1
|
Patel MA, Villalobos F, Shan K, Tardo LM, Horton LA, Sguigna PV, Blackburn KM, Munoz SB, Moog TM, Smith AD, Burgess KW, McCreary M, Okuda DT. Generative artificial intelligence versus clinicians: Who diagnoses multiple sclerosis faster and with greater accuracy? Mult Scler Relat Disord 2024; 90:105791. [PMID: 39146892 DOI: 10.1016/j.msard.2024.105791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/05/2024] [Accepted: 07/27/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Those receiving the diagnosis of multiple sclerosis (MS) over the next ten years will predominantly be part of Generation Z (Gen Z). Recent observations within our clinic suggest that younger people with MS utilize online generative artificial intelligence (AI) platforms for personalized medical advice prior to their first visit with a specialist in neuroimmunology. The use of such platforms is anticipated to increase given the technology driven nature, desire for instant communication, and cost-conscious nature of Gen Z. Our objective was to determine if ChatGPT (Generative Pre-trained Transformer) could diagnose MS in individuals earlier than their clinical timeline, and to assess if the accuracy differed based on age, sex, and race/ethnicity. METHODS People with MS between 18 and 59 years of age were studied. The clinical timeline for people diagnosed with MS was retrospectively identified and simulated using ChatGPT-3.5 (GPT-3.5). Chats were conducted using both actual and derivatives of their age, sex, and race/ethnicity to test diagnostic accuracy. A Kaplan-Meier survival curve was estimated for time to diagnosis, clustered by subject. The p-value testing for differences in time to diagnosis was accomplished using a general Wilcoxon test. Logistic regression (subject-specific intercept) was used to capture intra-subject correlation to test the accuracy prior to and after the inclusion of MRI data. RESULTS The study cohort included 100 unique people with MS. Of those, 50 were members of Gen Z (38 female; 22 White; mean age at first symptom was 20.6 years (y) (standard deviation (SD)=2.2y)), and 50 were non-Gen Z (34 female; 27 White; mean age at first symptom was 37.0y (SD=10.4y)). In addition, a total of 529 people that represented digital simulations of the original cohort of 100 people (333 female; 166 White; 136 Black/African American; 107 Asian; 120 Hispanic, mean age at first symptom was 31.6y (SD=12.4y)) were generated allowing for 629 scripted conversations to be analyzed. The estimated median time to diagnosis in clinic was significantly longer at 0.35y (95% CI=[0.28, 0.48]) versus that by ChatGPT at 0.08y (95% CI=[0.04, 0.24]) (p<0.0001). There was no difference in the diagnostic accuracy between ages and by race/ethnicity prior to the inclusion of MRI data. However, prior to including the MRI data, males had a 47% less likely chance of a correct diagnosis relative to females (p=0.05). Post-MRI data inclusion within GPT-3.5, the odds of an accurate diagnosis was 4.0-fold greater for Gen Z participants, relative to non-Gen Z participants (p=0.01) with the diagnostic accuracy being 68% less in males relative to females (p=0.009), and 75% less for White subjects, relative to non-White subjects (p=0.0004). CONCLUSION Although generative AI platforms enable rapid information access and are not principally designed for use in healthcare, an increase in use by Gen Z is anticipated. However, the obtained responses may not be generalizable to all users and bias may exist in select groups.
Collapse
Affiliation(s)
- Mahi A Patel
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, Texas, USA
| | - Francisco Villalobos
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, Texas, USA
| | - Kevin Shan
- The University of Texas Southwestern Medical Center, School of Medicine, Dallas, Texas, USA
| | - Lauren M Tardo
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, Texas, USA
| | - Lindsay A Horton
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, Texas, USA
| | - Peter V Sguigna
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, Texas, USA
| | - Kyle M Blackburn
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, Texas, USA
| | - Shanan B Munoz
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, Texas, USA
| | - Tatum M Moog
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, Texas, USA
| | - Alexander D Smith
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas, USA
| | - Katy W Burgess
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, Texas, USA
| | - Morgan McCreary
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, Texas, USA
| | - Darin T Okuda
- The University of Texas Southwestern Medical Center, Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Dallas, TX, USA; The University of Texas Southwestern Medical Center, Peter O'Donnell Jr. Brain Institute, Dallas, Texas, USA.
| |
Collapse
|
2
|
Jacobs BM, Schalk L, Tregaskis-Daniels E, Tank P, Hoque S, Peter M, Tuite-Dalton K, Witts J, Bove R, Dobson R. The relationship between ethnicity and multiple sclerosis characteristics in the United Kingdom: A UK MS Register study. Mult Scler 2024:13524585241277018. [PMID: 39301820 DOI: 10.1177/13524585241277018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
BACKGROUND Previous studies have suggested differences in multiple sclerosis (MS) severity according to ethnicity. METHODS Data were obtained from the UK MS Register, a prospective longitudinal cohort study of persons with MS. We examined the association between self-reported ethnic background and age at onset, symptom of onset and a variety of participant-reported severity measures. We used adjusted multivariable linear regression models to explore the association between ethnicity and impact of MS, and Cox proportional hazards models to assess disability progression. RESULTS We analysed data from 17,314 people with MS, including participants from self-reported Black (n = 157) or South Asian (n = 230) ethnic backgrounds. Age at MS onset and diagnosis was lower in those of South Asian (median 30.0) and Black (median 33.0) ethnicity compared with White ethnicity (median 35.0). In participants with online MS severity measures available, we found no statistically significant evidence for an association between ethnic background and physical disability in MS in both cross-sectional and longitudinal analyses. CONCLUSION We found no association between ethnic background and MS severity in a large, diverse UK cohort. These findings suggest that other factors, such as socioeconomic status and structural inequalities, may explain previous findings.
Collapse
Affiliation(s)
- Benjamin M Jacobs
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK Department of Neurology, Royal London Hospital, London, UK
| | - Luisa Schalk
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Emily Tregaskis-Daniels
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Pooja Tank
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Sadid Hoque
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | - Michelle Peter
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, UK
| | | | - James Witts
- UK MS Register, University of Swansea, Swansea, UK
| | - Riley Bove
- UCSF Weill Institute for Neurosciences, UCSF, San Francisco, CA, USA
| | - Ruth Dobson
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, UK Department of Neurology, Royal London Hospital, London, UK
| |
Collapse
|
3
|
Nadeem ZA, Ashraf H, Nadeem A, Kareem R, Ashfaq H, Majid Z, Ashraf A. Trends in mortality due to multiple sclerosis in the United States: A retrospective analysis from 1999 to 2020. Mult Scler Relat Disord 2024; 89:105765. [PMID: 39029341 DOI: 10.1016/j.msard.2024.105765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/30/2024] [Accepted: 07/07/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a neuroinflammatory condition with a prevalence of about 309.2 per 100,000 people in the United States. We aim to identify MS-related mortality trends in the USA from 1999 to 2020, stratified by age, sex, race, and geography, and its correlation with sunlight. METHODS Death certificates from the CDC-WONDER database were examined for adults aged ≥25 years. Crude rates (CR) and age-adjusted mortality rates (AAMRs) per 1,000,000 persons and annual percent change (APC) were calculated. We also retrieved data for daily sunlight from 1999 to 2011. RESULTS From 1999 to 2020, a total of 121,694 deaths occurred due to MS. The AAMR rose from 23.6 in 1999 to 29.7 in 2020 (APC 0.65), with a stable trend till 2018 (APC -0.22) followed by an abrupt increase towards 2020 (APC 9.27). Women had higher AAMR than men. Non-Hispanic (NH) Whites exhibited the highest AAMR (28.5), followed by NH Blacks (25.9), NH American Indians/Alaska Natives (9.6), Hispanics or Latino (6.8), and NH Asian or Pacific Islanders (1.9). AAMRs also varied substantially by region (Midwest: 32.4; Northeast: 26.9; West: 26.2; South: 19.4). States with the highest AAMRs were Montana, Wyoming, Colorado, and Oregon. The states with lower daily sunlight had higher AAMRs (r = -0.559, p = 0.000). AAMRs were comparable in urban (25) and rural (26.3) areas. Most deaths occurred in medical facilities (33.92 %) and nursing homes / long-term care (30.80 %), followed by home (27.79 %), and hospice (4.06 %). Adults ≥ 65 years depicted the highest mortality rates (CR 64.4) while adults aged 25 to 44 years showed the lowest rates (CR 4.6). CONCLUSION We found an overall stable trend in MS-related mortality rates in the US till 2018 with a sharp increase thereafter. We observed highest mortality among women and NH White adults, among residents of Midwest and Northeast regions, and among adults ≥ 65 years. Higher disease burden in recent years calls for devising timely policies focused on these high-risk populations.
Collapse
Affiliation(s)
- Zain Ali Nadeem
- Department of Medicine, Allama Iqbal Medical College, Pakistan
| | - Hamza Ashraf
- Department of Cardiology, Allama Iqbal Medical College, Pakistan
| | - Aimen Nadeem
- Department of Medicine, King Edward Medical University, Pakistan
| | - Rutaab Kareem
- Department of Medicine, King Edward Medical University, Pakistan
| | - Haider Ashfaq
- Department of Medicine, Allama Iqbal Medical College, Pakistan
| | - Zuha Majid
- Department of Medicine, King Edward Medical University, Pakistan
| | - Ali Ashraf
- Government College University, Lahore, Pakistan
| |
Collapse
|
4
|
Chang JHC, Bethoux F, Plow MA. Subjective Well-Being, Positive Affect, Life Satisfaction, and Happiness With Multiple Sclerosis: A Scoping Review of the Literature. Rehabil Nurs 2024; 49:156-168. [PMID: 39219021 DOI: 10.1097/rnj.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
PURPOSE People with multiple sclerosis (MS) may face challenges maintaining their subjective well-being, life satisfaction, happiness, and positive emotions. This scoping review's purpose was to summarize studies on these positive psychological constructs among people with MS. METHODS Observational and interventional studies that included measures of subjective well-being, life satisfaction, happiness, or positive affect were identified. Variables associated with these constructs were classified using the International Classification of Functioning, Disability and Health (ICF). RESULTS The review included 22 observational and 10 interventional studies. Variables were categorized into each of the ICF domains. Cognitive behavior therapy was the most common intervention, with content and dosing varying widely. CLINICAL RELEVANCE Subjective well-being, life satisfaction, happiness, and positive affect are crucial components of community and individual health. The findings of this scoping review highlight the complex interplay between function, personal factors, and environmental conditions in influencing positive psychological constructs. Given the limited evidence, rehabilitation nurses should leverage their skills in delivering holistic care and adopt data-driven approaches to integrate positive psychological strategies into care plans. CONCLUSION Further research is needed to measure and compare interventions aimed at improving these constructs and to examine the influence of personal and environmental factors among diverse MS populations.
Collapse
Affiliation(s)
- Julia H C Chang
- Department of Nursing, California State University Channel Islands, Camarillo, CA, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Neurological Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Matthew A Plow
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
5
|
Williams MJ, Amezcua L, Cohan SL, Cohen JA, Delgado SR, Hua LH, Lucassen EB, Piccolo RS, Koulouris CR, Stankiewicz J. Efficacy of Ofatumumab and Teriflunomide in Patients With Relapsing MS From Racial/Ethnic Minority Groups: ASCLEPIOS I/II Subgroup Analyses. Neurology 2024; 103:e209610. [PMID: 39018512 PMCID: PMC11314949 DOI: 10.1212/wnl.0000000000209610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 05/09/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Race and ethnicity may influence the efficacy of disease-modifying therapies in patients with multiple sclerosis (MS). Incidence of MS in ethnically diverse groups may be higher; however, these populations are under-represented in MS trials. This post hoc analysis compared the proportion of patients achieving 3-parameter no evidence of disease activity (NEDA-3) with ofatumumab vs teriflunomide in participants with relapsing MS (RMS) enrolled in the ASCLEPIOS I/II trials by race/ethnicity subgroup. METHODS ASCLEPIOS I/II were identical, double-blind, double-dummy, active-controlled, multicenter, phase 3 trials. Participants were randomized (1:1) to receive ofatumumab 20 mg every 4 weeks or teriflunomide 14 mg once daily for up to 30 months. Pooled data were used to determine the efficacy/safety of ofatumumab vs teriflunomide in participants who self-identified as non-Hispanic Black, non-Hispanic Asian, Hispanic/Latino, or non-Hispanic White. Participants who did not self-identify into one of these groups were classified as other/unknown. RESULTS Of the 1,882 participants, 64 (3.4%) self-identified as non-Hispanic Black, 71 (3.8%) as non-Hispanic Asian, 145 (7.7%) as Hispanic/Latino, and 1,538 (81.7%) as non-Hispanic White. Baseline participant demographics/characteristics were largely balanced across subgroups, aside from minor variations in sex, disease duration, and MRI lesions. From months 0 to 24, the proportion of ofatumumab vs teriflunomide-treated patients achieving NEDA-3 (odds ratio [95% CI]) was as follows: non-Hispanic Black, 33.3% vs 3.4% (15.9 [1.67-151.71; p = 0.0162]); non-Hispanic Asian, 42.9% vs 21.9% (3.18 [0.95-10.59; p = 0.06]); Hispanic/Latino, 36.6% vs 18.6% (3.21 [1.32-7.79; p = 0.01]); and non-Hispanic White, 37.4% vs 16.6% (3.57 [2.73-4.67; p < 0.0001]). Rates of AEs were generally similar between treatment groups and across race/ethnicity subgroups; no new or unexpected safety signals were identified. DISCUSSION Ofatumumab was associated with greater proportions of NEDA-3 achievement than teriflunomide across race/ethnicity subgroups in the ASCLEPIOS trials. Within each treatment group, the proportion of patients achieving NEDA-3 from months 0 to 24 was similar across the subgroups and overall pooled population. Both ofatumumab and teriflunomide were well tolerated. Future MS trials should include ethnically diverse groups to better inform treatment decisions and improve real-world patient outcomes. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov: NCT02792218 (clinicaltrials.gov/ct2/show/NCT02792218), NCT02792231 (clinicaltrials.gov/ct2/show/NCT02792231). Submission date: June 2, 2016. First enrollment: August 26, 2016. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that among patients aged 18-55 years with RMS, the improvement in NEDA-3 with ofatumumab was comparably better than with teriflunomide among patients self-identified as non-Hispanic Black, non-Hispanic Asian, non-Hispanic White, Hispanic/Latino, and other/unknown.
