Vol 55, No 2 (2021)
Research Paper
Published online: 2021-04-15

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Clinical course and outcome of SARS-CoV-2 infection in multiple sclerosis patients treated with disease-modifying therapies — the Polish experience

Agata Czarnowska1, Waldemar Brola2, Olga Zajkowska3, Stanisław Rusek4, Monika Adamczyk-Sowa5, Katarzyna Kubicka-Bączyk5, Alicja Kalinowska-Łyszczarz6, Karolina Kania7, Agnieszka Słowik8, Marcin Wnuk8, Monika Marona8, Aleksandra Podlecka-Piętowska9, Monika Nojszewska10, Beata Zakrzewska-Pniewska10, Elżbieta Jasińska11, Katarzyna Gołuch12, Beata Lech13, Magdalena Noga13, Adam Perenc13, Małgorzata Popiel13, Anetta Lasek-Bal14, Przemysław Puz14, Katarzyna Maciejowska14, Marta Kucharska-Lipowska15, Michał Lipowski16, Katarzyna Kapica-Topczewska1, Monika Chorąży1, Joanna Tarasiuk1, Jan Kochanowicz1, Joanna Kulikowska1, Sławomir Wawrzyniak17, Anna Niezgodzińska-Maciejek17, Anna Pokryszko-Dragan18, Ewa Gruszka18, Sławomir Budrewicz18, Marta Białek19, Iwona Kurkowska-Jastrzębska20, Katarzyna Kurowska20, Adam Stępień21, Agata Włodek22, Violetta Ptasznik23, Małgorzata Pawełczyk24, Piotr Sobolewski25, Henryka Lejmel26, Katarzyna Strzalińska27, Maciej Maciejowski28, Andrzej Tutaj29, Jacek Zwiernik30, Anna Litwin29, Bożena Lewańczyk31, Izabela Paprocka31, Beata Zwiernik32, Aleksandra Pawlos33, Andrzej Borysowicz34, Anna Narożnik35, Anna Michałowska29, Krzysztof Nosek33, Małgorzata Fudala36, Marta Milewska-Jędrzejczak37, Alina Kułakowska1, Halina Bartosik-Psujek38
Pubmed: 33856686
Neurol Neurochir Pol 2021;55(2):212-222.

Abstract

Introduction. The aim of this study was to report the course and outcome of SARS-CoV-2 infection in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs) in Poland. A major concern for neurologists worldwide is the course and outcome of SARS-CoV-2 infection in patients with MS treated with different DMTs. Although initial studies do not suggest an unfavourable course of infection in this group of patients, the data is limited.

Materials and methods.
This study included 396 MS patients treated with DMTs and confirmed SARS-CoV-2 infection from 28 Polish MS centres. Information concerning patient demographics, comorbidities, clinical course of MS, current DMT use, as well as symptoms of SARS-CoV-2 infection, need for pharmacotherapy, oxygen therapy, and/or hospitalisation, and short-term outcomes was collected up to 30 January 2021. Additional data about COVID-19 cases in the general population in Poland was obtained from official reports of the Polish Ministry of Health.

Results.
There were 114 males (28.8%) and 282 females (71.2%). The median age was 39 years (IQR 13). The great majority of patients with MS exhibited relapsing-remitting course (372 patients; 93.9%). The median EDSS was 2 (SD 1.38), and the mean disease duration was 8.95 (IQR 8) years. Most of the MS patients were treated with dimethyl fumarate (164; 41.41%). Other DMTs were less frequently used: interferon beta (82; 20.70%), glatiramer acetate (42; 10.60%), natalizumab (35;8.84%), teriflunomide (25; 6.31%), ocrelizumab (20; 5.05%), fingolimod (16; 4.04), cladribine (5; 1.26%), mitoxantrone (3; 0.76%), ozanimod (3; 0.76%), and alemtuzumab (1; 0.25%). The overall hospitalisation rate due to COVID-19 in the cohort was 6.81% (27 patients). Only one patient (0.3%) died due to SARS-CoV-2 infection, and three (0.76%) patients were treated with mechanical ventilation; 106 (26.8%) patients had at least one comorbid condition. There were no significant differences in the severity of SARS-CoV-2 infection regarding patient age, duration of the disease, degree of disability (EDSS), lymphocyte count, or type of DMT used.

Conclusions and clinical implications.
Most MS patients included in this study had a favourable course of SARS-CoV-2 infection. The hospitalisation rate and the mortality rate were not higher in the MS cohort compared to the general Polish population. Continued multicentre data collection is needed to increase the understanding of SARS-CoV-2 infection impact on the course of MS in patients treated with DMTs.

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