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Published in: Neurotherapeutics 4/2017

01-10-2017 | Review

Ocrelizumab and Other CD20+ B-Cell-Depleting Therapies in Multiple Sclerosis

Authors: Jeffrey M. Gelfand, Bruce A. C. Cree, Stephen L. Hauser

Published in: Neurotherapeutics | Issue 4/2017

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Abstract

Selective depletion of CD20+ B cells by anti-CD20 monoclonal antibodies as monotherapy in multiple sclerosis (MS) profoundly suppresses acute inflammatory disease activity and signifies an important advance in the treatment of relapsing-remitting MS. Ocrelizumab, a humanized anti-CD20 monoclonal antibody, is also the first proven therapy to lessen disability progression in primary progressive MS—a breakthrough for patients with a disease that had no proven therapy. Ocrelizumab is generally well tolerated, with the most common adverse events experienced being infusion reactions and infections. In ocrelizumab trials in MS a numerical imbalance in the risk of malignancies was observed. In this article, we review advances in anti-CD20 B-cell-depleting biological therapies for MS, including ocrelizumab, rituximab, and ofatumumab.
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Literature
1.
go back to reference Lassmann H, Bradl M. Multiple sclerosis: experimental models and reality. Acta Neuropathol 2017;133(2):223–244.CrossRefPubMed Lassmann H, Bradl M. Multiple sclerosis: experimental models and reality. Acta Neuropathol 2017;133(2):223–244.CrossRefPubMed
2.
go back to reference Bruck W, Gold R, Lund BT, et al. Therapeutic decisions in multiple sclerosis: moving beyond efficacy. JAMA Neurol 2013;70(10):1315–1324.PubMed Bruck W, Gold R, Lund BT, et al. Therapeutic decisions in multiple sclerosis: moving beyond efficacy. JAMA Neurol 2013;70(10):1315–1324.PubMed
3.
go back to reference Longbrake EE, Cross AH. Effect of multiple sclerosis disease-modifying therapies on B cells and humoral immunity. JAMA Neurol 2016;73(2):219–225.CrossRefPubMed Longbrake EE, Cross AH. Effect of multiple sclerosis disease-modifying therapies on B cells and humoral immunity. JAMA Neurol 2016;73(2):219–225.CrossRefPubMed
4.
go back to reference van Oosten BW, Lai M, Hodgkinson S, et al. Treatment of multiple sclerosis with the monoclonal anti-CD4 antibody cM-T412: results of a randomized, double-blind, placebo-controlled, MR-monitored phase II trial. Neurology 1997;49(2):351–357.CrossRefPubMed van Oosten BW, Lai M, Hodgkinson S, et al. Treatment of multiple sclerosis with the monoclonal anti-CD4 antibody cM-T412: results of a randomized, double-blind, placebo-controlled, MR-monitored phase II trial. Neurology 1997;49(2):351–357.CrossRefPubMed
5.
go back to reference Li R, Rezk A, Miyazaki Y, et al. Proinflammatory GM-CSF-producing B cells in multiple sclerosis and B cell depletion therapy. Sci Transl Med 2015;7(310):310ra166.CrossRefPubMed Li R, Rezk A, Miyazaki Y, et al. Proinflammatory GM-CSF-producing B cells in multiple sclerosis and B cell depletion therapy. Sci Transl Med 2015;7(310):310ra166.CrossRefPubMed
6.
go back to reference Dobson R, Ramagopalan S, Davis A, Giovannoni G. Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude. J Neurol Neurosurg Psychiatry 2013;84(8):909–914.CrossRefPubMed Dobson R, Ramagopalan S, Davis A, Giovannoni G. Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude. J Neurol Neurosurg Psychiatry 2013;84(8):909–914.CrossRefPubMed
7.
go back to reference Howell OW, Reeves CA, Nicholas R, et al. Meningeal inflammation is widespread and linked to cortical pathology in multiple sclerosis. Brain 2011;134(Pt 9):2755–2771.CrossRefPubMed Howell OW, Reeves CA, Nicholas R, et al. Meningeal inflammation is widespread and linked to cortical pathology in multiple sclerosis. Brain 2011;134(Pt 9):2755–2771.CrossRefPubMed
8.
go back to reference Magliozzi R, Howell OW, Reeves C, et al. A Gradient of neuronal loss and meningeal inflammation in multiple sclerosis. Ann Neurol 2010;68(4):477–493.CrossRefPubMed Magliozzi R, Howell OW, Reeves C, et al. A Gradient of neuronal loss and meningeal inflammation in multiple sclerosis. Ann Neurol 2010;68(4):477–493.CrossRefPubMed
9.
