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Bose G, Healy BC, Lokhande HA, Sotiropoulos MG, Polgar‐Turcsanyi M, Anderson M, Glanz BI, Guttman CRG, Bakshi R, Weiner HL, Chitnis T. Early predictors of clinical and MRI outcomes using LASSO in multiple sclerosis. Ann Neurol 2022; 92:87-96. [DOI: 10.1002/ana.26370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/28/2022] [Accepted: 04/10/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Gauruv Bose
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Brian C. Healy
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Hrishikesh A. Lokhande
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Marinos G. Sotiropoulos
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Mariann Polgar‐Turcsanyi
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Mark Anderson
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Bonnie I. Glanz
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Charles R. G. Guttman
- Harvard Medical School Boston MA US
- Center for Neurological Imaging, Department of Radiology, Brigham and Women’s Hospital Boston MA US
| | - Rohit Bakshi
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Howard L. Weiner
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
| | - Tanuja Chitnis
- Harvard Medical School Boston MA US
- Brigham Multiple Sclerosis Center & Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women’s Hospital Boston MA US
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102
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Brieva L, Estruch BC, Merino JAG, Meca-Lallana V, Río J, Rodríguez-Antigüedad A, Agüera E, Ara JR, Luque AA, Garcia CA, Blanco Y, Castillo-Triviño T, Costa-Frossard L, Platas MG, Pascual LL, Llaneza-González M, Ginés MLM, Matías-Guiu J, Meca-Lallana JE, Bilbao MM, Sempere AP, Romero-Pinel L, Saiz A, Moral E. DISEASE MODIFYING THERAPY SWITCHING IN RELAPSING MULTIPLE SCLEROSIS: A Delphi consensus of the demyelinating expert group of the Spanish Society of Neurology. Mult Scler Relat Disord 2022; 63:103805. [DOI: 10.1016/j.msard.2022.103805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 03/05/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
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103
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Kunkl M, Amormino C, Tedeschi V, Fiorillo MT, Tuosto L. Astrocytes and Inflammatory T Helper Cells: A Dangerous Liaison in Multiple Sclerosis. Front Immunol 2022; 13:824411. [PMID: 35211120 PMCID: PMC8860818 DOI: 10.3389/fimmu.2022.824411] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 11/15/2022] Open
Abstract
Multiple Sclerosis (MS) is a neurodegenerative autoimmune disorder of the central nervous system (CNS) characterized by the recruitment of self-reactive T lymphocytes, mainly inflammatory T helper (Th) cell subsets. Once recruited within the CNS, inflammatory Th cells produce several inflammatory cytokines and chemokines that activate resident glial cells, thus contributing to the breakdown of blood-brain barrier (BBB), demyelination and axonal loss. Astrocytes are recognized as key players of MS immunopathology, which respond to Th cell-defining cytokines by acquiring a reactive phenotype that amplify neuroinflammation into the CNS and contribute to MS progression. In this review, we summarize current knowledge of the astrocytic changes and behaviour in both MS and experimental autoimmune encephalomyelitis (EAE), and the contribution of pathogenic Th1, Th17 and Th1-like Th17 cell subsets, and CD8+ T cells to the morphological and functional modifications occurring in astrocytes and their pathological outcomes.
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Affiliation(s)
- Martina Kunkl
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy.,Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University, Rome, Italy
| | - Carola Amormino
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy.,Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University, Rome, Italy
| | - Valentina Tedeschi
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy
| | - Maria Teresa Fiorillo
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy
| | - Loretta Tuosto
- Department of Biology and Biotechnology Charles Darwin, Sapienza University, Rome, Italy.,Laboratory Affiliated to Istituto Pasteur Italia-Fondazione Cenci Bolognetti, Sapienza University, Rome, Italy
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104
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Portaccio E, Bellinvia A, Fonderico M, Pastò L, Razzolini L, Totaro R, Spitaleri D, Lugaresi A, Cocco E, Onofrj M, Di Palma F, Patti F, Maimone D, Valentino P, Confalonieri P, Protti A, Sola P, Lus G, Maniscalco GT, Brescia Morra V, Salemi G, Granella F, Pesci I, Bergamaschi R, Aguglia U, Vianello M, Simone M, Lepore V, Iaffaldano P, Filippi M, Trojano M, Amato MP. Progression is independent of relapse activity in early multiple sclerosis: a real-life cohort study. Brain 2022; 145:2796-2805. [PMID: 35325059 DOI: 10.1093/brain/awac111] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/12/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Disability accrual in multiple sclerosis may occur as relapse-associated worsening or progression independent of relapse activity. The role of progression independent of relapse activity in early MS is yet to be established. The objective of this multicentre, observational, retrospective cohort study was to investigate the contribution of relapse-associated worsening and progression independent of relapse activity to confirmed disability accumulation in patients with clinically isolated syndrome and early relapsing-remitting multiple sclerosis, assessed within one year from onset and with follow-up >/= 5 years (n = 5169). Data were extracted from the Italian Multiple Sclerosis Register. Confirmed disability accumulation was defined by an increase in Expanded Disability Status Scale score confirmed at 6 months, and classified per temporal association with relapses. Factors associated with progression independent of relapse activity and relapse-associated worsening were assessed using multivariable Cox regression models. Over a follow-up period of 11.5 ± 5.5 years, progression independent of relapse activity occurred in 1427 (27.6%) and relapse-associated worsening in 922 (17.8%) patients. Progression independent of relapse activity was associated with older age at baseline (HR = 1.19; 95CI 1.13-1.25, p < 0.001), having a relapsing-remitting course at baseline (HR = 1.44; 95CI 1.28-1.61, p < 0.001), longer disease duration at baseline (HR = 1.56; 95%CI 1.28-1.90, p < 0.001), lower Expanded Disability Status Scale at baseline (HR = 0.92; 95CI 0.88-0.96, p < 0.001), lower number of relapses before the event (HR = 0.76; 95CI 0.73-0.80, p < 0.001). Relapse-associated worsening was associated with younger age at baseline (HR = 0.87; 95CI 0.81-0.93, p < 0.001), having a relapsing-remitting course at baseline (HR = 1.55; 95CI 1.35-1.79, p < 0.001), lower Expanded Disability Status Scale at baseline (HR = 0.94; 95CI 0.89-0.99, p = 0.017), higher number of relapses before the event (HR = 1.04; 95CI 1.01-1.07, p < 0.001). Longer exposure to disease modifying drugs was associated with a lower risk of both progression independent of relapse activity and relapse-associated worsening (p < 0.001). This study provides evidence that in early relapsing-onset multiple sclerosis cohort, progression independent of relapse activity was an important contributor to confirmed disability accumulation. Our findings indicate that insidious progression appears even in the earliest phases of the disease, suggesting that inflammation and neurodegeneration can represent a single disease continuum, in which age is one of the main determinants of disease phenomenology.
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Affiliation(s)
- Emilio Portaccio
- University of Florence, Department of NEUROFARBA, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Department of Neurology, Florence, Italy
| | - Angelo Bellinvia
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | - Mattia Fonderico
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | - Luisa Pastò
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | | | - Rocco Totaro
- San Salvatore Hospital, Demyelinating Disease Center, L'Aquila, Italy
| | - Daniele Spitaleri
- AORN San G. Moscati di Avellino, Department of Neurology, Avellino, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla, Bologna, Italy.,Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie, Bologna, Italy
| | - Eleonora Cocco
- University of Cagliari, Department of Medical Science and Public health, Centro Sclerosi Multipla, Cagliari, Italy
| | - Marco Onofrj
- University G. d'Annunzio di Chieti-Pescara, Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
| | - Franco Di Palma
- ASST Lariana Ospedale S. Anna, Department of Neurology, Como, Italy
| | - Francesco Patti
- University of Catania, Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Catania, Italy
| | - Davide Maimone
- Ospedale Garibaldi Centro, Department of Neurology, Catania, Italy
| | - Paola Valentino
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Paolo Confalonieri
- Fondazione IRCCS Istituto Neurologico C. Besta, Neuroimmunology Unit, Milan, Italy
| | | | - Patrizia Sola
- University of Modena and Reggio Emilia, Department of Neurology, Modena, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Vincenzo Brescia Morra
- Federico II University, Naples, Multiple Sclerosis Clinical Care and Research Center, Department of Neuroscience (NSRO), Naples, Italy
| | - Giuseppe Salemi
- University of Palermo, Department of Biomedicine, Neuroscience and Advanced Diagnostics, Palermo, Italy
| | - Franco Granella
- University of Parma, Unit of Neurosciences, Department of Medicine and Surgery, Parma, Italy
| | - Ilaria Pesci
- Ospedale VAIO di Fidenza AUSL PR, Department of Neurology, Fidenza, Italy
| | | | - Umberto Aguglia
- Magna Graecia University of Catanzaro, Department of Medical and Surgical Sciences, Catanzaro, Italy
| | - Marika Vianello
- Unit of Neurology, Ca' Fancello Hospital, AULSS2, Treviso, Italy
| | - Marta Simone
- University 'Aldo Moro' of Bari, Child Neuropsychiatric Unit, Department of Biomedical Sciences and Human Oncology, Bari, Italy
| | - Vito Lepore
- Public Health Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Pietro Iaffaldano
- University of Bari Aldo Moro, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Bari, Italy
| | - Massimo Filippi
- San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute; Neuroimaging Research Unit, Division of Neuroscience; Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Trojano
- University of Bari Aldo Moro, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Bari, Italy
| | - Maria Pia Amato
- University of Florence, Department of NEUROFARBA, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Department of Neurology, Florence, Italy
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105
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Theodorsdottir A, Larsen PV, Nielsen HH, Illes Z, Ravnborg MH. Multiple sclerosis impairment scale and brain MRI in secondary progressive multiple sclerosis. Acta Neurol Scand 2022; 145:332-347. [PMID: 34799851 DOI: 10.1111/ane.13554] [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: 07/21/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the Multiple Sclerosis Impairment Scale (MSIS) in secondary progressive MS (SPMS) in relation to the Expanded Disability Status Scale (EDSS), magnetic resonance imaging (MRI) outcomes, and mobility. METHODS In this observational single-center study, 68 secondary progressive multiple sclerosis (SPMS) patients were examined by MSIS, EDSS, functional mobility tests of upper/lower extremities, and multimodal MRI. Participants had EDSS ≥3.5, a decline in daily activities over the last year unrelated to relapses, and/or 6-month confirmed disability progression. RESULTS Mean disease duration was 23.1 ± 8.3 years and mean age 54.4 ± 8.1 years. MSIS, EDSS, and their corresponding motor, cerebellar, and sensory subscores correlated (p < .0001). Motor subscores of MSIS correlated stronger with Timed-25-Foot-Walk (T25FW) than pyramidal functional system score (FSS) (p = .03), but EDSS had a stronger correlation to T25FW than the total MSIS score (p = .01). MSIS cerebellar subscore correlated stronger with 9-Hole Peg Test (9-HPT) than cerebellar FSS (p = .04). The sensory MSIS subscore also showed correlation with 9-HPT in contrast to sensory FSS (p = .006). MSIS subscores had stronger correlations with MRI volumetry measures than FSS scores (lesion volume and putamen, thalamus, corpus callosum volumetry, p = .0001-0.0017). CONCLUSION In patients with SPMS, MSIS correlated with functional motor tests. MSIS showed stronger correlations with atrophy of central nervous system areas, and may be more sensitive to scale cerebellar and sensory function than EDSS.
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Affiliation(s)
- Asta Theodorsdottir
- Department of Neurology Odense University Hospital Odense Denmark
- OPEN Odense Patient Data Explorative Network Odense University Hospital Odense Denmark
| | - Pia Veldt Larsen
- Mental Health Services at the Region of Southern Denmark Odense Denmark
| | - Helle Hvilsted Nielsen
- Department of Neurology Odense University Hospital Odense Denmark
- Department of Neurobiology Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
- Department of Clinical Research BRIDGE ‐ Brain Research – Inter Disciplinary Guided Excellence University of Southern Denmark Odense Denmark
| | - Zsolt Illes
- Department of Neurology Odense University Hospital Odense Denmark
- Department of Neurobiology Research Institute of Molecular Medicine University of Southern Denmark Odense Denmark
- Department of Clinical Research BRIDGE ‐ Brain Research – Inter Disciplinary Guided Excellence University of Southern Denmark Odense Denmark
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106
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Preziosa P, Pagani E, Meani A, Moiola L, Rodegher M, Filippi M, Rocca MA. Slowly Expanding Lesions Predict 9-Year Multiple Sclerosis Disease Progression. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/2/e1139. [PMID: 35105685 PMCID: PMC8808355 DOI: 10.1212/nxi.0000000000001139] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022]
Abstract
Background and Objectives Chronic active lesions contribute to multiple sclerosis (MS) severity, but their association with long-term disease progression has not been evaluated yet. White matter (WM) lesions showing linear expansion over time on serial T1- and T2-weighted scans (i.e., slowly expanding lesions [SELs]) have been proposed as a marker of chronic inflammation. In this study, we assessed whether SEL burden and microstructural abnormalities were associated with Expanded Disability Status Scale (EDSS) score worsening and secondary progressive (SP) conversion at 9.1-year follow-up in patients with relapsing-remitting (RR) MS. Methods In 52 patients with RRMS, SELs were identified among WM lesions by linearly fitting the Jacobian of the nonlinear deformation field between time points obtained combining 3T brain T1- and T2-weighted scans acquired at baseline and months 6, 12, and 24. Logistic regression analysis was applied to investigate the associations of SEL number, volume, magnetization transfer ratio (MTR), and T1-weighted signal intensity with disability worsening (i.e., EDSS score increase) and SP conversion after a median follow-up of 9.1 years. Results At follow-up, 20/52 (38%) patients with MS showed EDSS score worsening; 13/52 (25%) showed SP conversion. A higher baseline EDSS score (for each point higher: OR = 3.15 [95% CI = 1.61; 8.38], p = 0.003), a higher proportion of SELs among baseline lesions (for each % increase: OR = 1.22 [1.04; 1.58], p = 0.04), and lower baseline MTR values of SELs (for each % higher: OR = 0.66 [0.41; 0.92], p = 0.033) were significant independent predictors of EDSS score worsening at follow-up (C-index = 0.892). A higher baseline EDSS score (for each point higher: OR = 6.37 [1.98; 20.53], p = 0.002) and lower baseline MTR values of SELs (for each % higher: OR = 0.48 [0.25; 0.89], p = 0.02) independently predicted SPMS conversion (C-index = 0.947). Discussion The proportion of SELs is associated with MS progression after 9 years. More severe SEL microstructural abnormalities independently predict EDSS score worsening and SPMS conversion. The quantification of SEL burden and damage using T1-, T2-weighted, and MTR sequences may identify patients with RRMS at a higher risk of long-term disability progression and SPMS conversion. Classification of Evidence This study provides Class III evidence that in patients with RRMS starting treatment with natalizumab or fingolimod, the proportion of SELs on brain MRI was associated with EDSS score worsening and SPMS conversion at 9-year follow-up.
