Disease modifying therapies and Covid-19 severity in Multiple Sclerosis

Maria Pia Sormani, Nicola De Rossi, Irene Schiavetti, Luca Carmisciano, Cinzia Cordioli, Lucia Moiola, Marta Radaelli, Paolo Immovilli, Marco Capobianco, Maria Trojano, Paola Zaratin, Gioacchino Tedeschi, Giancarlo Comi, Mario Alberto Battaglia, Francesco Patti, Marco Salvetti
Annals of Neurology 2021 January 21

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.

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