Multiple sclerosis (Houndmills, Basingstoke, England)最新文献

{"title":"Neural networks to estimate multiple sclerosis disability and predict progression using routinely collected healthcare data.","authors":"Giuseppina Affinito, Marcello Moccia, Roberta Lanzillo, Ruth Ann Marrie, Jeremy Chataway, Vincenzo Brescia Morra, Raffaele Palladino","doi":"10.1177/13524585251347513","DOIUrl":"https://doi.org/10.1177/13524585251347513","url":null,"abstract":"<p><strong>Background and objectives: </strong>Multiple sclerosis (MS)-related disability is conventionally measured using the Expanded Disability Status Scale (EDSS), which requires neurological examination and is generally embedded in clinical records, making it unavailable in administrative datasets. This limits its utility for population-level estimates and healthcare planning. This study aims to use routinely collected healthcare data to fill this gap.</p><p><strong>Methods: </strong>We conducted a population-based study using administrative data from Campania Region (Italy) to develop and validate neural network algorithms to estimate MS-related disability and predict its progression (2015-2021). We employed a deep learning approach to estimate the EDSS, and a hybrid model combining survival analysis with neural network predictions to forecast the risk of EDSS progression.</p><p><strong>Results: </strong>The model estimated EDSS with 0.68 accuracy, 0.68 precision, and 0.67 F1-score. The hybrid model had a predictive performance of 0.92. From 2016 to 2021, 9.01% of the population had EDSS ⩽ 3.0, 62.10% had EDSS between 3.5 and 5.5, and 28.89% had EDSS ⩾ 6.0. Looking at projections from 2021 to 2026, 67.68% people with EDSS ⩽ 3.0 are expected to progress to EDSS 3.5-5.5.</p><p><strong>Conclusion: </strong>These findings highlight the potential of advanced data analytics using administrative data to improve MS monitoring, healthcare planning, and decision-making.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251347513"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of patient-reported outcomes: A call for their integration in the routine care of patients with multiple sclerosis.","authors":"Samantha Cruz Rivera, Stephanie Buxhoeveden, Olalekan Lee Aiyegbusi, Nina Bozinov, Paul Kamudoni, Robert McBurney, Melanie Calvert","doi":"10.1177/13524585251349354","DOIUrl":"https://doi.org/10.1177/13524585251349354","url":null,"abstract":"<p><p>Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Common symptoms include physical disability, cognitive impairment, spasticity, fatigue, bowel/bladder dysfunction and depression. The use of patient-reported outcomes (PROs) can be used to systematically assess the burden of the disease and its impact on treatment and health-related quality of life. Assessment of PROs in routine care of people with MS provides a unique and personal insight into the multifaceted impact of the disease, while avoiding perpetuating the paternalistic medical approach that privileges objective medical measurement.This review highlights the potential benefits of integrating PROs in MS routine care from the patient and clinician perspective, describes challenges associated with PRO data collection and their use in routine settings. Challenges in the integration of PROs into routine care include (1) selection of PRO measures, (2) provider and technical workflow and (3) equity, diversity and inclusivity challenges. In addition, the review provides solutions and recommendations to facilitate the integration of PROs in MS care. The adoption of PROs in MS routine care is essential to improve MS individuals' quality of care and deliver patient-centred care, which can lead to increased treatment adherence and patient outcomes.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251349354"},"PeriodicalIF":0.0,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant melanoma and multiple sclerosis therapies: A disproportionality analysis of the FDA adverse event reporting system.","authors":"Alexandra Balshi, John P Dempsey, Nova Manning, Grace Leuenberger, Ursela Baber, Jacob A Sloane","doi":"10.1177/13524585251342725","DOIUrl":"https://doi.org/10.1177/13524585251342725","url":null,"abstract":"<p><p>Despite nationwide cohort studies revealing an increased risk of malignant melanoma (MM) in people with multiple sclerosis (PwMS), the connection between MS disease-modifying therapies (DMTs) and MM risk remains underexplored. We identified 1200 reports of MM associated with MS DMTs in the FDA Adverse Event Reporting System (FAERS), and a pooled analysis of all DMTs showed disproportionately high MM reporting compared to all other FAERS medications (reporting odds ratio, 2.30; 95% confidence interval, 2.16-2.45; χ², 702.33). As MS DMTs may influence MM risk, clinicians should educate PwMS on the importance of regular skin self-examinations.