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Affiliation(s)
- Paolo Preziosa
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Elisabetta Pagani
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Alessandro Meani
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Lucia Moiola
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Mariaemma Rodegher
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy
| | - Maria A Rocca
- From the Neuroimaging Research Unit (P.P., E.P., A.M., M.F., M.A.R.), Division of Neuroscience; Neurology Unit (P.P., L.M., M.R., M.F., M.A.R.); Neurorehabilitation Unit (M.F.); Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute; and Vita-Salute San Raffaele University (M.F., M.A.R.); Milan, Italy.
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107
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Bischof A, Papinutto N, Keshavan A, Rajesh A, Kirkish G, Zhang X, Mallott JM, Asteggiano C, Sacco S, Gundel TJ, Zhao C, Stern WA, Caverzasi E, Zhou Y, Gomez R, Ragan NR, Santaniello A, Zhu AH, Juwono J, Bevan CJ, Bove RM, Crabtree E, Gelfand JM, Goodin DS, Graves JS, Green AJ, Oksenberg JR, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Reply to "Spinal cord atrophy is a preclinical marker of progressive MS". Ann Neurol 2022; 91:735-736. [PMID: 35233827 PMCID: PMC9511767 DOI: 10.1002/ana.26340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Antje Bischof
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA.,Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Germany
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anisha Keshavan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anand Rajesh
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Xinheng Zhang
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jacob M Mallott
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carlo Asteggiano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Tristan J Gundel
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Chao Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Yifan Zhou
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Refujia Gomez
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nicholas R Ragan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Alyssa H Zhu
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeremy Juwono
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carolyn J Bevan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Riley M Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Elizabeth Crabtree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Douglas S Goodin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jennifer S Graves
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Bruce A Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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108
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Hamdy E, Talaat F, Said SM, Ramadan I, Marouf H, Hamdy MM, Sadallah H, Ashmawi GAH, Elsalamawy D. Diagnosing ‘transition’ to secondary progressive multiple sclerosis (SPMS): A step-by-step approach for clinicians. Mult Scler Relat Disord 2022; 60:103718. [DOI: 10.1016/j.msard.2022.103718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/13/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
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109
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Lefort M, Le Corre G, Le Page E, Rizzato C, Le Port D, Michel L, Kerbrat A, Leray E, Edan G. Ten-year follow-up after mitoxantrone induction for early highly active relapsing-remitting multiple sclerosis: An observational study of 100 consecutive patients. Rev Neurol (Paris) 2022; 178:569-579. [PMID: 35181157 DOI: 10.1016/j.neurol.2021.11.014] [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: 08/04/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Six monthly courses of mitoxantrone were approved in France in 2003 for patients with highly active multiple sclerosis (MS). OBJECTIVE To report the 10-year clinical follow-up and safety of mitoxantrone as an induction drug followed by maintenance therapy in patients with early highly active relapsing-remitting MS (RRMS) and an Expanded Disability Status Scale (EDSS) score<4, 12months prior to mitoxantrone initiation. METHODS In total, 100 consecutive patients with highly active RRMS from the Rennes EDMUS database received monthly mitoxantrone 20mg combined with methylprednisolone 1g for 3 (n=75) or 6months (n=25) followed by first-line disease-modifying drug (DMD). The 10-year clinical impact was studied through clinical activity, DMD exposure, and adverse events. RESULTS Twenty-four percent were relapse-free over 10years and the mean annual number of relapses was 0.2 at 10years. The mean EDSS score remained significantly improved for up to 10years, changing from 3.5 at mitoxantrone initiation to 2.7 at 10years. The probability of disability worsening and improvement from mitoxantrone initiation to 10years were respectively 27% and 58%, and 13% converted to secondary progressive MS. Patients only remained untreated or treated with a first-line maintenance DMD for 6.5years in average. In our cohort, mitoxantrone was generally safe. No leukemia was observed and six patients developed neoplasms, including 4 solid cancers. CONCLUSION Monthly mitoxantrone for 3 or 6months, followed by maintenance first-line treatment, may be an attractive therapeutic option for patients with early highly active RRMS, particularly in low-income countries.
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Affiliation(s)
- M Lefort
- Univ Rennes, EHESP, CNRS, ARENES - UMR 6051, 15 avenue du Professeur Léon Bernard, 35000 Rennes, France; Rennes Clinical Investigation Center, Rennes University, Rennes University Hospital, INSERM, Rennes, France
| | - G Le Corre
- Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - E Le Page
- Rennes Clinical Investigation Center, Rennes University, Rennes University Hospital, INSERM, Rennes, France; Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - C Rizzato
- Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - D Le Port
- Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - L Michel
- Rennes Clinical Investigation Center, Rennes University, Rennes University Hospital, INSERM, Rennes, France; Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - A Kerbrat
- Rennes Clinical Investigation Center, Rennes University, Rennes University Hospital, INSERM, Rennes, France; Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - E Leray
- Univ Rennes, EHESP, CNRS, ARENES - UMR 6051, 15 avenue du Professeur Léon Bernard, 35000 Rennes, France; Rennes Clinical Investigation Center, Rennes University, Rennes University Hospital, INSERM, Rennes, France
| | - G Edan
- Rennes Clinical Investigation Center, Rennes University, Rennes University Hospital, INSERM, Rennes, France; Neurology Department, Pontchaillou University Hospital, Rennes, France.
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110
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Are Neurophysiological Biomarkers Able to Discriminate Multiple Sclerosis Clinical Subtypes? Biomedicines 2022; 10:biomedicines10020231. [PMID: 35203440 PMCID: PMC8869727 DOI: 10.3390/biomedicines10020231] [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: 12/02/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/26/2022] Open
Abstract
Secondary progressive multiple sclerosis (SPMS) subtype is retrospectively diagnosed, and biomarkers of the SPMS are not available. We aimed to identify possible neurophysiological markers exploring grey matter structures that could be used in clinical practice to better identify SPMS. Fifty-five people with MS and 31 healthy controls underwent a transcranial magnetic stimulation protocol to test intracortical interneuron excitability in the primary motor cortex and somatosensory temporal discrimination threshold (STDT) to test sensory function encoded in cortical and deep grey matter nuclei. A logistic regression model was used to identify a combined neurophysiological index associated with the SP subtype. We observed that short intracortical inhibition (SICI) and STDT were the only variables that differentiated the RR from the SP subtype. The logistic regression model provided a formula to compute the probability of a subject being assigned to an SP subtype based on age and combined SICI and STDT values. While only STDT correlated with disability level at baseline evaluation, both SICI and STDT were associated with disability at follow-up. SICI and STDT abnormalities reflect age-dependent grey matter neurodegenerative processes that likely play a role in SPMS pathophysiology and may represent easily accessible neurophysiological biomarkers for the SPMS subtype.
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111
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Bsteh G, Hegen H, Riedl K, Altmann P, Di Pauli F, Ehling R, Zulehner G, Rommer P, Leutmezer F, Deisenhammer F, Berger T. Estimating Risk of Multiple Sclerosis Disease Reactivation in Pregnancy and Postpartum: The VIPRiMS Score. Front Neurol 2022; 12:766956. [PMID: 35111123 PMCID: PMC8801570 DOI: 10.3389/fneur.2021.766956] [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: 08/30/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Evidence guiding personalized decision-making with respect to disease-modifying therapy (DMT) around pregnancy in relapsing multiple sclerosis (RMS) is lacking. Objective: To generate and validate a risk score for disease reactivation intrapartum and postpartum in RMS. Methods: From the Vienna Innsbruck MS database (VIMSD), we included 343 pregnancies in patients with RMS. Primary endpoint was disease reactivation. Patients were randomly assigned 2:1 in a generation and validation dataset. A predictive score was calculated using the Cox regression and validated. Results: In the generation dataset, occurrence of relapse and type of DMT in the year before conception, DMT washout duration, the Expanded Disability Status Scale (EDSS) at conception, and time until DMT restart postpartum were identified as independent predictors of disease reactivation (p < 0.001). The resulting 10-point risk score robustly predicted reactivation (explaining 75% of variance, p < 0.001) identifying patients at high [≥6 points; mean risk 65%; range 50–100%; hazard ratio (HR) 14.5], intermediate (3–5 points; mean risk 24%; range 15–35%; HR 4.3), and low risk (≤2 points; mean risk 6%; range 0–8%) of disease reactivation in pregnancy and up to 6 months postpartum. Conclusion: The composite Vienna Innsbruck Pregnancy Risk in Multiple Sclerosis (VIPRiMS) score is a valuable clinical tool to support patients and neurologists in anticipating risk and, thus, individualizing treatment decision-making around pregnancy.
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Affiliation(s)
- Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- *Correspondence: Gabriel Bsteh
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Riedl
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Patrick Altmann
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rainer Ehling
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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112
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Ostojic SM, Ostojic J, Zanini D, Jezdimirovic T, Stajer V. Guanidinoacetate-creatine in secondary progressive multiple sclerosis: a case report. J Int Med Res 2022; 50:3000605211073305. [PMID: 35000485 PMCID: PMC8753084 DOI: 10.1177/03000605211073305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Acute secondary progressive multiple sclerosis (SPMS) is characterized by escalating neurological disability, with limited disease-modifying therapeutic options. A 48-year-old woman with acute SPMS being treated with interferon beta-1a and oral corticosteroids presented as a clinical outpatient with no disease-modifying effects after treatment. A decision was made to treat her with a combination of guanidinoacetate and creatine for 21 days. She had made clinical progress at follow-up, with the intensity of fatigue dropping from severe to mild. Magnetic resonance spectroscopy revealed increased brain choline, creatine, N-acetylaspartate, and glutathione. Patients with SPMS may benefit from guanidinoacetate-creatine treatment in terms of patient- and clinician-reported outcomes; this requires additional study.
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Affiliation(s)
- Sergej M Ostojic
- FSPE Applied Bioenergetics Lab, 84981University of Novi Sad, University of Novi Sad, Novi Sad, Serbia.,Faculty of Health Sciences, University of Pécs, Pécs, Hungary.,Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Jelena Ostojic
- Faculty of Medicine, 84981University of Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - Dragana Zanini
- FSPE Applied Bioenergetics Lab, 84981University of Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - Tatjana Jezdimirovic
- FSPE Applied Bioenergetics Lab, 84981University of Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - Valdemar Stajer
- FSPE Applied Bioenergetics Lab, 84981University of Novi Sad, University of Novi Sad, Novi Sad, Serbia
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113
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Kelter BM, Wolfe AE, Kazis LE, Ryan CM, Acton A, Slavin MD, Schneider JC. Trajectory Curves for Purposes of Benchmarking and Predicting Clinical Outcomes: A Scoping Review. J Burn Care Res 2022; 43:1095-1104. [PMID: 34986488 PMCID: PMC9255662 DOI: 10.1093/jbcr/irab245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Trajectory curves are valuable tools to benchmark patient health status and predict future outcomes. A longitudinal study is underway to examine social participation after burn injury using the Life Impact Burn Recovery Evaluation (LIBRE) Profile with the goal of developing trajectory curves for specific domains that focus on social reintegration. We conducted a scoping review to inform and understand trajectory curves applied in clinical settings to compare outcomes for an individual to a matched cohort of comparable patients or predicted expected outcomes over time. This scoping review utilized a PubMed search from January 2014 to August 2019 for the following terms: "trajectory curves" or "trajectory models" and "clinic" or "clinical." Only articles that specifically referenced longitudinal and clinical research designs were included in the scoping review. Articles were assessed using standard scoping review methods and categorized based on clinical application of trajectory curves for either benchmarking or prediction. The initial literature review identified 141 manuscripts and 34 met initial inclusion criteria. The reviewed articles support the clinical use of trajectory curves. Findings provide insight into several key determinants involved with the successful development and implementation of trajectory curves in clinical settings. These findings will inform efforts to use the LIBRE Profile to model social participation recovery and assist in developing effective strategies using trajectory curves to promote social reintegration after burn injury.
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Affiliation(s)
- Brian M Kelter
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Audrey E Wolfe
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lewis E Kazis
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA,Department of Physical Medicine & Rehabilitation, Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA,Department of Health Law, Policy and Management, Boston University School of Public Health, Massachusetts, USA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA,Department of Surgery, Shriners Hospitals for Children—Boston®, Massachusetts, USA
| | - Amy Acton
- Phoenix Society for Burn Survivors, Grand Rapids, Michigan, USA
| | | | - Jeffrey C Schneider
- Address correspondence to Jeffrey C. Schneider, MD, 300 1st Avenue, Boston, MA 02129, USA.
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114
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Sabsabi S, Mikhael E, Jalkh G, Macaron G, Rensel M. Clinical Evaluation of Siponimod for the Treatment of Secondary Progressive Multiple Sclerosis: Pathophysiology, Efficacy, Safety, Patient Acceptability and Adherence. Patient Prefer Adherence 2022; 16:1307-1319. [PMID: 35637684 PMCID: PMC9148218 DOI: 10.2147/ppa.s221882] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION A number of disease-modifying therapies have been approved for use in relapsing-remitting multiple sclerosis (MS) in the past two decades. However, only few treatment options are available for patients with secondary progressive multiple sclerosis (SPMS). Siponimod has recently been approved for use in patients with active forms of SPMS (who experience clinical relapses or new lesions on MRI superimposed on secondary progression independent of relapse activity). OBJECTIVE The aim of this article is to provide a comprehensive review on the mechanism of action, efficacy, safety, cost effectiveness and patient adherence with siponimod. METHODS We performed a PubMed search using the search terms: "siponimod", "secondary progressive multiple sclerosis", "sphingosine 1-phosphate modulators". Titles and abstract were screened and selected for relevance to the key section of this article. FINDINGS Siponimod is an oral sphingosine-1-phosphate receptor (S1PR) modulator with selectivity to S1PR-1 and 5. Modulation of this receptor on lymphocytes causes its internalization and degradation, preventing their egress from lymphoid tissues to the blood. In the pivotal Phase 3 randomized controlled trial EXPAND, siponimod was superior to placebo in reducing the risk of disability progression confirmed at 3 and 6 months, as well as the development of new MRI lesions and the rate of brain volume loss. Secondary analysis also showed a benefit on measures of cognitive functioning. The risk of lymphopenia and first-dose bradycardia appears to be lower with siponimod compared to non-selective S1P1R modulators. Different CYP2C9 genotypes affect the metabolism of siponimod; hence, genetic testing is required to adapt the titration and final dose accordingly. CONCLUSION Long-term extension and real-world studies will allow further evaluation of efficacy and safety in this population. Future research should focus on better defining SPMS, and identifying biomarkers of progression and outcome measures of treatment response in this category of patients.
