COVID-19 severity and outcome in multiple sclerosis: Results of a national, registry-based, matched cohort study

Abstract

Background: Risk factors associated with coronavirus disease 2019 (COVID-19) severity in patients with multiple sclerosis (MS) have been described. Recent improvements in supportive care measures and increased testing capacity may modify the risk of severe COVID-19 outcome in MS patients. This retrospective study evaluates the severity and outcome of COVID-19 in MS and characterizes temporal trends over the course of the pandemic in the United States. Methods: We conducted a comparative cohort study using de-identified electronic health record (EHR) claims-based data. MS patients diagnosed with COVID-19 between February 2, 2020 and October 13, 2020 were matched (1:2) to a control group using propensity score analysis. The primary outcome was a composite of intensive care unit (ICU) admission, mechanical ventilation, and/or death. Results: A total of 2,529 patients (843 MS and 1,686 matched controls) were included. Non-ambulatory and pre-existing comorbidities were independent risk factors for COVID-19 severity. The risk for the severe composite outcome was lower in the late cohorts compared with the early cohorts. Conclusions: The majority of MS patients actively treated with a disease-modifying therapy (DMT) had mild disease. The observed trend toward a reduction in severity risk in recent months suggests an improvement in COVID-19 outcome.

Risk of COVID-19 infection and severe disease in MS patients on different disease-modifying therapies

“…Hispanic ethnicity was also a risk factor for SARS-CoV-2 infection and complications in other studies from our area [51,52] and in the United States [53]. Older age, obesity, and worse ambulation status are known risk factor for severe disease, and these findings were generally reflected in our sample as well [1,4,20,17,54]. Some risk factors for COVID-19 severity such as presence of certain comorbidities and insurance status (as a proxy for socioeconomic status) [55,56] were not observed in our study, likely due to a limited sample size and a relatively young population.…”

“…Improvement in COVID-19 management over the course of this study such as introduction of monoclonal antibodies to reduce hospitalization and use of dexamethasone in hospitalized patients, may also account for lower severity and fatality rates [17,19]. In addition, increased accessibility to testing led to improved detection of mild cases, which was not possible during the early phase of pandemic.An estimated 78% of cases in the United States were undocumented in 2020, so non-hospitalized cases were mostly undetected [46].…”

COVID-19 severity among patients with multiple sclerosis treated with cladribine: A systematic review and meta-analysis

“…Of the remaining 114, 7 were selected for the final analysis, along with 6 retrieved out from search strategy ( Figure 1 ). References of 13 selected manuscripts [ Sormani et al, 2021 , Salter et al, 2021 , Louapre et al, 2020 , Hervas-Garcia et al, 2020 , Czarnowska et al, 2021 , Arrambide et al, 2021 Jun 24 , Spelman et al, 2022 Jun , Drulovic et al, 2021 , Fragoso et al, 2021 , Bsteh et al, 2021 Jul 27 , Pérez et al, 2021 , Clinical Outcomes in Patients With COVID-19 During Two Phase IV Studies of Cladribine Tablets for Treatment of Multiple Sclerosis: An Update (P11-4.005) May 2022 ] are shown in Table 1 .

Figure 1 Flow diagram for study selection

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“…Of the remaining 114, 7 were selected for the final analysis, along with 6 retrieved out from search strategy (Figure 1). References of 13 selected manuscripts 6,7,9,16,17,18,19,20,21,22,23,24 are shown in Table 1.…”

“…Actually, the range mentioned above would include much closer values (respectively 0% - 21% and 0% - 4%) if the incidence reported from Perez et al is not considered (hospitalization rate 340/843, 40%; death rate 56/843, 7%). In this study, that is a data collection using an administrative claims-based method [Pérez et al, 2021] several limitations were reported, including the risk of possible misclassification, underreporting and/or inconsistent ICD coding practices being.…”