{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T01:15:28Z","timestamp":1775697328905,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T00:00:00Z","timestamp":1744848000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: B-cell-depleting drugs targeting the CD20 antigen have been increasingly implemented as an \u201cexit strategy\u201d from natalizumab for relapsing\u2013remitting multiple sclerosis (RRMS) patients due to the increased risk of progressive multifocal leukoencephalopathy. Data on recently approved anti-CD20 drugs, such as ofatumumab serving as a natalizumab \u201cexit strategy\u201d, are lacking. Furthermore, due to their immunosuppressive mechanism of action, prolonged use of these \u201chighly effective\u201d drugs is associated with the development of hypogammaglobulinemia and, consequently, a higher risk of infections. There are no guidelines for monitoring serum immunoglobulin levels in individuals undergoing \u201chighly effective\u201d multiple sclerosis treatment. Methods: We present a case of a 26-year-old male RRMS patient with selective IgM deficiency and multiple sclerosis initially treated with natalizumab and later ofatumumab. Results: The patient achieved \u201cno evident disease activity \u201cstatus while undergoing treatment with natalizumab and ofatumumab, but these therapies, especially ofatumumab, greatly impacted further drops in IgM levels. However, no significant decrease in IgG levels was observed, and no infectious events occurred. In addition, the patient did not show signs of disease activity while on ofatumumab, which also offered a more convenient mode of administration. Conclusions: Our experience points to the need to further explore benefit\u2013risk ratios of highly effective treatments, even in cases with low immunoglobulin levels. However, closely monitoring immunoglobulin levels and conducting clinical follow-ups to ensure prompt recognition of potential infectious complications constitute approaches that have been thought of for such patients.<\/jats:p>","DOI":"10.3390\/jpm15040155","type":"journal-article","created":{"date-parts":[[2025,4,17]],"date-time":"2025-04-17T04:16:21Z","timestamp":1744863381000},"page":"155","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Selective IgM Hypogammaglobulinemia and Multiple Sclerosis Treated with Natalizumab and Ofatumumab: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"given":"Francesco","family":"Crescenzo","sequence":"first","affiliation":[{"name":"Neurology Unit\u2014Multiple Sclerosis Center, \u201cMater Salutis\u201d Hospital, Verona Local Health Authority of Veneto Region (AULSS 9 Scaligera), 37045 Legnago, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelangelo","family":"Turazzini","sequence":"additional","affiliation":[{"name":"Neurology Unit\u2014Multiple Sclerosis Center, \u201cMater Salutis\u201d Hospital, Verona Local Health Authority of Veneto Region (AULSS 9 Scaligera), 37045 Legnago, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Rossi","sequence":"additional","affiliation":[{"name":"Neurology Unit\u2014Multiple Sclerosis Center, \u201cMater Salutis\u201d Hospital, Verona Local Health Authority of Veneto Region (AULSS 9 Scaligera), 37045 Legnago, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1038\/s41572-018-0041-4","article-title":"Multiple sclerosis","volume":"4","author":"Filippi","year":"2018","journal-title":"Nat. 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