Multiple Sclerosis

Soluble CD27 was the best biomarker of active intrathecal T-cell activation and inflammation in multiple sclerosis patients, according to Dr. Mika Komori and associates.

While the combination of all known existing biomarkers could only accurately diagnose MS 61.5% of the time, sCD27 was able to diagnose the disease correctly in all of the trial cases. Statistical analysis also showed that sCD27 was superior to the IgG index (area under the curve = 0.97 vs. area under the curve = 0.92). While no other biomarker was as effective as sCD27, sCD21 and sCD14 provided useful information about B cells and monocytes, respectively.

“The described combinatorial CSF biomarkers may facilitate the screening of such novel immunomodulatory therapies for progressive MS,” the researchers wrote. “Combinations of biomarkers and clinical data may validate surrogacy (or predictive value) of the biomarker for clinical outcome, which would open the era of rational personalized medicine to the neuroimmunology field,” they concluded.

Find the full study in the Annals of Neurology (doi: 10.1002/ana.24408).

Soluble CD27 was the best biomarker of active intrathecal T-cell activation and inflammation in multiple sclerosis patients, according to Dr. Mika Komori and associates.

While the combination of all known existing biomarkers could only accurately diagnose MS 61.5% of the time, sCD27 was able to diagnose the disease correctly in all of the trial cases. Statistical analysis also showed that sCD27 was superior to the IgG index (area under the curve = 0.97 vs. area under the curve = 0.92). While no other biomarker was as effective as sCD27, sCD21 and sCD14 provided useful information about B cells and monocytes, respectively.

“The described combinatorial CSF biomarkers may facilitate the screening of such novel immunomodulatory therapies for progressive MS,” the researchers wrote. “Combinations of biomarkers and clinical data may validate surrogacy (or predictive value) of the biomarker for clinical outcome, which would open the era of rational personalized medicine to the neuroimmunology field,” they concluded.

Find the full study in the Annals of Neurology (doi: 10.1002/ana.24408).

Soluble CD27 was the best biomarker of active intrathecal T-cell activation and inflammation in multiple sclerosis patients, according to Dr. Mika Komori and associates.

While the combination of all known existing biomarkers could only accurately diagnose MS 61.5% of the time, sCD27 was able to diagnose the disease correctly in all of the trial cases. Statistical analysis also showed that sCD27 was superior to the IgG index (area under the curve = 0.97 vs. area under the curve = 0.92). While no other biomarker was as effective as sCD27, sCD21 and sCD14 provided useful information about B cells and monocytes, respectively.

“The described combinatorial CSF biomarkers may facilitate the screening of such novel immunomodulatory therapies for progressive MS,” the researchers wrote. “Combinations of biomarkers and clinical data may validate surrogacy (or predictive value) of the biomarker for clinical outcome, which would open the era of rational personalized medicine to the neuroimmunology field,” they concluded.

Find the full study in the Annals of Neurology (doi: 10.1002/ana.24408).

Interferon beta and glatiramer acetate continue to be potent, cost-effective disease modifying therapies (DMTs) for multiple sclerosis patients after 6 years, reported Dr. Jacqueline Palace of Oxford (England) University.

In a clinical cohort study of 4,137 patients with relapsing MS, both Markov and multilevel statistical models showed slower progression than predicted, with a reduction of 24.2% and 40% in Expanded Disability Status Scale (EDSS) progression, respectively. Measures of cost effectiveness showed a better utility progression ratio than the expected 62% target (Markov model: 58.5%, 95% CI 54.2-62.8; multilevel model: 57.1%, 95% CI 53.0-61.2).

The findings support a “predicted long-term effect of multiple sclerosis DMTs in patients with relapsing-onset disease, consistent with their UK cost-effectiveness at an aggregate level,” Dr. Palace and her colleagues said in the report.Read the full paper online in the Lancet.

Interferon beta and glatiramer acetate continue to be potent, cost-effective disease modifying therapies (DMTs) for multiple sclerosis patients after 6 years, reported Dr. Jacqueline Palace of Oxford (England) University.

In a clinical cohort study of 4,137 patients with relapsing MS, both Markov and multilevel statistical models showed slower progression than predicted, with a reduction of 24.2% and 40% in Expanded Disability Status Scale (EDSS) progression, respectively. Measures of cost effectiveness showed a better utility progression ratio than the expected 62% target (Markov model: 58.5%, 95% CI 54.2-62.8; multilevel model: 57.1%, 95% CI 53.0-61.2).

