Mortality among patients with multiple sclerosis (MS) hospitalized for COVID-19 was lower among patients taking disease-modifying therapy (DMT), according to study findings published in Multiple Sclerosis and Related Disorders.
During the COVID-19 pandemic, there has been concern that patients receiving immunocompromising or immunomodulating drugs may be at increased risk for poorer COVID-19 outcomes. Patients with MS often receive such treatments and many patients were told at the beginning of the pandemic to withhold DMT. To date, there remains a paucity of robust data which evaluates the effect of DMTs in the course of a COVID-19 infection among patients with MS.
Data for this study were sourced from the Veterans Affairs (VA) Corporate Data Warehouse. Patients (n=258) with MS who were hospitalized at a VA center for COVID-19 between March 2020 and October 2021 were evaluated for all-cause mortality at 30 days. For the comparator group, patients with MS were propensity matched with the general population of patients (n=49,479) hospitalized with COVID-19. DMTs were defined as all DMTs except for anti-CD20 inhibitors, due to previous reports of increased mortality.
The propensity-matched MS (n=255) and control individuals (n=4628) cohorts were 80.39% and 89.28% (P <.0001) men, aged median 64 (interquartile range [IQR], 53-72) and 64 (IQR, 54-72) years, 70.20% and 68.73% were White, and 22.75% and 18.19% had received 2 doses of the COVID-19 vaccine, respectively.
The MS cohort was associated with higher readmission at 30 days (12.94% vs 6.31%; P <.0001) and longer length of hospitalization (median, 7 vs 2 days; P <.0001). MS was not associated with differing rates of intensive care unit (ICU) admission within 60 days (26.67% vs 22.75%; P =.15), ventilator use within 30 days (10.59% vs 8.30%; P =.20), 30-day mortality (9.41% vs 8.69%; P =.69), or ICU length of stay (median, 4 vs 2 days; P =.23).
Mortality was increased among patients who were over 65 years of age (odds ratio [OR], 5.93; 95% CI, 4.56-7.83; P <.0001), had congestive heart failure (OR, 1.96; 95% CI, 1.54-2.49; P <.0001), chronic kidney disease (OR, 1.56; 95% CI, 1.24-1.96; P =.0002), and diabetes (OR, 1.28; 95% CI, 1.02-1.59; P =.031). MS was not a predictor for 30-day COVID-19 mortality (OR, 1.53; 95% CI, 0.93-2.42; P =.089).
Both vaccination (OR, 0.35; 95% CI, 0.25-0.48; P <.0001) and MS DMTs (OR, 0.18; 95% CI, 0.00988-0.94; P =.041) were protective against mortality.
In the subgroup analysis of patients who were unvaccinated, MS DMTs remained associated with decreased risk for mortality (OR, 0.18; 95% CI, 0.0097-0.91; P =.036).
This study was limited by its source population, which was mostly older men. It remains unclear whether these findings may be generalizable to a younger, more female population.
Patients with MS who were hospitalized for COVID-19 and were taking DMTs, excluding anti-CD20 inhibitors, were over 5 times less likely to die from COVID-19-related complications compared with the general population.
“Results suggest that, in relation to the COVID-19 pandemic, not only is it safe to continue most DMTs in people with MS, but it may be beneficial given the decreased risk of COVID-19 mortality and decreased risk of MS disease progression,” the researchers concluded.
Fuchs TA, Wattengel BA, Carter MT, El-Solh AA, Lesse AJ, Mergenhagen KA. Outcomes of Multiple Sclerosis Patients Admitted with COVID-19 in a Large Veteran Cohort. Mult Scler Relat Disord. Published online June 11, 2022. doi:10.1016/j.msard.2022.103964