Severe COVID-19 in Multiple Sclerosis Linked to Disability Status, Age, Obesity

July 1, 2020

Notably, the cohort assessment did not identify a link between exposure to disease-modifying therapies and COVID-19 severity.

Céline Louapre, MD, PhD

In a recent attempt to understand the risk factors involved for patients with multiple sclerosis (MS) to possibly develop a severe form of the novel COVID-19 infection, results suggest that neurological disability, age, and obesity were all associated with severe infection. No link was observed between exposure to disease-modifying therapies (DMTs) and COVID-19 severity.1

Conducted by Céline Louapre, MD, PhD, of the Clinical Investigation Center, L'Institut du Cerveau et de la Moelle Épinière, and colleagues, the cohort study included 347 patients with MS. Infection severity was assessed on a 7-point ordinal scale ranging from 1—denoting no hospitalization with no limitations on activities—to 7—denoting death. There was a cutoff at 3 on the scale, which was defined as hospitalized and not requiring supplemental oxygen.

All told, 21% (n = 73) of patients had a severity score of ≥3, and 3.5% (n = 12) died from COVID-19. A higher proportion of those with a severity score of ≥3 had no DMT exposure (46%) compared to those with DMT exposure (15.5%; P <.001). As mentioned, age was independently associated with a higher risk of an infection severity ≥3 (odds ratio [OR] per 10 years: 1.9; 95% CI, 1.4—2.5), as was Expanded Disability Status Scale (EDSS) score ≥6 (OR, 6.3; 95% CI. 2.8-–4.4), and obesity (OR, 3.0; 95% CI, 1.0–8.7).

Notably, EDSS was associated with the highest variability of COVID-19 severe outcome (R2, 0.2), followed by age (R2, 0.06), and then obesity (R2, 0.01). The median EDSS score was 2.0 (range, 0—9.5), and 81.8% (n = 284) of the population were receiving a DMT.

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“The identification of these risk factors could provide a rationale for an individual strategy of clinical management in patients with MS during the COVID-19 pandemic,” Louapre and colleagues wrote. “Risk factors associated with the severity of COVID-19 in patients with MS are unknown. DMTs may modify the risk of developing a severe COVID-19 infection, besides identified risk factors such as age and comorbidities.”

This registry, dubbed Covisep, is a multicenter, retrospective, observational cohort study conducted in MS expert centers and general hospitals and with neurologists collaborating with MS expert centers and members of the Société Francophone de la Sclérose en Plaques. Those included were patients presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and May 21, 2020.

“COVID-19 has significantly changed medical practice for several weeks, and it is likely to remain an issue for months,” the authors concluded. “Our data do not support an increased risk of a severe outcome associated with DMTs, which should reinforce the recommendation of not stopping current DMTs and not delaying treatment initiation in patients who have higher disease inflammatory activity, the risk for relapses, or subsequent disability.”

These results echo the previous understanding of MS specialists as well as add to the literature that has been collected thus far from other assessments. A number of neurologic complications have been observed in patients with COVID-19 infection, and the infection has shown links to conditions such as stroke.

In a recent NeurologyLive News Network series, Jiwon Oh, MD, PhD, assistant professor of medicine, Division of Neurology, University of Toronto, commented on the potential risk factors that may increase a patient with MS’s risk of acquiring coronavirus or complications of COVID-19. Watch below as she discusses what is being done in clinical practice to reduce a patient’s risk during the pandemic.

REFERENCE

1. Louapre C, Collongues N, Stankoff B, et al. Clinical Characteristics and Outcomes in Patients With Coronavirus Disease 2019 and Multiple Sclerosis. JAMA Neurol. Published online June 26, 2020. doi:10.1001/jamaneurol.2020.2581