1
|
Rindi LV, Zaçe D, Braccialarghe N, Massa B, Barchi V, Iannazzo R, Fato I, De Maria F, Kontogiannis D, Malagnino V, Sarmati L, Iannetta M. Drug-Induced Progressive Multifocal Leukoencephalopathy (PML): A Systematic Review and Meta-Analysis. Drug Saf 2024; 47:333-354. [PMID: 38321317 DOI: 10.1007/s40264-023-01383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Progressive multifocal leukoencephalopathy (PML) was first described among patients affected by hematological or solid tumors. Following the human immunodeficiency virus (HIV) epidemic, people living with HIV have represented most cases for more than a decade. With the diffusion of highly active antiretroviral therapy, this group progressively decreased in favor of patients undergoing treatment with targeted therapy/immunomodulators. In this systematic review and meta-analysis, the objective was to assess which drugs are most frequently related to PML development, and report the incidence of drug-induced PML through a meta-analytic approach. METHODS The electronic databases MEDLINE, EMBASE, ClinicalTrials.gov, Web of Science and the Canadian Agency for Drugs and Technologies in Health Database (CADTH) were searched up to May 10, 2022. Articles that reported the risk of PML development after treatment with immunomodulatory drugs, including patients of both sexes under the age of 80 years, affected by any pathology except HIV, primary immunodeficiencies or malignancies, were included in the review. The incidence of drug-induced PML was calculated based on PML cases and total number of patients observed per 100 persons and the observation time. Random-effect metanalyses were conducted for each drug reporting pooled incidence with 95% confidence intervals (CI) and median (interquartile range [IQR]) of the observation time. Heterogeneity was measured by I2 statistics. Publication bias was examined through funnel plots and Egger's test. RESULTS A total of 103 studies were included in the systematic review. In our analysis, we found no includible study reporting cases of PML during the course of treatment with ocrelizumab, vedolizumab, abrilumab, ontamalimab, teriflunomide, daclizumab, inebilizumab, basiliximab, tacrolimus, belimumab, infliximab, firategrast, disulone, azathioprine or danazole. Dalfampridine, glatiramer acetate, dimethyl fumarate and fingolimod show a relatively safe profile, although some cases of PML have been reported. The meta-analysis showed an incidence of PML cases among patients undergoing rituximab treatment for multiple sclerosis (MS) of 0.01 cases/100 persons (95% CI - 0.08 to 0.09; I2 = 20.4%; p = 0.25) for a median observation period of 23.5 months (IQR 22.1-42.1). Treatment of MS with natalizumab carried a PML risk of 0.33 cases/100 persons (95% CI 0.29-0.37; I2 = 50%; p = 0.003) for a median observation period of 44.1 months (IQR 28.4-60) and a mean number of doses of 36.3 (standard deviation [SD] ± 20.7). When comparing data about patients treated with standard interval dosing (SID) and extended interval dosing (EID), the latter appears to carry a smaller risk of PML, that is, 0.08 cases/100 persons (95% CI 0.0-0.15) for EID versus 0.3 cases/100 persons (95% CI 0.25-0.34) for SID. CONCLUSIONS A higher risk of drug-related PML in patients whose immune system is not additionally depressed by means of neoplasms, HIV or concomitant medications is found in the neurological field. This risk is higher in MS treatment, and specifically during long-term natalizumab therapy. While this drug is still routinely prescribed in this field, considering the efficacy in reducing MS relapses, in other areas it could play a smaller role, and be gradually replaced by other safer and more recently approved agents.
Collapse
Affiliation(s)
- Lorenzo Vittorio Rindi
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Drieda Zaçe
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Neva Braccialarghe
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Barbara Massa
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Virginia Barchi
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Roberta Iannazzo
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Ilenia Fato
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Francesco De Maria
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Dimitra Kontogiannis
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Vincenzo Malagnino
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Loredana Sarmati
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Marco Iannetta
- Department of Systems Medicine, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy.
- Infectious Disease Clinic, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
| |
Collapse
|
2
|
Prosperini L, Haggiag S, Ruggieri S, Tortorella C, Gasperini C. Stopping Disease-Modifying Treatments in Multiple Sclerosis: A Systematic Review and Meta-Analysis of Real-World Studies. CNS Drugs 2023; 37:915-927. [PMID: 37740822 DOI: 10.1007/s40263-023-01038-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The question of whether multiple sclerosis requires life-long disease-modifying treatments (DMTs) remains unanswered. Some studies suggest that older patients with stable disease may safely discontinue their DMTs, yet comprehensive evidence-based data are scarce and real-world studies have provided mixed results. OBJECTIVE The aim of this study was to assess the rate of disease reactivation and associated risk factors after discontinuation of DMTs in patients with multiple sclerosis. METHODS We searched scientific databases (PubMed/MEDLINE, Scopus and Google Scholar) to identify real-world studies published until 31 July, 2023 that reported the number of patients who experienced relapses and/or disability accrual (outcomes of interest) following a therapy discontinuation longer than 12 months. Magnetic resonance activity and treatment re-start after DMT discontinuation were also considered as additional outcomes. We excluded studies where therapy discontinuation was explicitly related to an unintended or planned pregnancy or preceded a treatment switch. We ran random-effects meta-analyses, subgroup analyses and meta-regression models to provide pooled estimates of post-discontinuation relapse and disability events, and to identify their potential moderators (predictors). RESULTS After an independent screening, 22 articles met the eligibility criteria, yielding a pooled sample size of 2942 patients followed for 1-7 years after discontinuation (11,689 patient-years). The pooled rates for relapse and disability events were 6.7 and 5.8 per 100 patient-years, respectively. However, available data did not allow us to disentangle isolated disability accrual from relapse-associated worsening. Studies including older patients (β = -0.65, p = 0.006), patients with a longer exposure to DMTs (β = -2.22, p = 0.001) and patients with a longer period of disease stability (β = -2.74, p = 0.002) showed a lower risk of relapse events. According to meta-regression equations, the risk of relapse events after DMT discontinuation became negligible (arbitrarily set at < 1% per year) at approximately 60 years of age, and after either 10 years of DMT exposure, or 8 years of disease stability. Additional analyses showed pooled rates for magnetic resonance imaging activity and re-start events of 16.7 and 17.5 per 100 patient-years, respectively. CONCLUSIONS Based on our quantitative synthesis of real-world data, in the absence of definitive answers from clinical trials, DMT discontinuation appears feasible with a high degree of certainty in selected patients. While our findings are robust regarding relapse events, future efforts are warranted to determine if DMT discontinuation is associated with isolated disability accrual.
Collapse
Affiliation(s)
- Luca Prosperini
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy.
| | - Shalom Haggiag
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University, Viale dell'Università 30, 00185, Rome, Italy
- Neuroimmunology Unit, Santa Lucia Foundation, Via del Fosso di Fiorano 64/65, 00143, Rome, Italy
| | - Carla Tortorella
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| | - Claudio Gasperini
- Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy
| |
Collapse
|
3
|
Alharbi MA, Aldosari F, Althobaiti AH, Abdullah FM, Aljarallah S, Alkhawajah NM, Alanazi M, AlRuthia Y. Clinical and economic evaluations of natalizumab, rituximab, and ocrelizumab for the management of relapsing-remitting multiple sclerosis in Saudi Arabia. BMC Health Serv Res 2023; 23:552. [PMID: 37237257 DOI: 10.1186/s12913-023-09462-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION The advent of new disease-modifying therapies (DMTs), such as monoclonal antibodies (mAbs), resulted in significant changes in the treatment guidelines for Multiple sclerosis (MS) and improvement in the clinical outcomes. However, mAbs, such as rituximab, natalizumab, and ocrelizumab, are expensive with variable effectiveness rates. Thus, the present study aimed to compare the direct medical cost and consequences (e.g., clinical relapse, disability progression, and new MRI lesions) between rituximab and natalizumab in managing relapsing-remitting multiple sclerosis (RRMS) in Saudi Arabia. Also, the study aimed to explore the cost and consequence of ocrelizumab