Pub Date : 2026-01-19DOI: 10.1016/j.msard.2026.107020
Ying Li, Alice Saul, Bruce Taylor, Anne-Louise Ponsonby, Steve Simpson-Yap, Leigh Blizzard, Simon Broadley, Jeannette Lechner-Scott, Ingrid van der Mei
Background: Among environmental factors associated with multiple sclerosis (MS) susceptibility, few studies have examined different onset types. It remains unclear whether risk factors for primary progressive MS (PPMS) are comparable to those for relapse-onset MS (RMS). This study aimed to explore the association between selected environmental factors and PPMS risk, and compare their effect sizes with RMS.
Methods: We used a case-control design with participants from two datasets: the Primary-Progressive MS Study (2015-2021) and the Australian Multi-center Study of Environment and Immune Function (2003-2006). Questionnaires collected data on smoking, infectious and concussion history before MS onset, supplement intake before age 15, and breastfeeding history. Unconditional, conditional, and weighted multivariable logistic regression evaluated associations with PPMS and RMS onset risk.
Results: A significant positive association was observed between tobacco smoking prior to onset (≥20 pack-years: odds ratio (OR)=1.75, 95% confidence interval (CI)=0.96-3.20, P for trend=0.03) and history of infectious mononucleosis before MS onset (OR=1.74, 95% CI=1.05-2.88) in PPMS. Having vitamin supplements before age 15 (OR=0.52, 95% CI=0.31-0.87) and being breastfed during infancy (>6 months vs. never: OR=0.52, 95% CI=0.27-0.98) were associated with reduced PPMS risk. For RMS, tobacco smoking prior to onset (ever smoker OR=1.62, 95% CI=1.15-2.30; ≥20 pack-years: OR=2.17, 95% CI=1.20-3.80, P for trend=0.007) and infectious mononucleosis (OR=1.76, 95% CI=1.19-2.61) were also significantly associated with increased risk, with no difference in effect sizes compared to PPMS. Other infections, supplement intake, and being breastfed were not associated with RMS risk. Marijuana smoking and concussion history were not associated with either PPMS or RMS.
Conclusions: PPMS shares some common risk factors with RMS, such as tobacco smoking and infectious mononucleosis, with similar effect sizes. This suggests PPMS and RMS may share underlying disease mechanisms. Further studies are needed to validate the role of other factors associated with PPMS onset.
{"title":"Associations of smoking, infections, early-life exposures, and concussion with progressive-onset versus relapse-onset multiple sclerosis: A case-control study.","authors":"Ying Li, Alice Saul, Bruce Taylor, Anne-Louise Ponsonby, Steve Simpson-Yap, Leigh Blizzard, Simon Broadley, Jeannette Lechner-Scott, Ingrid van der Mei","doi":"10.1016/j.msard.2026.107020","DOIUrl":"https://doi.org/10.1016/j.msard.2026.107020","url":null,"abstract":"<p><strong>Background: </strong>Among environmental factors associated with multiple sclerosis (MS) susceptibility, few studies have examined different onset types. It remains unclear whether risk factors for primary progressive MS (PPMS) are comparable to those for relapse-onset MS (RMS). This study aimed to explore the association between selected environmental factors and PPMS risk, and compare their effect sizes with RMS.</p><p><strong>Methods: </strong>We used a case-control design with participants from two datasets: the Primary-Progressive MS Study (2015-2021) and the Australian Multi-center Study of Environment and Immune Function (2003-2006). Questionnaires collected data on smoking, infectious and concussion history before MS onset, supplement intake before age 15, and breastfeeding history. Unconditional, conditional, and weighted multivariable logistic regression evaluated associations with PPMS and RMS onset risk.</p><p><strong>Results: </strong>A significant positive association was observed between tobacco smoking prior to onset (≥20 pack-years: odds ratio (OR)=1.75, 95% confidence interval (CI)=0.96-3.20, P for trend=0.03) and history of infectious mononucleosis before MS onset (OR=1.74, 95% CI=1.05-2.88) in PPMS. Having vitamin supplements before age 15 (OR=0.52, 95% CI=0.31-0.87) and being breastfed during infancy (>6 months vs. never: OR=0.52, 95% CI=0.27-0.98) were associated with reduced PPMS risk. For RMS, tobacco smoking prior to onset (ever smoker OR=1.62, 95% CI=1.15-2.30; ≥20 pack-years: OR=2.17, 95% CI=1.20-3.80, P for trend=0.007) and infectious mononucleosis (OR=1.76, 95% CI=1.19-2.61) were also significantly associated with increased risk, with no difference in effect sizes compared to PPMS. Other infections, supplement intake, and being breastfed were not associated with RMS risk. Marijuana smoking and concussion history were not associated with either PPMS or RMS.</p><p><strong>Conclusions: </strong>PPMS shares some common risk factors with RMS, such as tobacco smoking and infectious mononucleosis, with similar effect sizes. This suggests PPMS and RMS may share underlying disease mechanisms. Further studies are needed to validate the role of other factors associated with PPMS onset.</p>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"108 ","pages":"107020"},"PeriodicalIF":2.9,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Azathioprine and mycophenolate mofetil remain widely used as first-line immunosuppressive therapies for neuromyelitis optica spectrum disorder (NMOSD) in resource-limited settings. However, a subset of patients experience ongoing disease activity or treatment intolerance requiring escalation to rituximab. Identification of clinical factors associated with treatment escalation may improve treatment strategies.
Objectives
To identify clinical factors associated with escalation from azathioprine and mycophenolate mofetil to rituximab in AQP4-IgG–positive NMOSD patients.
Methods
We conducted a retrospective cohort study of AQP4-IgG–positive NMOSD patients treated at the Neurological Institute of Thailand between 2019 and 2024. Patients initially treated with azathioprine or mycophenolate mofetil were followed until escalation to rituximab or last follow-up. Baseline demographic, clinical, and laboratory variables were analyzed using logistic regression to identify factors associated with treatment escalation.