Collapse
Affiliation(s)
- Mitzi J Williams
- From the Joi Life Wellness MS Center (M.J.W.), Atlanta, GA; University of Southern California (L.A.), Los Angeles; Providence Multiple Sclerosis Center (S.L.C.), Providence Brain and Spine Institute, Portland, OR; Cleveland Clinic Mellen Center (J.A.C.) OH; Department of Neurology (S.R.D.), University of Miami Miller School of Medicine, FL; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Novartis Pharmaceuticals Corporation (E.B.L., R.S.P., J.S.), East Hanover, NJ; and Envision Pharma, Inc. (C.R.K.), Horsham, United Kingdom
| | - Lilyana Amezcua
- From the Joi Life Wellness MS Center (M.J.W.), Atlanta, GA; University of Southern California (L.A.), Los Angeles; Providence Multiple Sclerosis Center (S.L.C.), Providence Brain and Spine Institute, Portland, OR; Cleveland Clinic Mellen Center (J.A.C.) OH; Department of Neurology (S.R.D.), University of Miami Miller School of Medicine, FL; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Novartis Pharmaceuticals Corporation (E.B.L., R.S.P., J.S.), East Hanover, NJ; and Envision Pharma, Inc. (C.R.K.), Horsham, United Kingdom
| | - Stanley L Cohan
- From the Joi Life Wellness MS Center (M.J.W.), Atlanta, GA; University of Southern California (L.A.), Los Angeles; Providence Multiple Sclerosis Center (S.L.C.), Providence Brain and Spine Institute, Portland, OR; Cleveland Clinic Mellen Center (J.A.C.) OH; Department of Neurology (S.R.D.), University of Miami Miller School of Medicine, FL; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Novartis Pharmaceuticals Corporation (E.B.L., R.S.P., J.S.), East Hanover, NJ; and Envision Pharma, Inc. (C.R.K.), Horsham, United Kingdom
| | - Jeffrey A Cohen
- From the Joi Life Wellness MS Center (M.J.W.), Atlanta, GA; University of Southern California (L.A.), Los Angeles; Providence Multiple Sclerosis Center (S.L.C.), Providence Brain and Spine Institute, Portland, OR; Cleveland Clinic Mellen Center (J.A.C.) OH; Department of Neurology (S.R.D.), University of Miami Miller School of Medicine, FL; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Novartis Pharmaceuticals Corporation (E.B.L., R.S.P., J.S.), East Hanover, NJ; and Envision Pharma, Inc. (C.R.K.), Horsham, United Kingdom
| | - Silvia R Delgado
- From the Joi Life Wellness MS Center (M.J.W.), Atlanta, GA; University of Southern California (L.A.), Los Angeles; Providence Multiple Sclerosis Center (S.L.C.), Providence Brain and Spine Institute, Portland, OR; Cleveland Clinic Mellen Center (J.A.C.) OH; Department of Neurology (S.R.D.), University of Miami Miller School of Medicine, FL; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Novartis Pharmaceuticals Corporation (E.B.L., R.S.P., J.S.), East Hanover, NJ; and Envision Pharma, Inc. (C.R.K.), Horsham, United Kingdom
| | - Le H Hua
- From the Joi Life Wellness MS Center (M.J.W.), Atlanta, GA; University of Southern California (L.A.), Los Angeles; Providence Multiple Sclerosis Center (S.L.C.), Providence Brain and Spine Institute, Portland, OR; Cleveland Clinic Mellen Center (J.A.C.) OH; Department of Neurology (S.R.D.), University of Miami Miller School of Medicine, FL; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Novartis Pharmaceuticals Corporation (E.B.L., R.S.P., J.S.), East Hanover, NJ; and Envision Pharma, Inc. (C.R.K.), Horsham, United Kingdom
| | - Elisabeth B Lucassen
- From the Joi Life Wellness MS Center (M.J.W.), Atlanta, GA; University of Southern California (L.A.), Los Angeles; Providence Multiple Sclerosis Center (S.L.C.), Providence Brain and Spine Institute, Portland, OR; Cleveland Clinic Mellen Center (J.A.C.) OH; Department of Neurology (S.R.D.), University of Miami Miller School of Medicine, FL; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Novartis Pharmaceuticals Corporation (E.B.L., R.S.P., J.S.), East Hanover, NJ; and Envision Pharma, Inc. (C.R.K.), Horsham, United Kingdom
| | - Rebecca S Piccolo
- From the Joi Life Wellness MS Center (M.J.W.), Atlanta, GA; University of Southern California (L.A.), Los Angeles; Providence Multiple Sclerosis Center (S.L.C.), Providence Brain and Spine Institute, Portland, OR; Cleveland Clinic Mellen Center (J.A.C.) OH; Department of Neurology (S.R.D.), University of Miami Miller School of Medicine, FL; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Novartis Pharmaceuticals Corporation (E.B.L., R.S.P., J.S.), East Hanover, NJ; and Envision Pharma, Inc. (C.R.K.), Horsham, United Kingdom
| | - Chloe R Koulouris
- From the Joi Life Wellness MS Center (M.J.W.), Atlanta, GA; University of Southern California (L.A.), Los Angeles; Providence Multiple Sclerosis Center (S.L.C.), Providence Brain and Spine Institute, Portland, OR; Cleveland Clinic Mellen Center (J.A.C.) OH; Department of Neurology (S.R.D.), University of Miami Miller School of Medicine, FL; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Novartis Pharmaceuticals Corporation (E.B.L., R.S.P., J.S.), East Hanover, NJ; and Envision Pharma, Inc. (C.R.K.), Horsham, United Kingdom
| | - James Stankiewicz
- From the Joi Life Wellness MS Center (M.J.W.), Atlanta, GA; University of Southern California (L.A.), Los Angeles; Providence Multiple Sclerosis Center (S.L.C.), Providence Brain and Spine Institute, Portland, OR; Cleveland Clinic Mellen Center (J.A.C.) OH; Department of Neurology (S.R.D.), University of Miami Miller School of Medicine, FL; Cleveland Clinic Lou Ruvo Center for Brain Health (L.H.H.), Las Vegas, NV; Novartis Pharmaceuticals Corporation (E.B.L., R.S.P., J.S.), East Hanover, NJ; and Envision Pharma, Inc. (C.R.K.), Horsham, United Kingdom
| |
Collapse
|
6
|
Ponzano M, Signori A, Bellavia A, Carbone A, Bovis F, Schiavetti I, Montobbio N, Sormani MP. Race and ethnicity in multiple sclerosis phase 3 clinical trials: A systematic review. Mult Scler 2024; 30:934-967. [PMID: 38849992 DOI: 10.1177/13524585241254283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Distinctive differences in multiple sclerosis (MS) have been observed by race and ethnicity. We aim to (1) assess how often race and ethnicity were reported in clinical trials registered on ClinicalTrials.gov, (2) evaluate whether the population was diverse enough, and (3) compare with publications. METHODS We included phase 3 clinical trials registered with results on ClinicalTrials.gov between 2007 and 2023. When race and/or ethnicity were reported, we searched for the corresponding publications. RESULTS Out of the 99 included studies, 56% reported race and/or ethnicity, of which only 26% of those primarily completed before 2017. Studies reporting race or ethnicity contributed to a total of 33,891 participants, mainly enrolled in Eastern Europe. Most were White (93%), and the median percentage of White participants was 93% (interquartile range (IQR) = 86%-98%), compared to 3% for Black (IQR = 1%-12%) and 0.2% for Asian (IQR = 0%-1%). Four trials omitted race and ethnicity in publications and even when information was reported, some discrepancies in terminology were identified and categories with fewer participants were often collapsed. CONCLUSION More efforts should be done to improve transparency, accuracy, and representativeness, in publications and at a design phase, by addressing social determinants of health that historically limit the enrollment of underrepresented population.
Collapse
Affiliation(s)
- Marta Ponzano
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Andrea Bellavia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alessio Carbone
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Francesca Bovis
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Irene Schiavetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Noemi Montobbio
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| |
Collapse
|
7
|
Koh MJ, Saffari SE, Tye JSN, Aw AYY, Siew RWE, Peng X, Tan JMM, Tan K, Yeo T. A comparison of multiple sclerosis disease characteristics across three genetically diverse Asian racial groups in Singapore. Sci Rep 2024; 14:14690. [PMID: 38918591 PMCID: PMC11199559 DOI: 10.1038/s41598-024-65575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/21/2024] [Indexed: 06/27/2024] Open
Abstract
Studies in Western populations have shown that Black and Hispanic patients have an earlier age of Multiple Sclerosis (MS) onset and a more severe disease course characterised by faster disability accrual compared to Whites. It is yet unclear whether MS disease characteristics and clinical course differ amongst Asian racial groups. Singapore is uniquely poised to investigate this as its multi-racial population comprises three genetically diverse Asian racial groups-Chinese, Malay and South Asian. Herein, we sought to elucidate differences in the clinical phenotypes, disease-modifying therapy (DMT) usage, and disease course amongst these three Asian racial groups by performinga retrospective observational study on MS patients seen at the National Neuroscience Institute, Singapore. Data on demographics, disease characteristics, ancillary investigations, and DMT usage were collected. One hundred and eighty-eight patients were included (90 Chinese, 32 Malay, and 66 South Asian). Our findings showed that MS prevalence was the highest in South Asians followed by Malays and Chinese, while demographics, healthcare access, and longer-term disease course were identical across the racial groups. However, several differences and trends were elucidated: (1) South Asian patients had milder sentinel attacks (p = 0.006), (2) a higher proportion of Malay patients had enhancing lesions on their initial MRI (p = 0.057) and the lesion topography differed across the races (p = 0.034), and (3) more Malay patients switched out of their initial DMT (p = 0.051). In conclusion, MS disease characteristics were largely similar across these three Asian racial groups, and while there were some clinical and radiological differences at presentation, these did not influence longer-term outcomes.
Collapse
Affiliation(s)
- Min Jie Koh
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Seyed Ehsan Saffari
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Janis Siew Noi Tye
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Amelia Yun Yi Aw
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Rachel Wan En Siew
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Xuejuan Peng
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Jeanne May May Tan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Kevin Tan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Tianrong Yeo
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, Singapore.
| |
Collapse
|
8
|
Kwon S, Han KD, Jung JH, Cho EB, Chung YH, Park J, Choi HL, Jeon HJ, Shin DW, Min JH. Risk of depression and anxiety in multiple sclerosis and neuromyelitis optica spectrum disorder: A nationwide cohort study in South Korea. Mult Scler 2024; 30:714-725. [PMID: 38561953 DOI: 10.1177/13524585241237093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND We investigated the risks of depression/anxiety in patients with multiple sclerosis (pwMS) or patients with neuromyelitis optica spectrum disorder (pwNMOSD). OBJECTIVES MS/NMOSD cohorts were collected from Korean National Health Insurance Service, using the International Classification of Diseases-10th and information on Rare Intractable Disease program. Patients who were younger than 20 years, had a previous depression/anxiety, or died in the index year were excluded. METHODS Hazard ratios (HRs) of depression/anxiety in pwMS and pwNMOSD from controls matched 1:5 for age, sex, hypertension, diabetes, and dyslipidemia were calculated using Cox regressions with a 1-year lag period and estimated over time. RESULTS During a mean follow-up of 4.1 years, adjusted hazard ratios (aHR) for depression were 3.25 (95% confidence interval (CI) = 2.59-4.07) in MS and 2.17 (1.70-2.76) in NMOSD, and aHRs for anxiety were 1.83 (1.49-2.23) in MS and 1.56 (1.26-1.91) in NMOSD. The risks of anxiety/depression did not differ between MS and NMOSD and were highest in the second year after diagnosis of MS/NMOSD. The relative risk of depression was higher in younger pwMS/pwNMOSD, and the relative risk of anxiety was higher in pwMS who was male, had low income, or lived in a non-urban area. CONCLUSION The risk of depression and anxiety was increased in pwMS/pwNMOSD.
Collapse
Affiliation(s)
- Soonwook Kwon
- Department of Neurology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Jin Hyung Jung
- Department of Biostatistics, The Catholic University of Korea, Seoul, South Korea
| | - Eun Bin Cho
- Department of Neurology, Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, South Korea
- Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Yeon Hak Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Junhee Park
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hea Lim Choi
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
- Depression Center, Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Clinical Research Design and Evaluation and Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Neuroscience Center, Samsung Medical Center, Seoul, South Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South KoreaYeon Hak Chung is currently affiliated to Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| |
Collapse
|
9
|
Ashtari F, Kavosh A, Baghbanian SM, Hosseini Nejad Mir N, Hosseini S, Razazian N, Majdinasab N, Farajzadegan Z, Shaygannejad V, Adibi I, Eskandarieh S, Sahraian MA. A national registry-based study of ethnic differences in people with multiple sclerosis in Iran. Clin Neurol Neurosurg 2024; 239:108216. [PMID: 38490075 DOI: 10.1016/j.clineuro.2024.108216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE The relationship between MS and ethnicity has been understudied in the Middle East compared to the United States and Europe. As Iran as the highest prevalence of MS in the Middle East, we decided to investigate the demographic and clinical differences in people with MS (pwMS) from major ethnicities Iran. METHODS In a cross-sectional study using data from National Multiple Sclerosis Registry in Iran. PwMS from six provinces were chosen and interviewed for determining their ethnicity. Persians (Fars), Kurds, Lurs, Azeris and Arabs with a clear ethnic background were included. Recorded data from the registry was used to compare the demographic and clinical features. RESULTS A total of 4015 pwMS (74.2% female) were included in the study with an average age of 36.76 ± 9.68 years. Persians and Kurds had the highest percentage of pwMS in youngest and oldest age groups, respectively, with 2.9% and 5.7% (p<0.01). The highest average age of onset was seen in Persians (29.47 ± 8.89) and the lowest observed in Mazandaranis (26.82 ± 7.68, p<0.01). Azeris and Kurds had the highest proportions of pwMS diagnosed <18 and >55, at rates of 12% and 1.6%, respectively (p<0.01). There were statistically significant differences in distribution of phenotypes (p<0.01) and time to progression to secondary progressive MS (p<0.01) such that Persians had the highest rate of clinically isolated syndrome (CIS) at 19.3% and Arabs had highest rates of relapsing-remitting MS (86.2%) and secondary progressive MS (16.4%). Lurs, Azeris and Mazandaranis had significantly more patients progressing to secondary-progressive MS <5 years from diagnosis (p<0.01). There was a significant difference in number of relapses between the ethnicities (p<0.01) with Lurs having the highest proportion of participants reporting >4 relapses with 23.0% and Azeris having the highest percentage of pwMS reporting no relapse (53.0%). Kurds had the highest Expanded Disability Status Scale (EDSS) average at 2.93 ± 1.99 and Lurs had the lowest with 1.28 ± 1.25 (p<0.01). The differences in prevalence of positive family history for the whole cohort between ethnicities were significant (P=0.02), ranging from 12.8% in Kurds to 19.6% in Persians. CONCLUSION We found Persians to have higher rates of pediatric MS and higher rates of CIS. Kurds and Lurs had higher and lower EDSS scores, respectively. Lurs and Persian had higher annual relapse rates. We also found lower rates of SPMS among Arabs and earlier progression to SPMS in Lurs, Azeris and Mazandaranis. Such differences highlight the importance of the potential role of ethnicities in diagnosis and prognosis of MS, especially considering their observation within the geographical limits of a single country.
Collapse
Affiliation(s)
- Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aryan Kavosh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Seyed Mohammad Baghbanian
- Neurology Department, Booalisina Hospital, Mazandaran University of Medical Sciences, Pasdaran Boulevard, Sari, Iran
| | | | - Samaneh Hosseini
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazanin Razazian
- Neurology Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nastaran Majdinasab
- Department of Neurology, Golestan Hospital, Ahvaz Jondishapour University of Medical Sciences, Iran
| | - Ziba Farajzadegan
- Department of Community Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Adibi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sharareh Eskandarieh
- Assistant Professor in Epidemiology, Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Sonnenberg A. Similar geographic distribution of mortality from multiple sclerosis, Hodgkin lymphoma, and inflammatory bowel disease in the United States. Mult Scler Relat Disord 2024; 84:105493. [PMID: 38354444 DOI: 10.1016/j.msard.2024.105493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/19/2023] [Accepted: 02/09/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Previous epidemiologic studies have suggested a linkage between the occurrence of multiple sclerosis (MS), Hodgkin lymphoma (HL), Crohn's disease (CD), and ulcerative colitis (UC). It was hypothesized that the 4 diagnoses would be characterized by similar geographic distributions within the United States. AIMS To compare the US geographic distributions of these 4 diagnoses in a cross-sectional study. METHODS Using the US vital statistics, state-specific death rates and age-specific proportional mortality ratios (PMR) were calculated for each diagnosis. Similarities in the geographic distributions of the 4 diagnoses were tested by linear and Poisson regression analyses. The PMR values from different states were correlated among pairs of consecutive age-groups. RESULTS The 6 linear correlation coefficients (r) among the geographic distributions of the 4 diseases were as follows: HL vs. MS (r = 0.28), HL vs. CD (r = 0.74), HL vs. UC (r = 0.64); MS vs. CD (r = 0.18), MS vs. UC (r = 0.66); CD vs. UC (r = 0.58). Using Poisson regression, the geographic distributions of MS, HL, CD, and UC were all found to be significantly correlated with each other. In MS, significant correlations between the PMR values of each two consecutive age-groups started with the age-group 25-44 years. In HL, such significant correlations started at age 10-14, in CD at age 20-24, and in UC at age 20-24 years. CONCLUSIONS Within the United States, mortality from MS, HL, CD, and UC are characterized by similar geographic distributions. The environmental influences responsible for these resembling geographic distributions start exerting their influence during early lifetime.