The findings support a “predicted long-term effect of multiple sclerosis DMTs in patients with relapsing-onset disease, consistent with their UK cost-effectiveness at an aggregate level,” Dr. Palace and her colleagues said in the report.Read the full paper online in the Lancet.

Interferon beta and glatiramer acetate continue to be potent, cost-effective disease modifying therapies (DMTs) for multiple sclerosis patients after 6 years, reported Dr. Jacqueline Palace of Oxford (England) University.

In a clinical cohort study of 4,137 patients with relapsing MS, both Markov and multilevel statistical models showed slower progression than predicted, with a reduction of 24.2% and 40% in Expanded Disability Status Scale (EDSS) progression, respectively. Measures of cost effectiveness showed a better utility progression ratio than the expected 62% target (Markov model: 58.5%, 95% CI 54.2-62.8; multilevel model: 57.1%, 95% CI 53.0-61.2).

The findings support a “predicted long-term effect of multiple sclerosis DMTs in patients with relapsing-onset disease, consistent with their UK cost-effectiveness at an aggregate level,” Dr. Palace and her colleagues said in the report.Read the full paper online in the Lancet.

Disease-modifying therapy may significantly reduce rates of disability-worsening events in patients with clinically isolated syndrome and early multiple sclerosis, a study showed.

Dr. Vilija G. Jokubaitis of the University of Melbourne in Parkville, Australia, and her associates examined data from 1,989 patients with clinically isolated syndrome enrolled in the MSBase Incident Study, split into groups according to proportion of time treated. Of the 391 patients who had a first 3-month disability-worsening event, 307 (78.5%) had worsening events that were sustained for at least 12 months.

A greater proportion of follow-up time exposed to treatment was associated with greater reductions in the rate of worsening. Patients exposed to disease-modifying therapy (DMT) for between 51% and 80% of their follow-up time had a 36% and a 57% reduction in the rate of 3-month confirmed and 12-month sustained disability-worsening events, respectively, the investigators reported.

The effect of DMT on reduction in short- and long-term disability worsening is not quite certain, although the researchers identified several factors that are predictors of individual first 3-month confirmed worsening events such as older age at clinically isolated syndrome onset, baseline dysfunction within the pyramidal system, and annualized relapse rate.

Read the full article here: Annals of Clinical and Translational Neurology 2015 (doi:10.1002/acn3.187).

Disease-modifying therapy may significantly reduce rates of disability-worsening events in patients with clinically isolated syndrome and early multiple sclerosis, a study showed.

Dr. Vilija G. Jokubaitis of the University of Melbourne in Parkville, Australia, and her associates examined data from 1,989 patients with clinically isolated syndrome enrolled in the MSBase Incident Study, split into groups according to proportion of time treated. Of the 391 patients who had a first 3-month disability-worsening event, 307 (78.5%) had worsening events that were sustained for at least 12 months.

A greater proportion of follow-up time exposed to treatment was associated with greater reductions in the rate of worsening. Patients exposed to disease-modifying therapy (DMT) for between 51% and 80% of their follow-up time had a 36% and a 57% reduction in the rate of 3-month confirmed and 12-month sustained disability-worsening events, respectively, the investigators reported.

The effect of DMT on reduction in short- and long-term disability worsening is not quite certain, although the researchers identified several factors that are predictors of individual first 3-month confirmed worsening events such as older age at clinically isolated syndrome onset, baseline dysfunction within the pyramidal system, and annualized relapse rate.

Read the full article here: Annals of Clinical and Translational Neurology 2015 (doi:10.1002/acn3.187).

Disease-modifying therapy may significantly reduce rates of disability-worsening events in patients with clinically isolated syndrome and early multiple sclerosis, a study showed.

Dr. Vilija G. Jokubaitis of the University of Melbourne in Parkville, Australia, and her associates examined data from 1,989 patients with clinically isolated syndrome enrolled in the MSBase Incident Study, split into groups according to proportion of time treated. Of the 391 patients who had a first 3-month disability-worsening event, 307 (78.5%) had worsening events that were sustained for at least 12 months.

