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.
A 24-year-old woman presented with sudden right-sided weakness and aphasia. Brain MRI was performed 5 hours after symptoms onset. On diffusion-weighted imaging (DWI), the lesion showed a marked increase in signal intensity and an approximatively 70% mean apparent diffusion coefficient (ADC) decline as compared with the contralateral hemispheric white matter ( figure). The patient met diagnostic criteria for multiple sclerosis and other etiologies were excluded.ADC decline in acute multiple sclerosis lesions, suggesting a diagnosis of ischemic stroke, has been previously reported.1,2 However, the decline in ADC values (22% to 40% decrease) was not as pronounced as our observation. Thus this fourth case of reduced ADC in acute demyelinating lesion indicates that the ADC drop may be important and close to that observed in the core of an acute brain infarction.
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