open access

Vol 55, No 2 (2021)
Research Paper
Submitted: 2021-02-24
Accepted: 2021-03-15
Published online: 2021-04-15
Get Citation

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
DOI: 10.5603/PJNNS.a2021.0031
·
Pubmed: 33856686
·
Neurol Neurochir Pol 2021;55(2):212-222.
Affiliations
  1. Medical University of Białystok, Poland
  2. Collegium Medicum, Jan Kochanowski University, Kielce, Poland
  3. Faculty of Economic Sciences, University of Warsaw, Poland
  4. Department of Neurology, Specialist Hospital Ludwika Rydygiera in Krakow, Poland
  5. Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
  6. Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poland
  7. Department of Neurology, Poznan University of Medical Sciences, Poland
  8. Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
  9. Department of Neurology, Medical University of Warsaw, Poland
  10. Department of Neurology, Medical University of Warsaw, Poland
  11. Collegium Medicum UJK, and Clinical Center, RESMEDICA, Kielce, Poland
  12. Clinical Center, RESMEDICA, Kielce, Poland
  13. Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, Poland
  14. Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, Poland
  15. Department of Neurology, Specialist Hospital in Końskie, Poland
  16. Department of Urology, Specialist Hospital in Końskie, Poland
  17. Department of Neurology, 10th Military Research Hospital and Polyclinic, Independent Public Healthcare Centre, Bydgoszcz, Poland
  18. Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
  19. Department of Neurology, Regional Specialised Hospital No. 4 in Bytom, Poland
  20. 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
  21. Department of Neurology, Military Institute of Medicine, Warsaw, Poland
  22. Department of Neurology, Masovian Voivodeship Hospital in Siedlce, Poland
  23. Department of Neurology, Specialist Hospital in Pila, Poland
  24. Department of Neurology and Stroke, Medical University of Lodz, Poland
  25. Department of Neurology and Stroke Unit in Sandomierz, Collegium Medicum, Jan Kochanowski University in Kielce
  26. Department of Neurology, The Regional Hospital in Suwalki, Poland
  27. Department of Neurology, The Regional Hospital in Łomża, Poland
  28. KMK Clinical, MS Center, Katowice, Poland
  29. Neurology Ward, Provincial Specialist Hospital, Olsztyn, Poland
  30. Neurology Ward, Provincial Specialist Hospital, Olsztyn, Poland; Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland
  31. Neurology Ward, Provincial Integrated Hospital, Elbląg, Poland
  32. Department of Neurology, University of Warmia and Mazury, Olsztyn, Poland; Clinic of Neurology, University of Warmia and Mazury, Olsztyn, Poland
  33. Department of Pharmacology and Toxicology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
  34. Department of Neurology, Specialist Hospital Dr Tytus Chałubiński Radom, Poland
  35. Department of Neurology, Specialist Hospital Dr Tytus Chałubiński Radom, Poland
  36. Department of Neurology, Regional Hospital in Skarżysko-Kamienna, Poland
  37. Department of Neurology and Ischemic Strokes, Medical University of Lodz, Poland
  38. Department of Neurology, Institute of Medical Sciences, Medical College of Rzeszow University, Poland

open access

Vol 55, No 2 (2021)
Research papers
Submitted: 2021-02-24
Accepted: 2021-03-15
Published online: 2021-04-15

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.

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.

Get Citation

Keywords

multiple sclerosis, COVID-19, SARS-CoV-2, disease-modifying therapies

About this article
Title

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

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 55, No 2 (2021)

Article type

Research Paper

Pages

212-222

Published online

2021-04-15

Page views

2803

Article views/downloads

1034

DOI

10.5603/PJNNS.a2021.0031

Pubmed

33856686

Bibliographic record

Neurol Neurochir Pol 2021;55(2):212-222.

Keywords

multiple sclerosis
COVID-19
SARS-CoV-2
disease-modifying therapies

Authors

Agata Czarnowska
Waldemar Brola
Olga Zajkowska
Stanisław Rusek
Monika Adamczyk-Sowa
Katarzyna Kubicka-Bączyk
Alicja Kalinowska-Łyszczarz
Karolina Kania
Agnieszka Słowik
Marcin Wnuk
Monika Marona
Aleksandra Podlecka-Piętowska
Monika Nojszewska
Beata Zakrzewska-Pniewska
Elżbieta Jasińska
Katarzyna Gołuch
Beata Lech
Magdalena Noga
Adam Perenc
Małgorzata Popiel
Anetta Lasek-Bal
Przemysław Puz
Katarzyna Maciejowska
Marta Kucharska-Lipowska
Michał Lipowski
Katarzyna Kapica-Topczewska
Monika Chorąży
Joanna Tarasiuk
Jan Kochanowicz
Joanna Kulikowska
Sławomir Wawrzyniak
Anna Niezgodzińska-Maciejek
Anna Pokryszko-Dragan
Ewa Gruszka
Sławomir Budrewicz
Marta Białek
Iwona Kurkowska-Jastrzębska
Katarzyna Kurowska
Adam Stępień
Agata Włodek
Violetta Ptasznik
Małgorzata Pawełczyk
Piotr Sobolewski
Henryka Lejmel
Katarzyna Strzalińska
Maciej Maciejowski
Andrzej Tutaj
Jacek Zwiernik
Anna Litwin
Bożena Lewańczyk
Izabela Paprocka
Beata Zwiernik
Aleksandra Pawlos
Andrzej Borysowicz
Anna Narożnik
Anna Michałowska
Krzysztof Nosek
Małgorzata Fudala
Marta Milewska-Jędrzejczak
Alina Kułakowska
Halina Bartosik-Psujek

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