Switching to ublituximab from prior anti-CD20 monoclonal antibody therapy: a case report series

Regina Berkovich ^1* Jonathan Calkwood ² Heidi Crayton ³ April Erwin ⁴ Simon Faissner ⁵ Ralf Gold ⁵ Joshua Katz ⁶ Mark Leekoff ⁷

• ¹ Department of Neurology, Berkovich MS Center and Research Institute, West Hollywood, United States
• ² Department of Neurology, Minnesota Center for Multiple Sclerosis, Plymouth, United States
• ³ Department of Neurology, MS Center of Greater Washington, Vienna, United States
• ⁴ Department of Neurology, Rocky Mountain MS Clinic, Salt Lake City, United States
• ⁵ Department of Neurology, Ruhr University Bochum, St Josef Hospital, Bochum, North Rhine-Westphalia, Germany
• ⁶ Department of Neurology, Elliot Lewis Center, Wellesley, United States
• ⁷ Department of Neurology, Atlantic Medical Group Multiple Sclerosis Comprehensive Care Center, Bridgewater, United States

Introduction: Anti-CD20 monoclonal antibody (mAb) therapies used to treat multiple sclerosis (MS) differ in their molecular structures, epitope recognition, and mechanisms of CD20-positive (CD20+) cell lysis, which may impact clinical efficacy and tolerability and support within-class switching for patients with suboptimal response to a prior anti-CD20 mAb.Patients and Methods: This is a retrospective case series of 7 individuals with MS treated in private practice or at an MS clinic who switched to ublituximab from a different anti-CD20 mAb therapy due to efficacy or tolerability concerns.Case Descriptions: Details of each case, including clinical and/or radiological outcomes on initial anti-CD20 mAb therapy, reasons for switching, and outcomes after starting ublituximab therapy are provided.Discussion: These cases highlight suboptimal B-cell depletion, inadequate MS disease control, and/or tolerability concerns in people with MS who had clinical improvements or stabilization of disease following a switch from ocrelizumab or rituximab to ublituximab.Conclusion: Within-class switching from a prior anti-CD20 mAb therapy to ublituximab is feasible and may improve outcomes in some people with MS.