ABSTRACT
BACKGROUND: Multiple sclerosis (MS) prevalence is rising in the Middle East. Most MS medications are available in the region, but not all, possibly affecting neurologists' prescribing habits. OBJECTIVES: To provide an overview of the current practices of Near East (NE) healthcare practitioners by probing their prescribing decisions, to report the COVID-19 impacts on neurologists' prescribing habits, and to explore the future relevance of current medication used in MS management among other newcomers. METHODS: A cross-sectional study was carried out using an online survey from April 27, 2022, to July 5, 2022. The questionnaire was designed with the input of five neurologists representing five NE countries (Iran, Iraq, Lebanon, Jordan & Palestine). They identified several factors that play a crucial role in the optimal care of MS patients. The link was shared among neurologists using snowball sampling. RESULTS: The survey included 98 neurologists. Effectiveness and safety balance was the most important factor considered when selecting the MS treatment. Among patients with MS, the most challenging factor for the patients was thought to be related to family planning, followed by affordability and tolerability of side effects. In the treatment of mild to moderate relapsing remitting multiple sclerosis (RRMS) in men, Interferon beta 1a SC, Fingolimod, and Glatiramer acetate were the most commonly recommended treatments. Dimethyl fumarate substituted fingolimod in female patients. Interferon beta 1a SC was the safest treatment for mild to moderate RRMS. Interferon beta 1a SC was preferred over other treatments for patients with mild to moderate MS and planning for pregnancy (56.6%) or breastfeeding (60.2%). Fingolimod was not a choice for these patients. Neurologists seemed to discuss the top three treatments of Natalizumab, Ocrelizumab, and Cladribine with patients with highly active MS. When asked to position future disease-modifying therapies five years from today, more than 45% of physicians expressed a lack of information on Bruton's tyrosine kinase (BTK) inhibitors. CONCLUSIONS: Most neurologists in the NE region followed Middle East North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) recommendations for prescribing treatment. The treatment choice also depended on the availability of disease-modifying therapies (DMTs) in the region. Regarding the use of upcoming DMTs, there is a clear need for real-world data, long-term extension studies, and comparative studies to support their efficacy and safety profiles in treating patients with MS.
ABSTRACT
Objective(s): The objectives were to provide an overview of the current practices of Near East (NE) healthcare practitioners (HCPs) by probing their prescribing decisions, to report the COVID-19 impacts on neurologists' prescribing habits, and to explore the future relevance of current medication used in MS management among other newcomers Material(s) and Method(s): A cross-sectional study was carried out using an online survey from April 27, 2022, to July 5, 2022. The questionnaire was designed with the input of five neurologists representing five NE countries (Iran, Iraq, Lebanon, Jordan & Palestine). They identified several factors that play a crucial role in the optimal care of MS patients. The link was shared among neurologists using snowball sampling Result(s): The survey included 98 neurologists from the included NE countries, the majority of whom had more than 15 years of experience in the field, and 39% were seeing more than 40 MS patients a month. Effectiveness and safety balance was the most important factor considered when selecting the MS treatment. In the treatment of mild to moderate RRMS in men, Interferon beta 1a SC, Fingolimod, and Glatiramer acetate were the most commonly recommended treatments. Dimethyl fumarate substituted fingolimod in female patients. According to 80.7% of participants, interferon beta 1a SC was the safest treatment for mild to moderate RRMS. Interferon beta 1a SC was preferred over other treatments for patients with mild to moderate MS and planning for pregnancy (56.6%) or breastfeeding (60.2%). Fingolimod was not a choice for these patients. Neurologists seemed to discuss the top three treatments of Natalizumab, Ocrelizumab, and Cladribine with patients with highly active MS. Conclusion(s): Most neurologists in the NE region followed MENACTRIMS recommendations for prescribing treatment. The treatment choice also depended on the availability of DMTs in the region. Regarding the use of upcoming DMTs such as Ofatumumab, Siponimod, Ozanimod, and BTK inhibitors, there is a clear need for real-world data, long-term extension studies, and comparative studies to support their efficacy and safety profiles in treating patients with MSCopyright © 2022
