CMSC 2019

Seattle – Alemtuzumab is more effective than interferon beta-1a at reducing serum levels of neurofilament light chain (NfL) in treatment-naive patients with relapsing-remitting multiple sclerosis (MS), according to an analysis presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. This finding is consistent with the superior clinical efficacy of alemtuzumab, compared with interferon beta-1a, seen in clinical trials, said the researchers. The clinical implications of alemtuzumab’s reduction of NfL levels remain to be clarified.

The CARE-MS I trial indicated that alemtuzumab significantly improved clinical and MRI outcomes vs. subcutaneous interferon beta-1a over 2 years in treatment-naive patients with relapsing-remitting MS. Serum NfL level may indicate response to disease-modifying therapy.

Evis Havari, MSc, laboratory head of neuroimmunology immunomodulation at Sanofi in Framingham, Mass., and colleagues analyzed CARE-MS I data to determine the effect of alemtuzumab and subcutaneous interferon beta-1a on serum NfL over 2 years. The investigators also sought to compare participants’ serum NfL levels with the age-dependent median serum NfL levels in healthy controls, based on the approach described by Disanto et al. (Ann Neurol. 2017;81[6]:857-70).

In CARE-MS I, the investigators measured serum NfL with a single-molecule array. They used Generalized Additive Models of Location, Scale, and Shape to model serum NfL distribution in healthy controls and its association with age. They also derived age-dependent percentiles of serum NfL. CARE-MS I patients received 44 mcg of subcutaneous interferon beta-1a 3 times per week or 12 mg/day of alemtuzumab (a 5-day course at baseline and a 3-day course at 1 year). To obtain an age-independent measure of serum NfL, the researchers dichotomized samples into levels above or below the median. They used repeated logistic regression to estimate odds ratios (ORs).

The age range of participants in CARE-MS I was 18-53 years. Mean Expanded Disability Status Scale score was 2.0. In all, 354 participants received alemtuzumab, and 157 received interferon beta-1a.

Median serum NfL levels for healthy controls ranged from 12.0 pg/mL at 18 years of age to 27.1 pg/mL at 53 years. Median serum NfL levels were similar between the alemtuzumab and interferon beta-1a groups at baseline (31.7 pg/mL vs. 31.4 pg/mL). At 6 months after treatment, median serum NfL levels were significantly lower with alemtuzumab than with interferon beta-1a (17.2 pg/mL vs. 21.4 pg/mL). These levels remained significantly lower at month 24 in the alemtuzumab group (13.2 pg/mL vs. 18.7 pg/mL).

Significantly fewer patients in the alemtuzumab group had serum NfL levels higher than the age-dependent median in healthy controls at each post baseline time point, compared with the interferon beta-1a group (month 6: 46% vs. 65%; month 12: 38% vs. 53%; month 18: 31% vs. 44%; month 24: 28% vs. 53%). The odds for achieving serum NfL levels less than or equal to median levels for healthy controls were significantly greater for alemtuzumab than interferon beta-1a at month 6 (OR, 2.34), month 12 (OR, 1.81), month 18 (OR, 1.72), and month 24 (OR, 2.85).

Sanofi and Bayer HealthCare Pharmaceuticals supported the study. Several of the investigators are employees of Sanofi.

[email protected]

SOURCE: Havari E et al. CMSC 2019. Abstract NIB01.

Seattle – Alemtuzumab is more effective than interferon beta-1a at reducing serum levels of neurofilament light chain (NfL) in treatment-naive patients with relapsing-remitting multiple sclerosis (MS), according to an analysis presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. This finding is consistent with the superior clinical efficacy of alemtuzumab, compared with interferon beta-1a, seen in clinical trials, said the researchers. The clinical implications of alemtuzumab’s reduction of NfL levels remain to be clarified.

The CARE-MS I trial indicated that alemtuzumab significantly improved clinical and MRI outcomes vs. subcutaneous interferon beta-1a over 2 years in treatment-naive patients with relapsing-remitting MS. Serum NfL level may indicate response to disease-modifying therapy.

Evis Havari, MSc, laboratory head of neuroimmunology immunomodulation at Sanofi in Framingham, Mass., and colleagues analyzed CARE-MS I data to determine the effect of alemtuzumab and subcutaneous interferon beta-1a on serum NfL over 2 years. The investigators also sought to compare participants’ serum NfL levels with the age-dependent median serum NfL levels in healthy controls, based on the approach described by Disanto et al. (Ann Neurol. 2017;81[6]:857-70).

In CARE-MS I, the investigators measured serum NfL with a single-molecule array. They used Generalized Additive Models of Location, Scale, and Shape to model serum NfL distribution in healthy controls and its association with age. They also derived age-dependent percentiles of serum NfL. CARE-MS I patients received 44 mcg of subcutaneous interferon beta-1a 3 times per week or 12 mg/day of alemtuzumab (a 5-day course at baseline and a 3-day course at 1 year). To obtain an age-independent measure of serum NfL, the researchers dichotomized samples into levels above or below the median. They used repeated logistic regression to estimate odds ratios (ORs).

The age range of participants in CARE-MS I was 18-53 years. Mean Expanded Disability Status Scale score was 2.0. In all, 354 participants received alemtuzumab, and 157 received interferon beta-1a.

Median serum NfL levels for healthy controls ranged from 12.0 pg/mL at 18 years of age to 27.1 pg/mL at 53 years. Median serum NfL levels were similar between the alemtuzumab and interferon beta-1a groups at baseline (31.7 pg/mL vs. 31.4 pg/mL). At 6 months after treatment, median serum NfL levels were significantly lower with alemtuzumab than with interferon beta-1a (17.2 pg/mL vs. 21.4 pg/mL). These levels remained significantly lower at month 24 in the alemtuzumab group (13.2 pg/mL vs. 18.7 pg/mL).

Significantly fewer patients in the alemtuzumab group had serum NfL levels higher than the age-dependent median in healthy controls at each post baseline time point, compared with the interferon beta-1a group (month 6: 46% vs. 65%; month 12: 38% vs. 53%; month 18: 31% vs. 44%; month 24: 28% vs. 53%). The odds for achieving serum NfL levels less than or equal to median levels for healthy controls were significantly greater for alemtuzumab than interferon beta-1a at month 6 (OR, 2.34), month 12 (OR, 1.81), month 18 (OR, 1.72), and month 24 (OR, 2.85).

Sanofi and Bayer HealthCare Pharmaceuticals supported the study. Several of the investigators are employees of Sanofi.

[email protected]

SOURCE: Havari E et al. CMSC 2019. Abstract NIB01.

Seattle – Alemtuzumab is more effective than interferon beta-1a at reducing serum levels of neurofilament light chain (NfL) in treatment-naive patients with relapsing-remitting multiple sclerosis (MS), according to an analysis presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. This finding is consistent with the superior clinical efficacy of alemtuzumab, compared with interferon beta-1a, seen in clinical trials, said the researchers. The clinical implications of alemtuzumab’s reduction of NfL levels remain to be clarified.

The CARE-MS I trial indicated that alemtuzumab significantly improved clinical and MRI outcomes vs. subcutaneous interferon beta-1a over 2 years in treatment-naive patients with relapsing-remitting MS. Serum NfL level may indicate response to disease-modifying therapy.

Evis Havari, MSc, laboratory head of neuroimmunology immunomodulation at Sanofi in Framingham, Mass., and colleagues analyzed CARE-MS I data to determine the effect of alemtuzumab and subcutaneous interferon beta-1a on serum NfL over 2 years. The investigators also sought to compare participants’ serum NfL levels with the age-dependent median serum NfL levels in healthy controls, based on the approach described by Disanto et al. (Ann Neurol. 2017;81[6]:857-70).

In CARE-MS I, the investigators measured serum NfL with a single-molecule array. They used Generalized Additive Models of Location, Scale, and Shape to model serum NfL distribution in healthy controls and its association with age. They also derived age-dependent percentiles of serum NfL. CARE-MS I patients received 44 mcg of subcutaneous interferon beta-1a 3 times per week or 12 mg/day of alemtuzumab (a 5-day course at baseline and a 3-day course at 1 year). To obtain an age-independent measure of serum NfL, the researchers dichotomized samples into levels above or below the median. They used repeated logistic regression to estimate odds ratios (ORs).

The age range of participants in CARE-MS I was 18-53 years. Mean Expanded Disability Status Scale score was 2.0. In all, 354 participants received alemtuzumab, and 157 received interferon beta-1a.

Median serum NfL levels for healthy controls ranged from 12.0 pg/mL at 18 years of age to 27.1 pg/mL at 53 years. Median serum NfL levels were similar between the alemtuzumab and interferon beta-1a groups at baseline (31.7 pg/mL vs. 31.4 pg/mL). At 6 months after treatment, median serum NfL levels were significantly lower with alemtuzumab than with interferon beta-1a (17.2 pg/mL vs. 21.4 pg/mL). These levels remained significantly lower at month 24 in the alemtuzumab group (13.2 pg/mL vs. 18.7 pg/mL).

Significantly fewer patients in the alemtuzumab group had serum NfL levels higher than the age-dependent median in healthy controls at each post baseline time point, compared with the interferon beta-1a group (month 6: 46% vs. 65%; month 12: 38% vs. 53%; month 18: 31% vs. 44%; month 24: 28% vs. 53%). The odds for achieving serum NfL levels less than or equal to median levels for healthy controls were significantly greater for alemtuzumab than interferon beta-1a at month 6 (OR, 2.34), month 12 (OR, 1.81), month 18 (OR, 1.72), and month 24 (OR, 2.85).