Collapse
Affiliation(s)
- Amnon Sonnenberg
- Section of Gastroenterology, Portland VA Medical Center, P3-GI, Portland, OR 97239, United States; Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, OR, United States.
| |
Collapse
|
11
|
Sonnenberg A, Kohen R. Epidemiologic Associations Between Inflammatory Bowel Disease and Hodgkin Lymphoma or Multiple Sclerosis. GASTRO HEP ADVANCES 2024; 3:605-611. [PMID: 39165410 PMCID: PMC11330903 DOI: 10.1016/j.gastha.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/20/2024] [Indexed: 08/22/2024]
Abstract
Background and Aims Epidemiologic evidence suggests that Hodgkin lymphoma (HL) and multiple sclerosis (MS) share a common set of risk factors with Crohn's disease (CD) and ulcerative colitis (UC). It was hypothesized that such shared risk factors would lead to similar geographic distributions of these 4 diagnoses and their concurrence in identical patients. Methods All subjects with HL, MS, CD, or UC were identified in the complete Inpatient Standard Analytic File of the Centers for Medicare and Medicaid Services from 2018. In a cross-sectional study, we evaluated whether the frequencies of HL, MS, CD, and UC occurrences among different US states were statistically correlated with each other. In a case-control study, the observed concurrences of each 2 of the 4 diagnoses were compared with their expected frequencies in the overall Medicare population by calculating odds ratios with their 95% confidence intervals. Results The total Centers for Medicare and Medicaid Services population comprised 6,462,321 unique patients, of whom 8027 presented with HL, 42,934 with MS, 40,623 with CD, and 32,521 with UC. Statistically significant positive correlations (r) with P < .001 were found between HL and MS (r = 0.50), HL and CD (0.46), HL and UC (0.68), MS and CD (0.66), MS and UC (0.72), and CD and UC (0.68). Any inflammatory bowel disease was significantly associated with a diagnosis of concurrent HL (odds ratio: 1.22, 95% confidence interval: 1.01-1.48) or MS (1.35, 1.25-1.46). Conclusion The epidemiologic associations of inflammatory bowel disease with HL or MS may reflect a common pathway in the etiology or pathogenesis of these diseases.
Collapse
Affiliation(s)
- Amnon Sonnenberg
- Section of Gastroenterology, Portland VA Medical Center, Portland, Oregon
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon
| | - Ruth Kohen
- Department of Psychiatry, University of Washington, Seattle, Washington
| |
Collapse
|
12
|
Parciak T, Geys L, Helme A, van der Mei I, Hillert J, Schmidt H, Salter A, Zakaria M, Middleton R, Stahmann A, Dobay P, Hernandez Martinez-Lapiscina E, Iaffaldano P, Plueschke K, Rojas JI, Sabidó M, Magyari M, van der Walt A, Arickx F, Comi G, Peeters LM. Introducing a core dataset for real-world data in multiple sclerosis registries and cohorts: Recommendations from a global task force. Mult Scler 2024; 30:396-418. [PMID: 38140852 PMCID: PMC10935622 DOI: 10.1177/13524585231216004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/09/2023] [Accepted: 10/23/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND As of September 2022, there was no globally recommended set of core data elements for use in multiple sclerosis (MS) healthcare and research. As a result, data harmonisation across observational data sources and scientific collaboration is limited. OBJECTIVES To define and agree upon a core dataset for real-world data (RWD) in MS from observational registries and cohorts. METHODS A three-phase process approach was conducted combining a landscaping exercise with dedicated discussions within a global multi-stakeholder task force consisting of 20 experts in the field of MS and its RWD to define the Core Dataset. RESULTS A core dataset for MS consisting of 44 variables in eight categories was translated into a data dictionary that has been published and disseminated for emerging and existing registries and cohorts to use. Categories include variables on demographics and comorbidities (patient-specific data), disease history, disease status, relapses, magnetic resonance imaging (MRI) and treatment data (disease-specific data). CONCLUSION The MS Data Alliance Core Dataset guides emerging registries in their dataset definitions and speeds up and supports harmonisation across registries and initiatives. The straight-forward, time-efficient process using a dedicated global multi-stakeholder task force has proven to be effective to define a concise core dataset.
Collapse
Affiliation(s)
- Tina Parciak
- University MS Center (UMSC), Hasselt-Pelt, Belgium
- UHasselt, Biomedical Research Institute (BIOMED), Diepenbeek, Belgium
- UHasselt, Data Science Institute (DSI), Diepenbeek, Belgium
| | - Lotte Geys
- University MS Center (UMSC), Hasselt-Pelt, Belgium
- UHasselt, Biomedical Research Institute (BIOMED), Diepenbeek, Belgium
- UHasselt, Data Science Institute (DSI), Diepenbeek, Belgium
| | - Anne Helme
- Multiple Sclerosis International Federation, London, UK
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, The Australian MS longitudinal study (AMSLS), Hobart, TAS, Australia
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hollie Schmidt
- Accelerated Cure Project, iConquerMS People-Powered Research Network, Waltham, MA, USA
| | - Amber Salter
- Section on Statistical Planning and Analysis, UT Southwestern Medical Center, NARCOMS Registry, COViMS Registry, Dallas, TX, USA
| | - Magd Zakaria
- Department of Neurology, Ain Shams University, Cairo, Egypt
| | - Rodden Middleton
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Alexander Stahmann
- German MS Register by the German MS Society, MS Research and Project Development gGmbH (MSFP), Hanover, Germany
| | | | - Elena Hernandez Martinez-Lapiscina
- Office of Therapies for Neurological and Psychiatric Disorders (H-NEU), Human Medicines (H-Division), European Medicines Agency, Amsterdam, The Netherlands
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences (DiBraiN), Università degli Studi di Bari Aldo Moro, Italian MS registry, Bari, Italy
| | - Kelly Plueschke
- Data Analytics and Methods Task Force, European Medicines Agency, Amsterdam, The Netherlands
| | - Juan I Rojas
- Neurology Department, Hospital Universitario de CEMIC, RelevarEM, Buenos Aires, Argentina
| | - Meritxell Sabidó
- Department of Epidemiology, Merck Healthcare KGaA, Darmstadt, Germany
| | - Melinda Magyari
- Danish Multiple Sclerosis Registry and Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital – Rigshospitalet, Glostrup, Denmark
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Francis Arickx
- National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Giancarlo Comi
- Department of Rehabilitation Neurosciences, Casa di Cura Igea, Milan, Italy
| | - Liesbet M Peeters
- University MS Center (UMSC), Hasselt-Pelt, Belgium
- UHasselt, Biomedical Research Institute (BIOMED), Diepenbeek, Belgium
- UHasselt, Data Science Institute (DSI), Diepenbeek, Belgium
| |
Collapse
|
13
|
Rotstein DL, Freedman MS, Lee L, Marrie RA, Morrow SA, McCombe JA, Parks NE, Smyth P, Konig A, Vyas MV. Predicting time to serologic diagnosis of AQP4+ NMOSD based on clinical factors and social determinants of health. Mult Scler Relat Disord 2024; 83:105434. [PMID: 38242051 DOI: 10.1016/j.msard.2024.105434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Early serologic diagnosis and initiation of targeted therapy are associated with better outcomes in aquaporin-4 IgG positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD). OBJECTIVE To determine predictors of time to serologic diagnosis of AQP4+ NMOSD. METHODS In CANOPTICS, a multi-centre, Canadian cohort study of NMOSD, we retrospectively evaluated time from the first clinical attack to first positive AQP4-IgG serology. We used a multivariable negative binomial regression model to evaluate possible predictors of time to diagnosis. RESULTS We identified 129 participants with AQP4+ NMOSD from 7 centres. Diagnostic delay of >1 month was observed in 82 (63.6 %). Asian compared to European (White) ethnicity (IRR:0.40, 95 % CI:0.21-0.78), female sex (IRR:0.56, 95 % CI:0.32-0.99), later calendar year (IRR:0.84, 95 % CI:0.81-0.86), and hospitalization for the first attack (IRR:0.35, 95 % CI:0.20-0.62) were associated with shorter times to serologic diagnosis. We did not observe any overall effect of Afro-Caribbean ethnicity, but in exploratory analyses, Afro-Caribbean individuals with low income had longer times to diagnosis. CONCLUSION More than 60 % of patients with NMOSD experienced delays to AQP4-IgG serologic diagnosis in this cohort. Given evidence of more adverse long-term outcomes in Afro-Caribbean individuals with NMOSD, intersectional effects of ethnicity and social determinants of health merit further study.
Collapse
Affiliation(s)
- Dalia L Rotstein
- St. Michael's Hospital, 30 Bond St., Toronto, Ontario M5B 1W8, Canada; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, 3rd floor, Toronto, Ontario M5S 3H2, Canada.
| | - Mark S Freedman
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Liesly Lee
- Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, 3rd floor, Toronto, Ontario M5S 3H2, Canada; Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Ruth Ann Marrie
- Departments of Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah A Morrow
- Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Andrea Konig
- St. Michael's Hospital, 30 Bond St., Toronto, Ontario M5B 1W8, Canada
| | - Manav V Vyas
- St. Michael's Hospital, 30 Bond St., Toronto, Ontario M5B 1W8, Canada; Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, 3rd floor, Toronto, Ontario M5S 3H2, Canada
| |
Collapse
|
14
|
Huynh TLT, Williams MJ, Motl RW. Walking and physical performance in black and white adults with multiple sclerosis controlling for social determinants of health. Mult Scler Relat Disord 2024; 83:105439. [PMID: 38219300 DOI: 10.1016/j.msard.2024.105439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND There is evidence for reduced walking and physical performance in persons with multiple sclerosis (MS) compared with healthy controls (HCs). There is further evidence suggesting increased overall mobility disability in Black persons with MS compared with White counterparts, yet little is known about the interplay of social determinants of health (SDOH) when considering differences in walking and physical performance. PURPOSE This cross-sectional, comparative study examined differences in walking and physical performance in Black and White persons with MS and HCs (MS Status), statistically controlling for SDOH. METHODS The study sample consisted of 208 persons with MS (141 White participants and 67 Black participants) and 95 HCs (59 White participants and 36 Black participants). Walking and physical function were measured using timed 25-foot walk (T25FW), six-minute walk (6MW), timed-up-and-go (TUG), and short physical performance battery (SPPB). We examined the differences in the walking and physical functions as a function of MS Status (MS vs. HCs) and Race (Black vs. White) using Multivariate Analysis of Covariance, controlling for age, sex, marital status and SDOH (i.e., education, employment, income). RESULTS There were no significant interactions between MS Status and Race on the outcomes, and the main effects of MS Status and Race remained statistically significant, controlling for SDOH and covariates. The main effects indicated significant lower T25FW (F = 34.6, p < .001, Ƞp2 = 0.11), 6MW (F = 58.5, p < .001, Ƞp2 = 0.18), TUG (F = 22.1, p < .001, Ƞp2 = 0.08), and SPPB (F = 25.2, p < .001, Ƞp2 = 0.09) performance for MS than HCs, and lower T25FW (F = 15.5, p < .001, Ƞp2 = 0.05), 6MW (F = 11.6, p < .001, Ƞp2 = 0.04), and TUG (F = 4.1, p < .05, Ƞp2 = 0.02) performance in Black than White samples. CONCLUSIONS We conclude that MS Status and Race independently influence walking and physical performance even after accounting for SDOH, and Black persons with MS have compromised walking and physical performance, perhaps necessitating focal rehabilitation.
Collapse
Affiliation(s)
- Trinh L T Huynh
- Department of Kinesiology and Nutrition, School of Applied Health Sciences, University of Illinois Chicago, 1919 W Taylor Street, Chicago, IL, USA.
| | | | - Robert W Motl
- Department of Kinesiology and Nutrition, School of Applied Health Sciences, University of Illinois Chicago, 1919 W Taylor Street, Chicago, IL, USA
| |
Collapse
|
15
|
Lizarraga KJ, Gyang T, Benson RT, Birbeck GL, Johnston KC, Royal W, Sacco RL, Segal B, Vickrey BG, Griggs RC, Holloway RG. Seven Strategies to Integrate Equity within Translational Research in Neurology. Ann Neurol 2024; 95:432-441. [PMID: 38270253 PMCID: PMC10922988 DOI: 10.1002/ana.26873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
The rapidly accelerating translation of biomedical advances is leading to revolutionary therapies that are often inaccessible to historically marginalized populations. We identified and synthesized recent guidelines and statements to propose 7 strategies to integrate equity within translational research in neurology: (1) learn history; (2) learn about upstream forces; (3) diversify and liberate; (4) change narratives and adopt best communication practices; (5) study social drivers of health and lived experiences; (6) leverage health technologies; and (7) build, sustain, and lead culturally humble teams. We propose that equity should be a major goal of translational research, equally important as safety and efficacy. ANN NEUROL 2024;95:432-441.
Collapse
Affiliation(s)
| | - Tirisham Gyang
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Richard T. Benson
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | | | - Karen C. Johnston
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Walter Royal
- Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Ralph L. Sacco
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Benjamin Segal
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Barbara G. Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert C. Griggs
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | | |
Collapse
|
16
|
Radzik AM, Amezcua L, Anderson A, Gilmore S, Ahmad S, Brandstadter R, Fabian MT, Graham EL, Hodgkinson S, Horton L, Jacobs DA, Katz Sand IB, Kohli A, Levine L, McLemore M, Okai AF, Patel J, Poole S, Riley C, Satyanarayan S, Tardo L, Verter E, Villacorta V, Zimmerman V, Zuroff L, Williams MJ, Houtchens MK, Bove R. Disparities by Race in Pregnancy Care and Clinical Outcomes in Women With Multiple Sclerosis: A Diverse Multicenter Cohort. Neurology 2024; 102:e208100. [PMID: 38261988 PMCID: PMC10962915 DOI: 10.1212/wnl.0000000000208100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 11/15/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Racial disparities exist in both neurologic and obstetric populations, underscoring the importance of evaluating pregnancy outcomes in diverse women with multiple sclerosis (MS). The objective of this multicenter retrospective study was to compare pregnancy care and outcomes between Black and Hispanic (underrepresented) and White women with MS. METHODS Demographic and clinical data were extracted from medical records of 9 US MS centers for women with MS/clinically isolated syndrome who delivered live births between 2010 and 2021. Sites identified at last 15 consecutive Black/Hispanic women and a matching number of White women. Socioeconomic factors, pregnancy, and MS care/outcomes were compared between groups (underrepresented and White and then Black and Hispanic) using Wilcoxon rank sum (U statistic and effect size r reported), χ2, t tests and logistic regressions as appropriate to data type. Multiple imputation by chained equation was used to account for missing data. RESULTS Overall, 294 pregnancies resulting in live births were analyzed ( 81 Black, 67 Hispanic, and 146 White mothers). Relative to underrepresented women, White women lived in areas of higher median (interquartile range [IQR]) Child Opportunity Index (79 [45.8] vs 22 [45.8], U = 3,824, r = 0.56, p < 0.0001) and were more often employed (84.9% vs 75%, odds ratio [OR] 2.57, CI 1.46-4.50, p = 0.0008) and privately insured (93.8% vs 56.8%, OR 11.6, CI 5.5-24.5, p < 0.0001) and more received a 14-week ultrasound (98.6% vs 93.9%, OR 4.66, CI 0.99-21.96, p = 0.027). Mode of delivery was significantly different between the three groups (X2(10,294) = 20.38, p = 0.03); notably, Black women had the highest rates of emergency cesarean deliveries, and Hispanic women highest rates of uncomplicated vaginal deliveries. Babies born to underrepresented women had lower median (IQR) birthweights than babies born to White women (3,198 g [435.3 g] vs 3,275 g [412.5 g], U = 9,255, r = 0.12, p = 0.04) and shorter median (IQR) breastfeeding duration (4.5 [3.3] vs 6.0 [4.2] months, U = 8,184, r = 0.21, p = 0.003). While underrepresented women were younger than White women (mean [SD] 30.9 [4.8] vs 33.8 [4.0], t = 1.97, CI 1.96-3.98, p < 0.0001), their median (Q1-Q3, IQR) Expanded Disability Status Scale was higher (1.5 [1-2.5, 1.5] vs 1 [0-1.5, 1.5], U = 7,260, r = 0.29, p < 0.0001) before pregnancy. Finally, medical records were missing more key data for Black women (19.7% missing vs 8.9% missing, OR 2.54, CI 1.25-5.06, p = 0.008). DISCUSSION In this geographically diverse multicenter cohort, underrepresented women entered pregnancy with higher disability and fewer health care resources. Pregnancy represents a pivotal window where structural factors affect maternal and fetal health and neurologic trajectories; it is a critical period to optimize care and health outcomes.
Collapse
Affiliation(s)
- Anne Marie Radzik
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Lilyana Amezcua
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Annika Anderson
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Serena Gilmore
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Sophie Ahmad
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Rachel Brandstadter
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Michelle T Fabian
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Edith L Graham
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Sophia Hodgkinson
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Lindsay Horton
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Dina A Jacobs
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Ilana B Katz Sand
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Amit Kohli
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Libby Levine
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Monica McLemore
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Annette F Okai
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Jasmin Patel
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Shane Poole
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Claire Riley
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Sammita Satyanarayan
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Lauren Tardo
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Elizabeth Verter
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Veronica Villacorta
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Vanessa Zimmerman
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Leah Zuroff
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Mitzi J Williams
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Maria K Houtchens
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| | - Riley Bove
- From the University of California San Francisco (A.M.R.); Department of Neurology (L.A.), University of Southern California, Los Angeles; Department of Neurology (A.A., S.P., R. Bove), UCSF Weill Institute for the Neurosciences, and Department of Neurology (S.G.), University of California San Francisco; Department of Neurology (S.A., E.L.G.), Northwestern University, Chicago, IL; Department of Neurology (R. Brandstadter, D.A.J., V.Z., L.Z.), Hospital of the University of Pennsylvania, Philadelphia; Corinne Goldsmith Dickinson Center for MS (M.T.F., I.B.K.S., A.K., J.P., S.S., E.V.), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; Brigham and Women's Hospital (S.H., M.K.H.), Boston, MA; University of Texas Southwestern Medical Center (L.H., L.T.), Dallas; Center for Translational and Computational Neuroimmunology and Multiple Sclerosis Center (L.L., C.R.), Department of Neurology, Columbia University Irving Medical Center, New York, NY; Family Health Care Nursing Department (M.M.), School of Nursing, University of California San Francisco; North Texas Institute of Neurology and Headache (A.F.O.), Frisco; University of Southern California (V.V.), Los Angeles; and Joi Life Wellness Group (M.J.W.), Multiple Sclerosis Center, Smyrna, GA
| |
Collapse
|
17
|
McGinley MP, Harvey T, Lopez R, Ontaneda D, Buchalter RB. Geographic Disparities in Access to Neurologists and Multiple Sclerosis Care in the United States. Neurology 2024; 102:e207916. [PMID: 38165332 PMCID: PMC11407503 DOI: 10.1212/wnl.0000000000207916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES A shortage of neurology clinicians and healthcare disparities may hinder access to neurologic care. This study examined disparities in geographic access to neurologists and subspecialty multiple sclerosis (MS) care among various demographic segments of the United States. METHODS Neurologist practice locations from 2022 CMS Care Compare physician data and MS Center locations as defined by the Consortium of Multiple Sclerosis Centers were used to compute spatial access for all U.S. census tracts. Census tract-level community characteristics (sex, age, race, ethnicity, education, income, insurance, % with computer, % without a vehicle, % with limited English, and % with hearing, vision, cognitive, and ambulatory difficulty) were obtained from 2020 American Community Survey 5-year estimates. Rural-urban status was obtained from 2010 rural-urban commuting area codes. Logistic and linear regression models were used to examine access to a neurologist or MS Center within 60 miles and 60-mile spatial access ratios. RESULTS Of 70,858 census tracts, 388 had no neurologists within 60 miles and 17,837 had no MS centers within 60 miles. Geographic access to neurologists (spatial access ratio [99% CI]) was lower for rural (-80.49%; CI [-81.65 to -79.30]) and micropolitan (-60.50%; CI [-62.40 to -58.51]) areas compared with metropolitan areas. Tracts with 10% greater percentage of Hispanic individuals (-4.53%; CI [-5.23 to -3.83]), men (-6.76%; CI [-8.96 to -4.5]), uninsured (-7.99%; CI [-9.72 to -6.21]), individuals with hearing difficulty (-40.72%; CI [-44.62 to -36.54]), vision difficulty (-13.0%; [-18.72 to -6.89]), and ambulatory difficulty (-15.68%; CI [-19.25 to -11.95]) had lower access to neurologists. Census tracts with 10% greater Black individuals (3.50%; CI [2.93-10.71]), college degree holders (-7.49%; CI [6.67-8.32]), individuals with computers (16.57%, CI [13.82-19.40]), individuals without a vehicle (9.57%; CI [8.69-10.47]), individuals with cognitive difficulty (25.63%; CI [19.77-31.78]), and individuals with limited English (18.5%; CI [16.30-20.73]), and 10-year older individuals (8.85%; CI [7.03-10.71]) had higher spatial access to neurologists. Covariates for access followed similar patterns for MS centers. DISCUSSION Geographic access to neurologists is decreased in rural areas, in areas with higher proportions of Hispanics, populations with disabilities, and those uninsured. Access is further limited for MS subspecialty care. This study highlights disparities in geographic access to neurologic care.
Collapse
Affiliation(s)
- Marisa P McGinley
- From the Mellen Center (M.P.M., D.O.), Cleveland; Center for Populations Health Research (R.B.B.), Department of Quantitative Health Sciences (T.H.), Cleveland Clinic, OH; and Department of Surgery (R.L.), University of Colorado Anschutz Medical Center, Aurora
| | - Tucker Harvey
- From the Mellen Center (M.P.M., D.O.), Cleveland; Center for Populations Health Research (R.B.B.), Department of Quantitative Health Sciences (T.H.), Cleveland Clinic, OH; and Department of Surgery (R.L.), University of Colorado Anschutz Medical Center, Aurora
| | - Rocio Lopez
- From the Mellen Center (M.P.M., D.O.), Cleveland; Center for Populations Health Research (R.B.B.), Department of Quantitative Health Sciences (T.H.), Cleveland Clinic, OH; and Department of Surgery (R.L.), University of Colorado Anschutz Medical Center, Aurora
| | - Daniel Ontaneda
- From the Mellen Center (M.P.M., D.O.), Cleveland; Center for Populations Health Research (R.B.B.), Department of Quantitative Health Sciences (T.H.), Cleveland Clinic, OH; and Department of Surgery (R.L.), University of Colorado Anschutz Medical Center, Aurora
| | - R Blake Buchalter
- From the Mellen Center (M.P.M., D.O.), Cleveland; Center for Populations Health Research (R.B.B.), Department of Quantitative Health Sciences (T.H.), Cleveland Clinic, OH; and Department of Surgery (R.L.), University of Colorado Anschutz Medical Center, Aurora
| |
Collapse
|
18
|
Jacobs BM, Tank P, Bestwick JP, Noyce AJ, Marshall CR, Mathur R, Giovannoni G, Dobson R. Modifiable risk factors for multiple sclerosis have consistent directions of effect across diverse ethnic backgrounds: a nested case-control study in an English population-based cohort. J Neurol 2024; 271:241-253. [PMID: 37676298 PMCID: PMC10769990 DOI: 10.1007/s00415-023-11971-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Multiple sclerosis is a leading cause of non-traumatic neurological disability among young adults worldwide. Prior studies have identified modifiable risk factors for multiple sclerosis in cohorts of White ethnicity, such as infectious mononucleosis, smoking, and obesity during adolescence/early adulthood. It is unknown whether modifiable exposures for multiple sclerosis have a consistent impact on risk across ethnic groups. AIM To determine whether modifiable risk factors for multiple sclerosis have similar effects across diverse ethnic backgrounds. METHODS We conducted a nested case-control study using data from the UK Clinical Practice Research Datalink. Multiple sclerosis cases diagnosed from 2001 until 2022 were identified from electronic healthcare records and matched to unaffected controls based on year of birth. We used stratified logistic regression models and formal statistical interaction tests to determine whether the effect of modifiable risk factors for multiple sclerosis differed by ethnicity. RESULTS We included 9662 multiple sclerosis cases and 118,914 age-matched controls. The cohort was ethnically diverse (MS: 277 South Asian [2.9%], 251 Black [2.6%]; Controls: 5043 South Asian [5.7%], 4019 Black [4.5%]). The age at MS diagnosis was earlier in the Black (40.5 [SD 10.9]) and Asian (37.2 [SD 10.0]) groups compared with White cohort (46.1 [SD 12.2]). There was a female predominance in all ethnic groups; however, the relative proportion of males was higher in the South Asian population (proportion of women 60.3% vs 71% [White] and 75.7% [Black]). Established modifiable risk factors for multiple sclerosis-smoking, obesity, infectious mononucleosis, low vitamin D, and head injury-were consistently associated with multiple sclerosis in the Black and South Asian cohorts. The magnitude and direction of these effects were broadly similar across all ethnic groups examined. There was no evidence of statistical interaction between ethnicity and any tested exposure, and no evidence to suggest that differences in area-level deprivation modifies these risk factor-disease associations. These findings were robust to a range of sensitivity analyses. CONCLUSIONS AND RELEVANCE Established modifiable risk factors for multiple sclerosis are applicable across diverse ethnic backgrounds. Efforts to reduce the population incidence of multiple sclerosis by tackling these risk factors need to be inclusive of people from diverse ethnicities.
Collapse
Affiliation(s)
- Benjamin M Jacobs
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
- Department of Neurology, Royal London Hospital, London, UK
| | - Pooja Tank
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
| | - Jonathan P Bestwick
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
| | - Alastair J Noyce
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
- Department of Neurology, Royal London Hospital, London, UK
| | - Charles R Marshall
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
- Department of Neurology, Royal London Hospital, London, UK
| | - Rohini Mathur
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, UK
| | - Gavin Giovannoni
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK
- Department of Neurology, Royal London Hospital, London, UK
- Blizard Institute, Queen Mary University London, London, UK
| | - Ruth Dobson
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University London, London, EC1M 6BQ, UK.
- Department of Neurology, Royal London Hospital, London, UK.
| |
Collapse
|
19
|
Mallawaarachchi G, Rog DJ, Das J. Ethnic disparities in the epidemiological and clinical characteristics of multiple sclerosis. Mult Scler Relat Disord 2024; 81:105153. [PMID: 38043364 DOI: 10.1016/j.msard.2023.105153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/13/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a neuroinflammatory disorder which affects 2.8 million people world-wide. A growing body of evidence shows ethnic disparities in MS. This review aims to evaluate differences, based upon ethnic background, in the incidence, prevalence, disease course, and efficacy of disease-modifying therapies (DMTs) among people with MS (PwMS). METHOD Ethnicities were classified as White, Black, Hispanic, Asian, and Middle Eastern and North African (MENA). A literature search was conducted using the PubMed search engine to identify articles on MS and ethnicity that were published in the English language between 01/01/2005 and 31/05/2022. RESULTS 101 studies met all inclusion criteria. Although the incidence and prevalence of MS varied among ethnicities, findings were inconsistent and depended on the continent of the study. Ethnicity may have an impact on the disease course. PwMS from Black, Hispanic, and MENA, but not Asian ethnicities, appeared to accumulate physical disability at a faster rate than those from White ethnicity. Although there was a lack of studies evaluating the relative safety and efficacy of DMTs among various ethnicities, interferon-beta was found to be less efficacious in PwMS from Black ethnicity. CONCLUSIONS Further studies, with more uniform definitions of ethnicity are required to comprehensively understand ethnic disparities in MS, in particular to identify underlying causes, to facilitate the delivery of personalised medical care and avoid inequity.
Collapse
Affiliation(s)
| | - David J Rog
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, United Kingdom M6 8HD
| | - Joyutpal Das
- University of Manchester, Oxford Rd, Manchester, United Kingdom M13 9PL; Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, United Kingdom M6 8HD.
| |
Collapse
|
20
|
Watson C, Thirumalai D, Barlev A, Jones E, Bogdanovich S, Kresa-Reahl K. Treatment Patterns and Unmet Need for Patients with Progressive Multiple Sclerosis in the United States: Survey Results from 2016 to 2021. Neurol Ther 2023; 12:1961-1979. [PMID: 37682512 PMCID: PMC10630256 DOI: 10.1007/s40120-023-00532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Much of the current literature on treatment patterns and disability progression in multiple sclerosis (MS) does not distinguish between the relapsing-remitting and progressive subtypes (including primary [PPMS] and secondary progressive MS [SPMS]), or between active/nonactive disease. Current treatment options for progressive MS are limited, with only one approved product for PPMS and none specifically for nonactive SPMS. Here we report treatment patterns, disability progression, and unmet needs among patients with active and nonactive PPMS and SPMS. METHODS The annual, cross-sectional survey from the Adelphi Disease Specific Program was used to collect physician-reported data on US adult patients with PPMS and SPMS, including active and nonactive disease. Treatment patterns (including the proportion of patients who were untreated with a disease-modifying therapy [DMT]), disability progression, and unmet need are described from 2016 to 2021. RESULTS Data were collected for 2067 patients with progressive MS (PPMS, 1583; SPMS, 484). A substantial proportion of patients were untreated across all groups, and this was highest for nonactive PPMS (~ 43%). The proportion of untreated patients generally declined over time but remained high in 2018-2021 (~ 10-38%). Among treated patients, the proportion receiving infusions increased over time to ~ 34-46%, largely driven by ocrelizumab use after approval. Disability progression was reported for most patients (> 50%), including many who were receiving a DMT. Across all disease subtypes, when physicians were asked about the greatest unmet need with current DMTs, they most frequently cited effectiveness (~ 63-87%), and specifically slowing disease progression (~ 32-59%). CONCLUSIONS This analysis of physician-reported data reveals that patients with progressive MS, particularly those with nonactive disease, frequently remain untreated or continue to decline despite treatment with available DMTs. Thus there is an enduring need for safe and effective treatments for this underserved population.
Collapse
Affiliation(s)
| | | | - Arie Barlev
- Atara Biotherapeutics, Thousand Oaks, CA, USA
| | - Eddie Jones
- Adelphi Real World, Bollington, Cheshire, UK
| | | | | |
Collapse
|
21
|
Geiger CK, Sheinson D, To TM, Jones D, Bonine NG. Treatment Patterns by Race and Ethnicity in Newly Diagnosed Persons with Multiple Sclerosis. Drugs Real World Outcomes 2023; 10:565-575. [PMID: 37733192 PMCID: PMC10730787 DOI: 10.1007/s40801-023-00387-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Non-Hispanic Black and Hispanic persons with MS (pwMS) are more likely to experience rapid disease progression and severe disability than non-Hispanic White pwMS; however, it is unknown how the initiation of high-efficacy disease-modifying therapies (DMTs) differs by race/ethnicity. This real-world study describes DMT treatment patterns in newly diagnosed pwMS in the United States (US) overall and by race/ethnicity. METHODS This retrospective analysis used the US Optum Market Clarity claims/electronic health records database (January 2015-September 2020). pwMS who were first diagnosed in 2016 or later and initiated any DMT in the two years following diagnosis were included. Continuous enrollment in the claims data for ≥ 12 months before and ≥ 24 months after diagnosis was required. Treatment patterns 2 years after diagnosis were analyzed descriptively overall and by race/ethnicity. RESULTS The sample included 682 newly diagnosed and treated pwMS (non-Hispanic Black, n = 99; non-Hispanic White, n = 479; Hispanic, n = 35; other/unknown race/ethnicity, n = 69). The mean time from diagnosis to DMT initiation was 4.9 months in all pwMS. Glatiramer acetate and dimethyl fumarate were the most common first-line DMTs in non-Hispanic Black (28% and 20% respectively) and Hispanic pwMS (31%, 29%); however, glatiramer acetate and ocrelizumab were the most common in non-Hispanic White pwMS (33%, 18%). Use of first-line high-efficacy DMTs was limited across all race/ethnicity subgroups (11-29%), but uptake increased in non-Hispanic Black and White pwMS over the study period. CONCLUSION Use of high-efficacy DMTs was low across all race/ethnicity subgroups of newly diagnosed pwMS in the US, including populations at a greater risk of experiencing rapid disease progression and severe disability.
