COVID-19 in MS patients: susceptibility, severity risk factors and serological response.

Zabalza, Ana; Cárdenas-Robledo, Simón; Tagliani, Paula; Arrambide, Georgina; Otero-Romero, Susana; Carbonell-Mirabent, Pere; Rodriguez-Barranco, Marta; Rodríguez-Acevedo, Breogán; Restrepo Vera, Juan Luis; Resina-Salles, Mireia; Midaglia, Luciana; Vidal-Jordana, Angela; Río, Jordi; Galan, Ingrid; Castillo, Joaquin; Cobo-Calvo, Álvaro; Comabella, Manuel; Nos, Carlos; Sastre-Garriga, Jaume; Tintore, Mar; Montalban, Xavier

BACKGROUND Information regarding multiple sclerosis (MS) patients with COVID-19 is scarce. The study objective is to describe the incidence and characteristics of MS patients with COVID-19, to identify susceptibility and severity risk factors, and to assess the proportion of positive SARS-CoV-2 serologies according to disease modifying treatments (DMTs). METHODS Retrospective study of an MS cohort analysing data collected between February and May 2020. Cases were identified through an email survey and clinical visits. We examined the relationship of demographic and MS characteristics with COVID-19 and of the DMTs with SARS-CoV-2 serostatus. RESULTS We collected data from 48 suspected cases out of 758 valid respondents and from 45 COVID-19 cases identified through clinical visits. Incidence was 6.3%. Nineteen(20.3%) patients were hospitalized and 2(2.2%) died. Multivariable models determined that age (odds ratio per 10 years:0.53[95% CI,0.34-0.85]), contact with a confirmed case (OR:197.02[56.36-688.79]), residence in Barcelona (OR:2.23[1.03-4.80]), MS duration (OR per 5y:1.41[1.09-1.83]), and time on anti-CD20-treatment (OR per 2y: 3.48[1.44-8.45]) were independent factors for presenting COVID-19 and age (OR per 10y:2.71[1.13-6.53]) for a severe COVID-19. Out of the 79 (84.9%) with serological test, 45.6% generated antibodies, but only 17.6% of those on anti-CD20 therapies. Lymphopenia or immunoglobulins levels did not relate with COVID-19. CONCLUSIONS MS patients present similar incidence, risk factors, and outcomes for COVID-19 than the general population. Patients treated with an anti-CD20 therapy for a longer period of time might be in a higher risk of COVID-19 and less than 20% generate antibody response. Only age was related with severity.