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Abstract
Inebilizumab (Uplizna®) is a recently approved monoclonal antibody for use in adults with neuromyelitis optica spectrum disorder (NMOSD) who are anti-aquaporin-4 (AQP4) antibody seropositive. Inebilizumab targets the B cell antigen CD19 and effectively depletes circulating B cells, thus suppressing inflammatory NMOSD attacks that are potentially disabling or life-threatening. It is approved as an intravenous infusion in several countries. In the pivotal phase 2/3 N-MOmentum trial, inebilizumab reduced the risk of NMOSD attacks compared with placebo, including in AQP4-antibody seropositive patients. Inebilizumab also significantly reduced the risk of disability score worsening, the number of NMOSD-related hospitalisations and MRI lesion count, but had no significant effect on low-contrast binocular vision. The treatment effect on relapse risk and disability scores was sustained in inebilizumab-treated patients for ≥ 4 years during the open-label extension. Inebilizumab was generally well tolerated, with the most common adverse events being urinary tract infection and arthralgia. Thus, inebilizumab is an effective treatment option for adults with AQP4-antibody seropositive NMOSD.
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Affiliation(s)
- Tina Nie
- Springer Nature, Mairangi Bay, Private Bag 65901, Auckland, 0754, New Zealand.
| | - Hannah A Blair
- Springer Nature, Mairangi Bay, Private Bag 65901, Auckland, 0754, New Zealand
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102
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Kastrati K, Aletaha D, Burmester GR, Chwala E, Dejaco C, Dougados M, McInnes IB, Ravelli A, Sattar N, Stamm TA, Takeuchi T, Trauner M, van der Heijde D, Voshaar MJH, Winthrop K, Smolen JS, Kerschbaumer A. A systematic literature review informing the consensus statement on efficacy and safety of pharmacological treatment with interleukin-6 pathway inhibition with biological DMARDs in immune-mediated inflammatory diseases. RMD Open 2022; 8:rmdopen-2022-002359. [PMID: 36260501 PMCID: PMC9462104 DOI: 10.1136/rmdopen-2022-002359] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/30/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Informing an international task force updating the consensus statement on efficacy and safety of biological disease-modifying antirheumatic drugs (bDMARDs) selectively targeting interleukin-6 (IL-6) pathway in the context of immune-mediated inflammatory diseases. Methods A systematic literature research of all publications on IL-6 axis inhibition with bDMARDs published between January 2012 and December 2020 was performed using MEDLINE, EMBASE and Cochrane CENTRAL databases. Efficacy and safety outcomes were assessed in clinical trials including their long-term extensions and observational studies. Meeting abstracts from ACR, EULAR conferences and results on clinicaltrials.gov were taken into consideration. Results 187 articles fulfilled the inclusion criteria. Evidence for positive effect of IL-6 inhibition was available in various inflammatory diseases such as rheumatoid arthritis, juvenile idiopathic arthritis, giant cell arteritis, Takayasu arteritis, adult-onset Still’s disease, cytokine release syndrome due to chimeric antigen receptor T cell therapy and systemic sclerosis-associated interstitial lung disease. Newcomers like satralizumab and anti-IL-6 ligand antibody siltuximab have expanded therapeutic approaches for Castleman’s disease and neuromyelitis optica, respectively. IL-6 inhibition did not provide therapeutic benefits in psoriatic arthritis, ankylosing spondylitis and certain connective tissue diseases. In COVID-19, tocilizumab (TCZ) has proven to be therapeutic in advanced disease. Safety outcomes did not differ from other bDMARDs, except higher risks of diverticulitis and lower gastrointestinal perforations. Inconsistent results were observed in several studies investigating the risk for infections when comparing TCZ to TNF-inhibitors. Conclusion IL-6 inhibition is effective for treatment of several inflammatory diseases with a safety profile that is widely comparable to other bDMARDs.
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Affiliation(s)
- Kastriot Kastrati
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Gerd R Burmester
- Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Eva Chwala
- University Library, Medical University of Vienna, Wien, Austria
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria
- Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | - Maxime Dougados
- Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France
| | - Iain B McInnes
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Angelo Ravelli
- UO Pediatria II-Reumatologia, Istituto Giannina Gaslini, Genova, Italy
| | - Naveed Sattar
- Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Japan
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Medical University of Vienna Department of Medicine III, Wien, Austria
| | | | - Marieke J H Voshaar
- Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek, Ubbergen, The Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kevin Winthrop
- Schools of Medicine and Public Health, Oregon Health and Science University, Portland, Oregon, USA
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Wien, Austria
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103
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Petzold A, Fraser CL, Abegg M, Alroughani R, Alshowaeir D, Alvarenga R, Andris C, Asgari N, Barnett Y, Battistella R, Behbehani R, Berger T, Bikbov MM, Biotti D, Biousse V, Boschi A, Brazdil M, Brezhnev A, Calabresi PA, Cordonnier M, Costello F, Cruz FM, Cunha LP, Daoudi S, Deschamps R, de Seze J, Diem R, Etemadifar M, Flores-Rivera J, Fonseca P, Frederiksen J, Frohman E, Frohman T, Tilikete CF, Fujihara K, Gálvez A, Gouider R, Gracia F, Grigoriadis N, Guajardo JM, Habek M, Hawlina M, Martínez-Lapiscina EH, Hooker J, Hor JY, Howlett W, Huang-Link Y, Idrissova Z, Illes Z, Jancic J, Jindahra P, Karussis D, Kerty E, Kim HJ, Lagrèze W, Leocani L, Levin N, Liskova P, Liu Y, Maiga Y, Marignier R, McGuigan C, Meira D, Merle H, Monteiro MLR, Moodley A, Moura F, Muñoz S, Mustafa S, Nakashima I, Noval S, Oehninger C, Ogun O, Omoti A, Pandit L, Paul F, Rebolleda G, Reddel S, Rejdak K, Rejdak R, Rodriguez-Morales AJ, Rougier MB, Sa MJ, Sanchez-Dalmau B, Saylor D, Shatriah I, Siva A, Stiebel-Kalish H, Szatmary G, Ta L, Tenembaum S, Tran H, Trufanov Y, van Pesch V, Wang AG, Wattjes MP, Willoughby E, Zakaria M, Zvornicanin J, Balcer L, Plant GT. Diagnosis and classification of optic neuritis. Lancet Neurol 2022; 21:1120-1134. [PMID: 36179757 DOI: 10.1016/s1474-4422(22)00200-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/16/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
There is no consensus regarding the classification of optic neuritis, and precise diagnostic criteria are not available. This reality means that the diagnosis of disorders that have optic neuritis as the first manifestation can be challenging. Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals with multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein antibody-associated disease. Epidemiological data show that, cumulatively, optic neuritis is most frequently caused by many conditions other than multiple sclerosis. Worldwide, the cause and management of optic neuritis varies with geographical location, treatment availability, and ethnic background. We have developed diagnostic criteria for optic neuritis and a classification of optic neuritis subgroups. Our diagnostic criteria are based on clinical features that permit a diagnosis of possible optic neuritis; further paraclinical tests, utilising brain, orbital, and retinal imaging, together with antibody and other protein biomarker data, can lead to a diagnosis of definite optic neuritis. Paraclinical tests can also be applied retrospectively on stored samples and historical brain or retinal scans, which will be useful for future validation studies. Our criteria have the potential to reduce the risk of misdiagnosis, provide information on optic neuritis disease course that can guide future treatment trial design, and enable physicians to judge the likelihood of a need for long-term pharmacological management, which might differ according to optic neuritis subgroups.
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104
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Treatment and Relapse Prevention of Typical and Atypical Optic Neuritis. Int J Mol Sci 2022; 23:ijms23179769. [PMID: 36077167 PMCID: PMC9456305 DOI: 10.3390/ijms23179769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
Optic neuritis (ON) is an inflammatory condition involving the optic nerve. Several important typical and atypical ON variants are now recognized. Typical ON has a more favorable prognosis; it can be idiopathic or represent an early manifestation of demyelinating diseases, mostly multiple sclerosis (MS). The atypical spectrum includes entities such as antibody-driven ON associated with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD), chronic/relapsing inflammatory optic neuropathy (CRION), and sarcoidosis-associated ON. Appropriate and timely diagnosis is essential to rapidly decide on the appropriate treatment, maximize visual recovery, and minimize recurrences. This review paper aims at presenting the currently available state-of-the-art treatment strategies for typical and atypical ON, both in the acute phase and in the long-term. Moreover, emerging therapeutic approaches and novel steps in the direction of achieving remyelination are discussed.
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105
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Monoclonal Antibody Engineering and Design to Modulate FcRn Activities: A Comprehensive Review. Int J Mol Sci 2022; 23:ijms23179604. [PMID: 36077002 PMCID: PMC9455995 DOI: 10.3390/ijms23179604] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 01/03/2023] Open
Abstract
Understanding the biological mechanisms underlying the pH-dependent nature of FcRn binding, as well as the various factors influencing the affinity to FcRn, was concurrent with the arrival of the first recombinant IgG monoclonal antibodies (mAbs) and IgG Fc-fusion proteins in clinical practice. IgG Fc–FcRn became a central subject of interest for the development of these drugs for the comfort of patients and good clinical responses. In this review, we describe (i) mAb mutations close to and outside the FcRn binding site, increasing the affinity for FcRn at acidic pH and leading to enhanced mAb half-life and biodistribution, and (ii) mAb mutations increasing the affinity for FcRn at acidic and neutral pH, blocking FcRn binding and resulting, in vivo, in endogenous IgG degradation. Mutations modifying FcRn binding are discussed in association with pH-dependent modulation of antigen binding and (iii) anti-FcRn mAbs, two of the latest innovations in anti-FcRn mAbs leading to endogenous IgG depletion. We discuss the pharmacological effects, the biological consequences, and advantages of targeting IgG–FcRn interactions and their application in human therapeutics.
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106
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Scholl AR, Korentzelos D, Forns TE, Brenneman EK, Kelm M, Datto M, Wheeler SE, Carlsen ED. Characterization of Casirivimab Plus Imdevimab, Sotrovimab, and Bamlanivimab Plus Etesevimab-Derived Interference in Serum Protein Electrophoresis and Immunofixation Electrophoresis. J Appl Lab Med 2022; 7:1379-1387. [PMID: 35993812 PMCID: PMC9452102 DOI: 10.1093/jalm/jfac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022]
Abstract
Background Therapeutic monoclonal antibodies can be a source of assay interference in clinical serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE), producing monoclonal bands that can be misinterpreted as a monoclonal gammopathy related to a B-cell or plasma cell neoplasm. The extent to which new anti-COVID-19 monoclonal antibodies produce this interference is unknown. Methods Casirivimab plus imdevimab, sotrovimab, and bamlanivimab plus etesevimab were spiked into patient serum samples to evaluate for SPEP/IFE interference, to characterize the position of therapy-derived bands relative to a reference band (either combined beta band or beta 1 band, depending on instrument platform), and to confirm heavy and light chain utilization of each medication. Serum samples from patients who had recently received casirivimab plus imdevimab or sotrovimab were also evaluated for comparison. Results When spiked into serum samples, all tested anti-COVID-19 monoclonal antibodies generated interference in SPEP/IFE. Importantly, the patterns of interference differed between spiked serum samples and serum from patients who had recently received casirivimab plus imdevimab or sotrovimab. Conclusions Imdevimab can be added to the growing list of therapeutic monoclonal antibodies that produce sustained interference in SPEP/IFE. Although casirivimab and sotrovimab also produce assay interference in vitro, these antibodies are not reliably detected in serum from recently infused patients. The value of relative band position in recognizing bands that may represent therapeutic monoclonal antibodies is also emphasized. Clinicians and laboratorians should consider therapeutic monoclonal antibody interference in diagnostic SPEP/IFE and review a patient’s medication list when new or transient monoclonal bands are identified.
