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Friedli C, Krajnc N, Hammer HN, Marti S, Zrzavy T, Evangelopoulos ME, Kapsali I, Rommer P, Berger T, Chan A, Bsteh G, Hoepner R. Different lymphocyte counts of multiple sclerosis patients treated with ofatumumab and ocrelizumab: A retrospective observational study. J Cent Nerv Syst Dis 2024; 16:11795735241249644. [PMID: 38711956 PMCID: PMC11072073 DOI: 10.1177/11795735241249644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 03/08/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Patients with Multiple Sclerosis (pwMS) treated with anti-CD20 (cluster of differentiation) monoclonal antibodies (mAbs) such as ocrelizumab (OCR) and ofatumumab (OFA) show a reduction mainly of B-lymphocytes, but also other lymphocyte subsets can be affected by these treatments. There is limited data on differences between lymphocyte subset counts of pwMS after treatment initiation with OCR or OFA. Objective To compare lymphocyte subset counts after treatment initiation in pwMS treated with OCR and OFA. Methods We analyzed 22 pwMS initiated on OFA and 56 sex-, age- and MS course matched pwMS initiated on OCR from 2 prospectively collected observational MS databases (Bern [n: OFA 14, OCR 44] and Vienna [n: OFA 8, OCR 12]) statistically comparing lymphocyte subset counts (Mann Whitney Test). Results We found that pwMS treated with OCR showed a stronger reduction of CD20 B-lymphocytes (P = .001), and a trend towards lower counts of CD8+ T cells (P = .056) compared to pwMS treated with OFA, whereas reduction of total lymphocyte, CD4+ lymphocyte and NK cell count was equally distributed between both treatments. Conclusion Different effects on lymphocyte subpopulations appear to be present in pwMS after treatment initiation with different anti-CD20 mAbs. Further studies are needed to determine potential effects on anti-CD20 treatment efficacy as well as treatment associated risks such as failed vaccinations and infections.
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Affiliation(s)
- Christoph Friedli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Neurology, Waikato Hospital, Hamilton, New Zealand
| | - Nik Krajnc
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Helly N. Hammer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Stefanie Marti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Tobias Zrzavy
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Maria E. Evangelopoulos
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Kapsali
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Paulus Rommer
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Thomas Berger
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Gabriel Bsteh
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
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Freeman SA, Zéphir H. Anti-CD20 monoclonal antibodies in multiple sclerosis: Rethinking the current treatment strategy. Rev Neurol (Paris) 2024:S0035-3787(24)00474-0. [PMID: 38599976 DOI: 10.1016/j.neurol.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 04/12/2024]
Abstract
Anti-CD20 monoclonal antibodies are highly-effective B-cell-depleting therapies in multiple sclerosis (MS). These treatments have expanded the arsenal of highly effective disease-modifying therapies, and have changed the landscape in understanding the pathophysiology of MS and the natural course of the disease. Nevertheless, these treatments come at the cost of immunosuppression and risk of serious infections, diminished vaccination response and treatment-related secondary hypogammaglobulinemia. However, the COVID pandemic has given way to a possibility of readapting these therapies, with most notably extended dosing intervals. While these new strategies show efficacy in maintaining inflammatory MS disease control, and although it is tempting to speculate that tailoring CD20 therapies will reduce the negative outcomes of long-term immunosuppression, it is unknown whether they provide meaningful benefit in reducing the risk of treatment-related secondary hypogammaglobulinemia and serious infections. This review highlights the available anti-CD20 therapies that are available for treating MS patients, and sheds light on encouraging data, which propose that tailoring anti-CD20 monoclonal antibodies is the next step in rethinking the current treatment strategy.
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Affiliation(s)
- S A Freeman
- Department of Neurology, CRC-SEP, CHU of Toulouse, Toulouse, France; University Toulouse III, Inserm UMR1291, CHU Purpan, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITY), 59000 Toulouse, France.
| | - H Zéphir
- Department of Neurology, CRC-SEP, CHU of Lille, Lille, France; University of Lille, Inserm, CHU of Lille, Laboratory of Neuroinflammation and Multiple Sclerosis (NEMESIS), U1172, Lille, France
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3
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Delgado SR, Faissner S, Linker RA, Rammohan K. Key characteristics of anti-CD20 monoclonal antibodies and clinical implications for multiple sclerosis treatment. J Neurol 2024; 271:1515-1535. [PMID: 37906325 PMCID: PMC10973056 DOI: 10.1007/s00415-023-12007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 11/02/2023]
Abstract
The recent success of anti-CD20 monoclonal antibody therapies in the treatment of multiple sclerosis (MS) has highlighted the role of B cells in the pathogenesis of MS. In people with MS, the inflammatory characteristics of B-cell activity are elevated, leading to increased pro-inflammatory cytokine release, diminished anti-inflammatory cytokine production and an accumulation of pathogenic B cells in the cerebrospinal fluid. Rituximab, ocrelizumab, ofatumumab, ublituximab and BCD-132 are anti-CD20 therapies that are either undergoing clinical development, or have been approved, for the treatment of MS. Despite CD20 being a common target for these therapies, differences have been reported in their mechanistic, pharmacological and clinical characteristics, which may have substantial clinical implications. This narrative review explores key characteristics of these therapies. By using clinical trial data and real-world evidence, we discuss their mechanisms of action, routes of administration, efficacy (in relation to B-cell kinetics), safety, tolerability and convenience of use. Clinicians, alongside patients and their families, should consider the aspects discussed in this review as part of shared decision-making discussions to improve outcomes and health-related quality of life for people living with MS.
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Affiliation(s)
- Silvia R Delgado
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Simon Faissner
- Department of Neurology, Ruhr-University Bochum, St Josef-Hospital, Bochum, Germany
| | - Ralf A Linker
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Kottil Rammohan
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
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Lorefice L, Mellino P, Frau J, Coghe G, Fenu G, Cocco E. Ocrelizumab use in multiple sclerosis: a real-world experience in a changing therapeutic scenario. Neurol Sci 2024:10.1007/s10072-024-07449-0. [PMID: 38472551 DOI: 10.1007/s10072-024-07449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION CD20-depleting therapies are a real milestone in the treatment of multiple sclerosis (MS). This study examined the ocrelizumab (OCR) use in patients with primary progressive (PP) and relapsing remitting (RR) MS, also evaluating the predictors of treatment response. METHODS Patients with MS treated with OCR between 2017 and 2022 were included, and OCR use trends examined. The patients' characteristics were assessed at baseline and after 24 months of OCR to assess the NEDA-3 status. RESULTS This study included 421 patients: 33 (7.9%) with PP and 388 (92.1%) with RR MS. Among these, 67 (17.3%) were naïve, while switchers from first- and second-line disease-modifying therapies (DMTs) were 199 (51.3%) and 122 (31.4%), respectively. An increasing trend in OCR use was reported. For six patients treated with rituximab, OCR was chosen to improve tolerability; for 390 switcher patients, the choice was due to ineffectiveness; and for 25, as an exit strategy from natalizumab due to JC virus positivity. NEDA-3 status was calculated for subjects exposed to 24 months of OCR and was achieved by 163/192 (84.9%) RR patients and 9/16 (56%) PP patients, with younger age (p = 0.048) and annualized relapse rate in the year previous to OCR (p = 0.005) emerging as determinants. For the 25 patients who switched to OCR after natalizumab, no clinical or MRI activity after 12 months was reported. CONCLUSION OCR has been confirmed to be a highly efficacious option for patients with PP and RR MS, even proving to be a valid exit strategy for natalizumab.
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Affiliation(s)
- Lorena Lorefice
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy.
| | - Paolo Mellino
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - Jessica Frau
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - Giuseppe Fenu
- Department of Neurosciences, ARNAS Brotzu, Cagliari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, Department of Medical Sciences and Public Health, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
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Ongphichetmetha T, Jitprapaikulsan J, Siritho S, Rattanathamsakul N, Detweeratham T, Prayoonwiwat N. Efficacy and safety of rituximab in multiple sclerosis and neuromyelitis optica spectrum disorder. Sci Rep 2024; 14:3503. [PMID: 38347079 PMCID: PMC10861443 DOI: 10.1038/s41598-024-53838-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024] Open
Abstract
In Thailand, resource limitations lead many multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients to use off-label immunosuppressants. This study assesses the efficacy and safety of rituximab (RTX) with a CD19-based reinfusion regimen among Thai MS and NMOSD patients. A retrospective review of patients at the Faculty of Medicine Siriraj Hospital from January 1994 to April 2023 was conducted. The primary outcome assessed was the change in annualized relapse rate (ARR) for patients using RTX for over a year. Secondary outcomes included changes in the Expanded Disability Status Scale (EDSS) scores, time to the first relapse after RTX initiation for patients using RTX for over a year, and an evaluation of the safety of RTX. The study encompassed 36 MS and 39 NMOSD patients. A majority of patients (91.7% of MS and 79.5% of NMOSD) experienced no relapses during a median follow-up of 30 months (Interquartile range [IQR] 20-46) and 31 months (IQR 23-41), respectively. The median ARR significantly decreased in both MS (from 0.77 [IQR 0.42-1.83] to 0 [IQR 0-0], p < 0.001) and NMOSD (from 0.92 [IQR 0.68-1.78] to 0 [IQR 0-0.17], p < 0.001) patients after switching to RTX, with no difference between those following a fixed 6-month time point regimen and a CD19-based reinfusion regimen. Median EDSS scores improved significantly at the last follow-up visit in both groups. The mean time to the first subsequent relapse was 8.3 ± 3.0 months in MS and 6.8 ± 1.7 months in NMOSD. Mild adverse drug reactions occurred in 44% of patients. RTX effectively prevents relapses in Thai MS and NMOSD patients, with no observed serious adverse drug reactions.
