Forschung & Innovation
Publikationen
Disease Course After Anti-CD20 Discontinuation in Secondary Progressive Multiple Sclerosis-A Multicenter Long-Term Longitudinal Study
PMU Autor*innen
Ferdinand Otto, Dariia Kliushnikova, Richard Friedrich Radlberger, Tobias Moser, Andrea Harrer, Wolfgang Hitzl, Peter Wipfler
Alle Autor*innen
Ferdinand Otto, Dariia Kliushnikova, Richard Friedrich Radlberger, Sinan Yasaroglu, Tobias Moser, Andrea Harrer, Kitty Kratzer, Wolfgang Hitzl, Christiane Gradl, Martin Schmidauer, Patrick Roth, Harald Hegen, Peter Wipfler
Fachzeitschrift
ANNALS OF CLINICAL AND TRANSLATIONAL NEUROLOGY
Kurzfassung
OBJECTIVE: To describe long-term outcomes after anti-CD20 discontinuation in selected patients with secondary progressive multiple sclerosis (SPMS) who remained without subsequent disease-modifying therapy (DMT).
METHODS: We retrospectively analyzed data from four centers in Austria and Switzerland. Inclusion criteria were SPMS, ≥ 2 anti-CD20 cycles, discontinuation without subsequent DMT, and ≥ 36 months follow-up. The primary endpoint was time to first confirmed Expanded Disability Status Scale (EDSS) worsening, defined as a ≥ 0.5-point increase after discontinuation documented at a subsequent routine visit. Secondary endpoints were relapses, MRI activity, and severe infections. No continuation cohort was available.
RESULTS: Fifty-five patients were included (61% female). Mean age at anti-CD20 start was 53.5 ± 6.6 years, disease duration 19.3 ± 10.1 years, treatment duration 32.8 ± 16.1 months, and post-discontinuation follow-up 55.1 ± 14.1 months. Mean EDSS increased from 5.9 ± 1.3 before anti CD20, to 6.3 ± 1.3 at discontinuation and 6.9 ± 1.2 at last follow-up. Confirmed EDSS worsening occurred in 31 patients (56%). Hazard analysis suggested an exploratory late increase between 48 and 60 months (p = 0.043) based on small numbers at risk. Relapses occurred in 6 patients (10.9%), MRI activity in 4/35 (11%), and severe infections in 17 (31%).
CONCLUSIONS: In this selected SPMS cohort, focal inflammatory activity was uncommon, whereas confirmed EDSS worsening accumulated over long-term follow-up. Because inclusion required ≥ 36 months untreated follow-up, early disease activity may have been underestimated, and apparent stability may have been overestimated. Findings are descriptive and hypothesis-generating and do not establish safety or optimal timing of anti-CD20 discontinuation.