Self-diagnosed COVID-19 in people with multiple sclerosis: a community-based cohort of the UK MS Register.Evangelou N, Garjani A, dasNair R, Hunter R, Tuite-Dalton KA, Craig EM, Rodgers WJ, Coles A, Dobson R, Duddy M, Ford DV, Hughes S, Pearson O, Middleton LA, Rog D, Tallantyre EC, Friede T, Middleton RM, Nicholas R.J Neurol Neurosurg Psychiatry. 2020 Aug 27:jnnp-2020-324449. doi: 10.1136/jnnp-2020-324449.
In the early phases of the UK COVID-19 outbreak, in the absence of clear evidence about the risks for people with multiple sclerosis (pwMS) and those taking immunomodulatory disease-modifying therapies (DMT), we launched a community-based study as part of the UK MS Register (UKMSR). We intended to capture the picture of COVID-19 among pwMS and their risk of contracting the disease. Here, they report our findings from 17 March to 24 April 2020.
As of 24 April, out of 3910 participants, 237 (6.1% (95% CI 5.3% to 6.8%)) reported self-diagnosed COVID-19 among whom 54 (22.8% (17.5% to 28.2%)) also had a diagnosis by a healthcare professional based on symptoms and 37 (15.6% (11.2% to 20.6%)) a confirmed diagnosis by testing. Three participants reported hospitalisation due to COVID-19. No deaths were reported.
Among 1283 siblings without MS, 79 (6.2%) had a reported diagnosis of COVID-19. Adjusting for age and gender, the likelihood of contracting COVID-19 in pwMS was similar to siblings (OR 1.180 (0.888 to 1.569)).
Seven hundred and fifty-nine of 3812 participants reported that they were self-isolating and that they had been self-isolating for at least 2 weeks before symptom onset if they had COVID-19. Of these, 2 (0.3% (0% to 0.7%)) had self-diagnosed COVID-19 whereas 137 of 3053 participants not self-isolating (4.5% (3.8% to 5.2%)) had the disease (p<0.001). Among participants with confirmed COVID-19, 94.6% (86.5% to 100%) were not self-isolating which was higher than those without the disease (79.9% (78.7% to 81.3%), p=0.023). Self-isolating participants were slightly older than those not self-isolating (p<0.001). A lower proportion of participants on DMTs were self-isolating compared with those not taking DMTs (18.1% (16.4% to 20%) vs 21.5% (19.6% to 23.3%), p=0.01). Rate of self-isolation in participants taking high-efficacy DMTs was similar to those not taking DMTs and higher than those taking moderate-efficacy DMTs (21.3% vs 21.4% and 16.5%, p=0.993 and p=0.014, respectively). More participants with progressive MS (PMS) were self-isolating compared with relapsing-remitting MS (RRMS) (23.2% (21% to 25.3%) vs 17.9% (16.3% to 19.5%), p<0.001).
Using self-diagnosed and confirmed COVID-19 as outcomes, 3714 and 3618 participants were included in the regression analysis, respectively. Self-isolation predicted a lower likelihood of having self-diagnosed COVID-19 (OR 0.064 (0.016 to 0.259)) but not confirmed COVID-19.
Participants on DMTs were less likely to have self-diagnosed COVID-19 (OR 0.640 (CI 0.428 to 0.957)), which remained significant after removing self-isolating participants (OR 0.633 (0.402 to 0.998)). High-efficacy DMTs reduced the likelihood of self-diagnosed COVID-19 compared with no DMTs (OR 0.540 (0.311 to 0.938)) but not compared with moderate-efficacy DMTs. There was no significant association between taking DMTs and having confirmed COVID-19. It was not possible to do a formal statistical test for the association between individual DMTs and COVID-19 due to small numbers
Younger age was associated with increased likelihood of having self-diagnosed (OR 1.043 (1.022 to 1.064)) and confirmed (OR 1.048 (1.009 to 1.087)) COVID-19.
Participants with PMS were less likely to have self-diagnosed (OR 0.429 (0.241 to 0.763)) or confirmed (OR 0.119 (0.015 to 0.967)) COVID-19 compared with those with RRMS, but this effect disappeared after excluding participants who were self-isolating.
Including webEDSS (n=2808) and physical MSIS-29v2 (n=3192) as additional predictors in the analysis showed no significant association with the likelihood of contracting COVID-19.
The gender distribution was similar between participants with and without COVID-19. More participants with self-diagnosed COVID-19 reported themselves as having any ethnicity other than white compared with those without the disease (6.9% (3.9% to 10.1%) vs 3.8% (3.2% to 4.4%), p=0.019). Gender and ethnicity did not affect the likelihood of having COVID-19.
Thet report initial findings of an ongoing community-based COVID-19 study in a large UK-wide population of pwMS which coincided with the peak of the COVID-19 outbreak in the UK/ They show that pwMS taking immunomodulatory treatments do not have an increased risk of contracting COVID-19. They did not find individual DMTs to be noticeably over-represented among pwMS with COVID-19.
The incidence of COVID-19 in our population of pwMS was not higher than that of the general population, and pwMS were not at a higher risk of having COVID-19 compared with their siblings without MS. The low hospitalisation rate in our population is possibly due to its patient-reported nature where hospitalised pwMS would fail to respond to the surveys.
The observation that self-isolating pwMS had a lower risk of COVID-19 was not unexpected. We found older pwMS and those with PMS were less likely to have COVID-19. This could be because they were self-isolating more. Similar to previous reports, we found evidence that pwMS with any ethnicity other than white had a higher chance of contracting COVID-19,3 but larger numbers are required to confirm this.
When this study launched, there was no accurate or accessible test to diagnose COVID-19. Therefore, we decided to set a diagnosis of COVID-19 made by participants, based on their symptoms, as the primary outcome of the study. This approach has also been adopted in other large-scale studies and is in line with the UK government policy not to seek medical advice for mild symptoms of COVID-19.
In conclusion, during a period with strict precautions in place to prevent the spread of COVID-19, pwMS and those taking DMTs are not at an increased risk of contracting the disease.
This early days and they must be fed up that they had to wait 4 months to get this published. The was fewer people developing suspected COVID in people taking beta interferons and more proportionally susceptible if they took alemtuzumab
Drug Total self-reported COVID