Multiple Sclerosis

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 – Plasma exchange, or PLEX, is a type of therapeutic apheresis that has been shown to be effective for acute attacks of demyelinating disease, but it’s not to be used for treatment of chronic or progressive multiple sclerosis.

Dr. Brian G. Weinshenker, professor of neurology at the Mayo Clinic College of Medicine in Rochester, Minn., summarized the current evidence and indications for plasma exchange in individuals with multiple sclerosis or neuromyelitis optica and shared a few practice tips at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis. 

For the latest guidelines, visit the American Academy of Neurology and the American Society for Apheresis.

nmiller@frontlinemedcom.com On Twitter @naseemsmiller

DALLAS – Plasma exchange, or PLEX, is a type of therapeutic apheresis that has been shown to be effective for acute attacks of demyelinating disease, but it’s not to be used for treatment of chronic or progressive multiple sclerosis.

Dr. Brian G. Weinshenker, professor of neurology at the Mayo Clinic College of Medicine in Rochester, Minn., summarized the current evidence and indications for plasma exchange in individuals with multiple sclerosis or neuromyelitis optica and shared a few practice tips at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis. 

For the latest guidelines, visit the American Academy of Neurology and the American Society for Apheresis.

nmiller@frontlinemedcom.com On Twitter @naseemsmiller

DALLAS – Plasma exchange, or PLEX, is a type of therapeutic apheresis that has been shown to be effective for acute attacks of demyelinating disease, but it’s not to be used for treatment of chronic or progressive multiple sclerosis.

Dr. Brian G. Weinshenker, professor of neurology at the Mayo Clinic College of Medicine in Rochester, Minn., summarized the current evidence and indications for plasma exchange in individuals with multiple sclerosis or neuromyelitis optica and shared a few practice tips at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis. 

For the latest guidelines, visit the American Academy of Neurology and the American Society for Apheresis.

nmiller@frontlinemedcom.com On Twitter @naseemsmiller

DALLAS – Persons with multiple sclerosis who had been taking natalizumab for at least 2 years and then switched to fingolimod or injectables such as interferon-beta or glatiramer acetate faced more disability than did their counterparts who continued on the drug, according to results from a retrospective study of patient-reported data.

"If people stopped natalizumab after 2 years, regardless of their risk of progressive multifocal leukoencephalopathy [PML], we wanted to know if their disease worsened," Stacey S. Cofield, Ph.D., said in an interview at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis. "What we have seen in a short follow-up time is that, yes, it does."

Dr. Cofield is the deputy director of the North American Research Committee on Multiple Sclerosis (NARCOMS) in Birmingham, Ala., and is a faculty member in the biostatistics department at the University of Alabama, Birmingham.

To help close the gap of knowledge on clinical outcomes for patients who stop natalizumab (Tysabri) treatment, often due to an elevated risk for PML, Dr. Cofield and her associates reviewed outcomes as measured by the Patient-Determined Disease Steps (PDDS) scale. The PDDS is a validated, patient-reported scale of disease progression that runs from normal with a score of 0 to bedridden with a score of 8.

The investigators created three groups from a total of 547 patients who had undergone at least 2 years of continuous natalizumab treatment between 2005 and 2013 and had completed at least one follow-up survey that included a PDDS assessment: 406 whose only disease-modifying treatment during the time reviewed was natalizumab; 50 who switched to fingolimod (Gilenya) after at least 2 years of natalizumab; and 71 who switched to injectables after at least 2 years of natalizumab. A total of 10 patients who’d switched to other treatments, including exclusively symptomatic treatments, were not included in the study. The investigators also excluded another 10 patients who lacked PDDS assessments in the first survey during natalizumab treatment.

Patient characteristics across all three study groups at the start of their natalizumab treatment trended similarly: They tended to be white, female, have a median age of 50 years (P greater than .05 for all), and have similar baseline PDDS scores of between 3 and 4 (P = .1334). Roughly a third of each group reported having employment outside the home (P = .7104).

The median months of total follow-up were significantly different across the arms. For the natalizumab-only arm, the median range for follow-up was about 48 months; for fingolimod, it was 54 months; and for injectables, it was 60 months (P less than .0001).

Once patients had transitioned, Dr. Cofield reported, "the fingolimod switch had about 12 months of follow-up time. Patients stayed on natalizumab about 4 years before switching, on average." This was due, in part, to fingolimod not being available until 2010, leaving very little "capture time" for the window of data the investigators were reviewing, she said.

For the injectables group, the median follow-up time was 12 months.

Older age, male gender, and a lower baseline PDDS score were predictors of lower PDDS scores at follow-up (P less than .03 for all), but the total follow-up time was not (P = .69).

The adjusted mean PDDS score did not differ between the groups after 2 years of natalizumab therapy (P = .11); however, at the end of follow-up, the mean PDDS increase in the fingolimod group (0.58 points) and the injectables group (0.71) was significantly different from that of the natalizumab group (0.31; P = .007).

