DMT for Multiple Sclerosis Tied to Lower Risk for In-Hospital COVID-19 Mortality

COVID19
Covid-19 coronavirus particles, illustration. The SARS-CoV-2 coronavirus was first identified in Wuhan, China, in December 2019. It is an enveloped RNA (ribonucleic acid) virus. Within the membrane are spike proteins (large protrusions) as well as membrane proteins and envelope proteins. SARS-CoV-2 causes the respiratory infection Covid-19, which can lead to fatal pneumonia. As of March 2020, the virus has spread to many countries worldwide and has been declared a pandemic. Hundreds of thousands have been infected with tens of thousands of deaths.
Researchers sought to evaluate all-cause mortality at 30 days in patients with MS who were hospitalized at a VA center for COVID-19 between March 2020 and October 2021.

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.

Reference

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