Safety of Switching From Rituximab to Ocrelizumab in MS Patients
What it found
The main measure showed a statistically significant benefit.
| Measure | Estimate | 95% CI | p |
|---|---|---|---|
| Difference in the Total Number of IRRs After Each Infusion of Ocrelizumab Compared to Rituximab Infusions in the Comparator Group. | Risk Ratio (RR) .2857 | .1006–.8114 | 0.0053 |
| Proportion of Patients With an IRR at Day 1 Versus Day 15 and Week 24 Infusions | Risk Ratio (RR) .2857 | .1072–.7613 | 0.0075 |
| Proportion of Patients With an IRR at Day 1 Versus Day 15 and Week 24 Infusions | Risk Ratio (RR) 3.0000 | 1.1260–7.9932 | 0.0209 |
| Proportion of Infusions With >= 1 IRR Between the Switching and Comparator Groups | Risk Ratio (RR) .6616 | .3666–1.1942 | 0.1996 |
| Proportion of Patients With an IRR at Day 1 Versus Day 15 and Week 24 Infusions | Risk Ratio (RR) .8571 | .4868–1.5093 | 0.5930 |
| Difference in the Total Number of IRRs After Each Infusion of Ocrelizumab Compared to Rituximab Infusions in the Comparator Group. | Risk Ratio (RR) .8571 | .4385–1.6753 | 0.6474 |
| Difference in the Total Number of IRRs After Each Infusion of Ocrelizumab Compared to Rituximab Infusions in the Comparator Group. | Risk Ratio (RR) 1.0000 | .5299–1.8872 | 1.0000 |
Statistical analysis as posted on ClinicalTrials.gov.
What was tested
Treatment tested
- Ocrelizumab
B-lymphocyte antigen CD20 binding agent
Compared with
- Rituximab
B-lymphocyte antigen CD20 binding agent
Results by group
Proportion of Infusions With >= 1 IRR Between the Switching and Comparator Groups
Day 1, Day 15, Week 24
| Group | Value | Interval | Number analysed |
|---|---|---|---|
| Switching Group | 10 percentage of infusions with IRRs | 300 | |
| Comparator Group | 14 percentage of infusions with IRRs | 200 |
Switching Group
Comparator Group
p = 0.1996; Risk Ratio (RR) .6616 (95% CI .3666–1.1942)
Difference in the Total Number of IRRs After Each Infusion of Ocrelizumab Compared to Rituximab Infusions in the Comparator Group.
Pre-study (Enrollment), Day 1, Day 15, Week 24
| Group | Value | Interval | Number analysed |
|---|---|---|---|
| Comparator Group | 28 Infusions | 200 | |
| Switching Group | 14 Infusions | 100 | |
| Switching Group | 4 Infusions | 100 | |
| Switching Group | 12 Infusions | 100 |
Comparator Group
Switching Group
Switching Group
Switching Group
p = 1.0000; Risk Ratio (RR) 1.0000 (95% CI .5299–1.8872)
Severity of IRRs Following the Day 1 Infusion of Ocrelizumab in the Switching and the Comparator Groups Infusions
Day 1, pre-study infusions
| Group | Value | Interval | Number analysed |
|---|---|---|---|
| Switching Group | 86 Infusions | 100 | |
| Comparator Group | 172 Infusions | 200 | |
| Switching Group | 8 Infusions | 100 | |
| Comparator Group | 3 Infusions | 200 | |
| Switching Group | 6 Infusions | 100 | |
| Comparator Group | 25 Infusions | 200 | |
| Switching Group | 0 Infusions | 100 | |
| Comparator Group | 0 Infusions | 200 |
Severity of IRRs Following the Day 15 Infusion of Ocrelizumab in the Switching and the Comparator Groups Infusions
Day 15, pre-study infusions
| Group | Value | Interval | Number analysed |
|---|---|---|---|
| Switching Group | 96 Infusions | 100 | |
| Comparator Group | 172 Infusions | 200 | |
| Switching Group | 0 Infusions | 100 | |
| Comparator Group | 3 Infusions | 200 | |
| Switching Group | 4 Infusions | 100 | |
| Comparator Group | 25 Infusions | 200 | |
| Switching Group | 0 Infusions | 100 | |
| Comparator Group | 0 Infusions | 200 |
Severity of IRRs Following the Week 24 Infusion of Ocrelizumab in the Switching and the Comparator Groups Infusions
Week 24, pre-study infusions
| Group | Value | Interval | Number analysed |
|---|---|---|---|
| Switching Group | 88 Infusions | 100 | |
| Comparator Group | 172 Infusions | 200 | |
| Switching Group | 9 Infusions | 100 | |
| Comparator Group | 3 Infusions | 200 | |
| Switching Group | 3 Infusions | 100 | |
| Comparator Group | 25 Infusions | 200 | |
| Switching Group | 0 Infusions | 100 | |
| Comparator Group | 0 Infusions | 200 |
Proportion of Patients With an IRR at Day 1 Versus Day 15 and Week 24 Infusions
Day 1, Day 15, Week 24
| Group | Value | Interval | Number analysed |
|---|---|---|---|
| Switching Group - Day 1 Infusion | 14 Participants | 100 | |
| Switching Group - Day 15 Infusion | 4 Participants | 100 | |
| Switching Group - Week 24 Infusion | 12 Participants | 100 |
Switching Group - Day 1 Infusion
Switching Group - Day 15 Infusion
Switching Group - Week 24 Infusion
p = 0.0075; Risk Ratio (RR) .2857 (95% CI .1072–.7613)
Values as posted on ClinicalTrials.gov. Outcomes measured differently across trials are not directly comparable.
