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COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context.

Maria Pia Sormani1, Irene Schiavetti1, Luca Carmisciano1

  • 1From the Department of Health Sciences (M.P.S., I.S., L.C.), University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S., M.I.), Genoa; Centro Sclerosi Multipla ASST Spedali Civili di Brescia (C.C., N.D.R.), Montichiari; Neurology Unit (M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Unit (M.F.), IRCCS San Raffaele Scientific Institute, Milan; Neuroimaging Research Unit (M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan; Vita-Salute San Raffaele University (M.F.), Milan; Department of Neurology and Multiple Sclerosis Center (M.R.), ASST "Papa Giovanni XXIII", Bergamo; Multiple Sclerosis Center (P.I.), Ospedale Guglielmo da Saliceto, Piacenza; Regional Referral Multiple Sclerosis Centre (M.C.), Department of Neurology, University Hospital San Luigi, Orbassano, Torino; AISM Rehabilitation Center (G.B.), Italian MS Society, Genoa; Centro Sclerosi Multipla (E.C.), ATS Sardegna; Dipartimento Scienze Mediche e Sanità Pubblica (E.C.), Università di Cagliari; IRCCS Istituto delle Scienze Neurologiche di Bologna (C.S.), UOSI Riabilitazione Sclerosi Multipla; MS Center (P. Cavalla), Department of Neuroscience, City of Health and Science University Hospital of Turin; Centro SM UOC Neurologia (I. Pesci), Fidenza, AUSL PR; Multiple Sclerosis Research Center (A.Z.), IRCCS Mondino Foundation, Pavia; Multiple Sclerosis Centre (P. Confalonieri), Neuroimmunology Department-"Carlo Besta" Neurological Institute, Milan; Multiple Sclerosis Clinical and Research Unit (G.A.M.), Department of Systems Medicine, Tor Vergata University, Rome; Department of Neurology Multiple Sclerosis Center (P.P.), University of Padua; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (M.I.), University of Genoa; Department of Basic Medical Sciences, Neurosciences and Sense Organs (M.T.), University of Bari; Federico II University of Naples (V.B.M.); Department of Advanced Medical and Surgical Sciences (G.T.), University of Campania, Napoli; Università Vita Salute San Raffaele (G.C.), Casa di Cura Privata Del Policlinico, Milan; Research Department (M.A.B.), Italian Multiple Sclerosis Foundation, Genoa; Department of Life Sciences (M.A.B.), University of Siena; Department of Medical and Surgical Sciences and Advanced Technologies (F.P.), GF Ingrassia, University of Catania; Centro Sclerosi Multipla (F.P.), Policlinico Catania, University of Catania; Department of Neuroscience, Mental Health and Sensory Organs (M.S.), Sapienza University of Rome; and Unit of Neurology (M.S.), IRCCS Neuromed, Pozzilli, Isernia, Italy.

Neurology(R) Neuroimmunology & Neuroinflammation
|November 10, 2021
PubMed
Summary
This summary is machine-generated.

Patients with multiple sclerosis (MS) face double the risk of severe COVID-19 outcomes like hospitalization and death. This increased risk is primarily linked to disability and comorbidities, not MS itself.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Epidemiology

Background:

  • The impact of multiple sclerosis (MS) on COVID-19 severity remains unclear.
  • Understanding COVID-19 outcomes in MS patients is crucial for risk stratification and management.

Purpose of the Study:

  • To compare COVID-19-related outcomes in an Italian cohort of MS patients with expected outcomes in the general population.
  • To identify factors influencing COVID-19 severity in individuals with MS.

Main Methods:

  • A retrospective observational case-cohort study compared 1,362 MS patients with an age- and sex-matched Italian population.
  • Outcomes included hospitalization, ICU admission, and death post-COVID-19 diagnosis.
  • Risk excess was quantified using risk ratios (RRs) and compared between higher-risk (EDSS > 3 or comorbidities) and lower-risk (EDSS ≤ 3, no comorbidities) subgroups.

Main Results:

  • MS patients exhibited approximately double the risk of hospitalization (RR=2.12), ICU admission (RR=2.19), and death (RR=2.43) compared to the general population.
  • The excess risk was concentrated in the higher-risk MS subgroup.
  • In the lower-risk subgroup, hospitalization risk increased for patients on anti-CD20 therapies (RR=3.03) but decreased for those on interferon (RR=0.04).

Conclusions:

  • The overall MS cohort faces a doubled risk of severe COVID-19 outcomes, primarily driven by disability (EDSS) and comorbidities.
  • MS patients with lower disability and no comorbidities generally have COVID-19 outcomes similar to the general population.
  • Specific therapies, like anti-CD20, may influence hospitalization risk, while interferon might be associated with reduced risk in lower-risk MS patients.