Clinical characteristics and outcomes in patients with coronavirus disease 2019 and multiple sclerosis

Background: Risk factors associated with the severity of COVID- 19 in patients with multiple sclerosis (MS) begin to be identified from several cohort studies Disease modifying therapies (DMTs) may modify the risk of developing a severe COVID-19 infection, beside identified risk factors such as age and comorbidities Objectives: The objective was to describe the clinical characteristics and outcomes in patients with COVID-19 and to identify the factors associated with COVID-19 severity Methods: This multicenter, retrospective, observational cohort study (COVISEP registry, NCT04355611) included patients with MS presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020 and July 14, 2020 The main outcome was COVID-19 severity assessed on a 7-point ordinal scale (ranging from 1: not hospitalized, no limitations on activities, to 7: death;cutoff at 3: hospitalized, not requiring supplemental oxygen) We collected demographics, neurological history, Expanded Disability Severity Score (EDSS), comorbidities, COVID-19 characteristics and outcome Univariate and multivariate logistic regression models were used to estimate the influence of collected variables on COVID-19 outcome Results: A total of 405 patients (mean age: 44 7 years, female/male: 293/112, mean disease duration: 13 4 years) were analyzed Seventy-eight patients (19 3%) had a COVID-19 severity score ≥ 3, and 12 patients (3 0%) died from COVID-19 Median EDSS was 2 0 (range: 0-9 5), 326 patients (80 5%) were on DMT There was a higher proportion of patients with COVID-19 severity score ≥ 3 among patients with no DMT relative to patients on DMTs (39 2% versus 14 4%, p<0 001) Multivariate logistic regression models determined that age (OR for 10 years: 1 8, 95% CI: 1 4-2 4), EDSS (OR for EDSS ≥ 6: 4 5, 95% CI: 2 0-10 0) were independent risk factors for COVID-19 severity score ≥ 3 (hospitalization or higher severity) while immunomodulatory treatment (interferon or glatiramer acetate) was associated with lower risk of COVID-19 severity score ≥ 3 (OR: 0 2, 95% CI: 0 05-0 8) EDSS was associated with the highest variability of COVID-19 severe outcome (R2= 0 18), followed by age (R2= 0 06) and immunomodulatory treatment (R2= 0 02) Conclusions: EDSS and age were independent risk factors of severe COVID-19, while exposure to immunomodulatory DMTs (interferon and glatiramer acetate) were independently associated with lower COVID-19 severity We did not find an association between other DMTs exposure (including immunosuppressive therapies) and COVID-19 severity The identification of these risk factors should provide the rationale for an individual strategy regarding clinical management of MS patients during the COVID- 19 pandemic