MS Briefs

Key clinical point: Applying a criterion of three lesions with the central vein sign distinguishes between multiple sclerosis and its mimics.

Major finding: The criterion has a sensitivity and specificity of 61.9% and 89.0%, respectively.

Study details: A multicenter study of 606 participants with clinically isolated syndrome, multiple sclerosis, and multiple sclerosis mimics.

Disclosures: Dr. Sinnecker reported receiving personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Actelion.

Citation: Sinnecker T et al. AAN 2019, Abstract S6.002.

Key clinical point: Applying a criterion of three lesions with the central vein sign distinguishes between multiple sclerosis and its mimics.

Major finding: The criterion has a sensitivity and specificity of 61.9% and 89.0%, respectively.

Study details: A multicenter study of 606 participants with clinically isolated syndrome, multiple sclerosis, and multiple sclerosis mimics.

Disclosures: Dr. Sinnecker reported receiving personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Actelion.

Citation: Sinnecker T et al. AAN 2019, Abstract S6.002.

Key clinical point: Applying a criterion of three lesions with the central vein sign distinguishes between multiple sclerosis and its mimics.

Major finding: The criterion has a sensitivity and specificity of 61.9% and 89.0%, respectively.

Study details: A multicenter study of 606 participants with clinically isolated syndrome, multiple sclerosis, and multiple sclerosis mimics.

Disclosures: Dr. Sinnecker reported receiving personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Actelion.

Citation: Sinnecker T et al. AAN 2019, Abstract S6.002.

Key clinical point: Women with MS may be able to have children, breastfeed, and resume treatment without experiencing an increased risk of relapse during the postpartum period.

Major finding: Patients’ annualized relapse rate was 0.39 pre-pregnancy, 0.07-0.14 during pregnancy, 0.27 in the first 3 months postpartum, and 0.37 at 4-6 months postpartum.

Study details: An analysis of prospectively collected data from 466 pregnancies among 375 women with MS between 2008 and 2016.

Disclosures: The study was supported by the National Multiple Sclerosis Society. The researchers had no disclosures.

Citation: Langer-Gould A et al. AAN 2019, Abstract S6.007.

Key clinical point: Women with MS may be able to have children, breastfeed, and resume treatment without experiencing an increased risk of relapse during the postpartum period.

Major finding: Patients’ annualized relapse rate was 0.39 pre-pregnancy, 0.07-0.14 during pregnancy, 0.27 in the first 3 months postpartum, and 0.37 at 4-6 months postpartum.

Study details: An analysis of prospectively collected data from 466 pregnancies among 375 women with MS between 2008 and 2016.

Disclosures: The study was supported by the National Multiple Sclerosis Society. The researchers had no disclosures.

Citation: Langer-Gould A et al. AAN 2019, Abstract S6.007.

Key clinical point: Women with MS may be able to have children, breastfeed, and resume treatment without experiencing an increased risk of relapse during the postpartum period.

Major finding: Patients’ annualized relapse rate was 0.39 pre-pregnancy, 0.07-0.14 during pregnancy, 0.27 in the first 3 months postpartum, and 0.37 at 4-6 months postpartum.

Study details: An analysis of prospectively collected data from 466 pregnancies among 375 women with MS between 2008 and 2016.

Disclosures: The study was supported by the National Multiple Sclerosis Society. The researchers had no disclosures.

Citation: Langer-Gould A et al. AAN 2019, Abstract S6.007.

Key clinical point: Lateral geniculate nucleus (LGN) volume loss in multiple sclerosis (MS) indicates structural damage with potential functional relevance.

Major finding: LGN volume was reduced in patients with relapsing-remitting MS vs healthy controls and was associated with ganglion cell-inner plexiform layer (GC-IPL) thickness and correlated with optic radiation (OR) lesion volume.

Study details: A cross-sectional study of 34 patients with relapsing-remitting MS and 33 matched healthy controls.

Disclosures: The lead author received funding for speaker or travel honoraria from Sanofi-Genzyme, Bayer AG, Teva, UCB-Pharma AG, and Hoffmann-La Roche.

Citation: Papadopoulou, et al. Neurology. doi:10.1212/WNL.0000000000007450.

Key clinical point: Lateral geniculate nucleus (LGN) volume loss in multiple sclerosis (MS) indicates structural damage with potential functional relevance.

