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Papukchieva S, Kahn M, Eberl M, Friedrich B, Joschko N, Ziemssen T. Data on Ocrelizumab Treatment Collected by MS Patients in Germany Using Brisa App. J Pers Med 2024; 14:409. [PMID: 38673036 PMCID: PMC11051290 DOI: 10.3390/jpm14040409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND With a rising number of multiple sclerosis (MS) cases and increasing pressure on health systems, digital companion apps like Brisa, designed specifically for people with MS, can play an important role in the patient journey. These apps enable the collection of real-time longitudinal data that are critical to our understanding of the pathophysiology and progression of MS. METHODS This retrospective, descriptive analysis consists of data from Brisa users who registered between 6 August 2021 and 8 September 2022. Of the unique users, 37.7% (n = 1593) fulfilled the inclusion criteria including information about medication and demographics and tracked one or more symptoms and/or patient-reported outcomes. Users were classified as moderate-efficacy treatment users, high-efficacy treatment users and ocrelizumab users, and the reporting frequency and scores of symptoms and patient-reported outcomes were analyzed. RESULTS The largest cohort of Brisa users (405) reported treatment with ocrelizumab and were mostly diagnosed 2-5 years before the survey. The most reported MS symptoms were similar between OUs (ocrelizumab users), HETUs (high-efficacy treatment users) and METUs (moderate-efficacy treatment users). OUs on average reported symptoms and answered questionnaires more frequently. Baseline scores between HETUs and OUs were similar, whereas baseline scores of METUs were slightly lower in comparison. In a further analysis of OUs, disability scores increased with age; users aged 26-45 years had higher pain scores than 18-25-year-olds. No significant differences were found in quality of life, bowel control and vision between age groups. CONCLUSION These findings show that the characteristics of the Brisa cohort are similar to the results of other studies and registries and can provide a representative overview of everyday disease management. Thereby, these results can bridge the gap between clinical research and real patient experience, but they also raise new questions, such as how often the hard-and-early therapy approach is already used and whether baseline characteristics and reasons for choosing a particular treatment contribute to the different outcomes over time. Answering these questions requires further research and analysis.
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Affiliation(s)
| | - Maria Kahn
- Temedica GmbH, 80687 Munich, Germany; (S.P.)
| | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus & Dresden University of Technology, 01307 Dresden, Germany
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Mountford S, Kahn M, Balakrishnan P, Jacyshyn-Owen E, Eberl M, Friedrich B, Joschko N, Ziemssen T. Correlation and differences of patient-reported outcomes vs. Likert-Rating of MS symptoms in a real-world cohort using a digital patient app. Digit Health 2023; 9:20552076231173520. [PMID: 37214657 PMCID: PMC10196529 DOI: 10.1177/20552076231173520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
Background Multiple Sclerosis (MS) is a chronic and progressive neurological autoimmune disease currently affecting 250,000 individuals in Germany. Patients suffering from the disease can be severely impaired in their day-to-day activities. BRISA is a digital app specifically designed to help MS patients monitor their disease by regularly tracking symptoms. Lengthy and time-consuming questionnaires for patient-reported outcomes (PRO) are the standard method to assess the patients' current condition. Here, we examine whether simplified versions of these questionnaires can provide comparable information regarding individual symptom presentations in BRISA users. Methods 828 users were included in the analysis. Patients who provided onboarding information and answered at least one questionnaire and the corresponding simplified smiley symptoms assessment were included. Correlation of questionnaire and symptom scores was calculated using Pearson's correlation. Results Our analysis cohort predominantly consisted of female, 26-55-year-olds. Relapsing-remitting MS (RRMS) was the most common MS type recorded. Most patients were diagnosed 2-5 years ago. Questionnaires regarding fatigue and vision impairment were among the most answered, those regarding bowel movement and sexual satisfaction received fewest responses. Overall, the scores from questionnaires and symptoms correlated positively. Scoring correlation could also be shown across the subgroups divided by gender, age groups, type of MS, and time since diagnosis of the disease. Conclusion Scores recorded from traditional PRO questionnaires can be reflected more easily as a trend in a simplified scale using smileys. Nevertheless, traditional questionnaires are needed to also maintain a more objective assessment. In conclusion, the patient will benefit most from an adaptive combination of regular traditional PRO questionnaire assessments and simplified symptom recording.
