Certain Factors Worsen Outcomes in MS Patients With COVID-19

People with multiple sclerosis (MS) who have more extensive mobility issues are more likely to have worse outcomes from COVID-19, a new study indicates.

The study findings also indicate that COVID-19-associated outcomes are worse among MS patients who are Black, older, have heart-related diseases, and who were treated with corticosteroids close to the time they were infected.

The results were published in JAMA Neurology in the study “Outcomes and Risk Factors Associated With SARS-CoV-2 Infection in a North American Registry of Patients With Multiple Sclerosis.”

Since the beginning of the COVID-19 pandemic researchers have been making a concerted effort to better understand who is at greatest risk for worse infections. Early on, there was a concern that people with MS might be at increased risk because the disease caused by the immune system erroneously attacking healthy tissue in the nervous system, and often is treated with immune-suppressing medications.

To better understand COVID-19 outcomes in people with MS, the COVID-19 Infections in MS (COViMS) Registry was established early on in the pandemic to record data about people with MS in North America who became infected with SARS-CoV-2 (the virus that causes COVID-19). In the new study, researchers in the U.S. and Canada reported findings from this registry.

As of December, the registry included information about 1,626 people with MS from the U.S., Canada, and Mexico. Of these patients, most were female (74%) and white (61.5%), and had relapsing-remitting MS or clinically isolated syndrome (80.4%). About half had at least one comorbidity (health conditions other than MS, such as high blood pressure or diabetes).

Across the group, the most common symptoms of COVID-19 included fever, cough, and fatigue. Of the MS patients in the registry, 320 (19.7%) were hospitalized, 104 (6.4%) were admitted to an intensive care unit (ICU), and 61 (3.8%) required use of a ventilator. The overall mortality rate was 3.3%.

Using statistical analyses, the researchers looked for clinical and demographic factors that were associated significantly with poorer COVID-19 outcomes.

Disability was tied significantly to worse outcomes. Compared to fully ambulatory individuals, people who need assistance to walk were more than two times more likely to be hospitalized, and to be admitted to an ICU and/or put on ventilation. Their likelihood of death also was more than three times greater.

MS patients who could not walk at all had an even greater likelihood of worse outcomes. Compared with those who were fully ambulatory, non-ambulatory patients were about 25 times more likely to die from COVID-19, nearly three times more likely to be hospitalized, and their chances of being admitted to an ICU and/or needing a ventilator were 3.5 times greater.

Worse outcomes also were tied to increasing age. For every 10-year increase in age, there was an estimated 30% increased likelihood of hospitalization and ICU admission and/or needing a ventilator, and a 76.5% greater risk of death.

Black MS patients were 47% more likely to be hospitalized and were more than two times more likely to be admitted to an ICU and/or require ventilation. However, race was not associated with a significantly altered risk of death.

“The worse outcomes observed for Black patients with MS indicate that close clinical monitoring of COVID-19 in these patients is warranted,” the researchers wrote.

Male sex was associated with a 41% increased odds of hospitalization and more than threefold  increased risk of death.

Individuals with heart disease were at a 91% increased risk of hospitalization, and were more than three times more likely to die from COVID-19. Other comorbidities also were linked with worse outcomes; for instance, hypertension (high blood pressure) was associated with a threefold higher risk of death.

Individuals who had been treated with glucocorticoids (immune-suppressing steroids) in the two months before developing COVID-19 were about two times more likely to be hospitalized, and about four times more likely to die.

The researchers said this finding was “not completely unexpected,” since, by definition, glucocorticoids lessen the activity of the immune system, which could make it harder for the body to fight off an infection like COVID-19.

Treatment with rituximab was associated with increased chances of hospitalization, but not with other health outcomes; other MS treatments generally were not associated significantly with altered outcomes from COVID-19.

Overall, “the COViMS Registry provides evidence that ambulation disability, older age, and Black race are associated with worse COVID-19 clinical course in a North American MS population,” the researchers concluded.

“Rituximab, recent treatment with corticosteroids, and risk factors known in the general population such as obesity and cardiovascular comorbidities were associated with worse COVID-19 clinical severity,” they added.