Gabriel Bsteh1, Hamid Assar2, Harald Hegen3, Bettina Heschl4, Fritz Leutmezer1, Franziska Di Pauli3, Christiane Gradl5, Gerhard Traxler6, Gudrun Zulehner1, Paulus Rommer1, Peter Wipfler7, Michael Guger6, Christian Enzinger4, Thomas Berger1. 1. Department of Neurology, Medical University of Vienna, Vienna, Austria. 2. Department of Neurology, Kepler University Hospital, Linz, Austria. 3. Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria. 4. Department of Neurology, Medical University of Graz, Graz, Austria. 5. Department of Neurology, Medical University of St. Pölten, St. Pölten, Austria. 6. Department of Neurology 2, Med Campus III, Kepler University Hospital GmbH, Linz, Austria. 7. Department of Neurology, Paracelsus Medical University of Salzburg, Salzburg, Austria.
Abstract
BACKGROUND: The COVID-19 pandemic challenges neurologists in counselling patients with multiple sclerosis (pwMS) regarding their risk by SARS-CoV-2 and in guiding disease-modifying treatment (DMT). OBJECTIVE: To characterize the prevalence and outcome of COVID-19 in pwMS specifically associated with different DMT in a nationwide population-based study. METHODS: We included patients aged ≥18 years with a confirmed diagnosis of MS and a diagnosis of COVID-19 established between January 1, 2020 and December 31, 2020. We classified COVID-19 course as either mild, severe or fatal. Impact of DMT and specifically immunosuppressants (alemtuzumab, cladribine, fingolimod, ocrelizumab or rituximab) on COVID-19 outcome was determined by multivariable models, adjusted for a-priori-risk. RESULTS: Of 126 MS patients with COVID-19 (mean age 43.2 years [SD 13.4], 71% female), 86.5% had a mild course, 9.5% a severe course and 3.2% died from COVID-19. A-priori-risk significantly predicted COVID-19 severity (R2 0.814; p<0.001) and mortality (R2 0.664; p<0.001). Adjusting for this a-priori-risk, neither exposure to any DMT nor exposure to specific immunosuppressive DMT were significantly associated with COVID-19 severity (odds ratio [OR] 1.6; p = 0.667 and OR 1.9; p = 0.426) or mortality (OR 0.5; p = 0.711 and 2.1; 0.233) when compared to no DMT. CONCLUSIONS: In a population-based MS cohort, COVID-19 outcome was not associated with exposure to DMT and immunosuppressive DMT when accounting for other already known risk factors. This provides reassuring evidence that COVID-19 risk can be individually anticipated in MS and-except for a very small proportion of high-risk patients-treatment decisions should be primarily focused on treating MS rather than the pandemic.
BACKGROUND: The COVID-19 pandemic challenges neurologists in counselling patients with multiple sclerosis (pwMS) regarding their risk by SARS-CoV-2 and in guiding disease-modifying treatment (DMT). OBJECTIVE: To characterize the prevalence and outcome of COVID-19 in pwMS specifically associated with different DMT in a nationwide population-based study. METHODS: We included patients aged ≥18 years with a confirmed diagnosis of MS and a diagnosis of COVID-19 established between January 1, 2020 and December 31, 2020. We classified COVID-19 course as either mild, severe or fatal. Impact of DMT and specifically immunosuppressants (alemtuzumab, cladribine, fingolimod, ocrelizumab or rituximab) on COVID-19 outcome was determined by multivariable models, adjusted for a-priori-risk. RESULTS: Of 126 MS patients with COVID-19 (mean age 43.2 years [SD 13.4], 71% female), 86.5% had a mild course, 9.5% a severe course and 3.2% died from COVID-19. A-priori-risk significantly predicted COVID-19 severity (R2 0.814; p<0.001) and mortality (R2 0.664; p<0.001). Adjusting for this a-priori-risk, neither exposure to any DMT nor exposure to specific immunosuppressive DMT were significantly associated with COVID-19 severity (odds ratio [OR] 1.6; p = 0.667 and OR 1.9; p = 0.426) or mortality (OR 0.5; p = 0.711 and 2.1; 0.233) when compared to no DMT. CONCLUSIONS: In a population-based MS cohort, COVID-19 outcome was not associated with exposure to DMT and immunosuppressive DMT when accounting for other already known risk factors. This provides reassuring evidence that COVID-19 risk can be individually anticipated in MS and-except for a very small proportion of high-risk patients-treatment decisions should be primarily focused on treating MS rather than the pandemic.
Authors: Gabriel Bsteh; Katharina Riedl; Nik Krajnc; Barbara Kornek; Fritz Leutmezer; Stefan Macher; Paulus Rommer; Gudrun Zulehner; Thomas Berger Journal: Mult Scler Relat Disord Date: 2022-05-23 Impact factor: 4.808
Authors: Helena Enocsson; Cornelia Idoff; Annette Gustafsson; Melissa Govender; Francis Hopkins; Marie Larsson; Åsa Nilsdotter-Augustinsson; Johanna Sjöwall Journal: Front Med (Lausanne) Date: 2021-12-02