Sanofi and Bayer HealthCare Pharmaceuticals supported the study. Several of the investigators are employees of Sanofi.

[email protected]

SOURCE: Havari E et al. CMSC 2019. Abstract NIB01.

SEATTLE – Cytomegalovirus (CMV) seropositivity is associated with increased likelihood of multiple sclerosis (MS) in the Middle East and decreased likelihood in Europe, according to a meta-analysis presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. In the United States, the association between CMV seropositivity and MS is not statistically significant, whereas combined data from all regions show a significant positive association, researchers said.

“To our knowledge, this is the largest meta-analysis evaluation of the association between CMV seropositivity and MS,” said Smathorn Thakolwiboon, MD, a neurology resident at Texas Tech University, Lubbock, and colleagues. Understanding the reasons for the geographic heterogeneity will require further research, they said.

Researchers have hypothesized that increased incidence of autoimmune conditions may be linked to the prevention or delay of common infections, but studies have been inconclusive (Neurology. 2017 Sep 26;89[13]:1330-7.).

To evaluate the association between CMV seropositivity and MS, Dr. Thakolwiboon and colleagues searched databases, including PubMed/MEDLINE, Embase, and Web of Science, from inception through Dec. 2018. They included in their analysis observational studies that evaluated the seroprevalence of CMV immunoglobulin G (IgG) in adults with MS and healthy controls. They estimated the odds ratio (OR) for CMV seropositivity and MS.

An initial search yielded 982 articles, 56 of which underwent full review. The researchers ultimately included 13 articles in their quantitative analysis. The studies included data from 3,049 patients with MS and 3,604 controls.

Overall, CMV seropositivity was significantly associated with MS (OR, 1.58; 95% confidence interval, 1.04-2.39; P = .031), but the relationship varied by region. In five U.S. studies, the association was not statistically significant (OR, 1.57; 95% CI, 0.83-2.99; P = .168). CMV seropositivity was negatively associated with MS in Europe (OR, 0.81; 95% CI, 0.68-0.96; P less than .001), but positively associated with MS in the Middle East (OR, 5.42; 95% CI, 1.06-27.89; P less than .001). “The meta-analysis showed a heterogeneity of the association between CMV seropositivity and MS,” the researchers concluded. “More genetic and environmental studies are needed for better understanding this geographic heterogeneity.”

Dr. Thakolwiboon had no disclosures. A coauthor disclosed speaking and advisory board roles with EMD Serono, Genzyme, Novartis, and Teva.
 

[email protected]

SOURCE: Thakolwiboon S et al. CMSC 2019. Abstract EPI01.

SEATTLE – Cytomegalovirus (CMV) seropositivity is associated with increased likelihood of multiple sclerosis (MS) in the Middle East and decreased likelihood in Europe, according to a meta-analysis presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. In the United States, the association between CMV seropositivity and MS is not statistically significant, whereas combined data from all regions show a significant positive association, researchers said.

“To our knowledge, this is the largest meta-analysis evaluation of the association between CMV seropositivity and MS,” said Smathorn Thakolwiboon, MD, a neurology resident at Texas Tech University, Lubbock, and colleagues. Understanding the reasons for the geographic heterogeneity will require further research, they said.

Researchers have hypothesized that increased incidence of autoimmune conditions may be linked to the prevention or delay of common infections, but studies have been inconclusive (Neurology. 2017 Sep 26;89[13]:1330-7.).

To evaluate the association between CMV seropositivity and MS, Dr. Thakolwiboon and colleagues searched databases, including PubMed/MEDLINE, Embase, and Web of Science, from inception through Dec. 2018. They included in their analysis observational studies that evaluated the seroprevalence of CMV immunoglobulin G (IgG) in adults with MS and healthy controls. They estimated the odds ratio (OR) for CMV seropositivity and MS.

An initial search yielded 982 articles, 56 of which underwent full review. The researchers ultimately included 13 articles in their quantitative analysis. The studies included data from 3,049 patients with MS and 3,604 controls.

Overall, CMV seropositivity was significantly associated with MS (OR, 1.58; 95% confidence interval, 1.04-2.39; P = .031), but the relationship varied by region. In five U.S. studies, the association was not statistically significant (OR, 1.57; 95% CI, 0.83-2.99; P = .168). CMV seropositivity was negatively associated with MS in Europe (OR, 0.81; 95% CI, 0.68-0.96; P less than .001), but positively associated with MS in the Middle East (OR, 5.42; 95% CI, 1.06-27.89; P less than .001). “The meta-analysis showed a heterogeneity of the association between CMV seropositivity and MS,” the researchers concluded. “More genetic and environmental studies are needed for better understanding this geographic heterogeneity.”

Dr. Thakolwiboon had no disclosures. A coauthor disclosed speaking and advisory board roles with EMD Serono, Genzyme, Novartis, and Teva.
 

[email protected]

SOURCE: Thakolwiboon S et al. CMSC 2019. Abstract EPI01.

SEATTLE – Cytomegalovirus (CMV) seropositivity is associated with increased likelihood of multiple sclerosis (MS) in the Middle East and decreased likelihood in Europe, according to a meta-analysis presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. In the United States, the association between CMV seropositivity and MS is not statistically significant, whereas combined data from all regions show a significant positive association, researchers said.

“To our knowledge, this is the largest meta-analysis evaluation of the association between CMV seropositivity and MS,” said Smathorn Thakolwiboon, MD, a neurology resident at Texas Tech University, Lubbock, and colleagues. Understanding the reasons for the geographic heterogeneity will require further research, they said.

Researchers have hypothesized that increased incidence of autoimmune conditions may be linked to the prevention or delay of common infections, but studies have been inconclusive (Neurology. 2017 Sep 26;89[13]:1330-7.).

To evaluate the association between CMV seropositivity and MS, Dr. Thakolwiboon and colleagues searched databases, including PubMed/MEDLINE, Embase, and Web of Science, from inception through Dec. 2018. They included in their analysis observational studies that evaluated the seroprevalence of CMV immunoglobulin G (IgG) in adults with MS and healthy controls. They estimated the odds ratio (OR) for CMV seropositivity and MS.

An initial search yielded 982 articles, 56 of which underwent full review. The researchers ultimately included 13 articles in their quantitative analysis. The studies included data from 3,049 patients with MS and 3,604 controls.

Overall, CMV seropositivity was significantly associated with MS (OR, 1.58; 95% confidence interval, 1.04-2.39; P = .031), but the relationship varied by region. In five U.S. studies, the association was not statistically significant (OR, 1.57; 95% CI, 0.83-2.99; P = .168). CMV seropositivity was negatively associated with MS in Europe (OR, 0.81; 95% CI, 0.68-0.96; P less than .001), but positively associated with MS in the Middle East (OR, 5.42; 95% CI, 1.06-27.89; P less than .001). “The meta-analysis showed a heterogeneity of the association between CMV seropositivity and MS,” the researchers concluded. “More genetic and environmental studies are needed for better understanding this geographic heterogeneity.”

Dr. Thakolwiboon had no disclosures. A coauthor disclosed speaking and advisory board roles with EMD Serono, Genzyme, Novartis, and Teva.
 

[email protected]

SOURCE: Thakolwiboon S et al. CMSC 2019. Abstract EPI01.

Seattle – Periodic limb movements during sleep (PLMS) are common in patients with multiple sclerosis (MS) who report fatigue, according to a retrospective analysis described at the annual meeting of the Consortium of Multiple Sclerosis Centers.

“PLMS may contribute to daytime sleepiness and should be recognized and potentially treated. The etiology of fatigue related to sleep problems in people with MS is multifactorial and not just due to obstructive sleep apnea,” said lead author Jared Srinivasan, clinical research coordinator at South Shore Neurologic Associates in East Northport, New York, and colleagues.

Fatigue is common in patients with MS and can be disabling. For many patients with MS, sleep apnea is the underlying cause of fatigue. PLMS – leg movements that usually occur at 20- to 40-second intervals during sleep – are not commonly reported in MS. These movements cause sleep fragmentation, increase the energy cost of sleep, and contribute to daytime somnolence. Patients with PLMS often are unaware that they have them and do not report related symptoms unless they are specifically questioned about them. Polysomnography (PSG) is an effective, objective method of evaluating a patient for PLMS, but previous studies of PLMS in patients with MS have been small.

Mr. Srinivasan and colleagues performed a retrospective analysis to investigate the incidence and degree of PLMS in people with MS who had reported fatigue, had not previously been diagnosed as having sleep apnea or PLMS, and agreed to undergo overnight PSG.

The investigators included 292 participants in their study. The population’s average age was 47.3 years. Approximately 81% of patients were female. About 41% of the population had a PLMS index (PLMS per hour) greater than 0. Of participants with PSG-identified PLMS, 10% had a PLMS index of 5-10, 5% had a PLMS index of 11-21, and 12% had a PLMS index greater than 21. About 38% of the population experienced arousal because of PLMS. Of patients with arousal, 34% had a PLMS arousal index (number of arousals per hour) between 0 and 5, 31% had PLMS arousal index of 5-20, 14% had a PLMS arousal index of 20-50, and 21% had a PLMS arousal index greater than 50.

The investigators did not receive financial support for this study and did not report disclosures.
 

[email protected]

SOURCE: Srinivasan J et al. CMSC 2019. Abstract QOL29.

Seattle – Periodic limb movements during sleep (PLMS) are common in patients with multiple sclerosis (MS) who report fatigue, according to a retrospective analysis described at the annual meeting of the Consortium of Multiple Sclerosis Centers.

“PLMS may contribute to daytime sleepiness and should be recognized and potentially treated. The etiology of fatigue related to sleep problems in people with MS is multifactorial and not just due to obstructive sleep apnea,” said lead author Jared Srinivasan, clinical research coordinator at South Shore Neurologic Associates in East Northport, New York, and colleagues.

Fatigue is common in patients with MS and can be disabling. For many patients with MS, sleep apnea is the underlying cause of fatigue. PLMS – leg movements that usually occur at 20- to 40-second intervals during sleep – are not commonly reported in MS. These movements cause sleep fragmentation, increase the energy cost of sleep, and contribute to daytime somnolence. Patients with PLMS often are unaware that they have them and do not report related symptoms unless they are specifically questioned about them. Polysomnography (PSG) is an effective, objective method of evaluating a patient for PLMS, but previous studies of PLMS in patients with MS have been small.

Mr. Srinivasan and colleagues performed a retrospective analysis to investigate the incidence and degree of PLMS in people with MS who had reported fatigue, had not previously been diagnosed as having sleep apnea or PLMS, and agreed to undergo overnight PSG.

The investigators included 292 participants in their study. The population’s average age was 47.3 years. Approximately 81% of patients were female. About 41% of the population had a PLMS index (PLMS per hour) greater than 0. Of participants with PSG-identified PLMS, 10% had a PLMS index of 5-10, 5% had a PLMS index of 11-21, and 12% had a PLMS index greater than 21. About 38% of the population experienced arousal because of PLMS. Of patients with arousal, 34% had a PLMS arousal index (number of arousals per hour) between 0 and 5, 31% had PLMS arousal index of 5-20, 14% had a PLMS arousal index of 20-50, and 21% had a PLMS arousal index greater than 50.

The investigators did not receive financial support for this study and did not report disclosures.
 

[email protected]

SOURCE: Srinivasan J et al. CMSC 2019. Abstract QOL29.

Seattle – Periodic limb movements during sleep (PLMS) are common in patients with multiple sclerosis (MS) who report fatigue, according to a retrospective analysis described at the annual meeting of the Consortium of Multiple Sclerosis Centers.

“PLMS may contribute to daytime sleepiness and should be recognized and potentially treated. The etiology of fatigue related to sleep problems in people with MS is multifactorial and not just due to obstructive sleep apnea,” said lead author Jared Srinivasan, clinical research coordinator at South Shore Neurologic Associates in East Northport, New York, and colleagues.

Fatigue is common in patients with MS and can be disabling. For many patients with MS, sleep apnea is the underlying cause of fatigue. PLMS – leg movements that usually occur at 20- to 40-second intervals during sleep – are not commonly reported in MS. These movements cause sleep fragmentation, increase the energy cost of sleep, and contribute to daytime somnolence. Patients with PLMS often are unaware that they have them and do not report related symptoms unless they are specifically questioned about them. Polysomnography (PSG) is an effective, objective method of evaluating a patient for PLMS, but previous studies of PLMS in patients with MS have been small.

Mr. Srinivasan and colleagues performed a retrospective analysis to investigate the incidence and degree of PLMS in people with MS who had reported fatigue, had not previously been diagnosed as having sleep apnea or PLMS, and agreed to undergo overnight PSG.

The investigators included 292 participants in their study. The population’s average age was 47.3 years. Approximately 81% of patients were female. About 41% of the population had a PLMS index (PLMS per hour) greater than 0. Of participants with PSG-identified PLMS, 10% had a PLMS index of 5-10, 5% had a PLMS index of 11-21, and 12% had a PLMS index greater than 21. About 38% of the population experienced arousal because of PLMS. Of patients with arousal, 34% had a PLMS arousal index (number of arousals per hour) between 0 and 5, 31% had PLMS arousal index of 5-20, 14% had a PLMS arousal index of 20-50, and 21% had a PLMS arousal index greater than 50.

The investigators did not receive financial support for this study and did not report disclosures.
 

[email protected]

SOURCE: Srinivasan J et al. CMSC 2019. Abstract QOL29.

SEATTLE – Neurologists who subspecialize in multiple sclerosis (MS) are more likely than are general neurologists to prescribe three out of five high-efficacy medications for patients with the condition, according to the findings from a single-system study. It is not clear if the greater reluctance among general neurologists to prescribe the drugs is hurting the health of patients, and the study does not examine whether general neurologists are referring their toughest patients to their subspecialist colleagues.

Still, the findings raise questions because “starting highly effective drugs early can prevent long-term disability,” said study lead author and neurologist Casey V. Farin, MD, a clinical fellow in the department of neurology at Duke University, Durham, N.C., who spoke in an interview prior to the presentation of the study findings at the annual meeting of the Consortium of Multiple Sclerosis Centers. “A lot of our general neurologists are prescribing the traditional platform therapies that have fallen a bit out of favor in the MS community,” she said.

Dr. Farin and colleagues launched their study to better understand whether “therapeutic inertia” is affecting how general neurologists treat MS. The term refers to “staying with one drug just because it is easier not to rock the boat,” she said. For the purposes of their study, the term encompasses reluctance of neurologists to escalate therapy or prescribe high-efficacy drugs.

“There have been small studies comparing subspecialists and general neurologists using surveys of theoretical cases,” she said. “No studies have looked at how people are prescribing disease-modifying therapy.”

In the new age of high-efficacy treatment, guidelines about early MS treatment are lacking. As the study abstract notes, “in the absence of robust head-to-head clinical data, neurologists do not have an accepted algorithm for initiation and escalation of therapy, although recent research indicates a benefit in initiating highly effective therapies early in the disease course.”

For the study, researchers tracked 4,753 patients with MS who were treated at the Duke University Health System from 2016 to 2018.

General neurologists prescribed platform therapies – interferons, glatiramer acetate (Copaxone) and dimethyl fumarate (Tecfidera) more often than did MS subspecialists (16% vs. 5%, P less than .0001, 12% vs. 6%, P = .001 and 31% vs. 11%, P less than .0001, respectively).

In regard to high-efficacy MS drugs, there was no significant difference in prescription rates of fingolimod (Gilenya) and natalizumab (Tysabri). But general neurologists were less likely to prescribe three other types than were general neurologists: Alemtuzumab (Lemtrada), ocrelizumab (Ocrevus) and rituximab (Rituxan) (0 vs. 8%, P = .0001, 3% vs. 27%, P less than .0001, and 2% vs. 7%, P = .0001, respectively).

Why might general neurologists be more resistant to embrace high-efficacy MS drugs? “They are newer and seen as more aggressive, and riskier,” Dr. Farin said. If general neurologists are not seeing many patients with MS and not prescribing these newer drugs very often, they may be more familiar with the older platform drugs, she said. “They may start with the ones that seem safer and are easier to start with.”

It is possible, she cautioned, that the study results may be confounded by general neurologists who refer patients to MS subspecialists when initial disease-modifying therapies fail.

No study funding was reported. Dr. Farin and two of the other four authors disclosed consulting fees from Biogen. No other disclosures were reported.

SOURCE: Farin CV et al. CMSC 2019. Abstract DXT44.

SEATTLE – Neurologists who subspecialize in multiple sclerosis (MS) are more likely than are general neurologists to prescribe three out of five high-efficacy medications for patients with the condition, according to the findings from a single-system study. It is not clear if the greater reluctance among general neurologists to prescribe the drugs is hurting the health of patients, and the study does not examine whether general neurologists are referring their toughest patients to their subspecialist colleagues.

Still, the findings raise questions because “starting highly effective drugs early can prevent long-term disability,” said study lead author and neurologist Casey V. Farin, MD, a clinical fellow in the department of neurology at Duke University, Durham, N.C., who spoke in an interview prior to the presentation of the study findings at the annual meeting of the Consortium of Multiple Sclerosis Centers. “A lot of our general neurologists are prescribing the traditional platform therapies that have fallen a bit out of favor in the MS community,” she said.

Dr. Farin and colleagues launched their study to better understand whether “therapeutic inertia” is affecting how general neurologists treat MS. The term refers to “staying with one drug just because it is easier not to rock the boat,” she said. For the purposes of their study, the term encompasses reluctance of neurologists to escalate therapy or prescribe high-efficacy drugs.

“There have been small studies comparing subspecialists and general neurologists using surveys of theoretical cases,” she said. “No studies have looked at how people are prescribing disease-modifying therapy.”

In the new age of high-efficacy treatment, guidelines about early MS treatment are lacking. As the study abstract notes, “in the absence of robust head-to-head clinical data, neurologists do not have an accepted algorithm for initiation and escalation of therapy, although recent research indicates a benefit in initiating highly effective therapies early in the disease course.”

For the study, researchers tracked 4,753 patients with MS who were treated at the Duke University Health System from 2016 to 2018.

General neurologists prescribed platform therapies – interferons, glatiramer acetate (Copaxone) and dimethyl fumarate (Tecfidera) more often than did MS subspecialists (16% vs. 5%, P less than .0001, 12% vs. 6%, P = .001 and 31% vs. 11%, P less than .0001, respectively).

