Causes of death in #rheumatoid #arthritis: How do they compare to the general population?

http://onlinelibrary.wiley.com/doi/10.1002/acr.23548/full

A total of 11,778 (14% of) RA patients and 32,472 (9% of) comparators died during 508,385 and 1,769,365 person-years (PY) of follow-up, respectively, for corresponding mortality rates of 232 (95% CI 228, 236) and 184 (95% CI 182, 186) per 10,000 PYs. Leading causes of death in both groups were diseases of the circulatory system, cancer, and respiratory conditions. Increased mortality for all-cause and specific causes was observed in RA relative to the general population. MRRs were elevated for most causes of death. Age-specific mortality ratios illustrated a high excess mortality among RA patients under 45 years of age for respiratory disease and circulatory disease. RA patients lost 7,436 potential years of life per 10,000 persons, compared with 4,083 YPLL among those without RA.

Conclusion
Mortality rates were increased in RA patients relative to the general population across most causes of death. The potential life years lost (before the age of 75) among RA patients was roughly double that among those without RA, reflecting higher rate ratios for most causes of death and RA patients dying at earlier ages.

Prevalence of Exceeding Maximum Daily #Dose of #Acetaminophen, and Seasonal Variations in Cold-Flu Season

http://onlinelibrary.wiley.com/doi/10.1111/bcp.13551/abstract

Overall, 6.3% 95% CI: 6.0%-6.6% of users exceeded 4 grams on at least one day; 3.7% 3.5%-3.9% of usage days exceeded 4 grams. Cold/flu symptoms were more likely to be experienced and treated with acetaminophen in CFS than off-season. Acetaminophen users were more likely to exceed 4 grams during CFS (6.5% vs 5.3%; OR= 1.24, 1.04-1.48); days exceeding 4 grams also increased (3.9% vs 2.8%; OR= 1.37, 1.11-1.69). This was not due to differences in characteristics of individuals using acetaminophen in CFS, but primarily to increased use of over-the-counter (OTC) combination medications designed to treat upper respiratory cold/flu symptoms (33.2% of usage days in CFS vs 24.8% in off-season; OR=1.6, 1.5-1.7). When such medications were omitted, there was no statistically significant seasonal variation in exceeding 4 grams.

Conclusions
Acetaminophen use and over-dosing increases in CFS, primarily due to increased use of OTC combinations treating upper respiratory cold/flu symptoms. Pharmacists should warn users to follow labeled dosing directions, especially during CFS

#Fluoroquinolone use and risk of aortic #aneurysm and dissection: nationwide cohort study

http://www.bmj.com/content/360/bmj.k678

Within the 60 day risk period, the rate of aortic aneurysm or dissection was 1.2 cases per 1000 person years among fluoroquinolone users and 0.7 cases per 1000 person years among amoxicillin users. Fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection (hazard ratio 1.66 (95% confidence interval 1.12 to 2.46)), with an estimated absolute difference of 82 (95% confidence interval 15 to 181) cases of aortic aneurysm or dissection by 60 days per 1 million treatment episodes. In a secondary analysis, the hazard ratio for the association with fluoroquinolone use was 1.90 (1.22 to 2.96) for aortic aneurysm and 0.93 (0.38 to 2.29) for aortic dissection.

Conclusions In a propensity score matched cohort, fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection. This association appeared to be largely driven by aortic aneurysm

#Sarcopenia and its clinical correlates in the general population: the Rotterdam Study

http://onlinelibrary.wiley.com/doi/10.1002/jbmr.3416/full

There were no statistical differences in the prevalence of chronic diseases, with the exception of a higher prevalence of COPD in pre-sarcopenic (29.1%) and sarcopenic (26.9%) individuals compared to non sarcopenic (13.4%) individuals. Osteoporotic individuals with (OR = 2.59, 95%CI:1.41-4.45) and without sarcopenia (OR = 2.75, 95%CI: 2.01-3.75) had similar elevated risk of non-vertebral fractures. The presence of sarcopenia appears to be independent of chronic diseases with the exception of COPD and more related to life-style factors and disabilities. Sarcopenic individuals in the general population are at no greater risk of fracture than what is determined by their low BMD

