SARS-CoV-2 infection increases long-term multiple sclerosis disease activity and all-cause mortality in an underserved inner-city population, 2024

Hadidchi et al:
SARS-CoV-2 infection increases long-term multiple sclerosis disease activity and all-cause mortality in an underserved inner-city population

Highlights:

• COVID-19 increases post-infection mortality risks 4 times in MS patients
• COVID-19 increases risk of new optic neuritis risks 3 times in MS patients
• COVID-19 increases use of high-dose methylprednisolone for an acute relapse
• COVID-19 increases risk of post-infection all-cause hospitalization in MS patients
• MS patients suffer worse select long-term outcomes following COVID-19

Abstract:

Background
Although certain subsets patients with multiple sclerosis (MS), an immune-mediated disorder, are at higher risk of worse acute COVID-19 outcomes compared to the general population, it is not clear whether SARS-CoV-2 infection impacts long-term outcomes compared with MS patients without COVID-19 infection.

Objectives
This study investigated MS disease activity and mortality 3.5 years post SARS-CoV-2 infection and compared with MS patients without COVID-19.

Methods
This retrospective study evaluated 1,633 patients with MS in the Montefiore Health System in the Bronx from January 2016 to July 2023. This health system serves a large minority population and was an epicenter for the early pandemic and subsequent surges of infection. Positive SARS-CoV-2 infection was determined by a positive polymerase-chain-reaction test. Primary outcomes were all-cause mortality, and optic neuritis post SARS-CoV-2 infection. Secondary outcomes included change in disease-modifying therapy (DMT), treatment with high-dose methylprednisolone, cerebellar deficits, relapse, and all-cause hospitalization post-infection.

Results
MS patients with COVID-19 had similar demographics but higher prevalence of pre-existing major comorbidities (hypertension, type-2 diabetes, chronic obstructive pulmonary disease, congestive heart failure, chronic kidney disease, and coronary artery disease), optic neuritis, and history of high dose steroid treatment for relapses compared to MS patients without COVID-19. MS patients with COVID-19 had greater risk of mortality (adjusted HR=4.34[1.67, 11.30], p<0.005), greater risk of post infection optic neuritis (adjusted HR=2.97[1.58, 5.58], p<0.005), higher incidence of methylprednisolone treatment for post infection acute relapse (12.65% vs. 2.54%, p<0.001), and more hospitalization (78.92% vs. 66.81%, p<0.01), compared to MS patients without COVID-19.

Conclusions
MS patients who survived COVID-19 infection experienced worse long-term outcomes, as measured by treatment for relapse, hospitalization and mortality. Identifying risk factors for worse long-term outcomes may draw clinical attention to the need for careful follow-up of at-risk individuals post-SARS-CoV-2 infection.

https://www.msard-journal.com/article/S2211-0348(24)00192-5/abstract?rss=yes#articleInformation

ETA: Link to study

 

I would like to see a similar study on ME patients and Covid infections.

 

Could be interesting to see whether that is just a general viral phenomenon or possibly even whether it has anything to do with EBV reactivating post SARS-COV-2 infection, given the various MS-EBV hypotheses (latent-lytic cycling, hit-and-run etc).

 

Typo in the heading surely? "under deserved" should be "under served"?

Perhaps someone got confused with "underserving"?

Not Freud's biggest fan, but there's an interesting slip, if it was one.

 

Ha, well spotted! yes, that was a typo from me and not the article. Have corrected now

 

Mady Hornig is thinking along the same lines:

Astonished to see nary a mention, even in Discussion, of reactivation of EBV as a cofactor. With all the data now suggesting a role for EBV in at least a substantial subset of MS, the questions remaining about EBV reactivation and the course of the different subtypes of MS once disease is already established, and the data separately showing potential association of SARS-CoV-2 with reactivation of either EBV or other herpesviruses, this seems rather derelict. Even if not possible within this study design, these considerations need to be on the platter for future work.

 

Well I've just noticed that I spelt "undeserving" wrong in my post, which will teach me to go correcting other people