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Doskas T, Dardiotis E, Vavougios GD, Ntoskas KT, Sionidou P, Vadikolias K. Stroke risk in multiple sclerosis: a critical appraisal of the literature. Int J Neurosci 2023; 133:1132-1152. [PMID: 35369835 DOI: 10.1080/00207454.2022.2056459] [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: 04/21/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Observational studies suggest that the occurrence of stroke on multiple sclerosis (MS) patients is higher compared to the general population. MS is a heterogeneous disease that involves an interplay of genetic, environmental and immune factors. The occurrence of stroke is subject to a wide range of both modifiable and non-modifiable, short- and long-term risk factors. Both MS and stroke share common risk factors. The immune mechanisms that underlie stroke are similar to neurodegenerative diseases and are attributed to neuroinflammation. The inflammation in autoimmune diseases may, therefore, predispose to an increased risk for stroke or potentiate the effect of conventional stroke risk factors. There are, however, additional determinants that contribute to a higher risk and incidence of stroke in MS. Due to the challenges that are associated with their differential diagnosis, the objective is to present an overview of the factors that may contribute to increased susceptibility or occurrence of stroke in MSpatients by performing a review of the available to date literature. As both MS and stroke can individually detrimentally affect the quality of life of afflicted patients, the identification of factors that contribute to an increased risk for stroke in MS is crucial for the prompt implementation of preventative therapeutic measures to limit the additive burden that stroke imposes.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, Athens, Greece
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Ciano-Petersen NL, Aliaga-Gaspar P, Hurtado-Guerrero I, Reyes V, Rodriguez-Bada JL, Rodriguez-Traver E, Brichette-Mieg I, Leyva Fernández L, Serrano-Castro P, Alonso A, Oliver-Martos B. Natalizumab-immunogenicity evaluation in patients with infusion related events or disease exacerbations. Front Immunol 2023; 14:1242508. [PMID: 37675113 PMCID: PMC10478078 DOI: 10.3389/fimmu.2023.1242508] [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: 06/19/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Natalizumab is a biologic drug for relapsing-remitting multiple sclerosis that may induce the generation of anti-drug antibodies in some patients. Anti-natalizumab antibodies (ANA) increase the risk of adverse events and reduce efficacy, being useful biomarkers for monitoring treatment response. Methods Retrospective observational study including MS patients treated with natalizumab that experienced infusion-related events (IRE) or disease exacerbations (DE). ANA were tested by Elisa including a screening and a confirmation assay. Patients were further classified as transient (one positive result) or persistent (two or more positive results) ANA. Results A total of 1251 MS patients were included and 153 (12.3%) had ANA with at least one single point determination, which were more frequent among patients with IRE compared to those with DE (21,6% vs.10.8%) during the first six infusions. Two or more determinations ANA were performed in 184 patients, being 31.5% permanently positive and 7.1% transiently positive. Interestingly, 26.1% of patients that experienced DE had persistent ANA, while 2.6% were transient. In contrast, 43% of patients with IRE had persistent ANA, and 9.3% had transient antibodies. Patients with persistent antibodies had more frequently high levels at the first sampling compared to patients with transient ANA. Conclusion Real-world evidence shows that the presence of ANA is behind an important percentage of patients treated with natalizumab that experience IRE, as well as DE but in a lower degree. These findings support the need to systematically evaluate ANA towards a personalized management of these patients to avoid undesired complications.
