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Disease‐Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis
- 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;
- Nozzolillo, Agostino;
- Bellacosa, Alessandra;
- Protti, Alessandra;
- Di Sapio, Alessia;
- Signori, Alessio;
- Petrone, Alfredo;
- Bisecco, Alvino;
- Iovino, Aniello;
- Dutto, Anna;
- Repice, Anna Maria;
- Conte, Antonella;
- Bertolotto, Antonio;
- Bosco, Antonio;
- Gallo, Antonio;
- Zito, Antonio;
- Sartori, Arianna;
- Giometto, Bruno;
- Tortorella, Carla;
- Antozzi, Carlo;
- Pozzilli, Carlo;
- Mancinelli, Chiara Rosa;
- Zanetta, Chiara;
- Cordano, Christian;
- Cordioli, Cinzia;
- 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;
- Susani, Emanuela Laura;
- Curti, Erica;
- Milano, Eva;
- Marinelli, Fabiana;
- Camilli, Federico;
- Boneschi, Filippo Martinelli;
- Govone, Flora;
- Bovis, Francesca;
- Calabria, Francesca;
- Caleri, Francesca;
- Rinaldi, Francesca;
- Vitetta, Francesca;
- Corea, Francesco;
- Crescenzo, Francesco;
- Patti, Francesco;
- Teatini, Francesco;
- Tabiadon, Giulietta;
- Granella, Franco;
- Boffa, Giacomo;
- Lus, Giacomo;
- Brichetto, Giampaolo;
- Comi, Giancarlo;
- Tedeschi, Gioacchino;
- Maniscalco, Giorgia Teresa;
- Borriello, Giovanna;
- De Luca, Giovanna;
- Konrad, Giovanna;
- Vaula, Giovanna;
- Marfia, Girolama Alessandra;
- Mallucci, Giulia;
- Liberatore, Giuseppe;
- Salemi, Giuseppe;
- Miele, Giuseppina;
- Sibilia, Grazia;
- Pesci, Ilaria;
- Schiavetti, Irene;
- Brambilla, Laura;
- Lopiano, Leonardo;
- Sinisi, Leonardo;
- Pasquali, Livia;
- Saraceno, Lorenzo;
- Carmisciano, Luca;
- Chiveri, Luca;
- Mancinelli, Luca;
- Moiola, Lucia;
- Grimaldi, Luigi ME;
- Caniatti, Luisa Maria;
- Capobianco, Marco;
- Della Cava, Marco;
- Onofrj, Marco;
- Rovaris, Marco;
- Salvetti, Marco;
- Vercellino, Marco;
- Bragadin, Margherita Monti;
- Buccafusca, Maria;
- Buscarinu, Maria Chiara;
- Celani, Maria Grazia;
- Grasso, Maria Grazia;
- Stromillo, Maria Laura;
- Petracca, Maria;
- Amato, Maria Pia;
- Sormani, Maria Pia;
- L'Episcopo, Maria Rita;
- Sessa, Maria;
- Ferrò, Maria Teresa;
- Trojano, Maria;
- Ercolani, Maria Vittoria;
- Bianco, Mariangela;
- Re, Marianna Lo;
- Vianello, Marika;
- Clerico, Marinella;
- Battaglia, Mario Alberto;
- di Napoli, Mario;
- Ponzano, Marta;
- Radaelli, Marta;
- Conti, Marta Zaffira;
- Calabrese, Massimiliano;
- Mirabella, Massimiliano;
- Filippi, Massimo;
- Inglese, Matilde;
- Lucchini, Matteo;
- Pozzato, Matteo;
- Danni, Maura Chiara;
- Zaffaroni, Mauro;
- Zampolini, Mauro;
- Ponzio, Michela;
- De Riz, Milena;
- De Rossi, Nicola;
- De Stefano, Nicola;
- Cavalla, Paola;
- De Mitri, Paola;
- Grossi, Paola;
- Zaratin, Paola;
- Confalonieri, Paolo;
- Gallo, Paolo;
- Immovilli, 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;
- Clerici, Valentina Torri;
- Barcella, Valeria;
- Bergamaschi, Valeria;
- Morra, Vincenzo Brescia;
- Dattola, Vincenzo;
- Mantero, Vittorio
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.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.