Laura Joszt

home

authors

laura-joszt

Early treatment of multiple sclerosis (MS) is associated with better physical outcomes. Now a Swedish study shows that early treatment may also be associated with better financial ones.

 of the Karolinska Institute and his colleagues divided 3,610 people with multiple sclerosis into two groups, those who started disease-modifying therapy (DMT) within two years of the onset of their disease (early treatment) and those who started DMT two years afterward (delayed treatment). They designed the study so a 95% decrease in annual earning was the main measure of financial outcome.

Multiple Sclerosis Journal — Experimental, Translational and Clinical

showed that patients in the delayed treatment group were more likely to reach that unfavorable financial threshold than the patients in the early treatment group.

Their findings were similar when they looked at slightly smaller group of people with MS and when they were likely to receive “social benefits,” such as a disability pension. Those in the delayed treatment group were more likely to receive social benefits than those in the early treatment group. More specifically, delayed treatment increased the “risk” of receiving benefits by 42%.

Kavaliunas and his colleagues said that this study was to their knowledge the first to examine the association between early and late treatment and the income of MS patients, although they have previously reported findings on early treatment and disability pensions, so the territory is not entirely uncharted. There is also a body of research that has shown an association between MS and lower income and early retirement.

In this study, the drugs that counted as disease-modifying therapy were interferon beta, glatiramer acetate, Tysabri (natalizumab), Gilenya (fingolimod), Rituxan (rituximab), Aubagio (teriflunomide), Lemtrada (alemtuzumab), mitoxantrone, and (Tecfidera) dimethyl fumarate.

“In conclusion, we confirm the benefits of early treatment initiation in the socioeconomic context using the novel and unbiased outcome, also support the idea that it can serve as a precise outcome measure and can be used as a proxy parameter of disability,” Kavaliunas and his co-authors concluded.

Articles

Earlier treatment of multiple sclerosis with disease-modifying therapy reduced the chances of a sharp decrease in income, according to Swedish researchers.

Study Shows Early DMT for Multiple Sclerosis Associated With Income Benefit 

Multiple sclerosis (MS) typically affects people in their prime working years, most often striking between the ages of 20 and 50. Rates of unemployment are high. As many as four out of every five people with the neurological condition that affects movement, gait and vision may be unemployed. 

 compares two groups of patients with MS to identify the factors that may influence their likelihood of holding a job.

“While much is known about the demographic and disease variables associated with 

unemployment in MS, less is known about the role of person-specific factors and one's engagement in health-related behaviors,” wrote author 

, Ph.D., senior research scientist at the Center for Neuropsychology and Neuroscience Research of the Kessler Foundation in East Hanover, New Jersey. The 

 funds research into people with disabilities and the employment issues they face.

Previous studies have examined MS and employment but were retrospective. The press release accompanying the publication of Strober’s findings says hers is the first to study the issue prospectively.

Strober’s study included 252 people with MS and divided them into two groups: “at risk” for leaving the workforce (n = 67) and “not at risk” (n = 185). The participants in the “at risk” group reported that they were considering reducing their hours or leaving the workforce altogether because of difficulties related to their MS.

Participants in the study were between the ages of 20 and 64 and were currently employed. They completed an online survey about a number of topics, including work status and history, disease symptoms, personality, coping, self-efficacy and disease management. Participants also completed the Symbol Digit Modalities Test (SDMT), which measures processing speed.

The “at risk” and “not at risk” groups were similar as far as age, gender, education, and disease duration were concerned. There was, though, a difference in disease course: A greater proportion of patients in the “at risk” group had a progressive course (13% vs 3%).

The “at risk” group also reported greater levels of fatigue, sleep disturbance, pain, depression and anxiety. Based on their survey responses, they also had greater levels of neuroticism; lower levels of extraversion, conscientiousness and agreeableness; lower MS self-efficacy; and a greater use of maladaptive coping.

