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009 Predicting infection risk in multiple sclerosis patients treated with ocrelizumab: a retrospective cohort study
  1. Nabil Seery1,
  2. Sifat Sharmin2,3,
  3. Vivien Li1,4,
  4. Ai-Lan Nguyen1,2,3,
  5. Claire Meaton1,
  6. Roberts Atvars1,
  7. Nicola Taylor5,
  8. Kelsey Tunnell5,
  9. Joh Carey5,
  10. Mark P Marriott1,6,
  11. Katherine A Buzzard1,6,
  12. Izanne Ross1,2,3,
  13. Chris Dwyer1,4,
  14. Josephine Baker1,
  15. Lisa Taylor1,
  16. Kymble Springs2,7,
  17. Trevor J Kilpatrick1,4,
  18. Tomas Kalincik1,2,3 and
  19. Mastura Monif1,8,9
  1. 1Melbourne MS Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
  2. 2Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
  3. 3Clinical Outcomes Research Unit, The University of Melbourne, Melbourne, VIC, Australia
  4. 4Florey Institute of Neurosciences and Mental Health, The University of Melbourne, Parkville, VIC, Australia
  5. 5Day Medical Centre, Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia
  6. 6Department of Neuroscience, Eastern Health Clinical School, Box Hill, VIC, Australia
  7. 7Department of Immunology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
  8. 8MS and Neuroimmunology Department, Alfred Health, Melbourne, VIC, Australia
  9. 9Department of Neuroscience, Monash University, Melbourne, VIC, Australia


Objective To examine factors determining risk of self-reported infections and antimicrobial use in patients receiving Ocrelizumab for MS.

Methods Retrospective, observational cohort study conducted in Ocrelizumab-treated patients at the Royal Melbourne Hospital. The association of clinical and laboratory factors with self-reported infection rate and antimicrobial use were estimated using univariate and multivariable logistic regression models.

Results 185 patients were included in the study, and 176 infections were reported in 89 patients (46.1%), and in 47 patients (25.3%) antimicrobial use was identified. In univariate analyses, a higher serum IgA was associated with reduced odds of infection (OR 0.44, 95% CI 0.25 - 0.76). In multivariable analyses, older age (OR 0.94, 95% CI 0.88 - 0.99), higher serum IgA (OR 0.37, 95% CI 0.17 - 0.80) and higher serum IgG (OR 0.81, 95% CI 0.67 - 0.99) were associated with reduced odds of infection. Older age (OR 0.85, 95% CI 0.75 - 0.96) and higher serum IgA (OR 0.23, 95% CI 0.07 - 0.79) were associated with reduced odds of antimicrobial use, whilst longer MS disease duration (OR 1.22, 95% CI 1.06 - 1.41) and higher EDSS (OR 1.99, 95% CI 1.02 - 3.86) were associated with increased odds of antimicrobial use.

Conclusions Higher serum IgA, IgG and older age were associated with reduced odds of infection. Our findings highlight non-uniformity of infection risk in Ocrelizumab-treated MS patients, and substantiate the need to monitor immunoglobulin levels pre-treatment and whilst on therapy.

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