scholarly journals Telemedicine during the Coronavirus Disease (COVID-19) Pandemic: A Multiple Sclerosis (MS) Outpatients Service Perspective

2021 ◽  
Vol 13 (1) ◽  
pp. 25-31
Author(s):  
Francesco Corea ◽  
Silvia Ciotti ◽  
Antonella Cometa ◽  
Claudia De Carlo ◽  
Giancarlo Martini ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Care Delivery ◽  
Oral Treatment ◽  
Case Series ◽  
Patient Characteristics ◽  
Stroke Care ◽  
Retrospective Case ◽  
Short Disease Duration ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis

Background: During the COVID-19 pandemic, the need for a broader implementation of telemedicine for many diseases has become apparent. Televisits are one type of telemedicine in which clinical visits are conducted remotely using an audio-visual connection with the patient at home. The use of televisits is more established in Stroke care but was also recently formally evaluated for Multiple Sclerosis (MS). This retrospective case series describes patient characteristics and reasons for televisits in persons with MS during the COVID-19 pandemic outbreak in Italy, which was declared in February 2020. Methods: Recruitment occurred in a general hospital based MS clinic during Italy’s lockdown months period (9 March–18 May). Each subject completed at least one televisit. The baseline data included were demographics and MS history; reasons for the remote house calls were analyzed focusing on COVID-19 related needs. Results: Forty-six participants completed at least one study visit. The patients enrolled were more often females suffering from Relapsing Remitting Multiple Sclerosis (RRMS). Half of the patients had an intermediate level of education and lived within a 60 min drive from the clinic. These patients predominately had a short disease duration and were mostly involved in oral treatment. The main reasons for the call were drug use and counseling on social distancing. In 5 cases, COVID-19 infection was reported. Conclusions: Televisits during the COVID-19 outbreak demonstrated their utility as a care delivery method for MS. Hence, it is vital to facilitate the implementation of this technology in common practice to both face infectious threats and increase accessibility of the health care system.

scholarly journals Severe rebound after cessation of fingolimod treated with ocrelizumab with coincidental transient aggravation: report of two cases

2019 ◽  
Vol 12 ◽  
pp. 175628641984681 ◽  
Author(s):  
Stephan Schmidt ◽  
Thomas Schulten
Keyword(s):  
Multiple Sclerosis ◽  
Monoclonal Antibody ◽  
Immune Reconstitution ◽  
Oral Treatment ◽  
Expanded Disability Status Scale ◽  
Radiological Findings ◽  
Highly Active ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis

Background: Fingolimod (FTY), an oral treatment for patients with relapsing-remitting multiple sclerosis (RRMS), has been associated with a significant rebound of disease activity after cessation of therapy. Methods: We present the clinical and radiological findings of two patients with severe rebound after FTY withdrawal, which was further aggravated by the initiation of treatment with the B cell-depleting monoclonal antibody, ocrelizumab. Results: Both patients exhibited significant Expanded Disability Status Scale progression after administration of ocrelizumab despite immune reconstitution more than 3 months after FTY withdrawal. Conclusions: Although the observed effect may be coincidental, ocrelizumab may complicate recovery of rebound after cessation of FTY. Further studies are warranted to better understand and predict the clinical and immunological consequences of sequential immunosuppressive and immunomodulatory treatments in patients with highly active RRMS.

Characteristics influencing therapy switch behavior after suboptimal response to first-line treatment in patients with multiple sclerosis

2013 ◽  
Vol 20 (7) ◽  
pp. 830-836 ◽  
Author(s):  
Barbara Teter ◽  
Neetu Agashivala ◽  
Katelyn Kavak ◽  
Lynn Chouhfeh ◽  
Ron Hashmonay ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Patient Characteristics ◽  
Initial Therapy ◽  
Clinical Relapse ◽  
Clinical Events ◽  
Disease Modifying Therapy ◽  
Relapsing Remitting ◽  
Mri Changes ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Therapy Switch

Background: Factors driving disease-modifying therapy (DMT) switch behavior are not well understood. Objective: The objective of this paper is to identify patient characteristics and clinical events predictive of therapy switching in patients with suboptimal response to DMT. Methods: This retrospective study analyzed patients with relapsing–remitting multiple sclerosis (MS) and a suboptimal response to initial therapy with either interferon β or glatiramer acetate. Suboptimal responders were defined as patients with ≥1 MS event (clinical relapse, worsening disability, or MRI worsening) while on DMT. Switchers were defined as those who changed DMT within six to 12 months after the MS event. Results: Of 606 suboptimal responders, 214 (35.3%) switched therapy. Switchers were younger at symptom onset ( p = 0.012), MS diagnosis ( p = 0.004), DMT initiation ( p < 0.001), and first MS event ( p = 0.011) compared with nonswitchers. Compared with one relapse alone, MRI worsening alone most strongly predicted switch behavior (odds ratio 6.3; 95% CI, 3.1–12.9; p < 0.001), followed by ≥2 relapses (2.8; 95% CI, 1.1–7.3; p = 0.040), EDSS plus MRI worsening (2.5; 95% CI, 1.1–5.9; p = 0.031) and EDSS worsening alone (2.2; 95% CI, 1.2–4.1; p = 0.009). Conclusions: Younger patients with disease activity, especially MRI changes, are more likely to have their therapy switched sooner than patients who are older at the time of MS diagnosis and DMT initiation.

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