Behavior problems, anxiety, and depression in youths were associated with these individuals participating in remote schooling during broader social lockdowns in a new study.

The systematic review, which was published in JAMA Pediatrics on Jan. 18, 2022, was based on data from 36 studies from 11 countries on mental health, physical health, and well-being in children and adolescents aged 0-18 years. The total population included 79,781 children and 18,028 parents or caregivers. The studies reflected the first wave of pandemic school closures and lockdowns from February to July 2020, with the duration of school closure ranging from 1 week to 3 months.

“There are strong theoretical reasons to suggest that school closures may have contributed to a considerable proportion of the harms identified here, particularly mental health harms, through reduction in social contacts with peers and teachers,” Russell Viner, PhD, of UCL Great Ormond St Institute of Child Health, London, and colleagues wrote in their paper.

The researchers included 9 longitudinal pre-post studies, 5 cohort studies, 21 cross-sectional studies, and 1 modeling study in their analysis. Overall, approximately one-third of the studies (36%) were considered high quality, and approximately two-thirds (64%) of the studies were published in journals. Twenty-five of the reports analyzed focused on mental health and well-being.

Schools provide not only education, but also services including meals, health care, and health supplies. Schools also serve as a safety net and source of social support for children, the researchers noted.

The losses children may have experienced during school closures occurred during a time when more than 167,000 children younger than 18 years lost a parent or caregiver to COVID-19, according to a recent report titled “Hidden Pain” by researchers at the University of Pennsylvania, Nemours Children’s Health, and the COVID Collaborative. Although not addressed in the current study, school closures would prevent bereaved children from receiving social-emotional support from friends and teachers. This crisis of loss also prompted the American Academy of Pediatrics to issue a National State of Emergency in Children’s Mental Health in October 2021.
 

New study results

These studies identified associations between school closures during broader lockdowns and increased emotional and behavioral problems, as well as increased restlessness and inattention. Across these studies, 18%-60% of children and adolescents scored higher than the risk thresholds for diagnoses of distress, especially depressive symptoms and anxiety.

Although two studies showed no significant association with suicide in response to school closures during lockdowns, three studies suggested increased use of screen time, two studies reported increased social media use, and six studies reported lower levels of physical activity.

Three studies of child abuse showed decreases in notifications during lockdowns, likely driven by lack of referrals from schools, the authors noted. A total of 10 studies on sleep and 5 studies on diet showed inconsistent evidence of harm during the specific period of school closures and social lockdowns.

“The contrast of rises in distress with decreases in presentations suggests that there was an escalation of unmet mental health need during lockdowns in already vulnerable children and adolescents,” the researchers wrote. “More troubling still is evidence of a reduction in the ability of the health and social care systems to protect children in many countries, as shown by the large falls in child protection referrals seen in high-quality cohort studies.”
 

‘Study presents concrete assessments rather than speculation’

“Concerns have been widely expressed in the lay media and beyond that school closures could negatively impact the mental and physical health of children and adolescents,” M. Susan Jay, MD, of the Medical College of Wisconsin, Milwaukee, said in an interview. “The authors presented a narrative synthesis summarizing available evidence for the first wave of COVID-19 on school closures during the broader social lockdown occurring during this period.”

The “importance” of this research is that “it is not a single convenience sample study, but a systematic review from 11 countries including the United States, United Kingdom, China, and Turkey, among others, and that the quality of the information was graded,” Dr. Jay said. “Although not a meta-analysis, the study presents concrete assessments rather than speculation and overviews its limitations so that the clinician can weigh this information. Importantly, the authors excluded closure of schools with transmission of infection.

“Clearly, school lockdowns as a measure of controlling infectious disease needs balance with potential of negative health behaviors in children and adolescents. Ongoing prospective longitudinal studies are needed as sequential waves of the pandemic continue,” she emphasized.

“Clinically, this study highlights the need for clinicians to consider [asking] about the impact of school closures and remote versus hybrid versus in-person education [as part of their] patients and families question inventory,” Dr. Jay said. “Also, the use of depression inventories can be offered to youth to assess their mental health state at a visit, either via telemedicine or in person, and ideally at sequential visits for a more in-depth assessment.”
 

Schools play key role in social and emotional development

“It was important to conduct this study now, because this current time is unprecedented,” Peter L. Loper Jr., MD, of the University of South Carolina, Columbia, said in an interview. “We know based on evolutionary biology, anthropology, and developmental psychology, among other disciplines, that meaningful interpersonal interactions embedded in the context of community are vital to supporting human well-being.

“In our current time, the primary framework of community for our children is the school setting; it is the predominant space where they engage in the interpersonal interactions necessary for developing resilience, their sense of purpose, belonging, and fidelity,” he emphasized.

