Do you need to hold Kesimpta (ofatumumab) when having an active infection?

Management of Kesimpta (Ofatumumab) During Active Infection

Kesimpta (ofatumumab) should be temporarily withheld until resolution of an active infection. 1

Rationale for Withholding Kesimpta During Active Infection

• The FDA label for Kesimpta explicitly states that if a patient has an active infection, healthcare providers should delay treatment with Kesimpta until the infection is resolved 1
• Kesimpta is a B-cell depleting therapy that targets CD20, which can impair immune responses and potentially worsen existing infections 1
• Serious infections, which can be life-threatening or cause death, can occur during treatment with Kesimpta and other anti-CD20 therapies 1
• Immunosuppressive therapy, including B-cell depleting agents, should be temporarily withheld until resolution of active infection (Evidence Level 5) 2

Types of Infections Requiring Withholding Therapy

• Bacterial infections requiring antibiotic therapy are considered serious enough to warrant holding Kesimpta 2
• Viral infections, particularly those causing systemic symptoms, may require withholding Kesimpta until resolution 2
• Invasive fungal infections should prompt immediate withholding of Kesimpta 2
• For opportunistic infections, including Pneumocystis jirovecii, Legionella pneumophila, and Salmonella species, immunomodulator therapy should be temporarily withheld until resolution 2

Monitoring for Infection Resolution

• Monitor for clinical improvement in symptoms (fever, chills, cough, body aches) 1
• Ensure normalization of inflammatory markers before restarting therapy 3
• For bacterial infections, complete the full course of antibiotics before considering restarting Kesimpta 3
• Wait at least 1-2 weeks after completion of antibiotics to ensure no recurrence of infection before restarting Kesimpta 3

Special Considerations

• Patients with a history of recurrent infections may need more prolonged withholding of therapy and closer monitoring 2
• For patients with neutropenia and infection, address both the infection and neutropenia before restarting Kesimpta 2
• In patients with chronic infections that cannot be completely eradicated, consult with infectious disease specialists before continuing or restarting Kesimpta 2
• For patients with hepatitis B virus (HBV) infection, Kesimpta is contraindicated in active HBV disease, and patients with prior HBV infection require monitoring during therapy 1

When to Restart Therapy

• Only restart Kesimpta after complete resolution of the active infection 2, 1
• Ensure the patient has completed the full course of antimicrobial therapy 3
• Verify absence of fever, systemic symptoms, and normalization of inflammatory markers 3
• For serious infections, consider a follow-up evaluation to confirm resolution before restarting therapy 2

Common Pitfalls to Avoid

• Restarting Kesimpta too early before complete infection resolution, which may lead to worsening infection or recurrence 2
• Failing to recognize that even mild infections may become serious in immunocompromised patients 2
• Not completing the full course of antimicrobial therapy before restarting Kesimpta 3
• Overlooking the need for prophylaxis against certain opportunistic infections in high-risk patients 2