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Affiliation(s)
- Nicolás Lundahl Ciano-Petersen
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga-IBIMA Plataforma Bionand, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), Málaga, Spain
| | - Pablo Aliaga-Gaspar
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga-IBIMA Plataforma Bionand, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Isaac Hurtado-Guerrero
- Department of Anatomy and Legal Medicine, Neuropsychopharmacology Group, Biomedical Research Institute of Málaga-IBIMA, Faculty of Medicine, University of Malaga, Málaga, Spain
| | - Virginia Reyes
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga-IBIMA Plataforma Bionand, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), Málaga, Spain
| | - José Luis Rodriguez-Bada
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga-IBIMA Plataforma Bionand, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Eva Rodriguez-Traver
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga-IBIMA Plataforma Bionand, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Isabel Brichette-Mieg
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga-IBIMA Plataforma Bionand, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Laura Leyva Fernández
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga-IBIMA Plataforma Bionand, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), Málaga, Spain
| | - Pedro Serrano-Castro
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga-IBIMA Plataforma Bionand, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), Málaga, Spain
- Department of Medicine and Dermatology, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Ana Alonso
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga-IBIMA Plataforma Bionand, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), Málaga, Spain
| | - Begoña Oliver-Martos
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga-IBIMA Plataforma Bionand, Hospital Regional Universitario de Málaga, Málaga, Spain
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), Málaga, Spain
- Department of Cell Biology, Genetics and Physiology, Physiology Area. Faculty of Science University of Malaga, Málaga, Spain
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Nicolò C, Sips F, Vaghi C, Baretta A, Carbone V, Emili L, Bursi R. Accelerating Digitalization in Healthcare with the InSilicoTrials Cloud-Based Platform: Four Use Cases. Ann Biomed Eng 2023; 51:125-136. [PMID: 36074307 PMCID: PMC9831955 DOI: 10.1007/s10439-022-03052-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/06/2022] [Indexed: 01/28/2023]
Abstract
The use of in silico trials is expected to play an increasingly important role in the development and regulatory evaluation of new medical products. Among the advantages that in silico approaches offer, is that they permit testing of drug candidates and new medical devices using virtual patients or computational emulations of preclinical experiments, allowing to refine, reduce or even replace time-consuming and costly benchtop/in vitro/ex vivo experiments as well as the involvement of animals and humans in in vivo studies. To facilitate and widen the adoption of in silico trials, InSilicoTrials Technologies has developed a cloud-based platform, hosting healthcare simulation tools for different bench, preclinical and clinical evaluations, and for diverse disease areas. This paper discusses four use cases of in silico trials performed using the InSilicoTrials.com platform. The first application illustrates how in silico approaches can improve the early preclinical assessment of drug-induced cardiotoxicity risks. The second use case is a virtual reproduction of a bench test for the safety assessment of transcatheter heart valve substitutes. The third and fourth use cases are examples of virtual patients generation to evaluate treatment effects in multiple sclerosis and prostate cancer patients, respectively.
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Affiliation(s)
- Chiara Nicolò
- InSilicoTrials Technologies S.P.A, Riva Grumula 2, 34123 Trieste, Italy
| | - Fianne Sips
- InSilicoTrials Technologies B.V., Bruistensingel 130, 5232 AC ’s Hertogenbosch, The Netherlands
| | - Cristina Vaghi
- InSilicoTrials Technologies S.P.A, Riva Grumula 2, 34123 Trieste, Italy
| | - Alessia Baretta
- InSilicoTrials Technologies S.P.A, Riva Grumula 2, 34123 Trieste, Italy
| | - Vincenzo Carbone
- InSilicoTrials Technologies S.P.A, Riva Grumula 2, 34123 Trieste, Italy
| | - Luca Emili
- InSilicoTrials Technologies S.P.A, Riva Grumula 2, 34123 Trieste, Italy
| | - Roberta Bursi
- InSilicoTrials Technologies B.V., Bruistensingel 130, 5232 AC ’s Hertogenbosch, The Netherlands
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Sips FLP, Pappalardo F, Russo G, Bursi R. In silico clinical trials for relapsing-remitting multiple sclerosis with MS TreatSim. BMC Med Inform Decis Mak 2022; 22:294. [PMID: 36380294 PMCID: PMC9665027 DOI: 10.1186/s12911-022-02034-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The last few decades have seen the approval of many new treatment options for Relapsing-Remitting Multiple Sclerosis (RRMS), as well as advances in diagnostic methodology and criteria. These developments have greatly improved the available treatment options for today's Relapsing-Remitting Multiple Sclerosis patients. This increased availability of disease modifying treatments, however, has implications for clinical trial design in this therapeutic area. The availability of better diagnostics and more treatment options have not only contributed to progressively decreasing relapse rates in clinical trial populations but have also resulted in the evolution of control arms, as it is often no longer sufficient to show improvement from placebo. As a result, not only have clinical trials become longer and more expensive but comparing the results to those of "historical" trials has also become more difficult. METHODS In order to aid design of clinical trials in RRMS, we have developed a simulator called MS TreatSim which can simulate the response of customizable, heterogeneous groups of patients to four common Relapsing-Remitting Multiple Sclerosis treatment options. MS TreatSim combines a mechanistic, agent-based model of the immune-based etiology of RRMS with a simulation framework for the generation and virtual trial simulation of populations of digital patients. RESULTS In this study, the product was first applied to generate diverse populations of digital patients. Then we applied it to reproduce a phase III trial of natalizumab as published 15 years ago as a use case. Within the limitations of synthetic data availability, the results showed the potential of applying MS TreatSim to recreate the relapse rates of this historical trial of natalizumab. CONCLUSIONS MS TreatSim's synergistic combination of a mechanistic model with a clinical trial simulation framework is a tool that may advance model-based clinical trial design.
