Evaluation of the Opinion of Patients With Multiple Sclerosis on the Outcomes of Catching COVID-19 and Its Effects on the MS Symptoms

Fear of re-infection, relapse, and anxiety during COVID-19 pandemic in patients with multiple sclerosis: A multi-center study

Background: Fear of relapse and re-infection during the coronavirus disease 2019 (COVID-19) pandemic can affect people with chronic relapsing diseases, such as multiple sclerosis (MS). We evaluated fear of re-infection, anxiety, and relapse during the COVID-19 pandemic in Iranian people with MS. Methods: This multicenter, cross-sectional study was performed in the MS clinic of Sina Hospital, Tehran, Iran, and Hakim Private Hospital, Isfahan, Iran, between January and April 2022. We asked the participants to fill out validated Persian versions of Fear of Relapse Scale (FoR), and Beck Anxiety Inventory (BAI) questionnaires and answer a binary question about their fear of getting reinfected with COVID-19. Results were reported as mean ± standard deviation (SD) for continuous variables or frequencies for categorical variables. For continuous variables which did not have a normal distribution, we reported the median and interquartile range (IQR). Spearman correlation coefficient between anxiety score and FoR score was calculated. An independent samples t-test was used to compare continuous variables. Results: Three hundred and sixty-eight patients participated in this study. The median scores of FoR and BAI were 49.7 and 34.3, respectively. Fifty-three had new relapses in their last infection. Thirty-six percent of the patients had a fear of getting COVID-19 again, and 43% had a fear of relapse during infection. Three hundred and twenty-three had two doses of COVID-19 vaccine; the most frequent type of vaccine was Sinopharm. There was a significant difference between the median FoR scores among patients with and without relapse during the last COVID-19. There was also a significant positive correlation between anxiety score and FoR (r = 0.49, P < 0.001). Conclusion: More than one-third of enrolled cases had fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) re-infection. Patients who experienced exacerbation of symptoms even in the form of relapse or pseudo relapse (possible clinical relapse) had a higher fear of infection.

Multiple sclerosis and COVID-19: A retrospective study in Iran

OBJECTIVES

Previous studies suggested a higher rate of COVID-19 infection in patients with multiple sclerosis than in the general population, and limited studies addressed the impact of COVID-19 and its vaccination in patients with multiple sclerosis in Iran. We decided to investigate the factors associated with COVID-19 infection, the effects and side effects of the COVID-19 vaccination in patients with multiple sclerosis (MS).

METHODS

We used the data of the patients with multiple sclerosis registered in a referral clinic in Kerman, one of the large cities in Iran (a population of 537,000 inhabitants), to explore the association between demographic variables, the history of COVID-19 vaccination, and the clinical outcomes.

RESULTS

Of the 367 participants in this study, 88.3% received the COVID-19 vaccine, 35.4% were confirmed COVID-19 cases, and the incidence of COVID-19 was much higher before vaccination (24.5% before vaccination versus 10.1% after vaccination). The multivariable logistic regression model showed that male gender (OR = 2.64, 95% confidence interval: 1.21, 5.74) and current employment (OR = 3.04, 95% confidence interval: 1.59, 5.80) were associated with an increased risk of COVID-19. The only factor associated with the adverse effects of COVID-19 vaccination was the type of vaccine (AstraZeneca).

CONCLUSION

Our findings showed that the vaccination protected MS cases considerably against COVID-19. In addition, the side effects of the vaccines were not noticeably high in these cases as well. Among all COVID-19 vaccines, AstraZeneca had the most common side effects, so people must be aware of them before vaccination. The male gender and employment were the most important variables in the prevalence of COVID-19 in patients with multiple sclerosis in our study.

