Key clinical point: Low serum levels of vitamin D are inversely associated with clinical and disease activity in patients with multiple sclerosis (MS).

Major finding: Patients with serum 25(OH)D levels ≥30 ng/mL group had lower median T2-weighted lesion counts than those with <30 ng/mL  (P = .03; adjusted for age, sex, 25(OH)D levels, and disease duration, P less than .001). Expanded disability status scale (EDSS) score had an inverse association with serum 25(OH)D levels after adjusting for age, sex, and disease duration (adjusted P less than .001).

Study details: The study analyzed baseline serum vitamin D levels of patients recruited in the randomized Efficacy of Vitamin D Supplementation in Multiple Sclerosis (EVIDIMS) study.

Disclosures: The study was funded by the German Research Organization grants awarded to FP and JD, the Einstein Foundation Berlin, and a limited research grant from Bayer Leverkusen, Germany. Priscilla Bäcker-Koduah, Judith Bellmann-Strobl, Jens Wuerfel, Jan Dörr, Alexander Ulrich Brandt, Friedemann Paul, Klaus-Dieter Wernecke reported ties with one or more pharmaceutical companies. Michael Scheel reported no conflicts of interest.

Citation: Bäcker-Koduah P et al. Front Neurol. 2020 Feb 25. doi: 10.3389/fneur.2020.00129.

Key clinical point: Low serum levels of vitamin D are inversely associated with clinical and disease activity in patients with multiple sclerosis (MS).

Major finding: Patients with serum 25(OH)D levels ≥30 ng/mL group had lower median T2-weighted lesion counts than those with <30 ng/mL  (P = .03; adjusted for age, sex, 25(OH)D levels, and disease duration, P less than .001). Expanded disability status scale (EDSS) score had an inverse association with serum 25(OH)D levels after adjusting for age, sex, and disease duration (adjusted P less than .001).

Study details: The study analyzed baseline serum vitamin D levels of patients recruited in the randomized Efficacy of Vitamin D Supplementation in Multiple Sclerosis (EVIDIMS) study.

Disclosures: The study was funded by the German Research Organization grants awarded to FP and JD, the Einstein Foundation Berlin, and a limited research grant from Bayer Leverkusen, Germany. Priscilla Bäcker-Koduah, Judith Bellmann-Strobl, Jens Wuerfel, Jan Dörr, Alexander Ulrich Brandt, Friedemann Paul, Klaus-Dieter Wernecke reported ties with one or more pharmaceutical companies. Michael Scheel reported no conflicts of interest.

Citation: Bäcker-Koduah P et al. Front Neurol. 2020 Feb 25. doi: 10.3389/fneur.2020.00129.

Key clinical point: Low serum levels of vitamin D are inversely associated with clinical and disease activity in patients with multiple sclerosis (MS).

Major finding: Patients with serum 25(OH)D levels ≥30 ng/mL group had lower median T2-weighted lesion counts than those with <30 ng/mL  (P = .03; adjusted for age, sex, 25(OH)D levels, and disease duration, P less than .001). Expanded disability status scale (EDSS) score had an inverse association with serum 25(OH)D levels after adjusting for age, sex, and disease duration (adjusted P less than .001).

Study details: The study analyzed baseline serum vitamin D levels of patients recruited in the randomized Efficacy of Vitamin D Supplementation in Multiple Sclerosis (EVIDIMS) study.

Disclosures: The study was funded by the German Research Organization grants awarded to FP and JD, the Einstein Foundation Berlin, and a limited research grant from Bayer Leverkusen, Germany. Priscilla Bäcker-Koduah, Judith Bellmann-Strobl, Jens Wuerfel, Jan Dörr, Alexander Ulrich Brandt, Friedemann Paul, Klaus-Dieter Wernecke reported ties with one or more pharmaceutical companies. Michael Scheel reported no conflicts of interest.

Citation: Bäcker-Koduah P et al. Front Neurol. 2020 Feb 25. doi: 10.3389/fneur.2020.00129.

Key clinical point: Continuation of natalizumab during the first trimester may lower the risk for disease reactivation during pregnancy in patients with active multiple sclerosis (MS).

Major finding: The secured first trimester (SFT) group vs secured conception (SC) group was associated with lower rates of relapse (3.6% vs 38.5%; P = .008) and disability progression (3.6% vs 30.8%; P = .03) during pregnancy.

Study details: Two strategies were compared for women with active MS planning to conceive: stopping natalizumab at the end of the first trimester (SFT, n = 29) and stopping at conception (SC, n = 14).

Disclosures: The study did not receive any funding. Audrey Rico, Adil Maarouf, Clémence Boutiere, Jean Pelletier and Bertrand Audoin reported ties with one or more pharmaceutical companies. Sarah Demortiere reported no disclosures.  

Citation: Demortiere S et al. Mult Scler. 2020 Mar 23. doi: 10.1177/1352458520912637.

Key clinical point: Continuation of natalizumab during the first trimester may lower the risk for disease reactivation during pregnancy in patients with active multiple sclerosis (MS).

Major finding: The secured first trimester (SFT) group vs secured conception (SC) group was associated with lower rates of relapse (3.6% vs 38.5%; P = .008) and disability progression (3.6% vs 30.8%; P = .03) during pregnancy.

Study details: Two strategies were compared for women with active MS planning to conceive: stopping natalizumab at the end of the first trimester (SFT, n = 29) and stopping at conception (SC, n = 14).

Disclosures: The study did not receive any funding. Audrey Rico, Adil Maarouf, Clémence Boutiere, Jean Pelletier and Bertrand Audoin reported ties with one or more pharmaceutical companies. Sarah Demortiere reported no disclosures.  

Citation: Demortiere S et al. Mult Scler. 2020 Mar 23. doi: 10.1177/1352458520912637.

Key clinical point: Continuation of natalizumab during the first trimester may lower the risk for disease reactivation during pregnancy in patients with active multiple sclerosis (MS).

Major finding: The secured first trimester (SFT) group vs secured conception (SC) group was associated with lower rates of relapse (3.6% vs 38.5%; P = .008) and disability progression (3.6% vs 30.8%; P = .03) during pregnancy.

Study details: Two strategies were compared for women with active MS planning to conceive: stopping natalizumab at the end of the first trimester (SFT, n = 29) and stopping at conception (SC, n = 14).

