Multiple Sclerosis

Key clinical point: Dalfampridine may be a treatment option for balance impairment associated with multiple sclerosis (MS).

Major finding: The dalfampridine treated group demonstrated better balance in both single- (quiet standing test) and dual-task (Stroop test) conditions than the placebo group; however, the benefits of dalfampridine were not retained beyond 4 weeks after discontinuation of treatment.

Study details: A substudy of a randomized, double-blind, placebo-controlled trial in which patients received dalfampridine 10 mg (27 patients) or placebo (14 patients) twice a day for 12 weeks.

Disclosures: The original trial was funded by Biogen. The corresponding author disclosed consultancy with Almirall, Biogen, Novartis, Genzyme, Roche, and Teva and research funding from Associazione Italiana Sclerosi Multipla and Genzyme.

Citation: Prosperini L, et al. Neurotherapeutics. 2019 Dec 9. doi: 10.1007/s13311-019-00813-5.

Key clinical point: Dalfampridine may be a treatment option for balance impairment associated with multiple sclerosis (MS).

Major finding: The dalfampridine treated group demonstrated better balance in both single- (quiet standing test) and dual-task (Stroop test) conditions than the placebo group; however, the benefits of dalfampridine were not retained beyond 4 weeks after discontinuation of treatment.

Study details: A substudy of a randomized, double-blind, placebo-controlled trial in which patients received dalfampridine 10 mg (27 patients) or placebo (14 patients) twice a day for 12 weeks.

Disclosures: The original trial was funded by Biogen. The corresponding author disclosed consultancy with Almirall, Biogen, Novartis, Genzyme, Roche, and Teva and research funding from Associazione Italiana Sclerosi Multipla and Genzyme.

Citation: Prosperini L, et al. Neurotherapeutics. 2019 Dec 9. doi: 10.1007/s13311-019-00813-5.

Key clinical point: Dalfampridine may be a treatment option for balance impairment associated with multiple sclerosis (MS).

Major finding: The dalfampridine treated group demonstrated better balance in both single- (quiet standing test) and dual-task (Stroop test) conditions than the placebo group; however, the benefits of dalfampridine were not retained beyond 4 weeks after discontinuation of treatment.

Study details: A substudy of a randomized, double-blind, placebo-controlled trial in which patients received dalfampridine 10 mg (27 patients) or placebo (14 patients) twice a day for 12 weeks.

Disclosures: The original trial was funded by Biogen. The corresponding author disclosed consultancy with Almirall, Biogen, Novartis, Genzyme, Roche, and Teva and research funding from Associazione Italiana Sclerosi Multipla and Genzyme.

Citation: Prosperini L, et al. Neurotherapeutics. 2019 Dec 9. doi: 10.1007/s13311-019-00813-5.

Key clinical point: Low sun exposure increases the risk of multiple sclerosis (MS) both directly and indirectly, which impacts vitamin D levels. Low sun exposure and vitamin D deficiency may be different risk factors acting synergistically.

Major finding: Low exposure to sunlight was associated with a 26% and 10% higher risk for MS through direct and indirect effects on the vitamin D levels, respectively. About 30% of the total effect of low sun exposure-related MS risk was mediated by vitamin D deficiency.

Study details: The data were obtained from two population-based case–control studies (7,069 cases; 6,632 matched controls).

Disclosures: The research was supported by grants received 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. Some of the investigators reported receiving grants and personal fees from multiple pharmaceutical companies.

Citation: Hedström AK, et al. J Neurol. 2019 Dec 12. doi: 10.1007/s00415-019-09677-3.

Key clinical point: Low sun exposure increases the risk of multiple sclerosis (MS) both directly and indirectly, which impacts vitamin D levels. Low sun exposure and vitamin D deficiency may be different risk factors acting synergistically.

Major finding: Low exposure to sunlight was associated with a 26% and 10% higher risk for MS through direct and indirect effects on the vitamin D levels, respectively. About 30% of the total effect of low sun exposure-related MS risk was mediated by vitamin D deficiency.

