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Monteiro I, Nicolella V, Fiorenza M, Novarella F, Carotenuto A, Lanzillo R, Mauriello L, Scalia G, Castaldo G, Terracciano D, Brescia Morra V, Moccia M. The ocrelizumab wearing-off phenomenon is associated with reduced immunomodulatory response and increased neuroaxonal damage in multiple sclerosis. J Neurol 2024:10.1007/s00415-024-12434-w. [PMID: 38777960 DOI: 10.1007/s00415-024-12434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The wearing-off phenomenon is common in people with multiple sclerosis (MS) treated with ocrelizumab. We aim to evaluate the presence and severity of wearing-off to ocrelizumab in relation to demographic and MS clinical variables, immune profiling, and a marker of neuroaxonal damage (plasma neurofilament light chain (pNfl)). METHODS This cross-sectional study included MS patients treated with ocrelizumab from at least 1 year. Wearing-off questionnaire and blood samples were collected between 21 and 23 weeks after the previous ocrelizumab infusion. Lymphocyte subpopulations were evaluated on peripheral blood using flow cytometry. PNfl was evaluated using fully automated chemiluminescent enzyme immunoassay. RESULTS We included 106 people with MS (age 49.5 ± 11.6 years; females 42.3%; wearing-off 57.6%). On regression models, wearing-off was associated with higher pNfl, CD8, CD3, and CD3CD27 lymphocytes. Most frequent wearing-off symptoms were cognitive, sensory, and balance problems; wearing-off started < 1 week (9.4%), 1-4 weeks (10.7%) or > 4 weeks (10.7%) before infusion; 44.8% of the complaints were moderate to severe. Severity of wearing-off was associated with higher pNfl and CD8 lymphocytes. CONCLUSIONS Wearing-off is common in people with MS treated with ocrelizumab, and is associated with reduced immunomodulation (higher T lymphocytes) and increased neuroaxonal damage, suggesting reduced treatment response.
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Affiliation(s)
- Isabel Monteiro
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Neurology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - Valerio Nicolella
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Mariano Fiorenza
- Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Federica Novarella
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Antonio Carotenuto
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | | | - Giulia Scalia
- Centre for Advanced Biotechnology (CEINGE), Naples, Italy
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
- Centre for Advanced Biotechnology (CEINGE), Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Marcello Moccia
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy.
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131, Naples, Italy.
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Ruggieri S, Ianniello A, Copetti M, Altieri M, Buscarinu MC, Centonze D, Cortese A, De Giglio L, Fantozzi R, Gasperini C, Grimaldi LME, Landi D, Marfia GA, Mirabella M, Nistri R, Nociti V, Oddo O, Romano S, Salemi G, Tortorella C, Pozzilli C, Petracca M. Treatment modifiers across different regimens of natalizumab treatment in MS: An Italian real-world experience. Neurotherapeutics 2024; 21:e00338. [PMID: 38413275 PMCID: PMC11070710 DOI: 10.1016/j.neurot.2024.e00338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 02/29/2024] Open
Abstract
Despite its widespread use in clinical practice, the effectiveness of natalizumab extended interval dosing (EID) adopted from treatment start across different treatment intervals and individual modifiers (body mass index - BMI) is still under-investigated. Here, seven-hundred and forty-five multiple sclerosis (MS) patients, exposed to natalizumab for 3.30 ± 1.34 years, were retrospectively enrolled in an observational multicenter study. After stratifying patients in EID or standard interval dosing (SID), we assessed differences in time to relapse, MRI activity and Expanded Disability Status Scale (EDSS) progression. The primary analysis was conducted on patients exposed to EID interval from 5 weeks and 1 day to 7 weeks, while a secondary analysis included also EID periods up to 8 weeks. An additional analysis explored the impact of BMI. No differences in time to first relapse, time to radiological activity, time to EDSS progression or time to EDA (evidence of disease activity) were detected between SID and EID group (EID interval from 5 weeks to 1 day to 7 weeks). When including EID periods from 7 weeks and 1 day to 8 weeks, the EID group showed a trend towards higher risk of experience clinical relapses than the SID group. A higher EDA risk was also identified in EID patients with BMI above median. In conclusion, a higher risk of relapses seems to occur for EID above 7 weeks. Independently from the EID scheme adopted, higher BMI increases the risk of EDA in these patients.
