Disease-Modifying Therapies for MS Protective Against COVID-19

Buffalo, NY—Almost since the beginning of the COVID-19 pandemic, concerns have been raised that immunomodulating therapies frequently used to slow MS progression would make patients even more vulnerable to infection.

It turns out that is not the case. A new study in the journal Multiple Sclerosis pointed out that MS patients receiving disease-modifying therapies (DMTs) are not at greater risk. In anything, according to authors from the University at Buffalo, State University of New York, they appear to do better than patients without MS when hospitalized with COVID-19.

Early analyses demonstrated that immunocompromised patients faced a substantially greater risk of severe disease, with higher rates of hospitalization and death associated with COVID-19 infection. Studies found that patients taking immunosuppressants following organ or stem cell transplants or to treat cancer fared poorly, and individuals with weakened immune systems caused by HIV also had a higher risk of severe disease and worse outcomes.

As a result, clinicians initially recommended pausing DMTs for patients with MS during the pandemic, even though there were concerns about disease progression without the therapies.

The recent study, conducted among U.S. veterans, found that patients hospitalized with COVID-19 who had MS and active DMT prescriptions had better outcomes than patients without MS.

"Results of this study suggest that not only is it safe to initiate or continue DMTs in MS patients during the COVID-19 pandemic, but it is also beneficial in the MS population given the decreased risk of COVID-19 mortality in addition to the established decreased risk of MS disease progression attributed to these therapies," the researchers stated.

The retrospective study analyzed 49,737 cases of veterans hospitalized with COVID-19 at 125 U.S. Department of Veterans Affairs facilities between March 3, 2020, and October 1, 2021, using the Corporate Data Warehouse. Of those, 255 had MS. The researchers evaluated all-cause mortality in these patients for 30 days after their initial positive COVID-19 test.

DMTs analyzed in the study included dimethyl fumarate, fingolimod, glatiramer, interferon 1A and 1B, natalizumab, siponimod, teriflunomide, as well as other, less common, therapies. Ocrelizumab and rituximab were not included as no veterans in the study were prescribed either therapy. Patients were considered to be on a DMT if they had received a prescription for one within 90 days of a positive COVID-19 test or if the record showed an inpatient medication order for a DMT.

Overall, coronary artery disease, heart failure, chronic kidney disease, cardiovascular disease, diabetes, and hypertension were less common in the MS cohort. Veterans with MS were also more likely to have been vaccinated.

On an unadjusted basis, no statistically significant difference in 30-day mortality was found between veterans with MS (9.3%) and those without MS (12.6%), P = .11. In the propensity score analysis, patients with MS had a 30-day mortality rate of 9.4% compared with 8.7% for those without MS (P = .69).

Multivariable logistic regression analysis showed, however, that DMT's for MS "consistently reduced the odds of 30-day mortality," the researchers wrote. In the whole model, DMTs reduced the odds of dying within 30 days by 84% (odds ratio [OR], 0.16; 95% CI, 0.01-0.82; P = .023). In comparison, vaccination reduced the risk of death 59% (OR, 0.41; 95% CI, 0.37-0.44; P <.0001). Similar results were seen in the propensity score–matched cohort and in a subanalysis of unvaccinated veterans.

"Following hospitalization for COVID-19 infection, MS patients who were taking DMTs (excluding anti-CD20 inhibitors) were over 5 times less likely to die from complications relating to COVID-19 infection (OR 0.18), accounting for other relevant factors, such as age, vaccination status, and comorbidities," the research team found.

While "MS patients were less likely to die than those in the general population when taking DMTs," even without DMTs, MS patients had comparable mortality rates with other hospitalized patients without MS, researchers pointed out.

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