Abstract Details

Title Multiple Sclerosis Disease Activity is Uncommon in Individuals With Pre-existing Multiple Sclerosis Exposed to Immune Checkpoint Inhibitor Therapy

Topic Multiple Sclerosis

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 19-002

Objective To determine neurologic outcomes in people with multiple sclerosis (pwMS) after exposure to immune checkpoint inhibitors (ICIs) for comorbid oncologic indications.

Background ICI therapy is associated with immune-related adverse events (irAEs) including de novo CNS demyelinating events and pre-existing autoimmune diseases exacerbations.

Design/Methods PwMS treated with ICIs for comorbid oncologic indications were identified by systematic retrospective chart review at 18 tertiary medical centers and outcomes were obtained using a structured data instrument.

Results We identified 165 individuals (72% female) with MS who were treated with ICIs. Median age at time of ICI initiation was 63 years old. During a median of 6 months of ICI therapy, 6 pwMS (3.6%) were diagnosed with an MS clinical relapse after ICI initiation, 2 of which occurred > 6 months after last ICI dose. Of these, 3 had full and 3 had partial clinical recovery. Seven additional subjects (4.2%) had new MS lesions on MRI post-ICI without associated clinical relapse, 2 of which occurred > 6 months after last ICI dose. One of 33 (3%) and 8 of 132 (6%) pwMS who were ≤55yo or >55yo, respectively, had evidence of MS disease activity post-ICI and within 6 months of last ICI dose. Ten of 33 (30%) and 34 of 132 (26%) pwMS who were ≤55yo or >55yo, respectively, were continued on disease-modifying therapy at ICI initiation. One of 19 (5.3%) and 3 of 68 (4.4%) of pwMS with their last documented MS clinical relapses ≤5 or >5 years pre-ICI, respectively, had evidence of disease activity post-ICI and within 6 months of last ICI dose. Eleven pwMS (6.7%) had non-MS neurologic irAEs and 36 (21%) had non-neurologic irAEs.

Conclusions

In this retrospective cohort study of pwMS, MS disease activity following ICI treatment was uncommon, including in younger individuals and those with more recent MS clinical disease activity.