Major finding: LGN volume was reduced in patients with relapsing-remitting MS vs healthy controls and was associated with ganglion cell-inner plexiform layer (GC-IPL) thickness and correlated with optic radiation (OR) lesion volume.

Study details: A cross-sectional study of 34 patients with relapsing-remitting MS and 33 matched healthy controls.

Disclosures: The lead author received funding for speaker or travel honoraria from Sanofi-Genzyme, Bayer AG, Teva, UCB-Pharma AG, and Hoffmann-La Roche.

Citation: Papadopoulou, et al. Neurology. doi:10.1212/WNL.0000000000007450.

Key clinical point: Lateral geniculate nucleus (LGN) volume loss in multiple sclerosis (MS) indicates structural damage with potential functional relevance.

Major finding: LGN volume was reduced in patients with relapsing-remitting MS vs healthy controls and was associated with ganglion cell-inner plexiform layer (GC-IPL) thickness and correlated with optic radiation (OR) lesion volume.

Study details: A cross-sectional study of 34 patients with relapsing-remitting MS and 33 matched healthy controls.

Disclosures: The lead author received funding for speaker or travel honoraria from Sanofi-Genzyme, Bayer AG, Teva, UCB-Pharma AG, and Hoffmann-La Roche.

Citation: Papadopoulou, et al. Neurology. doi:10.1212/WNL.0000000000007450.

Key clinical point: Patients with multiple sclerosis report a wide range of concerns about family planning and pregnancy.

Major finding: Of the 137 respondents who did not become pregnant following diagnosis, 22 (16%) indicated that their decision was driven by multiple sclerosis–related concerns, including MS worsening with pregnancy (64%).

Study details: A survey of 174 women with confirmed MS diagnosis who received care at the University of Virginia Medical Center.

Disclosures: The study was supported by the ziMS Foundation.

Citation: Engel CE et al. ACTRIMS Forum 2019, Poster 307.

Key clinical point: Patients with multiple sclerosis report a wide range of concerns about family planning and pregnancy.

Major finding: Of the 137 respondents who did not become pregnant following diagnosis, 22 (16%) indicated that their decision was driven by multiple sclerosis–related concerns, including MS worsening with pregnancy (64%).

Study details: A survey of 174 women with confirmed MS diagnosis who received care at the University of Virginia Medical Center.

Disclosures: The study was supported by the ziMS Foundation.

Citation: Engel CE et al. ACTRIMS Forum 2019, Poster 307.

Key clinical point: Patients with multiple sclerosis report a wide range of concerns about family planning and pregnancy.

Major finding: Of the 137 respondents who did not become pregnant following diagnosis, 22 (16%) indicated that their decision was driven by multiple sclerosis–related concerns, including MS worsening with pregnancy (64%).

Study details: A survey of 174 women with confirmed MS diagnosis who received care at the University of Virginia Medical Center.

Disclosures: The study was supported by the ziMS Foundation.

Citation: Engel CE et al. ACTRIMS Forum 2019, Poster 307.

Key clinical point: Patients who discontinued disease-modifying therapy after a period of disease inactivity had a similar time to next event, compared with patients who remained on treatment.

Major finding: Compared with patients aged 45 years and younger, older patients who discontinued disease-modifying therapy had significantly favorable disease course in terms of time to clinical relapse (P = .032), time to MRI event (P = .013), and time to any inflammatory event (P = .0005).

Study details: A single-center study of 140 patients with relapsing remitting multiple sclerosis.

Disclosures: Dr. Yano reported that he has received a research grant from the Yoshida Scholarship Foundation in Japan. His coauthors reported having numerous financial ties to industry.

Citation: Yano H et al. ACTRIMS Forum 2019, Poster 061.

Key clinical point: Patients who discontinued disease-modifying therapy after a period of disease inactivity had a similar time to next event, compared with patients who remained on treatment.

Major finding: Compared with patients aged 45 years and younger, older patients who discontinued disease-modifying therapy had significantly favorable disease course in terms of time to clinical relapse (P = .032), time to MRI event (P = .013), and time to any inflammatory event (P = .0005).

Study details: A single-center study of 140 patients with relapsing remitting multiple sclerosis.

