Background and Objectives It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian ageand sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon.
COVID-19 severity in multiple sclerosis / Sormani, Maria Pia; Schiavetti, Irene; Carmisciano, Luca; Cordioli, Cinzia; Filippi, Massimo; Radaelli, Marta; Immovilli, Paolo; Capobianco, Marco; De Rossi, Nicola; Brichetto, Giampaolo; Cocco, Eleonora; Scandellari, Cinzia; Cavalla, Paola; Pesci, Ilaria; Zito, Antonio; Confalonieri, Paolo; Marfia, Girolama Alessandra; Perini, Paola; Inglese, Matilde; Trojano, Maria; Brescia Morra, Vincenzo; Tedeschi, Gioacchino; Comi, Giancarlo; Battaglia, Mario Alberto; Patti, Francesco; Salvetti, Marco; Null, Null; Abbadessa, Gianmarco; Aguglia, Umberto; Allegorico, Lia; Allegri Rossi, Beatrice Maria; Amato, Maria Pia; Annovazzi, Pietro; Antozzi, Carlo; Appendino, Lucia; Arena, Sebastiano; Baione, Viola; Balgera, Roberto; Barcella, Valeria; Baroncini, Damiano; Barrilà, Caterina; Bellacosa, Alessandra; Bellucci, Gianmarco; Bergamaschi, Roberto; Bergamaschi, Valeria; Bezzini, Daiana; Biolzi, Beatrice; Bisecco, Alvino; Bonavita, Simona; Borriello, Giovanna; Bosa, Chiara; Bosco, Antonio; Bovis, Francesca; Bozzali, Marco; Brambilla, Laura; Buccafusca, Maria; Bucciantini, Elisabetta; Bucello, Sebastiano; Buscarinu, Maria Chiara; Cabboi, Maria Paola; Calabrese, Massimiliano; Calabria, Francesca; Caleri, Francesca; Camilli, Federico; Caniatti, Luisa Maria; Cantello, Roberto; Capra, Ruggero; Capuano, Rocco; Carta, Patrizia; Celani, Maria Grazia; Cellerino, Maria; Cerqua, Raffaella; Chisari, Clara; Clerici, Raffaella; Clerico, Marinella; Cola, Gaia; Conte, Antonella; Conti, Marta Zaffira; Cordano, Christian; Cordera, Susanna; Corea, Francesco; Correale, Claudio; Cottone, Salvatore; Crescenzo, Francesco; Curti, Erica; D'Ambrosio, Alessandro; D'Amico, Emanuele; Danni, Maura Chiara; D'Arma, Alessia; Dattola, Vincenzo; de Biase, Stefano; Luca, Giovanna De; Mercanti, Stefania Federica De; De Mitri, Paolo; De Stefano, Nicola; Cava, Marco Della; Napoli, Mario di; Sapio, Alessia Di; Docimo, Renato; Dutto, Anna; Evangelista, Luana; Fanara, Salvatore; Diana, Ferraro; Ferrò, Maria Teresa; Fioretti, Cristina; Fratta, Mario; Frau, Jessica; Fronza, Marzia; Furlan, Roberto; Gajofatto, Alberto; Gallo, Antonio; Gallo, Paolo; Gasperini, Claudio; Ghazaryan, Anna; Giometto, Bruno; Gobbin, Francesca; Govone, Flora; Granella, Franco; Grange, Erica; Grasso, Maria Grazia; Guareschi, Angelica; Guaschino, Clara; Guerrieri, Simone; Guidetti, Donata; Iaffaldano, Pietro; Ianniello, Antonio; Iasevoli, Luigi; Imperiale, Daniele; Infante, Maria Teresa; Iodice, Rosa; Iovino, Aniello; Konrad, Giovanna; Landi, Doriana; Lanzillo, Roberta; Lapucci, Caterina; Lavorgna, Luigi; L'Episcopo, Maria Rita; Leva, Serena; Liberatore, Giuseppe; Lo Re, Marianna; Longoni, Marco; Lopiano, Leonardo; Lorefice, Lorena; Lucchini, Matteo; Lus, Giacomo; Maimone, Davide; Malentacchi, Maria; Mallucci, Giulia; Malucchi, Simona; Mancinelli, Chiara