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‘Effective MS treatments should be available for everyone with MS, wherever they live in the UK’

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A medication for people with relapsing MS has been denied recommendation for NHS use England and Wales, despite it gaining approval from Scottish regulators earlier this year. 

Ozanimod, or Zeposia, is a disease modifying therapy which is taken as a tablet and traps immune T-cells in the body’s lymph nodes.

In a two-year clinical trial, it was shown to reduce relapses in those with active relapsing remitting MS by around 38 per cent, compared to beta interferon, an existing MS treatment.

However, the National Institute for Health and Care Excellence (NICE) has decided not to recommend it for people with relapsing MS on the NHS in England and Wales, confirming its provisional decision from January – despite the fact it was given approval by the Scottish Medicines Consortium (SMC).

Following a final review of evidence, including that from charities, NICE found that ozanimod was not cost effective enough to be recommended for use on the NHS. NICE considered that ozanimod’s effect on disability progression was uncertain.

MS charities have spoken of their disappointment at the decision, particularly given its approval for use in Scotland. 

“It’s disappointing that NICE has made this final decision not to recommend ozanimod as a treatment for relapsing multiple sclerosis in England,” says Fredi Cavander-Attwood, policy manager at the MS Society. 

“Oral treatments, like ozanimod, are limited and not allowing people this option could deny them a convenient way to manage MS symptoms.

“This rejection also highlights the inequities in access to treatments around the UK, as people living with MS in Scotland were granted access to ozanimod in February. 

“Effective MS treatments should be made available for everyone living with MS, regardless of where they live in the UK.”

In March 2020, ozanimod was licensed by the European Medicines Agency (EMA) to treat people with relapsing MS who have active disease.

Scotland is now the only nation in the UK to approve ozanimod, with 15 disease modifying therapies now available on the NHS in the country. The NICE decision applies to England and Wales, with decisions from the body reviewed by the government in Northern Ireland but are generally adopted. 

 

MS

VR ‘could improve traditional rehab for MS patients’

VR may increase the effectiveness of traditional cognitive rehabilitation and exercise training, say scientists

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Virtual reality (VR) technology could strengthen the effects of traditional rehabilitation for people living with multiple sclerosis (MS), new research has found. 

By increasing sensory input and promoting multi-sensory processing, VR may increase the effectiveness of traditional cognitive rehabilitation and exercise training in individuals with MS, according to Kessler Foundation researchers. 

Kessler Foundation scientists are advocates for the incorporation of VR technology in cognitive rehabilitation research in MS. 

They presented a conceptual framework supporting VR as an adjuvant to traditional cognitive rehabilitation and exercise training for MS, theorising that VR could strengthen the effects of traditional rehabilitative therapies by increasing sensory input and promoting multi-sensory integration and processing.

Current pharmacological therapies for MS are not effective for cognitive dysfunction, a common consequence of MS that affects the daily lives of many individuals. 

This lack of efficacy underscores the need to consider other approaches to managing these disabling cognitive deficits.

The inclusion of VR technology in rehabilitation research and care for MS has the potential not only to improve cognition, but to facilitate the transfer of those cognitive gains to improvements in everyday function, according to Dr Brian Sandroff, senior research scientist in the Center for Neuropsychology and Neuroscience Research at Kessler Foundation. 

It also builds on previous Kessler Foundation research which highlighted the positive impact of VR in stroke recovery.

“With VR, we can substantially increase engagement and the volume of sensory input,” he said.

“And by promoting multi-sensory integration and processing, VR can augment the effects of the two most promising non-pharmacological treatments – cognitive rehabilitation and exercise.”

Virtual environments are flexible and varied, enabling investigators to control the range and progression of cognitive challenges, with the potential for greater adaptations and stronger intervention effects. 

VR also allows for the incorporation of cognitive rehabilitation strategies into exercise training sessions, which may support a more direct approach to improving specific cognitive domains through exercise prescriptions.

The application of VR to stroke research has shown more improvement in motor outcomes compared with traditional therapy, as well as greater neural activation in the affected area of the brain, suggesting that greater gains may persist over time.

Dr. Sandroff emphasised the largely conceptual advantages for the use of VR to treat cognitive dysfunction in individuals with MS. 

“More clinical research is needed to explore the efficacy of combining VR with cognitive rehabilitation and/or exercise training, and the impact on everyday functioning on individual with MS,” he said. 

