The University of Melbourne
Melbourne School Of Population And Global Health

Author Of 1 Presentation

COVID-19 Late Breaking Abstracts

SS02.04 - First results of the COVID-19 in MS Global Data Sharing Initiative suggest anti-CD20 DMTs are associated with worse COVID-19 outcomes

Abstract

Background

As the COVID-19 pandemic amplifies, efforts to minimise the risk on vulnerable people are essential. People with multiple sclerosis (MS) may be a vulnerable group due to the high proportion taking long-term immunosuppressive disease-modifying therapies (DMTs). Studies from Italy and France suggest older age, higher disability and progressive MS are associated with severe COVID-19, yet there remains uncertainty around the influence of DMTs.

Objectives

Given the many approved MS DMTs and the relatively low frequency of COVID-19 in MS patients per country, international data sharing is desirable to examine the impact of DMTs on COVID-19 severity. Here, we present the first results of the COVID-19 in MS global data sharing initiative of the MS International Federation and MS Data Alliance and many other data partners to inform MS clinical management during the COVID-19 pandemic.

Methods

Clinician-reported data from 21 countries were aggregated into a dataset of 1540 patients. Characteristics of admission to hospital, admission to intensive care unit (ICU), need for artificial ventilation, and death, were assessed in patients with confirmed or suspected COVID-19 infection using log-binomial regression. Adjusted prevalence ratios (aPR) were calculated adjusting for age, sex, MS type, and Expanded Disability Status Scale (EDSS).

Results

Of 1540 patients, 476 (30.9%) with suspected and 776 (50.4%) with confirmed COVID-19 were included in the analysis. Older age, progressive MS and higher EDSS were associated with higher frequencies of severe outcomes. Anti-CD20 DMTs, ocrelizumab and rituximab, were positively associated with hospital admission (aPRs=1.19 & 1.58), ICU admission (aPRs=3.53 & 4.12), and the need for artificial ventilation (aPRs=3.17 & 7.27) compared to dimethyl fumarate. Higher frequencies of all three outcomes were associated with combined anti-CD20 DMT use compared to all other DMTs (hospitalisation aPR=1.49; ICU aPR=2.55; ventilation aPR=3.05) and compared to natalizumab (hospitalisation aPR=1.99; ICU aPR=2.39; ventilation aPR=2.84). Importantly, associations persisted on restriction to confirmed COVID-19 cases and upon exclusion of each contributing data source in turn. No associations were observed between DMTs and death.

Conclusions

This study used the largest federated international cohort of people with MS and COVID19 currently available. We demonstrate a consistent association of anti-CD20 DMTs with hospitalisation, ICU admission and use of artificial ventilation suggesting their use among MS patients at risk for COVID-19 exposure may be a risk factor for more severe COVID-19 disease. To address study limitations, further research incorporating comorbidities, smoking and body mass index is required. Alternative study designs are needed to address questions on COVID-19 susceptibility among people with MS.

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Presenter Of 1 Presentation

COVID-19 Late Breaking Abstracts

SS02.04 - First results of the COVID-19 in MS Global Data Sharing Initiative suggest anti-CD20 DMTs are associated with worse COVID-19 outcomes

Abstract

Background

As the COVID-19 pandemic amplifies, efforts to minimise the risk on vulnerable people are essential. People with multiple sclerosis (MS) may be a vulnerable group due to the high proportion taking long-term immunosuppressive disease-modifying therapies (DMTs). Studies from Italy and France suggest older age, higher disability and progressive MS are associated with severe COVID-19, yet there remains uncertainty around the influence of DMTs.

Objectives

Given the many approved MS DMTs and the relatively low frequency of COVID-19 in MS patients per country, international data sharing is desirable to examine the impact of DMTs on COVID-19 severity. Here, we present the first results of the COVID-19 in MS global data sharing initiative of the MS International Federation and MS Data Alliance and many other data partners to inform MS clinical management during the COVID-19 pandemic.

Methods

Clinician-reported data from 21 countries were aggregated into a dataset of 1540 patients. Characteristics of admission to hospital, admission to intensive care unit (ICU), need for artificial ventilation, and death, were assessed in patients with confirmed or suspected COVID-19 infection using log-binomial regression. Adjusted prevalence ratios (aPR) were calculated adjusting for age, sex, MS type, and Expanded Disability Status Scale (EDSS).

