The 'Coronavirus disease of 2019' is associated with disability worsening in patients with multiple sclerosis

ABSTRACT

Introduction: The 'coronavirus disease of 2019' (COVID-19) is an acute infection caused by the novel 'severe acute respiratory syndrome coronavirus-2' which has evolved into an ongoing pandemic with more than six million case fatalities to date. Evidence from large-scale observational studies has consistently shown that simply having MS does not make affected subjects more susceptible to contract COVID-19 nor to become severely ill from the infection, as compared to the general population. Risk factors are similar in both settings and include older age, male gender, cardiovascular comorbidities, African- American ethnicity, progressive disease and B-cell depleting agents. However, the reverse relationship - i.e., the impact of COVID-19 on clinical disability related to MS - remains less well described. Objective(s) To explore whether COVID-19 is associated with accelerated disability worsening in patients with MS. Method(s) Since March 2020, demographics and COVID-19 severity (categorized as ambulatory, hospitalized, death) of patients with MS have been collected at the Belgian National MS Center in Melsbroek in case of COVID-19 diagnosis (i.e., positive polymerase chain reaction test). On February 28, 2022, this database was locked and consisted of 234 unique cases. Clinical disability measures - including Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk Test, 9-Hole Peg Test and Symbol Digit Modalities Test scores - were available from a larger local database, obtained during routine medical follow-up. For each of these parameters, the first two assessments before COVID-19 diagnosis (labelled T0 and T1, respectively;T1 is the closest to COVID-19 diagnosis), and the first thereafter (labelled T2), were retrieved for every COVID-19 case. Result(s) Mortality and hospitalisation rate in this cohort was 5/234 (2.1%) and 37/234 (15.8%), respectively. Among the survivors with complete EDSS data (N = 139), mean annualized EDSS score changes between T1 and T2 (i.e., including the COVID-19 infection) were significantly increased, as compared with the respective changes between T0 and T1 (i.e., not including the COVID-19 infection) (0.09 versus 0.36, p = 0.008). Similar effects were not found for the other clinical outcome measures. Conclusion(s) COVID-19 infection is associated with global disability worsening in patients with MS. Our findings highlight the importance of preventive measures against COVID-19 spreading within this population.