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0 0.5 1 1.5 2+ Case 7% Improvement Relative Risk Vitamin D for COVID-19  Montini et al.  Sufficiency Are vitamin D levels associated with COVID-19 outcomes? Retrospective study in Italy (March 2020 - March 2021) Fewer cases with higher vitamin D levels (p<0.000001) Montini et al., J. Neurology, February 2023 Favors vitamin D Favors control

Modifiable risk factors of COVID-19 in patients with multiple sclerosis: a single-centre case–control study

Montini et al., Journal of Neurology, doi:10.1007/s00415-023-11618-0
Feb 2023  
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Vitamin D for COVID-19
8th treatment shown to reduce risk in October 2020
*, now known with p < 0.00000000001 from 120 studies, recognized in 8 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,000+ studies for 60+ treatments.
Case control analysis with 149 multiple sclerosis patients and 292 matched controls in Italy, showing lower risk of COVID-19 cases with higher vitamin D levels.
risk of case, 7.0% lower, OR 0.93, p < 0.001, adjusted per study, case control OR, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Montini et al., 16 Feb 2023, retrospective, Italy, peer-reviewed, 10 authors, study period March 2020 - March 2021. Contact:
This PaperVitamin DAll
Modifiable risk factors of COVID-19 in patients with multiple sclerosis: a single-centre case–control study
Federico Montini, Agostino Nozzolillo, Paola M V Rancoita, Chiara Zanetta, Lucia Moiola, Federica Cugnata, Federica Esposito, Maria A Rocca, Vittorio Martinelli, Massimo Filippi
Journal of Neurology, doi:10.1007/s00415-023-11618-0
Background Disease and treatment-associated immune system abnormalities may confer higher risk of Coronavirus disease 2019 (COVID-19) to people with multiple sclerosis (PwMS). We assessed modifiable risk factors associated with COVID-19 in PwMS. Methods Among patients referring to our MS Center, we retrospectively collected epidemiological, clinical and laboratory data of PwMS with confirmed COVID-19 between March 2020 and March 2021 (MS-COVID, n = 149). We pursued a 1:2 matching of a control group by collecting data of PwMS without history of previous COVID-19 (MS-NCOVID, n = 292). MS-COVID and MS-NCOVID were matched for age, expanded disability status scale (EDSS) and line of treatment. We compared neurological examination, premorbid vitamin D levels, anthropometric variables, life-style habits, working activity, and living environment between the two groups. Logistic regression and Bayesian network analyses were used to evaluate the association with COVID-19. Results MS-COVID and MS-NCOVID were similar in terms of age, sex, disease duration, EDSS, clinical phenotype and treatment. At multiple logistic regression, higher levels of vitamin D (OR 0.93, p < 0.0001) and active smoking status (OR 0.27, p < 0.0001) emerged as protective factors against COVID-19. In contrast, higher number of cohabitants (OR 1.26, p = 0.02) and works requiring direct external contact (OR 2.61, p = 0.0002) or in the healthcare sector (OR 3.73, p = 0.0019) resulted risk factors for COVID-19. Bayesian network analysis showed that patients working in the healthcare sector, and therefore exposed to increased risk of COVID-19, were usually non-smokers, possibly explaining the protective association between active smoking and COVID-19. Conclusions Higher Vitamin D levels and teleworking may prevent unnecessary risk of infection in PwMS.
Author contributions Concept and design: MR, MF. Acquisition, analysis, or interpretation of data: MN, RZ, MC, ER, MF. Drafting of the manuscript: MR, CR, MF. Statistical analysis: RC. Supervision: RMF. Declarations Conflict of interest Federico Montini has no potential conflicts of interest and reports no disclosures; Agostino Nozzolillo has no potential conflicts of interest and reports no disclosures; Paola M.V. Rancoita has no potential conflicts of interest and reports no disclosures; Chiara Zanetta has no potential conflicts of interest and reports no disclosures; Lucia Moiola received compensation for speaking activities, and/or consulting services from Merck, Biogen, Novartis, Roche, Sanofi, and TEVA; Federica Cugnata has no potential conflicts of interest and reports no disclosures; Federica Esposito received consulting and speaking fees from Novartis, Sanofi Genzyme; Maria A. Rocca received consulting fees from Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche; and speaker honoraria from AstraZaneca, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Horizon Therapeutics Italy, Merck Serono SpA, Novartis, Roche, Sanofi and Teva. She receives research support from the MS Society of Canada, the Italian Ministry of Health, and Fondazione Italiana Sclerosi Multipla. She is Associate Editor for Multiple Sclerosis and Related Disorders; Vittorio Martinelli received compensation for speaking and/or for consultancy and support for travel expenses and..
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