Phase 4
N=10
Effects of Ocrelizumab on B-cell Tolerance Defect in Relapsing Multiple Sclerosis
Multiple Sclerosis, Relapsing-Remitting
Bottom Line
View on ClinicalTrials.gov: NCT04261790 ↗Enrolled (actual)
10
Serious AEs
0.0%
Results posted
Feb 2025
Primary outcome: Primary: Change in Peripheral B-cell Tolerance Checkpoints in People With MS Before and After Ocrelizumab Therapy.
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 4
- Interventions
- Ocrelizumab (Drug)
- Age
- Adult, Older Adult · 18+ yrs
- Sex
- All
- Sponsor
- Johns Hopkins University
- Primary completion
- Oct 2024
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Change in Peripheral B-cell Tolerance Checkpoints in People With MS Before and After Ocrelizumab Therapy. |
— | — |
| PRIMARY Change in B-cell Subpopulations |
— | — |
| PRIMARY Change in Frequency of T-cell Phenotypes |
— | — |
| PRIMARY Change in the Production of Pro Inflammatory Cytokines Produced by Activated T-cells |
— | — |
| PRIMARY Change in the Production of Anti-inflammatory Cytokines Produced by Activated T-cells |
— | — |
| SECONDARY Patients With Return of Disease Activity |
10; 0 | — |
| SECONDARY Change in Disability as Assessed by Expanded Disability Status Scale (EDSS) |
-0.5 | — |
| SECONDARY Change in Quality of Life as Assessed by Neuro-QoL Fatigue T-score |
2.6 | — |
Summary
B-cells have an important role in the pathogenesis of multiple sclerosis (MS). Ocrelizumab, a medication that targets B-cells have been found to be highly effective in stopping the disease activity in relapsing-remitting MS.
The efficacy of ocrelizumab might be related to the specific pattern of B-cell tolerance defect in patients with MS and the potential of its normalization with treatment with ocrelizumab. By analyzing the reactivity of recombinant antibodies expressed from single B-cells, the investigators' collaborators have demonstrated that the pattern of B-cell tolerance defect is different in people with MS who only display an impaired removal of developing autoreactive B-cells in the periphery while central B-cell tolerance in the bone marrow is functional in most patients. In contrast, patients with rheumatoid arthritis (RA), type-1 diabetes (T1D) or Sjögren's syndrome (SS) show defective central and peripheral B-cell tolerance checkpoints. As a consequence, while anti-B-cell therapy does not correct defective early B-cell tolerance checkpoints in T1D and only temporarily slows down autoimmune processes before newly generated autoreactive B-cells likely induce patient relapse, the investigators postulate that the efficacy of ocrelizumab in MS may be linked to normal central B-cell tolerance and the production of a normal B-cell and T-cell compartment after ocrelizumab therapy.
In an open-label study, 10 patients with relapsing MS will be treated with two courses of ocrelizumab and will be followed clinically and radiologically for at least two and a half years. Assessment of T and B-cell phenotypes and function at baseline and 18-24 months post-B-cell depletion will be the primary outcome of the study.
Eligibility Criteria
Inclusion Criteria
- Diagnosis of relapsing remitting multiple sclerosis (RRMS) based on revised McDonald criteria
- At least one Gd-enhancing lesions on the brain or spinal cord MRI done in the prior three months OR at least one new T2/FLAIR lesion on the brain or spinal cord MRI done in the prior three months (compared to a prior MRI performed within 18 months of the most recent MRI)
- Naïve to Disease modifying therapy (DMT) or at least off these DMTs (natalizumab, fingolimod, DMF) for three months or on an injectable DMT (interferons or glatiramer acetate)
- Expanded Disability Status Scale (EDSS) score at the time of screening =<3
- Negative urine or serum pregnancy test must be available for premenopausal women and for women <12 months after the onset of menopause unless these women have undergone surgical sterilization
- Women of childbearing potential must agree to remain abstinent (refrain from heterosexual intercourse) or use one method of contraception with a failure rate of <1% per year or a barrier method supplemented with spermicide. Contraception must continue for the duration of study treatment and for at least 24 weeks after the last dose of study treatment
Exclusion Criteria
- Contraindication to treatment with an anti- cluster of differentiation antigen 20 (CD20) antibodies, including being seropositive for HBsAg
- Active hepatitis B virus infection
- Ever received B-cell depleting antibodies (rituximab, ocrelizumab, ofatumumab), alemtuzumab, daclizumab, mitoxantrone or hematopoietic stem-cell transplant
- Pregnant or lactating women
- Hypersensitivity to ocrelizumab
- Treatment with steroids in the past 30 days
Data sourced from ClinicalTrials.gov (NCT04261790). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.