Risk Factors of Severe COVID-19 in Multiple Sclerosis Patients: A Systematic Review and Meta-Analysis

Abstract Objectives: To gather, synthesize, and meta-analyze data regarding the risk factors associated with a severe course of COVID-19 among patients with multiple sclerosis (pwMS). Methods: MEDLINE, Embase, Scopus, and WoS were searched in May 2021. Briefly, the eligibility criteria included: 1) studies assessing COVID-19 severity among adult pwMS, 2) definitive diagnoses or high clinical suspicion of COVID-19, 3) a categorization of COVID-19 severity into at least two categories, 4) quantitative effect size and precision measurements, and 5) English language; and 6) clear effect size/precision measures. internal validity of studies was assessed using the NIH Quality Assessment Tools. A list of possible risk factors was created based on the search results and was later used in extraction, synthesis, and meta-analysis of the data. Results: Thirteen studies were included in the syntheses. Outcome measures were either extracted from the papers, obtained from the primary researchers or calculated manually. The meta-analyses showed a significantly (P Conclusion: This study facilitates evidence-based risk/benefit assessments in practice. Older male progressive MS patients on anti-CD20 therapies are more at risk of an unfortunate COVID-19 outcome.