多发性硬化症患者停用奥克立珠单抗后疾病活动的复发。

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2024-09-28 DOI:10.1016/j.msard.2024.105900

E. Coerver , L. Schoof , L. Hogenboom , M. Wessels , P. van Ruyven , A. van Samkar , J. Mostert , Z. van Kempen , B.W. van Oosten , B.H. Wokke , E. Tallantyre , KM. Myhr , O. Torkildsen , J. Killestein , I. Smets , E. Strijbis

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引用次数: 0

摘要

简介奥克雷珠单抗（OCR）是一种治疗多发性硬化症（MS）的高效药物，其 B 细胞再填充特征表明它可用作免疫重建疗法。然而，有关停用 OCR 治疗后疾病复发的数据却很少。我们的目的是评估停用 OCR 后疾病活动的复发情况：在这项多中心回顾性队列研究中，我们纳入了停用 OCR 12 个月或更长时间的多发性硬化症患者，这些患者在接受了至少一次 600 毫克的足量治疗后，没有改用其他治疗方法。我们将局灶性炎症定义为临床复发或明显的 MRI 活动（≥3 个新的 T2 病灶或≥2 个造影剂增强病灶）：我们纳入了 53 例多发性硬化症患者，其中 41 例为复发缓解型 (RRMS)，5 例为继发性进展型 (SPMS) ，7 例为原发性进展型 (PPMS)。停用 OCR 后的中位随访时间为 16 个月。我们只观察到RRMS患者停药后出现局灶性炎症；2.4%（1/41）的患者出现明显的磁共振成像活动和相应的临床症状，7.3%（3/41）的患者出现疑似临床复发，但无放射学活动：在最后一次输液后的中位时间为17个月时，共有9.8%（4/41）的患者出现局灶性炎症：讨论：我们发现 4 例（9.8%）RRMS 患者在停用 OCR 后出现局灶性炎症，其中 1 例经放射学证实。我们的观察结果表明，局灶性炎症的复发率似乎很低，但停药并不适合所有人。进一步的大型研究对于确定 OCR 的免疫重建治疗潜力非常重要。

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The recurrence of disease activity after ocrelizumab discontinuation in multiple sclerosis

Introduction

Ocrelizumab (OCR) is a highly effective treatment of multiple sclerosis (MS), and B cell repopulation profiles suggest that it might be used as an immune reconstitution therapy. However, data on disease recurrence after stopping treatment with OCR are scarce. Our objective was to evaluate the recurrence of disease activity after OCR discontinuation.

Methods

In this multicenter retrospective cohort study, we included MS patients who discontinued OCR, without switching to another treatment, for twelve months or more, after having received at least one full dosage of 600 mg. We defined focal inflammation as the occurrence of a clinical relapse or significant MRI activity (≥3 new T2 lesions or ≥2 contrast-enhancing lesions).

Results

We included 53 MS patients; 41 relapsing remitting (RRMS), 5 secondary progressive (SPMS) and 7 primary progressive (PPMS) patients. Median follow-up period after OCR discontinuation was 16 months. We only observed focal inflammation after discontinuation in RRMS patients; 2.4 % (1/41) patients presented with significant MRI activity and matching clinical symptoms, and 7.3 % (3/41) patients presented with a suspected clinical relapse without radiological activity: a total of 9.8 % (4/41) at a median time of 17 months after the last infusion.

Discussion

We found focal inflammation after discontinuation of OCR in 4 (9.8 %) of the RRMS patients, of which 1 was radiologically confirmed. Our observations highlight that recurrence of focal inflammation seems low but discontinuation may not be appropriate for everyone. Further larger studies are important to determine the immune reconstitution therapy potential of OCR.

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.