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Ghiasian M, Bawand R, Jabarzadeh S, Moradi A. Predictive factors and treatment challenges in malignant progression of relapsing-remitting multiple sclerosis. Heliyon 2024; 10:e26658. [PMID: 38420491 PMCID: PMC10900812 DOI: 10.1016/j.heliyon.2024.e26658] [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: 06/12/2023] [Revised: 01/25/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
Objective Our objective was to uncover the predictive factors that can help anticipate the malignant progression of individuals with Relapsing-Remitting Multiple Sclerosis (RRMS). Additionally, we sought to analyze and compare the response to treatment between patients with benign and malignant forms of RRMS. Methods This cohort study included RRMS patients categorized as benign (≥10 years since disease onset, Expanded Disability Status Scale (EDSS) ≤ 1) or malignant (≤5 years since disease onset, EDSS ≥6). Patients' data, including demographics, medical history, treatment, and MRI (Magnetic Resonance Imaging) scans, were collected and statistically analyzed. Results Among the 254 patients diagnosed with RRMS, 174 were found to have benign RRMS, while the remaining 80 were diagnosed with malignant RRMS. Notably, patients with malignant RRMS exhibited a significantly higher mean age of onset (32.00 ± 7.96 vs. 25.70 ± 17.19; P < 0.001) and a greater prevalence of males (40% vs. 18.4%; P = 0.014). Additionally, within the initial five years of diagnosis, patients with malignant RRMS experienced a higher number of relapses (median: 4 vs. 2; P < 0.001) and hospitalizations (median: 2 vs. 1; P = 0.006) compared to those with benign RRMS. Clinical presentations of malignant RRMS were predominantly characterized by multifocal attacks, whereas unifocal attacks were more prevalent in patients with benign RRMS. MRI scans revealed that malignant RRMS patients displayed a higher burden of plaques in the infratentorial and cord regions, as well as a greater number of black hole lesions. Conversely, benign RRMS patients exhibited a higher number of Gadolinium-enhanced lesions. Utilizing Disease-Modifying Therapies (DMTs) with an escalating approach has shown effectiveness in managing benign RRMS. However, it has proven insufficient in addressing malignant RRMS, resulting in frequent transitions to higher-line DMTs. As a result, it places a considerable burden on patients with malignant RRMS, consuming valuable time and resources, and ultimately yielding subpar outcomes. Conclusion Our study identifies prognostic factors for malignant progression in RRMS, including older age of onset, male gender, increased relapses and hospitalizations, multifocal attacks, higher plaque load, and black hole lesions. The current escalation strategy for DMTs is insufficient for managing malignant RRMS, requiring alternative approaches for improved outcomes. In other words, MS is a spectrum rather than a single disease, and some patients progress to a malignant phenotype of MS that is not effectively treated by the current approach.
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Affiliation(s)
- Masoud Ghiasian
- Department of Neuroimmunology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rashed Bawand
- Department of General Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sulmaz Jabarzadeh
- Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moradi
- Department of Social Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Specific Aspects of Immunotherapy for Multiple Sclerosis in Switzerland—A Structured Commentary, Update 2022. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn7010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Multiple sclerosis (MS), particularly relapsing MS (RMS), has become a treatable disease in recent decades, and immunotherapies are now able to influence long-term disease course. A wide range of disease-modifying drugs are available, which makes the choice of therapy in individual cases considerably more complex. Due to specific regulatory aspects (partly diverging approvals by Swissmedic compared to the European Medicines Agency (EMA), and an independent evaluation process for the Federal Office of Public Health (FOPH) specialities list (SL)), we issued a consensus recommendation regarding specific aspects of immunotherapy for MS in Switzerland in 2019. Here, we present revised recommendations with an update on newly approved drugs and new safety aspects, also in reference to the risk of COVID-19 infection and vaccination.
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Meca-Lallana V, Arroyo-González R, Meca-Lallana J, Martín-Hernández J, Sánchez-de la Rosa R. A consensus initiative for the assessment of patients newly diagnosed with multiple sclerosis in Spain: the eXamina Project. Neurodegener Dis Manag 2016; 6:363-74. [DOI: 10.2217/nmt-2016-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To create a national consensus checklist to assess newly diagnosed multiple sclerosis patients when considering treatment initiation in Spain. Materials & methods: The Delphi consensus method was used. A scientific committee drafted items/domains, 52 experts evaluated their inclusion in the project checklist and 47 experts assessed checklist use in clinical practice. Results: Forty-eight items from seven dimensions were selected: sociodemographics, n = 3; medical history, n = 10; multiple sclerosis clinical factors, n = 14; laboratory/MRI, n = 8; multiple sclerosis signs affecting treatment, n = 4; multiple sclerosis signs affecting management, n = 1; treatment-related features, n = 8. Understanding, acceptance, ease of use, effectiveness and suitability of checklist use were favorably rated by ≥75.5% of experts. Conclusion: This project provides a consensus checklist gathering necessary information when considering multiple sclerosis treatment in newly diagnosed patients.
