In patients with both multiple sclerosis (MS) and SARS-CoV-2 infection, treatment with ocrelizumab was not associated with increased infection severity; this was according to data from 2 patients who showed a mild clinical course of SARS-CoV-2 related pneumonia, published in Multiple Sclerosis and Related Disorders.
Ocrelizuamb, an anti CD20 monoclonal antibody that causes B-cell depletion, is one of the newest therapies for MS. Previous ocrelizumab registration studies reported increased risk for upper respiratory tract infection, raising concerns regarding its use during the COVID-19 pandemic. As a result, study researchers sought to determine the potential impact of this treatment on SARS-CoV-2 related pneumonia in 2 patients with MS.
The first case described a 36 year old Caucasian woman who was hospitalized for SARS-CoV-2 related pneumonia. Her past medical history consisted of a prior diagnosis of highly active relapsing remitting MS treated with ocrelizumab since March 2019. She was treated with plaquenil for 10 days and lopinavir/ritonavir for 12 days. The patient did not require oxygen therapy. During her hospitalization there was clinical, biochemical, and radiological improvement in her condition and she was discharged in good clinical condition.
The second case described a 54 year old Caucasian man who was hospitalized for SARS-CoV-2 with evidence of interstitial pneumonia on imaging. He had a previous diagnosis of secondary progressive MS, and was started on ocrelizumab in November 2018. The patient did not require oxygen therapy and was discharged in good clinical condition.
These findings support the claim that ocrelizumab is not necessarily associated with increased severity in patients with MS infected by SARS-CoV-2, even in those with severe B-cell impairment. Limitations to this study included the small sample size and limited amount of studies which may minimize the generalizability of results.
The researchers concluded that “more studies and larger cohorts are needed to clarify the clinical management of MS patients under DMTs [disease modifying therapies] in the setting of SARS-CoV-2 epidemic and the impact of DMTs on antiviral antibody production.”
Iannetta M, Cesta N, Stingone C, et al. Mild clinical manifestations of SARS-CoV-2 related pneumonia in two patients with multiple sclerosis under treatment with ocrelizumab. Mult Scler Relat Disord. Published online Aug 3, 2020. doi:10.1016/j.msard.2020.102442