Ocrelizumab, Rituximab Linked With More Severe COVID-19 in Multiple Sclerosis

A global data-sharing initiative of how coronavirus disease 2019 (COVID-19) impacts patients with multiple sclerosis (MS) found that certain disease-modifying therapies (DMTs), namely the B-cell depleting anti-CD20 biologics ocrelizumab and rituximab, are linked with higher rates of needing hospitalization, intubation, and admission to an intensive care unit (ICU).

The results were shared as part of the MSVirtual2020: 8th Joint ACTRIMS-ECTRIMS Meeting, which is concluding Saturday with a special session about COVID-19.

The researchers wrote that the frequency of COVID-19 among patients with MS per country is relatively low, but that they still needed to know its effect on MS, given the easily transmissible and possible severe consequences of the virus and its effect on vulnerable populations.

Previous studies from Italy and France suggest older age, higher disability, and progressive MS are associated with severe COVID-19, but the influence of DMTs is unknown, the researchers said. The data sharing thus allowed pooled information about patients who may be on long-term immunosuppressive DMTs.

They said it was the first results of the MS International Federation and MS Data Alliance and other data partners.

Information from 21 countries were aggregated into a dataset of 1540 patients; the database included characteristics of admission to the hospital, ICU admission, need for artificial ventilation, and death; both confirmed or suspected COVID-19 infection cases were included and analyzed using log-binomial regression.

Adjusted prevalence ratios (aPR) were calculated adjusting for age, sex, MS type, and Expanded Disability Status Scale (EDSS).

Of the 1540 patients, 476 (30.9%) had suspected infection, while 776 (50.4%) had confirmed infection.

Similar to other studies, older age, progressive MS, and higher EDSS scores were associated with greater frequency of severe outcomes.

Compared with dimethyl fumarate, ocrelizumab and rituximab were positively associated with hospital admission (aPRs = 1.19 and 1.58, respectively), ICU admission (aPRs = 3.53 and 4.12), and the need for artificial ventilation (aPRs = 3.17 and 7.27).

Higher frequencies of all 3 outcomes were linked with combined anti-CD20 DMT use compared with all other DMTs (hospitalization aPR = 1.49; ICU aPR = 2.55; ventilation aPR = 3.05) and compared with natalizumab (hospitalisation aPR = 1.99; ICU aPR = 2.39; ventilation aPR = 2.84).

After limiting the analysis to confirmed COVID-19 cases, the associations persisted, as well as when excluding each contributing data source in turn.

However, no associations were observed between DMTs and death.

The researchers said further research incorporating comorbidities, smoking, and body mass index is needed in order to address study limitations.