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.
Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis / Sormani, M. P.; De Rossi, N.; Schiavetti, I.; Carmisciano, L.; Cordioli, C.; Moiola, L.; Radaelli, M.; Immovilli, P.; Capobianco, M.; Trojano, M.; Zaratin, P.; Tedeschi, G.; Comi, G.; Battaglia, M. A.; Patti, F.; Salvetti, M.; Nozzolillo, A.; Bellacosa, A.; Protti, A.; Di Sapio, A.; Signori, A.; Petrone, A.; Bisecco, A.; Iovino, A.; Dutto, A.; Repice, A. M.; Conte, A.; Bertolotto, A.; Bosco, A.; Gallo, A.; Zito, A.; Sartori, A.; Giometto, B.; Tortorella, C.; Antozzi, C.; Pozzilli, C.; Mancinelli, C. R.; Zanetta, C.; Cordano, C.; Cordioli, C.; Scandellari, C.; Guaschino, C.; Gasperini, C.; Solaro, C.; Fioretti, C.; Bezzini, D.; Marastoni, D.; Paolicelli, D.; Vecchio, D.; Landi, D.; Bucciantini, E.; Pedrazzoli, E.; Signoriello, E.; Sbragia, E.; Susani, E. L.; Curti, E.; Milano, E.; Marinelli, F.; Camilli, F.; Boneschi, F. M.; Govone, F.; Bovis, F.; Calabria, F.; Caleri, F.; Rinaldi, F.; Vitetta, F.; Corea, F.; Crescenzo, F.; Patti, F.; Teatini, F.; Tabiadon, G.; Granella, F.; Boffa, G.; Lus, G.; Brichetto, G.; Comi, G.; Tedeschi, G.; Maniscalco, G. T.; Borriello, G.; De Luca, G.; Konrad, G.; Vaula, G.; Marfia, G. A.; Mallucci, G.; Liberatore, G.; Salemi, G.; Miele, G.; Sibilia, G.; Pesci, I.; Schiavetti, I.; Brambilla, L.; Lopiano, L.; Sinisi, L.; Pasquali, L.; Saraceno, L.; Carmisciano, L.; Chiveri, L.; Mancinelli, L.; Grimaldi, L. M. E.; Caniatti, L. M.; Cava, M. D.; Onofrj, M.; Rovaris, M.; Vercellino, M.; Bragadin, M. M.; Buccafusca, M.; Buscarinu, M. C.; Celani, M. G.; Grasso, M. G.; Stromillo, M. L.; Petracca, M.; Amato, M. P.; Sormani, M. P.; L'Episcopo, M. R.; Sessa, M.; Ferro, M. T.; Trojano, M.; Ercolani, M. V.; Bianco, M.; Re, M. L.; Vianello, M.; Clerico, M.; Battaglia, M. A.; di Napoli, M.; Ponzano, M.; Radaelli, M.; Conti, M. Z.; Calabrese, M.; Mirabella, M.; Filippi, M.; Inglese, M.; Lucchini, M.; Pozzato, M.; Danni, M. C.; Zaffaroni, M.; Zampolini, M.; Ponzio, M.; De Riz, M.; De Rossi, N.; De Stefano, N.; Cavalla, P.; De Mitri, P.; Grossi, P.; Zaratin, P.; Confalonieri, P.; Gallo, P.; Immovilli, P.; Ragonese, P.; Sola, P.; Annovazzi, P.; Iaffaldano, P.; Nardone, R.; Cerqua, R.; Clerici, R.; Lanzillo, R.; Motta, R.; Balgera, R.; Bergamaschi, R.; Totaro, R.; Iodice, R.; Capra, R.; Marangoni, S.; Realmuto, S.; Cottone, S.; Montepietra, S.; Rasia, S.; Arena, S.; Bucello, S.; Banfi, S.; Bonavita, S.; Malucchi, S.; Tonietti, S.; Vollaro, S.; Cordera, S.; Aguglia, U.; Clerici, V. T.; Barcella, V.; Bergamaschi, V.; Morra, V. B.; Dattola, V.; Mantero, V.. - In: ANNALS OF NEUROLOGY. - ISSN 0364-5134. - STAMPA. - 89:4(2021), pp. 780-789. [10.1002/ana.26028]
Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis
Giometto B.;
2021-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione
