Immunosuppressive and immunomodulatory therapies are a major issue during the current coronavirus disease 2019 pandemic, and in anticipation of possible next waves. A new study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, the study detected elements of risk and protection with respect to Covid-19 in multiple sclerosis.

In a nationwide study, researchers in Italy retrospectively collected data of persons with MS with suspected or confirmed Covid-19. They assessed the link of therapies for MS with Covid-19 by comparing their observed frequency with the one expected in nonpandemic conditions. They evaluated baseline characteristics and MS therapies linked to a severe Covid-19 course.

Of 784 persons with MS with suspected or confirmed Covid-19 and a median follow-up of 84 days, 13 died: 11 of them were in a progressive MS phase, and eight were without any therapy. Thirty-three were admitted to an intensive care unit; 90 had a radiologically documented pneumonia; 88 were hospitalized. Researchers found an excess of patients treated with ocrelizumab and a reduction of patients treated with interferon as compared to the frequency of use of these DMTs in the Italian MS population. 

After adjusting for region, age, sex, progressive MS course and recent methylprednisolone use, the therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly linked with an increased risk of severe Covid-19 course. Recent use of methylprednisolone was also linked with a worse outcome.

According to Dr. Ben Thrower, MS Focus senior medical advisor, “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.”

The findings were published in the journal The Lancet.