No abstract

BackgroundPeople with multiple sclerosis (MS) often report poor sleep, fatigue, sleepiness, depression and cognitive dysfunction. Interrelationships between symptoms and sleep are poorly understood.ObjectivesTo document objective parameters of sleep measured by polysomnography (PSG) and multi-sleep latency tests (MSLTs) in patients experiencing fatigue or sleepiness and to determine whether they correlate with symptoms.MethodsThirty-two MS patients, not on therapy, with fatigue or sleepiness completed the Modified Fatigue Impact Scale, Fatigue Severity Scale, Epworth Sleepiness Scale, Beck Depression Index and NeuroTrax cognitive tests and underwent PSG and MSLTs.ResultsSleep efficiency (SE) averaged 75.1%. wake after sleep onset (WASO), sleep onset latency and multi-sleep latency were 66.2, 43.4 and 10.43 min, respectively. Stage N3 and rapid eye movement sleep were absent in 10 and four patients, respectively. Increased limb movements were observed in eight patients. Obstructive sleep apnea was observed in 12 patients. Neither SE nor WASO correlated with fatigue or sleepiness. SE correlated with the global cognitive score and with executive function and information processing subscales.ConclusionsOverall, 30/32 MS patients reporting fatigue or sleepiness had evidence of one or more sleep disturbances. PSG should be considered in MS patients reporting fatigue or sleepiness in order to rule out treatable disturbances.

Head-to-head clinical trials of teriflunomide (TFM) versus dimethyl fumarate (DMF) have not been conducted. Objectives: To compare the real-world effectiveness of TFM versus DMF. Methods: Anonymized data were collected from patients with relapsing multiple sclerosis (MS) initiating treatment with teriflunomide (N = 50) or DMF (N = 50). Results: On follow-up magnetic resonance imaging (MRI) compared with baseline, with TFM versus DMF treatment, the proportion of patients with new/enlarging T2 or gadolinium-enhancing lesions was 30.0 versus 40.0% (p = 0.2752). However, median annualized percent whole brain volume change was -0.1 versus -0.5 (p = 0.0212). There were no significant treatment differences on additional MRI and clinical end points and no unexpected safety signals. Conclusion: The effectiveness of teriflunomide was superior to DMF on whole brain atrophy and similar to DMF on other MRI/clinical end points.

Disease-modifying drugs (DMDs) have transformed the treatment of relapsing-remitting multiple sclerosis (RRMS). Several studies have shown the benefits of long-term treatment in RRMS; however, all multiple sclerosis (MS) therapies are associated with treatment-related tolerability and safety issues that may challenge patient compliance with therapy. Tolerability issues include flulike symptoms and injection-site reactions for interferon β(IFNβ) and lipoatrophy and systemic postinjection reactions for glatiramer acetate (GA). Altered blood cell counts, depression, and elevated liver enzymes, including rare cases of acute liver injury, are safety issues that have been associated with IFNβand, rarely, systemic anaphylactoid reactions with glatiramer acetate. Common tolerability issues associated with natalizumab are hypersensitivity and postinfusion reactions, and mitoxantrone may cause amenorrhea, nausea, and alopecia. Serious safety issues that have limited the use of natalizumab and mitoxantrone as first-line treatments are progressive multifocal leukoencephalopathy for natalizumab and cardiotoxicity and leukemia for mitoxantrone. Although both tolerability and safety issues can affect patient adherence to therapy, numerous strategies are available to manage tolerability and monitor safety issues. Through careful monitoring of treatment-related safety issues, patient education, and tolerability management strategies, treatment nonadherence can be minimized, thereby maximizing the treatment benefits of DMDs.