Contributions
Abstract: 173
Type: Oral
Abstract Category: Pathology and pathogenesis of MS - MS and infections
Background: Progressive Multifocal Leukoencephalopathy (PML) is an uncommon side effect caused by the JC virus, emerging in natalizumab treated multiple sclerosis (NTZ-MS) patients. Immune restoration at NTZ withdrawal often causes an Immune Reconstitution Inflammatory Syndrome (IRIS), which causes additional damage of the nervous tissues.
Goals: To evaluate the impact of Plasma Exchange (PLEX) and use of steroids on the PML and PML-IRIS course.
Methods: Clinical and MRI data of 40 patients who developed PML were retrospectively collected from 28 Italian sites. The data were centrally reviewed and established IRIS according with definite criteria was identified in each patient by two neuroradiologists and two neurologists. Patients" clinical course (measured with longitudinal EDSS score at NTZ beginning, i.e. baseline, PML onset, month 2, month 6 and month 12 follow ups) was analyzed in the context of PLEX and steroids administration.
Results: The survival rate was 92.5%. The number of viral copies in the CSF is highly correlated with the Δ EDSS from PML onset to month 6 follow up (r=0.50, p=0.002). Twenty-nine out of 40 patients (72.5%) manifested IRIS. Patients were divided in two groups basing on whether or not they were submitted to PLEX (PLEX+ and PLEX-, respectively). Their EDSS at baseline did not differ (t=0.28, p=0.77); no difference was found between the groups for the EDSS (mixed ANOVA Group x Time - non significant Group x Time interaction, p=0.23). However, PLEX speeds up IRIS (t=-2.19, p=0.03) and increases its duration (t=1.8, p=0.08). Subsequently, patients were divided in two groups basing on whether the steroids were administered prior (NoIrSt) or during (IrSt) the established IRIS. A mixed ANOVA Group x Time (using PLEX and lesion size as covariates) revealed a Group x Time interaction (F[3,81]=2.77, p=0.04). Post hoc test revealed that NoIrSt EDSS scores worsened in the first months after diagnosis (p=0.002) and remained stable at 1 year follow up (p=0.003), while the IrSt EDSS score did not significantly changed over time (p>0.16). The use of steroids did not impact neither on the time elapsed between NTZ withdrawal and IRIS onset (t=-0.109, p=0.91), nor on IRIS duration (t=-0.640, p=0.52).
Conclusions: In this cohort, PLEX did not improve the clinical outcome and Steroids administered out of the IRIS onset are associated to a negative disability progression.
Disclosure:
Dr. De Rossi received speaker honoraria from Biogen and Teva and travel grants from Biogen, Teva and Merk Serono.
Dr. Cordioli received consulting fees from Novartis and Merk Serono.
Dr. Gerevini received speaker honoraria from Biogen-Idec.
Dr. Capra received consulting fees from Novartis, Biogen-Idec and lecture fees and/or travel grants from Novartis, Biogen-Idec, Genzyme and Sanofi-Aventis.
Dr. Scarpazza has nothing to disclose.
Abstract: 173
Type: Oral
Abstract Category: Pathology and pathogenesis of MS - MS and infections
Background: Progressive Multifocal Leukoencephalopathy (PML) is an uncommon side effect caused by the JC virus, emerging in natalizumab treated multiple sclerosis (NTZ-MS) patients. Immune restoration at NTZ withdrawal often causes an Immune Reconstitution Inflammatory Syndrome (IRIS), which causes additional damage of the nervous tissues.
Goals: To evaluate the impact of Plasma Exchange (PLEX) and use of steroids on the PML and PML-IRIS course.
Methods: Clinical and MRI data of 40 patients who developed PML were retrospectively collected from 28 Italian sites. The data were centrally reviewed and established IRIS according with definite criteria was identified in each patient by two neuroradiologists and two neurologists. Patients" clinical course (measured with longitudinal EDSS score at NTZ beginning, i.e. baseline, PML onset, month 2, month 6 and month 12 follow ups) was analyzed in the context of PLEX and steroids administration.
Results: The survival rate was 92.5%. The number of viral copies in the CSF is highly correlated with the Δ EDSS from PML onset to month 6 follow up (r=0.50, p=0.002). Twenty-nine out of 40 patients (72.5%) manifested IRIS. Patients were divided in two groups basing on whether or not they were submitted to PLEX (PLEX+ and PLEX-, respectively). Their EDSS at baseline did not differ (t=0.28, p=0.77); no difference was found between the groups for the EDSS (mixed ANOVA Group x Time - non significant Group x Time interaction, p=0.23). However, PLEX speeds up IRIS (t=-2.19, p=0.03) and increases its duration (t=1.8, p=0.08). Subsequently, patients were divided in two groups basing on whether the steroids were administered prior (NoIrSt) or during (IrSt) the established IRIS. A mixed ANOVA Group x Time (using PLEX and lesion size as covariates) revealed a Group x Time interaction (F[3,81]=2.77, p=0.04). Post hoc test revealed that NoIrSt EDSS scores worsened in the first months after diagnosis (p=0.002) and remained stable at 1 year follow up (p=0.003), while the IrSt EDSS score did not significantly changed over time (p>0.16). The use of steroids did not impact neither on the time elapsed between NTZ withdrawal and IRIS onset (t=-0.109, p=0.91), nor on IRIS duration (t=-0.640, p=0.52).
Conclusions: In this cohort, PLEX did not improve the clinical outcome and Steroids administered out of the IRIS onset are associated to a negative disability progression.
Disclosure:
Dr. De Rossi received speaker honoraria from Biogen and Teva and travel grants from Biogen, Teva and Merk Serono.
Dr. Cordioli received consulting fees from Novartis and Merk Serono.
Dr. Gerevini received speaker honoraria from Biogen-Idec.
Dr. Capra received consulting fees from Novartis, Biogen-Idec and lecture fees and/or travel grants from Novartis, Biogen-Idec, Genzyme and Sanofi-Aventis.
Dr. Scarpazza has nothing to disclose.