Contributions
Abstract: EP1724
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
Background: Cervical Dysplasia (CD) is linked to the Human Papilloma Virus (HPV). Immunocompromised patients are therefore thought to have an increased risk of CD, and to develop dysplastic changes faster compared to immunocompetent individuals. CD screening is recommended with Alemtuzumab, however there is no data regarding the incidence of CD in Multiple Sclerosis (MS) patients exposed to this treatment.
Goal: To ascertain the incidence of CD in patients receiving Alemtuzumab. Our secondary goal was to assess the role for HPV dna testing in determining patient risk.
Methods: We collected data from all 11 female patients treated with Alemtuzumab at the Alfred from 2014 to present. All patients had a pap test prior to treatment, and 3 out of 11 self funded additional HPV dna testing. Patients with abnormal pap tests or positive high risk HPV dna were referred to gynaecology for ongoing 6 monthly follow up. Patients with normal pre-treatment tests were advised to have ongoing annual testing. All abnormal pap tests were confirmed with colposcopy.
Results: Data was collected over a crude period of 13.25 patient years. 2 patients with normal initial pap tests developed changes (1 with low grade squamous epithelial lesion LSIL, and 1 with high grade squamous epithelial lesion HSIL). These changes were identified at a 6 month follow up interval. Both patients who developed CD changes tested positive for high risk HPV dna.
The crude incidence of HSIL in our Alemtuzumab treated patients with an additional positive high risk HPV tests was 55.5 per 100 patient-years. The population incidence of HSIL with a positive high risk HPV test is 0.25 per 100 patient-years suggesting a significant increased risk for patients who are exposed to Alemtuzumab.
Conclusion: This sample is too small to have meaningful statistical significant but does support concerns that exposure to immunosupressing therapies including Alemtuzumab increases risk of CD.
MS patients are typically young and female who will have long term exposure to immunosupressants. We recommend CD screening become a part of routine clinical care and to consider closer surveillance than the usual population screening protocols.
All patients in this study who tested positive for high risk HPV dna prior to Alemtuzumab treatment developed dysplastic changes on follow up testing. We advocate for additional HPV dna testing to be performed to help identify patients who warrant closer surveillance.
Disclosure:
Dr Skibina and Dr Nesbitt have both previously received sponsorship from Genzyme to attend educational meetings. There was no funding provided for this research project.
Louise Rath has no significant disclosures
Abstract: EP1724
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
Background: Cervical Dysplasia (CD) is linked to the Human Papilloma Virus (HPV). Immunocompromised patients are therefore thought to have an increased risk of CD, and to develop dysplastic changes faster compared to immunocompetent individuals. CD screening is recommended with Alemtuzumab, however there is no data regarding the incidence of CD in Multiple Sclerosis (MS) patients exposed to this treatment.
Goal: To ascertain the incidence of CD in patients receiving Alemtuzumab. Our secondary goal was to assess the role for HPV dna testing in determining patient risk.
Methods: We collected data from all 11 female patients treated with Alemtuzumab at the Alfred from 2014 to present. All patients had a pap test prior to treatment, and 3 out of 11 self funded additional HPV dna testing. Patients with abnormal pap tests or positive high risk HPV dna were referred to gynaecology for ongoing 6 monthly follow up. Patients with normal pre-treatment tests were advised to have ongoing annual testing. All abnormal pap tests were confirmed with colposcopy.
Results: Data was collected over a crude period of 13.25 patient years. 2 patients with normal initial pap tests developed changes (1 with low grade squamous epithelial lesion LSIL, and 1 with high grade squamous epithelial lesion HSIL). These changes were identified at a 6 month follow up interval. Both patients who developed CD changes tested positive for high risk HPV dna.
The crude incidence of HSIL in our Alemtuzumab treated patients with an additional positive high risk HPV tests was 55.5 per 100 patient-years. The population incidence of HSIL with a positive high risk HPV test is 0.25 per 100 patient-years suggesting a significant increased risk for patients who are exposed to Alemtuzumab.
Conclusion: This sample is too small to have meaningful statistical significant but does support concerns that exposure to immunosupressing therapies including Alemtuzumab increases risk of CD.
MS patients are typically young and female who will have long term exposure to immunosupressants. We recommend CD screening become a part of routine clinical care and to consider closer surveillance than the usual population screening protocols.
All patients in this study who tested positive for high risk HPV dna prior to Alemtuzumab treatment developed dysplastic changes on follow up testing. We advocate for additional HPV dna testing to be performed to help identify patients who warrant closer surveillance.
Disclosure:
Dr Skibina and Dr Nesbitt have both previously received sponsorship from Genzyme to attend educational meetings. There was no funding provided for this research project.
Louise Rath has no significant disclosures