Authors/Disclosures
Alexander J. Gill, MD, PhD PRESENTER	Dr. Gill has received personal compensation for serving as an employee of Novartis Pharmaceuticals Corporation. Dr. Gill has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medical Logix, LLC. Dr. Gill has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Health Union, LLC . Dr. Gill has received research support from National Multiple Sclerosis Society. Dr. Gill has a non-compensated relationship as a President, Treasurer, and Member of Board of Directors with Autoimmune Neurology Research Consortium, Inc. that is relevant to AAN interests or activities.
Jonathan Krett, MD	Dr. Krett has nothing to disclose.
Carson M. Quinn, MD (Mass General Brigham)	Dr. Quinn has nothing to disclose.
Prashanth Rajarajan, MD, PhD (Brigham and Women's Hospital)	Dr. Rajarajan has nothing to disclose.
Lyndsey Babcock, MD	Dr. Babcock has nothing to disclose.
Anna Kaiser, DO	Dr. Kaiser has nothing to disclose.
Andrew Morrison, MD (Hospital of the University of Pennsylvania)	Dr. Morrison has nothing to disclose.
Thomas J. Pisano, MD, PhD	The institution of Dr. Pisano has received research support from NIH.
Atika Paracha, MBBS	Dr. Paracha has nothing to disclose.
Cory K. Dodson, MD (Stanford Neurology)	Dr. Dodson has nothing to disclose.
Hannah Kopinsky, MD	Dr. Kopinsky has nothing to disclose.
Iwalewa Moninuola, MD	Dr. Moninuola has nothing to disclose.
Said Alhassan, BS	Mr. Alhassan has nothing to disclose.
Wendy A. Stewart, MD, PhD, FRCP	No disclosure on file
María Paula Aguilera Peña, MD	María Paula Aguilera Peña, MD has nothing to disclose.
Sofia Ramirez Guerrero, MD	Dr. Ramirez Guerrero has nothing to disclose.
Nikhil Modak, MD	Dr. Modak has nothing to disclose.
Maxime Jean, MD, PhD (University of Rochester Medical Center)	Dr. Jean has nothing to disclose.
Jessica Lamb, CRA	Ms. Lamb has nothing to disclose.
Yoav Piura, MD	Dr. Piura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Piura has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck.
Jordan Carrier, MD (Corewell Health)	Dr. CARRIER has nothing to disclose.
Muhammed Ikbal Arvas, MD (OU Health)	Dr. Arvas has nothing to disclose.
Celeste R. Camargo, MD	Dr. Camargo has nothing to disclose.
Vikram Bhise, MD (Rutgers - Robert Wood Johnson Medical School)	Dr. Bhise has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cycle Pharmaceuticals. The institution of Dr. Bhise has received research support from Horizon Blue Cross Blue Shield.
Jenny Linnoila, MD, PhD (University Neurology Associates, UPMC)	Dr. Linnoila has received personal compensation in the range of $10,000-$49,999 for serving as a expert respondent on autoimmune encephalitis with U.S. government/DHHS/Vaccine Injury Compensation Program.
Vinay Chaudhry, MD, FAAN	Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care. Dr. Chaudhry has received intellectual property interests from a discovery or technology relating to health care.
Shamik Bhattacharyya, MD, FAAN (Brigham and Women's Hospital)	Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NeuroLambda. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum. Dr. Bhattacharyya 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 Wiley. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Merck. The institution of Dr. Bhattacharyya has received research support from Alexion Pharmaceuticals. The institution of Dr. Bhattacharyya has received research support from National Institute of Health. The institution of Dr. Bhattacharyya has received research support from UCB. The institution of Dr. Bhattacharyya has received research support from Genentech. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care.
Enrique Alvarez, MD, PhD (University of Colorado)	Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Alvarez has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Alvarez has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Alvarez has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celgene/BMS. The institution of an immediate family member of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Alvarez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon.
Daniel Kantor, MD, FAAN (Medical Partnership 4 MS+)	Dr. Kantor has received personal compensation for serving as an employee of Gateway Institute for Brain Research. Dr. Kantor has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Bristol Myers Squibb. Dr. Kantor has a non-compensated relationship as a HAP with MSFous (MSF) that is relevant to AAN interests or activities. Dr. Kantor has a non-compensated relationship as a Medical Board with MS Views & News that is relevant to AAN interests or activities.
Flavia Nelson, MD (University of Miami, Miller School of Medicine)	Dr. Nelson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Brystol Meyer Squib. Dr. Nelson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Nelson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Nelson has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Genetech. The institution of Dr. Nelson has received research support from NIH. Dr. Nelson has received research support from Novartis.
Kottil W. Rammohan, MD (University of Miami)	Dr. Rammohan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Rammohan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Rammohan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Rammohan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Rammohan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genzyme. Dr. Rammohan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. The institution of Dr. Rammohan has received research support from Genentech. The institution of Dr. Rammohan has received research support from Genzyme. The institution of Dr. Rammohan has received research support from EMD Serono. The institution of Dr. Rammohan has received research support from Alexion.
Patricia K. Coyle, MD, FAAN (SUNY At Stony Brook)	Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Accordant. Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Coyle has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sanofi Genzyme. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GlaxoSmithKline. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon Therapeutics. The institution of Dr. Coyle has received research support from CorEvitas LLC. The institution of Dr. Coyle has received research support from Genentech/Roche. The institution of Dr. Coyle has received research support from NINDS. The institution of Dr. Coyle has received research support from Sanofi Genzyme. The institution of Dr. Coyle has received research support from Cleveland Clinic.
