Shalom Haggiag (Italy)
S. Camillo-Forlanini Hospital Dept. of NeurologyAuthor Of 1 Presentation
INCREASED RISK OF DEATH FROM COVID-19 IN MULTIPLE SCLEROSIS: A META-ANALYSIS OF OBSERVATIONAL STUDIES
- Luca Prosperini (Italy)
Abstract
Background and Aims:
The ongoing global SARS-CoV-2 pandemic has raised concerns that multiple sclerosis (MS) may increase the risk for death in this patient population. Therefore, we sought to assess the COVID-19-related fatality rate of patients with MS as compared to the general population.
Methods:
We searched PubMed/Medline for articles reporting the cause-specific (COVID-19) number of death in patients with MS to calculate the crude death rate (CDR) attributable to COVID-19 on individual-patient data. We estimated indirectly-adjusted age-standardised infection-fatality ratio (IFR) to compare the cause-specific risk of death in patients and in the general population. Inverse-variance weighted meta-regressions with random-effect models were fitted to explore potential effect modifiers for the CDR on aggregate data from articles with adequate sample size (n=/>30).
Results:
Out of 367 screened articles, 60 fulfilled criteria for meta-analysis, with a total of 5474 patients included (27% males, median age 45 years). Of them, 168 died, yielding a CDR of 3.1% (95% CIs 2.3-3.9). The age-standardised IFR was 1.24 (95% CIs 1.05-1.41) using age-specific fatality rates provided by the World Health Organization (WHO) from Europe and America. We found an increased death risk in studies including higher proportion of patients either with comorbidity (p=0.013) or treated with anti-CD20 agents (p=0.021). Studies involving greater proportions of suspected rather than confirmed COVID-19 cases reported fewer deaths (p=0.001).
Conclusions:
People with MS have a 24% higher lethality risk from COVID-19 than the general population. Appropriate attention should be paid to patients with comorbidities and for those treated with anti-CD20 agents.