Abstract
The COVID-19 pandemic challenges neurologists in counselling patients with multiple sclerosis (pwMS) regarding their risk by SARS-CoV-2 and in guiding disease-modifying treatment (DMT). To characterize the prevalence and outcome of COVID-19 in pwMS specifically associated with different DMT in a nationwide population-based study. We included patients aged ≥18 years with a confirmed diagnosis of MS and a diagnosis of COVID-19 established between January 1, 2020 and December 31, 2020. We classified COVID-19 course as either mild, severe or fatal. Impact of DMT and specifically immunosuppressants (alemtuzumab, cladribine, fingolimod, ocrelizumab or rituximab) on COVID-19 outcome was determined by multivariable models, adjusted for a-priori-risk. Of 126 MS patients with COVID-19 (mean age 43.2 years [SD 13.4], 71% female), 86.5% had a mild course, 9.5% a severe course and 3.2% died from COVID-19. A-priori-risk significantly predicted COVID-19 severity (R2 0.814; p<0.001) and mortality (R2 0.664; p<0.001). Adjusting for this a-priori-risk, neither exposure to any DMT nor exposure to specific immunosuppressive DMT were significantly associated with COVID-19 severity (odds ratio [OR] 1.6; p = 0.667 and OR 1.9; p = 0.426) or mortality (OR 0.5; p = 0.711 and 2.1; 0.233) when compared to no DMT. In a population-based MS cohort, COVID-19 outcome was not associated with exposure to DMT and immunosuppressive DMT when accounting for other already known risk factors. This provides reassuring evidence that COVID-19 risk can be individually anticipated in MS and-except for a very small proportion of high-risk patients-treatment decisions should be primarily focused on treating MS rather than the pandemic.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused more than 83 million confirmed infections worldwide and approximately 1.8 million have died from the consequences of the virus-associated respiratory disease (CoronaVirus-Disease 2019, COVID-19) as by December 31st, 2020
COVID-19 severity and mortality in multiple sclerosis do not depend on immunotherapy a qualified researcher and can be accessed from and upon approval by the ethics committee of the Medical University Vienna
In a population-based Multiple sclerosis (MS) cohort, COVID-19 outcome was not associated with exposure to disease-modifying treatment (DMT) and immunosuppressive DMT when accounting for other already known risk factors
Summary
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused more than 83 million confirmed infections worldwide and approximately 1.8 million have died from the consequences of the virus-associated respiratory disease (CoronaVirus-Disease 2019, COVID-19) as by December 31st, 2020. Multiple sclerosis (MS) is often considered as a disease affecting young adults, but a substantial number of patients with MS (pwMS) are older than 60 years and might be at an increased risk of severe morbidity and mortality from COVID-19 [2,3,4]. There is particular concern whether immunomodulatory or immunosuppressive disease-modifying treatments (DMT), which are to some extent associated with a greater risk of infection, increase the risk for COVID-19 severity and mortality [5, 6]. The objective of this study was to characterize the prevalence, severity and overall mortality of SARS-CoV-2 infections in pwMS associated with different DMT in a nationwide population-based study. The COVID-19 pandemic challenges neurologists in counselling patients with multiple sclerosis (pwMS) regarding their risk by SARS-CoV-2 and in guiding disease-modifying treatment (DMT)
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