COVID-19 in multiple sclerosis: The Dutch experience

Abstract

Here, we provide an extensive overview of all reported COVID-19 cases in multiple sclerosis (MS) patients in the Netherlands between 27 February and 9 June 2020, gathered by the Dutch MS Taskforce of the Netherlands Society of Neurology. A total of 86 MS patients were reported, 43 of whom tested positive for COVID-19. Of 43 patients who tested positive, 22 patients were hospitalized. Three intensive care unit (ICU) admissions and four deaths were reported. Our findings show no apparent difference in disease-modifying treatment (DMT) use and COVID-19 disease course in Dutch MS patients. In addition, a clear link between low lymphocyte count and severe disease was not observed.

Immunology of COVID‐19 and disease‐modifying therapies: The good, the bad and the unknown

“…The MS patients with SARS-CoV-2 infection and IFN-b treatment that have been reported to date experienced a mild disease course [57]. To our knowledge, of the published larger cohorts with a positive SARS-CoV-2 PCR, seven patients were on IFN-b treatment, one needed hospitalization and none required intensive care unit (ICU) treatment or died [58][59][60][61][62]. Therefore, there is no evidence to date that IFN-b exacerbates SARS-CoV-2 infection.…”

“…So far, case series on COVID-19-infected MS patients receiving DMF treatment report on rather mild disease courses and no need for intensive care treatment [116]. Of the published larger cohorts with a positive SARS-CoV-2 PCR, 27 patients were on DMF treatment, three needed hospitalization, one required ICU treatment and one patient died [58][59][60][61][62]. Similarly to T cells, circulating mature and differentiated B cells are reduced on DMF treatment, and B cell responses are altered in an anti-inflammatory manner [117].…”

“…However, to date, we are aware of six case reports on patients who received alemtuzumab and experienced a mild COVID-19 disease course [154][155][156][157]. Of the published larger cohorts with a positive SARS-CoV-2 PCR, one patient received alemtuzumab treatment without reported complications [58][59][60][61][62] harmful effects cannot be excluded, however, consistent with a general view on effects of immunosuppressants in hyperinflammatory syndrome, it may be speculated that alemtuzumab has anti-inflammatory properties for this condition.…”

“…To date, the MS patients treated with CD20-depleting agents and with confirmed SARS-CoV-2 infection recovered mostly without serious complications [171][172][173][174][175]. Of the published larger cohorts with a positive SARS-CoV-2 PCR, 32 patients received a CD20-depleting agent, seven needed hospitalization, four required ICU treatment and three died [58][59][60][61][62]. Nevertheless, whether an antibody-specific response will be mounted in CD20-treated patients or in response to a future anti-SARS-CoV-2 vaccination is an important matter of current debate [176].…”

SARS-CoV-2/COVID-19 in multiple sclerosis patients receiving disease-modifying therapy

“…The course of COVID-19 infection is mild in most patients [ 16 , 17 ]. Despite the published case reports, both the risk of infection and the course of COVID-19 in patients with MS are still unclear [ 15 , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] ]. It is known that patients with MS are generally more susceptible to infections [ 11 , 37 ], especially those with a higher degree of disability or serious comorbidities.…”