Disclosures: The study did not receive any funding. Audrey Rico, Adil Maarouf, Clémence Boutiere, Jean Pelletier and Bertrand Audoin reported ties with one or more pharmaceutical companies. Sarah Demortiere reported no disclosures.  

Citation: Demortiere S et al. Mult Scler. 2020 Mar 23. doi: 10.1177/1352458520912637.

No staff members or patients were diagnosed with COVID-19 after “strict protective measures” for screening and managing patients were implemented at the National Cancer Center/Cancer Hospital, Chinese Academy of Sciences, in Beijing, according to a report published online April 1 in JAMA Oncology.

However, the time period for the analysis, which included nearly 3000 patients, was short — only about 3 weeks (February 12 to March 3). Also, Beijing is more than 1100 kilometers from Wuhan, the center of the Chinese outbreak of COVID-19.

The Beijing cancer hospital implemented a multipronged safety plan in February in order to “avoid COVID-19 related nosocomial cross-infection between patients and medical staff,” explain the authors, led by medical oncologist Zhijie Wang, MD.

Notably, “all of the measures taken in China are actively being implemented and used in major oncology centers in the United States,” Robert Carlson, MD, chief executive officer, National Comprehensive Cancer Network (NCCN), told Medscape Medical News.  

John Greene, MD, section chief, Infectious Disease and Tropical Medicine, Moffitt Cancer Center, Tampa, Florida, pointed out that the Chinese safety plan, which is full of “good measures,” is being largely used at his center. However, he observed that one tool — doing a temperature check at the hospital front door — is not well supported by most of the literature. “It gives good optics and looks like you are doing the most you possibly can, but scientifically it may not be as effective [as other screening measures],” he said.

The Chinese plan consists of four broad elements

First, the above-mentioned on-site temperature tests are performed at the entrances of the hospital, outpatient clinic, and wards. Contact and travel histories related to the Wuhan epidemic area are also established and recorded.

Second, an outpatient appointment scheduling system allows both online scheduling and on-site registration. Online consultation channels are open daily, featuring instruction on medication taking and cancer-related symptom management. These “substantially reduced the flow of people in the hospital,” write the authors. On-site patients must wear a mask and have their own disinfectant.

Third, for patients with cancer preparing to be admitted to hospital, symptoms associated with COVID-19, such as fever and cough, are recorded. Mandatory blood tests and CT scans of the lungs are performed. COVID-19 virus nucleic acid tests are performed for patients with suspected pneumonia on imaging.

Fourth, some anticancer drugs conventionally administered by infusion have been changed to oral administration, such as etoposide and vinorelbine. For adjuvant or maintenance chemotherapy, the infusion intervals were appropriately prolonged depending on patients’ conditions.

Eight out of 2,900 patients had imaging suspicious for infection

The Chinese authors report that a total of 2,944 patients with cancer were seen for clinic consultation and treatment in the wards (2795 outpatients and 149 inpatients).

Patients with cancer are believed to have a higher probability of severe illness and increased mortality compared with the healthy population once infected with COVID-19, point out the authors.

Under the new “strict screening strategy,” 27 patients showed radiologic manifestations of inflammatory changes or multiple-site exudative pneumonia in the lungs, including eight suspected of having COVID-19 infection. “Fortunately, negative results from nucleic acid testing ultimately excluded COVID-19 infection in all these patients,” the authors report.

However, two of these patients “presented with recovered pneumonia after symptomatic treatment.” Commenting on this finding, Moffitt’s Greene said that may mean these two patients were tested and found to be positive but were early in the infection and not yet shedding the virus, or they were infected after the initial negative result.

Greene said his center has implemented some measures not mentioned in the Chinese plan. For example, the Florida center no longer allows inpatient visitation. Also, one third of staff now work from home, resulting in less social interaction. Social distancing in meetings, the cafeteria, and hallways is being observed “aggressively,” and most meetings are now on Zoom, he said.

Moffitt has not been hard hit with COVID-19 and is at level one preparedness, the lowest rung. The center has performed 60 tests to date, with only one positive for the virus (< 2%), Greene told Medscape Medical News.

Currently, in the larger Tampa Bay community setting, about 12% of tests are positive.

The low percentage found among the Moffitt patients “tells you that a lot of cancer patients have fever and respiratory symptoms due to other viruses and, more importantly, other reasons, whether it’s their immunotherapy or chemotherapy or their cancer,” said Greene.

NCCN’s Carlson said the publication of the Chinese data was a good sign in terms of international science.

“This is a strong example of how the global oncology community rapidly shares information and experience whenever it makes a difference in patient care,” he commented.

The authors, as well as Carlson and Greene, have reported no relevant financial relationships.

This article first appeared on Medscape.com.

No staff members or patients were diagnosed with COVID-19 after “strict protective measures” for screening and managing patients were implemented at the National Cancer Center/Cancer Hospital, Chinese Academy of Sciences, in Beijing, according to a report published online April 1 in JAMA Oncology.

However, the time period for the analysis, which included nearly 3000 patients, was short — only about 3 weeks (February 12 to March 3). Also, Beijing is more than 1100 kilometers from Wuhan, the center of the Chinese outbreak of COVID-19.

The Beijing cancer hospital implemented a multipronged safety plan in February in order to “avoid COVID-19 related nosocomial cross-infection between patients and medical staff,” explain the authors, led by medical oncologist Zhijie Wang, MD.

Notably, “all of the measures taken in China are actively being implemented and used in major oncology centers in the United States,” Robert Carlson, MD, chief executive officer, National Comprehensive Cancer Network (NCCN), told Medscape Medical News.  

John Greene, MD, section chief, Infectious Disease and Tropical Medicine, Moffitt Cancer Center, Tampa, Florida, pointed out that the Chinese safety plan, which is full of “good measures,” is being largely used at his center. However, he observed that one tool — doing a temperature check at the hospital front door — is not well supported by most of the literature. “It gives good optics and looks like you are doing the most you possibly can, but scientifically it may not be as effective [as other screening measures],” he said.

The Chinese plan consists of four broad elements

First, the above-mentioned on-site temperature tests are performed at the entrances of the hospital, outpatient clinic, and wards. Contact and travel histories related to the Wuhan epidemic area are also established and recorded.

Second, an outpatient appointment scheduling system allows both online scheduling and on-site registration. Online consultation channels are open daily, featuring instruction on medication taking and cancer-related symptom management. These “substantially reduced the flow of people in the hospital,” write the authors. On-site patients must wear a mask and have their own disinfectant.

