Anti-CD20 antibodies associated with worse COVID-19 outcomes

Findings from the COVID-19 in MS global data-sharing initiative show that the use of anti-CD20 medications (ocrelizumab and rituximab) is associated with higher COVID-19 severity, including hospitalisations and ICU admissions, compared with other disease-modifying treatments (DMTs) [1,2].

The COVID-19 in MS global data-sharing initiative is the largest international, real-world dataset of MS patients with suspected or confirmed COVID-19, including 4,646 (83.4%) confirmed cases from 32 countries [3]. Dr Steve Simpson-Yap (University of Melbourne, Australia) shared the updated results on the associations of anti-CD20 DMTs with COVID-19 severity relative to glatiramer acetate, all other pooled DMTs, and natalizumab.

Male sex, older age, progressive MS, and higher disability were associated with worse outcomes for SARS-CoV-2 infection. The use of anti-CD20 antibodies was associated with significantly worse COVID-19 outcomes. Compared to glatiramer acetate, ocrelizumab users were 1.6 (95% CI 1.06–2.43) times more likely to be hospitalised, and rituximab users were 2.4 (95% CI 1.54–3.81) times more likely to be hospitalised. Ocrelizumab and rituximab use was also associated with a 3.1 (95% CI 1.22–8.00) and 4.7 (95% CI 1.64–12.09) times higher risk of intensive care unit admission, respectively. Rituximab users were 3.6 (95% CI 1.38–9.20) times more likely to be given artificial ventilation; ocrelizumab users were 1.9 (95% CI 0.76–4.55) times more likely to require artificial ventilation. Rituximab users also had a 2.7 (95% CI 0.68–11.09) times higher risk to die, though this effect was non-significant.

The associations of ocrelizumab (n=1,100) and rituximab (n=636) with COVID-19 severity compared with other DMTs pooled (n=2,924) are shown in the Figure. Dr Simpson-Yap pointed out that all but one association are statistically significant, including the 2.4 times higher risk of death in rituximab users and a trend towards a higher risk of death in ocrelizumab users. Compared with natalizumab users, ocrelizumab and rituximab use was only associated with a higher risk of hospitalisation, intensive care unit admission, and artificial ventilation.

Figure: Associations of ocrelizumab and rituximab with Covid-19 severity versus other DMTs [1]
DMT, disease-modifying therapy; OMab, Ocrelizumab; RMab, rituximab. *P<0.05; **P<0.001.

1. 
   
   1. Simpson-Yap S, et al. Updated results of the COVID-19 in MS global data sharing initiative validate consistent associations of anti-CD20 and other reported risk factors with severe COVID-19 outcomes. OP098, ECTRIMS 2021 Virtual Congress, 13–15 October.
   2. Simpson-Yap S, et al. Neurology. 2021;97(19): e1870-e1885.
   3. Peeters LM, et al. Mult Scler. 2020;26(10):1157–1162.

 

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Posted on 9 December 202110 December 2021