Pfizer Stock Research Articles

A Financial Analysis and Valuation of Pfizer

Abstract: The rational valuation of the healthcare industry and the analysis and research of the financial risks faced by enterprises can not only provide a basis for rational investment and transaction pricing decisions, but also help enterprises to find out the shortcomings of the production and operation, so as to improve the management mode of the enterprise, and help enterprises to achieve the maximisation of management. Firstly, this paper analyse the risks faced by Pfizer from a financial point of view by quantitatively comparing the data of Pfizer and its two competitors, Amgen and Unitedhealth Group, and then qualitatively analysing their characteristics in terms of liquidity, solvency and profitability and the reasons for this. Next, Pfizer is valued by looking at its leverage, business risk, earnings per share, etc. to measure the financial risk of the business and the reasons for the capital structure. It then gives investors an objective investment recommendation by forecasting Pfizer's future share price. The study concludes that Pfizer Inc. is illiquid, has poor corporate solvency, is at risk of debt servicing, and has suffered a significant decline in profitability. Valuing Pfizer, the forecast suggests that Pfizer's stock is currently undervalued.

Comparing the Influence of the NASDAQ Index and Dow Jones Industrial Average (DJLA) on Pfizer Stock Return

The stock market, often known as the secondary market, is a venue for the transfer, purchase, sale, and circulation of stocks for listed firms and investors. There is a subtle relationship between the stock and the market, and market external factors influence the price of the stock. Thus, variations in stock prices can impact the profits of investors. Hence, the stock of Pfizer is the subject of this research. By analyzing the influence of the NASDAQ and DJLA on Pfizer stock prices. Determine the link between the two indices and the stock returns of Pfizer. Utilizing the Capital asset pricing model (CAPM) through regression analysis of the model and systematic Beta risk data constitutes the research methodology. The conclusion of the investigation is that the index influences the predicted portfolio return for investors. The relevance of this research is to demonstrate that investors can utilize the CAPM asset pricing model to evaluate portfolio returns. In addition, it explains the limitations and benefits of utilizing CAPM based on Pfizer stock data and provides investors with a reference for future usage of the modeling.

Development and electronic health record validation of an algorithm for identifying patients with Duchenne muscular dystrophy in US administrative claims.

BACKGROUND: Muscular dystrophies (MDs) comprise a heterogenous group of genetically inherited conditions characterized by progressive muscle weakness and increasing disability. The lack of separate diagnosis codes for Duchenne MD (DMD) and Becker MD, 2 of the most common forms of MD, has limited the conduct of DMD-specific real-world studies. OBJECTIVE: To develop and validate administrative claims-based algorithms for identifying patients with DMD and capturing their nonambulatory and ventilation-dependent status. METHODS: This was a retrospective cohort study using the statistically deidentified Optum Market Clarity Database (including patient claims linked with electronic health records [EHRs] data) to develop and validate the following algorithms: DMD diagnosis, nonambulatory status, and ventilation-dependent status. The initial study sample consisted of US patients in the database who had a diagnosis code for Duchenne/Becker MD (DBMD) between October 1, 2018, and September 30, 2020, who were male, aged 40 years or younger on their first DBMD diagnosis, and met continuous enrollment and 1-day minimal clinical activities requirement in a 12-month measurement period between October 1, 2017, and September 30, 2020. The algorithms, developed by a cross-functional team of DMD specialists (including patient advocates), were based on administrative claims data with International Classification of Diseases, Tenth Revision, Clinical Modifications coding, using information of diagnosis codes for DBMD, sex, age, treatment, and disease severity (eg, evidence of ambulation assistance/support and/or evidence of ventilation support or dependence). Patients who met each algorithm and had EHR notes available were then validated against structured fields and unstructured provider notes from their own linked EHR to confirm patients' DMD diagnoses, nonambulatory status, and ventilation-dependent status. Algorithm performance was assessed by positive predictive value with 95% CIs. RESULTS: A total of 1,300 patients were included in the initial study sample. Of these, EHR were available and reviewed for 303 patients. The mean age of the 303 patients was 14.8 years, with 61.7% being non-Hispanic White. A majority had a Charlson comorbidity index score of 0 (59.4%) or 1-2 (27.7%). Positive predictive value (95% CI) was 91.6% (85.8%-95.6%) for the DMD diagnosis algorithm, 88.4% (80.2%-94.1%) for the nonambulatory status algorithm, and 77.8% (62.9%-88.8%) for the ventilation-dependent status algorithm. CONCLUSIONS: This work provides the means to more accurately identify patients with DMD from administrative claims data without a specific diagnosis code. The algorithms validated in this study can be applied to assess treatment effectiveness and other outcomes among patients with DMD treated in clinical practice. DISCLOSURES: This study was funded by Pfizer, which contracted with Optum to perform the study and provide medical writing assistance. Ms Schrader reports being an employee of Parent Project Muscular Dystrophy. Mr Posner reports being an employee and stockholder of Pfizer and receiving support from Pfizer for attending conferences not related to this manuscript. Dr Dorling reports being an employee and stockholder of Pfizer at the time the study was conducted and is a current employee of Chiesi USA, Inc. Ms Senerchia reports being an employee of Optum and owning stock in Pfizer and UnitedHealth Group, the parent company of Optum. Dr Chen reports being an employee and stockholder of Pfizer. Ms Beaverson reports being an employee of Pfizer and owning stock in Pfizer and Amicus Therapeutics. Dr Seare reports being an employee of Optum at the time the study was conducted. Dr Garnier and Ms Merla report being employees of Pfizer. Ms Walker reports being an employee of Optum. Dr Alvir reports being an employee and stockholder of Pfizer. Dr Mahn reports being an employee and stockholder of Pfizer. Dr Zhang reports being an employee of Optum. Ms Landis reports being an employee of Optum. Ms Buikema reports being an employee of Optum and holding stock in UnitedHealth Group, the parent company of Optum.