Disclosures: Dr. Yano reported that he has received a research grant from the Yoshida Scholarship Foundation in Japan. His coauthors reported having numerous financial ties to industry.

Citation: Yano H et al. ACTRIMS Forum 2019, Poster 061.

Key clinical point: Patients who discontinued disease-modifying therapy after a period of disease inactivity had a similar time to next event, compared with patients who remained on treatment.

Major finding: Compared with patients aged 45 years and younger, older patients who discontinued disease-modifying therapy had significantly favorable disease course in terms of time to clinical relapse (P = .032), time to MRI event (P = .013), and time to any inflammatory event (P = .0005).

Study details: A single-center study of 140 patients with relapsing remitting multiple sclerosis.

Disclosures: Dr. Yano reported that he has received a research grant from the Yoshida Scholarship Foundation in Japan. His coauthors reported having numerous financial ties to industry.

Citation: Yano H et al. ACTRIMS Forum 2019, Poster 061.

Key clinical point: A higher number of comorbidities was associated with lower quality of life.

Major finding: All comorbidities accounted for 18.09% of the variance of overall health-related quality of life.

Study details: A longitudinal study of 902 patients with MS.

Disclosures: This study was supported by Multiple Sclerosis Research Australia.

Citation: Lo LMP et al. ACTRIMS Forum 2019, Abstract 80.

Key clinical point: A higher number of comorbidities was associated with lower quality of life.

Major finding: All comorbidities accounted for 18.09% of the variance of overall health-related quality of life.

Study details: A longitudinal study of 902 patients with MS.

Disclosures: This study was supported by Multiple Sclerosis Research Australia.

Citation: Lo LMP et al. ACTRIMS Forum 2019, Abstract 80.

Key clinical point: A higher number of comorbidities was associated with lower quality of life.

Major finding: All comorbidities accounted for 18.09% of the variance of overall health-related quality of life.

Study details: A longitudinal study of 902 patients with MS.

Disclosures: This study was supported by Multiple Sclerosis Research Australia.

Citation: Lo LMP et al. ACTRIMS Forum 2019, Abstract 80.

Key clinical point: In patients with relapsing-remitting MS, cerebellar volume may independently predict clinical disability as measured by the 25-foot walk test.

Major finding: Baseline cerebellar gray matter volume was the only MRI metric that significantly predicted 25-foot walk test results at 36 months (Beta = –0.172).

Study details: A retrospective analysis of MRI data from 838 patients in the phase 3 CombiRx trial.

Disclosures: The researchers had no disclosures.

Citation: Petracca M et al. ACTRIMS Forum 2019, Abstract 160.

Key clinical point: In patients with relapsing-remitting MS, cerebellar volume may independently predict clinical disability as measured by the 25-foot walk test.

Major finding: Baseline cerebellar gray matter volume was the only MRI metric that significantly predicted 25-foot walk test results at 36 months (Beta = –0.172).

Study details: A retrospective analysis of MRI data from 838 patients in the phase 3 CombiRx trial.

Disclosures: The researchers had no disclosures.

Citation: Petracca M et al. ACTRIMS Forum 2019, Abstract 160.

Key clinical point: In patients with relapsing-remitting MS, cerebellar volume may independently predict clinical disability as measured by the 25-foot walk test.

Major finding: Baseline cerebellar gray matter volume was the only MRI metric that significantly predicted 25-foot walk test results at 36 months (Beta = –0.172).

Study details: A retrospective analysis of MRI data from 838 patients in the phase 3 CombiRx trial.

Disclosures: The researchers had no disclosures.

Citation: Petracca M et al. ACTRIMS Forum 2019, Abstract 160.

In patients with multiple sclerosis (MS), the risk of acute myocardial infarction (AMI) is elevated but may not be accounted for by traditional vascular risk factors, a new study found. Researchers conducted a retrospective matched cohort study using population-based administrative data in 2 Canadian provinces. Incident MS cases were identified and for each case, up to 5 controls without MS were matched on age, sex, and region. The incidence of AMI between cohorts was compared using incidence rate ratios (IRRs). Among the findings:

• 14,565 persons with MS and 72,825 matched controls were identified.
• The crude incidence of AMI per 100,000 population was 146.2 in the MS population vs 128.8 in the matched population.
• After age standardization, the incidence of AMI was higher in the MS population vs the matched population (IRR 1.18).
• After adjustment, the hazard of AMI was 60% higher in the MS population vs the matched population (hazard ratio 1.63).