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Affiliation(s)
- Ashley Rose Scholl
- Department of Pathology, Duke University Medical Center , Durham NC , USA
| | - Dimitrios Korentzelos
- Department of Pathology, University of Pittsburgh Medical Center , Pittsburgh PA , USA
| | - Taylor E Forns
- Department of Pathology, Duke University Medical Center , Durham NC , USA
| | - Ethan K Brenneman
- Department of Pharmacy, Duke University Medical Center , Durham NC , USA
| | - Matthew Kelm
- Department of Pharmacy, Duke University Medical Center , Durham NC , USA
| | - Michael Datto
- Department of Pathology, Duke University Medical Center , Durham NC , USA
| | - Sarah E Wheeler
- Department of Pathology, University of Pittsburgh Medical Center , Pittsburgh PA , USA
| | - Eric D Carlsen
- Department of Pathology, Duke University Medical Center , Durham NC , USA
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107
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Affiliation(s)
- Dean M Wingerchuk
- From the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.M.W.); and the Department of Neurology, Mayo Clinic, Rochester, MN (C.F.L.)
| | - Claudia F Lucchinetti
- From the Department of Neurology, Mayo Clinic, Scottsdale, AZ (D.M.W.); and the Department of Neurology, Mayo Clinic, Rochester, MN (C.F.L.)
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108
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Mora Cuervo DL, Hansel G, Sato DK. Immunobiology of neuromyelitis optica spectrum disorders. Curr Opin Neurobiol 2022; 76:102618. [PMID: 35973380 DOI: 10.1016/j.conb.2022.102618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/11/2022] [Accepted: 07/08/2022] [Indexed: 11/03/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory disease of the central nervous system. Most of the cases are positive for autoantibodies targeting the water channel aquaporin-4 (AQP4-IgG). Activated B and T cells, innate immunity cells, pro-inflammatory cytokines, and activated complement contribute to the formation of the NMOSD lesions. Optic neuritis, longitudinally extensive myelitis, and area postrema syndrome are core clinical manifestations. NMOSD diagnosis is based on clinical manifestations, magnetic resonance imaging findings, and AQP4-IgG positivity. Cell-based assays are the preferred method for the detection of AQP4-IgG. Acute relapses are treated with IV methylprednisolone or plasma exchange. Recent advances on the NMOSD immunobiology led to approved treatments such as eculizumab, satralizumab, and inebilizumab.
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Affiliation(s)
- Daissy Liliana Mora Cuervo
- Medicine and Health Sciences Postgraduation Program, School of Medicine, Pontificial Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil. https://twitter.com/DaissyMora
| | - Gisele Hansel
- Medicine and Health Sciences Postgraduation Program, School of Medicine, Pontificial Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil; Neuroinflammation and Neuroimmunology Lab, Brain Institute of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Douglas Kazutoshi Sato
- Medicine and Health Sciences Postgraduation Program, School of Medicine, Pontificial Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil; Neuroinflammation and Neuroimmunology Lab, Brain Institute of Rio Grande Do Sul, Porto Alegre, Brazil; Institute of Geriatrics and Gerontology, Pontificial Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.
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109
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Aletaha D, Kerschbaumer A, Kastrati K, Dejaco C, Dougados M, McInnes IB, Sattar N, Stamm TA, Takeuchi T, Trauner M, van der Heijde D, Voshaar M, Winthrop KL, Ravelli A, Betteridge N, Burmester GRR, Bijlsma JW, Bykerk V, Caporali R, Choy EH, Codreanu C, Combe B, Crow MK, de Wit M, Emery P, Fleischmann RM, Gabay C, Hetland ML, Hyrich KL, Iagnocco A, Isaacs JD, Kremer JM, Mariette X, Merkel PA, Mysler EF, Nash P, Nurmohamed MT, Pavelka K, Poor G, Rubbert-Roth A, Schulze-Koops H, Strangfeld A, Tanaka Y, Smolen JS. Consensus statement on blocking interleukin-6 receptor and interleukin-6 in inflammatory conditions: an update. Ann Rheum Dis 2022; 82:773-787. [PMID: 35953263 DOI: 10.1136/ard-2022-222784] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Targeting interleukin (IL)-6 has become a major therapeutic strategy in the treatment of immune-mediated inflammatory disease. Interference with the IL-6 pathway can be directed at the specific receptor using anti-IL-6Rα antibodies or by directly inhibiting the IL-6 cytokine. This paper is an update of a previous consensus document, based on most recent evidence and expert opinion, that aims to inform on the medical use of interfering with the IL-6 pathway. METHODS A systematic literature research was performed that focused on IL-6-pathway inhibitors in inflammatory diseases. Evidence was put in context by a large group of international experts and patients in a subsequent consensus process. All were involved in formulating the consensus statements, and in the preparation of this document. RESULTS The consensus process covered relevant aspects of dosing and populations for different indications of IL-6 pathway inhibitors that are approved across the world, including rheumatoid arthritis, polyarticular-course and systemic juvenile idiopathic arthritis, giant cell arteritis, Takayasu arteritis, adult-onset Still's disease, Castleman's disease, chimeric antigen receptor-T-cell-induced cytokine release syndrome, neuromyelitis optica spectrum disorder and severe COVID-19. Also addressed were other clinical aspects of the use of IL-6 pathway inhibitors, including pretreatment screening, safety, contraindications and monitoring. CONCLUSIONS The document provides a comprehensive consensus on the use of IL-6 inhibition to treat inflammatory disorders to inform healthcare professionals (including researchers), patients, administrators and payers.
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Affiliation(s)
- Daniel Aletaha
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | | | - Kastriot Kastrati
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria.,Rheumatology, Brunico Hospital, Brunico, Italy
| | - Maxime Dougados
- Rheumatology, Universite Paris Descartes Faculte de Medecine Site Cochin, Paris, France
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Wien, Austria
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Japan
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Medical University of Vienna, Wien, Austria
| | - Désirée van der Heijde
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Marieke Voshaar
- Department of Psychology, Health and Technology, Enschede, Netherlands and Stichting Tools Patient Empowerment, University of Twente, Enschede, The Netherlands
| | - Kevin L Winthrop
- Schools of Medicine and Public Health, Division of Infectious Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Angelo Ravelli
- UO Pediatria II-Reumatologia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | | | - Johannes Wj Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vivian Bykerk
- Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, ASS G. Pini, University of Milan, Milano, Italy
| | - Ernest H Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Catalin Codreanu
- Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Bernard Combe
- Immunorhumatologie, CHU Lapeyronie, Montpellier, France
| | - Mary K Crow
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, New York City, New York, USA
| | - Maarten de Wit
- Medical Humanities, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Paul Emery
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Roy M Fleischmann
- Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cem Gabay
- Division of Rheumatology, Geneva University Hospitals, Geneve, Switzerland
| | - Merete Lund Hetland
- Department of Clinical Medicine, Copenhagen University Hospital, Kobenhavn, Denmark.,Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joel M Kremer
- Medicine Rheumatology, Albany Medical College, Albany, New York, USA
| | - Xavier Mariette
- Rheumatology, Assistance Publique-Hôpitaux de Paris, Paris, France.,Center for Immunology of Viral Infections and Auto-immune Diseases, Université Paris-Sud, Gif-sur-Yvette, France
| | - Peter A Merkel
- Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eduardo F Mysler
- Organización Médica de Investigación SA, Buenos Aires, Argentina
| | - Peter Nash
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
| | | | - Karel Pavelka
- Rheumatology Department, Charles University, Praha, Czech Republic
| | - Gyula Poor
- National Institute of Rheumatology & Physiology, Semmelweis University, Budapest, Hungary
| | - Andrea Rubbert-Roth
- Division of Rheumatology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Internal Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Anja Strangfeld
- Forschungsbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Josef S Smolen
- Division of Rheumatology, Medical University of Vienna, Wien, Austria
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110
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Wang L, Du L, Li Q, Li F, Wang B, Zhao Y, Meng Q, Li W, Pan J, Xia J, Wu S, Yang J, Li H, Ma J, ZhangBao J, Huang W, Chang X, Tan H, Yu J, Zhou L, Lu C, Wang M, Dong Q, Lu J, Zhao C, Quan C. Deep learning-based relapse prediction of neuromyelitis optica spectrum disorder with anti-aquaporin-4 antibody. Front Neurol 2022; 13:947974. [PMID: 35989911 PMCID: PMC9389264 DOI: 10.3389/fneur.2022.947974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/11/2022] [Indexed: 12/03/2022] Open
Abstract
Objective We previously identified the independent predictors of recurrent relapse in neuromyelitis optica spectrum disorder (NMOSD) with anti-aquaporin-4 antibody (AQP4-ab) and designed a nomogram to estimate the 1- and 2-year relapse-free probability, using the Cox proportional hazard (Cox-PH) model, assuming that the risk of relapse had a linear correlation with clinical variables. However, whether the linear assumption fits real disease tragedy is unknown. We aimed to employ deep learning and machine learning to develop a novel prediction model of relapse in patients with NMOSD and compare the performance with the conventional Cox-PH model. Methods This retrospective cohort study included patients with NMOSD with AQP4-ab in 10 study centers. In this study, 1,135 treatment episodes from 358 patients in Huashan Hospital were employed as the training set while 213 treatment episodes from 92 patients in nine other research centers as the validation set. We compared five models with added variables of gender, AQP4-ab titer, previous attack under the same therapy, EDSS score at treatment initiation, maintenance therapy, age at treatment initiation, disease duration, the phenotype of the most recent attack, and annualized relapse rate (ARR) of the most recent year by concordance index (C-index): conventional Cox-PH, random survival forest (RSF), LogisticHazard, DeepHit, and DeepSurv. Results When including all variables, RSF outperformed the C-index in the training set (0.739), followed by DeepHit (0.737), LogisticHazard (0.722), DeepSurv (0.698), and Cox-PH (0.679) models. As for the validation set, the C-index of LogisticHazard outperformed the other models (0.718), followed by DeepHit (0.704), DeepSurv (0.698), RSF (0.685), and Cox-PH (0.651) models. Maintenance therapy was calculated to be the most important variable for relapse prediction. Conclusion This study confirmed the superiority of deep learning to design a prediction model of relapse in patients with AQP4-ab-positive NMOSD, with the LogisticHazard model showing the best predictive power in validation.
