Age and EDSS are risk factors for severe COVID-19

In an observational French cohort study, EDSS and age were independent risk factors for severe COVID-19, while immunomodulating disease-modifying treatment (DMT) was independently associated with lower COVID-19 severity [1]. There was no association between immunosuppressive therapies and severity of COVID-19.

The study cohort (COVISEP registry) that was analysed included 405 MS patients with confirmed or highly suspected SARS-CoV-2 infection between 1 March 2020 and 14 July 2020. Included were patients who met at least one of the following criteria:

• biologically confirmed COVID-19 diagnosis based on SARS-CoV-2 RT-PCR positivity;
• typical thoracic CT abnormalities (ground-glass opacities) in epidemic areas;
• sudden-onset anosmia or ageusia in the absence of rhinitis or nasal obstruction; or
• typical symptoms (triad associating cough, fever, asthenia) in the epidemic zone of COVID-19.

Mean age was 44.7 years, mean MS duration was 13.4 years, and 293 patients (72%) were female. Median EDSS was 2.0 (range 0.0-9.5) and 326 patients (80.5%) used a disease-modifying treatment (DMT). COVID-19 severity was assessed on a 7-point ordinal scale, ranging from 1 (not hospitalised, no limitations on activities) to 7 (death). Cut-off score was at 3 (hospitalised, not requiring supplemental oxygen). The presented results were a follow-up on previously published results in JAMA Neurology [2].

Of 405 participants, 78 (19.3%) had a COVID-19 severity score ≥3 and 12 patients (3.0%) died from COVID-19. Most of the very severe COVID-19 patients did not use any DMT. The percentage of patients with a COVID-19 severity score ≥3 in patients with and without a DMT was 14.4% versus 39.2% (P<0.001). Independent risk factors for COVID-19 severity score ≥3 were higher age (OR 1.8 for 10 years) and higher EDSS (OR 4.5 for EDSS ≥6). Obesity and cardiac comorbidity were also associated with severe COVID-19 (OR 2.58 and 2.39, respectively). Immunomodulatory treatment with interferon or glatiramer acetate was associated with a lower risk of COVID-19 severity score ≥3 (OR 0.2) compared with no treatment. Knowing these risk factors should help to guide individualised clinical management of MS patients during the COVID-19 pandemic.

1. Louapre C, et al. Clinical Characteristics and Outcomes in Patients with Coronavirus Disease 2019 and Multiple Sclerosis. MSVirtual 2020, Abstract SS02.06
2. Louapre C, et al. JAMA Neurol. 2020;77(9):1079-88.