in managing RRMS as a second-choice treatment. METHODS The electronic medical records (EMRs) of patients with RRMS were retrospectively reviewed to retrieve the patients' baseline characteristics and disease progression from two tertiary care centers in Riyadh, Saudi Arabia. Biologic-naïve patients treated with rituximab or natalizumab or those switched to ocrelizumab and treated for at least six months were included in the study. The effectiveness rate was defined as no evidence of disease activity (NEDA-3) (i.e., absence of new T2 or T1 gadolinium (Gd) lesions as demonstrated by the Magnetic Resonance Imaging (MRI), disability progression, and clinical relapses), while the direct medical costs were estimated based on the utilization of healthcare resources. In addition, bootstrapping with 10,000 replications and inverse probability weighting based on propensity score were conducted. RESULTS Ninety-three patients met the inclusion criteria and were included in the analysis (natalizumab (n = 50), rituximab (n = 26), ocrelizumab (n = 17)). Most of the patients were otherwise healthy (81.72%), under 35 years of age (76.34%), females (61.29%), and on the same mAb for more than one year (83.87%). The mean effectiveness rates for natalizumab, rituximab, and ocrelizumab were 72.00%, 76.92%, and 58.83%, respectively. Natalizumab mean incremental cost compared to rituximab was $35,383 (95% CI: $25,401.09- $49,717.92), and its mean effectiveness rate was 4.92% lower than rituximab (95% CI: -30-27.5) with 59.41% confidence level that rituximab will be dominant. CONCLUSIONS Rituximab seems to be more effective and is less costly than natalizumab in the management of RRMS. Ocrelizumab does not seem to slow the rates of disease progression among patients previously treated with natalizumab.
Collapse
Affiliation(s)
- Mansour A Alharbi
- Department of Pharmacy, King Saud Medical City, Riyadh, 12746, Saudi Arabia
| | - Fahad Aldosari
- Department of Pharmacy, King Saud Medical City, Riyadh, 12746, Saudi Arabia
| | | | - Faris M Abdullah
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, 24382, Saudi Arabia
| | - Salman Aljarallah
- Department of Medicine, Neurology Division, College of Medicine, King Saud University, P.O. Box 3145, Riyadh, 12372, Saudi Arabia
| | - Nuha M Alkhawajah
- Department of Medicine, Neurology Division, College of Medicine, King Saud University, P.O. Box 3145, Riyadh, 12372, Saudi Arabia
| | - Miteb Alanazi
- Department of Pharmacy, King Khalid University Hospital, P.O. Box 3145, Riyadh, 12372, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh, 11451, Saudi Arabia.
- Pharmacoeconomics Research Unit, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh, 11451, Saudi Arabia.
| |
Collapse
|
4
|
Muñoz-Vendrell A, Arroyo-Pereiro P, León I, Bau L, Matas E, Martínez-Yélamos A, Martínez-Yélamos S, Romero-Pinel L. Natalizumab continuation versus switching to ocrelizumab after PML risk stratification in RRMS patients: a natural experiment. J Neurol 2023; 270:2559-2566. [PMID: 36913038 PMCID: PMC10129953 DOI: 10.1007/s00415-023-11645-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Natalizumab (NTZ) and ocrelizumab (OCR) can be used for the treatment of relapsing-remitting multiple sclerosis (RRMS). In patients treated with NTZ, screening for JC virus (JCV) is mandatory, and a positive serology usually requires a change in treatment after 2 years. In this study, JCV serology was used as a natural experiment to pseudo-randomize patients into NTZ continuation or OCR. METHODS An observational analysis of patients who had received NTZ for at least 2 years and were either changed to OCR or maintained on NTZ, depending on JCV serology status, was performed. A stratification moment (STRm) was established when patients were pseudo-randomized to either arm (NTZ continuation if JCV negativity, or change to OCR if JCV positivity). Primary endpoints include time to first relapse and presence of relapses after STRm and OCR initiation. Secondary endpoints include clinical and radiological outcomes after 1 year. RESULTS Of the 67 patients included, 40 continued on NTZ (60%) and 27 were changed to OCR (40%). Baseline characteristics were similar. Time to first relapse was not significantly different. Ten patients in the JCV + OCR arm presented a relapse after STRm (37%), four during the washout period, and 13 patients in the JCV-NTZ arm (32.5%, p = 0.701). No differences in secondary endpoints were detected in the first year after STRm. CONCLUSIONS The JCV status can be used as a natural experiment to compare treatment arms with a low selection bias. In our study, switching to OCR versus NTZ continuation led to similar disease activity outcomes.
