Browsing by Author "Spelman, Tim"

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Effect of Late-Onset on Multiple Sclerosis Phenotype and Outcome: Evidence From a Multi-National Registry
(Springer Heidelberg, 2026) Souissi, Amira; Patti, Francesco; Spelman, Tim; Chisari, Clara; Gargouri, Amina; John, Nevin; Gouider, Riadh
BackgroundMultiple Sclerosis (MS) severity is influenced by several factors. Understanding the impact of age at disease onset may help to better characterize clinical and disease features across age groups. This study aimed to characterize the clinical features and disability outcomes of late-onset MS (LOMS) and very late-onset MS (vLOMS), compared to adult-onset MS (AOMS).MethodsWe conducted an observational study using data from the MSBase registry and categorized patients based on age at MS onset: AOMS (18-39 years), transition onset (40-49 years), LOMS (50-59 years), and vLOMS (>= 60 years). Disease progression was assessed using the 24 week confirmed disability progression, EDSS4 and 6 milestones, conversion to secondary progressive MS(SPMS), and the first progression independent of relapse activity (PIRA) event. Cox proportional hazard regression models were used to determine unadjusted hazard ratios(HR), and propensity score inverse probability of treatment weighting(PS-IPTW) balanced covariate distributions.ResultsAmong 81,236 patients, 5.2% had LOMS and 1% had vLOMS. Primary progressive MS was more frequent in LOMS and vLOMS (21.7 and 24%, respectively). Patients with LOMS and vLOMS had a significantly increased risk of 24 week confirmed disability progression (HR:LOMS = 1.39, vLOMS = 1.80), EDSS 4 (HR:LOMS = 2.14, vLOMS = 2.95), EDSS 6 (HR:LOMS = 2.33, vLOMS = 6.33), SPMS (HR:LOMS = 1.62, vLOMS = 2.38), and first PIRA event (HR:LOMS = 2.12, vLOMS = 2.93).ConclusionLOMS and vLOMS exhibited a more progressive disease onset and higher disability milestones compared with AOMS.
Citation - WoS: 6
Citation - Scopus: 6
A Multi-Centre Longitudinal Study Analysing Multiple Sclerosis Disease-Modifying Therapy Prescribing Patterns During the Covid-19 Pandemic
(Springer heidelberg, 2024) Lal, Anoushka P.; Foong, Yi Chao; Sanfilippo, Paul G.; Spelman, Tim; Rath, Louise; Levitz, David; Fabis-Pedrini, Marzena; Van der Walt, Anneke
BackgroundThe COVID-19 pandemic raised concern amongst clinicians that disease-modifying therapies (DMT), particularly anti-CD20 monoclonal antibodies (mAb) and fingolimod, could worsen COVID-19 in people with multiple sclerosis (pwMS). This study aimed to examine DMT prescribing trends pre- and post-pandemic onset.MethodsA multi-centre longitudinal study with 8,771 participants from MSBase was conducted. Two time periods were defined: pre-pandemic (March 11 2018-March 10 2020) and post-pandemic onset (March 11 2020-11 March 2022). The association between time and prescribing trends was analysed using multivariable mixed-effects logistic regression. DMT initiation refers to first initiation of any DMT, whilst DMT switches indicate changing regimen within 6 months of last use.ResultsPost-pandemic onset, there was a significant increase in DMT initiation/switching to natalizumab and cladribine [(Natalizumab-initiation: OR 1.72, 95% CI 1.39-2.13; switching: OR 1.66, 95% CI 1.40-1.98), (Cladribine-initiation: OR 1.43, 95% CI 1.09-1.87; switching: OR 1.67, 95% CI 1.41-1.98)]. Anti-CD20mAb initiation/switching decreased in the year of the pandemic, but recovered in the second year, such that overall odds increased slightly post-pandemic (initiation: OR 1.26, 95% CI 1.06-1.49; Switching: OR 1.15, 95% CI 1.02-1.29. Initiation/switching of fingolimod, interferon-beta, and alemtuzumab significantly decreased [(Fingolimod-initiation: OR 0.55, 95% CI 0.41-0.73; switching: OR 0.49, 95% CI 0.41-0.58), (Interferon-gamma-initiation: OR 0.48, 95% CI 0.41-0.57; switching: OR 0.78, 95% CI 0.62-0.99), (Alemtuzumab-initiation: OR 0.27, 95% CI 0.15-0.48; switching: OR 0.27, 95% CI 0.17-0.44)].ConclusionsPost-pandemic onset, clinicians preferentially prescribed natalizumab and cladribine over anti-CD20 mAbs and fingolimod, likely to preserve efficacy but reduce perceived immunosuppressive risks. This could have implications for disease progression in pwMS. Our findings highlight the significance of equitable DMT access globally, and the importance of evidence-based decision-making in global health challenges.
