Multi-institutional Study of Neurologic Outcomes in People with Multiple Sclerosis Who Are Treated with Immune Checkpoint Inhibitors for Oncologic Indications
Carson Quinn1, Prashanth Rajarajan1, Hannah Kopinsky2, Andrew Wolf3, Celeste Soares De Camargo4, Alexander Gill5, Joseph Murray6, John Probasco7, Kristin Galetta8, Daniel Kantor9, Patricia Coyle10, Vikram Bhise11, Enrique Alvarez3, Sarah Conway1, Shamik Bhattacharyya1, Ilya Kister2
1Department of Neurology, Brigham and Women's Hospital, 2Department of Neurology, NYU Grossman School of Medicine, 3Department of Neurology, University of Colorado School of Medicine, 4Department of Neurology, Rutgers – Robert Wood Johnson Medical School, 5Department of Neurology, Johns Hopkins University, 6Sidney Kimmel Comprehensive Cancer Center, 7Department of Neurology, Johns Hopkins University School of Medicine, 8Department of Neurology, Stanford Medicine, 9Medical Partnership 4 MS+, 10Department of Neurology, Stony Brook University, 11Department of Neurology, Rutgers - Robert Wood Johnson Medical School

To define multiple sclerosis (MS) disease activity and neurologic outcomes after exposure to immune checkpoint inhibitors (ICIs) as cancer therapy.


ICIs are associated with immune-related adverse events (irAEs) as well as exacerbation of pre-existing autoimmune diseases.  There are reports of ICIs triggering relapses in people with MS (pwMS); however, the incidence of ICI-induced MS activity is unknown.


PwMS who were treated with ICIs were identified by chart review at 8 tertiary medical systems. Participating sites were recruited through the Medical Partnership 4 MS+ (MP4MS+) listserv, a group comprising over 1,300 neurologists and allied health professionals dedicated to the treatment and management of MS. Using a structured instrument, we collected data on MS history, cancer history, treatments, and outcomes.


In this interim analysis, we identified 38 patients (71% female, median age 66 years) with MS (33 relapsing remitting, 4 progressive, and 1 radiologically isolated syndrome) who were treated with ICIs. Thirteen (34%) pwMS were on disease modifying therapy (DMT) immediately prior to ICI initiation and only 8 continued on DMT during ICI therapy. The most common primary tumors were lung (11, 29%) and melanoma (10, 26%). Only 1 pwMS (2.6%) had a relapse following ICI treatment and 1 patient had ongoing progressive disease, during mean of 13 months of follow-up after ICI initiation. Two patients (5%) had peripheral nervous system ICI irAEs, and 12 (32%) had a non-neurologic ICI irAEs. Thirteen (34%) subjects had either partial or complete remission of their cancer at last follow up. Results from an estimated 60 patients will be presented.


In this multi-institutional study of pwMS, who were predominantly older and not on DMT, MS relapses and disease progression following ICI treatment were uncommon.