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Affiliation(s)
- Tatchaporn Ongphichetmetha
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Siriraj, Bangkok noi, Bangkok, 10700, Thailand
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
- Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Jiraporn Jitprapaikulsan
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Siriraj, Bangkok noi, Bangkok, 10700, Thailand
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Sasitorn Siritho
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
- Bumrungrad International Hospital, Bangkok, 10110, Thailand
| | - Natthapon Rattanathamsakul
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Siriraj, Bangkok noi, Bangkok, 10700, Thailand
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Thammachet Detweeratham
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Siriraj, Bangkok noi, Bangkok, 10700, Thailand
| | - Naraporn Prayoonwiwat
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd, Siriraj, Bangkok noi, Bangkok, 10700, Thailand.
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
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Nabizadeh F, Ahmadabad MA, Mohamadi M, Mirmosayyeb O, Maleki T, Kazemzadeh K, Seyedmirzaei H. Efficacy and safety of rituximab in multiple sclerosis: a systematic review and meta-analysis. Acta Neurol Belg 2023; 123:2115-2127. [PMID: 37428437 DOI: 10.1007/s13760-023-02329-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE We aimed to synthesize all available observational studies and clinical trials of rituximab to estimate the safety and efficacy of this monoclonal antibody in people with multiple sclerosis (MS). METHODS The four databases including PubMed, Scopus, Embase, and Web of Science were comprehensively searched in April 2022. We defined PICO as follows. Problem or study population (P): patients with MS; intervention (I): Rituximab; comparison (C): none; outcome (O): efficacy and safety. RESULTS After two-step screening, a total of 27 studies entered into our qualitative and quantitative synthesis. Our analysis showed a significant decrease in EDSS score in all patients with MS after treatment (SMD: - 0.44, 95% CI - 0.85, - 0.03). In addition, the ARR was reduced after using rituximab compared to the pre-treatment period (SMD: - 0.65, 95% CI - 1.55, 0.24) but it was not significant. The most common side effect after rituximab with a pooled prevalence of 28.63% (95% CI 16.61%, 42.33%). Furthermore, the pooled prevalence of infection was 24% in patients with MS (95% CI 13%, 36%). In the end, the pooled prevalence of malignancies after rituximab treatment was 0.39% (95% CI 0.02%, 1.03%). CONCLUSION Our findings illustrated an acceptable safety for this treatment. However, further studies with randomized design, long follow-up, and large sample sizes are needed to confirm the safety and efficacy of rituximab in patients with MS.
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Affiliation(s)
- Fardin Nabizadeh
- Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Mona Asghari Ahmadabad
- Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mobin Mohamadi
- Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tahereh Maleki
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Kimia Kazemzadeh
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Seyedmirzaei
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
- Interdisciplinary Neuroscience Research Program (INRP), Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Blok KM, van Rosmalen J, Tebayna N, Smolders J, Wokke B, de Beukelaar J. Disease activity in primary progressive multiple sclerosis: a systematic review and meta-analysis. Front Neurol 2023; 14:1277477. [PMID: 38020591 PMCID: PMC10661414 DOI: 10.3389/fneur.2023.1277477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Disease activity in multiple sclerosis (MS) is defined as presence of relapses, gadolinium enhancing lesions and/or new or enlarging lesions on MRI. It is associated with efficacy of immunomodulating therapies (IMTs) in primary progressive MS (PPMS). However, a thorough review on disease activity in PPMS is lacking. In relapsing remitting MS, the prevalence of activity decreases in more contemporary cohorts. For PPMS, this is unknown. Aim To review disease activity in PPMS cohorts and identify its predictors. Methods A systematic search in EMBASE, MEDLINE, Web of science Core Collection, COCHRANE CENTRAL register of trials, and GOOGLE SCHOLAR was performed. Keywords included PPMS, inflammation, and synonyms. We included original studies with predefined available data, extracted cohort characteristics and disease activity outcomes and performed meta-regression analyses. Results We included 34 articles describing 7,109 people with PPMS (pwPPMS). The weighted estimated proportion of pwPPMS with overall disease activity was 26.8% (95% CI 20.6-34.0%). A lower age at inclusion predicted higher disease activity (OR 0.91, p = 0.031). Radiological activity (31.9%) was more frequent than relapses (9.2%), and was predicted by longer follow-up duration (OR 1.27, p = 0.033). Year of publication was not correlated with disease activity. Conclusion Inflammatory disease activity is common in PPMS and has remained stable over the last decades. Age and follow-up duration predict disease activity, advocating prolonged monitoring of young pwPPMS to evaluate potential IMT benefits.
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Affiliation(s)
- Katelijn M. Blok
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Nura Tebayna
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Joost Smolders
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Immunology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
- Neuroimmunology Researchgroup, Netherlands Institute for Neuroscience, Amsterdam, Netherlands
| | - Beatrijs Wokke
- Department of Neurology, MS Center ErasMS, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Janet de Beukelaar
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
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8
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Alping P. Disease-modifying therapies in multiple sclerosis: A focused review of rituximab. Basic Clin Pharmacol Toxicol 2023; 133:550-564. [PMID: 37563891 DOI: 10.1111/bcpt.13932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Treatment for multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system, has changed drastically in the last 30 years. Several different disease-modifying therapies are now available, with off-label use of the B-cell-depleting antibody rituximab becoming an increasingly popular choice, as more and more studies report on its effectiveness. OBJECTIVES The objective of this study was to summarize the current state of evidence for rituximab as a treatment for relapsing-remitting MS (RRMS). METHODS A structured literature search was conducted in PubMed, focusing on peer-reviewed studies of adult populations with RRMS. Ongoing trials with rituximab in MS were identified through Clinicaltrials.gov and additional references were identified through review articles. FINDINGS Despite promising results for rituximab as a treatment of MS, the market-authorization holder switched focus from rituximab and discontinued the industry-sponsored trials programme. However, several observational studies, smaller clinical trials and one large investigator-initiated randomized-controlled trial have continued to report fewer clinical relapses, fewer contrast-enhancing lesions on magnetic resonance imaging and better drug survival with rituximab, compared with MS-approved alternatives. CONCLUSIONS Rituximab should be considered as both a first- and second-line therapy option for most MS patients with active, non-progressive disease. However, as an off-label therapy for MS, regulatory approval remains a barrier for wider adoption in many countries.
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Affiliation(s)
- Peter Alping
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Freeman SA, Lemarchant B, Alberto T, Boucher J, Outteryck O, Labalette M, Rogeau S, Dubucquoi S, Zéphir H. Assessing Sustained B-Cell Depletion and Disease Activity in a French Multiple Sclerosis Cohort Treated by Long-Term IV Anti-CD20 Antibody Therapy. Neurotherapeutics 2023; 20:1707-1722. [PMID: 37882961 PMCID: PMC10684468 DOI: 10.1007/s13311-023-01446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/27/2023] Open
Abstract
Few studies have investigated sustained B-cell depletion after long-term intravenous (IV) anti-CD20 B-cell depleting therapy (BCDT) in multiple sclerosis (MS) with respect to strict and/or minimal disease activity. The main objective of this study was to investigate how sustained B-cell depletion after BCDT influences clinical and radiological stability as defined by "no evidence of disease activity" (NEDA-3) and "minimal evidence of disease activity" (MEDA) status in MS patients at 12 and 18 months. Furthermore, we assessed the frequency of serious adverse events (SAE), and the influence of prior lymphocytopenia-inducing treatment (LIT) on lymphocyte subset counts and gammaglobulins in MS patients receiving long-term BCDT. We performed a retrospective, prospectively collected, study in a cohort of 192 MS patients of all clinical phenotypes treated by BCDT between January 2014 and September 2021. Overall, 84.2% and 96.9% of patients attained NEDA-3 and MEDA status at 18 months, respectively. Sustained CD19+ depletion was observed in 85.8% of patients at 18 months. No significant difference was observed when comparing patients achieving either NEDA-3 or MEDA at 18 months and sustained B-cell depletion. Compared to baseline levels, IgM and IgG levels on BCDT significantly decreased at 6 months and 30 months, respectively. Patients receiving LIT prior to BCDT showed significant CD4+ lymphocytopenia and lower IgG levels compared to non-LIT patients. Grade 3 or above SAEs were rare. As nearly all patients achieved MEDA at 18 months, we suggest tailoring IV BCDT after 18 months given the occurrence of lymphocytopenia, hypogammaglobulinemia, and SAE after this time point.
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Affiliation(s)
- Sean A Freeman
- Department of Neurology, CRC-SEP, CHU of Lille, Lille, France.
| | - Bruno Lemarchant
- Department of Neurology, CRC-SEP, CHU of Lille, Lille, France
- Laboratory of Neuroinflammation and Multiple Sclerosis (NEMESIS), Univ. Lille, INSERM, CHU Lille, U1172, Lille, France
| | - Tifanie Alberto
- Department of Neurology, CRC-SEP, CHU of Lille, Lille, France
| | - Julie Boucher
- Department of Neurology, CRC-SEP, CHU of Lille, Lille, France
| | - Olivier Outteryck
- Laboratory of Neuroinflammation and Multiple Sclerosis (NEMESIS), Univ. Lille, INSERM, CHU Lille, U1172, Lille, France
- Department of Neuroradiology, CHU Lille, Roger Salengro Hospital, Lille, France
| | - Myriam Labalette
- Univ. Lille, INSERM, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Stéphanie Rogeau
- Univ. Lille, INSERM, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Sylvain Dubucquoi
- Univ. Lille, INSERM, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Hélène Zéphir
- Department of Neurology, CRC-SEP, CHU of Lille, Lille, France
- Laboratory of Neuroinflammation and Multiple Sclerosis (NEMESIS), Univ. Lille, INSERM, CHU Lille, U1172, Lille, France
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Schuckmann A, Steffen F, Zipp F, Bittner S, Pape K. Impact of extended interval dosing of ocrelizumab on immunoglobulin levels in multiple sclerosis. MED 2023:S2666-6340(23)00141-1. [PMID: 37236189 DOI: 10.1016/j.medj.2023.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Long-term B cell depletion with ocrelizumab in multiple sclerosis (MS) is associated with severe side effects such as hypogammaglobulinemia and infections. Our study therefore aimed to assess immunoglobulin levels under treatment with ocrelizumab and implement an extended interval dosing (EID) scheme. METHODS Immunoglobulin levels of 51 patients with ≥24 months of treatment with ocrelizumab were analyzed. After ≥4 treatment cycles, patients chose to either continue on the standard interval dosing (SID) regimen (n = 14) or, in the case of clinically and radiologically stable disease, switch to B cell-adapted EID (n = 12, next dose at CD19+ B cells >1% of peripheral blood lymphocytes). FINDINGS Levels of immunoglobulin M (IgM) declined rapidly under ocrelizumab treatment. Risk factors for IgM and IgA hypogammaglobulinemia were lower levels at baseline and more previous disease-modifying therapies. B cell-adapted EID of ocrelizumab increased the mean time until next infusion from 27.3 to 46.1 weeks. Ig levels declined significantly in the SID group over 12 months but not in the EID group. Previously stable patients remained stable under EID as measured by expanded disability status scale (EDSS), neurofilament light chain, timed 25-foot walk (T25-FW), 9-hole peg test (9-HPT), symbol digit modalities test (SDMT), and multiple sclerosis impact scale (MSIS-29). CONCLUSIONS In our pilot study, B cell-adapted EID of ocrelizumab prevented the decline of Ig levels without affecting disease activity in previously stable patients with MS. Based on these findings, we propose a new algorithm for long-term ocrelizumab treatment. FUNDING This study was supported by the Deutsche Forschungsgemeinschaft (SFB CRC-TR-128, SFB 1080, and SFB CRC-1292) and the Hertie Foundation.