Collapse
Affiliation(s)
- Albert Muñoz-Vendrell
- Neurology Department, Multiple Sclerosis Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga S/N, 08907, Barcelona, Spain
| | - Pablo Arroyo-Pereiro
- Neurology Department, Multiple Sclerosis Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga S/N, 08907, Barcelona, Spain.
| | - Isabel León
- Neurology Department, Multiple Sclerosis Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga S/N, 08907, Barcelona, Spain
| | - Laura Bau
- Neurology Department, Multiple Sclerosis Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga S/N, 08907, Barcelona, Spain
| | - Elisabet Matas
- Neurology Department, Multiple Sclerosis Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga S/N, 08907, Barcelona, Spain
| | - Antonio Martínez-Yélamos
- Neurology Department, Multiple Sclerosis Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga S/N, 08907, Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Neurology Department, Multiple Sclerosis Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga S/N, 08907, Barcelona, Spain
| | - Lucía Romero-Pinel
- Neurology Department, Multiple Sclerosis Unit, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Carrer de la Feixa Llarga S/N, 08907, Barcelona, Spain
| |
Collapse
|
5
|
Santiago-Setien P, Barquín-Rego C, Hernández-Martínez P, Ezquerra-Marigomez M, Torres-Barquin M, Menéndez-Garcia C, Uriarte F, Jiménez-López Y, Misiego M, Sánchez de la Torre JR, Setien S, Delgado-Alvarado M, Riancho J. Switch to ocrelizumab in MS patients treated with natalizumab in extended interval dosing at high risk of PML: A 96-week follow-up pilot study. Front Immunol 2023; 14:1086028. [PMID: 36817456 PMCID: PMC9929864 DOI: 10.3389/fimmu.2023.1086028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/23/2023] [Indexed: 02/04/2023] Open
Abstract
We aimed to assess the long-term safety and effectiveness of ocrelizumab in a cohort of patients with multiple sclerosis (MS) at high risk of progressive multifocal leukoencephalopathy (PML), previously treated with natalizumab in extending interval dosing (EID), who switched to ocrelizumab and to compare them with patients who continued EID-natalizumab. Thirty MS patients previously treated with natalizumab in EID (every 8 weeks) were included in this observational retrospective cohort study. Among them, 17 patients were switched to ocrelizumab and 13 continued with EID-natalizumab. Except for the John Cunningham virus (JCV) index, no significant differences were detected between both groups. Main outcome measures included: annualized relapse rate (ARR), radiological activity, disability progression, and the NEDA-3 index. Patients were followed for 96 weeks. The median washout period in ocrelizumab-switchers was 6 weeks. Among them, AAR and radiological activity during follow-up were 0.03, without significant differences in comparison with the previous period on natalizumab-EID. The comparison between ocrelizumab-switchers and patients continuing on EID-natalizumab showed no significant differences in AAR, radiological activity, or disability progression. However, the proportion of patients maintaining a NEDA-3 status in week 96 was slightly superior among ocrelizumab-switchers (94 vs 69%). No serious adverse events were observed in any group. In conclusion, switching from EID-natalizumab to ocrelizumab can be considered as a therapeutic option, particularly in patients with MS at high risk of PML, to mitigate the risks of both PML and disease reactivation.
