• In 2020, approximately 600,000 Canadians live with dementia, with this number expected to reach 1 million by 2030 [1]
• As the disease progresses, there comes a point where it is significantly difficult for caregivers to fulfill the needs of a patient with dementia in the community, and may lead to increased distress and burden [2]
• A timely admission into LTC is vital for the optimal care of the patient and caregivers alike [3]

Identify the predictors of a transition to Long-Term Care in those presenting to the Rural and Remote Memory Clinic established in Saskatchewan.

• The charts of 635 community-dwelling participants presenting to the Rural and Remote Memory Clinic between its onset in March 2004 through June 2019 were reviewed and included in final data analysis. Of these, 222 did not transition to LTC and 413 have transitioned to LTC within two years of their first visit.
• At first visit, the patients and accompanying caregivers completed a series of psychometrically validated scales such as the Mini Mental Status Examination (MMSE), Functional Assessment Questionaire (FAQ), Clinical Dementia Rating scale (CDR), and the Neuropsychatric Inventory (NPI). Demographic information was also collected at first visit, and then the neurologist would administer a diagnosis. 

---

• The sample comprised of ~42% men and ~58% women. The most frequent diagnosis among those moved to LTC within two years (n = 222) was Alzheimer’s disease followed by non-AD dementia. In both groups, most caregivers accompanying the participants were their spouses, followed by their daughters. Participants, on average, were approximately 70 years old and had at least 10 years of formal education.
• Significant predictors include older age, gender (female), higher FAQ scores (more functional dependency), lower MMSE scores, and higher CDR scores.
• Neuropsychiatric symptoms, associated caregiver distress, and education were not significant.

• Significant predictors identified include older age, less ADL independence (FAQ), deteriorating cognition (MMSE), and more severe dementia (CDR), which is expected and consistent with previous meta-analyses and systematic reviews. [4-7].
• Women may be more prone to transition to LTC within the first two years of presentation due to significantly faster declines in global cognition and executive function [8], or longer life expectancy and higher morbidity as a result. 
• Neither severity, distress of neuropsychiatric symptoms nor education were significant, contrary to a multi-national European study [9]. This may reflect that physical dependencies rather than neuropsychiatric symptoms are primarily used as a threshold for LTC admission among caregivers, especially in considering the challenges of a rural population and differential access to facilities. 
• Early identification of higher risk individuals can direct the efforts of timely intervention aimed at preserving functional independence as well as cognition. Support programs that target activities of daily living and cognitive preservation strategies would be ideal in this population to potentially delay the LTC transition.

• By identifying these predictors in our patient population, potentially modifiable risk factors can be targeted with interventions to delay the transition to LTC.
• As this clinic continues to provide care to our rural population, these results direct our intervention strategies and allow us to refine our approach to caring for rural patients with dementia.

---

Conclusion

• We found AQP4 seropositive in ~ 3 % and MOG –IgG positive in ~  8% of tested samples
• Both anti-MOG and anti-AQP4 antibodies are more prevalent in females, although the difference is not statistically significant
• Anti-MOG antibodies are observed across a broad age range—from infancy to old age—whereas anti-AQP4 antibodies are typically found in older individuals, ranging from approximately 10 to 90 years

References
1. Waters PJ, Pittock SJ, Bennett JL, et al. Evaluation of aquaporin-4 antibody assays. Clin Exp Neuroimmunol. 2014; 5:290–303. DOI: 10.1111/cen3. 12107.
2. Waters PJ, Komorowski L, Woodhall M, et al. A multicenter comparison of MOG-IgG cell-based assays. Neurology. 2019;92: e1250–e1255. DOI: 10. 1212/WNL.0000000000007096.
3. Kumar P. et al, P.033 Detection of Myelin Oligodendrocyte Glycoprotein Immunoglobulin G (MOG-IgG) by live and fixed Cell-Based assays; June 2022. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques 49(s1): S16-S16 DOI: 10.1017/cjn.2022.135

• Gliomas are central nervous system cancers with high morbidity and mortality¹
• Despite advances in neuro-oncology, survival rates remain poor over recent decades¹
• Many glioma trials use highly selective eligibility criteria, limiting access and participation
• Only 21% of patients with primary brain tumors enroll in clinical trials², and a majority of neuro-oncology trials fail due to low enrollment³
• Selective criteria may fail to reflect the diversity of real-world patients, reducing generalizability⁴
• This limits the applicability of findings and hampers progression to late-phase trials⁵
• These barriers may contribute to poor patient outcomes and slower therapeutic progress
• Addressing this issue is key to:
  • Improving generalizability and applicability of outcomes to real-world patients
  • Ensuring equitable access
  • Guiding better trial design
• Research Question: What is the proportion and prevalence of selective eligibility criteria in glioma clinical trials, and do these criteria impact overall survival outcomes?

• ​​​​51 interventional glioma trials for either newly diagnosed or recurrent gliomas were extracted from the National Clinical Trial (NCT) database on June 1, 2024
• Each trial’s inclusion and exclusion criteria were manually reviewed and categorized as:
  • Selective: likely to exclude patients who could otherwise benefit
  • Generalizable: exclusions justified based on safety concerns, trial focus, or standard ethical considerations
• Classification was guided by clinical judgment and existing literature.
• Quantitative Analysis:
  • Recorded the number of selective criteria per trial
  • Calculated descriptive statistics: mean, median, and range
• Meta-Analysis:
  • Included trials that reported median overall survival (mOS)
  • A correlational analysis was conducted to assess the relationship between the number of selective criteria and mOS

• Meta-analysis included 46 of 51 studies (5 excluded for not reporting mOS)
• Shapiro-Wilk test showed data were not normally distributed (p < 0.05)
• Spearman’s rank correlation used due to non-normal distribution
  • No significant correlation between number of selective criteria and mOS
  • Spearman’s correlation: p = 0.327

• To our knowledge, this is one of the first studies to quantify the extent of selectivity in glioma trials and assess its impact on survival
• Selective eligibility criteria are common in glioma trials (mean: 6.8, median: 7, range: 0–14) especially exclusions for:
  • Prior malignancy with a specified disease-free period (N=29)
  • Karnofsky score (N=27)
  • Prior brain radiotherapy (N=16)
• No significant correlation found between number of selective criteria and median OS (mOS) (p = 0.327)
  • Suggests limited impact of selectivity on survival outcomes
• Findings support reducing selective criteria to improve trial access, generalizability, and real-world applicability, without compromising outcomes
• Broadening eligibility may help address enrollment barriers and accelerate therapeutic development
• These findings can inform future trial design guidelines and regulatory recommendations
• Next Steps:
  • Apply trial criteria to UCSF glioma patient dataset
  • Develop recommendations to make trials more inclusive
  • Explore large language models to improve patient-trial matching and awareness

• Lecanemab is the first anti-amyloid monoclonal antibody to receive traditional Food and Drug Administration (FDA) approval for the treatment of early Alzheimer’s disease (AD) in patients with mild cognitive impairment (MCI) or mild AD dementia stage of disease1-3
• Lecanemab selectively targets the most neurotoxic Aβ aggregates, oligomers and protofibrils, preventing Aβ deposition before plaques develop and removing existing plaques3-7
• As a newly approved AD agent from a novel treatment class, there is limited real-world data to help recognize adoption patterns, and inform the implementation of lecanemab treatment in routine clinical practice
• The objectives of this study were to describe demographics, clinical characteristics, provider information, and utilization patterns of patients receiving lecanemab in real-world settings in the United States

• This observational study used open administrative claims from the PurpleLab, a database encompassing medical and pharmacy claims sourced primarily from clearinghouses, pharmacies, and software platforms
• The observation period ran from the first lecanemab infusion date (defined as index date) to the latest clinical activity or data availability
• Patients who met all the following criteria were included:
  • Received ≥1 lecanemab infusions between Jan 6, 2023 and Dec 31, 2024
  • Had continuous clinical activity ≥6 months (2 consecutive quarters with ≥1 medical or pharmacy claim) prior to first lecanemab infusion
• Comorbidities were defined using ICD-10 codes; MRI exams were captured using ICD-10-PCS and CPT codes for head magnetic resonance imaging (MRI)
• Time intervals between lecanemab infusions (during which follow-up MRI exam is recommended by the FDA) were assessed
• Use of cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and/or memantine during lecanemab treatment was described
• Treatment gaps were calculated as number of days without treatment coverage, between consecutive lecanemab infusions or between the last lecanemab infusion and the end of follow-up period

• Overall, 4903 out of 6284 patients who received ≥1 lecanemab infusions during the study period had ≥6  months’ continuous clinical activity
• Mean follow-up was 202 (standard deviation [SD] 126) days from index date
  • 99.3% of patients initiated lecanemab treatment in or after July 2023 when the FDA granted full approval to lecanemab (Figure 1)

• Mean age was 76.1 years, and 95.8% of eligible patients were aged ≥65 years at index date (Table 1)
• Most patients were female (54.9%), 77.4% were White, 91.8% were non-Hispanic, and 98.3% were treated in urban settings (Table 1)
• Most patients were treated by neurologists (81.5%) (Table 1), while in rural settings, a smaller proportion (76.5%) were treated by neurologists (not presented in the tables)
• In the 30 days prior to lecanemab initiation, 77.4% of patients had an AD and 31.7% an MCI medical claim (Table 1), with over 98% of eligible patients (4825 out of 4903) with an AD or MCI claim
• The  most common comorbidities included dyslipidemia (37.6%) and hypertension (32.6%) (Table 1)
• Average time from the earliest observed AD or MCI diagnosis in baseline period to initiating the first lecanemab dose was 79 days (Table 2)
• The average number of lecanemab administrations per patient per month was 1.8 (SD 1.1), and the mean number of days between any consecutive administrations was 16.2 (SD 11.4) (Table 2)
• Times between any consecutive infusions, 4th and 5th, 6th and 7th, and 13th and 14th infusions were similar, with a consistent median of 14 days (Table 2)
• The mean time from lecanemab initiation to the first MRI follow-up was 54.0 (SD 41.3) days (Table 2)
• During treatment with lecanemab approximately 34.6% of patients were also treated with cholinesterase inhibitors and/or memantine (Table 2)
• Overall, 21.0% had any treatment gap of ≥90 days, including those who continued beyond the gap and those who discontinued; 3.3% of patients had a treatment interruption with ≥90-days gap, and continued treatment (Figure 2)

• As with any open claims database study, potential coding errors, inconsistencies in billing practices, and lack of clinical detail should be considered in the interpretation of study results
• Mean follow-up duration limits the investigation of longer-term treatment patterns; Coverage and benefit restrictions may have impacted lecanemab utilization

• Real-world use of lecanemab conforms with FDA-approved prescribing recommendations
• Access to lecanemab treatment in the United States has been increasing over time, while care disparities appear to exist between rural and minority populations relative to urban and White populations
• Future research is needed to better understand longer-term treatment patterns of lecanemab, and the barriers contributing to treatment gaps

Acknowledgements

Funding for the study, analyses, and editorial support (Mayville Medical Communications) was provided by Eisai Inc.

References

1. Swanson C, et al. Alzheimers Res Ther. 2021;13:80.    2. van Dyck CH, et al. N Engl J Med. 2023;388:9-21.  3. LEQEMBI™ (lecanemab-irmb) injection, for intravenous use [package insert]. Nutley, NJ: Eisai Inc. 4. Hampel H, et al. Mol Psychiatry. 2021;26(10):5481-5503.   5. Shi M, et al. Front Aging Neurosci. 2022; 14:1-11.6. Söderberg L, et al. Neurotherapeutics. 2023;20(1):195-206.  7. Kaplow JM, et al. Alzheimers Dement. 2013;9:P807-P808.

If you have any questions about this poster, please email or call Eisai Medical Information at ESI_Medinfo@eisai.com or 888-274-2378.

Alzheimer's Disease (AD) is a chronic, progressive neurodegenerative disorder that is the leading form of dementia and cause of cognitive and functional impairment.¹ AD pathology is characterized by the accumulation of amyloid beta (Aβ) plaques, which precedes neurodegeneration, and cognitive decline.^2,3  Early AD comprises mild cognitive impairment (MCI) due to AD and mild dementia due to AD.⁴ As AD progresses, cognitive decline worsens, leading to loss of independence, confusion, disorientation, mood changes, agitation, and eventually delusions or hallucinations.^4-6 Beyond the impact of AD on patients, there are also significant impacts on the care partners of patients with AD.⁷ All aspects of daily living, such as job absenteeism, financial hardships, daily tasks, and available time, are impacted by caring for a person living with early AD.⁷

The current standard of care (SoC) for patients with early AD consists of non-pharmacological interventions with or without cholinesterase inhibitors (ChEIs) for symptomatic relief. However, current therapeutic options only address the symptoms of the disease and not the underlying cause; they do not halt or slow disease progression, providing only modest and temporary benefit to symptoms that is lost after treatment discontinuation.^8-10 

Lecanemab is a humanized IgG1 monoclonal antibody that binds to Aβ protofibrils, which in turn leads to clearance of Aβ protofibrils and plaques.¹¹ Lecanemab was studied in the phase 3 randomized, multicenter, double-blind, placebo-controlled, parallel-group trial, Clarity AD (NCT03887455), in patients with early AD (MCI and mild dementia due to AD) with confirmed Aβ pathology.¹¹ Lecanemab significantly slowed disease progression on CDR-SB by 27.1% at 18 months.¹¹ Lecanemab was generally well-tolerated, with the most common adverse events (AEs) being infusion-related reactions, amyloid-related imaging abnormality-microhaemorrhage and haemosiderin deposit (ARIA-H), amyloid-related imaging abnormalities-oedema/effusion (ARIA-E), and headache. Most ARIA were asymptomatic and radiographically mild, and can be monitored by early magnetic resonance imaging (MRI).¹¹
 

- To determine the cost-effectiveness of lecanemab + SoC versus SoC alone in patients with early AD, with confirmed Aβ pathology.
- Standard of care was assumed to consist of symptomatic treatment only, including non-pharmacological treatments
- Considering the significant evidence of AD's impact on patients and caregivers, a societal perspective offers valuable context for lecanemab reimbursement decisions^12-17

Model Structure: A Markov model with a one-month cycle length and lifetime horizon (30 years) was developed and used to capture the costs and outcomes associated with lecanemab + SoC and SoC alone when treating early AD (Figure 1). The model included four distinct health states based on disease severity according to Clinical Dementia Rating – Sum of Boxes (CDR-SB) (replicated in the community and institutional care settings) and death (ie., nine health states in total). 

Impacts to Patient and Caregiver Quality of Life: The societal perspective included both patient and caregiver utilities. Patient and caregiver health state utilities were sourced from Landeiro et al. (2020)²² and Lopez-Bastida et al. (2006)²³, respectively. Utility decrements from Farina et al. (2020)²⁴ were applied to both patients and caregivers to capture impact of a patient’s care setting (entering institutional care) on health related quality of life (-0.16 and -0.09 for patients and caregivers, respectively). Utility decrements for patients incurring AEs (infusion-related reactions, ARIA-E, and ARIA-H events) were also included.

Costs: Costs included for the societal perspective included those for caregiver direct medical and non-medical care, caregiver productivity loss, drug acquisition and administration, disease management, diagnostic, adverse events, and patient direct medical and non-medical care. 

• In the base case, lecanemab + SoC was more costly ($77,812) and more effective (1.19 gain in quality adjusted life years [QALYs]) than SoC alone, resulting in an incremental cost utility ratio (ICUR) of $65,424 per QALY (Table 1)
• The probability that lecanemab was cost-effective at a threshold of CAD100,000 was an estimated 95.1% (Slideshow 1)
• Model results were generally stable across a variety of scenario analyses, including those in which key clinical inputs were varied

	Lecanemab + SoC	SoC	Incremental
Total life years (LYs)	8.14	7.48	0.66
Total QALYs	10.59	9.41	1.19
Incremental Costs	$146,219	$68,407	$77,812
ICER (Cost/LY)	$118,356
ICUR (Cost/QALY)	$65,424

• Lecanemab represents a cost-effective option for the treatment for early AD from the Canadian societal perspective
• Compared with SoC alone, lecanemab + SoC was more costly (CAD 77,812) and more effective (1.19 QALYs) over a lifetime, with an ICUR of CAD $65,424 per QALY gained
• The cost-utility analysis will be further informed by new long-term data as it becomes available (ie., Clarity AD OLE)

Background

Recent evidence suggests that mindfulness training can support self-management for people with Mild Cognitive Impairment (MCI) (Wells et al, 2019). 

Many mindfulness training programs, however, are not necessarily designed to address the specific needs of the MCI population, and sometimes even exclude persons with MCI from participating.

In 2021, the Neil and Susan Manning Cognitive Health Initiative (CHI) partnered with the BC Association for Living Mindfully (BCALM) to create a specialized mindfulness training program for MCI. 

Objectives

The BCALM-CHI collaboration created a specific course for persons with MCI based on Mindfulness Based Stress Reduction (MBSR), designed to develop community capacity. This was adapted from BCALMs "Art of Living Mindfully" course.

The study objectives were to: 

1) Increase self-management capacity for participants with early cognitive impairment; 
2) Address the programming gap in outpatient and community-based services in the Victoria region for persons with MCI; and
3) Contribute to the growing evidence-base for mindfulness interventions with the MCI population. 

Results

Acknowledgments

The Neil and Susan Manning Cognitive Health Initiative (CHI) is a partnership between the Vancouver Island Health Authority, UBC, the Universit of Victoria, and the Victoria Hospitals Foundation.  Thanks to these generous and visionary donors, the Initiative is now in its 8th year.

• Experimental and clinical evidence suggest that Parkinson's disease (PD) manifests differently between females and males, yet women have been underrepresented in PD clinical research, leading to a limited understanding of the sex- and gender-specific aspects of the disease. Understanding the needs of women with PD (WwPD) is critical.

