Neurol Neuroimmunol Neuroinflamm . Updated Results of the COVID-19 in MS Global Data Sharing Initiative: Anti-CD20 and Other Risk Factors Associated With COVID-19 Severity

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Neurol Neuroimmunol Neuroinflamm


. 2022 Aug 29;9(6):e200021.
doi: 10.1212/NXI.0000000000200021. Print 2022 Nov.
Updated Results of the COVID-19 in MS Global Data Sharing Initiative: Anti-CD20 and Other Risk Factors Associated With COVID-19 Severity


Steve Simpson-Yap ¹ , Ashkan Pirmani ² , Tomas Kalincik ² , Edward De Brouwer ² , Lotte Geys ² , Tina Parciak ² , Anne Helme ² , Nick Rijke ² , Jan A Hillert ² , Yves Moreau ² , Gilles Edan ² , Sifat Sharmin ² , Tim Spelman ² , Robert McBurney ² , Hollie Schmidt ² , Arnfin B Bergmann ² , Stefan Braune ² , Alexander Stahmann ² , Rod M Middleton ² , Amber Salter ² , Bruce Bebo ² , Anneke Van der Walt ² , Helmut Butzkueven ² , Serkan Ozakbas ² , Cavit Boz ² , Rana Karabudak ² , Raed Alroughani ² , Juan I Rojas ² , Ingrid A van der Mei ² , Guilherme Sciascia do Olival ² , Melinda Magyari ² , Ricardo N Alonso ² , Richard S Nicholas ² , Anibal S Chertcoff ² , Ana Zabalza de Torres ² , Georgina Arrambide ² , Nupur Nag ² , Annabel Descamps ² , Lars Costers ² , Ruth Dobson ² , Aleisha Miller ² , Paulo Rodrigues ² , Vesna Prčkovska ² , Giancarlo Comi ² , Liesbet M Peeters ²



Affiliations

• PMID: 36038263
• DOI: 10.1212/NXI.0000000000200021

Abstract

Background and objectives: Certain demographic and clinical characteristics, including the use of some disease-modifying therapies (DMTs), are associated with severe acute respiratory syndrome coronavirus 2 infection severity in people with multiple sclerosis (MS). Comprehensive exploration of these relationships in large international samples is needed.
Methods: Clinician-reported demographic/clinical data from 27 countries were aggregated into a data set of 5,648 patients with suspected/confirmed coronavirus disease 2019 (COVID-19). COVID-19 severity outcomes (hospitalization, admission to intensive care unit [ICU], requiring artificial ventilation, and death) were assessed using multilevel mixed-effects ordered probit and logistic regression, adjusted for age, sex, disability, and MS phenotype. DMTs were individually compared with glatiramer acetate, and anti-CD20 DMTs with pooled other DMTs and with natalizumab.
Results: Of 5,648 patients, 922 (16.6%) with suspected and 4,646 (83.4%) with confirmed COVID-19 were included. Male sex, older age, progressive MS, and higher disability were associated with more severe COVID-19. Compared with glatiramer acetate, ocrelizumab and rituximab were associated with higher probabilities of hospitalization (4% [95% CI 1-7] and 7% [95% CI 4-11]), ICU/artificial ventilation (2% [95% CI 0-4] and 4% [95% CI 2-6]), and death (1% [95% CI 0-2] and 2% [95% CI 1-4]) (predicted marginal effects). Untreated patients had 5% (95% CI 2-8), 3% (95% CI 1-5), and 1% (95% CI 0-3) higher probabilities of the 3 respective levels of COVID-19 severity than glatiramer acetate. Compared with pooled other DMTs and with natalizumab, the associations of ocrelizumab and rituximab with COVID-19 severity were also more pronounced. All associations persisted/enhanced on restriction to confirmed COVID-19.
Discussion: Analyzing the largest international real-world data set of people with MS with suspected/confirmed COVID-19 confirms that the use of anti-CD20 medication (both ocrelizumab and rituximab), as well as male sex, older age, progressive MS, and higher disability are associated with more severe course of COVID-19.