ICYMI Multiple Sclerosis

Key clinical point: Dimethyl fumarate (DMF) may slow down cognitive impairment in patients with relapsing-remitting multiple sclerosis (RRMS).

Major finding: Of 34 patients with cognitive impairment at baseline, 55.9% of patients did not show evidence of cognitive worsening at 2 years.

Study details: This prospective single-arm study enrolled patients with RRMS (n=217) treated with DMF for 2 years.

Disclosures: This study was funded by Biogen. The authors reported relationships with multiple pharmaceutical companies.

Citation: Amato MP et al. Neurol Sci. 2020 May 01. doi: 10.1007/s10072-020-04320-w.

Key clinical point: Dimethyl fumarate (DMF) may slow down cognitive impairment in patients with relapsing-remitting multiple sclerosis (RRMS).

Major finding: Of 34 patients with cognitive impairment at baseline, 55.9% of patients did not show evidence of cognitive worsening at 2 years.

Study details: This prospective single-arm study enrolled patients with RRMS (n=217) treated with DMF for 2 years.

Disclosures: This study was funded by Biogen. The authors reported relationships with multiple pharmaceutical companies.

Citation: Amato MP et al. Neurol Sci. 2020 May 01. doi: 10.1007/s10072-020-04320-w.

Key clinical point: Dimethyl fumarate (DMF) may slow down cognitive impairment in patients with relapsing-remitting multiple sclerosis (RRMS).

Major finding: Of 34 patients with cognitive impairment at baseline, 55.9% of patients did not show evidence of cognitive worsening at 2 years.

Study details: This prospective single-arm study enrolled patients with RRMS (n=217) treated with DMF for 2 years.

Disclosures: This study was funded by Biogen. The authors reported relationships with multiple pharmaceutical companies.

Citation: Amato MP et al. Neurol Sci. 2020 May 01. doi: 10.1007/s10072-020-04320-w.

Key clinical point: Ocrelizumab is a potential stabilizing treatment option for both treatment-naïve and pretreated patients with multiple sclerosis (MS).

Major finding: Among all patients, 24% were treatment naïve and 76% had previously received immune therapies. After initiating ocrelizumab, 13% of patients with relapsing-remitting multiple sclerosis (RRMS) or active secondary progressive multiple sclerosis (aSPMS) had a relapse (annualized relapse rate, 0.17). Among all patients with MS, 5% experienced a 12-week confirmed disability progression. Side effects were mostly mild and reported in 22% of the patients.

Study details: A retrospective analysis of real-world data on patients with MS who had received 2 ocrelizumab (300 mg) cycles at 2-week intervals. Of 210 patients, 55 had primary progressive MS and 155 had RRMS or aSPMS.

Disclosures: This study was supported by the German Research Council. The authors reported relationships with multiple pharmaceutical companies.

Citation: Nicholas J et al. J Med Econ. 2020 Apr 26. doi: 10.1212/NXI.0000000000000719.

Key clinical point: Ocrelizumab is a potential stabilizing treatment option for both treatment-naïve and pretreated patients with multiple sclerosis (MS).

Major finding: Among all patients, 24% were treatment naïve and 76% had previously received immune therapies. After initiating ocrelizumab, 13% of patients with relapsing-remitting multiple sclerosis (RRMS) or active secondary progressive multiple sclerosis (aSPMS) had a relapse (annualized relapse rate, 0.17). Among all patients with MS, 5% experienced a 12-week confirmed disability progression. Side effects were mostly mild and reported in 22% of the patients.

Study details: A retrospective analysis of real-world data on patients with MS who had received 2 ocrelizumab (300 mg) cycles at 2-week intervals. Of 210 patients, 55 had primary progressive MS and 155 had RRMS or aSPMS.

Disclosures: This study was supported by the German Research Council. The authors reported relationships with multiple pharmaceutical companies.

Citation: Nicholas J et al. J Med Econ. 2020 Apr 26. doi: 10.1212/NXI.0000000000000719.

Key clinical point: Ocrelizumab is a potential stabilizing treatment option for both treatment-naïve and pretreated patients with multiple sclerosis (MS).

Major finding: Among all patients, 24% were treatment naïve and 76% had previously received immune therapies. After initiating ocrelizumab, 13% of patients with relapsing-remitting multiple sclerosis (RRMS) or active secondary progressive multiple sclerosis (aSPMS) had a relapse (annualized relapse rate, 0.17). Among all patients with MS, 5% experienced a 12-week confirmed disability progression. Side effects were mostly mild and reported in 22% of the patients.

