Contributions
Abstract: EP1665
Type: ePoster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Background: Alemtuzumab has been shown to be efficacious in trials of early relapsing remitting multiple sclerosis (RRMS) in treatment naïve populations, and in those who have relapsed on injectable drugs. Despite limited clinical trial data, alemtuzumab is often used as a second or third-line agent in patients with longer disease durations and more established disability. A recent case series suggested a high risk of early relapses in patients switching from fingolimod to alemtuzumab.
Objectives: To investigate the frequency and predictors of relapse in RRMS patients switching from fingolimod to alemtuzumab.
Methods: We retrospectively analysed patients switching from fingolimod to alemtuzumab at the National Hospital for Neurology and Neurosurgery, London between 2015- 2017. Patient characteristics (age, sex, duration of RRMS, sequence of prior disease modifying therapies, relapses in the last 2 years, Extended Disability Status Scale (EDSS), and reason for switching treatments) and fingolimod treatment characteristics (duration of treatment, lymphocyte count, and wash out period) were collected.
Results: Fifteen patients were identified (mean age 38.5 (SD 8.75) years, 10 (66.7%) female, Mean EDSS 5.3 (SD 0.98), mean disease duration 10.2 (SD 6.34) years). The annualized relapse rate in the 2 years prior to switching to alemtuzumab was 1.07 (SD 0.59). The mean washout period between fingolimod and alemtuzumab treatment was 138 days. The mean follow-up on treatment with alemtuzumab was 9 months (range 0-18). 4/15 patients (26.7%) had relapses after a mean of 3.75 months after dosing (range 1-6). There was no difference in the annualized relapse rate, disease duration, lymphocyte count while on fingolimod or on starting alemtuzumab, or duration of the wash out period in patients with and without relapses after switching to alemtuzumab. Follow-up of the cohort is ongoing.
Conclusion: In this small case series of patients with active RRMS switching from fingolimod to alemtuzumab, one quarter had a relapse in the first year of treatment. Larger studies are required define risk factors for disease activity after switching from fingolimod to alemtuzumab.
Disclosure:
A Carroll: Nothing to disclose.
A Shields: Nothing to disclose.
WJ Brownlee: Nothing to disclose.
J Chataway has support from the National Institute of Health Research (NIHR) University College London Hospitals Biomedical Research Centres funding scheme and University College London (UCL). In the last 3 years, he has attended advisory boards for Roche, Merck and Apitope. He is local principal investigator for trials in multiple sclerosis funded by Novartis, Biogen, and Receptos.
Abstract: EP1665
Type: ePoster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Background: Alemtuzumab has been shown to be efficacious in trials of early relapsing remitting multiple sclerosis (RRMS) in treatment naïve populations, and in those who have relapsed on injectable drugs. Despite limited clinical trial data, alemtuzumab is often used as a second or third-line agent in patients with longer disease durations and more established disability. A recent case series suggested a high risk of early relapses in patients switching from fingolimod to alemtuzumab.
Objectives: To investigate the frequency and predictors of relapse in RRMS patients switching from fingolimod to alemtuzumab.
Methods: We retrospectively analysed patients switching from fingolimod to alemtuzumab at the National Hospital for Neurology and Neurosurgery, London between 2015- 2017. Patient characteristics (age, sex, duration of RRMS, sequence of prior disease modifying therapies, relapses in the last 2 years, Extended Disability Status Scale (EDSS), and reason for switching treatments) and fingolimod treatment characteristics (duration of treatment, lymphocyte count, and wash out period) were collected.
Results: Fifteen patients were identified (mean age 38.5 (SD 8.75) years, 10 (66.7%) female, Mean EDSS 5.3 (SD 0.98), mean disease duration 10.2 (SD 6.34) years). The annualized relapse rate in the 2 years prior to switching to alemtuzumab was 1.07 (SD 0.59). The mean washout period between fingolimod and alemtuzumab treatment was 138 days. The mean follow-up on treatment with alemtuzumab was 9 months (range 0-18). 4/15 patients (26.7%) had relapses after a mean of 3.75 months after dosing (range 1-6). There was no difference in the annualized relapse rate, disease duration, lymphocyte count while on fingolimod or on starting alemtuzumab, or duration of the wash out period in patients with and without relapses after switching to alemtuzumab. Follow-up of the cohort is ongoing.
Conclusion: In this small case series of patients with active RRMS switching from fingolimod to alemtuzumab, one quarter had a relapse in the first year of treatment. Larger studies are required define risk factors for disease activity after switching from fingolimod to alemtuzumab.
Disclosure:
A Carroll: Nothing to disclose.
A Shields: Nothing to disclose.
WJ Brownlee: Nothing to disclose.
J Chataway has support from the National Institute of Health Research (NIHR) University College London Hospitals Biomedical Research Centres funding scheme and University College London (UCL). In the last 3 years, he has attended advisory boards for Roche, Merck and Apitope. He is local principal investigator for trials in multiple sclerosis funded by Novartis, Biogen, and Receptos.