Neurologic outcomes in people with multiple sclerosis treated with immune checkpoint inhibitors for oncologic indications

Abstract

ObjectiveTo assess the prevalence of multiple sclerosis (MS) activity, as well as neurologic and non-neurologic immune-related adverse events (irAEs) in persons with MS (pwMS) treated with immune checkpoint inhibitors (ICIs) for cancer.BackgroundICIs are associated with irAEs and exacerbation of certain preexisting autoimmune diseases. PwMS are generally excluded from ICI clinical trials, so data on the safety of these drugs in pwMS is limited.Design/MethodsParticipating sites were recruited through the Medical Partnership 4 MS+ (MP4MS+) listserv. Seven large academic centers participated in the study, each conducting a systematic search of their electronic medical record system for patients with MS and ICI exposure. Demographics and data on MS and cancer history, treatments, and outcomes were abstracted from patient charts using a structured instrument.ResultsWe identified 66 pwMS (median age 66 years, 73% female, 68% not on disease-modifying therapy (DMT) for MS) who were treated with ICIs for lung cancers (35%), melanoma (21%) or other oncologic indications. During post-ICI follow-up (median: 11.7 months, range 0.2-106.3 months), two pwMS (3%) had relapse or MRI activity, three (5%) had neurologic irAEs, and 21 (32%) had non-neurologic irAEs. At the last follow-up, 25 (38%) subjects had partial or complete remission of their cancer while 35 (53%) were deceased.ConclusionsIn this multi-institutional systematic retrospective study of predominantly older pwMS who were off DMTs, MS activity and neurologic irAEs following ICI treatment were rare, suggesting that preexisting MS should not preclude the use of ICIs.