Clinical and radiologic outcomes in two patients with multiple sclerosis treated with tocilizumab for COVID-19

BACKGROUND: Tocilizumab is an interleukin-6 receptor antagonist used to treat COVID-19. A previous case report described development of multiple sclerosis (MS) after treatment with tocilizumab for rheumatoid arthritis, leading to an FDA warning label. We sought to identify patients with multiple sclerosis (MS) who were treated with tocilizumab for coronavirus disease 2019 (COVID-19) and characterize clinical outcomes. METHODS: We electronically identified MS patients who received tocilizumab for COVID-19 from January 2019 to September 2021 and performed retrospective chart review. RESULTS: Two patients were identified. The patients were both treated with ocrelizumab and had an average disease duration of 10.5 years. Both patients were hospitalized with COVID-19 infection (with WHO COVID-19 severity scales of 5 and 6) and received tocilizumab as treatment for COVID-19. At post-discharge follow-up, EDSS showed no or a mild increase (stable in one patient, and 1 to 2 in the second patient). There was no increase in PDSS score. Follow-up MRI after discharge showed no new T2 lesions, enhancing lesions, or worsening atrophy. CONCLUSIONS: In two MS patients who received tocilizumab for COVID-19, we did not observe significant clinical or radiologic worsening following treatment. Larger scale studies are needed to determine if use of tocilizumab for COVID-19 can provoke relapse or cause MS disease