SPMS were on DMTs. The ARR in RRMS and SPMS were the same (0.15). Validating this with pre-pandemic 2019 records found similar results. Conclusions: This contemporary UK-based study reports halving of the ARR previously reported in 2 similar studies in the UK 8 years ago. While relapse prevention has been achieved in RRMS, there appears to be significant unappreciated relapses occurring in the SPMS (pre-siponimod) cohort.
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Introduction: The COVID-19 pandemic potentially affected decisions around prescribing MS disease modifying therapies (DMTs) due to concerns about the safety of their use and disruptions to healthcare services. Objectives: To depict prescribing trends of MS DMTs during the COVID-19 outbreak in England and compare it to DMT use in other countries. Aims: To understand the effect of the pandemic on prescribing MS DMTs in England compared to other countries. Methods: National Health Service (NHS) England and NHS Improvement data on all issued MS DMT prescriptions during (1/03/2020 to 31/12/2020) and before (1/05/2019 to 29/02/2020) the outbreak was analysed. Interrupted time series analysis was used to depict the effect of the outbreak in England on prescribing trends of total and individual DMTs which will be presented as diagrams. Results: The outbreak had not affected the stationary trend of total DMT prescriptions;median (interquartile range) number of prescriptions per month was 20789 (2489) before and 21102 (1824) during the outbreak. COVID-19 significantly accelerated the pre-pandemic decline of alemtuzumab prescriptions, which dropped from 219 (85) to 63 (31) per month and remained low. The upward trend of cladribine and ocrelizumab prescriptions before the outbreak was interrupted by the first wave with their nadir during the first peak (April-May 2020). The monthly prescriptions of cladribine and ocrelizumab were 249 (47) and 641 (297) before the outbreak and dropped to 18 and 191 in May 2020, respectively. During the first 10 months of the pandemic, there was a 16% reduction in the number of MS patients treated with their firstever DMT from 3847 before to 3241 during the outbreak. These changes were mostly due to significant reductions in prescription of alemtuzumab, cladribine, and ocrelizumab especially during the peaks of the first and second (November 2020) waves of the outbreak which were not compensated by other DMTs. There was an increase in monthly natalizumab prescriptions as first-ever treatment from 32 (18) before to 61 (24) during the outbreak. Conclusion: These changes reflect recommendations of published guidelines on MS DMT use. Comparison of prescribing trends of MS DMTs in England with those from other countries highlights the interplay of different factors in altering DMT prescription practices. These observations have implications in population- based studies involving MS disease activity including the period of the COVID-19 pandemic.
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Introduction: Neurological symptoms of COVID-19 such as fatigue and cognitive and mental health problems constitute the most common long-lasting symptoms of the infection (long COVID) and are also prevalent in MS. Objectives: To assess the prevalence of and factors associated with long COVID in people with MS (pwMS). Aims: To understand how pwMS are affected by long COVID. Methods: This is an ongoing prospective and longitudinal community- based observational study in a national cohort of pwMS who have been reporting whether they have had symptoms suggestive of COVID-19 using the online questionnaire-based platform of the UK MS Register (UKMSR) since 17/03/2020. PwMS with COVID-19 have been regularly followed up to update their recovery status. Here, we report the findings until 19/03/2021. The UKMSR holds demographic and clinical data of registered pwMS and their pre-COVID-19 web-based Expanded Disability Status Scale (web-EDSS) and Hospital Anxiety and Depression Scale (HADS) scores (HADS scores ≥11 were considered as probable anxiety or depression), which allowed us to examine the effects of these variables on recovery from COVID-19 using multivariable Cox regression analysis. The results will be updated prior to ECTRIMS 2021. Results: Out of 1,096 pwMS with COVID-19, 599 updated their recovery status (participants);their median (interquartile range) age was 50 (41-57) years and 462 (77.1%) were women. 458 participants (76.5%) reported full recovery and 141 participants (23.5%) had persistent symptoms at their last follow-up. At least 181 participants (31.1%) had persistent symptoms for ≥4 weeks and 76 (13.1 %) for ≥12 weeks. Participants with higher web- EDSS scores (adjusted Hazard Ratio: 95% Confidence Interval, 0.92: 0.86-0.98), participants with anxiety and/or depression (0.70: 0.53-0.92), and women (0.78: 0.63-0.97) were less likely to recover from COVID-19. Taking DMTs was not associated with recovery from COVID-19 (0.92: 0.74-1.14). Conclusion: The prevalence of long COVID in pwMS appears to be higher than the general population (13.3% ≥4 weeks and 2.3% ≥12 weeks), and those with higher levels of pre-COVID-19 neurological impairment or mental health problems are at higher risk of long COVID. We have previously shown that COVID-19 can also lead to MS exacerbations. These observations indicates that pwMS require individualised pathways for the effective management of their post-COVID-19 rehabilitation.