Results
Among 173 patients, 35 (20.23%) required escalation to rituximab. In multivariable analysis, baseline severe disability (EDSS ≥6 prior to first-line therapy) was independently strongly associated with treatment escalation to rituximab (OR 18.19, 95% CI 2.22–148.95; p=0.007). Other demographic and laboratory variables were not independently associated.
Conclusion
Baseline severe disability was strongly associated with subsequent escalation to rituximab. Early identification of high-risk patients may support more individualized treatment strategies and inform future policy decisions in resource-limited healthcare systems.
在资源有限的情况下，硫唑嘌呤和霉酚酸酯仍被广泛用作治疗视神经脊髓炎谱系障碍（NMOSD）的一线免疫抑制疗法。然而，一部分患者经历持续的疾病活动或治疗不耐受，需要升级到利妥昔单抗。确定与治疗升级相关的临床因素可以改善治疗策略。目的探讨aqp4 - igg阳性NMOSD患者从硫唑嘌呤和霉酚酸酯向利妥昔单抗升级的相关临床因素。方法对2019年至2024年在泰国神经病学研究所接受治疗的aqp4 - igg阳性NMOSD患者进行回顾性队列研究。患者最初用硫唑嘌呤或霉酚酸酯治疗，直到升级到利妥昔单抗或最后一次随访。使用逻辑回归分析基线人口统计学、临床和实验室变量，以确定与治疗升级相关的因素。结果173例患者中，35例（20.23%）需要升级至利妥昔单抗。在多变量分析中，基线严重残疾（一线治疗前EDSS≥6）与治疗升级为利妥昔单抗独立强相关（OR 18.19, 95% CI 2.22-148.95; p=0.007）。其他人口统计学和实验室变量没有独立关联。结论：基线严重残疾与随后升级使用利妥昔单抗密切相关。在资源有限的卫生保健系统中，早期识别高风险患者可能支持更个性化的治疗策略，并为未来的政策决策提供信息。
{"title":"Baseline severe disability as a predictor of treatment escalation to rituximab in AQP4-IgG–positive NMOSD patients: A retrospective cohort study","authors":"Chayangkoon Siripornmongkol, Metha Apiwattanakul, Saharat Aungsumart","doi":"10.1016/j.msard.2026.107022","DOIUrl":"10.1016/j.msard.2026.107022","url":null,"abstract":"<div><h3>Introduction</h3><div>Azathioprine and mycophenolate mofetil remain widely used as first-line immunosuppressive therapies for neuromyelitis optica spectrum disorder (NMOSD) in resource-limited settings. However, a subset of patients experience ongoing disease activity or treatment intolerance requiring escalation to rituximab. Identification of clinical factors associated with treatment escalation may improve treatment strategies.</div></div><div><h3>Objectives</h3><div>To identify clinical factors associated with escalation from azathioprine and mycophenolate mofetil to rituximab in AQP4-IgG–positive NMOSD patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of AQP4-IgG–positive NMOSD patients treated at the Neurological Institute of Thailand between 2019 and 2024. Patients initially treated with azathioprine or mycophenolate mofetil were followed until escalation to rituximab or last follow-up. Baseline demographic, clinical, and laboratory variables were analyzed using logistic regression to identify factors associated with treatment escalation.</div></div><div><h3>Results</h3><div>Among 173 patients, 35 (20.23%) required escalation to rituximab. In multivariable analysis, baseline severe disability (EDSS ≥6 prior to first-line therapy) was independently strongly associated with treatment escalation to rituximab (OR 18.19, 95% CI 2.22–148.95; p=0.007). Other demographic and laboratory variables were not independently associated.</div></div><div><h3>Conclusion</h3><div>Baseline severe disability was strongly associated with subsequent escalation to rituximab. Early identification of high-risk patients may support more individualized treatment strategies and inform future policy decisions in resource-limited healthcare systems.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107022"},"PeriodicalIF":2.9,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.msard.2026.107021
Carolyn Akers , Philippe A. Bilodeau , Mattia Wruble Clark , Taymour Hashemzadeh , Michael Levy , Shamik Bhattacharyya , Ilya Kister
Patients with Neuromyelitis Optica Spectrum Disorders (NMOSD) have a well-recognized predilection to autoimmune comorbidities, of which systemic lupus erythematosus (SLE), Sjögren's syndrome (SjS), and autoimmune thyroid diseases are the most common. The question of whether some autoimmune diseases, such as inflammatory bowel disease (IBD), may not be overrepresented (or may even be underrepresented) in NMOSD has not received much attention. Here, we retrospectively reviewed the electronic medical records of all patients diagnosed with NMOSD in our two large referral centers (NYU and MGB), as well as patients with two neuroinflammatory disorders as comparator groups (myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and MS), and calculated the rates of IBD, SLE, SjS, autoimmune thyroid disorders, and myasthenia gravis (MG) in these groups. We found that 1 out of 347 NMOSD patients had a diagnosis of IBD (0.3%), and this patient was seronegative for anti-AQP4 autoantibodies, while 4/271 patients in the MS group (1.5%), 2 of whom were exposed to anti-CD20 therapy, had IBD, and 2/366 MOGAD patients (0.8%), neither of whom was exposed to anti-CD20 therapy, had IBD. In contrast, the rate of the other four autoimmune conditions was significantly higher in NMOSD (24%) than in MOGAD (8.5%, p < 0.0001) or MS (5.2%, p < 0.0001). Thus, IBD was not diagnosed in any of our 317 seropositive NMOSD patients, despite the fact that this group had a higher use of B-cell depletion than patients with MS and MOGAD. We discuss the various hypotheses that may explain this observation.