A greater proportion of follow-up time exposed to treatment was associated with greater reductions in the rate of worsening. Patients exposed to disease-modifying therapy (DMT) for between 51% and 80% of their follow-up time had a 36% and a 57% reduction in the rate of 3-month confirmed and 12-month sustained disability-worsening events, respectively, the investigators reported.

The effect of DMT on reduction in short- and long-term disability worsening is not quite certain, although the researchers identified several factors that are predictors of individual first 3-month confirmed worsening events such as older age at clinically isolated syndrome onset, baseline dysfunction within the pyramidal system, and annualized relapse rate.

Read the full article here: Annals of Clinical and Translational Neurology 2015 (doi:10.1002/acn3.187).

Using computerized cognitive training can help to improve processing speed and working memory in patients with multiple sclerosis, according to a pilot study.

Investigators randomized subjects into 6 weeks of training in either an active or sham group, and found the active training group improved on measures of processing speed and attention, with significant improvements on measures of other domains.

The study authors noted the results provide preliminary evidence that cognitive training in multiple sclerosis patients may produce moderate improvements in select areas of cognitive functioning.

Citation: Hancock LM, Bruce JM, Bruce AS, Lynch SG. Processing speed and working memory training in multiple sclerosis: a double-blind randomized controlled pilot study. J Clin Exp Neuropsychol. 2015:1-15.

Commentary: Cognitive impairment in MS is common and can impact employment, driving, and quality of life. So often treatments require costly medications and expensive treatments. The few clinical trials to evaluate medications to improve memory in patients with MS have not demonstrated great efficacy. Information processing speed and attention are 2 cognitive domains commonly affected in MS. Computerized cognitive training might be a great opportunity and option to provide an effective treatment approach for those impacted and be delivered in a manner that could be inexpensive, easily made available, and accessible. This pilot study might provide great promise for those in need. —Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY.

Using computerized cognitive training can help to improve processing speed and working memory in patients with multiple sclerosis, according to a pilot study.

Investigators randomized subjects into 6 weeks of training in either an active or sham group, and found the active training group improved on measures of processing speed and attention, with significant improvements on measures of other domains.

The study authors noted the results provide preliminary evidence that cognitive training in multiple sclerosis patients may produce moderate improvements in select areas of cognitive functioning.

Citation: Hancock LM, Bruce JM, Bruce AS, Lynch SG. Processing speed and working memory training in multiple sclerosis: a double-blind randomized controlled pilot study. J Clin Exp Neuropsychol. 2015:1-15.

Commentary: Cognitive impairment in MS is common and can impact employment, driving, and quality of life. So often treatments require costly medications and expensive treatments. The few clinical trials to evaluate medications to improve memory in patients with MS have not demonstrated great efficacy. Information processing speed and attention are 2 cognitive domains commonly affected in MS. Computerized cognitive training might be a great opportunity and option to provide an effective treatment approach for those impacted and be delivered in a manner that could be inexpensive, easily made available, and accessible. This pilot study might provide great promise for those in need. —Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY.

Using computerized cognitive training can help to improve processing speed and working memory in patients with multiple sclerosis, according to a pilot study.

Investigators randomized subjects into 6 weeks of training in either an active or sham group, and found the active training group improved on measures of processing speed and attention, with significant improvements on measures of other domains.

The study authors noted the results provide preliminary evidence that cognitive training in multiple sclerosis patients may produce moderate improvements in select areas of cognitive functioning.

Citation: Hancock LM, Bruce JM, Bruce AS, Lynch SG. Processing speed and working memory training in multiple sclerosis: a double-blind randomized controlled pilot study. J Clin Exp Neuropsychol. 2015:1-15.

Commentary: Cognitive impairment in MS is common and can impact employment, driving, and quality of life. So often treatments require costly medications and expensive treatments. The few clinical trials to evaluate medications to improve memory in patients with MS have not demonstrated great efficacy. Information processing speed and attention are 2 cognitive domains commonly affected in MS. Computerized cognitive training might be a great opportunity and option to provide an effective treatment approach for those impacted and be delivered in a manner that could be inexpensive, easily made available, and accessible. This pilot study might provide great promise for those in need. —Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY.

Postmenopausal patients with multiple sclerosis report worsening disease severity on the Multiple Sclerosis Rating Scale (MSRS), according to an online cohort study on the PatientsLikeMe (PLM) platform.

