Challenges of Antiviral Therapy on Clinical Outcomes and 30-Day Survival Benefits in Hospitalized Multiple Sclerosis Patients with COVID-19

Background: This study aimed to evaluate the efficacy and safety concerns of remdesivir and type 1 interferons (INFs) on the clinical outcomes of multiple sclerosis (MS) patients who were hospitalized 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 mortality rates.Results: Nine hundred ninety-nine hospitalized MS patients with a definite diagnosis of COVID-19 based on PCR were recorded in the electronic health systems.Almost half of the patients were under treatment with an anti-CD-20 agent (rituximab or ocrelizumab) at the time of hospital admission (50.3%), with higher mortality rates, needing ICU admission, and longer hospitalization (p < 0.05).There was a significant association between taking IFN alone (adjusted IRR = 1.21, 95% CI 1.32 to 1.42) or in combination with RDV (adjusted IRR = 1.30, 95% CI 1.18 to 1.5042) and longer hospitalization.There were no significant associations between antiviral treatment (RDV alone, IFNβ1 alone, and IFNβ1 plus RDV) and ICU admission (p > 0.2), 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-CD-20 agents. Conclusion:Our data reveal that RDV, IFN, or a combination of IFN and RDV administration has no benefit in the treatment of hospitalized MS patients with COVID-19.