R. Alonso
Hospital Ramos Mejía
Neurología

Author Of 1 Presentation

 Program
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

Speakers
Authors
Presentation Number
SS02.04
Presentation Topic
COVID-19
Lecture Time
11:21 - 11:33

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 16 Presentations

 On-Demand Program
Internet and Social Media Poster Presentation

LB1157 - Experiences of Latin American MS and/or NMOSD experts in practice during the COVID-19 pandemic: focus in Telemedicine. (ID 1198)

Speakers
Authors
Presentation Number
LB1157
Presentation Topic
Internet and Social Media

Abstract

Background

Different scientific associations have elaborated recommendations about MS and/or NMOSD patients care and management during COVID-19 pandemic. They advised to take extra care to minimize their exposure to the virus and use alternatives to face-to-face medical appointments. This has prompted a transition of conventional care to telemedicine (TM) as quickly as possible. There is no data regarding current patient’s follow-up neither TM usage among MS and/or NMOSD Latin American experts.

Objectives

To investigate experiences from Latin American MS and/or NMOSD experts on follow-up of their patients focusing on TM management.

Methods

A cross-sectional study was performed. 141 MS and/or NMOSD experts from Argentina (AR), Chile (CH), Colombia (CO) and Brazil (BR) were invited to answer an anonymous, voluntary web-based survey. The survey was sent via email (3 July 2020) to potential respondents and was available online for only one week to avoid bias regarding epidemic change in our region.

Results

A total of 129 (91.48 %) experts completed the survey (56 from AR, 33 BR, 30 CH, and 10 CO), age 41.23 ±10.20, 43.4% works at public hospital. Regarding medical appointments (virtual or face-to-face), it decreased on a 50% during the pandemic era (14.78 ±16.71 and 7.43 ±9.68 patients/week before and during the COVID-19 pandemic respectively). Only 19.4% had experience in TM previous COVID-19 pandemic (26.8% AR, 0% BR, 23.3% CH, and 30% CO), while 79.8% are currently using TM (89.3% AR, 75.8% BR, 60% CH, and 100% CO). Most of them using video call (52.3%). Using TM, 44.1% of the experts were able to carry out neurological examination, 85.6% believe be able to identify a relapse, 48.6% use Patient Determined Disease Steps (PDDS) and 38.7% continue using the conventional Expanded Disability Status Scale (EDSS). On the other hand, 83.7% continue face-to-face medical appointment, the most frequent causes were: first time appointment (91.8%), therapeutic failure (94.%) and management of a relapse (97.3%) and only 20% for the routine appointment. To decrease virus exposure, only 40% perform a complete and thorough neurological evaluation, most of them avoid funduscopy.

Conclusions

Considering the vertiginous speed of the spread of COVID-19 in Latin American, results from our survey demonstrate preparedness and responsiveness among Latin American MS and/or NMOSD experts. Despite scarce prior TM experience, most experts were able to use TM as a new tool for monitoring their patients.

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Disease Modifying Therapies – Risk Management Poster Presentation

P0301 - Beyond pivotal trials inclusion criteria: real world clinical profile of multiple sclerosis patients under disease modifying treatment in Argentina. (ID 851)

Speakers
Authors
Presentation Number
P0301
Presentation Topic
Disease Modifying Therapies – Risk Management

Abstract

Background

Background: In multiple sclerosis (MS), randomized controlled trials (RCT) have provided relevant information about the efficacy and safety in ideal scenarios. While RCT are powerful tools for developing scientific evidence based on their high internal validity, there is always uncertainty about the generalizability, especially since the populations enrolled in such studies may differ in significant ways from those seen in clinical practice.

Objectives

Objective: to describe the frequency and clinical profile of MS patients under disease modifying treatment in Argentina that would have not fulfilled inclusion criteria in RCT.

Methods

Methods: MS patients included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177) were analyzed. RelevarEM is a longitudinal, strictly observational MS and NMOSD registry in Argentina. From May 2018 to March 2020, the centers and principal investigators were contacted and incorporated into the Registry. All patients with definite MS and receiving DMT at 31 December 2019 were screened, those with EDSS >6, phenotypes secondary progressive (SP) and primary progressive (PP)(with other DMT than ocrelizumab) and age <18 and >55 years old were included in the analysis.

Results

Results: A total of 1782 patients with MS receiving DMT were screened, of whom 465 (26%)would not have been included in a pivotal trial. From the 465,218 had and EDSS >6, 67 had phenotype SP and 19 PP; 292 were patients with <18 and >55 years of age (2 under 18 years old). Most prescribed DMT among patients with EDSS >6 was fingolimod (31%), among age >55 was beta interferon (35%), phenotype SP fingolimod (30%) and PP fingolimod and glatiramer acetate (each 26%).

Conclusions

Conclusion: in our registry, we found a significant number of MS patients who would have not been included in pivotal trials, receiving DMT. Real life evidence is highly relevant to assess effectiveness as well as safety of DMT in this subset of patients.

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Epidemiology Poster Presentation

P0427 - Absence of latitudinal gradient in oligoclonal bands prevalence in Argentina (ID 858)

Speakers
Authors
Presentation Number
P0427
Presentation Topic
Epidemiology

Abstract

Background

Similarly, to what occurs with MS prevalence, it has been previously described that oligoclonal bands (OCB) prevalence follows a latitudinal gradient being more frequent farther away from the equator. Argentina has the particularity of being longitudinally extensive (21°46’S to 66°13’S). Previous epidemiological studies from Argentina have not found an MS prevalence latitudinal gradient.

