Associations of DMT therapies with COVID-19 severity in multiple sclerosis
| Autor: | Tomas Kalincik, Nick Rijke, Ingrid van der Mei, Clare Walton, Clément Gautrais, Stefan Braune, Yves Moreau, Tim Spelman, Robert McBurney, Georgina Arrambide, Guilherme Sciascia do Olival, Juan Ignacio Rojas, Edward De Brouwer, Jan Hillert, Amin Ardeshirdavani, Ashkan Pirmani, Giancarlo Comi, Lotte Geys, Anna Glaser, Alice Estavo Dias, Alexander Stahmann, Doralina Guimarães Brum, Alexander Fidao, Melinda Magyari, Rumen Ivanov, Lars Forsberg, Amber Salter, Rodden M. Middleton, Nikola Lazovski, Anneke van der Walt, R. Alroughani, Serkan Ozakbas, Liesbet M. Peeters, Helmut Butzkueven, Maria Fernanda Mendes, Anibal Chertcoff, Arnfin Bergmann, Hollie Schmidt, Nupur Nag, Tina Parciak, Richard Nicholas, Gilles Edan, Steve Simpson-Yap, Robert J. Fox, Johana Bauer, Ricardo Alonso, Anna Zabalza |
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| Rok vydání: | 2021 |
| Předmět: |
Artificial ventilation
medicine.medical_specialty business.industry medicine.medical_treatment Multiple sclerosis Logistic regression medicine.disease 3. Good health 03 medical and health sciences 0302 clinical medicine Natalizumab Internal medicine Cohort Medicine Ocrelizumab Rituximab 030212 general & internal medicine Risk factor business 030217 neurology & neurosurgery medicine.drug |
| Popis: | BackgroundPeople 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.MethodsData from 12 data-sources in 28 countries were aggregated. Demographic and clinical covariates were queried, alongside COVID-19 clinical severity outcomes, hospitalisation, admission to ICU, requiring artificial ventilation, and death. Characteristics of outcomes were assessed in patients with suspected/confirmed COVID-19 using multilevel mixed-effects logistic regression.Results657 (28.1%) with suspected and 1,683 (61.9%) with confirmed COVID-19 were analysed. 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 were associated 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.ConclusionsUsing 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, suggesting their use may be a risk factor for more severe COVID-19. |
| Databáze: | OpenAIRE |
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