Assessment of Multiple Sclerosis Patients' Knowledge and Behavioral Practice Regarding COVID-19 in Saudi Arabia

Background Coronavirus disease 2019 (COVID-19) is caused by a coronavirus subtype called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is crucial to control the spread of coronavirus by understanding the disease and practicing the measures adopted during the COVID-19 pandemic. Multiple sclerosis (MS) is a central nervous system immune-mediated inflammatory demyelinating disease. COVID-19 infection may exacerbate the MS disease and its relapses. Therefore, MS patients are more susceptible to infection because of their immunosuppressive or immunomodulatory medications. Objective We aimed to evaluate the knowledge, attitude, and behaviors of patients with MS in Saudi Arabia regarding the COVID-19 pandemic. Method A quantitative observational cross-sectional study was conducted. MS patients in Saudi Arabia were included in the study population. Data were collected via an online self-reported questionnaire from 214 participants from November 2020 to June 2021. Results A total of 214 MS patients participated in this study. The gender distribution showed that the male participants represented 38.3% (n = 82), while female participants accounted for 61.7% (n = 132). Most MS patients understood the COVID-19 preventive measures. The mean knowledge score was 15.7 (SD = 2.34, range: 1-20), showing an appropriate level of knowledge. While the mean behaviors score was 6.1 (SD = 1.2, range: 2-9), showing good behaviors. The mean score for attitude was 5.4 (SD = 1.77, range: 1-8), showing optimistic attitudes. However, a closer analysis of the participants' answers showed that 74.3% of the patients agreed that the treatment plan should be discussed with their doctors during the pandemic. In addition, almost half of the participants (49.1%) agreed that being an MS patient means they are at higher risk of getting infected by the virus. Data also showed that 17% of patients continued to attend social events involving many people. Also, 28.0% of the patients reported being in crowded places. Conclusion MS patients' risk of COVID-19 might be linked to their knowledge, attitude, and behaviors. Our results suggest that although MS patients have a high knowledge and good attitude and behaviors, it is still essential to have health education programs among MS patients to reduce the risk of SARS-CoV-2 infection and the impact of the COVID-19 pandemic on MS patients' care. Knowledge, attitude, and behaviors toward the COVID-19 pandemic can highlight the importance of education programs and translate the findings into action to minimize the disease risk.

Assessment of COVID-19 vaccine attitude in people with multiple sclerosis, its correlation with demographic factors, and fear of coronavirus: A cross-sectional survey

Background: Despite special global considerations which have been made to prioritize vaccination of people with multiple sclerosis (MS), some are reluctant to get vaccinated. This study was aimed to evaluate the attitude toward coronavirus disease-2019 (COVID-19) vaccine and its probable correlations. Methods: Considering the study objectives, two valid questionnaires including Fear of COVID-19 Scale (FCV-19S) and attitude questionnaires were administered pre and post COVID-19 vaccination among people with MS. Results: The questionnaires were administered among 349 people with MS pre and post vaccination. The mean age of participants was 38.78 ± 8.68 (range: 19 to 64) years. They all received the first dose of COVID-19 vaccine (Sinopharm). Although about 90% of participants felt satisfied after getting vaccinated and respected the preventive actions like social distancing and wearing face mask after vaccination, about 40% of them did not recommend vaccination to other patients. None of the demographic data was predictor of attitude score in COVID-19 vaccine and the only effective factor regarding fear of COVID-19 among people with MS was gender (P = 0.001). It was found that the more a patient's fear score was, the more he/she felt satisfied after vaccination. Those patients who had got the influenza vaccine last year felt more satisfied with the vaccine and accepted the COVID-19 vaccine easier than others. Conclusion: This study revealed that there was an inverse correlation between fear of coronavirus and less trust in the vaccine in patients with MS. However, it should be mentioned that the patients felt more satisfied after COVID-19 vaccination.

Characteristics of COVID-19 in patients with multiple sclerosis

Background

Regarding the high prevalence of multiple sclerosis (MS) and COVID-19 in Iran, a multicenter study of COVID-19 in Iranian MS patients with is carried out to address the concerns of this population.

Methods

Data on MS patients with COVID-19 from nine provinces of Iran were entered in a web-based registry system, between July 2020 and March 2021. Among the COVID-19 symptoms, dyspnea, altered mental status, or those resulting in hospital admission were considered severe.

