Multiple sclerosis and related disorders最新文献

{"title":"Efficacy and safety of percutaneous balloon compression for trigeminal neuralgia associated with multiple sclerosis: A systematic review and meta-analysis","authors":"Bardia Hajikarimloo ,&nbsp;Salem M. Tos ,&nbsp;Ibrahim Mohammadzadeh ,&nbsp;Arman Hasanzade ,&nbsp;Dorsa Najari ,&nbsp;Azin Ebrahimi ,&nbsp;Mohammad Amin Habibi","doi":"10.1016/j.msard.2026.107068","DOIUrl":"10.1016/j.msard.2026.107068","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) is a secondary cause of trigeminal neuralgia (TN). The prevalence of TN caused by MS (MS-TN) is 20 times higher than that of other causes. Along with pharmacological treatments, several other options are available for MS-TN patients, such as percutaneous balloon compression (PBC). This study aimed to evaluate the clinical outcomes and complications of PBC in patients with MS-TN.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature search on April 7, 2025, to identify studies reporting clinical outcomes in patients with MS-TN and PBC.</div></div><div><h3>Results</h3><div>Twelve studies comprising 386 patients met inclusion criteria. At the initial follow-up, the pooled pain-free rate was 65% (95% CI: 40%–86%) and the pooled adequate pain relief rate was 91% (95% CI: 81%–98%). At the subsequent follow-up, pooled estimates were 33% (95% CI: 16%–52%) for pain freedom and 77% (95% CI: 46%–98%) for adequate pain relief. Across studies, the pooled complication rate after PBC in MS-TN was 16% (95% CI: 10%–23%).</div></div><div><h3>Conclusions</h3><div>PBC is an effective and relatively safe treatment option for managing MS-TN patients. It shows promising immediate pain relief and can be considered for patients needing quick pain reduction. Future studies should directly compare PBC with other minimally invasive treatments using large datasets to identify the best option for MS-TN patients.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107068"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146192231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence analysis of lesion dynamics and brain volume in patients with multiple sclerosis","authors":"Clemens Bettray ,&nbsp;Thanos Tsaktanis ,&nbsp;Angelika Mennecke ,&nbsp;Gabriel Bazan Serrano ,&nbsp;Stefan Lang ,&nbsp;Hannes Lücking ,&nbsp;Ludwig Singer ,&nbsp;Stefan Gerner ,&nbsp;Veit Rothhammer ,&nbsp;Arnd Dörfler ,&nbsp;Manuel Alexander Schmidt","doi":"10.1016/j.msard.2026.107033","DOIUrl":"10.1016/j.msard.2026.107033","url":null,"abstract":"<div><h3>Background</h3><div>Quantitative MRI markers increasingly complement conventional clinical assessment in multiple sclerosis (MS). Artificial intelligence (AI)–based volumetry enables standardized evaluation of lesion burden and brain atrophy in routine care.</div></div><div><h3>Objective</h3><div>To examine the association between AI-derived volumetric measures and disability, assess whether annual brain volume loss (ABVL) and lesion dynamics predict atrophy, and descriptively compare proxy radiological phenotype groups with established clinical phenotypes in a real-world MS cohort.</div></div><div><h3>Material and Methods</h3><div>This retrospective study included 888 MRI examinations from 455 patients with MS (2016–2020). Longitudinal analyses were performed in 234 patients with ≥2 scans (667 MRIs), and an early MS cohort comprised 302 patients (580 scans). Automated segmentation (mdbrain® v3.4.0) provided lesion metrics and age/sex/skull-volume-adjusted brain volumes from routine 3D FLAIR and native T1-weighted sequences acquired under real-world clinical conditions. Pathological atrophy was defined as a normative z-score &lt; –2. Generalized estimating equations (GEE) evaluated predictors of atrophy.</div></div><div><h3>Results</h3><div>Proxy radiological phenotype groups were defined as lesion-led (43.2%), cortex-led (35.4%), and NAWM-led (21.4%); clinical phenotypes included RRMS (82%), SPMS (14%), and PPMS (4%). EDSS correlated with lesion volume (ρ=0.28, <em>p</em>&lt;.001) and total brain volume (ρ=–0.32, <em>p</em>&lt;.001). In 433 longitudinal intervals, 11.8% showed mdbrain-defined atrophy. Higher EDSS (OR 1.53, 95% CI 1.28–1.83, <em>p</em>&lt;.001) and longer follow-up (OR 2.24, 95% CI 1.36–3.70, <em>p</em>=.001) independently predicted atrophy; ABVL showed only borderline significance (<em>p</em>=.071). Lesion dynamics were not independently predictive of atrophy (<em>p</em>&gt;.60). ABVL alone showed low discriminative value (AUC 0.571), whereas EDSS + interval length achieved AUC 0.766.</div></div><div><h3>Conclusion</h3><div>Gray-matter–predominant atrophy correlated more strongly with disability than lesion burden and frequently occurred in the absence of new lesions, indicating lesion-independent neurodegenerative processes that were observed across the defined proxy radiological phenotype groups. AI-based quantitative MRI offers reproducible atrophy assessment in real-world practice and may support quantitative MRI-based monitoring frameworks that include brain volume loss and facilitate detection of subclinical progression.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107033"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of respiratory muscle training on respiratory function, exercise capacity and quality of life in people with multiple sclerosis: a systematic review and meta-analysis","authors":"Yunji Chen ,&nbsp;Kun Meng ,&nbsp;Xu Xiang ,&nbsp;Guole Jiang ,&nbsp;Yang Liu ,&nbsp;Qing Yi","doi":"10.1016/j.msard.2026.107034","DOIUrl":"10.1016/j.msard.2026.107034","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review and meta-analysis aimed to evaluate the effects of respiratory muscle training (RMT) on respiratory function, exercise capacity, and health-related quality of life (HRQoL) in individuals with multiple sclerosis (MS).</div></div><div><h3>Methods</h3><div>A systematic search was conducted across eight electronic databases—Web of Science, PubMed (including MEDLINE and PubMed Central), SPORTDiscus, ScienceDirect, Scopus, Cochrane Library, Embase, and ProQuest—from their inception through September 22, 2025. Randomized controlled trials (RCTs) and quasi-RCTs that compared RMT with passive control, sham RMT, or usual care in individuals with MS were eligible for inclusion, with no restrictions on publication date. Eligible studies were required to report at least one of the following outcomes: respiratory muscle strength (e.g., maximal inspiratory pressure, MIP; maximal expiratory pressure, MEP), pulmonary function (e.g., forced expiratory volume in 1 s, FEV₁; forced vital capacity, FVC), functional exercise capacity (e.g., 6-minute walk distance, 6MWD), or HRQoL (e.g., SF-36, MSQOL-54). Two independent reviewers conducted the literature search and performed data extraction. The methodological quality and risk of bias of the included studies were assessed using the Cochrane Risk of Bias 2.0 tool (RoB2) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.</div></div><div><h3>Results</h3><div>A total of 16 studies involving 542 participants were included. The meta-analysis indicated that RMT significantly improved respiratory muscle strength (MIP: Hedges’ <em>g</em> = 0.47; MEP: Hedges’ <em>g</em> = 0.28) and pulmonary function (FEV₁: Hedges’ <em>g</em> = 0.39; FVC: Hedges’ <em>g</em> = 0.24). In contrast, RMT did not significantly improve functional exercise capacity (6MWD: Hedges’ <em>g</em> = 0.03) or the overall physical component summary of HRQoL (Hedges’ <em>g</em> = 0.05). A secondary analysis of a specific quality-of-life domain, however, showed a significant effect on the SF-36 Physical Functioning subscale (Hedges’ <em>g</em> = 0.40, 95% CI: 0.01 to 0.80).</div></div><div><h3>Conclusion</h3><div>RMT effectively improves respiratory muscle strength and pulmonary function in individuals with MS, and positively impacts specific Physical Functioning domains of HRQoL. However, current evidence does not support an improvement in functional exercise capacity. Despite the limited number of included studies, RMT shows promise as an adjunctive therapy for targeted respiratory rehabilitation. This study provides a foundational evidence base to guide clinical practice and inform the design of future high-quality trials.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107034"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146181196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional, and national burden of multiple sclerosis from 1990 to 2021 and projections to 2040: A comprehensive analysis from the global burden of disease study","authors":"Jing Tan ,&nbsp;Daobin Han","doi":"10.1016/j.msard.2026.107027","DOIUrl":"10.1016/j.msard.2026.107027","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) is a leading cause of neurological disability in young adults, with a striking female predominance. Understanding of its temporal and geographic patterns is crucial for informing public health strategies.</div></div><div><h3>Methods</h3><div>Data from the Global Burden of Disease (GBD) 2021 study were used to assess the burden of MS from 1990 to 2021 at global, regional, and national levels. Estimates of incidence, deaths, and disability-adjusted life years (DALYs) were stratified by age, sex, and Socio-demographic Index (SDI). Temporal trends were evaluated using the estimated annual percentage change (EAPC). Bayesian Age-Period-Cohort (BAPC) modeling was employed to forecast the burden through 2040. Additionally, frontier analysis, decomposition analysis, inequality assessment, and estimation of the smoking-attributable burden were conducted.</div></div><div><h3>Results</h3><div>Between 1990 and 2021, the absolute numbers of MS incident cases, deaths, and DALYs increased globally due to population growth and aging. In contrast, age-standardized incidence rates remained relatively constant, while both age-standardized mortality and DALYs rates experienced modest declines. Females consistently bore a higher burden across all metrics and age groups. Frontier analysis revealed significant performance gaps, and BAPC projections suggested a continued gradual decline in global age-standardized mortality and DALY rates through 2040. Despite these encouraging trends, smoking remained a substantial modifiable risk factor.</div></div><div><h3>Conclusion</h3><div>MS continues to impose a significant global burden, with persistent regional and socioeconomic disparities. This highlights the necessity for targeted public health strategies, including early diagnosis, accessible treatment, functional rehabilitation, and preventive measures such as smoking cessation, to reduce disparities and optimize outcomes worldwide.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107027"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146132384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of traditional swallowing therapy plus neuromuscular electrostimulation in multiple sclerosis: A randomized controlled trial","authors":"Maria Grazia Grasso ,&nbsp;Giampaolo Brichetto ,&nbsp;Marco Rovaris ,&nbsp;Roberta Beccari ,&nbsp;Davide Cattaneo ,&nbsp;Alessandro Cuccaro ,&nbsp;Rachele Di Giovanni ,&nbsp;Shara De Santi ,&nbsp;Giulia Fusari ,&nbsp;Carla Giudice ,&nbsp;Erica Grange ,&nbsp;Katia Inglese ,&nbsp;Daniele Martinelli ,&nbsp;Elisa Monti ,&nbsp;Margherita Monti Bragadin ,&nbsp;Federico Masserano Zoli ,&nbsp;Giulia Musto ,&nbsp;Giorgia Presicce ,&nbsp;Arianna Servetto ,&nbsp;Marilia Simonelli ,&nbsp;Claudio Solaro","doi":"10.1016/j.msard.2026.107042","DOIUrl":"10.1016/j.msard.2026.107042","url":null,"abstract":"<div><h3>Background</h3><div>Dysphagia is a common and potentially life-threatening complication in people with multiple sclerosis (pwMS), even in early disease stages. Although compensatory strategies may reduce aspiration risk, they do not restore normal swallowing. Neuromuscular Electrical Stimulation (NMES) has shown promise in dysphagic populations, but evidence in pwMS is scarce. <strong>Objectives</strong>: This double-blind, randomized, placebo-controlled trial aimed to evaluate the feasibility and added benefit of NMES combined with standard swallowing therapy in pwMS with dysphagia.</div></div><div><h3>Results</h3><div>Of 151 dysphagic pwMS screened, 101 were enrolled and randomized to receive NMES plus conventional swallowing exercises (TST-NMES) (<em>n</em> = 52) or sham stimulation with the same therapy (TST-S) (<em>n</em> = 49).</div><div>Both groups improved in dysphagia disturbances over time. However, when we analysed the two groups according to disease severity, significantly greater ASHA score gains were observed in severely disabled patients (EDSS ≥7) receiving NMES. Baseline ASHA predicted outcomes, while EDSS influenced only controls. At follow-up, no adverse effects were reported, confirming treatment safety and tolerability.</div></div><div><h3>Conclusion</h3><div>NMES combined with standard swallowing therapy appears to be a feasible and effective intervention for dysphagia in pwMS, especially in more disabled people. These results support further investigation in larger randomized trials.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107042"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First demyelinating attack in children: A twelve year single center cohort","authors":"Alessandro Santagostino Barbone ,&nbsp;Thea Giacomini ,&nbsp;Silvia Casabona ,&nbsp;Elisa De Grandis ,&nbsp;Lucrezia Sartore ,&nbsp;Maria Grazia Calevo ,&nbsp;Federica Maria Bozzano ,&nbsp;Emanuela Maria Mobilia ,&nbsp;Matilde Inglese ,&nbsp;Maria Cellerino ,&nbsp;Maria Stella Vari ,&nbsp;Ramona Cordani ,&nbsp;Giampaola Pesce ,&nbsp;Elisabetta Amadori ,&nbsp;Edoardo Canale ,&nbsp;Pasquale Striano ,&nbsp;Andrea Rossi ,&nbsp;Martina Resaz ,&nbsp;Silvia Buratti ,&nbsp;Giacomo Brisca ,&nbsp;Maria Margherita Mancardi","doi":"10.1016/j.msard.2026.107026","DOIUrl":"10.1016/j.msard.2026.107026","url":null,"abstract":"<div><h3>Introduction</h3><div>Acquired demyelinating syndromes (ADS) of the central nervous system in children present a diagnostic challenge due to overlapping presentations. Differentiating monophasic from potentially recurrent conditions, such as pediatric-onset multiple sclerosis (POMS), myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and other seronegative ADS, is essential for treatment and prognosis. This study aimed to characterize the initial presentation of pediatric ADS and evaluate the evolution of diagnosis over time to better guide treatment.</div></div><div><h3>Methods</h3><div>A retrospective study of 59 children with ADS diagnosed at a tertiary pediatric center in Italy (2012–2024) was conducted. Initial classifications included MS, acute disseminated encephalomyelitis (ADEM), clinically isolated syndrome (CIS), optic neuritis (ON), neuromyelitis optica spectrum disorder (NMOSD), or “Indeterminate”. Final diagnoses were categorized as MS, MOGAD, or \"Other\" demyelinating conditions. Demographic, clinical, MRI, CSF, and outcome were analyzed. Statistical comparisons among groups used Mann–Whitney U, Chi-square, or Fisher’s exact tests (<em>p</em> &lt; 0.05).</div></div><div><h3>Results</h3><div>At final diagnosis, older age at onset, absence of preceding infection and characteristic MRI findings (periventricular/callosal lesions, cerebellar involvement) were more frequent in MS group. Younger age, preceding infection, fever, irritability, and cortical involvement were associated with MOGAD. Nearly one-third of final MS cases (29%) were initially CIS or ON, while no ADEM cases converted to MS. “Other” ADS (non-MS/MOG-IgG antibody negative patients) showed more severe initial disability (<em>p</em> = 0.01). Transition to adult neurology was significantly higher in MS (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>these findings underscore the heterogeneity of pediatric ADS at onset and the value of accurate acute management and longitudinal follow-up to refine diagnosis and guide treatment.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107026"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profiling peripheral blood oxidative stress in multiple sclerosis","authors":"Thomas Minton ,&nbsp;Kelly Hares ,&nbsp;Kevin Kemp ,&nbsp;Juliana Redondo ,&nbsp;Neil J Scolding ,&nbsp;Claire M Rice","doi":"10.1016/j.msard.2026.107039","DOIUrl":"10.1016/j.msard.2026.107039","url":null,"abstract":"<div><h3>Background</h3><div>Oxidative stress is implicated in the pathophysiology of multiple sclerosis (MS), but the potential of oxidative stress responses as MS biomarkers has not been systematically explored.</div></div><div><h3>Methods</h3><div>Over 12 months, we measured serial plasma concentrations or activity, and peripheral blood mononuclear cell (PBMC) expression of master antioxidant regulators, downstream antioxidant enzymes, and plasma end products of oxidation in blood from people with MS (pwMS), including a cohort commencing disease modifying therapy (DMT). Multivariable regression models were employed adjusting for age, sex, disease duration, smoking, and repeated measures.</div></div><div><h3>Results</h3><div>40 control subjects and 78 pwMS participants (53 relapsing-remitting MS (RRMS), 11 primary progressive MS (PPMS) &amp; 14 secondary progressive MS (SPMS)) were included; 12 commenced dimethyl fumarate (DMF), 12 ocrelizumab and 7 natalizumab. <em>NFE2L2</em> (nuclear factor erythroid 2-related factor 2; Nrf2), <em>CAT</em> (catalase) and <em>GPX1</em> (glutathione peroxidase 1) expression were downregulated in SPMS, with increased concentration of end products of oxidation. Plasma peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) concentration was higher in pwMS. Nrf2 concentration, catalase activity and PBMC <em>SOD1</em> expression increased with DMF. PBMC <em>NFE2L2, GPX1</em> and <em>SOD1</em> expression increased with natalizumab. Effect sizes were relatively modest and inter-individual heterogeneity was high limiting potential clinical application. No significant associations with the Expanded Disability Status Scale were observed.</div></div><div><h3>Conclusions</h3><div>Our data support dysregulated oxidative stress responses in MS but individual oxidative stress components are unlikely to inform disease stratification and monitoring. However, a constellation of biomarkers, may have clinical utility and inform regarding MS pathophysiology and therapy.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"Article 107039"},"PeriodicalIF":2.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lack of external validity of the MOG-AR score in a North American cohort","authors":"Mulan Jiang,&nbsp;Anastasia Vishnevetsky,&nbsp;Mattia Wruble Clark,&nbsp;Monique Anderson,&nbsp;Takahisa Mikami,&nbsp;Rebecca Gillani,&nbsp;Fabian Murillo,&nbsp;Joao Vitor Mahler Ferreira Oliveira,&nbsp;Rebecca Salky,&nbsp;Gabriela Romanow,&nbsp;Michael Levy,&nbsp;Philippe A. Bilodeau","doi":"10.1016/j.msard.2026.106987","DOIUrl":"10.1016/j.msard.2026.106987","url":null,"abstract":"","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106987"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended interval dosing of off-label rituximab in multiple sclerosis: A real-world retrospective analysis of clinical efficacy and safety","authors":"Sepideh Paybast ,&nbsp;Melika Jameie ,&nbsp;Zohreh Tajabadi ,&nbsp;Mehdi Azizmohammad Looha ,&nbsp;Fatemeh A. Basti ,&nbsp;Mobina Amanollahi ,&nbsp;Kiana Amani ,&nbsp;Marziyeh Mousavi ,&nbsp;Seyed Ehsan Mohammadianinejad ,&nbsp;Mohammad Hossein Harirchian","doi":"10.1016/j.msard.2026.106998","DOIUrl":"10.1016/j.msard.2026.106998","url":null,"abstract":"<div><h3>Objectives</h3><div>Rituximab, an anti-CD20 monoclonal antibody, is increasingly used off-label as a high-efficacy disease-modifying therapy (DMT) in multiple sclerosis (MS). Given an increasing interest to extended interval dosing (EID) (6-month infusion intervals +≥ 4 weeks) regimen as a strategy to mitigate the risk of infection associated with anti-CD20s, herein we aimed to investigate the treatment outcomes of patients with MS (PwMS) receiving EID vs. standard interval dosing (SID) of rituximab.</div></div><div><h3>Methods</h3><div>Between January 2020 and January 2022, PwMS prescribed rituximab at Imam Khomeini MS Center in Tehran, Iran, were identified. Clinician-reported data were retrospectively collected.</div></div><div><h3>Results</h3><div>Eighty-nine PwMS (67.4% with progressive MS; mean age: 41.2 ± 10.1 years; 58.4% female) were enrolled. Fifty-two received EID (9.40 ± 1.26 month) and 37 received SID. After adjusting for covariates, there was no significant inter-group difference for disability progression (P = 0.33). Except for one patient in the EID group, all remained relapse-free for one year. CD19+ B-cell reconstitution patterns were significantly different between the two groups (P = 0.021), showing a gradual rather than rapid peripheral CD19+ B-cell repopulation in the EID group. While the overall adverse event rates were similar, patients in the EID group had a significantly lower incidence of serious infectious adverse events at both 6 months (P = 0.03) and 12 months (P = 0.04).