Author Of 2 Presentations
P0375 - Quantifying the risk of disease reactivation after DMT discontinuation – the VIAADISC score (ID 765)
There is a lack of evidence guiding treatment decisions regarding discontinuation of disease-modifying therapy (DMT) in multiple sclerosis (MS)
To generate and validate a composite (clinical and MRI-based) score able to identify individual patients with relapsing MS (RMS) with a high risk of experiencing disease reactivation after discontinuation of DMT.
The study was conducted using a generation and a validation dataset drawn from two separate prospectively collected observational databases. We included RMS patients who received interferon-beta or glatirameracetate for ≥12 months, then discontinued DMT for ≥6 months and had ≥2 years of follow-up available. In the generation sample (n=168), regression analysis was performed to identify clinical or MRI variables independently predicting disease reactivation after DMT discontinuation. A predictive score was calculated using the variables included in the multivariable model. This score was then applied to the validation sample (n=98).
The variables included in the final model as independent predictors of disease reactivation were age at discontinuation (p<0.001), MRI activity at discontinuation (p<0.001), and duration of clinical stability (p<0.001). The resulting score (Vienna Innsbruck DMT discontinuation score based on age, activity on MRI and duration in stable course; VIAADISC) was able to identify patients at high (83-84%), moderate (35-38%) and low risk (7%) of disease reactivation within 5 years after DMT discontinuation both in the generation and in the validation cohorts.
The composite VIAADISC score may be a valuable tool informing patients and neurologists in the face of deciding if and when to discontinue injectable DMTs.
P1054 - Sexual dysfunction in multiple sclerosis: who is at risk? (ID 1793)
Multiple sclerosis (MS) related disability and sexual dysfunction (SD) are known to lower a patient’s health related quality of life (HRQoL) detrimentally. However, taking a sexual history in routine care is commonly evaded. Furthermore, there is not much knowledge on SD being either an independent symptom or merely a byproduct of other symptoms such as depression or anxiety.
To investigate the prevalence of SD in patients with MS and unveil possible associations with disease parameters, depression, anxiety and HRQoL.
We present results from a cross-sectional study of 93 patients with MS. SD was determined based on the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and correlated with physical disability (Expanded disability status scale, EDSS), depression and anxiety (Hospital Anxiety and Depression Scale, HADS), and HRQoL (Multiple Sclerosis Quality of Life-54 questionnaire, MSQoL-54).We present results from a cross-sectional study of 93 patients with MS. SD was determined based on the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and correlated with physical disability (Expanded disability status scale, EDSS), depression and anxiety (Hospital Anxiety and Depression Scale, HADS), and HRQoL (Multiple Sclerosis Quality of Life-54 questionnaire, MSQoL-54).
The mean (standard deviation) age in our cohort was 39 (11.4) years and sex distribution was 3:2 (f:m). At the time of enrollment, two thirds of patients had relapsing MS. The median (IQR) EDSS was 2.0 (0-4.5) with one third of patients being rated as 4.0 or higher. SD was reported by 43 (46%) patients on the MSISQ-19. Out of all included patients, 32 (34%) suffered from anxiety and 15 (16%) from depression. In comparison of patients with and without SD, we found that patients affected by SD were significantly more likely to be depressed (28% vs. 6%, p=0.005) and had a higher median [IQR] EDSS (1 [1-3] vs. 4 [1.5-6], p<0.001). HRQoL was significantly poorer in patients with MS suffering from SD (median [IQR] MSQoL-54 scores: physical subscale 52 [41-68] vs. 81 [69-89], p<0.001; mental subscale 50 [38-82] vs. 86 [70-89], p<0.001). Furthermore, SD occurred more frequently in the progressive phase of the disease. We found no associations between sexual functioning and age, sex or MS disease duration. In a multivariate linear regression model, we found the risk for SD to be 18.1-fold higher (95%CI 3.3-31.4, p<0.001) in patients with EDSS≥4, while neither depression nor anxiety were independent predictors of SD.
SD is common among people with MS and should be addressed in clinical routine. The risk for SD is growing substantially with increasing EDSS while being independent of depression and anxiety. SD is clearly associated with poorer HRQoL. Nonetheless, guidelines for a structured approach, patient needs and treatment strategies should be investigated further.