Author Of 2 Presentations
P0249 - Demyelinating events following initiation of anti-TNFɑ therapy in the British Society for Rheumatology Biologics Registry in Rheumatoid Arthritis (ID 1695)
Abstract
Background
Anti-tumour necrosis factor-ɑ (anti-TNFɑ) monoclonal antibodies are used to treat a number of autoimmune diseases. They have been associated with de novo central nervous system (CNS) demyelination and increased relapse rate in MS. The British Society for Rheumatology Biologics Register in Rheumatoid Arthritis (BSRBR-RA) is a large, prospective pharmacovigilance study which aims to monitor the safety of anti-TNFɑ.
Objectives
To establish the clinical characteristics, timing and incidence of demyelination in patients who have received anti-TNFɑ therapy.
Methods
BSRBR-RA data were used to identify adverse events reported in patients receiving anti-TNFɑ therapies. MedDRA codes and associated verbatim reports were searched for terms related to CNS demyelination. Patients with no reported demyelination prior to BSRBR-RA entry with at least one completed follow-up form were included. Demyelinating events were classified as definite, probable or possible based on available clinical information, with reference to MacDonald 2017 criteria. Crude rates of demyelination were calculated. Exploratory analyses calculated standardised incidence rates (SIRs) compared to the English population (HES/GPRD data; Mackenzie 2014) in the whole cohort and limited to those with definite/probable demyelination.
Results
38 individuals with demyelinating events were identified from a total pool of 12,980. Median age at study entry was 47 years and median disease duration 8 years; 69% were female. Median age at demyelinating event was 51. Events occurred a median of 3 (IQR 1-5) years from start of first anti-TNF therapy; 27 (71%) occurred within 5 years. Kaplan Meir plots indicated a steady event rate. 28 events occurred in individuals still taking anti-TNFɑ therapy; of the other 10, 6 were within 90 days of drug withdrawal. The crude incidence of demyelination was 21.4/100,000 patient years (95%CI 15.1-29.4). SIR in the whole population was 1.50 (95%CI 1.06-2.05) and 0.91 (0.57-1.36) when limited to definite/probable cases. Males showed a higher point estimate than females in both analyses.
Conclusions
Patients receiving biological therapy for the treatment of RA show a marginally increased SIR; this signal is lost when restricting to those with probable or definite demyelination. The BSRBR-RA provides a robust resource for pharmacovigilance. Patients concerned about demyelination associated with anti-TNFɑ can be relatively reassured that new development of demyelination is unlikely.
P0766 - Demographics of multiple sclerosis associated uveitis at Moorfields Eye Hospital (ID 239)
Abstract
Background
Uveitis describes intraocular inflammation of the uveal tract. It may occur in the absence of a predisposing underlying condition, or may be secondary to a systemic autoimmune disease or ocular infection. An association with Multiple Sclerosis (MS) has also been observed.
Objectives
Our aim is to describe the demographics of patients with multiple sclerosis (MS) associated uveitis in a tertiary referral centre in London, UK, in order to add to the literature on the subject and inform discussions with patients with uveitis who may be concerned about developing MS. This is particularly important at present as anti-tumour necrosis factor alpha (anti-TNFα) therapies which are being used to treat refractory uveitis have also been linked to de novo demyelinating events and the exacerbation of demyelinating disease such as MS.
Methods
A retrospective audit was conducted using the online medical records system OpenEyes to identify all potential patients with a diagnosis of both uveitis and multiple sclerosis. Medical notes of all patients were reviewed by two independent researchers for suitability for inclusion. Patients were excluded for the following reasons: no online records, insufficient evidence in documentation to confirm MS or uveitis diagnosis, comorbid disease also linked to uveitis or follow up not under Moorfields. Patients who were included in the audit had had information recorded with respect to gender, ethnicity, type of MS, history of optic neuritis, site of uveitis, laterality of uveitis and age at diagnosis of uveitis and MS.
Results
16,309 patients were seen in the uveitis service between 2010 and 2017. Of these there were 106 patients with both uveitis and multiple sclerosis giving a prevalence of 0.65%. Of these 106 patients, 80 were female (75.5%) and 70 were white (66.0%). 41 of these patients had medical records which included the time at which they were diagnosed with uveitis and the mean length of follow up for these patients was 6.9 years. In this group, the most common type of uveitis associated with MS was intermediate (65.9%) and uveitis was most commonly bilateral (68.3%). MS was diagnosed at a younger average age than uveitis (35.3 vs 41.1 years old) and was diagnosed first in 61.0% of cases.
Conclusions
The 0.65% prevalence of multiple sclerosis in uveitis patients is broadly in keeping with previous estimates and is higher than the population prevalence of multiple sclerosis in the UK which ranges from 0.08 - 0.2%. This supports the association between these two conditions and suggests a common pathological process. Observations relating to the predominance of patients with both uveitis and MS being female, white and having intermediate uveitis may help inform discussions with patients regarding the risk of developing MS. The data from this audit could be used to inform a prospective study in which in-depth phenotypic and genotypic information is recorded for uveitis patients who are studied for the development of MS.
