Selected highlights from the European Academy of Neurology annual meeting, Budapest, Hungary, July 1-4, 2023.
CONGRESS HIGHLIGHTS – WEDNESDAY EDITION
Ofatumumab – 5-year efficacy data
Ofatumumab is associated with sustained efficacy and safety, according to the most recent update of the ALITHIOS extension of the ASCLEPIOS I/II studies (Kappos et al. EAN 2023;EPR-097). In the group receiving continuous ofatumumab for up to five years (n=690), the annualized relapse rate (ARR) in year 5 was 0.031. In the group switched from teriflunomide to ofatumumab after two years, ARR was 0.051 in year 5; between-group differences were not significant. In year 5, the number of Gd+ lesions/scan was 0.009 with continuous ofatumumab and 0.024 in the teriflunomide/ofatumumab switch group; the number of new/enlarging T2 lesions/scan was 0.061 and 0.077, respectively. In the continuous treatment group, the proportion of patients with no evidence of disease activity (NEDA) increased from 80.0% in year 2 to 87.5% in year 3, 89.2% in year 4 and 93.4% in year 5. In the five-year safety analysis (n=1969), there was a low incidence of serious infections (4%) (Sacca et al. EAN 2023;EPO-642). Mean IgG and IgM levels remained above the lower limit of normal (LLN). The proportion of patients with IgG <LLN was 1.6%. Decreases in IgG and IgM were not associated with a risk of serious infections. The incidence rate for malignancies was 0.33/100 patient-years and was unchanged during the long-term follow-up. No new safety risks were identified. Safety data were previously presented at AAN (see AAN Update on anti-CD20 agents: long-term data, NeuroSens, May 10, 2023).
MS influenced by prior pregnancies
A novel study has examined the potential effect on MS of microchimerism, in which fetal cells that are genetically distinct from the mother migrate to the maternal bloodstream and persist for decades (Bianchi et al. EAN 2023;EPO-153). The study compared 43 MS patients with at least one son (XYp), only daughters (XXp) or who were nulliparous (NPp). The risk of MS onset in the postpartum period was higher in the XYp vs. XXp group (odds ratio 4.43). The XXp group had a significantly higher relapse rate. The XYp group had lower PASAT scores. Retinal nerve fibre layer (RNFL) thickness on OCT was higher in XYp vs. NPp; no differences were seen between XXp and NPp on this measure.
NfL not useful to predict cognitive impairment
A new study examined the possible association between serum neurofilament light chain (NfL) levels and cognitive impairment (Demjaha et al. EAN 2023;EPR-157). The study compared 186 MS patients (mean age 39 years) and 49 healthy controls. While 25% of MS patients demonstrated impairment in at least one domain, baseline sNfL z-scores were not correlated with scores on Brief Cognitive Assessment for MS (BICAMS) subtests, including the Symbol Digit Modalities Test (SDMT), the Verbal Learning Memory Test (VLMT) and the Brief Visuospatial Memory Test (BVMT).
Improved outcome with autoimmune comorbidity in MS
An analysis of 142 patients with MS found that 2% had an autoimmune comorbidity at the time of MS diagnosis and a further 17% subsequently developed an autoimmunity (Iacono et al. EAN 2023;EPO-335). The incidence rate for autoimmunity was 0.7/100 patient-years. The most common autoimmune disorders were Hashimoto’s thyroiditis (12%) and psoriasis (2.1%). The subgroup with an autoimmune comorbidity had a significantly higher annualized relapse rate compared to those without an autoimmunity (0.40 vs. 0.29) but a lower risk of secondary progression (HR= 0.42).
Clinical tip of the day
Older patients and those with a low absolute lymphocyte count (ALC) have a higher risk of developing Grade II/III lymphopenia during treatment with dimethyl fumarate, according to a single-centre retrospective analysis in Germany (Protopapa et al. EAN 2023;EPO-515). A total of 42 of 144 patients (29%) developed Grade II/III lymphopenia. Patients who developed lymphopenia had typically received several prior DMTs and had an overall higher JC virus titre suggestive of an increased risk of progressive multifocal leukoencephalopathy (PML).