Human #hippocampal #neurogenesis drops sharply in children to undetectable levels in adults

https://www.nature.com/articles/nature25975


In adult patients with epilepsy and healthy adults (18–77 years; n = 17 post-mortem samples from controls; n = 12 surgical resection samples from patients with epilepsy), young neurons were not detected in the dentate gyrus. In the monkey (Macaca mulatta) hippocampus, proliferation of neurons in the subgranular zone was found in early postnatal life, but this diminished during juvenile development as neurogenesis decreased. We conclude that recruitment of young neurons to the primate hippocampus decreases rapidly during the first years of life, and that neurogenesis in the dentate gyrus does not continue, or is extremely rare, in adult humans. The early decline in hippocampal neurogenesis raises questions about how the function of the dentate gyrus differs between humans and other species in which adult hippocampal neurogenesis is preserved

Potential negative effects of anti-#histamines on male #reproductive function

http://m.reproduction-online.org/content/early/2018/03/09/REP-17-0685.abstract

Via these receptors, HA has been reported to trigger positive or negative interactions with the LH/hCG signaling pathway depending upon its concentration, thereby contributing to the local control of testicular androgen levels. It should then be considered that anti-histamines may affect testicular homeostasis by increasing or decreasing steroid production. Additionally, HRH1 and HRH2 receptors are present in peritubular and germ cells, and HRH2 antagonists have been found to negatively affect peritubular cells and reduce sperm viability. The potential negative impact of anti-histamines on male reproduction becomes even more dramatic if we consider that HA has also been associated with human sexual behavior and penile erection. What is more, although testicular mast cells are the major source of locally produced HA, recent studies have described HDC expression in macrophages, Leydig cells and germ cells, revealing the existence of multiple sources of HA within the testis. Undoubtedly, the more we learn about the testicular histaminergic system, the more opportunities there will be for rational design of drugs aimed at treating HA-related pathologies, with minimum or nule negative impact on fertility

Role of #heme in lung bacterial infection after trauma hemorrhage and stored red blood cell #transfusion: A preclinical experimental study

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002522

Evidence from studies transfusing fresh and stored RBCs mixed with stored and fresh RBC supernatants, respectively, indicated that heme arising both during storage and from RBC hemolysis post-resuscitation plays a role in increased mortality after PAK (p < 0.001). Heme also increased endothelial permeability and inhibited macrophage-dependent phagocytosis in cultured cells. Stored RBCs also increased circulating high mobility group box 1 (HMGB1; mean 95% CI 15.4 ng/ml 6.7–24.0 for fresh RBCs and 50.3 ng/ml 12.3–88.2 for stored RBCs), and anti-HMGB1 blocking antibody protected against PAK-induced mortality in vivo (p = 0.001) and restored macrophage-dependent phagocytosis of P. aeruginosa in vitro. Finally, we showed that TH patients, admitted to the University of Alabama at Birmingham ER between 1 January 2015 and 30 April 2016 (n = 50), received high micromolar–millimolar levels of heme proportional to the number of units transfused, sufficient to overwhelm endogenous hemopexin levels early after TH and resuscitation. Limitations of the study include lack of assessment of temporal changes in different products of hemolysis after resuscitation and the small sample size precluding testing of associations between heme levels and adverse outcomes in resuscitated TH patients.

Conclusions
We provide evidence that large volume resuscitation with stored blood, compared to fresh blood, in mice increases mortality from subsequent pneumonia, which occurs via mechanisms sensitive to hemopexin and TLR4 and HMGB1 inhibition

#Endovascular treatment for acute ischaemic #stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry)

http://www.bmj.com/content/360/bmj.k949


1488 patients included in the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR CLEAN) Registry who had received endovascular treatment, including stent retriever thrombectomy, aspiration, and all alternative methods for acute ischaemic stroke within 6.5 hours from onset of symptoms between March 2014 and June 2016

A statistically significant shift was observed towards better functional outcome in patients in the MR CLEAN Registry compared with the MR CLEAN trial intervention arm (adjusted common odds ratio 1.30, 95% confidence interval 1.02 to 1.67) and the MR CLEAN trial control arm (1.85, 1.46 to 2.34). The reperfusion rate, with successful reperfusion defined as a score of 2B-3 on the extended thrombolysis in cerebral infarction score, was 58.7%, the same as for patients in the MR CLEAN trial. Duration from onset of stroke to start of endovascular treatment and from onset of stroke to successful reperfusion or last contrast bolus was one hour shorter for patients in the MR CLEAN Registry. Symptomatic intracranial haemorrhage occurred in 5.8% of patients in the MR CLEAN Registry compared with 7.7% in the MR CLEAN trial intervention arm and 6.4% in the MR CLEAN trial control arm.

