Abstract Details

Title Treatment of Anti-CD20 Therapy-Resistant Neuromyelitis Optica with Interleukin-6 Receptor Blockade: A Case Series

Topic MS and Related Diseases

Presentation(s) S60 - (-)

Poster/Presentation
Number 003

Objective

Background B-cell depleting therapy seems to be most promising in NMO, yet approximately 20% of patients still experience relapses. IL-6 is supposed to play a key role in NMO, directly activating a specific plasmablast subpopulation which secrets aquaporin-4 antibodies. The IL-6 receptor-blocking antibody tocilizumab could be a new therapeutic option for NMO.

Design/Methods We retrospectively studied the efficacy of tocilizumab in NMO patients diagnosed according to the revised Wingerchuk 2006 criteria, who failed to respond to a B-cell depleting therapy with rituximab. The annualized relapse rate (ARR), disability progression measured by the expanded disability status score (EDSS), and the spinal MRI activity were analyzed.

Results We report 3 female patients with a median age of 39 (26-40) years and aquaporin-4-positive NMO. All patients had been treated with different immunosuppressive and immunomodulating agents, followed by 1-3 cycles of rituximab. Despite complete CD20-cell depletion during rituximab therapy, the median ARR was 3.0 (2.3-3.0) and the median EDSS increased from 5.0 (4.5-7.0) to 6.5 (5.0-7.0). After switch to tocilizumab (median duration of therapy 18 months), the median ARR decreased to 0.6 (0-1.3). A total of 2 relapses occurred, however, they were mild and there were no changes in clinical disability or MRI disease activity. Apart from 2 mild infections there were no adverse events.

Conclusions The IL-6 receptor-blocking therapy can be effective in therapy resistant cases of NMO. Larger controlled studies are needed to confirm the efficacy of tocilizumab.

Authors/Disclosures
Ingo Kleiter (Neurologische Universitaetsklinik Regensburg) PRESENTER	No disclosure on file
Ilya Ayzenberg (Ruhr-Universitat Bochum)	Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Aventis. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. The institution of Dr. Ayzenberg has received research support from Diamed.
	No disclosure on file
Kerstin Hellwig (St. Josef Hospital Bochum)	Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mylan . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merck . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novartis . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Roche . The institution of Kerstin Hellwig has received research support from Roche . The institution of Kerstin Hellwig has received research support from Merck . The institution of Kerstin Hellwig has received research support from Biogen. The institution of Kerstin Hellwig has received research support from Genzyme . The institution of Kerstin Hellwig has received research support from Novartis . The institution of Kerstin Hellwig has received research support from BMS .
Andrew H. Chan, MD (Dept of Neurology, University of Bochum, St. Josef-Hospital)	No disclosure on file
Linda P. Lowes, PT PhD	The institution of Ms. Lowes has received research support from Sarepta Therapeutics.
Ralf Gold, MD (Neurologische Universitaetsklinik)	Dr. Gold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen . Dr. Gold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Gold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer Vital. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai Pharamaceuticals. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Gold has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SAGE Publishers. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Novartis. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Biogen. The institution of Dr. Gold has received research support from Novartis. The institution of Dr. Gold has received research support from Biogen.

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