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Affiliation(s)
| | - Francesco Pappalardo
- Department of Drug and Health Sciences, University of Catania, Catania, Italy
- Mimesis Srl, Catania, Italy
| | - Giulia Russo
- Department of Drug and Health Sciences, University of Catania, Catania, Italy
- Mimesis Srl, Catania, Italy
| | - Roberta Bursi
- InSilicoTrials Technologies, 's-Hertogenbosch, Netherlands.
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Krämer J, Wiendl H. What Have Failed, Interrupted, and Withdrawn Antibody Therapies in Multiple Sclerosis Taught Us? Neurotherapeutics 2022; 19:785-807. [PMID: 35794296 PMCID: PMC9294122 DOI: 10.1007/s13311-022-01246-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 12/13/2022] Open
Abstract
In the past two decades, monoclonal antibodies (mAbs) have revolutionized the treatment of multiple sclerosis (MS). However, a remarkable number of mAbs failed due to negative study results were withdrawn because of unexpected serious adverse events (SAEs) or due to studies being halted for other reasons. While trials with positive outcomes are usually published in prestigious journals, negative trials are merely published as abstracts or not at all. This review summarizes MS mAbs that have either failed in phase II-III trials, have been interrupted for various reasons, or withdrawn from the market since 2015. The main conclusions that can be drawn from these 'negative' experiences are as follows. mAbs that have been proven to be safe in other autoimmune conditions, will not have the same safety profile in MS due to immunopathogenetic differences in these diseases (e.g., daclizumab). Identification of SAEs in clinical trials is difficult highlighting the importance of phase IV studies. Memory B cells are central players in MS immunopathogenesis (e.g., tabalumab). The pathophysiological mechanisms of disease progression are independent of leukocyte 'outside-in' traffic which drives relapses in MS. Therefore, therapies for progressive MS must be able to sufficiently cross the blood-brain barrier. Sufficiently long trial duration and multicomponent outcome measures are important for clinical studies in progressive MS. The success of trials on remyelination-promoting therapies mainly depends on the sufficient high dose of mAb, the optimal readout for 'proof of concept', time of treatment initiation, and appropriate selection of patients. Failed strategies are highly important to better understand assumed immunopathophysiological mechanisms and optimizing future trial designs.
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Affiliation(s)
- Julia Krämer
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Heinz Wiendl
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
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Experiences in treatment of multiple sclerosis with natalizumab from a real-life cohort over 15 years. Sci Rep 2021; 11:23317. [PMID: 34857795 PMCID: PMC8639988 DOI: 10.1038/s41598-021-02665-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
Natalizumab (NTZ) has been used for treatment of highly active relapsing–remitting multiple sclerosis (MS). When stopping NTZ the risk of severe rebound phenomenon has to be considered. We aimed to investigate the use of NTZ in clinical routine and focused on identification of potential risk factors for disease reactivation after treatment discontinuation. At the Medical University of Innsbruck, Austria, we identified all MS patients who were treated with NTZ and performed a retrospective analysis on therapeutic decision making, disease course before, during and after treatment with NTZ and on risk factors for disease reactivation after NTZ discontinuation. 235 NTZ treated MS patients were included, of whom 105 had discontinued treatment. At NTZ start disease duration was 5.09 (IQR 2.09–10.57) years, average number of total relapses was 4 (IQR 3–6) and median EDSS 2.0 (range 0–6.5), whereby these values significantly decreased over time. Reduction of annualized relapse rate (ARR) on treatment was 93% and EDSS remained stable in 64%. In multivariate regression models only conversion to secondary progressive MS (SPMS) on treatment was significantly associated with lower risk of disease reactivation after NTZ, while ARR before treatment was associated with earlier disease reactivation. We could confirm the high therapeutic efficacy of NTZ which trends to be used earlier in the disease course nowadays. Discontinuation of NTZ seems safe only in patients who convert to SPMS during treatment, while higher ARR before NTZ increases the risk of disease reactivation after treatment discontinuation.
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López PA, Alonso R, Silva B, Carnero Contentti E. Natalizumab subcutaneous injection for the treatment of relapsing multiple sclerosis patients: A new delivery route. Mult Scler Relat Disord 2021; 55:103179. [PMID: 34339931 DOI: 10.1016/j.msard.2021.103179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alem´an, Buenos Aires, Argentina.
| | - Ricardo Alonso
- Neurology Department, Centro Universitario de Esclerosis Múltiple (CUEM), J.M. Ramos Mejía Hospital, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Berenice Silva
- Neurology Department, Centro Universitario de Esclerosis Múltiple (CUEM), J.M. Ramos Mejía Hospital, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Edgar Carnero Contentti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alem´an, Buenos Aires, Argentina.