Overview of alopecia areata for managed care and payer stakeholders in the United States.

Alopecia areata (AA) is an autoimmune disease with a complex pathophysiology resulting in nonscarring hair loss in genetically susceptible individuals. We aim to provide health care decision makers an overview of the pathophysiology of AA, its causes and diagnosis, disease burden, costs, comorbidities, and information on current and emerging treatment options to help inform payer benefit design and prior authorization decisions. Literature searches for AA were conducted using PubMed between 2016 and 2022 inclusive, using search terms covering the causes and diagnosis of AA, pathophysiology, comorbidities, disease management, costs, and impact on quality of life (QoL). AA is a polygenic autoimmune disease that significantly impacts QoL. Patients with AA face economic burden and an increased prevalence of psychiatric disease, as well as numerous systemic comorbidities. AA is predominantly treated using corticosteroids, systemic immunosuppressants, and topical immunotherapy. Currently, there are limited data to reliably inform effective treatment decisions, particularly for patients with extensive disease. However, several novel therapies that specifically target the immunopathology of AA have emerged, including Janus kinase (JAK) 1/2 inhibitors such as baricitinib and deuruxolitinib, and the JAK3/tyrosine kinase expressed in hepatocellular carcinoma (TEC) family kinase inhibitor ritlecitinib. To support disease management, a disease severity classification tool, the Alopecia Areata Severity Scale, was recently developed that evaluates patients with AA holistically (extent of hair loss and other factors). AA is an autoimmune disease often associated with comorbidities and poor QoL, which poses a significant economic burden for payers and patients. Better treatments are needed for patients, and JAK inhibitors, among other approaches, may address this tremendous unmet medical need. DISCLOSURES: Dr King reports seats on advisory boards for and/or is a consultant and/or clinical trial investigator for AbbVie, Aclaris Therapeutics Inc, AltruBio Inc, Almirall, Arena Pharmaceuticals, Bioniz Therapeutics, Bristol Meyers Squibb, Concert Pharmaceuticals Inc, Dermavant Sciences Inc, Eli Lilly and Company, Equillium, Incyte Corp, Janssen Pharmaceuticals, LEO Pharma, Otsuka/Visterra Inc, Pfizer, Regeneron, Sanofi Genzyme, TWi Biotechnology Inc, and Viela Bio; and speakers bureaus for AbbVie, Incyte, LEO Pharma, Pfizer, Regeneron, and Sanofi Genzyme. Pezalla is a paid consultant to Pfizer for market access and payer strategy concerns; Fung, Tran, Bourret, Takiya, Peeples-Lamirande, and Napatalung are employees of Pfizer and hold stock in Pfizer. This article was funded by Pfizer.

In-lab Assessment of a Sternum-Worn Accelerometer to Measure Gait Speed in Healthy Individuals (P3-11.010)

<h3>Objective:</h3> To assess the validity of gait speed derived using a sternum-worn accelerometer, thus supporting the deployment of a single device to measure multiple biosignals, e.g., gait and ECG. <h3>Background:</h3> Gait assessment is essential to understand, diagnose, and monitor numerous neurological disorders. In contrast to conventional clinical evaluations, wearable sensors used in free-living environments grant more objective measurements. While wearing the widespread lumbar-worn accelerometers may be burdensome over the long-term, sternum-worn devices, already validated for at-home vitals monitoring, may be more comfortable. <h3>Design/Methods:</h3> During two in-lab visits, twenty healthy individuals (13 females, mean±sd age: 33.9±9.1 years, BMI: 24.4±4.67kg/m²) were instrumented with a 6-sensor set (APDM), including lumbar-worn and sternum-worn accelerometers. Participants underwent two assessments: A1) walking three 20-ft laps on an instrumented mat (GAITRite), at normal, slow, and fast speeds; A2) freely performing in-lab 20-min activities with frequent walking bouts. Gait speed was extracted by sternum-worn and lumbar-worn accelerometers (test devices) using the in-house built GaitPy algorithm, and compared against the values collected by GAITRite and APDM (reference devices for A1 and A2, respectively). Agreement was evaluated via Bland-Altman analysis, Pearson’s correlation (R), and intraclass correlation coefficient (ICC). <h3>Results:</h3> In A1, sternum-worn device underestimated gait speed compared to GAITRite, but the values were highly correlated, and the ICC showed moderate-to-good agreement (R: 0.91, 0.81, 0.66; bias (m/s): −0.137, −0.162, −0.209; ICC: 0.59, 0.50, 0.43, for slow, normal, and fast speeds, respectively). In A2, bias=0.055, R=0.82, and ICC= 0.78 demonstrated excellent agreement between gait speed derived from APDM and sternum-worn device. Sternum-worn and lumbar-worn accelerometers showed comparable performances. <h3>Conclusions:</h3> Sternum-worn devices can reliably measure gait speed both in scripted walking tasks and naturalistic walks. They can be deployed to simultaneously capture gait parameters and vital signs, thus opening new opportunities for more in-depth, free-living studies of patients with neurological disorders. <b>Disclosure:</b> Dr. Camerlingo has received personal compensation for serving as an employee of Pfizer. Mr. Welbourn has received personal compensation for serving as an employee of Mindlance, Inc. (employee servicing Pfizer). Mr. Psaltos has received personal compensation for serving as an employee of Pfizer. Mr. Messere has nothing to disclose. Dr. Zhang has received personal compensation for serving as an employee of Pfizer. Dr. Demanuele has received personal compensation for serving as an employee of Pfizer. Dr. Demanuele has stock in Pfizer. Dr. Santamaria Serra has nothing to disclose. Mr. Adamowicz has received personal compensation for serving as an employee of Pfizer. Mr. Adamowicz has stock in Pfizer. Dr. Karahanoglu has received personal compensation for serving as an employee of Pfizer. Dr. Cai has received personal compensation for serving as an employee of Pfizer. Dr. Cai has stock in Pfizer.

Phase 1 Trial of Darigabat for the Reduction of Acute Psychological and Physiological Panic and Fear Symptoms Following CO2 Inhalation in Healthy Participants (S8.005)

<h3>Objective:</h3> To evaluate the panicolytic effect of 2 dose strengths of darigabat in reducing panic and fear symptoms following carbon dioxide (CO₂) inhalation by healthy participants. <h3>Background:</h3> Panic disorder is associated with subjective and physiological symptoms which no single drug class adequately addresses. Darigabat, in development for neurological and psychiatric disorders, was designed to have nonsedative panicolytic potential by selectively enhancing the effect of GABA at α2/3/5, while sparing activity at α1 GABA_A receptor subtypes. <h3>Design/Methods:</h3> This phase 1 randomized, double-blind, crossover, placebo- and active-controlled trial (NCT04592536) enrolled adults sensitive to anxiogenic effects of 35% CO₂ double-breath inhalation. Participants were randomized to receive placebo and either 1 of 3 active treatments in 3 separate cohorts for 8 days: darigabat 7.5 or 25 mg twice daily (BID) or alprazolam 1 mg BID. Target darigabat doses were achieved following a 4-day titration. After each crossover period, CO₂ challenge was performed 3 hours post-dose. Panic and fear symptoms were measured before and immediately after CO₂ inhalation using the Panic Symptom List-IV total score (PSL-IV; primary endpoint) and fear visual analog scale (VAS Fear; secondary endpoint). Each participant’s placebo treatment served as their own control. <h3>Results:</h3> Fifty-six participants were randomized. On Day 8, darigabat 7.5-mg and 25-mg BID groups demonstrated a 3.9-point (nominal <i>P</i>=0.036) and 4.5-point (nominal <i>P</i>=0.008) improvement on the PSL-IV versus placebo, respectively. Darigabat groups demonstrated a 12.8-point (nominal <i>P</i>=0.026) and 7.8-point (nominal <i>P</i>=0.282) improvement on the VAS Fear versus placebo, respectively. The positive control (alprazolam 1 mg BID) exhibited panicolytic effect compared with placebo, in line with expectations. Darigabat was generally well tolerated, with no serious adverse events and no discontinuations in darigabat cohorts. <h3>Conclusions:</h3> The panicolytic potential of darigabat was validated, warranting further evaluation in patients with panic disorder. <b>Disclosure:</b> Dr. Gurrell has received personal compensation for serving as an employee of Cerevel Therapeutics. Dr. Gurrell has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Cerevel Therapeutics. Dr. Gurrell has stock in Pfizer Ltd. Ms. Chang has received personal compensation for serving as an employee of Cerevel. Ms. Chang has stock in Cerevel Therapeutics. Dr. Dandurand has received personal compensation for serving as an employee of Cerevel. Dr. Dandurand has received personal compensation for serving as an employee of Otsuka. Dr. Dandurand has stock in Cerevel Therapeutics. An immediate family member of Dr. Dandurand has stock in Velocit . An immediate family member of Dr. Dandurand has stock in Cerebus. Dr. Duvvuri has received personal compensation for serving as an employee of Cerevel. Dr. Duvvuri has stock in Cerevel Therapeutics. Dr. Duvvuri has stock in Pfizer. Amy Guigliano has nothing to disclose. Dr. Pastino has received personal compensation for serving as an employee of Cerevel Therapeutics. Dr. Pastino has received personal compensation for serving as an employee of PRA Health Sciences. Dr. Pham has nothing to disclose. Dr. Versavel has received personal compensation for serving as an employee of Cerevel Therapeutics. Dr. Versavel has received stock or an ownership interest from Cerevel Therapeutics. Dr. Jacobs has nothing to disclose. Mr. Pour has nothing to disclose. Dr. Zuiker has nothing to disclose. Dr. Sanchez has received personal compensation for serving as an employee of Cerevel Therapeutics. Dr. Sanchez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Coleman Research. Dr. Sanchez has received personal compensation in the range of $500,000-$999,999 for serving as an officer or member of the Board of Directors for Cerevel Therapeutics. Dr. Sanchez has received stock or an ownership interest from Cerevel Therapeutics. Dr. Sanchez has received personal compensation in the range of $500-$4,999 for serving as a Consultant with GLG. Dr. Renger has received personal compensation for serving as an employee of Cerevel Therapeutics.

