What’s New in MS Research – November 2024

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

The world’s leading experts in multiple sclerosis (MS) gathered in Copenhagen, Denmark in September 2024 to share the results of their latest research into the causes, course, and treatment of the disease. That gathering, the 40th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), showcased encouraging findings from a number of vital studies.These trials covered important findings on many topics, which include: investigational and approved disease-modifying therapies (DMTs); the roles of exercise, diet, and sleep in managing MS and enhancing quality of life; and approaches to diagnosing, monitoring, and predicting the course of MS. The brief summaries that follow give a sense of the breadth and depth of that research, and provide much hope for the future.

 

The case for “starting strong”: two studies support early use of high-efficacy therapies

With two dozen therapies approved for the treatment of MS, clinicians have both a welcome opportunity and a considerable challenge when it comes to selecting the disease-modifying therapy (DMT) best suited for a particular individual with MS. One of the questions they face is whether to “start low and go slow” – initiating a lower- or moderate-efficacy therapy less likely to cause side effects and then moving to a high-efficacy therapy, as needed – or to “start strong” with a higher-efficacy therapy in hopes that the benefits it provides early in the course of MS will be worth the potential for more significant side effects.

While that decision has to be made in consultation between the physician and the patient, in the context of the individual’s specific situation, two recent studies drawing on data from the Swedish MS Registry provide support for early use of higher-efficacy DMTs.

The first study looked for an association between the type of therapy a person with MS first received and long-term disease progression.¹

Researchers compared the experiences of 2,390 people with relapsing forms of MS who were started on low-to-moderate efficacy therapies (LM-DMT) and 1,968 people with relapsing forms of MS who received first-line high-efficacy treatment (HE-DMT). There were 1,474 confirmed disability worsening events in the LM-DMT group compared with 982 such events in the HE-DMT cohort.

This translated into an unadjusted rate of 9.98 events per 100-person years in the lower/moderate-efficacy group versus 9.19 events in the high-efficacy group, which was a statistically significant difference. The HE-DMT group also had a lower rate of progression independent of relapse activity, although the difference between the two groups on this measure was not statistically significant.

The second study examined how the timing of initiating high-efficacy therapy in relapsing-remitting MS was associated with subsequent participation in the workforce.²

Researchers analyzed data on 866 people with relapsing forms of MS aged 18 to 55 years. They paired those study participants, matching 433 who started a HE-DMT less than two years after disease onset with 433 who began HE-DMT therapy two-to-four years following onset of MS. The pairs were also matched by age at onset, sex, and relapse rate, as well as their Expanded Disability Status Scale (EDSS) score in the first two years after diagnosis. Seventy percent of study participants were female, and the participants’ average age of MS onset was 33.2 years. Study endpoints were receipt of a partial or full disability pension.

Over an average eight years of follow-up, the people who started a HE-DM two-to-four years after disease onset were almost two-times more likely to be receiving a disability pension than those who began a high-efficacy DMT within two years of developing MS.

The study’s authors concluded that earlier initiation of high-efficacy DMTs is associated with longer time in the workforce, adding that this finding “supports the benefit of early [high-efficacy therapy] shown in previous studies on disability outcomes.”

 

Two large, long-term studies implicate infectious mononucleosis in MS risk

Researchers long have recognized a link between Epstein-Barr Virus (EBV) and multiple sclerosis, but the exact nature of that connection has been elusive. Now, two large studies analyzing decades’ worth of data have implicated infectious mononucleosis (IM), a contagious viral illness most often caused by EBV, as significantly increasing a person’s risk of developing MS.

In the first study, researchers drew on data from the Danish National Patient Register to identify 37,533 people who were diagnosed with IM caused by EBV.³ The patients were diagnosed in the hospital setting and did not have a prior diagnosis of MS. Their average age at diagnosis of EBV-IM was 18.4 years; 47% were female. Researchers matched each of those patients with 10 people from the general population who were the same sex and age.

In analyzing data collected from January 1977 through December 2022, the researchers found that the people diagnosed with EBV-IM had an incidence rate of MS events of 43.1 per 100,000 person-years, almost three-times greater than that of the 15.0 per 100,000 person-years rate in their counterparts who had not been diagnosed with EBV-IM. Further, they found that this elevated risk persisted for up to 40 years after being diagnosed with infectious mononucleosis.

The degree of risk varied by the age at which a person was diagnosed with EBV-IM, the researchers added, citing a 3.34-fold increased risk in people found to have IM at ages 11 to 19 years versus a 2.46-fold elevation in risk for those diagnosed with IM at age 10 years or younger and a two-fold increase in risk for people who developed IM at age 20 years or older.

In the second study, researchers looked at data on 669,538 people diagnosed with IM in Ontario, Canada between April 1992 and March 2017.⁴ From 1992 through March 2022, 2,475 of those people (0.4% of the total) were diagnosed with MS. Seventy-one percent of the people with MS were female. The median age at IM diagnosis was 18 years and the median age at MS onset was 31 years.

Delving more deeply into the data, the researchers found that the following characteristics were associated with an increased risk of developing MS following a diagnosis of infectious mononucleosis:

• Females, 1.9-times greater risk of developing MS relative to males
• IM diagnosis at age 10 to 25 years, 5.8-times greater risk of developing MS relative to diagnosis at 9 years or younger
• Previous need for mental health care, 1.2-times greater risk of developing MS relative to not receiving mental health care

Prior mental health care and older age at time of IM diagnosis also were associated with earlier onset of MS following infectious mononucleosis.

 

Researchers find that menopause is not a culprit in MS disability progression

Menopause may bring unwelcome changes in terms of hot flashes, reduced bone density, and other issues, but progression of MS-related disability isn’t one of them, according to a report by Australian researchers.⁵

Those investigators analyzed data on 1,117 women with MS who were receiving care at eight MS centers across Australia. Of the total, 656 women were pre-menopausal and 461 were post-menopausal. Researchers compared the two groups in terms of time to confirmed disability progression (CDP) and secondary-progressive multiple sclerosis (SPMS). While women in the postmenopausal group reached those milestones sooner than their pre-menopausal counterparts, statistical analysis showed that after adjusting for factors such as age at MS onset, disease duration, relapse history, and duration of use of high-efficacy disease-modifying therapies, menopause was no longer a predictor of CDP or SPMS in and of itself.

The researchers concluded, “The onset of menopause in women with MS is not the driving factor for disease progression, as measured using physical disability-based severity measures. These findings offer crucial insights and reassurance to women with MS navigating the menopausal transition.” They added, however, “Further research is needed to examine the impact of domain-specific markers of disability, including cognition.”

 

A delay of 31% in time to disability progression with tolebrutinib in non-relapsing SPMS

The oral disease-modifying therapy (DMT) tolebrutinib delayed time to onset of six-month confirmed disability progression by 31% compared to placebo in the Phase III HERCULES study involving more than 1,100 people with non-relapsing secondary-progressive multiple sclerosis (nrSPMS).^6,7

Tolebrutinib is an investigational medication that inhibits the activity of an enzyme called Bruton’s tyrosine kinase, or BTK. The enzyme helps direct the activity of different cells involved in neurological and immune function. In particular, it plays a role in the development and activation of B cells, immune cells that have been shown to contribute to the development of MS.

The 1,131 patients participating in HERCULES were an average age of 48.9 years and had an average time from MS symptom onset of 17.3 years. Sixty-two percent were female and 77% had received at least one prior DMT. Study participants were randomized 2:1 to receive 600 mg of tolebrutinib daily or placebo.

Sanofi, the company developing the BTK inhibitor, reported that 10% of study participants receiving tolebrutinib experienced confirmed disability improvements, compared to 5% of people receiving placebo.

The company also reported that liver enzyme elevations three-times greater than the upper limit of normal (ULN) occurred in 4.1% of people receiving tolebrutinib compared to 1.6% of those in the placebo group. One half of one percent of patients in the tolebrutinib group had increases more than 20-times the ULN in blood levels of the liver enzyme alanine aminotransferase (ALT). Those elevations all occurred in the first 90 days of treatment, the company said.

A Sanofi press release noted that all but one case of liver enzyme elevations resolved without further medical intervention. The press release also explained that, “Prior to the implementation of the revised study protocol with more stringent monitoring, one participant in the tolebrutinib arm received a liver transplant and died due to post-operative complications.”

To date, the implementation of more frequent monitoring has mitigated such serious effects on the liver. Other deaths in the trial were assessed as unrelated to treatment according to investigators; deaths were equal across the placebo and tolebrutinib arms at 0.3%. Liver enzyme elevations have been seen in a number of BTK inhibitors being developed by various companies.

There currently are no therapies approved by the Food and Drug Administration (FDA) specifically for the treatment of nrSPMS.

Results from the Phase III GEMINI 1 and GEMINI 2 studies evaluating tolebrutinib in relapsing MS also were announced at the ECTRIMS meetings. Those studies compared the BTK inhibitor to Aubagio^® (teriflunomide), an oral DMT approved by the FDA for the treatment of relapsing forms of MS.^7,8

The two studies enrolled more than 1,800 people (974 in GEMINI 1 and 899 in GEMINI 2) from 42 different countries. Study participants’ average age was 36.5 years, and their average time from diagnosis was 4.3 years. Two-thirds of the study participants were female and 63% had not received prior treatment with a DMT. Their average Expanded Disability Status Scale (EDSS) score was 2.38, indicating minimal or mild disability, and study participants had experienced an average of 1.2 relapses in the year prior to entering the study.

The primary endpoint for both GEMINI 1 and GEMINI 2 was a statistically significant improvement in annualized relapse rate (ARR) for tolebrutinib compared to Aubagio. Unfortunately, neither study met that primary endpoint, with the ARR for tolebrutinib actually slightly higher in GEMINI 1 and identical to that of Aubagio in GEMINI 2.

However, in a pooled analysis of data from the two studies, tolebrutinib delayed the time to onset of six-month confirmed disability worsening by 29%, in line with the 31% delay in confirmed disability progression seen in people with nrSPMS in the HERCULES study.

Preliminary analysis of safety data from GEMINI 1 and 2 showed that adverse events seen in the tolebrutinib and Aubagio study arms were generally comparable. Liver enzyme elevations more than three-times the ULN were recorded in 5.6% of people receiving tolebrutinib compared with 6.3% of participants receiving Aubagio. Those liver enzyme elevations resolved without further medical intervention, Sanofi reported. Deaths were balanced across the Aubagio and tolebrutinib arms, at 0.2% and 0.1% respectively, and were assessed as unrelated to treatment by investigators.

A fourth Phase III study of tolebrutinib, the PERSEUS trial evaluating the BTK inhibitor in primary-progressive MS, is ongoing, with results expected in the second half of 2025.

 

Study links Mediterranean Diet adherence to better mental health and quality of life in MS

A study involving 489 people with MS found that the more participants followed a Mediterranean Diet, the more likely they were to have better mental health and quality of life (QoL).⁹

The study, which drew on data from the United Kingdom Multiple Sclerosis Register (UKMSR), assessed participants’ dietary intake in 2016 and again in 2022. Based on self-reported eating habits, each study participant was assigned a score from 0 to 9 on the alternate Mediterranean Diet (aMED) instrument. Higher scores signify higher adherence to the diet, which emphasizes eating fruits, vegetables, whole grains, olive oil, and lean meats, while limiting or avoiding red meat and sugar, and consuming wine in moderation, if at all. The diet has been shown to have anti-inflammatory properties and is favored by many cardiologists and other physicians for the cardiovascular benefits it has demonstrated.

The researchers also measured participants’ degree of anxiety and depression using the Hospital Anxiety and Depression Scale, mental QoL with the Multiple Sclerosis Impact Scale, and overall quality of life with the EuroQol 5 Dimension. They also adjusted results to take into account factors including 2016 health outcomes and 2022 total energy intake (food and beverages consumed), age, sex, type of MS, and medication use.

They found that higher aMED scores in 2016 predicted reduced anxiety and a reduced risk for moderate or severe depression. Similarly, people with the highest degree of adherence to a Mediterranean diet (those with aMED scores of 7-9) had a 34% reduction in risk for low mental quality of life relative to those with the lowest degree of following a Mediterranean diet (participants with aMED scores of 0-3).

Researchers in the United States and other countries already are examining whether the Mediterranean diet can slow the progression of physical disability in MS, and the results they have achieved thus far are encouraging, though not definitive. Given these promising results so far, as well as the need for people with MS to protect their cardiovascular health, this study provides another reason for people with MS to talk with their clinicians about the potential benefits of “going Mediterranean.”

