Multiple Sclerosis Hub

DALLAS—Long-term data demonstrating the success of interferon titration suggests that a similar strategy could be effective for a select group of patients who struggle tolerating the initial recommended 0.5 mg daily fingolimod dose. Data presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS suggest that there may be a role for fingolimod 0.25 mg/day, however the optimal recommended therapeutic dose of 0.5 mg/day is achievable for many patients if side effects and titration is efficiently and effectively managed.

A major Australian tertiary teaching hospital with a large multiple sclerosis (MS) clinic anticipated that patients starting on fingolimod and experiencing poor drug tolerability would request, or simply decide on their own, to cease their medication. Historical experience with inferferon prompted discussions with the neurologist and MS nursing staff. Through consultation in relation to dosing alternatives, it was identified that there was an opportunity to explore individualized oral drug titration. Select patients whose quality of life was being disrupted by unwanted side effects were offered a titration and monitoring opportunity. The goal of the “go slow” approach was to achieve the full recommended daily dose regime and establish confidence with a nonexistent or minimal acceptable side effect profile.

Susanne Baker and Meena Sharma from the MS Clinic at Liverpool Hospital in Sydney, Australia, in collaboration with neurologists, endeavored to manage side effects and titrate the fingolimod dose according to side effects experienced. Patient who chose to withdraw from fingolimod treatment were given the option of a personalized management plan. No clinical assessment tool was used to grade the severity of the adverse events and all supportive care was given based on the patients’ self-report of discomfort. The program offered regular monitoring and side effect management for lymphopenia, gastrointestinal disturbance, headache, and a feeling of being generally unwell. Ongoing consultation with the neurologist by the MS nursing staff was maintained along with fingolimod dose adjustments. Supportive medication included, but was not limited to, paracetamol, ibuprofen, ranitidine, metoclopramide, and loperamide.

In total, 209 patients were treated with fingolimod at the MS clinic at Liverpool Hospital and 51 (24.4%) significant adverse events (eg, lymphopenia, herpes zoster, malignancy, headache, ophthalmologic symptoms, gastrointestinal disturbance, and a feeling of being generally unwell) were reported. From this patient group, 24 (47%) were offered a side effect management and drug titration plan. Sixteen patients (66.7%) chose to participate in the proposed plan. Of these, 10 were able to achieve the full dose and remain on treatment, two (12.5%) discontinued treatment due to poor tolerance, and four (25%) continued to remain on drug titration. No relapses were observed or reported during the titration period.

—Glenn S. Williams

DALLAS—Long-term data demonstrating the success of interferon titration suggests that a similar strategy could be effective for a select group of patients who struggle tolerating the initial recommended 0.5 mg daily fingolimod dose. Data presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS suggest that there may be a role for fingolimod 0.25 mg/day, however the optimal recommended therapeutic dose of 0.5 mg/day is achievable for many patients if side effects and titration is efficiently and effectively managed.

A major Australian tertiary teaching hospital with a large multiple sclerosis (MS) clinic anticipated that patients starting on fingolimod and experiencing poor drug tolerability would request, or simply decide on their own, to cease their medication. Historical experience with inferferon prompted discussions with the neurologist and MS nursing staff. Through consultation in relation to dosing alternatives, it was identified that there was an opportunity to explore individualized oral drug titration. Select patients whose quality of life was being disrupted by unwanted side effects were offered a titration and monitoring opportunity. The goal of the “go slow” approach was to achieve the full recommended daily dose regime and establish confidence with a nonexistent or minimal acceptable side effect profile.

Susanne Baker and Meena Sharma from the MS Clinic at Liverpool Hospital in Sydney, Australia, in collaboration with neurologists, endeavored to manage side effects and titrate the fingolimod dose according to side effects experienced. Patient who chose to withdraw from fingolimod treatment were given the option of a personalized management plan. No clinical assessment tool was used to grade the severity of the adverse events and all supportive care was given based on the patients’ self-report of discomfort. The program offered regular monitoring and side effect management for lymphopenia, gastrointestinal disturbance, headache, and a feeling of being generally unwell. Ongoing consultation with the neurologist by the MS nursing staff was maintained along with fingolimod dose adjustments. Supportive medication included, but was not limited to, paracetamol, ibuprofen, ranitidine, metoclopramide, and loperamide.

In total, 209 patients were treated with fingolimod at the MS clinic at Liverpool Hospital and 51 (24.4%) significant adverse events (eg, lymphopenia, herpes zoster, malignancy, headache, ophthalmologic symptoms, gastrointestinal disturbance, and a feeling of being generally unwell) were reported. From this patient group, 24 (47%) were offered a side effect management and drug titration plan. Sixteen patients (66.7%) chose to participate in the proposed plan. Of these, 10 were able to achieve the full dose and remain on treatment, two (12.5%) discontinued treatment due to poor tolerance, and four (25%) continued to remain on drug titration. No relapses were observed or reported during the titration period.

—Glenn S. Williams

DALLAS—Long-term data demonstrating the success of interferon titration suggests that a similar strategy could be effective for a select group of patients who struggle tolerating the initial recommended 0.5 mg daily fingolimod dose. Data presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS suggest that there may be a role for fingolimod 0.25 mg/day, however the optimal recommended therapeutic dose of 0.5 mg/day is achievable for many patients if side effects and titration is efficiently and effectively managed.

A major Australian tertiary teaching hospital with a large multiple sclerosis (MS) clinic anticipated that patients starting on fingolimod and experiencing poor drug tolerability would request, or simply decide on their own, to cease their medication. Historical experience with inferferon prompted discussions with the neurologist and MS nursing staff. Through consultation in relation to dosing alternatives, it was identified that there was an opportunity to explore individualized oral drug titration. Select patients whose quality of life was being disrupted by unwanted side effects were offered a titration and monitoring opportunity. The goal of the “go slow” approach was to achieve the full recommended daily dose regime and establish confidence with a nonexistent or minimal acceptable side effect profile.

Susanne Baker and Meena Sharma from the MS Clinic at Liverpool Hospital in Sydney, Australia, in collaboration with neurologists, endeavored to manage side effects and titrate the fingolimod dose according to side effects experienced. Patient who chose to withdraw from fingolimod treatment were given the option of a personalized management plan. No clinical assessment tool was used to grade the severity of the adverse events and all supportive care was given based on the patients’ self-report of discomfort. The program offered regular monitoring and side effect management for lymphopenia, gastrointestinal disturbance, headache, and a feeling of being generally unwell. Ongoing consultation with the neurologist by the MS nursing staff was maintained along with fingolimod dose adjustments. Supportive medication included, but was not limited to, paracetamol, ibuprofen, ranitidine, metoclopramide, and loperamide.

In total, 209 patients were treated with fingolimod at the MS clinic at Liverpool Hospital and 51 (24.4%) significant adverse events (eg, lymphopenia, herpes zoster, malignancy, headache, ophthalmologic symptoms, gastrointestinal disturbance, and a feeling of being generally unwell) were reported. From this patient group, 24 (47%) were offered a side effect management and drug titration plan. Sixteen patients (66.7%) chose to participate in the proposed plan. Of these, 10 were able to achieve the full dose and remain on treatment, two (12.5%) discontinued treatment due to poor tolerance, and four (25%) continued to remain on drug titration. No relapses were observed or reported during the titration period.

—Glenn S. Williams

DALLAS—Correcting vitamin D deficiency early in the course of treatment with interferon beta-1b is likely to improve the outcome for patients with multiple sclerosis (MS), according to data presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS. “The results of this study support the importance of identifying and correcting 25(OH)D insufficiency early in the course of MS,” said Alberto Ascherio, MD, DrPH, and colleagues. “The effects are likely additive to therapy with interferon beta-1b without decreasing its tolerability.”

Dr. Ascherio, from the Harvard School of Public Health in Boston, and colleagues sought to examine the predictive effect of serum 25(OH)D levels on disease activity and progression in patients with clinically isolated syndrome starting interferon beta-1b therapy. They also examined the effect of serum 25(OH)D levels on the occurrence of flu-like symptoms, a common side-effect of interferon beta-1b.

Drawing their study cohort from the BEtaferon/BEtaseron in Newly Emerging MS for Initial Treatment (BENEFIT) study, the researchers randomized patients with clinically isolated syndrome and two or more clinically silent brain MRI lesions to 250 mcg of interferon beta-1b (early treatment) or placebo (late treatment) subcutaneously every other day. Serum 25(OH)D concentration measurements were taken at baseline and at six, 12, and 24 months. Cox proportional hazard models or generalized mixed effects models were used to relate season-adjusted 25(OH)D concentrations to clinical and MRI outcomes up to five years. Occurrence of flu-like symptoms in the early treatment group with high or low serum 25(OH)D levels were compared by chi-square test.

Data from 216 patients in the early treatment group and 118 patients in the delayed treatment group were analyzed. When analyzed as a continuous variable, increases in 25(OH)D led to a lower probability of conversion to McDonald MS, with a trend toward lower probability of conversion to clinically definite MS. Increases in 25(OH)D also led to lower rates of newly active lesions, relapses, annual percent change in T2 volume, and annual percent change in brain volume. Dichotomous 25(OH)D levels were strongly and inversely associated with probability of conversion to clinically definite MS, cumulative number of new lesions on MRI, percent change in T2 volume, and percent change in brain volume. Occurrence of flu-like symptoms did not differ between patients in the early treatment group with high or low serum 25(OH)D levels at months 6, 12, and 24.

Dr. Ascherio and colleagues concluded that among patients who started interferon beta-1b treatment right after clinically isolated syndrome, incremental increases of 25(OH)D levels were associated with reduction of long-term MS disease activity and severity. “These results also suggest that early treatment with interferon beta-1b has an additive effect with 25(OH)D to reduce disease severity and progression on both clinical and imaging outcomes.”

Further research would be needed, the researchers said, to determine whether these results apply to patients with different MS subtypes or those treated with drugs other than interferon beta-1b.

DALLAS—Correcting vitamin D deficiency early in the course of treatment with interferon beta-1b is likely to improve the outcome for patients with multiple sclerosis (MS), according to data presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS. “The results of this study support the importance of identifying and correcting 25(OH)D insufficiency early in the course of MS,” said Alberto Ascherio, MD, DrPH, and colleagues. “The effects are likely additive to therapy with interferon beta-1b without decreasing its tolerability.”

Dr. Ascherio, from the Harvard School of Public Health in Boston, and colleagues sought to examine the predictive effect of serum 25(OH)D levels on disease activity and progression in patients with clinically isolated syndrome starting interferon beta-1b therapy. They also examined the effect of serum 25(OH)D levels on the occurrence of flu-like symptoms, a common side-effect of interferon beta-1b.

Drawing their study cohort from the BEtaferon/BEtaseron in Newly Emerging MS for Initial Treatment (BENEFIT) study, the researchers randomized patients with clinically isolated syndrome and two or more clinically silent brain MRI lesions to 250 mcg of interferon beta-1b (early treatment) or placebo (late treatment) subcutaneously every other day. Serum 25(OH)D concentration measurements were taken at baseline and at six, 12, and 24 months. Cox proportional hazard models or generalized mixed effects models were used to relate season-adjusted 25(OH)D concentrations to clinical and MRI outcomes up to five years. Occurrence of flu-like symptoms in the early treatment group with high or low serum 25(OH)D levels were compared by chi-square test.

Data from 216 patients in the early treatment group and 118 patients in the delayed treatment group were analyzed. When analyzed as a continuous variable, increases in 25(OH)D led to a lower probability of conversion to McDonald MS, with a trend toward lower probability of conversion to clinically definite MS. Increases in 25(OH)D also led to lower rates of newly active lesions, relapses, annual percent change in T2 volume, and annual percent change in brain volume. Dichotomous 25(OH)D levels were strongly and inversely associated with probability of conversion to clinically definite MS, cumulative number of new lesions on MRI, percent change in T2 volume, and percent change in brain volume. Occurrence of flu-like symptoms did not differ between patients in the early treatment group with high or low serum 25(OH)D levels at months 6, 12, and 24.

Dr. Ascherio and colleagues concluded that among patients who started interferon beta-1b treatment right after clinically isolated syndrome, incremental increases of 25(OH)D levels were associated with reduction of long-term MS disease activity and severity. “These results also suggest that early treatment with interferon beta-1b has an additive effect with 25(OH)D to reduce disease severity and progression on both clinical and imaging outcomes.”

Further research would be needed, the researchers said, to determine whether these results apply to patients with different MS subtypes or those treated with drugs other than interferon beta-1b.

DALLAS—Correcting vitamin D deficiency early in the course of treatment with interferon beta-1b is likely to improve the outcome for patients with multiple sclerosis (MS), according to data presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS. “The results of this study support the importance of identifying and correcting 25(OH)D insufficiency early in the course of MS,” said Alberto Ascherio, MD, DrPH, and colleagues. “The effects are likely additive to therapy with interferon beta-1b without decreasing its tolerability.”

Dr. Ascherio, from the Harvard School of Public Health in Boston, and colleagues sought to examine the predictive effect of serum 25(OH)D levels on disease activity and progression in patients with clinically isolated syndrome starting interferon beta-1b therapy. They also examined the effect of serum 25(OH)D levels on the occurrence of flu-like symptoms, a common side-effect of interferon beta-1b.

Drawing their study cohort from the BEtaferon/BEtaseron in Newly Emerging MS for Initial Treatment (BENEFIT) study, the researchers randomized patients with clinically isolated syndrome and two or more clinically silent brain MRI lesions to 250 mcg of interferon beta-1b (early treatment) or placebo (late treatment) subcutaneously every other day. Serum 25(OH)D concentration measurements were taken at baseline and at six, 12, and 24 months. Cox proportional hazard models or generalized mixed effects models were used to relate season-adjusted 25(OH)D concentrations to clinical and MRI outcomes up to five years. Occurrence of flu-like symptoms in the early treatment group with high or low serum 25(OH)D levels were compared by chi-square test.

Data from 216 patients in the early treatment group and 118 patients in the delayed treatment group were analyzed. When analyzed as a continuous variable, increases in 25(OH)D led to a lower probability of conversion to McDonald MS, with a trend toward lower probability of conversion to clinically definite MS. Increases in 25(OH)D also led to lower rates of newly active lesions, relapses, annual percent change in T2 volume, and annual percent change in brain volume. Dichotomous 25(OH)D levels were strongly and inversely associated with probability of conversion to clinically definite MS, cumulative number of new lesions on MRI, percent change in T2 volume, and percent change in brain volume. Occurrence of flu-like symptoms did not differ between patients in the early treatment group with high or low serum 25(OH)D levels at months 6, 12, and 24.

Dr. Ascherio and colleagues concluded that among patients who started interferon beta-1b treatment right after clinically isolated syndrome, incremental increases of 25(OH)D levels were associated with reduction of long-term MS disease activity and severity. “These results also suggest that early treatment with interferon beta-1b has an additive effect with 25(OH)D to reduce disease severity and progression on both clinical and imaging outcomes.”

Further research would be needed, the researchers said, to determine whether these results apply to patients with different MS subtypes or those treated with drugs other than interferon beta-1b.

DALLAS—Eighty-two percent of patients who present with late-onset multiple sclerosis (MS) have a relapsing-remitting course, and the others have a progressive illness, researchers reported at the 2014 Cooperative Meeting of CMSC and ACTRIMS.

Claudia Chaves, MD, and colleagues retrospectively reviewed the database from the Lahey Hospital and Medical Center’s MS Center in Lexington, Massachusetts, and selected patients with new-onset MS at age 50 and older. The investigators sought to determine the clinical characteristics and imaging features among patients with late-onset MS.

Fifty patients who presented to the clinic had late-onset MS, which was 7% of all patients with MS, according to Dr. Chaves. Forty-one patients (30 women; mean age, 55) had a relapsing-remitting course, and nine patients (seven women; mean age, 53.6) had a progressive illness. Gait problems were present in 80% of patients with relapsing-remitting MS and in all patients with progressive disease. Patients with progressive illness were significantly more likely to have motor deficits and a higher Expanded Disability Status Scale (EDSS) score, compared with those with relapsing-remitting MS.