There was also a significant difference across the groups in the number of patients who had an increase in their PDDS score of at least 1 point: 31% for the natalizumab group, 46% for the fingolimod group, and 42.3% for the injectables group (P = .03).

"The mean change in the fingolimod group was slightly lower, but their group had a higher proportion with a 1 point increase," Dr. Cofield said. "So, the ones who switched to fingolimod either weren’t changing [their PDDS score] or were changing by one whole point."

"The take-away is that patients should be aware of the discussion they should be having with their physician after 2 years of treatment" with natalizumab, Dr. Cofield said in the interview. "Physicians can use this information to discuss the balance between the side effects and the risks of natalizumab, with the changes patients may see if they leave the treatment."

Dr. Cofield reported that she has received consulting fees from Teva Neuroscience and GlaxoSmithKline, among others. Biogen Idec funded the analysis of data for this study.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

DALLAS – Persons with multiple sclerosis who had been taking natalizumab for at least 2 years and then switched to fingolimod or injectables such as interferon-beta or glatiramer acetate faced more disability than did their counterparts who continued on the drug, according to results from a retrospective study of patient-reported data.

"If people stopped natalizumab after 2 years, regardless of their risk of progressive multifocal leukoencephalopathy [PML], we wanted to know if their disease worsened," Stacey S. Cofield, Ph.D., said in an interview at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis. "What we have seen in a short follow-up time is that, yes, it does."

Dr. Cofield is the deputy director of the North American Research Committee on Multiple Sclerosis (NARCOMS) in Birmingham, Ala., and is a faculty member in the biostatistics department at the University of Alabama, Birmingham.

To help close the gap of knowledge on clinical outcomes for patients who stop natalizumab (Tysabri) treatment, often due to an elevated risk for PML, Dr. Cofield and her associates reviewed outcomes as measured by the Patient-Determined Disease Steps (PDDS) scale. The PDDS is a validated, patient-reported scale of disease progression that runs from normal with a score of 0 to bedridden with a score of 8.

The investigators created three groups from a total of 547 patients who had undergone at least 2 years of continuous natalizumab treatment between 2005 and 2013 and had completed at least one follow-up survey that included a PDDS assessment: 406 whose only disease-modifying treatment during the time reviewed was natalizumab; 50 who switched to fingolimod (Gilenya) after at least 2 years of natalizumab; and 71 who switched to injectables after at least 2 years of natalizumab. A total of 10 patients who’d switched to other treatments, including exclusively symptomatic treatments, were not included in the study. The investigators also excluded another 10 patients who lacked PDDS assessments in the first survey during natalizumab treatment.

Patient characteristics across all three study groups at the start of their natalizumab treatment trended similarly: They tended to be white, female, have a median age of 50 years (P greater than .05 for all), and have similar baseline PDDS scores of between 3 and 4 (P = .1334). Roughly a third of each group reported having employment outside the home (P = .7104).

The median months of total follow-up were significantly different across the arms. For the natalizumab-only arm, the median range for follow-up was about 48 months; for fingolimod, it was 54 months; and for injectables, it was 60 months (P less than .0001).

Once patients had transitioned, Dr. Cofield reported, "the fingolimod switch had about 12 months of follow-up time. Patients stayed on natalizumab about 4 years before switching, on average." This was due, in part, to fingolimod not being available until 2010, leaving very little "capture time" for the window of data the investigators were reviewing, she said.

For the injectables group, the median follow-up time was 12 months.

Older age, male gender, and a lower baseline PDDS score were predictors of lower PDDS scores at follow-up (P less than .03 for all), but the total follow-up time was not (P = .69).

The adjusted mean PDDS score did not differ between the groups after 2 years of natalizumab therapy (P = .11); however, at the end of follow-up, the mean PDDS increase in the fingolimod group (0.58 points) and the injectables group (0.71) was significantly different from that of the natalizumab group (0.31; P = .007).

There was also a significant difference across the groups in the number of patients who had an increase in their PDDS score of at least 1 point: 31% for the natalizumab group, 46% for the fingolimod group, and 42.3% for the injectables group (P = .03).

"The mean change in the fingolimod group was slightly lower, but their group had a higher proportion with a 1 point increase," Dr. Cofield said. "So, the ones who switched to fingolimod either weren’t changing [their PDDS score] or were changing by one whole point."

"The take-away is that patients should be aware of the discussion they should be having with their physician after 2 years of treatment" with natalizumab, Dr. Cofield said in the interview. "Physicians can use this information to discuss the balance between the side effects and the risks of natalizumab, with the changes patients may see if they leave the treatment."

Dr. Cofield reported that she has received consulting fees from Teva Neuroscience and GlaxoSmithKline, among others. Biogen Idec funded the analysis of data for this study.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

DALLAS – Persons with multiple sclerosis who had been taking natalizumab for at least 2 years and then switched to fingolimod or injectables such as interferon-beta or glatiramer acetate faced more disability than did their counterparts who continued on the drug, according to results from a retrospective study of patient-reported data.

"If people stopped natalizumab after 2 years, regardless of their risk of progressive multifocal leukoencephalopathy [PML], we wanted to know if their disease worsened," Stacey S. Cofield, Ph.D., said in an interview at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis. "What we have seen in a short follow-up time is that, yes, it does."

Dr. Cofield is the deputy director of the North American Research Committee on Multiple Sclerosis (NARCOMS) in Birmingham, Ala., and is a faculty member in the biostatistics department at the University of Alabama, Birmingham.

To help close the gap of knowledge on clinical outcomes for patients who stop natalizumab (Tysabri) treatment, often due to an elevated risk for PML, Dr. Cofield and her associates reviewed outcomes as measured by the Patient-Determined Disease Steps (PDDS) scale. The PDDS is a validated, patient-reported scale of disease progression that runs from normal with a score of 0 to bedridden with a score of 8.

The investigators created three groups from a total of 547 patients who had undergone at least 2 years of continuous natalizumab treatment between 2005 and 2013 and had completed at least one follow-up survey that included a PDDS assessment: 406 whose only disease-modifying treatment during the time reviewed was natalizumab; 50 who switched to fingolimod (Gilenya) after at least 2 years of natalizumab; and 71 who switched to injectables after at least 2 years of natalizumab. A total of 10 patients who’d switched to other treatments, including exclusively symptomatic treatments, were not included in the study. The investigators also excluded another 10 patients who lacked PDDS assessments in the first survey during natalizumab treatment.

Patient characteristics across all three study groups at the start of their natalizumab treatment trended similarly: They tended to be white, female, have a median age of 50 years (P greater than .05 for all), and have similar baseline PDDS scores of between 3 and 4 (P = .1334). Roughly a third of each group reported having employment outside the home (P = .7104).

The median months of total follow-up were significantly different across the arms. For the natalizumab-only arm, the median range for follow-up was about 48 months; for fingolimod, it was 54 months; and for injectables, it was 60 months (P less than .0001).

Once patients had transitioned, Dr. Cofield reported, "the fingolimod switch had about 12 months of follow-up time. Patients stayed on natalizumab about 4 years before switching, on average." This was due, in part, to fingolimod not being available until 2010, leaving very little "capture time" for the window of data the investigators were reviewing, she said.

For the injectables group, the median follow-up time was 12 months.

Older age, male gender, and a lower baseline PDDS score were predictors of lower PDDS scores at follow-up (P less than .03 for all), but the total follow-up time was not (P = .69).

The adjusted mean PDDS score did not differ between the groups after 2 years of natalizumab therapy (P = .11); however, at the end of follow-up, the mean PDDS increase in the fingolimod group (0.58 points) and the injectables group (0.71) was significantly different from that of the natalizumab group (0.31; P = .007).

There was also a significant difference across the groups in the number of patients who had an increase in their PDDS score of at least 1 point: 31% for the natalizumab group, 46% for the fingolimod group, and 42.3% for the injectables group (P = .03).

"The mean change in the fingolimod group was slightly lower, but their group had a higher proportion with a 1 point increase," Dr. Cofield said. "So, the ones who switched to fingolimod either weren’t changing [their PDDS score] or were changing by one whole point."

"The take-away is that patients should be aware of the discussion they should be having with their physician after 2 years of treatment" with natalizumab, Dr. Cofield said in the interview. "Physicians can use this information to discuss the balance between the side effects and the risks of natalizumab, with the changes patients may see if they leave the treatment."

Dr. Cofield reported that she has received consulting fees from Teva Neuroscience and GlaxoSmithKline, among others. Biogen Idec funded the analysis of data for this study.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

DALLAS – Patients with multiple sclerosis have likely already heard the worst about their treatment options from the Internet; they need help balancing risks and benefits.

The key is offering them options, knowing what problems need to be discussed, and monitoring treatment beyond what’s usually recommended on product labeling, said Dr. Donna Graves, an MS specialist at the University of Texas Southwestern Medical Center, Dallas. She shared her tips – and also a heads-up about alemtuzumab, which might be approved for MS as soon as this fall – at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

aotto@frontlinemedcom.com

DALLAS – Patients with multiple sclerosis have likely already heard the worst about their treatment options from the Internet; they need help balancing risks and benefits.

The key is offering them options, knowing what problems need to be discussed, and monitoring treatment beyond what’s usually recommended on product labeling, said Dr. Donna Graves, an MS specialist at the University of Texas Southwestern Medical Center, Dallas. She shared her tips – and also a heads-up about alemtuzumab, which might be approved for MS as soon as this fall – at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

aotto@frontlinemedcom.com

DALLAS – Patients with multiple sclerosis have likely already heard the worst about their treatment options from the Internet; they need help balancing risks and benefits.

