Siponimod Improves Cognitive Processing Speed, Opioid Use for Migraine in Emergency Departments, Reduced Stroke Admissions During Pandemic


Neurology News Network for the week ending February 27, 2021.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus.

New secondary data analysis from the EXPAND study showed that patients with secondary progressive multiple sclerosis treated with siponimod experienced a significant benefit on the Symbol Digit Modalities Test, suggesting that the oral S1P receptor modulator can improve cognitive processing speed. The between-group difference for the siponimod vs placebo groups in mean change from baseline in SDMT scores was 1.08 at 12 months, and 1.23 at month 18, and 2.30 at month 24. The data also showed a lower risk of having a decrease of 4 or more points and a higher risk of having an increase of 4 or more points on the SDMT for siponimod-treated patients. First author Ralph HB Benedict, PhD, professor of neurology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, and colleagues wrote that the data offer Class II evidence for the benefits of siponimod treatment. They noted that the data are at “a magnitude of change accepted as clinically meaningful.”

Results from a retrospective cohort study found that patients with migraine who received opioid medications at their emergency department visits were associated with increased future health resource utilization, highlighting the need for optimizing migraine management in emergency settings. A total of 788 patient cases pulled from the Baylor Scott & White Health record between December 2013 and April 2017 were included in the study. During the 6-month follow-up period, compared to patients with migraine who were non-recipients at their index ED visits, opioid recipients had significantly more all-cause and migraine-related opioid prescriptions.

Data from a recent study suggest that the COVID-19 pandemic has led to decreasing telestroke consultations, decreased ischemic stroke admissions, and reduced performance on stroke quality of care.Researchers found that telestroke consultations were reduced by 1.32% per week and IS patient admissions decreased from 13.3 patients per week prior to March 1, 2020 to 10.3 patients per week afterward. Patient presentation and care delivery time metrics were unchanged, but rates of adherence to dysphagia screening, early antithrombotic initiation, and early venous thrombo-embolism were reduced. The researchers found decreasing telestroke consultations over the 6-month study period, but no differences in the mean number of consultations prior to (33.7 per week) and after March 2020 (29.8 per week) or the mean number of stroke cases per week prior to March (23.9) and after (21.2). All stroke admissions decreased from 16.7 patients per week prior to March to 12.9 patients per week after March.

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