People with multiple sclerosis (MS) undergoing anti-CD20 therapy are at risk of developing secondary hypogammaglobulinemia, according to a literature review published in Multiple Sclerosis and Related Disorders. Anti-CD20 therapies, including Ocrevus (ocrelizumab; Genentech, South San Francisco, CA), Kesimpta (ofatumumab; Novartis, East Hanover, NJ), Briumvi (ublituximab; TG Therapeutics, New York, NY), and Rituxan (rituximab; Genentech, South San Francisco) have shown robust efficacy in reducing relapse rates and disease progression in MS, but they may also lead to a decrease in immunoglobulin levels, particularly IgG and IgM. This immunodeficiency can predispose patients to serious infections.

While the exact mechanism of hypogammaglobulinemia remains unclear, it is unlikely solely due to B-cell-depleting anti-CD20 therapies. Clinical trials and observational studies have reported varying impacts on immunoglobulin levels across different anti-CD20 therapies, with Rituxan and Ocrevus showing more pronounced reductions in IgG levels compared to Kesimpta and Briumvi.

Suggested precautions include regular monitoring of immunoglobulin levels, infection screening, and appropriate vaccinations. Intravenous immunoglobulin replacement therapy may be an option in some cases of severe hypogammaglobulinemia. The review authors also emphasize the need for individualized treatment plans and further research to develop standardized guidelines for managing this complication in people with MS.

Source: Alvarez E, Longbrake EE, Rammohan KW, et al. Secondary hypogammaglobulinemia in patients with multiple sclerosis on anti-CD20 therapy: pathogenesis, risk of infection, and disease management. Mult Scler Relat Disord. 2023;79:105009. doi:10.1016/j.msard.2023.105009