Literature Monitor

Key clinical point: Newer oral and intravenous drugs for multiple schlerosis provide significantly better disease activity control than the older injectables as initial disease-modifying therapy in children.

Major finding: The number needed to treat with a newer disease-modifying drug rather than an injectable agent to prevent one relapse was 3.7.

Study details: A prospective, multicenter, observational cohort study including 741 pediatric patients with MS followed while on their first-time disease-modifying therapy.

Disclosures: The study was sponsored by the Multiple Sclerosis Society. Dr. Kysko reported having no financial conflicts in regard to the study.

Citation: Krysko KM. ECTRIMS 2019, abstract 249.

Key clinical point: Newer oral and intravenous drugs for multiple schlerosis provide significantly better disease activity control than the older injectables as initial disease-modifying therapy in children.

Major finding: The number needed to treat with a newer disease-modifying drug rather than an injectable agent to prevent one relapse was 3.7.

Study details: A prospective, multicenter, observational cohort study including 741 pediatric patients with MS followed while on their first-time disease-modifying therapy.

Disclosures: The study was sponsored by the Multiple Sclerosis Society. Dr. Kysko reported having no financial conflicts in regard to the study.

Citation: Krysko KM. ECTRIMS 2019, abstract 249.

Key clinical point: Newer oral and intravenous drugs for multiple schlerosis provide significantly better disease activity control than the older injectables as initial disease-modifying therapy in children.

Major finding: The number needed to treat with a newer disease-modifying drug rather than an injectable agent to prevent one relapse was 3.7.

Study details: A prospective, multicenter, observational cohort study including 741 pediatric patients with MS followed while on their first-time disease-modifying therapy.

Disclosures: The study was sponsored by the Multiple Sclerosis Society. Dr. Kysko reported having no financial conflicts in regard to the study.

Citation: Krysko KM. ECTRIMS 2019, abstract 249.

Key clinical point: Treatment with DMT for more than 10 years reduces the risk of confirmed disability progression in MS.

Major finding: Continuous treatment with DMT reduced the risk of 24-month confirmed disability progression by 35%.

Study details: A retrospective analysis of data for 15,602 patients with relapsing-remitting MS.

Disclosures: Two of the researchers are employees of Biogen International, which supported the research. Several investigators received compensation or funding from various pharmaceutical companies.

Citation: Laffaldano P et al. ECTRIMS 2019. Abstract 94.

Key clinical point: Treatment with DMT for more than 10 years reduces the risk of confirmed disability progression in MS.

Major finding: Continuous treatment with DMT reduced the risk of 24-month confirmed disability progression by 35%.

Study details: A retrospective analysis of data for 15,602 patients with relapsing-remitting MS.

Disclosures: Two of the researchers are employees of Biogen International, which supported the research. Several investigators received compensation or funding from various pharmaceutical companies.

Citation: Laffaldano P et al. ECTRIMS 2019. Abstract 94.

Key clinical point: Treatment with DMT for more than 10 years reduces the risk of confirmed disability progression in MS.

Major finding: Continuous treatment with DMT reduced the risk of 24-month confirmed disability progression by 35%.

Study details: A retrospective analysis of data for 15,602 patients with relapsing-remitting MS.

Disclosures: Two of the researchers are employees of Biogen International, which supported the research. Several investigators received compensation or funding from various pharmaceutical companies.

Citation: Laffaldano P et al. ECTRIMS 2019. Abstract 94.

Key clinical point: Only one intervention – transcranial direct current stimulation (tDCS) – has been found to counteract cognitive fatigability in a trial with objective outcome measures.

Major finding: Compared with sham stimulation, anodal tDCS increased P300 amplitude and reduced fatigue-related decrements in reaction time in a preliminary study.

Study details: A systematic review of intervention studies that objectively measured cognitive fatigability in adults with neurologic disorders.

Disclosures: The authors had no disclosures.

Citation: Lindsay-Brown A et al. CMSC 2019, Abstract NNN10.

Key clinical point: Only one intervention – transcranial direct current stimulation (tDCS) – has been found to counteract cognitive fatigability in a trial with objective outcome measures.

