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Ocrelizumab and fingolimod increase the risk of COVID-19 and of worse outcomes

Presented by
Dr Nikos Evangelou, Nottingham University Hospital, UK

A nationwide study in the UK showed that MS patients using ocrelizumab or fingolimod are at an increased risk of contracting COVID-19 and hospitalisation due to COVID-19 compared with patients using other DMTs, and compared with the general population.

An immune response to COVID-19 vaccines varies between different DMTs used for MS. How does this translate into preventing COVID-19 and severe outcomes of the infection among MS patients? In order to assess this, a prospective and longitudinal cohort was formed of all MS patients in Great Britain who were using any DMT between March 2020 and August 2022. Data from 36,779 MS patients was provided by the National Health Service England and United Kingdom Health and Security Agency and comprised all COVID-19 tests, outcomes, and vaccinations. Outcomes were COVID-19 incidence, hospitalisation, and mortality compared with the general population and COVID-19-related hospitalisation and mortality in vaccinated patients. The results were presented by Dr Nikos Evangelou (Nottingham University Hospital, UK) [1,2].

Some of the results showed that in 2021, 80% of MS hospitalisations which involved COVID-19 had COVID-19 as primary diagnosis. In 2022 (until the end of August), this percentage went down to 50%. The most frequently used DMT among hospitalised MS patients with COVID-19 as primary diagnosis was ocrelizumab: 2.3% in 2021 and almost 1.5% in 2022. Looking only at MS patients who had received 2 COVID-19 vaccinations, rate of hospitalisation with COVID-19 as primary diagnosis was highest among users of anti-CD20 medications: 13 per 100 for ocrelizumab and 7.9 per 100 for fingolimod. COVID-19-related in-hospital mortality (per 1,000 people) was 0.3 for fingolimod, 2 for ocrelizumab, and 0–1.3 for other DMTs. Following a third vaccination in 2021 in the UK, no hospitalisations were measured with any of the MS DMTs except for fingolimod (14%) and ocrelizumab (6%); none of these patients died.

Generally speaking, in 2022, mortality decreased possibly due to the widespread use of antivirals and the relatively milder Omicron variant. On the other hand, vaccination rates were declining. How to explain to an MS patient the implications on a group level of being or not being vaccinated? The presented graph reflects the situation in the UK, according to Dr Evangelou (see Figure).

Figure: Effect of COVID-19 infection on MS patients in the UK on a DMT [1]

  1. Evangelou N. Effectiveness of COVID-19 vaccines in people with multiple sclerosis receiving disease-modifying therapies: a total population study of National Health Service (NHS) England. Abstract O137, ECTRIMS 2022, 26–28 October, Amsterdam, the Netherlands.
  2. Garjani A, et al. Mult Scler Relat Disord. 2022;57:103458.

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