Study details: The data were obtained from two population-based case–control studies (7,069 cases; 6,632 matched controls).

Disclosures: The research was supported by grants received 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. Some of the investigators reported receiving grants and personal fees from multiple pharmaceutical companies.

Citation: Hedström AK, et al. J Neurol. 2019 Dec 12. doi: 10.1007/s00415-019-09677-3.

Key clinical point: Low sun exposure increases the risk of multiple sclerosis (MS) both directly and indirectly, which impacts vitamin D levels. Low sun exposure and vitamin D deficiency may be different risk factors acting synergistically.

Major finding: Low exposure to sunlight was associated with a 26% and 10% higher risk for MS through direct and indirect effects on the vitamin D levels, respectively. About 30% of the total effect of low sun exposure-related MS risk was mediated by vitamin D deficiency.

Study details: The data were obtained from two population-based case–control studies (7,069 cases; 6,632 matched controls).

Disclosures: The research was supported by grants received 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. Some of the investigators reported receiving grants and personal fees from multiple pharmaceutical companies.

Citation: Hedström AK, et al. J Neurol. 2019 Dec 12. doi: 10.1007/s00415-019-09677-3.

Key clinical point: Breastfeeding may prevent postpartum relapses in women with multiple sclerosis (MS). Major finding: Women with MS who breastfed had a 37% lower risk of postpartum relapse, compared with those who did not breastfeed (P = .006); exclusive breastfeeding had a greater benefit than nonexclusive breastfeeding.

Study details: A systematic review and meta-analysis of 24 studies, including 2,974 women.

Disclosures: The National Multiple Sclerosis Society supported the study through a Sylvia Lawry Physician Fellowship awarded to Dr. Krysko.

Citation: Krysko KM, et al. JAMA Neurol. 2019 Dec 9. doi: 10.1001/jamaneurol.2019.4173.

Key clinical point: Breastfeeding may prevent postpartum relapses in women with multiple sclerosis (MS). Major finding: Women with MS who breastfed had a 37% lower risk of postpartum relapse, compared with those who did not breastfeed (P = .006); exclusive breastfeeding had a greater benefit than nonexclusive breastfeeding.

Study details: A systematic review and meta-analysis of 24 studies, including 2,974 women.

Disclosures: The National Multiple Sclerosis Society supported the study through a Sylvia Lawry Physician Fellowship awarded to Dr. Krysko.

Citation: Krysko KM, et al. JAMA Neurol. 2019 Dec 9. doi: 10.1001/jamaneurol.2019.4173.

Key clinical point: Breastfeeding may prevent postpartum relapses in women with multiple sclerosis (MS). Major finding: Women with MS who breastfed had a 37% lower risk of postpartum relapse, compared with those who did not breastfeed (P = .006); exclusive breastfeeding had a greater benefit than nonexclusive breastfeeding.

Study details: A systematic review and meta-analysis of 24 studies, including 2,974 women.

Disclosures: The National Multiple Sclerosis Society supported the study through a Sylvia Lawry Physician Fellowship awarded to Dr. Krysko.

Citation: Krysko KM, et al. JAMA Neurol. 2019 Dec 9. doi: 10.1001/jamaneurol.2019.4173.

The Food and Drug Administration has approved the first generics of fingolimod (Gilenya) for the treatment of relapsing forms of multiple sclerosis.

The three generic fingolimod applications came from HEC Pharm, Biocon, and Sun Pharmaceutical Industries.

Fingolimod is a widely used, orally administered treatment option for relapsing forms of multiple sclerosis in adults. The most common adverse events associated with fingolimod in clinical trials include headache, elevation of liver enzymes, diarrhea, cough, influenza, sinusitis, back pain, abdominal pain, and pain in the extremities.

The drug must be dispensed with a medication guide that contains important information on its usage and risk, the FDA noted. Serious risks associated with fingolimod include slowing of the heart rate, vision problems, posterior reversible encephalopathy syndrome, respiratory problems, liver injury, increased blood pressure, skin cancer, and risk of serious infection including a rare and often deadly brain infection called progressive multifocal leukoencephalopathy. Fingolimod can also cause harm to a developing fetus.

Find the full press release on the FDA website.

[email protected]

The Food and Drug Administration has approved the first generics of fingolimod (Gilenya) for the treatment of relapsing forms of multiple sclerosis.

The three generic fingolimod applications came from HEC Pharm, Biocon, and Sun Pharmaceutical Industries.

Fingolimod is a widely used, orally administered treatment option for relapsing forms of multiple sclerosis in adults. The most common adverse events associated with fingolimod in clinical trials include headache, elevation of liver enzymes, diarrhea, cough, influenza, sinusitis, back pain, abdominal pain, and pain in the extremities.

The drug must be dispensed with a medication guide that contains important information on its usage and risk, the FDA noted. Serious risks associated with fingolimod include slowing of the heart rate, vision problems, posterior reversible encephalopathy syndrome, respiratory problems, liver injury, increased blood pressure, skin cancer, and risk of serious infection including a rare and often deadly brain infection called progressive multifocal leukoencephalopathy. Fingolimod can also cause harm to a developing fetus.

Find the full press release on the FDA website.

[email protected]

The Food and Drug Administration has approved the first generics of fingolimod (Gilenya) for the treatment of relapsing forms of multiple sclerosis.

The three generic fingolimod applications came from HEC Pharm, Biocon, and Sun Pharmaceutical Industries.

Fingolimod is a widely used, orally administered treatment option for relapsing forms of multiple sclerosis in adults. The most common adverse events associated with fingolimod in clinical trials include headache, elevation of liver enzymes, diarrhea, cough, influenza, sinusitis, back pain, abdominal pain, and pain in the extremities.

The drug must be dispensed with a medication guide that contains important information on its usage and risk, the FDA noted. Serious risks associated with fingolimod include slowing of the heart rate, vision problems, posterior reversible encephalopathy syndrome, respiratory problems, liver injury, increased blood pressure, skin cancer, and risk of serious infection including a rare and often deadly brain infection called progressive multifocal leukoencephalopathy. Fingolimod can also cause harm to a developing fetus.

Find the full press release on the FDA website.

[email protected]

Key clinical point: Little is known about what factors predict the progression of cognitive impairment (CI) and progression after a diagnosis of multiple sclerosis (MS).

Major finding: Twenty-two percent of patients had CI at baseline in newly diagnosed MS patients. At follow-up, only 14% of patients had CI. Cognitive changes within 1 year of follow-up could not be determined by baseline characteristics or initiation of treatment.

Study details: Demographic, clinical, and conventional MRI markers at baseline were investigated for CI and changes in 1,123 patients from a multicenter cohort study.

Disclosures: “The German National MS cohort and KKNMS are supported by grants from the German Federal Ministry for Education and Research.” Several study investigators reported received financial support and grants from pharmaceutical agencies.

Citation: Johnen A, et al. J Neurol. 2019 Feb;266(2):386-397. doi: 10.1007/s00415-018-9142-y.

Key clinical point: Little is known about what factors predict the progression of cognitive impairment (CI) and progression after a diagnosis of multiple sclerosis (MS).

Major finding: Twenty-two percent of patients had CI at baseline in newly diagnosed MS patients. At follow-up, only 14% of patients had CI. Cognitive changes within 1 year of follow-up could not be determined by baseline characteristics or initiation of treatment.

Study details: Demographic, clinical, and conventional MRI markers at baseline were investigated for CI and changes in 1,123 patients from a multicenter cohort study.

Disclosures: “The German National MS cohort and KKNMS are supported by grants from the German Federal Ministry for Education and Research.” Several study investigators reported received financial support and grants from pharmaceutical agencies.

Citation: Johnen A, et al. J Neurol. 2019 Feb;266(2):386-397. doi: 10.1007/s00415-018-9142-y.

Key clinical point: Little is known about what factors predict the progression of cognitive impairment (CI) and progression after a diagnosis of multiple sclerosis (MS).

Major finding: Twenty-two percent of patients had CI at baseline in newly diagnosed MS patients. At follow-up, only 14% of patients had CI. Cognitive changes within 1 year of follow-up could not be determined by baseline characteristics or initiation of treatment.

Study details: Demographic, clinical, and conventional MRI markers at baseline were investigated for CI and changes in 1,123 patients from a multicenter cohort study.

Disclosures: “The German National MS cohort and KKNMS are supported by grants from the German Federal Ministry for Education and Research.” Several study investigators reported received financial support and grants from pharmaceutical agencies.

Citation: Johnen A, et al. J Neurol. 2019 Feb;266(2):386-397. doi: 10.1007/s00415-018-9142-y.

Key clinical point: Better management and treatment of diabetes and anxiety in MS patients may help improve cognition.

Major finding: Of 111 patients with relapsing remitting MS (majority were women with a mean age of 50 years), 22.7% had hypertension, 10.8% had diabetes, 9.9% had depression, and 9.9% had anxiety disorders.

Study details: Patients completed a psychiatric interview, a comorbidity questionnaire, and cognitive testing. Scores were converted to age-, sex-, and education-adjusted z-scores. Links between diabetes and hypertension and the cognitive z-scores were evaluated.

Disclosures: Authors disclosed receiving research support from various organizations. One author has conducted clinical trials for Biogen Idec and Rouche. Another has served as a consultant for several pharmaceutical companies, and has also received research grants and served on speaker’s bureaus for the industry.

Citation: Marrie, RA, et al.. Mult Scler Relat Disord. 2019 Jan;27:164-170. doi: 10.1016/j.msard.2018.10.018.

Key clinical point: Better management and treatment of diabetes and anxiety in MS patients may help improve cognition.

Major finding: Of 111 patients with relapsing remitting MS (majority were women with a mean age of 50 years), 22.7% had hypertension, 10.8% had diabetes, 9.9% had depression, and 9.9% had anxiety disorders.

Study details: Patients completed a psychiatric interview, a comorbidity questionnaire, and cognitive testing. Scores were converted to age-, sex-, and education-adjusted z-scores. Links between diabetes and hypertension and the cognitive z-scores were evaluated.

Disclosures: Authors disclosed receiving research support from various organizations. One author has conducted clinical trials for Biogen Idec and Rouche. Another has served as a consultant for several pharmaceutical companies, and has also received research grants and served on speaker’s bureaus for the industry.

Citation: Marrie, RA, et al.. Mult Scler Relat Disord. 2019 Jan;27:164-170. doi: 10.1016/j.msard.2018.10.018.

Key clinical point: Better management and treatment of diabetes and anxiety in MS patients may help improve cognition.

Major finding: Of 111 patients with relapsing remitting MS (majority were women with a mean age of 50 years), 22.7% had hypertension, 10.8% had diabetes, 9.9% had depression, and 9.9% had anxiety disorders.

Study details: Patients completed a psychiatric interview, a comorbidity questionnaire, and cognitive testing. Scores were converted to age-, sex-, and education-adjusted z-scores. Links between diabetes and hypertension and the cognitive z-scores were evaluated.

Disclosures: Authors disclosed receiving research support from various organizations. One author has conducted clinical trials for Biogen Idec and Rouche. Another has served as a consultant for several pharmaceutical companies, and has also received research grants and served on speaker’s bureaus for the industry.

Citation: Marrie, RA, et al.. Mult Scler Relat Disord. 2019 Jan;27:164-170. doi: 10.1016/j.msard.2018.10.018.

Key clinical point: More studies are needed with larger samples and more ethnicities to support the study's findings.

Major finding: The FOXP3 gene rs3761548 was found to increase the risk for MS, with a higher risk found in Asian patients.