Collapse
Affiliation(s)
- Pilar Santiago-Setien
- Service of Neurology, Hospital Sierrallana-Institute of Research Valdecilla (IDIVAL), Torrelavega, Spain
| | - Cristina Barquín-Rego
- Service of Neurology, Hospital Sierrallana-Institute of Research Valdecilla (IDIVAL), Torrelavega, Spain
| | | | | | | | | | | | - Yésica Jiménez-López
- Service of Neurology, Hospital Sierrallana-Institute of Research Valdecilla (IDIVAL), Torrelavega, Spain
| | - Mercedes Misiego
- Service of Neurology, Hospital Sierrallana-Institute of Research Valdecilla (IDIVAL), Torrelavega, Spain
| | | | - Sonia Setien
- Service of Neurology, Hospital Sierrallana-Institute of Research Valdecilla (IDIVAL), Torrelavega, Spain
| | - Manuel Delgado-Alvarado
- Service of Neurology, Hospital Sierrallana-Institute of Research Valdecilla (IDIVAL), Torrelavega, Spain
- Centro de Investigación en Red de Enfermedades Neurodegenerativas, CIBERNED, Instituto Carlos III, Madrid, Spain
| | - Javier Riancho
- Service of Neurology, Hospital Sierrallana-Institute of Research Valdecilla (IDIVAL), Torrelavega, Spain
- Centro de Investigación en Red de Enfermedades Neurodegenerativas, CIBERNED, Instituto Carlos III, Madrid, Spain
- Department of Medicine and Psychiatry, University of Cantabria, Santander, Spain
- Red Española de Esclerosis Múltiple, Madrid, Spain
| |
Collapse
|
6
|
Saidha S, Bell J, Harold S, Belisario JM, Hawe E, Shao Q, Wyse K, Maiese EM. Systematic literature review of immunoglobulin trends for anti-CD20 monoclonal antibodies in multiple sclerosis. Neurol Sci 2023; 44:1515-1532. [PMID: 36648561 PMCID: PMC9843103 DOI: 10.1007/s10072-022-06582-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To exp lore changes in immunoglobulin (Ig) levels for people with relapsing-multiple sclerosis (RMS) treated with ocrelizumab or ofatumumab and the relationship between Ig levels and infections. METHODS A systematic literature review (SLR) was conducted to identify clinical trials and real-world evidence (RWE) studies on Ig levels over time and studies on associations with infections for ocrelizumab and ofatumumab for people with RMS through 10 September 2021. Searches were conducted in Embase, MEDLINE, Cochrane Library, trial registries, and recent conference abstracts. RESULTS Of 1,580 articles identified, 30 reporting on 11 trials and 5 RWE studies were included. Ocrelizumab trials (n = 4) had 24-336 weeks of follow-up and reported decreasing Ig G (IgG) levels, while RWE (n = 5) had 52-78 weeks of follow-up and reported IgG to be stable or decrease only slightly. IgG levels were stable in ofatumumab trials (n = 5; 104-168 weeks of follow-up), but no RWE or longer-term studies were identified. No apparent association between decreased Ig levels and infections was observed during ofatumumab treatment (ASCLEPIOS I/II), while for ocrelizumab, the only data on apparent associations between decreased IgG levels and serious infection rates were for a pooled population of people with RMS or primary progressive MS. CONCLUSION Decreasing IgG levels have been correlated with increased infection risk over time. IgG levels appeared to decrease over time in ocrelizumab trials but remained relatively stable over time in ofatumumab trials. Additional research is needed to understand differences between ocrelizumab and ofatumumab and identify people at risk of decreasing IgG levels and infection.
