Latest developments in MS research:
- Learn about the weaker immune response and decreased booster efficacy among MS patients who received the Covid-19 vaccine prior to the introduction of anti-CD20s
- Early treatment is associated with improved long-term outcomes for individuals with MS who have experienced a first demyelinating event
- Risk of MS increases several folds among patients of Nordic ancestry who have a relative with MS
These noteworthy MS news highlights and more are included in our recently published ECTRIMS Bulletins – a 30-day snapshot of global news & publications on MS research, treatment and care.
ECTRIMS Bulletins can be sent to you every month, delivered straight to your inbox, via our free subscription service. Simply select all “topics” that are of interest to you, and when one of those appears in our news & publication cycle you’ll be sure to hear from us.
Clinical
Differential diagnosis of suspected multiple sclerosis: an updated consensus approach
Lancet Neurology | August 2023
Accurate diagnosis of MS can be challenging and the differential diagnosis requires careful attention. The authors of this article suggest that the significant increase in knowledge around MS since the diagnostic approaches published by The International Advisory Committee on Clinical Trials in Multiple Sclerosis in 2008 warrants an updated approach to diagnosis. Advances in distinguishing MS from other central nervous system (CNS) inflammatory disorders by means of clinical, magnetic resonance imaging (MRI) and laboratory findings have provided insights to refine diagnostic criteria, and define clinical and paraclinical red flags suggestive of alternative diagnosis that warrant further investigation to rule out alternative diagnosis.
Is vaccine response to SARS-CoV-2 preserved after switching to anti-CD20 therapies in patients with multiple sclerosis or related disorders?
J Neurol Neurosurg Psychiatry | 21 July 2023
This retrospective study aimed to expand the previously limited data regarding the evolution of post-vaccine immunity in individuals with MS treated with anti-CD20 therapies following vaccination. The study revealed that even when individuals received their primary vaccination before the initiation of anti-CD20 therapies, they exhibited weaker immune responses at 6 and 12 months when compared with individuals who had not initiated anti-CD20s. Moreover, booster efficacy was shown to be decreased in these individuals. Overall, these results suggest that, even when vaccinated prior to initiation of anti-CD20s, individuals with MS may not benefit from full vaccine protection.MS as a first demyelinating event.
Association of Very Early Treatment Initiation With the Risk of Long-Term Disability in Patients With a First Demyelinating Event
In individuals with early MS who have experienced a first demyelinating event, early treatment is associated with improved long-term outcomes. This study assessed the association between very early treatment and the risk of long-term disability in 580 individuals with MS and a first demyelinating event who received at least one disease modifying treatment (DMT). Participants were classified into tertiles according to the cohort’s distribution of the time from the first demyelinating event to the first DMT: First tertile or very early treatment (6 months; N=194); second tertile (6.1-16 months, N=192), and third tertile (16.1 months, N=194). Very early treatment decreased the risk of reaching EDSS 3.0, developing secondary progressive MS and sustained disease progression at 12 months after treatment initiation. Therefore, treatment initiation at very early stages was associated with a reduction in the risk of long-term disability accrual in individuals with MS as a first demyelinating event.
The familial risk and heritability of multiple sclerosis and its onset phenotypes: A case–control study
Multiple Sclerosis Journal | 12 July 2023
This study used data from 25,186 MS patients of Nordic ancestry who entered the Swedish MS Registry between 1987 and 2019. The aim was to evaluate the magnitude of familial components in primary progressive MS (PPMS) and relapsing-remitting MS (RRMS) and to estimate the heritability of disease phenotypes. Logistic regression analyses demonstrated that the risk of MS increased several folds in individuals who had a relation with MS. However, the chance of developing either disease phenotype was considered to be independent of genetic predisposition.
Imaging and Non-imaging Biomarkers
Serum neurofilament light chain reference database for individual application in paediatric care: a retrospective modelling and validation study
The Lancet Neurology | 28 July 2023
Measurement of serum neurofilament light chain (sNfL) concentrations, a specific marker of neuroaxonal injury, has the potential to contribute to the management of children with neurological conditions. This study used a population of 2667 healthy children and adolescents (aged 0–22 years) to establish an age-adjusted sNfL reference range database and to validate this in 220 paediatric patients with neurological conditions. In the healthy population, sNfL concentrations decreased with age by an estimated 6.8% per year until age 10.3 years, and thereafter remained stable up to 22 years of age. Age-adjusted sNfL concentrations were higher in children with neurological conditions than in the healthy population, allowing an estimation of neuroaxonal damage in this population.
Therapeutics
Best practices in phase III clinical trials on DMTs for multiple sclerosis: a systematic analysis and appraisal of published trials
J Neurol Neurosurg Psychiatry | 4 August 2023
This study systematically analysed publications on clinical trials in MS from January 2010 to December 2021. The aim was to critically appraise these trials and identify key areas for improvement. A total of 31 Phase III study publications were identified, with the most common limitations identified as an absence of comorbidity data reporting, unjustified use of placebo, inadequacy of outcomes design, and an absence of prospective registration. Addressing these limitations would enhance the quality, transparency and external validity of clinical trial publications in MS.