神经脊髓炎视谱障碍（NMOSD）患者普遍倾向于自身免疫性合并症，其中系统性红斑狼疮（SLE）、Sjögren综合征（SjS）和自身免疫性甲状腺疾病是最常见的。一些自身免疫性疾病，如炎症性肠病（IBD），在NMOSD中是否可能被过度代表（或甚至可能被低估）的问题尚未得到太多关注。在这里，我们回顾性地回顾了在我们的两个大型转诊中心（NYU和MGB）诊断为NMOSD的所有患者的电子病历，以及两种神经炎性疾病作为比较组（髓鞘少突胶质细胞糖蛋白抗体病（MOGAD）和MS）的患者，并计算了这些组中IBD、SLE、SjS、自身免疫性甲状腺疾病和重症肌无力（MG）的发生率。我们发现347例NMOSD患者中有1例诊断为IBD(0.3%)，该患者抗aqp4自身抗体血清阴性，而MS组中有4/271（1.5%）患者（其中2例接受抗cd20治疗）患有IBD，而MOGAD组中有2/366（0.8%）患者（均未接受抗cd20治疗）患有IBD。相比之下，NMOSD中其他四种自身免疫性疾病的发生率（24%）明显高于MOGAD （8.5%, p < 0.0001）或MS （5.2%, p < 0.0001）。因此，在我们的317例血清阳性NMOSD患者中，没有诊断出IBD，尽管这组患者比MS和MOGAD患者使用更高的b细胞消耗。我们讨论了可能解释这一观察结果的各种假设。
{"title":"Low prevalence of inflammatory bowel disease among patients with seropositive neuromyelitis optica spectrum disorder in two large referral centers","authors":"Carolyn Akers , Philippe A. Bilodeau , Mattia Wruble Clark , Taymour Hashemzadeh , Michael Levy , Shamik Bhattacharyya , Ilya Kister","doi":"10.1016/j.msard.2026.107021","DOIUrl":"10.1016/j.msard.2026.107021","url":null,"abstract":"<div><div>Patients with Neuromyelitis Optica Spectrum Disorders (NMOSD) have a well-recognized predilection to autoimmune comorbidities, of which systemic lupus erythematosus (SLE), Sjögren's syndrome (SjS), and autoimmune thyroid diseases are the most common. The question of whether some autoimmune diseases, such as inflammatory bowel disease (IBD), may not be overrepresented (or may even be underrepresented) in NMOSD has not received much attention. Here, we retrospectively reviewed the electronic medical records of all patients diagnosed with NMOSD in our two large referral centers (NYU and MGB), as well as patients with two neuroinflammatory disorders as comparator groups (myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and MS), and calculated the rates of IBD, SLE, SjS, autoimmune thyroid disorders, and myasthenia gravis (MG) in these groups. We found that 1 out of 347 NMOSD patients had a diagnosis of IBD (0.3%), and this patient was seronegative for anti-AQP4 autoantibodies, while 4/271 patients in the MS group (1.5%), 2 of whom were exposed to anti-CD20 therapy, had IBD, and 2/366 MOGAD patients (0.8%), neither of whom was exposed to anti-CD20 therapy, had IBD. In contrast, the rate of the other four autoimmune conditions was significantly higher in NMOSD (24%) than in MOGAD (8.5%, <em>p</em> < 0.0001) or MS (5.2%, <em>p</em> < 0.0001). Thus, IBD was not diagnosed in any of our 317 seropositive NMOSD patients, despite the fact that this group had a higher use of B-cell depletion than patients with MS and MOGAD. We discuss the various hypotheses that may explain this observation.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107021"},"PeriodicalIF":2.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This systematic review aims to analyze the clinical, laboratory, and imaging characteristics of GFAP astrocytopathy, with attention to differences between Asian and non-Asian populations.
Methods
We searched PubMed, Embase, and Scopus from inception through June 2025 for case reports, case series, and observational studies involving adult patients with GFAP astrocytopathy. Fifteen studies, including 538 patients, were analyzed. Data on clinical presentations, MRI findings, and laboratory results were extracted and compared across regions.
Results
We identified a total of 2,272 studies, of which 15 were included in our final analysis, comprising 538 patients. Our analysis identified three main clinical phenotypes: meningoencephalitis (164/371, 44.2%), meningoencephalomyelitis (94/371, 25.3%), and myelitis (26/371, 7.0%). The most common clinical symptoms were headache (186/470, 39.6%), abnormal movements (160/473, 33.8%), fever (172/538, 32.0%), and psychiatric symptoms (111/471, 23.6%). MRI findings frequently showed lesions in the periventricular (85/434, 19.6%) and subcortical regions (80/432, 18.5%). Perivascular and meningeal enhancements represented the most common radiological findings. Laboratory findings revealed positive GFAP antibodies in either serum or CSF. Co-existence of other antibodies in CSF and serum was also observed, most notably anti-AQP4, anti-MOG, and anti-NMDAR.
Conclusion
GFAP astrocytopathy is characterized by a wide range of clinical and radiological manifestations, most commonly presenting as meningoencephalitis, meningoencephalomyelitis, or myelitis, with meningoencephalitis being the most prevalent clinical syndrome observed in this study. Commonly reported symptoms include headache, fever, abnormal movements, and psychiatric symptoms. The disease exhibits diverse neurological and imaging features. Regional differences suggest that genetics, diagnostic practices, and cultural factors may influence symptom profiles. These findings highlight the need for standardized diagnostic criteria and further research across diverse populations.