Participants filled out a detailed reproductive history survey and linked to PLM’s prospectively collected patient-reported severity score. Of the 513 respondents:

• 55% were post-menopausal

• 54% of post-menopausal respondents reported induced menopause and were more likely to be treated with hormone replacement therapy

• median age at natural menopause was 51

Postmenopausal status, surgical menopause, and earlier age at menopause were associated with worse MSRS scores.

Citation: Bove R, Healy BC, Secor E, et al. Patients report worse MS symptoms after menopause: findings from an online cohort. Mult Scler Relat Disord. 2015;4(1):18-24. doi: 10.1016/j.msard.2014.11.009.

Postmenopausal patients with multiple sclerosis report worsening disease severity on the Multiple Sclerosis Rating Scale (MSRS), according to an online cohort study on the PatientsLikeMe (PLM) platform.

Participants filled out a detailed reproductive history survey and linked to PLM’s prospectively collected patient-reported severity score. Of the 513 respondents:

• 55% were post-menopausal

• 54% of post-menopausal respondents reported induced menopause and were more likely to be treated with hormone replacement therapy

• median age at natural menopause was 51

Postmenopausal status, surgical menopause, and earlier age at menopause were associated with worse MSRS scores.

Citation: Bove R, Healy BC, Secor E, et al. Patients report worse MS symptoms after menopause: findings from an online cohort. Mult Scler Relat Disord. 2015;4(1):18-24. doi: 10.1016/j.msard.2014.11.009.

Postmenopausal patients with multiple sclerosis report worsening disease severity on the Multiple Sclerosis Rating Scale (MSRS), according to an online cohort study on the PatientsLikeMe (PLM) platform.

Participants filled out a detailed reproductive history survey and linked to PLM’s prospectively collected patient-reported severity score. Of the 513 respondents:

• 55% were post-menopausal

• 54% of post-menopausal respondents reported induced menopause and were more likely to be treated with hormone replacement therapy

• median age at natural menopause was 51

Postmenopausal status, surgical menopause, and earlier age at menopause were associated with worse MSRS scores.

Citation: Bove R, Healy BC, Secor E, et al. Patients report worse MS symptoms after menopause: findings from an online cohort. Mult Scler Relat Disord. 2015;4(1):18-24. doi: 10.1016/j.msard.2014.11.009.

A biosocial approach including psychoeducational wellness programs for treating patients with multiple sclerosis may help to improve a patient’s overall quality of life and well-being, according to a 10-week study of the group sessions.

At baseline, 54 MS patients completed a series of self-reported questionnaires, then either attended 10, 90-minute weekly psychoeducational wellness group sessions or no interventions. The intervention was aimed at improving patients’ awareness of social, intellectual, emotional, and spiritual factors that can affect their overall well-being.

After 10 weeks study, subjects repeated the questionnaire and showed improvements in depression, anxiety, overall mental health, perceived stress, and pain, compared to the controls. No significant improvements were noted regarding social support, cognitive complaints, or fatigue.

Citation: McGuire KB, Stojanovic-Radic J, Strober L, Chiaravalloti ND, DeLuca J. Development and effectiveness of a psychoeducational wellness program for people with multiple sclerosis: description and outcomes. Int J MS Care. 2015;17(1):1-8. doi: 10.7224/1537-2073.2013-045.

A biosocial approach including psychoeducational wellness programs for treating patients with multiple sclerosis may help to improve a patient’s overall quality of life and well-being, according to a 10-week study of the group sessions.

At baseline, 54 MS patients completed a series of self-reported questionnaires, then either attended 10, 90-minute weekly psychoeducational wellness group sessions or no interventions. The intervention was aimed at improving patients’ awareness of social, intellectual, emotional, and spiritual factors that can affect their overall well-being.

After 10 weeks study, subjects repeated the questionnaire and showed improvements in depression, anxiety, overall mental health, perceived stress, and pain, compared to the controls. No significant improvements were noted regarding social support, cognitive complaints, or fatigue.

Citation: McGuire KB, Stojanovic-Radic J, Strober L, Chiaravalloti ND, DeLuca J. Development and effectiveness of a psychoeducational wellness program for people with multiple sclerosis: description and outcomes. Int J MS Care. 2015;17(1):1-8. doi: 10.7224/1537-2073.2013-045.

A biosocial approach including psychoeducational wellness programs for treating patients with multiple sclerosis may help to improve a patient’s overall quality of life and well-being, according to a 10-week study of the group sessions.

