Persistent progression independent of relapse activity in multiple sclerosis.

Patients with relapsing-remitting multiple sclerosis (RRMS) may experience disability progression independent of relapse activity (PIRA), which can be an early sign of secondary progressive MS (SPMS). We defined persistent PIRA as ongoing sustained disability over the entire available follow-up period. However, PIRA events can regress over time.

Haematopoietic stem cell transplant versus immune-reconstitution therapy in relapsing multiple sclerosis.

In the treatment of relapsing-remitting multiple sclerosis, autologous hematopoietic stem cell transplant and immune-reconstitution therapies show several similarities. These treatment strategies have not yet been compared head-to-head. This study emulated pairwise trials of comparative effectiveness of stem cell transplant vs.

Cognitive impairment in hematology patients planned for chimeric antigen receptor T-cell therapy.

Background: Chimeric antigen receptor T-cell (CAR-T) therapy is used to treat several types of relapsed and refractory hematological malignancies and is associated with cognitive side-effects. The accurate diagnosis of cognitive impairment following CAR-T requires knowledge of baseline cognitive status prior to the therapy.

Research Design And Methods: Adult patients with advanced hematologic or solid organ malignancies underwent cognitive assessment, including a self-report questionnaire of psychopathology and subjective cognitive function, prior to receiving CAR-T.

A single nucleotide polymorphism in the MerTK gene is associated with increased radiological disease activity in patients with multiple sclerosis on natalizumab therapy.

Background: Mer tyrosine kinase (MERTK), is a regulator of immune activity. HLA-DRB1*1501 and MERTK are modulators of MERTK expression on monocytes, and risk genes for Multiple Sclerosis (MS). Natalizumab treatment inhibits lymphocyte but not monocyte ingress into the CNS.

Relationship between brain atrophy and disability in a multi-site multiple sclerosis registry.

Background: In a retrospective multicentre cohort study, we explored the association between brain atrophy and multiple sclerosis (MS) disability using different MRI scanners and protocols at multiple sites.

Methods: Relapse-onset MS patients were included if they had two clinical MRIs 12 months apart and ≥2 Expanded Disability Status Scale (EDSS) scores. Percentage brain volume change (PBVC), percentage grey matter change (PGMC), fluid-attenuated inversion recovery (FLAIR) lesion volume change, whole brain volume (BV), grey matter volume (GMV), FLAIR lesion volume and T1 hypointense lesion volume were assessed by icobrain.

Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years.

Background: Corticosteroid treatment of multiple sclerosis (MS) relapses is assumed to improve the speed of relapse recovery, without modifying long-term disability risk. We aimed to re-evaluate this assumption in a large cohort of individuals with MS.

Methods: Individuals with clinically definite MS and ≥3 Expanded Disability Status Scale (EDSS) measurements over ≥12 months were identified within the international neuroimmunology registry MSBase.

Personalized federated learning for predicting disability progression in multiple sclerosis using real-world routine clinical data.

Early prediction of disability progression in multiple sclerosis (MS) remains challenging despite its critical importance for therapeutic decision-making. We present the first systematic evaluation of personalized federated learning (PFL) for 2-year MS disability progression prediction, leveraging multi-center real-world data from over 26,000 patients. While conventional federated learning (FL) enables privacy-aware collaborative modeling, it remains vulnerable to institutional data heterogeneity.

COVID-19 Vaccine Boosters in People With Multiple Sclerosis: Improved SARS-CoV-2 Cross-Variant Antibody Response and Prediction of Protection.

Background And Objectives: Although disease-modifying therapies (DMTs) may suppress coronavirus disease 2019 (COVID-19) vaccine responses in people with multiple sclerosis (pwMS), limited data are available on the cumulative effect of additional boosters. Maturation of Spike immunoglobulin G (IgG) to target a greater diversity of SARS-CoV-2 variants, especially past the BA.1 variant, has not been reported.

