Anti-CD20 therapy in Multiple Sclerosis: real-word data from a single-center in Northeast Brazil

Introduction: Anti-CD20 monoclonal antibodies mediating B-cell depletion, such as rituximab and ocrelizumab, have robust efficacy for the treatment of people with Multiple Sclerosis (pwMS) of both clinical phenotypes². Real-world data evaluating the clinical profile of Brazilian patients under these therapies are scarce. Objectives: To determine the clinical profile, indication patterns, and therapeutic response in pwMS under anti-CD20 therapy followed at a single reference center in Northeast Brazil. Methods: Patients under anti-CD20 therapy between October/22 and March/23 were included. Clinical, functional, and radiological characteristics were evaluated considering the year before anti-CD20 start, and after for those with at least 1-year of therapy. Results: From 39 patients under anti-CD20 therapy, 59% (n = 23) were women with mean age of 43 (range 27-62 years); 64% (n=25) had progressive MS, and 36% (n = 14) relapsing-remitting MS. The median time of disease was 120 months (range 17-504), 74.4% (n=29) were using Ocrelizumab, while 25.6% (n=10) were under Rituximab. Median EDSS before anti-CD20 treatment was 6.0 (range: 1-8.5), median annualized relapse rate (ARR) was zero (range: 0,5-1,5) and 11 patients (3 RRMS, 8 PMS) presented radiological activity preceding the first infusion. The main indication was progressive disease (n=19; 11 PPMS, 8 SPMS), followed by positive JC virus under natalizumabe (NTZ) therapy (n= 15; 9 RRMS, 6 PMS). From the 28 patients (18 PMS, 10 RRMS) who completed 1-year of infusion, the median ARR was zero (range: 0.5-1.5) and the median EDSS was 5.0 (range: 1.5-8.5). Four patients presented clinical progression despite the therapy, however two of these had delayed infusion. Conclusion: The main indication for anti-CD20 therapy was progressive disease and most patients had already high EDSS score, no radiological activity and low ARR. Among the patients with regular treatment only two continued to show clinical worsening.