Third, for patients with cancer preparing to be admitted to hospital, symptoms associated with COVID-19, such as fever and cough, are recorded. Mandatory blood tests and CT scans of the lungs are performed. COVID-19 virus nucleic acid tests are performed for patients with suspected pneumonia on imaging.

Fourth, some anticancer drugs conventionally administered by infusion have been changed to oral administration, such as etoposide and vinorelbine. For adjuvant or maintenance chemotherapy, the infusion intervals were appropriately prolonged depending on patients’ conditions.

Eight out of 2,900 patients had imaging suspicious for infection

The Chinese authors report that a total of 2,944 patients with cancer were seen for clinic consultation and treatment in the wards (2795 outpatients and 149 inpatients).

Patients with cancer are believed to have a higher probability of severe illness and increased mortality compared with the healthy population once infected with COVID-19, point out the authors.

Under the new “strict screening strategy,” 27 patients showed radiologic manifestations of inflammatory changes or multiple-site exudative pneumonia in the lungs, including eight suspected of having COVID-19 infection. “Fortunately, negative results from nucleic acid testing ultimately excluded COVID-19 infection in all these patients,” the authors report.

However, two of these patients “presented with recovered pneumonia after symptomatic treatment.” Commenting on this finding, Moffitt’s Greene said that may mean these two patients were tested and found to be positive but were early in the infection and not yet shedding the virus, or they were infected after the initial negative result.

Greene said his center has implemented some measures not mentioned in the Chinese plan. For example, the Florida center no longer allows inpatient visitation. Also, one third of staff now work from home, resulting in less social interaction. Social distancing in meetings, the cafeteria, and hallways is being observed “aggressively,” and most meetings are now on Zoom, he said.

Moffitt has not been hard hit with COVID-19 and is at level one preparedness, the lowest rung. The center has performed 60 tests to date, with only one positive for the virus (< 2%), Greene told Medscape Medical News.

Currently, in the larger Tampa Bay community setting, about 12% of tests are positive.

The low percentage found among the Moffitt patients “tells you that a lot of cancer patients have fever and respiratory symptoms due to other viruses and, more importantly, other reasons, whether it’s their immunotherapy or chemotherapy or their cancer,” said Greene.

NCCN’s Carlson said the publication of the Chinese data was a good sign in terms of international science.

“This is a strong example of how the global oncology community rapidly shares information and experience whenever it makes a difference in patient care,” he commented.

The authors, as well as Carlson and Greene, have reported no relevant financial relationships.

This article first appeared on Medscape.com.

No staff members or patients were diagnosed with COVID-19 after “strict protective measures” for screening and managing patients were implemented at the National Cancer Center/Cancer Hospital, Chinese Academy of Sciences, in Beijing, according to a report published online April 1 in JAMA Oncology.

However, the time period for the analysis, which included nearly 3000 patients, was short — only about 3 weeks (February 12 to March 3). Also, Beijing is more than 1100 kilometers from Wuhan, the center of the Chinese outbreak of COVID-19.

The Beijing cancer hospital implemented a multipronged safety plan in February in order to “avoid COVID-19 related nosocomial cross-infection between patients and medical staff,” explain the authors, led by medical oncologist Zhijie Wang, MD.

Notably, “all of the measures taken in China are actively being implemented and used in major oncology centers in the United States,” Robert Carlson, MD, chief executive officer, National Comprehensive Cancer Network (NCCN), told Medscape Medical News.  

John Greene, MD, section chief, Infectious Disease and Tropical Medicine, Moffitt Cancer Center, Tampa, Florida, pointed out that the Chinese safety plan, which is full of “good measures,” is being largely used at his center. However, he observed that one tool — doing a temperature check at the hospital front door — is not well supported by most of the literature. “It gives good optics and looks like you are doing the most you possibly can, but scientifically it may not be as effective [as other screening measures],” he said.

The Chinese plan consists of four broad elements

First, the above-mentioned on-site temperature tests are performed at the entrances of the hospital, outpatient clinic, and wards. Contact and travel histories related to the Wuhan epidemic area are also established and recorded.

Second, an outpatient appointment scheduling system allows both online scheduling and on-site registration. Online consultation channels are open daily, featuring instruction on medication taking and cancer-related symptom management. These “substantially reduced the flow of people in the hospital,” write the authors. On-site patients must wear a mask and have their own disinfectant.

Third, for patients with cancer preparing to be admitted to hospital, symptoms associated with COVID-19, such as fever and cough, are recorded. Mandatory blood tests and CT scans of the lungs are performed. COVID-19 virus nucleic acid tests are performed for patients with suspected pneumonia on imaging.

Fourth, some anticancer drugs conventionally administered by infusion have been changed to oral administration, such as etoposide and vinorelbine. For adjuvant or maintenance chemotherapy, the infusion intervals were appropriately prolonged depending on patients’ conditions.

Eight out of 2,900 patients had imaging suspicious for infection

The Chinese authors report that a total of 2,944 patients with cancer were seen for clinic consultation and treatment in the wards (2795 outpatients and 149 inpatients).

Patients with cancer are believed to have a higher probability of severe illness and increased mortality compared with the healthy population once infected with COVID-19, point out the authors.

Under the new “strict screening strategy,” 27 patients showed radiologic manifestations of inflammatory changes or multiple-site exudative pneumonia in the lungs, including eight suspected of having COVID-19 infection. “Fortunately, negative results from nucleic acid testing ultimately excluded COVID-19 infection in all these patients,” the authors report.

However, two of these patients “presented with recovered pneumonia after symptomatic treatment.” Commenting on this finding, Moffitt’s Greene said that may mean these two patients were tested and found to be positive but were early in the infection and not yet shedding the virus, or they were infected after the initial negative result.

Greene said his center has implemented some measures not mentioned in the Chinese plan. For example, the Florida center no longer allows inpatient visitation. Also, one third of staff now work from home, resulting in less social interaction. Social distancing in meetings, the cafeteria, and hallways is being observed “aggressively,” and most meetings are now on Zoom, he said.

Moffitt has not been hard hit with COVID-19 and is at level one preparedness, the lowest rung. The center has performed 60 tests to date, with only one positive for the virus (< 2%), Greene told Medscape Medical News.

Currently, in the larger Tampa Bay community setting, about 12% of tests are positive.

