Title

Evaluation of ocrelizumab in older progressive multiple sclerosis patients.

Authors

Samantha Epstein
Kathryn T Fong, Swedish Neuroscience Institute, Seattle, WA, USAFollow
Philip L De Jager
Libby Levine
Claire Riley
Sarah Wesley
Wendy S Vargas
Rebecca Farber

Document Type

Article

Publication Date

10-1-2021

Publication Title

Mult Scler Relat Disord

Keywords

washington; seattle; swedish; swedish neurosci; Aged; Antibodies, Monoclonal, Humanized; Humans; Immunologic Factors; Multiple Sclerosis; Multiple Sclerosis, Chronic Progressive; Retrospective Studies

Abstract

BACKGROUND: Seminal trials evaluating anti-CD20 therapy in progressive MS primarily found benefit in younger, less-disabled patients with more inflammatory disease activity. The risks and benefits of ocrelizumab use in older patients with progressive froms of MS are not known.

METHODS: Retrospective chart review was performed for patients older than 55 with primary or secondary progressive MS at the time of ocrelizumab initiation. Clinical endpoints from 2 years prior to anti-CD20 therapy served as a within-subject control.

RESULTS: Data was reviewed for 56 patients older than the age of 55 at the time of ocrelizumab initiation. Of 37 patients with 2-years of follow up on ocrelizumab, 40%(n=15) experienced confirmed disability progression (CDP) while 60% (n=22) remained stable or improved. 24 patients had data available for the within-subject control; for these patients, median age was 67, baseline EDSS 6.3, and disease duration 20.5 years. Prior to anti-CD20 therapy, 58% (n=14) of patients remained stable and 42% (n=10) experienced CDP. After ocrelizumab initiation, 71% (n=17) remained stable and 29% (n=7) experienced CDP. There was no difference between CDP (p=0.54) or change in EDSS (p=0.09) between time periods. Ocrelizumab was well tolerated and no difference in infection rate was seen using the within-subject control.

CONCLUSIONS: We found no difference in clinical endpoints for patients on ocrelizumab compared to prior to anti-CD20 therapy; however, we could not exclude a modest effect given our sample size. Larger trials are needed to evaluate ocrelizumab use in this understudied MS subpopulation.

Clinical Institute

Neurosciences (Brain & Spine)

Department

Neurosciences

Recommended Citation

Epstein, Samantha; Fong, Kathryn T; De Jager, Philip L; Levine, Libby; Riley, Claire; Wesley, Sarah; Vargas, Wendy S; and Farber, Rebecca, "Evaluation of ocrelizumab in older progressive multiple sclerosis patients." (2021). Articles, Abstracts, and Reports. 5349.
https://digitalcommons.providence.org/publications/5349