Abstract Details

Title What Happens When Older MS Patients Stop Their Anti-CD20? A Two-center Retrospective Study

Topic Multiple Sclerosis

Presentation(s) S40 - Multiple Sclerosis: Clinical Trials/Science and Real-world Evidence (2:24 PM-2:36 PM)

Poster/Presentation
Number 008

Objective What happens when older MS patients stop their anti-CD20? A two-center retrospective study.

Background Older, non-relapsing MS patients who stop anti-CD20 therapy due to recurrent infections, perceived lack of efficacy or other reasons, may not restart another disease-modifying therapy (DMT). Long-term disease trajectory (relapses, new lesions, disability progression) during post-drug discontinuation period is unknown.

Design/Methods This retrospective study included patients from NYU (New York) and UCD (Denver) MS Centers who were treated with anti-CD20 therapy for ≥1 year, aged ≥45 years at time of anti-CD20 cessation and were off all DMTs for at least 2 years subsequently. Clinical records were assessed for duration of therapy and reasons for discontinuation, relapses, MRI activity, changes in Patient Determined Disease Steps (PDDS) scores and DMT was restarted after >2 years.

Results We identified 52 patients (33 from NYU and 19 from UCD) who met our inclusion criteria (mean age 61, 77% female, disease duration 21 years). Stopped anti-CD20 therapies were ocrelizumab (n=37), rituximab (n=14), and ofatumumab (n=1). Mean duration on anti-CD20 was 48 months. Most patients stopped DMT due to infections or patient preference. Mean follow-up after stopping anti-CD20 was 3.9 years, during which only one patient experienced an MRI-negative relapse 4 years after last anti-CD20 treatment, and 3 patients had new MRI lesions. Disability measures for the NYU group remained stable in 79%, worsened in 15% or improved in 6%. 21% of patients from NYU reinitiated DMT versus none from UCD, predominantly anti-CD20 agents, driven by new activity or patient preference. Additional data from UCD center will be presented.

Conclusions In our retrospective study, long-term cessation of anti-CD20 therapy in this older, clinically stable MS population was associated with lasting disease quiescence and functional stability on over 90% of patients, challenging the need for continuous immunosuppression with anti-CD20 in this patient subset.

Authors/Disclosures
Mirza Omari, MD (New York University, Langone Medical Center) PRESENTER	Dr. Omari has nothing to disclose.
Andrew Wolf, MD	The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. The institution of Dr. Wolf has received research support from Genentech. The institution of Dr. Wolf has received research support from Rocky Mountain MS Center. The institution of Dr. Wolf has received research support from Michael J. Fox Foundation. Dr. Wolf has received publishing royalties from a publication relating to health care.
Enrique Alvarez, MD, PhD (University of Colorado)	Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Alvarez has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene/BMS. The institution of an immediate family member of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon.
Lyla Manini	Ms. Manini has nothing to disclose.
John Corboy, MD, FAAN (U of Colorado School of Medicine)	Dr. Corboy has received personal compensation for serving as an employee of U of Coloado. Dr. Corboy has received personal compensation for serving as an employee of Rocky Mountain MS Center. Dr. Corboy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Mylan. Dr. Corboy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squib. Dr. Corboy 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 AAN. Dr. Corboy 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 American Neurological Association. Dr. Corboy has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Mylan. The institution of Dr. Corboy has received research support from MedDay. The institution of Dr. Corboy has received research support from Novartis. The institution of Dr. Corboy has received research support from NMSS. The institution of Dr. Corboy has received research support from PCORI. The institution of Dr. Corboy has received research support from EMD Serono.
Ilya Kister, MD, FAAN (NYU School of Medicine)	Dr. Kister has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech-Roche. Dr. Kister has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. The institution of Dr. Kister has received research support from Genentech. The institution of Dr. Kister has received research support from Novartis. Dr. Kister has received publishing royalties from a publication relating to health care.

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