Patients with progressive illness had higher odds of cognitive impairment and more difficulties with coordination, though the rate was not statistically significant. Patients with relapsing-remitting MS had 2.2 times the odds of having sensory abnormalities. “No statistically significant difference was found for MRI measures between the two groups, including the presence of supra and infratentorial lesions, spinal cord involvement, contrast enhancement, and cerebral atrophy,” noted the investigators.

“However, the odds of infratentorial and spinal cord involvement were higher in [those with relapsing-remitting MS] and [those with progressive illness], respectively.” Ninety percent of patients with relapsing-remitting MS had been treated with a disease-modifying agent, and 78% of those with progressive illness were treated with a disease-modifying agent.

“Gait difficulties were common in both groups, with motor deficits and higher EDSS score significantly more common in patients with progressive disease,” the researchers concluded. “The MRI findings and clinical evolution were not significantly different between the two groups over the time period studied.”

—Colby Stong

DALLAS—Eighty-two percent of patients who present with late-onset multiple sclerosis (MS) have a relapsing-remitting course, and the others have a progressive illness, researchers reported at the 2014 Cooperative Meeting of CMSC and ACTRIMS.

Claudia Chaves, MD, and colleagues retrospectively reviewed the database from the Lahey Hospital and Medical Center’s MS Center in Lexington, Massachusetts, and selected patients with new-onset MS at age 50 and older. The investigators sought to determine the clinical characteristics and imaging features among patients with late-onset MS.

Fifty patients who presented to the clinic had late-onset MS, which was 7% of all patients with MS, according to Dr. Chaves. Forty-one patients (30 women; mean age, 55) had a relapsing-remitting course, and nine patients (seven women; mean age, 53.6) had a progressive illness. Gait problems were present in 80% of patients with relapsing-remitting MS and in all patients with progressive disease. Patients with progressive illness were significantly more likely to have motor deficits and a higher Expanded Disability Status Scale (EDSS) score, compared with those with relapsing-remitting MS.

Patients with progressive illness had higher odds of cognitive impairment and more difficulties with coordination, though the rate was not statistically significant. Patients with relapsing-remitting MS had 2.2 times the odds of having sensory abnormalities. “No statistically significant difference was found for MRI measures between the two groups, including the presence of supra and infratentorial lesions, spinal cord involvement, contrast enhancement, and cerebral atrophy,” noted the investigators.

“However, the odds of infratentorial and spinal cord involvement were higher in [those with relapsing-remitting MS] and [those with progressive illness], respectively.” Ninety percent of patients with relapsing-remitting MS had been treated with a disease-modifying agent, and 78% of those with progressive illness were treated with a disease-modifying agent.

“Gait difficulties were common in both groups, with motor deficits and higher EDSS score significantly more common in patients with progressive disease,” the researchers concluded. “The MRI findings and clinical evolution were not significantly different between the two groups over the time period studied.”

—Colby Stong

DALLAS—Eighty-two percent of patients who present with late-onset multiple sclerosis (MS) have a relapsing-remitting course, and the others have a progressive illness, researchers reported at the 2014 Cooperative Meeting of CMSC and ACTRIMS.

Claudia Chaves, MD, and colleagues retrospectively reviewed the database from the Lahey Hospital and Medical Center’s MS Center in Lexington, Massachusetts, and selected patients with new-onset MS at age 50 and older. The investigators sought to determine the clinical characteristics and imaging features among patients with late-onset MS.

Fifty patients who presented to the clinic had late-onset MS, which was 7% of all patients with MS, according to Dr. Chaves. Forty-one patients (30 women; mean age, 55) had a relapsing-remitting course, and nine patients (seven women; mean age, 53.6) had a progressive illness. Gait problems were present in 80% of patients with relapsing-remitting MS and in all patients with progressive disease. Patients with progressive illness were significantly more likely to have motor deficits and a higher Expanded Disability Status Scale (EDSS) score, compared with those with relapsing-remitting MS.

Patients with progressive illness had higher odds of cognitive impairment and more difficulties with coordination, though the rate was not statistically significant. Patients with relapsing-remitting MS had 2.2 times the odds of having sensory abnormalities. “No statistically significant difference was found for MRI measures between the two groups, including the presence of supra and infratentorial lesions, spinal cord involvement, contrast enhancement, and cerebral atrophy,” noted the investigators.

“However, the odds of infratentorial and spinal cord involvement were higher in [those with relapsing-remitting MS] and [those with progressive illness], respectively.” Ninety percent of patients with relapsing-remitting MS had been treated with a disease-modifying agent, and 78% of those with progressive illness were treated with a disease-modifying agent.

“Gait difficulties were common in both groups, with motor deficits and higher EDSS score significantly more common in patients with progressive disease,” the researchers concluded. “The MRI findings and clinical evolution were not significantly different between the two groups over the time period studied.”

—Colby Stong

DALLAS—Early exposure to other young children may be a protective factor against the development of neuromyelitis optica, suggesting that viral infections may contribute to disease risk modification, researchers reported at the 2014 Cooperative Meeting of CMSC and ACTRIMS.

Jennifer Graves, MD, PhD, Assistant Professor of Neurology at the University of California, San Francisco, Pediatric MS Center, and colleagues sought to determine whether environmental factors known to modify the risk for multiple sclerosis (MS) were associated with the risk for neuromyelitis optica in children. The researchers used chemoluminescence assay to measure serum 25(OH) vitamin D levels, and Epstein-Barr virus, cytomegalovirus, herpes simplex virus-1, and herpes simplex virus-2 antibody responses were determined by ELISA. The investigators also used multivariate logistic regression models to determine risk factor associations with neuromyelitis optica, including adjustments for age at sampling, sex, race, and ethnicity.

Analysis was based on 36 children with neuromyelitis optica, 491 with MS, and 224 healthy controls. Dr. Graves and colleagues found that daycare (odds ratio [OR], 0.33) and breastfeeding (OR, 0.41) were associated with lower odds of having neuromyelitis optica, compared with healthy children. “C-section tended to be associated with a twofold higher odds of neuromyelitis optica,” stated Dr. Graves. “Parental smoking was not meaningfully associated with neuromyelitis optica risk.”

A total of 34 children with neuromyelitis optica, 189 with MS, and 94 controls had serotyping. The investigators found that Epstein-Barr virus exposure “tended to be associated” with lower odds of having neuromyelitis optica, compared with children with MS. Exposure to herpes simplex virus-1 and being DRB1*15-positive were also associated with lower odds of having neuromyelitis optica.

“Unlike MS, pediatric neuromyelitis optica does not appear to be associated with exposures to common herpes viruses,” the investigators concluded.

—Colby Stong

DALLAS—Early exposure to other young children may be a protective factor against the development of neuromyelitis optica, suggesting that viral infections may contribute to disease risk modification, researchers reported at the 2014 Cooperative Meeting of CMSC and ACTRIMS.

Jennifer Graves, MD, PhD, Assistant Professor of Neurology at the University of California, San Francisco, Pediatric MS Center, and colleagues sought to determine whether environmental factors known to modify the risk for multiple sclerosis (MS) were associated with the risk for neuromyelitis optica in children. The researchers used chemoluminescence assay to measure serum 25(OH) vitamin D levels, and Epstein-Barr virus, cytomegalovirus, herpes simplex virus-1, and herpes simplex virus-2 antibody responses were determined by ELISA. The investigators also used multivariate logistic regression models to determine risk factor associations with neuromyelitis optica, including adjustments for age at sampling, sex, race, and ethnicity.

Analysis was based on 36 children with neuromyelitis optica, 491 with MS, and 224 healthy controls. Dr. Graves and colleagues found that daycare (odds ratio [OR], 0.33) and breastfeeding (OR, 0.41) were associated with lower odds of having neuromyelitis optica, compared with healthy children. “C-section tended to be associated with a twofold higher odds of neuromyelitis optica,” stated Dr. Graves. “Parental smoking was not meaningfully associated with neuromyelitis optica risk.”

A total of 34 children with neuromyelitis optica, 189 with MS, and 94 controls had serotyping. The investigators found that Epstein-Barr virus exposure “tended to be associated” with lower odds of having neuromyelitis optica, compared with children with MS. Exposure to herpes simplex virus-1 and being DRB1*15-positive were also associated with lower odds of having neuromyelitis optica.

“Unlike MS, pediatric neuromyelitis optica does not appear to be associated with exposures to common herpes viruses,” the investigators concluded.

—Colby Stong

DALLAS—Early exposure to other young children may be a protective factor against the development of neuromyelitis optica, suggesting that viral infections may contribute to disease risk modification, researchers reported at the 2014 Cooperative Meeting of CMSC and ACTRIMS.

Jennifer Graves, MD, PhD, Assistant Professor of Neurology at the University of California, San Francisco, Pediatric MS Center, and colleagues sought to determine whether environmental factors known to modify the risk for multiple sclerosis (MS) were associated with the risk for neuromyelitis optica in children. The researchers used chemoluminescence assay to measure serum 25(OH) vitamin D levels, and Epstein-Barr virus, cytomegalovirus, herpes simplex virus-1, and herpes simplex virus-2 antibody responses were determined by ELISA. The investigators also used multivariate logistic regression models to determine risk factor associations with neuromyelitis optica, including adjustments for age at sampling, sex, race, and ethnicity.

Analysis was based on 36 children with neuromyelitis optica, 491 with MS, and 224 healthy controls. Dr. Graves and colleagues found that daycare (odds ratio [OR], 0.33) and breastfeeding (OR, 0.41) were associated with lower odds of having neuromyelitis optica, compared with healthy children. “C-section tended to be associated with a twofold higher odds of neuromyelitis optica,” stated Dr. Graves. “Parental smoking was not meaningfully associated with neuromyelitis optica risk.”

A total of 34 children with neuromyelitis optica, 189 with MS, and 94 controls had serotyping. The investigators found that Epstein-Barr virus exposure “tended to be associated” with lower odds of having neuromyelitis optica, compared with children with MS. Exposure to herpes simplex virus-1 and being DRB1*15-positive were also associated with lower odds of having neuromyelitis optica.

“Unlike MS, pediatric neuromyelitis optica does not appear to be associated with exposures to common herpes viruses,” the investigators concluded.

—Colby Stong

DALLAS—Scores on Guy’s Neurological Disability Scale (GNDS) correlate well with walking distance and presence of pain and spasticity among patients with multiple sclerosis (MS), according to a study presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS. In addition, the Multidimensional Outcome Expectations for Exercise Scale (MOEES) questionnaire 3 subscales appear valid, and self-evaluative scale scores correlate with pain scores, as well as with a physical measure. Lead author Samuel M. Bierner, MD, and colleagues said that their early analysis revealed interesting relationships between patients’ perceived autonomy and daily pain scores. Dr. Bierner is affiliated with the Department of Physical Medicine and Rehabilitation at the University of Texas Southwestern Medical Center in Dallas.

