Safety of Non-MS Biologics in Patients with Multiple Sclerosis: A Multi-center Retrospective Study of MS Patients with Co-morbid Autoimmune Conditions
Evan Madill1, Kerry Lenzi2, Kristin Galetta3, John Lincoln4, Erin Longbrake5, Gloria Von Geldern1, Jacob Sloane6, Hamza Coban7, Asya Wallach8, Josef Gutman9, Nancy Le10, Carolyn Akers11, Raveena Vij11, Tamar Bacon11, Laura Naydovich2, Caitlin Pileggi2, Jeffrey Xi2, Bruna de Freitas Dias3, Joshua Hobbs5, Alexandra Balshi6, Mary Picone8, Josephine Vonderhaar10, Daniel Kantor12, Shamik Bhattacharyya13, Ilya Kister11
1Department of Neurology, University of Washington, 2Department of Neurology, University of Pennsylvania, 3Department of Neurology, Stanford University, 4Department of Neurology, McGovern Medical School, UTHealth, 5Department of Neurology, Yale University, 6Department of Neurology, Beth Israel Deaconess Medical Center, 7Department of Neurology, University of Connecticut, 8The Alfiero & Lucia Palestroni Foundation Multiple Sclerosis Center, Holy Name, 9Department of Neurology, NYU Langone Ambulatory Care Center East Meadow, 10Department of Neurology, University of Iowa, 11NYU Multiple Sclerosis Comprehensive Care Center, Department of Neurology, New York University Grossman School of Medicine, 12Medical Partnership 4 MS+, 13Department of Neurology, Brigham and Women's Hospital
Objective:
To assess the safety of non-MS biologics in patients with multiple sclerosis (MS) and co-morbid systemic autoimmune disease (AID).
Background:
Systemic autoimmune disease (AID) occurs in 5-10% of the general population, and at an even higher rate in multiple sclerosis (MS). Biologic therapies are increasingly used for the treatment of AID. While TNFa inhibitors are contraindicated, the safety of many other biologics in MS is uncertain. The use of non-MS biologics is of special concern when prescribed in combination with MS disease-modifying therapies (DMTs).
Design/Methods:
Retrospective chart review from 11 medical centers across the United States. Patients with MS who were treated with a biologic for a co-morbid AID were included.
Results:
We identified 190 patients with MS and AID who were treated with non-MS biologics (mean age [standard deviation]: 50.6 [12.7], female: 70%, mean MS disease duration: 11.57 years [10.9]). The most common AIDs were inflammatory bowel disease (37%), psoriasis (36%), and psoriatic arthritis (22%). The most commonly used biologics were anti-IL-12/IL-23s (37%), anti-IL-17s (27%), and anti-IL-23s (23%). The average time on a biologic was 3.0 years (for a total of 593.2 patient-years). In 152 patients (80%), an MS DMT was prescribed concurrently. There were 20 serious infections (3.4 per 100 patient-years). Other serious adverse events, such as malignancy and thromboembolism, were rare. Thirty-six clinical MS relapses were observed (6.1 per 100 patient-years). Detailed analysis on the updated cohort will be presented, including MS disease activity.
Conclusions:
Serious adverse events in patients with both MS and AID on non-MS biologics were rare, including among patients treated concurrently with an MS DMT. Our results may help inform care for patients with MS who require a non-MS biologic for management of a co-morbid AID.
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