 

Study finds high-dose Vitamin D reduces MS activity after first event

Taking high doses of Vitamin D3 every two weeks reduces multiple sclerosis disease activity in people who have had an initial demyelinating event, according to a team of French investigators.¹⁰

The researchers recruited 314 people ages 18 to 55 years who had experienced a clinically isolated syndrome – such as optic neuritis or some other episode potentially indicating MS – in the past 90 days. All study participants had low serum levels of Vitamin D, which is a risk factor for multiple sclerosis, and magnetic resonance imaging (MRI) findings that met the Swanton criteria for diagnosing MS.

Half of the study participants were assigned to receive 100,000 International units (IU) of oral cholecalciferol, also known as Vitamin D3, every two weeks for 24 months or until they had evidence of disease activity (EDA). The other half received placebo. Assignment to the two groups was made in random fashion, and researchers did not know which people were receiving cholecalciferol and which were taking placebo. EDA was defined as a relapse or the presence of new T2 lesions on MRI performed at three, 12, and 24 months. The study analysis conducted after two years included 303 of the 314 people who initially enrolled.

Over the course of the study, 74.1% of those receiving placebo had evidence of disease activity, as compared to 60.3% of people receiving cholecalciferol. That reduction in risk in the Vitamin D group was statistically significant, and was seen regardless of patient age, gender, and number of lesions on baseline MRI. Further, the median time to EDA was 224 days in the placebo group versus 432 days in the Vitamin D group, with that difference again being statistically significant. The study’s authors reported that the dose of 100,000 IU of cholecalciferol, which is considered a high dose of the vitamin, every two weeks was well tolerated.

Those researchers concluded, “Together with the good safety profile, these data support high dose [Vitamin D] supplementation in early MS.”

Vitamin D supplementation in people who have MS or who are at an elevated risk for developing the disease seems logical. After all, if Vitamin D deficiency increases the chances of developing multiple sclerosis, shouldn’t helping people achieve normal or higher-than-normal levels of the nutrient reduce their risk of MS and improve outcomes in people already diagnosed with the disease?

Unfortunately, that simple, understandable question has yielded a complex, difficult-to-interpret set of answers. The many studies exploring Vitamin D supplementation in MS have yielded an array of findings. Some – like this study – have provided encouraging results. Others have found no or little benefit from the use of Vitamin D. The matter is complicated by the fact that the studies have used different research methods, included different populations, assessed different types and doses of Vitamin D, and have focused on different outcomes.

If you are interested in taking Vitamin D supplements, or are already taking them, it is important to talk with your clinician to determine what the available evidence indicates is the best approach for you and your situation.

Editor’s note: Individuals looking to take Vitamin D supplements as part of their treatment regimen should consult their physician. Continued high-dose Vitamin D supplementation can lead to life-threatening conditions, including kidney failure and heart arrythmias.

 

Updates to the McDonald criteria for MS diagnosis

The tools and techniques available to clinicians for identifying MS have improved dramatically in the 23 years since Professor Ian McDonald and colleagues proposed the diagnostic criteria that bear his name. To make the most of those advances, an international team of experts has proposed comprehensive updates to the criteria.

In one of the most-anticipated sessions at the ECTRIMS meeting, Xavier Montalban, MD, PhD, outlined the revisions recommended by that group, the International Advisory Committee on Clinical Trials in Multiple Sclerosis.¹¹

Dr. Montalban, who practices at Vall d’Hebron University Hospital in Barcelona, Spain and is a leading MS researcher, explained that the updates are intended to speed and simplify the recognition of multiple sclerosis while enhancing diagnostic accuracy.

One of the main recommended changes focuses on the long-standing requirement that evidence of disease be both disseminated in space (DIS), meaning imaging showing MS lesions in various areas of the central nervous system (CNS), and disseminated in time (DIT), meaning apparent demyelinating events occurring on two or more occasions rather than just once. The proposed updates would drop the need to demonstrate DIT.

