Author Of 3 Presentations

Disease Modifying Therapies – Mechanism of Action Poster Presentation

LB1174 - Patient and healthcare professional perspectives of immune dynamics and MS disease-modifying therapies mode of action throughout COVID-19 pandemic   (ID 1766)

Speakers
Presentation Number
LB1174
Presentation Topic
Disease Modifying Therapies – Mechanism of Action

Abstract

Background

Disease-modifying therapies (DMTs) for relapsing multiple sclerosis (RMS) modulate or deplete immune cells, including T and B cells. Healthcare professionals (HCPs) and patients consider many factors when selecting a DMT in a shared decision model, including efficacy, frequency/route of administration and safety. Patient understanding of mechanisms of action (MoA), and DMT effects on the dynamics and function of the immune system may be challenging to understand and further influenced by the COVID-19 pandemic, including risk interpretation and administration preferences.

Objectives

To assess the involvement of patients in MS treatment selection and the importance for patient understanding of MoA using a patient narrative approach, and to design a preliminary qualitative survey to inform future studies.

Methods

A preliminary qualitative survey was developed to explore factors most important to patients when considering DMTs, including patient understanding of immunological aspects of MS, MoAs, preferences regarding route of administration and provision of MS clinical information. Perspectives were sought from HCPs and patients on how this dialog has changed during the COVID-19 pandemic. The survey was distributed by email to 3 patients and 1 caregiver.

Results

Results are based on survey results and email correspondence from two adults with RMS, and an adolescent with pediatric MS and her caregiver. Overall, respondents felt they understood the general role of the immune system in MS and the role of DMTs but had poorer understanding of B and T cell functions and the impact of DMTs and their MoAs. Safety and efficacy were equally the most important variables when considering a new DMT. Face-to-face discussions between patients and HCPs were preferred to noninteractive materials; HCP authors (3 neurologists and 1 MS physician assistant) agreed that more face-to-face clinic time for dialog is needed. Patient independence was a key factor in preferences for methods of administration. Respondents reported an increase in MoA conversations in light of COVID-19.

Conclusions

While safety and efficacy are important in patients’ considerations of DMTs, there is a clear need to increase understanding of MoAs when starting or switching DMTs; immunological knowledge has become increasingly important during the COVID-19 pandemic. The preliminary qualitative survey can be used to inform future studies of what is needed to improve communication on DMT MoAs.

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Clinical Outcome Measures Poster Presentation

P0044 - CogEval in the Real World: Feasibility, Implementation, and Real World Implications (ID 1295)

Speakers
Authors
Presentation Number
P0044
Presentation Topic
Clinical Outcome Measures

Abstract

Background

Cognitive dysfunction in multiple sclerosis (MS) patients is common, and routine/efficient screening for cognitive dysfunction is commonly not feasible in a real-world setting for a variety of reasons.

Objectives

To determine patient satisfaction with the CogEval app using the Processing Speed Test (PST), a validated analog of the Symbol Digit Modalities Test (SDMT) as well as time it takes to complete the PST, and clinical decision making as a result of PST testing.

Methods

30 established or new MS patients in our clinic were followed over a period of 64 weeks, and at each visit, PST was administered. Upon consent, patients were administered a single seven-question satisfaction survey using a 5-point Likert scale (1-strongly disagree, 2-disagree, 3-neutral, 4-agree, 5-strongly agree) during one of these visits. Time to complete practice test and PST was captured. Retrospective chart review was performed to determine clinical decision making as a result of performing the PST.

Results

The average time to complete PST was 4 minutes 23 seconds. Likert scale scores were as follows: I liked using the app (4.6/5), The directions on the app were easy to understand (4.8/5), I was familiar with the risk of cognitive dysfunction in MS before using the app (4.5/5), I like the fact that my provider is testing my cognitive status (4.9/5), Because of this app, I’ll be more motivated to learn about the potential effects of MS on my cognition (4.6/5), The app did not take too long to complete (4.8/5), I am willing to repeat cognitive testing at future visits (4.7/5).

Retrospective chart review regarding medical decision making as a result of performing PST are as follows: Discussion about cognitive dysfunction in MS-30 patients, MRI brain-11 patients, labs to rule out other potential causes of cognitive dysfunction-9 patients, initiate high efficacy therapy-9 patients, switch to high efficacy therapy-4 patients.

