publications | Ashkan Pirmani

2022

ATHENA
Augmenting THerapeutic Effectiveness Through Novel Analytics (ATHENA)-A Public and Private Partnership Project Funded by the Flemish Government (VLAIO).

Ploingarm Petsophonsakul, Ashkan Pirmani, Edward De Brouwer, and 8 more authors

Stud Health Technol Inform 2022

Abs Bib HTML

The complexity and heterogeneity of cancers leads to variable responses of patients to treatments and interventions. Developing models that accurately predict patient’s care pathways using prognostic and predictive biomarkers is increasingly important in both clinical practice and scientific research. The main objective of the ATHENA project is to:(1) accelerate data driven precision medicine for two use cases-bladder cancer and multiple myeloma,(2) apply distributed and privacy-preserving analytical methods/algorithms to stratify patients (decision support),(3) help healthcare professionals deliver earlier and better targeted treatments, and (4) explore care pathway automations and improve outcomes for each patient. Challenges associated with data sharing and integration will be addressed and an appropriate federated data ecosystem will be created, enabling an interoperable foundation for data exchange, analysis and interpretation. By combining multidisciplinary expertise and tackling knowledge gaps in ATHENA, we propose a novel federated privacy preserving platform for oncology research.
@article{petsophonsakul2022augmenting, title = {Augmenting THerapeutic Effectiveness Through Novel Analytics (ATHENA)-A Public and Private Partnership Project Funded by the Flemish Government (VLAIO).}, author = {Petsophonsakul, Ploingarm and Pirmani, Ashkan and De Brouwer, Edward and Akand, Murat and Botermans, Wouter and Van Der Aa, Frank and Vermeesch, Joris Robert and Offner, Fritz and Wuyts, Roel and Moreau, Yves and others}, journal = {Stud Health Technol Inform}, volume = {294}, pages = {829--833}, year = {2022}, }
GDSI

Severity of COVID19 infection among patients with multiple sclerosis treated with interferon-β

Steve Simpson-Yap, Ashkan Pirmani, Edward De Brouwer, and 41 more authors

Multiple Sclerosis and Related Disorders 2022

Abs HTML

Background Interferon-β, a disease-modifying therapy (DMT) for MS, may be associated with less severe COVID-19 in people with MS. Results Among 5,568 patients (83.4% confirmed COVID-19), interferon-treated patients had lower risk of severe COVID-19 compared to untreated, but not to glatiramer-acetate, dimethyl-fumarate, or pooled other DMTs. Conclusions In comparison to other DMTs, we did not find evidence of protective effects of interferon-β on the severity of COVID-19, though compared to the untreated, the course of COVID19 was milder among those on interferon-β. This study does not support the use of interferon-β as a treatment to reduce COVID-19 severity in MS.
GDSI
Updated Results of the COVID-19 in MS Global Data Sharing Initiative

