Updated Results of the COVID-19 in MS Global Data Sharing Initiative: Anti-CD20 and Other Risk Factors Associated With COVID-19 Severity

Steve Simpson-Yap, Ashkan Pirmani, Tomas Kalincik, Edward De Brouwer, Lotte Geys, Tina Parciak, Anne Helme, Nick Rijke, Jan A Hillert, Yves Moreau, Gilles Edan, Sifat Sharmin, Tim Spelman, Robert McBurney, Hollie Schmidt, Arnfin B Bergmann, Stefan Braune, Alexander Stahmann, Rod M Middleton, Amber SalterBruce Bebo, Anneke Van der Walt, Helmut Butzkueven, Serkan Ozakbas, Cavit Boz, Rana Karabudak, Raed Alroughani, Juan I Rojas, Ingrid A van der Mei, Guilherme Sciascia do Olival, Melinda Magyari, Ricardo N Alonso, Richard S Nicholas, Anibal S Chertcoff, Ana Zabalza de Torres, Georgina Arrambide, Nupur Nag, Annabel Descamps, Lars Costers, Ruth Dobson, Aleisha Miller, Paulo Rodrigues, Vesna Prčkovska, Giancarlo Comi, Liesbet M Peeters


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.

Original languageEnglish
JournalNeurology: Neuroimmunology and NeuroInflammation
Issue number6
Publication statusPublished - Nov 2022


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