1Raed Alroughani, 2Jihad Said Inshasi, 3Jasem Al-Hashel, 4Jaber Alkhaboury, 4Abdullah Alsalti, 2Reem Al Suwaidi, 5Loqman H. Hassino, 6,7Samar Farouk Ahmed
1Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait; 2Neurology Department, Rashid Hospital and Dubai Medical College, Dubai, United Arab Emirates; 3Faculty of Medicine, Kuwait University, Kuwait City, Kuwait; 4Neurology Unit, College of Medicine and Health Sciences, Sultan Qaboos University and Sultan Qaboos University Hospital, Muscat, Oman; 5Neurology Unit, Department of Medicine Jahra Hospital, Jahra, Kuwait; 6Ibn Sina Hospital, Kuwait City, Kuwait; 7Faculty of Medicine, Minia university, Minia, Egypt
Objective(s):
To evaluate the incidence, severity, and outcomes of coronavirus disease (COVID-19) and to identify demographic and clinical risk factors in patients with multiple sclerosis (MS).
Material(s) and Method(s):
A cross-sectional hospital records-based study was conducted on MS patients from clinics in Oman, Kuwait, and the United Arab Emirates (UAE) between March 2020 and February 2021. Patients diagnosed with MS using the 2010 McDonald criteria or previously accepted diagnostic criteria and with a positive diagnosis of COVID-19 were included in the study. Association between patient demographics, disease characteristics, use of disease-modifying therapies, and outcome of COVID-19 illness was evaluated statistically using an odds ratio estimation.
Result(s):
A total of 134 MS patients with COVID-19 (overall incidence rate of 3.7%) were analyzed in the study (116 with relapsing-remitting MS [RRMS], 11 with progressive MS; and 7 with clinically isolated MS). The median age of patients was 35.5 years. Of the total cohort, 127 (94.8%) patients were on disease-modifying therapy (DMT). A majority of the patients (126 [94.0%]) had mild COVID 19 illness and 122 (91.0%) made a full recovery while 1 (0.7%) patient died. A total of 8 patients (6.0%) were hospitalized; 3 (2.2%) required intensive care, while 2 (1.5%) reported ventilator requirement. The mean EDSS scores reported in the study were low (1.74) with 127 (94.8%) reporting a score between 0 – 4.5. Univariate logistic regression analysis identified a high EDSS score and progressive MS disease as a risk factor for moderate to severe COVID-19 requiring hospitalization. Rituximab use and anti CD20 therapy were also associated with a statistically significant higher risk of developing moderate/severe COVID-19. The presence of comorbidities was associated with a higher risk of non-recovery from the viral infection in both univariate and multivariate analyses.
Conclusion(s):
COVID-19 showed an incidence rate of 3.7% in the studied cohort of MS patients. The disease course and outcomes were mostly favorable with most patients not requiring hospitalization. A higher EDSS score, progressive disease, use of rituximab, and use of antiCD20 therapy were associated with statistically significant increased risk of developing moderate/severe COVID-19, while the presence of comorbidities was associated with a higher risk of non-recovery from COVID-19. Age, sex, smoking history, and duration of MS were not independent risk factors for increased severity or adverse COVID-19 disease outcomes.