ABSTRACT
Introduction: It seems that Multiple sclerosis (MS) patients are at the higher risk for COVID-19 implications due to the use of immunomodulatory or immunosuppressive treatments. Obesity as a risk factor may lead to more adverse consequences. Relationship between obesity and COVID-19 risk and outcome in Iranian MS patients still remains unclear. We aimed to investigate the impact of BMI as a modifiable risk factors on the risk and outcomes of COVID-19 in Iranian patients with MS. Material(s) and Method(s): A cross-sectional study was conducted in the Sina hospital, Tehran, Iran. MS patients were asked to complete an online questionnaire in the google form format. Demographic information, clinical data consisting of MS disease-related factors, COVID-19-related factors, and anthropometric information were collected. In total, 492 patients were filled the questionnaire. BMI was categorized considering WHO's standard classification as underweight (BMI<18.5), normal weight (BMI>=18.5 and <25), overweight (BMI>=25 and <30), obesity type I (BMI>=30 and <35), and obesity type II (BMI>=35) (3). Result(s): The mean age was 36.7+/-8.2 and 395(80.3%) of them were women. 350(71.1%) of participants were suffered from RRMS. The most received MS drugs was Rituximab (36.0%). The mean BMI was 24.3+/-4.5 kg/m2. 234(47.6%) participants reported COVID-19 infection during the pandemic. 465(94.5%) of them were two doses vaccinated and 15(3%) of them were one-dose vaccinated. The odds ratio of COVID-19 infection was significantly 4.41 times more than the normal group in the type 2 obesity category (OR:5.41;95%CI:1.00-29.09) in the fully adjusted regression model. COVID-19 severity was significantly different in BMI groups (P:0.02), So that 11(8.6%) patients in normal weight group and 4(50%) of patients in type II obesity group were hospitalized due to COVID-19 infection. Respiratory symptoms (P:0.05) and gastrointestinal symptoms (P<0.01) were more prevalent among types I and II of obesity. On the other hand, no one in the obesity type I and II reported COVID-19 infection without any symptoms (P:0.04). Conclusion(s): The results of current study support that obesity could play a key role in susceptibility to COVID-19 infection and symptoms severity in MS patients. One of the issues that emerge from these findings is recommended that neurologists pay more attention on patients' BMI during this pandemic.Copyright © 2022
ABSTRACT
Background Management of patients with multiple sclerosis (MS) and evidence of disease activity during treatment with cladribine tablets represents a challenging point. Objectives To report a patient with highly active multiple sclerosis (HAMS) who has been early switched from cladribine to alemtuzumab owing to tumultuous clinical and radiological activity Methods A single retrospective case report. Results. Treatment with alemtuzumab has led to a complete suppression of disease activity without any evidence of infections or acquired autoimmune diseases. Conclusion Our report suggests that an early switch from cladribine to alemtuzumab, may be safe and efficacious in selected HAMS cases.Copyright © 2022 The Authors
ABSTRACT
Background: Disease-modifying drugs (DMDs) are an inseparable part of multiple sclerosis (MS) management, which have dramatically changed the prognosis and course of the disease. A change during DMD therapy, which includes switching or stopping (temporary or permanent) medication, can manipulate the goals and has various causes such as side effects, ineffectiveness of treatment, patient's preference, presence of concurrent diseases and pregnancy. Therefore, we aimed to investigate the patterns and causes of DMD change in patients with MS (PwMS) in Tehran, Iran. The understanding will help us identify opportunities to improve adherence and ultimately patient outcomes and health system efficiency through effective education, and recognition of more tolerable or simpler regimens. The aim of this study is to identify rate and pattern of DMDs among PwMS in Tehran. Material(s) and Method(s): The study population of this cross-sectional was all PwMS in Tehran province who had changed their DMD for any reason in the last 5 years until June 2, 2022. The basic information was extracted through nationwide MS registry of Iran (NMSRI), Tehran, where all MS data including diagnosis had been confirmed by trained neurologists based on the 2017 revisions of the McDonald criteria. Moreover, supplementary unregistered