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

Radaelli M.;Capobianco M.;Tedeschi G.;Lopiano L.
Membro del Collaboration Group
;
Clerico M.
Membro del Collaboration Group
;
Arena S.
Membro del Collaboration Group
;
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.
2021
89
4
780
789
Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized; COVID-19; Dimethyl Fumarate; Female; Fingolimod Hydrochloride; Hospitalization; Humans; Immunologic Factors; Immunosuppressive Agents; Intensive Care Units; Interferons; Male; Middle Aged; Mortality; Multiple Sclerosis; Natalizumab; SARS-CoV-2; Severity of Illness Index; Young Adult
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.; Moiola L.; Grimaldi L.M.E.; Caniatti L.M.; Capobianco M.; Cava M.D.; Onofrj M.; Rovaris M.; Salvetti 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.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1782936
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