In regard to high-efficacy MS drugs, there was no significant difference in prescription rates of fingolimod (Gilenya) and natalizumab (Tysabri). But general neurologists were less likely to prescribe three other types than were general neurologists: Alemtuzumab (Lemtrada), ocrelizumab (Ocrevus) and rituximab (Rituxan) (0 vs. 8%, P = .0001, 3% vs. 27%, P less than .0001, and 2% vs. 7%, P = .0001, respectively).

Why might general neurologists be more resistant to embrace high-efficacy MS drugs? “They are newer and seen as more aggressive, and riskier,” Dr. Farin said. If general neurologists are not seeing many patients with MS and not prescribing these newer drugs very often, they may be more familiar with the older platform drugs, she said. “They may start with the ones that seem safer and are easier to start with.”

It is possible, she cautioned, that the study results may be confounded by general neurologists who refer patients to MS subspecialists when initial disease-modifying therapies fail.

No study funding was reported. Dr. Farin and two of the other four authors disclosed consulting fees from Biogen. No other disclosures were reported.

SOURCE: Farin CV et al. CMSC 2019. Abstract DXT44.

SEATTLE – Neurologists who subspecialize in multiple sclerosis (MS) are more likely than are general neurologists to prescribe three out of five high-efficacy medications for patients with the condition, according to the findings from a single-system study. It is not clear if the greater reluctance among general neurologists to prescribe the drugs is hurting the health of patients, and the study does not examine whether general neurologists are referring their toughest patients to their subspecialist colleagues.

Still, the findings raise questions because “starting highly effective drugs early can prevent long-term disability,” said study lead author and neurologist Casey V. Farin, MD, a clinical fellow in the department of neurology at Duke University, Durham, N.C., who spoke in an interview prior to the presentation of the study findings at the annual meeting of the Consortium of Multiple Sclerosis Centers. “A lot of our general neurologists are prescribing the traditional platform therapies that have fallen a bit out of favor in the MS community,” she said.

Dr. Farin and colleagues launched their study to better understand whether “therapeutic inertia” is affecting how general neurologists treat MS. The term refers to “staying with one drug just because it is easier not to rock the boat,” she said. For the purposes of their study, the term encompasses reluctance of neurologists to escalate therapy or prescribe high-efficacy drugs.

“There have been small studies comparing subspecialists and general neurologists using surveys of theoretical cases,” she said. “No studies have looked at how people are prescribing disease-modifying therapy.”

In the new age of high-efficacy treatment, guidelines about early MS treatment are lacking. As the study abstract notes, “in the absence of robust head-to-head clinical data, neurologists do not have an accepted algorithm for initiation and escalation of therapy, although recent research indicates a benefit in initiating highly effective therapies early in the disease course.”

For the study, researchers tracked 4,753 patients with MS who were treated at the Duke University Health System from 2016 to 2018.

General neurologists prescribed platform therapies – interferons, glatiramer acetate (Copaxone) and dimethyl fumarate (Tecfidera) more often than did MS subspecialists (16% vs. 5%, P less than .0001, 12% vs. 6%, P = .001 and 31% vs. 11%, P less than .0001, respectively).

In regard to high-efficacy MS drugs, there was no significant difference in prescription rates of fingolimod (Gilenya) and natalizumab (Tysabri). But general neurologists were less likely to prescribe three other types than were general neurologists: Alemtuzumab (Lemtrada), ocrelizumab (Ocrevus) and rituximab (Rituxan) (0 vs. 8%, P = .0001, 3% vs. 27%, P less than .0001, and 2% vs. 7%, P = .0001, respectively).

Why might general neurologists be more resistant to embrace high-efficacy MS drugs? “They are newer and seen as more aggressive, and riskier,” Dr. Farin said. If general neurologists are not seeing many patients with MS and not prescribing these newer drugs very often, they may be more familiar with the older platform drugs, she said. “They may start with the ones that seem safer and are easier to start with.”

It is possible, she cautioned, that the study results may be confounded by general neurologists who refer patients to MS subspecialists when initial disease-modifying therapies fail.

No study funding was reported. Dr. Farin and two of the other four authors disclosed consulting fees from Biogen. No other disclosures were reported.

SOURCE: Farin CV et al. CMSC 2019. Abstract DXT44.

SEATTLE – Future behavioral interventions for improving sleep in patients with multiple sclerosis (MS) should focus on sedentary behavior and light physical activity, according to a study presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. Reducing sedentary behavior among young adults with MS could improve sleep efficiency, and increasing the time spent in light physical activity could improve sleep latency for older adults with MS, said the researchers.

Sleep quality generally decreases with age. Among patients with MS, the prevalence of sleep problems increases threefold with age. Although data indicate that physical activity has many benefits for patients with MS, little research has examined the relationships between physical activity, sedentary behavior, and sleep quality across the lifespan in this population.

Katie L.J. Cederberg, a doctoral student at the University of Alabama at Birmingham, and colleagues recruited 127 adults with MS representing three age groups into a study. In all, 42 participants were younger (aged 20-39 years), 44 were middle-aged (40-59 years), and 41 were older (60-79 years). Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Patient-Determined Disease Steps (PDDS) scale. Each participant also wore an accelerometer for 7 days. Ms. Cederberg and colleagues analyzed the accelerometer data to determine the time per day that participants spent in light physical activity, moderate-to-vigorous physical activity, and sedentary behavior using MS-specific cutpoints.

Compared with younger adults, older adults had significantly lower PSQI global scores and reported more frequent use of sleeping medications. Compared with middle-aged adults, older adults had significantly higher disability levels and spent significantly less time in moderate-to-vigorous physical activity. In addition, among older adults, sleep latency was negatively associated with time spent in light physical activity, and clinical disability was inversely associated with time spent in moderate-to-vigorous physical activity.

In younger adults, habitual sleep efficiency was inversely associated with time spent in sedentary behavior. The researchers found no significant associations between these variables in middle-aged adults.
 

[email protected]

SOURCE: Cederberg KLJ et al. CMSC 2019. Abstract DXA05.

SEATTLE – Future behavioral interventions for improving sleep in patients with multiple sclerosis (MS) should focus on sedentary behavior and light physical activity, according to a study presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. Reducing sedentary behavior among young adults with MS could improve sleep efficiency, and increasing the time spent in light physical activity could improve sleep latency for older adults with MS, said the researchers.

Sleep quality generally decreases with age. Among patients with MS, the prevalence of sleep problems increases threefold with age. Although data indicate that physical activity has many benefits for patients with MS, little research has examined the relationships between physical activity, sedentary behavior, and sleep quality across the lifespan in this population.

Katie L.J. Cederberg, a doctoral student at the University of Alabama at Birmingham, and colleagues recruited 127 adults with MS representing three age groups into a study. In all, 42 participants were younger (aged 20-39 years), 44 were middle-aged (40-59 years), and 41 were older (60-79 years). Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Patient-Determined Disease Steps (PDDS) scale. Each participant also wore an accelerometer for 7 days. Ms. Cederberg and colleagues analyzed the accelerometer data to determine the time per day that participants spent in light physical activity, moderate-to-vigorous physical activity, and sedentary behavior using MS-specific cutpoints.

Compared with younger adults, older adults had significantly lower PSQI global scores and reported more frequent use of sleeping medications. Compared with middle-aged adults, older adults had significantly higher disability levels and spent significantly less time in moderate-to-vigorous physical activity. In addition, among older adults, sleep latency was negatively associated with time spent in light physical activity, and clinical disability was inversely associated with time spent in moderate-to-vigorous physical activity.

In younger adults, habitual sleep efficiency was inversely associated with time spent in sedentary behavior. The researchers found no significant associations between these variables in middle-aged adults.
 

[email protected]

SOURCE: Cederberg KLJ et al. CMSC 2019. Abstract DXA05.

SEATTLE – Future behavioral interventions for improving sleep in patients with multiple sclerosis (MS) should focus on sedentary behavior and light physical activity, according to a study presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. Reducing sedentary behavior among young adults with MS could improve sleep efficiency, and increasing the time spent in light physical activity could improve sleep latency for older adults with MS, said the researchers.

Sleep quality generally decreases with age. Among patients with MS, the prevalence of sleep problems increases threefold with age. Although data indicate that physical activity has many benefits for patients with MS, little research has examined the relationships between physical activity, sedentary behavior, and sleep quality across the lifespan in this population.

Katie L.J. Cederberg, a doctoral student at the University of Alabama at Birmingham, and colleagues recruited 127 adults with MS representing three age groups into a study. In all, 42 participants were younger (aged 20-39 years), 44 were middle-aged (40-59 years), and 41 were older (60-79 years). Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Patient-Determined Disease Steps (PDDS) scale. Each participant also wore an accelerometer for 7 days. Ms. Cederberg and colleagues analyzed the accelerometer data to determine the time per day that participants spent in light physical activity, moderate-to-vigorous physical activity, and sedentary behavior using MS-specific cutpoints.

Compared with younger adults, older adults had significantly lower PSQI global scores and reported more frequent use of sleeping medications. Compared with middle-aged adults, older adults had significantly higher disability levels and spent significantly less time in moderate-to-vigorous physical activity. In addition, among older adults, sleep latency was negatively associated with time spent in light physical activity, and clinical disability was inversely associated with time spent in moderate-to-vigorous physical activity.

In younger adults, habitual sleep efficiency was inversely associated with time spent in sedentary behavior. The researchers found no significant associations between these variables in middle-aged adults.
 

[email protected]

SOURCE: Cederberg KLJ et al. CMSC 2019. Abstract DXA05.

