COVID-19 infection associated with higher MS relapse rate

A multicentre cohort study found that COVID-19 infection was associated with a significantly increased MS relapse rate and shorter time to first relapse. No difference in confirmed Expanded Disability Status Scale (EDSS) progression was found. COVID-19 among patients receiving interferon beta/glatiramer acetate was associated with relatively greater relapse activity.

Mr David Levitz (Monash University, Australia) and colleagues aimed to evaluate the effect of COVID-19 infection on MS relapses and disability outcomes [1]. The effects on the MS disease course of patients on specific disease-modifying therapies (DMTs) were also evaluated.

Data was retrieved from the MSBase COVID-19 substudy. The study included 2,161 cases and the same number of propensity score-matched controls from 25 centres in 12 countries. Primary outcomes were time to first relapse, annualised relapse rate (ARR), and time to confirmed EDSS progression.

Table: Primary outcome results [1]



“Our primary outcome results showed that cases had a significantly higher ARR than matched controls. Furthermore, cases were associated with a greater hazard of time to first relapse,” said Mr Levitz (see Table). “This may suggest that COVID-19 was associated with acute neurological exacerbation.” He added that there was no significant association between COVID-19 and 24-week EDSS progression. Follow-up was only 1.71 years, Mr Levitz conceded, adding that “a longer follow-up period is required to more adequately evaluate whether COVID-19 affects disability outcomes in the longer term.” Finally, use of interferon beta/glatiramer acetate was associated with a shorter time to first relapse versus other DMTs (HR 1.83; 95% CI 1.25–2.68; P=0.002), and with a shorter time to EDSS score ≥3 (HR 2.04; 95% CI 1.06–3.90; P=0.032).

“Inform MS patients of the increased relapse risk following COVID-19 infection,” advised Mr Levitz. “Recommend them strategies to minimise COVID-19 risk. When making therapeutic decisions, specific DMT use of the patient should be taken into account, apart from disease-related factors.”

1. Levitz D, et al. The impact of COVID-19 infection on multiple sclerosis disease course: a propensity-matched cohort study. O185, MSMilan 2023, 11–13 October, Milan, Italy.

 

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Posted on 4 December, 20234 December, 2023