Abstract Details

Title Immunoglobulin Level Changes in Patients with Multiple Sclerosis Treated with Anti-CD20 Monoclonal Antibodies

Topic Multiple Sclerosis

Presentation(s) P9 - Poster Session 9 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-011

Background

Ocrelizumab(OCR), rituximab(RTX), and ofatumumab(OFA) are B-cell depleting therapies used in MS. A decrease in IgG concentration associated with B cell depletion may pose an increased risk of infection.

Objective To examine immunoglobulin G(IgG) and immunoglobulin M(IgM) changes while on anti-CD20 treatment for multiple sclerosis(MS).

Design/Methods Anti-CD20 naïve MS patients starting OCR (n=118), RTX(n=140), or OFA(n=68) at the Rocky Mountain MS Center, University of Colorado after January 2017 and at least one IgG value pre- and post-initiating therapy were retrospectively followed. Lab data, disease history, and patient characteristics were collected. Descriptive statistics and longitudinal regression models were used to examine patient characteristics and IgG and IgM changes over time.

Results OCR, RTX, and OFA patients had a mean age of 42.81, 42.92, and 40.74 years at treatment initiation; had a mean MS disease duration of 7.53, 6.17, and 4.03 years, respectively; and were predominantly female(OCR:69.49%; RTX:68.57%; OFA:80.88%). Mean time on therapy for OCR, RTX and OFA was 44.94, 40.19, and 16.17 months, respectively. Geometric mean baseline IgG values were 957.71(95% CI:922.24, 994.54), 940.34(95% CI:901.80, 980.53) and 978.56(95% CI:912.07, 1049.90) mg/dl for OCR, RTX, and OFA respectively. Few patients developed IgG levels below 500 mg/dl (OCR:5.93%; RTX:5.71%; OFA:0.00%). The estimated IgG annual changes were -2.93%(95% CI:-4.30%,-1.55%, p<0.0001), -1.81% (95% CI:-2.88%,-0.73%, p=0.0011), and -2.63%(95% CI:-7.27%,2.24%, p=0.2829), for OCR, RTX, and OFA respectively. Geometric mean baseline IgM values were 101.90(95% CI:92.32, 112.47), 101.11(95% CI:91.68, 111.51) and 104.01(95% CI:89.58, 120.77) for OCR, RTX and OFA, respectively. Few patients developed IgM levels below 25 mg/dl (OCR:15.38%; RTX:10.95%; OFA:6.25%). The estimated IgM annual changes were -17.82%(95% CI:-20.34,-15.23, p<0.0001), -19.00%(95% CI:-21.42,-16.52, p<0.0001), and -27.90%(95% CI:-35.02,-20.00, p<0.0001), for OCR, RTX, and OFA respectively.

Conclusions

Findings suggest a reduction in IgG and IgM values over time on B-cell depletion. Additional follow-up is needed to assess comparisons between therapies.

Authors/Disclosures
Enrique Alvarez, MD, PhD (University of Colorado) PRESENTER	Dr. Alvarez has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene/BMS. The institution of an immediate family member of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. The institution of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Motric Bio.
Brandi L. Vollmer, MPH (Columbia University, Anschutz Medical Campus)	Ms. Vollmer has nothing to disclose.
Timber Bourassa	No disclosure on file
Erin Marsh	No disclosure on file
Vi Dao	No disclosure on file
Abhijit Gadkari (Novartis)	No disclosure on file
Brandon Brown	No disclosure on file
Stefan Sillau	No disclosure on file
Kavita Nair, PhD, FAAN (University of Colorado)	Dr. Nair has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Meyers Squibb. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for PhRMA Foundation. Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MJH Healthcare. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. Dr. Nair has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Anylam . Dr. Nair has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi-Genzyme. The institution of Dr. Nair has received research support from Genentech. The institution of Dr. Nair has received research support from Novartis. The institution of Dr. Nair has received research support from Genentech. The institution of Dr. Nair has received research support from Phrma Foundation. The institution of Dr. Nair has received research support from Bristol Meyers Squibb. The institution of Dr. Nair has received research support from Novartis. The institution of Dr. Nair has received research support from NINDS.