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Ruggieri S, Prosperini L, Al-Araji S, Annovazzi PO, Bisecco A, Ciccarelli O, De Stefano N, Filippi M, Fleischer V, Evangelou N, Enzinger C, Gallo A, Garjani A, Groppa S, Haggiag S, Khalil M, Lucchini M, Mirabella M, Montalban X, Pozzilli C, Preziosa P, Río J, Rocca MA, Rovira A, Stromillo ML, Zaffaroni M, Tortorella C, Gasperini C. Assessing treatment response to oral drugs for multiple sclerosis in real-world setting: a MAGNIMS Study. J Neurol Neurosurg Psychiatry 2024; 95:142-150. [PMID: 37775266 DOI: 10.1136/jnnp-2023-331920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/09/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The assessment of treatment response is a crucial step for patients with relapsing-remitting multiple sclerosis on disease-modifying therapies (DMTs). We explored whether a scoring system developed within the MAGNIMS (MRI in Multiple Sclerosis) network to evaluate treatment response to injectable drugs can be adopted also to oral DMTs. METHODS A multicentre dataset of 1200 patients who started three oral DMTs (fingolimod, teriflunomide and dimethyl fumarate) was collected within the MAGNIMS network. Disease activity after the first year was classified by the 'MAGNIMS' score based on the combination of relapses (0-≥2) and/or new T2 lesions (<3 or ≥3) on brain MRI. We explored the association of this score with the following 3-year outcomes: (1) confirmed disability worsening (CDW); (2) treatment failure (TFL); (3) relapse count between years 1 and 3. The additional value of contrast-enhancing lesions (CELs) and lesion location was explored. RESULTS At 3 years, 160 patients experienced CDW: 12% of them scored '0' (reference), 18% scored '1' (HR=1.82, 95% CI 1.20 to 2.76, p=0.005) and 37% scored '2' (HR=2.74, 95% CI 1.41 to 5.36, p=0.003) at 1 year. The analysis of other outcomes provided similar findings. Considering the location of new T2 lesions (supratentorial vs infratentorial/spinal cord) and the presence of CELs improved the prediction of CDW and TFL, respectively, in patients with minimal MRI activity alone (one or two new T2 lesions). CONCLUSIONS Early relapses and substantial MRI activity in the first year of treatment are associated with worse short-term outcomes in patients treated with some of the oral DMTs.
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Affiliation(s)
- Serena Ruggieri
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luca Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Sarmad Al-Araji
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Pietro Osvaldo Annovazzi
- Neuroimmunology Unit-Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Alvino Bisecco
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, 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
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimo Filippi
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Vinzenz Fleischer
- Department of Neurology and Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Nikos Evangelou
- Mental Health & Clinical Neuroscience Unit, University of Nottingham, Nottingham, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Radiology (Division of Neuroradiology, Vascular and Interventional Radiology), Medical University of Graz, Graz, Austria
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Afagh Garjani
- Mental Health & Clinical Neuroscience Unit, University of Nottingham, Nottingham, UK
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sergiu Groppa
- Department of Neurology and Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Shalom Haggiag
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Matteo Lucchini
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Xavier Montalban
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Preziosa
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jordi Río
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Maria A Rocca
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria L Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mauro Zaffaroni
- Neuroimmunology Unit-Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Carla Tortorella
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Claudio Gasperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
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2
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Rispoli MG, D'Apolito M, Pozzilli V, Tomassini V. Lessons from immunotherapies in multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2023; 193:293-311. [PMID: 36803817 DOI: 10.1016/b978-0-323-85555-6.00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The improved understanding of multiple sclerosis (MS) neurobiology alongside the development of novel markers of disease will allow precision medicine to be applied to MS patients, bringing the promise of improved care. Combinations of clinical and paraclinical data are currently used for diagnosis and prognosis. The addition of advanced magnetic resonance imaging and biofluid markers has been strongly encouraged, since classifying patients according to the underlying biology will improve monitoring and treatment strategies. For example, silent progression seems to contribute significantly more than relapses to overall disability accumulation, but currently approved treatments for MS act mainly on neuroinflammation and offer only a partial protection against neurodegeneration. Further research, involving traditional and adaptive trial designs, should strive to halt, repair or protect against central nervous system damage. To personalize new treatments, their selectivity, tolerability, ease of administration, and safety must be considered, while to personalize treatment approaches, patient preferences, risk-aversion, and lifestyle must be factored in, and patient feedback used to indicate real-world treatment efficacy. The use of biosensors and machine-learning approaches to integrate biological, anatomical, and physiological parameters will take personalized medicine a step closer toward the patient's virtual twin, in which treatments can be tried before they are applied.
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Affiliation(s)
- Marianna G Rispoli
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Maria D'Apolito
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Valeria Pozzilli
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy
| | - Valentina Tomassini
- Institute for Advanced Biomedical Technologies (ITAB) and Department of Neurosciences, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; MS Centre, SS. Annunziata University Hospital, Chieti, Italy.
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3
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Nociti V, Romozzi M, Mirabella M. Update on Multiple Sclerosis Molecular Biomarkers to Monitor Treatment Effects. J Pers Med 2022; 12:549. [PMID: 35455665 PMCID: PMC9024668 DOI: 10.3390/jpm12040549] [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: 02/25/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system characterized by broad inter- and intraindividual heterogeneity. The relapse rate, disability progression, and lesion load assessed through MRI are used to detect disease activity and response to treatment. Although it is possible to standardize these characteristics in larger patient groups, so far, this has been difficult to achieve in individual patients. Easily detectable molecular biomarkers can be powerful tools, permitting a tailored therapy approach for MS patients. However, only a few molecular biomarkers have been routinely used in clinical practice as the validation process, and their transfer into clinical practice takes a long time. This review describes the characteristics of an ideal MS biomarker, the challenges of establishing new biomarkers, and promising molecular biomarkers from blood or CSF samples used to monitor MS treatment effects in clinical practice.
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Affiliation(s)
- Viviana Nociti
- Institute of Neurology, Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, 00168 Rome, Italy; (M.R.); (M.M.)
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marina Romozzi
- Institute of Neurology, Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, 00168 Rome, Italy; (M.R.); (M.M.)
| | - Massimiliano Mirabella
- Institute of Neurology, Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCS, 00168 Rome, Italy; (M.R.); (M.M.)
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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4
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Kunchok A, Lechner-Scott J, Granella F, Trojano M, Alroughani R, Sola P, Ferraro D, Lugaresi A, Onofrj M, Ozakbas S, Izquierdo G, Grammond P, Luis Sanchez-Menoyo J, Van Wijmeersch B, Boz C, Pucci E, McCombe P, Grand’Maison F, Spitaleri D, Vucic S, Hupperts R, Jokubaitis V, Sormani MP, Butzkueven H, Kalincik T. Prediction of on-treatment disability worsening in RRMS with the MAGNIMS score. Mult Scler 2020; 27:695-705. [DOI: 10.1177/1352458520936823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The magnetic resonance imaging in multiple sclerosis (MAGNIMS) score combines relapses and magnetic resonance imaging (MRI) lesions to predict disability outcomes in relapsing–remitting multiple sclerosis (RRMS) treated with interferon-β. Objective: To validate the MAGNIMS score and extend to other disease-modifying therapies (DMTs). To examine the prognostic value of gadolinium contrast-enhancing (Gd+) lesions. Methods: This RRMS MSBase cohort study ( n = 2293) used a Cox model to examine the prognostic value of relapses, MRI activity and the MAGNIMS score for disability worsening during treatment with interferon-β and three other DMTs. Results: Three new T2 lesions (hazard ratio (HR) = 1.60, p = 0.028) or two relapses (HR = 2.24, p = 0.002) on interferon-β (for 12 months) were predictive of disability worsening over 4 years. MAGNIMS score = 2 (1 relapse and ⩾3 T2 lesions or ⩾2 relapses) was associated with a greater risk of disability worsening on interferon-β (HR = 2.0, p = 0.001). In pooled cohort of four DMTs, similar associations were seen (MAGNIMS score = 2: HR = 1.72, p = 0.001). Secondary analyses demonstrated that the addition of Gd+ to the MAGNIMS did not materially improve its prediction of disability worsening. Conclusion: We have validated the MAGNIMS score in RRMS and extended its application to three other DMTs: 1 relapse and ⩾3 T2 lesions or ⩾2 relapses predicted worsening of disability. Contrast-enhancing lesions did not substantially improve the prognostic score.
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Affiliation(s)
- Amy Kunchok
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/Melbourne MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia/The University of Sydney, Sydney, NSW, Australia/Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia/Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy/Department of Emergency and General Medicine, Parma University Hospital, Parma, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait
| | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy/Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Marco Onofrj
- Clinica Neurologica, Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | | | | | | | | | - Bart Van Wijmeersch
- Rehabilitation and MS Centre Overpelt, Overpelt, Belgium/Hasselt University, Hasselt, Belgium
| | - Cavit Boz
- KTU Medical Faculty, Farabi Hospital, Trabzon, Turkey
| | - Eugenio Pucci
- UOC Neurologia, Azienda Sanitaria Unica Regionale Marche – AV3, Macerata, Italy
| | - Pamela McCombe
- The University of Queensland, Brisbane, QLD, Australia/Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | | | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Steve Vucic
- Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | | | - Vilija Jokubaitis
- Central Clinical School, Monash University, Melbourne, VIC, Australia/Department of Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, VIC, Australia/Department of Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia/ Melbourne MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
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5
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Diagnosis and management of multiple sclerosis: MRI in clinical practice. J Neurol 2020; 267:2917-2925. [PMID: 32472179 PMCID: PMC7501096 DOI: 10.1007/s00415-020-09930-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/22/2022]
Abstract
Background Recent changes in the understanding and management of multiple sclerosis (MS) have increased the role of MRI in supporting diagnosis and disease monitoring. However, published guidelines on the use of MRI in MS do not translate easily into different clinical settings and considerable variation in practice remains. Here, informed by published guidelines for the use of MRI in MS, we identified a clinically informative MRI protocol applicable in a variety of clinical settings, from district general hospitals to tertiary centres. Methods MS specialists geographically representing the UK National Health Service and with expertise in MRI examined existing guidelines on the use of MRI in MS and identification of challenges in their applications in various clinical settings informed the formulation of a feasible MRI protocol. Results We identified a minimum set of MRI information, based on clinical relevance, as well as on applicability to various clinical settings. This informed the selection of MRI acquisitions for scanning protocols, differentiated on the basis of their purpose and stage of the disease, and indication of timing for scans. Advice on standardisation of MRI requests and reporting, and proposed timing and frequency of MRI scans were generated. Conclusions The proposed MRI protocol can adapt to a range of clinical settings, aiding the impetus towards standardisation of practice and offering an example of research-informed service improvement to support optimisation of resources. Other neurological conditions, where a gap still exists between published guidelines and their clinical implementation, may benefit from this same approach.
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6
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Malpas CB, Manouchehrinia A, Sharmin S, Roos I, Horakova D, Havrdova EK, Trojano M, Izquierdo G, Eichau S, Bergamaschi R, Sola P, Ferraro D, Lugaresi A, Prat A, Girard M, Duquette P, Grammond P, Grand’Maison F, Ozakbas S, Van Pesch V, Granella F, Hupperts R, Pucci E, Boz C, Sidhom Y, Gouider R, Spitaleri D, Soysal A, Petersen T, Verheul F, Karabudak R, Turkoglu R, Ramo-Tello C, Terzi M, Cristiano E, Slee M, McCombe P, Macdonell R, Fragoso Y, Olascoaga J, Altintas A, Olsson T, Butzkueven H, Hillert J, Kalincik T. Early clinical markers of aggressive multiple sclerosis. Brain 2020; 143:1400-1413. [DOI: 10.1093/brain/awaa081] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/21/2020] [Accepted: 02/05/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Patients with the ‘aggressive’ form of multiple sclerosis accrue disability at an accelerated rate, typically reaching Expanded Disability Status Score (EDSS) ≥ 6 within 10 years of symptom onset. Several clinicodemographic factors have been associated with aggressive multiple sclerosis, but less research has focused on clinical markers that are present in the first year of disease. The development of early predictive models of aggressive multiple sclerosis is essential to optimize treatment in this multiple sclerosis subtype. We evaluated whether patients who will develop aggressive multiple sclerosis can be identified based on early clinical markers. We then replicated this analysis in an independent cohort. Patient data were obtained from the MSBase observational study. Inclusion criteria were (i) first recorded disability score (EDSS) within 12 months of symptom onset; (ii) at least two recorded EDSS scores; and (iii) at least 10 years of observation time, based on time of last recorded EDSS score. Patients were classified as having ‘aggressive multiple sclerosis’ if all of the following criteria were met: (i) EDSS ≥ 6 reached within 10 years of symptom onset; (ii) EDSS ≥ 6 confirmed and sustained over ≥6 months; and (iii) EDSS ≥ 6 sustained until the end of follow-up. Clinical predictors included patient variables (sex, age at onset, baseline EDSS, disease duration at first visit) and recorded relapses in the first 12 months since disease onset (count, pyramidal signs, bowel-bladder symptoms, cerebellar signs, incomplete relapse recovery, steroid administration, hospitalization). Predictors were evaluated using Bayesian model averaging. Independent validation was performed using data from the Swedish Multiple Sclerosis Registry. Of the 2403 patients identified, 145 were classified as having aggressive multiple sclerosis (6%). Bayesian model averaging identified three statistical predictors: age > 35 at symptom onset, EDSS ≥ 3 in the first year, and the presence of pyramidal signs in the first year. This model significantly predicted aggressive multiple sclerosis [area under the curve (AUC) = 0.80, 95% confidence intervals (CIs): 0.75, 0.84, positive predictive value = 0.15, negative predictive value = 0.98]. The presence of all three signs was strongly predictive, with 32% of such patients meeting aggressive disease criteria. The absence of all three signs was associated with a 1.4% risk. Of the 556 eligible patients in the Swedish Multiple Sclerosis Registry cohort, 34 (6%) met criteria for aggressive multiple sclerosis. The combination of all three signs was also predictive in this cohort (AUC = 0.75, 95% CIs: 0.66, 0.84, positive predictive value = 0.15, negative predictive value = 0.97). Taken together, these findings suggest that older age at symptom onset, greater disability during the first year, and pyramidal signs in the first year are early indicators of aggressive multiple sclerosis.
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Affiliation(s)
- Charles B Malpas
- CORe Unit, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Ali Manouchehrinia
- Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Sifat Sharmin
- CORe Unit, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Izanne Roos
- CORe Unit, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - 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 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
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Lugaresi
- Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Marc Girard
- CHUM and Universite de Montreal, Montreal, Canada
| | | | | | | | | | - Vincent Van Pesch
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Université Catholique de Louvain, Brussels, Belgium
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Eugenio Pucci
- UOC Neurologia, Azienda Sanitaria Unica Regionale Marche - AV3, Macerata, Italy
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - Youssef Sidhom
- Department of Neurology, Razi Hospital, Manouba, Tunisia
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, LR 18SP03, Clinical Investigation Center Neurosciences and Mental Health, Faculty of Medicine University Tunis El Manar, Tunis, Tunisia
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | | | | | | | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | | | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | | | - Mark Slee
- Flinders University, Adelaide, Australia
| | - Pamela McCombe
- University of Queensland, Brisbane, Australia
- Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | | | - Yara Fragoso
- Universidade Metropolitana de Santos, Santos, Brazil
| | - Javier Olascoaga
- Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario Donostia, San Sebastián, Spain
| | - Ayse Altintas
- Koc University, School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Australia
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Tomas Kalincik
- CORe Unit, Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
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7
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Conway DS, Hersh CM, Harris HC, Hua LH. Duration of natalizumab therapy and reasons for discontinuation in a multiple sclerosis population. Mult Scler J Exp Transl Clin 2020; 6:2055217320902488. [PMID: 32064117 PMCID: PMC6987494 DOI: 10.1177/2055217320902488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/05/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To determine multiple sclerosis patient characteristics that predict a
shorter duration of natalizumab treatment. Methods The Tysabri Outreach: Unified Commitment to Health database was reviewed to
identify patients treated with natalizumab at our centers. Cox proportional
hazards models were used to evaluate patient characteristics associated with
shorter treatment durations on natalizumab. Associations were also assessed
with respect to specific reasons for stopping natalizumab. Results We identified 554 patients who began and stopped natalizumab treatment during
the observation period. The average disease duration at natalizumab
initiation was 7.6 years, and the average number of infusions was 30. The
multivariable Cox proportional hazards model identified greater age
(P = 0.035), longer disease duration
(P < 0.001), progressive relapsing multiple
sclerosis phenotype (P = 0.003), current smoking
(P = 0.031), and greater depression
(P = 0.026) as significant predictors for natalizumab
discontinuation. Greater disability levels (P = 0.022) and
gadolinium-enhancing lesions on baseline magnetic resonance imaging
(P < 0.001) were significantly associated with
longer natalizumab treatment. Individuals with progressive relapsing
multiple sclerosis had a 14-fold increased hazard of discontinuing
natalizumab due to inflammatory events (P < 0.001) than
those with relapsing–remitting multiple sclerosis. Smokers had an 80%
increased hazard of discontinuation due to intolerance
(P = 0.008). Conclusions Our results suggest that smoking, depression, and a progressive relapsing
multiple sclerosis phenotype are associated with shorter natalizumab
treatment durations.
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Affiliation(s)
- Devon S Conway
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, USA
| | - Carrie M Hersh
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, USA
| | - Haleigh C Harris
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, USA
| | - Le H Hua
- Lou Ruvo Center for Brain Health, Cleveland Clinic Foundation, USA
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Gasperini C, Prosperini L, Tintoré M, Sormani MP, Filippi M, Rio J, Palace J, Rocca MA, Ciccarelli O, Barkhof F, Sastre-Garriga J, Vrenken H, Frederiksen JL, Yousry TA, Enzinger C, Rovira A, Kappos L, Pozzilli C, Montalban X, De Stefano N. Unraveling treatment response in multiple sclerosis: A clinical and MRI challenge. Neurology 2018; 92:180-192. [PMID: 30587516 DOI: 10.1212/wnl.0000000000006810] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/31/2018] [Indexed: 01/19/2023] Open
Abstract
Over the last few decades, the improved diagnostic criteria, the wide use of MRI, and the growing availability of effective pharmacologic treatments have led to substantial advances in the management of multiple sclerosis (MS). The importance of early diagnosis and treatment is now well-established, but there is still no consensus on how to define and monitor response to MS treatments. In particular, the clinical relevance of the detection of minimal MRI activity is controversial and recommendations on how to define and monitor treatment response are warranted. An expert panel of the Magnetic Resonance Imaging in MS Study Group analyzed and discussed published studies on treatment response in MS. The evolving concept of no evidence of disease activity and its effect on predicting long-term prognosis was examined, including the option of defining a more realistic target for daily clinical practice: minimal evidence of disease activity. Advantages and disadvantages associated with the use of MRI activity alone and quantitative scoring systems combining on-treatment clinical relapses and MRI active lesions to detect treatment response in the real-world setting were also discussed. While most published studies on this topic involved patients treated with interferon-β, special attention was given to more recent studies providing evidence based on treatment with other and more efficacious oral and injectable drugs. Finally, the panel identified future directions to pursue in this research field.
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Affiliation(s)
- Claudio Gasperini
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy.
| | - Luca Prosperini
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Mar Tintoré
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Maria Pia Sormani
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Massimo Filippi
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Jordi Rio
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Jacqueline Palace
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Maria A Rocca
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Olga Ciccarelli
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Frederik Barkhof
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Jaume Sastre-Garriga
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Hugo Vrenken
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Jette L Frederiksen
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Tarek A Yousry
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Christian Enzinger
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Alex Rovira
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Ludwig Kappos
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Carlo Pozzilli
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Xavier Montalban
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
| | - Nicola De Stefano
- From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy
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9
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Tomassini V, Fanelli F, Prosperini L, Cerqua R, Cavalla P, Pozzilli C. Predicting the profile of increasing disability in multiple sclerosis. Mult Scler 2018; 25:1306-1315. [PMID: 30070597 PMCID: PMC6681428 DOI: 10.1177/1352458518790397] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Effective therapeutic strategies to preserve function and delay progression
in multiple sclerosis (MS) require early recognition of individual disease
trajectories. Objectives: To determine the profiles of disability evolution, identify their early
predictors and develop a risk score of increasing disability. Methods: We analysed demographic, clinical and magnetic resonance imaging (MRI) data
from patients with relapsing MS, Expanded Disability Status Scale (EDSS)
score of 3.0–4.0 and follow-up ≥ 2 years. Attaining EDSS = 6.0 defined
increasing disability; relapses and/or MRI defined
disease activity. Results: In total, 344 out of 542 (63.5%) patients reached EDSS ≥ 6.0; of these, 220
(64.0%) showed disease activity. In patients with activity, the number of
relapses before reaching EDSS 3.0–4.0 predicted increasing disability;
age > 45 at baseline predicted increasing disability without activity.
Combining age and number of relapses increased the risk of and shortened the
time to EDSS = 6.0. Conclusion: Increasing disability is frequently associated with persistent activity. The
high number of relapses identifies early those patients worsening in the
presence of activity. Age predicts increasing disability in the absence of
activity. The presence of both factors increases the risk of developing
severe disability. As this study likely describes the transition to
progression, our findings contribute to improving patient management and
stratification in trials on progressive MS.