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Affiliation(s)
- Virginia Meca-Lallana
- Neurology Department, Demyelinating Disease Unit, Hospital Universitario La Princesa, Diego de León, 62, 28006 Madrid, Spain
| | - Rafael Arroyo-González
- Neurology Department, Hospital Universitario Quirón Madrid, Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Spain
| | - José Meca-Lallana
- Neurology Department, Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Carretera Madrid-Cartagena, S/N, 30120 Murcia, Spain
- Department of Clinical Neuroimmunology & Multiple Sclerosis, UCAM Universidad Católica San Antonio de Murcia, Avenida Jerónimos, 135, 30107 Guadalupe, Spain
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von Gumberz J, Mahmoudi M, Young K, Schippling S, Martin R, Heesen C, Siemonsen S, Stellmann JP. Short-term MRI measurements as predictors of EDSS progression in relapsing-remitting multiple sclerosis: grey matter atrophy but not lesions are predictive in a real-life setting. PeerJ 2016; 4:e2442. [PMID: 27688965 PMCID: PMC5036070 DOI: 10.7717/peerj.2442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 08/13/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the best biomarker of inflammatory disease activity in relapsing remitting Multiple Sclerosis (RRMS) so far but the association with disability is weak. Appearance of new MRI-lesions is used to evaluate response to immunotherapies in individual patients as well as being the most common primary outcome in phase-2 trials. Measurements of brain atrophy show promising outcomes in natural cohort studies and some phase-2 trials. From a theoretical perspective they might represent irreversible neurodegeneration and be more closely associated with disability. However, these atrophy measurements are not yet established as prognostic factors in real-life clinical routine. High field MRI has improved image quality and resolution and new methods to measure atrophy dynamics have become available. OBJECTIVE To investigate the predictive value of MRI classification criteria in to high/low atrophy and inflammation groups, and to explore predictive capacity of two consecutive routine MRI scans for disability progression in RRMS in a real-life prospective cohort. METHODS 82 RRMS-patients (40 untreated, 42 treated with immunotherapies, mean age 40 years, median Expanded Disability Status Scale (EDSS) of 2, underwent two clinically indicated MRI scans (3 Tesla) within 5-14 months, and EDSS assessment after a mean of 3.0 (1.5-4.2) years. We investigated the predictive value of predefined classifications in low/high inflammatory and atrophy groups for EDSS progression (≥1.5 if baseline EDSS = 0, ≥1.0 if baseline EDSS <5, ≥0.5 for other) by chi-square tests and by analysis of variance (ANOVA). The classifications were based on current scientific or clinical recommendation (e.g., treatment response criteria). Brain atrophy was assessed with three different methods (SIENA, SIENAX, and FreeSurfer). Post-hoc analyses aimed to explore clinical data and dynamics of MRI outcomes as predictors in multivariate linear and logit models. RESULTS Progression was observed in 24% of patients and was independent from treatment status. None of the predefined classifications were predictive for progression. Explorative post-hoc analyses found lower baseline EDSS and higher grey matter atrophy (FreeSurfer) as best predictors (R (2) = 0.29) for EDSS progression and the accuracy was overall good (Area under the curve = 0.81). CONCLUSION Beside EDSS at baseline, short-term grey matter atrophy is predictive for EDSS progression in treated and untreated RRMS. The development of atrophy measurements for individual risk counselling and evaluation of treatment response seems possible, but needs further validation in larger cohorts. MRI-atrophy estimates from the FreeSurfer toolbox seem to be more reliable than older methods.