Study details: This was a meta-analysis of 5 studies from January 1980 to October 2018. The studies were used to evaluate the association between FOXP3 gene polymorphism and MS. For FOXP3 gene rs3761548, there were 1,276 MS patients and 1,447 controls; and for FOXP3 gene rs2232365, there were 600 MS patients and 640 controls.

Disclosures: None.

Citation: Zhang Y, et al. Medicine. 2019 Sep;98(38):e17224. doi: 10.1097/MD.0000000000017224.

Key clinical point: More studies are needed with larger samples and more ethnicities to support the study's findings.

Major finding: The FOXP3 gene rs3761548 was found to increase the risk for MS, with a higher risk found in Asian patients.

Study details: This was a meta-analysis of 5 studies from January 1980 to October 2018. The studies were used to evaluate the association between FOXP3 gene polymorphism and MS. For FOXP3 gene rs3761548, there were 1,276 MS patients and 1,447 controls; and for FOXP3 gene rs2232365, there were 600 MS patients and 640 controls.

Disclosures: None.

Citation: Zhang Y, et al. Medicine. 2019 Sep;98(38):e17224. doi: 10.1097/MD.0000000000017224.

Key clinical point: More studies are needed with larger samples and more ethnicities to support the study's findings.

Major finding: The FOXP3 gene rs3761548 was found to increase the risk for MS, with a higher risk found in Asian patients.

Study details: This was a meta-analysis of 5 studies from January 1980 to October 2018. The studies were used to evaluate the association between FOXP3 gene polymorphism and MS. For FOXP3 gene rs3761548, there were 1,276 MS patients and 1,447 controls; and for FOXP3 gene rs2232365, there were 600 MS patients and 640 controls.

Disclosures: None.

Citation: Zhang Y, et al. Medicine. 2019 Sep;98(38):e17224. doi: 10.1097/MD.0000000000017224.

ST. LOUIS – Late-onset multiple sclerosis (MS), with symptoms starting at or after age 50, is more severe than earlier-onset disease, with faster accrual of disability, according to a review of 1,524 patients with MS treated at the University of Virginia, Charlottesville.

Whether the pathophysiology is different, or if the disease is simply compounded by the effects of aging, is uncertain. It is likely, however, that patients with late onset are at greater risk of misdiagnosis and delayed treatment, said Mattia Wruble, a 4th-year medical student at the University of Virginia.

The reason is that MS usually presents in young women as relapsing-remitting disease, but late onset is more typically primary progressive, with a higher proportion of men, which is something that has been demonstrated in previous work and also found in the new study.

“What we didn’t expect to find,” however, was greater “disability and higher disability accrual rates” across all subtypes. Late-onset MS “is a worse disease, a more severe disease” that might even need different treatment options, Ms. Wruble said at the American Neurological Association annual meeting.

Ms. Wruble and colleagues compared the charts of 1,381 patients with MS onset before age 50 years, at a median age of 33 years, with 143 patients whose symptoms began at age 50 years or later, at a median of 55 years.

It was one of the largest late-onset MS samples to date. Incidence of the condition is on the rise, but research has been limited. The investigators hoped to address a need for “a better and more thorough characterization of” the disease to aid treatment and improve outcomes, Ms. Wruble said.

There was a higher proportion of men in the late-onset group, 38% vs. 26%. About 75% of patients with early onset had relapsing remitting disease, and 10% had primary progressive disease. The late-onset group was about evenly split between relapsing-remitting and primary progressive MS (P less than .001).

Patients with late onset MS also had a higher degree of disability at their most recent visit across all subtypes (median Expanded Disability Status Scale score of 5 versus 3), despite having a shorter duration of disease (mean 12 vs. 17 years from symptom onset).

Overall disease accrual rate in the late-onset group was twice that of early-onset group, a decline of 0.647 points per year on the EDSS versus 0.357 points (P less than .001). The finding held when limited to early and late relapsing-remitting cases. The accrual rate for late-onset primary and secondary progressive MS was 1.5 times that of early-onset cases.