In addition, they reported lower “locus of control” — how strongly people believe that they have power over situations and experiences that affect their lives. The “at risk” group was also less likely to engage in positive health-related behaviors, such as healthy eating, exercise and social/intellectual activities.

“What is perhaps is more novel and exciting about the present findings is the fact that engagement in health-related behaviors, specifically diet and exercise proved to be a significant predictor even when disease and person-specific factors were taken into account,” Strober wrote.

Among the limitations that she noted was almost all (94%) of the patients in the study had a relapsing-remitting course, which was likely because the individuals recruited were still working and at the early stage of being considered “at risk” for unemployment. The study also did not include a measure of disease severity, because it relied on medical information from the patients’ neurologists, many of which did not report something like the Expanded Disability Status Scale.

"Risk of unemployment is highest during the first three to five years after diagnosis, so we need to be able to intervene early to prevent job losses, and their subsequent impact on physical and mental health, as well as on personal and family finances. This study points to factors related to risk of unemployment that may be amenable to early intervention," Strober said in the 

. "While further research is needed, professionals who provide MS care should be aware of the potential impact of this diagnosis on future employment and be prepared to intervene before individuals leave the workforce."

People with MS who are at risk for joblessness have poorer health-related habits and lower “locus of control” scores, according to findings by Kessler Foundation researcher Lauren Strober.

Prospective Study Identifies Factors Associated With Unemployment Among People With MS

While the frequency of cancer diagnoses has increased among patients with multiple sclerosis over the past 30 years, the overall cancer risk among patients with MS and matched controls is similar, according to a study 

Researchers used the United Kingdom’s Clinical Practice Research Datalink, which has been collecting primary care data since 1987, to conduct a population-based nested case control study. They used the data to compare the occurrence of cancer between people with MS or clinically isolated syndrome (CIS), a single inflammatory demyelinating event that can turn into multiple sclerosis, and controls who do not have MS or CIS.

“It has been suggested that the abnormal immune response seen in MS could improve 

surveillance against malignancy,” wrote the authors, led by Chiara Zecca of the Neurocenter of Southern Switzerland in Lugano, Switzerland. “However, chronic inflammation also represents a recognized risk factors for cancer development.”

The study included 10,204 patients with MS who were matched with 39,448 controls. Some of those patients were excluded from the study for various reasons, so the researchers ended up analyzing data for 9,816 patients with MS and 37,901 controls. Almost three-quarter (71.6%) of the people in both groups were women; their  median age was 47. People with MS were followed up for 5.6 years after index date and the controls were followed up for 6.2 years.

Cancer was reported in 433 (4.41%) patients with MS and 2014 (5.31%) controls. Female gender was negatively associated with the risk of cancer, while age at index date and calendar year at index date were both positively associated with cancer risk. Zecca and her colleagues noted that disease status (MS vs control) was not at all associated with the risk of cancer.

The authors pointed out that a previous study in Norway had found patients with MS had an increased risk of cancer, particularly with involvement of the respiratory, urinary and central nervous system, but the MS cohort in this study did not show risk for any specific type of cancer. The findings are consistent with others from Northern Europe and Iran that found no differences in cancer risk between patients with MS and the general population. Research conducted in the United States, Canada, and Europe have found that people with MS have a lower risk of developing cancer.

The research team pointed out that while cancer risk was stable for the control group over time, the risk increased among MS patients by approximately 2% per calendar year. They hypothesized that the introduction of new therapeutic agents, changes in clinical care, standardized and regular cancer screening programs, and changes in lifestyle behaviors may explain the increase over time among patients with MS. However, they noted that this finding requires further investigation.

“While several explanations appear to be possible, including increasing surveillance and more careful cancer screening programs in MS patients, we believe the rapid and continuous evolution of MS care, treatments and related potential secondary effects, require maximal attention in routine neurological care,” Zecca and her colleagues concluded.

Study found that while  frequency of cancer among people with multiple sclerosis (MS) increased over time, the overall cancer risk is similar between patients with MS and the general population.

