Updated Results of the COVID-19 in MS Global Data Sharing Initiative
Steve Simpson, Ashkan Pirmani, Tomáš Kalinčík, Edward De Brouwer, Lotte Geys, Tina Parciak, Anne Helme, Nick Rijke, Jan Hillert, Yves Moreau, Gilles Edan, Sifat Sharmin, Tim Spelman, Robert McBurney, Hollie Schmidt, Arnfin Bergmann, Stefan Braune, Alexander Stahmann, Rod Middleton, Amber Salter, Bruce F. Bebo, Anneke van der Walt, Helmut Butzkueven, Serkan Özakbaş, Cavit Boz, Rana Karabudak, Raed Alroughani, Juan Ignacio Rojas, Ingrid van der Mei, Guilherme Sciascia do Olival, Melinda Magyari, Ricardo Alonso, Richard Nicholas, Aníbal Chertcoff, Ana Zabalza de Torres, Georgina Arrambide, Nupur Nag, A. Descamps, Lars Costers, Ruth Dobson, Aleisha Miller, Paulo Rogério Melo Rodrigues, Vesna Prčkovska, Gıancarlo Comı, Liesbet M. Peeters
Abstract
BACKGROUND AND OBJECTIVES: Certain demographic and clinical characteristics, including the use of some disease-modifying therapies (DMTs), are associated with severe acute respiratory syndrome coronavirus 2 infection severity in people with multiple sclerosis (MS). Comprehensive exploration of these relationships in large international samples is needed. METHODS: Clinician-reported demographic/clinical data from 27 countries were aggregated into a data set of 5,648 patients with suspected/confirmed coronavirus disease 2019 (COVID-19). COVID-19 severity outcomes (hospitalization, admission to intensive care unit [ICU], requiring artificial ventilation, and death) were assessed using multilevel mixed-effects ordered probit and logistic regression, adjusted for age, sex, disability, and MS phenotype. DMTs were individually compared with glatiramer acetate, and anti-CD20 DMTs with pooled other DMTs and with natalizumab. RESULTS: Of 5,648 patients, 922 (16.6%) with suspected and 4,646 (83.4%) with confirmed COVID-19 were included. Male sex, older age, progressive MS, and higher disability were associated with more severe COVID-19. Compared with glatiramer acetate, ocrelizumab and rituximab were associated with higher probabilities of hospitalization (4% [95% CI 1-7] and 7% [95% CI 4-11]), ICU/artificial ventilation (2% [95% CI 0-4] and 4% [95% CI 2-6]), and death (1% [95% CI 0-2] and 2% [95% CI 1-4]) (predicted marginal effects). Untreated patients had 5% (95% CI 2-8), 3% (95% CI 1-5), and 1% (95% CI 0-3) higher probabilities of the 3 respective levels of COVID-19 severity than glatiramer acetate. Compared with pooled other DMTs and with natalizumab, the associations of ocrelizumab and rituximab with COVID-19 severity were also more pronounced. All associations persisted/enhanced on restriction to confirmed COVID-19. DISCUSSION: Analyzing the largest international real-world data set of people with MS with suspected/confirmed COVID-19 confirms that the use of anti-CD20 medication (both ocrelizumab and rituximab), as well as male sex, older age, progressive MS, and higher disability are associated with more severe course of COVID-19.