Four years on: Pregnancy and birth outcomes reported in the MSBase pregnancy, neonatal outcomes, and Women's Health Registry (2020-2024).

Background: Family planning is an important aspect of multiple sclerosis (MS), and neuromyelitis optica spectrum disorder (NMOSD) management. Knowledge gaps remain, including optimal perinatal management strategies, and fetal risks associated with disease-modifying therapy (DMT) exposure.

Objective: To describe perinatal DMT use, together with pregnancy and neonatal outcomes prospectively recorded in the International MSBase Pregnancy and Women's Health Registry.

Acute and Long-Term Immune-Treatment Strategies in Anti-LGI1 Antibody-Mediated Encephalitis: A Multicenter Cohort Study.

Background And Objectives: Few studies have evaluated acute immunotherapy and relapse prevention strategies in patients with anti-leucine-rich glioma-inactivated 1 (LGI1) antibody (Ab)-mediated encephalitis. The objective of this study was to analyze the outcomes of acute and long-term immunotherapy strategies in this population.

Methods: We undertook a multicenter cohort study of 55 patients with anti-LGI1 Ab-mediated encephalitis, either recruited prospectively or identified retrospectively from 10 Australian hospitals as part of the Australian Autoimmune Encephalitis Consortium.

Rituximab Use for Relapse Prevention in Anti-NMDAR Antibody-Mediated Encephalitis: A Multicenter Cohort Study.

Background And Objectives: Rituximab is an anti-CD20 monoclonal antibody used in patients with anti-NMDAR antibody (Ab)-mediated encephalitis as both an acute escalation therapy and a longer term relapse risk-reduction treatment. The potential long-term benefit of a single course administered during the acute disease phase on future relapse risk is uncertain. Moreover, the optimal dosing duration to reduce relapse risk is unknown.

The topography of infratentorial lesions in depression and anxiety in multiple sclerosis.

Background: Depression and anxiety are highly prevalent in multiple sclerosis and significantly impact patient outcomes. However, their link to specific areas of demyelination remains unclear.

Objectives: This study examines the association between infratentorial lesions and depression or anxiety, focusing on three regions of interest: raphe nuclei, locus coeruleus, and cerebellar lobule VIIA.

Multiple Sclerosis Classification Using the Local Divergence Exponent: Parameters Selection for State-Space Reconstruction.

Background: Using the local divergence exponent (LDE), it has been concluded that walking stability is impaired in people with multiple sclerosis (pwMS). However, the use of several calculation approaches hinders comparisons across studies. We aimed to determine whether using different parameters for state space reconstruction to calculate LDE affects the classification of pwMS.

Multimodal prognostication of autoimmune encephalitis: an Australian autoimmune encephalitis consortium study.

Background And Objectives: To identify factors predictive of a favourable modified Rankin score (mRS) at 12 months in patients with autoimmune encephalitis (AE). To evaluate predictors of a binary composite clinical-functional outcome measure, encompassing mRS, drug-resistant epilepsy (DRE) and memory impairment, at 12 months.

Methods: Univariable and multivariable logistic regression analyses for predictors of a favourable mRS (i.

Standardized Definition of Progression Independent of Relapse Activity (PIRA) in Relapsing-Remitting Multiple Sclerosis.

Importance: Progression independent of relapse activity (PIRA) is a significant contributor to long-term disability accumulation in relapsing-remitting multiple sclerosis (MS). Prior studies have used varying PIRA definitions, hampering the comparability of study results.

Objective: To compare various definitions of PIRA.

Progression independent of relapse activity and relapse-associated worsening in seronegative NMOSD: an international cohort study.

Background: Previous studies have indicated that progression independent of relapse activity (PIRA) is uncommon in patients with aquaporin- 4 antibody-positive (AQP4-IgG) neuromyelitis optica spectrum disorder (NMOSD). However, the patterns of disability accumulation in seronegative NMOSD are unknown. This study aimed to evaluate the prevalence of PIRA and relapse-associated worsening (RAW) in seronegative NMOSD.

