Disparities in Telehealth Care in Multiple Sclerosis.

Background and Objectives: The COVID-19 pandemic has dramatically increased telehealth use. We assessed access to and use of telehealth care, including videoconferencing and usability of videoconferencing, among persons with multiple sclerosis (MS). Methods: In Fall 2020, we surveyed participants in the North American Research Committee on Multiple Sclerosis Registry. Participants reported availability and receipt of MS care or education through telehealth. Participants who completed ≥1 live videoconferencing visit completed the Telehealth Usability Questionnaire (TUQ). We tested factors associated with access to and receipt of telehealth care using logistic regression. We tested factors associated with TUQ scores using quantile regression. Results: Of the 8,434 participants to whom the survey was distributed, 6,043 responded (71.6%); 5,403 were eligible for analysis. Of the respondents, 4,337 (80.6%) were women, and they had a mean (SD) age of 63.2 (10.0) years. Overall, 2,889 (53.5%) reported access to MS care via telehealth, and 2,110 (39.1%) reported receipt of MS care via telehealth including 1,523 (28%) via videoconference. Among participants who reported telehealth was available, older age was associated with decreased odds of having a telehealth video visit; higher income and being physically active were associated with increased odds. Older age and moderate to very severe visual symptoms were associated with lower perceived usability of telehealth. Discussion: Older age, lower socioeconomic status, and disease-related impairments are associated with less access to and use of telehealth services in people with MS. Barriers to telehealth should be addressed to avoid aggravating health care disparities when using digital medicine.

Données IRM, efficacité et sécurité d'emploi du tolébrutinib chez des patients atteints d'une SEP très active : données à 2 ans de l'étude de sécurité d'emploi à long terme de phase 2b (LTS, Long-Term Safety)

Référent amel.gheribbenblidia@sanofi.com (A. Gherib Benblidia). Introduction Dans l'étude de phase 2b (NCT03889639), le tolébrutinib (TOL), un inhibiteur de la tyrosine kinase qui pénètre le SNC, a été bien toléré et a démontré une réduction dose-dépendante du nombre de lésion IRM nouvelle ou élargie. Objectifs Rapporter les résultats cliniques, radiologiques et de sécurité d'emploi à 2 ans de l'étude d'extension de sécurité d'emploi à long terme (LTS, Long-Term Safety) chez des patients atteints de SEP récurrente très active. Méthodes Dans la partie A en double aveugle (Part A) de l'extension, les patients ont reçu la même dose de tolébrutinib que dans l'étude princeps (5, 15, 30, ou 60mg/j). Dans la partie B (Part B) en ouvert, les patients ont reçu du tolébrutinib à 60mg/j. La SEP très active a été définie par 1 poussée dans l'année précédente et ≥ 1 lésion Gd+ à l'IRM dans les 6 mois précédents ou ≥ 9 lésions T2 à la baseline (BL) ou ≥ 2 poussées dans l'année précédente. Résultats Soixante et un patients avaient une SEP très active à la BL ;60 ont continué dans la Part A de la LTS et 59 ont participé à la Part B, 55 étaient encore dans l'étude au 7/3/22. Le nombre de nouvelle lésions Gd+ et de lésion T2 nouvelle ou élargie est resté faible dans le bras 60/60-mg. Les évènements indésirables les plus fréquents ont été : COVID-19, rhinopharyngite, céphalée (20 %, 16,7 %, 13,3 %, respectivement). Chez les patients ayant reçu 60mg/j pendant 8 semaines minimum, le TAP était de 0,10 et 92,9 % étaient libres de poussée. Discussion Il n'y a pas eu de lien entre la dose et les EI sous traitement ni les EI graves dans la Part A, ni de nouveaux évènements de sécurité d'emploi chez les patients qui sont passés à la dose de 60mg dans la Part B. Pour les patients ayant reçu du tolébrutinib à 60mg/j pendant 8 semaines minimum, le TAP était de 0,10 (IC 95 % : 0,02, 0,66) et 92,9 % étaient toujours libres de poussées à la S96. Les scores EDSS moyens sont restés stables jusqu'à 2 ans. Conclusion Dans la SEP très active, tolébrutinib 60mg a démontré une sécurité d'emploi et une tolérance favorable, comparables à celles de la population totale, associées à un TAP et un nombre de nouvelles lésions Gd+ faibles à 2 ans.