• Patient-centered outcomes-based mixed methods study.
• Phase 1: Qualitative focus groups, patient-centered discussions, led by female interviewers. Interviews were transcribed verbatim and analyzed in NVivo 12 using six-step thematic analysis. A codebook was iteratively refined to capture emerging patterns. 
• Phase 2: Nationwide survey via the Qualtrics platform, informed by focus group findings. We report the Phase 1 preliminary results.

• We conducted five focus groups with 22 cisgender women (mean age: 60.5; range: 44–81; mean disease duration: 6.8 years). Two key themes emerged:
• Mental Health – Participants reported depression, anxiety, altered self-image, and disruptions to family, social, and work life.
• Physical Health & Healthcare – While some were satisfied with care, women with young-onset PD described misdiagnoses, dismissal, and lack of information. Sexual health was often neglected, with reports of vaginal dryness, pain, and intimacy challenges. Menopause and PD symptom overlap was noted, along with the importance of exercise and nutrition for managing symptoms.

• Findings highlight significant health challenges in women, underscoring the importance of integrating gender-specific approaches into PD care.

Background:
Anti-B cell therapies (e.g. ocrelizumab, ofatumumab) are increasingly used in individuals living with multiple sclerosis  around the time of conception. Neonatal B-cell suppression can occur when these agents cross the placenta mid to late pregnancy. Some guidelines recommend assessing neonatal B cells at birth, but this is not yet routinely implemented at our center.

The Workshop

We met on January 30th, 2025 to address the clinical and logistical challenges of neonatal B cell assessments following in utero exposure to anti-B cell therapies. Presentations by MS pregnancy specialists and experts from St. Michael's Hospital in Toronto, Ontario, were complemented by collaborative problem-solving among participants, including a paediatric haematologist, MS neurologists, MS nurse and nurse practionner, obstetricians, paediatricians, nurses, IT specialists, and a quality specialist. Two patients shared their lived expereinces and feedback. 

Outcome Goals

• Practical LHSC-specific care pathway

• Timing and communication protocol for sample collection

• Education and support for pediatricians and pathway to pediatric hematology

• Paper +/- EMR prompts and nurse-led reminders, including Nurse Specialist Lead 

• Plan to coordinate and track any changes to baby vaccine schedules

Early Impact
Participants reported greater clarity and engagement in shared care responsibilities. A prototype paper based order requisition was created by Dr. Ben Hedley. Pathway pilot testing is underway. Future metrics include cord blood collection rates, timely B-cell reporting, and parent satisfaction.

Conclusions
Cross-disciplinary collaboration is essential to close the care gap in neonatal monitoring following in utero exposure to anti-B cell agents. This initiative demonstrates the power of clinical innovation driven by patient-centered design and teamwork.

In-person meetings that bring together all members of the healthcare team—nurses, physicians, administrators, IT professionals, quality specialists, and representatives from multiple hospitals and regions—can further enhance success through shared real-time collaboration and innovation.

Acknowledgements
We woudl like to thank London Health Sciences Center, St. Michael’s Hospital, Western University & the University of Toronto, and the patient community. Support for lunch and speakers provided by Roche Canada.

Disclosures: Financial support for this project for food and transportation was provided by Roche. Courtney Casserly has received funding in the form of honoraria, consulting fees, or other compensation from: Multiple Sclerosis (MS): Biogen, Novartis, Roche, Sanofi, EMD Serono; Neuromyelitis Optica Spectrum Disorder (NMOSD): Horizon Therapeutics, Genentech/Roche, Alexion; Education funding through the Western Libraries Digital Innovation Grant & the Western Teaching Innovation Award.

This study explored whether Myelin Water Imaging could detect myelin injury in Anti-NMDA receptor autoimmune encephalitis (NMDAr-AIE), where traditional neuroimaging is often normal. Myelin Water Fraction (MWF) quantifies myelin content by distinguishing myelin sheath water from other brain water compartments.

Adult participants with confirmed NMDAr-AIE diagnoses and healthy controls (HC) underwent 3T brain MRI (Magnetic Resonance Imaging) including MWF mapping. Participants were recruited after discharge from the hospital. Mean MWF was calculated for 4 white matter regions of interest (ROI). MHI (Myelin heterogeneity Index) was calculated by dividing the MWF standard deviation by the mean MWF. Patient demographics, clinical assessments, treatment, and outcomes were collected.

Five participants with NMDAr-AIE (4F/1M, mean age 30, SD 7) and four HC (3F/1M, mean age 36, SD 6) were included. All NMDAr-AIE participants had normal or non-specific T2 hyperintensities on initial imaging and had received immunotherapy. The mean Modified Rankin Score (MRS) on discharge was 2. MWF (mean ± SD) for normal-appearing white matter, corpus callosum, corticospinal tract, and superior longitudinal fasciculus were 0.10±0.02, 0.12±0.02, 0.15±0.03, 0.12±0.02, which were very similar to HC at 0.09±0.02, 0.11±0.01, 0.15±0.02, and 0.11±0.02, respectively.

Myelin Water Imaging showed no myelin pathology in five NMDAr-AIE patients, with MWF and MHI values comparable to HC, suggesting that myelin pathways are relatively preserved post-recovery from AIE. Moving forward, we aim to continue recruiting healthy controls, patients post-recovery and those experiencing active disease to determine if there are any MWF abnormalities throughout the disease course. Future studies are needed to assess MWF changes in other antibody-mediated encephalitides. 

Acknowledgements and Funding: We thank participants, technologists and all study coordinators. This study was funded by the Canadian Institute for Health Research (CIHR). 

• The COVID-19 pandemic disrupted global healthcare systems, limiting access to care for individuals with chronic diseases, including people with multiple sclerosis (PwMS).

• PwMS are at increased risk during pandemics due to immunosuppressive disease-modifying therapies (DMTs) and a higher baseline prevalence of psychosocial distress.

• Oman, classified as a medium-risk zone for MS, had no prior data evaluating the pandemic's impact on PwMS.

• Evaluate the impact of COVID-19 on MS management and disease progression.

• Investigate the incidence and clinical outcomes of COVID-19 infection among Omani PwMS.

• Investigate the psychosocial impact of the pandemic on PwMS and its demographic and clinical determinants.

• Cross-sectional study of 104 adult Omani PwMS, at Sultan Qaboos University Hospital (SQUH) between Jan–Apr 2021.

• Data collected via structured phone interviews and medical record reviews; COVID-19 diagnosis confirmed via PCR.

• Assessed disease characteristics, MS relapses, DMT adherence, access to care, COVID-19 symptoms, and psychosocial status.

• Statistical analyses were conducted using R version 4.2.2 and included both descriptive and inferential statistics.

• COVID-19 infection was relatively uncommon in this MS cohort, and most cases were mild.

• Females, younger participants, and those with lower mental well-being were more likely to report COVID-19 effects.

• Most PwMS continued their MS therapy and had minimal disruption to care.

• Psychological concerns were prevalent, especially among males, despite females being more likely to report COVID-19 effects.

• Severe MS worsening due to COVID-19 was rare.

• COVID-19 infection was uncommon and generally mild among Omani PwMS, likely due to proactive healthcare measures.
   
• Ongoing support, culturally tailored interventions, and crisis preparedness remain essential to protect the mental health and well-being of this vulnerable group.

• MS is a chronic inflammatory demyelinating disease of the central nervous system.
   
• It is characterized by acute or subacute attacks lasting at least 24 hours, and not attributable to infection.
   
• HDS are the primary treatment for MS attacks.
   
• No significant differences in outcomes between oral and intravenous (IV) HDS routes.
   
• Factors influencing physicians' choice of treatment route and the characteristics of attacks that prompt treatment remain unclear.

This study aims to:

1. Assess annual trends in oral versus IV HDS use.
    
2. Assess relationship between HDS route and:
   • Attack type
   • Prescriber’s specialty

• Retrospective analysis of relapsing remitting MS patients' data from the MS database (MuSicaL).
   
• Natural Language Processing (NLP) used to extract patients' data from 2010 to 2022 followed by investigators' verification.
   
• All statistical analyses performed using the R Project for Statistical Computing (version 4.2.2).

• Oral HDS use has increased over time.
   
• IV HDS is more commonly used for severe relapses (e.g., multifocal attacks).
   

• A significant association was observed between relapse type and HDS route, while prescriber specialty didn’t significantly impact route selection.

  However, these findings should be interpreted with caution given the substantial proportion of relapses with undocumented HDS route and the single-center nature of the study.
   
• Further research is needed to confirm trends and inform standardized guidelines for MS relapse management.

• Multiple Sclerosis International Federation. Atlas of MS, 3rd Edition. MSIF, 2020.

• Lublin, Fred D., et al. "Defining the Clinical Course of Multiple Sclerosis: The 2013 Revisions." Neurology, vol. 83, no. 3, 2014, pp. 278–286.

• Sørensen, Per Soelberg. "New Management Algorithms in Multiple Sclerosis." Current Opinion in Neurology, vol. 27, no. 3, 2014, pp. 246–259.

• Berkovich, Regina. "Treatment of Acute Relapses in Multiple Sclerosis." Neurotherapeutics, vol. 10, no. 1, 2013, pp. 97–105.

• Morrow, S. A., et al. "Management of Multiple Sclerosis Relapses in Canada: A Survey of Neurologists." The Canadian Journal of Neurological Sciences, vol. 38, no. 5, 2011, pp. 719–725.

INTRODUCTION

Multiple sclerosis (MS) is an autoimmune disease in which the immune system attacks the myelin sheath of neurons, leading to progressive neurological symptoms. Anti-CD20 monoclonal antibodies have emerged as highly effective treatments for relapsing MS (RMS), with Ocrelizumab (OCR) being the standard approved therapy and Rituximab (RTX) used as an off-label alternative. The impact of anti-CD20 therapies on immune markers remains understudied, though deficiencies are frequently observed and may be associated with increased risk of infection. Our objective is to compare lymphocyte, neutrophil, and immunoglobulin levels in OCR- versus RTX-treated persons with RMS.

METHODS

This retrospective chart review included patients with confirmed RMS who initiated treatment with OCR or RTX between January 2017 and June 2023, and who had at least one pre-treatment complete blood count (CBC) and one post-treatment CBC and immunoglobulin panel available. Treatment assignment was primarily influenced by insurance coverage. Lymphocyte, neutrophil and immunoglobulin levels (IgG, IgA, IgM) from before and after treatment initiation were collected, where available. Deficiencies were defined as values below the lower limit of normal as per local laboratory guidelines. The statistical approach comprised three complementary analyses:

• Fisher's Exact Test compared the prevalence of new-onset deficiencies between OCR and RTX groups at 2, 4, and beyond 4 years of treatment.
• Kaplan-Meier survival analysis estimated deficiency-free probability over time, with Log-rank Tests comparing treatments and Cox Proportional Hazards Models quantifying relative risk.
• Linear Regression with Mixed-Effects Models were used to illustrate laboratory value trajectories.

RESULTS

A total of 634 patients were included (OCR=386, RTX=248), with the OCR group being slightly older (44.7±9.9 vs 42.9±11.1 years, p=0.043) and having longer treatment duration (67.7±17.9 vs 48.2±18.8 months, p<0.05), while the RTX group had significantly greater pre-treatment immunoglobulin panel availability (39.9% vs 7.5%, p<0.05) (Table 1).

No significant differences were observed between the OCR and RTX treatment groups at 2, 4, and more than 4 years, although both groups showed a progressive accumulation of immune marker deficiencies over time (Figure 1). By year 4 of treatment, deficiencies were most common in IgM (26-31%), followed by IgG (12-13%), IgA (4-7%), lymphocytes (5.3-5.4%), and neutrophils (0-1.7%).
 

Survival analysis reveals that RTX is associated with significantly higher risks of developing IgM deficiency (HR=1.6, p=0.016, 95% CI 1.09-2.34) and IgA deficiency (HR=2.38, p=0.048, 95% CI 1.01-5.63) compared to OCR, despite similar cross-sectional prevalence rates. Linear regression analysis confirms RTX causes significantly faster IgM depletion (p=0.0044 for slope difference, p < 0.05 in mixed model, Figure 2).

CONCLUSION

• All measured immunoglobulins show progressive depletion over time, with substantial increases in deficiency rates beyond 2 years of treatment, emphasizing the importance of long-term monitoring.
• Both medications show greater effects on IgM, followed by IgG, and IgA, with lesser longitudinal impact on neutrophils and lymphocytes.
• Survival analysis reveals RTX is associated with significantly higher risks of developing IgM deficiency and IgA deficiency, with RTX causing significantly faster IgM depletion.
• Clinical correlation is essential to determine the functional significance of laboratory-observed immunoglobulin deficiencies.

Background

EBV antigen titers were quantified in a cohort of 37 pwRIS, 50 people with MS (pwMS), and 24 healthy controls (HC) using Enzyme-Linked Immunosorbent Assay (ELISA). Cognitive function of pwRIS were assessed using Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS).

1. Bjornevik, K., Münz, C., Cohen, J.I. et al. Epstein–Barr virus as a leading cause of multiple sclerosis: mechanisms and implications. Nat Rev Neurol 19, 160–171 (2023).
2. Benedict RH, Cookfair D, Gavett R, Gunther M, Munschauer F, Garg N, Weinstock-Guttman B. Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS). J Int Neuropsychol Soc. 2006 Jul;12(4):549-58.

Methods

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Discussion

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• GBS has incidence of 0.81 to 1.91 cases per 100,000 person-years. FDP accounts for about 1% of those cases.³
• Most FDP cases are not associated with anti-gangliosides antibodies.^3,4,5 Some case reports have shown association with anti-GM2² and one with anti-GD1a.⁶
• GBS incidence is not increased during pregnancy⁷ but is increased during the postpartum period, particularly the first 30 days after delivery.^8,9
• Differential diagnosis for acute facial diplegia includes bilateral Bell's palsy, sarcoidosis, Lyme disease and viral infection by EBV, HSV-1, VZV.^3,10

Conclusion

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Hyperglycemia presenting with visual hallucinations due to occipital lobe seizures

 

• Repeated nonconcussive head impacts, defined as subthreshold blows that do not cause acute symptoms, may contribute to long-term neurological dysfunction¹
• Two measures of cerebrovascular health include:
  • Cerebrovascular reactivity (CVR): The ability of cerebral vessels to respond to changes in metabolic demand, reflecting vascular reserve²
  • Cerebral blood flow (CBF): The rate of blood delivery to brain tissue, essential for metabolic support³
• In athletes, repetitive head impacts may disrupt CBF and CVR, suggesting subtle cerebrovascular changes even in the absence of overt symptoms²
• This study investigates seasonal changes in these parameters to assess their utility as early biomarkers of nonconcussive impacts

After exposure to repetitive nonconcussive impacts, football athletes will have reduced CVR and increased CBF.

• 20 male football athletes (21 ± 1.3 years) were scanned using a 3T Siemens Prisma
• Scans were taken pre-season (PRE), after training camp (MID), and post-season (POST, 10 ± 5.3 days after the season)
• T1-weighted MP-RAGE sequence was acquired for anatomical reference
• CVR protocol:
  • Six-minute BOLD fMRI sequence using the RespirAct gas control system (Thornhill Medical, Toronto, Canada)
  • Gas challenge: 2 minutes of baseline end tidal partial pressure of carbon dioxide (P_ETCO₂), 2 minutes hypercapnia (+10 mmHg P_ETCO₂), 2 minutes back at baseline. P_ETO₂ was held constant at 110 mmHg
  • BOLD data was preprocessed using FSL⁴ and the seeVR toolbox⁵ was used to calculate CVR

• CBF protocol:
  • CBF was measured using pseudo-continuous arterial spin labeling
  • Images were acquired with a 2D multiband EPI readout
  • CBF quantification was performed using the Human Connectome ASL pipeline⁶ 
• Paired t-tests were performed between time points 
• Family-wise error (FWE) correction was implemented using FSL's randomise tool with 10,000 permutations and threshold-free cluster enhancement
• Results were considered significant at FWE-corrected p<0.05

• Our results demonstrate that nonconcussive head impacts may lead to decreased CVR and possibly increased CBF, suggesting vascular dysfunction² and compensatory hyperemia⁷
• These metrics show promise as early biomarkers of trauma-related brain changes in contact sports. Longitudinal studies should assess long-term consequences of observed CBF/CVR change

1. Champagne AA, et al. (2020). J Cereb Blood Flow Metab 40:1453-1467.
2. Svaldi DO, et al. (2017). Brain Imaging Behav 11:98-112.
3. Willie CK, et al. (2014). J Appl Physiol 116(7):905-910.
4. Jenkinson MM, et al. (2012). Neuroimage 62:782-790. 
5. Bhogal AA, et al. (2021). NeuroImage 245:118771. 
6. HCP-ASL pipeline version 0.1.8 https://github.com/physimals/hcp-asl/releases/tag/v0.1.8
7. Slobounov SM, et al. (2017). Neuroimage: clinical 14:708-718.

