Liu Ning, Yu WuHan, Sun Mengjiao, Zhang Wenjing, Zhou Dan, Sun Jing, Wang ManXia
Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China.
Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, China.
J Clin Neurol. 2023 Jul;19(4):381-391. doi: 10.3988/jcn.2022.0348. Epub 2023 Mar 13.
A systematic review and meta-analysis was performed of the outcome of Coronavirus disease 2019 (COVID-19) infection in patients with multiple sclerosis (MS) who received disease-modifying therapies (DMTs).
Relevant studies published before November 2022 in the PubMed, Cochrane Library, Chinese National Knowledge Infrastructure, and Web of Science databases were retrieved using the following search expression: ("multiple sclerosis" OR "MS") AND ("DMT" OR "disease modifying therapies") AND ("COVID-19"). Two authors independently screened the articles and extracted the data. Qualitative analyses and a meta-analysis constituted 22 of the 794 retrieved articles. Differences in the hospitalization and mortality rates were used as the main measures of efficacy, and the meta-analysis was performed using RevMan software.
22 clinical trials were selected. The hospitalization rate was lower in the 3,216 patients who received DMTs than in the 774 patients who did not receive any treatment, with a moderate effect size of 0.43 (<0.00001). The mortality rate was also lower among patients with MS treated using DMTs than in controls (odds ratio [OR]=0.19, 95% confidence interval [CI]=0.13-0.27, <0.00001). The hospitalization rates for COVID-19 infection in patients with MS treated with anti-CD20 therapy also increased markedly (OR=3.32, 95% CI=2.63-4.20, <0.00001). However, there was no significant difference between patients with MS who did and did not receive DMTs.
In summary, the application of DMTs was found to be valuable for patients with MS infected with COVID-19. However, more clinical studies are needed to determine the use of anti-CD20 drugs in patients with MS during the COVID-19 pandemic.
对接受疾病修正治疗（DMTs）的多发性硬化症（MS）患者感染2019冠状病毒病（COVID-19）的结局进行系统评价和荟萃分析。
使用以下检索式检索2022年11月之前发表在PubMed、Cochrane图书馆、中国知网和Web of Science数据库中的相关研究：（“多发性硬化症”或“MS”）且（“DMT”或“疾病修正治疗”）且（“COVID-19”）。两位作者独立筛选文章并提取数据。对检索到的794篇文章中的22篇进行定性分析和荟萃分析。将住院率和死亡率的差异作为主要疗效指标，使用RevMan软件进行荟萃分析。
选择了22项临床试验。接受DMTs治疗的3216例患者的住院率低于未接受任何治疗的774例患者，效应量适中，为0.43（<0.00001）。使用DMTs治疗的MS患者的死亡率也低于对照组（优势比[OR]=0.19，95%置信区间[CI]=0.13 - 0.27，<0.00001）。接受抗CD20治疗的MS患者中COVID-19感染的住院率也显著增加（OR=3.32，95%CI=2.63 - 4.20，<0.00001）。然而，接受和未接受DMTs的MS患者之间没有显著差异。
总之，发现DMTs的应用对感染COVID-19的MS患者有价值。然而，需要更多的临床研究来确定在COVID-19大流行期间MS患者中抗CD20药物的使用。
