Contributions
Abstract: P1261
Type: Poster Sessions
Abstract Category: Therapy - Tools for detecting therapeutic response
Background: Fampridine is an effective treatment for ambulatory dysfunction in patients with multiple sclerosis (MS). The effects on subgroups of patients and upper extremity function (UEF) are less clear.
Objective: To analyse effects on ambulation and UEF on subgroups of patients from a real-world evidence cohort.
Methods: Patients diagnosed with multiple sclerosis (MS) with all clinical phenotypes with ambulatory dysfunction and an estimated Expanded Disability Status Scale (EDSS) score between 4.0 and 7.0 were included. Ambulatory function was assessed with the Timed 25-Foot-Walk (T25FW) and the MS Walking Scale (MSWS). Measures for UEF were the 9-Hole Peg Test (9HPT) and the Arm function in MS Questionnaire (AMSQ). Assessments were performed before starting fampridine and after at least two weeks of treatment. Patients were stratified according to disease duration (0 - 9, 10 - 25 and >25 years), EDSS (4.0 - 5.5 and 6.0 - 7.0), T25FW (< 6, 6 - 7.99 and >8 seconds) and various responder subgroups (for T25FW defined as 20% improvement). Paired t-tests and the Wilcoxon test were used to compare groups.
Results: A total of 276 patients were included. The total cohort showed significant improvement of T25FW, MSWS and AMSQ at follow up. Improvement of T25FW and AMSQ was more pronounced in the higher EDSS subgroup (resp. 15.6 vs 10.7% and 17.9 vs 6.7%). Stratification by disease duration showed decremental improvement of T25FW (0 - 9 years: 24.5%; 10 - 25 years: 17.5%; >25 years: 10.5%) and incremental improvement of AMSQ (0 - 9 years: 10.4%; 10 - 25 years: 24.8%; >25 years: 36.0%). Furthermore, AMSQ improvement was more pronounced in the worse T25FW subgroups (< 6 sec, 10.6%; 6 - 7.99 sec: 17.3%; >8 sec: 20%). More T25FW responders were found in the higher than in the lower EDSS subgroup (43.9 vs 24.8%).
Conclusion: Patients with higher EDSS scores showed greater improvement of T25FW than lower EDSS scores, although this effect decreased with a longer disease duration. In contrast, subjective UEF (measured with AMSQ) showed a more pronounced improvement in patients with longer disease duration and worse ambulatory dysfunction. These preliminary findings may indicate an additional treatment window for a subgroup of MS patients with impaired UEF, independent of ambulatory function. Since these data were derived from patients collected with ambulatory dysfunction, our findings might even be more pronounced in a cohort selected on impaired UEF.
Disclosure: L. Kaya has no conflicts of interest.
C.E.P. van Munster has received travel support from Novartis Pharma AG, Sanofi Genzyme and Teva Pharmaceuticals, and honoraria for lecturing and consulting from Biogen-Idec and Merck Serono.
K.H. Lam has no conflicts of interest.
N.F. Kalkers has received speaker and consultancy fees from Biogen, Teva, Genzyme, Roche and Novartis.
J. Killestein has accepted speaker and consultancy fees from Merck, Biogen, Teva, Genzyme, Roche and Novartis.
B.M.J. Uitdehaag has received consultancy fees from Biogen Idec, Genzyme, Merck Serono, Novartis, Roche and Teva.
Abstract: P1261
Type: Poster Sessions
Abstract Category: Therapy - Tools for detecting therapeutic response
Background: Fampridine is an effective treatment for ambulatory dysfunction in patients with multiple sclerosis (MS). The effects on subgroups of patients and upper extremity function (UEF) are less clear.
Objective: To analyse effects on ambulation and UEF on subgroups of patients from a real-world evidence cohort.
Methods: Patients diagnosed with multiple sclerosis (MS) with all clinical phenotypes with ambulatory dysfunction and an estimated Expanded Disability Status Scale (EDSS) score between 4.0 and 7.0 were included. Ambulatory function was assessed with the Timed 25-Foot-Walk (T25FW) and the MS Walking Scale (MSWS). Measures for UEF were the 9-Hole Peg Test (9HPT) and the Arm function in MS Questionnaire (AMSQ). Assessments were performed before starting fampridine and after at least two weeks of treatment. Patients were stratified according to disease duration (0 - 9, 10 - 25 and >25 years), EDSS (4.0 - 5.5 and 6.0 - 7.0), T25FW (< 6, 6 - 7.99 and >8 seconds) and various responder subgroups (for T25FW defined as 20% improvement). Paired t-tests and the Wilcoxon test were used to compare groups.
Results: A total of 276 patients were included. The total cohort showed significant improvement of T25FW, MSWS and AMSQ at follow up. Improvement of T25FW and AMSQ was more pronounced in the higher EDSS subgroup (resp. 15.6 vs 10.7% and 17.9 vs 6.7%). Stratification by disease duration showed decremental improvement of T25FW (0 - 9 years: 24.5%; 10 - 25 years: 17.5%; >25 years: 10.5%) and incremental improvement of AMSQ (0 - 9 years: 10.4%; 10 - 25 years: 24.8%; >25 years: 36.0%). Furthermore, AMSQ improvement was more pronounced in the worse T25FW subgroups (< 6 sec, 10.6%; 6 - 7.99 sec: 17.3%; >8 sec: 20%). More T25FW responders were found in the higher than in the lower EDSS subgroup (43.9 vs 24.8%).
Conclusion: Patients with higher EDSS scores showed greater improvement of T25FW than lower EDSS scores, although this effect decreased with a longer disease duration. In contrast, subjective UEF (measured with AMSQ) showed a more pronounced improvement in patients with longer disease duration and worse ambulatory dysfunction. These preliminary findings may indicate an additional treatment window for a subgroup of MS patients with impaired UEF, independent of ambulatory function. Since these data were derived from patients collected with ambulatory dysfunction, our findings might even be more pronounced in a cohort selected on impaired UEF.
Disclosure: L. Kaya has no conflicts of interest.
C.E.P. van Munster has received travel support from Novartis Pharma AG, Sanofi Genzyme and Teva Pharmaceuticals, and honoraria for lecturing and consulting from Biogen-Idec and Merck Serono.
K.H. Lam has no conflicts of interest.
N.F. Kalkers has received speaker and consultancy fees from Biogen, Teva, Genzyme, Roche and Novartis.
J. Killestein has accepted speaker and consultancy fees from Merck, Biogen, Teva, Genzyme, Roche and Novartis.
B.M.J. Uitdehaag has received consultancy fees from Biogen Idec, Genzyme, Merck Serono, Novartis, Roche and Teva.