Risk of COVID-19 infection in MS and neuromyelitis optica spectrum disorders

Fan, Moli; Qiu, Wei; Bu, Bitao; Xu, Yan; Yang, Huan; Huang, Dehui; Lau, Andy K. S.; Guo, Jun; Zhang, Meini; Zhang, Xinghu; Yang, Chun-Sheng; Chen, Jingshan; Zheng, Pei; Liu, Qiang; Zhang, Chao; Shi, Fu‐Dong

doi:10.1212/nxi.0000000000000787

Cited by 85 publications

(93 citation statements)

References 5 publications

(5 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this systematic survey of 75 NMO/SD patients, 6.7% had a highly suspected or confirmed COVID-19, which is consistent with the estimated seroprevalence in Ilede-France [5]. This rate is slightly higher than the 3.8% prevalence reported in an Iranian study [6], while a large survey in China described a very low risk of COVID-19: 2 confirmed COVID-19 pneumonia out of 3060 NMO/SD patients [7]. Despite ongoing immunosuppressive therapy, no severe infection was encountered in our study.…”

supporting

confidence: 86%

COVID-19 infection in NMO/SD patients: a French survey

et al. 2020

View full text Add to dashboard Cite

COVID-19 pandemic due to SARS-CoV2 virus is ongoing, with a fatality rate around 5.4% [1]. Neuromyelitis optica spectrum disorders (NMO/SD) is a rare disabling disease requiring immunosuppressive therapy. The risk of severe COVID-19 remains unknown in NMO/SD. The aim of this case-series study is to describe the prevalence and characteristics of COVID-19 in NMO/SD patients. We conducted a monocentric retrospective caseseries study of NMO/SD patients with highly suspected or proven COVID-19. They fulfilled at least one of the three NMO diagnostic criteria sets [2-4] and were registered in the NOMADMUS cohort (gathering data from French expert NMO/SD centers). Among 117 NMO/ SD patients followed in the department of neurology of Pitié Salpêtrière Hospital in Paris, 75 were questioned by phone about COVID-19 infection between 05/05/2020 and 06/15/2020 (33 were lost to follow-up, 9 were unreachable by phone). We collected demographics, neurological history, comorbidities, COVID-19 characteristics and outcome. COVID-19 diagnosis was retained on ≥ 1 of the following criteria was fulfilled: (1) positive SARS-CoV2 PCR (naso-pharyngeal swab) or serology (IgG); (2) typical thoracic ground glass opacities on CT scan; (3) acute anosmia/ageusia of sudden onset in the absence of rhinitis or nasal obstruction; (4) typical triad symptoms (cough, fever, asthenia) in epidemic zone of COVID-19. The study received approval from the ethic committee of Sorbonne University (#CER-2020-19).

show abstract

supporting

confidence: 86%

COVID-19 infection in NMO/SD patients: a French survey

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In an observational study evaluating outcomes of 76 actively treated patients with multiple sclerosis with confirmed (n=37) or suspected (n=39) COVID-19, a slightly higher rate (34 of 65 patients who were on DMT's) of patients were receiving anti-CD20 therapy compared to the centre's overall proportion of patients on such therapy, though the significance of this finding was uncertain, and overall hospitalisation (24%) and mortality rates (7%) were comparable to the general population (Parrotta et al, 2020). That none of our patients had contracted COVID-19 may have reflected the overall low incidence in Melbourne and Victoria Australia during the study period, though notwithstanding this, was in keeping with the results of a study of 1,836 patients with MS and 3,128 patients with NMOSD from 10 centres across China, where no increased risk COVID-19 could be detected despite 61.9% of patients being on DMT's, including 108 patients on Rituximab, with only 2 confirmed cases (Fan et al, 2020). The authors noted the effect of preventive protocols instituted across the country offsetting the number of cases could not be excluded, and of relevance to our cohort, none of these patients received Ocrelizumab or Natalizumab.…”

Section: Discussionsupporting

confidence: 82%

Evaluating the perspective of patients with MS and related conditions on their DMT in relation to the COVID-19 pandemic in one MS centre in Australia

Seery

Nguyen

et al. 2020

Multiple Sclerosis and Related Disorders

View full text Add to dashboard Cite

Patients with Multiple Sclerosis (MS) and on disease modifying therapies (DMTs) that can be immunosuppressive or immunomodulatory form a special group where risk of continuation of DMT needs to be taken into account with risk of contracting Covid-19. This concept can pose a degree of anxiety for patients as well as neurologists. We aimed to evaluate patient perspectives regarding the use of Natalizumab and anti-CD20 therapies (Rituximab and Ocrelizumab) in the context of the COVID-19 pandemic. Methods: cross-sectional study conducted via voluntary survey filled in by patients with MS and related disorders receiving their infusional treatment in one MS centre in Australia, exploring their concerns regarding their therapy, their therapy and COVID-19, precautions undertaken in response to the pandemic, and factors impacting their decision-making. Results: 170 patients completed the survey. Of patients on Natalizumab, the majority had either no or mild concern regarding their DMT and COVID-19, and of patients on B-cell depleting therapies, again, the majority had no or mild concern, though a slightly higher proportion had a moderate level of concern. Asked to delineate their concerns, an increased risk of contracting COVID-19 was more commonly conveyed than MS-specific factors or poor outcomes pertaining to COVID-19 if contracted, by patients in both groups. Conversely, being invited to specifically consider the possibility of contracting COVID-19 or experience a relapse of MS, almost half of the cohort rated both of equal of concern. More than half of the cohort were self-isolating more stringently than general government advice and government-related resources followed by information provided by patient's neurologist where the commonest means of information to guide decision making. Conclusions: Whilst a large proportion of patients had some concern regarding the impact of their DMT on COVID-19, whether on their risk of contracting COVID-19 or a theoretical risk for more severe disease, the overall level of concern in most cases was at most mild. Patients on B-cell depleting therapies were more inclined to express a higher level of concern. A similar concern was ascribed to a risk of a relapse or worsening MS symptoms compared to the risk of contracting COVID-19. Such attitudes may underscore a willingness of patients to continue their DMT where benefits outweigh risks during future phases of the COVID-19 pandemic.

show abstract

“…The present study indicated that the use of rituximab increases the risk of developing COVID-19. This was not documented in the study of Fan et al (2020). However, in another study in Iran, 712 patients with MS filled out a questionnaire about COVID-19 symptoms, of which 34 patients (4.8%) had COVID-19 symptoms.…”

Section: Discussionmentioning

confidence: 88%

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

Sahraian

Azimi

Navardi

et al. 2020

Multiple Sclerosis and Related Disorders

100

View full text Add to dashboard Cite

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.

show abstract

Risk of COVID-19 infection in MS and neuromyelitis optica spectrum disorders

Cited by 85 publications

References 5 publications

COVID-19 infection in NMO/SD patients: a French survey

COVID-19 infection in NMO/SD patients: a French survey

Evaluating the perspective of patients with MS and related conditions on their DMT in relation to the COVID-19 pandemic in one MS centre in Australia

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

Contact Info

Product

Resources

About