A Phase 3, Open-Label, Multicenter Study To Evaluate Eculizumab In Adolescents With Refractory Generalized Myasthenia Gravis (S5.009)

A Phase 3, Open-Label, Multicenter Study To Evaluate Eculizumab In Adolescents With Refractory Generalized Myasthenia Gravis (S5.009)

Achievement of Improved Post-Intervention Status in Patients with Generalized Myasthenia Gravis Treated with Ravulizumab during the CHAMPION MG Study (S5.008)

Achievement of Improved Post-Intervention Status in Patients with Generalized Myasthenia Gravis Treated with Ravulizumab during the CHAMPION MG Study (S5.008)

Change in Concomitant Therapies for Generalized Myasthenia Gravis in Patients Receiving Eculizumab: a Retrospective Analysis of Registry Data (P1-5.002)

Change in Concomitant Therapies for Generalized Myasthenia Gravis in Patients Receiving Eculizumab: a Retrospective Analysis of Registry Data (P1-5.002)

Correlating Testing for Rare Genetic Variants with a Broad Clinicopathologic Spectrum of Congenital Myopathies (N4.003)

Correlating Testing for Rare Genetic Variants with a Broad Clinicopathologic Spectrum of Congenital Myopathies (N4.003)

Beyond migraine headache day reduction: Clinically meaningful improvement in disability (MIDAS score) in the absence of greater than 50% reductions in monthly migraine days with galcanezumab (P10-12.008)

Beyond migraine headache day reduction: Clinically meaningful improvement in disability (MIDAS score) in the absence of greater than 50% reductions in monthly migraine days with galcanezumab (P10-12.008)

Spontaneous Paradoxical Improvement of Motor Function after a Second Stroke (P2-5.009)

<h3>Objective:</h3> Describe paradoxical improvement of the motor function after a second stroke located in the area of the first stroke. <h3>Background:</h3> Animal studies have shown that humoral factors induced by acute stroke facilitate recovery more if rehabilitation is commenced earlier than later. Moreover, a second stroke may improve recovery from the first stroke. It is unknown if this phenomenon occurs in humans. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> 53-year-old right-handed woman with a history of hypertension and ischemic stroke 2 years before, with residual left hemiplegia, and post-stroke epilepsy presented with acute onset of mild weakness and numbness of the right arm and leg. Neurological examination revealed mild weakness and numbness of the left face, power of 4/5 and 5/5 in the right arm and leg respectively, and 0/5 in the left arm and leg. Sensation to light touch and pin was decreased in the left arm and leg. Vibration was decreased on left and proprioception was impaired distally bilaterally. Reflexes were 1+ at right triceps and biceps, 2+ at right patella, 3+ at left triceps, biceps, patella, and 0 at ankle bilaterally. Next day, she developed dysarthria and the power of right limbs decreased to 2/5. By the third day, dysarthria and right hemiparesis resolved. Additionally, the patient noted spontaneous increased power of the proximal left side to 3/5 in both arm and leg. However, distally, power remained 0/5 in both left arm and leg. MRI demonstrated acute infarction located in the center of a chronic infarct corresponding to the territory of right anterior cerebral artery. CT angiogram showed right anterior cerebral artery occlusion. <h3>Conclusions:</h3> The patient had spontaneous paradoxical improvement of the motor deficit after a second stroke. There is no similar case report in humans. This may confirm the limited window of improved recovery triggered by another stroke. <b>Disclosure:</b> Mr. Li has nothing to disclose. Dr. Bloch has nothing to disclose. Dr. Baek has nothing to disclose. Dr. Sivakumar has nothing to disclose. Dr. Hiana has nothing to disclose. Dr. Marchidann has stock in Eli Lilly. Dr. Marchidann has stock in Pfizer. Dr. Marchidann has stock in Merck. Dr. Marchidann has stock in Illumina. Dr. Marchidann has stock in Aeterna Zentaris. Dr. Marchidann has stock in Abbot. Dr. Marchidann has received publishing royalties from a publication relating to health care. Dr. Marchidann has received publishing royalties from a publication relating to health care.

Tracking Motor Impairment in People with Neurosarcoidosis (P9-5.009)