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Affiliation(s)
- Serena Ruggieri
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Antonio Ianniello
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, IRCCS - "Casa Sollievo della Sofferenza" - Hospital, San Giovanni Rotondo (FG), Italy
| | - Marta Altieri
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "Sapienza" University of Rome, Rome, Italy; Neurology Unit, S. Andrea University Hospital, Rome, Italy
| | - Diego Centonze
- IRCCS Neuromed, Pozzilli (IS), Italy; Department of Systems Medicine, Multiple Sclerosis Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Antonio Cortese
- Multiple Sclerosis Center, Neurology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Laura De Giglio
- Multiple Sclerosis Center, Neurology Unit, San Filippo Neri Hospital, Rome, Italy
| | | | - Claudio Gasperini
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luigi M E Grimaldi
- Neurology and Multiple Sclerosis Center, Fondazione Instituto "G. Giglio", Cefalù, Italy
| | - Doriana Landi
- Department of Systems Medicine, Multiple Sclerosis Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Girolama A Marfia
- Multiple Sclerosis Center, Neurology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Massimiliano Mirabella
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Nistri
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Viviana Nociti
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Oscar Oddo
- Neurology and Multiple Sclerosis Center, Fondazione Instituto "G. Giglio", Cefalù, Italy
| | - Silvia Romano
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), "Sapienza" University of Rome, Rome, Italy; Neurology Unit, S. Andrea University Hospital, Rome, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Carla Tortorella
- Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Maria Petracca
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy.
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Bernardes C, Fernandes C, Cunha C, Nunes C, Macário C, Sousa L, Batista S, Correia I. Natalizumab extended interval dosing: what about wearing-off effect? J Neurol Sci 2024; 458:122930. [PMID: 38368641 DOI: 10.1016/j.jns.2024.122930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Up to two thirds of patients with multiple sclerosis (MS) under natalizumab report a resurgence of symptoms at the end of the natalizumab cycle (wearing-off (WO) effect). At the outbreak of COVID-19, in line with the international recommendations for MS management, our centre switched all clinically stable patients on natalizumab therapy for more than one year from standard interval dosing (SID) to extended interval dosing (EID) with every six weeks infusions. This study aimed to evaluate the impact of EID in WO in MS patients under natalizumab. METHODS An observational retrospective study in patients with MS under natalizumab on EID was conducted. A questionnaire regarding current (on EID) and past (on SID) experience of WO effect was applied. RESULTS Seventy-six patients were included. No significant differences were found in the annual relapse rate after the switch to EID (p = 0.083). However, there was a significant increase in the proportion of patients complaining of WO from 38.2% to 56.6% (p = 0.001). Moreover, patients with WO on SID, referred a significant increase in severity (p = 0.019) and duration of WO symptoms (p = 0.029), due to an anticipation of the symptoms relative to the day of natalizumab infusion (p = 0.019), when switching to EID. Symptoms improved with treatment maintenance in 23.3% of patients; instead, a reduction in interval dosing was needed in 54.8% with symptom improvement. CONCLUSION WO affects a significant proportion of MS patients under natalizumab. Its prevalence, severity, and duration increase on EID, therefore despite clinical effectiveness maintenance of this posology should be individualized.
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Affiliation(s)
- Catarina Bernardes
- Neurology Department, Coimbra University Hospital Centre, Coimbra, Portugal.
