Ioannis Vardakas, Johannes Dorst, André Huss, Benjamin Mayer, Pia Eichele, Tanja Fangerau, Daniela Taranu, Hayrettin Tumani, Makbule Senel
{"title":"Plasma Exchange vs. Immunoadsorption: Effects on Immunological Markers and Predictive Value in Steroid-Refractory MS Attacks.","authors":"Ioannis Vardakas, Johannes Dorst, André Huss, Benjamin Mayer, Pia Eichele, Tanja Fangerau, Daniela Taranu, Hayrettin Tumani, Makbule Senel","doi":"10.1177/20552173251321797","DOIUrl":"https://doi.org/10.1177/20552173251321797","url":null,"abstract":"<p><strong>Background: </strong>Evidence on neurochemical mechanisms underlying response to apheresis in steroid-refractory Multiple Sclerosis (MS) attacks is limited.</p><p><strong>Objective: </strong>To examine the effect of immunoadsorption (IA) versus plasma exchange (PLEX) on serum immunological parameters [IgG, IgA, IgM, kappa- and lambda-immunoglobulin free light chains (κ-FLC, λ-FLC), CXCL13, CXCL12] and the predictive value of these parameters on response to apheresis.</p><p><strong>Methods: </strong>Pre- and postprocedural serum samples of 38 participants (IA: n = 19, PLEX: n = 19) from the IAPEMS trial (NCT02671682), conducted in our tertiary centre, were examined.</p><p><strong>Results: </strong>Serum immunoglobulins were strongly reduced after both procedures (IgG: IA median -96.04%; PLEX median -85.98%). κ-FLC levels were reduced after PLEX (median -34.74%), not affected by IA. Both procedures caused a decrease in λ-FLC levels. CXCL13 slightly increased after PLEX (median +24.16%), conversely decreased after IA (median -21.92%). CXCL12 levels were reduced after IA (median -45.69%), but not significantly altered after PLEX. None of the serum parameters evaluated showed predictive value for apheresis response.</p><p><strong>Conclusion: </strong>IA and PLEX have a differential effect on serum immunological parameters. IA appears to reduce B-cell derived inflammation more effectively. This finding requires further evaluation and comparative analysis with clinical outcomes, especially in the context of the efficacy of B-cell therapies in treating MS.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 2","pages":"20552173251321797"},"PeriodicalIF":2.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Agne Straukiene, Sarah Hughes, Jon Grundy, Finn Moxon
{"title":"Evaluating patient care in multiple sclerosis: Impact of combined digital tools and holistic management strategies.","authors":"Agne Straukiene, Sarah Hughes, Jon Grundy, Finn Moxon","doi":"10.1177/20552173251317020","DOIUrl":"https://doi.org/10.1177/20552173251317020","url":null,"abstract":"<p><strong>Background: </strong>Innovations are essential to meet the needs of people with MS (PwMS), particularly in addressing delays in diagnosis and treatment, and in supporting patient self-management.</p><p><strong>Objectives: </strong>To evaluate the real-world use and outcomes of digital technologies and holistic management strategies for MS at a UK Centre.</p><p><strong>Methods: </strong>Digital tools for PwMS included Patients Know Best (a personal health record) and CONNECTPlus<sup>®</sup> (an educational app). Tools for healthcare professionals included Infoflex (a clinical database with MSProDiscuss for assessing disease progression). A Healthy Lifestyle Clinic was introduced to promote brain health. The impact of these interventions on time-to-diagnosis, time-to-disease-modifying therapy (DMT) initiation, non-elective admissions, and hospital costs was evaluated retrospectively from 2018 to 2023, comparing pre-intervention (2018-2019) with post-intervention (2020-2023) periods, while accounting separately for COVID-19 years (2020-2021).</p><p><strong>Results: </strong>Trends indicated a higher likelihood of disease progression in patients with delayed MS diagnosis (p < 0.001), and a reduction in time from diagnosis to DMT initiation, from an average of 23.5 to 5.8 months (p = 0.024), post-MS Infoflex disease management database implementation. Non-elective admissions and healthcare costs also decreased compared to neighbouring hospitals.</p><p><strong>Conclusions: </strong>Digital and holistic interventions were associated with positive trends in MS care delivery. Further research is needed to validate these findings.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 2","pages":"20552173251317020"},"PeriodicalIF":2.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laura B Odom, Gary A Thomas, Jikku J Zachariah, Ian S Zagon, Patricia J McLaughlin