Steve Simpson-Yap, Ashkan Pirmani, Tomas Kalincik, and 42 more authors

Neurology - Neuroimmunology Neuroinflammation 2022

Abs Bib HTML PDF

Background and Objectives Certain demographic and clinical characteristics, including the use of some disease-modifying therapies (DMTs), are associated with severe acute respiratory syndrome coronavirus 2 infection severity in people with multiple sclerosis (MS). Comprehensive exploration of these relationships in large international samples is needed.Methods Clinician-reported demographic/clinical data from 27 countries were aggregated into a data set of 5,648 patients with suspected/confirmed coronavirus disease 2019 (COVID-19). COVID-19 severity outcomes (hospitalization, admission to intensive care unit [ICU], requiring artificial ventilation, and death) were assessed using multilevel mixed-effects ordered probit and logistic regression, adjusted for age, sex, disability, and MS phenotype. DMTs were individually compared with glatiramer acetate, and anti-CD20 DMTs with pooled other DMTs and with natalizumab.Results Of 5,648 patients, 922 (16.6%) with suspected and 4,646 (83.4%) with confirmed COVID-19 were included. Male sex, older age, progressive MS, and higher disability were associated with more severe COVID-19. Compared with glatiramer acetate, ocrelizumab and rituximab were associated with higher probabilities of hospitalization (4% [95% CI 1–7] and 7% [95% CI 4–11]), ICU/artificial ventilation (2% [95% CI 0–4] and 4% [95% CI 2–6]), and death (1% [95% CI 0–2] and 2% [95% CI 1–4]) (predicted marginal effects). Untreated patients had 5% (95% CI 2–8), 3% (95% CI 1–5), and 1% (95% CI 0–3) higher probabilities of the 3 respective levels of COVID-19 severity than glatiramer acetate. Compared with pooled other DMTs and with natalizumab, the associations of ocrelizumab and rituximab with COVID-19 severity were also more pronounced. All associations persisted/enhanced on restriction to confirmed COVID-19.Discussion Analyzing the largest international real-world data set of people with MS with suspected/confirmed COVID-19 confirms that the use of anti-CD20 medication (both ocrelizumab and rituximab), as well as male sex, older age, progressive MS, and higher disability are associated with more severe course of COVID-19.aβ=adjusted β; BMI=body mass index; COVID-19=coronavirus disease 2019; DMT=disease-modifying therapy; EDSS=Expanded Disability Status Scale; ICU=intensive care unit; MS=multiple sclerosis; RRMS=relapsing-remitting MS
@article{Simpson-Yape200021, author = {Simpson-Yap, Steve and Pirmani, Ashkan and Kalincik, Tomas and De Brouwer, Edward and Geys, Lotte and Parciak, Tina and Helme, Anne and Rijke, Nick and Hillert, Jan A. and Moreau, Yves and Edan, Gilles and Sharmin, Sifat and Spelman, Tim and McBurney, Robert and Schmidt, Hollie and Bergmann, Arnfin B. and Braune, Stefan and Stahmann, Alexander and Middleton, Rod M. and Salter, Amber and Bebo, Bruce and Van der Walt, Anneke and Butzkueven, Helmut and Ozakbas, Serkan and Boz, Cavit and Karabudak, Rana and Alroughani, Raed and Rojas, Juan I. and van der Mei, Ingrid A. and Sciascia do Olival, Guilherme and Magyari, Melinda and Alonso, Ricardo N. and Nicholas, Richard S. and Chertcoff, Anibal S. and de Torres, Ana Zabalza and Arrambide, Georgina and Nag, Nupur and Descamps, Annabel and Costers, Lars and Dobson, Ruth and Miller, Aleisha and Rodrigues, Paulo and Pr{\v c}kovska, Vesna and Comi, Giancarlo and Peeters, Liesbet M.}, title = {Updated Results of the COVID-19 in MS Global Data Sharing Initiative}, volume = {9}, number = {6}, elocation-id = {e200021}, year = {2022}, doi = {10.1212/NXI.0000000000200021}, publisher = {Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology}, journal = {Neurology - Neuroimmunology Neuroinflammation} }

2021

GDSI
Associations of Disease-Modifying Therapies With COVID-19 Severity in Multiple Sclerosis

