MS Briefs

Key clinical point: Better management and treatment of diabetes and anxiety in MS patients may help improve cognition.

Major finding: Of 111 patients with relapsing remitting MS (majority were women with a mean age of 50 years), 22.7% had hypertension, 10.8% had diabetes, 9.9% had depression, and 9.9% had anxiety disorders.

Study details: Patients completed a psychiatric interview, a comorbidity questionnaire, and cognitive testing. Scores were converted to age-, sex-, and education-adjusted z-scores. Links between diabetes and hypertension and the cognitive z-scores were evaluated.

Disclosures: Authors disclosed receiving research support from various organizations. One author has conducted clinical trials for Biogen Idec and Rouche. Another has served as a consultant for several pharmaceutical companies, and has also received research grants and served on speaker’s bureaus for the industry.

Citation: Marrie, RA, et al.. Mult Scler Relat Disord. 2019 Jan;27:164-170. doi: 10.1016/j.msard.2018.10.018.

Key clinical point: Better management and treatment of diabetes and anxiety in MS patients may help improve cognition.

Major finding: Of 111 patients with relapsing remitting MS (majority were women with a mean age of 50 years), 22.7% had hypertension, 10.8% had diabetes, 9.9% had depression, and 9.9% had anxiety disorders.

Study details: Patients completed a psychiatric interview, a comorbidity questionnaire, and cognitive testing. Scores were converted to age-, sex-, and education-adjusted z-scores. Links between diabetes and hypertension and the cognitive z-scores were evaluated.

Disclosures: Authors disclosed receiving research support from various organizations. One author has conducted clinical trials for Biogen Idec and Rouche. Another has served as a consultant for several pharmaceutical companies, and has also received research grants and served on speaker’s bureaus for the industry.

Citation: Marrie, RA, et al.. Mult Scler Relat Disord. 2019 Jan;27:164-170. doi: 10.1016/j.msard.2018.10.018.

Key clinical point: Better management and treatment of diabetes and anxiety in MS patients may help improve cognition.

Major finding: Of 111 patients with relapsing remitting MS (majority were women with a mean age of 50 years), 22.7% had hypertension, 10.8% had diabetes, 9.9% had depression, and 9.9% had anxiety disorders.

Study details: Patients completed a psychiatric interview, a comorbidity questionnaire, and cognitive testing. Scores were converted to age-, sex-, and education-adjusted z-scores. Links between diabetes and hypertension and the cognitive z-scores were evaluated.

Disclosures: Authors disclosed receiving research support from various organizations. One author has conducted clinical trials for Biogen Idec and Rouche. Another has served as a consultant for several pharmaceutical companies, and has also received research grants and served on speaker’s bureaus for the industry.

Citation: Marrie, RA, et al.. Mult Scler Relat Disord. 2019 Jan;27:164-170. doi: 10.1016/j.msard.2018.10.018.

Key clinical point: More studies are needed with larger samples and more ethnicities to support the study's findings.

Major finding: The FOXP3 gene rs3761548 was found to increase the risk for MS, with a higher risk found in Asian patients.

Study details: This was a meta-analysis of 5 studies from January 1980 to October 2018. The studies were used to evaluate the association between FOXP3 gene polymorphism and MS. For FOXP3 gene rs3761548, there were 1,276 MS patients and 1,447 controls; and for FOXP3 gene rs2232365, there were 600 MS patients and 640 controls.

Disclosures: None.

Citation: Zhang Y, et al. Medicine. 2019 Sep;98(38):e17224. doi: 10.1097/MD.0000000000017224.

Key clinical point: More studies are needed with larger samples and more ethnicities to support the study's findings.

Major finding: The FOXP3 gene rs3761548 was found to increase the risk for MS, with a higher risk found in Asian patients.

Study details: This was a meta-analysis of 5 studies from January 1980 to October 2018. The studies were used to evaluate the association between FOXP3 gene polymorphism and MS. For FOXP3 gene rs3761548, there were 1,276 MS patients and 1,447 controls; and for FOXP3 gene rs2232365, there were 600 MS patients and 640 controls.

Disclosures: None.

Citation: Zhang Y, et al. Medicine. 2019 Sep;98(38):e17224. doi: 10.1097/MD.0000000000017224.

Key clinical point: More studies are needed with larger samples and more ethnicities to support the study's findings.

Major finding: The FOXP3 gene rs3761548 was found to increase the risk for MS, with a higher risk found in Asian patients.

Study details: This was a meta-analysis of 5 studies from January 1980 to October 2018. The studies were used to evaluate the association between FOXP3 gene polymorphism and MS. For FOXP3 gene rs3761548, there were 1,276 MS patients and 1,447 controls; and for FOXP3 gene rs2232365, there were 600 MS patients and 640 controls.

Disclosures: None.

Citation: Zhang Y, et al. Medicine. 2019 Sep;98(38):e17224. doi: 10.1097/MD.0000000000017224.

Key clinical point: Disability milestones are not being met as quickly for patients with multiple sclerosis (MS), as disease progression has slowed.

Major finding: In patients with relapsing-onset MS there was a decreased risk of reaching disability milestones by 3%, 6%, and 7% in Expanded Disability Status Score (EDSS) scores of 3.0, 4.0, and 6.0, respectively. In patients with progressive-onset MS there was no significant decrease.

Study details: This was a nationwide population-based retrospective cohort study of 12,512 patients in Sweden. Of those patients 7,331 (5,196 females) were diagnosed with MS at a mean age of 38.3 years between January 1995 and December 2010 and had 2 recorded EDSS scores.

Disclosures: Research was funded by the Swedish Research Council and the Swedish Brain Foundation.

Citation: Beiki O, et al. JAMA Neurol. 2019;76(6):665-671. doi: 10.1001/jamaneurol.2019.0330.

Key clinical point: Disability milestones are not being met as quickly for patients with multiple sclerosis (MS), as disease progression has slowed.

Major finding: In patients with relapsing-onset MS there was a decreased risk of reaching disability milestones by 3%, 6%, and 7% in Expanded Disability Status Score (EDSS) scores of 3.0, 4.0, and 6.0, respectively. In patients with progressive-onset MS there was no significant decrease.

Study details: This was a nationwide population-based retrospective cohort study of 12,512 patients in Sweden. Of those patients 7,331 (5,196 females) were diagnosed with MS at a mean age of 38.3 years between January 1995 and December 2010 and had 2 recorded EDSS scores.

Disclosures: Research was funded by the Swedish Research Council and the Swedish Brain Foundation.

Citation: Beiki O, et al. JAMA Neurol. 2019;76(6):665-671. doi: 10.1001/jamaneurol.2019.0330.

Key clinical point: Disability milestones are not being met as quickly for patients with multiple sclerosis (MS), as disease progression has slowed.

Major finding: In patients with relapsing-onset MS there was a decreased risk of reaching disability milestones by 3%, 6%, and 7% in Expanded Disability Status Score (EDSS) scores of 3.0, 4.0, and 6.0, respectively. In patients with progressive-onset MS there was no significant decrease.

Study details: This was a nationwide population-based retrospective cohort study of 12,512 patients in Sweden. Of those patients 7,331 (5,196 females) were diagnosed with MS at a mean age of 38.3 years between January 1995 and December 2010 and had 2 recorded EDSS scores.

Disclosures: Research was funded by the Swedish Research Council and the Swedish Brain Foundation.

Citation: Beiki O, et al. JAMA Neurol. 2019;76(6):665-671. doi: 10.1001/jamaneurol.2019.0330.

Key clinical point: The use, type, and timing of disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS) patients may lead to secondary progressive MS.

Major finding: RRMS patients beginning DMTs of fingolimod, alemtuzumab, or natalizumab had a lower chance of secondary progressive MS, whereas patients taking glatiramer acetate or interferon beta had a higher chance.

Study details: This was a cohort study that examined 1,555 RRMS patients (1,123 females) across 21 countries that began DMTs (interferon beta, glatiramer acetate, fingolimod, natalizumab, or alemtuzumab) between 1988 and 2012.

Disclosures: This study was financially supported by the National Health and Medical Research Council of Australia, the University of Melbourne, a Next Generation Fellowship funded by the Grand Charity of the Freemason’s, and the MSBase 2017 Fellowship. Alemtuzumab studies done in Cambridge were supported by the NIHR Cambridge Biomedical Research Centre and the MS Society UK.

Citation: Brown JWL, et al. JAMA. 2019;321(2):175-187. doi: 10.1001/jama.2018.20588.

Key clinical point: The use, type, and timing of disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS) patients may lead to secondary progressive MS.

Major finding: RRMS patients beginning DMTs of fingolimod, alemtuzumab, or natalizumab had a lower chance of secondary progressive MS, whereas patients taking glatiramer acetate or interferon beta had a higher chance.

Study details: This was a cohort study that examined 1,555 RRMS patients (1,123 females) across 21 countries that began DMTs (interferon beta, glatiramer acetate, fingolimod, natalizumab, or alemtuzumab) between 1988 and 2012.

Disclosures: This study was financially supported by the National Health and Medical Research Council of Australia, the University of Melbourne, a Next Generation Fellowship funded by the Grand Charity of the Freemason’s, and the MSBase 2017 Fellowship. Alemtuzumab studies done in Cambridge were supported by the NIHR Cambridge Biomedical Research Centre and the MS Society UK.

Citation: Brown JWL, et al. JAMA. 2019;321(2):175-187. doi: 10.1001/jama.2018.20588.

Key clinical point: The use, type, and timing of disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS) patients may lead to secondary progressive MS.

Major finding: RRMS patients beginning DMTs of fingolimod, alemtuzumab, or natalizumab had a lower chance of secondary progressive MS, whereas patients taking glatiramer acetate or interferon beta had a higher chance.

Study details: This was a cohort study that examined 1,555 RRMS patients (1,123 females) across 21 countries that began DMTs (interferon beta, glatiramer acetate, fingolimod, natalizumab, or alemtuzumab) between 1988 and 2012.

Disclosures: This study was financially supported by the National Health and Medical Research Council of Australia, the University of Melbourne, a Next Generation Fellowship funded by the Grand Charity of the Freemason’s, and the MSBase 2017 Fellowship. Alemtuzumab studies done in Cambridge were supported by the NIHR Cambridge Biomedical Research Centre and the MS Society UK.

Citation: Brown JWL, et al. JAMA. 2019;321(2):175-187. doi: 10.1001/jama.2018.20588.

Key clinical point: Teriflunomide may be more cost effective than interferon beta-1b for relapsing MS patients.

Major finding: Over the course of 20 years, the cost of treatment with teriflunomide would cost $567,767, compared with the cost of treatment for interferon beta of $620,191 for patients in China.

Study details: A Markov cost model was developed for the study. Eleven neurologists were surveyed throughout China about costs related to treatment for RMS including acquisition and administration, patient monitoring, treating relapse, and the management of adverse events.

Disclosures: This study was funded by Sanofi China. Two study investigators reported being employees of the company.

Citation: Xu Y, et al. Clin Drug Investig. 2019 Mar;39(3):331-340. doi: 10.1007/s40261-019-00750-3.

Key clinical point: Teriflunomide may be more cost effective than interferon beta-1b for relapsing MS patients.

Major finding: Over the course of 20 years, the cost of treatment with teriflunomide would cost $567,767, compared with the cost of treatment for interferon beta of $620,191 for patients in China.

Study details: A Markov cost model was developed for the study. Eleven neurologists were surveyed throughout China about costs related to treatment for RMS including acquisition and administration, patient monitoring, treating relapse, and the management of adverse events.

Disclosures: This study was funded by Sanofi China. Two study investigators reported being employees of the company.

Citation: Xu Y, et al. Clin Drug Investig. 2019 Mar;39(3):331-340. doi: 10.1007/s40261-019-00750-3.

Key clinical point: Teriflunomide may be more cost effective than interferon beta-1b for relapsing MS patients.

Major finding: Over the course of 20 years, the cost of treatment with teriflunomide would cost $567,767, compared with the cost of treatment for interferon beta of $620,191 for patients in China.

Study details: A Markov cost model was developed for the study. Eleven neurologists were surveyed throughout China about costs related to treatment for RMS including acquisition and administration, patient monitoring, treating relapse, and the management of adverse events.

Disclosures: This study was funded by Sanofi China. Two study investigators reported being employees of the company.

Citation: Xu Y, et al. Clin Drug Investig. 2019 Mar;39(3):331-340. doi: 10.1007/s40261-019-00750-3.

Key clinical point: Polypharmacy frequency can have a negative effect on relapsing-remitting multiple sclerosis (RRMS) patients.

Major finding: The proportion of polypharmacy among patients with a secondary illness to RRMS was four times higher than in patients without a secondary illness. Patients with polypharmacy were older, had a lower level of education, and had higher comorbidities than patients without polypharmacy.

Study details: Subgroups of 145 RRMS patients were analyzed. The subgroups were patients with polypharmacy, patients without polypharmacy, patients with secondary illness, and patients without secondary illness.

Disclosures: Michael Hecker support from Bayer HealthCare, Biogen, Novartis and Teva. Uwe Klaus Zettl received support from Almirall, Bayer HealthCare, Biogen, Merck Serono, Novartis, Sanofi and Teva. Niklas Frahm has no relevant conflicts of interest.