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Affiliation(s)
- Valentina Tomassini
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, UK
| | - Fulvia Fanelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Luca Prosperini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy/Department of Neurosciences, San Camillo- Forlanini Hospital, Rome, Italy
| | - Raffaella Cerqua
- Neurological Clinic, Marche Polytechnic University, Ancones, Italy
| | - Paola Cavalla
- Department of Neurosciences, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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10
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Maarouf A, Boutière C, Rico A, Audoin B, Pelletier J. How much progress has there been in the second-line treatment of multiple sclerosis: A 2017 update. Rev Neurol (Paris) 2018; 174:429-440. [PMID: 29779849 DOI: 10.1016/j.neurol.2018.01.369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 02/04/2023]
Abstract
In 1993, the US Food and Drug Administration (FDA) approved the first drug specifically for treating multiple sclerosis (MS). More than two decades later, a dozen such treatments are now available. Of these, four are considered second-line treatments for use in escalation strategies and two new drugs are currently undergoing accreditation procedures. Soon, they will provide clinicians with a range of six effective disease-modifying treatments (DMTs) to thwart the inflammatory processes in MS patients with active disease. However, while such a large number of DMTs for MS can help to control early inflammation, any decisions to be made by clinicians have also been made substantially more complex. This complexity is increased by the lack of head-to-head studies comparing these second-line therapies and the benefit-risk profiles for each of these drugs, which are likely to vary among patients. Ultimately, good awareness of the benefits and, more important, the risks of each MS DMT is crucial for the effective management of inflammation in MS.
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Affiliation(s)
- A Maarouf
- CRMBM UMR 7339 CNRS, Aix Marseille Université, 13005 Marseille, France; AP-HM, Hôpital de la Timone, Pôle d'Imagerie Médicale, CEMEREM, 13005 Marseille, France; AP-HM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005 Marseille, France.
| | - C Boutière
- AP-HM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005 Marseille, France
| | - A Rico
- AP-HM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005 Marseille, France
| | - B Audoin
- CRMBM UMR 7339 CNRS, Aix Marseille Université, 13005 Marseille, France; AP-HM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005 Marseille, France
| | - J Pelletier
- CRMBM UMR 7339 CNRS, Aix Marseille Université, 13005 Marseille, France; AP-HM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005 Marseille, France
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11
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Traboulsee A, Li D, Tam R, Zhao G, Riddehough A, Fang J, Dangond F, Kappos L. Subcutaneous interferon β-1a three times weekly and the natural evolution of gadolinium-enhancing lesions into chronic black holes in relapsing and progressive multiple sclerosis: Analysis of PRISMS and SPECTRIMS trials. Mult Scler J Exp Transl Clin 2017; 3:2055217317745340. [PMID: 29276624 PMCID: PMC5734469 DOI: 10.1177/2055217317745340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 11/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background Evolution of gadolinium-enhancing lesions into chronic black holes (CBH) may be reduced by interferon (IFN) therapy. Objective The objective of this paper is to assess the effect of IFN β-1a and placebo on CBH evolution and disability in patients with relapsing–remitting multiple sclerosis (RRMS), as well as CBH evolution in patients with secondary progressive multiple sclerosis (SPMS). Methods A post hoc, exploratory analysis of patients with RRMS and SPMS with monthly MRI scans (months –1 to 9) from two separate placebo-controlled clinical trials of IFN β-1a was conducted. Results In RRMS patients, the risk of ≥1 evolved CBH was lower for IFN β-1a versus placebo (odds ratio 0.42; p = 0.024); volume of newly evolved CBH was numerically reduced. A numerically higher proportion of patients with ≥1 evolving CBH vs no evolving CBH had confirmed three-month disability progression (four-year rate 55.8% vs 43.1%, respectively). Proportion of lesions evolving into CBH (patient level: 34.7% vs 12.6%, p < 0.0001; lesion level: 28.8% vs 11.0%, p < 0.0001) and evolved CBH volume (median 33.5 mm3 (Quartile 1, 0.0; Quartile 3, 173.4) vs 0.0 mm3 (0.0; 52.4); p = 0.0008) was higher for SPMS than RRMS patients treated with IFN β-1a. Conclusion In RRMS, IFN β-1a significantly decreased the proportion of new T1 Gd+ lesions evolving into CBH and the risk of developing a CBH. In patients with SPMS, more lesions develop to CBH, indicating reduced repair capacity, and the natural history of lesion development appears to be unaffected by IFN β-1a treatment.
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Affiliation(s)
- A Traboulsee
- Department of Medicine, Faculty of Medicine, University of British Columbia, Canada
| | - Dkb Li
- Department of Medicine, Faculty of Medicine, University of British Columbia, Canada
| | - R Tam
- University of British Columbia, Canada
| | - G Zhao
- Division of Neurology, University of British Columbia, Canada
| | - A Riddehough
- Division of Neurology, University of British Columbia, Canada
| | | | | | - L Kappos
- Departments of Medicine, Biomedicine, Clinical Research and Biomedical Engineering, University Hospital Basel, Switzerland
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12
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Kaunzner UW, Gauthier SA. MRI in the assessment and monitoring of multiple sclerosis: an update on best practice. Ther Adv Neurol Disord 2017; 10:247-261. [PMID: 28607577 DOI: 10.1177/1756285617708911] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/09/2017] [Indexed: 01/14/2023] Open
Abstract
Magnetic resonance imaging (MRI) has developed into the most important tool for the diagnosis and monitoring of multiple sclerosis (MS). Its high sensitivity for the evaluation of inflammatory and neurodegenerative processes in the brain and spinal cord has made it the most commonly used technique for the evaluation of patients with MS. Moreover, MRI has become a powerful tool for treatment monitoring, safety assessment as well as for the prognostication of disease progression. Clinically, the use of MRI has increased in the past couple decades as a result of improved technology and increased availability that now extends well beyond academic centers. Consequently, there are numerous studies supporting the role of MRI in the management of patients with MS. The aim of this review is to summarize the latest insights into the utility of MRI in MS.
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Affiliation(s)
- Ulrike W Kaunzner
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, New York, NY, USA
| | - Susan A Gauthier
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, 1305 York Avenue, New York, NY 10021, USA
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13
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Kaunzner UW, Al-Kawaz M, Gauthier SA. Defining Disease Activity and Response to Therapy in MS. Curr Treat Options Neurol 2017; 19:20. [PMID: 28451934 DOI: 10.1007/s11940-017-0454-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT Disease activity in multiple sclerosis (MS) has classically been defined by the occurrence of new neurological symptoms and the rate of relapses. Definition of disease activity has become more refined with the use of clinical markers, evaluating ambulation, dexterity, and cognition. Magnetic resonance imaging (MRI) has become an important tool in the investigation of disease activity. Number of lesions as well as brain atrophy have been used as surrogate outcome markers in several clinical trials, for which a reduction in these measures is appreciated in most treatment studies. With the increasing availability of new medications, the overall goal is to minimize inflammation to decrease relapse rate and ultimately prevent long-term disability. The aim of this review is to give an overview on commonly used clinical and imaging markers to monitor disease activity in MS, with emphasis on their use in clinical studies, and to give a recommendation on how to utilize these measures in clinical practice for the appropriate assessment of therapeutic response.
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Affiliation(s)
- Ulrike W Kaunzner
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, 1305 York Avenue, New York City, NY, 10021, USA
| | - Mais Al-Kawaz
- NewYork Presbyterian, Weill Cornell Medicine, 535 East 68th street, New York City, NY, USA
| | - Susan A Gauthier
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, 1305 York Avenue, New York City, NY, 10021, USA.
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14
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McNamara C, Sugrue G, Murray B, MacMahon PJ. Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 2-Surveillance for Treatment Complications and Disease Progression. AJNR Am J Neuroradiol 2017; 38:1672-1680. [PMID: 28428206 DOI: 10.3174/ajnr.a5148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An understanding of the new generation of MS drugs in conjunction with the key role MR imaging plays in the detection of disease progression, opportunistic infections, and drug-related adverse effects is of vital importance to the neuroradiologist. Part 1 of this review outlined the current treatment options available for MS and examined the mechanisms of action of the various medications. It also covered specific complications associated with each form of therapy. Part 2, in turn deals with the subject of pharmacovigilance and the optimal frequency of MRI monitoring for each individual patient, depending on his or her unique risk profile. Special attention is given to the diagnosing of progressive multifocal leukoencephalopathy in patients treated with natalizumab as this is a key area in which neuroradiologists can contribute to improved patient outcomes. This article also outlines the aims of treatment and reviews the possibility of "no evidence of disease activity" becoming a treatment goal with the availability of more effective therapies. Potential future areas and technologies including image subtraction, brain volume measurement and advanced imaging techniques such as double inversion recovery are also reviewed. It is anticipated that such advancements in this rapidly developing field will improve the accuracy of monitoring an individual patient's response to treatment.
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Affiliation(s)
- C McNamara
- From the Departments of Radiology (C.M., G.S., P.J.M.)
| | - G Sugrue
- From the Departments of Radiology (C.M., G.S., P.J.M.)
| | - B Murray
- Neurology (B.M.), Mater Misericordiae University Hospital, Dublin, Ireland
| | - P J MacMahon
- From the Departments of Radiology (C.M., G.S., P.J.M.)
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15
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Clarelli F, Liberatore G, Sorosina M, Osiceanu AM, Esposito F, Mascia E, Santoro S, Pavan G, Colombo B, Moiola L, Martinelli V, Comi G, Martinelli-Boneschi F. Pharmacogenetic study of long-term response to interferon-β treatment in multiple sclerosis. THE PHARMACOGENOMICS JOURNAL 2017; 17:84-91. [PMID: 26644207 DOI: 10.1038/tpj.2015.85] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/10/2015] [Accepted: 10/16/2015] [Indexed: 02/07/2023]
Abstract
The aim of the study is the identification of genetic factors that influence the long-term response to interferon-β (IFNβ) (4-year follow-up). We performed a genome-wide association study in 337 IFNβ-treated Italian multiple sclerosis patients at the extreme of treatment response, and we meta-analyzed association effects, integrating results with pathway analysis, gene-expression profiling of IFNβ-stimulated peripheral blood mononuclear cells from 20 healthy controls (HC) and expression quantitative locus (eQTL) analyses. From meta-analysis, 43 markers were associated at P<10-4, and two of them (rs7298096 and rs4726460) pointed to two genes, NINJ2 and TBXAS1, that were significantly downregulated after IFNβ stimulation in HC (P=3.1 × 10-9 and 5.6 × 10-10). We also observed an eQTL effect for the allele associated with favorable treatment response (rs4726460A); moreover, TBXAS1 appeared downregulated upon IFNβ administration (β=-0.39; P=0.02). Finally, we found an enrichment of pathways related to inflammatory processes and presynaptic membrane, the latter with involvement of genes related to glutamatergic system (GRM3 and GRIK2), confirming its potential role in the response to IFNβ.
