Jose Marques Lopes, PhD, science editor —

Lesions in the infratentorial region of the brain at the onset of clinically isolated syndrome (CIS) and lesions in white matter one year after CIS onset are associated with worse disability 30 years later, a study reports. The study, “Early MRI predictors of long-term multiple sclerosis outcomes:…

A higher frequency of early relapses, as well as a larger volume of lesions and older age at disease onset, increase the risk of transitioning from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive MS (SPMS), according to a study. The study, “Early cortical pathology and…

Infections and complications from severe disability are the greatest contributors to mortality among multiple sclerosis (MS) patients, according to a population-based study in British Columbia, Canada, which also found that that MS is a more common underlying cause of death among younger patients. The study, “Causes that…

Processing speed is associated with the extent of brain and spinal cord injury in patients with multiple sclerosis (MS), according to a new study conducted in a clinical setting. The results support using the Processing Speed Test (PST) in both clinical practice and trials. The study, “…

Treatment of multiple sclerosis (MS) patients with rituximab does not increase breast cancer risk in women, and is not associated with a higher risk for malignant cancer of any type in men or women, when compared to Gilenya (fingolimod) or Tysabri (natalizumab), according to a nationwide study in…

Treatment of multiple sclerosis (MS) patients with rituximab leads to lower-than-reported mortality rates, according to a large real-world study in the U.S. and Sweden. The findings also revealed no deaths due to infusion reactions or to systemic inflammation. The study, “Mortality rates in large US and…

Vitamin D may increase the therapeutic benefits of glucocorticosteroids (GCs) for multiple sclerosis (MS) through a protein complex called mTORc1, according to a study in a mouse model and in cells from MS patients. The study, “Vitamin D augments glucocorticosteroid efficacy via inhibition of mTORc1,” was presented…

Patients with relapsing-remitting multiple sclerosis (RRMS) who switch to Tysabri (natalizumab) after relapses on first-line treatment with other medications show greater relapse reduction and less disability progression than those switching to Gilenya (fingolimod), according to a real-world study. The research, “Comparative effectiveness of switching…

A new subtype of multiple sclerosis (MS) — called myelocortical MS (MCMS) — is characterized by cortical neuronal loss, but not by loss of myelin in the brain’s white matter, according to a study. Research on this new type of MS was presented today at the 34th congress of…

Clinical data and real-world results support the long-term efficacy of Biogen’s medications for multiple sclerosis (MS), according to scientific presentations being released by the company. Specifically, findings support the effectiveness of Tecfidera (dimethyl fumarate) and Tysabri (natalizumab) used early in the disease’s course, as well as the…

Treatment with Ocrevus (ocrelizumab) over five years lessened upper limb disability progression in primary progressive multiple sclerosis (PPMS) patients, reduced relapses and brain disease activity in patients with relapsing MS, and helped achieve no evidence of disease progression (NEDA) in a greater proportion of African-descent patients, compared to treatment…

A 48-week treatment of relapsing multiple sclerosis (MS) with TG Therapeutics’ investigational compound ublituximab led to a marked reduction of brain and spinal cord lesions, massive depletion of relapse-associated immune B-cells, and significantly halted disability progression, according to results from a Phase 2 clinical trial. The data…

Smoking may increase multiple sclerosis (MS) disease activity, quicken disability progression, and speed the transition from relapsing to secondary progressive MS (SPMS) by as much as eight years, according to an MS Society review study. The review data shows that, although the U.K.’s National Institute for Health…

Four disease-modifying therapies (DMTs) for  multiple sclerosis — Avonex, Rebif, Betaferon, and Copaxone — are cost-effective and reduce disease progression in MS patients, especially those with relapsing-remitting disease, according to 10-year, real-world results from U.K.’s MS Risk Sharing Scheme (RSS). But the long-term benefits observed wane over…

The Committee for Medicinal Products for Human Use (CHMP), an arm of the European Medicines Agency (EMA), has recommended that Gilenya (fingolimod) be approved to treat children and adolescents, ages 10 to 17, with relapsing-remitting multiple sclerosis (RRMS). If the CHMP opinion is accepted, Gilenya — marketed by…

A molecule known as Sox10 enables brain cells called astrocytes to convert into myelin-forming oligodendrocytes, a new study in mice reports. The findings suggest an approach for myelin repair in patients with multiple sclerosis (MS) and similar disorders, its researchers said. The study, “In vivo conversion of…