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Affiliation(s)
- Aaron Schuckmann
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Katrin Pape
- Department of Neurology, Focus Program Translational Neuroscience (FTN), and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
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11
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Sabahi Z, Daei Sorkhabi A, Sarkesh A, Naseri A, Asghar-Rezaei N, Talebi M. A systematic review of the safety and efficacy of monoclonal antibodies for progressive multiple sclerosis. Int Immunopharmacol 2023; 120:110266. [PMID: 37209514 DOI: 10.1016/j.intimp.2023.110266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Progressive multiple sclerosis (PMS) is a debilitating condition characterized by progressively worsening symptoms. Monoclonal antibodies are novel therapies for MS, but their safety and efficacy in the progressive form have not been comprehensively studied. In this systematic review, we aimed to evaluate the available evidence regarding monoclonal antibody treatment for PMS. METHODS After registration of the study protocol in PROSPERO, we systematically searched three major databases for clinical trials involving monoclonal antibodies administration for PMS treatment. All the retrieved results were imported into the EndNote reference manager. After removing the duplicates, two independent researchers did the study selection and data extraction. The risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist. RESULTS Of the 1846 studies in the preliminary search, 13 clinical trials investigating monoclonal antibodies (Ocrelizumab, Natalizumab, Rituximab, and Alemtuzumab) in PMS patients were included. Ocrelizumab was significantly effective in reducing clinical disease progression measures in primary PMS patients. The results for Rituximab were not completely reassuring and only showed significant changes for some endpoints on MRI and clinical measures. Natalizumab decreased the relapse rate and improved MRI features for secondary PMS patients, but not clinical endpoints. The studies on Alemtuzumab treatment revealed conflicting outcomes, with improvements observed in MRI endpoints but clinical worsening in patients. Additionally, among the studied adverse events, upper respiratory infections, urinary tract infections, and nasopharyngitis were frequently reported. CONCLUSION Based on our findings, Ocrelizumab is the most efficient monoclonal antibody for primary PMS, although it is associated with a higher risk of infection. While other monoclonal antibodies did not show significant promise in treating PMS, more research is necessary.
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Affiliation(s)
- Zahra Sabahi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Daei Sorkhabi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aila Sarkesh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazli Asghar-Rezaei
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahnaz Talebi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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12
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Techa-Angkoon P, Siritho S, Tisavipat N, Suansanae T. Current evidence of rituximab in the treatment of multiple sclerosis. Mult Scler Relat Disord 2023; 75:104729. [PMID: 37148577 DOI: 10.1016/j.msard.2023.104729] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/08/2023]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system. The immunopathology of MS involves both T and B lymphocytes. Rituximab is one of the anti-CD20 monoclonal antibody therapies which deplete B-cells. Although some anti-CD20 therapies have been approved by the Food and Drug Administration for treatment of MS, rituximab is used off-label. Several studies have shown that rituximab has a good efficacy and safety in MS, including certain specific patient conditions such as treatment-naïve patients, treatment-switching patients, and the Asian population. However, there are still questions about the optimal dose and duration of rituximab in MS due to the different dosing regimens used in each study. Moreover, many biosimilars have become available at a lower cost with comparable physicochemical properties, pharmacokinetics, pharmacodynamics, efficacy, safety, and immunogenicity. Thus, rituximab may be considered as a potential therapeutic option for patients without access to standard treatment. This narrative review summarized the evidence of both original and biosimilars of rituximab in MS treatment including pharmacokinetics, pharmacodynamics, clinical efficacy, safety, and dosing regimen.
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Affiliation(s)
- Phanutgorn Techa-Angkoon
- Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - Sasitorn Siritho
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Bumrungrad International Hospital, Bangkok, Thailand
| | | | - Thanarat Suansanae
- Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri Ayutthaya Road, Ratchathewi, Bangkok 10400, Thailand.
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13
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Zhao D, Zhao C, Lu J, Han Y, Sun T, Ren K, Ma C, Zhang C, Li H, Guo J. Efficacy and safety of repeated low-dose rituximab therapy in relapsing-remitting multiple sclerosis: A retrospective case series study. Mult Scler Relat Disord 2023; 70:104518. [PMID: 36657326 DOI: 10.1016/j.msard.2023.104518] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Rituximab (RTX) is an extensively used off-label drug for multiple sclerosis (MS), whereas the induction and maintenance regimens vary widely among studies. Few data are available on efficacy and safety of repeated low-dose RTX therapy in MS patients. OBJECTIVE This study aimed to evaluate the efficacy and safety of repeated low-dose RTX therapy for relapsing-remitting MS (RRMS), the most common form of MS affecting approximately 85% of patients. METHODS Nine RRMS patients were enrolled and the medical records were retrospectively reviewed. RTX at 100 mg per week for three consecutive weeks was used as induction therapy. Maintenance therapy was reinfusions of RTX at 100 mg every 6 months during the first year, followed by 100 mg every 6 to 12 months. Main outcome measures included annualized relapse rate (ARR), expanded disability status scale (EDSS) score, and T2 lesion burden on MRI for evaluating the efficacy of low-dose RTX regimen. Meanwhile, adverse events (AEs) were recorded to assess the safety of repeated RTX infusions. RESULTS All patients were females with an average onset age of 25.4 ± 6.7 years. The median disease duration before the first RTX infusion was 56 (range, 3-108) months and the median follow-up period was 30 (range, 15-40) months. No relapses were recorded in all patients after RTX therapy. Repeated low-dose RTX therapy resulted in a dramatic reduction of median ARR (pre-RTX vs post-RTX, 1.1 vs 0, p = 0.012), median EDSS score (2.0 vs 0, p = 0.007), and the number of T2 lesions on MRI (35.6 ± 18.0 vs 29.4 ± 18.1, p = 0.001). A total of 35 episodes of AEs occurred during repeated low-dose RTX therapy, and all of them were mild and transient. CONCLUSION Repeated low-dose RTX therapy is cost-effective for RRMS patients and shows a good safety profile. It may be a promising option for those having no access or poor response to first-line disease-modified drugs (DMDs), particularly in low- or middle-income countries.
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Affiliation(s)
- Daidi Zhao
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Cong Zhao
- Department of Neurology, Air Force Medical Center of PLA, Beijing 100142, China
| | - Jiarui Lu
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Yu Han
- Department of Radiology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Tangna Sun
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Kaixi Ren
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Chao Ma
- Department of Cardiology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Chao Zhang
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China
| | - Hongzeng Li
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China.
| | - Jun Guo
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi'an 710038, China.
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14
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Toorop AA, Hogenboom L, Bloem K, Kocyigit M, Commandeur NWM, Wijnants A, Lissenberg-Witte BI, Strijbis EMM, Uitdehaag BMJ, Rispens T, Killestein J, van Kempen ZLE. Ocrelizumab concentration and antidrug antibodies are associated with B-cell count in multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:487-493. [PMID: 36693720 DOI: 10.1136/jnnp-2022-330793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND The majority of patients with multiple sclerosis on ocrelizumab have B-cell depletion after standard interval dosing of 26 weeks. With B-cell-guided dosing patients receive their next dose when B-cell repopulation occurs. Prediction of B-cell repopulation using ocrelizumab concentrations could aid in personalising treatment regimes. The objectives of this study were to evaluate the association between ocrelizumab drug concentration, antidrug antibodies (ADAs) and CD19 B-cell count, and to define a cut-off ocrelizumab concentration for start of B-cell repopulation (defined by ≥10 CD19+ B cells/µL). METHODS In this investigator-initiated prospective study, blood samples at various time points during ocrelizumab treatment were collected from a biobank. Serum ocrelizumab concentrations and ADAs were measured with two different assays developed for this study. Data were analysed using linear mixed effect models. An receiver operating characteristic (ROC) curve was used to determine a cut-off ocrelizumab concentration for start of B-cell repopulation (defined by ≥10 cells/µL). RESULTS A total of 452 blood samples from 72 patients were analysed. Ocrelizumab concentrations were detectable up until 53.3 weeks after last infusion and ranged between <0.0025 and 204 µg/mL after 1-67 weeks. Ocrelizumab concentration was negatively associated with B-cell count, with body mass index identified as effect modifier. We found a cut-off value of 0.06 µg/mL for start of B-cell repopulation of ≥10 cells/µL. Ocrelizumab ADAs were detectable in four patients (5.7%) with corresponding low ocrelizumab concentrations and start of B-cell repopulation. CONCLUSIONS Serum ocrelizumab concentration was strongly associated with B-cell count. Measurement of ocrelizumab drug concentrations and ADAs could play an important role to further personalise treatment and predict the start of B-cell repopulation.
