Impact of immunotherapies on COVID-19 outcomes in multiple sclerosis patients

ABSTRACT

Introduction

SARS-CoV-2 pandemic has led the scientific community to maximize efforts to prevent infections and disease severity in patients with multiple sclerosis (pwMS). We analyze the impact of immunotherapies on COVID-19 outcomes in pwMS, providing our interpretation of data.

Areas covered

Infections, hospitalizations, intensive care unit admissions, and death rates in COVID-19 pwMS are comparable to the general population. Severity of disability, MS clinical phenotype, age, and comorbidities, along with the use of intravenous methylprednisolone and anti-CD20 treatments, are risk factors for COVID-19 severity. Disease-modifying treatments (DMTs) can be safely started and continued during the pandemic. Benefit-risk evaluation is mandatory when managing second-line therapies to balance risk of worse COVID-19 outcomes and MS reactivation. COVID-19 vaccination is safe in MS, and its efficacy could be reduced in fingolimod- and ocrelizumab-treated patients.

Expert opinion

The rate of (re)-infection and outcomes with SARS-CoV-2 variants in pwMS and antiviral properties of DMTs need to be further explored. Data on COVID-19 in pregnant MS women, children, and elderly pwMS are limited. Evidence on long-term effects of infection is needed. Impact of emerging DMTs on COVID-19 should be investigated. More data and longer follow-up are needed to characterize long-term efficacy and safety profile of vaccinations in pwMS.

KEYWORDS:

• COVID-19
• disease-modifying drugs
• multiple sclerosis
• SARS-CoV-2
• SARS-CoV-2 vaccination

Article highlights

• Some patients with MS could represent a possible high-risk group for COVID-19

• Infection and rates of COVID-19 severe disease in MS are comparable to those of the general population

• Risk factors for worse COVID-19 outcomes are represented by high EDSS scores, progressive clinical phenotype, older age, obesity, comorbidities, preinfection use of intravenous methylprednisolone, and anti-CD20 treatments

• When managing high-efficacy drugs, risk vs benefit ratio must be evaluated to balance likelihood of infection and severe COVID-19 outcomes with threat of MS reactivation

• COVID-19 vaccines are safe for patients with MS, and no specific contraindications on COVID-19 vaccinations and no increase of disease activity have been demonstrated so far

• In anti-CD20-treated patients, specific humoral response to vaccination can be impaired, but T-cell response seems to be spared

• In some studies, time from last anti-CD20 administration and total time on treatment influenced vaccine B-cell response

• Both humoral and cellular responses can be markedly reduced in fingolimod-treated patients

Declaration of interest

M Rocca received speaker honoraria from Bayer, Biogen, Bristol Myers Squibb, Celgene, Genzyme, Merck Serono, Novartis, Roche, and Teva and received research support from the MS Society of Canada and Fondazione Italiana Sclerosi Multipla. M Filippi is an Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Associate Editor of Radiology, and Associate Editor of Neurological Sciences; received compensation for consulting services and/or speaking activities from Alexion, Almirall, Bayer, Biogen, Celgene, Eli Lilly, Genzyme, Merck-Serono, Novartis, Roche, Sanofi, Takeda, and Teva Pharmaceutical Industries; and received research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers of this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

Data sharing is not applicable to this article as no data sets were generated or analyzed during the study.