Sécurité d'emploi et efficacité clinique du tolébrutinib dans l'étude d'extension à long terme chez des patients atteints de SEP récurrente : résultats à 2 ans

Référent amel.gheribbenblidia@sanofi.com (A. Gherib Benblidia). Introduction Dans une étude de phase 2b, le tolébrutinib, un inhibiteur de la tyrosine kinase qui pénètre le SNC, a été bien toléré et a réduit le nombre de nouvelles lésions T1 Gd+ et des lésions T2 nouvelles ou élargies sur 12 semaines. Objectifs Décrire le profil de sécurité d'emploi et l'efficacité du tolébrutinib (TOL) à 96 semaines (2 ans), dans la phase d'extension de sécurité d'emploi à long terme (LTS, Long-term study : NCT03996291) de l'étude de phase 2b. Méthodes Dans la partie A (Part A) de l'extension, les patients ont reçu la même dose de tolébrutinib que dans l'étude princeps (5, 15, 30, ou 60mg/jour) en double aveugle jusqu'à la sélection de la dose pour les phases 3 (60mg/jour). Dans la partie B (Part B), les patients ont reçu tolébrutinib 60mg/jour en ouvert. La sécurité d'emploi a été évaluée via la déclaration des événements indésirables (EI). Les critères d'efficacité incluaient le taux annualisé de poussées (TAP) et la variation du score EDSS versus la baseline. Résultats Parmi les 125 patients ayant complété la Part A, 124 ont été dans la Part B. Au total, 114 (90,5 %) y étaient toujours au 7/3/22. Un patient sous TOL 5mg/j est sorti de la Part A pour progression de la maladie et 10 de la Part B pour EI (n=3), manque d'efficacité (n=4), autres (n=3). À 2 ans, aucun nouveau signal n'a été observé. Les EI les plus fréquents ont été : COVID-19, céphalée, rhinopharyngite, infection respiratoire haute, cystite bactérienne, pharyngite et arthralgie (20,8 %, 13,6 %, 11,2 %, 11,2 %, 7,2 %, 5,6 %, 5,6 %, respectivement). Discussion Il n'y a pas eu de lien entre la dose et les EI sous traitement ni les EI graves dans la Part A, ni de nouveaux événements de sécurité d'emploi chez les patients qui sont passés à la dose de 60mg dans la Part B. Pour les patients ayant reçu du tolébrutinib 60mg/j pendant 8 semaines minimum, le TAP était de 0,17 (95 % CI : 0,12, 0,25) et 80,6 % d'entre eux sont restés libres de poussée. L'EDSS moyen est resté stable jusqu'à la semaine 96. Conclusion Jusqu'à la semaine 96 de l'étude LTS, tolébrutinib 60mg/j continue à démontrer une sécurité d'emploi favorable et est associé à un TAP faible et un handicap stable.

Assessing prevalence, validity, and correlates of ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder in Ireland.

BACKGROUND: The most frequently used measure of the 11th edition of the International Classification of Diseases (ICD-11) complex posttraumatic stress disorder (CPTSD) is the International Trauma Questionnaire (ITQ). While there is strong support for the psychometric properties of the ITQ, few studies have assessed its reliability and validity in nationally representative samples. Additionally, several correlates of ICD-11 CPTSD have been identified; however, few studies have assessed multiple correlates simultaneously. OBJECTIVE: To assess the factorial validity and internal reliability of the ITQ in a nationally representative sample of adults living in Ireland (N = 1,100); determine the prevalence rates of ICD-11 posttraumatic stress disorder (PTSD) and CPTSD; and identify correlates of CPTSD symptoms and how CPTSD symptoms relate to risk of suicide. METHOD: Confirmatory factor analysis was performed to evaluate the factorial validity of the ITQ, and structural equation modeling (SEM) was used to determine the unique multivariate associations between 10 predictor variables (age, sex, urban dwelling, unemployment status, number of traumatic events, COVID-19 infection, knowing someone who died from COVID-19, loneliness, social support, and sleep problems) and symptoms of CPTSD, and the unique associations between CPTSD symptoms and suicide risk. RESULTS: The ITQ produces reliable and valid scores, 11.2% of people met requirements for ICD-11 PTSD (2.4%) or CPTSD (8.8%), exposure to a higher number of traumatic life events, higher levels of loneliness, and more sleep problems predicted CPTSD symptoms; and negative self-concept (NSC) symptoms were most strongly associated with suicidality. CONCLUSIONS: Where the risk of suicide is high, treating symptoms of NSC, loneliness, and sleep problems may be advisable. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