Results

A total of 397 eligible patients were identified. In addition, 310 (78%) were female. The mean age was 36.5 ± 9.5. 294 (74%) patients had relapsing- remitting form. Also, four patients (1%) expired due to COVID-19 infection. The mean duration of admission in hospitalized patients was 9 (± 5.3) days. MRI was performed on 111 (28%) patients after developing COVID-19. MRI changes were observed in 27 (24%) of these cases. MS drug was changed in 26 (6%) patients. Steroid use in the past three months (OR: 2.43, 95% CI: 1.003–5.88) (p value: 0.049) and antiCD20s (OR: 4.03, 95% CI: 2.41–6.68) (p value < 0.001) showed significant association with severe COVID-19 symptoms.

Conclusion

The death rate of COVID-19 among MS patients (1%) is lower than the overall death rate of the pandemic in Iran (3%). Those who received steroid in the past three months may be at increased risk of more severe forms of COVID-19. There are still doubts about the effect of anti CD20s on COVID-19 severity.

Opinions, beliefs and knowledge of people with multiple sclerosis on COVID-19 pandemic and vaccine

BACKGROUND

Considering the potential COVID-19 impact on pwMS health and the importance of vaccination for this population, we decided to assess: (a) pwMS’ beliefs and knowledge on COVID-19 pandemic; (b) their acceptance towards COVID-19 vaccination and (c) pwMS’ opinions on general vaccination.

METHODS

Observational study, based on a cross-sectional (10-20^th September 2020) online survey, conducted in a cohort of pwMS’ followed at two Portuguese hospitals. The survey included measures to characterize the sample and a questionnaire designed to assess the topics defined for this study.

RESULTS

270 respondents completed the full survey (response rate 58.2%). pwMS greatest concern during the pandemic was an aggravation of MS, especially by patients older than 50 years old. Almost 40% of the patients older than 50 felt that the pandemic negatively affected their MS related medical assistance. Most patients believed they would recover from COVID-19 infection. More than half of the responders feared a MS aggravation if they got COVID-19; this was more pronounced in patients with progressive MS. About 12% of the participants did not want to be vaccinated and almost 40% was unsure. Regarding vaccines in general, almost a third of the participants feared their side effects or MS related complications.

CONCLUSION

Having knowledge of pwMS’ opinions on COVID-19 pandemic impact and vaccination is useful to better address these issues. Fears and expectations towards vaccination must be discussed with pwMS.

Fear of relapse, social support, and psychological well-being (depression, anxiety, and stress level) of patients with multiple sclerosis (MS) during the COVID-19 pandemic stage

Background

Psychological well-being assessment during the COVID-19 pandemic is essential for patients with multiple sclerosis (MS). The goal of this study is to evaluate fear of relapse, social support, and psychological well-being (depression, anxiety, and stress level) of Iranian patients with MS during the COVID-19 pandemic stage.

Methods

One hundred and sixty-five patients were enrolled. We asked all cases to fill valid and reliable Persian version of depression, anxiety, and stress scale (DASS-21), perceived social support, and fear of relapse scale questionnaires.

Results

One hundred and sixty-five patients were enrolled. Female to male ratio was (F/M) = 4.6. Mean age and mean duration of disease were 35.3±8.6 and 7.1±5 years, respectively. Mean scores of social support, DASS, and FoR questionnaires were 63.1±16.8, 16.4±13.4, and 51.4±17.3, respectively. There was a significant negative correlation between social support and FoR scores and also significant positive correlations between components of DASS and FoR. Linear regression analysis by considering FoR as dependent variable and age, sex, marital status, duration of the disease, and EDSS as dependent variables showed that sex was an independent predictor of FoR score.

Conclusion

Psychological well-being as well as fear of relapse should be considered in patients with MS during the COVID-19 pandemic stage.

The COVID-19 Pandemic Experience in Multiple Sclerosis: The Good, the Bad and the Neutral

Introduction

While the current COVID-19 pandemic has affected the lives of many, there is a paucity of information on the impact on people with multiple sclerosis (MS). This study sought to gain insight into the impact of the current situation on people with MS and the factors that influence this.

Methods

324 MS patients participated in this online cross-sectional survey during the COVID-19 lockdown period. A mixed methods design was used, with quantitative information collected on MS-related factors as well as COVID-19 impact and an open-ended, qualitative response looking for reasons behind the self-reported COVID-19 impact.

