Multiple sclerosis (MS) has a major impact on the physical, psychological and social life of patients and their families. The aim of this study was to evaluate the different perceptions of patients and caregivers about management of MS, particularly about the same items, to gather information to ameliorate the care of patients.

The principal biomarker of neurodegeneration in multiple sclerosis (MS) is believed to be brain volume, which is associated with cognitive functions and retinal nerve fibre layer (RNFL). A cross-sectional and longitudinal assessment of the relationship between RNFL, cognitive functions and brain volume. At baseline, relapsing patients and healthy controls underwent 1.5 T MRI to estimate the normalized volume of brain (NBV), grey (NGV), white (NWV) and peripheral grey (pNGV) matter. Cognitive functions were evaluated by BICAMS, RNFL by Spectral-Domain OCT. Patients were re-evaluated after 12 months. Cognitive functions, brain volume, and RNFL differed between the group of 66 patients and that of 16 healthy controls. In the MS group, at baseline, an association was found between: p-NGV and symbol-digit (SDMT) (p = 0.022); temporal-RNFL and NBV (p = 0.007), NWV (p = 0.012), NGV (p = 0.048), and p-NGV (p = 0.021); papillo-macular bundle-RNFL and NBV (p = 0.013), NWV (p = 0.02), NGV (p = 0.049), and p-NGV (p = 0.032). Over the observational period, we found a reduction of brain volume (p < 0.001), average-RNFL (p = 0.001), temporal-RNFL (p = 0.006), and papillo-macular bundle-RNFL (p = 0.009). No association was found between OCT, MRI, and cognitive changes. Brain volume, cognitive functions, and RNFL are continuous measures of different neurodegenerative aspects. BICAMS and OCT have low costs and can be easily used in clinical practice to monitor neurodegeneration.

Background Real-world data on Alemtuzumab are limited and do not provide evidence on its effectiveness after different Disease Modifying Therapies (DMTs). Our aim was to provide real-world data on the impact of clinical variables and previous DMTs on clinical response to Alemtuzumab. Methods Sixteen Italian MS-centers retrospectively included patients who started Alemtuzumab from January 2015 to December 2018, and recorded demographics, previous therapies, washout duration, relapses, EDSS, and MRI data. Negative-binomial regression models were used to assess the effect of factors on Annualized Relapse Rate (ARR) after Alemtuzumab initiation. Results We studied 322 patients (mean age 36.8 years, median EDSS 3, median follow-up 1.94 years). Previous treatments were: Fingolimod (106), Natalizumab (80), first-line orals (56), first-line injectables (IFN/GA, 30), other drugs (15). Thirty-five patients were treatment-naïve. Pre-Alemtuzumab ARR was 0.99 and decreased to 0.13 during Alemtuzumab (p<0.001). Number of previous year relapses was associated with Alemtuzumab-ARR (adjusted RR=1.38; p=0.009). Progression-free survival was 94.5% after one, and 89.2% after two years of Alemtuzumab. EDSS improvement occurred in 13.5% after one, and 20.6% after two years. Re-baselining patients after 6 months of Alemtuzumab treatment, led to a NEDA status in 71.6% after 1 year and 58.9% after 2 years. Conclusions Alemtuzumab decreases ARR independent of previous therapy, including patients with disease activity during Natalizumab. Overall, 90% of patients showed no disease progression, and 20% an improvement after two years of Alemtuzumab.