Author Of 2 Presentations
P0244 - A simple two-step test based on CSF flow cytometry helps to discriminate MS from other inflammatory and non-inflammatory neurologic disorders (ID 1943)
Abstract
Background
Several studies have shown that relative proportions of B-lineage cells are increased in CSF of patients with MS as compared to other inflammatory (OIND) and non-inflammatory (NIND) neurologic disorders. We hypothesized that the relative proportion of CD19+ and plasma (CD19+138+) cells in CSF, as assessed with commercially available flow cytometry, could be useful for improving the specificity of MS diagnostics.
Objectives
1. To determine whether a combination of elevated CD19+ cells and plasma (CD19+138+) cells in CSF (‘CD19/Plasma Cell Test’) allows for accurate differentiation of MS from OIND (e.g. MOG Ab disorder, neurosarcoidosis, Susac syndrome) and between MS and NIND (e.g. stoke, malignancies, conversion disorder). 2. To compare the sensitivity and specificity of CD19/Plasma Cell Test to that of oligoclonal bands (OCB) in CSF.
Methods
We retrospectively reviewed the charts of consecutive patients evaluated at NYU Langone Medical Center between 1/2013 - 3/2020 for whom lymphocyte subtyping in CSF was available. We defined ‘elevated CD19 count’ as >1% of total lymphocyte count in CSF and ‘elevated plasma cell count’ as >0.1% of total lymphocyte count in CSF. We calculated proportions of patients with elevated CD19 and, within this subset, of patients with elevated plasma cell counts for MS, OIND, and NIND. We calculated the sensitivity and specificity of the CD19/Plasma Cell Test for discriminating MS from OIND and from NIND.
Results
The cohort was comprised of 69 patients with MS (age at LP: 39.1 ±11.7 years; 64% female, 65% white), 25 with OIND (age - 45.3±13.7; 56% female; 48% white), and 43 with NIND (age - 48.5 ±14.8; 63% female; 70% white). OCB (2 or more) were present in 51/67 MS patients (76%), 10/13 IND (77%) and 0/38 NIND (0%). Thus, OCB had sensitivity 76% for MS, and specificity of 56% for MS when compared to OIND, and 100% when compared to NIND. Elevated CD19 count was found in 45/69 MS patients (65%), 10/25 OIND (40%), and 8/43 of NIND (18%). Of the patients with elevated CD19 count (N=63), 27 MS patients, 3 OIND and 0 NIND patients had an elevated plasma cell count. Thus, a two step-test that sequentially assesses for elevated CD19 count and elevated plasma cell count, has sensitivity of 39% for MS, specificity of 88% for discriminated MS from OIND, and 100% for discriminating MS from NIND.
Conclusions
OCB have high sensitivity for MS, but lack specificity for discriminating MS from OIND. A simple, two-step CD19/Plasma Cell Test, based on widely available flow cytometry assay, was inferior to OCB with regard to sensitivity for MS (39% v. 76%), but superior with regard to specificity (88% v 56%) for discriminating MS from OIND. Both tests had excellent specificity for differentiating MS from NIND.
P0923 - The presence of SARS CoV2 antibodies in MS patients (ID 990)
Abstract
Background
The COVID-19 pandemic has raised novel questions for people with multiple sclerosis (pwMS), which worldwide registries will help answer. One question is - how will disease modifying treatment (DMT) use affect the efficacy of a future vaccine against SARS-CoV2 (the virus that causes COVID-19) in pwMS? To begin to address this question, we evaluated our patients who were clinically diagnosed with Covid-19 for antibodies (Ab).
Objectives
To determine the frequency of SARS-CoV-2 Ab in our patients with Covid-19 and co-morbid MS, and describe their clincal characteristics.
Methods
This is a case series of pwMS who are patients of the Holy Name MS Center and were either proven by PCR or highly suspected of active COVID-19 infection as of July 15, 2020.
