What’s New in MS Research – July 2023

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

More than 1,800 multiple sclerosis (MS) researchers, clinicians, and advocates recently convened at the base of the Rocky Mountains for high-level discussions on the latest findings on the potential causes, impact, diagnosis, and management of MS.

The occasion was the Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC). The gathering featured more than 170 speakers, 330 presentations, and 260 posters outlining research findings.

More than a dozen of the key studies presented at the meeting are summarized below. They include promising results from a Phase II study of an investigational medication for relapsing MS, new evidence on the link between fatigue and lesion burden as identified on magnetic resonance imaging (MRI), and unexpected findings on quality of life as people with MS grow older.

We hope you find the following summaries from the 2023 CMSC Annual Meeting to be both interesting and encouraging.

A new approach to treating MS? A Phase II trial of frexalimab shows encouraging results

Twelve weeks of treatment with an investigational medication that takes a new approach to treating multiple sclerosis significantly reduced MS lesions seen on magnetic resonance imaging (MRI) in people with relapsing forms of the disease.¹

The medication, frexalimab, is a monoclonal antibody that inhibits CD40L, a protein expressed by T-cells, which is a type of immune system cell that plays a role in MS. Frexalimab is thought to block T-cell interactions with two other types of immune system cells – B-cells and innate antigen presenting cells (APCs) – that also are involved in the MS disease process.

While T-cells express CD40L, B-cells and innate APCs express a similar protein, CD40. The CD40/CD40L costimulatory pathway regulates immune responses and has been implicated in both acute and chronic MS. Researchers say that frexalimab modulates T-cell and B-cell activation and innate immune cell function without depleting B-cells.

Those researchers studied the effects of frexalimab in a Phase II trial that included 125 people with relapsing MS. The trial had two phases. Part A was a 12-week, double-blind, randomized, placebo-controlled trial. People were randomly assigned to receive high-dose frexalimab, low-dose frexalimab, or placebo. Part B was an ongoing, open-label extension period after 12 weeks in which all participants received either high-dose or low-dose frexalimab. The study’s primary endpoint was number of new gadolinium-enhancing (Gd+) lesions seen on Tesla 1 (T1) MRI at 12 weeks. Key secondary findings were the number of new or enlarging lesions at Week 12 compared to Week 8 on Tesla 2 (T2) MRI, total number of Gd+ T1 lesions at week 12, and safety measures.

Study results were provided at a poster presentation at the CMSC meeting and in the Whitaker Lecture – a main event at each year’s CMSC gathering. The Whitaker Lecture was delivered by Gavin Giovannoni, MD, PhD, Chair of Neurology at the Blizard Institute and The London School of Medicine and Dentistry, Queen Mary University of London. Key results included:¹

• At Week 12, high-dose frexalimab reduced the number of new Gd+ T1 lesions by 89% relative to the placebo group, meeting the study’s primary endpoint. Low-dose frexalimab reduced the number of those lesions by 79%. Both results were statistically significant.
  
• At Week 12, high-dose frexalimab reduced new/enlarging T2 lesions by 92% relative to placebo, while low-dose frexalimab had an 86% relative reduction.
  
• Similarly, the total number of Gd+ T1 lesions at Week 12 was reduced by 88% with high-dose frexalimab and 80% by low-dose frexalimab relative to placebo.
  
• At 24 weeks, 96% of participants in the high-dose frexalimab group and 80% of those in the low-dose group were free of new Gd+ T1 lesions.
  
• No serious or severe treatment-emergent adverse events were reported. Four people receiving frexalimab reported headaches, and five had mild or moderate uncomplicated cases of COVID-19. Only one patient, who was receiving low-dose frexalimab, left the study due to an adverse event.

The results are the first data to be generated by a Phase II trial of an anti-CD40L medication in multiple sclerosis. Researchers said that the findings support further investigation of frexalimab for the treatment of relapsing MS.