{"title":"Clinical, imaging, and immunological features of GFAP astrocytopathy: a systematic review with regional comparison","authors":"Ekdanai Uawithya , Piyachai Siriphiphatcharoen , Ben Benjapibal , Supawit Kittipadakul , Sasitorn Siritho","doi":"10.1016/j.msard.2026.107019","DOIUrl":"10.1016/j.msard.2026.107019","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review aims to analyze the clinical, laboratory, and imaging characteristics of GFAP astrocytopathy, with attention to differences between Asian and non-Asian populations.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and Scopus from inception through June 2025 for case reports, case series, and observational studies involving adult patients with GFAP astrocytopathy. Fifteen studies, including 538 patients, were analyzed. Data on clinical presentations, MRI findings, and laboratory results were extracted and compared across regions.</div></div><div><h3>Results</h3><div>We identified a total of 2,272 studies, of which 15 were included in our final analysis, comprising 538 patients. Our analysis identified three main clinical phenotypes: meningoencephalitis (164/371, 44.2%), meningoencephalomyelitis (94/371, 25.3%), and myelitis (26/371, 7.0%). The most common clinical symptoms were headache (186/470, 39.6%), abnormal movements (160/473, 33.8%), fever (172/538, 32.0%), and psychiatric symptoms (111/471, 23.6%). MRI findings frequently showed lesions in the periventricular (85/434, 19.6%) and subcortical regions (80/432, 18.5%). Perivascular and meningeal enhancements represented the most common radiological findings. Laboratory findings revealed positive GFAP antibodies in either serum or CSF. Co-existence of other antibodies in CSF and serum was also observed, most notably anti-AQP4, anti-MOG, and anti-NMDAR.</div></div><div><h3>Conclusion</h3><div>GFAP astrocytopathy is characterized by a wide range of clinical and radiological manifestations, most commonly presenting as meningoencephalitis, meningoencephalomyelitis, or myelitis, with meningoencephalitis being the most prevalent clinical syndrome observed in this study. Commonly reported symptoms include headache, fever, abnormal movements, and psychiatric symptoms. The disease exhibits diverse neurological and imaging features. Regional differences suggest that genetics, diagnostic practices, and cultural factors may influence symptom profiles. These findings highlight the need for standardized diagnostic criteria and further research across diverse populations.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107019"},"PeriodicalIF":2.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.msard.2026.107017
Georgia Brice , Anthony P. James , Daniel Rudaizky , Lucinda J. Black , Eleanor Dunlop , Rebecca D. Russell
Depression and anxiety are more prevalent in people with multiple sclerosis (MS) than in the general population. A high-quality diet has been shown to have beneficial effects on MS symptoms, including mental health outcomes. Adults with MS gather information from a range of resources with the aim of improving their diet and mental health. However, the development and nature of diet-focused resources aimed at improving mental health in adults with MS remain unclear. We conducted a scoping review to identify and map diet-focused resources aimed at improving depression and anxiety in adults with MS. From 956 resources screened (n = 834 articles and other resources retrieved from databases; n = 98 resources retrieved from websites; n = 17 resources retrieved from organisations; n = 7 retrieved from citation searching), 64 were included (n = 42 resources from organisations or web searches, e.g., podcast episodes, blog posts, web articles; n = 20 peer-reviewed articles; n = 1 mobile application in development; n = 1 book). Resources mentioned an extensive range of dietary information linked to depression and anxiety for people with MS. These resources involved a combination of input from experts (n = 54), organisations (n = 23), lived experience (n = 22), authors/journalists (n = 5), or co-design (n = 1); however, six resources were based solely on lived experience. Twenty resources were not directly accessible to people with MS. There is a need to develop co-designed and accessible diet-focused resources to improve mental health in people with MS.
{"title":"A scoping review of diet-focused resources to improve depression and anxiety among people with multiple sclerosis","authors":"Georgia Brice , Anthony P. James , Daniel Rudaizky , Lucinda J. Black , Eleanor Dunlop , Rebecca D. Russell","doi":"10.1016/j.msard.2026.107017","DOIUrl":"10.1016/j.msard.2026.107017","url":null,"abstract":"<div><div>Depression and anxiety are more prevalent in people with multiple sclerosis (MS) than in the general population. A high-quality diet has been shown to have beneficial effects on MS symptoms, including mental health outcomes. Adults with MS gather information from a range of resources with the aim of improving their diet and mental health. However, the development and nature of diet-focused resources aimed at improving mental health in adults with MS remain unclear. We conducted a scoping review to identify and map diet-focused resources aimed at improving depression and anxiety in adults with MS. From 956 resources screened (<em>n</em> = 834 articles and other resources retrieved from databases; <em>n</em> = 98 resources retrieved from websites; <em>n</em> = 17 resources retrieved from organisations; <em>n</em> = 7 retrieved from citation searching), 64 were included (<em>n</em> = 42 resources from organisations or web searches, e.g., podcast episodes, blog posts, web articles; <em>n</em> = 20 peer-reviewed articles; <em>n</em> = 1 mobile application in development; <em>n</em> = 1 book). Resources mentioned an extensive range of dietary information linked to depression and anxiety for people with MS. These resources involved a combination of input from experts (<em>n</em> = 54), organisations (<em>n</em> = 23), lived experience (<em>n</em> = 22), authors/journalists (<em>n</em> = 5), or co-design (<em>n</em> = 1); however, six resources were based solely on lived experience. Twenty resources were not directly accessible to people with MS. There is a need to develop co-designed and accessible diet-focused resources to improve mental health in people with MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107017"},"PeriodicalIF":2.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.msard.2026.107012
Olavi Misin , Anni Piispanen , Markus Matilainen , Riitta Parkkola , Mikko Nyman , Teija Sainio , Jussi Hirvonen , Laura Airas
Background
Paramagnetic rim lesions (PRLs) are an emerging MRI biomarker in multiple sclerosis (MS). On susceptibility-sensitive MRI, PRLs are characterized by a paramagnetic shift at the lesion rim corresponding to iron-laden macrophages and microglia, and PRL detection can hence be viewed as a proxy for lesion-associated smoldering inflammation in MS brain. The aim of this study was to identify PRLs in a standard university hospital setting to explore the associations between PRL burden and MS-related clinical and paraclinical parameters.
Methods
We retrospectively reviewed all 3T brain MRI studies performed as part of MS patient management at a tertiary university hospital in Finland between September 2021 and December 2023. PRLs were visually identified on filtered phase images from susceptibility-weighted imaging (SWI) sequences. Brain volumetric data were extracted from post-contrast 3D T1-weighted images using an automated quantification tool (cNeuro® cMRI). Clinical and laboratory variables were obtained by manual chart review from electronic medical records.
Results
The final cohort included 206 patients. 34% of patients had at least one PRL (the PRL1+ group). The median number of PRLs in the PRL1+ group was 2 and the maximum number was 11. Within the PRL1+ group, PRL count correlated positively with Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Score (MSSS) and T2 lesion volume. Patients with PRLs had significantly smaller thalami compared to those without PRLs.
