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Published on: December 9, 2015
SARS-CoV-2 Infection in Multiple Sclerosis: Results of the Spanish Neurology Society Registry
Georgina Arrambide1, Miguel Ángel Llaneza-González1, Lucienne Costa-Frossard França1
1From the Centro de Esclerosis Múltiple de Cataluña (G.A.), (Cemcat), Instituto de Investigación Vall d'Hebron, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona; Complejo Hospitalario Universitario de Ferrol (M.Á.L.-G.); Hospital Universitario Ramón y Cajal (L.C.-F.F.), Madrid; Hospital Universitario de la Princesa (V.M.L.), Madrid; Complejo Hospitalario Universitario de Albacete, (E.F.D.); Hospital Universitario Fundación Jiménez Díaz (I.M.T.), Madrid; Hospital General Universitario Gregorio Marañón (J.M.G.-D.), Madrid; Hospital La Mancha Centro (G.O.-S., Á.D.S.), Alcázar de San Juan; Hospital Universitario Príncipe de Asturias (L.A.P.), Alcalá de Henares; Hospital Universitario Infanta Leonor (M.G.M.), Madrid; Hospital Universitario Mútua Terrasa (J.J.S.-F.); Complejo Asistencial de Ávila (A.B.C.-R.), Ávila; Hospital Universitario de Fuenlabrada (L.A.R.A.), Madrid; Hospital Universitario Son Espases, Palma de Mallorca (M.C.S.); Complejo Hospitalario de Navarra (M.A.O.-M., T.A.B.), Pamplona; Hospital Universitario y Politécnico La Fe (F.C.P.-M.), Valencia; Hospital Regional Universitario de Málaga (V.R.G.); Hospital Universitario de Getafe (J.J.B.-G.), Madrid; Hospital Santa Barbara (M.M.P.), Puertollano; Hospital Virgen de la Salud (I.P.M.), Toledo; Hospital Universitario Virgen de las Nieves (C.A.G.), Granada; Hospital Universitario Puerta del Sur (CINAC), Madrid (C.G.C.); Hospital Clínico Universitario Zaragoza (C.Í.M.), Zaragoza; Hospital Clínico Universitario Valladolid (N.T.L.,), Valladolid; Hospital Virgen del Puerto (F.C.P.), Plasencia; Hospital Universitario Donostia (T.C.T.), San Sebastian; Hospital General de Segovia (D.M.C.-S.), Segovia; Hospital General Universitario de Alicante (Á.P.S.), Alicante; Hospital Universitario Miguel Servet (IIS Aragón) (B.S.T.), Zaragoza; Hospital Universitario Araba (A.Á.A.), Vitoria; Hospital Clínico Universitario de Santiago de Compostela (E.C.A.), Santiago de Compostela; Hospital Universitario Juan Ramón Jiménez (E.D.-F.), Huelva; Hospital de Terrasa (M.F.M.), Terrasa; Hospital Universitario de Canarias (M.G.P.), San Cristobal de La Laguna; Hospital Universitario Dr Peset de Valencia (L.L.P.), Valencia; Complejo Hospitalario Universitario de Cartagena (J.M.P.), Murcia; Hospital Clínico San Carlos (C.O.-G.),Facultad de Medicina, Universidad Complutense de Madrid, IdISSC, Madrid; and CSUR Unidad de Esclerosis Múltiple y Neuroinmunología Clínica (J.E.M.-L.), Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Cátedra de Esclerosis Múltiple y Neuroinmunología Clínica, UCAM, Universidad Católica San Antonio, Murcia, Spain.
Objective:
To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments.
Methods:
Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome.
Results:
Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome.
Conclusions:
This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal disease.
Insights
People with multiple sclerosis (MS) are not at higher risk for severe COVID-19 due to disease-modifying treatments. Advanced age, progressive MS, and disability are key risk factors for severe or fatal COVID-19 outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
- Disease-modifying treatments (DMTs) for MS can impact immune function, raising concerns about COVID-19 severity.
- Understanding COVID-19 characteristics in MS patients is crucial for risk stratification and management.
Purpose of the Study:
- To characterize COVID-19 in individuals with multiple sclerosis (MS).
- To identify individuals with MS at high risk for severe COVID-19 outcomes.
- To assess the role of disease-modifying treatments in COVID-19 course.
Main Methods:
- Retrospective, multicenter registry study of patients with MS and suspected or confirmed COVID-19.
- Analysis of disease course (mild, severe, critical) and correlation with MS characteristics.
- Identification of risk factors for severe and fatal COVID-19 outcomes.
Main Results:
- Of 326 patients, 21.3% had severe, 3% critical, and 2.1% fatal COVID-19.
- Severe COVID-19 was associated with older age, male sex, comorbidities, progressive MS, longer disease duration, and higher disability.
- MS therapy did not emerge as a primary risk factor; however, rituximab treatment led to hospitalization in 15/33 patients.
Conclusions:
- MS therapy did not demonstrate a critical role in COVID-19 course.
- Advanced age, progressive MS, and higher disability are independent risk factors for severe and fatal COVID-19 in MS patients.
- Focusing on patient-specific factors like age and disability is key for managing COVID-19 risk in multiple sclerosis.
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