{"title":"Exploring the relationships of physical, mental, and emotional symptoms and serum biomarkers of angiogenesis in multiple sclerosis.","authors":"Laura B Odom, Gary A Thomas, Jikku J Zachariah, Ian S Zagon, Patricia J McLaughlin","doi":"10.1177/20552173251329904","DOIUrl":"10.1177/20552173251329904","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS) involves symptoms that may be impacted by angiogenesis. Vascular endothelial growth factor (VEGF), a potent pro-angiogenic molecule, is elevated in early MS, but its activity in later disease is understudied. [Met<sup>5</sup>]-enkephalin (ENK) has anti-angiogenic activity and is decreased in persons with MS (PwMS).</p><p><strong>Objectives: </strong>To determine salient symptoms of MS and evaluate relationships between common MS symptoms and angiogenesis-associated biomarkers.</p><p><strong>Methods: </strong>PwMS and non-MS control participants were identified for this cross-sectional study. Walking times and self-reported fatigue, anxiety, depression, and pain were measured. Serum VEGF and [Met<sup>5</sup>] ENK levels were measured in a subset of PwMS.</p><p><strong>Results: </strong>PwMS (<i>n</i> = 66) had significantly greater fatigue than controls (<i>n</i> = 35). In PwMS, fatigue, anxiety, depression, and pain were positively intercorrelated; fatigue was positively correlated with slower walking. Serum ENK and VEGF had a trending negative relationship. Serum ENK, but not VEGF, had a trending negative relationship with the length of disease. Serum ENK and VEGF were not correlated to walking time or self-report measures.</p><p><strong>Conclusion: </strong>Fatigue is a salient MS symptom when compared to non-MS controls. Imbalanced pro- and anti-angiogenic signaling may influence fatigue in established MS, but further studies with larger sample sizes are needed to elucidate this potential relationship.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 2","pages":"20552173251329904"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11963715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Camilla Juhl, Kasper Byskov, Lars G Hvid, Ulrik Dalgas, Uwe M Pommerich, Anders G Skjerbæk
{"title":"Cut-points of the 6-min walk test, the six spot step test, and the timed-25-foot walk test discriminating impaired from non-impaired walking capacity in persons with Multiple sclerosis.","authors":"Camilla Juhl, Kasper Byskov, Lars G Hvid, Ulrik Dalgas, Uwe M Pommerich, Anders G Skjerbæk","doi":"10.1177/20552173251324600","DOIUrl":"10.1177/20552173251324600","url":null,"abstract":"<p><strong>Background: </strong>Assessing and interpreting walking capacity in persons with Multiple sclerosis (PwMS) is essential in clinical practice and research - and thus for PwMS themselves - yet research evaluating cut-points is limited. The present study aims to establish cut-points for 6-min walk test (6MWT), six spot step test (SSST), and timed 25-foot walk test (T25FWT) in PwMS.</p><p><strong>Methods: </strong>Classification of PwMS having walking impairments and PwMS having limited or no walking impairments was based on distinct benchmarks for each walking test, as derived from the 12-item Multiple Sclerosis Walking Scale (MSWS-12) on a 5-point Likert scale. Cut-points, area under the curve (AUC), sensitivity (Se), and specificity (Sp) were established using receiver operating characteristic curve analyses.</p><p><strong>Results: </strong>A total of <i>n</i> = 211 ambulatory PwMS were enrolled (68% females, 54 ± 11 years, patient-determined disease step 2.9 ± 1.9 [range; 0-7], 65.1% relapse-remitting Multiple sclerosis). The following cut-points between the two groups were established: 6MWT (446 m; AUC = 0.82, Se = 0.87, Sp = 0.78), SSST (0.121 rounds/s (corresponding to 8.3 s); AUC = 0.80, Se = 0.84, Sp = 0.75), and T25FWT (1.39 m/s (corresponding to 5.5 s); AUC = 0.79, Se = 0.89, Sp = 0.69).</p><p><strong>Conclusion: </strong>Cut-points discriminating PwMS having walking impairments vs. PwMS having limited or no walking impairments were identified for 6MWT (446 m), SSST (8.3 s), and T25FWT (5.5 s).</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 1","pages":"20552173251324600"},"PeriodicalIF":2.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valerie J Block, Kyra Henderson, Shane Poole, Gabby B Joseph, Jeffrey M Gelfand, Bruce Ac Cree, Riley Bove
