Author Of 2 Presentations
P0838 - Autonomic dysfunction in patients with relapsing-remitting multiple sclerosis treated with different oral disease modifying therapies – a pilot study (ID 1454)
Abstract
Background
Autonomic dysfunction is common among patients with multiple sclerosis (MS) and can contribute to significant disability. However, there are limited data concerning the influence of disease modifying therapies (DMT) on autonomic dysfunction in MS.
Objectives
The aim of this pilot study was to evaluate cardiovascular autonomic function in relapsing-remitting MS (RRMS) patients treated with two different oral DMTs – dimethyl fumarate (DMF) and fingolimod (FTY) – using standard autonomic tests.
Methods
In 8 patients without signs of recent clinical relapse and 8 age and gender matched healthy persons (26.9±2.9 vs 29.1±7.0 years, p=0.42; 7 females in each subgroup, p=1.00), we continuously monitored heart rate (HR), blood pressure (BP) and respiration during supine rest, deep breathing, Valsalva maneuver and head-up tilt. The tests were repeated in patients after initiation of DMF or FTY, with median interval of 9 (7-17) weeks. Six patients started DMF (5 treatment-naïve and 1 switched from interferon beta-1a s.c.). Two patients previously treated with 2 other DMTs (one with interferon beta-1b s.c. and glatiramer acetate and another with interferon beta-1a i.m. and 2 natalizumab infusions) initiated FTY.
Results
Median EDSS was 1.69±1.00 and median time from first MS symptoms was 58.4 months. Clinical autonomic symptoms, such as bradycardia, flushing or gastrointestinal disturbances occurred in 5 patients (62.5%) after DMF or FTY initiation. Before DMT, mean and diastolic BP responses to tilt were significantly smaller in patients than in controls (change from supine baseline by -1.2±2.5 vs 6.0±5.9%, p=0.007 and 0.2±6.2 vs 9.6±8.9%, p=0.03, respectively). Furthermore, prior to treatment, orthostatic hypotension was present in 50% of patients (in 3 from DMF and 1 from FTY group) and none of controls (χ2=5.33, p=0.02). Initiation of oral DMT did not significantly change autonomic variables, however, there was a tendency to lower HR during tilt following DMF (84.6±9.8 vs 80.8±7.6 bpm, p=0.08). Moreover, after DMT initiation, orthostatic hypotension was observed in both FTY patients but only in 1 out of 6 DMF patients (p=0.22). Clinical autonomic symptoms did not correlate with HR responses to orthostatic stress in patients (p>0.1).
Conclusions
Patients with RRMS demonstrated reduced sympathetic responses to orthostatic stress. However, DMF or FTY did not significantly change cardiovascular autonomic function within several weeks of therapy.
P0893 - Olfactory dysfunction in patients with relapsing-remitting multiple sclerosis treated with disease modifying therapies (ID 357)
Abstract
Background
Previous studies showed that olfactory dysfunction was more common in patients with multiple sclerosis (MS) than in healthy individuals and correlated with neurological deficit and cognitive disturbances. However, most studies required the use of time-consuming olfaction examination.
Objectives
The aim of this study was to assess olfactory function in patients with relapsing-remitting MS (RRMS) and its possible correlation with inflammatory and neurodegenerative features of the disease with the use of short and simple screening olfactory test.
Methods
The study included 30 controls and 30 patients with RRMS matched for age and gender, all of Caucasian origin. Patients with RRMS were treated with disease modifying therapies (DMT) – 18 with injectables (interferon beta or glatiramer acetate) and 12 with oral drugs (dimethyl fumarate or fingolimod). Olfactory function was assessed with the Sniffin’ Sticks Identification Test (SSIT) comprising 8 pens with different scents. The score of 6 or less points was defined as hyposmia. The data concerning number of previous relapses, disability in Expanded Disability Status Scale (EDSS) and new T2 or gadolinium enhancing brain MRI lesions were collected from each patient. Cognition and fatigue in patients were evaluated with Symbol Digit Modalities Test (SDMT) and Fatigue Scale for Motor and Cognitive Functions (FSMC), respectively. Moreover, the volume of thalami and the width of the third ventricle on brain MRI were recorded in every patient.
Results
Patients with RRMS had nearly two-fold higher risk of hyposmia (odds ratio, OR=1.82, 95%CI: 1.10–3.67, p=0.02). The SSIT score did not correlate with disease duration (r=0.28, p=0.13), the length of DMT use (r=0.05, p=0.78) and the number of previous DMTs (r=0.26, p=0.17). Neither inflammatory (number of previous relapses, number of new T2 or gadolinium enhancing lesions on recent brain MRI) nor neurodegenerative (EDSS score and its progression, SDMT and FSMC scores, volume of thalami and the width of the third ventricle on MRI) MS features did not show any correlation with SSIT score (p>0.05). Hyposmia also did not correlate with new disease activity within the next 12 months after olfactory evaluation in relation to new clinical relapses (r=0.20, p=0.28) and new T2 (r=0.17, p=0.36) or gadolinium enhancing brain MRI lesions (r=-0.07, p=0.71). In the subgroup of patients treated with oral DMTs olfactory dysfunction strongly correlated with FSMC score (r=-0.90, p=0.006), mainly with its cognitive subscale (r=-0.90, p=0.006). Such correlation was not observed for patients receiving injectables.
Conclusions
Olfactory dysfunction is common in RRMS and correlates with the level of fatigue in cognitive functions in patients treated with dimethyl fumarate or fingolimod.