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

A population-based MS cohort found COVID-19 severity and mortality to depend on age, comorbidity, and degree of disability. Exposure to disease-modifying therapy (DMT) and immunosuppressive DMT was not an essential factor, except for CD20 inhibitors. This adds to the evidence that COVID-19 risk can be individually anticipated in MS patients and, except possibly for those on anti-CD20 therapies, does not generally influence treatment decisions [1–3].

The objective of this Austrian, nationwide, population-based study was to characterise the prevalence, severity, and overall mortality of SARS-CoV-2 infection in MS patients associated with a specific DMT. Dr Gabriel Bsteh (Medical University of Vienna, Austria) explained that 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.

Overall, 126 MS patients with COVID-19 were included, with a mean age of 43 years, and 71% were women. Median Expanded Disability Status Scale (EDSS) score was 2.0 and 18.4% had lymphopenia. The total use ratio of DMT was 71%: 38% received an immunomodulatory DMT, 33% an immunosuppressive DMT. COVID-19 course was asymptomatic in 4%, mild in 86.5%, and severe in 9.5%, of whom 3.2% died. 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.

Results showed that exposure to any DMT or exposure to specific immunosuppressive DMT were not 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; P=0.233) compared with no DMT. Dr Bsteh added that there is a caveat for CD20-inhibitors: “Although we did not find a statistical difference in our cohort, there is evidence that CD20-antibodies may be associated with a somewhat higher risk of a severe COVID-19 course.”

1. 
   
   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. OP096, ECTRIMS 2021, 13–15 October.
   2. Bsteh G, et al. PloS one. 2021;16(7):e0255316.
   3. Bsteh G, et al. Mult Scler. 2021;27(14):2209-2218.

 

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Posted on 9 December 20219 December 2021