<h3>Objective:</h3> Evaluate NIH Toolbox motor battery (NIHTB-M), a multidimensional set of measures used to track motor impairment, for use in people with neurosarcoidosis (PwNS). <h3>Background:</h3> Despite its profound impact on quality of life, there are no validated measures of neurologic impairment in NS to track disability progression or treatment response. <h3>Design/Methods:</h3> Cross-sectional study of adults with NS recruited from a tertiary referral center for sarcoidosis. All participants were adults meeting NS Consortium diagnostic criteria for NS. NIHTB-M measures were compared to age-, education-, sex-, and race/ethnicity-matched peers using neurologically healthy individuals from the NIHTB norming project. NIHTB-M measures were compared to patient-reported assessments of mobility and fine motor control using Quality of Life in Neurological Disorders (Neuro-QoL) and clinician-assessed functional impairment using Barthel Index (BI). <h3>Results:</h3> 41 PwNS were enrolled, 62% female, 29% African American, 71% Caucasian, 86% with biopsy-proven sarcoidosis. 7% had severe, 27% moderate, 7% slight, and 56% no functional dependence by BI. Compared to propensity-matched healthy controls, impairment (≥ 1 standard deviation worse than normative mean) was more common in PwNS on 9-Hole Peg Test (9-HPT) (81% vs. 14%, OR: 19.53, 95%CI [6.51, 67.56]) and 4-Meter Walk Test (4-MWT) (77% vs. 15%, OR: 18.89, 95% CI [6.41, 64.41]). There were moderate correlations between 9-HPT and Neuro-QoL fine motor scores (r = 0.39, 95% CI [0.03, 0.66]) and strong correlations between 4-MWT and 2-Minute Walk Test (2-MWT) and Neuro-QoL mobility scores (r = −0.69, 95% CI [−0.84, −0.44]; 0.66, 95% CI [0.44, 0.78], respectively). Scores on 9-HPT (<i>P</i>=0.008), 4-MWT (<i>P</i>=0.007), 2-MWT (<i>P</i>=0.032), and select measures of Standing Balance Test (SBT) (<i>P</i> &lt; 0.001) were significantly different between subjects who were functionally dependent versus independent by BI. <h3>Conclusions:</h3> We provide preliminary evidence for validity of 9-HPT as a measure of fine motor control and 4-MWT, 2-MWT, and SBT as measures of mobility in PwNS. <b>Disclosure:</b> Dr. Moss has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. An immediate family member of Dr. Moss has stock in Pfizer. The institution of Dr. Moss has received research support from Novartis. The institution of Dr. Moss has received research support from Genentech. Nicholas Thompson has nothing to disclose. Daniel Culver has nothing to disclose.

Testosterone Therapy in a Transgender Male Patient as a cause of Acute Ischemic Stroke (P2-5.011)

<h3>Objective:</h3> To share an intriguing case of a young transgender male patient receiving testosterone therapy who developed locked-in syndrome due to an acute ischemic stroke and to highlight potential risk factors for stroke in the LGBTQI+ community <h3>Background:</h3> There are many studies identifying risk factors for stroke in racially and ethnically diverse populations. However, there is little existing data for stroke risk factors in the LGBTQI+ community. Prior research has shown testosterone therapy in cis-gender men with initially low levels of testosterone increases the risk of stroke, especially in the first 2 years of use¹. While testosterone therapy has been shown to increase the risk of venous thrombosis, its role in arterial thrombosis is unclear². A proposed mechanism for thrombosis with testosterone replacement includes erythrocytosis, but the potential contribution of an independent pro-coagulant effect is yet to be determined³. <h3>Design/Methods:</h3> Literature review and case report. <h3>Results:</h3> An otherwise healthy 23-year-old transgender male on one year of testosterone therapy presented in an obtunded state. Examination revealed complete quadriplegia with sparing of vertical eye movements, consistent with locked-in syndrome. Imaging revealed complete occlusion of the basilar artery with distal reconstitution at the superior cerebellar arteries, and a large bilateral ischemic infarct of the pons. Computed tomography angiography did not demonstrate other large vessel disease or structural vascular abnormalities. Unfortunately, the patient was out of the time window for any acute stroke interventions. A hypercoagulable workup was performed but results were unrevealing and hematocrit was normal. Further investigation with transthoracic echocardiogram, transesophageal echocardiogram, and telemetry were negative for thrombus, patent foramen ovale, and atrial fibrillation. <h3>Conclusions:</h3> Acute ischemic stroke may be an under recognized complication of testosterone therapy in transgender males independent of degree of erythrocytosis. Further research is needed to establish a safety profile of testosterone therapy in this understudied population. <b>Disclosure:</b> Dr. Tan has nothing to disclose. Mrs. Kim Sing has nothing to disclose. Dr. Danziger has nothing to disclose. Mr. AW has nothing to disclose. Dr. Kim has nothing to disclose. Dr. Avila has nothing to disclose. Dr. Alambyan has stock in Teleflex. Dr. Alambyan has stock in Natera. Dr. Alambyan has stock in Labcorp. Dr. Alambyan has stock in Veracyte. Dr. Alambyan has stock in Vicarious Surgical. Dr. Alambyan has stock in Unity Biotechnology. Dr. Alambyan has stock in Scynexis. Dr. Alambyan has stock in Stryker. Dr. Alambyan has stock in Eli Lilly. Dr. Alambyan has stock in DaVita. Dr. Alambyan has stock in Invitae. Dr. Alambyan has stock in Pfizer. Dr. Alambyan has stock in Bristol-Myers Squibb. Dr. Alambyan has stock in Johnson and Johnson. Dr. Alambyan has stock in Merck. Dr. Alambyan has stock in Medtronic. Dr. Alambyan has stock in AbbVie. The institution of Dr. Alambyan has received research support from Albert Einstein Healthcare Network. Dr. Mehdi has nothing to disclose. Dr. Gezalian has nothing to disclose. Dr. Ayodele has nothing to disclose. Dr. Toossi has nothing to disclose.

