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Outcome of COVID-19 infection in multiple sclerosis patients receiving disease-modifying therapies
Masoud Etemadifar1, Ramin Sami2, Mehri Salari3
1Department of Neurosurgery, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Background:
With the spread of COVID-19, treatment of diseases such as multiple sclerosis (MS) should be resumed with caution due to the disease-modifying therapies (DMTs) used in this subset of patients and the immunoregulatory effects of these drugs. We aim to assess the outcome of COVID-19 infection in MS patients receiving DMTs.
Materials And Methods:
This is a cross-sectional study involving 45 COVID-19-infected patients previously diagnosed with MS. The data regarding their MS status and the type of DMT taken by the patients were extracted from the Isfahan MS Institute registry and were summarized. Diagnosis of MS was based on the 2017 McDonald Criteria, and the diagnosis of COVID-19 was based on computed tomography scan and polymerase chain reaction of nasopharyngeal swabs.
Results:
Out of the 45 MS patients infected with COVID-19, 5 had unfavorable outcomes. Two patients deceased and the other three had persistent respiratory complications on the 4-week follow-up visit. Hypertension, diabetes, seizures, and rheumatoid arthritis were among the comorbidities that the patients reported. Both patients who died received rituximab as part of their MS treatment. All other patients recovered completely.
Conclusion:
Each different drug category may possess a distinct risk for infection, therefore until robust evidence are available, the safest drug should be utilized or the therapy should be postponed, if possible, to minimize patient risk. Disease-modifying therapy use in MS patients should be cautiously applied as their effect on COVID-19 infection prognosis is not yet studied.
Insights
COVID-19 infection in multiple sclerosis (MS) patients on disease-modifying therapies (DMTs) can lead to poor outcomes, particularly with rituximab. Caution is advised when using DMTs during the pandemic.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- The COVID-19 pandemic necessitates careful management of patients with multiple sclerosis (MS) due to their use of immunomodulatory disease-modifying therapies (DMTs).
- Understanding the impact of DMTs on COVID-19 outcomes in MS patients is crucial for patient safety and treatment strategies.
Purpose of the Study:
- To evaluate the clinical outcomes of COVID-19 infection in patients with multiple sclerosis (MS) undergoing treatment with disease-modifying therapies (DMTs).
Main Methods:
- A cross-sectional study was conducted on 45 patients diagnosed with both MS and COVID-19.
- Data on MS status, DMT use, and COVID-19 diagnosis (PCR and CT scan) were extracted from the Isfahan MS Institute registry.
- MS diagnosis adhered to the 2017 McDonald Criteria.
Main Results:
- Of 45 MS patients with COVID-19, 5 experienced unfavorable outcomes, including 2 deaths and 3 with persistent respiratory issues.
- The two deceased patients were receiving rituximab for their MS treatment.
- Comorbidities such as hypertension, diabetes, seizures, and rheumatoid arthritis were noted. All other patients recovered fully.
Conclusions:
- The choice of disease-modifying therapy (DMT) may influence infection risk and COVID-19 prognosis in multiple sclerosis (MS) patients.
- Cautious application of DMTs is recommended until more robust evidence clarifies their specific impact on COVID-19 outcomes.
- Postponing therapy or selecting the safest available DMT may be prudent to minimize patient risk during the pandemic.
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