SEATTLE – Pain, fatigue, depression, and anxiety are common among patients with multiple sclerosis (MS) in the 12 months after diagnosis, researchers reported at the annual meeting of the Consortium of Multiple Sclerosis Centers. In a novel study, about half of patients with MS reported clinically significant symptoms of depression or pain, and approximately 60% reported fatigue during that time.

Michigan Medicine

Pain, fatigue, depression, and anxiety are common in MS, but their prevalence in the first year after diagnosis is not well understood. To examine the rates of these conditions and how often they co-occur during that period, Anna L. Kratz, PhD, associate professor of physical medicine and rehabilitation at the University of Michigan in Ann Arbor, and her research colleagues had 231 adults with MS complete validated surveys at 1, 2, 3, 6, 9, and 12 months after diagnosis to assess symptoms of these conditions.

Overall, 47.2% of patients reported clinically significant levels of depression, 38.5% reported clinically significant levels of anxiety, 50.4% reported clinically significant pain, and 62.2% reported clinically significant fatigue at any point during the year after diagnosis. “Of those who did not have clinically significant symptoms at time of diagnosis, 21.3% went on to develop clinically significant depression, 17.0% anxiety, 30.9% pain, and 34.1% fatigue,” the authors reported.

About 23% of patients did not have clinically significant symptoms for any condition, while 20% had clinically significant symptoms for one condition, 21% for two, 19% for three, and 17% for all four.

Depression and fatigue had the highest rate of comorbidity, whereas pain and anxiety had the lowest rate of comorbidity.

“Important clinical symptoms associated with MS are present at high levels in the first year post diagnosis,” Dr. Kratz and colleagues concluded. “While the rates and severity are marginally lower than have been identified in studies of individuals farther into the MS disease course, this study is a reminder that early MS intervention should incorporate interventions for these symptoms that are known to have strong associations with quality of life.”

The researchers had no disclosures.

[email protected]

SEATTLE – Pain, fatigue, depression, and anxiety are common among patients with multiple sclerosis (MS) in the 12 months after diagnosis, researchers reported at the annual meeting of the Consortium of Multiple Sclerosis Centers. In a novel study, about half of patients with MS reported clinically significant symptoms of depression or pain, and approximately 60% reported fatigue during that time.

Michigan Medicine

Pain, fatigue, depression, and anxiety are common in MS, but their prevalence in the first year after diagnosis is not well understood. To examine the rates of these conditions and how often they co-occur during that period, Anna L. Kratz, PhD, associate professor of physical medicine and rehabilitation at the University of Michigan in Ann Arbor, and her research colleagues had 231 adults with MS complete validated surveys at 1, 2, 3, 6, 9, and 12 months after diagnosis to assess symptoms of these conditions.

Overall, 47.2% of patients reported clinically significant levels of depression, 38.5% reported clinically significant levels of anxiety, 50.4% reported clinically significant pain, and 62.2% reported clinically significant fatigue at any point during the year after diagnosis. “Of those who did not have clinically significant symptoms at time of diagnosis, 21.3% went on to develop clinically significant depression, 17.0% anxiety, 30.9% pain, and 34.1% fatigue,” the authors reported.

About 23% of patients did not have clinically significant symptoms for any condition, while 20% had clinically significant symptoms for one condition, 21% for two, 19% for three, and 17% for all four.

Depression and fatigue had the highest rate of comorbidity, whereas pain and anxiety had the lowest rate of comorbidity.

“Important clinical symptoms associated with MS are present at high levels in the first year post diagnosis,” Dr. Kratz and colleagues concluded. “While the rates and severity are marginally lower than have been identified in studies of individuals farther into the MS disease course, this study is a reminder that early MS intervention should incorporate interventions for these symptoms that are known to have strong associations with quality of life.”

The researchers had no disclosures.

[email protected]

SEATTLE – Pain, fatigue, depression, and anxiety are common among patients with multiple sclerosis (MS) in the 12 months after diagnosis, researchers reported at the annual meeting of the Consortium of Multiple Sclerosis Centers. In a novel study, about half of patients with MS reported clinically significant symptoms of depression or pain, and approximately 60% reported fatigue during that time.

Michigan Medicine

Pain, fatigue, depression, and anxiety are common in MS, but their prevalence in the first year after diagnosis is not well understood. To examine the rates of these conditions and how often they co-occur during that period, Anna L. Kratz, PhD, associate professor of physical medicine and rehabilitation at the University of Michigan in Ann Arbor, and her research colleagues had 231 adults with MS complete validated surveys at 1, 2, 3, 6, 9, and 12 months after diagnosis to assess symptoms of these conditions.

Overall, 47.2% of patients reported clinically significant levels of depression, 38.5% reported clinically significant levels of anxiety, 50.4% reported clinically significant pain, and 62.2% reported clinically significant fatigue at any point during the year after diagnosis. “Of those who did not have clinically significant symptoms at time of diagnosis, 21.3% went on to develop clinically significant depression, 17.0% anxiety, 30.9% pain, and 34.1% fatigue,” the authors reported.

About 23% of patients did not have clinically significant symptoms for any condition, while 20% had clinically significant symptoms for one condition, 21% for two, 19% for three, and 17% for all four.

Depression and fatigue had the highest rate of comorbidity, whereas pain and anxiety had the lowest rate of comorbidity.

“Important clinical symptoms associated with MS are present at high levels in the first year post diagnosis,” Dr. Kratz and colleagues concluded. “While the rates and severity are marginally lower than have been identified in studies of individuals farther into the MS disease course, this study is a reminder that early MS intervention should incorporate interventions for these symptoms that are known to have strong associations with quality of life.”

The researchers had no disclosures.

[email protected]

SEATTLE – The proportion of patients with multiple sclerosis (MS) who start a disease-modifying therapy (DMT) within 1 year of MS onset has increased in Southern Alberta, researchers reported at the annual meeting of the Consortium of Multiple Sclerosis Centers. During 1999-2004, about 20% of patients with MS started a DMT within 1 year of disease onset, compared with 60% of patients during 2015-2017, said Jamie Greenfield, MPH, an epidemiologist at the University of Calgary, Alta., and colleagues.

Studies suggest that early initiation of DMT may change the course of MS, but diagnostic delays and barriers to treatment “often impede this opportunity,” the investigators said at the annual meeting of the Consortium of Multiple Sclerosis Centers. To assess time to treatment initiation among patients with relapsing-remitting MS, the researchers analyzed administrative data from the Calgary MS Clinic. They determined the time to initiation of an approved first-line DMT from MS onset, first MS clinic appointment, MS diagnosis, and most recent prior MS clinic appointment. They excluded patients who started a second-line DMT, started a DMT before an MS clinic appointment, or started a DMT during a clinical trial. In addition, they excluded patients with MS onset before 1999, when government reimbursements for DMTs became available.

In all, 1,462 eligible patients started DMTs during August 1999–March 2018; 57.2% started glatiramer acetate, 28.2% interferon-beta, 12.5% dimethyl fumarate, and 2.1% teriflunomide. Average age at treatment initiation was 36 years, and 71.3% were women. Median Expanded Disability Status Scale (EDSS) score was 2.0, and about 90% were urban residents. Approximately 23% had MS diagnosed before their first visit, 37% at their first visit, and 40% after their first visit.

Median time to DMT initiations was 20.3 months from MS onset, 5.4 months from first appointment, 4.1 months from MS diagnosis, and 1.6 months from most recent prior appointment. During 2015-2017, a greater percentage of patients started a DMT within 1 year of MS onset, compared with 1999-2004 (60.9% vs. 20.4%). During 2015-2017, patients also were more likely to start DMTs within 1 year of their first appointment (88.4% vs. 65.7%), within 1 year of MS diagnosis (92.8% vs. 81.3%), and within 3 months of their most recent prior appointment (89.2% vs. 59.5%), compared with 1999-2004.

The investigators used Spearman rank correlations or Kruskal-Wallis tests to evaluate associations between baseline characteristics and time to DMT initiation. A diagnosis of MS or a relapsing-remitting MS course at the first appointment, older age at MS onset, longer MS duration at the first appointment, higher EDSS scores at the first or most recent prior appointment, and shorter time between diagnosis and first appointment, regardless of whether diagnosis occurred before or after the appointment, were associated with earlier DMT initiation.

“Treatment delays are improving. Better understanding of these delays will guide development of additional early-initiation strategies,” the authors concluded.

Ms. Greenfield had no disclosures. A coauthor reported consulting fees from Biogen, Roche, Sanofi Genzyme, and Serono.

[email protected]

SOURCE: Greenfield J et al. CMSC 2019, Abstract DXT25.




 

SEATTLE – The proportion of patients with multiple sclerosis (MS) who start a disease-modifying therapy (DMT) within 1 year of MS onset has increased in Southern Alberta, researchers reported at the annual meeting of the Consortium of Multiple Sclerosis Centers. During 1999-2004, about 20% of patients with MS started a DMT within 1 year of disease onset, compared with 60% of patients during 2015-2017, said Jamie Greenfield, MPH, an epidemiologist at the University of Calgary, Alta., and colleagues.

Studies suggest that early initiation of DMT may change the course of MS, but diagnostic delays and barriers to treatment “often impede this opportunity,” the investigators said at the annual meeting of the Consortium of Multiple Sclerosis Centers. To assess time to treatment initiation among patients with relapsing-remitting MS, the researchers analyzed administrative data from the Calgary MS Clinic. They determined the time to initiation of an approved first-line DMT from MS onset, first MS clinic appointment, MS diagnosis, and most recent prior MS clinic appointment. They excluded patients who started a second-line DMT, started a DMT before an MS clinic appointment, or started a DMT during a clinical trial. In addition, they excluded patients with MS onset before 1999, when government reimbursements for DMTs became available.