Results
Of the 11 patients included, 91% (n=10) were female, average age 50.5 years (range 34-64 years); 7 patients treated with an anti-CD 20 monoclonal Ab (6 ocrelizumab (OCR), 1 rituximab (RTX)), 1 teriflunomide, 1 interferon beta-1a, and 2 patients not on DMT. Nine tested positive for SARS-CoV2 Ag by nasopharyngeal PCR; 1 was not tested but had a household exposure who tested positive and herself had clinical symptoms of cough, dyspnea, myalgia, weakness, fatigue and headache; and 1 patient tested negative for SARS-CoV2 PCR but was febrile with cough, fatigue and headache during the pandemic. Of this series, 5 tested positive for SARS-CoV2 Ab (Abbott test); of which only 1 was on treatment with OCR (with absent CD19 cells). In terms of clinical outcome – 4 patients (all OCR/RTX treated) required hospital admission for supplemental non-invasive oxygen. All patients survived infection.
Conclusions
This case series suggests that MS treatment with monoclonal anti-CD20 drugs may be associated with some increased risk of developing COVID-19. All of our patients who required hospitalization for this infection were treated with anti-CD20 threapy. Patients with MS who are on OCR/RTX may be less likely to mount an antibody response to this infection, whereas patients treated with interferons and teriflunomide can. Lack of seroconversion following OCR treatment was also noted in another case series of pwMS (Thornton 2020). Although it is reassuring that B-cells are not required to recover from COVID-19 infection, as evidenced by a case series of X-linked agammaglobulinemia patients (Soresina et al. 2020), our findings raise further questions for the health and safety of our patients with respect to this pandemic. Will OCR treated patients be at a unique risk to suffering reinfection from COVID-19 given they are less likely to seroconvert? And, how effective will a future vaccine be in patients treated with OCR (and similar monoclonal antibodies)?
Presenter Of 1 Presentation
P0923 - The presence of SARS CoV2 antibodies in MS patients (ID 990)
Abstract
Background
The COVID-19 pandemic has raised novel questions for people with multiple sclerosis (pwMS), which worldwide registries will help answer. One question is - how will disease modifying treatment (DMT) use affect the efficacy of a future vaccine against SARS-CoV2 (the virus that causes COVID-19) in pwMS? To begin to address this question, we evaluated our patients who were clinically diagnosed with Covid-19 for antibodies (Ab).
Objectives
To determine the frequency of SARS-CoV-2 Ab in our patients with Covid-19 and co-morbid MS, and describe their clincal characteristics.
Methods
This is a case series of pwMS who are patients of the Holy Name MS Center and were either proven by PCR or highly suspected of active COVID-19 infection as of July 15, 2020.
Results
Of the 11 patients included, 91% (n=10) were female, average age 50.5 years (range 34-64 years); 7 patients treated with an anti-CD 20 monoclonal Ab (6 ocrelizumab (OCR), 1 rituximab (RTX)), 1 teriflunomide, 1 interferon beta-1a, and 2 patients not on DMT. Nine tested positive for SARS-CoV2 Ag by nasopharyngeal PCR; 1 was not tested but had a household exposure who tested positive and herself had clinical symptoms of cough, dyspnea, myalgia, weakness, fatigue and headache; and 1 patient tested negative for SARS-CoV2 PCR but was febrile with cough, fatigue and headache during the pandemic. Of this series, 5 tested positive for SARS-CoV2 Ab (Abbott test); of which only 1 was on treatment with OCR (with absent CD19 cells). In terms of clinical outcome – 4 patients (all OCR/RTX treated) required hospital admission for supplemental non-invasive oxygen. All patients survived infection.
Conclusions
This case series suggests that MS treatment with monoclonal anti-CD20 drugs may be associated with some increased risk of developing COVID-19. All of our patients who required hospitalization for this infection were treated with anti-CD20 threapy. Patients with MS who are on OCR/RTX may be less likely to mount an antibody response to this infection, whereas patients treated with interferons and teriflunomide can. Lack of seroconversion following OCR treatment was also noted in another case series of pwMS (Thornton 2020). Although it is reassuring that B-cells are not required to recover from COVID-19 infection, as evidenced by a case series of X-linked agammaglobulinemia patients (Soresina et al. 2020), our findings raise further questions for the health and safety of our patients with respect to this pandemic. Will OCR treated patients be at a unique risk to suffering reinfection from COVID-19 given they are less likely to seroconvert? And, how effective will a future vaccine be in patients treated with OCR (and similar monoclonal antibodies)?