Natural History of Seizures in Alexander Disease (P10-9.011)

<h3>Objective:</h3> To describe seizure burden in Alexander disease (AxD) <h3>Background:</h3> Seizures in AxD contribute to both burden of disease and neurologic deterioration. Patients with provoked seizures at presentation are often not initiated on anti-seizure medication (ASM) in the setting of delayed recognition of AxD. Improved understanding of seizure burden over time in AxD may aid in diagnosis, anticipatory guidance, and management. <h3>Design/Methods:</h3> Medical records and structured interviews of AxD participants in a natural history study (1/2016–9/2022) were reviewed for occurrence of seizures and presence of provoking factors (illnesses with or without fever, ingestions, head trauma). Descriptive statistics were used to quantify seizure burden over time. <h3>Results:</h3> Of 81 patients with a median age at last follow-up of 10.1 years (IQR11.3), 46 (57%) had ≥1 seizure. First seizure occurred at a mean age of 29.9 months (SD45.6) overall, with no significant difference between patients whose first seizure was provoked vs unprovoked (22.4 months, SD18.0 vs 45.3 months, SD75.0, p=0.3). Overall, 96% of patients had additional seizures; of these 87% had multiple unprovoked seizures. Only 9% had exclusively provoked seizures. Excluding two outliers, first seizure preceded the diagnosis of AxD by a mean of 20.8 months (SD41.5). EEG abnormalities (generalized or focal slowing, epileptiform discharges) were similarly common prior to diagnosis. Of these patients, 63% had their first seizure, provoked or unprovoked, prior to 2 years of age. At this same age 94% of the cohort had already demonstrated developmental delay. <h3>Conclusions:</h3> Provoked seizures are common in patients with AxD, often occurring concurrently with developmental delays and prior to the diagnosis of underlying leukodystrophy. Provoked seizures in the setting of developmental delays, even when mild, should prompt additional evaluation. Given high incidence of unprovoked seizures over time as well as associated risk of neurologic regression, provoked seizures in patients with AxD should prompt consideration of ASM. <b>Disclosure:</b> Miss Gallison has nothing to disclose. Dr. Porcari has nothing to disclose. Ms. Sergio has nothing to disclose. Dr. Waldman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for SwanBio. An immediate family member of Dr. Waldman has stock in Pfizer. The institution of Dr. Waldman has received research support from Ionis Pharmaceuticals. Dr. Waldman has received publishing royalties from a publication relating to health care.

Cryoglobulinemia and Neuromyelitis optica: a case of progressive weakness and neurocognitive decline (P10-5.026)

<h3>Objective:</h3> Describe a case of a woman with mixed cryoglobulinemia who presented with progressive weakness and biopsy proven systemic vasculitis in the setting of Hepatitis C virus (HCV) negative serology. <h3>Background:</h3> The disease expression of mixed cryoglobulinemia vasculitis caused by HCV infection triggers the downstream B-cell arm of autoimmunity. <h3>Design/Methods:</h3> A 61 year old woman with a history of HCV infection, mixed cryoglobulinemia, mononeuritis multiplex secondary to nervous system vasculitis affecting peripheral nerves and hypertension presented with weakness that progressed to quadriparesis and neurocognitive decline over a period of eight months. <h3>Results:</h3> MRI examination of the brain showed bilateral ventral pontine lesions extending into the middle cerebellar peduncles, ventrolateral midbrain and cerebral peduncles as well as bilateral cortical frontal lobe lesions. Also present were intrinsic mixed intensity DWI/ADC lesions of undetermined etiology and extensive subcortical and periventricular white matter hyperintensities. CT angiography of her head and neck showed large vessel intracranial vasculopathy involving the bilateral MCA branches. Conventional angiogram, however, did not show any evidence of angiographic vasculitis. MRI spectroscopy was non-diagnostic. MRI of the neuroaxis showed a small focus of linear non-enhancing hyperintense lesion at the level of C3. EMG demonstrated severe generalized sensory-motor polyneuropathy with severe axonal loss. EEG showed mild to moderate diffuse slowing. CSF evaluation was negative, HCV viral load was undetectable, connective tissue markers (Anti-dsDNA, Anti-SCL70, Anti-CENTR, Anti-RNP, Anti-Smith, Anti-SSA/SSB, ANCA) were negative and the remaining serology was significant for elevated ESR, CRP, low C4 complements, positive anti-AQP4 antibodies titers (1:2560) and positive myelin basic protein. Brain biopsy showed perivascular lymphocytic inflammation, confirming vasculitis. Our patient completed courses of high dose steroids, IVIG and Rituximab with mild improvement in motor strength. <h3>Conclusions:</h3> Although an atypical feature of NMO, cryoglobulinemia with production of anti-AQP4 antibodies may, in part, contribute to development of a demyelinating process. <b>Disclosure:</b> Dr. Esechie has nothing to disclose. Dr. Harazeen has nothing to disclose. Dr. Rivera Vega has nothing to disclose. Dr. Thottempudi has nothing to disclose. Dr. Chhabra has stock in Pfizer. Dr. Chhabra has stock in Biogen. Dr. Chhabra has stock in Johnson and Johnson. Dr. Chhabra has stock in Medtronic. Dr. Shaltoni has nothing to disclose. Muhammad Zeeshan Memon, MD has nothing to disclose. Dr. Patel has nothing to disclose. Dr. Wu has nothing to disclose.