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Affiliation(s)
| | | | | | | | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience,
Department of Neurology, University Hospital Carl Gustav Carus, Dresden University
of Technology, Dresden, Germany
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3
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Balakrishnan P, Groenberg J, Jacyshyn-Owen E, Eberl M, Friedrich B, Joschko N, Ziemssen T. Demographic Patterns of MS Patients Using BRISA: An MS-Specific App in Germany. J Pers Med 2022; 12:jpm12071100. [PMID: 35887597 PMCID: PMC9325101 DOI: 10.3390/jpm12071100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Multiple sclerosis (MS) is a chronic, progressive neurological autoimmune disease impacting quality of life. BRISA is an app designed to help MS patients in Germany track their disease course by symptom-monitoring. This study aimed to understand demographic and health-related characteristics of BRISA users. Methods: Demographic data provided by 2095 users were analyzed to describe characteristics such as sex, age, type of MS, and medication. The distribution of tracked symptoms based on age and time since diagnosis were studied. Furthermore, the covariance of specific symptom pairs was analyzed. Results: BRISA users are predominantly female and between 26 and 55 years old. Relapsing–remitting MS was the most prevalent form of MS. First-line category 1 drugs were most frequently used, followed by high-efficacy category 3 drugs (e.g., monoclonal antibodies). The relative frequencies of use of category 1 and category 2 drugs (e.g., spingosine-1-phosphate-receptor modulators) significantly altered with time since diagnosis. Fatigue, concentration disorders, tingling, forgetfulness, and pain were the top five symptoms affecting users. Conclusion: The results highlight the diversity among MS patients and the need for extensive cohort characterization in the real-world scenario. In-depth analysis could help in identifying novel insights that could aid in disease management.
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Affiliation(s)
| | | | | | - Markus Eberl
- Temedica GmbH, 80636 Munich, Germany; (P.B.); (E.J.-O.); (M.E.)
| | - Benjamin Friedrich
- Temedica GmbH, 80636 Munich, Germany; (P.B.); (E.J.-O.); (M.E.)
- Correspondence:
| | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Clinic Carl Gustav Carus & Dresden University of Technology, 01307 Dresden, Germany;
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4
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Altmann P, Leutmezer F, Ponleitner M, Ivkic D, Krajnc N, Rommer PS, Berger T, Bsteh G. Remote visits for people with multiple sclerosis during the COVID-19 pandemic in Austria: The TELE MS randomized controlled trial. Digit Health 2022; 8:20552076221112154. [PMID: 35847524 PMCID: PMC9277439 DOI: 10.1177/20552076221112154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Continuous monitoring is the hallmark of managing chronic disease. Multiple
sclerosis (MS), in particular, requires patients to visit their treating
neurologists typically twice a year, at least. In that respect, the COVID-19
pandemic made us rethink our communication strategies. This study determined
satisfaction with remote visits for people with MS (pwMS) by comparing
non-inferiority to conventional visits. Methods TELE MS was a randomized controlled trial that was open to any person with
MS. We randomized a volunteer sample of 45 patients. We compared
satisfaction with remote visits (via phone or via videochat) with
conventional outpatient visits. The primary endpoint was patient
satisfaction determined by the Telemedicine Perception Questionnaire (TMPQ,
min: 17 and max: 85 points) with the hypothesis of non-inferiority of
televisits to conventional visits. Physician satisfaction measured on the
PPSM score (Patient and Physician Satisfaction with Monitoring, min: 5 and
max: 25 points) was the secondary endpoint. Results The trial met both endpoints. Mean (SD) TMPQ scores in the individual groups
were 58 (6.7) points for conventional visits, 65 (7.5) points for phone
visits, and 62 (5.5) points for video visits. Physician satisfaction over
the whole cohort was similarly high. Median (range) PPSM scores were 23
(16–25) for the whole cohort, 19 (16–25) for conventional visits, 25 (17–25)
for phone visits, and 25 (16–25) for video visits. Conclusions Televisits in multiple sclerosis yield a high level of satisfaction for both
patients and treating physicians. This concept for remote patient monitoring
adopted during the current pandemic may be communicable to other chronic
diseases as well. ClinicalTrials.gov identifier: NCT04838990
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Affiliation(s)
- Patrick Altmann
- Department of Neurology, Medical University of Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Austria