The key is offering them options, knowing what problems need to be discussed, and monitoring treatment beyond what’s usually recommended on product labeling, said Dr. Donna Graves, an MS specialist at the University of Texas Southwestern Medical Center, Dallas. She shared her tips – and also a heads-up about alemtuzumab, which might be approved for MS as soon as this fall – at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

aotto@frontlinemedcom.com

DALLAS – Vaccinations are beneficial for individuals with multiple sclerosis because they help avoid infections, which in turn lower the risk of relapse.

But while inactive vaccines are considered safe for MS patients, the use of live vaccines such as Varivax, Zostavax, or yellow fever vaccine is more nuanced, especially as more disease-modifying therapies (DMT) become available. There are limited data available about the effect of live vaccines on patients who are on DMTs, and the final decision comes down to the risk-benefit ratio, said, Dr. Patricia K. Coyle, professor of neurology and director of the MS Comprehensive Care Center at Stony Brook (N.Y.) University Medical Center.

In a video interview at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis, Dr. Coyle summarizes what’s known so far about vaccines and MS, and provides tips to clinicians.

nmiller@frontlinemedcom.com

On Twitter @naseemmiller

DALLAS – Vaccinations are beneficial for individuals with multiple sclerosis because they help avoid infections, which in turn lower the risk of relapse.

But while inactive vaccines are considered safe for MS patients, the use of live vaccines such as Varivax, Zostavax, or yellow fever vaccine is more nuanced, especially as more disease-modifying therapies (DMT) become available. There are limited data available about the effect of live vaccines on patients who are on DMTs, and the final decision comes down to the risk-benefit ratio, said, Dr. Patricia K. Coyle, professor of neurology and director of the MS Comprehensive Care Center at Stony Brook (N.Y.) University Medical Center.

In a video interview at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis, Dr. Coyle summarizes what’s known so far about vaccines and MS, and provides tips to clinicians.

nmiller@frontlinemedcom.com

On Twitter @naseemmiller

DALLAS – Vaccinations are beneficial for individuals with multiple sclerosis because they help avoid infections, which in turn lower the risk of relapse.

But while inactive vaccines are considered safe for MS patients, the use of live vaccines such as Varivax, Zostavax, or yellow fever vaccine is more nuanced, especially as more disease-modifying therapies (DMT) become available. There are limited data available about the effect of live vaccines on patients who are on DMTs, and the final decision comes down to the risk-benefit ratio, said, Dr. Patricia K. Coyle, professor of neurology and director of the MS Comprehensive Care Center at Stony Brook (N.Y.) University Medical Center.

In a video interview at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis, Dr. Coyle summarizes what’s known so far about vaccines and MS, and provides tips to clinicians.

nmiller@frontlinemedcom.com

On Twitter @naseemmiller

DALLAS – It might come as a surprise to learn how many good studies there are to support marijuana for multiple sclerosis, especially for subjective symptoms. The data are summarized in recent MS complementary and alternative medicine guidelines from the American Academy of Neurology.

But most of those studies were done using standardized products not available in the United States, which means that U.S. providers have to give advice in a country in which marijuana types and products vary considerably. It comes down to a case-by-case approach, Dr. Allen C. Bowling of the Colorado Neurological Institute, Englewood, explained in a video interview at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

aotto@frontlinemedcom.com

DALLAS – It might come as a surprise to learn how many good studies there are to support marijuana for multiple sclerosis, especially for subjective symptoms. The data are summarized in recent MS complementary and alternative medicine guidelines from the American Academy of Neurology.

But most of those studies were done using standardized products not available in the United States, which means that U.S. providers have to give advice in a country in which marijuana types and products vary considerably. It comes down to a case-by-case approach, Dr. Allen C. Bowling of the Colorado Neurological Institute, Englewood, explained in a video interview at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

aotto@frontlinemedcom.com

DALLAS – It might come as a surprise to learn how many good studies there are to support marijuana for multiple sclerosis, especially for subjective symptoms. The data are summarized in recent MS complementary and alternative medicine guidelines from the American Academy of Neurology.

But most of those studies were done using standardized products not available in the United States, which means that U.S. providers have to give advice in a country in which marijuana types and products vary considerably. It comes down to a case-by-case approach, Dr. Allen C. Bowling of the Colorado Neurological Institute, Englewood, explained in a video interview at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

aotto@frontlinemedcom.com

DALLAS – Exercise is generally safe for individuals with multiple sclerosis, according to a systematic review of randomized, controlled trials, supporting the promotion of exercise in this patient group.

