Anti-CD20 and COVID-19 in multiple sclerosis and related disorders: A case series of 60 patients from Madrid, Spain Dear Editor, We have read with great interest the case report of a patient with Multiple Sclerosis (MS) treated with ocrelizumab that developed COVID-19 without serious complications (Novi et al., 2020). The authors suggest a potential protective effect for severe complications of COVID-19 of anti-CD20 drugs. Besides, Prof. Giovannoni's editorial reviews the evidence supporting the hypothesis that immunosuppression of patients with MS on certain disease-modifying therapies may protect of severe COVID-19 infection (Giovannoni, 2020). These data contradict the first assumption that patients with MS on immunosuppressive therapies could be at risk of severe complications of COVID-19.We aimed to analyze the frequency and severity of COVID-19 in our series of patients treated with anti-CD20 in a tertiary hospital in Madrid, Spain, one of the regions worst affected by the pandemic. All patients were contacted by phone from 28 th to 29 th April 2020 (Matías-Guiu et al., 2020a), when total confirmed cases in the Region of Madrid accounted for 60,765. At the moment of the beginning of the pandemic, 60 patients were treated with anti-CD20 (54 with rituximab and 6 with ocrelizumab). The mean age was 47.21 ± 9.86 years-old in the whole group, 47.09 ± 9.56 in patients with rituximab, and 48.33 ± 12.16 in patients with ocrelizumab. 32 patients were classified as having relapsing-remitting MS (53.3%), 14 (23.3%) as secondary-progressive, 9 (15.0%) as primary-progressive forms and 5 as optic neuromyelitis (8.3%). COVID-19 infection was reported in 9 (15%) in the whole sample, 7 (12,9%) in patients receiving rituximab, and 2 (33,3%) in patients with ocrelizumab. Main clinical characteristics of COVID-19 are depicted in Table 1. Interestingly, all patients with COVID-19 did not show serious complications, despite that a patient required admission to a hospital.We also analyzed the time of administration and the frequency of infection by SARS-CoV2, with no apparent relationship. In this regard, 2 (15.38%) of the 13 patients that received treatment in June-August 2019 were infected; 1 (10%) of 10 patients treated in September-October 2019; 2 (13,3%) of the 15 patients that were treated in November-December 2019; and 4 (20%) of 20 patients that received the treatment in January-February 2020. Two patients had received the first dose with the onset of the pandemic, and no one was infected.

Background Series of patients with SARS‐CoV‐2 infection report headache in 6%‐15% of cases, although some data suggest that the actual frequency is higher, and that headache is not associated with fever. No study published to date has analyzed the characteristics of headache in these patients. Objective To analyze the characteristics of COVID‐19 related headaches. Methods We conducted a survey of Spaniard healthcare professionals who have been infected by SARS‐CoV‐2 and presented headache during the course of the disease. The survey addressed respondents’ medical history and headache characteristics, and we analyzed the association between both. Results We analyzed the responses of a sample of 112 healthcare professionals. History of migraine was reported by 20/112 (17.9%) of respondents, history of tension‐type headache by 8/112 (7.1%), and history of cluster headache was reported by a single respondent; 82/112(73.2%) of respondents had no history of headache. Headache presented independently of fever, around the third day after symptom onset. The previous history of migraine was associated with a higher frequency of pulsating headache (20% in patients with previous migraine vs 4.3% in those with no history of migraine, P = .013). Conclusion Headache is often holocranial, hemicranial, or occipital, pressing, and worsens with physical activity or head movements. Because the characteristics of the headache and the associated symptoms are heterogeneous in our survey, we suggest that several patterns with specific pathophysiological mechanisms may underlie the headache associated with COVID‐19.

No abstract