#MSCOVID19 What do you think should I be anxious?

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Here it the Roche Ocrelizumab data presented by Heinz Weindl at the International Women in MS Meeting presented May 5th

So with 100 cases 26% were hospitalised, 5% went to ICU and at the time of writing 3/5 are still touch and go…Is this scary if you are on ocrelizumab?….Are they hiding anything…well I think there is a chance that some people could die as people on ventilation have a higher risk. However, to me this is the good news at present, in that analysis says there were no deaths. Now, I know there has been at least one, but it is not the avalanche that the immunosuppression doom and gloomers gave us two months ago. Is the 26% having a tough time significant, maybe may be not, you can have your own opinions. Is it relevant that there was 100 cases does it put you at more risk. This will will come out in the wash.

Personally I applaud Roche for releasing this data. If you are any other company, I will happily put your story up too. If you are a cynic you can say they are spinning things, but I say there are plenty of other cases out there and the truth will be out. It is not just MS and ocrelizumab, but arthritis and NMO and MS etc in people taking rituximab

Did I put it up to say let’s all use ocrelizumab…..No.

I put this information up to give people who have taken ocrelizumab some insight and hope it eases some fears. This data is in the public domain. There is more data.

If people can assimilate the data for the other studies I will put it up too. I have not had time to summate the data in the public domain. If I get time I may do this.

If you want to make issue that ocrelizumab give more severe data, you can.

A possible role for B cells in COVID-19?: Lesson from patients with Agammaglobulinemia. Quinti I, Lougaris V, Milito C, Cinetto F, Pecoraro A, Mezzaroma I, Mastroianni CM, Turriziani O, Bondioni MP, Filippini M, Soresina A, Spadaro G, Agostini C, Carsetti R, Plebani A. J Allergy Clin Immunol. 2020 Apr 22. pii: S0091-6749(20)30557-1.

Well I sure Prof Weindl will still get a publication and apologises to him for outing the information…but who knows this could be 3 months down the line.

P.S. This is updated I made a mistake originally read below.

COI: multiple

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20 comments

  • What do I think?
    1. Unless its independent, ‘data’ can usually be ‘fudged’ in some way to show a favorable / expected outcome, especially when money is involved.
    2. I thought anti CD20 therapies were meant to (theoretically) give a better outcome or a less severe disease.
    3. Without knowing about a vaccine or natural antibody response could we be entering the COVID 19 lottery multiple times? therefore increasing the risk of an unfavorable ending.

    • The better outcome could have been severe covid and not death. I dont know the demographic of the people involved.

      Having independent data… you will get that is due course as the case reports I have seen two published on anti CD20 and registry data appear.

      However just because it has a load of familalr names does not mean it is independent…as companies general write the papers the way they want the data presented.

      • I think demographic data is the key missing detail here. The GenPop data includes the entire elderly population. If the Ocrevus population has similar penetration in the 65+ population as the 30-65 population, this data is really encouraging. If instead the Ocrevus dataset is skewed towards people between the ages of 30-65 (which would be my guess), then the 20% hospitalization rate would be really high/concerning.

        (Note, I’m assuming both populations exclude kids.)

        • I do not have the data so I cannot answer this. I guesss Prof Weindl will have to answer this or maybe Roche. I also suspect this is data from a pharmacovigilence prospective and this is the standard adverse event reporting and therefore it will be biased as people doing well would not come onto the radar. Based on what I have read (CDC) the occurence of hospitalisation due to covid is about 2.5% of the the population and therfore 25%+ would be high however, if we look at the COVID Positive cases data from China based on 70,000+ cases the rate of hospitalisation is 20% and ICU cases were 6%, if I remember correctly. Therefore 25+% is not that different.

    • There is data on fingolimod and all DMT but I have seen more data on anti-CD20. I guess it depends on what is being used in the different countries, I remeber in the Italian Cohort there were more DMF. Maybe Novaritis can send us a slide of what they I have picked up. I am guess the cases with the ocrelizumab would have been picked up by doctors doing pharmacovigilence

  • The numbers on the slide don’t make sense. How can there be 19 patients recovered and only 13 discharged from the hospital ?

  • I can’t believe that any respiratory doctors are still saying that 20% of the population with CoVID-19 are hospitalised. Clearly their denominator value is wrong. Studies in some parts of New York indicated that 50% of the population had been infected. This would mean that 10% of the New York population had been hospitalised, which is not true, because hospitals would have failed under such a major disaster. I don’t mean to belittle the importance of this, but catastrophising is creating unjustified paranoia in our community.

    • Oops meant to say of the COVID 19 infected population, I’m having a brain fart and in a rush……..80% symptomatic 20% symptomatic 5% hospitalised.
      I will just remove it until i ge the right graph

  • This data needs to be interpreted in context. It is voluntary reporting of COVID-19 in ocrelizumab treated subjects to Roche-Genentech. It is likely to be biased in favour of severe or hospitalised cases. I am sure many people with MS with mild COVID-19 who aren’t getting swabbed or not being reported.

    Overall this data, in conjunction with the Italian, French and UK register data, is good news. As we predicted it looks as if pwMS on ocrelizumab and other DMTs for that matter are not at increased risk of COVID-19 and severe COVID-19. This is one of the reasons why I haven’t stopped starting ocrelizumab or redosing ocrelizumab during the COVID-19 pandemic.

    • If that is your position, why don’t the ABN agree with continuing ocrelizumab during the COVID 19 pandemic? Do you think they will review their guidance soon?

  • I am aware that this data has been submitted to a journal for rapid publication. Instead of it being vetted and peer-reviewed, it gets presented on a webinar and then on social media (YouTube and this blog). It shows you how information flow has been changed by COVID-19. Publication etiquette has been thrown out of the window.

    I would be very interested to know how the data got into the public domain in the first place 😉

    • The bottom of the Slide says Roche Communication 6:5:2020…..

      Pubmed contains a few percent gold and 90% drivel, BioRXIV and MedRiv will get a mega impact factor as a result of this outbreak. If we can link the pre-print sites to the sites like pubmed….the current publishing model is dead….Long live the revolution!

  • The better outcome could have been severe covid and not death. I dont know the demographic of the people involved.

    Having independent data… you will get that is due course as the case reports I have seen two published on anti CD20 and registry data appear.

    However just because it has a load of familalr names does not mean it is independent…as companies general write the papers the way they want the data presented.

  • I feel like in the last 48hr Ocrelizumab has suddenly become the danger DMT that everyone is concentrating on whereas before it was just one in a list of possible risks. Why is this? Do I suddenly need to worry more than I have been?

    I read that as most people on ocrelizumab did fine but maybe I need to take my rose tinted glasses off.

    Oh and whilst I’m here – can you confirm that ocrelizumab DOESN’T mean you have to shield!! I see so many people on social media shielding because of it and unless I’ve interpreted MS society guidance incorrectly, that isn’t necessary.

    Again, perhaps I need to worry more 🙁

    • I think the opposite. Anti-CD20 is looking safe. Ocrelizumab is clearly one of the go-to high efficacy DMT in the current environment alongside natalizumab and cladribine. With cladribine, you would need to self-isolate until you are sure your lymphocyte counts don’t go below 500/mm3. Self-isolation is not required with ocrelizumab.

      There are issues around ocrelizumab and vaccine-readiness if a SARS-CoV-2 vaccine emerges. But I would recommend crossing the vaccine bridge if and when the vaccine arrives.

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