Background and purpose
Information regarding multiple sclerosis (MS) patients with the 2019 novel coronavirus disease (COVID‐19) is scarce. The study objective was to describe the incidence and ...characteristics of MS patients with COVID‐19, to identify susceptibility and severity risk factors and to assess the proportion of positive severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) serologies according to disease‐modifying treatments.
Methods
This was a retrospective study of an MS cohort analysing data collected between February and May 2020. Cases were identified through an email survey and clinical visits. The relationship of demographic and MS characteristics with COVID‐19 and of the disease‐modifying treatments with SARS‐CoV‐2 serostatus were examined.
Results
Data from 48 suspected cases out of 758 valid respondents and from 45 COVID‐19 cases identified through clinical visits were collected. Incidence was 6.3%. Nineteen (20.3%) patients were hospitalized and two (2.2%) died. Multivariable models determined that age (odds ratio OR per 10 years 0.53, 95% confidence interval CI 0.34–0.85), contact with a confirmed case (OR 197.02, 95% CI 56.36–688.79), residence in Barcelona (OR 2.23, 95% CI 1.03–4.80), MS duration (OR per 5 years 1.41, 95% CI 1.09–1.83) and time on anti‐CD20 treatment (OR per 2 years 3.48, 95% CI 1.44–8.45) were independent factors for presenting COVID‐19 and age (OR per 10 years 2.71, 95% CI 1.13–6.53) for a severe COVID‐19. Out of the 79 (84.9%) with serological test, 45.6% generated antibodies, but only 17.6% of those on anti‐CD20 therapies. Lymphopaenia or immunoglobulin levels did not relate to COVID‐19.
Conclusions
Multiple sclerosis patients present similar incidence, risk factors and outcomes for COVID‐19 as the general population. Patients treated with an anti‐CD20 therapy for a longer period of time might be at a higher risk of COVID‐19 and less than 20% generate an antibody response. Only age was related to severity.
This was a study of a Catalan multiple sclerosis (MS) cohort with the objective to describe the incidence and characteristics of MS patients with the 2019 novel coronavirus disease (COVID‐19), to identify susceptibility and severity risk factors and to assess the proportion of positive severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) serologies according to disease‐modifying treatments. The results show that MS patients present similar incidence, risk factors and outcomes for COVID‐19 as the general population. Patients treated with an anti‐CD20 therapy for a longer period of time might be at a higher risk of COVID‐19 and less than 20% generate an antibody response.
Background and purpose
With the new highly active drugs available for people with multiple sclerosis (pwMS), vaccination becomes an essential part of the risk management strategy. We aimed to develop ...a European evidence‐based consensus for the vaccination strategy of pwMS who are candidates for disease‐modifying therapies (DMTs).
Methods
This work was conducted by a multidisciplinary working group using formal consensus methodology. Clinical questions (defined as population, interventions and outcomes) considered all authorized DMTs and vaccines. A systematic literature search was conducted and quality of evidence was defined according to the Oxford Centre for Evidence‐Based Medicine Levels of Evidence. The recommendations were formulated based on the quality of evidence and the risk–benefit balance.
Results
Seven questions, encompassing vaccine safety, vaccine effectiveness, global vaccination strategy and vaccination in subpopulations (pediatric, pregnant women, elderly and international travelers) were considered. A narrative description of the evidence considering published studies, guidelines and position statements is presented. A total of 53 recommendations were agreed by the working group after three rounds of consensus.
Conclusion
This first European consensus on vaccination in pwMS proposes the best vaccination strategy according to current evidence and expert knowledge, with the goal of homogenizing the immunization practices in pwMS.
Background and purpose
To evaluate the effect of menopause on disability accumulation in women followed from their clinically isolated syndrome (CIS).
Methods
We examined the longitudinal changes in ...Expanded Disability Status Scale (EDSS) scores from CIS until the last follow‐up in women belonging to the Barcelona CIS prospective cohort, followed through their menopausal transition. The analysis is based on 13,718 EDSS measurements, with an average of 28 EDSS measurements per patient. Differences in EDSS trajectories between menopausal and nonmenopausal women, controlling for age and disease duration, were evaluated. We performed two sensitivity analyses in women with confirmed MS and in those experiencing early menopause.
Results
From 764 eligible women, 496 (65%) responded to the questionnaire, and 74 (14.9%) reached menopause over the follow‐up. We did not find a significant inflection point in EDSS trajectories around menopause (slope change −0.009; 95% CI −0.066; 0.046). The annual increase in EDSS over the complete course of the disease was significantly higher in menopausal women (0.049; 95% CI, 0.026–0.074) versus nonmenopausal (0.019; 95% CI, 0.008–0.031; interaction p value 0.025). This difference was lost when controlling for age and disease duration (EDSS annual increase of 0.059; 95% CI, 0.025–0.094 vs. 0.038; 95% CI, 0.021–0.057, respectively; interaction p value 0.321). No inflection point was detected when the analysis was restricted to women with confirmed MS or with earlier menopause.
Conclusions
Menopause is not associated with an increased risk of disability in a CIS population, considering EDSS trajectories throughout the course of the disease together with age and disease duration.
We examined the longitudinal changes in Expanded Disability Status Scale (EDSS) from clinically isolated syndrome (CIS) until the last follow‐up in 496 women belonging to the Barcelona CIS prospective cohort. The within‐subject changes before–after the menopause did not show a significant inflection point around menopause. Global EDSS trajectories based on 13,718 EDSS measurements, with an average of 28 EDSS measurements per patient, were not significantly different between menopausal and nonmenopausal women when controlling for age and disease duration. The same results were obtained for the subgroup of women with confirmed multiple sclerosis.
Background and purpose
Comorbidities are common in multiple sclerosis (MS), and have been associated with worse outcomes and increased health care resource usage. We studied the frequency of ...comorbidities and adverse health behaviors (AHBs) in MS patients in the Mediterranean region of Catalonia.
Methods
This population‐based, case–control study used primary health care information covering 80% of Catalonia's population. Cases were matched by age/sex with randomly chosen controls (ratio = 1:5). Demographic information, comorbidities, AHBs, annual visits, sick leave days, and medication dispensing were studied. The association of comorbidities with MS and the profile of comorbidities according to sex within MS cases were assessed with multivariate logistic regression models, after adjusting for confounding variables. Health care resource usage was analyzed in MS cases compared to controls, and within MS cases in those with compared to those without comorbidities.
Results
Five thousand five hundred forty‐eight MS cases and 27,710 controls (70% female, mean age = 48.3 years) were included. Stroke (odds ratio OR = 1.54, 95% confidence interval CI = 1.17–1.99), epilepsy (OR = 2.46, 95% CI = 1.94–3.10), bipolar disorder (OR = 1.67, 95% CI = 1.17–2.36), and depression (OR = 1.83, 95% CI = 1.70–1.98) were more frequent in MS. Cases were more prone to smoking but less to alcohol intake. Among cases, psychiatric comorbidities were more frequent in women, whereas cardiovascular diseases and AHBs were more frequent in men. MS patients, particularly with comorbidities, had higher health care resource usage than controls.
Conclusions
Psychiatric comorbidities, stroke, epilepsy, and AHBs are more common in MS patients than in the general population in the western Mediterranean region of Catalonia. The presence of comorbidities increases the health care resource usage in MS patients.
We conducted a population‐based case–control study, with more than 30,000 subjects, aimed at addressing the risk of comorbidities and adverse health behaviors in multiple sclerosis (MS) patients compared to controls. After adjusting for confounding variables, we found an increased risk of epilepsy, depressive disorder, bipolar disorder, and stroke, as well as increased adverse health behaviors in MS patients compared to controls. We also found increased health care resource usage in MS patients compared to controls, and among MS patients, in those with comorbidities.
