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Ocrelizumab in MS patients with persistence of disease activity after alemtuzumab: A multi-center Italian study

Caterina Lapucci1, Jessica Frau2, Eleonora Cocco2,3

  • 1IRCCS Ospedale Policlinico San Martino, Genoa, Italy.

Multiple Sclerosis (Houndmills, Basingstoke, England)
|August 15, 2024
PubMed
Abstract

Insights

Ocrelizumab (OCR) appears safe and effective for multiple sclerosis (MS) patients with disease activity after alemtuzumab (ALM). However, inflammatory activity between ALM courses may increase relapse risk on OCR.

Area of Science:

  • Neuroimmunology
  • Clinical Neurology
  • Pharmacology

Background:

  • The efficacy of sequential therapy in multiple sclerosis (MS) remains an area of active research.
  • Understanding disease activity after alemtuzumab (ALM) is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To evaluate the safety and efficacy of ocrelizumab (OCR) as a sequential therapy in MS patients experiencing disease activity post-alemtuzumab (ALM).

Main Methods:

  • An observational, retrospective, multi-center Italian cohort study was conducted.
  • Seventy-two MS patients with disease activity after two ALM courses were included.
  • Follow-up data were collected over a mean period of 2.4 years.

Main Results:

  • Ocrelizumab (OCR) treatment demonstrated high 2-year relapse-free (92.1%), MRI-activity-free (90.8%), and disability-worsening-free (89.2%) survival rates.
  • Adverse events were reported in 62.5% of patients, primarily infections (96.7%).
  • Lymphocyte depletion and decreased Immunoglobulin M (IgM) levels were observed, with a higher risk of relapse and MRI activity in patients with inflammatory activity between ALM courses.

Conclusions:

  • Ocrelizumab (OCR) is a potentially safe and effective sequential treatment option for MS patients with persistent disease activity after alemtuzumab (ALM).
  • Early IgM hypogammaglobulinemia is a notable side effect.
  • Pre-treatment inflammatory activity between alemtuzumab courses is a significant predictor of suboptimal response to ocrelizumab.
Keywords:
Multiple sclerosisalemtuzumabefficacyinductionocrelizumabsafetytherapy

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