{"title":"No evidence of fluctuations in daily step count between infusions in people with multiple sclerosis treated with anti-CD20 monoclonal antibodies.","authors":"Valerie J Block, Kyra Henderson, Shane Poole, Gabby B Joseph, Jeffrey M Gelfand, Bruce Ac Cree, Riley Bove","doi":"10.1177/20552173251329817","DOIUrl":"10.1177/20552173251329817","url":null,"abstract":"<p><strong>Background: </strong>Patients with multiple sclerosis (MS) on some disease-modifying therapies (i.e., natalizumab), report a \"wearing-off\" effect characterized by increased symptoms directly before infusions. Prior research suggests this may reflect natural MS fluctuations rather than true treatment waning; however, this has not been confirmed for anti-CD20 agents (e.g., ocrelizumab). Daily step count (STEPS) can reflect overall function. This study examined temporal associations between anti-CD20 therapy infusions and STEPS.</p><p><strong>Methods: </strong>Retrospective analysis evaluated data from two Fitbit-monitored cohorts (<i>N</i> = 145 total, 32 anti-CD20-treated participants) across 60 treatment cycles. Monthly STEPS were recorded directly pre- and three-month post-infusion over the six-month treatment intervals. Mixed-effects models evaluated the relationship between infusion timing, STEPS, and participant demographics, controlling for confounding variables.</p><p><strong>Results: </strong>No significant difference in STEPS was observed pre- versus post-infusion (<i>p</i> = 0.32). An average decrease of 3.3% was noted post-infusion but was not statistically significant. No associations between STEPS and participant characteristics (e.g., age, disability level) were identified. Individual variability existed, but no clear group-level trends emerged.</p><p><strong>Conclusions: </strong>This study found no evidence of an association between timing of anti-CD20 infusion and changes in STEPS. Findings highlight the need for integrating objective measures with patient-reported outcomes and biomarkers in future research to better understand potential treatment fluctuations.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 1","pages":"20552173251329817"},"PeriodicalIF":2.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E Martin, M S Aigrot, N Frère, R Lepaulmier, B Stankoff, U Boschert, C Lubetzki, B Zalc
{"title":"Positive effect of evobrutinib in CNS remyelination models and lack of synergy with clemastine-A dose response study.","authors":"E Martin, M S Aigrot, N Frère, R Lepaulmier, B Stankoff, U Boschert, C Lubetzki, B Zalc","doi":"10.1177/20552173251326913","DOIUrl":"10.1177/20552173251326913","url":null,"abstract":"<p><strong>Background: </strong>To recover normal functions, remyelination in multiple sclerosis is crucial. Although endogenous remyelination occurs, it is often insufficient, and finding molecules promoting repair of demyelinated lesions is needed.</p><p><strong>Objectives: </strong>To compare the remyelination potential of evobrutinib, an inhibitor of Bruton's tyrosine kinase and clemastine, an antagonist of M1 muscarinic acetylcholine receptor.</p><p><strong>Methods: </strong>Remyelination was investigated in lysolecithin demyelinated organotypic mouse cerebellar slices and a transgenic <i>Xenopus</i> model of inducible-demyelination.</p><p><strong>Results: </strong>Evobrutinib (100 nM) and clemastine (200 nM) potentiated remyelination of mouse cerebellar slices by a factor of 2.9 and 1.76, respectively. In conditionally demyelinated <i>Xenopus</i>, evobrutinib and clemastine increased remyelination by a factor of 1.61 and 1.92, respectively. Evobrutinib targets Bruton's tyrosine kinase expressed by microglia, and we showed that the increase in number of myeloid cells following demyelination is due to an extravasation from nearby vessels of macrophages migrating toward the optic nerve. In contrast, clemastine is expected to antagonize muscarinic receptor 1 expressing cells of the oligodendroglial lineage. We investigated a possible synergistic effect on remyelination by adding simultaneously both molecules. In both experimental models tested no significative improvement on remyelination of co-treatment with evobrutinib plus clemastine was observed.</p><p><strong>Discussion: </strong>While evobrutinib increased 1.59 fold the number of microglia/macrophages, in the presence of clemastine the number of innate immune cells was decreased by 0.39 fold, therefore counteracting the beneficial effect of microglia/macrophages on remyelination.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 1","pages":"20552173251326913"},"PeriodicalIF":2.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laurits Taul-Madsen, Ulrik Dalgas, Hjalte Riis, Magnus K Broløs, Jesper Lundbye-Jensen, Lars G Hvid