data were gathered through telephone follow-ups carried out by 6 trained physicians with precise quality checks. The questionnaires covered 5 aspects of MS including demographics, disease history, diagnosis, progress and treatment. DMDs were classified into 10 general classes. All participants were asked to attribute the change to distinct categories following a written pre-existing consent. IBM SPSS (version 23) was used for statistical analysis. All the steps taken were in complete adherence with the tenets of the declaration of Helsinki. Result(s): Among 1999 enrolled patients with a mean age of 36.9+/-9.4 and total disease duration of 7.06+/-5.8 years, 1315 experienced change (Group 1) during study period, while 684 did not (Group 2). There was no difference in terms of demographic characteristics between the two groups. On the other hand, Group 1 had longer disease durations and more comorbidities (P <0.001). Getting infected with COVID-19 more than 4 times was observed to be significantly higher in Group 1 (P =0.032). Unlike Patients with PPMS and RRMS, SPMS patients showed higher EDSS scores when experiencing no DMD change. The most widely used DMDs were interferons, while ocrelizumab was the least used drug. Corona virus had the most effect on the change of ocrelizumab. Conclusion(s): DMD change generally occurs independent of socioeconomic level. Since most of the patients (65.8%) experienced DMD change, which serves as the biggest cost component in PwMS, the economic aspects of MS management in this field should be considered in the future.Copyright © 2022
ABSTRACT
Background: Dimethyl fumarate (DMF) is an approved treatment for multiple sclerosis (MS). Due to its efficacy and safety profile, DMF is the most prescribed oral medication for relapsing remitting (RR) MS. Given the long-term course of treatment with DMF in MS, continuous surveillance of opportunistic infections is fundamental. Case presentation: We report the occurrence of facial herpes zoster (HZ) associated with MS disease reactivation in a person with RRMS after 6 years of DMF therapy. Case report: A 44-year-old woman with RRMS developed right temple pain and blisters over the right cheek, suggestive of facial HZ. A normal lymphocyte count with however relatively lower proportions of CD8+ T cells and higher percentages of natural killer cells were detected in blood. The patient failed oral treatment and required hospitalization for intravenous acyclovir. She eventually developed symptoms of an MS exacerbation featured by lower extremities weakness and urinary retention. Conclusion(s): Our case highlights the importance of counseling patients on the possibility of HZ reactivation even in the setting of a normal lymphocyte count, the risk of MS exacerbation possibly associated with HZ occurrence and the importance of timely vaccination.Copyright © 2022
ABSTRACT
Natalizumab, a humanized anti-alpha4-integrin antibody, is a valuable therapeutic option for relapsing-remitting multiple sclerosis and has been widely used in this indication since 2006. The growing body of data on its high efficacy and safety profile, both from randomised trials and clinical practice, has allowed to identify risk factors for progressive multifocal leukoencephalopathy and to develop a preventive algorithm, which increased the therapeutic safety. Natalizumab also seems relatively safe in pregnant women as there is no indication in the available literature suggesting that exposure to this drug has a significant impact on pregnancy outcomes. However, adequate and well-controlled studies are still lacking and natalizumab should only be used in pregnancy if clearly needed. The mechanism of action of natalizumab also proved successful during the COVID-19 pandemic. Most patients receiving this therapy experienced only mild infection and developed normal vaccine-induced immunity after immunisation. We present a description of 15 patients with relapsing-remitting multiple sclerosis treated with natalizumab in 15 different centres throughout Poland. The drug was included both due to first-line treatment failure and in cases of rapidly progressing, severe form of multiple sclerosis. The patients differed in terms of disease duration, the length of natalizumab therapy, and JCV serological status. The described cases include patients from the natalizumab registration trial, women who became pregnant while on the therapy, and patients who developed COVID-19. The presented case reports summarise the experience to date with the use of natalizumab in the treatment of relapsing-remitting multiple sclerosis in PolandCopyright © 2022 Buchajewicz et al.
