Successful switch to ofatumumab after liver injury associated with ocrelizumab treatment in multiple sclerosis: a case report

Alice Mariottini; Alessandro Barilaro; Antonio Lotti; Fabio Marra; Luca Massacesi

doi:10.3389/fneur.2024.1363493

Successful switch to ofatumumab after liver injury associated with ocrelizumab treatment in multiple sclerosis: a case report

Front Neurol. 2024 Feb 29:15:1363493. doi: 10.3389/fneur.2024.1363493. eCollection 2024.

Authors

Alice Mariottini^{1

2}, Alessandro Barilaro², Antonio Lotti¹, Fabio Marra³, Luca Massacesi^{1

2}

Affiliations

¹ Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy.
² Department of Neurology 2 and Tuscan Region Multiple Sclerosis Referral Centre, Careggi University Hospital, Florence, Italy.
³ Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy.

Abstract

Drug-induced liver injury (DILI) is a potential adverse event of disease-modifying therapies (DMTs) for the treatment of multiple sclerosis (MS), as well as of methylprednisolone pulsed therapy used in case of MS relapse. DILI may be induced by different mechanisms, including idiosyncratic reaction, autoimmune hepatitis or viral reactivation. In patients receiving the humanized anti-CD20 monoclonal antibody (mAb) ocrelizumab, DILI has been rarely reported and was mostly associated with hepatitis B virus (HBV) reactivation. Here we present the case of a woman with highly active relapsing-remitting MS who had experienced two episodes of DILI while receiving different DMTs, and was successfully switched to ofatumumab, a fully human anti-CD20 mAb, after a further event associated with ocrelizumab treatment and unrelated to HBV reactivation. Despite sharing the mechanism of action, differences in structure, pharmacokinetic/pharmacodynamic profile, and use of ancillary drugs (only needed for ocrelizumab) may have accounted for the successful switch. To our knowledge, this is the first report of a successful switch from ocrelizumab to ofatumumab due to DILI. Ofatumumab may therefore represent a valid therapeutic option for patients experiencing DMTs- and ocrelizumab-induced liver injury, providing that HBV reactivation has been ruled out.

Keywords: B-cell depletion; case report; liver injury; monoclonal antibody; multiple sclerosis; ocrelizumab; ofatumumab.

Publication types

Case Reports

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study received funding from Novartis Farma SpA, providing support for open access fee after acceptance of the article. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.