ABSTRACT
Background: Multiple sclerosis (MS) patients have been considered a higher-risk population for COVID-19 due to the high prevalence of disability and disease-modifying therapy use;however, there is little data in our Middle East and North Africa region (MENA) identifying clinical characteristics of MS associated with worse COVID-19 outcomes. Material(s) and Method(s): This a nationwide, multicenter, retrospective cohort study conducted between March 2020 and February 2021 and included MS patients with a suspected or confirmed COVID-19. Using data collected from the MENACTRIMS registry and local COVID-19 registries, the association of patient demographics, MS disease characteristics, and use of disease-modifying therapies with outcomes and severity of COVID-19 illness were evaluated by multivariate logistic models. Result(s): A total of 600 MS patients with suspected (n=58) or confirmed (n=542) COVID-19 (mean age: 36.4 +/- 10.16 years;414 (69%) females;mean disease duration: 8.3+/- 6.6 years) were analyzed. Seventy-three patients (12.2%) had a COVID-19 severity score of 3 or more, and 15 patients (2.5%) died of COVID-19. The median EDSS was 2.0 (range, 0-9.5), and 559 patients (93.2%) were receiving disease-modifying therapy (DMT). There was a higher proportion of patients with a COVID-19 severity score of 3 or more among patients treated with DMTs relative to untreated patients (82.9% vs 17.1%;P < .001), from whom the majority (n=117;19.7%) were maintained on anti-CD20 therapies such as ocrelizumab and rituximab. Comorbidities mainly hypertension and cardiovascular diseases, progressive MS, disease duration, and EDSS were associated with severe or worse COVID-19 disease outcome. Multivariate logistic regression analysis showed that older age (odds ratio per 10 years, 1.5 [95%CI, 1.1-2.0]), male gender (OR, 2.1 [95%CI. 1.2-3.8]), obesity (OR, 2.8 [95%CI, 1.3-5.8]), and treatment ocrelizumab/rituximab (OR for ocrelizumab, 4.6 [95%CI. 1.2-17.7], OR for rituximab, 14.1 [95%CI, 4.8-41.3]) or off-label immunosuppressive medications such as azathioprine or mycophenolate mofetil (OR, 8.8 [95%CI. 1.7-44.0]) were risk factors for moderate to severe COVID-19 requiring hospitalization. Surprisingly, smoking and diabetes were not identified as risk factors for severe COVID-19 disease in our cohort. Conclusion(s): In this registry-based cohort study of patients with MS, age, sex, EDSS, obesity, progressive MS were independent risk factors for severe COVID-19. Moreover, there was an association found between exposure to anti-CD20 DMTs and COVID-19 severity. Knowledge of these risk factors may help improve the clinical management of MS patients with COVID-19 infection.Copyright © 2022
ABSTRACT
Background and aims: The COVID-19 pandemic persisting crisis showed an upheaval on the whole world. People with multiple sclerosis (MS) are a particularly vulnerable group. We aimed to assess how this pandemic has affected MS patients during the lockdown decreed in Tunisia. Methods: After obtaining the approval of ethics committee, a phone survey was conducted from the 15th of May to the 15th of June in the MS center in Razi hospital in Tunis- Tunisia. The designed questionnaire includedin particular the impact of the lockdown on patients' medical follow-up, MS symptoms, treatment availability and daily lifestyle and professional activities. Results: A total of 213 questionnaires were fulfilled. There was no SARS CoV-2 infected case in our cohort. Patients completely followed quarantine guidelines in 176 cases (82.6%). Professional activities were totally stopped in 80.3% while teleworking was adopted in only 4.9% of active patients. During the lockdown, 46 patients (21.6%) experienced a relapse. Steroids were prescribed in 15 cases. Exacerbation of existing symptoms related to MS was described by 133 patients (mainly mood disorders (87%) and sleep disturbances (62%)). About 58 patients interrupted their MS treatments mainly because of mobility issues (n=24) and treatment unavailability (n=27). This was significatively associated with the exacerbation of neuropathic pain (p=0.01)) but not with relapses (p=0.27). Physical activity interruption was associated to the exacerbation of fatigue (p=0.02). Conclusion: COVID-19 lockdown negatively affected our MS patients especially in work, psychological state and MS treatments availability. As a consequence, worsening of MS related symptoms and psychiatric features were described.