Anti CD20 induced hypogammaglobulinemia in multiple sclerosis and neuromyelitis optica spectrum disorder: a cross sectional study

Abstract

Abstract Background Multiple sclerosis (MS) and Neuromyelitis Optica Spectrum Disorder (NMOSD) are chronic neurological conditions that carry significant morbidity and mortality. Anti-CD20 agents are a class of monoclonal antibodies that are used in the treatment of MS and NMOSD. However, treatment with these agents is associated with hypogammaglobulinemia, which increases the risk of infections and hospitalizations. Predictors of hypogammaglobulinemia in these conditions remain poorly understood, and its prevalence in certain regions, is not well documented. This study aims to assess the prevalence and predictors of hypogammaglobulinemia in MS and NMOSD patients receiving anti CD20 therapies (rituximab and ocrelizumab). Results The mean age of the study population was 36.65 ± 11.32 years. Six patients (10%) were found to suffer from hypogammaglobulinemia. There was one serious infection (1.7%). There was a statistically significant correlation between duration of treatment and decline in serum IgG level, with correlation coefficient of – 0.357 (p-value: 0.005). There were no significant differences between patients on rituximab and those on ocrelizumab as regard the risk of developing hypogammaglobulinemia or serious infections. Conclusion Our findings highlight the importance of monitoring infection risk and hypogammaglobulinemia in patients being treated with anti-CD20 therapies especially those who have been on the treatment for longer periods, and the need for more prospective clinical studies to compare between rituximab and ocrelizumab as regard safety and efficacy.