Multiple Sclerosis Patients on Rituximab Face Higher COVID-19 Hospitalization: Study

The findings published in, the journal Annals of Indian Academy of Neurology, elucidate the impact of rituximab on multiple sclerosis patients in the COVID-19 era, revealing the susceptibility to covid -19 infection compared to those treated with Natalizumab. Furthermore, more frequent hospitalization was observed when treated with rituximab compared to healthy controls.

Multiple sclerosis (MS) is a chronic autoimmune disease where the immune system attacks the protective sheath (myelin) that covers nerve fibres which causes muscle weakness, vision change, numbness, and memory issues. COVID-19 has significantly affected a large portion of the population, particularly those with autoimmune diseases such as multiple sclerosis.

The effect of COVID-19, 2019 infection on people living with multiple sclerosis (PwMS) who are receiving various immunomodulating therapies, such as rituximab and natalizumab, remains unknown in the Indian population.

For this purpose, Thomas Mathew, Department of Neurology, St. John’s Medical College Hospital, Bengaluru, Karnataka, India and colleagues, conducted a retrospective multicentric study where they included data derived from a centralized MS registry of four centers in South India.

The registry data of patients treated with rituximab and natalizumab, recruited from February 2020 to December 2022, were extracted and analyzed.

The outcomes examined included the incidence of COVID-19 infection, hospitalization, ICU admission, death, post-COVID-19 relapses, and relapses following vaccination. These outcomes were compared between the treatment groups and their matched control groups.

The study reveals the following results:

• COVID-19 infection was observed in 49.1% (26 out of 53) of patients on rituximab, 19.2% (5 out of 26) of patients on natalizumab, and 11.5% (6 out of 52) of healthy controls.
• In the rituximab group, 8 out of 53 (15.1%) were hospitalized, while in the natalizumab group, 1 out of 26 (3.8%) required hospitalization. All 6 out of 52 (11.5%) individuals in the control group experienced mild infections and none were hospitalized.
• The incidence of COVID-19 infection was significantly higher in the rituximab group compared to the natalizumab group and healthy controls.
• Hospitalizations were significantly higher in the rituximab group compared to the healthy controls.

“These findings provide helpful information for making smart decisions about disease-modifying therapies (DMTs) during pandemics like COVID-19. Furthermore, considering the ongoing COVID-19 pandemic, patients on rituximab or natalizumab treatments need to keep following preventive measures to reduce their risk of infection,” said the researchers.

Reference: Mathew, Thomas; Garg, Surabhi; John, Saji K.; Kimi, Mal S.; Chhakchhuak, Naom Z.; Koshy, Sherina; Yangdonq, Tenzin; George, Molly; Bhardwaj, Shagun; Reddy, Yerasu M.¹; Murgod, Uday²; Kamath, Vikram³; Shivde, Sonia; Badachi, Sagar; Huddar, Akshata; Sarma, Gosala R. K.; Nadig, Raghunandan. COVID-19 Infection in Multiple Sclerosis Patients Treated with Rituximab Compared to Natalizumab and Healthy Controls: A Real-World Multicenter Study. Annals of Indian Academy of Neurology 27(3):p 264-268, May–Jun 2024. | DOI: 10.4103/aian.aian_151_24