Journal: Multiple Sclerosis and Related Disorders

Abbreviation

Mult Scler Relat Disord

Publisher

Elsevier

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ISSN

2211-0356
2211-0348

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2020 - 202613
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Publications 1 - 10 of 13
  • Relapse activity during pregnancy and the postpartum year is associated with accelerated disability progression in multiple sclerosis
    Item type: Journal Article
    Walter , Lea I.; Kana , Veronika; Hösli , Sarah; et al. (2026)
    Multiple Sclerosis and Related Disorders
    Management of multiple sclerosis (MS) presents unique challenges during pregnancy, particularly regarding disease-modifying therapies (DMT) and the risk of postpartum relapses. We investigated DMT exposure and further clinical and radiological parameters to identify predictors of relapse and disability progression during pregnancy and the postpartum year. We identified 112 pregnancies in 70 women with MS followed between 2010 and 2023. After excluding pregnancies lasting <22 weeks, 96 pregnancies in 66 women, primarily with relapsing-remitting MS (RRMS), were included in the analysis. 77 pregnancies (80.2 %) developed during DMT exposure, with natalizumab, injectables, and fumarates being the most common. Relapse during pregnancy or the postpartum year occurred in 33 pregnancies, with 39.5 % happening during pregnancy and 60.5 % in the postpartum year, peaking in the first postpartum trimester. Women with pregnancies complicated by relapses during pregnancy or the postpartum year had lower rates of DMT exposure (66.7 % vs. 87.3 %, p = 0.016) and a non-significant trend toward higher baseline disability at conception. Disability progression within the first postpartum year was more frequent in the relapse group (25.8 % vs. 5.5 %, p = 0.010), with sustained differences in EDSS at two years postpartum. Postpartum MRI showed higher lesion load and more contrast-enhancing lesions in the relapse group. Spinal lesions at diagnosis and prior to conception were associated with significant higher risk of relapse during pregnancy and the postpartum year. Subgroup analysis of pregnant women treated with natalizumab indicated a lower relapse risk when natalizumab was continued into the third trimester. Pregnancy outcomes were mostly favorable, with 95.4 % term births and no significant differences in delivery mode or neonatal outcomes between women with versus without relapses during pregnancy. Our findings emphasize the importance of DMT management, particularly the potential benefits of sustained natalizumab therapy for high-risk pregnancies. These results highlight the need for tailored treatment strategies to minimize postpartum relapses and long-term disability progression for women with MS.
  • Effect of Ozanimod on Symbol Digit Modalities Test Performance in Relapsing MS
    Item type: Journal Article
    DeLuca, John; Schippling, Sven; Montalban, Xavier; et al. (2021)
    Multiple Sclerosis and Related Disorders
    Background Cognitive dysfunction, including slowed cognitive processing speed (CPS), is one of the most disabling symptoms of multiple sclerosis (MS). The Symbol Digit Modalities Test (SDMT) is a preferred measure of CPS for MS trials and routine screening. Based on encouraging SDMT results in the phase 3 SUNBEAM trial, these post hoc, exploratory analyses were conducted to further compare effects of the sphingosine 1-phosphate receptor modulator ozanimod versus intramuscular interferon β-1a on CPS in participants with relapsing multiple sclerosis (RMS). Methods In the phase 3, double-blind, double-dummy, SUNBEAM study, adults (aged 18‒55 years) with RMS (N=1,346) were randomized to once-daily oral ozanimod 0.92 or 0.46 mg, or weekly intramuscular interferon β-1a 30 µg. The study continued until the last participant was treated for 12 months. CPS was measured as part of a secondary endpoint using the SDMT. Exploratory, post hoc analyses evaluated SDMT change and percentages of participants with clinically meaningful (≥4-point) SDMT improvement or worsening at months 6 and 12, and relationship between SDMT and brain volume on magnetic resonance imaging. Results Ozanimod improved SDMT scores compared with interferon β-1a at months 6 and 12. At month 12, least squares mean difference in SDMT z-scores for ozanimod 0.92 mg versus interferon β-1a was 0.102 (95% CI, 0.031‒0.174, nominal p = 0.0051; standardized mean difference = 0.1376). A greater percentage of ozanimod 0.92 mg‒treated participants had clinically meaningful improvements in SDMT scores versus interferon β-1a at month 6 (30.0% versus 22.2%) and month 12 (35.6% versus 27.9%). Of those with SDMT improvement at month 6, 66.4% of those treated with ozanimod 0.92 mg and 55.9% of those treated with interferon β-1a had sustained improvement at month 12. Brain volume loss was similar for those with SDMT improvement versus worsening at month 12. Conclusions In these exploratory analyses, ozanimod had modestly beneficial effects on CPS in RMS participants. The effects of ozanimod on SDMT are being further evaluated in an ongoing 3-year clinical trial. SUNBEAM is registered on clinicaltrials.gov (NCT02294058) and the European Clinical Trials Database (EudraCT 2014‐002320‐27).