go back to reference Bar-Or A, Fawaz L, Fan B, et al. Abnormal B-cell cytokine responses a trigger of T-cell-mediated disease in MS? Ann Neurol 2010;67(4):452–461.CrossRefPubMed Bar-Or A, Fawaz L, Fan B, et al. Abnormal B-cell cytokine responses a trigger of T-cell-mediated disease in MS? Ann Neurol 2010;67(4):452–461.CrossRefPubMed
10.
go back to reference Kinnunen T, Chamberlain N, Morbach H, et al. Specific peripheral B cell tolerance defects in patients with multiple sclerosis. J Clin Invest 2013;123:2737–2741.CrossRefPubMedPubMedCentral Kinnunen T, Chamberlain N, Morbach H, et al. Specific peripheral B cell tolerance defects in patients with multiple sclerosis. J Clin Invest 2013;123:2737–2741.CrossRefPubMedPubMedCentral
11.
go back to reference International Multiple Sclerosis Genetics Consortium, Wellcome Trust Case Control Consortium 2, Sawcer S, et al. Genetic risk and a primary role for cell-mediated immune mechanisms in multiple sclerosis. Nature 2011;476(7359):214–219.CrossRef International Multiple Sclerosis Genetics Consortium, Wellcome Trust Case Control Consortium 2, Sawcer S, et al. Genetic risk and a primary role for cell-mediated immune mechanisms in multiple sclerosis. Nature 2011;476(7359):214–219.CrossRef
12.
go back to reference Stashenko P, Nadler LM, Hardy R, Schlossman SF. Characterization of a human B lymphocyte-specific antigen. J Immunol 1980;125(4):1678–1685.PubMed Stashenko P, Nadler LM, Hardy R, Schlossman SF. Characterization of a human B lymphocyte-specific antigen. J Immunol 1980;125(4):1678–1685.PubMed
13.
go back to reference Krumbholz M, Derfuss T, Hohlfeld R, Meinl E. B cells and antibodies in multiple sclerosis pathogenesis and therapy. Nat Rev Neurol 2012;8(11):613–623.CrossRefPubMed Krumbholz M, Derfuss T, Hohlfeld R, Meinl E. B cells and antibodies in multiple sclerosis pathogenesis and therapy. Nat Rev Neurol 2012;8(11):613–623.CrossRefPubMed
14.
go back to reference Hauser SL, Waubant E, Arnold DL, et al. B-cell depletion with rituximab in relapsing-remitting multiple sclerosis. N Engl J Med 2008;358(7):676–688.CrossRefPubMed Hauser SL, Waubant E, Arnold DL, et al. B-cell depletion with rituximab in relapsing-remitting multiple sclerosis. N Engl J Med 2008;358(7):676–688.CrossRefPubMed
15.
go back to reference Hauser SL, Li D, Calabresi P, et al. Week 144 results of a phase II, randomized, multicenter trial assessing the safety and efficacy of ocrelizumab in patients with relapsing–remitting multiple sclerosis (RRMS). Neurology 2013;80(7 Supplement, S31.004). Hauser SL, Li D, Calabresi P, et al. Week 144 results of a phase II, randomized, multicenter trial assessing the safety and efficacy of ocrelizumab in patients with relapsing–remitting multiple sclerosis (RRMS). Neurology 2013;80(7 Supplement, S31.004).
16.
go back to reference Kappos L, Li D, Calabresi PA, et al. Ocrelizumab in relapsing-remitting multiple sclerosis: a phase 2, randomised, placebo-controlled, multicentre trial. Lancet 2011;378(9805):1779–1787.CrossRefPubMed Kappos L, Li D, Calabresi PA, et al. Ocrelizumab in relapsing-remitting multiple sclerosis: a phase 2, randomised, placebo-controlled, multicentre trial. Lancet 2011;378(9805):1779–1787.CrossRefPubMed
17.
go back to reference Palanichamy A, Jahn S, Nickles D, et al. Rituximab efficiently depletes increased CD20-expressing T cells in multiple sclerosis patients. J Immunol 2014;193(2):580–586.CrossRefPubMedPubMedCentral Palanichamy A, Jahn S, Nickles D, et al. Rituximab efficiently depletes increased CD20-expressing T cells in multiple sclerosis patients. J Immunol 2014;193(2):580–586.CrossRefPubMedPubMedCentral
18.
