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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

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posted on 2023-05-21, 14:58 authored by Steve Simpson JRSteve Simpson JR, Pirmani, A, Kalincik, T, De Brouwer, E, Geys, L, Parciak, T, Helme, A, Rijke, N, Hillert, JA, Moreau, Y, Edan, G, Sharmin, S, Spelman, T, McBurney, R, Schmidt, H, Bergmann, AB, Braune, S, Stahmann, A, Middleton, RM, Salter, A, Bebo, B, Van der Walt, A, Butzkueven, H, Ozakbas, S, Boz, C, Karabudak, R, Alroughani, R, Rojas, JI, Ingrid van der MeiIngrid van der Mei, Sciascia do Olival, G, Magyari, M, Alonso, RN, Nicholas, RS, Chertcoff, AS, de Torres, AZ, Arrambide, G, Nag, N, Descamps, A, Costers, L, Dobson, R, Miller, A, Rodrigues, P, Prckovska, V, Comi, G, Peeters, LM

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.


Publication title

Neurology® neuroimmunology & neuroinflammation










Menzies Institute for Medical Research


Wolters Kluwer Health/Lippincott Williams & Wilkins

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United States

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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 (

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