Author Of 1 Presentation
P0809 - Extended Interval Dosing Natalizumab and cognitive function in Relapsing-Remitting Multiple Sclerosis patients: A retrospective audit (ID 116)
Abstract
Background
Background: Cognitive impairment and neuropsychiatric symptoms are frequently reported in Relapsing-Remitting Multiple Sclerosis (RRMS). Multiple cognitive domains including processing speed, episodic memory and executive function can be impaired. Depression frequently has a negative impact on cognition and can have profound repercussions on patient’s employment, independence and quality of life. Natalizumab (NTZ) is a humanised monoclonal antibody to α4β1 subunit of VLA4 on leucocytes. It is usually administered on a 4-weekly schedule. However, Extended Interval Dosing (EID) at 6-week intervals has been proven non-inferior regarding relapse risk, with the benefit of a lower risk of Progressive Multifocal Leukoencephalopathy (PML). The impact of EID Natalizumab on neuropsychological deficits in RRMS has not been studied.
Objectives
Objective: To determine whether 6 weekly Natalizumab Extended Interval dosing (NTZ EID) improves in neuropsychological parameters in RRMS patients.
Methods
Method: We performed a monocentric retrospective analysis of 34 RRMS patients treated between August 2015 and August 2017. Patients underwent baseline neuropsychological testing prior to commencing NTZ EID. A second evaluation was performed, on average 28 months after commencing treatment. A screening battery of neuropsychological tests with the Hospital Anxiety and Depression Scale (HADS) was administered at each assessment. Univariate analysis of pre- and post- NTZ Z scores was performed. A Wilcoxon test (p<0.05) and a correlation matrix were applied.
Results
Results: Z scores at the initial assessment showed baseline cognitive impairment in multiple domains in particular; Attention and Abstraction (Trail A and B), Executive functioning (Digit span, Figure copy, Letter fluency and Inhibition, Inhibition Switching) and Short Term Memory (List memory, Story memory, Digit memory, List recall and List recognition). 14/20 Z-scores showed an improvement post-NTZ and 5/14 reached statistical significance; namely Trails A (visual attention/processing speed), Line-orientation (visual-spatial), Picture-naming (word finding), Digital-Span (attention, executive function and memory) and Story-recall (memory). HADS data remained unchanged. Correlation matrix showed no association between HADS scores, the time between assessments and the changes in Z scores.
Conclusions
Conclusion: This data suggests the efficacy of NTX EID in improving cognitive impairment in RRMS. A prospective observational study is recommended.