Patients with multiple sclerosis (MS) and SARS-CoV-2 were at increased risk of serious illness and mortality if they were of advanced age and had progressive MS, according to study results published in Neurology Neuroimmunology and Neuroinflammation.
Study researchers from multiple hospitals across Spain evaluated data from patients (N = 326) with MS who tested positive for SARS-CoV-2, collected by the Spanish Society of Neurology registry. The clinical outcomes through June 2020 were related to the clinical features of MS.
The patients had a mean age of 44.8 (standard deviation [SD], ± 11.5) years and 67.8% were women. On average, they had been diagnosed 11.0 (SD, ± 8.0) years previously, 80.7% had relapsing-remitting MS, 13.2% had secondary progressive MS, 6.1% had primary progressive MS, 24.5% received pulsed immunosuppressive therapies and 16.2% were reversible immunosuppressive therapies.
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The study researchers divided the patients into mild (n = 244), severe (n = 69) and critical (n = 10) COVID-19 disease courses. Serious patients were inpatients, critical patients were in the intensive care unit or the deceased.
Based on the COVID-19 history, people differed significantly in terms of age, gender, MS duration, MS history, Expanded Disability Status Scale (EDSS), use of dimethyl fumarate, use of rituximab, number of comorbidities, and lymphocyte levels during infection.
The risk of a critical COVID-19 was associated with the treatment of COVID-19 (odds ratio [OR], 7.81; 95% CI, 1.63-37.44; P = .010), EDSS scores (OR 1.33; 95% CI 1.05-1.69; P = 0.018), age (OR 1.07; 95% CI 1.01-1.12; P. = 0.007), lymphocyte level (OR 0.99; 95% CI 0.99-1; P = 0.014) and MS phenotype (OR 0.23; 95% CI 0.06 to 0.81; P = 0.022).
Patients who did not survive their COVID-19 infection were older (mean 60.7 vs. 44.5 years; P <0.001), had relapsing-remitting MS less often (28.5% vs. 81.8%; P < 0.001) and had a higher EDSS score (mean 5.4 vs. 2.6; P <.001), received no disease-modifying therapies (71.4% vs. 16.9%; P <.001) and had a longer one MS duration (mean 17.4 vs. 10.9 years; P <.05).
Mortality from COVID-19 was with EDSS scores (OR 1.55; 95% CI 1.15-2.08; P = 0.003), age (OR 1.11; 95% CI 1.04-1 , 17; P = 0.001) related MS phenotype (OR, 0.09; 95% CI, 0.02-0.47; P = 0.046).
This study was limited as investigators could not determine whether the patients were receiving oxygen assistance or what the specific COVID-19 symptoms were.
These data showed that age and MS severity were significant predictors of severe COVID-19 infection and mortality. Investigators did not see a large effect of immunosuppressive treatments on SARS-CoV-2 outcomes.
Disclosure: Several authors stated links to the pharmaceutical industry. For a full list of the details, see the original article.
reference
Arrambide G, Llaneza-González M., França LCF, et al. SARS-CoV-2 infection in multiple sclerosis: results from the registry of the Spanish Society of Neurology. Neurol Neuroimmunol Neuroinflamm. 2021; 8 (5): e1024. doi: 10.1212 / NXI.0000000000001024