“Rarely in the course of human existence have kids been removed from the broader context of community to this extent and for this duration,” Dr. Loper said. “This study capitalizes on this unprecedented moment to begin to further understand how compromises in our sociocultural infrastructure of community, like school closures and lockdowns, may manifest as mental health problems in children and adolescents. More importantly, it contributes to the exploration of potential unintended consequences of our current infection control measures so we can adapt to support the overall well-being of our children in this ‘new normal.’ ”

Dr. Loper added that he was not surprised by the new study’s findings.

“We were already seeing a decline in pediatric mental health and overall well-being in the years preceding COVID-19 because of the ‘isolation epidemic’ involving many of the factors that this study explored,” he said. “I think this review further illustrates the vital necessity of community to support the health and well-being of humans, and specifically children and adolescents.”

From a clinical standpoint, “we need to be intentional and consistent in balancing infection control measures with our kids’ fundamental psychosocial needs,” Dr. Loper said.

“We need to recognize that, when children and adolescents are isolated from community, their fundamental psychosocial needs go unmet,” he emphasized. “If children and adolescents cannot access the meaningful interpersonal interactions necessary for resilience, then they cannot overcome or navigate distress. They will exhibit the avoidance and withdrawal behaviors that accumulate to manifest as adverse mental health symptoms like anxiety and depression.

“Additional research is needed to further explore how compromises in the psychosocial infrastructure of community manifest as downstream symptom indicators such as anxiety and depression,” which are often manifestations of unmet needs, Dr. Loper said.
 

Limitations and strengths, according to authors

The findings were limited by several factors, including a lack of examination of school closures’ effects on mental health independent of broader social lockdowns, according to the researchers. Other limitations included the authors potentially having missed studies, inclusion of cross-sectional studies with relatively weak evidence, potential bias from studies using parent reports, and a focus on the first COVID-19 wave, during which many school closures were of limited duration. Also, the researchers said they did not include studies focused on particular groups, such as children with learning difficulties or autism.

The use of large databases from education as well as health care in studies analyzed were strengths of the new research, they said. The investigators received no outside funding for their study. The researchers, Dr. Jay, and Dr. Loper had no financial conflicts to disclose. Dr. Jay serves on the editorial advisory board of Pediatric News.

Behavior problems, anxiety, and depression in youths were associated with these individuals participating in remote schooling during broader social lockdowns in a new study.

The systematic review, which was published in JAMA Pediatrics on Jan. 18, 2022, was based on data from 36 studies from 11 countries on mental health, physical health, and well-being in children and adolescents aged 0-18 years. The total population included 79,781 children and 18,028 parents or caregivers. The studies reflected the first wave of pandemic school closures and lockdowns from February to July 2020, with the duration of school closure ranging from 1 week to 3 months.

“There are strong theoretical reasons to suggest that school closures may have contributed to a considerable proportion of the harms identified here, particularly mental health harms, through reduction in social contacts with peers and teachers,” Russell Viner, PhD, of UCL Great Ormond St Institute of Child Health, London, and colleagues wrote in their paper.

The researchers included 9 longitudinal pre-post studies, 5 cohort studies, 21 cross-sectional studies, and 1 modeling study in their analysis. Overall, approximately one-third of the studies (36%) were considered high quality, and approximately two-thirds (64%) of the studies were published in journals. Twenty-five of the reports analyzed focused on mental health and well-being.

Schools provide not only education, but also services including meals, health care, and health supplies. Schools also serve as a safety net and source of social support for children, the researchers noted.

The losses children may have experienced during school closures occurred during a time when more than 167,000 children younger than 18 years lost a parent or caregiver to COVID-19, according to a recent report titled “Hidden Pain” by researchers at the University of Pennsylvania, Nemours Children’s Health, and the COVID Collaborative. Although not addressed in the current study, school closures would prevent bereaved children from receiving social-emotional support from friends and teachers. This crisis of loss also prompted the American Academy of Pediatrics to issue a National State of Emergency in Children’s Mental Health in October 2021.
 

New study results

These studies identified associations between school closures during broader lockdowns and increased emotional and behavioral problems, as well as increased restlessness and inattention. Across these studies, 18%-60% of children and adolescents scored higher than the risk thresholds for diagnoses of distress, especially depressive symptoms and anxiety.

Although two studies showed no significant association with suicide in response to school closures during lockdowns, three studies suggested increased use of screen time, two studies reported increased social media use, and six studies reported lower levels of physical activity.

Three studies of child abuse showed decreases in notifications during lockdowns, likely driven by lack of referrals from schools, the authors noted. A total of 10 studies on sleep and 5 studies on diet showed inconsistent evidence of harm during the specific period of school closures and social lockdowns.

“The contrast of rises in distress with decreases in presentations suggests that there was an escalation of unmet mental health need during lockdowns in already vulnerable children and adolescents,” the researchers wrote. “More troubling still is evidence of a reduction in the ability of the health and social care systems to protect children in many countries, as shown by the large falls in child protection referrals seen in high-quality cohort studies.”
 