Real-World Effectiveness of Ocrelizumab in Relapsing Multiple Sclerosis: An Msbase Registry Sub-Study
(Elsevier Sci Ltd, 2026) Butzkueven, Helmut; Farr, Pamela; Ozakbas, Serkan; Boz, Cavit; Kalincik, Tomas; Taylor, Lisa; Spelman, Tim
Introduction: The MSOCR-R study evaluates the long-term effectiveness of ocrelizumab (OCR) in patients with relapsing multiple sclerosis (RMS) in real-world clinical settings. Methods: MSOCR-R is an ongoing, prospective, longitudinal, observational cohort study of people with RMS newly treated with OCR, using data from the international MSBase registry. The study started in July 2018, and data collected up to October 2023 were analyzed. Outcomes were confirmed disability worsening (CDW), progression independent of relapses (PIRA), and no evidence of disease activity (NEDA-3: absence of relapse, 24-week CDW, or imaging activity). Results: Overall, 1011 patients were enrolled (18.1% initiated OCR first-line therapy; 81.9% switched from previous treatment), with a median time of 3.4 years on OCR treatment. About 67% of patients were females. At OCR initiation, mean age was 41.9 years, median disease duration was 10.4 years, and median Expanded Disability Status Scale score was 3.0. The 4-year Kaplan-Meier probabilities of 24-week CDW or PIRA were 25.2% (95% CI 21.6-29.1) and 21.9% (95% CI 18.3-25.2), respectively. Annualized relapse rate substantially decreased from 0.58 (95% CI 0.53-0.63) before OCR to 0.05 (95% CI 0.04-0.06) after treatment initiation. NEDA-3 was assessed in 366 patients and the probability of achieving NEDA-3 was 39.7% (95% CI 36.0-43.5) at 4 years. Persistence on OCR was 88.0% (95% CI, 85.2-90.3) at 4 years. Better clinical outcomes were consistently observed among the first-line treatment cohort. Conclusion: The MSOCR-R study provides strong real-world evidence of OCR effectiveness in people with RMS.
Real-World Experience With Cladribine (Mavenclad) in the MSBase Registry
(Sage Publications Ltd, 2024) Butzkueven, Helmut; Spelman, Tim; Van der Walt, Anneke; Hodgkinson, Suzanne; Ozakbas, Serkan; Alroughani, Raed; Jarvinen, Elina
Real-World Experience with Cladribine Tablets in the MSBase Registry 2025 Update
(Sage Publications Ltd, 2025) Spelman, Tim; van der Walt, Anneke; Ozakbas, Serkan; Horakova, Dana; Alroughani, Raed; Kalincik, Tomas; Butzkueven, Helmut; Jarvinen, Elina; Hodgkinson, Suzanne
Safety-Driven Ocrelizumab Discontinuation Vs Continuation: Comparative Insights From MSBase
(Sage Publications Ltd, 2025) D'Amico, Emanuele; Zanghi, Aurora; Spelman, Tim; Kermode, Allan G.; Pedrini, Marzena; Carroll, William; Gerlach, Oliver