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Association Between Anti-CD20 Therapies and COVID-19 Severity Among Patients With Relapsing-Remitting and Progressive Multiple Sclerosis
IMPORTANCE: In patients with multiple sclerosis (MS), factors associated with severe COVID-19 include anti-CD20 therapies and neurologic disability, but it is still unclear whether these 2 variables are independently associated with severe COVID-19 or whether the association depends on MS clinical c...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290250/ https://www.ncbi.nlm.nih.gov/pubmed/37351881 http://dx.doi.org/10.1001/jamanetworkopen.2023.19766 |
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author | Januel, Edouard Hajage, David Labauge, Pierre Maillart, Elisabeth De Sèze, Jérome Zephir, Hélène Pelletier, Jean Guilloton, Laurent Bensa, Caroline Heinzlef, Olivier Casez, Olivier Biotti, Damien Bourre, Bertrand Vukusic, Sandra Maurousset, Aude Berger, Eric Laplaud, David Lebrun-Frénay, Christine Dubessy, Anne-Laure Branger, Pierre Thouvenot, Eric Clavelou, Pierre Sellal, François Manchon, Eric Moreau, Thibault Papeix, Caroline Tubach, Florence Louapre, Céline |
author_facet | Januel, Edouard Hajage, David Labauge, Pierre Maillart, Elisabeth De Sèze, Jérome Zephir, Hélène Pelletier, Jean Guilloton, Laurent Bensa, Caroline Heinzlef, Olivier Casez, Olivier Biotti, Damien Bourre, Bertrand Vukusic, Sandra Maurousset, Aude Berger, Eric Laplaud, David Lebrun-Frénay, Christine Dubessy, Anne-Laure Branger, Pierre Thouvenot, Eric Clavelou, Pierre Sellal, François Manchon, Eric Moreau, Thibault Papeix, Caroline Tubach, Florence Louapre, Céline |
author_sort | Januel, Edouard |
collection | PubMed |
description | IMPORTANCE: In patients with multiple sclerosis (MS), factors associated with severe COVID-19 include anti-CD20 therapies and neurologic disability, but it is still unclear whether these 2 variables are independently associated with severe COVID-19 or whether the association depends on MS clinical course. OBJECTIVE: To assess the association between anti-CD20 therapies and COVID-19 severity in patients with relapsing-remitting MS (RRMS) and progressive MS (PMS). DESIGN, SETTING, AND PARTICIPANTS: This multicenter, retrospective cohort study used data from the COVISEP study, which included patients with MS and COVID-19 from February 1, 2020, to June 30, 2022, at 46 French MS expert centers, general hospitals, and private neurology practices. Eligible patients with RRMS were those treated with high-efficacy MS therapy (ie, anti-CD20, fingolimod, or natalizumab), and eligible patients with PMS were those younger than 70 years with an Expanded Disability Status Scale (EDSS) score of 8 or lower. Patients were monitored from COVID-19 symptom onset until recovery or death. EXPOSURES: Current anti-CD20 therapy (ocrelizumab or rituximab). MAIN OUTCOMES AND MEASURES: The main outcome was severe COVID-19 (ie, hospitalization with any mode of oxygenation or death). All analyses were conducted separately in patients with RRMS and PMS using propensity score–weighted logistic regression. Subgroup analyses were performed according to COVID-19 vaccine status, sex, EDSS score, and age. RESULTS: A total of 1400 patients, 971 with RRMS (median age, 39.14 years [IQR, 31.38-46.80 years]; 737 [76.1%] female) and 429 with PMS (median age, 54.21 years [IQR, 48.42-60.14 years]; 250 [58.3%] female) were included in the study. A total of 418 patients with RRMS (43.0%) and 226 with PMS (52.7%) were treated with anti-CD20 therapies. In weighted analysis, 13.4% and 2.9% of patients with RRMS treated and not treated with anti-CD20 had severe COVID-19, respectively, and anti-CD20 treatment was associated with increased risk of severe COVID-19 (odds ratio [OR], 5.20; 95% CI, 2.78-9.71); this association persisted among vaccinated patients (7.0% vs 0.9%; OR, 8.85; 95% CI, 1.26-62.12). Among patients with PMS, 19.0% and 15.5% of patients treated and not treated with anti-CD20 had severe COVID-19, respectively, and there was no association between anti-CD20 treatment and severe COVID-19 (OR, 1.28; 95% CI, 0.76-2.16). In PMS subgroup analysis, anti-CD20 exposure interacted negatively with EDSS score (P = .009 for interaction) and age (P = .03 for interaction); anti-CD20 therapies were associated with risk of severe COVID-19 only in patients with less neurologic disability and younger patients with PMS. CONCLUSIONS AND RELEVANCE: In this cohort study, risk of severe COVID-19 was higher in patients with PMS than in those with RRMS. Use of anti-CD20 therapies was associated with an increased risk of severe COVID-19 among patients with RRMS. In patients with PMS, there was no association between anti-CD20 therapies and risk of severe COVID-19. |
format | Online Article Text |
