Selected highlights from the European Academy of Neurology annual meeting, Vienna, Austria, June 25-28, 2022.
CONGRESS HIGHLIGHTS – WEDNESDAY EDITION
Results from the updated interim analysis (n=33) of the ongoing KYRIOS study of CoV-2 mRNA vaccine response during treatment with ofatumumab 20 mg/month SC are now available (Ziemssen et al. EAN 2022; OPR-132). Mean age was 41.6 years; mean time between first and second vaccine doses was 4.8 weeks; mean time to first booster was 6.1 months. Mean B cell count in the group that was vaccinated during ofatumumab treatment was 0.1 cells/µL. All patients on continuous ofatumumab had an immune response within one week of full vaccination. The CoV-2-specific T cell response was unaffected by treatment. The level of neutralizing antibodies was lower than was seen in controls but 50% were seropositive. The study is ongoing.
An analysis of the EXPAND trial estimated that siponimod reduces the risk of reaching EDSS >7.0 by 40% versus placebo in patients with SPMS (Vermersch et al. EAN 2022; EPR-056). Risk reduction was more substantial in SPMS patients with active disease (51% reduction) compared to inactive SPMS (22% reduction). The results translated into a median delay in time to wheelchair dependence of 5.8 years (15.3 vs. 9.4 years).
Autologous HSCT was approved in Switzerland in 2018 for patients with aggressive or progressive MS. According to registry data (n=35), mean age at transplantation was 40 years (range 20-54 years), median disease duration was 9 years (range 1.6-19.7 years), and median EDSS score was 4.0 (range 1.5-6.5) (Jelcic et al. EAN 2022; EPR-184). One-year NEDA was 81.5%; 20.0% had disability worsening and 57.1% had disability improvement. Mucotoxic and infectious complications were common (82.9%). Two patients committed suicide.
The first study to report on vaccine response in systemic lupus erythematosus patients (mean age 43 years) during Bruton’s tyrosine kinase (BTK) inhibitor therapy has found that patients are able to mount an adequate humoral response (Cross et al. EAN 2022; EPR-253). Patients received evobrutinib 50 mg BID or 75 mg OD. Hemagglutination inhibition (HI) serum antibody titres were obtained 8-12 weeks after influenza vaccination. Seroconversion rates were 53.1% with evobrutinib (dosing groups combined) vs. 47.8% with placebo; seroprotection rates (HI titer of ≥1:40) were 81.3% and 91.3%, respectively. Prior studies have reported an attenuated response to influenza and pneumococcal vaccination with BTK inhibitors (ibrutinib) in oncology patients (Douglas et al. Haematologica 2017;102:e397-e399. Andrick et al. Br J Haematol 2018;182:712-714.
Serum glutamate may help in differentiating NMOSD from MS (Rabah et al. EAN 2022; EPO-638). A study found higher serum glutamate levels in NMO without relapses vs. MS patients without relapses (16.78 vs. 10.84 μg/mL). A cut-off value of >10.3 μg/mL predicted a diagnosis of NMO rather than MS.