Rituximab Infusion Timing, Cumulative Dose, and Hospitalization for COVID-19 in Persons With Multiple Sclerosis in Sweden | Allergy and Clinical Immunology | JN Learning | AMA Ed Hub [Skip to Content]
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Rituximab Infusion Timing, Cumulative Dose, and Hospitalization for COVID-19 in Persons With Multiple Sclerosis in Sweden

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Rituximab therapy has been associated with more severe COVID-19 infection in persons with multiple sclerosis,1,2 although this finding was based on a small number of events. Further research is needed to evaluate the potential increased risk for severe disease. In this study, we examined the association between timing and dose of rituximab and hospitalization for COVID-19 across Sweden.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: October 5, 2021.

Published: December 1, 2021. doi:10.1001/jamanetworkopen.2021.36697

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 McKay KA et al. JAMA Network Open.

Corresponding Author: Thomas Frisell, PhD, Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, T2, Karolinska University Hospital, 171 76 Stockholm, Sweden (thomas.frisell@ki.se).

Author Contributions: Dr McKay had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: McKay, Piehl, Langer-Gould, Frisell.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: McKay, Piehl.

Critical revision of the manuscript for important intellectual content: Piehl, Englund, He, Langer-Gould, Hillert, Frisell.

Statistical analysis: McKay, Langer-Gould, Frisell.

Obtained funding: Piehl, Langer-Gould, Hillert.

Administrative, technical, or material support: Piehl, He, Frisell.

Supervision: Piehl, Hillert.

Conflict of Interest Disclosures: Dr McKay reported receiving research funding from the Swedish Research Council for Health, Working Life and Welfare. Dr Piehl reported receiving grants from Swedish Medical Research Council, County of Stockholm, Merck KGaA, UCB, and Sanofi-Genzyme as well as personal fees from Parexel and Roche outside the submitted work. Dr Hillert reported receiving grants from Biogen, Celgene, Merck KGaA, Novartis, Bristol Myers Squibb, Roche, and Sanofi-Genzyme; personal fees from Biogen, Celgene, Sanofi-Genzyme, Merck KGaA, Novartis, Teva, Janssen, and Sandoz; and research funding from Swedish Research Council and the Swedish Brain Foundation outside the submitted work. Dr Frisell reported receiving research funding from the Swedish Research Council and NEURO Sweden. No other disclosures were reported.

Funding/Support: This study was supported by the Patient-Centered Outcomes Research Institute (PCORI/MS-1511-33196).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Sormani  MP , De Rossi  N , Schiavetti  I ,  et al; Musc-19 Study Group.  Disease-modifying therapies and Coronavirus Disease 2019 severity in multiple sclerosis.   Ann Neurol. 2021;89(4):780-789. doi:10.1002/ana.26028 PubMedGoogle ScholarCrossref
2.
Langer-Gould  A , Smith  JB , Li  BH ; KPSC MS Specialist Group.  Multiple sclerosis, rituximab, and COVID-19.   Ann Clin Transl Neurol. 2021;8(4):938-943. doi:10.1002/acn3.51342 PubMedGoogle ScholarCrossref
3.
Louapre  C , Collongues  N , Stankoff  B ,  et al; Covisep investigators.  Clinical characteristics and outcomes in patients with Coronavirus Disease 2019 and multiple sclerosis.   JAMA Neurol. 2020;77(9):1079-1088. doi:10.1001/jamaneurol.2020.2581 PubMedGoogle ScholarCrossref
4.
Simpson-Yap  S , de Brouwer  E , Kalincik  T ,  et al  Associations of DMT therapies with COVID-19 severity in multiple sclerosis.   medRxiv. Preprint posted February 10, 2021. doi:10.1101/2021.02.08.21251316 Google Scholar
5.
Alping  P , Piehl  F , Langer-Gould  A , Frisell  T ; COMBAT-MS Study Group.  Validation of the Swedish Multiple Sclerosis Register: further improving a resource for pharmacoepidemiologic evaluations.   Epidemiology. 2019;30(2):230-233. doi:10.1097/EDE.0000000000000948 PubMedGoogle ScholarCrossref
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Luna  G , Alping  P , Burman  J ,  et al.  Infection risks among patients with multiple sclerosis treated with fingolimod, natalizumab, rituximab, and injectable therapies.   JAMA Neurol. 2020;77(2):184-191. doi:10.1001/jamaneurol.2019.3365 PubMedGoogle ScholarCrossref
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