‘Study presents concrete assessments rather than speculation’

“Concerns have been widely expressed in the lay media and beyond that school closures could negatively impact the mental and physical health of children and adolescents,” M. Susan Jay, MD, of the Medical College of Wisconsin, Milwaukee, said in an interview. “The authors presented a narrative synthesis summarizing available evidence for the first wave of COVID-19 on school closures during the broader social lockdown occurring during this period.”

The “importance” of this research is that “it is not a single convenience sample study, but a systematic review from 11 countries including the United States, United Kingdom, China, and Turkey, among others, and that the quality of the information was graded,” Dr. Jay said. “Although not a meta-analysis, the study presents concrete assessments rather than speculation and overviews its limitations so that the clinician can weigh this information. Importantly, the authors excluded closure of schools with transmission of infection.

“Clearly, school lockdowns as a measure of controlling infectious disease needs balance with potential of negative health behaviors in children and adolescents. Ongoing prospective longitudinal studies are needed as sequential waves of the pandemic continue,” she emphasized.

“Clinically, this study highlights the need for clinicians to consider [asking] about the impact of school closures and remote versus hybrid versus in-person education [as part of their] patients and families question inventory,” Dr. Jay said. “Also, the use of depression inventories can be offered to youth to assess their mental health state at a visit, either via telemedicine or in person, and ideally at sequential visits for a more in-depth assessment.”
 

Schools play key role in social and emotional development

“It was important to conduct this study now, because this current time is unprecedented,” Peter L. Loper Jr., MD, of the University of South Carolina, Columbia, said in an interview. “We know based on evolutionary biology, anthropology, and developmental psychology, among other disciplines, that meaningful interpersonal interactions embedded in the context of community are vital to supporting human well-being.

“In our current time, the primary framework of community for our children is the school setting; it is the predominant space where they engage in the interpersonal interactions necessary for developing resilience, their sense of purpose, belonging, and fidelity,” he emphasized.

“Rarely in the course of human existence have kids been removed from the broader context of community to this extent and for this duration,” Dr. Loper said. “This study capitalizes on this unprecedented moment to begin to further understand how compromises in our sociocultural infrastructure of community, like school closures and lockdowns, may manifest as mental health problems in children and adolescents. More importantly, it contributes to the exploration of potential unintended consequences of our current infection control measures so we can adapt to support the overall well-being of our children in this ‘new normal.’ ”

Dr. Loper added that he was not surprised by the new study’s findings.

“We were already seeing a decline in pediatric mental health and overall well-being in the years preceding COVID-19 because of the ‘isolation epidemic’ involving many of the factors that this study explored,” he said. “I think this review further illustrates the vital necessity of community to support the health and well-being of humans, and specifically children and adolescents.”

From a clinical standpoint, “we need to be intentional and consistent in balancing infection control measures with our kids’ fundamental psychosocial needs,” Dr. Loper said.

“We need to recognize that, when children and adolescents are isolated from community, their fundamental psychosocial needs go unmet,” he emphasized. “If children and adolescents cannot access the meaningful interpersonal interactions necessary for resilience, then they cannot overcome or navigate distress. They will exhibit the avoidance and withdrawal behaviors that accumulate to manifest as adverse mental health symptoms like anxiety and depression.

“Additional research is needed to further explore how compromises in the psychosocial infrastructure of community manifest as downstream symptom indicators such as anxiety and depression,” which are often manifestations of unmet needs, Dr. Loper said.
 

Limitations and strengths, according to authors

The findings were limited by several factors, including a lack of examination of school closures’ effects on mental health independent of broader social lockdowns, according to the researchers. Other limitations included the authors potentially having missed studies, inclusion of cross-sectional studies with relatively weak evidence, potential bias from studies using parent reports, and a focus on the first COVID-19 wave, during which many school closures were of limited duration. Also, the researchers said they did not include studies focused on particular groups, such as children with learning difficulties or autism.

The use of large databases from education as well as health care in studies analyzed were strengths of the new research, they said. The investigators received no outside funding for their study. The researchers, Dr. Jay, and Dr. Loper had no financial conflicts to disclose. Dr. Jay serves on the editorial advisory board of Pediatric News.

Behavior problems, anxiety, and depression in youths were associated with these individuals participating in remote schooling during broader social lockdowns in a new study.

The systematic review, which was published in JAMA Pediatrics on Jan. 18, 2022, was based on data from 36 studies from 11 countries on mental health, physical health, and well-being in children and adolescents aged 0-18 years. The total population included 79,781 children and 18,028 parents or caregivers. The studies reflected the first wave of pandemic school closures and lockdowns from February to July 2020, with the duration of school closure ranging from 1 week to 3 months.

“There are strong theoretical reasons to suggest that school closures may have contributed to a considerable proportion of the harms identified here, particularly mental health harms, through reduction in social contacts with peers and teachers,” Russell Viner, PhD, of UCL Great Ormond St Institute of Child Health, London, and colleagues wrote in their paper.