| | | | - Dominik Ivkic
- Department of Neurology, Medical University of Vienna, Austria
| | - Nik Krajnc
- Department of Neurology, Medical University of Vienna, Austria
| | | | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Austria
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Thiel S, Ciplea AI, Gold R, Hellwig K. The German Multiple Sclerosis and Pregnancy Registry: rationale, objective, design, and first results. Ther Adv Neurol Disord 2021; 14:17562864211054956. [PMID: 34840606 PMCID: PMC8613898 DOI: 10.1177/17562864211054956] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives: Multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) predominantly affect women of reproductive age. During the last few decades many disease-modifying therapies (DMTs) have been approved. It is therefore important to provide epidemiological structures for the collection of safety information on exposed pregnancies. Data on disease activity after withdrawal of DMTs are in high demand especially as severe relapses have been described after ceasing highly effective DMTs. Although breastfeeding is recommended, it is still unclear if the early reintroduction, especially of highly effective DMTs, has a beneficial effect on postpartum relapse risk or a combination of both, however safety data are lacking. Methods: The German MS and Pregnancy Registry (DMSKW) is a nationwide, observational, cohort study of pregnant women with MS or NMOSD, founded in 2006. As the study procedure has undergone important adaptation in recent years, described here is the updated methodology including data source and acquisition as well as variables collected within the DMSKW. Results: As of December 2020, the DMSKW database comprises 2579 pregnancies, 2568 with MS and 11 with NMOSD. Women are enrolled at a median gestational week of 11 (range: 0.02–42.1), have a median postpartum follow up of 1.2 years (range: 0–9.2) with 76% of all pregnancies being exposed to a DMT, mostly in the first trimester. Spontaneous abortion and preterm birth occurred in 7% and 10%, respectively; 19% of all women suffered from at least one relapse during pregnancy, with a minimum of 6% during the third trimester of pregnancy. Conclusion: The DMSKW is a valuable structure in providing safety data on drug exposure during pregnancy and lactation in combination with information on disease activity up to 6 years postpartum. This article will be the reference for describing the methods of future publications from the DMSKW.
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Affiliation(s)
- Sandra Thiel
- Department of Neurology, St. Josef Hospital - Katholisches Klinikum Bochum GmbH, Ruhr University Bochum, Bochum, Germany
| | - Andrea I Ciplea
- Department of Neurology, St. Josef Hospital - Katholisches Klinikum Bochum GmbH, Ruhr University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital - Katholisches Klinikum Bochum GmbH, Ruhr University Bochum, Bochum, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital - Katholisches Klinikum Bochum GmbH, Ruhr University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
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Schriefer D, Haase R, Ness NH, Ziemssen T. Cost of illness in multiple sclerosis by disease characteristics - A review of reviews. Expert Rev Pharmacoecon Outcomes Res 2021; 22:177-195. [PMID: 34582300 DOI: 10.1080/14737167.2022.1987218] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: In light of the increasing number of economic burden studies and heterogeneity in methodology and reporting standards, there is a need for robust evidence synthesis on an umbrella review level.Areas covered: We performed the first review of reviews of cost-of-illness studies in multiple sclerosis. Focusing on disaggregated costs by disease characteristics (disability level, relapse, disease course), we also characterized the underlying methodological evidence base of individual (primary) studies.Expert Commentary: We identified 17 reviews encompassing 111 unique primary studies, and a high degree of overlap across reviews. Costs were substantial, rising with disability level, relapse episodes, and disease progression. Disability was the key cost driver. Compared to mild disability, total costs for moderate disability were 1.4-2.3-fold higher and 1.8-2.9-fold higher for severe disability. With escalating disability, the share of costs outside the health system (indirect costs, informal care) increasingly outweighed the share of direct medical costs. Of all 111 primary studies, 72% gathered resource use/loss data by patient self-report. Associated costs were mostly reported by disability level (75%), followed by relapse (48%) and disease course (21%). In conclusion, although heterogeneity can make in-depth comparisons of costs across studies impossible, important patterns are broadly apparent.
