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Various toxicities: 5 case reports In a compassionate use programme, involving 489 patients treated with off-label ocrelizumab for primary progressive multiple sclerosis (PPMS) in Germany between February 2017 and January 2018, five patients, including a female patient [ages not stated; not all sexes stated] were described, who developed infusion-related reaction, herpes zoster infection or lymphopenia secondary to ocrelizumab (3 patients), progressive multifocal leukoencephalopathy (PML) secondary to natalizumab (1 patient) or a nonconvulsive status epilepticus secondary to fampridine [1 patient; not all routes, dosages, times to reactions onsets and outcomes stated]. All 5 patients, who had PPMS, started receiving off-label therapy with IV infusions of ocrelizumab 600mg in 500mL every 6 months. The first dose was split into two infusions of 300mg (each 250mL), 2 weeks apart. The subsequent doses were administered as a single IV infusion of 600mg every 6 months. The patients also received methylprednisolone and unspecified antihistaminics to reduce the frequency of infusion-related reactions. However, within 24 hours of receiving the first infusion, one patient developed mild leucocytosis and tachycardia, consistent with an infusion-related reaction attributed to ocrelizumab. That patient was subfebrile and required prolonged hospitalisation due to the aforementioned symptoms. The symptoms gradually regressed without intervention; the patient tolerated the second infusion well. Another patient developed herpes zoster infection requiring hospitalisation, whereas one patient developed lymphopenia (lymphocyte count 1000/µL, twelve days after initial administration of ocrelizumab), which were both attributed to ocrelizumab. A female patient, who had been treated with natalizumab infusions from 2013 to 2017 (last infusion on 13 February 2017), tested positive for anti-John Cunningham virus (JCV)antibodies in serum/plasma in 2013. Her symptoms of MS progressed during treatment with natalizumab. Prior to enrolment, MRI revealed no signs of PML. In March 2017, her anti-JCV antibody index was 4.11. After the two initial infusions of ocrelizumab in April 2017, brain MRI and presence of JCV-DNA in CSF in May 2017 confirmed PML. She developed aspiration pneumonia [aetiology not stated] a few days later. Repeat MRI in June 2017 revealed progression of PML with accompanying reconstitution inflammatory syndrome. Her PML was attributed to natalizumab therapy. A patient, who had extensive demyelinating disease and had been receiving fampridine, was hospitalised following ’seizure’, which was later identified to be a non-convulsive status epilepticus secondary to fampridine. The patient, who developed herpes zoster infection due to ocrelizumab, was treated with acyclovir and ocrelizumab was continued. The patient, who developed lymphopenia due to ocrelizumab, required postponement of the second infusion for 1 week; the lymphocyte level further decreased to 750/µL. The female patient, who developed PML secondary to natalizumab,