American Academy of Neurology annual meeting – April 17-22, 2021
CONGRESS HIGHLIGHTS – MONDAY EDITION
An ongoing Italian observation study of COVID-19 has now obtained data for 902 MS patients (Sormani et al. AAN 2021; S28.002). The risk of ICU admission/death was somewhat higher for the anti-CD20 group (8%) compared to patients treated with an interferon-β (0%) or another DMT (5%). MS patients were also less likely to have asymptomatic COVID while on an anti-CD20 agent (1.1%) compared to an interferon (8.3%) or another DMT (4%). Risk factors for severe COVID were age (odds ratio 1.05), EDSS score (OR 1.13), male sex (OR 1.44) and DMT used (OR 1.99 for anti-CD20).
At the New York University MS clinic, 21% of rituximab-treated patients developed COVID, 10% of the ocrelizumab or S1PR (fingolimod or siponimod) groups, and 4% of natalizumab patients (Smith TE. AAN 2021; P014).
In the ALITHIOS study of ofatumumab, 12 of 1623 patients had confirmed COVID-19 (Cross AH. AAN 2021; P197). Mean age was 37.8 years. Ofatumumab exposure ranged from 8.5-13.8 months. One patient developed severe COVID requiring hospitalization for pneumonia. The regimen of monthly injections was interrupted in four patients and uninterrupted in seven.
Only 9 confirmed COVID cases were identified in the SMH registry (N=5600) for the period March-October 2020 (Solomon J. AAN 2021; P.013). Mean age was 43.2 years; median EDSS score was 1.0 (range 0-5.5). Eight of 9 were on a DMT. Seven patients had mild symptoms, 1 was asymptomatic and 1 required hospitalization.
A retrospective cohort study in Chicago compared an ND cohort (n=132) with 132 controls who were hospitalized for COVID-19 (Patel RA. AAN 2021; S21.004). The mortality rate (19.7% vs. 23.5%) and ICU rate (31.5% vs. 35.9%) were comparable. ND patients had a higher risk of encephalopathy.
A second Chicago study reviewed 50 COVID-19 cases referred to the neurology service (Vargas A. AAN 2021; P.002). Most patients were African-American (48%) or Latino (24%). The most common neurological complications were encephalopathy, cerebrovascular disease, cognitive impairment, seizures and hypoxic brain injury. Cases were more severe/critical in the group with neurological symptoms that developed >24 hours after hospitalization.
A separate report found that 71% of COVID cases had neurological manifestations. The most common were headache (22%), altered mental status (19%), dizziness (8%), gait imbalance (5%) and stroke (0.8%) (Vaish A. AAN 2021; P.005). CNS complications were more frequent in patients with comorbidities, such as cardiac disease, dementia, hypertension and COPD.
The Continuous Quality Improvement Research Collaborative, an ongoing QI initiative, adopted telehealth in response to the pandemic (Mehta F. AAN 2021; P.018). However, most clinical encounters continued to be in-person (45.1%), followed by telephone check-ups (28.1%) and videoconferencing (26.8%).
In one UK MS centre, all in-person visits were rescheduled as telephone follow-ups (Ramsay SJ. AAN 2021; P.234). A subsequent mail questionnaire determined that patient satisfaction with telephone visits was high, although 60% did not respond to the survey. Opinion was mixed about telephone calls remaining part of the clinic procedure post-COVID.