Study details: A retrospective analysis of real-world data on patients with MS who had received 2 ocrelizumab (300 mg) cycles at 2-week intervals. Of 210 patients, 55 had primary progressive MS and 155 had RRMS or aSPMS.

Disclosures: This study was supported by the German Research Council. The authors reported relationships with multiple pharmaceutical companies.

Citation: Nicholas J et al. J Med Econ. 2020 Apr 26. doi: 10.1212/NXI.0000000000000719.

Key clinical point: Long-term exposure to fingolimod is associated with lower disability progression in patients with relapsing multiple sclerosis (MS).

Major finding: The high (≥8 years) vs. low (<8 years) exposure groups showed a smaller increase in the mean Expanded Disability Status Scale (+0.55 vs. +1.21) and lower frequencies of disability progression (34.7% vs. 56.1%; P less than .01) and wheelchair use (4.9% vs. 16.9%; P less than .0276) at 10 years.

Study details: ACROSS was a cross-sectional follow-up study of patients with relapsing MS enrolled in a phase 2 proof-of-concept study. Disability outcomes were assessed in patients grouped as per fingolimod exposure: high exposure (n=104) and low exposure (n=71).

Disclosures: The study was funded by Novartis Pharma AG, Basel, Switzerland. Amin Azmon and Davorka Tomic are employees of Novartis. The other authors reported relationships with multiple pharmaceutical companies.

Citation: Derfuss T et al. Mult Scler J Exp Transl Clin. 2020 Mar 30. doi: 10.1177/2055217320907951.

Key clinical point: Long-term exposure to fingolimod is associated with lower disability progression in patients with relapsing multiple sclerosis (MS).

Major finding: The high (≥8 years) vs. low (<8 years) exposure groups showed a smaller increase in the mean Expanded Disability Status Scale (+0.55 vs. +1.21) and lower frequencies of disability progression (34.7% vs. 56.1%; P less than .01) and wheelchair use (4.9% vs. 16.9%; P less than .0276) at 10 years.

Study details: ACROSS was a cross-sectional follow-up study of patients with relapsing MS enrolled in a phase 2 proof-of-concept study. Disability outcomes were assessed in patients grouped as per fingolimod exposure: high exposure (n=104) and low exposure (n=71).

Disclosures: The study was funded by Novartis Pharma AG, Basel, Switzerland. Amin Azmon and Davorka Tomic are employees of Novartis. The other authors reported relationships with multiple pharmaceutical companies.

Citation: Derfuss T et al. Mult Scler J Exp Transl Clin. 2020 Mar 30. doi: 10.1177/2055217320907951.

Key clinical point: Long-term exposure to fingolimod is associated with lower disability progression in patients with relapsing multiple sclerosis (MS).

Major finding: The high (≥8 years) vs. low (<8 years) exposure groups showed a smaller increase in the mean Expanded Disability Status Scale (+0.55 vs. +1.21) and lower frequencies of disability progression (34.7% vs. 56.1%; P less than .01) and wheelchair use (4.9% vs. 16.9%; P less than .0276) at 10 years.

Study details: ACROSS was a cross-sectional follow-up study of patients with relapsing MS enrolled in a phase 2 proof-of-concept study. Disability outcomes were assessed in patients grouped as per fingolimod exposure: high exposure (n=104) and low exposure (n=71).

Disclosures: The study was funded by Novartis Pharma AG, Basel, Switzerland. Amin Azmon and Davorka Tomic are employees of Novartis. The other authors reported relationships with multiple pharmaceutical companies.

Citation: Derfuss T et al. Mult Scler J Exp Transl Clin. 2020 Mar 30. doi: 10.1177/2055217320907951.

Key clinical point: Elevated body mass index (BMI) is independently associated with an accelerated rate of ganglion cell+inner plexiform layer (GCIPL) atrophy in patients with multiple sclerosis (MS).

Major findings: Obese (n=146; BMI, ≥30 kg/m²) vs. normal weight (n=214; BMI, 18.5-24.9 kg/m²) patients showed accelerated rate of GCIPL atrophy (−0.57%/year vs. −0.42%/year; P = .012). Atrophy rates were not significantly different between overweight (n=153; BMI, 25-29.9 kg/m²) and normal weight patients (−0.47%/year vs. −0.42%/year; P = .41). GCIPL atrophy rate accelerated by −0.011% per year with each 1 kg/m² higher BMI (P =.003).

Study details: This observational study included 522 patients with MS from Johns Hopkins MS Center who were followed with retinal imaging for a median of 4.4 years.

Disclosures: The study was funded by the National MS Society, Race to Erase MS, and NIH/NINDS. The presenting author had no disclosures. One coauthor reported receiving support from the Race to Erase MS foundation.

