A case series and literature review of multiple sclerosis and COVID-19: Clinical characteristics, outcomes and a brief review of immunotherapies

Abstract

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.

COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: A systematic review

“… Confirmed patients Death Suspicious patients TotalPatients TotalDeath (%) Interferon beta ( Safavi et al, 2020 , Bowen et al, 2020 , Louapre et al, 2020 , Parrotta et al, 2020 , Barzegar et al, 2020 , Ciampi et al, 2020 , Mantero et al, 2020 , Sahraian et al, 2020 , Chaudhry et al, 2020 , Castillo Álvarez et al, 2020 , Sormani et al, 2020 , Evangelou et al, 2020 , Loonstra et al, 2020 ) 61 74 135 0 Interferons/GA ( Dalla Costa et al, 2020 , Nesbitt et al, 2020 ) - - 84 84 0 GA ( Bowen et al, 2020 , Louapre et al, 2020 , Parrotta et al, 2020 , Sahraian et al, 2020 , Maillart et al, 2020 , Chaudhry et al, 2020 , Sormani et al, 2020 , Evangelou et al, 2020 , Loonstra et al, 2020 , Kataria et al, 2020 ) 67 1-71 -year-old,Male, SPMS Comorbidities: Venus Thrombo embli and obesity ( Parrotta et al, 2020 ) 2-64 -year-old, Male, RRMS, EDSS: 2, no comorbidity. ( Sormani et al, 2020 ) 73 140 2(1.4%) DMF ( Louapre et al, 2020 , Parrotta et al, 2020 , Barzegar et al, 2020 , Ciampi et al, 2020 , Mantero et al, 2020 ...…”

COVID-19 and the Risk of Relapse in Multiple Sclerosis Patients: A Fight with No Bystander Effect?

“…All patients tested positive for COVID-19 infection via RT-PCR. All patients' EDSS scores improved back to baseline after appropriate medical management for COVID-19; thus, the worsening of their symptoms was equated to pseudo-exacerbations rather than MS relapses (Kataria et al, 2020).…”

NfL levels predominantly increase at disease onset in MOG-Abs-associated disorders

“…Interferons/GA (Dalla Costa et al, 2020;Nesbitt et al, 2020) --84 0 GA (Bowen et al, 2020;C Louapre et al, 2020;Parrotta et al, 2020;Maillart et al, 2020;Chaudhry et al, 2020;Sormani et al, 2020;Evangelou et al, 2020;Loonstra et al, 2020;Kataria et al, 2020) 67 1-71 -year-old,Male, SPMS Comorbidities: Venus Thrombo embli and obesity ( Parrotta et al, 2020) 2-64 -year-old, Male, RRMS, EDSS: 2, no comorbidity. (Sormani et al, 2020) 73 2(1.4%) Louapre et al, 2020;Parrotta et al, 2020;M Barzegar et al, 2020;E Ciampi et al, 2020;V Mantero et al, 2020;Nesbitt et al, 2020;Chaudhry et al, 2020;Castillo Á lvarez et al, 2020;V Mantero et al, 2020;Crescenzo et al, 2020;Sormani et al, 2020;Evangelou et al, 2020;Loonstra et al, 2020;Kataria et al, 2020) 119 1-68 -year-old,Male, SPMS, EDSS:6 Comorbidities: cerebrovascular disease, Hypertension (Sormani et al, 2020) 195 1(0.3%) DMF/Teriflunomide (Nesbitt et al, 2020;Dalla Costa et al, 2020) 108 0 Teriflunomide (Safavi et al, 2020;Bowen et al, 2020;C Louapre et al, 2020;E Ciampi et al, 2020;V Mantero et al, 2020;Nesbitt et al, 2020;Chaudhry et al, 2020;…”