Kesimpta (ofatumumab) is a relatively new medication specifically designed to treat relapsing forms of multiple sclerosis (MS) by targeting and depleting B cells, a type of immune cell involved in the disease process. When considering whether Kesimpta can be taken with other MS treatments, it is important to understand its mechanism, potential interactions, and clinical guidelines.
Kesimpta works by selectively targeting CD20-positive B cells, which play a key role in the autoimmune attack on the nervous system in MS. This targeted B-cell depletion helps reduce disease activity and relapse rates. Because Kesimpta is a monoclonal antibody administered via subcutaneous injection, it differs from many traditional MS therapies that may be oral or injectable but have different mechanisms.
**Combining Kesimpta with Other MS Treatments**
Generally, Kesimpta is not recommended to be taken simultaneously with other disease-modifying therapies (DMTs) for MS. This is primarily due to the increased risk of immunosuppression and infections when multiple immune-targeting drugs are combined. Most MS treatment protocols advise switching from one DMT to another rather than combining them. For example, patients transitioning from interferon-based therapies like Rebif or Avonex to Kesimpta usually undergo a washout period to reduce overlapping immunosuppressive effects.
**Why Avoid Combining Kesimpta with Other DMTs?**
1. **Increased Infection Risk:** Since Kesimpta depletes B cells, combining it with other immunosuppressive drugs can excessively weaken the immune system, raising the risk of serious infections.
2. **Lack of Safety Data:** Clinical trials for Kesimpta have primarily studied it as a monotherapy. There is limited evidence regarding safety or efficacy when used alongside other MS medications.
3. **Potential Overlapping Side Effects:** Combining treatments may amplify side effects such as low white blood cell counts, liver toxicity, or injection site reactions.
**Common MS Treatments and Kesimpta Compatibility**
– **Interferons (e.g., Rebif, Avonex):** These are older injectable therapies that modulate the immune response differently. Patients switching to Kesimpta typically stop interferons before starting Kesimpta. Concurrent use is not standard practice.
– **Oral Therapies (e.g., Gilenya, Tecfidera, Vumerity):** These drugs have different mechanisms, such as sphingosine-1-phosphate receptor modulation or fumarate pathways. Like interferons, they are usually discontinued before Kesimpta initiation to avoid additive immunosuppression.
– **Other Monoclonal Antibodies (e.g., alemtuzumab, ocrelizumab):** These also target immune cells but in different ways. Combining Kesimpta with other monoclonal antibodies is generally contraindicated due to heightened infection risk and immune system compromise.
**Transitioning Between Treatments**
When switching from another MS therapy to Kesimpta, neurologists carefully plan the timing to minimize risks. This often involves a washout period, where the previous medication is stopped and enough time is allowed for its effects to diminish before starting Kesimpta. This approach helps reduce the chance of overlapping immunosuppression and adverse effects.
**Monitoring and Precautions**
Patients on Kesimpta require regular monitoring for infections, blood cell counts, and liver function. If a patient has recently used other immunosuppressive MS drugs, doctors pay close attention to these parameters before and during Kesimpta treatment.
**Special Considerations**
– **Vaccinations:** Because Kesimpta affects B cells, live vaccines are generally avoided during treatment, and vaccination status is reviewed before starting therapy.
– **Infections:** Active infections are a contraindication to starting Kesimpta. Combining Kesimpta with other immunosuppressants could worsen infection ris
