TITLE Demographic, clinical and treatment factors associated with the risk and severity of Covid-19 in people with Multiple Sclerosis
Demographic, clinical and treatment factors associated with the risk and severity of Covid-19 in people with Multiple Sclerosis
Introduction and aims
The newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV2 or Covid-19) has rapidly spread across the globe becoming a pandemia.
There is a great demand for timely acquired data on the impact of the virus on people with Multiple Sclerosis (PwMS).
Up to 70% of PwMS are treated with disease-modifying therapies (DMTs) which impact the immune response; in turn, these therapeutic agents may expose the patient to increased risk of developing Covid-19 and experiencing worse Covid-19 outcomes than individuals not receiving these agents. Several national and international initiatives have been set up to rapidly collect data about potential risk factors associated with the severity of Covid-19 in PwMS. The majority of these studies have consistently demonstrated male sex, older age, comorbidities, and higher disability as risk factors for a more severe disease course. The role of DMTs in the Covid-19 severity has also been investigated with conflicting results. Different studies showed an increased risk of a severe course for PwMS with a recent use of methylprednisolone and a last therapy with depletive anti-CD20 drugs, while others did not find association between DMT exposure and Covid-19 severity. In addition, some researchers reported a protective role of Interferon beta.
The Italian MS Register offers the possibility to collect data about the complete MS history, in particular data about DMTs exposure and sequences.
In this project, using data collected from the Italian MS Register (IMSR), we conducted for the first time, a case-control study aimed at investigating factors associated with the risk of getting Covid-19. We focused not only on the role of the last administered therapy but also on the potential cumulative effect of previous DMT sequences and on the location where the last treatment was administered (i.e. hospital- or home-based treatment). As a secondary objective, we further assessed the risk factors associated with the severity of Covid-19 outcomes.
We set-up a case-control (1-2) study. Cases were PwMS with a confirmed diagnosis of Covid-19, controls were 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 have been included in the present study.
Covid-19 risk was estimated by multivariable logistic regression models including demographic and clinical covariates. The impact of DMTs was assessed in three independent logistic regression models including one of the following covariates: last administered DMT or previous DMT sequences or the place where the last treatment was administered.
A total of 779 confirmed Covid-19 cases were matched to 1558 controls. In all 3 models, comorbidities, female sex and a younger age were significantly associated (p<0.02) to 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.
Our study provides evidence that among patients with MS, younger age, being female, having more comorbidities, receiving natalizumab, undergoing an escalating treatment strategy, or receiving treatment at a hospital was 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, while not being on treatment or receiving a beta-interferon agent was protective
Pubblicazioni e Comunicazioni a Congressi/ Publications and Congress Presentations
The risk of Covid-19 in people with Multiple Sclerosis: a case-control study from the Italian MS Register. Oral presentation. ECTRIMS 2021: ONLINE, 13-15 October 2021
De Luca G, Lugaresi A, Cavalla P, Montepietra S, Maniscalco GT, Granella F, Ragonese P, Vianello M, Brambilla L, Totaro R, Toscano S, Malucchi S, Petracca M, Moiola L, Ferraro D, Lepore V, Mosconi P, Ponzio M, Tedeschi G, Comi G, Battaglia MA, Filippi M, Amato MP, Trojano M; Italian MS Register. Risk of Getting COVID-19 in People With Multiple Sclerosis: A Case-Control Study. Neurol Neuroimmunol Neuroinflamm. 2022 Jan 19;9(2):e1141.
Iaffaldano P, Lucisano G, Manni A, Paolicelli D, Patti F, Capobianco M, Brescia Morra V, Sola P, Pesci I, Lus G, De Luca G, Lugaresi A, Cavalla P, Montepietra S, Maniscalco GT, Granella F, Ragonese P, Vianello M, Brambilla L, Totaro R, Toscano S, Malucchi S, Petracca M, Moiola L, Ferraro D, Lepore V, Mosconi P, Ponzio M, Tedeschi G, Comi G, Battaglia MA, Filippi M, Amato MP, Trojano M; Italian MS Register. Risk of Getting COVID-19 in People With Multiple Sclerosis: A Case-Control Study. Neurol Neuroimmunol Neuroinflamm. 2022 Jan 19;9(2):e1141. doi: 10.1212/NXI.0000000000001141.