  • Self-reports by persons with multiple sclerosis are an adequate surrogate for healthcare provider data on disease-modifying therapy and multiple sclerosis type
    Item type: Journal Article
    Stanikić, Mina; Braun, Julia; Ajdacic-Gross, Vladeta; et al. (2023)
    Multiple Sclerosis and Related Disorders
    Introduction: Self-reports are a valuable and cost-effective method of data collection, though they can be influenced by bias. Limited evidence exists on the quality of self-reports by persons with multiple sclerosis (pwMS), particularly since more potent disease-modifying therapies (DMTs) have been introduced. This study aimed to assess the reliability and validity of self-reported DMT use and multiple sclerosis (MS) type in the Swiss Multiple Sclerosis Registry (SMSR) by comparing self-reports with reimbursement approval requests from the Swiss Association for Joint Tasks of Health Insurers. Methods: The self-reported and reimbursement approval data were linked using privacy-preserving methods based on information available in both databases, i.e., date of birth, canton of residence, sex, and year of MS diagnosis. The SMSR baseline questionnaire data was utilized for the main analysis, while the SMSR follow-up survey data was utilized for the sensitivity analysis. For both analyses, we compared self-reported data with reimbursement approval data that corresponded to the respective periods of the SMSR data collection. Thus, the main analysis included the entirety of the data over the six-year period, while the sensitivity analysis captured a more recent snapshot of the data. To assess reliability, we estimated agreement using Cohen's kappa, and for validity, we estimated accuracy parameters using reimbursement approvals as the reference standard. Univariable and multivariable logistic regression models were employed to investigate factors associated with discordance between self-reports and reimbursement approvals in the main analysis. Results: The main analysis included 446 participants, and the sensitivity analysis included 193 participants. The agreement between self-reported and reimbursement approval data for medication use was near-perfect in both analyses (κ = 0.87, 95% confidence interval (CI) 0.85, 0.90 and κ = 0.82, 95% CI 0.76, 0.88). However, the agreement between self-reported and reimbursement approval-documented MS types ranged from fair to moderate (κ = 0.37, 95% CI 0.25, 0.48 to κ = 0.61, 95% CI 0.46, 0.77). The accuracy estimates for self-reported DMT use were generally high (≥ 0.80) with narrow CIs, except for less frequently reported drugs. While the sensitivity and specificity for RRMS were high, there was a notable possibility of false-negative self-reports for RRMS (NPV = 0.33, 95% CI 0.22, 0.45), and false-positive reports for SPMS (PPV = 0.36, 95% CI 0.21, 0.54). Multivariable logistic regression models showed that age (OR = 1.07, 95% CI 1.04, 1.10 per year) and education level (OR = 0.27, 95% CI 0.11, 0.65) were associated with discordance in reported and documented MS types, whereas possession of Swiss citizenship (OR = 0.32, 95% CI 0.14, 0.72) was associated with discordance in DMT use. Conclusion: Self-reported DMT use in pwMS is a reliable and valid information source, with near-perfect agreement and high accuracy. Self-reported MS types showed fair to moderate agreement and varying accuracy, likely reflecting the complexity of diagnosing progressive forms of MS and access to DMTs. In population-based MS research, self-reports of MS types, and particularly DMT use, can serve as a suitable surrogate for healthcare provider data.
