Searched for: in-biosketch:true
person:kistei01
NATALIZUMAB EXTENDED INTERVAL DOSING (EID) IS ASSOCIATED WITH A SIGNIFICANT REDUCTION IN PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML) RISK COMPARED WITH STANDARD INTERVAL DOSING (SID) IN THE TOUCH (R) PRESCRIBING PROGRAM [Meeting Abstract]
Ryerson, Lana Zhovtis; Foley, John; Chang, Ih; Kister, Ilya; Cutter, Gary; Metzger, Ryan; Goldberg, Judith D.; Li, Xiaochun; Riddle, Evan; Smirnakis, Karen; Yu, Bei; Ren, Zheng; Hotermans, Christophe; Ho, Pei-Ran; Campbell, Nolan
ISI:000438056200071
ISSN: 0022-3050
CID: 5191992
Short-term disability progression in two multiethnic multiple sclerosis centers in the treatment era
Kister, Ilya; Bacon, Tamar E; Cutter, Gary R
Background/UNASSIGNED:Short-term disease progression is well documented in clinical trials, but there are limited published data on disease course in real-life practice. Methods/UNASSIGNED:Patient-Determined Disease Steps (PDDS). Clinicians recorded disease subtype and relapse status at each visit, but did not rate disability. PMSSS change from the first to the last visit was calculated for the cohort as a whole and for subgroups of interest. Multivariable regression models were constructed for predicting final PMSSS based on readily available predictor variables collected at the initial visit and relapse history during follow up. Results/UNASSIGNED:0.28). The only major predictor of final PMSSS was the initial PMSSS. Demographic variables (age, sex, race) or relapse status did not predict final severity score. Conclusions/UNASSIGNED:Baseline disability in two MS clinics was much lower than in the reference population from which PMSSS was derived. We observed no discernable slowing of disability accumulation during the short-term follow up in our cohort compared with the reference cohort. Overwhelmingly the most important predictor of final disease severity rank score was the initial disease severity rank score.
PMCID:6134488
PMID: 30214486
ISSN: 1756-2856
CID: 3277922
Clinical Reasoning: A patient with a history of encephalomyelitis and recurrent optic neuritis
Gutman, Josef Maxwell; Levy, Michael; Galetta, Steven; Kister, Ilya
PMCID:5679419
PMID: 29109139
ISSN: 1526-632x
CID: 2772062
Predictors of relapses and disability progression after stopping disease-modifying therapies for multiple sclerosis [Meeting Abstract]
Kister, I; Spelman, T; Patti, F; Duquette, P; Trojano, M; Izquierdo, G; Lugaresi, A; Grammond, P; Sola, P; Ferraro, D; Grand'Maison, F; Alroughani, R; Terzi, M; Boz, C; Hupperts, R; Lechner-Scott, J; Kapos, L; Pucci, E; Hodgkinson, S; Solaro, C; Butzkueven, H
Background: MS patients often stop disease-modifying therapy (DMT). MSBase, a 50,000-patient, global observational MS registry, provides a unique opportunity to identify predictors of relapses and disease progression after DMTs are stopped. Objectives: To identify predictors of relapse and confirmed disability progression after stopping DMTs. Methods: We included MS patients who, at the time of stopping DMT, were >=18 years and were on a DMT continuously for >=1 year. We also required that, after stopping DMT, each patient be followed for >2 years; did not restart DMT for > 6 months (to exclude therapy 'switchers'); and did not become pregnant for >1 year. Predictors of time to first relapse and 3-month confirmed progression (1.5 EDSS steps for baseline EDSS 0; 0.5-for baseline EDSS 6-6.5; 1-for all others) were analyzed using Cox proportional hazards regression. Hazard proportionality was assessed with scaled Schoenfeld residuals; p< 0.05 was considered significant. Results: We identified 4,842 patients in the MSBase who met our inclusion criteria (74% female; mean (SD) age 40.7 years (10.4); mean (SD) disease duration 11.6 years (7.7)). Median (IQR) EDSS at baseline was 3 (1.5, 5.5). The discontinued DMTs were: IFNb-1a sc in 28%; IFNb-1b-26%; IFNb-1a im-20%; glatiramer acetate 18%; natalizumab-6%; fingolimod 3%. Most common reasons for discontinuation, recorded