期刊
NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION
卷 9, 期 6, 页码 -出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/NXI.0000000000200021
关键词
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资金
- Multiple Sclerosis International Federation (MSIF)
- Multiple Sclerosis Data Alliance (MSDA) under the European Charcot Foundation (ECF)
- Biogen
- Bristol-Myers Squibb
- Canopy Growth Corporation
- Genzyme
- Icometrix
- Merck
- Mylan
- Novartis
- QMENTA
- Quanterix
- Roche
- Med-Day
- Flemish Government under the Onderzoeksprogramma Artificiele Intelligentie (AI) Vlaanderen programme
- Research Foundation Fladers (FWO)
- NHMRC [1129189, 1140766]
This study found that male sex, older age, progressive MS, and higher disability are associated with more severe COVID-19. The use of anti-CD20 medications is also linked to increased severity of COVID-19.
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% CI 2-8), 3% (95% CI 1-5), and 1% (95% CI 0-3) higher probabilities of the 3 respective levels 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 age, progressive MS, and higher disability are associated with more severe course of COVID-19.
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