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Abstract Details

Enhanced Safety Profile of Ocrelizumab Over Rituximab in Multiple Sclerosis Treatment
Multiple Sclerosis
P8 - Poster Session 8 (8:00 AM-9:00 AM)
1-006

Compare long-term safety profiles of ocrelizumab and rituximab in multiple sclerosis (MS) patients using real-world data from multiple specialized MS centers. 

The anti-CD20 monoclonal antibodies ocrelizumab and rituximab have similar mechanisms but differ in molecular structure, epitope target, and cell-killing processes, potentially resulting in unique safety profiles. Despite their broad clinical use in MS, direct comparative data on their long-term safety is lacking. 
We conducted a multi-center, retrospective observational study, analyzing data from 2,917 MS patients treated with either ocrelizumab or rituximab at six University of California clinical centers. Data from electronic health records were combined with information extracted from unstructured clinical notes using large language models. The primary endpoint was the rate of all-cause hospitalization, while secondary endpoints included infection-related hospitalizations, serum IgG levels, and confirmed disability progression. Propensity score matching was applied to balance cohorts, with follow-up durations of up to 4 years.
Rituximab-treated patients had significantly higher all-cause cumulative hospitalization compared to ocrelizumab-treated patients (HR 1.93, 95% CI [1.19-3.13], p=0.007) at UCSF; HR 4.01; 95% CI [2.25-6.32], p<0.001) across the UC-wide cohort (Excluding UCSF). Rituximab was also associated with higher infection-related hospitalization rates and a greater likelihood of hypogammaglobulinemia. Ocrelizumab-treated patients showed a trend towards slower disability progression, although not statistically significant. These results remained robust in separate subgroup analyses: one controlling for potential selection bias and another examining the effects among patients on low-dose rituximab regimens.
This large-scale observational study suggests ocrelizumab has a superior safety profile to rituximab in MS treatment. The significant difference in hospitalization rates and increased hypogammaglobulinemia risk with rituximab may impact clinical practice and healthcare resource use. While these findings cannot replace randomized clinical trials, they provide valuable real-world data to inform MS treatment decisions. 
Authors/Disclosures
Gabriel A. Cerono (UCSF)
PRESENTER 		Dr. Cerono has nothing to disclose.
Bruce A. Cree, MD, PhD, MAS, FAAN (UCSF, Multiple Sclerosis Center) The institution of Dr. Cree has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. The institution of Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. The institution of Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. The institution of Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Cree has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Cree has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neuron23. Dr. Cree has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Pharma. Dr. Cree has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hexal/Sandoz. Dr. Cree has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Immunic AG. The institution of Dr. Cree has received research support from Genentech. The institution of Dr. Cree has received research support from Kyverna. Dr. Cree has received publishing royalties from a publication relating to health care.
Stephen L. Hauser, MD (UCSF Weill Institute for Neurosciences) Dr. Hauser has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NGM Bio. Dr. Hauser has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Moderna. Dr. Hauser has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BD. Dr. Hauser has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pheno Therapeutics. Dr. Hauser has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Nurix Therapeutics. Dr. Hauser has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gilead. Dr. Hauser has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Accure. Dr. Hauser has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alector. Dr. Hauser has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Hinge Therapeutics. Dr. Hauser has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Neurona. Dr. Hauser has a non-compensated relationship as a Clinical Trial/Primary Investigator with Roche that is relevant to AAN interests or activities. Dr. Hauser has a non-compensated relationship as a Clinical Trial/Primary Investigator with Novartis that is relevant to AAN interests or activities.
Sergio Baranzini (UCSF) Sergio Baranzini has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Sergio Baranzini has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono . Sergio Baranzini has stock in MATE Bioservices. The institution of Sergio Baranzini has received research support from Valhalla Charitable Fund. The institution of Sergio Baranzini has received research support from Salah Foundation. The institution of Sergio Baranzini has received research support from NIH. The institution of Sergio Baranzini has received research support from NSF. Sergio Baranzini has received intellectual property interests from a discovery or technology relating to health care. Sergio Baranzini has a non-compensated relationship as a co-funder with Mate Bioservices that is relevant to AAN interests or activities.