Objectives

The aim of the present study is to describe the prevalence of OCB in CSF in patients with MS, CIS and RIS included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177) and to investigate if the prevalence follows a latitudinal gradient.

Methods

RelevarEM is a longitudinal, observational MS and NMOSD registry in Argentina. For each province, an average latitude was calculated using extreme N and S latitudes obtained from Google Maps. Regarding OCB, pattern II or III where considered as positive. The frequency of OCB was calculated for each diagnostic category (MS, CIS, RIS) and for each province. Statistical analysis was carried out using SPSS v22. Multivariate logistical regression analysis was performed considering OCB as a dichotomic dependent variable and latitude as an ordinal independent variable, adjusted by clinically relevant variables. Also, the percentage of patients OCB positive for each province was calculated and linear correlation was tested.

Results

We included 2866 patients from different locations in Argentina (92.4% MS, 5.8% CIS and 1.8% RIS). The mean age at diagnosis (SD) was 32.7 (11.2), 35.2 (10.7) and 40.7 (11.2) for MS, CIS and RIS patients, respectively. Lumbar puncture was performed in 54.6%, 63.9%, and 43.4% of MS, CIS and RIS patients, respectively. OCB where positive in 75.4%, 55.7% and 60.9% of MS, CIS and RIS patients, respectively. No association was found between OCB positivity and latitude, adjusted by gender, age at diagnosis and diagnostic category. No linear correlation was found between the percentage of OCB positive patients and latitude.

Conclusions

Similarly, to what has been described regarding MS prevalence, OCB positivity does not seem to follow a latitudinal gradient in Argentina. Also, OCB positivity in our study is lower that described in previous reports from other world regions.

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Comorbidities Poster Presentation

P0483 - Prevalence of cancer in multiple sclerosis patients in Argentina: cross sectional study from RelevarEM (ID 1043)

Speakers
Authors
Presentation Number
P0483
Presentation Topic
Comorbidities

Abstract

Background

Multiple Sclerosis (MS) is an autoimmune demyelinating and neurodegenerative disease of the central nervous system of multifactorial origin. Studies about the prevalence of cancer in MS population are scarce and results are conflicting. Previous studies described a higher prevalence as well as an increased risk of cancer in MS patients while there are others that found no differences regarding general population.

Objectives

The aim of our study was to estimate the prevalence of cancer in a large sample of multiple sclerosis patients in Argentina.

Methods

the eligible study population and cohort selection included all patients with definite MS included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177) at 31 December 2019. History of current or past cancer diagnosis, was collected. Prevalence rates and 95% CI were calculated.

Results

We analyzed 2647 MS patients. 14 malignancies were identified. Overall prevalence of cancer was 0.53% (CI95% 0.02-0.08%). 78.6% were female, 85.8% relapsing remitting MS, median (IQR) disease duration: 10.5 (6-13) years; median (IQR) age at diagnosis: 42.5 (37-49); median (IQR) age at study date: 52.5, median (IQR); current EDSS: 2 (1.5-4.5); 42% patients were untreated and 58% under DMT (beta interferon 1a: 14.3%, 1b: 7.1%, glatiramer acetate: 7.1% and fingolimod: 28.6%). Most frequent malignancy was breast cancer (28.6%).

Conclusions

The prevalence of cancer in MS population identified in Argentina was 0.53% (CI 95% 0.02-0.08), being females more affected than males and breast cancer the most frequent one.

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Epidemiology Poster Presentation

P0493 - Severe infections in patients with multiple sclerosis: a nationwide registry study in Argentina (ID 929)

Speakers
Authors
Presentation Number
P0493
Presentation Topic
Epidemiology

Abstract

Background

Data on the rates of infections among patients with multiple sclerosis (MS) are sparse and even more from Latin American countries.

Objectives

The objective of this study was to quantify the incidence of severe infections (SI) in patients with MS included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177).

Methods

RelevarEM is a longitudinal, strictly observational MS and NMOSD registry in Argentina. From May 2018 to March 2020, the centers and principal investigators were contacted and incorporated into the Registry. SI were defined as those that required intravenous treatment or that led to hospitalization or death. Patients contributed person-years of follow-up for the study period. Incidence rates and 95% CI were calculated.

Results

A total of 2158 patients with MS were included, mean age 42 (IIQ 34-52), 65,5% (1576) were female, 82,3% were RRMS. During the period (May 2018-March 2020), 28 SI were reported (IR 1.16, 95%CI 0.77-1.68). In patients with SI, the mean age was 54 (min 43- max 63, p<0.01) years, 11 (39%) were secondary progressive MS (p<0.01), the mean EDSS was 6.5 (range 5-8)(p<0.01), mean disease duration 12 years (p<0.01). 42% of patients were free of MS treatment while 17% were on injectables, 25% on orals and 10% on monoclonal antibodies (p=0.24). The most common sites of severe infection were the lower respiratory tract (39%)

Conclusions

IR of severe infection during the study period was 1.16 (95%CI 0.77-1.68). Most frequent SI were in SPMS and older patients while no relation was observed regarding MS treatment.

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Neuro-Ophthalmology Poster Presentation

P0768 - Optical Coherence Tomography and unconventional neuro-ophthalmological evaluation of patients with Multiple Sclerosis (ID 1536)

Speakers
Authors
Presentation Number
P0768
Presentation Topic
Neuro-Ophthalmology

Abstract

Background

The afferent visual pathway (AVP) is frequently affected in Multiple Sclerosis (MS) patients and visual quality of life (VQL) is commonly compromised, also with no history of optic neuritis (ON). High contrast visual acuity (HCVA) and confrontation visual field (VF) exam are performed in clinical practice to assess visual impairment. However, this tests may be normal in a high percentage of patients with visual complaints. Therefore, this evaluation methodology has a low sensitivity to detect AVP impairment in MS patients.

Objectives

To conduct an objective and subjective assessment of the AVP in MS patients in order to find a more sensitive parameter that demonstrate its damage.

Methods

A prospective cohort study was conducted. Neuro-ophthalmological assessment was performed: HCVA (Snellen chart), color vision (Ishihara chart), LCLA (Pelli-Robson chart) and confrontation VF exam. VQL questionnaire was performed using the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25I) from which a numerical scale is obtained according to the VFQ25 Score Algorithm. Optical Coherence Tomography (OCT) study was performed using a spectral domain equipment. Statistical analysis was performed using the SPSS package.

Results

We evaluated 117 eyes of 59 patients, 59% were women, mean age 38 years, 91% with relapsing remitting MS. Visual complaints were present in 83%. Of 117 eyes, 30% had history of ON, HCVA was normal in 92% and LCLA was altered in 63%. Color vision and VF exams were normal in 82% and 97% respectively. The VQL was mild affected in 75% of the patients and moderate in 17%, the rest were normal. We found a correlation between NEI-VFQ-25I results and LCLA (r = 0.52 p = 0.013) not found with HCVA or VF exam. OCT was performed in 71 eyes, of which 25.3% had history of ON. The RNFL thinning was found in 50.7% and the temporal quadrant was the most frequently altered (70.4%). The GCL thinning was observed in 58.3%. We found a correlation between RNFL and GCL thickness (r = 0.325, p <0.01) and between decreased RNFL thickness with LCLA deterioration (r = - 0.389, p <0.01), as well as between RNFL thickness and HCVA (r = 0.336, p <0.01).

Conclusions

We detected a high percentage of patients with AVP compromise and normal conventional evaluation. Since we found a correlation between LCLA, NEI-VFQ-25I and OCT we consider the relevance of its use in clinical practice routine to assess visual function. We could demonstrate that those are more sensitive measurable parameters of visual disability in MS patients.

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Neuropsychology and Cognition Poster Presentation

P0804 - Dual task during walking in patients with Multiple Sclerosis: cognitive or motor interference?

  (ID 1453)

Speakers
Authors
Presentation Number
P0804
Presentation Topic
Neuropsychology and Cognition

Abstract

Background

Impairment in dual task (DT) activities has been previously reported in patients with multiple sclerosis (MS). Most studies analyze DT during walking whether incorporating a second cognitive or motor task. More research is needed in order to define what type of task (cognitive or motor) determines the severity of the interference produced in the DT.

Objectives

1) To compare DT performance between patients with MS and healthy controls. 2) To analyze DT performance according to the type of task that interferes (cognitive or motor).

Methods

94 patients with relapsing remitting MS and 25 healthy controls (HC) were included. Patient age: 38.61 ± 11.44; Education: 13.26 ± 3.77; Disability (EDSS): 2.13 ± 1.16; Evolution: 9.66 ± 8.96. HC age: 34.00 ± 14.25; Education: 14.50 ± 2.65. Measuring instruments: Clinical variables: EDSS; Fatigue severity scale; Beck Depression Inventory II. Cognitive variables: BICAMS battery; DT: cognitive-motor task (walking while performing cognitive task) and motor-motor task (walking while performing motor task). The difference between performance in the single task and in the dual task situation was obtained. Parametric and non-parametric statistics were used, to define significance a value of p <0.05 was accepted

Results

: patients and HC did not differ in age (p = 0.12) and education (p = 0.11). Patient presented poorer performance than HC in cognitive-motor DT (U: between 334.50 and 238.50; p <0.05) but not in motor-motor DT (p> 0.05). Patients with EDSS> 2, presented lower performance than the controls in both types of task (p <0.05). The motor-motor task differentiated patients with EDSS <y> 2 (t: 2.85 and 3.51; p <0.05).

Conclusions

MS patients show impairment in the DT performance when the second task is cognitive. In patients with greater disability, alteration is found in both DT. Studying patient’s performance in DT allows a more ecological approach to their symptoms in order to directly intervene in daily life alterations.

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Neuropsychology and Cognition Poster Presentation

P0819 - Perceived Social Support in Multiple Sclerosis: Impact on patient’s quality of life. (ID 1241)

Speakers
Authors
Presentation Number
P0819
Presentation Topic
Neuropsychology and Cognition

Abstract

Background

Social support plays an extremely important role in treatment and evolution of patients with multiple sclerosis (MS). However, there are scarce data that describes the size and quality of social network in MS patients, as well as its impact on their quality of life.

Objectives

(a) to analyze differences in perceived social support (PSS) between MS patients and healthy controls. (b) to study the associations between PSS and clinical and health-related quality of life (HRQoL) variables in MS patients, and (c) to analyze the influence of PSS on HRQoL.

Methods

151 MS patients and 89 healthy controls (HC) were studied. HC: Age: 42.01±12.25 years; Education: 14.60±2.44 years; Patients: Age: 41.46±9.97; Education:14.05±3.26 years; EDSS:2.88±2.10; Disease evolution:12.46±10.07 years. Instruments: PSS: MOS (Medical Outcomes Study Social Support Survey); Clinical Variables: EDSS, Fatigue Scale (FSS); Depression Inventory (BDI-II); HRQoL: MusiQol. Parametric and non-parametric statistics were used, significance p value<0.05.

Results

Patients presented lower scores than HC in global score of PSS (t(238)=- 1.99, p=0.04) and in each functional dimension (t(238)=between-2.59 and -2.09, p<0.05). Associations were found between PSS with depression and fatigue (r = between-0.20 and -0.29, p <0.05) and with the different dimensions of the MusiQol (r = between-0.18 and 0.48, p <0.05). In multiple regression analysis, the four models tested contributed significantly to the explained variance of HRQoL (between 41 and 47%). The model constituted with emotional/informational support explained the greatest variation of HRQoL (47%).

Conclusions

Patients with MS perceive a decrease in their social support impacting on their quality of life. This should be considered for a better therapeutic approach.

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Observational Studies Poster Presentation

P0836 - Aggressive multiple sclerosis in Argentina: data from the nationwide registry RelevarEM (ID 1632)

Speakers
Authors
Presentation Number
P0836
Presentation Topic
Observational Studies

Abstract

Background

Aggressive MS (AMS) describes a form of the disease with a rapid progressive course leading to significant disability in multiple neurologic systems or even death in a relatively short time after onset. Despite there being no consensus on the exact definition of AMS, several studies performed during the last years have tried to better identify and understand the frequency and distribution as well as the progression and treatment response in order to determine more accurately which patients with AMS would most benefit from higher-efficacy, higher-risk treatments

Objectives

The objectives of the present study were to describe the frequency of aggressive multiple sclerosis (AMS) as well as to compare clinical and radiological characteristics in AMS and non-AMS patients included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177).

Methods

The eligible study population and cohort selection included adult-onset patients (≥18 years) with definite MS. AMS were defined as those reaching confirmed EDSS ≥6 within 5 years from symptom onset. Confirmation was achieved when a subsequent EDSS ≥6 was recorded at least six months later but within 5 years of the first clinical presentation. AMS and non-AMS were compared using the χ2 test for categorical and the Mann-Whitney for continuous variables at MS onset and multivariable analysis was performed using forward stepwise logistic regression with baseline characteristics at disease onset.

Results

A total of 2158 patients with MS were included: 74 AMS and 2084 non-AMS. The prevalence of AMS in our cohort was 3.4% (95%CI 2.7-4.2). AMS were more likely to be male (p=0.003), older at MS onset (p<0.001), have primary progressive MS (PPMS) phenotype (p=0.03), multifocal presentation (p<0.001), and spinal cord as well as infratentorial lesions at MRI during disease onset (p=0.004 and p=0.002, respectively).

Conclusions

3.4% of our patient population could be considered AMS. Men, patients older at symptom onset, multifocal presentation, PPMS phenotype, and spinal cord as well as brainstem lesion on MRI at clinical presentation all had higher odds of having AMS.

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Observational Studies Poster Presentation

P0905 - Real-world experience of ocrelizumab in multiple sclerosis patients in Latin America (ID 1307)

Speakers
Authors
Presentation Number
P0905
Presentation Topic
Observational Studies

Abstract

Background

Ocrelizumab was approved in March 2017 for the treatment of relapsing or primary progressive MS. Despite the abundance of information concerning the efficacy and safety of ocrelizumab in phase III clinical trials, there is scarce evidence regarding real world patient profiles

Objectives

The aim of this study was to evaluate patient profiles, effectiveness and persistence to treatment in patients who used ocrelizumab for the treatment of multiple sclerosis (MS) in Latin America (LATAM)

Methods

retrospective multicenter study in Argentina, Chile and Mexico. Medical record databases of patients who received ocrelizumab and were followed for at least 1 year before and after treatment initiation were analyzed. Demographic and clinical variables were described as well as the effectiveness outcomes that included the proportion of patients free from clinical relapses, from disability progression, from new or enlarging T2 or T1 gadolinium-enhancing lesions on annual MRI. The proportion of patients discontinuing the treatment and the reason were registered.

Results

A total of 81 patients were included. The most frequent phenotype was relapsing remitting MS in 64.2% of patients. The mean age at study entry was 41.3 ± 12 years and 51.8 % were women. A total of 38% had relapse activity during the previous 12 months of ocrelizumab initiation, with a mean relapse rate of 1.3 ±0.6 during that period. 75 % were free from clinical relapses and 91% were free from gadolinium enhancing lesions in RRMS. Ocrelizumab discontinuation during the first 12 months was observed in 3 patients (3.7%). The mean persistence observed during the first year follow up was 338 ± 24 days.

Conclusions

Our study is in line with previous randomized clinical trials and recent real-world studies describing patient profiles effectiveness and persistence to ocrelizumab treatment in MS patients in LATAM.

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Observational Studies Poster Presentation

P0930 - Usage trend of oral drugs for multiple sclerosis in Argentina (ID 1183)

Speakers
Authors
Presentation Number
P0930
Presentation Topic
Observational Studies

Abstract

Background

Over the past decade, numerous disease modifying drugs (DMDs) for relapsing multiple sclerosis (RMS) have been approved in Argentina. It is believed that the use of oral DMDs (oDMDs) i.e. fingolimod, teriflunomide and dimetil fumarate has increased in recent years, although the real-life data in our country is limited.

Objectives

Our aim was to describe the tendency of the use of oDMDs (as first treatment option or after switch) regarding its approval in Argentina.

Methods

A retrospective study was conducted in a cohort of MS patients follow-up in five Argentinian MS centers incorporated in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177). Patients who started their treatment since 2012 were included. Regarding to the availability of different oDMDs in Argentina, we define three period (P1-3): P1: 2012 – 2014; P2: 2015 - 2017 and P3: 2018 - 2020. An analysis was performed comparing between these three periods to assess the tendency of oDMDs use over time. Three scenarios were defined: initial treatment, first switch and second switch. For the switch scenarios, only P1 and P2 were analyzed considering that the patients belonging P3 have a short evolution time and a scarce patient’s number required treatment changes.

Results

Out of 202 patients, 58% were female, mean age 32.4 ±11.0 years, mean disease evolution 8.0 ±5.5 years, 46 % started with oDMDs and 64% was the first choice after a switch. Injectable therapies were the most frequently withdrawn in relation to oDMDs and monoclonal antibodies (p<0.01). The main cause of switching treatment was treatment failture (39%). We found an increase in the use of oDMDs as initial treatment over time (P1: 17.7%, P2: 63.9% and P3: 65.0%; p <0.01). We found a tendency in increasing use of oDMDs after a first switch (P1: 59.6%, P2: 73.1%) or second switch (P1: 59.6%, P2: 73.1%). Multivariate analysis showed that disease evolution (OR=1.06, p=0.04), and year of starting treatment (OR=0.66, p<0.01) were independently associated with choice of oDMDs.

Conclusions

We have identified an increasing tendency in the use of oDMDs as initial treatment of RMS regarding its approval in Argentina.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1012 - Coping Strategies: Seeking personalized care in Multiple Sclerosis. A patient reported measure– Coping Responses Inventory. (ID 1548)

Speakers
Authors
Presentation Number
P1012
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Background: Coping is defined as a set of cognitive and behavioral efforts made to master stressful specific demands. Adaptation to chronic diseases, such as Multiple Sclerosis (MS), depends on the effectiveness of coping.

Objectives

Objective: to assess the psychometric properties of the Coping Responses Inventory (CRI-A) in the subpopulation of MS patients, to verify the transferability of the instrument, which has already been validated in the Argentine general population and to assess the analysis of external criterion validity, by studying the relationship between coping styles and physical disability, depression, fatigue and years of evolution of the disease and clinical course.

Methods

Methods: 90 MS patients were included; Outcomes measures: CRI-A Inventory, Expanded Disability Status Scale (EDSS), Beck Depression Inventory and Fatigue Severity Scale.

Results

Results: 95.56% of the patients had Relapsing-Remitting MS (RRMS), 2.22% Primary-Progressive MS (PPMS), and 2.22% Secondary-Progressive MS (SPMS). The group comprised 59 women (65.56%), with a mean age of 40.97±12.85 years and mean education of 13.46±3.93 years. The group shows a mean of 13.92±10.45 for depression, 3.77±1.72 for fatigue, 10.76±9.72 for disease evolution and 2.48±1.79 for disability. CRI-A Inventory maintains the psychometric properties of the Argentine general population in the MS subpopulation, with adequate validity and reliability. The respondents most frequently utilized a problem focused coping style. A significant positive correlation was found between the problem-focused coping style and education (r= 0.31). As regards clinical variables, significant positive correlations were found between the emotion‑focused coping style and fatigue (r=0.21) and depression (r= 0.43). Nevertheless, when studying each of the 8 coping strategies on their own, a significant positive correlation was found between 3 strategies of the emotion-focused coping style: avoidance (r=0.27), acceptance (r=0.27) and emotional discharge (r=0.42), and depression. In addition, the seeking alternative rewards strategy was linked to the disease evolution and fatigue (r= 0.24/-0.22).

Conclusions

Conclusions: The results demonstrate the transferability of the CRI-A of the general population of Argentina in the subpopulation of patients with MS. Patients with MS develop more problem-focused strategies.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1014 - Decision Making Process in Argentinian Patients with Multiple Sclerosis (ID 1223)

Speakers
Authors
Presentation Number
P1014
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Considering the complexity of the disease and its treatment, patients with multiple sclerosis (PwMS) need up-to-date evidence-based information in order to make an informed decision together with their physicians based on their preferences. There is scarce information regarding decision-making-process (DMP) in PwMS from Latin America.

Objectives

We aimed to evaluate DMP in Argentinian PwMS and to assess its relationship with patient preferences and clinical-demographic characteristics.

Methods

Twelve hundred seventy-five PwMS from the patient organization Esclerosis Múltiple Argentina (EMA) were invited to participate in a self-administered web-based survey. Participants were asked to provide clinical-demographic information and to complete a questionnaire assessing perceived information provision, the Control Preference Scale, the Satisfaction with the Decisions and Care questionnaire, and were inquired on preferred sources of information about MS. Descriptive analyses, parametric and nonparametric statistics were performed, p value <0.05 was accepted.

Results

Three hundred seventy-nine PwMS completed the survey. Most were females (67%); mean age was 40.3 (SD=11.1) years; mean disease duration was 7.9 (SD= 7.2) years. The majority of PwMS were satisfied with information provision from their neurologist on MS characteristics, prognosis, complementary studies and treatment. Patients decisional control preference role was active in 47%, shared in 27%, and passive in 26%. A moderate agreement (weighted kappa 0.55) was observed between patients’ preferences and self-reported DMP. Seventy-two percent of the PwMS participated in the DMP according to their preferences (concordance rates: active 66%, shared 87%, passive 51%). Most patients (83%) declared receiving information from their neurologists, matching their preferences (94%). Social networks were the least preferred source of information (40%).

Conclusions

Argentinian PwMS have distinctive preferences regarding information management and decision-making compared to other populations. This may be probably due to cultural, religious, or idiosyncratic issues, among others. More studies are needed to corroborate our findings in order to improve understanding of patients’ needs.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1033 - Health-related quality of life in relapsing multiple sclerosis patients from Argentina: impact of clinical features and coping strategies (ID 1032)

Speakers
Authors
Presentation Number
P1033
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Multiple sclerosis (MS) patients have reported decreased health-related quality of life (HRQoL). Identifying factors that contribute to a worse HRQoL is needing in order to improve the HRQoL of these patients.

Objectives

We aimed to investigate the HRQoLin an Argentinean population of MS patients and their correlation with clinical variables and coping strategies.

Methods

Nationwide cross-sectional study. Screening instruments: Demographics and clinical data, HRQoL (MS Impact Scale, [MSIS-29]), Fatigue Severity Scale and physical disability (self-administrated Expanded Disability Status Scale, [EDSS]) and coping strategies (Brief Coping Orientation to Problems Experienced, [COPE-28]).

Results

We included 249 (74.7% women) MS patients with a mean age at survey of 38.6 (±10.7), a MS duration of 7.3 years (range: 1-43 years) and a mean EDSS of 1.9 (±1.8). The multivariate analysis via linear regression showed: lower fatigue scores and higher EDSS score, perception of severity of MS score and dysfunctional (maladaptive) coping strategies score significantly correlated with both higher (worse) HRQoL total (from p=0.009 to p<0.0001) and MSIS-physical scores (from p=0.04 to p<0.0001). Additionally, higher age and lower fatigue, dysfunctional coping strategies and perception of severity of MS scores were significantly correlated with worse MSIS-psychological (from p=0.006 to p<0.0001). An inverse correlation between live alone (p=0.04) and emotion-focused strategies (p=0.02) was significantly associated with a better MSIS-psychological.

Conclusions

This study showed a negative impact of physical disability and maladaptive coping strategies on HRQoL in MS patients from Argentina. Therefore, it would be necessary to increase interdisciplinary interventions and based on adaptive coping strategies to improve the HRQoL of these patients.

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Gender Differences, Hormones and Sex Chromosomes Poster Presentation

P1120 - Disparities in access to health care for women with multiple sclerosis in Argentina (ID 1509)

Speakers
Authors
Presentation Number
P1120
Presentation Topic
Gender Differences, Hormones and Sex Chromosomes

Abstract

Background

Disparities about health care access in females were previously reported. In Argentina, previous studies have shown the unequal access to health care in MS patients stratified by health coverage, but no information were obtained regarding disparities in the access by gender

Objectives

The objective of the study was to evaluate whether disparities in the access to healthcare was identified in women with multiple sclerosis (MS) in Argentina.

Methods

A cross-sectional study based on a self-administered survey was carried in 13 provinces from Argentina. We asked about demographic and clinical aspects of the disease as well as the access and barriers to MS care through self-report measures on waiting time for both neurological visits and MRI test, disease modifying treatment (DMTs) access and waiting time for delivery of DMTs. We applied multivariate analysis via both logistic and lineal regression to evaluate the impact of different factors on health care resources utilization

Results

We included 219 patients, mean age 39 (± 16) years and a female predominance 149 (68%). There were no differences between females and males in RRMS phenotype (92% vs. 89%), mean EDSS (2.5 ± 1 vs. 2.2 ± 1.3), mean age at disease onset (38±4 vs. 36 ±5 years) and working status (currently full time employed 63% vs. 68%) respectively. 97% of males vs. 89% of females received DMDs (p=0.02). No differences in neurological visits between females and males (at least 2 visits during the last year) (98% vs. 95%) neither MRI test (93% vs. 97%) was identified, respectively. Females reported longer waiting time for delivery of first DMDs (7.1 ±2 vs. 5.1 ±1.1 weeks, p=0.02) and longer waiting time for delivery of DMDs at follow-up DMDs (4.1 ±0.6 vs. 3.1 ±1 weeks, p=0.03). No differences in legal actions were identified between gender (22 % females vs. 19 % males).

Conclusions

despite no differences between demographic and clinical aspects, we identified an increased time for delivery of DMTs in female MS patients compared to males in our region.

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Reproductive Aspects and Pregnancy Poster Presentation

P1122 - Family planning in women with multiple sclerosis: an important yet seldom approached issue (ID 1174)

Speakers
Authors
Presentation Number
P1122
Presentation Topic
Reproductive Aspects and Pregnancy

Abstract

Background

There are scarce data from Argentina or Latin America that evaluate family planning (FP) in women with multiple sclerosis (WwMS).

Objectives

The purpose of this study was to assess family planning experience and knowledge among Argentinian women with multiple sclerosis

Methods

604 WwMS from 10 MS Argentinian centers were invited to answer an online survey. Demographics, disease characteristics, disease modifying treatment (DMDs), knowledge and influences on FP, parenthood desire, occurrence of unplanned pregnancies were collected.

Results

A total of 433 (71.68%) WwMS completed the survey, mean age 32.4 ±11.0 years, mean EDSS 1.88 ±1.99, disease evolution ≤ 3 years 29.9%, motherhood before MS diagnosis 42.1%. A total of 82 WwMS became pregnant after MS diagnosis and regarding last pregnancy, 63.41% were planned and 36.58% unplanned. 53% of unplanned did not received information on FP. 55.8% stopped DMDs after pregnancy confirmation. In WwMS of reproductive age, 230 ≤ 40 years were identified. 49,6% considered FP an important factor in choice of treatment. Out of 230, 88.69% experienced concerns regarding maternity and MS, 32.2% changed maternity longing after MS diagnosis and 48.69% have future motherhood desire. Age 32.37 ±5.56, MS evolution ≤5 years, EDSS<3, no pregnancy before MS diagnosis and neurologist discussed FP planning, were significantly associated with future desire for motherhood (p<0.05).

Conclusions

The research highlights that pregnancy remains an important concern among WwMS. More than half of unplanned pregnancies did not receive FP. FP should be discussed not only out of a desire for motherhood, but also as part of the treatment decision process.

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Presenter Of 4 Presentations

 On-Demand Program
Internet and Social Media Poster Presentation

LB1157 - Experiences of Latin American MS and/or NMOSD experts in practice during the COVID-19 pandemic: focus in Telemedicine. (ID 1198)

Speakers
Authors
Presentation Number
LB1157
Presentation Topic
Internet and Social Media

Abstract

Background

Different scientific associations have elaborated recommendations about MS and/or NMOSD patients care and management during COVID-19 pandemic. They advised to take extra care to minimize their exposure to the virus and use alternatives to face-to-face medical appointments. This has prompted a transition of conventional care to telemedicine (TM) as quickly as possible. There is no data regarding current patient’s follow-up neither TM usage among MS and/or NMOSD Latin American experts.

Objectives

To investigate experiences from Latin American MS and/or NMOSD experts on follow-up of their patients focusing on TM management.

Methods

A cross-sectional study was performed. 141 MS and/or NMOSD experts from Argentina (AR), Chile (CH), Colombia (CO) and Brazil (BR) were invited to answer an anonymous, voluntary web-based survey. The survey was sent via email (3 July 2020) to potential respondents and was available online for only one week to avoid bias regarding epidemic change in our region.

Results

A total of 129 (91.48 %) experts completed the survey (56 from AR, 33 BR, 30 CH, and 10 CO), age 41.23 ±10.20, 43.4% works at public hospital. Regarding medical appointments (virtual or face-to-face), it decreased on a 50% during the pandemic era (14.78 ±16.71 and 7.43 ±9.68 patients/week before and during the COVID-19 pandemic respectively). Only 19.4% had experience in TM previous COVID-19 pandemic (26.8% AR, 0% BR, 23.3% CH, and 30% CO), while 79.8% are currently using TM (89.3% AR, 75.8% BR, 60% CH, and 100% CO). Most of them using video call (52.3%). Using TM, 44.1% of the experts were able to carry out neurological examination, 85.6% believe be able to identify a relapse, 48.6% use Patient Determined Disease Steps (PDDS) and 38.7% continue using the conventional Expanded Disability Status Scale (EDSS). On the other hand, 83.7% continue face-to-face medical appointment, the most frequent causes were: first time appointment (91.8%), therapeutic failure (94.%) and management of a relapse (97.3%) and only 20% for the routine appointment. To decrease virus exposure, only 40% perform a complete and thorough neurological evaluation, most of them avoid funduscopy.

Conclusions

Considering the vertiginous speed of the spread of COVID-19 in Latin American, results from our survey demonstrate preparedness and responsiveness among Latin American MS and/or NMOSD experts. Despite scarce prior TM experience, most experts were able to use TM as a new tool for monitoring their patients.

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Observational Studies Poster Presentation

P0930 - Usage trend of oral drugs for multiple sclerosis in Argentina (ID 1183)

Speakers
Authors
Presentation Number
P0930
Presentation Topic
Observational Studies

Abstract

Background

Over the past decade, numerous disease modifying drugs (DMDs) for relapsing multiple sclerosis (RMS) have been approved in Argentina. It is believed that the use of oral DMDs (oDMDs) i.e. fingolimod, teriflunomide and dimetil fumarate has increased in recent years, although the real-life data in our country is limited.

Objectives

Our aim was to describe the tendency of the use of oDMDs (as first treatment option or after switch) regarding its approval in Argentina.

Methods

A retrospective study was conducted in a cohort of MS patients follow-up in five Argentinian MS centers incorporated in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177). Patients who started their treatment since 2012 were included. Regarding to the availability of different oDMDs in Argentina, we define three period (P1-3): P1: 2012 – 2014; P2: 2015 - 2017 and P3: 2018 - 2020. An analysis was performed comparing between these three periods to assess the tendency of oDMDs use over time. Three scenarios were defined: initial treatment, first switch and second switch. For the switch scenarios, only P1 and P2 were analyzed considering that the patients belonging P3 have a short evolution time and a scarce patient’s number required treatment changes.

Results

Out of 202 patients, 58% were female, mean age 32.4 ±11.0 years, mean disease evolution 8.0 ±5.5 years, 46 % started with oDMDs and 64% was the first choice after a switch. Injectable therapies were the most frequently withdrawn in relation to oDMDs and monoclonal antibodies (p<0.01). The main cause of switching treatment was treatment failture (39%). We found an increase in the use of oDMDs as initial treatment over time (P1: 17.7%, P2: 63.9% and P3: 65.0%; p <0.01). We found a tendency in increasing use of oDMDs after a first switch (P1: 59.6%, P2: 73.1%) or second switch (P1: 59.6%, P2: 73.1%). Multivariate analysis showed that disease evolution (OR=1.06, p=0.04), and year of starting treatment (OR=0.66, p<0.01) were independently associated with choice of oDMDs.

Conclusions

We have identified an increasing tendency in the use of oDMDs as initial treatment of RMS regarding its approval in Argentina.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1014 - Decision Making Process in Argentinian Patients with Multiple Sclerosis (ID 1223)

Speakers
Authors
Presentation Number
P1014
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Considering the complexity of the disease and its treatment, patients with multiple sclerosis (PwMS) need up-to-date evidence-based information in order to make an informed decision together with their physicians based on their preferences. There is scarce information regarding decision-making-process (DMP) in PwMS from Latin America.

Objectives

We aimed to evaluate DMP in Argentinian PwMS and to assess its relationship with patient preferences and clinical-demographic characteristics.

Methods

Twelve hundred seventy-five PwMS from the patient organization Esclerosis Múltiple Argentina (EMA) were invited to participate in a self-administered web-based survey. Participants were asked to provide clinical-demographic information and to complete a questionnaire assessing perceived information provision, the Control Preference Scale, the Satisfaction with the Decisions and Care questionnaire, and were inquired on preferred sources of information about MS. Descriptive analyses, parametric and nonparametric statistics were performed, p value <0.05 was accepted.

Results

Three hundred seventy-nine PwMS completed the survey. Most were females (67%); mean age was 40.3 (SD=11.1) years; mean disease duration was 7.9 (SD= 7.2) years. The majority of PwMS were satisfied with information provision from their neurologist on MS characteristics, prognosis, complementary studies and treatment. Patients decisional control preference role was active in 47%, shared in 27%, and passive in 26%. A moderate agreement (weighted kappa 0.55) was observed between patients’ preferences and self-reported DMP. Seventy-two percent of the PwMS participated in the DMP according to their preferences (concordance rates: active 66%, shared 87%, passive 51%). Most patients (83%) declared receiving information from their neurologists, matching their preferences (94%). Social networks were the least preferred source of information (40%).

Conclusions

Argentinian PwMS have distinctive preferences regarding information management and decision-making compared to other populations. This may be probably due to cultural, religious, or idiosyncratic issues, among others. More studies are needed to corroborate our findings in order to improve understanding of patients’ needs.

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Reproductive Aspects and Pregnancy Poster Presentation

P1122 - Family planning in women with multiple sclerosis: an important yet seldom approached issue (ID 1174)

Speakers
Authors
Presentation Number
P1122
Presentation Topic
Reproductive Aspects and Pregnancy

Abstract

Background

There are scarce data from Argentina or Latin America that evaluate family planning (FP) in women with multiple sclerosis (WwMS).

Objectives

The purpose of this study was to assess family planning experience and knowledge among Argentinian women with multiple sclerosis

Methods

604 WwMS from 10 MS Argentinian centers were invited to answer an online survey. Demographics, disease characteristics, disease modifying treatment (DMDs), knowledge and influences on FP, parenthood desire, occurrence of unplanned pregnancies were collected.

Results

A total of 433 (71.68%) WwMS completed the survey, mean age 32.4 ±11.0 years, mean EDSS 1.88 ±1.99, disease evolution ≤ 3 years 29.9%, motherhood before MS diagnosis 42.1%. A total of 82 WwMS became pregnant after MS diagnosis and regarding last pregnancy, 63.41% were planned and 36.58% unplanned. 53% of unplanned did not received information on FP. 55.8% stopped DMDs after pregnancy confirmation. In WwMS of reproductive age, 230 ≤ 40 years were identified. 49,6% considered FP an important factor in choice of treatment. Out of 230, 88.69% experienced concerns regarding maternity and MS, 32.2% changed maternity longing after MS diagnosis and 48.69% have future motherhood desire. Age 32.37 ±5.56, MS evolution ≤5 years, EDSS<3, no pregnancy before MS diagnosis and neurologist discussed FP planning, were significantly associated with future desire for motherhood (p<0.05).

Conclusions

The research highlights that pregnancy remains an important concern among WwMS. More than half of unplanned pregnancies did not receive FP. FP should be discussed not only out of a desire for motherhood, but also as part of the treatment decision process.

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