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251342725"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reinforcing the evidence framework for paramagnetic rim lesions in MS: Advancing toward broad clinical integration.","authors":"Alessandro Cagol, Àlex Rovira","doi":"10.1177/13524585251349971","DOIUrl":"10.1177/13524585251349971","url":null,"abstract":"","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251349971"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-dependent response to initial highly effective treatment in relapsing multiple sclerosis.","authors":"Emilio Portaccio, Matteo Betti, Ermelinda De Meo, Luisa Pastò, Lorenzo Razzolini, Francesco Patti, Vincenzo Brescia Morra, Giovanna De Luca, Carlo Pozzilli, Carla Tortorella, Eleonora Cocco, Giuseppe Salemi, Diana Ferraro, Marika Vianello, Giacomo Lus, Alessandra Lugaresi, Matilde Inglese, Gioacchino Tedeschi, Sara Montepietra, Alessia Di Sapio, Mauro Zaffaroni, Pietro Iaffaldano, Marta Simone, Massimo Filippi, Maria Trojano, Maria Pia Amato","doi":"10.1177/13524585251345317","DOIUrl":"https://doi.org/10.1177/13524585251345317","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the impact of age on the superiority of highly effective (HE) disease-modifying treatments (DMTs) compared to platform DMTs in a real-world population of relapsing MS patients (pwMS).</p><p><strong>Methods: </strong>A total of 20,984 pwMS were extracted from the Italian Multiple Sclerosis Register with a diagnosis of Clinically Isolated Syndrome or Relapsing-Remitting MS, at least four Expanded Disability Status Scale (EDSS) evaluations and 2 years follow-up, starting DMT. The baseline was the nearest visit to the first DMT starting date. The risk of first 24-week confirmed disability accumulation (CDA) on EDSS in HE versus platform DMTs after 2 years and the entire follow-up was assessed through Cox regression models.</p><p><strong>Results: </strong>After 1:1 propensity score matching, we evaluated 1698 pwMS initiating HE-DMTs and 1698 initiating platforms. After 2 years follow-up, the proportion of CDA events was lower in patients on HE-DMTs (12.2%) than those on platform DMTs (15%), as confirmed by Cox regression analysis (hazard ratio (HR) = 0.22, 95% confidence interval (CI) = 0.10-0.47; <i>p</i> < 0.001). HE-DMTs were more effective in patients under 45 years of age (HR = 0.49, 95% CI = 0.39-0.63; <i>p</i> < 0.001), but not in patients over 45 (HR = 0.77, 95% CI = 0.54-1.08, <i>p</i> = 0.125). Notably, prolonged exposure to any DMT during follow-up reduced disability accumulation even in patients over 45 (HR = 0.13, 95% CI = 0.02-0.99; <i>p</i> = 0.050).</p><p><strong>Conclusion: </strong>This real-world study of relapsing pwMS demonstrates that the benefit of initial HE treatment diminishes with age. However, even in older patients, DMT exposure, regardless of the efficacy level, appears to reduce disability accumulation, and so, on an individual level, initial HE treatment could still be more effective.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251345317"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gynecological health: A missing link in comprehensive treatment monitoring for multiple sclerosis.","authors":"Melika Arab Bafrani, Viviana Rios, Min Ji Kim, Ayushi Balan, Riley Bove","doi":"10.1177/13524585251346371","DOIUrl":"https://doi.org/10.1177/13524585251346371","url":null,"abstract":"<p><p>Safety monitoring of disease-modifying therapies (DMTs) used to treat multiple sclerosis (MS) has largely overlooked the domain of gynecological health. This topical review aims to provide MS clinicians with an overview of the three categories of complications described to date, as well as risk mitigation strategies. These are increased risk of human papilloma virus (HPV) positivity and related cervical dysplasia/cancers; inflammatory and infectious vaginitis and susceptibility to bacterial vaginosis (BV); and herpesvirus infections, including genital Herpes Simplex Virus (HSV). Current knowledge may be biased due to limited studies and lack of gynecological focus in neurological encounters. Risk mitigation strategies include promoting HPV vaccination, following guidance for immune compromised individuals relating to cervical cancer screening and antiviral suppression, and proactive communication with patients about gynecological health when starting DMTs. Together, these might improve gynecological health and thereby quality of life in females with neuroinflammatory diseases.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251346371"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with delay to diagnosis of multiple sclerosis in Zambia.","authors":"Malya Sahu, Mashina Chomba, Dominique Mortel, Sarah Braun, Lorraine Chishimba, Frighton Mutete, Naluca Mwendaweli, Coolwe Namangala, Stanley Zimba, Deanna Saylor","doi":"10.1177/13524585251344832","DOIUrl":"https://doi.org/10.1177/13524585251344832","url":null,"abstract":"<p><strong>Background/objectives: </strong>Delays to diagnosis of multiple sclerosis (MS) are largely unknown in sub-Saharan Africa. This study utilizes a quantitative approach to determine factors independently associated with delays to diagnosis among a cohort of Zambian people with MS.</p><p><strong>Methods: </strong>This cross-sectional study enrolled people with a confirmed diagnosis of MS at a public outpatient neurology clinic in Lusaka, Zambia. Standardized surveys were administered. Diagnostic delay was categorized into patient delay, health-system delay, and all delay. A multivariable linear regression model was used to determine factors independently associated with time to diagnosis.