Part 1:
The following summarizes some of the highlights from the Americas Committee for Treatment and Research in MS (ACTRIMS) Forum, held February 25-27, 2021.
COVID-19 risk: Healthcare providers (HCPs) generally perceive themselves to be at higher risk of contracting COVID-19 than do MS patients, according to a U.S. survey (n=146) (Ben-Zacharia et al. ACTRIMS 2021; P051). Overall, 26% of HCPs vs. 20% of patients perceive themselves to be at high risk; and 58% and 39%, respectively, see themselves at moderate risk. A total of 88% of the sample said they would accept COVID vaccination when available.
Neurofilament-light – real-world data: The MS PATHS group evaluated serum NfL in a real-world cohort of 6,968 MS patients and 201 healthy controls (Sotirchos et al. ACTRIMS 2021; S1.1). Elevated NfL was defined as >97.5th percentile for the healthy cohort. sNfL levels were generally similar in MS patients and healthy controls although 17.2% of MS patients had elevated sNfL levels at baseline. Risk factors for elevated sNfL were diabetes (odds ratio 1.89), progressive MS (OR 1.63), current smoking (OR 1.49), and non-white race (OR 1.43). There was a lower risk with higher BMI (OR 0.83). Elevated sNfL was more common in younger patients with shorter disease duration.
Treating RIS: A retrospective study at the Massachusetts General Hospital, Boston, found that about 30% of patients with a diagnosis of radiologically isolated syndrome (30%) were treated with a disease-modifying therapy (DMT) (George et al. ACTRIMS 2021; P168). Subjects were significantly more likely to be treated if they were younger (mean age 36.7%); 15.4% of treated RIS subjects had a first-degree relative with MS. The reason for initiating treatment was most commonly MRI activity; most did not receive a lumbar puncture (39.3%). The preferred starting DMTs were dimethyl fumarate, glatiramer acetate and teriflunomide although one-third ultimately received a high-efficacy DMT. During the follow-up period, 11% of treated RIS patients converted to clinically-definite MS.
B cell kinetics with ocrelizumab: A post-hoc analysis of the OPERA studies examined depletion of B cell subsets during treatment with ocrelizumab (Hauser et al. ACTRIMS 2021; P061). The median B cell count at baseline was 228 cells/µL. The limit of detection was 5 cells/µL. After one course (600 mg) of drug exposure, <4% of ocrelizumab-treated patients had detectable B cell counts at week 24. The majority of reconstituting cells were mature naïve B cells. All B cell subsets showed significant depletion; there was less depletion of plasma cell and plasmablast populations, both of which have little or no CD20+ expression. Greater reductions in B cell subsets were seen with repeated ocrelizumab dosing.