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Affiliation(s)
- Alyssa A Toorop
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Laura Hogenboom
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Karien Bloem
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Merve Kocyigit
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | | | - Anne Wijnants
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eva M M Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Theo Rispens
- Biologics Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Landsteiner Laboratory, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC Location VUMC, Amsterdam, The Netherlands
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15
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Gascón-Giménez F, Alcalá C, Ramió-Torrentà L, Montero P, Matías-Guiu J, Gómez-Esteve I, Oreja-Guevara C, Gil-Perotín S, Blanco Y, Carcelén M, Quintanilla-Bordás C, Costa L, Villar LM, Martínez-Rodriguez JE, Domínguez JA, Calles C, González I, Sotoca J, Oterino A, Lucas-Jimenez C, Pérez-Miralles F, Casanova B. Treatment of multiple sclerosis with rituximab: A Spanish multicenter experience. Front Neurol 2023; 14:1060696. [PMID: 36959824 PMCID: PMC10027934 DOI: 10.3389/fneur.2023.1060696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/09/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction Rituximab (RTX) is considered a potential therapeutic option for relapsing-remitting (RRMS) and progressive forms (PMS) of multiple sclerosis (MS). The main objective of this work was to investigate the effectiveness and safety of rituximab in MS. Patients and methods Observational multicenter study of clinical and radiological effectiveness and safety of rituximab in RRMS and PMS. Results A total of 479 rituximab-treated patients were included in 12 Spanish centers, 188 RRMS (39.3%) and 291 (60.7%) PMS. Despite standard treatment, the annualized relapse rate (ARR) the year before RTX was 0.63 (SD: 0.8) and 156 patients (41%) had at least one gadolinium-enhanced lesion (GEL) on baseline MRI. Mean EDSS had increased from 4.3 (SD: 1.9) to 4.8 (SD: 1.7) and almost half of the patients (41%) had worsened at least one point. After a median follow-up of 14.2 months (IQR: 6.5-27.2), ARR decreased by 85.7% (p < 0.001) and GEL by 82.9%, from 0.41 to 0.07 (p < 0.001). A significant decrease in EDSS to 4.7 (p = 0.046) was observed after 1 year of treatment and this variable remained stable during the second year of therapy. There was no evidence of disease activity in 68% of patients. Infusion-related symptoms were the most frequent side effect (19.6%) and most were mild. Relevant infections were reported only in 18 patients (including one case of probable progressive multifocal leukoencephalopathy). Conclusion Rituximab could be an effective and safe treatment in RRMS, including aggressive forms of the disease. Some selected PMS patients could also benefit from this treatment.
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Affiliation(s)
- Francisco Gascón-Giménez
- Neuroimmunology Unit, Neurology Department, Hospital Clinico Universitario, Valencia, Spain
- *Correspondence: Francisco Gascón-Giménez
| | - Carmen Alcalá
- Neuroimmunology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Paloma Montero
- Department of Neurology, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Jorge Matías-Guiu
- Department of Neurology, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Irene Gómez-Esteve
- Department of Neurology, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | - Sara Gil-Perotín
- Neuroimmunology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Yolanda Blanco
- Neurology Department, Clinical Hospital of Barcelona, Barcelona, Spain
| | - María Carcelén
- Neurology Department, General University Hospital of Valencia, Valencia, Spain
| | | | - Lucienne Costa
- Neurology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | | - José Andrés Domínguez
- Neuroimmunology Unit, Neurology Department, Hospital Clinico Universitario, Valencia, Spain
| | - Carmen Calles
- Neurology Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Inés González
- Neurology Department, Álvaro Cunqueiro Hospital, Vigo, Spain
| | - Javier Sotoca
- Neurology Department, Mutua de Terrasssa University Hospital, Barcelona, Spain
| | - Agustin Oterino
- Neurology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Celia Lucas-Jimenez
- Systems and Applications Engineer Department, Subdirectorate of Information Systems Hospital La Fe, Valencia, Spain
| | | | - Bonaventura Casanova
- Neuroimmunology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
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16
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Chico-García JL, Rodríguez-Jorge F, Sainz-Amo R, Monreal E, Walo-Delgado P, Roldán E, Rodríguez-Martín E, Masjuan J, Costa-Frossard L, Sainz de la Maza S, Villar LM. B-lymphocyte-guided retreatment contributes to establish good effectiveness and safety profile in MS patients treated with rituximab. Mult Scler Relat Disord 2022; 68:104218. [PMID: 36270253 DOI: 10.1016/j.msard.2022.104218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rituximab is extensively used for multiple sclerosis (MS) treatment. However, the best dosage remains to be established. It has been proposed that retreatment could be guided by B lymphocyte (BL) percentages. OBJECTIVE To establish the best BL value for retreatment with rituximab in MS and to confirm the safety and efficacy of this approach. METHODS A prospective study was done with an exploratory cohort and a confirmatory cohort of MS patients treated with rituximab between 2017 and 2021. The first one comprised 10 MS patients with BL assessed every 3 months after rituximab infusion and retreatment done when BL values were ≥0.5%. The confirmatory cohort included 41 MS patients (41.5% women, 87.8% with secondary progressive MS, median age = 46.3 (interquartile range: 41.3-52.1) years, disease duration = 14.1 (9-19.6) years, EDSS score = 5.5 (4.0-6.5)). The confirmatory cohort was treated with rituximab following the pattern established in the exploratory cohort. RESULTS In the exploratory cohort, ≥0.2% BL was established as the best value for retreatment because in most cases, a substantial increase of BL counts was preceded by initial values of 0.2-0.3%. In the confirmatory cohort, rituximab reduced the annualized relapse rate (ARR 0.56 vs. 0.125, p < 0.001), proportion of patients with appearance of new/enlarged T2 lesions (63.4% vs. 12.2%, p < 0.001), gadolinium-enhancing lesions (39% vs. 0%, p < 0.001), and confirmed disability progression (55% vs. 27.5%, p = 0.037). There were 22 patients (53.7%) who achieved NEDA-3. No patients had severe infections, and 10.7% cases had reduced IgG levels. CONCLUSION Rituximab treatment guided by BL showed high effectiveness and a good safety profile for MS patients after one year of treatment.
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Affiliation(s)
- Juan Luis Chico-García
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, M-607, 9, 100, Madrid 28034, Spain.
| | - Fernando Rodríguez-Jorge
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, M-607, 9, 100, Madrid 28034, Spain
| | - Raquel Sainz-Amo
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, M-607, 9, 100, Madrid 28034, Spain
| | - Enric Monreal
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, M-607, 9, 100, Madrid 28034, Spain; Universidad de Alcalá, Alcalá de Henares, Spain
| | - Paulette Walo-Delgado
- Department of Immunology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Ernesto Roldán
- Department of Immunology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - Jaime Masjuan
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, M-607, 9, 100, Madrid 28034, Spain; Universidad de Alcalá, Alcalá de Henares, Spain
| | - Lucienne Costa-Frossard
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, M-607, 9, 100, Madrid 28034, Spain
| | - Susana Sainz de la Maza
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, IRYCIS, M-607, 9, 100, Madrid 28034, Spain; Universidad de Alcalá, Alcalá de Henares, Spain
| | - Luisa Maria Villar
- Department of Immunology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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17
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Minervini G, Mariani P, Fiorillo L, Cervino G, Cicciù M, Laino L. Prevalence of temporomandibular disorders in people with multiple sclerosis: A systematic review and meta-analysis. Cranio 2022:1-9. [PMID: 36315017 DOI: 10.1080/08869634.2022.2137129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To explore the prevalence of temporomandibular disorders (TMD) in patients affected by multiple sclerosis (MS) and whether there is a correlation between TMD prevalence and MS severity. METHODS PubMed, Web of Science, and Lilacs were systematically searched until July 30 2022, to identify studies presenting patients affected by MS and whether there is a correlation between TMD prevalence and MS severity. RESULTS Out of 292 papers, 8 studies were included with 1312 study participants. Among the 8 studies, 5 had a control group; 5 used the RDC/TMD criteria, 1 used the NOT-S instrument, and 2 did not define a standardized method to define TMD symptoms. Meta-analysis revealed that the MS group had a higher rate than the control group, showing an association between MS and TMD (RR 2.10; 95% CI: 1.21-3.65). CONCLUSION These findings show an association between TMD and MS. ABBREVIATIONS Australian Longitudinal Study of MS (AMSLS); Computed Tomography (CT); Community Periodontal Index of Treatment Needs (CPITN); Central Nervous System (CNS); Decayed, Missing, and Filled (DMF); Decayed, Missing, or Filled Teeth Index (DMFT); Expanded Disability Status Scale (EDSS); European Academy of Craniomandibular Disorders (EACD); Healthy Controls (HC); International Prospective Register of Systematic Reviews (PROSPERO); Multiple Sclerosis (MS); Nordic Orofacial Test-Screening (NOT-S); Participants, model of Intervention, Comparison and Outcome (PICO); Preferred Reporting Items for Systematic Reviews (PRISMA); Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD); Temporomandibular Joint (TMJ); Temporomandibular Disorders (TMD); World Health Organization (WHO).