Presenter Of 2 Presentations
P0249 - Demyelinating events following initiation of anti-TNFɑ therapy in the British Society for Rheumatology Biologics Registry in Rheumatoid Arthritis (ID 1695)
Abstract
Background
Anti-tumour necrosis factor-ɑ (anti-TNFɑ) monoclonal antibodies are used to treat a number of autoimmune diseases. They have been associated with de novo central nervous system (CNS) demyelination and increased relapse rate in MS. The British Society for Rheumatology Biologics Register in Rheumatoid Arthritis (BSRBR-RA) is a large, prospective pharmacovigilance study which aims to monitor the safety of anti-TNFɑ.
Objectives
To establish the clinical characteristics, timing and incidence of demyelination in patients who have received anti-TNFɑ therapy.
Methods
BSRBR-RA data were used to identify adverse events reported in patients receiving anti-TNFɑ therapies. MedDRA codes and associated verbatim reports were searched for terms related to CNS demyelination. Patients with no reported demyelination prior to BSRBR-RA entry with at least one completed follow-up form were included. Demyelinating events were classified as definite, probable or possible based on available clinical information, with reference to MacDonald 2017 criteria. Crude rates of demyelination were calculated. Exploratory analyses calculated standardised incidence rates (SIRs) compared to the English population (HES/GPRD data; Mackenzie 2014) in the whole cohort and limited to those with definite/probable demyelination.
Results
38 individuals with demyelinating events were identified from a total pool of 12,980. Median age at study entry was 47 years and median disease duration 8 years; 69% were female. Median age at demyelinating event was 51. Events occurred a median of 3 (IQR 1-5) years from start of first anti-TNF therapy; 27 (71%) occurred within 5 years. Kaplan Meir plots indicated a steady event rate. 28 events occurred in individuals still taking anti-TNFɑ therapy; of the other 10, 6 were within 90 days of drug withdrawal. The crude incidence of demyelination was 21.4/100,000 patient years (95%CI 15.1-29.4). SIR in the whole population was 1.50 (95%CI 1.06-2.05) and 0.91 (0.57-1.36) when limited to definite/probable cases. Males showed a higher point estimate than females in both analyses.
Conclusions
Patients receiving biological therapy for the treatment of RA show a marginally increased SIR; this signal is lost when restricting to those with probable or definite demyelination. The BSRBR-RA provides a robust resource for pharmacovigilance. Patients concerned about demyelination associated with anti-TNFɑ can be relatively reassured that new development of demyelination is unlikely.
P0766 - Demographics of multiple sclerosis associated uveitis at Moorfields Eye Hospital (ID 239)
Abstract
Background
Uveitis describes intraocular inflammation of the uveal tract. It may occur in the absence of a predisposing underlying condition, or may be secondary to a systemic autoimmune disease or ocular infection. An association with Multiple Sclerosis (MS) has also been observed.
Objectives
Our aim is to describe the demographics of patients with multiple sclerosis (MS) associated uveitis in a tertiary referral centre in London, UK, in order to add to the literature on the subject and inform discussions with patients with uveitis who may be concerned about developing MS. This is particularly important at present as anti-tumour necrosis factor alpha (anti-TNFα) therapies which are being used to treat refractory uveitis have also been linked to de novo demyelinating events and the exacerbation of demyelinating disease such as MS.
Methods
A retrospective audit was conducted using the online medical records system OpenEyes to identify all potential patients with a diagnosis of both uveitis and multiple sclerosis. Medical notes of all patients were reviewed by two independent researchers for suitability for inclusion. Patients were excluded for the following reasons: no online records, insufficient evidence in documentation to confirm MS or uveitis diagnosis, comorbid disease also linked to uveitis or follow up not under Moorfields. Patients who were included in the audit had had information recorded with respect to gender, ethnicity, type of MS, history of optic neuritis, site of uveitis, laterality of uveitis and age at diagnosis of uveitis and MS.
Results
16,309 patients were seen in the uveitis service between 2010 and 2017. Of these there were 106 patients with both uveitis and multiple sclerosis giving a prevalence of 0.65%. Of these 106 patients, 80 were female (75.5%) and 70 were white (66.0%). 41 of these patients had medical records which included the time at which they were diagnosed with uveitis and the mean length of follow up for these patients was 6.9 years. In this group, the most common type of uveitis associated with MS was intermediate (65.9%) and uveitis was most commonly bilateral (68.3%). MS was diagnosed at a younger average age than uveitis (35.3 vs 41.1 years old) and was diagnosed first in 61.0% of cases.
Conclusions
The 0.65% prevalence of multiple sclerosis in uveitis patients is broadly in keeping with previous estimates and is higher than the population prevalence of multiple sclerosis in the UK which ranges from 0.08 - 0.2%. This supports the association between these two conditions and suggests a common pathological process. Observations relating to the predominance of patients with both uveitis and MS being female, white and having intermediate uveitis may help inform discussions with patients regarding the risk of developing MS. The data from this audit could be used to inform a prospective study in which in-depth phenotypic and genotypic information is recorded for uveitis patients who are studied for the development of MS.