The researchers included 9 longitudinal pre-post studies, 5 cohort studies, 21 cross-sectional studies, and 1 modeling study in their analysis. Overall, approximately one-third of the studies (36%) were considered high quality, and approximately two-thirds (64%) of the studies were published in journals. Twenty-five of the reports analyzed focused on mental health and well-being.

Schools provide not only education, but also services including meals, health care, and health supplies. Schools also serve as a safety net and source of social support for children, the researchers noted.

The losses children may have experienced during school closures occurred during a time when more than 167,000 children younger than 18 years lost a parent or caregiver to COVID-19, according to a recent report titled “Hidden Pain” by researchers at the University of Pennsylvania, Nemours Children’s Health, and the COVID Collaborative. Although not addressed in the current study, school closures would prevent bereaved children from receiving social-emotional support from friends and teachers. This crisis of loss also prompted the American Academy of Pediatrics to issue a National State of Emergency in Children’s Mental Health in October 2021.
 

New study results

These studies identified associations between school closures during broader lockdowns and increased emotional and behavioral problems, as well as increased restlessness and inattention. Across these studies, 18%-60% of children and adolescents scored higher than the risk thresholds for diagnoses of distress, especially depressive symptoms and anxiety.

Although two studies showed no significant association with suicide in response to school closures during lockdowns, three studies suggested increased use of screen time, two studies reported increased social media use, and six studies reported lower levels of physical activity.

Three studies of child abuse showed decreases in notifications during lockdowns, likely driven by lack of referrals from schools, the authors noted. A total of 10 studies on sleep and 5 studies on diet showed inconsistent evidence of harm during the specific period of school closures and social lockdowns.

“The contrast of rises in distress with decreases in presentations suggests that there was an escalation of unmet mental health need during lockdowns in already vulnerable children and adolescents,” the researchers wrote. “More troubling still is evidence of a reduction in the ability of the health and social care systems to protect children in many countries, as shown by the large falls in child protection referrals seen in high-quality cohort studies.”
 

‘Study presents concrete assessments rather than speculation’

“Concerns have been widely expressed in the lay media and beyond that school closures could negatively impact the mental and physical health of children and adolescents,” M. Susan Jay, MD, of the Medical College of Wisconsin, Milwaukee, said in an interview. “The authors presented a narrative synthesis summarizing available evidence for the first wave of COVID-19 on school closures during the broader social lockdown occurring during this period.”

The “importance” of this research is that “it is not a single convenience sample study, but a systematic review from 11 countries including the United States, United Kingdom, China, and Turkey, among others, and that the quality of the information was graded,” Dr. Jay said. “Although not a meta-analysis, the study presents concrete assessments rather than speculation and overviews its limitations so that the clinician can weigh this information. Importantly, the authors excluded closure of schools with transmission of infection.

“Clearly, school lockdowns as a measure of controlling infectious disease needs balance with potential of negative health behaviors in children and adolescents. Ongoing prospective longitudinal studies are needed as sequential waves of the pandemic continue,” she emphasized.

“Clinically, this study highlights the need for clinicians to consider [asking] about the impact of school closures and remote versus hybrid versus in-person education [as part of their] patients and families question inventory,” Dr. Jay said. “Also, the use of depression inventories can be offered to youth to assess their mental health state at a visit, either via telemedicine or in person, and ideally at sequential visits for a more in-depth assessment.”
 

Schools play key role in social and emotional development

“It was important to conduct this study now, because this current time is unprecedented,” Peter L. Loper Jr., MD, of the University of South Carolina, Columbia, said in an interview. “We know based on evolutionary biology, anthropology, and developmental psychology, among other disciplines, that meaningful interpersonal interactions embedded in the context of community are vital to supporting human well-being.

“In our current time, the primary framework of community for our children is the school setting; it is the predominant space where they engage in the interpersonal interactions necessary for developing resilience, their sense of purpose, belonging, and fidelity,” he emphasized.

“Rarely in the course of human existence have kids been removed from the broader context of community to this extent and for this duration,” Dr. Loper said. “This study capitalizes on this unprecedented moment to begin to further understand how compromises in our sociocultural infrastructure of community, like school closures and lockdowns, may manifest as mental health problems in children and adolescents. More importantly, it contributes to the exploration of potential unintended consequences of our current infection control measures so we can adapt to support the overall well-being of our children in this ‘new normal.’ ”

Dr. Loper added that he was not surprised by the new study’s findings.

“We were already seeing a decline in pediatric mental health and overall well-being in the years preceding COVID-19 because of the ‘isolation epidemic’ involving many of the factors that this study explored,” he said. “I think this review further illustrates the vital necessity of community to support the health and well-being of humans, and specifically children and adolescents.”

From a clinical standpoint, “we need to be intentional and consistent in balancing infection control measures with our kids’ fundamental psychosocial needs,” Dr. Loper said.

“We need to recognize that, when children and adolescents are isolated from community, their fundamental psychosocial needs go unmet,” he emphasized. “If children and adolescents cannot access the meaningful interpersonal interactions necessary for resilience, then they cannot overcome or navigate distress. They will exhibit the avoidance and withdrawal behaviors that accumulate to manifest as adverse mental health symptoms like anxiety and depression.

