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. 2021 Jun 1;78(6):699-708.
doi: 10.1001/jamaneurol.2021.0688.

Outcomes and Risk Factors Associated With SARS-CoV-2 Infection in a North American Registry of Patients With Multiple Sclerosis

Amber Salter  1 , Robert J Fox  2 , Scott D Newsome  3 , June Halper  4 , David K B Li  5 , Pamela Kanellis  6 , Kathleen Costello  7 , Bruce Bebo  7 , Kottil Rammohan  8 , Gary R Cutter  9 , Anne H Cross  1
Affiliations

Outcomes and Risk Factors Associated With SARS-CoV-2 Infection in a North American Registry of Patients With Multiple Sclerosis

Amber Salter et al. JAMA Neurol. .

Erratum in

  • Error in Discussion.
    [No authors listed] [No authors listed] JAMA Neurol. 2021 Jun 1;78(6):765. doi: 10.1001/jamaneurol.2021.1236. JAMA Neurol. 2021. PMID: 33938923 Free PMC article. No abstract available.

Abstract

Importance: Emergence of SARS-CoV-2 causing COVID-19 prompted the need to gather information on clinical outcomes and risk factors associated with morbidity and mortality in patients with multiple sclerosis (MS) and concomitant SARS-CoV-2 infections.

Objective: To examine outcomes and risk factors associated with COVID-19 clinical severity in a large, diverse cohort of North American patients with MS.

Design, setting, and participants: This analysis used deidentified, cross-sectional data on patients with MS and SARS-CoV-2 infection reported by health care professionals in North American academic and community practices between April 1, 2020, and December 12, 2020, in the COVID-19 Infections in MS Registry. Health care professionals were asked to report patients after a minimum of 7 days from initial symptom onset and after sufficient time had passed to observe the COVID-19 disease course through resolution of acute illness or death. Data collection began April 1, 2020, and is ongoing.

Exposures: Laboratory-positive SARS-CoV-2 infection or highly suspected COVID-19.

Main outcomes and measures: Clinical outcome with 4 levels of increasing severity: not hospitalized, hospitalization only, admission to the intensive care unit and/or required ventilator support, and death.

Results: Of 1626 patients, most had laboratory-positive SARS-CoV-2 infection (1345 [82.7%]), were female (1202 [74.0%]), and had relapsing-remitting MS (1255 [80.4%]). A total of 996 patients (61.5%) were non-Hispanic White, 337 (20.8%) were Black, and 190 (11.7%) were Hispanic/Latinx. The mean (SD) age was 47.7 (13.2) years, and 797 (49.5%) had 1 or more comorbidity. The overall mortality rate was 3.3% (95% CI, 2.5%-4.3%). Ambulatory disability and older age were each independently associated with increased odds of all clinical severity levels compared with those not hospitalized after adjusting for other risk factors (nonambulatory: hospitalization only, odds ratio [OR], 2.8 [95% CI, 1.6-4.8]; intensive care unit/required ventilator support, OR, 3.5 [95% CI, 1.6-7.8]; death, OR, 25.4 [95% CI, 9.3-69.1]; age [every 10 years]: hospitalization only, OR, 1.3 [95% CI, 1.1-1.6]; intensive care unit/required ventilator support, OR, 1.3 [95% CI, 0.99-1.7]; death, OR, 1.8 [95% CI, 1.2-2.6]).

