Repeated Iv Anti-CD20 Treatment in Multiple Sclerosis: Long-term Effects on Peripheral Immune Cell Subsets

Overview

Journal Ann Clin Transl Neurol

Specialty Neurology

Date 2024 Jan 11

PMID 38204286

Authors

Julia Feige

Tobias Moser

Katja Akgun

Kerstin Schwenker

Wolfgang Hitzl

Elisabeth Haschke-Becher

Tjalf Ziemssen

Johann Sellner

Affiliations

Soon will be listed here.

Abstract

Objective: Repeated intravenous administration of anti-CD20 depleting monoclonal antibodies 6 months apart is among the highly effective treatment options in multiple sclerosis (MS). Here, we aimed to investigate peripheral immune cell subset depletion kinetics following either rituximab (RTX) or ocrelizumab (OCR) infusions in people with MS (pwMS).

Methods: We studied pwMS treated de-novo with either RTX (n = 7) or OCR (n = 8). The examinations were scheduled before the initiation of anti-CD20 therapy and every 12 weeks for up to 15 months. Immunophenotyping of immune cell subsets in peripheral blood was performed by multiparametric fluorescence cytometry.

Results: A significant, persistent decrease of CD19 B cells was observed already with the first anti-CD20 infusion (p < 0.0001). A significant proportional reduction of memory B cells within the B-cell pool was achieved only after two treatment cycles (p = 0.005). We observed a proportional increase of immature (p = 0.04) and naive B cells (p = 0.004), again only after the second treatment cycle. As for the peripheral T-cell pool, we observed a continuous proportional increase of memory T helper (TH) cells/central memory TH cells (p = 0.02/p = 0.008), while the number of regulatory T cells (Treg) decreased (p = 0.007). The percentage of B-cell dependent TH17.1 central memory cells dropped after the second treatment cycle (p = 0.02). No significant differences in the depletion kinetics between RTX and OCR were found.

Interpretation: Peripheral immune cell profiling revealed more differentiated insights into the prompt and delayed immunological effects of repeated intravenous anti-CD20 treatment. The observation of proportional changes of some pathogenetically relevant immune cell subsets only after two infusion cycles deserves further attention.

Citing Articles

B-Cell and T-Cell Populations in Peripheral Blood Linked to Ocrelizumab Treatment Efficacy in Multiple Sclerosis.

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PMID: 40010950 PMC: 11884471. DOI: 10.21873/invivo.13920.

Longitudinal analysis of peripheral immune cells in patients with multiple sclerosis treated with anti-CD20 therapy.

Waede M, Voss L, Kingo C, Moeller J, Elkjaer M, Illes Z Ann Clin Transl Neurol. 2024; 11(10):2657-2672.

PMID: 39279291 PMC: 11514931. DOI: 10.1002/acn3.52182.

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