Above Image: Lisa Morgan, Eloise Hinson & A/Prof Helmut Butzkueven of MSBase Foundation Ltd, along with MSBase University of Melbourne Research Fellows Dr Tomas Kalincik and Dr Vilija Jokubaitis. Introducing the MSBase Project Team MSBase is an international multiple sclerosis (MS) registry that is helping answer many questions about MS. In this short video, Associate Professor Helmut Butzkueven (neurologist, MS researcher) explains MSBase and the work being undertaken by the MSBase project team, who form part of the Multiple Sclerosis Research Unit. While A/Prof Butzkueven provides a high-level overview of the team’s work, the following research summaries, provided by Dr Tomas Kalincik and Dr Vilija Jokubaitis, go into greater detail about the types of research projects being undertaken. SEX AS A DETERMINANT OF RELAPSE INCIDENCE AND PROGRESSIVE COURSE OF MULTIPLE SCLEROSIS Dr Tomas Kalincik et al Relapses of MS activity present with worsening of neurological symptoms and are usually followed by periods of stability. These are a defining feature of relapsing-remitting MS, the most common form of MS. MSBase is a large, international collaboration that records large amounts of information from people with MS over the course of their disease. Researchers from The University of Melbourne used the MSBase to conduct a large study examining the relationship between gender and relapses. The study used data from 11,570 patients with relapsing-remitting MS from 25 countries. It showed that women are more likely to experience relapses than men. In particular, among patients with multiple relapses per year, there are more women than men, especially later in the disease course. It has been shown that the frequency of relapses decreases with time. The MSBase study showed that this decrease is determined more by patient age than MS duration. The mechanisms underlying the relationship between sex and relapses are unknown, and figuring this out may improve our understanding of the mechanisms of MS. RISK OF RELAPSE PHENOTYPE RECURRENCE IN MULTIPLE SCLEROSIS Dr Tomas Kalincik et al Relapses of MS activity present with worsening of neurological symptoms and are usually followed by periods of stability. They are a defining feature of relapsing-remitting MS, the most common MS form. Relapses may present with a variety of symptoms, which may be classified by the neurological function they involve into visual, sensory, motor, cerebellar (affecting mainly balance and coordination), brainstem (affecting mainly sensation in the face and the function of the facial muscles), bowel and bladder, and cognitive (affecting mental performance). MSBase is a large, international collaboration that records large amounts of information from people with MS over the course of their disease. Researchers from the University of Melbourne used the MSBase to examine how patient sex, age, MS type or MS duration relates to the type of relapse experienced. The study used data from 14969 patients with relapsing MS from 25 countries. It examined 49276 recorded relapses. The study showed that women were more likely to experience visual and sensory relapses, while men are more prone to motor, cerebellar and brainstem relapses. While younger patients more commonly encounter visual and brainstem relapses, older patients are more likely to experience motor and bowel or bladder relapses. Visual, sensory and brainstem relapses are more common in early MS, whereas motor and cerebellar relapses are more frequent later in the disease. Importantly, patients with a history of certain relapse types tend to experience similar relapses again. This study indicates that a variety of factors may influence the type of relapse that a person with MS undergoes. Understanding the factors that determine the type of relapse experienced may help us better understand the mechanisms of MS itself. FINGOLIMOD AFTER NATALIZUMAB AND THE RISK OF SHORT-TERM RELAPSE Dr Vilija Jokubaitis et al Natalizumab (Tysabri) is an antibody used for the treatment of multiple sclerosis (MS). It is currently the strongest drug available for the treatment of MS, however, it has also been linked to a small number of cases of progressive multifocal leukoencephalopathy (PML). Fingolimod (Gilenya) is a relatively new MS treatment and has become a common choice for people with MS who have not responded to a first-choice therapy or are at risk of developing PML. Recently, it was reported that a small number of people who transferred from Tysabri to Gilenya experienced a large increase in relapses in the first 6 months on Gilenya, whereas some people also reported having very severe relapses on Gilenya. To determine whether this occurrence was linked to the move from Tysabri to Gilenya, this study utilised the independent MSBase registry database to examine 536 people with MS using Gilenya for the first time. The study investigated the relapse rate from people in three different groups: People on Tysabri moving to Gilenya People on interferon-beta/Copaxone moving to Gilenya People taking Gilenya as a first ever treatment for MS The results indicated that the relapse rate after the switch to Gilenya was low in all groups. Relapse activity in the 6 months prior to treatment with Gilenya was found to be the best predictor to future relapse rate. Based on this study, the investigators suggested a maximum 2 month gap when switching from Tysabri to Gilenya to decrease the potential for relapse (this gap is not required when switching from injectable medications). The severe relapses and increased relapse activity reported in other studies could, therefore, be a result of very long treatment gaps between Tysabri and Gilenya or it could be the result of a Gilenya-specific side effect in a very small number of patients. People with MS should be reassured that, in most cases, switching from Tysabri to Gilenya is safe and does not result in increased relapses.