Disease-modifying therapy for multiple sclerosis in Slovenia: analysis of 20 years of treatment

Introduction: Disease-modifying therapy (DMT) dramatically influenced the management of re- lapsing-remitting multiple sclerosis (RRMS). Novel medicines have been developing constantly and therapeutic strategy has changed. We aimed to analyse the development of DMT for MS in Slovenia with a special emphasis on contemporary approaches to the patient management. Materials and Methods: Prescriptions of all DMT in Slovenia from 2001-2021 were analysed as well as re- ferrals to the Committee for MS DMT the Centre for MS in Ljubljana in the last three years (2019-2021). Results: Altogether approximately 360 patients were on DMT in 2001 and 1839 in 2021. The total number of patients on injectable therapies decreased through time while the number of patients on oral therapies increased. Dimethyl fumarate is currently the most frequently used medicine with 505 patients on the drug in 2021. The number of patients on potent medications increased from 28 (3%) in 2012 to 763 (41%) in 2021. Highly active medicines represented 52%, 62% and 69% of all DMT approvals in 2019, 2020 and 2021, respectively. Conclusions: The number of treated MS patients has been increasing steadily in Slovenia as well as the number of patients on potent DMT which proves that neurologists follow the modern concept of MS treatment

Disease-modifying therapy for multiple sclerosis in Slovenia: analysis of 20 years of treatment

Introduction: Disease-modifying therapy (DMT) dramatically influenced the management of re- lapsing-remitting multiple sclerosis (RRMS). Novel medicines have been developing constantly and therapeutic strategy has changed. We aimed to analyse the development of DMT for MS in Slovenia with a special emphasis on contemporary approaches to the patient management. Materials and Methods: Prescriptions of all DMT in Slovenia from 2001-2021 were analysed as well as re- ferrals to the Committee for MS DMT the Centre for MS in Ljubljana in the last three years (2019-2021). Results: Altogether approximately 360 patients were on DMT in 2001 and 1839 in 2021. The total number of patients on injectable therapies decreased through time while the number of patients on oral therapies increased. Dimethyl fumarate is currently the most frequently used medicine with 505 patients on the drug in 2021. The number of patients on potent medications increased from 28 (3%) in 2012 to 763 (41%) in 2021. Highly active medicines represented 52%, 62% and 69% of all DMT approvals in 2019, 2020 and 2021, respectively. Conclusions: The number of treated MS patients has been increasing steadily in Slovenia as well as the number of patients on potent DMT which proves that neurologists follow the modern concept of MS treatment

Management of infusion related reactions associated with alemtuzumab in patients with multiple sclerosis

OBJECTIVE: Infusion-associated reactions (IARs) occur in >90% patients with multiple sclerosis (MS) treated with alemtuzumab. We aimed to study the frequency of IARs at 2 sites using 5 days of steroids (1g/day of IV methylprednisolone), but otherwise distinct protocols. ----- METHODS: This was retrospective chart review of 38 consecutive MS patients who were treated with alemtuzumab from June 2015 till February 2017 at Department of Neurology, University Hospital Center Zagreb, Croatia and Department of Neurology, University Medical Center Ljubljana, Slovenia. ----- RESULTS: Seventeen patients (44.7%) did not experience IARs. Skin reactions and fever were the most common IARs attributed to alemtuzumab infusions and they were most frequent on Day 5 and Day 1, respectively. We have observed significant differences in the occurrence of fever (p = 0.005) depending on the site of alemtuzumab administration which could be explained by different antipyretics used; fever was absent in the Slovenian cohort because high dose intravenous metamizole was administered. Two out of 9 treatment naïve, and 19 out of 29 patients who previously received immunomodulatory treatment had IARs (χ2 = 5.208, p = 0.022). ----- CONCLUSION: Modified premedication scheme consisting of 1g/day of IV methylprednisolone throughout all 5 days of alemtuzumab treatment may reduce overall IARs. Intravenous administration of antipyretics may work better than oral administration

Parkinson's disease in a patient with multiple sclerosis and heterozygous glucocerebrosidase gene mutation

More than 30 patients with multiple sclerosis (MS) and Parkinson's disease (PD) have been reported so far. Theories on the co-occurrence of MS and PD range from coincidental to causal. There has been only one report of MS in young onset PD in a patient heterozygous for Parkin mutation. We report a patient with MS who developed signs typical for PD and was found to be heterozygous mutation carrier in the gene for glucocerebrosidase (GBA1), a well-known risk factor for PD

Humoral immune response in convalescent COVID-19 people with multiple sclerosis treated with high-efficacy disease-modifying therapies: A multicenter, case-control study

Aim: To determine the influence of high-efficacy disease modifying therapy (DMT) on the development of IgG SARS-CoV-2 antibody response in COVID-19 convalescent people with multiple sclerosis (pwMS). ----- Methods: Seventy-four pwMS taking high-efficacy DMTs (specifically natalizumab, fingolimod, alemtuzumab, ocrelizumab, cladribine and ublituximab) and diagnosed with COVID-19 and 44 healthy persons (HC) were enrolled. SARS-CoV2 antibodies were tested with Elecsys® Anti-SARSCoV-2 S assay. ----- Results: pwMS taking high-efficacy DMTs had a significantly higher chance of having negative titer of SARS-CoV2 antibodies compared to healthy controls (33 negative pwMS [44.6%] compared to one negative HC [2.3%], p < 0.001). pwMS taking B-cell depleting therapy (ocrelizumab and ublituximab) had a significantly higher chance of having negative titer of SARS-CoV2 antibodies compared to pwMS on all other DMTs (29 negative pwMS on B-cell therapy [64.4%] compared to four negative pwMS on all other DMTs [13.8%], p < 0.001). Out of other DMTs, two (33.3%) pwMS taking fingolimod and two (16.7%) pwMS taking cladribine failed to develop IgG SARS-COV-2 antibodies. B-cell depleting therapy independently predicted negative titer of IgG SARS-CoV-2 antibody (Exp[B] =0.014, 95%CI 0.002-0.110, p < 0.001). ----- Conclusions: A significant proportion of convalescent COVID-19 pwMS on high-efficacy DMTs will not develop IgG SARS-CoV-2 antibodies. B-cell depleting therapies independently predict negative and low titer of IgG SARS-CoV-2 antibody