Study provides support for “de-escalation” treatment strategies

Moving from a higher-efficacy to a lower-efficacy disease-modifying therapy (DMT) does not appear to increase relapses, disability, or MRI evidence of disease activity, according to a study of 135 people with MS.²

The feasibility of “de-escalating” – shifting from a higher-efficacy therapy to a lower-efficacy treatment – has become an increasingly important topic in recent years. That’s because a number of studies have provided support for “starting strong” in terms of beginning MS treatment with more-potent DMTs. In many cases, however, the greater disease control that higher-efficacy therapies provide relative to lower-efficacy alternatives is accompanied by a greater side effect burden. As a result, many clinicians are asking whether the optimal approach may be to begin with a higher-efficacy medication and then, after the patient shows evidence of being stable on that therapy, shifting to a lower-efficacy alternative that is associated with fewer side effects.

To help answer that question, a team of researchers analyzed data on 135 patients who moved from a higher- to a lower-efficacy DMT.² The study participants switched therapies for a variety of reasons, including adverse effects, tolerability, and concerns about safety. The higher-efficacy DMTs taken by study participants included Tecfidera^® (dimethyl fumarate) and Gilenya^® (fingolimod). The medications that the people shifted to included glatiramer acetate and interferon therapies.

In assessing the impact of the change in therapies, researchers looked at relapse rate, measures of disability, MRI evidence, and patient-reported outcomes. The standard that the investigators used in evaluating change was non-inferiority, meaning that the second medication was not associated with worse outcomes than the first. They defined non-inferiority as no more than an 8% increase in disease activity.

Based on that definition, the lower-efficacy DMTs proved to be non-inferior in terms of MRI lesion burden. They also were below the 8% level for relapse rate and disability level, but those results did not reach statistical significance.

The study’s findings are welcome news for people who experience significant side effects on higher-efficacy medications. At the same time, some important caveats should be noted. First, the study was retrospective, meaning that it looked back on people’s experience rather than following them prospectively, or going forward. This approach can yield valuable insights, but prospective studies remain the gold standard.

In addition, with 135 patients, the study was modestly sized – not small, but not large – either. And finally, and perhaps because of biostatistical limitations imposed by its size, the results in terms of relapse rates and disability were favorable but did not achieve statistical significance. As the study’s authors note, “This area requires further investigation, and decisions regarding treatment should be based on the patient’s individual disease characteristics.” While subsequent research is needed, this study provides valuable insights into a topic that is only going to become more important to more and more people with MS.

Exploring the link between fatigue and MRI findings in MS

Have you ever wondered whether the fatigue you’re experiencing is tied to MS-related physical changes or instead is just “all in your head?” If so, the answer is Yes.

That is, your head is implicated in the fatigue you’re feeling, but that doesn’t mean that you’re imagining things.

Researchers at Johns Hopkins University recently analyzed data on 4,012 people with MS to see if there were links between the findings on brain imaging and fatigue severity and persistence.³ Just over half of the study participants reported no fatigue at baseline, while 16% had mild fatigue and 33% had moderate to severe fatigue. Seventy-two percent of the people studied were women and 86% were white. Seventy percent had relapsing-remitting MS and 30% had progressive disease. The study subjects’ average age was 45.6 years.

The researchers found that people who had less evidence of brain atrophy, as measured by brain parenchymal fraction (BPF) and gray matter fraction (GMF) on their baseline MRI, had lower initial fatigue scores on the Quality of Life in Neurological Disorders measurement system. Further, a higher BPF at baseline was associated with lower odds of having a fatigue episode subsequently or of always feeling fatigued. Meanwhile, people with a higher volume of brain lesions on T2 MRI had a higher likelihood of reporting that they were always fatigued relative to never feeling fatigued.