At baseline, 54 MS patients completed a series of self-reported questionnaires, then either attended 10, 90-minute weekly psychoeducational wellness group sessions or no interventions. The intervention was aimed at improving patients’ awareness of social, intellectual, emotional, and spiritual factors that can affect their overall well-being.

After 10 weeks study, subjects repeated the questionnaire and showed improvements in depression, anxiety, overall mental health, perceived stress, and pain, compared to the controls. No significant improvements were noted regarding social support, cognitive complaints, or fatigue.

Citation: McGuire KB, Stojanovic-Radic J, Strober L, Chiaravalloti ND, DeLuca J. Development and effectiveness of a psychoeducational wellness program for people with multiple sclerosis: description and outcomes. Int J MS Care. 2015;17(1):1-8. doi: 10.7224/1537-2073.2013-045.

Lower urinary tract symptoms (LUTS) are common among patients with multiple sclerosis, however they remain largely untreated, according to an online, cross-sectional survey of 1,052 individuals with MS.

One or more lower urinary tract symptoms were present in 92% of subjects with the most common as follows:

• Post-micturition dribble (64.9%)

• Urinary urgency (61.7%)

• Feeling of incomplete emptying (60.7%)

• Some type of UTI (79%)

Of those with symptoms, 70% previously discussed it with a health care provider, however, only 32% had seen a health care provider in the past year. Patients were more likely to seek treatment for urgency, intermittent urine stream, and urgency urinary incontinence.

Citation: Khalaf KM, Coyne KS, Globe DR, Armstrong EP, Malone DC, Burks J. Lower urinary tract symptom prevalence and management among patients with multiple sclerosis. Int J MS Care. 2015;17(1):14-25. doi: 10.7224/1537-2073.2013-040.

Lower urinary tract symptoms (LUTS) are common among patients with multiple sclerosis, however they remain largely untreated, according to an online, cross-sectional survey of 1,052 individuals with MS.

One or more lower urinary tract symptoms were present in 92% of subjects with the most common as follows:

• Post-micturition dribble (64.9%)

• Urinary urgency (61.7%)

• Feeling of incomplete emptying (60.7%)

• Some type of UTI (79%)

Of those with symptoms, 70% previously discussed it with a health care provider, however, only 32% had seen a health care provider in the past year. Patients were more likely to seek treatment for urgency, intermittent urine stream, and urgency urinary incontinence.

Citation: Khalaf KM, Coyne KS, Globe DR, Armstrong EP, Malone DC, Burks J. Lower urinary tract symptom prevalence and management among patients with multiple sclerosis. Int J MS Care. 2015;17(1):14-25. doi: 10.7224/1537-2073.2013-040.

Lower urinary tract symptoms (LUTS) are common among patients with multiple sclerosis, however they remain largely untreated, according to an online, cross-sectional survey of 1,052 individuals with MS.

One or more lower urinary tract symptoms were present in 92% of subjects with the most common as follows:

• Post-micturition dribble (64.9%)

• Urinary urgency (61.7%)

• Feeling of incomplete emptying (60.7%)

• Some type of UTI (79%)

Of those with symptoms, 70% previously discussed it with a health care provider, however, only 32% had seen a health care provider in the past year. Patients were more likely to seek treatment for urgency, intermittent urine stream, and urgency urinary incontinence.

Citation: Khalaf KM, Coyne KS, Globe DR, Armstrong EP, Malone DC, Burks J. Lower urinary tract symptom prevalence and management among patients with multiple sclerosis. Int J MS Care. 2015;17(1):14-25. doi: 10.7224/1537-2073.2013-040.

The modified Story Memory Technique (mSMT), a behavioral intervention aimed at improving new learning and memory in patients with multiple sclerosis, may help with processing speed and other cognitive markers, according to the double-blind, placebo-controlled, MEMREHAB trial of patients with clinically definite multiple sclerosis.

Participants were randomized to either mSMT or a placebo group, and underwent baseline and follow-up neuropsychological assessment. Compared to the control group, the treatment group showed significant improvements on California Verbal Learning Test (CVLT).

Investigators also note that performance on the Symbol Digit Modalities Test (SDMT) was a significant predictor of benefit from mSMT therapy, suggesting SDMT scores may serve as a proxy for overall cognitive impairment.