</p><p><strong>Results: </strong>A total of 22 participants had a confirmed diagnosis of MS. Median all delay from symptom onset to MS diagnosis was 11.4 months (interquartile range (IQR) = 4-35.5), with health-system delay accounting for the majority. Asian race correlated with a decrease in all delay, while evaluation outside of Zambia was associated with a decrease in patient delay and birthplace outside of Zambia correlated with decreased health-system delay.</p><p><strong>Conclusion: </strong>Black African people born in Zambia and evaluated in Zambia experienced prolonged diagnostic delays when compared to non-black Zambians born and/or evaluated outside Zambia, likely due to a combination of health system and patient factors, which necessitate further study to shorten time to diagnosis.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251344832"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kappa free light chain index predicts long-term disease activity and disability accrual in multiple sclerosis.","authors":"Klaus Berek, Martin Schmidauer, Gabriel Bsteh, Michael Auer, Robert Barket, Thomas Berger, Franziska Di Pauli, Astrid Ellen Grams, Michaela Hassler, Lukas Lenhart, Dejan Milosavljevic, Anne Zinganell, Janette Walde, Florian Deisenhammer, Harald Hegen","doi":"10.1177/13524585251344807","DOIUrl":"https://doi.org/10.1177/13524585251344807","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of κ-free light chain (κ-FLC) index over the long term is unknown.</p><p><strong>Objectives: </strong>The objective of the study was to determine whether κ-FLC index determined at disease onset predicts relapse activity and disability accrual during long-term follow-up.</p><p><strong>Methods: </strong>Patients with a first demyelinating event of the central nervous system who had cerebrospinal fluid and serum sampling were eligible for inclusion. At baseline, demographics, clinical data, number of T2 hyperintense (T2L) and contrast-enhancing lesions (CEL) on MRI were assessed. During follow-up occurrence of relapses, Expanded Disability Status Scale (EDSS) scores and disease-modifying treatments (DMT) were registered. κ-FLC was measured by nephelometry and κ-FLC index calculated as (CSF κ-FLC/serum κ-FLC)/albumin quotient.</p><p><strong>Results: </strong>Sixty-four patients with a median age at onset of 32 years (25th-75th percentile: 27-39) and a female predominance of 75% were followed over a median of 113 (90-129) months. Forty-six (72%) patients experienced relapse, 30 (47%) showed disability accrual. Multivariable Cox regression analysis adjusted for age, sex, disease duration, T2L, CEL and DMT revealed that κ-FLC index independently predicts time to relapse (per increase of 10: hazard ratio (HR) = 1.04, lower limit (LL)-confidence interval (CI) = 1.001, <i>p</i> = 0.044) and disability accrual (per increase of 10: HR = 1.05, LL-CI = 1.009, <i>p</i> = 0.022).</p><p><strong>Conclusions: </strong>κ-FLC index predicts long-term disease activity independently of other risk factors.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251344807"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Should natalizumab be used despite JC virus positivity? Yes'.","authors":"William M Carroll","doi":"10.1177/13524585251346374","DOIUrl":"https://doi.org/10.1177/13524585251346374","url":null,"abstract":"","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251346374"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive reserve in multiple sclerosis: The role of depression and fatigue.","authors":"Clara Stein, Fiadhnait O'Keeffe, Méadhbh Brosnan, Claire Flynn, Christopher McGuigan, Jessica Bramham","doi":"10.1177/13524585251338757","DOIUrl":"https://doi.org/10.1177/13524585251338757","url":null,"abstract":"<p><strong>Background: </strong>Several reports suggest that cognitive reserve (CR) may protect against cognitive impairment in MS. Fatigue and depression are common in MS. Yet, their influence on engagement with activities that build CR is unclear.</p><p><strong>Objectives: </strong>This study aimed to achieve a better understanding of CR-building in MS, by examining how CR differs in people with MS (pwMS) compared with neurologically healthy individuals and by investigating how common MS symptoms interact with CR-building.</p><p><strong>Methods: </strong>In total, 206 pwMS and 150 age- and gender-matched controls participated in this cross-sectional study. Participants completed self-report measures of CR accumulated in early life and across the lifespan (including education, occupation, cognitively enriching leisure activities), and of cognitive functioning, fatigue, depression, anxiety and MS-impact on everyday life.</p><p><strong>Results: </strong>PwMS' recent engagement in cognitively enriching leisure activities was negatively associated with self-reported cognitive difficulties (rho = -0.31, <i>p</i> < 0.001). However, after controlling for fatigue and depression, this association was no longer present. Correspondingly, we observed that higher levels of depression were associated with lower engagement in cognitively enriching leisure activities (<i>B</i> = -0.41 (95% confidence interval (CI): -0.61 to -0.22), <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Our results highlight the importance of addressing depression and fatigue in the context of lifestyle recommendations.</p>","PeriodicalId":520714,"journal":{"name":"Multiple sclerosis (Houndmills, Basingstoke, England)","volume":" ","pages":"13524585251338757"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}