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Published on: December 9, 2015
Risk of Getting COVID-19 in People With Multiple Sclerosis: A Case-Control Study
Pietro Iaffaldano1, Giuseppe Lucisano1, Alessia Manni1
1From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy.
Background And Objectives:
Several studies have assessed risk factors associated with the severity of COVID-19 outcomes in people with multiple sclerosis (PwMS). The potential role of disease-modifying therapies (DMTs) and demographic and clinical factors on the risk of acquiring SARS-CoV-2 infection has not been evaluated so far. The objective of this study was to assess risk factors of contracting SARS-CoV-2 infection in PwMS by using data collected in the Italian MS Register (IMSR).
Methods:
A case-control (1:2) study was set up. Cases included PwMS with a confirmed diagnosis of COVID-19, and controls included PwMS without a confirmed diagnosis of COVID-19. Both groups were propensity score-matched by the date of COVID-19 diagnosis, the date of last visit, and the region of residence. No healthy controls were included in this study. COVID-19 risk was estimated by multivariable logistic regression models including demographic and clinical covariates. The impact of DMTs was assessed in 3 independent logistic regression models including one of the following covariates: last administered DMT, previous DMT sequences, or the place where the last treatment was administered.
Results:
A total of 779 PwMS with confirmed COVID-19 (cases) were matched to 1,558 PwMS without COVID-19 (controls). In all 3 models, comorbidities, female sex, and a younger age were significantly associated (p < 0.02) with a higher risk of contracting COVID-19. Patients receiving natalizumab as last DMT (OR [95% CI]: 2.38 [1.66-3.42], p < 0.0001) and those who underwent an escalation treatment strategy (1.57 [1.16-2.13], p = 0.003) were at significantly higher COVID-19 risk. Moreover, PwMS receiving their last DMT requiring hospital access (1.65 [1.34-2.04], p < 0.0001) showed a significant higher risk than those taking self-administered DMTs at home.
Discussion:
This case-control study embedded in the IMSR showed that PwMS at higher COVID-19 risk are younger, more frequently female individuals, and with comorbidities. Long-lasting escalation approach and last therapies that expose patients to the hospital environment seem to significantly increase the risk of SARS-CoV2 infection in PwMS.
Classification Of Evidence:
This study provides Class III evidence that among patients with MS, younger age, being female individuals, having more comorbidities, receiving natalizumab, undergoing an escalating treatment strategy, or receiving treatment at a hospital were associated with being infected with COVID-19. Among patients with MS who were infected with COVID-19, a severe course was associated with increasing age and having a progressive form of MS, whereas not being on treatment or receiving an interferon beta agent was protective.
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