Collapse
Affiliation(s)
- Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | | | | | | | - Emma Hawe
- RTI Health Solutions, Manchester, UK
| | - Qiujun Shao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ USA
| | - Kerri Wyse
- Novartis Pharmaceuticals Corporation, East Hanover, NJ USA
| | - Eric M. Maiese
- Novartis Pharmaceuticals Corporation, East Hanover, NJ USA
| |
Collapse
|
7
|
Zanghì A, Avolio C, Signoriello E, Abbadessa G, Cellerino M, Ferraro D, Messina C, Barone S, Callari G, Tsantes E, Sola P, Valentino P, Granella F, Patti F, Lus G, Bonavita S, Inglese M, D'Amico E. Is It Time for Ocrelizumab Extended Interval Dosing in Relapsing Remitting MS? Evidence from An Italian Multicenter Experience During the COVID-19 Pandemic. Neurotherapeutics 2022; 19:1535-1545. [PMID: 36036858 PMCID: PMC9422942 DOI: 10.1007/s13311-022-01289-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 01/05/2023] Open
Abstract
In the COVID-19 pandemic era, safety concerns have been raised regarding the risk of severe infection following administration of ocrelizumab (OCR), a B-cell-depleting therapy. We enrolled all relapsing remitting multiple sclerosis (RRMS) patients who received maintenance doses of OCR from January 2020 to June 2021. Data were extracted in December 2021. Standard interval dosing (SID) was defined as a regular maintenance interval of OCR infusion every 6 months, whereas extended interval dosing (EID) was defined as an OCR infusion delay of at least 4 weeks. Three infusions were considered in defining SID vs. EID (infusions A, B, and C). Infusion A was the last infusion before January 2020. The primary study outcome was a comparison of disease activity during the A-C interval, which was defined as either clinical (new relapses) or radiological (new lesions on T1-gadolinium or T2-weighted magnetic resonance imaging (MRI) sequences). Second, we aimed to assess confirmed disability progression (CDP). A total cohort of 278 patients (174 on SID and 104 on EID) was enrolled. Patients who received OCR on EID had a longer disease duration and a higher rate of vaccination against severe acute respiratory syndrome-coronavirus 2 (p < 0.05). EID was associated with an increased risk of MRI activity during the A-C interval (OR 5.373, 95% CI 1.203-24.001, p = 0.028). Being on SID or EID did not influence CDP (V-Cramer 0.47, p = 0.342). EID seemed to be associated with a higher risk of MRI activity in our cohort. EID needs to be carefully considered for OCR-treated patients.
Collapse
Affiliation(s)
- Aurora Zanghì
- UOC Neurology, Sant'Elia Hospital, Caltanissetta, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Head of Multiple Sclerosis Center, Dept. of Neurosciences, Policlinico Riuniti Hospital, Foggia, Italy
| | - Elisabetta Signoriello
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Gianmarco Abbadessa
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Diana Ferraro
- University of Modena and Reggio Emilia, Modena, Italy
| | - Christian Messina
- Department "G.F. Ingrassia", MS Center University of Catania, Catania, Italy
| | - Stefania Barone
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | | | - Elena Tsantes
- Department of General Medicine, Parma University Hospital, Parma, Italy
| | - Patrizia Sola
- University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Valentino
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
- Multiple Sclerosis Centre, Department of General Medicine, Parma University Hospital, Parma, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", MS Center University of Catania, Catania, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Simona Bonavita
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, and Mother-Child Health (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emanuele D'Amico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| |
Collapse
|
8
|
Hartung HP, Mares J, Meuth SG, Berger T. Multiple Sclerosis: Switching from Natalizumab to Other High-Efficacy Treatments to Mitigate Progressive Multifocal Leukoencephalopathy Risk. Neurotherapeutics 2021; 18:1654-1656. [PMID: 34480292 PMCID: PMC8609079 DOI: 10.1007/s13311-021-01102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Hans-Peter Hartung
- Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
- Brain and Mind Centre, University of Sydney, Sydney, Australia.
- Department of Neurology, Palacky University, Olomouc, Olomouc, Czech Republic.
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
| | - Jan Mares
- Department of Neurology, Palacky University, Olomouc, Olomouc, Czech Republic
| | - Sven G Meuth
- Department of Neurology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|