• Adult Neurology Competence by Design (CBD) curriculum requires specific training experiences (TEs) and entrustable professional activities (EPAs) in the Transition to Practice (TTP) stage
• Limited literature exists to support an evidence-based approach to its implementation and evaluation.
  • Scoping reviews, survey-based methods → identify topics and recommendations for curriculum development
• TTP defined as a ” bridge to autonomous practice” (Sanaee et al. 2020)
  • “certain professional activities will be emphasized”
  • “others newly introduced to increase practice readiness”
  • “enhance their ability to function autonomously and build their confidence to provide quality care for large numbers of patients”
  • Highly rated content areas for TTP
    • Further sophistication of clinical skills, how to set up a practice, and time management skills
  • TTP principles felt better assessed by feedback, coaching, and self-assessment/reflection

• PGY-5 residents expected to be transitioning into independent practice in <12 months
• Inpatient → “junior attending” rotations already in existence
• Outpatient → no similar experience existed locally, but there are RC required training experiences
• Goal: facilitate residents’ transition from a trainee to an independent consultant in neurology by resident-directed, consultant-level outpatient practice management and providing them with formal instruction and supervision to attain the required competencies
  • Build on prior FOD, COD outpatient training experiences by specifically addressing TTP training experiences set forth by the Royal College Neurology Specialty Committee

• Assess the need for an outpatient advanced general neurology rotation for senior residents to support their transition from trainee to independent neurologist
• Develop a longitudinal outpatient rotation addressing the Royal College of Physicians and Surgeons of Canada required and recommended TTP training experiences in Neurology
• Evaluate the experience of participating resident trainees and supervising clinicians in this new rotation to assess if trainees perceived needs are being met, TTP stage competencies are achieved, and inform iterative improvement of the rotation

• Focused needs assessment
  • Review of RC neurology training experiences → multiple recommended/required experiences
  • Review of Adult Neurology program → no outpatient TTP stage experiences being addressed despite EPAs existing
  • Meeting with program director and administrator
  • Informal interviews of PGY-4 residents, felt:
    • lack of independence commensurate to their level of training while caring for longitudinal outpatients
    • limited exposure to practice management principles to help develop their own style
  • Meeting and proposal to local Neurology Education Committee
• Rotation development
  • “Junior Attending” blocks divided 2-weeks each of IP/OP
  • 4 days/week of general neurology clinic: 9am-1pm across 2 sites
  • # of patients booked commensurate with the expectation of senior trainee about to enter independent clinical practice
  • Resident sees patient independently + brief review with attending, preferably with ability to tolerate a slightly different plan/approach
  • Afternoon → admin tasks to be completed by resident, mentorship/teaching re: principles of practice management
  • Debrief and review of key learning points end of day
• Evaluation
  • Entrustable Professional Activities (EPAs)
  • In Training Assessment Reports (ITARs)

• Trial without trainees July 2024 → block-based with trainees during 2024-2025 academic year
• Each trainee (8) has 2 “junior attending” blocks, each with a 2-week outpatient block
• Two sites, Sunnybrook Health Sciences and Unity Health St. Michael's hospital
• 3-4 months apart to allow for investigations to return, allow appropriate follow-up time (some variation in timing by trainee)
• In addition to mentorship/feedback, formal practice management resources provided to trainee for the rotation

• Currently completing 1st academic year cycle; early feedback is positive:
  • Trainees:
    • enjoying the experience, showing noticeably increased comfort in embracing increased autonomy between blocks
    • appreciate the opportunity to develop their own “style”
    • express a desire for this to be a longitudinal as opposed to block-based experience
  • Attendings:
    • enthusiastic, flexible, comfortable with advanced trainee role and promoting independence
• ​​​Program evaluation
  • Review of anonymized rotation feedback
  • Formal anonymized survey of qualitative experience of participating trainees at various time points throughout the experience
    • e.g. end of PGY-5/TTP year, subsequent 1-year intervals into independent practice. 
  • Future participants will be surveyed prior to initiation of the rotation as well
  • Formal anonymized survey of participating staff physicians at year end
  • Consideration of qualitative group interview/focus group with trainees
  • Modification to rotation
    • Transition to longitudinal structure as opposed to block-based

Sport-related concussion poses significant diagnostic challenges due to its subtle, transient nature and lack of identifiable biomarkers. To capture the changes from injury holistically, we integrated advanced neuroimaging with quantitative robotic assessment: Diffusion Tensor Imaging (DTI) and Neurite Orientation Dispersion and Density Imaging (NODDI) were used to detect acute microstructural white matter changes, while the Kinarm robotic platform objectively measured sensorimotor function via the Reverse Visually Guided Reaching (RVGR) task. This multimodal approach was applied to 12 concussed athletes (21 ± 2.1 y; 9 M/3 F; tested ~7 days post-injury) and 24 matched controls (21 ± 2.5 y; 11 M/16 F) to bridge structural and functional insights.

Neuroimaging (DTI/NODDI): Highly sensitive, revealing significant acute microstructural alterations in key white matter tracts.

Our findings demonstrate that acute sport-related concussion induces detectable microstructural alterations in specific white matter tracts (↑FA, ↓MD/RD/Viso), yet these changes occur without concurrent deficits in sensorimotor performance on the precise Kinarm RVGR task. This critical disconnect underscores that advanced diffusion MRI (DTI/NODDI) is highly sensitive for detecting subclinical brain injury, revealing underlying pathology that standard functional assessments may miss. Consequently, relying solely on behavioural measures risks underestimating injury severity and compromising athlete safety. Multimodal assessment protocols, integrating both advanced neuroimaging and quantitative functional tools, are therefore essential for accurate diagnosis, informed return-to-play decisions, risk stratification, and targeted rehabilitation strategies following concussion.

• There is heterogeneity in the literature with regards to differences in functional independence between men and women after endovascular thrombectomy (EVT) for stroke (1,2).
• Some studies suggest a lower likelihood of independence at 90 days among females, while others have found no difference when accounting for age, baseline functional independence, stroke severity and comorbidity burden (3).
• Differences in procedural complications and symptomatic intracerebral hemorrhage (sICH) between men and women after EVT is less well known.
•  This study aims to evaluate sex differences in sICH in patients who underwent EVT.

• OPTIMISE is a pan-Canadian prospective registry of patients treated with EVT across 20 sites and 7 provinces between 2018-01 and 2022-12.
• Using OPTIMISE data, we compared men and women with regards to baseline characteristics, functional outcomes and, as our primary outcomes, procedural complications and sICH
• sICH was defined  as a ≥4-point increase in the NIHSS score associated with the presence of parenchymal hematoma type 1 or 2 on follow-up CT, as determined by the treating physician

3631 patients were included for analysis:

• Women were older (71.8±14.6 vs 68.0±13.1 years, p<0.001).
• There were no differences in median time from onset to puncture {232 (155-365) men vs. 235 (163-377) women, p=0.159}, and from puncture to reperfusion between sexes {(25 (17-37) vs. 24 (17-37), p=0.984}.

•  There were no differences in sICH rates {44 (2.5%) vs. 37 (2%), p=0.388}.

• Procedural complication rates were not different between men and women (5.8 vs 5.6% p=0.76)

	Men (N=1778)	Women (N=1853)	p-value
Age (mean±SD)	68.0±13.1	71.8±14.6	0.001
Median (IQR) onset to puncture - min	232 (155-365)	235 (163-377)	0.159
Median (IQR) puncture to reperfusion - min	25 (17-37)	24 (17-37)	0.984
Tici 2b3	1446 (81.3%)	1554 (83.9%)	0.319
Tici 3	898 (50.5%)	1021 (55.1%)	0.264
sICH	44 (2.5%)	37 (2%)	0.388
Complications Dissection Perforation Embolization Arterial access	26 (1.5%) 11 (0.6%) 25 (1.4%) 45 (2.5%)	30 (1.6%) 7 (0.4%) 25 (1.3%) 43 (2.3%)	0.804 0.426 0.996 0.761

 

Table: Baseline characteristics in male and female

• There were similarly low and reassuring rates of sICH and procedural complications between men and women undergoing EVT in this large multicentre prospective cohort.
• Our findings complement previous studies that have demonstrated similar functional outcomes between men and women after EVT.

1. Carvalho A, Cunha A, Greg´orio T, et al. Is the efficacy of endovascular treatment for acute ischemic stroke sex-related. Interv Neurol. 2018;7:42–7. DOI10.1159/000484098.
2. Uchida K, Yoshimura S, Sakai N, Yamagami H, Morimoto T. Sex differences in management and outcomes of acute ischemic stroke with large vessel occlusion. Stroke. 2019;50:1915–8. DOI 10.1161/strokeaha.119.025344.
3. Momen AI, Francis T, Schaafsma JD, Rac V, Baig A, Pereira VM, Pikula A. Sex Differences in Functional Outcomes Following Endovascular Treatment for Acute Ischemic Stroke. Can J Neurol Sci. 2023 Mar;50(2):174-181. doi: 10.1017/cjn.2022.22.

The use of Tenecteplase (TNK) in the Extended Time Window (ETW) for Acute Ischemic Stroke (AIS) remains an ongoing debate. We aim to evaluate the current literature and data of TNK use for AIS in the ETW. 

Inclusion criteria for RCT of thrombolysis in the ETW:   

• Study performed between 2018-2025
• Patients > 18 years of age
• AIS presenting within 4.5-24 hours from LKW or unknown/wake up stroke
• Pre-admission mRS < 2

Studies that did not meet these criteria were excluded from review. 
From this, 3 RCTs were included in our review: 

• TIMELESS
• TRACE 3
• CHABLIS-T II

Better recanalization rates are seen with TNK in ETW, but may not be associated with improved functional outcomes at 90 days compared to medical management. Incidence of sICH also remains largely favorable, except in TRACE 3, which showed a higher incidence in the TNK group. There remains a need for more RCTs in this population.

1. Albers GW, Jumaa M, Purdon B, et al. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. N Engl J Med. 2024;390(8):701-711. doi:10.1056/NEJMoa2310392
2. Cheng X, Hong L, Lin L, et al. Tenecteplase Thrombolysis for Stroke up to 24 Hours After Onset With Perfusion Imaging Selection: The CHABLIS-T II Randomized Clinical Trial. Stroke. 2025;56(2):344-354. doi:10.1161/STROKEAHA.124.048375
3. Xiong, Y., et al. (2024). Tenecteplase for ischemic stroke at 4.5 to 24 hours without thrombectomy. New England Journal of Medicine, 391(3), 203–212.

