Infection Rates Associated with Anti-CD20 Treatment In Pediatric Onset Multiple Sclerosis
Lauren Seidman1, Nadine Azmy2, Anna Sosa2, Ugo Nwigwe2, Kimberly O'Neill2, Lauren Krupp2
1New York Medical College, 2NYU Langone Medical Center
Objective:
To describe frequency and type of infections in a single-center cohort of 91 POMS patients on anti-CD20 therapy.
Background:
Approximately 5% of MS patients experience symptoms under age 18 years, termed Pediatric Onset Multiple Sclerosis (POMS). Disease-Modifying Therapies that act on CD positive 20 cells, e.g. rituximab and ocrelizumab, are effective for relapse prevention in POMS. The limitation of anti-CD20 treatment is the risk of infection associated with B-cell depletion.
Design/Methods:
A retrospective chart review of 91 POMS from NYU Langone Pediatric MS Center was conducted. Inclusion criteria: MS onset < 18 years, RRMS subtype, anti-CD20 therapy > 12 months (rituximab, ocrelizumab, or both). Infection information was obtained from the medical records. Mild infections were defined as infections not requiring antibiotics. Moderate infections were defined as infections requiring oral antibiotics. Severe infections were defined as infections requiring intravenous antibiotics or hospitalization. Demographics, medical history, and laboratory values were also obtained.
Results:
POMS mean age was 22.00 years, range (11-31) with a mean MS disease duration of 8.33 years, range (1.76-24.10). A total of 41/91 (45.05%) patients reported any infection, including urinary tract infection 12/91 (13.19%), pneumonia 5/91(5.49%), sinusitis 4/91 (4.40%) and skin infection 4/91 (4.40%). 11/91 (12.09%) of patients had mild infections, 24/91 (26.37%) had moderate infections, and 6/91 (6.59%) had severe infections. On average, patients with severe infections were older (26.50 years vs. 21.75 years, p=.012), had longer CD20 treatment duration (5.20 years vs. 4.76 years, p=.041), and longer MS disease duration (13.26 years vs. 8.05 years, p=.008) when compared to patients with either mild or no infections.
Conclusions:
Risk of severe infections was associated with increasing patient age, MS disease duration, and CD20 treatment duration. Understanding the risk factors associated with CD20-associated infections in the POMS population can help optimize treatment and counsel patients and families appropriately.