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Affiliation(s)
- F Clarelli
- Laboratory of Genetics of Neurological Complex Disorders, CNS Inflammatory Unit, Division of Neuroscience & INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - G Liberatore
- Laboratory of Genetics of Neurological Complex Disorders, CNS Inflammatory Unit, Division of Neuroscience & INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - M Sorosina
- Laboratory of Genetics of Neurological Complex Disorders, CNS Inflammatory Unit, Division of Neuroscience & INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - A M Osiceanu
- Laboratory of Genetics of Neurological Complex Disorders, CNS Inflammatory Unit, Division of Neuroscience & INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - F Esposito
- Laboratory of Genetics of Neurological Complex Disorders, CNS Inflammatory Unit, Division of Neuroscience & INSPE, San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology and Neurorehabilitation, Division of Neuroscience, INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - E Mascia
- Laboratory of Genetics of Neurological Complex Disorders, CNS Inflammatory Unit, Division of Neuroscience & INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - S Santoro
- Laboratory of Genetics of Neurological Complex Disorders, CNS Inflammatory Unit, Division of Neuroscience & INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - G Pavan
- Department of Neurology and Neurorehabilitation, Division of Neuroscience, INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - B Colombo
- Department of Neurology and Neurorehabilitation, Division of Neuroscience, INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - L Moiola
- Department of Neurology and Neurorehabilitation, Division of Neuroscience, INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - V Martinelli
- Department of Neurology and Neurorehabilitation, Division of Neuroscience, INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - G Comi
- Department of Neurology and Neurorehabilitation, Division of Neuroscience, INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - F Martinelli-Boneschi
- Laboratory of Genetics of Neurological Complex Disorders, CNS Inflammatory Unit, Division of Neuroscience & INSPE, San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology and Neurorehabilitation, Division of Neuroscience, INSPE, San Raffaele Scientific Institute, Milan, Italy
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16
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Ziemssen T, Kern R, Cornelissen C. Study design of PANGAEA 2.0, a non-interventional study on RRMS patients to be switched to fingolimod. BMC Neurol 2016; 16:129. [PMID: 27502119 PMCID: PMC4977700 DOI: 10.1186/s12883-016-0648-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/26/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The therapeutic options for patients with Multiple Sclerosis (MS) have steadily increased due to the approval of new substances that now supplement traditional first-line agents, demanding a paradigm shift in the assessment of disease activity and treatment response in clinical routine. Here, we report the study design of PANGAEA 2.0 (Post-Authorization Non-interventional GermAn treatment benefit study of GilEnyA in MS patients), a non-interventional study in patients with relapsing-remitting MS (RRMS) identify patients with disease activity and monitor their disease course after treatment switch to fingolimod (Gilenya®), an oral medication approved for patients with highly active RRMS. METHOD/DESIGN In the first phase of the PANGAEA 2.0 study the disease activity status of patients receiving a disease-modifying therapy (DMT) is evaluated in order to identify patients at risk of disease progression. This evaluation is based on outcome parameters for both clinical disease activity and magnetic resonance imaging (MRI), and subclinical measures, describing disease activity from the physician's and the patient's perspective. In the second phase of the study, 1500 RRMS patients identified as being non-responders and switched to fingolimod (oral, 0.5 mg/daily) are followed-up for 3 years. Data on relapse activity, disability progression, MRI lesions, and brain volume loss will be assessed in accordance to 'no evidence of disease activity-4' (NEDA-4). The modified Rio score, currently validated for the evaluation of treatment response to interferons, will be used to evaluate the treatment response to fingolimod. The MS management software MSDS3D will guide physicians through the complex processes of diagnosis and treatment. A sub-study further analyzes the benefits of a standardized quantitative evaluation of routine MRI scans by a central reading facility. PANGAEA 2.0 is being conducted between June 2015 and December 2019 in 350 neurological practices and centers in Germany, including 100 centers participating in the sub-study. DISCUSSION PANGAEA 2.0 will not only evaluate the long-term benefit of a treatment change to fingolimod but also the applicability of new concepts of data acquisition, assessment of MS disease activity and evaluation of treatment response for the in clinical routine. TRIAL REGISTRATION BfArM6532; Trial Registration Date: 20/05/2015.
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Affiliation(s)
- Tjalf Ziemssen
- Zentrum für klinische Neurowissenschaften, Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 43, D-01307, Dresden, Germany.
| | - Raimar Kern
- Zentrum für klinische Neurowissenschaften, Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 43, D-01307, Dresden, Germany
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Leocani L, Rocca MA, Comi G. MRI and neurophysiological measures to predict course, disability and treatment response in multiple sclerosis. Curr Opin Neurol 2016; 29:243-53. [DOI: 10.1097/wco.0000000000000333] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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18
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Freedman MS, Rush CA. Severe, Highly Active, or Aggressive Multiple Sclerosis. Continuum (Minneap Minn) 2016; 22:761-84. [DOI: 10.1212/con.0000000000000331] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Galassi S, Prosperini L, Logoteta A, Hirsch MN, Fanelli F, De Giglio L, Pozzilli C. A lesion topography-based approach to predict the outcomes of patients with multiple sclerosis treated with Interferon Beta. Mult Scler Relat Disord 2016; 8:99-106. [PMID: 27456883 DOI: 10.1016/j.msard.2016.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/09/2016] [Accepted: 05/15/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND With increasing availability of effective disease-modifying treatments for multiple sclerosis (MS), an early identification of patients who do not adequately respond to Interferon Beta (IFNB) is relevant to decide the future strategy. OBJECTIVE To investigate the predictive role of new lesion location on the risk of breakthrough disease in IFNB-treated patients with MS. METHODS We analysed data from 392 patients starting IFNB and regularly followed up to 5 years. Before and after one year of IFNB treatment, all patients underwent a conventional brain and spinal cord magnetic resonancer imaging (MRI) scan with the same 1.5T magnet to obtain the count and location of new MRI lesions. Relapses and MRI activity occurred in the first year of IFNB treatment (year 0-1) were included in the set of potential predictors for relapses and disability worsening in the subsequent four years (year 2-5). RESULTS We found that 96 (24.5%) patients had relapses and/or MRI activity in the first year of IFNB treatment, while 41.6% of the patients experienced relapses and 17.8% experienced disability worsening. from year 2 to 5. The risk of relapses (year 2-5) was associated with ≥2 relapses (HR=5.65, p<0.001) and new T2-hyperintense lesions (for 2 new lesions: HR=1.96, p=0.011; for ≥3 new lesions: HR=3.55, p<0.001) in the first year of treatment. Other than male sex (HR=2.01, p=0.01) and higher EDSS score (HR=2.17, p<0.001), the risk of disability worsening (year 2-5) was associated with ≥2 relapses (HR=4.33, p<0.001) and new spinal cord or infratentorial lesions (HR=4.45,p<0.001) in the first year of treatment. CONCLUSIONS Our findings suggest a dose-effect relationship between the lesion count and the risk of future relapses, while the occurrence of new MRI lesions in sites representing anatomical bottle-necks was better than lesion count at predicting the future risk of disability worsening despite IFNB treatment.
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Affiliation(s)
- Stefania Galassi
- Department of Diagnostic Imaging, San Giovanni Decollato Andosilla Hospital, Viterbo, Italy
| | - Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | | | | | | | - Laura De Giglio
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy; S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Carlo Pozzilli
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy; S. Andrea Hospital, Sapienza University, Rome, Italy
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Klistorner A, Wang C, Yiannikas C, Graham SL, Parratt J, Barnett MH. Progressive Injury in Chronic Multiple Sclerosis Lesions Is Gender-Specific: A DTI Study. PLoS One 2016; 11:e0149245. [PMID: 26901540 PMCID: PMC4764675 DOI: 10.1371/journal.pone.0149245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/28/2016] [Indexed: 12/20/2022] Open
Abstract
Objective To evaluate the longitudinal integrity of white matter tracts in patients with relapsing remitting multiple sclerosis (RRMS) as determined by changes in diffusivity indices of lesional and non-lesional white matter in the optic radiation over 12 months. Methods The optic radiation (OR) was identified in sixty RRMS patients using probabilistic tractography. MS lesions were segmented on FLAIR T2 images and a lesion mask was intersected with the co-registered OR. Lesions within the OR were identified in 39 patients. Voxel-based analysis of axial diffusivity (AD) and radial diffusivity (RD) within OR lesions and non-lesional normal appearing white matter (NAWM) was performed at baseline and 12 months in 34 patients (five patients excluded due to new OR lesions). Results Both RD and AD demonstrated much higher values within the lesions compared with non-lesional NAWM. There was a significant (p<0.001) increase of lesional AD and RD during the follow-up period. This increase, however, was driven almost entirely by the male cohort, in which a significantly greater change in both AD (M-2.7%, F-0.9%) and RD (M-4.6%, F-0.7%) was observed during the follow-up period. Non-lesional NAWM also demonstrated an increase in both AD and RD, albeit on a much lesser scale (1.0% and 0.6% respectively). In contradistinction to lesions, the diffusivity change in non-lesional NAWM was similar between sexes. Conclusions The evolution of AD and RD in chronic MS lesions over 12 months suggests ongoing inflammatory demyelinating activity accompanied by axonal loss. In addition, our findings are consistent with the recently observed trend of more rapid clinical progression in males and establish a potential in vivo biomarker of gender dichotomy by demonstrating a significantly faster rate of microstructural change in the chronic lesions of male patients with MS.
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Affiliation(s)
- Alexander Klistorner
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, Australia
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
- Sydney Neuroimaging Analysis Centre, Sydney, NSW, Australia
- * E-mail:
| | - Chenyu Wang
- Sydney Neuroimaging Analysis Centre, Sydney, NSW, Australia
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Stuart L. Graham
- Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | | | - Michael H. Barnett
- Sydney Neuroimaging Analysis Centre, Sydney, NSW, Australia
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Abstract
Due to its sensitivity to the different multiple sclerosis (MS)-related abnormalities, magnetic resonance imaging (MRI) has become an established tool to diagnose MS and to monitor its evolution. MRI has been included in the diagnostic workup of patients with clinically isolated syndromes suggestive of MS, and ad hoc criteria have been proposed and are regularly updated. In patients with definite MS, the ability of conventional MRI techniques to explain patients' clinical status and progression of disability is still suboptimal. Several advanced MRI-based technologies have been applied to estimate overall MS burden in the different phases of the disease. Their use has allowed the heterogeneity of MS pathology in focal lesions, normal-appearing white matter and gray matter to be graded in vivo. Recently, additional features of MS pathology, including macrophage infiltration and abnormal iron deposition, have become quantifiable. All of this, combined with functional imaging techniques, is improving our understanding of the mechanisms associated with MS evolution. In the near future, the use of ultrahigh-field systems is likely to provide additional insight into disease pathophysiology. However, the utility of advanced MRI techniques in clinical trial monitoring and in assessing individual patients' response to treatment still needs to be assessed.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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22
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Goodin DS, Reder AT, Bermel RA, Cutter GR, Fox RJ, John GR, Lublin FD, Lucchinetti CF, Miller AE, Pelletier D, Racke MK, Trapp BD, Vartanian T, Waubant E. Relapses in multiple sclerosis: Relationship to disability. Mult Scler Relat Disord 2015; 6:10-20. [PMID: 27063617 DOI: 10.1016/j.msard.2015.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 08/21/2015] [Accepted: 09/02/2015] [Indexed: 12/21/2022]
Abstract
Multiple sclerosis (MS) is a recurrent inflammatory disease of the central nervous system, which ultimately causes substantial disability in many patients. A key clinical feature of this disease is the occurrence of relapses, consisting of episodes of neurological dysfunction followed by periods of remission. This review considers in detail the importance of the occurrence of relapses to the ultimate course of MS and the impact of relap setreatment (both acutely and prophylactically) on the long-term outcome for individuals. The ultimate goal of therapy in MS is the reduction of long-term disability. Clinical trials in MS, however, typically only extend for a very short time period compared to the time it takes for disability to evolve. Consequently, short-term outcome measures that are associated with, and predict, future disability need to be identified. In this regard, not only are relapses a characteristic feature of MS, they have also been proven to be associated with the occurrence of long-term disability. Moreover, treatments that reduce the number and severity of these attacks improve the long-term prognosis.
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Affiliation(s)
- Douglas S Goodin
- Multiple Sclerosis Center, University of California, San Francisco Medical Center, San Francisco, CA, United States; Department of Neurology, University of California, San Francisco School of Medicine, San Francisco, CA, United States.
| | - Anthony T Reder
- Department of Neurology, The University of Chicago, Chicago, IL, United States
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Gary R Cutter
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Gareth R John
- Multiple Sclerosis Research Laboratory, Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Friedman Brain Institute, New York, NY, United States; Department of Neurology, Mount Sinai School of Medicine, New York, NY, United States
| | - Fred D Lublin
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Aaron E Miller
- Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Daniel Pelletier
- Neuro-Immunology Division and Yale Multiple Sclerosis Center, Advanced Imaging in Multiple Sclerosis (AIMS) Laboratory, Yale University School of Medicine, New Haven, CT, United States
| | - Michael K Racke
- Department of Neurology, Wexner Medical Center at The Ohio State University, Columbus, OH, United States
| | - Bruce D Trapp
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Timothy Vartanian
- Judith Jaffe Multiple Sclerosis Center, New York-Presbyterian Hospital/Weill Cornell Medical Center, Weill Cornell Medical College, United States
| | - Emmanuelle Waubant
- UCSF Regional Pediatric MS Center, Race to Erase MS, San Francisco, CA, United States
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Ziemssen T, De Stefano N, Sormani MP, Van Wijmeersch B, Wiendl H, Kieseier BC. Optimizing therapy early in multiple sclerosis: An evidence-based view. Mult Scler Relat Disord 2015; 4:460-469. [DOI: 10.1016/j.msard.2015.07.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/01/2015] [Accepted: 07/15/2015] [Indexed: 01/26/2023]
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Abstract
Multiple sclerosis (MS) is a CNS disorder characterized by inflammation, demyelination and neurodegeneration, and is the most common cause of acquired nontraumatic neurological disability in young adults. The course of the disease varies between individuals: some patients accumulate minimal disability over their lives, whereas others experience a rapidly disabling disease course. This latter subset of patients, whose MS is marked by the rampant progression of disability over a short time period, is often referred to as having 'aggressive' MS. Treatment of patients with aggressive MS is challenging, and optimal strategies have yet to be defined. It is important to identify patients who are at risk of aggressive MS as early as possible and implement an effective treatment strategy. Early intervention might protect patients from irreversible damage and disability, and prevent the development of a secondary progressive course, which thus far lacks effective therapy.
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Romeo M, Martinelli V, Rodegher M, Perego E, Maida S, Sormani MP, Comi G. Validation of 1-year predictive score of long-term response to interferon-β in everyday clinical practice multiple sclerosis patients. Eur J Neurol 2015; 22:973-80. [DOI: 10.1111/ene.12695] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/12/2015] [Indexed: 01/21/2023]
Affiliation(s)
- M. Romeo
- Division of Neuroscience; Department of Neurology; Institute of Experimental Neurology (INSPE); San Raffaele Scientific Institute; Milan Italy
| | - V. Martinelli
- Division of Neuroscience; Department of Neurology; Institute of Experimental Neurology (INSPE); San Raffaele Scientific Institute; Milan Italy
| | - M. Rodegher
- Division of Neuroscience; Department of Neurology; Institute of Experimental Neurology (INSPE); San Raffaele Scientific Institute; Milan Italy
| | - E. Perego
- Division of Neuroscience; Department of Neurology; Institute of Experimental Neurology (INSPE); San Raffaele Scientific Institute; Milan Italy
| | - S. Maida
- Division of Neuroscience; Department of Neurology; Institute of Experimental Neurology (INSPE); San Raffaele Scientific Institute; Milan Italy
| | - M. P. Sormani
- Department of Health Sciences; University of Genoa; Genoa Italy
| | - G. Comi
- Division of Neuroscience; Department of Neurology; Institute of Experimental Neurology (INSPE); San Raffaele Scientific Institute; Milan Italy
- Vita-Salute San Raffaele University; Milan Italy
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Update on treatments in multiple sclerosis. Presse Med 2015; 44:e137-51. [DOI: 10.1016/j.lpm.2015.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/01/2015] [Accepted: 02/09/2015] [Indexed: 02/04/2023] Open
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Bertolotto A, Granieri L, Marnetto F, Valentino P, Sala A, Capobianco M, Malucchi S, Di Sapio A, Malentacchi M, Matta M, Caldano M. Biological monitoring of IFN-β therapy in Multiple Sclerosis. Cytokine Growth Factor Rev 2015; 26:241-8. [DOI: 10.1016/j.cytogfr.2014.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/09/2014] [Indexed: 11/26/2022]
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28
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Freedman MS, Abdoli M. Evaluating response to disease-modifying therapy in relapsing multiple sclerosis. Expert Rev Neurother 2015; 15:407-23. [DOI: 10.1586/14737175.2015.1023711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bertolotto A. Evaluation of the impact of neutralizing antibodies on IFNβ response. Clin Chim Acta 2015; 449:31-6. [PMID: 25769291 DOI: 10.1016/j.cca.2015.02.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
IFNβ therapeutic action depends on a sequence of biological steps: i) the interaction between interferon beta (IFNβ) and its receptor (IFNAR) located at the cell surface of peripheral blood mononuclear cells; ii) activation of second messengers; iii) transcription of several genes containing specific ISRE regions (Interferon Stimulated Response Elements); and iv) synthesis of specific proteins. Although IFNβ therapy has improved treatment options of patients with multiple sclerosis (MS), the long-term efficacy of IFNβs can be compromised due to the development of neutralizing antibodies (NAbs). High titer NAbs develop in about 15% of patients; they abolish IFNβ biological activity and consequently the therapeutic action of IFNβ. Different IFNβ preparations carry different risks of developing NAbs, ranging from 3 to 28%. The risk of inducing NAbs must be considered in the selection of treatment. Guidelines for NAbs testing and the therapeutic decision in case of NAbs positivity have been established. NAbs positivity predicts MRI and clinical activity. Precocious identification of Nabs-positive patients and switch to alternative treatments can improve the percentage of responders and allow a better allocation of relevant economical resources.
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Affiliation(s)
- Antonio Bertolotto
- Neurologia 2-CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi, Orbassano, Italy.
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30
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Arnold DL, Calabresi PA, Kieseier BC, Sheikh SI, Deykin A, Zhu Y, Liu S, You X, Sperling B, Hung S. Effect of peginterferon beta-1a on MRI measures and achieving no evidence of disease activity: results from a randomized controlled trial in relapsing-remitting multiple sclerosis. BMC Neurol 2014; 14:240. [PMID: 25551571 PMCID: PMC4311432 DOI: 10.1186/s12883-014-0240-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/05/2014] [Indexed: 12/19/2022] Open
Abstract
Background Subcutaneous peginterferon beta-1a provided clinical benefits at Year 1 (placebo-controlled period) of the 2-Year Phase 3 ADVANCE study in relapsing-remitting multiple sclerosis (RRMS). Here we report the effect of peginterferon beta-1a on brain magnetic resonance imaging (MRI) lesions, and no evidence of disease activity (NEDA; absence of clinical [relapses and 12-week confirmed disability progression] and MRI [gadolinium-enhancing, and new or newly-enlarging T2 hyperintense lesions] disease activity) during Year 1. Methods RRMS patients (18–65 years; Expanded Disability Status Scale score ≤5) were randomized to double-blind placebo or peginterferon beta-1a 125 μg every 2 or 4 weeks. Sensitivity analyses of last observation carried forward and composite disease activity (using minimal MRI allowance definitions) were conducted. Results 1512 patients were randomized and dosed (placebo n = 500; peginterferon beta-1a every 2 [n = 512] or 4 [n = 500] weeks). Every 2 week dosing significantly reduced, versus placebo and every 4 week dosing, the number of new or newly-enlarging T2 hyperintense lesions at Weeks 24 (by 61% and 51%, respectively) and 48 (secondary endpoint; by 67% and 54%, respectively); all p < 0.0001. Every 2 week dosing also provided significant reductions versus placebo and every 4 week dosing in the number of new T1 hypointense, gadolinium-enhancing, and new active (gadolinium-enhancing plus non-enhancing new T2) lesions (all p < 0.0001), as well as the volume of T2 and T1 lesions (p < 0.05) at Weeks 24 and 48. Significantly more patients dosed every 2 weeks had NEDA versus placebo and every 4 weeks (all p < 0.01) from baseline to Week 48 (33.9% versus 15.1% and 21.5%, respectively [odds ratios, ORs: 2.89 and 1.87]), from baseline to Week 24 (41.0% versus 21.9% and 30.7%, [ORs: 2.47 and 1.57]) and from Week 24 to Week 48 (60.2% versus 28.9% and 36.6%, [ORs: 3.71 and 2.62]). Consistent results were seen when allowing for minimal MRI activity. Conclusion During Year 1 of ADVANCE, significantly more RRMS patients receiving peginterferon beta-1a every 2 weeks had NEDA, and early and sustained improvements in all MRI endpoints, versus placebo and every 4 week dosing. NEDA sensitivity analyses align with switch strategies in clinical practice settings and provide insight into future responders/non-responders. Trial registration ClinicalTrials.gov: NCT00906399 Electronic supplementary material The online version of this article (doi:10.1186/s12883-014-0240-x) contains supplementary material, which is available to authorized users.
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Sellebjerg F, Søndergaard HB, Koch-Henriksen N, Sørensen PS, Oturai AB. Prediction of response to interferon therapy in multiple sclerosis. Acta Neurol Scand 2014; 130:268-75. [PMID: 24943672 DOI: 10.1111/ane.12269] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Single nucleotide polymorphisms (SNPs) in the genes encoding interferon response factor (IRF)-5, IRF-8 and glypican-5 (GPC5) have been associated with disease activity in multiple sclerosis (MS) patients treated with interferon (IFN)-β. We analysed whether SNPs in the IRF5, IRF8 and GPC5 genes are associated with clinical disease activity in MS patients beginning de novo treatment with IFN-β. METHODS The SNPs rs2004640, rs3807306 and rs4728142 in IRF5, rs13333054 and rs17445836 in IRF8 and rs10492503 in GPC5 were genotyped in 575 patients with relapsing-remitting MS followed prospectively after the initiation of their first treatment with IFN-β. RESULTS 62% of patients experienced relapses during the first 2 years of treatment, and 32% had disability progression during the first 5 years of treatment. Patients with a pretreatment annualized relapse rate >1 had an increased risk of relapse (hazard ratio 1.53, 95% confidence interval 1.24-1.90) and progression (hazard ratio 1.48, 95% confidence interval 1.10-1.99) on treatment and patients with breakthrough relapses in the form of relapses during the first 2 years of treatment had an increased risk of progression during the first 5 years of treatment (hazard ratio 2.04, 95% confidence interval 1.47-2.85).The gene variants in IRF5, IRF8 and GPC5 were not associated with risk of relapse or disease progression. CONCLUSIONS Pretreatment relapse rate and clinical disease activity during the first 2 years of treatment may be associated with disease progression in MS patients treated with IFN-β. Genetic analysis of the studied gene variants do not provide additional information.
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Affiliation(s)
- F. Sellebjerg
- Danish Multiple Sclerosis Center; Department of Neurology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - H. B. Søndergaard
- Danish Multiple Sclerosis Center; Department of Neurology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - N. Koch-Henriksen
- The Danish MS Registry under the Danish MS Center; Rigshospitalet; University of Copenhagen and Clinical Institute; Copenhagen Denmark
- Department of Clinical Epidemiology; Aarhus University; Aarhus Denmark
| | - P. S. Sørensen
- Danish Multiple Sclerosis Center; Department of Neurology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - A. B. Oturai
- Danish Multiple Sclerosis Center; Department of Neurology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
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Abstract
The Canadian Multiple Sclerosis Working Group (CMSWG) developed practical recommendations in 2004 to assist clinicians in optimizing the use of disease-modifying therapies (DMT) in patients with relapsing multiple sclerosis. The CMSWG convened to review how disease activity is assessed, propose a more current approach for assessing suboptimal response, and to suggest a scheme for switching or escalating treatment. Practical criteria for relapses, Expanded Disability Status Scale (EDSS) progression and MRI were developed to classify the clinical level of concern as Low, Medium and High. The group concluded that a change in treatment may be considered in any RRMS patient if there is a high level of concern in any one domain (relapses, progression or MRI), a medium level of concern in any two domains, or a low level of concern in all three domains. These recommendations for assessing treatment response should assist clinicians in making more rational choices in their management of relapsing MS patients.
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Kinkel RP, Simon JH, O'Connor P, Hyde R, Pace A. Early MRI activity predicts treatment nonresponse with intramuscular interferon beta-1a in clinically isolated syndrome. Mult Scler Relat Disord 2014; 3:712-9. [PMID: 25891550 DOI: 10.1016/j.msard.2014.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/31/2014] [Accepted: 08/18/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Determine whether MRI activity 6 months after treatment initiation in the Controlled High-Risk Subjects Avonex® Multiple Sclerosis Prevention Study (CHAMPS) predicted progression to clinically definite multiple sclerosis (CDMS) over the subsequent 30 months in intramuscular interferon beta-1a (IM IFNβ-1a)-treated patients vs placebo-treated patients. METHODS CHAMPS patients were randomized to once-weekly IM IFNβ-1a 30 μg or placebo for up to 36 months. MRI was performed every 6 months until CDMS confirmation. Patient groups were defined based on new T2 and/or Gd+ lesions at 6 months. RESULTS Thirteen IM IFNβ-1a patients (6.7%) and 24 placebo patients (12.6%) developed CDMS prior to month 6 and did not undergo the 6-month MRI. At 6 months, 29.7% of IM IFNβ-1a-treated patients vs 40.9% of placebo-treated patients were defined as having high MRI activity levels (≥2 new T2 and/or ≥2 Gd+ lesions). In this subgroup, estimated cumulative probabilities of CDMS were similar between groups (HR=0.88 [0.44-1.77], p=0.7227). A significant treatment response was seen for patients with <2 new T2 and <2 Gd+ lesions at 6 months (HR=0.39 [0.19-0.82], p=0.0120). CONCLUSION MRI scans 6 months after IM IFNβ-1a initiation in CIS patients predict early treatment non-response. Standardized scanning and monitoring may facilitate early disease management.
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Affiliation(s)
- R P Kinkel
- Department of Neurosciences, University of California San Diego, 9500 Gilman Dr, MC 0662, La Jolla, CA 92093, USA.
| | - J H Simon
- Portland VA Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239, USA.
| | - P O'Connor
- Multiple Sclerosis Clinic, St. Michael׳s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
| | - R Hyde
- Biogen Idec Inc., 14 Cambridge Center, Cambridge, MA 02142, USA.
| | - A Pace
- Biogen Idec Inc., 14 Cambridge Center, Cambridge, MA 02142, USA.
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Prosperini L, Capobianco M, Giannì C. Identifying responders and nonresponders to interferon therapy in multiple sclerosis. Degener Neurol Neuromuscul Dis 2014; 4:75-85. [PMID: 32669902 PMCID: PMC7337239 DOI: 10.2147/dnnd.s42734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/06/2014] [Indexed: 12/16/2022] Open
Abstract
Interferon beta is a well established disease-modifying agent used for relapsing-remitting multiple sclerosis. Despite treatment, a relevant proportion of patients continue to experience clinical (ie, relapses, worsening of disability) and magnetic resonance imaging (MRI) activity. Early identification of responders and nonresponders to interferon beta is strongly recommended to select patients who need a prompt switch to another disease-modifying agent and to ultimately avoid accumulation of fixed disability over time. Detecting responders and nonresponders to interferon beta can be challenging, mainly because of the lack of a clear and shared clinical definition of response to treatment. Clinical features at the start of treatment should be considered as prognostic factors, but MRI parameters assessed during treatment, such as contrast-enhancing lesions or new T2-hyperintense lesions, may be sensitive markers of response to interferon beta. Quantitative scoring systems derived from a combination of relapses and MRI activity have recently been proposed as practical tools for use in the everyday clinical setting. Blood biomarkers, such as neutralizing antibodies to interferon beta and Myxovirus resistance protein A, provide further useful information for detecting responders and nonresponders to interferon beta. However, since the presence of neutralizing antibodies can only partially explain the nonresponse to interferon beta, biomarkers of interferon beta activity possibly related to the pathogenesis of the disease could represent a future step toward a tailored, long-lasting effective treatment against multiple sclerosis.
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Affiliation(s)
- Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Marco Capobianco
- Regional Multiple Sclerosis Centre, University Hospital San Luigi Gonzaga, Orbassano, Italy
| | - Costanza Giannì
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
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Cook SD, Dhib-Jalbut S, Dowling P, Durelli L, Ford C, Giovannoni G, Halper J, Harris C, Herbert J, Li D, Lincoln JA, Lisak R, Lublin FD, Lucchinetti CF, Moore W, Naismith RT, Oehninger C, Simon J, Sormani MP. Use of Magnetic Resonance Imaging as Well as Clinical Disease Activity in the Clinical Classification of Multiple Sclerosis and Assessment of Its Course: A Report from an International CMSC Consensus Conference, March 5-7, 2010. Int J MS Care 2014; 14:105-14. [PMID: 24453741 DOI: 10.7224/1537-2073-14.3.105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
It has recently been suggested that the Lublin-Reingold clinical classification of multiple sclerosis (MS) be modified to include the use of magnetic resonance imaging (MRI). An international consensus conference sponsored by the Consortium of Multiple Sclerosis Centers (CMSC) was held from March 5 to 7, 2010, to review the available evidence on the need for such modification of the Lublin-Reingold criteria and whether the addition of MRI or other biomarkers might lead to a better understanding of MS pathophysiology and disease course over time. The conference participants concluded that evidence of new MRI gadolinium-enhancing (Gd+) T1-weighted lesions and unequivocally new or enlarging T2-weighted lesions (subclinical activity, subclinical relapses) should be added to the clinical classification of MS in distinguishing relapsing inflammatory from progressive forms of the disease. The consensus was that these changes to the classification system would provide more rigorous definitions and categorization of MS course, leading to better insights as to the evolution and treatment of MS.
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Affiliation(s)
- Stuart D Cook
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Suhayl Dhib-Jalbut
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Peter Dowling
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Luca Durelli
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Corey Ford
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Gavin Giovannoni
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - June Halper
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Colleen Harris
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Joseph Herbert
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - David Li
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - John A Lincoln
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Robert Lisak
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Fred D Lublin
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Claudia F Lucchinetti
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Wayne Moore
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Robert T Naismith
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Carlos Oehninger
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Jack Simon
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
| | - Maria Pia Sormani
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA (SDC); Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (SDJ); VA Medical Center-East Orange, East Orange, NJ, USA (PD); Department of Clinical and Biological Sciences, San Luigi Gonzaga Medical School, University of Torino, Orbassano, Italy (LD); Multiple Sclerosis Clinic, University of New Mexico Health Sciences Center, Albuquerque, NM, USA (CF); Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, Whitechapel, London, UK (GG); Consortium of Multiple Sclerosis Centers, Hackensack, NJ, USA (J Halper); Multiple Sclerosis Clinic, Foothills Medical Centre, Calgary, Alberta, Canada (CH); MS Comprehensive Care Center, NYU Langone Medical Center, New York, NY, USA (J Herbert); MS Clinic, University of British Columbia Hospital, Vancouver, British Columbia, Canada (DL); MS Research Group, University of Texas Health, Houston, TX, USA (JAL); Comprehensive Clinical and Research MS Center, Wayne State University, Detroit, MI, USA (RL); Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Mount Sinai School of Medicine, New York, NY, USA (FDL); Department of Neurology, Mayo Clinic, Rochester, MN, USA (CFL); Vancouver General Hospital, Vancouver, British Columbia, Canada (WM); Department of Neurology, Washington University, St. Louis, MO, USA (RTN); LACTRIMS and Institute of Neurology, Montevideo, Uruguay (CO); VA Medical Center, Portland, OR, USA (JS); and Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy (MPS)
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Dobson R, Rudick RA, Turner B, Schmierer K, Giovannoni G. Assessing treatment response to interferon-β: is there a role for MRI? Neurology 2014; 82:248-54. [PMID: 24336144 PMCID: PMC3902760 DOI: 10.1212/wnl.0000000000000036] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/02/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Interferon-β (IFN-β) has been shown to reduce relapse rates in multiple sclerosis; however, the clinical response appears to vary among individuals. Can early MRI be used to identify those patients who have a poor response to treatment? METHODS A systematic review of studies examining differential treatment response and clinical endpoints in groups defined as responders or nonresponders to IFN-β was performed. Meta-analytic techniques were used to combine study results where appropriate. RESULTS Patients with MRI evidence of poor response to IFN-β treatment as defined by either ≥2 new hyperintense T2 lesions or new gadolinium-enhancing lesions had significantly increased risk of both future relapses and progression as defined by the Expanded Disability Status Scale. There appeared to be an increased risk of poor outcomes 16 years after treatment initiation in those with an initial poor response to treatment. Previous evidence has shown this not to be the case in placebo arms of clinical trials. CONCLUSIONS For those patients starting IFN-β, early MRI, within 6 to 24 months after starting treatment, has the potential to provide important information when counseling patients about the likelihood of future treatment failure. This can inform treatment decisions before clinical relapses or disease progression.
