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ECTRIMS Bulletin: May 2023

min read

Latest developments in MS research:

  • Learn about new population-based estimates for the prevalence of multiple sclerosis in the United States
  • Read about how a pro-inflammatory diet in people with MS is associated with an increased rate of relapse and increased FLAIR lesion volume on MRI in early MS
  • Review a 25-year retrospective analysis about improvements in time to MS diagnosis from New York State MS Consortium.

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.


Population-Based Estimates for the Prevalence of Multiple Sclerosis in the United States by Race, Ethnicity, Age, Sex, and Geographic Region

JAMA Neurol. | 15 May 2023

This cohort study aimed to calculate the US prevalence of MS in Hispanic, non-Hispanic Black, and non-Hispanic White individuals stratified by age, sex, and region. In 2010, overall MS prevalence was highest in non-Hispanic White individuals followed by those who were non-Hispanic Black, members of other non-Hispanic race and ethnic groups, and Hispanic. Differences in MS prevalence between racial and ethnic groups varied by US Census region, and a strong association was observed between geographic latitude and prevalence.

Incorporating the Central Vein Sign Into the Diagnostic Criteria for Multiple Sclerosis

JAMA Neurol. | 17 April 2023

The central vein sign (CVS) has emerged as a promising candidate, which could be easily integrated into clinical practice and be included as a specific diagnostic feature of MS in future iterations of the McDonald criteria. Once included in diagnostic criteria, more specific operationalisation of the CVS will occur as data gaps are filled from ongoing research, in a process similar to how magnetic resonance imaging (MRI) lesions were incorporated and then subsequently refined.


A pro-inflammatory diet in people with multiple sclerosis is associated with an increased rate of relapse and increased FLAIR lesion volume on MRI in early multiple sclerosis: A prospective cohort study

Mult Scler. | 6 May 2023

A pro-inflammatory diet has been posited to induce chronic inflammation within the central nervous system (CNS). This study examined whether Dietary Inflammatory Index (DII®)) scores were associated with measures of MS progression and inflammatory activity by following a cohort of 223 patients with a first diagnosis of demyelination for up to 10 years. A more pro-inflammatory diet was found to be associated with a higher relapse risk in patients with MS, with a longitudinal association between a higher DII and a worsening in relapse rate.

Imaging and Non-Imaging Biomarkers

Association of serum neurofilament light with microglial activation in multiple sclerosis

Journal of Neurology, Neurosurgery & Psychiatry | 2 May 2023

Increased activation of microglia, the resident immune cells in the brain that contribute to chronic inflammation in MS, is significantly associated with higher levels of neurofilament light chain (NfL) protein, indicating more nerve damage. Strong links have been identified between activated microglia in chronic T1 hypointense lesions and in white matter found in deeper brain tissues, and NfL blood levels. Together, these findings show a “link between neuronal damage and microglial activation in MS”.


Comparative Effectiveness of Autologous Hematopoietic Stem Cell Transplant vs Fingolimod, Natalizumab, and Ocrelizumab in Highly Active Relapsing-Remitting Multiple Sclerosis

JAMA Neurology | 15 May 2023

This observational study examined the comparative effectiveness of autologous hematopoietic stem cell transplant (AHSCT) vs individual highly potent disease-modifying therapies (DMTs) for relapsing-remitting MS (RRMS). Overall, 4915 individuals were studied, using a composite cohort from specialised MS centres and the MSBase international registry. The effectiveness of AHSCT was compared with one medium-efficacy and two high-efficacy DMTs (fingolimod, natalizumab, and ocrelizumab) in patients with RRMS, a high frequency of relapses, and moderate disability. Over 5 years, the results indicate that the clinical effectiveness of AHSCT in RRMS is considerably superior to fingolimod and marginally superior to natalizumab.

Improvement in time to multiple sclerosis diagnosis: 25-year retrospective analysis from New York State MS Consortium (NYSMSC)

Multiple Sclerosis Journal | Vol 29 Issue 6 | May 2023

Judicious multiple sclerosis (MS) diagnosis and early start of disease modifying therapy significantly improves long-term disability outcomes in persons with MS (pwMS). Retrospective analysis based on 25-year New York State MS Consortium (NYSMSC) data determined the effect of changes in the respective diagnostic criteria in shortening the time between symptom onset to MS diagnosis. Based on 9378 current and historical MS cases, there was a significant decrease in time to diagnosis in pwMS from 1982–2001 to >2017 periods (average 4.2 vs. 1.1 years, p < 0.001). Additional improvements and better implementation of the MS diagnostic criteria can further decrease the diagnosis lag.

Ocrelizumab-treated patients with relapsing multiple sclerosis show volume loss rates similar to healthy aging

Mult Scler. | 6 May 2023

The aim of this study was to compare neurodegenerative processes, in the form of global and regional brain volume loss rates, in healthy controls and in patients with relapsing MS (RMS) treated with ocrelizumab in the OPERA II randomised, controlled trial. Ocrelizumab-treated patients showed global and regional brain volume loss rates that were approaching that of healthy controls, suggesting an important role of inflammation on overall tissue loss.