Multiple Sclerosis Hub

For patients who have active multiple sclerosis (MS) despite using injectable immunomodulators, switching to the oral immunomodulator fingolimod yields fewer relapses and less disability than does switching to a different injectable immunomodulator, according to a report published in the April issue of JAMA Neurology.

To compare MS outcomes using different treatment regimens, researchers used information from the MSBase registry, which collects observational data on the disorder as part of routine patient care. For this study, the investigators retrospectively analyzed data entered between 1996 and 2014 for 527 patients with MS who had breakthrough disease while receiving injectable immunomodulators (typically an interferon beta or glatiramer acetate preparation) and who switched to either oral fingolimod (148 patients) or a different interferon beta or glatiramer agent (379 patients) up to 12 months after on-treatment clinical disease activity.

The two groups were propensity matched for baseline clinical and demographic variables, including patient age, area of residence, disease duration, total number of previous treatments, disability score, number of relapses, and previous medications. The groups were followed for a median of 13 months (range, three to 80 months) after switching therapies, said Anna He, MBBS, a neurologist at Royal Melbourne Hospital in Australia, and her associates. Head-to-head analyses of relapse and disability outcomes used paired, weighted, negative binomial models or frailty proportional hazards models adjusted for MRI variables.

Patients who switched to fingolimod had a lower mean annualized relapse rate, compared with the other patients (0.31 vs 0.42). The fingolimod group had a decreased risk of relapse (hazard ratio [HR], 0.74), compared with patients who switched to a different injectable therapy. Patients who switched to fingolimod also had a 47% decreased risk of progression of disability. In addition, the fingolimod group had a markedly increased likelihood of disability regression (HR, 2.0). Furthermore, the rate of continuing on the new treatment at two years was higher with fingolimod (82.5%) than with a different injectable (73.2%), said Dr. He and her associates.

“Although analyses of observational data do not serve as a substitute for trial data, our study provides real-world evidence, representative of clinical practice in tertiary MS centers, to support clinical decision-making that is highly relevant to the management of active MS,” said the investigators.

—Mary Ann Moon

For patients who have active multiple sclerosis (MS) despite using injectable immunomodulators, switching to the oral immunomodulator fingolimod yields fewer relapses and less disability than does switching to a different injectable immunomodulator, according to a report published in the April issue of JAMA Neurology.

To compare MS outcomes using different treatment regimens, researchers used information from the MSBase registry, which collects observational data on the disorder as part of routine patient care. For this study, the investigators retrospectively analyzed data entered between 1996 and 2014 for 527 patients with MS who had breakthrough disease while receiving injectable immunomodulators (typically an interferon beta or glatiramer acetate preparation) and who switched to either oral fingolimod (148 patients) or a different interferon beta or glatiramer agent (379 patients) up to 12 months after on-treatment clinical disease activity.

The two groups were propensity matched for baseline clinical and demographic variables, including patient age, area of residence, disease duration, total number of previous treatments, disability score, number of relapses, and previous medications. The groups were followed for a median of 13 months (range, three to 80 months) after switching therapies, said Anna He, MBBS, a neurologist at Royal Melbourne Hospital in Australia, and her associates. Head-to-head analyses of relapse and disability outcomes used paired, weighted, negative binomial models or frailty proportional hazards models adjusted for MRI variables.

Patients who switched to fingolimod had a lower mean annualized relapse rate, compared with the other patients (0.31 vs 0.42). The fingolimod group had a decreased risk of relapse (hazard ratio [HR], 0.74), compared with patients who switched to a different injectable therapy. Patients who switched to fingolimod also had a 47% decreased risk of progression of disability. In addition, the fingolimod group had a markedly increased likelihood of disability regression (HR, 2.0). Furthermore, the rate of continuing on the new treatment at two years was higher with fingolimod (82.5%) than with a different injectable (73.2%), said Dr. He and her associates.

“Although analyses of observational data do not serve as a substitute for trial data, our study provides real-world evidence, representative of clinical practice in tertiary MS centers, to support clinical decision-making that is highly relevant to the management of active MS,” said the investigators.

—Mary Ann Moon

For patients who have active multiple sclerosis (MS) despite using injectable immunomodulators, switching to the oral immunomodulator fingolimod yields fewer relapses and less disability than does switching to a different injectable immunomodulator, according to a report published in the April issue of JAMA Neurology.

To compare MS outcomes using different treatment regimens, researchers used information from the MSBase registry, which collects observational data on the disorder as part of routine patient care. For this study, the investigators retrospectively analyzed data entered between 1996 and 2014 for 527 patients with MS who had breakthrough disease while receiving injectable immunomodulators (typically an interferon beta or glatiramer acetate preparation) and who switched to either oral fingolimod (148 patients) or a different interferon beta or glatiramer agent (379 patients) up to 12 months after on-treatment clinical disease activity.

The two groups were propensity matched for baseline clinical and demographic variables, including patient age, area of residence, disease duration, total number of previous treatments, disability score, number of relapses, and previous medications. The groups were followed for a median of 13 months (range, three to 80 months) after switching therapies, said Anna He, MBBS, a neurologist at Royal Melbourne Hospital in Australia, and her associates. Head-to-head analyses of relapse and disability outcomes used paired, weighted, negative binomial models or frailty proportional hazards models adjusted for MRI variables.

Patients who switched to fingolimod had a lower mean annualized relapse rate, compared with the other patients (0.31 vs 0.42). The fingolimod group had a decreased risk of relapse (hazard ratio [HR], 0.74), compared with patients who switched to a different injectable therapy. Patients who switched to fingolimod also had a 47% decreased risk of progression of disability. In addition, the fingolimod group had a markedly increased likelihood of disability regression (HR, 2.0). Furthermore, the rate of continuing on the new treatment at two years was higher with fingolimod (82.5%) than with a different injectable (73.2%), said Dr. He and her associates.

“Although analyses of observational data do not serve as a substitute for trial data, our study provides real-world evidence, representative of clinical practice in tertiary MS centers, to support clinical decision-making that is highly relevant to the management of active MS,” said the investigators.

—Mary Ann Moon

WASHINGTON, DC—A common anticonvulsant may protect the eyesight of patients with multiple sclerosis (MS), according to a study presented at the American Academy of Neurology’s 67th Annual Meeting. “About half of people with MS experience optic neuritis at some point in their life,” said study author Raj Kapoor, MD, with the National Hospital for Neurology and Neurosurgery in London. “The condition can cause sudden total or partial blindness, foggy or blackened vision, and pain. Even though eyesight can recover eventually, each attack still damages the nerve and the eye.”

For the study, Dr. Kapoor and colleagues randomly selected 86 patients with acute optic neuritis within two weeks of symptom onset to receive either phenytoin or a placebo for three months. The researchers then used medical imaging to measure the thickness of the retina at the beginning of the study and then six months later. Each patient’s eyesight (including sharpness and color perception) was also tested.

On average, the group who took phenytoin had 30% less damage to the nerve fiber layer, compared with those who received the placebo. The volume of the macula was 34% higher in those who took phenytoin than those who received the placebo. As expected after a single attack, patients’ vision successfully recovered, and there weren’t any significant differences in visual outcomes over the long term between the two groups.

“Eyesight is key to many important aspects of life, such as working, driving, and participating in social activities,” said Dr. Kapoor. “If this finding is confirmed by larger studies, it could lead to a treatment that may prevent nerve damage and blindness in MS and could help other attacks of MS, serving a major unmet need.”

The study was supported by the National Multiple Sclerosis Society, the Multiple Sclerosis Society of Great Britain and Northern Ireland, an unrestricted grant from Novartis, the National Institute for Health Research Clinical Research Network, and University College London Hospitals Biomedical Research Center.

WASHINGTON, DC—A common anticonvulsant may protect the eyesight of patients with multiple sclerosis (MS), according to a study presented at the American Academy of Neurology’s 67th Annual Meeting. “About half of people with MS experience optic neuritis at some point in their life,” said study author Raj Kapoor, MD, with the National Hospital for Neurology and Neurosurgery in London. “The condition can cause sudden total or partial blindness, foggy or blackened vision, and pain. Even though eyesight can recover eventually, each attack still damages the nerve and the eye.”

For the study, Dr. Kapoor and colleagues randomly selected 86 patients with acute optic neuritis within two weeks of symptom onset to receive either phenytoin or a placebo for three months. The researchers then used medical imaging to measure the thickness of the retina at the beginning of the study and then six months later. Each patient’s eyesight (including sharpness and color perception) was also tested.

On average, the group who took phenytoin had 30% less damage to the nerve fiber layer, compared with those who received the placebo. The volume of the macula was 34% higher in those who took phenytoin than those who received the placebo. As expected after a single attack, patients’ vision successfully recovered, and there weren’t any significant differences in visual outcomes over the long term between the two groups.

“Eyesight is key to many important aspects of life, such as working, driving, and participating in social activities,” said Dr. Kapoor. “If this finding is confirmed by larger studies, it could lead to a treatment that may prevent nerve damage and blindness in MS and could help other attacks of MS, serving a major unmet need.”

The study was supported by the National Multiple Sclerosis Society, the Multiple Sclerosis Society of Great Britain and Northern Ireland, an unrestricted grant from Novartis, the National Institute for Health Research Clinical Research Network, and University College London Hospitals Biomedical Research Center.

WASHINGTON, DC—A common anticonvulsant may protect the eyesight of patients with multiple sclerosis (MS), according to a study presented at the American Academy of Neurology’s 67th Annual Meeting. “About half of people with MS experience optic neuritis at some point in their life,” said study author Raj Kapoor, MD, with the National Hospital for Neurology and Neurosurgery in London. “The condition can cause sudden total or partial blindness, foggy or blackened vision, and pain. Even though eyesight can recover eventually, each attack still damages the nerve and the eye.”

For the study, Dr. Kapoor and colleagues randomly selected 86 patients with acute optic neuritis within two weeks of symptom onset to receive either phenytoin or a placebo for three months. The researchers then used medical imaging to measure the thickness of the retina at the beginning of the study and then six months later. Each patient’s eyesight (including sharpness and color perception) was also tested.

