J. Miguez
Hospital Italiano de Buenos Aires
Neurología

Author Of 4 Presentations

 On-Demand Program
Epidemiology Poster Presentation

P0493 - Severe infections in patients with multiple sclerosis: a nationwide registry study in Argentina (ID 929)

Speakers
Authors
Presentation Number
P0493
Presentation Topic
Epidemiology

Abstract

Background

Data on the rates of infections among patients with multiple sclerosis (MS) are sparse and even more from Latin American countries.

Objectives

The objective of this study was to quantify the incidence of severe infections (SI) in patients with MS included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177).

Methods

RelevarEM is a longitudinal, strictly observational MS and NMOSD registry in Argentina. From May 2018 to March 2020, the centers and principal investigators were contacted and incorporated into the Registry. SI were defined as those that required intravenous treatment or that led to hospitalization or death. Patients contributed person-years of follow-up for the study period. Incidence rates and 95% CI were calculated.

Results

A total of 2158 patients with MS were included, mean age 42 (IIQ 34-52), 65,5% (1576) were female, 82,3% were RRMS. During the period (May 2018-March 2020), 28 SI were reported (IR 1.16, 95%CI 0.77-1.68). In patients with SI, the mean age was 54 (min 43- max 63, p<0.01) years, 11 (39%) were secondary progressive MS (p<0.01), the mean EDSS was 6.5 (range 5-8)(p<0.01), mean disease duration 12 years (p<0.01). 42% of patients were free of MS treatment while 17% were on injectables, 25% on orals and 10% on monoclonal antibodies (p=0.24). The most common sites of severe infection were the lower respiratory tract (39%)

Conclusions

IR of severe infection during the study period was 1.16 (95%CI 0.77-1.68). Most frequent SI were in SPMS and older patients while no relation was observed regarding MS treatment.

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Neuromyelitis Optica and Anti-MOG Disease Poster Presentation

P0762 - What percentage of AQP4-Ab-negative NMOSD patients are MOG-Ab positive? A study from the Argentinean multiple sclerosis registry (RelevarEM) (ID 1033)

Speakers
Authors
Presentation Number
P0762
Presentation Topic
Neuromyelitis Optica and Anti-MOG Disease

Abstract

Background

Myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) have been described in aquaporin-4-antibodies(AQP4-Ab)-negative neuromyelitis optica spectrum disorders (NMOSD) patients.

Objectives

We aimed to investigate the percentage of AQP4-Ab-negative NMOSD patients who are positive for MOG-Ab included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177).

Methods

RelevarEM is a longitudinal, strictly observational multiple sclerosis (MS) and NMOSD registry in Argentina. Epidemiological, serological test and neuroimaging (MRI) data from NMOSD were described.

Results

A total of 165 patients (79 AQP4-Ab positive, 67 AQP4-Ab negative and 19 unknown) were included. Of these, 155 patients fulfilled the 2015 NMOSD diagnostic criteria. Of 67 AQP4-Ab-negative patients, 36 were tested for MOG-Ab and 10 of them (31.8%) tested positive. Presence of relapses during the previous 6 months (40% vs. 12.9%), shorter disease duration (3.9 vs. 7.5 years), lower disability (2.3 vs. 3.4) and treatment duration (1.5 vs. 3.4 years) and both optic neuritis (90% vs. 44.5%) and optic nerve lesion on MRI (80% vs. 25.1%) were significantly associated with MOG-Ab-positive compared with NMOSD respectively

Conclusions

This is the first study of the longitudinal Argentinean registry of MS and NMOSD describing and comparing diseases that contributes to provide reliable real-world data in the country. We observed that 31.8% (10/36) of the AQP4-ab-negative patients tested for MOG-Ab were positive for this antibody, in line with results from other world regions.

