47 research outputs found
Risk of Getting COVID-19 in People With Multiple Sclerosis
Background and Objectives
Several studies have assessed risk factors associated with the severity of COVID-19 outcomes in
people with multiple sclerosis (PwMS). The potential role of disease-modifying therapies
(DMTs) and demographic and clinical factors on the risk of acquiring SARS-CoV-2 infection
has not been evaluated so far. The objective of this study was to assess risk factors of contracting
SARS-CoV-2 infection in PwMS by using data collected in the Italian MS Register (IMSR).
Methods
Acase-control (1:2) studywas set up. Cases included PwMSwith a confirmed diagnosis ofCOVID-19,
and controls included PwMS without a confirmed diagnosis of COVID-19. Both groups were propensity
score–matched by the date of COVID-19 diagnosis, the date of last visit, and the region of
residence. No healthy controls were included in this study. COVID-19 risk was estimated by multivariable
logistic regression models including demographic and clinical covariates. The impact of DMTs
was assessed in 3 independent logistic regression models including one of the following covariates: last
administeredDMT, previousDMTsequences, or the place where the last treatment was administered.
Results
A total of 779 PwMS with confirmed COVID-19 (cases) were matched to 1,558 PwMS without
COVID-19 (controls). In all 3 models, comorbidities, female sex, and a younger age were significantly
associated (p < 0.02)with a higher risk of contractingCOVID-19. Patients receiving natalizumab as last
DMT(OR[95%CI]: 2.38 [1.66–3.42], p < 0.0001) and those who underwent an escalation treatment
strategy (1.57 [1.16–2.13], p = 0.003) were at significantly higher COVID-19 risk. Moreover, PwMS receiving their last DMT requiring
hospital access (1.65 [1.34–2.04], p < 0.0001) showed a significant higher risk than those taking self-administered DMTs at home.
Discussion
This case-control study embedded in the IMSR showed that PwMS at higher COVID-19 risk are younger, more frequently
female individuals, and with comorbidities. Long-lasting escalation approach and last therapies that expose patients to the
hospital environment seem to significantly increase the risk of SARS-CoV2 infection in PwMS.
Classification of Evidence
This study provides Class III evidence that among patients with MS, younger age, being female individuals, having more
comorbidities, receiving natalizumab, undergoing an escalating treatment strategy, or receiving treatment at a hospital were
associated with being infected with COVID-19. Among patients with MS who were infected with COVID-19, a severe course
was associated with increasing age and having a progressive form of MS, whereas not being on treatment or receiving an
interferon beta agent was protective
Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis
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
COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context
Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon
DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France
We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon
Immunoreactivity of GAD-Ab-positive sera on rat hippocampal neurons in culture
4nonenoneItalian Association of Neuropathologists; VIANELLO M; VASSANELLI S; MUCIGNAT C.; GIOMETTO BVianello, M; Vassanelli, S; Mucignat, C.; Giometto,
Reactivity of GAD-Ab positive sera on cultures of rat hippocampal neurons
4nonenone-; VIANELLO M; VASSANELLI S; MUCIGNAT C.; GIOMETTO BVianello, M; Vassanelli, S; Mucignat, C.; Giometto,
Morphological and functional analysis of the effect of GAD-antibody positive sera on rat hippocampal neurons in culture
5nonenoneM. Vianello; C. Mucignat; S. Vassanelli; K. Fountzoulas; B. GiomettoVianello, M.; Mucignat, C.; Vassanelli, S.; Fountzoulas, K.; Giometto, B