The study findings raise intriguing questions about the potential clinical impact of slowing or stabilizing brain matter atrophy and reducing lesion volume through use of disease-modifying therapies (DMTs). While researchers continue to explore those questions, it is important for people with MS to not only take practical steps to manage their fatigue, but also to recognize that what they’re experiencing is a very real and very common manifestation of multiple sclerosis, and not something to be doubted or discounted.

The power of partnership in promoting physical activity in MS

Most people with MS should be more physically active. The same is true for everyone else, including the family care partners of people with MS.

Recognizing this widespread need to get more people moving more often, a team of Canadian researchers explored the feasibility of a program aimed at having people with MS engage in physical activity with family members who act as caregivers. ⁴

Titled, Physical Activity Together for MS (PAT-MS), the 12-week intervention involved 10 people with MS and their care partners. Half of those pairs (or “dyads” in research terms) were assigned to PAT-MS sessions while the other five dyads were assigned to the study’s waitlist. Researchers examined issues including the extent to which people participated in the program, their satisfaction with the program, and injuries or other adverse effects. They also assessed participants’ degree of physical activity, as measured both by people’s own reports and from data generated by accelerometers, devices worn on the wrist, hip, or elsewhere on the body that record movement.

People in the PAT-MS group reported a high degree of satisfaction with the program and made regular use of its offerings, with 92% of group sessions, 83% of individual support calls, and 80% of practice activities being completed. Two people in the PAT-MS group reported mild adverse events that were deemed unrelated to the study – an injured back and a rolled ankle. Both the participants’ own reports and the accelerometer data indicated that participating in PAT-MS promoted increased physical activity.

Researchers said findings from the small study will help them design a larger trial to further investigate the benefits of having people with MS exercise with their care partners.

And if peddling stationary bikes or walking on treadmills side-by-side doesn’t sound like an appealing way to exercise with a care partner, another team of researchers has a suggestion for you – put on your dancing shoes!⁵

Researchers from the University of Pennsylvania and New York University conducted a small study to assess the feasibility of offering a virtual dance program for people with MS. They enrolled 13 people – 12 women and one man – who ranged in age from 41 to 63 years. The study participants had Expanded Disability Status Scale scores of 2.5 to 6.5, meaning that some people had mild disability while others required the use of walking aids to cover roughly 20 yards without resting.

The program entailed a modern dance class taught via Zoom twice a week for five weeks. Ninety-two participants completed the class, with those people attending between 80% and 100% of the classes. The class won high marks from the dancers, all of whom said they would recommend such a class to other people with MS.

Two-thirds of participants reported gains in quality of life, and at the conclusion of the program there was evidence of improvement from baseline in depression, pain, and emotional well-being.

An unexpected finding on age and quality of life in people with MS

In a small study conducted at the Medical College of Wisconsin, people with MS aged 65 years and older had a better mental quality of life (QoL) than younger adults with MS.⁶

The researchers studied 35 patients to explore how unmet needs, quality of life, and depression in older people with MS and in people with advanced MS differed from those of younger people with MS who were fully independent. Twenty-one people participating in the study were aged 64 or younger and did not require assistance with daily activities. These people served as the control group against which older people and those with an Expanded Disability Status Scale score of 7 or higher, indicating advanced MS, were compared.

While researchers noted that the better mental QoL among older people with MS relative to younger people was surprising, they did not offer potential explanations for the finding. They did say, however, that they plan to conduct future studies to look deeper into these results and to better understand the needs of older people with MS and people with advanced MS.

Assessing the long-term impact of Mavenclad^® on highly active relapsing MS

More than 80% of people with highly active relapsing MS who took the disease-modifying therapy (DMT) Mavenclad^® (cladribine) did not have a relapse or indications of disease progression over the course of two years.⁷

That finding emerged from the Phase IV MAGNIFY-MS study involving 270 people. Phase IV studies are conducted after a medication has received FDA approval. They typically are focused on the long-term efficacy and safety of a therapy. Participants in MAGNIFY-MS had a median age of 38.5 years; two-thirds were females. Researchers employed several measures to monitor the study subjects, including annualized relapse rate (ARR), change in Timed 25-Foot Walk Test (T25FW), Nine-Hole Peg Test (NHPT) results to evaluate disease progression, and lesion count on MRI. They also tracked the incidence, type, and severity of treatment side effects.

