Author Of 2 Presentations
LB1262 - Low Prevalence of SARS-CoV-2 Antibodies in People with Multiple Sclerosis Residing in Massachusetts (ID 2159)
- E. Klawiter
- J. Smith
- K. Brewer
- K. Stockel
- S. Fischinger
- C. Luedemann
- H. Bien
- A. Russo
- A. Vaeth
- R. Bakshi
- S. Bhattacharyya
- A. Cabot
- I. George
- R. Gillani
- M. Hickey
- M. Houtchens
- T. Bockow Kaplan
- D. Kimbrough
- I. Kister
- F. Mateen
- M. Matiello
- C. Severson
- T. Singhal
- J. Stankiewicz
- L. Stazzone
- H. Weiner
- J. Zurawski
- A. Eloyan
- T. Chitnis
- G. Alter
Abstract
Background
Seroepidemiology is an important tool to characterize the epidemiology and immunobiology of SARS-CoV-2. Most people with multiple sclerosis (MS) are treated with immunomodulators or immunosuppressants, so it is crucial to understand the immune response to the novel SARS-CoV-2 in people with MS.
Objectives
To investigate the prevalence and persistence of the SARS-CoV-2 antibody response in MS and how this relates to MS phenotype and treatment.
Methods
227 consecutive people with MS residing in MA and receiving care at Massachusetts General Hospital or Brigham and Women’s Hospital and 143 of their cohabitants were enrolled May 29-July 23, 2020. In addition, 8 people with MS receiving care elsewhere who tested positive for SARS-CoV-2 nasal swab PCR and 7 cohabitants of that group were enrolled to enrich the sample for select analyses. Each participant remotely submitted a dried blood card for in-house MGH SARS-CoV-2 IgG ELISA assay testing. The assay displays 99.7% sensitivity and 100% specificity >14 days from symptom onset. Participants completed a REDCap questionnaire covering demographics, MS history and treatments, comorbidities, and COVID-19 symptoms and exposure. Antibody prevalence in MS participants will be compared to that in their cohabitants using Pearson’s Chi-squared tests.
Results
The majority of MS participants were characterized as relapsing/remitting (76.8%) and were taking disease modifying therapies (72.6%) at the time of collection. SARS-CoV-2 antibodies were detected in 3.5% of people with MS residing in MA and 6.3% of their cohabitants (X2=1.54, p=0.22). For comparison, ~1.5% of the MA population had tested positive by PCR in this date range. Exposure and treatment data will be presented in 13 cases of antibody discordance between the person with MS and his/her cohabitant; the person with MS was antibody-negative in 10 cases and antibody-positive in 3 cases with discordance. In total there were 6 MS participants and no cohabitants who previously tested positive by nasal swab PCR but lacked antibodies at follow-up. Of the COVID-positive participants (by PCR or antibody), 54.5% (6 of 11) of MS and 88.9% (8 of 9) of cohabitants were asymptomatic (p=0.16).
Conclusions
Antibody prevalence was low overall in people with MS residing in MA. Discordance between MS participants and their cohabitants and lack of detectable antibodies in some people with MS with prior nasal swab PCR positivity suggest SARS-CoV-2 antibodies may be less persistent in people with MS.
P0555 - Characterization of MRI Activity Following Treatment with Ocrelizumab for Multiple Sclerosis (ID 1543)
Abstract
Background
Ocrelizumab (OCR) is a CD20 directed cytolytic monoclonal antibody approved for treatment of relapsing and primary progressive forms of multiple sclerosis (MS). In clinical trials, 5% or fewer developed new MRI gadolinium (Gd)-enhancing lesions on OCR.
Objectives
To characterize frequency and types of radiological relapses on MRI during treatment with OCR in a “real world” study.
Methods
A single center, retrospective review of routine MRI in patients with MS treated with OCR in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB) cohort. A patient was considered to have MRI activity if any of the following were present in brain or spinal cord MRI obtained after initiation of OCR: (1) Gd enhancement (2) new restricted diffusivity of a lesion, or (3) a new or enlarging T2 lesion in comparison to a baseline MRI acquired at the start or following start of OCR.
