What’s New in MS Research – January 2025

Reviewed by MSAA Chief Medical Officer Barry A. Hendin, MD

A new year promises to bring a wealth of new insights into the nature and management of multiple sclerosis (MS). The study summaries included in this edition of “What’s New in MS Research” highlight the broad spectrum of inquiry that is driving the progress to develop better treatments against the disease.

The clinical trials and other analyses to follow examine topics ranging from the impact of discontinuing or switching disease-modifying therapies (DMTs), to associations between MS and weight gain, as well as MS and COVID-19 infection. The studies also highlight recent evidence of the effectiveness of various DMTs and the connection between overall health and MS outcomes.

The bottom line: There is abundant cause for hope and considerable opportunity to take a proactive approach to optimizing your physical and emotional well-being.

 

Dutch study shows hazards of stopping disease-modifying therapies

Does it make sense to stop disease-modifying therapy (DMT) following a long period of stability on treatment? It’s a question that many people with MS ask themselves after 10, 20, or even more years of taking medication.

While discontinuing therapy can be an attractive option in terms of cost savings and avoiding potential side effects of treatment, a study from the Netherlands shows that those benefits can come at the price of increased risk of renewed MS activity.¹

The study involved 89 adults with relapsing-onset MS who had not experienced relapses or substantial magnetic resonance imaging (MRI) evidence of disease activity over the course of five years on their initial DMT. Study participants had a median age of 54 years, and two-thirds were female. The people in the study were assigned in random fashion to either continue or discontinue their therapy.

After a median follow-up of 15.3 months, the trial was stopped ahead of schedule because of inflammatory disease activity beyond pre-defined acceptable limits. Specifically, eight of the 45 people in the discontinuation group had recurrent inflammation. In most cases, that inflammation involved new or newly active brain lesions identified on MRI. However, two of the people had clinical relapses. By contrast, none of the 44 people assigned to continue their DMT had significant inflammatory disease activity.

Among the eight people who had imaging evidence of inflammation or a clinical relapse, the median time from DMT discontinuation to recurrent disease activity was 12 months. 



The study’s authors note that in their trial, “Even in patients with long-term MS [whose disease activity was] stable for over five years, first-line DMT discontinuation can lead to recurrence of inflammatory disease activity. Although this study cohort was relatively small, the recurrence of inflammation in the discontinue group was significantly higher than in the continue group.”


Decisions about whether to maintain or stop DMT regimens involve consideration of several factors, including many that are specific to each person. Those decisions are best made in consultation with one’s MS clinician and in view of the latest available evidence. This study’s finding that roughly one in six people who discontinued their DMT experienced recurrent disease activity within a median one year of stopping therapy provides important data to discuss in the process of shared decision-making, which refers to the process of patients working together with their healthcare team to determine their best treatment plan.

 

FDA designates tolebrutinib as a Breakthrough Therapy for non-relapsing secondary-progressive MS

In December 2024, the Food and Drug Administration (FDA) granted Breakthrough Therapy designation to tolebrutinib, an investigational, oral medication being developed by the French biopharmaceutical company Sanofi for the treatment of non-relapsing secondary-progressive multiple sclerosis (nrSPMS).² The FDA designation is designed to expedite the development and review of medicines that target serious or life-threatening conditions. Medications qualifying for this designation must show the potential for substantial improvement in clinically significant endpoints versus currently available therapies.

While more than 20 disease-modifying therapies (DMTs) are approved for use in various forms of relapsing MS, none are specifically approved for nrSPMS, a condition in which people initially diagnosed with relapsing-remitting MS experience progressive disability without having relapses.

Sanofi said that the Breakthrough Therapy designation was based on positive results from the Phase III HERCULES study involving more than 1,100 people with nrSPMS. The study found that tolebrutinib delayed the time to onset of six-month confirmed disability progression (CDP) by 31% compared to placebo. Further, 10% of study participants receiving tolebrutinib experienced confirmed disability improvement, compared to 5% receiving placebo.

The study also found a higher incidence of liver enzyme elevations in the tolebrutinib group than the placebo group. Just over 4% of people receiving tolebrutinib had liver enzyme levels more than three-times the upper limit of normal (ULN), compared to 1.6% of people in the placebo group. Sanofi noted that 0.5% of people in the tolebrutinib group experienced peak increases in a specific liver enzyme (alanine aminotransferase [ALT]) that were more than 20 times the ULN, all within the first 90 days of treatment. All but one case of liver enzyme elevations resolved without further medical intervention, the Company said. 

