Black People May Respond Differently to Anti-CD20 Treatment for Multiple Sclerosis

A preliminary retrospective study suggests Black people may respond differently to antiCD20 treatments commonly used to treat multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). After treatment with B-cell depleting antiCD20 agents rituximab or ocrelizumab via infusion, Black persons with MS or NMOSD had more rapid reconstitution of B cells compared with white persons. The relative distribution of B-cell subsets was the same in Black and white individuals. 

At 4 to 6 months after treatment, the proportion of Black (20.8%, 5/24) and white (17.9%, 5/28) individuals who had B-cell reconstitution was similar (P=.79). At 6 to 12 months, however, 76.2% (16/21) of Black individuals had B-cell reconstitution compared with 33.3% (4/12) of white individuals (P=.02). 

Of 168 individuals treated (134 with MS; 32 with NMOSD), 50 (29.8%) had detectable B-cell repopulation at a median 6.8 months following anti-CD20 treatment. At 4 months postinfusion, no individuals had B-cell repopulation, between 4 and 6 months after treatment, 23% (18/79) had B-cell reconstitutions, at 6 to 12 months, 25/41 (61%) had B-cell reconstitution. 

No information in the study addressed the reasons for faster B-cell reconstitution among Black individuals, which could be due to environmental factors (eg, stress or discrimination), biologic factors (eg, comorbidities) or a combination of both. 

“While previous research has shown that this type of infusion therapy is effective for people with those diseases, we also know that Black people tend to have more severe courses of MS,” said llya Kister, MD, Grossman School of Medicine. “We wanted to compare how quickly the B-cells came back in Black people and white people after treatment. Our findings raise the question of whether the same therapy dose may be equally effective for all people, and that could have implications for the way Black people with autoimmune diseases like MS and neuromyelitis optica spectrum disorder are treated in the future.”

For the study, demographics, disease-related information, and anti-CD20 treatment history were retrospectively collected on patients with MS or NMOSD who receive care at the NYU MS Care Center and had flow cytometry results after infusion of rituximab or ocrelizumab.

These data were presented at the American Academy of Neurology Virtual Annual Meeting 2021.