Other changes include:

• Allowing radiologically isolated syndrome (RIS) – the incidental discovery on magnetic resonance imaging (MRI) of CNS lesions characteristic of MS in people with no MS symptoms – to be diagnosed as MS in specific situations
• Including the optic nerve as one of the CNS areas, or “topographies,” that can be counted toward dissemination in space
• Applying stricter criteria for diagnosing people age 50 years or older who have headache or vascular disorders
• Employing a single, unified framework for diagnosing relapsing-remitting MS and primary-progressive MS, with the latter requiring evidence of clinical progression over at least 12 months
• Assessing levels of kappa free light chains (kFLCs), proteins that can be produced when there is chronic inflammation in the intrathecal space between the spinal cord and its protective membranes, to aid in diagnosis
• Using the myelin oligodendrocyte glycoprotein IgG Antibody (MOG-IgG Ab) blood test to confirm the diagnosis of MS in children and adolescents
• Specifying that the central vein sign and paramagnetic rim lesions – two indicators of MS identified on MRI – are optional tools for aiding in diagnosis in certain circumstances

Dr. Montalban, who chaired the committee proposing these updates, said that next steps are developing a paper outlining the revised criteria and an accompanying diagnostic algorithm, consulting with the wider MS community, and launching a global education campaign.

 

Does steroid treatment for relapses improve the longer-term course of MS?

When clinicians prescribe corticosteroids to people experiencing MS relapses, the goal is to speed recovery from that acute event, not to slow disability worsening over time.

Now, however, a study involving 3,673 people with MS who received steroids to treat a relapse suggests that the medication may have a favorable longer-term impact.¹² Study participants had clinically definite MS and an Expanded Disability Status Scale (EDSS) score of 3 or greater (indicating at least moderate disability in one functional system or mild disability in three or four functional systems). The study’s primary outcomes measure was disability worsening confirmed over 12 months, as measured by change in EDSS score.

The study participants had a total of 5,809 relapses, 4,671 of which were treated with corticosteroids, and 1,138 of which were untreated. Over a median 5.2 years of follow-up, 32.7% of people in the overall study group had confirmed disability worsening. People who had not received a corticosteroid for their relapse were roughly 1.5-times more likely to experience disability worsening than those who had been treated with steroids.

The study’s authors concluded, “Corticosteroid treatment of MS relapses may impact not only recovery speed, but also the severity of residual structural damage.”

 

Better quality of life in MS tied to better quality of sleep

Call it a victory for truth in advertising. A Danish study involving 405 people with MS confirms what all those mattress company spokespeople tell us: a good night’s sleep really does make a huge difference in quality of life.¹³

Study participants were ages 18-to-65 years old and had Expanded Disability Status Scale (EDSS) scores of 7.5 or less, indicating mild to moderate degrees of MS-related impairment. Based on their scores on the Pittsburgh Sleep Quality Index (PSQI) instrument, researchers categorized them as “good sleepers,” “poor sleepers,” and “very poor sleepers.”

The researchers then looked for differences between the three sleep groups in terms of scores on the MS-specific health-related quality of life (HRQoL) instrument and the Functional Assessment of MS (FAMS) questionnaire, both of which are scientifically validated measures.

Not surprisingly, better sleep quality was associated with better health-related quality of life. Similarly, average scores on the FAMS instrument were highest among good sleepers and lowest among very poor sleepers.

While the results may have been predictable, they nonetheless serve a valuable purpose in confirming and underscoring the importance of good sleep for people with multiple sclerosis. Of course, getting a good night’s sleep is easier said than done when dealing with the various symptoms of MS. Hopefully, this study will provide people with MS and their clinicians with reason to revisit problem-solving strategies for the spasticity, urinary urgency/frequency, or other manifestations of MS that prevent people from sleeping soundly.

 

German study examines use of MS medications during pregnancy

Taking disease-modifying therapies (DMTs) during pregnancy did not increase risk for miscarriage, preterm birth, or delivering a child with major birth defects, according to a German study examining 3,722 pregnancies in women with MS.¹⁴

The study reached that welcomed conclusion by comparing the outcomes of 2,885 pregnancies marked by maternal exposure to DMTs with the outcomes of 837 pregnancies without DMT exposure.

However, women with MS were almost twice as likely as women without MS to have a baby who was small for gestational age (SGA). The study found that among all pregnancies in women with MS – including those that were and were not marked by exposure to DMTs – 18.8% of deliveries involved a baby who was SGA, while that rate in the general German population of pregnant women is 10%.