Conclusion In routine clinical practice, endovascular treatment for patients with acute ischaemic stroke is at least as effective and safe as in the setting of a randomised controlled trial

#Gut bacteria selectively promoted by dietary #fibers alleviate type 2 diabetes

http://science.sciencemag.org/content/359/6380/1151

The gut microbiota benefits humans via short-chain fatty acid (SCFA) production from carbohydrate fermentation, and deficiency in SCFA production is associated with type 2 diabetes mellitus (T2DM). We conducted a randomized clinical study of specifically designed isoenergetic diets, together with fecal shotgun metagenomics, to show that a select group of SCFA-producing strains was promoted by dietary fibers and that most other potential producers were either diminished or unchanged in patients with T2DM. When the fiber-promoted SCFA producers were present in greater diversity and abundance, participants had better improvement in hemoglobin A1c levels, partly via increased glucagon-like peptide-1 production. Promotion of these positive responders diminished producers of metabolically detrimental compounds such as indole and hydrogen sulfide. Targeted restoration of these SCFA producers may present a novel ecological approach for managing T2DM.

Low-level #lead exposure and #mortality in US adults: a population-based cohort study

http://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30025-2/fulltext


During median follow-up of 19·3 years (IQR 17·6–21·0), 4422 people died, 1801 (38%) from cardiovascular disease and 988 (22%) from ischaemic heart disease. An increase in the concentration of lead in blood from 1·0 μg/dL to 6·7 μg/dL (0·048 μmol/L to 0·324 μmol/L), which represents the tenth to 90th percentiles, was associated with all-cause mortality (hazard ratio 1·37, 95% CI 1·17–1·60), cardiovascular disease mortality (1·70, 1·30–2·22), and ischaemic heart disease mortality (2·08, 1·52–2·85). The population attributable fraction of the concentration of lead in blood for all-cause mortality was 18·0% (95% CI 10·9–26·1), which is equivalent to 412 000 deaths annually. Respective fractions were 28·7% (15·5–39·5) for cardiovascular disease mortality and 37·4% (23·4–48·6) for ischaemic heart disease mortality, which correspond to 256 000 deaths a year from cardiovascular disease and 185 000 deaths a year from ischaemic heart disease.

Interpretation
Low-level environmental lead exposure is an important, but largely overlooked, risk factor for cardiovascular disease mortality in the USA. A comprehensive strategy to prevent deaths from cardiovascular disease should include efforts to reduce lead exposure

Direct-acting #Antivirals Do Not Increase the Risk of #Hepatocellular Carcinoma Recurrence after Local-Regional Therapy or Liver Transplant Waitlist Dropout

http://onlinelibrary.wiley.com/doi/10.1002/hep.29855/abstract

Whether direct-acting antivirals (DAA) increase the risk of hepatocellular carcinoma (HCC) recurrence after tumor-directed therapy is controversial. We sought to determine the impact of DAA therapy on HCC recurrence after local-regional therapy (LRT) and waitlist dropout among liver transplant (LT) candidates with HCC. We performed a retrospective cohort study of 149 LT candidates with HCV and HCC at a single center from 2014-2016. Cumulative incidence of HCC recurrence post-LRT and waitlist dropout was estimated by DAA group. Factors associated with each outcome were evaluated using competing risks regression. A propensity score stabilized inverse probability weighting approach was used to account for differences in baseline characteristics between groups. The no DAA group (n=87) had more severe cirrhosis and lower rates of complete radiologic tumor response after LRT than those treated with DAA (n=62), but had similar alpha-fetoprotein and tumor burden at listing. Cumulative incidence of HCC recurrence within 1-year of complete response after LRT was 47.0% in the DAA group and 49.8% in the no DAA group (p=0.93). In adjusted competing risk analysis using weighted propensity score modeling, risk of HCC recurrence was similar in the DAA group compared to those without DAA (HR 0.91, 95% CI 0.58-1.42, p=0.67). Patients treated with DAA had lower risk of waitlist dropout due to tumor progression or death compared to the no DAA group in adjusted weighted analysis (HR 0.30, 95% CI 0.13-0.69, p=0.005).

