‘Wearing off’ monoclonal antibodies leads to patient dissatisfaction, depression in MS

Key takeaways:

• More than half of survey respondents being treated with monoclonal antibodies experienced a “wearing-off” effect.
• Depression was significantly associated with the wearing-off phenomenon.

WEST PALM BEACH, Fla. — The “wearing-off” effect with monoclonal antibodies prescribed for multiple sclerosis led to treatment dissatisfaction and was associated with depression, according to a poster from ACTRIMS 2024.

“We sent a survey out to more than a thousand patients (asking them to) talk about symptoms they were experiencing with Ocrevus, rituxin,” Kathleen A. Harris, MSN-APRN, CNP, a nurse practitioner at the Cleveland Clinic’s Mellen Center for Multiple Sclerosis, told Healio.

Many individuals with MS report a wearing-off phenomenon with monoclonal antibody (MAb) treatment, in which perceived benefits wear off before administration of subsequent doses.

Harris and colleagues attempted to determine prevalence of the wearing-off effect with MAbs, the symptoms patients experienced, its impact on treatment satisfaction and what patient characteristics predict a wearing-off effect.

They issued an online survey with questions regarding experience with MAb to more than 1,000 individuals who received at least two doses of natalizumab, ocrelizumab, ofatumumab or rituximab at a tertiary MS center. Additional treatment history and patient characteristic data were collected from electronic medical records.

A total of 258 responses (mean age 48.1 years; 74.6% female) were received with therapeutic breakdown as follows: ocrelizumab (n = 154), rituximab (n = 28), ofatumumab (n = 39) and natalizumab (n = 37).

Descriptive statistics were used to characterize the cohort and the wearing-off phenomenon. Analysis of variance was used to make unadjusted comparisons of MAbs with respect to frequency of the wearing-off phenomenon and treatment satisfaction.

The researchers used a logistic regression model to determine if patient characteristics predicted the wearing-off effect, as well as linear regression to evaluate the impact of the wearing-off effect on treatment satisfaction. The models were adjusted for age, disease duration, race, sex, BMI, education and depression as measured by the Patient Health Questionnaire-9 (PHQ-9). A total of 141 (54.7%) survey respondents reported experienced the wearing-off phenomenon.

Prevalence was not significantly different between MAbs (P = 0.44), while the most common wearing-off symptom was fatigue, which ranged from 45.9% of patients receiving ofatumumab to 53.6% of those on rituximab. Among other reported symptoms were worsened cognitive functioning (26.0%), worsening mobility (28.6%) and increased paresthesias (29.9%).

In the logistic regression model, depression was significantly associated with the wearing-off phenomenon, with each additional PHQ-9 point adding 2% to odds of experiencing it.

Additionally, the mean reported treatment satisfaction was 8.8 (SD = 1.8) on a scale of 1 to 10 and did not significantly differ between MAbs in the unadjusted analysis. In the linear regression model, the wearing-off effect (P = 0.04) and higher PHQ-9 (P < 0.01) significantly reduced treatment satisfaction.

“Depressions significantly increases odds of the wearing-off effect, suggesting some psychological component,” the researchers wrote in the poster.