Steve Simpson-Yap, Edward De Brouwer, Tomas Kalincik, and 44 more authors

Neurology 2021

Abs Bib HTML PDF

Background and Objectives People with multiple sclerosis (MS) are a vulnerable group for severe coronavirus disease 2019 (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 DMTs) covariates were queried, along with COVID-19 severity outcomes, hospitalization, intensive care unit (ICU) admission, need for 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 Expanded Disability Status Scale (EDSS) score.Results Six hundred fifty-seven (28.1%) with suspected and 1,683 (61.9%) with confirmed COVID-19 were analyzed. Among suspected plus confirmed and confirmed-only COVID-19, 20.9% and 26.9% were hospitalized, 5.4% and 7.2% were admitted to ICU, 4.1% and 5.4% required artificial ventilation, and 3.2% and 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 hospitalization (adjusted odds ratio [aOR] 1.56, 95% confidence interval [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), although only rituximab was associated with higher risk of artificial ventilation (aOR 4.00, 95% CI 1.54–10.39). Compared to pooled other DMTs, ocrelizumab and rituximab were associated with hospitalization (aOR 1.75, 95% CI 1.29–2.38; aOR 2.76, 95% CI 1.87–4.07) and ICU admission (aOR 2.55, 95% CI 1.49–4.36; aOR 4.32, 95% CI 2.27–8.23), but only rituximab was associated with artificial ventilation (aOR 6.15, 95% CI 3.09–12.27). Compared to natalizumab, ocrelizumab and rituximab were associated with hospitalization (aOR 1.86, 95% CI 1.13–3.07; aOR 2.88, 95% CI 1.68–4.92) and ICU admission (aOR 2.13, 95% CI 0.85–5.35; aOR 3.23, 95% CI 1.17–8.91), but only rituximab was associated with ventilation (aOR 5.52, 95% CI 1.71–17.84). Associations persisted on restriction to confirmed COVID-19 cases. No associations were observed between DMTs and death. Stratification by age, MS phenotype, and EDSS score found no indications that DMT associations with COVID-19 severity reflected differential DMT allocation by underlying COVID-19 severity.Discussion Using the largest cohort of people with MS and COVID-19 available, we demonstrated consistent associations of rituximab with increased risk of hospitalization, ICU admission, and need for artificial ventilation and of ocrelizumab with hospitalization and ICU admission. Despite the cross-sectional design of the study, the internal and external consistency of these results with prior studies suggests that rituximab/ocrelizumab use may be a risk factor for more severe COVID-19.aOR=adjusted OR; BMI=body mass index; CI=confidence interval; COVID-19=coronavirus disease 2019; DMT=disease-modifying therapy; EDSS=Expanded Disability Status Scale; ICU=intensive care unit; MS=multiple sclerosis; MSDA=MS Data Alliance; OR=odds ratio; RRMS=relapsing-remitting MS; SARS-CoV-2=severe acute respiratory syndrome coronavirus 2
@article{Simpson-Yape1870, author = {Simpson-Yap, Steve and De Brouwer, Edward and Kalincik, Tomas and Rijke, Nick and Hillert, Jan A. and Walton, Clare and Edan, Gilles and Moreau, Yves and Spelman, Tim and Geys, Lotte and Parciak, Tina and Gautrais, Clement and Lazovski, Nikola and Pirmani, Ashkan and Ardeshirdavanai, Amin and Forsberg, Lars and Glaser, Anna and McBurney, Robert and Schmidt, Hollie and Bergmann, Arnfin B. and Braune, Stefan and Stahmann, Alexander and Middleton, Rodden and Salter, Amber and Fox, Robert J. and van der Walt, Anneke and Butzkueven, Helmut and Alroughani, Raed and Ozakbas, Serkan and Rojas, Juan I. and van der Mei, Ingrid and Nag, Nupur and Ivanov, Rumen and Sciascia do Olival, Guilherme and Dias, Alice Estavo and Magyari, Melinda and Brum, Doralina and Mendes, Maria Fernanda and Alonso, Ricardo N. and Nicholas, Richard S. and Bauer, Johana and Chertcoff, An{\'\i}bal Sebasti{\'a}n and Zabalza, Anna and Arrambide, Georgina and Fidao, Alexander and Comi, Giancarlo and Peeters, Liesbet}, title = {Associations of Disease-Modifying Therapies With COVID-19 Severity in Multiple Sclerosis}, volume = {97}, number = {19}, pages = {e1870--e1885}, year = {2021}, doi = {10.1212/WNL.0000000000012753}, publisher = {Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology}, issn = {0028-3878}, journal = {Neurology}, }