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Affiliation(s)
- Liang Wang
- Department of Neurology, Huashan Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
| | - Lei Du
- Department of Neurology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Qinying Li
- Department of Rehabilitation Medicine, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai, China
| | - Fang Li
- National Center for Neurological Disorders (NCND), Shanghai, China
- Department of Rehabilitation Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bei Wang
- Department of Neurology, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yuanqi Zhao
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiang Meng
- Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Wenyu Li
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Juyuan Pan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junhui Xia
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shitao Wu
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Yang
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, China
| | - Heng Li
- Department of Neurology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jianhua Ma
- Department of Neurology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Jingzi ZhangBao
- Department of Neurology, Huashan Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
| | - Wenjuan Huang
- Department of Neurology, Huashan Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
| | - Xuechun Chang
- Department of Neurology, Huashan Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
| | - Hongmei Tan
- Department of Neurology, Huashan Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Zhou
- Department of Neurology, Huashan Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
| | - Chuanzhen Lu
- Department of Neurology, Huashan Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
| | - Min Wang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
| | - Jiahong Lu
- Department of Neurology, Huashan Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
| | - Chao Quan
- Department of Neurology, Huashan Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- *Correspondence: Chao Quan
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Lotan I, Levy M. New treatment perspectives for acute relapses in neuromyelitis optica spectrum disorder. Transfus Med Rev 2022; 36:230-232. [DOI: 10.1016/j.tmrv.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 10/15/2022]
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Abstract
PURPOSE OF REVIEW This article reviews the cardinal clinical features, distinct immunopathology, current diagnostic criteria, relapse-related risk factors, emerging biomarkers, and evolving treatment strategies pertaining to neuromyelitis optica spectrum disorders (NMOSD). RECENT FINDINGS The discovery of the pathogenic aquaporin-4 (AQP4)-IgG autoantibody and characterization of NMOSD as an autoimmune astrocytopathy have spearheaded the identification of key immunologic therapeutic targets in this disease, including but not limited to the complement system, the interleukin 6 (IL-6) receptor, and B cells. Accordingly, four recent randomized controlled trials have demonstrated the efficacy of three new NMOSD therapies, namely eculizumab, satralizumab, and inebilizumab. SUMMARY Currently, NMOSD poses both diagnostic and treatment challenges. It is debated whether individuals who are seropositive for myelin oligodendrocyte glycoprotein (MOG)-IgG belong within the neuromyelitis optica spectrum. This discussion is fueled by disparities in treatment responses between patients who are AQP4-IgG seropositive and seronegative, suggesting different immunopathologic mechanisms may govern these conditions. As our understanding regarding the immune pathophysiology of NMOSD expands, emerging biomarkers, including serum neurofilament light chain and glial fibrillary acidic protein (GFAP), may facilitate earlier relapse detection and inform long-term treatment decisions. Future research focal points should include strategies to optimize relapse management, restorative treatments that augment neurologic recovery, and practical solutions that promote equitable access to approved therapies for all patients with NMOSD.
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Stathopoulos P, Dalakas MC. The role of complement and complement therapeutics in neuromyelitis optica spectrum disorders. Expert Rev Clin Immunol 2022; 18:933-945. [PMID: 35899480 DOI: 10.1080/1744666x.2022.2105205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) are characterized in the majority of cases by the presence of IgG1 autoantibodies against aquaporin 4 (AQP4) and myelin-oligodendrocyte glycoprotein (MOG), both capable of activating complement. AREAS COVERED We review evidence of complement involvement in NMOSD pathophysiology from pathological, in vitro, in vivo, human studies, and clinical trials. EXPERT OPINION In AQP4 NMOSD, complement deposition is a prominent pathological feature, while in vitro and in vivo studies have demonstrated complement-dependent pathogenicity of AQP4 antibodies. Consistent with these studies, the anti-C5 monoclonal antibody eculizumab was remarkably effective and safe in a phase 2/3 trial of AQP4-NMOSD patents leading to FDA-approved indication. Several other anti-complement agents, either approved or in trials for other neuro-autoimmunities, like myasthenia, CIDP, and GBS, are also relevant to NMOSD generating an exciting group of evolving immunotherapies. Limited but compelling in vivo and in vitro data suggest that anti-complement therapeutics may be also applicable to a subset of MOG NMOSD patients with severe disease. Overall, anticomplement agents, along with the already approved anti-IL6 and anti-CD19 monoclonal antibodies sartralizumab and inebilizumab, are rapidly changing the therapeutic algorithm in NMOSD, a previously difficult-to-treat autoimmune neurological disorder.
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Affiliation(s)
- Panos Stathopoulos
- Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos C Dalakas
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.,Neuroimmunology Unit, National and Kapodistrian University of Athens, Athens, Greece
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Update on glial antibody-mediated optic neuritis. Jpn J Ophthalmol 2022; 66:405-412. [PMID: 35895155 DOI: 10.1007/s10384-022-00932-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/16/2022] [Indexed: 10/16/2022]
Abstract
Optic neuritis (ON) refers to inflammatory demyelinating lesions of the optic nerve, which can cause acute or subacute vision loss and is a major cause of vision loss in young adults. Much of our understanding of typical ON is from the Optic Neuritis Treatment Trial. Glial autoantibodies to aquaporin-4 immunoglobulin (AQP4-IgG) and myelin oligodendrocyte glycoprotein immunoglobulin (MOG-IgG) are recently established biomarkers of ON that have revolutionized our understanding of atypical ON. The detection of glial antibodies is helpful in the diagnosis, treatment, and follow-up of patients with different types of ON. AQP4-IgG and MOG-IgG screening is strongly recommended for patients with atypical ON. Research on the pathogenesis of NMOSD and MOGAD will promote the development and marketing of targeted immunotherapies. The application of new and efficient drugs, such as the selective complement C5 inhibitor, IL-6 receptor inhibitor, B cell-depleting agents, and drugs against other monoclonal antibodies, provides additional medical evidence. This review provides information on the diagnosis and management of glial antibody-mediated ON.
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Relevance of Pathogenetic Mechanisms to Clinical Effectiveness of B-Cell-Depleting Monoclonal Antibodies in Multiple Sclerosis. J Clin Med 2022; 11:jcm11154288. [PMID: 35893382 PMCID: PMC9332715 DOI: 10.3390/jcm11154288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 01/27/2023] Open
Abstract
Evidence of the effectiveness of B-cell-depleting monoclonal antibodies (mAbs) in multiple sclerosis (MS) prompted a partial revisitation of the pathogenetic paradigm of the disease, which was, so far, considered a T-cell-mediated autoimmune disorder. Mechanisms underlying the efficacy of B-cell-depleting mAbs in MS are still unknown. However, they likely involve the impairment of pleiotropic B-cell functions different from antibody secretion, such as their role as antigen-presenting cells during both the primary immune response in the periphery and the secondary response within the central nervous system (CNS). A potential impact of B-cell-depleting mAbs on inflammation compartmentalised within the CNS was also suggested, but little is known about the mechanism underlying this latter phenomenon as no definite evidence was provided so far on the ability of mAbs to cross the blood–brain barrier and reliable biomarkers of compartmentalised inflammation are lacking. The present paper briefly summarises the immunopathogenesis of MS with a focus on onset of autoimmunity and compartmentalisation of the immune response; mechanisms mediating B-cell depletion and underlying the effectiveness of B-cell-depleting mAbs are also discussed.
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Neuromyelitis Optica Spectrum Disorder: From Basic Research to Clinical Perspectives. Int J Mol Sci 2022; 23:ijms23147908. [PMID: 35887254 PMCID: PMC9323454 DOI: 10.3390/ijms23147908] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 02/05/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease of the central nervous system characterized by relapses and autoimmunity caused by antibodies against the astrocyte water channel protein aquaporin-4. Over the past decade, there have been significant advances in the biologic knowledge of NMOSD, which resulted in the IDENTIFICATION of variable disease phenotypes, biomarkers, and complex inflammatory cascades involved in disease pathogenesis. Ongoing clinical trials are looking at new treatments targeting NMOSD relapses. This review aims to provide an update on recent studies regarding issues related to NMOSD, including the pathophysiology of the disease, the potential use of serum and cerebrospinal fluid cytokines as disease biomarkers, the clinical utilization of ocular coherence tomography, and the comparison of different animal models of NMOSD.
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Costello F, Burton JM. Contemporary management challenges in seropositive NMOSD. J Neurol 2022; 269:5674-5681. [PMID: 35816205 PMCID: PMC9272395 DOI: 10.1007/s00415-022-11241-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) is an inflammatory disorder of the central nervous system that presents unique management challenges. Neurologic disability in NMOSD is directly linked to acute attacks, therefore, relapse prevention is an overarching goal of care. To this end, identifying effective biomarkers that predict relapse onset and severity is of critical importance. As treatment becomes more precision-based and patient-centred, clinicians will need to be familiar with managing circumstances of particular vulnerability for patients with NMOSD, including infection, pregnancy, and the post-partum phase. The discovery of the pathogenic aquaporin-4 Immunoglobulin G (AQP4 IgG) autoantibody almost 20 years ago ultimately distinguished NMOSD as an autoimmune astrocytopathy and helped spearhead recent therapeutic advancements. Targeted therapies, including eculizumab, satralizumab, and inebilizumab, approved for use in aquaporin-4 immunoglobulin G (AQP4 IgG) seropositive patients with NMOSD will likely improve outcomes, but there are formidable costs involved. Importantly, seronegative patients continue to have limited therapeutic options. Moving forward, areas of research exploration should include relapse prevention, restorative therapies, and initiatives that promote equitable access to approved therapies for all people living with NMOSD.
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Affiliation(s)
- Fiona Costello
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
- Department of Surgery, University of Calgary, Calgary, Canada.
| | - Jodie M Burton
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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Ciano-Petersen NL, Muñiz-Castrillo S, Birzu C, Vogrig A, Farina A, Villagrán-García M, Joubert B, Psimaras D, Honnorat J. Cytokine dynamics and targeted immunotherapies in autoimmune encephalitis. Brain Commun 2022; 4:fcac196. [PMID: 35999839 PMCID: PMC9392471 DOI: 10.1093/braincomms/fcac196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/20/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Autoimmune encephalitides constitute a diverse group of immune-mediated central nervous system disorders mainly characterized by the presence of antibodies targeting neuronal or glial antigens. Despite the notable contribution of antibody discovery to the understanding of their physiopathology, the specific immune cells and inflammatory mediators involved in autoimmune encephalitis are still poorly defined. However, cytokines have recently emerged as crucial signalling molecules in the pathogenesis of autoimmune encephalitis. Cytokines are biologically active, soluble, low-molecular-weight proteins or glycoproteins involved in a wide variety of physiological functions, including central nervous system development and homeostasis, immune surveillance, as well as proliferation and maturation of immune cells. Since unbalanced cytokine expression is considered a hallmark of many autoimmune central nervous system disorders, their identification and quantification has become an essential element in personalized medicine applied to the field of neuroimmunology. Several studies have explored the cytokine profile of autoimmune encephalitis, but their interpretation and comparison is challenging due to their small sample sizes and extremely high heterogeneity, especially regarding the cytokines analysed, type of sample used, and associated neural antibody. Only the cytokine profile of anti-N-methyl-D-aspartate receptor encephalitis has extensively been investigated, with findings suggesting that, although humoral immunity is the main effector, T cells may also be relevant for the development of this disorder. A better understanding of cytokine dynamics governing neuroinflammation might offer the opportunity of developing new therapeutic strategies against specific immune cells, cytokines, antibodies, or intracellular signalling cascades, therefore leading to better outcomes and preventing undesired side effects of the presently used strategies. In this review, we first summarize the current knowledge about the role of cytokines in the pathogenesis of autoimmune encephalitis, combining theoretical analysis with experimental validations, to assess their suitability as clinical biomarkers. Second, we discuss the potential applicability of the novel targeted immunotherapies in autoimmune encephalitis depending on the immunobiology of the associated antibody, their limitations, as well as the main limitations that should be addressed in future studies.