Marrie RA, Garland A, Schaffer SA. Traditional risk factors may not explain increased incidence of myocardial infarction in MS. [Published online ahead of print March 6, 2019]. Neurology. doi:10.1212/WNL.0000000000007251.

In patients with multiple sclerosis (MS), the risk of acute myocardial infarction (AMI) is elevated but may not be accounted for by traditional vascular risk factors, a new study found. Researchers conducted a retrospective matched cohort study using population-based administrative data in 2 Canadian provinces. Incident MS cases were identified and for each case, up to 5 controls without MS were matched on age, sex, and region. The incidence of AMI between cohorts was compared using incidence rate ratios (IRRs). Among the findings:

• 14,565 persons with MS and 72,825 matched controls were identified.
• The crude incidence of AMI per 100,000 population was 146.2 in the MS population vs 128.8 in the matched population.
• After age standardization, the incidence of AMI was higher in the MS population vs the matched population (IRR 1.18).
• After adjustment, the hazard of AMI was 60% higher in the MS population vs the matched population (hazard ratio 1.63).

Marrie RA, Garland A, Schaffer SA. Traditional risk factors may not explain increased incidence of myocardial infarction in MS. [Published online ahead of print March 6, 2019]. Neurology. doi:10.1212/WNL.0000000000007251.

In patients with multiple sclerosis (MS), the risk of acute myocardial infarction (AMI) is elevated but may not be accounted for by traditional vascular risk factors, a new study found. Researchers conducted a retrospective matched cohort study using population-based administrative data in 2 Canadian provinces. Incident MS cases were identified and for each case, up to 5 controls without MS were matched on age, sex, and region. The incidence of AMI between cohorts was compared using incidence rate ratios (IRRs). Among the findings:

• 14,565 persons with MS and 72,825 matched controls were identified.
• The crude incidence of AMI per 100,000 population was 146.2 in the MS population vs 128.8 in the matched population.
• After age standardization, the incidence of AMI was higher in the MS population vs the matched population (IRR 1.18).
• After adjustment, the hazard of AMI was 60% higher in the MS population vs the matched population (hazard ratio 1.63).

Marrie RA, Garland A, Schaffer SA. Traditional risk factors may not explain increased incidence of myocardial infarction in MS. [Published online ahead of print March 6, 2019]. Neurology. doi:10.1212/WNL.0000000000007251.

In a recent survey, patients with multiple sclerosis (MS) displayed a wide range of risk tolerance (RT) to MS therapies. People with MS from the North American Research Committee on Multiple Sclerosis Registry’s online cohort and the National Multiple Sclerosis Society were invited to complete a questionnaire on tolerance to real-world risks associated with a hypothetical therapy. Multiple risk levels were presented, including skin rash, infection, kidney injury, thyroid injury, liver injury, and progressive multifocal leukoencephalopathy (PML). Researchers found:

• Both PML and kidney injury had the lowest RT; thyroid and infection risk had the highest tolerance.
• Men, younger individuals, and those with greater disability reported a higher tolerance to all risk scenarios.
• Participants currently taking an MS therapy reported higher tolerance vs those not taking any therapy.

Fox RJ, Cosenza C, Cripps L, et al. A survey of risk tolerance to multiple sclerosis therapies. [Published online ahead of print March 13, 2019]. Neurology. doi:10.1212/WNL.0000000000007245.

In a recent survey, patients with multiple sclerosis (MS) displayed a wide range of risk tolerance (RT) to MS therapies. People with MS from the North American Research Committee on Multiple Sclerosis Registry’s online cohort and the National Multiple Sclerosis Society were invited to complete a questionnaire on tolerance to real-world risks associated with a hypothetical therapy. Multiple risk levels were presented, including skin rash, infection, kidney injury, thyroid injury, liver injury, and progressive multifocal leukoencephalopathy (PML). Researchers found:

• Both PML and kidney injury had the lowest RT; thyroid and infection risk had the highest tolerance.
• Men, younger individuals, and those with greater disability reported a higher tolerance to all risk scenarios.
• Participants currently taking an MS therapy reported higher tolerance vs those not taking any therapy.