Discussion
Our real-world data reinforce evidence that PRLs are linked to more severe disease and demonstrate that PRL identification using manufacturer-reconstructed SWI filtered phase images provides a feasible imaging parameter to assess progression-associated pathology in MS in a standard clinical setting.
{"title":"Real-world detection of paramagnetic rim lesions and their association with disease burden in multiple sclerosis","authors":"Olavi Misin , Anni Piispanen , Markus Matilainen , Riitta Parkkola , Mikko Nyman , Teija Sainio , Jussi Hirvonen , Laura Airas","doi":"10.1016/j.msard.2026.107012","DOIUrl":"10.1016/j.msard.2026.107012","url":null,"abstract":"<div><h3>Background</h3><div>Paramagnetic rim lesions (PRLs) are an emerging MRI biomarker in multiple sclerosis (MS). On susceptibility-sensitive MRI, PRLs are characterized by a paramagnetic shift at the lesion rim corresponding to iron-laden macrophages and microglia, and PRL detection can hence be viewed as a proxy for lesion-associated smoldering inflammation in MS brain. The aim of this study was to identify PRLs in a standard university hospital setting to explore the associations between PRL burden and MS-related clinical and paraclinical parameters.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all 3T brain MRI studies performed as part of MS patient management at a tertiary university hospital in Finland between September 2021 and December 2023. PRLs were visually identified on filtered phase images from susceptibility-weighted imaging (SWI) sequences. Brain volumetric data were extracted from post-contrast 3D T1-weighted images using an automated quantification tool (cNeuro® cMRI). Clinical and laboratory variables were obtained by manual chart review from electronic medical records.</div></div><div><h3>Results</h3><div>The final cohort included 206 patients. 34% of patients had at least one PRL (the PRL1+ group). The median number of PRLs in the PRL1+ group was 2 and the maximum number was 11. Within the PRL1+ group, PRL count correlated positively with Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Score (MSSS) and T2 lesion volume. Patients with PRLs had significantly smaller thalami compared to those without PRLs.</div></div><div><h3>Discussion</h3><div>Our real-world data reinforce evidence that PRLs are linked to more severe disease and demonstrate that PRL identification using manufacturer-reconstructed SWI filtered phase images provides a feasible imaging parameter to assess progression-associated pathology in MS in a standard clinical setting.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107012"},"PeriodicalIF":2.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Therapeutic plasma exchange (TPE) is an established rescue therapy for steroid-refractory demyelinating attacks in neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). The optimal replacement fluid for TPE—human albumin or fresh frozen plasma (FFP)—remains uncertain, particularly in resource-limited settings.
Methods
We conducted a retrospective cohort study at two tertiary care centers in Thailand, comparing the efficacy and safety of albumin versus FFP as replacement fluids in TPE. Adult patients with NMOSD or MS experiencing refractory exacerbation were included. Clinical outcomes were evaluated using the Expanded Disability Status Scale (EDSS) and Opticospinal Impairment Scale (OSIS), including visual and motor subscales, at baseline, post-treatment, day 90, and day 180. The primary outcome was the proportion of patients achieving favorable functional outcome (EDSS < 6) at day 180.
Results
Among 67 patients (97 % NMOSD), 41 received albumin and 26 received FFP. At day 180, 75.6 % in the albumin group and 73.1 % in the FFP group achieved a favorable outcome (P = 1.00). EDSS and OSIS scores improved significantly in both groups over time, with albumin associated with greater motor recovery and FFP with superior visual improvement. Adverse events were mild and comparable between groups.
Conclusion
TPE using either albumin or FFP is effective and safe for treating steroid-refractory NMOSD and MS. Given that FFP is more readily available and often less costly than albumin, especially in developing countries, it may serve as a practical alternative in resource-limited healthcare settings.
{"title":"Efficacy of fresh frozen plasma and human albumin in therapeutic plasma exchange for refractory neuromyelitis optica spectrum disorders and multiple sclerosis exacerbation: A two-tertiary care center study","authors":"Bhume Kanokvichitra , Chutithep Teekaput , Kitti Thiankhaw , Saharat Aungsumart , Metha Apiwattanakul","doi":"10.1016/j.msard.2026.107018","DOIUrl":"10.1016/j.msard.2026.107018","url":null,"abstract":"<div><h3>Background</h3><div>Therapeutic plasma exchange (TPE) is an established rescue therapy for steroid-refractory demyelinating attacks in neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). The optimal replacement fluid for TPE—human albumin or fresh frozen plasma (FFP)—remains uncertain, particularly in resource-limited settings.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study at two tertiary care centers in Thailand, comparing the efficacy and safety of albumin versus FFP as replacement fluids in TPE. Adult patients with NMOSD or MS experiencing refractory exacerbation were included. Clinical outcomes were evaluated using the Expanded Disability Status Scale (EDSS) and Opticospinal Impairment Scale (OSIS), including visual and motor subscales, at baseline, post-treatment, day 90, and day 180. The primary outcome was the proportion of patients achieving favorable functional outcome (EDSS < 6) at day 180.</div></div><div><h3>Results</h3><div>Among 67 patients (97 % NMOSD), 41 received albumin and 26 received FFP. At day 180, 75.6 % in the albumin group and 73.1 % in the FFP group achieved a favorable outcome (P = 1.00). EDSS and OSIS scores improved significantly in both groups over time, with albumin associated with greater motor recovery and FFP with superior visual improvement. Adverse events were mild and comparable between groups.</div></div><div><h3>Conclusion</h3><div>TPE using either albumin or FFP is effective and safe for treating steroid-refractory NMOSD and MS. Given that FFP is more readily available and often less costly than albumin, especially in developing countries, it may serve as a practical alternative in resource-limited healthcare settings.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107018"},"PeriodicalIF":2.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.msard.2026.107013
Canan Duman İlki , Ahmed Serkan Emekli , Tuncay Gündüz , Murat Kürtüncü , Mefküre Eraksoy
Introduction
This study aimed to characterize demographic features, clinical presentations, and long-term outcomes of pediatric-onset multiple sclerosis (POMS) patients in a Turkish tertiary MS center.