In all, 1,462 eligible patients started DMTs during August 1999–March 2018; 57.2% started glatiramer acetate, 28.2% interferon-beta, 12.5% dimethyl fumarate, and 2.1% teriflunomide. Average age at treatment initiation was 36 years, and 71.3% were women. Median Expanded Disability Status Scale (EDSS) score was 2.0, and about 90% were urban residents. Approximately 23% had MS diagnosed before their first visit, 37% at their first visit, and 40% after their first visit.

Median time to DMT initiations was 20.3 months from MS onset, 5.4 months from first appointment, 4.1 months from MS diagnosis, and 1.6 months from most recent prior appointment. During 2015-2017, a greater percentage of patients started a DMT within 1 year of MS onset, compared with 1999-2004 (60.9% vs. 20.4%). During 2015-2017, patients also were more likely to start DMTs within 1 year of their first appointment (88.4% vs. 65.7%), within 1 year of MS diagnosis (92.8% vs. 81.3%), and within 3 months of their most recent prior appointment (89.2% vs. 59.5%), compared with 1999-2004.

The investigators used Spearman rank correlations or Kruskal-Wallis tests to evaluate associations between baseline characteristics and time to DMT initiation. A diagnosis of MS or a relapsing-remitting MS course at the first appointment, older age at MS onset, longer MS duration at the first appointment, higher EDSS scores at the first or most recent prior appointment, and shorter time between diagnosis and first appointment, regardless of whether diagnosis occurred before or after the appointment, were associated with earlier DMT initiation.

“Treatment delays are improving. Better understanding of these delays will guide development of additional early-initiation strategies,” the authors concluded.

Ms. Greenfield had no disclosures. A coauthor reported consulting fees from Biogen, Roche, Sanofi Genzyme, and Serono.

[email protected]

SOURCE: Greenfield J et al. CMSC 2019, Abstract DXT25.




 

SEATTLE – The proportion of patients with multiple sclerosis (MS) who start a disease-modifying therapy (DMT) within 1 year of MS onset has increased in Southern Alberta, researchers reported at the annual meeting of the Consortium of Multiple Sclerosis Centers. During 1999-2004, about 20% of patients with MS started a DMT within 1 year of disease onset, compared with 60% of patients during 2015-2017, said Jamie Greenfield, MPH, an epidemiologist at the University of Calgary, Alta., and colleagues.

Studies suggest that early initiation of DMT may change the course of MS, but diagnostic delays and barriers to treatment “often impede this opportunity,” the investigators said at the annual meeting of the Consortium of Multiple Sclerosis Centers. To assess time to treatment initiation among patients with relapsing-remitting MS, the researchers analyzed administrative data from the Calgary MS Clinic. They determined the time to initiation of an approved first-line DMT from MS onset, first MS clinic appointment, MS diagnosis, and most recent prior MS clinic appointment. They excluded patients who started a second-line DMT, started a DMT before an MS clinic appointment, or started a DMT during a clinical trial. In addition, they excluded patients with MS onset before 1999, when government reimbursements for DMTs became available.

In all, 1,462 eligible patients started DMTs during August 1999–March 2018; 57.2% started glatiramer acetate, 28.2% interferon-beta, 12.5% dimethyl fumarate, and 2.1% teriflunomide. Average age at treatment initiation was 36 years, and 71.3% were women. Median Expanded Disability Status Scale (EDSS) score was 2.0, and about 90% were urban residents. Approximately 23% had MS diagnosed before their first visit, 37% at their first visit, and 40% after their first visit.

Median time to DMT initiations was 20.3 months from MS onset, 5.4 months from first appointment, 4.1 months from MS diagnosis, and 1.6 months from most recent prior appointment. During 2015-2017, a greater percentage of patients started a DMT within 1 year of MS onset, compared with 1999-2004 (60.9% vs. 20.4%). During 2015-2017, patients also were more likely to start DMTs within 1 year of their first appointment (88.4% vs. 65.7%), within 1 year of MS diagnosis (92.8% vs. 81.3%), and within 3 months of their most recent prior appointment (89.2% vs. 59.5%), compared with 1999-2004.

The investigators used Spearman rank correlations or Kruskal-Wallis tests to evaluate associations between baseline characteristics and time to DMT initiation. A diagnosis of MS or a relapsing-remitting MS course at the first appointment, older age at MS onset, longer MS duration at the first appointment, higher EDSS scores at the first or most recent prior appointment, and shorter time between diagnosis and first appointment, regardless of whether diagnosis occurred before or after the appointment, were associated with earlier DMT initiation.

“Treatment delays are improving. Better understanding of these delays will guide development of additional early-initiation strategies,” the authors concluded.

Ms. Greenfield had no disclosures. A coauthor reported consulting fees from Biogen, Roche, Sanofi Genzyme, and Serono.

[email protected]

SOURCE: Greenfield J et al. CMSC 2019, Abstract DXT25.




 

SEATTLE – Patients with multiple sclerosis (MS) are more than twice as likely as the general population to engage in significant hoarding behaviors, according to a small study that appears to be the first of its kind. It is not clear how MS and hoarding may be linked, but study author Joshua Bacon, PhD, an MS researcher and associate professor at New York University, and coauthors suspect that physical limitations are an important factor.

“It is important for clinicians to identify patients who might be hoarders and/or clutterers. It is very likely that this has an impact on the trajectory of their activities of daily living,” he said in an interview prior to the presentation of the study findings at the annual meeting of the Consortium of Multiple Sclerosis Centers.

Dr. Bacon said the study was inspired by his observation that hoarding and cluttering behavior appear to be common among patients with MS. “As I became more interested in it, it became clear there hasn’t been any work on this in the MS population.”

For the new study, Dr. Bacon and colleagues surveyed 139 consecutive patients with MS at the New York University MS Center. The patients had a mean age of 45 years and mean disease duration of 14 years; 71% were female, and 48% were non white. The researchers measured the patients on scales of hoarding behavior (Activities of Daily Living for Hoarding and the Hoarding Rating Scale) and disability (Patient-Determined Disability Steps).

The researchers found that nearly 12% showed signs of clinically significant hoarding behavior, compared with an estimated 5% of the general population (P = .0008). Researchers linked disability and Hoarding Rating Scale to the variability in degree of difficulty in performing activities of daily living (P less than .0001).

Dr. Bacon and colleagues do not believe MS is the direct cause of hoarding behaviors. “There has been no literature on this, and we do not know whether this is connected to the neurological condition,” he said. “I think it has more to do with physical capabilities.”

Patients with MS may have mobility problems that disrupt their ability to organize their homes, he said. “You can’t move things the way you can when you have normal mobility,” he said. “Things can start building up, and it is harder to get yourself out of the mess because you don’t have the wherewithal to move things out of that way.”

As a result, he said, patients may become more isolated if they become embarrassed about inviting people into their homes. To make matters worse, some patients with MS already suffer from social isolation, he said.

He added that some patients with MS may be “clutterers” who do not fit the definition of hoarders but are still affected. “Even cluttering can have an impact on quality of life. You do not have to have the disorder,” he said.

What can be done to help patients who are hoarders or clutterers? Dr. Bacon acknowledged that hoarding behavior is very difficult to treat successfully, but cluttering – a step below hoarding – may be easier to address.

“As therapists, we try to help MS patients confront the debilitating emotional distress that inevitably emerges from the loss of control as disability progresses,” he said. “A central emphasis in therapy is to turn the focus away from the neurological changes and their sequelae that cannot be changed to those facets of their lives over which they can have control and that can be nurtured and strengthened.”

No study funding was reported, and the study authors reported no relevant disclosures.

SEATTLE – Patients with multiple sclerosis (MS) are more than twice as likely as the general population to engage in significant hoarding behaviors, according to a small study that appears to be the first of its kind. It is not clear how MS and hoarding may be linked, but study author Joshua Bacon, PhD, an MS researcher and associate professor at New York University, and coauthors suspect that physical limitations are an important factor.

“It is important for clinicians to identify patients who might be hoarders and/or clutterers. It is very likely that this has an impact on the trajectory of their activities of daily living,” he said in an interview prior to the presentation of the study findings at the annual meeting of the Consortium of Multiple Sclerosis Centers.

Dr. Bacon said the study was inspired by his observation that hoarding and cluttering behavior appear to be common among patients with MS. “As I became more interested in it, it became clear there hasn’t been any work on this in the MS population.”

For the new study, Dr. Bacon and colleagues surveyed 139 consecutive patients with MS at the New York University MS Center. The patients had a mean age of 45 years and mean disease duration of 14 years; 71% were female, and 48% were non white. The researchers measured the patients on scales of hoarding behavior (Activities of Daily Living for Hoarding and the Hoarding Rating Scale) and disability (Patient-Determined Disability Steps).

The researchers found that nearly 12% showed signs of clinically significant hoarding behavior, compared with an estimated 5% of the general population (P = .0008). Researchers linked disability and Hoarding Rating Scale to the variability in degree of difficulty in performing activities of daily living (P less than .0001).

Dr. Bacon and colleagues do not believe MS is the direct cause of hoarding behaviors. “There has been no literature on this, and we do not know whether this is connected to the neurological condition,” he said. “I think it has more to do with physical capabilities.”