COVID-19 in the pregnant or postpartum MS patient: Symptoms and outcomes.

Women with multiple sclerosis (MS) are often of childbearing age. Thirty-six women with MS who were pregnant (n = 27) or within 6 weeks postpartum (n = 9) were reported in the North American COViMS registry and their COVID-19 outcomes were described. One pregnant and one postpartum woman were hospitalized. No deaths occurred. To compare COVID-19 clinical outcomes in pregnant and postpartum females with females who were not pregnant or postpartum, a 1:2 propensity score match was performed. While not powered to detect small differences, it was reassuring that no increased risks for those with MS who were pregnant/postpartum were revealed.

State of Ireland's mental health: findings from a nationally representative survey.

AIMS: Current information about the prevalence of various mental health disorders in the general adult population of the Republic of Ireland is lacking. In this study, we examined the prevalence of 12 common mental disorders, the proportion of adults who screened positive for any disorder, the sociodemographic factors associated with meeting criteria for a disorder and the associations between each disorder and history of attempted suicide. METHODS: A non-probability nationally representative sample (N = 1110) of adults living in Ireland completed self-report measures of 12 mental health disorders. Effect sizes were calculated using odds ratios from logistic regression models, and population attributable risk fractions (PAFs) were estimated to quantify the associations between each disorder and attempted suicide. RESULTS: Prevalence rates ranged from 15.0% (insomnia disorder) to 1.7% (histrionic personality disorder). Overall, 42.5% of the sample met criteria for a mental health disorder, and 11.1% had a lifetime history of attempted suicide. Younger age, being a shift worker and trauma exposure were independently associated with a higher likelihood of having a mental health disorder, while being in university was associated with a lower likelihood of having a disorder. ICD-11 complex posttraumatic stress disorder, borderline personality disorder and insomnia disorder had the highest PAFs for attempted suicide. CONCLUSIONS: Mental health disorder prevalence in Ireland is relatively high compared to international estimates. The findings are discussed in relation to important mental health policy implications.

Attitudes toward coronavirus disease 2019 vaccination in people with multiple sclerosis.

Objective: We estimated coronavirus disease 2019 (COVID-19) vaccination rates in the North American Research Committee on Multiple Sclerosis (NARCOMS) population and investigated reasons for vaccine hesitancy. Methods: In Spring 2021, we surveyed the NARCOMS participants about COVID-19 vaccinations. Participants reported whether they had received any COVID-19 vaccination; if not, they reported why not. They also reported whether they had received influenza vaccination. Using multivariable logistic regression, we assessed participant characteristics associated with uptake of COVID-19 and influenza vaccines. Results: Of 4955 eligible respondents, 3998 (80.7%) were females with a mean (SD) age of 64.0 (9.7) years. Overall, 4165 (84.1%) reported that they had received a COVID-19 vaccine, most often Pfizer-BioNTech and Moderna, and 3723 (75.4%) received a seasonal influenza vaccine. Reasons for not getting the COVID-19 vaccine included possible adverse effects (47.73%), possible lack of efficacy (13.7%), and lack of perceived need (17.1%). Factors associated with receiving the COVID-19 vaccine included receipt of influenza vaccine, older age, higher socioeconomic status, any leisure physical activity, and use of disease-modifying therapy. Conclusion: In this older cohort of people with multiple sclerosis, COVID-19 vaccine uptake was high, exceeding uptake of seasonal influenza vaccine. Concerns regarding safety, efficacy, and lack of perceived risk were associated with not obtaining the COVID-19 vaccine.

Mixed methods protocol to examine the acceptability and clinical characteristics of a remote monitoring programme for delivery of COVID-19 care, among healthcare staff and patients

IntroductionThe use of remote monitoring technology to manage the care of patients with COVID-19 has been implemented to help reduce the burden placed on healthcare systems during the pandemic and protect the well-being of both staff and patients. Remote monitoring allows patients to record their signs and symptoms remotely (eg, while self-isolating at home) rather than requiring hospitalisation. Healthcare staff can, therefore, continually monitor their symptoms and be notified when the patient is showing signs of clinical deterioration. However, given the recency of the COVID-19 outbreak, there is a lack of research regarding the acceptance of remote monitoring interventions to manage COVID-19. This study will aim to evaluate the use of remote monitoring for managing COVID-19 cases from the perspective of both the patient and healthcare staff.Methods and analysisDischarged patients from a large urban teaching hospital in Ireland, who have undergone remote monitoring for COVID-19, will be recruited to take part in a cross-sectional study consisting of a quantitative survey and a qualitative interview. A mixed methods design will be used to understand the experiences of remote monitoring from the perspective of the patient. Healthcare staff who have been involved in the provision of remote monitoring of patients with COVID-19 will be recruited to take part in a qualitative interview to understand their experiences with the process. Structural equation modelling will be used to examine the acceptance of the remote monitoring technology. Latent class analysis will be used to identify COVID-19 symptom profiles. Interview data will be examined using thematic analysis.Ethics and disseminationEthical approval has been granted by the ethical review boards at University College Dublin and the National Research Ethics Committee for COVID-19-related Research. Findings will be disseminated via publications in scientific journals, policy briefs, short reports and social media.

Associations of Disease-Modifying Therapies With COVID-19 Severity in Multiple Sclerosis.

BACKGROUND AND OBJECTIVES: People with multiple sclerosis (MS) are a vulnerable group for severe coronavirus disease 2019 (COVID-19), particularly those taking immunosuppressive disease-modifying therapies (DMTs). We examined the characteristics of COVID-19 severity in an international sample of people with MS. METHODS: Data from 12 data sources in 28 countries were aggregated (sources could include patients from 1-12 countries). Demographic (age, sex), clinical (MS phenotype, disability), and DMT (untreated, alemtuzumab, cladribine, dimethyl fumarate, glatiramer acetate, interferon, natalizumab, ocrelizumab, rituximab, siponimod, other DMTs) covariates were queried, along with COVID-19 severity outcomes, hospitalization, intensive care unit (ICU) admission, need for artificial ventilation, and death. Characteristics of outcomes were assessed in patients with suspected/confirmed COVID-19 using multilevel mixed-effects logistic regression adjusted for age, sex, MS phenotype, and Expanded Disability Status Scale (EDSS) score. RESULTS: Six hundred fifty-seven (28.1%) with suspected and 1,683 (61.9%) with confirmed COVID-19 were analyzed. Among suspected plus confirmed and confirmed-only COVID-19, 20.9% and 26.9% were hospitalized, 5.4% and 7.2% were admitted to ICU, 4.1% and 5.4% required artificial ventilation, and 3.2% and 3.9% died. Older age, progressive MS phenotype, and higher disability were associated with worse COVID-19 outcomes. Compared to dimethyl fumarate, ocrelizumab and rituximab were associated with hospitalization (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI] 1.01-2.41; aOR 2.43, 95% CI 1.48-4.02) and ICU admission (aOR 2.30, 95% CI 0.98-5.39; aOR 3.93, 95% CI 1.56-9.89), although only rituximab was associated with higher risk of artificial ventilation (aOR 4.00, 95% CI 1.54-10.39). Compared to pooled other DMTs, ocrelizumab and rituximab were associated with hospitalization (aOR 1.75, 95% CI 1.29-2.38; aOR 2.76, 95% CI 1.87-4.07) and ICU admission (aOR 2.55, 95% CI 1.49-4.36; aOR 4.32, 95% CI 2.27-8.23), but only rituximab was associated with artificial ventilation (aOR 6.15, 95% CI 3.09-12.27). Compared to natalizumab, ocrelizumab and rituximab were associated with hospitalization (aOR 1.86, 95% CI 1.13-3.07; aOR 2.88, 95% CI 1.68-4.92) and ICU admission (aOR 2.13, 95% CI 0.85-5.35; aOR 3.23, 95% CI 1.17-8.91), but only rituximab was associated with ventilation (aOR 5.52, 95% CI 1.71-17.84). Associations persisted on restriction to confirmed COVID-19 cases. No associations were observed between DMTs and death. Stratification by age, MS phenotype, and EDSS score found no indications that DMT associations with COVID-19 severity reflected differential DMT allocation by underlying COVID-19 severity. DISCUSSION: Using the largest cohort of people with MS and COVID-19 available, we demonstrated consistent associations of rituximab with increased risk of hospitalization, ICU admission, and need for artificial ventilation and of ocrelizumab with hospitalization and ICU admission. Despite the cross-sectional design of the study, the internal and external consistency of these results with prior studies suggests that rituximab/ocrelizumab use may be a risk factor for more severe COVID-19.