Conclusions: In LT candidates with HCV and HCC with initial complete response to LRT, DAA use is not associated with increased risk of HCC recurrence, but rather is associated with reduced risk of waitlist dropout due to tumor progression or death

Relationship between serum #urate concentration and clinically evident incident #gout: an individual participant data analysis

http://ard.bmj.com/content/early/2018/02/28/annrheumdis-2017-212288


This analysis included 18 889 participants who were gout-free at baseline, with mean (SD) 11.2 (4.2) years and 212 363 total patient-years of follow-up. The cumulative incidence at each time point varied according to baseline serum urate concentrations, with 15-year cumulative incidence (95% CI) ranging from 1.1% (0.9 to 1.4) for <6 mg/dL to 49% (31 to 67) for ≥10 mg/dL. Compared with baseline serum urate <6 mg/dL, the adjusted HR for baseline serum urate 6.0–6.9 mg/dL was 2.7, for 7.0–7.9 mg/dL was 6.6, for 8.0–8.9 mg/dL was 15, for 9.0–9.9 mg/dL was 30, and for ≥10 mg/dL was 64.

Conclusions Serum urate level is a strong non-linear concentration-dependent predictor of incident gout. Nonetheless, only about half of those with serum urate concentrations ≥10mg/dL develop clinically evident gout over 15 years, implying a role for prolonged hyperuricaemia and additional factors in the pathogenesis of gout

Quantifying population-level health benefits and #harms of #ecigarette use in the United States

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193328

The model estimated that 2,070 additional current cigarette smoking adults aged 25–69 (95% CI: -42,900 to 46,200) would quit smoking in 2015 and remain continually abstinent from smoking for ≥7 years through the use of e-cigarettes in 2014. The model also estimated 168,000 additional never-cigarette smoking adolescents aged 12–17 and young adults aged 18–29 (95% CI: 114,000 to 229,000), would initiate cigarette smoking in 2015 and eventually become daily cigarette smokers at age 35–39 through the use of e-cigarettes in 2014. Overall, the model estimated that e-cigarette use in 2014 would lead to 1,510,000 years of life lost (95% CI: 920,000 to 2,160,000), assuming an optimistic 95% relative harm reduction of e-cigarette use compared to cigarette smoking. As the relative harm reduction decreased, the model estimated a greater number of years of life lost. For example, the model estimated-1,550,000 years of life lost (95% CI: -2,200,000 to -980,000) assuming an approximately 75% relative harm reduction and -1,600,000 years of life lost (95% CI: -2,290,000 to -1,030,000) assuming an approximately 50% relative harm reduction.

Conclusions
Based on the existing scientific evidence related to e-cigarettes and optimistic assumptions about the relative harm of e-cigarette use compared to cigarette smoking, e-cigarette use currently represents more population-level harm than benefit. Effective national, state, and local efforts are needed to reduce e-cigarette use among youth and young adults if e-cigarettes are to confer a net population-level benefit in the future

Trends in Hospitalizations for #Acute #Kidney Injury — United States, 2000–2014

https://www.cdc.gov/mmwr/volumes/67/wr/mm6710a2.htm

Clinicians increasingly recognize acute kidney injury as an in-hospital complication of sepsis, heart conditions, and surgery. It is associated with higher likelihood of long-term care, increased incidence of chronic kidney disease, increased hospital mortality, and higher health care costs. A number of U.S. studies have indicated an increasing incidence of dialysis-treated acute kidney injury since the late 1990s.

Analysis of data from the 2000–2014 National Inpatient Sample and the National Health Interview Surveys indicates a significant absolute and relative increase in hospitalization rates for acute kidney injury among men and women in the United States. Hospitalization for acute kidney injury among persons with diabetes accounted for approximately 40% of all such hospitalizations; absolute increases in hospitalization rates among persons with diabetes were larger than those among persons without diabetes.

Diabetes is a known risk factor for acute kidney injury. The increasing number of persons living with diabetes is likely to also increase the number of persons with acute kidney injury. Improved awareness by health care providers that diabetes, hypertension, and advanced age are important risk factors for acute kidney injury might reduce its occurrence and improve management of the underlying diseases in an aging population

Midlife #cardiovascular fitness and #dementia
A 44-year longitudinal population study in women

http://n.neurology.org/content/early/2018/03/14/WNL.0000000000005290


Compared with medium fitness, the adjusted hazard ratio for all-cause dementia during the 44-year follow-up was 0.12 (95% confidence interval CI 0.03–0.54) among those with high fitness and 1.41 (95% CI 0.72–2.79) among those with low fitness. High fitness delayed age at dementia onset by 9.5 years and time to dementia onset by 5 years compared to medium fitness.

