背景:以前尚未澄清COVID-19是否引发疾病活动性并增加多发性硬化症患者因COVID-19住院的风险。我们研究了COVID-19与全身性皮质类固醇处方的使用以及神经科的医院接触作为多发性硬化症患者疾病活动的代理之间的关系。此外,与参考文献相比,我们研究了多发性硬化症患者是否更有可能因COVID-19住院.
方法:本研究基于全国范围的卫生登记数据,包括2,222,946名COVID-19PCR检测阳性的丹麦人口。为了研究疾病活动,我们的研究人群包括所有多发性硬化症和COVID-19PCR检测阳性的患者。使用二项回归模型,在COVID-19PCR阳性测试后与之前比较了我们的疾病活动代理。根据年龄进行了调整,性别,合并症,多发性硬化症诊断的长度,日历期间,疫苗接种,和免疫调节治疗。为了研究多发性硬化症患者因COVID-19住院的风险,我们的研究人群包括所有COVID-19PCR检测阳性的丹麦公民。在逻辑回归模型中,我们估计了多发性硬化症患者相对于其他自身免疫性疾病(炎症性肠病/类风湿性关节炎)患者的COVID-19住院的比值比(OR),和相对于普通人群的个体。根据年龄进行了调整,性别,合并症,疫苗接种,和日历周期。为了检查疾病改善治疗的影响,与未接受任何疾病改善治疗的患者相比,在接受疾病改善治疗的患者中,估计接受COVID-19的患者住院风险.
结果:我们纳入了7358例多发性硬化症患者,COVID-19PCR检测阳性。多发性硬化症患者COVID-19后使用皮质类固醇处方的校正发生率比率(aIRR)为0.93(95%CI0.78-1.10),COVID-19感染后神经内科/以多发性硬化症为主要诊断的入院患者的医院接触者的aIRR为1.10(95%1.00-1.22)。与其他自身免疫性疾病患者相比,在COVID-19PCR检测阳性后30天内,COVID-19住院的校正OR(aOR)为3.21(95%CI2.75-3.74),与普通人群中所有其他阳性患者相比,多发性硬化症患者的aOR为5.34(95%CI4.65-6.14)。我们发现,与未接受疾病修饰治疗的多发性硬化症患者相比,在COVID-19PCR检测阳性前6个月接受疾病修饰治疗的多发性硬化症患者住院风险没有增加(aOR0.94(95%CI0.69-1.27))。
结论:在这个全国性的多发性硬化症患者队列中,COVID-19似乎没有引发多发性硬化症活动(基于代理变量)。我们发现,无论参考人群的类型如何,多发性硬化症患者在COVID-19PCR检测阳性后的前30天因COVID-19住院的风险显着增加。在多发性硬化症患者中,使用疾病改善治疗并未增加COVID-19住院的风险.
BACKGROUND: It has not previously been clarified if COVID-19 triggers disease activity and increases the risk of hospitalisation with COVID-19 in patients with multiple sclerosis. We examined the association between COVID-19 and the use of systemic corticosteroids prescriptions and hospital contacts at neurological departments as proxies of disease activity among patients with multiple sclerosis. Furthermore, we examined whether patients with multiple sclerosis were more likely to be hospitalised with COVID-19 compared to references.
METHODS: This
study was based on nationwide health registries with data on the Danish population of 2,222,946 individuals with a positive COVID-19 PCR test. To
study disease activity our
study population consisted of all patients with multiple sclerosis and a positive COVID-19 PCR test. Our proxies for disease activity were compared after versus before a positive COVID-19 PCR test using a binomial regression model. Adjustments were made for age, sex, comorbidity, length of multiple sclerosis diagnosis, calendar period, vaccination, and immunomodulatory treatment. To
study the risk of hospitalisation with COVID-19 in patients with multiple sclerosis our
study population here consisted of all Danish citizens with a COVID-19 positive PCR test. In logistic regression models we estimated odds ratio (OR) for hospitalisation with COVID-19 in patients with multiple sclerosis relative to patients affected with other autoimmune diseases (inflammatory bowel disease/rheumatoid arthritis), and relative to individuals from the general population. Adjustments were made for age, sex, comorbidity, vaccination, and calendar period. To examine the impact of disease-modifying treatment, the risk of hospitalisation with COVID-19 was estimated in those with disease-modifying treatment versus those without any disease-modifying treatment.
RESULTS: We included 7358 patients with multiple sclerosis and a positive COVID-19 PCR test. The adjusted incidence rate ratio (aIRR) for having corticosteroid prescriptions after COVID-19 in patients with multiple sclerosis was 0.93 (95 % CI 0.78 - 1.10), and the aIRR for hospital contacts at neurological departments/admissions with multiple sclerosis as primary diagnosis after COVID-19 infection was 1.10 (95 % 1.00-1.22). Adjusted OR (aOR) for hospitalisation with COVID-19 in the 30 days after a positive COVID-19 PCR test was 3.21 (95 % CI 2.75-3.74) compared to patients with other autoimmune diseases and the aOR was 5.34 (95 % CI 4.65-6.14) for patients with multiple sclerosis compared to all other individuals in the general population with a positive test. We found no increased risk of hospitalisations with COVID-19 in patients with multiple sclerosis using disease-modifying treatment 6 months prior to a positive COVID-19 PCR test compared to patients with multiple sclerosis without disease-modifying treatment (aOR 0.94 (95 % CI 0.69-1.27)).
CONCLUSIONS: In this nationwide cohort of patients with multiple sclerosis, COVID-19 did not seem to trigger multiple sclerosis disease activity (based on proxy variables). We found a significantly increased risk of being hospitalised with COVID-19 in the first 30 days after a positive COVID-19 PCR test in patients with multiple sclerosis irrespective of the type of reference population. In patients with multiple sclerosis, the use of disease-modifying treatment did not increase the risk of hospitalisation with COVID-19.