Patients with MS experience COVID-19 outcomes similar to general population
The impact of COVID-19 on patients with MS is similar to its impact on the general population, with no “marked increases” in severe COVID-19 among patients on disease-modifying therapies.
The findings were presented at the Annual Meeting of the American Neurological Association, which is being held virtually this year.
“It is unclear whether people with MS are more susceptible to complications of COVID-19, especially in those on certain disease-modifying therapies (DMTs),” the researchers wrote. “COViMS is a North American clinician registry that is capturing data on outcomes of people with MS and other [central nervous system] demyelinating diseases who have developed COVID-19.”
Scott D. Newsome, DO, MSCS, FAAN, director of the Johns Hopkins’ Neurosciences Consultation and Infusion Center and associate professor of neurology at Johns Hopkins Medicine, and colleagues described characteristics of patients in the COViMS registry who were hospitalized secondarily to COVID-19 and analyzed risk factors for hospitalization and the need for ICU care. They restricted their analysis to laboratory-positive patients with MS between April 1, 2020, and Sept. 7, 2020.
As of Sept. 7, 2020, the COViMS registry included 986 patients with MS. Among these patients, there were 765 laboratory-confirmed cases of COVID-19. Most patients with COVID-19 were women (n = 560). The group of patients with confirmed COVID-19 infection included 551 patients with relapsing-remitting MS, 119 patients with secondary progressive MS and 41 patients with primary progressive MS. More than 80% of patients were receiving DMTs at the time of COVID-19 infection, according to Newsome and colleagues.
Hospitalizations occurred in 216 of the patients with COVID-19. Of these patients, 73 required ICU care and 50 needed ventilation.
Factors associated with hospitalizations included older age, higher rates of progressive disease, increased levels of disability, longer disease duration and more comorbidities, according to Newsome and colleagues (P < .001 for all factors). They identified cardiovascular conditions, cerebrovascular conditions, chronic kidney disease, chronic lung disease, diabetes, hypertension, morbid obesity and immunodeficiency disease as key comorbidities associated with hospitalization.
Patients requiring ICU care for COVID-19 were more likely to be older, with a longer disease duration, Newsome and colleagues found (P = .024 and P = .005, respectively). Key comorbidities in patients who required ICU care included cardiovascular conditions and chronic liver disease. Patients admitted to the ICU were also more likely to die compared with patients who were hospitalized but did not require ICU care.
Factors significantly associated with mortality included sex (men vs. women, OR = 3.2; 95% CI, 1.3-8), age (per 10 years, OR = 1.7; 95% CI, 1-2.7), ambulation (non-ambulatory vs. fully ambulatory, OR = 15.7; 95% CI, 3.7-67) and comorbidities (unknown vs. no, OR = 48.9; 95% CI, 4.9-489.8). The researchers observed no increased odds for COVID-19-related death with use of a DMT in general or with a specific type of DMT.
While the findings are subject to reporting biases, they demonstrated that the impact of COVID-19 among patients with MS is like its impact in the general population, according to Newsome and colleagues.
“Our data thus far are not showing marked increases in severe COVID-19 disease with MS DMTs,” the researchers wrote. “Data will continue to be collected to confirm this preliminary impression, especially since this has relevance to MS treatment guidelines related to COVID-19.”