What’s New in MS Research: July 2019

The effort to enhance the lives and health of people with multiple sclerosis (MS) is advancing on many fronts, as researchers explore the impact of approaches ranging from stress management, exercise, diet, stem-cell therapy, and cannabis use, to a variety of approved and investigational disease-modifying therapies (DMTs).

This latest edition of “What’s New in MS Research” features highlights from the annual meetings of the American Academy of Neurology (AAN) and the Consortium of Multiple Sclerosis Centers (CMSC), both held in May of this year. We hope that this information will be of interest and value to you. Meanwhile, please remember that MSAA is committed not only to providing you with the latest news on emerging therapies and lifestyle interventions, but also to helping you with your MS-related information and support needs. Please contact us at (800) 532-7667 or visit us at mymsaa.org.

Examining How Anxiety, Exercise, and Stem-Cell Therapy May Affect Cognition in MS

Can slowing down anxiety speed up thinking in people with MS?

Anxiety and cognitive issues are common in multiple sclerosis, and often are difficult to manage effectively. A recent study raises the intriguing prospect that addressing the first condition may help improve the second. 1

Researchers at the MS Center at Holy Name Hospital in Teaneck, NJ, measured self-reported levels of anxiety and fatigue in 183 people with MS. In evaluating fatigue, the investigators measured both motor fatigue (MF), which relates to physical stamina, and cognitive fatigue (CF), a gauge of mental stamina. They also had study participants complete the Symbol Digit Modalities Test (SDMT), which measures mental-processing speed.

Participants who reported higher levels of anxiety and cognitive fatigue performed worse on the SDMT than those who had less anxiety and cognitive fatigue. Further, motor fatigue did not interact with anxiety to affect SDMT scores, underscoring the impact of cognitive fatigue (versus motor fatigue) on mental-processing speed.

The researchers noted that their findings “have implications on development of cognitive remediation strategies, which may aim to target patient fatigue and/or anxiety to improve processing speed.”

Remember to exercise – and exercise to remember

After participating in a 12-week exercise program, 13 people with multiple sclerosis reported fewer problems remembering to carry out planned tasks. They also performed better on a test of information-processing speed than they did before starting the program. And, in a finding that is somewhat self-contradictory – but one that has been demonstrated in many exercise studies – they reported that exerting themselves actually reduced, rather than increased, their fatigue. 2

The 10 men and three women participating in the study had an average age of 58 years. All had relapsing-remitting MS. Each engaged in speeded walking three times a week for 12 weeks. Both before and after participating in the program, each person took tests to measure fatigue, mood, memory, and information-processing speed.

In comparing the scores on the baseline and post-intervention tests, researchers found that the program did not seem to affect mood, ability to remember things that had happened in the past, or attention, but did have a positive impact on fatigue, the speed with which participants processed information, and so-called “prospective memory,” which refers to a person’s remembering to do things he or she planned to do.

The study’s authors noted, “Physical activity holds promise for managing some symptoms of MS,” and called for future studies to assess the impact of exercise on people with progressive forms of MS.

Assessing the impact of stem-cell therapy on cognition in MS

Ten people with multiple sclerosis demonstrated cognitive stability 48 weeks after receiving stem-cell therapy, according to a recent report from a team of Canadian researchers.3

These individuals were participants in the Mesenchymal Stem Cell Therapy for Canadian MS Patients study and were recruited from the Ottawa Hospital MS Clinic. They had neuropsychological testing both before and at 48 weeks after a procedure in which their own mesenchymal stem cells were taken from them, multiplied, and then re-introduced into their bodies via infusion. (Mesenchymal stem cells are termed “multipotent” because they can differentiate into multiple tissues, including connective tissue, bone, cartilage, and muscle.) Researchers noted that the study – which looked at learning, memory, and processing speed – was the first wide-ranging evaluation of cognition following mesenchymal stem-cell therapy.

At the 48-week follow-up, most of the participants showed stability across the range of cognitive domains, although some demonstrated declines in specific areas, while others had improvement in particular domains. Five participants had declines in visual memory, while two had reduced visual learning scores and two had a decline in verbal learning. By contrast, one participant had improved verbal memory, another had gains in processing speed, and a third demonstrated enhanced visual learning and memory relative to baseline.

The study’s authors noted that the cognitive decline seen in some participants might be anticipated given the progressive nature of MS, and that 48 weeks may not have been a sufficient amount of time to assess how stem cell therapy affects cognition. They called on future studies to examine the question over longer periods of time.

Findings on Certain Risk Factors: Mediterranean Diet and Unprocessed Red Meat; Changes in Gut Microbiome

Mediterranean diet, unprocessed red meat, and risk of demyelination

Can daily intake of unprocessed red meat significantly reduce the risk of a first demyelinating event? That’s the tantalizing, if controversial, question raised by a recently reported study examining potential connections between diet and multiple sclerosis.

Research has shown cardiovascular and weight-control benefits to following a Mediterranean-type diet, which entails primarily eating fruits and vegetables, beans, nuts, healthy grains, fish, and olive oil, with only small amounts of meat, dairy, and red wine. Now, investigators in Australia have reported that a Mediterranean diet that includes unprocessed red meat may reduce the risk of an initial episode of demyelination. In demyelination, the myelin sheath that provides a protective cover to nerve fibers in the brain, spinal cord, and optic nerves is damaged, causing MS symptoms such as optic neuritis and MS relapses. 4

The investigators drew on data from the Ausimmune study, which matched people with MS with healthy controls of the same age, gender, and other characteristics, in an attempt to identify risk factors for the first clinical diagnosis of demyelination. The researchers grouped study participants into four categories, based on how closely those people’s eating habits matched a Mediterranean diet, and then looked for a connection between diet and risk of demyelination. They did not find any statistically significant association.

When the researchers took an extra step, however, a different picture emerged. They re-categorized the study participants by looking at how closely their food choices matched a Mediterranean-type diet, weighted to include attention to intake of unprocessed red meat. On that basis, people whose eating habits most closely matched a Mediterranean diet that included daily intake of one serving of unprocessed red meat had a 42% reduction in their risk of a first demyelinating event compared to those whose food intake was least similar to a Mediterranean diet.

The researchers concluded, “A Mediterranean diet that includes unprocessed red meat may be beneficial for those at high risk of MS.” It is important to note that “unprocessed” red meat does not mean meat that has not been sufficiently cooked. Rather, the term “unprocessed meat” signifies that meat has not been salted, cured, fermented, or smoked to preserve or flavor it prior to cooking. Ham, bacon, sausage and hot dogs are examples of processed meats.

A ‘gut check’ to assess microbiome components that affect MS risk

The search for factors that contribute to the development of multiple sclerosis increasingly is focusing on the “gut microbiome” – the milieu of bacterial organisms in the gastrointestinal tract that constitutes a major and highly dynamic component of the immune system. In a recent study, researchers assessed 93 people who had first-degree relatives with MS and who had been shown on genetic testing to have varying degrees of risk for developing MS themselves.5 Drawing on blood and stool samples, as well as information that participants provided on food frequency questionnaires, the investigators found that asymptomatic people at elevated risk for MS had a loss of abundance of bacteria associated with greater immune tolerance. In particular, those study subjects had relatively fewer organisms belonging to the Lachnospiraceae family, which produces short-chain fatty acids, or SCFAs. This finding is significant because other research has shown that SCFA may help combat the onset of MS.

The study provides further support for conducting clinical trials and other investigations to determine whether dietary interventions can change the composition of the gut microbiome and, as a result, reduce the risk for MS.

Managing Symptoms with Cannabis

Evidence that cannabis use eases spasticity and other MS symptoms

Two recent studies found that cannabis use improved spasticity and other common symptoms of multiple sclerosis.6, 7

The first study was a retrospective chart review of data for 77 people with MS who used medical cannabis for symptom management. Fifty-three of the participants were women and 24 were men; their average age was 49 years.6 Seventy-one percent reported that medical cannabis relieved MS-associated pain, while 43% said that it helped with spasticity, and 42% said it aided with sleep. One-third of the participants said that their use of cannabis enabled them to reduce or discontinue use of other medications, including opioids. Six percent of the participants reported sleepiness associated with their cannabis use, which was the most common side effect noted. Fourteen percent stopped using cannabis during the period studied, with cost and lack of effectiveness being the reasons cited most often.

The second study involved 29 people with MS in the Portland, Oregon area who enrolled in a clinical trial offering education and exercise as means of managing MS-associated spasticity.7 Nine of the 29 subjects reported using cannabis. Of that subgroup, 56% said they used the agent once daily or less often, while 44% reported more than daily use. All said that cannabis was somewhat or very helpful in managing their pain, while 78% said it helped with spasticity as well. Almost 90% were also taking a prescription agent for spasticity. The study is collecting data on additional patients.

The positive results from these relatively small studies suggest the need for confirmation from larger trials as patients and clinicians alike seek to identify the optimal role of cannabis in managing MS and other chronic conditions.

Blood Protein “NfL” May Help Predict Disease Course

Predicting the course of MS by monitoring blood levels of a protein

A protein called neurofilament light chain (NfL) has emerged in recent years as an indicator of the likely course of multiple sclerosis and response to disease-modifying therapy (DMT), but front-line clinicians need information on how to integrate data on blood levels of NfL into their decision-making.

A recent analysis of serum NfL levels in more than 1,400 patients participating in four clinical trials may provide important guidance in that regard.8 Researchers found that serum NfL levels of more than 16 pg/mL reflected a high probability of disease activity in the following 12 months. That >16 pg/mL blood level had a positive predictive value (PPV) of 91%, meaning that in 91 cases out of 100, people with MS who had that amount of NfL in their blood would experience disease activity in the subsequent year. When serum NfL exceeded 16 pg/mL on three readings taken three months apart, the positive predictive value increased to 94%. This information can be helpful in counseling patients debating whether to start a disease-modifying therapy (DMT). The data also can be useful in monitoring response to treatment. The analysis found that DMTs lowered serum NfL levels, with Tysabri (natalizumab) lowering blood levels of NfL below 16 pg/mL in 96% of patients.

The study’s authors said that their findings “demonstrated the feasibility of establishing relevant cut-points for disease severity stratification and treatment monitoring” in people with relapsing-remitting MS.

Life at Home with MS: Hoarding More Common; Care Partners Need More Support

Hoarding twice as common among people with MS versus the general population

More than 11% of people with multiple sclerosis participating in a recent study met the criteria for clinically significant hoarding, while an estimated 5% of the overall population engages in hoarding and cluttering behavior (HCB).9

The study involved 139 people with MS who attended the NYU MS Center in New York City. Their average age was 44.9 years, and the average duration of disease was 14.4 years. Seventy-one percent were female. Participants were assessed by means of the Activities of Daily Living for Hoarding (ADLH), Hoarding Rating Scale (HRS), and Patient-Determined Disability Steps (PDDS) instruments.

While the study’s authors did not propose an explanation for why hoarding may be more prevalent in the MS patient population, they did note that the behavior can have particularly negative consequences for people with MS, who may already face challenges with mobility, vision, or other issues that can affect safety as one moves around the home.

Indeed, the researchers found that hoarding behavior, as measured by scores on the HRS, was second only to degree of disability among factors contributing to the participants’ degree of disability in performing activities of daily living. Participants’ age, sex, and disease duration all had less impact.

The study’s authors concluded, “Given the wider impact of HCB on health and psychosocial wellbeing that has been demonstrated in the general population, the results of this study highlight the importance of identifying and characterizing HCB in MS patients with the goal of developing effective therapeutic interventions.”

Caring for MS caregivers: Surveys chart an unmet need

Three-quarters of caregivers supporting a person with multiple sclerosis reported anxiety, stress, burnout, depression, or isolation in a series of recent surveys. Further, while more than 70% said that assessing health-related decisions was among their main responsibilities, 61% said they did not feel that they were a trusted member of the care team.10

The surveys, which were completed by 171 people providing care to a loved one or friend with MS, also found that caregivers assist with an average of 4.64 daily tasks, such as dressing, attending to personal hygiene, and moving about. One-third of survey respondents reported devoting more than 30 hours each week to providing care.