The low percentage found among the Moffitt patients “tells you that a lot of cancer patients have fever and respiratory symptoms due to other viruses and, more importantly, other reasons, whether it’s their immunotherapy or chemotherapy or their cancer,” said Greene.

NCCN’s Carlson said the publication of the Chinese data was a good sign in terms of international science.

“This is a strong example of how the global oncology community rapidly shares information and experience whenever it makes a difference in patient care,” he commented.

The authors, as well as Carlson and Greene, have reported no relevant financial relationships.

This article first appeared on Medscape.com.

Key clinical point: Patients with multiple sclerosis (MS), particularly those with relapsing-remitting MS (RRMS) have higher serum levels of homocysteine (Hcy). 

Major finding: The MS group had higher serum levels of Hcy (standardized mean difference [SMD], 0.64; P less than .0001) compared with the control group. There were no significant differences in levels of vitamin B12 (SMD, –0.08; P = .58) or folate (SMD, 0.07; P = .52) between the MS and control groups. There was a statistically significant difference for Hcy between patients with RRMS and control individuals (SMD, 0.67; P = .004) but not between patients with primary or secondary progressive MS and control individuals.

Study details: A meta-analysis of 21 studies, including 1,738 patients with MS and 1,424 control individuals.

Disclosures: The study was supported by the National Natural Science Foundation of China and the Beijing Municipal Administration of Hospitals Incubating Program. The authors declared no conflicts of interest. 

Citation: Li X et al. Int J Med Sci. 2020 Mar 5. doi: 10.7150/ijms.42058.

Key clinical point: Patients with multiple sclerosis (MS), particularly those with relapsing-remitting MS (RRMS) have higher serum levels of homocysteine (Hcy). 

Major finding: The MS group had higher serum levels of Hcy (standardized mean difference [SMD], 0.64; P less than .0001) compared with the control group. There were no significant differences in levels of vitamin B12 (SMD, –0.08; P = .58) or folate (SMD, 0.07; P = .52) between the MS and control groups. There was a statistically significant difference for Hcy between patients with RRMS and control individuals (SMD, 0.67; P = .004) but not between patients with primary or secondary progressive MS and control individuals.

Study details: A meta-analysis of 21 studies, including 1,738 patients with MS and 1,424 control individuals.

Disclosures: The study was supported by the National Natural Science Foundation of China and the Beijing Municipal Administration of Hospitals Incubating Program. The authors declared no conflicts of interest. 

Citation: Li X et al. Int J Med Sci. 2020 Mar 5. doi: 10.7150/ijms.42058.

Key clinical point: Patients with multiple sclerosis (MS), particularly those with relapsing-remitting MS (RRMS) have higher serum levels of homocysteine (Hcy). 

Major finding: The MS group had higher serum levels of Hcy (standardized mean difference [SMD], 0.64; P less than .0001) compared with the control group. There were no significant differences in levels of vitamin B12 (SMD, –0.08; P = .58) or folate (SMD, 0.07; P = .52) between the MS and control groups. There was a statistically significant difference for Hcy between patients with RRMS and control individuals (SMD, 0.67; P = .004) but not between patients with primary or secondary progressive MS and control individuals.

Study details: A meta-analysis of 21 studies, including 1,738 patients with MS and 1,424 control individuals.

Disclosures: The study was supported by the National Natural Science Foundation of China and the Beijing Municipal Administration of Hospitals Incubating Program. The authors declared no conflicts of interest. 

Citation: Li X et al. Int J Med Sci. 2020 Mar 5. doi: 10.7150/ijms.42058.

Key clinical point: Cancer risks with natalizumab and rituximab in patients with multiple sclerosis (MS) are similar to the general population, whereas there is a possible modest increase in risk with fingolimod.

Major finding: Adjusting for demography, previous cancer, and comorbidities, the risk of invasive cancer was similar or slightly lower for natalizumab (hazard ratio [HR], 1.01; 95% CI, 0.57-1.77) and rituximab (HR, 0.85; 95% CI, 0.54-1.32) compared with the general population. There was a possibly higher risk for fingolimod compared with the general population (HR, 1.53; 95% CI, 0.98-2.38) and rituximab (HR, 1.68; 95% CI, 1.00-2.84).

Study details: A Swedish register-based cohort study included 6,136 patients with MS and 37,801 non-MS individuals from the general population.

Disclosures: The study was funded through a Patient-Centered Outcomes Research Institute award. Johan Askling, Anna Fogdell-Hahn, Jan Hillert, Jan Lycke, Petra Nilsson, Magnus Vrethem, Tomas Olsson and Fredrik Piehl reported ties with one or more pharmaceutical companies. The remaining authors declared no conflicts of interest. 

Citation: Alping P et al. Ann Neurol. 2020 Feb 13. doi: 10.1002/ana.25701.

Key clinical point: Cancer risks with natalizumab and rituximab in patients with multiple sclerosis (MS) are similar to the general population, whereas there is a possible modest increase in risk with fingolimod.

Major finding: Adjusting for demography, previous cancer, and comorbidities, the risk of invasive cancer was similar or slightly lower for natalizumab (hazard ratio [HR], 1.01; 95% CI, 0.57-1.77) and rituximab (HR, 0.85; 95% CI, 0.54-1.32) compared with the general population. There was a possibly higher risk for fingolimod compared with the general population (HR, 1.53; 95% CI, 0.98-2.38) and rituximab (HR, 1.68; 95% CI, 1.00-2.84).

Study details: A Swedish register-based cohort study included 6,136 patients with MS and 37,801 non-MS individuals from the general population.

Disclosures: The study was funded through a Patient-Centered Outcomes Research Institute award. Johan Askling, Anna Fogdell-Hahn, Jan Hillert, Jan Lycke, Petra Nilsson, Magnus Vrethem, Tomas Olsson and Fredrik Piehl reported ties with one or more pharmaceutical companies. The remaining authors declared no conflicts of interest. 

Citation: Alping P et al. Ann Neurol. 2020 Feb 13. doi: 10.1002/ana.25701.

Key clinical point: Cancer risks with natalizumab and rituximab in patients with multiple sclerosis (MS) are similar to the general population, whereas there is a possible modest increase in risk with fingolimod.

