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Graille-Avy L, Boutiere C, Rigollet C, Perriguey M, Rico A, Demortiere S, Durozard P, Hilezian F, Vely F, Bertault-Peres P, Pelletier J, Maarouf A, Audoin B. Effect of Prior Treatment With Fingolimod on Early and Late Response to Rituximab/Ocrelizumab in Patients With Multiple Sclerosis. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200231. [PMID: 38626360 DOI: 10.1212/nxi.0000000000200231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
BACKGROUND AND OBJECTIVES Real-life studies noted that the risk of disease activity in multiple sclerosis (MS) after switching to rituximab (RTX) or ocrelizumab (OCR) may be unequal depending on prior disease-modifying therapy (DMT), with a higher risk associated with fingolimod (FING). METHODS We performed a retrospective analysis of a structured prospective data collection including all consecutive patients with relapsing MS who were prescribed RTX/OCR in the MS center of Marseille. Cox proportional hazards models were applied to clinical and MRI outcomes. RESULTS We included 321 patients with a median (interquartile range [IQR]) follow-up of 3.5 years (1.5-5) after RTX/OCR initiation. At the first RTX/OCR infusion, the mean (SD) age of patients was 37 (10) years, and the median (IQR) disease duration was 8 years (3-15): 68 patients did not receive treatment before RTX/OCR and 108 switched from FING, 47 from low efficacy therapy, and 98 from natalizumab. For statistical analysis, the group "FING" was divided into "short-FING" and "long-FING" groups according to the median value of the group's washout period (27 days). On Cox proportional hazards analysis, for only the "long-FING" group, the risk of relapse within the first 6 months of RTX/OCR was increased as compared with patients without previous DMT (hazard ratio [HR]: 8.78; 95% CI 1.72-44.86; p < 0.01). Previous DMT and washout period duration of FING had no effect on B-cell levels at 6 months. Beyond the first 6 months of RTX/OCR, age <40 years was associated with increased risk of relapse (HR: 3.93; 95% CI 1.30-11.89; p = 0.01), male sex with increased risk of new T2 lesions (HR: 2.26; 95% CI 1.08-4.74; p = 0.03), and EDSS ≥2 with increased risk of disability accumulation (HR: 3.01; 95% CI 1.34-6.74; p < 0.01). Previous DMT had no effect on the effectiveness of RTX/OCR beyond 6 months after initiation. DISCUSSION For patients switching from FING to RTX/OCR, the risk of disease reactivation within the first 6 months of treatment was increased as compared with patients with other DMT or no previous DMT only when the washout period exceeded 26 days. Neither FING nor other previous DMT reduced the effectiveness of RTX/OCR beyond the first 6 months of treatment.
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Affiliation(s)
- Lisa Graille-Avy
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Clemence Boutiere
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Camille Rigollet
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Marine Perriguey
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Audrey Rico
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Sarah Demortiere
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Pierre Durozard
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Frederic Hilezian
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Frederic Vely
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Pierre Bertault-Peres
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Jean Pelletier
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Adil Maarouf
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Bertrand Audoin
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
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Demortiere S, Joubert B, Benaiteau M, Hilezian F, Boutiere C, Rico A, Stolowy N, Dubois V, Audoin B, Maarouf A, Pelletier J. Anti-IgLON5 Disease With Inaugural Bilateral Neuropapillitis. Neurology 2024; 102:e209284. [PMID: 38527243 DOI: 10.1212/wnl.0000000000209284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/22/2024] [Indexed: 03/27/2024] Open
Affiliation(s)
- Sarah Demortiere
