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Li R, Zhou J, Wu H, Wang Y, Chen J. Sustained Effectiveness and Safety Over Time of Teriflunomide in Chinese Patients with Relapsing Multiple Sclerosis in the Greater Bay Area of China: Insights from Real-World Data. Neurol Ther 2024; 13:1117-1133. [PMID: 38753124 PMCID: PMC11263525 DOI: 10.1007/s40120-024-00599-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/28/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION The real-world data on the medium- to long-term effectiveness and safety of teriflunomide in Chinese patients with relapsing multiple sclerosis (MS) is limited. Therefore, this study aims to assess the treatment outcomes of teriflunomide in Chinese patients with MS over a medium- to long-term period. METHODS This cohort study was carried out in three tertiary hospitals and regional MS centers located in the Greater Bay Area of China. We obtained the historical clinical data of patients who underwent teriflunomide treatment for at least 6 months. The primary objective was to evaluate the proportion of patients achieving no evidence of disease activity (NEDA)-3 status, which is characterized by the absence of relapses, confirmed disability worsening, and new or enlarging MRI lesions, over time. Secondary objectives included assessing the proportion of patients meeting each NEDA-3 criterion, changes in motor and cognitive function, as well as the incidence of adverse events and treatment discontinuations. RESULTS A total of 160 patients with MS were enrolled, including 125 patients treated with teriflunomide for at least 1 year (≥ 1-year completers) and 71 patients treated for at least 2 years (≥ 2-year completers). A total of 85.63% of the overall population achieved clinical NEDA-3 status at 6 months of teriflunomide treatment, and 71.20% of ≥ 1-year completers achieved NEDA-3 status at 12 months of teriflunomide treatment. The median timed 25-foot walk test (T25FW), nine-hole peg test (9-HPT), and paced auditory serial addition test (PASAT) results were relatively stable before and after treatment. CONCLUSION Medium- to long-term MS disease activity, as indicated by NEDA-3 status, is well controlled in patients treated with continuous teriflunomide treatment in real-world settings.
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Affiliation(s)
- Rui Li
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, China
| | - Jing Zhou
- Department of Neurology, The First People's Hospital of Foshan, Foshan, China
| | - Haotian Wu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, China.
| | - Juanjuan Chen
- Department of Neurology, Peking University Shenzhen Hospital, No. 1120 Lianhua Road, Futian District, Shenzhen, China.
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Guo J, Wu J, Wang L, Liu H, Wu X, Yang H, Li W, Wang H, Bu B, Yang C, Zhou H, Guo S, Zhao Y, Wang Z, Li C, Tian DC, Chen S, Xue H, Zhang Y, Xu Y, Liang H, Wu Z, Zhang Y, Dong Q, Wang J, Quan C. Treatment algorithms of relapsing multiple sclerosis: an exploration based on the available disease-modifying therapies in China. Ther Adv Neurol Disord 2024; 17:17562864241239117. [PMID: 38616782 PMCID: PMC11015775 DOI: 10.1177/17562864241239117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/14/2024] [Indexed: 04/16/2024] Open
Abstract
Multiple sclerosis (MS) was defined as a rare disease in China due to its low prevalence. For a long time, interferon β was the only approved disease-modifying therapy (DMT). Since the first oral DMT was approved in 2018, DMT approval accelerated, and seven DMTs were approved within 5 years. With an increasing number of DMTs being prescribed in clinical practice, it is necessary to discuss the standardized MS treatment algorithms depending on the disease activity and DMT availability. In this review paper, more than 20 Chinese experts in MS have reviewed the therapeutic progress of MS in China and worldwide and discussed algorithms for treating relapsing MS (RMS) based on the available DMTs in China, providing insights for establishing the standardized RMS treatment algorithms in this country.