Transition to secondary progressive disease also was faster in the late-onset group, a mean of about 7 years versus 15-19 years. Patients with late onset also were more likely to have a history of smoking.

The cerebrospinal fluid in late-onset MS generally has fewer unique oligoclonal bands, which are part of the McDonald diagnostic criteria for MS. “The McDonald criteria were made for patients between 20 and 50 years old; maybe they are not the best criteria to diagnose this late-onset group,” Ms. Wruble said.

There was no external funding, and Ms. Wruble had no disclosures.

[email protected]

SOURCE: Wruble M et al. ANA 2019. Abstract S234.

ST. LOUIS – Late-onset multiple sclerosis (MS), with symptoms starting at or after age 50, is more severe than earlier-onset disease, with faster accrual of disability, according to a review of 1,524 patients with MS treated at the University of Virginia, Charlottesville.

Whether the pathophysiology is different, or if the disease is simply compounded by the effects of aging, is uncertain. It is likely, however, that patients with late onset are at greater risk of misdiagnosis and delayed treatment, said Mattia Wruble, a 4th-year medical student at the University of Virginia.

The reason is that MS usually presents in young women as relapsing-remitting disease, but late onset is more typically primary progressive, with a higher proportion of men, which is something that has been demonstrated in previous work and also found in the new study.

“What we didn’t expect to find,” however, was greater “disability and higher disability accrual rates” across all subtypes. Late-onset MS “is a worse disease, a more severe disease” that might even need different treatment options, Ms. Wruble said at the American Neurological Association annual meeting.

Ms. Wruble and colleagues compared the charts of 1,381 patients with MS onset before age 50 years, at a median age of 33 years, with 143 patients whose symptoms began at age 50 years or later, at a median of 55 years.

It was one of the largest late-onset MS samples to date. Incidence of the condition is on the rise, but research has been limited. The investigators hoped to address a need for “a better and more thorough characterization of” the disease to aid treatment and improve outcomes, Ms. Wruble said.

There was a higher proportion of men in the late-onset group, 38% vs. 26%. About 75% of patients with early onset had relapsing remitting disease, and 10% had primary progressive disease. The late-onset group was about evenly split between relapsing-remitting and primary progressive MS (P less than .001).

Patients with late onset MS also had a higher degree of disability at their most recent visit across all subtypes (median Expanded Disability Status Scale score of 5 versus 3), despite having a shorter duration of disease (mean 12 vs. 17 years from symptom onset).

Overall disease accrual rate in the late-onset group was twice that of early-onset group, a decline of 0.647 points per year on the EDSS versus 0.357 points (P less than .001). The finding held when limited to early and late relapsing-remitting cases. The accrual rate for late-onset primary and secondary progressive MS was 1.5 times that of early-onset cases.

Transition to secondary progressive disease also was faster in the late-onset group, a mean of about 7 years versus 15-19 years. Patients with late onset also were more likely to have a history of smoking.

The cerebrospinal fluid in late-onset MS generally has fewer unique oligoclonal bands, which are part of the McDonald diagnostic criteria for MS. “The McDonald criteria were made for patients between 20 and 50 years old; maybe they are not the best criteria to diagnose this late-onset group,” Ms. Wruble said.

There was no external funding, and Ms. Wruble had no disclosures.

[email protected]

SOURCE: Wruble M et al. ANA 2019. Abstract S234.

ST. LOUIS – Late-onset multiple sclerosis (MS), with symptoms starting at or after age 50, is more severe than earlier-onset disease, with faster accrual of disability, according to a review of 1,524 patients with MS treated at the University of Virginia, Charlottesville.

Whether the pathophysiology is different, or if the disease is simply compounded by the effects of aging, is uncertain. It is likely, however, that patients with late onset are at greater risk of misdiagnosis and delayed treatment, said Mattia Wruble, a 4th-year medical student at the University of Virginia.

