Abstract Details

Title Should Elderly MS Patients Follow Conventional Dosing of Ocrelizumab?

Topic Multiple Sclerosis

Presentation(s) P16 - Poster Session 16 (5:30 PM-6:30 PM)

Poster/Presentation
Number 9-013

Objective To report prolonged CD19 depletion in an elderly MS patient treated with half-dose Ocrelizumab (OCR).

Background The only FDA-approved anti-CD20 medication for MS is OCR, which is effective in treating RRMS and PPMS. There is insufficient data about the safety and efficacy of OCR in elderly patients; OCR studies only enrolled patients up to the age of 55.

Design/Methods We report a 76-year-old man with MS for 30 years, treated previously with Interferon Beta, Glatimer Acetate and Natalizumab. He remained relapse-free after he was started on Natalizumab in 2008. He was switched to OCR in 2018 for an insidiously worsening gait, in the hopes to preserve his ability to walk independently.

Results In February 2018, after a 2-month washout, he received OCR 300 mg. His absolute CD19 count 3 months later was 0. He was given a repeat 300 mg dose in August 2018. After this infusion, his CD19 count remained undetectable for 9 months, after which his CD19 cells reconstituted. Meanwhile, he developed repeated urinary tract infections for which received multiple courses of antibiotics and was started on methenamine hippurate.

Conclusions Despite receiving half of the recommended OCR dose, our patient continued to have CD19 depletion 9 months post-infusion. In OCR trials, B-cells returned to the lower level of normal and/or baseline in 27-152 weeks (median of 72 weeks), with the clinical effect often lasting far longer. While is it customary to use CD19-guided treatment with Rituximab in MS and other immune disorders, OCR is infused in a set protocol. Elderly patients treated with Rituximab for rheumatoid arthritis are known to have more infections than younger patients. We conclude that OCR should be used judiciously in elderly patients and treatment should be driven by CD19 monitoring. Further studies are needed to determine optimal dosing and benefit of OCR in elderly MS patients.

Authors/Disclosures
Soumya Bouchachi, MD (OSU) PRESENTER	Dr. Bouchachi has nothing to disclose.
Machteld E. Hillen, MD, FAAN (Rutgers-NJMS)	The institution of Dr. Hillen has received research support from Genentech.

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