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Affiliation(s)
- Jun Guo
- Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Jiayong Wu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lihua Wang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Hongbo Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaomu Wu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Wenyu Li
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Honghao Wang
- Department of Neurology, Guangzhou First People’s Hospital, Guangzhou, China
| | - Bitao Bu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunsheng Yang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Shougang Guo
- Department of Neurology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Yinan Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhanhang Wang
- Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Chunyang Li
- Department of Neurology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - De-Cai Tian
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sheng Chen
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiru Xue
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yanlin Zhang
- Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yongfeng Xu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Liang
- Department of Neurology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhe Wu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | | | - Qiang Dong
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12, Middle Wulumuqi Road, Shanghai 200040, China
- National Center for Neurological Disorders, Shanghai, China
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Tan H, Li X, Li Y, He F, ZhangBao J, Zhou L, Yang L, Zhao C, Lu C, Dong Q, Li H, Quan C. Real-world experience of teriflunomide in relapsing multiple sclerosis: paramagnetic rim lesions may play a role. Front Immunol 2024; 15:1343531. [PMID: 38558796 PMCID: PMC10979358 DOI: 10.3389/fimmu.2024.1343531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives The aims of this study were to report the effectiveness and safety of teriflunomide in Chinese patients with relapsing-remitting multiple sclerosis (RRMS) and to explore the association of paramagnetic rim lesion (PRL) burden with patient outcome in the context of teriflunomide treatment and the impact of teriflunomide on PRL burden. Methods This is a prospective observational study. A total of 100 RRMS patients treated with teriflunomide ≥3 months were included in analyzing drug persistence and safety. Among them, 96 patients treated ≥6 months were included in assessing drug effectiveness in aspects of no evidence of disease activity (NEDA) 3. The number and total volume of PRL were calculated in 76 patients with baseline susceptibility-weighted imaging (SWI), and their association with NEDA3 failure during teriflunomide treatment was investigated. Results Over a treatment period of 19.7 (3.1-51.7) months, teriflunomide reduced annualized relapse rate (ARR) from 1.1 ± 0.8 to 0.3 ± 0.5, and Expanded Disability Status Scale (EDSS) scores remained stable. At month 24, the NEDA3% and drug persistence rate were 43.8% and 65.1%, respectively. In patients with a baseline SWI, 81.6% had at least 1 PRL, and 42.1% had ≥4 PRLs. The total volume of PRL per patient was 0.3 (0.0-11.5) mL, accounting for 2.3% (0.0%-49.0%) of the total T2 lesion volume. Baseline PRL number ≥ 4 (OR = 4.24, p = 0.009), younger onset age (OR = 0.94, p = 0.039), and frequent relapses in initial 2 years of disease (OR = 13.40, p = 0.026) were associated with NEDA3 failure. The PRL number and volume were not reduced (p = 0.343 and 0.051) after teriflunomide treatment for more than 24 months. No new safety concerns were identified in this study. Conclusion Teriflunomide is effective in reducing ARR in Chinese patients with RRMS. Patients with less PRL burden, less frequent relapses, and relatively older age are likely to benefit more from teriflunomide, indicating that PRL might be a valuable measurement to inform clinical treatment decision.
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Affiliation(s)
- Hongmei Tan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Xiang Li
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Yuxin Li
- National Center for Neurological Disorders, Shanghai, China
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Fanru He
- National Center for Neurological Disorders, Shanghai, China
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jingzi ZhangBao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Lei Zhou
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Liqin Yang
- National Center for Neurological Disorders, Shanghai, China
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Chuanzhen Lu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Haiqing Li
- National Center for Neurological Disorders, Shanghai, China
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
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Quan C, Zhou H, Yang H, Jiao Z, Zhang M, Zhang B, Tan G, Bu B, Jin T, Li C, Xue Q, Dong H, Shi F, Qin X, Zhang X, Gao F, Zhang H, Wang J, Hu X, Chen Y, Liu J, Qiu W. Safety of teriflunomide in Chinese adult patients with relapsing multiple sclerosis: A phase IV, 24-week multicenter study. Chin Med J (Engl) 2024:00029330-990000000-00949. [PMID: 38311806 DOI: 10.1097/cm9.0000000000002990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Disease-modifying therapies have been approved for the treatment of relapsing multiple sclerosis (RMS). The present study aims to examine the safety of teriflunomide in Chinese patients with RMS. METHODS This non-randomized, multi-center, 24-week, prospective study enrolled RMS patients with variant (c.421C>A) or wild type ABCG2 who received once-daily oral teriflunomide 14 mg. The primary endpoint was the relationship between ABCG2 polymorphisms and teriflunomide exposure over 24 weeks. Safety was assessed over the 24-week treatment with teriflunomide. RESULTS Eighty-two patients were assigned to variant (n = 42) and wild type groups (n = 40), respectively. Geometric mean and geometric standard deviation (SD) of pre-dose concentration (variant, 54.9 [38.0] μg/mL; wild type, 49.1 [32.0] μg/mL) and area under plasma concentration-time curve over a dosing interval (AUCtau) (variant, 1731.3 [769.0] μg∙h/mL; wild type, 1564.5 [1053.0] μg∙h/mL) values at steady state were approximately similar between the two groups. Safety profile was similar and well tolerated across variant and wild type groups in terms of rates of treatment emergent adverse events (TEAE), treatment-related TEAE, grade ≥3 TEAE, and serious adverse events (AEs). No new specific safety concerns or deaths were reported in the study. CONCLUSION ABCG2 polymorphisms did not affect the steady-state exposure of teriflunomide, suggesting a similar efficacy and safety profile between variant and wild type RMS patients. REGISTRATION NCT04410965, https://clinicaltrials.gov.
