High risk of COVID-19 mortality with neurological diseases, vaccine effective in some MS patients

A territory-wide study carried out by the Chinese University of Hong Kong (CUHK) finds that patients with neurological diseases, especially stroke and Parkinson’s disease (PD), are at high risk of mortality if infected with severe acute respiratory syndrome coronavirus (SARS-CoV)–2 or SARS-CoV, while data from Israel show that the BNT162b2 vaccine does not increase the risk of relapse and is effective in multiple sclerosis (MS) patients, apart from those on certain types of MS medication.

“Recent reports suggested that neurological diseases, particularly stroke, dementia and advanced PD, were important predictors of coronavirus disease 2019 [COVID-19]–related mortality,” said Professor Alexander Lau of Gerald Choa Neuroscience Centre at CUHK, discussing the CUHK study findings at the Advances in Medicine 2021 virtual conference. [Nature 2020;584:430-436; Clin Neurol Neurosurg 2020;doi:10.1016/j.clineuro.2020.106183; Parkinsonism Relat Disord 2020;78:134-137]

“We investigated the impact of pre-existing neurological diseases on the mortality of patients with COVID-19 and SARS in Hong Kong by carrying out a territory-wide retrospective cohort study using data from the Clinical Data Analysis and Reporting System [CDARS], since these findings could inform vaccination prioritization for patients with chronic neurological diseases,” he explained. [J Neurol Neurosurg Psychiatry 2021;doi:10.1136/jnnp-2021-326286]

A total of 3,164 patients with COVID-19 were identified during the period of 23 January 2020–31 July 2020 and 1,670 patients with SARS were identified during March–June 2003. The overall case fatality rates of COVID-19 and SARS in the studied period were 2.28 percent and 16.8 percent, respectively.

“In multivariable analysis of patients with COVID-19, stroke [adjusted hazard ratio (aHR), 2.31; 95 percent confidence interval (CI), 1.35 to 3.96; p=0.002] emerged as the third most notable predictor of mortality, after advanced age and renal diseases. In multivariable analysis of patients with SARS, PD was the second strongest predictor of death [aHR, 1.9; 95 percent CI, 1.05 to 3.64; p=0.035], after advanced age,” reported the CUHK researchers.

“Based on our findings, protective strategies such as prioritizing patients with pre-existing neurological diseases, in particular, those with stroke and PD, and their caregivers for vaccination, as well as facilitating use of telemedicine, warrant urgent consideration to minimize morbidity and mortality during COVID-19 pandemic,” they concluded.

With calls to prioritize patients with neurological disorders for COVID-19 vaccination, data are beginning to emerge regarding the safety and efficacy of COVID-19 vaccines in these patients.

In Israel, the National Multiple Sclerosis Society and other expert organizations recommended that all patients with MS should be vaccinated against COVID-19. Between December 2020 and January 2021, researchers from Tel-Aviv University assessed the safety of the BNT162b2 vaccine in 555 MS patients who have received their first dose and 435 patients who have received both doses. “There were three cases of COVID-19 after the first dose. No increased risk of MS relapse activity was noted over a median follow-up of 20 and 38 days after first and second vaccine doses, respectively. The rate of acute MS relapse was 2.1 percent and 1.6 percent following the first and second doses, respectively, which is similar to the rate in non-vaccinated patients during the corresponding period,” they reported. [Mult Scler 2021;27:864-870]

Another study from Israel reported protective humoral immunity of 100 percent, 100 percent, 22.7 percent, and 3.8 percent in untreated MS patients (n=32), those treated with cladribine (n=23), ocrelizumab (n=44), and fingolimod (n=26), respectively. [Ther Adv Neurol Disord 2021;14:1-8]