Transitioning From S1P Receptor Modulators to B Cell–Depleting Therapies in Multiple Sclerosis Clinical, Radiographic, and Laboratory Data
Bassem IYamout, Professor of Neurology, American University of Beirut-Lebanon and Harley Street Medical Center, Abu Dhabi-UAE
Submitted July 08, 2022
Rowles et al report on 108 MS patients transitioning from S1P receptor modulators to B cell-depleting therapies.1 They note that all relapses during the washout period occurred in patients with long intervals between treatments. The interesting observation, however, is that all relapses after treatment initiation with B cell-depleting therapies occurred in patients with short washout periods, mostly less than a month. No such late relapses were seen in patients with long washout periods. This raises the possibility that lymphocytes that were still sequestered in the lymph nodes due to the short washout period escaped the lytic effect of B cell-depleting therapies and therefore led to disease reactivation at a later stage. A similar scenario was described with patients transitioning from S1P receptor modulators to alemtuzumab. The authors need to consider this possibility and its implications in future management of such patients.
Disclosures:
The author(s) report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References:
1. Rowles WM, Wan-Yu Hsu W-Y, McPolin K , et al.Transitioning From S1P Receptor Modulators to B Cell–Depleting Therapies in Multiple Sclerosis Clinical, Radiographic, and Laboratory Data. Neurol Neuroimmunol Neuroinflamm 2022;9:e1183
Rowles et al report on 108 MS patients transitioning from S1P receptor modulators to B cell-depleting therapies.1 They note that all relapses during the washout period occurred in patients with long intervals between treatments. The interesting observation, however, is that all relapses after treatment initiation with B cell-depleting therapies occurred in patients with short washout periods, mostly less than a month. No such late relapses were seen in patients with long washout periods. This raises the possibility that lymphocytes that were still sequestered in the lymph nodes due to the short washout period escaped the lytic effect of B cell-depleting therapies and therefore led to disease reactivation at a later stage. A similar scenario was described with patients transitioning from S1P receptor modulators to alemtuzumab. The authors need to consider this possibility and its implications in future management of such patients.
Disclosures:
The author(s) report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References:
1. Rowles WM, Wan-Yu Hsu W-Y, McPolin K , et al.Transitioning From S1P Receptor Modulators to B Cell–Depleting Therapies in Multiple Sclerosis Clinical, Radiographic, and Laboratory Data. Neurol Neuroimmunol Neuroinflamm 2022;9:e1183