Disease‐Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis. Issue 4 (9th February 2021)

• Record Type: Journal Article
• Authors: 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
• Other Names: Nozzolillo Agostino investigator.; Bellacosa Alessandra investigator.; Protti Alessandra investigator.; Di Sapio Alessia investigator.; Signori Alessio investigator.; Petrone Alfredo investigator.; Bisecco Alvino investigator.; Iovino Aniello investigator.; Dutto Anna investigator.; Repice Anna Maria investigator.; Conte Antonella investigator.; Bertolotto Antonio investigator.; Bosco Antonio investigator.; Gallo Antonio investigator.; Zito Antonio investigator.; Sartori Arianna investigator.; Giometto Bruno investigator.; Tortorella Carla investigator.; Antozzi Carlo investigator.; Pozzilli Carlo investigator.; Mancinelli Chiara Rosa investigator.; Zanetta Chiara investigator.; Cordano Christian investigator.; Cordioli Cinzia investigator.; Scandellari Cinzia investigator.; Guaschino Clara investigator.; Gasperini Claudio investigator.; Solaro Claudio investigator.; Fioretti Cristina investigator.; Bezzini Daiana investigator.; Marastoni Damiano investigator.; Paolicelli Damiano investigator.; Vecchio Domizia investigator.; Landi Doriana investigator.; Bucciantini Elisabetta investigator.; Pedrazzoli Elisabetta investigator.; Signoriello Elisabetta investigator.; Sbragia Elvira investigator.; Susani Emanuela Laura investigator.; Curti Erica investigator.; Milano Eva investigator.; Marinelli Fabiana investigator.; Camilli Federico investigator.; Boneschi Filippo Martinelli investigator.; Govone Flora investigator.; Bovis Francesca investigator.; Calabria Francesca investigator.; Caleri Francesca investigator.; Rinaldi Francesca investigator.; Vitetta Francesca investigator.; Corea Francesco investigator.; Crescenzo Francesco investigator.; Patti Francesco investigator.; Teatini Francesco investigator.; Tabiadon Giulietta investigator.; Granella Franco investigator.; Boffa Giacomo investigator.; Lus Giacomo investigator.; Brichetto Giampaolo investigator.; Comi Giancarlo investigator.; Tedeschi Gioacchino investigator.; Maniscalco Giorgia Teresa investigator.; Borriello Giovanna investigator.; De Luca Giovanna investigator.; Konrad Giovanna investigator.; Vaula Giovanna investigator.; Marfia Girolama Alessandra investigator.; Mallucci Giulia investigator.; Liberatore Giuseppe investigator.; Salemi Giuseppe investigator.; Miele Giuseppina investigator.; Sibilia Grazia investigator.; Pesci Ilaria investigator.; Schiavetti Irene investigator.; Brambilla Laura investigator.; Lopiano Leonardo investigator.; Sinisi Leonardo investigator.; Pasquali Livia investigator.; Saraceno Lorenzo investigator.; Carmisciano Luca investigator.; Chiveri Luca investigator.; Mancinelli Luca investigator.; Moiola Lucia investigator.; Grimaldi Luigi M.E. investigator.; Caniatti Luisa Maria investigator.; Capobianco Marco investigator.; Cava Marco Della investigator.; Onofrj Marco investigator.; Rovaris Marco investigator.; Salvetti Marco investigator.; Vercellino Marco investigator.; Bragadin Margherita Monti investigator.; Buccafusca Maria investigator.; Buscarinu Maria Chiara investigator.; Celani Maria Grazia investigator.; Grasso Maria Grazia investigator.; Stromillo Maria Laura investigator.; Petracca Maria investigator.; Amato Maria Pia investigator.; Sormani Maria Pia investigator.; L'Episcopo Maria Rita investigator.; Sessa Maria investigator.; Ferrò Maria Teresa investigator.; Trojano Maria investigator.; Ercolani Maria Vittoria investigator.; Bianco Mariangela investigator.; Re Marianna Lo investigator.; Vianello Marika investigator.; Clerico Marinella investigator.; Battaglia Mario Alberto investigator.; di Napoli Mario investigator.; Ponzano Marta investigator.; Radaelli Marta investigator.; Conti Marta Zaffira investigator.; Calabrese Massimiliano investigator.; Mirabella Massimiliano investigator.; Filippi Massimo investigator.; Inglese Matilde investigator.; Lucchini Matteo investigator.; Pozzato Matteo investigator.; Danni Maura Chiara investigator.; Zaffaroni Mauro investigator.; Zampolini Mauro investigator.; Ponzio Michela investigator.; De Riz Milena investigator.; De Rossi Nicola investigator.; De Stefano Nicola investigator.; Cavalla Paola investigator.; De Mitri Paola investigator.; Grossi Paola investigator.; Zaratin Paola investigator.; Confalonieri Paolo investigator.; Gallo Paolo investigator.; Immovilli Paolo investigator.; Ragonese Paolo investigator.; Sola Patrizia investigator.; Annovazzi Pietro investigator.; Iaffaldano Pietro investigator.; Nardone Raffaele investigator.; Cerqua Raffaella investigator.; Clerici Raffaella investigator.; Lanzillo Roberta investigator.; Motta Roberta investigator.; Balgera Roberto investigator.; Bergamaschi Roberto investigator.; Totaro Rocco investigator.; Iodice Rosa investigator.; Capra Ruggero investigator.; Marangoni Sabrina investigator.; Realmuto Sabrina investigator.; Cottone Salvatore investigator.; Montepietra Sara investigator.; Rasia Sarah investigator.; Arena Sebastiano investigator.; Bucello Sebastiano investigator.; Banfi Silvia investigator.; Bonavita Simona investigator.; Malucchi Simona investigator.; Tonietti Simone investigator.; Vollaro Stefano investigator.; Cordera Susanna investigator.; Aguglia Umberto investigator.; Clerici Valentina Torri investigator.; Barcella Valeria investigator.; Bergamaschi Valeria investigator.; Morra Vincenzo Brescia investigator.; Dattola Vincenzo investigator.; Mantero Vittorio investigator.;
• Is Part Of: Annals of neurology. Volume 89:Issue 4(2021)
• Page Start: 780
• Page End: 789
• Publication Date: 2021-02-09
• Subjects: Neurology -- Periodicals; Pediatric neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; 616.8
• DOI: 10.1002/ana.26028
• Languages: English
• ISSNs: 0364-5134

Abstract

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