go back to reference Cree BA, Lamb S, Morgan K, Chen A, Waubant E, Genain C. An open label study of the effects of rituximab in neuromyelitis optica. Neurology 2005;64(7):1270–1272.CrossRefPubMed Cree BA, Lamb S, Morgan K, Chen A, Waubant E, Genain C. An open label study of the effects of rituximab in neuromyelitis optica. Neurology 2005;64(7):1270–1272.CrossRefPubMed
19.
go back to reference Bar-Or A, Calabresi PA, Arnold D, et al. Rituximab in relapsing-remitting multiple sclerosis: a 72-week, open-label, phase I trial. Ann Neurol 2008;63(3):395–400.CrossRefPubMed Bar-Or A, Calabresi PA, Arnold D, et al. Rituximab in relapsing-remitting multiple sclerosis: a 72-week, open-label, phase I trial. Ann Neurol 2008;63(3):395–400.CrossRefPubMed
20.
go back to reference Salzer J, Svenningsson R, Alping P, et al. Rituximab in multiple sclerosis: a retrospective observational study on safety and efficacy. Neurology 2016;87(20):2074–2081.CrossRefPubMedPubMedCentral Salzer J, Svenningsson R, Alping P, et al. Rituximab in multiple sclerosis: a retrospective observational study on safety and efficacy. Neurology 2016;87(20):2074–2081.CrossRefPubMedPubMedCentral
21.
go back to reference Rubenstein JL, Combs D, Rosenberg J, et al. Rituximab therapy for CNS lymphomas: targeting the leptomeningeal compartment. Blood 2003;101(2):466–468.CrossRefPubMed Rubenstein JL, Combs D, Rosenberg J, et al. Rituximab therapy for CNS lymphomas: targeting the leptomeningeal compartment. Blood 2003;101(2):466–468.CrossRefPubMed
22.
go back to reference Ruhstaller TW, Amsler U, Cerny T. Rituximab: active treatment of central nervous system involvement by non-Hodgkin's lymphoma? Ann Oncol 2000;11(3):374–375.CrossRefPubMed Ruhstaller TW, Amsler U, Cerny T. Rituximab: active treatment of central nervous system involvement by non-Hodgkin's lymphoma? Ann Oncol 2000;11(3):374–375.CrossRefPubMed
23.
go back to reference Naismith RT, Piccio L, Lyons JA, et al. Rituximab add-on therapy for breakthrough relapsing multiple sclerosis: a 52-week phase II trial. Neurology 2010;74(23):1860–1867.CrossRefPubMedPubMedCentral Naismith RT, Piccio L, Lyons JA, et al. Rituximab add-on therapy for breakthrough relapsing multiple sclerosis: a 52-week phase II trial. Neurology 2010;74(23):1860–1867.CrossRefPubMedPubMedCentral
24.
go back to reference Alping P, Frisell T, Novakova L, et al. Rituximab versus fingolimod after natalizumab in multiple sclerosis patients. Ann Neurol 2016;79(6):950–958.CrossRefPubMed Alping P, Frisell T, Novakova L, et al. Rituximab versus fingolimod after natalizumab in multiple sclerosis patients. Ann Neurol 2016;79(6):950–958.CrossRefPubMed
25.
go back to reference Rommer PS, Dorner T, Freivogel K, et al. Safety and clinical outcomes of rituximab treatment in patients with multiple sclerosis and neuromyelitis optica: experience from a national online registry (GRAID). J Neuroimmune Pharmacol 2016;11(1):1–8.CrossRefPubMed Rommer PS, Dorner T, Freivogel K, et al. Safety and clinical outcomes of rituximab treatment in patients with multiple sclerosis and neuromyelitis optica: experience from a national online registry (GRAID). J Neuroimmune Pharmacol 2016;11(1):1–8.CrossRefPubMed
26.
go back to reference Dale RC, Brilot F, Duffy LV, et al. Utility and safety of rituximab in pediatric autoimmune and inflammatory CNS disease. Neurology 2014;83(2):142–150.CrossRefPubMedPubMedCentral Dale RC, Brilot F, Duffy LV, et al. Utility and safety of rituximab in pediatric autoimmune and inflammatory CNS disease. Neurology 2014;83(2):142–150.CrossRefPubMedPubMedCentral
27.
go back to reference Hauser SL, Bar-Or A, Comi G, et al. Ocrelizumab versus Interferon beta-1a in relapsing multiple sclerosis. N Engl J Med 2017;376(3):221–234.CrossRefPubMed Hauser SL, Bar-Or A, Comi G, et al. Ocrelizumab versus Interferon beta-1a in relapsing multiple sclerosis. N Engl J Med 2017;376(3):221–234.CrossRefPubMed
28.