| | - Catarina Fernandes
- Neurology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Carolina Cunha
- Neurology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Carla Nunes
- Neurology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Carmo Macário
- Neurology Department, Coimbra University Hospital Centre, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Lívia Sousa
- Neurology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Sónia Batista
- Neurology Department, Coimbra University Hospital Centre, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Inês Correia
- Neurology Department, Coimbra University Hospital Centre, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
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Kister I, Oh C, Douglas EA, Bacon TE, O'Shea IL, Parrotta EH, Bouley A, Lathi E, Katz J. No Increase in Symptoms Toward the End of the Ocrelizumab Infusion Cycle in Patients With Multiple Sclerosis: Symptom Burden on Ocrelizumab: A Longitudinal Study (SymBOLS). Neurol Clin Pract 2023; 13:e200185. [PMID: 37674871 PMCID: PMC10479935 DOI: 10.1212/cpj.0000000000200185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/07/2023] [Indexed: 09/08/2023]
Abstract
Background and Objectives Some patients with multiple sclerosis (MS) receiving ocrelizumab (OCR) report worsening symptoms toward the end of the 6-month infusion cycle ('wearing off'). The objective of our study was to comprehensively assess changes in symptom burden across 2 consecutive OCR infusion cycles. Methods SYMptom Burden on Ocrelizumab, a Longitudinal Study (SymBOLS; NCT04855617) was an investigator-initiated, 2-center study of patients with MS starting or receiving OCR. Patients' symptoms were assessed with NeuroQoL short forms, SymptoMScreen, and Work Productivity and Activity Impairment Questionnaire at the start-cycle, mid-cycle, and end-cycle time points in each of the 2 infusion cycles. Symptom scores at the 3 time points within each cycle were compared with repeated-measures ANOVA or the Friedman rank-sum test for non-normal variables. The proportions of patients with a meaningful symptomatic change from the start to the end of each infusion cycle were calculated, and patients whose symptoms improved, worsened, and stayed the same from the start to the end of the cycle were compared with respect to demographic and clinical characteristics. Results One hundred three patients with MS provided longitudinal data for analyses (mean age [SD]: 46.7 [12.2] years, 68% female, 33% non-White, disease duration: 15.5 [5] years, 41% with the Extended Disability Status Scale score >3). On a group level, NeuroQoL and SymptoMScreen scores mostly remained stable or even improved slightly toward the end of each cycle. On an individual level, symptoms remained unchanged across either cycle for most patients, and meaningful symptom worsening from the start to the end of the cycle was no more common than improvement. Meaningful change in symptoms in both cycles was very rare and generally in the direction of improvement toward the end cycle. Despite the lack of evidence for symptom worsening with a longer time from infusion, 54% of patients endorsed feeling of "wearing off" at least sometimes, most commonly as an increase in fatigue. Discussion Our prospective study failed to uncover evidence for the worsening of symptoms with a longer time from OCR infusion. These findings cast doubt on the existence of wearing off as a physiologic phenomenon in OCR-treated patients with MS. The perception of wearing off is likely the result of natural fluctuations in MS symptoms and attribution bias.
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Affiliation(s)
- Ilya Kister
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Cheongeun Oh
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Elizabeth A Douglas
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Tamar E Bacon
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Isabella L O'Shea
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Erica H Parrotta
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Andrew Bouley
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Ellen Lathi
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
| | - Joshua Katz
- NYU Multiple Sclerosis Comprehensive Care Center (IK, TEB), Department of Neurology; Department of Population Health (CO), NYU Grossman School of Medicine, New York; The Elliot Lewis Center for Multiple Sclerosis Care (EAD, ILOS, AB, EL, JK), Wellesley, MA; and St. Peter's MS and Headache Center (EHP), Albany, NY
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Foley J, Berkovich R, Gudesblatt M, Luce E, Schneider B, de Moor C, Liao S, Lee L, Bodhinathan K, Avila R. Characterizing the 'feel-good experience' in multiple sclerosis patients treated with natalizumab or other therapies. Neurodegener Dis Manag 2023; 13:23-34. [PMID: 36285716 DOI: 10.2217/nmt-2022-0003] [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] [Indexed: 02/03/2023] Open
Abstract
Aim: Patients with relapsing-remitting multiple sclerosis (RRMS) treated with natalizumab have anecdotally reported a 'feel-good experience' (FGE). The authors characterized the FGE using survey data from patients with RRMS treated with natalizumab or other disease-modifying therapies (other-DMT). Methods: Questionnaire data from RRMS patients who use MyMSTeam, an online patient social network, were analyzed. Results: The survey included 347 patients (95 natalizumab; 252 other-DMT). More natalizumab than other-DMT patients self-reported having an FGE (62.1 vs 44.8%; p = 0.001) as well as other physical, emotional and cognitive benefits. Conclusion: This study demonstrates that physical, emotional and cognitive benefits were more commonly reported by patients treated with natalizumab than those treated with other disease-modifying therapies and helps characterize patient-reported factors associated with the FGE.
