Prediction of multiple sclerosis outcomes when switching to ocrelizumab. (May 2022)

• Record Type: Journal Article
• Authors: Zhong, Michael; van der Walt, Anneke; Stankovich, Jim; Kalincik, Tomas; Buzzard, Katherine; Skibina, Olga; Boz, Cavit; Hodgkinson, Suzanne; Slee, Mark; Lechner-Scott, Jeannette; Macdonell, Richard; Prevost, Julie; Kuhle, Jens; Laureys, Guy; Van Hijfte, Liesbeth; Alroughani, Raed; Kermode, Allan G; Butler, Ernest; Barnett, Michael; Eichau, Sara; van Pesch, Vincent; Grammond, Pierre; McCombe, Pamela; Karabudak, Rana; Duquette, Pierre; Girard, Marc; Taylor, Bruce; Yeh, Wei; Monif, Mastura; Gresle, Melissa; Butzkueven, Helmut; Jokubaitis, Vilija G;
• Is Part Of: Multiple sclerosis. Volume 28:Number 6(2022)
• Page Start: 958
• Page End: 969
• Publication Date: 2022-05
• Subjects: Ocrelizumab -- fingolimod -- switch -- washout; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/13524585211049986
• Languages: English
• ISSNs: 1352-4585

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-β/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.