Tysabri: reducing the risk of PML with extended interval dosing
The study in brief
Tysabri (natalizumab) is very effective for people with highly active relapsing remitting MS but it carries the risk of developing a rare but very serious brain infection called progressive multifocal leukoencephalopathy (PML).
Measures are taken to minimise the risk of PML and monitor for early signs of the infection. It has been suggested that a longer time between infusions might further reduce the risk of PML. But would Tysabri still be effective and how would this suit people who feel that the effects of Tysabri wear off just before their next infusion? Three recently published studies have looked at these issues.
Researchers analysed data collected through the TOUCH program which monitors treatment with Tysabri and PML risk in the United States. Records of 35,521 people were analysed. The risk of developing PML was between 88% and 94% lower for people on EID compared to SID.
To evaluate effectiveness of the two dosing patterns, Italian researchers reviewed medical records from 14 MS clinics and identified 360 people who had taken Tysabri for more than two years. They were grouped according to the average number of weeks between doses; less than 5 weeks, SID; more than 5 weeks, EID. Relapse rates for both groups were very low and the researchers concluded that both dosing patterns were equally effective at reducing relapses.
People taking Tysabri often report that symptoms, particularly fatigue and cog fog, are worse in the days leading up to their next infusion. Dutch researchers studied this in a group of 93 people. Just over a half (54%) of the group had experienced a wearing off effect at some point since they had started taking Tysabri and about one third (32%) reported a wearing off effect at the time of the study. The wearing off effect was more frequently reported with SID (39%) than with EID (19%) and was not associated with reduced Tysabri blood levels or binding to immune cells.
Overall, these studies do suggest that increasing the gap between Tysabri infusions from four to six or eight weeks does reduce the risk of PML, without loss of effectiveness. The wearing off effect was not related to blood levels of Tysabri, and does not appear to increase with EID.
The study in more detail
Background
Tysabri (natalizumab) has proved to be a very effective for people with highly active relapsing remitting MS but it carries a risk of developing a rare but very serious brain infection called progressive multifocal leukoencephalopathy (PML) which can cause severe disability or even death.
Measures are routinely taken to minimise the risk of PML and monitor for early signs and symptoms of the infection. It has been suggested that a longer time between Tysabri infusions (currently every four weeks) would reduce blood levels of Tysabri sufficiently to allow some immune cells to pass into the brain and prevent PML from developing. But with a bigger gap between infusions, would Tysabri still be effective? And how would this suit people who feel that the effects of Tysabri wear off just before their next infusion? Three recently published studies have looked at these issues.
1. Extended interval dosing and PML risk
Researchers analysed data collected through the TOUCH program which monitors treatment with Tysabri and PML risk in the United States. Records of 35,521 people who had a positive test for the JC virus and therefore at risk of developing PML were selected. The investigators used three definitions of extended interval dosing (EID) to identify people who had received less than the official number of infusions and compared their risk of PML with those receiving standard interval dosing (SID).
What was found?
For all three definitions, people who were treated with Tysabri EID were significantly less likely to develop PML. The risk of developing PML was between 88% and 94% lower for people on EID compared to SID. For one definition of EID (people who had received EID for the duration of their Tysabri treatment) there were no cases of PML.
2. Is Tysabri still effective with a longer interval between infusions?
Italian researchers reviewed medical records from 14 MS clinics and identified 360 people who had taken Tysabri for more than two years. People were grouped in two categories according to the average number of weeks between doses; less than 5 weeks, SID; more than 5 weeks, EID.
What was found?
The average relapse rates for SID group was 0.06 relapses per year, for the EID group 0.039 relapses per year. The researchers concluded that both dosing patterns were equally effective at reducing relapses.
3. Do the effects of Tysabri wear off?
People taking Tysabri often report that symptoms, particularly fatigue and cog fog, are worse in the days leading up to their next infusion; would this be worse if the interval between doses was longer? Dutch researchers studied this in a group of 93 people who had received at least six infusions. Participants were asked to complete questionnaires about their symptoms and blood levels of Tysabri were measured just before their next infusion.
What was found?
