Anti-CD20 immunotherapy in progressive multiple sclerosis: 2-year real-world follow-up of 108 patients

Abstract

Background: Anti-CD20 monoclonal antibodies are recently introduced treatments in progressive MS and real-world data are lacking.

Objective: The aim of this study is to describe a cohort of progressive MS patients treated with ocrelizumab or rituximab in a real-world setting.

Methods: This monocentric prospective cohort study at the University Hospital of Strasbourg included patients with primary progressive or secondary progressive MS that started treatment with anti-CD20 antibodies before June 2019. Every six months, patients were assessed using the following standardized clinical evaluations: Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9-HPT) and Symbol Digit Modalities Test (SDMT). The primary analysis considered EDSS progression (of at least 1.0 if EDSS ≤ 5.5 and at least 0.5 if EDSS ≥ 6.0).

Results: We included 108 patients, with a median age upon inclusion of 53 years [48.0-58.0]. 72% were classified as primary progressive forms. Median baseline EDSS was 6.0 [4.0-6.5]. EDSS was significantly correlated with T25FW, SDMT and 9-HPT. Following 2 years of treatment, 38.9% of patients presented EDSS progression compared to baseline.

Conclusion: Our large cohort confirms tolerance of these treatments in a real-world setting. Standardized clinical assessments could improve detection of deteriorating patients. Further studies are needed to establish predictive factors.

Keywords: Antigens, CD20; Immunotherapy; Multiple sclerosis; Multiple sclerosis, chronic progressive; Rituximab.