Risk factors of severe COVID-19 in people with multiple sclerosis : A systematic review and meta-analysis

M Etemadifar; H Nouri; M R Maracy; A Akhavan Sigari; M Salari; Y Blanco; M Sepúlveda; A Zabalza; S Mahdavi; M Baratian; N Sedaghat

doi:10.1016/j.neurol.2021.10.003

Risk factors of severe COVID-19 in people with multiple sclerosis : A systematic review and meta-analysis

Rev Neurol (Paris). 2022 Jan-Feb;178(1-2):121-128. doi: 10.1016/j.neurol.2021.10.003. Epub 2021 Nov 4.

Authors

M Etemadifar¹, H Nouri², M R Maracy³, A Akhavan Sigari⁴, M Salari⁵, Y Blanco⁶, M Sepúlveda⁶, A Zabalza⁷, S Mahdavi⁸, M Baratian⁸, N Sedaghat⁹

Affiliations

¹ Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
² Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran.
³ Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴ Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
⁵ Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁶ Center of Neuroimmunology and Service of Neurology, August Pi Sunyer Institute of Biomedical Research, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
⁷ Servei de Neurologia-Neuroimmunologia, Departament de Medicina, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
⁸ Clinical Research Development Center, Islamic Azad University of Najafabad, Isfahan, Iran.
⁹ Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran. Electronic address: nahad.sedaghat@gmail.com.

Abstract

Objectives: To gather, synthesize, and meta-analyze data regarding the risk factors associated with a severe course of COVID-19 among patients with multiple sclerosis (pwMS).

Methods: MEDLINE, Embase, Scopus, and WoS were searched in May 2021. Briefly, the eligibility criteria included: 1) studies assessing COVID-19 severity among adult pwMS; 2) definitive diagnoses or high clinical suspicion of COVID-19; 3) a categorization of COVID-19 severity into at least two categories; 4) quantitative effect size and precision measurements; and 5) English language; and 6) clear effect size/precision measures. internal validity of studies was assessed using the NIH Quality Assessment Tools. A list of possible risk factors was created based on the search results and was later used in extraction, synthesis, and meta-analysis of the data.

Results: Thirteen studies were included in the syntheses. Outcome measures were either extracted from the papers, obtained from the primary researchers or calculated manually. The meta-analyses showed a significantly (P<0.05) increased odds of a severe COVID-19 in pwMS with all of the assessed risk factors, except smoking and most DMTs.

Conclusion: This study facilitates evidence-based risk/benefit assessments in practice. Older men with progressive MS on anti-CD20 therapies are more at risk of an unfortunate COVID-19 outcome.

Keywords: COVID-19; Disease-modifying therapies; Meta-analysis; Multiple sclerosis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Aged
COVID-19*
Humans
Male
Multiple Sclerosis* / complications
Multiple Sclerosis* / diagnosis
Multiple Sclerosis* / epidemiology
Risk Factors
SARS-CoV-2