Abstract
Ocrelizumab is often used as an alternative therapy in natalizumab-treated MS patients at risk for progressive multifocal leukoencephalopathy (PML). Our objective was to assess efficacy and safety of JC-virus positive patients switching (either directly or indirectly) from natalizumab to ocrelizumab. Forty-two patients were included from an observational cohort (median follow-up 21 months). No evidence of disease activity was found in 83% of direct switchers and 50% of indirect switchers. Two direct switchers were diagnosed with carry-over PML. Our data support a direct switch for adequate disease suppression, although carry-over PML illustrates the dilemma when choosing between a direct or indirect switch.
Highlights
Ocrelizumab is considered an appropriate alternative therapy for relapsing remitting MS (RRMS) patients with an increased risk of natalizumab-associated progressive multifocal leukoencephalopathy (PML)
The rate of patients who established or maintained NEDA in our cohort is relatively lower in indirect switchers compared to direct switchers
As both groups were similar with regard to other risk factors for not achieving NEDA, this could mainly be due to the less effective treatment with other disease-modifying therapies (DMTs) prior to ocrelizumab initiation
Summary
Ocrelizumab is considered an appropriate alternative therapy for relapsing remitting MS (RRMS) patients with an increased risk of natalizumab-associated progressive multifocal leukoencephalopathy (PML). Challenging aspects of switching patients from natalizumab to ocrelizumab include the choice between a direct switch or bridging with other disease-modifying therapies (DMTs) without a long-lasting pharmacodynamic effect, which can be halted more in case of carry-over PML.. Challenging aspects of switching patients from natalizumab to ocrelizumab include the choice between a direct switch or bridging with other disease-modifying therapies (DMTs) without a long-lasting pharmacodynamic effect, which can be halted more in case of carry-over PML.1 The objectives of this observational cohort study are to report on the efficacy and safety of switching JCvirus (JCV) positive MS patients from natalizumab to ocrelizumab, and to share the switch protocol of the MS Center Amsterdam Challenging aspects of switching patients from natalizumab to ocrelizumab include the choice between a direct switch or bridging with other disease-modifying therapies (DMTs) without a long-lasting pharmacodynamic effect, which can be halted more in case of carry-over PML. The objectives of this observational cohort study are to report on the efficacy and safety of switching JCvirus (JCV) positive MS patients from natalizumab to ocrelizumab, and to share the switch protocol of the MS Center Amsterdam
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