“Additional research is needed to further explore how compromises in the psychosocial infrastructure of community manifest as downstream symptom indicators such as anxiety and depression,” which are often manifestations of unmet needs, Dr. Loper said.
 

Limitations and strengths, according to authors

The findings were limited by several factors, including a lack of examination of school closures’ effects on mental health independent of broader social lockdowns, according to the researchers. Other limitations included the authors potentially having missed studies, inclusion of cross-sectional studies with relatively weak evidence, potential bias from studies using parent reports, and a focus on the first COVID-19 wave, during which many school closures were of limited duration. Also, the researchers said they did not include studies focused on particular groups, such as children with learning difficulties or autism.

The use of large databases from education as well as health care in studies analyzed were strengths of the new research, they said. The investigators received no outside funding for their study. The researchers, Dr. Jay, and Dr. Loper had no financial conflicts to disclose. Dr. Jay serves on the editorial advisory board of Pediatric News.

Key clinical point: Compared with the general population, patients with multiple sclerosis (MS) may be at a slightly higher risk of developing myocardial infarction (MI) but not stroke.

Major finding: An increased risk for MI was found to be causally associated with MS (odds ratio [OR], 1.03; P = .0243). MS and stroke showed no significant causal association (OR, 1.01; P = .2974).

Study details: This was a 2-sample Mendelian randomization analysis of genetic summary data for MS (14,498 patients and 24,091 healthy controls), MI (43,676 patients and 128,199 healthy controls), and stroke (40,585 patients and 446,696 healthy controls) from large-scale genome-wide association studies.

Disclosures: The study was supported by Cultivation of Guangdong College Students' Scientific and Technological Innovation. The authors declared no conflict of interests.

Source: Peng H et al. Mult Scler Relat Disord. 2022 Jan 6. doi: 10.1016/j.msard.2022.103501.

Key clinical point: Compared with the general population, patients with multiple sclerosis (MS) may be at a slightly higher risk of developing myocardial infarction (MI) but not stroke.

Major finding: An increased risk for MI was found to be causally associated with MS (odds ratio [OR], 1.03; P = .0243). MS and stroke showed no significant causal association (OR, 1.01; P = .2974).

Study details: This was a 2-sample Mendelian randomization analysis of genetic summary data for MS (14,498 patients and 24,091 healthy controls), MI (43,676 patients and 128,199 healthy controls), and stroke (40,585 patients and 446,696 healthy controls) from large-scale genome-wide association studies.

Disclosures: The study was supported by Cultivation of Guangdong College Students' Scientific and Technological Innovation. The authors declared no conflict of interests.

Source: Peng H et al. Mult Scler Relat Disord. 2022 Jan 6. doi: 10.1016/j.msard.2022.103501.

Key clinical point: Compared with the general population, patients with multiple sclerosis (MS) may be at a slightly higher risk of developing myocardial infarction (MI) but not stroke.

Major finding: An increased risk for MI was found to be causally associated with MS (odds ratio [OR], 1.03; P = .0243). MS and stroke showed no significant causal association (OR, 1.01; P = .2974).

Study details: This was a 2-sample Mendelian randomization analysis of genetic summary data for MS (14,498 patients and 24,091 healthy controls), MI (43,676 patients and 128,199 healthy controls), and stroke (40,585 patients and 446,696 healthy controls) from large-scale genome-wide association studies.

Disclosures: The study was supported by Cultivation of Guangdong College Students' Scientific and Technological Innovation. The authors declared no conflict of interests.

Source: Peng H et al. Mult Scler Relat Disord. 2022 Jan 6. doi: 10.1016/j.msard.2022.103501.

Key clinical point: Women presenting with multiple sclerosis (MS) are more likely to develop trigeminal neuralgia (TN) relative to men with MS.

Major finding: The estimated pooled TN prevalence in the overall population was 3.4%, with the prevalence being greater among women with MS (3.8%; 95% CI, 0.8%-8.7%) than among men with MS (2.4%; 95% CI, 0.5%-5.4%).

Study details: Findings are from a meta-analysis of 19 studies involving 30,348 patients with MS.

Disclosures: This study reported no funding source or conflict of interests.

Source: Houshi S et al. Mult Scler Relat Disord. 2021 Dec 28. doi: 10.1016/j.msard.2021.103472.

Key clinical point: Women presenting with multiple sclerosis (MS) are more likely to develop trigeminal neuralgia (TN) relative to men with MS.

Major finding: The estimated pooled TN prevalence in the overall population was 3.4%, with the prevalence being greater among women with MS (3.8%; 95% CI, 0.8%-8.7%) than among men with MS (2.4%; 95% CI, 0.5%-5.4%).

Study details: Findings are from a meta-analysis of 19 studies involving 30,348 patients with MS.