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Affiliation(s)
- Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pierluigi Mariani
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, G. Martino Polyclinic, Messina, Italy
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, G. Martino Polyclinic, Messina, Italy
| | - Marco Cicciù
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, G. Martino Polyclinic, Messina, Italy
| | - Luigi Laino
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
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18
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Mirmosayyeb O, Shaygannejad V, Ebrahimi N, Ghoshouni H, Ghajarzadeh M. The prevalence of cancer in patients with multiple sclerosis (MS) who received rituximab: a systematic review and meta-analysis. Neurologia 2022:S2173-5808(22)00090-6. [PMID: 36055575 DOI: 10.1016/j.nrleng.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/29/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate the pooled prevalence of cancer in patients with multiple sclerosis (MS) cases who were under treatment with rituximab. METHODS We searched PubMed, Scopus, EMBASE, Web of Science, and google scholar along with gray literature up to April 2021. The search strategy included the MeSH and text words as (("CD20 Antibody" AND Rituximab) OR "Rituximab CD20 Antibody" OR Mabthera OR "IDEC-C2B8 Antibody" OR "IDEC C2B8 Antibody" OR IDEC-C2B8 OR "IDEC C2B8" OR GP2013 OR Rituxan OR rituximab) AND ((Sclerosis AND multiple) OR (sclerosis AND disseminated) OR "disseminated sclerosis" OR "multiple sclerosis" OR "acute fulminating"). RESULTS The literature search revealed 3577 articles, after deleting duplicates 2066 remained. For the meta-analysis, 22 studies were included. Totally, 15599 patients were enrolled while 133 cancers were detected. The pooled prevalence of cancer in MS patients under treatment with rituximab is 1in 100,000 (I2 = 99.9%, p < 0.001). CONCLUSION The results of this systematic review and meta-analysis show that the pooled prevalence of cancer in MS patients who received rituximab is 1 in 100,000 cases.
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Affiliation(s)
- O Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - V Shaygannejad
- Department of Neurology, School of Medicine, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - N Ebrahimi
- Department of Neurology, School of Medicine, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - H Ghoshouni
- Department of Neurology, School of Medicine, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Ghajarzadeh
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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19
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Cárcamo C, Ciampi E. Low-dose rituximab should be used for treating MS in resource-limited settings: Commentary. Mult Scler 2022; 28:1032-1033. [PMID: 35608104 DOI: 10.1177/13524585221098612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Claudia Cárcamo
- Departamento de Neurología, PontificiaUniversidad Católica de Chile, Santiago, Chile
| | - Ethel Ciampi
- Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago, Chile; Servicio de Neurología, Hospital Sótero del Río, Santiago, Chile
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20
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Havla J, Hohlfeld R. Antibody Therapies for Progressive Multiple Sclerosis and for Promoting Repair. Neurotherapeutics 2022; 19:774-784. [PMID: 35289375 PMCID: PMC9294105 DOI: 10.1007/s13311-022-01214-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 12/21/2022] Open
Abstract
Progressive multiple sclerosis (PMS) is clinically distinct from relapsing-remitting MS (RRMS). In PMS, clinical disability progression occurs independently of relapse activity. Furthermore, there is increasing evidence that the pathological mechanisms of PMS and RRMS are different. Current therapeutic options for the treatment of PMS remain inadequate, although ocrelizumab, a B-cell-depleting antibody, is now available as the first approved therapeutic option for primary progressive MS. Recent advances in understanding the pathophysiology of PMS provide hope for new innovative therapeutic options: these include antibody therapies with anti-inflammatory, neuroprotective, and/or remyelination-fostering effects. In this review, we summarize the relevant trial data relating to antibody therapy and consider future antibody options for treating PMS.
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Affiliation(s)
- Joachim Havla
- Institute of Clinical Neuroimmunology, University Hospital, LMU Munich, Munich, Germany.
- Biomedical Center (BMC), Faculty of Medicine, LMU Munich, Martinsried, Germany.
- Data Integration for Future Medicine (DIFUTURE) Consortium, LMU Munich, Munich, Germany.
| | - Reinhard Hohlfeld
- Institute of Clinical Neuroimmunology, University Hospital, LMU Munich, Munich, Germany
- Biomedical Center (BMC), Faculty of Medicine, LMU Munich, Martinsried, Germany
- Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
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21
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van Kempen ZLE, Toorop AA, Sellebjerg F, Giovannoni G, Killestein J. Extended dosing of monoclonal antibodies in multiple sclerosis. Mult Scler 2021; 28:2001-2009. [PMID: 34949134 DOI: 10.1177/13524585211065711] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past two decades, treatment options for patients with multiple sclerosis (MS) have increased exponentially. In the current therapeutic landscape, "no evidence of MS disease activity" is within reach in many of our patients. Minimizing risks of complications, improving treatment convenience, and decreasing health care costs are goals that are yet to be reached. One way to optimize MS therapy is to implement personalized or extended interval dosing. Monoclonal antibodies are suitable candidates for personalized dosing (by therapeutic drug monitoring) or extended interval dosing. An increasing number of studies are performed and underway reporting on altered dosing intervals of anti-α4β1-integrin treatment (natalizumab) and anti-CD20 treatment (ocrelizumab, rituximab, and ofatumumab) in MS. In this review, current available evidence regarding personalized and extended interval dosing of monoclonal antibodies in MS is discussed with recommendations for future research and clinical practice.
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Affiliation(s)
- Zoé LE van Kempen
- MS Center Amsterdam, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| | - Alyssa A Toorop
- MS Center Amsterdam Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gavin Giovannoni
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Joep Killestein
- MS Center Amsterdam Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
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22
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Abstract
BACKGROUND Multiple sclerosis (MS) is the most common neurological cause of disability in young adults. Off-label rituximab for MS is used in most countries surveyed by the International Federation of MS, including high-income countries where on-label disease-modifying treatments (DMTs) are available. OBJECTIVES: To assess beneficial and adverse effects of rituximab as 'first choice' and as 'switching' for adults with MS. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, and trial registers for completed and ongoing studies on 31 January 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled non-randomised studies of interventions (NRSIs) comparing rituximab with placebo or another DMT for adults with MS. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. We used the Cochrane Collaboration's tool for assessing risk of bias. We rated the certainty of evidence using GRADE for: disability worsening, relapse, serious adverse events (SAEs), health-related quality of life (HRQoL), common infections, cancer, and mortality. We conducted separate analyses for rituximab as 'first choice' or as 'switching', relapsing or progressive MS, comparison versus placebo or another DMT, and RCTs or NRSIs. MAIN RESULTS We included 15 studies (5 RCTs, 10 NRSIs) with 16,429 participants of whom 13,143 were relapsing MS and 3286 progressive MS. The studies were one to two years long and compared rituximab as 'first choice' with placebo (1 RCT) or other DMTs (1 NRSI), rituximab as 'switching' against placebo (2 RCTs) or other DMTs (2 RCTs, 9 NRSIs). The studies were conducted worldwide; most originated from high-income countries, six from the Swedish MS register. Pharmaceutical companies funded two studies. We identified 14 ongoing studies. Rituximab as 'first choice' for relapsing MS Rituximab versus placebo: no studies met eligibility criteria for this comparison. Rituximab versus other DMTs: one NRSI compared rituximab with interferon beta or glatiramer acetate, dimethyl fumarate, natalizumab, or fingolimod in active relapsing MS at 24 months' follow-up. Rituximab likely results in a large reduction in relapses compared with interferon beta or glatiramer acetate (hazard ratio (HR) 0.14, 95% confidence interval (CI) 0.05 to 0.39; 335 participants; moderate-certainty evidence). Rituximab may reduce relapses compared with dimethyl fumarate (HR 0.29, 95% CI 0.08 to 1.00; 206 participants; low-certainty evidence) and natalizumab (HR 0.24, 95% CI 0.06 to 1.00; 170 participants; low-certainty evidence). It may make little or no difference on relapse compared with fingolimod (HR 0.26, 95% CI 0.04 to 1.69; 137 participants; very low-certainty evidence). The study reported no deaths over 24 months. The study did not measure disability worsening, SAEs, HRQoL, and common infections. Rituximab as 'first choice' for progressive MS One RCT compared rituximab with placebo in primary progressive MS at 24 months' follow-up. Rituximab likely results in little to no difference in the number of participants who have disability worsening compared with placebo (odds ratio (OR) 0.71, 95% CI 0.45 to 1.11; 439 participants; moderate-certainty evidence). Rituximab may result in little to no difference in recurrence of relapses (OR 0.60, 95% CI 0.18 to 1.99; 439 participants; low-certainty evidence), SAEs (OR 1.25, 95% CI 0.71 to 2.20; 439 participants; low-certainty evidence), common infections (OR 1.14, 95% CI 0.75 to 1.73; 439 participants; low-certainty evidence), cancer (OR 0.50, 95% CI 0.07 to 3.59; 439 participants; low-certainty evidence), and mortality (OR 0.25, 95% CI 0.02 to 2.77; 439 participants; low-certainty evidence). The study did not measure HRQoL. Rituximab versus other DMTs: no studies met eligibility criteria for this comparison. Rituximab as 'switching' for relapsing MS One RCT compared rituximab with placebo in relapsing MS at 12 months' follow-up. Rituximab may decrease recurrence of relapses compared with placebo (OR 0.38, 95% CI 0.16 to 0.93; 104 participants; low-certainty evidence). The data did not confirm or exclude a beneficial or detrimental effect of rituximab relative to placebo on SAEs (OR 0.90, 95% CI 0.28 to 2.92; 104 participants; very low-certainty evidence), common infections (OR 0.91, 95% CI 0.37 to 2.24; 104 participants; very low-certainty evidence), cancer (OR 1.55, 95% CI 0.06 to 39.15; 104 participants; very low-certainty evidence), and mortality (OR 1.55, 95% CI 0.06 to 39.15; 104 participants; very low-certainty evidence). The study did not measure disability worsening and HRQoL. Five NRSIs compared rituximab with other DMTs in relapsing MS at 24 months' follow-up. The data did not confirm or exclude a beneficial or detrimental effect of rituximab relative to interferon beta or glatiramer acetate on disability worsening (HR 0.86, 95% CI 0.52 to 1.42; 1 NRSI, 853 participants; very low-certainty evidence). Rituximab likely results in a large reduction in relapses compared with interferon beta or glatiramer acetate (HR 0.18, 95% CI 0.07 to 0.49; 1 NRSI, 1383 participants; moderate-certainty evidence); and fingolimod (HR 0.08, 95% CI 0.02 to 0.32; 1 NRSI, 256 participants; moderate-certainty evidence). The data did not confirm or exclude a beneficial or detrimental effect of rituximab relative to natalizumab on relapses (HR 1.0, 95% CI 0.2 to 5.0; 1 NRSI, 153 participants; very low-certainty evidence). Rituximab likely increases slightly common infections compared with interferon beta or glatiramer acetate (OR 1.71, 95% CI 1.11 to 2.62; 1 NRSI, 5477 participants; moderate-certainty evidence); and compared with natalizumab (OR 1.58, 95% CI 1.08 to 2.32; 2 NRSIs, 5001 participants; moderate-certainty evidence). Rituximab may increase slightly common infections compared with fingolimod (OR 1.26, 95% CI 0.90 to 1.77; 3 NRSIs, 5187 participants; low-certainty evidence). It may make little or no difference compared with ocrelizumab (OR 0.02, 95% CI 0.00 to 0.40; 1 NRSI, 472 participants; very low-certainty evidence). The data did not confirm or exclude a beneficial or detrimental effect of rituximab on mortality compared with fingolimod (OR 5.59, 95% CI 0.22 to 139.89; 1 NRSI, 136 participants; very low-certainty evidence) and natalizumab (OR 6.66, 95% CI 0.27 to 166.58; 1 NRSI, 153 participants; very low-certainty evidence). The included studies did not measure SAEs, HRQoL, and cancer. AUTHORS' CONCLUSIONS For preventing relapses in relapsing MS, rituximab as 'first choice' and as 'switching' may compare favourably with a wide range of approved DMTs. A protective effect of rituximab against disability worsening is uncertain. There is limited information to determine the effect of rituximab for progressive MS. The evidence is uncertain about the effect of rituximab on SAEs. They are relatively rare in people with MS, thus difficult to study, and they were not well reported in studies. There is an increased risk of common infections with rituximab, but absolute risk is small. Rituximab is widely used as off-label treatment in people with MS; however, randomised evidence is weak. In the absence of randomised evidence, remaining uncertainties on beneficial and adverse effects of rituximab for MS might be clarified by making real-world data available.