Teamworking in Healthcare during the COVID-19 Pandemic: A Mixed-Method Study.

The widespread impact of COVID-19 on healthcare has demanded new ways of working across many organisation types and many forms of healthcare delivery while at the same time endeavouring to place minimal, or no, additional burden on already strained healthcare teams. This is a cross-sectional mixed-method study which captured the experiences of teamwork during the COVID-19 pandemic contributing to successful collaboration. We hypothesised that work engagement and psychological safety separately contribute to collective leadership and organisational citizenship behaviours. Participants were healthcare staff on active duty during the COVID-19 pandemic in Ireland (n = 152) who responded to our social media (Twitter) invitation to participate in this study. Survey and free-text responses were collected through an online platform. Structural equation modelling examined the relationships between work engagement and psychological safety, and collective leadership and OCBs. Open text responses relating to experiences of teamworking during the pandemic were analysed for latent themes. From the survey data, the structural model demonstrated excellent statistical fit indicating that psychological safety, but not work engagement, was predictive of collective leadership and OCBs. From the qualitative data, two key themes were generated: (1) Contrasting experiences of working in a team during the pandemic; and (2) The pandemic response: a tipping point for burnout. This study offers a valuable starting point to explore the factors driving change and the shift to more collective ways of working observed in response to COVID-19. Future studies should use longitudinal data to capture the temporal relationship of these variables which could be moderated by prolonged pressure to healthcare staff during the pandemic.

Trajectories of change in internalizing symptoms during the COVID-19 pandemic: A longitudinal population-based study.

BACKGROUND: Longitudinal data indicates that the mental health of the general population may not have been as badly affected by the COVID-19 pandemic as some had feared. Most studies examining change in mental health during the pandemic have assumed population homogeneity which may conceal evidence of worsening mental health for some. In this study, we applied a heterogeneous perspective to determine if there were distinct groups in the population characterised by different patterns of change in internalizing symptoms during the pandemic. METHODS: Self-report data were collected from a nationally representative sample of Irish adults (N = 1041) at four time-points between April and December 2020. RESULTS: In the entire sample, mean levels of internalizing symptoms significantly declined from March to December 2020. However, we identified four distinct groups with different patterns of change. The most common response was 'Resilience' (66.7%), followed by 'Improving' (17.9%), 'Worsening' (11.3%), and 'Sustained' (4.1%). Belonging to the 'Worsening' class was associated with younger age, city dwelling, current and past treatment for a mental health problem, higher levels of empathy, and higher levels of loneliness. LIMITATIONS: Sample attrition was relatively high and although this was managed using robust statistical methods, bias associated with non-responses cannot be entirely ruled out. CONCLUSION: The majority of adults experienced no change, or an improvement in internalizing symptoms during the pandemic, and a relatively small proportion of adults experienced a worsening of internalizing symptoms. Limited public mental health resources should be targeted toward helping these at-risk individuals.

COVID-19 in Patients With Neuromyelitis Optica Spectrum Disorders and Myelin Oligodendrocyte Glycoprotein Antibody Disease in North America: From the COViMS Registry.