On average, the group who took phenytoin had 30% less damage to the nerve fiber layer, compared with those who received the placebo. The volume of the macula was 34% higher in those who took phenytoin than those who received the placebo. As expected after a single attack, patients’ vision successfully recovered, and there weren’t any significant differences in visual outcomes over the long term between the two groups.

“Eyesight is key to many important aspects of life, such as working, driving, and participating in social activities,” said Dr. Kapoor. “If this finding is confirmed by larger studies, it could lead to a treatment that may prevent nerve damage and blindness in MS and could help other attacks of MS, serving a major unmet need.”

The study was supported by the National Multiple Sclerosis Society, the Multiple Sclerosis Society of Great Britain and Northern Ireland, an unrestricted grant from Novartis, the National Institute for Health Research Clinical Research Network, and University College London Hospitals Biomedical Research Center.

WASHINGTON, DC—A significant minority of patients with multiple sclerosis (MS) who were in remission for at least five years before discontinuing disease-modifying therapy (DMT) experienced disease worsening upon stopping their medication, according to research presented at the 67th Annual Meeting of the American Academy of Neurology.

Ilya Kister, MD, Assistant Professor of Neurology at the NYU Langone Multiple Sclerosis Comprehensive Care Center, and colleagues analyzed data from the MSBase Registry, an international database that collects physician-submitted data on approximately 30,000 patients, to study relapse rate and disability progression after first-line DMT is discontinued in previously stable patients.

“If and when MS patients can safely discontinue DMT treatment is an important question that frequently comes up in clinical practice, especially with regard to patients who have been clinically and radiologically stable for a long time,” the researchers said. Some patients grow tired of taking their medicine, or feel it doesn’t work, and may stop taking it with or without their doctors’ consent, said Dr. Kister, the study’s lead author. Patients also might not be able to afford medication copayments or might encounter other insurance issues, according to the National MS Society.

The researchers identified 182 patients who met their inclusion criteria. Patients were age 40 or older at baseline and had stable Expanded Disability Status Scale (EDSS) scores and no relapse for at least five years prior to baseline. Patients were treated continuously with DMT for at least three years before the therapy was discontinued, and patients were followed for at least three years after stopping their medication. Patients who reinitiated DMT within three months were considered “DMT switchers” and excluded from the analysis.

Approximately one in four patients experienced a clinician-confirmed relapse, and approximately one in three patients had confirmed disability progression. Confirmed disability progression was defined as an increase of at least one point in EDSS score above a baseline score of 1–5.5, confirmed at repeat assessment at least three months or one year later.

Reasons for stopping DMTs included lack of improvement (9%), perceived disease progression (10%), intolerance (8%), inconvenience (8%), adverse event (6%), and unknown (66%). During the post-discontinuation period (median 4.2 years), 44 (24.2%) patients had a relapse, 36 (of 113, 31.9%) had three-month disability progression, and 12 patients (10.6%) had relapse and disability progression.

DMTs were restarted by 77 of 182 patients (42%) after three or more months, with a median time to restart of 22 months. Those who restarted DMT had a 59% decrease in the rate of disability progression compared with those who did not restart DMT, researchers said. Those who did and did not restart DMT had similar relapse rates.

“Decisions regarding stopping disease-modifying therapy may have implications for short and long-term prognosis. We know a lot about what happens when therapy is started, but we know very little about what happens when therapy is stopped,” Dr. Kister said. The researchers call for a randomized DMT discontinuation trial in stable, older patients to help answer whether and when patients may stop DMT.

WASHINGTON, DC—A significant minority of patients with multiple sclerosis (MS) who were in remission for at least five years before discontinuing disease-modifying therapy (DMT) experienced disease worsening upon stopping their medication, according to research presented at the 67th Annual Meeting of the American Academy of Neurology.

Ilya Kister, MD, Assistant Professor of Neurology at the NYU Langone Multiple Sclerosis Comprehensive Care Center, and colleagues analyzed data from the MSBase Registry, an international database that collects physician-submitted data on approximately 30,000 patients, to study relapse rate and disability progression after first-line DMT is discontinued in previously stable patients.

“If and when MS patients can safely discontinue DMT treatment is an important question that frequently comes up in clinical practice, especially with regard to patients who have been clinically and radiologically stable for a long time,” the researchers said. Some patients grow tired of taking their medicine, or feel it doesn’t work, and may stop taking it with or without their doctors’ consent, said Dr. Kister, the study’s lead author. Patients also might not be able to afford medication copayments or might encounter other insurance issues, according to the National MS Society.

The researchers identified 182 patients who met their inclusion criteria. Patients were age 40 or older at baseline and had stable Expanded Disability Status Scale (EDSS) scores and no relapse for at least five years prior to baseline. Patients were treated continuously with DMT for at least three years before the therapy was discontinued, and patients were followed for at least three years after stopping their medication. Patients who reinitiated DMT within three months were considered “DMT switchers” and excluded from the analysis.

Approximately one in four patients experienced a clinician-confirmed relapse, and approximately one in three patients had confirmed disability progression. Confirmed disability progression was defined as an increase of at least one point in EDSS score above a baseline score of 1–5.5, confirmed at repeat assessment at least three months or one year later.

Reasons for stopping DMTs included lack of improvement (9%), perceived disease progression (10%), intolerance (8%), inconvenience (8%), adverse event (6%), and unknown (66%). During the post-discontinuation period (median 4.2 years), 44 (24.2%) patients had a relapse, 36 (of 113, 31.9%) had three-month disability progression, and 12 patients (10.6%) had relapse and disability progression.

DMTs were restarted by 77 of 182 patients (42%) after three or more months, with a median time to restart of 22 months. Those who restarted DMT had a 59% decrease in the rate of disability progression compared with those who did not restart DMT, researchers said. Those who did and did not restart DMT had similar relapse rates.

“Decisions regarding stopping disease-modifying therapy may have implications for short and long-term prognosis. We know a lot about what happens when therapy is started, but we know very little about what happens when therapy is stopped,” Dr. Kister said. The researchers call for a randomized DMT discontinuation trial in stable, older patients to help answer whether and when patients may stop DMT.

WASHINGTON, DC—A significant minority of patients with multiple sclerosis (MS) who were in remission for at least five years before discontinuing disease-modifying therapy (DMT) experienced disease worsening upon stopping their medication, according to research presented at the 67th Annual Meeting of the American Academy of Neurology.

Ilya Kister, MD, Assistant Professor of Neurology at the NYU Langone Multiple Sclerosis Comprehensive Care Center, and colleagues analyzed data from the MSBase Registry, an international database that collects physician-submitted data on approximately 30,000 patients, to study relapse rate and disability progression after first-line DMT is discontinued in previously stable patients.

“If and when MS patients can safely discontinue DMT treatment is an important question that frequently comes up in clinical practice, especially with regard to patients who have been clinically and radiologically stable for a long time,” the researchers said. Some patients grow tired of taking their medicine, or feel it doesn’t work, and may stop taking it with or without their doctors’ consent, said Dr. Kister, the study’s lead author. Patients also might not be able to afford medication copayments or might encounter other insurance issues, according to the National MS Society.

The researchers identified 182 patients who met their inclusion criteria. Patients were age 40 or older at baseline and had stable Expanded Disability Status Scale (EDSS) scores and no relapse for at least five years prior to baseline. Patients were treated continuously with DMT for at least three years before the therapy was discontinued, and patients were followed for at least three years after stopping their medication. Patients who reinitiated DMT within three months were considered “DMT switchers” and excluded from the analysis.

Approximately one in four patients experienced a clinician-confirmed relapse, and approximately one in three patients had confirmed disability progression. Confirmed disability progression was defined as an increase of at least one point in EDSS score above a baseline score of 1–5.5, confirmed at repeat assessment at least three months or one year later.

Reasons for stopping DMTs included lack of improvement (9%), perceived disease progression (10%), intolerance (8%), inconvenience (8%), adverse event (6%), and unknown (66%). During the post-discontinuation period (median 4.2 years), 44 (24.2%) patients had a relapse, 36 (of 113, 31.9%) had three-month disability progression, and 12 patients (10.6%) had relapse and disability progression.

DMTs were restarted by 77 of 182 patients (42%) after three or more months, with a median time to restart of 22 months. Those who restarted DMT had a 59% decrease in the rate of disability progression compared with those who did not restart DMT, researchers said. Those who did and did not restart DMT had similar relapse rates.

“Decisions regarding stopping disease-modifying therapy may have implications for short and long-term prognosis. We know a lot about what happens when therapy is started, but we know very little about what happens when therapy is stopped,” Dr. Kister said. The researchers call for a randomized DMT discontinuation trial in stable, older patients to help answer whether and when patients may stop DMT.

WASHINGTON, DC—Drinking coffee may be associated with a lower risk of developing multiple sclerosis (MS), according to a study presented at the American Academy of Neurology’s 67th Annual Meeting. “Caffeine intake has been associated with a reduced risk of Parkinson’s and Alzheimer’s diseases, and our study shows that coffee intake may also protect against MS, supporting the idea that the drug may have protective effects for the brain,” said study author Ellen Mowry, MD, MCR, of Johns Hopkins University School of Medicine in Baltimore.

For the study, researchers looked at two population-based case–control studies—a Swedish study of 1,629 patients with MS and 2,807 healthy controls, and a Kaiser Permanente Northern California study of 1,159 patients with MS and 1,172 healthy controls. The studies characterized coffee consumption among patients with MS one and five years before MS symptoms began (as well as 10 years before MS symptoms began in the Swedish study) and compared it with coffee consumption of people who did not have MS at similar time periods. The study also accounted for other factors such as age, sex, smoking, BMI, and sun exposure habits.

The Swedish study found that compared with people who drank at least six cups of coffee per day during the year before symptoms appeared, those who did not drink coffee had about a one and a half times increased risk of developing MS. Drinking large amounts of coffee five or 10 years before symptoms started was similarly protective.

In the US study, people who did not drink coffee were also about one and a half times more likely to develop the disease than those who drank four or more cups of coffee per day in the year before symptoms started to develop the disease.

“Caffeine should be studied for its impact on relapses and long-term disability in MS as well,” said Dr. Mowry.

The study was supported by the Swedish Medical Research Council; the Swedish Research Council for Health, Working Life and Welfare; the Knut and Alice Wallenberg, AFA, and Swedish Brain Foundations; the Swedish Association for Persons with Neurological Disabilities; and the U.S. National Institute of Neurological Disorders and Stroke, the National Institute of Environmental Health Sciences, and the National Institute on Aging.

WASHINGTON, DC—Drinking coffee may be associated with a lower risk of developing multiple sclerosis (MS), according to a study presented at the American Academy of Neurology’s 67th Annual Meeting. “Caffeine intake has been associated with a reduced risk of Parkinson’s and Alzheimer’s diseases, and our study shows that coffee intake may also protect against MS, supporting the idea that the drug may have protective effects for the brain,” said study author Ellen Mowry, MD, MCR, of Johns Hopkins University School of Medicine in Baltimore.

For the study, researchers looked at two population-based case–control studies—a Swedish study of 1,629 patients with MS and 2,807 healthy controls, and a Kaiser Permanente Northern California study of 1,159 patients with MS and 1,172 healthy controls. The studies characterized coffee consumption among patients with MS one and five years before MS symptoms began (as well as 10 years before MS symptoms began in the Swedish study) and compared it with coffee consumption of people who did not have MS at similar time periods. The study also accounted for other factors such as age, sex, smoking, BMI, and sun exposure habits.

The Swedish study found that compared with people who drank at least six cups of coffee per day during the year before symptoms appeared, those who did not drink coffee had about a one and a half times increased risk of developing MS. Drinking large amounts of coffee five or 10 years before symptoms started was similarly protective.

In the US study, people who did not drink coffee were also about one and a half times more likely to develop the disease than those who drank four or more cups of coffee per day in the year before symptoms started to develop the disease.

“Caffeine should be studied for its impact on relapses and long-term disability in MS as well,” said Dr. Mowry.

The study was supported by the Swedish Medical Research Council; the Swedish Research Council for Health, Working Life and Welfare; the Knut and Alice Wallenberg, AFA, and Swedish Brain Foundations; the Swedish Association for Persons with Neurological Disabilities; and the U.S. National Institute of Neurological Disorders and Stroke, the National Institute of Environmental Health Sciences, and the National Institute on Aging.

WASHINGTON, DC—Drinking coffee may be associated with a lower risk of developing multiple sclerosis (MS), according to a study presented at the American Academy of Neurology’s 67th Annual Meeting. “Caffeine intake has been associated with a reduced risk of Parkinson’s and Alzheimer’s diseases, and our study shows that coffee intake may also protect against MS, supporting the idea that the drug may have protective effects for the brain,” said study author Ellen Mowry, MD, MCR, of Johns Hopkins University School of Medicine in Baltimore.

For the study, researchers looked at two population-based case–control studies—a Swedish study of 1,629 patients with MS and 2,807 healthy controls, and a Kaiser Permanente Northern California study of 1,159 patients with MS and 1,172 healthy controls. The studies characterized coffee consumption among patients with MS one and five years before MS symptoms began (as well as 10 years before MS symptoms began in the Swedish study) and compared it with coffee consumption of people who did not have MS at similar time periods. The study also accounted for other factors such as age, sex, smoking, BMI, and sun exposure habits.

The Swedish study found that compared with people who drank at least six cups of coffee per day during the year before symptoms appeared, those who did not drink coffee had about a one and a half times increased risk of developing MS. Drinking large amounts of coffee five or 10 years before symptoms started was similarly protective.

In the US study, people who did not drink coffee were also about one and a half times more likely to develop the disease than those who drank four or more cups of coffee per day in the year before symptoms started to develop the disease.

“Caffeine should be studied for its impact on relapses and long-term disability in MS as well,” said Dr. Mowry.

The study was supported by the Swedish Medical Research Council; the Swedish Research Council for Health, Working Life and Welfare; the Knut and Alice Wallenberg, AFA, and Swedish Brain Foundations; the Swedish Association for Persons with Neurological Disabilities; and the U.S. National Institute of Neurological Disorders and Stroke, the National Institute of Environmental Health Sciences, and the National Institute on Aging.

WASHINGTON, DC—A new study suggests that an investigational drug for multiple sclerosis (MS) may repair myelin, according to a study presented at the American Academy of Neurology’s 67th Annual Meeting. “This study, for the first time, provides biological evidence of repair of damaged myelin in the human brain and advances the field of neuroreparative therapies,” said study lead author Diego Cadavid, MD, a Senior Director at Biogen Idec in Cambridge, Massachusetts.

The phase 2 study involved 82 patients who had their first incident of acute optic neuritis. All participants were treated with high dose steroids and randomly selected with equal probability to receive either the experimental antibody, called anti-LINGO-1, or a placebo once every four weeks, for a total of six doses. Participants were assessed every four weeks for six months and at a final visit at eight months. The drug’s effectiveness in repairing myelin was evaluated by comparing the recovery of the optic nerve latency in the damaged eye at six and eight months to the normal unaffected eye at the start of the study.

