Increased disability, older age, black race, cardiovascular disease, and recent corticosteroid treatment are risk factors for poorer outcomes associated with SARS-CoV-2 infection in patients with multiple sclerosis (MS). This is evident from study results published in JAMA Neurology.
Because MS affects the immune system and treatment of these patients can have a significant impact on the immune response, data on clinical outcomes and risk factors related to outcomes in patients with MS concomitantly SARS-CoV-2 are critical.
The aim of the current study was to evaluate the clinical results and to identify risk factors for SARS-CoV-2 infection in a North American registry of MS patients.
Using data from the COVID-19 infection registry in the MS registry, the study researchers identified patients with MS and a laboratory-positive SARS-CoV-2 infection or a highly suspicious COVID-19 between April 1, 2020 and December 12, 2020.
Clinicians reported the progress of COVID-19 and the responses were used to determine the severity of COVID-19: not hospitalized, hospitalized only, intensive care unit (ICU) admission, and / or ventilation assistance required and death.
The sample comprised 1626 patients (74% women; mean age 47.7 years), including 1345 patients with laboratory-positive SARS-CoV-2 infection and 281 patients with suspected COVID-19. Most of the participants had recurrent MS (1,255 patients, 80.4%).
During the study period, all-cause mortality was 3.3% (54 patients), including 43 patients (79.6%) admitted to the hospital, 29 patients (53.7%) admitted to the intensive care unit, and 25 patients (46.3%) who required ventilation assistance.
Mortality increased with age, with the highest mortality rate in patients aged 75 and over (22.6%), while no deaths occurred in patients under 35 years of age. For each increase in age by 10 years, there was a 76.5% higher risk of death.
Mortality was also significantly higher in black patients compared to white patients with MS (4.2% versus 3.5%). After adjusting for covariates, black patients with MS had a 47% increased chance of hospitalization alone, a more than two-fold increased risk of ICU admission and / or ventilation, but no increased risk of mortality.
Outpatient disability was associated with an increased likelihood of all clinical severity grades compared to those who were not treated in hospital. The need for a walker was associated with at least a twofold risk for all clinical severity grades. Being non-outpatient was 2.8 times more likely to be hospitalized alone, 3.5 times more likely to be admitted and / or ventilated to intensive care, and 25 times more likely to die compared to fully outpatients connected.
Cardiovascular disease was associated with a 91% increased risk of hospitalization alone and a more than three-fold increased risk of death from COVID-19.
Treatment with rituximab was associated with a 4.5-fold increased risk of hospitalization for COVID-19, and ocrelizumab was associated with a 1.63-fold increased risk. However, no other clinical severity levels were associated with these treatments. Corticosteroid use in the past 2 months was associated with a 2-fold increased risk of hospitalization and a 4-fold increased risk of death.
The study had several limitations, including potential reporting biases and a lack of data on compliance with public health recommendations.
“Identifying risk factors can improve the management of patients with MS and COVID-19 by alerting doctors to patients who need more intensive treatment or monitoring,” the study’s researchers concluded.
Disclosure: Several authors of the study have stated that they are part of the pharmaceutical industry. For a full list of the authors’ information, see the original reference.
Salter A, Fox RJ, Newsome SD, et al. Results and risk factors associated with SARS-CoV-2 infection in a North American registry of patients with multiple sclerosis. JAMA Neurol. Published online March 19, 2021. doi: 10.1001 / jamaneurol.2021.0688