</div></div><div><h3>Conclusions</h3><div>In this real-world cohort, EID regimen of rituximab was associated with reduced risk of serious infections, without compromising disease control or disability progression. Further prospective studies are warranted to validate our findings.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 106998"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicenter, retrospective study in patients with multiple sclerosis treated with natalizumab in a real-world setting in Japan: The REFIND study","authors":"Ichiro Nakashima ,&nbsp;Takashi Ohashi ,&nbsp;Kazumasa Yokoyama ,&nbsp;Kenichi Kaida ,&nbsp;Jin Nakahara ,&nbsp;Takayuki Kondo ,&nbsp;Nobuaki Yoshikura ,&nbsp;Yuko Shimizu ,&nbsp;Chiyoko Nohara ,&nbsp;Kenzo Sakurai ,&nbsp;Hiroaki Yokote ,&nbsp;Masaaki Niino ,&nbsp;Takashi Yamamura ,&nbsp;Kazuo Fujihara ,&nbsp;Noriko Isobe ,&nbsp;Hirofumi Ochi ,&nbsp;Masahiro Mori ,&nbsp;Izumi Kawachi ,&nbsp;Fumitaka Shimizu ,&nbsp;Michihiro Kanda ,&nbsp;Toshiyuki Fukazawa","doi":"10.1016/j.msard.2026.107007","DOIUrl":"10.1016/j.msard.2026.107007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Natalizumab (TYSABRI&lt;sup&gt;Ⓡ&lt;/sup&gt;) is known to be an efficacious treatment at a standard-interval dosing (SID; 300 mg administered intravenously every 4 weeks) for patients with relapsing-remitting sclerosis (RRMS). However, the SID of natalizumab is associated with increased risk of progressive multifocal leukoencephalopathy (PML). Lengthening the time between doses of natalizumab beyond 4 weeks, also known as extended-interval dosing (EID), is associated with lower risk of PML in patients with RRMS, and patients have been switched from SID to EID without meaningful loss of efficacy. In this multicenter, retrospective, observational study, REFIND, we examined real-world natalizumab dosing patterns and MS disease activity in patients with RRMS in Japan.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;REFIND retrospectively collected data from medical records of patients at 20 study centers in Japan. Patients with MS aged 20 years and older who received at least one dose of natalizumab after January 1, 2018, and had at least one clinical assessment were included. The primary endpoints were dosing patterns used in clinical practice and MS disease activity by dosing patterns. SID was defined as a mean natalizumab dosing interval ≤35 days, and EID was defined as a mean natalizumab dosing interval ≥36 to ≤84 days. Dosing pattern groups included SID-only, EID-only, or SID followed by EID (SID/EID). For each dosing pattern group, the annualized relapse rate (ARR) before and after administration of natalizumab was compared using a negative binomial regression model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 203 patients with MS eligible for inclusion in the REFIND study, 120 patients with RRMS were treated with natalizumab for ≥1 year, with a mean ± standard deviation (SD) age of 36.0 ± 9.4 years and a mean ± SD administration period of 32.8 ± 18.8 months. Among these patients, 13 had an SID-only natalizumab dosing pattern, 49 had EID-only, and 58 had SID/EID, with mean ± SD dosing intervals of 30.8 ± 1.6 days, 45.9 ± 3.4 days, and 38.7 ± 3.4 days, respectively. Overall ARR 1 year before vs 1 year after initiation of natalizumab was 1.03 vs 0.12 (&lt;em&gt;P&lt;/em&gt; &lt; 0.0001). ARR before vs after natalizumab in the SID-only group was 1.08 vs 0.62 (&lt;em&gt;P&lt;/em&gt; = 0.378), in the EID-only group was 0.95 vs 0.02 (97.9% reduction, &lt;em&gt;P&lt;/em&gt; = 0.0005), and in the SID/EID group was 1.08 vs 0.09 (91.7% reduction, &lt;em&gt;P&lt;/em&gt; &lt; 0.0001). Proportions of patients with new or enlarging T2 lesions in the SID-only, and the EID-only, and SID/EID groups were reduced by 89.1%, 83.5%, and 95.7%, respectively, after natalizumab initiation compared with the year before natalizumab.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The significant reduction in ARR observed with EID or SID/EID suggests that there is little difference between these dosing regimens in this retrospective dataset in Japan. The effectiveness of natalizumab in reducing the number of new or enla","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107007"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}