Medical University of Białystok, Poland.
Collegium Medicum, Jan Kochanowski University, Kielce, Poland.
Neurol Neurochir Pol. 2021;55(2):212-222. doi: 10.5603/PJNNS.a2021.0031. Epub 2021 Apr 15.
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.
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.
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.
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.
本研究旨在报告在波兰接受疾病修正治疗（DMT）的多发性硬化症（MS）患者中 SARS-CoV-2 感染的病程和结果。全世界的神经科医生都主要关注不同 DMT 治疗的 MS 患者 SARS-CoV-2 感染的病程和结果。尽管初步研究并未表明该组患者的感染病程不利，但数据有限。
本研究纳入了来自波兰 28 个 MS 中心的 396 名接受 DMT 治疗并确诊 SARS-CoV-2 感染的 MS 患者。收集了患者人口统计学、合并症、MS 临床病程、当前 DMT 使用情况以及 SARS-CoV-2 感染症状、药物治疗需求、氧疗和/或住院治疗以及短期结果等信息，直至 2021 年 1 月 30 日。从波兰卫生部的官方报告中获得了波兰普通人群中 COVID-19 病例的其他数据。
114 名男性（28.8%）和 282 名女性（71.2%）。中位年龄为 39 岁（IQR 13）。绝大多数 MS 患者表现为复发缓解病程（372 例；93.9%）。EDSS 中位数为 2（SD 1.38），平均病程为 8.95（IQR 8）年。大多数 MS 患者接受了富马酸二甲酯治疗（164 例；41.41%）。其他 DMT 的使用频率较低：干扰素-β（82 例；20.70%）、那他珠单抗（35 例；8.84%）、特立氟胺（25 例；6.31%）、奥瑞珠单抗（20 例；5.05%）、芬戈莫德（16 例；4.04%）、克拉屈滨（5 例；1.26%）、米托蒽醌（3 例；0.76%）、奥扎那平（3 例；0.76%）和阿仑单抗（1 例；0.25%）。该队列中因 COVID-19 住院的总体住院率为 6.81%（27 例）。仅 1 例患者（0.3%）因 SARS-CoV-2 感染死亡，3 例（0.76%）患者接受机械通气治疗；106 例（26.8%）患者至少存在一种合并症。在 SARS-CoV-2 感染的严重程度方面，患者年龄、疾病持续时间、残疾程度（EDSS）、淋巴细胞计数或使用的 DMT 类型与感染病程之间无显著差异。
本研究纳入的大多数 MS 患者 SARS-CoV-2 感染病程良好。与波兰普通人群相比，MS 队列的住院率和死亡率并未更高。需要继续进行多中心数据收集，以提高对 DMT 治疗的 MS 患者 SARS-CoV-2 感染对病程影响的认识。