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Bastien Joubert
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Marie Benaiteau
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Frederic Hilezian
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Clemence Boutiere
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Audrey Rico
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Natacha Stolowy
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Valerie Dubois
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Bertrand Audoin
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Adil Maarouf
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
| | - Jean Pelletier
- From the Department of Neurology (S.D., F.H., C.B., A.R., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (B.J., M.B., B.A., A.M., J.P.); Department of Neurology (B.J., M.B., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; Department of Ophtalmology (N.S., B.A., A.M., J.P.), Centre Hospitalier la Timone, Aix Marseille Univ; Departement of Medical Biology (V.D., B.A., A.M., J.P.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon; and Aix Marseille Univ (B.A., A.M., J.P.), CNRS, CRMBM, Marseille, France
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Cruz ES, Fortanier E, Hilezian F, Maarouf A, Boutière C, Demortière S, Rico A, Delmont E, Pelletier J, Attarian S, Audoin B. Factors affecting the topography of nitrous oxide-induced neurological complications. Eur J Neurol 2024:e16291. [PMID: 38532638 DOI: 10.1111/ene.16291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/04/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The factors underlying the topography of nitrous oxide (N2O)-induced neurological complications are unknown. METHODS We included all consecutive patients admitted to the university hospital of Marseille for N2O-induced neurological complications in a prospective observational study. Patients underwent neurological examination, spinal cord magnetic resonance imaging, and nerve conduction studies within the first 4 weeks after admission. RESULTS In total, 61 patients were included: 45% with myeloneuropathy, 34% with isolated myelopathy, and 21% with isolated neuropathy. On multivariable analysis, the odds of myelopathy were associated with the amount of weekly N2O consumption (~600 g cylinder per week, odds ratio [OR] = 1.11, 95% confidence interval [CI] = 1.001-1.24). The extent of the myelopathy (number of vertebral segments) was correlated with the number of ~600-g cylinders consumed weekly (ρ = 0.40, p < 0.005). The odds of neuropathy were associated with the duration of consumption (per month; OR = 1.29, 95% CI = 1.05-1.58). Mean lower-limb motor nerve amplitude was correlated with the duration of consumption (in months; ρ = -0.34, p < 0.05). CONCLUSIONS The odds of myelopathy increased with the amount of N2O consumption, and the odds of neuropathy increased with the duration of N2O exposure, which suggests distinct pathophysiological mechanisms underlying these two neurological complications.
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Affiliation(s)
- Eva Sole Cruz
- Reference Center for Neuromuscular Diseases and ALS, La Timone University Hospital, APHM, Marseille, France
| | - Etienne Fortanier
- Reference Center for Neuromuscular Diseases and ALS, La Timone University Hospital, APHM, Marseille, France
| | - Frederic Hilezian
- APHM, Department of Neurology, La Timone University Hospital, APHM, Marseille, France
| | - Adil Maarouf
- APHM, Department of Neurology, La Timone University Hospital, APHM, Marseille, France
- Aix-Marseille University, CRMBM UMR 7339, CNRS, Marseille, France
| | - Clémence Boutière
- APHM, Department of Neurology, La Timone University Hospital, APHM, Marseille, France
| | - Sarah Demortière
- APHM, Department of Neurology, La Timone University Hospital, APHM, Marseille, France
| | - Audrey Rico
- APHM, Department of Neurology, La Timone University Hospital, APHM, Marseille, France
- Aix-Marseille University, CRMBM UMR 7339, CNRS, Marseille, France
| | - Emilien Delmont
- Reference Center for Neuromuscular Diseases and ALS, La Timone University Hospital, APHM, Marseille, France