id | pubmed-10290250 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-102902502023-06-25 Association Between Anti-CD20 Therapies and COVID-19 Severity Among Patients With Relapsing-Remitting and Progressive Multiple Sclerosis Januel, Edouard Hajage, David Labauge, Pierre Maillart, Elisabeth De Sèze, Jérome Zephir, Hélène Pelletier, Jean Guilloton, Laurent Bensa, Caroline Heinzlef, Olivier Casez, Olivier Biotti, Damien Bourre, Bertrand Vukusic, Sandra Maurousset, Aude Berger, Eric Laplaud, David Lebrun-Frénay, Christine Dubessy, Anne-Laure Branger, Pierre Thouvenot, Eric Clavelou, Pierre Sellal, François Manchon, Eric Moreau, Thibault Papeix, Caroline Tubach, Florence Louapre, Céline JAMA Netw Open Original Investigation IMPORTANCE: In patients with multiple sclerosis (MS), factors associated with severe COVID-19 include anti-CD20 therapies and neurologic disability, but it is still unclear whether these 2 variables are independently associated with severe COVID-19 or whether the association depends on MS clinical course. OBJECTIVE: To assess the association between anti-CD20 therapies and COVID-19 severity in patients with relapsing-remitting MS (RRMS) and progressive MS (PMS). DESIGN, SETTING, AND PARTICIPANTS: This multicenter, retrospective cohort study used data from the COVISEP study, which included patients with MS and COVID-19 from February 1, 2020, to June 30, 2022, at 46 French MS expert centers, general hospitals, and private neurology practices. Eligible patients with RRMS were those treated with high-efficacy MS therapy (ie, anti-CD20, fingolimod, or natalizumab), and eligible patients with PMS were those younger than 70 years with an Expanded Disability Status Scale (EDSS) score of 8 or lower. Patients were monitored from COVID-19 symptom onset until recovery or death. EXPOSURES: Current anti-CD20 therapy (ocrelizumab or rituximab). MAIN OUTCOMES AND MEASURES: The main outcome was severe COVID-19 (ie, hospitalization with any mode of oxygenation or death). All analyses were conducted separately in patients with RRMS and PMS using propensity score–weighted logistic regression. Subgroup analyses were performed according to COVID-19 vaccine status, sex, EDSS score, and age. RESULTS: A total of 1400 patients, 971 with RRMS (median age, 39.14 years [IQR, 31.38-46.80 years]; 737 [76.1%] female) and 429 with PMS (median age, 54.21 years [IQR, 48.42-60.14 years]; 250 [58.3%] female) were included in the study. A total of 418 patients with RRMS (43.0%) and 226 with PMS (52.7%) were treated with anti-CD20 therapies. In weighted analysis, 13.4% and 2.9% of patients with RRMS treated and not treated with anti-CD20 had severe COVID-19, respectively, and anti-CD20 treatment was associated with increased risk of severe COVID-19 (odds ratio [OR], 5.20; 95% CI, 2.78-9.71); this association persisted among vaccinated patients (7.0% vs 0.9%; OR, 8.85; 95% CI, 1.26-62.12). Among patients with PMS, 19.0% and 15.5% of patients treated and not treated with anti-CD20 had severe COVID-19, respectively, and there was no association between anti-CD20 treatment and severe COVID-19 (OR, 1.28; 95% CI, 0.76-2.16). In PMS subgroup analysis, anti-CD20 exposure interacted negatively with EDSS score (P = .009 for interaction) and age (P = .03 for interaction); anti-CD20 therapies were associated with risk of severe COVID-19 only in patients with less neurologic disability and younger patients with PMS. CONCLUSIONS AND RELEVANCE: In this cohort study, risk of severe COVID-19 was higher in patients with PMS than in those with RRMS. Use of anti-CD20 therapies was associated with an increased risk of severe COVID-19 among patients with RRMS. In patients with PMS, there was no association between anti-CD20 therapies and risk of severe COVID-19. American Medical Association 2023-06-23 /pmc/articles/PMC10290250/ /pubmed/37351881 http://dx.doi.org/10.1001/jamanetworkopen.2023.19766 Text en Copyright 2023 Januel E et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Januel, Edouard Hajage, David Labauge, Pierre Maillart, Elisabeth De Sèze, Jérome Zephir, Hélène Pelletier, Jean Guilloton, Laurent Bensa, Caroline Heinzlef, Olivier Casez, Olivier Biotti, Damien Bourre, Bertrand Vukusic, Sandra Maurousset, Aude Berger, Eric Laplaud, David Lebrun-Frénay, Christine Dubessy, Anne-Laure Branger, Pierre Thouvenot, Eric Clavelou, Pierre Sellal, François Manchon, Eric Moreau, Thibault Papeix, Caroline Tubach, Florence Louapre, Céline Association Between Anti-CD20 Therapies and COVID-19 Severity Among Patients With Relapsing-Remitting and Progressive Multiple Sclerosis |
title | Association Between Anti-CD20 Therapies and COVID-19 Severity Among Patients With Relapsing-Remitting and Progressive Multiple Sclerosis |
title_full | Association Between Anti-CD20 Therapies and COVID-19 Severity Among Patients With Relapsing-Remitting and Progressive Multiple Sclerosis |
title_fullStr | Association Between Anti-CD20 Therapies and COVID-19 Severity Among Patients With Relapsing-Remitting and Progressive Multiple Sclerosis |
title_full_unstemmed | Association Between Anti-CD20 Therapies and COVID-19 Severity Among Patients With Relapsing-Remitting and Progressive Multiple Sclerosis |
title_short | Association Between Anti-CD20 Therapies and COVID-19 Severity Among Patients With Relapsing-Remitting and Progressive Multiple Sclerosis |
title_sort | association between anti-cd20 therapies and covid-19 severity among patients with relapsing-remitting and progressive multiple sclerosis |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290250/ https://www.ncbi.nlm.nih.gov/pubmed/37351881 http://dx.doi.org/10.1001/jamanetworkopen.2023.19766 |
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