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Affiliation(s)
- Chao Quan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, National Centre for Neurological Disorders, Shanghai 201206, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Zheng Jiao
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Meini Zhang
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030012, China
| | - Baorong Zhang
- Department of Neurology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Guojun Tan
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Bitao Bu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Tao Jin
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Chunyang Li
- Department of Neurology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, China
| | - Qun Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Fudong Shi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xinyue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xinghu Zhang
- Center of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Feng Gao
- Department of Neurology, Peking University First Hospital, Beijing100034, China
| | - Hua Zhang
- Department of Neurology, Beijing Hospital, Beijing 100730, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730 China
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China
| | - Yueting Chen
- Department of Pharmacy, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Jue Liu
- Medical Department, Sanofi Investment Co., Ltd., Shanghai 200040, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China
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Edinger A, Habibi M. The evolution of multiple sclerosis disease-modifying therapies: An update for pharmacists. Am J Health Syst Pharm 2024; 81:37-55. [PMID: 37777869 DOI: 10.1093/ajhp/zxad247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Indexed: 10/02/2023] Open
Abstract
PURPOSE Multiple sclerosis (MS) and the evolution of disease-modifying therapies (DMTs) and their indications, mechanisms of action, efficacy, pregnancy class, and cost are discussed. SUMMARY MS is an immune-mediated, demyelinating, and progressive neurological disorder that can cause both motor and cognitive deficits. Onset of MS typically occurs between the ages of 20 and 40 years, and the disease can result in significant disability over time. Since the introduction of the first DMT for the treatment of MS in 1993, significant progress has been made in the development of new classes of DMTs with different mechanisms of action, higher efficacy, and simpler administration schedules, offering patients better alternatives. However, drawbacks with the use of DMTs include their increasing cost and formulary restrictions. CONCLUSION The treatment landscape of MS has significantly changed over the past 2 decades, and the introduction of newer classes of DMTs provides an opportunity for pharmacists to play an important role in the management of this patient population.
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Affiliation(s)
| | - Mitra Habibi
- Department of Pharmacy Practice and Department of Neurology, University of Illinois at Chicago, Chicago, IL, USA
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Meca-Lallana JE, Prieto González JM, Caminero Rodríguez AB, Olascoaga Urtaza J, Alonso AM, Durán Ferreras E, Espinosa R, Dotor J, Romera M, Ares Luque A, Pérez Ruiz D, Calles C, Hernández MA, Hervás García M, Mendoza Rodríguez A, Berdei Montero Y, Téllez N, Herrera Varó N, Sotoca J, Presas-Rodríguez S, Querol Gutierrez LA, Hervás Pujol M, Batlle Nadal J, Martín Ozaeta G, Gubieras Lillo L, Martínez Yélamos S, Ramió-Torrentà L, Mallada Frechin J, Belenguer Benavides A, Gascón-Giménez F, Casanova B, Landete Pascual L, Berenguer L, Navarro L, Gómez Gutierrez M, Durán C, Rodríguez Regal A, Álvarez E, García-Estévez DA, López Real AM, Llaneza González MA, Marzo Sola ME, Sánchez-Menoyo JL, Oterino A, Villaverde González R, Castillo-Triviño T, Álvarez de Arcaya A, Llarena C. Effectiveness and Safety of Teriflunomide in Relapsing-Remitting Multiple Sclerosis and Improvements in Quality of Life: Results from the Real-World TERICARE Study. Neurol Ther 2023; 12:2177-2193. [PMID: 37861931 PMCID: PMC10630277 DOI: 10.1007/s40120-023-00557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Teriflunomide is a once-daily oral immunomodulator approved for relapsing forms of multiple sclerosis (MS) or relapsing-remitting multiple sclerosis (RRMS; depending on the local label), based on extensive evidence from clinical trials and a real-world setting on efficacy, tolerability and patient-reported benefits. The TERICARE study assessed the impact of teriflunomide treatment over 2 years on health-related quality of life (HRQoL) and some of the most common and disabling symptoms of MS, such as fatigue and depression. METHODS This prospective observational study in Spain included RRMS patients treated with teriflunomide for ≤ 4 weeks. The following patient-reported outcomes (PROs) were collected at baseline and every 6 months for 2 years: the 29-item Multiple Sclerosis Impact Scale version 2 (MSIS-29), the 21-item Modified Fatigue Impact Scale (MFIS-21), the Beck Depression Inventory (BDI-II), the Short Form (SF)-Qualiveen and the Treatment Satisfaction Questionnaire for Medication v1.4 (TSQM). Annualised relapse rate (ARR), disability progression according to the Expanded Disability Status Scale (EDSS), and no evidence of disease activity (NEDA-3) were also assessed. RESULTS A total of 325 patients were analysed. Patients had a mean (SD) age of 43.2 years (10.4), a mean baseline EDSS score of 1.75 (1.5), a mean number of relapses in the past 2 years of 1.5 (0.7), and 64% had received prior disease-modifying therapy (DMT). Patients showed significant improvements in the psychological domain of MSIS-29 from 35.9 (26.6) at baseline to 29.4 (25.5) at 18 months (p = 0.004) and 29.0 (24.6) at 24 months (p = 0.002). Levels of fatigue and depression were also reduced. After 2 years of treatment with teriflunomide, ARR was reduced to 0.17 (95% CI 0.14-0.21) from the baseline of 0.42 (95% CI 0.38-0.48), representing a 60.1% reduction. Mean EDSS scores remained stable during the study, and 79.9% of patients showed no disability progression. 54.7% of patients achieved NEDA-3 in the first 12 months, which increased to 61.4% during months 12-24. Patients reported increased satisfaction with treatment over the course of the study, regardless of whether they were DMT naive or not. CONCLUSION Teriflunomide improves psychological aspects of HRQoL and maintains low levels of fatigue and depression. Treatment with teriflunomide over 2 years is effective in reducing ARR and disability progression.
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Affiliation(s)
- José E Meca-Lallana
- Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit, Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca)/Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio, Murcia, Spain.
| | - José M Prieto González
- Neurology Service, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Ana M Alonso
- Neurology Service, Hospital Regional Universitario Málaga, Málaga, Spain
| | | | - Raúl Espinosa
- Neurology Unit, Hospital Universitario Jerez de La Frontera, Cádiz, Spain
| | - Julio Dotor
- Neurology Service, Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Mercedes Romera
- Neurology Service, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | | | - Carmen Calles
- Neurology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Miguel A Hernández
- Neurology Service, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Miguel Hervás García
- Neurology Service, Hospital Insular Universitario de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Nieves Téllez
- Neurology Service, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | | | - Javier Sotoca
- Neurology Department, Hospital Mútua Terrassa, Barcelona, Spain
| | - Silvia Presas-Rodríguez
- MS-Neuroimmunology Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Luis A Querol Gutierrez
- Neuromuscular Diseases Unit-Autoimmune Neurology-Neuromuscular Lab, Neurology Department-Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain
| | | | | | | | | | - Sergio Martínez Yélamos
- Multiple Sclerosis Unit, Hospital Universitario de Bellvitge, Institut Català de la Salut, Barcelona, Spain
| | - Lluís Ramió-Torrentà
- Neurology Department, Hospital Universitario Dr. Josep Trueta i Santa Caterina, Girona, Spain
| | | | | | | | | | | | | | - Laura Navarro
- Neurology Department, Hospital General Universitario de Elche, Alicante, Spain
| | | | - Carmen Durán
- Neurology Service, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - Ana Rodríguez Regal
- Neurology Service, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Elena Álvarez
- Neurology Service, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Ana M López Real
- Neurology Service, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | | | | | - Agustín Oterino
- Neurology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | - Cristina Llarena
- Neurology Service, Hospital Universitario Basurto, Bilbao, Spain
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Kreiter D, Spee R, Merry A, Hupperts R, Gerlach O. Effect of disease-modifying treatment on spinal cord lesion formation in multiple sclerosis: A retrospective observational study. Mult Scler Relat Disord 2023; 79:104994. [PMID: 37683557 DOI: 10.1016/j.msard.2023.104994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/12/2023] [Accepted: 09/03/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Spinal cord lesions in multiple sclerosis (MS) are an important contributor to disability. Knowledge on the effect of disease-modifying treatment (DMT) on spinal lesion formation in MS is sparse, as cord outcome measures are seldom included in MS treatment trials. We aim to investigate whether intermediate- or high-efficacy DMTs (i/hDMT) can reduce spinal lesion formation, compared with low-efficacy DMTs (lDMT) and/or no treatment. METHODS Relapse-onset MS patients with ≥2 spinal MRIs (interval >3 months and <10 years) were retrospectively identified. The i/hDMT-group was defined as patients who were treated with i/hDMTs during ≥90% of spinal MRI follow-up time. Controls received lDMTs and/or no treatment ≥90% of follow-up duration. In a secondary analysis, only patients using lDMT for ≥90% of follow-up were considered controls. Patients were matched using propensity-scores. Cox proportional hazards models were used to estimate the risk of new spinal lesions. RESULTS 323 patients had ≥2 spinal cord MRIs. 49 satisfied i/hDMT and 168 control group criteria. 34 i/hDMT patients were matched to 83 controls. Patients in the i/hDMT-group were significantly less likely to develop new cord lesions at follow-up (HR 0.29 [0.12-0.75], p = 0.01). When the i/hDMT-group was matched to only controls using lDMT ≥90% of follow-up time (n = 17 and n = 25, respectively), there was no statistically significant difference (HR 1.01 [0.19-5.24], p = 0.99). CONCLUSION Treatment with intermediate- or high-efficacy DMTs reduces the risk of new spinal cord lesions compared with matched patients receiving no treatment and/or lDMTs. No conclusions could be drawn on whether i/hDMTs provide a larger risk reduction compared to only lDMTs (control group receiving lDMTs ≥90% of follow-up time).
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Affiliation(s)
- Daniel Kreiter
- Department of Neurology, Academic MS center Zuyd, Zuyderland MC, Sittard-Geleen, The Netherlands; Department of Neurology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Romy Spee
- Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Audrey Merry
- Zuyderland Academy, Zuyderland Medical Center, Sittard-Geleen & Heerlen, The Netherlands
| | - Raymond Hupperts
- Department of Neurology, Academic MS center Zuyd, Zuyderland MC, Sittard-Geleen, The Netherlands; Department of Neurology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Oliver Gerlach
- Department of Neurology, Academic MS center Zuyd, Zuyderland MC, Sittard-Geleen, The Netherlands; Department of Neurology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
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8
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Etta I, Elballushi R, Kolesnyk V, Sia KP, Rehman S, Arif S, Moonnumackel SJ, Nair A. Comparison of Pharmacological Therapies in Relapse Rates in Patients With Relapsing-Remitting Multiple Sclerosis. Cureus 2023; 15:e45454. [PMID: 37859931 PMCID: PMC10583624 DOI: 10.7759/cureus.45454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune neurological disorder that significantly impacts the central nervous system (CNS), which includes the brain and spinal cord. Approximately 2.8 million individuals are believed to be living with MS worldwide. The management of MS has evolved considerably over the years, offering a multitude of guidelines, diverse treatment options, and different approaches to signs and symptoms. The present systematic literature review serves as a comprehensive analysis of the current therapeutic options for MS. It provides a thorough literature review of Food and Drug Administration (FDA)-approved drugs comparing their various clinical end points while concurrently assessing their risk-benefit ratio. It also provides an extensive review of current guidelines and offers an in-depth examination of the different approaches to MS. Through this multifaceted approach, this paper facilitates easy access to available treatment options and aims to aid healthcare providers in decision-making as well as providing a foundation for future research aimed at enhancing treatment options for MS.
