COVID-19 结局在多发性硬化症患者中用利妥昔单抗治疗。
COVID-19 outcomes in persons with multiple sclerosis treated with rituximab.
机构信息
Department of Neurology, Vikram Hospital, Millers Road, Bangalore, India.
Department of Neurology, Vikram Hospital, Millers Road, Bangalore, India.
出版信息
Mult Scler Relat Disord. 2022 Jan;57:103371. doi: 10.1016/j.msard.2021.103371. Epub 2021 Nov 10.
BACKGROUND
Outcomes of COVID-19 in PwMS (persons with Multiple Sclerosis) on immunosuppressive therapies, particularly B-cell depletors, can be unpredictable. There has been a concern for postponing or avoiding use of Rituximab (RTX) during the COVID-19 pandemic. We report the course and outcomes of COVID-19 in PwMS receiving RTX.
METHODS
PwMS receiving RTX who contracted COVID-19 were closely monitored by tele-consultation and/or evaluated during hospital visits. Those requiring hospitalization for oxygen therapy or admission to ICU or expiring due to COVID-19 were considered to have severe disease. Those without desaturation and manageable at home were considered to have mild disease. Disease course and outcomes were noted.
RESULTS
Twelve out of 62 (19.4%) PwMS on RTX therapy developed COVID-19. Four (age 35-49 years; mean 43.5) had severe COVID; three of whom had Secondary Progressive MS (SPMS). One PwMS expired. Two had prolonged fever lasting >1 month. One demonstrated features of SARS-CoV-2 reactivation. Interval from last RTX infusion (average dose 750 mg) to COVID-19 onset ranged 1-4 (mean 3.7) months. Eight PwMS had mild COVID-19 (age 26-54 years; mean 37.7); six had RRMS and two SPMS. RTX dose was lower (average dose 625 mg) and infusion to COVID-19 onset duration was longer, ranging 4-20 (mean 9.5) months. Four patients, two each from mild and severe COVID-19 groups had neurological deterioration, but none had true relapses.
CONCLUSION
RTX treated PwMS may have unpredictable disease outcomes if they contract COVID-19, but may be at risk of severe disease and persistent infection. In our series higher age, SPMS, shorter interval from RTX infusion to COVID-19 onset and higher dose of RTX were noted amongst those developing severe disease. RTX should be use cautiously during the COVID-19 pandemic and if unavoidable, less frequent and lower doses should be considered. Patients receiving RTX must be counselled to follow strict COVID-19 preventive measures.
背景
COVID-19 在接受免疫抑制治疗的多发性硬化症（MS）患者（即 PwMS）中的结局可能不可预测，尤其是在使用 B 细胞耗竭剂时。在 COVID-19 大流行期间，人们曾担心推迟或避免使用利妥昔单抗（RTX）。我们报告了接受 RTX 治疗的 PwMS 中 COVID-19 的发病过程和结局。
方法
通过远程咨询密切监测接受 RTX 治疗并感染 COVID-19 的 PwMS，并在住院期间或就诊时进行评估。需要吸氧治疗或入住 ICU 或因 COVID-19 而死亡的患者被认为患有重症。那些没有出现低氧血症且可在家中得到控制的患者被认为患有轻症。记录疾病的发病过程和结局。
结果
62 名接受 RTX 治疗的 PwMS 中有 12 名（19.4%）感染了 COVID-19。4 名（35-49 岁；平均 43.5 岁）患者患有重症 COVID；其中 3 名患有继发进展型 MS（SPMS）。1 名 PwMS 死亡。2 名患者持续发热超过 1 个月。1 名患者出现 SARS-CoV-2 再激活的特征。末次 RTX 输注（平均剂量 750mg）至 COVID-19 发病的时间间隔为 1-4 个月（平均 3.7 个月）。8 名 PwMS 患有轻症 COVID-19（26-54 岁；平均 37.7 岁）；其中 6 名患有 RRMS，2 名患有 SPMS。RTX 剂量较低（平均剂量 625mg），且从 RTX 输注至 COVID-19 发病的时间间隔较长，范围为 4-20 个月（平均 9.5 个月）。轻症和重症 COVID-19 组各有 2 名患者出现神经功能恶化，但均未发生真正的复发。
结论
如果感染 COVID-19，接受 RTX 治疗的 PwMS 的疾病结局可能不可预测，但可能存在发生重症疾病和持续感染的风险。在我们的研究中，更年轻的年龄、SPMS、从 RTX 输注至 COVID-19 发病的时间间隔较短以及更高剂量的 RTX 与发生重症疾病相关。在 COVID-19 大流行期间应谨慎使用 RTX，如果不可避免，应考虑减少频率和降低剂量。接受 RTX 治疗的患者必须接受咨询，以遵循严格的 COVID-19 预防措施。
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