Major finding: Adjusting for demography, previous cancer, and comorbidities, the risk of invasive cancer was similar or slightly lower for natalizumab (hazard ratio [HR], 1.01; 95% CI, 0.57-1.77) and rituximab (HR, 0.85; 95% CI, 0.54-1.32) compared with the general population. There was a possibly higher risk for fingolimod compared with the general population (HR, 1.53; 95% CI, 0.98-2.38) and rituximab (HR, 1.68; 95% CI, 1.00-2.84).

Study details: A Swedish register-based cohort study included 6,136 patients with MS and 37,801 non-MS individuals from the general population.

Disclosures: The study was funded through a Patient-Centered Outcomes Research Institute award. Johan Askling, Anna Fogdell-Hahn, Jan Hillert, Jan Lycke, Petra Nilsson, Magnus Vrethem, Tomas Olsson and Fredrik Piehl reported ties with one or more pharmaceutical companies. The remaining authors declared no conflicts of interest. 

Citation: Alping P et al. Ann Neurol. 2020 Feb 13. doi: 10.1002/ana.25701.

Key clinical point: Although injectables are the most frequently used disease-modifying agents (DMAs) for multiple sclerosis (MS), the utilization of oral DMAs is increasing.

Major finding: Between 2006 and 2015, DMAs were prescribed in 45% of MS visits. Although injectables remain the most commonly prescribed DMAs (78%), the use of oral DMAs has increased (from 11% in 2010-2011 to 40% in 2014-2015) and that of injectable DMAs has decreased (from 96% in 2006-2007 to 52% in 2014-2015). Visiting a neurologist was the strongest predictor of DMA use (odds ratio, 6.61; 95% CI, 3.66-11.93). 

Study details: A cross-sectional study examined the prescribing patterns and trends of DMAs in the US using the 2006-2015 National Ambulatory Medical Care Survey.

Disclosures: The study was not funded. George Hutton and Rajender Aparasu reported receiving grants from multiple pharmaceutical companies outside the submitted work. The remaining authors declared no conflicts of interest. 

Citation: Earla JR et al. Res Social Adm Pharm. 2020 Mar 11. doi: 10.1016/j.sapharm.2020.02.016. 

Key clinical point: Although injectables are the most frequently used disease-modifying agents (DMAs) for multiple sclerosis (MS), the utilization of oral DMAs is increasing.

Major finding: Between 2006 and 2015, DMAs were prescribed in 45% of MS visits. Although injectables remain the most commonly prescribed DMAs (78%), the use of oral DMAs has increased (from 11% in 2010-2011 to 40% in 2014-2015) and that of injectable DMAs has decreased (from 96% in 2006-2007 to 52% in 2014-2015). Visiting a neurologist was the strongest predictor of DMA use (odds ratio, 6.61; 95% CI, 3.66-11.93). 

Study details: A cross-sectional study examined the prescribing patterns and trends of DMAs in the US using the 2006-2015 National Ambulatory Medical Care Survey.

Disclosures: The study was not funded. George Hutton and Rajender Aparasu reported receiving grants from multiple pharmaceutical companies outside the submitted work. The remaining authors declared no conflicts of interest. 

Citation: Earla JR et al. Res Social Adm Pharm. 2020 Mar 11. doi: 10.1016/j.sapharm.2020.02.016. 

Key clinical point: Although injectables are the most frequently used disease-modifying agents (DMAs) for multiple sclerosis (MS), the utilization of oral DMAs is increasing.

Major finding: Between 2006 and 2015, DMAs were prescribed in 45% of MS visits. Although injectables remain the most commonly prescribed DMAs (78%), the use of oral DMAs has increased (from 11% in 2010-2011 to 40% in 2014-2015) and that of injectable DMAs has decreased (from 96% in 2006-2007 to 52% in 2014-2015). Visiting a neurologist was the strongest predictor of DMA use (odds ratio, 6.61; 95% CI, 3.66-11.93). 

Study details: A cross-sectional study examined the prescribing patterns and trends of DMAs in the US using the 2006-2015 National Ambulatory Medical Care Survey.

Disclosures: The study was not funded. George Hutton and Rajender Aparasu reported receiving grants from multiple pharmaceutical companies outside the submitted work. The remaining authors declared no conflicts of interest. 

Citation: Earla JR et al. Res Social Adm Pharm. 2020 Mar 11. doi: 10.1016/j.sapharm.2020.02.016. 

Key clinical point: Patients with migraine have an increased risk for comorbidities, and the risk is influenced by headache pain intensity and monthly headache days.

Major finding: Patients with migraine vs those without had an increased risk for insomnia, depression, anxiety, gastric ulcers/gastrointestinal bleeding, peripheral artery disease, angina, epilepsy, asthma, arthritis, stroke or transient ischemic attack, rheumatoid arthritis, allergies/hay fever, and vitamin D deficiency (P less than. 001). Increasing headache pain intensity was associated with an increased risk for inflammatory comorbidities, and monthly headache day frequency with risk for nearly all conditions.

Study details: The data come from the Migraine in America Symptoms and Treatment Study, which included 15,133 patients with migraine and 77,453 control individuals without migraine.

Disclosures: This study was funded and sponsored by Dr. Reddy’s Laboratories group of companies, Princeton, NJ. Sagar Munjal and Preeti Singh are employees of Dr. Reddy’s Laboratories. Richard B. Lipton, Dawn C. Buse, Michael L. Reed, Todd J. Schwedt, and David W. Dodick reported paid consultancy for Dr. Reddy’s Laboratories. The authors also reported ties with one or more pharmaceutical companies.

Citation: Buse DC et al. J Headache Pain. 2020 Mar 2. doi: 10.1186/s10194-020-1084-y.

Key clinical point: Patients with migraine have an increased risk for comorbidities, and the risk is influenced by headache pain intensity and monthly headache days.

Major finding: Patients with migraine vs those without had an increased risk for insomnia, depression, anxiety, gastric ulcers/gastrointestinal bleeding, peripheral artery disease, angina, epilepsy, asthma, arthritis, stroke or transient ischemic attack, rheumatoid arthritis, allergies/hay fever, and vitamin D deficiency (P less than. 001). Increasing headache pain intensity was associated with an increased risk for inflammatory comorbidities, and monthly headache day frequency with risk for nearly all conditions.

Study details: The data come from the Migraine in America Symptoms and Treatment Study, which included 15,133 patients with migraine and 77,453 control individuals without migraine.

