Multiple sclerosis, rituximab, and COVID-19

Annette Langer-Gould, Jessica B Smith, Bonnie H Li, KPSC MS Specialist Group, Brandon E Beaber, Sonu M Brara, Julie Debacker, Allen Scott Nielsen, Samira Amirova, Oluwasheyi Ayeni, Annette Langer-Gould, Jessica B Smith, Bonnie H Li, KPSC MS Specialist Group, Brandon E Beaber, Sonu M Brara, Julie Debacker, Allen Scott Nielsen, Samira Amirova, Oluwasheyi Ayeni

Abstract

We conducted a retrospective cohort study in Kaiser Permanente Southern California from 1 January 2020 to 30 September 2020. We found that rituximab-treated persons with multiple sclerosis (pwMS, n = 1895) were more likely be hospitalized (n = 8, 33.3%), but not die (n = 0) from COVID-19, compared to the 4.81 million non-MS population (5.8% and 1.4%, respectively). Time in months (adjusted OR = 0.32, 95% CI = 0.15-0.69, p = 0.0033) and receiving 1000 mg compared to lower doses at last infusion (adjusted OR = 6.28, 95% CI = 1.38-28.5, p = 0.0173) were independent predictors of COVID-19 severity. Rituximab-treated pwMS should be counseled to take extra precautions in the 5 months following each infusion. Using extended dosing intervals and lower doses could be considered.

Conflict of interest statement

ALG has received grant support and awards from the National Institutes of Health, Patient‐Centered Outcomes Research Institute, and the National MS Society. She currently serves as a voting member on the California Technology Assessment Forum, a core program of the Institute for Clinical and Economic Review (ICER). She has received sponsored and reimbursed travel from ICER. JBS and BHL have nothing to report.

© 2021 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.

Figures

Figure 1
Figure 1
The Relationship between COVID‐19 Severity and Most Recent Rituximab Treatment for Multiple Sclerosis. Depicted is the proportion of COVID‐19 MS patients who required hospitalization (orange) and those COVID‐19 patients who did not (blue) in the months (mos.) following their most recent rituximab infusion. The sample sizes (N) are denoted above each bar. The risk of a moderate course appears highest in the first 2 months following rituximab infusion and dissipates by 6 months.

References

    1. Luna G, Alping P, Burman J, et al. Infection risks among patients with multiple sclerosis treated with fingolimod, natalizumab, rituximab, and injectable therapies. JAMA Neurol 2020;77:184–191.
    1. Wolinsky JS, Arnold DL, Brochet B, et al. Long‐term follow‐up from the ORATORIO trial of ocrelizumab for primary progressive multiple sclerosis: a post‐hoc analysis from the ongoing open‐label extension of the randomised, placebo‐controlled, phase 3 trial [published correction appears in Lancet Neurol. 2020 Nov 17;:]. Lancet Neurol. 2020;19:998–1009. 10.1016/S1474-4422(20)30342-2
    1. Louapre C, Collongues N, Stankoff B, et al. Clinical characteristics and outcomes in patients with coronavirus disease 2019 and multiple sclerosis. JAMA Neurol 2020;77:1079–1088.
    1. Montero‐Escribano P, Matias‐Guiu J, Gomez‐Iglesias P, et al. Anti‐CD20 and COVID‐19 in multiple sclerosis and related disorders: a case series of 60 patients from Madrid, Spain. Mult Scler Relat Disord 2020;42:102185.
    1. Parrotta E, Kister I, Charvet L, et al. COVID‐19 outcomes in MS: observational study of early experience from NYU Multiple Sclerosis Comprehensive Care Center. Neurol Neuroimmunol Neuroinflamm 2020;7:1‐9.
    1. Chaudhry F, Bulka H, Rathnam AS, et al. COVID‐19 in multiple sclerosis patients and risk factors for severe infection. J Neurol Sci 2020;418:117147.
    1. Hughes R, Whitley L, Fitovski K, et al. COVID‐19 in ocrelizumab‐treated people with multiple sclerosis. Mult Scler Relat Disord 2020;49:102725.
    1. Sormani MP, De Rossi N, Schiavetti I, et al. Disease‐modifying therapies and coronavirus disease 2019 severity in multiple sclerosis. ANN NEUROL 2021:1‐10.
    1. Sahraian MA, Azimi A, Navardi S, et al. Evaluation of the rate of COVID‐19 infection, hospitalization and death among Iranian patients with multiple sclerosis. Mult Scler Relat Disord 2020;46:102472.
    1. Simpson‐Yap S, De Brouwer E, Kalincik T, et al. SS02.04 First results of the COVID‐19 in MS Global Data Sharing Initiative suggest anti‐CD20 DMTs are associated with worse COVID‐19 outcomes. Mult Scler 2020;26:48–49.
    1. Koebnick C, Langer‐Gould AM, Gould MK, et al. Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data. Perm J 2012;16:37–41.
    1. Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018;17:162–173.
    1. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD‐9‐CM and ICD‐10 administrative data. Med Care 2005;43:1130–1139.
    1. Li G, Fan Y, Lai Y, et al. Coronavirus infections and immune responses. J Med Virol 2020;92:424–432.
    1. Baker D, Roberts CAK, Pryce G, et al. COVID‐19 vaccine‐readiness for anti‐CD20‐depleting therapy in autoimmune diseases. Clin Exp Immunol 2020;202:149–161.
    1. Hauser SL, Waubant E, Arnold DL, et al. B‐cell depletion with rituximab in relapsing‐remitting multiple sclerosis. N Engl J Med 2008;358:676–688.
    1. Juto A, Fink K, Al Nimer F, Piehl F. Interrupting rituximab treatment in relapsing‐remitting multiple sclerosis; no evidence of rebound disease activity. Mult Scler Relat Disord 2020;37:101468.
    1. Smith JB, Hellwig K, Fink K, et al. Rituximab, MS, and pregnancy. Neurol Neuroimmunol Neuroinflamm 2020;7:e734.
    1. Salzer J, Svenningsson R, Alping P, et al. Rituximab in multiple sclerosis: a retrospective observational study on safety and efficacy. Neurology 2016;87:2074–2081.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever