scholarly journals Cognitive Performance in Relapsing-Remitting Multiple Sclerosis: At Risk or Impaired?

2020 ◽  
Vol 49 (6) ◽  
pp. 539-543
Author(s):  
Marta Altieri ◽  
Mariangela Fratino ◽  
Ilaria Maestrini ◽  
Claudia Dionisi ◽  
Rosanna Annecca ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
At Risk ◽  
Cognitive Assessment ◽  
Screening Test ◽  
Neuropsychological Battery ◽  
Relapsing Remitting ◽  
Patients At Risk ◽  
Risk Patients ◽  
Lower Education ◽  
Relapsing Remitting Multiple Sclerosis

<b><i>Introduction:</i></b> Since cognitive impairment (CI) occurs on average in 45% of multiple sclerosis (MS) patients, the early detection of patients “at risk” of CI is important in order to promptly apply preventive strategies. The aim of the present study was to investigate the prevalence and risk factors for CI in MS patients using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) as a screening test. <b><i>Methods:</i></b> During the 1-year period, CI was evaluated in 82 consecutives mild relapsing-remitting MS (EDSS ≤ 3.5) patients. Patients with 1 altered BICAMS test were defined “at risk.” Both “at risk” and CI patients underwent an extensive neuropsychological battery. <b><i>Results:</i></b> We found that: (i) 23% had CI, (ii), 25% were “at risk” of CI, and (iii) 76% of the “at risk” patients were already impaired at the NP assessment. In particular, the Symbol Digit Modalities Test was the most compromised (70% of “at risk” and 79% of CI patients). Patients with CI had more frequently an EDSS ≥ 2.5 (<i>p</i> = 0.05), lower education (<i>p</i> = 0.05), and relapses in the last 12 months (<i>p</i> = 0.03). <b><i>Conclusions:</i></b> CI is a significant issue in MS and integration of a screening test, such as the SDMT, into routine clinical practice could be of worth to identify “at risk” patients and to promote an early therapeutic intervention.

Switching to ocrelizumab in RRMS patients at risk of PML previously treated with extended interval dosing of natalizumab

2020 ◽  
pp. 135245852094601
Author(s):  
Chiara Rosa Mancinelli ◽  
Cristina Scarpazza ◽  
Cinzia Cordioli ◽  
Nicola De Rossi ◽  
Sarah Rasia ◽  
...  
Keyword(s):  
At Risk ◽  
Resonance Imaging ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Patients At Risk ◽  
Risk Of Disease ◽  
Previously Treated ◽  
Disease Reactivation ◽  
Magnetic Resonance Imaging Mri ◽  
Relapsing Remitting Multiple Sclerosis

Discontinuation of natalizumab in patients with relapsing-remitting multiple sclerosis (RRMS) at risk of progressive multifocal leukoencephalopathy (PML) is associated with disease reactivation. Forty-two RRMS patients, who switched from an extended interval dose (EID) of natalizumab to ocrelizumab, underwent magnetic resonance imaging (MRI) and clinical monitoring during washout and after ocrelizumab starting. During the first 3 months, disease reactivation was observed in five (12%) patients; 6 months after ocrelizumab starting, no further relapses were recorded, and Expanded Disability Status Scale (EDSS) remained stable in 38 (90%) patients. In conclusion, ocrelizumab could be considered a choice to mitigate the risk of disease reactivation in patients previously treated with natalizumab-EID.

scholarly journals Natalizumab versus fingolimod for patients with active relapsing-remitting multiple sclerosis: results from REVEAL, a prospective, randomised head-to-head study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038861
Author(s):  
Helmut Butzkueven ◽  
Stephanie Licata ◽  
Douglas Jeffery ◽  
Douglas L Arnold ◽  
Massimo Filippi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cumulative Probability ◽  
T2 Lesions ◽  
Parallel Group ◽  
Relapsing Remitting ◽  
Patients At Risk ◽  
Secondary Endpoints ◽  
Remitting Multiple Sclerosis ◽  
Intent To Treat ◽  
Relapsing Remitting Multiple Sclerosis