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Affiliation(s)
- Dirk Schriefer
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Rocco Haase
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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Wicks CR, Sloan R, DiMauro S, Thompson EL, Billington S, Webb M, Pepper G. Patients' experiences of self-identification, seeking support, and anticipation of potential relapse in multiple sclerosis. Mult Scler Relat Disord 2021; 56:103259. [PMID: 34628265 DOI: 10.1016/j.msard.2021.103259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/17/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) relapses are associated with increased disability, reduced quality of life and negative psychosocial impacts. However, they often go unrecognised; people with MS (MSers) may face barriers to self-identification of relapses or seeking support for them. The charity Shift.ms sought to better understand 1) MSers' challenges in self-identifying potential relapses, 2) where MSers' seek support for potential relapses, and 3) the impact of the anticipation of relapses on MSers' wellbeing and daily living. METHODS Shift.ms developed a patient perspective 8-question pilot survey (included likert-style, multiple-choice, and optional free-text responses) and shared it with Shift.ms' international online community (n = 20,052). Descriptive quantitative analysis, and content analysis and thematic analysis of qualitative free-text responses were used. RESULTS 1,737 MSers responded. Just under one third (29.9%) of MSers reported that it takes them 24 h or less to self-identify a potential relapse, while more than half (54.5%) reported that identification occurs within 48 h; 55% MSers felt that the "at least 24 h" clinical criterion of relapse classification was appropriate. Challenges to relapse self-identification included confounding background symptoms or infection, variability of relapse symptoms, and individualistic nature of MS. Fatigue was reported to be the most common symptom of relapse (75%), however fatigue was also the symptom most commonly mistaken for relapse (40%). Barriers to relapse self-identification were a shorter duration since MS diagnosis and a perceived lack of consensus around relapse classification. Respondents reported they most often seek relapse support/advice from healthcare professionals (HCPs) (37.1%), family/friends (32.1%), or not at all (16.9%). Rather than temporal criteria (i.e. the 24 h criterion), participants felt that severity of symptoms could play a more critical role in whether to seek support for a potential relapse. Barriers to seeking support/advice included variability in HCP advice and feelings of invalidation. Anticipation of relapses negatively impacted MSers wellbeing; led to reduced participation in activities, and the development of adjustment/coping strategies. Relapse triggers included stress, reduced self-care, infection/illness; 78.5% reported stress or anxiety had triggered relapse. CONCLUSIONS These findings highlight difficulties MSers face in self-identifying relapses, barriers to accessing support, and impact of anticipation of relapses. They also highlight opportunities for improved MSer and HCP communication, dialogue and two-way education to help optimise patient access to relapse support and intervention.
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Affiliation(s)
| | - Rob Sloan
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | - Sophie DiMauro
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | | | - Sam Billington
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | - Mark Webb
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK
| | - George Pepper
- Shift.ms, Platform, New Station Street, Leeds, LS1 4JB, UK.
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8
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Riccardi A, Ognibene F, Mondini S, Nucci M, Margoni M, Meglioranzi I, Carta E, Zywicki S, Miante S, Perini P, Rinaldi F, Puthenparampil M, Gallo P. Designing a Self-Perception Cognitive Questionnaire for Italian Multiple Sclerosis Patients (Sclerosi Multipla Autovalutazione Cognitiva, SMAC). A Preliminary Exploratory Pilot Study. Front Neurol 2021; 12:668933. [PMID: 34262521 PMCID: PMC8273489 DOI: 10.3389/fneur.2021.668933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Although cognition in multiple sclerosis (MS) is assessed by means of several neuropsychological tests, only a few tools exist to investigate patients' perspectives on cognitive functioning. Objective: To develop a new questionnaire aimed at exploring patients' self-perception with respect to cognition in Italian MS patients. Methods: A total of 120 relapsing-remitting MS (RRMS) patients and 120 matched healthy controls (HC) completed a 25-item questionnaire called the Sclerosi Multipla Autovalutazione Cognitiva (SMAC). The Symbol Digit Modalities Test (SDMT), the Delis-Kaplan Executive Function System Sorting Test (D-KEFS ST), the Beck Depression Inventory (BDI-II), and the Fatigue Scale (FSS) were also administered to the patients. Results: Significantly higher SMAC scores were displayed by RRMS patients compared with HC (30.1 ± 16.9 vs. 23.4 ± 10.4, p = 0.003). SMAC inversely correlated with SDMT (r = −0.31, p < 0.001), D-KEFS ST FSC (r = −0.21, p = 0.017), D-KEFS ST FSD (r = −0.22, p = 0.015) and D-KEFS ST SR (r = −0.19, p = 0.035) and positively correlated with FSS (r = 0.42, p < 0.001) and BDI-II (r = 0.59, p < 0.001). Cronbach's alpha coefficient for the questionnaire was 0.94. Conclusion: Preliminary findings suggest that SMAC is a promising patient-reported outcome to be included in MS neuropsychological evaluation and thus warrants being further tested and developed.