The survey’s authors summed up their findings by noting, “Despite their significant role in providing care to patients with MS, caregivers do not feel fully involved in care decisions and planning. Furthermore, there is a significant personal impact on the caregivers themselves, who may benefit from additional support.”

Treating Pediatric MS

A trend toward increased treatment of newly diagnosed pediatric MS

Two-thirds of children and teenagers diagnosed with multiple sclerosis in recent years did not receive a disease-modifying therapy (DMT) in the 12 months following their diagnosis, a recent study found. However, researchers added that the use of oral and infused DMTs in pediatric patients increased from 2010 – the start of the period studied – to 2017. 11

Investigators examined insurance claims data to identify 288 children and adolescents age 17 years or younger diagnosed with MS from January 2010 to December 2016. The patients’ average age was 14 years, and 61% were female. One hundred and eighty-eight, or 65% of the total, did not receive a DMT in the year after their diagnosis.

Among those who did receive a DMT, 83% initially were prescribed either interferon-based therapies or glatiramer acetate, which is available as Copaxone® or in a generic formulation. Twenty percent of patients switched therapies in the first six months of treatment, and patients generally discontinued their first-line agent about 10 months after being diagnosed.

The study’s authors observed, “This analysis suggests the proportion of undertreated pediatric MS patients is considerable.” It is worth noting, however, that the study period ended more than a year before the FDA’s May 2018 approval of Gilenya (fingolimod) to treat relapsing MS in children and adolescents age 10 years and older.12 This action marked the first FDA approval of an MS medication for pediatric patients. That approval may make some clinicians more comfortable with prescribing therapy to a pediatric patient. Additionally, Gilenya is an oral agent, while the DMTs prescribed for most pediatric patients in the study are injectable medications. The route of administration may be an important consideration for pediatric patients and their parents, as the study’s authors referenced in writing, “With the growing uptake of newer oral and infusible DMTs over the recent years, there is a need to increase treatment awareness in the pediatric MS population.”

Experimental Medication Evobrutinib (M2951) Shown to Reduce Number of Lesions

Investigational oral medication reduces number of lesions on MRI over 24 weeks

Evobrutinib (M2951) is an oral medication being evaluated for potential use in relapsing forms of multiple sclerosis and in secondary-progressive MS. The agent inhibits Bruton’s tyrosine kinase (BTK), an enzyme that regulates the function of B cells and macrophages, components of the immune system shown to play a role in MS.

A recent Phase II study examined how various doses of evobrutinib affected the total number of T1 gadolinium-enhancing lesions seen on magnetic resonance imaging (MRI) at weeks 12, 16, 20, and 24 of treatment. The study also assessed safety, the annualized relapse rate (ARR), and MRI findings at weeks 24 and 48.13

Two hundred and sixty-seven adults with relapsing forms of MS entered the study. These participants were randomized to receive 25 mg of evobrutinib once daily, 75 mg of evobrutinib once daily, 75 mg of evobrutinib twice daily, 240 mg of Tecfidera® (dimethyl fumarate) twice daily, or placebo. People in the placebo group were switched to evobrutinib 25 mg once daily after 24 weeks. Two hundred and twenty-seven patients – or 85% of the original group – received 48 weeks of treatment.

The total number of T1 gadolinium-enhancing lesions was significantly reduced in patients receiving 75 mg of evobrutinib daily or twice daily, thus meeting the study’s primary endpoint. However, there was not MRI evidence of either dose having further effects on those lesions between weeks 24 and 48. The ARR over 48 weeks was 0.25 for patients receiving 75 mg of evobrutinib once daily and 0.11 for those receiving 75 mg of the agent twice daily, as compared to 0.37 for the placebo group over 24 weeks. Significant elevations in liver enzymes affected up to 5.4% of patients receiving evobrutinib.