MSDA

Multiple Sclerosis Data Alliance – A global multi-stakeholder collaboration to scale-up real world data research

Liesbet M. Peeters, Tina Parciak, Dipak Kalra, and 18 more authors

Multiple Sclerosis and Related Disorders 2021

Abs Bib HTML

The Multiple Sclerosis Data Alliance (MSDA), a global multi-stakeholder collaboration, is working to accelerate research insights for innovative care and treatment for people with multiple sclerosis (MS) through better use of real-world data (RWD). Despite the increasing reliance on RWD, challenges and limitations complicate the generation, collection, and use of these data. MSDA aims to tackle sociological and technical challenges arising with scaling up RWD, specifically focused on MS data. MSDA envisions a patient-centred data ecosystem in which all stakeholders contribute and use big data to co-create the innovations needed to advance timely treatment and care of people with MS.

@article{PEETERS2021102634,
  title = {Multiple Sclerosis Data Alliance – A global multi-stakeholder collaboration to scale-up real world data research},
  journal = {Multiple Sclerosis and Related Disorders},
  volume = {47},
  pages = {102634},
  year = {2021},
  issn = {2211-0348},
  doi = {https://doi.org/10.1016/j.msard.2020.102634},
  author = {Peeters, Liesbet M. and Parciak, Tina and Kalra, Dipak and Moreau, Yves and Kasilingam, Elisabeth and {van Galen}, Pieter and Thalheim, Christoph and Uitdehaag, Bernard and Vermersch, Patrick and Hellings, Niels and Stinissen, Piet and {Van Wijmeersch}, Bart and Ardeshirdavani, Amin and Pirmani, Ashkan and {De Brouwer}, Edward and Bauer, Christian Robert and Krefting, Dagmar and Ribbe, Stephanie and Middleton, Rod and Stahmann, Alexander and Comi, Giancarlo},
  keywords = {Real world data, multiple sclerosis, learning health system, collaboration, patient engagement}
}

GDSI
Updated results of the COVID-19 in MS global data sharing initiative validate consistent associations of anti-CD20 and other reported risk factors with severe COVID-19 outcomes

S Simpson-Yap, Ashkan Pirmani, E De Brouwer, and 8 more authors

Multiple Sclerosis Journal 2021

Abs Bib HTML

Background: As the COVID-19 pandemic continues, evidencebased clinical guidance for managing the care of people with multiple sclerosis (MS) is an ongoing concern. In recent months, data from cohorts of people with MS has indicated that certain demographic and clinical characteristics, including use of some disease- modifying therapies (DMTs), leads to worse outcomes from SARS-CoV-2 infection. The COVID-19 in MS global data sharing initiative, which now includes over 4,500 confirmed COVID- 19 cases in people with MS, gives the opportunity to corroborate previous findings with greater certainty. Methods: Clinician-reported data from 32 countries were aggregated into a dataset of 5,543 patients who had suspected or confirmed COVID-19. Demographic and clinical covariates were queried, alongside COVID-19 clinical severity outcomes. These outcomes (hospitalisation, admission to ICU, requiring artificial ventilation, and death) were assessed in patients with suspected/ confirmed COVID-19 using multilevel mixed-effects logistic regression. All models were corrected for age, sex, EDSS, and MS type. DMTs were individually compared to glatiramer acetate (GA), as well as to pooled other DMTs and natalizumab. Results: Of 5,543 patients in the clinician-reported dataset, 909 with suspected and 4,634 with confirmed COVID-19 were included in the analysis. Previous demographic findings were confirmed male sex, older age, progressive MS, and higher disability were associated with worse outcomes from SARS-CoV-2 infection. Use of anti-CD20 DMTs (ocrelizumab and rituximab) was associated with worse COVID-19 outcomes. Compared to GA, ocrelizumab and rituximab were associated with increased risk of hospitalisation (aOR=1.61(95%CI=1.06-2.43);aOR=2.42(95%CI=1.54-3.81) and ICU admission (aOR=3.13(95%CI=1.22-8.00);aOR=4.46 (95%CI=1.64-12.09)). Rituximab was associated with increased risk of artificial ventilation (aOR=3.57(95%CI=1.38-9.20));ocrelizumab showed a positive trend (aOR=1.86(95%CI=0.76-4.55). Rituximab showed a positive trend with increased risk of death (aOR=2.74(95%CI=0.68-11.09). Associations persisted on restriction to confirmed COVID-19 cases. Conclusions: Analysing the largest international real world dataset of people with MS who have suspected or confirmed COVID- 19 confirms previous findings that male sex, older age, progressive MS, higher disability, the use of anti-CD20 medication (ocrelizumab and rituximab) are associated with worse COVID-19 outcomes.
@article{simpson2021updated, title = {Updated results of the COVID-19 in MS global data sharing initiative validate consistent associations of anti-CD20 and other reported risk factors with severe COVID-19 outcomes}, author = {Simpson-Yap, S and Pirmani, Ashkan and De Brouwer, E and Geys, Lotte and Parciak, Tina and Helme, A and Rijke, N and Kalincik, T and Hillert, J and Moreau, Y and others}, journal = {Multiple Sclerosis Journal}, pages = {741--743}, year = {2021} }
GDSI
1298Associations of DMT therapies with COVID-19 severity in multiple sclerosis

