Anti-CD20 and COVID-19 in multiple sclerosis and related disorders: A case series of 60 patients from Madrid, Spain

Abstract

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.

COVID-19 in multiple sclerosis: The Dutch experience

“…Compared to current evidence, a relatively high proportion of patients using ocrelizumab were observed in our cohort, of which the vast majority of the positively tested was hospitalized. 2 , 4 However, this may be attributed to indication bias and/or reporting bias. Overall, our findings show no apparent difference in DMT use and COVID-19 disease course in Dutch MS patients, which is similar to that reported in an Italian cohort.…”

COVID-19 vaccine-readiness for anti-CD20-depleting therapy in autoimmune diseases

“…1), suggesting that most MS treatments that largely exhibit limited persistent effects on the innate immune and CD8 T cell responses would have limited influence on COVID‐19. SARS‐CoV‐2 is eliminated by the majority of people with MS and other autoimmunities on immunotherapies, without significant consequences [34–56] (Table 1). Anti‐viral antibodies, notably those targeting the receptor binding domain of the viral spike protein, clearly neutralize the virus [57,58] and can contribute to the elimination of the primary SARS‐CoV‐2 infection in humans [58,59].…”

COVID-19 infection in NMO/SD patients: a French survey

“…It may be related to the young age and low rate of comorbidity in the infected patients. Some authors reported a favorable outcome of COVID-19 in anti-CD20-treated patients [8,9], possibly due to its minor impact on T-cell counts [10]. A beneficial effect on the inflammatory response to SARS-CoV2 remains to be confirmed [11], but other immunosuppressive treatments are studied for this purpose [12].…”