Just over a half (54%) of the group had experienced a wearing off effect at some point since they had started taking Tysabri and about one third (32%) reported a wearing off effect at the time of the study. The wearing off effect was more frequently reported with SID (39%) than with EID (19%); the duration of symptoms was similar for the two groups. The wearing off effect was not associated with reduced Tysabri blood levels or binding to immune cells.
What does it mean?
Overall, the studies do suggest that increasing the gap between Tysabri infusions from four to six or eight weeks does reduce the risk of PML, without loss of effectiveness. The wearing off effect does not appear to be related to blood levels of Tysabri, and does not appear to increase with EID.
Some commentators were surprised by the dramatic reduction in PML risk achieved by a small difference in dosing intervals and have urged caution in drawing conclusions from the study. One explanation could be that the JC virus that causes PML is very susceptible to a small increase in the number of immune cells passing into the brain.
Another criticism was that these studies are retrospective, in other words they use historical medical records, which can introduce bias into the results. To obtain more reliable data, a new study is recruiting 480 participants to compare the effectiveness of Tysabri SID and EID over two years, measuring relapse rates, lesions seen on MRI scans and disability worsening. The number of participants in the study will be too small to give data on the risk of PML; because PML is a rare side effect, it can be evaluated only by analysing data from thousands of people.
Ryerson LZ, et al.
Risk of natalizumab-associated PML in patients with MS is reduced with extended interval dosing.
Neurology 2019;93(15):e1452-e1462.
Read the full study
Clerico M, et al.
Extending the interval of natalizumab dosing: is efficacy preserved?
Neurotherapeutics. 2019 Aug 26. [Epub ahead of print]
Read the summary
van Kempen ZLE, et al.
The natalizumab wearing-off effect: end of natalizumab cycle, recurrence of MS symptoms.
Neurology. 2019 Oct 22;93(17):e1579-e1586.
Read the full study
Find out more about PML
The JC virus is a common infection carried by the majority of the general population and completely unrelated to MS. The JC virus is normally kept under control by the immune system and does not cause any problems.
However, if your immune system is weakened, the JC virus can become active and cause inflammation and damage to the brain, known as progressive multifocal leukoencephalopathy (PML).
Treatment with some of the more effective disease modifying drugs, in particular Tysabri (natalizumab), but also very rarely Gilenya (fingolimod) and Tecfidera (dimethyl fumarate) can increase the risk of developing PML. This is because they work by suppressing your immune system.
Several factors are known to increase the risk of developing PML while taking Tysabri:
- Infection with the JC virus – this can be detected with a blood test
- Amount of JC virus antibody (titre) in your blood
- Previous treatment with other drugs which suppress the immune system
- How long you have been taking Tysabri (risk increases after two years)
With different combinations of these factors the risk of developing PML ranges from less than 1 in 10,000 up to 1 in 125.
Browse more from the latest research
Carers
Bassi M, Cilia S, Falautano M, Grobberio M, Negri L, Niccolai C, Pattini M, Pietrolongo E, Quartuccio ME, Viterbo RG, Allegri B, Amato MP, Benin M, De Luca G, Gasperini C, Minacapelli E, Patti F, Trojano M, Delle Fave A.
The caring experience in multiple sclerosis: Caregiving tasks, coping strategies and psychological well-being.
Health Soc Care Community. 2019 Sep 16. doi: 10.1111/hsc.12858. [Epub ahead of print]
Summary(link is external)
Childhood MS
Johnen A, Elpers C, Riepl E, Landmeyer NC, Krämer J, Polzer P, Lohmann H, Omran H, Wiendl H, Göbel K, Meuth SG.
Early effective treatment may protect from cognitive decline in paediatric multiple sclerosis.
Eur J Paediatr Neurol. 2019 Nov;23(6):783-791. doi: 10.1016/j.ejpn.2019.08.007. Epub 2019 Sep 5.
Summary(link is external)
Eskandarieh S, Sahraiain MA, Molazadeh N, Moghadasi AN.
Pediatric multiple sclerosis and its familial recurrence: A population based study (1999-2017).
Mult Scler Relat Disord. 2019 Aug 27;36:101377. doi: 10.1016/j.msard.2019.101377. [Epub ahead of print]
Summary(link is external)
Deiva K, Huppke P, Banwell B, Chitnis T, Gärtner J, Krupp L, Waubant E, Stites T, Pearce GL, Merschhemke M.
