Abstract Details

Title Assessing the Impact of Immune Checkpoint Inhibitor Therapy on Clinical and MRI Activity in Patients with Multiple Sclerosis

Topic Multiple Sclerosis

Presentation(s) P9 - Poster Session 9 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-003

Objective To assess relapse and MRI activity in patients with multiple sclerosis (PwMS) receiving immune checkpoint inhibitor therapy (ICI).

Background There are reports of disease activity in PwMS receiving ICI. However, this risk is not yet fully understood.

Design/Methods In this retrospective cohort study, adult PwMS who received ICI therapy between 2017-2023 were identified using the electronic medical record. Relapses were defined as new neurological symptoms for >24 hours. MRI activity was defined as new T2 or contrast-enhancing lesions.

Results Among 9158 PwMS, 27 PwMS (67% female, median age=64, range=41-79) who received ICI were identified. MS phenotypes included; primary progressive (2, [9%]), secondary progressive (1, [5%]), relapsing-remitting (17, [81%]) and clinically isolated syndrome (1, [5%]). ICI indications included; melanoma (5, [18%]), lung cancer (12, [44%]), genitourinary carcinoma (5, [18%]), squamous cell carcinoma [tongue, maxillary sinus, anus] (3, [11%]) and gynecologic cancer (2, [8%]). ICIs included; pembrolizumab (15, [55%]), nivolumab (10, [37%]) and durvalumab (2, [7%]). Concurrent disease modifying therapy (DMT) was continued in 11 (40%), including high (7) and low efficacy (4). Median clinical follow-up time was 1.2 years (IQR=0.26-3.5) after ICI treatment. Of 27 patients, 18 had MRI follow-up after ICI with a median radiological follow up of 1 year (IQR=0.22-1.8). Five patients experienced new disease activity; 1 (3.7%) had relapse with new MRI lesions (no DMT, fingolimod paused) and 4 (15%) developed new MRI lesions (no DMT, fingolimod paused [1], ocrelizumab [1], dimethyl fumarate [2]). MS disease activity occurred at a median of 15 days (range 12-226) from the last ICI dose. Seven patients experienced other irAE; Grade 2 (peripheral neuropathy, pneumonitis, colitis, rash), Grade 3 (pneumonitis, colitis) and grade 4 (myasthenia gravis).

Conclusions In this PwMS cohort, clinical relapse after ICI was uncommon. However, asymptomatic new MRI activity was slightly more frequent suggesting a role for MRI monitoring in PwMS receiving ICI.

Authors/Disclosures
Saira Afzal, MD PRESENTER	Dr. Afzal has nothing to disclose.
Yadi Li	No disclosure on file
Brittany Lapin	No disclosure on file
Lucy Kennedy (Cleveland Clinic Foundation)	No disclosure on file
Jeffrey A. Cohen, MD (Cleveland Clinic)	Dr. Cohen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Convelo. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astoria. Dr. Cohen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viatris. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PSI. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celltrion.
Marisa P. McGinley, DO (Cleveland Clinic)	Dr. McGinley has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. McGinley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. McGinley has received research support from Biogen. The institution of Dr. McGinley has received research support from Genentech. The institution of Dr. McGinley has received research support from NIH. The institution of Dr. McGinley has received research support from AHRQ. The institution of Dr. McGinley has received research support from EMD Serono.
Amy Kunchok, MBBS (Cleveland Clinic - Mellen Centre)	Dr. Kunchok has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology:Open Access Journal .

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