The main finding of the study focused on the latency of the visual evoked potential (VEP). The results showed that patients treated with anti-LINGO-1 who did not miss more than one dose (per protocol population) had significantly improved conduction, as measured by latency recovery, compared with people who received the placebo. At six months, those who received the drug improved on average by 7.55 milliseconds, or 34%, compared with placebo. The effect continued to eight months with an average improvement of 9.13 milliseconds or 41% over placebo.

In addition, the percentage of subjects whose VEP latency in the affected eye recovered to normal or nearly normal (ie, within 10% of that of the normal eye) more than doubled from 26% on placebo to 53% on the drug.

A substudy using an exploratory method of measuring latency called multifocal VEP revealed similar treatment effects. “More studies are needed to evaluate whether these changes lead to clinical improvement,” said Dr. Cadavid. A second study of anti-LINGO-1 in patients with MS is ongoing.

The study was supported by Biogen Idec.

WASHINGTON, DC—A new study suggests that an investigational drug for multiple sclerosis (MS) may repair myelin, according to a study presented at the American Academy of Neurology’s 67th Annual Meeting. “This study, for the first time, provides biological evidence of repair of damaged myelin in the human brain and advances the field of neuroreparative therapies,” said study lead author Diego Cadavid, MD, a Senior Director at Biogen Idec in Cambridge, Massachusetts.

The phase 2 study involved 82 patients who had their first incident of acute optic neuritis. All participants were treated with high dose steroids and randomly selected with equal probability to receive either the experimental antibody, called anti-LINGO-1, or a placebo once every four weeks, for a total of six doses. Participants were assessed every four weeks for six months and at a final visit at eight months. The drug’s effectiveness in repairing myelin was evaluated by comparing the recovery of the optic nerve latency in the damaged eye at six and eight months to the normal unaffected eye at the start of the study.

The main finding of the study focused on the latency of the visual evoked potential (VEP). The results showed that patients treated with anti-LINGO-1 who did not miss more than one dose (per protocol population) had significantly improved conduction, as measured by latency recovery, compared with people who received the placebo. At six months, those who received the drug improved on average by 7.55 milliseconds, or 34%, compared with placebo. The effect continued to eight months with an average improvement of 9.13 milliseconds or 41% over placebo.

In addition, the percentage of subjects whose VEP latency in the affected eye recovered to normal or nearly normal (ie, within 10% of that of the normal eye) more than doubled from 26% on placebo to 53% on the drug.

A substudy using an exploratory method of measuring latency called multifocal VEP revealed similar treatment effects. “More studies are needed to evaluate whether these changes lead to clinical improvement,” said Dr. Cadavid. A second study of anti-LINGO-1 in patients with MS is ongoing.

The study was supported by Biogen Idec.

WASHINGTON, DC—A new study suggests that an investigational drug for multiple sclerosis (MS) may repair myelin, according to a study presented at the American Academy of Neurology’s 67th Annual Meeting. “This study, for the first time, provides biological evidence of repair of damaged myelin in the human brain and advances the field of neuroreparative therapies,” said study lead author Diego Cadavid, MD, a Senior Director at Biogen Idec in Cambridge, Massachusetts.

The phase 2 study involved 82 patients who had their first incident of acute optic neuritis. All participants were treated with high dose steroids and randomly selected with equal probability to receive either the experimental antibody, called anti-LINGO-1, or a placebo once every four weeks, for a total of six doses. Participants were assessed every four weeks for six months and at a final visit at eight months. The drug’s effectiveness in repairing myelin was evaluated by comparing the recovery of the optic nerve latency in the damaged eye at six and eight months to the normal unaffected eye at the start of the study.

The main finding of the study focused on the latency of the visual evoked potential (VEP). The results showed that patients treated with anti-LINGO-1 who did not miss more than one dose (per protocol population) had significantly improved conduction, as measured by latency recovery, compared with people who received the placebo. At six months, those who received the drug improved on average by 7.55 milliseconds, or 34%, compared with placebo. The effect continued to eight months with an average improvement of 9.13 milliseconds or 41% over placebo.

In addition, the percentage of subjects whose VEP latency in the affected eye recovered to normal or nearly normal (ie, within 10% of that of the normal eye) more than doubled from 26% on placebo to 53% on the drug.

A substudy using an exploratory method of measuring latency called multifocal VEP revealed similar treatment effects. “More studies are needed to evaluate whether these changes lead to clinical improvement,” said Dr. Cadavid. A second study of anti-LINGO-1 in patients with MS is ongoing.

The study was supported by Biogen Idec.

The Consortium of Multiple Sclerosis Centers (CMSC) Task Force has updated its standardized MRI protocol and clinical guidelines for the diagnosis and follow-up of MS. The revision to the 2006 MRI protocols include the following changes:

• an emphasis on 3D sequences of brain MRI

• a specific monitoring protocol for progressive multifocal leukoencephalopathy (PML)

• an optional orbit MRI protocol for severe optic neuritis

Key changes to the 2006 clinical guidelines include:

• specific timing for using brain MRIs to monitor response to disease-modifying therapies

• timing of brain MRIs for PML surveillance

• inclusion of radiologic isolated syndrome

The updated guidelines also include new evidence regarding the value of MRI changes in determining treatment effectiveness.

