SARS-CoV-2 Severity, Outcomes Linked to Age and Multiple Sclerosis Subtype

Female medical professional in protective suit adjusting IV drip of patient. Senior woman with oxygen mask is lying on bed in intensive care unit. They are in hospital during COVID-19 outbreak.
A team of investigators sought to understand COVID-19 characteristics in people with multiple sclerosis and identify high-risk patients.

Patients with multiple sclerosis (MS) and SARS-CoV-2 were at increased risk for severe disease and mortality if they were of advanced age and had progressive MS, according to study findings published in Neurology Neuroimmunology and Neuroinflammation.

Study researchers from multiple hospitals around Spain assessed data from patients (N=326) with MS who tested positive for SARS-CoV-2, collected by the Spanish Neurology Society Registry. Clinical outcomes through June 2020 were associated with clinical features of MS.

Patients had a mean age of 44.8 (standard deviation [SD], ±11.5) years and 67.8% were women. On average, they had been diagnosed 11.0 (SD, ±8.0) years previously, 80.7% had relapsing remitting MS, 13.2% had secondary progressive MS, 6.1% had primary progressive MS, 24.5% were using pulsed immunosuppressive therapies, and 16.2% reversible immunosuppressive therapies.

Study researchers subdivided patients into mild (n=244), severe (n=69), and critical (n=10) COVID-19 disease courses. Patients who were severe consisted of those who were hospitalized, and those who were critical were among those admitted to the intensive care unit or who had died.

On the basis of COVID-19 course, individuals differed significantly for age, sex, MS duration, MS course, Expanded Disability Status Scale (EDSS), use of dimethyl fumarate, use of rituximab, number of comorbidities, and lymphocyte levels during infection.

Risk for critical COVID-19 was associated with receiving treatment for COVID-19 (odds ratio [OR], 7.81; 95% CI, 1.63-37.44; P =.010), EDSS scores (OR, 1.33; 95% CI, 1.05-1.69; P =.018), age (OR, 1.07; 95% CI, 1.01-1.12; P =.007), lymphocyte level (OR, 0.99; 95% CI, 0.99-1; P =.014), and MS phenotype (OR, 0.23; 95% CI, 0.06-0.81; P =.022).

Patients who did not survive their COVID-19 infection were older (mean, 60.7 vs 44.5 years; P <.001), less likely to have relapsing-remitting MS (28.5% vs 81.8%; P <.001), had higher EDSS scores (mean, 5.4 vs 2.6; P <.001), did not receive disease modifying therapies (71.4% vs 16.9%; P <.001), and had longer MS duration (mean, 17.4 vs 10.9 years; P <.05).

Mortality from COVID-19 was associated with EDSS scores (OR, 1.55; 95% CI, 1.15-2.08; P =.003), age (OR, 1.11; 95% CI, 1.04-1.17; P =.001), and MS phenotype (OR, 0.09; 95% CI, 0.02-0.47; P =.046).

This study was limited as the investigators were unable to determine whether patients received oxygen support or what the specific COVID-19 symptoms were.

These data indicated that age and MS severity were significant predictors of severe COVID-19 infection and mortality. The study investigators did not observe a large effect of immunosuppressive treatments on SARS-CoV-2 outcomes.

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


Arrambide G, Llaneza-González MÁ, França LCF, et al. SARS-CoV-2 Infection in Multiple Sclerosis: Results of the Spanish Neurology Society Registry. Neurol Neuroimmunol Neuroinflamm. 2021;8(5):e1024. doi:10.1212/NXI.0000000000001024