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 2

League table showing the results of network meta-analysis comparing the effect of DMTs on the risk of getting COVID-19.
(a) Results from univariate analyses

ALZ or CLA0.27
(0.06, 1.28)
...1.29
(0.24, 6.90)
1.07
(0.41, 2.80)
.

0.83
(0.30, 2.27)
Anti-CD20 agents3.11
(0.75, 12.94)
2.56
(0.91, 7.20)
0.70
(0.17, 2.98)
2.86
(1.21, 6.77)
1.32
(0.84, 2.07)
0.77
(0.18, 3.24)
2.40
(0.43, 13.3)
2.90
(0.70, 12.03)
DMF0.82
(0.15, 4.52)
0.23
(0.03, 1.64)
1.33
(0.19, 9.47)
0.55
(0.13, 2.43)
0.25
(0.03, 1.78)
1.71
(0.51, 5.69)
2.07
(0.94, 4.54)
0.71
(0.15, 3.45)
FNG0.28
(0.05, 1.53)
1.61
(0.29, 8.84)
0.74
(0.34, 1.60)
0.30
(0.05, 1.66)
0.62
(0.17, 2.17)
0.74
(0.31, 1.82)
0.26
(0.05, 1.32)
0.36
(0.12, 1.08)
NTZ5.85
(0.81, 42.25)
1.97
(0.85, 4.56)
1.09
(0.15, 7.94)
2.62
(0.77, 8.83)
3.17
(1.38, 7.25)
1.09
(0.22, 5.47)
1.53
(0.52, 4.50)
4.25
(1.34, 13.46)
No DMT0.39
(0.17, 0.92)
0.19
(0.03, 1.34)
1.17
(0.45, 3.02)
1.41
(0.92, 2.17)
0.49
(0.11, 2.06)
0.68
(0.32, 1.45)
1.90
(0.82, 4.38)
0.45
(0.19, 1.02)
Platform therapy0.45
(0.10, 1.99)
0.59
(0.11, 3.33)
0.72
(0.17, 3.01)
0.25
(0.03, 1.78)
0.35
(0.07, 1.70)
0.96
(0.19, 5.00)
0.23
(0.04, 1.15)
0.51
(0.12, 2.18)
TRF

(b) Results from multivariate analyses

ALZ or CLA.....3.78
(0.79, 18.00)
.

1.88
(0.33, 10.73)
Anti-CD20 agents3.25
(1.46, 7.24)
..0.91
(0.39, 2.12)
1.27
(0.31, 5.13)
.
3.64
(0.65, 20.46)
1.88
(0.33, 10.73)
DMF0.87
(0.37, 2.05)
0.71
(0.30, 1.69)
1.07
(0.40, 2.85)
.1.12
(0.44, 2.89)
3.48
(0.59, 20.33)
3.64
(0.65, 20.46)
0.96
(0.48, 1.90)
FNG.0.68
(0.16, 2.82)
0.94
(0.25, 3.57)
.
2.19
(0.38, 12.49)
3.48
(0.59, 20.33)
0.60
(0.32, 1.14)
0.63
(0.27, 1.49)
NTZ1.27
(0.51, 3.19)
2.25
(0.60, 8.42)
.
2.59
(0.47, 14.12)
2.19
(0.38, 12.49)
0.71
(0.41, 1.23)
0.75
(0.35, 1.57)
1.18
(0.62, 2.25)
No DMT1.69
(0.66, 4.38)
0.65
(0.15, 2.92)
3.78
(0.79, 18.00)
2.59
(0.47, 14.12)
1.04
(0.50, 2.18)
1.09
(0.48, 2.49)
1.73
(0.80, 3.76)
1.46
(0.75, 2.84)
Platform therapy.
3.18
(0.49, 20.81)
3.78
(0.79, 18.00)
0.87
(0.39, 1.97)
0.91
(0.32, 2.58)
1.46
(0.54, 3.94)
1.23
(0.50, 2.99)
0.84
(0.30, 2.39)
TRF

On the upper triangle, the effect size are direct comparisons; the effect sizes presented on lower triangle are network meta-analyses (indirect comparison). Comparisons should be read from left to right (example for upper triangle: OR (95% CI) of developing COVID-19 in anti-CD20 agents compared to DMF is 3.25 (1.46, 7.24); example for lower triangle: OR (95% CI) of developing COVID-19 in the ALZ or CLA group compared to anti-CD20 agents is 1.88 (0.33, 10.73). Platform therapy: interferon and glatiramer acetate; anti-CD20 agents: rituximab and ocrelizumab. ALZ: alemtuzumab; CLA: cladribine; DMF: dimethyl fumarate; FNG: fingolimod; NTZ: natalizumab; TRF: teriflunomide; DMT: disease-modifying therapy.