CD20-depleting antibodies and catching COVID-19 is reported to be bad news however
In this study there were 9/258 people who got COVID and the conclusion was that “rituximab seems not to be safe enough during the pandemic”. This is a opinion. This could be countered other opinions, by the data from the Global Data Sharing approach where hundreds of CD20-treated people developed COVID-19 and the vast, vast majority recovered.
Esmaeili S, Abbasi MH, Abolmaali M, Mojtahed M, Alavi SNR, Soleimani S, Mokhtari M, Hatam J, Khotbehsara ST, Motamed MR, Joghataei MT, Mirzaasgari Z, Moghaddasi M. Rituximab and risk of COVID-19 infection and its severity in patients with MS and NMOSD. BMC Neurol. 2021; 21:183.
Background: Choosing a safe disease modifying therapy during the COVID-19 pandemic is challenging. This case series study was conducted to determine the incidence rate and the course of Covid-19 infection in MS/NMOSD patients treated with rituximab.
Methods: In this study, we designed a web-based questionnaire. Baseline information such as patient- reported walking disability, total number of rituximab infusions received, delayed injections, occurrence of any relapse, and the use of corticosteroids during the pandemic were collected. Also, information regarding the Covid-19 pandemic such as adherence to self-isolation, any recent exposure to an infected individual and the presence of suggestive symptoms were collected. In case of positive test results, patients were grouped into 2 categories; mild to moderate and seriously ill and outcomes were evaluated as favorable (improved/ discharged) and unfavorable (expired).
Results: Two hundred fifty-eight patients with Multiple Sclerosis were enrolled in this study, 9 of the subjects (3.4%) were confirmed positive for Covid-19, five of which required hospitalizations (55.5%), two patients required ICU admission (22.2%) and 2 two patients died (22.2%). None of these patients ever mentioned using corticosteroids during the pandemic. In comparison to MS patients who were not receiving disease modifying therapy (DMT), our study indicated a higher incidence of Covid-19 infection, higher ratio of serious illness and a higher fatality ratio.
Conclusions: Rituximab seems not to be safe enough during the pandemic.
Risk of COVID-19 in MS
Barzegar M, Mirmosayyeb O, Gajarzadeh M, Afshari-Safavi A, Nehzat N, Vaheb S, Shaygannejad V, Maghzi AH. COVID-19 Among Patients With Multiple Sclerosis: A Systematic Review. Neurol Neuroimmunol Neuroinflamm. 2021 May 20;8(4):e1001.
Objective: We systematically reviewed the literature on COVID-19 in patients with multiple sclerosis (MS).
Methods: We searched PubMed, Scopus, EMBASE, CINAHL, Web of Science, Google Scholar, and World Health Organization database from December 1, 2019, to December 18, 2020. Three conference abstract databases were also searched. We included any types of studies that reported characteristics of patients with MS with COVID-19.
Results: From an initial 2,679 publications and 3,138 conference abstracts, 87 studies (67 published articles and 20 abstracts) consisting of 4,310 patients with suspected/confirmed COVID-19 with MS met the inclusion criteria. The female/male ratio was 2.53:1, the mean (SD) age was 44.91 (4.31) years, the mean disease duration was 12.46 (2.27), the mean Expanded Disability Status Scale score was 2.54 (0.81), the relapsing/progressive ratio was 4.75:1, and 32.9% of patients had at least 1 comorbidity. The most common symptoms were fever (68.8%), followed by cough (63.9%), fatigue/asthenia (51.2%), and shortness of breath (39.5%). In total, 837 of 4,043 patients with MS with suspected/confirmed COVID-19 (20.7%) required hospitalization, and 130 of 4,310 (3.0%) died of COVID-19. Among suspected/confirmed patients, the highest hospitalization and mortality rates were in patients with no disease-modifying therapies (42.9% and 8.4%), followed by B cell-depleting agents (29.2% and 2.5%).
Conclusion: Our study suggested that MS did not significantly increase the mortality rate from COVID-19. These data should be interpreted with caution as patients with MS are more likely female and younger compared with the general population where age and male sex seem to be risk factors for worse disease outcome.
