Modifiable risk factors of COVID-19 in patients with multiple sclerosis: a single-centre case–control study

Abstract

Background Disease 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. Methods Among 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. Results MS-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. Conclusions Higher Vitamin D levels and teleworking may prevent unnecessary risk of infection in PwMS.

The Association of Weight Reduction and Other Variables after Bariatric Surgery with the Likelihood of SARS-CoV-2 Infection

“…Physicians should, therefore, be aware of the importance of physical activity after bariatric surgery. Smoking was negatively associated with the rates of SARS-CoV-2 infection, as has been previously observed in our study focused on patients with asthma [48] Other epidemiological studies on COVID-19, from Israel [49], Italia [50,51], China [52], and the United States [53] also have reported lower prevalence of smoking among SARS-CoV-2 positive individuals. This is probably not an independent factor, but secondary to behavior (such as being in open spaces outside closed buildings for smoking) and other characteristics that were not included in the study analysis.…”

Multiple sclerosis and COVID-19: a northern China survey

“…Nevertheless, we cannot completely discount the impact of other factors on SARS-CoV-2 infection incidence, including comorbid diseases, MS type and other modifiable risk factors [ 14 ]. A retrospective study from Italy [ 15 ] evaluating modifiable risk factors associated with COVID-19 in pwMS suggests that higher Vitamin D levels and teleworking may prevent the risk of unwanted infections in pwMS. This also provides a more practical strategy for the management of pwMS during pandemic.…”

COVID-19 Vaccination and Disease Course in People with Multiple Sclerosis in Greece

“…Clinicians are suggested to closely monitor aged, SARS-CoV-2infected PwMS with significant comorbid conditions. Additional modifiable risk factors, such as smoking status and vitamin D3 levels, should also be considered [85].…”