| Abstrakt: |
BACKGROUND: Ocrelizumab (OCR), an anti-CD20 monoclonal antibody, is an IV infusion administered every 6 months to treat people with multiple sclerosis (PwMS). Some PwMS on OCR have reported a wearing-off phenomenon, characterized as a return of their MS-related symptoms shortly before their next infusion date. One survey-based study of 117 PwMS on OCR found that more than half reported wearing-off. OBJECTIVES: This retrospective chart review aims to assess the prevalence, predictive factors, and impacts of different interventions on the OCR wearing-off phenomenon in a large cohort of PwMS. METHODS: Records of PwMS treated with OCR at a single MS subspecialty clinic were reviewed to collect (1) demographic variables, (2) clinical characteristics (eg, MS subtype, degree of disability as shown by Patient-Determined Disease Steps [PDDS], tolerability of OCR), (3) comorbidities (including quantitative measures of fatigue and depression), (4) presence of wearing-off and its onset relative to OCR start, timing of symptoms relative to the next infusion, and specific symptoms of wearing-off, and (5) interventions focused on wearing-off and responses. Logistic regression modeling was used to assess risk factors for wearing-off. RESULTS: The study population was 528 PwMS with an average age of 47.5; 72.9% were women; 72.3% had relapsing-remitting MS. Mean PDDS score was 3.1. OCR was well-tolerated by 91.3% of PwMS who were treated. Wearing-off was observed in 24.8%, most often characterized by worsening of residual focal symptoms (79.4%) and fatigue (67.2%). Wearing-off commonly developed 2 to 4 weeks before the next infusion was due (59.5%), and more than 80% of those who developed wearing-off did so within the first 3 years of treatment. Risk factors for wearing-off included comorbid fatigue (OR 2.10, P = .001) and non-White race (OR 2.19, P = .018). Protective factors against wearing-off included male sex (OR 0.56, P = .026) and Hispanic ethnicity (OR 0.48, P = .029). Any intervention, such as shortening OCR infusion intervals or switching therapies, improved or resolved wearing-off over 80% of the time (P < .001). CONCLUSIONS: A wearingoff phenomenon was observed in nearly a quarter of our study population of PwMS on OCR. Clinicians should be aware of several factors that may predict wearing-off. Wearing-off tended not to self-resolve, and interventions were generally effective at mitigating this phenomenon. [ABSTRACT FROM AUTHOR] |
