37th Congress of the European Committee for Treatment and Research in Multiple Sclerosis – October 13-15, 2021
The following summarizes some of the highlights from Day 1 of ECTRIMS 2021.
CONGRESS HIGHLIGHTS – WEDNESDAY EDITION
Risk of COVID-19 risk in MS patients
An Italian case-control study has found that some MS patients have a higher risk of contracting COVID-19 than those in the general population (Iaffaldano et al. ECTRIMS 2021; abstract P823). Risk factors for COVID-19 were female sex, younger age and comorbidities. There was also a higher risk in patients who had recently escalated therapy or who were on a higher-efficacy DMT as their most recent treatment. Part of this elevated risk appeared to be attributable to in-hospital drug administration; patients who needed to visit a hospital for treatment had a significantly higher risk of contracting COVID-19 compared to those who self-administered a DMT at home. A complete summary of COVID-19 data will be available in the ECTRIMS Highlights slide deck available on NeuroSens.
COVID-19 mortality and MS
A meta-analysis of 60 papers (n=5474 MS patients) has estimated that the mortality risk from COVID-19 is 3.1% for MS patients – about 24% higher than in the general population (Prosperini et al. ECTRIMS 2021; abstract P759). Worldwide mortality is currently 2.0%; the case-mortality rate in Canada is 1.7% (www.worldometers.info/coronavirus/). Risk factors for COVID-19 mortality were comorbidities and treatment with an anti-CD20 agent. A separate study at ECTRIMS reported a non-significant 20% increase in COVID-19 mortality in treated MS patients vs. the general population in the UK (Evangelou et al. ECTRIMS 2021; abstract P142). An earlier study reported a COVID-19 mortality rate of 3.0%, with 50% of deaths occurring in MS patients aged >60 years (see COVID-19 mortality in MS patients: a systematic review, NeuroSens, June 1, 2021).
COVID-19 and NMOSD/MOGAD
An analysis of the CoViMS database has examined COVID-19 severity in patients with neuromyelitis optica spectrum disorder (NMOSD, n=77) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD, n=20) (Newsome et al. ECTRIMS 2021; abstract P032). Most were receiving treatment with rituximab at the time of COVID-19 diagnosis. There was high mortality (10.4%) in the NMOSD group; no deaths occurred in the MOGAD cohort. Comorbid NMOSD patients were six-fold more likely to have a poor outcome compared to non-comorbid patients.
RIS: stratifying risk of progression
An analysis of the RelevarEM MS/NMOSD registry in Argentina (n=88) reported that patients with radiologically isolated syndrome with two or three risk factors were at high risk of progression to CIS/MS (Rojas et al. ECTRIMS 2021; abstracts P006 and P009). Over the 40-month follow-up period, 44.3% showed a new MRI lesion and 26.1% experienced a relapse. At RIS diagnosis, risk factors for progression were the presence of oligoclonal banding (hazard ratio 5.9), infratentorial lesions (HR 3.7) or spinal cord lesions (HR 5.3). When two of these factors were present, the hazard ratios for subsequent relapse or new MRI lesion were 10.4 and 9.4, respectively; if all three factors were present, the hazard ratios for the two outcomes were 15.6 and 14.3, respectively. In the low-risk group (no risk factors), only 1 of 29 subjects had a relapse and 6/29 had a new MRI lesion. No low-risk patient progressed after 24 months of follow-up.
Progression independent of relapse activity (PIRA)
Recent studies have indicated that most early disability accumulation is not associated with a relapse in the preceding 6-month period, which some have interpreted as blurring the distinction between relapsing and progressive MS (Kappos et al. JAMA Neurol 2020;77:1132-1140). A new analysis of the Italian MS registry examined 6-month confirmed disability accumulation in patients with CIS/early MS followed for at least 5 years (n=5340) (Portaccio et al. ECTRIMS 2021; abstract P108). Overall, about two-thirds of disability accumulation could be attributed to PIRA. After 11 years, 6% had been diagnosed with SPMS. Patients with relapse-associated worsening were more likely to be diagnosed with SPMS than those with PIRA. The authors found that PIRA did not increase the risk of transitioning to SPMS. They speculated that some PIRA events, as currently defined, are not correlated with neurodegeneration but are due to undetected inflammatory activity.
Clinical tip of the day
A Canadian study showed that over a 5-year period, 56% of MS patients visited a hospital emergency room (Graf et al. ECTRIMS 2021; abstract P140). Infection-related visits accounted for 18.4% of ER visits, with 29.2% of infection-related visits resulting in a hospital stay. The mean age at admission was 62 years; 56% were women.