Natural history studies have identified factors that predict evolution to multiple sclerosis or risk of disability accumulation over time. Although these studies are based on large multicentre ...cohorts with long follow-ups, they have limitations such as lack of standardized protocols, a retrospective data collection or lack of a systematic magnetic resonance imaging acquisition and analysis protocol, often resulting in failure to take magnetic resonance and oligoclonal bands into account as joint covariates in the prediction models. To overcome some of these limitations, the aim of our study was to identify and stratify baseline demographic, clinical, radiological and biological characteristics that might predict multiple sclerosis development and disability accumulation using a multivariate approach based on a large prospective cohort of patients with clinically isolated syndromes. From 1995 to 2013, 1058 patients with clinically isolated syndromes were included. We evaluated the influence of baseline prognostic factors on the risk for developing clinically definite multiple sclerosis, McDonald multiple sclerosis, and disability accumulation (Expanded Disability Status Scale score of 3.0) based on univariate (hazard ratio with 95% confidence intervals) and multivariate (adjusted hazard ratio with 95% confidence intervals) Cox regression models. We ultimately included 1015 patients followed for a mean of 81 (standard deviation = 57) months. Female/male ratio was 2.1. Females exhibited a similar risk of conversion to multiple sclerosis and of disability accumulation compared to males. Each younger decade at onset was associated with a greater risk of conversion to multiple sclerosis and with a protective effect on disability. Patients with optic neuritis had a lower risk of clinically definite multiple sclerosis hazard ratio 0.6 (0.5-0.8) and disability progression hazard ratio 0.5 (0.3-0.8); however, this protective effect remained marginal only for disability adjusted hazard ratio 0.6 (0.4-1.0) in adjusted models. The presence of oligoclonal bands increased the risk of clinically definite multiple sclerosis adjusted hazard ratio 1.3 (1.0-1.8) and of disability adjusted hazard ratio 2.0 (1.2-3.6) independently of other factors. The presence of 10 or more brain lesions on magnetic resonance increased the risk of clinically definite multiple sclerosis adjusted hazard ratio 11.3 (6.7-19.3) and disability adjusted hazard ratio 2.9 (1.4-6.0). Disease-modifying treatment before the second attack reduced the risk of McDonald multiple sclerosis adjusted hazard ratio 0.6 (0.4-0.9) and disability accumulation adjusted hazard ratio 0.5 (0.3-0.9). We conclude that the demographic and topographic characteristics are low-impact prognostic factors, the presence of oligoclonal bands is a medium-impact prognostic factor, and the number of lesions on brain magnetic resonance is a high-impact prognostic factor.
Background:
Population-based studies on neuromyelitis optica spectrum disorders (NMOSD) are limited, and it is unclear whether the rates have changed with the implementation of the new 2015 criteria.
...Objectives:
To estimate the incidence and prevalence of NMOSD in Catalonia (Spain), using both the 2006 and the 2015 criteria.
Methods:
In this clinic-based retrospective study, patients diagnosed with NMOSD between 2006 and 2015 were identified using multiple sources, including direct contact to all Catalan hospitals, identification of cases through the Catalan Health Surveillance System, and registry of antibodies to aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) in a reference laboratory. The incidence rate was calculated for the period 1 January 2006–1 January 2016 and prevalence for the date 1 January 2016.
Results:
We identified 74 patients (by the 2015 criteria). Most patients were Caucasian (81%), and female (76%) with a median age at disease onset of 42 years (range, 10–76 years). In total, 54 (73%) patients were positive for AQP4-IgG, 11 (15%) double-seronegative, and 9 (12%) MOG-IgG-positive. Rates of incidence and prevalence (0.63/1,000,000 person-years and 0.89/100,000, respectively) were 1.5-fold higher than those reported by the 2006 criteria. Lowest rates were seen in children and elder people and highest in women and middle-aged people (40–59 years). The female predominance was lost in incident AQP4-IgG-seronegative children and AQP4-IgG-positive elder people. MOG-IgG and double-seronegativity contributed similarly but did not influence the long-term outcome.
Conclusion:
The new criteria increase the estimates, but NMOSD remains as a rare disease. The differences in age- and sex-specific estimates highlight the importance of the serologic classification.
OBJECTIVE:To study the contribution of the symptomatic lesion in establishing multiple sclerosis (MS) diagnosis and prognosis.
METHODS:We performed an observational study based on a prospective ...clinically isolated syndrome (CIS) cohort of 1,107 patients recruited for clinical and brain MRI follow-up from 1995 to 2014. Eligible patients (n = 954) were divided into 4 groups according to baseline MRIpatients with a normal MRI (n = 290); patients with a single asymptomatic lesion (n = 18); patients with a single cord/brainstem symptomatic lesion (n = 35); and patients with more than 1 lesion (n = 611). For each group, we studied the risk of second attack, with 2005 McDonald MS and Expanded Disability Status Scale 3.0, using univariable and multivariable regression models adjusted by age, sex, oligoclonal bands, and disease-modifying treatments. We tested the diagnostic performance of a modified dissemination in space (DIS) criterion that includes symptomatic lesions in the total count and compared it to the DIS criteria (at least 1 asymptomatic lesion in at least 2 of the 4 MS characteristic MS locations) for all patients and for the subgroup of patients with brainstem or spinal cord topography.
RESULTS:Patients with a cord/brainstem single symptomatic lesion have a higher risk of second attack and disability accumulation than patients with 0 lesions but have a similar risk compared to patients with 1 asymptomatic lesion. Diagnostic properties are reasonably maintained when the symptomatic lesion qualifies for DIS.
CONCLUSIONS:Despite the recommendations of the 2010 McDonald criteria, symptomatic lesions should be taken into account when considering the diagnosis and prognosis of patients with CIS.
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