How do Patients with MS fair with COVID 19?
As reported at the American Consortium for the Treatment and Research in Multiple Sclerosis (ACTRIMS), the national 2021 meeting was held virtually. There, the latest information concerning COVID 19 and MS was reported. To answer the foregoing question, the COViMS Registry was established April 1, 2020, and supported by Consortium for MS Centers (CMSC) and the National MS Society (NMSS). Healthcare professionals were asked to enter patients with MS, NMO and MOG antibody disorder with confirmed or suspected COVID -19 infection. They were to report only after a minimum of 7 days allowing sufficient time to observe the disease course through resolution of acute illness or death. Non-identifiable data on MS patients with COVID 19 in North America was housed at the Washington University in St. Louis in a HIPPA compliant web-based registry. It began April 1, 2020, and continues to the present. The data was analyzed and presented by biostatistician, Amber Salter, Ph.D., of Washington University in St. Louis.
The data for this presentation were contributed to by 150 US physicians. For the purpose of this analysis, only patients with CIS and MS were included. They were diagnosed with COVID 19 either clinically or laboratory confirmed. They established four outcome measures:
COVID but no Hospitalization
COVID with Hospitalization only
COVID with Hospitalization and ICU admission and /or required ventilation support
Death
Risk factors collected included demographics (sex, race, age, cigarette use), Cardiovascular, Cerebrovascular, Chronic Kidney and Chronic lung Disease, Diabetes, Hypertension and Morbid Obesity.
MS characteristics gathered included the Clinical course, Disease duration, Ambulation, and Disease Modifying Therapy Use.
Ambulation was judged as a substitute for disability status. A simple scale included:
Fully ambulatory
Walks with assistance or assisted devices
Non ambulatory
There were 2059 COVID CIS and MS patients reported through January 2021. Of these patients, 85.4% were laboratory confirmed and 14.6% were clinically confirmed. Additionally, 96.8% came from USA and 2.3% from Canada. Exactly 600 of the patients came from New York and/or New Jersey area, 100 from Ohio and 100 from Texas, and 7 from Puerto Rico. There were 49 Canadian patients the majority of whom came from the province of Ontario. Of these numbers, 75% of the total patients were female with an average age of 48, 70% were non-Hispanic white, 18.2% black or African American, 5.5% Hispanic/ Latin, and 6.3% unknown. Disease duration was 12.9 years.
The clinical course was relapsing/Remitting 83.3% and Progressive 16.7%. Fully ambulatory represented 75.8%, 15.2% walked with assistance and 9% were non-ambulatory.
Furthermore, 30% were taking Ocrelizumab at the time of their infection, 13% taking dimethyl fumarate, 11% taking natalizumab, 30% on other DMTs with 15% taking no disease modifying therapy.
Of the 2059 patients only 11.5% were hospitalized, 4.2% were admitted to the ICU and/or ventilated and 3% died.
Age and ambulation status were the two important risk factors associated with a poor outcome. As age increase the mortality rate increases. Age 75 and older had a higher mortality rate; however, their total sample consisted of only 38 pts. As ambulation increases mortality rate and hospitalization increases.
They looked at the clinical severity of outcome depending upon the date of disease. They split the time course from “April 2020 to September 2020” as early time course and “November 2020 to present” (as of this writing) as late time course. From age 25 to 75 or older, death and ICU and/or ventilation decreased in the late versus early time course. Hospitalizations remained constant throughout both courses. The late time course showed an increase in NON-HOSPITALIZATION.
Of those patients ambulating, the proportion not hospitalized in all age groups increased from the early to the late period.
In the international registries that were reviewed (Italian and French) , the overall mortality ranged from 1.5 to 3.5%. Factors associated with poorer outcomes include increasing age, increasing disability and obesity.
The data on COVID -19 is growing and continues to grow. Observable and consistent factors associated with poorer clinical COVID-19 outcomes include older age and greater disability.
Association of poorer outcomes with the anti-CD20’s disease modifying therapies (example ocrelizumab) was variable.
Written by: Jay Rosenberg, MD
Keywords: COVID19, Multiple Sclerosis, MS, Clinical Study, Research, Data