Similar Cancer Risk Between Patients With MS, General Population in the UK, Study Finds

As SARS-CoV-2 virus that causes COVID-19 spread around the world, misinformation about the RNA virus and the disease it causes were fellow travelers. 

Every public health crisis spawns some falsehoods and unsubstantiated beliefs, but the COVID-19 pandemic has engendered more than its fair share, partly because of the dynamics of social media and partly because it is a new disease. Research published in the 

American Journal of Tropical Medicine and Hygiene

 this summer identified 2,311 reports of rumors, stigma, and conspiracy languages in 87 countries.

MJH Life Sciences™’s, the parent company of 

®, recently hosted a one-hour free webinar about COVID-19 myths as part of its COVID-19 Coalition.

, Ph.D., M.P.H., M.A., CIC, term assistant professor, George Mason University, and adjunct professor, University of Arizona College of Public Health, moderated the discussion that included 

, Ph.D., associate research scientist, Columbia University Mailman School of Public Health, and 

, Ph.D., M.S., research fellow, Epidemiology Unit, Division of Intramural Research, of the National Institute of Allergy and Infectious Diseases.

The “airborneness” of SARS-CoV-2 and its transmission continues to be a source of confusion. Just yesterday, CDC issued a revised guidance that says SARS-CoV-2 can linger in the air in smaller particles and spread among people who are more than six feet apart while also stating that the virus is most frequently spread through relatively large respiratory droplets among people in close contact with one another.

During the webinar, which was held before CDC issued its guidance, Rasmussen noted that there is a limit to just how “airborne” SARS-CoV-2 is. For instance, the virus is not moving through the air ducts of a building and travelling long distances to infect people in other rooms or on other floors. “This virus does not appear to be particularly transmissible in that way,” Rasmussen said.

“It's not like measles — it's not like you're gonna walk inside and automatically get COVID,” said 

But the word “airborne” could mean different things to different people, and it may not be clearly understood, noted Ricotta “We, as scientists, need to be maybe a little clearer in the way that we're communicating this to everybody,” she said. “And I think that's where some of the confusion has come in.”

Herd immunity is achievable through natural infection — and right around the corner.

Without a vaccine, natural infection is the only way to achieve herd immunity. But achieving herd immunity through transmission and natural infection would put a lot of people at risk, noted Ricotta. Currently, roughly a quarter of the population has been infected, but the threshold for achieving herd immunity is between 40% and 70%.

“Globally, we've never managed to achieve herd immunity through natural infection for any pathogen,” Rasmussen noted. Some local populations have gained herd immunity; for instance, it is believed that herd immunity in the Americas has kept the Zika virus from circulating. “However, that doesn't provide long-lasting immunity that will keep it out of the global population indefinitely.”

The panelists said that data, especially data on a new pathogen, are tricky and tell a story that requires interpretation. In order to see the full story, people can’t look at just one data point, Ricotta explained. Data may show that 3,000 people were hospitalized, but it doesn’t put it in to the context of whether those 3,000 people were in a town of 5,000 or a city of a few million. Data quality is affected by a number of factors, such as the source and the consistency of data reporting.

The panelists also discussed models that were in the news this spring and how they might have contributed to some of confusion about the reliability of data.

Also I think the whole model thing has fallen by the wayside now that the country has experienced the pandemic for the better part of a year. Brix was big on models and she has also fallen out of the news

Models aren’t crystal balls that predict the future, Rasmussen said. They change and update as new data becomes available.

“So, people just need to understand models in the context of what they are,” she said. “They're not a roadmap to a certain future. They're an indication of what might happen if certain conditions are met.”

Are individuals truly asymptomatic or are they actually presymptomatic? It can be difficult to distinguish, explained Rasmussen. People who test positive without having any symptoms might be considered asymptomatic, but they could develop symptoms later. What’s more, asymptomatic cases are often based on self-reported data, but COVID-19 produces a wide, varied range of symptoms. Some people might not recognize their diarrhea might be a symptom of COVID-19, even though they didn’t have the telltale cough.