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Kim KH, Kim SH, Park NY, Hyun JW, Kim HJ. Real-World Effectiveness of Natalizumab in Korean Patients With Multiple Sclerosis. Front Neurol 2021; 12:714941. [PMID: 34305808 PMCID: PMC8299833 DOI: 10.3389/fneur.2021.714941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Natalizumab is a highly efficacious disease-modifying therapy for relapsing-remitting multiple sclerosis (MS). Data on the efficacy and safety profile of natalizumab in Asian patients with MS are limited. This study assessed the efficacy and safety of natalizumab in Korean patients with MS in a real-world setting. Methods: This study enrolled consecutive Korean patients with active relapsing-remitting MS who were treated with natalizumab for at least 6 months between 2015 and 2021. To evaluate the therapeutic outcome of natalizumab, we used the Expanded Disability Status Scale (EDSS) scores and brain magnetic resonance imaging; adverse events were assessed at regular intervals. No evidence of disease activity (NEDA) was defined as no clinical relapse, no worsening of EDSS score, and no radiological activities. Results: Fourteen subjects with MS were included in the study. The mean age at initiation of natalizumab therapy was 32 years. All patients were positive for anti-John Cunningham virus antibodies before natalizumab administration. The mean annual relapse rate was markedly reduced from 2.7 ± 3.2 before natalizumab therapy to 0.1 ± 0.4 during natalizumab therapy (p = 0.001). Disability was either improved or stabilized after natalizumab treatment in 13 patients (93%). During the 1st year and 2 years after initiating natalizumab, NEDA-3 was achieved in 11/12 (92%) and 9/11 (82%) patients, respectively. No progressive multifocal leukoencephalopathy or other serious adverse events leading to the discontinuation of natalizumab were observed. Conclusions: Natalizumab therapy showed high efficacy in treating Korean patients with active MS, without unexpected safety problems.
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Affiliation(s)
- Ki Hoon Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Na Young Park
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
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Callegari I, Derfuss T, Galli E. Update on treatment in multiple sclerosis. Presse Med 2021; 50:104068. [PMID: 34033862 DOI: 10.1016/j.lpm.2021.104068] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/29/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. In recent years, many disease-modifying therapies (DMT) have been approved for MS treatment. For this reason, a profound knowledge of the characteristics and indications of the available compounds is required to tailor the therapeutic strategy to the individual patient characteristics. This should include the mechanism of action and pharmacokinetic of the drug, the safety and efficacy profile provided by clinical trials, as well as the understanding of possible side effects. Moreover, the evolving knowledge of the disease is paving the way to new and innovative therapeutic approaches, as well as the development of new biomarkers to monitor the therapeutic response and to guide the clinician's therapeutic choices. In this review we provide a comprehensive overview on currently approved therapies in MS and the emerging evidence-based strategies to adopt for initiating, monitoring, and eventually adapting a therapeutic regimen with DMT.
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Affiliation(s)
- Ilaria Callegari
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland
| | - Tobias Derfuss
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland; Department of Neurology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Edoardo Galli
- Department of Biomedicine, University Hospital Basel, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland; Department of Neurology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland
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Ysrraelit MC, Caride A, Sinay V, Kindel MR, Halfon MJ, Patrucco L, Piedrabuena R, Aragunde VED. Real-world effectiveness of natalizumab treatment in patients with relapsing multiple sclerosis in Argentina and Chile. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:407-414. [PMID: 34161529 PMCID: PMC9394560 DOI: 10.1590/0004-282x-anp-2020-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The real-world effectiveness of natalizumab in people with relapsing multiple sclerosis (PwRMS) in Argentina and Chile has not been reported. OBJECTIVE To evaluate the effectiveness of natalizumab treatment in PwRMS in Argentina and Chile, in clinical practice. METHODS We conducted a multicenter retrospective and observational study. We reviewed the medical records of PwRMS who had been treated with natalizumab for at least one year, without any interruption in MS treatment that lasted more than 12 weeks. We analyzed changes in annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) score and magnetic resonance imaging (MRI). RESULTS We enrolled 117 PwRMS treated with natalizumab. Natalizumab treatment was associated with a significant reduction in ARR from baseline after one year and two years of treatment (from 1.97 to 0.06 and 0.09 respectively; p<0.01 at each time point). From baseline, EDSS scores were reduced by 0.71 and 0.73 points at one and two years, respectively (p<0.01). No worsening of disability was observed in 82.9 and 67.5% of PwRMS at one and two years, respectively. The improvement in disability was 44.4% at one year and 39.3% at two years. During natalizumab treatment, the number of relapse-related hospitalizations was significantly reduced (p<0.01). MRI lesions (new/enlarging T2 or gadolinium-enhancing) were significantly reduced, compared with baseline. No evidence of disease activity was observed in 65% at two years of natalizumab treatment. CONCLUSIONS Natalizumab significantly reduced disease activity in PwRMS in Argentina and Chile, in clinical practice. Natalizumab also decreased the number of hospitalizations compared with pre-natalizumab treatment.