Disclosures: This study reported no funding source or conflict of interests.

Source: Houshi S et al. Mult Scler Relat Disord. 2021 Dec 28. doi: 10.1016/j.msard.2021.103472.

Key clinical point: Women presenting with multiple sclerosis (MS) are more likely to develop trigeminal neuralgia (TN) relative to men with MS.

Major finding: The estimated pooled TN prevalence in the overall population was 3.4%, with the prevalence being greater among women with MS (3.8%; 95% CI, 0.8%-8.7%) than among men with MS (2.4%; 95% CI, 0.5%-5.4%).

Study details: Findings are from a meta-analysis of 19 studies involving 30,348 patients with MS.

Disclosures: This study reported no funding source or conflict of interests.

Source: Houshi S et al. Mult Scler Relat Disord. 2021 Dec 28. doi: 10.1016/j.msard.2021.103472.

Key clinical point: Ocrelizumab may be preferred over fingolimod as an exit strategy after natalizumab discontinuation in patients with relapsing-remitting multiple sclerosis (RRMS).

Major finding: At 1 year, fewer relapses were observed in patients receiving ocrelizumab vs fingolimod (0.12±0.39 vs 0.41±0.71; P = .035), realizing a 70.7% lower annualized relapse rate. The cumulative probability of relapse was significantly higher with fingolimod vs ocrelizumab (31.5% vs 10.4%; adjusted hazard ratio, 3.4; P = .04).

Study details: The data come from an observational, retrospective study involving 102 patients with RRMS who received either fingolimod (n=54) or ocrelizumab (n=48) after natalizumab cessation.

Disclosures: No source of funding was disclosed. Some of the authors including the lead author reported receiving consultancy fees and travel grants from various pharmaceutical companies.

Source: Bigaut K et al. J Neurol. 2022 Jan 4. doi: 10.1007/s00415-021-10950-7.

Key clinical point: Ocrelizumab may be preferred over fingolimod as an exit strategy after natalizumab discontinuation in patients with relapsing-remitting multiple sclerosis (RRMS).

Major finding: At 1 year, fewer relapses were observed in patients receiving ocrelizumab vs fingolimod (0.12±0.39 vs 0.41±0.71; P = .035), realizing a 70.7% lower annualized relapse rate. The cumulative probability of relapse was significantly higher with fingolimod vs ocrelizumab (31.5% vs 10.4%; adjusted hazard ratio, 3.4; P = .04).

Study details: The data come from an observational, retrospective study involving 102 patients with RRMS who received either fingolimod (n=54) or ocrelizumab (n=48) after natalizumab cessation.

Disclosures: No source of funding was disclosed. Some of the authors including the lead author reported receiving consultancy fees and travel grants from various pharmaceutical companies.

Source: Bigaut K et al. J Neurol. 2022 Jan 4. doi: 10.1007/s00415-021-10950-7.

Key clinical point: Ocrelizumab may be preferred over fingolimod as an exit strategy after natalizumab discontinuation in patients with relapsing-remitting multiple sclerosis (RRMS).

Major finding: At 1 year, fewer relapses were observed in patients receiving ocrelizumab vs fingolimod (0.12±0.39 vs 0.41±0.71; P = .035), realizing a 70.7% lower annualized relapse rate. The cumulative probability of relapse was significantly higher with fingolimod vs ocrelizumab (31.5% vs 10.4%; adjusted hazard ratio, 3.4; P = .04).

Study details: The data come from an observational, retrospective study involving 102 patients with RRMS who received either fingolimod (n=54) or ocrelizumab (n=48) after natalizumab cessation.

Disclosures: No source of funding was disclosed. Some of the authors including the lead author reported receiving consultancy fees and travel grants from various pharmaceutical companies.

Source: Bigaut K et al. J Neurol. 2022 Jan 4. doi: 10.1007/s00415-021-10950-7.

Key clinical point: Cognitive dysfunction in patients with multiple sclerosis (MS) is predictive of a higher risk for conversion from relapse-remitting MS to secondary progressive MS and a higher risk for death.

Major finding: Cognitive dysfunction was linked to a greater risk of converting from relapse-remitting course to progressive disease course (adjusted odds ratio, 2.29; P = .043) and shorter survival (adjusted hazard ratio, 3.07; P = .006).

Study details: This was a retrospective analysis of 408 patients with MS.

Disclosures: No external funding was received for this study. The authors reported no conflict of interests.

Source: Cavaco S et al. Mult Scler. 2021 Dec 30. doi: 10.1177/13524585211066598.

Key clinical point: Cognitive dysfunction in patients with multiple sclerosis (MS) is predictive of a higher risk for conversion from relapse-remitting MS to secondary progressive MS and a higher risk for death.

Major finding: Cognitive dysfunction was linked to a greater risk of converting from relapse-remitting course to progressive disease course (adjusted odds ratio, 2.29; P = .043) and shorter survival (adjusted hazard ratio, 3.07; P = .006).