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Affiliation(s)
- Graziella Filippini
- Scientific Director's Office, Carlo Besta Foundation and Neurological Institute, Milan, Italy
| | - Jera Kruja
- Neurology, UHC Mother Theresa, University of Medicine, Tirana, Albania
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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23
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Margoni M, Preziosa P, Filippi M, Rocca MA. Anti-CD20 therapies for multiple sclerosis: current status and future perspectives. J Neurol 2021; 269:1316-1334. [PMID: 34382120 PMCID: PMC8356891 DOI: 10.1007/s00415-021-10744-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/26/2022]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease affecting the central nervous system (CNS), often characterized by the accumulation of irreversible clinical disability over time. During last years, there has been a dramatic evolution in several key concepts of immune pathophysiology of MS and in the treatment of this disease. The demonstration of the strong efficacy and good safety profile of selective B-cell-depleting therapies (such as anti-CD20 monoclonal antibodies) has significantly expanded the therapeutic scenario for both relapsing and progressive MS patients with the identification of a new therapeutic target. The key role of B cells in triggering MS disease has been also pointed out, determining a shift from the traditional view of MS activity as largely being ‘T-cell mediated’ to the notion that MS-related pathological processes involve bi-directional interactions between several immune cell types, including B cells, both in the periphery and in the CNS. This review provides an updated overview of the involvement of B cells in the immune pathophysiology and pathology of MS. We summarize the rationale regarding the use of anti-CD20 therapies and the results of the main randomized controlled trials and observational studies investigating the efficacy and safety profile of rituximab, ocrelizumab, ofatumumab and ublituximab. Suggestions regarding vaccinations and management of MS patients during COVID-19 pandemic with anti-CD20 therapies are also discussed. Finally, therapies under investigation and future perspectives of anti-CD20 therapies are taken into consideration.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Multiple Sclerosis Center of the Veneto Region, Department of Neurosciences, University Hospital-School of Medicine, Padua, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, 20132, Milan, Italy.
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24
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Tobias Z, Esther D, Niklas S, Dennis W, Alexander W, Helmut R, Michael H, Fahmy AD, Stefanie M, Fritz L, Thomas B, Gabriel B, Klaus ZU, Paulus R. Rituximab versus mitoxantrone: comparing effectiveness and safety in advanced relapsing multiple sclerosis. Ther Adv Chronic Dis 2021; 12:20406223211024366. [PMID: 34377385 PMCID: PMC8323410 DOI: 10.1177/20406223211024366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Rituximab (RTX), a CD20 depleting agent, is a frequently used off-label treatment for multiple sclerosis (MS), while mitoxantrone (MTX) is approved, albeit rarely used for active relapsing MS (RMS). However, observational data comparing RTX and MTX effectiveness and safety are scarce. Objective: We aimed to compare effectiveness and safety of MTX and RTX in patients with active RMS. Methods: From combined retrospective clinical data of three MS centers, we selected patients who had received at least one infusion of RTX or MTX and had at least a 6-month clinical follow-up available. Treatment groups were compared by propensity score (PS)-adjusted regression and inverse PS-weighted generalized estimated equation models regarding disability progression, relapse activity, and adverse events (AEs). Results: We included 292 RMS patients (mean age 41.8 years, 71.6% female) who received RTX (119 patients, mean age 36.8 years, 74.8% female) or MTX (173 patients mean age 45.3 years, 69.4% female). Using both PS methods, we did not find a significant effect favoring RTX or MTX treatment regarding the probability of disability worsening or relapse occurrence. However, RTX treatment was associated with a significantly lower probability of severe AEs and AEs. Conclusions: RTX shows comparable effectiveness but a favorable safety profile compared with MTX in active RMS.
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Affiliation(s)
- Zrzavy Tobias
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Daniels Esther
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Stuka Niklas
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Weber Dennis
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Rauschka Helmut
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders and Diseases, Klinik Donaustadt, Vienna, Austria
| | - Hecker Michael
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Aboulenein-Djamshidian Fahmy
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders and Diseases, Klinik Donaustadt, Vienna, Austria
| | - Meister Stefanie
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Leutmezer Fritz
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Berger Thomas
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Bsteh Gabriel
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Zettl Uwe Klaus
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Rommer Paulus
- Department of Neurology, Medical University of Vienna, Vienna, Austria Department of Neurology, Rostock University Medical Center, Rostock, Germany
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25
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Brancati S, Gozzo L, Longo L, Vitale DC, Drago F. Rituximab in Multiple Sclerosis: Are We Ready for Regulatory Approval? Front Immunol 2021; 12:661882. [PMID: 34295328 PMCID: PMC8290177 DOI: 10.3389/fimmu.2021.661882] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/15/2021] [Indexed: 12/19/2022] Open
Abstract
Despite the availability of a lot of effective disease-modifying drugs, multiple sclerosis (MS) (in particular the progressive forms) still represents an important unmet medical need, because of issues in terms of effectiveness, duration of response, safety, and patient compliance. An increasing body of evidence from randomized clinical trials and real-world data suggest that rituximab is a highly effective alternative in both relapsing and progressive MS, with a low discontinuation rate, related to a good benefit/risk profile, and a good compliance. To date, the use of rituximab in patients with multiple sclerosis is not in accordance with the authorized product information (off-label use). However, the use of this medicine is widespread in several countries, and in some cases, it is the most commonly used disease-modifying drug for MS subtypes. This use could be officially recognized by national regulatory authorities, according to specific procedures, to ensure equal access for patients to a safe and effective option.
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Affiliation(s)
- Serena Brancati
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Lucia Gozzo
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Laura Longo
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Daniela Cristina Vitale
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
| | - Filippo Drago
- Clinical Pharmacology Unit/Regional Pharmacovigilance Centre, University Hospital of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
- Centre for Research and Consultancy in HTA and Drug Regulatory Affairs (CERD), University of Catania, Catania, Italy
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26
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Holloman JP, Axtell RC, Monson NL, Wu GF. The Role of B Cells in Primary Progressive Multiple Sclerosis. Front Neurol 2021; 12:680581. [PMID: 34163430 PMCID: PMC8215437 DOI: 10.3389/fneur.2021.680581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
The success of ocrelizumab in reducing confirmed disability accumulation in primary progressive multiple sclerosis (PPMS) via CD20-targeted depletion implicates B cells as causal agents in the pathogenesis of PPMS. This review explores the possible mechanisms by which B cells contribute to disease progression in PPMS, specifically exploring cytokine production, antigen presentation, and antibody synthesis. B cells may contribute to disease progression in PPMS through cytokine production, specifically GM-CSF and IL-6, which can drive naïve T-cell differentiation into pro-inflammatory Th1/Th17 cells. B cell production of the cytokine LT-α may induce follicular dendritic cell production of CXCL13 and lead indirectly to T and B cell infiltration into the CNS. In contrast, production of IL-10 by B cells likely induces an anti-inflammatory effect that may play a role in reducing neuroinflammation in PPMS. Therefore, reduced production of IL-10 may contribute to disease worsening. B cells are also capable of potent antigen presentation and may induce pro-inflammatory T-cell differentiation via cognate interactions. B cells may also contribute to disease activity via antibody synthesis, although it's unlikely the benefit of ocrelizumab in PPMS occurs via antibody decrement. Finally, various B cell subsets likely promulgate pro- or anti-inflammatory effects in MS.