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Affiliation(s)
- Maria Celica Ysrraelit
- FLENIInstitute for Neurological Research Dr Raul CarreaNeurology DepartmentBuenos AiresArgentinaInstitute for Neurological Research Dr Raul Carrea, FLENI, Neurology Department, Buenos Aires, Argentina.
| | - Alejandro Caride
- Hospital AlemanDepartment of NeuroscienceNeuroimmunology UnitBuenos AiresArgentinaHospital Aleman, Department of Neuroscience, Neuroimmunology Unit, Buenos Aires, Argentina.
| | - Vladimiro Sinay
- Fundación Favaloro HospitalBuenos AiresArgentinaFundación Favaloro Hospital, Buenos Aires, Argentina.
| | - Mario Rivera Kindel
- Clínica DávilaRegión MetropolitanaChileClínica Dávila, Recoleta, Región Metropolitana, Chile.
| | - Mario Javier Halfon
- British Hospital of Buenos AiresBuenos AiresArgentinaBritish Hospital of Buenos Aires, Buenos Aires, Argentina.
| | - Liliana Patrucco
- Hospital Italiano de Buenos AiresBuenos AiresArgentinaHospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Raul Piedrabuena
- Clínica Universitaria Reina FabiolaServicio de NeurologíaCórdobaArgentinaClínica Universitaria Reina Fabiola, Servicio de Neurología, Córdoba, Argentina.
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Bigaut K, Fabacher T, Kremer L, Ongagna JC, Kwiatkowski A, Sellal F, Ferriby D, Courtois S, Vermersch P, Collongues N, Zéphir H, De Seze J, Outteryck O. Long-term effect of natalizumab in patients with RRMS: TYSTEN cohort. Mult Scler 2020; 27:729-741. [PMID: 32643521 DOI: 10.1177/1352458520936239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Data are needed on long-term effect of natalizumab (NTZ) in relapsing-remitting multiple sclerosis (RRMS). OBJECTIVES To evaluate the time of onset of secondary progressive phase in patients with an RRMS treated with NTZ and to investigate predictive factors. METHODS TYSTEN is an observational study. Patients starting NTZ between 2007 and 2012 were included and followed up until October 2018. Relapses, Expanded Disability Status Scale (EDSS) scores, and results of brain magnetic resonance imaging (MRI) were collected each year. Data were used to estimate the cumulative probability of several poor outcomes such as secondary progressive multiple sclerosis (SPMS) conversion, EDSS worsening, EDSS 4.0, and EDSS 6.0. RESULTS 770 patients were included. The mean follow-up duration was 97 months and the mean time exposure to NTZ was 66 months. At 10 years, the cumulative probability of SPMS was 27.7%. Predictive factors for poor outcomes were a ⩾1-point increase in EDSS score from baseline, new T2 lesion or T1 gadolinium-enhancing lesion, the occurrence of relapse at 1 or 2 years and No Evidence of Disease Activity (NEDA-3; no relapse, no new T2 or T1 gadolinium-enhancing lesions, no progression) was a protective factor. CONCLUSION In our cohort of patients treated with NTZ, poor outcomes were infrequent and are driven by disease activity.