Study details: This was a retrospective analysis of 408 patients with MS.

Disclosures: No external funding was received for this study. The authors reported no conflict of interests.

Source: Cavaco S et al. Mult Scler. 2021 Dec 30. doi: 10.1177/13524585211066598.

Key clinical point: Cognitive dysfunction in patients with multiple sclerosis (MS) is predictive of a higher risk for conversion from relapse-remitting MS to secondary progressive MS and a higher risk for death.

Major finding: Cognitive dysfunction was linked to a greater risk of converting from relapse-remitting course to progressive disease course (adjusted odds ratio, 2.29; P = .043) and shorter survival (adjusted hazard ratio, 3.07; P = .006).

Study details: This was a retrospective analysis of 408 patients with MS.

Disclosures: No external funding was received for this study. The authors reported no conflict of interests.

Source: Cavaco S et al. Mult Scler. 2021 Dec 30. doi: 10.1177/13524585211066598.

Key clinical point: Spending more time outdoors in the summer and higher exposure to summer ultraviolet radiation (UVR) markedly reduces the risk of developing pediatric multiple sclerosis (MS).

Major finding: Compared with spending <30 minutes outdoors daily during the most recent summer, greater time spent outdoors was associated with a significantly decreased risk of developing MS (30-60 minutes: adjusted odds ratio [aOR], 0.48; P = .05; 1-2 hours: aOR, 0.19; P < .001). Additionally, the ambient UVR dose also showed a protective effect (aOR, 0.76; P = .01).

Study details: This was a multicenter case-control study involving children with MS (n=332) compared with age- and gender-matched controls (n=534).

Disclosures: This study was funded by the NIH and the National MS Society. Some of the authors declared receiving grants from National MS Society and NIH and/or financial support and consulting/personal fees from various other sources.

Source: Sebastian P et al. Neurology. 2021 Dec 8. doi: 10.1212/WNL.0000000000013045.

Key clinical point: Spending more time outdoors in the summer and higher exposure to summer ultraviolet radiation (UVR) markedly reduces the risk of developing pediatric multiple sclerosis (MS).

Major finding: Compared with spending <30 minutes outdoors daily during the most recent summer, greater time spent outdoors was associated with a significantly decreased risk of developing MS (30-60 minutes: adjusted odds ratio [aOR], 0.48; P = .05; 1-2 hours: aOR, 0.19; P < .001). Additionally, the ambient UVR dose also showed a protective effect (aOR, 0.76; P = .01).

Study details: This was a multicenter case-control study involving children with MS (n=332) compared with age- and gender-matched controls (n=534).

Disclosures: This study was funded by the NIH and the National MS Society. Some of the authors declared receiving grants from National MS Society and NIH and/or financial support and consulting/personal fees from various other sources.

Source: Sebastian P et al. Neurology. 2021 Dec 8. doi: 10.1212/WNL.0000000000013045.

Key clinical point: Spending more time outdoors in the summer and higher exposure to summer ultraviolet radiation (UVR) markedly reduces the risk of developing pediatric multiple sclerosis (MS).

Major finding: Compared with spending <30 minutes outdoors daily during the most recent summer, greater time spent outdoors was associated with a significantly decreased risk of developing MS (30-60 minutes: adjusted odds ratio [aOR], 0.48; P = .05; 1-2 hours: aOR, 0.19; P < .001). Additionally, the ambient UVR dose also showed a protective effect (aOR, 0.76; P = .01).

Study details: This was a multicenter case-control study involving children with MS (n=332) compared with age- and gender-matched controls (n=534).

Disclosures: This study was funded by the NIH and the National MS Society. Some of the authors declared receiving grants from National MS Society and NIH and/or financial support and consulting/personal fees from various other sources.

Source: Sebastian P et al. Neurology. 2021 Dec 8. doi: 10.1212/WNL.0000000000013045.

Key clinical point: Patients with multiple sclerosis (MS) are at an increased risk for cancer than the general population.

Major finding: Compared with the general population, patients with MS were at a significantly higher risk for cancer (hazard ratio [HR], 1.36; 95% CI, 1.29-1.43), particularly prostate cancer (HR, 2.08; 95% CI, 1.68-2.58), colorectal and anal cancer (HR, 1.35; 95% CI, 1.16-1.58), and trachea bronchus and lung cancer (HR, 2.36; 95% CI, 1.96-2.84).

Study details: This population-based matched-cohort study included 95,474 patients with MS matched with 95,474 individuals from the general population.

Disclosures: This study was sponsored by Merck Healthcare KGaA. Four authors including the lead author reported being employees of the Bordeaux PharmacoEpi, and the remaining authors reported being full-time employees of Merck Healthcare KGaA, Darmstadt, Germany. The lead author reported receiving speaker fees from Biogen.

Source: Bosco-Lévy P et al. Eur J Neurol. 2021 Dec 22. doi: 10.1111/ene.15226.

Key clinical point: Patients with multiple sclerosis (MS) are at an increased risk for cancer than the general population.

