No Cover Image

Journal article 20 views 1 download

Associations of Disease-Modifying Therapies With COVID-19 Severity in Multiple Sclerosis / Steve Simpson-Yap, Edward De Brouwer, Tomas Kalincik, Nick Rijke, Jan A. Hillert, Clare Walton, Gilles Edan, Yves Moreau, Tim Spelman, Lotte Geys, Tina Parciak, Clement Gautrais, Nikola Lazovski, Ashkan Pirmani, Amin Ardeshirdavanai, Lars Forsberg, Anna Glaser, Robert McBurney, Hollie Schmidt, Arnfin B. Bergmann, Stefan Braune, Alexander Stahmann, Rod Middleton, Amber Salter, Robert J. Fox, Anneke van der Walt, Helmut Butzkueven, Raed Alroughani, Serkan Ozakbas, Juan I. Rojas, Ingrid van der Mei, Nupur Nag, Rumen Ivanov, Guilherme Sciascia do Olival, Alice Estavo Dias, Melinda Magyari, Doralina Brum, Maria Fernanda Mendes, Ricardo N. Alonso, Richard S. Nicholas, Johana Bauer, Aníbal Sebastián Chertcoff, Anna Zabalza, Georgina Arrambide, Alexander Fidao, Giancarlo Comi, Liesbet Peeters

Neurology, Volume: 97, Issue: 19, Pages: e1870 - e1885

Swansea University Author: Rod Middleton

  • 58429.pdf

    PDF | Version of Record

    © 2021 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY)

    Download (747.75KB)

Abstract

People with multiple sclerosis (MS) are a vulnerable group for severe COVID- 19, particularly those taking immunosuppressive disease-modifying therapies (DMTs). We examined the characteristics of COVID-19 severity in an international sample of people with MS. Data from 12 data-sources in 28 countrie...

Full description

Published in: Neurology
ISSN: 0028-3878 1526-632X
Published: Ovid Technologies (Wolters Kluwer Health) 2021
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa58429
Tags: Add Tag
No Tags, Be the first to tag this record!
Abstract: People with multiple sclerosis (MS) are a vulnerable group for severe COVID- 19, particularly those taking immunosuppressive disease-modifying therapies (DMTs). We examined the characteristics of COVID-19 severity in an international sample of people with MS. Data from 12 data-sources in 28 countries were aggregated (sources could include patients from 1-12 countries). Demographic (age, sex), clinical (MS-phenotype, disability), and DMT (untreated, alemtuzumab, cladribine, dimethyl-fumarate, glatiramer acetate, interferon, natalizumab, ocrelizumab, rituximab, siponimod, other DMTs) covariates were queried, alongside COVID-19 severity outcomes, hospitalisation, ICU admission, requiring artificial ventilation, and death. Characteristics of outcomes were assessed in patients with suspected/confirmed COVID-19 using multilevel mixed-effects logistic regression, adjusted for age, sex, MS-phenotype, and EDSS. 657(28.1%) with suspected and 1,683(61.9%) with confirmed COVID-19 were analysed. Among suspected+confirmed and confirmed-only COVID-19, 20.9% and 26.9% were hospitalised, 5.4% and 7.2% were admitted to ICU, 4.1% and 5.4% required artificial ventilation, and 3.2% and 3.9% died. Older age, progressive MS-phenotype, and higher disability were associated with worse COVID-19 outcomes. Compared to dimethyl-fumarate, ocrelizumab and rituximab were associated with hospitalisation (aOR=1.56,95%CI=1.01- 2.41; aOR=2.43,95%CI=1.48-4.02) and ICU admission (aOR=2.30,95%CI=0.98-5.39;aOR=3.93,95%CI=1.56-9.89), though only rituximab was associated with higher risk of artificial ventilation (aOR=4.00,95%CI=1.54-10.39). Compared to pooled other DMTs, ocrelizumab and rituximab were associated with hospitalisation (aOR=1.75,95%CI=1.29- 2.38; aOR=2.76,95%CI=1.87-4.07) and ICU admission (aOR=2.55,95%CI=1.49-4.36;aOR=4.32,95%CI=2.27-8.23) but only rituximab with artificial ventilation (aOR=6.15,95%CI=3.09-12.27). Compared to natalizumab, ocrelizumab and rituximab wereassociated with hospitalisation (aOR=1.86,95%CI=1.13-3.07; aOR=2.88,95%CI=1.68-4.92) and ICU admission (aOR=2.13,95%CI=0.85-5.35; aOR=3.23,95%CI=1.17-8.91), but only rituximab with ventilation (aOR=5.52,95%CI=1.71-17.84). Importantly, associations persisted on restriction to confirmed COVID-19 cases. No associations were observed between DMTs and death. Stratification by age, MS-phenotype, and EDSS found no indications that DMT associations with COVID-19 severity reflected differential DMT allocation by underlying COVID-19 severity. Using the largest cohort of people with MS and COVID-19 available, we demonstrated consistent associations of rituximab with increased risk of hospitalisation, ICU admission, and requiring artificial ventilation, and ocrelizumab with hospitalisation and ICU admission. Despite the study's cross-sectional design, the internal and external consistency of these results with prior studies suggests rituximab/ocrelizumab use may be a risk factor for more severe COVID-19.
College: Swansea University Medical School
Issue: 19
Start Page: e1870
End Page: e1885