Successful treatment of multiple sclerosis with refractory rheumatoid arthritis using ofatumumab: A case report

Background

Ofatumumab is an anti-CD20 human monoclonal antibody that is approved in several countries worldwide for the treatment of relapsing forms of multiple sclerosis (MS). Recent studies have shown promising results of ofatumumab therapy for rheumatoid arthritis (RA). We report a case with both MS and refractory RA that was successfully treated with ofatumumab.

Case Presentation

A 44-year-old woman with a history of RA since the age of 40, and prior treatment with methotrexate, prednisolone, and several disease-modifying antirheumatic drugs (DMARDs), including salazosulfapyridine, iguratimod, tacrolimus, presented with a recent onset of visual acuity loss in the left eye. Ophthalmic examination revealed a decreased central flicker frequency (CFF) and central scotoma. Brain magnetic resonance imaging (MRI) revealed periventricular multiple lesions and contrast enhancement of the left optic nerve. Cerebrospinal fluid analysis revealed mild lymphocytic pleocytosis, elevation of protein, and oligoclonal bands. Serum anti-aquaporin-4 (AQP4) antibodies, anti-myelin oligodendrocyte glycoprotein (MOG) antibodies, and other serological tests for optic neuritis were unremarkable. She was diagnosed with relapsing and remitting MS at 10 months after development of optic neuritis when she experienced a relapse, accompanied by new asymptomatic lesions detected on brain MRI. After ofatumumab administration, we discontinued all DMARDs and maintained remission over a 12-month period.

Conclusion

There is growing evidence of significant involvement of B-cells in the pathogenesis of RA and the effectiveness of B-cell depletion therapy in managing RA. Ofatumumab is an effective treatment for patients with MS and refractory RA.