Innovations In Clinical Neuroscience

HOTTOP Multiple Sclerosis MAR 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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11 Hot Topics in Multiple Sclerosis [March 2018] ACTRIMS Forum 2018 February 1–3, 2018 San Diego, California Highlights of selected presentations from the 2018 conference Meeting Highlights SYMPTOM MANAGEMENT OF MULTIPLE SCLEROSIS Effect of ocrelizumab on visual outcomes in patients with baseline visual impairment in the OPERA studies in relapsing remitting multiple sclerosis (RRMS). Results from the OPERA studies measured how ocrelizumab impacted low-contrast letter acuity (LCLA), one of multiple ways to measure visual function in patients with multiple sclerosis (MS). These results were presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2018 in February in San Diego, California. The researchers conducted binocular LCLA testing at 1.25 percent and 2.5 percent contrast using the Sloan charts at baseline, as well as every 12 weeks until Week 96. They compared the difference in the number of letters correctly identified at baseline compared to each test. Of the 375 patients randomly selected to the ocrelizumab group, there was an average of a 3.440-letter increase compared to baseline at the 2.5-percent contrast, compared to a -0.470-letter decrease for the interferon (IFN b-1a)group. The researchers aim to provide results from the LCLA testing at 1.25- percent contrast in future presentations. Overall, ocrelizumab successfully resulted in improved LCLA measures in patients with MS. Evaluation of No Evidence of Progression or Active Disease (NEPAD) in patients with RRMS in the OPERA I and OPERA II trials. Additional results from the OPERA studies were presented at the ACTRIMS Forum 2018 in San Diego, including how ocrelizumab impacts patients with MS with "no evidence of progression or active disease" (NEPAD) compared to IFN b-1a. NEPAD is a "clinically expanded version of the no evidence of disease activity (NEDA) outcome." Patients were given either ocrelizumab 600mg every 24 weeks (n=740) or IFN b-1a three times a week for 96 weeks (n=753). NEPAD was measured by the timed 25-foot walk test (T25FW) and the 9-hole peg test (9HPT).Ocrelizumab increased the proportion of patients with NEPAD by 82 percent compared to the IFN b-1a group. Effect of ocrelizumab on severe progression of upper extremity impairment in patients with primary progressive multiple sclerosis (PPMS) in ORATORIO. One aspect of the ORATORIO study, from which results were presented at the ACTRIMS Forum 2018, was the effect of ocrelizumab on upper extremity (UE) impairment in patients with PPMS. UE impairment was measured by the 9HPT, which was administered at baseline and every 12 weeks on both hands of the study subjects. The hand for which the lower score was recorded was labeled the "worse hand" (WH) and the hand with the higher score was labeled the "better hand" (BH). Additionally, the scores of both hands were combined to create an additional "both hands" (2H) score. Ocrelizumab decreased the risk of 12- and 24-week confirmed disease progression (measured by at least a 35% increase on the 9HPT time) by at least 40 percent for all hand categories, compared to placebo, for patients with PPMS. Ocrelizumab safety in patients with MS: updated analyses with a focus on infusion-related reactions. In the OPERA I and II and ORATORIO studies that measured the safety and efficacy of ocrelizumab on patients with PPMS or RRMS, respectively, the treatment was administered exclusively via infusion. Infusion-related reactions (IRRs) were common, occurring in 34.3 percent of patients in the OPERA studies and 39.9 percent of patients in the ORATORIO studies. The IRRs were mostly minor and usually occurred during the first infusion dose. Based on pooled data, there were only 71.3 infections per 100 patient-years. Additionally, there were only 1.86 serious infections and 0.454 malignancies per 100 patient-years, suggesting that the overall safety profile of ocrelizumab is consistent with past studies.

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