Tolebrutinib belongs to a class of medications known as Bruton’s tyrosine kinase (BTK) inhibitors. BTK is an enzyme that helps govern the activity of different cells involved in neurological and immune functions. The enzyme has been shown to play a role in the development and activation of B cells, which are immune cells that contribute to the development of MS.

Tolebrutinib is able to penetrate the brain to better reach areas of inflammation, while reaching levels of concentrations within the cerebrospinal fluid to enable it to modulate B cells and microglia. Both of these support the immune system, and the microglia are also involved with brain development, maintenance of neuronal networks, and repair of injured nerves. In addition to the HERCULES trial evaluating tolebrutinib in nrSPMS, the Phase III PERSEUS study is assessing the medication in primary-progressive MS. Results from that study are expected in the first half of this year.

 

FDA issues anaphylaxis warning for Copaxone^® and Glatopa^®

On January 22, the Food and Drug Administration (FDA) issued a warning about the risk of anaphylaxis, a rare but serious allergic reaction, with use of the disease-modifying therapy (DMT) glatiramer acetate, which is marketed as Copaxone^® and Glatopa^®.³

In announcing the warning, the FDA wrote that the reaction “can occur at any time while on treatment, after the first dose or after doses administered months or years after starting the medicine. For most patients who experienced anaphylaxis with glatiramer acetate use, the symptoms appeared within one hour of injection. In some cases, anaphylaxis resulted in hospitalization and death.”

The federal agency said that it was adding the risk of anaphylaxis to a new Boxed Warning, its most prominent type of warning, and to the Warnings and Precautions section of the prescribing information for glatiramer acetate.

The FDA explained, “We identified 82 worldwide cases of anaphylaxis associated with glatiramer acetate occurring from December 1996 through May 2024, including 19 cases that reported anaphylaxis more than one year after starting the medicine.” The agency’s announcement continued, “The 82 worldwide cases include only reports submitted to FDA and found in the medical literature, so there are likely additional cases about which we are unaware. While anaphylaxis in these cases appears to be rare compared to how often the medicine is used, these 82 patients reported serious outcomes that required emergency room visits or hospitalizations for medical treatment, and six died.”

Copaxone was one of the first DMTs to receive FDA approval, which was granted in 1996. Since then, it has been used by hundreds of thousands of people with relapsing forms of MS. Glatopa is a generic version of glatiramer acetate that has been available since 2015. It, too, has been used by numerous people with multiple sclerosis since its approval for treatment of relapsing MS. The FDA reported that in 2023 alone, an estimated 240,000 glatiramer acetate prescriptions were dispensed.

The FDA noted that symptoms of anaphylaxis include wheezing, difficulty breathing, swelling of the face, lips, or throat, and hives. “These symptoms can quickly progress to more serious symptoms, including severe rash or shock, which is a life-threatening condition,” the agency said. It added, “Patients should be aware that the early symptoms of anaphylaxis can be similar to a temporary reaction that sometimes happens right after or within minutes after an injection of the medicine into the skin. This immediate post-injection reaction goes away on its own, usually within 15-30 minutes, with no specific treatment.

This reaction can occur with the first dose, or after doses administered months or even years after starting the medicine. This immediate post-injection reaction may involve symptoms such as flushing, chest pain, palpitations, anxiety, shortness of breath, rash, or hives. Call the health care professional who prescribed the medicine if you have any of these immediate post-injection reaction symptoms. Do not continue taking more injections until your prescriber tells you to do so. Seek immediate medical attention by going to an emergency room or calling 911 if any of these symptoms worsen or do not go away.”

The agency added, “We cannot determine how likely it is that someone will experience these side effects when taking glatiramer acetate. Your healthcare professionals know you best, so talk to them if you have questions or concerns about risks of taking glatiramer acetate.”

In addition to being aware of the symptoms of anaphylaxis described above, the FDA’s advice to talk with your MS clinician is particularly important guidance for people taking Copaxone or Glatopa. Together, you can assess the benefits and risks of your current therapy and potential alternatives, ensure that you have a plan of action should you experience concerning symptoms, and decide on the approach that’s best for you.

