BACKGROUND: When the novel coronavirus disease 2019 (COVID-19) appeared, concerns about its course in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) arose. This study aimed to evaluate the incidence, severity and risk factors of the more severe COVID-19 course among MS and NMOSD patients. METHODS: From March 1, 2020, to February 28, 2021, 12 MS centres, representing 70% of the Czech MS and NMOSD population, reported laboratory-confirmed COVID-19 cases via the Czech nationwide register of MS and NMOSD patients (ReMuS). The main outcome was COVID-19 severity assessed on an 8-point scale with a cut-off at 4 (radiologically confirmed pneumonia) according to the World Health Organisation´s (WHO) COVID-19 severity assessment. RESULTS: We identified 958 MS and 13 NMOSD patients, 50 MS and 4 NMOSD patients had pneumonia, 3 MS and 2 NMOSD patients died. The incidence of COVID-19 among patients with MS seems to be similar to the general Czech population. A multivariate logistic regression determined that higher body mass index (BMI [OR 1.07, 95% CI, 1.00-1.14]), older age (OR per 10 years 2.01, 95% CI, 1.41-2.91), high-dose glucocorticoid treatment during the 2 months before COVID-19 onset (OR 2.83, 95% CI, 0.10-7.48) and anti-CD20 therapy (OR 7.04, 95% CI, 3.10-15.87) were independent variables associated with pneumonia in MS patients. Increase odds of pneumonia in anti-CD20 treated MS patients compared to patients with other disease-modifying therapy (same age, sex, BMI, high-dose glucocorticoid treatment during the 2 months before COVID-19 onset, presence of pulmonary comorbidity) were confirmed by propensity score matching (OR 8.90, 95% CI, 3.04-33.24). Reports on COVID-19 infection in patients with NMOSD are scarce, however, data available up to now suggest a high risk of a more severe COVID-19 course as well as a higher mortality rate among NMOSD patients. In our cohort, 4 NMOSD patients (30.77%) had the more severe COVID-19 course and 2 patients (15.39%) died. CONCLUSION: The majority of MS patients had a mild COVID-19 course contrary to NMOSD patients, however, higher BMI and age, anti-CD20 therapy and high-dose glucocorticoid treatment during the 2 months before COVID-19 onset were associated with pneumonia. Based on this study, we have already started an early administration of anti-SARS-CoV-2 monoclonal antibodies and preferential vaccination in the risk group of patients.

Charles University Prague 3rd Faculty of Medicine Charles University and Hospital Kralovske Vinohrady Prague Czechia

Department of Neurology 2nd Faculty of Medicine Charles University Prague and Motol University Hospital Prague Czechia

Department of Neurology and Centre of Clinical Neuroscience 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czechia

Department of Neurology and Centre of Clinical Neuroscience 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czechia; 2nd Department of Neurology Faculty of Medicine Comenius University Bratislava Slovakia

Department of Neurology and Centre of Clinical Neuroscience 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czechia; Department of Neurology KZ a s Hospital Teplice Teplice Czechia

Department of Neurology Charles University Prague Faculty of Medicine and University Hospital Hradec Kralove Hradec Kralove Czechia

Department of Neurology Charles University Prague Faculty of Medicine in Pilsen and University Hospital Pilsen Pilsen Czechia

Department of Neurology Faculty of Medicine Palacky University and University Hospital Olomouc Olomouc Czechia

Department of Neurology Hospital Ceske Budejovice Ceske Budejovice Czechia

Department of Neurology Hospital of Jihlava Jihlava Czechia

Department of Neurology Thomayer Hospital Prague Czechia

Department of Neurology Tomas Bata Regional Hospital Zlin Czechia

Department of Neurology University Hospital Ostrava Ostrava Czechia

Endowment Fund IMPULS Prague Czechia

Endowment Fund IMPULS Prague Czechia; Department of Economic Statistics Prague University of Economics and Business Prague Czechia

