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. 2021 Apr;89(4):780-789.
doi: 10.1002/ana.26028. Epub 2021 Feb 9.

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Collaborators, Affiliations

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Maria P Sormani et al. Ann Neurol. 2021 Apr.

Abstract

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS).

Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results.

Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses.

Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists. ANN NEUROL 2021;89:780-789.

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Conflict of interest statement

M.P.S. reports a grant from Roche to cover data management of this study; Roche makes ocrelizumab, which is one of the DMTs assessed in this study. The remaining authors have nothing to report.

Figures

FIGURE 1
FIGURE 1
Percentage of patients with pneumonia/hospitalization and intensive care unit (ICU)/death in the subgroup of subjects with age < 65 years and Expanded Disability Status Scale < 6.5, according to multiple sclerosis (MS) phenotype (relapsing–remitting vs progressive MS), in the anti‐CD20, no therapy, and other therapies groups. DMT = disease‐modifying therapy.

References

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