 

UTIs most common reason for hospital admission in MS

Urinary tract infections (UTIs) are responsible for more hospital admissions among people with multiple sclerosis (MS) than any other cause, according to a recently published study.⁴

Researchers examined the records of 210 adults with MS who were admitted to Duke University Hospital between January 2018 and January 2020. They found that 10.3% of the admissions were for UTIs. The next most-frequent causes were neurologic deficits of nonidentifiable cause (9.2%), MS exacerbation (7.6%), and falls/ambulation difficulty/spasticity (6.2%).

Having MS did not appear to contribute to a significantly longer hospital stay or a greater risk of being re-admitted to the hospital within 30 days of discharge. The average length of stay was 6.1 days for people with MS versus 5.5 days for the general population, while 30-day re-admission rates were 14.9% and 15.5%, respectively. Interestingly, almost half of the people with MS (48.5%) were not taking a disease-modifying therapy (DMT) upon admission.

The study’s authors concluded, “Given the prevalence of bladder dysfunction in MS, it is not surprising that a UTI was the most common reason for admission. Actively addressing management of and techniques for bladder dysfunction may decrease the admission rate for individuals with MS.”

This study, while conducted at a single institution and involving a modest-sized population, is consistent with other research on the causes of hospitalization in people with MS. Its findings underscore the value of talking with your clinician about approaches to managing urinary incontinence, urinary retention, and similar conditions that are common in MS and that increase risk for UTIs.

While many UTIs do not cause symptoms, the study also highlights the importance of promptly contacting your primary care provider or MS clinician should you experience possible indicators of a UTI. These include pain or burning with urination, an urgent need to urinate frequently, or cloudy or bloody urine.

 

Analysis finds that the impact of fatigue declines as mood improves

A study involving 218 adults with MS found that a reduction in symptoms of depression was accompanied by a reduction in the impact that fatigue had on people’s lives.⁵

Most study participants were female (72%), white (76%), and middle-aged (average age 53.7 years). Their average time since MS diagnosis was 12.5 years. They were assigned at random to a fatigue self-management intervention or to receive general MS education on improving fatigue. Researchers noted that the two interventions showed similar efficacy.

Rather than stopping there, however, the investigators went on to conduct a secondary analysis. They looked at whether a clinically significant improvement in depressive symptoms over the course of the trial (as measured by at least a 17.5% reduction in total Beck Depression Inventory-II score), correlated with a reduction in measures of the impact of fatigue, from the start of the study through a six-month follow-up.

The researchers found that improvement in their Beck Depression Inventory II score was associated with a reduction in the physical, cognitive, and psychosocial impact of fatigue as measured by the Modified Fatigue Impact Scale. The study’s authors noted, “These findings, building on previous research, support the importance of reducing depressive symptoms for improving fatigue impact in people with MS. Future research should examine whether explicit focus on reducing depressive symptoms or related cognitive behavioral factors reduces fatigue in people with MS.”

While researchers will continue to explore the link between depression and fatigue in multiple sclerosis, this study provides individuals with MS with one more reason to overcome any reluctance they may have to talk with their clinician about symptoms of depression. Both within and outside the setting of MS, depression and fatigue can operate in a vicious cycle, with low mood robbing people of energy and a lack of energy preventing them from taking steps to deal with depression. This study suggests that there also may be a “virtuous cycle,” in which acting to improve one’s mental health may help to reduce the impact that fatigue has on different aspects of life.

 

Swedish study finds increased MS risk in people hospitalized for COVID-19

People hospitalized for treatment of COVID-19 were roughly 2.5 times more likely than those not diagnosed with the coronavirus to later develop multiple sclerosis (MS), according to a Swedish study.⁶

Researchers drew on a national database to analyze health records for all Swedish residents ages 3 years to 100 years who did not have a diagnosis of demyelinating disease prior to January 1, 2020. The investigators tracked health outcomes for that cohort – more than 9.9 million people – through November 2022. They found that the rate of MS diagnosis during that period was 9.5 per 100,000 person-years for people who had not been identified as having COVID-19 vs. 21.0 per 100,000 person-years for those who had been admitted to the hospital due to COVID-19. That represents a 2.48-fold increase in risk of MS, with the difference being statistically significant.

The finding raises important questions about the connection between the inflammatory processes that mark acute viral infections such as COVID-19 and the onset of MS, an autoimmune disease marked by inflammation. At the same time, two caveats should be noted.

