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 Iaffaldano, Pietro
A1 Lucisano, Giuseppe
A1 Manni, Alessia
A1 Paolicelli, Damiano
A1 Patti, Francesco
A1 Capobianco, Marco
A1 Brescia Morra, Vincenzo
A1 Sola, Patrizia
A1 Pesci, Ilaria
A1 Lus, Giacomo
A1 De Luca, Giovanna
A1 Lugaresi, Alessandra
A1 Cavalla, Paola
A1 Montepietra, Sara
A1 Maniscalco, Giorgia Teresa
A1 Granella, Franco
A1 Ragonese, Paolo
A1 Vianello, Marika
A1 Brambilla, Laura
A1 Totaro, Rocco
A1 Toscano, Simona
A1 Malucchi, Simona
A1 Petracca, Maria
A1 Moiola, Lucia
A1 Ferraro, Diana
A1 Lepore, Vito
A1 Mosconi, Paola
A1 Ponzio, Michela
A1 Tedeschi, Gioacchino
A1 Comi, Giancarlo
A1 Battaglia, Mario Alberto
A1 Filippi, Massimo
A1 Amato, Maria Pia
A1 Trojano, Maria
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