Hospital Universitari de Bellvitge
Department of Neurology

Author Of 5 Presentations

Clinical Outcome Measures Poster Presentation

P0029 - Assessment of Multiple Sclerosis Severity Score and Age-Related Multiple Sclerosis Severity Score as health indicators in a population-based cohort (ID 447)

Speakers
Presentation Number
P0029
Presentation Topic
Clinical Outcome Measures

Abstract

Background

Persons with multiple sclerosis (MS) present varying degrees of disability throughout the course of the disease. The Multiple Sclerosis Severity Score (MSSS) and the Age-Related Multiple Sclerosis Severity Score (ARMSSS) adjust the score obtained in the Expanded Disability Status Scale (EDSS) according to disease duration and age, respectively. These measures could be useful as health outcome indicators.

Objectives

The aim of this study was to describe the severity of MS in our health district and assess MSSS and ARMSSS consistency over time.

Methods

Patients diagnosed with MS according to 2010 McDonald criteria, with at least one year of disease duration and followed up in our MS unit within the previous 18 months were selected. Sex, age at onset, disease duration, clinical course, age and irreversible EDSS at last follow-up visit were collected. MSSS and ARMSSS were calculated. Our cohort was studied twice, in 2017 and 2020 to assess the consistency of both instruments.

Results

One hundred and seventy-seven patients were included in 2017, and 208 in 2020. Prevalence of MS in our health district was 90 and 105 per 100,000 inhabitants, respectively, in line with the expected prevalence. Median MSSS and ARMSSS were similar in both study years. In 2017, median MSSS was 1.77 (IQR 0.76-4.28) and ARMSSS was 2.9 (IQR 1.47-5.72). In 2020, median MSSS was 2.03 (IQR 0.82-4.36) and ARMSSS was 2.93 (IQR 1.51-5.56).

Conclusions

According to MSSS and ARMSSS, our cohort presented mild disease, and the results were consistent at both time points. MSSS and ARMSSS may be reliable health outcome measures.

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Clinical Outcome Measures Poster Presentation

P0054 - Cost of a relapse-free patient in relapsing-remitting multiple sclerosis, a reliable result-based health indicator. (ID 461)

Speakers
Presentation Number
P0054
Presentation Topic
Clinical Outcome Measures

Abstract

Background

Nowadays we know the efficacy and safety of disease-modifying therapies (DMTs) in multiple sclerosis (MS) but we lack result-based health indicators to evaluate its cost-effectiveness.

Objectives

The objective of the study is to analyze if the cost per year of a relapse-free patient is a reliable health indicator comparing the cost between 2016 and 2019 of DMTs in a cohort of relapsing-remitting MS (RRMS) treated with DMTs in a representative population cohort.

Methods

Patients followed in our MS unit during 2019, diagnosed with MS and belonging to our sanitary district were evaluated, our center has the only MS unit in the district. From them, patients diagnosed with RRMS were retrospectively selected for this study. Clinical data were collected prospectively on a 6-monthly basis and at the time of any relapse. All patients were visited by a qualified neurologist who performed a neurological examination assessing the disease severity by the Expanded Disease Status Scale (EDSS). Data from magnetic resonance imaging (MRI) were retrospectively retrieved. The proportion of patients with no evidence of disease activity (NEDA) was analysed. The mean cost of DMTs during 2019 had been analyzed as well as the cost of a relapse-free patient. The cost of a relapse-free patient was a ratio between the total cost of DMTs and the number of relapse-free patients. The results of 2019 were compared with the results already obtained in 2016.

Results

A total of 214 patients belonging to our sanitary district diagnosed with MS and followed in our MS unit in 2019, were selected. They indicated an MS prevalence of 105 per 100000 inhabitants, representative of the expected prevalence of MS in epidemiological population-based studies performed in our area. From them, 183 patients were RRMS and were included in our study. They were 67.8% women, their mean age was 48.3 (SD 12.9) years, their mean age at onset was 31.8 (SD 10.8) years, their disease duration was 16.32 (SD 11.7) years and their median irreversible EDSS was 2.0 (range 0-7.5). From those 183, 126 patients (68.9% of the cohort) were treated with DMTs during 2019, 151 patients (82.5% of the cohort) remained free of relapses during 2019, 171 patients did not increase their EDSS (93.4% of the cohort) and 126 of the 144 with Magnetic Resonance Imaging (MRI) in 2019 had neither new T2 lesions nor gadolinium-enhancing lesions (87.5%). The proportion of NEDA (no evidence of disease activity) in those 144 patients was 69.4%. The mean cost of DMTs per patient in 2019 was 6985.4 euros (95% CI: 5986.9-7983.9) when all patients were considered, relapse-free and relapsing patients as well as treated and not treated, in 2016 it was 7414.3 euros (95% CI: 6325.2-8503.4). The cost per year of DMTs of a relapse-free patient was 8465.8 euros in 2019 and 9762.2 euros in 2016.

Conclusions

The cost per year of a relapse-free patient may be a reliable result-based health indicator given its stability in successive measurements in the same population.

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Neuropsychology and Cognition Poster Presentation

P0820 - Phase II trial of cognitive rehabilitation in patients with multiple sclerosis: preliminary results (ID 847)

Abstract

Background

Around 50% of patients with multiple sclerosis (MS) present a decline in cognitive behavior that impacts negatively on their autonomy, social and working skills. The benefits of cognitive rehabilitation on cognition and brain plasticity are not well understood due to methodological limitations of most studies, such the use of an inappropriate control group or the small number of patients included.

Objectives

To study the efficacy on attention, processing speed and working memory of a cognitive training program in patients with MS.

Methods

Multi-center, phase II, double-blind and randomized clinical trial to a treatment group (upward intensity training) or control group (low intensity static training). Patients were assessed using Rao's battery before and after 12 weeks of online training with the Guttmann, NeuroPersonalTrainer® (GNPT). The main objective was to demonstrate an improvement in attention and working memory tests (Pasat Auditory Serial Addition Test, PASAT, and Symbol Digit Modalities Test, SDMT) in the treatment group.

Results

The recruitment is still active. In an interim analysis on May 2020, 61 patients had been evaluated, of whom 35 fulfilled the inclusion criteria, and 23 had completed the follow-up period (age 48.8±7.4, disease duration 19.2±9.3 years). Ten patients had been assigned to the treatment group and 13 to the control group. The treatment group showed a significant reduction in z-scores of attention and working memory tests (z-score=-1.68±0.90 at baseline and -1.26±1.05 at follow up) compared to the control group (-1.78±0.63 at baseline and -1.45±1.06 at follow up), p corrected=0.003, and a trend for verbal memory (treatment group z-score -2.19±1.14 and -1.61±1.68 and sham group z-score -1.38±1.32 and -1.34±1.5 at baseline and follow up respectively, corrected p=0.074). There were no significant changes in other cognitive domains (verbal, visual, and fluency memory).

Conclusions

This preliminary analysis shows that intensive rehabilitation focused on attention, information processing speed and working memory can improve these cognitive functions.

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Observational Studies Poster Presentation

P0840 - Benign Multiple Sclerosis: Is the EDSS scale enough to define it?  (ID 436)

Speakers
Presentation Number
P0840
Presentation Topic
Observational Studies

Abstract

Background

Benign multiple sclerosis (BMS) is a controversial concept. Most definitions only consider the Expanded Disability Status Scale (EDSS) and disease duration to define it, although other factors may influence patient’s disability.

Objectives

The aim of this study was to assess symptoms not evaluated or underestimated in the EDSS scale in patients with BMS defined as EDSS≤3 after 10 years of disease.

Methods

Patients were selected from a hospital-based series of 485 multiple sclerosis (MS) patients assessed in 1996.  Those fulfilling the definition of BMS were selected. Patients were followed up in a prospective basis and EDSS were obtained after 20 and 30 years. At 30 years, the following test were completed: Patient Health Questionnaire (PHQ-9), Modified Fatigue Impact Scale (MFIS), Symbol Digit Modalities Test (SDMT) and Visual Analogue Scale (VAS) to evaluate severity of MS.

Results

82 from 485 patients evaluated in 1996 were selected. In 51 out of 68 (75%) patients evaluated in 2006 and in 35 out of 58 (60.3%) in 2016, the EDSS remained ≤3. Eighteen from the 35 BMS patients completed the questionnaire. 9/18 (50%) showed fatigue in the MFIS, 4/18 (22%) depression in the PHQ-9 and 15/18 (83%) cognitive impairment in the SDMT. 11/18 (61%) perceived their illness as more severe than estimated by the Multiple Sclerosis Severity Scale (MSSS). Fatigue and depression results were similar to those obtained in the rest of our MS patients (47.3% fatigue, 31% depression).

Conclusions

In patients with BMS, fatigue and depression frequency is similar to that of our MS cohort. A high percentage of patients present cognitive impairment, although it could be influenced by the older age of the patients.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1050 - Quantifying the patient´s perspective in neuromyelitis optica spectrum disorders: Design of a multicenter, non-interventional study (ID 222)

Abstract

Background

Patients with neuromyelitis optica spectrum disorders (NMOSD) experience a spectrum of symptoms negatively impacting on daily living and quality of life. The systematic assessment of patient perspectives has the capacity to provide crucial clinical information that could otherwise be lost when relying on clinical evaluation alone. However, the patient experience living with NMOSD is limited, in particular implementing standardized patient-reported outcomes (PROs).

Objectives

The primary objective of this study protocol is to assess the health-related quality of life and well-being of NMOSD patients.

Methods

A multicenter, non-interventional, cross-sectional study will be conducted with patients diagnosed with NMOSD (2015 Wingerchuk criteria) (PERSPECTIVES-NMO Study). Primary outcomes measures will be the 29-item Multiple Sclerosis Impact Scale and the Satisfaction with Life Scale. Demographic characteristics, clinical and imaging outcomes will be collected, including the number and type of attacks, antibody status, Expanded Disability Status Scale score, Nine-Hole Peg Test, Timed 25-Foot Walk, and Magnetic Resonance Imaging findings. Cognition will be evaluated using the Rao Brief Repeatable Neuropsychological Battery. Additional outcomes from the patient´s perspective (PROs) will be collected, including symptoms severity (SymptoMScreen questionnaire), fatigue (Fatigue Impact Scale for Daily Use), pain (MOS Pain Effects Scale), mood (Beck Depression Inventory-Fast Screen), perception of stigma (8-item Stigma Scale for Chronic Illness), and work-related difficulties (23-item Multiple Sclerosis Work Difficulties Questionnaire).

Results

Patient recruitment began in December 2019 with a planned total sample of 70 patients. The study is currently ongoing.

Conclusions

The study results are expected to provide meaningful insights into the clinical burden of disease. A better understanding of patient experiences may foster the development of patient-centered specific plans and more targeted rehabilitation in clinical practice.

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Presenter Of 1 Presentation

Clinical Outcome Measures Poster Presentation

P0054 - Cost of a relapse-free patient in relapsing-remitting multiple sclerosis, a reliable result-based health indicator. (ID 461)

Speakers
Presentation Number
P0054
Presentation Topic
Clinical Outcome Measures

Abstract

Background

Nowadays we know the efficacy and safety of disease-modifying therapies (DMTs) in multiple sclerosis (MS) but we lack result-based health indicators to evaluate its cost-effectiveness.

Objectives

The objective of the study is to analyze if the cost per year of a relapse-free patient is a reliable health indicator comparing the cost between 2016 and 2019 of DMTs in a cohort of relapsing-remitting MS (RRMS) treated with DMTs in a representative population cohort.

Methods

Patients followed in our MS unit during 2019, diagnosed with MS and belonging to our sanitary district were evaluated, our center has the only MS unit in the district. From them, patients diagnosed with RRMS were retrospectively selected for this study. Clinical data were collected prospectively on a 6-monthly basis and at the time of any relapse. All patients were visited by a qualified neurologist who performed a neurological examination assessing the disease severity by the Expanded Disease Status Scale (EDSS). Data from magnetic resonance imaging (MRI) were retrospectively retrieved. The proportion of patients with no evidence of disease activity (NEDA) was analysed. The mean cost of DMTs during 2019 had been analyzed as well as the cost of a relapse-free patient. The cost of a relapse-free patient was a ratio between the total cost of DMTs and the number of relapse-free patients. The results of 2019 were compared with the results already obtained in 2016.

Results

A total of 214 patients belonging to our sanitary district diagnosed with MS and followed in our MS unit in 2019, were selected. They indicated an MS prevalence of 105 per 100000 inhabitants, representative of the expected prevalence of MS in epidemiological population-based studies performed in our area. From them, 183 patients were RRMS and were included in our study. They were 67.8% women, their mean age was 48.3 (SD 12.9) years, their mean age at onset was 31.8 (SD 10.8) years, their disease duration was 16.32 (SD 11.7) years and their median irreversible EDSS was 2.0 (range 0-7.5). From those 183, 126 patients (68.9% of the cohort) were treated with DMTs during 2019, 151 patients (82.5% of the cohort) remained free of relapses during 2019, 171 patients did not increase their EDSS (93.4% of the cohort) and 126 of the 144 with Magnetic Resonance Imaging (MRI) in 2019 had neither new T2 lesions nor gadolinium-enhancing lesions (87.5%). The proportion of NEDA (no evidence of disease activity) in those 144 patients was 69.4%. The mean cost of DMTs per patient in 2019 was 6985.4 euros (95% CI: 5986.9-7983.9) when all patients were considered, relapse-free and relapsing patients as well as treated and not treated, in 2016 it was 7414.3 euros (95% CI: 6325.2-8503.4). The cost per year of DMTs of a relapse-free patient was 8465.8 euros in 2019 and 9762.2 euros in 2016.

Conclusions

The cost per year of a relapse-free patient may be a reliable result-based health indicator given its stability in successive measurements in the same population.

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