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Affiliation(s)
- Sajida Sabsabi
- Department of Neurology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Elio Mikhael
- Department of Internal Medicine, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Georges Jalkh
- Department of Neurology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Gabrielle Macaron
- Department of Neurology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA
- Correspondence: Mary Rensel, Email
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115
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Rzepiński Ł, Kośliński P, Gackowski M, Koba M, Maciejek Z. Amino Acid Levels as Potential Biomarkers of Multiple Sclerosis in Elderly Patients: Preliminary Report. J Clin Neurol 2022; 18:529-534. [PMID: 36062770 PMCID: PMC9444553 DOI: 10.3988/jcn.2022.18.5.529] [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: 10/01/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Łukasz Rzepiński
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Bydgoszcz, Poland
- Sanitas-Neurology Outpatient Clinic, Bydgoszcz, Poland
| | - Piotr Kośliński
- Department of Toxicology and Bromatology, Faculty of Pharmacy, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marcin Gackowski
- Department of Toxicology and Bromatology, Faculty of Pharmacy, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marcin Koba
- Department of Toxicology and Bromatology, Faculty of Pharmacy, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Zdzisław Maciejek
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Bydgoszcz, Poland
- Sanitas-Neurology Outpatient Clinic, Bydgoszcz, Poland
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116
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Klinsing S, Yalachkov Y, Foerch C. Difficulty in identification of patients with active secondary progressive multiple sclerosis by clinical classification tools. Eur J Neurol 2021; 29:1100-1105. [PMID: 34939266 DOI: 10.1111/ene.15227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The transition from relapsing-remitting (RRMS) to secondary progressive (SPMS) multiple sclerosis is not well defined. Different definitions and tools to identify SPMS have been proposed. Meanwhile, early diagnosis of "active" SPMS is getting progressively more important as pharmaceutical treatment options are being developed. In this study, we compared different classification methods regarding their accuracy to reliably identify "active SPMS". METHODS Independent from previous diagnostic classification, we descriptively analyzed the disease course (regarding relapses, progression and MR-activity) in 208 consecutive multiple sclerosis patients treated in our MS outpatient clinic in 2018. Patients were reclassified according to different SPMS criteria and tools. Diagnostic accuracy to identify patients with "active SPMS" was determined. RESULTS Comparing the tools to each other, significant variability in the number of patients identified as having SPMS as well as in the proportion of these patients having "active SPMS" was noted. Applying both diagnostic criteria "SPMS" and "active disease" reduced the sensitivity to identify patients with active progressive disease in all approaches. CONCLUSION We propose to lessen the emphasis on the label "SPMS" in favor of the more open term "active progressive disease" to simplify the process of identification of patients who may benefit from immune therapy.
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Affiliation(s)
- Svenja Klinsing
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Yavor Yalachkov
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
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117
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Bischof A, Papinutto N, Keshavan A, Rajesh A, Kirkish G, Zhang X, Mallott JM, Asteggiano C, Sacco S, Gundel TJ, Zhao C, Stern WA, Caverzasi E, Zhou Y, Gomez R, Ragan NR, Santaniello A, Zhu AH, Juwono J, Bevan CJ, Bove RM, Crabtree E, Gelfand JM, Goodin DS, Graves JS, Green AJ, Oksenberg JR, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Spinal cord atrophy predicts progressive disease in relapsing multiple sclerosis. Ann Neurol 2021; 91:268-281. [PMID: 34878197 PMCID: PMC8916838 DOI: 10.1002/ana.26281] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
Objective A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper cervical cord area from legacy brain MRI scans we aimed to study the role of spinal cord and brain atrophy for silent progression and conversion to secondary progressive disease (SPMS). Methods From a single‐center observational study, all RRMS (n = 360) and SPMS (n = 47) patients and 80 matched controls were evaluated. RRMS patient subsets who converted to SPMS (n = 54) or silently progressed (n = 159), respectively, during the 12‐year observation period were compared to clinically matched RRMS patients remaining RRMS (n = 54) or stable (n = 147), respectively. From brain MRI, we assessed the value of brain and spinal cord measures to predict silent progression and SPMS conversion. Results Patients who developed SPMS showed faster cord atrophy rates (−2.19%/yr) at least 4 years before conversion compared to their RRMS matches (−0.88%/yr, p < 0.001). Spinal cord atrophy rates decelerated after conversion (−1.63%/yr, p = 0.010) towards those of SPMS patients from study entry (−1.04%). Each 1% faster spinal cord atrophy rate was associated with 69% (p < 0.0001) and 53% (p < 0.0001) shorter time to silent progression and SPMS conversion, respectively. Interpretation Silent progression and conversion to secondary progressive disease are predominantly related to cervical cord atrophy. This atrophy is often present from the earliest disease stages and predicts the speed of silent progression and conversion to Progressive MS. Diagnosis of SPMS is rather a late recognition of this neurodegenerative process than a distinct disease phase. ANN NEUROL 2022;91:268–281
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Affiliation(s)
- Antje Bischof
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anisha Keshavan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anand Rajesh
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Xinheng Zhang
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jacob M Mallott
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carlo Asteggiano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Tristan J Gundel
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Chao Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Yifan Zhou
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Refujia Gomez
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nicholas R Ragan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Alyssa H Zhu
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeremy Juwono
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carolyn J Bevan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Riley M Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Elizabeth Crabtree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Douglas S Goodin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jennifer S Graves
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | -
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Bruce A Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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Thompson AJ, Carroll W, Ciccarelli O, Comi G, Cross A, Donnelly A, Feinstein A, Fox RJ, Helme A, Hohlfeld R, Hyde R, Kanellis P, Landsman D, Lubetzki C, Marrie RA, Morahan J, Montalban X, Musch B, Rawlings S, Salvetti M, Sellebjerg F, Sincock C, Smith KE, Strum J, Zaratin P, Coetzee T. Charting a global research strategy for progressive MS-An international progressive MS Alliance proposal. Mult Scler 2021; 28:16-28. [PMID: 34850641 PMCID: PMC8688983 DOI: 10.1177/13524585211059766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Progressive forms of multiple sclerosis (MS) affect more than 1 million individuals globally. Recent approvals of ocrelizumab for primary progressive MS and siponimod for active secondary progressive MS have opened the therapeutic door, though results from early trials of neuroprotective agents have been mixed. The recent introduction of the term 'active' secondary progressive MS into the therapeutic lexicon has introduced potential confusion to disease description and thereby clinical management. OBJECTIVE This paper reviews recent progress, highlights continued knowledge and proposes, on behalf of the International Progressive MS Alliance, a global research strategy for progressive MS. METHODS Literature searches of PubMed between 2015 and May, 2021 were conducted using the search terms "progressive multiple sclerosis", "primary progressive multiple sclerosis", "secondary progressive MS". Proposed strategies were developed through a series of in-person and virtual meetings of the International Progressive MS Alliance Scientific Steering Committee. RESULTS Sustaining and accelerating progress will require greater understanding of underlying mechanisms, identification of potential therapeutic targets, biomarker discovery and validation, and conduct of clinical trials with improved trial design. Encouraging developments in symptomatic and rehabilitative interventions are starting to address ongoing challenges experienced by people with progressive MS. CONCLUSION We need to manage these challenges and realise the opportunities in the context of a global research strategy, which will improve quality of life for people with progressive MS.
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Affiliation(s)
| | | | | | | | - Anne Cross
- Washington University in St. Louis, St. Louis, MO, USA
| | | | | | | | | | - Reinhard Hohlfeld
- Munich Cluster for Systems Neurology, Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | | | | | | | | | - Xavier Montalban
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Marco Salvetti
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy/Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Finn Sellebjerg
- Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark
| | | | | | - Jon Strum
- International Progressive MS Alliance, Los Angeles, CA, USA
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119
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Healy BC, Zurawski J, Chitnis T, Weiner HL, Glanz BI. Patient-reported outcomes associated with transition to secondary progressive multiple sclerosis. Qual Life Res 2021; 31:1799-1805. [PMID: 34783972 DOI: 10.1007/s11136-021-03034-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate patient-reported outcome (PRO) measures in patients with relapsing-remitting multiple sclerosis (RRMS) who transition to secondary progressive multiple sclerosis (SPMS). METHODS Subjects enrolled in the Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women's Hospital (CLIMB) who completed PRO measures in the RRMS and SPMS phases were identified (n = 52). The PRO measures were Medical Outcomes Study Short-Form 36 Health Survey (SF-36), the Modified Fatigue Impact Scale (MFIS), and the Center for Epidemiologic Studies Depression Scale (CESD). Two control groups of RRMS CLIMB patients who did not progress to SPMS were identified based on different matching criteria related to age, sex, disease duration and Expanded Disability Status Scale (EDSS). Summary statistics for each PRO were calculated at the last RRMS measurement and first SPMS measurement, and the change over this transition was calculated using a paired t-test. Patients who transitioned were compared to the control groups using linear regression to adjust for age, disease duration and EDSS and a mixed model to further account for the matching with a random effect for matched group. RESULTS Patients who transitioned from RRMS to SPMS had noticeable deficits in terms of Quality of Life (QOL) and fatigue at the visit prior to the transition. Patients worsened in terms of SF-36 Role Physical (- 3.6 [- 6.6, - 0.7]), Social Functioning (- 3.7 [- 6.4, - 1.0]), and Physical Component Summary (- 2.3 [- 4.5, - 0.1]) during the transition from RRMS to SPMS. When patients who transitioned were compared to the matched subjects, they had worse scores on several outcomes, including Physical Functioning (adjusted mean difference = - 10.8 [- 14.1, - 7.5]), Physical Component Summary (- 5.2 [- 9.3, - 1.0]), fatigue (8.9 [1.7, 16.1]), and depression (3.1 [0.3, 5.9]). CONCLUSIONS Patients in the period closely preceding transition from RRMS to SPMS have worse physical QOL and fatigue compared to subjects who remain RRMS.
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Affiliation(s)
- Brian C Healy
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Neurology, Harvard Medical School, Boston, MA, USA. .,Biostatistics Center, Massachusetts General Hospital, 60 Fenwood Rd, Boston, MA, 02115, USA.
| | - Jonathan Zurawski
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Howard L Weiner
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Bonnie I Glanz
- Partners MS Center, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
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120
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Jakimovski D, Kavak KS, Vaughn CB, Goodman AD, Coyle PK, Krupp L, Gottesman M, Edwards KR, Lenihan M, Perel A, Zivadinov R, Weinstock-Guttman B. Discontinuation of disease modifying therapies is associated with disability progression regardless of prior stable disease and age. Mult Scler Relat Disord 2021; 57:103406. [PMID: 34915316 DOI: 10.1016/j.msard.2021.103406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/02/2021] [Accepted: 11/13/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) patients with stable disease course might view continued treatment as unnecessary. However, guidelines regarding treatment discontinuation are currently lacking. OBJECTIVE To assess the clinical course after treatment discontinuation in MS patients with long disease duration. METHODS Patients who discontinued disease-modifying treatments (DMTs) and not resume treatment (n = 216) were extracted from New York State MS Consortium (NYSMSC) and followed across three time points (average 4.6 years). Stable course was defined as no change in Expanded Disability Status Scale (EDSS) scores (<1.0 increase if EDSS<6.0 or <0.5-point increase if EDSS≥6.0) from baseline (time 1) to DMT discontinuation (time 2). Both stable and worsening MS patients were later assessed again after the DMT discontinuation (time 3). Additional analyses were performed based on disease subtype, type of medication, age cut-off of 55 and EDSS of 6.0. RESULTS From the cohort of 216 MS patients who discontinued DMT, 161 (72.5%) were classified as stable before DMT discontinuation. After DMT discontinuation, 53 previously stable MS patients (32.9%) experienced disability worsening/progression (DWP). 29.2 and 40% of previously stable RRMS and SPMS respectively had DWP after DMT discontinuation. Over two years after DMT discontinuation, the rate of DWP was similar between patients younger or older than 55 years (31.1% vs 25.9%, respectively). MS patients with EDSS≥6.0 had greater DWP when compared to less disabled patients while remaining on therapy as well as after discontinuation (40.7% vs 15.4%, p < 0.001 and 39.6% vs 15.2%, p < 0.001, respectively). CONCLUSION MS patients with stable disease course experience DWP after treatment discontinuation, with no clear relation to age and disease subtype. Patients with EDSS≥6.0 are at higher risk for DWP.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo, 1010 Main Street, Buffalo, NY 14202, USA
| | - Katelyn S Kavak
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo, 1010 Main Street, Buffalo, NY 14202, USA
| | - Caila B Vaughn
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo, 1010 Main Street, Buffalo, NY 14202, USA
| | - Andrew D Goodman
- Department of Neurology, University of Rochester, Rochester, NY USA
| | | | | | - Malcolm Gottesman
- Division of Neurology, Winthrop University Hospital, Mineola, NY, USA
| | - Keith R Edwards
- MS Center of Northeastern NY - Empire Neurology, P.C. Latham, NY, USA
| | | | | | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo, 1010 Main Street, Buffalo, NY 14202, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo, 1010 Main Street, Buffalo, NY 14202, USA.
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Graf J, Leussink VI, Soncin G, Lepka K, Meinl I, Kümpfel T, Meuth SG, Hartung HP, Havla J, Aktas O, Albrecht P. Relapse-independent multiple sclerosis progression under natalizumab. Brain Commun 2021; 3:fcab229. [PMID: 34755108 PMCID: PMC8573181 DOI: 10.1093/braincomms/fcab229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 08/17/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to investigate confirmed progression independent of relapse activity in relapsing-remitting multiple sclerosis patients under long-term natalizumab treatment. We performed a retrospective, cross-sectional study of clinical data captured between 1994 and 2019 at two German multiple sclerosis tertiary referral centres. Data files of all relapsing-remitting multiple sclerosis patients treated with natalizumab for ≥24 months were analysed. Confirmed progression independent of relapse activity was defined as ≥12 week confirmed disability progression on a roving Expanded Disability Status Scale reference score by 1 point in patients with an Expanded Disability Status Scale score ≤3 or 0.5 in patients with an Expanded Disability Status Scale score ≥3.5 in the absence of a relapse. Cox proportional hazard models were used to analyse the probability of developing confirmed progression independent of relapse activity depending on both disease and natalizumab treatment duration. Among the 184 patients identified, 44 (24%) developed confirmed progression independent of relapse activity under natalizumab irrespective of the Expanded Disability Status Scale score at natalizumab onset. Time to confirmed progression independent of relapse activity was not affected by Expanded Disability Status Scale at natalizumab onset (categorized by Expanded Disability Status Scale score ≤3.5 versus >3.5) nor by duration of disease nor by duration of therapy. Confirmed progression independent of relapse activity occurred earlier in the disease course in patients with an earlier natalizumab therapy onset with regard to disease duration. A stepwise forward regression analysis revealed disease duration as the main factor for confirmed progression independent of relapse activity development (P = 0.005). Taken together, confirmed progression independent of relapse activity occurs in a substantial proportion of patients on long-term natalizumab treatment and independent of Expanded Disability Status Scale score at natalizumab onset. Our findings suggest that patients who are initiated on natalizumab early during disease course, usually in order to treat an aggressive clinical phenotype, have a higher risk of early confirmed progression independent of relapse activity.