The study’s authors concluded, “To our knowledge, evobrutinib is the first BTK inhibitor to demonstrate disease activity reduction” in an autoimmune condition. They added that their findings supported further clinical development of the agent.

Additional DMT Studies to Compare Treatments, Reduce PML Risk with Tysabri, and Evaluate the Impact of Ocrevus on Disability

Comparing the efficacy and safety of two disease-modifying therapies

Determining whether to switch disease-modifying therapies (DMTs) can be a difficult decision for people with multiple sclerosis and their clinicians. The dilemma is heightened by the fact that there are very few studies directly comparing one DMT to another.

That dearth of head-to-head trials makes the ASSESS study noteworthy. The Phase IIIb trial randomized 1,064 people with relapsing-remitting MS to receive the oral medication Gilenya® (fingolimod) in a 0.5-mg or a 0.25-mg daily dose, or to receive subcutaneously injected glatiramer acetate (which is marketed as both a branded and generic medication, with names including Copaxone®) in a 20-mg daily dose.14

The study’s primary endpoint was reduction in the annualized relapse rate (ARR). The trial also looked at MRI indications of disease activity at 12 months, as well as safety and tolerability. More than 80% of the randomized patients completed the study.

Participants receiving 0.5 mg of Gilenya had an annualized relapse rate of 0.153, as compared to an ARR of 0.258 for glatiramer acetate (GA), which translates into a 40.7% relative reduction in the relapse rate. The lower 0.25-mg dose of Gilenya also had a relative reduction in the ARR compared to glatiramer acetate, but the difference was not statistically significant.

Both doses of Gilenya also reduced the mean number of new or newly enlarged lesions seen on MRI relative to GA, with the relative reductions ranging from 42.1% to 55.6%, depending on the Gilenya dose and type of lesion. The adverse events reported with Gilenya were consistent with those seen in prior studies.

Progress toward identifying a Tysabri dosing schedule that best balances benefits and risk

Helping patients obtain the maximal benefit from a medication while minimizing their risk of side effects is a challenge for clinicians treating a wide variety of conditions. In relapsing-remitting multiple sclerosis (RRMS), the disease-modifying therapy (DMT) Tysabri® (natalizumab) provides a case study in this balancing act.

Tysabri reduces disability and relapses in RRMS, but also increases the risk of progressive multifocal leukoencephalopathy (PML), an opportunistic viral infection of the brain that can be life-threatening.15

Three factors appear to drive the increased risk of PML associated with taking Tysabri:

  • Longer use of the DMT, particularly use beyond two years
  • Prior treatment with an immunosuppressant agent
  • Having anti John Cunningham Virus (anti-JCV) antibodies15

Less than one person in 1,000 who is anti-JCV antibody negative, has no history of using immunosuppressants, and takes Tysabri for 24 months, will develop PML. By contrast, if 1,000 people who have the anti-JCV antibody and have used immunosuppressants take Tysabri for more than four years, it is estimated that 13 of them will contract PML.15

With these risk factors in mind, clinicians regularly consider a person’s past treatment history and test them for anti-JCV antibodies when assessing whether he or she is a candidate for Tysabri. Additionally, they seek to limit how long a patient who starts Tysabri stays on the medication.

But what is the best way to proceed when an individual who is doing well on the agent approaches the two-year mark of use? To address that question and related ones, and to help more people obtain the benefits of the DMT while minimizing their risk for PML, researchers have been studying whether spreading out the dosing schedule for Tysabri can reduce the risk associated with the medication while maintaining its effectiveness.

The approved dosing schedule entails an intravenous infusion of 300 mg every four weeks. Data collected from the TOUCH prescribing program sponsored by Biogen, which markets Tysabri, indicates that extending the interval between infusions to up to three months can significantly cut the risk of PML, with a risk reduction of up to 90% seen in one analysis.16

As researchers continue to collect and analyze data from the TOUCH prescribing program, other investigators are examining the impact of their own extended-dosing regimens. It appears that the collective effect of those efforts will be to identify means of reducing the risk while preserving the clinical benefits that the DMT offers to appropriately selected patients.