{"title":"Implications of maximal muscle strength and aerobic capacity for lower extremity physical function in people with multiple sclerosis-a cross-sectional study.","authors":"Laurits Taul-Madsen, Ulrik Dalgas, Hjalte Riis, Magnus K Broløs, Jesper Lundbye-Jensen, Lars G Hvid","doi":"10.1177/20552173251326171","DOIUrl":"10.1177/20552173251326171","url":null,"abstract":"<p><strong>Background: </strong>Multiple sclerosis (MS) is characterized by impairment of physical function that is often linked to neuromuscular and cardiovascular deficits. However, the specific contributions of muscle strength and aerobic capacity to physical function in MS are not fully understood.</p><p><strong>Objective: </strong>This study aimed to investigate the independent roles of maximal muscle strength (MVC) and aerobic capacity (VO<sub>2</sub>peak) on lower extremity physical function, as measured by the 6-minute walk test (6MWT) and five-time sit-to-stand test (5STS) in people with MS (pwMS).</p><p><strong>Methods: </strong>In a cross-sectional study, 150 pwMS underwent assessment of VO<sub>2</sub>peak, maximal voluntary contraction (MVC), and physical function (6MWT and 5STS). Regression analyses were conducted to explore the associations between physiological parameters and physical function.</p><p><strong>Results: </strong>MVC and VO<sub>2</sub>peak were moderately associated with (i.e., explained) 6MWT (R² = 0.40, p < 0.001), yet with VO<sub>2</sub>peak (β = 7.9, std. β = 0.45, p < 0.001) having a preferential influence compared to MVC (β = 48.2, std. β = 0.26, p < 0.001). MVC and VO<sub>2</sub>peak were weakly associated with (i.e., explained) 5STS (R² = 0.14, p < 0.001), yet with MVC (β = 0.06, std. β = 0.28, p = 0.004) having a preferential influence compared to VO<sub>2</sub>peak (β = 0.00, std. β = 0.16, p = 0.101).</p><p><strong>Conclusion: </strong>Both maximal muscle strength and aerobic capacity to physical function in pwMS. Maximal muscle strength was preferentially linked to performance in the 5STS test, whereas aerobic capacity was preferentially linked to performance in the 6MWT. These findings support the need for tailored exercise interventions to target specific physiological deficits during MS rehabilitation.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 1","pages":"20552173251326171"},"PeriodicalIF":2.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Päivi Hämäläinen, Matias Viitala, Merja Soilu-Hänninen, Hanna Kuusisto, Marja Niiranen, Sari Avikainen, Juha Puustinen, Juhani Ruutiainen, Mervi Ryytty, Henrik Ahvenjärvi, Carl Björkholm, Annika Hulten
{"title":"Evaluation of patient-perceived fatigue in multiple sclerosis utilizing the Finnish MS registry.","authors":"Päivi Hämäläinen, Matias Viitala, Merja Soilu-Hänninen, Hanna Kuusisto, Marja Niiranen, Sari Avikainen, Juha Puustinen, Juhani Ruutiainen, Mervi Ryytty, Henrik Ahvenjärvi, Carl Björkholm, Annika Hulten","doi":"10.1177/20552173251325098","DOIUrl":"10.1177/20552173251325098","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize patient-perceived fatigue by using the Finnish Multiple Sclerosis (MS) registry data.</p><p><strong>Materials & methods: </strong>Fatigue was assessed with the Fatigue Severity Scale (FSS), the Fatigue Scale for Motor and Cognitive Functions (FSMC), and the Visual Analogue Scale-Fatigue. Disease severity was evaluated with the Expanded Disability Status Scale and symptoms with the Visual Analogue Scales. Patient reported outcomes (PROs) included the Multiple Sclerosis Neuropsychological Questionnaire, the Euro Quality of Life - 5 dimensions, the 15 D, and the Multiple Sclerosis Impact Scale. For the purposes of the study, patients were classified to those without (FSS ≤ 4) and those with (FSS ≥ 5) fatigue. The FSS scores were correlated with the results of other PROs.</p><p><strong>Results: </strong>Based on the 512 FSS scores, 47% of the patients reported fatigue (FSS ≥ 5). Fatigue was related to higher disability, lower education, and smoking. FSS correlated significantly with other measures of fatigue, cognitive, and mood symptoms, and was associated with lower Quality of Life.</p><p><strong>Conclusions: </strong>As an invisible and debilitating symptom fatigue should be evaluated systematically. In the screening, it is important to recognize the characteristics of the different scales. Whereas the FSS may serve as an overall screen, the FSMC may help to identify aspects of cognitive and motor fatigue separately.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 1","pages":"20552173251325098"},"PeriodicalIF":2.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jérôme de Seze, Chiara Zecca, Giovanni Castelnovo, Xavier Ayrignac, Patrick Vermersch, Claudio Gobbi, Giulia Mallucci, Clarisse Carra-Dallière, Pierre Labauge, Kévin Bigaut, Laurent Kremer, Nicolas Collongues, Livia Lanotte, Eric Thouvenot, Christine Ernon, Dominique Dive