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Affiliation(s)
- Jonas Graf
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Verena I Leussink
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany.,Neurologie in Meerbusch, 40667 Meerbusch, Germany
| | - Giulia Soncin
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Klaudia Lepka
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Ingrid Meinl
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, 81377 Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, 81377 Munich, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany.,Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia.,Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria.,Department of Neurology, Palacky University in Olomouc, 779 00 Olomouc, Czech Republic
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, 81377 Munich, Germany.,Data Integration for Future Medicine Consortium, LMU Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany
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122
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Mohammad Rezaie S, Shahabinejad M, Loripoor M, Sayadi AR. The effect of aromatherapy with lavender essential oil on the working memory of women with multiple sclerosis. J Med Life 2021; 14:776-781. [PMID: 35126747 PMCID: PMC8811666 DOI: 10.25122/jml-2020-0115] [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: 07/05/2020] [Accepted: 10/23/2021] [Indexed: 11/19/2022] Open
Abstract
Working memory, one of the cognitive components, may be impaired in patients with multiple sclerosis. Accordingly, this study aims to determine the effects of aromatherapy with lavender essential oil on the working memory of women with multiple sclerosis (MS). In this clinical trial, 60 women with multiple sclerosis were selected using the sampling method from patients referred to the MS Clinic of Rafsanjan. Based on the inclusion and exclusion criteria, the participants were randomly divided into intervention and placebo groups. In addition, the working memory test developed by Daneman and Carpenter was used to evaluate the participants’ working memory before the intervention and the day after the last intervention. The collected data were analyzed using SPSS Statistics version 18.0. According to intragroup comparison results and based on the paired t-test, the mean score of the working memory before the intervention in the intervention group was 82.77±6.87, which increased to 87.64±5.57 after the intervention (P<0.001). The average working memory score of the placebo group was 80.30±11.09 and 82.09±11.31 before and after the intervention, respectively, which did not have a statistically significant difference (P=0.154). Based on findings from the independent t-test, the mean scores of working memory had a statistically significant difference between the intervention and placebo groups after the intervention (P=0.02). According to the results from this study, aromatherapy with lavender essential oil improved working memory in women with multiple sclerosis.
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Affiliation(s)
- Sara Mohammad Rezaie
- Internal Surgery Nursing, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Maryam Shahabinejad
- Department of Medical Surgical Nursing, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Marzeyeh Loripoor
- Department of Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ahmad Reza Sayadi
- Department of Psychiatric Nursing, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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123
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Samjoo IA, Worthington E, Haltner A, Spin P, Drudge C, Cameron C, Brennan R, Dahlke F, Adlard N. Indirect comparisons of siponimod with fingolimod and ofatumumab in multiple sclerosis: assessing the feasibility of propensity score matching analyses. Curr Med Res Opin 2021; 37:1933-1944. [PMID: 34384311 DOI: 10.1080/03007995.2021.1968362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Head-to-head trials comparing siponimod with fingolimod or ofatumumab in patients with multiple sclerosis (MS) are lacking. Instead, the comparative efficacy of siponimod can be derived from indirect treatment comparisons (ITCs). We assessed the suitability of ITCs leveraging individual patient data from relevant phase III trials across different MS phenotypes. METHODS One siponimod trial in patients with secondary progressive MS (SPMS), four fingolimod trials (three in relapsing-remitting MS [RRMS], and one in primary progressive MS [PPMS]), and two ofatumumab trials in relapsing MS (RMS) were considered. The suitability of ITCs was evaluated based on trial design, patient eligibility criteria, baseline patient characteristics, placebo response, and outcome definitions for each trial. Analyses deemed feasible were conducted using one-to-one propensity score matching (PSM). RESULTS An ITC between siponimod in SPMS and either fingolimod in RRMS or ofatumumab in RMS was not feasible because of insufficient overlap in key patient characteristics (e.g. disability level and relapse history) and differences in placebo response. However, a comparison between siponimod in SPMS and fingolimod in PPMS was feasible because of sufficient overlap in eligibility criteria and baseline characteristics. One-to-one PSM demonstrated siponimod was favored relative to fingolimod for time to 6- and 3-month confirmed disability progression though not significantly different (hazard ratio 0.76 [95% confidence interval 0.48-1.20; p-value = .240] and hazard ratio 0.80 [95% confidence interval 0.52-1.22; p-value = .300], respectively). CONCLUSIONS For trials in MS, clinical phenotype is an important determinant of ITC feasibility. An ITC between siponimod in SPMS and either fingolimod in RRMS or ofatumumab in RMS was not feasible. The only feasible comparison was between siponimod in SPMS and fingolimod in PPMS.
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Bergmann A, Stangel M, Weih M, van Hövell P, Braune S, Köchling M, Roßnagel F. Development of Registry Data to Create Interactive Doctor-Patient Platforms for Personalized Patient Care, Taking the Example of the DESTINY System. Front Digit Health 2021; 3:633427. [PMID: 34713104 PMCID: PMC8521878 DOI: 10.3389/fdgth.2021.633427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/25/2021] [Indexed: 02/03/2023] Open
Abstract
“Real-world evidence (RWE)” is becoming increasingly important in order to integrate the results of randomized studies into everyday clinical practice. The data collection of RWE is usually derived from large-scale national and international registries, often driven by academic centers. We have developed a digitalized doctor–patient platform called DESTINY (DatabasE-assiSted Therapy decIsioN support sYstem) that is utilized by NeuroTransData (NTD), a network of neurologists and psychiatrists throughout Germany. This platform can be integrated into everyday practice and, as well as being used for scientific evaluations in healthcare research, can also serve as an individual, personalized treatment application. Its various modules allow for a timely identification of side-effects or interactions of treatments, can involve patients via the “My NTC Health Guide” portal, and can collect data of individual disease histories that are integrated into innovative algorithms, e.g., for the prediction of treatment response [currently available for multiple sclerosis (MS), with other indications in the pipeline]. Here, we describe the doctor–patient platform DESTINY for outpatient neurological practices and its contribution to improved treatment success as well as reduction of healthcare costs. Platforms like DESTINY may facilitate the goal of personalized healthcare.
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Affiliation(s)
| | - Martin Stangel
- Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, Hannover, Germany
| | - Markus Weih
- NTD Study Group, NeuroTransData GmbH, Neuburg, Germany
| | | | - Stefan Braune
- NTD Study Group, NeuroTransData GmbH, Neuburg, Germany
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125
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Application of definitions for conversion to secondary progressive MS in a Danish nationwide population. Mult Scler Relat Disord 2021; 56:103319. [PMID: 34666241 DOI: 10.1016/j.msard.2021.103319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/29/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The number of patients with relapsing remitting multiple sclerosis (RRMS) who convert to secondary progressive (SP) MS is uncertain, and with emerging treatment options for SPMS, it is important to identify RRMS patients in transition to the SP phase. The objective of the present study was to characterize clinical parameters and use of disease modifying therapies in patients diagnosed with SPMS and RRMS patients already entered the SP phase by use of the Danish Multiple Sclerosis Registry (DMSR). METHODS We used a cross-sectional design, including all living patients with MS as of June 30, 2020 from DMSR. First, we applied the MSBase definition of SPMS on all RRMS patients. Second, we applied the slightly modified inclusion criteria from the EXPAND clinical trial on patients with clinically confirmed SPMS and patients with RRMS fulfilling the MSBase definition of SPMS to identify SPMS patients recently progressed who may benefit from treatment with disease modifying therapy. We compared clinical characteristics and disease-modifying therapy use in the different patient groups. RESULTS Among patients with clinically confirmed SPMS, application of a slightly modified EXPAND trial inclusion criteria for SPMS (m-EXPAND) captured patients who had converted to SPMS more recently and who had relapsed and initiated high-efficacy treatment more frequently. Moreover, our RRMS patients fulfilling the "SPMS"-criteria according to MSBase and recently progression according to m-EXPAND had similar characteristics and remarkably resembled the SPMS population in the EXPAND trial. CONCLUSION Our results indicate that data-driven diagnostic definitions might help identify RRMS patients at risk for SPMS and we highlight the challenges and reluctance in diagnosing SPMS in clinical practice.
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Souissi A, Mrabet S, Nasri A, Ben Djebara M, Gargouri A, Kacem I, Gouider R. Clinical predictors of disease progression in a cohort of Tunisian progressive Multiple Sclerosis. Mult Scler Relat Disord 2021; 56:103232. [PMID: 34619488 DOI: 10.1016/j.msard.2021.103232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/11/2021] [Accepted: 08/29/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Knowledge about progressive Multiple Sclerosis (MS) is mainly based on Caucasian studies. In our North-African context, MS exhibits particular characteristics that are mainly related to a more severe phenotype. Given the limited data available, there is an imminent need to characterize progressive MS in our latitudes. OBJECTIVE To describe the specificities of progressive MS and identify the inherent clinical predictors of disability accrual with a Tunisian cohort. METHODS A retrospective, hospital-based study was conducted in the department of neurology of Razi hospital. Patients, who had been diagnosed with MS, were divided into relapsing MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS). Epidemiological, clinical and paraclinical data were compared among the three groups. RESULTS Of the 504 patients, a progressive MS was described among 115 patients. This percentage of (22.8%) is divided into 13.9% SPMS and 8.9% PPMS. During the first clinical attack, motor symptoms have revealed to be predominant during PPMS (91.1%). For SPMS onset, the median time was 10 years, and was significantly delayed for patients with visual onset or full recovery from the first relapse. Patients with progressive MS exhibited a more rapid disability accumulation. CONCLUSION Compared to Caucasians, Tunisians exhibited a faster rate of conversion to SPMS. According to our natural progressive MS history, early clinical features are predictors of MS disability accrual.
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Affiliation(s)
- A Souissi
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi Universitary Hospital, Manouba, Tunis, Tunisia
| | - S Mrabet
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi Universitary Hospital, Manouba, Tunis, Tunisia; Faculty of medicine, University Tunis El Manar, 1007, Tunis, Tunisia
| | - A Nasri
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi Universitary Hospital, Manouba, Tunis, Tunisia; Faculty of medicine, University Tunis El Manar, 1007, Tunis, Tunisia
| | - M Ben Djebara
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi Universitary Hospital, Manouba, Tunis, Tunisia; Faculty of medicine, University Tunis El Manar, 1007, Tunis, Tunisia
| | - A Gargouri
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi Universitary Hospital, Manouba, Tunis, Tunisia; Faculty of medicine, University Tunis El Manar, 1007, Tunis, Tunisia
| | - I Kacem
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi Universitary Hospital, Manouba, Tunis, Tunisia; Faculty of medicine, University Tunis El Manar, 1007, Tunis, Tunisia
| | - R Gouider
- Department of Neurology, LR 18SP03, Clinical Investigation Centre Neurosciences and Mental Health, Razi Universitary Hospital, Manouba, Tunis, Tunisia; Faculty of medicine, University Tunis El Manar, 1007, Tunis, Tunisia.
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Ziemssen T, Giovannoni G, Alvarez E, Bhan V, Hersh C, Hoffmann O, Oreja-Guevara C, Robles-Cedeño RR, Trojano M, Vermersch P, Dobay P, Khwaja M, Stadler B, Rauser B, Hach T, Piani-Meier D, Burton J. Multiple Sclerosis Progression Discussion Tool Usability and Usefulness in Clinical Practice: Cross-sectional, Web-Based Survey. J Med Internet Res 2021; 23:e29558. [PMID: 34612826 PMCID: PMC8529467 DOI: 10.2196/29558] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/05/2021] [Accepted: 07/27/2021] [Indexed: 01/22/2023] Open
Abstract
Background A digital tool, Multiple Sclerosis Progression Discussion Tool (MSProDiscuss), was developed to facilitate discussions between health care professionals (HCPs) and patients in evaluating early, subtle signs of multiple sclerosis (MS) disease progression. Objective The aim of this study is to report the findings on the usability and usefulness of MSProDiscuss in a real-world clinical setting. Methods In this cross-sectional, web-based survey, HCPs across 34 countries completed an initial individual questionnaire (comprising 7 questions on comprehensibility, usability, and usefulness after using MSProDiscuss during each patient consultation) and a final questionnaire (comprising 13 questions on comprehensibility, usability, usefulness, and integration and adoption into clinical practice to capture the HCPs’ overall experience of using the tool). The responses were provided on a 5-point Likert scale. All analyses were descriptive, and no statistical comparisons were made. Results In total, 301 HCPs tested the tool in 6974 people with MS, of whom 77% (5370/6974) had relapsing-remitting MS, including those suspected to be transitioning to secondary progressive MS. The time taken to complete MSProDiscuss was reported to be in the range of 1 to 4 minutes in 97.3% (6786/6974; initial) to 98.2% (269/274; final) of the cases. In 93.54% (6524/6974; initial) to 97.1% (266/274; final) of the cases, the HCPs agreed (4 or 5 on the Likert scale) that patients were able to comprehend the questions in the tool. The HCPs were willing to use the tool again in the same patient, 90.47% (6310/6974; initial) of the cases. The HCPs reported MSProDiscuss to be useful in discussing MS symptoms and their impact on daily activities (6121/6974, 87.76% initial and 252/274, 92% final) and cognitive function (5482/6974, 78.61% initial and 271/274, 79.2% final), as well as in discussing progression in general (6102/6974, 87.49% initial and 246/274, 89.8% final). While completing the final questionnaire, 94.9% (260/274) of the HCPs agreed that the questions were similar to those asked in regular consultation, and the tool helped to better understand the impact of MS symptoms on daily activities (249/274, 90.9%) and cognitive function (220/274, 80.3%). Overall, 92% (252/274) of the HCPs reported that they would recommend MSProDiscuss to a colleague, and 85.8% (235/274) were willing to integrate it into their clinical practice. Conclusions MSProDiscuss is a usable and useful tool to facilitate a physician-patient discussion on MS disease progression in daily clinical practice. Most of the HCPs agreed that the tool is easy to use and were willing to integrate MSProDiscuss into their daily clinical practice.
