4CPS-333\u2005Treating multiple sclerosis patients with infusion of disease modifying treatments during the COVID-19 pandemic

Abstract

Background and importanceMultiple sclerosis (MS) secondline disease modifying treatments (DMT) cause lymphocyte or B cell depletion, such as therapy with natalizumab, ocrelizumab, alemtuzumab or rituximab They can present a varying degree of immunodeficiency that can translate into an increased risk of infections The decision making process should balance the risks of stopping an active treatment and the risk of COVID-19 infection Aim and objectivesTo evaluate the management of MS patients with secondline DMT via infusion with natalizumab, ocrelizumab, rituximab and alemtuzumab during the COVID-19 pandemic Material and methodsAn observational retrospective study was conducted between January 2020 and October 2020 of MS patients on active treatment with natalizumab, ocrelizumab, rituximab or alemtuzumab who were expected to receive new dosages in this period For data collection, the electronic clinic history system (Selene) and the programme Farmatools were used Variables collected were: sex, age, expanded disability status scale (EDSS), COVID-19 diagnosis and type of MS Treatment changes/delays due to COVID-19 were reviewed In case of delay, the number of days was quantified Results40 patients (65% women) treated with different infusion therapies were evaluated with a median age of 47 3 (SD 13,3) The average EDSS was 3 8 (SD 2 1) 29 patients had relapsing–remitting MS (72,5%), 7 had primary progressive MS (17 5%) and 4 had secondary progressive MS (10%) Five (12 5%) COVID-19 cases were diagnosed No delays were registered in 13 infusions of natalizumab;2 patients, due to a suboptimal response, were changed to ocrelizumab, reducing hospital visits, and one was transferred to another hospital Three patients were expected to receive alemtuzumab No one received alemtuzumab and two were changed to ocrelizumab due to the European Medicines Agency (EMA) alert that recommended restricting the use of alemtuzumab during the COVID-19 pandemic Two patients received rituximab in time;one was changed to natalizumab due to infusion reactions and in one case the dosing interval was extended to 36 days Eight patients began ocrelizumab treatment, eight received their dose without delay, one died and in five cases the dosing interval was extended to 39 days (SD 23 8) Conclusion and relevanceAccording to the recommendations, a case-by-case analysis should be performed, but it seems that the COVID-19 pandemic has conditioned MS treatments as changes/delays were registered Five (12 5%) COVID-19 cases were diagnosed, similar to the outcomes obtained in the seroprevalence study in the same region References and/or acknowledgementsConflict of interestNo conflict of interest