Results

We found that 48% of the participants reported that COVID-19 had a neutral impact on their lives and 16% reported a positive impact. However, 36% reported a negative impact, and had greater levels of MS- and non-MS-related worries, and higher levels of bother related to psychological and cognitive symptoms and fatigue than the groups reporting a neutral or positive impact. Significant predictors of this adversely affected group were age, type of MS and presence of psychological symptoms. Antidepressant medication use, time since diagnosis, gender, location, living arrangements or employment status did not predict impact. Open-ended responses explaining personal COVID-19 impact indicate that coping strategies may contribute to these findings. In particular, active, problem-focused approaches were reported by the majority of people who reported a positive impact, as well as a third of those who reported a neutral impact.

Conclusion

These findings suggest that younger people, those with progressive types of MS, and those with psychological symptoms are particularly vulnerable to the negative effects of a COVID-19 pandemic induced lockdown. Coping strategies provide further insight into these findings with those reporting active problem-focused approaches seemingly faring better than those who do not state any coping strategies. These results also have implications for understanding other like neurological conditions that share many similarities with MS and how best to direct support.

People with Multiple Sclerosis (MS) are more vulnerable to psychological disorders such as anxiety. Consequences of the COVID-19 pandemic could potentially heighten these levels due to the impact on health and healthcare. An online survey was completed by 324 people with MS during the COVID-19 pandemic to identify the level of COVID-19 impact (positive, neutral or negative) and the reasons why they felt this way. Findings show that just under half of people who completed the survey reported a neutral impact, with a negative impact reported by just over a third of participants. Having a progressive diagnosis of MS, being younger and having psychological symptoms predicted a negative impact. Coping strategies also appear to play a part in the COVID-19 experience for people with MS, with active, problem-focused strategies being an approach used by nearly all who reported a positive impact and over a third of people who reported a neutral impact. These findings can be used to direct support to the most vulnerable people within this population as well as those with other neurological conditions.

COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: A systematic review

Introduction

The Coronavirus disease-19 (COVID-19) pandemic continues to expand across the world. This pandemic has had a significant impact on patients with chronic diseases. Among patients with demyelinating diseases of the central nervous system (CNS), such as Multiple Sclerosis (MS) or Neuromyelitis Optica Spectrum Disorder (NMOSD), concerns remain about the potential impact of COVID-19 on these patients given their treatment with immunosuppressive or immunomodulatory therapies. In this study, we review the existing literature investigating the impact of disease-modifying therapies(DMT) on COVID-19 risks in this group of patients.

Method

For this systematic review, we searched PubMed from January 1, 2020, to December 3, 2020. The following keywords were used: “COVID-19” AND “Multiple Sclerosis” OR “Neuromyelitis Optica.” Articles evaluating COVID-19 in patients with demyelinating diseases of CNS were included. This study evaluates the different aspects of the DMTs in these patients during the COVID-19 era.

Results and conclusion

A total of 262 articles were found. After eliminating duplicates and unrelated research papers, a total of 84 articles met the final inclusion criteria in our study. Overall, the experiences of 2493 MS patients and 37 NMOSD patients with COVID-19 were included in this review. Among them, 46(1.8%) MS patients died(the global death-to-case ratio of Covid-19 was reported about 2.1%). Among DMTs, Rituximab had the highest mortality rate (4%). Despite controversies, especially concerning anti-CD20 monoclonal antibody therapies, a relation between DMT-use and COVID-19 disease- course was not found in many studies. This observation reinforces the recommendation of not stopping current DMTs. Other variables such as age, higher expanded disability status scale (EDSS) scores, cardiac comorbidities, and obesity were independent risk factors for severe COVID-19.

Despite the risks of infection, most patients were willing to continue their DMT during the pandemic because of more significant concern about the risk of relapse or worsening MS symptoms. After the infection, an immune response's attenuation was seen in the patients on Fingolimod and anti-CD20 monoclonal antibodies. This may be a critical finding in future vaccinations.