#MSCOVID19 French Registry Reports

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The french registry has delivered their first taste of the COVID-19 pot and they support our suggestions that DMT are not creating mega problems if you get infected with SARS-CoV-2. The risk factors are age (co-morbidities increase with age), obesity (co-morbidities increase) and disablity (co-morbidities increase with disability). Interestingly, DMTs were associated with lower risks of severe COVID-19 (interferon or glatiramer acetate: OR, 0.07 [95% CI, 0.02-0.25]; teriflunomide, dimethylfumarate, natalizumab, or other drugs: OR, 0.18 [95% CI, 0.09-0.36]; alemtuzumab, cladribine, fingolimod, ocrelizumab, or rituximab: OR, 0.37
[95% CI, 0.19-0.72]).

Disease-modifying therapies
Interferon beta 20 (5.8%)
Glatiramer 33 (9.5%)
Teriflunomide 33 (9.5%)
Dimethylfumarate 35 (10.1%)
Natalizumab 57 (16.4%)
Fingolimod 42 (12.1%)
Ocrelizumab 38 (11.0%)
Rituximab 17 (4.9%)
Cladribine 3 (0.9%)
Alemtuzumab 1 (0.3%)
Othera 5 (1.4%)
None 63 (18.2%)

Clinical Characteristics and Outcomes in Patients With Coronavirus Disease 2019 and Multiple Sclerosis.Louapre C, Collongues N, Stankoff B, Giannesini C, Papeix C, Bensa C, Deschamps R, Créange A, Wahab A, Pelletier J, Heinzlef O, Labauge P, Guilloton L, Ahle G, Goudot M, Bigaut K, Laplaud DA, Vukusic S, Lubetzki C, De Sèze J; Covisep investigators.JAMA Neurol. 2020 Jun 26. doi: 10.1001/jamaneurol.2020.2581. Online ahead of print.

Importance: Risk factors associated with the severity of coronavirus disease 2019 (COVID-19) in patients with multiple sclerosis (MS) are unknown. Disease-modifying therapies (DMTs) may modify the risk of developing a severe COVID-19 infection, beside identified risk factors such as age and comorbidities.

Objective: To describe the clinical characteristics and outcomes in patients with MS and COVID-19 and identify factors associated with COVID-19 severity.

Design, setting, and participants: The Covisep registry is a multicenter, retrospective, observational cohort study conducted in MS expert centers and general hospitals and with neurologists collaborating with MS expert centers and members of the Société Francophone de la Sclérose en Plaques. The study included patients with MS presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and May 21, 2020.

Exposures: COVID-19 diagnosed with a polymerase chain reaction test on a nasopharyngeal swab, thoracic computed tomography, or typical symptoms.

Main outcomes and measures: The main outcome was COVID-19 severity assessed on a 7-point ordinal scale (ranging from 1 [not hospitalized with no limitations on activities] to 7 [death]) with a cutoff at 3 (hospitalized and not requiring supplemental oxygen). We collected demographics, neurological history, Expanded Disability Severity Scale score (EDSS; ranging from 0 to 10, with cutoffs at 3 and 6), comorbidities, COVID-19 characteristics, and outcomes. Univariate and multivariate logistic regression models were used to estimate the association of collected variables with COVID-19 outcomes.

Results: A total of 347 patients (mean [SD] age, 44.6 [12.8] years, 249 women; mean [SD] disease duration, 13.5 [10.0] years) were analyzed. Seventy-three patients (21.0%) had a COVID-19 severity score of 3 or more, and 12 patients (3.5%) died of COVID-19. The median EDSS was 2.0 (range, 0-9.5), and 284 patients (81.8%) were receiving DMT. There was a higher proportion of patients with a COVID-19 severity score of 3 or more among patients with no DMT relative to patients receiving DMTs (46.0% vs 15.5%; P < .001). Multivariate logistic regression models determined that age (odds ratio per 10 years: 1.9 [95% CI, 1.4-2.5]), EDSS (OR for EDSS ≥6, 6.3 [95% CI. 2.8-14.4]), and obesity (OR, 3.0 [95% CI, 1.0-8.7]) were independent risk factors for a COVID-19 severity score of 3 or more (indicating hospitalization or higher severity). The EDSS was associated with the highest variability of COVID-19 severe outcome (R2, 0.2), followed by age (R2, 0.06) and obesity (R2, 0.01).

Conclusions and relevance: In this registry-based cohort study of patients with MS, age, EDSS, and obesity were independent risk factors for severe COVID-19; there was no association found between DMTs exposure and COVID-19 severity. The identification of these risk factors should provide the rationale for an individual strategy regarding clinical management of patients with MS during the COVID-19 pandemic.

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MouseDoctor

6 comments

  • Hi Mouse Doctor,
    if I read it correctly, the French registry reverses the severity of the treatments, do IRTs have a lower risk of contracting severe form of covid? Could this be due to the lack of an autoimmune response?
    If it´s true, it´s good news for those who have lymphopenia, but from what values of lymphocytes in the blood does this study apply?

    • In the study they suggest lymphopenia is a risk factor…However lymphopenia is a product of COVID19 and a poor prognostic featue because it suggests that covid is clearing your lymph glands of lymphocytes in the mild cases the cases with alemtuzumab tell us that blood counts are not going to tell you an informative story

  • Thanks for this. Did they have anti CD20 patients doing ok with mild Covid? (I read the report and they had 2 ocrelizumab with severe who both had BMI>40 but both recovered)

      • The holy grail is death certification. The death certification form is universal and standardized for global health monitoring and reference. It has lines and boxes for death sequence from “underlying” to “immediate” cause so that every combination can be recorded. Death is a process and there are many roads to it. In the case of COVID-19, MS would be listed in Part 2 of the form which is for “Other.” MS would not be a factor in the death but that is the value of the Part 2 box. A researcher can exclude MS as having been a factor. With the death certification filled out honestly and factually (most physicians don’t take the time) the death sequence or antecedents from the original, underlying COVID-19 cause would illustrate exactly which antecedent conditions were present to make it fatal. If medications for MS are a factor, these are entered as an antecedent. This information is extremely useful down the line and much easier than scrambling after the fact.

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