Imperial College Healthcare NHS Trust

Author Of 2 Presentations

Disease Modifying Therapies – Risk Management Poster Presentation

LB1167 - Reported Covid19 symptoms in patients on oral Disease Modifying Treatmentss (DMTs) at a single centre (ID 1493)

Presentation Number
LB1167
Presentation Topic
Disease Modifying Therapies – Risk Management

Abstract

Background

There is concern amongst the MS community regarding increased risk of COVID-19 infection in patients on Disease Modifying Therapies (DMTs). Guidance from the Association of British Neurologists (ABN) recommends to continue most oral DMTs during the pandemic.

Objectives

To identify number of patients on oral DMTs in a single centre who reported COVID-19 symptoms. To identify how this compares to national infection rate, whether there was a link to lymphocyte counts prior to infection and how many patients stopped or interrupted treatment.

Methods

Patients on oral DMTs (dimethyl fumarate (DMF), teriflunomide (TF) & fingolimod (FING)) were identified through a local database. The pharmacy team called these patients to advise on DMT monitoringduring the pandemic. Patients were also asked if they had experienced any symptoms of COVID-19 infection, had been tested, or had stopped treatment . Recent lymphocyte counts were obtained.

Results

501 patients on oral DMTs were identified (14 on TF, 169 on FING, 318 on DMF). 50% of these were contacted. (DMF=174, FING=71, TF=10). The average age of those on treatment was 45, average EDSS 2.2, and average time on DMT 3.7 years. Of those asked 90% (229) reported that they had not exprienced COVID-19 symptoms. 10% (26) reported that they had experienced COVID-19 symptoms (3 on TF, 8 on FING, 15 on DMF). According to a recent study by the UK Office of National statistics, of those individuals providing blood samples in the UK, 7% tested positive for antibodies to COVID-19. Of those who reported symptoms the last recorded lymphocyte counts were all within accepted ranges, with a mean of 1.2 (TF 2.0, DMF 1.5, FING 0.4). One patient taking DMF died due to COVID-19. Further data will be presented on the average lymphocyte counts in those who did not report symptoms, number of patients who went on to be tested for COVID-19 and the number who stopped or interrupted treatment.

Conclusions

Results present real world data on COVID-19 infection in patients on oral DMTs for MS and how these relate to lymphocyte count and infections rates in general population.

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Disease Modifying Therapies – Risk Management Poster Presentation

P0318 - Early monitoring of B cells on ocrelizumab may help to identify those at risk of adverse effects (ID 923)

Presentation Number
P0318
Presentation Topic
Disease Modifying Therapies – Risk Management

Abstract

Background

Ocrelizumab (OCR) is a humanized anti-CD20 monoclonal antibody used in the treatment of MS. The drug targets CD20 and acts to reduce circulating B cells. Infection is a known adverse effect of treatment. It is not a requirement of the licence to monitor the effect of OCR on B cells counts and the relationship between B cell count and adverse effects is unknown.

Objectives

We aimed to assess the impact of OCR infusions on B cell counts in our patient group and whether there is a relationship between B cell count & adverse events such as infusion reactions or infections

Methods

Lymphocyte subsets were measured for each patient at baseline and before each subsequent infusion. Patients who had received OCR were identified from hospital records & lymphocyte subset results obtained from pathology reports. Date of infusions were noted and B cell data was correlated to determine average counts before or after each dose. Patient records were examined retrospectively to identify reports of adverse events including infection. These were then related to the degree of B cell suppression.

Results

170 people with MS (pwMS) received infusions of ocrelizumab from Sept 2018 to March 2020. Baseline B cell subsets were collected on 145 of these. The mean count ±SD was 279mm3 ±175 (range 44-1290) . Sampling was performed on average 92±62 days prior to dosing. 136 individual pwMS had sampling performed after the first infusion (194 samples in total). In 101 pwMS, between the first and second infusion, the mean B cell counts were 15mm3 ±32.6 . Samples were performed 171±40 days after the first infusion. In 32 pwMS sampled between second and third infusions, mean cell B counts were 13.9mm3 ±29.6 . Samples were performed 353±63 days after the 2nd infusion. In the naïve subgroup (n=10 vs n=71 not naive) there was a more significant drop in B cells 7.7 vs 18.6 (p=0.038) with treatment. However they did not experience more adverse effects. Adverse effects were seen in 54/83 subjects. 21/54 had infusion related reactions. 43 reported infections including herpes (1), cellulitis (1), gastroenteritis (6), upper (18) or lower respiratory tract (7), urinary tract infections (22) or other infection (8). In those who had adverse effects there was no difference in the B cell counts at baseline. However, those who developed infections had a significant reduction in B cells (infection 6mm3 vs no adverse effects 28mm3, p=0.045). This difference persisted after the second dose (infection 5mm3 vs no adverse effects 27mm3, p=0.19). There was however no difference in the absolute lymphocyte counts (p=0.8) , CD8 or NK cells.

Conclusions

This data suggests that regular monitoring of B cell counts, rather than absolute lymphocyte counts, may be a method of identifying those patients at risk of adverse effects, such as infection, following ocrelizumab.

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