Conclusions Among Swedish women, a high cardiovascular fitness in midlife was associated with a decreased risk of subsequent dementia. Promotion of a high cardiovascular fitness may be included in strategies to mitigate or prevent dementia. Findings are not causal, and future research needs to focus on whether improved fitness could have positive effects on dementia risk and when during the life course a high cardiovascular fitness is most important.

Long Term Outcomes and Predictive Scores for #Hepatocellular Carcinoma and #HBsAg Seroclearance after #HBeAg Seroclearance

http://onlinelibrary.wiley.com/doi/10.1002/hep.29874/abstract

The significance of hepatitis B e-antigen seroclearance (ESC) in the long term is not well defined. The current study aimed to determine the clinical outcomes, the factors and predictive scores for hepatocellular carcinoma (HCC) and hepatitis B surface antigen (HBsAg) seroclearance of a large cohort of patients undergoing ESC. Patients with documented ESC were followed up 3-6 monthly. Baseline characteristics and longitudinal laboratory results were recorded. Predictive scores for HCC (HCC-ESC) and HBsAg seroclearance (HBsAg-ESC) were derived from multivariate Cox regression models. A total of 723 patients underwent ESC with a median ESC age and follow-up of 36.0 and 18.3 years respectively. Only 3.5% and 3.0% had persistently normal ALT and HBV DNA <2logs IU/mL respectively after ESC. For patients with 100%, 100-90%, 90-50%, 50-10%, 10-0%, and 0% normal ALT after HBeAg seroclearance, the rate of HCC was 4.3%, 2.2%, 3.6%, 3.9%, 17.3%, and 37.2% at 20 years after ESC respectively (p<0.001). At 20 years after ESC, the cumulative incidence of HCC and HBsAg seroclearance was 7.9% and 13.5% respectively, with an overall survival of 91.5%. ESC age, male sex, cirrhosis, hypoalbuminemia, viral load, and ALT were significant factors for HCC, whereas ESC age, male sex, viral load, and antiviral therapy were significant factors for HBsAg seroclearance. The AUROC for HCC-ESC and HBsAg-ESC scores to predict HCC and HBsAg seroclearance at 20 years after ESC was 0.92 and 0.74 respectively.

The Role of Aging, Drug Dependence, and Hepatitis #C Comorbidity in #Alcoholism #Cortical Compromise

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2674964

Given the high drug-dependence incidence (54.5%) in the alcoholism group, analysis examined drug subgroups (cocaine, cannabis, amphetamines, opiates) compared with drug-dependence–free alcoholism and control groups. Although the alcohol plus cocaine (t = −2.310, P = .04) and alcohol plus opiate (t = −2.424, P = .04) groups had smaller frontal volumes than the drug-dependence–free alcoholism group, deficits in precentral (t = −2.575, P = .01), supplementary motor (t = −2.532, P = .01), and medial (t = −2.800, P = .01) volumes endured in drug-dependence–free participants with alcoholism compared with control participants. Those with HCV infection had greater deficits than those without HCV infection in frontal (t = 3.468, P = .01), precentral (t = 2.513, P = .03), superior (t = 2.533, P = .03), and orbital (t = 2.506, P = .03) volumes, yet total frontal (t = 2.660, P = .02), insular (t = 3.526, P = .003), parietal (t = 2.414, P = .03), temporal (t = 3.221, P = .005), and precentral (t = 3.180, P = .01) volume deficits persisted in the uninfected participants with alcoholism compared with control participants with known HCV status.

Conclusions and Relevance Drug dependence and HCV infection compounded deleterious effects of alcohol dependence on frontal cortical volumes but could not account for the frontally distributed volume deficits in the drug-free participants with alcoholism. We speculate that age-alcohol interactions notable in frontal cortex put older adults at heightened risk for age-associated neurocompromise even if alcohol misuse is initiated later in life