Major finding: Compared with sham stimulation, anodal tDCS increased P300 amplitude and reduced fatigue-related decrements in reaction time in a preliminary study.

Study details: A systematic review of intervention studies that objectively measured cognitive fatigability in adults with neurologic disorders.

Disclosures: The authors had no disclosures.

Citation: Lindsay-Brown A et al. CMSC 2019, Abstract NNN10.

Key clinical point: Only one intervention – transcranial direct current stimulation (tDCS) – has been found to counteract cognitive fatigability in a trial with objective outcome measures.

Major finding: Compared with sham stimulation, anodal tDCS increased P300 amplitude and reduced fatigue-related decrements in reaction time in a preliminary study.

Study details: A systematic review of intervention studies that objectively measured cognitive fatigability in adults with neurologic disorders.

Disclosures: The authors had no disclosures.

Citation: Lindsay-Brown A et al. CMSC 2019, Abstract NNN10.

Key clinical point: Prices of self-administered disease-modifying therapies for multiple sclerosis increased significantly from 2006 to 2016.

Major finding: Patients’ out-of-pocket costs increased by a factor of 7.2 during this period.

Study details: A cohort study of Medicare claims data from 2006 to 2016.

Disclosures: The Myers Family Foundation and the National Heart, Lung, and Blood Institute funded this research. Several authors are employees of health insurance companies such as the UPMC Health Plan Insurance Services Division and Humana. One author received personal fees from Pfizer that were unrelated to this study.

Citation: San-Juan-Rodriguez A et al. JAMA Neurol. 2019 Aug 26. doi: 10.1001/jamaneurol.2019.2711; Hartung DM and Bourdette D. JAMA Neurol. 2019 Aug 26. doi: 10.1001/jamaneurol.2019.2445.

Key clinical point: Prices of self-administered disease-modifying therapies for multiple sclerosis increased significantly from 2006 to 2016.

Major finding: Patients’ out-of-pocket costs increased by a factor of 7.2 during this period.

Study details: A cohort study of Medicare claims data from 2006 to 2016.

Disclosures: The Myers Family Foundation and the National Heart, Lung, and Blood Institute funded this research. Several authors are employees of health insurance companies such as the UPMC Health Plan Insurance Services Division and Humana. One author received personal fees from Pfizer that were unrelated to this study.

Citation: San-Juan-Rodriguez A et al. JAMA Neurol. 2019 Aug 26. doi: 10.1001/jamaneurol.2019.2711; Hartung DM and Bourdette D. JAMA Neurol. 2019 Aug 26. doi: 10.1001/jamaneurol.2019.2445.

Key clinical point: Prices of self-administered disease-modifying therapies for multiple sclerosis increased significantly from 2006 to 2016.

Major finding: Patients’ out-of-pocket costs increased by a factor of 7.2 during this period.

Study details: A cohort study of Medicare claims data from 2006 to 2016.

Disclosures: The Myers Family Foundation and the National Heart, Lung, and Blood Institute funded this research. Several authors are employees of health insurance companies such as the UPMC Health Plan Insurance Services Division and Humana. One author received personal fees from Pfizer that were unrelated to this study.

Citation: San-Juan-Rodriguez A et al. JAMA Neurol. 2019 Aug 26. doi: 10.1001/jamaneurol.2019.2711; Hartung DM and Bourdette D. JAMA Neurol. 2019 Aug 26. doi: 10.1001/jamaneurol.2019.2445.

Key clinical point: Clinical and imaging outcomes improve among patients with MS who switch from interferon beta-1a to alemtuzumab.

Major finding: The rate of freedom from relapse ranged from 83% to 90%, and disability scores were stable for 51% of patients.

Study details: An examination of data for 117 patients with MS who participated in extensions of the CARE-MS II trial.

Disclosures: Sanofi and Bayer HealthCare Pharmaceuticals supported this study. Dr. Ionete received research support from Biogen, Roche, and Sanofi. She reported receiving compensation for advisory board participation from Sanofi.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Clinical and imaging outcomes improve among patients with MS who switch from interferon beta-1a to alemtuzumab.

Major finding: The rate of freedom from relapse ranged from 83% to 90%, and disability scores were stable for 51% of patients.

Study details: An examination of data for 117 patients with MS who participated in extensions of the CARE-MS II trial.

Disclosures: Sanofi and Bayer HealthCare Pharmaceuticals supported this study. Dr. Ionete received research support from Biogen, Roche, and Sanofi. She reported receiving compensation for advisory board participation from Sanofi.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Clinical and imaging outcomes improve among patients with MS who switch from interferon beta-1a to alemtuzumab.

Major finding: The rate of freedom from relapse ranged from 83% to 90%, and disability scores were stable for 51% of patients.

Study details: An examination of data for 117 patients with MS who participated in extensions of the CARE-MS II trial.

Disclosures: Sanofi and Bayer HealthCare Pharmaceuticals supported this study. Dr. Ionete received research support from Biogen, Roche, and Sanofi. She reported receiving compensation for advisory board participation from Sanofi.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Patients with multiple sclerosis who consider marijuana use are more likely to smoke and drink alcohol.

Major finding: Among multiple sclerosis patients who responded to a survey, 25.4% had used marijuana for their multiple sclerosis, 20.0% had discussed it with their doctors, and 16.1% were currently using some form of marijuana.

Study details: Questionnaire responses about health behaviors from 5,481 active participants in the North American Research Committee on Multiple Sclerosis.

Disclosures: The North American Research Committee on Multiple Sclerosis is funded in part by the Consortium of Multiple Sclerosis Centers and the Foundation of the CMSC. The present study had no funding support. Dr. Cofield reported receiving a consulting fee from the U.S. Department of Defense.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Patients with multiple sclerosis who consider marijuana use are more likely to smoke and drink alcohol.

Major finding: Among multiple sclerosis patients who responded to a survey, 25.4% had used marijuana for their multiple sclerosis, 20.0% had discussed it with their doctors, and 16.1% were currently using some form of marijuana.

Study details: Questionnaire responses about health behaviors from 5,481 active participants in the North American Research Committee on Multiple Sclerosis.

Disclosures: The North American Research Committee on Multiple Sclerosis is funded in part by the Consortium of Multiple Sclerosis Centers and the Foundation of the CMSC. The present study had no funding support. Dr. Cofield reported receiving a consulting fee from the U.S. Department of Defense.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Patients with multiple sclerosis who consider marijuana use are more likely to smoke and drink alcohol.

Major finding: Among multiple sclerosis patients who responded to a survey, 25.4% had used marijuana for their multiple sclerosis, 20.0% had discussed it with their doctors, and 16.1% were currently using some form of marijuana.

Study details: Questionnaire responses about health behaviors from 5,481 active participants in the North American Research Committee on Multiple Sclerosis.

Disclosures: The North American Research Committee on Multiple Sclerosis is funded in part by the Consortium of Multiple Sclerosis Centers and the Foundation of the CMSC. The present study had no funding support. Dr. Cofield reported receiving a consulting fee from the U.S. Department of Defense.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Patients with pediatric-onset multiple sclerosis (MS) are more likely than those with adult-onset MS to have cognitive impairment in adulthood.

Major finding: At age 35 years, the mean Symbol Digit Modalities Test score for patients with adult-onset MS was 61, whereas for patients with pediatric-onset MS it was 51. By age 40 years, the mean score was 58 for adult-onset MS versus 46 for pediatric-onset MS.

Study details: A Swedish population-based, longitudinal cohort study of 5,704 patients with MS, 300 of whom had pediatric-onset MS (5%).

Disclosures: The study was supported by the Swedish Research Council, the Swedish Brain Foundation, and by postdoctoral awards from the Canadian Institutes of Health Research and European Committee for Treatment and Research in Multiple Sclerosis, both to Dr. McKay. Coauthors reported receiving honoraria for speaking and serving on advisory boards for various pharmaceutical companies, as well as receiving research funding from agencies, foundations, and pharmaceutical companies.

Citation: McKay KA et al. JAMA Neurol. 2019 Jun 17. doi: 10.1001/jamaneurol.2019.1546.

Key clinical point: Patients with pediatric-onset multiple sclerosis (MS) are more likely than those with adult-onset MS to have cognitive impairment in adulthood.

