B-Cell Depletion and COVID-19 Severity in Multiple Sclerosis: Remaining Challenges

There has been substantial interest in a possible increased risk of developing severe coronavirus disease 2019 (COVID-19) in patients with autoimmune diseases.1 Early observations in people with multiple sclerosis (MS) did not uniformly confirm such an increase.2,3 However, several observations point toward a different risk profile for severe COVID-19 with the use of specific disease-modifying therapies (DMTs) in people with MS.3,4 In addition, attenuated humoral responses after both COVID-19 infection5,6 and vaccination have been reported for different DMTs.1,7,8 The exact magnitude of the increased risk of a more complicated COVID-19 disease course in MS subgroups on different DMTs still has to be established. More knowledge about the specific risk profiles for each DMT will be very important in counseling patients. It is important to take COVID-19 severity proportionally into account for the risk-benefit evaluation at treatment start and switch in MS. Large cohort studies to confirm the relationship between DMTs and COVID-19 severity have remained elusive until now.

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