Collapse
Affiliation(s)
| | - Daniel Sheinson
- Genentech, Inc., 350 DNA Way, South San Francisco, CA, 94080, USA
| | - Tu My To
- Genentech, Inc., 350 DNA Way, South San Francisco, CA, 94080, USA
| | - David Jones
- Genentech, Inc., 350 DNA Way, South San Francisco, CA, 94080, USA
| | | |
Collapse
|
22
|
Mateen FJ, Trápaga Hacker C. Perceptions of people with multiple sclerosis on social determinants of health: Mixed methods. Mult Scler Relat Disord 2023; 80:105089. [PMID: 37897932 DOI: 10.1016/j.msard.2023.105089] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To explore the social determinants of health (SDOH) in people with multiple sclerosis (MS) with SDOH, elucidating the SDOH variables of highest salience in this geographical region. METHODS Focus groups and a structured survey of Massachusetts residents with SDOH and a diagnosis of MS were conducted by a neurologist and staff, December 2022-July 2023, via Zoom™. Twenty-one consecutively-recruited, convenience-sampled adults participated in four groups. A thematic inductive approach was taken. RESULTS Participants (average age 45 years old; average time since MS diagnosis 13.7 years; 14 cisgender female, 1 transgender female, 5 cisgender male, 1 non-binary; 33 % white, 57 % black, 5 % Asian, 5 % other; 18 % Hispanic/Latinx; modal response of 5 SDOH) identified the following key SDOH: (1) race and ethnicity, related to (a) diagnostic delays in MS, (b) limited familiarity with MS and its etiology, and (c) value of ongoing MS care; (2) gender, focused on limited published data in African American men and transgender people; (3) social and community contexts; and (4) financial burdens, related to (a) out-of-pocket costs of MS disease modifying therapies, (b) lost work time, and (c) transportation. Lower frequency SDOH variables were access to public toilets, lost job promotions, environmental exposures, and concern about discrimination. Unmet needs emphasized (1) public understanding of MS; (2) financial support for DMT costs, closer access to infusion centers, and culturally competent care; (3) support for research participation; (4) reliable transportation; and (5) patient awareness of extant services and support programs. CONCLUSIONS This in-depth assessment of people with MS who possess multiple SDOH identified the most salient and commonly experienced SDOH, common themes related to the SDOH in MS, unmet needs, and future opportunities.
Collapse
Affiliation(s)
- Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, United States; Harvard Medical School, United States.
| | | |
Collapse
|
23
|
Sanghi P, Luis J, Ajamil S, Yeung IY, Hindle E, Sandhu S, Hassan S, Turner B, Rees A, Westcott M. Predictive Factors for Magnetic Resonance Imaging Changes Suggestive of Demyelination in Adult Patients with Uveitis Scanned Prior to Commencing Adalimumab Therapy. Ocul Immunol Inflamm 2023; 31:1804-1812. [PMID: 36099542 DOI: 10.1080/09273948.2022.2118134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To report the predictive clinical factors for abnormal magnetic resonance imaging (MRI) scans suggestive of demyelination by analysis of MRI's performed for adult non-infectious uveitic patients prior to commencing adalimumab therapy. METHODS Retrospective case review of 240 patients was conducted in a single tertiary institution between November 2017 and March 2020. Aetiology of underlying disease, clinical characteristics, and MRI outcomes were analysed. RESULTS The presence of bilateral idiopathic intermediate uveitis (IIU) (p = .0048) and neurological symptoms (p = .028) were highly predictive of an abnormal MRI strongly suggestive of demyelination (MRSSD); 5 out of 64 scans (7.8%) with these clinical characteristics had MRSSD. CONCLUSIONS Tumor necrosis factor antagonist-induced demyelination is a concern in adalimumab use. We propose an MRI screening protocol to identify those at high risk of demyelination; positive results can be maximised by screening all patients with IIU and those with neurological symptoms.
Collapse
Affiliation(s)
- Priyanka Sanghi
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Joshua Luis
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Sofia Ajamil
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Ian Yl Yeung
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Edward Hindle
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Selina Sandhu
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Said Hassan
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Ben Turner
- Department of Ophthalmology, Barts Health NHS Trust, London, UK
| | - Angela Rees
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mark Westcott
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Ophthalmology, Barts Health NHS Trust, London, UK
| |
Collapse
|
24
|
Cruz Rivera S, Aiyegbusi OL, Piani Meier D, Dunne A, Harlow DE, Henke C, Kamudoni P, Calvert MJ. The effect of disease modifying therapies on fatigue in multiple sclerosis. Mult Scler Relat Disord 2023; 79:105065. [PMID: 37839365 DOI: 10.1016/j.msard.2023.105065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Fatigue is one of the most common and debilitating symptoms in people with multiple sclerosis (PwMS). Disease-modifying therapies (DMTs) are currently the gold standard in the treatment of MS and their effectiveness has been assessed through randomized clinical trials (RCTs). However, there is limited evidence on the impact of DMTs on fatigue in (PwMS). We conducted a systematic review to 1) understand whether fatigue is included as an outcome in MS trials of DMTs; 2) determine the effects on fatigue of treating MS with DMTs and 3) assess the quality of MS trials including fatigue as an outcome. METHODS Two independent researchers systematically searched MEDLINE, EMBASE and ClinicalTrials.gov from 1993 to January 2023 for RCTs that measured fatigue as an outcome. Adherence to reporting standards was assessed with the Consolidated Standards of Reporting Trials (CONSORT)-Patient-Reported Outcomes (PRO), while the risk of bias (RoB) was assessed with the RoB 2 tool by the Cochrane Handbook for Systematic Reviews of Interventions. The systematic review protocol was registered in PROSPERO (CRD42022383321). RESULTS The search strategy identified 130 RCTs of DMTs of which 7 (5%) assessed fatigue as an outcome. Of the 7 trials, only two presented statistically significant results. In addition, the reporting of fatigue among RCTs was suboptimal with a mean adherence to the CONSORT-PRO Statement of 36% across all trials. Of the 7 trials included, four were assessed as 'high' RoB.. CONCLUSIONS Fatigue has a major impact on PwMS yet there is limited trial-based evidence on the impact of DMTs on fatigue. Assessment of fatigue as an outcome is underrepresented in trials of DMTs and the reporting of PRO trial data is suboptimal. Thus, it is imperative that MS researchers conduct RCTs that include fatigue as an outcome, to support clinicians and people with MS (PwMS) to consider the impact of the different DMTs on fatigue.
Collapse
Affiliation(s)
- Samantha Cruz Rivera
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.
| | - Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, UK
| | | | | | | | | | | | - Melanie J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK; National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; NIHR Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, UK; UK SPINE, University of Birmingham, Birmingham, UK; Health Data Research, Birmingham, UK
| |
Collapse
|
25
|
de Freitas Dias B, Fieni Toso F, Slhessarenko Fraife Barreto ME, de Araújo Gleizer R, Dellavance A, Kowacs PA, Teive H, Spitz M, Freire Borges Juliano A, Januzi de Almeida Rocha L, Braga-Neto P, Ribeiro Nóbrega P, Oliveira-Filho J, Maciel Dias R, de Oliveira Godeiro Júnior C, Martins Maia F, Barbosa Thomaz R, Santos ML, Sousa de Melo E, da Nóbrega Júnior AW, Lin K, Graziani Povoas Barsottini O, Endmayr V, Coelho Andrade LE, Höftberger R, Almeida Dutra L. Brazilian autoimmune encephalitis network (BrAIN): antibody profile and clinical characteristics from a multicenter study. Front Immunol 2023; 14:1256480. [PMID: 37954587 PMCID: PMC10634608 DOI: 10.3389/fimmu.2023.1256480] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/04/2023] [Indexed: 11/14/2023] Open
Abstract
Background The frequency of antibodies in autoimmune encephalitis (AIE) may vary in different populations, however, data from developing countries are lacking. To describe the clinical profile of AIE in Brazil, and to evaluate seasonality and predictors of AIE in adult and pediatric patients. Methods We evaluated patients with possible AIE from 17 centers of the Brazilian Autoimmune Encephalitis Network (BrAIN) between 2018 and 2022. CSF and serum were tested with TBAs and CBAs. Data on clinical presentation, complementary investigation, and treatment were compiled. Seasonality and predictors of AIE in adult and pediatric populations were analyzed. Results Of the 564 patients, 145 (25.7%) were confirmed as seropositive, 69 (12.23%) were seronegative according to Graus, and 58% received immunotherapy. The median delay to diagnosis confirmation was 5.97 ± 10.3 months. No seasonality variation was observed after 55 months of enrolment. The following antibodies were found: anti-NMDAR (n=79, 54%), anti-MOG (n=14, 9%), anti-LGI1(n=12, 8%), anti-GAD (n=11, 7%), anti-GlyR (n=7, 4%), anti-Caspr2 (n=6, 4%), anti-AMPAR (n=4, 2%), anti-GABA-BR (n=4, 2%), anti-GABA-AR (n=2, 1%), anti-IgLON5 (n=1, 1%), and others (n=5, 3%). Predictors of seropositive AIE in the pediatric population (n=42) were decreased level of consciousness (p=0.04), and chorea (p=0.002). Among adults (n=103), predictors of seropositive AIE were movement disorders (p=0.0001), seizures (p=0.0001), autonomic instability (p=0.026), and memory impairment (p=0.001). Conclusion Most common antibodies in Brazilian patients are anti-NMDAR, followed by anti-MOG and anti-LGI1. Only 26% of the possible AIE patients harbor antibodies, and 12% were seronegative AIE. Patients had a 6-month delay in diagnosis and no seasonality was found. Findings highlight the barriers to treating AIE in developing countries and indicate an opportunity for cost-effect analysis. In this scenario, some clinical manifestations help predict seropositive AIE such as decreased level of consciousness, chorea, and dystonia among children, and movement disorders and memory impairment among adults.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Helio Teive
- Hospital Universitário da Universidade Federal do Paraná, Curitiba, Brazil
| | - Mariana Spitz
- Hospital Universitário Pedro Ernesto da Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | | | | | | | | | | | | | | | - Katia Lin
- Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | | | - Verena Endmayr
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | | | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
26
|
Polick CS, Ploutz-Snyder R, Braley TJ, Connell CM, Stoddard SA. Fatigue, pain interference, and psychiatric morbidity in multiple sclerosis: The role of childhood stress. PLoS One 2023; 18:e0292233. [PMID: 37851620 PMCID: PMC10584096 DOI: 10.1371/journal.pone.0292233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a progressive, autoimmune disease of the central nervous system that affects nearly one million Americans. Despite the existence of immunomodulatory therapies to slow physical and cognitive disability progression, interventions to ameliorate common symptoms of MS, including fatigue and pain, remain limited. Poor understanding of risk factors for these symptoms may contribute to treatment challenges. In recent years, childhood stress has been investigated as a risk factor for chronic autoimmune conditions including MS; yet remarkably few studies have investigated the relationship between childhood stressors and chronic MS symptoms. Our aim was to examine clusters of stressors and three key features of MS: fatigue, pain interference, and psychiatric morbidity. METHODS Cross-sectional data were collected from a sample of People with MS (PwMS) via a national web-based survey that assessed the presence and type of childhood stressors and MS clinical features. Hierarchical block regression was used to assess associations among emotional, physical, and environmental childhood stressors and three clinical features commonly experienced by PwMS. RESULTS N = 719 adults with MS (aged 21-85) completed the survey. Childhood emotional and physical stressors were significantly associated with overall presence of fatigue (p = 0.02; p<0.03) and pain interference (p<0.001; p<0.001) in adulthood, as well as the magnitude of both outcomes. Environmental stressors (p<0.001), in addition to emotional (p<0.001) and physical (p<0.001) stressors were significantly associated with psychiatric morbidity in PwMS. CONCLUSION Childhood stress may predict fatigue, psychiatric morbidity, and pain in adults with MS. Further research is needed to show cause and effect; however, if an association exists, strategies to mitigate the impact of childhood stress could offer new pathways to reduce the severity of these symptoms. Broadly, this work adds to the body of evidence supporting upstream preventive measures to help address the stress on children and families.
Collapse
Affiliation(s)
- Carri S. Polick
- School of Nursing, Duke University, Durham, NC, United States of America
- Durham VA Health Care System, Durham, NC, United States of America
| | - Robert Ploutz-Snyder
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Tiffany J. Braley
- Division of Multiple Sclerosis & Neuroimmunology, Department of Neurology, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Cathleen M. Connell
- School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Sarah A. Stoddard
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| |
Collapse
|
27
|
Hunter EA, Meyer JM, Brown GM, Hanks MA. Stress indicators in minorities with multiple sclerosis. Mult Scler Relat Disord 2023; 78:104914. [PMID: 37499341 DOI: 10.1016/j.msard.2023.104914] [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: 02/16/2023] [Revised: 06/12/2023] [Accepted: 07/23/2023] [Indexed: 07/29/2023]
Abstract
Black Americans with multiple sclerosis (MS) experience higher levels of disease-related disability compared to White Americans (Marrie et al., 2006). Comorbidities such as depression and anxiety, which are underdiagnosed and undertreated in this population, negatively impact quality of life and treatment outcomes for people living with multiple sclerosis (plwMS) (D'Alisa et al., 2006; Marrie et al., 2009; Stepleman et al., 2014). Acts of discrimination toward Black Americans is associated with stress, which is a contributing factor for depression (Carter, 2017; Nadimpalli, 2015; Williams and Mohammed, 2009). This study compared the severity of multiple sclerosis symptoms amongst Black Americans and White Americans, and whether worsened MS symptoms in Black Americans are associated with increased experiences of discrimination. Data was analyzed from 143 plwMS in the Stress Indicators in Minorities with Multiple Sclerosis (SiMMS) study. Using the Mann-Whitney U test, significant differences were found on the NIH Emotional Distress - Anxiety measure (U = 1466.500, p = 0.045) and NIH Sleep Disturbance measure (U = 1467.000, p = 0.044) between the Black participant and the White participant groups. Discrimination was significantly correlated with both NIH Emotional Distress - Anxiety (r = 0.677, p < .001) and NIH Sleep Disturbance (r = 0.446, p = .007) in Black MS individuals. Additionally, several physiological condition and psychological outcome measures were correlated with the NIH Emotional Distress - Anxiety and NIH Sleep Disturbance measures. This study contributes to literature highlighting the negative impacts of discrimination and race related stress on the physical and mental health of Black Americans.
Collapse
Affiliation(s)
- Evelyn A Hunter
- Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, United States.
| | - J M Meyer
- Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, United States
| | - G M Brown
- Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, United States
| | - M A Hanks
- Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, United States
| |
Collapse
|
28
|
Grant JG, Rapport LJ, Darling R, Waldron-Perrine B, Lumley MA, Whitfield KE, Bernitsas E. Cognitive enrichment and education quality moderate cognitive dysfunction in black and white adults with multiple sclerosis. Mult Scler Relat Disord 2023; 78:104916. [PMID: 37552903 DOI: 10.1016/j.msard.2023.104916] [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: 02/27/2023] [Revised: 05/30/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To examine the extent to which three sociobehavioral proxies of cognitive reserve-years of education, education quality, and cognitive enrichment-differ in their prediction of cognitive performance among Black and White people with MS (PwMS). METHODS 82 PwMS (Black n = 41, White n = 41) underwent a neurological examination and a neuropsychological evaluation that included tests of word recognition (Wechsler Test of Adult Reading) as well as measures of verbal memory, visuospatial memory, and processing speed (the Brief International Cognitive Assessment for MS; BICAMS). Participants rated their lifetime engagement in various cognitively-enriching activities (Cognitive Reserve Scale). RESULTS For the full sample, education quality and cognitive enrichment were more strongly associated with cognitive performance than were years of education. Cognitive enrichment was not associated with cognitive performance among participants with high education quality. In contrast, among participants with low education quality, cognitive enrichment was strongly associated with cognitive performance, suggesting that high engagement in cognitively-enriching activities provided similar protection to high education quality. Furthermore, among Black participants, cognitive enrichment and educational quality moderated the relationship between disability level and cognitive performance. In contrast, among White participants, cognitive enrichment did not provide additional protection beyond the buffering effect of education quality. CONCLUSIONS PwMS can successfully build reserve through multiple routes, including formal education or informal cognitive enrichment. Treatment for MS should incorporate cognitively-enriching activities to build resilience against cognitive decline, particularly for members of marginalized racial/ethnic groups, who are at greatest risk for poor health outcomes, and for whom years of education may not best reflect education quality.
Collapse
Affiliation(s)
- Jeremy G Grant
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Detroit, MI 48202, USA.
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Detroit, MI 48202, USA
| | - Rachel Darling
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brigid Waldron-Perrine
- Department of Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., Detroit, MI 48202, USA
| | - Keith E Whitfield
- Department of Psychology and Department of Brain Health, University of Nevada, Las Vegas, NV, USA
| | - Evanthia Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
29
|
Sheehan CM, Garcia MA, Chiu CT, Cantu PA. Racial and Ethnic Differences in Sleep Duration Life Expectancies among Men and Women in Mid-to-Late Life. Res Aging 2023; 45:620-629. [PMID: 36548945 DOI: 10.1177/01640275221146478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This analysis documents U.S. racial/ethnic and gender differences in life expectancies with different self-reported sleep durations among adults aged 50 and older. We used self-reported sleep duration and linked mortality information from the 2004-2015 National Health Interview Survey (n = 145,015) to calculate Sullivan Method Lifetables for life expectancies with different self-reported sleep duration states: short (≤6 hours), optimal (seven to 8 hours), and long (≥9 hours) sleep duration per-day by race/ethnicity and gender. Non-Hispanic Black men (35.8%, 95% CI: 34.8%-36.8%) and women (36.5%, 95% CI: 35.7%-37.1%) exhibited the highest proportion of years lived with short sleep duration followed by Hispanic men (31.1%, 95% CI: 29.9%-32.3%) and women (34.1%, 95% CI: 33.1%-35.1%) and Non-Hispanic White men (25.8%, 95% CI: 25.4%-26.2%) and women (27.4%, 95% CI: 27.0%-27.7%). These results highlight how race/ethnic inequality in sleep duration and life expectancy are intertwined among older adults in the U.S.
