Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS). Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18\u20134.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20\u201312.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses. Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists. ANN NEUROL 2021;89:780\u2013789

Data monitoring roadmap. The experience of the Italian Multiple Sclerosis and Related Disorders Register

Introduction Over the years, disease registers have been increasingly considered a source of reliable and valuable population studies. However, the validity and reliability of data from registers may be limited by missing data, selection bias or data quality not adequately evaluated or checked.This study reports the analysis of the consistency and completeness of the data in the Italian Multiple Sclerosis and Related Disorders Register.MethodsThe Register collects, through a standardized Web-based Application, unique patients.Data are exported bimonthly and evaluated to assess the updating and completeness, and to check the quality and consistency. Eight clinical indicators are evaluated.ResultsThe Register counts 77,628 patients registered by 126 centres. The number of centres has increased over time, as their capacity to collect patients.The percentages of updated patients (with at least one visit in the last 24 months) have increased from 33% (enrolment period 2000-2015) to 60% (enrolment period 2016-2022). In the cohort of patients registered after 2016, there were >= 75% updated patients in 30% of the small centres (33), in 9% of the medium centres (11), and in all the large centres (2).Clinical indicators show significant improvement for the active patients, expanded disability status scale every 6 months or once every 12 months, visits every 6 months, first visit within 1 year and MRI every 12 months.ConclusionsData from disease registers provide guidance for evidence-based health policies and research, so methods and strategies ensuring their quality and reliability are crucial and have several potential applications

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

A Comparative Risk Assessment Of Burden Of Disease And Injury Attributable To 67 Risk Factors And Risk Factor Clusters In 21 Regions, 1990–2010: A Systematic Analysis For The Global Burden Of Disease Study 2010

Background Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time

Substance use education in Victorian secondary schools : what are teachers teaching?

Introduction and Aims: 'Cannabis Withdrawal Syndrome' is proposed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) due for release May 2013. Problematic cannabis use among remote Indigenous communities has been reported in Northern Territory and Queensland studies. When cannabis use is curtailed, many suffer symptoms which can lead to violence, threats, intimidation, sleep disturbances and heightened risk factors of selfharm. Sudden cessation of cannabis use by detainees and inmates could further increase risk. Despite patterns of high cannabis use, dependence and demonstrated risk factors, whether Indigenous detainees/inmates experience withdrawal differently has not been considered.\ud \ud Design and Methods: Dependent cannabis users who identify as Indigenous (Aboriginal and/or Torres Strait Island) aged between 18–40 years will be recruited from far north Queensland police watch houses/Correctional Centres. Interviews with new detainees/inmates will occur on eight different occasions over 28 days. Assessments validated with biological markers, will examine onset and severity of\ud cannabis withdrawal and psychological distress.\ud \ud Results: Retrospective pilot data interviews will be presented along with preliminary fi ndings of the current study. Pilot data revealed 70% (n = 70) of male inmates used cannabis before incarceration with 63% (n = 44) meeting dependence. The average number\ud symptoms using DSM-5 criteria was 2.9 and included irritability/anger/aggression, nervousness/anxiety, sleep difficulties, depression\ud and physical symptoms.\ud \ud Discussion and Conclusions: To improve assessment and timely treatment of cannabis withdrawal within custodial settings, studies are needed to document onset and severity of symptoms and to devise culturally-acceptable resources and support to assist new inmates/detainees to manage withdrawal. Findings from this study will inform the DSM-5, for cultural variations and considerations to\ud the proposed criteria

Sex Differences in Substance Use and Psychological Distress Among Prisoners in Queensland, Australia

Introduction and Aims: High rates of cannabis use and dependence are significant issues in remote Indigenous communities. We have previously shown extremely high rates of cannabis use, dependence and adverse mental health impacts in Arnhem Land. This study reports the first data on cannabis use and its mental health impacts in Cape York. \ud \ud Design and Methods: We interviewed over 300 Aboriginal people aged 16–40 years in three remote Cape York communities. Data was gathered on rates of cannabis use, mental health impacts including dependence and withdrawal, and reasons for quitting. \ud \ud Results: One in two individuals interviewed was using cannabis, with most using cannabis daily or weekly. Approximately 70% reported cannabis dependence. Encouragingly, more than 70% of current users were considering quitting/cutting down or had made previous attempts. In current users, seeking or starting employment was the most common motivation for wanting to quit, whilst former users quit primarily for family reasons. Users reported negative mental health impacts of cannabis. One in four reported ‘stressing out’ when cannabis was unavailable, suggesting withdrawal. Anger/ irritability, paranoia, auditory hallucinations, thoughts of suicide/ self-harm and memory impairment were reported in up to 10% of users. \ud \ud Discussion and Conclusions: Rates of use and dependence are much higher than national rates (4.9% of males and 2.2% of females nationally used cannabis in the past week, 21% exhibiting dependence), and are similar to Northern Territory rates. One in four Aboriginal users in remote communities may be suffering mental ill health. Interventions should enhance quit support and employment opportunities and strengthen families

Telemedicine for management of patients with amyotrophic lateral sclerosis through COVID-19 tail

Over the last months, due to coronavirus disease (COVID-19) pandemic, containment measures have led to important social restriction. Healthcare systems have faced a complete rearrangement of resources and spaces, with the creation of wards devoted to COVID-19 patients. In this context, patients affected by chronic neurological diseases, such as amyotrophic lateral sclerosis (ALS), are at risk to be lost at follow-up, leading to a higher risk of morbidity and mortality. Telemedicine may allow meet the needs of these patients. In this commentary, we briefly discuss the digital tools to remotely monitor and manage ALS patients. Focusing on detecting disease progression and preventing life-threatening conditions, we propose a toolset able to improve ALS management during this unprecedented situation

A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis

A sixth month phase II multicenter-pilot trial with a low dose of the opiate antagonist Naltrexone (LDN) has been carried out in 40 patients with primary progressive multiple sclerosis (PPMS). The primary end points were safety and tolerability. Secondary outcomes were efficacy on spasticity, pain, fatigue, depression, and quality of life. Clinical and biochemical evaluations were serially performed. Protein concentration of beta-endorphins (BE) and mRNA levels and allelic variants of the mu-opiod receptor gene (OPRM1) were analyzed. Five dropouts and two major adverse events occurred. The remaining adverse events did not interfere with daily living. Neurological disability progressed in only one patient. A significant reduction of spasticity was measured at the end of the trial. BE concentration increased during the trial, but no association was found between OPRM1 variants and improvement of spasticity. Our data clearly indicate that LDN is safe and well tolerated in patients with PPMS