Citation: Filippatou AG et al. Mult Scler. 2020 Apr 16. doi: 10.1177/1352458519900942.

Key clinical point: Elevated body mass index (BMI) is independently associated with an accelerated rate of ganglion cell+inner plexiform layer (GCIPL) atrophy in patients with multiple sclerosis (MS).

Major findings: Obese (n=146; BMI, ≥30 kg/m²) vs. normal weight (n=214; BMI, 18.5-24.9 kg/m²) patients showed accelerated rate of GCIPL atrophy (−0.57%/year vs. −0.42%/year; P = .012). Atrophy rates were not significantly different between overweight (n=153; BMI, 25-29.9 kg/m²) and normal weight patients (−0.47%/year vs. −0.42%/year; P = .41). GCIPL atrophy rate accelerated by −0.011% per year with each 1 kg/m² higher BMI (P =.003).

Study details: This observational study included 522 patients with MS from Johns Hopkins MS Center who were followed with retinal imaging for a median of 4.4 years.

Disclosures: The study was funded by the National MS Society, Race to Erase MS, and NIH/NINDS. The presenting author had no disclosures. One coauthor reported receiving support from the Race to Erase MS foundation.

Citation: Filippatou AG et al. Mult Scler. 2020 Apr 16. doi: 10.1177/1352458519900942.

Key clinical point: Elevated body mass index (BMI) is independently associated with an accelerated rate of ganglion cell+inner plexiform layer (GCIPL) atrophy in patients with multiple sclerosis (MS).

Major findings: Obese (n=146; BMI, ≥30 kg/m²) vs. normal weight (n=214; BMI, 18.5-24.9 kg/m²) patients showed accelerated rate of GCIPL atrophy (−0.57%/year vs. −0.42%/year; P = .012). Atrophy rates were not significantly different between overweight (n=153; BMI, 25-29.9 kg/m²) and normal weight patients (−0.47%/year vs. −0.42%/year; P = .41). GCIPL atrophy rate accelerated by −0.011% per year with each 1 kg/m² higher BMI (P =.003).

Study details: This observational study included 522 patients with MS from Johns Hopkins MS Center who were followed with retinal imaging for a median of 4.4 years.

Disclosures: The study was funded by the National MS Society, Race to Erase MS, and NIH/NINDS. The presenting author had no disclosures. One coauthor reported receiving support from the Race to Erase MS foundation.

Citation: Filippatou AG et al. Mult Scler. 2020 Apr 16. doi: 10.1177/1352458519900942.

Key clinical point: Low fish consumption is associated with an increased risk of developing multiple sclerosis (MS); vitamin D does not mediate this association.

Major finding: Regardless of sun exposure habits, MS risk was higher with low fish consumption, including both lean and fatty fish (odds ratio, 1.2; 95% confidence interval, 1.1-1.4). The mediation analysis revealed that the effect mediated by vitamin D deficiency on this association was very small. A significant interaction was noted between DRB1*15:01 allele and both low sun exposure and low fish consumption.

Study details: The data come from 2 Swedish population-based case-control studies (6,914 patients with MS and 6,590 control participants).

Disclosures: The study was supported by grants from the Swedish Medical Research Council, the Swedish Research Council for Health, Working Life and Welfare, the Swedish Brain Foundation, and the Swedish Society for Medical Research. Dr Olsson reported receiving grants from the Swedish Research Council, the Knut and Alice Wallenberg Foundation, and the Swedish Brain Foundation. Dr Alfredsson reported receiving grants from the Swedish Research Council, the Swedish

Research Council for Health Working Life and Welfare, and the Swedish Brain Foundation.

Citation: Hedström AK et al. Neurol Neuroimmunol Neuroinflamm. 2020 Apr 10. doi: 10.1212/NXI.0000000000000717.

Key clinical point: Low fish consumption is associated with an increased risk of developing multiple sclerosis (MS); vitamin D does not mediate this association.

Major finding: Regardless of sun exposure habits, MS risk was higher with low fish consumption, including both lean and fatty fish (odds ratio, 1.2; 95% confidence interval, 1.1-1.4). The mediation analysis revealed that the effect mediated by vitamin D deficiency on this association was very small. A significant interaction was noted between DRB1*15:01 allele and both low sun exposure and low fish consumption.

Study details: The data come from 2 Swedish population-based case-control studies (6,914 patients with MS and 6,590 control participants).