We do know that there is “a substantial amount of transmission from presymptomatic people,” Rasmussen said, and controlling the spread of COVID-19 remains difficult because people are infectious before they develop symptoms.

“So while asymptomatic transmission or asymptomatic cases and transmission probably exists, we don't really know the number for that,” she said. “But we definitely know that presymptomatic transmission exists, and it's a major driver of this pandemic.”

With more than 160 candidates in the pipeline, at least one of them will likely have an acceptable safety profile, but it isn’t possible to know what the safety of any of these vaccines will be without the results of the ongoing clinical trials, Rasmussen said.

The clinical trials of the vaccines are designed to provide data on their safety, but Ricotta also mentioned postmarket evaluations once the vaccine is approved to determine long-term safety and efficacy.

Every vaccine confers a little bit of risk, she pointed out. The flu vaccine may hurt your arm, make you tired, or even give you a little fever, and all these side effects are considered “acceptable risks” compared with getting the actual disease. So far, it seems vaccines for COVID-19 are relatively safe, and it will make sense to get the vaccine “because we know that COVID itself is very, very bad,” Ricotta said.

Young people can’t get sick from SARS-CoV-2 infection.

The myth of youthful immunity to SARS-CoV-2 is one that can be decisively debunked: “Young adults and children can absolutely get sick from COVID,” said Ricotta. She noted that the CDC reported that the number of cases in people under the age of 20 doubled from March to August. The data show a clear shift in the pandemic in the U.S. from older individuals to younger ones.

However, it is true that young people, as a group, tend to have milder symptoms, a pattern that may explain the confusion about whether young people are immune from infection. Importantly, Ricotta, added, not only can younger people get sick from COVID-19, but they are but younger people can definitely still transmit COVID-19. 

The evidence does not currently show that hydroxychloroquine, either by itself or in combination with another treatment, has any measurable clinical benefit in COVID-19, Rasmussen said. In June, the FDA revoked its emergency use authorization for hydroxychloroquine and chloroquine.

The only people who might view hydroxychloroquine as a miracle drug as those who take it for lupus, rheumatoid arthritis, or malaria, she noted.

President Trump posted remarks today that made comparisons between COVID-19 and the flu. In a Tweet that Twitter has flagged as spreading misleading information, the president wrote, “Flu season is coming up! Many people every year, sometimes over 100,000, and despite the Vaccine, die from the Flu. Are we going to close down our Country? No, we have learned to live with it, just like we are learning to live with Covid, in most populations far less lethal!!”

During the webinar, Ricotta said that as COVID-19 first began to spread in China, the Northern Hemisphere was still in flu season and there were concerns that people were not getting their flu vaccine. This timing might explain why the narrative began to emerge that COVID-19 was no worse than the flu, she said.

However, as the understanding of SARS-CoV-2 improved and the pandemic spread to North America, the difference became more apparent. Flu and COVID-19 have different, if overlapping symptoms, and the mortality rate is higher for COVID-19, Ricotta noted. “Comparing the flu to COVID is sort of an unfair comparison.”

Differentiating COVID-19 from the flu is important as the U.S. and the rest of North America enters another flu season. They might both be respiratory viruses, but they are “fundamentally different viruses…from a virology perspective,” Rasmussen said.

“It is important to know that if you get COVID, you won't be immune to flu; if you get a flu shot, you won't be protected against COVID,” she said. “But you should still get your flu shot. And you should still take the same precautions to avoid getting infected with either because both of them can be severe public health problems.”

Experts discuss the falsehoods and half-baked ideas that are in circulation about COVID-19 transmission, treatment and equivalence to the flu.

Laura Joszt

Articles

Study Shows Early DMT for Multiple Sclerosis Associated With Income Benefit

Prospective Study Identifies Factors Associated With Unemployment Among People With MS

Similar Cancer Risk Between Patients With MS, General Population in the UK, Study Finds

Debunking Myths and Misconceptions About COVID-19