Disclosures: This study was funded and sponsored by Dr. Reddy’s Laboratories group of companies, Princeton, NJ. Sagar Munjal and Preeti Singh are employees of Dr. Reddy’s Laboratories. Richard B. Lipton, Dawn C. Buse, Michael L. Reed, Todd J. Schwedt, and David W. Dodick reported paid consultancy for Dr. Reddy’s Laboratories. The authors also reported ties with one or more pharmaceutical companies.

Citation: Buse DC et al. J Headache Pain. 2020 Mar 2. doi: 10.1186/s10194-020-1084-y.

Key clinical point: Patients with migraine have an increased risk for comorbidities, and the risk is influenced by headache pain intensity and monthly headache days.

Major finding: Patients with migraine vs those without had an increased risk for insomnia, depression, anxiety, gastric ulcers/gastrointestinal bleeding, peripheral artery disease, angina, epilepsy, asthma, arthritis, stroke or transient ischemic attack, rheumatoid arthritis, allergies/hay fever, and vitamin D deficiency (P less than. 001). Increasing headache pain intensity was associated with an increased risk for inflammatory comorbidities, and monthly headache day frequency with risk for nearly all conditions.

Study details: The data come from the Migraine in America Symptoms and Treatment Study, which included 15,133 patients with migraine and 77,453 control individuals without migraine.

Disclosures: This study was funded and sponsored by Dr. Reddy’s Laboratories group of companies, Princeton, NJ. Sagar Munjal and Preeti Singh are employees of Dr. Reddy’s Laboratories. Richard B. Lipton, Dawn C. Buse, Michael L. Reed, Todd J. Schwedt, and David W. Dodick reported paid consultancy for Dr. Reddy’s Laboratories. The authors also reported ties with one or more pharmaceutical companies.

Citation: Buse DC et al. J Headache Pain. 2020 Mar 2. doi: 10.1186/s10194-020-1084-y.

Key clinical point: Topical basil essential oil at higher doses can effectively reduce the severity of pain intensity and frequency of migraine attacks.

Major Finding: The interaction between dose and time factors was significantly associated with both pain intensity and frequency of attack (P less than .001 for both). The odds of higher pain intensity and rates of higher frequency of migraine attacks in the basil essential oil vs placebo group decreased over time.

Study details: In a triple-blind study, 144 patients with migraine were randomly assigned to basil essential oil 2%, 4%, 6%, and placebo groups (1:1:1:1) by a stratified method.

Disclosures: This study was supported by the Lorestan University of Medical Sciences, Khorramabad, Iran. The authors declared no conflicts of interest. 

Citation: Ahmadifard M et al. Complement Med Res. 2020 Mar 10. doi: 10.1159/000506349. 

Key clinical point: Topical basil essential oil at higher doses can effectively reduce the severity of pain intensity and frequency of migraine attacks.

Major Finding: The interaction between dose and time factors was significantly associated with both pain intensity and frequency of attack (P less than .001 for both). The odds of higher pain intensity and rates of higher frequency of migraine attacks in the basil essential oil vs placebo group decreased over time.

Study details: In a triple-blind study, 144 patients with migraine were randomly assigned to basil essential oil 2%, 4%, 6%, and placebo groups (1:1:1:1) by a stratified method.

Disclosures: This study was supported by the Lorestan University of Medical Sciences, Khorramabad, Iran. The authors declared no conflicts of interest. 

Citation: Ahmadifard M et al. Complement Med Res. 2020 Mar 10. doi: 10.1159/000506349. 

Key clinical point: Topical basil essential oil at higher doses can effectively reduce the severity of pain intensity and frequency of migraine attacks.

Major Finding: The interaction between dose and time factors was significantly associated with both pain intensity and frequency of attack (P less than .001 for both). The odds of higher pain intensity and rates of higher frequency of migraine attacks in the basil essential oil vs placebo group decreased over time.

Study details: In a triple-blind study, 144 patients with migraine were randomly assigned to basil essential oil 2%, 4%, 6%, and placebo groups (1:1:1:1) by a stratified method.

Disclosures: This study was supported by the Lorestan University of Medical Sciences, Khorramabad, Iran. The authors declared no conflicts of interest. 

Citation: Ahmadifard M et al. Complement Med Res. 2020 Mar 10. doi: 10.1159/000506349. 

Updated April 2, 2020.

The commander of a US Navy aircraft carrier in the midst of a COVID-19 outbreak was swiftly fired by Acting Secretary of the Navy Thomas Modly following media coverage of the plight of more than 200 COVID-19 positive sailors on the USS Theodore Roosevelt.

In a statement released April 2, Modly announced the removal of Capt. Brett Crozier for writing a memo that was later leaked to the San Francisco Chronicle newspaper. According to Acting Secretary Modly, the memo was sent “outside the chain of command” and his action “made his Sailors, their families, and many in the public believe that his letter was the only reason help from our larger Navy family was forthcoming, which was hardly the case.”

On Monday, March 30, Capt. Crozier, commanding officer of the nuclear aircraft carrier USS Theodore Roosevelt, sent an urgent request for assistance to senior Navy officials: “[I]n combat we are willing to take certain risks that are not acceptable in peacetime. However, we are not at war, and therefore cannot allow a single Sailor to perish as a result of this pandemic unnecessarily. Decisive action is required now in order to comply with CDC and NAVADMIN 083/20 guidance and prevent tragic outcomes.”

Even as a number of cruise ships with ill and dying passengers were—are—waiting to be allowed to dock in Florida and elsewhere, the USS Theodore Roosevelt was also dealing with a COVID-19 outbreak onboard—and awaiting permission to let the crew of more than 4,000 on shore so they could quarantine safely.

Crozier pointed to “lessons learned” from the Diamond Princess—the only comparable situation at the time. He quoted from the abstract to an epidemiological research study: An index case on board the cruise ship was reported in late January; a month later, 619 of 3,700 passengers and crew had tested positive. Without any interventions, the abstract noted, between January 21st and February 19th an estimated 2,920 of the passengers would have been infected. Isolation and quarantine, it concluded, prevented 2,307 cases. Further, an early evacuation would have been associated with 76 infected persons.

The Diamond Princess, Crozier wrote, was able to more effectively isolate people due to a higher percentage of individual and compartmentalized accommodations. However, due to a warship’s “inherent limitations of space,” his crew could not comply with orders to practice social distancing. “With the exceptions of a handful of senior officer staterooms,” he wrote, “none of the berthing onboard a warship is appropriate for quarantine or isolation.” He also pointed to other obstacles: shared bathrooms, shared sleeping quarters, group mealtimes, and ladders and other surfaces touched and possibly contaminated as crew move around the ship.

Moreover, Crozier wrote, “The spread of the disease is ongoing and accelerating.” By Tuesday March 31st, nearly 1,300 sailors had been tested, and hundreds were testing negative, but 243 sailors had tested positive and 87 more were showing symptoms, according to the latest reports. So far, none are showing serious symptoms.

“If we do not act now, we are failing to take care of our most trusted asset—our sailors,” Capt Crozier wrote. At first, no one seemed to be listening, but after the Chronicle broke the story and it began circulating in the media—things changed. “I heard about the letter from Capt. Crozier [Tuesday] morning,” said Acting Secretary Modly in an interview with the Chronicle. “I know that our command organization has been aware of this for about 24 hours and we have been working actually the last 7 days to move those sailors off the ship and get them into accommodations in Guam. The problem is that Guam doesn’t have enough beds right now and we’re having to talk to the government there to see if we can get some hotel space, create tent-type facilities.”

He noted that the situation for the USS Theodore Roosevelt is “a little bit different and unique” in that it has aircraft and armaments on it, fire hazards, and “we have to run a nuclear power plant.” Crozier had proposed that approximately 10% of the crew remain on board to take care of the duties such as tending to the nuclear reactor.

As of April 1, the Navy plans to remove some 2,700 sailors to the hotel rooms government officials on Guam have secured for them. Secretary Modly made no mention of the care or treatment of infected sailors in his April 2nd statement, but offered this reassurance: "You can offer comfort to your fellow citizens who are struggling and fearful here at home by standing the watch, and working your way through this pandemic with courage and optimism and set the example for the nation. We have an obligation to ensure you have everything you need as fast as we can get it there, and you have my commitment that we will not let you down."

Updated April 2, 2020.

The commander of a US Navy aircraft carrier in the midst of a COVID-19 outbreak was swiftly fired by Acting Secretary of the Navy Thomas Modly following media coverage of the plight of more than 200 COVID-19 positive sailors on the USS Theodore Roosevelt.

In a statement released April 2, Modly announced the removal of Capt. Brett Crozier for writing a memo that was later leaked to the San Francisco Chronicle newspaper. According to Acting Secretary Modly, the memo was sent “outside the chain of command” and his action “made his Sailors, their families, and many in the public believe that his letter was the only reason help from our larger Navy family was forthcoming, which was hardly the case.”

On Monday, March 30, Capt. Crozier, commanding officer of the nuclear aircraft carrier USS Theodore Roosevelt, sent an urgent request for assistance to senior Navy officials: “[I]n combat we are willing to take certain risks that are not acceptable in peacetime. However, we are not at war, and therefore cannot allow a single Sailor to perish as a result of this pandemic unnecessarily. Decisive action is required now in order to comply with CDC and NAVADMIN 083/20 guidance and prevent tragic outcomes.”

Even as a number of cruise ships with ill and dying passengers were—are—waiting to be allowed to dock in Florida and elsewhere, the USS Theodore Roosevelt was also dealing with a COVID-19 outbreak onboard—and awaiting permission to let the crew of more than 4,000 on shore so they could quarantine safely.

Crozier pointed to “lessons learned” from the Diamond Princess—the only comparable situation at the time. He quoted from the abstract to an epidemiological research study: An index case on board the cruise ship was reported in late January; a month later, 619 of 3,700 passengers and crew had tested positive. Without any interventions, the abstract noted, between January 21st and February 19th an estimated 2,920 of the passengers would have been infected. Isolation and quarantine, it concluded, prevented 2,307 cases. Further, an early evacuation would have been associated with 76 infected persons.

The Diamond Princess, Crozier wrote, was able to more effectively isolate people due to a higher percentage of individual and compartmentalized accommodations. However, due to a warship’s “inherent limitations of space,” his crew could not comply with orders to practice social distancing. “With the exceptions of a handful of senior officer staterooms,” he wrote, “none of the berthing onboard a warship is appropriate for quarantine or isolation.” He also pointed to other obstacles: shared bathrooms, shared sleeping quarters, group mealtimes, and ladders and other surfaces touched and possibly contaminated as crew move around the ship.

Moreover, Crozier wrote, “The spread of the disease is ongoing and accelerating.” By Tuesday March 31st, nearly 1,300 sailors had been tested, and hundreds were testing negative, but 243 sailors had tested positive and 87 more were showing symptoms, according to the latest reports. So far, none are showing serious symptoms.

“If we do not act now, we are failing to take care of our most trusted asset—our sailors,” Capt Crozier wrote. At first, no one seemed to be listening, but after the Chronicle broke the story and it began circulating in the media—things changed. “I heard about the letter from Capt. Crozier [Tuesday] morning,” said Acting Secretary Modly in an interview with the Chronicle. “I know that our command organization has been aware of this for about 24 hours and we have been working actually the last 7 days to move those sailors off the ship and get them into accommodations in Guam. The problem is that Guam doesn’t have enough beds right now and we’re having to talk to the government there to see if we can get some hotel space, create tent-type facilities.”

He noted that the situation for the USS Theodore Roosevelt is “a little bit different and unique” in that it has aircraft and armaments on it, fire hazards, and “we have to run a nuclear power plant.” Crozier had proposed that approximately 10% of the crew remain on board to take care of the duties such as tending to the nuclear reactor.

As of April 1, the Navy plans to remove some 2,700 sailors to the hotel rooms government officials on Guam have secured for them. Secretary Modly made no mention of the care or treatment of infected sailors in his April 2nd statement, but offered this reassurance: "You can offer comfort to your fellow citizens who are struggling and fearful here at home by standing the watch, and working your way through this pandemic with courage and optimism and set the example for the nation. We have an obligation to ensure you have everything you need as fast as we can get it there, and you have my commitment that we will not let you down."

Updated April 2, 2020.

The commander of a US Navy aircraft carrier in the midst of a COVID-19 outbreak was swiftly fired by Acting Secretary of the Navy Thomas Modly following media coverage of the plight of more than 200 COVID-19 positive sailors on the USS Theodore Roosevelt.

