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ECTRIMS Bulletin December

min read

Latest developments in MS research:

  • Learn about the effect of a low-fat diet on fatigue in people with MS
  • Read whether serum biomarker levels might correlate with disability progression
  • Know more about smoking during pregnancy and the risk of MS in offspring and mother

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.


A low-fat diet improves fatigue in multiple sclerosis: Results from a randomized controlled trial

Multiple Sclerosis Journal | 8 November 2023

This 16-week, randomised trial examined whether a diet with daily fat calories not exceeding 20% might improve fatigue in individuals with MS. The study collected 2 weeks of baseline diet data, followed by randomisation. The active group subsequently underwent 2 weeks of nutrition counselling prior to a 12-week low-fat diet intervention, while the control group continued their pre-study diet and received diet training during the study completion. Individuals in the active group decreased their daily calorie intake by 11% and showed an improvement in their Modified Fatigue Impact Scale (MFIS) scores compared with control individuals. Thus, the authors concluded that a low-fat dietary intervention could significantly reduce fatigue in individuals with MS.

Cognitive rehabilitation and aerobic exercise for cognitive impairment in people with progressive multiple sclerosis (CogEx): a randomised, blinded, sham-controlled trial

The Lancet Neurology | October 2023

Cognitive rehabilitation and exercise have been shown to improve cognitive dysfunction in individuals with relapsing-remitting MS (RRMS). CogEx was a randomised, sham-controlled trial completed in 11 hospital clinics, universities, and rehabilitation centres in Belgium, Canada, Denmark, Italy, UK, and USA, which investigated the individual and synergistic effects of cognitive rehabilitation and exercise in patients with progressive MS (PMS). Participants were randomised 1:1:1:1 to receive either cognitive rehabilitation plus exercise, cognitive rehabilitation plus sham exercise, exercise plus sham cognitive rehabilitation, or sham exercise plus sham cognitive rehabilitation. At 12 weeks, no differences in cognitive function were noted between the study arms, and a combination of cognitive rehabilitation plus exercise did not improve cognitive function in individuals with PMS.



Multiple Sclerosis Progression and Relapse Activity in Children

JAMA Neurology | 27 November 2023

Questions remain regarding the relative impact of relapse on worsening of disability in individuals with MS, and how this might differ between adult-onset and paediatric-onset MS (POMS). This recently published cohort study of over 16,000 individuals with MS noted that progression independent of relapse activity (PIRA) was rarely observed before 18 years of age, and that individuals with POMS generally had less disability, exhibited more active disease and longer exposure to disease-modifying therapy (DMT) than those with adult-onset MS. However, the incidence of PIRA increased rapidly after 20 years of age, suggesting that POMS does not offer long-term protection against disability worsening, even in the absence of relapse.

Smoking during pregnancy and risk of multiple sclerosis in offspring and mother: A Danish nationwide register-based cohort study

Multiple Sclerosis Journal | 19 November 2023

This study used data from the Danish Medical Birth Register and the National Patient Register to examine nationwide information on maternal smoking and any association between smoking habits and an elevated risk of MS among smokers or their offspring exposed to smoking before birth. A 42% increased risk of developing MS was noted among women who smoked during pregnancy, with a 38% greater risk of MS among offspring of women who smoked during pregnancy compared with the offspring of non-smoking women.

Imaging and Non-imaging Biomarkers

Serum biomarker levels predict disability progression in patients with primary progressive multiple sclerosis

Journal of Neurology, Neurosurgery and Psychiatry | 8 November 2023

A total of 141 individuals with primary progressive MS (PPMS) drawn from 18 European centres participated in a study to examine how serum levels of neurofilament light chain (sNfL), glial fibrillar acidic protein (sGFAP) and chitinase 3-like 1 (sCHI3L1) might correlate with disability progression as measured by change in Expanded Disability Status Scale (EDSS) score. In multivariate analyses, levels of all three biomarkers were associated with changes in EDSS over time. However, in patients without inflammatory disease, only sCHI3L1 remained predictive of future EDSS change.



Prospective trial of natalizumab personalised extended interval dosing by therapeutic drug monitoring in relapsing-remitting multiple sclerosis (NEXT-MS)

Journal of Neurology, Neurosurgery & Psychiatry | 14 November 2023

As part of the overall strategy to optimise treatment for individuals with MS, extended interval dosing of natalizumab has been explored in an investigator-initiated, Phase IV, non-randomised study. A total of 376 individuals with relapsing-remitting MS who had received ≥6 natalizumab infusions entered the study and were treated using personalised, extended interval dosing of natalizumab to maintain a prespecified target drug trough concentration. This approach was found to provide adequate control of MS disease activity, suggesting the possibility to extend treatment intervals to >6 weeks.