Contributions
Abstract: EP1743
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
Introduction: These are the principal reasons for lumbar puncture (LP) in people with MS (pwMS) on NTL. Early on, progressive multifocal leukoencephalopathy (PML) can be difficult to distinguish from a MS based on symptoms and imaging but prompt diagnosis improves clinical outcome. In addition changing therapy from NTL to a treatment where prolonged immunosuppression is expected increasingly drives a need to exclude PML. We studied the reasons for, results from and outcome after LP in those on NTL in our cohort.
Methods: We collected clinical and MRI data, serum anti-JC Virus antibody (JCVab) titres and CSF results for pwMS who had LP's performed on NTL.
Results: 58 pwMS (64% female) were identified (mean: age 40.95±9.55, MS duration 3.91±2.24, anti-JCVab titre 2.05±1.41). Compared to the total cohort of pwMS on NTL the only difference was in the mean anti-JCVab titre (p< 0.0001). Of the three indications for LP worsening symptoms was the reason in 20 (new lesions: 2, PML: 2), medication change in 29 (new lesions: 6, PML: 0) and new lesions in 9 (PML: 0). The total number of patients with new lesions was 17 (29.3%), comparable to the total cohort (p=0.13). Worsening symptoms had a positive predictive value (PPV) for developing PML of 10% (95% confidence interval (CI) 7.06%-13.98%); new lesions PPV of PML of 5.88% (95%CI 1.45%-20.98%) and changing medication PPV of PML of 0%. Analysis of the LP results found that there was an increase in white cell counts in JCV-DNA positive cases versus JCV-DNA negative cases (p=0.002). After LP, 13 remained on NTL, 30 changed medication and 13 stopped all treatment. Two pwMS developed PML and both survived.
Discussion: Though the emphasis on monitoring focuses on the specificity of new lesions in the diagnosis of PML in this cohort new lesions were a common finding on NTL but did not in isolation have a high PPV for PML. The most important feature was new symptoms.
Disclosure:
Abbas Alidina: nothing to disclose
Joel Raffel: nothing to disclose
Richard Nicholas: Sanofi-Genzyme, Biogen Idec honorarium for speaking, advisory boards, Roche - advisory boards, CASTINGS committee member
Abstract: EP1743
Type: ePoster
Abstract Category: Therapy - disease modifying - 29 Risk management for disease modifying treatments
Introduction: These are the principal reasons for lumbar puncture (LP) in people with MS (pwMS) on NTL. Early on, progressive multifocal leukoencephalopathy (PML) can be difficult to distinguish from a MS based on symptoms and imaging but prompt diagnosis improves clinical outcome. In addition changing therapy from NTL to a treatment where prolonged immunosuppression is expected increasingly drives a need to exclude PML. We studied the reasons for, results from and outcome after LP in those on NTL in our cohort.
Methods: We collected clinical and MRI data, serum anti-JC Virus antibody (JCVab) titres and CSF results for pwMS who had LP's performed on NTL.
Results: 58 pwMS (64% female) were identified (mean: age 40.95±9.55, MS duration 3.91±2.24, anti-JCVab titre 2.05±1.41). Compared to the total cohort of pwMS on NTL the only difference was in the mean anti-JCVab titre (p< 0.0001). Of the three indications for LP worsening symptoms was the reason in 20 (new lesions: 2, PML: 2), medication change in 29 (new lesions: 6, PML: 0) and new lesions in 9 (PML: 0). The total number of patients with new lesions was 17 (29.3%), comparable to the total cohort (p=0.13). Worsening symptoms had a positive predictive value (PPV) for developing PML of 10% (95% confidence interval (CI) 7.06%-13.98%); new lesions PPV of PML of 5.88% (95%CI 1.45%-20.98%) and changing medication PPV of PML of 0%. Analysis of the LP results found that there was an increase in white cell counts in JCV-DNA positive cases versus JCV-DNA negative cases (p=0.002). After LP, 13 remained on NTL, 30 changed medication and 13 stopped all treatment. Two pwMS developed PML and both survived.
Discussion: Though the emphasis on monitoring focuses on the specificity of new lesions in the diagnosis of PML in this cohort new lesions were a common finding on NTL but did not in isolation have a high PPV for PML. The most important feature was new symptoms.
Disclosure:
Abbas Alidina: nothing to disclose
Joel Raffel: nothing to disclose
Richard Nicholas: Sanofi-Genzyme, Biogen Idec honorarium for speaking, advisory boards, Roche - advisory boards, CASTINGS committee member