Joint Mobilization Exercises Improve Systemic Sclerosis Spasticity, Ocrelizumab Long-Term Safety, Antiplatelets Non-Effect on Recurrent ICH

This week Neurology News Network covered a study evaluating joint mobilization exercises in patients with systemic sclerosis, the long-term safety and tolerability of ocrelizumab, and the lack of significant effect antiplatelets have on recurrent intracerebral hemorrhage.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus.

Using Maitland’s joint mobilization and therapeutic exercises twice weekly for a 12-week period, patients with systemic sclerosis demonstrated improvements in the functionality of their hands, reduced pain in the hands and wrists, increased range of motion, and improved quality of life. Senior author Andrea T. Dantas, PhD, and colleagues concluded that the evidence supports this type of physical therapy within this patient population and is also "accessible, inexpensive, safe, and easily reproducible in treatment centers of different complexities." A total of 24 patients diagnosed with systemic sclerosis were randomized to the physical therapy group (n = 12) or control group (n = 12) and were evaluated at the end of 12 weeks. Functionality of the hands, the primary end point, was assessed using the Cochin Hand Functional Scale (COCHIN). Between the 2 groups, a mean difference of 11.33 (95% CI, –2.31 to 24.97) on the COCHIN scale at the end of treatment. The effect size was considered moderate, according to investigators (d = 0.7; P = .09). Four participants (2 from physical therapy group and 2 from the control group) did not complete the 12-weeks of intervention.

Pooled real-world data from more than 5000 patients with multiple sclerosis (PwMS) treated with ocrelizumab (Ocrevus; Genentech) showed that the therapy was associated with a favorable and manageable safety profile, without any emerging safety concerns over a 7-year follow-up. Ocrelizumab, an FDA-approved treatment for patients with relapsing (RMS) or primary progressive forms of MS (PPMS), had its safety data pulled from 11 clinical trials, including the controlled treatment and open-label extension periods of the phase 2 and 3 trials as of January 2020.At cut-off, 5680 PwMS (RMS, n = 4376; PPMS, n = 1304) were exposed to treatment for a total of 11,424 patient-years over a period of up to 7 years. More than 50% of patients received at least 5 doses of ocrelizumab and 28% of patients had received at least 10 doses of the therapy. After pooling the data, rates of AEs and SAEs in all patients with RMS or PPMS remained consistent with the rates observed in controlled treatment programs of the phase 3 trials.

A follow-up of the Restart of Stop Antithrombotics Randomized Trial found no significant effect of antiplatelet therapy on recurrent intracerebral hemorrhage or any major vascular events in patients with ICH that had taken antithrombotic therapy, allowing physicians to feel some reassurance about the use of antiplatelet therapy in this patient population. During an extended follow-up through November 20, 2020, for a median total of 3 years (interquartile range [IQR], 2.0-5.0), investigators found that, of those randomized to start antiplatelet therapy (n = 268), 22 patients (8.2%) experienced the primary outcome of recurrent ICH, and of those randomized to avoid antiplatelet therapy (n = 269; 1 withdrawal), 25 patients (9.3%) experienced recurrent ICH, resulting in a nonsignificant difference.

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