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Affiliation(s)
- Nicolás Lundahl Ciano-Petersen
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
- Neuroimmunology and Neuroinflammation group. Biomedical Research Institute of Málaga (IBIMA) , Málaga , Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA). Hospital Regional Universitario de Málaga , Málaga , Spain
| | - Sergio Muñiz-Castrillo
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
| | - Cristina Birzu
- Service de Neurologie 2-Mazarin, Centre de Recherche de l’Institut du Cerveau et de la Moelle Epinière, Groupe Hospitalier Pitie-Salpetrière et Université Pierre et Marie Curie-Paris 6, AP-HP , Paris , France
| | - Alberto Vogrig
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
| | - Antonio Farina
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
| | - Macarena Villagrán-García
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
| | - Bastien Joubert
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
| | - Dimitri Psimaras
- Service de Neurologie 2-Mazarin, Centre de Recherche de l’Institut du Cerveau et de la Moelle Epinière, Groupe Hospitalier Pitie-Salpetrière et Université Pierre et Marie Curie-Paris 6, AP-HP , Paris , France
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique , Bron , France
- SynatAc Team, Institute MeLiS, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1 , Lyon , France
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Letter to the Editor Regarding "Network Meta-analysis of Food and Drug Administration-approved Treatment Options for Adults with Aquaporin-4 Immunoglobulin G-positive Neuromyelitis Optica Spectrum Disorder". Neurol Ther 2022; 11:1439-1443. [PMID: 35779190 PMCID: PMC9338188 DOI: 10.1007/s40120-022-00376-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/07/2022] [Indexed: 10/26/2022] Open
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Comparison on the effect of seven drugs to prevent relapses of neuromyelitis optica spectrum disorders: A modeling analysis of literature aggregate data. Int Immunopharmacol 2022; 110:109004. [PMID: 35785726 DOI: 10.1016/j.intimp.2022.109004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/30/2022] [Accepted: 06/23/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) is an immune-mediated demyelinating disease of the central nervous system. This study aimed to perform a comprehensive comparison of the effect of seven drugs to prevent relapses of NMOSD. METHOD A literature search was conducted using public databases. Clinical studies on the seven drugs (eculizumab, inebilizumab, satralizumab, rituximab, tocilizumab, azathioprine, and mycophenolate mofetil) to prevent relapses of NMOSD were identified. A time-course model was established using the time to first relapse as the primary endpoint, in order to evaluate the long-term effect of each drug in preventing relapse. RESULTS Twenty-four trials, including 2207 patients, were included in the model analysis. The results showed that monoclonal antibody therapy could significantly prolong the time to first relapse. Among all seven drugs, eculizumab can most significantly prevent patient from relapse. The estimated proportion of relapse-free patients treated with eculizumab was 98.9% at 24 months. CONCLUSION Based on the construction of a time-course pharmacodynamic model, this study made a comprehensive quantitative comparison of seven drugs for the treatment of NMOSD for the first time. These results can not only serve as a quantitative supplement for the rational use of drugs in clinical practice but also provide a pharmacodynamic reference for clinical trial design and decision making in the future.
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121
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Pathomrattanapiban C, Tisavipat N, Jitprapaikulsan J, Prayoonwiwat N, Rattanathamsakul N, Siritho S. The efficacy and safety of mycophenolate mofetil in Thai neuromyelitis optica spectrum disorder patients. Mult Scler Relat Disord 2022; 63:103882. [DOI: 10.1016/j.msard.2022.103882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
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122
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Shi M, Chu F, Jin T, Zhu J. Progress in treatment of neuromyelitis optica spectrum disorders (NMOSD): Novel insights into therapeutic possibilities in NMOSD. CNS Neurosci Ther 2022; 28:981-991. [PMID: 35426485 PMCID: PMC9160456 DOI: 10.1111/cns.13836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory demyelinating disorder of the central nervous system (CNS), which is a severely disabling disorder leading to devastating sequelae or even death. Repeated acute attacks and the presence of aquaporin-4 immunoglobulin G (AQP4-IgG) antibody are the typical characteristics of NMOSD. Recently, the phase III trials of the newly developed biologicals therapies have shown their effectiveness and good tolerance to a certain extent when compared with the traditional therapy with the first- and second-line drugs. However, there is still a lack of large sample, double-blind, randomized, clinical studies to confirm their efficacy, safety, and tolerability. Especially, these drugs have no clear effect on NMOSD patients without AQP4-IgG and refractory patients. Therefore, it is of strong demand to further conduct large sample, double-blind, randomized, clinical trials, and novel therapeutic possibilities in NMOSD are discussed briefly here.
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Affiliation(s)
- Mingchao Shi
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrcs, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Fengna Chu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrcs, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Tao Jin
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrcs, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
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Long-term safety of satralizumab in neuromyelitis optica spectrum disorder (NMOSD) from SAkuraSky and SAkuraStar. Mult Scler Relat Disord 2022; 66:104025. [DOI: 10.1016/j.msard.2022.104025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/30/2022] [Accepted: 07/03/2022] [Indexed: 12/27/2022]
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124
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Giuseppe M. Olamkicept(sgp130Fc): The missing trial in Neuromyelitis optica spectrum disorder. Clin Immunol 2022; 241:109072. [DOI: 10.1016/j.clim.2022.109072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/30/2022] [Indexed: 11/27/2022]
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125
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Immuno-pathogenesis of neuromyelitis optica and emerging therapies. Semin Immunopathol 2022; 44:599-610. [DOI: 10.1007/s00281-022-00941-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 01/01/2023]
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126
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Meta-Analysis of Two Human RNA-seq Datasets to Determine Periodontitis Diagnostic Biomarkers and Drug Target Candidates. Int J Mol Sci 2022; 23:ijms23105580. [PMID: 35628390 PMCID: PMC9145972 DOI: 10.3390/ijms23105580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023] Open
Abstract
Periodontitis is a chronic inflammatory oral disease that affects approximately 42% of adults 30 years of age or older in the United States. In response to microbial dysbiosis within the periodontal pockets surrounding teeth, the host immune system generates an inflammatory environment in which soft tissue and alveolar bone destruction occur. The objective of this study was to identify diagnostic biomarkers and the mechanistic drivers of inflammation in periodontitis to identify drugs that may be repurposed to treat chronic inflammation. A meta-analysis comprised of two independent RNA-seq datasets was performed. RNA-seq analysis, signal pathway impact analysis, protein-protein interaction analysis, and drug target analysis were performed to identify the critical pathways and key players that initiate inflammation in periodontitis as well as to predict potential drug targets. Seventy-eight differentially expressed genes, 10 significantly impacted signaling pathways, and 10 hub proteins in periodontal gingival tissue were identified. The top 10 drugs that may be repurposed for treating periodontitis were then predicted from the gene expression and pathway data. The efficacy of these drugs in treating periodontitis has yet to be investigated. However, this analysis indicates that these drugs may serve as potential therapeutics to treat inflammation in gingival tissue affected by periodontitis.
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Yao XY, Xie L, Cai Y, Zhang Y, Deng Y, Gao MC, Wang YS, Xu HM, Ding J, Wu YF, Zhao N, Wang Z, Song YY, Wang LP, Xie C, Li ZZ, Wan WB, Lin Y, Jin HF, Wang K, Qiu HY, Zhuang L, Zhou Y, Jin YY, Ni LP, Yan JL, Guo Q, Xue JH, Qian BY, Guan YT. Human Umbilical Cord Mesenchymal Stem Cells to Treat Neuromyelitis Optica Spectrum Disorder (hUC-MSC-NMOSD): A Study Protocol for a Prospective, Multicenter, Randomized, Placebo-Controlled Clinical Trial. Front Neurol 2022; 13:860083. [PMID: 35547390 PMCID: PMC9082633 DOI: 10.3389/fneur.2022.860083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Neuromyelitis Optica spectrum disorder (NMOSD) is severe relapsing and disabling autoimmune disease of the central nervous system. Its optimal first-line treatment to reduce relapse rate and ameliorate neurological disability remains unclear. We will conduct a prospective, multicenter, randomized, placebo-controlled clinical trial to study the safety and effectiveness of human umbilical cord mesenchymal stem cells (hUC-MSCs) in treating NMOSD. Methods The trial is planned to recruit 430 AQP4-IgG seropositive NMOSD patients. It consists of three consecutive stages. The first stage will be carried out in the leading center only and aims to evaluate the safety of hUC-MSCs. Patients will be treated with three different doses of hUC-MSCs: 1, 2, or 5 × 106 MSC/kg·weight for the low-, medium-, and high-dose group, respectively. The second and third stages will be carried out in six centers. The second stage aims to find the optimal dosage. Patients will be 1:1:1:1 randomized into the low-, medium-, high-dose group and the controlled group. The third stage aims to evaluate the effectiveness. Patients will be 1:1 randomized into the optimal dose and the controlled group. The primary endpoint is the first recurrent time and secondary endpoints are the recurrent times, EDSS scores, MRI lesion numbers, OSIS scores, Hauser walking index, and SF-36 scores. Endpoint events and side effects will be evaluated every 3 months for 2 years. Discussion Although hUC-MSC has shown promising treatment effects of NMOSD in preclinical studies, there is still a lack of well-designed clinical trials to evaluate the safety and effectiveness of hUC-MSC among NMOSD patients. As far as we know, this trial will be the first one to systematically demonstrate the clinical safety and efficacy of hUC-MSC in treating NMOSD and might be able to determine the optimal dose of hUC-MSC for NMOSD patients. Trial registration The study was registered with the Chinese Clinical Trial Registry (CHICTR.org.cn) on 2 March 2016 (registration No. ChiCTR-INR-16008037), and the revised trial protocol (Protocol version 1.2.1) was released on 16 March 2020.