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Affiliation(s)
- Ruth Dobson
- From the Queen Mary University London (R.D., K.S., G.G.), Blizard Institute, UK; Neurological Institute (R.A.R.), Mellen Center for MS Treatment and Research, Cleveland, OH; and Royal London Hospital (R.D., B.T., K.S., G.G.), Barts Health NHS Trust, UK
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Pozzilli C, Petsas N, Prosperini L. MRI for monitoring response to preventive treatment in multiple sclerosis. Expert Rev Neurother 2014; 9:305-7. [DOI: 10.1586/14737175.9.3.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Guidelines on the clinical use for the detection of neutralizing antibodies (NAbs) to IFN beta in multiple sclerosis therapy: report from the Italian Multiple Sclerosis Study group. Neurol Sci 2013; 35:307-16. [PMID: 24374787 DOI: 10.1007/s10072-013-1616-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/17/2013] [Indexed: 01/04/2023]
Abstract
Interferon beta (IFNβ) was the first specific disease-modifying treatment licensed for relapsing-remitting multiple sclerosis, and is still one of the most commonly prescribed treatments. A strong body of evidence supports the effectiveness of IFNβ preparations in reducing the annual relapse rate, magnetic resonance (MRI) disease activity and disease progression. However, the development of binding/neutralizing antibodies (BAbs/NAbs) during treatment negatively affects clinical and MRI outcomes. Therefore, guidelines for the clinical use for the detection of NAbs in MS may result in better treatment of these patients. In October 2012, a panel of Italian neurologists from 17 MS clinics convened in Milan to review and discuss data on NAbs and their clinical relevance in the treatment of MS. In this paper, we report the panel's recommendations for the use of IFNβ Nabs detection in the early identification of IFNβ non-responsiveness and the management of patients on IFNβ treatment in Italy, according to a model of therapeutically appropriate care.
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Brochet B. [Is MRI monitoring useful in clinical practice in patients with multiple sclerosis? Yes]. Rev Neurol (Paris) 2013; 169:858-63. [PMID: 24094530 DOI: 10.1016/j.neurol.2013.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 08/29/2013] [Indexed: 10/26/2022]
Abstract
The place of magnetic resonance imaging (MRI) in the monitoring of patients with multiple sclerosis (MS) is not codified except during the diagnostic phase. Several studies in the literature have shown that lesion load measured on an MRI done at the beginning of the disease or its increase during the first years had a predictive value, although moderate, on the occurrence of long-term disability as measured by the EDSS. Early worsening of brain atrophy during the early stages of the disease is predictive of worsening cognitive impairment in the following years. Perform an MRI is not required when setting up a first-line disease-modifying therapy (DMT) such as an immunomodulatory treatment but it is useful because it can be used as a reference scan in case of treatment failure. The indications of second-line DMTs, whether prescribed in naive patients with an active disease or after failure of a first-line DMT, are based on combined criteria incorporating MRI data acquired in the previous 3 months compared with a recent MRI. Thus the practical criteria for failure of first-line DMTs are partly based on MRI. During interferon therapy, identification of disease activity on an MRI conducted 1 year after the start of the treatment can predict treatment failure in combination with clinical criteria, such as relapses occurring during the first year. Finally, MRI is essential to the safety monitoring of patients on natalizumab to detect progressive multifocal leukoencephalopathies (PML). In patients at high risk for PML, tested positive for JC virus antibodies and having received natalizumab for more than 2 years, it could be proposed to do a short MRI with FLAIR and diffusion weighted imaging sequences every 3 months to detect preclinical PML.
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Affiliation(s)
- B Brochet
- Service de neurologie, centre hospitalier Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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40
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Prosperini L, Mancinelli CR, De Giglio L, De Angelis F, Barletta V, Pozzilli C. Interferon beta failure predicted by EMA criteria or isolated MRI activity in multiple sclerosis. Mult Scler 2013; 20:566-76. [DOI: 10.1177/1352458513502399] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective: The objective of this paper is to investigate four-year outcomes of interferon beta (IFNB)-treated patients with multiple sclerosis (MS) according to their clinical or magnetic resonance imaging (MRI) activity status at first year of treatment. Methods: A total of 370 patients with MS duration ≤5 years before IFNB start were followed-up for four years. The optimal threshold for one-year MRI activity that more accurately predicted subsequent relapses or disability worsening was identified. The risk of relapses and disability worsening after the first year was then estimated by propensity score (PS)-adjusted analyses in patients fulfilling European Medicines Agency (EMA) criteria for second-line escalation and in those with isolated MRI activity. Results: A total of 192 (51.9%) patients relapsed, and 66 (17.8%) worsened in disability from year 1 to 4 of follow-up. The more accurate threshold for one-year MRI activity was the occurrence of ≥1 enhancing or ≥2 new T2-lesions. An increased risk of relapses and disability worsening was found in either patients fulfilling EMA criteria (hazard ratio (HR) = 3.69, and HR = 6.02) and in those experiencing isolated MRI activity (HR = 3.15, and HR = 5.31) at first year of treatment, when compared with stable patients (all p values <0.001). Conclusion: The four-year outcomes of patients with isolated MRI activity did not differ from those fulfilling EMA criteria at first year of IFNB treatment.
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Affiliation(s)
- Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | | | - Laura De Giglio
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
- Department of Psychology, Sapienza University, Rome, Italy
| | | | - Valeria Barletta
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Carlo Pozzilli
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
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Sormani MP, De Stefano N. Defining and scoring response to IFN-β in multiple sclerosis. Nat Rev Neurol 2013; 9:504-12. [PMID: 23897407 DOI: 10.1038/nrneurol.2013.146] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The advent of a large number of new therapies for multiple sclerosis (MS) warrants the development of tools that enable selection of the best treatment option for each new patient with MS. Evidence from clinical trials clearly supports the efficacy of IFN-β for the treatment of MS, but few factors that predict a response to this drug in individual patients have emerged. This deficit might be due, at least in part, to the lack of a standardized definition of the clinical outcomes that signify improvement or worsening of the disease. MRI markers and clinical relapses have been the most widely studied short-term factors to predict long-term response to IFN-β, although the results are conflicting. Recently, integrated strategies combining MRI and clinical markers in scoring systems have provided a potentially useful approach for the management of patients with MS. In this Review, we focus on the many definitions of clinical response to IFN-β and explore the markers that can be used to predict this response. We also highlight advantages and limitations of the existing scoring systems in light of future expansion of these models to biological markers and to other classes of emerging therapies for MS.
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Affiliation(s)
- Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, Genoa 16132, Italy. mariapia.sormani@ unige.it
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Guidelines from The Italian Neurological and Neuroradiological Societies for the use of magnetic resonance imaging in daily life clinical practice of multiple sclerosis patients. Neurol Sci 2013; 34:2085-93. [PMID: 23828372 DOI: 10.1007/s10072-013-1485-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 06/20/2013] [Indexed: 01/21/2023]
Abstract
MRI is highly sensitive in detecting focal white matter lesions in multiple sclerosis (MS). For this reason, it has been formally included in the diagnostic workup of patients with clinically isolated syndromes suggestive of MS, through the definition of ad hoc sets of criteria to show disease dissemination in space and time. MRI is used in virtually all clinical trials of the disease as a surrogate measure of treatment response. Several guidelines have been published to help characterizing the imaging features on conventional MR sequences of "typical" MS lesions and work has also been performed to identify "red flags" which should alert the clinicians to exclude possible alternative conditions. Despite this, the application of the available guidelines and criteria in daily life clinical practice is still limited and varies among and within countries (including Italy) due to regulatory issues and heterogeneity of MRI facilities. It is crucial for neurologists and neuroradiologists to become familiar with these criteria to improve the quality of their diagnostic assessment. In patients with established MS, the main problem is to define standard procedures for monitoring the course of the disease and treatment response. This review aims at providing daily life guidelines to clinicians for a correct application of MRI in the workup of patients suspected of having MS as well as in the monitoring of disease evolution in those with established MS. It also offers clues for the standardization of MRI studies and relative reporting to be applied at a national level.
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Carvalho AT, Sá MJ. Switching and escalating therapy in long-lasting multiple sclerosis: not always necessary. ISRN NEUROLOGY 2013; 2012:451457. [PMID: 23316389 PMCID: PMC3539327 DOI: 10.5402/2012/451457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/03/2012] [Indexed: 12/04/2022]
Abstract
Although therapy switch is common among patients with multiple sclerosis (MS), sometimes the initial prescribed treatment is maintained for a long period with clinical stability, low disability, and nonsignificant side effects. We aim to describe demographic and clinical characteristics of patients treated in our MS clinic with the same disease-modifying drug (DMD) lasting for >12 years. From the cohort of 51 patients followed in our MS clinic with relapse-remitting MS who started an DMD between 1996 and 1999, we found a high percentage (51%) of patients who were efficiently treated with the first DMD. These patients were mainly females, with low annualized relapse rate and Multiple Sclerosis Severity Score (MSSS). Our results may be related to the open and multidisciplinary model of our MS clinic organization. Identifying characteristics associated with therapy persistence may be useful in developing strategies to improve therapy effectiveness.