Major finding: Compared with the general population, patients with MS were at a significantly higher risk for cancer (hazard ratio [HR], 1.36; 95% CI, 1.29-1.43), particularly prostate cancer (HR, 2.08; 95% CI, 1.68-2.58), colorectal and anal cancer (HR, 1.35; 95% CI, 1.16-1.58), and trachea bronchus and lung cancer (HR, 2.36; 95% CI, 1.96-2.84).

Study details: This population-based matched-cohort study included 95,474 patients with MS matched with 95,474 individuals from the general population.

Disclosures: This study was sponsored by Merck Healthcare KGaA. Four authors including the lead author reported being employees of the Bordeaux PharmacoEpi, and the remaining authors reported being full-time employees of Merck Healthcare KGaA, Darmstadt, Germany. The lead author reported receiving speaker fees from Biogen.

Source: Bosco-Lévy P et al. Eur J Neurol. 2021 Dec 22. doi: 10.1111/ene.15226.

Key clinical point: Patients with multiple sclerosis (MS) are at an increased risk for cancer than the general population.

Major finding: Compared with the general population, patients with MS were at a significantly higher risk for cancer (hazard ratio [HR], 1.36; 95% CI, 1.29-1.43), particularly prostate cancer (HR, 2.08; 95% CI, 1.68-2.58), colorectal and anal cancer (HR, 1.35; 95% CI, 1.16-1.58), and trachea bronchus and lung cancer (HR, 2.36; 95% CI, 1.96-2.84).

Study details: This population-based matched-cohort study included 95,474 patients with MS matched with 95,474 individuals from the general population.

Disclosures: This study was sponsored by Merck Healthcare KGaA. Four authors including the lead author reported being employees of the Bordeaux PharmacoEpi, and the remaining authors reported being full-time employees of Merck Healthcare KGaA, Darmstadt, Germany. The lead author reported receiving speaker fees from Biogen.

Source: Bosco-Lévy P et al. Eur J Neurol. 2021 Dec 22. doi: 10.1111/ene.15226.

Key clinical point: Cognitive impairments may be evaluated up to 30 days before and up to 550 days after a relapse, beyond which they revert to prerelapse levels in patients with relapsing-remitting multiple sclerosis (RRMS).

Major finding: From 30 days prerelapse to 550 days postrelapse, there was a significant drop in the Symbol Digit Modalities Test (SDMT) score, with the largest decline occurring at 0-30 days postrelapse (β-coefficient, −4.00; 95% CI, −4.61 to −3.39) compared with the period of remission.

Study details: This nationwide cohort study recorded 31,529 SDMTs from among 3,877 patients with incident RRMS, each having a minimum of 2 SDMT scores recorded.

Disclosures: This study was funded by a postdoctoral fellowship award to KA McKay from the Swedish Research Council for Health, Working Life, and Welfare (Forte). The authors reported no conflict of interests.

Source: McKay KA et al. Ann Neurol. 2022 Jan 4. doi: 10.1002/ana.26301.

Key clinical point: Cognitive impairments may be evaluated up to 30 days before and up to 550 days after a relapse, beyond which they revert to prerelapse levels in patients with relapsing-remitting multiple sclerosis (RRMS).

Major finding: From 30 days prerelapse to 550 days postrelapse, there was a significant drop in the Symbol Digit Modalities Test (SDMT) score, with the largest decline occurring at 0-30 days postrelapse (β-coefficient, −4.00; 95% CI, −4.61 to −3.39) compared with the period of remission.

Study details: This nationwide cohort study recorded 31,529 SDMTs from among 3,877 patients with incident RRMS, each having a minimum of 2 SDMT scores recorded.

Disclosures: This study was funded by a postdoctoral fellowship award to KA McKay from the Swedish Research Council for Health, Working Life, and Welfare (Forte). The authors reported no conflict of interests.

Source: McKay KA et al. Ann Neurol. 2022 Jan 4. doi: 10.1002/ana.26301.

Key clinical point: Cognitive impairments may be evaluated up to 30 days before and up to 550 days after a relapse, beyond which they revert to prerelapse levels in patients with relapsing-remitting multiple sclerosis (RRMS).

Major finding: From 30 days prerelapse to 550 days postrelapse, there was a significant drop in the Symbol Digit Modalities Test (SDMT) score, with the largest decline occurring at 0-30 days postrelapse (β-coefficient, −4.00; 95% CI, −4.61 to −3.39) compared with the period of remission.

Study details: This nationwide cohort study recorded 31,529 SDMTs from among 3,877 patients with incident RRMS, each having a minimum of 2 SDMT scores recorded.

Disclosures: This study was funded by a postdoctoral fellowship award to KA McKay from the Swedish Research Council for Health, Working Life, and Welfare (Forte). The authors reported no conflict of interests.

Source: McKay KA et al. Ann Neurol. 2022 Jan 4. doi: 10.1002/ana.26301.