الفهرس 
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Abstract
This study showed that most of patients were females by 73.3%, but males were 26.7%. The mean age at onset of illness was 29.93 ± 5.55 years and the mean duration of illness was 6.9 ± 4.96. 70% of patients had ≤3 relapses in previous 2 years, while 86.7% had improvement in the annual relapse rate. Regarding history of DMT most patients (66.7%) had two, but only 13.3% were naïve.
The median of CD19 B cells count was 30.65(5.96-106) cells/µl and significantly depleted to 2.76 (2.1-4.26), 4.43(2.62-38.5) and 4.74 (1.65-11.87) cells/µl after 1, 6 and 12 months, respectively. This was associated with significant decline in the median (IQR) ARR from 20 (66.67%) to 0 (0%) after 12 months of ocrelizumab therapy and the median (IQR) EDSS from 4.5 (3.5 – 5.5) pretreatment to 3.5 (2.5 - 4.5) and 2.5(2.5-4.5) after 6 and 12 months, respectively. Most patients showed either stationary cerebral and cord lesions (as regards number and size of the lesions) and also there was a statistically significant decline in number of patients who had gadolinium enhanced cerebral lesions after 1 year as p-value was <0.05.
In our study, the changes in the Multiple Sclerosis Functional Composite score (a composite measure of walking speed, upper-limb movements, and cognition) showed a statistically significant improvement in all parameters of assessment across the three time points.
As long as the depletion of CD19 B cell counts was associated with marked clinical and radiological improvement,we found a statistically significant correlation between CD19 B cell counts and EDSS. Furthermore, there was no statistically significant correlation with changes in the multiple sclerosis functional composite score (a composite measure of walking speed, upper-limb movements, and cognition) and MRI Disease activity.
Patients with multiple sclerosis (MS) who are treated with ocrelizumab frequently reported an increase of MS-related symptoms prior to the next dose known as the wearing-off phenomena. Our study showed that 56.7% of participants have reported wearing off phenomena. We have found a statistically significant increase in CD19 B cell counts within the patients’ group who had wearing off phenomena after 6 months and 1 year of assessment as p-value was <0.05.
The wearing off phenomena was not elicited by clinical relapses or MRI activity, the ocrelizumab wearing off phenomena therefore does not seem to reflect suboptimal control of MS disease activity.
In conclusion, ocrelizumab was highly efficacious in reducing relapses, preventing disability progression and reducing activity either clinically as EDSS and functional composite score or radiologically in a sample of Egyptian MS patients with evidence of weaning off phenomena that was maximal within four weeks prior to reinfusion. A fixed-dose schedule of 6-monthly infusion achieved a good relapse free rate. Continous treatment with ocrelizumab in patients with MS leads to sustained CD19 B cells depletion.