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Affiliation(s)
- Xiao-Ying Yao
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li Xie
- Clinical Research Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Cai
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Zhang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ye Deng
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mei-Chun Gao
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Shu Wang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui-Ming Xu
- State Key Laboratory of Oncogenes and Related Genes, Renji-Med-X Clinical Stem Cell Research Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Ding
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Fan Wu
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Zhao
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ze Wang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ya-Ying Song
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Ping Wang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chong Xie
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ze-Zhi Li
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Bin Wan
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Lin
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hai-Feng Jin
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kan Wang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui-Ying Qiu
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhuang
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhou
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Yan Jin
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Li-Ping Ni
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jia-Li Yan
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Quan Guo
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jia-Hui Xue
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bi-Yun Qian
- Clinical Research Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Clinical Research Promotion and Development Center, Shanghai Hospital Development Center, Shanghai, China
| | - Yang-Tai Guan
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Meca-Lallana JE, Gómez-Ballesteros R, Pérez-Miralles F, Forero L, Sepúlveda M, Calles C, Martínez-Ginés ML, González-Suárez I, Boyero S, Romero-Pinel L, Sempere ÁP, Meca-Lallana V, Querol L, Costa-Frossard L, Prefasi D, Maurino J. Impact of Neuromyelitis Optica Spectrum Disorder on Quality of Life from the Patients' Perspective: An Observational Cross-Sectional Study. Neurol Ther 2022; 11:1101-1116. [PMID: 35524037 PMCID: PMC9075919 DOI: 10.1007/s40120-022-00356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Neuromyelitis optica spectrum disorder (NMOSD) is associated with a reduced health-related quality of life (HRQoL). The purpose of this study was to describe the impact of NMOSD on HRQoL from the patients’ perspective and its relationship with other disease factors. Methods An observational, cross-sectional study was conducted at 13 neuroimmunology clinics in Spain. Patients with NMOSD diagnosis (2015 Wingerchuk criteria) were included. The 29-item Multiple Sclerosis Impact Scale (MSIS-29) was used to assess the HRQoL. Different questionnaires were used to measure symptom severity, stigma, mood disorders, pain, fatigue, and difficulties in the workplace. Factors that impact HRQoL were identified by Spearman’s correlation and multivariate linear regression analysis. Results Seventy-one patients were included (mean age 47.4 ± 14.9 years, 80.3% female, mean time since disease onset 9.9 ± 8.1 years). The median Expanded Disability Status Scale score was 3.0 (1.5–4.5). The mean (± SD) physical and psychological MSIS-29 sub-scores were 41.9 ± 16.8 and 20.9 ± 8.3, respectively. Fatigue and body pain were the most prevalent symptoms. Depressive symptoms were found in 44.3% (n = 31) of patients. The physical MSIS-29 dimension showed the highest correlation with symptom severity (ρ = 0.85584, p < 0.0001), whereas the highest correlations for psychological MSIS-29 dimension were pain, MSIS-29 physical dimension, and depression (ρ = 0.76487, 0.72779, 0.71380; p < 0.0001, respectively). Pain was a predictor of both dimensions of MSIS-29. Conclusion Fatigue, pain, and depressive symptoms are frequent problems among patients with NMOSD, impacting on their quality of life. Assessment of patient-oriented outcomes may be useful to achieve a holistic approach, allowing early specific interventions.
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Affiliation(s)
- José E Meca-Lallana
- Clinical Neuroimmunology Unit and Multiple Sclerosis CSUR, Department of Neurology, Hospital Universitario "Virgen de la Arrixaca", IMIB-Arrixaca, Murcia, Spain
| | | | - Francisco Pérez-Miralles
- Unit of Neuroimmunology, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lucía Forero
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - María Sepúlveda
- Department of Neurology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Carmen Calles
- Department of Neurology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | - Sabas Boyero
- Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain
| | - Lucía Romero-Pinel
- Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ángel P Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Luis Querol
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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129
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Ouellette R. Advanced MRI quantification of neuroinflammatory disorders. J Neurosci Res 2022; 100:1389-1394. [PMID: 35460291 PMCID: PMC9321072 DOI: 10.1002/jnr.25054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Russell Ouellette
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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130
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MacDougall M, El-Hajj Sleiman J, Beauchemin P, Rangachari M. SARS-CoV-2 and Multiple Sclerosis: Potential for Disease Exacerbation. Front Immunol 2022; 13:871276. [PMID: 35572514 PMCID: PMC9102605 DOI: 10.3389/fimmu.2022.871276] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
While the respiratory tract is the primary route of entry for SARS-CoV-2, evidence shows that the virus also impacts the central nervous system. Intriguingly, case reports have documented SARS-CoV-2 patients presenting with demyelinating lesions in the brain, spinal cord, and optic nerve, suggesting possible implications in neuroimmune disorders such as multiple sclerosis (MS) and other related neuroimmune disorders. However, the cellular mechanisms underpinning these observations remain poorly defined. The goal of this paper was to review the literature to date regarding possible links between SARS-CoV-2 infection and neuroimmune demyelinating diseases such as MS and its related disorders, with the aim of positing a hypothesis for disease exacerbation. The literature suggests that SARS-CoV, SARS-CoV-2, and orthologous murine coronaviruses invade the CNS via the olfactory bulb, spreading to connected structures via retrograde transport. We hypothesize that a glial inflammatory response may contribute to damaged oligodendrocytes and blood brain barrier (BBB) breakdown, allowing a second route for CNS invasion and lymphocyte infiltration. Potential for molecular mimicry and the stimulation of autoreactive T cells against myelin is also described. It is imperative that further studies on SARS-CoV-2 neuroinvasion address the adverse effects of the virus on myelin and exacerbation of MS symptoms, as nearly 3 million people suffer from MS worldwide.
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Affiliation(s)
- Madison MacDougall
- Department of Biological Sciences, Salisbury University, Salisbury, MD, United States
- Department of Psychology, Salisbury University, Salisbury, MD, United States
| | - Jad El-Hajj Sleiman
- Division of Neurology, Department of Medicine, CHU de Québec – Université Laval, Quebec City, QC, Canada
| | - Philippe Beauchemin
- Division of Neurology, Department of Medicine, CHU de Québec – Université Laval, Quebec City, QC, Canada
| | - Manu Rangachari
- Axe Neurosciences, Centre de Recherche du CHU de Québec – Université Laval, Quebec City, QC, Canada
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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131
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Wang L, Du L, Li Q, Li F, Wang B, Zhao Y, Meng Q, Li W, Pan J, Xia J, Wu S, Yang J, Li H, Ma J, ZhangBao J, Huang W, Chang X, Tan H, Yu J, Zhou L, Lu C, Wang M, Dong Q, Lu J, Zhao C, Quan C. Neuromyelitis Optica Spectrum Disorder With Anti-Aquaporin-4 Antibody: Outcome Prediction Models. Front Immunol 2022; 13:873576. [PMID: 35432315 PMCID: PMC9012141 DOI: 10.3389/fimmu.2022.873576] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/10/2022] [Indexed: 12/29/2022] Open
Abstract
Background Recognizing the predictors of disease relapses in patients with anti-aquaporin-4 antibody (AQP4-ab)-positive neuromyelitis optica spectrum disorder (NMOSD) is essential for individualized treatment strategy. We aimed to identify the factors that predicted relapses among patients with AQP4-ab-positive NMOSD, develop outcome prediction models, and validate them in a multicenter validation cohort. Methods Between January 2015 and December 2020, 820 patients with NMOSD were registered at Huashan Hospital. We retrospectively reviewed their medical records, and included 358 AQP4-ab-positive patients with 1135 treatment episodes. Univariate and multivariate analyses were used to explore the predictors of relapse, severe visual or motor disability during follow-up. A model predicting the 1- and 2-year relapse-free probability was developed and validated in an external validation cohort of 92 patients with 213 treatment episodes. Results Lower serum AQP4-ab titer (< 1:100), higher Expanded Disability Status Scale (EDSS) score at onset (≥ 2.5), and use of intravenous methylprednisolone (IVMP) at the first attack predicted an overall lower annualized relapse rate. Older age (> 48 years), optic neuritis at onset, and higher onset EDSS score (≥ 2.5) significantly increased the risk for blindness, while IVMP at the first attack and maintenance therapy reduced the risk for blindness. Myelitis at onset increased the possibility of motor disability (EDSS ≥ 6.0), severe motor disability or death (EDSS ≥ 8.0), while maintenance therapy reduced these possibilities. Anderson and Gill model identified that the risk factors predicting recurrent relapses under certain treatment status were female gender, high AQP4-ab titer (≥ 1:100), previous attack under same therapy, lower EDSS score at treatment initiation (< 2.5), and no maintenance therapy or oral prednisone lasting less than 6 months. A nomogram using the above factors showed good discrimination and calibration abilities. The concordance indexes in the primary and validation cohort were 0.66 and 0.65, respectively. Conclusion This study reports the demographic, clinical and therapeutic predictors of relapse, and severe visual or motor disability in NMOSD. Early identification of patients at risk of unfavorable outcomes is of paramount importance to inform treatment decisions.
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Affiliation(s)
- Liang Wang
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders (NCND), Shanghai, China
| | - Lei Du
- Department of Neurology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qinying Li
- Department of Rehabilitation Medicine, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai, China
| | - Fang Li
- National Center for Neurological Disorders (NCND), Shanghai, China.,Department of Rehabilitation Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bei Wang
- Department of Neurology, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yuanqi Zhao
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiang Meng
- Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, China
| | - Wenyu Li
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Juyuan Pan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junhui Xia
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shitao Wu
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Yang
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, China
| | - Heng Li
- Department of Neurology, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jianhua Ma
- Department of Neurology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jingzi ZhangBao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders (NCND), Shanghai, China
| | - Wenjuan Huang
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders (NCND), Shanghai, China
| | - Xuechun Chang
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders (NCND), Shanghai, China
| | - Hongmei Tan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders (NCND), Shanghai, China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Zhou
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders (NCND), Shanghai, China
| | - Chuanzhen Lu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders (NCND), Shanghai, China
| | - Min Wang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders (NCND), Shanghai, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders (NCND), Shanghai, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders (NCND), Shanghai, China
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,National Center for Neurological Disorders (NCND), Shanghai, China
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132
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Huang W, Wang L, Xia J, Li W, Wang M, Yu J, Li Q, Wang B, Pan J, Du L, Ma J, Tan H, Chang X, Lu C, Zhao C, Lu J, Zhou L, ZhangBao J, Quan C. Efficacy and safety of azathioprine, mycophenolate mofetil and reduced dose of rituximab in neuromyelitis optica spectrum disorder. Eur J Neurol 2022; 29:2343-2354. [PMID: 35398950 DOI: 10.1111/ene.15355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/05/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Wenjuan Huang
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Liang Wang
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Junhui Xia
- Department of Neurology The First Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang Province China
| | - Wenyu Li
- Department of Neurology Sir Run Run Shaw Hospital School of Medicine Zhejiang University Hangzhou Zhejiang Province China
| | - Min Wang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital Fudan University Shanghai China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital Fudan University Shanghai China
| | - Qinying Li
- Department of Rehabilitation Medicine Jing’an District Centre Hospital of Shanghai Fudan University Shanghai 200040 China
| | - Bei Wang
- Department of Neurology Jing’an District Centre Hospital of Shanghai Fudan University Shanghai 200040 China
| | - Juyuan Pan
- Department of Neurology The First Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang Province China
| | - Lei Du
- Department of Neurology The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang Uygur Autonomous Region China
| | - Jianhua Ma
- Department of Neurology The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang Uygur Autonomous Region China
| | - Hongmei Tan
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Xuechun Chang
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Chuanzhen Lu
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Chongbo Zhao
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Jiahong Lu
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Lei Zhou
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Jingzi ZhangBao
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Chao Quan
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
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Giglhuber K, Berthele A. Adverse Events in NMOSD Therapy. Int J Mol Sci 2022; 23:ijms23084154. [PMID: 35456972 PMCID: PMC9029040 DOI: 10.3390/ijms23084154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are rare neurologic autoimmune diseases that have a poor prognosis if left untreated. For many years, generic oral immunosuppressants and repurposed monoclonal antibodies that target the interleukin-6 pathway or B cells were the mainstays of drug treatment. Recently, these drug treatments have been complemented by new biologics developed and approved specifically for NMOSD. In principle, all of these drugs are effective, but treatment recommendations that take this into account are still pending. Instead, the choice of a drug may depend on other criteria such as drug safety or tolerability. In this review, we summarise current knowledge on the adverse effects of azathioprine, mycophenolate mofetil, rituximab, tocilizumab, eculizumab, satralizumab, and inebilizumab in NMOSD. Infections, cytopenias, and infusion-related reactions are most common, but the data are as heterogeneous as the manifestations are diverse. Nevertheless, knowledge of safety issues may facilitate treatment choices for individual patients.
