1
|
Graille-Avy L, Boutiere C, Rigollet C, Perriguey M, Rico A, Demortiere S, Durozard P, Hilezian F, Vely F, Bertault-Peres P, Pelletier J, Maarouf A, Audoin B. Effect of Prior Treatment With Fingolimod on Early and Late Response to Rituximab/Ocrelizumab in Patients With Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200231. [PMID: 38626360 PMCID: PMC11090020 DOI: 10.1212/nxi.0000000000200231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/02/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND AND OBJECTIVES Real-life studies noted that the risk of disease activity in multiple sclerosis (MS) after switching to rituximab (RTX) or ocrelizumab (OCR) may be unequal depending on prior disease-modifying therapy (DMT), with a higher risk associated with fingolimod (FING). METHODS We performed a retrospective analysis of a structured prospective data collection including all consecutive patients with relapsing MS who were prescribed RTX/OCR in the MS center of Marseille. Cox proportional hazards models were applied to clinical and MRI outcomes. RESULTS We included 321 patients with a median (interquartile range [IQR]) follow-up of 3.5 years (1.5-5) after RTX/OCR initiation. At the first RTX/OCR infusion, the mean (SD) age of patients was 37 (10) years, and the median (IQR) disease duration was 8 years (3-15): 68 patients did not receive treatment before RTX/OCR and 108 switched from FING, 47 from low efficacy therapy, and 98 from natalizumab. For statistical analysis, the group "FING" was divided into "short-FING" and "long-FING" groups according to the median value of the group's washout period (27 days). On Cox proportional hazards analysis, for only the "long-FING" group, the risk of relapse within the first 6 months of RTX/OCR was increased as compared with patients without previous DMT (hazard ratio [HR]: 8.78; 95% CI 1.72-44.86; p < 0.01). Previous DMT and washout period duration of FING had no effect on B-cell levels at 6 months. Beyond the first 6 months of RTX/OCR, age <40 years was associated with increased risk of relapse (HR: 3.93; 95% CI 1.30-11.89; p = 0.01), male sex with increased risk of new T2 lesions (HR: 2.26; 95% CI 1.08-4.74; p = 0.03), and EDSS ≥2 with increased risk of disability accumulation (HR: 3.01; 95% CI 1.34-6.74; p < 0.01). Previous DMT had no effect on the effectiveness of RTX/OCR beyond 6 months after initiation. DISCUSSION For patients switching from FING to RTX/OCR, the risk of disease reactivation within the first 6 months of treatment was increased as compared with patients with other DMT or no previous DMT only when the washout period exceeded 26 days. Neither FING nor other previous DMT reduced the effectiveness of RTX/OCR beyond the first 6 months of treatment.
Collapse
Affiliation(s)
- Lisa Graille-Avy
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Clemence Boutiere
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Camille Rigollet
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Marine Perriguey
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Audrey Rico
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Sarah Demortiere
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Pierre Durozard
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Frederic Hilezian
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Frederic Vely
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Pierre Bertault-Peres
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Jean Pelletier
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Adil Maarouf
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| | - Bertrand Audoin
- From the APHM (L.G.-A., C.B., C.R., M.P., A.R., S.D., F.H., J.P., A.M., B.A.), Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie; Aix-Marseille University (A.R., J.P., A.M., B.A.), CNRS, CRMBM, Marseille; Centre hospitalier d'Ajaccio (P.D.), Service de Neurologie, Ajaccio; APHM (F.V.), Hôpital de la Timone, Service d'immunologie, Marseille Immunopôle; Aix Marseille University (F.V.), CNRS, INSERM, CIML; and APHM (P.B.-P.), Hôpital de la Timone, Service Pharmacie, Marseille, France
| |
Collapse
|
4
|
Ferraro D, Iaffaldano P, Guerra T, Inglese M, Capobianco M, Brescia Morra V, Zaffaroni M, Mirabella M, Lus G, Patti F, Cavalla P, Cellerino M, Malucchi S, Pisano E, Vitetta F, Paolicelli D, Sola P, Trojano M. Risk of multiple sclerosis relapses when switching from fingolimod to cell-depleting agents: the role of washout duration. J Neurol 2021; 269:1463-1469. [PMID: 34292396 DOI: 10.1007/s00415-021-10708-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fingolimod (FTY) induces sequestration of lymphocytes in secondary lymphoid organs and the average lymphocyte recovery following discontinuation takes 1-2 months. It has been hypothesized that the therapeutic effects of subsequent cell-depleting agents may be compromised if initiated before lymphocyte recovery has occurred. OBJECTIVE To assess the risk of relapses following FTY discontinuation and the initiation of a B/T cell-depleting agent in relation to washout duration using data from the Italian MS Register. METHODS The risk of relapses was assessed in relation to different washout durations (< 6, 6-11, 12-17 and > / = 18 weeks) in patients starting alemtuzumab, rituximab, ocrelizumab or cladribine following FTY discontinuation. RESULTS We included 329 patients in the analysis (226F, 103 M; mean age 41 ± 10 years). During the cell-depleting treatment, the incidence rate ratio for a relapse was significantly greater in patients with a washout period of 12-17 and > / = 18 weeks compared to the reference period (< 6 weeks). The risk of a relapse was significantly influenced by the occurrence of relapses during FTY treatment and by washout length, with hazard ratios markedly increasing with the washout duration. CONCLUSION The risk of relapses increases with the washout duration when switching from FTY to lymphocyte-depleting agents.
Collapse
Affiliation(s)
- D Ferraro
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy. .,Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126, Modena, Italy.
| | - P Iaffaldano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Policlinico, Bari, Italy
| | - T Guerra
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Policlinico, Bari, Italy
| | - M Inglese
- Department of Neuroscience, Rehabilitation, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - M Capobianco
- Regional Referral MS Center, Neurological Unit, University Hospital San Luigi, Orbassano, Italy
| | | | - M Zaffaroni
- Multiple Sclerosis Center, Gallarate Hospital, ASST Della Valle Olona, Gallarate, Italy
| | - M Mirabella
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Lus
- MS Center, II Division of Neurology, Univ. Della Campania "L. Vanvitelli", Naples, Italy
| | - F Patti
- Multiple Sclerosis Centre, AOU Policlinico "G. Rodolico", Catania, Italy.,Department of Medical and Surgical and Advanced Technologies, GF Ingrassia, University of Catania, Catania, Italy
| | - P Cavalla
- MS Centre, I Division of Neurology, City of Health and Science Turin Univ. Hospital, Turin, Italy
| | - M Cellerino
- Department of Neuroscience, Rehabilitation, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - S Malucchi
- Regional Referral MS Center, Neurological Unit, University Hospital San Luigi, Orbassano, Italy
| | - E Pisano
- MS Center-AOU Policlinico Federico II, Naples, Italy
| | - F Vitetta
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - D Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Policlinico, Bari, Italy
| | - P Sola
- Neurology Unit, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - M Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Policlinico, Bari, Italy
| | | |
Collapse
|