Barzegar Mahdi, Houshi Shakiba, Sadeghi Erfan, Hashemi Mozhgan Sadat, Pishgahi Ghasem, Bagherieh Sara, Afshari-Safavi Alireza, Mirmosayyeb Omid, Shaygannejad Vahid, Zabeti Aram
Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Mult Scler Int. 2022 Sep 21;2022:9388813. doi: 10.1155/2022/9388813. eCollection 2022.
We conducted this study to assess the effect of disease-modifying therapies (DMTs) on coronavirus disease (COVID-19) susceptibility and severity in people with multiple sclerosis (MS).
Available studies from PubMed, Scopus, EMBASE, Web of Science, and gray literature, including reference lists and conference abstracts, were searched from December 1, 2019, to July 26, 2021. We included cross-sectional, case-control, and cohort studies assessing the association of DMTs with risk of contracting COVID-19 or its outcomes in MS patients on univariate or multivariate regression analyses. We conducted a network meta-analysis (NMA) to compare the risk of COVID-19 and developing severe infection across DMTs.
Out of the initial 3893 records and 1883 conference abstracts, a total of 10 studies were included. Pairwise comparisons showed that none of the DMTs meaningfully affect the risk of acquiring infection. There was significant total heterogeneity and inconsistency across this NMA. In comparison with no DMT, dimethyl fumarate (0.62 (0.42, 0.93)), fingolimod (0.55 (0.32, 0.94)), natalizumab (0.50 (0.31, 0.81)), and interferon (0.42 (0.22, 0.79)) were associated with a decreased risk of severe COVID-19; but, rituximab was observed to increase the risk (1.94 (1.20, 3.12)). Compared to rituximab or ocrelizumab, all DMTs were associated with a decreased risk. Pairwise comparisons showed no differences across other DMTs. Interferon and rituximab were associated with the lowest and highest risks of severe COVID-19.
Our study showed an increased risk of severe COVID-19 in patients on rituximab and ocrelizumab. No association with COVID-19 severity across other DMTs was observed.
我们开展这项研究以评估疾病修正疗法（DMTs）对多发性硬化症（MS）患者感染冠状病毒病（COVID - 19）的易感性及病情严重程度的影响。
检索了2019年12月1日至2021年7月26日期间来自PubMed、Scopus、EMBASE、Web of Science以及灰色文献（包括参考文献列表和会议摘要）中的现有研究。我们纳入了横断面研究、病例对照研究和队列研究，这些研究通过单变量或多变量回归分析评估DMTs与MS患者感染COVID - 19的风险或其结局之间的关联。我们进行了一项网状Meta分析（NMA），以比较不同DMTs导致COVID - 19及发生严重感染的风险。
在最初的3893条记录和1883篇会议摘要中，共纳入了10项研究。两两比较显示，没有一种DMTs对感染风险有显著影响。该NMA存在显著的总体异质性和不一致性。与未使用DMT相比，富马酸二甲酯（0.62（0.42，0.93））、芬戈莫德（0.55（0.32，0.94））、那他珠单抗（0.50（0.31，0.81））和干扰素（0.42（0.22，0.79））与严重COVID - 19风险降低相关；但是，观察到利妥昔单抗会增加风险（1.94（1.20，3.12））。与利妥昔单抗或奥瑞珠单抗相比，所有DMTs都与风险降低相关。两两比较显示其他DMTs之间没有差异。干扰素和利妥昔单抗分别与最低和最高的严重COVID - 19风险相关。
我们的研究表明，使用利妥昔单抗和奥瑞珠单抗的患者发生严重COVID - 19的风险增加。未观察到其他DMTs与COVID - 19严重程度之间存在关联。