Disclosures: The study was supported by grants from the Swedish Medical Research Council, the Swedish Research Council for Health, Working Life and Welfare, the Swedish Brain Foundation, and the Swedish Society for Medical Research. Dr Olsson reported receiving grants from the Swedish Research Council, the Knut and Alice Wallenberg Foundation, and the Swedish Brain Foundation. Dr Alfredsson reported receiving grants from the Swedish Research Council, the Swedish

Research Council for Health Working Life and Welfare, and the Swedish Brain Foundation.

Citation: Hedström AK et al. Neurol Neuroimmunol Neuroinflamm. 2020 Apr 10. doi: 10.1212/NXI.0000000000000717.

Key clinical point: Low fish consumption is associated with an increased risk of developing multiple sclerosis (MS); vitamin D does not mediate this association.

Major finding: Regardless of sun exposure habits, MS risk was higher with low fish consumption, including both lean and fatty fish (odds ratio, 1.2; 95% confidence interval, 1.1-1.4). The mediation analysis revealed that the effect mediated by vitamin D deficiency on this association was very small. A significant interaction was noted between DRB1*15:01 allele and both low sun exposure and low fish consumption.

Study details: The data come from 2 Swedish population-based case-control studies (6,914 patients with MS and 6,590 control participants).

Disclosures: The study was supported by grants from the Swedish Medical Research Council, the Swedish Research Council for Health, Working Life and Welfare, the Swedish Brain Foundation, and the Swedish Society for Medical Research. Dr Olsson reported receiving grants from the Swedish Research Council, the Knut and Alice Wallenberg Foundation, and the Swedish Brain Foundation. Dr Alfredsson reported receiving grants from the Swedish Research Council, the Swedish

Research Council for Health Working Life and Welfare, and the Swedish Brain Foundation.

Citation: Hedström AK et al. Neurol Neuroimmunol Neuroinflamm. 2020 Apr 10. doi: 10.1212/NXI.0000000000000717.

Key clinical point: Mercury-containing dental amalgam fillings (AMF) are not associated with the risk of developing multiple sclerosis (MS).

Major finding: The risk of MS with AMF did not differ significantly between patients and control participants (adjusted odds ratio [aOR], 0.823; 95% confidence interval [CI], 0.648-1.046). MS was not associated with AMF irrespective of gender (women: aOR, 0.743; 95% CI, 0.552-1.000; men: aOR, 1.006; 95% CI, 0.670-1.509).

Study details: The data come from a Taiwanese population-based case-control study of 612 participants with MS and 612 matched participants without MS.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Citation: Tseng CF et al. Int J Environ Res Public Health. 2020 Apr 12. doi: 10.3390/ijerph17082637.

Key clinical point: Mercury-containing dental amalgam fillings (AMF) are not associated with the risk of developing multiple sclerosis (MS).

Major finding: The risk of MS with AMF did not differ significantly between patients and control participants (adjusted odds ratio [aOR], 0.823; 95% confidence interval [CI], 0.648-1.046). MS was not associated with AMF irrespective of gender (women: aOR, 0.743; 95% CI, 0.552-1.000; men: aOR, 1.006; 95% CI, 0.670-1.509).

Study details: The data come from a Taiwanese population-based case-control study of 612 participants with MS and 612 matched participants without MS.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Citation: Tseng CF et al. Int J Environ Res Public Health. 2020 Apr 12. doi: 10.3390/ijerph17082637.

Key clinical point: Mercury-containing dental amalgam fillings (AMF) are not associated with the risk of developing multiple sclerosis (MS).

Major finding: The risk of MS with AMF did not differ significantly between patients and control participants (adjusted odds ratio [aOR], 0.823; 95% confidence interval [CI], 0.648-1.046). MS was not associated with AMF irrespective of gender (women: aOR, 0.743; 95% CI, 0.552-1.000; men: aOR, 1.006; 95% CI, 0.670-1.509).

Study details: The data come from a Taiwanese population-based case-control study of 612 participants with MS and 612 matched participants without MS.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Citation: Tseng CF et al. Int J Environ Res Public Health. 2020 Apr 12. doi: 10.3390/ijerph17082637.

The efficacy of the influenza vaccine when given to patients with multiple sclerosis (MS) is similar to that in healthy controls, Jackie Nguyen reported at the virtual annual meeting of the Consortium of Multiple Sclerosis Centers (CMSC). She presented a systematic review and meta-analysis of nine published cohort studies including 417 MS patients and more than 500 healthy controls, all of whom received inactivated seasonal influenza vaccine.