Citation: Frahm N, et al. PLoS One. 2019 Jan 24;14(1):e0211120. doi: 10.1371/journal.pone.0211120.

Key clinical point: Polypharmacy frequency can have a negative effect on relapsing-remitting multiple sclerosis (RRMS) patients.

Major finding: The proportion of polypharmacy among patients with a secondary illness to RRMS was four times higher than in patients without a secondary illness. Patients with polypharmacy were older, had a lower level of education, and had higher comorbidities than patients without polypharmacy.

Study details: Subgroups of 145 RRMS patients were analyzed. The subgroups were patients with polypharmacy, patients without polypharmacy, patients with secondary illness, and patients without secondary illness.

Disclosures: Michael Hecker support from Bayer HealthCare, Biogen, Novartis and Teva. Uwe Klaus Zettl received support from Almirall, Bayer HealthCare, Biogen, Merck Serono, Novartis, Sanofi and Teva. Niklas Frahm has no relevant conflicts of interest.

Citation: Frahm N, et al. PLoS One. 2019 Jan 24;14(1):e0211120. doi: 10.1371/journal.pone.0211120.

Key clinical point: Polypharmacy frequency can have a negative effect on relapsing-remitting multiple sclerosis (RRMS) patients.

Major finding: The proportion of polypharmacy among patients with a secondary illness to RRMS was four times higher than in patients without a secondary illness. Patients with polypharmacy were older, had a lower level of education, and had higher comorbidities than patients without polypharmacy.

Study details: Subgroups of 145 RRMS patients were analyzed. The subgroups were patients with polypharmacy, patients without polypharmacy, patients with secondary illness, and patients without secondary illness.

Disclosures: Michael Hecker support from Bayer HealthCare, Biogen, Novartis and Teva. Uwe Klaus Zettl received support from Almirall, Bayer HealthCare, Biogen, Merck Serono, Novartis, Sanofi and Teva. Niklas Frahm has no relevant conflicts of interest.

Citation: Frahm N, et al. PLoS One. 2019 Jan 24;14(1):e0211120. doi: 10.1371/journal.pone.0211120.

Key clinical point: Two algorithms identified in a new study can be used for future clinical research of relapsing-remitting multiple sclerosis (RRMS). Major finding: Using EHRs and the coded health care claims of 5,308 patients with possible MS, 837 and 2,271 were identified as having RRMS, respectively. There were also 779 patients identified using both algorithms.

Study details: Two different algorithms “unstructured clinical notes (EHR clinical notes-based algorithm) and structured/coded data (claims-based algorithms)” were used to identify patients with RRMS.

Disclosures: The investigators reported no conflicts of interest.

Citation: Van Le H, et al. Value Health. 2019 Jan;22(1):77-84. doi: 10.1016/j.jval.2018.06.014.

Key clinical point: Two algorithms identified in a new study can be used for future clinical research of relapsing-remitting multiple sclerosis (RRMS). Major finding: Using EHRs and the coded health care claims of 5,308 patients with possible MS, 837 and 2,271 were identified as having RRMS, respectively. There were also 779 patients identified using both algorithms.

Study details: Two different algorithms “unstructured clinical notes (EHR clinical notes-based algorithm) and structured/coded data (claims-based algorithms)” were used to identify patients with RRMS.

Disclosures: The investigators reported no conflicts of interest.

Citation: Van Le H, et al. Value Health. 2019 Jan;22(1):77-84. doi: 10.1016/j.jval.2018.06.014.

Key clinical point: Two algorithms identified in a new study can be used for future clinical research of relapsing-remitting multiple sclerosis (RRMS). Major finding: Using EHRs and the coded health care claims of 5,308 patients with possible MS, 837 and 2,271 were identified as having RRMS, respectively. There were also 779 patients identified using both algorithms.

Study details: Two different algorithms “unstructured clinical notes (EHR clinical notes-based algorithm) and structured/coded data (claims-based algorithms)” were used to identify patients with RRMS.

Disclosures: The investigators reported no conflicts of interest.

Citation: Van Le H, et al. Value Health. 2019 Jan;22(1):77-84. doi: 10.1016/j.jval.2018.06.014.

Key clinical point: ARMSS-rate at 2 years accurately predicts disease course over the subsequent 8 years.

Major finding: ARMSS-rate at 2 years had an area under the curve of 0.921 for predicting the next 8 years of ARMSS-rate.

Study details: An analysis of data for 4,514 participants in the Swedish MS Registry.

Disclosures: Dr. Ramanujam had no conflicts of interest to disclose. He receives funding from the MultipleMS Project, which is part of the EU Horizon 2020 Framework.

