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Selmaj K, Arnold D, Brinar V, Cohen J, Coles A, Confavreux C, Fox E, Giovannoni G, Hartung H, Havrdova E, Stojanovic M, Weiner H, Lake S, Margolin D, Oyuela P, Panzara M, Compston A. Incidence of Autoimmunity in a Phase 3 Trial: Comparison of Alemtuzumab and Rebif(R) in Multiple Sclerosis I (CARE-MS I) (S41.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s41.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Havrdova E, Arnold D, Cohen J, Coles A, Confavreux C, Fox E, Hartung H, Selmaj K, Weiner H, Brinar V, Giovannoni G, Stojanovic M, Lake S, Margolin D, Oyuela P, Panzara M, Compston A. Infections in Phase 3 Study: Comparison of Alemtuzumab and Rebif(R) Efficacy in Multiple Sclerosis I (CARE-MS I) (S41.007). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s41.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Michel L, Vukusic S, De Seze J, Ducray F, Ongagna JC, Confavreux C, Laplaud D, Wiertlewski S. Mycophenolate Mofetil as a Monotherapy in Multiple Sclerosis: A Multicenter Retrospective Study on 362 Patients (P04.144). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Miller A, Lublin F, O'Connor P, Wolinsky J, Comi G, Kappos L, Freedman M, Olsson T, Dive-Pouletty C, Bego-Le-Bagousse G, Confavreux C. Effect of Teriflunomide on Relapses with Sequelae and Relapse Leading to Hospitalization in a Population with Relapsing Forms of Multiple Sclerosis: Results from the TEMSO Study (S30.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s30.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fox E, Arnold D, Brinar V, Cohen J, Coles A, Confavreux C, Giovannoni G, Hartung H, Havrdova E, Selmaj K, Stojanovic M, Weiner H, Lake S, Margolin D, Panzara M, Compston A. Relapse Outcomes with Alemtuzumab vs. Rebif(R) in Treatment-Naive Relapsing-Remitting Multiple Sclerosis (CARE-MS I): Secondary and Tertiary Endpoints (PD5.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd5.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Coles A, Brinar V, Arnold D, Cohen J, Confavreux C, Fox E, Hartung H, Havrdova E, Selmaj K, Weiner H, Giovannoni G, Stojanovic M, Lake S, Margolin D, Panzara M, Compston A. Efficacy and Safety Results from Comparison of Alemtuzumab and Rebif(R) Efficacy in Multiple Sclerosis I (CARE-MS I): A Phase 3 Study in Relapsing-Remitting Treatment-Naive Patients (S01.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Arnold D, Brinar V, Cohen J, Coles A, Confavreux C, Fisher E, Fox E, Giovannoni G, Hartung H, Havrdova E, Selmaj K, Weiner H, Stojanovic M, Lake S, Margolin D, Panzara M, Compston A. Effect of Alemtuzumab vs. Rebif(R) on Brain MRI Measurements: Results of CARE-MS I, a Phase 3 Study (S11.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cohen J, Twyman C, Arnold D, Coles A, Confavreux C, Fox E, Hartung H, Havrdova E, Selmaj K, Weiner H, Miller T, Lake S, Margolin D, Panzara M, Compston A. Efficacy and Safety Results from Comparison of Alemtuzumab and Rebif(R) Efficacy in Multiple Sclerosis II (CARE-MS II): A Phase 3 Study in Relapsing-Remitting Multiple Sclerosis Patients Who Relapsed on Prior Therapy (S01.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Polman C, Havrdova E, Confavreux C, Rudick R. Relationship between Timed 25-Foot Walk Walking Speed and Health-Related Quality of Life in AFFIRM and SENTINEL (P07.097). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Freedman M, O'Connor P, Wolinsky J, Confavreux C, Comi G, Kappos L, Olsson T, Truffinet P, Dukovic D, Miller A. Teriflunomide Increases the Proportion of Patients Free from Disease Activity in the TEMSO Phase III Study (PD5.007). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd5.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bourre B, Marignier R, Zéphir H, Papeix C, Brassat D, Castelnovo G, Collongues N, Vukusic S, Labauge P, Outteryck O, Fontaine B, Vermersch P, Confavreux C, de Seze J. Neuromyelitis optica and pregnancy. Neurology 2012; 78:875-9. [PMID: 22402855 DOI: 10.1212/wnl.0b013e31824c466f] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of our study was to assess the influence of pregnancy on the course of neuromyelitis optica (NMO) and the impact of epidural analgesia and breastfeeding on its activity in the postpartum period. METHODS We performed a retrospective study of patients with NMO diagnosed according to Wingerchuk criteria. We noted the number of relapses during the year before