Multiple sclerosis, rituximab, and COVID‐19

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.

Multiple sclerosis and COVID‐19: The Swedish experience

“…Furthermore, a North American registry‐based study of 1626 MS patients with COVID‐19 described an increased risk for hospitalization in patients treated with rituximab (4.5 fold increase) compared to patients without DMTs 23 . Langer‐Gould et al 24 …”

Multiple Sclerosis, Disease-Modifying Therapies and COVID-19: A Systematic Review on Immune Response and Vaccination Recommendations

“…It is worth to note that our results are likely to reflect some overlap between isolated case reports and those reported in the Roche ® (Basel, Switzerland) safety database [ 55 ]. Regarding rituximab group, we identified 236 patients with MS who had been infected with SARS-CoV-2 [ 7 , 8 , 11 , 12 , 15 , 22 , 23 , 24 , 25 , 54 , 59 , 64 , 65 , 66 , 67 , 68 ]. Among these, eight (3.4%) patients died.…”

“…The same was replicated in Iranian patients [ 7 , 15 ], despite the absence of an increased odds of hospitalization in this series. In a retrospective cohort study using electronic health records in California, rituximab-treated MS patients ( n = 24) were more likely be hospitalized ( n = 8, 33.3%), but not die ( n = 0) from COVID-19 than a non-MS population (5.8% and 1.4%, respectively) [ 67 ]. Similarly, rituximab-patients seem to have 4.5-fold increased odds of hospitalization and possibly worse outcomes (albeit the last was not statistically significant) [ 25 ].…”

Long-Term Safety of Rituximab (Risks of Viral and Opportunistic Infections)

“…Despite the upfront cost, HBV screening and prophylaxis were found to be cost effective [18]. There is still limited data regarding COVID-19 severity in the setting of rituximab, however, case reports, case-series, and a larger observational study suggest rituximab use is associated with more severe disease, higher mortality with COVID-19, and hospitalizations appear to be higher within the first 6 months following rituximab dose [24][25][26][27][28]31]. We currently have limited data on vaccine response in this population with one study showing decreased antibody response after a single dose of SARS-CoV-2 mRNA vaccine in those taking methotrexate or rituximab [36].…”

“…Based on the limited available data, there is concern that rituximab, especially in combination with high-dose steroids, may lead to more severe disease and increased risk of death with COVID-19. The numbers are small, but over half of those with COVID-19 and rheumatologic conditions are admitted, with two case series specifically evaluating rituximab use identifying over half of those admitted meeting criteria for ARDS and 37-40% mortality [24][25][26][27][28]31]. We currently have limited data on vaccine response in this population with one study showing decreased antibody response after a single dose of SARS-CoV-2 mRNA vaccine in those taking methotrexate or rituximab [36].…”