Citation: Manouchehrinia A et al. ECTRIMS 2019. Abstract 218.

Key clinical point: ARMSS-rate at 2 years accurately predicts disease course over the subsequent 8 years.

Major finding: ARMSS-rate at 2 years had an area under the curve of 0.921 for predicting the next 8 years of ARMSS-rate.

Study details: An analysis of data for 4,514 participants in the Swedish MS Registry.

Disclosures: Dr. Ramanujam had no conflicts of interest to disclose. He receives funding from the MultipleMS Project, which is part of the EU Horizon 2020 Framework.

Citation: Manouchehrinia A et al. ECTRIMS 2019. Abstract 218.

Key clinical point: ARMSS-rate at 2 years accurately predicts disease course over the subsequent 8 years.

Major finding: ARMSS-rate at 2 years had an area under the curve of 0.921 for predicting the next 8 years of ARMSS-rate.

Study details: An analysis of data for 4,514 participants in the Swedish MS Registry.

Disclosures: Dr. Ramanujam had no conflicts of interest to disclose. He receives funding from the MultipleMS Project, which is part of the EU Horizon 2020 Framework.

Citation: Manouchehrinia A et al. ECTRIMS 2019. Abstract 218.

Key clinical point: Patients with MS who quit smoking tobacco may experience improved cognitive function.

Major finding: Former smokers with MS scored an average of 3.6 points lower on the Processing Speed Test than never smokers, and current smokers scored 5.9 points lower.

Study details: This cross-sectional study included 997 patients with MS who had cognitive function test scores and brain MRIs.

Disclosures: The study presenter reported having no relevant financial interests.

Citation: Alshehri E et al. ECTRIMS 2019. Abstract P461.

Key clinical point: Patients with MS who quit smoking tobacco may experience improved cognitive function.

Major finding: Former smokers with MS scored an average of 3.6 points lower on the Processing Speed Test than never smokers, and current smokers scored 5.9 points lower.

Study details: This cross-sectional study included 997 patients with MS who had cognitive function test scores and brain MRIs.

Disclosures: The study presenter reported having no relevant financial interests.

Citation: Alshehri E et al. ECTRIMS 2019. Abstract P461.

Key clinical point: Patients with MS who quit smoking tobacco may experience improved cognitive function.

Major finding: Former smokers with MS scored an average of 3.6 points lower on the Processing Speed Test than never smokers, and current smokers scored 5.9 points lower.

Study details: This cross-sectional study included 997 patients with MS who had cognitive function test scores and brain MRIs.

Disclosures: The study presenter reported having no relevant financial interests.

Citation: Alshehri E et al. ECTRIMS 2019. Abstract P461.

Key clinical point: Inflammatory pulmonary events occurring at age 11-15 years may be a risk factor for subsequent multiple sclerosis.

Major finding: Swedes who experienced pneumonia at age 11-15 years had an adjusted 2.8-fold increased risk of MS later in life.

Study details: This Swedish national registry cohort study included 6,109 MS patients and 49,479 controls matched for age, gender, and locale.

Disclosures: The presenter reported receiving research funding from F. Hoffmann–La Roche, Novartis, and AstraZeneca and serving on an advisory board for IQVIA.

Citation: Montgomery S. ECTRIMS 2019, Abstract 270.

Key clinical point: Inflammatory pulmonary events occurring at age 11-15 years may be a risk factor for subsequent multiple sclerosis.

Major finding: Swedes who experienced pneumonia at age 11-15 years had an adjusted 2.8-fold increased risk of MS later in life.

Study details: This Swedish national registry cohort study included 6,109 MS patients and 49,479 controls matched for age, gender, and locale.

Disclosures: The presenter reported receiving research funding from F. Hoffmann–La Roche, Novartis, and AstraZeneca and serving on an advisory board for IQVIA.

Citation: Montgomery S. ECTRIMS 2019, Abstract 270.

Key clinical point: Inflammatory pulmonary events occurring at age 11-15 years may be a risk factor for subsequent multiple sclerosis.

Major finding: Swedes who experienced pneumonia at age 11-15 years had an adjusted 2.8-fold increased risk of MS later in life.

Study details: This Swedish national registry cohort study included 6,109 MS patients and 49,479 controls matched for age, gender, and locale.

Disclosures: The presenter reported receiving research funding from F. Hoffmann–La Roche, Novartis, and AstraZeneca and serving on an advisory board for IQVIA.

Citation: Montgomery S. ECTRIMS 2019, Abstract 270.