New research was presented at ECTRIMS 2022, the 38th Congress of the European Committee for Treatment and Research in MS. The features below highlight some of the studies presented during the conference.

Cognitive Rehab & Mindfulness Reduce Cognitive Complaints in MS

The randomized-controlled REMIND-MS study investigated the effectiveness of both cognitive rehabilitation therapy (CRT) and mindfulness-based cognitive therapy (MBCT) on patient-reported cognitive complaints in patients with MS (N=110), including 63 (57%) who were objectively cognitively impaired. Participants were randomly assigned to CRT, MBCT, or enhanced treatment as usual (ETAU); 100 participants completed the study. Both CRT and MBCT positively affected patient-reported cognitive complaints compared with ETAU after 9 weeks, but not 6 months later. At 9 weeks, CRT resulted in a decrease in general cognitive complaints and executive-function cognitive complaints. The latter effect was also found in the MBCT group. At 6 months, participants in the CRT group better achieved personalized cognitive goals. MBCT had a positive effect on processing speed. Participants with fewer cognitive complaints at baseline benefited more from CRT, while participants with better processing speed at baseline benefited more from MBCT. Ilse Nauta, PhD, MSc, of Vrije Universiteit Amsterdam in the Netherlands, concluded that regardless of whether patients were relatively less or relatively more affected by cognitive problems, they all benefited from the interventions, and both seem promising in the treatment of MS-related cognitive problems.

Efficacy of DMTs Fade in Secondary Progressive MS

Untreated patients with secondary progressive MS (SPMS) generally have higher Expanded Disability Status Scale (EDSS) scores than treated patients, suggesting a beneficial effect of DMTs in slowing disease accumulation at the earlier stage of progressive MS (PMS). Luigi Pontieri, PhD, and colleagues combined data from eight registries plus the MSBase registry. Included patients were aged 18 or older, had clinically defined SPMS, and were divided into treated and untreated patients. The influence of DMTs on EDSS score trajectories was evaluated for 4 years. The data collected in each registry was converted into a standardized format, the so-called common data model. Compared with untreated participants, treated participants were generally younger at index date, had a shorter disease duration, and less often had SPMS. Results from the LME model indicated that treated participants had a lower EDSS score at index date (untreated group coefficient; registry range, 0.12-0.74 point/year]. The EDSS score generally increased during follow-up (time coefficient; registry range, 0.04-0.18 point/year). Staying on DMTs did not have a significant effect on the
EDSS score.

Long-Term Natalizumab Impacts MS Activity & Pregnancy Outcomes

A prospective observational cohort study assessed relapses during pregnancy and postpartum, as well as pregnancy outcomes that included fetal hematologic abnormalities, in women with highly active MS who used natalizumab. Patients were divided into those who terminated natalizumab during the first trimester (1 Trim-group) or after the first trimester (>1 Trim-group). The latter group stopped natalizumab after a median of 31 gestational weeks (range, 12.1-39.7). Women in the >1 Trim-group had significantly fewer relapses during pregnancy (5.2% vs 32.4%) and postpartum (22.8% vs 49.7%) compared with the 1 Trim group. Also, early restart (4 weeks postpartum) decreased relapse risk postpartum (OR, 0.32). Pregnancy outcomes were similar between groups. In the >1 Trim group and the 1 Trim group, 12.9% and 10.6% of births were preterm, respectively, while 4.7% and 3.4% of newborns, respectively, had congenital abnormalities. In both groups, newborns were smaller than expected. To assess anemia and thrombocytopenia in 122 newborns with available blood counts, the >1 Trim group was stratified into women who stopped natalizumab after gestational week 30 (>30GW) and before week 30 (<30GW). Compared with the <30GW group, newborns in the >30GW group had more hematologic abnormalities (57% vs 39.5%). Rates of anemia were 46.8% and 27.9%, respectively; rates of thrombocytopenia were 22.8% and 16.3%, respectively. Significantly more women in the <30GW group experienced relapse (38.5% vs 16%), especially during the first postpartum trimester.

Physical Impairment Present Before Perceived MS Onset

A prospective registry data analysis reflected 55-yearlong disease trajectories, using only data from a 10-year period. The aim was to gather new insights into the evolution of physical disability across MS subtypes. It focused on two patient-reported outcomes (PROs), namely the MS Impact Scale (MSIS-29) motor component and the MS Walking Scale (MSWS-12), which measure general motor and walking abilities, respectively. A total of 15,976 patients with MS in the UK MS Register provided data. The records were analyzed by disease length and by MS subtype: relapsing-remitting MS (RRMS), primary progressive MS (PPMS), secondary progressive MS (SPMS), and benign MS. Results showed that PROs worsen over time in each disease subtype except benign MS (2% of the total population) and at each disease timepoint. The average scores of all subtypes differed from each other, and disease duration had an association with PROs for all subtypes. Patients with PPMS and SPMS had notably higher PROs from the first year up to 10 years later. Patients with
RRMS whose disease progressed within the 10-year follow-up also had higher average PROs from onset.