Journal
JOURNAL OF NEUROLOGY
Volume 270, Issue 4, Pages 1835-1842Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s00415-023-11618-0
Keywords
Multiple sclerosis; Case-control studies; Viral infections; Medical care
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This study assessed modifiable risk factors associated with COVID-19 in people with multiple sclerosis (PwMS). The results showed that higher vitamin D levels and active smoking status were associated with a lower risk of COVID-19, while external contact and working in the healthcare sector increased the risk. Therefore, vitamin D supplementation and teleworking may help prevent infection risk in PwMS.
BackgroundDisease and treatment-associated immune system abnormalities may confer higher risk of Coronavirus disease 2019 (COVID-19) to people with multiple sclerosis (PwMS). We assessed modifiable risk factors associated with COVID-19 in PwMS.MethodsAmong patients referring to our MS Center, we retrospectively collected epidemiological, clinical and laboratory data of PwMS with confirmed COVID-19 between March 2020 and March 2021 (MS-COVID, n = 149). We pursued a 1:2 matching of a control group by collecting data of PwMS without history of previous COVID-19 (MS-NCOVID, n = 292). MS-COVID and MS-NCOVID were matched for age, expanded disability status scale (EDSS) and line of treatment. We compared neurological examination, premorbid vitamin D levels, anthropometric variables, life-style habits, working activity, and living environment between the two groups. Logistic regression and Bayesian network analyses were used to evaluate the association with COVID-19.ResultsMS-COVID and MS-NCOVID were similar in terms of age, sex, disease duration, EDSS, clinical phenotype and treatment. At multiple logistic regression, higher levels of vitamin D (OR 0.93, p < 0.0001) and active smoking status (OR 0.27, p < 0.0001) emerged as protective factors against COVID-19. In contrast, higher number of cohabitants (OR 1.26, p = 0.02) and works requiring direct external contact (OR 2.61, p = 0.0002) or in the healthcare sector (OR 3.73, p = 0.0019) resulted risk factors for COVID-19. Bayesian network analysis showed that patients working in the healthcare sector, and therefore exposed to increased risk of COVID-19, were usually non-smokers, possibly explaining the protective association between active smoking and COVID-19.ConclusionsHigher Vitamin D levels and teleworking may prevent unnecessary risk of infection in PwMS.
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