COVID-19 Infection Not Severe in PPMS Patient on Ocrevus, Case Report Finds

COVID-19 Infection Not Severe in PPMS Patient on Ocrevus, Case Report Finds
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COVID-19 infection in a multiple sclerosis (MS) patient being treated with Ocrevus (ocrelizumab) — an immunosuppressive therapy — was not associated with any serious complications, a case study reports.

This finding supports current suggestions that immunosuppressive therapies, by dampening immune and inflammatory responses, may help to protect against the “cytokine storm” and hyperinflammation associated with COVID-19’s severe complications.

The case report, “COVID-19 in a MS patient treated with ocrelizumab: does immunosuppression have a protective role?” was published in the journal Multiple Sclerosis and Related Disorders.

COVID-19 is an infection caused by a new virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While most infected patients show mild symptoms, about 15% of them develop severe complications, such as respiratory insufficiency, that can require ventilation and intensive care.

Individuals older than 65 and people with clinical conditions are at higher risk of developing a severe case of COVID-19.

People with a compromised immune system — associated with either immunodeficiency disorders or the use of immunosuppressive therapies — may be more susceptible to COVID-19 complications due to the absence of a prompt immune response against the virus.

Currently approved treatments for MS include a number of such immunosuppressive therapies, including Ocrevus (by Genentech, a member of the Roche Group), Lemtrada (by Sanofi-Genzyme), and Gilenya and Mayzent (both by Novartis).

However, increasing evidence suggests that immunosuppression “might play a protective role during COVID-19 infection by preventing or dampening the overly active immune response that, in some cases, might drive clinical deterioration,” the researchers wrote.

Scientists in Genova, Italy — one of the countries in Europe most affected by COVID-19 — detail the case of a 58-year-old man with primary progressive MS (PPMS) who was infected by the virus while on Ocrevus treatment.

He was diagnosed with PPMS in 2009, and treated with interferon beta-1a (sold under several brand names), glatiramer acetate (sold as CopaxoneGlatopa, and other generics), and Gilenya (fingolimod) before beginning Ocrevus treatment in 2018 within a compassionate use program.

Ocrevus — given intravenously (directly into-the-vein) once every six months — works by targeting B-cells, a type of immune cell that drives the inflammation that damages the nervous system in MS.

The man was admitted to the hospital on March 10 with a persistent high fever and severe cough, both of which had started four days before.

A blood exam showed normal white blood cell counts, high levels of C-reactive protein (a marker of inflammation), a slight increase in IL-6 (a pro-inflammatory molecule produced by several cells, including activated B-cells), and moderately low levels of IgG (a class of antibodies often affected by Ocrevus). Increases in both C-reactive protein and IL-6 levels can be caused by a number of conditions, including infections.

As expected in people using Ocrevus, the patient had a complete B-cell depletion. He also showed normal blood oxygenation and no signs of lung involvement (assessed through a chest X-ray).

After testing positive for SARS-CoV-2 in two samples of nasal swab, he was given paracetamol to manage the high fever, and his symptoms resolved in two days. He was discharged to home-quarantine three days after his admission, with normal white blood cell counts and lower levels of C-reactive protein.

Two weeks later, a phone interview confirmed that the man was still quarantined at home, and had experienced no new symptoms.

“In this report we describe the first case of a [B-cell-depleted patient] that developed COVID-19, without serious complications,” the researchers wrote.

This person’s case “supports the putative role of immunosuppressive therapy in COVID-19 affected patients,” the team added, noting that the moderately reduced immune response associated with the lack of B-cells and subsequent non-significant increase in IL-6 levels may have benefitted this patient.

“If confirmed by larger case series, our observation might indicate that patients who undergo B-cell depletion could be protected from serious complications of COVID-19, and might support the use of selective immunosuppressant[s],” the researchers wrote.

Marta Figueiredo holds a BSc in Biology and a MSc in Evolutionary and Developmental Biology from the University of Lisbon, Portugal. She is currently finishing her PhD in Biomedical Sciences at the University of Lisbon, where she focused her research on the role of several signalling pathways in thymus and parathyroid glands embryonic development.
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Patrícia holds her PhD in Medical Microbiology and Infectious Diseases from the Leiden University Medical Center in Leiden, The Netherlands. She has studied Applied Biology at Universidade do Minho and was a postdoctoral research fellow at Instituto de Medicina Molecular in Lisbon, Portugal. Her work has been focused on molecular genetic traits of infectious agents such as viruses and parasites.
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Marta Figueiredo holds a BSc in Biology and a MSc in Evolutionary and Developmental Biology from the University of Lisbon, Portugal. She is currently finishing her PhD in Biomedical Sciences at the University of Lisbon, where she focused her research on the role of several signalling pathways in thymus and parathyroid glands embryonic development.
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