Rituximab and risk of COVID-19 infection and its severity in patients with MS and NMOSD

Sara Esmaeili, Mohammad Hossein Abbasi, Meysam Abolmaali, Mohammad Mojtahed, Seyedeh Niloufar Rafiei Alavi, Sevim Soleimani, Mahisa Mokhtari, Jaber Hatam, Samaneh Tanhapour Khotbehsara, Mohammad Reza Motamed, Mohammad Taghi Joghataei, Zahra Mirzaasgari, Mehdi Moghaddasi

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. 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). 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. Rituximab seems not to be safe enough during the pandemic.