See more in PubMed

Alonso R., Silva B., Garcea O., Diaz P.E.C., dos Passos G.R., Navarro D.A.R., Valle L.A.G., Salinas L.C.R., Negrotto L., Luetic G., Tkachuk V.A., Míguez J., de Bedoya F.H.D., Goiry L.G., Sánchez N.E.R., Burgos M., Steinberg J., Balbuena M.E., Alvarez P.M., López P.A., Ysrraelit M.C., León R.A., Cohen A.B., Gracia F., Molina O., Casas M., Deri N.H., Pappolla A., Patrucco L., Cristiano E., Tavolini D., Nadur D., Granda A.M.T., Weiser R., Cassará F.P., Sinay V., Rodríguez C.C., Lazaro L.G., Menichini M.L., Piedrabuena R., Escobar G.O., Carrá A., Chertcoff A., Pujols B.S., Vrech C., Tarulla A., Carvajal R., Mainella C., Becker J., Peeters L.M., Walton C., Serena M.A., Nuñez S., Rojas J.I. COVID-19 in multiple sclerosis and neuromyelitis optica spectrum disorder patients in Latin America. Mult. Scler. Rel. Disord. 2021;51 doi: 10.1016/j.msard.2021.102886. PubMed DOI PMC

Český statistický úřad, n.d.Obyvatelstvo | ČSÚ [WWW Document]. URL https://www.czso.cz/csu/czso/obyvatelstvo_lide (accessed 4.17.21).

Ciampi E., Uribe-San-Martín R., Soler B., Fernández R., García P., Navarrete-Asenjo C., Miguel Tirapegui J., Torres R., Polanco J., Suárez F., José Cuello M., Cárcamo C. COVID-19 in MS and NMOSD: A multicentric online national survey in Chile. 2020. PubMed DOI PMC

Creed M.A., Ballesteros E., Jr L.J.G., Imitola J. Mild COVID-19 infection despite chronic B cell depletion in a patient with aquaporin-4-positive neuromyelitis optica spectrum disorder. Mult. Scler. Rel. Disord. 2020;44 doi: 10.1016/j.msard.2020.102199. PubMed DOI PMC

Fan M., Qiu W., Bu B., Xu Y., Yang H., Huang D., Lau A.Y., Guo J., Zhang M.N., Zhang X., Yang C.S., Chen J., Zheng P., Liu Q., Zhang C., Shi F.D. Risk of COVID-19 infection in MS and neuromyelitis optica spectrum disorders. Neurol. Neuroimmunol. Neuroinflamm. 2020;7:787. doi: 10.1212/NXI.0000000000000787. PubMed DOI PMC

George P.M., Barratt S.L., Condliffe R., Desai S.R., Devaraj A., Forrest I., Gibbons M.A., Hart N., Jenkins R.G., McAuley D.F., Patel B.v., Thwaite E., Spencer L.G. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax. 2020;75:1009–1016. doi: 10.1136/thoraxjnl-2020-215314. PubMed DOI

Gianfrancesco M., Hyrich K.L., Hyrich K.L., Al-Adely S., Al-Adely S., Carmona L., Danila M.I., Gossec L., Gossec L., Izadi Z., Jacobsohn L., Katz P., Lawson-Tovey S., Lawson-Tovey S., Mateus E.F., Rush S., Schmajuk G., Simard J., Strangfeld A., Trupin L., Wysham K.D., Bhana S., Costello W., Grainger R., Hausmann J.S., Hausmann J.S., Liew J.W., Sirotich E., Sirotich E., Sufka P., Wallace Z.S., Wallace Z.S., Yazdany J., MacHado P.M., MacHado P.M., MacHado P.M., Robinson P.C., Robinson P.C. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: Data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann. Rheum. Dis. 2020;79:859–866. doi: 10.1136/annrheumdis-2020-217871. PubMed DOI PMC

Goumenou M., Sarigiannis D., Tsatsakis A., Anesti O., Docea A.O., Petrakis D., Tsoukalas D., Kostoff R., Rakitskii V., Spandidos D.A., Aschner M., Calina D. Covid 19 in Northern Italy: an integrative overview of factors possibly influencing the sharp increase of the outbreak (Review) Mol. Med. Rep. 2020 doi: 10.3892/mmr.2020.11079. PubMed DOI PMC

Komenda M., Karolyi M., Bulhart V., Žofka J., Brauner T., Hak J., Jarkovský J., Mužík J., Blaha M., Kubát J., Klimeš D., Langhammer P., Daňková Š., Májek O., Bartůňková M., Dušek L. COVID 19: Přehled aktuální situace v ČR [WWW Document]. Onemocnění aktuálně [online] 2021. https://onemocneni-aktualne.mzcr.cz/covid-19 URL. (accessed 4.17.21)

