PT  - JOURNAL ARTICLE
AU  - Branger, Pierre
AU  - Derache, Nathalie
AU  - Kassis, Nizam
AU  - Maillart, Elisabeth
AU  - Assouad, Rana
AU  - Defer, Gilles
TI  - Relapses during high doses of biotin in progressive multiple sclerosis: A case series (P5.348)
DP  - 2018 Apr 10
TA  - Neurology
PG  - P5.348
VI  - 90
IP  - 15 Supplement
4099  - http://n.neurology.org/content/90/15_Supplement/P5.348.short
4100  - http://n.neurology.org/content/90/15_Supplement/P5.348.full
SO  - Neurology2018 Apr 10; 90
AB  - Objective: Report and identify relationship between high doses of biotin and a potential pro-inflammatory effect in progressive multiple sclerosis (PMS).Background: High doses of biotin represent an effective treatment in patients with not-active PMS with a confirmed reduction in MS-related disability. Radiological data in the placebo-controlled pivotal study may suggest a potential pro-inflammatory effect of biotin (Tourbah, 2016).Design/Methods: Identify in MS centers PMS patients with stable disease who developed unexpected clinical and/or radiological inflammatory activity under high doses of biotin.Results: First five PMS patients were identified (3 women and 2 men, 51 to 62 years, 8 to 23 years of disease duration). All had similar stable disease without clinical or radiological activity and received high doses of biotin. A relapse with new T2 and/or gadolinium-enhancing brain lesions on MRI occured in all patients after 3 to 7 months of treatment exposure. Biotin was stopped due to a potential adverse effect.Conclusions: High doses of biotin in PMS could have a potential pro-inflammatory effect. In the pivotal placebo-controlled study, more new or enlarging MRI lesions occurred in the treated arm than in the placebo arm (23.4% vs 13.0% respectively, p=0.36) with more relapses in the extension phase (6.6% in the treated arm vs 4.8% in the placebo arm). A recent case report of solitary sclerosis showed also new T2 lesions after 2 years of biotin. Even if clinical or radiological activity were also present in PMS without treatment, relapses after recent introduction of biotin in not-active MS patients challenge the question of a potential relationship. Follow-up of PMS patients initiating high doses of biotin in a real life setting should include careful assessment of MRI activity to monitor pro-inflammatory effect of biotin. This monitoring may be recommended before and shortly after introduction of biotin to detect new T2 and/or gadolinium-enhancing lesions.Disclosure: Dr. Branger has nothing to disclose. Dr. Derache has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Merck Serono, Biogen, Novartis, Teva, Sanofi-Genzyme. Dr. Kassis has nothing to disclose. Dr. Maillart has nothing to disclose. Dr. Assouad has nothing to disclose. Dr. Defer has nothing to disclose.