Multiple sclerosis and related disorders最新文献

Background: Autoimmune comorbidities occur more frequently in patients with multiple sclerosis (MS) and have been proposed to exacerbate disease through a putative increase in immune burden. Whether the coexistence of autoimmune disease translates into greater inflammatory activity or accelerated disability progression in relapsing MS remains uncertain.

Methods: We performed a large retrospective matched cohort study using the international MSBase registry, including patients with relapsing - remitting MS or clinically isolated syndrome. Autoimmune comorbidity was defined by documented diagnoses present before or at baseline. Patients with and without autoimmune comorbidity were matched 1:2 using propensity scores. Clinical and radiological outcomes included annualized relapse rate, time to first relapse, MRI inflammatory activity, and 6-month confirmed disability worsening (6M-CDW), analyzed using negative binomial and Cox proportional hazards models.

Results: The matched cohort comprised 1773 patients, of whom 591 had at least one autoimmune comorbidity. Autoimmune comorbidity was not associated with higher relapse rates, shorter time to first relapse, or increased MRI inflammatory activity. In contrast, patients with autoimmune comorbidity had a significantly higher risk of confirmed disability worsening over time (hazard ratio 1.21, 95% CI 1.04-1.41).

Conclusions: In relapsing multiple sclerosis, autoimmune comorbidity is not associated with increased relapse activity or inflammatory MRI findings. However, patients with autoimmune comorbidity experience a higher risk of disability worsening over time. This pattern suggests that autoimmune comorbidity does not intensify acute inflammatory disease activity, but may increase susceptibility to chronic, relapse-independent mechanisms of disability accumulation.

Objectives: To estimate the nationwide population-based incidence and prevalence of MOGAD in the Danish adult population (age ≥18 years) based on the 2023 International MOGAD Panel proposed criteria.

Methods: In this population-based historically prospective study, data were sourced from laboratories providing MOG-IgG test, the Danish Multiple Sclerosis Registry, and departments of neurology in Denmark. We computed the crude-, sex-, age-, race- specific incidence and prevalence.

Results: We confirmed MOGAD in 71 cases between 2016 and 2020. The incidence of MOGAD in the Danish adult population was 0.205 per 100,000 person-years (95% CI: 0.145-0.281), and the prevalence was 1.51 per 100,000 persons (95% CI: 1.18-1.91). The incidence in the female adult population was 0.192 and in the male population 0.218 per 100,000 person-years (95% CI: 0.114-0.303 and 0.133-0.337). The prevalence among female was 1.43 while in male 1.6 per 100,000 persons, respectively (95% CI: 0.99-2.00 and 1.13-2.20). The incidence and prevalence peaked in the age group 18-39 years, however MOGAD occurred in all age groups inclusive in elderly (age 65≤). No difference in the race-specific data was found.

Conclusions: We report estimates of incidence and prevalence of MOGAD in a national population-based design according to the 2023 criteria. Considering recent national population-based data in neuromyelitis optica spectrum disorder (NMOSD) obtained with similar approaches in the Danish adult population, the incidence and prevalence of MOGAD are 3 times and 1.4 times higher, respectively.

Introduction: In 2023, the natalizumab biosimilar Tyruko® was approved for relapsing-remitting multiple sclerosis. Here, we assessed patient experiences and natalizumab serum concentrations in a real-world cohort of patients who switched from the originator, Tysabri®, to the biosimilar. Furthermore, we evaluated the consistency of the new John Cunningham virus (JCV) assay that comes with the biosimilar.

Methods: Patients, aware of the switch, completed questionnaires and had natalizumab concentrations measured during treatment with both products. Questionnaires assessed impact of MS symptoms, treatment satisfaction and wearing-off symptoms. An additional questionnaire assessed perceived differences or side effects with the biosimilar. JCV results of the new ImmunoWELL assay were analyzed over time.

Results: Among 83 patients, 15% reported more side effects during treatment with the biosimilar. Overall satisfaction was lower during treatment with the biosimilar compared to the originator. Other questionnaire scores and trough concentrations did not differ significantly. JCV results of the ImmunoWELL assay remained mainly consistent.

Conclusion: While most patients perceived the biosimilar as equivalent to the originator, overall satisfaction was lower, and some reported more side effects. As these findings differ from blinded approval trials, a nocebo effect may influence patient perceptions in real-world settings when switching from originator to biosimilar natalizumab.

Background: Persons with multiple sclerosis (MS) rely heavily on the emergency department (ED) for acute care, with marginalized populations bearing an unequal MS burden of disease. Understanding how social determinants of health influence ED utilization is crucial for optimizing MS management.

Objectives: Examine the relationship between ED utilization, race, insurance type, and the Distressed Communities Index in patients with MS.

Methods: We analyzed encounters from seven healthcare institutions in the Chicago Area Patient-Centered Outcomes Research Network. Differences in ED utilization across patient groups were assessed using Chi-square tests and risk ratios for each characteristic combination investigated.

Results: The sample included 217,184 encounters from 12,770 patients between 2015 and 2021. Each factor had a statistically significant relationship with ED utilization. Increased ED utilization was associated with living in At risk or Distressed neighborhoods, being Black or Hispanic, lacking private insurance, and not having prior neurology encounters. Combined, these factors resulted in over three times the relative risk of ED encounters compared to White patients with private insurance living in more affluent areas who saw a neurologist (risk ratio 3.57, 95% CI [3.12, 4.08]).

Conclusions: These findings can guide efforts to address systemic inequities, and individual healthcare needs to improve MS management.

Background: Early clinical and radiological characteristics at presentation provide important prognostic information in multiple sclerosis (MS). However, baseline disease severity in treatment-naïve patients from Middle Eastern and North African populations remains scarce.

Objective: To quantify poor prognostic factors at first presentation and identify independent predictors of early disability in a large Egyptian MS cohort.

Methods: We retrospectively analyzed 1095 consecutive treatment-naïve patients with relapsing MS presenting for the first time to a tertiary referral center. Demographic, clinical, and MRI variables at baseline were collected. Established poor prognostic factors were predefined, and the cumulative burden per patient was calculated. Moderate to severe disability was defined as Expanded Disability Status Scale (EDSS) ≥3. Independent predictors were evaluated using multivariable logistic regression.

Results: A total of 1095 patients were analyzed (72.6% female; median age 37 years; median onset age 26 years). The median diagnostic delay was 9 years. At presentation, 39.3% had EDSS ≥3. Poor prognostic features were common, including pyramidal involvement (38.8 %), short inter-attack interval (42.0%), ≥2 relapses during the first year (34.7%), infratentorial lesions (60.1%), and spinal lesions (61.6%). Overall, 82.9% of patients exhibited ≥4 poor prognostic factors and 50.8% had ≥6. On multivariable analysis, age at onset >40 years (OR 1.04), pyramidal involvement (OR 1.72), cerebellar involvement (OR 1.81), infratentorial lesions (OR 1.49), and T1 black holes (OR 1.76) independently predicted EDSS ≥3 (all p < 0.05). Sex, smoking, relapse frequency, and gadolinium enhancement were not independently associated with disability.

Conclusions: Treatment-naïve patients presenting to our tertiary MS center frequently exhibited multiple unfavorable prognostic features and substantial disability. However, the prolonged diagnostic delay observed in this cohort likely reflects referral patterns specific to this tertiary center and should not be interpreted as representative of national MS diagnostic timelines in Egypt. Early motor pathway involvement and MRI markers of tissue damage, rather than inflammatory activity alone, were the principal determinants of disability at presentation.