Immunological Monitoring During Anti-CD20 Therapies to Predict Infection Risk and Treatment Response in Multiple...

Area of Science:

• Neuroimmunology
• Immunology
• Infectious Diseases

Background:

• Disease-modifying therapies (DMTs) for multiple sclerosis (MS) require immunological monitoring to anticipate infectious complications.
• Anti-CD20 treatments are widely used for MS, but their impact on patient immunodeficiency requires further investigation.
• Identifying predictive immunological markers for infection risk and treatment response is crucial for managing MS patients.

Purpose of the Study:

• To determine if anti-CD20 therapies in MS patients induce immunodeficiency.
• To evaluate specific immunological parameters for predicting infection risk.
• To assess the potential of immunological markers in predicting treatment response in MS patients.

Main Methods:

• Retrospective, observational, single-centre study of MS patients treated with ocrelizumab or rituximab (2017-2023).
• Analysis of lymphocyte subpopulations (T, B, NK) and immunoglobulin levels (IgG, IgA, IgM) at baseline and 24-month follow-up.
• Detailed baseline B cell analysis, including CD20 depletion assessment during follow-up.

Main Results:

• Sixty-four percent of patients experienced infections, primarily COVID-19; IgG hypogammaglobulinemia was a significant risk factor.
• Infections correlated with reduced mature memory B cells and lower NK cell percentages.
• Lower naïve and mature memory B cell proportions were linked to inflammatory activity and disease progression, respectively; lack of CD20 depletion predicted clinical worsening.

Conclusions:

• Baseline immunophenotyping and ongoing immunological monitoring are valuable for predicting infection risk in MS patients.
• These assessments can also help predict the efficacy of anti-CD20 therapies in multiple sclerosis.
• Immunological monitoring aids in personalized treatment strategies for MS patients receiving anti-CD20 agents.