Collapse
Affiliation(s)
- Connor M Sheehan
- School of Social and Family Dynamics, Arizona State University, Tempe, AZ, USA
| | - Marc A Garcia
- Department of Sociology, Aging Studies Institute, Center for Aging and Policy Studies, Lerner Center for Public Health Promotion, Syracuse University, Syracuse, New York, USA
| | - Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, Taipei, Taiwan
| | - Phillip A Cantu
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
30
|
Tardo L, Salter A, Truong-Le M, Horton L, Blackburn KM, Sguigna PV. A narrative review of neuro-ophthalmologic disease in African Americans and Hispanics with multiple sclerosis. Ther Adv Chronic Dis 2023; 14:20406223231202645. [PMID: 37790945 PMCID: PMC10542320 DOI: 10.1177/20406223231202645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Multiple sclerosis (MS) is the most common non-traumatic cause of disability in young people, with vision loss in the disease representing the second largest contributor to disability. In particular, African-American patients with MS are noted to have lower vision than their Caucasian counterparts. In this review, we examine the disparities in eye diseases in the MS population with our gaps in knowledge and discuss the underlying nature of pathological disparities.
Collapse
Affiliation(s)
- Lauren Tardo
- Department of Neurology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8806, USA
| | - Amber Salter
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melanie Truong-Le
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lindsay Horton
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kyle M. Blackburn
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter V. Sguigna
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
31
|
Xu W, Yan D, Ning Z. Associations between multiple sclerosis and in-hospital outcomes of patients with hemorrhagic stroke. J Stroke Cerebrovasc Dis 2023; 32:107281. [PMID: 37523878 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To determine the influence of multiple sclerosis (MS) on in-hospital outcomes of patients with hemorrhagic strokes using a large, nationally representative database. MATERIALS AND METHODS This population-based, retrospective study extracted data of adults with hemorrhagic stroke from the US Nationwide Inpatient Sample (NIS) database from 2016 to 2018. Patients with/without MS were then compared. Hemorrhagic stroke and MS were identified by the International Classification of Diseases, Tenth editions (ICD-10) codes. In-hospital outcomes (i.e., in-hospital mortality, discharge destination, length of stay [LOS], total hospital cost, and major complications) were compared between subjects with and without MS using logistic regression analysis. RESULTS Among 107,573 patients with hemorrhagic stroke, 0.3% (n=337) had MS. After 1:10 propensity-score (PS) matching, 3,707 patients remained in the analytic sample. Multivariable analysis revealed that patients with MS had significantly shorter LOS (adjusted β=-1.34 days; 95% CI: -2.41 to -0.26, p=0.015), and lower total hospital costs (adjusted β=-28.82; 95% CI: -43.57 to -14.06, p<0.001) than those without MS. No significant different risks of any major complications, in-hospital mortality, or transfer to nursing homes/long-term care facilities were observed. For major complications, patients with MS had a significantly lower risk of cerebral edema than those without MS (adjusted odds ratio [aOR] = 0.66, 95%CI: 0.51 to 0.86, p =0.002) CONCLUSIONS: In hospitalized patients with hemorrhagic stroke, those with MS have shorter LOS, lower costs, and a lower risk of cerebral edema compared to no MS. More relevant experiments and studies are needed to confirm results of this study.
Collapse
Affiliation(s)
- Weiguang Xu
- Department of Neurosurgery, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China.
| | - Dajun Yan
- Department of Neurosurgery, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China
| | - Zeqian Ning
- Department of Neurosurgery, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510080, China
| |
Collapse
|
32
|
Gunzler DD, De Nadai AS, Miller D, Ontaneda D, Briggs FB. Long-term trajectories of ambulatory impairment in multiple sclerosis. Mult Scler 2023; 29:1282-1295. [PMID: 37503861 PMCID: PMC10528275 DOI: 10.1177/13524585231187521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Ambulatory impairment is a common and complex manifestation of multiple sclerosis (MS), and longitudinal patterns are not well understood. OBJECTIVE To characterize longitudinal walking speed trajectories in a general MS patient population and in those with early disease (⩽ 5 years from onset), identify subgroups with similar patterns, and examine associations with individual attributes. METHODS Using a retrospective cohort study design, latent class growth analysis was applied to longitudinal timed 25-foot walk (T25-FW) data from 7683 MS patients, to determine T25-FW trajectories. Associations were evaluated between trajectory assignment and individual attributes. Analyses were repeated for 2591 patients with early disease. RESULTS In the general patient population, six trajectories were discerned, ranging from very minimal to very high impairment at baseline, with variability in impairment accrual. The clusters with moderate to very high walking impairment were associated with being female, older and Black American, longer symptom duration, progressive course, and depressive symptoms. In the early disease subset, eight trajectories were discerned that included two subgroups that rapidly accrued impairment. CONCLUSION We identified novel subgroups of MS patients will distinct long-term T25-FW trajectories. These results underscore that socially disadvantaged and economically marginalized MS patients are the most vulnerable for severe ambulatory impairment.
Collapse
Affiliation(s)
- Douglas D. Gunzler
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Center for Health Care Research and Policy, School of
Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Deborah Miller
- The Mellen Center for Multiple Sclerosis and Research,
Department of Neurology, Neurological Institute, Cleveland Clinic Foundation,
Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case
Western Reserve University, Cleveland, OH, USA
| | - Daniel Ontaneda
- The Mellen Center for Multiple Sclerosis and Research,
Department of Neurology, Neurological Institute, Cleveland Clinic Foundation,
Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case
Western Reserve University, Cleveland, OH, USA
| | - Farren B.S. Briggs
- Department of Population and Quantitative Health Sciences,
Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
33
|
Amezcua L, Livingston T, Hayward B, Zhou J, Williams MJ. Impact of adherence to disease modifying therapies on long-term clinical and economic outcomes in multiple sclerosis: A claims analysis of real-world data. Mult Scler Relat Disord 2023; 77:104866. [PMID: 37487345 DOI: 10.1016/j.msard.2023.104866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurodegenerative inflammatory disease that requires long-term commitment to treatment for optimal outcomes. A variety of disease-modifying therapies (DMTs) are now available that reduce relapses and delay disease progression in people with MS. However, adherence remains a significant issue, with a variety of mental, physical, and emotional factors contributing to non-adherence. In a large number of studies, non-adherence has been associated with worse clinical outcomes (relapses and disease severity), a higher economic burden, and loss of work productivity. However, many of these studies were short-term (1-2 years) or cross-sectional studies; thus, more data are needed on the long-term clinical and economic impacts of DMT non-adherence. The objective of this study was to determine the longer-term impact of adherence to DMTs on disease activity and healthcare resource utilization (HCRU) in people with MS. The study hypothesis was that non-adherence to DMTs would be associated long-term with worse clinical outcomes and a higher economic burden. METHODS A retrospective administrative claims analysis of the US MarketScan® Commercial database (2011-2017) in individuals (18-65 years) with MS (based on International Classification of Disease coding) was conducted. Adherence was classified by proportion of days covered (PDC) ≥0.8 and non-adherence by PDC <0.8; sensitivity analyses helped further categorize as moderately (PDC ≥0.6-<0.8) or highly (PDC <0.6) non-adherent. Cohorts were matched using propensity score matching. Time to first relapse, annualized relapse rate (ARR), time to use of assistive devices (cane/walker or wheelchair), and annual HCRU (inpatient, emergency room [ER], outpatient, and MRI visits and costs) were compared between cohorts. RESULTS 10,248 MS cases were identified; 58% met adherence criteria, and 42% met non-adherence criteria. Mean follow-up from diagnosis or first DMT claim was 5.3 years. Adherent individuals had a longer time to first relapse (hazard ratio [HR] 0.83; 95% confidence interval [CI]: 0.77-0.90; p<0.0001), a lower ARR (0.13 vs. 0.18, respectively; rate ratio [RR] 0.75 [95% CI: 0.71-0.79]; p<0.0001), and longer lag times to cane/walker use (HR 0.79 [95% CI: 0.66-0.94]; p=0.0067) and wheelchair use (HR 0.68 [95% CI: 0.55-0.83]; p=0.0002) than non-adherent individuals. Adherent individuals had fewer annual inpatient and ER visits and lower total costs than those who were non-adherent (p<0.0001). Sensitivity analyses showed that differences in disease activity and HCRU were generally more pronounced between matched adherent and highly non-adherent pairs than between matched adherent and moderately non-adherent pairs. CONCLUSION Significant differences in MS disease activity and HCRU were observed based on adherence to DMTs. Our study underscores the negative impact of non-adherence to DMTs on long-term clinical and economic outcomes in MS.
Collapse
Affiliation(s)
- Lilyana Amezcua
- Department of Neurology, Keck School of Medicine, University of Southern California, USA.
| | | | - Brooke Hayward
- One Technology Place, EMD Serono, Inc., Rockland, MA, USA
| | - Jia Zhou
- One Technology Place, EMD Serono, Inc., Rockland, MA, USA
| | | |
Collapse
|
34
|
Pereira JG, Leon LAA, de Almeida NAA, Raposo-Vedovi JV, Fontes-Dantas FL, Farinhas JGD, Pereira VCSR, Alves-Leon SV, de Paula VS. Higher frequency of Human herpesvirus-6 (HHV-6) viral DNA simultaneously with low frequency of Epstein-Barr virus (EBV) viral DNA in a cohort of multiple sclerosis patients from Rio de Janeiro, Brazil. Mult Scler Relat Disord 2023; 76:104747. [PMID: 37267685 DOI: 10.1016/j.msard.2023.104747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 06/04/2023]
Abstract
Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease of the central nervous system (CNS). The etiology of MS is not well understood, but it's likely one of the genetic and environmental factors. Approximately 85% of patients have relapsing-remitting MS (RRMS), while 10-15% have primary progressive MS (PPMS). Epstein-Barr virus (EBV) and Human herpesvirus 6 (HHV-6), members of the human Herpesviridae family, are strong candidates for representing the macroenvironmental factors associated with MS) pathogenesis. Antigenic mimicry of EBV involving B-cells has been implicate in MS risk factors and concomitance of EBV and HHV-6 latent infection has been associated to inflammatory MS cascade. To verify the possible role of EBV and HHV-6 as triggering or aggravating factors in RRMS and PPMS, we compare their frequency in blood samples collected from 166 MS patients. The presence of herpes DNA was searched by real-time PCR (qPCR). The frequency of EBV and HHV-6 in MS patients were 1.8% (3/166) and 8.9% (14/166), respectively. Among the positive patients, 100% (3/3) EBV and 85.8% (12/14) HHV-6 are RRMS and 14.4% (2/14) HHV-6 are PPMS. Detection of EBV was 1.2% (2/166) and HHV-6 was 0.6% (1/166) in blood donors. About clinical phenotype of these patients, incomplete multifocal myelitis, and optic neuritis were the main CNS manifestations. These are the first data about concomitant infection of these viruses in MS patients from Brazil. Up to date, our findings confirm a higher prevalence in female with MS and a high frequency of EBV and HHV-6 in RRMS patients.
Collapse
Affiliation(s)
| | - Luciane A Amado Leon
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute/ Fiocruz, Rio de Janeiro, Brazil
| | | | - Jéssica Vasques Raposo-Vedovi
- Laboratory of Translacional Neurosciences, Biomedical Institute, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, Brazil
| | - Fabrícia Lima Fontes-Dantas
- Department of Pharmacology, Institute of Biology, Rio de Janeiro State University, (UERJ), Rio de Janeiro, Brazil
| | - João Gabriel Dib Farinhas
- Department of Neurology/Reference and Research Center for Multiple Sclerosis and Other Central Nervous System Idiopathic Demyelinating Inflammatory Diseases, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valéria Coelho Santa Rita Pereira
- Department of Neurology/Reference and Research Center for Multiple Sclerosis and Other Central Nervous System Idiopathic Demyelinating Inflammatory Diseases, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Soniza V Alves-Leon
- Department of Neurology/Reference and Research Center for Multiple Sclerosis and Other Central Nervous System Idiopathic Demyelinating Inflammatory Diseases, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Laboratory of Translacional Neurosciences, Biomedical Institute, Federal University of the State of Rio de Janeiro/UNIRIO, Rio de Janeiro, Brazil.
| | - Vanessa S de Paula
- Laboratory of Molecular Virology, Oswaldo Cruz Institute/ Fiocruz, Rio de Janeiro, Brazil
| |
Collapse
|
35
|
Mañago MM, Seamon BA, Boncella KL, Wallin MT, Maloni H, Hoover B, Blackman MR, Harris-Love MO. Ultrasound measures of muscle morphology in people with multiple sclerosis are associated with muscle performance and functional mobility. Mult Scler Relat Disord 2023; 75:104759. [PMID: 37192587 PMCID: PMC10330594 DOI: 10.1016/j.msard.2023.104759] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Neurologically-based muscle weakness is a common symptom in people with multiple sclerosis MS (MS), who may also exhibit muscle morphology changes and intrinsic muscle dysfunction. Diagnostic ultrasound (sonography) is a non-invasive, inexpensive, and clinically feasible method to measure muscle morphology. The purpose of this study was to investigate possible asymmetries in lower limb muscle morphology and performance in people with MS, and to assess the relationships of muscle morphology measures with individual patient characteristics, muscle performance, and functional mobility. METHODS This cross-sectional study was conducted at the Washington, DC Veterans Affairs Medical Center. The study participants were 29 Veterans with MS (52% female, 79% African-American, 48.6 ± 11.2 years old, Mean Expanded Disability Status Scale: 3.6 ± 1.4) who completed seated knee extension isokinetic strength and power tests, functional assessments (Timed 25-Foot Walk - T25FW, 5-Times Sit-to-Stand - 5STS), and quantitative B-mode ultrasound image acquisition of the rectus femoris muscle to derive morphology measures (thickness and echogenicity). The limb with weaker knee extension strength was identified as the more-involved limb. Differences between the more and less-involved limb were quantified using a t-test for all muscle morphology and muscle performance measures. Relationships between muscle morphology and patient characteristics, muscle performance, and functional mobility were evaluated using bivariate and multivariate analyses. RESULTS The rectus femoris thickness from the more-involved limb was lower (p<0.001) than that of the less-involved limb, whereas echogenicity was not different between the two limbs (p=0.147). Rectus femoris thickness of the more-involved limb was directly related to age (r=-0.63, p<0.001), muscle strength (r=0.53, p=0.003) and power (r=0.53, p=0.003), and gait speed (r=0.42, p=0.024); whereas its echogenicity was positively associated only with muscle strength (r=-0.46, p=0.013) and power (r=-0.50, p=0.006). Together rectus femoris thickness and echogenicity of the more involved limb explained 44% and 48% of the variance in muscle strength and power, respectively (p<0.001). CONCLUSION This study supports the ability of sonography to measure muscle morphology in people with MS, identify asymmetries, and quantify associations with important clinical correlates. Compared with more invasive and costly alternatives, sonography is a clinically feasible, relatively low-cost tool that can be used to assess muscle morphology in people with MS. Further research is warranted to determine the potential clinical utility of sonographic measures of muscle morphology in evaluating changes due to disease progression or therapeutic interventions in this population.