ABSTRACT
The proceedings contain 14 papers. The topics discussed include: MOG-positive anti-NMDA receptor encephalitis with no demyelinating lesions: two case reports;safety and tolerability of rozanolixizumab in the randomized phase 3 MycarinG study;Outcomes from RAISE: A randomized, phase 3 trial of zilucoplan in generalized myasthenia gravis;efficacy and safety of zilucoplan in myasthenia gravis: responder analysis from the randomized Phase 3 RAISE trial;distinct effects among calcium-binding proteins for microglia to produce chemokines associated with the clinical severity of ALS;astroglial connexin 43 is a novel therapeutic target for a chronic multiple sclerosis model;targeting lymphocytes in SPMS: Th cell populations as a biomarker to predict the efficacy of Siponimod;CSF lysophospholipids as a novel biomarker in relapsing-remitting multiple sclerosis;the immune response to SARS-COV-2 MRNA vaccines in siponimod-treated patients with secondary progressive multiple sclerosis;patient characteristics of siponimod-treated SPMS patients in Japan: interim results from post-marketing surveillance;and efficacy of ravulizumab across sex and age subgroups of patients with generalized myasthenia gravis: a post hoc analysis of the CHAMPION MG study.
ABSTRACT
BACKGROUND: The prevalence of multiple sclerosis (MS) in older people is increasing due to population aging and availability of effective disease-modifying therapies (DMTs). Treating older people with MS is complicated by age-related and MS-related comorbidities, immunologic effects of prior DMTs, and immunosenescence. Teriflunomide is a once-daily oral immunomodulator that has demonstrated efficacy and acceptable safety in clinical trials of adults with relapsing forms of MS (RMS). However, there are limited clinical trial and real-world data regarding teriflunomide use in people with MS aged >55 years. We analyzed real-world data to assess the effectiveness and safety of teriflunomide in older people with RMS who had switched to this agent from other DMTs. METHODS: People with RMS (relapsing remitting and active secondary progressive MS) aged ≥55 years who had switched from other DMTs to teriflunomide (7 mg or 14 mg) for ≥1 year were identified retrospectively by chart review at four sites in the United States. Data were extracted from medical records from 1 year pre-index to 2 years post-index (index defined as the teriflunomide start date). Assessments of effectiveness included annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) score, and magnetic resonance imaging (MRI) outcomes. Assessments of safety included lymphocyte counts, infections, and malignancies. We examined the effectiveness outcomes and lymphocyte counts within sub-groups defined by age (55-64, ≥65 years), sex, MS type, and prior route of DMT administration (oral, injectable, infusible). RESULTS: In total, 182 patients with RMS aged ≥55 years who switched from other DMTs to teriflunomide were identified (mean [SD] age: 62.5 [5.4] years). Mean ARR decreased from the start of teriflunomide treatment (mean [SD]: 0.43 [0.61]) to year 1 post-index (0.13 [0.65]) and year 2 post-index (0.05 [0.28]). Mean EDSS score remained unchanged from index (mean [SD]: 4.5 [1.8]) to 1 year post-treatment (4.5 [1.8]) and increased slightly at 2 years post-treatment (4.7 [1.7]). MRI scans from index and years 1 and 2 post-index compared with scans from the previous year indicated that most patients had stable or improved MRI outcomes at index (87.7%) and remained stable or improved at years 1 (96.0%) and 2 (93.6%). Lymphopenia decreased at years 1 (21.4%) and 2 post-index (14.8%, compared to index (23.5%). By 1 year post-index, fewer patients had grade 3 or 4 lymphopenia, and at 2 years post-index, there were no patients with grade 3 or 4 lymphopenia. Infection incidence was low (n = 40, 22.0%) and none were related to teriflunomide. The decreases in lymphopenia were driven by decreases among people who switched from a prior oral DMT; there were no notable differences in lymphopenia across the other sub-groups examined. ARR, EDSS score, and MRI outcomes across all sub-groups were similar to the results of the overall population. CONCLUSION: Our multicenter, longitudinal, retrospective study demonstrated that patients with RMS aged 55 or older switching to teriflunomide from other DMTs had significantly improved ARR, stable disability, and stable or improved MRI over up to 2 years' follow up. Safety results were acceptable with fewer patients exhibiting lymphopenia at years 1 and 2 post-index.
