Comparative Safety Profiles of Ocrelizumab and Rituximab in Multiple Sclerosis Treatment Using Real-World Evidence

Area of Science:

• Neurology
• Immunology
• Pharmacology

Background:

• Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
• Ocrelizumab and rituximab are B-cell depleting therapies used in MS management.
• Comparing their long-term safety is crucial for optimizing patient care.

Purpose of the Study:

• To compare the long-term safety profiles of ocrelizumab and rituximab in individuals with multiple sclerosis.
• To evaluate differences in hospitalization rates, hypogammaglobulinemia, and infection incidence between the two treatments.

Main Methods:

• Retrospective analysis of University of California Health System data, simulating a target clinical trial.
• Propensity score matching was used to balance patient characteristics between ocrelizumab and rituximab groups.
• Primary endpoint: all-cause hospitalization rate; secondary endpoints: hypogammaglobulinemia and infection incidence.

Main Results:

• Rituximab was associated with significantly higher all-cause hospitalization rates compared to ocrelizumab in both primary (IRR=2.29) and validation (IRR=4.54) cohorts.
• The risk of developing hypogammaglobulinemia was also higher with rituximab (UCSF HR=2.72, UC-wide HR=4.79).
• Cumulative hazard ratios for adverse events were elevated with rituximab in both analyzed cohorts.

Conclusions:

• Ocrelizumab exhibits a more favorable long-term safety profile than rituximab in multiple sclerosis patients.
• Lower rates of hospitalization and hypogammaglobulinemia were observed with ocrelizumab.
• These findings support ocrelizumab as a potentially safer treatment option for managing MS.