Rosa; Mancinelli, Luca; Manganotti, Paolo; Maniscalco, Giorgia Teresa; Mantero, Vittorio; Marangoni, Sabrina; Marastoni, Damiano; Marinelli, Fabiana; Marti, Alessandro; Boneschi, Filippo Martinelli; Masserano Zoli, Federco; Matta, Francesca; Mendozzi, Laura; Meucci, Giuseppe; Miante, Silvia; Miele, Giuseppina; Milano, Eva; Mirabella, Massimiliano; Missione, Rosanna; Moccia, Marcello; Moiola, Lucia; Montepietra, Sara; Montibragadin, Margherita; Montini, Federico; Motta, Roberta; Nardone, Raffaele; Nicoletti, Carolina Gabri; Nobile-Orazio, Eduardo; Nozzolillo, Agostino; Onofrj, Marco; Orlandi, Riccardo; Palmieri, Anna; Paolicelli, Damiano; Pasquali, Livia; Pastò, Luisa; Pedrazzoli, Elisabetta; Petracca, Maria; Petrone, Alfredo; Piantadosi, Carlo; Pietroboni, Anna M; Pinardi, Federica; Ponzano, Marta; Portaccio, Emilio; Pozzato, Mattia; Pozzilli, Carlo; Prosperini, Luca; Protti, Alessandra; Ragonese, Paolo; Rasia, Sarah; Realmuto, Sabrina; Repice, Anna; Rigoni, Eleonora; Rilla, Maria Teresa; Rinaldi, Francesca; Romano, Calogero Marcello; Ronzoni, Marco; Rovaris, Marco; Ruscica, Francesca; Sabattini, Loredana; Salemi, Giuseppe; Saraceno, Lorenzo; Sartori, Alessia; Sartori, Arianna; Sbragia, Elvira; Scarano, Giuditta Ilaria; Scarano, Valentina; Schillaci, Valentina; Sessa, Maria; Sgarito, Caterina; Sibilia, Grazia; Siciliano, Gabriele; Signori, Alessio; Signoriello, Elisabetta; Sinisi, Leonardo; Sireci, Francesca; Sola, Patrizia; Solaro, Claudio; Sotgiu, Stefano; Sparaco, Maddalena; Stromillo, Maria Laura; Strumia, Silvia; Susani, Emanuela Laura; Tabiadon, Giulietta; Teatini, Francesco; Tomassini, Valentina; Tonietti, Simone; Torri, Clerici Valentina; Tortorella, Carla; Toscano, Simona; Totaro, Rocco; Trotta, Maria; Turano, Gabriella; Ulivelli, Monica; Valentino, Manzo; Vaula, Giovanna; Vecchio, Domizia; Vercellino, Marco; Verrengia, Elena Pinuccia; Vianello, Marika; Virgilio, Eleonora; Vitetta, Francesca; Vollaro, Stefano; Zaffaroni, Mauro; Zampolini, Mauro; Zarbo, Ignazio Roberto; Zuliani, Luigi. - In: NEUROLOGY® NEUROIMMUNOLOGY & NEUROINFLAMMATION. - ISSN 2332-7812. - 9:1(2022). [10.1212/nxi.0000000000001105]
COVID-19 severity in multiple sclerosis
Sormani, Maria Pia;Zito, Antonio;Patti, Francesco;Salvetti, Marco;Baione, Viola;Bellucci, Gianmarco;Bonavita, Simona;Borriello, Giovanna;Buscarinu, Maria Chiara;Conte, Antonella;Correale, Claudio;d'Ambrosio, Alessandro;De Stefano, Nicola;Napoli, Mario di;Gasperini, Claudio;Ianniello, Antonio;Lopiano, Leonardo;Mancinelli, Luca;Palmieri, Anna;Paolicelli, Damiano;Petracca, Maria;Pozzilli, Carlo;Prosperini, Luca;Rovaris, Marco;Salemi, Giuseppe;Scarano, Valentina;Siciliano, Gabriele;Signori, Alessio;
2022
Abstract
Background and Objectives It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian ageand sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon.| File | Dimensione | Formato | |
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