SARS-COV-2 infection impact on patients with multiple sclerosis and neuromyelitis spectrum disorder in a Colombia cohort

ABSTRACT

Background: SARS-COV2, the virus responsible for COVID-19, has posed unique challenges in the management of individuals with demyelinating diseases. Objective: To describe the demographic, clinical, and outcome characteristics of patients diagnosed with multiple sclerosis and spectrum of neuromyelitis optica disease who had a SARS-CoV-2 infection during the pandemic. Methods: A retrospective descriptive study was carried out of a cohort of patients diagnosed with multiple sclerosis (MS) and neuromyelitis optic spectrum disease (NMOSD) who got infected with SARS-CoV-2. Results: 26 patients were included. Median age was 33.5 years (IQR 29-44), 81% of them were female, with a median duration of disease of 5 years (IQR 3-14). The diagnosis of COVID-19 infection was established by reverse transcriptase polymerase chain reaction (RT-PCR) in 14 patients. The remaining patients were diagnosed based on clinical symptoms and an epidemiological nexus. 77% have diagnosis of RRMS, 11% of PPMS, and seropositive and seronegative NMOSD, 8 and 4% respectively. 65% had minimal or no disability (EDSS 0 to 2), and 23% had a higher functional compromise (EDSS 6 to 9). 35% received Natalizumab, 19% Fingolimod, 15% Ocrelizumab, 8% Alemtuzumab, and 8% Rituximab;15% were not receiving DMT, and 27% had received the last dose of their respective DMT in the previous 30 days[IA1]. 12% of patients had comorbidity with hypothyroidism, 12% migraine, 8% dysautonomia and 4% diabetes mellitus, hypertension, dyslipidemia, or smoking. The most frequently reported COVID-19 symptoms were asthenia and fatigue in 65% and 15% of the patients were asymptomatic. 85% of patients were treated in an outpatient setting, 8% hospitalized and 8% required admission to the ICU. Regarding the outcome, 8% mortality was evidenced[MIZR2] (1 patient with PPMS and 1 with NMOSD )[IA3] , 100% of them had greater functional compromise, with an EDSS previous to COVID infection between 6 and 9 points. No relationship has been found between the treatment received and mortality but a higher frequency of admission into ICU was found in patients with a history of DM2, hypertension and use of AntiCD20 therapies. Conclusion: Clinical outcomes of COVID infection in patients with MS and NMOSD did not differ from what is reported in similar studies in Latin-American population.