Selected highlights from the European Academy of Neurology annual meeting, Vienna, Austria, June 25-28, 2022.
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Relapses uncommon after COVID vaccination
The aging MS patient
Ocrelizumab EID
Natalizumab EID
Clinical tip of the day
CONGRESS HIGHLIGHTS – TUESDAY EDITION
Relapses uncommon after COVID vaccination
DMT-treated MS patients (N=2203) were not predisposed to COVID vaccination-related complications, according to a multicentre analysis at MS centres in Poland (Kulikowska et al. EAN 2022; OPR-037). About 81% received mRNA vaccines. While mild symptoms post-vaccination were common, there was only one case of severe side effects (pro-thrombotic complications). A total of 99 MS patients (4.5%) experienced a relapse post-vaccination.
Also noteworthy was the finding from the AutMuSC study of COVID-19 in MS patients, which reported no significant increase in relapses (8.6% vs. 7.0%) or EDSS worsening (5.6% vs. 4.2%) among MS patients with vs. without COVID (Bsteh et al. EAN 2022; EPR-166).
A cross-sectional study of 266 older MS patients (>60 years) found that 22% were diagnosed after age 50 years; two-thirds of this subgroup were RRMS and one-third were PPMS at diagnosis (Michelis et al. EAN 2022; EPO-691). A total of 27% had an EDSS score < 6.0, and 29.2% were currently taking a DMT (primarily interferon-β, glatiramer acetate and azathioprine). Comorbidity (cardiovascular, orthopedic, metabolic/endocrine) was common (87%). A second study of MS patients at a tertiary-care neurology unit reported that 18.9% were aged >60 years (De Lorenzo et al. EAN 2022; EPO-192). Median EDSS score in this group was 4.0; median EDSS score was 2.5 for RRMS, 6.5 for SPMS and 6.0 for PPMS. Mean relapse-free time was 13 years. A total of 58% were on a DMT. There was no difference in relapse-free time or EDSS score between groups with or without a DMT.
Two studies have examined the clinical impact of delaying ocrelizumab infusions during the pandemic. The first study reported that extended-interval dosing (EID, defined as a dosing interval >7 months) was not associated with an increased risk of relapses or MRI activity (Zanghi et al. EAN 2022; EPR-254). The relapse risk was higher in patients with higher baseline MRI activity and a progressive course. A separate study of EID (mean dosing interval 7.67 months) reported no relapses or progression; 5 of 47 patients had mild disease activity on MRI that was not correlated with B cell repopulation.
The ongoing NEXT study is examining personalized natalizumab dosing based on drug trough concentrations of 10 µg/mL (median q5wk dosing) and 5 µg/mL (median q6wk dosing) (Toorop et al. EAN 2022; EPR-067). According to the interim analysis (n=295), new MRI lesions were uncommon (<4%) and no patient experienced a relapse with EID. The authors noted that EID dosing may be feasible in 78% of natalizumab-treated patients. EID may reduce the risk of PML with natalizumab. A Biogen database analysis identified 34 PML cases in patients receiving natalizumab EID (defined as >q4wk) (Dsilva et al. EAN 2022; EPO-128). The number of EID patients was not reported so the incidence of PML in this subgroup could not be determined. The anti-JCV index was >1.5 in 56.7% (U.S.) and 44.1% (rest of world) EID patients who developed PML. Mean duration of natalizumab treatment at PML onset was 90 months (U.S.) and 70 months (rest of world).
Screening for autoimmune disorders is generally not warranted as part of the work-up in suspected MS patients unless there is clinical suspicion of a systemic autoimmune disease (Riedl et al. EAN 2022; EPR-072). A retrospective study of 212 MS patients identified only three patients with autoimmune disorders (rheumatoid arthritis, Sjögren’s syndrome).
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