ICYMI Multiple Sclerosis

Over the past 50 years, excess mortality rates among patients with multiple sclerosis (MS) relative to the general population has not changed, with female patients at a greater disadvantage than males, according to a meta-analysis of 12 studies spanning from 1949 to 2012.

Investigators determined all-cause, cause-specific, and gender-specific crude mortality rates to assess standardized mortality ratios (SMRs) in 27,423 MS patients and found the following SMRs:

• Pooled all-cause: 2.8

• All-cause, male: 2.56

• All-cause, female: 3.06

• Cancer: 0.89

• Cardiovascular: 1.29

• Suicide: 2.13

• Respiratory disease and infection: 2.91

Citation: Manouchehrinia A, Tanasescu R, Tench CR, Constantinescu CS. Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios. J Neurol Neurosurg Psychiatry. 2015. doi:10.1136/jnnp-2015-310361.

Over the past 50 years, excess mortality rates among patients with multiple sclerosis (MS) relative to the general population has not changed, with female patients at a greater disadvantage than males, according to a meta-analysis of 12 studies spanning from 1949 to 2012.

Investigators determined all-cause, cause-specific, and gender-specific crude mortality rates to assess standardized mortality ratios (SMRs) in 27,423 MS patients and found the following SMRs:

• Pooled all-cause: 2.8

• All-cause, male: 2.56

• All-cause, female: 3.06

• Cancer: 0.89

• Cardiovascular: 1.29

• Suicide: 2.13

• Respiratory disease and infection: 2.91

Citation: Manouchehrinia A, Tanasescu R, Tench CR, Constantinescu CS. Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios. J Neurol Neurosurg Psychiatry. 2015. doi:10.1136/jnnp-2015-310361.

Over the past 50 years, excess mortality rates among patients with multiple sclerosis (MS) relative to the general population has not changed, with female patients at a greater disadvantage than males, according to a meta-analysis of 12 studies spanning from 1949 to 2012.

Investigators determined all-cause, cause-specific, and gender-specific crude mortality rates to assess standardized mortality ratios (SMRs) in 27,423 MS patients and found the following SMRs:

• Pooled all-cause: 2.8

• All-cause, male: 2.56

• All-cause, female: 3.06

• Cancer: 0.89

• Cardiovascular: 1.29

• Suicide: 2.13

• Respiratory disease and infection: 2.91

Citation: Manouchehrinia A, Tanasescu R, Tench CR, Constantinescu CS. Mortality in multiple sclerosis: meta-analysis of standardised mortality ratios. J Neurol Neurosurg Psychiatry. 2015. doi:10.1136/jnnp-2015-310361.

Established risk factors for multiple sclerosis (MS) do not appear to impact risk of transverse myelitis (TM) or neuromyelitis optica (NMO), according to a case-control study of participants in the Accelerated Cure Project for Multiple Sclerosis.

Researchers analyzed 1,237 MS cases, 98 NMO cases, 133 TM cases, and 488 healthy controls for MS risk factors including smoking history, a history of infectious mononucleosis, anti-EBNA1 Ab titers, and HLA-DR15, and found:

• Risk factors and odds of MS were as expected.

• There was little evidence of an association between the risk factors for MS and increased odds of NMO or TM.

Citation: Simon KC, Schmidt H, Loud S, Ascherio A. Risk factors for multiple sclerosis, neuromyelitis optica and transverse myelitis. Mult Scler. 2015;21(6):703-709. doi:10.1177/1352458514551780.

Established risk factors for multiple sclerosis (MS) do not appear to impact risk of transverse myelitis (TM) or neuromyelitis optica (NMO), according to a case-control study of participants in the Accelerated Cure Project for Multiple Sclerosis.

Researchers analyzed 1,237 MS cases, 98 NMO cases, 133 TM cases, and 488 healthy controls for MS risk factors including smoking history, a history of infectious mononucleosis, anti-EBNA1 Ab titers, and HLA-DR15, and found:

• Risk factors and odds of MS were as expected.

• There was little evidence of an association between the risk factors for MS and increased odds of NMO or TM.

Citation: Simon KC, Schmidt H, Loud S, Ascherio A. Risk factors for multiple sclerosis, neuromyelitis optica and transverse myelitis. Mult Scler. 2015;21(6):703-709. doi:10.1177/1352458514551780.

Established risk factors for multiple sclerosis (MS) do not appear to impact risk of transverse myelitis (TM) or neuromyelitis optica (NMO), according to a case-control study of participants in the Accelerated Cure Project for Multiple Sclerosis.

Researchers analyzed 1,237 MS cases, 98 NMO cases, 133 TM cases, and 488 healthy controls for MS risk factors including smoking history, a history of infectious mononucleosis, anti-EBNA1 Ab titers, and HLA-DR15, and found:

• Risk factors and odds of MS were as expected.

• There was little evidence of an association between the risk factors for MS and increased odds of NMO or TM.

Citation: Simon KC, Schmidt H, Loud S, Ascherio A. Risk factors for multiple sclerosis, neuromyelitis optica and transverse myelitis. Mult Scler. 2015;21(6):703-709. doi:10.1177/1352458514551780.

The stress of being a caregiver to a patient with multiple sclerosis can result in substantial physical and psychological health concerns, and have a negative impact on employment, according to a survey of 1,446 care partners from the North American Research Committee on Multiple Sclerosis (NARCOMS).

Researchers analyzed data from an online questionnaire, including demographic characteristics, health status, caregiver burden as measured by the Zarit Caregiver Burden Interview, and impact on employment. They found:

• The average Zarit score was 24.6, which is in the mild caregiver burden range.

• Female caregivers reported higher levels of burden and stress than their male counterparts, and were more likely to use medication for stress, anxiety, and mood disorders.

• Male caregivers had higher rates of physical complaints than females.

• Care partners of patients with primary progressive MS reported greater perceived burden than those with secondary progressive MS and relapsing-remitting MS.

• In the past year, more than 40% of care partners had missed work due to caregiving responsibilities.   

Citation: McKenzie T, Quig ME, Tyry T, et al. Care partners and multiple sclerosis: differential impact on men and women. Int J MS Care. 2015. doi:10.7224/1537-2073.2014-083 [epub ahead of print].

The stress of being a caregiver to a patient with multiple sclerosis can result in substantial physical and psychological health concerns, and have a negative impact on employment, according to a survey of 1,446 care partners from the North American Research Committee on Multiple Sclerosis (NARCOMS).

Researchers analyzed data from an online questionnaire, including demographic characteristics, health status, caregiver burden as measured by the Zarit Caregiver Burden Interview, and impact on employment. They found:

• The average Zarit score was 24.6, which is in the mild caregiver burden range.

• Female caregivers reported higher levels of burden and stress than their male counterparts, and were more likely to use medication for stress, anxiety, and mood disorders.

• Male caregivers had higher rates of physical complaints than females.

• Care partners of patients with primary progressive MS reported greater perceived burden than those with secondary progressive MS and relapsing-remitting MS.

• In the past year, more than 40% of care partners had missed work due to caregiving responsibilities.   

Citation: McKenzie T, Quig ME, Tyry T, et al. Care partners and multiple sclerosis: differential impact on men and women. Int J MS Care. 2015. doi:10.7224/1537-2073.2014-083 [epub ahead of print].

The stress of being a caregiver to a patient with multiple sclerosis can result in substantial physical and psychological health concerns, and have a negative impact on employment, according to a survey of 1,446 care partners from the North American Research Committee on Multiple Sclerosis (NARCOMS).

Researchers analyzed data from an online questionnaire, including demographic characteristics, health status, caregiver burden as measured by the Zarit Caregiver Burden Interview, and impact on employment. They found:

• The average Zarit score was 24.6, which is in the mild caregiver burden range.

• Female caregivers reported higher levels of burden and stress than their male counterparts, and were more likely to use medication for stress, anxiety, and mood disorders.

• Male caregivers had higher rates of physical complaints than females.

• Care partners of patients with primary progressive MS reported greater perceived burden than those with secondary progressive MS and relapsing-remitting MS.

• In the past year, more than 40% of care partners had missed work due to caregiving responsibilities.   

Citation: McKenzie T, Quig ME, Tyry T, et al. Care partners and multiple sclerosis: differential impact on men and women. Int J MS Care. 2015. doi:10.7224/1537-2073.2014-083 [epub ahead of print].

A purported multiple sclerosis cure widely known as the “liberation” procedure — venoplasty to treat chronic cerebrospinal venous insufficiency — has patients traveling abroad against doctor advice to receive the unregulated procedure.

An analysis of data from the Canadian Survey of Health Lifestyle and Aging with MS, which included 753 patients over the age of 55 years old with 20 years or more of MS symptoms, found 13% underwent the alternative treatment. Researchers determined the following odds ratio for 5 factors:

• Living alone, 0.24

• Diagnosis of anxiety, 0.29

• Rating of neurologist’s helpfulness, 0.56

• Body mass index, 0.93

• Perceived physical impact of MS, 1.02

The study authors recommend physicians provide information on the risks and benefits of unregulated procedures to patients and their families who are dissatisfied with their neurologists.

Citation: Ploughman M, Manning OJ, Beaulieu S, et al.  Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case-control study. BMC Health Serv Res. 2015. 15:161. doi:10.1186/s12913-015-835-y.

A purported multiple sclerosis cure widely known as the “liberation” procedure — venoplasty to treat chronic cerebrospinal venous insufficiency — has patients traveling abroad against doctor advice to receive the unregulated procedure.

An analysis of data from the Canadian Survey of Health Lifestyle and Aging with MS, which included 753 patients over the age of 55 years old with 20 years or more of MS symptoms, found 13% underwent the alternative treatment. Researchers determined the following odds ratio for 5 factors:

• Living alone, 0.24

• Diagnosis of anxiety, 0.29

• Rating of neurologist’s helpfulness, 0.56

• Body mass index, 0.93

• Perceived physical impact of MS, 1.02

The study authors recommend physicians provide information on the risks and benefits of unregulated procedures to patients and their families who are dissatisfied with their neurologists.

Citation: Ploughman M, Manning OJ, Beaulieu S, et al.  Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case-control study. BMC Health Serv Res. 2015. 15:161. doi:10.1186/s12913-015-835-y.

A purported multiple sclerosis cure widely known as the “liberation” procedure — venoplasty to treat chronic cerebrospinal venous insufficiency — has patients traveling abroad against doctor advice to receive the unregulated procedure.

An analysis of data from the Canadian Survey of Health Lifestyle and Aging with MS, which included 753 patients over the age of 55 years old with 20 years or more of MS symptoms, found 13% underwent the alternative treatment. Researchers determined the following odds ratio for 5 factors:

• Living alone, 0.24

• Diagnosis of anxiety, 0.29

• Rating of neurologist’s helpfulness, 0.56

• Body mass index, 0.93

• Perceived physical impact of MS, 1.02

The study authors recommend physicians provide information on the risks and benefits of unregulated procedures to patients and their families who are dissatisfied with their neurologists.

Citation: Ploughman M, Manning OJ, Beaulieu S, et al.  Predictors of chronic cerebrospinal venous insufficiency procedure use among older people with multiple sclerosis: a national case-control study. BMC Health Serv Res. 2015. 15:161. doi:10.1186/s12913-015-835-y.

The Multiple Sclerosis Coalition’s consensus paper on the use of disease-modifying therapies (DMTs) in multiple sclerosis (MS) includes the following recommendations:

• Treatment with an FDA-approved DMT should be initiated as soon as possible following a diagnosis of relapsing disease; after a first clinical event with MRI features consistent with MS in which other causes have been ruled out; and in patients with progressive MS with clinical relapses and/or inflammatory activity.

• Treatment with DMTs should continue indefinitely unless there are intolerable side effects, inadequate adherence, sub-optimal treatment response, or a more appropriate option becomes available.

• When additional clinical or MRI activity occurs while on treatment, consider an alternate regimen with a different mechanism of action.

• Absence of relapse while on DMT should not be considered a reason to discontinue treatment.

The full report is available here.

Citation: Costello K, Halper J, Kalb R, Skutnik L, Rapp R. The use of disease-modifying therapies in multiple sclerosis: principles and current evidence. A consensus paper by the Multiple Sclerosis Coalition. http://www.nationalmssociety.org/getmedia/5ca284d3-fc7c-4ba5-b005-ab537d495c3c/DMT_Consensus_MS_Coalition_color. Updated March 2015. Accessed April 30, 2015.

Commentary: Multiple Sclerosis is a disease with no cure but treatment options that have evolved and expanded over the past 25 years. The need to treat early, treat effectively, and to monitor for disease activity not apparent clinically but identified on MRI and by other metrics has become more critical due to the multiplicity of treatment options. The complexity and nuances of mechanism of action, route, frequency, efficacy, sequencing, and monitoring for disease modifying therapy has also become more involved, and keeping abreast of the ever expanding and important information required to effectively treat this illness has become more than a full time job. 

This article is an extremely important review of many of the ins and outs, risks and benefits, and options of treatment. More importantly, it is a comprehensive resource with background information regarding the impact of this disease related to cognition, fatigue, mood, and incidence of these less commonly recognized but ever-present burdens that add to disease-related disability that should be identified and treated along with disease activity. To provide anything less than effective and comprehensive care is no longer justified. This review provides an overview of care needs and treatment options for MS clinicians and for our patients. — Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY 

The Multiple Sclerosis Coalition’s consensus paper on the use of disease-modifying therapies (DMTs) in multiple sclerosis (MS) includes the following recommendations:

• Treatment with an FDA-approved DMT should be initiated as soon as possible following a diagnosis of relapsing disease; after a first clinical event with MRI features consistent with MS in which other causes have been ruled out; and in patients with progressive MS with clinical relapses and/or inflammatory activity.

• Treatment with DMTs should continue indefinitely unless there are intolerable side effects, inadequate adherence, sub-optimal treatment response, or a more appropriate option becomes available.

• When additional clinical or MRI activity occurs while on treatment, consider an alternate regimen with a different mechanism of action.

• Absence of relapse while on DMT should not be considered a reason to discontinue treatment.

The full report is available here.

Citation: Costello K, Halper J, Kalb R, Skutnik L, Rapp R. The use of disease-modifying therapies in multiple sclerosis: principles and current evidence. A consensus paper by the Multiple Sclerosis Coalition. http://www.nationalmssociety.org/getmedia/5ca284d3-fc7c-4ba5-b005-ab537d495c3c/DMT_Consensus_MS_Coalition_color. Updated March 2015. Accessed April 30, 2015.

Commentary: Multiple Sclerosis is a disease with no cure but treatment options that have evolved and expanded over the past 25 years. The need to treat early, treat effectively, and to monitor for disease activity not apparent clinically but identified on MRI and by other metrics has become more critical due to the multiplicity of treatment options. The complexity and nuances of mechanism of action, route, frequency, efficacy, sequencing, and monitoring for disease modifying therapy has also become more involved, and keeping abreast of the ever expanding and important information required to effectively treat this illness has become more than a full time job. 

This article is an extremely important review of many of the ins and outs, risks and benefits, and options of treatment. More importantly, it is a comprehensive resource with background information regarding the impact of this disease related to cognition, fatigue, mood, and incidence of these less commonly recognized but ever-present burdens that add to disease-related disability that should be identified and treated along with disease activity. To provide anything less than effective and comprehensive care is no longer justified. This review provides an overview of care needs and treatment options for MS clinicians and for our patients. — Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY 

The Multiple Sclerosis Coalition’s consensus paper on the use of disease-modifying therapies (DMTs) in multiple sclerosis (MS) includes the following recommendations:

• Treatment with an FDA-approved DMT should be initiated as soon as possible following a diagnosis of relapsing disease; after a first clinical event with MRI features consistent with MS in which other causes have been ruled out; and in patients with progressive MS with clinical relapses and/or inflammatory activity.

• Treatment with DMTs should continue indefinitely unless there are intolerable side effects, inadequate adherence, sub-optimal treatment response, or a more appropriate option becomes available.

• When additional clinical or MRI activity occurs while on treatment, consider an alternate regimen with a different mechanism of action.

• Absence of relapse while on DMT should not be considered a reason to discontinue treatment.

The full report is available here.

Citation: Costello K, Halper J, Kalb R, Skutnik L, Rapp R. The use of disease-modifying therapies in multiple sclerosis: principles and current evidence. A consensus paper by the Multiple Sclerosis Coalition. http://www.nationalmssociety.org/getmedia/5ca284d3-fc7c-4ba5-b005-ab537d495c3c/DMT_Consensus_MS_Coalition_color. Updated March 2015. Accessed April 30, 2015.

Commentary: Multiple Sclerosis is a disease with no cure but treatment options that have evolved and expanded over the past 25 years. The need to treat early, treat effectively, and to monitor for disease activity not apparent clinically but identified on MRI and by other metrics has become more critical due to the multiplicity of treatment options. The complexity and nuances of mechanism of action, route, frequency, efficacy, sequencing, and monitoring for disease modifying therapy has also become more involved, and keeping abreast of the ever expanding and important information required to effectively treat this illness has become more than a full time job. 

This article is an extremely important review of many of the ins and outs, risks and benefits, and options of treatment. More importantly, it is a comprehensive resource with background information regarding the impact of this disease related to cognition, fatigue, mood, and incidence of these less commonly recognized but ever-present burdens that add to disease-related disability that should be identified and treated along with disease activity. To provide anything less than effective and comprehensive care is no longer justified. This review provides an overview of care needs and treatment options for MS clinicians and for our patients. — Mark Gudesblatt, MD, Medical Director of the Comprehensive MS Care Center at South Shore Neurologic Associates in Islip, NY 

Participation in the Connected Care Multiple Sclerosis (CCMS) treatment management program for 6 months or more significantly increased medication adherence, regardless of positive screenings for depression and fatigue, according to a retrospective study of 939 patients with multiple sclerosis (MS) who filled prescriptions at Walgreens, 720 of whom were enrolled in the CCMS program. 

Researchers compared rates of medication adherence among those enrolled in the program, which provided enhanced levels of monitoring, oversight, and care for patients taking MS disease-modifying therapies (DMTs), and found those who remained in the program for at least 6 months had better rates of mean proportion of days covered than those who were less managed.

In addition, positive screenings for depression and fatigue reduced adherence in the less managed group, but not in patients with longer participation in the program. 

Citation: DuChane J, Clark B, Staskon F, Miller R, Love K, Duncan I. Walgreens Connected Care. Impact of managed therapy on adherence to medications used to treat multiple sclerosis and related comorbid conditions. Int J MS Care. 2015;17:57–64. doi: 10.7224/1537-2073.2013-051.

Participation in the Connected Care Multiple Sclerosis (CCMS) treatment management program for 6 months or more significantly increased medication adherence, regardless of positive screenings for depression and fatigue, according to a retrospective study of 939 patients with multiple sclerosis (MS) who filled prescriptions at Walgreens, 720 of whom were enrolled in the CCMS program. 

Researchers compared rates of medication adherence among those enrolled in the program, which provided enhanced levels of monitoring, oversight, and care for patients taking MS disease-modifying therapies (DMTs), and found those who remained in the program for at least 6 months had better rates of mean proportion of days covered than those who were less managed.

In addition, positive screenings for depression and fatigue reduced adherence in the less managed group, but not in patients with longer participation in the program. 

Citation: DuChane J, Clark B, Staskon F, Miller R, Love K, Duncan I. Walgreens Connected Care. Impact of managed therapy on adherence to medications used to treat multiple sclerosis and related comorbid conditions. Int J MS Care. 2015;17:57–64. doi: 10.7224/1537-2073.2013-051.

Participation in the Connected Care Multiple Sclerosis (CCMS) treatment management program for 6 months or more significantly increased medication adherence, regardless of positive screenings for depression and fatigue, according to a retrospective study of 939 patients with multiple sclerosis (MS) who filled prescriptions at Walgreens, 720 of whom were enrolled in the CCMS program. 

Researchers compared rates of medication adherence among those enrolled in the program, which provided enhanced levels of monitoring, oversight, and care for patients taking MS disease-modifying therapies (DMTs), and found those who remained in the program for at least 6 months had better rates of mean proportion of days covered than those who were less managed.

In addition, positive screenings for depression and fatigue reduced adherence in the less managed group, but not in patients with longer participation in the program. 

Citation: DuChane J, Clark B, Staskon F, Miller R, Love K, Duncan I. Walgreens Connected Care. Impact of managed therapy on adherence to medications used to treat multiple sclerosis and related comorbid conditions. Int J MS Care. 2015;17:57–64. doi: 10.7224/1537-2073.2013-051.

Testing for autoantibodies during clinical work-up of patients with clinically isolated syndrome (CIS) should not be routinely performed, except when patients present with symptoms suggestive of other autoimmune diseases (AD), a prospective cohort study suggests.

Researchers followed 772 CIS patients who were tested for anti-nuclear-antibodies, anti-SSA and anti-SSB autoantibodies within the first year of diagnosis, and during a mean 6.6 years follow-up, found:

• One or more autoantibodies were present in 29% of patients.

• Only 1.8% of patients developed another AD.

• The concurrent AD was not considered the cause of CIS in any cases.

• In each case, the diagnosis of another AD was based on the symptoms suggested of the other disease.

Citation: Negrotto L, Tur C, Tintoré M, et al. Should we systematically test patients with clinically isolated syndrome for auto-antibodies? Mult Scler. 2015. doi:10.1177/1352458515575338.

Testing for autoantibodies during clinical work-up of patients with clinically isolated syndrome (CIS) should not be routinely performed, except when patients present with symptoms suggestive of other autoimmune diseases (AD), a prospective cohort study suggests.

Researchers followed 772 CIS patients who were tested for anti-nuclear-antibodies, anti-SSA and anti-SSB autoantibodies within the first year of diagnosis, and during a mean 6.6 years follow-up, found:

• One or more autoantibodies were present in 29% of patients.

• Only 1.8% of patients developed another AD.

• The concurrent AD was not considered the cause of CIS in any cases.

• In each case, the diagnosis of another AD was based on the symptoms suggested of the other disease.

Citation: Negrotto L, Tur C, Tintoré M, et al. Should we systematically test patients with clinically isolated syndrome for auto-antibodies? Mult Scler. 2015. doi:10.1177/1352458515575338.

Testing for autoantibodies during clinical work-up of patients with clinically isolated syndrome (CIS) should not be routinely performed, except when patients present with symptoms suggestive of other autoimmune diseases (AD), a prospective cohort study suggests.

Researchers followed 772 CIS patients who were tested for anti-nuclear-antibodies, anti-SSA and anti-SSB autoantibodies within the first year of diagnosis, and during a mean 6.6 years follow-up, found:

• One or more autoantibodies were present in 29% of patients.

• Only 1.8% of patients developed another AD.

• The concurrent AD was not considered the cause of CIS in any cases.

• In each case, the diagnosis of another AD was based on the symptoms suggested of the other disease.

Citation: Negrotto L, Tur C, Tintoré M, et al. Should we systematically test patients with clinically isolated syndrome for auto-antibodies? Mult Scler. 2015. doi:10.1177/1352458515575338.