Methods
We retrospectively analyzed 143 patients diagnosed with multiple sclerosis (MS) before age 16, based on the 2017 McDonald criteria, and clinically monitored between 1981 and 2018. Demographic and clinical data, including age at onset, initial symptoms, relapse history, and Expanded Disability Status Scale (EDSS) scores, were collected. Disability milestones (EDSS 4 and 6) and conversion to secondary progressive MS (SPMS) were examined using Kaplan–Meier survival analysis and Cox regression.
Results
We followed 143 POMS patients for a median of 11 years (69.2% female; median onset age: 14.6 years). By study completion, 22.4% reached EDSS 4 and 16.8% converted to SPMS. Onset before age 14 was associated with a longer time to EDSS 4 (p < 0.001) and SPMS-free survival (p = 0.03). In multivariate analysis, male sex, onset after age 14, higher baseline EDSS, and incomplete recovery from the first attack independently predicted disability progression. Delayed disease modifying therapy initiation (≥12 months) was also associated with increased risk of reaching EDSS 4. SPMS conversion was predicted by onset after age 14, higher baseline EDSS, brainstem onset, and incomplete recovery from the first attack.
Conclusion
In this large Turkish POMS cohort, onset after age 14, brainstem involvement, and poor recovery from the first attack were associated with earlier disability milestones. These findings highlight the prognostic role of early disease characteristics and emphasize the importance of optimizing treatment strategies in pediatric MS.
{"title":"Long-term prognostic features of pediatric-onset multiple sclerosis: A large cohort from Türkiye","authors":"Canan Duman İlki , Ahmed Serkan Emekli , Tuncay Gündüz , Murat Kürtüncü , Mefküre Eraksoy","doi":"10.1016/j.msard.2026.107013","DOIUrl":"10.1016/j.msard.2026.107013","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to characterize demographic features, clinical presentations, and long-term outcomes of pediatric-onset multiple sclerosis (POMS) patients in a Turkish tertiary MS center.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 143 patients diagnosed with multiple sclerosis (MS) before age 16, based on the 2017 McDonald criteria, and clinically monitored between 1981 and 2018. Demographic and clinical data, including age at onset, initial symptoms, relapse history, and Expanded Disability Status Scale (EDSS) scores, were collected. Disability milestones (EDSS 4 and 6) and conversion to secondary progressive MS (SPMS) were examined using Kaplan–Meier survival analysis and Cox regression.</div></div><div><h3>Results</h3><div>We followed 143 POMS patients for a median of 11 years (69.2% female; median onset age: 14.6 years). By study completion, 22.4% reached EDSS 4 and 16.8% converted to SPMS. Onset before age 14 was associated with a longer time to EDSS 4 (<em>p</em> < 0.001) and SPMS-free survival (<em>p</em> = 0.03). In multivariate analysis, male sex, onset after age 14, higher baseline EDSS, and incomplete recovery from the first attack independently predicted disability progression. Delayed disease modifying therapy initiation (≥12 months) was also associated with increased risk of reaching EDSS 4. SPMS conversion was predicted by onset after age 14, higher baseline EDSS, brainstem onset, and incomplete recovery from the first attack.</div></div><div><h3>Conclusion</h3><div>In this large Turkish POMS cohort, onset after age 14, brainstem involvement, and poor recovery from the first attack were associated with earlier disability milestones. These findings highlight the prognostic role of early disease characteristics and emphasize the importance of optimizing treatment strategies in pediatric MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107013"},"PeriodicalIF":2.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>Natalizumab (TYSABRI<sup>Ⓡ</sup>) is known to be an efficacious treatment at a standard-interval dosing (SID; 300 mg administered intravenously every 4 weeks) for patients with relapsing-remitting sclerosis (RRMS). However, the SID of natalizumab is associated with increased risk of progressive multifocal leukoencephalopathy (PML). Lengthening the time between doses of natalizumab beyond 4 weeks, also known as extended-interval dosing (EID), is associated with lower risk of PML in patients with RRMS, and patients have been switched from SID to EID without meaningful loss of efficacy. In this multicenter, retrospective, observational study, REFIND, we examined real-world natalizumab dosing patterns and MS disease activity in patients with RRMS in Japan.</div></div><div><h3>Methods</h3><div>REFIND retrospectively collected data from medical records of patients at 20 study centers in Japan. Patients with MS aged 20 years and older who received at least one dose of natalizumab after January 1, 2018, and had at least one clinical assessment were included. The primary endpoints were dosing patterns used in clinical practice and MS disease activity by dosing patterns. SID was defined as a mean natalizumab dosing interval ≤35 days, and EID was defined as a mean natalizumab dosing interval ≥36 to ≤84 days. Dosing pattern groups included SID-only, EID-only, or SID followed by EID (SID/EID). For each dosing pattern group, the annualized relapse rate (ARR) before and after administration of natalizumab was compared using a negative binomial regression model.</div></div><div><h3>Results</h3><div>Of the 203 patients with MS eligible for inclusion in the REFIND study, 120 patients with RRMS were treated with natalizumab for ≥1 year, with a mean ± standard deviation (SD) age of 36.0 ± 9.4 years and a mean ± SD administration period of 32.8 ± 18.8 months. Among these patients, 13 had an SID-only natalizumab dosing pattern, 49 had EID-only, and 58 had SID/EID, with mean ± SD dosing intervals of 30.8 ± 1.6 days, 45.9 ± 3.4 days, and 38.7 ± 3.4 days, respectively. Overall ARR 1 year before vs 1 year after initiation of natalizumab was 1.03 vs 0.12 (<em>P</em> < 0.0001). ARR before vs after natalizumab in the SID-only group was 1.08 vs 0.62 (<em>P</em> = 0.378), in the EID-only group was 0.95 vs 0.02 (97.9% reduction, <em>P</em> = 0.0005), and in the SID/EID group was 1.08 vs 0.09 (91.7% reduction, <em>P</em> < 0.0001). Proportions of patients with new or enlarging T2 lesions in the SID-only, and the EID-only, and SID/EID groups were reduced by 89.1%, 83.5%, and 95.7%, respectively, after natalizumab initiation compared with the year before natalizumab.</div></div><div><h3>Conclusions</h3><div>The significant reduction in ARR observed with EID or SID/EID suggests that there is little difference between these dosing regimens in this retrospective dataset in Japan. The effectiveness of natalizumab in reducing the number of new or enla
