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Round-up of research on coronavirus, Covid-19 and multiple sclerosis

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  1. Background
  2. Does MS affect your risk of catching coronavirus?
  3. Does MS affect the severity of Covid-19?
  4. Do disease modifying drugs affect the risk of coronavirus or severity of Covid-19?
  5. Find out more about coronavirus, Covid-19 and multiple sclerosis
  6. Browse more from the latest research on MS and coronavirus

Background

The coronavirus pandemic has generated an enormous amount of research, with over 40,000 papers published in the first six months of 2020. We’ve been sifting through the research up to the end of June to bring you a round-up of the studies that give an idea of what coronavirus means for people with MS. This is a rapidly evolving topic and we’ll update you with any further news in future issues of Research Update.

Most of the studies so far have reported data on single cases or on small numbers of people. They do give a general indication but we need to interpret them with caution. Around the world, registries have been set up to capture information supplied by neurologists and people with MS. Analysis of data from larger numbers of people will give us a better picture of how people with MS are affected by coronavirus and Covid-19. The UK MS Register has launched a survey to look at how people are coping with guidance from the government as well as to capture data on confirmed or unconfirmed cases of Covid-19 in people with MS. Whether you have had symptoms of Covid-19 or not, you can contribute your experiences by signing up for the survey.

Does MS affect your risk of catching coronavirus?

As coronavirus began to spread globally, one of the first questions to be asked was would people with multiple sclerosis be more likely catch coronavirus.

Based on our understanding of the biology of MS, we would not expect someone who has MS, and is otherwise healthy, to have a greater risk of becoming infected compared to the general public; MS does not weaken your immune system. At this stage, we don’t have data from sufficiently large numbers of the population to absolutely confirm this, but there’s been no indication that people with MS are more likely to catch coronavirus.

Does MS affect the severity of Covid-19?

Italy was the first European country to see a rapid rise in the number of people with Covid-19. Italian researchers set up an online registry to record and collect data about people with MS who have been diagnosed with Covid-19 or have developed symptoms (suspected Covid-19). MS neurologists across Italy were asked to input data and share patient outcomes.

Their preliminary data included 232 people with MS who tested positive for Covid-19 (57 people) or had suspected Covid-19 (175 people). 211 were taking a disease modifying drug (DMD).

The data recorded the severity of Covid-19 in these people:

  • 222 (96%) had a mild infection
  • 4 (2%) had a severe infection
  • 6 (3%) had a critical infection

Of those who were critical, one person recovered and five people died. The people who died tended to be older (50+) and have other health conditions.

A French registry has also published data on people with MS with confirmed or highly suspected Covid-19. Of the 347 people in the study, 73 (21%) needed hospital care and there were 12 deaths (3.5%). Age, disability and obesity were most strongly linked to a more severe course of Covid-19.

Although the numbers reported are fairly small, they suggest that having MS doesn’t increase your likelihood of a more severe Covid-19 infection and that the majority of people with MS who do develop Covid-19 are likely to have a mild infection, the same as the general population.

Data gathered from the wider population has identified other factors which can increase the risk of having a more severe course of Covid-19, such as an older age and having underlying health conditions, particularly those affecting the heart or lungs. If you are more severely affected by MS, for example if you have difficulty with swallowing, clearing your lungs or are prone to chest infections, you will also be at greater risk of developing complications from Covid-19.

Do disease modifying drugs affect the risk of coronavirus or severity of Covid-19?

Disease modifying drugs (DMDs) work by damping down your immune system in a number of different ways, so there is a possibility that they might make you more susceptible to infection with coronavirus or affect the course of Covid-19. Much of the research published so far has focused on this aspect of coronavirus and MS.

At the beginning of the pandemic, teams drew on expert opinion to publish recommendations on starting, continuing or suspending DMDs. Guidelines from the Association of British Neurologists have formed the basis of advice in the UK. More information on UK guidelines.

Data from around the world is now being published and this may lead to refinements to the initial guidelines. The Italian and French registry studies assessed the impact of DMDs on the course of Covid-19. In the Italian study, 211 people (91%) were taking a DMD; in the French study, 284 people (82%) were taking a DMD. In both studies, taking a DMD did not appear to cause more severe Covid-19 but both research groups acknowledged the small number of people taking any one drug made it difficult to draw firm conclusions.

A further set of data on the risk of Covid-19 in people with MS has been collected by neurologists in China. A survey reported details of 1,836 people with MS, of whom 882 (49%) were taking a DMD. None of those taking a DMD were diagnosed with COVID-19.

Finally, a number of studies have reported outcomes for individuals or a small number of people who developed Covid-19 while taking one of the DMDs (including Ocrevus, Tysabri, Gilenya, Lemtrada, Aubagio). In all of these, there has been no evidence to suggest that taking a DMD increases your risk of developing more serious complications.

Taken together, these studies provide reassurance that taking one of the DMDs does not lead to a more serious course of Covid-19. Combining data from registries and carrying out further, detailed analyses will shed further light on the impact of coronavirus and Covid-19 on people with MS.

Sormani MP, et al.
An Italian programme for COVID-19 infection in multiple sclerosis.
Lancet Neurology 2020; 19(6):482-482
Read the full study

Fan M, et al.
Risk of COVID-19 infection in MS and neuromyelitis optica spectrum disorders.
Neurology, Neuroimmunology and Neuroinflammation 2020; 7(5):e787.
Read the full study

Louapre C, et al.
Clinical characteristics and outcomes in patients with coronavirus disease 2019 and multiple sclerosis.
JAMA Neurology 2020; June 26 [Epub ahead of print]
Read the full study
 

Find out more about coronavirus, Covid-19 and multiple sclerosis

As a group, coronaviruses are common across the world. In general, they cause mild respiratory or sometimes gastric symptoms. The new strain of coronavirus has been named SARS-CoV-2. In this article, we use coronavirus to describe the virus and Covid-19 for the disease it causes.

The main symptoms of Covid-19 are:

  • a new, continuous cough – this means you’ve started coughing repeatedly
  • a high temperature – you feel hot to touch on your chest and/or back
  • shortness of breath
  • a loss or a change to your sense of taste or smell

If you have any of the main symptoms, you should stay at home (self-isolate) and get tested for coronavirus as soon as possible.
For more information, visit mstrust.org.uk/coronavirus.

Browse more from the latest research on MS and coronavirus

The ADAMS project

The ADAMS project

25/05/2022 - 00:00

Dr Benjamin Jacobs spoke to us about a new study on the genetics of MS in people from minority ethnic backgrounds which may eventually shed light on why MS can be more severe for Black and Asian people.

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