| | - Jean Pelletier
- APHM, Department of Neurology, La Timone University Hospital, APHM, Marseille, France
- Aix-Marseille University, CRMBM UMR 7339, CNRS, Marseille, France
| | - Shahram Attarian
- Reference Center for Neuromuscular Diseases and ALS, La Timone University Hospital, APHM, Marseille, France
- Aix-Marseille University, INSERM, GMGF, Marseille, France
| | - Bertrand Audoin
- APHM, Department of Neurology, La Timone University Hospital, APHM, Marseille, France
- Aix-Marseille University, CRMBM UMR 7339, CNRS, Marseille, France
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Claverie R, Perriguey M, Rico A, Boutiere C, Demortiere S, Durozard P, Hilezian F, Dubrou C, Vely F, Pelletier J, Audoin B, Maarouf A. Efficacy of Rituximab Outlasts B-Cell Repopulation in Multiple Sclerosis: Time to Rethink Dosing? Neurol Neuroimmunol Neuroinflamm 2023; 10:e200152. [PMID: 37604695 PMCID: PMC10442066 DOI: 10.1212/nxi.0000000000200152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/05/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Patients with multiple sclerosis (PwMS) receiving extended dosing of rituximab (RTX) have exhibited no return of disease activity, which suggests that maintenance of deep depletion of circulating B cells is not necessary to maintain the efficacy of RTX in MS. METHODS This was a prospective monocentric observational study including all consecutive PwMS who started or continued RTX after 2019, when the medical staff decided to extend the dosing interval up to 24 months for all patients. Circulating B-cell subsets were monitored regularly and systematically in case of relapse. The first extended interval was analyzed. RESULTS We included 236 PwMS (81% with relapsing-remitting MS; mean [SD] age 43 [12] years; median [range] EDSS score 4 [0-8]; mean relapse rate during the year before RTX start 1.09 [0.99]; 41.5% with MRI activity). The median number of RTX infusions before extension was 4 (1-13). At the time of the analysis, the median delay in dosing was 17 months (8-39); the median proportion of circulating CD19+ B cells was 7% (0-25) of total lymphocytes and that of CD27+ memory B cells was 4% (0-16) of total B cells. The mean annual relapse rate did not differ before and after the extension: 0.03 (0.5) and 0.04 (0.15) (p = 0.51). Similarly, annual relapse rates did not differ before and after extension in patients with EDSS score ≤3 (n = 79) or disease duration ≤5 years (n = 71) at RTX onset. During the "extended dosing" period, MRI demonstrated no lesion accrual in 228 of the 236 patients (97%). Five patients experienced clinical relapse, which was confirmed by MRI. In these patients, the level of B-cell subset reconstitution at the time of the relapse did not differ from that for patients with the same extension window. DISCUSSION The efficacy of RTX outlasted substantial reconstitution of circulating B cells in PwMS, which suggests that renewal of the immune system underlies the prolonged effect of RTX in MS. These findings suggest that extended interval dosing of RTX that leads to a significant reconstitution of circulating B cells is safe in PwMS, could reduce the risk of infection, and could improve vaccine efficacy.
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Affiliation(s)
- Roxane Claverie
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France
| | - Marine Perriguey
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France
| | - Audrey Rico
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France
| | - Clemence Boutiere
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France
| | - Sarah Demortiere
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France
| | - Pierre Durozard
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France
| | - Frederic Hilezian
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France
| | - Clea Dubrou
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France
| | - Frederic Vely
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France
| | - Jean Pelletier
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France
| | - Bertrand Audoin
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France.
