番茄社区

Multiple sclerosis (MS) patients with SARS-CoV-2 infection had worse COVID-19 outcomes if they needed help walking or couldn't walk at all, COViMS registry data showed.

Older age, Black race, and cardiovascular comorbidities also raised the risk of more severe COVID in MS patients, reported Amber Salter, PhD, of Washington University in St. Louis, and co-authors in .

"The findings from COViMS add evidence on MS-specific factors such as ambulatory disability, treatment with rituximab [Rituxan], and recent corticosteroid use that are associated with worse COVID-19 outcomes from a large, diverse group of persons with MS in North America," Salter told 番茄社区. "We think this information may be used by healthcare providers to improve the monitoring and treatment of COVID-19 in persons with MS."

The analysis was based on 2020 data from April to mid-December in , a registry supported by the Consortium of MS Centers, the National MS Society, and the MS Society of Canada. Of 1,626 MS patients in the study, 82.7% had laboratory-positive SARS-CoV-2 infection. Nearly all participants (97%) were from the U.S.

Most (74%) were women, and 80.4% had relapsing-remitting MS. Mean age was about 48 and mean disease duration about 13 years. Almost 62% of participants were non-Hispanic white, 20.8% were Black, and 11.7% were Hispanic or Latino.

Half the participants had one or more comorbidity, most commonly hypertension (22%), morbid obesity (11%), diabetes (9.1%), or cardiovascular disease (5.7%). Most were fully ambulatory (75.2%), 15.3% walked with assistance, and 9.5% couldn't walk. Nearly a third (30.9%) were taking ocrelizumab (Ocrevus) at the time of SARS-CoV-2 infection; 15.1% were not taking any disease-modifying therapy. About 5% were on rituximab, which is used off-label to treat MS in the U.S., and 4.2% had been treated with glucocorticoids in the past 2 months.

Overall, 19.7% of MS patients with COVID-19 were hospitalized, 6.4% were admitted to the ICU, 3.8% required ventilator support, and 3.3% died. Mortality rates ranged from 1.2% for patients 35-44 years old to 22.6% for people 75 and older. No one under age 35 died.

MS patients who needed help walking had at least twice the risk of worse COVID-19 outcomes as those who were fully ambulatory, after adjusting for other risk factors. Patients who couldn't walk at all had a higher likelihood of being hospitalized (OR 2.8, 95% CI 1.6-4.8), being admitted to the ICU or ventilated (OR 3.5, 95% CI 1.6-7.8), or dying (OR 25.4, 95% CI 9.34-69.1).

For every 10-year increase in age, MS patients had a higher risk of hospitalization (OR 1.3, 95% CI 1.1-1.6) and death (OR 1.8, 95% CI 1.2-2.6). Cardiovascular disease also raised the risk of hospitalization (OR 1.91, 95% 1.02-3.59) and death (OR 3.15, 95% CI 1.18-8.45). Black MS patients had increased odds of hospitalization and more than twice the risk of ICU admission or ventilation as white patients (OR 2.28, 95% CI 1.22-4.23), but no increased risk of death.

Patients taking rituximab were more likely to be hospitalized (OR 4.56, 95% CI 2.10-9.90) than patients on no disease-modifying treatment. This association was not as strong for the other anti-CD20 drug in the study, ocrelizumab (OR 1.63, 95% CI 0.98-2.72). Patients who used glucocorticoids in the past 2 months were more than twice as likely to be hospitalized and four times as likely to die as those who didn't have this treatment.

These results are similar to some, but not all, other studies of MS and COVID-19, observed Jeffrey Cohen, MD, of the Cleveland Clinic in Ohio, who wasn't involved with the research.

"Some studies have suggested an increased risk of more severe outcomes from COVID-19 in patients with MS on ocrelizumab or rituximab, although some other studies have not shown that," Cohen told 番茄社区. "My take on these results is that there was some increased relative risk from those two medications. It seemed to be somewhat greater for rituximab than ocrelizumab, but still, the overall absolute risk of patients on those medications having a severe outcome was low."

Treatment decisions during a pandemic depend on other factors, too, Cohen pointed out. "As this study showed, use of recent steroids also had an increased risk, so inadequate control of MS activity might also put someone at risk for COVID complications," he said.

Findings overall were consistent with those discussed at the ACTRIMS Forum earlier this year. COViMS reporting was voluntary, which may have biased the study toward more severe COVID-19 cases, Salter and co-authors acknowledged. Cases were reported by more than 150 different sites across North America, but a large proportion of data, including 21 of 54 deaths, were from the northeastern U.S.

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