At the conclusion of the study, those researchers found that:

• The study participants’ ARR was 0.11, which represents just over one relapse among 1,000 people in one year
• 83% of people did not have a qualifying relapse
• 87.4% did not experience six-month confirmed disability progression
• More than 92% of those with data that could be evaluated, did not have indications of progression based on the timed walk test or the NHPT
  

At the start of the study, 47% of people did not have active lesions on MRI. By Months 18-24, that proportion had increased to 86.2%. Ten patients – or 3.7% of the total –experienced severe treatment-emergent adverse events, while only one patient permanently discontinued treatment.

The researchers reported that the safety profile seen in the two-year study was consistent with findings from earlier, shorter trials.

Highly active MS imposes tremendous burdens on the people it affects and has long been a challenge for clinicians. The results of MAGNIFY-MS indicate that patients and clinicians alike have a new approach to consider for reducing the impact of MS.

Quantifying shingles risk in people with MS

People with MS are at increased risk for shingles, and that risk increases with age and with the immunosuppressive effects of any disease-modifying therapy (DMT) they may be taking.⁸

That was the main finding to emerge from an analysis that looked at the incidence of shingles, also known as herpes zoster, in 42,185 people with MS and 1,000,000 people who did not have any evidence of a compromised immune system. The study participants with MS were somewhat older than the people with whom they were compared (average age 53 years versus 46 years), and 75% of people in the MS group were women, as compared to 50% of the people in the larger “immunocompetent” group. Of the people with MS, 55% were deemed to have no baseline immunosuppression due to DMTs, while 35% were considered to have low immunosuppression and 10% to have a high degree of immunosuppression.

The rate of shingles in people with MS was more than double that of the immunocompetent group – 13.78 diagnoses per 1,000 patient years versus 5.64 cases per 1,000 patient years. Both groups saw the incidence of shingles increase with age. In people with MS, the rate per 1,000 patient years climbed from 11.61 in people ages 18 to 49 years to 15.16 in those 50 years and older. Among people without any immunocompromising condition, the rate increased from 3.46 in adults aged 49 and younger to 8.57 in those age 50 and older.Among people with MS, the rate ranged from 12.97 cases per 1,000 patient years for those with no DMT-related immunosuppression to 14.03 cases in people on a DMT causing a low degree of immunosuppression and 18.0 for people on a high-immunosuppression DMT.

Shingles is a reactivation of the varicella-zoster virus that causes chickenpox. People who had chickenpox in childhood are at risk for developing shingles in adulthood, particularly after age 50. As anyone who has experienced shingles knows, the conditions can cause extreme itching and significant pain. Further, about 20% of people with shingles have ongoing nerve pain, known as post-herpetic neuralgia.

Vaccines are effective in significantly reducing the risk of shingles, but it is important to speak with your MS clinician about whether you should be vaccinated and, if so, which specific vaccine you should receive. Your clinician’s recommendation may be based, in part, on which DMT you are taking. MS specialists generally advise patients not to get live-virus vaccines because these vaccines can increase disease activity. Fortunately, the shingles vaccine given most often in the US does not contain live virus.

Survey of women with MS finds need for pregnancy education and mental health support

Researchers at the Duke MS Clinic set out to learn how much women with multiple sclerosis know about pregnancy and MS treatment options. In the process, they received an education in the often-heartbreaking impact that MS can have on patients and their families, and the resultant need for mental health support.⁹

The researchers distributed a 13-question survey to female patients receiving care at their clinic. Many of the questions pertained to knowledge and perceptions about specific aspects of pregnancy and MS treatment. However, it was the last question, an open-ended query that asked participants what they wanted to know about those topics, that elicited the most-telling responses.