Results

Of 1540 patients, 476 (30.9%) with suspected and 776 (50.4%) with confirmed COVID-19 were included in the analysis. Older age, progressive MS and higher EDSS were associated with higher frequencies of severe outcomes. Anti-CD20 DMTs, ocrelizumab and rituximab, were positively associated with hospital admission (aPRs=1.19 & 1.58), ICU admission (aPRs=3.53 & 4.12), and the need for artificial ventilation (aPRs=3.17 & 7.27) compared to dimethyl fumarate. Higher frequencies of all three outcomes were associated with combined anti-CD20 DMT use compared to all other DMTs (hospitalisation aPR=1.49; ICU aPR=2.55; ventilation aPR=3.05) and compared to natalizumab (hospitalisation aPR=1.99; ICU aPR=2.39; ventilation aPR=2.84). Importantly, associations persisted on restriction to confirmed COVID-19 cases and upon exclusion of each contributing data source in turn. No associations were observed between DMTs and death.

Conclusions

This study used the largest federated international cohort of people with MS and COVID19 currently available. We demonstrate a consistent association of anti-CD20 DMTs with hospitalisation, ICU admission and use of artificial ventilation suggesting their use among MS patients at risk for COVID-19 exposure may be a risk factor for more severe COVID-19 disease. To address study limitations, further research incorporating comorbidities, smoking and body mass index is required. Alternative study designs are needed to address questions on COVID-19 susceptibility among people with MS.

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Author Of 8 Presentations

Epidemiology Poster Presentation

P0432 - Assessment of Depression, Anxiety and Fatigue in relation to diet quality in Multiple Sclerosis (ID 120)

Speakers
Presentation Number
P0432
Presentation Topic
Epidemiology

Abstract

Background

Many people with multiple sclerosis (MS) modify their dietary intake, but there is low evidence that this influences MS disease activity or progression.

Objectives

We examined whether indices of diet quality (Dietary Quality Tracker and Australian Recommended Food Score) were associated with depression, anxiety and fatigue using a prospective cohort.

Methods

The Auslong Study participants were followed annually for 10 years (n=223 with MS at 10 years). Depression & anxiety (Hospital Anxiety & Depression Scale, HADS) and fatigue (Fatigue Severity Scale) were assessed at the 5th and 10th-year reviews. Dietary intake in the preceding 12 months using the Cancer Council Victoria Food Frequency Questionnaire was assessed at the baseline, 5th and 10th year reviews.

Results

Overall diet quality at the 5th-year review was not associated with a change in depression, anxiety or fatigue in the subsequent 5 years. However, a higher intake of protein, grain and discretionary foods at the 5th-year review using the Dietary Quality Tracker were associated with an increase in HADS depression score over the subsequent 5 years (e.g. highest vs lowest quartile protein: β=2.14,95%CI=0.91,3.37,p<0.001). Also, a higher legume intake at the 5th-year review was associated with a decrease in HADS anxiety score over the subsequent 5 years( e.g. highest vs lowest quartile: β=-1.92,95%CI=-3.32,-0.53,p=0.01).

Conclusions

Overall diet quality was not associated with a subsequent change in depression, anxiety or fatigue over 5-years but some specific food groups were associated with depression and anxiety. Replication is required before testing these findings with diet intervention programs in people with MS.

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Epidemiology Poster Presentation

P0463 - Healthy-lifestyle-scores associated with lower subsequent fatigue risk in multiple sclerosis using inverse probability treatment weighting (ID 290)

Speakers
Presentation Number
P0463
Presentation Topic
Epidemiology

Abstract

Background

Several lifestyle factors, including smoking, diet, physical activity, BMI, and smoking, have been associated with the onset and progression of multiple sclerosis (MS). Combining these lifestyle factors into scoring indices is an efficient way to assess their collective relationship with clinical outcomes.

Objectives

To examine the association of two lifestyle scores with clinically significant fatigue and change thereof over two years’ follow-up.