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Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological University Clinic Carl-Gustav Carus, Dresden, Germany
| | - Gavin Giovannoni
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Enrique Alvarez
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Virender Bhan
- University of British Columbia, Vancouver, BC, Canada
| | - Carrie Hersh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Olaf Hoffmann
- Department of Neurology, St Josefs-Krankenhaus, Potsdam, Germany
| | | | - Rene R Robles-Cedeño
- Department of Neurology, Girona Neuroimmunology & Multiple Sclerosis Unit, Dr. Josep Trueta University Hospital & Santa Caterina Hospital, Girona, Spain
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Patrick Vermersch
- University of Lille, INSERM U1172, Lille Neuroscience and Cognition, CHU Lille, FHU Precise, Lille, France
| | - Pamela Dobay
- Real World Evidence Solutions, IQVIA AG, Basel, Switzerland
| | | | | | | | | | | | - Jason Burton
- Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Perth, Australia
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Uphaus T, Steffen F, Muthuraman M, Ripfel N, Fleischer V, Groppa S, Ruck T, Meuth SG, Pul R, Kleinschnitz C, Ellwardt E, Loos J, Engel S, Zipp F, Bittner S. NfL predicts relapse-free progression in a longitudinal multiple sclerosis cohort study. EBioMedicine 2021; 72:103590. [PMID: 34571362 PMCID: PMC8479646 DOI: 10.1016/j.ebiom.2021.103590] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background Easily accessible biomarkers enabling the identification of those patients with multiple sclerosis (MS) who will accumulate irreversible disability in the long term are essential to guide early therapeutic decisions. We here examine the utility of serum neurofilament light chain (sNfL) for forecasting relapse-free disability progression and conversion to secondary progressive MS (SPMS) in the prospective Neurofilamentandlongtermoutcome inMS (NaloMS) cohort. Methods The predictive ability of sNfL at Baseline and sNfL follow-up (FU)/ Baseline (BL) ratio with regard to disability progression was assessed within a development cohort (NaloMS, n=196 patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome) and validated with an external independent cohort (Düsseldorf, Essen, n=204). Both relapse-free EDSS-progression (RFP: inflammatory-independent EDSS-increase 12 months prior to FU) and SPMS-transition (minimum EDSS-score of 3.0) were investigated. Findings During the study period, 17% (n=34) of NaloMS patients suffered from RFP and 14% (n=27) converted to SPMS at FU (validation cohort RFP n=42, SPMS-conversion n=24). sNfL at BL was increased in patients with RFP (10.8 pg/ml (interquartile range (IQR) 7.7-15.0) vs. 7.2 pg/ml (4.5-12.5), p<0.017). In a multivariable logistic regression model, increased sNfL levels at BL (Odds Ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04, p=0.012) remained an independent risk factor for RFP and predicted individual RFP risk with an accuracy of 82% (NaloMS) and 83% (validation cohort) as revealed by support vector machine. In addition, the sNfL FU/BL ratio was increased in SPMS-converters (1.16 (0.89-1.70) vs. 0.96 (0.75-1.23), p=0.011). This was confirmed by a multivariable logistic regression model, as sNfL FU/BL ratio remained in the model (OR 1.476, 95%CI 1.078-2,019, p=0.015) and individual sNfL FU/BL ratios showed a predictive accuracy of 72% in NaloMS (63% in the validation cohort) as revealed by machine learning. Interpretation sNfL levels at baseline predict relapse-free disability progression in a prospective longitudinal cohort study 6 years later. While prediction was confirmed in an independent cohort, sNfL further discriminates patients with SPMS at follow-up and supports early identification of patients at risk for later SPMS conversion. Funding This work was supported by the German Research Council (CRC-TR-128), Else Kröner Fresenius Foundation and Hertie-Stiftung.
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Affiliation(s)
- Timo Uphaus
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Falk Steffen
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Biomedical Statistics and Multimodal Signal Processing Unit, Focus Program Translational Neuroscience (FTN) Neuroimaging Center, Department of Neurology, Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nina Ripfel
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tobias Ruck
- Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Sven G Meuth
- Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Refik Pul
- Department of Neurology and Center for Translational and Behavioral Neuroscience (C-TBNS), University Duisburg-Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational and Behavioral Neuroscience (C-TBNS), University Duisburg-Essen, Essen, Germany
| | - Erik Ellwardt
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Julia Loos
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sinah Engel
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Weber CE, Krämer J, Wittayer M, Gregori J, Randoll S, Weiler F, Heldmann S, Roßmanith C, Platten M, Gass A, Eisele P. Association of iron rim lesions with brain and cervical cord volume in relapsing multiple sclerosis. Eur Radiol 2021; 32:2012-2022. [PMID: 34549326 PMCID: PMC8831268 DOI: 10.1007/s00330-021-08233-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/22/2021] [Accepted: 07/22/2021] [Indexed: 10/28/2022]
Abstract
OBJECTIVES In multiple sclerosis (MS), iron rim lesions (IRLs) are indicators of chronic low-grade inflammation and ongoing tissue destruction. The aim of this study was to assess the relationship of IRLs with clinical measures and magnetic resonance imaging (MRI) markers, in particular brain and cervical cord volume. METHODS Clinical and MRI parameters from 102 relapsing MS patients (no relapses for at least 6 months, no contrast-enhancing lesions) were included; follow-up data obtained after 12 months was available in 49 patients. IRLs were identified on susceptibility-weighted images (SWIs). In addition to standard brain and spinal cord MRI parameters, normalised cross-sectional area (nCSA) of the upper cervical cord was calculated. RESULTS Thirty-eight patients had at least one IRL on SWI MRI. At baseline, patients with IRLs had higher EDSS scores, higher lesion loads (brain and spinal cord), and lower cortical grey matter volumes and a lower nCSA. At follow-up, brain atrophy rates were higher in patients with IRLs. IRLs correlated spatially with T1-hypointense lesions. CONCLUSIONS Relapsing MS patients with IRLs showed more aggressive MRI disease characteristics in both the cross-sectional and longitudinal analyses. KEY POINTS • Multiple sclerosis patients with iron rim lesions had higher EDSS scores, higher brain and spinal cord lesion loads, lower cortical grey matter volumes, and a lower normalised cross-sectional area of the upper cervical spinal cord. • Iron rim lesions are a new lesion descriptor obtained from susceptibility-weighted MRI. Our data suggests that further exploration of this lesion characteristic in regard to a poorer prognosis in multiple sclerosis patients is warranted.
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Affiliation(s)
- Claudia E Weber
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | - Julia Krämer
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1; Gebäude A1, Westturm, Ebene 5, 48149, Münster, Germany
| | - Matthias Wittayer
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | | | - Sigurd Randoll
- Mediri GmbH, Eppelheimer Straße 113, 69115, Heidelberg, Germany
| | | | | | - Christina Roßmanith
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany.
| | - Philipp Eisele
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany
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van der Walt A, Butzkueven H, Shin RK, Midaglia L, Capezzuto L, Lindemann M, Davies G, Butler LM, Costantino C, Montalban X. Developing a Digital Solution for Remote Assessment in Multiple Sclerosis: From Concept to Software as a Medical Device. Brain Sci 2021; 11:brainsci11091247. [PMID: 34573267 PMCID: PMC8471038 DOI: 10.3390/brainsci11091247] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 01/02/2023] Open
Abstract
There is increasing interest in the development and deployment of digital solutions to improve patient care and facilitate monitoring in medical practice, e.g., by remote observation of disease symptoms in the patients’ home environment. Digital health solutions today range from non-regulated wellness applications and research-grade exploratory instruments to regulated software as a medical device (SaMD). This paper discusses the considerations and complexities in developing innovative, effective, and validated SaMD for multiple sclerosis (MS). The development of SaMD requires a formalised approach (design control), inclusive of technical verification and analytical validation to ensure reliability. SaMD must be clinically evaluated, characterised for benefit and risk, and must conform to regulatory requirements associated with device classification. Cybersecurity and data privacy are also critical. Careful consideration of patient and provider needs throughout the design and testing process help developers overcome challenges of adoption in medical practice. Here, we explore the development pathway for SaMD in MS, leveraging experiences from the development of Floodlight™ MS, a continually evolving bundled solution of SaMD for remote functional assessment of MS. The development process will be charted while reflecting on common challenges in the digital space, with a view to providing insights for future developers.
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Affiliation(s)
- Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia;
- The Alfred, Melbourne, VIC 3004, Australia
- Correspondence: ; Tel.: +61-3-99030555
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia;
| | - Robert K. Shin
- MedStar Georgetown University Hospital, Washington, DC 20007, USA;
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d’Hebron (VHIR), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
| | - Luca Capezzuto
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (L.C.); (M.L.); (G.D.); (L.M.B.); (C.C.)
| | - Michael Lindemann
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (L.C.); (M.L.); (G.D.); (L.M.B.); (C.C.)
| | - Geraint Davies
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (L.C.); (M.L.); (G.D.); (L.M.B.); (C.C.)
| | - Lesley M. Butler
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (L.C.); (M.L.); (G.D.); (L.M.B.); (C.C.)
| | - Cristina Costantino
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (L.C.); (M.L.); (G.D.); (L.M.B.); (C.C.)
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
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Krajnc N, Bsteh G, Berger T. Clinical and Paraclinical Biomarkers and the Hitches to Assess Conversion to Secondary Progressive Multiple Sclerosis: A Systematic Review. Front Neurol 2021; 12:666868. [PMID: 34512500 PMCID: PMC8427301 DOI: 10.3389/fneur.2021.666868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
Conversion to secondary progressive (SP) course is the decisive factor for long-term prognosis in relapsing multiple sclerosis (MS), generally considered the clinical equivalent of progressive MS-associated neuroaxonal degeneration. Evidence is accumulating that both inflammation and neurodegeneration are present along a continuum of pathologic processes in all phases of MS. While inflammation is the prominent feature in early stages, its quality changes and relative importance to disease course decreases while neurodegenerative processes prevail with ongoing disease. Consequently, anti-inflammatory disease-modifying therapies successfully used in relapsing MS are ineffective in SPMS, whereas specific treatment for the latter is increasingly a focus of MS research. Therefore, the prevention, but also the (anticipatory) diagnosis of SPMS, is of crucial importance. The problem is that currently SPMS diagnosis is exclusively based on retrospectively assessing the increase of overt physical disability usually over the past 6–12 months. This inevitably results in a delay of diagnosis of up to 3 years resulting in periods of uncertainty and, thus, making early therapy adaptation to prevent SPMS conversion impossible. Hence, there is an urgent need for reliable and objective biomarkers to prospectively predict and define SPMS conversion. Here, we review current evidence on clinical parameters, magnetic resonance imaging and optical coherence tomography measures, and serum and cerebrospinal fluid biomarkers in the context of MS-associated neurodegeneration and SPMS conversion. Ultimately, we discuss the necessity of multimodal approaches in order to approach objective definition and prediction of conversion to SPMS.
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Affiliation(s)
- Nik Krajnc
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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132
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Measuring Treatment Response in Progressive Multiple Sclerosis-Considerations for Adapting to an Era of Multiple Treatment Options. Biomolecules 2021; 11:biom11091342. [PMID: 34572555 PMCID: PMC8470215 DOI: 10.3390/biom11091342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
Disability in multiple sclerosis accrues predominantly in the progressive forms of the disease. While disease-modifying treatment of relapsing MS has drastically evolved over the last quarter-century, the development of efficient drugs for preventing or at least delaying disability in progressive MS has proven more challenging. In that way, many drugs (especially disease-modifying treatments) have been researched in the aspect of delaying disability progression in patients with a progressive course of the disease. While there are some disease-modifying treatments approved for progressive multiple sclerosis, their effect is moderate and limited mostly to patients with clinical and/or radiological signs of disease activity. Several phase III trials have used different primary outcomes with different time frames to define disease progression and to evaluate the efficacy of a disease-modifying treatment. The lack of sufficiently sensitive outcome measures could be a possible explanation for the negative clinical trials in progressive multiple sclerosis. On the other hand, even with a potential outcome measure that would be sensitive enough to determine disease progression and, thus, the efficacy or failure of a disease-modifying treatment, the question of clinical relevance remains unanswered. In this systematic review, we analyzed outcome measures and definitions of disease progression in phase III clinical trials in primary and secondary progressive multiple sclerosis. We discuss advantages and disadvantages of clinical and paraclinical outcome measures aiming for practical ways of combining them to detect disability progression more sensitively both in future clinical trials and current clinical routine.
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133
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Pinto C, Cambron M, Dobai A, Vanheule E, Casselman JW. Smoldering lesions in MS: if you like it then you should put a rim on it. Neuroradiology 2021; 64:703-714. [PMID: 34498108 DOI: 10.1007/s00234-021-02800-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE In multiple sclerosis (MS), chronic active/smoldering white matter lesions presenting with hypointense rims on susceptibility-weighted imaging (SWI) of the brain have been recognized as an important radiological feature. The aim of this work was to study the prevalence of paramagnetic rim lesions (RLs) in MS patients in a clinical setting and to assess differences in demographic and clinical variables regarding the presence of RLs. METHODS All 3 T brain magnetic resonance (MR) studies performed in MS patients between July 2020 and January 2021 were reviewed. In all patients, RLs were assessed on three-dimensional (3D) SWI images and the T2 FLAIR lesion load volume was assessed. Demographic, laboratory (oligoclonal bands in CSF), and clinical data, including functional status with Expanded Disability Status Scale (EDSS), were retrieved from the clinical files. RESULTS Of the 192 patients, 113 (59%) presented with at least 1 RL. In the RL-positive group, the mean RL count was 4.81 ranging from 1 to 37. There was no significant difference in the number of RLs between the different types of MS (p = 0.858). Regarding the presence of RLs, there were no significant differences based on gender (p = 0.083), disease duration (p = 0.520), treatment regime (p = 0.326), EDSS score (p = 0.103), and the associated T2 FLAIR lesion load volume. CONCLUSION SWI RLs were frequently detected in our cohort regardless of the MS type, T2 FLAIR lesion load volume, demographic features, disease duration, or clinical score. Our results suggest that RLs are not associated with more severe forms of the disease. Today, RLs can be seen on 3 T 3D SWI, although this is not a clinical standard sequence yet. Therefore, it should be considered an additional helpful MR sequence in the diagnostic workup of MS, although more studies are warranted to establish the role of RLs as prognostic markers.
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Affiliation(s)
- Catarina Pinto
- Neuroradiology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Department of Radiology, AZ St. Jan Brugge-Oostende av, Campus Brugge, Ruddershove 10, B-8000, Brugge, Belgium
| | - Melissa Cambron
- Department of Neurology, AZ St. Jan Brugge-Oostende av, Campus Brugge, Ruddershove 10, B-8000, Brugge, Belgium
| | - Adrienn Dobai
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, Szentkirályi u. 47, Budapest, 1088, Hungary
- Department of Neuroradiology, Medical Imaging Centre, Semmelweis University, Balassa street 6, Budapest, 1083, Hungary
| | - Eva Vanheule
- Department of Radiology, AZ St. Jan Brugge-Oostende av, Campus Brugge, Ruddershove 10, B-8000, Brugge, Belgium
- Department of Radiology, UZ-Gent, Gent, Belgium
| | - Jan W Casselman
- Department of Radiology, AZ St. Jan Brugge-Oostende av, Campus Brugge, Ruddershove 10, B-8000, Brugge, Belgium.
- University Ghent, Gent, Belgium.
- Department of Radiology, AZ St. Augustinus, Oosterveldlaan 24, B-2610, Antwerpen, Belgium.