pregnancy (BP), during pregnancy (first trimester, second trimester, third trimester), and the year after (Y + 1: first trimester, second trimester [PP2], and third and fourth trimesters postpartum). Epidural analgesia and breastfeeding were recorded. Disability was evaluated with the Kurtzke Expanded Disability Status Scale (EDSS). The annualized relapse rate (ARR) was calculated. RESULTS We identified 124 patients (85 female) in the French NOMADMUS cohort on November 1, 2010. A total of 20 women (including 25 pregnancies) were informative with complete files. Comparisons between the ARR of each period and BP (1.0 ± 0.09) only showed an increased tendency for PP2 (0.8 ± 0.06, p = 0.07). Epidural analgesia and breastfeeding had no influence on the course of NMO. The EDSS score increased from 1.5 ± 1.7 BP to 2.6 ± 1.9 Y + 1 (p = 0.027). CONCLUSION This study shows that pregnancy influences the activity of NMO, a finding that justifies close medical monitoring. We found no evidence to suggest that either epidural analgesia or breastfeeding has an aggravating effect on NMO.
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Androdias G, Maillet D, Marignier R, Pinède L, Broussolle C, Sève P, Confavreux C, Vukusic S. Efficacité du mycophenolate mofetil dans les atteintes neurologiques centrales liées à la sarcoïdose. Rev Neurol (Paris) 2012. [DOI: 10.1016/s0035-3787(12)70025-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ritzenthaler T, Dailler F, Vukusic S, Confavreux C, Marignier R. First attack of Devic’s neuromyelitis optica following endovascular treatment and rupture of brain arteriovenous malformation. Mult Scler 2011; 17:895-6. [DOI: 10.1177/1352458511401945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Petzold A, Marignier R, Verbeek MM, Confavreux C. Glial but not axonal protein biomarkers as a new supportive diagnostic criteria for Devic neuromyelitis optica? Preliminary results on 188 patients with different neurological diseases. J Neurol Neurosurg Psychiatry 2011; 82:467-9. [PMID: 20667859 DOI: 10.1136/jnnp.2009.196550] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Androdias G, Maillet D, Marignier R, Pinede L, Confavreux C, Broussolle C, Vukusic S, Seve P. Mycophenolate mofetil may be effective in CNS sarcoidosis but not in sarcoid myopathy. Neurology 2011; 76:1168-72. [DOI: 10.1212/wnl.0b013e318212aafb] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Orton SM, Wald L, Confavreux C, Vukusic S, Krohn JP, Ramagopalan SV, Herrera BM, Sadovnick AD, Ebers GC. Association of UV radiation with multiple sclerosis prevalence and sex ratio in France. Neurology 2011; 76:425-31. [PMID: 21282589 DOI: 10.1212/wnl.0b013e31820a0a9f] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND French farmers and their families constitute an informative population to study multiple sclerosis (MS) prevalence and related epidemiology. We carried out an ecological study to evaluate the association of MS prevalence and ultraviolet (UV) radiation, a candidate climatologic risk factor. METHODS Mean annual and winter (December-March) UVB irradiation values were systematically compared to MS prevalence rates in corresponding regions of France. UVB data were obtained from the solar radiation database (SoDa) service and prevalence rates from previously published data on 2,667 MS cases registered with the national farmer health insurance system, Mutualité Sociale Agricole (MSA). Pearson correlation was used to examine the relationship of annual and winter UVB values with MS prevalence. Male and female prevalence were also analyzed separately. Linear regression was used to test for interaction of annual and winter UVB with sex in predicting MS prevalence. RESULTS There was a strong association between MS prevalence and annual mean UVB irradiation (r = -0.80, p < 0.001) and average winter UVB (r = -0.87, p < 0.001). Both female (r = -0.76, p < 0.001) and male (r = -0.46, p = 0.032) prevalence rates were correlated with annual UVB. Regression modeling showed that the effect of UVB on prevalence rates differed by sex; the interaction effect was significant for both annual UVB (p = 0.003) and winter UVB (p = 0.002). CONCLUSIONS The findings suggest that regional UVB radiation is predictive of corresponding MS prevalence rates and supports the hypothesis that sunlight exposure influences MS risk. The evidence also supports a potential role for gender-specific effects of UVB exposure.
