Association of Disease-Modifying Therapies with COVID-19 Susceptibility and Severity in Patients with Multiple Sclerosis: A Systematic Review and Network Meta-Analysis

Author:

Barzegar Mahdi12ORCID,Houshi Shakiba1ORCID,Sadeghi Erfan3ORCID,Hashemi Mozhgan Sadat4ORCID,Pishgahi Ghasem4ORCID,Bagherieh Sara1ORCID,Afshari-Safavi Alireza5ORCID,Mirmosayyeb Omid12ORCID,Shaygannejad Vahid12ORCID,Zabeti Aram6ORCID

Affiliation:

1. Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2. Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3. Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran

4. Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

5. Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran

6. Department of Neurology and Rehabilitation Medicine, Waddell center in Multiple Sclerosis, University of Cincinnati, Cincinnati, OH, USA

Abstract

Background. 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). Methods. 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. Results. 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. Conclusion. 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.

Funder

Biogen

Publisher

Hindawi Limited

Subject

Neurology (clinical)

Reference53 articles.

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