for 48% patients, were adverse events (9%), inconvenience (7%) and intolerance (7%). Post-DMT follow up was 31,691 patient-years. Post-DMT annualized relapse rate (ARR) was 0.22 and was lowest post-IFNb-1b (ARR=0.19) and highest post-Natalizumab (ARR=0.32). Disability data was available for 2,678 patients. The incidence of post-DMT confirmed disability progression was 8.23 per 100 person-years (95% CI: 7.72, 8.76); it was lowest post-IFNb-1a (6.40 (5.45, 7.51)) and highest post-Natalizumab (12.55 (10.04, 15.69). DMT was restarted by 2,984 (61.6%) patients after a median (IQR) of 18.22 months (IQR 10.97, 36.60). For each DMT, we will present predictors of time to relapse and confirmed disability progression, and DMT restart based on Cox regression model. Conclusions: Understanding risk factors for post-DMT relapses and disability accumulation after cessation of DMTs may allow clinicians to identify patients at low risk of disease worsening, who may choose to safely discontinue a particular DMT, and those at high risk, who would be well advised to continue on therapy
EMBASE:619357797
ISSN: 1477-0970
CID: 2871672
Hispanic Americans and African Americans with multiple sclerosis have more severe disease course than Caucasian Americans
Ventura, Rachel E; Antezana, Ariel O; Bacon, Tamar; Kister, Ilya
Whether disease course in Hispanic Americans (HA) with multiple sclerosis (MS) is different from Caucasian Americans (CA) or African Americans (AA) is unknown. We compared MS severity in the three main ethnic populations in our tertiary MS clinics using disease duration-adjusted rank score of disability: Patient-Derived Multiple Sclerosis Severity Score (P-MSSS). The age- and gender-adjusted P-MSSS was significantly higher in HA (3.9 +/- 2.6) and AA (4.5 +/- 3.0) compared to CA (3.4 +/- 2.6; p < 0.0001 for both). Adjusting for insurance did not change these results. These findings suggest that HA, as AA, have more rapid disability accumulation than CA.
PMID: 27899551
ISSN: 1477-0970
CID: 2329282
Disease-modifying therapies can be safely discontinued in an individual with stable relapsing-remitting
Kister, Ilya
PMID: 28673111
ISSN: 1477-0970
CID: 2617192
Which symptoms contribute the most to patients' perception of health in multiple sclerosis?
Green, Rivka; Cutter, Gary; Friendly, Michael; Kister, Ilya
BACKGROUND: Multiple sclerosis is a polysymptomatic disease. Little is known about relative contributions of the different multiple sclerosis symptoms to self-perception of health. OBJECTIVES: To investigate the relationship between symptom severity in 11 domains affected by multiple sclerosis and self-rated health. METHODS: Multiple sclerosis patients in two multiple sclerosis centers assessed self-rated health with a validated instrument and symptom burden with symptoMScreen, a validated battery of Likert scales for 11 domains commonly affected by multiple sclerosis. Pearson correlations and multivariate linear regressions were used to investigate the relationship between symptoMScreen scores and self-rated health. RESULTS: Among 1865 multiple sclerosis outpatients (68% women, 78% with relapsing-remitting multiple sclerosis, mean age 46.38 +/- 12.47 years, disease duration 13.43 +/- 10.04 years), average self-rated health score was 2.30 ('moderate to good'). Symptom burden (composite symptoMScreen score) highly correlated with self-rated health (r = 0.68, P < 0.0001) as did each of the symptoMScreen domain subscores. In regression analysis, pain (t = 7.00), ambulation (t = 6.91), and fatigue (t = 5.85) contributed the highest amount of variance in self-rated health (P < 0.001). CONCLUSIONS: Pain contributed the most to multiple sclerosis outpatients' perception of health, followed by gait dysfunction and fatigue. These findings suggest that 'invisible disability' may be more important to patients' sense of wellbeing than physical disability, and challenge the notion that physical disability should be the primary outcome measure in multiple sclerosis.