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Collongues N, Marignier R, Zéphir H, Blanc F, Vukusic S, Outteryck O, Fleury M, Ruet A, Borgel F, Thouvenot E, Moreau T, Defer G, Derache N, Pelletier J, Audoin B, Debouverie M, Labauge P, Gout O, Camu W, Brassat D, Brochet B, Vermersch P, Confavreux C, Seze JD. High-risk syndrome for neuromyelitis optica: a descriptive and comparative study. Mult Scler 2011; 17:720-4. [DOI: 10.1177/1352458510396923] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Neuromyelitis optica (NMO) frequently begins with a monofocal episode of optic neuritis or myelitis. A concept named high-risk syndrome (HRS) for NMO has been proposed for patients with monofocal episodes and NMO-IgG antibodies. Objective: To describe HRS patients and compare them with NMO patients. Methods: We identified 30 patients with HRS: 18 with extensive myelitis (HRM) and 12 with optic neuritis (HRON), in a database pooling patients from 25 centres in France. Clinical, laboratory/magnetic resonance imaging (MRI) data and outcome were analysed and compared with a national cohort of 125 NMO patients extracted from the same database. Results: Mean follow-up was 4.8 years. Mean age at onset was 42.8 years (range: 12.4–70) with a female:male ratio of 0.9. Asymptomatic lesions were report on visual evoked potentials in 4/8 tested HRM patients and on spinal cord MRI in 2/7 HRON patients. Three patients died, two owing to a cervical lesion. HRS and NMO patients had similar clinical/paraclinical data, except for a predominance of men in the HRS group and a later mean age at onset in the HRM subgroup. Conclusion: The description of HRS patients is compatible with a monofocal form of NMO. Asymptomatic lesions could be included in a new set of NMO diagnostic criteria.
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Collongues N, Marignier R, Zéphir H, Papeix C, Fontaine B, Blanc F, Rodriguez D, Fleury M, Vukusic S, Pelletier J, Audoin B, Thouvenot E, Camu W, Barroso B, Ruet A, Brochet B, Vermersch P, Confavreux C, de Seze J. Long-term follow-up of neuromyelitis optica with a pediatric onset. Neurology 2010; 75:1084-8. [PMID: 20855851 DOI: 10.1212/wnl.0b013e3181f39a66] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Neuromyelitis optica (NMO) is a rare inflammatory disease. Average age at onset is 35 years. Few data exist on patients with pediatric-onset NMO (p-NMO), with disease onset before age 18 years. We report the clinical and paraclinical features and long-term outcome of patients with p-NMO and compare them with a large adult-onset NMO (a-NMO) cohort. METHODS We performed a retrospective, multicenter study of patients with p-NMO in pediatric and adult medical centers. We identified 125 patients with NMO (12 p-NMO; 113 a-NMO) fulfilling the 2006 criteria. Data were collected using hospital files and standardized assessment forms for NMO. RESULTS Patients with p-NMO were followed up during a mean 19.3 years. Median age at onset was 14.5 years (4.1-17.9) with a female:male ratio of 3:1. Three patients (25%) fulfilled Paty criteria for multiple sclerosis on first brain MRI, including one patient with acute disseminated encephalomyelitis. Median interval between onset and residual Expanded Disability Status Scale (EDSS) score 4 was 20.7 years, score 6 was 26 years, and score 7 was 28.7 years. Median interval between onset and residual visual loss ≤1/10 was 1.3 years. Compared with a-NMO, p-NMO showed a longer time to EDSS scores 4 and 6, largely explained by the severity of the first myelitis in the a-NMO group. Time to first treatment was longer in the p-NMO group (13.1 vs 3.4 years). CONCLUSION Patients with p-NMO can present a diffuse inflammatory process on first brain MRI and have a longer time to disability than patients with a-NMO.
