Evidence map›Paper›PMID 33480077›Full record

ArticleAnnals of neurology2021

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis.

Maria P Sormani, Nicola De Rossi, Irene Schiavetti, Luca Carmisciano, Cinzia Cordioli, Lucia Moiola, Marta Radaelli, Paolo Immovilli, Marco Capobianco, Maria Trojano and 7 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05298670 (Drug Repurposing Using Metformin for Improving the Therapeutic Outcome in Multiple Sclerosis Patients), which is not on this map. Cited by 282 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
282citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05298670 phase2unknown statusnot on this mapstarted 2022, after this paper: background citation

Drug Repurposing Using Metformin for Improving the Therapeutic Outcome in Multiple Sclerosis Patients

TypeinterventionalSponsorGerman University in CairoRan2022 to 2023Enrolled80ConditionsMultiple SclerosisArmsMetFORMIN 1000 Mg Oral Tablet, Interferon beta-1a
3 · Its place in the literature

Who cites it

282 citing papers in PubMed, 10 syntheses or guidelines pooled it.

  1. Rituximab for people with multiple sclerosis.The Cochrane database of systematic reviews · 2025
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  7. Systematic review of risk of SARS-CoV-2 infection and severity of COVID-19 with therapies approved to treat multiple sclerosis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2022
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  16. CD56Clinical & translational immunology · 2026
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222 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Maria P SormaniDepartment of Health Sciences, University of Genoa, Genoa, Italy.ORCID 0000-0001-6892-104X
Nicola De RossiCentro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy.
Irene SchiavettiDepartment of Health Sciences, University of Genoa, Genoa, Italy.
Luca CarmiscianoDepartment of Health Sciences, University of Genoa, Genoa, Italy.
Cinzia CordioliCentro Sclerosi Multipla ASST Spedali Civili di Brescia, Montichiari, Italy.
Lucia MoiolaDepartment of Neurology, Multiple Sclerosis Center, IRCCS Ospedale San Raffaele, Milan, Italy.
Marta RadaelliDepartment of Neurology and Multiple Sclerosis Center, ASST Papa Giovanni XXIII, Bergamo, Italy.
Paolo ImmovilliMultiple Sclerosis Center, Ospedale Guglielmo da Saliceto, Piacenza, Italy.
Marco CapobiancoDepartment of Neurology, Regional Referral Multiple Sclerosis Center, University Hospital San Luigi, Orbassano, Torino, Italy.
Maria TrojanoDepartment of Basic Medical Sciences, Neurosciences, and Sense Organs, University of Bari, Bari, Italy.
Paola ZaratinResearch Department, Italian Multiple Sclerosis Foundation, Genoa, Italy.
Gioacchino TedeschiDepartment of Advanced Medical and Surgical Sciences, University of Campania, Naples, Italy.
Giancarlo ComiInstitute of Experimental Neurology, IRCCS Ospedale San Raffaele, Milan, Italy.ORCID 0000-0002-6989-1054
Mario A BattagliaResearch Department, Italian Multiple Sclerosis Foundation, Genoa, Italy.
Francesco PattiDepartment of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy.ORCID 0000-0002-6923-0846
Marco SalvettiDepartment of Neuroscience, Mental Health, and Sensory Organs, Sapienza University of Rome, Rome, Italy.
Musc-19 Study Group

Funding

F. Hoffmann-La Roche donating the web-based platform for data collectio
6 · The paper itself

Abstract

objectiveThis study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS).

methodsWe retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results.

resultsOf 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses.

interpretationThis study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists. ANN NEUROL 2021;89:780-789.

Indexed as

AdolescentAdultAgedAged, 80 and overAntibodies, Monoclonal, HumanizedCOVID-19Dimethyl FumarateFemaleFingolimod HydrochlorideHospitalizationHumansImmunologic FactorsImmunosuppressive AgentsIntensive Care UnitsInterferonsMaleAntibodies, Monoclonal, HumanizedDimethyl FumarateFingolimod HydrochlorideImmunologic FactorsImmunosuppressive AgentsInterferonsNatalizumabocrelizumab

Identifiers

PMID33480077
PMCPMC8013440

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.