Multiple sclerosis (MS) patients who were disabled were more likely to be hospitalized, end up in the intensive care unit (ICU) or on a ventilator, or die if they developed COVID-19, North American registry data showed.

Of non-ambulatory MS patients with COVID-19, 14.0% died, 8.3% were in the ICU or on a ventilator, and 24.6% were hospitalized, reported Anne Cross, MD, of Washington University in St. Louis, in a presentation at the annual Consortium of Multiple Sclerosis Centers (CMSC) meeting.

In contrast, 0.6% of fully ambulatory MS patients with COVID died, 2.0% were in the ICU or on a ventilator, and 7.5% were hospitalized (P<0.001).

The analysis was based on data from April 1, 2020 to Oct. 5, 2021 in COViMS, a registry supported by the CMSC, the National MS Society, and the MS Society of Canada. It updated COViMS findings from 2020 that were published earlier this year.

Of 3,452 MS patients in the current study, 46.5% were from U.S. census regions in the South, 27.2% were from the Midwest, 15.9% were from the Northeast, and 10.4% were from the West. Fewer than 1% were from Canada or Mexico.

Most (75.1%) were women and 81.8% had relapsing-remitting MS. Mean age was 47 and mean disease duration was 12.4 years. Almost 69% of participants were non-Hispanic white, 17.6% were Black, and 7.7% were Hispanic or Latino. Most patients were fully ambulatory (77.9%), 13.9% walked with assistance, and 8.2% couldn’t walk.

“Proportions have changed very little since January 2021, despite the changing geography of COVID-19,” Cross observed.

Every 10 years of age increased the risk of death by almost 90% (OR 1.875, P<0.0001), the updated COViMS data showed. Men were more than twice as likely to die as women (OR 2.21, P=0.0077), and Black MS patients with COVID were 2.5 times more likely be hospitalized, in the ICU, or on a ventilator (OR 2.53, P=0.0005) when compared to white MS patients with COVID.

In the current study, 30.0% of MS patients with COVID were on ocrelizumab (Ocrevus), 11.3% were on dimethyl fumarate (Tecfidera), 10.6% were on natalizumab (Tysabri), 9.5% were on fingolimod (Gilenya) or similar drugs, 5.8% were on glatiramer acetate (Copaxone), 5.8% were on teriflunomide (Aubagio), 4.7% were on rituximab (Rituxan), 3.7% were on interferons, and 2.9% were on other treatment. A total of 15.4% of MS patients were untreated.

“Almost a third of the cases were on ocrelizumab,” Cross pointed out. “This tells you right away this might be a biased registry. We don’t know how many people in North America are on ocrelizumab.”

About 90% of people taking each MS treatment were not hospitalized; rituximab and ocrelizumab were outliers. Of patients using no MS treatment, 4.7% died. Of people on ocrelizumab, 2.2% died.

What should clinicians do if MS patients on immunotherapy or with high-risk factors become infected with SARS-CoV-2? “People in all different areas of medicine now recommend that patients at high risk get monoclonal antibody cocktails against the virus itself,” Cross said. “The current one being used in my region is Regen-Cov, which is casirivimab and imdevimab. Those two together lower the risk of high-risk people being hospitalized by over 80%.”

In COViMS, researchers are starting to collect information about monoclonal antibodies being used to treat MS patients with COVID. None of 72 high-risk MS patients who were given SARS-CoV-2 monoclonal antibodies died. Six were hospitalized and two required ICU care or a ventilator. Fast treatment is key, Cross said: “Less than 5 days is ideal.”

Registry data have limitations, Cross acknowledged. Registries are voluntary and ascertainment bias occurs. In addition, findings within the U.S. may differ. “People may behave differently in Florida than in California,” Cross said. “Things have been changing over time and geography, and different variants of the virus have come up.”