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134
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Redenbaugh V, Flanagan EP. Monoclonal Antibody Therapies Beyond Complement for NMOSD and MOGAD. Neurotherapeutics 2022; 19:808-822. [PMID: 35267170 PMCID: PMC9294102 DOI: 10.1007/s13311-022-01206-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 01/09/2023] Open
Abstract
Aquaporin-4 (AQP4)-IgG seropositive neuromyelitis optica spectrum disorders (AQP4-IgG seropositive NMOSD) and myelin oligodendrocyte glycoprotein (MOG)-IgG-associated disease (MOGAD) are inflammatory demyelinating disorders distinct from each other and from multiple sclerosis (MS).While anti-CD20 treatments can be used to treat MS and AQP4-IgG seropositive NMOSD, some MS medications are ineffective or could exacerbate AQP4-IgG seropositive NMOSD including beta-interferons, natalizumab, and fingolimod. AQP4-IgG seropositive NMOSD has a relapsing course in most cases, and preventative maintenance treatments should be started after the initial attack. Rituximab, eculizumab, inebilizumab, and satralizumab all have class 1 evidence for use in AQP4-IgG seropositive NMOSD, and the latter three have been approved by the US Food and Drug Administration (FDA). MOGAD is much more likely to be monophasic than AQP4-IgG seropositive NMOSD, and preventative therapy is usually reserved for those who have had a disease relapse. There is a lack of any class 1 evidence for MOGAD preventative treatment. Observational benefit has been suggested from oral immunosuppressants, intravenous immunoglobulin (IVIg), rituximab, and tocilizumab. Randomized placebo-controlled trials are urgently needed in this area.
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Affiliation(s)
- Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA.
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135
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Stathopoulos P, Dalakas MC. Evolution of Anti-B Cell Therapeutics in Autoimmune Neurological Diseases. Neurotherapeutics 2022; 19:691-710. [PMID: 35182380 PMCID: PMC9294112 DOI: 10.1007/s13311-022-01196-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 02/08/2023] Open
Abstract
B cells have an ever-increasing role in the etiopathology of a number of autoimmune neurological disorders, acting as antigen-presenting cells facilitating antibody production but also as sensors, coordinators, and regulators of the immune response. In particular, B cells can regulate the T cell activation process through their participation in antigen presentation, production of proinflammatory cytokines (bystander activation or suppression), and contribution to ectopic lymphoid aggregates. Such an important interplay between B and T cells makes therapeutic depletion of B cells an attractive treatment strategy. The last decade, anti-B cell therapies using monoclonal antibodies against B cell surface molecules have evolved into a rational approach for successfully treating autoimmune neurological disorders, even when T cells seem to be the main effector cells. The paper summarizes basic aspects of B cell biology, discusses the roles of B cells in neurological autoimmunities, and highlights how the currently available or under development anti-B cell therapeutics exert their action in the wide spectrum and immunologically diverse neurological disorders. The efficacy of the various anti-B cell therapies and practical issues on induction and maintenance therapy is specifically detailed for the treatment of patients with multiple sclerosis, neuromyelitis-spectrum disorders, autoimmune encephalitis and hyperexcitability CNS disorders, autoimmune neuropathies, myasthenia gravis, and inflammatory myopathies. The success of anti-B cell therapies in inducing long-term remission in IgG4 neuroautoimmunities is also highlighted pointing out potential biomarkers for follow-up infusions.
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Affiliation(s)
- Panos Stathopoulos
- 1st Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos C Dalakas
- Thomas Jefferson University, Philadelphia, PA, USA.
- Neuroimmunology Unit, National and Kapodistrian University of Athens, Athens, Greece.
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Abstract
Autoimmune encephalitis (AE) comprises a heterogeneous group of disorders in which the host immune system targets self-antigens expressed in the central nervous system. The most conspicuous example is an anti-N-methyl-D-aspartate receptor encephalitis linked to a complex neuropsychiatric syndrome. Current treatment of AE is based on immunotherapy and has been established according to clinical experience and along the concept of a B cell-mediated pathology induced by highly specific antibodies to neuronal surface antigens. In general, immunotherapy for AE follows an escalating approach. When first-line therapy with steroids, immunoglobulins, and/or plasma exchange fails, one converts to second-line immunotherapy. Alkylating agents could be the first choice in this stage. However, due to their side effect profile, most clinicians give preference to monoclonal antibodies (mAbs) directed at B cells such as rituximab. Newer mAbs might be added as a third-line therapy in the future, or be given even earlier if shown effective. In this chapter, we will discuss mAbs targeting B cells (rituximab, ocrelizumab, inebulizumab, daratumumab), IL-6 (tocilizumab, satralizumab), the neonatal Fc receptor (FCRn) (efgartigimod, rozanolixizumab), and the complement cascade (eculizumab).
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Affiliation(s)
- I Smets
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M J Titulaer
- Erasmus University Medical Center, Rotterdam, The Netherlands.
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Carnero Contentti E, López PA, Rojas JI. Emerging drugs for the acute treatment of relapses in adult neuromyelitis optica spectrum disorder patients. Expert Opin Emerg Drugs 2022; 27:91-98. [PMID: 35341428 DOI: 10.1080/14728214.2022.2059463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) are rare but often devastating neuroinflammatory autoimmune diseases of the central nervous system. Acute treatment is critically important and it should be initiated early and aggressively, as relapses result in severe residual disability. Acute treatments are still based on clinical experience and observational studies. The most commonly used treatments are steroids and plasmapheresis. Several new treatments to improve management and recovery after relapses in NMOSD are currently under investigation. AREAS COVERED : This review discusses current and the most recent advances in active development of phase II/III clinical trials for acute treatment options and therapeutic strategies that can help management improvement of NMOSD during a relapse. These treatments include bevacizumab, ublituximab and HBM9161. EXPERT OPINION NMOSD relapses require prompt evaluation and timely treatment to restore function and mitigate disability. Timing is critical. Plasmapheresis showed better outcomes in terms of recovery when compared to high-dose intravenous methylprednisolone alone. Some groups suggest that plasmapheresis could be considered as an initial treatment approach in different clinical scenarios due to its higher effectiveness. Future research and/or real-world data will establish the advantages and disadvantages of these new treatments and define the appropriate patient profile.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina.,Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Remlinger J, Madarasz A, Guse K, Hoepner R, Bagnoud M, Meli I, Feil M, Abegg M, Linington C, Shock A, Boroojerdi B, Kiessling P, Smith B, Enzmann V, Chan A, Salmen A. Antineonatal Fc Receptor Antibody Treatment Ameliorates MOG-IgG-Associated Experimental Autoimmune Encephalomyelitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/2/e1134. [PMID: 35027475 PMCID: PMC8759074 DOI: 10.1212/nxi.0000000000001134] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/03/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD) is a rare, autoimmune demyelinating CNS disorder, distinct from multiple sclerosis and neuromyelitis optica spectrum disorder. Characterized by pathogenic immunoglobulin G (IgG) antibodies against MOG, a potential treatment strategy for MOGAD is to reduce circulating IgG levels, e.g., by interference with the IgG recycling pathway mediated by the neonatal Fc receptor (FcRn). Although the optic nerve is often detrimentally involved in MOGAD, the effect of FcRn blockade on the visual pathway has not been assessed. Our objective was to investigate effects of a monoclonal anti-FcRn antibody in murine MOG-IgG-associated experimental autoimmune encephalomyelitis (EAE). METHODS We induced active MOG35-55 EAE in C57Bl/6 mice followed by the application of a monoclonal MOG-IgG (8-18C5) 10 days postimmunization (dpi). Animals were treated with either a specific monoclonal antibody against FcRn (α-FcRn, 4470) or an isotype-matched control IgG on 7, 10, and 13 dpi. Neurologic disability was scored daily on a 10-point scale. Visual acuity was assessed by optomotor reflex. Histopathologic hallmarks of disease were assessed in the spinal cord, optic nerve, and retina. Immune cell infiltration was visualized by immunohistochemistry, demyelination by Luxol fast blue staining and complement deposition and number of retinal ganglion cells by immunofluorescence. RESULTS In MOG-IgG-augmented MOG35-55 EAE, anti-FcRn treatment significantly attenuated neurologic disability over the course of disease (mean area under the curve and 95% confidence intervals (CIs): α-FcRn [n = 27], 46.02 [37.89-54.15]; isotype IgG [n = 24], 66.75 [59.54-73.96], 3 independent experiments), correlating with reduced amounts of demyelination and macrophage infiltration into the spinal cord. T- and B-cell infiltration and complement deposition remained unchanged. Compared with isotype, anti-FcRn treatment prevented reduction of visual acuity over the course of disease (median cycles/degree and interquartile range: α-FcRn [n = 16], 0.50 [0.48-0.55] to 0.50 [0.48-0.58]; isotype IgG [n = 17], 0.50 [0.49-0.54] to 0.45 [0.39-0.51]). DISCUSSION We show preserved optomotor response and ameliorated course of disease after anti-FcRn treatment in an experimental model using a monoclonal MOG-IgG to mimic MOGAD. Selectively targeting FcRn might represent a promising therapeutic approach in MOGAD.
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Affiliation(s)
- Jana Remlinger
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Adrian Madarasz
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Kirsten Guse
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Robert Hoepner
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Maud Bagnoud
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Ivo Meli
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Moritz Feil
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Mathias Abegg
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Christopher Linington
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Anthony Shock
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Babak Boroojerdi
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Peter Kiessling
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Bryan Smith
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Volker Enzmann
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Andrew Chan
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany
| | - Anke Salmen
- From the Department of Neurology (J.R., A.M., K.G., R.H., M.B., I.M., A.C., A. Salmen), Inselspital, Bern University Hospital and University of Bern; Department of Biomedical Research (J.R., A.M., K.G., R.H., M.B., I.M., V.E., A.C., A. Salmen), and Graduate School for Cellular and Biomedical Sciences (J.R., A.M., M.B.), University of Bern; Department of Ophthalmology (M.F., M.A., V.E.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Institute of Infection (C.L.), Immunity and Inflammation, University of Glasgow; UCB Pharma (A. Shock, B.S.), Slough, United Kingdom; and UCB Pharma (B.B., P.K.), Monheim-am-Rhein, Germany.
