MS Briefs

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.

Key clinical point: Managing comorbid psychiatric disorders in patients with MS could reduce the burden of functional GI disorders.

Major finding: Approximately 42% of patients with MS report functional GI disorders.

Study details: A survey of 6,312 participants in the North American Research Committee on MS Registry.

Disclosures: The study had no sponsor. Dr. Marrie had no disclosures, but other researchers had financial relationships with pharmaceutical companies, such as Merck, Novartis, Roche, Sanofi-Aventis, and Teva.

Citation: Marrie RA et al. CMSC 2019, Abstract QOL13.

Key clinical point: Managing comorbid psychiatric disorders in patients with MS could reduce the burden of functional GI disorders.

Major finding: Approximately 42% of patients with MS report functional GI disorders.

Study details: A survey of 6,312 participants in the North American Research Committee on MS Registry.

Disclosures: The study had no sponsor. Dr. Marrie had no disclosures, but other researchers had financial relationships with pharmaceutical companies, such as Merck, Novartis, Roche, Sanofi-Aventis, and Teva.

Citation: Marrie RA et al. CMSC 2019, Abstract QOL13.

Key clinical point: Managing comorbid psychiatric disorders in patients with MS could reduce the burden of functional GI disorders.

Major finding: Approximately 42% of patients with MS report functional GI disorders.

Study details: A survey of 6,312 participants in the North American Research Committee on MS Registry.

Disclosures: The study had no sponsor. Dr. Marrie had no disclosures, but other researchers had financial relationships with pharmaceutical companies, such as Merck, Novartis, Roche, Sanofi-Aventis, and Teva.

Citation: Marrie RA et al. CMSC 2019, Abstract QOL13.

Key clinical point: Patients with relapsing-remitting MS gain comparable benefits from cladribine therapy, regardless of age.

Major finding: The annual rate of qualifying relapses was 0.14 for treated patients older than 45 years and 0.15 for treated patients aged 45 or younger.

Study details: A post hoc analysis of data from the CLARITY and CLARITY extension studies, which included 870 patients.

Disclosures: Merck KGaA, which manufactures and markets cladribine, supported the study. Several of the investigators have received speaker honoraria, consulting fees, or other funding from Merck KGaA.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Patients with relapsing-remitting MS gain comparable benefits from cladribine therapy, regardless of age.

Major finding: The annual rate of qualifying relapses was 0.14 for treated patients older than 45 years and 0.15 for treated patients aged 45 or younger.

Study details: A post hoc analysis of data from the CLARITY and CLARITY extension studies, which included 870 patients.

Disclosures: Merck KGaA, which manufactures and markets cladribine, supported the study. Several of the investigators have received speaker honoraria, consulting fees, or other funding from Merck KGaA.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Patients with relapsing-remitting MS gain comparable benefits from cladribine therapy, regardless of age.

Major finding: The annual rate of qualifying relapses was 0.14 for treated patients older than 45 years and 0.15 for treated patients aged 45 or younger.

Study details: A post hoc analysis of data from the CLARITY and CLARITY extension studies, which included 870 patients.

Disclosures: Merck KGaA, which manufactures and markets cladribine, supported the study. Several of the investigators have received speaker honoraria, consulting fees, or other funding from Merck KGaA.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Treatment with evobrutinib reduced the number of enhancing lesions versus placebo in patients with relapsing multiple sclerosis, supporting further development of this Bruton’s tyrosine kinase (BTK) inhibitor.

Major finding: The cumulative number of MRI-assessed T1 Gd+ lesions from weeks 12-24 was significantly reduced versus placebo; lesion rate ratios were 0.30 for the 75-mg daily arm, and 0.44 for the 75-mg twice-daily arm, with unadjusted P values of .002 and .031, respectively.

Study details: Forty-eight-week results of a randomized, phase 2, placebo-controlled study of 267 patients with relapsing multiple sclerosis.

Disclosures: Dr. Montalban provided disclosures related to Biogen, Merck Serono, Genentech, Genzyme, Novartis, Sanofi-Aventis, Teva Pharmaceuticals, Roche, Celgene, Actelion, National Multiple Sclerosis Society, and Multiple Sclerosis International Federation.

Citation: Montalban X et al. AAN 2019. Abstract S56.004.

Key clinical point: Treatment with evobrutinib reduced the number of enhancing lesions versus placebo in patients with relapsing multiple sclerosis, supporting further development of this Bruton’s tyrosine kinase (BTK) inhibitor.

Major finding: The cumulative number of MRI-assessed T1 Gd+ lesions from weeks 12-24 was significantly reduced versus placebo; lesion rate ratios were 0.30 for the 75-mg daily arm, and 0.44 for the 75-mg twice-daily arm, with unadjusted P values of .002 and .031, respectively.

Study details: Forty-eight-week results of a randomized, phase 2, placebo-controlled study of 267 patients with relapsing multiple sclerosis.

Disclosures: Dr. Montalban provided disclosures related to Biogen, Merck Serono, Genentech, Genzyme, Novartis, Sanofi-Aventis, Teva Pharmaceuticals, Roche, Celgene, Actelion, National Multiple Sclerosis Society, and Multiple Sclerosis International Federation.

Citation: Montalban X et al. AAN 2019. Abstract S56.004.

Key clinical point: Treatment with evobrutinib reduced the number of enhancing lesions versus placebo in patients with relapsing multiple sclerosis, supporting further development of this Bruton’s tyrosine kinase (BTK) inhibitor.

Major finding: The cumulative number of MRI-assessed T1 Gd+ lesions from weeks 12-24 was significantly reduced versus placebo; lesion rate ratios were 0.30 for the 75-mg daily arm, and 0.44 for the 75-mg twice-daily arm, with unadjusted P values of .002 and .031, respectively.

Study details: Forty-eight-week results of a randomized, phase 2, placebo-controlled study of 267 patients with relapsing multiple sclerosis.

Disclosures: Dr. Montalban provided disclosures related to Biogen, Merck Serono, Genentech, Genzyme, Novartis, Sanofi-Aventis, Teva Pharmaceuticals, Roche, Celgene, Actelion, National Multiple Sclerosis Society, and Multiple Sclerosis International Federation.

Citation: Montalban X et al. AAN 2019. Abstract S56.004.

Key clinical point: Twice-daily, extended-release arbaclofen effectively reduces MS-related spasticity.

Major finding: Mean change in TNmAS-MAL was −2.90 with arbaclofen and −1.95 with placebo.

Study details: A multicenter, double-blind, parallel-group study of 341 adults with MS and spasticity.

Disclosures: The study did not have funding support. Dr. Kantor reported having received consulting fees from AbbVie, Actelion, Bayer, Biogen, Celgene, EMD Serono, Genentech/Roche, Mylan, Novartis, Osmotica, and Sanofi Genzyme.

Citation: Kantor D et al. CMSC 2019, Abstract SXM07.

Key clinical point: Twice-daily, extended-release arbaclofen effectively reduces MS-related spasticity.

Major finding: Mean change in TNmAS-MAL was −2.90 with arbaclofen and −1.95 with placebo.

Study details: A multicenter, double-blind, parallel-group study of 341 adults with MS and spasticity.

Disclosures: The study did not have funding support. Dr. Kantor reported having received consulting fees from AbbVie, Actelion, Bayer, Biogen, Celgene, EMD Serono, Genentech/Roche, Mylan, Novartis, Osmotica, and Sanofi Genzyme.

Citation: Kantor D et al. CMSC 2019, Abstract SXM07.

Key clinical point: Twice-daily, extended-release arbaclofen effectively reduces MS-related spasticity.

Major finding: Mean change in TNmAS-MAL was −2.90 with arbaclofen and −1.95 with placebo.

Study details: A multicenter, double-blind, parallel-group study of 341 adults with MS and spasticity.