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Affiliation(s)
- John Foley
- Rocky Mountain MS Clinic, Salt Lake City, UT 80031, USA
| | - Regina Berkovich
- Neurology Program, Los Angeles County, & USC Medical Center, Los Angeles, CA 90033, USA
| | | | | | | | | | | | - Lily Lee
- Biogen, Cambridge, MA 02142, USA
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Perncezky J, Sellner J. Natalizumab extended-interval dosing in multiple sclerosis to mitigate progressive multifocal leukoencephalopathy risk: initial study evidence and real-world experience. J Cent Nerv Syst Dis 2022; 14:11795735221135485. [PMID: 36277271 PMCID: PMC9580073 DOI: 10.1177/11795735221135485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The high efficacy of natalizumab in the treatment of relapsing-remitting multiple sclerosis (MS) is without controversy. Indeed, effective disease control was not only demonstrated in the pivotal trials but has been corroborated impressively in real-world observations. This monoclonal IgG4 antibody blocks the α4β1 integrin-mediated leukocyte-endothelial interaction and thereby inhibits the migration of immune cells to the brain parenchyma. However, treatment with natalizumab carries the risk of progressive multifocal leukoencephalopathy (PML). This potentially lethal side effect is a significant limitation for treatment initiation and long-term therapy. Natalizumab is given intravenously or subcutaneously in the standard dose of 300 mg every 4 weeks, allowing drug concentrations at levels that ensure continuous α4β1 integrin receptor saturation on the surface of immune cells. Extended-interval dosing (EID) is an emerging treatment approach that aims to mitigate the natalizumab-related PML risk by prolonging the standard infusion intervals to 6 weeks or even more. This treatment approach may abrogate the PML risk due to improved immune surveillance within the central nervous system while maintaining clinical efficacy. Moreover, even an individual interval dosing can be envisioned based on the availability of a biomarker that is capable of monitoring both safety and efficacy aspects. This review summarizes the early and encouraging evidence for EID from observational and randomized-controlled trials and discusses current limitations and upcoming challenges for introducing a tailored treatment approach.
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Affiliation(s)
- Julian Perncezky
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria,Johann Sellner, Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr 67, Mistelbach 2130, Austria.
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The wearing-off phenomenon of ocrelizumab in patients with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103364. [PMID: 35158470 DOI: 10.1016/j.msard.2021.103364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with multiple sclerosis (MS) who are treated with monoclonal antibodies frequently report an increase of MS-related symptoms prior to the next dose known as the wearing-off phenomenon. The objective of this study was to assess the prevalence and predicting factors of the wearing-off phenomenon in patients with MS using ocrelizumab. METHODS This was a prospective cohort study in patients with MS receiving ocrelizumab ≥1 year. Most participants received B-cell guided personalized extended interval dosing to limit ocrelizumab exposure and hospital visits during the COVID-19 pandemic (cut-off ≥ 10 cells/µL). Participants completed questionnaires during ocrelizumab infusion and 2 weeks thereafter. Demographics, clinical and radiological characteristics, CD19 B-cell counts, and serum neurofilament light (sNfL) levels were collected. Data were analyzed using logistic regression analyses. RESULTS Seventy-one (61%) out of 117 participants reported the wearing-off phenomenon during ocrelizumab treatment. The most frequently reported symptoms were fatigue, cognitive disability and sensory symptoms. Wearing-off symptoms started < 1 week (11%), 1-4 weeks (49%) or more than 4 weeks (37%) before ocrelizumab infusion. Fifty participants (43%) reported a current wearing-off phenomenon at the first questionnaire. Higher body mass index (threshold BMI ≥ 25) increased the odds of reporting a current wearing-off phenomenon (OR 2.70, 95% CI 1.26 to 5.80, p = .011). Infusion interval, EDSS score, MRI disease activity, clinical relapses, CD19 B-cell counts, and sNfL levels were no predictors. Disappearance of the wearing-off phenomenon occurred in the first week after ocrelizumab infusion in most participants. Participants with a current wearing-off phenomenon significantly improved in self-reported physical and psychological functioning after ocrelizumab infusion. Reporting the wearing-off phenomenon did not influence treatment satisfaction. Forty of 109 participants (37%) reported post-infusion symptoms, such as fatigue, flu-like symptoms or walking difficulties. These post-infusion symptoms started directly or in the first week after ocrelizumab infusion and disappeared within 2 weeks. CONCLUSIONS The wearing-off phenomenon is reported by more than half of patients with MS using ocrelizumab. Only BMI was identified as a predicting factor. The wearing-off phenomenon was not elicited by extending infusion intervals or higher B-cell counts. The wearing-off phenomenon of ocrelizumab therefore does not seem to reflect suboptimal control of MS disease activity.
