Author Of 2 Presentations
P0446 - Comorbid Anxiety, Depression, and Fatigue Symptoms by Disease Modifying Therapy: A National Multiple Sclerosis Cohort (ID 396)
Abstract
Background
Psychiatric comorbidities are common in multiple sclerosis (MS) and are associated with diminished quality of life and non-adherence to disease-modifying therapy (DMT). Depression is linked to immune activation in inflammatory disorders. We hypothesized that persons with self-reported MS not receiving DMT and those on lower efficacy DMT (low [LED] and moderate [MED]) had more symptoms of anxiety, depression, and fatigue, as compared to those on DMT and on high efficacy DMT (HED).
Objectives
Our team sought to determine if symptoms of depression, anxiety, and fatigue in MS correlate with the use and efficacy of DMT.
Methods
We developed a web-based survey including the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, and the Modified Fatigue Impact Scale 5-item version (MFIS-5). Invitations to complete the survey were distributed electronically by MS organizations. DMTs were classified in LED (interferon beta-1a, interferon beta-1b, peginterferon beta-1a, glatiramer acetate), MED (teriflunomide, fingolimod, siponimod, dimethyl fumarate), and HED (alemtuzumab, ocrelizumab, rituximab, natalizumab, cladribine). Analyses were conducted using linear models adjusted for age, sex, ethnicity, disease duration, employment status, and whether the individual has an MS provider.
Results
2121 persons completed the survey (age 51.1±12.4 years, 18% male, and 52% have had MS for >10 years). 1650 were on DMT (465 LED, 546 MED, 624 HED, 15 other). MFIS-5 and GAD-7 scores were lower for those on DMT as compared to those not on DMT (for MFIS-5: 0.79 points lower, 95% CI -1.37, -0.21; p=0.007; for GAD-7: 0.68 points lower; 95% CI -1.29, -0.07, p=0.03). Those on LED had -1.18 (95% CI -1.97, -0.38; p=0.004) lower PHQ-9 scores compared to those on no DMT. Among individuals on a DMT, those on HED had higher MFIS-5 and PHQ-9 scores relative to those on LED (for MFIS-5: 1.78 points higher, 95% CI 1.13, 2.24, p<0.001; for PHQ-9: 1.00 points higher; 95% CI 0.25, 1.74, p=0.009).
Conclusions
In this cross-sectional study, untreated patients had more fatigue and anxiety than those on DMT and greater depression than those on LED. LED-treated patients had lower fatigue and depression scores compared to those on HED. Indication biases may have influenced our results; longitudinal studies taking into account prior DMT history and indicators for specific DMTs should evaluate whether certain DMT classes affect future depression, anxiety, or fatigue levels.
P1082 - Therapeutic Response in Pediatric Neuromyelitis Optics Spectrum Disorder (ID 1820)
Abstract
Background
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune condition which can led to significant disability. Approximately 4% of the NMOSD cases are pediatric onset. At present, there are limited studies that aim at guiding physicians in their treatment choices for NMOSD in children.
Objectives
To evaluate the effect of different disease modifying therapies (DMT) with respect to attack prevention in children with NMOSD.
Methods
Cohort study that included 12 clinical centers participating in the US Network of Pediatric MS Centers. Cases were validated for NMOSD diagnostic criteria and classified via serostatus as AQP4+, MOG+, or double-seronegative (DS). Clinical data, including demographics, attack details, type of initial DMT (rituximab, mycophenolate mofetil, azathioprine, IVIg) and neurological visit data were extracted from charts, centrally collected in a database, and analyzed. Treatment response in the three serostatus subgroups was evaluated. Effect of DMTs on annualized relapse rate (ARR) was assessed by negative binomial regression.