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Background: The effects of MS disease modifying therapies (DMTs) on COVID-19 morbidity and mortality have been studied in clinician-reported registries, but the true prevalence of SARSCoV-2 infection and its outcomes in the MS population receiving DMTs are unknown. Objectives: To assess the prevalence of SARS-CoV-2 infection and its outcomes, and their association with individual DMTs among all MS patients receiving DMTs in England. Aims: To understand the magnitude of COVID-19's impact on a population of MS patients receiving DMTs. Methods: We analysed merged national databases to ascertain the rate of SARS-CoV-2 positive tests and COVID-19 in-hospital mortality among all MS patients receiving DMTs in England from 1/02/2020 to 27/03/2021. The National Health Service (NHS) England and NHS Improvement collect prescribing and dispensing data on all MS DMTs. Public Health England collects data on all SARS-CoV-2 tests and COVID-19 in-hospital deaths. Further clinical data collection on a random sample of patients who tested positive (cases) or were not tested (controls) for SARS-CoV-2 is ongoing in multiple centres to establish risk factors of adverse COVID-19 outcomes without selection bias. Results: A total of 35556 MS patients had received a DMT. Their mean (standard deviation) age was 44 (12) years. A total of 16,108 patients (45.3%) were tested for SARS-CoV-2, and 2000 (5.6%) tested positive with a mean age of 42 (12) years. Twentysix patients with a positive test (1.3%) died in hospital. Their mean age was 54 (16) years. The age-standardised mortality ratio (95% confidence interval) of the MS versus the general population was 1.2 (0.7-1.7). There was no clear difference between individual DMTs in their rates of positive tests or inhospital mortality. Detailed data on 79 randomly selected patients with a positive test has been collected at two centres so far. Their mean age is 44 (11) years and 55 (69.6%) are women. Five were hospitalised due to COVID-19 out of whom one was admitted to an intensive therapy unit and died. Data will be updated and reanalysed prior to ECTRIMS 2021. Conclusions: So far, COVID-19 does not appear to significantly increase the risk of mortality in MS patients on DMTs compared to the general population, in this large population study.