Major finding: At age 35 years, the mean Symbol Digit Modalities Test score for patients with adult-onset MS was 61, whereas for patients with pediatric-onset MS it was 51. By age 40 years, the mean score was 58 for adult-onset MS versus 46 for pediatric-onset MS.

Study details: A Swedish population-based, longitudinal cohort study of 5,704 patients with MS, 300 of whom had pediatric-onset MS (5%).

Disclosures: The study was supported by the Swedish Research Council, the Swedish Brain Foundation, and by postdoctoral awards from the Canadian Institutes of Health Research and European Committee for Treatment and Research in Multiple Sclerosis, both to Dr. McKay. Coauthors reported receiving honoraria for speaking and serving on advisory boards for various pharmaceutical companies, as well as receiving research funding from agencies, foundations, and pharmaceutical companies.

Citation: McKay KA et al. JAMA Neurol. 2019 Jun 17. doi: 10.1001/jamaneurol.2019.1546.

Key clinical point: Patients with pediatric-onset multiple sclerosis (MS) are more likely than those with adult-onset MS to have cognitive impairment in adulthood.

Major finding: At age 35 years, the mean Symbol Digit Modalities Test score for patients with adult-onset MS was 61, whereas for patients with pediatric-onset MS it was 51. By age 40 years, the mean score was 58 for adult-onset MS versus 46 for pediatric-onset MS.

Study details: A Swedish population-based, longitudinal cohort study of 5,704 patients with MS, 300 of whom had pediatric-onset MS (5%).

Disclosures: The study was supported by the Swedish Research Council, the Swedish Brain Foundation, and by postdoctoral awards from the Canadian Institutes of Health Research and European Committee for Treatment and Research in Multiple Sclerosis, both to Dr. McKay. Coauthors reported receiving honoraria for speaking and serving on advisory boards for various pharmaceutical companies, as well as receiving research funding from agencies, foundations, and pharmaceutical companies.

Citation: McKay KA et al. JAMA Neurol. 2019 Jun 17. doi: 10.1001/jamaneurol.2019.1546.

Key clinical point: Data do not support an association between vaccination and increased risk of MS.

Major finding: The odds of MS were lower in participants who received vaccination, compared with participants without autoimmune disease (odds ratio, 0.870).

Study details: A systematic retrospective analysis of claims data for 12,262 patients with MS and 210,773 controls.

Disclosures: A grant from the German Federal Ministry of Education and Research Competence Network MS supported the study. The authors had no relevant conflicts.

Citation: Hapfelmeier A et al. Neurology. 2019 Jul 30. doi: 10.1212/WNL.0000000000008012.

Key clinical point: Data do not support an association between vaccination and increased risk of MS.

Major finding: The odds of MS were lower in participants who received vaccination, compared with participants without autoimmune disease (odds ratio, 0.870).

Study details: A systematic retrospective analysis of claims data for 12,262 patients with MS and 210,773 controls.

Disclosures: A grant from the German Federal Ministry of Education and Research Competence Network MS supported the study. The authors had no relevant conflicts.

Citation: Hapfelmeier A et al. Neurology. 2019 Jul 30. doi: 10.1212/WNL.0000000000008012.

Key clinical point: Data do not support an association between vaccination and increased risk of MS.

Major finding: The odds of MS were lower in participants who received vaccination, compared with participants without autoimmune disease (odds ratio, 0.870).

Study details: A systematic retrospective analysis of claims data for 12,262 patients with MS and 210,773 controls.

Disclosures: A grant from the German Federal Ministry of Education and Research Competence Network MS supported the study. The authors had no relevant conflicts.

Citation: Hapfelmeier A et al. Neurology. 2019 Jul 30. doi: 10.1212/WNL.0000000000008012.

Key clinical point: Evaluating black holes as part of routine clinical practice could be a quick method for screening people with MS for referral to a comprehensive cognitive assessment.

Major finding: Mean Symbol Digit Modalities Test score was 49.0 in patients without a black hole and 42.9 in patients with at least one black hole.

Study details: A prospective study of 226 patients with MS.

Disclosures: The investigators had no disclosures and conducted their study without financial support.

