City of Health and Science University Hospital of Turin
Department of Neurosciences

Author Of 2 Presentations

Disease Modifying Therapies – Mechanism of Action Poster Presentation

P0400 - Switching to Ocrelizumab from other second line treatments in relapsing-remitting Multiple Sclerosis: a single Center cohort (ID 1150)

Speakers
Presentation Number
P0400
Presentation Topic
Disease Modifying Therapies – Mechanism of Action

Abstract

Background

Ocrelizumab (OCR) is a new a humanized monoclonal antibody able to bind to a specific epitope of CD20, expressed in the majority of B-cell lines. OCR has been approved for treatment of aggressive relapsing-remitting Multiple Sclerosis (RR-MS) and for primary progressive MS.

Objectives

To evaluate the clinical and radiological outcomes in a cohort of RR-MS patients after switching from other second line treatments (Natalizumab – NTZ, Fingolimod - FTY or Alemtuzumab - ALEM) to OCR. We also evaluated safety of OCR treatment

Methods

All consecutive patients (pts), evaluated in the City of Health and Science University Hospital of Turin MS Center, switching to OCR from other second line treatment, were included in the study. Study outcomes were: clinical disease activity (EDSS progression, relapses), radiological disease activity (new/enlarging T2 lesions, T1 Gd+ lesions) evaluated by MRI scans at 3, 6 and 12 months after starting OCR compared with a reference MRI scan performed within one month before switching, and treatment safety (any infusion reaction and/or adverse event related to OCR therapy).

Results

We identified 42 patients (mean age 42±9 years, 27 (64%) female, mean Expanded Disability Status Scale 4) who switched from NTZ (23 pts), FTY (16 pts) and ALEM (3 pts) to OCR between January 2019 to June 2020. Mean disease duration from MS diagnosis to start of OCR was 11±6 years. Reasons for switch were: persistence of disease activity (23 patients), PML risk (17 pts) or tolerability (2 pts). Mean washout period was 60 days after NTZ and 45 days after FTY. During the follow-up period (mean 10±2 months) no significant adverse events were observed during OCR treatment: 6 pts (14%) had minor infusion reactions, no serious infections were reported. Switching to OCR appears to be effective in most patients: 4/42 (1pt switched from FTY, 3 pts from NTZ) had a relapse treated with corticosteroids, occurring within 4 months after starting OCR. One patient experienced an early rebound of disease activity within 6 weeks after stopping FTY, before switching to OCR. MRI follow-up showed new/enlarging T2 lesions in 4 patients (3 switching from FTY and 1 from NTZ), on average 7 months after starting OCR, and a T1 Gd+ lesion in one patient switching from FTY (3 months after starting OCR). All other patients did not show clinical or radiological disease activity.

Conclusions

In our single Center cohort, switching to OCR from other second line treatments appears to be safe and in most patient effective.

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Imaging Poster Presentation

P0571 - Evaluating agreement between Mean Upper Cervical Cord Area measurements from 3D-FLAIR and 3D-T1 brain images (ID 1030)

Speakers
Presentation Number
P0571
Presentation Topic
Imaging

Abstract

Background

Cervical spinal cord atrophy is an MRI biomarker of neurodegeneration and in MS it correlates with disability and disease progression. The Mean Upper Cervical Cord Area (MUCCA) can be used to measure this atrophy. Recently there has been an increasing interest towards calculating the MUCCA from MR brain images. It has been shown that MUCCA measurements calculated from brain T1-weighted images are comparable with those calculated from cervical cord T1-weighted images. Moreover, gadolinium (Gd) administration seems to have no effect on these measurements.

Objectives

To evaluate the correlation and the agreement between MUCCA measurements calculated from 3D-FLAIR and 3D-T1 post Gd brain images.

Methods

We used the images of 20 patients with Progressive MS who underwent a 1.5 T MRI as a routine radiological follow-up. 3D- FLAIR and post Gd 3D-T1 brain images were acquired. In our study, MUCCA was defined as the mean cross-sectional area (CSA) of a 12.8 mm long section of the cervical spinal cord, starting from the tip of the C1 vertebra. 3D-FLAIR and 3D-T1 were co-registered and resampled to the same voxel size. The MUCCA and the CSA per slice were compared.

Results

The mean difference between the MUCCA measurements from FLAIR and T1 images was 1.12 mm2 (1.9 %), range -3.13 mm2 (5.4 %) - 4.18 mm2 (7.2%). High positive correlation was observed between the MUCCA measurements from FLAIR and T1 images (r= .976 , p < .0001) and between the CSA per slice measurements from FLAIR and T1 images (r = .940 , p < .0001). High agreement was shown also by inspection of the Bland Altman plot.

Conclusions

Excellent correlation was observed between the MUCCA from 3D-FLAIR and post Gd 3D-T1 brain images. Hence 3D-FLAIR brain images, which are largely used in routine radiological follow-up, may be used to measure the MUCCA, allowing retrospective studies on spinal cord atrophy in addition to prospective ones. Further studies are needed to validate this approach, especially comparing 3D-FLAIR brain images with 3D-T1 spinal cord images.

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