Examining the long-term impact of Ocrevus® on disability progression

In March 2017, Ocrevus® (ocrelizumab) became the first drug to receive FDA approval for the treatment of primary-progressive multiple sclerosis (PPMS). While patients and clinicians welcomed the availability of an approved therapy shown to be effective against PPMS, which affects roughly 15% of people with MS, some asked whether the benefits that the monoclonal antibody demonstrated in its clinical trials would be maintained over the longer term.

A recently presented study with 5.5 years of follow-up data answers that question in the affirmative. The study included individuals from the ORATORIO Phase III trial of Ocrevus. At the end of that double-blind, placebo-controlled trial, patients who had received Ocrevus and those who had received placebo were given the opportunity to enter an open-label extension study in which all participants would receive Ocrevus.17

The open-label extension study found that patients who had been taking Ocrevus from the start of the original study had lower rates of confirmed disability progression than those who had received placebo originally and only began Ocrevus in the open-label period. For example, at Week 168, 30.5% (less than one-third) of those on continuous Ocrevus had shown disability progression over the prior 48 weeks, compared to 44.4% (closer to one-half) of those who started Ocrevus after placebo. Similarly, after 264 weeks, or more than five years, 43.7% of patients who had received Ocrevus from the start had experienced disability progression over the past 12 months, compared with 53.1% of those who started Ocrevus later.

The study’s authors concluded that the findings “demonstrate consistent and sustained benefit with ocrelizumab treatment, and advantages for accrued disability for patients starting earlier on continuous ocrelizumab.”

MSAA Poster Presentations

Cognitive Impairment in Multiple Sclerosis: A Look at Phenotypes

The Multiple Sclerosis Association of America (MSAA), @Point of Care, and Dr. James Bowen from the Swedish Neuroscience Institute presented a poster at the Consortium of Multiple Sclerosis Centers Annual Meeting. This poster highlights data from a cognition scale, which has been incorporated into MSAA’s My MS Manager™ mobile phone app.18

Users of the app voluntarily provided answers to questions on cognitive function through the PROMIS® v2.0 Cognitive Function-Short Form 8a tool. Launched in March 2019, more than 538 individuals with MS accessed this tool within eight weeks. Selecting responses from the Likert scale, participants answered each of the eight questions with one of the following: never; rarely; sometimes; often; and very often. These eight questions covered topics about how quickly one’s thinking has been, if keeping track of an activity or changing between activities has become more difficult, if the ability to concentrate or pay attention has been reduced, and other similar assessments.

The poster noted the following conclusions:

  • The severity of cognitive impairment associated with MS can vary by type of MS and, overall, worsens with age
  • Both SPMS (secondary-progressive MS) and PPMS (primary-progressive MS) patients compared with RRMS (relapsing-remitting MS) patients were trending worse for all eight questions on the cognition scale
  • Utilizing a simple app tool to capture cognitive deficits allows those with MS to easily enter, track, and share their cognition data with their medical professionals

Please note: The My MS Manager patient app provides an easy way for patients, especially those with cognitive impairment, to enter and track their MS disease and share this information with their clinicians. For information on downloading MSAA’s free app for both Android and iOS devices, please visit https://mymsaa.org/msaa-community/mobile/

About @Point of Care
Founded in 2012, @Point of Care is dedicated to creating innovative digital tools that not only better connect patients, caregivers and clinicians, but provide a means to analyze and share data to encourage shared decision-making that can improve health outcomes.

About Dr. James Bowen
James D. Bowen, MD, is Medical Director of the Multiple Sclerosis (MS) Center at Swedish Neuroscience Institute in Seattle, WA. His research interests span various aspects of MS and focus on clinical trials for new treatments. Dr. Bowen has authored more than 200 articles, abstracts, and publications on MS and other neurological diseases.

