‘Wearing Off’ Of MS Treatments Between Doses

Research Summary: The patient-reported wearing-off phenomenon with monoclonal antibody treatments for multiple sclerosis

One of the major developments in the treatment of multiple sclerosis has been the introduction of highly effective monoclonal antibody therapies (i.e. natalizumab, ocrelizumab, rituximab, ofatumumab).  Today, we are going to summarise a recent publication that has looked at the ‘wearing off’ effect described by some people living with MS that are taking these medications.

What?

People living with MS that were taking either natalizumab, ocrelizumab, rituximab or ofatumumab were offered the opportunity to participate in a survey.  The survey asked questions to determine whether the individual experienced a ‘wearing off’ feeling in between doses of their treatment, when this occurred and which symptoms were impacted.

Who?

This research was conducted by a team at the Mellen Center for Multiple Sclerosis Treatment and Research at the Cleveland Clinic (Cleveland, Ohio, USA).

Where?

The article was published in the Multiple Sclerosis Journal.  The full study is currently freely accessible and can be accessed here.

When?

The study was first published online on May 6, 2024.

BACKGROUND #1: There is a lot of anecdotal evidence from some people living with MS that suggests that, although they feel better after receiving a monoclonal antibody treatment, this feeling ‘wears off’ before it is time for their next dose.

BACKGROUND #2:  While this phenomenon has been previously described for some treatments, it is not known how common it is and whether it differs between different monoclonal antibody therapies.  The exact reasons for it are also not well understood.

FINDING #1:  The study received 258 survey responses for analysis.  Of these, almost 55% reported experiencing a ‘wearing off’ feeling in between treatment doses.

FINDING #2:  In people that experienced a ‘wearing off’ of the treatment, the most common timeframe was within 2 months of having received their therapy.

FINDING #3: Fatigue was the most common symptom that appeared in those that felt their treatment was ‘wearing off’.  Other symptoms that were frequently reported were cognitive difficulties, reduced mobility and pain.

FINDING #4: Depression was found to be significantly associated with the experience of feeling a treatment was ‘wearing off’.  The higher a person scored on a common clinical questionnaire for depression, the more likely they were to report the ‘wearing off’ effect.

We are sure that this study will align with the experience of many people in our community.  We would love for you to share your thoughts with us, as this discussion furthers our understanding of this research.  In advance of that, here are a couple of our thoughts on the study itself.

THOUGHT #1:  As the authors themselves discuss in the paper, there are a couple of key limitations that need to be considered when making conclusions from these findings.  Firstly, the participants were from a single hospital and so it is not clear how this applies to other places in the US and around the world.  Secondly, while attempts were made to minimise this, there is definitely a potential bias in the responses received – that is, people who experience this ‘wearing off’ effect are more likely to want to contribute to the survey.

THOUGHT #2: While this study confirms previous research that suggests this feeling is very common amongst people living with MS on these therapies, it is still very unclear what causes it.  As it is known that this experience can lead to people wanting to switch therapies, even if it is successfully reducing disease progression, it is important that we get a better understanding of what is happening.

THOUGHT #3: The link to depression is interesting and should be investigated further.  This provides even more evidence for why mental health in people living with multiple sclerosis should be made a focus and priority in the management of the disease.

If you have questions on this study, please don’t hesitate to post them under this article or on any of our social media channels.

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