Table 2. Association of Rituximab Treatment With COVID-19 Hospitalization Among SARS-CoV-2–Vaccinated Patients With MS.
| Variable | Rituximab compared with no or other DMT groupa | Comparison of rituximab treatment characteristics among patients with MS treated with rituximab | ||||||
|---|---|---|---|---|---|---|---|---|
| Crude | Adjusted | Crude | Adjusted | |||||
| OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | |
| Age, | 0.99 (0.97-1.01) | .43 | NA | NA | 1.01 (0.98-1.04) | .58 | NA | NA |
| Female sex | 0.92 (0.43-1.99) | .84 | NA | NA | 0.85 (0.37-1.95) | .70 | NA | NA |
| White race | 0.46 (0.23-0.93) | .03 | 0.62 (0.31-1.26) | .18 | 0.52 (0.23-1.16) | .11 | 0.58 (0.25-1.35) | .21 |
| Advanced disability (walker or worse) | 1.21 (0.52-2.79) | .66 | NA | NA | 1.84 (0.77-4.40) | .17 | 1.82 (0.69-4.78) | .22 |
| Elixhauser Comorbidity Index | 1.10 (0.96-1.27) | .17 | 1.25 (1.08-1.45) | .003 | 1.10 (0.89-1.35) | .38 | NA | NA |
| Vaccination characteristics | ||||||||
| mRNA vaccines only | 0.32 (0.13-0.77) | .01 | 0.36 (0.15-0.90) | .03 | 0.22 (0.09-0.59) | .002 | 0.28 (0.11-0.73) | .009 |
| ≥1 Booster dose received | 0.29 (0.14-0.58) | <.001 | 0.31 (0.15-0.64) | .002 | 0.49 (0.23-1.05) | .07 | 0.61 (0.28-1.34) | .22 |
| ≤150 Days since last vaccine | 0.65 (0.33-1.30) | .22 | NA | NA | 1.60 (0.67-3.81) | .29 | NA | NA |
| Rituximab treatment | 6.35 (2.76-14.62) | <.001 | 7.33 (3.05-17.63) | <.001 | NA | NA | NA | NA |
| Rituximab characteristics | ||||||||
| Timing of SARS-CoV-2 vaccine dose | ||||||||
| All doses ≤6 mo | NA | NA | NA | NA | 1 [Reference] | NA | 1 [Reference] | NA |
| Any dose >6 mo | NA | NA | NA | NA | 0.17 (0.08-0.37) | <.001 | 0.22 (0.10-0.49) | <.001 |
| Dose at last infusion ≥1000 mg | NA | NA | NA | NA | 2.04 (0.69-6.00) | .20 | 1.11 (0.32-3.86) | .87 |
| Cumulative dose ≥9000 mg | NA | NA | NA | NA | 3.90 (1.44-10.56) | .007 | 2.50 (0.77-8.09) | .13 |
Abbreviations: DMT, disease-modifying therapy; mRNA, messenger RNA; MS, multiple sclerosis; NA, not applicable; OR, odds ratio.
a
Untreated persons with MS or treated with DMTs that do not interfere with SARS-CoV-2 vaccine efficacy (interferon-betas, glatiramer acetate, natalizumab, or dimethyl fumarate).