Author Of 2 Presentations
LB1243 - Disease modifying treatment changes in pediatric onset multiple sclerosis patients over the past 10 years. A single center retrospective study. (ID 2129)
Abstract
Background
Disease modifying treatments (DMT) in multiple sclerosis (MS) have evolved significantly over the past decade. The expansion of treatment choices provides more options to patients and providers with regards to delivery methods and relapse rate control, however, this also poses new challenges secondary to their side effect profiles. The debate is ongoing in subject to induction versus escalation therapy. The prior proposes initiation of treatments with lower efficacy (lower risk profile) then switching to higher efficacy as needed, whereas the latter recommends immediate higher efficacy treatment. The guidelines to this subject are even less clear in pediatric onset multiple sclerosis patients (POMS).
Objectives
To examine trends of DMT use in POMS patients at a tertiary care center (Baylor College of Medicine/Texas Children’s Hospital) over the past ten years.
Methods
Retrospective chart review via SlicerDicer software was performed looking for POMS patients. Of the initial 239 patients, 124 patients met the following inclusion criteria: diagnosis of MS <18 years of age, ages 0-21 and use of DMT. Data collected: demographics, DMTs used, magnetic resonance imaging findings, expanded disability score status and clinical relapses. Disease progression was defined as the development of new lesions on MRI or a clinical relapse. DMT: injectables-glatiramer acetate, interferons; per os (PO)-fingolimod, dimethyl fumarate, teriflunomide; infusion-rituximab, natalizumab, ocrelizumab.
Results
Of the 124 POMS patients, 41.1% were male and 58.8% were female, with mean age of diagnosis at 15 years (standard deviation +/- 3). 60 patients (48.4%) transitioned DMT during follow up, while 64 (51.6%) remained on their initial medication. Of those who transitioned DMT, 17 switched more than once (totaling 85 switches). 45 switches were due to disease progression (52.9%), whilst 40 were due to side effects and/or noncompliance (47.1%). Of the patients switching DMT due to disease progression, 60% were on injectables, 37.8% on PO and 2.2% on infusions. For those who never switched DMT, 39.7% were on injectables, 33.3% on infusions, and 27% were on PO. 95.45% of patients started on infusions never switched, however 54.84% on PO and 35.71% on injectables switched their DMT. In 2011, 20 patients were on injectables, 14 on PO and 2 on infusions. Whereas in 2020, only 6 patients were on injectables, 8 on PO and 29 on infusions, demonstrating an upward trend in use of infusions. Annual relapse rate (AAR) between 2011-2020 regardless of DMT was 0.13 with a median of 0. The AAR for injectables, orals and infusions were 0.13, 0.17 and 0.026, respectively.
Conclusions
At this tertiary care institution, nearly half of patients with POMS have changed DMT either due to disease progression or side effects. Those on infusion therapies were seen to be more likely to remain on their treatment, have lower ARR and less disease progression compared to other treatment options.
P1076 - Effect of Rituximab on Immunoglobulin levels in Pediatric Multiple Sclerosis Patients (ID 911)
Abstract
Background
The efficacy of Rituximab as an off-label treatment for pediatric multiple sclerosis (MS) has been well-documented. The effects of Rituximab on immunoglobulin (Ig) levels have been documented in adult multiple sclerosis patients, but not in pediatric multiple sclerosis patients.
Objectives
In this study, we analyzed the relationship between pediatric Rituximab use for multiple sclerosis and Ig levels and the efficacy of interventions to manage Rituximab induced hypogammaglobulinemia.
Methods
In a retrospective chart review, we searched for pediatric multiple sclerosis patients who 1) used Rituximab as the sole disease modifying agent for MS 2) used Rituximab to only manage MS 3) had IgA, IgM and IgG measurements and 4) were <22 years old at dosing and Ig measurements.
Results
Thirty-four patients, 14 males and 20 females with a mean age of 16 years at time of initiation of Rituximab, had Ig measurements taken at least 40 days post Rituximab initiation. These Ig measurements were compared to baseline levels obtained from thirteen patients who had Ig levels within 40 days of the initial Rituximab dose, meeting baseline criteria. Rituximab dosing was 1000 mg per dose every 6.10 months on average. The average follow-up time between Ig measurements was 6.33 months. Of the 34 patients, 17 had Ig levels were within normal reference range after an average of 13.04 months of treatment. 17 patients had Ig levels below reference range after an average of 19.03 months of treatment. Patients with normal Ig values were on Rituximab therapy started on average at 16.35 years old, while patients with low Ig values started on average at 15.65 years old. All 17 had low IgM, 11 had only low IgM, 4 had low IgM and IgG, and 2 low IgM and IgA. 8 patients with low Ig levels did not receive an intervention, 5 had dose reduction to 750 mg, and 2 were subsequently reduced to 500 mg. The average follow-up Ig measurements in patients that had abnormal Ig measurements was every 5.26 months. The average time to initiate a lower Rituximab dose was 12.30 months. 2 of 5 patients who received a lower dose following a low Ig measurement had subsequent Ig measurements, and neither returned to reference range Ig levels.
Conclusions
In pediatric MS patients treated with Rituximab, 50% had low Ig levels. Neither of the 2 patients who were treated with lowered Rituximab dosing for low Ig and had follow-up Ig measurements returned to reference range Ig levels.