Dr. Bierner and colleagues conducted a prospective cohort study designed to assess the relationship between attitudes toward exercise and autonomy and physical measures of upper and lower body strength and exercise performed. They reported the initial results of the cohort at the time of entry into the study.

Patients from an academic MS center completed two physical measures: grip strength dynamometry and the two-minute walk test (2MWT). They also completed the GNDS, the Impact on Participation and Autonomy Questionnaire (IPA), and the MOEES, previously validated in the ambulatory MS population. A medical history relevant to MS was elicited. In the second part of the study (not reported here), the subjects completed an exercise diary for two weeks.

The initial study of 46 subjects showed a mean GNDS score of 10.7 for males and 12.1 for females, and these scores were not statistically different. Bivariate correlation analyses showed a significant relationship between GNDS and 2MWT as well as GNDS and presence of pain or spasticity.

The IPA subscales—Autonomy Indoors scale, Family Role scale, and Autonomy Outdoors scale—showed significant correlations with average daily pain rating.

The MOEES scale data evaluated by principal components analysis showed excellent agreement with published three-subscale factor model. The Self-Evaluative subscale showed significant correlation with average daily pain rating.

Grip dynamometry results were 30.9 kg for the left hand and 32.1 kg for the right hand. Regression model showed that right-hand grip was predicted by MOEES Self-Evaluative subscale score, fatigue, and gender.

According to Dr. Bierner and colleagues, their initial study showed a relatively healthy sample, with GNDS disability scores lower than other published studies. Average grip strength was within normal limits for age and gender. The 2MWT was negatively correlated with GNDS total score and all IPA subscales. As expected, subjects who were able to walk greater distances had less perceived disability and greater autonomy and participation in their daily activities.

Subjects’ pain ratings correlated with multiple questionnaire scores, including the GNDS total score (reflecting perceived MS disability), the MOEES self-evaluative subscale, and all IPA subscales except work/education. Pain appears to affect one’s self evaluation, sense of disability, autonomy, and participation in daily activities.

According to the researchers, the three MOEES subscales (physical, social, and self-evaluative outcome expectations) appear valid. Principal component analysis of the MOEES responses from the 46 subjects revealed three factors that matched 13 of the 15 (86.7%) original questions used in the study validation. Question 9 (ie, “Exercise will aid in weight control”) and Question 13 (ie, “Exercise will increase my mental alertness”) were the two mismatches. The researchers noted that mean values from each subscale nearly matched those values published in the original MOEES validation paper.

—Glenn S. Williams

DALLAS—Scores on Guy’s Neurological Disability Scale (GNDS) correlate well with walking distance and presence of pain and spasticity among patients with multiple sclerosis (MS), according to a study presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS. In addition, the Multidimensional Outcome Expectations for Exercise Scale (MOEES) questionnaire 3 subscales appear valid, and self-evaluative scale scores correlate with pain scores, as well as with a physical measure. Lead author Samuel M. Bierner, MD, and colleagues said that their early analysis revealed interesting relationships between patients’ perceived autonomy and daily pain scores. Dr. Bierner is affiliated with the Department of Physical Medicine and Rehabilitation at the University of Texas Southwestern Medical Center in Dallas.

Dr. Bierner and colleagues conducted a prospective cohort study designed to assess the relationship between attitudes toward exercise and autonomy and physical measures of upper and lower body strength and exercise performed. They reported the initial results of the cohort at the time of entry into the study.

Patients from an academic MS center completed two physical measures: grip strength dynamometry and the two-minute walk test (2MWT). They also completed the GNDS, the Impact on Participation and Autonomy Questionnaire (IPA), and the MOEES, previously validated in the ambulatory MS population. A medical history relevant to MS was elicited. In the second part of the study (not reported here), the subjects completed an exercise diary for two weeks.

The initial study of 46 subjects showed a mean GNDS score of 10.7 for males and 12.1 for females, and these scores were not statistically different. Bivariate correlation analyses showed a significant relationship between GNDS and 2MWT as well as GNDS and presence of pain or spasticity.

The IPA subscales—Autonomy Indoors scale, Family Role scale, and Autonomy Outdoors scale—showed significant correlations with average daily pain rating.

The MOEES scale data evaluated by principal components analysis showed excellent agreement with published three-subscale factor model. The Self-Evaluative subscale showed significant correlation with average daily pain rating.

Grip dynamometry results were 30.9 kg for the left hand and 32.1 kg for the right hand. Regression model showed that right-hand grip was predicted by MOEES Self-Evaluative subscale score, fatigue, and gender.

According to Dr. Bierner and colleagues, their initial study showed a relatively healthy sample, with GNDS disability scores lower than other published studies. Average grip strength was within normal limits for age and gender. The 2MWT was negatively correlated with GNDS total score and all IPA subscales. As expected, subjects who were able to walk greater distances had less perceived disability and greater autonomy and participation in their daily activities.

Subjects’ pain ratings correlated with multiple questionnaire scores, including the GNDS total score (reflecting perceived MS disability), the MOEES self-evaluative subscale, and all IPA subscales except work/education. Pain appears to affect one’s self evaluation, sense of disability, autonomy, and participation in daily activities.

According to the researchers, the three MOEES subscales (physical, social, and self-evaluative outcome expectations) appear valid. Principal component analysis of the MOEES responses from the 46 subjects revealed three factors that matched 13 of the 15 (86.7%) original questions used in the study validation. Question 9 (ie, “Exercise will aid in weight control”) and Question 13 (ie, “Exercise will increase my mental alertness”) were the two mismatches. The researchers noted that mean values from each subscale nearly matched those values published in the original MOEES validation paper.

—Glenn S. Williams

DALLAS—Scores on Guy’s Neurological Disability Scale (GNDS) correlate well with walking distance and presence of pain and spasticity among patients with multiple sclerosis (MS), according to a study presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS. In addition, the Multidimensional Outcome Expectations for Exercise Scale (MOEES) questionnaire 3 subscales appear valid, and self-evaluative scale scores correlate with pain scores, as well as with a physical measure. Lead author Samuel M. Bierner, MD, and colleagues said that their early analysis revealed interesting relationships between patients’ perceived autonomy and daily pain scores. Dr. Bierner is affiliated with the Department of Physical Medicine and Rehabilitation at the University of Texas Southwestern Medical Center in Dallas.

Dr. Bierner and colleagues conducted a prospective cohort study designed to assess the relationship between attitudes toward exercise and autonomy and physical measures of upper and lower body strength and exercise performed. They reported the initial results of the cohort at the time of entry into the study.

Patients from an academic MS center completed two physical measures: grip strength dynamometry and the two-minute walk test (2MWT). They also completed the GNDS, the Impact on Participation and Autonomy Questionnaire (IPA), and the MOEES, previously validated in the ambulatory MS population. A medical history relevant to MS was elicited. In the second part of the study (not reported here), the subjects completed an exercise diary for two weeks.

The initial study of 46 subjects showed a mean GNDS score of 10.7 for males and 12.1 for females, and these scores were not statistically different. Bivariate correlation analyses showed a significant relationship between GNDS and 2MWT as well as GNDS and presence of pain or spasticity.

The IPA subscales—Autonomy Indoors scale, Family Role scale, and Autonomy Outdoors scale—showed significant correlations with average daily pain rating.

The MOEES scale data evaluated by principal components analysis showed excellent agreement with published three-subscale factor model. The Self-Evaluative subscale showed significant correlation with average daily pain rating.

Grip dynamometry results were 30.9 kg for the left hand and 32.1 kg for the right hand. Regression model showed that right-hand grip was predicted by MOEES Self-Evaluative subscale score, fatigue, and gender.

According to Dr. Bierner and colleagues, their initial study showed a relatively healthy sample, with GNDS disability scores lower than other published studies. Average grip strength was within normal limits for age and gender. The 2MWT was negatively correlated with GNDS total score and all IPA subscales. As expected, subjects who were able to walk greater distances had less perceived disability and greater autonomy and participation in their daily activities.

Subjects’ pain ratings correlated with multiple questionnaire scores, including the GNDS total score (reflecting perceived MS disability), the MOEES self-evaluative subscale, and all IPA subscales except work/education. Pain appears to affect one’s self evaluation, sense of disability, autonomy, and participation in daily activities.

According to the researchers, the three MOEES subscales (physical, social, and self-evaluative outcome expectations) appear valid. Principal component analysis of the MOEES responses from the 46 subjects revealed three factors that matched 13 of the 15 (86.7%) original questions used in the study validation. Question 9 (ie, “Exercise will aid in weight control”) and Question 13 (ie, “Exercise will increase my mental alertness”) were the two mismatches. The researchers noted that mean values from each subscale nearly matched those values published in the original MOEES validation paper.

—Glenn S. Williams

DALLAS—Baseline use of corticosteroids and documentation of other brain MRI results may be significantly associated with higher costs for patients with multiple sclerosis (MS), according to data presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS. “This study provides insight into factors associated with high-cost MS patients and may help to prospectively identify potential high-cost MS patients who may benefit from cost-effective proactive clinical management,” the researchers said. “Additionally, while most patients have documentation of brain MRI in their medical records, many of the additional clinical characteristics needed to assess disease severity are not documented in the medical record.”

Debra F. Eisenberg, MS, PhD, and colleagues sought to assess patient demographics, clinical characteristics, medication utilization, and resource use among patients with MS stratified as low, medium, and high cost through administrative claims review and patient medical record review. For their observational, retrospective cohort study, the researchers used data drawn from the HealthCore Integrated Research Database (HIRD), which includes medical and pharmacy claims data. Patients age 18 or older newly diagnosed with MS during the period from January 1, 2007, to April 30, 2011, were identified in the database. Annualized MS-related cost was computed, and patients were classified into high-, medium-, and low-cost strata. A total of 400 patients with a confirmed diagnosis of MS and documentation of brain MRI were selected for medical record review. Bivariate analyses and multivariate logistic regression models were used to identify factors associated with high-cost patients.

Among the 400 patient medical records abstracted, 84, 132, and 184 patients fell in the low-, medium-, and high-cost groups, respectively. Patients had a mean age of 41 at diagnosis, and 70% were female. Nearly all (97%) of the patients had brain MRI results documented in their medical records. Of the 389 patients with MRI results, 31.7% of the low-, 53.6% of the medium-, and 35.2% of the high-cost patients had active brain lesions. Common symptoms reported were numbness (63%), fatigue (59%), and pain (59%). Relapsing-remitting disease was documented in 14% of the low-, 40% of the medium-, and 33% of the high-cost patients. Approximately 50% of the patients had gait impairment, ranging from 38% of the low-, 44% of the medium-, and 64% of the high-cost patients. Other brain MRI results not related to T2 imaging, active lesions, demyelination, black holes, and brain atrophy were seen to a greater extent among high-cost patients. In addition, high-cost patients were more likely to use antidepressants (31.5%), corticosteroids (43.5%), narcotics (38.6%), and stimulants (6.5%). High-cost patients also were more likely to have electrocardiogram (36.4%) and spinal tap (20.1%) procedures.

