Do Disease-Modifying Therapies for Multiple Sclerosis Increase COVID-19 Risk?

For patients with multiple sclerosis (MS) who are using disease-modifying therapy (DMT), there was no evidence to support altering DMT regimen in order to prevent COVID-19 infection or hospitalization. These findings were presented at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), held October 25-28, 2021 in Orlando, Florida.

Earlier in the global COVID-19 pandemic, some evidence was published linking B-cell-depleting (anti-CD20) therapies with risk for COVID-19. However, these findings were from underpowered studies. In order to better assess the relationship between DMT and COVID-19, researchers from NYU MS Care Center reviewed medical charts of patients (N=1635) with MS who were receiving sphingosine 1-phosphate (S1P) receptor modulators, anti-CD20 therapies, dimethyl fumarate, or natalizumab between March 2020 and February 2021. Incidence and severity of COVID-19 infections were assessed on the basis of DMT therapy.

A total of 203 (12%) patients presented with COVID-19. Patients who became ill with COVID-19 were aged mean 41.6±12.6 years, 72% were women, 49% were White, 23% were Black, and 59% had ³1 COVID-19-associated risk factor.

Stratified by DMT, COVID-19 occurred among 18% of rituximab recipients, 5 were hospitalized and 1 died; 15% of dimethyl fumarate recipients, 6 were hospitalized; 13% of natalizumab recipients, 1 was hospitalized and 1 died; 11% of ocrelizumab recipients, 5 were hospitalized and 1 died; and 10% of the S1P modulator recipients, 2 were hospitalized.

Predictors of infection with COVID-19 were public insurance (odds ratio [OR], 6.1; 95% CI, 4.29-8.78), younger age (OR, 4.7; 95% CI, 1.73-12.76), and Hispanic ethnicity (OR, 1.7; 95% CI, 1.03-2.71). COVID-19-related hospitalization associated with Hispanic ethnicity (OR, 4.8; 95% CI, 1.08-21.45).

DMT was not associated with infection or hospitalization.

These data were sourced from a single center and may not be generalizable to other populations.

The researchers concluded “this analysis does not convincingly suggest that changing DMT during the pandemic to prevent COVID-19 infection or hospitalization is warranted.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Smith TE, Madhavan M, Gratch D, et al. Do Frequency and Severity of COVID-19 Differ by Disease-Modifying Therapy in Multiple Sclerosis Patients? Presented at: CMSC 2021 Annual Meeting; October 25-28, 2021; Orlando, Florida. Abstract DMT69.