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Bringeland GH, Blaser N, Myhr KM, Vedeler CA, Gavasso S. Wearing-off symptoms during standard and extended natalizumab dosing intervals: Experiences from the COVID-19 pandemic. J Neurol Sci 2021; 429:117622. [PMID: 34474301 PMCID: PMC8445695 DOI: 10.1016/j.jns.2021.117622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/05/2021] [Accepted: 08/20/2021] [Indexed: 11/04/2022]
Abstract
Natalizumab effectively prevents disease activity in relapsing-remitting multiple sclerosis, but many treated patients report subjective wearing-off symptoms at the end of the 4-week interval between infusions. Extended interval dosing (EID) is a promising strategy to mitigate the risk of natalizumab-associated progressive multifocal leukoencephalopathy, but it is unknown whether EID affects wearing-off symptoms. In this observational study, we evaluated if prevalence or intensity of wearing-off symptoms changed when natalizumab dosing intervals were extended from 4 to 6 weeks in 30 treated patients during the outbreak of COVID-19 in Norway. New or increased wearing-off symptoms during EID were reported by 50%. Symptom increase was more frequent among patients with pre-existing wearing-off symptoms during standard dosing compared to patients without such pre-existing symptoms [p = 0.0005]. Our observations support the need to study the effect of EID on wearing-off symptoms in randomized controlled trials.
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Affiliation(s)
- Gerd Haga Bringeland
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Nello Blaser
- Department of Informatics, University of Bergen, Bergen, Norway; Center for Data Science, CEDAS, University of Bergen, Bergen, Norway
| | - Kjell-Morten Myhr
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Alexander Vedeler
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Sonia Gavasso
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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9
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Wearing-off at the end of natalizumab dosing interval and risk of MS disease activity: A prospective 1-year follow-up study. J Neurol Sci 2020; 415:116880. [PMID: 32413799 DOI: 10.1016/j.jns.2020.116880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 11/24/2022]
Abstract
Natalizumab effectively prevents disease activity in relapsing-remitting multiple sclerosis by binding α4 integrin and inhibiting leukocyte migration to the central nervous system. We recently reported an association between low natalizumab receptor occupancy and subjective wearing-off symptoms at the end of the 4-week dosing interval. Here, we aimed to evaluate the short-term risk of disease activity in a 1-year prospective follow-up of the same patient cohort (n = 40). We found that all patients available for follow-up after one year (n = 35) fulfilled the criteria for no evidence of disease activity (NEDA). Thus, wearing-off symptoms were not associated with increased short-term risk of disease activity. Longer follow-up in a larger patient cohort is required to establish whether therapeutic efficacy is maintained in patients with wearing-off symptoms.
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11
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Foley JF, Stuve O. Natalizumab wearing-off effect. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2020; 7:7/3/e706. [PMID: 32156774 PMCID: PMC7136038 DOI: 10.1212/nxi.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- John F Foley
- From the Rocky Mountain Multiple Sclerosis Clinic (J.F.F.), Salt Lake City, UT; Department of Neurology and Neurotherapeutics (O.S.), University of Texas Southwestern Medical Center at Dallas; and Neurology Section (O.S.), VA North Texas Health Care System, Medical Service, Dallas
| | - Olaf Stuve
- From the Rocky Mountain Multiple Sclerosis Clinic (J.F.F.), Salt Lake City, UT; Department of Neurology and Neurotherapeutics (O.S.), University of Texas Southwestern Medical Center at Dallas; and Neurology Section (O.S.), VA North Texas Health Care System, Medical Service, Dallas.
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