Melbourne School of Population and Global Health - Research Publications

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Author: Nag, Nupur × End date: 2023 × Start date: 2020 × Type: Abstract ×

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    Associations of DMT therapies with COVID-19 severity in multiple sclerosis
    Simpson-Yap, S ; De Brouwer, E ; Kalincik, T ; Rijke, N ; Hillert, J ; Walton, C ; Edan, G ; Spelman, T ; Geyes, L ; Parciak, T ; Gautrais, C ; Lazovski, N ; Pirmani, A ; Ardeshirdavani, A ; Forsberg, L ; Glaser, A ; McBurney, R ; Schmidt, H ; Bergmann, A ; Braune, S ; Stahmann, A ; Middleton, R ; Salter, A ; Fox, R ; van der Walt, A ; Butzkueven, H ; Rojas, J ; van der Mei, I ; Nag, N ; Ivanov, R ; do Olival, GS ; Dias, AE ; Magyari, M ; Brum, DG ; Mendes, MF ; Alonso, R ; Nicholas, R ; Bauer, J ; Chertcoff, A ; Zabalza, A ; Arrambide, G ; Fidao, A ; Comi, G ; Peeters, L (OXFORD UNIV PRESS, 2021-09)
    Abstract Background People with multiple sclerosis (MS) are a vulnerable group for severe COVID-19, particularly those taking immunosuppressive disease-modifying therapies (DMTs). We examined the characteristics of COVID-19 severity in an international sample of people with MS. Methods Data from 12 data-sources in 28 countries were aggregated (sources could include patients from 1-12 countries). Demographic (age, sex), clinical (MS phenotype, disability), and DMT (untreated, alemtuzumab, cladribine, dimethyl-fumarate, glatiramer-acetate, interferon, natalizumab, ocrelizumab, rituximab, siponimod, other) covariates were queried, alongside COVID-19 hospitalisation, admission to ICU, requiring artificial ventilation, and death. Characteristics of outcomes were assessed in patients with suspected/confirmed COVID-19 using multilevel mixed-effects logistic regression, adjusted for age, sex, MS phenotype, and EDSS. Results 657 (28.1%) with suspected and 1,683 (61.9%) with confirmed COVID-19 were analysed. Among suspected+confirmed/confirmed-only COVID-19, 20.9%/26.9% were hospitalised, 5.4%/7.2% were admitted to ICU, 4.1%/5.4% required artificial ventilation, and 3.2%/3.9% died. Older age, progressive MS-phenotype, and higher disability were associated with worse COVID-19 outcomes. Compared to dimethyl-fumarate, ocrelizumab and rituximab were associated with hospitalisation (aOR=1.56,95%CI=1.01-2.41; aOR=2.43,95%CI=1.48-4.02) and ICU admission (aOR=2.30,95%CI=0.98-5.39; aOR=3.93,95%CI=1.56-9.89), though only rituximab was associated with higher risk of artificial ventilation (aOR=4.00,95%CI=1.54-10.39). Importantly, associations persisted on restriction to confirmed COVID-19 cases. No associations were observed between DMTs and death. Conclusions Despite the cross-sectional design of this study, the internal and external consistency of these results with prior studies suggests their use may be a risk factor for more severe COVID-19. Key messages Anti-CD20 DMTs may be associated with worse COVID-19 severity amongst people with multiple sclerosis.
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    Identifying Shared Symptoms and Comorbidities to Inform Risk Reduction Strategies Across Prevalent Neurological disorders
    Nag, N ; Lin, X ; Jelinek, G ; Neate, S ; Levin, M (OXFORD UNIV PRESS, 2021-09)
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    Vitamin-d-supplement use but not sun exposure associated with higher quality of life in multiple sclerosis
    Simpson-Yap, S ; Jelinek, P ; Weiland, T ; Nag, N ; Neate, S ; Jelinek, G (SAGE PUBLICATIONS LTD, 2020-12)