Safety
| Group | Participants at risk | Serious adverse events | Deaths |
|---|---|---|---|
| Switching Group | 100 | 8 (8.0%) | 0 |
| Comparator Group | 100 | 0 (0.0%) | 0 |
As posted on ClinicalTrials.gov. Serious adverse events include any serious health event during the trial, whether or not the treatment caused it.
What it measured
Main measures
Proportion of Infusions With >= 1 IRR Between the Switching and Comparator Groups
Day 1, Day 15, Week 24
SafetyDifference in the Total Number of IRRs After Each Infusion of Ocrelizumab Compared to Rituximab Infusions in the Comparator Group.
Pre-study (Enrollment), Day 1, Day 15, Week 24
Severity of IRRs Following the Day 1 Infusion of Ocrelizumab in the Switching and the Comparator Groups Infusions
Day 1, pre-study infusions
SafetySeverity of IRRs Following the Day 15 Infusion of Ocrelizumab in the Switching and the Comparator Groups Infusions
Day 15, pre-study infusions
SafetySeverity of IRRs Following the Week 24 Infusion of Ocrelizumab in the Switching and the Comparator Groups Infusions
Week 24, pre-study infusions
SafetyProportion of Patients With an IRR at Day 1 Versus Day 15 and Week 24 Infusions
Day 1, Day 15, Week 24
Other measures (35)
Presence of Ocrelizumab Anti-drug Anti-bodies
Day 1 and Week 24
Presence of Rituximab Anti-drug Anti-bodies
Day 1 and Week 24
B Cell Depletion (CD19)
Day 1, Week 24, 1 Year
Immune responseB Cell Depletion (CD20)
Day 1, Week 24, 1 Year
Immune responseCytokine: Eotaxin - Pre-Post Infusion - Day 1
Day 1
Immune responseCytokine: IFN-gamma - Pre-Post Infusion - Day 1
Day 1
Immune responseCytokine: IL-10 - Pre-Post Infusion - Day 1
Day 1
Immune responseCytokine: IL-12/IL-23p40 - Pre-Post Infusion - Day 1
Day 1
Immune responseCytokine: IL-16 - Pre-Post Infusion - Day 1
Day 1
Immune responseCytokine: IL-1RA - Pre-Post Infusion - Day 1
Day 1
Immune response
Who could take part
Relapsing MS · 18 to 65
Inclusion Criteria: Switching group: * Current active patient of RMMSC * 18-65 years * Diagnosis of relapsing forms of MS * Completed ≥ two doses of rituximab with the last dose having been administered: 1. Within 12 months of screening and 2. At least 6 months prior to the first planned infusion of study drug * Are receiving their current infusions of rituximab at the University of Colorado Outpatient Infusion Center * Have discussed the possibility of switching to ocrelizumab with their MS provider * Screened for Hepatitis B and C and TB within 2 years of first dose of ocrelizumab * A negative serum pregnancy test must be available for premenopausal women and for women \<12 months after the onset of menopause, unless they have undergone surgical sterilization. * Women of childbearing potential must agree to use a "highly effective", hormonal form of contraception or two "effective" forms of non-hormonal contraception. Contraception must continue for the duration of study treatment and for at least three months after the last dose of study treatment * Are able to complete patient reported outcomes developed as English written scales. * Must be able and willing to give meaningful, written informed consent prior to participation in the trial, in accordance with local regulatory requirements Comparator group: * Current active patient of RMMSC * 18-65 years * Diagnosis of relapsing forms of MS * Completed ≥ two doses of rituximab with the last dose having been administered within 12 months of screening as standard of care * Are receiving their current infusions of rituximab as standard of care at the University of Colorado Outpatient Infusion Center and will continue to do so * Are willing to be followed for up to two additional rituximab infusions during the study period as standard of care * Must be able and willing to give meaningful, written informed consent prior to participation in the trial, in accordance with local regulatory requirements Exclusion Criteria: Both groups: * Pregnant or lactating women * Hypersensitivity to trial medications * Hepatic Dysfunction (liver enzymes are 5 times greater than normal) * History of Congestive Heart Failure * Any history of a positive blood assay for Hepatitis B or C * Any history of TB or a positive Quantiferon Gold Assay * Concurrent use of immunosuppressant medications * Any history of immunodeficiency or other medical condition increasing risk of anti-CD 20 therapy. * No serious infection at the time of a scheduled study infusion. * Any medical, psychiatric or other condition that could result in the patient not being able to give fully informed consent, or to comply with the protocol requirements as determined by the investigator
As registered. Criteria can change, so ask the trial team or your neurologist.
About this trial
In the sponsor's words
This is a prospective between and within group observational study to determine differences in tolerability, immunogenicity and safety related outcomes for 100 multiple sclerosis (MS) patients who have been administered at least two infusions of rituximab, six months apart and are willing to be switched to ocrelizumab compared to a 100 patients who are continuing on rituximab as a comparison cohort from the clinic population treated as part of clinical care.
Papers
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History
Started
Jan 2017
Main results due
Mar 2019
Finished
Mar 2019
Results posted
Jan 2020
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