The researchers also looked at how the type of DMT used affected pregnancy outcomes. They found that pregnancies marked by exposure to sphingosine-1-phosphate-receptor-modulators (S1P group) and anti-CD-20-antibodies (CD-20 group) – two classes of higher-efficacy DMTs – were about 1.5-times more likely to result in delivery of a baby who was small for gestational age relative to a pregnancy in which a woman with MS did not take DMTs.

They also reported that use of Tysabri^® (natalizumab) later in pregnancy and exposure to S1P group medications were associated with reduced birth weight. Further, the investigators found that the risk of severe infections during pregnancy was highest among women taking S1P agents and fumarate-class DMTs.

 

Can gait training be a step toward enhancing brain white matter in MS?

We all know that the brain controls movement, but can movement have an impact on brain anatomy in people with MS? A small study from Germany raises that intriguing question.¹⁵

The study involved 31 people with MS who completed four weeks of gait training (physical therapy to improve walking). The study participants had a median age of 44 years and a median Expanded Disability Status Scale (EDSS) score of 2.5, indicating a mild degree of disability. Researchers used magnetic resonance imaging (MRI) to evaluate the participants’ brains at baseline and at the end of the study. The imaging included creation of “fractional anisotropy (FA) maps,” which assess white-matter integrity. White matter is a network of nerve fibers that plays a key role in balance, walking, learning, and problem-solving, among other functions.

After the four-week study period, 11 of the 31 participants had increased the distance they could walk in two minutes by 5% or more from their baseline performance. Researchers termed these people responders. People who did not increase their baseline distance by at least 5% were categorized as non-responders.

The findings from this study were quite interesting. On baseline MRI, there were no noteworthy differences in the FA maps of the people who turned out to be responders and those who were non-responders. However, at the end of the training, the responders showed evidence of enhanced white matter integrity in areas involved in motor function.

It is important to note that this was a small study. Its findings will need to be replicated in a larger trial, and the practical implications of those findings will need to be determined. However, the prospect of people with MS being able to enhance the integrity of brain tissue (along with the functioning of brain tissue) through supervised exercise, remains exciting.

 

Investigational medication frexalimab shows enduring efficacy over 18 months

The investigational disease-modifying therapy (DMT) frexalimab demonstrated a sustained reduction in MS disease activity and a continued favorable safety profile over an 18-month period, researchers reported.¹⁶

Frexalimab is a monoclonal antibody, or a protein that affects immune response. It blocks the CD40/CD40L pathway, which activates immune system T cells and B cells and has been implicated in the development of MS.

In a Phase II trial of the medication, 125 people with relapsing MS were assigned to receive either 1,200 mg of frexalimab administered intravenously (IV) every four weeks, 300 mg of frexalimab administered by subcutaneous (SC) injection every two weeks, or corresponding doses of placebo. At the end of the 12-week trial, the 1,200-mg dose of IV frexalimab decreased new gadolinium-enhancing (Gd+) T1 lesions by 89% compared to placebo.

People completing the trial were invited to enter its open-label extension (OLE). During that period of ongoing monitoring, study participants who had been randomly assigned to placebo in the main study switched over to receive frexalimab. Further, the dose of subcutaneous frexalimab was increased to 1,800 mg every four weeks, providing medication exposure comparable to that of 1,200 mg given intravenously every four weeks.

Researchers reported that the treatment benefit seen in the 12-week study was maintained over 48 weeks in the OLE period.

At the ECTRIMS meeting in September, those researchers provided follow-up data extending out to 18 months for 111 study participants. They reported that the number of Gd+ T1 lesions remained low both in participants who continued frexalimab and in those who had switched from placebo to frexalimab, with the average number of T1 lesions being:

• 0.1 in those who received intravenous (IV) frexalimab from the outset
• 0.4 in those who received subcutaneous (SC) injection frexalimab from the outset
• 0.0 in those who switched from placebo to IV frexalimab at Week 12
• 0.2 in those who switched from placebo to SC frexalimab at Week 12

The researchers added that no new safety signals were seen over 18 months of frexalimab treatment, with the most common reported adverse events being colds/sore throat (experienced by 13% of study participants), COVID-19 (12%), and headache (11%).

