tetano
Editor, Senior Moderator
Ann Neurol
. 2021 Jan 21.
doi: 10.1002/ana.26028. Online ahead of print.
Disease modifying therapies and Covid-19 severity in Multiple Sclerosis
Maria Pia Sormani[SUP] 1 2 [/SUP], Nicola De Rossi[SUP] 3 [/SUP], Irene Schiavetti[SUP] 1 [/SUP], Luca Carmisciano[SUP] 1 [/SUP], Cinzia Cordioli[SUP] 3 [/SUP], Lucia Moiola[SUP] 4 [/SUP], Marta Radaelli[SUP] 5 [/SUP], Paolo Immovilli[SUP] 6 [/SUP], Marco Capobianco[SUP] 7 [/SUP], Maria Trojano[SUP] 8 [/SUP], Paola Zaratin[SUP] 9 [/SUP], Gioacchino Tedeschi[SUP] 10 [/SUP], Giancarlo Comi[SUP] 11 [/SUP], Mario Alberto Battaglia[SUP] 9 12 [/SUP], Francesco Patti[SUP] 13 14 [/SUP], Marco Salvetti[SUP] 15 16 [/SUP], Musc-19 study group
Affiliations
Abstract
Objective: To assess the impact of immunosuppressive and immunomodulatory therapies on the severity of Coronavirus disease 2019 (Covid-19) in people with MS (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 vs pneumonia or hospitalization vs Intensive Care Unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated to a severe Covid-19 by multivariable 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 a radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, EDSS, disease duration, BMI, comorbidities and recent methylprednisolone use, the therapy with an anti-CD20 agent (Ocrelizumab or Rituximab) was significantly associated (OR = 2.37,95%CI = 1.18-4.74,p = 0.015) with an 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 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 is persisting. This article is protected by copyright. All rights reserved.
Keywords: Coronavirus; Immunomodulatory therapies; Multiple Sclerosis.
. 2021 Jan 21.
doi: 10.1002/ana.26028. Online ahead of print.
Disease modifying therapies and Covid-19 severity in Multiple Sclerosis
Maria Pia Sormani[SUP] 1 2 [/SUP], Nicola De Rossi[SUP] 3 [/SUP], Irene Schiavetti[SUP] 1 [/SUP], Luca Carmisciano[SUP] 1 [/SUP], Cinzia Cordioli[SUP] 3 [/SUP], Lucia Moiola[SUP] 4 [/SUP], Marta Radaelli[SUP] 5 [/SUP], Paolo Immovilli[SUP] 6 [/SUP], Marco Capobianco[SUP] 7 [/SUP], Maria Trojano[SUP] 8 [/SUP], Paola Zaratin[SUP] 9 [/SUP], Gioacchino Tedeschi[SUP] 10 [/SUP], Giancarlo Comi[SUP] 11 [/SUP], Mario Alberto Battaglia[SUP] 9 12 [/SUP], Francesco Patti[SUP] 13 14 [/SUP], Marco Salvetti[SUP] 15 16 [/SUP], Musc-19 study group
Affiliations
- PMID: 33480077
- DOI: 10.1002/ana.26028
Abstract
Objective: To assess the impact of immunosuppressive and immunomodulatory therapies on the severity of Coronavirus disease 2019 (Covid-19) in people with MS (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 vs pneumonia or hospitalization vs Intensive Care Unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated to a severe Covid-19 by multivariable 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 a radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, EDSS, disease duration, BMI, comorbidities and recent methylprednisolone use, the therapy with an anti-CD20 agent (Ocrelizumab or Rituximab) was significantly associated (OR = 2.37,95%CI = 1.18-4.74,p = 0.015) with an 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 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 is persisting. This article is protected by copyright. All rights reserved.
Keywords: Coronavirus; Immunomodulatory therapies; Multiple Sclerosis.