First, the increased risk was seen in people whose COVID-19 was so severe that it warranted hospitalization, not in all people with COVID. Second, the study period was not quite three years. As a result, the numbers involved are small, with 28 people diagnosed with MS during that time. The study’s authors note, “Longer duration of follow-up will assist in identifying whether the associations are causal or due to shared susceptibility or surveillance bias.”

 

Mavenclad^® shows multiple benefits following a first demyelinating event

People who began taking the oral disease-modifying therapy Mavenclad^® (cladribine) after experiencing a first clinical demyelinating event were less likely to convert to clinically definite multiple sclerosis (CDMS) than people with an initial event who did not receive the medication.⁷

That was one of the key findings to emerge from a study involving 227 people who had a demyelinating event such as optic neuritis or numbness in a limb that may represent the first manifestation of MS. Roughly 69% of the study participants received Mavenclad, while 31% did not. After a median follow-up of 9.5 years, the rate of conversion to CDMS was 51.5% for those who received one or more courses of Mavenclad versus 80.6% for those not treated with the medication. Further, the median time to conversion was 10 times longer in the Mavenclad group than in the untreated group – 8.4 years versus 0.8 years, respectively.

People in the treatment group who converted to MS were also less likely to be using a wheelchair or ambulatory device than their untreated counterparts. Additionally, 53.2% of Mavenclad-treated people who converted to MS were relapse-free at follow-up, as compared to 28.2% of the group not exposed to the medication.

Clinicians long have weighed the best response to a first demyelinating event. The desire to start therapy early in people who may go on to clinically definite MS was balanced by concern about exposing people who may not convert to MS to a potent therapy that can cause side effects. In recent years, however, studies providing greater insight into the likelihood of conversion and documenting the benefits of early therapy may have begun to tip the balance in favor of a more-interventionist approach. This study would seem to add further weight to the argument for early therapy, but such decisions must be made on a case-by-case basis with individuals and their clinicians carefully considering each person’s specific situation.

  

Comparing clinician and patient preferences for MS treatments

People with MS and their clinicians have a shared goal of finding the disease-modifying therapy (DMT) best suited to each person, but are they aligned in terms of the relative importance of various characteristics of a DMT? This is largely true, but not entirely, according to the results of a recent Italian study.⁸

Researchers surveyed 1,069 people with MS and 186 healthcare professionals (HCPs) to assess their preferences for different medication attributes. Patients and clinicians alike gave high priority to patient-reported outcomes, identifying a therapy’s impact on cognitive impairment and walking ability as being particularly important.

However, the two groups differed in terms of preferred route of medication administration and location of treatment delivery. People with MS favored oral medications as well as home administration of treatments delivered by other routes, such as injection or infusion. Clinicians favored hospital-based treatments, a choice that implicitly signifies a preference for infused or injected therapies.

Slowing time to progression was of greater importance to clinicians, while people with MS showed a stronger preference for medications that can be delivered less frequently, such as twice yearly rather than monthly.

Commenting on their findings, the researchers wrote, “This study underscores the necessity of incorporating both patient and HCP perspectives into MS treatment planning. Shared decision-making, which considers individual preferences, can enhance treatment adherence and outcomes. These insights into treatment preferences provide valuable guidance for personalized MS care, aiming to improve patient quality of life and optimize therapeutic efficacy.”

 

Speed matters when moving from Tysabri^® to anti-CD20 therapy

When switching from Tysabri^® (natalizumab) to an anti-CD20 monoclonal antibody such as Ocrevus^® (ocrelizumab), Kesimpta^® (ofatumumab), or Briumvi^® (ublituximab), a shorter transition period appears to offer reduced risk of relapse compared to a longer transition, according to a European study.⁹

The study involved 139 people with relapsing forms of multiple sclerosis receiving care at one of eight MS centers in Austria, Switzerland, and Germany. All of the study participants had received Tysabri or a biosimilar version of the medication for at least three months. Seventy percent of the patients were female. The study participants’ average age at time of medication switch was 38.8 years. Their average disease duration was 11.3 years and their median time on Tysabri or its biosimilar version was 4.4 years. Their median transition time was 58 days.

