'Reassuring' Study Examines COVID-19 Risk in MS

Damian McNamara

May 08, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's  Coronavirus Resource Center.

Multiple sclerosis (MS) may not be one of the more serious comorbidities when it comes to COVID-19, researchers in Italy suggest after evaluating a series of almost 250 people.

They report 96% of people with MS experienced a "mild" case of COVID-19, defined as mild pneumonia or no pneumonia. Although preliminary, the findings also suggest that MS immunosuppressant therapy does not worsen outcomes.

The study was published online April 29 in Lancet Neurology.

"The data are still not enough to draw conclusions. However, up to the date of the article publication, there was no signal of an increased risk related to specific drugs," lead author Maria Pia Sormani, PhD, Department of Health Sciences at the University of Genoa in Italy, told Medscape Medical News.

Some coexisting conditions like diabetes, hypertension, and obesity have been linked to a greater severity of COVID-19, as previously reported by Medscape Medical News. However, Pia Sormani notes that "how less common conditions, such as MS, affect COVID-19 outcomes remains uncertain."

Another unanswered question is if immunosuppressive MS treatments confer any risk or protection regarding COVID-19.

To learn more, Pia Sormani examined outcomes on 232 people with MS from 38 centers across Italy. This cohort included 57 people who tested positive for COVID-19 and 175 others with suspected COVID-19 symptoms without a positive test result.

Clinicians across Italy reported these cases using an online form, part of a program launched by the Italian Multiple Sclerosis Society, the Italian Multiple Sclerosis Foundation, and the Multiple Sclerosis Study Group of the Italian Neurological Society. Mean follow-up was approximately 13 days.

Five COVID-19 Deaths

In addition to the 222 patients who experienced only mild COVID-19 illness, four people had severe disease. Severe COVID-19 was defined by shortness of breath, a respiratory rate or 30 or more breaths per minute, blood oxygen saturation of 93% or less, a PaO₂:FiO₂ ratio below 300 mm Hg/% and/or a greater than 50% increase in lung infiltrates within 24 to 48 hours.

The remaining six patients in the series were in critical condition with respiratory failure, septic shock and/or multiple organ dysfunction. One of these patients recovered and the other five died.

"Three out of five patients who died were not under treatment and they were all disabled with an EDSS [Expanded Disability Status Scale] of 6 or greater," said Pia Sormani.

These results appear to be "slightly reassuring" and "do not seem to contradict guidelines that we and others had already issued on the management of multiple sclerosis treatments in the time of the COVID-19 pandemic," she notes.

Pia Sormani reported findings up until April 7 on behalf of the Italian Study Group on COVID-19 Infection in Multiple Sclerosis. The research is ongoing. "We now have in the dataset more than 500 patients. The data continue to be overall reassuring," Pia Sormani said earlier this week.

Going forward, "we will explore if the severity of outcomes can be related to specific MS treatments."

"More to Learn"

"This is indeed an encouraging report and not dissimilar to reports on other autoimmune diseases showing that COVID-19 does not seem worse due to coexisting autoimmune disease," Betty Diamond, MD, director of molecular medicine at the Feinstein Institutes for Medical Research at Northwell Health in Manhasset, New York, told Medscape Medical News when asked to comment.

"There are data suggesting that the use of corticosteroids, sometimes used in individuals with autoimmune disease, does increase risk for infection," she added.

The current report is encouraging, Diamond said, "but there is more to learn." For example, research is needed to determine if individuals on immunosuppressive therapy might shed virus for a longer period of time.

Pia Sormani disclosed she receives personal fees from Biogen, Merck, Teva, Novartis, Sanofi Genzyme, Roche, GeNeuro, and Medday, outside the submitted work. Diamond has disclosed no relevant financial relationships.

Lancet Neurol. Published online April 29, 2020. Abstract

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