Conclusions

Based on Likert Scale scores, patient satisfaction with PST testing was high, instructions were easy for patients to understand, patients appreciated the fact that routine cognitive screening was performed at their clinic visits, and the time to complete PST testing was not burdensome. The average time for PST practice test/test completion was 4 minutes 23 seconds. The PST is an efficient, rapid, and repeatable tool to assess for cognitive dysfunction in MS patients longitudinally.

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Clinical Outcome Measures Poster Presentation

P0074 - Effects of Ocrelizumab on Cognition-Real World Evidence Using the CogEval App (ID 504)

Speakers
Authors
Presentation Number
P0074
Presentation Topic
Clinical Outcome Measures

Abstract

Background

Cognitive dysfunction in MS patients is common, with up to 65% of patients experiencing cognitive difficulties during the course of the disease. The effects of ocrelizumab on cognition have not been studied in a real-world setting.

Objectives

We sought to determine the effects of ocrelizumab on cognition in patients with relapsing multiple sclerosis (MS) or active secondary progressive multiple sclerosis (aSPMS) using the CogEval app's Processing Speed Test (PST), a validated analogue of the Symbol Digit Modalities Test (SDMT). The PST has three major advantages over the SDMT: 1) PST takes only 2 minutes to complete, and does not require a healthcare professional to be present with the patient during testing, 2) PST has been shown to be more sensitive to T2 lesion volume compared to SDMT, and 3) There is a smaller learning effect with PST compared to SDMT.

Methods

We performed the PST on patients in our clinic currently receiving ocrelizumab or who were started on ocrelizumab from January 2019 to April 2020. Only patients who had received at least two doses of ocrelizumab and had at least 3 PST scores were included in the analysis. 28 patients met these criteria. Based on the average of subsequent PST tests performed (Range: 2-5) we analyzed the proportion of patients who improved on PST (>4 points) were stable (no change >4 points or <4 points) or worsened (< 4 points). We performed univariate regression analyses based on age (>40 and <40), gender, smoking, and educational attainment (four-year college degree vs. no college degree). We also performed a sub-group analysis on nine patients starting ocrelizumab therapy with a PST score prior to initiation of ocrelizumab.

Results

Average time on treatment for the cohort was 430 days. 32.1% of patients showed improvement of their PST scores, 50% of patients had stable PST scores, and 17.9% of patients had a worsening of their PST scores. Univariate regression analyses were performed based on age, gender, smoking, and educational attainment (four-year college degree vs. no college degree) and there were no significant trends with any of these analyses. In the sub-group analysis of nine patients with a PST score prior to initiation of ocrelizumab, three patients showed improvement in their PST scores, four patients were stable, and two patients worsened.

Conclusions

To our knowledge, this is the first real-world analysis of the effects of ocrelizumab on cognition using the PST, a validated analogue of SDMT. A substantial majority of patients showed stability or improvement on PST during the course of their treatment with ocrelizumab. Univariate regression analyses looking at age, gender, smoking and educational attainment showed no significant trends, suggesting baseline demographics/disease characteristics did not affect the outcome of PST scores. Longer-term real-world analyses are necessary to determine the effects of prolonged B cell depletion on cognition in MS patients taking ocrelizumab.

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Presenter Of 2 Presentations

Clinical Outcome Measures Poster Presentation

P0044 - CogEval in the Real World: Feasibility, Implementation, and Real World Implications (ID 1295)

Speakers
Authors
Presentation Number
P0044
Presentation Topic
Clinical Outcome Measures

Abstract

Background

Cognitive dysfunction in multiple sclerosis (MS) patients is common, and routine/efficient screening for cognitive dysfunction is commonly not feasible in a real-world setting for a variety of reasons.

Objectives

To determine patient satisfaction with the CogEval app using the Processing Speed Test (PST), a validated analog of the Symbol Digit Modalities Test (SDMT) as well as time it takes to complete the PST, and clinical decision making as a result of PST testing.

Methods

30 established or new MS patients in our clinic were followed over a period of 64 weeks, and at each visit, PST was administered. Upon consent, patients were administered a single seven-question satisfaction survey using a 5-point Likert scale (1-strongly disagree, 2-disagree, 3-neutral, 4-agree, 5-strongly agree) during one of these visits. Time to complete practice test and PST was captured. Retrospective chart review was performed to determine clinical decision making as a result of performing the PST.

