Case Report Reveals Promising Efficacy of Ofatumumab as Long-Term Treatment in Relapsing CIDP

In a newly published case study in Frontiers in Immunology, a 46-year-old man diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP) faced numerous relapses since his initial diagnosis, requiring adjustments to his treatment regimen. After several unsuccessful attempts with traditional therapies, treatment with ofatumumab (Kesimpta; Novartis), a fully human anti-CD20 monoclonal antibody approved for multiple sclerosis (MS), demonstrated efficacy in managing his condition.¹

CIDP, a rare autoimmune disorder, often leads to progressive muscle weakness, sensory loss, and a range of neurological impairments.² The patient's condition started in February 2017 with severe limb weakness that worsened over time, requiring him to rely on a wheelchair for mobility. After numerous relapses and failed treatments, a new therapeutic strategy, including the use of ofatumumab, showed promise in preventing future relapses and potentially raising hopes for more consistent disease management.

The first dose of ofatumumab was administered in April 2022. The patient experienced some initial adverse effects, including shortness of breath and an allergic reaction, which were managed with corticosteroids. Despite these complications, subsequent doses were well-tolerated, and after 6 injections, the patient's condition stabilized with no further relapses. Over 23 months of follow-up, the patient showed no signs of new episodes, and his limb strength remained intact.

Conducted by lead author Jian Wang, MD, an associate professor in the department of neurology at Affiliated Aerospace Hospital of Zunyi Medical University in China, the patient was initially presented with a 3-month history of progressive limb weakness, with significant symptoms including an inability to grasp objects, difficulty walking, and sensory loss. Diagnostic testing revealed signs consistent with CIDP, including reduced conduction velocity in nerve conduction studies and elevated protein levels in cerebrospinal fluid. The patient's diagnosis of CIDP was confirmed, and he was treated with intravenous immunoglobulin (IVIg) therapy, which successfully improved his condition, returning his muscle strength to normal levels.

READ MORE: Clinical and Ultrasound Scores Helps Differentiate CIDP from Diabetic Polyneuropathy

Despite initial improvement, the benefits were not sustained, and by early 2018, he experienced his first relapse, requiring readmission for further IVIg treatment and corticosteroids. Over the next few years, the patient faced additional relapses in 2018, 2019, 2020, and 2021, each time requiring readmission and adjustments to his treatment regimen. These included combinations of IVIg, corticosteroids, and in some instances, plasma exchange therapy. Despite these treatments, the relapses continued, prompting further investigation into more potent therapies.

In early 2022, the patient experienced his sixth relapse, with continued worsening of muscle strength and sensory deficits. At this stage, conventional treatments had failed to prevent the relapses, leading the medical team to explore newer treatment options. After a comprehensive review of the patient's medical history, the decision was made to begin treatment with ofatumumab, an antibody that depletes CD19+ B cells, which is a key player in the immune response involved in CIDP. This treatment is generally used in other autoimmune disorders such as MS, but its application in CIDP is emerging as a promising approach.

This patient's experience with ofatumumab highlighted the challenges of managing CIDP and the promise of newer therapies. Although conventional treatments like IVIg and corticosteroids initially provided relief, they couldn't prevent long-term relapses, which prompted a shift to ofatumumab. As a targeted immune modulator, ofatumumab has shown potential as a well-tolerated, effective option for patients with relapsing CIDP. The patient's continued progress underscored the need for personalized treatment regimens, and while ofatumumab represents a promising step forward, further studies may be needed to confirm its long-term efficacy and safety, especially in refractory cases.

REFERENCES
1. Wang J, Xiang Q. Successful treatment of relapsed and refractory CIDP with ofatumumab: a first case report. Front Immunol. 2024;15:1437848. Published 2024 Jul 31. doi:10.33 OFA 89/fimmu.2024.1437848
2. Van den Bergh PY, Hadden RD, Bouche P, et al. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society - first revision. Eur J Neurol. 2010;17(3):356-363. doi:10.1111/j.1468-1331.2009.02930.x