• Over 80,000 Canadians live with spinal cord injury (SCI), which can lead to complete or partial loss of motor, sensory and autonomic function.
• Exercise response is evoked by thoracic spinal autonomic neuronal systems that innervate and activate the peripheral tissues/organs to mobilize metabolic support during exercise. These include activation of cardiovascular, homeostatic and metabolic functions (e.g. HR, BP, etc.). 
• Inability to mount appropriate sympathetic responses affects exercise ability, contributing to health consequences such as obesity, cardiovascular disease and type II diabetes.
• Non-invasive trans-spinal electrical stimulation (ts-ES) is a method to activate spinal neural networks below the injury and improve motor function recovery in people after SCI.
• Combined personalized functional electrical stimulation of peripheral nerves and muscles in combination with ts-ES during walking has not been tested.

• Compare changes in motor and autonomic function attributable to ts-ES during personalized 4 week locomotor training in people living with incomplete SCI
• Compare effects of combining personalized step-cycle based peripheral nerve and/or muscle stimulation with ts-ES during locomotor training​

• Due to diversity in participant injury and motor deficits, VO2 and RQ changes are best compared for individual data
• ts-ES tended to increase HR and decrease RQ within one session. ts-ES facilitated EMG activity in ankle and knee extensors (vastus lateralis and gastrocnemii) by >10%
• Combined stimulation methods were tolerable over 12 sessions of training. There were slight improvements in clinical outcome measures when comparing individual data.
• Combining ts-ES with classical physiotherapy exercises may increase motor and autonomic functional recovery in individuals with SCI and this research can influence wider clinical applications of personalized rehabilitation strategies.

• Insomnia disorder and obstructive sleep apnea (OSA) are common sleep disorders that are frequently comorbid, a clinical entity referred to as COMISA (comorbid insomnia and
  sleep apnea)¹
• COMISA is associated with daytime functioning and cognitive impairments^1,2
• Some sleep-promoting medications cause residual morning sleepiness, potentially exacerbating daytime impairment in this patient population predisposed to sleepiness³
• Lemborexant (LEM) is a competitive dual orexin-receptor antagonist approved in multiple countries, including Canada, for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance⁴
• In phase 3 studies in participants with insomnia, greater improvements in sleep onset and sleep maintenance were observed with LEM compared with placebo (PBO) over 1 month in Study E2006-G000-304 (Study 304; SUNRISE 1; NCT02783729) and over 6 months in Study E2006-G000-303 (Study 303; SUNRISE 2; NCT02952820)^5,6
• In two phase 1 studies in participants with either mild OSA (E2006-A001-102; Study 102; NCT03471871) or moderate-to-severe OSA (E2006-A001-113; Study 113; NCT04647383), respiratory parameters (apnea-hypopnea index [AHI] and peripheral oxygen saturation) were not impacted by LEM treatment compared with PBO^7,8

• This post hoc analysis assessed the impact of LEM on morning sleepiness/alertness in participants with comorbid insomnia and mild OSA

• Study 304 was a 1-month, phase 3, global, multicenter, randomized, double-blind, parallel-group, PBO-controlled and active-comparator (zolpidem tartrate extended-release 6.25 mg [ZOL]; not reported here) study⁵
• Additional details regarding study design (Figure 1 – see full poster via QR code), inclusion/exclusion criteria, and statistical analysis are included in the full poster
• A daily sleep diary assessed subjective ratings of alertness/morning sleepiness within 1 hour of wake time (Figure 2)
  • Participants rated their alertness/sleepiness on a 9-point Likert scale

      Demographic and Baseline Clinical Characteristics

• Baseline demographic and clinical characteristics were comparable across treatment groups in the analyzed subgroup of participants with COMISA (Table 1)

      Morning Sleepiness/Alertness Rating

• Alertness ratings increased (improved) in all groups after randomization (Table 2)
  • Increases from baseline in alertness ratings were significantly larger in the last 7 mornings of treatment with LEM5 compared with PBO (P<0.05) (Table 2)
• A greater percentage of participants treated with LEM5 or LEM10 shifted towards more alertness vs treatment with PBO during the first 7 mornings (Table 3) and last 7 mornings (Table 4) of 1 month of treatment

      Safety

• In this cohort of participants with comorbid insomnia and mild OSA, LEM was well tolerated, with no new safety signals compared with the total participant population (Table 5)

•  While the sample size was too small to detect statistical differences, a greater percentage of participants with COMISA experienced improvements in morning sleepiness across the treatment period with LEM compared with PBO
• Consistent with the current findings, a previous analysis found that participants with insomnia and mild-to-moderate baseline sleepiness who were treated with LEM showed significantly greater improvements in sleepiness from baseline to week 1 compared with PBO⁹
• These data provide further evidence that, compared with PBO, LEM is not likely to impair tasks requiring morning alertness^10,11
• LEM was well tolerated, with no new safety signals, in this cohort of participants
  with COMISA
• Overall, these data support the use of LEM in patients with COMISA 

• Insomnia, which is characterized by difficulties with sleep onset and/or sleep maintenance, affects approximately 30% of individuals worldwide^1-3​
• Lemborexant (LEM) is a competitive dual orexin-receptor antagonist (DORA) approved in the United States, Japan, Canada, Australia, and several Asian and Middle Eastern countries for the treatment of insomnia in adults​
• The original LEM phase 3 clinical trial, Study E2006-G000-304 (Study 304; NCT02783729), was conducted in adult women and men with insomnia recruited from clinical trial sites in North America and Europe^4​
  • Results showed that LEM treatment improved both objective and subjective sleep onset and sleep maintenance parameters compared with placebo (PBO)​
• However, few Chinese participants enrolled in Study 304; therefore, Study E2006-J086-311 (Study 311; NCT04549168), a phase 3 clinical trial, was conducted to confirm the efficacy of LEM for the treatment of insomnia in adult Chinese participants​
• Pharmacodynamic studies found no clinically important differences in the efficacy or safety of LEM based on age, sex, race, or body mass index^5,6​
• In a set of pharmacokinetic studies, exposure was found to be equivalent in Chinese, Japanese, and White participants, suggesting that the same dosing regimen can be applied across racial groups^5,6​
  • Based on these findings, it was anticipated that there would be no significant differences in efficacy between the studies​

• This analysis aimed to assess the consistency of effects of LEM treatment on objective sleep parameters, as assessed by polysomnography (PSG) across the 2 studies​

​​​​​​​

• Study 304 was a 1-month, randomized, double-blind, parallel-group, active-comparator–controlled (zolpidem [ZOL]), PBO-controlled phase 3 study that assessed the effects of lemborexant 5 mg (LEM5), lemborexant 10 mg (LEM10), ZOL, or PBO on polysomnographic (PSG; objective) sleep parameters in participants with insomnia disorder (Figure 1A – see full poster via QR code) ​
  • Since LEM5 and ZOL were not included in Study 311, they are not presented here​
• Study 311 was a 1-month, randomized, double-blind, parallel-group, PBO-controlled phase 3 study that assessed the effects of LEM10 or PBO on PSG sleep parameters in Chinese participants with insomnia disorder (Figure 1B – see full poster via QR code)​
• Additional details regarding study design, inclusion/exclusion criteria, PSG assessments, and statistical analysis are included in the full poster

      Demographics and Baseline Characteristics

• In Study 304, the majority of participants were White, female, and approximately 63–64 years of age, whereas in Study 311, all participants were Chinese and most were female and approximately 42 years of age (Table 1)

      Sleep Parameters

• In both studies, mean (SD) decreases from baseline in LPS were significantly larger (improved) with LEM10 compared with PBO (Figure 2, Table 2 – see full poster via QR code)
• In both studies, LSM increases from baseline in SE were significantly larger (improved) with LEM10 compared with PBO (Figure 3, Table 2 – see full poster via QR code)
• In both studies, LSM decreases from baseline in WASO were significantly larger (improved) with LEM10 compared with PBO (Figure 4, Table 2 – see full poster via QR code)
• In both studies, LSM increases from baseline in TST were significantly larger (improved) with LEM10 compared with PBO (Figure 5, Table 2 – see full poster via QR code)

      Safety

• In both studies, LEM was well tolerated, and most treatment-emergent adverse events (TEAEs) were mild or moderate in severity (Table 3 –see full poster via QR code)
• In Study 304, the most common TEAEs among participants receiving LEM10 were headache (4.9%), somnolence (7.1%), and urinary tract infection (3.4%)
• In Study 311, the most common TEAEs among participants receiving LEM10 were coronavirus disease 2019 (COVID-19; 8.5%), fatigue (2.1%), and dizziness (2.1%)
  • Somnolence occurred infrequently in Study 311 (PBO: 0.0%; LEM10: 1.1%)

• Short-term (1-month) treatment with LEM10 consistently improved objective sleep parameters (LPS, SE, WASO, and TST) in both Chinese and non-Chinese participants
• LEM was well tolerated in both populations
• Findings support the efficacy and safety of LEM for treating insomnia globally, regardless
  of race

• Accessible ambulatory neurology care can reduce the need for inpatient evaluation.¹
• A routine patient waits up to 18 months to see a neurologist in Calgary.
• Optimal ambulatory patient flow (activity), aligns referral requests (demand) with provider and space resources (capacity).

