De-escalation from anti-CD20 to cladribine tablets in multiple sclerosis: A pilot study

Rosaria Sacco; Giulio Disanto; Emanuele Pravatà; Giulia Mallucci; Aleksandra Maleska Maceski; Jens Kuhle; Claudio Gobbi; Chiara Zecca

doi:10.1016/j.msard.2024.106145

De-escalation from anti-CD20 to cladribine tablets in multiple sclerosis: A pilot study

Mult Scler Relat Disord. 2024 Dec:92:106145. doi: 10.1016/j.msard.2024.106145. Epub 2024 Oct 28.

Authors

Rosaria Sacco¹, Giulio Disanto¹, Emanuele Pravatà², Giulia Mallucci¹, Aleksandra Maleska Maceski³, Jens Kuhle³, Claudio Gobbi⁴, Chiara Zecca⁵

Affiliations

¹ Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano 6900, Switzerland.
² Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano 6900, Switzerland; Faculty of biomedical Sciences, Università della Svizzera Italiana, Via Buffi 13, 6900 Lugano, Switzerland; Department of Neuroradiology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland.
³ Department of Neurology, University Hospital and University of Basel, Basel, Switzerland; Multiple Sclerosis Centre and Research Centre for Clinical Neurimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland.
⁴ Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano 6900, Switzerland; Faculty of biomedical Sciences, Università della Svizzera Italiana, Via Buffi 13, 6900 Lugano, Switzerland.
⁵ Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano 6900, Switzerland; Faculty of biomedical Sciences, Università della Svizzera Italiana, Via Buffi 13, 6900 Lugano, Switzerland. Electronic address: Chiara.zecca@eoc.ch.

PMID: 39510011
DOI: 10.1016/j.msard.2024.106145

Abstract

Prolonged treatment with anti-CD20 antibodies can lead to hypogammaglobulinemia and increased infection risk in multiple sclerosis (MS). We investigated switch from anti-CD20 to cladribine as a strategy to prevent immunoglobulin reduction while preserving efficacy. We prospectively analysed serum IgG, IgM, neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) in 44 patients, 14 who were switched from anti-CD20 to cladribine and 30 continuing anti-CD20. Over 1 year, serum IgG, IgM, NfL and GFAP remained stable after switch and similar to patients continuing anti-CD20. More than 90 % of patients remained free of disease activity. Cladribine should be further explored as de-escalating agent from anti-CD20 in MS.

Keywords: Anti-CD20; Cladribine; De-escalation; Immunoglobulins; Neurofilaments.

MeSH terms

Adult
Antigens, CD20 / immunology
Cladribine* / administration & dosage
Cladribine* / pharmacology
Drug Substitution
Female
Glial Fibrillary Acidic Protein / blood
Humans
Immunoglobulin G / blood
Immunoglobulin M / blood
Immunologic Factors / administration & dosage
Immunologic Factors / pharmacology
Immunosuppressive Agents / administration & dosage
Male
Middle Aged
Multiple Sclerosis / blood
Multiple Sclerosis / drug therapy
Multiple Sclerosis / immunology
Multiple Sclerosis, Relapsing-Remitting / blood
Multiple Sclerosis, Relapsing-Remitting / drug therapy
Neurofilament Proteins / blood
Pilot Projects
Prospective Studies
Rituximab / administration & dosage
Rituximab / pharmacology

Substances

Cladribine
neurofilament protein L
Immunologic Factors
Glial Fibrillary Acidic Protein
Neurofilament Proteins
Immunoglobulin G
Immunoglobulin M
Rituximab
GFAP protein, human
Immunosuppressive Agents
Antigens, CD20