RESUMO
Background: We conducted this study to assess the effect of disease-modifying therapies (DMTs) on coronavirus disease (COVID-19) susceptibility and severity in people with multiple sclerosis (MS). Methods: Available studies from PubMed, Scopus, EMBASE, Web of Science, and gray literature, including reference lists and conference abstracts, were searched from December 1, 2019, to July 26, 2021. We included cross-sectional, case-control, and cohort studies assessing the association of DMTs with risk of contracting COVID-19 or its outcomes in MS patients on univariate or multivariate regression analyses. We conducted a network meta-analysis (NMA) to compare the risk of COVID-19 and developing severe infection across DMTs. Results: Out of the initial 3893 records and 1883 conference abstracts, a total of 10 studies were included. Pairwise comparisons showed that none of the DMTs meaningfully affect the risk of acquiring infection. There was significant total heterogeneity and inconsistency across this NMA. In comparison with no DMT, dimethyl fumarate (0.62 (0.42, 0.93)), fingolimod (0.55 (0.32, 0.94)), natalizumab (0.50 (0.31, 0.81)), and interferon (0.42 (0.22, 0.79)) were associated with a decreased risk of severe COVID-19; but, rituximab was observed to increase the risk (1.94 (1.20, 3.12)). Compared to rituximab or ocrelizumab, all DMTs were associated with a decreased risk. Pairwise comparisons showed no differences across other DMTs. Interferon and rituximab were associated with the lowest and highest risks of severe COVID-19. Conclusion: Our study showed an increased risk of severe COVID-19 in patients on rituximab and ocrelizumab. No association with COVID-19 severity across other DMTs was observed.
RESUMO
OBJECTIVE: The purpose of this study was to determine the pooled prevalence of vaccination willingness, unwillingness, and hesitancy among patients with multiple sclerosis. METHODS: Databases including PubMed, Scopus, EMBASE, Web of Science, and Google Scholar were searched. by two expert researchers, as well as references in the included studies, which were published before October 2021. RESULTS: Three hundred eighty articles were found in four data bases. One hundred eighty-two studies remained following deleting duplicates. Finally, ten studies remained for the meta-analysis. Totally, 5983 patients with MS were assessed. The pooled prevalence of willingness to vaccination among patients with MS was 76% (95% CI: 67-85%) (I2 = 98.4%, p < 0.001). Unwillingness pooled prevalence to vaccination among patients with MS was 2% (95% CI: 2-3%) (I2 = 97.9%, p < 0.001). Hesitancy pooled prevalence to vaccination among patients with MS was 0% (I2 = 98%, p < 0.001). CONCLUSION: According to the findings of this systematic review and meta-analysis, more than two-thirds of patients with MS were willing to obtain COVID-19 vaccines.