Methods

Data on sociodemographic, lifestyle and clinical characteristics surveyed from the international HOLISM cohort of people with MS at baseline and 2.5-year follow-up. Fatigue was defined by Fatigue Severity Scale (FSS), and healthy lifestyle by the Healthy Lifestyle Index Score (HLIS), and SNAP (Smoking, Nutrition, Alcohol, Physical Activity) score. Analyses by standard logistic and inverse probability treatment weighting (IPTW) models adjusted for age, sex, MS type, disability, comorbidity number, immunomodulatory medication use, prescription antifatigue medication use, and ongoing relapse symptoms; change in fatigue models also adjusted for baseline fatigue.

Results

1,160 participants completed the FSS questionnaire at both timepoints, and roughly 62% had fatigue at each timepoint. By logistic regression, baseline HLIS and SNAP were each associated with lower risk of being fatigued at follow-up, persisting on adjustment. Using doubly-robust IPTW these associations were attenuated but high (>11) HLIS (OR=0.91, 95% CI=0.83-1.00) and high (>3) SNAP (OR=0.82, 95% CI=0.74-0.91) were each associated with lower risk of fatigue at follow-up. Evaluating change in fatigue, while higher SNAP score was associated with lower risk of change in fatigue (OR=0.89, 95% CI=0.80-0.97), HLIS was not associated (OR=0.97, 95% CI=0.89-1.06).

Conclusions

In this sample of people with MS, healthy lifestyle scores were consistenyl associated with less fatigue 2.5 years later, though only SNAP score was associated with change in fatigue over this interval.

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Epidemiology Poster Presentation

P0498 - The effect of national disease modifying therapy subsidy policy on long-term disability outcomes in people with multiple sclerosis (ID 1652)

Speakers
Presentation Number
P0498
Presentation Topic
Epidemiology

Abstract

Background

Disease-modifying therapies (DMT), which modify, mediate or suppress the immune system, are a major medication class for treating people with relapsing-onset multiple sclerosis (MS). However, our knowledge about these medications is largely limited to their short-term effects.

Objectives

To determine: 1) the impact of national-level DMT subsidy policy on DMT use and disability in people living with MS (PwMS); and 2) the long-term effects of DMT on disability (EDSS and MSSS) and quality of life (EQ5D5L utility score).

Methods

This project was an ecological, observational cohort study comparing populations in Australia and New Zealand with similar demographics, but markedly different levels of DMT use 10-20 years post-diagnosis. Differences between countries were assessed using standardized differences (Cohen’s d), phi coefficient and Cramer’s V. Associations were assessed with univariable and multivariable (mediation) linear regression models.

Results

We recruited 328 Australian participants, 93.9% of whom had been treated with DMT, and 256 New Zealand participants, 50.4% of whom had been treated with DMT. The Australian cohort had a longer median treatment duration (148 vs 0 months), greater proportion of disease course treated (86% vs 0%), and shorter time between diagnosis and first DMT (3 vs 24 months). The Australian cohort also had lower median EDSS (3.5 vs 4.0) and MSSS (3.05 vs 3.71), and higher quality of life (0.71 vs 0.65) at follow-up. In multivariable models, differences in DMT use significantly mediated the effect of country on disability and quality of life.

Conclusions

This large ecological study provides evidence for the impact of national level policy on DMT use and subsequent disability outcomes in PwMS. It also demonstrates that the protective effect of DMT may mediate the effect of national policy on disability progression and quality of life 10-20 years post-diagnosis in people with relapsing-onset MS.

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Epidemiology Poster Presentation

P0512 - Vitamin-D-supplement use but not sun exposure associated with higher quality of life in multiple sclerosis (ID 208)

Speakers
Presentation Number
P0512
Presentation Topic
Epidemiology

Abstract

Background

Multiple sclerosis (MS) is an autoimmune condition of the central nervous system. Sun exposure and vitamin D are associated with MS onset and progression and may affect quality of life (QoL).

Objectives

To investigate the prospective relationship of sun exposure and vitamin D supplement use with QoL and change thereof from baseline to 2.5 years follow-up in an international cohort of people with MS.

Methods

Sun exposure and vitamin D supplement use were queried at both timepoints. QoL was assessed by MSQOL-54, estimating physical and mental health QoL composite scores, and subdomains within each. Characteristics of QoL at follow-up were assessed by linear regression, adjusted for age, sex, socioeconomic status, comorbidity number, MS type, disability, fatigue, prescription antidepressant medication use, and ongoing relapse symptoms. Baseline predictors of change in QoL were additionally adjusted for baseline QoL score.

Results

Mean baseline QoL composite scores were 61.99 for physical (n=1155) and 70.29 for mental (n=1316) QoL composite score, materially unchanged at follow-up. QoL scores were higher among those taking vitamin D supplements (physical: aβ=3.44, 95% CI=1.17-5.71; emotional: aβ=3.14, 95% CI=0.76-5.51); higher supplementation frequency and dose were more strongly associated with both. Baseline vitamin D supplementation was associated with greater increase in physical (aβ=1.06, 95% CI=0.26-1.86), but not mental health (aβ=0.16,95%CI=-0.96,1.28), QoL. Sun exposure was cross-sectionally associated with higher QoL scores but not with change in QoL.

Conclusions

Vitamin D supplementation, particularly average daily doses over 5000IU/d, were associated with higher QoL and with an increase in physical QoL.

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Observational Studies Poster Presentation

P0851 - Clinical & demographic determinants of self-reported diet program adherence in people living with multiple sclerosis (ID 288)

Speakers
Presentation Number
P0851
Presentation Topic
Observational Studies

Abstract

Background

A range of diets have been recommended for people living with MS, ranging from low or no-meat Swank-inspired diets, to the modified Palaeolithic Wahls diet. While the clinical efficacy of these diets to modulate MS progression is uncertain, the popularity of these diets amongst people living with MS is manifest.

Objectives

To assess the clinical and demographic characteristics of adherence to several diets recommended for people with MS.

Methods

Data derived from the 5-year review of the HOLISM international cohort study. Self-reported adherence to diets were queried, ranging 1-5. Adherence was restricted to ≥12months adherence, and then dichotomised: those reporting 4-5/5 adherence defined 2nd-most adherent, 3-5/5 adherence defined 3rd-most adherent. Determinants of adherence were evaluated by log-binomial regression, adjusted for age, sex, socioeconomic status (SES), education, and fatigue. Due to low numbers, only the Overcoming MS (OMS), Swank and Wahls diets were quantitatively evaluated.

Results

458/952 (48.1%) reported following MS-specific diets for ≥12months; 61.8% followed OMS, 12.7% Swank, 3.5% Wahls, 0.9% Ashton-Embry, 0.9% McDougal, 5.7% other. OMS adherence (2nd-most) was more common among males, higher SES, lower disability, less fatigue, and fewer comorbidities. Wahls adherence (2nd-most) was more common among participants with progressive MS or greater disability. Swank adherence (2nd-most) did not vary by any parameter. Analogous results were found using the 3rd-most adherent definition.

Conclusions

These results indicate that MS-specific diet adherence is common in this patient population, but uptake is highly heterogenous between demographic and clinical subgroups. Further study of diet uptake among MS patients is indicated, particularly as the efficacy of these diets in MS is yet uncertain.

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Observational Studies Poster Presentation

P0878 - Lifestyle characteristics of adherence to diet programs in an international cohort of people with MS (ID 289)

Speakers
Presentation Number
P0878
Presentation Topic
Observational Studies

Abstract

Background

Multiple sclerosis (MS) is a demyelinating condition of the central nervous system of complex aetiology. One such factor implicated in its onset and progression is diet and because of this a number of diet program have been proposed which their creators assert will improve MS.

Objectives

This study sought to investigate the prevalence and characteristics of adherence to several popular diets proposed for people with MS.

Methods

The international observational cohort study, the HOLISM Study, has measured lifestyle and clinical characteristics over 5 years of follow-up. At the 5-year review, 952 participants were queried as to their adherence to 6 diet programs – the Overcoming MS (OMS), Wahls Elimination, Swank, McDougall, Ashton Embry Best Bet, and Palaeolithic diets – adherence constrained to those doing so for at least 12 months. Adherence was defined by two dichotomisations of the 5-point Likert at 3 and 4 of 5. Lifestyle characteristics of adherence to each diet were assessed by log-binomial regression.

Results

OMS adherence was common, with roughly 30-40% adhering, while Swank (5-6%) and Wahls (2-3%) adherence was less frequent and other diets even less (<2%). Higher BMI and smokers were less likely to follow OMS, while participants who were more active, those consuming alcohol or using vitamin D/omega-3 supplements, and who meditated were more likely to adhere. OMS adherers were less likely to consume meat or dairy. Swank adherence was higher among those who were more active and less so among those of higher BMI, but otherwise did not differ by any lifestyle characteristics. Wahls adherence was more common among those consuming alcohol and those who consumed meat but less common among those consuming dairy.

Conclusions

OMS and to a lesser extent Swank and Wahls diets had material followings in this international cohort. Though it was expected all diet adherence would generally track with healthier lifestyle, there was some variability, suggesting that adherence to these diet programs is more likely in certain subgroups.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1007 - Assessing the impact of fatigue, disability, depression on quality of life in adults with multiple sclerosis: a systematic review (ID 1246)

Speakers
Presentation Number
P1007
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Multiple sclerosis (MS) is a chronic, progressive autoimmune disease of the central nervous system. Fatigue, disability, and depression are some of the clinical symptoms of MS that can be debilitating and have a major impact on quality of life (QOL).

Objectives

To conduct a systematic review of evidence related to the relationship of fatigue, disability, and depression with QOL in people with MS (pwMS) over time.

Methods

Medline, EMBASE, PsycINFO, EBMR, and CINHAL were searched for articles published from database inception up to 23 March 2020. The search was restricted to peer-reviewed English-language articles that assessed the impact of at least one of the three symptoms on QOL in pwMS, using validated measurement tools and longitudinal study designs. Two independent reviewers independently identified studies, extracted the data, and rated study quality using Covidence and the ROBINS-E tool. Final studies included were agreed by consensus.

Results

Of 1,880 studies assessed, 12 studies met the inclusion criteria; these were analysed using a descriptive approach due to large heterogeneity in exposure and outcome measures. Only two studies were identified as low risk of bias, while the remaining studies were of serious and moderate risk of bias. Fatigue at baseline was found to have consistent negative associations with QOL, particularly physical QOL. The associations of disability at baseline were most apparent with physical QOL, specifically physical functioning, role, and vitality subdomains. Depression at baseline was found to be predictive of both physical and mental health QOL.

Conclusions

Baseline fatigue, disability, and depression have an overall negative effect on QOL; each symptom affects different subdomains and composites of QOL over time. These symptoms should be carefully screened at initial stages to maintain QOL in pwMS. Future studies with larger sample sizes and longer follow-up periods are needed for a more comprehensive review. Additional research should also consider whether the associations differ across sex, age group, and MS type.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1059 - The effectiveness of mindfulness on quality of life in people with multiple sclerosis: a systematic review. (ID 774)

Speakers
Presentation Number
P1059
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Multiple sclerosis (MS) is a demyelinating autoimmune disease of the central nervous system. MS manifests in a wide range of motor, sensory and other symptoms including fatigue, pain, and cognitive impairments, which may have significant negative impacts on quality of life (QoL). Mindfulness-Based Interventions (MBIs) have been shown to safely improve MS-specific predictors of reduced QoL, including fatigue, anxiety, stress, and depression, in people with MS (pwMS). However, the efficacy and long-term effects of MBIs on QoL, remain unclear.

Objectives

To systematically review the literature for evidence for the effectiveness of MBIs on QoL in pwMS and the long-term effects.

Methods

EMBASE, PsycINFO, and Medline were searched for studies, published from database inception to 2020, that assessed the association of MBIs on QoL in pwMS. Randomized controlled trials (RCTs), quasi-RCTs, and observational studies were included. Study quality was assessed using Cochrane Collaboration Risk of Bias tools.

Results

Of 181 studies identified, seven met the inclusion criteria; five were high-quality RCTs with moderate risks of bias, and two were observational studies with serious risks of bias. Three studies adopted non-active control, three used active control, and one had no control comparison. Interventions and QoL tools varied across studies, the most common being mindfulness-based stress reduction and multiple sclerosis quality of life – 54, respectively. All studies measured QoL pre- and immediate post-intervention. The follow-up periods were between 3-12 months in RCTs. Six of seven studies found MBIs improved overall QoL from baseline to post-intervention. Four studies additionally reported improved mental health QoL, and one reported improved physical QoL. RCTs assessed long-term effects, of which only three reported lasting positive effects of up to 12 months.

Conclusions

This review is the first to investigate the long-term effect of mindfulness in pwMS on QoL. It provides further evidence that MBIs are valuable methods to improve overall and mental health QoL in pwMS, effects which may be long-lasting. The differences in long term-effects may be due to many things, including adherence of mindfulness self-practice among pwMS. Future studies using consistent QoL tools and monitoring intervention adherence are needed.

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Presenter Of 4 Presentations

Epidemiology Poster Presentation

P0463 - Healthy-lifestyle-scores associated with lower subsequent fatigue risk in multiple sclerosis using inverse probability treatment weighting (ID 290)

Speakers
Presentation Number
P0463
Presentation Topic
Epidemiology

Abstract

Background

Several lifestyle factors, including smoking, diet, physical activity, BMI, and smoking, have been associated with the onset and progression of multiple sclerosis (MS). Combining these lifestyle factors into scoring indices is an efficient way to assess their collective relationship with clinical outcomes.

Objectives

To examine the association of two lifestyle scores with clinically significant fatigue and change thereof over two years’ follow-up.

Methods

Data on sociodemographic, lifestyle and clinical characteristics surveyed from the international HOLISM cohort of people with MS at baseline and 2.5-year follow-up. Fatigue was defined by Fatigue Severity Scale (FSS), and healthy lifestyle by the Healthy Lifestyle Index Score (HLIS), and SNAP (Smoking, Nutrition, Alcohol, Physical Activity) score. Analyses by standard logistic and inverse probability treatment weighting (IPTW) models adjusted for age, sex, MS type, disability, comorbidity number, immunomodulatory medication use, prescription antifatigue medication use, and ongoing relapse symptoms; change in fatigue models also adjusted for baseline fatigue.

Results

1,160 participants completed the FSS questionnaire at both timepoints, and roughly 62% had fatigue at each timepoint. By logistic regression, baseline HLIS and SNAP were each associated with lower risk of being fatigued at follow-up, persisting on adjustment. Using doubly-robust IPTW these associations were attenuated but high (>11) HLIS (OR=0.91, 95% CI=0.83-1.00) and high (>3) SNAP (OR=0.82, 95% CI=0.74-0.91) were each associated with lower risk of fatigue at follow-up. Evaluating change in fatigue, while higher SNAP score was associated with lower risk of change in fatigue (OR=0.89, 95% CI=0.80-0.97), HLIS was not associated (OR=0.97, 95% CI=0.89-1.06).

Conclusions

In this sample of people with MS, healthy lifestyle scores were consistenyl associated with less fatigue 2.5 years later, though only SNAP score was associated with change in fatigue over this interval.

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Epidemiology Poster Presentation

P0512 - Vitamin-D-supplement use but not sun exposure associated with higher quality of life in multiple sclerosis (ID 208)

Speakers
Presentation Number
P0512
Presentation Topic
Epidemiology

Abstract

Background

Multiple sclerosis (MS) is an autoimmune condition of the central nervous system. Sun exposure and vitamin D are associated with MS onset and progression and may affect quality of life (QoL).

Objectives

To investigate the prospective relationship of sun exposure and vitamin D supplement use with QoL and change thereof from baseline to 2.5 years follow-up in an international cohort of people with MS.

Methods

Sun exposure and vitamin D supplement use were queried at both timepoints. QoL was assessed by MSQOL-54, estimating physical and mental health QoL composite scores, and subdomains within each. Characteristics of QoL at follow-up were assessed by linear regression, adjusted for age, sex, socioeconomic status, comorbidity number, MS type, disability, fatigue, prescription antidepressant medication use, and ongoing relapse symptoms. Baseline predictors of change in QoL were additionally adjusted for baseline QoL score.

Results

Mean baseline QoL composite scores were 61.99 for physical (n=1155) and 70.29 for mental (n=1316) QoL composite score, materially unchanged at follow-up. QoL scores were higher among those taking vitamin D supplements (physical: aβ=3.44, 95% CI=1.17-5.71; emotional: aβ=3.14, 95% CI=0.76-5.51); higher supplementation frequency and dose were more strongly associated with both. Baseline vitamin D supplementation was associated with greater increase in physical (aβ=1.06, 95% CI=0.26-1.86), but not mental health (aβ=0.16,95%CI=-0.96,1.28), QoL. Sun exposure was cross-sectionally associated with higher QoL scores but not with change in QoL.

Conclusions

Vitamin D supplementation, particularly average daily doses over 5000IU/d, were associated with higher QoL and with an increase in physical QoL.

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Observational Studies Poster Presentation

P0851 - Clinical & demographic determinants of self-reported diet program adherence in people living with multiple sclerosis (ID 288)

Speakers
Presentation Number
P0851
Presentation Topic
Observational Studies

Abstract

Background

A range of diets have been recommended for people living with MS, ranging from low or no-meat Swank-inspired diets, to the modified Palaeolithic Wahls diet. While the clinical efficacy of these diets to modulate MS progression is uncertain, the popularity of these diets amongst people living with MS is manifest.

Objectives

To assess the clinical and demographic characteristics of adherence to several diets recommended for people with MS.

Methods

Data derived from the 5-year review of the HOLISM international cohort study. Self-reported adherence to diets were queried, ranging 1-5. Adherence was restricted to ≥12months adherence, and then dichotomised: those reporting 4-5/5 adherence defined 2nd-most adherent, 3-5/5 adherence defined 3rd-most adherent. Determinants of adherence were evaluated by log-binomial regression, adjusted for age, sex, socioeconomic status (SES), education, and fatigue. Due to low numbers, only the Overcoming MS (OMS), Swank and Wahls diets were quantitatively evaluated.

Results

458/952 (48.1%) reported following MS-specific diets for ≥12months; 61.8% followed OMS, 12.7% Swank, 3.5% Wahls, 0.9% Ashton-Embry, 0.9% McDougal, 5.7% other. OMS adherence (2nd-most) was more common among males, higher SES, lower disability, less fatigue, and fewer comorbidities. Wahls adherence (2nd-most) was more common among participants with progressive MS or greater disability. Swank adherence (2nd-most) did not vary by any parameter. Analogous results were found using the 3rd-most adherent definition.

Conclusions

These results indicate that MS-specific diet adherence is common in this patient population, but uptake is highly heterogenous between demographic and clinical subgroups. Further study of diet uptake among MS patients is indicated, particularly as the efficacy of these diets in MS is yet uncertain.

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Observational Studies Poster Presentation

P0878 - Lifestyle characteristics of adherence to diet programs in an international cohort of people with MS (ID 289)

Speakers
Presentation Number
P0878
Presentation Topic
Observational Studies

Abstract

Background

Multiple sclerosis (MS) is a demyelinating condition of the central nervous system of complex aetiology. One such factor implicated in its onset and progression is diet and because of this a number of diet program have been proposed which their creators assert will improve MS.

Objectives

This study sought to investigate the prevalence and characteristics of adherence to several popular diets proposed for people with MS.

Methods

The international observational cohort study, the HOLISM Study, has measured lifestyle and clinical characteristics over 5 years of follow-up. At the 5-year review, 952 participants were queried as to their adherence to 6 diet programs – the Overcoming MS (OMS), Wahls Elimination, Swank, McDougall, Ashton Embry Best Bet, and Palaeolithic diets – adherence constrained to those doing so for at least 12 months. Adherence was defined by two dichotomisations of the 5-point Likert at 3 and 4 of 5. Lifestyle characteristics of adherence to each diet were assessed by log-binomial regression.

Results

OMS adherence was common, with roughly 30-40% adhering, while Swank (5-6%) and Wahls (2-3%) adherence was less frequent and other diets even less (<2%). Higher BMI and smokers were less likely to follow OMS, while participants who were more active, those consuming alcohol or using vitamin D/omega-3 supplements, and who meditated were more likely to adhere. OMS adherers were less likely to consume meat or dairy. Swank adherence was higher among those who were more active and less so among those of higher BMI, but otherwise did not differ by any lifestyle characteristics. Wahls adherence was more common among those consuming alcohol and those who consumed meat but less common among those consuming dairy.

Conclusions

OMS and to a lesser extent Swank and Wahls diets had material followings in this international cohort. Though it was expected all diet adherence would generally track with healthier lifestyle, there was some variability, suggesting that adherence to these diet programs is more likely in certain subgroups.

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