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Exploring steroid tapering in patients with neuromyelitis optica spectrum disorder treated with satralizumab in SAkuraSky: a case series. Mult Scler Relat Disord 2022; 61:103772. [DOI: 10.1016/j.msard.2022.103772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 01/06/2023]
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Tahara M, Tomoko O, Okada K, Ochi K, Maruyama H, Fukaura H, Nomura K, Shimizu Y, Nakashima I, Misu T, Umemura A, Yamamoto K, Sawada H. Compassionate open-label use of rituximab following a randomised clinical trial against neuromyelitis optica (RIN-2 study): B cell monitoring-based administration. Mult Scler Relat Disord 2022; 60:103730. [DOI: 10.1016/j.msard.2022.103730] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 11/24/2022]
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141
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Cai H, Zhou R, Jiang F, Zeng Q, Yang H. Vaccination in neuromyelitis optica spectrum disorders: Friend or enemy? Mult Scler Relat Disord 2022; 58:103394. [PMID: 35216775 DOI: 10.1016/j.msard.2021.103394] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/26/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) are uncommon antibody-mediated autoimmune diseases of the central nervous system (CNS), mainly occurring in optic nerves and spinal cord, which can cause visual impairment, paralysis, and occasionally bulbar dysfunction. Such neurological deficits can adversely affect pulmonary functions and increase complicated infection risk. Besides, most NMOSD patients undergo immunosuppressive therapy. All these factors make NMOSD patients the potential high-risk group under the current pandemic of coronavirus disease 2019 (COVID-19). Meanwhile, COVID-19 infection has already been demonstrated as a risk factor for NMOSD relapses. This review discusses the basic immunology of vaccination and common problems, including immunogenicity, safety, and efficacy of vaccination on NMOSD patients. Additionally, we offered vaccination recommendations, health care and treatment advice for NMOSD patients under the background of COVID-19.
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Affiliation(s)
- Haobing Cai
- Department of Neurology, Xiangya Hospital, Central South University, Changsha410008, China
| | - Ran Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha410008, China
| | - Fei Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha410008, China
| | - Qiuming Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha410008, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha410008, China.
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Clarke L, Bukhari W, O'Gorman CM, Khalilidehkordi E, Arnett S, Woodhall M, Prain KM, Parratt JDE, Barnett MH, Marriott MP, McCombe PA, Sutton I, Boggild M, Brownlee W, Carroll WM, Hodgkinson S, Macdonell RAL, Mason DF, Pereira J, Slee M, Das C, Henderson APD, Kermode AG, Lechner-Scott J, Waters P, Sun J, Broadley SA. Response to treatment in NMOSD: the Australasian experience. Mult Scler Relat Disord 2022; 58:103408. [PMID: 35216788 DOI: 10.1016/j.msard.2021.103408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/09/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is associated with significant morbidity and mortality. Several therapies have been recommended for NMOSD and more recently clinical trials have demonstrated efficacy for three monoclonal antibody therapies. We present a retrospective observational study of treatment response in NMOSD. METHODS This was a retrospective, unblinded, observational study of treatment efficacy for rituximab and traditional immunosuppressive therapy in patients with AQP4 antibody positive NMOSD. Treatment efficacy was assessed using annualised relapse rates (ARR), time to first relapse and expanded disability status scale (EDSS) scores. RESULTS Complete relapse and treatment data were available for 43/68 (63%) of AQP4 antibody positive NMOSD cases covering 74 episodes of treatment. In a time to first relapse analysis rituximab showed a risk ratio of 0.23 (95% CI 0.08 - 0.65) when compared with no treatment and there was a non-significant reduction in ARR of 35% compared to pre-treatment. β-interferon (p = 0.0002) and cyclophosphamide (p = 0.0034) were associated with an increased ARR compared to pre-treatment. Rituximab (median 4.0 [range 0.0 - 7.0]; p = 0.042) and traditional immunosuppressive therapy (median 4.0 [range 0.0 - 8.0]; p = 0.016) were associated with a lower final EDSS compared to β-interferon (median 6.0 [range 4.0 - 7.5]). CONCLUSIONS These data provide additional support for the use of rituximab in preference to traditional immunosuppressive agents and MS disease modifying therapies as first line treatment of NMOSD.
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Affiliation(s)
- Laura Clarke
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology Princess Alexandra Hospital, Woolloongabba QLD 4102, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; St Vincent's Hospital Melbourne, Fitzroy VIC 3065, AustraliA
| | - Cullen M O'Gorman
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology Princess Alexandra Hospital, Woolloongabba QLD 4102, Australia; Department of Neurology, Mater Hospital Brisbane, South Brisbane QLD, 4101, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford OX3 9DU, UK
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston QLD 4006, Australia
| | - John D E Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown NSW 2006, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney, Camperdown NSW 2006, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville VIC 3052, Australia
| | - Pamela A McCombe
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia; Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston QLD 4029, AustraliA
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Darlinghurst NSW 2010, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas QLD 4814, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton 1023, New Zealand; Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands WA 6009, AustraliA
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool NSW 2170, Australia
| | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch 8140, New Zealand
| | - Jennifer Pereira
- Department of Neurology, Auckland City Hospital, Grafton 1023, New Zealand
| | - Mark Slee
- Flinders Medical Centre, Flinders University, Bedford Park SA 5042, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran ACT 2605, Australia
| | | | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands WA 6009, AustraliA; Institute for Immunology and Infectious Disease, Murdoch University, Murdoch WA 6150, AustraliA
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights NSW 2305, AustralIA
| | | | - Patrick Waters
- Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia.
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143
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Tur C, Dubessy AL, Otero-Romero S, Amato MP, Derfuss T, Di Pauli F, Iacobaeus E, Mycko M, Abboud H, Achiron A, Bellinvia A, Boyko A, Casanova JL, Clifford D, Dobson R, Farez MF, Filippi M, Fitzgerald KC, Fonderico M, Gouider R, Hacohen Y, Hellwig K, Hemmer B, Kappos L, Ladeira F, Lebrun-Frénay C, Louapre C, Magyari M, Mehling M, Oreja-Guevara C, Pandit L, Papeix C, Piehl F, Portaccio E, Ruiz-Camps I, Selmaj K, Simpson-Yap S, Siva A, Sorensen PS, Sormani MP, Trojano M, Vaknin-Dembinsky A, Vukusic S, Weinshenker B, Wiendl H, Winkelmann A, Zuluaga Rodas MI, Tintoré M, Stankoff B. The risk of infections for multiple sclerosis and neuromyelitis optica spectrum disorder disease-modifying treatments: Eighth European Committee for Treatment and Research in Multiple Sclerosis Focused Workshop Review. April 2021. Mult Scler 2022; 28:1424-1456. [PMID: 35196927 DOI: 10.1177/13524585211069068] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the recent years, the treatment of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) has evolved very rapidly and a large number of disease-modifying treatments (DMTs) are now available. However, most DMTs are associated with adverse events, the most frequent of which being infections. Consideration of all DMT-associated risks facilitates development of risk mitigation strategies. An international focused workshop with expert-led discussions was sponsored by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and was held in April 2021 to review our current knowledge about the risk of infections associated with the use of DMTs for people with MS and NMOSD and corresponding risk mitigation strategies. The workshop addressed DMT-associated infections in specific populations, such as children and pregnant women with MS, or people with MS who have other comorbidities or live in regions with an exceptionally high infection burden. Finally, we reviewed the topic of DMT-associated infectious risks in the context of the current SARS-CoV-2 pandemic. Herein, we summarize available evidence and identify gaps in knowledge which justify further research.
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Affiliation(s)
- Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Anne-Laure Dubessy
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/ Department of Neurology, Saint Antoine Hospital, AP-HP, Paris, France
| | - Susana Otero-Romero
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Tobias Derfuss
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Franziska Di Pauli
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ellen Iacobaeus
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Marcin Mycko
- Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Hesham Abboud
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland Medical Center, Cleveland, OH, USA
| | - Anat Achiron
- Sheba Medical Center at Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Angelo Bellinvia
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Alexey Boyko
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia/Institute of Clinical Neurology and Department of Neuroimmunology, Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - David Clifford
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK/Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Mauricio F Farez
- Center for Research on Neuroimmunological Diseases, FLENI, Buenos Aires, Argentina
| | - Massimo Filippi
- Neurology Unit, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Kathryn C Fitzgerald
- Department of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Mattia Fonderico
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, Tunis, Tunisia
| | - Yael Hacohen
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Filipa Ladeira
- Neurology Department, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Christine Lebrun-Frénay
- CRCSEP Côte d'Azur, CHU de Nice Pasteur 2, UR2CA-URRIS, Université Nice Côte d'Azur, Nice, France
| | - Céline Louapre
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/Sorbonne University, Paris Brain Institute-ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Paris, France
| | - Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Copenhagen, Denmark
| | - Matthias Mehling
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico San Carlos, Idissc, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Lekha Pandit
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, India
| | - Caroline Papeix
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/Sorbonne University, Paris Brain Institute-ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Paris, France
| | - Fredrik Piehl
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Isabel Ruiz-Camps
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Krzysztof Selmaj
- Collegium Medicum, Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland/Center of Neurology, Lodz, Poland
| | - Steve Simpson-Yap
- Clinical Outcomes Research Unit, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Aksel Siva
- Department of Neurology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Per Soelberg Sorensen
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Adi Vaknin-Dembinsky
- Hadassah-Hebrew University Medical Center, Department of Neurology, The Agnes-Ginges Center for Neurogenetics Jerusalem, Jerusalem, Israel
| | - Sandra Vukusic
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Centre des Neurosciences de Lyon, Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France/Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, Lyon, France
| | | | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Münster, Germany
| | | | | | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Bruno Stankoff
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/ Department of Neurology, Saint Antoine Hospital, AP-HP, Paris, France
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144
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Kishimoto T, Kang S. IL-6 Revisited: From Rheumatoid Arthritis to CAR T Cell Therapy and COVID-19. Annu Rev Immunol 2022; 40:323-348. [PMID: 35113729 DOI: 10.1146/annurev-immunol-101220-023458] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The diverse biological activity of interleukin-6 (IL-6) contributes to the maintenance of homeostasis. Emergent infection or tissue injury induces rapid production of IL-6 and activates host defense through augmentation of acute-phase proteins and immune responses. However, excessive IL-6 production and uncontrolled IL-6 receptor signaling are critical to pathogenesis. Over the years, therapeutic agents targeting IL-6 signaling, such as tocilizumab, a humanized anti-IL-6 receptor antibody, have shown remarkable efficacy for rheumatoid arthritis, Castleman disease, and juvenile idiopathic arthritis, and their efficacy in other diseases is continually being reported. Emerging evidence has demonstrated the benefit of tocilizumab for several types of acute inflammatory diseases, including cytokine storms induced by chimeric antigen receptor T-cell therapy and coronavirus disease 2019 (COVID-19). Here, we refocus attention on the biology of IL-6 and summarize the distinct pathological roles of IL-6 signaling in several acute and chronic inflammatory diseases. Expected final online publication date for the Annual Review of Immunology, Volume 40 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Tadamitsu Kishimoto
- Laboratory of Immune Regulation, WPI Immunology Frontier Research Center, Osaka University, Osaka, Japan; ,
| | - Sujin Kang
- Laboratory of Immune Regulation, WPI Immunology Frontier Research Center, Osaka University, Osaka, Japan; ,
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145
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Seok JM, Cho W, Son DH, Shin JH, Cho EB, Kim ST, Kim BJ, Seong JK, Min JH. Association of subcortical structural shapes with fatigue in neuromyelitis optica spectrum disorder. Sci Rep 2022; 12:1579. [PMID: 35091634 PMCID: PMC8799731 DOI: 10.1038/s41598-022-05531-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/03/2022] [Indexed: 01/18/2023] Open
Abstract
Although fatigue is a major symptom in patients with neuromyelitis optica spectrum disorder (NMOSD), the underlying mechanism remains unclear. We explored the relationship between subcortical structures and fatigue severity to identify neural substrates of fatigue in NMOSD. Clinical characteristics with brain magnetic resonance imaging were evaluated in forty patients with NMOSD. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-fatigue) questionnaire (a higher score indicates less fatigue). We assessed the correlation between subcortical structures and fatigue severity using surface-based shape analysis. Most of the enrolled patients showed fatigue (72.5%; mean FACIT-fatigue score, 34.8 ± 10.8). The FACIT-fatigue score was negatively correlated with Expanded Disability Status Scale and Beck Depression Inventory scores (r = - 0.382, p = 0.016; r = - 0.578, p < 0.001). We observed that the right thalamus was the only extracted region for various threshold experiments. Further, patients with lower FACIT-fatigue scores (more fatigue) had decreased local shape volume in the right thalamus. Fatigue is common in patients with NMOSD, and atrophy in the right thalamus is strongly correlated with fatigue severity. The local shape volume of the right thalamus might serve as a biomarker of fatigue in NMOSD.
