A Proposed Approach to Screening and Surveillance Labs for Patients With Multiple Sclerosis on Anti-Cd20 Therapy

Authors

Stephanie Gandelman, Department of Neurology (SG, CM, JRB), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (SG), New York Medical College, Valhalla; and Department of Pharmacy (KAL), Hospital of the University of Pennsylvania, Philadelphia.
Kerry A. Lenzi, Department of Neurology (SG, CM, JRB), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (SG), New York Medical College, Valhalla; and Department of Pharmacy (KAL), Hospital of the University of Pennsylvania, Philadelphia.
Clyde Markowitz, Department of Neurology (SG, CM, JRB), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (SG), New York Medical College, Valhalla; and Department of Pharmacy (KAL), Hospital of the University of Pennsylvania, Philadelphia.
Joseph R. Berger, Department of Neurology (SG, CM, JRB), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (SG), New York Medical College, Valhalla; and Department of Pharmacy (KAL), Hospital of the University of Pennsylvania, Philadelphia.

Author Type(s)

Faculty

DOI

10.1212/CPJ.0000000000200241

Journal Title

Neurology. Clinical Practice

First Page

e200241

Document Type

Article

Publication Date

2-1-2024

Department

Neurology

Abstract

BACKGROUND: Anti-CD20 therapies have proven to be highly effective and safe therapies for multiple sclerosis (MS) and have had rapid uptake in the MS community. However, no clear consensus has arisen regarding an approach to screening or surveillance lab monitoring. RECENT FINDINGS: Based on current evidence, for screening labs before anti-CD20 initiation, we propose checking liver function test (LFT), complete blood count with differential (CBC), absolute B-cell count, quantitative immunoglobulins, hepatitis B virus serologies, varicella zoster virus IgG, John Cunningham virus (JCV) status, and age-appropriate vaccination history. For surveillance monitoring in an otherwise asymptomatic individual, we propose biannual LFTs and CBC, quantitative immunoglobulins annually after year 3, absolute B-cell count at month 6 and in the setting of relapse, and JCV only if clinical or radiographic features of progressive multifocal leukoencephalopathy arise. For ublituximab, pregnancy testing is additionally recommended before each infusion. IMPLICATIONS FOR PRACTICE: We propose evidence-based screening and safety surveillance labs which take into account likelihood of changing management in an otherwise stable or asymptomatic individual.

Recommended Citation

Gandelman, S., Lenzi, K. A., Markowitz, C., & Berger, J. R. (2024). A Proposed Approach to Screening and Surveillance Labs for Patients With Multiple Sclerosis on Anti-Cd20 Therapy. Neurology. Clinical Practice, 14 (1), e200241. https://doi.org/10.1212/CPJ.0000000000200241