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Updated results of the COVID-19 in MS Global Data Sharing Initiative: Anti-CD20 and other risk factors associated with COVID-19 severity


Simpson-Yap, S and Pirmani, A and Kalincik, T and De Brouwer, E and Geys, L and Parciak, T and Helme, A and Rijke, N and Hillert, JA and Moreau, Y and Edan, G and Sharmin, S and Spelman, T and McBurney, R and Schmidt, H and Bergmann, AB and Braune, S and Stahmann, A and Middleton, RM and Salter, A and Bebo, B and Van der Walt, A and Butzkueven, H and Ozakbas, S and Boz, C and Karabudak, R and Alroughani, R and Rojas, JI and van der Mei, IA and Sciascia do Olival, G and Magyari, M and Alonso, RN and Nicholas, RS and Chertcoff, AS and de Torres, AZ and Arrambide, G and Nag, N and Descamps, A and Costers, L and Dobson, R and Miller, A and Rodrigues, P and Prckovska, V and Comi, G and Peeters, LM, Updated results of the COVID-19 in MS Global Data Sharing Initiative: Anti-CD20 and other risk factors associated with COVID-19 severity, Neurology neuroimmunology & neuroinflammation, 9, (6) pp. 1-13. ISSN 2332-7812 (2022) [Refereed Article]

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Copyright Statement

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license (

DOI: doi:10.1212/NXI.0000000000200021


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.

Item Details

Item Type:Refereed Article
Keywords:COVID-19, disease modifying therapies, multiple sclerosis, hospitalisation, anti-CD20
Research Division:Health Sciences
Research Group:Epidemiology
Research Field:Epidemiology not elsewhere classified
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Simpson-Yap, S (Dr Steve Simpson JR)
UTAS Author:van der Mei, IA (Professor Ingrid van der Mei)
ID Code:154307
Year Published:2022
Deposited By:Menzies Institute for Medical Research
Deposited On:2022-11-22
Last Modified:2023-01-13
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