Citation: Özakbas S et al. CMSC 2019, Abstract IMG02.

Key clinical point: Evaluating black holes as part of routine clinical practice could be a quick method for screening people with MS for referral to a comprehensive cognitive assessment.

Major finding: Mean Symbol Digit Modalities Test score was 49.0 in patients without a black hole and 42.9 in patients with at least one black hole.

Study details: A prospective study of 226 patients with MS.

Disclosures: The investigators had no disclosures and conducted their study without financial support.

Citation: Özakbas S et al. CMSC 2019, Abstract IMG02.

Key clinical point: Evaluating black holes as part of routine clinical practice could be a quick method for screening people with MS for referral to a comprehensive cognitive assessment.

Major finding: Mean Symbol Digit Modalities Test score was 49.0 in patients without a black hole and 42.9 in patients with at least one black hole.

Study details: A prospective study of 226 patients with MS.

Disclosures: The investigators had no disclosures and conducted their study without financial support.

Citation: Özakbas S et al. CMSC 2019, Abstract IMG02.

Key clinical point: Neutrophil levels may decline in patients with relapsing multiple sclerosis (MS) who have been on fingolimod for 2 or more years.

Major finding: In a cohort of patients continuously treated with fingolimod for at least 2 years, neutrophils declined over 6 months by about 9%, from an average of 3,698.56 cells per microliter to 3,336.13 cells per microliter.

Study details: Analysis of interim, 6-month data from the ongoing, open-label, phase 4 FLUENT study, which is a 12-month, prospective, multicenter, nonrandomized study to assess changes in the immune cell profiles of patients with relapsing MS who receive fingolimod. The interim results include data from 216 treatment-experienced patients and 166 treatment-naive patients.

Disclosures: Novartis funded the study, and four of the authors are Novartis employees. Dr. Cree disclosed consulting fees from Novartis and other pharmaceutical companies. His coauthors disclosed consulting fees, speaking fees, research support, and serving on advisory boards for pharmaceutical companies, including Novartis.

Citation: Mao-Draayer Y et al. CMSC 2019, Abstract DXM03.

Key clinical point: Neutrophil levels may decline in patients with relapsing multiple sclerosis (MS) who have been on fingolimod for 2 or more years.

Major finding: In a cohort of patients continuously treated with fingolimod for at least 2 years, neutrophils declined over 6 months by about 9%, from an average of 3,698.56 cells per microliter to 3,336.13 cells per microliter.

Study details: Analysis of interim, 6-month data from the ongoing, open-label, phase 4 FLUENT study, which is a 12-month, prospective, multicenter, nonrandomized study to assess changes in the immune cell profiles of patients with relapsing MS who receive fingolimod. The interim results include data from 216 treatment-experienced patients and 166 treatment-naive patients.

Disclosures: Novartis funded the study, and four of the authors are Novartis employees. Dr. Cree disclosed consulting fees from Novartis and other pharmaceutical companies. His coauthors disclosed consulting fees, speaking fees, research support, and serving on advisory boards for pharmaceutical companies, including Novartis.

Citation: Mao-Draayer Y et al. CMSC 2019, Abstract DXM03.

Key clinical point: Neutrophil levels may decline in patients with relapsing multiple sclerosis (MS) who have been on fingolimod for 2 or more years.

Major finding: In a cohort of patients continuously treated with fingolimod for at least 2 years, neutrophils declined over 6 months by about 9%, from an average of 3,698.56 cells per microliter to 3,336.13 cells per microliter.

Study details: Analysis of interim, 6-month data from the ongoing, open-label, phase 4 FLUENT study, which is a 12-month, prospective, multicenter, nonrandomized study to assess changes in the immune cell profiles of patients with relapsing MS who receive fingolimod. The interim results include data from 216 treatment-experienced patients and 166 treatment-naive patients.

Disclosures: Novartis funded the study, and four of the authors are Novartis employees. Dr. Cree disclosed consulting fees from Novartis and other pharmaceutical companies. His coauthors disclosed consulting fees, speaking fees, research support, and serving on advisory boards for pharmaceutical companies, including Novartis.

Citation: Mao-Draayer Y et al. CMSC 2019, Abstract DXM03.