Impact of mass vaccination on SARS-CoV-2 infections among the total multiple sclerosis population receiving immunomodulatory disease-modifying therapies in England

This study aimed to understand changes in the risk of SARS-CoV-2 infection among all people with multiple sclerosis (MS) receiving immunomodulatory disease-modifying therapies (DMTs) in England, compared to the general population, following mass vaccination. Longitudinal data collected by the National Health Service (NHS) England on all MS DMT prescriptions and the UK Health Security Agency on all registered SARS-CoV-2 test results were analysed. The incidence rate ratio of SARS-CoV-2 infection among people with MS taking DMTs compared to the general population was calculated before (November 2020-January 2021) and after (July-August 2021) mass vaccination. Risk of SARS-CoV-2 infection among people on ocrelizumab or fingolimod compared to the general population increased following liberalisation of COVID-19 restrictions (during March-July 2021) despite mass vaccination. No changes were found with other DMTs. These findings converge with the impaired immune response to vaccines observed with ocrelizumab and fingolimod.

Evaluation of the Unidimensional Fatigue Impact Scale (U-FIS) in Crohn's Disease: The Importance of Local Item Dependency

Background and PurposeThe Unidimensional Fatigue Impact Scale (U-FIS) was developed for use in a multiple sclerosis population. The aim was to determine whether the U-FIS is a valid tool for measuring the impact of fatigue in Crohn's disease (CD).MethodCD patients completed the U-FIS as part of a validation study of the Crohn's Life Impact Questionnaire (CLIQ). Data were analyzed according to Rasch measurement theory (RMT).ResultsTwo hundred sixty-one completed U-FIS questionnaires were available for analysis. After rescoring the items to resolve disordered thresholds, all 22 items showed acceptable RMT fit. However, there was considerable local item dependency (LID).ConclusionThe U-FIS did not provide unidimensional measurement in a sample of CD patients due to high levels of LID. Combining the three FIS outcomes into a single measure was not justified.

Teriflunomide Safety and Efficacy in Advanced Progressive Multiple Sclerosis

Objectives. To explore the safety and efficacy profile of teriflunomide in progressive multiple sclerosis. Methods. We conducted a single-center retrospective observational analysis of a progressive multiple sclerosis population, assessing safety and efficacy in patients treated at least one year with teriflunomide or glatiramer acetate. Sustained progression of expanded disability status scale and sustained worsening of timed 25-foot walk were compared using a Cox proportional hazards model. Results. Teriflunomide group ( n = 29 ) mean characteristics: age = 58 years ( SD ± 7.6 ), disease duration = 16.7 years ( SD ± 9.5 ), expanded disability status score = 5.9 ( SD ± 1.3 ), and follow − up = 32.4 months ( SD ± 13.6 ). Glatiramer acetate group ( n = 30 ) mean characteristics: age = 52.4 years ( SD ± 11.3 ), disease duration = 15.1 years ( SD ± 10.4 ), expanded disability status score = 5.7 ( SD ± 1.6 ), and follow − up = 46.9 months ( SD ± 43.9 ). Both treatments were well tolerated without serious side effects. After adjustment for age, sex, and baseline expanded disability status score, sustained expanded disability status score progression did not differ between groups ( hazard ratio = 1.17 ; 95% confidence interval: 0.45, 3.08; p = 0.75 ). Sustained timed 25-foot walk worsening after adjustment also did not differ ( hazard ratio = 0.56 ; 95% confidence interval: 0.2, 1.53; p = 0.26 ). Conclusion. In an advanced progressive multiple sclerosis population, no substantial differences in tolerability, safety, sustained EDSS progression, or sustained T25FW worsening over time were observed between glatiramer acetate and teriflunomide-treated groups. The small sample precluded definitive determination.