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Affiliation(s)
- Jin Myoung Seok
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Wanzee Cho
- Department of Artificial Intelligence, Korea University, Seoul, South Korea
| | - Doo-Hwan Son
- School of Biomedical Engineering, Korea University, Seoul, South Korea
| | - Jong Hwa Shin
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Eun Bin Cho
- Department of Neurology, Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, South Korea.,Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Joon-Kyung Seong
- Department of Artificial Intelligence, Korea University, Seoul, South Korea. .,School of Biomedical Engineering, Korea University, Seoul, South Korea. .,Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea.
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. .,Neuroscience Center, Samsung Medical Center, Seoul, South Korea. .,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, 135-710, South Korea.
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146
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Hümmert MW, Schöppe LM, Bellmann-Strobl J, Siebert N, Paul F, Duchow A, Pellkofer H, Kümpfel T, Havla J, Jarius S, Wildemann B, Berthele A, Bergh FT, Pawlitzki M, Klotz L, Kleiter I, Stangel M, Gingele S, Weber MS, Faiss JH, Pul R, Walter A, Zettl U, Senel M, Stellmann JP, Häußler V, Hellwig K, Ayzenberg I, Aktas O, Ringelstein M, Schreiber-Katz O, Trebst C. Costs and Health-Related Quality of Life in Patients With NMO Spectrum Disorders and MOG-Antibody-Associated Disease: CHANCE NMO Study. Neurology 2022; 98:e1184-e1196. [PMID: 35082170 PMCID: PMC8935443 DOI: 10.1212/wnl.0000000000200052] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives To evaluate costs and health-related quality of life (HRQoL) of neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD). Methods In this multicenter cross-sectional study, data on consumption of medical and nonmedical resources and work ability were assessed via patient questionnaires. Costs were analyzed in Euros for 2018 from the societal perspective. HRQoL was captured by the EuroQoL Group 5 Dimension 5 Level Scale (EQ-5D-5L) questionnaire. Clinical data were retrieved from the Neuromyelitis Optica Study Group (NEMOS) database. Results Two hundred twelve patients (80% women, median age 50 [19–83] years, median disease duration 7 [0–43] years, median Expanded Disability Status Scale [EDSS] score 3.5 [0–8.5], 66% aquaporin-4 immunoglobulin G [IgG] positive, 22% MOG IgG positive, 12% double seronegative) were analyzed. The mean total annual per capita cost of illness accounted for €59,574 (95% CI 51,225–68,293 or US dollars [USD] 70,297, 95% CI 60,445–80,586), and the mean index value of the EQ-5D-5L was 0.693 (95% CI 0.65–0.73). The most important cost drivers were informal care costs (28% of total costs), indirect costs (23%), and drugs (16%), especially immunotherapeutics. Costs showed a positive correlation with disease severity (ρ = 0.56, 95% CI 0.45–0.65); in the EDSS score 6.5 to 8.5 subgroup, the mean annual costs were €129,687 (95% CI 101,946–160,336 or USD 153,031, 95% CI 120,296–189,196). The HRQoL revealed a negative correlation to disease severity (ρ = −0.69, 95% CI −0.76 to −0.61); in the EDSS score 6.5 to 8.5 subgroup, the EQ-5D-5L mean index value was 0.195 (95% CI 0.13–0.28). Neither antibody status nor disease duration influenced the total annual costs or HRQoL. Discussion These German data from the era without approved preventive immunotherapies show enormous effects of the diseases on costs and quality of life. An early and cost-effective therapy should be provided to prevent long-term disability and to preserve quality of life.
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Affiliation(s)
- Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Louisa M Schöppe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany.,Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nadja Siebert
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany.,Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany.,Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ankelien Duchow
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany.,Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hannah Pellkofer
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians Universität München, Munich, Germany.,Institute of Neuropathology, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians Universität München, Munich, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians Universität München, Munich, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | | | - Marc Pawlitzki
- Department of Neurology, University of Münster, Münster, Germany.,Department of Neurology, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Luisa Klotz
- Department of Neurology, University of Münster, Münster, Germany
| | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany.,Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Martin Stangel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Martin S Weber
- Institute of Neuropathology, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Juergen H Faiss
- Department of Neurology, Asklepios Expert Clinic Teupitz, Teupitz, Germany
| | - Refik Pul
- Department of Neurology, University of Essen, Essen, Germany
| | - Annette Walter
- Department of Neurology, Herford Hospital, Herford, Germany
| | - Uwe Zettl
- Neuroimmunological Section, Department of Neurology, University of Rostock, Rostock, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Germany.,Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille Cedex, France.,APHM, Hopital de la Timone, CEMEREM, Marseille, France
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
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147
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Schneider-Gold C, Gilhus NE. Advances and challenges in the treatment of myasthenia gravis. Ther Adv Neurol Disord 2022; 14:17562864211065406. [PMID: 34987614 PMCID: PMC8721395 DOI: 10.1177/17562864211065406] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/18/2021] [Indexed: 01/04/2023] Open
Abstract
Myasthenia gravis (MG) is a chronic autoimmune disease with fluctuating muscle weakness and fatigability. Standard immunomodulatory treatment may fail to achieve sufficient improvement with minimal symptom expression or remission of myasthenic symptoms, despite adequate dosing and duration of treatment. Treatment-resistant MG poses a challenge for both patients and treating neurologists and requires new therapeutic approaches. The spectrum of upcoming immunotherapies that more specifically address distinct targets of the main immunological players in MG pathogenesis includes T-cell directed monoclonal antibodies that block the intracellular cascade associated with T-cell activation, monoclonal antibodies directed against key B-cell molecules, as well as monoclonal antibodies against the fragment crystallizable neonatal receptor (FcRn), cytokines and transmigration molecules, and also drugs that inhibit distinct elements of the complement system activated by the pathogenic MG antibodies. The review gives an overview on new drugs being evaluated in still ongoing or recently finished controlled clinical trials and drugs of potential benefit in MG due to their mechanisms of action and positive effects in other autoimmune disorders. Also, the challenges associated with the new therapeutic options are discussed briefly.
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Affiliation(s)
- Christiane Schneider-Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University of Bochum, Gudrunstrasse 56, Bochum D-44791, Germany
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Bergen, NorwayDepartment of Neurology, Haukeland University Hospital, Bergen, Norway
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148
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Loda E, Arellano G, Perez-Giraldo G, Miller SD, Balabanov R. Can Immune Tolerance Be Re-established in Neuromyelitis Optica? Front Neurol 2022; 12:783304. [PMID: 34987468 PMCID: PMC8721118 DOI: 10.3389/fneur.2021.783304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Neuromyelitis optica (NMO) is a chronic inflammatory disease of the central nervous system that primarily affects the optic nerves and spinal cord of patients, and in some instances their brainstem, diencephalon or cerebrum as spectrum disorders (NMOSD). Clinical and basic science knowledge of NMO has dramatically increased over the last two decades and it has changed the perception of the disease as being inevitably disabling or fatal. Nonetheless, there is still no cure for NMO and all the disease-modifying therapies (DMTs) are only partially effective. Furthermore, DMTs are not disease- or antigen-specific and alter all immune responses including those protective against infections and cancer and are often associated with significant adverse reactions. In this review, we discuss the pathogenic mechanisms of NMO as they pertain to its DMTs and immune tolerance. We also examine novel research therapeutic strategies focused on induction of antigen-specific immune tolerance by administrating tolerogenic immune-modifying nanoparticles (TIMP). Development and implementation of immune tolerance-based therapies in NMO is likely to be an important step toward improving the treatment outcomes of the disease. The antigen-specificity of these therapies will likely ameliorate the disease safely and effectively, and will also eliminate the clinical challenges associated with chronic immunosuppressive therapies.
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Affiliation(s)
- Eileah Loda
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Neurology, Northwestern University, Chicago, IL, United States
| | - Gabriel Arellano
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Gina Perez-Giraldo
- Department of Neurology, Northwestern University, Chicago, IL, United States
| | - Stephen D Miller
- Department of Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Roumen Balabanov
- Department of Neurology, Northwestern University, Chicago, IL, United States
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149
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Potential therapeutic strategies in chronic inflammatory demyelinating polyradiculoneuropathy. Clin Exp Rheumatol 2022; 21:103032. [PMID: 34999243 DOI: 10.1016/j.autrev.2022.103032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/01/2022] [Indexed: 11/23/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an autoimmune neuropathy involving peripheral nerve and nerve roots. The pathological hallmark of CIDP is macrophage-induced demyelination. Antibodies against nerve fibers, complement decomposition, abnormalities in plasma and cerebrospinal fluid cytokine profile, and changes of peripheral blood cell proportion were also reported in CIDP patients. These findings in immunopathology provide support for the introduction of potential therapeutic options for the treatment of CIDP. In this review, we systematically listed the potential therapeutic strategies targeting different components of the immune system by comparing the treatment of other autoimmune inflammatory diseases of the nervous system. Several ongoing clinical trials will assess the efficacy and safety of potential CIDP treatments.
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150
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Huang TL, Chu YC. What's new in neuromyelitis optica spectrum disorder treatment? Taiwan J Ophthalmol 2022. [DOI: 10.4103/2211-5056.355329] [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] Open
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