Prediction of multiple sclerosis outcomes when switching to ocrelizumab


Zhong M., van der Walt A., Stankovich J., Kalincik T., Buzzard K., Skibina O., ...More

MULTIPLE SCLEROSIS JOURNAL, vol.28, no.6, pp.958-969, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 28 Issue: 6
  • Publication Date: 2022
  • Doi Number: 10.1177/13524585211049986
  • Journal Name: MULTIPLE SCLEROSIS JOURNAL
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, PASCAL, BIOSIS, EMBASE, MEDLINE
  • Page Numbers: pp.958-969
  • Keywords: Ocrelizumab, fingolimod, switch, washout, DISEASE-MODIFYING THERAPIES, LYMPHOCYTE COUNTS, FINGOLIMOD, NATALIZUMAB, RITUXIMAB
  • Hacettepe University Affiliated: Yes

Abstract

Background: Increasingly, people with relapsing-remitting multiple sclerosis (RRMS) are switched to highly effective disease-modifying therapies (DMTs) such as ocrelizumab. Objective: To determine predictors of relapse and disability progression when switching from another DMT to ocrelizumab. Methods: Patients with RRMS who switched to ocrelizumab were identified from the MSBase Registry and grouped by prior disease-modifying therapy (pDMT; interferon-beta/glatiramer acetate, dimethyl fumarate, teriflunomide, fingolimod or natalizumab) and washout duration (<1 month, 1-2 months or 2-6 months). Survival analyses including multivariable Cox proportional hazard regression models were used to identify predictors of on-ocrelizumab relapse within 1 year, and 6-month confirmed disability progression (CDP). Results: After adjustment, relapse hazard when switching from fingolimod was greater than other pDMTs, but only in the first 3 months of ocrelizumab therapy (hazard ratio (HR) = 3.98, 95% confidence interval (CI) = 1.57-11.11, p = 0.004). The adjusted hazard for CDP was significantly higher with longer washout (2-6 m compared to <1 m: HR = 9.57, 95% CI = 1.92-47.64, p = 0.006). Conclusion: The risk of disability worsening during switch to ocrelizumab is reduced by short treatment gaps. Patients who cease fingolimod are at heightened relapse risk in the first 3 months on ocrelizumab. Prospective evaluation of strategies such as washout reduction may help optimise this switch.