#MSVirtual2020 – Disability Level and DMT Use Don’t Raise COVID-19 Risk, UK Study Finds

When safety measures like isolation are in place, neither disease-modifying therapy (DMT) use nor greater physical disability appear to heighten the risk of people with multiple sclerosis (MS) contracting COVID-19, a large U.K. registry-based study found.

Preliminary study data also suggested that these factors do not affect a patient’s ability to recover from the disease.

These findings were presented at MSVirtual2020 by Afagh Garjani, a PhD student at the University of Nottingham, on Sept. 26 in the late-breaking presentation “COVID-19 in people with MS: A large community-based study of the UK MS Register.”

Since the start of the pandemic, research in the field of MS has focused on assessing the severity of COVID-19 and risk factors that might increase the chances of poor clinical outcomes in this patient population.

Among questions raised was whether MS raised a person’s risk of contracting COVID-19 relative to the general population.

Garjani reported the findings of a U.K. registry study evaluating and comparing the incidence of COVID-19 among MS patients and the general U.K. population.

Researchers also evaluated how certain demographic and clinical parameters — such as age, gender, disability severity, and DMT use — influenced patients’ risk of this virus.

The study drew on data from the U.K. MS Register (UKMSR), which has been collecting demographic and clinical information on MS patients throughout the U.K. since 2011.

On March 17, registry patients were asked to complete a series of survey questions related to COVID-19, and by doing so join the study. After this first survey, participants responded every two weeks to follow-up surveys, depending on whether they had contracted COVID-19.

A total of 5,309 patients joined by submitting responses, and 3,385 answered follow-up surveys.

Of the full study group, 535 (10.1%) were self-diagnosed with COVID-19, and 75 (1.4%) reported formally testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as the virus that causes COVID-19 is known.

Looking at trends over time, researchers found the overall disease incidence among these MS patients to have peaked in the second week following the U.K. lockdown, which started on March 23. From that time onward, disease incidence gradually dropped, reaching a minimum shortly after the lockdown was lifted on June 23.

This trend was identical among patients who self-diagnosed and those with confirmed COVID-19 cases. A similar incidence trend was observed among confirmed cases in the general U.K. population, particularly during lockdown.

The team then looked for predictors of self-isolation during lockdown, as “this would help us interpret our findings when we study the risk of contracting COVID-19 among people with MS,” Garjani said in her presentation.

Results showed that nearly half (47%) of survey respondents reported having self-isolated at some point during lockdown.

Patients who were older, had higher EDSS scores (indicative of greater disability), and higher Physical MSIS-29 scores (indicative of greater physical impairments) were more likely to self-isolate, their analyses found. Of these factors, EDSS was the strongest predictor of self-isolation.

DMT use or MS type, in general, did not associate with a higher likelihood of self-isolation.

When investigators looked at specific types of DMTs, however, they found that patients whose therapies were based on monoclonal antibodies, like alemtuzumab (sold as Lemtrada, among others names) and Gilenya (fingolimod), were more likely to self-isolate than were patients using self-injectable DMTs.

Factors influencing the chance of these MS patients contracting COVID-19, taking reports of self-diagnosis and positive tests separately, were then evaluated.

Older patients and those with higher EDSS scores (greater disability) were seen as less likely to contract the disease, which “is not surprising” Garjani said, “given the fact that these populations were self-isolating more [during the outbreak].”

In contrast, DMT use and MS type and duration were generally not found to associate with a likelihood of contracting COVID-19. These findings were similar regardless of whether analyses were based on self-reported or confirmed viral cases.

In terms of ethnicity, “we found that people from a BAME [black, Asian, and minority ethnic] background were significantly more likely to report a self-diagnosis of COVID-19 compared to participants from a white background,” Garjani said, adding that this observation was in line with general population findings.

“We can conclude that during lockdown physical disability, taking DMTs, or disease duration are not necessarily associated with increased likelihood of contracting COVID-19 among people with MS,” Garjani said.

Preliminary data from a subgroup of 249 study patients who reported contracting and then recovering from COVID-19 indicated no clear evidence of a link between recovery and a person’s physical disability, DMT use, or type and duration of MS.

“In general, our findings are reassuring,” Garjani concluded. “We showed that during lockdown, when strict precautions are in place, DMTs or physical disability in people with MS do not put them at an increased risk of contracting COVID-19.

“And it seems that these factors do not affect recovery from COVID-19 among this population, either.”