Steve Simpson-Yap, Edward De Brouwer, Tomas Kalincik, and 41 more authors

International Journal of Epidemiology Sep 2021

Abs Bib HTML PDF

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.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.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.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.Anti-CD20 DMTs may be associated with worse COVID-19 severity amongst people with multiple sclerosis.
@article{10.1093/ije/dyab168.604, author = {Simpson-Yap, Steve and Brouwer, Edward De and Kalincik, Tomas and Rijke, Nick and Hillert, Jan and Walton, Clare and Edan, Gilles and Spelman, Tim and Geyes, Lotte and Parciak, Tina and Gautrais, Clément and Lazovski, Nikola and Pirmani, Ashkan and Ardeshirdavani, Amin and Forsberg, Lars and Glaser, Anna and McBurney, Robert and Schmidt, Hollie and Bergmann, Arnfin and Braune, Stefan and Stahmann, Alexander and Middleton, Rodden and Salter, Amber and Fox, Robert and van der Walt, Anneke and Butzkueven, Helmut and Rojas, Juan and van der Mei, Ingrid and Nag, Nupur and Ivanov, Rumen and Olival, Guilherme Sciascia do and Dias, Alice Estavo and Magyari, Melinda and Brum, Doralina Guimarães and Mendes, Maria Fernandes and Alonso, Ricardo and Nicholas, Richard and Bauer, Johana and Chertcoff, Anibal and Zabalza, Ana and Arrambide, Georgina and Fidao, Alexander and Comi, Giancarlo and Peeters, Liesbet}, title = {{1298Associations of DMT therapies with COVID-19 severity in multiple sclerosis}}, journal = {International Journal of Epidemiology}, volume = {50}, number = {Supplement_1}, year = {2021}, month = sep, issn = {0300-5771}, doi = {10.1093/ije/dyab168.604}, note = {dyab168.604}, }
MSDA
The Multiple Sclerosis Data Alliance Catalogue: enabling web-based discovery of metadata from real-world multiple sclerosis data sources