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Affiliation(s)
- Kévin Bigaut
- Department of Neurology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France/Clinical Investigation Center, INSERM U1434, Strasbourg, France/Biopathology of Myelin, Neuroprotection and Therapeutic Strategies, INSERM U1119, Strasbourg, France
| | - Thibaut Fabacher
- Groupe méthode en recherche clinique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laurent Kremer
- Department of Neurology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France/Clinical Investigation Center, INSERM U1434, Strasbourg, France/Biopathology of Myelin, Neuroprotection and Therapeutic Strategies, INSERM U1119, Strasbourg, France
| | - Jean-Claude Ongagna
- Department of Neurology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Arnaud Kwiatkowski
- Department of Neurology, Hôpital Saint Vincent De Paul, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France
| | - François Sellal
- Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France
| | - Didier Ferriby
- Department of Neurology, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Sylvie Courtois
- Department of Neurology, Groupe Hospitalier de la Région de Mulhouse et Sud Alsace, Mulhouse, France
| | - Patrick Vermersch
- Department of Neurology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Nicolas Collongues
- Department of Neurology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France/Clinical Investigation Center, INSERM U1434, Strasbourg, France/Biopathology of Myelin, Neuroprotection and Therapeutic Strategies, INSERM U1119, Strasbourg, France
| | - Hélène Zéphir
- Department of Neurology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Jérôme De Seze
- Department of Neurology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France/Clinical Investigation Center, INSERM U1434, Strasbourg, France/Biopathology of Myelin, Neuroprotection and Therapeutic Strategies, INSERM U1119, Strasbourg, France
| | - Olivier Outteryck
- Department of Neurology, Centre Hospitalier Universitaire de Lille, Lille, France/Department of Neuroradiology, Centre Hospitalier Universitaire de Lille, Lille, France
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Butzkueven H, Kappos L, Wiendl H, Trojano M, Spelman T, Chang I, Kasliwal R, Jaitly S, Campbell N, Ho PR, Licata S. Long-term safety and effectiveness of natalizumab treatment in clinical practice: 10 years of real-world data from the Tysabri Observational Program (TOP). J Neurol Neurosurg Psychiatry 2020; 91:660-668. [PMID: 32234967 PMCID: PMC7279201 DOI: 10.1136/jnnp-2019-322326] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/20/2020] [Accepted: 03/14/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The Tysabri Observational Programme (TOP), which began >10 years ago, is an open-label, multinational, prospective observational study evaluating the long-term safety and effectiveness of natalizumab in relapsing-remitting multiple sclerosis patients. METHODS These data provide a 10-year interim analysis of safety and effectiveness in TOP. Annualised relapse rates (ARRs) and disability progression/improvement were analysed using the Poisson model and the Kaplan-Meier method, respectively. Analyses included patients on natalizumab and those who discontinued natalizumab but remained in TOP. RESULTS As of November 2017, TOP included 6148 patients. Overall, 829 patients (13.5%) experienced ≥1 serious adverse event (SAE), with infection the most common (4.1%). Fifty-three patients (0.9%) had confirmed progressive multifocal leukoencephalopathy. SAE data were consistent with natalizumab's known safety profile; no new safety signals were identified. A total of 3210 patients (52.2%) discontinued natalizumab; 2117 (34.4%) withdrew from TOP. Median time on natalizumab was 3.3 (range 0-11.6) years; median follow-up time was 5.2 (range 0-10.8) years. The on-natalizumab ARR was 0.15, a 92.5% reduction from the year before initiation. Ten-year cumulative probabilities of disability worsening and improvement were 27.8% and 33.1%, respectively. On-natalizumab ARRs were similar between patients who discontinued or remained on natalizumab, suggesting limited attrition bias. CONCLUSIONS Since the TOP 5-year interim analysis (December 2012), cohort size (6148 vs 4821), median exposure (3.3 vs 1.8 years) and median follow-up time (62 vs 26 months) have increased. This 10-year interim analysis further supports the robust real-world effectiveness and well-established safety profile of natalizumab. TRIAL REGISTRATION NUMBER NCT00493298.
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Affiliation(s)
- Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Alfred Campus, Monash University, Melbourne, Victoria, Australia
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
| | - Heinz Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | - Maria Trojano
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Tim Spelman
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Ih Chang
- Biostatistics, Biogen, Cambridge, Massachusetts, USA
| | - Rachna Kasliwal
- Safety and Benefit Risk, Biogen, Cambridge, Massachusetts, USA (at the time of these analyses)
| | - Seema Jaitly
- Safety and Benefit Risk, Biogen, Cambridge, Massachusetts, USA (at the time of these analyses)
| | | | - Pei-Ran Ho
- Global Medical, Biogen, Cambridge, Massachusetts, USA
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Butzkueven H, Trojano M, Kappos L, Spelman T, Wiendl H, Rosales K, Su R, Licata S, Ho PR, Campbell N. Clinical outcomes in patients who discontinue natalizumab therapy after 2 years in the Tysabri ® Observational Program (TOP). Mult Scler 2020; 27:410-419. [PMID: 32406786 DOI: 10.1177/1352458520917925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Natalizumab is a highly efficacious therapy for relapsing-remitting multiple sclerosis (RRMS). Patients who discontinue natalizumab may experience return of MS disease activity. OBJECTIVE The aim of this study was to analyze predictors of post-natalizumab disease activity return. METHODS The Tysabri® Observational Program (TOP) is an ongoing observational study of natalizumab-treated RRMS patients. Patients discontinuing natalizumab are encouraged to remain in TOP. RESULTS Analyses included 3221 TOP patients. After ⩾2 years on natalizumab, relapse risk was twice as high for patients who switched to an oral therapy (n = 660, hazard ratio (HR) = 2.18, p < 0.001) and three times as high for patients who switched to an injectable therapy (n = 95, HR = 3.02, p < 0.001) as for those who stayed on natalizumab (n = 2466). Relapse rates after switching remained below pre-natalizumab rates. In patients who switched to an oral therapy, higher relapse risk was predicted by longer washout time, more pre-natalizumab relapses, higher Expanded Disability Status Scale score at natalizumab initiation, and shorter natalizumab treatment duration. CONCLUSION Patients who stayed on natalizumab had better clinical outcomes than those who switched to an oral or injectable therapy after ⩾2 years on natalizumab. These results highlight modifiable risk factors for disease activity return (e.g. natalizumab treatment duration and washout duration) to consider when making treatment decisions.
