COVID-19 and MS: Do You Know the Risk Factors? What the American Registry Analysis Showed

Introduction

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system. It thus has its specifics concerning the immune system and infectious diseases. Although the general risk factors for a severe course of COVID-19 (mainly advanced age, male gender, and certain comorbidities) were clarified relatively early, many questions arose about the course of COVID-19 in MS patients. The authors of this paper decided to address some of these questions.

Analyzed Data

Patients with laboratory-confirmed SARS-CoV-2 infection or those with a highly suspicious infection were included in the North American MS and COVID-19 registry (COViMS Registry). Collected data included demographic information (gender, age, race, ethnicity, state/country), details about the course of MS (duration of illness, degree of disability), comorbidities (cancer, cardiovascular and cerebrovascular diseases, chronic kidney, liver, and lung diseases, chronic neurological/neuromuscular diseases, diabetes, arterial hypertension, immunodeficiencies, morbid obesity, and others). Data on smoking habits, the use of glucocorticoids within two months before COVID-19 infection, and current disease-modifying treatments (DMDs) were also collected.

Regarding COVID-19 severity evaluation, patients were divided into four groups: non-hospitalized, hospitalized, patients requiring intensive care unit (ICU) admission/artificial ventilation (AV), and deceased.

Findings

Between April 1 and December 12, 2020, a total of 1626 patients were included in the database (1245 laboratory-confirmed COVID-19 cases, others highly suspicious). The majority were women (1202; 74.0%) and most suffered from relapsing-remitting MS (RRMS; 1255; 80.4%). The average age was 47.7 years (standard deviation [SD] 13.2), and the average MS duration was 13.1 years (SD 9.9). Approximately half of the reported patients had one or more comorbidities, most commonly arterial hypertension, morbid obesity, and diabetes (358, 179, and 148 patients, respectively). The most common symptoms of COVID-19 infection were fever (55%), dry cough, and fatigue (40%), shortness of breath (30.3%), loss of taste/smell, and pain (25%). Neurological symptoms were reported in 8.9% of patients.

A total of 425 (26.1%) patients visited the emergency room, 320 (19.7%) were hospitalized, 112 (6.9%) had pneumonia, 104 (6.4%) were admitted to the ICU, and 61 (3.8%) required AV. The mortality in the observed population was 3.3% (n = 54; 43 hospitalized, of which 29 admitted to the ICU, 25 on AV). Mortality was higher in older age groups.

The risk of death increased by 76.5% with every 10 years of age. Older age also proved to be a significant risk factor for hospitalization and ICU admission/need for AV (30% per 10 years). Men had a 41% higher probability of hospitalization and a 3 times higher probability of death compared to women. The inability to walk or the need for walking aid was also associated with a worse course of COVID-19. Patients with cardiovascular disease had a 91% higher risk of hospitalization and more than a 3 times higher risk of death. Diabetes increased the hospitalization risk by approximately 2.5 times, morbid obesity by 68.5%.

Compared to patients not using DMDs, those treated with rituximab had a 4.5 times higher risk of hospitalization. Higher risk was also seen in patients receiving ocrelizumab. The use of glucocorticoids two months before SARS-CoV-2 infection increased the risk of hospitalization by approximately 2 times and the risk of death by 4 times.

Conclusion

According to this study, patients at higher risk of severe COVID-19 were older, male, those with reduced ability to walk, cardiovascular patients, diabetics, and those morbidly obese. Most risk factors thus align with the general population. Anti-CD20 antibody therapy (rituximab and ocrelizumab) also increased the risk of hospitalization.

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Source: Salter A., Fox R. J., Newsome S. D. et al. Outcomes and risk factors associated with SARS-CoV-2 infection in a North American registry of patients with multiple sclerosis. JAMA Neurol 2021 Mar 19; e210688, doi: 10.1001/jamaneurol.2021.0688 [Epub ahead of print].