Georgina Arrambide1, Miguel Ángel Llaneza-González1, Lucienne Costa-Frossard França1, Virginia Meca-Lallana2, Eva Fernández- Díaz1, Irene Moreno-Torres1, Jose Manuel García-Domínguez1, Gloria Ortega-Suero1, Lucía Ayuso-Peralta1, Mayra Gómez-Moreno1, Javier J Sotoca-Fernández1, Ana Belén Caminero-Rodríguez1, Luis A Rodríguez de Antonio1, Marcial Corujo-Suárez1, María A Otano-Martínez1, Francisco Carlos Pérez-Miralles1, Virginia Reyes-Garrido1, Teresa Ayuso-Blanco1, José Jesús Balseiro-Gómez1, Mercedes Muñoz-Pasadas1, Inmaculada Pérez-Molina1, Carmen Arnal-García1, Ángela Domingo-Santos1, Cristina Guijarro-Castro1, Cristina Íñiguez-Martínez1, Nieves Téllez Lara1, Fernando Castellanos-Pinedo1, Tamara Castillo-Triviño1, Debora María Cerdán-Santacruz1, Ángel Pérez-Sempere1, Berta Sebastián Torres1, Amaya Álvarez de Arcaya1, Eva Costa-Arpín1, Eduardo Durán-Ferreras1, Marta Fragoso-Martínez1, Montserrat González-Platas1, Lamberto Landete Pascual1, Jorge Millán-Pascual1, Celia Oreja-Guevara1, José E Meca-Lallana2. 1. From the Centro de Esclerosis Múltiple de Cataluña (G.A.), (Cemcat), Instituto de Investigación Vall d'Hebron, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona; Complejo Hospitalario Universitario de Ferrol (M.Á.L.-G.); Hospital Universitario Ramón y Cajal (L.C.-F.F.), Madrid; Hospital Universitario de la Princesa (V.M.L.), Madrid; Complejo Hospitalario Universitario de Albacete, (E.F.D.); Hospital Universitario Fundación Jiménez Díaz (I.M.T.), Madrid; Hospital General Universitario Gregorio Marañón (J.M.G.-D.), Madrid; Hospital La Mancha Centro (G.O.-S., Á.D.S.), Alcázar de San Juan; Hospital Universitario Príncipe de Asturias (L.A.P.), Alcalá de Henares; Hospital Universitario Infanta Leonor (M.G.M.), Madrid; Hospital Universitario Mútua Terrasa (J.J.S.-F.); Complejo Asistencial de Ávila (A.B.C.-R.), Ávila; Hospital Universitario de Fuenlabrada (L.A.R.A.), Madrid; Hospital Universitario Son Espases, Palma de Mallorca (M.C.S.); Complejo Hospitalario de Navarra (M.A.O.-M., T.A.B.), Pamplona; Hospital Universitario y Politécnico La Fe (F.C.P.-M.), Valencia; Hospital Regional Universitario de Málaga (V.R.G.); Hospital Universitario de Getafe (J.J.B.-G.), Madrid; Hospital Santa Barbara (M.M.P.), Puertollano; Hospital Virgen de la Salud (I.P.M.), Toledo; Hospital Universitario Virgen de las Nieves (C.A.G.), Granada; Hospital Universitario Puerta del Sur (CINAC), Madrid (C.G.C.); Hospital Clínico Universitario Zaragoza (C.Í.M.), Zaragoza; Hospital Clínico Universitario Valladolid (N.T.L.,), Valladolid; Hospital Virgen del Puerto (F.C.P.), Plasencia; Hospital Universitario Donostia (T.C.T.), San Sebastian; Hospital General de Segovia (D.M.C.-S.), Segovia; Hospital General Universitario de Alicante (Á.P.S.), Alicante; Hospital Universitario Miguel Servet (IIS Aragón) (B.S.T.), Zaragoza; Hospital Universitario Araba (A.Á.A.), Vitoria; Hospital Clínico Universitario de Santiago de Compostela (E.C.A.), Santiago de Compostela; Hospital Universitario Juan Ramón Jiménez (E.D.-F.), Huelva; Hospital de Terrasa (M.F.M.), Terrasa; Hospital Universitario de Canarias (M.G.P.), San Cristobal de La Laguna; Hospital Universitario Dr Peset de Valencia (L.L.P.), Valencia; Complejo Hospitalario Universitario de Cartagena (J.M.P.), Murcia; Hospital Clínico San Carlos (C.O.-G.),Facultad de Medicina, Universidad Complutense de Madrid, IdISSC, Madrid; and CSUR Unidad de Esclerosis Múltiple y Neuroinmunología Clínica (J.E.M.-L.), Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Cátedra de Esclerosis Múltiple y Neuroinmunología Clínica, UCAM, Universidad Católica San Antonio, Murcia, Spain. 2. From the Centro de Esclerosis Múltiple de Cataluña (G.A.), (Cemcat), Instituto de Investigación Vall d'Hebron, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona; Complejo Hospitalario Universitario de Ferrol (M.