Collapse
Affiliation(s)
- Mark M Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; VA Research Service, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.
| | - Bryant A Seamon
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA; Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Research Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Katie L Boncella
- Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mitchell T Wallin
- VA Multiple Sclerosis Center of Excellence and Neurology Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Heidi Maloni
- VA Multiple Sclerosis Center of Excellence and Neurology Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Brian Hoover
- Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Research Service, Washington DC VA Medical Center, Washington, DC, USA
| | - Marc R Blackman
- Research Service, Washington DC VA Medical Center, Washington, DC, USA; Departments of Medicine and Rehabilitation Medicine, Georgetown University, Washington, DC, USA; Department of Medicine, George Washington University, Washington, DC, USA
| | - Michael O Harris-Love
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; VA Research Service, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA; Muscle Morphology, Mechanics and Performance Lab, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Research Service, Washington DC VA Medical Center, Washington, DC, USA; Geriatric Service, Washington DC VA Medical Center, Washington, DC, USA
| |
Collapse
|
36
|
Nathoo N, Zeydan B, Neyal N, Chelf C, Okuda DT, Kantarci OH. Do magnetic resonance imaging features differ between persons with multiple sclerosis of various races and ethnicities? Front Neurol 2023; 14:1215774. [PMID: 37448745 PMCID: PMC10338060 DOI: 10.3389/fneur.2023.1215774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Those of African American or Latin American descent have been demonstrated to have more severe clinical presentations of multiple sclerosis (MS) than non-Latin American White people with MS. Concurrently, radiological burden of disease on magnetic resonance imaging (MRI) in African Americans with MS has also been described as being more aggressive. Here, we review MRI studies in diverse racial and ethnic groups (adult and pediatric) investigating lesion burden, inflammation, neurodegeneration, and imaging response to disease modifying therapy. We also discuss why such disparities may exist beyond biology, and how future studies may provide greater insights into underlying differences.
Collapse
Affiliation(s)
- Nabeela Nathoo
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Burcu Zeydan
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Nur Neyal
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Cynthia Chelf
- Mayo Clinic College of Medicine and Science, Library-Public Services, Mayo Clinic, Rochester, MN, United States
| | - Darin T. Okuda
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Orhun H. Kantarci
- Division of Multiple Sclerosis and Autoimmune Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
37
|
Khan Z, Gupta GD, Mehan S. Cellular and Molecular Evidence of Multiple Sclerosis Diagnosis and Treatment Challenges. J Clin Med 2023; 12:4274. [PMID: 37445309 DOI: 10.3390/jcm12134274] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that impacts the central nervous system and can result in disability. Although the prevalence of MS has increased in India, diagnosis and treatment continue to be difficult due to several factors. The present study examines the difficulties in detecting and treating multiple sclerosis in India. A lack of MS knowledge among healthcare professionals and the general public, which delays diagnosis and treatment, is one of the significant issues. Inadequate numbers of neurologists and professionals with knowledge of MS management also exacerbate the situation. In addition, MS medications are expensive and not covered by insurance, making them inaccessible to most patients. Due to the absence of established treatment protocols and standards for MS care, India's treatment techniques vary. In addition, India's population diversity poses unique challenges regarding genetic variations, cellular and molecular abnormalities, and the potential for differing treatment responses. MS is more difficult to accurately diagnose and monitor due to a lack of specialized medical supplies and diagnostic instruments. Improved awareness and education among healthcare professionals and the general public, as well as the development of standardized treatment regimens and increased investment in MS research and infrastructure, are required to address these issues. By addressing these issues, it is anticipated that MS diagnosis and treatment in India will improve, leading to better outcomes for those affected by this chronic condition.
Collapse
Affiliation(s)
- Zuber Khan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
| | - Ghanshyam Das Gupta
- Department of Pharmaceutics, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
| | - Sidharth Mehan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy, IK Gujral Punjab Technical University, Jalandhar 144603, India
| |
Collapse
|
38
|
Jawad A, Baattaiah BA, Alharbi MD, Chevidikunnan MF, Khan F. Factors contributing to falls in people with multiple sclerosis: The exploration of the moderation and mediation effects. Mult Scler Relat Disord 2023; 76:104838. [PMID: 37390785 DOI: 10.1016/j.msard.2023.104838] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/12/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The prevalence of multiple sclerosis (MS) has significantly increased in recent decades. People with MS have a high risk of falling; these falls may lead to serious injuries, affecting their quality of life PURPOSE: The aim of this study is to assess the factors affecting falls in people with MS and map out the most significant ones. This study also aims to determine whether fatigue has a moderation effect and balance has a mediation effect on falls in people with MS METHODS: In total, 103 people with MS with a mean age of 32.09 ± 7.17 were enrolled. All subjects were assessed for multiple variables including balance using the Berg Balance Scale (BBS), speed of gait using the Timed Up and Go (TUG) test, fear of falling using the Falls Efficacy Scale-International (FES-I), level of fatigue using the Modified Fatigue Impact Scale (MFIS), and lower limb muscle strength using a handheld digital dynamometer RESULTS: Simple binary logistic regression analysis showed significant results for BBS (OR: 10.88; 95% CI: 4.24-27.96; p < 0.0001), TUG (OR: 1.18; 95% CI: 1.09-1.28; p < 0.0001), FES-I (OR: 1.06; 95% CI: 1.02-1.10; p = 0.001), and MFIS (OR: 1.04; 95% CI: 1.02-1.07; p < 0.0001) as factors affecting falls. According to multivariate analysis, balance (OR: 3.924; 95% CI: 1.307-11.780, p = 0.015), speed of gait (OR: 1.122; 95% CI: 1.023-1.231; p = 0.015), and fatigue (OR: 1.029; 95% CI: 1.002-1.058; p = 0.038) were the strongest predicting factors of falls. Hayes's PROCESS analysis showed that fatigue had a significant moderation effect on the relationship between gait speed and falls (MFIS; β; 0.10; p < 0.0001; 95% CI: 0.07-0.14) and balance had a mediation effect on the relationship between gait speed and falls (BBS; indirect effect; 0.08; 95% CI: 0.02-0.13) CONCLUSIONS: People with MS with impaired balance, slower gait speeds, higher levels of fatigue, and a fear of falling were at a high risk of falling. The relationship between gait speed and falls can be mediated by impaired balance and moderated by the level of fatigue. Our data suggest that targeting balance and fatigue while developing rehabilitation interventions could decrease the incidence of falls among people with MS.
Collapse
Affiliation(s)
- Adel Jawad
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia; Department of Physical Therapy, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Baian A Baattaiah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mutasim D Alharbi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia.
| |
Collapse
|
39
|
Sarin S, Modak N, Sun R, Subei O, Serra A, Morgan M, Abboud H. Predicting the final clinical phenotype after the first attack of optic neuritis. J Neuroimmunol 2023; 381:578130. [PMID: 37343437 DOI: 10.1016/j.jneuroim.2023.578130] [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: 03/22/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the factors determining the final clinical phenotype after an initial isolated attack of optic neuritis (ON). ON could be an isolated event or the initial presentation of a chronic neuroimmunological condition. METHODS This was a retrospective analysis of patients presenting to University Hospitals Cleveland Medical Center for an initial, isolated attack of ON. Final clinical phenotypes were idiopathic ON, multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein associated disease (MOGAD), or secondary ON (e.g. neurosarcoidosis). Several potential predictors at the time of initial presentation were compared among the different phenotypes to determine early predictors. Categorical variables were compared using Pearson χ2 or Fisher's exact test, and continuous variables were compared using independent t-test. RESULTS Sixty-four patients met criteria (average age 41.3 ± 13.3, 78.1% females). Average time to final diagnosis was 8.3 months, and average follow-up was 47 months. The final phenotypes were MS (22, 34%), idiopathic ON (14, 22%), MOGAD (11, 17%), NMOSD (10, 16%), and secondary ON (7, 11%). White race, unilateral ON, short segment hyperintensity on orbital MRI, classical demyelination on brain MRI, and not requiring PLEX were associated with MS. Older age, poor steroid responsiveness, and requiring PLEX were associated with NMOSD. African American race, bilateral ON, papillitis on fundoscopy, long segment hyperintensity on orbital MRI, and normal brain MRI were associated with MOGAD. Normal or thinned retinal nerve fiber layer on OCT, short segment hyperintensity on orbital MRI, and normal brain MRI were associated with idiopathic ON. CONCLUSION The final clinical phenotype may be predictable at the time of initial ON presentation. This requires a careful evaluation of patient demographics, treatment response, funduscopic findings, OCT, and orbital and brain MRIs. Utilizing early predictors in clinical practice could better inform prognosis and management decisions.
Collapse
Affiliation(s)
- Shlok Sarin
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Nikhil Modak
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Rongyi Sun
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Omar Subei
- Duke University Medical Center, Durham, NC, United States of America
| | - Alessandro Serra
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America; MS Center of Excellence, Cleveland Veterans Affairs Medical Center, United States of America
| | - Michael Morgan
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America; Department of Ophthalmology, University Hospitals Cleveland Medical Center, United States of America
| | - Hesham Abboud
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America.
| |
Collapse
|
40
|
Williams MJ, Okai AF, Cross AH, Monson NL, Vartanian T, Thrower BW, Reder AT, English JB, Wu GF, Bernitsas E, Yap S, Ndrio J, Pei J, Mowry EM, Magrini F, Acosta J, Amezcua L. Demographics and baseline disease characteristics of Black and Hispanic patients with multiple sclerosis in the open-label, single-arm, multicenter, phase IV CHIMES trial. Mult Scler Relat Disord 2023; 76:104794. [PMID: 37356256 DOI: 10.1016/j.msard.2023.104794] [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: 11/07/2022] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Black/African American patients with multiple sclerosis (BpwMS) and Hispanic/Latino patients with multiple sclerosis (HpwMS), who historically have been underrepresented in multiple sclerosis (MS) clinical trials, exhibit greater disease severity and more rapid disease progression than White patients with MS (WpwMS). The lack of diversity and inclusion in clinical trials, which may be due to barriers at the system, patient and study levels, impacts the ability to effectively assess risks, benefits and treatment responses in a generalized patient population. METHODS CHIMES (Characterization of Ocrelizumab in Minorities With Multiple Sclerosis), an open-label, single-arm, multicenter, phase IV study of self-identified BpwMS and HpwMS aged 18-65 years with relapsing MS and an Expanded Disability Status Score (EDSS) of ≤5.5, was developed in collaboration with patients with MS, national advocacy groups and clinical researchers. Patients were enrolled at study centers across the US, including Puerto Rico, and 1 site in Kenya. RESULTS A total of 182 patients enrolled in CHIMES: 113 (62.1%) were BpwMS, and 69 (37.9%) were HpwMS; the mean (SD) baseline EDSS score was 2.4 (1.4), and 62.6% of patients were treatment naive. Using the pooled non-BpwMS/HpwMS group in the OPERA ocrelizumab trials as a reference population, patients enrolled in CHIMES were younger, had a higher mean body mass and had a greater T2 lesion volume but similar T2 lesion number on MRI. CONCLUSION BpwMS and HpwMS have been consistently underrepresented in clinical trials, limiting the understanding of disease biology and response to treatment in this population. Data from the CHIMES study revealed differences in demographics and some baseline disease characteristics and disease burden between BpwMS and HpwMS vs WpwMS. These differences could have an impact when assessing clinical outcomes in BpwMS and HpwMS. CLINICALTRIALS GOV IDENTIFIER NCT04377555.
Collapse
Affiliation(s)
- Mitzi J Williams
- Joi Life Wellness MS Center, 767 Concord Rd SE, Smyrna, GA, 30082, USA.
| | - Annette F Okai
- North Texas Institute of Neurology and Headache, 6201 Dallas Pkwy, Plano, TX, 75024, USA
| | - Anne H Cross
- Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St Louis, MO, 63110, USA
| | - Nancy L Monson
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Timothy Vartanian
- Weill Cornell Medical College, 1305 York Ave, New York, NY, 10021, USA
| | - Ben W Thrower
- Andrew C. Carlos MS Institute, Shepherd Center, 2020 Peachtree Road, NW, Atlanta, GA, 30309, USA
| | - Anthony T Reder
- University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Jeffrey B English
- Atlanta Neuroscience Institute/Multiple Sclerosis Center of Atlanta, 3200 Downwood Cir NW, Atlanta, GA, 30327, USA
| | - Gregory F Wu
- Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St Louis, MO, 63110, USA
| | - Evanthia Bernitsas
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Shereen Yap
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Jugena Ndrio
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Jinglan Pei
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Ellen M Mowry
- Johns Hopkins Hospital, 600 N Wolfe St, Pathology 627, Baltimore, MD, 21287, USA
| | - Fabio Magrini
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Juan Acosta
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, 94080, USA
| | - Lilyana Amezcua
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| |
Collapse
|
41
|
Davis GE, Davis MJ, Lowell WE. Triggering multiple sclerosis at conception and early gestation: The variation in ultraviolet radiation is as important as its intensity. Heliyon 2023; 9:e16954. [PMID: 37346332 PMCID: PMC10279836 DOI: 10.1016/j.heliyon.2023.e16954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/17/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023] Open
Abstract
Background and objectives Medical science needs to further elucidate the role of ultraviolet radiation (UVR), geographic latitude, and the role of vitamin D in the autoimmune disease multiple sclerosis (MS). We separated several papers into categories out of the thousands published and used their conclusions to explore the relationship between UVR and MS. Relevance MS is increasing in incidence, particularly in women where MS is two to three times that in men and particularly severe in African Americans. Methods We collected UVR data at our observatory in Central Maine and calculated the average coefficient of variation (CVUVR) for each month for 15 years (2007-2021, inclusive). Results The month of conception (MOC) is more important than the month of birth (MOB) in explaining how UVR triggers the variable genetic predisposition to MS. We hypothesize that the rapidly increasing CVUVR is important in preventing an increase in the activity of the vitamin D receptor (VDR) from August to December, which then requires a higher intensity of UVR later in life to suppress the immune system, therefore predisposing to more MS. Limitations One observatory at about 44° latitude. Conclusions While variation in UVR is important at the MOC if UVR exceeds a threshold (e.g., if the sunspot number equals or is greater than 90, usually at a solar cycle MAX, or at elevations above approximately 3,000 feet above sea level), the MS mitigating vitamin D-VDR mechanism is overwhelmed and the genotoxic effects of higher-intensity UVR promote MS in those with a genetic predisposition. What is new in this research This paper offers a new concept in MS research.
Collapse
Affiliation(s)
- George E. Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, ME, 04333-0011, USA
| | - Matthew J. Davis
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, ME, 04333-0011, USA
| | - Walter E. Lowell
- Riverview Psychiatric Center, 250 Arsenal Street, State House Station #11, Augusta, ME, 04333-0011, USA
| |
Collapse
|
42
|
Rotstein DL, Gyang TV, Ontaneda D. Making Sure Multiple Sclerosis Counts and Is Counted for All-An Update on Multiple Sclerosis Prevalence by Race and Ethnicity in the United States. JAMA Neurol 2023:2805040. [PMID: 37184874 DOI: 10.1001/jamaneurol.2023.0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Dalia L Rotstein
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Department of Neurology, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
43
|
Moore MZ, Pérez CA, Hutton GJ, Patel H, Cuascut FX. Health Disparities in Multiple Sclerosis among Hispanic and Black Populations in the United States. Biomedicines 2023; 11:biomedicines11041227. [PMID: 37189845 DOI: 10.3390/biomedicines11041227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/07/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Multiple sclerosis (MS) is an acquired demyelinating disease of the central nervous system (CNS). Historically, research on MS has focused on White persons with MS. This preponderance of representation has important possible implications for minority populations with MS, from developing effective therapeutic agents to understanding the role of unique constellations of social determinants of health. A growing body of literature involving persons of historically underrepresented races and ethnicities in the field of multiple sclerosis is assembling. Our purpose in this narrative review is to highlight two populations in the United States: Black and Hispanic persons with multiple sclerosis. We will review the current understanding about the patterns of disease presentation, genetic considerations, response to treatment, roles of social determinants of health, and healthcare utilization. In addition, we explore future directions of inquiry as well as practical methods of meeting these challenges.
