College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
King Abduaziz University, Jeddah, Saudi Arabia.
Mult Scler Relat Disord. 2021 Jul;52:103004. doi: 10.1016/j.msard.2021.103004. Epub 2021 May 7.
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread and developed as a pandemic threatening global health. Patients with multiple sclerosis (MS)-an autoimmune demyelinating inflammatory disease of the central nervous system (CNS)-are predominantly treated with immunomodulatory/immunosuppressive disease-modifying therapies (DMTs), which can increase the risk of infection. Therefore, there is concern that these patients may have a higher risk of COVID-19. In response to growing concerns of neurologists and patients, this study aimed to determine the prevalence, severity, and possible complications of COVID-19 infection in patients with MS in Saudi Arabia (SA).
In this prospective cohort study, demographic and clinical data were obtained from patients residing in SA with MS who had a positive result for COVID-19 per reverse transcription-polymerase chain reaction test or viral gene sequencing, using respiratory or plasma samples. Comparison of COVID-19 severity groups was performed using one-way ANOVA or Kruskal-Wallis test for numerical variables and Chi-squared test for categorical variables.
Seventy patients with MS and COVID-19 (71% female) were included in this analysis. Of the 53 (75.7%) patients receiving a DMT at the time of COVID-19 infection, the most frequently used DMTs were fingolimod (25%) and interferon-beta (25%). Nine (13%) patients had MS relapse and were treated with intravenous methylprednisolone in the four weeks before COVID-19 infection. The most common symptoms at the peak of COVID-19 infection were fever (46%), fatigue (37%), and headache (36%). Symptoms lasted for a mean duration of 8.7 days; all symptomatic patients recovered and no deaths were reported. COVID-19 severity was categorized in three groups: asymptomatic (n = 12), mild-not requiring hospitalization (n = 48), and requiring hospitalization (n = 10; two of whom were admitted to the intensive care unit [ICU]). Between the three groups, comparison of age, body mass index , Expanded Disability Severity Score , MS disease duration, and DMT use at the time of infection showed no significant differences. A higher percentage of patients who were admitted to hospital or the ICU (40%; p = 0.026) presented with an MS relapse within the prior four weeks compared with those who were asymptomatic or had a mild infection (both 8.3%).
These findings present a reassuring picture regarding COVID-19 infection in patients with MS. However, patients with MS who have had a relapse in the preceding four weeks (requiring glucocorticoid treatment) may have an increased risk of severe COVID-19.
2019 年冠状病毒病（COVID-19）的爆发迅速蔓延并发展成为威胁全球健康的大流行病。多发性硬化症（MS）-一种中枢神经系统（CNS）的自身免疫性脱髓鞘炎症性疾病-的患者主要接受免疫调节/免疫抑制性疾病修正疗法（DMTs）治疗，这会增加感染的风险。因此，人们担心这些患者可能有更高的 COVID-19 风险。针对神经科医生和患者日益增长的担忧，本研究旨在确定沙特阿拉伯（SA）MS 患者 COVID-19 感染的流行率、严重程度和可能的并发症。
在这项前瞻性队列研究中，从在沙特阿拉伯居住的 COVID-19 经逆转录-聚合酶链反应检测或病毒基因测序呈阳性的 MS 患者中获得人口统计学和临床数据，使用呼吸道或血浆样本。使用单向方差分析或 Kruskal-Wallis 检验对数值变量进行 COVID-19 严重程度组的比较，使用卡方检验对分类变量进行比较。
本分析共纳入 70 例 COVID-19 感染的 MS 患者（71%为女性）。在 53 例（75.7%）感染 COVID-19 时接受 DMT 治疗的患者中，最常使用的 DMT 是芬戈莫德（25%）和干扰素-β（25%）。9 例（13%）患者在 COVID-19 感染前四周有 MS 复发，并用静脉注射甲基强的松龙治疗。COVID-19 感染高峰期最常见的症状是发热（46%）、疲劳（37%）和头痛（36%）。症状平均持续 8.7 天；所有有症状的患者均康复，无死亡报告。COVID-19 严重程度分为三组：无症状（n=12）、轻度-无需住院（n=48）和需要住院（n=10；其中 2 人入住重症监护病房[ICU]）。在这三组之间，年龄、体重指数、扩展残疾严重程度评分、MS 疾病持续时间和感染时使用 DMT 的比较无显著差异。与无症状或轻度感染的患者相比，住院或 ICU 收治的患者（40%；p=0.026）在过去四周内有 MS 复发的比例更高（均为 8.3%）。
这些发现为 MS 患者的 COVID-19 感染提供了一个令人安心的情况。然而，在过去四周内有复发（需要糖皮质激素治疗）的 MS 患者可能有发生严重 COVID-19 的风险增加。
