Favorable outcome after COVID-19 infection in a multiple sclerosis patient initiated on ocrelizumab during the pandemic

Ghajarzadeh, Mahsa; Mirmosayyeb, Omid; Barzegar, Mahdi; Nehzat, Nasim; Vaheb, Saeed; Shaygannejad, Vahid; Maghzi, Amir Hadi

doi:10.1016/j.msard.2020.102222

Cited by 34 publications

(35 citation statements)

References 10 publications

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“…Albeit rituximab increased the rate of infection, it did not affect the rate of hospitalization in these patients. Several studies have indicated that B-cell depleting therapies do not increase the severity of COVID-19 disease (Montero-Escribano et al, 2020;Ghajarzadeh et al, 2020). However, recently a preprint of Italian registry data supports an increased occurrence of COVID-19 in people treated with CD20-depleting antibodies using ocrelizumab (Sormani and De Rossi Nicola, 2020).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the rate of COVID-19 infection, hospitalization and death among Iranian patients with multiple sclerosis

Sahraian

Azimi

Navardi

et al. 2020

Multiple Sclerosis and Related Disorders

100

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Background: COVID-19 is increasingly expanding all over the world. People who have an underlying disease or taking immunosuppressive drugs are generally more likely to be infected than the others. Multiple sclerosis (MS) patients may also be at risk of the disease and its complications depending on the medication they are taking. In this study, we evaluated a large population of patients with MS with different disease modifying drugs to show if any of them increases the risk. In addition, this study evaluates the incidence of COVID-19 in patients with MS, the rate of hospitalization or death in these patients. Method: This study was performed at the MS Clinic of Sina Hospital. All patients were contacted and their demographic characteristics were recorded. They were then asked about their COVID-19 symptoms. Patients with these symptoms were further evaluated. The documents were reviewed by treating neurologist and MS nurses to be sure about diagnosis of COVID19. The positive polymerase chain reaction (PCR) result or compatible lung computed tomography (CT) scan was acceptable for COVID-19 diagnosis. Results: 4647 patients answered the phone contact. Of these, 68 were infected with the COVID-19. The rate of hospitalization was 25% which is far more than general population. Two patients died from COVID-19. Rituximab was associated with increase rate of COVID-19 infection but not with hospitalization rate. There was no significant correlation between use of other drugs and rate of infection. Conclusion: This study revealed that the incidence of COVID-19 in MS patients is not more than general population, but the risk of hospitalization in these patients is higher than estimated for the disease. This highlights the importance of communicating to patients the severity of COVID-19 and the importance of risk reduction behaviors like social distancing and mask use.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the rate of COVID-19 infection, hospitalization and death among Iranian patients with multiple sclerosis

Sahraian

Azimi

Navardi

et al. 2020

Multiple Sclerosis and Related Disorders

100

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“…One case series suggested increased susceptibility to SARS-CoV-2 in patients receiving anti-CD20 agents as previously mentioned [75]. However, several case reports described favorable outcomes in ocrelizumab-treated patients after COVID-19 infection [83,84]. The discrepancy and variability of the COVID-19 disease course in patients treated with anti-CD20 therapies could be anecdotally explained by the fact that B cells could have both a beneficial and a harmful effect in SARS-CoV-2-related infection.…”

Section: Potential Relevance To the Covid-19 Pandemic And Possible Rimentioning

confidence: 90%

Multiple Sclerosis Disease-Modifying Therapy and the COVID-19 Pandemic: Implications on the Risk of Infection and Future Vaccination

et al. 2020

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The coronavirus 2019 (COVID-19) pandemic is expected to linger. Decisions regarding initiation or continuation of diseasemodifying therapy for multiple sclerosis have to consider the potential relevance to the pandemic. Understanding the mechanism of action and the possible idiosyncratic effects of each therapeutic agent on the immune system is imperative during this special time. The infectious side-effect profile as well as the route and frequency of administration of each therapeutic agent should be carefully considered when selecting a new treatment or deciding on risk mitigation strategies for existing therapy. More importantly, the impact of each agent on the future severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2) vaccine should be carefully considered in treatment decisions. Moreover, some multiple sclerosis therapies may have beneficial antiviral effects against SARS-CoV-2 while others may have beneficial immune-modulating effects against the cytokine storm and hyperinflammatory phase of the disease. Conventional injectables have a favorable immune profile without an increased exposure risk and therefore may be suitable for mild multiple sclerosis during the pandemic. However, moderate and highly active multiple sclerosis will continue to require treatment with oral or intravenous high-potency agents but a number of risk mitigation strategies may have to be implemented. Immune-modulating therapies such as the fumerates, sphinogosine-1P modulators, and natalizumab may be anecdotally preferred over cell-depleting immunosuppressants during the pandemic from the immune profile standpoint. Within the cell-depleting agents, selective (ocrelizumab) or preferential (cladribine) depletion of B cells may be relatively safer than non-selective depletion of lymphocytes and innate immune cells (alemtuzumab). Patients who develop severe iatrogenic or idiosyncratic lymphopenia should be advised to maintain social distancing even in areas where lockdown has been removed or ameliorated. Patients with iatrogenic hypogammaglobulinemia may require prophylactic intravenous immunoglobulin therapy in certain situations. When the future SARS-CoV-2 vaccine becomes available, patients with multiple sclerosis should be advised that certain therapies may interfere with mounting a protective immune response to the vaccine and that serological confirmation of a response may be required after vaccination. They should also be aware that most multiple sclerosis therapies are incompatible with live vaccines if a live SARS-CoV-2 vaccine is developed. In this article, we review and compare disease-modifying therapies in terms of their effect on the immune system, published infection rates, potential impact on SARS-CoV-2 susceptibility, and vaccine-related implications. We propose risk mitigation strategies and practical approaches to disease-modifying therapy during the COVID-19 pandemic.

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Baker

Roberts

Pryce

et al. 2020

Clinical and Experimental Immunology

171

201

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Based on the known and emerging biology of autoimmune diseases and COVID‐19, it was hypothesised that whilst B‐cell depletion should not necessarily expose people to severe SARS‐CoV‐2‐related issues, it may inhibit or blunt the protective immunity following infection and vaccination. This is supported clinically, as the majority of SARS‐CoV‐2 infected, CD20‐depleted people with autoimmunity, have recovered. However, in CD‐20 treated people until naïve B‐cells repopulate, based on B‐cell repopulation‐kinetics and vaccination responses, from published rituximab, and unpublished ocrelizumab (NCT00676715, NCT02545868) trial data shown here suggests that it may be possible to undertake dose‐interruption to maintain inflammatory disease control, whilst allowing effective vaccination against SARS‐CoV‐29, if and when an effective vaccine is available.

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Favorable outcome after COVID-19 infection in a multiple sclerosis patient initiated on ocrelizumab during the pandemic

Cited by 34 publications

References 10 publications

Evaluation of the rate of COVID-19 infection, hospitalization and death among Iranian patients with multiple sclerosis

Evaluation of the rate of COVID-19 infection, hospitalization and death among Iranian patients with multiple sclerosis

Multiple Sclerosis Disease-Modifying Therapy and the COVID-19 Pandemic: Implications on the Risk of Infection and Future Vaccination

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

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