A Lancet study update: Disease Modifying Therapies and COVID-19 Severity in Multiple Sclerosis

Having MS does not bar you from getting COVID-19. This is the reason why we we post articles concerning this important topic. We do hope you use the information wisely, learn-from, and share with others (with and without #MS.)

Source: Centers for Disease Control and Prevention       –  Stay Healthy, Stay Home and Wash Your Hands

Department of Health Sciences (DISSAL); Institute of Hospitalization and Care with a Scientific Character (IRCCS) – Ospedale Policlinico San Martino

Centro Sclerosi Multipla ASST Spedali Civili di Brescia

Department of Health Sciences, University of Genova

Department of Health Sciences, University of Genova

Centro Sclerosi Multipla ASST Spedali Civili di Brescia

Department of Neurology, Multiple Sclerosis Center, IRCCS Ospedale San Raffaele

Department of Neurology and Multiple Sclerosis Center, ASST “Papa Giovanni XXIII

Multiple Sclerosis Center, Ospedale Guglielmo da Saliceto

Regional Referral Multiple Sclerosis Centre, Dept. of Neurology, University Hospital San Luigi

Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari

Research Department, Italian Multiple Sclerosis Foundation

Department of Advanced Medical and Surgical Sciences, University of Campania

Institute of Experimental Neurology, IRCCS Ospedale San Raffaele

Research Department, Italian Multiple Sclerosis Foundation

Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania

University of Rome I – Department of Neuroscience, Mental Health and Sensory Organs

Background: Immunosuppressive and immunomodulatory therapies are a major issue during the current coronavirus disease 2019 (Covid-19) pandemic, and in anticipation of possible next waves. Methods: In a nationwide study we retrospectively collected data of persons with Multiple Sclerosis (PwMS) with suspected or confirmed Covid-19. We assessed the association of therapies for MS with Covid-19 by comparing their observed frequency with the one expected in non-pandemic conditions (expressing the association by Odds Ratios [OR]). We evaluated baseline characteristics and MS therapies associated to a severe Covid-19 course by multivariate logistic models.Findings: Of 784 PwMS with suspected (n=593) or confirmed (n=191) Covid-19 and a median follow-up of 84 days (range=30-135), 13 (1·66%) died: 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-three (4·2%) were admitted to an Intensive Care Unit; 90 (11·5%) had a radiologically documented pneumonia; 88 (11·2%) were hospitalized. We found an excess of patients treated with Ocrelizumab (OR=1·84,95%CI=1·31-2·56, p<0·001) and a reduction of patients treated with Interferon (OR=0·47,95%CI=0·33-0·67, p<0·001) as compared to the frequency of use of these DMTs in the Italian MS population. After adjusting for region, age, sex, progressive MS course and recent methylprednisolone use, the therapy with an anti-CD20 agent (Ocrelizumab or Rituximab) was significantly associated (OR=2·59,95%CI=1·43-4·67, p=0·002) with an increased risk of severe Covid-19 course. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR=6·0,95%CI=2·2-16·5, p=0·007).Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, the study detected elements of risk and protection with respect to Covid-19 in MS. These will need to be considered in countries where the pandemic is persisting and in preparation for post-pandemic scenarios.Funding: Roche donated the web-Platform and funded a fellowship to the University of Genoa.