Rituximab and risk of COVID-19 infection and its severity in patients with MS and NMOSD

Abstract

Background Choosing a safe disease modifying therapy during the COVID-19 pandemic is challenging. This case series study was conducted to determine the incidence rate and the course of Covid-19 infection in MS/NMOSD patients treated with Rituximab. Methods In this study, we designed a web-based questionnaire. Baseline information such as patient- reported walking disability, total number of Rituximab infusions received, delayed injections, occurrence of any relapse, and the use of corticosteroids during the pandemic were collected. Also, information regarding the Covid-19 pandemic such as adherence to self-isolation, any recent exposure to an infected individual and the presence of suggestive symptoms were collected. In case of positive test results, patients were grouped into 2 categories; mild to moderate and seriously ill and outcomes were evaluated as favorable (improved/ discharged) and unfavorable (expired). Results Two hundred fifty-eight patients with Multiple Sclerosis were enrolled in this study, 9 of the subjects (3.4%) were confirmed positive for Covid-19, five of which required hospitalizations (55.5%), two patients required ICU admission (22.2%) and 2 two patients died (22.2%). None of these patients ever mentioned using corticosteroids during the pandemic. In comparison to MS patients who were not receiving disease modifying therapy (DMT), our study indicated a higher incidence of Covid-19 infection, higher ratio of serious illness and a higher fatality ratio. Conclusions Rituximab seems not to be safe enough during the pandemic.

Case Report: Discovery a Novel SARS-CoV-2 Variant in a Six-Months Long-Term Swab Positive Female Suffering From Non-Hodgkin Lymphoma

“…Nevertheless, differently from findings reported by Esmaeili et al. ( 24 ), rituximab administration was not associated with higher risk of severe side effects and more severe WHO clinical progression scale. It is however reported a prolonged SARS-CoV-2 infection in patient und rituximab regimen ( 25 ).…”

“…Nevertheless, it is reported that the immunocompromised individuals are more likely to produce variants due to long-term virus replication, which is probably due to the selective pressure from therapeutic such antibody cocktails ( 23 ). We cannot exclude that the prolonged positivity on NFS have been amplified by concomitant rituximab therapy ( 24 , 25 ). Nevertheless, differently from findings reported by Esmaeili et al.…”

The study of COVID-19 infection following vaccination in patients with multiple sclerosis

“…Anti CD20 monoclonal antibodies (rituximab and ocrelizumab) are considered to be associated with severe forms of COVID-19 ( Cabreira et al, 2021 ; Esmaeili et al, 2021 ; Safavi et al, 2020 ). Although, some contradicting results are reported ( Sharifian-Dorche et al, 2021 ).…”

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

“…A case series from Spain reported mild COVID-19 infections with only one hospitalization in patients taking anti-CD20 with multiple sclerosis, however, SARS-CoV2 was diagnosed only by symptoms [ 29 ]. In contrast, a case series in Tehran evaluated COVID-19 in nine patients with multiple sclerosis taking rituximab with five requiring hospitalization, two of which required ICU admission and two died, giving a mortality of 40% for those admitted [ 30 ]. None of the patients reported steroid use prior to their COVID-19 diagnosis [ 30 ].…”

“…In contrast, a case series in Tehran evaluated COVID-19 in nine patients with multiple sclerosis taking rituximab with five requiring hospitalization, two of which required ICU admission and two died, giving a mortality of 40% for those admitted [ 30 ]. None of the patients reported steroid use prior to their COVID-19 diagnosis [ 30 ]. A case series in Spain evaluated 13 patients with probable or confirmed COVID-19 treated with rituximab in the 12 months before the study [ 31 ].…”