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

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

How the COVID-19 Pandemic has changed multiple sclerosis clinical practice: Results of a nationwide provider survey

“…The published literature suggests partial support for these approaches. For example, the Musc 19 Study Group retrospectively evaluated 844 Italian adults with MS who had had suspected or confirmed COVID-19 infection (Sormani et al, 2021) and found that treatment with a B cell-depleting therapy was an independent risk factor for severe COVID-19 infection, while treatment with other MS disease-modifying therapies (including alemtuzumab or cladribine) was not.…”

COVID-19 in Patients with Multiple Sclerosis: Associations with Disease-Modifying Therapies

“…Minority populations, such as those of Black/African ancestry and Hispanic ethnicity, have a higher morbidity and mortality with COVID [27,28]. Morbidity in these populations is amplified by older age, MS disability, and comorbidities, all associated with a higher risk of acquiring COVID-19 and a more severe clinical course of infection [26,27,[29][30][31][32][33].…”

Alemtuzumab in Covid era

“…Case studies have demonstrated that patients in treatment with B-cell depleting recovered from SARS-CoV-2 infection, affirming that innate and/or acquired protective mechanisms against the virus remain effective [6]. However, more recent worldwide data have indicated an increased risk of serious infections for patients on these therapies [7]. Furthermore, a large European prospective cohort study (RADAR-CNS) identified a trend for increased risk of SARS-CoV-2 infection in patients taking alemtuzumab or cladribine compared to injectable drugs independently of age, sex and disease course.…”