The analysis showed that persons with MS who exercised had 27% lower risk of relapse, compared with patients who didn’t exercise. However, those who exercised had a 67% higher risk of adverse events, but the rate was no higher than adverse events (AEs) in healthy populations.

Frontline Medical News Image Library

"Patients with MS should not be deterred from exercise participation for concern of experiencing a relapse or adverse events, and such patients would further be expected to experience the many benefits of exercise training documented in the literature," wrote Mr. Matthew E. Platta and his colleagues in a study that was published in the Journal of the Neurological Sciences (2014 May 19 [doi:10.1016/j.jns.2014.05.016]).

Although reviews have shown the benefits of exercise for individuals with MS, none have looked at the risks of relapse and other AEs, Mr. Platta said at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

Mr. Platta, a graduate student in the department of kinesiology and community health at the University of Illinois at Urbana-Champaign, and his colleagues analyzed 26 trials, including 1,295 participants. The trials were published up to November 2013 and examined the effect of exercise on MS relapses and adverse events. All trials included a nontreatment control arm.

The exercises included yoga, resistance training, aerobics, aquatics, and combined aerobics and resistance training.

Results showed that there were 26 relapses in the control groups, compared with 29 in the exercise group, corresponding with 6.3% and 4.6% of participants in the control and exercise groups, respectively.

The exercise group also had a 27% lower relative risk of relapse.

As for AEs, there were 5 in the control group, compared with 13 in the exercise group (or 1.2% and 2.0% in each group, respectively).

But the exercise group had a 67% higher relative risk of AEs, compared with the control group. However, the rate was not higher than the rates of AEs associated with exercise training in healthy populations, the researchers said.

The most common AEs in the control group were illness, ankle sprain, knee pain, and fall. The exercise group had additional AEs, including stroke, low back pain, trigeminal neuralgia, traffic accident, upper respiratory tract infection, rheumatoid arthritis flare up, and hernia. The most common types of AEs were musculoskeletal injuries (46%) and illnesses (23%).

"MS patients and clinicians can expect a low occurrence of AEs with exercise training, and, when AEs do occur, such events are commonly musculoskeletal in nature," Mr. Platta and his colleagues wrote.

There was no difference in the dropout rate between the two groups. The authors noted that "Future research might consider the inclusion of behavioral strategies for reducing dropout in RCTs of exercise training in MS."

They said that some of the analysis limitations include lack of complete reporting on the exercise training protocols, and potential for attention bias in the exercise group, compared with the control group.

Also, there was considerable variation in the type and prescription of exercises, they said. The sessions were between 1 and 5 days per week for 20-90 minutes per day. The duration of the programs was 4-24 weeks. Mr. Platta said there were too few trials to analyze the effect of different types of exercise separately.

The authors added that it is also important to record frequency and severity of temporary symptomatic changes in response to acute exercise bouts.

"Take-home message is that, taking into account that there are a lot of benefits to exercise, our findings show that the amount of relapses and adverse events are not too high to prevent physicians from recommending exercise [to individuals with MS]."

Mr. Platta and his coauthors had no disclosures.

nmiller@frontlinemedcom.com

On Twitter @naseemsmiller

DALLAS – Exercise is generally safe for individuals with multiple sclerosis, according to a systematic review of randomized, controlled trials, supporting the promotion of exercise in this patient group.

The analysis showed that persons with MS who exercised had 27% lower risk of relapse, compared with patients who didn’t exercise. However, those who exercised had a 67% higher risk of adverse events, but the rate was no higher than adverse events (AEs) in healthy populations.

Frontline Medical News Image Library

"Patients with MS should not be deterred from exercise participation for concern of experiencing a relapse or adverse events, and such patients would further be expected to experience the many benefits of exercise training documented in the literature," wrote Mr. Matthew E. Platta and his colleagues in a study that was published in the Journal of the Neurological Sciences (2014 May 19 [doi:10.1016/j.jns.2014.05.016]).

Although reviews have shown the benefits of exercise for individuals with MS, none have looked at the risks of relapse and other AEs, Mr. Platta said at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

Mr. Platta, a graduate student in the department of kinesiology and community health at the University of Illinois at Urbana-Champaign, and his colleagues analyzed 26 trials, including 1,295 participants. The trials were published up to November 2013 and examined the effect of exercise on MS relapses and adverse events. All trials included a nontreatment control arm.

The exercises included yoga, resistance training, aerobics, aquatics, and combined aerobics and resistance training.

Results showed that there were 26 relapses in the control groups, compared with 29 in the exercise group, corresponding with 6.3% and 4.6% of participants in the control and exercise groups, respectively.

The exercise group also had a 27% lower relative risk of relapse.

As for AEs, there were 5 in the control group, compared with 13 in the exercise group (or 1.2% and 2.0% in each group, respectively).

But the exercise group had a 67% higher relative risk of AEs, compared with the control group. However, the rate was not higher than the rates of AEs associated with exercise training in healthy populations, the researchers said.