Subject(s)
Leukopenia , Lymphopenia , Multiple Sclerosis, Relapsing-Remitting , Multiple Sclerosis , Adult , Humans , Aged , Middle Aged , Multiple Sclerosis/drug therapy , Retrospective Studies , Crotonates/therapeutic use , Toluidines/therapeutic use , Recurrence , Lymphopenia/chemically induced , Multiple Sclerosis, Relapsing-Remitting/drug therapyABSTRACT
OBJECTIVES: To compare the clinical and radiological effectiveness of ocrelizumab in primary progressive multiple sclerosis (PPMS) and relapsing-remitting multiple sclerosis (RRMS) in a clinical practice setting and describe its tolerability and adverse events. METHODS: A retrospective observational cohort study was conducted comparing clinical and magnetic resonance imaging (MRI) data of all patients with (pw)PPMS and RRMS who had received treatment with ocrelizumab at least one cycle and have been followed up for one year at minimum. RESULTS: 42 patients (27 women) treated with ocrelizumab: 29 had RRMS and 13 PPMS. The follow-up period was 26.4 ± 8.4 months. The proportion of pwRRMS with no evidence of disease activity (NEDA) in the first year was 69.2% and in the second was 80%. In the first year, radiological activity was reduced by 80.0% in pwRRMS and 91.7% in pwPPMS. In the second year, radiological activity was completely reduced in both groups. A statistically significant difference (p<0.05) was observed between the pre-ocrelizumab rate of disability progression vs. the first year rate of progression for pwRRMS and pwPPMS. However, an increase in the disability progression rate in the second year of treatment was found in pwPPMS. Ocrelizumab was mostly well tolerated and some adverse effects were reported: infusion-related reactions (IRRs) were the most frequent adverse event, followed by infections and hematological side effects. Discontinuations were due to infections, hematological complications, and perception of ineffectiveness. CONCLUSIONS: Ocrelizumab was very effective in reducing relapses and MRI activity. The rate of progression was slowed down; however, the effect was more evident for pwRRMS than for pwPPMS over time.
Subject(s)
Drug-Related Side Effects and Adverse Reactions , Multiple Sclerosis, Chronic Progressive , Multiple Sclerosis, Relapsing-Remitting , Multiple Sclerosis , Humans , Female , Multiple Sclerosis/drug therapy , Immunologic Factors/adverse effects , Multiple Sclerosis, Chronic Progressive/diagnostic imaging , Multiple Sclerosis, Chronic Progressive/drug therapy , Retrospective Studies , Multiple Sclerosis, Relapsing-Remitting/diagnostic imaging , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Multiple Sclerosis, Relapsing-Remitting/chemically induced , Drug-Related Side Effects and Adverse Reactions/drug therapy , RecurrenceABSTRACT
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system leading to demyelination and neurodegeneration of brain tissue. For a long time, research focused on T cells as the primary mechanism of disease. Driven by reports on the clinical results of B cell-depleting therapies, this therapeutic approach has come into focus in the last decade, and new highly effective treatments have been developed and are now complementing the therapeutic landscape. This review provides an overview of the development of B cell-depleting therapies and shows the advantages and disadvantages of current developments. In addition, we discuss basic considerations for CD20-depleted MS patients in the face of the COVID-19 pandemic.
