BACKGROUND AND OBJECTIVES: Large-scale observational studies have shown that, in patients with multiple sclerosis (MS), the risk of becoming more severely ill from coronavirus disease 2019 (COVID-19) is determined by older age, male sex, cardiovascular comorbidities, African American ethnicity, progressive disease, recent use of corticosteroids, and B cell-depleting disease-modifying treatment. In contrast, the effect of COVID-19 on the disease course of MS has been studied much less extensively. Our main goal was to explore whether COVID-19 is associated with accelerated clinical disability worsening in patients with MS.METHODS: Since March 2020, demographics and infectious outcome (categorized as ambulatory, hospitalized, and/or death) of patients with MS who developed COVID-19 have been collected at the Belgian National MS Center in Melsbroek. On February 28, 2022, this database was locked and complemented with clinical disability measures-Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk Test (T25FWT), 9-Hole Peg Test (9HPT), and Symbol Digit Modalities Test (SDMT)-that were available from a larger local database, obtained during routine medical follow-up. For each parameter, the first 2 assessments before COVID-19 diagnosis (T0 and T1 T1 is the closest to COVID-19 diagnosis), and the first thereafter (T2), were retrieved.RESULTS: We identified 234 unique cases of COVID-19. Thirty-one patients were hospitalized (13.2%), and 5 died (2.1%) as a result of their infection. Among survivors with complete EDSS results (N = 138), mean annualized T1-to-T2 EDSS worsening was more pronounced, compared with the respective change between T0 and T1 (0.3 ± 0.9 vs 0.1 ± 0.9, p = 0.012). No such differences were found for the T25FWT, 9HPT, and SDMT scores. Severe COVID-19 (hospitalization) was associated with clinically relevant T1-to-T2 EDSS worsening (OR 2.65, p = 0.042). Vaccination coverage in the total cohort was 53.8%. Being unprotected by vaccination at the time of infection was associated with a worse COVID-19 outcome (hospitalization and/or death OR 3.52, p = 0.002) but not with clinically relevant T1-to-T2 EDSS worsening.DISCUSSION: The occurrence and severity of COVID-19 are both associated with clinical disability worsening in patients with MS. Vaccination protects against a more severe course of COVID-19 in this specific population.TRIAL REGISTRATION INFORMATION: The study has been registered at ClinicalTrials.gov (study registration number: NCT05403463).
Peeters, G , Van Remoortel, A , Nagels, G , Van Schependom, J & D'haeseleer, M 2023, ' Occurrence and Severity of Coronavirus Disease 2019 Are Associated With Clinical Disability Worsening in Patients With Multiple Sclerosis ', Neurology: Neuroimmunology & Neuroinflammation , vol. 10, no. 3, e200089.
Peeters, G. , Van Remoortel, A. , Nagels, G. , Van Schependom, J. , & D'haeseleer, M. (2023). Occurrence and Severity of Coronavirus Disease 2019 Are Associated With Clinical Disability Worsening in Patients With Multiple Sclerosis . Neurology: Neuroimmunology & Neuroinflammation , 10 (3), [e200089].
@article{952bf6d8a2604a25a5f7eee35ac8c544,
title = " Occurrence and Severity of Coronavirus Disease 2019 Are Associated With Clinical Disability Worsening in Patients With Multiple Sclerosis " ,
abstract = " BACKGROUND AND OBJECTIVES: Large-scale observational studies have shown that, in patients with multiple sclerosis (MS), the risk of becoming more severely ill from coronavirus disease 2019 (COVID-19) is determined by older age, male sex, cardiovascular comorbidities, African American ethnicity, progressive disease, recent use of corticosteroids, and B cell-depleting disease-modifying treatment. In contrast, the effect of COVID-19 on the disease course of MS has been studied much less extensively. Our main goal was to explore whether COVID-19 is associated with accelerated clinical disability worsening in patients with MS.METHODS: Since March 2020, demographics and infectious outcome (categorized as ambulatory, hospitalized, and/or death) of patients with MS who developed COVID-19 have been collected at the Belgian National MS Center in Melsbroek. On February 28, 2022, this database was locked and complemented with clinical disability measures-Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk Test (T25FWT), 9-Hole Peg Test (9HPT), and Symbol Digit Modalities Test (SDMT)-that were available from a larger local database, obtained during routine medical follow-up. For each parameter, the first 2 assessments before COVID-19 diagnosis (T0 and T1 T1 is the closest to COVID-19 diagnosis), and the first thereafter (T2), were retrieved.RESULTS: We identified 234 unique cases of COVID-19. Thirty-one patients were hospitalized (13.2%), and 5 died (2.1%) as a result of their infection. Among survivors with complete EDSS results (N = 138), mean annualized T1-to-T2 EDSS worsening was more pronounced, compared with the respective change between T0 and T1 (0.3 ± 0.9 vs 0.1 ± 0.9, p = 0.012). No such differences were found for the T25FWT, 9HPT, and SDMT scores. Severe COVID-19 (hospitalization) was associated with clinically relevant T1-to-T2 EDSS worsening (OR 2.65, p = 0.042). Vaccination coverage in the total cohort was 53.8%. Being unprotected by vaccination at the time of infection was associated with a worse COVID-19 outcome (hospitalization and/or death OR 3.52, p = 0.002) but not with clinically relevant T1-to-T2 EDSS worsening.DISCUSSION: The occurrence and severity of COVID-19 are both associated with clinical disability worsening in patients with MS. Vaccination protects against a more severe course of COVID-19 in this specific population.TRIAL REGISTRATION INFORMATION: The study has been registered at ClinicalTrials.gov (study registration number: NCT05403463). " ,
keywords = " Humans, Male, Multiple Sclerosis/epidemiology, COVID-19 Testing, COVID-19, Disabled Persons, Disease Progression " ,
author = " Gertjan Peeters and {Van Remoortel}, Ann and Guy Nagels and {Van Schependom}, Jeroen and Miguel D'haeseleer " ,
note = " Publisher Copyright: { extcopyright} American Academy of Neurology. " ,
year = " 2023 " ,
month = feb,
day = " 17 " ,
doi = " 10.1212/NXI.0000000000200089 " ,
language = " English " ,
volume = " 10 " ,
journal = " Neurology: Neuroimmunology & Neuroinflammation " ,
issn = " 2332-7812 " ,
publisher = " Lippincott, Williams & Wilkins " ,
number = " 3 " ,
}