Results

The average time to complete PST was 4 minutes 23 seconds. Likert scale scores were as follows: I liked using the app (4.6/5), The directions on the app were easy to understand (4.8/5), I was familiar with the risk of cognitive dysfunction in MS before using the app (4.5/5), I like the fact that my provider is testing my cognitive status (4.9/5), Because of this app, I’ll be more motivated to learn about the potential effects of MS on my cognition (4.6/5), The app did not take too long to complete (4.8/5), I am willing to repeat cognitive testing at future visits (4.7/5).

Retrospective chart review regarding medical decision making as a result of performing PST are as follows: Discussion about cognitive dysfunction in MS-30 patients, MRI brain-11 patients, labs to rule out other potential causes of cognitive dysfunction-9 patients, initiate high efficacy therapy-9 patients, switch to high efficacy therapy-4 patients.

Conclusions

Based on Likert Scale scores, patient satisfaction with PST testing was high, instructions were easy for patients to understand, patients appreciated the fact that routine cognitive screening was performed at their clinic visits, and the time to complete PST testing was not burdensome. The average time for PST practice test/test completion was 4 minutes 23 seconds. The PST is an efficient, rapid, and repeatable tool to assess for cognitive dysfunction in MS patients longitudinally.

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Clinical Outcome Measures Poster Presentation

P0074 - Effects of Ocrelizumab on Cognition-Real World Evidence Using the CogEval App (ID 504)

Speakers
Authors
Presentation Number
P0074
Presentation Topic
Clinical Outcome Measures

Abstract

Background

Cognitive dysfunction in MS patients is common, with up to 65% of patients experiencing cognitive difficulties during the course of the disease. The effects of ocrelizumab on cognition have not been studied in a real-world setting.

Objectives

We sought to determine the effects of ocrelizumab on cognition in patients with relapsing multiple sclerosis (MS) or active secondary progressive multiple sclerosis (aSPMS) using the CogEval app's Processing Speed Test (PST), a validated analogue of the Symbol Digit Modalities Test (SDMT). The PST has three major advantages over the SDMT: 1) PST takes only 2 minutes to complete, and does not require a healthcare professional to be present with the patient during testing, 2) PST has been shown to be more sensitive to T2 lesion volume compared to SDMT, and 3) There is a smaller learning effect with PST compared to SDMT.

Methods

We performed the PST on patients in our clinic currently receiving ocrelizumab or who were started on ocrelizumab from January 2019 to April 2020. Only patients who had received at least two doses of ocrelizumab and had at least 3 PST scores were included in the analysis. 28 patients met these criteria. Based on the average of subsequent PST tests performed (Range: 2-5) we analyzed the proportion of patients who improved on PST (>4 points) were stable (no change >4 points or <4 points) or worsened (< 4 points). We performed univariate regression analyses based on age (>40 and <40), gender, smoking, and educational attainment (four-year college degree vs. no college degree). We also performed a sub-group analysis on nine patients starting ocrelizumab therapy with a PST score prior to initiation of ocrelizumab.

Results

Average time on treatment for the cohort was 430 days. 32.1% of patients showed improvement of their PST scores, 50% of patients had stable PST scores, and 17.9% of patients had a worsening of their PST scores. Univariate regression analyses were performed based on age, gender, smoking, and educational attainment (four-year college degree vs. no college degree) and there were no significant trends with any of these analyses. In the sub-group analysis of nine patients with a PST score prior to initiation of ocrelizumab, three patients showed improvement in their PST scores, four patients were stable, and two patients worsened.

Conclusions

To our knowledge, this is the first real-world analysis of the effects of ocrelizumab on cognition using the PST, a validated analogue of SDMT. A substantial majority of patients showed stability or improvement on PST during the course of their treatment with ocrelizumab. Univariate regression analyses looking at age, gender, smoking and educational attainment showed no significant trends, suggesting baseline demographics/disease characteristics did not affect the outcome of PST scores. Longer-term real-world analyses are necessary to determine the effects of prolonged B cell depletion on cognition in MS patients taking ocrelizumab.

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