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Multicenter Study
. 2024 Nov:91:105900.
doi: 10.1016/j.msard.2024.105900. Epub 2024 Sep 28.

The recurrence of disease activity after ocrelizumab discontinuation in multiple sclerosis

E Coerver  1 , L Schoof  2 , L Hogenboom  1 , M Wessels  1 , P van Ruyven  1 , A van Samkar  3 , J Mostert  4 , Z van Kempen  1 , B W van Oosten  1 , B H Wokke  5 , E Tallantyre  6 , K M Myhr  7 , O Torkildsen  7 , J Killestein  1 , I Smets  5 , E Strijbis  1
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Free article
Multicenter Study

The recurrence of disease activity after ocrelizumab discontinuation in multiple sclerosis

E Coerver et al. Mult Scler Relat Disord. 2024 Nov.
Free article

Abstract

Introduction: Ocrelizumab (OCR) is a highly effective treatment of multiple sclerosis (MS), and B cell repopulation profiles suggest that it might be used as an immune reconstitution therapy. However, data on disease recurrence after stopping treatment with OCR are scarce. Our objective was to evaluate the recurrence of disease activity after OCR discontinuation.

Methods: In this multicenter retrospective cohort study, we included MS patients who discontinued OCR, without switching to another treatment, for twelve months or more, after having received at least one full dosage of 600 mg. We defined focal inflammation as the occurrence of a clinical relapse or significant MRI activity (≥3 new T2 lesions or ≥2 contrast-enhancing lesions).

Results: We included 53 MS patients; 41 relapsing remitting (RRMS), 5 secondary progressive (SPMS) and 7 primary progressive (PPMS) patients. Median follow-up period after OCR discontinuation was 16 months. We only observed focal inflammation after discontinuation in RRMS patients; 2.4 % (1/41) patients presented with significant MRI activity and matching clinical symptoms, and 7.3 % (3/41) patients presented with a suspected clinical relapse without radiological activity: a total of 9.8 % (4/41) at a median time of 17 months after the last infusion.

Discussion: We found focal inflammation after discontinuation of OCR in 4 (9.8 %) of the RRMS patients, of which 1 was radiologically confirmed. Our observations highlight that recurrence of focal inflammation seems low but discontinuation may not be appropriate for everyone. Further larger studies are important to determine the immune reconstitution therapy potential of OCR.

Keywords: Multiple sclerosis; Ocrelizumab; Treatment discontinuation.

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Conflict of interest statement

Declaration of competing interest E. Coerver reports no disclosures. L. Schoof reports no disclosures. L. Hogenboom reports no disclosures. M. Wessels reports no disclosures. P. v. Ruyven reports no disclosures. A. v. Samkar reports no disclosures. J. Mostert reports no disclosures. Z. v. Kempen reports no disclosures. B. v. Oosten reports no disclosures. B. Wokke reports no disclosures. E. Tallantyre has received honorarium for consulting work from Biogen, Janssen, Merck, Novartis, and Roche. She has received travel grants to attend or speak at educational meetings from Biogen, Merck, Roche, Takeda and Novartis. KM. Myrh has received speaker honoraria from Alexion, Biogen, Novartis, or Sanofi and has participated in clinical trials organized by Biogen, Merck, Novartis, Roche, and Sanofi. O. Torkildsen received speaker honoraria from Biogen, Merck, Sanofi, Teva, Gilead, Janssen and Novartis; and has participated in clinical trials organized by Biogen, Merck, Sanofi, Novartis, and Roche. J. Killestein received consulting fees for F. Hoffmann-La Roche, Biogen, Teva, Merck, Novartis and Sanofi/Genzyme (payments to institution); reports speaker relationships with F. Hoffmann-La Roche, Biogen, Teva, Merck, Novartis and Sanofi/Genzyme (payments to institution); adjudication committee of MS clinical trials of Immunic (payments to institution). I. Smets received honoraria from Merck, Biogen Idec and Sanofi. E. Strijbis has received speaker fees from Merck and Novartis.

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