Subject(s)
COVID-19 , Multiple Sclerosis, Relapsing-Remitting , Multiple Sclerosis , Humans , Rituximab/therapeutic use , Multiple Sclerosis/drug therapy , Pandemics , Antigens, CD20/therapeutic use , Immunologic Factors/adverse effects , Immunotherapy , Multiple Sclerosis, Relapsing-Remitting/drug therapyABSTRACT
Objective: Describing the occurrence of infections in patients with relapsing-remitting multiple sclerosis (RRMS) treated with fingolimod and with different degrees of lymphopenia in our unit. Patients and Methods: Observational, descriptive, longitudinal, and retrospective study in the Hospital Centro Médico Nacional Siglo XXI. Patients with RRMS and treatment with fingolimod were grouped based on lymphocyte count and infections. Quantitative variables were expressed as mean, standard deviation, and interquartile range;qualitative variables were expressed as frequencies and percentages. Results: 110 patients, 76 (69.1%) female, 34 (30.9%) male, mean age 38.3 years (17-63, SD 9.85). Mean of initial expanded disability status scale 1.59 (0-5.5, SD 1.15) with a mean diagnosis time of 63.6 months (3-252, SD 50.96). Prior to starting fingolimod, 90.09% of patients had lymphocyte count >1,000. At six months of treatment, 35.64% had lymphocyte >1,000. At twelve months 32.95% had lymphocyte from 501 to 700. At 24 months, 34.21% had lymphocyte from 701 to 1,000. Of the 110 patients, 31.8% had mild infections, of which pharyngitis was reported in 10%, gastroenteritis 2.7%, urinary tract infection 10.9%, HPV infection 0.9%, SARS-CoV-2 infection 3.6%, ophthalmic herpes 0.9%, molluscum contagiosum 0.9%, oral candidiasis 0.9%. 68.18% did not present infections of any kind, no serious infections were reported even with lymphocyte levels below 200. Conclusions: Selective lymphopenia caused by fingolimod was not associated with infections of any kind in this population even at levels of 200-500 cells/mm³. (English) [ FROM AUTHOR] Objetivo: Describir la ocurrencia de infecciones severas en pacientes con EMRR tratados con fingolimod y con diferentes grados de linfopenia en nuestra unidad Métodos: Estudio observacional, descriptivo, longitudinal y retrospectivo realizado en el Hospital Centro Médico Nacional Siglo XXI. Pacientes con EMRR tratados con fingolimod, se agruparon por grados de linfopenia e infecciones. Las variables cuantitativas se expresaron como media, desviación estándar y rango intercuartil;las variables cualitativas se expresaron en frecuencias y porcentajes. Resultados: 110 pacientes, 76 mujeres (69.1%), 34 hombres (30.9%), media de edad 38.39 (17-63 DE 9.85). Media EDSS inicial 1.59 (0-5.5, DE 1.15), tiempo diagnóstico medio 63.67 meses (3-252, DE 50.96). Previo al inicio de fingolimod, 90.09% de los pacientes tenía linfocitos absolutos >1,000. A los 6 meses de tratamiento, 35.64% tenía >1,000 linfocitos. A los 12 meses el 32.95% tenía 501-700 linfocitos, a los 24 meses el 34.21% tenía 701-1,000 linfocitos. De los 110 pacientes, el 31.8% presentó infecciones leves, de las cuales se informó faringitis en 10%, gastroenteritis 2.7%, infección del tracto urinario 10.9%, infección por VPH 0.9%, infección por SARS-CoV-2 3.6%, herpes oftálmico 0.9%, molusco contagioso 0.9%, candidiasis oral 0.9%. El 68.18% no presentó infecciones de ningún tipo, no se reportó infecciones graves incluso con niveles de linfocitos inferiores a 200. Conclusiones: La linfopenia selectiva causada por fingolimod no se asoció a infecciones severas en esta población incluso en niveles de 200 a 500 células/mm³. (Spanish) [ FROM AUTHOR] Copyright of Revista Mexicana de Neurociencia is the property of Academia Mexicana de Neurologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Conclusive data to suggest a causal link between vaccination against COVID-19 (2019 coronavirus disease) and the onset of multiple sclerosis are currently missing. As of December 31, 2021, only 13 cases of relapsing-remitting multiple sclerosis coinciding with vaccination against COVID-19 have been reported. Clinical signs were observed from day 1 to 5 weeks after vaccination, with magnetic resonance imaging scans showing lesions typical of multiple sclerosis in all cases. Intravenous steroid treatment allowed for improvement in most patients. The paper presents two new case reports of patients who developed neurological symptoms shortly after vaccination against COVID-19, with additional tests and further follow-up allowing for the diagnosis of relapsing-remitting multiple sclerosis. Similar cases described in the medical literature are also presented.