Collapse
Affiliation(s)
- Michael Z Moore
- Maxine Mesinger Multiple Sclerosis Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Carlos A Pérez
- Maxine Mesinger Multiple Sclerosis Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - George J Hutton
- Maxine Mesinger Multiple Sclerosis Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Hemali Patel
- Maxine Mesinger Multiple Sclerosis Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Fernando X Cuascut
- Maxine Mesinger Multiple Sclerosis Center, Baylor College of Medicine, Houston, TX 77030, USA
| |
Collapse
|
44
|
Fakolade A, Akbar N, Mehelay S, Phadke S, Tang M, Alqahtani A, Pullattayil AK, Busse M. Mapping two decades of multiple sclerosis rehabilitation trials: A systematic scoping review and call to action to advance the study of race and ethnicity in rehabilitation research. Mult Scler Relat Disord 2023; 72:104606. [PMID: 36917889 DOI: 10.1016/j.msard.2023.104606] [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: 11/21/2022] [Revised: 01/16/2023] [Accepted: 03/04/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Multiple sclerosis (MS), is prevalent across many racial and ethnic groups, and disproportionately impacts racially minoritized populations. Rehabilitation interventions are an important component of comprehensive MS care. Yet, we do not know the extent to which MS rehabilitation trials consider race and ethnicity in defining eligibility criteria, planning recruitment strategies, selecting outcome measures, supporting intervention delivery, and designing approaches to promote adherence and retention. METHODS We conducted a scoping review of five databases (MEDLINE, CINAHL, Cochrane Central, EMBASE, and Web of Science) to locate randomized controlled rehabilitation trials published from January 2002 to March 2022. We extracted data from relevant studies, assessed their methodological quality, and narratively summarized results. Reporting of this review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). RESULTS Fifty-six studies of neurorehabilitation (n = 3), cognitive rehabilitation (n = 6), exercise training (n = 9) and self-management (n = 38) interventions were included in this review. The studies were predominantly from North America (n = 44; 73%) or Europe (n = 12; 20%) and included 4280 participants. Most participants (n = 3669; 86%) were Caucasians. Less than 10% of participants were Black (n = 282), Latinx/Hispanic (n = 60), Asian (n = 46), Indigenous (n = 7), or Arab (n = 2). Few studies discussed how race and/or ethnicity were considered in trial planning or execution. CONCLUSIONS Without consistent and systematic attention to race and ethnicity, both in terms of trial design and reporting, it is impossible to know how MS rehabilitation interventions will translate into real-world applications. This call to action - to the MS rehabilitation research community to ensure trial and intervention processes that accommodate the needs of diverse racial and ethnic groups - is an important first step in addressing inequities in rehabilitation care for persons with MS.
Collapse
Affiliation(s)
- Afolasade Fakolade
- School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston K7L 3N6, Canada.
| | - Nadine Akbar
- School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston K7L 3N6, Canada; Research Department, Humber River Hospital, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Sumaya Mehelay
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Siona Phadke
- Department of Psychology, Queen's University, Kingston, Canada; Department of Biology, Queen's University, Kingston, Canada
| | - Matthew Tang
- Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Ashwaq Alqahtani
- School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston K7L 3N6, Canada; Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah 52645, Saudi Arabia
| | | | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|
45
|
Ramanathan S, Brilot F, Irani SR, Dale RC. Origins and immunopathogenesis of autoimmune central nervous system disorders. Nat Rev Neurol 2023; 19:172-190. [PMID: 36788293 DOI: 10.1038/s41582-023-00776-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/16/2023]
Abstract
The field of autoimmune neurology is rapidly evolving, and recent discoveries have advanced our understanding of disease aetiologies. In this article, we review the key pathogenic mechanisms underlying the development of CNS autoimmunity. First, we review non-modifiable risk factors, such as age, sex and ethnicity, as well as genetic factors such as monogenic variants, common variants in vulnerability genes and emerging HLA associations. Second, we highlight how interactions between environmental factors and epigenetics can modify disease onset and severity. Third, we review possible disease mechanisms underlying triggers that are associated with the loss of immune tolerance with consequent recognition of self-antigens; these triggers include infections, tumours and immune-checkpoint inhibitor therapies. Fourth, we outline how advances in our understanding of the anatomy of lymphatic drainage and neuroimmune interfaces are challenging long-held notions of CNS immune privilege, with direct relevance to CNS autoimmunity, and how disruption of B cell and T cell tolerance and the passage of immune cells between the peripheral and intrathecal compartments have key roles in initiating disease activity. Last, we consider novel therapeutic approaches based on our knowledge of the immunopathogenesis of autoimmune CNS disorders.
Collapse
Affiliation(s)
- Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
| | - Fabienne Brilot
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Science, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Russell C Dale
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.
- TY Nelson Department of Paediatric Neurology, Children's Hospital Westmead, Sydney, New South Wales, Australia.
| |
Collapse
|
46
|
Tisavipat N, Jitpratoom P, Siritho S, Prayoonwiwat N, Apiwattanakul M, Boonyasiri A, Rattanathamsakul N, Jitprapaikulsan J. The epidemiology and burden of neuromyelitis optica spectrum disorder, multiple sclerosis, and MOG antibody-associated disease in a province in Thailand: A population-based study. Mult Scler Relat Disord 2023; 70:104511. [PMID: 36640562 DOI: 10.1016/j.msard.2023.104511] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Central nervous system inflammatory demyelinating diseases (CNSIDDs) have notable interracial heterogeneity. The epidemiology of CNSIDDs in Thailand, a mainland Southeast Asian country, is unknown. OBJECTIVES To determine the cumulative incidence, point prevalence, and disease burden of neuromyelitis optica spectrum disorder (NMOSD) and other CNSIDDs in Thailand using population-based data of Chumphon. METHODS Searching for CNSIDD patients at a public secondary care hospital in Chumphon, the only neurology center in the province, from January 2016 to December 2021 was implemented using relevant ICD-10-CM codes. All diagnoses were individually ascertained by a retrospective chart review. Cumulative incidence, point prevalence, attack rate, mortality rate, and disability-adjusted life years (DALYs) were calculated. RESULTS Aquaporin 4-IgG-positive NMOSD was the most prevalent CNSIDD in the Thai population at 3.08 (1.76-5.38) per 100,000 persons. The prevalence of multiple sclerosis (MS) followed at 0.77 (0.26-2.26) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) at 0.51(0.14-1.87) per 100,000 adults. In the pediatric population, the incidence of acute disseminated encephalomyelitis was 0.28 (0.08-1.02) per 100,000 persons/year. Among other idiopathic demyelinating diseases, idiopathic optic neuritis had the highest incidence at 0.58 (0.24-0.92) per 100,000 persons/year, followed by acute transverse myelitis at 0.44 (0.14-0.74). Idiopathic demyelinating brainstem syndrome was also observed at 0.04 (0.01-0.25) per 100,000 persons/year. Although most had a fair recovery, disability was worst among NMOSD patients with DALYs of 3.61 (3.00-4.36) years per 100,000 persons. Mortality rate was the highest in NMOSD as well. CONCLUSION CNSIDDs are rare diseases in Thailand. The prevalence is comparable to that of East Asian populations. A nationwide CNSIDDs registry would better elaborate the epidemiology of these diseases.
Collapse
Affiliation(s)
- Nanthaya Tisavipat
- Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Pornpong Jitpratoom
- Department of Medicine, Chumphon Khet Udomsak Hospital, Chumphon 86000, Thailand
| | - Sasitorn Siritho
- Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Bumrungrad International Hospital, Bangkok 10110, Thailand
| | - Naraporn Prayoonwiwat
- Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Metha Apiwattanakul
- Department of Neurology, Neurological Institute of Thailand, Bangkok 10400, Thailand
| | - Adhiratha Boonyasiri
- Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Natthapon Rattanathamsakul
- Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Jiraporn Jitprapaikulsan
- Siriraj Neuroimmunology Center, Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| |
Collapse
|
47
|
Liang Z, Fu Q, Li H, Xu X, Ding P, Tang W, Ye Y, Shao X, Tan X, Wang X, Luo X, Wang J, Wang D, Zhong H, Liu M. Metabolite Comparison between Spleen-Deficiency and Healthy Children. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:5937308. [PMID: 37089718 PMCID: PMC10115538 DOI: 10.1155/2023/5937308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023]
Abstract
Objective From the perspective of metabolomics, this study compares the metabolomics characteristics of feces and urine between children with spleen-deficiency and healthy children to explain the scientific connotation of children with spleen-deficiency susceptibility to digestive system diseases from the metabolic level and provide a scientific basis for further research. Methods This study included 20 children with spleen-deficiencies and 17 healthy children. Children's symptom scores, height, and weight were recorded in groups, and feces and urine samples were collected. The samples were detected using ultrahigh-performance liquid chromatography-mass spectrometry. The data were analyzed using multivariate statistical analysis such as principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA). Related differential metabolites were identified through database comparisons between two groups based on the MS and KEGG. Results Compared to healthy children, the metabolites glucuronic acid, xanthine, and indole-3-acetaldehyde tend to be reduced in children with spleen-deficiency. Moreover, these children showed an increase in metabolites such as quinic acid, adenine, 4-methyl-5-thiazole-ethanol, 3-formyl indole, and 5-hydroxy indole-3-acetic acid. The condition affected many of the critical metabolic pathways, including the metabolism of tryptophan, cysteine, methionine, and pentose phosphate. Conclusion The children with spleen-deficiency had disorders at the metabolic level, which might be due to factors such as diet, personal preferences, and genes, leading to various symptoms, making spleen-deficiency children more prone to suffer from digestive diseases than healthy children. The results set a basis for the research on children's TCM constitution, which can be a reference to further studies to deal with the spleen-deficiency.
Collapse
Affiliation(s)
- Zhiyi Liang
- School of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Qianzeng Fu
- School of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
- Hunan Acupuncture & Moxibustion, Clinical Medicine Research Center, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
| | - Haiman Li
- School of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
- Hunan Acupuncture & Moxibustion, Clinical Medicine Research Center, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
| | - Xuan Xu
- School of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Panting Ding
- School of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Wei Tang
- Hunan Acupuncture & Moxibustion, Clinical Medicine Research Center, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
| | - Yong Ye
- Hunan Acupuncture & Moxibustion, Clinical Medicine Research Center, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
| | - Xiangning Shao
- Hunan Acupuncture & Moxibustion, Clinical Medicine Research Center, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, China
| | - Xiaowen Tan
- Xiangxi Hospital of Chinese Medicine of Tujia and Miao Ethnic Group, Jishou 416000, China
| | - Xiaojun Wang
- Xiangxi Hospital of Chinese Medicine of Tujia and Miao Ethnic Group, Jishou 416000, China
| | - Xun Luo
- Kerry Rehabilitation Medicine Research Institute, Shenzhen 518000, China
| | - Jun Wang
- Department of Anatomy, School of Medicine, Shenzhen University, Shenzhen 518060, China
| | - Dejun Wang
- School of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Huan Zhong
- School of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Mi Liu
- School of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine, Changsha 410208, China
| |
Collapse
|
48
|
Petracca M, Palladino R, Droby A, Kurz D, Graziano N, Wang K, Riley C, Howard J, Klineova S, Lublin F, Inglese M. Disability outcomes in early-stage African American and White people with multiple sclerosis. Mult Scler Relat Disord 2023; 69:104413. [PMID: 36399964 PMCID: PMC9892256 DOI: 10.1016/j.msard.2022.104413] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/28/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Factors driving differences in disease burden between African American and White people with multiple sclerosis (pwMS) remain unclear. Here, we explored whether differences in disability outcomes could be observed after controlling for major sociodemographic factors and comorbidities, and assessed the presence of a possible interaction between MS and race. METHODS In this cross-sectional study, 120 pwMS within 6 years from disease onset and 82 healthy controls between 18 and 70 years of age, self-identified as either African American or White, were prospectively enrolled. Inclusion criteria for pwMS were: diagnosis of MS according to the revised McDonald criteria, relapsing-remitting phenotype and Expanded Disability Status Scale (EDSS) < 6.5. Study outcomes included: (i) global disability (EDSS); (ii) quantitative mobility and leg function (Timed 25 Foot Walk Test-T25FWT); (iii) quantitative finger dexterity (9-Hole Peg Test-9HPT); (iv) cognitive efficiency and speed performance (Symbol Digit Modalities Test-SDMT). Differences in disability outcomes were assessed employing multivariable linear regression models. Based on their association with MS or disability, covariates included age, gender, race, years of education, total income, body mass index, comorbidities. The interaction between MS and race on disability outcomes was estimated via relative excess risk of interaction and attributable proportion. RESULTS Accounting for age, gender, total income, education, body mass index and comorbidities, African American pwMS showed significantly worse performances in manual dexterity and cognition than White pwMS (White pwMS coeff. 3.24, 95% CI 1.55, 4.92 vs African American pwMS coeff. 5.52, 95% CI 3.55, 7.48 and White pwMS coeff. -5.87, 95% CI -8.86, -2.87 vs African American pwMS coeff. -7.99, 95% CI -11.58,-4.38). MS and race independently contributed to the observed gradient in disability severity. CONCLUSIONS Complex social disparities and systemic racism might contribute to clinical heterogeneity in MS.
Collapse
Affiliation(s)
- Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Raffaele Palladino
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Amgad Droby
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Kurz
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole Graziano
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine Wang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claire Riley
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Jonathan Howard
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Sylvia Klineova
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fred Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matilde Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; DINOGMI, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCSS, Genoa, Italy.
| |
Collapse
|
49
|
Selective vulnerability of brainstem and cervical spinal cord regions in people with non-progressive multiple sclerosis of Black or African American and European ancestry. Mult Scler 2022; 29:691-701. [PMID: 36507671 DOI: 10.1177/13524585221139575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: We evaluated imaging features suggestive of neurodegeneration within the brainstem and upper cervical spinal cord (UCSC) in non-progressive multiple sclerosis (MS). Methods: Standardized 3-Tesla three-dimensional brain magnetic resonance imaging (MRI) studies were prospectively acquired. Rates of change in volume, surface texture, curvature were quantified at the pons and medulla-UCSC. Whole and regional brain volumes and T2-weighted lesion volumes were also quantified. Independent regression models were constructed to evaluate differences between those of Black or African ancestry (B/AA) and European ancestry (EA) with non-progressive MS. Results: 209 people with MS (pwMS) having at least two MRI studies, 29% possessing 3–6 timepoints, resulted in 487 scans for analysis. Median follow-up time between MRI timepoints was 1.33 (25th–75th percentile: 0.51–1.98) years. Of 183 non-progressive pwMS, 88 and 95 self-reported being B/AA and EA, respectively. Non-progressive pwMS demonstrated greater rates of decline in pontine volume ( p < 0.0001) in B/AA and in medulla-UCSC volume ( p < 0.0001) for EA pwMS. Longitudinal surface texture and curvature changes suggesting reduced tissue integrity were observed at the ventral medulla-UCSC ( p < 0.001), dorsal pons ( p < 0.0001) and dorsal medulla ( p < 0.0001) but not the ventral pons ( p = 0.92) between groups. Conclusions: Selectively vulnerable regions within the brainstem-UCSC may allow for more personalized approaches to disease surveillance and management.
Collapse
|
50
|
Abstract
Social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are the non-medical factors that influence health outcomes. Evidence indicates that health behaviours, comorbidities and disease-modifying therapies all contribute to multiple sclerosis (MS) outcomes; however, our knowledge of the effects of social determinants — that is, the ‘risks of risks’ — on health has not yet changed our approach to MS. Assessing and addressing social determinants of health could fundamentally improve health and health care in MS; this approach has already been successful in improving outcomes in other chronic diseases. In this narrative Review, we identify and discuss the body of evidence supporting an effect of many social determinants of health, including racial background, employment and social support, on MS outcomes. It must be noted that many of the published studies were subject to bias, and screening tools and/or practical interventions that address these social determinants are, for the most part, lacking. The existing work does not fully explore the potential bidirectional and complex relationships between social determinants of health and MS, and the interpretation of findings is complicated by the interactions and intersections among many of the identified determinants. On the basis of the reviewed literature, we consider that, if effective interventions targeting social determinants of health were available, they could have substantial effects on MS outcomes. Therefore, funding for and focused design of studies to evaluate and address social determinants of health are urgently needed. Here, the authors discuss the potential effects of social determinants of health on multiple sclerosis risk and outcomes. They suggest that addressing these determinants of health could substantially improve the lives of individuals with multiple sclerosis and call for more research. Addressing an individual’s social determinants of health — that is, the conditions under which they are born, grow, live, work and age — could provide opportunities to reduce the burden of living with multiple sclerosis (MS). Individual factors that may influence MS-related outcomes include sex, gender and sexuality, race and ethnicity, education and employment, socioeconomic status, and domestic abuse. Societal infrastructures, including access to food, health care and social support, can also affect MS-related outcomes. Awareness of the specific circumstances of a patient with MS might help neurologists deliver better care. Social determinants of health are not static and can change according to wider sociopolitical contexts, as highlighted by the COVID-19 pandemic. Rigorous studies of interventions to ameliorate the effects of poor social determinants on people with MS are urgently needed.
Collapse
|