One woman wrote: “More pertinent to my family size was the implications that MS had on my marriage – my partner’s resentment toward the limitations my disease put on me. My experience has been that while people can be somewhat sympathetic, it is very difficult to understand why the person with MS has difficulties.”

Other responses to the question struck a similar chord, with women detailing how MS has affected them and their families, stressing the need for mental health screening and referrals.

Among the 38 women who had completed the survey when researchers submitted their findings for presentation at the CMSC meeting:

• 29.7% believed their risk of relapse would increase during pregnancy
• 29% reported that they did not have as many children as they desired
• 10.8% believed the risk of relapse did not increase following pregnancy

Two women said they had been told they could not have children because of their MS.

Another woman wrote, “We want to start a family and I don’t know what to expect and when or if to stop medications.”

In commenting on their findings, the researchers concluded: “To provide comprehensive care, it is imperative to address issues around family planning with patients. This survey highlighted that even patients at a large subspeciality clinic are underinformed about pregnancy and MS and have misunderstandings about their ability to have children, the risk of relapse throughout pregnancy, and treatment options.”

Charting the COVID-19 pandemic’s impact on mental health in people with MS

The health worries, financial pressures, social isolation, and other stresses of the COVID-19 pandemic’s early months took a particularly heavy toll on the mental health of people with MS, according to recently published survey results.¹⁰

The nationwide survey was fielded in December 2020, roughly nine months after the coronavirus began infecting people in America. The research was a component of the CopesMS study, which the University of Texas and the Multiple Sclerosis Association of America (MSAA) conducted to study the pandemic’s indirect impact on health care access and outcomes for people with MS.

Of the 592 people who completed the survey, which included the Patient Health Questionnaire-9 (PHQ-9):

• 27.7% reported moderate to severe depression, as measured by their PHQ-9 scores, and 12.4% indicated having thoughts of suicide several days a week or more.
• 18.9% of people reported “far-above-average” concern about their financial future. The rates of significant depression and of suicidal ideation in this group were more than double those of the overall group, with 61.6% having moderate to severe depression and 31.3% saying they had thoughts of suicide several days a week or more.
• The incidence of moderate to severe depression and suicidal ideation also was elevated in survey respondents who reported that someone in their household had lost a job during the pandemic, standing at 42.5% and 17.5%, respectively.
• Social isolation also was associated with worse mental health. Among people who reported connecting with just one to three people per week, 31.2% reported moderate to severe depression and 14.3% acknowledged having thoughts of suicide. By comparison, those rates were 23.9% and 10.3%, respectively, for survey participants who said they were in contact with four or more people each week.

While those early, frightening months of the pandemic can seem like a distant memory, these survey results offer enduring lessons. Financial worries and social isolation can fuel depression regardless of whether they are prompted by a public health emergency or some other cause. Indeed, the researchers noted that, compared to the general population, people with MS had a higher incidence of mental health challenges before the pandemic arrived.

One bright spot in the survey was that 43.7% of respondents reported that they were receiving treatment for depression. Those people offer an example worth emulating by anyone with MS who is experiencing depression, suicidal thoughts, anxiety, or any of the other negative impacts MS can have on mental health.

In late 2020, it was easy to fear that things would never get better, that we would never put the worst of COVID-19 behind us. Depression can feel the same way. But more than three years after the pandemic first hit the United States, the situation today proves that tough times do pass when we get the help we need.

Helping young people with MS succeed in college

Starting college is a major step for all students. Add multiple sclerosis to the mix, and the challenges can increase exponentially. Specifically, a recent study of people with MS found that visual disturbances, balance issues, mental health, and memory-cognition were the MS symptoms with the greatest impact on their college experience.¹¹

The research, which examined students’ use and assessment of the MS Toolkit for Academic Success, found that 50% of respondents rarely felt supported in managing symptoms at college, while the other 50% said they felt supported less than half of the time. No wonder, then, that participants said that the information most helpful to them related to the accommodations process, the types of accommodations available to them, and how to access those accommodations. The study participants – 90% of whom were female and two-thirds of whom had relapsing-remitting MS – also expressed an interest in more information on classroom use of assistive technologies.