Citation: 2015 Revised CMSC MRI Protocol and Guidelines. CMSC website. http://c.ymcdn.com/sites/www.mscare.org/resource/collection/9C5F19B9-3489-48B0-A54B-623A1ECEE07B/MRIprotocol2015.pdf. Updated April 2015. Accessed April 10, 2015.

The Consortium of Multiple Sclerosis Centers (CMSC) Task Force has updated its standardized MRI protocol and clinical guidelines for the diagnosis and follow-up of MS. The revision to the 2006 MRI protocols include the following changes:

• an emphasis on 3D sequences of brain MRI

• a specific monitoring protocol for progressive multifocal leukoencephalopathy (PML)

• an optional orbit MRI protocol for severe optic neuritis

Key changes to the 2006 clinical guidelines include:

• specific timing for using brain MRIs to monitor response to disease-modifying therapies

• timing of brain MRIs for PML surveillance

• inclusion of radiologic isolated syndrome

The updated guidelines also include new evidence regarding the value of MRI changes in determining treatment effectiveness.

Citation: 2015 Revised CMSC MRI Protocol and Guidelines. CMSC website. http://c.ymcdn.com/sites/www.mscare.org/resource/collection/9C5F19B9-3489-48B0-A54B-623A1ECEE07B/MRIprotocol2015.pdf. Updated April 2015. Accessed April 10, 2015.

The Consortium of Multiple Sclerosis Centers (CMSC) Task Force has updated its standardized MRI protocol and clinical guidelines for the diagnosis and follow-up of MS. The revision to the 2006 MRI protocols include the following changes:

• an emphasis on 3D sequences of brain MRI

• a specific monitoring protocol for progressive multifocal leukoencephalopathy (PML)

• an optional orbit MRI protocol for severe optic neuritis

Key changes to the 2006 clinical guidelines include:

• specific timing for using brain MRIs to monitor response to disease-modifying therapies

• timing of brain MRIs for PML surveillance

• inclusion of radiologic isolated syndrome

The updated guidelines also include new evidence regarding the value of MRI changes in determining treatment effectiveness.

Citation: 2015 Revised CMSC MRI Protocol and Guidelines. CMSC website. http://c.ymcdn.com/sites/www.mscare.org/resource/collection/9C5F19B9-3489-48B0-A54B-623A1ECEE07B/MRIprotocol2015.pdf. Updated April 2015. Accessed April 10, 2015.

A biomarker of Epstein-Barr virus, infectious mononucleosis, and smoking are environmental factors associated with multiple sclerosis (MS) that have the strongest consistent evidence, according to an umbrella review of 44 meta-analyses.

The review included 416 primary studies of different risk factors and MS, including vaccinations, comorbidities, surgeries, environmental agents, and biomarkers. Of those, only 3 had strong enough sample sizes to make consistent associations:

• IgG seropositivity for Epstein-Barr virus nuclear antigen (EBNA) (odds ratio [OR], 4.46)

• infectious mononucleosis (OR, 2.17)

• smoking (OR, 1.52)

The study authors conclude that more data from better-designed studies are needed to establish robust associations.

Citation: Belbasis L, Bellou V, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol. 2015;14(3):263-273. doi: 10.1016/S1474-4422(14)70267-4.

A biomarker of Epstein-Barr virus, infectious mononucleosis, and smoking are environmental factors associated with multiple sclerosis (MS) that have the strongest consistent evidence, according to an umbrella review of 44 meta-analyses.

The review included 416 primary studies of different risk factors and MS, including vaccinations, comorbidities, surgeries, environmental agents, and biomarkers. Of those, only 3 had strong enough sample sizes to make consistent associations:

• IgG seropositivity for Epstein-Barr virus nuclear antigen (EBNA) (odds ratio [OR], 4.46)

• infectious mononucleosis (OR, 2.17)

• smoking (OR, 1.52)

The study authors conclude that more data from better-designed studies are needed to establish robust associations.

Citation: Belbasis L, Bellou V, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol. 2015;14(3):263-273. doi: 10.1016/S1474-4422(14)70267-4.

A biomarker of Epstein-Barr virus, infectious mononucleosis, and smoking are environmental factors associated with multiple sclerosis (MS) that have the strongest consistent evidence, according to an umbrella review of 44 meta-analyses.

The review included 416 primary studies of different risk factors and MS, including vaccinations, comorbidities, surgeries, environmental agents, and biomarkers. Of those, only 3 had strong enough sample sizes to make consistent associations:

• IgG seropositivity for Epstein-Barr virus nuclear antigen (EBNA) (odds ratio [OR], 4.46)

• infectious mononucleosis (OR, 2.17)

• smoking (OR, 1.52)

The study authors conclude that more data from better-designed studies are needed to establish robust associations.

Citation: Belbasis L, Bellou V, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol. 2015;14(3):263-273. doi: 10.1016/S1474-4422(14)70267-4.

Psychiatric comorbidity, particularly depression and anxiety, is common in multiple sclerosis. A systematic review of 118 studies found the prevalence of psychiatric disorders as follows:

• depression, 23%

• anxiety, 22%

• alcohol abuse, 15%

• bipolar disorder, 6%

• psychosis, 4%

• substance abuse, 3%

The study authors note that developing a consistent approach to measuring psychiatric comorbidity would enhance future studies.

