Reduction in ocrelizumab-induced infusion reactions by a modified premedication protocol

Area of Science:

• Immunology
• Pharmacology
• Neurology

Background:

• Ocrelizumab, a CD20+ B cell depleting monoclonal antibody, is approved for Multiple Sclerosis (MS).
• Infusion-associated reactions (IARs) are the most common side effect of ocrelizumab treatment.
• Identifying strategies to mitigate IARs is crucial for patient management.

Purpose of the Study:

• To evaluate the efficacy of a modified premedication protocol in reducing ocrelizumab-induced IARs.
• To identify patient-specific predictors of IARs during ocrelizumab therapy.

Main Methods:

• A modified premedication regimen including oral and intravenous medications, alongside increased hydration, was administered prior to ocrelizumab infusions.
• Infusion-associated reaction (IAR) rates in patients receiving the modified protocol were compared to historical controls who received standard pretreatment.
• Baseline characteristics including age, sex, BMI, race, and smoking status were analyzed for their association with IARs.

Main Results:

• The modified premedication protocol was associated with a significant 60% reduction in the odds of IARs (OR 0.40, p=0.024).
• Increasing age (OR 0.94, p=0.001) and male sex (OR 0.34, p=0.034) were significantly associated with reduced odds of IARs.
• Higher Body Mass Index (BMI) was a significant risk factor, increasing the odds of IARs (OR 1.07, p=0.029).

Conclusions:

• The enhanced premedication protocol effectively and significantly decreases the incidence of infusion-associated reactions (IARs) in patients receiving ocrelizumab.
• Age and male sex appear to be protective factors against IARs, whereas higher BMI is a risk factor.
• This modified protocol represents a beneficial strategy for improving the safety and tolerability of ocrelizumab treatment in MS patients.