Citation: Chiaravalloti ND, DeLuca J. The influence of cognitive dysfunction on benefit from learning and memory rehabilitation in MS: a sub-analysis of the MEMREHAB trial. Mult Scler. 2015. pii: 1352458514567726.

The modified Story Memory Technique (mSMT), a behavioral intervention aimed at improving new learning and memory in patients with multiple sclerosis, may help with processing speed and other cognitive markers, according to the double-blind, placebo-controlled, MEMREHAB trial of patients with clinically definite multiple sclerosis.

Participants were randomized to either mSMT or a placebo group, and underwent baseline and follow-up neuropsychological assessment. Compared to the control group, the treatment group showed significant improvements on California Verbal Learning Test (CVLT).

Investigators also note that performance on the Symbol Digit Modalities Test (SDMT) was a significant predictor of benefit from mSMT therapy, suggesting SDMT scores may serve as a proxy for overall cognitive impairment.

Citation: Chiaravalloti ND, DeLuca J. The influence of cognitive dysfunction on benefit from learning and memory rehabilitation in MS: a sub-analysis of the MEMREHAB trial. Mult Scler. 2015. pii: 1352458514567726.

The modified Story Memory Technique (mSMT), a behavioral intervention aimed at improving new learning and memory in patients with multiple sclerosis, may help with processing speed and other cognitive markers, according to the double-blind, placebo-controlled, MEMREHAB trial of patients with clinically definite multiple sclerosis.

Participants were randomized to either mSMT or a placebo group, and underwent baseline and follow-up neuropsychological assessment. Compared to the control group, the treatment group showed significant improvements on California Verbal Learning Test (CVLT).

Investigators also note that performance on the Symbol Digit Modalities Test (SDMT) was a significant predictor of benefit from mSMT therapy, suggesting SDMT scores may serve as a proxy for overall cognitive impairment.

Citation: Chiaravalloti ND, DeLuca J. The influence of cognitive dysfunction on benefit from learning and memory rehabilitation in MS: a sub-analysis of the MEMREHAB trial. Mult Scler. 2015. pii: 1352458514567726.

Fingolimod reduced neurofilament-light chain levels in the cerebrospinal fluid of patients with relapsing-remitting multiple sclerosis who participated in the 2-year, phase III FREEDOMS study, according to Dr. Jens Kuhle and associates.

At baseline, the placebo group had a median NfL level of 886 pg/mL, while the fingolimod group (at doses of 0.5 mg or 1.25 mg) had a median level of 652 pg/mL. After 12 months, the median value for the fingolimod group had decreased significantly to 335 pg/mL. The median value in the placebo group decreased slightly to 738 pg/mL, but this was not a significant reduction. A lower NfL level after 12 months was also correlated with a lower rate of relapse and improved MRI outcomes.

The study results “support the need for future larger scale studies including CSF sampling and investigating easier accessible compartments like peripheral blood to further examine the utility of NfL levels as a potential biomarker in MS,” the investigators concluded.

In a related editorial, Dr. Bibiana Bielekova and Michael McDermott, Ph.D., wrote, “This correlation with clinical experience is encouraging, as it indicates that NfL may capture relevant biology directly related to the development of neurologic disability in MS.”

Find the full study (doi:10.1212/WNL.0000000000001491) and editorial (doi: 10.1212/WNL.0000000000001506) in Neurology.

Fingolimod reduced neurofilament-light chain levels in the cerebrospinal fluid of patients with relapsing-remitting multiple sclerosis who participated in the 2-year, phase III FREEDOMS study, according to Dr. Jens Kuhle and associates.

At baseline, the placebo group had a median NfL level of 886 pg/mL, while the fingolimod group (at doses of 0.5 mg or 1.25 mg) had a median level of 652 pg/mL. After 12 months, the median value for the fingolimod group had decreased significantly to 335 pg/mL. The median value in the placebo group decreased slightly to 738 pg/mL, but this was not a significant reduction. A lower NfL level after 12 months was also correlated with a lower rate of relapse and improved MRI outcomes.

The study results “support the need for future larger scale studies including CSF sampling and investigating easier accessible compartments like peripheral blood to further examine the utility of NfL levels as a potential biomarker in MS,” the investigators concluded.

In a related editorial, Dr. Bibiana Bielekova and Michael McDermott, Ph.D., wrote, “This correlation with clinical experience is encouraging, as it indicates that NfL may capture relevant biology directly related to the development of neurologic disability in MS.”