natalizumab （TYSABRIⓇ）是一种标准间隔剂量（SID；每4周静脉给药300 mg）治疗复发-缓解型硬化症（RRMS）患者的有效药物。然而，那他珠单抗的SID与进行性多灶性白质脑病（PML）的风险增加相关。延长natalizumab给药间隔时间超过4周，也称为延长间隔给药（EID），与RRMS患者PML风险降低相关，并且患者已经从SID切换到EID而没有明显的疗效损失。在这项多中心、回顾性、观察性研究REFIND中，我们研究了日本RRMS患者的真实世界natalizumab给药模式和MS疾病活动性。方法refind回顾性收集日本20个研究中心患者的病历资料。纳入了在2018年1月1日之后接受至少一剂natalizumab的20岁及以上MS患者，并进行了至少一次临床评估。主要终点是临床实践中使用的剂量模式和由剂量模式引起的MS疾病活动性。SID定义为平均纳他珠单抗给药间隔≤35天，EID定义为平均纳他珠单抗给药间隔≥36至≤84天。给药模式组包括SID-only、EID-only或SID后EID （SID/EID）。对于每个给药模式组，使用负二项回归模型比较纳塔珠单抗给药前后的年化复发率（ARR）。结果在REFIND研究纳入的203例MS患者中，120例RRMS患者接受natalizumab治疗≥1年，平均±标准差（SD）年龄为36.0±9.4岁，平均±SD给药期为32.8±18.8个月。在这些患者中，13例为SID-only给药模式，49例为EID-only， 58例为SID/EID，平均±SD给药间隔分别为30.8±1.6天，45.9±3.4天和38.7±3.4天。开始使用natalizumab前1年和开始使用natalizumab后1年的总ARR分别为1.03和0.12 （P < 0.0001）。仅SID组的ARR为1.08 vs 0.62 (P = 0.378)，仅EID组的ARR为0.95 vs 0.02（降低97.9%,P = 0.0005）， SID/EID组的ARR为1.08 vs 0.09（降低91.7%,P < 0.0001）。与纳他珠单抗治疗前相比，单SID组、单EID组和SID/EID组中新发或扩大T2病变的患者比例分别降低了89.1%、83.5%和95.7%。结论：在日本的回顾性数据集中，EID或SID/EID组观察到的ARR显著降低表明这些给药方案之间差异不大。在所有给药组中，natalizumab在减少新发或扩大T2病变数量方面的有效性是相似的，并且与natalizumab在控制疾病活动性方面的已知高效一致。这些关于日本natalizumab EID的真实数据可能有助于为亚洲人群的治疗选择提供信息。
{"title":"A multicenter, retrospective study in patients with multiple sclerosis treated with natalizumab in a real-world setting in Japan: The REFIND study","authors":"Ichiro Nakashima , Takashi Ohashi , Kazumasa Yokoyama , Kenichi Kaida , Jin Nakahara , Takayuki Kondo , Nobuaki Yoshikura , Yuko Shimizu , Chiyoko Nohara , Kenzo Sakurai , Hiroaki Yokote , Masaaki Niino , Takashi Yamamura , Kazuo Fujihara , Noriko Isobe , Hirofumi Ochi , Masahiro Mori , Izumi Kawachi , Fumitaka Shimizu , Michihiro Kanda , Toshiyuki Fukazawa","doi":"10.1016/j.msard.2026.107007","DOIUrl":"10.1016/j.msard.2026.107007","url":null,"abstract":"<div><h3>Background</h3><div>Natalizumab (TYSABRI<sup>Ⓡ</sup>) is known to be an efficacious treatment at a standard-interval dosing (SID; 300 mg administered intravenously every 4 weeks) for patients with relapsing-remitting sclerosis (RRMS). However, the SID of natalizumab is associated with increased risk of progressive multifocal leukoencephalopathy (PML). Lengthening the time between doses of natalizumab beyond 4 weeks, also known as extended-interval dosing (EID), is associated with lower risk of PML in patients with RRMS, and patients have been switched from SID to EID without meaningful loss of efficacy. In this multicenter, retrospective, observational study, REFIND, we examined real-world natalizumab dosing patterns and MS disease activity in patients with RRMS in Japan.</div></div><div><h3>Methods</h3><div>REFIND retrospectively collected data from medical records of patients at 20 study centers in Japan. Patients with MS aged 20 years and older who received at least one dose of natalizumab after January 1, 2018, and had at least one clinical assessment were included. The primary endpoints were dosing patterns used in clinical practice and MS disease activity by dosing patterns. SID was defined as a mean natalizumab dosing interval ≤35 days, and EID was defined as a mean natalizumab dosing interval ≥36 to ≤84 days. Dosing pattern groups included SID-only, EID-only, or SID followed by EID (SID/EID). For each dosing pattern group, the annualized relapse rate (ARR) before and after administration of natalizumab was compared using a negative binomial regression model.</div></div><div><h3>Results</h3><div>Of the 203 patients with MS eligible for inclusion in the REFIND study, 120 patients with RRMS were treated with natalizumab for ≥1 year, with a mean ± standard deviation (SD) age of 36.0 ± 9.4 years and a mean ± SD administration period of 32.8 ± 18.8 months. Among these patients, 13 had an SID-only natalizumab dosing pattern, 49 had EID-only, and 58 had SID/EID, with mean ± SD dosing intervals of 30.8 ± 1.6 days, 45.9 ± 3.4 days, and 38.7 ± 3.4 days, respectively. Overall ARR 1 year before vs 1 year after initiation of natalizumab was 1.03 vs 0.12 (<em>P</em> < 0.0001). ARR before vs after natalizumab in the SID-only group was 1.08 vs 0.62 (<em>P</em> = 0.378), in the EID-only group was 0.95 vs 0.02 (97.9% reduction, <em>P</em> = 0.0005), and in the SID/EID group was 1.08 vs 0.09 (91.7% reduction, <em>P</em> < 0.0001). Proportions of patients with new or enlarging T2 lesions in the SID-only, and the EID-only, and SID/EID groups were reduced by 89.1%, 83.5%, and 95.7%, respectively, after natalizumab initiation compared with the year before natalizumab.</div></div><div><h3>Conclusions</h3><div>The significant reduction in ARR observed with EID or SID/EID suggests that there is little difference between these dosing regimens in this retrospective dataset in Japan. The effectiveness of natalizumab in reducing the number of new or enla","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107007"},"PeriodicalIF":2.9,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-15DOI: 10.1016/j.msard.2026.107015
Andrea Kirk-Brown , Pieter Van Dijk , Brian Cooper , Ross Donohue , Ingrid van der Mei
Background
Psychosocial factors are implicated in the decision to prematurely leave employment for people with multiple sclerosis (PwMS), beyond the impact of symptoms. We longitudinally tested the sequential relationship between psychological safety (PS), work self-efficacy (WSE), and the perceived impact of fatigue on work performance predicting employment exit intentions (EI).
