COVID-19 severity and mortality in multiple sclerosis are not associated with immunotherapy: Insights from a nation-wide Austrian registry.
COVID-19 severity and mortality in multiple sclerosis are not associated with immunotherapy: Insights from a nation-wide Austrian registry.
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多发性硬化症中的Covid-19的严重程度和死亡率与免疫疗法无关：来自全国性奥地利注册中心的见解。
DOI：
10.1371/journal.pone.0255316
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
AUT-MuSC investigators
中科院分区：
文献类型：
--
作者：
Bsteh G;Assar H;Hegen H;Heschl B;Leutmezer F;Di Pauli F;Gradl C;Traxler G;Zulehner G;Rommer P;Wipfler P;Guger M;Enzinger C;Berger T;AUT-MuSC investigators
COVID-19 大流行对神经科医生提出了挑战，要求他们向多发性硬化症 (pwMS) 患者提供有关 SARS-CoV-2 风险的咨询，并指导疾病缓解治疗 (DMT)。在一项全国性基于人群的研究中，描述与不同 DMT 相关的 pwMS 中 COVID-19 的患病率和结果。我们纳入了 2020 年 1 月 1 日至 2020 年 12 月 31 日期间确诊为 MS 且确诊为 COVID-19 的年龄≥18 岁的患者。我们将 COVID-19 病程分为轻度、重度或致命。 DMT 和特别是免疫抑制剂（阿仑单抗、克拉屈滨、芬戈莫德、奥瑞珠单抗或利妥昔单抗）对 COVID-19 结果的影响是通过多变量模型确定的，并根据先验风险进行了调整。在 126 名患有 COVID-19 的 MS 患者中（平均年龄 43.2 岁 [SD 13.4]，71% 为女性），86.5% 为轻度病程，9.5% 为重度病程，3.2% 死于 COVID-19。先验风险显着预测了 COVID-19 的严重程度（R2 0.814；p<0.001）和死亡率（R2 0.664；p<0.001）。调整这一先验风险后，与未接受 DMT 相比，暴露于任何 DMT 或暴露于特定免疫抑制性 DMT 均与 COVID-19 严重程度（比值比 [OR] 1.6；p = 0.667 和 OR 1.9；p = 0.426）或死亡率（OR 0.5；p = 0.711 和 2.1；0.233）显着相关。在基于人群的 MS 队列中，考虑到其他已知的危险因素，COVID-19 的结果与接触 DMT 和免疫抑制性 DMT 无关。这提供了令人放心的证据，表明 MS 中的 COVID-19 风险可以单独预测，并且除了极少数高风险患者外，治疗决策应主要集中于治疗 MS 而不是大流行。
The COVID-19 pandemic challenges neurologists in counselling patients with multiple sclerosis (pwMS) regarding their risk by SARS-CoV-2 and in guiding disease-modifying treatment (DMT). To characterize the prevalence and outcome of COVID-19 in pwMS specifically associated with different DMT in a nationwide population-based study. We included patients aged ≥18 years with a confirmed diagnosis of MS and a diagnosis of COVID-19 established between January 1, 2020 and December 31, 2020. We classified COVID-19 course as either mild, severe or fatal. Impact of DMT and specifically immunosuppressants (alemtuzumab, cladribine, fingolimod, ocrelizumab or rituximab) on COVID-19 outcome was determined by multivariable models, adjusted for a-priori-risk. Of 126 MS patients with COVID-19 (mean age 43.2 years [SD 13.4], 71% female), 86.5% had a mild course, 9.5% a severe course and 3.2% died from COVID-19. A-priori-risk significantly predicted COVID-19 severity (R2 0.814; p<0.001) and mortality (R2 0.664; p<0.001). Adjusting for this a-priori-risk, neither exposure to any DMT nor exposure to specific immunosuppressive DMT were significantly associated with COVID-19 severity (odds ratio [OR] 1.6; p = 0.667 and OR 1.9; p = 0.426) or mortality (OR 0.5; p = 0.711 and 2.1; 0.233) when compared to no DMT. In a population-based MS cohort, COVID-19 outcome was not associated with exposure to DMT and immunosuppressive DMT when accounting for other already known risk factors. This provides reassuring evidence that COVID-19 risk can be individually anticipated in MS and–except for a very small proportion of high-risk patients–treatment decisions should be primarily focused on treating MS rather than the pandemic.
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