 

References

1. Spelman T, Glaser A, Hilert J. Immediate high-efficacy treatment in multiple sclerosis is associated with long-term reduction in progression independent of relapse activity (PIRA) compared to low-moderate efficacy treatment – a Swedish MS Registry study. ECTRIMS 2024. P842/178. Mult Scler J. 2024; 30:(3S):651. 
2. He A, Sebside F, McKay K, et al. Earlier high-efficacy therapy is associated with less work disability in relapsing multiple sclerosis: a nationwide observational cohort study. Abstract P341/1258. ECTRIMS 2024. Mult Scler J. 2024; 30:(3S).
3. Kopp T, Magyari M, Winther Torring C, et al. A Danish observational study on the risk of multiple sclerosis associated with infectious mononucleosis caused by Epstein-Barr virus over 40 years. Abstract P075/572. ECTRIMS 2024. Mult Scler J. 2024;30:(3S):181.
4. Rotstein D, Marrie RA, Tremlett H, et al. Risk and onset of multiple sclerosis after infectious mononucleosis (IM): a population-based study of >650,000 cases of IM. ECTRIMS 2024. P078/385. Mult Scler J. 2024;30:(3S):184.
5. Bridge F, Sanfilippo P, Skibina O, et al. Driving forces: investigating menopause’s influence on MS disability progression. Abstract P091/464. ECTRIMS 2024.
6. Fox RJ, Bar-Or A, Traboulsee A, et al. Efficacy and safety of tolebrutinib versus placebo in non-relapsing secondary progressive multiple sclerosis: results from the Phase 3 HERCULES trial. Abstract O136/4027. ECTRIMS 2024.
7. Sanofi. Tolebrutinib demonstrated a 31% delay in time to onset of confirmed disability progression in non-relapsing secondary progressive multiple sclerosis phase 3 study. Press release. September 24, 2024. Paris, France. Accessible at https://www.sanofi.com/en/media-room/press-releases/2024/2024-09-20-09-30-00-2949552. Accessed November 5, 2024.
8. Oh J, Arnold DL, Cree BAC, et al. Efficacy and safety of tolebrutinib versus teriflunomide in relapsing multiple sclerosis: results from the Phase 3 GEMINI 1 and 2 trials. ECTRIMS 2024. O135/4026. Mult Scler J. 2024;30:(3S):1145.
9. Yu M, Reece J, Coe S, et al. A higher Mediterranean Diet score is prospectively associated with better mental health and quality of life in a national multiple sclerosis cohort. ECTRIMS 2024. P370/524. Mult Scler J. 2024; 30:(3S):390.
10. Thouvenot E, Laplaud D, Lebrun-Frenay, et al. High-dose cholecalciferol reduces multiple sclerosis disease activity after a clinically isolated syndrome: results of a 24-month placebo-controlled randomized trial (D-lay MS). Abstract O065/1291.ECTRIMS 2024.
11. Montalban X. 2024 revisions of the McDonald criteria. ECTRIMS 2024.
12. Roberts J, Sharmin S, Horakova D, et al. Corticosteroid treatment of multiple sclerosis relapses is associated with lower disability worsening over 5 years. ECTRIMS 2024. P333/214. Mult Scler J. 2024;30:(3S):357.
13. Langeskov-Christensen M, Boesen F, Trenel P, et al. Poor sleep has a deleterious impact on health-related quality of life in people with multiple sclerosis – The Danish MS hospitals rehabilitation study. ECTRIMS 2024. P114/1662. Mult Scler J. 2024;30:(3S):210.
14. Bast N, Dost-Kovalsky K, Haben S, et al. Impact of disease-modifying therapies on pregnancy outcomes in multiple sclerosis: a cohort study from the German Multiple Sclerosis and Pregnancy Registry. Abstract O090/320. ECTRIMS 2024.
15. Helmlinger B, Seebacher B, Opriessnig P. Changes in white matter integrity after gait training in people with multiple sclerosis. ECTRIMS 2024. P181/893. Mult Scler J. 2024; 30:(3S):253.
16. Giovannoni G, Granziera C, Mao-Draayer Y, et al. Safety and efficacy of frexalimab in the treatment of relapsing multiple sclerosis: 18-month results from the Phase 2 open-label extension. Abstract O066/242. ECTRIMS 2024.

 

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@mymsaadev.wpengine.com.

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