University of Padua
Department of Neuroscience

Author Of 2 Presentations

Disease Modifying Therapies – Risk Management Poster Presentation

P0286 - Alemtuzumab following natalizumab: a multicentric Italian real-world experience (ID 993)

Speakers
Presentation Number
P0286
Presentation Topic
Disease Modifying Therapies – Risk Management

Abstract

Background

Alemtuzumab was approved by EMA in 2013 for active relapsing-remitting multiple sclerosis patients (RRMS). The ideal candidate is an active patient in early phase of disease. iIn real world alemtuzumab is also used when many treatments before have failed. Patients with long-term natalizumab exposure and anti JCV seropositivity who stop natalizumab for the risk of PML are a category of patients for whom no specific therapeutic strategy has been established.

At present, neurologists have may highly active drugs but there are no head to head studies directly comparing the efficacy of alemtuzumab with other efficacious therapies and the decision to chose the most suitable medication depends on different factors, such as the potential side effects. In patients who stop natalizumab alemtuzumab can represent a choice.

Objectives

The aim ot this observational study was to evaluate the efficacy and safety of alemtuzumab when used in patients previously treated with natalizumab.

Methods

This is a multicentric retrospective observational study.

Study population is composed by 50 RRMS patients (18 male and 32 female) with a median EDSS of 2 (range 1-7) from five Italian Multiple Sclerosis Centres who stopped natalizumab treatment after a median number of 22 infusions (range 3-114).

Five out of 50 patients were JCV seronegative and in these patients decision to stop natalizumab was due to radiological activity during natalizumab (2 patients), hypertransaminasemia (2 patients), patient request (1 patient). 45 out of patients were JCV seropositive and for these patients reason for stopping was the risk of PML.

Switch to alemtuzumab was made after a median wash out period of 2 months (range 0,7-5 months).

Patients underwent brain MRI at the end of natalizumab treatment, at 6 and 12 months after alemtuzumab infusion.

Results

Brain MRI at six months after alemtuzumab was available for 48 out of 50 patients and in 43 of them neither signs of disease activity nor new lesions were present; 3 patients showed new lesions and 1 patient had radiological activity. No patient showed clinical activity.

Brin MRI at 12 months after alemtuzumab was available in 46 out of 50 patients and in 42 out of 46 there was no sign of disease activity. In 4 patients brain MRI showed disease activity (1 pt) or new lesions (2 pts ) or both (1 pt).

Clinical relapse after alemtuzumab therapy occurred in 1 out of 50 patients; this patient underwent the third infusion of drug.

No patient developed PML.

Conclusions

Alemtuzumab started shortly after natalizumab interruption was highly efficacious in controlling disease course, as 87% of patients showed no evidence of clinical and radiological activity one year after treatment starting.

The choice of alemtuzumab use in JCV seropositive patients must take in consideration the necessity to treat a very severe disease and the safety profile of the drug to which switching.

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Pediatric MS Poster Presentation

P1072 - Cerebellar grey matter lesions are common in pediatric multiple sclerosis at clinical onset. (ID 126)

Speakers
Presentation Number
P1072
Presentation Topic
Pediatric MS

Abstract

Background

Background. No data are available on the occurrence of grey matter lesions (GML) in the cerebellum of pediatric multiple sclerosis (pedMS).

Objectives

Objectives. We analyzed frequency, number and topography of GML and their correlation with cerebellar-related disability in pedMS at clinical onset.

Methods

Methods. Fifteen adolescents with pedMS (12F/3M; mean age: 14.9±2.2, range 11–17) were studied. Neurological and cognitive evaluations were done by means of EDSS, Trail Making Test – Part B (TMT-B) and Symbol Digit Modalities Test – oral version (SDMT). Cerebellar GML were investigated with double inversion recovery (DIR) and phase sensitive inversion recovery (PSIR) sequences obtained with a 3T-MRI scan.

Results

Results. All patients had white matter lesions (WML) and/or GML in the cerebellum. A significantly higher GML number was observed on PSIR compared to DIR (mean: 2.3±2.3 vs 1.1±1.6; median: 2.0 (IQR, 1.0-2.0) vs 1.0 (IQR, 0.0-0.0.1); p=0.004). GML were observed in 14/15 (93.3%) patients and were more frequent in the posterior than in the anterior lobe (mean: 1.8±2.2 vs 0.47±0.74; median: 2.0 (IQR, 0.5-2.0) vs 0.0 (IQR, 0.0-1.0); p=0.044). No correlation was found between lesion number or topography and EDSS (r=0.12, p=0.69), TMT-B and SDMT.

Conclusions

Conclusions. At clinical onset, cerebellar GML are common in pedMS, are very often asymptomatic, do not correlate with physical and cognitive disability and more frequently affect the posterior lobe.

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