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Published on: December 9, 2015
Prediction of multiple sclerosis outcomes when switching to ocrelizumab
Michael Zhong1, Anneke van der Walt1, Jim Stankovich2
1Central Clinical School, Monash University, Melbourne, VIC, Australia/Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia.
Background:
Increasingly, people with relapsing-remitting multiple sclerosis (RRMS) are switched to highly effective disease-modifying therapies (DMTs) such as ocrelizumab.
Objective:
To determine predictors of relapse and disability progression when switching from another DMT to ocrelizumab.
Methods:
Patients with RRMS who switched to ocrelizumab were identified from the MSBase Registry and grouped by prior disease-modifying therapy (pDMT; interferon-β/glatiramer acetate, dimethyl fumarate, teriflunomide, fingolimod or natalizumab) and washout duration (<1 month, 1-2 months or 2-6 months). Survival analyses including multivariable Cox proportional hazard regression models were used to identify predictors of on-ocrelizumab relapse within 1 year, and 6-month confirmed disability progression (CDP).
Results:
After adjustment, relapse hazard when switching from fingolimod was greater than other pDMTs, but only in the first 3 months of ocrelizumab therapy (hazard ratio (HR) = 3.98, 95% confidence interval (CI) = 1.57-11.11, p = 0.004). The adjusted hazard for CDP was significantly higher with longer washout (2-6 m compared to <1 m: HR = 9.57, 95% CI = 1.92-47.64, p = 0.006).
Conclusion:
The risk of disability worsening during switch to ocrelizumab is reduced by short treatment gaps. Patients who cease fingolimod are at heightened relapse risk in the first 3 months on ocrelizumab. Prospective evaluation of strategies such as washout reduction may help optimise this switch.
Insights
Switching to ocrelizumab poses a higher relapse risk for patients previously on fingolimod. Minimizing treatment gaps when switching disease-modifying therapies (DMTs) for multiple sclerosis (MS) is crucial for reducing disability progression.
Area of Science:
- Neurology
- Immunology
- Pharmacology
Background:
- Relapsing-remitting multiple sclerosis (RRMS) management increasingly involves switching to highly effective disease-modifying therapies (DMTs) like ocrelizumab.
- Understanding predictors of disease activity during these treatment transitions is essential for patient care.
Purpose of the Study:
- To identify factors associated with relapse and disability progression when transitioning from prior DMTs to ocrelizumab in RRMS patients.
- To analyze the impact of prior DMT and washout duration on outcomes after switching to ocrelizumab.
Main Methods:
- Utilized the MSBase Registry to identify RRMS patients switching to ocrelizumab.
- Grouped patients by prior DMT (e.g., fingolimod, interferon-β/glatiramer acetate) and washout duration (<1 month, 1-2 months, 2-6 months).
- Applied survival analyses, including multivariable Cox regression, to assess predictors of on-ocrelizumab relapse and 6-month confirmed disability progression (CDP).
Main Results:
- Switching from fingolimod increased relapse hazard within the first 3 months of ocrelizumab therapy (HR=3.98).
- Longer washout durations (2-6 months vs. <1 month) were associated with a significantly higher hazard of CDP (HR=9.57).
Conclusions:
- Shortening treatment gaps during DMT switches to ocrelizumab can mitigate the risk of disability worsening.
- Patients discontinuing fingolimod require close monitoring for heightened relapse risk in the initial 3 months of ocrelizumab treatment.
- Further research into optimizing switching strategies, such as reducing washout periods, is warranted.
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