COVID-19 found to increase risk of hospitalization, death in MS: Study

People with multiple sclerosis (MS) in England had a seven times greater risk of hospitalization and a fourfold increased risk of death from COVID-19 in 2022 than did the general population, according to a study of almost 12 million people in the European nation.

The elevated risk of both COVID-19 hospitalization and death among MS patients was observed even in those who had received at least three doses of a COVID-19 vaccine, the researchers found.

“We hope that these findings raise awareness that the threat of COVID-19 is still very real for many, and that vaccine boosters are inadequate to protect this clinically vulnerable group,” Jennifer Quint, PhD, the study lead at the Imperial College London, said in a press release.

“With new variants constantly emerging, people living with MS should be considered an important high-risk group for COVID-19 hospitalization and death for which additional preventive measures and multilayered public health protections are urgently needed,” Quint added.

The team’s findings will be presented later this month at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024), in Barcelona, Spain.

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Study focused on impact of COVID-19 caused by Omicron variant

Most disease-modifying therapies approved for MS are designed to suppress or modulate the immune system and reduce the inflammatory attacks that target and damage the brain and spinal cord.

However, suppressing the immune system, particularly with therapies that deplete antibody-producing immune B-cells, can increase the risk of infections and reduce the effectiveness of vaccines.

To assess the impact of COVID-19 caused by the Omicron variant of the SARS-CoV-2 virus among people with compromised immune systems, researchers in England launched the INFORM study (ISRCTN53375662).

A recent analysis of INFORM data showed that immunocompromised individuals faced a markedly higher risk of developing severe COVID-19 outcomes than did the general population. Still, the virus’ impact on people with MS who were not considered immunocompromised was not specifically investigated.

To find out more, Quint and colleagues conducted a study, sponsored by AstraZeneca, that explored the risk of hospitalization and death due to COVID-19 among vaccinated individuals with MS in England in 2022.

The researchers collected electronic data from a random sample of 25% of people, ages 12 and older, registered with the country’s National Health Service (NHS).

Of the 11,990,730 people included, 16,350 — 0.1% of the total — were diagnosed with MS. About half of the general population (51%), and more than three-quarters of MS patients (79%), received at least three doses of a COVID-19 vaccine before the beginning of 2022.

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During the study period, there were 20,910 hospitalizations and 4,810 deaths caused by COVID-19 in the general population. Among MS patients, there were 215 COVID-19-related hospitalizations and 25 deaths.

These data corresponded to a higher incidence of hospitalizations among MS patients than the general population (1.28 vs. 0.24 per 100 person-years). Likewise, the incidence of deaths was also higher in MS patients (0.14 vs. 0.06 per 100 person-years). Person-years account for the total number of patients and the amount of time each patient spent in the study.

After adjusting for age and sex, MS patients had a seven times higher risk of hospitalization and a fourfold higher risk of death due to COVID-19 compared with the general population, the researchers found.

MS should be considered an important high-risk group for COVID-19 hospitalization and death for which preventive interventions in addition to vaccination are urgently needed.

The team noted that the study did not assess how underlying illness and level of MS disability may have influenced the results, nor did the work examine the effect of disease-modifying therapies, prior infections, the time since the last vaccination, and the type of vaccination.

Still, the researchers believe that “MS should be considered an important high-risk group for COVID-19 hospitalization and death for which preventive interventions in addition to vaccination are urgently needed,” they wrote in the study abstract.

Quint noted that MS itself is not a risk factor for COVID-19 — but some treatments can increase the likelihood of patients becoming infected.

“Having multiple sclerosis in itself doesn’t increase the risk of getting COVID-19, rather it’s the taking of immune modifying medicine such as B-cell depletion therapies that can reduce the effectiveness of vaccines by preventing the immune system from mounting a robust protective response,” Quint said.

She added, however, that “some MS-specific factors, such as having underlying conditions or higher levels of disability can contribute to poor outcomes.”

“As a result, even after repeated doses of COVID-19 vaccines, some individuals with MS remain at high risk of serious outcomes from COVID-19,” Quinn said.