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Affiliation(s)
- Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Alfred Campus, Monash University, Melbourne, VIC, Australia/Department of Neurology, Box Hill Hospital, Monash University, Box Hill, VIC, Australia
| | - Maria Trojano
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Tim Spelman
- Department of Medicine and Melbourne Brain Centre, Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Heinz Wiendl
- Department of Neurology-Inflammatory Disorders of the Nervous System and Neuro-Oncology, University of Münster, Münster, Germany
| | | | - Ray Su
- Biogen, Cambridge, MA, USA
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Kaufmann M, Haase R, Proschmann U, Ziemssen T, Akgün K. Real-World Lab Data in Natalizumab Treated Multiple Sclerosis Patients Up to 6 Years Long-Term Follow Up. Front Neurol 2018; 9:1071. [PMID: 30581413 PMCID: PMC6292961 DOI: 10.3389/fneur.2018.01071] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/23/2018] [Indexed: 12/12/2022] Open
Abstract
Natalizumab inhibits the transmigration of immune cells across the blood-brain barrier thus inhibiting inflammation in the central nervous system. Generally, this blockade at the blood-brain barrier has significant influence on the circulating lymphocytes. Up to date, only short-term data on peripheral blood parameters are available which are mostly from controlled clinical trials and not from real-world experience. Real-world lab data of 120 patients diagnosed with highly active disease course of relapsing-remitting multiple sclerosis (RRMS) were analyzed during natalizumab treatment. Patient sampling was performed by consecutive recruitment in the Multiple Sclerosis Center Dresden. Lab testing was performed before and at every third infusion up to 72 months follow-up. After first natalizumab infusion, absolute numbers of all major lymphocyte populations including CD4+ T-cells, CD8+ T-cells, CD19+ B-cells, and NK-cells significantly increased and remained stable during the whole observation period of 72 months. Upon lymphocyte subsets, CD19+ B-cells presented a disproportionate increase up to levels higher than normal level in most of the treated patients. Neutralizing antibodies to natalizumab abrogated the described changes. Intra-individual variation of lymphocytes and its subsets remained in a narrow range for the whole treatment period. CD4/CD8 ratio did not change compared to baseline measurement up to 6 years of natalizumab treatment. Monocytes, eosinophils, and basophils, but not neutrophils persistently increased during natalizumab treatment. Hematological parameters including erythrocyte, platelet count, hemoglobin, and hematocrit remained unchanged compared to baseline. Interestingly, immature precursor cells including erythroblasts were detectable in 36,8% of the treated patients during natalizumab therapy, but not in the pretreatment period. Asymptomatic elevations of liver enzymes were rare, mostly only transient and lower than 3x upper normal limit. Kidney function parameters remained stable within physiological ranges in most patients. CRP levels >20 mg/dl were recognized only in 10 patients during natalizumab therapy and were mostly linked to respiratory tract infections. In our present analysis, we report persistent, but stable increases of peripheral immune cell subtypes in natalizumab treated patients. Additional serological analyses confirm excellent tolerability and safety even 6 years after natalizumab initiation in post-marketing experience.
