Wearing-off phenomenon in multiple sclerosis patients on ofatumumab: A case series

Background

Multiple sclerosis (MS) patients receiving the disease modifying therapies (DMT) ocrelizumab and natalizumab occasionally report a transient worsening of MS symptoms prior to receiving their next treatment course. This worsening of symptoms is formally referred to as “end-of-dosing-interval” (EDI) or more commonly referred to as the “crap-gap” within the MS community. The etiology of this process remains poorly understood. To our knowledge, no such report has yet been published on patients receiving ofatumumab. In this report, we describe the cases of 3 MS patients who experienced EDI symptoms while on ofatumumab.

Methods

Information presented in this case series was collected as part of routine clinical care.

Conclusion

This is the first report of MS patients experiencing EDI symptoms on ofatumumab. Clinical providers need to be aware of this phenomenon to better communicate with their patients as they experience these changes. Its existence seems to expand beyond our traditional DMT options especially as new drugs are coming online.