Kesimpta (Ofatumumab) is Not a Treatment for Sleep Disorders
Kesimpta (ofatumumab) is a disease-modifying therapy specifically approved for relapsing forms of multiple sclerosis and has no role in treating sleep disorders, even when comorbid with MS. 1, 2
What Kesimpta Actually Treats
Ofatumumab is a fully human anti-CD20 monoclonal antibody that targets B-cell depletion to reduce MS disease activity 2. The medication demonstrated superior efficacy versus teriflunomide in reducing annualized relapse rates (0.05 with continuous treatment), MRI-detected lesion activity, and disability worsening in relapsing MS 3. It is administered subcutaneously by patients themselves and has been used safely for up to 3.5 years with a manageable tolerability profile 4.
Managing Sleep Disorders in MS Patients
If your MS patient has a comorbid sleep disorder, you must treat each condition separately with appropriate therapies:
For Chronic Insomnia Disorder
- First-line treatment: Cognitive Behavioral Therapy for Insomnia (CBT-I) is strongly recommended over pharmacotherapy 5
- CBT-I demonstrates clinically meaningful improvements in remission rates, sleep quality, sleep latency, and wake after sleep onset with durable long-term benefits 5
- If short-course pharmacotherapy is necessary after CBT-I, use low-dose doxepin (3-6 mg) or a nonbenzodiazepine benzodiazepine receptor agonist 5
- Avoid diphenhydramine, melatonin, valerian, and chamomile as these have weak recommendations against their use 5
For Hypersomnia Secondary to MS
- Modafinil is the recommended treatment for excessive daytime sleepiness in MS patients 5
- Start modafinil with awareness that it is FDA Schedule IV controlled substance and may cause fetal harm in pregnancy 5
- Common adverse events include insomnia, nausea, diarrhea, headache, and dry mouth 5
- Modafinil may reduce effectiveness of oral contraception 5
For Circadian Rhythm Disorders
- Evening bright light therapy (2-3 hours of ~4,000 lux between 20:00-23:00) is suggested for advanced sleep-wake phase disorder 5
- Prescribed sleep-wake scheduling and behavioral modifications are first-line for delayed sleep-wake phase disorder 5
Critical Clinical Caveat
Do not confuse MS disease-modifying therapy with sleep disorder management. Ofatumumab will continue to suppress MS disease activity and reduce relapses 3, but it provides zero benefit for sleep disturbances. The most common adverse events with ofatumumab (nasopharyngitis, headache, upper respiratory tract infections) 2 are unrelated to sleep improvement and should not be misinterpreted as sleep-related effects.
The infection risk with ofatumumab (58.35% experienced infections and infestations over extended treatment) 3 requires monitoring but does not contraindicate concurrent behavioral sleep interventions like CBT-I 5.