  • Reliability and validity of a novel device for quantifying ankle dorsiflexion force in persons with multiple sclerosis
    Item type: Journal Article
    Asmussen, Michael J.; Mauracher, Marita E.; Omu, Onutobor; et al. (2020)
    Multiple Sclerosis and Related Disorders
  • Persistent longitudinal T cell responses after SARS-CoV-2 mRNA vaccines in MS patients on different disease modifying treatments
    Item type: Journal Article
    Disanto, Giulio; Galante, Alice; Sacco, Rosaria; et al. (2024)
    Multiple Sclerosis and Related Disorders
    Few data are available regarding vaccine induced SARS-CoV-2 specific T cell responses over time and after booster doses in multiple sclerosis (MS) patients on different disease modifying treatments. We measured SARS-CoV-2 specific CD4+ T cell responses in 72 samples collected from 36 MS patients. The percentage of CD4+ CTVlow CD25+ ICOS+ T cells after stimulation with Spike Recombinant Protein was 29.9 (17.0–43.6) on teriflunomide, 32.4 (11.9–42.5) on ocrelizumab, but much lower (0.6 [0.3–5.9]) on sphingosine-1-phospate receptor modulators (β = −26.35, p = 0.003). SARS-CoV-2 specific T cells were mainly of Th1 type and stable over time and after booster vaccine doses. mRNA vaccines elicit strong and persistent CD4+ T cell responses against SARS-CoV-2 in MS patients on anti-CD20 and teriflunomide, but not in those on sphingosine-1-phospate receptor modulators.
  • Treatment strategies of AQP4-IgG positive neuromyelitis optica spectrum disorder and MOG antibody-associated disorder in Switzerland: a nationwide survey
    Item type: Journal Article
    Steinegger, Lukas; Kana, Veronika; Pot, Caroline; et al. (2025)
    Multiple Sclerosis and Related Disorders
    Introduction: Neuromyelitis optica spectrum disorders (NMOSD) and Myelin Oligodendrocyte Glycoprotein (MOG) antibody-associated disease (MOGAD) are neuroinflammatory conditions characterized by attacks, primarily affecting the spinal cord and the optic nerve. When left untreated, these disorders can result in severe neurological disability. Although recent advancements have improved treatment, many questions remain regarding the optimal management of these rare conditions. Methods: We conducted a national survey among neurologists in Switzerland experienced in treating NMOSD and MOGAD. The survey comprised 42 questions covering diagnostic methods, acute treatment, maintenance immunotherapy and approaches to long-term strategy. Results: Twenty-one out of 28 invited neurologists took part in the survey (response rate 75 %). There was high consensus on treating acute attacks with high-dose steroids and with plasmapheresis in severe cases. In NMOSD, 71.4 % recommended oral steroid tapering, compared to 85.7 % in MOGAD. All participants advocated maintenance treatment after the first attack in NMOSD, compared to only 10 % in MOGAD. Indeed, many participants advised starting therapy in MOGAD after the first attack only in cases of severe attacks (38 %), persistent MOG-antibodies (10 %) or both (19 %). Rituximab was the most used first-line maintenance immunotherapy for both diseases. Approaches to treatment strategy for the long-term varied with a tendency to recommend de-escalation or discontinuation in stable patients with MOGAD, but not with NMOSD. Discussion: This study highlights current treatment approaches to NMOSD and MOGAD across Switzerland. Rituximab remains the most prescribed drug for both conditions. The overall variability in recommendations underscores the need for greater awareness of disease-specific management and for further research to optimize treatment strategies for patients with NMOSD and MOGAD.
  • Prognosis of walking function in multiple sclerosis supported by gait pattern analysis
    Item type: Journal Article
    Zörner, Björn; Hostettler, Pascal; Meyer, Christian; et al. (2022)
    Multiple Sclerosis and Related Disorders
    Background: Walking impairment is a common and highly disabling symptom in people with MS (PwMS). Ambulatory deterioration is poorly characterized in PwMS and reliable prognosis that may guide clinical decisions is elusive. This study aimed to objectively track the progression of clinical walking performance and kinematic gait patterns in PwMS over 4 years, thereby revealing potential prognostic markers for deterioration of ambulatory function. Methods: Twenty-two PwMS (48.8 ± 9.9 years, 14 females; expanded disability status scale [EDSS]: 4.5 ± 0.9 points) with gait impairments were recruited at the University Hospital Zurich, Switzerland. Gait function was monitored over a period of 4 years using a set of standardized clinical walking tests (timed 25-foot walk [T25FW], 6 min walk test [6MWT], 12-item MS walking scale [MSWS-12]) and comprehensive 3D kinematic gait analysis. Walking decline was assessed in the full patient cohort and in patient sub-groups that were built according to MS type (relapsing-remitting [RRMS], progressive [PMS]) and subjects' pathological gait signature (cluster groups 1–3). Results: In the total cohort (n = 22), we found a significant worsening in the 6MWT (BL vs. 4y: -41.1 m; P = 0.0053), while the performance in the T25FW, MSWS-12 and the EDSS remained unchanged over 4 years. Subjects with PMS (n = 12) showed a significant worsening in the EDSS (BL vs. 4y: +0.6 points; P = 0.0053), which was not observed in participants with RRMS (n = 10). Whereas deterioration of clinical walking function was not different between subjects with RRMS and PMS, we identified differences in clinical walking deterioration between PwMS with varying gait pattern pathologies: Subjects with spastic-paretic gait impairments (cluster 1; n = 9) demonstrated a marked worsening in the T25FW (BL vs. 4y: +2 s; P = 0.0020) and 6MWT (BL vs. 4y: -92.9 m; P < 0.0001) which was not seen in PwMS with an ataxia-like (cluster 2; n = 8) or unstable walking pattern (cluster 3; n = 5). Deterioration of clinical walking performance in cluster 1 was accompanied by a specific worsening of gait deficits that were characteristic of this cluster at baseline, a phenomenon not found in the other sub-groups. Accordingly, aggravation of cluster 1-specific gait impairments over 4 years predicted deterioration of the 6MWT in the total cohort (n = 22) with an accuracy of 90.9% (sensitivity: 90.9%; specificity: 90.9%; Nagelkerkes coefficient of determination R2: 0.721), unveiling key determinants of MS-related walking decline. Conclusions: Our findings highlight the potential of quantitative, functional outcomes for objective tracking of disease progression in PwMS. Gait pattern analysis can provide valuable information on the underlying pathomechanisms of gait deterioration and may represent a complementary prognostic tool for walking function in PwMS. Clinical trial: clinicaltrials.gov, NCT01576354
  • Physiotherapy use and access-barriers in persons with multiple sclerosis: A cross-sectional analysis
    Item type: Journal Article
    Fortunato, Remo; van der Maas, Nico A.; Biland-Thommen, Ursula; et al. (2021)
    Multiple Sclerosis and Related Disorders
    Introduction Physiotherapy may alleviate many multiple sclerosis (MS) symptoms, yet very little is known about physiotherapy accessibility and possible barriers in persons with MS (pwMS). We therefore aimed to elucidate physiotherapy use and possible access-barriers using data from 1493 pwMS from the Swiss Multiple Sclerosis Registry (SMSR), a patient-centered, longitudinal, observational MS study. Methods We used data of the SMSR to investigate the question at hand in a multivariable logistic regression model with regularly receiving physiotherapy (yes/no) as the outcome. Potential explanatory variables were investigated following an AIC-driven model selection approach and consisted of a priori specified socio-demographic variables, health status, and personal or social mobility variables. As a last step, the impact of physiotherapist supply on regular use was assessed in the final model. Missing data were handled by multiple imputation (main analysis), and complete case sensitivity analyses were performed. Results The main analysis included 1493 participants. In the multivariable logistic regression, positive associations were found between the use of physiotherapy and the following variables: having a primary-progressive MS (Odds Ratio (OR) [95% Confidence Intervals] 1.97 [1.18; 3.29]), being more severely impaired (EDSS 4-6.5 OR 1.84 [1.16; 2.91]), higher number of current symptoms (1 OR 3.31 [1.63; 6.74], 2-3 OR 3.43 [1.8; 6.53], 4-5 OR 4.44 [2.28; 8.66], 6-7 OR 4.06 [1.90; 8.70], 8-9 OR 3.87 [1.71; 8.75], being on disability pension (OR 1.75 [1.24; 2.46], or having applied for it OR 2.25 [1.31; 3.85]), having gait problems (OR 1.58 [1.11; 2.23]), having been in a rehabilitation clinic in the past 12 months (OR 4.43 [2.17; 9.03]), and currently being on disease-modifying treatment (OR 1.61 [1.12; 2.31]). Negative associations were found for a higher quality of life (OR 0.92 [0.85; 0.98]), working more than 80% (OR 0.47 [0.30; 0.75]) and being from the French language region (OR 0.66 [0.47; 0.94]). No association between physiotherapist supply and regular physiotherapy use was detected. Discussion In a large, Swiss-based MS population, little evidence for socio-demographic barriers to physical therapy was found. Physiotherapy uptake was higher among pwMS with more impairments, lower health-related quality of life, or who have been discharged recently from inpatient rehabilitation. The uptake differences by language region warrant further investigations.