Lotte Geys, Tina Parciak, Ashkan Pirmani, and 8 more authors

International journal of MS care Sep 2021

Abs Bib HTML

Background: One of the major objectives of the Multiple Sclerosis Data Alliance (MSDA) is to enable better discovery of multiple sclerosis (MS) real-world data (RWD). Methods: We implemented the MSDA Catalogue, which is available worldwide. The current version of the MSDA Catalogue collects descriptive information on governance, purpose, inclusion criteria, procedures for data quality control, and how and which data are collected, including the use of e-health technologies and data on collection of COVID-19 variables. The current cataloguing procedure is performed in several manual steps, securing an effective catalogue. Results: Herein we summarize the status of the MSDA Catalogue as of January 6, 2021. To date, 38 data sources across five continents are included in the MSDA Catalogue. These data sources differ in purpose, maturity, and variables collected, but this landscaping effort shows that there is substantial alignment on some domains. The MSDA Catalogue shows that personal data and basic disease data are the most collected categories of variables, whereas data on fatigue measurements and cognition scales are the least collected in MS registries/cohorts. Conclusions:The Web-based MSDA Catalogue provides strategic overview and allows authorized end users to browse metadata profiles of data cohorts and data sources. There are many existing and arising RWD sources in MS. Detailed cataloguing of MS RWD is a first and useful step toward reducing the time needed to discover MS RWD sets and promoting collaboration.
@article{geys2021multiple, title = {The Multiple Sclerosis Data Alliance Catalogue: enabling web-based discovery of metadata from real-world multiple sclerosis data sources}, author = {Geys, Lotte and Parciak, Tina and Pirmani, Ashkan and McBurney, Robert and Schmidt, Hollie and Malba{\v{s}}a, Tanja and Ziemssen, Tjalf and Bergmann, Arnfin and Rojas, Juan I and Cristiano, Edgardo and others}, journal = {International journal of MS care}, volume = {23}, number = {6}, pages = {261--268}, year = {2021}, publisher = {The Consortium of Multiple Sclerosis Centers}, }

2020

GDSI
COVID-19 in people with multiple sclerosis: A global data sharing initiative

Liesbet M Peeters, Tina Parciak, Clare Walton, and 45 more authors

Multiple Sclerosis Journal Sep 2020

Abs Bib HTML PDF

Background:We need high-quality data to assess the determinants for COVID-19 severity in people with MS (PwMS). Several studies have recently emerged but there is great benefit in aligning data collection efforts at a global scale.Objectives:Our mission is to scale-up COVID-19 data collection efforts and provide the MS community with data-driven insights as soon as possible.Methods:Numerous stakeholders were brought together. Small dedicated interdisciplinary task forces were created to speed-up the formulation of the study design and work plan. First step was to agree upon a COVID-19 MS core data set. Second, we worked on providing a user-friendly and rapid pipeline to share COVID-19 data at a global scale.Results:The COVID-19 MS core data set was agreed within 48 hours. To date, 23 data collection partners are involved and the first data imports have been performed successfully. Data processing and analysis is an on-going process.Conclusions:We reached a consensus on a core data set and established data sharing processes with multiple partners to address an urgent need for information to guide clinical practice. First results show that partners are motivated to share data to attain the ultimate joint goal: better understand the effect of COVID-19 in PwMS.
@article{doi:10.1177/1352458520941485, author = {Peeters, Liesbet M and Parciak, Tina and Walton, Clare and Geys, Lotte and Moreau, Yves and Brouwer, Edward De and Raimondi, Daniele and Pirmani, Ashkan and Kalincik, Tomas and Edan, Gilles and Simpson-Yap, Steve and Raedt, Luc De and Dauxais, Yann and Gautrais, Clément and Rodrigues, Paulo R and McKenna, Landon and Lazovski, Nikola and Hillert, Jan and Forsberg, Lars and Spelman, Tim and McBurney, Robert and Schmidt, Hollie and Bergmann, Arnfin and Braune, Stefan and Stahmann, Alexander and Middleton, Rodden and Salter, Amber and Bebo, Bruce F and Rojas, Juan I and van der Walt, Anneke and Butzkueven, Helmut and van der Mei, Ingrid and Ivanov, Rumen and Hellwig, Kerstin and do Olival, Guilherme Sciascia and Cohen, Jeffrey A and Hecke, Wim Van and Dobson, Ruth and Magyari, Melinda and Brum, Doralina Guimarães and Alonso, Ricardo and Nicholas, Richard and Bauer, Johana and Chertcoff, Anibal and de Sèze, Jérôme and Louapre, Céline and Comi, Giancarlo and Rijke, Nick}, title = {COVID-19 in people with multiple sclerosis: A global data sharing initiative}, journal = {Multiple Sclerosis Journal}, volume = {26}, number = {10}, pages = {1157-1162}, year = {2020}, doi = {10.1177/1352458520941485}, note = {PMID: 32662757}, }
GDSI
First results of the COVID-19 in MS Global Data Sharing Initiative suggest anti-CD20 DMTs are associated with worse COVID-19 outcomes