The most common AEs in the control group were illness, ankle sprain, knee pain, and fall. The exercise group had additional AEs, including stroke, low back pain, trigeminal neuralgia, traffic accident, upper respiratory tract infection, rheumatoid arthritis flare up, and hernia. The most common types of AEs were musculoskeletal injuries (46%) and illnesses (23%).

"MS patients and clinicians can expect a low occurrence of AEs with exercise training, and, when AEs do occur, such events are commonly musculoskeletal in nature," Mr. Platta and his colleagues wrote.

There was no difference in the dropout rate between the two groups. The authors noted that "Future research might consider the inclusion of behavioral strategies for reducing dropout in RCTs of exercise training in MS."

They said that some of the analysis limitations include lack of complete reporting on the exercise training protocols, and potential for attention bias in the exercise group, compared with the control group.

Also, there was considerable variation in the type and prescription of exercises, they said. The sessions were between 1 and 5 days per week for 20-90 minutes per day. The duration of the programs was 4-24 weeks. Mr. Platta said there were too few trials to analyze the effect of different types of exercise separately.

The authors added that it is also important to record frequency and severity of temporary symptomatic changes in response to acute exercise bouts.

"Take-home message is that, taking into account that there are a lot of benefits to exercise, our findings show that the amount of relapses and adverse events are not too high to prevent physicians from recommending exercise [to individuals with MS]."

Mr. Platta and his coauthors had no disclosures.

nmiller@frontlinemedcom.com

On Twitter @naseemsmiller

DALLAS – Exercise is generally safe for individuals with multiple sclerosis, according to a systematic review of randomized, controlled trials, supporting the promotion of exercise in this patient group.

The analysis showed that persons with MS who exercised had 27% lower risk of relapse, compared with patients who didn’t exercise. However, those who exercised had a 67% higher risk of adverse events, but the rate was no higher than adverse events (AEs) in healthy populations.

Frontline Medical News Image Library

"Patients with MS should not be deterred from exercise participation for concern of experiencing a relapse or adverse events, and such patients would further be expected to experience the many benefits of exercise training documented in the literature," wrote Mr. Matthew E. Platta and his colleagues in a study that was published in the Journal of the Neurological Sciences (2014 May 19 [doi:10.1016/j.jns.2014.05.016]).

Although reviews have shown the benefits of exercise for individuals with MS, none have looked at the risks of relapse and other AEs, Mr. Platta said at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

Mr. Platta, a graduate student in the department of kinesiology and community health at the University of Illinois at Urbana-Champaign, and his colleagues analyzed 26 trials, including 1,295 participants. The trials were published up to November 2013 and examined the effect of exercise on MS relapses and adverse events. All trials included a nontreatment control arm.

The exercises included yoga, resistance training, aerobics, aquatics, and combined aerobics and resistance training.

Results showed that there were 26 relapses in the control groups, compared with 29 in the exercise group, corresponding with 6.3% and 4.6% of participants in the control and exercise groups, respectively.

The exercise group also had a 27% lower relative risk of relapse.

As for AEs, there were 5 in the control group, compared with 13 in the exercise group (or 1.2% and 2.0% in each group, respectively).

But the exercise group had a 67% higher relative risk of AEs, compared with the control group. However, the rate was not higher than the rates of AEs associated with exercise training in healthy populations, the researchers said.

The most common AEs in the control group were illness, ankle sprain, knee pain, and fall. The exercise group had additional AEs, including stroke, low back pain, trigeminal neuralgia, traffic accident, upper respiratory tract infection, rheumatoid arthritis flare up, and hernia. The most common types of AEs were musculoskeletal injuries (46%) and illnesses (23%).

"MS patients and clinicians can expect a low occurrence of AEs with exercise training, and, when AEs do occur, such events are commonly musculoskeletal in nature," Mr. Platta and his colleagues wrote.

There was no difference in the dropout rate between the two groups. The authors noted that "Future research might consider the inclusion of behavioral strategies for reducing dropout in RCTs of exercise training in MS."

They said that some of the analysis limitations include lack of complete reporting on the exercise training protocols, and potential for attention bias in the exercise group, compared with the control group.

Also, there was considerable variation in the type and prescription of exercises, they said. The sessions were between 1 and 5 days per week for 20-90 minutes per day. The duration of the programs was 4-24 weeks. Mr. Platta said there were too few trials to analyze the effect of different types of exercise separately.

The authors added that it is also important to record frequency and severity of temporary symptomatic changes in response to acute exercise bouts.

"Take-home message is that, taking into account that there are a lot of benefits to exercise, our findings show that the amount of relapses and adverse events are not too high to prevent physicians from recommending exercise [to individuals with MS]."

Mr. Platta and his coauthors had no disclosures.

nmiller@frontlinemedcom.com

On Twitter @naseemsmiller

DALLAS – Identifying and correcting low 25-hydroxyvitamin D levels early in the course of multiple sclerosis was associated with improved outcomes, results of a randomized study showed.

"In people who have had MS for many years, a low vitamin D level may be a consequence of the disease rather than a cause," Dr. Alberto Ascherio, a professor of epidemiology and nutrition at Harvard Medical School, Boston, said in an interview during the poster session at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

Whitney McKnight/Frontline Medical News

"We looked at whether, at the first sign of a demyelinating attack, did the vitamin D level predict the long-term outcome of the disease?" Dr. Ascherio said.

Accordingly, in a randomized study, Dr. Ascherio and his colleagues found that patients with low vitamin D levels were found to have higher MS activity and more relapses with accelerated brain atrophy and neurodegeneration over a 5-year period, compared with patients whose vitamin D levels were higher.

In the study, 216 patients with clinically isolated syndrome (CIS) and two or fewer clinically silent brain lesions detected with imaging were randomly assigned to the early treatment arm. They received interferon beta-1b (Betaseron) 250 mcg subcutaneously every other day. The control arm of 118 patients, also with CIS and two or fewer clinically silent brain lesions received placebo treatment. The results of the study are published in JAMA Neurology (2014;71:306-14).

Serum levels of 25-hydroxyvitamin D [25(OH)D] were taken at baseline, and at 6, 12, and 24 months. The effects of 25(OH)D levels in patients assigned early treatment with interferon beta-1b were assessed by analyzing the vitamin’s serum concentration as a continuous variable at 20 ng/mL (50 nmol/L) increments, or as a dichotomous variable at levels less than 50 nmol/L vs. those of 50 nmol/L or greater.

Clinical and imaging follow-up was conducted on both treatment arms through 5 years.

Serum concentrations of 25(OH)D that increased by 20 ng/mL at 12 months resulted in a lower probability of conversion to MS (hazard ratio, 0.43; 95% confidence interval, 0.22-0.84; P = .01), and a lower trend toward conversion to clinically definite MS (HR, 0.48, 95% CI, 0.22-1.04; P = .06). The rate of newly active lesions was lower, with a rate ratio of 0.31 (95% CI, 0.15-0.61; P = .0008), and the rate ratio of relapse was 0.38 (95% CI, 0.14-0.99; P = .048).

With a 20 ng/mL change in [25(OH)D] in the first 12 months, the annual percentage change in T2 lesion volume was –26% (–39% to –12%; P = .0007), while the annual percent decline in brain volume was 0.64% (0.08% to 1.2%; P = .02).

The occurrence of flulike symptoms, commonly reported in interferon beta-1b treatment, was found not to differ according to 25(OH)D plasma levels in patients in the early treatment arm when tested at 6, 12, and 24 months.

Dr. Ascherio noted the findings were limited by the question of its generalizability, since nearly all patients were of white, of European descent, and had begun their treatment early. However, he concluded that the role of vitamin D in the course of the disease is now established and that, "it’s important to identify those patients with lower levels and correct their vitamin D deficiency early in the disease course."

This study was funded by Bayer. Dr. Ascherio said he has received honoraria from Almirall, Roche, Sanofi-Aventis, and Serono.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

DALLAS – Identifying and correcting low 25-hydroxyvitamin D levels early in the course of multiple sclerosis was associated with improved outcomes, results of a randomized study showed.

"In people who have had MS for many years, a low vitamin D level may be a consequence of the disease rather than a cause," Dr. Alberto Ascherio, a professor of epidemiology and nutrition at Harvard Medical School, Boston, said in an interview during the poster session at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

Whitney McKnight/Frontline Medical News

"We looked at whether, at the first sign of a demyelinating attack, did the vitamin D level predict the long-term outcome of the disease?" Dr. Ascherio said.

Accordingly, in a randomized study, Dr. Ascherio and his colleagues found that patients with low vitamin D levels were found to have higher MS activity and more relapses with accelerated brain atrophy and neurodegeneration over a 5-year period, compared with patients whose vitamin D levels were higher.

In the study, 216 patients with clinically isolated syndrome (CIS) and two or fewer clinically silent brain lesions detected with imaging were randomly assigned to the early treatment arm. They received interferon beta-1b (Betaseron) 250 mcg subcutaneously every other day. The control arm of 118 patients, also with CIS and two or fewer clinically silent brain lesions received placebo treatment. The results of the study are published in JAMA Neurology (2014;71:306-14).

Serum levels of 25-hydroxyvitamin D [25(OH)D] were taken at baseline, and at 6, 12, and 24 months. The effects of 25(OH)D levels in patients assigned early treatment with interferon beta-1b were assessed by analyzing the vitamin’s serum concentration as a continuous variable at 20 ng/mL (50 nmol/L) increments, or as a dichotomous variable at levels less than 50 nmol/L vs. those of 50 nmol/L or greater.

