Clinical characteristics and outcomes in patients with coronavirus disease 2019 and multiple sclerosis
Céline Louapre, Nicolas Collongues, Bruno Stankoff, C. Giannesini, Caroline Papeix, Caroline Bensa, Romain Deschamps, Alain Créange, Abdul Wahab, Jonathan Pelletier, O. Heinzlef, Pierre Labauge, L. Guilloton, Guido Ahle, Mathilde Goudot, Kévin Bigaut, David Laplaud, Sandra Vukusic, Catherine Lubetzki, de Sèze
Abstract
Background: Risk factors associated with the severity of COVID- 19 in patients with multiple sclerosis (MS) begin to be identified from several cohort studies Disease modifying therapies (DMTs) may modify the risk of developing a severe COVID-19 infection, beside identified risk factors such as age and comorbidities Objectives: The objective was to describe the clinical characteristics and outcomes in patients with COVID-19 and to identify the factors associated with COVID-19 severity Methods: This multicenter, retrospective, observational cohort study (COVISEP registry, NCT04355611) included patients with MS presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020 and July 14, 2020 The main outcome was COVID-19 severity assessed on a 7-point ordinal scale (ranging from 1: not hospitalized, no limitations on activities, to 7: death;cutoff at 3: hospitalized, not requiring supplemental oxygen) We collected demographics, neurological history, Expanded Disability Severity Score (EDSS), comorbidities, COVID-19 characteristics and outcome Univariate and multivariate logistic regression models were used to estimate the influence of collected variables on COVID-19 outcome Results: A total of 405 patients (mean age: 44 7 years, female/male: 293/112, mean disease duration: 13 4 years) were analyzed Seventy-eight patients (19 3%) had a COVID-19 severity score ≥ 3, and 12 patients (3 0%) died from COVID-19 Median EDSS was 2 0 (range: 0-9 5), 326 patients (80 5%) were on DMT There was a higher proportion of patients with COVID-19 severity score ≥ 3 among patients with no DMT relative to patients on DMTs (39 2% versus 14 4%, p<0 001) Multivariate logistic regression models determined that age (OR for 10 years: 1 8, 95% CI: 1 4-2 4), EDSS (OR for EDSS ≥ 6: 4 5, 95% CI: 2 0-10 0) were independent risk factors for COVID-19 severity score ≥ 3 (hospitalization or higher severity) while immunomodulatory treatment (interferon or glatiramer acetate) was associated with lower risk of COVID-19 severity score ≥ 3 (OR: 0 2, 95% CI: 0 05-0 8) EDSS was associated with the highest variability of COVID-19 severe outcome (R2= 0 18), followed by age (R2= 0 06) and immunomodulatory treatment (R2= 0 02) Conclusions: EDSS and age were independent risk factors of severe COVID-19, while exposure to immunomodulatory DMTs (interferon and glatiramer acetate) were independently associated with lower COVID-19 severity We did not find an association between other DMTs exposure (including immunosuppressive therapies) and COVID-19 severity The identification of these risk factors should provide the rationale for an individual strategy regarding clinical management of MS patients during the COVID- 19 pandemic