Modifiable risk factors of COVID-19 in patients with multiple sclerosis: a single-centre case–control study
Montini et al.
, Modifiable risk factors of COVID-19 in patients with multiple sclerosis: a single-centre case–control study
, Journal of Neurology, doi:10.1007/s00415-023-11618-0
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.
Abstract: Journal of Neurology
Modifiable risk factors of COVID‑19 in patients with multiple sclerosis:
a single‑centre case–control study
Federico Montini1 · Agostino Nozzolillo1 · Paola M. V. Rancoita2 · Chiara Zanetta1 · Lucia Moiola1 ·
Federica Cugnata2 · Federica Esposito1 · Maria A. Rocca1,3,4 · Vittorio Martinelli1 · Massimo Filippi1,3,4,5,6
Received: 21 December 2022 / Revised: 8 February 2023 / Accepted: 8 February 2023
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2023
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 COVID19 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.
Keywords Multiple sclerosis · Case–control studies · Viral infections · Medical care
Vittorio Martinelli and Massimo Filippi have equally contributed to
* Massimo Filippi
Demographic, ecological, and politico-economic factors
together with comorbidities have influenced the severity
of Coronavirus disease 2019 (COVID-19) worldwide .
Among others, this pandemic has also raised health concerns
related to people with multiple sclerosis (PwMS) in the acute
phase of the outbreak. These people have been considered
at higher risk to contract SARS-CoV-2 infection and have
a more severe COVID-19 course due to their clinical disability, comorbidities, disease-associated immune alterations
and the use of disease modifying therapies (DMTs) [2, 3].
In the general population more than 6,500,000 deaths
have been reported in the world . Data collected during the pandemic suggest that COVID-19 may determine
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