{"title":"European experience of cladribine tablets in elderly patients with multiple sclerosis: Could it be the last treatment?","authors":"Jérôme de Seze, Chiara Zecca, Giovanni Castelnovo, Xavier Ayrignac, Patrick Vermersch, Claudio Gobbi, Giulia Mallucci, Clarisse Carra-Dallière, Pierre Labauge, Kévin Bigaut, Laurent Kremer, Nicolas Collongues, Livia Lanotte, Eric Thouvenot, Christine Ernon, Dominique Dive","doi":"10.1177/20552173251321810","DOIUrl":"10.1177/20552173251321810","url":null,"abstract":"<p><strong>Background: </strong>Recent studies support the need for early and intensive disease-modifying treatment (DMT) for patients with multiple sclerosis (PWMS). Abrupt DMT withdrawal may risk disease reactivation. Recent studies showed that MS disease activity was not rare after DMT withdrawal for PWMS aged >45/55 y. Immune reconstitution therapy (IRT) with cladribine tablets (CladT), may be an option for older PWMS who wish to stop DMT.</p><p><strong>Objective: </strong>We retrospectively analysed PWMS aged >45 y who initiated CladT in 6 MS centers in Europe.</p><p><strong>Results: </strong>One hundred and twenty nine PWMS (95 women/34 men, mean age 55.0 +/-7.5y initiated CladT; 83 (64.3%) previously received platform DMT, 35 (27.2%) previously received high efficacy DMT and 11 (8.5%) received CladT as a 1<sup>st</sup> DMT due to a late onset of MS or to a delayed therapy decision. Mean follow-up was 2.4 y (1-5) on CladT. Only three patient experienced 4 relapses. The first one had 2 relapses after switching from fingolimod with a 2-month interval between treatments. The 2 remaining were naïve patients that had a relapse between the 2 courses of CladT.</p><p><strong>Conclusion: </strong>Last/exit therapy with CladT seems to avoid MS disease reactivation in older PWMS and may be an interesting alternative solution to continue immunosuppression/immunomodulation.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 1","pages":"20552173251321810"},"PeriodicalIF":2.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ruth Ann Marrie, Afolasade Fakolade, Janice Linton, Colleen J Maxwell, Dalia Rotstein, Brayden Schindell, Helen Tremlett, Ann Yeh, Marcia Finlayson
{"title":"Characterizing the diversity of the multiple sclerosis population in Canada: A scoping review.","authors":"Ruth Ann Marrie, Afolasade Fakolade, Janice Linton, Colleen J Maxwell, Dalia Rotstein, Brayden Schindell, Helen Tremlett, Ann Yeh, Marcia Finlayson","doi":"10.1177/20552173251321814","DOIUrl":"10.1177/20552173251321814","url":null,"abstract":"<p><strong>Background: </strong>This scoping review aimed to identify existing information and gaps in knowledge regarding the diversity characteristics of the multiple sclerosis (MS) population in Canada.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, Cumulated Index in Nursing and Allied Health Literature (CINAHL), SCOPUS and ProQuest's global dataset of theses and dissertations from 2010 to January 12, 2024. Data sources were case reports/series, cohort studies, case-control studies, analytical cross-sectional studies, randomized clinical trials, qualitative, mixed methods, participatory studies and systematic reviews conducted in Canada, published in English or French, that included participants with clinically isolated syndrome or MS. Sample characteristics were extracted applying Cochrane's PROGRESS-Plus framework.</p><p><strong>Results: </strong>We included 259 studies, most often studying disease-modifying therapy (24.3%) and access to care (20.9%). Among primary data collection studies 40% used one recruitment strategy, usually MS Clinics and MS Canada. Age (92.7%) and sex (86.9%) were reported most often, ≤10% of studies reported race or ethnicity; religion, sexual orientation and language were not reported.</p><p><strong>Conclusions: </strong>We lack an understanding of characteristics of people living with MS in Canada relevant to health equity. Existing research has been insufficiently inclusive. Better reporting of diversity characteristics is needed, along with specific efforts to recruit and retain more diverse samples.</p>","PeriodicalId":18961,"journal":{"name":"Multiple Sclerosis Journal - Experimental, Translational and Clinical","volume":"11 1","pages":"20552173251321814"},"PeriodicalIF":2.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}