Exploring the financial costs of MS and their drivers

The most important “costs” of multiple sclerosis are those that the disease imposes on people’s lives, but the financial costs can be considerable, too. A recent review of 65 studies helped to quantify those costs and identify their drivers in the United States.¹²

In the studies included in the review, the direct annual costs of MS varied from $16,614 to $72,744. Disease-modifying therapies (DMTs) represented the single largest component of those direct costs, ranging from 43% to 86% of the total across studies. Meanwhile, reported indirect costs of the disease were from $9,122 to $30,601, depending on the study. These indirect costs reflected the monetary impact of work absenteeism, early retirement, and informal, uncompensated caregiving. As would be expected, greater degrees of disability were associated with higher costs and resource use. Relapses also emerged as a significant cost driver.

The study’s authors noted, “In the US, direct costs, particularly DMTs, appear to be the major cost drivers for patients with MS. Availability of lower-cost therapies may considerably decrease the economic burden on these patients and the health care systems.” While less-expensive therapies undoubtedly would be welcome, the financial costs of DMTs have to be weighed against their ability to reduce the human “cost” of MS in terms of relapses avoided, disease progression halted or deferred, and the other demonstrated benefits of the therapies.

Study raises possibility of 10-minute administration time for Ocrevus^®

People with MS who take Ocrevus^® (ocrelizumab) may be able to switch from twice-yearly intravenous infusions of two hours or longer to 10-minute subcutaneous injections if the results of the recently completed OCARINA II trial prompt Food and Drug Administration (FDA) approval of the shortened administration time.¹³ The injections would be given twice a year.

Approved by the FDA in 2017, Ocrevus is indicated for the treatment of relapsing forms of multiple sclerosis (RMS), including clinically isolated syndrome, relapsing-remitting MS, and active secondary-progressive multiple sclerosis. Further, it is the only medication approved to treat primary-progressive MS (PPMS).

Currently, Ocrevus is infused intravenously, with initial doses of 300 mg given over 2.5 hours or more two weeks apart, followed every six months by 600 mg typically administered over 3.5 hours or longer. Based on post-approval studies, the FDA sanctioned shortening the infusion time for 600-mg dose to two hours or longer in people who had no prior serious infusion reaction with any previous Ocrevus infusion.¹⁴

Ocrevus is a monoclonal antibody designed to target CD20-positive B cells, a type of immune cell thought to be a key contributor to myelin (nerve cell insulation and support) and axonal (nerve cell) damage. The investigational subcutaneous formulation evaluated in the OCARINA II trial combines Ocrevus with Halozyme Therapeutics’ Enhanze^® drug-delivery technology. The Enhanze technology is based on a proprietary enzyme that increases the permeability of the tissue under the skin, allowing space for large molecules like Ocrevus to enter, and enables the subcutaneous formulation to be absorbed into the bloodstream.

OCARINA II is a Phase III randomized trial conducted at study sites in several different countries. Its purpose is to assess the pharmacokinetics (or drug activity and availability), safety, and radiological and clinical effects of Ocrevus injected subcutaneously compared with Ocrevus infused intravenously in 236 patients with RMS or PPMS. The study’s primary endpoint is non-inferiority in serum area under the curve (AUC) from Day 1 to Week 12 following subcutaneous injection compared to IV infusion. “Non-inferiority” means that an approach isn’t less favorable than another approach to which it is being compared, while serum AUC is a measure of drug exposure in the blood, which is an important consideration in a medication’s ability to have an effect.