• Use a quality improvement approach to understand and address demand (referral requests)
  • Reduce variability, improve reliability and minimize waste in the referral management process.
• Outcome Measure: Average wait time to see a neurologist. 
• Process: Number of accepted referrals / number of referrals received.
• Balancing Measure: Time from referral received to triage decision.

Process Mapping

• Current state referral process mapped with primary care referring physicians, general and subspecialty neurologists.

Root Cause Analysis revealed:

• Unclear consensus among neurologists: Which patients require neurology consulation?
• Manual audit of 1000 referrals across 10 programs
  • ~30% of accepted referrals did not meet triage criteria
• High variation in triage decisions for the same referral
• Referrals with less information had more triage decision variability
• High administrative process variation (e.g. management of no-shows)

 

Outcome Measure
Wait time to see a neurologist increased by 16%, (though significantly more referrals were received per month after the interventions) (987 vs. 859, p <0.00).

• Optimized referral management resulted in a significant reduction in the number of referrals accepted (relative to the number of referrals received) but wait times continue to increase.
• This suggests that capacity (provider and space resources) is a significant problem, requiring further improvement work and advocacy.

BACKGROUND

• CIDP is an autoimmune peripheral neuropathy characterized by progressive or relapsing muscle weakness and sensory
  disturbance, and associated with a high treatment burden^1–5
• IgG autoantibodies play a key role in CIDP demyelination^6–9
• Efgartigimod selectively reduces IgG by blocking FcRn-mediated
  IgG recycling without impacting antibody production, reducing
  albumin levels, or affecting other parts of the immune system^6–9

• Efgartigimod PH20 SC is a coformulation of efgartigimod and recombinant human hyaluronidase PH20, which allows for rapid (30–90s single injection) SC administration^10,11 (Figure 1)

• In the ADHERE trial (Figure 2), efgartigimod PH20 SC reduced
  the risk of relapse and led to clinically meaningful improvements in functional ability, daily activity, or grip strength versus placebo,
  and was well tolerated in participants with CIDP¹⁵
• ADHERE+ was an open-label extension trial in which participants
  were treated with efgartigimod PH20 SC 1000 mg (Figure 2)

aINCAT, adjusted Inflammatory Neuropathy Cause and Treatment; CDAS, CIDP disease activity status; CIDP, chronic inflammatory demyelinating polyradiculoneuropathy; ECI, evidence of clinical improvement; ECMD, evidence of clinically meaningful deterioration; 
Fc, fragment crystallizable; FcRn, neonatal Fc receptor; Ig, immunoglobulin; 

• To report efficacy from an interim analysis 
  (data cutoff: February 16, 2024) of ADHERE+

METHODS

PATIENTS

Baseline characteristics were similar across ADHERE Stages A and B
and ADHERE+

EFFICACY

• Mean change from run-in baseline (SE) to Week 36 in ADHERE+
  for aINCAT, I-RODS, and grip strength score are shown in Figure 3, Figure 4, and Figure 5, respectively
• Restabilization (based on aINCAT scores) in ADHERE+
  in participants with disease relapse in ADHERE Stage B
  is shown in Figure 6

a
INCAT, Inflammatory Neuropathy Cause and Treatment; I-RODS, Inflammatory Rasch-Buillt Overall Disability Scale; IVIg, intravenous immunoglobulin; OLE open-label extension;
PH20, recombinant human hyaluronidase PH20; QW, once weekly, R, randomized;
SC, subcutaneous; SCIg, subcutaneous Ig; SD, standard deviation; SE, standard error; TEAE, treatment-emergent adverse event. 

1. Cox ZC, et al. Clin Geriatr Med. 2021;37(2):327–45. 2. Van den Bergh PYK, et al. Eur J Neurol. 2021;28(11):3556–83. 3. Brun S, et al. Immuno. 2022;2(1):118–31. 4. Bus SRM, et al. J Neurol. 2022;269(2):945–55. 5. Gorson KC. Ther Adv Neurol Disord. 2012;5(6):359–73. 6. Querol LA, et al. Neurotherapeutics. 2022;19(3):864–73. 7. Yan WX, et al. Ann Neurol. 2000;47(6):765–75. 8. Dziadkowiak E, et al. Int J Mol Sci. 2021;23(1):179. 9. Koike H, et al. Neurol Ther. 2020;9(2):213–27. 10. Locke KW, et al. Drug Deliv. 2019;26(1):98–1-6.

SAFETY

KEY TAKEAWAYS

• ADHERE+ trial interim results indicate that efgartigimod PH20 SC treatment results in long-term clinical efficacy in participants with CIDP
• Clinically meaningful improvements in functional ability and dominant hand grip strength in ADHERE+, irrespective of ADHERE Stage B treatment, were observed with efgartigimod PH20 SC
• The majority of participants on efgartigimod PH20 SC who experienced disease relapse during ADHERE Stage B restabilized, and half did so as early as Week 4 of ADHERE+
• Weekly efgartigimod PH20 SC was well tolerated in ADHERE+ with safety similar to that seen in ADHERE

11. VYGART HYRULO. Prescribing Information. argenx; 2024. https://argenx.com/product/
vygart-hytrulo-prescribing-information.pdf. Accessed March 12, 2025. 12. Ulrichts P, et al. J Clin Invest. 2018;128(10):4372–86. 13. Roopenian DC, Akilesh S. Nat Rev Immunol. 2007;7:715–25. 14. Ward ES, Ober RJ. Trends Pharmacol Sci. 2018;39:892–904. 15. Allen JA, et al. Lancet Neurol. 2024;23(10):1013–24. 16. Van den Bergh PYK, et al. Eur J Neurol. 2010;17(3):356–63. 17. Breiner A, et al. Muscle Nerve. 2014;50(1):40–6. 18. van Nes SI, et al. Neurology. 2011;76(4):337–45. 19. Vanhoutte EK. Eur J Neurol. 2013;20(5):748–55.

• Generalized myasthenia gravis (gMG) is a rare autoimmune disease resulting from immunoglobulin G (IgG)-mediated disruption of cholinergic neuromuscular transmission.^1,2
• gMG is marked by chronic weakness of the bulbar muscles, extremities, or axial muscles, resulting in debilitating symptoms such as fatigue and impaired mobility that significantly impact patients’ daily activities and health-related quality of life.³
• While advanced therapies such as targeted immunotherapies are now available, there remains an unmet need for effective gMG treatment to maintain sustained control of disease activity and minimize symptoms.⁴
• The neonatal Fc receptor (FcRn) extends the half-life of serum IgG by preventing IgG clearance via lysosomal degradation; targeted inhibition of FcRn-IgG binding accelerates IgG clearance, potentially benefiting patients with gMG.^4,5
• Nipocalimab, a fully human anti-FcRn monoclonal antibody that inhibits FcRn-IgG binding, demonstrated rapid, substantial, and sustained efficacy in the 24-week phase 3 Vivacity-MG3 (NCT04951622) study in participants with gMG^4,6,7 

To evaluate disease control over time as measured using MG Activities of Daily Living (MG-ADL) in the Vivacity-MG3 study population

• In the Vivacity-MG3 study (NCT04951622), participants with a suboptimal response to standard-of-care (SOC)* treatment were randomly assigned (1:1) to receive either placebo or nipocalimab administered intravenously every two weeks for 24 weeks.
• All analyses were conducted on the primary efficacy analysis set, which included all randomized, seropositive (positive for anti-AChR, anti-MuSK, and anti-LRP4 antibodies) participants who received at least one dose of the study intervention. 

The baseline demographic and disease characteristics were generally balanced between the treatment groups.

• Nipocalimab + SOC demonstrated statistically significant improvement in MG-ADL total score vs placebo + SOC over weeks 22, 23, and 24
• LS-mean change (SE): −4.7 (0.329) vs −3.25 (0.335); difference in LS-means (SE): −1.45 (0.470), p=0.002
• The mean difference, in favor of nipocalimab + SOC, was significant as early as week 1 LS-mean change (SE): −2.72 (2.979) vs −1.77 (2.426); difference in LS-means (SE): −0.82 (0.410), p=0.046
• Significantly greater proportion of participants treated with nipocalimab + SOC achieved sustained improvement over time in MG-ADL ≥2 versus placebo + SOC (Figure 1).
• The odds of achieving a ≥2-point improvement in MG-ADL at weeks 22, 23, and 24 were 2.49 times higher with nipocalimab + SOC compared to placebo + SOC (61.0% vs 38.7%; OR [95% CI]: 2.49 [1.29, 4.77]; p=0.009).

• Similarly, the median percentage of time in the study with ≥2-point improvement in MG-ADL total score was significantly higher for the nipocalimab + SOC group (84.5%) compared to the placebo + SOC group (39.9%), p-value=0.007.

