Highlights from

MS Virtual 2020

8th Joint ACTRIMS and ECTRIMS Meeting

Virtual 11 - 13 September 2020

Anti-CD20 mAbs associated with worse COVID-19 outcomes

The first results of the COVID-19 in MS Global Data Sharing Initiative suggest anti-CD20 monoclonal antibodies (mAbs) are consistently associated with hospitalisation, intensive care admission, and use of artificial ventilation [1]. These results suggest that anti-CD20 mAb use among MS patients at risk for COVID-19 exposure may be a risk factor for more severe COVID-19 disease.

The results were presented by Dr Steve Simpson-Yap (University of Melbourne, Australia). He said that multiple previous studies have indicated that MS patients, especially when on immunosuppressive disease-modifying treatment (DMT), are at an increased risk of infection. This explains the concern for the possible impact of DMT on the risk and severity of COVID-19. The goal of this study was to explore associations between COVID-19 severity and DMT use, with a special focus on anti-CD20 DMT versus other DMT in general and versus natalizumab in particular. Clinician-reported data from 21 countries all over the world were aggregated into a data set of 1,540 patients. Of these, 476 (30.9%) with suspected and 776 (50.4%) with confirmed COVID-19 were included in the analysis.

Older age, progressive MS, and higher Expanded Disability Status Scale (EDSS) score were associated with a higher likelihood of admission to hospital, being female with a lower likelihood. Progressive MS and more disability were associated with a higher likelihood of intensive care admission. Mortality risk was elevated in patients with progressive MS, older age, and higher disability. The adjusted prevalence ratio (aPR) of hospitalisation (313 events) was established per DMT, with dimethyl fumarate as comparison. Use of anti-CD20 monoclonal antibodies ocrelizumab and rituximab was positively associated with hospital admission (aPR 1.19 and 1.58), intensive care admission (aPR 3.53 and 4.12), and the need for artificial ventilation (aPR 3.17 and 7.27). There was no association between any DMT and death. Risk of all 3 clinical outcomes was higher in anti-CD20 users (n=343) compared with all other DMT users (n=492): hospitalisation aPR 1.49; intensive care admission aPR 2.55; and ventilation aPR 3.05. These risks were also higher compared with natalizumab: hospitalisation aPR 1.99; intensive care admission aPR 2.39; ventilation aPR 2.84. Associations persisted when restricting analysis to confirmed COVID-19 cases only.

  1. Simpson-Yap S, MSVIRTUAL2020, SS02.04.

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