•COVID-19 related death rate in Iranian MS patients is not higher than general population.•Anti CD20s may be related to more severe forms of COVID-19.•Steroid use in the past three months may be a ...risk factor for severe COVID-19.
Regarding the high prevalence of multiple sclerosis (MS) and COVID-19 in Iran, a multicenter study of COVID-19 in Iranian MS patients with is carried out to address the concerns of this population.
Data on MS patients with COVID-19 from nine provinces of Iran were entered in a web-based registry system, between July 2020 and March 2021. Among the COVID-19 symptoms, dyspnea, altered mental status, or those resulting in hospital admission were considered severe.
A total of 397 eligible patients were identified. In addition, 310 (78%) were female. The mean age was 36.5 ± 9.5. 294 (74%) patients had relapsing- remitting form. Also, four patients (1%) expired due to COVID-19 infection. The mean duration of admission in hospitalized patients was 9 (± 5.3) days. MRI was performed on 111 (28%) patients after developing COVID-19. MRI changes were observed in 27 (24%) of these cases. MS drug was changed in 26 (6%) patients. Steroid use in the past three months (OR: 2.43, 95% CI: 1.003–5.88) (p value: 0.049) and antiCD20s (OR: 4.03, 95% CI: 2.41–6.68) (p value < 0.001) showed significant association with severe COVID-19 symptoms.
The death rate of COVID-19 among MS patients (1%) is lower than the overall death rate of the pandemic in Iran (3%). Those who received steroid in the past three months may be at increased risk of more severe forms of COVID-19. There are still doubts about the effect of anti CD20s on COVID-19 severity.
Introduction: Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disorder of the central nervous system, which is associated with brain atrophy and volume changes in some ...brain structures. This study aimed to compare the volume of the basal ganglia, thalamus, cerebellum, and brainstem in patients with relapsing-remitting MS with that of the control group using magnetic resonance imaging (MRI). Methods: In this cross-sectional study, MRI brain scans were obtained from 25 patients with relapsing-remitting MS and 25 healthy control subjects. Volumetric analyses were performed using Brain Suite software. Results: The mean age of the MS and the control groups was 33.96±8.75 and 40.40±8.72, respectively. No statistically significant difference was found in gender (P=0.747). The bilateral putamen and caudate nuclei volumes were significantly higher in the case group than in the control group (P<0.001). Moreover, lower the volume of the brainstem, cerebellum, bilateral thalamus, and globus pallidus were identified in the MS patients compared to the control group (P<0.001). There was an inverse correlation between the disease and treatment duration with the thalamus and cerebellum volume in MS patients (P=0.001). Treatment duration also had an inverse correlation with brainstem volume (P=0.047). Conclusion: The volume of some structures of the brain, including globus pallidus, thalamus, cerebellum, and brainstem is lower in MS and can be one of the markers of disease progression and disability among MS patients.
Neuromyelitis Optica Spectrum Disorder (NMOSD) is a relapsing neuro inflammatory disease of the central nervous system that typically presents with optic neuritis or myelitis and may cause severe ...disability. The diagnostic criteria have been updated and several immunosuppressive agents have been demonstrated to prevent acute exacerbations. As the disease rarely develops in a progressive course, management of acute attacks and proper prevention of exacerbations may change the long term out-come and prevent future disability. Consensus recommendations and guidelines will help the physicians to improve their practice and unify the treatment approaches in different communities.
In order to develop a national consensus and recommendations for the diagnosis and management of NMOSD in Iran, a group of neurologists with long term experience in management of NMOSD were gathered to develop this consensus based on available national and international data. The primary draft was prepared and discussed to suggest the most appropriate treatment for these patients. We propose strategies for early diagnosis and treatment for prevention of relapses and minimizing consequences of attacks as a primary therapeutic goal. Attacks are currently treated with intravenous corticosteroids and, in refractory cases, with plasma exchange. All participants agreed on preventive treatment with currently available immunosuppressive agents such as azothioprin, rituximab and mycofenolate mofetil based on previous positive data in NMOSD in order to reduce attack frequency. The current consensus reviews the previous data and provides the clinicians with practical recommendations and advices for the diagnosis and management of NMOSD based on scientific data and clinical experience.
•This paper provides the clinicians a consensus recommendation for the diagnosis and management of Neuromyelitis optica Spectrum Disorder (NMOSD).•We propose strategies for early diagnosis and treatment for prevention of relapses and minimizing consequences of attacks as a primary therapeutic goal.•Preventive treatment with immunosuppressive agents such as azathioprine, rituximab and mycophenolate mofetil is advised to reduce attack frequency.•These practical recommendations and advices for the diagnosis and management of NMOSD are based on scientific data and clinical experience.
•Around 1.6% of registered Iranian MS cases are in the late-onset (LOMS) category.•The age-standardized LOMS prevalence was around 75 per 100,000 people.•About half of the Iranian LOMS cases suffered ...relapsing-remitting course.•Nearly 23% of LOMS patients did not receive any disease-modifying treatment.
Today, it is estimated that around 5% of multiple sclerosis (MS) patients are in the late-onset category (age at disease onset ≥ 50). Diagnosis and treatment in this group could be challenging. Here, we report the latest update on the characteristics of Iranian patients with late-onset MS (LOMS).
This cross-sectional study used the information provided by the nationwide MS registry of Iran (NMSRI). The registrars from 14 provinces entered data of patients with a confirmed diagnosis of MS by neurologists. Patients with disease onset at or later than 50 years of age were considered LOMS.
Of 20,036 records, the late-onset category included 321 patients (1.6%). The age-standardized LOMS prevalence was around 75 per 100,000 people. 215 patients (67%) were female. Median Expanded Disability Status Scale (EDSS) was 3 (interquartile range: 1.5–5). The majority of the cases (56%) suffered from relapsing-remitting (RR) course while 20% were diagnosed with primary progressive (PP) MS. Significantly higher proportion of male sex, PPMS, and higher EDSS were seen in the late-onset group compared with early-onset and adult-onset cases (p-value < 0.05). Seventy-five (23%) patients did not receive any disease-modifying treatment.
The more prominent degenerative pathology of LOMS may be the underlying mechanism of the observed differences in comparison to non-LOMS.
There are substantial differences and knowledge gaps regarding LOMS which could be the subject of further research.
Background: Multiple Sclerosis (MS) is one of the disorders of the central nervous system which creates many challenges for the psychological adjustment of patients all over the world. ...Objectives:This research was performed to demonstrate the effect of positive group-psychotherapy on reducing the psychological symptoms (depression, anxiety, and stress) and improving the quality of life in women with MS. Materials & Methods: The method of this research is quasi-experimental with pre-test, post-test, and control group. A total of 30 women were selected through a convenient sampling method from the patients of the MS-Society of Guilan Province, Iran. Then, they and randomly divided into 2 equal groups (experimental and control). The study data were collected through Depression Anxiety Stress Scale (DASS) and Multiple Sclerosis Impact Scale‐29 (MSIS) questionnaires. The intervention process was performed for the experimental group as 8 training sessions of 90 minutes long. The obtained data were analyzed by univariate analysis of covariance and multivariate analysis of covariance in SPSS V. 24. Results: The analysis showed that positive group-psychotherapy significantly modified the depression, anxiety, stress (F=39.13, P<0.001), and quality of life (F=50.44, P<0.001) in the experimental group. Conclusion: Positive group-psychotherapy can be used as an effective and efficient psychotherapy method to reduce and improve the psychological symptoms (depression, anxiety, and stress) of women with multiple sclerosis and improve their quality of life.
Introduction: Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disorder of the central nervous system, which is associated with brain atrophy and volume changes in some ...brain structures.This study aimed to compare the volume of the basal ganglia, thalamus, cerebellum, and brainstem in patients with relapsing-remitting multiple sclerosis with that of the control group using magnetic resonance imaging (MRI).Methods: In this cross-sectional study, MRI brain scans were obtained from 25 patients with relapsing-remitting and 25 healthy control subjects. Volumetric analyses were performed using Brain Suite software.Results: The mean ages ± standard deviation (SD) of the MS and the control groups were 33.96±8.75 and 40.40±8.72, respectively. No statistically significant difference was found in gender distribution (p=0.747). The bilateral putamen and caudate nuclei volumes were significantly higher in the case group than in the control group (p<0.001). Moreover, lower volume of brainstem and cerebellum and bilateral thalamus and globus pallidus were identified in the MS patients, compared to the control group (p<0.001). There was an inverse correlation between the disease and treatment duration with the thalamus and cerebellum volume in MS patients (p=0.001). Treatment duration also had an inverse correlation with brainstem volume (p=0.047).Conclusion:The findings indicate that the volume of some structures of the brain including globus pallidus and thalamus and cerebellum and brainstem is lower in MS and can be one of the markers of disease progression and disability among MS patients.
Neuromyelitis optica (NMO) and the associated NMO spectrum disorders are demyelinating disorders affecting the spinal cord and optic nerves. It has prominent female predominance and many of these ...patients are in their childbearing years. As pregnancy seems to have a major impact on this disease course, in this review, recent studies with a focus on this disease and pregnancy and safety of available treatment options during this period are discussed.
•This is the first clinical study that directly compared peginterferon beta-1a to interferon beta-1a in relapsing remitting multiple sclerosis patients.•Peginterferon beta-1a was shown to be ...non-inferior to interferon beta-1a in reducing the relapse rate and both medications were also comparable in other efficacy outcomes and safety profiles.•These findings support considering peginterferon beta-1a as a safe, efficient, and convenient option in patients with relapsing remitting multiple sclerosis.
Multiple sclerosis (MS) is a prevalent, disabling, inflammatory, neurodegenerative disease that typically manifests during a highly productive stage of life. Interferon beta-1a was among the first approved disease-modifying therapies for MS and remains among the first-line treatment options. Pegylation of the interferon beta-1a molecule prolongs its half-life while maintaining its efficacy and safety profile. In PEGINTEGRITY study, we aimed to compare peginterferon beta-1a with interferon beta-1a in terms of efficacy and safety in relapsing-remitting multiple sclerosis (RRMS) patients.
This study was a randomized, active-controlled, parallel-group, multi-center Phase 3 trial conducted in Iran in participants with RRMS. Participants received 125 µg of subcutaneous peginterferon beta-1a every two weeks or 30 µg of intramuscular interferon beta-1a once a week for up to 96 weeks. The primary outcome was the non-inferiority of peginterferon beta-1a to interferon beta-1a in reducing annualized relapse rate (ARR). Other outcomes included the number of patients with 12-week confirmed disability progression, the number of new or newly-enlarging T2 hyperintense lesions, the number of gadolinium-enhancing lesions, the number of new T1 hypointense lesions, the volume of new or newly-enlarging T2 hyperintense lesions, changes in brain volume, immunogenicity, and safety assessments.
A total of 168 patients who met the eligibility criteria were enrolled and assigned to two arms of the study, each consisting of 84 participants. Totally, 41 participants (24 patients in the peginterferon beta-1a group and 17 patients in the interferon beta-1a group) were withdrawn from the study. The withdrawn patients were included in the per-protocol analysis for the period of time they were in the study. In 96 weeks, in the per-protocol population, the ARR was 0.05 in the peginterferon beta-1a group versus 0.11 in the interferon beta-1a group, which does not reflect a statistically significant difference (p=0.09; 95 % CI, 0.18-1.14). Considering the upper limit of the one-sided 95 % CI of the rate ratio of peginterferon beta-1a compared to interferon beta-1a, as well as the non-inferiority margin, it can be concluded that the primary outcome was met. The results were also comparable for other efficacy and safety outcomes.
The results demonstrate the non-inferiority of peginterferon beta-1a to interferon beta-1a with similar efficacy in 96-week ARR in RRMS patients. Both arms were also comparable in other efficacy outcomes and safety profiles with no statistically significant differences. These findings support considering peginterferon beta-1a as a safe and efficient option in patients with RRMS.
This study was registered on Iranian Registry of Clinical Trials (IRCT201612306135N8) and clinicaltrials.gov (NCT05242133).
•A group of Iranian neurologists with experience in the field of MS gathered to develop a practical consensus in diagnosis and management of PPMS.•In this consensus recommendation, the authors try to ...review how to diagnose PPMS correctly and give answers to important questions in this field in order to define a uniform treatment strategy.•This consensus recommendation is the conclusion of a discussion among expert clinician neurologists, who are involved in this field.
The development of oral treatments for relapsing–remitting multiple sclerosis (RRMS) may alter patient satisfaction and quality of life (QoL). Additionally, patient-reported outcomes (PRO) offer a ...comprehensive assessment of the RRMS disease and its treatment.
PROFIT is a phase 4, open-label, prospective single-arm (treatment with DMF), 12-month observational study was applied. Primary endpoints were evaluated at baseline and month 6 of follow-up including the mean changes in PRO score in terms of Qol, depression, productivity, sleep disorders in naïve and switchers, and the mean changes in treatment satisfaction in switchers. To achieve the end point, enrolled patients were asked to complete the Treatment Satisfaction Questionnaire for Medication-14 (TSQM-14), the European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), the Beck's Depression Inventory-7 (BDI-7), the Work Productivity and Activity Impairment Questionnaire: Multiple Sclerosis (WPAI-MS), and the Pittsburgh Sleep Quality Index (PSQI). Factors associated with the mentioned questionnaires and scores were evaluated using paired t-test analysis.
Four Hundred and Ten patients (79.5% females and 20.5% male, mean age 34.0 ± 7.7 years) receiving DMF were recruited of which 340 (82.9%) completed the study. No correlation existed between drop rate (17.1%) and age, gender, education and history of treatment (naive or switcher). Patient satisfaction improved from baseline to month 6 in all dimension including TSQM effectiveness (change: -10.94, 95% CI: -17.06 to -4.82, p<0.001), TSQM side effect (change: -6.54, 95% CI: -10.40 to -2.68, p=0.001), TSQM Convenience (change: -34.40, 95% CI: -40.44 to -28.36, p<0.001) and TSQM Global Satisfaction (change: -13.64, 95% CI: -18.14 to -9.13, p<0.001). Additionally, EQ-5D-3L VAS satisfaction improvement was noted (change: -2.87, 95% CI: -4.86 to -0.88, p=0.005). Regarding PSQI, significant improvement including 0.16 change in the sleep quality score (95% CI: 0.05-0.28, p=0.007) and 99.0 change in PSQI Global score were reported. In terms of WPAI-MS, from baseline to month 6, significant reduction was reported.
The 6-month treatment showed significant improvements in various dimensions of TSQM, including effectiveness, side effects, convenience, and global satisfaction. In addition, sleep quality and work productivity were increased. These data suggest potential benefits in the DMF treatment in MS patients, concerning their work and activity functionality.
PDF