CHANTER Syndrome: A Rare Cause of Encephalopathy and Ischemic Lesions (P2-5.017)

<h3>Objective:</h3> To present a rare case of Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER) Syndrome. <h3>Background:</h3> CHANTER syndrome is a recently recognized constellation of clinical and radiologic findings. The clinical features include acutely depressed consciousness with obstructive hydrocephalus secondary to cerebellar edema. MRI findings are restricted diffusion in the cerebellar cortex, hippocampi, and basal nuclei. CHANTER is distinguished from ischemic stroke by lack of distribution in a specific vascular territory or vascular occlusion present on angiographic imaging. Etiology may be a primary metabolic or mitochondrial failure of the gray matter with anoxic injury precipitated by opiates or other drugs of abuse. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A 70-year-old right-handed hypertensive woman with HIV, end-stage renal failure, and lymphoma in remission was in respiratory distress. Seizures of unclear duration were noted on ambulance arrival and midazolam was administered. She was intubated and loaded with levetiracetam for status epilepticus. Norepinephrine was given during a hypotensive episode. Neurological examination was remarkable for lack of motor response to noxious stimuli and present brainstem reflexes consistent with coma. Opiates were detected in urine. MRI brain showed multiple small foci of restricted diffusion involving bilateral cerebellar hemispheres, hippocampi, basal ganglia, and in the right parietal cortex. MR angiography of the head and neck was normal. Video EEGs showed severe diffuse slowing, generalized periodic discharges that became blunted with triphasic morphology after lorazepam and levetiracetam administration. Cardiac monitoring and echocardiogram were unremarkable. Her alertness improved and withdrew minimally all extremities to painful stimuli. She was discharged to a long-term skilled nursing facility. <h3>Conclusions:</h3> This case highlights a rare clinical manifestation suggestive of CHANTER syndrome. Unlike other cases previously described, the cerebellar lesions were not sufficiently large to cause hydrocephalus. However, the clinical recovery was very limited. Status epilepticus and transient hypotension may have played a role in the poor recovery. <b>Disclosure:</b> Dr. Hiana has nothing to disclose. Dr. Soh has nothing to disclose. Dr. Marchidann has stock in Eli Lilly. Dr. Marchidann has stock in Pfizer. Dr. Marchidann has stock in Merck. Dr. Marchidann has stock in Illumina. Dr. Marchidann has stock in Aeterna Zentaris. Dr. Marchidann has stock in Abbot. Dr. Marchidann has received publishing royalties from a publication relating to health care. Dr. Marchidann has received publishing royalties from a publication relating to health care.

Endovascular Thrombectomy Versus Medical Management for Large Vessel Occlusion Stroke Patients with Severe Baseline Disability (S24.008)

<h3>Objective:</h3> To compare the long-term outcomes and likelihood of transitions to comfort care for large vessel occlusion (LVO) stroke patients with severe baseline disability treated with endovascular thrombectomy (EVT) versus medical management. <h3>Background:</h3> Patients with baseline disability account for up to one-third of stroke presentations, but have traditionally been excluded from early clinical trials of acute stroke interventions. Despite growing evidence supporting a benefit from endovascular thrombectomy, there remains significant controversy in treatment selection. <h3>Design/Methods:</h3> Individuals who presented with LVO were identified from a prospectively maintained database from January 2017 to December 2020. Severe baseline disability was defined as modified Rankin Scale (mRS) 3–5. Delta mRS was defined as the difference between baseline and 90-day mRS. Logistic and ordinal regressions were performed to evaluate the relationships between EVT and clinical outcomes. <h3>Results:</h3> A total of 175/1007 (17%) patients were identified with severe baseline disability. The median age was 82 (IQR 70–89), and 59% were female. Thirty-two (18%) patients with severe baseline disability were treated with EVT. EVT was independently associated with improved delta mRS (B=−1.048; 95%CI=−1.777,−0.318; p=0.005) when accounting for age and NIHSS. However, EVT did not reduce the odds of transitioning to comfort care (aOR=0.794; 95%CI=0.347,1.818; p=0.585) when accounting for age and NIHSS. Seventy-six (43%) patients with severe baseline disability were transitioned to comfort care. Of the 99 patients who were not transitioned to comfort care, 18 were treated with EVT. In this subgroup not transitioned to comfort care, EVT was independently associated with improved delta mRS (B=−2.794; 95%CI=−4.002,−1.586; p&lt;0.0001) when accounting for age and NIHSS. <h3>Conclusions:</h3> Among patients with severe baseline disability, EVT is associated with less post-stroke accumulated disability without limiting transitions to comfort care. EVT is compatible with goal-concordant care in patients with severe baseline disability; it should not be routinely withheld on the sole basis of baseline disability. <b>Disclosure:</b> Dr. Awad has nothing to disclose. Dr. Young has nothing to disclose. Dr. Andreev has nothing to disclose. Dr. Dmytriw has nothing to disclose. Dr. Vranic has nothing to disclose. James D. Rabinov has stock in Pfizer. Dr. Stapleton has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll Circulation. Dr. Das has nothing to disclose. An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (Education) with Biogen. Dr. Rost has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care. Aman Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Penumbra. Aman Patel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Microvention. Aman Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. The institution of Aman Patel has received research support from Siemens. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation.