Over one year of follow-up, 16.1% of patients who had a transition period of 45 days or more experienced a relapse. By contrast, 11.1% of those whose transition lasted 30 to 44 days had a relapse and no patients who made the switch in less than 30 days experienced a relapse. Over an extended follow-up period of approximately four years, study participants reported six severe infections. Researchers did not find any association between length of transition time and risk of infection.

Tysabri and the various anti-CD20 monoclonal antibodies are considered high-efficacy disease-modifying therapies (DMTs). Since 2017, when Ocrevus became the first anti-CD20 therapy approved for use in MS in the United States, many clinicians have sought to shift their patients with MS from Tysabri to another high-potency DMT because of concerns about progressive multifocal leukoencephalopathy (PML), a rare but often fatal opportunistic infection of the brain.

While cases of PML have occurred in patients taking anti-CD20 therapy as well as in those receiving Tysabri, duration of use of Tysabri has been identified as a risk factor for the condition¹⁰, prompting many clinicians to try to limit their patients’ time on the medication. This study offers providers and people with MS key insights into how to manage the switch from Tysabri to another high-efficacy medication.

 

Further evidence of the link between overall health and brain health in MS

A recent study provides new support for the guidance that attending to their overall health is one of the most important steps people can take to manage their MS and its impact on their lives.

The study, which involved 445 people with secondary-progressive multiple sclerosis, found that having high blood pressure or high levels of “bad” cholesterol was associated with decreased grey matter volume in the brain’s cortical region.¹¹ The cerebral cortex is responsible for processes including language, memory, reasoning, learning, decision-making, and intelligence. Loss of volume, or atrophy, of the cortex can adversely affect those functions.

Study participants had an average age of 55 years and a median Expanded Disability Status Scale score of 6.0, indicating the need to use an assistive device such as a walking stick. Two-thirds of the people in the study were female. Thirteen percent had hypertension, or high blood pressure, while 9% had hyperlipidemia, or elevated levels of low-density lipoprotein cholesterol (LDL-C), the so-called bad cholesterol.

The study did not address the ways in which hypertension and hyperlipidemia may affect or be affected by cortical grey matter volume in the setting of MS, nor did it explore whether successfully treating those cardiovascular conditions can have a favorable impact on brain volume or function. Nonetheless, it gives people with MS another reason to take a holistic, proactive approach to enhance overall well-being and hopefully avoid the development of other chronic conditions.

 

A future role for functional MRI in tracking cognitive impairment?

Magnetic resonance imaging (MRI) long has been central to the diagnosis and ongoing assessment of multiple sclerosis. In future years, however, an enhanced version of the imaging modality may play an even larger role in identifying MS-related cognitive impairment and monitoring disease progression, according to three researchers from the University of Miami.¹²

Those researchers conducted an extensive review of the evidence on use of functional magnetic resonance imaging (fMRI) in assessing neuroplasticity – the brain’s ability to change and adapt – and its relationship to cognitive impairment in people with MS. fMRI tracks brain activity by identifying changes in blood flow throughout the brain. As a rough analogy, think of the difference between conventional MRI and fMRI as the difference between a black-and-white snapshot and a color photo.

After evaluating the scientific literature, the researchers found that fMRI studies have documented disruptions in brain connectivity and other issues that decrease neuronal network efficiency, ultimately leading to cognitive impairment. They add that fMRI also provides evidence of the brain mounting a beneficial compensatory response in the earlier stages of MS, with that response eventually being blunted as the disease progresses and lesion burden increases.

They write, “These findings support fMRI not only as a diagnostic tool for [MS-related cognitive impairment] but also as a potential imaging biomarker to improve our understanding of disease progression.” While routine screening with functional MRI [fMRI] is not on the near horizon, this review suggests that people with MS and their clinicians eventually may have another means of monitoring disease status and planning accordingly.

 

Women with MS at higher risk for weight gain than men

Women are almost twice as likely than men to experience rapid weight gain in the two years following a diagnosis of MS, according to a team of researchers from the Cleveland Clinic and University of Miami.¹³  

The researchers examined records for 942 people newly diagnosed with MS. Of that total, 265 (27.9%) were overweight and 403 (42.4%) were obese at baseline. After an average follow-up period of 2.1 years, women were 1.84 times more likely than men to have had a rapid increase in weight. In addition, the researchers found that a greater degree of education was associated with lower odds of rapid weight gain.