go back to reference Klein C, Lammens A, Schafer W, et al. Epitope interactions of monoclonal antibodies targeting CD20 and their relationship to functional properties. mAbs 2013;5(1):22–33.CrossRefPubMedPubMedCentral Klein C, Lammens A, Schafer W, et al. Epitope interactions of monoclonal antibodies targeting CD20 and their relationship to functional properties. mAbs 2013;5(1):22–33.CrossRefPubMedPubMedCentral
29.
go back to reference Giovannoni G, Turner B, Gnanapavan S, Offiah C, Schmierer K, Marta M. Is it time to target no evident disease activity (NEDA) in multiple sclerosis? Mult Scler Relat Disord 2015;4(4):329–333.CrossRefPubMed Giovannoni G, Turner B, Gnanapavan S, Offiah C, Schmierer K, Marta M. Is it time to target no evident disease activity (NEDA) in multiple sclerosis? Mult Scler Relat Disord 2015;4(4):329–333.CrossRefPubMed
30.
go back to reference Bevan CJ, Cree BA. Disease activity free status: a new end point for a new era in multiple sclerosis clinical research? JAMA Neurol 2014;71(3):269–270.CrossRefPubMed Bevan CJ, Cree BA. Disease activity free status: a new end point for a new era in multiple sclerosis clinical research? JAMA Neurol 2014;71(3):269–270.CrossRefPubMed
31.
go back to reference Sorensen PS, Lisby S, Grove R, et al. Safety and efficacy of ofatumumab in relapsing-remitting multiple sclerosis: a phase 2 study. Neurology 2014;82(7):573–581.CrossRefPubMed Sorensen PS, Lisby S, Grove R, et al. Safety and efficacy of ofatumumab in relapsing-remitting multiple sclerosis: a phase 2 study. Neurology 2014;82(7):573–581.CrossRefPubMed
32.
go back to reference Bar-Or A, Grove R, Austin D, et al. The MIRROR Study: a randomized, double-blind, placebo-controlled, parallel-group, dose-ranging study to investigate the safety and MRI efficacy of subcutaneous ofatumumab in subjects with relapsing-remitting multiple sclerosis. Neurology 2014;82(10):S23.006. Bar-Or A, Grove R, Austin D, et al. The MIRROR Study: a randomized, double-blind, placebo-controlled, parallel-group, dose-ranging study to investigate the safety and MRI efficacy of subcutaneous ofatumumab in subjects with relapsing-remitting multiple sclerosis. Neurology 2014;82(10):S23.006.
34.
go back to reference Weinshenker BG, Bass B, Rice GP, et al. The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain 1989;112 ( Pt 1):133–146.CrossRefPubMed Weinshenker BG, Bass B, Rice GP, et al. The natural history of multiple sclerosis: a geographically based study. I. Clinical course and disability. Brain 1989;112 ( Pt 1):133–146.CrossRefPubMed
35.
go back to reference Tremlett H, Zhao Y, Devonshire V. Natural history comparisons of primary and secondary progressive multiple sclerosis reveals differences and similarities. J Neurol 2009;256(3):374–381.CrossRefPubMed Tremlett H, Zhao Y, Devonshire V. Natural history comparisons of primary and secondary progressive multiple sclerosis reveals differences and similarities. J Neurol 2009;256(3):374–381.CrossRefPubMed
36.
go back to reference Confavreux C, Vukusic S, Moreau T, Adeleine P. Relapses and progression of disability in multiple sclerosis. N Engl J Med 2000;343(20):1430–1438.CrossRefPubMed Confavreux C, Vukusic S, Moreau T, Adeleine P. Relapses and progression of disability in multiple sclerosis. N Engl J Med 2000;343(20):1430–1438.CrossRefPubMed
37.
go back to reference Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69(2):292–302.CrossRefPubMedPubMedCentral Polman CH, Reingold SC, Banwell B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011;69(2):292–302.CrossRefPubMedPubMedCentral
38.
go back to reference Ontaneda D, Thompson AJ, Fox RJ, Cohen JA. Progressive multiple sclerosis: prospects for disease therapy, repair, and restoration of function. Lancet 2017;389:1357–1366.CrossRefPubMed Ontaneda D, Thompson AJ, Fox RJ, Cohen JA. Progressive multiple sclerosis: prospects for disease therapy, repair, and restoration of function. Lancet 2017;389:1357–1366.CrossRefPubMed
39.