Find the full study (doi:10.1212/WNL.0000000000001491) and editorial (doi: 10.1212/WNL.0000000000001506) in Neurology.

Fingolimod reduced neurofilament-light chain levels in the cerebrospinal fluid of patients with relapsing-remitting multiple sclerosis who participated in the 2-year, phase III FREEDOMS study, according to Dr. Jens Kuhle and associates.

At baseline, the placebo group had a median NfL level of 886 pg/mL, while the fingolimod group (at doses of 0.5 mg or 1.25 mg) had a median level of 652 pg/mL. After 12 months, the median value for the fingolimod group had decreased significantly to 335 pg/mL. The median value in the placebo group decreased slightly to 738 pg/mL, but this was not a significant reduction. A lower NfL level after 12 months was also correlated with a lower rate of relapse and improved MRI outcomes.

The study results “support the need for future larger scale studies including CSF sampling and investigating easier accessible compartments like peripheral blood to further examine the utility of NfL levels as a potential biomarker in MS,” the investigators concluded.

In a related editorial, Dr. Bibiana Bielekova and Michael McDermott, Ph.D., wrote, “This correlation with clinical experience is encouraging, as it indicates that NfL may capture relevant biology directly related to the development of neurologic disability in MS.”

Find the full study (doi:10.1212/WNL.0000000000001491) and editorial (doi: 10.1212/WNL.0000000000001506) in Neurology.

The presence of oligoclonal bands and abnormal cranial MRI scans were the best independent predictors of progression to multiple sclerosis in a retrospective cohort study of 357 children with isolated optic neuritis who presented to 27 centers, according to Dr. Nicole Heussinger and her associates.

Abnormal cranial MRI scans were the best predictor of progression to MS, with a hazard ratio of 5.9. Presence of cerebrospinal fluid oligoclonal immunoglobulin G bands (OCB) was also an important predictor of MS, with an HR of 3.7. Age was an important factor as well: The HR for MS was 1.08 for each additional year of age. If a patient had both abnormal cranial MRI and OCB, the risk of progression to MS progression was nearly 27 times higher than without either factor.

“This work represents an important step forward in the characterization of prognostic indicators in children with isolated [optic neuritis], and it will help to guide prognostic evaluation and treatment decisions,” the investigators concluded.Find the full study in Annals of Neurology (doi:10.1002/ana.24409).

The presence of oligoclonal bands and abnormal cranial MRI scans were the best independent predictors of progression to multiple sclerosis in a retrospective cohort study of 357 children with isolated optic neuritis who presented to 27 centers, according to Dr. Nicole Heussinger and her associates.

Abnormal cranial MRI scans were the best predictor of progression to MS, with a hazard ratio of 5.9. Presence of cerebrospinal fluid oligoclonal immunoglobulin G bands (OCB) was also an important predictor of MS, with an HR of 3.7. Age was an important factor as well: The HR for MS was 1.08 for each additional year of age. If a patient had both abnormal cranial MRI and OCB, the risk of progression to MS progression was nearly 27 times higher than without either factor.

“This work represents an important step forward in the characterization of prognostic indicators in children with isolated [optic neuritis], and it will help to guide prognostic evaluation and treatment decisions,” the investigators concluded.Find the full study in Annals of Neurology (doi:10.1002/ana.24409).

The presence of oligoclonal bands and abnormal cranial MRI scans were the best independent predictors of progression to multiple sclerosis in a retrospective cohort study of 357 children with isolated optic neuritis who presented to 27 centers, according to Dr. Nicole Heussinger and her associates.

Abnormal cranial MRI scans were the best predictor of progression to MS, with a hazard ratio of 5.9. Presence of cerebrospinal fluid oligoclonal immunoglobulin G bands (OCB) was also an important predictor of MS, with an HR of 3.7. Age was an important factor as well: The HR for MS was 1.08 for each additional year of age. If a patient had both abnormal cranial MRI and OCB, the risk of progression to MS progression was nearly 27 times higher than without either factor.

“This work represents an important step forward in the characterization of prognostic indicators in children with isolated [optic neuritis], and it will help to guide prognostic evaluation and treatment decisions,” the investigators concluded.Find the full study in Annals of Neurology (doi:10.1002/ana.24409).