S Simpson-Yap, E De Brouwer, T Kalincik, and 8 more authors

Multiple Sclerosis Journal Sep 2020

Abs Bib HTML

Background: As the COVID-19 pandemic amplifies, efforts to minimise the risk on vulnerable people are essential. People with multiple sclerosis (MS) may be a vulnerable group due to the high proportion taking long-term immunosuppressive disease-modifying therapies (DMTs). Studies from Italy and France suggest older age, higher disability and progressive MS are associated with severe COVID-19, yet there remains uncertainty around the influence of DMTs. Objectives: Given the many approved MS DMTs and the relatively low frequency of COVID-19 in MS patients per country, international data sharing is desirable to examine the impact of DMTs on COVID-19 severity. Here, we present the first results of the COVID-19 in MS global data sharing initiative of the MS International Federation and MS Data Alliance and many other data partners to inform MS clinical management during the COVID-19 pandemic. Methods: Clinician-reported data from 21 countries were aggregated into a dataset of 1540 patients. Characteristics of admission to hospital, admission to intensive care unit (ICU), need for artificial ventilation, and death, were assessed in patients with confirmed or suspected COVID-19 infection using log-binomial regression. Adjusted prevalence ratios (aPR) were calculated adjusting for age, sex, MS type, and Expanded Disability Status Scale (EDSS). Results: Of 1540 patients, 476 (30.9%) with suspected and 776 (50.4%) with confirmed COVID-19 were included in the analysis. Older age, progressive MS and higher EDSS were associated with higher frequencies of severe outcomes. Anti-CD20 DMTs, ocrelizumab and rituximab, were positively associated with hospital admission (aPRs=1.19 & 1.58), ICU admission (aPRs=3.53 & 4.12), and the need for artificial ventilation (aPRs=3.17 & 7.27) compared to dimethyl fumarate. Higher frequencies of all three outcomes were associated with combined anti-CD20 DMT use compared to all other DMTs (hospitalisation aPR=1.49; ICU aPR=2.55; ventilation aPR=3.05) and compared to natalizumab (hospitalisation aPR=1.99; ICU aPR=2.39; ventilation aPR=2.84). Importantly, associations persisted on restriction to confirmed COVID-19 cases and upon exclusion of each contributing data source in turn. No associations were observed between DMTs and death. Conclusions: This study used the largest federated international cohort of people with MS and COVID19 currently available. We demonstrate a consistent association of anti-CD20 DMTs with hospitalisation, ICU admission and use of artificial ventilation suggesting their use among MS patients at risk for COVID-19 exposure may be a risk factor for more severe COVID-19 disease. To address study limitations, further research incorporating comorbidities, smoking and body mass index is required. Alternative study designs are needed to address questions on COVID-19 susceptibility among people with MS.
@article{simpson2020first, title = {First results of the COVID-19 in MS Global Data Sharing Initiative suggest anti-CD20 DMTs are associated with worse COVID-19 outcomes}, author = {Simpson-Yap, S and De Brouwer, E and Kalincik, T and Rijke, N and Hillert, J and Walton, C and Edan, G and Moreau, Y and Spelman, T and Geys, Lotte and others}, journal = {Multiple Sclerosis Journal}, pages = {48--49}, volume = {26}, year = {2020}, }