Lauryn Hemminger (Strong Memorial Hospital)	Dr. Hemminger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion.
Nicole Baldwin, MD	Dr. Baldwin has received personal compensation in the range of $500-$4,999 for serving as a volunteer international neurology instructor with CMDA, MAP International, and INMED (NGOs).
George J. Hutton, MD, FAAN (Baylor College of Medicine)	Dr. Hutton has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Autoimmunity Biologic Solutions, Inc.. The institution of Dr. Hutton has received research support from Biogen. The institution of Dr. Hutton has received research support from Genentech. The institution of Dr. Hutton has received research support from Genzyme.
Alexandra C. Simpson, MD (Johns Hopkins Hospital)	Dr. Simpson has received research support from National MS Society.
Paula Barreras, MD (Cedars-Sinai Medical Center)	Dr. Barreras has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Barreras has received research support from Foundation for Sarcoidosis Research. The institution of Dr. Barreras has received research support from ��ɫ��.
Irena Dujmovic Basuroski, MD, PhD (University of North Carolina At Chapel Hill)	The institution of Dr. Dujmovic Basuroski has received research support from Alexion Pharmaceuticals, Inc. The institution of Dr. Dujmovic Basuroski has received research support from Biogen MA Inc. The institution of Dr. Dujmovic Basuroski has received research support from EMD Serono Research and Development Institute, Inc . The institution of Dr. Dujmovic Basuroski has received research support from Celgene Corporation/Bristol-Myers Squibb. The institution of Dr. Dujmovic Basuroski has received research support from The Bodford Family Transverse Myelitis Center Fund. The institution of Dr. Dujmovic Basuroski has received research support from CorEvitas, LLC. The institution of Dr. Dujmovic Basuroski has received research support from Novartis. The institution of Dr. Dujmovic Basuroski has received research support from Ad Scientiam. Dr. Dujmovic Basuroski has received personal compensation in the range of $0-$499 for serving as a Travel -related expenses to attend clinical trial investigator meeting with Novartis. Dr. Dujmovic Basuroski has received personal compensation in the range of $500-$4,999 for serving as a International Clinical Consortium Member, Travel -related expenses to attend the meeting with The Guthy-Jackson Charitable Foundation.
Cole A. Harrington, MD, PhD (The Ohio State University)	Dr. Harrington has nothing to disclose.
Anne G. Douglas, MD	Dr. Douglas has nothing to disclose.
Gregory S. Day, MD, MSc, FAAN (Mayo Clinic)	Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for DynaMed (EBSCO Health). Dr. Day has or had stock in ANI Pharmaceuticals. The institution of Dr. Day has received research support from National Institutes of Health / NIA. The institution of Dr. Day has received research support from National Institutes of Health / NINDS. The institution of Dr. Day has received research support from Amgen Pharmaceuticals. The institution of Dr. Day has received research support from AVID Radiopharmaceuticals. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Presenter at Annual Meeting (CME) with ��ɫ��. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Content Development (CME) with PeerView, Inc. Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Content Development (CME) with Continuing ��ɫ��, Inc. Dr. Day has received personal compensation in the range of $5,000-$9,999 for serving as a Content Development (CME) with Ionis Pharmaceuticals. Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a ��ɫ��al Case Development + Presentation (video) with PeerDirect (P\S\L Group). Dr. Day has received personal compensation in the range of $500-$4,999 for serving as a Content Development / Presentation (non-CME) with MJH Life Sciences (NeurologyLive). Dr. Day has a non-compensated relationship as a Clinical Director with Anti-NMDA Receptor Encephalitis Foundation that is relevant to AAN interests or activities.
Ilya Kister, MD, FAAN (NYU School of Medicine)	Dr. Kister has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech-Roche. Dr. Kister has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. The institution of Dr. Kister has received research support from Genentech. The institution of Dr. Kister has received research support from Novartis. Dr. Kister has received publishing royalties from a publication relating to health care.
Kristin M. Galetta, MD (Stanford University)	Dr. Galetta has received personal compensation in the range of $0-$499 for serving as a Speaker with Can Do MS.
Sarah Conway, MD (BWH)	Dr. Conway has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurology Live.
Shuvro Roy, MD (University of Washington)	Dr. Roy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Roy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Roy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Roy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Roy has received research support from The Siegel Rare Neuroimmune Association.
Sachin Gadani, MD, PhD (Johns Hopkins)	Dr. Gadani has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. The institution of Dr. Gadani has received research support from National MS Society.
Andrew Wolf, MD	The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Wolf has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. The institution of Dr. Wolf has received research support from Genentech. The institution of Dr. Wolf has received research support from Rocky Mountain MS Center. The institution of Dr. Wolf has received research support from Michael J. Fox Foundation. Dr. Wolf has received publishing royalties from a publication relating to health care.
John Probasco, MD, FAAN (The Johns Hopkins Hospital)	Dr. Probasco 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 NEJM Clinician. The institution of Dr. Probasco has received research support from Roche/Genentech.

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