BACKGROUND AND OBJECTIVE: To describe the impact of coronavirus disease 2019 (COVID-19) on people with neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD). METHODS: The COVID-19 Infections in Multiple Sclerosis (MS) and Related Diseases (COViMS) Registry collected data on North American patients with MS and related diseases with laboratory-positive or highly suspected SARS-CoV-2 infection. Deidentified data were entered into a web-based registry by health care providers. Data were analyzed using t-tests, Pearson χ2 tests, or Fisher exact tests for categorical variables. Univariate logistic regression models examined effects of risk factors and COVID-19 clinical severity. RESULTS: As of June 7, 2021, 77 patients with NMOSD and 20 patients with MOGAD were reported in the COViMS Registry. Most patients with NMOSD were laboratory positive for SARS-CoV-2 and taking rituximab at the time of COVID-19 diagnosis. Most patients with NMOSD were not hospitalized (64.9% [95% CI: 53.2%-75.5%]), whereas 15.6% (95% CI: 8.3%-25.6%) were hospitalized only, 9.1% (95% CI: 3.7%-17.8%) were admitted to the ICU and/or ventilated, and 10.4% (95% CI: 4.6%-19.5%) died. In patients with NMOSD, having a comorbidity was the sole factor identified for poorer COVID-19 outcome (OR = 6.0, 95% CI: 1.79-19.98). Most patients with MOGAD were laboratory positive for SARS-CoV-2, and almost half were taking rituximab. Among patients with MOGAD, 75.0% were not hospitalized, and no deaths were recorded; no factors were different between those not hospitalized and those hospitalized, admitted to the ICU, or ventilated. DISCUSSION: Among the reported patients with NMOSD, a high mortality rate was observed, and the presence of comorbid conditions was associated with worse COVID-19 outcome. There were no deaths reported in the patients with MOGAD, although these observations are limited due to small sample size.

Predicting risk along the suicidality continuum: A longitudinal, nationally representative study of the Irish population during the COVID-19 pandemic.

INTRODUCTION: Little is known about the lifetime prevalence of different indicators of suicidality in the Irish general population; whether suicidality has increased during the COVID-19 pandemic; and what factors associated with belonging to different points on a continuum of suicidality risk. METHODS: A nationally representative sample of Irish adults (N = 1,032) completed self-report measures in May 2020 and a follow-up in August 2020 (n = 715). RESULTS: Lifetime prevalence rates were 29.5% for suicidal ideation, 12.9% for non-suicidal self-injury (NSSI), and 11.2% for attempted suicide. There were no changes in past two-week rates of NSSI and attempted suicide during the pandemic. Correlations between the indicators of suicidality supported a progression from ideation to NSSI to attempted suicide. Suicidal ideation alone was associated with being male, unemployed, higher loneliness, and lower religiosity. NSSI (with no co-occurring attempted suicide) was associated with a history of mental health treatment. Attempted suicide was associated with ethnic minority status, lower education, lower income, PTSD, depression, and history of mental health treatment. CONCLUSION: Suicidal ideation, NSSI, and attempted suicide are relatively common phenomena in the general adult Irish population, and each has unique psychosocial correlates. These findings highlight important targets for prevention and intervention efforts.

A longitudinal assessment of depression and anxiety in the Republic of Ireland before and during the COVID-19 pandemic.

Few studies have examined changes in mental health before and after the outbreak of COVID-19. We examined changes in the prevalence of major depression and generalized anxiety disorder (GAD) between February 2019 and March-April 2020; if there were changes in major depression and GAD during six weeks of nationwide lockdown; and we identified factors that predicted major depression and GAD across the six-week lockdown period. Nationally representative samples of Irish adults were gathered using identical methods in February 2019 (N = 1020) and March-April 2020 (N = 1041). The latter was reassessed six weeks later. Significantly more people screened positive for depression in February 2019 (29.8% 95% CI = 27.0, 32.6) than in March-April 2020 (22.8% 95% CI = 20.2, 25.3), and there was no change in GAD. There were no significant changes in depression and GAD during the lockdown. Major depression was predicted by younger age, non-city dwelling, lower resilience, higher loneliness, and higher somatic problems. GAD was predicted by a broader set of variables including several COVID-19 specific variables. These findings indicate that the prevalence of major depression and GAD did not increase as a result of, or during the early phase of the COVID-19 pandemic in Ireland.

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

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.