Clinical impact of delaying ocrelizumab infusions during the SARS-COV-2 pandemic

ABSTRACT

Introduction: At the onset of the SARS-COV-2- pandemic in the United States, ocrelizumab (OCR) infusions were delayed for many of our MS patients due to the uncertainty of the impact the infection could have on patients treated on anti-B cell therapy. In addition, there was concern regarding the safety of prolonged stays in the infusion center. Objective: To evaluate if delaying infusions had a negative impact on patients with relapsing MS. Methods: Patients in the Providence Ocrelizumab Registry (POR) with relapsing MS, who had at least two courses of OCR, for whom infusions were delayed due to the pandemic, were included in the analysis. Time delayed, prior DMT use, time on OCR prior to delay, relapses, and MRIs were summarized as percentages, means (SD) or medians [interquartile range (IQR)= Q1, Q3]. Patient data were assessed for relapses and active MRI changes during the delay period (April 2020 through September 2020) and for the six months following their eventual infusion. Results: Of the 352 patients with relapsing MS, 93 had their infusion delayed due to the SARS-COV-2 pandemic. The mean age of those delayed was 49.7 (11.8) years and the mean disease duration was 12.3 (6.9) years. The median time on OCR prior to delay was 22.6 [15.4, 25.0] months. The mean time the infusion was delayed was 8.2 (4.5) weeks. ARR (SD) on OCR in the 12 months prior to delayed infusion was 0.04 (0.16). During the delay period and the period following the delayed infusion, 2 (2.1%) patients possibly had a clinical relapse;however, 68 patients had a MRI during this period of infusion delay and none revealed an enhancing lesion, including the 2 patients with a possible relapse. Conclusions: Despite an average delay of 2 months in 93 patients, there was minimal to no adverse impact, and this suggests in a broader context that less frequent infusions may be just as effective as the currently recommended every 6 month regimen. Further and larger studies will be needed to address this latter question.