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Affiliation(s)
- Indu Etta
- Department of Internal Medicine, Kakatiya Medical College, Warangal, IND
| | - Ruaa Elballushi
- School of Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, Muharraq, BHR
| | | | - Kim P Sia
- School of Medicine, Emilio Aguinaldo College, Manila, PHL
| | - Sana Rehman
- College of Medicine, Fatima Memorial Hospital (FMH) College of Medicine and Dentistry, Lahore, PAK
| | - Sehrish Arif
- College of Medicine, Fatima Memorial Hospital (FMH) College of Medicine and Dentistry, Lahore, PAK
| | | | - Arun Nair
- Department of Pediatrics, Saint Peter's University Hospital, Somerset, USA
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Bu B, Quan C, Li W, Zeng Q, Shi Z, Chen B, Zhou L, Jin L, Zhou H, Yang H. The effectiveness of teriflunomide in patients with multiple sclerosis in China: a real-world comparison to no DMT treatment in the first year after diagnosis. Ther Adv Neurol Disord 2023; 16:17562864231181170. [PMID: 37529720 PMCID: PMC10387708 DOI: 10.1177/17562864231181170] [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: 11/30/2022] [Accepted: 05/23/2023] [Indexed: 08/03/2023] Open
Abstract
Background Teriflunomide is a first-line oral immunomodulatory agent approved in China for the treatment of relapsing multiple sclerosis. Objective To compare the treatment outcomes of teriflunomide and no disease-modifying therapy (DMT) treatment (in first year) in multi-center real-world Chinese multiple sclerosis patients. Design Retrospective study. Methods This study was conducted in five tertiary hospitals in different geographical regions of China. We collected clinical data of patients treated with teriflunomide and no DMT treatment (in first year) between 1 January 2017 and 31 August 2021. The effectiveness of teriflunomide was described. Potential factors influencing the effectiveness of teriflunomide were investigated. Results A total of 372 patients treated with teriflunomide and 148 no DMT treatment patients were included. A total of 292 patients were treated with teriflunomide for at least 6 months, described as a stable teriflunomide cohort. The annualized relapse rate was significantly lower in the stable teriflunomide cohort than in the no DMT treatment cohort (0.23 ± 0.47 versus 0.87 ± 0.67, p < 0.001). The mean Expanded Disability Status Scale (EDSS) score of the stable teriflunomide cohort (1.77 ± 1.62) was slightly different from that of the no DMT treatment cohort (2.09 ± 2.00). A previous annualized relapse rate of ⩾1, a previous EDSS score of ⩾2, and a long disease duration of ⩾5 years were associated with better clinical effectiveness. Conclusion Teriflunomide is associated with a lower relapse rate and less disability accumulation in Chinese patients with multiple sclerosis.
