Rituximab vs Ocrelizumab in Relapsing-Remitting Multiple Sclerosis.

Autor:	Roos I; Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.; CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia., Hughes S; Royal Victoria Hospital, Belfast, United Kingdom., McDonnell G; Belfast City Hospital, Belfast, United Kingdom., Malpas CB; Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.; CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia., Sharmin S; CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia., Boz C; KTU Medical Faculty Farabi Hospital, Trabzon, Turkey., Alroughani R; Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait., Ozakbas S; Dokuz Eylul University, Konak/Izmir, Turkey., Buzzard K; Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Department of Neurology, Box Hill Hospital, Melbourne, Victoria, Australia.; Monash University, Melbourne, Victoria, Australia., Skibina O; Department of Neurology, Box Hill Hospital, Melbourne, Victoria, Australia.; Monash University, Melbourne, Victoria, Australia.; Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia., van der Walt A; Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia.; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia., Butzkueven H; Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia.; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia., Lechner-Scott J; School of Medicine and Public Health, University Newcastle, Newcastle, New South Wales, Australia.; Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia., Kuhle J; Departments of Medicine, Biomedicine, and Clinical Research, Neurologic Clinic and Policlinic, University Hospital and University of Basel, Basel, Switzerland., Terzi M; Medical Faculty, 19 Mayis University, Samsun, Turkey., Laureys G; Department of Neurology, Ghent University Hospital, Ghent, Belgium., Van Hijfte L; Department of Neurology, Ghent University Hospital, Ghent, Belgium., John N; Department of Neurology, Monash Health, Melbourne, Victoria, Australia.; Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia., Grammond P; CISSS Chaudière-Appalache, Levis, Canada., Grand'Maison F; Neuro Rive-Sud, Longueuil, Québec, Canada., Soysal A; Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey., Jensen AV; Danish Multiple Sclerosis Center, Rigshospitalet Glostrup, Copenhagen University Hospital, Denmark., Rasmussen PV; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark., Svendsen KB; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark., Barzinji I; Aalborg University Hospital, Denmark., Nielsen HH; The Multiple Sclerosis Clinic, Department of Neurology, Odense University Hospital, Odense C, Denmark., Sejbæk T; Department of Neurology, Esbjerg Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark.; Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark., Prakash S; Neurological Department, Viborg Hospital, Denmark., Stilund MLM; Department of Neurology and Physiotherapy, Gødstrup Hospital, Herning, Denmark., Weglewski A; Neurology Department Herlev Hospital, Denmark.; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Issa NM; Department of Neurology, North Zealand Hospital, Hillerod, Denmark., Kant M; Hospital of Southern Jutland, University of Southern Denmark, Aabenraa, Denmark., Sellebjerg F; Danish Multiple Sclerosis Center, Rigshospitalet Glostrup, Copenhagen University Hospital, Denmark., Gray O; South Eastern HSC Trust, Belfast, United Kingdom., Magyari M; Danish Multiple Sclerosis Center, Rigshospitalet Glostrup, Copenhagen University Hospital, Denmark., Kalincik T; Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.; CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	JAMA neurology [JAMA Neurol] 2023 Aug 01; Vol. 80 (8), pp. 789-797.
DOI:	10.1001/jamaneurol.2023.1625
Abstrakt:	Importance: Ocrelizumab, a humanized monoclonal antibody targeted against CD20+ B cells, reduces the frequency of relapses by 46% and disability worsening by 40% compared with interferon beta 1a in relapsing-remitting multiple sclerosis (MS). Rituximab, a chimeric monoclonal anti-CD20 agent, is often prescribed as an off-label alternative to ocrelizumab. Objective: To evaluate whether the effectiveness of rituximab is noninferior to ocrelizumab in relapsing-remitting MS. Design, Setting, and Participants: This was an observational cohort study conducted between January 2015 and March 2021. Patients were included in the treatment group for the duration of study therapy and were recruited from the MSBase registry and Danish MS Registry (DMSR). Included patients had a history of relapsing-remitting MS treated with ocrelizumab or rituximab, a minimum 6 months of follow-up, and sufficient data to calculate the propensity score. Patients with comparable baseline characteristics were 1:6 matched with propensity score on age, sex, MS duration, disability (Expanded Disability Status Scale), prior relapse rate, prior therapy, disease activity (relapses, disability accumulation, or both), magnetic resonance imaging lesion burden (missing values imputed), and country. Exposure: Treatment with ocrelizumab or rituximab after 2015. Main Outcomes and Measures: Noninferiority comparison of annualized rate of relapses (ARRs), with a prespecified noninferiority margin of 1.63 rate ratio. Secondary end points were relapse and 6-month confirmed disability accumulation in pairwise-censored groups. Results: Of the 6027 patients with MS who were treated with ocrelizumab or rituximab, a total of 1613 (mean [SD] age; 42.0 [10.8] years; 1089 female [68%]) fulfilled the inclusion criteria and were included in the analysis (898 MSBase, 715 DMSR). A total of 710 patients treated with ocrelizumab (414 MSBase, 296 DMSR) were matched with 186 patients treated with rituximab (110 MSBase, 76 DMSR). Over a pairwise censored mean (SD) follow-up of 1.4 (0.7) years, the ARR ratio was higher in patients treated with rituximab than in those treated with ocrelizumab (rate ratio, 1.8; 95% CI, 1.4-2.4; ARR, 0.20 vs 0.09; P < .001). The cumulative hazard of relapses was higher among patients treated with rituximab than those treated with ocrelizumab (hazard ratio, 2.1; 95% CI, 1.5-3.0). No difference in the risk of disability accumulation was observed between groups. Results were confirmed in sensitivity analyses. Conclusion: In this noninferiority comparative effectiveness observational cohort study, results did not show noninferiority of treatment with rituximab compared with ocrelizumab. As administered in everyday practice, rituximab was associated with a higher risk of relapses than ocrelizumab. The efficacy of rituximab and ocrelizumab administered at uniform doses and intervals is being further evaluated in randomized noninferiority clinical trials.
Databáze:	MEDLINE
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