Ocrelizumab’s Impact on Humoral Response to EBV: Robert Zivadinov, MD, PhD

WATCH TIME: 5 minutes

"The study confirmed what have been found in phase 3 trials—a good amount of patients remained stable or slightly improved in their disability over the 24-month follow-up. All in all, it’s a novel study because it’s one of the first prospective studies of leptomeningeal inflammation in MS in addition with the EBV component."

Until recently, there was no data on the effect of ocrelizumab, an FDA-approved medication to treat relapsing and progressive multiple sclerosis (MS), on leptomeningeal inflammation (LM). It had been hypothesized that dysregulating Epstein-Barr virus (EBV)—the most plausible cause of MS—infected b-cells may induce LM inflammation that contributes to gray matter pathology. At the 2022 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress, October 26-28, in Amsterdam, Netherlands, data from a phase 4, prospective, longitudinal pilot study assessing ocrelizumab’s impact on LM inflammation was presented.

The study, conducted from March 2017 to August 2021, included 27 patients with relapsing MS who started ocrelizumab 600 mg and were assessed on clinical, neuropsychological, MRI, and laboratory examinations. Led by Robert Zivadinov, MD, PhD, individuals were analyzed at baseline, 12-, and 24-months, with disability progression (DP) defined as an increase from baseline in Expanded Disability Status Scale scores of at least 1.0 point, or 0.5 if the baseline EDSS score was greater than 5.5.

In the 24 patients who remained on treatment for the duration of the study, 72.7% remained stable in their LM contrast-enhancing (CE) status. Over time, a significant decrease in percentage volume loss of cortex (P = .009), gray matter (P = .01), and thalamus (P = .038) was detected, while the T1-left ventricular brain region increased (P = .02). Zivadinov, director of the Buffalo Neuroimaging Analysis Center, sat down with NeurologyLive^® at ECTRIMS 2022 to provide context on the study, including the most notable take-home points.

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REFERENCE
1. Zivadinov R, Jakimovski D, Ramanathan M, et al. Effect of ocrelizumab on leptomeningeal inflammation and humoral response to Epstein Barr-Virus in multiple sclerosis. Presented at: 2022 ECTRIMS Congress; October 26-28; Amsterdam, Netherlands. Abstract P753