Fellow of autoimmune neurology, Massachusetts General Hospital

Spencer Hutto, MD

“Everybody has these questions. How do patients with MS fare with COVID-19? How do we adjust their immunotherapies if they become infected? That's been a real challenge. Also, how do we balance their treatments while they're undergoing vaccinations? What are the best strategies for that? So, I think from just a clinical perspective, and from a research perspective, that's been a real challenge.”

Central nervous system (CNS) demyelination in patients treated with tumor necrosis factor alpha inhibitor (TNFαi) treatment can 

 in prolonged follow-up, data from a recent study suggest. Spencer K. Hutto, MD, clinical fellow, Advanced General and Autoimmune Neurology, Massachusetts General Hospital, presented these findings virtually at the 

Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2021

Hutto and colleagues found that TNFαi were discontinued at the onset of demyelinating events in 86% (n = 18) of patients, and 69% (n = 14) were treated acutely with steroids. Ultimately, 42% (n = 9) of patients used multiple sclerosis (MS) disease-modifying therapies (DMTs). Twelve patients (57%) had new disease activity over time, and clinical relapse was experienced by 48% (n = 10), with a median of 41 months to first relapse (range, 12-80). 

reached out to Hutto to learn more about CNS demyelination and the work he and colleagues did. He discussed the overlap between autoimmune neurology and rheumatology, and also touched on questions concerning associations between MS and COVID-19.

For more coverage of ACTRIMS Forum 2021, click 

Hutto SK, Rice DR, Mateen FJ. Long-term outcomes of CNS demyelination associated with exposure to TNFa Inhibitors: A Retrospective cohort analysis. Presented at ACTRIMS Annual Forum; February 25-27, 2021. Abstract P165

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The fellow of autoimmune neurology at Massachusetts General Hospital also discussed concerns of associations between multiple sclerosis and COVID-19. 

CNS Demyelination and Autoimmune Neurology: Spencer Hutto, MD

“The main clinical takeaway is to dispel the concept that demyelination might just be purely related to the drug. It's very easy to say that and then not worry about future concern for relapses... We think our study supports the conclusion that the drug is really not the sole contributor to these clinical attacks and MRI findings.”

Data from a recent study suggest that in patients treated with tumor necrosis factor alpha inhibitor (TNFαi) treatment, central nervous system (CNS) demyelination can 

These findings were presented virtually at the 

, February 25-27, by first author Spencer K. Hutto, MD, clinical fellow, Advanced General and Autoimmune Neurology, Massachusetts General Hospital.

The patients in the study had a median rheumatologic illness duration of 102 months and a mean TNFαi use of 11 months. TNFαis used were adalimumab (n = 10; 48%), etanercept (n = 6; 28%), and infliximab (n = 5; 24%). More than half (n = 12; 57%) had new disease activity over time, and 48% (n = 10) experienced relapse with a median of 41 months to first relapse (range, 12-80). Magnetic resonance imaging (MRI) lesion accrual occurred in 47% (n = 10), with a median of 28 months to new lesion or lesions (range, 3-139).

 reached out to Hutto to learn more about the associations between TNFαi and CNS demyelination. He stressed that more research needs to be conducted, especially in larger populations.

The fellow of autoimmune neurology at Massachusetts General Hospital discussed the need for follow-up with patients long-term after TNFα inhibitor treatment. 

Investigating Causes of CNS Demyelination: Spencer Hutto, MD

“Most patients suffered this new activity within the first 2 to 3 years, and so we think that informs how long patients should be followed for as opposed to just stopping the treatment and assuming that the issue is laid to rest. We think it's important to follow these patients for a prolonged period of time.”

Data from a recent study presented at the 

Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS)

, February 25-27, suggest that in patients treated with tumor necrosis factor alpha inhibitor (TNFαi) treatment, central nervous system (

 after discontinuation in prolonged follow-up.

Researchers found that over half of patients (n = 12; 57%) had new disease activity over time, and 48% (n = 10) experienced relapse with a median of 41 months to first relapse (range, 12-80). Magnetic resonance imaging (MRI) lesion accrual occurred in 47% (n = 10), with a median of 28 months to new lesion or lesions (range, 3-139).

 reached out to first author Spencer K. Hutto, MD, clinical fellow, Advanced General and Autoimmune Neurology, Massachusetts General Hospital to learn more about the study’s findings. He stressed that CNS demyelination events in TNFαi treatment are very rare and should not deter patients from receiving medically necessary treatments.

For more coverage of ACTRIMS Forum 2021, 

Hutto SK, Rice DR, Mateen FJ. Long-term outcomes of CNS demyelination associated with exposure to TNFaInhibitors: A Retrospective cohort analysis. Presented at ACTRIMS Annual Forum; February 25-27, 2021. Abstract P165

The fellow of autoimmune neurology at Massachusetts General Hospital discusses the ongoing question about whether the demyelination is an unmasking of disease or consequence of the treatment. 

High Rates of MS Relapse after TNFα Inhibitor Discontinuation: Spencer Hutto, MD

“I think the main question is are these drugs provoking or initiating central nervous system (CNS) demyelination or a CNS demyelinating disease? Or are they really just unmasking en masse in people who would have otherwise developed it later on?”

 in prolonged follow-up despite tumor necrosis factor alpha inhibitor (TNFαi) treatment discontinuation.

First author Spencer K. Hutto, MD, clinical fellow, Advanced General and Autoimmune Neurology, Massachusetts General Hospital and colleagues found that over half of the patients (n = 12; 57%) had new disease activity over time. Clinical relapse was experienced by 48% (n = 10), with a median of 41 months to first relapse (range, 12-80). Magnetic resonance imaging (MRI) lesion accrual was experienced by 47% (n = 10), with a median of 28 months to new lesion or lesions (range, 3-139).

 reached out to Hutto to learn more about the associations between TNFαi and CNS demyelination. He discussed his team’s retrospective analysis of a cohort of patients with multiple sclerosis from the Mass General Brigham Research Patient Data registry.

The fellow of autoimmune neurology at Massachusetts General Hospital discussed the analysis his team conducted to clarify the known associations. 

Spencer Hutto, MD

Articles

CNS Demyelination and Autoimmune Neurology: Spencer Hutto, MD

Investigating Causes of CNS Demyelination: Spencer Hutto, MD

High Rates of MS Relapse after TNFα Inhibitor Discontinuation: Spencer Hutto, MD

Investigating TNFα Inhibition and CNS Demyelination: Spencer Hutto, MD