PMCID:5588807
PMID: 28904811
ISSN: 2055-2173
CID: 2701412
Total hip and knee arthroplasty in multiple sclerosis patients: The NYU experience [Meeting Abstract]
Gutman, J; Schwarzkopf, R; Kister, I
Objective: To investigate indications for and outcomes of total hip and knee arthroplasty in patients with multiple sclerosis (MS). Background: MS patients may need joint replacement due to MS-related factors, such as falls or avascular necrosis, or for unrelated indications (eg primary/secondary osteoarthritis). Literature on outcomes of total joint replacement in MS patients is limited to case reports that highlight surgical complications or unusual presentations. There are no systematic reviews of indications for and short- and long-term outcomes of hip and knee arthroplasty in MS patients. Design/Methods: Retrospective chart review of NYU MS Center patients who underwent hip or knee arthroplasty after MS onset. Results: 13 MS patients followed at NYU MS Care Center underwent hip (N=8) or knee (N=5) replacement at NYU. Average age at surgery was 56+/-11 years (range 35-69 years) and MS duration was 16+/-9 years; 10/13 were female. 3 patients had prior joint trauma and 1 had avascular necrosis of the hip presumably from steroid use; the remainder suffered from osteoarthritis. Ambulatory status before surgery was: 4-walking unassisted, 7 - cane, 2 - bilateral assistance. Ambulatory status after surgery at last follow up was: 8 walking unassisted, 3 using a cane, and 2 using a walker. Perioperative complications included acute blood loss in 4, pneumonia in 2, DVT in 1, and urinary retention in 1. Reoperation was required in 1 patient for recurrent hip dislocation. Conclusions: Orthopaedic literature focuses on perioperative complications after total joint arthroplasty in MS patients, but our data on unselected patients show that the surgery appears to benefit most of them, though (mostly) non-neurologic complications were seen in approximately half of the cases. These data can help optimize selection and surgical management of MS patients who are considering knee or hip replacement. We intend to present additional data on our patients that will include patient-reported outcomes
EMBASE:616555869
ISSN: 1526-632x
CID: 2608492
Author response: Reducing costs while enhancing quality of care in MS
Kister, Ilya; Corboy, John
PMID: 28320926
ISSN: 1526-632x
CID: 2518492
SymptoMScreen: A Tool for Rapid Assessment of Symptom Severity in MS Across Multiple Domains
Green, R; Kalina, J; Ford, R; Pandey, K; Kister, I
The objective of this study was to describe SymptoMScreen, an in-house developed tool for rapid assessment of MS symptom severity in routine clinical practice, and to validate SymptoMScreen against Performance Scales (PS). MS patients typically experience symptoms in many neurologic domains. A tool that would enable MS patients to efficiently relay their symptom severity across multiple domains to the healthcare providers could lead to improved symptom management. We developed "SymptoMScreen," a battery of 7-point Likert scales for 12 distinct domains commonly affected by MS: mobility, dexterity, body pain, sensation, bladder function, fatigue, vision, dizziness, cognition, depression, and anxiety. We administered SymptoMScreen and PS scales to consecutive MS patients at a specialty MS Care Center. We assessed the criterion and construct validity of SymptoMScreen by calculating Spearmen rank correlations between the SymptoMScreen composite score and PS composite score, and between SymptoMScreen subscale and the respective PS subscale scores, where applicable. A total of 410 patients with MS (age 46.6 +/- 12.9 years; 74% female; mean disease duration 12.2 +/- 8.7 years) completed the SymptoMScreen and PSs during their clinic visit. Composite SymptoMScreen score correlated strongly with combined PS score (r = 0.88, p < 0.0001). SymptoMScreen sub scores correlated strongly with the criterion measures of the respective PS (r = 0.69-0.87, p < 0.0001). Test-retest reliability of SymptoMScreen and its subscales was excellent (r = 0.71-0.94, p < .0001). SymptoMScreen is a single-page battery of Likert scales that assesses symptom impact in 12 domains commonly affected in MS. It has excellent criterion and construct validity. SymptoMScreen is patient and clinician friendly, takes approximately one minute to complete, and can help better document, understand, and manage patients' symptoms in routine clinical practice. SymptoMScreen is freely available to clinicians and researchers.
PMID: 27077687
ISSN: 2327-9109
CID: 2078422