The reason is that MS usually presents in young women as relapsing-remitting disease, but late onset is more typically primary progressive, with a higher proportion of men, which is something that has been demonstrated in previous work and also found in the new study.

“What we didn’t expect to find,” however, was greater “disability and higher disability accrual rates” across all subtypes. Late-onset MS “is a worse disease, a more severe disease” that might even need different treatment options, Ms. Wruble said at the American Neurological Association annual meeting.

Ms. Wruble and colleagues compared the charts of 1,381 patients with MS onset before age 50 years, at a median age of 33 years, with 143 patients whose symptoms began at age 50 years or later, at a median of 55 years.

It was one of the largest late-onset MS samples to date. Incidence of the condition is on the rise, but research has been limited. The investigators hoped to address a need for “a better and more thorough characterization of” the disease to aid treatment and improve outcomes, Ms. Wruble said.

There was a higher proportion of men in the late-onset group, 38% vs. 26%. About 75% of patients with early onset had relapsing remitting disease, and 10% had primary progressive disease. The late-onset group was about evenly split between relapsing-remitting and primary progressive MS (P less than .001).

Patients with late onset MS also had a higher degree of disability at their most recent visit across all subtypes (median Expanded Disability Status Scale score of 5 versus 3), despite having a shorter duration of disease (mean 12 vs. 17 years from symptom onset).

Overall disease accrual rate in the late-onset group was twice that of early-onset group, a decline of 0.647 points per year on the EDSS versus 0.357 points (P less than .001). The finding held when limited to early and late relapsing-remitting cases. The accrual rate for late-onset primary and secondary progressive MS was 1.5 times that of early-onset cases.

Transition to secondary progressive disease also was faster in the late-onset group, a mean of about 7 years versus 15-19 years. Patients with late onset also were more likely to have a history of smoking.

The cerebrospinal fluid in late-onset MS generally has fewer unique oligoclonal bands, which are part of the McDonald diagnostic criteria for MS. “The McDonald criteria were made for patients between 20 and 50 years old; maybe they are not the best criteria to diagnose this late-onset group,” Ms. Wruble said.

There was no external funding, and Ms. Wruble had no disclosures.

[email protected]

SOURCE: Wruble M et al. ANA 2019. Abstract S234.

Key clinical point: Disability milestones are not being met as quickly for patients with multiple sclerosis (MS), as disease progression has slowed.

Major finding: In patients with relapsing-onset MS there was a decreased risk of reaching disability milestones by 3%, 6%, and 7% in Expanded Disability Status Score (EDSS) scores of 3.0, 4.0, and 6.0, respectively. In patients with progressive-onset MS there was no significant decrease.

Study details: This was a nationwide population-based retrospective cohort study of 12,512 patients in Sweden. Of those patients 7,331 (5,196 females) were diagnosed with MS at a mean age of 38.3 years between January 1995 and December 2010 and had 2 recorded EDSS scores.

Disclosures: Research was funded by the Swedish Research Council and the Swedish Brain Foundation.

Citation: Beiki O, et al. JAMA Neurol. 2019;76(6):665-671. doi: 10.1001/jamaneurol.2019.0330.

Key clinical point: Disability milestones are not being met as quickly for patients with multiple sclerosis (MS), as disease progression has slowed.

Major finding: In patients with relapsing-onset MS there was a decreased risk of reaching disability milestones by 3%, 6%, and 7% in Expanded Disability Status Score (EDSS) scores of 3.0, 4.0, and 6.0, respectively. In patients with progressive-onset MS there was no significant decrease.

Study details: This was a nationwide population-based retrospective cohort study of 12,512 patients in Sweden. Of those patients 7,331 (5,196 females) were diagnosed with MS at a mean age of 38.3 years between January 1995 and December 2010 and had 2 recorded EDSS scores.

Disclosures: Research was funded by the Swedish Research Council and the Swedish Brain Foundation.

Citation: Beiki O, et al. JAMA Neurol. 2019;76(6):665-671. doi: 10.1001/jamaneurol.2019.0330.