Fox RJ, Cosenza C, Cripps L, et al. A survey of risk tolerance to multiple sclerosis therapies. [Published online ahead of print March 13, 2019]. Neurology. doi:10.1212/WNL.0000000000007245.

In a recent survey, patients with multiple sclerosis (MS) displayed a wide range of risk tolerance (RT) to MS therapies. People with MS from the North American Research Committee on Multiple Sclerosis Registry’s online cohort and the National Multiple Sclerosis Society were invited to complete a questionnaire on tolerance to real-world risks associated with a hypothetical therapy. Multiple risk levels were presented, including skin rash, infection, kidney injury, thyroid injury, liver injury, and progressive multifocal leukoencephalopathy (PML). Researchers found:

• Both PML and kidney injury had the lowest RT; thyroid and infection risk had the highest tolerance.
• Men, younger individuals, and those with greater disability reported a higher tolerance to all risk scenarios.
• Participants currently taking an MS therapy reported higher tolerance vs those not taking any therapy.

Fox RJ, Cosenza C, Cripps L, et al. A survey of risk tolerance to multiple sclerosis therapies. [Published online ahead of print March 13, 2019]. Neurology. doi:10.1212/WNL.0000000000007245.

In an age and gender-based US national retrospective analysis, overall 30-day readmission in multiple sclerosis (MS) was ∼10%, with higher readmission rates observed in older patients. The retrospective observational cohort study included patients hospitalized with primary discharge diagnosis of MS using 2013 Nationwide Readmission Database (NRD). Age (<40 vs >40 years) and gender-based analyses were performed using multivariable logistic regression adjusting co-variables to identify the patient/system-specific factors associated with 30-day readmission. Researchers found:

• 30-day readmission rate in MS was 10.2% in the cohort.
• Higher 30-day readmission was observed in patients aged >40 years due to burden of comorbidities.
• Readmission causes were MS exacerbations, sepsis, and respiratory complications.
• Readmission was associated with higher cost of care and longer length of stay compared to index admissions.

Patel S, SirDeshpande P, Desai R, et al. Thirty-day readmissions in multiple sclerosis: An age and gender-based US national retrospective analysis. [Published online ahead of print March 20, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.03.012.

In an age and gender-based US national retrospective analysis, overall 30-day readmission in multiple sclerosis (MS) was ∼10%, with higher readmission rates observed in older patients. The retrospective observational cohort study included patients hospitalized with primary discharge diagnosis of MS using 2013 Nationwide Readmission Database (NRD). Age (<40 vs >40 years) and gender-based analyses were performed using multivariable logistic regression adjusting co-variables to identify the patient/system-specific factors associated with 30-day readmission. Researchers found:

• 30-day readmission rate in MS was 10.2% in the cohort.
• Higher 30-day readmission was observed in patients aged >40 years due to burden of comorbidities.
• Readmission causes were MS exacerbations, sepsis, and respiratory complications.
• Readmission was associated with higher cost of care and longer length of stay compared to index admissions.

Patel S, SirDeshpande P, Desai R, et al. Thirty-day readmissions in multiple sclerosis: An age and gender-based US national retrospective analysis. [Published online ahead of print March 20, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.03.012.

In an age and gender-based US national retrospective analysis, overall 30-day readmission in multiple sclerosis (MS) was ∼10%, with higher readmission rates observed in older patients. The retrospective observational cohort study included patients hospitalized with primary discharge diagnosis of MS using 2013 Nationwide Readmission Database (NRD). Age (<40 vs >40 years) and gender-based analyses were performed using multivariable logistic regression adjusting co-variables to identify the patient/system-specific factors associated with 30-day readmission. Researchers found:

• 30-day readmission rate in MS was 10.2% in the cohort.
• Higher 30-day readmission was observed in patients aged >40 years due to burden of comorbidities.
• Readmission causes were MS exacerbations, sepsis, and respiratory complications.
• Readmission was associated with higher cost of care and longer length of stay compared to index admissions.

Patel S, SirDeshpande P, Desai R, et al. Thirty-day readmissions in multiple sclerosis: An age and gender-based US national retrospective analysis. [Published online ahead of print March 20, 2019]. Mult Scler Relat Disord. doi:10.1016/j.msard.2019.03.012.