Patients with MS may have mobility problems that disrupt their ability to organize their homes, he said. “You can’t move things the way you can when you have normal mobility,” he said. “Things can start building up, and it is harder to get yourself out of the mess because you don’t have the wherewithal to move things out of that way.”

As a result, he said, patients may become more isolated if they become embarrassed about inviting people into their homes. To make matters worse, some patients with MS already suffer from social isolation, he said.

He added that some patients with MS may be “clutterers” who do not fit the definition of hoarders but are still affected. “Even cluttering can have an impact on quality of life. You do not have to have the disorder,” he said.

What can be done to help patients who are hoarders or clutterers? Dr. Bacon acknowledged that hoarding behavior is very difficult to treat successfully, but cluttering – a step below hoarding – may be easier to address.

“As therapists, we try to help MS patients confront the debilitating emotional distress that inevitably emerges from the loss of control as disability progresses,” he said. “A central emphasis in therapy is to turn the focus away from the neurological changes and their sequelae that cannot be changed to those facets of their lives over which they can have control and that can be nurtured and strengthened.”

No study funding was reported, and the study authors reported no relevant disclosures.

SEATTLE – Patients with multiple sclerosis (MS) are more than twice as likely as the general population to engage in significant hoarding behaviors, according to a small study that appears to be the first of its kind. It is not clear how MS and hoarding may be linked, but study author Joshua Bacon, PhD, an MS researcher and associate professor at New York University, and coauthors suspect that physical limitations are an important factor.

“It is important for clinicians to identify patients who might be hoarders and/or clutterers. It is very likely that this has an impact on the trajectory of their activities of daily living,” he said in an interview prior to the presentation of the study findings at the annual meeting of the Consortium of Multiple Sclerosis Centers.

Dr. Bacon said the study was inspired by his observation that hoarding and cluttering behavior appear to be common among patients with MS. “As I became more interested in it, it became clear there hasn’t been any work on this in the MS population.”

For the new study, Dr. Bacon and colleagues surveyed 139 consecutive patients with MS at the New York University MS Center. The patients had a mean age of 45 years and mean disease duration of 14 years; 71% were female, and 48% were non white. The researchers measured the patients on scales of hoarding behavior (Activities of Daily Living for Hoarding and the Hoarding Rating Scale) and disability (Patient-Determined Disability Steps).

The researchers found that nearly 12% showed signs of clinically significant hoarding behavior, compared with an estimated 5% of the general population (P = .0008). Researchers linked disability and Hoarding Rating Scale to the variability in degree of difficulty in performing activities of daily living (P less than .0001).

Dr. Bacon and colleagues do not believe MS is the direct cause of hoarding behaviors. “There has been no literature on this, and we do not know whether this is connected to the neurological condition,” he said. “I think it has more to do with physical capabilities.”

Patients with MS may have mobility problems that disrupt their ability to organize their homes, he said. “You can’t move things the way you can when you have normal mobility,” he said. “Things can start building up, and it is harder to get yourself out of the mess because you don’t have the wherewithal to move things out of that way.”

As a result, he said, patients may become more isolated if they become embarrassed about inviting people into their homes. To make matters worse, some patients with MS already suffer from social isolation, he said.

He added that some patients with MS may be “clutterers” who do not fit the definition of hoarders but are still affected. “Even cluttering can have an impact on quality of life. You do not have to have the disorder,” he said.

What can be done to help patients who are hoarders or clutterers? Dr. Bacon acknowledged that hoarding behavior is very difficult to treat successfully, but cluttering – a step below hoarding – may be easier to address.

“As therapists, we try to help MS patients confront the debilitating emotional distress that inevitably emerges from the loss of control as disability progresses,” he said. “A central emphasis in therapy is to turn the focus away from the neurological changes and their sequelae that cannot be changed to those facets of their lives over which they can have control and that can be nurtured and strengthened.”

No study funding was reported, and the study authors reported no relevant disclosures.

SEATTLE – Concomitant medication use is common when patients with multiple sclerosis (MS) start disease-modifying drugs (DMDs), according to research presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. The likelihood of particular comorbidities and concomitant medications varies by age and sex, researchers reported.

“This may have implications for MS treatment,” said study author Jacqueline Nicholas, MD, MPH, of Ohio Multiple Sclerosis Center in Columbus and her research colleagues. “A better understanding of the effects of comorbidities and concomitant medications on the effectiveness and safety of DMDs is needed to support clinical decision making.”

Researchers have examined comorbidities in patients with MS, but concomitant medication use among patients starting DMDs is poorly understood, the authors said.

To study this question, Dr. Nicholas and colleagues analyzed retrospective administrative claims data from IQVIA’s Real-World Data Adjudicated Claims–U.S. database from Jan. 1, 2010, to June 30, 2017. Their analysis included patients with two or more MS diagnosis claims and at least one DMD claim between Jan. 1, 2011, and June 30, 2015. Eligible patients were aged 18-63 years and had continuous eligibility with commercial insurance 1 year before and 2 years after DMD initiation. In addition, patients had no evidence of DMD use during the 1-year baseline period.

The investigators used International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes and claims to evaluate patients’ comorbidities and concomitant medications during the study period.

The researchers identified 8,251 eligible patients. Patients had a mean age of 43.2 years, and 75.5% were female. Average baseline Charlson comorbidity score was 0.41. In the 2 years after DMD initiation, common comorbid diagnoses were hyperlipidemia (30.0%), hypertension (28.2%), gastrointestinal disorders (26.2%), depression (25.5%), and anxiety (20.1%).

Common concomitant medications included antibiotics (70.6%); analgesics (57.0%); corticosteroids (52.0%); antidepressants (47.7%); anticonvulsants (46.7%); anxiolytics, sedatives, or hypnotics (43.2%); spasticity medications (36.2%); and muscle relaxants (35.4%).

Most comorbidities and many medications, including bladder and antifatigue medications, were more common among patients aged 55 years and older. Hyperlipidemia, hypertension, and diabetes were more likely in males than in females. Females were more likely to have gastrointestinal disease, depression, thyroid disease, anxiety, lung disease, and arthritis. In addition, females were more likely than males to use many of the concomitant medications.

Dr. Nicholas disclosed grant support from EMD Serono. A coauthor is an employee of Health Services Consulting Corporation and received funding from EMD Serono to conduct the study. Other coauthors are employees of EMD Serono.

[email protected]

SEATTLE – Concomitant medication use is common when patients with multiple sclerosis (MS) start disease-modifying drugs (DMDs), according to research presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. The likelihood of particular comorbidities and concomitant medications varies by age and sex, researchers reported.

“This may have implications for MS treatment,” said study author Jacqueline Nicholas, MD, MPH, of Ohio Multiple Sclerosis Center in Columbus and her research colleagues. “A better understanding of the effects of comorbidities and concomitant medications on the effectiveness and safety of DMDs is needed to support clinical decision making.”

Researchers have examined comorbidities in patients with MS, but concomitant medication use among patients starting DMDs is poorly understood, the authors said.

To study this question, Dr. Nicholas and colleagues analyzed retrospective administrative claims data from IQVIA’s Real-World Data Adjudicated Claims–U.S. database from Jan. 1, 2010, to June 30, 2017. Their analysis included patients with two or more MS diagnosis claims and at least one DMD claim between Jan. 1, 2011, and June 30, 2015. Eligible patients were aged 18-63 years and had continuous eligibility with commercial insurance 1 year before and 2 years after DMD initiation. In addition, patients had no evidence of DMD use during the 1-year baseline period.

The investigators used International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes and claims to evaluate patients’ comorbidities and concomitant medications during the study period.

The researchers identified 8,251 eligible patients. Patients had a mean age of 43.2 years, and 75.5% were female. Average baseline Charlson comorbidity score was 0.41. In the 2 years after DMD initiation, common comorbid diagnoses were hyperlipidemia (30.0%), hypertension (28.2%), gastrointestinal disorders (26.2%), depression (25.5%), and anxiety (20.1%).

Common concomitant medications included antibiotics (70.6%); analgesics (57.0%); corticosteroids (52.0%); antidepressants (47.7%); anticonvulsants (46.7%); anxiolytics, sedatives, or hypnotics (43.2%); spasticity medications (36.2%); and muscle relaxants (35.4%).

Most comorbidities and many medications, including bladder and antifatigue medications, were more common among patients aged 55 years and older. Hyperlipidemia, hypertension, and diabetes were more likely in males than in females. Females were more likely to have gastrointestinal disease, depression, thyroid disease, anxiety, lung disease, and arthritis. In addition, females were more likely than males to use many of the concomitant medications.

Dr. Nicholas disclosed grant support from EMD Serono. A coauthor is an employee of Health Services Consulting Corporation and received funding from EMD Serono to conduct the study. Other coauthors are employees of EMD Serono.

[email protected]

SEATTLE – Concomitant medication use is common when patients with multiple sclerosis (MS) start disease-modifying drugs (DMDs), according to research presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. The likelihood of particular comorbidities and concomitant medications varies by age and sex, researchers reported.

“This may have implications for MS treatment,” said study author Jacqueline Nicholas, MD, MPH, of Ohio Multiple Sclerosis Center in Columbus and her research colleagues. “A better understanding of the effects of comorbidities and concomitant medications on the effectiveness and safety of DMDs is needed to support clinical decision making.”

Researchers have examined comorbidities in patients with MS, but concomitant medication use among patients starting DMDs is poorly understood, the authors said.

