Observational Studies Poster Presentation

P0923 - The presence of SARS CoV2 antibodies in MS patients (ID 990)

Speakers
  • A. Wallach
Authors
  • A. Wallach
  • S. Melvin
  • M. Schiebel
  • M. Picone
Presentation Number
P0923
Presentation Topic
Observational Studies

Abstract

Background

The COVID-19 pandemic has raised novel questions for people with multiple sclerosis (pwMS), which worldwide registries will help answer. One question is - how will disease modifying treatment (DMT) use affect the efficacy of a future vaccine against SARS-CoV2 (the virus that causes COVID-19) in pwMS? To begin to address this question, we evaluated our patients who were clinically diagnosed with Covid-19 for antibodies (Ab).

Objectives

To determine the frequency of SARS-CoV-2 Ab in our patients with Covid-19 and co-morbid MS, and describe their clincal characteristics.

Methods

This is a case series of pwMS who are patients of the Holy Name MS Center and were either proven by PCR or highly suspected of active COVID-19 infection as of July 15, 2020.

Results

Of the 11 patients included, 91% (n=10) were female, average age 50.5 years (range 34-64 years); 7 patients treated with an anti-CD 20 monoclonal Ab (6 ocrelizumab (OCR), 1 rituximab (RTX)), 1 teriflunomide, 1 interferon beta-1a, and 2 patients not on DMT. Nine tested positive for SARS-CoV2 Ag by nasopharyngeal PCR; 1 was not tested but had a household exposure who tested positive and herself had clinical symptoms of cough, dyspnea, myalgia, weakness, fatigue and headache; and 1 patient tested negative for SARS-CoV2 PCR but was febrile with cough, fatigue and headache during the pandemic. Of this series, 5 tested positive for SARS-CoV2 Ab (Abbott test); of which only 1 was on treatment with OCR (with absent CD19 cells). In terms of clinical outcome – 4 patients (all OCR/RTX treated) required hospital admission for supplemental non-invasive oxygen. All patients survived infection.

Conclusions

This case series suggests that MS treatment with monoclonal anti-CD20 drugs may be associated with some increased risk of developing COVID-19. All of our patients who required hospitalization for this infection were treated with anti-CD20 threapy. Patients with MS who are on OCR/RTX may be less likely to mount an antibody response to this infection, whereas patients treated with interferons and teriflunomide can. Lack of seroconversion following OCR treatment was also noted in another case series of pwMS (Thornton 2020). Although it is reassuring that B-cells are not required to recover from COVID-19 infection, as evidenced by a case series of X-linked agammaglobulinemia patients (Soresina et al. 2020), our findings raise further questions for the health and safety of our patients with respect to this pandemic. Will OCR treated patients be at a unique risk to suffering reinfection from COVID-19 given they are less likely to seroconvert? And, how effective will a future vaccine be in patients treated with OCR (and similar monoclonal antibodies)?

Collapse