Á.L.-G.); Hospital Universitario Ramón y Cajal (L.C.-F.F.), Madrid; Hospital Universitario de la Princesa (V.M.L.), Madrid; Complejo Hospitalario Universitario de Albacete, (E.F.D.); Hospital Universitario Fundación Jiménez Díaz (I.M.T.), Madrid; Hospital General Universitario Gregorio Marañón (J.M.G.-D.), Madrid; Hospital La Mancha Centro (G.O.-S., Á.D.S.), Alcázar de San Juan; Hospital Universitario Príncipe de Asturias (L.A.P.), Alcalá de Henares; Hospital Universitario Infanta Leonor (M.G.M.), Madrid; Hospital Universitario Mútua Terrasa (J.J.S.-F.); Complejo Asistencial de Ávila (A.B.C.-R.), Ávila; Hospital Universitario de Fuenlabrada (L.A.R.A.), Madrid; Hospital Universitario Son Espases, Palma de Mallorca (M.C.S.); Complejo Hospitalario de Navarra (M.A.O.-M., T.A.B.), Pamplona; Hospital Universitario y Politécnico La Fe (F.C.P.-M.), Valencia; Hospital Regional Universitario de Málaga (V.R.G.); Hospital Universitario de Getafe (J.J.B.-G.), Madrid; Hospital Santa Barbara (M.M.P.), Puertollano; Hospital Virgen de la Salud (I.P.M.), Toledo; Hospital Universitario Virgen de las Nieves (C.A.G.), Granada; Hospital Universitario Puerta del Sur (CINAC), Madrid (C.G.C.); Hospital Clínico Universitario Zaragoza (C.Í.M.), Zaragoza; Hospital Clínico Universitario Valladolid (N.T.L.,), Valladolid; Hospital Virgen del Puerto (F.C.P.), Plasencia; Hospital Universitario Donostia (T.C.T.), San Sebastian; Hospital General de Segovia (D.M.C.-S.), Segovia; Hospital General Universitario de Alicante (Á.P.S.), Alicante; Hospital Universitario Miguel Servet (IIS Aragón) (B.S.T.), Zaragoza; Hospital Universitario Araba (A.Á.A.), Vitoria; Hospital Clínico Universitario de Santiago de Compostela (E.C.A.), Santiago de Compostela; Hospital Universitario Juan Ramón Jiménez (E.D.-F.), Huelva; Hospital de Terrasa (M.F.M.), Terrasa; Hospital Universitario de Canarias (M.G.P.), San Cristobal de La Laguna; Hospital Universitario Dr Peset de Valencia (L.L.P.), Valencia; Complejo Hospitalario Universitario de Cartagena (J.M.P.), Murcia; Hospital Clínico San Carlos (C.O.-G.),Facultad de Medicina, Universidad Complutense de Madrid, IdISSC, Madrid; and CSUR Unidad de Esclerosis Múltiple y Neuroinmunología Clínica (J.E.M.-L.), Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Cátedra de Esclerosis Múltiple y Neuroinmunología Clínica, UCAM, Universidad Católica San Antonio, Murcia, Spain. pmecal@gmail.com.
Abstract
OBJECTIVE: To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments. METHODS: Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome. RESULTS: Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome. CONCLUSIONS: This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal disease.
OBJECTIVE: To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments. METHODS: Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome. RESULTS: Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome. CONCLUSIONS: This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal disease.
Authors: Steve Simpson-Yap; Ashkan Pirmani; Tomas Kalincik; Edward De Brouwer; Lotte Geys; Tina Parciak; Anne Helme; Nick Rijke; Jan A Hillert; Yves Moreau; Gilles Edan; Sifat Sharmin; Tim Spelman; Robert McBurney; Hollie Schmidt; Arnfin B Bergmann; Stefan Braune; Alexander Stahmann; Rod M Middleton; Amber Salter; Bruce Bebo; Anneke Van der Walt; Helmut Butzkueven; Serkan Ozakbas; Cavit Boz; Rana Karabudak; Raed Alroughani; Juan I Rojas; Ingrid A van der Mei; Guilherme Sciascia do Olival; Melinda Magyari; Ricardo N Alonso; Richard S Nicholas; Anibal S Chertcoff; Ana Zabalza de Torres; Georgina Arrambide; Nupur Nag; Annabel Descamps; Lars Costers; Ruth Dobson; Aleisha Miller; Paulo Rodrigues; Vesna Prčkovska; Giancarlo Comi; Liesbet M Peeters Journal: Neurol Neuroimmunol Neuroinflamm Date: 2022-08-29