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

Coronavirus COVID-19 computer generated image.
Researchers assessed whether the frequency and severity of COVID-19 differed by disease-modifying therapies among patients with multiple sclerosis (MS) who received care in the NYU MS Care Center.
The following article is part of conference coverage from the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), held October 25-28 2021, in Orlando, Florida. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from the 2021 CMSC Annual Meeting.

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.

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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.