Citation: Marrie RA, Reingold S, Cohen J, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review. Mult Scler. 2015;21(3):305-317.

Commentary: Multiple sclerosis disease impact is classically gauged by physical disability characterized by neurological examination findings from EDSS. White matter disconnection impacts more than just walking, coordination, and vision, however. This very important review clearly demonstrates the high incidence of psychiatric disorders — specifically anxiety and depression — in patients with MS, not only at presentation but the increasing incidence over time. Mood can impact reported fatigue, employment, quality of life, and adherence to medications. The MS clinician no longer can entirely focus on relapse and MRI, but must evaluate and address mood-related problems in MS care to provide quality care and effective intervention of not only symptoms but long-term disease management as well.   –Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY

Psychiatric comorbidity, particularly depression and anxiety, is common in multiple sclerosis. A systematic review of 118 studies found the prevalence of psychiatric disorders as follows:

• depression, 23%

• anxiety, 22%

• alcohol abuse, 15%

• bipolar disorder, 6%

• psychosis, 4%

• substance abuse, 3%

The study authors note that developing a consistent approach to measuring psychiatric comorbidity would enhance future studies.

Citation: Marrie RA, Reingold S, Cohen J, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review. Mult Scler. 2015;21(3):305-317.

Commentary: Multiple sclerosis disease impact is classically gauged by physical disability characterized by neurological examination findings from EDSS. White matter disconnection impacts more than just walking, coordination, and vision, however. This very important review clearly demonstrates the high incidence of psychiatric disorders — specifically anxiety and depression — in patients with MS, not only at presentation but the increasing incidence over time. Mood can impact reported fatigue, employment, quality of life, and adherence to medications. The MS clinician no longer can entirely focus on relapse and MRI, but must evaluate and address mood-related problems in MS care to provide quality care and effective intervention of not only symptoms but long-term disease management as well.   –Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY

Psychiatric comorbidity, particularly depression and anxiety, is common in multiple sclerosis. A systematic review of 118 studies found the prevalence of psychiatric disorders as follows:

• depression, 23%

• anxiety, 22%

• alcohol abuse, 15%

• bipolar disorder, 6%

• psychosis, 4%

• substance abuse, 3%

The study authors note that developing a consistent approach to measuring psychiatric comorbidity would enhance future studies.

Citation: Marrie RA, Reingold S, Cohen J, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review. Mult Scler. 2015;21(3):305-317.

Commentary: Multiple sclerosis disease impact is classically gauged by physical disability characterized by neurological examination findings from EDSS. White matter disconnection impacts more than just walking, coordination, and vision, however. This very important review clearly demonstrates the high incidence of psychiatric disorders — specifically anxiety and depression — in patients with MS, not only at presentation but the increasing incidence over time. Mood can impact reported fatigue, employment, quality of life, and adherence to medications. The MS clinician no longer can entirely focus on relapse and MRI, but must evaluate and address mood-related problems in MS care to provide quality care and effective intervention of not only symptoms but long-term disease management as well.   –Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY

Comorbidity with multiple sclerosis can impact diagnosis, disability progression, and quality of life, but there are substantial gaps in epidemiological knowledge of comorbidities, according to a systematic review of 249 studies that found a wide variability in study designs and reporting.

Researchers quantitatively assessed population-based studies and found:

• The 5 most prevalent comorbidities were depression, anxiety, hypertension, hyperlipidemia, and chronic lung disease.

• The most prevalent autoimmune diseases were thyroid disease and psoriasis.

• The most prevalent cancers were cervical, breast, and digestive system cancers.

Citation: Marrie RA, Cohen J, Stuve O, et al. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler. 2015;21(3):263-281.

Comorbidity with multiple sclerosis can impact diagnosis, disability progression, and quality of life, but there are substantial gaps in epidemiological knowledge of comorbidities, according to a systematic review of 249 studies that found a wide variability in study designs and reporting.

Researchers quantitatively assessed population-based studies and found:

• The 5 most prevalent comorbidities were depression, anxiety, hypertension, hyperlipidemia, and chronic lung disease.

• The most prevalent autoimmune diseases were thyroid disease and psoriasis.

• The most prevalent cancers were cervical, breast, and digestive system cancers.

Citation: Marrie RA, Cohen J, Stuve O, et al. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler. 2015;21(3):263-281.

Comorbidity with multiple sclerosis can impact diagnosis, disability progression, and quality of life, but there are substantial gaps in epidemiological knowledge of comorbidities, according to a systematic review of 249 studies that found a wide variability in study designs and reporting.

Researchers quantitatively assessed population-based studies and found:

• The 5 most prevalent comorbidities were depression, anxiety, hypertension, hyperlipidemia, and chronic lung disease.

• The most prevalent autoimmune diseases were thyroid disease and psoriasis.

• The most prevalent cancers were cervical, breast, and digestive system cancers.

Citation: Marrie RA, Cohen J, Stuve O, et al. A systematic review of the incidence and prevalence of comorbidity in multiple sclerosis: overview. Mult Scler. 2015;21(3):263-281.