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Abstract Details

Multiple Sclerosis Disease Breakthrough on B-cell Depleting Therapies: Experience of a Tertiary Academic Medical Center in the Midwest
Multiple Sclerosis
P9 - Poster Session 9 (8:00 AM-9:00 AM)
6-016

B cell therapies are highly effective treatments for relapsing forms of MS; nevertheless, clinical or MRI relapses occur in a minority of patients. The risk factors and severity of MS relapse while on B cell therapy have not been fully characterized. 

To review patients with relapsing forms of multiple sclerosis (MS) who had a clinical or/and radiologic relapse while on a B cell therapy (rituximab, ocrelizumab, or ofatumumab) with low (CD19 <15) or suppressed (CD19 of 0) B cells, with a few exceptions, evaluating for any commonalities or extenuating circumstances leading to relapse.

Retrospective chart review.

Out of 601 patients on B cell therapies (42 on rituximab, 475 on ocrelizumab, 84 on ofatumumab), 12 patients (1.99%) experienced a clinical and/or MRI relapse (2 on RTX, 8 on OCR, 2 on OFA). Seven patients had breakthrough disease by imaging, 3 had clinical relapses (2 optic neuritis and 1 transverse myelitis), and 2 had clinical and radiologic findings. It is important to note the radiologic relapse lesions were compelling for interval demyelination and not ischemia or alternate etiologies. We will present a detailed summary of each case, including patient's demographics, age at MS diagnosis, relapse and disease modifying treatment history, relapse severity, CD19 count coinciding with the relapse, and the number of infusions/injections prior to disease breakthrough.

MS relapse while on B cell therapies is a rare but thought -provoking phenomenon. While the reasons for relapses remain elusive, potential causes we have encountered in our cohort include fertility treatment, viral infections, alternative diagnoses, early MRIs after medication initiation, transient increase in B Cell Activating Factor, extended dosing intervals, body mass index and early B cell repopulation. We will review the literature for other potential factors.

Authors/Disclosures
Chelsie Thompson, DO
PRESENTER
Dr. Thompson has nothing to disclose.
Lakshman N. Arcot Jayagopal, MD (Nebraska Medical Center) Dr. Arcot Jayagopal has nothing to disclose.
Mac McLaughlin, MD (University of Nebraska Medical Center) Dr. McLaughlin has nothing to disclose.
Renee Stewart, RN, NP (University of Nebraska Medical Center) Mrs. Stewart has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Rana K. Zabad, MD, FAAN (University of Nebraska Medical Center) Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene/BMS. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck Serono. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva Neurosciences. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Teva. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. The institution of Dr. Zabad has received research support from Adamas. The institution of Dr. Zabad has received research support from Biogen. The institution of Dr. Zabad has received research support from Novartis. The institution of Dr. Zabad has received research support from Sun Pharma. The institution of Dr. Zabad has received research support from Parexel & MedDay Pharmaceuticals.