Contributors: Simpson-Yap, Steve; PIRMANI, Ashkan; Kalincik, Tomas; DE BROUWER, Edward; GEYS, Lotte; PARCIAK, Tina; Helme, Anne; Rijke, Nick; Hillert, Jan A.; Moreau, Yves; Edan, Gilles; Sharmin, Sifat; Spelman, Tim; McBurney, Robert; Schmidt, Hollie; Bergmann, Arnfin B.; Braune, Stefan; Stahmann, Alexander; Middleton, Rod M.; Salter, Amber; Bebo, Bruce; Van der Walt, Anneke; Butzkueven, Helmut; Ozakbas, Serkan; Boz, Cavit; Karabudak, Rana; Alroughani, Raed; Rojas, Juan I.; van der Mei, Ingrid A.; Sciascia do Olival, Guilherme; Magyari, Melinda; Alonso, Ricardo N.; Nicholas, Richard S.; Chertcoff, Anibal S.; de Torres, Ana Zabalza; Arrambide, Georgina; Nag, Nupur; Descamps, Annabel; Costers, Lars; Dobson, Ruth; Miller, Aleisha; Rodrigues, Paulo; Prčkovska, Vesna; Comi, Giancarlo; PEETERS, Liesbet
نبذة مختصرة : Background and Objectives Certain demographic and clinical characteristics, including the use of some disease-modifying therapies (DMTs), are associated with severe acute respiratory syndrome coronavirus 2 infection severity in people with multiple sclerosis (MS). Comprehensive exploration of these relationships in large international samples is needed. Methods Clinician-reported demographic/clinical data from 27 countries were aggregated into a data set of 5,648 patients with suspected/confirmed coronavirus disease 2019 (COVID-19). COVID-19 severity outcomes (hospitalization, admission to intensive care unit [ICU], requiring artificial ventilation, and death) were assessed using multilevel mixed-effects ordered probit and logistic regression, adjusted for age, sex, disability, and MS phenotype. DMTs were individually compared with glatiramer acetate, and anti-CD20 DMTs with pooled other DMTs and with natalizumab. Results Of 5,648 patients, 922 (16.6%) with suspected and 4,646 (83.4%) with confirmed COVID-19 were included. Male sex, older age, progressive MS, and higher disability were associated with more severe COVID-19. Compared with glatiramer acetate, ocrelizumab and rituximab were associated with higher probabilities of hospitalization (4% [95% CI 1–7] and 7% [95%CI 4–11]), ICU/artificial ventilation (2% [95% CI 0–4] and 4% [95% CI 2–6]), and death (1% [95% CI 0–2] and 2% [95% CI 1–4]) (predicted marginal effects). Untreated patients had 5% (95%CI2–8),3%(95%CI1–5),and1%(95%CI0–3)higherprobabilitiesofthe3respectivelevels of COVID-19 severity than glatiramer acetate. Compared with pooled other DMTs and with natalizumab, the associations of ocrelizumab and rituximab with COVID-19 severity were also more pronounced. All associations persisted/enhanced on restriction to confirmed COVID-19. Discussion Analyzing the largest international real-world data set of people with MS with suspected/confirmed COVID-19 confirms that the use of anti-CD20 medication (both ocrelizumab and rituximab), as well as male sex, older ...
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