Predictors of Catching COVID‑19 Infection during Pandemic Stage in Patients with Multiple Sclerosis (MS)

Mahsa Ghajarzadeh, Omid Mirmosayyeb, Negar Molazadeh, Mohammad Ali Sahraian, Simona Bonavita, Vahid Shaygannejad

Abstract


Background: Patients with multiple sclerosis (MS) are considered at higher risk of COVID‑19 infection due to treatment with immune modulators and immune‑suppressive agents. The exact risk factors are not clear. So, we aimed to conduct a study to determine the predictors of catching COVID‑19 infection during the pandemic stage in patients with multiple sclerosis (MS). Methods: We conducted a multicenter screening study and developed an online questionnaire to collect patients’ self‑reported demographic features along with MS‑related and COVID‑19–related information. The online questionnaire link was released by the Iran Multiple Sclerosis Society (IMSS) social media channel, accessible for 4160 MS patients totally and also was sent by WhatsApp for nonmember cases. Results: Totally, 1448 MS patients participated in our study. Twenty‑five (1.7%) patients were diagnosed with COVID‑19, from which 4 were hospitalized, 4 were treated with medical therapy, and 17 patients had home‑quarantine. The patients with COVID‑19 diagnosis were more frequently treated with rituximab (28% vs 24%, P = 0.001) than others, and cardiovascular comorbidity was more frequent in this group (8% vs 1.6%, P = 0.01). Regression analysis showed that cardiovascular disease was a significant positive predictor of COVID‑19 infection (OR = 5.2, 95% CI: 1.1–23.7). Conclusions: Patients with MS who have cardiovascular disease should be more monitored for COVID‑19 infection as they are at higher risk of infection.

Keywords


COVID‑19; Iran, multiple sclerosis; predictor

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References


Singhal T. A review of coronavirus disease‑2019 (COVID‑19).

Indian J Pediatr 2020;87:281‑6.

Sahraian MA, Gheini MR, Rezaeimanesh N, Ghajarzadeh M,

Naser Moghadasi A. Knowledge regarding COVID‑19 pandemic

in patients with multiple sclerosis (MS): A report from Iran.

Mult Scler Relat Disord 2020;42:102193. doi: 10.1016/j.msard.

102193.

Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of

coronaviruses on inanimate surfaces and their inactivation with

biocidal agents. J Hosp Infect 2020;104:246‑51.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical

features of patients infected with 2019 novel coronavirus in

Wuhan, China. Lancet 2020;395:497‑506.

Wijnands JMA, Zhu F, Kingwell E, Fisk JD, Evans C,

Marrie RA, et al. Disease‑modifying drugs for multiple sclerosis

and infection risk: A cohort study. J Neurol Neurosurg Psychiatry

;89:1050‑6.

Muniz‑Rodriguez K, Fung IC, Ferdosi SR, Ofori SK, Lee Y,

Tariq A, Chowell G. Severe acute respiratory syndrome

coronavirus 2 transmission potential, Iran, 2020. Emerg Infect

Dis 2020;26:1915‑7.

Almasi‑Hashiani A, Sahraian MA, Eskandarieh S. Evidence of

an increased prevalence of multiple sclerosis: A population‑based

study of Tehran registry during 1999‑2018. BMC Neurol

;20:169.

Bonavita S, Tedeschi G, Atreja A, Lavorgna L. Digital triage

for people with multiple sclerosis in the age of COVID‑19

pandemic. Neurol Sci 2020;41:1007‑9.

Sahraian MA, Azimi A, Navardi S, Ala S, Moghadasi AN.

Evaluation of the rate of COVID‑19 infection, hospitalization

and death among Iranian patients with multiple sclerosis. Mult

Scler Relat Disord 2020;46:102472.

Dai X. ABO blood group predisposes to COVID‑19 severity and

cardiovascular diseases. Eur J Prevent Cardiol 2020;27:1436‑7.

Luna G, Alping P, Burman J, Fink K, Fogdell‑Hahn A,

Gunnarsson M, et al. Infection risks among patients with multiple

sclerosis treated with fingolimod, natalizumab, rituximab, and

injectable therapies. JAMA Neurol 2020;77:184‑91.

Novi G, Mikulska M, Briano F, Toscanini F, Tazza F, Uccelli A,

et al. COVID‑19 in a MS patient treated with ocrelizumab: Does

immunosuppression have a protective role? Mult Scler Relat

Disord 2020;42:102120. doi: 10.1016/j.msard.2020.102120.

Suwanwongse K, Shabarek N. Benign course of COVID‑19 in a

multiple sclerosis patient treated with Ocrelizumab. Mult Scler

Relat Disord 2020:102201. doi: 10.1016/j.msard.2020.102201.

Mayer L, Kappos L, Racke MK, Rammohan K, Traboulsee A,

Hauser SL, et al. Ocrelizumab infusion experience in patients

with relapsing and primary progressive multiple sclerosis:

Results from the phase 3 randomized OPERA I, OPERA II, and

ORATORIO studies. Mult Scler Relat Disord 2019;30:236‑43.

Safavi F, Nourbakhsh B, Azimi AR. B‑cell depleting therapies

may affect susceptibility to acute respiratory illness among patients with Multiple Sclerosis during the early COVID‑19

epidemic in Iran. Mult Scler Relat Disord 2020;43:102195. doi:

1016/j.msard.2020.102195.

Montero‑Escribano P, Matías‑Guiu J, Gómez‑Iglesias P,

Porta‑Etessam J, Pytel V, Matias‑Guiu JA. Anti‑CD20 and

COVID‑19 in multiple sclerosis and related disorders: A case

series of 60 patients from Madrid, Spain. Mult Scler Relat

Disord 2020;42:102185. doi: 10.1016/j.msard.2020.102185.

Foerch C, Friedauer L, Bauer B, Wolf T, Adam EH. Severe

COVID‑19 infection in a patient with multiple sclerosis treated

with fingolimod. Mult Scler Relat Disord 2020;42:102180. doi:

1016/j.msard.2020.102180.

Giovannoni G, Hawkes C, Lechner‑Scott J, Levy M,

Waubant E, Gold J. The COVID‑19 pandemic and the use

of MS disease‑modifying therapies. Mult Scler Relat Disord

;39:102073. doi: 10.1016/j.msard.2020.102073.

Eskandari G, Ghajarzadeh M, Yekaninejad MS, Sahraian MA,

Gorji R, Rajaei F, et al. Comparison of serum vitamin D level

in multiple sclerosis patients, their siblings, and healthy controls.

Iran J Neurol 2015;14:81‑5.

Tsujino I, Ushikoshi‑Nakayama R, Yamazaki T, Matsumoto N,

Saito I. Pulmonary activation of vitamin D3 and preventive

effect against interstitial pneumonia. J Clin Biochem Nutr

;65:245‑51.

Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB,

Aliano JL, et al. Evidence that vitamin D supplementation could

reduce risk of influenza and COVID‑19 infections and deaths.

Nutrients 2020;12:988.

Panarese A, Shahini E. Covid‐19, and vitamin D. Aliment

Pharmacol Ther 2020;51:993‑5.

Faridar A, Eskandari G, Sahraian MA, Minagar A, Azimi A.

Vitamin D and multiple sclerosis: A critical review and

recommendations on treatment. Acta Neurologica Belgica

;112:327‑33.