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 (<1month) 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.

Disease-modifying therapies and coronavirus disease 2019 severity in multiple sclerosis / Sormani, Maria P; De Rossi, Nicola; Schiavetti, Irene; Carmisciano, Luca; Cordioli, Cinzia; Moiola, Lucia; Radaelli, Marta; Immovilli, Paolo; Capobianco, Marco; Trojano, Maria; Zaratin, Paola; Tedeschi, Gioacchino; Comi, Giancarlo; Battaglia, Mario A; Patti, Francesco; Salvetti, Marco; Musc-19 Study, Group; Petracca, Maria. - In: ANNALS OF NEUROLOGY. - ISSN 0364-5134. - 89:4(2021), pp. 1-10. [10.1002/ana.26028]

Disease-modifying therapies and coronavirus disease 2019 severity in multiple sclerosis

Sormani, Maria P;Patti, Francesco;Salvetti, Marco;Petracca, Maria
Membro del Collaboration Group
2021

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 (<1month) 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.
File allegati a questo prodotto
File Dimensione Formato  
Sormani_Disease-modifying_2021.pdf

accesso aperto

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Creative commons
Dimensione 274.99 kB
Formato Adobe PDF
274.99 kB Adobe PDF Visualizza/Apri PDF
Sormani_CollaborationGroup_2021.pdf

accesso aperto

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Creative commons
Dimensione 907.79 kB
Formato Adobe PDF
907.79 kB Adobe PDF Visualizza/Apri PDF

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11573/1496809
Citazioni
  • ???jsp.display-item.citation.pmc??? 179
  • Scopus 201
  • ???jsp.display-item.citation.isi??? 195
social impact