Impact of COVID-19 infection and COVID vaccinations on the management of MS and related disorders in a low middle income country-real world experience from a demyelinating disease registry

ABSTRACT

Background and objective: The impact of COVID-19 infection and the effect of vaccinations on patients with demyelinating central nervous system disease in low middle income countries (LMIC's) have not been reported in detail earlier. We sought to identify risk factors associated with COVID-19 infection and the role of vaccinations in patients with MS and related disorders in order to develop management guidelines relevant to our patients. Method(s) A total of 621 patients (297 MS and 324 non MS disorders) from our registry were contacted. COVID-19 infection and vaccination status were queried. Patients who had infection were compared with noninfected patients to identify factors associated with susceptibility for COVID-19 infection. Univariate and multivariate analysis of potential risk factors included demographic and clinical features, body mass index (BMI), presence of comorbidities, absolute lymphocyte count, treatment types and vaccination status. Result(s) Sixty seven patients with MS and 27 with non MS disorders developed COVID-19 infection. Among them 13 patients were hospitalized, all of whom recovered. Vaccination status was known in 582 patients among whom 69.8% had completed or taken one dose of vaccine at the time of inquiry. Majority of treated patients (61.3%) were on nonspecific immunosuppressants. Multivariate analysis of all patients with MS and related disorders showed that higher mean body mass index(BMI [p - 0.002, OR- 0.86,95% CI - 0.78-0.94]), presence of >= 1 comorbidity ( p-0.005, OR- 3.57,95% CI- 1.46- 8.7) and concurrent treatment with disease modifying therapy(p- 0.004, OR- 2.80, 95% CI- 1.39- 5.6)were significantly associated with risk of COVID-19 infection. Vaccination against COVID-19 infection was strongly protective (p- 0.0001, OR- 0.10, 95% CI- 0.05- 0.20). In the unvaccinated group, patients on treatment ( 61% were on nonspecific immunosuppressants) were significantly at risk of Covid-19 infection (p- 0.001, OR- 10.1, 95% CI- 4.59- 22.22) when compared to untreated patients. Conclusion(s) Frequency and severity of COVID-19 infection was low among our patient cohort.Higher rate of infection in the treated group was significant among unvaccinated patients. Our preliminary results suggests that in LMIC's, where off label therapies with inexpensive immunosuppressives are the main disease modifying drugs, mRNA vaccinations appear safe and protective against severe COVID-19 infection.