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-β1 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-β1- β1 alone, and interferon-β1plus 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-β1, or a combination of both does not benefit hospitalized ms patients with covid-19.