COVID-19 Hits Black MS Patients Hard

Black patients with multiple sclerosis (MS) and SARS-CoV-2 virus had a different COVID-19 disease course and worse outcomes than white MS patients with the virus, data from the clinician-based COViMS registry showed.

Black race was associated with increased odds of a composite outcome of mortality or ICU admission (OR 3.7), and increased odds of a composite outcome of mortality, ICU admission, or hospitalization (OR 1.7), reported Amber Salter, PhD, of Washington University School of Medicine in St. Louis, at MS Virtual 2020, the joint ACTRIMS-ECTRIMS meeting.

“Race and ethnicity are critical components to understanding MS disparities and the impact of the SARS-CoV-2 virus,” Salter told MedPage Today.

“Our study finds that much like the general population, Black patients with MS have an increased odds of more severe COVID-19 disease course compared to white patients with MS, after controlling for other risk factors such as age, sex, comorbidities, disease-modifying therapy use, and disability.”

The study was based on data from the COViMS registry, a joint effort of the Consortium of MS Centers, the MS Society of Canada, and the National MS Society. The registry contained de-identified patient data submitted by clinicians who treated MS patients with confirmed or suspected COVID-19 from April 1 to August 31. Nearly all patients in the study (98%) were from the U.S.

Analyses included only white and Black MS patients. Of 858 MS patients in the COViMS study, 503 (58.6%) were reported as non-Hispanic white and 223 (26.0%) as Black.

Black patients were age 47.1 on average and had mean disease duration of 11.4 years. Most Black MS patients (77%) were female, 73% were fully ambulatory, and 71% were never-smokers. Eight in 10 Black patients (82%) had relapsing-remitting disease, 13% had secondary progressive, and 4% had primary progressive MS.

White patients were age 50.8 on average and had mean disease duration of 15.2 years, while 72% were female, 69% were fully ambulatory, and 59% were never-smokers. More than seven in 10 (73%) white patients had relapsing-remitting MS; 19% had secondary progressive, and 7% had primary progressive disease.

About 42% of Black MS patients had hypertension, compared with 19.5% of white patients (P<0.001). In addition, 16% of Black MS patients had morbid obesity, compared with 9% of white patients (P=0.004).

“A higher percentage of black MS patients had hypertension, cerebrovascular disease, chronic lung disease, and diabetes, which are known risk factors for worse outcomes from COVID-19 infection,” said Benjamin Segal, MD, of The Ohio State University in Columbus, who was not involved with the study.

“These data reflect what has been observed in the general population, and underscore the importance of exercising vigilance and prompt supportive interventions when managing Black individuals with SARS-CoV-2 infection, including Black MS patients,” Segal told MedPage Today.

There was no difference in whether disease-modifying therapy (DMT) was used (P=0.06) and no differences in specific DMTs used (P=0.40) between Black and white patients.

Mortality was 5.4% for Black MS patients with COVID-19 and 6.3% for white MS patients; the difference between race was not statistically significant.

Overall rates of the composite outcome of mortality or ICU admission were 16.9% (95% CI 11.8-23.2) for Black MS patients and 12.8% for white patients (95% CI 9.8-16.3). After adjusting for covariates — age, sex, MS disease characteristics, smoking, and comorbidities at the time of COVID-19 — race was independently associated with the composite outcome mortality or ICU admission (OR 3.7, 95% 1.6-8.2; P=0.002).

Rates of the composite outcome of mortality, ICU admission, or hospitalization were 35.8% (95% 29.0-43.1) for Black patients and 30.2% for white patients (95% 26.0-34.8). Race was independently associated with this outcome (OR 1.7, 95% 1.02-2.84; P=0.04), after adjustment.

“Data from COViMS, one of the largest single sources tracking outcomes of COVID-19 in people with MS in the world, suggest that Black people with MS tend to have more severe outcomes from COVID infection than white people with MS,” commented Bruce Bebo, PhD, executive vice president of research at the National MS Society.

The findings suggest multiple factors contribute to these outcomes and “further research to understand these disparities should be prioritized,” Bebo told MedPage Today.

The analysis has several limitations, Salter noted. The registry may have potential reporting bias towards severe cases, she said. The study is not population-based and other potential confounders were not included in the analysis.