University of Toronto

Moderator Of 1 Session

Parallel Session Fri, Sep 11, 2020
Session Type
Parallel Session
Date
Fri, Sep 11, 2020
Time (ET)
10:15 - 11:45

Author Of 3 Presentations

Imaging Late Breaking Abstracts

LB1177 - PAMRINO: International MRI and clinical data repository for neuromyelitis optica spectrum disorder (ID 469)

Abstract

Background

Neuromyelitis optica spectrum disorders (NMOSD) encompasses a group of rare inflammatory diseases which primarily target the optic nerves, spinal cord, and brain. Typically, magnetic resonance imaging (MRI) data from single-center studies comprise 20-50 patients, limiting statistical power for outcomes research. Using retrospective data from the PArallel MRI in NmOsd (PAMRINO) study, a novel prospective NMOSD image repository (NMOsDIR) representing multiple international sites was coordinated by Charité-Universitätsmedizin Berlin and the Medical Image Analysis Center (Basel).

Objectives

The PAMRINO study aimed to investigate and analyze retrospective MRIs collected from NMOSD-specialized centers, potentially for the evaluation of disease-related brain and spinal cord changes. NMOsDIR serves as an international imaging research resource (comprising standardized retinal optical coherence tomography and MRI scans) and clinical data hub for prospective studies in NMOSD. Linking imaging and clinical data, as well as enabling analysis pipelines for each modality, will facilitate multi-centered studies using sufficient data and statistical power to advance outcomes research in this rare disease.

Methods

For clinical data collection in PAMRINO, a Research Electronic Data Capture (REDCap) platform was used, where participating centers entered data relevant for NMOSD patient monitoring. An image database (XNAT) was established for image uploads. This large collection of MRI data is currently being analyzed in a joint international effort of NMOSD clinical neuroradiologists and scientists.

Results

Brain, spinal cord, and optic nerve MRI scans with associated clinical data were collected from 514 NMOSD patients and 56 healthy controls from 17 international centers. Roughly 20,000 individual MRI scans from patients and healthy controls were collected. Of these, 78% had T1-weighted cerebral MRIs (55% with 3D scans), 80% had T2-weighted cerebral MRIs (54% with 3D scans), 86% had T2-weighted spinal cord MRIs (55% with 3D scans), and 35% had optic nerve MRIs.

Conclusions

We successfully established PAMRINO, an international collaborative retrospective MRI and clinical data repository. The knowledge gained during this process provided important new insights, where the initial analysis of the dataset has underscored the large degree of heterogeneity in image and clinical data collection in NMOSD-specialized centers. Thus, calling for more standardized methods of data acquisition and imaging analysis, as not to limit research opportunities. The new longitudinal, prospective NMOsDIR will help us to answer many pressing - yet open - questions regarding patients seropositive for aquaporin-4-IgG+, myelin oligodendrocyte glycoprotein-IgG+ and other autoimmune-related diseases. In turn, such a strategy will strengthen future capabilities in research, diagnosis, monitoring and improving NMOSD patient care.

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Comorbidities Poster Presentation

P0449 - Comorbidities at MS diagnosis in Immigrants in Ontario, Canada (ID 995)

Speakers
Presentation Number
P0449
Presentation Topic
Comorbidities

Abstract

Background

Multiple sclerosis (MS) is associated with increased incidence and prevalence of some comorbidities including vascular disease and mood disorders. Although immigrants have lower incidence of MS than long-term residents in Ontario, Canada, comorbidity burden was associated with increased MS risk in immigrants.

Objectives

To compare prevalence of individual comorbidities in immigrants and long-term residents at MS diagnosis, and in matched control populations without MS.