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Affiliation(s)
| | | | | | | | | | - Bo Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhou
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Luya Jin
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
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Wu Q, Wang Q, Yang J, Mills EA, Chilukuri P, Saad A, Dowling CA, Fisher C, Kirch B, Mao-Draayer Y. Teriflunomide modulates both innate and adaptive immune capacities in multiple sclerosis. Mult Scler Relat Disord 2023; 75:104719. [PMID: 37172367 DOI: 10.1016/j.msard.2023.104719] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/02/2023] [Accepted: 04/15/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND Teriflunomide (TER) (Aubagio™) is an FDA-approved disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS). The mechanism of action of TER is thought to be related to the inhibition of dihydroorotate dehydrogenase (DHODH), a key mitochondrial enzyme in the de novo pyrimidine synthesis pathway required by rapidly dividing lymphocytes. Several large pivotal studies have established the efficacy and safety of TER in patients with RRMS. Despite this, little is known about how the adaptive and innate immune cell subsets are affected by the treatment in patients with MS. METHODS We recruited 20 patients with RRMS who were newly started on TER and performed multicolor flow cytometry and functional assays on peripheral blood samples. A paired t-test was used for the statistical analysis and comparison. RESULTS Our data showed that TER promoted a tolerogenic environment by shifting the balance between activated pathogenic and naïve or immunosuppressive immune cell subsets. In our cohort, TER increased the expression of the immunosuppressive marker CD39 on regulatory T cells (Tregs) while it decreased the expression of the activation marker CXCR3 on CD4+ T helper cells. TER treatment also reduced switched memory (sm) B cells while it increased naïve B cells and downregulated the expression of co-stimulatory molecules CD80 and CD86. Additionally, TER reduced the percentage and absolute numbers of natural killer T (NKT) cells, as well as the percentage of natural killer (NK) cells and showed a trend toward reducing the CD56dim NK pathogenic subset. CONCLUSION TER promotes the tolerogenic immune response and suppresses the pathogenic immune response in patients with RRMS.
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Affiliation(s)
- Qi Wu
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; Autoimmunity Center of Excellence, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Qin Wang
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; Autoimmunity Center of Excellence, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer Yang
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; Autoimmunity Center of Excellence, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Elizabeth A Mills
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; Autoimmunity Center of Excellence, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Pavani Chilukuri
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; Autoimmunity Center of Excellence, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Aiya Saad
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; Autoimmunity Center of Excellence, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Catherine A Dowling
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; Autoimmunity Center of Excellence, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Caitlyn Fisher
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; Autoimmunity Center of Excellence, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brittany Kirch
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; Autoimmunity Center of Excellence, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA; Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI, USA; Autoimmunity Center of Excellence, University of Michigan Medical School, Ann Arbor, MI, USA
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11
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Wang Z, Chen G. Immune regulation in neurovascular units after traumatic brain injury. Neurobiol Dis 2023; 179:106060. [PMID: 36871640 DOI: 10.1016/j.nbd.2023.106060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/19/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023] Open
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Survivors may experience movement disorders, memory loss, and cognitive deficits. However, there is a lack of understanding of the pathophysiology of TBI-mediated neuroinflammation and neurodegeneration. The immune regulation process of TBI involves changes in the peripheral and central nervous system (CNS) immunity, and intracranial blood vessels are essential communication centers. The neurovascular unit (NVU) is responsible for coupling blood flow with brain activity, and comprises endothelial cells, pericytes, astrocyte end-feet, and vast regulatory nerve terminals. A stable NVU is the basis for normal brain function. The concept of the NVU emphasizes that cell-cell interactions between different types of cells are essential for maintaining brain homeostasis. Previous studies have explored the effects of immune system changes after TBI. The NVU can help us further understand the immune regulation process. Herein, we enumerate the paradoxes of primary immune activation and chronic immunosuppression. We describe the changes in immune cells, cytokines/chemokines, and neuroinflammation after TBI. The post-immunomodulatory changes in NVU components are discussed, and research exploring immune changes in the NVU pattern is also described. Finally, we summarize immune regulation therapies and drugs after TBI. Therapies and drugs that focus on immune regulation have shown great potential for neuroprotection. These findings will help us further understand the pathological processes after TBI.
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Affiliation(s)
- Zongqi Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu Province 215006, China; Institute of Stroke Research, Soochow University, Suzhou, Jiangsu Province 215006, China
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu Province 215006, China; Institute of Stroke Research, Soochow University, Suzhou, Jiangsu Province 215006, China.
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Doggrell SA. The ULTIMATE trials: are there advantages of ublituximab over teriflunomide in relapsing multiple sclerosis? Expert Opin Biol Ther 2022; 22:1339-1343. [DOI: 10.1080/14712598.2022.2143262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sheila A Doggrell
- School of Pharmacy and Medical Sciences, Griffith University, Queensland, Australia
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