The impetus for this project was a recognition that the great majority of the research on the impact of influenza vaccine in patients with MS has focused on safety and MS relapse rates. In contrast, the nine studies included in the meta-analysis contained data on influenza vaccine efficacy as reflected in the ability to mount an adequate immune response. This was defined in standard fashion either by seroconversion, which required at least a fourfold increase in antibody titers following vaccination, or seroprotection, with a postvaccination antihemagglutination immunoglobulin G titer of at least 40. The analysis included patients with MS irrespective of disease duration or severity or treatment regimen, noted Ms. Nguyen, a third-year medical student at Nova Southeastern University College of Allopathic Medicine in Davie, Fla.

The researchers found that there was no significant difference between patients with MS and healthy controls in the rates of an adequate immune response for influenza H1N1, H3N2, or influenza B virus. “The vaccine should thus continue to be recommended for MS patients, as the data shows it to be efficacious,” she said.

Her conclusion is consistent with guidance provided in the American Academy of Neurology’s 2019 practice guideline update on immunization in MS, highlighted elsewhere at CMSC 2020 in a presentation by Marijean Buhse, PhD, of Stony Brook University in New York.

The guideline, updated for the first time in 17 years, states that all MS patients should be advised to receive influenza vaccine annually: “With known risks of exacerbation and other morbidity with influenza infection and no identified risks of exacerbation with influenza vaccines, benefits of influenza vaccination outweigh the risks in most scenarios. The exception involves the relatively few MS patients having a specific contraindication to the influenza vaccine, such as a previous severe reaction, noted Dr. Buhse, who wasn’t involved in developing the evidence-based guidelines.

The available evidence indicates that some but not all disease-modifying therapies for MS reduce the effectiveness of vaccination against influenza.

According to the guideline, “it is possible” that persons with MS being treated with glatiramer acetate have a reduced likelihood of seroprotection from influenza vaccine, a conclusion the guidelines committee drew with “low confidence in the evidence.” Further, the guideline states that “it is probable” MS patients on fingolimod have a lower likelihood of obtaining seroprotection from influenza vaccine than patients not on the drug, with moderate confidence in the evidence. Also, it is deemed probable that patients with MS who are taking mitoxantrone have a reduced likelihood of response to influenza vaccination, compared with healthy controls. But it is probable that patients with MS who are receiving interferon-beta have no diminution in the likelihood of seroprotection. According to the guideline, there is insufficient evidence to say whether patients with MS who are on natalizumab, teriflunomide, or methotrexate have a diminished response to influenza vaccination.

Dr. Buhse noted that rituximab is off-label therapy for MS, so there are no data available regarding the likelihood of seroprotection in response to influenza vaccination in that setting. However, rituximab profoundly decreases the immunogenicity of influenza and pneumococcal vaccines in rheumatoid arthritis patients. It is therefore recommended that inactivated influenza vaccine be given to patients with MS at least 2 weeks prior to starting rituximab or 6 months after the last dose in order to optimize the humoral results. Ms. Nguyen reported having no financial conflicts regarding her presentation. Dr. Buhse reported having received honoraria from Genzyme and Biogen.

[email protected]

The efficacy of the influenza vaccine when given to patients with multiple sclerosis (MS) is similar to that in healthy controls, Jackie Nguyen reported at the virtual annual meeting of the Consortium of Multiple Sclerosis Centers (CMSC). She presented a systematic review and meta-analysis of nine published cohort studies including 417 MS patients and more than 500 healthy controls, all of whom received inactivated seasonal influenza vaccine.

The impetus for this project was a recognition that the great majority of the research on the impact of influenza vaccine in patients with MS has focused on safety and MS relapse rates. In contrast, the nine studies included in the meta-analysis contained data on influenza vaccine efficacy as reflected in the ability to mount an adequate immune response. This was defined in standard fashion either by seroconversion, which required at least a fourfold increase in antibody titers following vaccination, or seroprotection, with a postvaccination antihemagglutination immunoglobulin G titer of at least 40. The analysis included patients with MS irrespective of disease duration or severity or treatment regimen, noted Ms. Nguyen, a third-year medical student at Nova Southeastern University College of Allopathic Medicine in Davie, Fla.

The researchers found that there was no significant difference between patients with MS and healthy controls in the rates of an adequate immune response for influenza H1N1, H3N2, or influenza B virus. “The vaccine should thus continue to be recommended for MS patients, as the data shows it to be efficacious,” she said.

Her conclusion is consistent with guidance provided in the American Academy of Neurology’s 2019 practice guideline update on immunization in MS, highlighted elsewhere at CMSC 2020 in a presentation by Marijean Buhse, PhD, of Stony Brook University in New York.

The guideline, updated for the first time in 17 years, states that all MS patients should be advised to receive influenza vaccine annually: “With known risks of exacerbation and other morbidity with influenza infection and no identified risks of exacerbation with influenza vaccines, benefits of influenza vaccination outweigh the risks in most scenarios. The exception involves the relatively few MS patients having a specific contraindication to the influenza vaccine, such as a previous severe reaction, noted Dr. Buhse, who wasn’t involved in developing the evidence-based guidelines.

