Immunotherapy in MS does not influence COVID-19 severity and mortality

In a population-based MS cohort, COVID-19 severity and mortality was found to depend on age, comorbidity, and degree of disability.

Prevalence, severity, and overall mortality of SARS-CoV-2 infections in MS patients associated with specific DMTs were the focus

Neurologists and MS patients continue to have concerns about patients' possibly elevated risk of SARS-CoV-2 infection and of an unfavourable course due to DMT. The objective of this Austrian, nationwide population-based study was to characterise prevalence, severity, and overall mortality of SARS-CoV-2 infections in MS patients associated with specific DMTs. As first author Dr Gabriel Bsthe (medical university of Vienna, Austria) explained, the study included MS patients aged ≥18 years with COVID-19 diagnosed between 1 January 2020 and 30 April 2021.

COVID-19 course was classified as either mild (no hospitalisation), severe, or fatal. Impact of DMT,specifically immunosuppressive medications, on probability of severe or fatal COVID-19 was determined. Importantly, the researchers conducted an a-priori risk categorisation based on a recently developed risk score comprising age, diabetes and other comorbidities, obesity, smoking, and severe disability (Expanded Disability Status Scale (EDSS) score >6).

A-priori-risk significantly predicted COVID-19 severity

In the study cohort 126 MS patients with COVID-19 were included, with a mean age of 43 years, and 71% being female. Median EDSS was 2.0; 19% had lymphopenia. The total use ratio of DMTs was 71%: 38% received an immunomodulatory DMT, 33% an immunosuppressive DMT. COVID-19 course was asymptomatic in 4%, mild in 7%, severe in 6%, and fatal in 4%. A-priori-risk significantly predicted COVID-19 severity (R2 0.814; p<0.001) and mortality (R2 0.664; p<0.001), but DMT class did not.

Adjusting for the a-priori-risk, neither exposure to any DMT nor exposure to specific immunosuppressive DMT were significantly associated with COVID-19 severity (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. Dr Bsteh added that there is a caveat for CD20 inhibitors: “We did not find a statistically difference in our cohort, but there is evidence that CD20 antibodies may be associated with a somewhat higher risk of a severe COVID-19 course.”

Reference
  1. Bsteh G, et al. COVID-19 severity and mortality in multiple sclerosis do not depend on immunotherapy: insights from a nation-wide Austrian Registry. Abstract 096, ECTRIMS 2021, 13–15 Oct.