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.