Recent studies in multiple sclerosis
The American Academy of Neurology (AAN) meeting is normally held annually and is an important forum for new MS research. The meeting was cancelled this year due to the COVID-19 pandemic, but the research results have been made available online. Here are some of the highlights.
MS and the environment: A UK study looked at environmental factors that can increase the risk of developing MS (Jacobs and colleagues. AAN 2020; P4.013). Two important factors were smoking, and obesity during childhood. A variety of other factors, such as bottle vs. breast feeding, exposure to second-hand smoke and birth weight, did not influence the risk of developing MS.
Obesity and MS: Body weight appears to increase the risk of more severe eye symptoms in men (but not women) with early MS (Rosso and colleagues. AAN 2020; P4.012). The study found that men with moderate or severe optic neuritis (inflammation of the optic nerve causing vision problems) had a higher body-mass index (BMI) than those people with milder symptoms. The average BMI among those with moderate/severe symptoms was 31 (a BMI of 30 or more is considered obese) compared to 26 (considered normal weight) for those with mild symptoms. The underlying problem may have been the hormone estradiol, which was found to be at higher levels in people who were obese.
Predicting worsening MS: Italian researchers looked at who was at risk of worsening MS over the first 11 years after diagnosis (Dalla Costa and colleagues. AAN 2020; P5.015). They found that inflammatory lesions in the spinal cord and poor recovery from a relapse were associated with worse outcomes. The risks were somewhat higher if people had low vitamin D levels (because of diet or little sun exposure) and were current smokers.
Treating older people with MS: Older people with MS are more likely to develop side effects with a medication because of various factors, such as poorer health, other medical conditions and age-related changes in their immune response. Recent studies have looked at the feasibility of stopping treatment in people older than 60 years who no longer have active MS (relapses or MRI lesions). Several new studies at AAN examined this issue. A Canadian study reported that the effects of Tecfidera on immune function were similar in younger and older individuals with MS, and older people didn’t appear to have a higher risk of side effects (Giuliani and colleagues. AAN 2020; P6.011). A separate study looked at people as old as 56 years treated with Gilenya or Tecfidera (Memon and colleagues. AAN 2020; abstract P6.006). Both treatments continued to be effective; the median time to a first relapse after starting the drugs was just over a year. The most common side effects were a slow heart rate with Gilenya, and flushing with Tecfidera. There were no new safety issues, suggesting that oral MS drugs can be continued in older people.
Blood pressure and Lemtrada: A Canadian study looked at blood pressure changes during a course of treatment with Lemtrada (Shosha and colleagues. AAN 2020; P7.003). No one undergoing the 5-day course of treatment had hypertension beforehand. However, the average blood pressure reading increased by about 20% when people started the drug (e.g. from 119/75 mmHg up to 138/81 mmHg). Overall, 54% had a 20% increase in blood pressure; and 29% had an even higher BP reading.
Imaging brain tissue loss: OCT (for Optical Coherence Tomography) is an imaging technique that uses light to measure the thickness of the retina in the eye (much like CT scans use sound waves to show an image of internal organs). The thickness of the retina is important because it provides an indication of the amount of nerve tissue loss that occurs in MS. An OCT study examined the effect of three medications – an interferon, Tecfidera and Tysabri – on retinal thickness in people with MS (Wong and colleagues. AAN 2020; P7.020). The study found that the amount of nerve tissue loss was stabilized, and there was no worsening of vision or walking ability during treatment with the three drugs. This finding suggests that treatments can provide some protection against the neurodegeneration that occurs in MS.
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