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July 2022; 9 (4) Research ArticleOpen Access

Transitioning From S1P Receptor Modulators to B Cell–Depleting Therapies in Multiple Sclerosis

Clinical, Radiographic, and Laboratory Data

View ORCID ProfileWilliam M. Rowles, Wan-Yu Hsu, Kira McPolin, Alyssa Li, Steven Merrill, Chu-Yueh Guo, Ari J. Green, View ORCID ProfileJeffrey Marc Gelfand, View ORCID ProfileRiley M. Bove
First published May 17, 2022, DOI: https://doi.org/10.1212/NXI.0000000000001183
William M. Rowles
From the UCSF Weill Institute for Neurosciences (W.M.R., W.-Y.H., K.M., A.L., C.-Y.G., A.J.G., J.M.G., R.M.B.), Division of Neuroimmunology and Glial Biology, Department of Neurology, Department of Clinical Pharmacy (S.M.), and UCSF Department of Ophthalmology (A.J.G.), University of California, San Francisco.
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  • For correspondence: william.rowles@ucsf.edu
Wan-Yu Hsu
From the UCSF Weill Institute for Neurosciences (W.M.R., W.-Y.H., K.M., A.L., C.-Y.G., A.J.G., J.M.G., R.M.B.), Division of Neuroimmunology and Glial Biology, Department of Neurology, Department of Clinical Pharmacy (S.M.), and UCSF Department of Ophthalmology (A.J.G.), University of California, San Francisco.
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  • For correspondence: wan-yu.hsu@ucsf.edu
Kira McPolin
From the UCSF Weill Institute for Neurosciences (W.M.R., W.-Y.H., K.M., A.L., C.-Y.G., A.J.G., J.M.G., R.M.B.), Division of Neuroimmunology and Glial Biology, Department of Neurology, Department of Clinical Pharmacy (S.M.), and UCSF Department of Ophthalmology (A.J.G.), University of California, San Francisco.
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  • For correspondence: kira.mcpolin@gmail.com
Alyssa Li
From the UCSF Weill Institute for Neurosciences (W.M.R., W.-Y.H., K.M., A.L., C.-Y.G., A.J.G., J.M.G., R.M.B.), Division of Neuroimmunology and Glial Biology, Department of Neurology, Department of Clinical Pharmacy (S.M.), and UCSF Department of Ophthalmology (A.J.G.), University of California, San Francisco.
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  • For correspondence: alyssa.li@berkeley.edu
Steven Merrill
From the UCSF Weill Institute for Neurosciences (W.M.R., W.-Y.H., K.M., A.L., C.-Y.G., A.J.G., J.M.G., R.M.B.), Division of Neuroimmunology and Glial Biology, Department of Neurology, Department of Clinical Pharmacy (S.M.), and UCSF Department of Ophthalmology (A.J.G.), University of California, San Francisco.
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  • For correspondence: steven.merrill@ucsf.edu
Chu-Yueh Guo
From the UCSF Weill Institute for Neurosciences (W.M.R., W.-Y.H., K.M., A.L., C.-Y.G., A.J.G., J.M.G., R.M.B.), Division of Neuroimmunology and Glial Biology, Department of Neurology, Department of Clinical Pharmacy (S.M.), and UCSF Department of Ophthalmology (A.J.G.), University of California, San Francisco.
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  • For correspondence: chu-yueh.guo@ucsf.edu
Ari J. Green
From the UCSF Weill Institute for Neurosciences (W.M.R., W.-Y.H., K.M., A.L., C.-Y.G., A.J.G., J.M.G., R.M.B.), Division of Neuroimmunology and Glial Biology, Department of Neurology, Department of Clinical Pharmacy (S.M.), and UCSF Department of Ophthalmology (A.J.G.), University of California, San Francisco.
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  • For correspondence: agreen@ucsf.edu
Jeffrey Marc Gelfand
From the UCSF Weill Institute for Neurosciences (W.M.R., W.-Y.H., K.M., A.L., C.-Y.G., A.J.G., J.M.G., R.M.B.), Division of Neuroimmunology and Glial Biology, Department of Neurology, Department of Clinical Pharmacy (S.M.), and UCSF Department of Ophthalmology (A.J.G.), University of California, San Francisco.
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  • ORCID record for Jeffrey Marc Gelfand
  • For correspondence: jeffrey.gelfand@ucsf.edu
Riley M. Bove
From the UCSF Weill Institute for Neurosciences (W.M.R., W.-Y.H., K.M., A.L., C.-Y.G., A.J.G., J.M.G., R.M.B.), Division of Neuroimmunology and Glial Biology, Department of Neurology, Department of Clinical Pharmacy (S.M.), and UCSF Department of Ophthalmology (A.J.G.), University of California, San Francisco.
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Full PDF
Citation
Transitioning From S1P Receptor Modulators to B Cell–Depleting Therapies in Multiple Sclerosis
Clinical, Radiographic, and Laboratory Data
William M. Rowles, Wan-Yu Hsu, Kira McPolin, Alyssa Li, Steven Merrill, Chu-Yueh Guo, Ari J. Green, Jeffrey Marc Gelfand, Riley M. Bove
Neurol Neuroimmunol Neuroinflamm Jul 2022, 9 (4) e1183; DOI: 10.1212/NXI.0000000000001183

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    Figure 1 CONSORT Diagram

    A total of 123 patients were identified as having transitioned from fingolimod to ocrelizumab or rituximab between 2010 and October 2020 at the UCSF Multiple Sclerosis and Neuroinflammation center; 108 were included in analyses. DMT = disease-modifying therapy; EMR = electronic medical record; UCSF = University of California, San Francisco

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    Figure 2 Timing of the 10 (9 Shown) Clinical Relapses in the 12 Months Following Fingolimod Discontinuation

    The vertical black line indicates the split between categorically long and short intervals between treatments (±30 days); red and blue coloring indicate the treatment status: between treatments (red) or after the first anti-CD20 infusion (blue). Data truncated at 500 days after fingolimod discontinuation.

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    Figure 3 Clinical Relapses and MRI Activity in the Subset of 63 Patients With MRIs Available

    Data presented on a timeline relative to anti-CD20 initiation. Green lines denote time off active treatment (interval), and red asterisks indicate clinical relapse. The end points denote available MRIs: blue-filled segment end points indicate Gd+ MRI, black-filled segment end points indicate the presence of new T2 lesions from prior comparison, and open end points denote MRIs unchanged from prefingolimod discontinuation reference image.

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    Figure 4 ALCs in the Subset of 92 Patients With ALC Labs Checked, Relative to Fingolimod Discontinuation

    Dots indicate ALC values available. Green dots indicate ALC in the normal range, defined as >0.8 × 10E9/L. Dots indicating ALC values below the normal range are gray before fingolimod discontinuation and red after fingolimod discontinuation. The vertical line indicates fingolimod discontinuation, and the horizontal gray lines represent the interval between fingolimod and anti-CD20 treatments. ALC = absolute lymphocyte count.

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Letters: Rapid online correspondence

  • Transitioning From S1P Receptor Modulators to B Cell–Depleting Therapies in Multiple Sclerosis Clinical, Radiographic, and Laboratory Data
    • Bassem I Yamout, Professor of Neurology, American University of Beirut-Lebanon and Harley Street Medical Center, Abu Dhabi-UAE
    Submitted July 08, 2022
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