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Catenoix H, Marignier R, Ritleng C, Dufour M, Mauguière F, Confavreux C, Vukusic S. Multiple sclerosis and epileptic seizures. Mult Scler 2010; 17:96-102. [DOI: 10.1177/1352458510382246] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The association between epilepsy and multiple sclerosis (MS) is not a coincidence. Objective: Our objective was to compare MS patients with or without history of seizures. Methods: In a population of 5041 MS patients, we identified 102 (2%) patients with epileptic seizures. In 67 patients (1.3%), epileptic seizure could not be explained by any cause other than MS. Results: In these 67 patients, the median age at occurrence of the first epileptic seizure was 33 years. Epilepsy was the initial clinical manifestation of MS in seven patients. In total, 62 patients (92.5%) presented only one or a few seizures, and 18 patients (27%) presented at least one episode of status epilepticus, fatal in two. Compared with MS patients without epilepsy, there was no difference in gender, type of MS course and time from onset of MS to the progressive phase. Conversely, the median age at MS onset was earlier (25.0 years vs. 30, p < 0.0001) and there was a trend for a shorter time from MS onset to non-reversible disability. Conclusions: Our study confirms an increased risk of epileptic seizures in MS patients. It underlines that seizures may be the first observable symptom in MS and the frequency and seriousness of status epilepticus.
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Collongues N, Marignier R, Zéphir H, Papeix C, Blanc F, Ritleng C, Tchikviladzé M, Outteryck O, Vukusic S, Fleury M, Fontaine B, Brassat D, Clanet M, Milh M, Pelletier J, Audoin B, Ruet A, Lebrun-Frenay C, Thouvenot E, Camu W, Debouverie M, Créange A, Moreau T, Labauge P, Castelnovo G, Edan G, Le Page E, Defer G, Barroso B, Heinzlef O, Gout O, Rodriguez D, Wiertlewski S, Laplaud D, Borgel F, Tourniaire P, Grimaud J, Brochet B, Vermersch P, Confavreux C, de Seze J. Neuromyelitis optica in France: a multicenter study of 125 patients. Neurology 2010; 74:736-42. [PMID: 20194912 DOI: 10.1212/wnl.0b013e3181d31e35] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There have been few epidemiologic studies on neuromyelitis optica (NMO) and none used the recent 2006 diagnostic criteria. Here we describe the clinical, laboratory, MRI, and disability course of NMO in a French cohort of 125 patients. METHODS We performed an observational, retrospective, multicenter study. Data were collected from September 2007 through August 2008, corresponding to the endpoint of the study. We identified 125 patients fulfilling the 2006 NMO criteria. Selection was made using hospital files and a specific clinical questionnaire for NMO. RESULTS Mean age at onset was 34.5 years (range 4-66) with a mean disease duration of 10 +/- 7.8 years at the endpoint. The patients were mainly (87%) Caucasian, with a female:male ratio of 3:1. In 90% of cases, the association of optic neuritis, longitudinal extensive myelitis, and a Paty-negative initial brain MRI was sufficient to fulfill the supportive criteria. Eighty-eight percent of patients were treated with immunosuppressive therapies. Median delay from onset to Expanded Disability Status Scale (EDSS) score 4 was 7 years; score 6, 10 years; and score 7, 21 years. The first episode of myelitis was immediately followed by an EDSS score > or = 4 in 37.3% of cases, and a severe residual visual loss was observed in 22% of patients after the first episode of optic neuritis. Multivariate analysis did not reveal any predictors of a poor evolution other than a high number of MRI brain lesions at diagnosis, which were predictive of a residual visual acuity < or = 1/10. CONCLUSIONS Our demographic data provide new data on disability in patients with neuromyelitis optica, most of whom were receiving treatment.
