Contributions
Abstract: P614
Type: Poster Sessions
Abstract Category: Therapy - Risk management for disease modifying treatments
Introduction: Ocrelizumab is a novel humanized CD-20 monoclonal antibody that has been deemed safe and effective for treatment in Multiple Sclerosis. Primary adverse events were comparable to placebo, and less frequent than other non-humanized antibody infusions.
Objectives: We present two patients with unique psychiatric presentations occurring approximately two weeks after the second induction infusion. Both patients had a similar weakness, paranoid and somatic delusions, memory deficits, and delirium and both followed a similar natural time course.
Aims: We aim to describe a novel and ultimately benign clinical phenomenon associated with ocrelizumab infusions in two patients.
Methods: Patients self presented to local emergency departments at the urging of family who noticed an atypical confusion. They were monitored and evaluated for other causes of encephalopathy, and they were seen in follow up in a rehab setting, and then followed clinically by their neurologists. When the atypical nature of their syndrome became present, data was gathered retrospectively from documentation during their hospitalizations and follow up to determine similarities and differences in their clinical course and recovery.
Results: Case 1: 48 year old woman with a 20 year history of treatment for relapsing remitting multiple sclerosis (RRMS), anxiety, hypothyroidism, insomnia, and post-menopausal symptoms. She presented to a regional medical center in January of 2018 for weakness, fatigue, and confusion. She described three weeks of new episodic anterograde memory deficits, paranoia, and somatic delusions of her bones changing. Case 2: 54 year old woman with 6 year history of treatment for RRMS who presented in December of 2017 for falls, weakness, paranoia, anterograde memory loss, and a belief that her teeth were melting. For both patients, symptoms had begun two weeks after receiving her second induction dose of ocrelizumab. Workup was negative and both patients improved to near baseline within 2 months with minimal intervention.
Conclusions: Two separate cases of a unique psychiatric syndrome within six months of regular use of a monoclonal antibody is not enough to suggest causation. However, because patients with neuroinflammation and degeneration may have unique psychiatric reactions to immune modulating infusions, better and more focused analysis of the progression and phenomenology of post infusion syndromes should be monitored and analyzed.
Disclosure: Joshua Claunch M.D.: nothing to disclose
Kate Stanton M.D.: nothing to disclose
Navid Valizadeh MB BCh, MSc, MRCPI: Nothing to disclose
Carolina Ionete M.D.: Does scientific consulting for Genzyme Sanofi and received research support from Biogen, Genentech, and Genzyme
John Sullivan M.D.: nothing to disclose
Abstract: P614
Type: Poster Sessions
Abstract Category: Therapy - Risk management for disease modifying treatments
Introduction: Ocrelizumab is a novel humanized CD-20 monoclonal antibody that has been deemed safe and effective for treatment in Multiple Sclerosis. Primary adverse events were comparable to placebo, and less frequent than other non-humanized antibody infusions.
Objectives: We present two patients with unique psychiatric presentations occurring approximately two weeks after the second induction infusion. Both patients had a similar weakness, paranoid and somatic delusions, memory deficits, and delirium and both followed a similar natural time course.
Aims: We aim to describe a novel and ultimately benign clinical phenomenon associated with ocrelizumab infusions in two patients.
Methods: Patients self presented to local emergency departments at the urging of family who noticed an atypical confusion. They were monitored and evaluated for other causes of encephalopathy, and they were seen in follow up in a rehab setting, and then followed clinically by their neurologists. When the atypical nature of their syndrome became present, data was gathered retrospectively from documentation during their hospitalizations and follow up to determine similarities and differences in their clinical course and recovery.
Results: Case 1: 48 year old woman with a 20 year history of treatment for relapsing remitting multiple sclerosis (RRMS), anxiety, hypothyroidism, insomnia, and post-menopausal symptoms. She presented to a regional medical center in January of 2018 for weakness, fatigue, and confusion. She described three weeks of new episodic anterograde memory deficits, paranoia, and somatic delusions of her bones changing. Case 2: 54 year old woman with 6 year history of treatment for RRMS who presented in December of 2017 for falls, weakness, paranoia, anterograde memory loss, and a belief that her teeth were melting. For both patients, symptoms had begun two weeks after receiving her second induction dose of ocrelizumab. Workup was negative and both patients improved to near baseline within 2 months with minimal intervention.
Conclusions: Two separate cases of a unique psychiatric syndrome within six months of regular use of a monoclonal antibody is not enough to suggest causation. However, because patients with neuroinflammation and degeneration may have unique psychiatric reactions to immune modulating infusions, better and more focused analysis of the progression and phenomenology of post infusion syndromes should be monitored and analyzed.
Disclosure: Joshua Claunch M.D.: nothing to disclose
Kate Stanton M.D.: nothing to disclose
Navid Valizadeh MB BCh, MSc, MRCPI: Nothing to disclose
Carolina Ionete M.D.: Does scientific consulting for Genzyme Sanofi and received research support from Biogen, Genentech, and Genzyme
John Sullivan M.D.: nothing to disclose