Promoting Healthy Lifestyle Practices through a Multiple Sclerosis Health and Wellness Patient and Caregiver Education Series

The Multiple Sclerosis Association of America (MSAA) and the Cleveland Clinic Neurological Institute presented a poster at the Consortium of Multiple Sclerosis Centers Annual Meeting. The objective was to pilot a multi-disciplinary patient and caregiver health and wellness education series on evidence-based lifestyle practices for MS management and quality of life.19

The authors noted that vascular comorbidities, vitamin D deficiency, stress, and tobacco smoking contribute to an increased risk of disease activity, disability progression, and reduced quality of life in persons with multiple sclerosis (PwMS). Time limitations in clinic may not allow for optimal patient education for disease and comorbidity management. A multi-disciplinary team may reduce the MS burden through patient and caregiver education on healthy lifestyle choices and mitigating risk factors. This poster presents a unique program that addressed these important topics in a time-permitting format while offering additional support for patients and caregivers.

MSAA recruited 344 participants to attend four two-hour sessions, held weekly during a one-month period. These programs featured a multi-disciplinary team of MS specialists and included dinner as well as take-home educational materials. Topics were as follows:

  • Session 1: MS neurologist educated participants on etiology, prognosis, and comorbidity management.
  • Session 2: Physical and yoga therapists guided participants through beneficial exercises and provided education on the importance of movement.
  • Session 3: Health psychologist and licensed clinical social worker presented mental-health awareness, sleep-hygiene education, and how to navigate employment options.
  • Session 4: Local executive chef and registered dietitian nutritionist offered nutritional guidance and demonstrated how to prepare MS-healthy foods.

A brief survey was given at the end of each session, which was completed by 217 of the participants. A total of 88% of those taking the survey rated the program as “excellent,” while the remaining 12% gave the program a rating of “very good.” The conclusions were as follows:

  • Overall, PwMS and their caregivers responded favorably to our health and wellness education program and would like to participate in a future series.
  • The majority of participants were particularly interested in nutrition and exercise.
  • This unique, comprehensive program provides pilot data and future directions for practitioners to implement an alternative, time-permissive format for lifestyle education.

For More Information

For general information or to speak with a trained Client Services Specialist, please call MSAA’s Helpline at (800) 532-7667, extension 154. Questions to MSAA’s Client Services department may also be emailed to MSquestions@mymsaa.org.

Written by Tom Garry, Medical Writer
Reviewed by Jack Burks, MD
Edited by Susan Wells Courtney, MSAA Senior Writer


1. Altaras C, Miller J, Vissichio N, Foley F. How anxiety and fatigue interact to interfere with processing speed in multiple sclerosis. Abstract PSY06. 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC). May 28, 2019 to June 1, 2019. Seattle, WA.

2. Mayo C, Lacey C, Gawryluk JR. Impact of a 12-week exercise intervention on symptoms of fatigue, depressed mood, and perceived and objective cognitive impairment in multiple sclerosis. Abstract SXM01. 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC). May 28, 2019 to June 1, 2019. Seattle, WA.

3. Abu-AlHawa M, Freedman S, Atkins H, Walker LAS. Cognition following mesenchymal stem cell therapy in multiple sclerosis: an interim analysis. Abstract PSY01. 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC). May 28, 2019 to June 1, 2019. Seattle, WA.

4. Black LJ, Baker K, Lucas R, Pereira G. A higher Mediterranean Diet score, including unprocessed red meat, associates with a reduced risk of central nervous system demyelination. Abstract EP102.  33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC). May 28, 2019 to June 1, 2019. Seattle, WA.

5. Xia Z, White C, Gu Y, et al. Integrative analysis of risk burden, microbiome and metabolome in people at risk for multiple sclerosis. Abstract P4.2-056. 71st Annual Meeting of the American Academy of Neurology (AAN). May 4, 2019 to May 10, 2019. Philadelphia, PA.

6. McCormack K, Lewandowski E, Rainka M, et al. Multiple sclerosis and use of medical cannabis: a retrospective review evaluating symptom outcomes. Abstract P5.2-106. 71st Annual Meeting of the American Academy of Neurology (AAN). May 4, 2019 to May 10, 2019. Philadelphia, PA.