The available evidence indicates that some but not all disease-modifying therapies for MS reduce the effectiveness of vaccination against influenza.

According to the guideline, “it is possible” that persons with MS being treated with glatiramer acetate have a reduced likelihood of seroprotection from influenza vaccine, a conclusion the guidelines committee drew with “low confidence in the evidence.” Further, the guideline states that “it is probable” MS patients on fingolimod have a lower likelihood of obtaining seroprotection from influenza vaccine than patients not on the drug, with moderate confidence in the evidence. Also, it is deemed probable that patients with MS who are taking mitoxantrone have a reduced likelihood of response to influenza vaccination, compared with healthy controls. But it is probable that patients with MS who are receiving interferon-beta have no diminution in the likelihood of seroprotection. According to the guideline, there is insufficient evidence to say whether patients with MS who are on natalizumab, teriflunomide, or methotrexate have a diminished response to influenza vaccination.

Dr. Buhse noted that rituximab is off-label therapy for MS, so there are no data available regarding the likelihood of seroprotection in response to influenza vaccination in that setting. However, rituximab profoundly decreases the immunogenicity of influenza and pneumococcal vaccines in rheumatoid arthritis patients. It is therefore recommended that inactivated influenza vaccine be given to patients with MS at least 2 weeks prior to starting rituximab or 6 months after the last dose in order to optimize the humoral results. Ms. Nguyen reported having no financial conflicts regarding her presentation. Dr. Buhse reported having received honoraria from Genzyme and Biogen.

[email protected]

The efficacy of the influenza vaccine when given to patients with multiple sclerosis (MS) is similar to that in healthy controls, Jackie Nguyen reported at the virtual annual meeting of the Consortium of Multiple Sclerosis Centers (CMSC). She presented a systematic review and meta-analysis of nine published cohort studies including 417 MS patients and more than 500 healthy controls, all of whom received inactivated seasonal influenza vaccine.

The impetus for this project was a recognition that the great majority of the research on the impact of influenza vaccine in patients with MS has focused on safety and MS relapse rates. In contrast, the nine studies included in the meta-analysis contained data on influenza vaccine efficacy as reflected in the ability to mount an adequate immune response. This was defined in standard fashion either by seroconversion, which required at least a fourfold increase in antibody titers following vaccination, or seroprotection, with a postvaccination antihemagglutination immunoglobulin G titer of at least 40. The analysis included patients with MS irrespective of disease duration or severity or treatment regimen, noted Ms. Nguyen, a third-year medical student at Nova Southeastern University College of Allopathic Medicine in Davie, Fla.

The researchers found that there was no significant difference between patients with MS and healthy controls in the rates of an adequate immune response for influenza H1N1, H3N2, or influenza B virus. “The vaccine should thus continue to be recommended for MS patients, as the data shows it to be efficacious,” she said.

Her conclusion is consistent with guidance provided in the American Academy of Neurology’s 2019 practice guideline update on immunization in MS, highlighted elsewhere at CMSC 2020 in a presentation by Marijean Buhse, PhD, of Stony Brook University in New York.

The guideline, updated for the first time in 17 years, states that all MS patients should be advised to receive influenza vaccine annually: “With known risks of exacerbation and other morbidity with influenza infection and no identified risks of exacerbation with influenza vaccines, benefits of influenza vaccination outweigh the risks in most scenarios. The exception involves the relatively few MS patients having a specific contraindication to the influenza vaccine, such as a previous severe reaction, noted Dr. Buhse, who wasn’t involved in developing the evidence-based guidelines.

The available evidence indicates that some but not all disease-modifying therapies for MS reduce the effectiveness of vaccination against influenza.

According to the guideline, “it is possible” that persons with MS being treated with glatiramer acetate have a reduced likelihood of seroprotection from influenza vaccine, a conclusion the guidelines committee drew with “low confidence in the evidence.” Further, the guideline states that “it is probable” MS patients on fingolimod have a lower likelihood of obtaining seroprotection from influenza vaccine than patients not on the drug, with moderate confidence in the evidence. Also, it is deemed probable that patients with MS who are taking mitoxantrone have a reduced likelihood of response to influenza vaccination, compared with healthy controls. But it is probable that patients with MS who are receiving interferon-beta have no diminution in the likelihood of seroprotection. According to the guideline, there is insufficient evidence to say whether patients with MS who are on natalizumab, teriflunomide, or methotrexate have a diminished response to influenza vaccination.