Consistent control of disease activity with fingolimod versus IFN β-1a in paediatric-onset multiple sclerosis: further insights from PARADIGMS.
J Neurol Neurosurg Psychiatry. 2019 Aug 29. pii: jnnp-2019-321124. doi: 10.1136/jnnp-2019-321124. [Epub ahead of print]
Summary(link is external)
Read the full text of this paper (link is external)
Co-existing conditions
Marrie RA, Tremlett H, Kingwell E, Schaffer SA, Yogendran M, Zhu F, Fransoo R, Garland A.
Disparities in management and outcomes of myocardial infarction in multiple sclerosis: A matched cohort study.
Mult Scler. 2019 Sep 13:1352458519876038. doi: 10.1177/1352458519876038. [Epub ahead of print]
Summary(link is external)
Diagnosis
Barin L, Kamm CP, Salmen A, Dressel H, Calabrese P, Pot C, Schippling S, Gobbi C, Müller S, Chan A, Rodgers S, Kaufmann M, Ajdacic-Gross V, Steinemann N, Kesselring J, Puhan MA, von Wyl V; Swiss Multiple Sclerosis Registry..
How do patients enter the healthcare system after the first onset of multiple sclerosis symptoms? The influence of setting and physician specialty on speed of diagnosis.
Mult Scler. 2019 Jan 18:1352458518823955. doi: 10.1177/1352458518823955. [Epub ahead of print]
Summary(link is external)
Read the full text of this paper (link is external)
Disease modifying drugs
Palte MJ, Wehr A, Tawa M, Perkin K, Leigh-Pemberton R, Hanna J, Miller C, Penner N.
Improving the gastrointestinal tolerability of fumaric acid esters: early findings on gastrointestinal events with diroximel fumarate in patients with relapsing-remitting multiple sclerosis from the phase 3, open-label EVOLVE-MS-1 study
Adv Ther. 2019 Nov;36(11):3154-3165. doi: 10.1007/s12325-019-01085-3. Epub 2019 Sep 19.
Summary(link is external)
Read the full text of this paper (link is external)
Paolicelli D, Lucisano G, Manni A, Avolio C, Bonavita S, Brescia Morra V, Capobianco M, Cocco E, Conte A, De Luca G, De Robertis F, Gasperini C, Gatto M, Gazzola P, Lus G, Iaffaldano A, Iaffaldano P, Maimone D, Mallucci G, Maniscalco GT, Marfia GA, Patti F, et al.
Retrospectively acquired cohort study to evaluate the long-term impact of two different treatment strategies on disability outcomes in patients with relapsing multiple sclerosis (RE.LO.DI.MS): data from the Italian MS Register.
J Neurol. 2019 Dec;266(12):3098-3107. doi: 10.1007/s00415-019-09531-6. Epub 2019 Sep 18.
Summary(link is external)
Cohen JA, Comi G, Selmaj KW, Bar-Or A, Arnold DL, Steinman L, Hartung HP, Montalban X, Kubala Havrdová E, Cree BAC, Sheffield JK, Minton N, Raghupathi K, Huang V, Kappos L; RADIANCE Trial Investigators..
Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (RADIANCE): a multicentre, randomised, 24-month, phase 3 trial.
Lancet Neurol. 2019 Nov;18(11):1021-1033. doi: 10.1016/S1474-4422(19)30238-8. Epub 2019 Sep 3.
Summary(link is external)
Comi G, Kappos L, Selmaj KW, Bar-Or A, Arnold DL, Steinman L, Hartung HP, Montalban X, Kubala Havrdová E, Cree BAC, Sheffield JK, Minton N, Raghupathi K, Ding N, Cohen JA; SUNBEAM Study Investigators..
Safety and efficacy of ozanimod versus interferon beta-1a in relapsing multiple sclerosis (SUNBEAM): a multicentre, randomised, minimum 12-month, phase 3 trial.
Lancet Neurol. 2019 Nov;18(11):1009-1020. doi: 10.1016/S1474-4422(19)30239-X. Epub 2019 Sep 3.
Summary(link is external)
Barkhof F, Kappos L, Wolinsky JS, Li DKB, Bar-Or A, Hartung HP, Belachew S, Han J, Julian L, Sauter A, Napieralski J, Koendgen H, Hauser SL.
Onset of clinical and MRI efficacy of ocrelizumab in relapsing multiple sclerosis.
Neurology. 2019 Nov 5;93(19):e1778-e1786. doi: 10.1212/WNL.0000000000008189. Epub 2019 Sep 4.
Summary(link is external)
Read the full text of this paper (link is external)
Vukusic S, Rollot F, Casey R, Pique J, Marignier R, Mathey G, Edan G, Brassat D, Ruet A, De Sèze J, Maillart E, Zéphir H, Labauge P, Derache N, Lebrun-Frenay C, Moreau T, Wiertlewski S, Berger E, Moisset X, Rico-Lamy A, Stankoff B, Bensa C, et al.
Progressive multifocal leukoencephalopathy incidence and risk stratification among natalizumab users in France.
JAMA Neurol. 2019 Sep 3. doi: 10.1001/jamaneurol.2019.2670. [Epub ahead of print]
Summary(link is external)
Boz C, Terzi M, Özer B, Turkoglu R, Karabudak R, Efendi H, Soysal A, Sevim S, Altintas A, Kurne A, Akçalı A, Akman G, Yüceyar N, Balcı BP, Ekmekci Ö, Karahan SZ, Demirkıran M, Altunrende B, Turan ÖF, Gökçen GözübatıkÇelik, Kale N, Köseoğlu M, et al.
Comparative analysis of fingolimod versus teriflunomide in relapsing-remitting multiple sclerosis.
Mult Scler Relat Disord. 2019 Aug 26;36:101376. doi: 10.1016/j.msard.2019.101376. [Epub ahead of print]
Summary(link is external)
Scappaticcio L, Castellana M, Virili C, Bellastella G, Centanni M, Cannavò S, Campennì A, Ruggeri RM, Giovanella L, Trimboli P.
Alemtuzumab-induced thyroid events in multiple sclerosis: a systematic review and meta-analysis.
J Endocrinol Invest. 2019 Aug 26. doi: 10.1007/s40618-019-01105-7. [Epub ahead of print]
Summary(link is external)
Families
Wood V, Kasser SL.
Spousal support and self-determined physical activity in individuals with multiple sclerosis: A theory-informed qualitative exploration.
Disabil Health J. 2019 Aug 14:100835. doi: 10.1016/j.dhjo.2019.100835. [Epub ahead of print]
Summary(link is external)
Genetics
Andrijauskis D, Balnyte R, Keturkaite I, Vaitkus A.
Clinical and diagnostic features of patients with familial multiple sclerosis.
Med Hypotheses. 2019 Oct;131:109310. doi: 10.1016/j.mehy.2019.109310. Epub 2019 Jul 13.
Summary(link is external)
Hormones
Guven Yorgun Y, Ozakbas S.
Effect of hormonal changes on the neurological status in the menstrual cycle of patient with multiple sclerosis.
Clin Neurol Neurosurg. 2019 Nov;186:105499. doi: 10.1016/j.clineuro.2019.105499. Epub 2019 Sep 10.
Summary(link is external)
Other treatments
Shi J, Wu X, Chen Y.
Study on dalfampridine in the treatment of multiple sclerosis mobility disability: a meta-analysis.
PLoS One. 2019 Sep 12;14(9):e0222288. doi: 10.1371/journal.pone.0222288. eCollection 2019.
Summary(link is external)
Read the full text of this paper (link is external)
Schepici G, Silvestro S, Bramanti P, Mazzon E.
The gut microbiota in multiple sclerosis: an overview of clinical trials.
Cell Transplant. 2019 Sep 12:963689719873890. doi: 10.1177/0963689719873890. [Epub ahead of print]
Summary(link is external)
Read the full text of this paper (link is external)
Liu M, Fan S, Xu Y, Cui L.
Non-invasive brain stimulation for fatigue in multiple sclerosis patients: A systematic review and meta-analysis.
Mult Scler Relat Disord. 2019 Aug 28;36:101375. doi: 10.1016/j.msard.2019.08.017. [Epub ahead of print] Review.
Summary(link is external)
Farez MF, Correale J, Armstrong MJ, Rae-Grant A, Gloss D, Donley D, Holler-Managan Y, Kachuck NJ, Jeffery D, Beilman M, Gronseth G, Michelson D, Lee E, Cox J, Getchius T, Sejvar J, Narayanaswami P.
Practice guideline update summary: Vaccine-preventable infections and immunization in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.
Neurology. 2019 Sep 24;93(13):584-594. doi: 10.1212/WNL.0000000000008157. Epub 2019 Aug 28.
Summary(link is external)
Read the full text of this paper (link is external)
Zrzavy T, Kollaritsch H, Rommer PS, Boxberger N, Loebermann M, Wimmer I, Winkelmann A, Zettl UK.
Vaccination in multiple sclerosis: friend or foe?
Front Immunol. 2019 Aug 7;10:1883. doi: 10.3389/fimmu.2019.01883. eCollection 2019. Review.
Summary(link is external)
Read the full text of this paper (link is external)
Prognosis
Solari A, Giovannetti AM, Giordano A, Tortorella C, Torri Clerici V, Brichetto G, Granella F, Lugaresi A, Patti F, Salvetti M, Pesci I, Pucci E, Centonze D, Danni MC, Bonavita S, Ferraro D, Gallo A, Gajofatto A, Nociti V, Grimaldi L, Grobberio M, Lanzillo R, et al.
Conversion to secondary progressive multiple sclerosis: patient awareness and needs. Results from an online survey in Italy and Germany.
Front Neurol. 2019 Aug 22;10:916. doi: 10.3389/fneur.2019.00916. eCollection 2019.
Summary(link is external)
Read the full text of this paper (link is external)
Elliott C, Belachew S, Wolinsky JS, Hauser SL, Kappos L, Barkhof F, Bernasconi C, Fecker J, Model F, Wei W, Arnold DL.
Chronic white matter lesion activity predicts clinical progression in primary progressive multiple sclerosis.
Brain. 2019 Sep 1;142(9):2787-2799. doi: 10.1093/brain/awz212.
Summary(link is external)
Read the full text of this paper (link is external)
Granella F, Tsantes E, Graziuso S, Bazzurri V, Crisi G, Curti E.
Spinal cord lesions are frequently asymptomatic in relapsing-remitting multiple sclerosis: a retrospective MRI survey.
J Neurol. 2019 Dec;266(12):3031-3037. doi: 10.1007/s00415-019-09526-3. Epub 2019 Sep 7.
Summary(link is external)
Ivashynka A, Copetti M, Naldi P, D'Alfonso S, Leone MA.
The impact of lifetime alcohol and cigarette smoking loads on multiple sclerosis severity.
Front Neurol. 2019 Aug 13;10:866. doi: 10.3389/fneur.2019.00866. eCollection 2019.
Summary(link is external)
Read the full text of this paper (link is external)
Provision of care
Oreja-Guevara C, Potra S, Bauer B, Centonze D, Giambastiani MP, Giovannoni G, Kesselring J, Langdon D, Morrow SA, Nouvet-Gire J, Pontaga M, Rieckmann P, Schippling S, Alexandri N, Shanahan J, Thompson H, Van Galen P, Vermersch P, Yeandle D.
Joint healthcare professional and patient development of communication tools to improve the standard of MS care.
Adv Ther. 2019 Nov;36(11):3238-3252. doi: 10.1007/s12325-019-01071-9. Epub 2019 Sep 5.
Summary(link is external)
Read the full text of this paper (link is external)
Alschuler KN, Stobbe GA, Hertz DP, Johnson KL, von Geldern G, Wundes A, Reynolds P, Unruh K, Scott JD.
Impact of multiple sclerosis project ECHO (Extension for Community Healthcare Outcomes) on provider confidence and clinical practice.
Int J MS Care. 2019 Jul-Aug;21(4):143-150. doi: 10.7224/1537-2073.2018-014.
Summary(link is external)
Read the full text of this paper (link is external)
Robb JF, Hyland MH, Goodman AD.
Comparison of telemedicine versus in-person visits for persons with multiple sclerosis: A randomized crossover study of feasibility, cost, and satisfaction.
Mult Scler Relat Disord. 2019 May 6;36:101258. doi: 10.1016/j.msard.2019.05.001. [Epub ahead of print]
Summary(link is external)
Psychological aspects
Van Heugten C, Köhler S, Francke M, Bol Y.
The association between executive functioning, coping styles and depressive symptoms in patients with Multiple Sclerosis.
Mult Scler Relat Disord. 2019 Sep 9;36:101392. doi: 10.1016/j.msard.2019.101392. [Epub ahead of print]
Summary(link is external)
Ochoa-Morales A, Hernández-Mojica T, Paz-Rodríguez F, Jara-Prado A, Trujillo-De Los Santos Z, Sánchez-Guzmán MA, Guerrero-Camacho JL, Corona-Vázquez T, Flores J, Camacho-Molina A, Rivas-Alonso V, Dávila-Ortiz de Montellano DJ.
Quality of life in patients with multiple sclerosis and its association with depressive symptoms and physical disability.
Mult Scler Relat Disord. 2019 Sep 9;36:101386. doi: 10.1016/j.msard.2019.101386. [Epub ahead of print]
Summary(link is external)
Vissicchio NA, Altaras C, Parker A, Schneider S, Portnoy JG, Archetti R, Stimmel M, Foley FW.
Relationship between anxiety and cognition in multiple sclerosis: implications for treatment.
Int J MS Care. 2019 Jul-Aug;21(4):151-156. doi: 10.7224/1537-2073.2018-027.
Summary(link is external)
Read the full text of this paper (link is external)
Kalb R, Feinstein A, Rohrig A, Sankary L, Willis A.
Depression and suicidality in multiple sclerosis: red flags, management strategies, and ethical considerations.
Curr Neurol Neurosci Rep. 2019 Aug 28;19(10):77. doi: 10.1007/s11910-019-0992-1. Review.
Summary(link is external)
Read the full text of this paper (link is external)
Rintala A, Matcham F, Radaelli M, Locafaro G, Simblett S, Barattieri di San Pietro C, Bulgari V, Burke P, Devonshire J, Weyer J, Wykes T, Comi G, Hotopf M, Myin-Germeys I; on the behalf of the RADAR-CNS Consortium..
Emotional outcomes in clinically isolated syndrome and early phase multiple sclerosis: a systematic review and meta-analysis.
J Psychosom Res. 2019 Sep;124:109761. doi: 10.1016/j.jpsychores.2019.109761. Epub 2019 Jul 5. Review.
Summary(link is external)
Rehabilitation
Gervasoni E, Cattaneo D, Bertoni R, Grosso C, Bisio A, Rovaris M, Bove M.
Effect of arm cycling and task-oriented exercises on fatigue and upper limb performance in multiple sclerosis: a randomized crossover study.
Int J Rehabil Res. 2019 Dec;42(4):300-308. doi: 10.1097/MRR.0000000000000362.
Summary(link is external)
Cano Porras D, Sharon H, Inzelberg R, Ziv-Ner Y, Zeilig G, Plotnik M.
Advanced virtual reality-based rehabilitation of balance and gait in clinical practice.
Ther Adv Chronic Dis. 2019 Aug 23;10:2040622319868379. doi: 10.1177/2040622319868379. eCollection 2019.
Summary(link is external)
Read the full text of this paper (link is external)
Miller Renfrew L, Lord AC, Warren J, Hunter R.
Evaluating the effect of functional electrical stimulation used for foot drop on aspects of health-related quality of life in people with multiple sclerosis: a systematic review.
Int J MS Care. 2019 Jul-Aug;21(4):173-182. doi: 10.7224/1537-2073.2018-015.
Summary(link is external)
Read the full text of this paper (link is external)
Willingham TB, Melbourn J, Moldavskiy M, McCully KK, Backus D.
Effects of treadmill training on muscle oxidative capacity and endurance in people with multiple sclerosis with significant walking limitations.
Int J MS Care. 2019 Jul-Aug;21(4):166-172. doi: 10.7224/1537-2073.2018-021.
Summary(link is external)
Read the full text of this paper (link is external)
Prosperini L, Di Filippo M.
Beyond clinical changes: Rehabilitation-induced neuroplasticity in MS.
Mult Scler. 2019 Sep;25(10):1348-1362. doi: 10.1177/1352458519846096.
Summary(link is external)
Plow M, Finlayson M.
Beyond supervised therapy: Promoting behavioral changes in people with MS.
Mult Scler. 2019 Sep;25(10):1379-1386. doi: 10.1177/1352458519861267.
Summary(link is external)
Leocani L, Chieffo R, Gentile A, Centonze D.
Beyond rehabilitation in MS: Insights from non-invasive brain stimulation.
Mult Scler. 2019 Sep;25(10):1363-1371. doi: 10.1177/1352458519865734.
Summary(link is external)
Stem cells
Bose G, Thebault SDX, Atkins HL, Freedman MS.
Does resetting the immune system fix multiple sclerosis?
Can J Neurol Sci. 2019 Sep 12:1-10. doi: 10.1017/cjn.2019.294. [Epub ahead of print]
Summary(link is external)
Benjaminy S, Lo C, Schepmyer A, Traboulsee A, Illes J.
Perspectives about time frames in stem cell research for multiple sclerosis: "Time Is Brain".
Int J MS Care. 2019 Jul-Aug;21(4):185-193. doi: 10.7224/1537-2073.2018-102.
Summary(link is external)
Read the full text of this paper (link is external)
Symptoms and symptom management
Silveira SL, Pilutti LA, Motl RW.
No evidence of associations among body composition and symptoms in persons with multiple sclerosis.
Rehabil Psychol. 2019 Sep 16. doi: 10.1037/rep0000292. [Epub ahead of print]
Summary(link is external)
Hugos CL, Cameron MH.
Assessment and measurement of spasticity in MS: state of the evidence.
Curr Neurol Neurosci Rep. 2019 Aug 30;19(10):79. doi: 10.1007/s11910-019-0991-2. Review.
Summary(link is external)
Braakhuis HEM, Berger MAM, van der Stok GA, van Meeteren J, de Groot V, Beckerman H, Bussmann JBJ; TREFAMS-ACE study group..
Three distinct physical behavior types in fatigued patients with multiple sclerosis.
J Neuroeng Rehabil. 2019 Aug 23;16(1):105. doi: 10.1186/s12984-019-0573-1.
Summary(link is external)
Read the full text of this paper (link is external)
Łabuz-Roszak B, Niewiadomska E, Starostka-Tatar A, Kubicka-Bączyk K, Krzystanek E, Arkuszewski M, Tyrpień-Golder K, Rybus-Kalinowska B, Pierzchała B, Pierzchała K.
Multiple sclerosis: oral health, behaviours and limitations of daily oral hygiene - a questionnaire study.
Neurol Neurochir Pol. 2019;53(4):271-276. doi: 10.5603/PJNNS.a2019.0033. Epub 2019 Aug 23.
Summary(link is external)
Read the full text of this paper (link is external)
Vitamin D
Abbatemarco JR, Fox RJ, Li H, Ontaneda D.
Vitamin D and MRI measures in progressive multiple sclerosis.
Mult Scler Relat Disord. 2019 Oct;35:276-282. doi: 10.1016/j.msard.2019.08.014. Epub 2019 Aug 13.
Summary(link is external)
Work
Strober LB, Callanan RM.
Unemployment in multiple sclerosis across the ages: How factors of unemployment differ among the decades of life.
J Health Psychol. 2019 Sep 14:1359105319876340. doi: 10.1177/1359105319876340. [Epub ahead of print]
Summary(link is external)


Updated NICE multiple sclerosis guideline contains some good news and some bad news
22/06/2022 - 00:00
There are some positive points in the revised 2022 guideline but the MS Trust is disappointed that NICE has been unable to recommend Fampyra.


The ADAMS project
25/05/2022 - 00:00
Dr Benjamin Jacobs spoke to us about a new study on the genetics of MS in people from minority ethnic backgrounds which may eventually shed light on why MS can be more severe for Black and Asian people.


Is a ketogenic diet good for people with multiple sclerosis?
18/05/2022 - 00:00
Researchers assessed whether a ketogenic diet, low in carbohydrates and high in fats, is suitable for people with multiple sclerosis.

Sign up for updates from us
Keep up-to-date with the latest MS news, explore new research, read the stories of people living with MS, find out practical tips from MS experts, and discover exciting fundraising opportunities.