• Significantly greater proportion of participants treated with nipocalimab + SOC achieved sustained improvement over time in MG-ADL ≥3 (substantial improvement) versus placebo + SOC (Figure 2).
• The odds of achieving a clinically substantial improvement in MG-ADL score, defined as a ≥3-point change at weeks 22, 23, and 24 were 2.93 times higher with nipocalimab + SOC compared to placebo + SOC (53.2% vs 28.%; OR [95% CI]: 2.93 [1.492, 5.747]).
• Similarly, the median percentage of time with a ≥3-point improvement in MG-ADL total score was 69.6% for the nipocalimab + SOC group, compared to 20.2% for the placebo + SOC group, p-value <0.001.
• Participants treated with nipocalimab + SOC were approximately three times more likely to achieve MSE at any point during the 24-week study compared to those receiving placebo + SOC, with an OR of 2.99 (95% CI: 1.314, 6.796) and a MSE rate of 31.2% vs 13.2%, respectively

• For the 25 participants (18 nipocalimab, 7 placebo) who reached MSE at any time during the double-blind phase, the median time with sustained MSE was approximately double for nipocalimab + SOC with 101.5 days (60.4%) vs 55 days (32.7%) for placebo + SOC

Based on MG-ADL data from the 24-week Phase 3 Vivacity-MG3 study, the FcRn blocker nipocalimab demonstrated rapid, substantial and sustained symptom control in participants with gMG

BACKGROUND
Generalized myasthenia gravis 
Generalized myasthenia gravis is a potentially life-threatening chronic autoimmune disease that impairs communication between nerves and muscles. The range of symptoms experienced by those with gMG impairs work productivity causing absenteeism, presenteeism and people to leave the workforce^1-3.
Treatment landscape and target population

• The primary focus of treating gMG is symptom management. In Canada, the SOC medications include AChEIs, corticosteroids, and nonsteroidal immunosuppressive therapies.^4-7 When SOC does not adequately control the disease, chronic immunoglobulins are used off-label as an add-on treatment. However, these treatment options may not offer optimal responses and can raise safety concerns.^8,9
• Efgartigimod has shown clinically meaningful and persistent improvements in the MG-ADL when added to SOC medication, in AChR-Ab+ gMG patients whose symptoms persisted despite a stable dose of SOC medication. It has also proven to be a well-tolerated treatment.¹⁰

Caregiving needs and fiscal consequences

• As gMG progresses, individuals often need help from caregivers on their daily activities. This assistance is largely provided by family members that may forego paid work.¹¹ When patients and informal caregivers (iCGs) are less able to work, household income is affected.³
• Besides household productivity and income, the economic effects of gMG extend to other economic domains, including government budgets. Patients and caregivers might rely on social benefits supported by governments (e.g., sickness benefits, disability, early retirement, and caregiving benefits) and the tax revenue from productive work is reduced.

Objective 

• To compare the fiscal impact of efgartigimod versus the current bundle of treatments in Canada (weighted comparator) in adults living with AChR-Ab+ gMG whose symptoms persist despite stable doses of SOC medication.

METHODS
Model overview

• The fiscal model framework (Figure 1) is based on the premise that gMG symptoms and disease progression impacts labor market outcomes and, consequently, government benefits' payments and tax revenue. An effective treatment will not only reduce disease management costs, but will also improve patients' ability to work, reducing the needs for help from iCGs and for government benefit. Patients and iCGs remaining in the workforce and reductions in absenteeism will improve household income and consequently the tax revenue to Canadian governments.
• The current fiscal analysis is based on a lifetime Markov cohort simulation model^4,12, in which gMG patients are distributed according to MG-ADL scores' categories (<5; 5-7; 8-9; ≥10), MG crisis event, and death. A cohort of iCGs was added to the model, as an effective treatment will indirectly impact their labor market outcomes.

Model overview (continued)

• Fiscal consequences to the Canadian governments are the main outcomes of the model: tax revenue, healthcare costs, and government benefits payments (e.g., sickness benefits, disability benefits, retirement pensions, and caregiving benefits). Fiscal outcomes are then compared per treatment arm.
• Efgartigimod is compared to the current bundle of treatments used by the targeted population in Canada. Labeled as “weighted comparator,” it considers 25% of patients on SOC alone and 75% on additional chronic IG.¹³ Treatment effectiveness and health care costs of efgartigimod, SOC, and chronic IG were based on a previously presented cost-effectiveness model.^4,12
• Age at model start and gender distribution are consistent with patients starting efgartigimod treatment in the ADAPT trial¹⁰ and to the iCG’s age difference in the MyRealWorld (MRW) MG study^15,16: an average patient is assumed to start treatment at 47 years of age while the iCG is 50 years of age. Most patients are female (67%) while iCGs are mostly male (61%).

• One-way deterministic sensitivity analysis was conducted and summarized in a tornado
  diagram applying 95% CIs to fiscal parameters.

Sensitivity analysis  

• Figure 3 presents the most impactful fiscal parameters on incremental benefits associated with efgartigimod. 
• The parameters with the highest impact on results are the iCG’s age and gender and the relative risks of patient’s being employed per MG-ADL score. Nevertheless, sensitivity analysis suggests that incremental benefits of using efgartigimod exceed CAN$ 450,000 per patient.

Limitations 
The main limitation of the current work is relying on a single study (MRW MG study^15,16) to estimate this relative risk, with a low number of people by MG-ADL score. Disease modeling and treatment comparative effectiveness were discussed elsewhere.⁴

SUMMARY 

• Investment in efgartigimod (CAN$ 291,000) is estimated to save the Canadian governments CAN$ 459,000 over the lifetime of an average symptomatic gMG patient and respective informal caregiver when compared with current treatments (25% on SOC and 75% on chronic IG).
• Besides savings in disease management costs, enabling patients and informal caregivers to pursue full-time employment can prevent the loss of tax revenue from governments and the need for benefit payments.
• Evidence of health technologies’ impact on the broader public economy should be made available and considered by decision-makers for evaluating new medical therapies.

• Consent is the cornerstone of ethical research.
• Informed consent is not always feasible during life threatening emergencies. 
• Deferred consent is a recognized, but underutilized approach.
• Deferred Consent is informed consent that is obtained retrospectively from the participant or substitute decision maker after the intervention has been carried out.  

• We aim to evaluate the use of deferred consent in two prospective cohort studies involving critically ill patients. 

• The ACT-TBI^1,2  and CANCCAP^3,4 studies both focused on evaluating the efficacy of CT-Perfusion in diagnosing early neurological death. 
• Patients in both studies were incapacitated and unable to provide informed consent themselves.
• Eligible participants with severe traumatic brain injury  (ACT-TBI study^1,2) and comatose cardiac arrest patients (CANCCAP study^3,4) were enrolled and underwent a CT-perfusion scan at the time of their first in-hospital imaging.
• To avoid delaying clinical treatment and ensure a timely baseline scan, deferred consent was obtained. 
• We analyzed the frequency of deferred consent, the number of days required to obtain it, the proportion of refusals, and the instances where a waiver of consent was necessary.
• Demographic data was analyzed using descriptive summary statistics and multivariate logistic regression was conducted to determine the influence of study type, age, sex, and hospital discharge status on a binary outcome of obtaining deferred consent.

RESULTS
 

RESULTS
 

RESULTS
 

CONCLUSION 

• Deferred consent is an acceptable method of obtaining consent in emergency research when the intervention risk is low.
• In a cohort of critically ill patients undergoing CT-perfusion imaging, deferred consent was obtained in 86.6% of cases, with most consents secured within seven days.
• We observed significantly larger odds in obtaining deferred consent for those in the CANCCAP study, increases in age, and those that were alive at hospital discharge. 

Postural Orthostatic Tachycardia Syndrome (POTS) is characterized by a sustained increase in heart rate (HR) of >30 beats per minute (bpm; >40 bpm in patients under 18 years of age) —often exceeding 120 bpm—within 10 minutes of standing or head-up tilt (HUT), in the absence of accompanying orthostatic hypotension (OH). However, some patients develop presyncopal symptoms after 10 minutes of upright posture in the absence of OH. This group remains poorly characterized.

OBJECTIVES

To characterize the clinical and laboratory features of early and delayed orthostatic intolerance (OI) in a large cohort of patients.

METHODS

Study design: Chart-based retrospective cohort study. 

Population: Clinical histories and autonomic laboratory test results of 1,127 patients referred to the University of Alberta Autonomic Laboratory between 2010 and 2025 for assessment of orthostatic intolerance (OI) were reviewed. Symptoms suggestive of OI included lightheadedness, presyncope or syncope, palpitations, postural tachycardia, and/or shortness of breath. Patients were excluded if they had incomplete or artifact-laden data, a diagnosis of diabetes, underlying cardiovascular disease, or had used chronotropic or inotropic medications within five days of testing.

All patients underwent comprehensive autonomic testing, including:

Delayed OI criteria: Patients were considered to have abnormal delayed orthostatic tachycardia after the first 10 minutes during the HUT if they developed symptoms of OI and their HR increased by ≥40 bpm from baseline or reached ≥140 beats per minute.

RESULTS