РОЛЬ ИНФЕКЦИОННЫХ ЗАБОЛЕВАНИЙ В РАЗВИТИИ РАССЕЯННОГО СКЛЕРОЗА В РЕСПУБЛИКЕ СЕВЕРНАЯ ОСЕТИЯ — АЛАНИЯ

The article describes a research which comprised 220 people, including 110 patients with multiple sclerosis (MS) and 110 control patients who were matched in pairs according to sex, age (± 5 years), ethnicity (all — Ossetians) and place of birth. The authors applied the most convenient and commonly used method of case-control study. The authors revealed a reliable link between multiple sclerosis and infectious mononucleosis or mononucleosis-like diseases, chronic tonsillitis and sinusitis that occurred between the ages of 7 and 15 years as well as varicella that occurred from 0 to 7 years. Под наблюдением находились 220 человек, из них 110 больных рассеянным склерозом (РС) и 110 пациентов контрольной группы, попарно подобранных друг к другу по полу, возрасту (± 5 лет), национальности (все — осетины) и месту рождения. Нами был применён наиболее удобный и часто используемый метод случай-контроль. Была выявлена достоверная связь РС с перенесенными в возрасте от 7 до 15 лет инфекционным мононуклеозом и мононуклеозоподобными заболеваниями, хроническими тонзиллитами и синуситами, а также с перенесенной в возрасте от 0 до 7 лет ветряной оспой.

The efficiency of telerehabilitation in patients with multiple sclerosis

The aim of the study - to evaluate the possibilities and efficacy of telerehabilitation in patients with MS.Цель исследования – оценка возможностей и эффективности телереабилитации у пациентов с РС

Effect of natalizumab on disease progression in secondary progressive multiple sclerosis (ASCEND). a phase 3, randomised, double-blind, placebo-controlled trial with an open-label extension

Background: Although several disease-modifying treatments are available for relapsing multiple sclerosis, treatment effects have been more modest in progressive multiple sclerosis and have been observed particularly in actively relapsing subgroups or those with lesion activity on imaging. We sought to assess whether natalizumab slows disease progression in secondary progressive multiple sclerosis, independent of relapses. Methods: ASCEND was a phase 3, randomised, double-blind, placebo-controlled trial (part 1) with an optional 2 year open-label extension (part 2). Enrolled patients aged 18–58 years were natalizumab-naive and had secondary progressive multiple sclerosis for 2 years or more, disability progression unrelated to relapses in the previous year, and Expanded Disability Status Scale (EDSS) scores of 3·0–6·5. In part 1, patients from 163 sites in 17 countries were randomly assigned (1:1) to receive 300 mg intravenous natalizumab or placebo every 4 weeks for 2 years. Patients were stratified by site and by EDSS score (3·0–5·5 vs 6·0–6·5). Patients completing part 1 could enrol in part 2, in which all patients received natalizumab every 4 weeks until the end of the study. Throughout both parts, patients and staff were masked to the treatment received in part 1. The primary outcome in part 1 was the proportion of patients with sustained disability progression, assessed by one or more of three measures: the EDSS, Timed 25-Foot Walk (T25FW), and 9-Hole Peg Test (9HPT). The primary outcome in part 2 was the incidence of adverse events and serious adverse events. Efficacy and safety analyses were done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01416181. Findings: Between Sept 13, 2011, and July 16, 2015, 889 patients were randomly assigned (n=440 to the natalizumab group, n=449 to the placebo group). In part 1, 195 (44%) of 439 natalizumab-treated patients and 214 (48%) of 448 placebo-treated patients had confirmed disability progression (odds ratio [OR] 0·86; 95% CI 0·66–1·13; p=0·287). No treatment effect was observed on the EDSS (OR 1·06, 95% CI 0·74–1·53; nominal p=0·753) or the T25FW (0·98, 0·74–1·30; nominal p=0·914) components of the primary outcome. However, natalizumab treatment reduced 9HPT progression (OR 0·56, 95% CI 0·40–0·80; nominal p=0·001). In part 1, 100 (22%) placebo-treated and 90 (20%) natalizumab-treated patients had serious adverse events. In part 2, 291 natalizumab-continuing patients and 274 natalizumab-naive patients received natalizumab (median follow-up 160 weeks [range 108–221]). Serious adverse events occurred in 39 (13%) patients continuing natalizumab and in 24 (9%) patients initiating natalizumab. Two deaths occurred in part 1, neither of which was considered related to study treatment. No progressive multifocal leukoencephalopathy occurred. Interpretation: Natalizumab treatment for secondary progressive multiple sclerosis did not reduce progression on the primary multicomponent disability endpoint in part 1, but it did reduce progression on its upper-limb component. Longer-term trials are needed to assess whether treatment of secondary progressive multiple sclerosis might produce benefits on additional disability components. Funding: Biogen

Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis

Supported by F. Hoffmann–La Roche

Nervous system damage in COVID-19 with an emphasis on the management of patients with multiple sclerosis

The main target for COVID-19 is the lung with the development of acute respiratory failure. But the virus also displays tropism to the central nervous, muscle, and immune systems. The paper gives the data available in the literature on nervous system damage and the characteristics of clinical and magnetic resonance imaging manifestations of brain damage in COVID-19. Among the neurological symptoms of COVID-19, there may be stroke, encephalitis, and neuropathy. An account is given of the features of multiple sclerosis patient management during the COVID-19 pandemic depending on the risk of developing coronavirus infection

THE ROLE OF INFECTIOUS DISEASES IN THE DEVELOPMENT OF MULTIPLE SCLEROSIS IN NORTH OSSETIA – ALANIA REPUBLIC

The article describes a research which comprised 220 people, including 110 patients with multiple sclerosis (MS) and 110 control patients who were matched in pairs according to sex, age (± 5 years), ethnicity (all — Ossetians) and place of birth. The authors applied the most convenient and commonly used method of case-control study. The authors revealed a reliable link between multiple sclerosis and infectious mononucleosis or mononucleosis-like diseases, chronic tonsillitis and sinusitis that occurred between the ages of 7 and 15 years as well as varicella that occurred from 0 to 7 years

Recommendations from the Expert Meeting «Secondary progressive multiple sclerosis: unresolved issues and prospects»

The meeting of experts discussed the clinical and pathophysiological features of secondary progressive multiple sclerosis (MS) (SPMS), clinical trials, and promising treatments for the progressive MS stage, as well as proposals contributing to the improvement of the current state of the problem of SPMS. In particular, the definition of and criteria for SPMS are formulated; the earliest period, when its confirmed progression can be recorded, is stated to be 3 months. The exacerbation-unaffected disability progression confirmed 6 months later may be considered to be more convincing. The introduction of tools for the early assessment of disability progression into routine practice will be able to identify the signs of progression at an earlier stage in order to timely change treatment policy. It is also noted that therapeutic possibilities in establishing secondary progression, especially in the absence of exacerbations, but in maintaining progression, are still insufficient. Certain hopes for slowing the progression in patients with SPMS are associated with the advent of siponimod, a new molecular class of S1P receptor modulators. The confirmed efficiency of siponimod in a large population of patients with SPMS allows the latter to be recommended for its treatment with both persistent disease activity (SPMS with exacerbations) and disability progression without exacerbations (SPMS without exacerbations)

Recommendations for switching patients with highly active multiple sclerosis from other disease modifying drugs for multiple sclerosis to cladribine tablets

The need for optimal treatment of the active forms of multiple sclerosis (MS), especially highly active MS (HAMS), poses a number of difficult problems for specialists, including not only the choice of a highly effective disease-modifying drug for MS (DMDMS), but also conditions for the timely and safe switching from other DMDMS. A group of expert neurologists from various clinics in Russia presents a consensus on the practical aspects of switching patients with HAMS from other DMDMS to cladribine tablets, which has been registered in Russia in March 2020. The paper discusses indications for changing therapy and gives indications, contraindications, and conditions for initiating cladribine therapy. It details the procedure and results of the expert consensus, on the basis of which the recommendations have been developed to switch to cladribine tablets from each of the DMDMS registered in Russia for the treatment of MS

Clinical recommendations for the use of ocrelizumab in patients with multiple sclerosis

The paper presents a detailed algorithm for the treatment and follow-up of patients with recurrent multiple sclerosis and primary progressive multiple sclerosis in the use of ocrelizumab

РОЛЬ ИНФЕКЦИОННЫХ ЗАБОЛЕВАНИЙ В РАЗВИТИИ РАССЕЯННОГО СКЛЕРОЗА В РЕСПУБЛИКЕ СЕВЕРНАЯ ОСЕТИЯ — АЛАНИЯ

The article describes a research which comprised 220 people, including 110 patients with multiple sclerosis (MS) and 110 control patients who were matched in pairs according to sex, age (± 5 years), ethnicity (all — Ossetians) and place of birth. The authors applied the most convenient and commonly used method of case-control study. The authors revealed a reliable link between multiple sclerosis and infectious mononucleosis or mononucleosis-like diseases, chronic tonsillitis and sinusitis that occurred between the ages of 7 and 15 years as well as varicella that occurred from 0 to 7 years. Под наблюдением находились 220 человек, из них 110 больных рассеянным склерозом (РС) и 110 пациентов контрольной группы, попарно подобранных друг к другу по полу, возрасту (± 5 лет), национальности (все — осетины) и месту рождения. Нами был применён наиболее удобный и часто используемый метод случай-контроль. Была выявлена достоверная связь РС с перенесенными в возрасте от 7 до 15 лет инфекционным мононуклеозом и мононуклеозоподобными заболеваниями, хроническими тонзиллитами и синуситами, а также с перенесенной в возрасте от 0 до 7 лет ветряной оспой. </p