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Introduction: Ocrelizumab is licenced for a fixed treatment interval of six-monthly infusions to treat multiple sclerosis (MS). Disruption in clinical services, triggered by the COVID-19 pandemic, has led to extended intervals between treatments for some patients. Increasing evidence suggests that extended interval dosing of another anti-CD20 medicine, rituximab, maintains its efficacy while reducing the risks of immunosuppression. Objectives: To assess for evidence of clinical or radiological MS disease activity with extended interval dosing of ocrelizumab. To assess the rates of developing low immunoglobulin levels and timing of CD19+ B-cell count repopulation in a real-world clinical population. Methods: We audited the clinical, radiological and immunological data of 301 patients given ocrelizumab by our clinical services. Baseline demographics included age, sex, previous disease modifying treatment (DMT), phase of MS, and Expanded Disability Status Scale (EDSS). Dates of ocrelizumab administration were recorded. Disease activity was defined as on treatment EDSS progression, radiological activity or clinical relapse. All monitoring of CD19+ cell counts and immunoglobulin levels were recorded. Results: 301 participants were included in the analysis, among whom 62% were women, the mean age was 43 years and the median baseline EDSS was 3 (IQR 1-6). Half had previously used other DMTs and six (2%) had low immunoglobulin levels at baseline. They received 966 treatment cycles, of which 70 were administered with a treatment interval of 7-8 months, 45 with an interval of 8-9 months and 14 with an interval of more than nine months. In total, 131 (44%) participants had extended interval dosing. Disease activity included 33 (11%) with EDSS progression, 16 (5%) with new MRI lesions and 4 (1%) participants had clinical relapses. The odds ratio for rates of disease activity comparing extended to standard interval dosing was 0.97. Low immunoglobulin levels developed in 22 (7%). The longest recorded suppression of CD19+ B-cells was 405 days. We will present our mixed effects linear regression model of the factors that influence CD19+ count repopulation. Conclusions: This real-world data of extended interval dosing of ocrelizumab indicates no detrimental effect on short-term treatment efficacy. Our CD19+ dataset, could inform the design of a prospective trial of individualised retreatment intervals in ocrelizumab.
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BACKGROUND: In March 2020, the United Kingdom Multiple Sclerosis Register (UKMSR) established an electronic case return form, designed collaboratively by MS neurologists, to record data about COVID-19 infections in people with MS (pwMS). OBJECTIVES: Examine how hospital admission and mortality are affected by disability, age and disease modifying treatments (DMTs) in people with Multiple Sclerosis with COVID-19. METHODS: Anonymised data were submitted by clinical teams. Regression models were tested for predictors of hospitalisation and mortality outcomes. Separate analyzes compared the first and second 'waves' of the pandemic. RESULTS: Univariable analysis found hospitalisation and mortality were associated with increasing age, male gender, comorbidities, severe disability, and progressive MS; severe disability showed the highest magnitude of association. Being on a DMT was associated with a small, lower risk. Multivariable analysis found only age and male gender were significant. Post hoc analysis demonstrated that factors were significant for hospitalisation but not mortality. In the second wave, hospitalisation and mortality were lower. Separate models of the first and second wave using age and gender found they had a more important role in the second wave. CONCLUSIONS: Features associated with poor outcome in COVID-19 are similar to other populations and being on a DMT was not found to be associated with adverse outcomes, consistent with smaller studies. Once in hospital, no factors were predictive of mortality. Reassuringly, mortality appears lower in the second wave.
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COVID-19 , Multiple Sclerosis , Humans , Male , Multiple Sclerosis/epidemiology , Multiple Sclerosis/therapy , Pandemics , Patient Reported Outcome Measures , SARS-CoV-2ABSTRACT
Objective: To assess factors associated with recovery from the coronavirus disease 2019 (COVID-19) among people with multiple sclerosis (pwMS) Background: It is important to understand the recovery process from COVID-19 among pwMS to identify those who are most vulnerable to the long-term sequelae of infection. Design/Methods: The UK MS Register COVID-19 study is a community-based prospective cohort of pwMS launched on March 17th, 2020. We have been collecting data from participants (n=6,618 as of October 5th, 2020) every two weeks from the time of their enrolment in the study. We ask participants about COVID-19 and follow them through their recovery. The UK MS Register holds pre-COVID-19 longitudinal and prospectively collected patient-reported data including web-based Expanded Disability Status Scale (webEDSS), MS Impact Scale (MSIS-29), and Hospital Anxiety and Depression Scale (HADS) scores. Results: Out of 709 participants with self-diagnosed COVID-19, 391 responded to the follow-up questionnaires. 76% (n=297) had fully recovered, 15.9% (n=62) had mostly recovered, and 8.2% (n=32) were still experiencing symptoms at the time of their latest follow-up. Among participants with full recovery, the median (IQR) duration of disease was 10 (6-21) days. Participants who had not recovered completely had been followed up for a median (IQR) duration of 105 (35-131) days. PwMS who had a higher webEDSS score (OR 0.78, 95%CI 0.65-0.93) or physical component of MSIS-29 score (OR 0.97, 95%CI 0.96-0.98) were less likely to report a full recovery. The presence of anxiety (HADS-anxiety ≥11), recorded the year before the pandemic, was associated with a lower probability of complete recovery (OR 0.26, 95%CI 0.10-0.66). Demographics, diseasemodifying therapies, MS duration, or type of MS were not associated with recovery. Conclusions: Physical disability and anxiety prior to the pandemic are the main determinants of persistent COVID-19 symptoms among people with MS.