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Affiliation(s)
- Alice Riccardi
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Francesca Ognibene
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Sara Mondini
- Department of Philosophy, Sociology, Education and Applied Psychology, Human Inspired Technology Research Centre- HIT, University of Padua, Padua, Italy
| | - Massimo Nucci
- Department of General Psychology, Human Inspired Technology Research Centre- HIT, University of Padua, Padua, Italy
| | - Monica Margoni
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Ilaria Meglioranzi
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Elisa Carta
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Sofia Zywicki
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Silvia Miante
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Paola Perini
- Multiple Sclerosis Center, University Hospital of Padua, Padua, Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Center, University Hospital of Padua, Padua, Italy
| | - Marco Puthenparampil
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
| | - Paolo Gallo
- Department of Neuroscience, Multiple Sclerosis Center, University of Padua, Padua, Italy
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Garjani A, Middleton RM, Hunter R, Tuite-Dalton KA, Coles A, Dobson R, Duddy M, Hughes S, Pearson OR, Rog D, Tallantyre EC, das Nair R, Nicholas R, Evangelou N. COVID-19 is associated with new symptoms of multiple sclerosis that are prevented by disease modifying therapies. Mult Scler Relat Disord 2021; 52:102939. [PMID: 34010764 PMCID: PMC9585399 DOI: 10.1016/j.msard.2021.102939] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/23/2022]
Abstract
Background Infections can trigger exacerbations of multiple sclerosis (MS). The effects of the coronavirus disease 2019 (COVID-19) on MS are not known. The aim of this study was to understand the impact of COVID-19 on new and pre-existing symptoms of MS. Methods The COVID-19 and MS study is an ongoing community-based, prospective cohort study conducted as part of the United Kingdom MS Register. People with MS and COVID-19 were invited by email to complete a questionnaire about their MS symptoms during the infection. An MS exacerbation was defined as developing new MS symptoms and/or worsening of pre-existing MS symptoms. Results Fifty-seven percent (230/404) of participants had an MS exacerbation during their infection; 82 developed new MS symptoms, 207 experienced worsened pre-existing MS symptoms, and 59 reported both. Disease modifying therapies (DMTs) reduced the likelihood of developing new MS symptoms during the infection (OR 0.556, 95%CI 0.316–0.978). Participants with a higher pre-COVID-19 webEDSS (web-based Expanded Disability Status Scale) score (OR 1.251, 95%CI 1.060–1.478) and longer MS duration (OR 1.042, 95%CI 1.009–1.076) were more likely to experience worsening of their pre-existing MS symptoms during the infection. Conclusion COVID-19 infection was associated with exacerbation of MS. DMTs reduced the chance of developing new MS symptoms during the infection.
