b'adementiacategorizeddiseasesuchasThrower- B-cell depleting therapies include Alzheimers.SomeofthemorecommonOcrevus (ocrelizumab), Kesimpta (ofatumumab), cognitive issues seen with MS are word-ndingBriumvi (ublituximab), and Rituxan (rituximab) difficulties and slowed processing speed. Theand represent an effective and important class cognitivechangesseeninMScanbeof DMTs in MS. These monoclonal antibodies problematic and lead to vocational disability.target the CD20 receptor on B cells, leading This study suggests that people with MS areto the depletion of certain populations of these at lower risk for Alzheimers disease than theimmune cells. We measure the depletion of general population. If you are struggling withCD20 B cells using the CD19 marker, since cognitive dysfunction, make sure to discuss itthese two receptors are both represented on B with your healthcare team. The Symbol Digitcells up until the point of the B cell maturation Modality Test is a quick screening tool to lookinto plasma cells. So, when we talk about the fordeclinesinprocessingspeed.Formalnumbers of CD19 cells, we are really referring neuropsychological testing can give a moreto CD20 cells. B cell depletion can be linked detailed look at where the decits in cognitionto low T cell counts, low IgG, and IgM levels, might be. Speech language pathologists mayand an increase in infections. also help through cognitive rehabilitation. Planned dose reduction ofConventional wisdom believed these therapies ocrelizumab in RRMSworked best when B cells, as measured by CD19 Researchers at the College of Medicine andcounts, were kept near zero. For ocrelizumab, Dentistry, James Cook University, Townsville,our standard dosing is 600mg intravenously every six months. Research is making us Queensland, Australia, evaluated the effectivenessrethink things, however. Many patients appear and safety of reducing ocrelizumab dose fromtohavethesameefficacywith300mgof 600 to 300 mg in patients with RRMS. A totalocrelizumab every six months that was seen of 35 patients were treated with 177 full andwith 600mg every six months.107 reduced doses. The average follow-up onAnother potential dose modication with reduced dose was 17 months. The studysocrelizumab is extended interval dosing. authors observed no relapses or new MRIResearchers have shown that giving ocrelizumab activity in the cohort receiving the reducedevery nine months appears to be as effective dose, accompanied by persistent CD19+B cellas every six months. Interestingly, in the EID depletion. Mean IgG, IgA, and IgM levelsgroup,theefficacywasunchangedeven remained stable throughout the study. No newwhen the B cells were starting to come back. safety concerns arose. In this single-centerThis has led researchers to look at what types observationalstudy,dosereductionofof B cells are returning after depletion. The ocrelizumab from 600 to 300 mg every sixrepopulating B cells appear to be less angry months after two years appeared to maintainthan the pretreatment B cells. efficacy in terms of new inammatory disease activity. A randomized trial may be warrantedSo, we may be able to give ocrelizumab at to conrm this and explore the effect of doselower doses or at less frequent doses and still reduction on long-term safety. The ndingshave good results. Hopefully, these lower were published in the journal BMJ Neurologyor extended interval doses would result in Open.improved safety without sacricing efficacy. 47 msfocusmagazine.org'