| Autor: |
Gill, Alexander J., Quinn, Carson, Rajarajan, Prashanth, Kopinsky, Hannah, Wolf, Andrew, Bennett, Jeffrey L., de Camargo, Celeste Soares, Murray, Joseph, Conway, Sarah, Alvarez, Enrique, Coyle, Patricia K., Galetta, Kristin, Bhise, Vikram, Kantor, Daniel, Probasco, John, Bhattacharyya, Shamik, Kister, Ilya |
| Předmět: |
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| Zdroj: |
International Journal of MS Care; 2024 Supplement, Vol. 26, p5-6, 2p |
| Abstrakt: |
BACKGROUND: Immune checkpoint inhibitors (ICIs) are associated with immune-related adverse events (irAEs) including several well-described central nervous system (CNS) complications and exacerbation of preexisting autoimmune diseases. There are case reports of ICIs triggering relapses in people with MS (PwMS). The incidence of ICI-associated demyelination in PwMS and other CNS demyelinating disorders (PwMS+) is unknown. OBJECTIVES: To determine rate of relapses/MRI activity, and neurologic and oncologic outcomes in PwMS+ after exposure to ICIs. METHODS: PwMS+ exposed to ICIs were identified by retrospective chart review at 7 tertiary medical systems. Participating sites were recruited through the Medical Partnership 4 MS+ (MP4MS+) network, a group of 1300 health professionals dedicated to the treatment and management of PwMS+. Using a structured instrument, data on MS+ clinical, radiologic, and treatment history, cancer history, ICI-treatments, and neurologic and oncologic outcomes were collected. RESULTS: In this interim analysis of the largest reported series, we identified 58 patients (74% female, median age 65 years) with MS (51 relapsing-remitting, 4 secondary progressive, and 3 primary progressive) and 2 with neuromyelitis optica spectrum disorder (NMOSD) who were exposed to ICIs. The median time from last relapse in PwMS prior to ICI initiation was 8.5 years. Nineteen (33%) PwMS were on disease-modifying therapy (DMT) immediately prior to ICI initiation, 9 of whom continued DMT during ICI therapy. The most frequent ICI exposure was pembrolizumab (62%). The most common primary tumors were lung (19, 32%) and melanoma (13, 22%). During a mean of 9 cycles of ICI therapy, 2 PwMS (3.4%) were diagnosed with new CNS inflammatory activity: 1 PwMS on interferon-beta-1a had 2 new asymptomatic supratentorial demyelinating lesions on MRI 3 months after ICI initiation, and a second PwMS on glatiramer acetate had 2 new brain lesions with worsening gait 4 months after ICI initiation, but with return to neurologic baseline after steroids. One of the 2 NMOSD patients had new disease activity on ICI despite being relapse-free on inebilizumab for 6 years. Ten days after the first dose of pembrolizumab, the patient developed an enhancing longitudinally extensive cervical cord lesion resulting in significant persistent disability. Three PwMS+ (5%) had peripheral nervous system irAEs, 1 (1.7%) had a non-demyelinating CNS irAE, and 15 (25%) had nonneurologic ICI-irAEs. Twenty-one (35%) had partial or complete remission of their cancer at last follow-up. CONCLUSIONS: In this series of PwMS who were predominantly older and not on a DMT, MS relapses following ICI treatment were rare and of mild severity. In contrast, 1 of 2 patients with NMOSD experienced a severe ICI-associated relapse on inebilizumab, suggesting ICIs may be able to trigger NMOSD disease activity in the setting of B-cell depleting therapy. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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