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.

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Livia Pasquali
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.
2021
P Sormani, Maria; 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; A Battaglia, Mario; Patti, Francesco; Salvetti and Musc-19 Study Group Agostino Nozzolillo, Marco; Bellacosa, Alessandra; Protti, Alessandra; Di Sapio, Alessia; Signori, Alessio; Petrone, Alfredo; Bisecco, Alvino; Iovino, Aniello; Dutto, Anna; Maria Repice, Anna; Conte, Antonella; Bertolotto, Antonio; Bosco, Antonio; Gallo, Antonio; Zito, Antonio; Sartori, Arianna; Giometto, Bruno; Tortorella, Carla; Antozzi, Carlo; Rosa Mancinelli, Chiara; Zanetta, Chiara; Cordano, Christian; Scandellari, Cinzia; Guaschino, Clara; Gasperini, Claudio; Solaro, Claudio; Fioretti, Cristina; Bezzini, Daiana; Marastoni, Damiano; Paolicelli, Damiano; Vecchio, Domizia; Landi, Doriana; Bucciantini, Elisabetta; Pedrazzoli, Elisabetta; Signoriello, Elisabetta; Sbragia, Elvira; Laura Susani, Emanuela; Curti, Erica; Milano, Eva; Marinelli, Fabiana; Camilli, Federico; Martinelli Boneschi, Filippo; Ferrari Centre, Dino; Govone, Flora; Bovis, Francesca; Calabria, Francesca; Caleri, Francesca; Rinaldi, Francesca; Vitetta, Francesca; Corea, Francesco; Crescenzo, Francesco; Teatini, Francesco; Tabiadon, Giulietta; Granella Giacomo Boffa, Franco; Lus, Giacomo; Brichetto, Giampaolo; Teresa Maniscalco, Giorgia; Borriello, Giovanna; De Luca, Giovanna; Konrad, Giovanna; Vaula, Giovanna; Alessandra Marfia, Girolama; Mallucci, Giulia; Liberatore, Giuseppe; Salemi, Giuseppe; Miele Grazia Sibilia, Giuseppina; Pesci, Ilaria; Brambilla, Laura; Lopiano, Leonardo; Sinisi, Leonardo; Pasquali, Livia; Saraceno, Lorenzo; Chiveri, Luca; Mancinelli, Luca; Grimaldi, Luigi M. E.; Maria Caniatti, Luisa; Della Cava, Marco; Onofrj, Marco; Rovaris, Marco; Vercellino, Marco; Monti Bragadin, Margherita; Buccafusca, Maria; Chiara Buscarinu, Maria; Grazia Celani, Maria; Grazia Grasso, Maria; Laura Stromillo, Maria; Petracca, Maria; Pia Amato, Maria; Rita, Maria; Maria Sessa, Alba; Teresa Ferrò, Maria; Vittoria Ercolani, Maria; Bianco, Mariangela; Lo Re, Marianna; Vianello, Marika; Clerico, Marinella; di Napoli, Mario; Ponzano, Marta; Zaffira Conti, Marta; Calabrese, Massimiliano; Mirabella, Massimiliano; Filippi, Massimo; Inglese, Matilde; Lucchini, Matteo; Pozzato, Matteo; Chiara Danni, Maura; Zaffaroni, Mauro; Zampolini, Mauro; Ponzio, Michela; De Riz, Milena; Ferrari Centre, Dino; De Stefano, Nicola; Cavalla, Paola; De Mitri, Paola; Grossi, Paola; Confalonieri Centro Sclerosi Multipla, Paolo; Gallo, Paolo; Ragonese, Paolo; Sola, Patrizia; Annovazzi, Pietro; Iaffaldano, Pietro; Nardone, Raffaele; Cerqua, Raffaella; Clerici, Raffaella; Lanzillo, Roberta; Motta, Roberta; Balgera, Roberto; Bergamaschi, Roberto; Totaro, Rocco; Iodice, Rosa; Capra, Ruggero; Marangoni, Sabrina; Realmuto, Sabrina; Cottone, Salvatore; Montepietra, Sara; Rasia, Sarah; Arena, Sebastiano; Bucello, Sebastiano; Banfi, Silvia; Bonavita, Simona; Malucchi, Simona; Tonietti, Simone; Vollaro, Stefano; Cordera, Susanna; Aguglia, Umberto; Torri Clerici, Valentina; Barcella, Valeria; Bergamaschi, Valeria; Brescia Morra, Vincenzo; Dattola, Vincenzo; Mantero, Vittorio
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1103217
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