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Affiliation(s)
- Jameson P Holloman
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, United States
| | - Robert C Axtell
- Department of Arthritis and Clinical Immunology Research, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States.,Department of Microbiology and Immunology, Oklahoma University Health Science Center, Oklahoma City, OK, United States
| | - Nancy L Monson
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, United States.,Department of Immunology, University of Texas Southwestern, Dallas, TX, United States
| | - Gregory F Wu
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, United States.,Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, United States
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27
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Tazza F, Lapucci C, Cellerino M, Boffa G, Novi G, Poire I, Mancuso E, Bruschi N, Sbragia E, Laroni A, Capello E, Inglese M. Personalizing ocrelizumab treatment in Multiple Sclerosis: What can we learn from Sars-Cov2 pandemic? J Neurol Sci 2021; 427:117501. [PMID: 34044238 PMCID: PMC8133824 DOI: 10.1016/j.jns.2021.117501] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/25/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022]
Abstract
During SARS-CoV-2 pandemic, we adopted a personalized delayed protocol for ocrelizumab infusions in Relapsing Remitting Multiple Sclerosis (RRMS) patients according to the national recommendations. Out of the 83 RRMS patients whose infusion was scheduled between March and December 2020, 56 patients experienced a delay in treatment based on MS severity and SARS-CoV2 infection risk profile. In most cases, the immunophenotype was performed monthly to guide re-infusions. Specifically, B CD19 + cells repopulation rate was monitored. Mean infusion delay was 103,1 [SD 40,6] days, and none of the patients presented relapses or active disease at MRI at the end of the observation period. Treatment naïve status and the interval between immunophenotyping and the last ocrelizumab infusion were predictors of earlier B CD19 + cells repopulation. Two patients contracted SARS-CoV2 with complete recovery. Definitive data about Sars-Cov2 vaccine efficacy in patients treated with ocrelizumab are still lacking. Our findings suggest that a personalized treatment with a delayed infusion schedule does not compromise ocrelizumab short-term efficacy and may help to lengthen the therapeutic window for an effective response to SARS-CoV2 vaccine.
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Affiliation(s)
- F Tazza
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - C Lapucci
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Laboratory of Experimental Neurosciences, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - M Cellerino
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - G Boffa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - G Novi
- Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - I Poire
- Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - E Mancuso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - N Bruschi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - E Sbragia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - A Laroni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - E Capello
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - M Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
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Signoriello E, Lus G, Bonavita S, Lanzillo R, Saccà F, Landi D, Frau J, Baroncini D, Zaffaroni M, Maniscalco GT, Curti E, Sartori A, Cepparulo S, Marfia GA, Nicoletti CG, Carotenuto A, Nociti V, Caleri F, Sormani MP, Signori A. Switch from sequestering to anti-CD20 depleting treatment: disease activity outcomes during wash-out and in the first 6 months of ocrelizumab therapy. Mult Scler 2021; 28:93-101. [PMID: 33855897 DOI: 10.1177/13524585211005657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Switching between treatments is an opportunity for patients with multiple sclerosis (MS) to ameliorate disease control or safety. The aim of this study was to investigate the impact of switching from fingolimod (FTY) or natalizumab (NTZ) to ocrelizumab (OCR) on disease activity. METHODS We retrospectively enrolled 165 patients treated with OCR from 11 MS centres. We assessed the association of demographic and clinical characteristics on relapse rate (RR) and activity on magnetic resonance imaging (MRI) during wash-out and after 6 months of treatment with OCR through univariable and multivariable negative binomial regression models. RESULTS We registered a total of 35 relapses during the wash-out period. Previous treatment with FTY, relapses in the previous year, and relapsing-remitting course were associated with higher RR. In the first 6 months of OCR, 12 patients had clinical or MRI disease activity. Higher Expanded Disability Status Scale (EDSS) and higher lymphocyte count at OCR start were associated with a reduced probability of relapse. DISCUSSION AND CONCLUSION This study confirms that withdrawal from sequestering agents as FTY increases the risk of relapses in the wash-out period. Nevertheless, starting OCR before achieving complete immune reconstitution could limit its effectiveness in the first 6 months probably because trapped lymphocytes escape the CD20-mediated depletion.
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Affiliation(s)
- Elisabetta Signoriello
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Simona Bonavita
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Francesco Saccà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Jessica Frau
- Centro Sclerosi Multipla, ASSL Cagliari (ATS Sardegna)/Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Damiano Baroncini
- Multiple Sclerosis Center, ASST della Valle Olona, Hospital of Gallarate, Gallarate, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, ASST della Valle Olona, Hospital of Gallarate, Gallarate, Italy
| | | | - Erica Curti
- Multiple Sclerosis Center, Neurology Unit, University Hospital of Parma, Parma, Italy
| | - Arianna Sartori
- Multiple Sclerosis Center, Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, ASUGI, University of Trieste, Trieste, Italy
| | - Simone Cepparulo
- Multiple Sclerosis Center, Second Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Carolina Gabri Nicoletti
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Viviana Nociti
- Multiple Sclerosis Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - Francesca Caleri
- Neurology Department, F. Tappeiner Hospital Meran (BZ), Meran, Italy
| | | | - Alessio Signori
- Department of Health Sciences, University of Genova, Genova, Italy
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29
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Torgauten HM, Myhr KM, Wergeland S, Bø L, Aarseth JH, Torkildsen Ø. Safety and efficacy of rituximab as first- and second line treatment in multiple sclerosis - A cohort study. Mult Scler J Exp Transl Clin 2021; 7:2055217320973049. [PMID: 33796328 PMCID: PMC7970692 DOI: 10.1177/2055217320973049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/17/2020] [Indexed: 12/04/2022] Open
Abstract
Background Rituximab is increasingly used as off-label therapy in multiple sclerosis (MS). More data are needed on safety and efficacy of rituximab, particularly in cohorts of de novo patients and patients in early therapy escalation. Objective To investigate the safety and efficacy of off-label treatment with rituximab in an MS-cohort of predominantly de novo patients or as therapy escalation. Methods We retrieved safety and efficacy data from the Norwegian MS-registry and biobank for all MS-patients treated with rituximab at Haukeland University Hospital, Bergen, Norway, during a four year period. Results In the 365 MS-patients (320 relapsing-remitting MS (RRMS), 23 secondary progressive MS (SPMS), and 22 primary progressive MS (PPMS)), the overall annualized relapse rate (ARR) was 0.03 and annualized drug discontinuation rate (ADDR) was 0.05. NEDA-3 was achived in 79% of patients with available data (n=351). Sixty-one patients experienced infusion-related adverse events of which two were serious (CTCAE grade 3–4). Eighteen patients experienced serious non-infusion related adverse events, of which 16 were infections. Infections (n = 34; 9.3%, CTCAE grade 2-5), hypogammaglobulinemia (n = 19, 5.2%) and neutropenia (n = 16; 4.4%) were the most common non-infusion-related adverse events. Conclusion Rituximab was a safe and highly efficient disease modifying therapy in this cohort of MS-patients; however, infections and neutropenia need to be monitored.
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Affiliation(s)
- Hilde Marie Torgauten
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kjell-Morten Myhr
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Stig Wergeland
- Norwegian Multiple Sclerosis Registry, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Lars Bø
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Jan H Aarseth
- Norwegian Multiple Sclerosis Registry, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Øivind Torkildsen
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Saini L, Sondhi V. CNS autoimmunity in children: An unwanted wrinkle in a smooth narrative. Med J Armed Forces India 2021; 77:138-146. [PMID: 33867628 DOI: 10.1016/j.mjafi.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/13/2021] [Indexed: 11/25/2022] Open
Abstract
The emerging paradigm of childhood autoimmune neurological disorders has exploded in recent times due to reliable diagnostic methods and their ease of availability, well-defined diagnostic criteria, and universal awareness about these disorders. The most important aspect of these disorders is a considerable recovery in response to early targeted immunotherapy. If left untreated and/or ill-treated, these can lead to mortality or lifelong morbidity. Autoantibodies can target any part of the central nervous system (CNS), ranging from superficial structures like myelin to deep intracellular ion channels like voltage-gated potassium channels, resulting in contrasting and at times overlapping symptomatology. Though neuroimaging characteristics and serological tests confirm these disorders' diagnosis, it is essential to suspect them clinically and start management before the reports are available for minimizing morbidity and mortality. In the pediatric age group, several metabolic conditions, like mitochondrial disorders and enzyme deficiencies like HMG-CoA-lyase deficiency, can develop neuroimaging patterns similar to those seen in childhood CNS autoimmune disorders and may also show a favorable response to steroids in acute phases. Hence, the clinician must suspect and work up the index patient appropriately. Here, we briefly discuss the pathophysiology, clinical clues, and potential therapeutic targets related to pediatric CNS autoimmune disorders.
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Affiliation(s)
- Lokesh Saini
- Assistant Professor (Pediatrics), Pediatric Neurology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sondhi
- Associate Professor, Department of Pediatrics, Armed Forces Medical College, Pune, India
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31
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Anti-CD20 Agents for Multiple Sclerosis: Spotlight on Ocrelizumab and Ofatumumab. Brain Sci 2020; 10:brainsci10100758. [PMID: 33092190 PMCID: PMC7589300 DOI: 10.3390/brainsci10100758] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/05/2020] [Accepted: 10/16/2020] [Indexed: 01/23/2023] Open
Abstract
Until recently, in the pathogenesis of Multiple Sclerosis (MS), the contribution of B cells has been largely underestimated, and the disease was considered a T-cell-mediated disorder. However, newer evidence shows that B cells play a crucial role in the pathogenesis of MS via antigen-driven autoantibody responses and through the cross regulation of T-helper cells. As B cells express the surface molecule CD20 at all points of differentiation, it provides a specific target for monoclonal antibodies, and the development and clinical testing of anti-CD20 antibody treatments for MS have been successful. After some observations, some small clinical trials found positive effects for the first anti-CD20 therapeutic rituximab in MS; newer agents have been specifically evaluated, resulting in the development of ocrelizumab and ofatumumab. Ocrelizumab, a humanized anti-CD20 monoclonal antibody, was approved in March 2017 by the Food and Drug Administration (FDA) and is also the first proven therapy to reduce disability progression in primary progressive MS. This is particularly significant considering that disease-modifying treatment options are few for both primary and secondary progressive MS. Ofatumumab, a fully human anti-CD20 monoclonal antibody, that binds a distinct epitope, has been further investigated in phase 3 trials for relapsing forms of MS. In this review, we discuss in detail these two anti-CD20 agents and their advent for treatment of MS.