Conclusions and relevance: In this registry-based cross-sectional study, increased disability was independently associated with worse clinical severity including death from COVID-19. Other risk factors for worse outcomes included older age, Black race, cardiovascular comorbidities, and recent treatment with corticosteroids. Knowledge of these risk factors may improve the treatment of patients with MS and COVID-19 by helping clinicians identify patients requiring more intense monitoring or COVID-19 treatment.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Salter reports grants from National Multiple Sclerosis Society and is a statistical editor for Circulation: Cardiovascular Imaging during the conduct of the study. Dr Fox reports personal fees from AB Science, Actelion, Biogen, Celgene, EMD Serono, Genentech, Immunic Therapeutics, Novartis, Sanofi, Teva Pharmaceutical, and TG Therapeutics and clinical trial contract and research grant funding from Biogen and Novartis during the conduct of the study. Dr Newsome reports personal fees from Biogen, Novartis, Genentech, Bristol Myers Squibb, EMD Serono, Greenwich Biosciences, BioIncept, Autobahn, Celgene, and MedDay and other support from Biogen, Novartis, Genentech, National Multiple Sclerosis Society, US Department of Defense, and Patient-Centered Outcomes Research Institute paid to their institution outside the submitted work. Dr Li reports personal fees from Biogen and personal fees from Sanofi Genzyme; grants from Sanofi Genzyme, Roche, Novartis, and MS Society of Canada; is emeritus director of the University of British Columbia Multiple Sclerosis/Magnetic Resonance Imaging Research Group, which has been contracted to perform central analysis of magnetic resonance imaging scans for therapeutic trials with Roche and SanofiGenzyme and has received grant support for investigator-initiated studies from Sanofi Genzyme, Novartis, and Roche; and has served on the Progressive Multifocal Leukoencephalopathy–Multiple Sclerosis Steering Committee for Biogen and given lectures, supported by nonrestricted education grants from Academy of Healthcare Learning, Biogen, Consortium of Multiple Sclerosis Centers, and Sanofi Genzyme outside the submitted work. Dr Rammohan reports grants from Biogen, Novartis, Genzyme, Roche Genentech, Alexion, EMD Serono, MedDay Pharma, TG Therapeutics, and US Department of Defense and personal fees from Biogen, Novartis, Genzyme, Roche Genentech, Alexion, and EMD Serono outside the submitted work. Dr Cutter reports personal fees for serving on the data and safety monitoring boards of AstraZeneca, AveXis Pharmaceuticals, BioLineRx, Brainstorm Cell Therapeutics, Bristol Myers Squibb/Celgene, CSL Behring, Galmed Pharmaceuticals, Green Valley Pharma, Horizon Therapeutics, Hisun Pharmaceuticals, Mapi Pharma, Merck, Merck/Pfizer, Opko Biologics, OncoImmune, Neurim Pharmaceuticals, Novartis, Ophazyme, Sanofi-Aventis, Reata Pharmaceuticals, Teva Pharmaceuticals, Viela Bio, Vivus, National Heart, Lung, and Blood Institute (protocol review committee), Eunice Kennedy Shriver National Institute of Child Health and Human Development (obstetric pharmacology research units oversight committee); personal fees from consulting or serving on advisory boards of BioDelivery Sciences International, Biogen, Click Therapeutics, Genzyme, Genentech, GW Pharmaceuticals, Immunic, Klein Buendel, Medimmune/Viela Bio, MedDay, Merck/Serono, Neurogenesis, Novartis, Osmotica Pharmaceuticals, Perception Neuroscience, Recursion/CereXis Pharmaceuticals, Regeneron, Reckover Pharmaceuticals, Roche, and TG Therapeutics; and is President of Pythagoras Inc, a private consulting company. Dr Cross reports personal fees from Biogen, Celgene (Bristol Myers Squibb), EMD Serono, Genentech, Greenwich Biosciences, Janssen, Novartis, and TG Therapeutics outside the submitted work; grants from EMD Serono and Genentech outside the submitted work; and is secretary of the Consortium of Multiple Sclerosis Centers Board of Governors (an elected position), which is a supporter of the COVID-19 Infections in MS Registry, along with National Multiple Sclerosis Society (US) and MS Society of Canada. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Frequency of COVID-19 Symptoms for Each COVID-19 Clinical Severity Level
ICU indicates intensive care unit.
Figure 2.
Figure 2.. COVID-19 Clinical Severity Rates by Age and Race/Ethnicity
ICU indicates intensive care unit.
See this image and copyright information in PMC

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