NHSGGC/NHSL

Author Of 3 Presentations

Epidemiology Poster Presentation

LB1155 - Vitamin D levels in the UK MS population and COVID-19 susceptibility (ID 1116)

Abstract

Background

Despite the well-described association between vitamin D and MS, little is known about current behaviours surrounding vitamin D and the corresponding vitamin D status in this group at a population level across the UK. During the COVID-19 pandemic, interest in the role that vitamin D might play in reducing susceptibility to and severity of COVID-19 has come to the foreground.

Objectives

To determine the vitamin D status of the UK MS population, understand the factors that influence it, and examine how vitamin D supplementation affects the risk of COVID-19.

Methods

A cohort study using the UK MS Register was performed. Self-reported data surrounding vitamin D and remotely collected biological samples were collected. 1768 people with MS (pwMS) completed a questionnaire regarding vitamin D-influencing behaviours; dried blood spots were collected from 388 of these pwMS and 309 matched controls, and serum 25(OH)D was measured. Subsequently, 592 participants from this MS cohort prospectively completed questionnaires evaluating symptoms suggestive of COVID-19.

Results

Marked differences were observed between supplementation behaviours with pwMS more likely to take supplements (72% vs 26% controls, p<0.001), and at higher doses (median 1600 IU/day vs 600 IU/day in controls, p<0.001). Serum levels of 25(OH)D were higher in pwMS than controls (71nmol/L, IQR 48 vs 49nmol/L, IQR 27, p<0.001). People with MS who did not supplement had lower serum 25(OH)D levels than non-supplementing controls (median 38 nmol/L, IQR 35 vs 44 nmol/L, IQR 21, p<0.001). 71% of those self-diagnosed with COVID-19 reported taking vitamin D vs 72% without COVID-19. Median dose for those with COVID-19 was reported as 1000 IU/day vs 2000 IU/day in those without (p=0.682).

Conclusions

pwMS living in the UK are more likely to have adequate levels of vitamin D than controls, and is driven by the higher rate and dose of supplementation across this population. This has implications on the design and interpretation of any future clinical trials with vitamin D in this population. In addition, we found no evidence that vitamin D supplementation had an impact on susceptibility to COVID-19 in this population.

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Disease Modifying Therapies – Risk Management Poster Presentation

P0309 - Cladribine is a safe and effective treatment for highly active relapsing-remitting multiple sclerosis (ID 423)

Speakers
Presentation Number
P0309
Presentation Topic
Disease Modifying Therapies – Risk Management

Abstract

Background

Cladribine is a novel disease-modifying therapy (DMT) that has recently been licensed for the treatment of highly active relapsing-remitting multiple sclerosis (rrMS) in Scotland. Lymphocytopaenia (LLC) was reported as the main side-effect of this treatment, in clinical trials.

Objectives

1. Determining the real-world incidence of adverse effects of cladribine

2. Assessing the temporo-spatial likelihood of adverse effects

3. Commenting on current practice for monitoring and managing adverse incidents.

Methods

A retrospective cohort analysis of 120 patients prescribed cladribine, over four health boards in Scotland, assessed the incidence of adverse effects at 1 and 2 year intervals, by examination of patient notes, documented self-reported patient comments and follow-up blood monitoring results.

Results

It is affirmed that LLC is the main adverse effect of cladribine, occurring in around 68% of patients following receipt of the first treatment cycle and 75% following receipt of the second. Mild to moderate LLC (Grades 0-2) was present in 84% of LLC patients within treatment year 1, but only 58% of LLC patients after year 2. The average lag to peak LLC is noted to be two to four months after first treatment (n patients = 75%) and similarly after the second (n = 66%), indicating the optimal time frame for routine follow-up screening.

Other adverse effects were noted in 25 patients (21%), most commonly fatigue (incidence = 0.07), hair loss (incidence = 0.05) and nausea (incidence = 0.03). Allergic-type reactions were also observed in 2% of patients, but these were mild and treatable, without interruption to therapy. All patients in this cohort had adequate V. zoster pre-screening and prophylaxis. Treatment continuation was disrupted in 31% of patients due to COVID-19.

Conclusions

Adequate infection prophylaxis and counselling are noted to be key aspects of preassessment. Treatment is interrupted where no adequate protection can be provided. It is essential to ensure adequate lymphocyte populations, via routine screening and follow-up monitoring, before treatment initiation or progression. Shielding of cladribine patients from COVID-19 or similar may be indicated for up to 6 months after treatment, covering the nadir of LLC.

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Epidemiology Poster Presentation

P0465 - Higher mortality related to disability and social deprivation in a cohort of people with MS in Scotland. (ID 811)

Speakers
Presentation Number
P0465
Presentation Topic
Epidemiology

Abstract

Background

Multiple sclerosis (MS) is a progressive neurological disorder causing significant morbidity and mortality. Global MS prevalence varies due to genetic and environmental factors with Scotland having a high prevalence of 290 per 100,000. Cohort studies can help us understand morbidity and mortality in people with MS (pwMS) and explore links with deprivation, something which is recorded regularly in Scotland.

Objectives

In this study we reviewed the characteristics of pwMS aiming to determine what factors may contribute to their disability and death. It is hoped that this may highlight areas in which care provision can be optimised and outcomes for pwMS improved.

Methods

A database prospectively maintained since 2016, comprising of pwMS in a Scottish health-board was reviewed in March 2020. Out of 1290 pwMS, 1194 were alive and evaluated for age, sex and MS type. Between February 2016 and March 2020, 84 pwMS died. For these we recorded diagnosis date, cause and date of death, use of disease-modifying treatment, Extended Disability Status Scale score and a measure of socio-economic deprivation based on home address.

Results

The mean age-standardised mortality rate for pwMS was 1648 (95% CI: 710-2585) per 100,000, this is greater than the local population equivalent of 1245 (95% CI: 1239-1253) per 100,000 (National Records of Scotland). The standardized mortality ratio for pwMS was 2.31 (95% CI: 1.93-2.69).

Of those who had died, 48% had primary progressive MS, 39% secondary progressive, and 5% relapsing-remitting. 70% of deaths occurred between 45 and 69 years with less than 25% living past 70. The mean age of death for pwMS was 61 years (95% CI: 58.94-63.13). These data significantly differ from the local life expectancy of 78 (p<0.05). In the deceased cohort, disability was substantial with 65% wheelchair or bed-bound prior to their death, this varied by subtype. 55% of deaths were attributed to MS-related disability with 94% of these due to infections, primarily of the respiratory and urinary tracts.

A significant correlation was found between disability and deprivation suggesting those in more deprived areas accrue greater disability before death (correlation coefficient -0.25; p<0.05).

Conclusions

Our study supports existing literature in finding higher mortality and shorter life expectancy in pwMS. The significant MS-related disability and death found here highlights the importance of minimizing functional decline. Accessible specialist MS services with efficient diagnosis, appropriate therapy and effective rehabilitation may improve the lives of pwMS. The association found between disability and deprivation suggests health inequalities may contribute to mortality in pwMS, although we cannot confirm a causal relationship and further work is necessary to determine the mechanism for this.

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