Relative increase of memory B-cell subsets under s.c. B-cell-depleting therapies in multiple sclerosis

Monoclonal antibodies targeting CD20-expressing B cells constitute effective therapies for people with multiple sclerosis (pwMS) and can be administered intravenously (i.v.) or subcutaneously (s.c.). However, little is known about the differences in immunomodulatory effects of distinct B-cell depletion therapies.

We performed detailed characterizations of the immune cell composition in blood samples of pwMS treated with either i.v. [ocrelizumab (Ocre); n = 25] or s.c. [ofatumumab (Ofa); n = 25 or Ocre n = 25] administered anti-CD20 therapy compared to healthy controls (HC, n = 20). In addition, blood samples from n = 25 pwMS who switched their anti-CD20 therapy from i.v. Ocre to s.c. Ofa injection were analyzed before therapy change and after 4 and 8 weeks. We performed flow cytometry analysis of whole blood samples and purified peripheral blood mononuclear cells for intracellular cytokine staining.

Both anti-CD20 mAbs resulted in a depletion of CD19⁺ B cells [median (IQR) HC: 16.5 (10.1-22.2), Ocre i.v.: 0.4 (0.1-0.9), Ocre s.c.: 0.8 (0.4-1.2), Ofa s.c.: 1.7 (0.8-2.2)] and CD20⁺ T cells [median (IQR) HC: 9.1 (6.6-16), Ocre i.v.: 0.6 (0.1-1), Ocre s.c.: 0.3 (0.2-0.5), Ofa s.c.: 0.1 (0.1-0.4)] in peripheral blood. More in-depth characterization of the patients' remaining B cells indicated higher percentages of memory B cells in Ocre and Ofa s.c. compared to Ocre i.v. treated pwMS [median (IQR) Ocre i.v.: 6.6 (0-13), Ocre s.c.: 18.4 (4-26.8), Ofa s.c.: 26.4 (21.1-30)]. In pwMS who switched from i.v. Ocre to s.c. Ofa therapy, the percentage of memory B cells increased over time [median (IQR) baseline: 14.6 (6.4-20.8), 4 weeks after switch: 12.1 (6-23.4), 8 weeks after switch: 22.8 (16.7-29.5)]. I.v. Ocre treatment led to significantly lower serum IgG levels in pwMS compared to HC.

Our data add to the knowledge on distinct antibody-specific properties and differential effects of s.c. versus i.v. administered B-cell depletion in pwMS. We identified a higher percentage of memory B cells in s.c. Ocre and Ofa B cell-depleted pwMS and pwMS who switched their anti-CD20 therapy from i.v. Ocre to s.c. Ofa injection. Further analysis will be needed to investigate how these observations link to safety and efficacy profiles of the different anti-CD20 therapies.