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ECTRIMS Bulletin November

min read

Latest developments in MS research:

  • Learn about the efficacy and safety of autologous stem cell transplantation in individuals with relapsing remitting MS
  • Read whether pronounced neuroaxonal damage precedes disability worsening events
  • Know more about the prevalence and relative burden of psychiatric morbidity in individuals 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.



Multiple sclerosis

The Lancet | 7 November 2023

This review article provided a comprehensive overview of the novel pathophysiological findings, diagnostic criteria and guidelines recommendations associated with MS. The authors highlighted how increasing the understanding of the long prodromal period and its identification would further improve diagnosis, resulting in earlier treatment initiation in MS and better long-term disease outcomes. The development of medications to target the neurodegeneration associated with MS, and to create sensitive imaging and fluid biomarkers, were identified as future challenges in the management of the disease.

Exploring the cost-effectiveness of EBV vaccination to prevent multiple sclerosis in an Australian setting

Journal of Neurology, Neurosurgery & Psychiatry | 2 November 2023

Given the increasing body of evidence that vaccination against the Epstein-Barr virus (EBV) may have the potential to prevent MS, this study examined the cost-effectiveness of this approach in an Australian setting using a five-state Markov model. The authors concluded that based on total lifetime costs and quality-adjusted life years, vaccinating at 12 years of age was a cost-effective approach. Furthermore, sensitivity analyses suggested that EBV vaccination to prevent MS would be cost-effective under a wide range of plausible scenarios.

COVID-19 has no impact on disease activity, progression and cognitive performance in people with multiple sclerosis: a 2-year study

Journal of Neurology, Neurosurgery & Psychiatry | 19 October 2023

This study enrolled 174 individuals with MS and a history of COVID-19 between March 2020 and March 2021 and compared them to 348 individuals with MS who had no history of COVID-19 over the same period. Groups were matched for age, sex, disease duration, Expanded Disability Status Scale (EDSS) score and line of treatment. Similar rates of EDSS worsening (15% vs 11%, p=1.00), number of relapses (6% vs 5%, p=1.00), disease-modifying therapy change (7% vs 4%, p=0.81), patients with new T2-lesions (9% vs 11%, p=1.00) and gadolinium-enhancing lesions (7% vs 4%, p=1.00) on brain magnetic resonance imaging (MRI) were observed in the two groups. The authors concluded that COVID-19 had no impact on disease activity, course and cognitive performance 18–24 months after infection in individuals with MS.

Psychiatric Comorbidity During the Prodromal Period in Patients With Multiple Sclerosis

JAMA | 25 September 2023

This study, using linked administrative and clinical data from British Columbia, Canada, compared the prevalence and relative burden of psychiatric morbidity in individuals with MS with matched controls before MS onset. The prevalence of psychiatric morbidity in the 5 years before the first demyelinating event or symptom onset was identified, with 28% of cases having psychiatric morbidity in the 5 years pre-MS onset compared with 14.9% control individuals, which is almost double. The investigators identified a significant burden due to psychiatric morbidity prior to MS onset. These findings may provide evidence that mental health conditions form part of the MS prodrome.





Harmonizing Definitions for Progression Independent of Relapse Activity in Multiple Sclerosis: A Systematic Review

JAMA Neurology | 2 October 2023

This systematic review of 48 studies aimed to examine the current evidence on progression independent of relapse activity (PIRA) in MS and to investigate the definitions and terminology used in the literature. The authors noted that PIRA was the most common form of disability accumulation across all MS phenotypes, nonetheless, no standard definition of PIRA exists within the literature. Accepting the occurrence of PIRA may improve understanding of factors that underlie MS evolution and facilitate more targeted interventions in clinical trials and practice. Standardisation of how PIRA is defined would also permit comparability of results in current and future studies.

Imaging and Non-imaging Biomarkers

Neurofilament Light Chain Elevation and Disability Progression in Multiple Sclerosis

JAMA Neurology | 6 November 2023

This cohort study of 1899 individuals examined when neuroaxonal pathology occurs in those with MS who experience disability worsening. The investigators noted that serum neurofilament light chain elevation, assessed as a sign of accelerated neuroaxonal injury, was detected approximately 1 year preceding disability worsening events associated with relapses, and 1 to 2 years before worsening events independent of clinical relapses. These findings suggest that pronounced neuroaxonal damage precedes disability worsening events, with or without preceding clinical relapses, in individuals with MS.

Proteomics reveal biomarkers for diagnosis, disease activity and long-term disability outcomes in multiple sclerosis

Nature Communications | 30 October 2023

To achieve personalised treatment for individuals with MS, there is a need to identify sensitive and reliable protein biomarkers that can predict the likely disease course. In this proteomics study, the investigators used a highly sensitive proximity-extension assay, combined with next generation sequencing, to quantify almost 1500 proteins derived from the cerebrospinal fluid (CSF) and plasma of almost 150 individuals with early-stage MS. This approach identified proteins in the CSF that consistently predicted both short- and long-term disease progression, with neurofilament light chain demonstrated to be superior in predicting the absence of disease activity 2 years after testing compared to all other proteins examined.




Assessing treatment response to oral drugs for multiple sclerosis in real-world setting: a MAGNIMS Study

Journal of Neurology, Neuroscience & Psychiatry | 28 September 2023

Assessment of treatment response is important for individuals with MS receiving disease modifying therapies (DMTs). This study explored whether a scoring system developed to evaluate response to injectable drugs might also be adopted for oral DMTs. The collected dataset consisted of 1200 individuals with MS treated with either fingolimod, teriflunomide or dimethyl fumarate. Following 3 years of treatment application of the MAGNIMS (Magnetic Resonance Imaging in MS) scoring system, early relapses and magnetic resonance imaging disease activity were both found to be associated with worse short-term outcomes, demonstrating the potential usefulness of this approach.

The impact of healthcare systems on the clinical diagnosis and disease-modifying treatment usage in relapse-onset multiple sclerosis: a real-world perspective in five registries across Europe

Therapeutic Advances in Neurological Disorders | 26 September 2023

This study analysed cohort data from five European registries for individuals with an initial diagnosis of relapsing-remitting MS (RRMS). Variations in DMT use were noted between countries, with individuals in the UK less likely to receive DMTs than those in the other countries studied (Czech Republic, Denmark, Germany and Sweden). Given the ability of early treatment to improve long-term health and wellbeing for individuals with MS, there may be a need to standardise and improve MS care within the UK.

Haematopoietic stem cell transplantation for treatment of relapsing-remitting multiple sclerosis in Sweden: an observational cohort study

Journal of Neurology, Neuroscience & Psychiatry | 25 September 2023

This study assessed the efficacy and safety of autologous stem cell transplantation when implemented in routine healthcare for 174 individuals with RRMS. Efficacy was evaluated using a retrospective analysis of prospectively collected data from the Swedish MS registry, with procedure-related safety assessed using data from electronic patient records covering a period of 100 days following transplantation. Over half of patients who reported disability at baseline noted improvements in disease activity, with a further third considering that their disease had become stable. The authors concluded that stem cell transplantation in individuals with RRMS was associated with freedom from disease activity, with acceptable adverse events.