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Hargrave A, Sredar N, Khushzad F, Yarp J, Tomczak A, Han M, Kipp L, Dubra A, Moss HE. Novel Foveal Features Associated With Vision Impairment in Multiple Sclerosis. Invest Ophthalmol Vis Sci 2021; 62:27. [PMID: 34581726 PMCID: PMC8479576 DOI: 10.1167/iovs.62.12.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To characterize scattering and hyperreflective features in the foveal avascular zone of people with multiple sclerosis (MS) using adaptive optics scanning laser ophthalmoscopy (AOSLO) and to evaluate their relationship with visual function and MS disease characteristics. Methods Twenty subjects with MS underwent confocal reflectance and non-confocal split-detection AOSLO foveal imaging. Peripapillary retinal nerve fiber layer thickness was measured using optic nerve optical coherence tomography. Blood pressure, intraocular pressure (IOP), and best-corrected high-contrast visual acuity (HCVA) and low-contrast visual acuity (LCVA) were measured. AOSLO images were graded to determine the presence and characteristics of distinct structures. Results Two distinct structures were seen in the avascular zone of the foveal pit. Hyperreflective puncta, present in 74% of eyes, were associated with IOP and blood pressure. Scattering features, observed in 58% of eyes, were associated with decreased HCVA and LCVA, as well as increased MS duration and disability, but were not associated with retinal nerve fiber layer thickness. Hyperreflective puncta and scattering features were simultaneously present in 53% of eyes. Conclusions Hyperreflective puncta were associated with parameters affecting ophthalmic perfusion, but they were not associated with MS disease parameters. Scattering features were associated with parameters corresponding to advanced MS, suggesting that they may be related to disease progression. Scattering features were also correlated with reduced visual function independent from ganglion cell injury, suggesting the possibility of a novel ganglion cell-independent mechanism of impaired vision in people with MS.
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Affiliation(s)
- Aubrey Hargrave
- Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Nripun Sredar
- Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Fareshta Khushzad
- Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Jennifer Yarp
- Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Anna Tomczak
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, United States
| | - May Han
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, United States
| | - Lucas Kipp
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, United States
| | - Alfredo Dubra
- Department of Ophthalmology, Stanford University, Palo Alto, California, United States
| | - Heather E. Moss
- Department of Ophthalmology, Stanford University, Palo Alto, California, United States
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, United States
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Pfeuffer S, Ruck T, Pul R, Rolfes L, Korsukewitz C, Pawlitzki M, Wildemann B, Klotz L, Kleinschnitz C, Scalfari A, Wiendl H, Meuth SG. Impact of previous disease-modifying treatment on effectiveness and safety outcomes, among patients with multiple sclerosis treated with alemtuzumab. J Neurol Neurosurg Psychiatry 2021; 92:1007-1013. [PMID: 33712515 PMCID: PMC8372391 DOI: 10.1136/jnnp-2020-325304] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/14/2021] [Accepted: 02/07/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Alemtuzumab is effective in patients with active multiple sclerosis but has a complex safety profile, including the development of secondary autoimmunity. Most of patients enrolled in randomised clinical trials with alemtuzumab were either treatment naïve or pretreated with injectable substances. Other previous disease-modifying treatments (DMTs) were not used in the study cohorts, and therefore, associated risks might yet remain unidentified. METHODS We retrospectively evaluated a prospective dual-centre alemtuzumab cohort of 170 patients. We examined the baseline characteristics as well as safety and effectiveness outcomes, including the time to first relapse, the time to 3 months confirmed disability worsening and the time to secondary autoimmunity. RESULTS The regression analysis showed that, among all previously used DMTs, the pretreatment with fingolimod (n=33 HRs for the time to first relapse (HR 5.420, 95% CI 2.520 to 11.660; p<0.001)) and for the time to worsening of disability (HR 7.676, 95% CI 2.870 to 20.534; p<0.001). Additionally, patients pretreated with fingolimod were more likely to experience spinal relapses (55% vs 10% among previously naïve patients; p<0.001) and had an increased risk of secondary autoimmunity (HR 5.875, 95% CI 2.126 to 16.27; p<0.001). CONCLUSION In the real-world setting, we demonstrated suboptimal disease control and increased risk of secondary autoimmunity following alemtuzumab, among patients previously treated with fingolimod. These data can provide guidance for improving MS therapeutic management.
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Affiliation(s)
- Steffen Pfeuffer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Tobias Ruck
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.,Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Refik Pul
- Department of Neurology, Universitat Duisburg-Essen, Duisburg, Germany
| | - Leoni Rolfes
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Catharina Korsukewitz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Marc Pawlitzki
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Brigitte Wildemann
- Division of Molecular Neuroimmunology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | | | - Antonio Scalfari
- Centre for Neuroscience, Division of Experimental Medicine, Hammersmith Hospital, Imperial College London, London, UK
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany.,Department of Neurology, Heinrich-Heine-University, Düsseldorf, Germany
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Rammohan K, Coyle PK, Sylvester E, Galazka A, Dangond F, Grosso M, Leist TP. The Development of Cladribine Tablets for the Treatment of Multiple Sclerosis: A Comprehensive Review. Drugs 2021; 80:1901-1928. [PMID: 33247831 PMCID: PMC7708385 DOI: 10.1007/s40265-020-01422-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cladribine is a purine nucleoside analog initially developed in the 1970s as a treatment for various blood cancers. Due to the molecule’s ability to preferentially reduce T and B lymphocytes, it has been developed into an oral formulation for the treatment of multiple sclerosis (MS). The unique proposed mechanism of action of cladribine allows for the therapy to be delivered orally over two treatment-week cycles per year, one cycle at the beginning of the first month and one cycle at the beginning of the second month of years 1 and 2, with the potential for no further cladribine treatment required in years 3 and 4. This review summarizes the clinical development program for cladribine tablets in patients with MS, including the efficacy endpoints and results from the 2-year phase III CLARITY study in patients with relapsing–remitting MS (RRMS), the 2-year CLARITY EXTENSION study, and the phase III ORACLE-MS study in patients with a first clinical demyelinating event at risk for developing MS. Efficacy results from the phase II ONWARD study, in which cladribine tablets were administered as an add-on to interferon-β therapy in patients with RRMS, are also summarized. A review of all safety data, including lymphopenia, infections, and malignancies, is provided based on data from all trials in patients with MS, including the initial parenteral formulation studies. Based on these data, cladribine tablets administered at 3.5 mg/kg over 2 years have been approved across the globe for various forms of relapsing MS. The development of cladribine tablets for the treatment of multiple sclerosis: a comprehensive review (MP4 279143 kb)
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Affiliation(s)
- Kottil Rammohan
- Multiple Sclerosis Center, University of Miami, Miami, FL, USA.
| | - Patricia K Coyle
- Multiple Sclerosis Comprehensive Care Center, Stony Brook University, Stony Brook, NY, USA
| | | | | | - Fernando Dangond
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Megan Grosso
- EMD Serono, Inc., Rockland, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Thomas P Leist
- Comprehensive MS Center, Jefferson University, Philadelphia, PA, USA
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Tobias Z, Esther D, Niklas S, Dennis W, Alexander W, Helmut R, Michael H, Fahmy AD, Stefanie M, Fritz L, Thomas B, Gabriel B, Klaus ZU, Paulus R. Rituximab versus mitoxantrone: comparing effectiveness and safety in advanced relapsing multiple sclerosis. Ther Adv Chronic Dis 2021; 12:20406223211024366. [PMID: 34377385 PMCID: PMC8323410 DOI: 10.1177/20406223211024366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Rituximab (RTX), a CD20 depleting agent, is a frequently used off-label treatment for multiple sclerosis (MS), while mitoxantrone (MTX) is approved, albeit rarely used for active relapsing MS (RMS). However, observational data comparing RTX and MTX effectiveness and safety are scarce. Objective: We aimed to compare effectiveness and safety of MTX and RTX in patients with active RMS. Methods: From combined retrospective clinical data of three MS centers, we selected patients who had received at least one infusion of RTX or MTX and had at least a 6-month clinical follow-up available. Treatment groups were compared by propensity score (PS)-adjusted regression and inverse PS-weighted generalized estimated equation models regarding disability progression, relapse activity, and adverse events (AEs). Results: We included 292 RMS patients (mean age 41.8 years, 71.6% female) who received RTX (119 patients, mean age 36.8 years, 74.8% female) or MTX (173 patients mean age 45.3 years, 69.4% female). Using both PS methods, we did not find a significant effect favoring RTX or MTX treatment regarding the probability of disability worsening or relapse occurrence. However, RTX treatment was associated with a significantly lower probability of severe AEs and AEs. Conclusions: RTX shows comparable effectiveness but a favorable safety profile compared with MTX in active RMS.
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Affiliation(s)
- Zrzavy Tobias
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Daniels Esther
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Stuka Niklas
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Weber Dennis
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Rauschka Helmut
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders and Diseases, Klinik Donaustadt, Vienna, Austria
| | - Hecker Michael
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Aboulenein-Djamshidian Fahmy
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders and Diseases, Klinik Donaustadt, Vienna, Austria
| | - Meister Stefanie
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Leutmezer Fritz
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Berger Thomas
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Bsteh Gabriel
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Zettl Uwe Klaus
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Rommer Paulus
- Department of Neurology, Medical University of Vienna, Vienna, Austria Department of Neurology, Rostock University Medical Center, Rostock, Germany
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Plowman RS, Varma H. Prognostic factors in Tumefactive demyelinating lesions: A retrospective study. J Neurol Sci 2021; 428:117591. [PMID: 34333380 DOI: 10.1016/j.jns.2021.117591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Demyelinating lesions occasionally present as mass-like lesions on imaging, raising concern for malignancy. The disease course of such tumefactive demyelinating lesions (TDLs) is still being defined. METHODS We retrospectively analyzed 21 patients with new-onset neurologic symptoms and mass-like lesions on brain magnetic resonance imaging (MRI), which resulted in biopsy-proven diagnoses of demyelination. 18 patients had a median follow-up of 52 months. The clinical, radiologic and histologic features were associated with disease course. RESULTS An aggressive disease course (ADC) was noted in 33% of the patients and was associated with an initial largest lesion size ≥35 mm (p = 0.0007), mass effect (p = 0.01) and perilesional edema (p = 0.01) on MRI. Age 30 years and older, at presentation (p = 0.05), as well as the absence of a prior tonsillectomy (p = 0.0128) were also associated with an ADC. CONCLUSIONS We identified several factors, including initial larger lesion size, mass effect and perilesional edema on MRI, presentation after 30 years of age and the absence of a prior tonsillectomy, that predict an ADC in patients presenting with TDLs. These predictors of disease course can help guide patient follow-up and stratification for intervention.
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Affiliation(s)
- R Skipper Plowman
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Hemant Varma
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Monreal E, Sainz de la Maza S, Costa-Frossard L, Walo-Delgado P, Zamora J, Fernández-Velasco JI, Villarrubia N, Espiño M, Lourido D, Lapuente P, Toboso I, Álvarez-Cermeño JC, Masjuan J, Villar LM. Predicting Aggressive Multiple Sclerosis With Intrathecal IgM Synthesis Among Patients With a Clinically Isolated Syndrome. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/5/e1047. [PMID: 34301819 PMCID: PMC8299514 DOI: 10.1212/nxi.0000000000001047] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/14/2021] [Indexed: 01/14/2023]
Abstract
Objective To determine the best method to measure intrathecal immunoglobulin (Ig) M synthesis (ITMS), a biomarker of worse prognosis in multiple sclerosis (MS). We compared the ability for predicting a poor evolution of 4 methods assessing ITMS (IgM oligoclonal bands [OCMBs], lipid-specific OCMBs [LS-OCMBs], Reibergram, and IgM index) in patients with a clinically isolated syndrome (CIS). Methods Prospective study with consecutive patients performed at a referral MS center. We used unadjusted and multivariate Cox regressions for predicting a second relapse, Expanded Disability Status Scale (EDSS) scores of 4 and 6, and development of secondary progressive MS (SPMS). Results A total of 193 patients were included, with a median (interquartile range) age of 31 (25–38) years and a median follow-up of 12.9 years. Among all methods, only OCMB, LS-OCMB, and Reibergram significantly identified patients at risk of some of the pre-established outcomes, being LS-OCMB the technique with the strongest associations. Adjusted hazard ratio (aHR) of LS-OCMB for predicting a second relapse was 2.50 (95% CI 1.72–3.64, p < 0.001). The risk of reaching EDSS scores of 4 and 6 and SPMS was significantly higher among patients with LS-OCMB (aHR 2.96, 95% CI 1.54–5.71, p = 0.001; aHR 4.96, 95% CI 2.22–11.07, p < 0.001; and aHR 2.31, 95% CI 1.08–4.93, p = 0.03, respectively). Conclusions ITMS predicts an aggressive MS at disease onset, especially when detected as LS-OCMB. Classification of Evidence This study provides Class II evidence that lipid-specific IgM oligoclonal bands can predict progression from CIS to MS and a worse disease course over a follow-up of at least 2 years.
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Affiliation(s)
- Enric Monreal
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
| | - Susana Sainz de la Maza
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Lucienne Costa-Frossard
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Paulette Walo-Delgado
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Javier Zamora
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - José Ignacio Fernández-Velasco
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Noelia Villarrubia
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Mercedes Espiño
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Daniel Lourido
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Paloma Lapuente
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Inmaculada Toboso
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - José Carlos Álvarez-Cermeño
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Jaime Masjuan
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Luisa María Villar
- From the Department of Neurology (E.M., S.S.d.l.M., L.C.-F., J.C.Á.-C., J.M.), and Department of Immunology (P.W.-D., J.I.F.-V., N.V., M.E., P.L., I.T., L.M.V.), Hospital Universitario Ramón y Cajal, REEM, IRYCIS; Clinical Biostatistics Unit (J.Z.), Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain; Institute of Metabolism and System Research (J.Z.), University of Birmingham, United Kingdom; and Department of Radiology (D.L.), Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Cerebrospinal fluid oligoclonal immunoglobulin gamma bands and long-term disability progression in multiple sclerosis: a retrospective cohort study. Sci Rep 2021; 11:14987. [PMID: 34294805 PMCID: PMC8298473 DOI: 10.1038/s41598-021-94423-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) patients with immunoglobulin gamma (IgG) oligoclonal bands (OCB) in the cerebrospinal fluid (CSF) have different genetic backgrounds and brain MRI features compared to those without. In this study, we aimed to determine whether CSF-OCB status is associated with long-term disability outcomes. We used Swedish MS register data on clinically definite MS patients with known OCB status. Date of birth, age at MS onset, and time to sustained Expanded Disability Status Scale (EDSS) milestones 3, 4, and 6; time to conversion to secondary progressive (SP) MS, sex, and immunomodulatory treatment (IMTs) duration were collected. Multivariate Cox regression models were used to investigate the association between OCB status and risk of reaching each milestone. The OCB-positive group reached disability milestones at an earlier time and younger age. OCB-positivity significantly increased the risk of reaching EDSS 3.0 (HR = 1.29, 95% CI 1.12 to 1.48, P < 0.001) and 4.0 (HR = 1.38, 95% CI 1.17 to 1.63, P < 0.001). The OCB-positive group had a 20% higher risk of conversion to SPMS. CSF-OCB presence is associated with higher risk of reaching EDSS milestones and conversion to SPMS. Our findings suggest higher disease modifying effect of OCB presence in the early inflammatory stages of MS.