Secondary endpoints include maximum serum concentration of Ocrevus, the total number of active, gadolinium-enhancing T1 lesions at 8 and 12 weeks, new or enlarging T2 lesions at 12 and 24 weeks, and safety and immunogenicity outcomes.

On July 13, 2023, Genentech, which markets Ocrevus, announced that OCARINA II met its primary and secondary endpoints in patients with RMS and PPMS. The Company added that subcutaneous injection was shown to be non-inferior to IV infusion based on pharmacokinetic measures at 12 weeks – the study’s primary endpoint – while being comparable to Ocrevus intravenous infusion in controlling MRI measures of disease activity. Further, the Company said, the safety profile of Ocrevus subcutaneous injection was comparable to that of Ocrevus given by infusion.

Genentech is a member of The Roche Group, which stated that trial results will be presented at an upcoming medical meeting and submitted to health authorities in countries around the world.

References

1. Vermersch P. Granziera C, Mao-Draayer M, et al. Frexalimab, a CD40L inhibitor, in relapsing multiple sclerosis: results from a randomized controlled phase 2 trial. LB02. CMSC 2023.
2. Goldschmidt CH, Glassman J, Ly B, Harvey T, Hua LH. A retrospective study on the effects of de-escalation of disease-modifying therapy in patients with multiple sclerosis. DMT01. CMSC 2023.
3. Simpson AC, Hu C, Fitzgerald KC, Nourbakhsh B. Structural magnetic resonance imaging correlates are associated with fatigue severity and persistence in a large real-world cohort of people with multiple sclerosis. QOL05. CMSC 2023.
4. Fakolade A, Awadia Z, McKenna OJ, et al. Physical activity together for multiple sclerosis (PAT-MS): preliminary results of a randomized controlled feasibility trial. REHO4. CMSC 2023.
5. Pfister A, Sweeney Smith M, Lane C, et al. Effect and feasibility of a virtual dance program for patients living with multiple sclerosis. QOL04. CMSC 2023.
6. Jacobson R, Erickson K, Obeidat A. A comparative study of the quality of life and unmet needs of people living with multiple sclerosis. WH105. CMSC 2023.
7. De Stefano N, Achiron A, Barkhof F, et al. Efficacy in clinical and magnetic resonance imaging outcomes with cladribine tablet treatment in highly active relapsing multiple sclerosis (MAGNIFY-MS). DMT 44. CMSC 2023.
8. Stempniewicz N, Steffens A, Kim K, et al. Herpes zoster incidence in patients with multiple sclerosis: a retrospective cohort study. EP109. CMSC 2023.
9. Veal K, Lackey E, Shah S. Assessment of patient knowledge in pregnancy and multiple sclerosis. MOC27. CMSC 2023.
10. Largent A, Carron O, Andino D, et al. Financial stress, job insecurity, and social isolation in people with MS during the COVID-19 pandemic: impact on depression and suicidal ideation. PSY02. CMSC 2023.
11. Faraclas EM, Watson C, Faria A, Sjogren K, Lowy A. Adoption and effectiveness of a toolkit to promote academic success in the multiple sclerosis population. QOL13. CMSC 2023.
12. Schauf M, Chinthapatia H, Dimri S, et al. Economic burden of multiple sclerosis in the United States: a systematic literature review. EP105. CMSC 2023.
13. Genentech, Inc. Positive Phase III results for Genentech’s Ocrevus (ocrelizumab) twice a year, 10-minute subcutaneous injection in patients with multiple sclerosis. South San Francisco, CA. July 13, 2023. Available at https://www.businesswire.com/news/home/20230712019800/en/Positive-Phase-III-Results-for-Genentech%E2%80%99s-Ocrevus-ocrelizumab-Twice-a-Year-10-Minute-Subcutaneous-Injection-in-Patients-With-Multiple-Sclerosis. Accessed July 16, 2023.
14. Genentech, Inc. OCREVUS^® (ocrelizumab) injection, for intravenous use [prescribing information]. South San Francisco, CA. March 2023.

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