Danaher Digital

Author Of 1 Presentation

Clinical Outcome Measures Poster Presentation

P0138 - "Progressive Multifocal Leukoencephalopathy outcomes in Multiple Sclerosis: A Systemic review and Metanalysis "  (ID 1013)

Speakers
Presentation Number
P0138
Presentation Topic
Clinical Outcome Measures

Abstract

Background

Multiple Sclerosis (MS) is an autoimmune, demyelinating disorder of the central nervous system (CNS), treated with disease modifying therapies (DMT). Although DMT are commonly well tolerated, a potentially fatal complication is progressive multifocal leukoencephalopathy (PML). PML is a severe, sometimes fatal disease of the CNS caused by the John Cunnigham virus (JCV) characterized by a wide range of neurologic deficits.

Objectives

This is a systemic review and metanalysis on DMT-induced PML outcomes in MS. Literature is limited and results are not uniform due to incomplete data and various treatment protocols.

Methods

We conducted a systematic review and metanalysis of articles in PubMed, SCOPUS and EMBASE database from Jan 2005 to Dec 2019 for MS patients being treated for PML. Disability progression was defined as an increase in the Expanded Disability Status Scale (EDSS) score of >=1.0 point from the time of PML diagnosis to post PML treatment. We categorized the PML cases into two groups - people who did not improve in the EDSS score by 1 point (EDSS-NI) versus people with improved EDSS score by at least 1 point after the PML treatment (EDSS-I).

Results

A total of 569 articles were screened with 62 articles included with total number of patients were 214, out of which 158 were in EDSS-NI group and 36 were in EDSS-I group. A total of 129 women (66.5%) and 65 men (33.5%) participate in the study (20 cases gender were not available). The mean age of EDSS-NI was 44.7 while the mean age of EDSS-I was 40.5 (p-value: 0.021). In terms of DMT at the time of PML diagnosis, the most common DMT was natalizumab (185/214; 86.4%) followed by fingolimod (20/214; 9.3%) and others including dimethyl fumarate, ocrelizumab, alemtuzumab (9/214; 4.2%). Out of 214 cases CSF JCV DNA (copies per ml) were available in only 188 patients. In EDSS-NI group 108 cases had CSF JCV DNA >100 copies/ml (108/151; 71.5%). Whereas, in EDSS-I group 19 patients had CSF JCV DNA >100 copies/ml (19/37; 51.4%). There was significant difference in outcomes of the patients who had <100 copies/ml of CSF JCV DNA with p-value of 0.03, meaning that fewer CSF JCV DNA copies were associated with better outcomes.

Conclusions

The most important variables that determine outcome are age at the PML diagnosis and number of copies/ml of CSF JCV DNA. Old age and high number of copies of CSF JCV DNA are associated with worse outcome, which is either disability or death. None of the DMT are independently associated with outcome.

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