ABSTRACT
Multiple sclerosis (MS) is the most common autoimmune disease in the United States, in which demyelination of the brain and spinal cord disrupts the transmission of signals throughout the body. With an average life expectancy of 30 years from the start of the disease, treatment relies on symptom management through steroids and disease-modifying agents, as there is no cure. While MS patients have not been shown to be at increased risk for coronavirus disease 19 (COVID-19) infection, prolonged hospitalizations and severe COVID-19 sequelae have been linked to various MS subgroups. Limited studies, however, have reported on the role of COVID-19 in precipitating MS exacerbations, as flare-ups often occur during times of stress or immunological insult. Here we present a 45-year-old patient with relapsing-remitting multiple sclerosis whose neurological symptoms worsened sharply in the weeks following an inpatient admission for COVID-19 pneumonia.
ABSTRACT
ÐBJECTIVE: Sleep disturbances and fatigue are frequent symptoms in multiple sclerosis patients. The aim was to assess the quality of sleep (QoS) and fatigue in patients with the relapsing-remitting multiple sclerosis (RRMS), during the coronavirus disease-2019 (COVID-19) pandemic. METHODS: The study included 67 patients with RRMS and 85 healthy control subjects. RRMS patients, who were tested in first half of 2019, were retested in April and May 2020, during the COVID-19 pandemic. We collected sociodemographic and clinical data, and also used the following questionnaires: Pittsburgh sleep quality index (PSQI), Fatigue Severity Scale (FSS), and Multiple Sclerosis Quality of Life-54 Instrument (MSQOL-54). RESULTS: The FSS score and PSQI global score were significantly higher in patients with RRMS than in the control group (p < 0.01). We noticed a statistically significant difference between the results obtained a year ago and the results during the COVID-19 pandemic in PSQI global score (p < 0.01) and all subscores. Higher disability status was an independent predictor of the worse PSQI scores. CONCLUSION: During the COVID-19 outbreak worse QoS were noticed in RRMS patients than in healthy individuals. Also, QoS of RRMS patients is more affected during the COVID-19 pandemic than in regular circumstances. High levels of sleep disturbance and fatigue in RRMS patients correlates with worse life quality, female gender, lower educational level and partner status. The results of the present study provide evidence in support of regular screening and monitoring of fatigue and QoS in this patient population, especially during the pandemic states.
ABSTRACT
BACKGROUND: COVID-19 is speculated to increase the likelihood of relapsing-remitting multiple sclerosis (RRMS) exacerbation. OBJECTIVE: To investigate the association between contraction of COVID-19 and incidence of acute MS attacks in RRMS patients six months post-infection. METHODS: This retrospective cohort study compares the risk of relapse in RRMS patients with (n=56) and without COVID-19 (n=69). Incidence of relapse was recorded for six-month following contraction of COVID-19. Incidence of RRMS exacerbation in patients with COVID-19 was compared to patients without COVID-19 (the independent control group) and the same patients six months prior to the COVID-19 pandemic. RESULTS: A lower incidence rate of RRMS exacerbation was observed in patients that contracted COVID-19 than in patients who did not contract COVID-19 (incidence rate ratio: 0.275; p=0.026). Self-controlled analysis showed no significant difference in relapse rates before the COVID-19 pandemic and after contracting COVID-19 (p=0.222). The relapse risk was not different between patients who had been hospitalized due to COVID-19 severity and those who had not (p=0.710). CONCLUSION: COVID-19 contraction may not increase the risk of acute MS attacks shortly following contraction. We hypothesize that COVID-19-associated lymphopenia may partly preclude the autoreactive memory cells from expansion and initiating relapses through a so-called bystander effect of COVID-19 infection.