Lead author Dr. Eisenberg is affiliated with HealthCore, which is headquartered in Wilmington, Delaware.

—Glenn S. Williams

DALLAS—Baseline use of corticosteroids and documentation of other brain MRI results may be significantly associated with higher costs for patients with multiple sclerosis (MS), according to data presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS. “This study provides insight into factors associated with high-cost MS patients and may help to prospectively identify potential high-cost MS patients who may benefit from cost-effective proactive clinical management,” the researchers said. “Additionally, while most patients have documentation of brain MRI in their medical records, many of the additional clinical characteristics needed to assess disease severity are not documented in the medical record.”

Debra F. Eisenberg, MS, PhD, and colleagues sought to assess patient demographics, clinical characteristics, medication utilization, and resource use among patients with MS stratified as low, medium, and high cost through administrative claims review and patient medical record review. For their observational, retrospective cohort study, the researchers used data drawn from the HealthCore Integrated Research Database (HIRD), which includes medical and pharmacy claims data. Patients age 18 or older newly diagnosed with MS during the period from January 1, 2007, to April 30, 2011, were identified in the database. Annualized MS-related cost was computed, and patients were classified into high-, medium-, and low-cost strata. A total of 400 patients with a confirmed diagnosis of MS and documentation of brain MRI were selected for medical record review. Bivariate analyses and multivariate logistic regression models were used to identify factors associated with high-cost patients.

Among the 400 patient medical records abstracted, 84, 132, and 184 patients fell in the low-, medium-, and high-cost groups, respectively. Patients had a mean age of 41 at diagnosis, and 70% were female. Nearly all (97%) of the patients had brain MRI results documented in their medical records. Of the 389 patients with MRI results, 31.7% of the low-, 53.6% of the medium-, and 35.2% of the high-cost patients had active brain lesions. Common symptoms reported were numbness (63%), fatigue (59%), and pain (59%). Relapsing-remitting disease was documented in 14% of the low-, 40% of the medium-, and 33% of the high-cost patients. Approximately 50% of the patients had gait impairment, ranging from 38% of the low-, 44% of the medium-, and 64% of the high-cost patients. Other brain MRI results not related to T2 imaging, active lesions, demyelination, black holes, and brain atrophy were seen to a greater extent among high-cost patients. In addition, high-cost patients were more likely to use antidepressants (31.5%), corticosteroids (43.5%), narcotics (38.6%), and stimulants (6.5%). High-cost patients also were more likely to have electrocardiogram (36.4%) and spinal tap (20.1%) procedures.

Lead author Dr. Eisenberg is affiliated with HealthCore, which is headquartered in Wilmington, Delaware.

—Glenn S. Williams

DALLAS—Baseline use of corticosteroids and documentation of other brain MRI results may be significantly associated with higher costs for patients with multiple sclerosis (MS), according to data presented at the 2014 Cooperative Meeting of CMSC and ACTRIMS. “This study provides insight into factors associated with high-cost MS patients and may help to prospectively identify potential high-cost MS patients who may benefit from cost-effective proactive clinical management,” the researchers said. “Additionally, while most patients have documentation of brain MRI in their medical records, many of the additional clinical characteristics needed to assess disease severity are not documented in the medical record.”

Debra F. Eisenberg, MS, PhD, and colleagues sought to assess patient demographics, clinical characteristics, medication utilization, and resource use among patients with MS stratified as low, medium, and high cost through administrative claims review and patient medical record review. For their observational, retrospective cohort study, the researchers used data drawn from the HealthCore Integrated Research Database (HIRD), which includes medical and pharmacy claims data. Patients age 18 or older newly diagnosed with MS during the period from January 1, 2007, to April 30, 2011, were identified in the database. Annualized MS-related cost was computed, and patients were classified into high-, medium-, and low-cost strata. A total of 400 patients with a confirmed diagnosis of MS and documentation of brain MRI were selected for medical record review. Bivariate analyses and multivariate logistic regression models were used to identify factors associated with high-cost patients.

Among the 400 patient medical records abstracted, 84, 132, and 184 patients fell in the low-, medium-, and high-cost groups, respectively. Patients had a mean age of 41 at diagnosis, and 70% were female. Nearly all (97%) of the patients had brain MRI results documented in their medical records. Of the 389 patients with MRI results, 31.7% of the low-, 53.6% of the medium-, and 35.2% of the high-cost patients had active brain lesions. Common symptoms reported were numbness (63%), fatigue (59%), and pain (59%). Relapsing-remitting disease was documented in 14% of the low-, 40% of the medium-, and 33% of the high-cost patients. Approximately 50% of the patients had gait impairment, ranging from 38% of the low-, 44% of the medium-, and 64% of the high-cost patients. Other brain MRI results not related to T2 imaging, active lesions, demyelination, black holes, and brain atrophy were seen to a greater extent among high-cost patients. In addition, high-cost patients were more likely to use antidepressants (31.5%), corticosteroids (43.5%), narcotics (38.6%), and stimulants (6.5%). High-cost patients also were more likely to have electrocardiogram (36.4%) and spinal tap (20.1%) procedures.

Lead author Dr. Eisenberg is affiliated with HealthCore, which is headquartered in Wilmington, Delaware.

—Glenn S. Williams