Progressive multiple sclerosis patients — with primary or secondary progressive disease — treated with high doses of oral ibudilast in a Phase 2 clinical trial showed a 48 percent slowing in the progression of brain atrophy, or shrinkage, relative to those given a placebo, study data show. What this…

Treating primary progressive multiple sclerosis patients with Ocrevus (ocrelizumab) led to a three-fold increase in the proportion of those showing no evidence of disease progression and no signs of inflammatory disease activity over more than two years of treatment, results of a Phase 3 trial show, and support new measures that might better capture disability in PPMS patients. The research, “Evaluation of No Evidence of Progression or Active Disease (NEPAD) in Patients With Primary Progressive Multiple Sclerosis in the ORATORIO Trial,” was published in the journal Annals of Neurology. Measuring disease progression in clinical trials and clinical practice requires reliable and comprehensible measures. Although widely used, the Expanded Disability Status Scale (EDSS, range 0-10) cannot fully capture changes in walking speed and hand or arm function, which are key determinants of overall disability in progressive forms of MS. No evidence of progression (NEP) is a newer measure that reflects the absence of disability progression, including upper limb function and walking speed. Maintaining NEP status means stable disease with no worsening in EDSS, in walking ability (assessed by the Timed 25-Foot Walk (T25FW) test, or the time it takes to walk 25 feet as quickly and safely as possible), and in upper limb function (assessed by the 9-Hole Peg Test (9HPT), a test of arm and hand dexterity). Patients with PPMS have less frequent signs of disease activity, which include relapses and brain lesions (assessed though magnetic resonance imaging or MRI). So scientists proposed a new measure — called “no evidence of progression or active disease” (NEPAD) — to evaluate both NEP and clinical and MRI measures of active disease. The researchers believe that NEPAD may represent a more sensitive and comprehensive measure of disease control in PPMS patients. The randomized, double-blind ORATORIO Phase 3 trial (NCT01194570) analyzed the efficacy and safety of Ocrevus — developed by Genentech, part of the Roche group — in 732 PPMS patients (age range 18–55). Results showed that Ocrevus treatment delayed the relative risk of disability progression by 25% compared to placebo, while also reducing the volume of chronic brain lesions and total brain volume loss. As a result, Ocrevus became the first therapy approved by the U.S. Food and Drug Administration and the European Commission for both PPMS and relapsing MS. Now, researchers assessed Ocrevus’ effect in PPMS patients included in the Roche-funded ORATORIO study using as trial goals changes in NEP and NEPAD. These people received either 600 mg of Ocrevus or placebo by intravenous (IV) infusion every six months for a minimum of 120 weeks (about 2.3 years). The trial’s main goal was time to onset of clinical disability progression (CDP) sustained for at least 12 weeks. CDP was defined as a 1.0 point or greater increase in EDSS score from a baseline (study start) score of 5.5 or less, or a 0.5-point increase from a baseline score greater than 5.5. NEP status, analyzed in 230 placebo- and 461 Ocrevus-treated patients, was defined as no evidence of CDP for 12 weeks, no 20% or more change in hand/arm function as measured by the 9HPT for 12 weeks, and no 20% or more change in walking ability as measured by the T25FW test for 12 weeks. "The 20% cut-off for progression on the T25FW test and the 9HPT has previously been shown to be a clinically meaningful magnitude of disease progression," the study noted. In turn, NEPAD — assessed in 234 placebo- and 465 Ocrevus-treated patients — included NEP, no brain MRI-measured disease activity, and no relapses. Relapses were defined as new or worsening neurological symptoms attributable to MS lasting longer than 24 hours and preceded by neurological stability for a minimum of 30 days. Brain MRI scans were conducted at baseline, and weeks 24, 48, and 120; new or enlarging T2 lesions and/or T1 enhancing lesions were considered evidence of MRI disease activity (T1 MRI imaging offers information about current disease activity by highlighting areas of active inflammation, while a T2 MRI image provides information about disease burden or lesion load). Overall, the majority of the PPMS patients analyzed experienced clinical disease progression or evidence of disease activity. From baseline to week 120, Ocrevus-treated patients who achieved NEP (42.7% of 461 people) or NEPAD (29.9% of 465)  — no disease activity or progression — were found to have lower T2 brain lesion volume and a lower EDSS score (lesser disability) compared to those with evidence of MS progression. They also had a slightly superior performance on the 9HPT and the T25FW test. Patients who reached NEPAD also showed fewer T1 lesions than patients with progressing or active disease. Compared to placebo treatment, the proportion of Ocrevus-treated PPMS patients maintaining NEP or NEPAD from baseline to week 120 was higher — for NEP, 42.7% versus 29.1% in the placebo group; for NEPAD, 29.9% versus 9.4% in the placebo group. These results showed that Ocrevus treatment increased the proportion of PPMS patients with NEPAD throughout the 120 weeks of the study by three-fold. “In conclusion, ocrelizumab (Ocrevus) increased the proportion of patients with PPMS with no evidence of progression and no clinical and subclinical disease activity compared with placebo,” the team wrote. “As such, NEPAD may represent a meaningful and comprehensive disease outcome in patients with PPMS.” However, data from ORATORIO's open-label extension and real-world data are needed to "determine whether NEPAD maintained throughout 120 weeks will translate into sustained NEPAD and enhanced protection against accrual of disability in patients with PPMS over the long term," the researchers concluded. Of note, five of the study’s 11 authors are employees and/or shareholders of Roche or Genentech.

