COVID-19 infection Disease Severity and Outcomes in Patients on Disease Modifying treatment for Multiple Sclerosis
The findings from 2 large studies of MS patients is summarized below.
• Analysis of 1787 MS patients from registries in Italy and France
• Included patients with RRMS/SPMS/PPMS
• Most patients, as is typical of MS were RRMS
• Patients were on any of several medications for MS
• Older age, male sex, higher disability and Co-morbidities were associated with more severe outcomes
• Among the medications, treatment with anti- CD20 agent was associated with increased risk of severe COVID-19 disease
• Recent ( within one month) steroids treatment was also associated disease severity
• Analysis of 1626 MS patients from North American Registry of Patients with MS
• Included patients with RRMS/SPMS/PPMS
• Patients on any of several treatments for MS
• Older age, higher disability, cardiopulmonary co-morbidities, and African American race were associated with more severe outcomes
• Among the medications, treatment with anti- CD20 agents was associated with increased risk of hospitalization
• Recent steroid treatment was also associated disease severity
Anti-CD 20 treatmnents are -ocrelizumab, rituximab, Ofatumumab
Impact of Disease modifying therapy on COVID-19 vaccination response
Ongoing treatment with anti-CD 20 treatments and SIP modulators like Fingolimod were associated with decreased rate fo antibody response to vaccination.
For ongoing treatment with anti-CD 20
- Timing of infusions and vaccination, vaccination 3-6 months post-infusion had better vaccine response than earlier
- Increased vigilance in the immediate aftermath of an infusion as greatest risk period is in the first few weeks after an infusion
- Re-dosing based on B cell recovery, delaying until the numbers start coming up on blood test
Jai S Perumal ,MD