Dr. Buhse noted that rituximab is off-label therapy for MS, so there are no data available regarding the likelihood of seroprotection in response to influenza vaccination in that setting. However, rituximab profoundly decreases the immunogenicity of influenza and pneumococcal vaccines in rheumatoid arthritis patients. It is therefore recommended that inactivated influenza vaccine be given to patients with MS at least 2 weeks prior to starting rituximab or 6 months after the last dose in order to optimize the humoral results. Ms. Nguyen reported having no financial conflicts regarding her presentation. Dr. Buhse reported having received honoraria from Genzyme and Biogen.

[email protected]

Key clinical point: Periconceptional rituximab is a highly effective and safe treatment for women with suboptimally controlled multiple sclerosis (MS).

Major finding: Among 38 live births, 3 deliveries were preterm (including 1 set of twins), 1 baby was admitted for perinatal ischemic stroke, and 1 twin died after 6 days from an intraventricular hemorrhage. Fifteen women reported at least one first-trimester miscarriage, of whom 8 had a history of infertility. No stillbirths, chorioamnionitis, or major malformations were recorded. Only 2 women experienced relapses, one during pregnancy and the other postpartum.

Study details: The data come from a study of 55 women with MS (74 pregnancies) treated with at least 1 dose of rituximab infusion before conception.

Disclosures: This study was supported in part by the Patient-Centered Outcomes Research Institute.

Some of the investigators reported receiving research grants from multiple pharmaceutical companies.

Citation: Smith JB et al. Neurol Neuroimmunol Neuroinflamm. 2020 May 01. doi: 10.1212/NXI.0000000000000734.

Key clinical point: Periconceptional rituximab is a highly effective and safe treatment for women with suboptimally controlled multiple sclerosis (MS).

Major finding: Among 38 live births, 3 deliveries were preterm (including 1 set of twins), 1 baby was admitted for perinatal ischemic stroke, and 1 twin died after 6 days from an intraventricular hemorrhage. Fifteen women reported at least one first-trimester miscarriage, of whom 8 had a history of infertility. No stillbirths, chorioamnionitis, or major malformations were recorded. Only 2 women experienced relapses, one during pregnancy and the other postpartum.

Study details: The data come from a study of 55 women with MS (74 pregnancies) treated with at least 1 dose of rituximab infusion before conception.

Disclosures: This study was supported in part by the Patient-Centered Outcomes Research Institute.

Some of the investigators reported receiving research grants from multiple pharmaceutical companies.

Citation: Smith JB et al. Neurol Neuroimmunol Neuroinflamm. 2020 May 01. doi: 10.1212/NXI.0000000000000734.

Key clinical point: Periconceptional rituximab is a highly effective and safe treatment for women with suboptimally controlled multiple sclerosis (MS).

Major finding: Among 38 live births, 3 deliveries were preterm (including 1 set of twins), 1 baby was admitted for perinatal ischemic stroke, and 1 twin died after 6 days from an intraventricular hemorrhage. Fifteen women reported at least one first-trimester miscarriage, of whom 8 had a history of infertility. No stillbirths, chorioamnionitis, or major malformations were recorded. Only 2 women experienced relapses, one during pregnancy and the other postpartum.

Study details: The data come from a study of 55 women with MS (74 pregnancies) treated with at least 1 dose of rituximab infusion before conception.

Disclosures: This study was supported in part by the Patient-Centered Outcomes Research Institute.

Some of the investigators reported receiving research grants from multiple pharmaceutical companies.

Citation: Smith JB et al. Neurol Neuroimmunol Neuroinflamm. 2020 May 01. doi: 10.1212/NXI.0000000000000734.

Key clinical point: Patients with multiple sclerosis (MS) are at an increased risk of cardiovascular and cerebrovascular diseases that traditional risk factors do not fully explain.

Major finding: Compared with people without MS, patients with MS had increased risks for coronary syndrome (hazard ratio [HR], 1.28), cerebrovascular disease (HR, 1.59), any macrovascular disease (HR, 1.32), all-cause mortality (HR, 3.46), and cardiovascular disease mortality (HR, 1.47).

Study details: This population-based, retrospective matched cohort study conducted in England included 12,251 patients with MS and 72,572 people without MS.

Disclosures: The presenting author had no disclosures. Two coauthors received research funding/support from various organizations.

Citation: Palladino R et al. JAMA Neurol. 2020 May 04. doi: 10.1001/jamaneurol.2020.0664. 

Key clinical point: Patients with multiple sclerosis (MS) are at an increased risk of cardiovascular and cerebrovascular diseases that traditional risk factors do not fully explain.