Cigarette smoking worsens shortness of breath and fatigue, increases the rate of hospital admissions, and fosters a sedentary lifestyle in patients with multiple sclerosis (MS), according to a new study. The research, “Effects of cigarette smoking on respiratory problems and functional levels in multiple sclerosis patients,”…

Poor sleep quality is very common among patients with relapsing-remitting multiple sclerosis (RRMS) or clinically isolated syndrome (CIS), and is associated with a lower quality of life, and greater fatigue, depression and anxiety, according to a real-world study in patients treated with Betaferon (interferon beta-1b). The study, “…

Carmen Navarrete, PhD, has been granted a Scientific Innovation Award for her post-doctoral presentation suggesting that the multiple sclerosis (MS) treatment candidate EHP-101 is anti-inflammatory and may boost remyelination, Emerald Health Pharmaceuticals announced. Navarrete, a senior scientist at Vivacell Biotechnology Espana, a company owned by Emerald Health Research, received the award at the…

Dysphagia, or problems with swallowing, is common in patients with multiple sclerosis and significantly reduces their quality of life, according to a new Australian study. Symptoms such as coughing and choking, and mental health issues related to eating or drinking, are common in this patient population, the data show.

Patients’ perceptions of stress and sleep quality are both linked to their sense of cognitive difficulties and depression, and focusing on these perceptions may be a way of treating depressive symptoms in multiple sclerosis (MS), a study reports. The research, “Perceived cognitive deficits and depressive symptoms in…

Hair thinning in relapsing-remitting multiple sclerosis (RRMS) patients using Aubagio is usually mild and temporary, and does not require stopping treatment, a small real-world study reports. The research, “Real-World Observational Evaluation of Hair Thinning in Patients with Multiple Sclerosis Receiving Teriflunomide: Is It an Issue in Clinical…

Removing a specific microRNA molecule — miR-150 – eased disease severity, inflammation, and loss of myelin in a mouse model of multiple sclerosis (MS), researchers report. Their study, “Silencing miR-150 Ameliorates Experimental Autoimmune Encephalomyelitis,” was published in the journal Frontiers in Neuroscience. Micro RNAs (miRNAs) are…

African-Americans with relapsing–remitting multiple sclerosis (RRMS) show higher adherence and greater satisfaction when treated with oral Gilenya (fingolimod, by Novartis) than with injectable therapies, according to a new study. The research, “Treatment retention on fingolimod compared with injectable multiple sclerosis therapies in African-American patients: A…

Activation of the immune response mediated by cells called microglia favors remyelination and myelin repair in multiple sclerosis (MS), according to a new Canadian study using mice. The research, “mCSF-Induced Microglial Activation Prevents Myelin Loss and Promotes Its Repair in a Mouse Model of Multiple Sclerosis,” was…

Blocking a protein receptor called muscarinic type 3 (M3R) could be an effective way to promote remyelination in multiple sclerosis (MS) patients, according to a State University of New York at Buffalo (UB) study in mice. The research, “Muscarinic receptor M3R signaling prevents efficient remyelination by…

Brain volume loss takes place at a faster rate in the first five years of multiple sclerosis than later in disease course, researchers report in a study that calls for scientists to “reconsider” — for this and related reasons — proposals to use volume loss as a measure of treatment efficacy…

Relapsing-remitting multiple sclerosis (RRMS) patients with active disease may now be treated with Ocrevus (ocrelizumab, developed by Genentech) within the National Health Service (NHS) — the subsidized public health system that covers England and Wales. But those in Scotland will not. The National Institute for Health and…