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Affiliation(s)
- Afagh Garjani
- Mental Health and Clinical Neuroscience Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK; Clinical Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Rachael Hunter
- College of Health and Human Science, Swansea University, Swansea, UK
| | | | - Alasdair Coles
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - Ruth Dobson
- Preventive Neurology Unit, Queen Mary University London, London, UK
| | - Martin Duddy
- Neurosciences, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Stella Hughes
- Department of Neurology, Belfast Health and Social Care Trust, Belfast, UK
| | - Owen R Pearson
- Neurology Department, Swansea Bay University Health Board, Swansea, UK
| | - David Rog
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Emma C Tallantyre
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Roshan das Nair
- Mental Health and Clinical Neuroscience Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK; Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Richard Nicholas
- Department of Cellular and Molecular Neuroscience, Imperial College London, London, UK
| | - Nikos Evangelou
- Mental Health and Clinical Neuroscience Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK; Clinical Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Torkildsen Ø, Linker RA, Sesmero JM, Fantaccini S, Sanchez-de la Rosa R, Seze JD, Duddy M, Chan A. Living with secondary progressive multiple sclerosis in Europe: perspectives of multiple stakeholders. Neurodegener Dis Manag 2020; 11:9-19. [PMID: 33234006 DOI: 10.2217/nmt-2020-0054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The transition from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis (SPMS) remains a clinical challenge owing to the heterogeneous course of the disease, indistinct disease progression and lack of availability of validated biomarkers and diagnostic tools. This article summarizes the outcomes from an international expert group meeting conducted to validate the preliminary research findings gathered through interviews with primary healthcare stakeholders and pharmaceutical representatives, and to understand the current and future patient journey of SPMS across seven European countries. We highlight the uncertainty in SPMS diagnosis and management and, consequently, the need for uniform assessment guidelines, enhanced awareness and a collaborative effort between the stakeholders associated with SPMS patient care and the pharmaceutical industry.
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Affiliation(s)
- Øivind Torkildsen
- Department of Neurology, Haukeland University Hospital, 5020, Bergen, Norway
| | - Ralf A Linker
- Department of Neurology, University Hospital, 93053, Regensburg, Germany
| | | | | | | | - Jerome de Seze
- University Hospital of Strasbourg, 67200, Strasbourg, France
| | - Martin Duddy
- Department of Neurology, The Newcastle upon Tyne Hospitals Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
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11
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Bazi A, Baghbanian SM, Ghazaeian M, Saeedi M, Hendoiee N. Efficacy and safety of oral prednisolone tapering following intravenous methyl prednisolone in patients with multiple sclerosis relapses: A randomized, double-blind, placebo-controlled trial. Mult Scler Relat Disord 2020; 47:102640. [PMID: 33310419 DOI: 10.1016/j.msard.2020.102640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Relapse is one of the main features of multiple sclerosis (MS). Corticosteroids are the first line of management during MS relapse. Since tapering or non-tapering prednisolone after corticosteroid pulse has been a controversial issue, this clinical trial is designed to evaluate the efficacy and safety of the tapering regimen. METHODS Having been treated by intravenous methylprednisolone (IVMP) pulse, sixty-six patients with MS-relapse were randomly assigned to receive oral prednisolone tapering (OPT) or placebo. The regimen was administered in line with the study protocol and the dose was tapered over 20 days. Demographics and symptoms, impact on activities of daily living (ADL), and management procedures were recorded according to Assessing Relapse in Multiple Sclerosis (ARMS) Questionnaire. The incidence of adverse events was assessed using the same questionnaire. Patients' disability improvement was assessed using the Extended Disability Scale (EDSS) during relapse, and over the first, third, sixth months following treatment. RESULTS As shown by the results of the questionnaire, 75% reported that their ADL was not or minimally affected by OPT and there was no significant difference in terms of ADL after treatment between the two groups (p=0.3). The effect of treatment on return to the previous state of health (RSH) showed that there were no differences between the two groups of the study (p=0.5). The improvement of disability in the two groups of oral prednisolone and placebo did not indicate a difference in terms of EDSS in the first and third and six months (p = 0.5, p = 0.9, p=0.3, respectively). Also, the occurrence of some side effects such as weight gain (p = 0.000) and increased appetite (p = 0.004) was higher in the OPT group. CONCLUSION The findings of this study revealed that the efficacy of an OPT after a corticosteroid pulse is non-superior to IVMP plus only in case the safety and tolerability profile are comparable.
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Affiliation(s)
- Aliyeh Bazi
- Department of Clinical Pharmacy, Faculty of pharmacy, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | | | - Monireh Ghazaeian
- Department of Clinical Pharmacy, Faculty of pharmacy, Mazandaran University of Medical Sciences, Mazandaran, Iran.
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Narjes Hendoiee
- Department of Clinical Pharmacy, Faculty of pharmacy, Mazandaran University of Medical Sciences, Mazandaran, Iran
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