麻豆传媒

In a session at the recent Consortium of Multiple Sclerosis Centers (CMSC) meeting, data were presented from the , a North American registry of people with multiple sclerosis (MS) who also tested positive for COVID-19.

In this exclusive 麻豆传媒 video, Anne H. Cross, MD, of Washington University in St. Louis, discusses how COVID-19 has affected people with MS, which disease-modifying therapies have been associated with good or bad outcomes, and how the patients in the registry have responded to vaccinations.

Following is a transcript of her remarks:

I was representing a large number of people who are involved in the COViMS registry, which is a registry of North American people with MS, and also some people with similar diseases, that have developed COVID-19 or have had a positive test for SARS-CoV-2, the virus that causes COVID-19 -- and just presenting data from this registry on what happened to people with MS who developed COVID-19, what things were associated with bad outcomes versus good outcomes, and what disease-modifying therapies were associated with bad versus good outcomes.

And I also reviewed some of the literature from around the world. There are several registries around the world that have done this -- Europe, Italy, France, and also the Netherlands. And then there's an international federation that has put together a lot of the data from these registry studies on MS patients with COVID-19 over the last 18 months. And I reviewed that compilation of data as well. And I talked a little bit about responses to vaccines against COVID-19 in people with MS, on the various different types of disease-modifying therapies.

So I think my takeaway points from my own talk and some of the other talks in my session were that most people with MS who developed COVID-19 do fine. I mean, they don't get hospitalized and they recover. But a small percentage of people who do end up in the hospital, and an even a smaller percentage end up on a ventilator in the ICU, or dying. And certain things that are associated with that in people with MS include age. For every 10 years older you are, your risk of dying from COVID-19 is considerably more -- something like 80-plus percent higher for every 10 years. If you are male, your risk of dying or doing poorly with COVID-19, is worse by a good bit compared to females.

There's some data from North America on Black or African-American people with MS who developed COVID-19. And at least in the registry, the COViMS registry, there was not a statistical association with death in Black versus white people with MS. But there was a trend in that direction. And there was a statistically increased risk in Black MS patients from North America with being hospitalized and ending up in the ICU or on a ventilator.

Disability, at least in terms of walking, was associated with worse outcomes. There are more people who died, who were wheelchair-bound, and very few who were walking. And that also goes for the lesser severe COVID-19 outcomes, such as being in an ICU or on a ventilator -- more people were wheelchair bound or requiring aid to walk versus those who walked without aid.

And other things that were covered included an association -- and I want to just say right now, this is a registry. And so there's a lot of limitations when you look at registry data. There's a concern for what's called ascertainment bias, which means that the data is put in by healthcare providers. Some may have more time to do it than others. There may be a tendency to submit cases that are worse than others, because you remember those; you remember who the patient is.

So a lot of things go into these data, but that said, if you look at all the different people on different disease-modifying therapies in COViMS, people who were on B-cell depleting agents -- particularly rituximab -- tended to do worse than those who were on other drugs, like, for example, the beta interferons or glatiramer acetate. And that has been shown also in some other studies around the world, including the Italian study that I mentioned earlier. That's also a registry study, though. You don't have a denominator with the registry. You don't know how many people were risks that aren't being presented there. And so there's a lot of information that's missing when you have a registry study.

We have had the opportunity to look a little bit at what has happened to people this year who have been vaccinated in the registry. There's a report on about 70-something people in the registry who were vaccinated against COVID-19, and who nonetheless developed COVID-19 despite that. And there have been eight so far deaths of people who were vaccinated reported in the registry. And so it just goes to show that vaccination is not a complete suit of armor against this disease.

And we looked at people who had received the monoclonal antibody cocktails. I don't know if everyone is familiar with these, but they are monoclonal antibodies that are directed against the SARS-CoV-2 virus itself. So they block the virus. And if you can get them into people who are outpatients and who are at high risk for hospitalization early, they can prevent hospitalization about 80% of the time or more.

So those have been used in 70-something people in the COViMS registry, and those people did particularly well. There was a very low rate of hospitalization and no deaths in that group, despite that they were deemed to be at higher risk than normal for being hospitalized.

Comment