MS, NMOSD and COVID-19: What Did a Year of Pandemic in Czechia Mean for Our Patients and Which Risk Factors Were Confirmed?

Introduction

When the COVID-19 infection first appeared in Czechia on March 1, 2020, concerns arose about its course in chronic patients, such as those with autoimmune diseases like MS and NMOSD. Therefore, 12 Czech MS centers, which manage about 70% of this population, immediately began collecting data on the course of COVID-19 via the Czech MS patient registry (ReMuS).

Results

This multicenter retrospective observational study included patients with laboratory-confirmed COVID-19 infection from March 1, 2020, to February 28, 2021, for whom it was known at the time of analysis whether they had recovered or died from the illness. The incidence in this specific population corresponded to the general incidence in Czechia. In total, there were 958 patients with MS and 13 with NMOSD. Pneumonia occurred in 50 MS patients and 4 NMOSD patients. A total of 3 MS patients and 2 NMOSD patients died.

The most common symptoms of COVID-19 in more than half of the patients were fatigue and headache. New neurological symptoms or worsening of existing ones appeared in 13.25% of patients, and in 26% of these cases, the worsening was evaluated as an attack requiring glucocorticoid treatment. Except for throat pain, nasal congestion, and loss of taste or smell, all monitored symptoms (worsening neurological symptoms or new neurological symptoms, fever, fatigue, dry cough, bone, joint, and muscle pain, shortness of breath, chills, headache, loss of appetite, nausea, vomiting, diarrhea, abdominal pain, thromboembolic disease, conjunctivitis, rash) were more frequent in patients who developed pneumonia.

Multivariate analysis demonstrated a higher risk of pneumonia in older patients (odds ratio [OR] per 10 years 2.01; 95% confidence interval [CI] 1.41–2.91), those with a higher body mass index (BMI; OR 1.07; 95% CI 1.00–1.14), and those who received a glucocorticoid pulse in the 2 months before COVID-19 infection (OR 2.83; 95% CI 0.10–7.48). Another important finding was the higher risk of pneumonia in patients treated with anti-CD20 antibodies targeting the CD20 molecule expressed on the surface of B lymphocytes.

The nearly 9-time higher risk of pneumonia in patients treated with anti-CD20 was also confirmed by the propensity score matching method (OR 8.90; 95% CI 3.04–33.24). In this case, patients treated with anti-CD20 were paired with patients receiving other disease-modifying therapies based on the following parameters: age, gender, BMI, glucocorticoid administration, presence of pulmonary comorbidity. Therefore, these factors should not play a significant role in the determined 9-time risk of pneumonia.

Data on the course of COVID-19 in patients with NMOSD are still scarce, but available publications warn of a significantly worse course and higher mortality in this specific group. This is also confirmed by data from the Czech population. Among the 13 NMOSD patients who contracted COVID-19, 4 developed pneumonia, and 2 died.

Conclusion

Outputs from the Czech ReMuS registry and international data showed that COVID-19 generally progresses in MS patients similarly to the general population. The incidence is comparable, and the risk factors (higher BMI, age, presence of comorbidities) are the same. However, patients who were treated with high doses of glucocorticoids in the 2 months before COVID-19 and those receiving anti-CD20 antibodies are at a higher risk of severe course. There is still limited data on NMOSD patients, but even this clearly points to a higher risk of severe course and mortality in this specific population.

The good news is that based on these findings, preferential vaccination was initiated for high-risk patient groups in Czechia, and the administration of monoclonal antibodies against SARS-CoV-2 was indicated in the early stages of infection.

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Source: Šťastná D., Meňkyová I., Drahota J. et al. Multiple sclerosis, neuromyelitis optica spectrum disorder and COVID-19: a pandemic year in Czechia. Mult Scler Relat Disord 2021 Jun 24; 54: 103104, doi: 10.1016/j.msard.2021.103104 [Epub ahead of print].