Enhancing Clinical Outcomes and Survival in Hospitalized Multiple Sclerosis Patients with COVID-19: Challenges of Antiviral Therapy

Introduction:This study aimed to evaluate the efficacy and safety concerns of remdesivir and type 1 interferons on the clinical outcomes of hospitalized multiple sclerosis patients with COVID-19.Methods: Using electronic health records systems; this is a cross-sectional study of two years of hospital admissions in terms of COVID-19 in Iran from March 2019 to August 2021.The severities of COVID-19 outcomes were ICU admission, hospitalization days, and 30-day survival rates.Results: A total of 993 hospitalized multiple sclerosis patients with a confirmed diagnosis of COVID-19 based on PCR testing were recorded in the electronic health systems.Nearly half of these patients (50.3%) had received treatment with an anti-CD20 agent (rituximab or ocrelizumab) at the hospital admission.This group exhibited higher mortality rates, increased need for ICU admission, and longer hospitalization (p<0.05).There was a significant association between taking interferon-1 alone (adjusted IRR=1.21,95% CI 1.32 to 1.42) or in combination with remdesivir (adjusted IRR=1.30,95% CI 1.18 to 1.5042) and longer hospitalization.There were no significant associations between antiviral treatment (remdesivir alone, interferon-1-1 alone, and interferon-1plus remdesivir) and ICU admission (p>0.2), the in-hospital mortality rate (p>0.2), or 30-day survival rate (p>0.2).The results were similar in patients who did or did not receive anti-CD20 agents.These results were consistent among patients regardless of whether they received anti-CD20 agents.Conclusion: Our data suggest that remdesivir, interferon-1, or a combination of both does not benefit hospitalized MS patients with COVID-19.