Behaviors, movements, and #transmission of droplet-mediated respiratory diseases during transcontinental airline #flights

http://www.pnas.org/content/early/2018/03/13/1711611115

Over a dozen cases of inflight transmission of serious infections have been documented, and air travel can serve as a conduit for the rapid spread of newly emerging infections and pandemics. Despite sensational media stories and anecdotes, the risks of transmission of respiratory viruses in an airplane cabin are unknown. Movements of passengers and crew may facilitate disease transmission. On 10 transcontinental US flights, we chronicled behaviors and movements of individuals in the economy cabin on single-aisle aircraft. We simulated transmission during flight based on these data. Our results indicate there is low probability of direct transmission to passengers not seated in close proximity to an infectious passenger. This data-driven, dynamic network transmission model of droplet-mediated respiratory disease is unique. To measure the true pathogen burden, our team collected 229 environmental samples during the flights. Although eight flights were during Influenza season, all qPCR assays for 18 common respiratory viruses were negative

Efficacy of foot #orthoses for the treatment of plantar #heel pain: a systematic review and meta-analysis

http://bjsm.bmj.com/content/early/2018/02/23/bjsports-2017-097892

Twenty studies investigating eight different types of foot orthoses were included in the review. Most studies were of high quality. Pooled data from six studies showed no difference between prefabricated orthoses and sham orthoses for pain at short term (mean difference (MD) of 0.26 (95% CI −0.09 to 0.60)). No difference was found between sham orthoses and custom orthoses for pain at short term (MD 0.22 (95% CI −0.05 to 0.50)), nor was there a difference between prefabricated orthoses and custom orthoses for pain at short term (MD 0.03 (95% CI −0.15 to 0.22)). For the majority of other interventions, no significant differences were found.

Conclusions Foot orthoses are not superior for improving pain and function compared with sham or other conservative treatment in patients with PHP

Association of Inhaled Corticosteroids and Long-Acting #Muscarinic Antagonists With Asthma Control in Patients With Uncontrolled, Persistent #Asthma

https://jamanetwork.com/journals/jama/fullarticle/2675736

Of 1326 records identified, 15 randomized clinical trials (N = 7122 patients) were included. Most trials assessed adding LAMA vs placebo or LAMA vs LABA to inhaled corticosteroids. Adding LAMA vs placebo to inhaled corticosteroids was associated with a significantly reduced risk of exacerbation requiring systemic corticosteroids (RR, 0.67 95% CI, 0.48 to 0.92; RD, −0.02 95% CI, −0.04 to 0.00). Compared with adding LABA, adding LAMA to inhaled corticosteroids was not associated with significant improvements in exacerbation risk (RR, 0.87 95% CI, 0.53 to 1.42; RD, 0.00 95% CI, −0.02 to 0.02), or any other outcomes of interest. Triple therapy was not significantly associated with improved exacerbation risk vs inhaled corticosteroids and LABA (RR, 0.84 95% CI, 0.57 to 1.22; RD, −0.01 95% CI, −0.08 to 0.07).

Conclusions and Relevance In this systematic review and meta-analysis, the use of LAMA compared with placebo as add-on therapy to inhaled corticosteroids was associated with a lower risk of asthma exacerbations; however, the association of LAMA with benefit may not be greater than that with LABA. Triple therapy was not associated with a lower risk of exacerbations

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#MS #stem cell treatment stabilises disease and reduces disability, trial shows

http://www.sth.nhs.uk/news/news?action=view&newsID=1035

•MIST is the first ever international large scale randomised trial into autologous haematopoietic stem cell transplantation (AHSCT) in relapsing remitting multiple sclerosis (MS) and has shown that the treatment stabilised the disease and improves disability in people who had experienced 2 or more relapses in the year before joining the trial 110 people with active relapsing remitting MS despite been treated with disease modifying drugs were randomised to receive either the best available drug treatment or AHSCT.

• During the treatment follow up period, disability improved significantly after AHSCT.
• The EDSS score of patients receiving the transplantation improved from an average of 3.5 to 2.4, which is unprecedented in MS treatment trials. This contrasted significantly with those receiving standard drug treatment whose EDSS scores declined from an average score of 3.3 to 3.9.
• Within a year of joining the trial, only one patient in the transplant arm of the trial suffered a relapse compared to 39 relapses observed in the drug treatment arm.
• With a mean follow up of 3 years, treatment failure measured by disability progression was 6% in the HSCT arm and 60% in drug treatment arm.
• 30 people who were originally randomly allocated into the drug treatment arm of the trial were moved over to the transplant arm during the trial period after they had a decline in their EDSS scores. After AHSCT their scores improved from 5.2 to 2.6.
• No person in the AHSCT arm suffered any significant side effects.