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Sedal L, Winkel A, Laing J, Law LY, McDonald E. Current concepts in multiple sclerosis therapy. Degener Neurol Neuromuscul Dis 2017; 7:109-125. [PMID: 30050382 PMCID: PMC6053095 DOI: 10.2147/dnnd.s109251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Over the past 20 years, the available therapies for multiple sclerosis have expanded exponentially. With several more agents likely to be approved for public funding in Australia in the next 12 months on top of the existing multitude of Australian Pharmaceutical Benefits Scheme-subsidized therapies, the choice is becoming even more complex. This review summarizes the current state of available therapies and anticipates likely future directions, including an important focus on contemporary symptom management. For each agent, the major trials, side effects, and clinical utility are summarized, with a particular focus on the Australian experience of these therapies. It is hoped this review provides an up-to-date reference of the exciting current state of multiple sclerosis therapy.
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Affiliation(s)
- Leslie Sedal
- Department of Neurology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia,
| | - Antony Winkel
- Department of Neurology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia,
| | - Joshua Laing
- Department of Neurology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia,
| | - Lai Yin Law
- Department of Neurology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia,
| | - Elizabeth McDonald
- Department of Neurology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia,
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Cohen M, Brochet B, Clavelou P, Le Page E, Vermersch P, Tourbah A, Moreau T, Joly H, Sakarovitch C, Lebrun C. Cognition and quality of life in clinically isolated syndrome patients starting a disease modifying therapy in the QUALICIS study may not predict treatment response at one year. J Neurol Sci 2017; 382:73-78. [PMID: 29111024 DOI: 10.1016/j.jns.2017.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/01/2017] [Accepted: 09/20/2017] [Indexed: 11/26/2022]
Abstract
Cognition and health-related quality of life (HRQoL) are early involved in multiple sclerosis (MS). The aim of QUALICIS study was to monitor cognition and HRQoL prospectively in a cohort of clinically isolated syndrome (CIS) patients starting a treatment with subcutaneous beta-1b interferon as a first disease modifying treatment (DMT), and to assess their correlation with the clinical outcome 6years later. Relapse history, EDSS and yearly standardized brain MRI data were also collected. 37 patients were included. Cognition and HRQoL remained stable over treatment period. At baseline, we found that SDMT was moderately correlated to T2 lesion load (r=-0.47, p=0.04). Baseline SDMT was predictive of HRQoL at year 2 (r=0.53, p=0.02). Regarding 6-year outcome, the most specific predictive factor of favorable outcome was achieving "No Evidence of Disease Activity" (NEDA) status at year 1. In this group, all the patients had a stable EDSS score and none switched to a second line therapy. In the "non-NEDA" group, 44% of patients experienced EDSS worsening and 38.9% switched to a second line therapy. The number of gadolinium enhancing lesions on baseline scan was the only predictive factor of poor outcome in this subgroup of patients (2 vs. 0.13, p=0.03). Our results suggest that NEDA at 1year could be used to predict long term outcome after initiation of DMT in CIS. For non-NEDA patients, monitoring SDMT and brain atrophy could be potentially relevant, but this should be confirmed on a larger sample.
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Affiliation(s)
- Mikael Cohen
- Université Côte d'Azur, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Service de Neurologie, Nice, France.
| | - Bruno Brochet
- Service de Neurologie, CHU de Bordeaux, Bordeaux, France; INSERM U1215-Labex TRAIL-FHU TALISMAN, France; Univ-Bordeaux, France
| | - Pierre Clavelou
- Service de Neurologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Patrick Vermersch
- Service de Neurologie, Univ Lille, CHU Lille, LIRIC - INSERM U995, FHU Imminent, F-59037 Lille, France
| | - Ayman Tourbah
- Service de Neurologie et Faculté de Médecine de Reims, CHU de Reims, URCA, Reims, France; LPN EA 207, Université Paris 8, Saint-Denis, France
| | | | - Héloïse Joly
- Université Côte d'Azur, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Service de Neurologie, Nice, France
| | - Charlotte Sakarovitch
- Département de la Recherche Clinique, Université Côte d'Azur, Hôpital de Cimiez, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Christine Lebrun
- Université Côte d'Azur, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Service de Neurologie, Nice, France
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