Background: Some authors have reported positive associations between B-cell-depleting (anti-CD20) therapies and COVID-19 infection risk or severity, but all with numerator data (COVID-19 cases only). To assess the risks of COVID-19 by DMT, it is necessary to also collect denominator data on all patients on the DMTs of interest.
Objectives: To determine whether frequency and severity of COVID-19 differ by disease modifying therapy (DMTs) among patients with multiple sclerosis (MS) who receive care in the NYU MS Care Center.
Methods: We reviewed charts from March 2020 through February 2021 for all patients on S1P modulators (fingolimod, siponimod), anti-CD20 therapies (rituximab, ocrelizumab), dimethyl fumarate, and natalizumab followed at the NYU MS Care Center in New York City. COVID-19 status was determined by clinical symptoms (CDC case definition) and laboratory testing where available (SARS-CoV-2 PCR, SARS-CoV-2 IgG). Multivariable analyses were conducted to determine predictors of infection and hospitalization.
Results: 1635 patients in our clinic were on a DMT of interest and had their chart reviewed, of whom 12% experienced COVID-19 (N=203, mean age 41.6 ± 12.6 years; 72% were female; 49% white and 23% Black; 59% with at least one COVID-relevant comorbidity). In the ocrelizumab group, 69 out of 656 patients (11%) had COVID-19 (5 hospitalizations and 1 death). In the rituximab group, 29 out of 159 patients (18%) had COVID-19 (5 hospitalizations and 1 death). In the S1P modulators group (273 on fingolimod and 20 on siponimod) 30 out of 293 patients (10%) had COVID-19 (2 hospitalizations and 0 deaths). In the dimethyl fumarate group, 41 out of 269 patients (15%) had COVID-19 (6 hospitalizations and 0 deaths). In the natalizumab group, 34 out of 258 patients (13%) had COVID-19 (1 hospitalization and 1 death). In multivariable analyses, significant predictors of infection were: public insurance (OR 6.1, 95% CI 4.29-8.78), younger age (OR 4.7, 95% CI 1.73-12.76), and Hispanic ethnicity (OR 1.7, 95% CI 1.03-2.71). Hispanic ethnicity was the only predictor of hospitalization (OR 4.8, 95% CI 1.08-21.45). DMT was not a predictor of infection or hospitalization after adjustment for these other factors.
Conclusions: This analysis does not convincingly suggest that changing DMT during the pandemic to prevent COVID-19 infection or hospitalization is warranted.