Clinical characteristics, re-infection, seropositivity and the role of Disease Modifying Drugs (DMDs) in COVID19 infected MS and NMOSD patients: A 12 months prospective observational study

Abstract

Objectives: Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorder (NMOSD) patients may have
higher risk of contracting COVID-19 infection due to the medications, disability and other comorbidities leading
to immune system dysfunction. COVID-19 may aggravate MS and NMOSD or lead to their progression. Methods:
We investigated the clinical characteristics of COVID-19 infection and the relationship between using disease
modifying drugs (DMDs) and other possible contributing factors with the rate and severity of COVID-19
infection in MS/NMOSD patients through a cohort as a longitudinal observational cross-sectional study. The
sample was all MS and NMOSD patients those whom visited in a referral MS clinic in Tehran, Iran, and went
through three-monthly follow-ups for 12 months. Patients were assessed for clinical symptoms, re-infection
with COVID-19 and its seropositivity. Results: From the total 2878 patients, 2328 were under treatment with
DMDs. In confirmed COVID-19 contracted patients (42), 12 patients used Rituximab, 6 Beta interferon, 3
Teriflunomide, 5 Natalizumab, 9 Fingolimod, 3 Dimethyl fumarate, one Azathioprine and 3 were no DMD using.
Some patients treated with DMDs such as Rituximab, Fingolimod and Natalizumab were at a higher risk of
COVID-19 infection or even re-infection compared to other DMDs. It is probable that some drugs could have
relatively protective effects.We had limited report of exacerbation of MS and NMOSD among confirmed cases
not close to the infection time, at least in our short-term follow-up. Conclusions: MS and NMOSD patients had
no higher risk of contracting COVID-19 infection than general population. Some DMDs had a role in severity of
infection or re-infection and also in the rate of seropositivity.