In a statement released April 2, Modly announced the removal of Capt. Brett Crozier for writing a memo that was later leaked to the San Francisco Chronicle newspaper. According to Acting Secretary Modly, the memo was sent “outside the chain of command” and his action “made his Sailors, their families, and many in the public believe that his letter was the only reason help from our larger Navy family was forthcoming, which was hardly the case.”

On Monday, March 30, Capt. Crozier, commanding officer of the nuclear aircraft carrier USS Theodore Roosevelt, sent an urgent request for assistance to senior Navy officials: “[I]n combat we are willing to take certain risks that are not acceptable in peacetime. However, we are not at war, and therefore cannot allow a single Sailor to perish as a result of this pandemic unnecessarily. Decisive action is required now in order to comply with CDC and NAVADMIN 083/20 guidance and prevent tragic outcomes.”

Even as a number of cruise ships with ill and dying passengers were—are—waiting to be allowed to dock in Florida and elsewhere, the USS Theodore Roosevelt was also dealing with a COVID-19 outbreak onboard—and awaiting permission to let the crew of more than 4,000 on shore so they could quarantine safely.

Crozier pointed to “lessons learned” from the Diamond Princess—the only comparable situation at the time. He quoted from the abstract to an epidemiological research study: An index case on board the cruise ship was reported in late January; a month later, 619 of 3,700 passengers and crew had tested positive. Without any interventions, the abstract noted, between January 21st and February 19th an estimated 2,920 of the passengers would have been infected. Isolation and quarantine, it concluded, prevented 2,307 cases. Further, an early evacuation would have been associated with 76 infected persons.

The Diamond Princess, Crozier wrote, was able to more effectively isolate people due to a higher percentage of individual and compartmentalized accommodations. However, due to a warship’s “inherent limitations of space,” his crew could not comply with orders to practice social distancing. “With the exceptions of a handful of senior officer staterooms,” he wrote, “none of the berthing onboard a warship is appropriate for quarantine or isolation.” He also pointed to other obstacles: shared bathrooms, shared sleeping quarters, group mealtimes, and ladders and other surfaces touched and possibly contaminated as crew move around the ship.

Moreover, Crozier wrote, “The spread of the disease is ongoing and accelerating.” By Tuesday March 31st, nearly 1,300 sailors had been tested, and hundreds were testing negative, but 243 sailors had tested positive and 87 more were showing symptoms, according to the latest reports. So far, none are showing serious symptoms.

“If we do not act now, we are failing to take care of our most trusted asset—our sailors,” Capt Crozier wrote. At first, no one seemed to be listening, but after the Chronicle broke the story and it began circulating in the media—things changed. “I heard about the letter from Capt. Crozier [Tuesday] morning,” said Acting Secretary Modly in an interview with the Chronicle. “I know that our command organization has been aware of this for about 24 hours and we have been working actually the last 7 days to move those sailors off the ship and get them into accommodations in Guam. The problem is that Guam doesn’t have enough beds right now and we’re having to talk to the government there to see if we can get some hotel space, create tent-type facilities.”

He noted that the situation for the USS Theodore Roosevelt is “a little bit different and unique” in that it has aircraft and armaments on it, fire hazards, and “we have to run a nuclear power plant.” Crozier had proposed that approximately 10% of the crew remain on board to take care of the duties such as tending to the nuclear reactor.

As of April 1, the Navy plans to remove some 2,700 sailors to the hotel rooms government officials on Guam have secured for them. Secretary Modly made no mention of the care or treatment of infected sailors in his April 2nd statement, but offered this reassurance: "You can offer comfort to your fellow citizens who are struggling and fearful here at home by standing the watch, and working your way through this pandemic with courage and optimism and set the example for the nation. We have an obligation to ensure you have everything you need as fast as we can get it there, and you have my commitment that we will not let you down."

Key clinical point: Cervical noninvasive vagus nerve stimulation (nVNS) is a safe and effective technique for relieving acute pain in migraine and cluster headaches.

Major finding: The nVNS vs. sham-device treatment was effective in attaining a pain-free status within 30 minutes (P = .02), pain-relief status within 30 minutes (P = .007), pain-relief status at 60 minutes (P = .006), pain-free status in ≥50% of treated attacks (P = .005) and reduced use of abortive medication (P = .02). No significant differences were observed in decreased headache days (P = .117), adverse events (P = .81), and satisfaction (P = .07) between the nVNS and sham-device groups.

Study details: A systematic review and meta-analysis of 6 randomized controlled trials of nVNS for treating headaches (n = 983).

Disclosures: The authors declared no conflicts of interest.

Citation: Lai YH et al. Neuromodulation. 2020 Mar 12. doi: 10.1111/ner.13122. 

Key clinical point: Cervical noninvasive vagus nerve stimulation (nVNS) is a safe and effective technique for relieving acute pain in migraine and cluster headaches.

Major finding: The nVNS vs. sham-device treatment was effective in attaining a pain-free status within 30 minutes (P = .02), pain-relief status within 30 minutes (P = .007), pain-relief status at 60 minutes (P = .006), pain-free status in ≥50% of treated attacks (P = .005) and reduced use of abortive medication (P = .02). No significant differences were observed in decreased headache days (P = .117), adverse events (P = .81), and satisfaction (P = .07) between the nVNS and sham-device groups.

Study details: A systematic review and meta-analysis of 6 randomized controlled trials of nVNS for treating headaches (n = 983).

Disclosures: The authors declared no conflicts of interest.

Citation: Lai YH et al. Neuromodulation. 2020 Mar 12. doi: 10.1111/ner.13122. 

Key clinical point: Cervical noninvasive vagus nerve stimulation (nVNS) is a safe and effective technique for relieving acute pain in migraine and cluster headaches.

Major finding: The nVNS vs. sham-device treatment was effective in attaining a pain-free status within 30 minutes (P = .02), pain-relief status within 30 minutes (P = .007), pain-relief status at 60 minutes (P = .006), pain-free status in ≥50% of treated attacks (P = .005) and reduced use of abortive medication (P = .02). No significant differences were observed in decreased headache days (P = .117), adverse events (P = .81), and satisfaction (P = .07) between the nVNS and sham-device groups.

Study details: A systematic review and meta-analysis of 6 randomized controlled trials of nVNS for treating headaches (n = 983).

Disclosures: The authors declared no conflicts of interest.

Citation: Lai YH et al. Neuromodulation. 2020 Mar 12. doi: 10.1111/ner.13122.