The impact of high-efficacy therapies (HET) on progression independent of relapse and MRI activity (PIRMA) remains poorly defined. In this context, using the French MS registry, we aimed to assess the real-life effectiveness of HET compared with moderate-efficacy therapies (MET) on PIRMA in patients with relapsing-onset multiple sclerosis. Data were collected from patients with relapsing-onset multiple sclerosis of the French MS registry, between January 2010 and June 2023, with a mean follow-up of 3.7 years. Patients with relapsing-onset multiple sclerosis were included in the analysis if they were treated first with HET (2666 included) or MET (7833 included) and had expanded disability status scale and MRI follow-up every 2 years. Each outcome was studied using a propensity score framework. The primary outcome was time to first PIRMA. Secondary outcomes were PIRMA incidence, time to first confirmed disability progression, relapse-associated worsening (RAW), MRI-associated worsening (MAW) and identification of risk factors associated with PIRMA. A total of 10 499 patients fulfilled the inclusion criteria. The mean and standard deviation (SD) age at treatment initiation was 36.4 (10.3) years, with a mean (SD) disease duration of 3.1 (5.1) years. The restricted mean (SD) survival time to first PIRMA was slightly, but significantly shorter in the HET group compared with the MET group [8.7 (0.08) versus 8.9 (0.05) years, P = 0.017]. However, when looking at time to first confirmed disability progression, it tend to be longer in the HET group compared with the MET group [7.6 (0.10) versus 7.3 (0.06) years, P = 0.071], and it was probably linked to the shorter time to first RAW and MAW in the MET group [9.2 (0.06) versus 8.7 (0.05) years, P < 0.001 for RAW; and 9.0 (0.05) versus 8.5 (0.07) years, P < 0.001 for MAW]. Baseline risk factors associated with increased PIRMA incidence in the whole population were high expanded disability status scale, higher age at baseline and the presence of spinal cord lesions. Even if HET gives better control on disability accumulation related to disease activity than MET, our real-life study suggests that PIRMA-related mechanisms are not differentially affected by HET versus MET.
Sleeve gastrectomy (SG) has become the most frequent bariatric surgery procedure. Secondary gastroesophageal reflux (GERD) may indicate conversion to Roux-en-Y gastric bypass (RYGB). However, in patients with sufficient weight loss, there is no clear answer in the literature as to whether RYGB should be performed with loop lengths leading to metabolic effect, or whether it should be performed solely for anti-reflux purposes. We aimed to evaluate current surgical practices and limb-length preferences among French-speaking bariatric surgeons managing GERD after SG in patients with satisfactory weight loss. A cross-sectional survey was distributed to members of the Société Française et Francophone de Chirurgie de l'Obésité et des Maladies Métaboliques (SOFFCO-MM). The questionnaire included demographics, criteria for “satisfactory weight loss”, diagnostic workup for GERD and RYGB technical configurations. Fifty-three surgeons responded. Only 22.6
The recreational use of nitrous oxide (N2O) has increased significantly in recent years, becoming an emerging public health concern owing to its association with severe neurological complications. Vitamin B12 is inactivated by N2O, and accumulation of homocysteine (Hcy) could be a relevant marker of N₂O toxicity. Kinetics of Hcy after cessation of exposure remain poorly understood. This retrospective study examined the Hcy levels of patients hospitalized consecutively for neurological impairment secondary to N₂O intoxication. Demographic and clinical data were collected, including clinical phenotype and motor deficit severity. Levels, dates, and hours of blood testing for vitamin B12, Hcy, and hospital entrance were collected. The statistical analysis used the Wilcoxon test or the Chi-square test. Among the 86 patients (median age 22 years; 59% woman), 92% exhibited abnormal Hcy levels, with a median Hcy concentration of 69 µmol/L [38; 106] (normal < 15 µmol/L). Vitamin B12 levels were normal in 80% of cases. Hcy levels were significantly lower in patients who had received vitamin B12 supplementation (p = 0.016). When blood testing was performed within the first 8 h after hospital admission, Hcy levels were high (median 106 µmol/L [89; 112]). A rapid decrease was observed within the following hours, reaching normal levels approximately one week after admission. The exponential decline of Hcy underscores its potential as a valuable biomarker for N₂O-induced toxicity under the condition of a very early sampling and patient reference. In current practice, Hcy values that do not increase dramatically could suggest a delay in testing rather than low N2O usage.
BACKGROUND:Ofatumumab and ocrelizumab are widely used high-efficacy anti-CD20 therapies for relapsing-remitting multiple sclerosis (RRMS), but direct comparative evidence remains limited. We aimed to compare their effectiveness in routine clinical practice. METHODS:We conducted an observational cohort study emulating a target trial using data from the MSBase and Observatoire Français de la Sclérose en Plaques registries (January 2021 to December 2024). Adults with RRMS initiating ofatumumab or ocrelizumab were included. Patients were matched 1:1 using propensity scores. Primary outcomes were annualised relapse rate (ARR) and time to first relapse. Secondary outcomes included time to confirmed disability progression (CDP), progression independent of relapse activity (PIRA), confirmed disability improvement (CDI), MRI activity and treatment discontinuation. Negative binomial and Cox regression models were applied. RESULTS:A total of 5288 patients were matched with a median follow-up of 1.2 years for ofatumumab and 1.4 years for ocrelizumab. ARR was 0.07 (95% CI 0.05 to 0.08) with ofatumumab and 0.04 (0.03 to 0.05) with ocrelizumab, corresponding to an ARR ratio of 1.75 (1.43 to 2.13). Ofatumumab was associated with a lower risk of CDP (HR 0.66; 0.49 to 0.87) and PIRA (0.53; 0.39 to 0.73), but a lower probability of CDI (0.76; 0.60 to 0.96). No significant differences were observed in MRI activity or treatment discontinuation. CONCLUSIONS:Both therapies were highly effective in a large cohort of patients with RRMS, with very low relapse or CDP rates. Ofatumumab was associated with slightly greater disability control, while ocrelizumab more effectively suppressed relapses. These differences were modest, and their clinical relevance requires further evidence and should be interpreted with caution.