Methods
Participants (n = 372) were surveyed at three time points over a four-year period (86% female; mean age 46 at T1) using latent variable structural equation modelling.
Results
PS at T1 was positively related to WSE at T2 (β = 0.17, 95% CI: 0.05 to 0.29). WSE mediated the relationship between PS and EI (Indirect Effect (IE) = -0.03, 95% CI = -0.07 to -0.01). WSE and fatigue sequentially mediated the relationship between PS and EI (IE, -0.02, 95% CI = -0.05 to -0.01). Unexpectedly, PS directly reduced perceptions of fatigue decreasing EI. PS was directly related to EI at T3 independently of WSE and fatigue (β = -0.24, SE = 0.07, p < .01, 95% CI: -0.10 to -0.38).
Conclusion
Our findings indicate that PS represents a supportive job resource that is critical in dealing with work-related demands, which helps explain why employees leave before medically assessed disability would indicate the need to. Over time, employees who experience a work environment characterised by PS also experience higher levels of WSE and reduced perceptions of work-related fatigue, which in turn reduces the risk of prematurely leaving employment. Interventions targeting these modifiable aspects of the workplace psychosocial climate are required.
背景：除了症状的影响外，心理社会因素与多发性硬化症患者过早离职的决定有关。本研究对心理安全（PS）、工作自我效能（WSE）和疲劳对工作绩效的感知影响预测就业退出意向（EI）之间的序贯关系进行了纵向检验。方法采用潜在变量结构方程模型，在四年期间的三个时间点对参与者（n = 372）进行调查（86%为女性，T1时平均年龄46岁）。结果T1时的sps与T2时的WSE呈正相关（β = 0.17, 95% CI: 0.05 ~ 0.29）。WSE介导了PS和EI之间的关系（间接效应(IE) = -0.03, 95% CI = -0.07 ~ -0.01）。WSE和疲劳依次介导了PS和EI之间的关系（IE, -0.02, 95% CI = -0.05 ~ -0.01）。出乎意料的是，PS直接降低了疲劳降低EI的感知。PS与T3时EI直接相关，不依赖于WSE和疲劳（β = -0.24, SE = 0.07, p < 0.01, 95% CI: -0.10 ~ -0.38）。结论：我们的研究结果表明，PS是一种支持性的工作资源，在处理与工作相关的需求方面至关重要，这有助于解释为什么员工在医学评估残疾表明需要之前离职。随着时间的推移，经历过以PS为特征的工作环境的员工也会经历更高水平的WSE，并减少与工作有关的疲劳感，这反过来降低了过早离职的风险。需要针对工作场所社会心理气候的这些可改变方面进行干预。
{"title":"Safe to stay: A longitudinal evaluation of the sequential relationship between psychological safety, work self-efficacy, fatigue, and employment exit intentions of employees with multiple sclerosis","authors":"Andrea Kirk-Brown , Pieter Van Dijk , Brian Cooper , Ross Donohue , Ingrid van der Mei","doi":"10.1016/j.msard.2026.107015","DOIUrl":"10.1016/j.msard.2026.107015","url":null,"abstract":"<div><h3>Background</h3><div>Psychosocial factors are implicated in the decision to prematurely leave employment for people with multiple sclerosis (PwMS), beyond the impact of symptoms. We longitudinally tested the sequential relationship between psychological safety (PS), work self-efficacy (WSE), and the perceived impact of fatigue on work performance predicting employment exit intentions (EI).</div></div><div><h3>Methods</h3><div>Participants (<em>n</em> = 372) were surveyed at three time points over a four-year period (86% female; mean age 46 at T1) using latent variable structural equation modelling.</div></div><div><h3>Results</h3><div>PS at T1 was positively related to WSE at T2 (β = 0.17, 95% CI: 0.05 to 0.29). WSE mediated the relationship between PS and EI (Indirect Effect (IE) = -0.03, 95% CI = -0.07 to -0.01). WSE and fatigue sequentially mediated the relationship between PS and EI (IE, -0.02, 95% CI = -0.05 to -0.01). Unexpectedly, PS directly reduced perceptions of fatigue decreasing EI. PS was directly related to EI at T3 independently of WSE and fatigue (β = -0.24, SE = 0.07, <em>p</em> < .01, 95% CI: -0.10 to -0.38).</div></div><div><h3>Conclusion</h3><div>Our findings indicate that PS represents a supportive job resource that is critical in dealing with work-related demands, which helps explain why employees leave before medically assessed disability would indicate the need to. Over time, employees who experience a work environment characterised by PS also experience higher levels of WSE and reduced perceptions of work-related fatigue, which in turn reduces the risk of prematurely leaving employment. Interventions targeting these modifiable aspects of the workplace psychosocial climate are required.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"107 ","pages":"Article 107015"},"PeriodicalIF":2.9,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146034584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号