So maybe anti-CD20 is a risk factor for COVID19
Etemadifar M, Sigari AA, Sedaghat N, Salari M, Nouri H. Acute relapse and poor immunization following COVID-19 vaccination in a rituximab-treated multiple sclerosis patient. Hum Vaccin Immunother. 2021 May 20:1-3. doi: 10.1080/21645515.2021.1928463
With the progress of COVID-19 vaccination programs worldwide, some new adverse events associated with the available vaccines may unfold, especially in subpopulations, representatives of whom were not included in phase I, II, and III clinical trials of these vaccines, such as patients with autoimmune diseases, including multiple sclerosis (MS). A 34-year-old woman presented with severe right hemiplegia and ataxia. She was diagnosed with relapsing-remitting MS (RRMS) 13 years ago and treated with rituximab (an anti-CD20 monoclonal antibody) during the last 15 months. She had received her first dose of adenovirus-vectored COVID-19 vaccine Gam-COVID-Vac (Sputnik V) three months after her last infusion of rituximab and three days before experiencing her latest MS relapse episode, preceded by mild symptoms (fatigue, myalgia, generalized weakness, etc.). Magnetic resonance imaging revealed several new periventricular, juxtacortical, brainstem, and cerebellar peduncle lesions. She received corticosteroid therapy for five consecutive days, and her neurological deficits slightly improved. Twenty-one days after receiving the first dose of the vaccine, her anti-SARS-CoV-2 antibodies were below the lower detection limit. However, a decision was made to adhere to the vaccination schedule and not risk the patient’s safety against an unfortunate COVID-19 contraction, and thus, she was advised to receive the second Gam-COVID-Vac dose after discontinuation of oral steroid taper. The safety of adenovirus-based vaccines in patients with autoimmune diseases requires further investigation. Meanwhile, clinicians should raise awareness among their patients regarding the potentially limited efficacy of COVID-19 vaccination in those treated with anti-CD20 treatments. After careful, individualized risk-benefit assessments, planning a delay/pause in such treatments to create a time window for patients to receive the vaccine and develop anti-SARS-CoV-2 immunity may be recommended.
Was the relapse due to the vaccine or was it going to happen anyway especially as it occurred 3 days after vaccine. I don’t know on another issue and the anti-vaccine response having see alot of the antibody responses after the first dose of vaccine, I would say ensure you get the second jab because the antibody response to the first cycle may be abit rubbish even if you dont have a DMT, compared to what happens after the second cycle. Mine was rubbish. But the question we are waiting for what happened after the second vaccine dose. It would be known by now.
Maybe a way to reduce the risk of relative vaccine failure
We sort of know that people on ocrelizumab are not going to make a good vaccine-related ocrelizumab whilst on active treatment and one wonders if the way to to deal with this is to give people an antibody response. It is being shown that anti-COVID-19 antibodies produced from the makers of anti-CD20 can reduce the the risk of hospitalisation from infection. It makes me think that this could protect people with cancer and MS.
REGEN-COV Antibody Cocktail Clinical Outcomes Study in Covid-19 OutpatientsWeinreich, D et al. MedRXiv 10.1101/2021.05.19.21257469 — Posted: 2021-05-21
Background: REGEN-COV antibody cocktail (casirivimab with imdevimab) rapidly reduced viral load and decreased medically-attended visits in the phase 1/2 portion of this trial; REGEN-COV, retains activity in vitro against emerging SARS-CoV-2 variants of concern. Methods: The phase 3 portion of this adaptive, randomized, master protocol, included 4,057 Covid-19 outpatients with one or more risk factors for severe disease.
Conclusions: Treatment with REGEN-COV was well-tolerated and significantly reduced Covid-19-related hospitalization or all-cause death, rapidly resolved symptoms, and reduced viral load. (NCT04425629.)
No some good news for MS as a covid-19 trial shows benefit…so it should work in MS?
Metforin is reported to rejuveniate macrophages and oligodendrocytes by making them useful. We have suggested that macropahges are key to surviving covid-19. So if this is true then metforin should protect against COVID-19. So what happens? Yet you guessed it, So Cambridge and the rest seem to be on the right track. So if they can get the trials right it should be good news….Watch this space
Metformin Is Associated with Favorable Outcomes in Patients with COVID-19 and Type 2 Diabetes MellitusMa, Z., Patel, N., Vemparala, P., Krishnamurthy, M.10.1101/2021.05.20.21257490 — Posted: 2021-05-21
Aim: We aim to address whether metformin use offers a low mortality on patients with COVID-19 and pre-existing type 2 diabetes mellitus (T2DM). Materials and Methods: A cohort of 1356 hospitalized patients with COVID-19 and pre-existing T2DM was analyzed
. Conclusions: Our results provide supporting evidence that metformin may confer increased survival in patients with COVID-19 and T2DM treated with Metformin prior to hospitalization
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