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Ramanujam R, Zhu F, Fink K, Karrenbauer VD, Lorscheider J, Benkert P, Kingwell E, Tremlett H, Hillert J, Manouchehrinia A. Accurate classification of secondary progression in multiple sclerosis using a decision tree. Mult Scler 2021; 27:1240-1249. [PMID: 33263261 PMCID: PMC8227440 DOI: 10.1177/1352458520975323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The absence of reliable imaging or biological markers of phenotype transition in multiple sclerosis (MS) makes assignment of current phenotype status difficult. OBJECTIVE The authors sought to determine whether clinical information can be used to accurately assign current disease phenotypes. METHODS Data from the clinical visits of 14,387 MS patients in Sweden were collected. Classifying algorithms based on several demographic and clinical factors were examined. Results obtained from the best classifier when predicting neurologist recorded disease classification were replicated in an independent cohort from British Columbia and were compared to a previously published algorithm and clinical judgment of three neurologists. RESULTS A decision tree (the classifier) containing only most recently available expanded disability scale status score and age obtained 89.3% (95% confidence intervals (CIs): 88.8-89.8) classification accuracy, defined as concordance with the latest reported status. Validation in the independent cohort resulted in 82.0% (95% CI: 81.0-83.1) accuracy. A previously published classification algorithm with slight modifications achieved 77.8% (95% CI: 77.1-78.4) accuracy. With complete patient history of 100 patients, three neurologists obtained 84.3% accuracy compared with 85% for the classifier using the same data. CONCLUSION The classifier can be used to standardize definitions of disease phenotype across different cohorts. Clinically, this model could assist neurologists by providing additional information.
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Affiliation(s)
- Ryan Ramanujam
- Department of Clinical Neuroscience, Karolinska
Institutet, Stockholm, Sweden/Department of Mathematics, KTH—Royal Institute
of Technology, Stockholm, Sweden
| | - Feng Zhu
- Faculty of Medicine (Neurology), UBC Hospital,
and Djavad Mowafaghian Centre for Brain Health, University of British
Columbia, Vancouver, BC, Canada
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska
Institutet, Stockholm, Sweden/Neuro Theme, Karolinska University Hospital,
Stockholm, Sweden/Academic Specialist Center, Multiple Sclerosis Centre,
Stockholm, Sweden
| | - Virginija Danylaitė Karrenbauer
- Department of Clinical Neuroscience, Karolinska
Institutet, Stockholm, Sweden/Neuro Theme, Karolinska University Hospital,
Stockholm, Sweden
| | - Johannes Lorscheider
- Neurologic Clinic and Policlinic, Departments of
Medicine and Clinical Research, University Hospital Basel, University of
Basel, Basel, Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical
Research, University Hospital Basel, Basel, Switzerland
| | - Elaine Kingwell
- Faculty of Medicine (Neurology), UBC Hospital,
and Djavad Mowafaghian Centre for Brain Health, University of British
Columbia, Vancouver, BC, Canada
| | - Helen Tremlett
- Faculty of Medicine (Neurology), UBC Hospital,
and Djavad Mowafaghian Centre for Brain Health, University of British
Columbia, Vancouver, BC, Canada
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska
Institutet, Stockholm, Sweden/Neuro Theme, Karolinska University Hospital,
Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska
Institutet, Stockholm, Sweden/The Karolinska Neuroimmunology & Multiple
Sclerosis Centre, Centre for Molecular Medicine (CMM), Karolinska
Institutet, Stockholm, Sweden
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142
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Dobson R, Salter A. Differing Impact of DMT on Relapse and Progression: Time to Consider Inflammation and Neuroprotection Separately? Neurology 2021; 97:407-408. [PMID: 34193591 DOI: 10.1212/wnl.0000000000012356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University London .,Department of Neurology, Barts Health NHS Trust, London
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143
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Roos I, Leray E, Casey R, Horakova D, Havrdova E, Izquierdo G, Madueño SE, Patti F, Edan G, Debouverie M, Pelletier J, Ozakbas S, Amato MP, Clavelou P, Grammond P, Boz C, Buzzard K, Skibina O, Ciron J, Gerlach O, Grand'Maison F, Lechner-Scott J, Malpas MPsych CliNeuro C, Butzkueven H, Vukusic S, Kalincik T. Effects of High and Low Efficacy Therapy in Secondary Progressive Multiple Sclerosis. Neurology 2021; 97:e869-e880. [PMID: 34193589 DOI: 10.1212/wnl.0000000000012354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/19/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To compare the clinical effectiveness of high- and low-efficacy treatments in patients with recently active and inactive secondary progressive multiple sclerosis (SPMS) after accounting for therapeutic lag. METHODS Patients treated with high- (natalizumab, alemtuzumab, mitoxantrone, ocrelizumab, rituximab, cladribine, fingolimod) or low-efficacy (interferon β, glatiramer acetate, teriflunomide) therapies after SPMS onset were selected from MSBase and OFSEP, two large observational cohorts. Therapeutic lag was estimated for each patient based on their demographic and clinical characteristics. Propensity score was used to match patients treated with high and low-efficacy therapies. Outcomes after disregarding the period of therapeutic lag were compared in paired, pairwise-censored analyses. RESULTS 1000 patients were included in the primary analysis. Patients with active SPMS treated with high-efficacy therapy experienced less frequent relapses than those on low-efficacy therapy (hazard ratio [HR] 0.7, p=0.006). In patients with inactive SPMS, there was no evidence for a difference in relapse frequency between groups (HR=0.8,p=0.39). No evidence for a difference in the risk of disability progression was observed. CONCLUSION In treated patients with SPMS, high-efficacy therapy is superior to low-efficacy therapy in reducing relapses in patients with active, but not those with inactive, SPMS. However, more potent therapies do not offer an advantage in reducing disability progression in this patient group. CLASSIFICATION OF EVIDENCE This study provides class III evidence that high-efficacy therapy is superior to low-efficacy therapy in reducing relapses in patients with active SPMS whilst we did not find a difference in disability progression between patients treated with high- and low-efficacy therapy.
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Affiliation(s)
- Izanne Roos
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne
| | - Emmanuelle Leray
- Rennes University, EHESP, REPERES EA 7449, F-35000 Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], F-35000 Rennes, France
| | | | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy.,Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Gilles Edan
- Centre hospitalier universitaire de Rennes, Hôpital Pontchaillou, Service de neurologie, CIC1414 INSERM, F-35000 Rennes, France
| | - Marc Debouverie
- Nancy University Hospital, Department of Neurology, Nancy, France. Université de Lorraine, APEMAC, F-54000 Nancy, France
| | - Jean Pelletier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005 Marseille, France
| | | | - Maria Pia Amato
- Department of Neurosciences, Psychology, Drugs and Child Health Area (NEUROFARBA), Section Neurosciences, University of Florence, Florence, Italy
| | - Pierre Clavelou
- CHU Clermont-Ferrand, Department of Neurology, F-63000 Clermont-Ferrand.,Université Clermont Auvergne, Inserm, Neuro-Dol, F-63000 Clermont-Ferrand, France France
| | | | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - Katherine Buzzard
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia
| | - Olga Skibina
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia.,The Alfred Hospital, Melbourne, Australia
| | - Jonathan Ciron
- CHU de Toulouse, Hôpital Pierre-Paul Riquet, Department of Neurology, CRC-SEP, F-31059 Toulouse Cedex 9, France
| | - Oliver Gerlach
- Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, Australia.,Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - Charles Malpas MPsych CliNeuro
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne
| | - Helmut Butzkueven
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia.,Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | | | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia .,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne
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Barzegar M, Najdaghi S, Afshari-Safavi A, Nehzat N, Mirmosayyeb O, Shaygannejad V. Early predictors of conversion to secondary progressive multiple sclerosis. Mult Scler Relat Disord 2021; 54:103115. [PMID: 34216997 DOI: 10.1016/j.msard.2021.103115] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We conducted this study to estimated the time of conversion from relapsing-remitting MS (RRMS) to SPMS and its early predictor factors. METHODS In this retrospective study, demographic, clinical, and imaging data from MS patients at diagnosis were extracted. Cox proportional hazards model was used to assess the association between various baseline characteristics and conversion to SPMS. We also assessed the association brtween escalation and early intensive therapy approaches with transition to progressive phase. RESULTS Out of 1903 patients with RRMS at baseline, 293 (15.4%) patients progressed to SPMS during follow-up. The estimated number of patients converted to SPMS was 10% at 10-years, 50% at 20-years, and 93% at 30-years. On multivariate Cox regression analysis older age at onset (HR: 1.067, 95%CI: 1.048-1.085, p < 0.001), smoking (HR: 2.120, 95%CI: 1.203-3.736, p = 0.009), higher EDSS at onset (HR: 1.199, 95%CI: 1.109-1.295, p < 0.001), motor dysfunction (HR: 2.470, 95%CI: 1.605-3.800, p < 0.001), cerebellar dysfunction (HR: 3.096, 95%CI: 1.840-5.211, p < 0.001), and presence of lesions in spinal cord (HR: 0.573, 95%CI: 0.297-0.989, p = 0.042) increased the risk of conversion from RRMS to SPMS. No significant difference between escalation and EIT groups in the risk of transition to progressive phase (weighted HR = 1.438; 95% CI: 0.963, 2.147; p = 0.076) was found. CONCLUSION Our data support previous observations that smoking is a modifiable risk factor for secondary progressive MS and confirms that spinal cord involvement, age, and more severe disease at onset are prognostic factors for converting to secondary progressive MS.
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Affiliation(s)
- Mahdi Barzegar
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soroush Najdaghi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Nasim Nehzat
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran; Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran.
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145
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Lizak N, Malpas CB, Sharmin S, Havrdova EK, Horakova D, Izquierdo G, Eichau S, Lugaresi A, Duquette P, Girard M, Prat A, Larochelle C, Trojano M, Grand'Maison F, Grammond P, Sola P, Ferraro D, Hupperts R, Bergamaschi R, Boz C, Van Pesch V, Spitaleri D, Terzi M, Kalincik T. Association of Sustained Immunotherapy With Disability Outcomes in Patients With Active Secondary Progressive Multiple Sclerosis. JAMA Neurol 2021; 77:1398-1407. [PMID: 32716480 DOI: 10.1001/jamaneurol.2020.2453] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Importance It is unclear whether relapses and disease-modifying therapies are associated with the rate of disability accumulation in patients with secondary progressive multiple sclerosis (SPMS). Objective To examine the association of relapses with the rate of disability accumulation in patients with SPMS and to assess whether treatment before or during the secondary progressive phase can slow the progression of disability accumulation. Design, Setting, and Participants In this observational cohort study, patient data were prospectively collected from the MSBase international registry between January 1, 1995, and February 1, 2018. Among 53 680 patients in the MSBase registry, 4997 patients with SPMS (using the Lorscheider definition) were identified. Of those, 1621 patients were eligible for study inclusion based on sufficient follow-up before and after the onset of SPMS. Data were analyzed from November 15, 2017, to January 13, 2020. Exposures The association between disability accumulation and several clinical and demographic variables, including relapses and exposure to immunotherapy, was evaluated. Main Outcomes and Measures Two outcomes were analyzed as measures of disability accumulation during SPMS: the rate of disability accumulation during the secondary progressive phase (change relative to the reference population of patients with MS and absolute change) and the risk of becoming wheelchair dependent. A third outcome, the cumulative risk of experiencing confirmed disability progression events, was used for a secondary analysis. Outcomes were evaluated using multivariable mixed models (ie, linear and Cox models). Results Of 1621 patients eligible for inclusion, 1103 patients (68.0%) were female, with a mean (SD) age at MS onset of 33.9 (10.6) years. A total of 661 patients (40.8%) experienced superimposed relapses during SPMS. Therapy receipt and relapses during early relapsing-remitting MS were not associated with disability accumulation during the secondary progressive phase. Higher relapse rates during the secondary progressive disease stage were associated with an increased risk of becoming wheelchair dependent (hazard ratio [HR], 1.87; 95% CI, 1.17-3.00; P = .009). Among patients who experienced superimposed relapses during SPMS, greater receipt of disease-modifying therapies was significantly associated with a reduced rate of disability progression and a lower risk of becoming wheelchair dependent. Conclusions and Relevance In this study, the rate of disability progression after the onset of SPMS was not associated with the early disease course and treatment decisions. Relapses during SPMS were associated with accelerated disability progression and represent an accessible treatment target. Disease-modifying therapy was associated with improvements in disability outcomes among patients with active relapses during SPMS. The study's results suggest that inflammatory disease activity remains a substantial yet modifiable component of SPMS.
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Affiliation(s)
- Nathaniel Lizak
- Clinical Outcomes Research Unit (CORe), Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Charles B Malpas
- Clinical Outcomes Research Unit (CORe), Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sifat Sharmin
- Clinical Outcomes Research Unit (CORe), Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Guillermo Izquierdo
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Sara Eichau
- Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Alessandra Lugaresi
- Istituto delle Scienze Neurologiche di Bologna, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Unita Operative Semplici d'Istituto (UOSI) Riabilitazione Sclerosi Multipla, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Universita di Bologna, Bologna, Italy
| | - Pierre Duquette
- Department of Neurology, Hopital Notre Dame, Montreal, Quebec, Canada.,Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Universite de Montreal, Montreal, Quebec, Canada
| | - Marc Girard
- Department of Neurology, Hopital Notre Dame, Montreal, Quebec, Canada.,Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Universite de Montreal, Montreal, Quebec, Canada
| | - Alexandre Prat
- Department of Neurology, Hopital Notre Dame, Montreal, Quebec, Canada.,Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Universite de Montreal, Montreal, Quebec, Canada
| | - Catherine Larochelle
- Department of Neurology, Hopital Notre Dame, Montreal, Quebec, Canada.,Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Universite de Montreal, Montreal, Quebec, Canada
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | | | - Pierre Grammond
- Integrated Health and Social Services Centres (CISSS), Chaudiere-Appalaches, Levis, Quebec, Canada
| | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Raymond Hupperts
- Department of Neurology, Zuyderland Ziekenhuis, Sittard, the Netherlands
| | - Roberto Bergamaschi
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Mondino Foundation, Pavia, Italy
| | - Cavit Boz
- Medical Faculty, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey
| | - Vincent Van Pesch
- Department of Laboratory Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Neurochemistry Unit, Institute of Neuroscience, Universite Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Daniele Spitaleri
- Institute of Neurology, Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - Tomas Kalincik
- Clinical Outcomes Research Unit (CORe), Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Stangel M, Becker V, Elias-Hamp B, Havla J, Grothe C, Pul R, Rau D, Richter S, Schmidt S. Oral pulsed therapy of relapsing multiple sclerosis with cladribine tablets - expert opinion on issues in clinical practice. Mult Scler Relat Disord 2021; 54:103075. [PMID: 34261026 DOI: 10.1016/j.msard.2021.103075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Oral cladribine is the first oral pulsed therapy licensed for relapsing multiple sclerosis (RMS). Three years after the introduction into the European market, we evaluated practical aspects in the use of cladribine tablets, incorporating the experience gained in routine clinical practice and real-world studies. METHODS Based on a structured review process, a panel of nine neurologists experienced in MS therapy discussed salient statements regarding the use of cladribine tables. For each statement the level of evidence was determined according to the levels of evidence recommended by the Centre for Evidence-Based Medicine, Oxford. The strength of each expert statement was then evaluated by means of a linear scale from 1 (very strong rejection) to 9 (very strong approval). Votes were collected by a formalized blinded process. Consent was considered to be reached if at least 75% of the experts agreed on a particular statement (i.e. voted for 7-9 points on the linear scale). RESULTS . Statements include efficacy in early RMS, risk of side effects and infections, vaccination, pregnancy, and monitoring requirements. CONCLUSION The consented recommendations summarize the practical experience inthe use of cladribine tablets in a real-world setting. These may provide guidance for unanswered questions arising with the introduction of new treatments such as cladribine tablets.