The team of researchers also analyzed data on 10,934 people with longstanding MS to assess the impact of degree of disability and other factors on weight gain. While they did not find an association between greater disability and greater likelihood for annualized increases in body mass index (BMI) – an indirect measure of weight – they again identified an association between women and risk of weight gain.

Noting that “obesity predisposes individuals to a pro-inflammatory state and cardiovascular comorbidities, both of which can negatively impact MS disease course,” the researchers said, “the frequency of overweight and obese [people with multiple sclerosis] suggests that weight management is an important part of MS care.”

 

References

1. Coerver EME, Fung WH, de Beukalaar J, et al. Discontinuation of first-line disease-modifying therapy in patients with stable multiple sclerosis: the DOT-MS randomized clinical trial. JAMA Neurol. 2024 Dec 9. doi: 10.1001/jamaneurol.2024.4164. Online ahead of print.
2. Sanofi-Aventis Groupe. Tolebrutinib designated Breakthrough Therapy by the FDA for non-relapsing secondary progressive multiple sclerosis. December 13, 2024. Available at https://www.globenewswire.com/news-release/2024/12/13/2996609/0/en/Press-Release-Tolebrutinib-designated-Breakthrough-Therapy-by-the-FDA-for-non-relapsing-secondary-progressive-multiple-sclerosis.html. Accessed January 15, 2025.
3. Food and Drug Administration. FDA Drug Safety Communication. FDA adds Boxed Warning about a rare but serious allergic reaction called anaphylaxis with the multiple sclerosis medicine glatiramer acetate (Copaxone, Glatopa). January 22, 2025. Available at https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-boxed-warning-about-rare-serious-allergic-reaction-called-anaphylaxis-multiple-sclerosis. Accessed January 23, 2025.
4. Paredes D, Lackey E, Shah S. Reasons for hospital admission in individuals with multiple sclerosis. Int J MS Care. 2024;26:302-307.
5. Knowles LM, Mistretta EG, Arewasikporn A, et al. Improvement in depressive symptoms is associated with sustained improvement in fatigue impact in adults with multiple sclerosis. Mult Scler Relat Disord. 2024 Dec:92:106158. doi: 10.1016/j.msard.2024.106158.  
6. Montgomery S, Vingeliene S, Li H, et al. SARS-CoV-2 infection and risk of subsequent demyelinating diseases: national register–based cohort study. Brain Commun. 2024; 6(6): doi.org/10.1093/braincomms/fcae406.
7. Giovannoni G, Boyko A, Correale J, et al. Long-term follow-up of patients with a first clinical demyelinating event (clinically isolated syndrome) who received cladribine tablets in CLASSIC-MS: findings for the ORACLE-MS cohort. Mult Scler. 2024 Dec 17:13524585241302170. doi: 10.1177/13524585241302170. Online ahead of print.
8. Gasperini C, Battaglia MA, Balzani F, et al. Unveiling preferences in multiple sclerosis care: insights from an Italian discrete-choice experiment with patients and healthcare professionals. J Neurol. 2024 Dec 12;272(1):27.doi: 10.1007/s00415-024-12725-2.
9. Bsteh G, Hoepner R, Gernert JA, et al. Switching from natalizumab to antiCD20 monoclonal antibodies: Short transition interval is associated with improved outcome. Eur J Neurol. 2025 Jan;32(1):e16587. doi: 10.1111/ene.16587.
10. TYSABRI^® (natalizumab) injection, for intravenous use [prescribing information]. October 2023. Biogen Inc. Cambridge, MA. 
11. John NA, Li Y, De Angelis F, et al. Vascular risk factors are associated with grey matter atrophy in secondary progressive multiple sclerosis. Eur J Neurol. 2025 Jan;32(1): e16586.
12. Mahmoudi F, McCarthy M, Nelson F. Functional MRI and cognition in multiple sclerosis – where are we now? J Neuroimaging. 2025 Jan-Feb;35(1):e13252. doi: 10.1111/jon.13252.
13. Conway DS, Toljan K, Harris KA, et al. Body mass index trends over four years in persons with multiple sclerosis. Mult Scler Relat Disord. 2024 Dec 8:93:106218. doi: 10.1016/j.msard.2024.106218. Online ahead of print.

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 Dr. Barry Hendin, MSAA Chief Medical Officer
Edited by Susan Wells Courtney, MSAA Senior Writer