Outcomes of multiple sclerosis patients admitted with COVID-19 in a large veteran cohort.
Outcomes of multiple sclerosis patients admitted with COVID-19 in a large veteran cohort.
复制标题
DOI：
10.1016/j.msard.2022.103964
复制
发表时间：
2022-08
影响因子：
4
通讯作者：
Mergenhagen, Kari A.
中科院分区：
文献类型：
--
作者：
Fuchs, Tom A.;Wattengel, Bethany A.;Carter, Michael T.;El-Solh, Ali A.;Lesse, Alan J.;Mergenhagen, Kari A.
鉴于对免疫功能的担忧，在COVID-19大流行期间是否继续对多发性硬化症（MS）患者进行疾病修饰治疗（DMT）的决定一直具有挑战性，在没有治疗的情况下MS疾病进展的风险使其复杂化。这项对在美国退伍军人事务医疗保健系统接受COVID-19感染治疗的患者的回顾性分析，调查了患有和不患有MS的患者在首次COVID-19阳性后30天的全因死亡率。我们检查了MS疾病修饰治疗的死亡风险影响，考虑了已知与COVID-19死亡率相关的其他相关因素。根据MS诊断，患者的倾向评分以1：20的方式匹配。确定了49，737例COVID-19住院病例，其中258例被诊断为MS。在倾向评分匹配队列中，服用DMT的MS患者（不包括接受抗CD 20抗体的患者）的30天死亡率较低（OR：0.18 [95%CI：0.00988-0.94] p=0.041）。同样，在不匹配队列中，接受DMT的患者死亡风险较低（OR：0.16 [95%CI：0.01-0.82] p=0.023）。在倾向匹配队列中，年龄超过65岁、心力衰竭、慢性肾脏疾病（CKD）和糖尿病增加了死亡风险，而接种疫苗降低了死亡风险。考虑到其他相关因素，因COVID-19住院的MS退伍军人患者在服用DMT（不包括接受抗CD 20抗体的患者）时死亡的可能性较小。结果表明，与COVID-19大流行相关，MS患者继续大多数DMT不仅是安全的，而且考虑到COVID-19死亡风险降低和MS疾病进展风险降低，这可能是有益的。
Given concerns over immune function, the decision whether to continue disease modifying therapy (DMT) in multiple sclerosis (MS) patients during the COVID-19 pandemic has been challenging, complicated by the risk of MS disease progression in the absence of treatment. This retrospective analysis of patients treated for COVID-19 infection at veteran affairs healthcare systems across the United States, investigated 30-day all-cause mortality after first positive COVID-19 in patients with and without MS. We examined mortality risk impact of disease modifying therapy for MS, accounting for other relevant factors known to be associated with COVID-19 mortality. Patients were propensity score matched in a 1:20 fashion based on MS diagnosis. 49,737 COVID-19 inpatient cases were identified, of which 258 were diagnosed with MS. In the propensity score matched cohort, MS patients taking DMT (excluding those receiving anti-CD20 antibodies) had a lower odds of 30 day mortality (OR: 0.18 [95%CI: 0.00988-0.94] p=0.041). Similarly, in the unmatched cohort, patients on DMT had a lower risk of death (OR: 0.16 [95%CI: 0.01-0.82] p=0.023). There was no statistically significant difference in mortality between those with and without MS. In the propensity matched cohort, age over 65, heart failure, chronic kidney disease (CKD), and diabetes increased the risk of mortality while vaccination reduced the risk of mortality. Veteran patients with MS hospitalized for COVID-19 were less likely to die when taking DMTs (excluding those receiving anti-CD20 antibodies), accounting for other relevant factors. Results suggest that, in relation to the COVID-19 pandemic, not only is it safe to continue most DMTs in people with MS, but it may be beneficial given the decreased risk of COVID-19 mortality and decreased risk of MS disease progression.
登录
查看更多内容
影响因子：
6
作者：
Chisari CG;Sgarlata E;Arena S;Toscano S;Luca M;Patti F
通讯作者：
Patti F
影响因子：
2.2
作者：
Jewell, Paul;Ansorge, Olaf;Zamboni, Giovanna
通讯作者：
Zamboni, Giovanna
影响因子：
11
作者：
Wijnands, Jose Maria Andreas;Zhu, Feng;Tremlett, Helen
通讯作者：
Tremlett, Helen
影响因子：
82.9
作者：
Del Valle DM;Kim-Schulze S;Huang HH;Beckmann ND;Nirenberg S;Wang B;Lavin Y;Swartz TH;Madduri D;Stock A;Marron TU;Xie H;Patel M;Tuballes K;Van Oekelen O;Rahman A;Kovatch P;Aberg JA;Schadt E;Jagannath S;Mazumdar M;Charney AW;Firpo-Betancourt A;Mendu DR;Jhang J;Reich D;Sigel K;Cordon-Cardo C;Feldmann M;Parekh S;Merad M;Gnjatic S
通讯作者：
Gnjatic S
DOI：
10.1016/s1473-3099(20)30243-7
发表时间：
2020-06-01
期刊：
The Lancet. Infectious diseases
影响因子：
--
作者：
Verity, Robert;Okell, Lucy C;Ferguson, Neil M
通讯作者：
Ferguson, Neil M