that people with multiple sclerosis get infections more often than healthy people has been known for a long time. Also that disease-modifying drugs, such as those often used in relapsing courses, can increase the risk of infection.
However, how high the risk for MS sufferers with different courses, at different ages and gender-specific is – for these subgroups there were not enough participants in previous studies to collect representative data. This is what the present study did, using patient data from Germany.
Subgroups: history, age and gender
From 3.4 million patient records, 4,250 patients with MS were filtered and analyzed by subgroup over 5 years based on whether they
- had RRMS, PPMS or SPMS,
- between 18 and 50, 51 and 65 or over 65 years old and whether they
- were male or female.
Only severe infections that required hospitalization were counted. Repeat admissions within six weeks were not counted (considered one severe infection). A total of 32 patients changed from relapsing to secondary progression within the observation period and were counted there accordingly.
Greatest risk: progressive, older and male
The results are clear. Those most at risk are not patients with a relapsing course because they take immunomodulators, as one might assume, but patients with a progressive course, older age and male sex.
The fact that more severe infections are to be expected in older age also corresponds to the general population. In addition, the progressive patient groups here were significantly older than those in the relapsing trajectory (which is natural since the secondary progressive trajectory follows the relapsing trajectory). However, the differences (albeit weakened) were also evident within one age group.
course as a risk factor
First, the 100-patient-year rate of hospitalizations for severe infections only after progression: Here the rate was 3.37 for relapsing courses, 13.52 for primary progressive MS, and 13.58 for secondary progressive MS. In the case of the progressive courses, that is around four times as much.
Broken down by gender alone, the average rate was 5.69 for women and 10.4 for men. Even if you continue to look at the sexes separately according to course, it shows that the progressive courses have a much higher infection rate (2.98, 10.05 and 11.54 in women with a relapsing, primary progressive or secondary progressive course, i.e approximately tripled in the progressive courses, compared to 4.53, 19.45 and 17.85 in men and thus quadrupled or tripled).
Risk at least doubled, regardless of age
If you look at the age groups separately, not only does it show an increase from 2.74 (18 to 50 year olds) to 7.76 (51 to 65 year olds) to 16.47 (over 65 year olds), but remains above that the infection rate also increases significantly within these three age groups when it comes to progressive MS:
In 18 to 50 year olds there are 2.25 serious infections per 100 patient-years in relapsing forms, 6.29 in primary progressive MS and 5.82 in secondary progressive MS. This corresponds to at least a doubling of the rate with progression. In the 51 to 65 age group, the risk increases from 3.94 (relapsing) to 11.91 (primary progressive) and finally 14.34 (secondary progressive). Here the rate has roughly tripled. Over 65-year-olds with relapsing-remitting MS have a rate of 10.24, with primary progressive MS it is 18.54 and with secondary progressive MS it is 16.47 cases per 100 patient-years, which is still almost twice the rate for progression compared to relapses.
Who know, protect yourself better
This knowledge is important for MS sufferers and physicians in several respects. For one, you can prophylaxis operate, take special care of yourself, do not overexert yourself and, for example, take special hygiene measures, vaccinate (not only against corona, but also against flu and shingles, for example), possibly consider distance from infected people. On the other hand, take immediate measures if you are infected so that you do not have to be instructed in the first place. So it’s better to get on the couch with a hot-water bottle and tea in good time and rather go to the doctor once too often than try to please “everyone” “quickly”.
It is also important to avoid infection with regard to multiple sclerosis yourself: It is known from other studies that (severe) infections can also aggravate the underlying disease MS, for example walking becomes more difficult after a severe urinary infection. Most infections in the present study involved the respiratory organs, bladder and genital tract.
By the way: The study discussed here also documents concomitant diseases that the MS patients “brought along”. Another detailed report on the subject of “comorbidities in multiple sclerosis” will be published on amsel.de in the coming days.