Author Of 2 Presentations
P0018 - Variability of the response to immunotherapy among sub-groups of patients with multiple sclerosis (ID 1239)
- I. Diouf
- C. Malpas
- D. Horakova
- E. Kubala Havrdová
- F. Patti
- V. Shaygannejad
- S. Ozakbas
- G. Izquierdo
- S. Eichau
- M. Zakaria
- M. Onofrj
- A. Lugaresi
- R. Alroughani
- A. Prat
- M. Girard
- P. Duquette
- M. Terzi
- C. Boz
- F. Grand'Maison
- S. Hamdy
- P. Sola
- D. Ferraro
- P. Grammond
- R. Turkoglu
- H. Butzkueven
- B. Yamout
- A. Altintas
- V. Van Pesch
- D. Maimone
- J. Lechner-Scott
- R. Bergamaschi
- R. Karabudak
- F. Giuliano
- C. McGuigan
- E. Cartechini
- M. Barnett
- S. Hughes
- M. Sa
- L. Kappos
- C. Ramo-Tello
- E. Cristiano
- S. Hodgkinson
- D. Spitaleri
- A. Soysal
- T. Petersen
- M. Slee
- E. Butler
- F. Granella
- F. Verheul
- P. McCombe
- R. Ampapa
- O. Skibina
- J. Prevost
- L. Sinnige
- J. Sánchez-Menoyo
- S. Vucic
- G. Laureys
- L. Van Hijfte
- D. Khurana
- R. Macdonell
- T. Castillo-Trivino
- O. Gray
- E. Agüera
- I. Kister
- C. Shaw
- N. Deri
- T. Al-Harbi
- Y. Fragoso
- T. Csepany
- A. Sempere
- T. Kalincik
Abstract
Background
Our current understanding of demographic and clinical modifiers of the effectiveness of multiple sclerosis (MS) therapies is limited.
Objectives
To assess whether patients’ response to disease modifying therapies (DMT) in MS varies by disease activity (annualised relapse rate, presence of new MRI lesions), disability, age, MS duration or disease phenotype.
Methods
Using the international MSBase registry, we selected patients with MS followed for ≥1 year, with ≥3 visits, ≥1 visit per year. Marginal structural models (MSMs) were used to compare the hazard ratios (HR) of 6-month confirmed worsening and improvement of disability (EDSS), and the incidence of relapses between treated and untreated periods. MSMs were continuously re-adjusted for patient age, sex, pregnancy, date, time from first symptom, prior relapse history, disability and MRI activity.
Results
Among 23 687 patients with relapsing MS, those on DMT experienced 20% greater chance of disability improvement [HR 1.20 (95% CI 1.0-1.5)], 47% lower risk of disability worsening [HR 0.53 (0.39-0.71)] and 51% reduction in relapses [HR 0.49 (0.43-0.55)]. The effect of DMT on relapses and EDSS worsening was attenuated with longer MS duration and higher prior relapse rate. The effect of DMT on EDSS improvement and relapses was more evident in low EDSS categories. DMT was associated with 51% EDSS improvement in patients without new MRI lesions [HR 1.51 (1.00-2.28)] compared to 4% in those with MRI activity [HR 1.04 (0.88-1.24)]. Among 26329 participants with relapsing or progressive MS, DMT was associated with 25% reduction in EDSS worsening and 42% reduction in relapses in patients with relapsing MS [HR 0.75 (0.65-0.86) and HR 0.58 (CI 0.54-62), respectively], while evidence for such beneficial effects of treatment in patients with progressive MS was not found [HR 1.11 (0.91-1.46) and HR 1.16 (0.91-1.46), respectively].
Conclusions
DMTs are associated with reduction in relapse frequency, progression of disability, and increased chance of recovery from disability. In general, the effectiveness of DMTs was most pronounced in subgroups with shorter MS duration, lower EDSS, lower relapse rate and relapsing MS phenotype.
P0631 - Recommendations for the coordination of Neurology and Neuroradiology departments in the management of patients with multiple sclerosis (ID 314)
Abstract
Background
Magnetic resonance imaging (MRI) is widely used for the diagnosis and follow-up of patients with multiple sclerosis (MS). It is considered the most reliable and accurate paraclinical tool to evaluate disease activity and progression due to the high sensitivity to detect demyelinating lesions. Coordination between Neurology and Neuroradiology departments is essential to ensure that radiological studies are effectively performed and interpreted. However, in clinical practice, this coordination can be improved to maximize MS management and care.
Objectives
To establish a set of organizational recommendations focused on the coordination between neurologists and neuroradiologists to improve MS management in clinical practice.
Methods
A panel of 17 experts, including neurologists and neuroradiologists, from eight Spanish academic hospitals participated in the study. The Consensus Recommendation Guideline was conducted in four phases: 1) definition of the scope and methodology of the study; 2) review of the literature on good practices or recommendations in the use of MRI in MS; 3) discussion of drafted recommendations to achieve a consensus between the authors; 4) formalization and validation of the contents in a set of recommendations.
Results
We provide nine recommendations to improve the coordination between Neurology and Neuroradiology departments, which can be summarized as follows: 1) standardize the MRI requests, reports and schedules, 2) create shared protocols for MRI studies, 3) establish multidisciplinary working committees and coordination sessions, and 4) generate formal communication channels to improve the coordination between professionals from both departments. These recommendations are based on the available scientific evidence, international good practice guidelines and the experience of the panel experts.
Conclusions
We propose a series of recommendations expected to serve as a functional guide to implement improvements in the coordination between neurologists and neuroradiologists that will ultimately lead to improve the diagnosis and follow-up of MS patients.