What is the risk of returning to work in a major hospital after receiving anti-CD20 therapy?

Question: What is the risk of returning to work in a major hospital after receiving anti-CD20 therapy?

Answer:
We do not have much information to guide us at present but here is what we know:

1. Genentech has reported preliminary information on 100 confirmed or suspected cases of COVID-19 infection in patients receiving Ocrelizumab, another anti-CD20 monoclonal antibody expected to have identical effects on the immune system as Rituximab. Twenty-six  patients were hospitalized and 5 were listed in critical condition. We have no idea if these patients had other risk factors for severe COVID-19 infection (i.e. age over 60, male sex, vascular disease, hypertension, diabetes, obesity or significant physical disability) or how long they had been receiving Ocrelizumab. Presumably, the risk of immunosuppression is greater after long term treatment compared to one infusion cycle.

Generally, I recommend that patients with MS on Ocrevus who work in healthcare get transferred to duties with decreased patient interaction, if they are young and have no other risk factors for severe COVID-19 infection. If  a person has multiple known risk factors in addition to receiving treatment with COVID 19, I recommend a leave of absence from work until there is a steady decline in cases to the health facility for over 2 weeks and then allow a return to work initially to  duties with decreased patient interaction.

In all cases workers should follow social distancing rules with adequate PPE and frequent cleaning of hands and equipment.

I hope this helps
​
Revere P (Rip) Kinkel, MD
​Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego