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MSWA Bulletin Magazine Autumn 2019

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MS RESEARCH ROUND UP SHARING RESEARCH UPDATES FROM AROUND THE WORLD Read more at: SUE SHAPLAND RN, BN, Cert MS Nursing, MSCN Here we provide summaries of research sourced from websites in Australia and around the world, we hope it’s of interest to you. From the Barts website in the UK Prevalence of asthma in MS: A United States populationbased study. Hill E, Abboud H, Briggs FBS. Mult Scler Relat Disord. 2018 Dec 12;28:69-74 MS and asthma are complex multifactorial diseases; adversely impacting daily function. As the prevalence of asthma in people with MS isn’t clear, this study sought to characterise the prevalence of asthma in people with MS. METHODS: A U.S. population-study was conducted using electronic health record information for 56.6 million Americans. The researchers evaluated the prevalence of asthma in people with MS (141,880) and non-MS (56,416,790); looking at age, gender, and race. Results: The prevalence of asthma was significantly greater among people with MS; three times more common, with the greatest amongst the young and the elderly. Conclusion: Asthma is significantly more common in people with MS than in the general population - particularly in the young and elderly irrespective of gender and race. The results add to the growing MS comorbidity literature and emphasise the need for management as a part of comprehensive MS patient care. From MS News Today Daily Digest Comorbid anxiety, depression, and cognition in MS and other immune-mediated disorders. Christiane E. Whitehouse, John D. Fisket al. This study sought to determine if anxiety and depression are associated with cognition in MS, and whether these associations are similar in other immune-mediated inflammatory diseases; including inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) and in anxious/depressed individuals without these conditions. The study included 255 people with MS, 247 with IBD, 154 with RA and 308 with anxiety and depressions. Several cognition tests and scales were conducted. Results: All groups exhibited higher rates of impairment in processing speed, verbal learning, and delayed recall memory compared to general population norms. Higher levels of anxiety symptoms were associated with slower processing speed, lower verbal learning, and lower working memory performance. Higher levels of depression symptoms were associated with slower processing speed. These associations did not differ across cohorts. Conclusion: Managing symptoms of anxiety and depression in MS, as well as other immune-mediated conditions is important to mitigate their effect on cognition. Neurofilament Light Chain Levels in Blood as a Biomarker of MS Activity and Treatment Response. Jens Kuhle, Harald Kropshofer et al; Neurology March 05,2019;92(10) This study assessed the value of blood neurofilament light chain (NfL) as a biomarker of recent, ongoing, and future disease activity, tissue damage, and its utility to monitor treatment response in relapsing-remitting multiple sclerosis (RRMS). NfL was measured in blood samples from 589 RRMS patients and 35 healthy controls and compared with clinical and MRI related outcomes. Results: At baseline, NfL levels were higher in MS patients than in healthy controls and correlated with MRI lesion load. NfL levels were associated with an increased number of new or enlarging lesions, relapses, brain volume loss and risk of confirmed disability worsening. Conclusion: Blood NfL levels are associated with clinical and MRI-related measures of disease activity and neuroaxonal damage which have prognostic value. Our results support the use of blood NfL as an easily accessible biomarker of disease evolution and treatment response. From the UK MS Trust Bexarotene drug trial for myelin repair. This drug, currently used to treat certain types of skin cancer, and taken as tablets once daily, is being tested for its potential to repair myelin. The MS damage to myelin interrupts or blocks nerve messages. In the earlier stages of MS, oligodendrocytes (a type of nerve cell in the brain) can often repair areas of damage, i.e. by remyelination. As MS is more established, these cells stop functioning or are killed off and myelin damage isn’t repaired, resulting in increasing disability. Bexarotene binds to special locations (receptors), called retinoid X receptors, on the oligodendrocytes. Lab studies have found that drugs which act on these receptors can encourage oligodendrocytes to remyelinate, offering the potential to reverse damage caused by MS and improve symptoms. A Phase II trial is recruiting 50 people with relapsing remitting MS, currently receiving therapy. Half will take bexarotene and half will take a placebo. The main aim of the study is to monitor the safety of bexarotene and to assess whether bexarotene can promote remyelination by comparing MRI scans, measuring EDSS and visual evoked potentials. A randomised double-blind placebo-controlled feasibility trial of flavonoid-rich cocoa for fatigue in people with relapsing and remitting MS. Coe S, Cossington J, Collett J, et al. Results from researchers at Oxford Brookes University suggest a daily mug of cocoa, made from dark chocolate, could improve MS fatigue. Cocoa made from dark chocolate contains high levels of a group of chemicals called flavonoids which could potentially reduce fatigue through several biological processes. Having shown a single drink improved fatigue, researchers wanted to find out what would happen when you have a mug of cocoa every day for six weeks. 40 people with relapsing remitting MS diagnosed within the last 10 years and with moderate to severe fatigue took part in this study. Everyone drank a mug of cocoa first thing in the morning for six weeks; half drank cocoa with high flavonoid content; the other half drank cocoa with low flavonoid content. Participants rated fatigue level three times a day and visited the study centre for further testing at the beginning, middle and end of the six-week period. Results: After six weeks there was a small improvement in fatigue levels in 11 of those drinking high flavonoid cocoa and in eight of those taking the low flavonoid cocoa. Those taking the high flavonoid cocoa were able to walk slightly further in a six-minute walking test. There was also some improvement in the pain and discomfort component of health-related quality of life questionnaire. Condition: The results suggest that high flavonoid cocoa could lead to a modest improvement in fatigue levels, but a bigger study would be needed to confirm the results. Fatigue is a common symptom in MS and can have a major impact on daily life. Many factors can contribute to fatigue so finding ways to cope requires a very individual approach. If a daily mug of cocoa continues to show potential in future larger studies, it would be a simple, safe and low-cost addition to the fatigue management toolkit. From MS Research Australia Treating MS In Pregnancy. MS predominately affects young women when they are starting or growing their families, making treatment decisions even harder. Two new publications seek to provide evidence and guidelines regarding the use of disease modifying therapies during pregnancy. 1. A large international study, led by Australian researcher Dr Vilija Jokubaitis from Monash University, is using data from MSBase, which stores information about treatments and outcomes from thousands of people with MS world-wide. The analysis included over 9000 women with MS, aged 15 to 45, of which 1,178 women recorded 1,521 pregnancies. 42% of these pregnancies occurred whilst taking a MS disease modifying therapy. On average, women were on treatment for 30 days of their pregnancy. These pregnancies were compared to those which occurred within a year of stopping treatment (20%) and pregnancies where the woman had received no treatment for over a year (39%). Results: Comparing pregnancy outcomes in women on treatment to those off treatment, there was no difference in the rates of full-term pregnancies, pre-term or premature deliveries or miscarriages. Women were more likely to have had an induced abortion if they were on MS treatments carrying the higher pregnancy classifications i.e. evidence of some harm to the foetus in pregnant women or evidence of harm from animal studies. 2. The Association of British Neurologists released consensus guidelines for the treatment of MS in pregnancy. These were based on data from pregnancy registers for some MS medications currently available and other published information. The guidelines have very detailed recommendations for clinicians about the use of each of the currently available medications during pregnancy and identified these key points for women with MS who wish to have children: 8 | MSWA BULLETIN AUTUMN 2019 MSWA BULLETIN AUTUMN 2019 | 9