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Background: The UK MS Register captures longitudinal data directly from people with MS (pwMS) as patient reported outcome measures but also from NHS Trusts via electronic Case Return Form (eCRF). As part of our response to the COVID19 pandemic we designed an anonymised clinical capture instrument to allow clinicians from non affiliated NHS hospitals capture important clinical data on incident cases. Here we outline our current clinicians reported findings from these collected data. Objectives: Report on patients with Multiple Sclerosis and COVID as reported by UK National Health Service MS clinicians to the UK MS Register Methods: Data were captured using the RedCap platform to design forms and were stored on secured databases at Swansea University Medical School. The URL for data capture was shared on social media and via clinician groups to encourage as many clinicians as possible to report hospitalised pwMS and confirmed COVID. Variables included: Age, Gender, MS Type, Expanded Disability Status Score (EDSS), Disease Modifying Therapy (DMT) Details, COVID clinical treatment and outcomes. Results: Between 27/03/2020 and 14/07/2020, 93 patients with COVID were reported. Their mean Age was 53.38 (±14.2) and median EDSS 6.0. Of these 11 patients died with mean Age 63.7(±10.9). Median EDSS 8.0. Multivariate regression showed increased EDSS score to be the most significant factor for mortality (P <0.01) with the other variables (age, gender, disease type, DMT,) not influencing mortality. All the patients that died had progressive MS and only one was on a DMT. Conclusions: Here we present the UK PwMS, with laboratory confirmed COVID19 as reported by hospital clinicians. We found increased disability rather than age or MS type to be the only predictor of mortality. These results are strikingly different from the patients reported UK MS register COVID study (separate abstract) that had a much milder COVID illness that led to hospitalisation in only 3% of the cases.
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Introduction: The Coronavirus disease 2019 (COVID-19) pandemic has created uncertainties about different aspects of the lives of people with multiple sclerosis (PwMS). We intend to understand the impact of the virus and the risks of the infection in PwMS. Methods: The study was launched on 17 March 2020 as part of the United Kingdom (UK) MS Register (UKMSR), a research project with 13,916 PwMS registered as of 22 April 2020 which holds longitudinal data about patients' demographics, MS related and other medical information, and patient-reported outcome measures since 2011. All patients on the UKMSR were asked to participate in the study by completing COVID-19 related questionnaires fortnightly. Telephone interviews by a neurologist confirmed the suspected diagnosis of COVID-19 based on symptoms. We also asked healthcare professionals to provide anonymised data on MS patients with COVID-19 using a separate questionnaire. Results: As of 22 April 2020, 3,702 PwMS participated in the study and recruitment is on-going. A total of 196 (5.29%) participants reported that they had suspected COVID-19 out of which 41 (20.92%) reported having been diagnosed by a healthcare professional. Only three (1.53%) of the patients with suspected COVID-19 required hospitalisation. On the contrary, out of the 26 suspected COVID-19 cases reported by clinicians, 21 have positive polymerase chain reaction tests and 3 have died. Conclusion: These contrasting results emphasise the need to supplement clinician-reported outcomes with community- based studies to understand the true impact of COVID-19 in PwMS.