Louapre C., Collongues N., Stankoff B., Giannesini C., Papeix C., Bensa C., Deschamps R., Créange A., Wahab A., Pelletier J., Heinzlef O., Labauge P., Guilloton L., Ahle G., Goudot M., Bigaut K., Laplaud D.-A., Vukusic S., Lubetzki C., de Sèze J. Clinical Characteristics and Outcomes in Patients With Coronavirus Disease 2019 and Multiple Sclerosis. JAMA Neurol. 2020;77 doi: 10.1001/jamaneurol.2020.2581. PubMed DOI PMC

Louapre C., Maillart E., Papeix C., Zeidan S., Biotti D., Lepine Z., Wahab A., Zedet M., Labauge P., Tilikete C., Pique J., Tourbah A., Mathey G., Dimitri Boulos D., Branger P., Kremer L.D., Marignier R., Collongues N., de Seze J. Outcomes of coronavirus disease 2019 in patients with neuromyelitis optica and associated disorders. Eur. J. Neurol. 2020;14612 doi: 10.1111/ene.14612. PubMed DOI

Mares J., Hartung H.-P. Multiple sclerosis and COVID-19 164. 2020. pp. 217–225. PubMed DOI

Mehta P., Porter J.C., Chambers R.C., Isenberg D.A., Reddy V. B-cell depletion with rituximab in the COVID-19 pandemic: where do we stand? Lancet Rheumatol. 2020 doi: 10.1016/S2665-9913(20)30270-8. PubMed DOI PMC

Möhn N., Konen F.F., Pul R., Kleinschnitz C., Prüss H., Witte T., Stangel M., Skripuletz T. Experience in Multiple Sclerosis Patients with COVID-19 and Disease-Modifying Therapies: A Review of 873 Published Cases. J. Clin. Med. 2020;9:4067. doi: 10.3390/jcm9124067. PubMed DOI PMC

NF IMPULS [WWW Document], URLhttp://www.multiplesclerosis.cz/. (accessed 4.18.21).

Peeters L.M., Parciak T., Walton C., Geys L., Moreau Y., de Brouwer E., Raimondi D., Pirmani A., Kalincik T., Edan G., Simpson-Yap S., de Raedt L., Dauxais Y., Gautrais C., Rodrigues P.R., McKenna L., Lazovski N., Hillert J., Forsberg L., Spelman T., McBurney R., Schmidt H., Bergmann A., Braune S., Stahmann A., Middleton R., Salter A., Bebo B.F., Rojas J.I., van der Walt A., Butzkueven H., van der Mei I., Ivanov R., Hellwig K., Sciascia do Olival G., Cohen J.A., van Hecke W., Dobson R., Magyari M., Brum D.G., Alonso R., Nicholas R., Bauer J., Chertcoff A., de Sèze J., Louapre C., Comi G., Rijke N. COVID-19 in people with multiple sclerosis: a global data sharing initiative. Mult. Scler. J. 2020;26:1157–1162. doi: 10.1177/1352458520941485. PubMed DOI PMC

Sahraian M.A., Azimi A., Navardi S., Rezaeimanesh N., Naser Moghadasi A. Evaluation of COVID-19 infection in patients with Neuromyelitis optica spectrum disorder (NMOSD): A report from Iran. Mult. Scler. Rel. Disord. 2020 doi: 10.1016/j.msard.2020.102245. PubMed DOI PMC

Salter A., Fox R.J., Newsome S.D., Halper J., Li D.K.B., Kanellis P., Costello K., Bebo B., Rammohan K., Cutter G.R., Cross A.H. Outcomes and risk factors associated with SARS-CoV-2 infection in a north American registry of patients with multiple sclerosis. JAMA Neurol. 2021 doi: 10.1001/jamaneurol.2021.0688. PubMed DOI PMC

Sharifian-Dorche M., Sahraian M.A., Fadda G., Osherov M., Sharifian-Dorche A., Karaminia M., Saveriano A.W., la Piana R., Antel J.P., Giacomini P.S. COVID-19 and disease-modifying therapies in patients with demyelinating diseases of the central nervous system: a systematic review. Mult. Scler. Rel. Disord. 2021 doi: 10.1016/j.msard.2021.102800. PubMed DOI PMC

