COVID-19 vaccines, boosters recommended for MS patients taking rituximab
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People with MS who are being treated with rituximab are strongly encouraged to receive mRNA SARS-CoV-2 vaccines and booster doses more than 6 months after their last rituximab infusion, researchers reported in JAMA Network Open.
“Treatment with rituximab or other B-cell-depleting therapies has been associated with an increased risk of more severe COVID-19, including death in unvaccinated persons with MS, compared with those treated with several other disease modifying-therapies and the general population without MS,” Jessica B. Smith, MPH, of the department of research and evaluation at the Southern California Permanente Medical Group, and colleagues wrote.
Smith and colleagues sought to examine whether rituximab treatment is associated with an increased risk for hospitalization from COVID-19 among vaccinated individuals with MS and whether delaying vaccination more than 6 months after rituximab treatment is associated with decreased risk.
The researchers conducted a retrospective cohort study using Kaiser Permanente’s Southern California electronic health record database to identify individuals who had MS and who had been vaccinated against SARS-CoV-2.
Among 3,974 vaccinated people with MS (mean age, 55.3 years; 75% women), those treated with rituximab (n = 1,516) were more likely to be hospitalized but not die compared with 2,458 individuals with MS who were receiving either no or other DMTs (adjusted OR = 7.33; 95% CI, 3.05-17.63).
According to the authors, receiving an mRNA SARS-CoV-2 vaccine (aOR = 0.36; 95% CI, 0.15-0.9) and receiving a booster vaccination (aOR = 0.31; 95% CI, 0.15-0.64) were independently associated with a decreased risk for hospitalization for COVID-19.
In MS patients being treated with rituximab, receiving any vaccination dose more than 6 months after their last rituximab infusion was associated with a reduced risk for COVID-19 hospitalization (aOR = 0.22; 95% CI, 0.1-0.49).
“Rituximab biosimilars have marked affordability, efficacy and convenience advantages over other DMTs, particularly in countries with poor access to MS specialty care and unaffordable drug prices, including the U.S.,” Smith and colleagues wrote. “The low risk of hospitalization for COVID-19 among mRNA-vaccinated individuals with MS receiving rituximab should not preclude rituximab use. Instead, expanding access to SARS-CoV-2 vaccines for individuals receiving rituximab therapy in low- and middle-income countries should be prioritized.”