Key clinical point: Disability milestones are not being met as quickly for patients with multiple sclerosis (MS), as disease progression has slowed.

Major finding: In patients with relapsing-onset MS there was a decreased risk of reaching disability milestones by 3%, 6%, and 7% in Expanded Disability Status Score (EDSS) scores of 3.0, 4.0, and 6.0, respectively. In patients with progressive-onset MS there was no significant decrease.

Study details: This was a nationwide population-based retrospective cohort study of 12,512 patients in Sweden. Of those patients 7,331 (5,196 females) were diagnosed with MS at a mean age of 38.3 years between January 1995 and December 2010 and had 2 recorded EDSS scores.

Disclosures: Research was funded by the Swedish Research Council and the Swedish Brain Foundation.

Citation: Beiki O, et al. JAMA Neurol. 2019;76(6):665-671. doi: 10.1001/jamaneurol.2019.0330.

Key clinical point: The use, type, and timing of disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS) patients may lead to secondary progressive MS.

Major finding: RRMS patients beginning DMTs of fingolimod, alemtuzumab, or natalizumab had a lower chance of secondary progressive MS, whereas patients taking glatiramer acetate or interferon beta had a higher chance.

Study details: This was a cohort study that examined 1,555 RRMS patients (1,123 females) across 21 countries that began DMTs (interferon beta, glatiramer acetate, fingolimod, natalizumab, or alemtuzumab) between 1988 and 2012.

Disclosures: This study was financially supported by the National Health and Medical Research Council of Australia, the University of Melbourne, a Next Generation Fellowship funded by the Grand Charity of the Freemason’s, and the MSBase 2017 Fellowship. Alemtuzumab studies done in Cambridge were supported by the NIHR Cambridge Biomedical Research Centre and the MS Society UK.

Citation: Brown JWL, et al. JAMA. 2019;321(2):175-187. doi: 10.1001/jama.2018.20588.

Key clinical point: The use, type, and timing of disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS) patients may lead to secondary progressive MS.

Major finding: RRMS patients beginning DMTs of fingolimod, alemtuzumab, or natalizumab had a lower chance of secondary progressive MS, whereas patients taking glatiramer acetate or interferon beta had a higher chance.

Study details: This was a cohort study that examined 1,555 RRMS patients (1,123 females) across 21 countries that began DMTs (interferon beta, glatiramer acetate, fingolimod, natalizumab, or alemtuzumab) between 1988 and 2012.

Disclosures: This study was financially supported by the National Health and Medical Research Council of Australia, the University of Melbourne, a Next Generation Fellowship funded by the Grand Charity of the Freemason’s, and the MSBase 2017 Fellowship. Alemtuzumab studies done in Cambridge were supported by the NIHR Cambridge Biomedical Research Centre and the MS Society UK.

Citation: Brown JWL, et al. JAMA. 2019;321(2):175-187. doi: 10.1001/jama.2018.20588.

Key clinical point: The use, type, and timing of disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS) patients may lead to secondary progressive MS.

Major finding: RRMS patients beginning DMTs of fingolimod, alemtuzumab, or natalizumab had a lower chance of secondary progressive MS, whereas patients taking glatiramer acetate or interferon beta had a higher chance.

Study details: This was a cohort study that examined 1,555 RRMS patients (1,123 females) across 21 countries that began DMTs (interferon beta, glatiramer acetate, fingolimod, natalizumab, or alemtuzumab) between 1988 and 2012.

Disclosures: This study was financially supported by the National Health and Medical Research Council of Australia, the University of Melbourne, a Next Generation Fellowship funded by the Grand Charity of the Freemason’s, and the MSBase 2017 Fellowship. Alemtuzumab studies done in Cambridge were supported by the NIHR Cambridge Biomedical Research Centre and the MS Society UK.

Citation: Brown JWL, et al. JAMA. 2019;321(2):175-187. doi: 10.1001/jama.2018.20588.