ObjectiveTo directly compare the efficacy of natalizumab and fingolimod in patients with active relapsing-remitting multiple sclerosis.MethodsThis phase 4, randomised, rater- and sponsor-blinded, prospective, parallel-group, clinic-based head-to-head study was conducted at 43 sites in nine countries. Patients were randomised (1:1) to intravenous natalizumab 300 mg every 4 weeks or oral fingolimod 0.5 mg once daily for ≤52 weeks. Enrolment-related early study termination precluded assessment of the primary endpoint (evolution of new on-treatment gadolinium-enhancing (Gd+) lesions to persistent black holes). Unplanned exploratory analyses of secondary endpoints evaluated the effects of treatment on the development of new T1 Gd+ lesions and new/newly enlarging T2 lesions, lesion volumes and relapse outcomes.ResultsThe intent-to-treat population comprised 108 patients (natalizumab, n=54; fingolimod, n=54); 63 completed ≥24 weeks of treatment. Due to the limited numbers of events and patients at risk, MRI and relapse outcomes were reported over up to 24 and 36 weeks, respectively. The mean number of new T1 Gd+ lesions was numerically lower with natalizumab than with fingolimod by 4 weeks; accumulation rates were 0.02 and 0.09 per week, respectively, over 24 weeks (p=0.004). The cumulative probability of developing ≥1 lesion at 24 weeks was 40.7% with natalizumab versus 58.0% with fingolimod (HR=0.60; 95% CI 0.31–1.16; p=0.126); the corresponding probabilities for ≥2 lesions were 11.5% vs 48.5% (HR=0.25; 95% CI 0.09–0.68; p=0.007). No significant between-group differences were observed for the other MRI outcomes at 24 weeks. The cumulative probability of relapse over follow-up was 1.9% with natalizumab versus 22.3% with fingolimod (HR=0.08; 95% CI 0.01–0.64; p=0.017). Adverse events were consistent with known safety profiles.ConclusionsThese results suggest that natalizumab is more efficacious than fingolimod in reducing multiple sclerosis relapses and T1 Gd+ lesion accumulation in patients with active disease.Trial registration numbersNCT02342704; EUCTR2013-004622-29-IT; Post-results.

scholarly journals Risk factors for leaving employment due to multiple sclerosis and changes in risk over the past decades: Using competing risk survival analysis

2020 ◽  
pp. 135245852095416
Author(s):  
Jing Chen ◽  
Bruce Taylor ◽  
Leigh Blizzard ◽  
Steve Simpson-Yap ◽  
Andrew J Palmer ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Survival Analysis ◽  
Progressive Multiple Sclerosis ◽  
Education Level ◽  
Competing Risk ◽  
Primary Progressive Multiple Sclerosis ◽  
Lower Education Level ◽  
Relapsing Remitting ◽  
Lower Education ◽  
Relapsing Remitting Multiple Sclerosis

Background: No studies have assessed changes in employment survival in multiple sclerosis (MS) populations over recent decades, including the introduction of disease-modifying therapies (DMTs). Objectives: To evaluate factors associated with leaving employment due to MS; to assess whether the risk of leaving employment has changed over recent decades in Australia, stratified by MS phenotype. Methods: We included 1240 participants who were working before MS diagnosis. Information on employment status, reasons for leaving employment and year of leaving were collected. Data were analysed using competing risk survival analysis. Results: Males, progressive MS, lower education level and older age at diagnosis were associated with a higher sub-distribution hazard of leaving employment. Compared to the period before 2010, the sub-distribution hazard during 2010–2016 for relapsing-remitting multiple sclerosis (RRMS) was reduced by 43% (sub-distribution hazard ratio (sHR) 0.67, 95% confidence interval (CI): 0.50 to 0.90), while no significant reduction was seen for primary-progressive multiple sclerosis (PPMS) (sHR 1.25, 95% CI: 0.72 to 2.16) or secondary-progressive multiple sclerosis (SPMS) (sHR 1.37, 95% CI: 0.84 to 2.25). Conclusion: Males, people with progressive MS and those of lower education level were at higher risk of leaving employment. The differential changed risk of leaving employment between people with different MS phenotype after 2010 coincides with the increased usage of high-efficacy DMTs for RRMS.

scholarly journals Recurrence of disease activity during pregnancy after cessation of fingolimod in multiple sclerosis

2017 ◽  
Vol 24 (7) ◽  
pp. 991-994 ◽  
Author(s):  
Ingrid Meinl ◽  
Joachim Havla ◽  
Reinhard Hohlfeld ◽  
Tania Kümpfel
Keyword(s):  
Multiple Sclerosis ◽  
At Risk ◽  
Disease Activity ◽  
Effective Treatment ◽  
Disease Course ◽  
Risk Of Recurrence ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Risk Of Relapse

Background: Fingolimod is an effective treatment for active relapsing–remitting multiple sclerosis (MS). Discontinuation of therapy may be followed by recurrence of disease activity. Thus, female MS patients may be at risk of relapse during pregnancy after stopping fingolimod. Objectives and methods: To report the disease course during pregnancy of five women who interrupted therapy with fingolimod for pregnancy. Results: All patients experienced relapses during pregnancy and/or postpartum after stopping fingolimod. Conclusion: The risk of recurrence of disease activity during pregnancy after stopping fingolimod may be substantial. This should be considered and discussed with MS patients who are planning to become pregnant.

Effects of relapsing-remitting multiple sclerosis on the stomatognathic system: preliminary findings

2020 ◽  
Vol 179 (6) ◽  
Author(s):  
Gabriel Pádua da Silva ◽  
Marcelo Palinkas ◽  
Robson F. Tosta Lopes ◽  
Saulo C. Vallin Fabrin ◽  
Bruno Ferreira ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Stomatognathic System ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis
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