| | - Adil Maarouf
- From the Department of Neurology (B.A., M.P., A.R., C.B., S.D., F.H., J.P., A.M.), CRMBM, University Hospital of Marseille, Aix-Marseille University; Service d'immunologie (D.C., F.V.), Marseille Immunopôle, APHM, Aix Marseille University, CNRS, INSERM, CIML; Faculté de Pharmacie (R.C.), Aix-Marseille University; and Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, France
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Demortiere S, Maarouf A, Rico A, Boutiere C, Hilezian F, Durozard P, Pelletier J, Audoin B. Disease Evolution in Women With Highly Active MS Who Suspended Natalizumab During Pregnancy vs Rituximab/Ocrelizumab Before Conception. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200161. [PMID: 37550074 PMCID: PMC10406425 DOI: 10.1212/nxi.0000000000200161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/29/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND AND OBJECTIVES In women with highly active multiple sclerosis (MS), suspending rituximab (RTX) for planning pregnancy is associated with low disease reactivation. Whether this strategy reduces the risk of disease reactivity as compared with suspending natalizumab (NTZ) 3 months after conception is unclear. METHODS We retrospectively included women with MS followed in our department during pregnancy and 1 year after birth who suspended NTZ at the end of the first trimester (option mostly proposed before 2016) or suspended RTX/ocrelizumab (RTX/OCR) in the year before conception (option proposed since 2016). RESULTS In women who suspended NTZ, 45 pregnancies resulted in 3 miscarriages and 42 live births, including 1 newborn with major malformations. In women who suspended RTX/OCR, 37 pregnancies resulted in 3 miscarriages and 33 live births; 1 pregnancy was terminated for malformation. During pregnancy, relapse occurred in 3/42 (7.1%) patients of the NTZ group and 1/33 (3%) of the RTX/OCR group (p = 0.6). After delivery, relapse occurred in 9/42 (21.4%) patients of the NTZ group and 0/33 of the RTX/OCR group (p < 0.01). In the NTZ group, 8/9 relapses occurred in patients who restarted NTZ less than 4 weeks after delivery. The proportion of patients with gadolinium-enhanced and/or new T2 lesions on brain or spinal cord MRI performed after delivery was higher in the NTZ than RTX/OCR group (14/40 [35%] vs 1/31 [3%] patients, p = 0.001), the proportion with EDSS score progression during the period including pregnancy and the year after delivery was higher (7/42 [17%] vs 0/33 patients, p = 0.01), and the proportion fulfilling NEDA-3 during this period was lower (21/40 [53%] vs 30/31 [97%] patients, p < 0.001). DISCUSSION Suspending RTX/OCR in the year before conception in women with highly active MS was associated with no disease reactivation during and after pregnancy. As previously reported, stopping NTZ at the end of the first trimester was associated with disease reactivation. In women receiving NTZ who are planning pregnancy, a bridge to RTX/OCR for pregnancy or continuing NTZ until week 34 are both reasonable clinical decisions. The RTX/OCR option is more comfortable for women and reduces the exposure of infants to monoclonal antibodies.
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Affiliation(s)
- Sarah Demortiere
- From the Department of Neurology (S.D., A.M., A.R., C.B., F.H., J.P., B.A.), CRMBM, APHM, Aix Marseille University; and Centre Hospitalier d'Ajaccio (P.D.), France
| | - Adil Maarouf
- From the Department of Neurology (S.D., A.M., A.R., C.B., F.H., J.P., B.A.), CRMBM, APHM, Aix Marseille University; and Centre Hospitalier d'Ajaccio (P.D.), France
| | - Audrey Rico
- From the Department of Neurology (S.D., A.M., A.R., C.B., F.H., J.P., B.A.), CRMBM, APHM, Aix Marseille University; and Centre Hospitalier d'Ajaccio (P.D.), France
| | - Clemence Boutiere
- From the Department of Neurology (S.D., A.M., A.R., C.B., F.H., J.P., B.A.), CRMBM, APHM, Aix Marseille University; and Centre Hospitalier d'Ajaccio (P.D.), France
| | - Frederic Hilezian
- From the Department of Neurology (S.D., A.M., A.R., C.B., F.H., J.P., B.A.), CRMBM, APHM, Aix Marseille University; and Centre Hospitalier d'Ajaccio (P.D.), France
| | - Pierre Durozard
- From the Department of Neurology (S.D., A.M., A.R., C.B., F.H., J.P., B.A.), CRMBM, APHM, Aix Marseille University; and Centre Hospitalier d'Ajaccio (P.D.), France
| | - Jean Pelletier
- From the Department of Neurology (S.D., A.M., A.R., C.B., F.H., J.P., B.A.), CRMBM, APHM, Aix Marseille University; and Centre Hospitalier d'Ajaccio (P.D.), France
| | - Bertrand Audoin
- From the Department of Neurology (S.D., A.M., A.R., C.B., F.H., J.P., B.A.), CRMBM, APHM, Aix Marseille University; and Centre Hospitalier d'Ajaccio (P.D.), France.
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