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Affiliation(s)
- Johanna von Gumberz
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mina Mahmoudi
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kim Young
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Roland Martin
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Christoph Heesen
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Siemonsen
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Associations of Lifestyle, Medication, and Socio-Demographic Factors with Disability in People with Multiple Sclerosis: An International Cross-Sectional Study. PLoS One 2016; 11:e0161701. [PMID: 27560626 PMCID: PMC4999178 DOI: 10.1371/journal.pone.0161701] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/10/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Emerging evidence links modifiable lifestyle risk factors to disease progression in multiple sclerosis (MS). We sought further evidence around this hypothesis through detailed analysis of the association with disability of lifestyle behaviours of a large international sample of people with MS. MATERIALS AND METHODS A total of 2469 people with MS from 57 countries provided self-reported data via cross-sectional online survey on lifestyle (mostly with validated tools) and the primary outcome measure, disability (Patient Determined Disease Steps), categorised from 8 steps into 3 categories, mild, moderate and major disability. Multinomial logistic regression modelling derived relative risk ratios (RRRs) for disability categories. RESULTS RRRs of having moderate vs mild disability were: diet (per 30 points on 100 point scale) 0.72 (95%CI 0.52-0.98), ever smoking 1.32 (1.06-1.65), exercise (moderate/high vs low) 0.35 (0.28-0.44), latitude (per degree from the equator) 1.02 (1.01-1.04), and number of comorbidities (2 vs none) 1.43 (1.04-1.95), (3 vs none) 1.56 (1.13-2.16). RRRs of having major vs mild disability were: exercise (moderate/high vs low) 0.07 (0.04-0.11), alcohol consumption (moderate vs low) 0.45 (0.30-0.68), plant-based omega 3 supplementation 0.39 (0.18-0.86), and disease-modifying medication use 0.45 (0.29-0.70). CONCLUSIONS Healthier lifestyle has strong associations with disability in our large international sample of people with MS, supporting further investigation into the role of lifestyle risk factors in MS disease progression.
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Del Boccio P, Rossi C, di Ioia M, Cicalini I, Sacchetta P, Pieragostino D. Integration of metabolomics and proteomics in multiple sclerosis: From biomarkers discovery to personalized medicine. Proteomics Clin Appl 2016; 10:470-84. [DOI: 10.1002/prca.201500083] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/17/2015] [Accepted: 12/30/2015] [Indexed: 01/04/2023]
Affiliation(s)
- Piero Del Boccio
- Department of Medical Oral and Biotechnological Sciences; University “G. d'Annunzio” of Chieti- Pescara; Chieti Italy
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| | - Claudia Rossi
- Department of Medical Oral and Biotechnological Sciences; University “G. d'Annunzio” of Chieti- Pescara; Chieti Italy
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| | - Maria di Ioia
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
- Department of Neurosciences and Imaging; University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| | - Ilaria Cicalini
- Department of Medical Oral and Biotechnological Sciences; University “G. d'Annunzio” of Chieti- Pescara; Chieti Italy
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| | - Paolo Sacchetta
- Department of Medical Oral and Biotechnological Sciences; University “G. d'Annunzio” of Chieti- Pescara; Chieti Italy
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| | - Damiana Pieragostino
- Department of Medical Oral and Biotechnological Sciences; University “G. d'Annunzio” of Chieti- Pescara; Chieti Italy
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
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Charvet LE, Beekman R, Amadiume N, Belman AL, Krupp LB. The Symbol Digit Modalities Test is an effective cognitive screen in pediatric onset multiple sclerosis (MS). J Neurol Sci 2014; 341:79-84. [DOI: 10.1016/j.jns.2014.04.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/08/2014] [Accepted: 04/05/2014] [Indexed: 11/29/2022]
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Hauser SL, Chan JR, Oksenberg JR. Multiple sclerosis: Prospects and promise. Ann Neurol 2013; 74:317-27. [PMID: 23955638 DOI: 10.1002/ana.24009] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 08/05/2013] [Indexed: 12/15/2022]
Abstract
We have entered a golden era in multiple sclerosis (MS) research. Two decades ago, our understanding of the disease was largely descriptive and there were no approved therapies to modify the natural history of MS. Today, delineation of immune pathways relevant to MS have been clarified; a comprehensive map of genes that influence risk compiled; clues to environmental triggers identified; noninvasive in vivo monitoring of the MS disease process has been revolutionized by high-field MRI; and many effective therapies for the early, relapsing, component of MS now exist. However, major challenges remain. We still have no useful treatment for progressive MS (the holy grail of MS research), no means to repair injured axons or protect neurons, and extremely limited evidence to guide treatment decisions. Recent advances have set in place a foundation for development of increasingly selective immunotherapy for patients; application of genetic and genomic discoveries to improve therapeutic options; development of remyelination or neuroprotection therapies for progressive MS; and integrating clinical, imaging and genomic data for personalized medicine. MS has now advanced from the backwaters of autoimmune disease research to the front-line, and definitive answers, including cures, are now realistic goals for the next decade. Many of the breakthrough discoveries in MS have also resulted from meaningful interactions across disciplines, and especially from translational and basic scientists working closely with clinicians, highlighting that the clinical value of discoveries are most often revealed when ideas developed in the laboratory are tested at the bedside.
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Affiliation(s)
- Stephen L Hauser
- Department of Neurology, University of California, San Francisco, San Francisco, CA
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