Selected highlights from the American Academy of Neurology annual meeting, Seattle WA, 2-7 April 2022.
CONGRESS HIGHLIGHTS – TUESDAY EDITION
A Swedish study reported that a third booster vaccination against COVID-19 appears to be ineffective in patients receiving ocrelizumab (Repovic P. AAN 2022;P14.005). The retrospective study examined 20 RMS patients (age 28-74 years) receiving ocrelizumab at the time of vaccination. One patient contracted COVID after the second vaccination and had detectable antibody titres prior to the third shot; titres increased 9.5-fold after the booster injection. The other 19 patients were seronegative prior to the booster; only 2 of 19 developed detectable antibody titres a mean 26 days after the booster injection. The time from ocrelizumab dosing to third vaccine dose was not associated with seroconversion.
An analysis of the Canadian CANPREG-MS and U.S. PREG-MS longitudinal studies found that the rate of pregnancy in woman planning a pregnancy was lower in MS patients compared to the general population (Houtchens et al. AAN 2022;P9.009). The study enrolled 129 women during pregnancy planning. There were 102 conceptions during the observation period; 73.5% were viable and 26.5% were pregnancy losses. Overall, 58.4% of pregnancies were achieved within 6 months, which was lower than what is seen in the general population (75%). DMT exposure during pregnancy was not associated with delayed conception or pregnancy loss.
A separate study in Germany reported that 64.2% of women with MS continue to take symptomatic therapies during pregnancy (Witt et al. AAN 2022;P9.011). The most common therapies were analgesics (31.3%), antidepressants (24.9%) and anticonvulsants (8.7%). Treatments did not appear to have an impact on the duration of gestation, birth weight or the rate of fetal loss.
A new open-label study randomized 105 MS patients to cognitive-behavioural therapy (CBT) or standard care. The CBT program was 6 weeks and included booster sessions (Heinzlef et al. AAN 2022;S19.009). The primary outcome was change from baseline on the Modified Fatigue Impact Scale (MFIS). At one year, the CBT group had a significantly lower MFIS score compared to controls (mean 41.2 vs. 50.2). The beneficial effects of CBT on fatigue appeared to be maintained for 18 months.
MS patients are more likely than their neurologist to identify cognitive impairment (CI) (Penner et al. AAN 2022;P10.004). The European study used data from an MS program that included separate evaluation forms completed by clinicians and patients (n=2643). For the patient self-assessment, 36.8% reported mild CI, 18.6% moderate CI and 6.1% severe CI (total 61.5%). For those same patients, physicians reported mild, moderate and severe CI in 19.9%, 6.8% and 0.3%, respectively (total 27.0%). The authors suggested that this high discrepancy may be due to physicians not routinely discussing cognitive problems during the consult.