Immunosuppressive DMTs Associated With Longer COVID-19 Hospitalization in Patients With Multiple Sclerosis

Data presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2022, February 24-26, in West Palm Beach, Florida, suggest health care providers should take risks of severe COVID-19 infection into consideration before starting immunosuppressive disease-modifying therapy (IS-DMT) in patients with multiple sclerosis (MS), as they were observed to have longer hospitalization when compared with those on immunomodulatory-DMT (IM-DMT).¹

Investigators, led by Zhila Maghbooli, PhD, MSc, Neuroscience Institute, Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Iran, evaluated the main risk factors related to adverse clinical outcomes in patients with MS who developed COVID-19. The cross-sectional study utilized 2 years of hospital admissions for COVID-19 infection in this patient population in Iran from March 2019 to Aug 2021.

A total of 2859 patients with MS were recorded in the electronic health records systems, Medical Care Monitoring Center (MCMC) and Hospitals’ Information System (HIS), with 1579 patients having a definitive diagnosis of COVID-19 with real-time polymerase chain reaction that were then included in data analysis. Among those that were included, 16.3% were not receiving a DMT at the time of COVID-19 infection. All remaining patients (83.7%) were on DMTs, 38.2% on IM-DMT and 45.5% on IS-DMT.

Those who were on IS-DMT were found to have longer hospitalization than those on IM-DMT, with mean stays of 8 days (standard deviation [SD], 6.5) and 6 days (SD, 5.5), respectively. This observation remained even after adjusting for age, sex, body mass index (BMI), presence of comorbidities, smoking status, duration of MS, Expanded Disability Status Scale score, and the disease course at time of admission. Maghbooli et al found that comorbidity was the independent common risk factor associated with severity outcomes, longer hospitalization, presence in the intensive care unit, and mortality (P <.01 for all).

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Both the MCMC and the HIS are nationwide health information systems that were established by the Information Technology and Statistics Department of the Ministry of Health, recording data on patients admitted to the hospital with COVID-19 in the MCMC and patient demographic data, diagnosis, and hospital inpatients services recorded by the HIS. Data related to patients with MS were collected by the MS nationwide registry system and the MS Society of Iran. Investigators included 10 study factors, including demographic information (age, sex, and BMI), smoking habit, medical history, principal clinical symptoms and onset time, real-time polymerase chain reaction results, radiological findings, comorbidity, needing intensive care, hospitalization days, and in-hospital mortality.

The relationship between COVID-19 infection and DMTs has been widely studied in MS, in addition to the interaction of approved COVID-19 vaccines and DMTs. At the recent 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), October 25-28, Amit Bar-Or, MD, FRCPC, FAAN, FANA, Melissa and Paul Anderson President’s Distinguished Professor; director, Center for Neuroinflammation and Neurotherapeutics; and chief, Multiple Sclerosis Division, department of neurology, Perelman School of Medicine, University of Pennsylvania, gave a presentation outlining research and expert opinions on the topic, stating that emerging data on vaccine response suggest an absence of risk is a patient with MS gets vaccinated for COVID-19 while on a DMT.

There is, however, concern about maximal vaccine response, with Bar-Or suggesting that patients ensure vaccinations are “up to speed” prior to starting a high-efficacy therapy, such as an anti-CD20 agent. As the currently approved COVID-19 vaccinations are not categorized as live or attenuated, Bar-Or added there is no associated risk of the vaccine contributing to or spreading infection, nor causing infection-related complications in vaccinated patients.

For more coverage of ACTRIMS Forum 2022, click here.

REFERENCE
1. Maghbooli Z, Aghababaei Y, Hosseinpour H, et al. Association between disease-modifying therapies and adverse clinical outcomes in multiple sclerosis patients with COVID-19 infection. Presented at 2022 ACTRIMS Forum; February 24-26; West Palm Beach, FL and Virtual. Poster P124.