Melbourne, Australia—
Multiple sclerosis (MS) patients face heightened risks from COVID-19, and earlier research has shown that older age, higher levels of disability, and progressive forms of the disease are associated with severe illness. It has been unknown, however, how much disease-modifying therapies (DMTs) affect that risk.

“Given the many approved MS DMTs and the relatively low frequency of COVID-19 in MS patients per country, international data sharing is desirable to examine the impact of DMTs on COVID-19 severity,” according to a presentation at MS Virtual 2020, a joint meeting of the Americas Committee for Treatment and Research in Multiple Sclerosis and the European Committee for Treatment and Research in Multiple Sclerosis ECTRIMS. 

University of Melbourne–led researchers presented the first results of the COVID-19 in an MS global data-sharing initiative. This is an initiative by the MS International Federation and MS Data Alliance and many other data partners to inform MS clinical management during the COVID-19 pandemic.

The authors aggregated clinician-reported data from 21 countries into a dataset of 1,540 patients. For the patients with confirmed or suspected COVID-19 infection, the study team assessed characteristics of admission to hospital, admission to intensive care unit (ICU), need for artificial ventilation, and death. Also considered were age, sex, MS type, and Expanded Disability Status Scale (EDSS).

Results indicate that older age, progressive MS, and higher EDSS were associated with higher frequencies of severe outcomes. In terms of medication therapy, anti-CD20 DMTs ocrelizumab and rituximab were positively associated with hospital admission (aPRs = 1.19 and 1.58), ICU admission (aPRs = 3.53 and 4.12), and the need for artificial ventilation (aPRs = 3.17 and 7.27) compared with dimethyl fumarate, according to the report.

The authors point out that higher frequencies of all three outcomes were associated with combined anti-CD20 DMT use compared to all other DMTs (hospitalization aPR = 1.49; ICU aPR = 2.55; ventilation aPR = 3.05) and compared to natalizumab (hospitalization aPR = 1.99; ICU aPR = 2.39; ventilation aPR = 2.84).

“Importantly, associations persisted on restriction to confirmed COVID-19 cases and upon exclusion of each contributing data source in turn,” the study concludes. “No associations were observed between DMTs and death.”

The authors emphasize that the study demonstrates “a consistent association of anti-CD20 DMTs with hospitalization, ICU admission and use of artificial ventilation suggesting their use among MS patients at risk for COVID-19 exposure may be a risk factor for more severe COVID-19 disease. To address study limitations, further research incorporating comorbidities, smoking and body mass index is required. Alternative study designs are needed to address questions on COVID-19 susceptibility among people with MS.”

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