Subject(s)
COVID-19 , Multiple Sclerosis, Relapsing-Remitting , Multiple Sclerosis , Bystander Effect , Humans , Multiple Sclerosis, Relapsing-Remitting/epidemiology , Pandemics , Recurrence , Retrospective Studies , SARS-CoV-2ABSTRACT
BACKGROUND: In view of the emerging coronavirus pandemic, the demand for knowledge about the impact of SARS-CoV-2 on people with Multiple Sclerosis (MS) continues to grow. Patients receiving disease modifying therapy (DMT) for MS have a higher background risk of infection-related health care utilization when compared to the general population. Therefore, there is a need of evidence-based recommendations to reduce the risk of infection and also managing MS patients with SARS-CoV-2. CASE DESCRIPTION: We present three patients with history of Multiple Sclerosis (MS) on DMTs presenting with worsening MS symptoms likely pseudo exacerbation who were diagnosed with COVID-19. DISCUSSION: An extensive review of 7 articles was performed, in addition to a brief review on DMTs use in MS patients with COVID-19. In our cases, all patients were on DMT and severe course of disease was noted in 2 cases. No fatality was observed. CONCLUSIONS: This review provides a base on the clinical characteristics, outcomes and the roles of DMTs in MS patients suffering from n-cov-2. Physicians need to be vigilant about considering COVID-19 infection related relapse in the MS patients, especially in this COVID-19 pandemic era and look for pseudo-exacerbation. As most cases are found to have mild course and full recovery on DMTs, further research is needed to formulate evidence-based guidelines. This review will particularly be helpful for the researchers and registries to collect future data on MS and COVID-19.
ABSTRACT
BACKGROUND: The coronavirus disease 2019 (COVID-19) is a global health emergency. The aim was to investigate the impact of COVID-19 pandemic on the psychological status of patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: Data on the socio-demographic and clinical characteristics of 95 RRMS patients were collected. We used a self-designed questionnaire, the Multiple Sclerosis Quality of Life-54 Instrument (MSQOL-54), Hamilton scales for the assessment of anxiety (HAM-A), and depression (HAM-D). Patients who were tested one year ago were reassessed using the same questionnaires during the COVID-19 outbreak. Group of 99 healthy individuals (HC) were tested, using the same questionnaires. RESULTS: The main concerns in RRMS patients were that someone that they know could be infected with COVID-19 (78.5%), or could die due to the infection (33.8%), and the lack of specific treatment options (25.8%). The main concerns about the RRMS status were that their disease would be worse if they get infected with COVID-19 (36.4%), that they would experience some difficulties in drug availability (43.6%), that they could not go to the hospital as usual (72.4%). Results on all questionnaires were worse in RRMS patients than in HC (p<0.01). We noticed a statistically significant difference between the results obtained a year ago and the results from April 2020 in HAM-A (p<0.05). CONCLUSIONS: There is an impact of the COVID-19 pandemic on the psychological status of RRMS patients. Healthcare organizations need to provide professional therapeutic advice and psychosocial support for this population of patients during the pandemic.
Subject(s)
Coronavirus Infections/psychology , Multiple Sclerosis, Relapsing-Remitting/psychology , Pandemics , Pneumonia, Viral/psychology , Adult , Anxiety/epidemiology , Anxiety/etiology , Betacoronavirus , COVID-19 , Female , Humans , Male , Middle Aged , SARS-CoV-2 , Surveys and QuestionnairesABSTRACT
BACKGROUND: The novel Coronavirus SARS-CoV-2, which was identified after a recent outbreak in Wuhan, China, in December 2019, has generated a global pandemic impacting over 200 countries around the world. Recent reports suggest that ACE2, which is the target protein to invade the host, has a ubiquitous presence in human organs, including lung parenchyma, gastrointestinal tract, nasal mucosa, renal and urinary tract, airway epithelia, lymphoid tissues, reproductive organs, vascular endothelium and neurons. In this scenario, neurologists are particularly involved into considering even more specific therapeutic strategies according to the available data during the pandemic. In particular, MS patients are usually receiving disease-modifying therapies (DMTs) with immunosuppressant or immunomodulatory effects, which increase the risk of infections and morbidity, compared with the general population. Development of PML or other serious opportunistic infections during treatment with natalizumab forces to consider whether de-risking strategies are needed in this particular context and how to manage a high-efficacy treatment. METHODS: In this paper we report on a patient treated with natalizumab for relapsing MS who developed COVID-19 and recovered in a few days without complications. RESULTS: After recovery natalizumab has been administered in the window of the extended interval dosing (EID), without reporting any worsening or new symptoms. DISCUSSION: This case supports the opportunity to avoid discontinuing or delaying the retreatment over 8 weeks in patients recovered from a recent COVID-19.