MS Reclamation

Ocrelizumab and COVID-19

Guidance for PwMS from their neurologists seems to have been “carry on per usual” with COVID guidance, which for a lot of folks seems to mean to do them as they normally would, which I completely understand the want for, but please, stay aware and cautious out there.  I’m seeing so much misinformation about the Anti-CD20 monoclonal antibodies (mAbs). Predominantly: neurologists telling their patients there isn’t cause for exceptional caution with any DMT. With a couple of therapies though, this might not be precisely accurate.

From the National MS Society MS Treatment Guidelines During Coronavirus:

“Therapies that target CD20 – ocrelizumab (Ocrevus) and rituximab (Rituxan)– may be linked to an increased chance of being admitted to hospital or requiring intensive care treatment due to COVID-19. This preliminary finding requires further investigation.”

“People with MS who are currently taking ocrelizumab (Ocrevus) or rituximab (Rituxan) and are living in a community with a COVID-19 outbreak should be extra vigilant and may want to consider self-isolation to reduce their risk of infection.”

I have seen everything from people saying “may means it might be linked, not that it is,”  to “my neurologist said there’s no greater risk for anyone in the MS community regardless of DMT”. I would like to stress here that doctors looking at this are still  seeking data and confirmation one way or another, so the “may” is applied cautiously. The voluntary COViMS database  is a work in progress:

“Summary data is provided below, however, this is a voluntary registry and the true number of cases of COVID-19 in people with CNS demyelinating diseases is unknown. We do not recommend these data be used to inform clinical decisions at this time.”

As of July 24th, there was a new article about more extensive research on MS Focus, “Study: Higher Severe COVID-19 Risk for Patients on Ocrevus, Rituxan“, following the course of COVID infection among 784 patients in Italy. The guidance given by Dr. Ben Thrower:

“For most patients with MS, the benefits of remaining on their therapy still outweighs the risk. Individual treatment decisions need to be made between the person with MS and their healthcare team. People on Ocrevus and Rituxan should be getting appropriate lab monitoring to monitor their immune response to their medication.”

Regardless of philosophy, guidance is roughly the same. Keep wearing masks, social distance, wash your hands. In some cases, your guidance could be to self-isolate, but that would be the directions from your specific neurologist. If your neurologist isn’t aware of the updated guidelines from the NMSS, you can share this information with them.

Additionally, with all of this, there is also new data indicating that Anti-CD20 medications might reduce attenuation of antibody response.   While this data is concerning, no one really knows which way this will go yet. There is still hope that a vaccine would be beneficial and we’d be able to mount an appropriate response:

“The question is whether exposure to a future
vaccine will also result in an attenuation of humoral response. However, as seen in the VELOCE trial, patients were still able to mount an immune response to vaccines despite the attenuated humoral response.”

Barts-MS Blog also posted another article August 1st, “Ocrelizumab Inhibits Vaccine Responses”   that further elaborates on the blunted effects of vaccination in B-cell depleted patients.  These data were collected pre-COVID, though the implications are clearly relevant.

“Peripherally B-cell depleted OCR recipients mounted attenuated humoral responses to clinically relevant vaccines and the neoantigen, KLH, suggesting use of standard non-live vaccines while on OCR treatment remains a consideration. For seasonal influenza vaccines, it is recommended to vaccinate patients on OCR, as a potentially protective humoral response, even if attenuated, can be expected.”

Update 08/07: A new article published on Barts-MS Blog  now highlights:

  • Ocrelizumab is not associated to increased severity in MS patients with COVID-19
  • B-cell depleting treatment could impact on virus-specific antibody production
  • B-cell depleting therapies can reduce IL-6 production, thus modulating inflammation

This article outlines a mild-COVID course for patients on Ocrevus , and that the vaccination response is still a concern based on “vaccine type,  the type of response (recall versus response to a novel antigen), and the impact of the individual disease-modifying therapy on humoral and cellular immunity in response to that vaccine type.”

Essentially, there are still concerns about whether or not a vaccine would be effective, but the disease course itself for COVID doesn’t look as concerning.  However, this data keeps changing, and while the data provided by the National MS Society was preliminary,   so are most of the other data at this point, we don’t really understand the full picture as of yet. For me – I’ll be exercising an abundance of caution until we have more substantive data.

For these and future updates, I recommend following Barts-MS Blog.  While not always the most accessible, the data provided is invaluable and incredibly up-to-the-minute comparatively. They also post many “Easy reader” articles that are meant to be accessible for anyone regardless of “knowledge of MS or science”.