Medical University of Vienna

Author Of 5 Presentations

Clinical Outcome Measures Poster Presentation

P0127 - Oral therapies for treatment of relapsing-remitting multiple sclerosis in Austria (ID 252)

Speakers
Presentation Number
P0127
Presentation Topic
Clinical Outcome Measures

Abstract

Background

Studies matching the clinical efficacy between fingolimod (FTY), dimethylfumarate (DMF) and teriflunomide (TERI) provided conflicting results. These discrepancies ask for further investigations to confirm or rebut the published findings, especially by real-life experiences.

Objectives

To compare the efficacies, frequencies and reasons for treatment interruption of FTY, DMF or TERI in a nationwide observational cohort.

Methods

Twocohorts of patients with relapsing-remitting multiple sclerosis (RRMS) having started treatment with FTY, DMF or TERI documented in the Austrian MS Treatment Registry (AMSTR) since 2014 and either staying on therapy for at least 24 months (24m cohort) or with at least one follow-up visit after start of treatment (total cohort). The 24m cohort included 629 RRMS patients: 295 in the FTY, 227 in the DMF and 107 in the TERI group. We used multinomial propensity scores for inverse probability weighting in generalized linear and Cox proportional hazards models to correct for the bias of this non-randomised registry study.

Results

Estimated mean annualized relapse rates (ARR) over 24 months were 0.13 for FTY, 0.09 for DMF and 0.11 for TERI treatment. For TERI in comparison with DMF, we observed higher probability for treatment interruption (p=0.023) and reduced sustained EDSS regression for 12 (p=0.016) and 24 weeks (p=0.031) and, for the comparison of DMF versus FTY, a reduced sustained EDSS progression for 12 weeks (p=0.02).

Conclusions

Relapse rates with treatment with FTY, DMF and TERI were similar. Patients treated with DMF showed less sustained disability progression for 12 weeks than FTY treated patients. However, FTY and DMF treatment was associated with more likely EDSS regression for 12 and 24 weeks and a lowerprobability for treatment interruptionas compared to TERI treated patients.

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Biomarkers and Bioinformatics Poster Presentation

P0148 - Retinal layer thinning is reflecting disability progression independent of relapse activity in multiple sclerosis (ID 304)

Speakers
Presentation Number
P0148
Presentation Topic
Biomarkers and Bioinformatics

Abstract

Background

Retinal thinning is a biomarker of neuroaxonal degeneration in multiple sclerosis (MS) and is associated with disability progression. Recently, the term PIRA, or progression independent of relapse, has emerged purporting to quantify the proportion of disability worsening due to non-inflammatory neurodegenerative processes.

Objectives

The objective of this study was to determine the association of retinal thinning with PIRA in comparison to traditional physical disability worsening and relapse.

Methods

In a 4-year prospective observational study including 171 relapsing MS (RMS) patients, retinal thinning was determined by annual spectral-domain optical coherence tomography measuring macular-ganglion-cell-and-inner-plexiform-layer(mGCIPL). Physical disability was assessed by expanded disability status scale (EDSS), cognitive disability by the symbol digit modalities test (SDMT). PIRA was defined as either an EDSS or SDMT worsening during the observation period confirmed after 24 weeks with no relapse in the 30 days before or after the disability worsening. Multivariate linear regression models adjusted for sex, age, disease duration and disease-modifying treatment regarding retinal thinning were calculated.

Results

Each PIRA event was associated with a mean additional loss of GCIPL (1.8µm) and pRNFL (1.9µm), similar to the impact of EDSS and SDMT worsening. Overall relapse and relapse without subsequent EDSS worsening did not influence retinal thinning, while a relapse with EDSS worsening was associated with an additional loss of GCIPL (1.3µm) and pRNFL (1.4µm).

Conclusions

PIRA is associated with retinal thinning, likely reflecting non-inflammatory neurodegenerative processes. It might be a clinical measure to identify MS patients with ongoing MS-associated neurodegeneration.

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Biomarkers and Bioinformatics Poster Presentation

P0149 - Retinal layer thinning rate as a biomarker predicting treatment response in relapsing multiple sclerosis (ID 295)

Speakers
Presentation Number
P0149
Presentation Topic
Biomarkers and Bioinformatics

Abstract

Background

Peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell plus inner plexiform layer (mGCIPL) thinning are markers of neuroaxonal degeneration in relapsing multiple sclerosis (RMS). pRNFL and mGCIPL thinning is more pronounced in patients with physical or cognitive disability progression, while it is reduced by disease-modifying treatment (DMT).

Objectives

The objective of this study was to investigate the potential of retinal layer thinning for prediction of treatment response in RMS.

Methods

In this 4-year prospective observational study on 113 RMS patients, pRNFL and GCIPL were measured at DMT initiation and after 12 (M12) and 24 months (M24) of follow-up by spectral-domain optical coherence tomography (OCT). Inclusion criteria included adherence to DMT for at least 2 years. Patients suffering optic neuritis between baseline and M24 were excluded. Treatment response was defined as absence of 6 month confirmed EDSS progression and Symbol Digit Modalities Test (SDMT) worsening during the observation period. Best possible cut-off values of retinal thinning for predicting treatment response were determined by receiver-operating characteristics (ROC) analyses. Odds ratios (OR) for treatment response were calculated by multivariate logistic regression models correcting for age, sex, disease duration and EDSS/SDMT at baseline.

Results

Thinning of mGCIPL <0.5mm at M24 displayed superior prediction of treatment response (odds ratio [OR] 4.5; 95% confidence interval [CI]: 1.8 – 7.6; p<0.001; specificity 91%, sensitivity 81%) followed by mGCIPL <0.3mm at M12 (OR 3.9; 95% CI: 1.4 – 6.9; p<0.001; specificity 85%, sensitivity 78%) and pRNFL <2mm at M24 (OR 3.7; 95% CI: 1.1 – 6.5; p=0.023; specificity 84%, sensitivity 69%), while pRNFL at M12 was not significantly predictive.

Conclusions

mGCIPL – and to a lesser degree pRNFL – thinning predict physical and cognitive disability progression upon DMT initiation. Pending validation, retinal layer thinning may be a useful and easily accessible biomarker of treatment response in RMS.

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Disease Modifying Therapies – Risk Management Poster Presentation

P0375 - Quantifying the risk of disease reactivation after DMT discontinuation – the VIAADISC score (ID 765)

Abstract

Background

There is a lack of evidence guiding treatment decisions regarding discontinuation of disease-modifying therapy (DMT) in multiple sclerosis (MS)

Objectives

To generate and validate a composite (clinical and MRI-based) score able to identify individual patients with relapsing MS (RMS) with a high risk of experiencing disease reactivation after discontinuation of DMT.

Methods

The study was conducted using a generation and a validation dataset drawn from two separate prospectively collected observational databases. We included RMS patients who received interferon-beta or glatirameracetate for ≥12 months, then discontinued DMT for ≥6 months and had ≥2 years of follow-up available. In the generation sample (n=168), regression analysis was performed to identify clinical or MRI variables independently predicting disease reactivation after DMT discontinuation. A predictive score was calculated using the variables included in the multivariable model. This score was then applied to the validation sample (n=98).

Results

The variables included in the final model as independent predictors of disease reactivation were age at discontinuation (p<0.001), MRI activity at discontinuation (p<0.001), and duration of clinical stability (p<0.001). The resulting score (Vienna Innsbruck DMT discontinuation score based on age, activity on MRI and duration in stable course; VIAADISC) was able to identify patients at high (83-84%), moderate (35-38%) and low risk (7%) of disease reactivation within 5 years after DMT discontinuation both in the generation and in the validation cohorts.

Conclusions

The composite VIAADISC score may be a valuable tool informing patients and neurologists in the face of deciding if and when to discontinue injectable DMTs.

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Patient-Reported Outcomes and Quality of Life Poster Presentation

P1054 - Sexual dysfunction in multiple sclerosis: who is at risk? (ID 1793)

Speakers
Presentation Number
P1054
Presentation Topic
Patient-Reported Outcomes and Quality of Life

Abstract

Background

Multiple sclerosis (MS) related disability and sexual dysfunction (SD) are known to lower a patient’s health related quality of life (HRQoL) detrimentally. However, taking a sexual history in routine care is commonly evaded. Furthermore, there is not much knowledge on SD being either an independent symptom or merely a byproduct of other symptoms such as depression or anxiety.

Objectives

To investigate the prevalence of SD in patients with MS and unveil possible associations with disease parameters, depression, anxiety and HRQoL.

Methods

We present results from a cross-sectional study of 93 patients with MS. SD was determined based on the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and correlated with physical disability (Expanded disability status scale, EDSS), depression and anxiety (Hospital Anxiety and Depression Scale, HADS), and HRQoL (Multiple Sclerosis Quality of Life-54 questionnaire, MSQoL-54).We present results from a cross-sectional study of 93 patients with MS. SD was determined based on the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19) and correlated with physical disability (Expanded disability status scale, EDSS), depression and anxiety (Hospital Anxiety and Depression Scale, HADS), and HRQoL (Multiple Sclerosis Quality of Life-54 questionnaire, MSQoL-54).

Results

The mean (standard deviation) age in our cohort was 39 (11.4) years and sex distribution was 3:2 (f:m). At the time of enrollment, two thirds of patients had relapsing MS. The median (IQR) EDSS was 2.0 (0-4.5) with one third of patients being rated as 4.0 or higher. SD was reported by 43 (46%) patients on the MSISQ-19. Out of all included patients, 32 (34%) suffered from anxiety and 15 (16%) from depression. In comparison of patients with and without SD, we found that patients affected by SD were significantly more likely to be depressed (28% vs. 6%, p=0.005) and had a higher median [IQR] EDSS (1 [1-3] vs. 4 [1.5-6], p<0.001). HRQoL was significantly poorer in patients with MS suffering from SD (median [IQR] MSQoL-54 scores: physical subscale 52 [41-68] vs. 81 [69-89], p<0.001; mental subscale 50 [38-82] vs. 86 [70-89], p<0.001). Furthermore, SD occurred more frequently in the progressive phase of the disease. We found no associations between sexual functioning and age, sex or MS disease duration. In a multivariate linear regression model, we found the risk for SD to be 18.1-fold higher (95%CI 3.3-31.4, p<0.001) in patients with EDSS≥4, while neither depression nor anxiety were independent predictors of SD.

Conclusions

SD is common among people with MS and should be addressed in clinical routine. The risk for SD is growing substantially with increasing EDSS while being independent of depression and anxiety. SD is clearly associated with poorer HRQoL. Nonetheless, guidelines for a structured approach, patient needs and treatment strategies should be investigated further.

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