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Observational Studies Poster Presentation

P0841 - Brain volume loss during the first year and physical and cognitive impairment over 3 years in naïve multiple sclerosis patients under fingolimod (ID 1301)

Speakers
Authors
Presentation Number
P0841
Presentation Topic
Observational Studies

Abstract

Background

The loss of brain volume (BVL), or brain atrophy, has been classically considered as a marker present in severe or advanced stages of the disease

Objectives

The objective of this study was analyze the percentage of brain volume loss (PBVL) during the first year and physical and cognitive impairment over 3 years multiple sclerosis (MS) patients

Methods

prospective cohort study that include naïve patients who initiated fingolimod. Patients were followed longitudinally for at least 36 months evaluating relapses and EDSS progression (defined as worsening of 1 point on the EDSS). Magnetic resonance image (MRI) evaluation was done at 6 months (range 4-7 months) after fingolimod initiation (baseline MRI), and then at 12, 24 and 36 months after. PBVL loss between the baseline MRI and the first year MRI after treatment initiation was done by SIENA. Cognitive evaluation was done at study entry to exclude patients with cognitive impairment (CI) (defined as patients who scored at least 2 SDs below controls on at least 2 domains) and then at month 24 and 36. At 36 months patients with CI and EDSS progression were identified. Logistic regression analysis between the first year BVL and CI and EDSS progression was done adjusted by co-variables

Results

A total of 71 patients were included, mean age 35.4 ± 3 years, mean follow up time 43 ± 5 months. At month 36, 12% patients were classified as CI and 5.6% had EDSS progression. In the CI group, first year PBVL was -0.52 (± 0.07) vs. -0.42 (± 0.04) in no CI (p 0.003, OR=2.13, 95% CI 1.63-2.31). In the group that showed EDSS progression the PBVL was 0.59 (± 0.05) vs. 0.42 (± 0.03) (p 0.008, OR=2.13, 95% CI 1.63-2.31).

Conclusions

In patients that progressed in terms of CI and physical disability, the rate of PBVL during the first year of treatment was significantly high than in patients that did not. This is the first study that shows this association in our region.

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Observational Studies Poster Presentation

P0930 - Usage trend of oral drugs for multiple sclerosis in Argentina (ID 1183)

Speakers
Authors
Presentation Number
P0930
Presentation Topic
Observational Studies

Abstract

Background

Over the past decade, numerous disease modifying drugs (DMDs) for relapsing multiple sclerosis (RMS) have been approved in Argentina. It is believed that the use of oral DMDs (oDMDs) i.e. fingolimod, teriflunomide and dimetil fumarate has increased in recent years, although the real-life data in our country is limited.

Objectives

Our aim was to describe the tendency of the use of oDMDs (as first treatment option or after switch) regarding its approval in Argentina.

Methods

A retrospective study was conducted in a cohort of MS patients follow-up in five Argentinian MS centers incorporated in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177). Patients who started their treatment since 2012 were included. Regarding to the availability of different oDMDs in Argentina, we define three period (P1-3): P1: 2012 – 2014; P2: 2015 - 2017 and P3: 2018 - 2020. An analysis was performed comparing between these three periods to assess the tendency of oDMDs use over time. Three scenarios were defined: initial treatment, first switch and second switch. For the switch scenarios, only P1 and P2 were analyzed considering that the patients belonging P3 have a short evolution time and a scarce patient’s number required treatment changes.

Results

Out of 202 patients, 58% were female, mean age 32.4 ±11.0 years, mean disease evolution 8.0 ±5.5 years, 46 % started with oDMDs and 64% was the first choice after a switch. Injectable therapies were the most frequently withdrawn in relation to oDMDs and monoclonal antibodies (p<0.01). The main cause of switching treatment was treatment failture (39%). We found an increase in the use of oDMDs as initial treatment over time (P1: 17.7%, P2: 63.9% and P3: 65.0%; p <0.01). We found a tendency in increasing use of oDMDs after a first switch (P1: 59.6%, P2: 73.1%) or second switch (P1: 59.6%, P2: 73.1%). Multivariate analysis showed that disease evolution (OR=1.06, p=0.04), and year of starting treatment (OR=0.66, p<0.01) were independently associated with choice of oDMDs.

Conclusions

We have identified an increasing tendency in the use of oDMDs as initial treatment of RMS regarding its approval in Argentina.

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