Disclosures: The study did not have funding support. Dr. Kantor reported having received consulting fees from AbbVie, Actelion, Bayer, Biogen, Celgene, EMD Serono, Genentech/Roche, Mylan, Novartis, Osmotica, and Sanofi Genzyme.

Citation: Kantor D et al. CMSC 2019, Abstract SXM07.

Key clinical point: Management of multiple sclerosis relapse consists of three main steps: timely and careful evaluation; treatment, if necessary; and assessment of treatment response, according to an algorithm developed by MS clinicians.

Major finding: Between 3 and 5 weeks after the initial evaluation, the group recommends clinical reassessment using a tool such as the Assessing Relapse in Multiple Sclerosis (ARMS) Questionnaire.

Study details: A consensus statement developed by a work group of MS clinicians based on a literature review and clinical experience.

Disclosures: The work group did not receive funding. The authors disclosed financial ties with various pharmaceutical companies.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Management of multiple sclerosis relapse consists of three main steps: timely and careful evaluation; treatment, if necessary; and assessment of treatment response, according to an algorithm developed by MS clinicians.

Major finding: Between 3 and 5 weeks after the initial evaluation, the group recommends clinical reassessment using a tool such as the Assessing Relapse in Multiple Sclerosis (ARMS) Questionnaire.

Study details: A consensus statement developed by a work group of MS clinicians based on a literature review and clinical experience.

Disclosures: The work group did not receive funding. The authors disclosed financial ties with various pharmaceutical companies.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Management of multiple sclerosis relapse consists of three main steps: timely and careful evaluation; treatment, if necessary; and assessment of treatment response, according to an algorithm developed by MS clinicians.

Major finding: Between 3 and 5 weeks after the initial evaluation, the group recommends clinical reassessment using a tool such as the Assessing Relapse in Multiple Sclerosis (ARMS) Questionnaire.

Study details: A consensus statement developed by a work group of MS clinicians based on a literature review and clinical experience.

Disclosures: The work group did not receive funding. The authors disclosed financial ties with various pharmaceutical companies.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Initial treatment with high-efficacy DMT is associated with a reduction in depressive symptoms, compared with an initial low-efficacy DMT.

Major finding: Initiation of high-efficacy DMT was associated with a reduction of 0.58 points/year in depression scores, compared with initiation of low-efficacy DMT.

Study details: An interim analysis of data for 1,501 participants in the ongoing MS PATHS study.

Disclosures: The study was not supported by outside funding. Ellen M. Mowry, MD, one of the investigators, reported having performed contracted research for Biogen, Genzyme, and Sun Pharma. Ms Youkyung and another two investigators reported disclosures or conflicts of interest.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Initial treatment with high-efficacy DMT is associated with a reduction in depressive symptoms, compared with an initial low-efficacy DMT.

Major finding: Initiation of high-efficacy DMT was associated with a reduction of 0.58 points/year in depression scores, compared with initiation of low-efficacy DMT.

Study details: An interim analysis of data for 1,501 participants in the ongoing MS PATHS study.

Disclosures: The study was not supported by outside funding. Ellen M. Mowry, MD, one of the investigators, reported having performed contracted research for Biogen, Genzyme, and Sun Pharma. Ms Youkyung and another two investigators reported disclosures or conflicts of interest.

Citation: REPORTING FROM CMSC 2019

Key clinical point: Initial treatment with high-efficacy DMT is associated with a reduction in depressive symptoms, compared with an initial low-efficacy DMT.

Major finding: Initiation of high-efficacy DMT was associated with a reduction of 0.58 points/year in depression scores, compared with initiation of low-efficacy DMT.

Study details: An interim analysis of data for 1,501 participants in the ongoing MS PATHS study.

Disclosures: The study was not supported by outside funding. Ellen M. Mowry, MD, one of the investigators, reported having performed contracted research for Biogen, Genzyme, and Sun Pharma. Ms Youkyung and another two investigators reported disclosures or conflicts of interest.

Citation: REPORTING FROM CMSC 2019