We evaluated the effect of DMTs on Covid‐19 severity in patients with MS, with a pooled‐analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid‐19 severity was assessed by multivariate ordinal‐logistic models and pooled by a fixed‐effect meta‐analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti‐CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid‐19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled‐analysis confirms an increased risk of severe Covid‐19 in patients on anti‐CD20 therapies and supports the protective role of interferon.

This study provides Class III evidence that p-syn in skin nerve fibers on skin biopsy accurately distinguishes DLB from other forms of dementia.

Background: The MuSC-19 project is an Italian cohort study open to international partners that collects data on multiple sclerosis (MS) patients with COVID-19. During the second wave of the pandemic, serological tests became routinely available. Objective: To evaluate the seroprevalence of anti-SARS-CoV-2 antibodies according to the use of disease-modifying therapy (DMT) in a subset of patients included in the MuSC-19 data set who had undergone a serological test. Methods: We evaluated the association between positive serological test results and time elapsed since infection onset, age, sex, Expanded Disability Status Scale score, comorbidities and DMT exposure using a multivariable logistic model. Results: Data were collected from 423 patients (345 from Italy, 61 from Turkey and 17 from Brazil) with a serological test performed during follow-up. Overall, 325 out of 423 tested patients (76.8%) had a positive serological test. At multivariate analysis, therapy with anti-CD20 was significantly associated with a reduced probability of developing antibodies after COVID-19 (odds ratio (OR) = 0.20, p = 0.002). Conclusion: Patients with MS maintain the capacity to develop humoral immune response against SARS-COV-2, although to a lesser extent when treated with anti-CD20 drugs. Overall, our results are reassuring with respect to the possibility to achieve sufficient immunization with vaccination.

Background and Objectives.Studies on tumefactive brain lesions in myelin-oligodendrocyte-glycoprotein-IgG-associated disease (MOGAD) are lacking. We sought to characterize the frequency, clinical, laboratory, and MRI features of these lesions in MOGAD and compare them to multiple sclerosis (MS) and aquaporin-4-IgG-positive-neuromyelitis-optica-spectrum-disorder (AQP4+NMOSD).Methods.We retrospectively searched 194 MOGAD and 359 AQP4+NMOSD patients with clinical/MRI details available from the Mayo Clinic databases and included those with ≥1 tumefactive brain lesion (maximum transverse diameter ≥2 cm) on MRI. Tumefactive MS patients were identified using the Mayo Clinic medical-record-linkage-system. Binary multivariable stepwise logistic regression identified independent predictors of MOGAD diagnosis; Cox proportional regression models were used to assess the risk of relapsing disease and gait aid in tumefactivevs. non-tumefactive MOGAD patients.Results.We included 108 patients with tumefactive demyelination (MOGAD=43; AQP4+NMOSD=16; MS=49). Tumefactive lesions were more frequent among MOGAD (43/194[22%]) than AQP4+NMOSD (16/359[5%]) (p<0.001). Risk of relapse and need for gait aid were similar in tumefactive and non-tumefactive MOGAD. Clinical features more frequent in MOGAD than MS included headache (18/43[42%]vs.10/49[20%]; p=0.03) and somnolence (12/43[28%]vs.2/49[4%]; p=0.003), the latter also more frequent than AQP4+NMOSD (0/16[0%]; p=0.02). The presence of: peripheral T2-hypointense rim, T1-hypointensity, diffusion restriction (particularly an arc pattern), ring enhancement, Balo’-like or cystic appearance favored MS over MOGAD (p<0.001). MRI features were broadly similar in MOGAD and AQP4+NMOSD, except for more frequent diffusion restriction in AQP4+NMOSD (10/15[67%]) than MOGAD (11/42[26%], p=0.005). Cerebrospinal fluid analysis revealed less frequent positive oligoclonal bands in MOGAD (2/37[5%]) than MS (30/43[70%]) (p<0.001) and higher median white cell count in MOGAD than MS (33vs.6 cells/µl, p<0.001). At baseline, independent predictors of MOGAD diagnosis were presence of somnolence/headache, absence of T2-hypointense rim, lack of T1-hypointensity, and no diffusion restriction (Nagelkerke R Squared=0.67). Tumefactive lesion resolution was more common in MOGAD than MS or AQP4+NMOSD and improved model performance.Discussion.Tumefactive lesions are frequent in MOGAD but are not associated with a worse prognosis. The clinical, MRI, and CSF attributes of tumefactive MOGAD differ from tumefactive MS, and are more similar to tumefactive AQP4+NMOSD with the exception of lesion resolution, which favors MOGAD.

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Background and purpose Some studies have shown that air pollution, often assessed by thin particulate matter with diameter below 2.5 µg/m 3 (PM2.5), may contribute to severe COVID‐19 courses, as well as play a role in the onset and evolution of multiple sclerosis (MS). However, the impact of air pollution on COVID‐19 has never been explored specifically amongst patients with MS (PwMS). This retrospective observational study aims to explore associations between PM2.5 and COVID‐19 severity amongst PwMS. Methods Data were retrieved from an Italian web‐based platform (MuSC‐19) which includes PwMS with COVID‐19. PM2.5 2016–2018 average concentrations were provided by the Copernicus Atmospheric Monitoring Service. Italian patients inserted in the platform from 15 January 2020 to 9 April 2021 with a COVID‐19 positive test were included. Ordered logistic regression models were used to study associations between PM2.5 and COVID‐19 severity. Results In all, 1087 patients, of whom 13% required hospitalization and 2% were admitted to an intensive care unit or died, were included. Based on the multivariate analysis, higher concentrations of PM2.5 increased the risk of worse COVID‐19 course (odds ratio 1.90; p = 0.009). Conclusions Even if several other factors explain the unfavourable course of COVID‐19 in PwMS, the role of air pollutants must be considered and further investigated.

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