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Novi G, Bovis F, Fabbri S, Tazza F, Gazzola P, Maietta I, Currò D, Bruschi N, Roccatagliata L, Boffa G, Lapucci C, Pesce G, Cellerino M, Solaro C, Laroni A, Capello E, Mancardi G, Sormani M, Inglese M, Uccelli A. Tailoring B cell depletion therapy in MS according to memory B cell monitoring. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/5/e845. [PMID: 32753406 PMCID: PMC7413707 DOI: 10.1212/nxi.0000000000000845] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/05/2020] [Indexed: 11/15/2022]
Abstract
Objective We wanted to evaluate efficacy on inflammatory parameters of rituximab (RTX)-personalized reinfusion scheme using a memory B cell–based treatment regimen. Methods This is a prospective, uncontrolled, open-label study including patients with MS treated with RTX in 2 Italian MS units. All patients were treated with RTX induction, followed by maintenance infusion at the dosage of 375 mg/m2, according to memory B cell repopulation (0.05% of peripheral-blood mononuclear cells [PBMCs] for the first 2 years, 0.1% of PBMC for the third year). MS activity was assessed as clinical or MRI activity. Results One hundred two patients were included in the analysis. Mean follow-up was 2.40 years (range 0.57–7.15 years). The annualized relapse rate (ARR) was 0.67 in the year before RTX start and decreased to 0.01 in the 3 years after RTX initiation (global ARR). The proportion of patient with MS activity (i.e., relapse or MRI activity) was 63.16% in the year before RTX start and decreased to 8.7% (0–6 months), 1.3% (6–12 months), 0% (12–24 months), and 0% (24–36 months). Annualized RTX infusion rates were 1.67 (95% confidence interval [CI]: 1.43–1.94), 0.76 (95% CI: 0.58–0.98), and 0.78 (95% CI: 0.52–1.12) for the first 3 years after RTX initiation, respectively. Patients were reinfused with a mean infusion interval of 367 days (range 181–839 days). Conclusion The results of this study show that the memory B cell–based RTX reinfusion protocol is able to reduce the mean number of RTX reinfusions with persistent reduction of disease activity. Classification of evidence This study provides Class IV evidence that for patients with MS, a memory B cell–based RTX reinfusion protocol can reduce the mean number of RTX reinfusions with persistent reduction of disease activity.
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Affiliation(s)
- Giovanni Novi
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy.
| | - Francesca Bovis
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Sabrina Fabbri
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Francesco Tazza
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Paola Gazzola
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Ilaria Maietta
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Daniela Currò
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Nicolò Bruschi
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Luca Roccatagliata
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Giacomo Boffa
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Caterina Lapucci
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Giampaola Pesce
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Maria Cellerino
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Claudio Solaro
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Alice Laroni
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Elisabetta Capello
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Gianluigi Mancardi
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Mariapia Sormani
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Matilde Inglese
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
| | - Antonio Uccelli
- From the Department of Neuroscience (G.N.), Ospedale Policlinico San Martino-IRCCS; Department of Health Sciences (DISSAL) (F.B., I.M., L.R., M.S.), University of Genova, Italy; Ospedale A. Micone (S.F., P.G.), Genova; Department of Neuroscience (F.T., N.B., G.B., C.L., M.C., A.L., E.C., G.M.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova; Ospedale Policlinico San Martino-IRCCS (F.T., N.B., L.R., A.L., E.C., M.S., M.I., A.U.), Genova, Italy; Ospedale San Paolo (D.C.), Savona; Autoimmunity Laboratory DiMI (G.P.), University of Genova, Italy; Monsignor Luigi Novarese Rehabilitation Center (C.S.), Moncrivello, Vercelli; Istituti Clinici Scientifici Maugeri (G.M.), IRCCS, Pavia; and Department of Neuroscience (M.I., A.U.), Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) and Center of Excellence for Biomedical Research (CEBR), University of Genova, Italy
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Signoriello E, Bonavita S, Di Pietro A, Abbadessa G, Rossi F, Miele G, Casertano S, Lus G. BMI influences CD20 kinetics in multiple sclerosis patients treated with ocrelizumab. Mult Scler Relat Disord 2020; 43:102186. [DOI: 10.1016/j.msard.2020.102186] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 12/11/2022]
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Tian X, Chen C, Ma L, Wei R, Li M, Wang X, Wu Y, Zhou Y, Cui Y. Efficacy and safety of rituximab in relapsing-remitting multiple sclerosis: A systematic review and meta-analysis. J Neuroimmunol 2020; 347:577317. [PMID: 32731048 DOI: 10.1016/j.jneuroim.2020.577317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study aimed to quantitatively review and summarize the effectiveness and safety of rituximab (RTX) treatment for patients with relapsing-remitting multiple sclerosis (RRMS). METHODS PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov databases were searched, and studies were screened based on inclusion and exclusion criteria. Meta-analysis was conducted with Stata. Primary outcomes included annualized relapse rate (ARR) change from baseline and relapse-free rate (RFR) at week 24, 48, 72, and 96. Secondary outcomes included Expanded Disability Status Scale (EDSS) change from baseline, the proportion of patients with infusion-related events (IRE) after treatment, and the proportion of patients with infections after treatment. Study quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Collaboration's tool. RESULTS A total of 20 studies were included in this article and 13 of them were under quantitative synthesis. The 20 studies included 2020 patients suffering from RRMS. The overall absolute reduction in ARR of rituximab treatment in RRMS patients was 1.00 (95% confidence interval (CI) 0.83-1.17). And the overall RFRs at week 24, 48, 72, and 96 were 90.4%, 88.5%, 86.4% and 86.2%, respectively. The estimated reduction in EDSS score was 0.62 (95% CI 0.20-1.04). The overall proportion of IRE and infections were 31% and 33%, respectively. CONCLUSION Rituximab can improve relapse and disability conditions in patients with RRMS and has the potential for RRMS treatment. Additional evaluations on the safety of RTX is required.
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Affiliation(s)
- Xin Tian
- Department of Pharmacy, Peking University First Hospital, Beijing, China; Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Chaoyang Chen
- Department of Pharmacy, Peking University First Hospital, Beijing, China; Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Lingyun Ma
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Ran Wei
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Min Li
- Department of Pharmacy, Peking University First Hospital, Beijing, China; Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Xiaoqing Wang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Ye Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Zhou
- Department of Pharmacy, Peking University First Hospital, Beijing, China; Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China; Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China.
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Abstract
Ocrelizumab ist ein monoklonaler Antikörper, der sich gegen das Differenzierungsantigen CD20 richtet und zu einer effektiven längerfristigen Depletion von Lymphozyten, insbesondere von B‑Zellen, führt. Unlängst publizierte Phase-3-Studien belegen, dass Ocrelizumab sowohl bei der Behandlung der schubförmigen als auch der primär progressiven Multiplen Sklerose (MS) wirksam ist. Darauf basierend wurde Ocrelizumab als erstes Medikament zur Behandlung der primär chronisch-progredienten MS zugelassen. Um diesen Durchbruch besser in den Kontext des heutigen MS-Therapiekanons einordnen zu können, lohnt sowohl ein Blick zurück auf die Entwicklung der antikörpervermittelten CD20-Depletion als auch auf die der Zulassung zugrunde liegenden Studien sowie deren Extensionsphasen. Diese Übersichtsarbeit diskutiert die verfügbaren Daten zur Wirksamkeit und Sicherheit der langfristigen B‑Zell-Depletion bei MS-Patienten und erörtert den aktuellen Kenntnisstand zur Rolle von B‑Lymphozyten in der Immunpathogenese der MS.
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Perez T, Rico A, Boutière C, Maarouf A, Roudot M, Honoré S, Pelletier J, Bertault-Peres P, Audoin B. Comparison of rituximab originator (MabThera ®) to biosimilar (Truxima ®) in patients with multiple sclerosis. Mult Scler 2020; 27:585-592. [PMID: 32180508 DOI: 10.1177/1352458520912170] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Rituximab's originator MabThera® or Rituxan® has demonstrated high efficacy in multiple sclerosis (MS). Because of the patent expiration, rituximab biosimilars have been developed. However, because a biosimilar is not the exact copy of the originator, the efficacy and safety of a biosimilar may significantly differ. OBJECTIVES To compare the efficacy and safety of the biosimilar Truxima® and the originator MabThera® in MS. METHODS Consecutive MS patients receiving MabThera® or Truxima® were prospectively followed during 1 year after treatment introduction. Allocation to each treatment depended on the period of introduction and not the physician's choice. Lymphocyte count, clinical and magnetic resonance imaging (MRI) activity, Expanded Disability Status Scale (EDSS), and adverse events were compared. RESULTS In total, 105 and 40 patients received MabThera® and Truxima®, respectively. The two groups did not differ in baseline characteristics. Effect on CD19+ lymphocytes and disease activity were similar during follow-up. EDSS remained stable, with no difference between groups. Adverse events were similar between groups. CONCLUSION The efficacy and safety of the rituximab biosimilar Truxima® seem equivalent to the originator MabThera® in MS patients. Truxima® could represent a relatively cheap and safe therapeutic alternative to MabThera® and could improve access to highly efficient therapy for MS in low- or middle-income countries.
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Affiliation(s)
- Thomas Perez
- Service Pharmacie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France Institute of NeuroPhysiopathology (INP), CNRS, Aix-Marseille University, Marseille, France
| | - Audrey Rico
- Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Clémence Boutière
- Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Adil Maarouf
- Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Marjorie Roudot
- Service Pharmacie, APHM, Hôpital de la Timone, Aix Marseille University, Marseille, France
| | - Stéphane Honoré
- Service Pharmacie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France Institute of NeuroPhysiopathology (INP), CNRS, Aix-Marseille University, Marseille, France
| | - Jean Pelletier
- Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Pierre Bertault-Peres
- Service Pharmacie, APHM, Hôpital de la Timone, Aix Marseille University, Marseille, France
| | - Bertrand Audoin
- Pôle de Neurosciences Cliniques, Service de Neurologie, APHM, Hôpital de la Timone, Aix-Marseille University, Marseille, France
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