Brigham and Women's Hospital
Neurology

Author Of 1 Presentation

Imaging Poster Presentation

P0555 - Characterization of MRI Activity Following Treatment with Ocrelizumab for Multiple Sclerosis (ID 1543)

Speakers
Presentation Number
P0555
Presentation Topic
Imaging

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.

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