Evaluation of the rate of COVID-19 infection, hospitalization and death among Iranian patients with multiple sclerosis

Abstract

Background: COVID-19 is increasingly expanding all over the world. People who have an underlying disease or taking immunosuppressive drugs are generally more likely to be infected than the others. Multiple sclerosis (MS) patients may also be at risk of the disease and its complications depending on the medication they are taking. In this study, we evaluated a large population of patients with MS with different disease modifying drugs to show if any of them increases the risk. In addition, this study evaluates the incidence of COVID-19 in patients with MS, the rate of hospitalization or death in these patients. Method: This study was performed at the MS Clinic of Sina Hospital. All patients were contacted and their demographic characteristics were recorded. They were then asked about their COVID-19 symptoms. Patients with these symptoms were further evaluated. The documents were reviewed by treating neurologist and MS nurses to be sure about diagnosis of COVID19. The positive polymerase chain reaction (PCR) result or compatible lung computed tomography (CT) scan was acceptable for COVID-19 diagnosis. Results: 4647 patients answered the phone contact. Of these, 68 were infected with the COVID-19. The rate of hospitalization was 25% which is far more than general population. Two patients died from COVID-19. Rituximab was associated with increase rate of COVID-19 infection but not with hospitalization rate. There was no significant correlation between use of other drugs and rate of infection. Conclusion: This study revealed that the incidence of COVID-19 in MS patients is not more than general population, but the risk of hospitalization in these patients is higher than estimated for the disease. This highlights the importance of communicating to patients the severity of COVID-19 and the importance of risk reduction behaviors like social distancing and mask use.

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

“…Overall, the data of 2493 MS patients and 37 NMOSD patients were reported with COVID-19. ( Table 1 , 2 ) ( Sahraian et al, 2020 , Safavi et al, 2020 , Bowen et al, 2020 , Louapre et al, 2020 , Dalla Costa et al, 2020 , Parrotta et al, 2020 , Barzegar et al, 2020 , Ciampi et al, 2020 , Mantero et al, 2020 , Sahraian et al, 2020 , Nesbitt et al, 2020 , Chaudhry et al, 2020 , Castillo Álvarez et al, 2020 , Shalhoub, 2020 , Delbue et al, 2007 , Berger and Brandstadter, 2020 , Maillart et al, 2020 , Ciampi et al, 2020 , Mantero et al, 2020 , Crescenzo et al, 2020 , Mehta et al, 2019 , Maghzi et al, 2020 , Möhn et al, 2020 , Bollo et al, 2020 , Ciardi et al, 2020 , Valencia-Sanchez and Wingerchuk, 2020 , Foerch et al, 2020 , Barzegar et al, 2020 , Chiarini et al, 2020 , Gomez-Mayordomo et al, 2020 , Mallucci et al, 2020 , Giovannoni et al, 2020 , Borriello and Ianniello, 2020 , Louapre et al, 2020 , Aguirre et al, 2020 , Rimmer et al, 2020 , Luna et al, 2019 , Carandini et al, 2020 , Matías-Guiu et al, 2020 , Guevara et al, 2020 , Fernández-Díaz et al, 2020 , Amor et al, 2020 , Fiorella and Lorna, 2020 , Dersch et al, 2020 , De Angelis et al, 2020 , Celius, 2020 , Jack et al, 2020 , Suwanwongse and Shabarek, 2020 , Ghajarzadeh et al, 2020 , Montero-Escribano et al, 2020 , Novi et al, 2020 , …”

“… 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 ...…”

“…( 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 , Sahraian et al, 2020 , Nesbitt et al, 2020 , Chaudhry et al, 2020 , Castillo Álvarez et al, 2020 , 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 ) 195 314 1(0.3%) DMF/Teriflunomide ( Nesbitt et al, 2020 , Dalla Costa et al, 2020 ) 108 108 0 Teriflunomide ( Safavi et al, 2020 , Bowen et al, 2020 , Louapre et al, 2020 , Ciampi et al, 2020 , Mantero et al, 2020 , Sahraian et al, 2020 , Nesbitt et al, 2020 , Chaudhry et al, 2020 , Castillo Álvarez et al, 2020 , Maillart et al, 2020 , Crescenzo et al, 2020 , Maghzi et al, 2020 , Möhn et al, 2020 , Bollo et al, 2020 , Ciardi et al, 2020 , Valencia-Sanchez and Wingerchuk, 2020 , Sormani et al, 2020 , Evangelou et al, 2020 , …”

Death by SARS-CoV 2 - a Romanian COVID-19 multi-centre comorbidity study

“…The hypothesis about the diseases of the respiratory system and the neoplasms as prognosis factors for the mortality through COVID-19 is not con rmed in our study. Therefore, it is likely that patients died because of the impact and virulence of the SARS-CoV-2 infection over comorbidities like hypertension, diabetes mellitus or obesity, in combination with age and gender [37].…”

Impact of disease‐modifying drugs on the severity of COVID‐19 infection in multiple sclerosis patients

“…Therefore, it seems that DMTs, especially the first‐generation drugs such as IFN‐β and glatiramer acetate, are not related to severe infection in MS patients. However, very recent reports about the risk of COVID‐19 infection in MS patients demonstrated that there is no correlation between incidences of COVID‐19 in the MS patients 48–50 . However, Sahraian et al 48 showed a higher risk of hospitalization in the MS patients infected by COVID‐19 as compared with the general population.…”