RT Journal Article SR Electronic T1 Risk of Getting COVID-19 in People With Multiple Sclerosis JF Neurology - Neuroimmunology Neuroinflammation JO Neurol Neuroimmunol Neuroinflamm FD Lippincott Williams & Wilkins SP e1141 DO 10.1212/NXI.0000000000001141 VO 9 IS 2 A1 Pietro Iaffaldano A1 Giuseppe Lucisano A1 Alessia Manni A1 Damiano Paolicelli A1 Francesco Patti A1 Marco Capobianco A1 Vincenzo Brescia Morra A1 Patrizia Sola A1 Ilaria Pesci A1 Giacomo Lus A1 Giovanna De Luca A1 Alessandra Lugaresi A1 Paola Cavalla A1 Sara Montepietra A1 Giorgia Teresa Maniscalco A1 Franco Granella A1 Paolo Ragonese A1 Marika Vianello A1 Laura Brambilla A1 Rocco Totaro A1 Simona Toscano A1 Simona Malucchi A1 Maria Petracca A1 Lucia Moiola A1 Diana Ferraro A1 Vito Lepore A1 Paola Mosconi A1 Michela Ponzio A1 Gioacchino Tedeschi A1 Giancarlo Comi A1 Mario Alberto Battaglia A1 Massimo Filippi A1 Maria Pia Amato A1 Maria Trojano A1 , YR 2022 UL http://nn.neurology.org/content/9/2/e1141.abstract AB 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 A case-control (1:2) study was set up. Cases included PwMS with a confirmed diagnosis of COVID-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 administered DMT, previous DMT sequences, 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 contracting COVID-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.DMT=disease-modifying therapy; EC=ethical committee; EDSS=Expanded Disability Status Scale; IMSR=Italian MS Register; IQR=interquartile range; MedDRA=Medical Dictionary for Regulatory Activities; MoA=mechanisms of action; MS=multiple sclerosis; PS=propensity score; PwMS=people with multiple sclerosis