Major finding: Compared with people without MS, patients with MS had increased risks for coronary syndrome (hazard ratio [HR], 1.28), cerebrovascular disease (HR, 1.59), any macrovascular disease (HR, 1.32), all-cause mortality (HR, 3.46), and cardiovascular disease mortality (HR, 1.47).

Study details: This population-based, retrospective matched cohort study conducted in England included 12,251 patients with MS and 72,572 people without MS.

Disclosures: The presenting author had no disclosures. Two coauthors received research funding/support from various organizations.

Citation: Palladino R et al. JAMA Neurol. 2020 May 04. doi: 10.1001/jamaneurol.2020.0664. 

Key clinical point: Patients with multiple sclerosis (MS) are at an increased risk of cardiovascular and cerebrovascular diseases that traditional risk factors do not fully explain.

Major finding: Compared with people without MS, patients with MS had increased risks for coronary syndrome (hazard ratio [HR], 1.28), cerebrovascular disease (HR, 1.59), any macrovascular disease (HR, 1.32), all-cause mortality (HR, 3.46), and cardiovascular disease mortality (HR, 1.47).

Study details: This population-based, retrospective matched cohort study conducted in England included 12,251 patients with MS and 72,572 people without MS.

Disclosures: The presenting author had no disclosures. Two coauthors received research funding/support from various organizations.

Citation: Palladino R et al. JAMA Neurol. 2020 May 04. doi: 10.1001/jamaneurol.2020.0664. 

Key clinical point: Relapse rates are comparable for patients with relapsing-remitting multiple sclerosis (RRMS) treated with fingolimod, dimethyl fumarate, or teriflunomide.

Major finding: After 2 years of treatment initiation, the estimated mean annualized relapse rates were 0.13 (95% confidence interval, 0.04-0.43) for fingolimod, 0.09 (95% confidence interval, 0.03-0.26) for dimethyl fumarate, and 0.11 (95% confidence interval, 0.04-0.35) for teriflunomide.

Study details: The study used inverse probability weighing to compare the efficacy of fingolimod (n=295), dimethyl fumarate (n=227), and teriflunomide (n=107) treatment for at least 24 months in patients with RRMS identified from the Austrian MS Treatment Registry.

Disclosures: The study was funded by Kepler Universitätsklinikum Linz. S Kalcher and E Kvas declared no conflicts of interest. Other authors reported ties with one or more pharmaceutical companies.

Citation: Guger M et al. J Neurol. 2020 Apr 3. doi: 10.1007/s00415-020-09811-6.

Key clinical point: Relapse rates are comparable for patients with relapsing-remitting multiple sclerosis (RRMS) treated with fingolimod, dimethyl fumarate, or teriflunomide.

Major finding: After 2 years of treatment initiation, the estimated mean annualized relapse rates were 0.13 (95% confidence interval, 0.04-0.43) for fingolimod, 0.09 (95% confidence interval, 0.03-0.26) for dimethyl fumarate, and 0.11 (95% confidence interval, 0.04-0.35) for teriflunomide.

Study details: The study used inverse probability weighing to compare the efficacy of fingolimod (n=295), dimethyl fumarate (n=227), and teriflunomide (n=107) treatment for at least 24 months in patients with RRMS identified from the Austrian MS Treatment Registry.

Disclosures: The study was funded by Kepler Universitätsklinikum Linz. S Kalcher and E Kvas declared no conflicts of interest. Other authors reported ties with one or more pharmaceutical companies.

Citation: Guger M et al. J Neurol. 2020 Apr 3. doi: 10.1007/s00415-020-09811-6.

Key clinical point: Relapse rates are comparable for patients with relapsing-remitting multiple sclerosis (RRMS) treated with fingolimod, dimethyl fumarate, or teriflunomide.

Major finding: After 2 years of treatment initiation, the estimated mean annualized relapse rates were 0.13 (95% confidence interval, 0.04-0.43) for fingolimod, 0.09 (95% confidence interval, 0.03-0.26) for dimethyl fumarate, and 0.11 (95% confidence interval, 0.04-0.35) for teriflunomide.

Study details: The study used inverse probability weighing to compare the efficacy of fingolimod (n=295), dimethyl fumarate (n=227), and teriflunomide (n=107) treatment for at least 24 months in patients with RRMS identified from the Austrian MS Treatment Registry.

Disclosures: The study was funded by Kepler Universitätsklinikum Linz. S Kalcher and E Kvas declared no conflicts of interest. Other authors reported ties with one or more pharmaceutical companies.

Citation: Guger M et al. J Neurol. 2020 Apr 3. doi: 10.1007/s00415-020-09811-6.