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Affiliation(s)
- Ana Teresa Carvalho
- MS Clinic, Department of Neurology, Centro Hospitalar de São João, 4200-319 Porto, Portugal ; Department of Neurology, Centro Hospitalar de Vila Nova Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
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Stępień A, Chalimoniuk M, Lubina-Dąbrowska N, Chrapusta SJ, Galbo H, Langfort J. Effects of interferon β-1a and interferon β-1b monotherapies on selected serum cytokines and nitrite levels in patients with relapsing-remitting multiple sclerosis: a 3-year longitudinal study. Neuroimmunomodulation 2013; 20:213-22. [PMID: 23711618 DOI: 10.1159/000348701] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/06/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Interferon (IFN)β treatment is a mainstay of relapsing-remitting multiple sclerosis (RRMS) immunotherapy. Its efficacy is supposedly a consequence of impaired trafficking of inflammatory cells into the central nervous system and modification of the proinflammatory/antiinflammatory cytokine balance. However, the effects of long-term monotherapy using various IFNβ preparations on cytokine profiles and the relevance of these effects for the therapy outcome have not yet been elucidated. METHODS Changes were compared in serum levels of TNFα, IFNγ, interleukin (IL)-6, IL-10 and nitrite between RRMS patients given 3-year treatment with intramuscular IFNβ-1a (30 μg once a week) or subcutaneous IFNβ-1b (250 μg every other day). Only the data from patients who completed the 3-year study (n = 20 and n = 18, respectively) were analyzed. RESULTS Three-year IFNβ-1a or IFNβ-1b monotherapy reduced serum nitrite levels by 77 and 71%, respectively, lowered multiple sclerosis relapse annual rate by 70 and 71%, respectively, and significantly and similarly lowered Expanded Disability Status Scale scores in both study groups (by 0.9 on average). The two monotherapies showed little if any effect on cytokine levels and cytokine level ratios after the first year, but exerted diverging effects on these indices later on; the only exception was the IFNγ/IL-6 ratio that showed a monotonous rise in both study groups over the entire study period. CONCLUSION During long-term IFNβ monotherapy, the levels of the studied cytokines show no relevance to the course of RRMS and neurological status of patients, whereas there seems to be a link between these clinical indices and the activity of nitric oxide-mediated pathways.
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Affiliation(s)
- Adam Stępień
- Department of Neurology, Military Institute of Medicine, Warsaw, Poland
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Vigeveno RM, Wiebenga OT, Wattjes MP, Geurts JJG, Barkhof F. Shifting imaging targets in multiple sclerosis: from inflammation to neurodegeneration. J Magn Reson Imaging 2012; 36:1-19. [PMID: 22696123 DOI: 10.1002/jmri.23578] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Classically multiple sclerosis (MS) has been regarded as an auto-immune disease of the white matter in the central nervous system leading to severe disability over the course of several decades. Current therapeutic strategies in MS are mostly based on either immune suppression or immune modulation. Although effective in decreasing relapse frequency and severity as well as delaying disease progression, MS pathology ensues nonetheless. In the last decade it became evident that gray matter pathology plays an important role in disease progression and helps explaining certain aspects of MS-related disability such as cognitive decline. Conventional MRI outcome measures commonly used in clinical trials are sufficient to demonstrate an anti-inflammatory drug-effect but lack pathological specificity and are poor to moderate predictors of disability. In this article, we review new insights in gray matter pathology and functional reorganization in MS and how these novel fields in MS research may validate and establish new MRI outcome measures, aid in the development of new therapeutic strategies for neuroprotection and neurorepair, and may lead to development of novel predictive measures of disability and disease progression in MS.
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Affiliation(s)
- René M Vigeveno
- VU University Medical Center, Department of Radiology, Amsterdam, the Netherlands
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Sormani MP, Rio J, Tintorè M, Signori A, Li D, Cornelisse P, Stubinski B, Stromillo ML, Montalban X, De Stefano N. Scoring treatment response in patients with relapsing multiple sclerosis. Mult Scler 2012; 19:605-12. [PMID: 23012253 DOI: 10.1177/1352458512460605] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND We employed clinical and magnetic resonance imaging (MRI) measures in combination, to assess patient responses to interferon in multiple sclerosis. OBJECTIVE To optimize and validate a scoring system able to discriminate responses to interferon treatment in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS Our analysis included two large, independent datasets of RRMS patients who were treated with interferons that included 4-year follow-up data. The first dataset ("training set") comprised of 373 RRMS patients from a randomized clinical trial of subcutaneous interferon beta-1a. The second ("validation set") included an observational cohort of 222 RRMS patients treated with different interferons. The new scoring system, a modified version of that previously proposed by Rio et al., was first tested on the training set, then validated using the validation set. The association between disability progression and risk group, as defined by the score, was evaluated by Kaplan Meier survival curves and Cox regression, and quantified by hazard ratios (HRs). RESULTS The score (0-3) was based on the number of new T2 lesions (>5) and clinical relapses (0,1 or 2) during the first year of therapy. The risk of disability progression increased with higher scores. In the validation set, patients with score of 0 showed a 3-year progression probability of 24%, while those with a score of 1 increased to 33% (HR = 1.56; p = 0.13), and those with score greater than or equal to 2 increased to 65% (HR = 4.60; p < 0.001). CONCLUSIONS We report development of a simple, quantitative and complementary tool for predicting responses in interferon-treated patients that could help clinicians make treatment decisions.
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Affiliation(s)
- M P Sormani
- Department of Health Sciences, University of Genoa, Italy.
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Prosperini L, Giannì C, Barletta V, Mancinelli C, Fubelli F, Borriello G, Pozzilli C. Predictors of freedom from disease activity in natalizumab treated-patients with multiple sclerosis. J Neurol Sci 2012; 323:104-12. [PMID: 23006974 DOI: 10.1016/j.jns.2012.08.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/28/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To identify baseline predictors of the response to natalizumab in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS We prospectively collected clinical and magnetic resonance imaging (MRI) data of RRMS patients treated with natalizumab and followed-up for 24 months. They were categorized according to different outcomes of response to natalizumab: (i) "full" responders, i.e. those having no relapses, no sustained disability worsening on Expanded Disability Status Scale (EDSS), and no MRI activity; (ii) "partial" responders, i.e. those having MRI activity, but not relapses and/or EDSS worsening; and (iii) "poor" responder, i.e. those experiencing relapses and/or EDSS worsening. RESULTS We analysed data of 210 RR-MS patients (147 F, 63 M); at the end of the 24-month study period, 120 (57.1%), 36 (17.1%), and 54 (25.8%) patients were defined as "full", "partial" or "poor" responders, respectively. Thirty-two (89%) patients classified as "partial" responders experienced MRI activity at the 6-month scan; the majority of them had >2 contrast-enhancing lesions at baseline MRI scan or >2 relapses in the year prior to starting therapy. A "full" response to natalizumab was found more likely in patients with ≤ 2 relapses in the year prior to treatment start (OR=3.68; p=0.002), and in those with an EDSS score ≤ 2.5 at baseline (OR=3.60; p<0.001). Accordingly, patients with >2 relapses in the year prior to treatment start, or those with an EDSS score ≥ 3.0 at baseline were more likely to be classified as "poor responders". These figures were replicated even after excluding 20 patients who developed anti-natalizumab antibodies. CONCLUSION Our results suggest that natalizumab may lead to a complete remission of MS if started in patients with less aggressive disease (i.e. few relapses and mild disability), thus suggesting its possible role as first switching option, or even first-line therapy, at least in JCV-negative patients. We also support the recommendation against an immediate discontinuation of despite the occurrence of MRI activity in the first few months of treatment, since the freedom from clinical disease activity could be still achieved.
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Affiliation(s)
- Luca Prosperini
- Dept. of Neurology and Psychiatry, Multiple Sclerosis Centre, S. Andrea Hospital, Sapienza University, Rome, Italy.
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Giovannoni G, Southam E, Waubant E. Systematic review of disease-modifying therapies to assess unmet needs in multiple sclerosis: tolerability and adherence. Mult Scler 2012; 18:932-46. [PMID: 22249762 DOI: 10.1177/1352458511433302] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reviews of therapeutic drugs usually focus on the highly selected and closely monitored patient populations from randomized controlled trials. The objective of this study was to review systematically the tolerability and adherence of multiple sclerosis disease-modifying therapies, using data from both randomized controlled trials and observational settings. Relevant literature was identified using predefined search terms, and adverse event and study discontinuation data were extracted and categorized according to study type (randomized controlled trial or observational) and study duration. A total of 151 papers were selected for analysis; 33% were classified as randomized controlled trials and 62% as observational studies. Most of the papers concerned interferon preparations and glatiramer acetate; the limited available information on mitoxantrone and natalizumab precluded extensive examination of these. The most common adverse events were flu-like symptoms (interferon therapies only) and injection-site reactions. Mean discontinuation rates ranged from 16% to 27%. There were no marked differences in tolerability or adherence data from randomized controlled trials and observational studies, but the incidence of adverse events remained high in lengthy studies and discontinuations accumulated with time. The present systematic review of randomized clinical trial and observational data highlights the tolerability and adherence issues associated with commonly used first-line multiple sclerosis treatments.
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Affiliation(s)
- G Giovannoni
- Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Balancing the benefits and risks of disease-modifying therapy in patients with multiple sclerosis. J Neurol Sci 2011; 311 Suppl 1:S29-34. [DOI: 10.1016/s0022-510x(11)70006-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The development of neutralizing antibodies (NAbs) is a major problem in multiple sclerosis (MS) patients treated with interferon-beta (IFN-ß). Whereas binding antibodies (BAbs) can be demonstrated in the vast majority of patients, only a smaller proportion of patients develop NAbs. The principle in NAb in vitro assays is the utilization of cultured cell lines that are responsive to IFN-ß. The cytopathic effect (CPE) assay measures the capacity of NAbs to neutralize IFN- ß's protective effect on cells challenged with virus and the MxA induction assay measures the ability of NAbs to reduce the IFN-ß-induced expression of MxA, either at the mRNA or the protein level. A titer of >20 neutralizing units/ml traditionally defines NAb posi-tivity. NAbs in high titers completely abrogate the in vivo response to IFN-ß, whereas the effect of low and intermediate titers is unpredictable. As clinically important NAbs appear only after 9-18 months IFN- ß0 therapy, short-term studies of two years or less are unsuitable for evaluation of clinical NAb effects. All long-term trials of three years or more concordantly show evidence of a detrimental effect of NAbs on relapses, disease activity on MRI, or on disease progression. Persistent high titers of NAbs indicate an abrogation of the biological response and, hence, absence of therapeutic efficacy, and this observation should lead to a change of therapy. As low and medium titers are ambiguous treatment decisions in patients with low NAb titres should be guided by determination of in vivo mRNA MxA induction and clinical disease activity.
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Affiliation(s)
- Per Soelberg Sorensen
- Danish Multiple Sclerosis Research Center Department of Neurology 2082, Copenhagen University Hospital Rigshospitalet, DK-2100 Copenhagen, Denmark.
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