Transient Perivascular Inflammation of the Carotid Artery (TIPIC) Syndrome after Breast Implant Surgery (P2-5.003)

<h3>Objective:</h3> Describe a rare case of TIPIC syndrome in a patient with breast implants. <h3>Background:</h3> TIPIC syndrome is a rare cause of neck pain caused by inflammation of unknown etiology. Silicone from the breast implant shell may may leak in the systemic circulation and trigger silicone implant incompatibility syndrome (SIIS) a form of autoimmune/inflammatory syndrome induced by adjuvants (ASIA). Several autoimmune conditions including vasculitis at distance from the implant were described. The association between breast implantation and TIPIC syndrome was not reported yet. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> 38-year-old woman with a history of asthma, HIV, and depression complained of refractory left-sided neck pain for ten days. Pain started gradually, was sharp, radiating to the left face, and was aggravated by motion and swallowing. Three weeks before onset, she had transient respiratory infection. She denied preceding neck trauma or other neurological symptoms. Acetaminophen, oxycodone, morphine and ketorolac provided moderate, short-lived relief. She had sex reassignment surgery including breast implants. Her home medications were spironolactone, estradiol, aripiprazole, emtricitabine and tenofovir disoproxil fumarate. She drinks alcohol occasionally. Clinical examination revealed left neck tenderness but no bruit, warmth, or swelling. Neurological examination was normal. CT showed eccentric hypoattenuation surrounding the left distal common carotid artery and a soft intimal plaque. MRI showed enhancement surrounding the left as well as the right common carotid artery without luminal narrowing, suggestive of TIPIC. Neck pain resolved after a short course of oral prednisone. ESR and CRP were normal. Repeated MRI after 6 months showed resolution of the perivascular inflammation. <h3>Conclusions:</h3> This is the first TIPIC case reported after breast implantation, suggesting an autoimmune response. Reactivity against the left carotid plaque is an alternative cause, but it does not explain the inflammation around the right carotid artery where is no plaque. TIPIC syndrome should be differentiated from other causes of vasculitis and dissection. <b>Disclosure:</b> Dr. Peringassery Sateesh has nothing to disclose. Dr. Marchidann has stock in Eli Lilly. Dr. Marchidann has stock in Pfizer. Dr. Marchidann has stock in Merck. Dr. Marchidann has stock in Illumina. Dr. Marchidann has stock in Aeterna Zentaris. Dr. Marchidann has stock in Abbot. Dr. Marchidann has received publishing royalties from a publication relating to health care. Dr. Marchidann has received publishing royalties from a publication relating to health care.

Invasive Fungal Infection of the Duramater as the Presenting Manifestation of Disseminated Sarcoidosis (P10-10.005)

<h3>Objective:</h3> To describe a case of invasive fungal infection of the duramater which was the presenting manifestation of Disseminated sarcoidosis <h3>Background:</h3> Invasive Central nervous system fungal infections are usually encountered in the setting of immunosuppressive conditions, craniospinal trauma or instrumentation. It is rare for a treatment naïve patient with sarcoidosis to develop fungal infection of the duramater. <h3>Design/Methods:</h3> We describe the case of a young male who was found to have nodular thickening of the duramater due to Invasive CNS fungal infection. <h3>Results:</h3> We had a 27 year old man who had no prior comorbidities who presented with a single seizure. On evaluation, he was found to have nodular thickening of the Duramater. Differentials of infective, inflammatory, histiocytic and malignant conditions were considered. He underwent detailed evaluation and PET-CT revealed generalized lymphadenopathy. Biopsy from the dural thickening revealed septate hyphae and fungal culture showed Acremonium species. There were granulomas found on histopathologic examination of the dural as well as subcarinal lymphnode biopsy. He was treated with Voriconazole for 24 weeks followed by treatment of sarcoidosis. <h3>Conclusions:</h3> Sarcoidosis may be associated with immunodeficiency due to its effects on the lymphocytes, bone marrow and other organs such as the thymus. There have been several reports of patients with sarcoidosis being predisposed to infections such as Progressive multifocal leukoencephalopathy, fungal infections, tuberculosis and other bacterial infections. These infections may occur de-novo in the absence of immunosuppressant drugs or corticosteroids which have been traditionally used in the management of sarcoidosis with organ threatening or life threatening symptoms. Infections that occur as the first manifestation of an underlying autoimmune condition are challenging to diagnose. Appropriate diagnosis is essential to ensure optimum treatment of both conditions. <b>Disclosure:</b> Dr. Elavarasi has stock in Pfizer. Dr. Elavarasi has stock in PGHL. The institution of Dr. Elavarasi has received research support from All India Institute of Medical Sciences, New Delhi. The institution of Dr. Elavarasi has received research support from Indian Council for Medical Research. Dr. SINGH has nothing to disclose. Dr. CHHATTERPAL has nothing to disclose. Dr. Wig has nothing to disclose. Dr. Mittal has nothing to disclose. Mehar Chand Sharma has nothing to disclose. Dr. DAS has nothing to disclose. Ajay Garg has nothing to disclose. Dr. Jagdevan has nothing to disclose. Dr. Shamim has nothing to disclose. Dr. Tripathi has nothing to disclose. Dr. Vibha has nothing to disclose. Rajesh Kumar Singh has nothing to disclose.