A case series and literature review of multiple sclerosis and COVID-19: Clinical characteristics, outcomes and a brief review of immunotherapies

Saurabh Kataria; Medha Tandon; Violina Melnic; Shitiz Sriwastava

doi:10.1016/j.ensci.2020.100287

A case series and literature review of multiple sclerosis and COVID-19: Clinical characteristics, outcomes and a brief review of immunotherapies

eNeurologicalSci. 2020 Dec:21:100287. doi: 10.1016/j.ensci.2020.100287. Epub 2020 Nov 2.

Authors

Saurabh Kataria¹, Medha Tandon², Violina Melnic³, Shitiz Sriwastava³

Affiliations

¹ Department of Neurology, University of Missouri Healthcare at Columbia, MO.
² Safdarjung Hospital, Delhi, India.
³ Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, United States of America.

Abstract

Background: In view of the emerging coronavirus pandemic, the demand for knowledge about the impact of SARS-CoV-2 on people with Multiple Sclerosis (MS) continues to grow. Patients receiving disease modifying therapy (DMT) for MS have a higher background risk of infection-related health care utilization when compared to the general population. Therefore, there is a need of evidence-based recommendations to reduce the risk of infection and also managing MS patients with SARS-CoV-2.

Case description: We present three patients with history of Multiple Sclerosis (MS) on DMTs presenting with worsening MS symptoms likely pseudo exacerbation who were diagnosed with COVID-19.

Discussion: An extensive review of 7 articles was performed, in addition to a brief review on DMTs use in MS patients with COVID-19. In our cases, all patients were on DMT and severe course of disease was noted in 2 cases. No fatality was observed.

Conclusions: This review provides a base on the clinical characteristics, outcomes and the roles of DMTs in MS patients suffering from n-cov-2. Physicians need to be vigilant about considering COVID-19 infection related relapse in the MS patients, especially in this COVID-19 pandemic era and look for pseudo-exacerbation. As most cases are found to have mild course and full recovery on DMTs, further research is needed to formulate evidence-based guidelines. This review will particularly be helpful for the researchers and registries to collect future data on MS and COVID-19.

Keywords: ALT, Alanine Transaminase; AST, Aspartate Transaminase; ATS/IDSA, American Thoracic Society and Infectious Disease Society of America; Antigen presenting cells, (APCs); BUN, Blood Urea Nitrogen; COVID-19; COVID-19, Coronavirus Disease 2019; CRP, C-Reactive Protein; CSF, Cerebrospinal fluid; CT, Computed Tomography; DMT, Disease Modifying Therapy; EDSS, Expanded Disability Status Score; IV, Intravenous; Immunotherapies; JCV, John Cunnigham virus; L, Liters; MS, Multiple Sclerosis; Multiple sclerosis; NK cells, Natural Killer Cells; Novel coronavirus; Ocrelizumab; PPMS, Primary Progressive Multiple Sclerosis; Progressive multifocal leukoencephalopathy, (PML).; RRMS, Relapsing Remitting Multiple Sclerosis; RT PCR, Reverse Transcription Polymerase Chain Reaction; SARS-CoV-2; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; Terminally differentiated late effector memory T cells, (TEMRA); n-Cov2, Novel coronavirus 2; ul, Microliters.