Ocrelizumab in a case of refractory Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) with antibodies anti Rituximab.

BACKGROUND Rituximab (RTX), a chimeric anti-CD20 monoclonal antibody, has demonstrated a good efficacy as treatment in patients with resistant Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), but it is highly immunogenic due to its structure. Ocrelizumab (OCR) is a humanized anti-CD20 antibody, with higher tolerability and lower immunogenic profile compared to RTX. We present a case of refractory CIDP effectively treated with OCR switched from RTX after the development of anti-drug antibodies (ADA). CASE REPORT A 25 years old man was admitted to our clinic for the onset of distal upper and lower limbs weakness and numbness, with electrodiagnostic criteria of CIDP. Therefore, after attempted several standard CIDP treatments, RTX was introduced, due to poor control on clinical relapses. Unfortunately, he developed high titer of ADA after RTX infusion with no control of disease. OCR as off-label treatment was started, recording a partial recovery from the last recurrence and achieving a good prevention of new relapses without any adverse events. DISCUSSION AND CONCLUSION We suggest that OCR should be considered as another therapeutic chance in refractory CIDP. In literature this is the first case of CIDP treated with OCR, demonstrating good efficacy for its anti CD20 effect and better tolerability for the lower immunogenicity.