Results
There were 383 patients treated with OCR [68% female, mean age 48.4 (SD 12.3) years, mean disease duration 15 (SD 10.9) years, median EDSS 2.5 (range 0-8) of whom 68% had relapsing-remitting (RRMS), 21% secondary progressive (SPMS), and 11% primary progressive (PPMS) disease. The last MRI was obtained 14.2 (SD 7.3) months after starting OCR with total of 458 patient-years of imaging follow-up. Of the 383 patients, 333 (87%) did not have evidence of MRI activity, 26 (6.7%) had new/enlarging T2 lesions but no new baseline scan at the start of OCR. In total, there were 25 MRI relapses identified in 24 (6.2%) patients [23 new Gd enhancing, 1 new restricted diffusion, 1 new T2 lesion]. Patients with MRI activity were 63% female with mean age of 41.4 (SD 11.3) years, median EDSS of 3 of whom 79% had RRMS and 21% had SPMS. Radiological relapses were present in scans acquired median of 8 months (range 0-21 months) after starting OCR. There were two distinct patterns of radiological relapses. The first was new lesion formation, present in 11 MRI scans (8 brain, 3 spinal cord) obtained median of 5 months after OCR start. The second pattern was gadolinium enhancement or new restricted diffusion of an old lesion present in a scan prior to start of OCR. This pattern occurred in 14 MRI scans (6 brain, 8 spinal cord) acquired a median of 9 months after OCR start. One patient with recurrent enhancement pattern had a brain biopsy showing active demyelination.
Conclusions
Radiological relapse is infrequent in OCR but can occur early or late. The more common pattern of radiological relapse was recurrent activity at an old lesion site with predominance in the spinal cord.
Presenter Of 1 Presentation
P0555 - Characterization of MRI Activity Following Treatment with Ocrelizumab for Multiple Sclerosis (ID 1543)
Abstract
Background
Ocrelizumab (OCR) is a CD20 directed cytolytic monoclonal antibody approved for treatment of relapsing and primary progressive forms of multiple sclerosis (MS). In clinical trials, 5% or fewer developed new MRI gadolinium (Gd)-enhancing lesions on OCR.
Objectives
To characterize frequency and types of radiological relapses on MRI during treatment with OCR in a “real world” study.
Methods
A single center, retrospective review of routine MRI in patients with MS treated with OCR in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB) cohort. A patient was considered to have MRI activity if any of the following were present in brain or spinal cord MRI obtained after initiation of OCR: (1) Gd enhancement (2) new restricted diffusivity of a lesion, or (3) a new or enlarging T2 lesion in comparison to a baseline MRI acquired at the start or following start of OCR.
Results
There were 383 patients treated with OCR [68% female, mean age 48.4 (SD 12.3) years, mean disease duration 15 (SD 10.9) years, median EDSS 2.5 (range 0-8) of whom 68% had relapsing-remitting (RRMS), 21% secondary progressive (SPMS), and 11% primary progressive (PPMS) disease. The last MRI was obtained 14.2 (SD 7.3) months after starting OCR with total of 458 patient-years of imaging follow-up. Of the 383 patients, 333 (87%) did not have evidence of MRI activity, 26 (6.7%) had new/enlarging T2 lesions but no new baseline scan at the start of OCR. In total, there were 25 MRI relapses identified in 24 (6.2%) patients [23 new Gd enhancing, 1 new restricted diffusion, 1 new T2 lesion]. Patients with MRI activity were 63% female with mean age of 41.4 (SD 11.3) years, median EDSS of 3 of whom 79% had RRMS and 21% had SPMS. Radiological relapses were present in scans acquired median of 8 months (range 0-21 months) after starting OCR. There were two distinct patterns of radiological relapses. The first was new lesion formation, present in 11 MRI scans (8 brain, 3 spinal cord) obtained median of 5 months after OCR start. The second pattern was gadolinium enhancement or new restricted diffusion of an old lesion present in a scan prior to start of OCR. This pattern occurred in 14 MRI scans (6 brain, 8 spinal cord) acquired a median of 9 months after OCR start. One patient with recurrent enhancement pattern had a brain biopsy showing active demyelination.
Conclusions
Radiological relapse is infrequent in OCR but can occur early or late. The more common pattern of radiological relapse was recurrent activity at an old lesion site with predominance in the spinal cord.