Results
111 pediatric patients with NMOSD were identified: 80 AQP4+, 10 MOG+, 14 double seronegative (DS), and 7 with unknown serostatus (94 females and 17 males; 48 white, 47 African American, 13 other races). Mean follow-up duration was 1.9 years (SD±2.2). About 6% of patients were treatment-naive. First-line DMTs varied by serostatus: in the AQP4+ subgroup 42% used rituximab, 16% mycophenolate mofetil, 16% azathioprine, and 8% IVIg. Among MOG+ patients, 13% received rituximab, 13% azathioprine, 13% mycophenolate, and 38% IVIg. Within the DS group, rituximab was used in 21% of cases, azathioprine in 7%, mycophenolate in 21%, and IVIg in 21%. In the unknown serogroup, 33% received rituximab, 17% azathioprine, 0% mycophenolate, and 33% IVIg. The ARR calculated in all the serogroups was 0.25 (95% CI 0.13-0.46) for rituximab, 0.73 (95% CI 0.27-2.00) for azathioprine, 0.40 (95% CI 0.18-0.89) for mycophenolate, and 0.56 (95% CI 0.26-1.20) for IVIg. In the AQP4+ subgroup, the patients started on rituximab showed an ARR of 0.25 (95% CI 0.13-0.48), those on azathioprine an ARR of 0.76 (95% CI 0.24-2.39), those on mycophenolate an ARR 0.43 (95% CI 0.17-1.07), and those on IVIg an ARR of 0.63 (95% CI 0.26-1.55).
Conclusions
This retrospective study showed that rituximab is associated with a lowered annual relapse rate in pediatric NMOSD and in particular in the AQP4+ subgroup.
Presenter Of 1 Presentation
P1082 - Therapeutic Response in Pediatric Neuromyelitis Optics Spectrum Disorder (ID 1820)
Abstract
Background
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune condition which can led to significant disability. Approximately 4% of the NMOSD cases are pediatric onset. At present, there are limited studies that aim at guiding physicians in their treatment choices for NMOSD in children.
Objectives
To evaluate the effect of different disease modifying therapies (DMT) with respect to attack prevention in children with NMOSD.
Methods
Cohort study that included 12 clinical centers participating in the US Network of Pediatric MS Centers. Cases were validated for NMOSD diagnostic criteria and classified via serostatus as AQP4+, MOG+, or double-seronegative (DS). Clinical data, including demographics, attack details, type of initial DMT (rituximab, mycophenolate mofetil, azathioprine, IVIg) and neurological visit data were extracted from charts, centrally collected in a database, and analyzed. Treatment response in the three serostatus subgroups was evaluated. Effect of DMTs on annualized relapse rate (ARR) was assessed by negative binomial regression.
Results
111 pediatric patients with NMOSD were identified: 80 AQP4+, 10 MOG+, 14 double seronegative (DS), and 7 with unknown serostatus (94 females and 17 males; 48 white, 47 African American, 13 other races). Mean follow-up duration was 1.9 years (SD±2.2). About 6% of patients were treatment-naive. First-line DMTs varied by serostatus: in the AQP4+ subgroup 42% used rituximab, 16% mycophenolate mofetil, 16% azathioprine, and 8% IVIg. Among MOG+ patients, 13% received rituximab, 13% azathioprine, 13% mycophenolate, and 38% IVIg. Within the DS group, rituximab was used in 21% of cases, azathioprine in 7%, mycophenolate in 21%, and IVIg in 21%. In the unknown serogroup, 33% received rituximab, 17% azathioprine, 0% mycophenolate, and 33% IVIg. The ARR calculated in all the serogroups was 0.25 (95% CI 0.13-0.46) for rituximab, 0.73 (95% CI 0.27-2.00) for azathioprine, 0.40 (95% CI 0.18-0.89) for mycophenolate, and 0.56 (95% CI 0.26-1.20) for IVIg. In the AQP4+ subgroup, the patients started on rituximab showed an ARR of 0.25 (95% CI 0.13-0.48), those on azathioprine an ARR of 0.76 (95% CI 0.24-2.39), those on mycophenolate an ARR 0.43 (95% CI 0.17-1.07), and those on IVIg an ARR of 0.63 (95% CI 0.26-1.55).
Conclusions
This retrospective study showed that rituximab is associated with a lowered annual relapse rate in pediatric NMOSD and in particular in the AQP4+ subgroup.