Neutropaenia complications from Ocrelizumab and Rituximab treatment

Venus Pang, Nabil Seery, Robb Wesselingh, Wei Yeh, Michael Zhong, Tracie Tan, Chris Dwyer, Cassie Nesbitt, Louise Rath, Deborah Perera, Francesca Bridge, Olga Skibina, Julian J. Bosco, Vilija Jokubaitis, Mark Marriott, Helmut Butkueven, Anneke Van Der Walt, Jennifer Massey, Ian Sutton, Mastura Monif

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Ocrelizumab is an anti-CD20 monoclonal antibody (mAb) that has been shown in phase 3 clinical trials to reduce relapses and disease progression in multiple sclerosis (MS) patients. Prior to the approval of ocrelizumab, rituximab, a chimeric anti-CD20 mAb was used to treat MS. Rituximab is still used to treat MS in many countries outside of Australia and remains mainstay of treatment of many non-MS neuroimmunological and systemic inflammatory diseases. Rituximab is currently used in neuromyelitis optica spectrum disorder (NMOSD) and autoimmune encephalitis, in addition to its widespread usage in hematological malignancies and systemic inflammatory diseases. Ocrelizumab is currently approved in Australia for treatment of relapsing-remitting MS (RRMS). Neutropaenia is a rare complication of both ocrelizumab and rituximab treatment. This case series reports 12 patients who have experienced neutropaenia following ocrelizumab or rituximab treatment and aims to characterize the clinical parameters of neutropaenia experienced by these patients, including the severity and duration of neutropaenia, length of hospital admission, the types of subsequent infections experienced and types of treatment necessary before patients reached count recovery. The unpredictability of neutropaenia and potential for serious infections highlight the need for continued hematological monitoring for patients on B-cell depleting therapies and calls for careful patient counselling to provide guidance on whether to continue such therapies in patients who have experienced related neutropaenia.

Original languageEnglish
Article number105147
Number of pages6
JournalMultiple Sclerosis and Related Disorders
Publication statusPublished - Jan 2024


  • Multiple sclerosis
  • Neutropaenia
  • Ocrelizumab
  • Rituximab

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