Real-Time Assessment of Covid-19 Impact on Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder Under Disease-Modifying Treatments: A Multicenter Study In China

Abstract

Background: In December 2022, the SARS-CoV-2 pandemic surged in China. Patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) may have an increased risk of developing coronavirus disease 2019 (COVID-19), particularly those undergoing disease-modifying therapies (DMTs). Due to variations in race, strains, and DMT usage, this study investigated the epidemiology and symptoms of COVID-19 and post-COVID-19, and the worsening of MS and NMOSD symptoms among patients in China.

Methods: A total of 107 patients with MS (n=91, 85%) and NMOSD (n=16, 15%; treated with rituximab) were recruited from three hospitals in China. Data on demographics (age, sex), changes in clinical symptoms, DMTs (untreated, teriflunomide, sphingosine 1-phosphate receptor (S1P)-modulators, rituximab, dimethyl fumarate, and others), COVID-19 symptoms, and post-COVID-19 symptoms (PCS) were collected. Multivariable logistic regression was used to examine the impact of DMTs on COVID-19, and clinical symptoms of MS and NMOSD.

Results: The cohort had similar age, sex, and disease duration in both groups. The median duration of COVID-19 symptoms was 7 (4–10) days, with a median fever duration of 2 (1–2) days and a temperature of 38.5°C (38–39)°C. Three patients developed COVID-19 pneumonia; however, no fatalities occurred. The most common COVID-19 symptoms were fever, dry cough, fatigue, myalgia, and headache. PCS was reported by 33% of patients, including fatigue, cough, insomnia, dysgeusia/anosmia, depression/anxiety, and myalgia. COVID-19 incidence was 76.19% in the no-DMT group, 89.65% in the teriflunomide group, 76.92% in the S1P-modulator group, and 95% in the rituximab group. Logistic regression analysis revealed a significantly higher likelihood of COVID-19 in the rituximab group compared to the no-DMT group (odds ratio [OR]=34.37, 95% confidence interval [CI]=1.37–864.49, P=0.032). Patients treated with teriflunomide (OR=7.450, 95%CI=1.52–46.51, P=0.013) had a higher likelihood of worsened demyelinating symptoms.

Conclusion: Patients with MS and NMOSD undergoing DMTs were generally safe; however, a significant proportion experienced PCS. Anti-CD20 treatment was associated with a higher risk of developing COVID-19, and teriflunomide treatment was linked to an increased risk of aggravated demyelinating symptoms.

Note:
Funding Information: This work was supported by the Jiangsu Provincial Research Hospital, Jiangsu Provincial Medical Innovation Center, Jiangsu Provincial Medical Key Discipline (Laboratory) (ZDXK202217), the Jiangsu Young Medical Talents Project (qnrc2016871), the Natural Science Foundation of Jiangsu Province for Young Scholars (SBK2024047621).

Declaration of Interests: The authors declare no conflicts of interest.

Ethical Approval Statement: All patients provided informed consent before participating. The Ethics Committee of the Second Affiliated Hospital of Soochow University approved this study.

Keywords: Disease-modifying treatments, Multiple sclerosis (MS), Neuromyelitis optica spectrum disorder, Coronavirus disease 2019 (COVID-19)