The outcome of a national MS-Covid-19 study: What the Turkish MS cohort reveals?

Abstract

Background The pandemic of the new type of corona virus infection 2019 [Covid-19] also affect people with Multiple Sclerosis (pwMS). Currently, the accumulating information on the effects of the infection regarding the demographic and clinical characteristics of the disease, as well as outcomes within different DMTs¸ enable us to have better practices on the management of the Covid-19 infection in pwMS. Objective To investigate the incidence of coronavirus disease 2019 (Covid-19) and to reveal the relationship between the demographic-clinical and therapeutic features and the outcome of Covid-19 infection in a multi-center national cohort of pwMS. Methods The Turkish Neurological Society-MS Study Group in association with the Italian MuSC-19 Study Group initiated this study. A web-based electronic Case Report Form (eCRF) of Study-MuSC-19 were used to collect the data. The demographic data and MS histories of the patients were obtained from the file tracking forms of the relevant clinics. Results 309 MS patients with confirmed Covid-19 infection were included in this study. Two hundred nineteen (219) were females (70.9%). The mean age was 36.9, ranging from 18 to 66, 194 of them (62.8%) were under 40. The clinical phenotype was relapsing-remitting in 277 (89.6%) and progressive in 32 (10.4%). Disease duration ranged from 0.2 years to 31.4 years. The median EDSS was 1.5, ranging from 0 to 8.5. The EDSS score was<= 1 in 134 (43%) of the patients. 91.6% of the patients were on a DMT, Fingolimod was the most frequently used drug (22.0%), followed by Interferon (20.1%). The comorbidity rate is 11.7%. We were not able to detect any significant association of DMTs with Covid-19 severity. Conclusion The Turkish MS-Covid-19 cohort had confirmed that pwMS are not at risk of having a more severe COVID-19 outcome irrespective of the DMT that they are treated. In addition, due to being a younger population with less comorbidities most had a mild disease further highlight that the only associated risk factors for having a moderate to severe COVID-19 course are similar with the general population such as having comorbid conditions and being older.

Determinants of COVID-19-related lethality in multiple sclerosis: a meta-regression of observational studies

“…Most of the data were collected during the first pandemic wave, and anyway, before the anti-SARS-COV-2 vaccination was available. According to different articles, data collection was locked in April 2020 [ 32 ], May 2020 [ 23 , 27 , 31 , 33 ], June 2020 [ 22 , 24 , 25 , 28 , 30 ], whereas data of the remaining studies were collected until September 2020 [ 35 , 36 ], October 2020 [ 20 ], December 2020 [ 26 , 34 ], February 2021 [ 21 , 37 ], April 2021 [ 29 ].…”

“…Studies were conducted in the following countries: Iran (3 articles) [ 23 , 24 , 33 ], United States (2 articles) [ 27 , 32 ], Austria [ 26 ], Brazil [ 25 ], Chile [ 28 ], Czechia [ 37 ], France [ 31 ], Italy [ 36 ], Netherland [ 30 ], Poland [ 29 ], Saudi Arabia [ 21 ], Spain [ 22 ], Turkey [ 35 ]; two articles included data from different countries of Latin America [ 20 ] and North America [ 34 ]. Three articles included also data of 20 patients with neuromyelitis optica spectrum disorder that were removed from further analysis [ 20 , 28 , 37 ].…”

Systematic review of risk of SARS-CoV-2 infection and severity of COVID-19 with therapies approved to treat multiple sclerosis

“…The multi-center retrospective French study by Louapre et al with 347 MS patients did not find an association of hospitalization for COVID-19 with anti-CD20 therapies, but its small sample size limited the ability to detect any associations [ 10 ]. Similarly, a relatively small study in Turkey among 309 MS patients with SARS-CoV-2 infection did not identify an increased risk of severe COVID-19 in people treated with rituximab or ocrelizumab when compared to fingolimod or natalizumab [ 19 ] .…”

“…Studies conducted in EHR databases may have missed out-of-network COVID-19 diagnoses and outcomes; also, data completeness may be affected by the high medical workload during the pandemic [ 17 , 20 ]. Most studies were subject to selection bias—some of them analyzed younger and healthier populations and missed patients with higher degree of neurological disability and hospitalized patients [ 8 , 9 , 12 – 14 , 16 , 18 , 19 ]; others used reporting of COVID-19 cases who had been in contact with their neurologists and, therefore, may have selected more moderate-to-severe cases (i.e., underreporting of mild cases), individuals receiving therapies with the stronger immunosuppressive effects, and/or those with more frequent contacts with treating neurologists [ 3 , 6 , 7 , 10 , 25 ]; fatal cases were not represented or were likely underrepresented in these studies [ 3 , 6 – 10 , 12 – 14 , 16 , 18 , 19 ]. Also, if the factors that influence sample selection also influence the variables of interest, the relationship between these variables of interest can become distorted [ 35 ].…”

Severe outcomes of COVID-19 among patients with multiple sclerosis under anti-CD-20 therapies: A systematic review and meta-analysis

“…All selected articles were rigorously appraised by two authors according to a modified version of the Dutch Cochrane center critical review checklist proposed by MOOSE (Stroup et al, 2000). Key domains assessed by the MOOSE tool include: (I) Clear definition of study population; (II) Clear definition of outcomes and outcomes assessment; (III) Independent assessment of outcome parameters; (IV) Sufficient The presence of SARS-CoV2 antibodies in MS patients (Armstrong et al, 2021;Arrambide et al, 2021;Barzegar et al, 2020Barzegar et al, , 2021Bose and Galetta, 2021;Bsteh et al, 2021;Chaudhry et al, 2020;Ciampi et al, 2020;Conte, 2020;Czarnowska et al, 2021;D'Abramo et al, 2021;Devogelaere et al, 2020;Fernandez-Diaz et al, 2021;Fragoso et al, 2021;Garg et al, 2020;Hervas-Garcia, 2020;Loonstra et al, 2020;Louapre et al, 2020;Montero-Escribano et al, 2020;Olivares Gazca et al, 2020;Sahraian et al, 2020;Salter et al, 2021;Sen et al, 2021;Sormani et al, 2021b,a;Spelman et al, 2021;Stroup et al, 2000;Suwanwongse and Shabarek, 2020;Thornton and Harel, 2020 *Data provided by the authors but not published.…”