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Secondary Organising Pneumonia Among Immunocompromised Multiple Sclerosis Patients Treated With Ocrelizumab Following
Tarake M Aljarod1, Richard Scott Morehead2
1Division of Pulmonary, Critical Care and Sleep Medicine Marshall University School of Medicine Huntington West Virginia USA.
Abstract:
Anti-CD20 medications, such as rituximab and coronavirus disease 2019 (COVID-19) infection, have been shown to cause secondary organising pneumonia (OP). Ocrelizumab is an anti-CD20 monoclonal antibody widely used as a disease-modifying therapy for relapsing-remitting and primary progressive forms of multiple sclerosis (MS). We describe two cases of biopsy-proven secondary OP in ocrelizumab-treated MS patients occurring several weeks after contracting COVID-19 infection. These cases had been on ocrelizumab for 6.5 years (latent period) before the development of OP. Withdrawal of ocrelizumab and corticosteroids resulted in clinical and radiographic recovery. Literature review revealed seven cases of secondary OP in ocrelizumab-treated MS patients without evidence of infection and 10 MS cases with secondary OP due to COVID-19 infection in the setting of ocrelizumab treatment. Although unproven, ocrelizumab could trigger pneumotoxicity in patients when combined with COVID infection.
Insights
Ocrelizumab, used for multiple sclerosis (MS), may cause secondary organizing pneumonia (OP) after COVID-19 infection. Stopping ocrelizumab and corticosteroids led to recovery in two MS patients.
Area of Science:
- Immunology
- Neurology
- Pulmonology
Background:
- Anti-CD20 therapies, including ocrelizumab, are used for multiple sclerosis (MS).
- Secondary organizing pneumonia (OP) has been linked to anti-CD20 medications and COVID-19 infection.
- Ocrelizumab is a monoclonal antibody targeting B-cells in MS treatment.
Purpose of the Study:
- To report two cases of secondary OP in ocrelizumab-treated MS patients following COVID-19 infection.
- To review existing literature on ocrelizumab-associated OP and COVID-19-related OP in MS.
Main Methods:
- Case report of two patients with biopsy-proven secondary OP.
- Review of medical literature for similar cases.
- Analysis of treatment outcomes following drug withdrawal and corticosteroid use.
Main Results:
- Two MS patients developed biopsy-proven secondary OP weeks after COVID-19 infection while on long-term ocrelizumab therapy.
- Literature search identified seven cases of ocrelizumab-associated OP without infection and ten MS cases with OP due to COVID-19 during ocrelizumab treatment.
- Discontinuation of ocrelizumab and corticosteroid treatment resulted in clinical and radiographic improvement.
Conclusions:
- Ocrelizumab may contribute to pneumotoxicity, particularly when co-occurring with COVID-19 infection in MS patients.
- Early recognition and management involving drug withdrawal are crucial for recovery.
- Further research is needed to confirm the causal link between ocrelizumab, COVID-19, and secondary OP.
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