Can pulse steroid therapy increase the risk of infection by COVID-19 in patients with multiple sclerosis?

Abstract

Background Iran is one of the countries with a high prevalence of multiple sclerosis (MS) and COVID-19. MS patients receiving the immunomodulatory or immunosuppressive therapy have a higher risk of infection. Due to the significance of determining the risk factors for getting COVID-19 among MS patients, the present study was designed to assess the risk of infection following the pulse steroid therapy. Methods This cross-sectional study included all MS patients that received corticosteroids in Tehran from December 2019 to August 2020 during the COVID-19 pandemic spread. The subjects’ clinical records including their sex, age, the type of MS, the type of medication, the number of days using corticosteroids, the status of prednisolone intake, and the number of days receiving prednisolone after the corticosteroid therapy were obtained. Moreover, main outcomes such as COVID-19 infection and the occurrence of death were recorded by patient’s visits and follow-up phone calls. COVID-19 infection was confirmed by physicians according to the clinical performance of RT-PCR, chest CT scan, and antibody tests. Results Totally, 133 MS cases participated in the study, and the pulse therapy was completed for 104 (78.2%) patients up to 5-7 days. 89 (66.9%) cases used the prednisolone tablet following the pulse therapy. Overall, the infection by Covid-19 was observed in 8 (6%) cases, among whom 5 (71.4%) cases received the pulse therapy for 5-7 days and 4 (57.1%) cases had a history of taking the prednisolone tablet. The age of less than 40 years (OR = 1.03; 95% CI (0.23-4.51)), male sex (OR = 0.35; 95% CI (0.03-3.34)), and the RRMS type (OR = 2.87; 95% CI (0.52-15.72)) had no effect on the risk of Covid-19 infection. In addition, there was not statistically significant difference between subjects with the short-term pulse therapy duration (3-4 days) (OR 0.68 (0.12–3.74) and those with the long-term pulse therapy duration (5-7 days). Similarly, no statistically significant difference was observed between subjects taking prednisolone (OR = 1.62 (0.34–7.61) and those not taking prednisolone. Furthermore, there was no significant association between different medication groups and the risk of Covid-19 infection (p < 0.05). No death occurred due to Covid-19 infection among the subjects. Conclusion COVID-19 infection was more common among female and younger patients as well as patients with a longer duration of the pulse therapy and prednisolone intake. There was no significant association between the pulse steroid therapy in MS patients and the risk of infection by COVID-19 in the Iranian population.

Effects of early corticosteroid use in patients with severe coronavirus disease 2019

“…Other types of corticosteroids, such as hydrocortisone [ 19 ], have also been demonstrated to improve clinical outcomes [ 20 ]. The use of corticosteroids could theoretically cause several side effects [ 21 ], but did not inhibit secondary bacterial infection or viral clearance [ 22 , 23 ]. Strong evidence for dexamethasone use has been suggested from the RECOVERY trial.…”

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

“…Eight of the included studies were cross-sectional [7, 17-20, 22, 23, 30], 11 were cohort [5, 6, 14-16, 24-29], and one was pharmacovigilance [21]. Four studies reported data each from the USA [7, 16, 21, 27] and Iran [18, 20, 22, 23], three from Spain [24, 28, 30], two each from Italy [6, 17], and Latin America [25, 26], and one each from France [5], United Kingdom [15], and Turkey [29]. Two studies were multi-centric, one from Europe [14] and another was conducted in the USA and Spain [19].…”

“…Two studies have discussed the effect of corticosteroids on the risk of COVID-19 and none found any association between the infection and using corticosteroids in the past 3 months [24], pulse therapy [18], or treatment with prednisolone [18].…”

“…Association between corticosteroids and COVID-19 susceptibility among MS patients have been investigated in two studies but none was able to find any relation [18, 24]. However, two large studies provided evidence suggesting that previous use of corticosteroids could affect COVID-19 prognosis [6, 7].…”

Interferon Beta-1a treatment promotes SARS-CoV-2 mRNA vaccine response in multiple sclerosis subjects

“…Multiple sclerosis (MS) subjects, especially those with older age, severe disabilities, progressive forms and comorbidities, have been shown to be at higher risk of serious illness or death secondarily to SARS-Co-V-2 infection; however, this point is still debated (Achiron et al, 2021;Naser Moghadasi, Shabany et al 2021;Sormani et al, 2021). Preliminary data showed that COVID-19 vaccines are safe in MS subjects, with no evidence of increased risk of relapse (Achiron et al, 2021).…”