Abstract Details

Title The Role of B-cell Therapy in the Treatment of Tumefactive Multiple Sclerosis: A Retrospective Cohort Study

Topic Multiple Sclerosis

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

Poster/Presentation
Number 6-007

Background Tumefactive multiple sclerosis (TMS) is characterized by large demyelinating brain lesions, typically >2cm in diameter. Effective treatment approaches are uncertain.

Objective To report the long-term clinical outcomes of TMS patients, comparing disease modifying therapeutic drug classes.

Design/Methods A retrospective cohort study of adults with TMS (2015-2023) at two Boston hospitals. Case files were reviewed by two MS neurologists. Immunosuppressive therapies were categorized into B-cell depleting therapy, other high-efficacy, and no/low/ medium-efficacy therapy. Outcomes of interest were the expanded disability status scale (EDSS) score at one year and last known follow up.

Results

67 patients had TMS (female 70.2%; White 83.6%, Asian 4.4%, Black 4.4%, median age 36 years; 95.5% newly MS diagnosed). 62 (92.5%) were treated with maintenance immunosuppressives (median time to initiation 137 days). Treatments were: B-cell depleting therapy (n=36, 21 on ocrelizumab, 13 on rituximab, 2 on ofatumumab); other high-efficacy therapy (n=6, 3 each on natalizumab and cyclophosphamide), and low/medium efficacy therapy (n=18, 9 on dimethyl fumarate, 2 each on glatiramer acetate, interferon-beta, mycophenolate mofetil, fingolimod and 1 on siponimod). One patient switched cyclophosphamide to glatiramer acetate and one from natalizumab to rituximab.

The mean EDSS was 3.3 (range 1.5-5.1) at TMS onset, 2.1 (range 1.0-2.8) at year one, and 2.5 (1.0-2.1) at last follow up (median 1270 days). Comparing mean EDSS scores, patients receiving non-B-cell high efficacy therapy did worse than with no treatment/low efficacy therapies (2.5, p value= 0.02) and B-cell therapy showed no difference compared to no treatment/low efficacy (-0.52, p-value=0.42) controlling for age and sex. A multilinear regression model found higher presentation EDSS and non-B-cell high efficacy therapies were associated with higher EDSS at last follow up.

Conclusions Non-B-cell high-efficacy therapy should likely be avoided in TMS. Further research, prospectively, is needed to confirm these findings, determine the value of B-cell therapies, and rule out reverse causation.

Authors/Disclosures
Kristin M. Galetta, MD (Stanford University) PRESENTER	Dr. Galetta has received personal compensation in the range of $0-$499 for serving as a Speaker with AAN.
Anastasia Vishnevetsky, MD (Massachusetts General Hospital)	The institution of Dr. Vishnevetsky has received research support from National MS Society. The institution of Dr. Vishnevetsky has received research support from NIH (NeuroNext).
Andrew Siyoon Ham	No disclosure on file
Shamik Bhattacharyya, MD, FAAN (Brigham and Women's Hospital)	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 Alexion Pharmaceuticals. 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 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. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care.
Farrah J. Mateen, MD, PhD, FAAN (Massachusetts General Hospital)	Dr. Mateen has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Mateen 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. Mateen 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. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Mateen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology. The institution of Dr. Mateen has received research support from Genentech. The institution of Dr. Mateen has received research support from EMD Serono. The institution of Dr. Mateen has received research support from Novartis. The institution of Dr. Mateen has received research support from Horizon Therapeutics.