Recommendations for essential medicines for multiple sclerosis in low-resource settings.

Background: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that, when untreated, can lead to significant disability in young adults. Despite the increase in the number of disease-modifying therapies (DMTs), many people living with MS in low-resource settings do not have access to treatment.

Objective: The primary aim was to develop recommendations on the minimum essential DMTs for MS that should be available in low-resource settings.

Long-term acceptability of MSReactor digital cognitive monitoring among people living with multiple sclerosis.

Background: Monitoring of cognition in multiple sclerosis (MS) is critical. Traditional cognitive testing is resource intensive and insensitive to subtle changes. Digital tests could address this need; however, their long-term usability remains unexplored.

Efficacy of natalizumab in secondary progressive multiple sclerosis: analysis of two phase III trials.

Background: The ASCEND trial did not find benefit of natalizumab during secondary progressive multiple sclerosis compared with placebo; however, its open-label extension suggests this may be obscured by therapeutic lag.We aimed to compare the efficacy of natalizumab and interferon β-1a in slowing disease progression in secondary progressive multiple sclerosis after accounting for therapeutic lag.

Methods: We analysed pooled data from the ASCEND (natalizumab vs placebo) and SPECTRIMS (interferon β-1a vs placebo) trials.

Longitudinal Trajectories of Digital Cognitive Biomarkers for Multiple Sclerosis.

Background: Cognitive impairment is one of the most common and debilitating symptoms of relapsing-remitting multiple sclerosis (RRMS). Digital cognitive biomarkers require less time and resources and are rapidly gaining popularity in clinical settings. We examined the longitudinal trajectory of the iPad-based Processing Speed Test (PST) and predictors of PST scores.

First-year treatment response predicts the following 5-year disease course in patients with relapsing-remitting multiple sclerosis.

Predicting long-term prognosis and choosing the appropriate therapeutic approach in patients with Multiple Sclerosis (MS) at the time of diagnosis is crucial in view of a personalized medicine. We investigated the impact of early therapeutic response on the 5-year prognosis of patients with relapsing-remitting MS (RRMS). We recruited patients from MSBase Registry covering the period between 1996 and 2022.

Explainable time-to-progression predictions in multiple sclerosis.

Background: Prognostic machine learning research in multiple sclerosis has been mainly focusing on black-box models predicting whether a patients' disability will progress in a fixed number of years. However, as this is a binary yes/no question, it cannot take individual disease severity into account. Therefore, in this work we propose to model the time to disease progression instead.

Treatment De-escalation in Relapsing-Remitting Multiple Sclerosis: An Observational Study.

Background: In relapsing-remitting multiple sclerosis (RRMS), extended exposure to high-efficacy disease modifying therapy may increase the risk of side effects, compromise treatment adherence, and inflate medical costs. Treatment de-escalation, here defined as a switch to a lower efficacy therapy, is often considered by patients and physicians, but evidence to guide such decisions is scarce. In this study, we aimed to compare clinical outcomes between patients who de-escalated therapy versus those who continued their therapy.

Consensus recommendations on multiple sclerosis management in Australia and New Zealand: part 2.

Introduction: Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system with rapidly evolving treatment options and strategies. An iterative modified Delphi process was used to develop 80 consensus recommendations for the management of MS in Australia and New Zealand. Part 1 of these guidelines includes recommendations related to selection of initial disease-modifying therapy (DMT) for MS, assessments before commencing DMT, monitoring disease activity on DMT, switching DMT, and discontinuing DMT.

Consensus recommendations on multiple sclerosis management in Australia and New Zealand: part 1.

Introduction: Multiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system. There were 33 335 people with MS in Australia in 2021 and 2917 in New Zealand in 2006 and the prevalence and incidence are increasing with time. Although new treatments have substantially improved outcomes in recent decades, the treatment landscape has become increasingly complex due to the expanding number of disease-modifying therapies (DMTs) and associated safety considerations.