To study this question, Dr. Nicholas and colleagues analyzed retrospective administrative claims data from IQVIA’s Real-World Data Adjudicated Claims–U.S. database from Jan. 1, 2010, to June 30, 2017. Their analysis included patients with two or more MS diagnosis claims and at least one DMD claim between Jan. 1, 2011, and June 30, 2015. Eligible patients were aged 18-63 years and had continuous eligibility with commercial insurance 1 year before and 2 years after DMD initiation. In addition, patients had no evidence of DMD use during the 1-year baseline period.

The investigators used International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes and claims to evaluate patients’ comorbidities and concomitant medications during the study period.

The researchers identified 8,251 eligible patients. Patients had a mean age of 43.2 years, and 75.5% were female. Average baseline Charlson comorbidity score was 0.41. In the 2 years after DMD initiation, common comorbid diagnoses were hyperlipidemia (30.0%), hypertension (28.2%), gastrointestinal disorders (26.2%), depression (25.5%), and anxiety (20.1%).

Common concomitant medications included antibiotics (70.6%); analgesics (57.0%); corticosteroids (52.0%); antidepressants (47.7%); anticonvulsants (46.7%); anxiolytics, sedatives, or hypnotics (43.2%); spasticity medications (36.2%); and muscle relaxants (35.4%).

Most comorbidities and many medications, including bladder and antifatigue medications, were more common among patients aged 55 years and older. Hyperlipidemia, hypertension, and diabetes were more likely in males than in females. Females were more likely to have gastrointestinal disease, depression, thyroid disease, anxiety, lung disease, and arthritis. In addition, females were more likely than males to use many of the concomitant medications.

Dr. Nicholas disclosed grant support from EMD Serono. A coauthor is an employee of Health Services Consulting Corporation and received funding from EMD Serono to conduct the study. Other coauthors are employees of EMD Serono.

[email protected]

SEATTLE – Anxiety and fatigue interact significantly and affect the rate of processing speed in patients with multiple sclerosis (MS), according to data described at the annual meeting of the Consortium of Multiple Sclerosis Centers. Increased anxiety is associated with slower processing speed in the context of increasing cognitive fatigue. “This [finding] has implications on development of cognitive remediation strategies, which may aim to target patient fatigue or anxiety to improve processing speed,” said Caroline Altaras, a doctoral candidate at Yeshiva University in New York, and colleagues.

Approximately 90% of patients with MS have fatigue, which can be a highly debilitating symptom. Fatigue often is understood to include motor fatigue (difficulty maintaining physical stamina) and cognitive fatigue (difficulty maintaining mental stamina). MS-related fatigue decreases patients’ quality of life, including cognitive functioning.

Anxiety is a psychiatric comorbidity that is highly prevalent in MS and that has a bidirectional association with fatigue. Anxiety and fatigue independently impair cognitive function.

Impaired processing speed is the most common cognitive impairment among patients with MS. Ms. Altaras and colleagues conducted a study to analyze how anxiety and fatigue interact to affect processing speed in MS. They evaluated total fatigue, cognitive fatigue, and motor fatigue separately. The investigators collected data from 183 patients with MS who had been referred by physicians for neuropsychological testing at the MS Center at Holy Name Medical Center in Teaneck, New Jersey. Researchers measured patients’ anxiety and fatigue using the Hospital Anxiety and Depression Scale (HADS, a self-reported measure) and the Fatigue Scale for Motor and Cognitive Functions (FSMC), which measures cognitive fatigue and motor fatigue. Patients also took the Symbol Digit Modalities Test (SDMT), a neuropsychological measure of processing speed. Ms. Altaras and colleagues created three multivariate general linear models using SPSS 25.0 to test the hypothesized relationships, using fatigue types (cognitive, motor, and total) as separate outcomes. The investigators controlled their analyses for gender, age, and education.

The researchers found a significant interaction effect of cognitive fatigue and anxiety on SDMT score. Specifically, patients with MS and minimal anxiety and cognitive fatigue had similar SDMT performance; as anxiety increased, patients who had increased cognitive fatigue demonstrated worse performance on the SDMT. Ms. Altaras and colleagues observed that SDMT performance improved slightly with worsening anxiety when cognitive fatigue was minimal. Although total fatigue interacted significantly with anxiety to affect SDMT performance, motor fatigue did not, which suggests that the effects of total fatigue largely resulted from cognitive fatigue.

The study had no outside financial support, and the authors reported no disclosures.

[email protected]

SEATTLE – Anxiety and fatigue interact significantly and affect the rate of processing speed in patients with multiple sclerosis (MS), according to data described at the annual meeting of the Consortium of Multiple Sclerosis Centers. Increased anxiety is associated with slower processing speed in the context of increasing cognitive fatigue. “This [finding] has implications on development of cognitive remediation strategies, which may aim to target patient fatigue or anxiety to improve processing speed,” said Caroline Altaras, a doctoral candidate at Yeshiva University in New York, and colleagues.

Approximately 90% of patients with MS have fatigue, which can be a highly debilitating symptom. Fatigue often is understood to include motor fatigue (difficulty maintaining physical stamina) and cognitive fatigue (difficulty maintaining mental stamina). MS-related fatigue decreases patients’ quality of life, including cognitive functioning.

Anxiety is a psychiatric comorbidity that is highly prevalent in MS and that has a bidirectional association with fatigue. Anxiety and fatigue independently impair cognitive function.

Impaired processing speed is the most common cognitive impairment among patients with MS. Ms. Altaras and colleagues conducted a study to analyze how anxiety and fatigue interact to affect processing speed in MS. They evaluated total fatigue, cognitive fatigue, and motor fatigue separately. The investigators collected data from 183 patients with MS who had been referred by physicians for neuropsychological testing at the MS Center at Holy Name Medical Center in Teaneck, New Jersey. Researchers measured patients’ anxiety and fatigue using the Hospital Anxiety and Depression Scale (HADS, a self-reported measure) and the Fatigue Scale for Motor and Cognitive Functions (FSMC), which measures cognitive fatigue and motor fatigue. Patients also took the Symbol Digit Modalities Test (SDMT), a neuropsychological measure of processing speed. Ms. Altaras and colleagues created three multivariate general linear models using SPSS 25.0 to test the hypothesized relationships, using fatigue types (cognitive, motor, and total) as separate outcomes. The investigators controlled their analyses for gender, age, and education.

The researchers found a significant interaction effect of cognitive fatigue and anxiety on SDMT score. Specifically, patients with MS and minimal anxiety and cognitive fatigue had similar SDMT performance; as anxiety increased, patients who had increased cognitive fatigue demonstrated worse performance on the SDMT. Ms. Altaras and colleagues observed that SDMT performance improved slightly with worsening anxiety when cognitive fatigue was minimal. Although total fatigue interacted significantly with anxiety to affect SDMT performance, motor fatigue did not, which suggests that the effects of total fatigue largely resulted from cognitive fatigue.

The study had no outside financial support, and the authors reported no disclosures.

[email protected]

SEATTLE – Anxiety and fatigue interact significantly and affect the rate of processing speed in patients with multiple sclerosis (MS), according to data described at the annual meeting of the Consortium of Multiple Sclerosis Centers. Increased anxiety is associated with slower processing speed in the context of increasing cognitive fatigue. “This [finding] has implications on development of cognitive remediation strategies, which may aim to target patient fatigue or anxiety to improve processing speed,” said Caroline Altaras, a doctoral candidate at Yeshiva University in New York, and colleagues.

Approximately 90% of patients with MS have fatigue, which can be a highly debilitating symptom. Fatigue often is understood to include motor fatigue (difficulty maintaining physical stamina) and cognitive fatigue (difficulty maintaining mental stamina). MS-related fatigue decreases patients’ quality of life, including cognitive functioning.

Anxiety is a psychiatric comorbidity that is highly prevalent in MS and that has a bidirectional association with fatigue. Anxiety and fatigue independently impair cognitive function.

Impaired processing speed is the most common cognitive impairment among patients with MS. Ms. Altaras and colleagues conducted a study to analyze how anxiety and fatigue interact to affect processing speed in MS. They evaluated total fatigue, cognitive fatigue, and motor fatigue separately. The investigators collected data from 183 patients with MS who had been referred by physicians for neuropsychological testing at the MS Center at Holy Name Medical Center in Teaneck, New Jersey. Researchers measured patients’ anxiety and fatigue using the Hospital Anxiety and Depression Scale (HADS, a self-reported measure) and the Fatigue Scale for Motor and Cognitive Functions (FSMC), which measures cognitive fatigue and motor fatigue. Patients also took the Symbol Digit Modalities Test (SDMT), a neuropsychological measure of processing speed. Ms. Altaras and colleagues created three multivariate general linear models using SPSS 25.0 to test the hypothesized relationships, using fatigue types (cognitive, motor, and total) as separate outcomes. The investigators controlled their analyses for gender, age, and education.

The researchers found a significant interaction effect of cognitive fatigue and anxiety on SDMT score. Specifically, patients with MS and minimal anxiety and cognitive fatigue had similar SDMT performance; as anxiety increased, patients who had increased cognitive fatigue demonstrated worse performance on the SDMT. Ms. Altaras and colleagues observed that SDMT performance improved slightly with worsening anxiety when cognitive fatigue was minimal. Although total fatigue interacted significantly with anxiety to affect SDMT performance, motor fatigue did not, which suggests that the effects of total fatigue largely resulted from cognitive fatigue.

The study had no outside financial support, and the authors reported no disclosures.

[email protected]