Author Of 3 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
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.
To investigate the prevalence and persistence of the SARS-CoV-2 antibody response in MS and how this relates to MS phenotype and treatment.
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.
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).
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.
P0871 - Efficacy and safety of dimethyl fumarate in progressive multiple sclerosis (ID 1547)
Dimethyl fumarate (DMF) is an FDA approved drug for relapsing forms of multiple sclerosis. Currently, there is limited data analyzing the safety and efficacy of DMF in progressive multiple sclerosis (PMS) population. A combination of immunomodulatory and neuroprotective effects demonstrated with DMF could theoretically benefit this subset of patients.
To analyze the safety and efficacy of dimethyl fumarate in patients diagnosed with progressive forms of multiple sclerosis.
We conducted a single-center retrospective observational analysis of patients with PMS assessing the safety and efficacy of DMF. We used Cox proportional hazards models to compare the time to sustained worsening and improvement on the Expanded Disability Status Scale (EDSS) and timed 25-foot walk (T25FW) between patients treated with DMF and glatiramer acetate (GA) for at least one year. A multivariable analysis adjusting for age, sex, disease duration, and baseline EDSS was also performed.
Eighty-eight patients were included in this study, 46 patients in the DMF group and 42 in the GA group. Safety and tolerability of GA and DMF were consistent with established profiles. There was a non-significant reduction in sustained EDSS and T25FW progression in the DMF group compared to the GA group after adjustment (HR=0.74; 95% CI: 0.32, 1.70; p=0.46 and HR=0.51; 95% CI: 0.21, 1.21; p=0.12, respectively). Sustained EDSS improvement showed a significant difference in the DMF group compared to the GA group (HR=4.23; 95% CI: 1.09, 16.42; p=0.04) after adjustment.
In a well-characterized PMS population, DMF showed a consistent though non-significant reduction of disease progression metrics and a significant increase in proportion of patients experiencing sustained EDSS improvement compared to patients treated with GA. The small sample precluded definitive determination though suggested that further study of DMF in PMS is warranted.
P0918 - Teriflunomide safety and efficacy in advanced progressive multiple sclerosis (ID 1541)
Teriflunomide is an FDA approved medication for relapsing-remitting multiple sclerosis. The efficacy of teriflunomide in progressive multiple sclerosis is not well characterized.
To explore the safety and efficacy profile of teriflunomide in patients diagnosed with progressive multiple sclerosis.
We conducted a single-center retrospective observational analysis of a progressive multiple sclerosis population, assessing safety and efficacy in patients treated at least one year with teriflunomide or glatiramer acetate. Sustained progression of expanded disability status scale (EDSS) and sustained worsening of timed 25-foot walk (T25FW) were compared using a cox proportional hazards model.
Teriflunomide group (n=29) mean characteristics: age=58 years (SD±7.6), disease duration=16.7 years (SD±9.5), EDSS =5.9 (SD±1.3), follow-up=32.4 months (SD±13.6). Glatiramer acetate group (n=30) mean characteristics: age=52.4 years (SD±11.3), disease duration=15.1 years (SD±10.4), EDSS =5.7 (SD±1.6), follow-up=46.9 months (SD±43.9). Both treatments were well tolerated without serious side effects. After adjustment for age, sex, and baseline EDSS, sustained EDSS progression did not differ between groups (Hazard Ratio =1.17; 95% Confidence Interval: 0.45, 3.08; p=0.75). Sustained T25FW worsening after adjustment also did not differ (Hazard Ratio =0.56; 95% Confidence Interval: 0.2, 1.53; p=0.26).
In an advanced progressive multiple sclerosis population no substantial differences in tolerability, safety, sustained EDSS progression, or sustained T25FW worsening over time were observed between glatiramer acetate and teriflunomide treated groups.