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Disability and age were associated with poorer COVID-19 outcomes in multiple sclerosis (MS) patients, registry data showed.

Of approximately 2,000 people with MS and COVID-19 in North America, 17.8% of non-ambulatory patients died, compared with 4.3% of MS patients who walked with assistance and 0.6% of patients who were fully ambulatory, reported Amber Salter, PhD, of Washington University School of Medicine in St. Louis. Death occured most frequently in MS patients, ages 75 and older, who had COVID-19, she said in a presentation at ACTRIMS Forum 2021, the annual meeting of the Americas Committee for Treatment and Research in Multiple Sclerosis.

Findings came from , a registry supported by the Consortium of MS Centers, the National MS Society, and the MS Society of Canada. "Healthcare professionals were asked to report patients with MS and other related diseases after a minimum of 7 days and sufficient time had passed to observe the COVID-19 disease course," Salter said.

The data set included 2,059 MS patients reported by over 150 healthcare providers in North America from April 1, 2020 to Jan. 29, 2021. Most (85.4%) had laboratory-confirmed SARS-CoV-2 infection. Three-quarters (75.6%) were women and mean age was about 48.

Nearly all (96.8%) were from the U.S.; 70% were white, 18.2% were Black, and 5.5% were Latino. Average disease duration was about 13 years, with 83.3% of participants having relapsing-remitting MS. Most people in the cohort (75.8%) were fully ambulatory, 15.2% walked with assistance, and 9.0% were non-ambulatory.

Nearly a third of participants (30%) were taking ocrelizumab (Ocrevus) at the time of SARS-CoV-2 infection. About 13% were taking dimethyl fumarate (Tecfidera) and 11% were taking natalizumab (Tysabri); 15% were not taking any disease-modifying therapy.

Overall, 11.5% MS patients with COVID-19 were hospitalized, 4.2% were admitted to the ICU or were ventilated, and 3% had died. COVID-19 outcomes appeared better for older MS patients and patients with disability in the late half of the study (after Sept. 15, 2020) than they were in the early half.

"Other registries across the world have started to report their findings," Salter said, including the study group in Italy, the registry in France, and the . Specific information also has been collected about with MS, including real-world data from the OPTUM database, she noted.

In , multivariable analysis showed an increased odds of severe COVID-19 disease course (OR 2.37, P=0.015) for MS patients using the anti-CD20 drugs ocrelizumab and rituximab (Rituxan), Salter said. Recent use of methylprednisolone also associated with worse outcome (OR 5.2, P=0.001). Covisep data showed that age, disability, and obesity in MS patients were associated with worse COVID-19 outcomes.

The COVID-19 and MS Global Data Sharing Initiative of 20 registries across the world confirmed links between age, progressive MS, disability and severe outcomes, but also reported higher frequencies of severe outcomes with anti-CD20 drugs than other disease-modifying treatments. OPTUM database analyses showed similar rates of hospitalization, invasive ventilation, and death in ocrelizumab-treated versus non-ocrelizumab-treated MS cohorts.

"Generally, older age and greater disability have been associated with poorer clinical outcomes for COVID-19," Salter said. "The association between anti-CD20 disease-modifying therapies is still a little unclear, but there is growing data to suggest there may be some association between these therapies and a poorer COVID-19 clinical outcome."