7. Hugos C, Rice J, Cameron M. Cannabis use in people with multiple sclerosis and self-reported spasticity. Abstract P5.2-100. 71st Annual Meeting of the American Academy of Neurology (AAN). May 4, 2019 to May 10, 2019. Philadelphia, PA.

8. Calabresi PA, Kuhle J, Arnold DL, et al. Serum neurofilament light (sNfL) for disease prognosis and treatment monitoring in multiple sclerosis patients: Towards implementation into clinical care. Abstract S26.001. 71st Annual Meeting of the American Academy of Neurology (AAN). May 4, 2019 to May 10, 2019. Philadelphia, PA.

9. Chapman E, Schiff T, Rimlder Z, et al. Prevalence of hoarding and cluttering disorder in multiple sclerosis patients. Abstract PSF01. 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC). May 28, 2019 to June 1, 2019. Seattle, WA.

10. Shankar S, Adelman B, Sorathia A. Preferences, needs, and opportunity areas for US multiple sclerosis caregivers. Abstract FAM02. 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC). May 28, 2019 to June 1, 2019. Seattle, WA.

11. Greenberg B, Kolodny S, Wang M, Deshpande C. Treatment patterns of disease-modifying therapy among pediatric patients with multiple sclerosis in the United States. Abstract DXM02. 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC). May 28, 2019 to June 1, 2019. Seattle, WA.

12. Food and Drug Administration (FDA). FDA expands approval of Gilenya to treat multiple sclerosis in pediatric patients. May 11, 2018. Available at: https://www.fda.gov/news-events/press-announcements/fda-expands-approval-gilenya-treat-multiple-sclerosis-pediatric-patients. Accessed June 21, 2019.

13. Montalban X, Arnold DL, Weber MS, et al. Efficacy and safety of the Bruton’s tyrosine kinase inhibitor evobrutinib (M2951) in patients with relapsing multiple sclerosis over 48 weeks: a randomized, placebo-controlled Phase 2 study. Abstract S56.005. 71st Annual Meeting of the American Academy of Neurology (AAN). May 4, 2019 to May 10, 2019. Philadelphia, PA.

14. Cree B, Goldman M, Corboy J, et al. Efficacy and safety of fingolimod 0.5 mg and 0.25 mg versus glatiramer acetate 20 mg in patients with relapsing-remitting multiple sclerosis – ASSESS Study Group. Abstract S56.009. 71st Annual Meeting of the American Academy of Neurology (AAN). May 4, 2019 to May 10, 2019. Philadelphia, PA.

15. Tysabri (natalizumab) prescribing information. April 2018. Biogen Inc. Cambridge, MA.

16. Ryerson LZ, Foley J, Chang I, et al. Reduced risk of progressive multifocal leukoencephalopathy (PML) associated with natalizumab extended interval dosing (EID): updated analysis of the TOUCH® Prescribing Program database. Abstract S26.006. 71st Annual Meeting of the American Academy of Neurology (AAN). May 4, 2019 to May 10, 2019. Philadelphia, PA.

17. Wolinsky JS, Kappos L, Montalban X, et al. Reduction in 48-week confirmed disability progression after 5.5 years of ocrelizumab treatment in patients with primary progressive multiple sclerosis. Abstract P3.2-031. 71st Annual Meeting of the American Academy of Neurology (AAN). May 4, 2019 to May 10, 2019. Philadelphia, PA.

18. Rudell E, Peterson P, Griffin A, Agrawal T, Ingram M, Bowen JD. Cognitive Impairment in Multiple Sclerosis: A Look at Phenotypes. Poster LB6358. 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC). May 28, 2019 to June 1, 2019. Seattle, WA.

19. Meyer S, Nash J, Kruskall L, Castello K, Barton K, LeGrand M, Sullivan A, Hersh CM. Promoting Healthy Lifestyle Practices through a Multiple Sclerosis Health and Wellness Patient and Caregiver Education Series. Poster PGM04. 33rd Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC). May 28, 2019 to June 1, 2019. Seattle, WA.