Factors associated with COVID-19 susceptibility and severity in patients with multiple sclerosis: A systematic review

Abstract

AbstractBackgroundWe conducted this systematic review to identify factors associated with coronavirus disease (COVID-19) susceptibility and outcomes among people with multiple sclerosis (MS).MethodsAvailable studies from PubMed, Scopus, EMBASE, Web of Science, and gray literature including reference list and conference abstracts were searched from December 1, 2019, through April 12, 2021. We included cross-sectional, case-control, and cohort studies that reported risk factors of contracting COVID-19 or its outcome in patients with MS on univariate or multivariate regression analyses.ResultsOut of the initial 2719 records and 1553 conference abstracts, a total of 20 studies were included. Factors associated with COVID-19 susceptibility were reported in 11 studies and risk factors for infection outcomes were discussed in 10. History of contact with an infected is strongly suggested as a risk factor for COVID-19 susceptibility. Other factors that could be associated with contracting infection are younger age, relapsing course, and anti-CD20 agents. The evidence suggests that increasing age, greater MS severity, treatment with anti-CD20 agents, previous use of corticosteroids, and specific comorbidities (obesity and coronary artery disease) could be independently associated with worse infection outcomes. Male sex is likely to be a risk factor for more severe disease. The black or African American race was reported as a possible risk factor.ConclusionDue to a paucity of research and methodological issues, no risk factors for COVID-19 susceptibility and outcomes neither be confirmed nor excluded. Further large studies are needed to address factors associated with COVID-19 susceptibility and severity.