“The conceptual framework we outline includes examples of ways immersive and interactive VR can be incorporated into MS clinical trials that will form the basis for larger randomised clinical trials.” 

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MS

Support for MS symptoms ‘must be offered at diagnosis’

Non-pharmaceutical help from clinicians should not be delayed, new research recommends

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Clinicians should offer non-pharmaceutical help for symptoms like pain, fatigue, depression or anxiety at the time of diagnosis for patients with multiple sclerosis (MS), rather than wait, new research has recommended. 

A new study has shown that clinically-significant levels of pain,  experienced by 50 per cent of patients; fatigue for 60 per cent; depression for 47 per cent; and anxiety for 39 per cent were regularly seen for patients within the first year after diagnosis. 

“The take home was that we found these symptoms, pain, fatigue, depression and anxiety quite prevalent at the point of diagnosis,” said Dr Kevin Alschuler, principal investigator of the UW Medicine study. 

“We want to address this immediately, rather than five or 10 years down the road.”

The findings also indicated that prompt screening was necessary if quality of life was to be maintained and optimised.

Globally, more than 2.3million people have been diagnosed with MS, a disease for which there is no cure and results from the body’s immune system attacking the brain and spinal cord, damaging the myelin which disrupts signals to and from the brain. 

In a further study from UW Medicine, the quality of life for MS patients was explored immediately after, at two months, three months, six months, nine months and then a year after diagnosis. 

The results of the study showed that, on average, quality of life was largely stable throughout the year – a finding that surprised researchers.

“Patients who are newly diagnosed have to deal with the emotional impact of the diagnosis, as well as numerous tests and treatment decision-making,” noted Dr Alschuler, who was lead author on the study.

“Results showed that, on average, if they came in and were doing great at diagnosis, they had a tendency to stay that way throughout the first year.

“If they were struggling, they also tended to stay that way.”

Many times, patients had been dealing with the symptoms years before a formal diagnosis, both noted.

“Through symptom self-management, including cognitive behavioral therapy, we help patients become empowered with coping skills, especially in the areas of fatigue and pain,” said Dr Dawn Ehde, a co-author on the quality of life study.

“We teach them how to use strategies such as relaxation or mindfulness meditation techniques, as well as how to pace themselves to decrease fatigue and better manage stress. 

“Patients who learn these skills often find that not only do their pain and fatigue go down, they are able to do more of what is important to them despite their MS.”

The next step for the team is to explore options for early interventions to help newly diagnosed patients.

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MS

‘Promote aquatic exercise for MS patients’

Barriers to participation must be reduced to ensure the wellbeing of people with Multiple Sclerosis, a report recommends

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Barriers to exercise – and particularly aquatic exercise – for patients living with Multiple Sclerosis (MS) should be reduced, a study concluded. 

Many people with MS report difficulties engaging in traditional land-based physical activity due to heat sensitivity and physical disability, meaning aquatic exercise is often a suitable alternative. 

In new Kessler Foundation research, 100 per cent of people with MS who had tried aquatic exercise said they preferred it to land-based alternatives. 

However, their participation has been impacted by the COVID-19 pandemic. 

The study found that while 56 per cent of people participated in exercise during the restrictions, only seven per cent took part solely in aquatic exercise. 

Although that was the preferred option by individuals with experience with this type of exercise, lack of access to pools and the costs associated with access were significant barriers.

Now, as we move on from the pandemic, the study’s authors have urged barriers to be removed from MS patients’ participation in aquatic exercise. 

“Clinicians should encourage their patients with MS to resume exercising as pandemic restrictions ease,” said Dr Helen Genova. 

“Given the benefits of aquatic exercise for people with MS, and the finding that it was preferred, it is worthwhile to look at reducing barriers to this type of exercise. 

“Encouraging community organisations and health and wellness programs to sponsor affordable aquatic exercise activities for people with MS would lower the barriers for participation, especially for the economically disadvantaged.”

Available treatments for MS have limitations in terms of symptomatic relief of the array of physical and cognitive symptoms experienced by many individuals, which has spurred interest in the role of health-related behaviours in minimising MS-related disability. 

As a health-related behaviour with known benefits on gait, balance, mood, and fatigue, exercise is a key topic in providing some antidote. 

In the study, researchers conducted an online survey of 179 individuals with MS about their exercise activities from October 2020 to April 2021, which established a general decrease in levels of activity, but also highlighted the importance of water-based activity in people’s lives. 

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