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Affiliation(s)
- Martin Stangel
- Klinik für Neurologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
| | - Veit Becker
- Neurologische Praxis Eppendorf, Kümmellstr. 1, D-20249 Hamburg, Germany.
| | - Birte Elias-Hamp
- Birte Elias-Hamp, Praxis für Neurologie und Psychiatrie, Bengelsdorfstr. 5, D-22179 Hamburg, Germany.
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, and Data Integration for Future Medicine (DIFUTURE) consortium, LMU Hospital, Ludwig-Maximilians Universität München, Munich, Germany.
| | - Christoph Grothe
- GFO-Kliniken Troisdorf, Wilhelm-Busch-Straße 9, D-53840 Troisdorf, Germany.
| | - Refik Pul
- Klinik für Neurologie am Universitätsklinikum in Essen, Hufelandstr. 55, D-45147 Essen, Germany.
| | - Daniela Rau
- Nervenfachärztliche Gemeinschaftspraxis in Ulm, Pfauengasse 8, D-89073 Ulm, Germany.
| | - Stephan Richter
- MIND-MVZ Stuttgart, Charlottenstr. 14, D-70182 Stuttgart, Germany.
| | - Stephan Schmidt
- Neurologische Gemeinschaftspraxis Bonn, Gesundheitszentrum St. Johannes, Kölnstr. 54, D-53111 Bonn, Germany.
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Cree BAC, Arnold DL, Chataway J, Chitnis T, Fox RJ, Pozo Ramajo A, Murphy N, Lassmann H. Secondary Progressive Multiple Sclerosis: New Insights. Neurology 2021; 97:378-388. [PMID: 34088878 PMCID: PMC8397587 DOI: 10.1212/wnl.0000000000012323] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/13/2021] [Indexed: 01/01/2023] Open
Abstract
In most cases, multiple sclerosis (MS) begins with a relapsing-remitting course followed by insidious disability worsening that is independent from clinically apparent relapses and is termed secondary progressive MS (SMPS). Major differences exist between relapsing-remitting MS (RRMS) and SPMS, especially regarding therapeutic response to treatment. This review provides an overview of the pathology, differentiation, and challenges in the diagnosis and treatment of SPMS. We emphasize the criticality of conversion from a relapsing-remitting to a secondary progressive disease course not only because such conversion is evidence of disability progression, but also because, until recently, treatments that effectively reduced disability progression in relapsing MS were not proven to be effective in SPMS. Clear clinical, imaging, immunologic, or pathologic criteria marking the transition from RRMS to SPMS have not yet been established. Early identification of SPMS will require tools that, together with the use of appropriate treatments, may result in better long-term outcomes for the population of patients with SPMS.
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Affiliation(s)
- Bruce A C Cree
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (B.A.C.C.), University of California San Francisco; NeuroRx Research (D.L.A.), Montreal; Brain Imaging Centre (D.L.A.), Montreal Neurological Institute, McGill University, Canada; Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation (J.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health Research (J.C.), University College London Hospitals, Biomedical Research Centre, UK; Brigham Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital, Boston, MA; Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Oxford PharmaGenesis (A.P.R.), UK; Novartis Pharma AG (N.M.), Basel, Switzerland; and Center for Brain Research (H.L.), Medical University of Vienna, Austria.
| | - Douglas L Arnold
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (B.A.C.C.), University of California San Francisco; NeuroRx Research (D.L.A.), Montreal; Brain Imaging Centre (D.L.A.), Montreal Neurological Institute, McGill University, Canada; Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation (J.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health Research (J.C.), University College London Hospitals, Biomedical Research Centre, UK; Brigham Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital, Boston, MA; Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Oxford PharmaGenesis (A.P.R.), UK; Novartis Pharma AG (N.M.), Basel, Switzerland; and Center for Brain Research (H.L.), Medical University of Vienna, Austria
| | - Jeremy Chataway
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (B.A.C.C.), University of California San Francisco; NeuroRx Research (D.L.A.), Montreal; Brain Imaging Centre (D.L.A.), Montreal Neurological Institute, McGill University, Canada; Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation (J.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health Research (J.C.), University College London Hospitals, Biomedical Research Centre, UK; Brigham Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital, Boston, MA; Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Oxford PharmaGenesis (A.P.R.), UK; Novartis Pharma AG (N.M.), Basel, Switzerland; and Center for Brain Research (H.L.), Medical University of Vienna, Austria
| | - Tanuja Chitnis
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (B.A.C.C.), University of California San Francisco; NeuroRx Research (D.L.A.), Montreal; Brain Imaging Centre (D.L.A.), Montreal Neurological Institute, McGill University, Canada; Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation (J.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health Research (J.C.), University College London Hospitals, Biomedical Research Centre, UK; Brigham Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital, Boston, MA; Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Oxford PharmaGenesis (A.P.R.), UK; Novartis Pharma AG (N.M.), Basel, Switzerland; and Center for Brain Research (H.L.), Medical University of Vienna, Austria
| | - Robert J Fox
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (B.A.C.C.), University of California San Francisco; NeuroRx Research (D.L.A.), Montreal; Brain Imaging Centre (D.L.A.), Montreal Neurological Institute, McGill University, Canada; Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation (J.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health Research (J.C.), University College London Hospitals, Biomedical Research Centre, UK; Brigham Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital, Boston, MA; Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Oxford PharmaGenesis (A.P.R.), UK; Novartis Pharma AG (N.M.), Basel, Switzerland; and Center for Brain Research (H.L.), Medical University of Vienna, Austria
| | - Angela Pozo Ramajo
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (B.A.C.C.), University of California San Francisco; NeuroRx Research (D.L.A.), Montreal; Brain Imaging Centre (D.L.A.), Montreal Neurological Institute, McGill University, Canada; Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation (J.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health Research (J.C.), University College London Hospitals, Biomedical Research Centre, UK; Brigham Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital, Boston, MA; Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Oxford PharmaGenesis (A.P.R.), UK; Novartis Pharma AG (N.M.), Basel, Switzerland; and Center for Brain Research (H.L.), Medical University of Vienna, Austria
| | - Niamh Murphy
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (B.A.C.C.), University of California San Francisco; NeuroRx Research (D.L.A.), Montreal; Brain Imaging Centre (D.L.A.), Montreal Neurological Institute, McGill University, Canada; Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation (J.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health Research (J.C.), University College London Hospitals, Biomedical Research Centre, UK; Brigham Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital, Boston, MA; Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Oxford PharmaGenesis (A.P.R.), UK; Novartis Pharma AG (N.M.), Basel, Switzerland; and Center for Brain Research (H.L.), Medical University of Vienna, Austria
| | - Hans Lassmann
- From the UCSF Weill Institute for Neurosciences, Department of Neurology (B.A.C.C.), University of California San Francisco; NeuroRx Research (D.L.A.), Montreal; Brain Imaging Centre (D.L.A.), Montreal Neurological Institute, McGill University, Canada; Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation (J.C.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; National Institute for Health Research (J.C.), University College London Hospitals, Biomedical Research Centre, UK; Brigham Multiple Sclerosis Center (T.C.), Brigham and Women's Hospital, Boston, MA; Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute (R.J.F.), Cleveland Clinic, OH; Oxford PharmaGenesis (A.P.R.), UK; Novartis Pharma AG (N.M.), Basel, Switzerland; and Center for Brain Research (H.L.), Medical University of Vienna, Austria
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148
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Chataway J, Murphy N, Khurana V, Schofield H, Findlay J, Adlard N. Secondary progressive multiple sclerosis: a systematic review of costs and health state utilities. Curr Med Res Opin 2021; 37:995-1004. [PMID: 33733976 DOI: 10.1080/03007995.2021.1904860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: To identify evidence in the literature presenting the economic and humanistic (based on health state utility values [HSUVs]) burden of multiple sclerosis (MS) and report the incremental burden of secondary progressive MS (SPMS) compared with relapsing-remitting MS (RRMS).Methods: Electronic databases (Embase, MEDLINE, MEDLINE In-Process, Cochrane Library) and other relevant repositories were systematically searched from the date of inception until November 2019 for evidence on the economic burden of MS, or HSUVs in patients with MS. Data were extracted from studies investigating cost data or HSUVs for patients with SPMS compared with RRMS.Results: In total, 25 studies were identified that reported data on the economic and HSUV burden of SPMS versus RRMS: 18 studies reported cost data and nine presented HSUVs. Overall, costs associated with SPMS were consistently higher than those for RRMS. Major cost drivers appeared to shift following transition from RRMS to SPMS, with higher direct medical costs associated with RRMS than with SPMS, while the opposite was true for direct non-medical costs and indirect costs. In all studies presenting HSUVs specifically in patients with SPMS, the disease burden was greater (indicated by lower HSUV scores or a negative regression coefficient vs RRMS) for patients with SPMS than for those with RRMS. Fatigue and psychological stress (including depression) were identified as key drivers of this reduced health-related quality of life (HRQoL).Conclusions: Our findings indicate that SPMS is associated with higher costs and more substantial HRQoL decrements than RRMS. These results highlight the substantial unmet need for effective treatments that can slow disease progression in patients with SPMS, which, in turn, would reduce the rate of HRQoL deterioration and increasing healthcare costs.
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Affiliation(s)
- Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospitals, London, UK
| | | | - Vivek Khurana
- Patient Access Solutions, Novartis Corporation (Malaysia) Sdn. Bhd, Petaling Jaya, Malaysia
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149
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A non-parametric propensity score for estimating the effect of interferon-beta or glatiramer acetate on long-term outcomes of multiple sclerosis. Mult Scler Relat Disord 2021; 53:103050. [PMID: 34116479 DOI: 10.1016/j.msard.2021.103050] [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: 02/26/2021] [Revised: 04/30/2021] [Accepted: 05/22/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The few observational studies that investigated the long-term effects of interferon-beta and glatiramer acetate were usually focused on progression to irreversible disability and other outcomes such as number of relapses and transition to secondary-progressive multiple sclerosis (SPMS) have been rarely studied. The objective of this paper is to estimate the effect of interferon-beta/glatiramer acetate on progression to irreversible disability, transition from relapsing-remitting multiple sclerosis (RRMS) to SPMS and the rate of relapses over 10 years. METHODS Analyses included 2498 patients with confirmed diagnosis of RRMS followed in Montréal from 1977 to 2016. Marginal structural models with propensity score for treatment and censoring were used to account for potential confounding and attrition. Specifically, we used pooled logistic regression for progression to irreversible disability and transition to SPMS, and Poisson models for the rate of relapses. RESULTS 77% of subjects were female and the median age at RRMS diagnosis was 35 years. The hazard of progression to irreversible disability was lower among treated patients than untreated patients (HR=0.73, 95% CI [0.57-0.94]). We did not find evidence of an association between interferon-beta/glatiramer acetate and the rate of transition to SPMS either over the 3-month intervals or for the duration of treatment. Patients treated for >5 years had a lower rate of relapses compared to those untreated (HR=0.70, 95% CI [0.57-0.86]). CONCLUSION Treatment with interferon-beta/glatiramer acetate suggests a beneficial effect on progression to irreversible disability and rate of relapses, but not on transition to SPMS.
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150
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Latchem-Hastings J, Randell E, Button K, Jones F, Lowe R, Dawes H, Wood F, Davies F, Poile V, O'Halloran R, Stensland B, Tallantyre E, Playle R, Edwards A, Busse M. Lifestyle, exercise and activity package for people living with progressive multiple sclerosis (LEAP-MS): protocol for a single-arm feasibility study. Pilot Feasibility Stud 2021; 7:111. [PMID: 34022955 PMCID: PMC8140324 DOI: 10.1186/s40814-021-00852-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/11/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We have co-designed a tailored blended physiotherapy intervention for people with progressive multiple sclerosis (PwPMS) who often struggle to access support for physical activity. Underpinned by self-management principles, the Lifestyle, Exercise and Activity Package for people with Multiple Sclerosis (LEAP-MS) intervention incorporates face-to-face or online physiotherapy coaching sessions with an accompanying online physical activity platform. The LEAP-MS platform is a multi-user system enabling user and physiotherapist to co-create activity plans. The LEAP-MS platform consists of an information and activity suite, interactive components enabling selection of exercises into an activity programme, goal setting and activity logging. The platform also facilitates online remote support from a physiotherapist through an embedded online messaging function. We aim to evaluate the LEAP-MS platform in a feasibility trial. METHODS LEAP-MS will be evaluated within a single-arm feasibility study with embedded process evaluation. After registration and initial eligible screening, 21 participants will be required to complete baseline self-completion measures. This will be followed by an initial home-based or online coaching session with a physiotherapist (who has received tailored self-management and digital resource training) and access to the online intervention for an initial 3-month period. During this period, participants are given the option to request up to five further home-based or online physiotherapy coaching sessions. Follow-up questionnaires and semi-structured interviews will be administered 3 months after baseline with participants and intervention physiotherapists. The LEAP-MS platform will be available to participants for a further 3 months. Usage of the LEAP-MS platform will be tracked during the full 6-month period and final follow-up will be conducted 6 months after baseline. DISCUSSION Feasibility outcomes (recruitment, retention, intervention uptake and safety) will be reported. The process evaluation will be undertaken to identify possible mechanisms for any observed effects. The data will inform full-scale evaluations of this co-produced, blended physiotherapy intervention. TRIAL REGISTRATION ClinicalTrials.gov , NCT03951181 . Registered 15 May 2019.
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Affiliation(s)
- Julie Latchem-Hastings
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Elizabeth Randell
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Ty Dewi Sant, Heath Park, Cardiff, UK
| | - Fiona Jones
- Faculty of Health and Social Care Science, St George's University of London and Kingston University, London, UK
| | - Rachel Lowe
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Helen Dawes
- Movement Science Group, Oxford Brookes University, Gipsy Lane, Headington, Oxford, UK
| | - Fiona Wood
- Division of Population Medicine and PRIME Centre Wales, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Freya Davies
- Division of Population Medicine and PRIME Centre Wales, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Vincent Poile
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Rhian O'Halloran
- Helen Durham Neuro-Inflammatory Centre, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Barbara Stensland
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Emma Tallantyre
- Helen Durham Neuro-Inflammatory Centre, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Rebecca Playle
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine and PRIME Centre Wales, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Monica Busse
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, UK.
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