Methods

We identified incident cases of MS aged 20-65 years using a validated case definition applied to health administrative data in Ontario, Canada from 1994-2017. Incident MS cases were categorized as immigrants or long-term residents. We identified two control populations of immigrants and long-term residents without MS matched 3:1 on sex, age and rurality status to MS cases. We identified comorbidities at MS diagnosis using validated administrative case definitions applied to the three years before MS diagnosis. We calculated prevalence ratios (PRs) of individual comorbidities for immigrants compared to long-term residents with MS and for both MS groups compared with their respective controls.

Results

There were 1,534 immigrants and 23,731 long-term residents with MS, as well as 4,585 immigrant and 71,193 long-term resident controls without MS. Common comorbidities in immigrants at MS diagnosis included mood or anxiety disorders (27.4%), hypertension (9.1%), and migraines (4.7%). Chronic obstructive pulmonary disease (COPD) (PR 1.68; 95%CI 1.17-2.40), diabetes (PR 2.57; 95%CI 1.86-3.55), ischemic heart disease (IHD) (PR 1.41; 95%CI 1.05-1.90), migraine (PR 2.12; 95%CI 1.73-2.60), epilepsy (PR 2.20; 95%CI 1.32-3.68), and mood/anxiety disorders (PR 1.97; 95%CI 1.78-2.17) were more common in immigrants with MS compared to immigrant controls. These comorbidities were also more common in long-term residents with MS than in long-term resident controls (p<0.05). Immigrants with MS had relatively higher prevalence of diabetes, migraine, and mood/anxiety disorders compared to long-term residents with MS.

Conclusions

Immigrants who develop MS have a high comorbidity burden and are more likely to be affected by comorbidities such as mood/anxiety disorders, migraine, diabetes, COPD, and IHD than other immigrants. Since comorbidities worsen long-term outcomes in MS, clinicians should pay close attention to identification and management of comorbidity in immigrants with MS.

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Invited Presentations Invited Abstracts

TC05.01 - Presentation 01 (ID 600)

Speakers
Authors
Presentation Number
TC05.01
Presentation Topic
Invited Presentations

Abstract

Abstract

This talk will address management of multiple sclerosis (MS) in the peripartum and postpartum periods. The peripartum period is typically uneventful without any observed increase in maternal or neonatal adverse outcomes in women with MS. Recent studies confirm an increased risk of relapse in the initial postpartum phase (1-3 months). The decision regarding when to restart DMT should be made on an individual basis, taking into account the woman’s preferences regarding breastfeeding and future pregnancies, and her level of MS disease activity. Most women with MS can safely stay off of DMT while breastfeeding. There are multiple benefits of breastfeeding, and exclusive breastfeeding may reduce the risk of postpartum relapse. For women with more aggressive MS, early re-initiation of DMT should be considered. There is emerging evidence that use of certain DMTs may be compatible with breastfeeding. Unmet needs remain in postpartum care of women with MS, including strategies to prevent disease activity in highly active patients in the first months postpartum before full effect of recommenced therapy is realized.

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Presenter Of 2 Presentations

Comorbidities Poster Presentation

P0449 - Comorbidities at MS diagnosis in Immigrants in Ontario, Canada (ID 995)

Speakers
Presentation Number
P0449
Presentation Topic
Comorbidities

Abstract

Background

Multiple sclerosis (MS) is associated with increased incidence and prevalence of some comorbidities including vascular disease and mood disorders. Although immigrants have lower incidence of MS than long-term residents in Ontario, Canada, comorbidity burden was associated with increased MS risk in immigrants.

Objectives

To compare prevalence of individual comorbidities in immigrants and long-term residents at MS diagnosis, and in matched control populations without MS.

Methods

We identified incident cases of MS aged 20-65 years using a validated case definition applied to health administrative data in Ontario, Canada from 1994-2017. Incident MS cases were categorized as immigrants or long-term residents. We identified two control populations of immigrants and long-term residents without MS matched 3:1 on sex, age and rurality status to MS cases. We identified comorbidities at MS diagnosis using validated administrative case definitions applied to the three years before MS diagnosis. We calculated prevalence ratios (PRs) of individual comorbidities for immigrants compared to long-term residents with MS and for both MS groups compared with their respective controls.

Results

There were 1,534 immigrants and 23,731 long-term residents with MS, as well as 4,585 immigrant and 71,193 long-term resident controls without MS. Common comorbidities in immigrants at MS diagnosis included mood or anxiety disorders (27.4%), hypertension (9.1%), and migraines (4.7%). Chronic obstructive pulmonary disease (COPD) (PR 1.68; 95%CI 1.17-2.40), diabetes (PR 2.57; 95%CI 1.86-3.55), ischemic heart disease (IHD) (PR 1.41; 95%CI 1.05-1.90), migraine (PR 2.12; 95%CI 1.73-2.60), epilepsy (PR 2.20; 95%CI 1.32-3.68), and mood/anxiety disorders (PR 1.97; 95%CI 1.78-2.17) were more common in immigrants with MS compared to immigrant controls. These comorbidities were also more common in long-term residents with MS than in long-term resident controls (p<0.05). Immigrants with MS had relatively higher prevalence of diabetes, migraine, and mood/anxiety disorders compared to long-term residents with MS.

Conclusions

Immigrants who develop MS have a high comorbidity burden and are more likely to be affected by comorbidities such as mood/anxiety disorders, migraine, diabetes, COPD, and IHD than other immigrants. Since comorbidities worsen long-term outcomes in MS, clinicians should pay close attention to identification and management of comorbidity in immigrants with MS.

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Invited Presentations Invited Abstracts

TC05.01 - Presentation 01 (ID 600)

Speakers
Authors
Presentation Number
TC05.01
Presentation Topic
Invited Presentations

Abstract

Abstract

This talk will address management of multiple sclerosis (MS) in the peripartum and postpartum periods. The peripartum period is typically uneventful without any observed increase in maternal or neonatal adverse outcomes in women with MS. Recent studies confirm an increased risk of relapse in the initial postpartum phase (1-3 months). The decision regarding when to restart DMT should be made on an individual basis, taking into account the woman’s preferences regarding breastfeeding and future pregnancies, and her level of MS disease activity. Most women with MS can safely stay off of DMT while breastfeeding. There are multiple benefits of breastfeeding, and exclusive breastfeeding may reduce the risk of postpartum relapse. For women with more aggressive MS, early re-initiation of DMT should be considered. There is emerging evidence that use of certain DMTs may be compatible with breastfeeding. Unmet needs remain in postpartum care of women with MS, including strategies to prevent disease activity in highly active patients in the first months postpartum before full effect of recommenced therapy is realized.

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Moderator Of 1 Session

Teaching Course Fri, Sep 11, 2020
Session Type
Teaching Course
Date
Fri, Sep 11, 2020

Invited Speaker Of 1 Presentation

Invited Presentations Invited Abstracts

TC05.01 - Presentation 01 (ID 600)

Speakers
Authors
Presentation Number
TC05.01
Presentation Topic
Invited Presentations

Abstract

Abstract

This talk will address management of multiple sclerosis (MS) in the peripartum and postpartum periods. The peripartum period is typically uneventful without any observed increase in maternal or neonatal adverse outcomes in women with MS. Recent studies confirm an increased risk of relapse in the initial postpartum phase (1-3 months). The decision regarding when to restart DMT should be made on an individual basis, taking into account the woman’s preferences regarding breastfeeding and future pregnancies, and her level of MS disease activity. Most women with MS can safely stay off of DMT while breastfeeding. There are multiple benefits of breastfeeding, and exclusive breastfeeding may reduce the risk of postpartum relapse. For women with more aggressive MS, early re-initiation of DMT should be considered. There is emerging evidence that use of certain DMTs may be compatible with breastfeeding. Unmet needs remain in postpartum care of women with MS, including strategies to prevent disease activity in highly active patients in the first months postpartum before full effect of recommenced therapy is realized.

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