Clinical and imaging follow-up was conducted on both treatment arms through 5 years.

Serum concentrations of 25(OH)D that increased by 20 ng/mL at 12 months resulted in a lower probability of conversion to MS (hazard ratio, 0.43; 95% confidence interval, 0.22-0.84; P = .01), and a lower trend toward conversion to clinically definite MS (HR, 0.48, 95% CI, 0.22-1.04; P = .06). The rate of newly active lesions was lower, with a rate ratio of 0.31 (95% CI, 0.15-0.61; P = .0008), and the rate ratio of relapse was 0.38 (95% CI, 0.14-0.99; P = .048).

With a 20 ng/mL change in [25(OH)D] in the first 12 months, the annual percentage change in T2 lesion volume was –26% (–39% to –12%; P = .0007), while the annual percent decline in brain volume was 0.64% (0.08% to 1.2%; P = .02).

The occurrence of flulike symptoms, commonly reported in interferon beta-1b treatment, was found not to differ according to 25(OH)D plasma levels in patients in the early treatment arm when tested at 6, 12, and 24 months.

Dr. Ascherio noted the findings were limited by the question of its generalizability, since nearly all patients were of white, of European descent, and had begun their treatment early. However, he concluded that the role of vitamin D in the course of the disease is now established and that, "it’s important to identify those patients with lower levels and correct their vitamin D deficiency early in the disease course."

This study was funded by Bayer. Dr. Ascherio said he has received honoraria from Almirall, Roche, Sanofi-Aventis, and Serono.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

DALLAS – Identifying and correcting low 25-hydroxyvitamin D levels early in the course of multiple sclerosis was associated with improved outcomes, results of a randomized study showed.

"In people who have had MS for many years, a low vitamin D level may be a consequence of the disease rather than a cause," Dr. Alberto Ascherio, a professor of epidemiology and nutrition at Harvard Medical School, Boston, said in an interview during the poster session at a meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis.

Whitney McKnight/Frontline Medical News

"We looked at whether, at the first sign of a demyelinating attack, did the vitamin D level predict the long-term outcome of the disease?" Dr. Ascherio said.

Accordingly, in a randomized study, Dr. Ascherio and his colleagues found that patients with low vitamin D levels were found to have higher MS activity and more relapses with accelerated brain atrophy and neurodegeneration over a 5-year period, compared with patients whose vitamin D levels were higher.

In the study, 216 patients with clinically isolated syndrome (CIS) and two or fewer clinically silent brain lesions detected with imaging were randomly assigned to the early treatment arm. They received interferon beta-1b (Betaseron) 250 mcg subcutaneously every other day. The control arm of 118 patients, also with CIS and two or fewer clinically silent brain lesions received placebo treatment. The results of the study are published in JAMA Neurology (2014;71:306-14).

Serum levels of 25-hydroxyvitamin D [25(OH)D] were taken at baseline, and at 6, 12, and 24 months. The effects of 25(OH)D levels in patients assigned early treatment with interferon beta-1b were assessed by analyzing the vitamin’s serum concentration as a continuous variable at 20 ng/mL (50 nmol/L) increments, or as a dichotomous variable at levels less than 50 nmol/L vs. those of 50 nmol/L or greater.

Clinical and imaging follow-up was conducted on both treatment arms through 5 years.

Serum concentrations of 25(OH)D that increased by 20 ng/mL at 12 months resulted in a lower probability of conversion to MS (hazard ratio, 0.43; 95% confidence interval, 0.22-0.84; P = .01), and a lower trend toward conversion to clinically definite MS (HR, 0.48, 95% CI, 0.22-1.04; P = .06). The rate of newly active lesions was lower, with a rate ratio of 0.31 (95% CI, 0.15-0.61; P = .0008), and the rate ratio of relapse was 0.38 (95% CI, 0.14-0.99; P = .048).

With a 20 ng/mL change in [25(OH)D] in the first 12 months, the annual percentage change in T2 lesion volume was –26% (–39% to –12%; P = .0007), while the annual percent decline in brain volume was 0.64% (0.08% to 1.2%; P = .02).

The occurrence of flulike symptoms, commonly reported in interferon beta-1b treatment, was found not to differ according to 25(OH)D plasma levels in patients in the early treatment arm when tested at 6, 12, and 24 months.

Dr. Ascherio noted the findings were limited by the question of its generalizability, since nearly all patients were of white, of European descent, and had begun their treatment early. However, he concluded that the role of vitamin D in the course of the disease is now established and that, "it’s important to identify those patients with lower levels and correct their vitamin D deficiency early in the disease course."

This study was funded by Bayer. Dr. Ascherio said he has received honoraria from Almirall, Roche, Sanofi-Aventis, and Serono.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

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