  • Factors associated with material deprivation in persons with multiple sclerosis in Switzerland: Cross-sectional data from the Swiss Multiple Sclerosis Registry
    Item type: Journal Article
    Sanak, Lisa; Kamm, Christian Philipp; Chan, Andrew; et al. (2023)
    Multiple Sclerosis and Related Disorders
    Background Multiple sclerosis (MS) impacts education, future career pathways and working capability and therefore may negatively impact the financial situation of persons with MS (pwMS) in Switzerland. We therefore investigated the financial situation and its influencing sociodemographic and disease-specific factors of pwMS compared to the general Swiss population with focus on material deprivation (MD). Methods Data on the financial situation of pwMS were collected via a specific questionnaire added to the regular, semi-annual follow-up assessments of the Swiss Multiple Sclerosis Registry. Questions were taken in an unmodified format from the standardized “Statistics on Income and Living Conditions” (SILC) questionnaire 2019 of the Federal Statistical Office of Switzerland which evaluates the financial situation of the general Swiss population, enabling a direct comparison of pwMS with the general Swiss population. Results PwMS were 1.5 times more frequently affected by MD than the general Swiss population (6.3% of pwMS versus 4.2% of the general Swiss population) which was confirmed in a multivariable logistic regression analysis of pooled SILC and Swiss Multiple Sclerosis Registry (SMSR) data. High symptom burden, having only mandatory schooling, well as having a pending disability insurance application (as opposed to no application or receiving benefits) were associated with a higher odds of MD whereas higher education, older age, having a Swiss citizenship, living with a spouse or a partner or being currently employed were independently associated with a lower odds of MD. Conclusion MS has a negative impact on the financial situation and is associated with MD. PwMS with a high symptom burden at the transition from work force to receiving disability benefits appeared to be vulnerable for MD. Higher education, older age, having a Swiss citizenship, living with a spouse or a partner or being currently employed were independently associated with a lower odds of MD.
  • Association of age and disease duration with comorbidities and disability: A study of the Swiss Multiple Sclerosis Registry
    Item type: Journal Article
    Stanikić, Mina; Salmen, Anke; Chan, Andrew; et al. (2022)
    Multiple Sclerosis and Related Disorders
    Background While comorbidities increase with age, duration of multiple sclerosis (MS) leads to disability accumulation in persons with MS. The influence of ageing vis-a-vis MS duration remains largely unexplored. We studied the independent associations of ageing and MS duration with disability and comorbidities in the Swiss MS Registry participants. Methods Self-reported data was cross-sectionally analyzed using confounder-adjusted logistic regression models for 6 outcomes: cancer, type 2 diabetes (T2D), hypertension, cardiac diseases, depression, and having at least moderate or severe gait disability. Using cubic splines, we explored non-linear changes in risk shapes. Results Among 1615 participants age was associated with cardiac diseases (OR 1.05, 95% CI [1.02, 2.08]), hypertension (OR 1.08, 95% CI [1.06, 2.10]), T2D (OR 1.10, 95%CI [1.05, 1.16]) and cancer (OR 1.04, 95% CI [1.01, 1.07]). MS duration was not associated with comorbidities, except for cardiac diseases (OR 1.03, 95% CI [1.00, 1.06]). MS duration and age were independently associated with having at least moderate gait disability (OR 1.06, 95% CI [1.04, 1.07]; OR 1.04, 95% CI [1.02, 1.05], respectively), and MS duration was associated with severe gait disability (OR 1.05, 95% CI [1.03, 1.08]). The spline analysis suggested a non-linear increase of having at least moderate gait disability with age. Conclusions Presence of comorbidities was largely associated with age only. Having at least moderate gait disability was associated with both age and MS duration, while having severe gait disabity was associated with MS duration only.
Publications 1 - 10 of 13