go back to reference Hawker K, O'Connor P, Freedman MS, et al. Rituximab in patients with primary progressive multiple sclerosis: results of a randomized double-blind placebo-controlled multicenter trial. Ann Neurol 2009;66(4):460–471.CrossRefPubMed Hawker K, O'Connor P, Freedman MS, et al. Rituximab in patients with primary progressive multiple sclerosis: results of a randomized double-blind placebo-controlled multicenter trial. Ann Neurol 2009;66(4):460–471.CrossRefPubMed
40.
go back to reference Montalban X, Hauser SL, Kappos L, et al. Ocrelizumab versus placebo in primary progressive multiple sclerosis. N Engl J Med 2017;376(3):209–220.CrossRefPubMed Montalban X, Hauser SL, Kappos L, et al. Ocrelizumab versus placebo in primary progressive multiple sclerosis. N Engl J Med 2017;376(3):209–220.CrossRefPubMed
41.
go back to reference Komori M, Lin YC, Cortese I, et al. Insufficient disease inhibition by intrathecal rituximab in progressive multiple sclerosis. Ann Clin Transl Neurol 2016;3(3):166–179.CrossRefPubMedPubMedCentral Komori M, Lin YC, Cortese I, et al. Insufficient disease inhibition by intrathecal rituximab in progressive multiple sclerosis. Ann Clin Transl Neurol 2016;3(3):166–179.CrossRefPubMedPubMedCentral
42.
go back to reference van der Kolk LE, Grillo-Lopez AJ, Baars JW, Hack CE, van Oers MH. Complement activation plays a key role in the side-effects of rituximab treatment. Br J Haematol 2001;115(4):807–811.CrossRefPubMed van der Kolk LE, Grillo-Lopez AJ, Baars JW, Hack CE, van Oers MH. Complement activation plays a key role in the side-effects of rituximab treatment. Br J Haematol 2001;115(4):807–811.CrossRefPubMed
44.
go back to reference Dyson JK, Jopson L, Ng S, et al. Improving testing for hepatitis B before treatment with rituximab. Eur J Gastroenterol Hepatol 2016;28(10):1172–1178.CrossRefPubMedPubMedCentral Dyson JK, Jopson L, Ng S, et al. Improving testing for hepatitis B before treatment with rituximab. Eur J Gastroenterol Hepatol 2016;28(10):1172–1178.CrossRefPubMedPubMedCentral
45.
go back to reference Lee J, Park JY, Huh KH, et al. Rituximab and hepatitis B reactivation in HBsAg-negative/ anti-HBc-positive kidney transplant recipients. Nephrol Dialysis Transplant 2017;32(4):722–729. Lee J, Park JY, Huh KH, et al. Rituximab and hepatitis B reactivation in HBsAg-negative/ anti-HBc-positive kidney transplant recipients. Nephrol Dialysis Transplant 2017;32(4):722–729.
46.
go back to reference Seto WK, Wong DH, Chan TY, et al. Association of hepatitis B core-related antigen with hepatitis B virus reactivation in occult viral carriers undergoing high-risk immunosuppressive therapy. Am J Gastroenterol 2016;111(12):1788–1795.CrossRefPubMed Seto WK, Wong DH, Chan TY, et al. Association of hepatitis B core-related antigen with hepatitis B virus reactivation in occult viral carriers undergoing high-risk immunosuppressive therapy. Am J Gastroenterol 2016;111(12):1788–1795.CrossRefPubMed
47.
go back to reference Clifford DB, Ances B, Costello C, , et al. Rituximab-associated progressive multifocal leukoencephalopathy in rheumatoid arthritis. Arch Neurol 2011;68(9):1156–1164.CrossRefPubMedPubMedCentral Clifford DB, Ances B, Costello C, , et al. Rituximab-associated progressive multifocal leukoencephalopathy in rheumatoid arthritis. Arch Neurol 2011;68(9):1156–1164.CrossRefPubMedPubMedCentral
48.
go back to reference Bove R, Alwan S, Friedman JM, et al. Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review. Obstetr Gynecol 2014;124(6):1157–1168.CrossRef Bove R, Alwan S, Friedman JM, et al. Management of multiple sclerosis during pregnancy and the reproductive years: a systematic review. Obstetr Gynecol 2014;124(6):1157–1168.CrossRef
Metadata
Title
Ocrelizumab and Other CD20+ B-Cell-Depleting Therapies in Multiple Sclerosis
Authors
Jeffrey M. Gelfand
Bruce A. C. Cree
Stephen L. Hauser
Publication date
01-10-2017
Publisher
Springer US
Published in
Neurotherapeutics / Issue 4/2017
Print ISSN: 1933-7213
Electronic ISSN: 1878-7479
DOI
https://doi.org/10.1007/s13311-017-0557-4

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