QOL04
COVID-19 Outcomes in Multiple Sclerosis and Related Diseases before and after Vaccination
COVID-19 outcomes and risk factors in patients with MS and other demyelinating diseases have been reported for the pre-vaccine period. Outcomes in vaccinated MS patients have not been described.
Objectives:
We aimed to compare COVID-19 outcomes between vaccinated vs. unvaccinated patients with demyelinating disease at a single center.
Methods:
Patients with demyelinating disease infected with COVID-19 from March 2020 to the present were identified using either our Epic registry or by patients self-reporting to their neurologists. Patients were then invited to complete a survey on their MS histories, co-morbidities, and COVID-19 disease courses. Additional information was acquired by chart review; survey completion was not required for inclusion. Data were entered into a REDCap database and analyzed using Stata 16.
Results:
392 COVID-19 cases were identified: 120 in vaccinated patients and 272 in unvaccinated patients. 109 completed the survey. Vaccinated patients were younger than unvaccinated patients on average: 43.5 vs. 46.9 years, p = 0.017. Sex distributions were similar between vaccinated patients (75% female) and unvaccinated patients (78% female). Fewer vaccinated patients identified as Black (12.2%) compared to unvaccinated patients (31.2%), p = 0.04. Overall, 95.5% of patients had MS of which 79.9% had RRMS, 8.9% had PPMS, and 10.7% had SPMS.
Factors associated with worse outcomes in unvaccinated patients were similar to those reported previously. Hospitalization risk increased with age (OR 2.25 per 10 years [95% CI 1.49, 3.38]); ambulatory dysfunction (need for assistive device OR 7.52 [95% CI 2.65, 21.3], non-ambulatory status OR 8.68 [95% CI 2.34, 32.3]); current smoking (OR 2.98 [95% CI 1.23, 7.18]); and HTN (OR 2.76 [95% CI 1.15, 6.64]).
Vaccination was associated with decreased risk of hospitalization: OR 0.36 [95% CI 0.17, 0.79]. In vaccinated patients, 9/84 patients on anti-CD20 therapies were hospitalized vs. 0/14 patients on no therapy or immunomodulatory therapies, but χ2 test was not significant (p = 0.2). However, patients on anti-CD20 therapies made up a larger proportion of post-vaccination cases compared to pre-vaccination cases: 77% vs. 41%, p < 0.001.
Conclusions:
Vaccinated patients with demyelinating disease had lower risk of severe outcomes from COVID-19. Anti-CD20 therapies comprised a significant fraction of post-vaccine infections but further data is needed to assess outcome severity.