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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.
Background And Objectives:
It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population.
Methods:
Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs).
Results:
The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04).
Discussion:
Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon.
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