COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Sormani MP, 6.; Schiavetti, I; Carmisciano, L; Cordioli, C; Filippi, M; Radaelli, M; Immovilli, P; Capobianco, M; De Rossi, N; Brichetto, G; Cocco, E; Scandellari, C; Cavalla, P; Pesci, I; Zito, A; Confalonieri, P; Marfia, Ga; Perini, P; Inglese, M; Trojano, M; Brescia Morra, V; Tedeschi, G; Comi, G; Battaglia, Ma; Patti, F; Salvetti, M; MuSC-19 Study, Group. Abbadessa G.; Aguglia, U.; Allegri Rossi, B. Amato M. P.; Annovazzi, P. Antozzi C.; Appendino, L.; Arena, S.; Baione, V.; Balgera, R.; Baroncini, D.; Barrilà, C.; Bellacosa, A.; Bellucci, G.; Bergamaschi, R.; Bergamaschi, V.; Bezzini, D.; Biolzi, B.; Bisecco, A.; Bonavita, S.; Borriello, G.; Bosco, A.; Bovis, F.; Bozzali, M.; Brambilla, L.; Brescia Morra, V. F.; Buccafusca, M.; Bucciantini, E.; Bucello, S.; Buscarinu, M. C.; Cabboi, M. P.; Calabrese, M.; Calabria, F.; Caleri, F.; Camilli, F.; Caniatti, L. M.; Cantello, R.; Capobianco, M.; Capra, R.; Capuano, R.; Carmisciano, L.; Carta, P.; Cavalla, P.; Celani, M. G.; Cellerino, M.; Cerqua, R.; Chisari, C.; Clerici, R.; Clerico, M.; Cocco, E.; Cola, G.; Comi, G.; Confalonieri, P.; Conte, A.; Conti, M. Z.; Cordera, S.; Cordioli, C.; Corea, F.; Correale, C.; Cottone, S.; Crescenzo, F.; Curti, E.; D'Ambrosio, A.; D'Amico, E.; Danni, M.; Dattola, V.; De Biase, S.; De Luca, G.; De Mercanti, S. F.; De Mitri, P.; De Rossi, N.; De Stefano, N.; Della Cava, M.; Di Sapio, A.; Docimo, R.; Dutto, A.; Evangelista, L.; Fanara, S.; Ferraro, D.; Ferrò, M. T.; Filippi, M.; Fioretti, C.; Fratta, M.; Frau, J.; Fronza, M.; Gajofatto, A.; Gallo, A.; Gallo, P.; Gasperini, C.; Ghazaryan, A.; Gobbin, F.; Govone, F.; Granella, F.; Grange, E.; Grasso, M. G.; Guareschi, A.; Guaschino, C.; Guerrieri, S.; Guidetti, D.; Iaffaldano, P.; Ianniello, A.; Iasevoli, L.; Immovilli, P.; Imperiale, D.; Infante, M. T.; Inglese, M.; Iodice, R.; Iovino, A.; Konrad, G.; Landi, D.; Lanzillo, R.; Lapucci, C.; Lavorgna, L.; L'Episcopo, M. R.; Leva, S.; Liberatore, G.; Lo Re, M.; Longoni, M.; Lopiano, L.; Lorefice, L.; Lucchini, M.; Lus, G.; Maimone, D.; Malentacchi, M.; Mallucci, G.; Malucchi, S.; Mancinelli, C. R.; Mancinelli, L.; Manganotti, P.; Maniscalco, G. T.; Mantero, V.; Marangoni, S.; Marastoni, D; Marfia, G. A.; Marinelli, F.; Marti, A.; Martinelli Boneschi, F.; Masserano Zoli, F.; Matta, F.; Mendozzi, L.; Meucci, G.; Miante, S.; Miele, G.; Milano, E.; Mirabella, M.; Missione, R.; Moccia, M. F.; Moiola, L.; Montepietra, S.; Montibragadin, M.; Montini, F.; Motta, R.; Nardone, R.; Nicoletti, C. G.; Nozzolillo, A.; Orlandi, R.; Palmieri, A.; Paolicelli, D.; Pasquali, L.; Pastò, L.; Patti, F.; Pedrazzoli, E.; Perini, P.; Pesci, I.; Petracca, M.; Petrone, A.; Piantadosi, C.; Pinardi, F.; Ponzano, M.; Portaccio, E.; Pozzilli, C.; Prosperini, L.; Protti, A.; Radaelli, M.; Ragonese, P.; Rasia, S.; Repice, A.; Rigoni, E.; Rilla, M. T.; Rinaldi, F.; Romano, C. M.; Ronzoni, M.; Ruscica, F.; Sabattini, L.; Salemi, G.; Saraceno, L.; Sartori, A.; Sartori, A.; Sbragia, E.; Scandellari, C.; Scarano, V.; Schiavetti, I.; Sessa, M.; Sibilia, G.; Siciliano, G.; Signori, A.; Signoriello, E.; Sinisi, L.; Sireci, F.; Sola, P.; Solaro, C.; Sotgiu, S.; Sparaco, M.; Stromillo, M. L.; Strumia, S.; Susani, E. L.; Tabiadon, G.; Teatini, F.; Tedeschi, G.; Tonietti, S.; Totaro, R.; Trotta, M.; Ulivelli, M.; Vaula, G.; Vecchio, D.; Vercellino, M.; Verrengia, E. P.; Vianello, M.; Virgilio, E.; Vitetta, F.; Vollaro, S.; Zaffaroni, M.; Zampolini, M.; Zito, A.; Zuliani, L

doi:10.1212/NXI.0000000000001105

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 age- and 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.