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Vukusic S, Passante N, Ritleng C, Laforest L, Van Ganse E, Rocher F, Clanet M, Castot A, Confavreux C. 220 Safety of multiple sclerosis patients treated by natalizumab (Network EDMUS). BMJ Qual Saf 2010. [DOI: 10.1136/qshc.2010.041632.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Michel L, Foucher Y, De Sèze J, Vukusic S, Confavreux C, Brassat D, Clavelou P, Ouallet JC, Brochet B, Pelletier J, Labauge P, Lebrun C, Lefrere F, Jacq-Foucher M, Wiertlewski S, Laplaud DA. Étude rétrospective multicentrique évaluant le retentissement des traitements utilisés pour la fécondation in vitro sur le risque de poussées de Sclérose en plaques. Rev Neurol (Paris) 2010. [DOI: 10.1016/s0035-3787(10)70004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Maillet D, Vukusic S, Confavreux C, Pinede L, Broussolle C, Sève P. Utilisation du mycophénolate mofétil au cours de la neurosarcoïdose : analyse rétrospective de 10 observations. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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49
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Vukusic S, Ionescu I, El-Etr M, Schumacher M, Baulieu E, Cornu C, Confavreux C. The Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPART'MUS) trial: Rationale, objectives and state of advancement. J Neurol Sci 2009; 286:114-8. [DOI: 10.1016/j.jns.2009.08.056] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 08/19/2009] [Accepted: 08/25/2009] [Indexed: 10/20/2022]
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Tappenden P, Saccardi R, Confavreux C, Sharrack B, Muraro PA, Mancardi GL, Kozak T, Farge-Bancel D, Madan J, Rafia R, Akehurst R, Snowden J. Autologous haematopoietic stem cell transplantation for secondary progressive multiple sclerosis: an exploratory cost-effectiveness analysis. Bone Marrow Transplant 2009; 45:1014-21. [PMID: 19855441 DOI: 10.1038/bmt.2009.305] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Treatment options for secondary progressive multiple sclerosis (SPMS) are limited. Mitoxantrone is routinely used to stabilize disease progression; however, evolving evidence suggests clinical benefit from intensive treatment with autologous haematopoietic stem cell transplantation (HSCT). Given differences in cost and outcomes, preliminary cost-effectiveness studies are warranted if this approach is to be developed for more widespread application in SPMS. We developed a decision-analytic Markov model to explore the potential cost-effectiveness of autologous HSCT versus mitoxantrone in SPMS, using patient-level data from registry sources. The model evaluates the lifetime costs and health outcomes associated with disability progression and relapse. Sensitivity analyses were undertaken to examine the uncertainty surrounding cost-effectiveness outcomes. In the absence of randomised controlled trial (RCT) evidence, conditions for comparative analysis were not ideal. Under optimistic assumptions, HSCT is estimated to cost below pound3000 per quality adjusted life year gained. However, when a strict 6-month sustained progression rule is adopted, HSCT may be less effective and more expensive than mitoxantrone. The model results were sensitive to reducing procedural costs and HSCT-related mortality. We conclude that HSCT could potentially achieve an acceptable level of cost-effectiveness. However, caution should be exercised as large, high-quality RCTs comparing HSCT versus mitoxantrone are necessary to validate these findings.
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