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Can pulse steroid therapy increase the risk of infection by COVID-19 in patients with multiple sclerosis?
Abdorreza Naser Moghadasi1, Maryam Shabany2, Hora Heidari1
1Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
Background:
Iran is one of the countries with a high prevalence of multiple sclerosis (MS) and COVID-19.MS patients receiving the immunomodulatory or immunosuppressive therapy have a higher risk of infection. Due to the significance of determining the risk factors for getting COVID-19 among MS patients, the present study was designed to assess the risk of infection following the pulse steroid therapy.
Methods:
This cross-sectional study included all MS patients that received corticosteroids in Tehran from December 2019 to August 2020 during the COVID-19 pandemic spread. The subjects' clinical records including their sex, age, the type of MS, the type of medication, the number of days using corticosteroids, the status of prednisolone intake, and the number of days receiving prednisolone after the corticosteroid therapy were obtained. Moreover, main outcomes such as COVID-19 infection and the occurrence of death were recorded by patient's visits and follow-up phone calls. COVID-19 infection was confirmed by physicians according to the clinical performance of RT-PCR, chest CT scan, and antibody tests.
Results:
Totally, 133 MS cases participated in the study, and the pulse therapy was completed for 104 (78.2%) patients up to 5-7 days. 89 (66.9%) cases used the prednisolone tablet following the pulse therapy. Overall, the infection by Covid-19 was observed in 8 (6%) cases, among whom 5 (71.4%) cases received the pulse therapy for 5-7 days and 4 (57.1%) cases had a history of taking the prednisolone tablet. The age of less than 40 years (OR = 1.03; 95% CI (0.23-4.51)), male sex (OR = 0.35; 95% CI (0.03-3.34)), and the RRMS type (OR = 2.87; 95% CI (0.52-15.72)) had no effect on the risk of Covid-19 infection. In addition, there was not statistically significant difference between subjects with the short-term pulse therapy duration (3-4 days) (OR 0.68 (0.12-3.74) and those with the long-term pulse therapy duration (5-7 days). Similarly, no statistically significant difference was observed between subjects taking prednisolone (OR = 1.62 (0.34-7.61) and those not taking prednisolone. Furthermore, there was no significant association between different medication groups and the risk of Covid-19 infection (p < 0.05). No death occurred due to Covid-19 infection among the subjects.
Conclusion:
COVID-19 infection was more common among female and younger patients as well as patients with a longer duration of the pulse therapy and prednisolone intake. There was no significant association between the pulse steroid therapy in MS patients and the risk of infection by COVID-19 in the Iranian population.
Insights
This study found no significant link between pulse steroid therapy and COVID-19 infection risk in Iranian multiple sclerosis (MS) patients. While infection was more common in younger females with longer therapy, overall risk was not significantly associated with treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Multiple Sclerosis (MS) and COVID-19 are prevalent in Iran.
- MS patients on immunomodulatory/immunosuppressive therapy face increased infection risks.
- Assessing COVID-19 risk factors in MS patients undergoing pulse steroid therapy is crucial.
Purpose of the Study:
- To evaluate the risk of COVID-19 infection in multiple sclerosis patients following pulse steroid therapy.
- To identify potential risk factors associated with COVID-19 infection in this patient cohort during the pandemic.
Main Methods:
- A cross-sectional study was conducted on MS patients receiving corticosteroids in Tehran (Dec 2019 - Aug 2020).
- Clinical data including demographics, MS type, medication details, and corticosteroid/prednisolone duration were collected.
- COVID-19 infection and death outcomes were recorded via patient visits and follow-up calls, with infection confirmed by RT-PCR, CT scans, or antibody tests.
Main Results:
- Out of 133 MS patients, 8 (6%) contracted COVID-19.
- Infection was more frequent in those with longer pulse therapy (5-7 days) and prednisolone intake.
- No statistically significant association was found between pulse steroid therapy duration, prednisolone use, or medication groups and COVID-19 infection risk.
Conclusions:
- COVID-19 infection appeared more common in younger, female MS patients with longer pulse steroid therapy and prednisolone intake.
- Pulse steroid therapy in Iranian MS patients was not significantly associated with an increased risk of COVID-19 infection.
- No COVID-19 related deaths occurred among the study participants.
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