Sormani, Maria P., de Rossi N., Schiavetti I., Carmisciano L., Cordioli C., Moiola L., Radaelli M., Immovilli P., Capobianco M., Trojano M., Zaratin P., Tedeschi G., Comi G., Battaglia, Mario A., Patti F., Salvetti M., Nozzolillo A., Bellacosa A., Protti A., di Sapio A., Signori A., Petrone A., Bisecco A., Iovino A., Dutto A., Repice A.M., Conte A., Bertolotto A., Bosco A., Gallo A., Zito A., Sartori A., Giometto B., Tortorella C., Antozzi C., Pozzilli C., Mancinelli C.R., Zanetta C., Cordano C., Cordioli C., Scandellari C., Guaschino C., Gasperini C., Solaro C., Fioretti C., Bezzini D., Marastoni D., Paolicelli D., Vecchio D., Landi D., Bucciantini E., Pedrazzoli E., Signoriello E., Sbragia E., Susani E.L., Curti E., Milano E., Marinelli F., Camilli F., Boneschi F.M., Govone F., Bovis F., Calabria F., Caleri F., Rinaldi F., Vitetta F., Corea F., Crescenzo F., Patti F., Teatini F., Tabiadon G., Granella F., Boffa G., Lus G., Brichetto G., Comi G., Tedeschi G., Maniscalco G.T., Borriello G., de Luca G., Konrad G., Vaula G., Marfia G.A., Mallucci G., Liberatore G., Salemi G., Miele G., Sibilia G., Pesci I., Schiavetti I., Brambilla L., Lopiano L., Sinisi L., Pasquali L., Saraceno L., Carmisciano L., Chiveri L., Mancinelli L., Moiola L., Grimaldi L.M.E., Caniatti L.M., Capobianco M., Cava M.della, Onofrj M., Rovaris M., Salvetti M., Vercellino M., Bragadin M.M., Buccafusca M., Buscarinu M.C., Celani M.G., Grasso M.G., Stromillo M.L., Petracca M., Amato M.P., Sormani Maria Pia, L’Episcopo M.R., Sessa M., Ferrò M.T., Trojano M., Ercolani M.V., Bianco M., Re M.lo, Vianello M., Clerico M., Battaglia, Mario Alberto, Napoli M., Ponzano M., Radaelli M., Conti M.Z., Calabrese M., Mirabella M., Filippi M., Inglese M., Lucchini M., Pozzato M., Danni M.C., Zaffaroni M., Zampolini M., Ponzio M., de Riz M., de Rossi N., de Stefano N., Cavalla P., de Mitri P., Grossi P., Zaratin P., Confalonieri P., Gallo P., Immovilli P., Ragonese P., Sola P., Annovazzi P., Iaffaldano P., Nardone R., Cerqua R., Clerici R., Lanzillo R., Motta R., Balgera R., Bergamaschi R., Totaro R., Iodice R., Capra R., Marangoni S., Realmuto S., Cottone S., Montepietra S., Rasia S., Arena S., Bucello S., Banfi S., Bonavita S., Malucchi S., Tonietti S., Vollaro S., Cordera S., Aguglia U., Clerici V.T., Barcella V., Bergamaschi V., Morra V.B., Dattola V., Mantero V. Disease-modifying therapies and coronavirus disease 2019 severity in multiple sclerosis. Ann. Neurol. 2021;89 doi: 10.1002/ana.26028. PubMed DOI PMC

Syed Y.Y. Ocrelizumab: a review in multiple sclerosis. CNS Drugs. 2018 doi: 10.1007/s40263-018-0568-7. PubMed DOI

World Health Organisation . Clinical Management of COVID-19. 2020. https://apps.who.int/iris/rest/bitstreams/1328457/retrieve [WWW Document], URL. (accessed 4.18.21)

Yam C., Jokubaitis V., Hellwig K., Dobson R. MS, pregnancy and COVID-19. Mult. Scler. J. 2020 doi: 10.1177/1352458520949152. PubMed DOI PMC

Zeidan S., Maillart E., Louapre C., Roux T., Lubetzki C., Papeix C. COVID-19 infection in NMO/SD patients: a French survey. J. Neurol. 2020 doi: 10.1007/s00415-020-10112-1. PubMed DOI PMC

SARS-CoV-2 Is Linked to Brain Volume Loss in Multiple Sclerosis

The Czech National MS Registry (ReMuS): Data trends in multiple sclerosis patients whose first disease-modifying therapies were initiated from 2013 to 2021

Immunity following SARS-CoV-2 vaccination in autoimmune neurological disorders treated with rituximab or ocrelizumab

To be or not to be vaccinated: The risk of MS or NMOSD relapse after COVID-19 vaccination and infection

Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival