Multiple Sclerosis International

Review Article

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

Table 1

(a) Characteristics of studies assessing association of DMTs with COVID-19 susceptibility
AuthorScenario of studyType of studyCountry reportingTotal MS patientsNumber of suspected/confirmed COVID-19 casesDefinition of COVID-19 suspected or confirmed groupAnalytical method usedStudy quality
Sahraian et al., [30]Contacted MS patients who were managed in the MS Clinic of Sina Hospital, IranCross-sectionalIran464768Patients were asked about COVID-19-related symptoms, CFT scan findings, PCR test, and hospitalization.Univariate logistic regressionUnsatisfactory
Dalla Costa et al., [14]A questionnaire sent to MS patients across EuropeCohortEuropean multicentric39952Patients experiencing fever or anosmia/ageusia+any other COVID-19 symptoms, or respiratory symptoms+two other COVID-19
Symptoms		Univariate and multivariate penalized likelihood logistic regression modelsGood
Reder et al., [9]Using the IBM Explorys real-world datasetPharmacovigilanceUSA30478344Patients with PCR-confirmed COVID-19 were considered COVID-19 positive; all others were considered COVID-19 negative.Logistic regression adjusted for patient age, sex, BMI, comorbidities, and raceGood
Zabalza et al., [15]Self-administered survey sent to patients were followed in Multiple Sclerosis Centre of Catalonia (Cemcat). Suspected COVID-19 cases were interviewed by phone.CohortSpain75848(1) Patients with fever, dyspnoea, persistent cough, or (2) sudden onset of anosmia, ageusia or dysgeusia, or (3) radiological images compatible with COVID-19 were considered suspected cases. Patients with a positive SARS-CoV-2 PCR were considered confirmed casesUnivariable and multivariable logistic regressionsGood
Levin et al., [16]Online surveys using the Research Electronic Data Capture (REDCap) platform was sent to patients MS or a related disorder across USACohortUSA630104(1) Patients with cough or shortness of breath, or (2) any two of the following: fever, muscle pain, sore throat, and new loss of taste or smellMultivariate logistic regressionsFair
(b) Characteristics of studies assessing association of DMTs with COVID-19 severity
AuthorScenario of studyType of studyCountry reportingTotal MS patients with COVID-19Number of severe casesDefinition of COVID-19 severityAnalytical method usedStudy quality
Salter et al., [17]Registry of MS and patients with confirmed or suspected COVID-19 in North America (COViMS Registry)Cross-sectionalNorth America1626(a) Requiring hospitalization only
(b) ICU and/or required ventilator support
(c) Death		Multivariable multinomial logistic regressionVery good
Sormani et al., [18]Collected data of MS patients who had been in contact with their neurologist because of a confirmed or suspected COVID-19 (MUSC-19 registry)CohortItaly844136(a) No need for hospitalization or documented diagnosis of pneumonia
(b) Diagnosis of pneumonia or hospitalization
(c) Death or ICU admission		Univariate and multivariate ordinal logistic regressionsFair
Spelman et al., [19]Registry of Swedish MS patients with suspected and confirmed COVID-19 infection (SMSreg)CohortSweden47673(a) Not requiring hospitalization
(b) Hospitalization, ICU, or death		Weighted logistic regression with IPTW approach to adjust confoundersFair
Moreno-Torres et al., [20]Registry of MS and patients with confirmed or highly suspected COVID-19 across MadridCohortSpain21951(a) No need for hospitalization
(b) Requiring hospitalization		Univariate and multivariate logistic regression models with an L1 penalty (Lasso regression)Good
Klineova et al., [21]Patients with MS or related CNS disorders with suspected or confirmed COVID-19 in New York or surrounded city (NYCNIC registry)CohortUSA47458(a) Not requiring hospitalization
(b) Hospitalization, ICU, or death		Univariable and multivariable logistic regressionsFair
Only hospitalized patients. ICU: intensive care unit.