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Affiliation(s)
- Maxi Kaufmann
- MS Center Dresden, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, University of Technology Dresden, Dresden, Germany
| | - Rocco Haase
- MS Center Dresden, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, University of Technology Dresden, Dresden, Germany
| | - Undine Proschmann
- MS Center Dresden, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, University of Technology Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- MS Center Dresden, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, University of Technology Dresden, Dresden, Germany
| | - Katja Akgün
- MS Center Dresden, Center of Clinical Neuroscience, Carl Gustav Carus University Hospital, University of Technology Dresden, Dresden, Germany
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Natalizumab Treatment for Relapsing-Remitting Multiple Sclerosis: The Experience From Saudi Arabia. Clin Neuropharmacol 2018; 41:199-201. [PMID: 30234558 DOI: 10.1097/wnf.0000000000000305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Natalizumab is the first targeted humanized monoclonal antibody to be approved for the treatment of relapsing-remitting multiple sclerosis (RRMS). Natalizumab appears to be more effective than current first-line disease-modifying therapies. In our study, we aimed to evaluate the outcome of Saudi patients with active RRMS treated with natalizumab and compare the results with other outcomes in the Gulf and international trials. METHODS We conducted a retrospective single-center observational study involving 32 patients with RRMS at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria included all patients diagnosed with RRMS according to the revised McDonald criteria who are currently receiving or received natalizumab treatment in the past for a minimum of 6 months. RESULTS The mean baseline Expanded Disability Status Scale score was 4.50 ± 1.80 (range, 1.5-6; median, 5), whereas the mean Expanded Disability Status Scale at the follow-up was 4.02 ± 2.08 (range, 1-6; median, 4.25) (P = 0.3274). The mean annualized relapse rate was significantly reduced from 2.41 ± 2.48 at baseline to 0.16 ± 0.37 at the last follow-up (P < 0.0001). Twenty-seven patients (84.4%) had no relapses since the treatment with natalizumab was started, whereas 5 patients (15.6%) had only 1 relapse. In addition to clinically measurable improvement, radiological improvement was observed through magnetic resonance imaging. Magnetic resonance imaging activity was significantly improved at follow-up magnetic resonance imaging studies when compared with baseline. CONCLUSIONS Our single-center study in Saudi Arabia provides further support for the efficacy of natalizumab in the clinical practice setting. The sharp decrease in relapse rate and progression of disability following the initiation of natalizumab treatment was similar to other observational studies conducted in different countries across the globe. Natalizumab was a satisfactory therapy for the management of our MS population, both from the patients' and the physicians' perspectives.
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Yang Q, Bavi P, Wang JY, Roehrl MH. Immuno-proteomic discovery of tumor tissue autoantigens identifies olfactomedin 4, CD11b, and integrin alpha-2 as markers of colorectal cancer with liver metastases. J Proteomics 2017; 168:53-65. [DOI: 10.1016/j.jprot.2017.06.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/03/2017] [Accepted: 06/26/2017] [Indexed: 11/29/2022]
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Singer BA. The role of natalizumab in the treatment of multiple sclerosis: benefits and risks. Ther Adv Neurol Disord 2017; 10:327-336. [PMID: 28861122 PMCID: PMC5557182 DOI: 10.1177/1756285617716002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/23/2017] [Indexed: 02/04/2023] Open
Abstract
Natalizumab, a monoclonal antibody that blocks lymphocyte infiltration in the central nervous system, is a valuable tool in the treatment of relapsing forms of multiple sclerosis (MS). In a phase III clinical trial comparing natalizumab with placebo over 2 years, natalizumab reduced annualized relapse rate by 68%, 12-week confirmed disability progression by 42%, and reduced contrast-enhancing lesions by 92%. In post hoc analyses, natalizumab treatment was associated with 37% of patients achieving no evidence of disease activity (versus 7% on placebo) and 30% achieving sustained disability improvement (versus 19% on placebo). Natalizumab did not achieve a statistically significant primary composite disability outcome in a trial of 887 patients with secondary progressive MS, but it did demonstrate a benefit on a prespecified component of the 9-Hole Peg Test. The greatest risk of natalizumab treatment is progressive multifocal leukoencephalopathy (PML), with a 23% mortality rate. Risk stratification on the basis of immunosuppressant exposure, natalizumab treatment duration and anti-John Cunningham virus (JCV) antibody status and index has greatly improved clinical decision making. Other potential serious natalizumab-associated risks reported in clinical trials and postmarketing settings include infusion reactions, hepatotoxicity and rare, serious opportunistic infections. With more than a decade of continuous postmarketing experience, natalizumab remains a very effective option for patients with relapsing forms of MS. To optimize appropriate selection of natalizumab for patients with relapsing MS, however, a thorough understanding of individual patient risk factors for PML or other adverse events is also required.
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Affiliation(s)
- Barry A Singer
- The MS Center for Innovations in Care, Missouri Baptist Medical Center, 3009 North Ballas Road, Suite 207B, St Louis, MO 63131, USA
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