Author Of 2 Presentations
P0431 - Assessment of clinical, genetic and immune repertoire data to predict disease activity and progression in RRMS (ID 1330)
Multiple Sclerosis (MS) has a highly heterogeneous clinical course and, given the broad spectrum of approved therapies, there is a strong need to identify parameters that can guide treatment choice
The present study investigates clinical, genetic and immunological parameters associated with MS severity in order to combine them into a predictive model.
An “Extended” cohort of ~1,000 patients who started a first-line drug, with available clinical and genetic data, and a “Core” dataset of ~200 patients with clinical, genetic and immune repertoire information obtained before first-line treatment start were enrolled. The following outcomes were considered at the 4-year follow-up: NEDA-3 criterion, time to first relapse (TFR), EDSS and MS Severity Score (MSSS). A regression analysis was performed on both cohorts and results were meta-analyzed.
A younger age at onset (AAO) and a shorter disease duration strongly correlate with higher inflammatory activity; a higher baseline EDSS and AAO are the best prognostic markers of disability increase. The genetic study identified some interesting signals with suggestive association: rs6925307 is associated with NEDA status (OR 0.55, p:1.53e-06) and has an eQTL effect on CLVS2 gene, required for normal morphology of endosomes and lysosomes in neurons. Rs9264731, an intronic variant in the HLA-C gene, is associated with TFR (HR 1.49, p:4.11e-06). T-cell receptor (TCR) sequencing is ongoing and immune repertoire data are already available for 123 patients: overall more than 16.000.000 sequences have been obtained, of which 81.5% are productive, corresponding on average to ~77.000 unique clonotypes per patient.
We confirmed the association of clinical parameters with disease severity and we identified some interesting genetic markers whose association need to be replicated. TCR data are being generated and will be integrated in a predictive model of disease activity.
P0666 - Telemedicine in/outside the pandemic: a survey about satisfaction of this tool in a cohort of multiple sclerosis patients and their neurologists (ID 1810)
Telemedicine is a live communication between patients and physicians through different technological tools. It became fundamental during COVID-19 pandemic to keep on taking care of patients in more medical fields than before. Given the chance for telemedicine to become a pivotal part of neurological routine practice, we investigated patients and neurologists satisfaction about this tool.
This survey aimed to understand satisfactionabout telemedicine during pandemic and its possible use in the future outside pandemic
We administered a brief survey to a cohort of Multiple Sclerosis (MS) patients and their neurologists at MS center of San Raffaele Hospital, Milan. Demographic and clinical data (EDSS, treatment) were collected.
151 patients filled out the survey: 75% females; mean age 42.2yy (18-73); median EDSS 1.5 (0-7). Treatments were almost equally distributed across first and second-line drugs (10% interferon, 10% glatiramer acetate, 14% teriflunomide, 22% dimethylfumarate, 23% fingolimod, 3% cladribine, 8% alemtuzumab, 10% ocrelizumab).
87% of patients appreciated telemedicine during pandemic; 10% had a positive opinion but with a need for traditional evaluations, while 3% were not satisfied.
Considering the possible routine use of telemedicine outside the pandemic, 82% firmly stated the importance of traditional evaluations. In particular, 44% would alternate in person and remote visits, while 38% strongly preferred traditional ones. Among the latters, the main reasons were the need for human empathy with the neurologist and the feeling that traditional evaluations may lead to better clinical outcomes. The remaining 18% would always use telemedicine except in the case of acute events. Neurologists and residents (n=18) were inquired about telemedicine: no one would use it as the only tool, 33% would alternate it with traditional practice and 67% would use it only in special contexts.
In our survey, both patients and neurologists recognized the importance of telemedicine during a pandemic. Patients more than physicians seemed ready to use it in everyday clinical practice. These data may be biased by a still ongoing patients fear and physicians lack of confidence in this multifaceted tool. The pandemic spurred the development of institutional telematic platforms capable of providing legal protection and traceability of visits and communication between patients and physicians. So far, we can conclude that telemedicine is a useful tool to overcome space-time limits, giving the best care to all patients in any condition. However, it cannot replace but only integrate traditional medicine.