Abstract Details

Title Efficacy of Short Washout Periods After Switching from Natalizumab to an Alternative DMT.

Topic Multiple Sclerosis

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-070

Objective To determine the efficacy of short washout times when switching from natalizumab to other DMTs.

Background Using natalizumab to treat multiple sclerosis (MS) is limited by risk of progressive multifocal leukoencephalopathy (PML), therefore, at-risk patients are often switched to alternate disease modifying therapies (DMTs). Unfortunately, concerns about disease rebound 2-4 months after natalizumab cessation complicates the transition. Shorter washout times may reduce risk of disease recurrence.

Design/Methods Retrospective review of patients switching from natalizumab to other DMTs in our MS Clinics (Cleveland, OH and Las Vegas, NV). Washout times, relapses, and MRI changes after switching are reported.

Results We identified 556 patients who discontinued natalizumab from December 2005 to January 2018. Our cohort is characterized by: mean age 47.2 years, 67.9% female, 77.5% white, median disease duration 13.0 years, and 95.4% relapsing-remitting course. Reasons for natalizumab discontinuation were: PML risk (54.7%), breakthrough disease activity (18.5%), and adverse effects (14.6%). In our cohort, 23.1% switched to high efficacy therapies (ET) (ocrelizumab, alemtuzumab, rituximab), 49.5 % switched to moderate ET (fingolimod, dimethyl fumarate), 11.2% were switched to low ET (interferons, glatiramer acetate, teriflunomide), and 10.3% did not start another DMT. Washout times were: 42.3% less than 60 days, 19% between 61-120 days, and 7% between 91-180 days. Relapses occurred in 9.4% of patients within 6 months and in 5.4% between 6-12 months. Gadolinium enhancing lesions occurred in 14.3% of patients within six months and in 17.3% between 6-12 months. New T2-weighted lesions occurred in 18.3% of patients within 6 months and in 24.0% between 6-12 months.

Conclusions Our cohort had fewer relapses in the first 6 months of natalizumab discontinuation (9.4%) compared with other studies, which may be related to shorter washout periods. After additional analyses, we will present data to determine the effects of shorter washout times on relapses and MRI activity.

Authors/Disclosures
Le Hua, MD, FAAN (Cleveland Clinic) PRESENTER	Dr. Hua has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Hua has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Hua has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Hua has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genzyme. Dr. Hua has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Hua has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Hua has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Octave Bioscience. Dr. Hua has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Hua has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for TG Therapuetics. The institution of Dr. Hua has received research support from Genentech.
Haleigh C. Harris	No disclosure on file
Devon Conway, MD	Dr. Conway has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Conway has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amgen. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Conway has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Conway has received research support from Novartis. The institution of Dr. Conway has received research support from BMS. The institution of Dr. Conway has received research support from Biogen.
Carrie M. Hersh, DO, MSc, FAAN (Cleveland Clinic Lou Ruvo Center for Brain Health)	Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech_GN41791. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol-Myers Squibb . Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon Therapeutics. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genzyme. Dr. Hersh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Hersh has received research support from Biogen. The institution of Dr. Hersh has received research support from Novartis. The institution of Dr. Hersh has received research support from Genentech_GN41791. The institution of Dr. Hersh has received research support from PCORI. The institution of Dr. Hersh has received research support from Bristol Myers Squibb.

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