Contributions
Abstract: EP1522
Type: ePoster
Abstract Category: Therapy - disease modifying - Risk management for disease modifying treatments
Background: Natalizumab (Tysabri) is a highly effective therapy approved for treatment of rapidly evolving and severe multiple sclerosis (MS). Its use may be complicated by progressive multifocal leukoencephalopathy (PML), a potentially fatal opportunistic infection caused by the John Cunningham virus (JCV). The relative risk for patients on natalizumab to develop PML depends on four factors: time on treatment, prior exposure to immunosuppressive drugs, seropositivity for anti-JCV antibodies and viral antibody titre.
Aim: To determine whether
(1) seroconversion to JC virus before or after commencement of natalizumab therapy, and
(2) the presence of high (≥1.5) serum anti-JCV antibody titres influence MS patients" decision to start or continue natalizumab.
Methods: An audit of JCV test results and subsequent therapies prescribed to MS patients treated at the Greater Manchester Neurosciences Centre, UK. In this centre, JCV antibody titres were first requested in August 2011 and records auditied up to March 2016. Results for 290 patients were included for analysis.
Results:
(1) Pre-treatment
94/174 results were negative. Of these, 63 patients (68%) started natalizumab, 6 are undecided,
2 remained off treatment and 23 continued on existing therapy or started another medication. Of 44 patients with high positive (≥1.5) titre, 29 (66%) started natalizumab, 14 chose other medications and 1 stayed off treatment. Of 36 patients with low positive titre, 17 (46%) started natalizumab, 2 stayed off treatment,, 2 did not meet treatment criteria and 15 continued existing therapy or started another medication.
(2) On treatment
Mean time on treatment when tested was 2.1 years. 177/290 patients were seronegative and all patients remained on treatment. Of 113 seropositive patients, 4 (3.5%; all with high titres) switched treatment (3 to Fingolimod; 1 to Alemtuzumab) due to perceived risk. The remaining 109 patients (including 52 with high titres) chose to continue natalizumab, including 5 patients who seroconverted while on treatment.
Conclusion: Most patients on natalizumab stayed on treatment regardless of seroconversion or JCV antibody titre, suggesting the perceived benefit of natalizumab on their MS outweighed the potential risk of PML. Fewer patients tested pre-treatment opted for natalizumab, but we found no major difference in uptake between seronegative patients and those with a high antibody titre, suggesting other factors contributed to the decision-making process.
Disclosure:
William Lusher: nothing to disclose
David Rog: nothing to disclose
Paul Talbot: nothing to disclose
Tatiana Mihalova: nothing to disclose
Nazar Sharaf: nothing to disclose
Adrian Pace: nothing to disclose
Abstract: EP1522
Type: ePoster
Abstract Category: Therapy - disease modifying - Risk management for disease modifying treatments
Background: Natalizumab (Tysabri) is a highly effective therapy approved for treatment of rapidly evolving and severe multiple sclerosis (MS). Its use may be complicated by progressive multifocal leukoencephalopathy (PML), a potentially fatal opportunistic infection caused by the John Cunningham virus (JCV). The relative risk for patients on natalizumab to develop PML depends on four factors: time on treatment, prior exposure to immunosuppressive drugs, seropositivity for anti-JCV antibodies and viral antibody titre.
Aim: To determine whether
(1) seroconversion to JC virus before or after commencement of natalizumab therapy, and
(2) the presence of high (≥1.5) serum anti-JCV antibody titres influence MS patients" decision to start or continue natalizumab.
Methods: An audit of JCV test results and subsequent therapies prescribed to MS patients treated at the Greater Manchester Neurosciences Centre, UK. In this centre, JCV antibody titres were first requested in August 2011 and records auditied up to March 2016. Results for 290 patients were included for analysis.
Results:
(1) Pre-treatment
94/174 results were negative. Of these, 63 patients (68%) started natalizumab, 6 are undecided,
2 remained off treatment and 23 continued on existing therapy or started another medication. Of 44 patients with high positive (≥1.5) titre, 29 (66%) started natalizumab, 14 chose other medications and 1 stayed off treatment. Of 36 patients with low positive titre, 17 (46%) started natalizumab, 2 stayed off treatment,, 2 did not meet treatment criteria and 15 continued existing therapy or started another medication.
(2) On treatment
Mean time on treatment when tested was 2.1 years. 177/290 patients were seronegative and all patients remained on treatment. Of 113 seropositive patients, 4 (3.5%; all with high titres) switched treatment (3 to Fingolimod; 1 to Alemtuzumab) due to perceived risk. The remaining 109 patients (including 52 with high titres) chose to continue natalizumab, including 5 patients who seroconverted while on treatment.
Conclusion: Most patients on natalizumab stayed on treatment regardless of seroconversion or JCV antibody titre, suggesting the perceived benefit of natalizumab on their MS outweighed the potential risk of PML. Fewer patients tested pre-treatment opted for natalizumab, but we found no major difference in uptake between seronegative patients and those with a high antibody titre, suggesting other factors contributed to the decision-making process.
Disclosure:
William Lusher: nothing to disclose
David Rog: nothing to disclose
Paul Talbot: nothing to disclose
Tatiana Mihalova: nothing to disclose
Nazar Sharaf: nothing to disclose
Adrian Pace: nothing to disclose