Selected highlights from the American Academy of Neurology annual meeting, Seattle WA, 2-7 April 2022.
CONGRESS HIGHLIGHTS – WEDNESDAY EDITION
The Adelphi Disease Specific Program surveyed 779 SPMS patients for the period 2018-2021 and found that 9.9% of active and 23.8% nonactive patients were untreated (Thirumalai et al. AAN 2022). DMTs most commonly used for SPMS were infusion drugs and orals; first-line injectables were used in 15-23% of SPMS patients.
An analysis of the OPERA I/II and ORATORIO trials reported that achieving no evidence of disease activity (NEDA) during treatment with ocrelizumab or interferon-beta was not predictive of 24-week confirmed disability progression in RMS patients (Montalban et al. AAN 2022;P16.007). NEDA was predictive of CDP in PPMS (HR 0.63).
The Barcelona group has proposed that a larger spinal cord canal area, termed the spinal cord reserve, is associated with better disability outcomes (Sastre-Garriga et al. AAN 2022;S26.006). A total of 3172 3T MRI scans of brain down to C5 were analysed. Spinal cord area was significantly lower in MS patients versus controls (60.35 vs. 65.02 mm2), as was the spinal cord parenchymal fraction (0.28 vs. 0.31). A larger spinal cord canal area was significantly associated with a lower score on the Patient-determined Disease Steps (PDDS) scale.
Thalamic volume at the time of an MS relapse appears to have an impact on the degree of cognitive recovery as assessed by the Symbol Digit Modalities Test (SDMT) (Weinstock et al. AAN 2022;P14.010). The mean SDMT score decreased from 57.9 to 54.6 during a relapse and recovered to 59.4. However, there was considerable variation in cognitive decline and recovery in individual patients. Thalamic volume – but not T2 lesion volume – at the time of relapse was significantly related to the degree of SDMT recovery post-relapse.
The SCALA pilot study is examining the effect of alemtuzumab – subcutaneous and IV – in patients with primary- and secondary-progressive MS (Acevedo et al. AAN 2022). The subcutaneous dosing regimen is the same as the usual infusion dosing (12 mg x 5 days in year 1, 12 mg x 3 days in year 2). Thus far, lymphocyte kinetics (CD3+, CD4+ and CD8+ T cells, CD19+ B cells) appear similar with the different routes of administration. However, bioavailability and serum drug concentrations are lower with SC administration.
MS patients would like to be told about their long-term prognosis by their neurologist, according to a new multicentre study (Castillo-Trivino et al. AAN 2022;P17.007). The study administered the Prognosis in MS Questionnaire to 189 MS patients early in their clinical course; mean age was 36 years; mean disease duration was 1.2 years; and median EDSS score was 1.0. Overall, 73.5% said they wanted to be informed about their prognosis at diagnosis. However, 68.5% said they had never discussed prognosis with their neurologist.