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Kalincik T, Kubala Havrdova E, Horakova D, Izquierdo G, Prat A, Girard M, Duquette P, Grammond P, Onofrj M, Lugaresi A, Ozakbas S, Kappos L, Kuhle J, Terzi M, Lechner-Scott J, Boz C, Grand'Maison F, Prevost J, Sola P, Ferraro D, Granella F, Trojano M, Bergamaschi R, Pucci E, Turkoglu R, McCombe PA, Pesch VV, Van Wijmeersch B, Solaro C, Ramo-Tello C, Slee M, Alroughani R, Yamout B, Shaygannejad V, Spitaleri D, Sánchez-Menoyo JL, Ampapa R, Hodgkinson S, Karabudak R, Butler E, Vucic S, Jokubaitis V, Spelman T, Butzkueven H. Comparison of fingolimod, dimethyl fumarate and teriflunomide for multiple sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:458-468. [PMID: 30636699 DOI: 10.1136/jnnp-2018-319831] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Oral immunotherapies have become a standard treatment in relapsing-remitting multiple sclerosis. Direct comparison of their effect on relapse and disability is needed. METHODS We identified all patients with relapsing-remitting multiple sclerosis treated with teriflunomide, dimethyl fumarate or fingolimod, with minimum 3-month treatment persistence and disability follow-up in the global MSBase cohort study. Patients were matched using propensity scores. Three pairwise analyses compared annualised relapse rates and hazards of disability accumulation, disability improvement and treatment discontinuation (analysed with negative binomial models and weighted conditional survival models, with pairwise censoring). RESULTS The eligible cohorts consisted of 614 (teriflunomide), 782 (dimethyl fumarate) or 2332 (fingolimod) patients, followed over the median of 2.5 years. Annualised relapse rates were lower on fingolimod compared with teriflunomide (0.18 vs 0.24; p=0.05) and dimethyl fumarate (0.20 vs 0.26; p=0.01) and similar on dimethyl fumarate and teriflunomide (0.19 vs 0.22; p=0.55). No differences in disability accumulation (p≥0.59) or improvement (p≥0.14) were found between the therapies. In patients with ≥3-month treatment persistence, subsequent discontinuations were less likely on fingolimod than teriflunomide and dimethyl fumarate (p<0.001). Discontinuation rates on teriflunomide and dimethyl fumarate were similar (p=0.68). CONCLUSION The effect of fingolimod on relapse frequency was superior to teriflunomide and dimethyl fumarate. The effect of the three oral therapies on disability outcomes was similar during the initial 2.5 years on treatment. Persistence on fingolimod was superior to the two comparator drugs.
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Affiliation(s)
- Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia .,Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | - Alexandre Prat
- Montreal, Quebec, Hopital Notre-Dame, Canada.,CHUM and Universite de Montreal, Montreal, Quebec, Canada
| | - Marc Girard
- Montreal, Quebec, Hopital Notre-Dame, Canada.,CHUM and Universite de Montreal, Montreal, Quebec, Canada
| | - Pierre Duquette
- Montreal, Quebec, Hopital Notre-Dame, Canada.,CHUM and Universite de Montreal, Montreal, Quebec, Canada
| | | | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G d'Annunzio, Chieti, Italy
| | - Alessandra Lugaresi
- Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy.,Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, New South Wales, Australia.,Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Emergency and General Medicine, Parma University Hospital, Parma, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | | | - Eugenio Pucci
- UOC Neurologia, Azienda Sanitaria Unica Regionale Marche-AV3, Macerata, Italy
| | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Pamela A McCombe
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Vincent Van Pesch
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Bart Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium
| | - Claudio Solaro
- Department of Neurology, ASL3 Genovese, and Department of Rehabilitation, ML Novarese Hospital Moncrivello, Genova, Italy
| | | | - Mark Slee
- Flinders University, Adelaide, South Australia, Australia
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | | | | | | | | | - Ernest Butler
- Monash Medical Centre, Melbourne, Victoria, Australia
| | - Steve Vucic
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Vilija Jokubaitis
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tim Spelman
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Victoria, Australia
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Prosperini L, Lucchini M, Haggiag S, Bellantonio P, Bianco A, Buscarinu MC, Buttari F, Centonze D, Cortese A, De Giglio L, Fantozzi R, Ferraro E, Fornasiero A, Francia A, Galgani S, Gasperini C, Marfia GA, Millefiorini E, Nociti V, Pontecorvo S, Pozzilli C, Ruggieri S, Salvetti M, Sgarlata E, Mirabella M. Fingolimod vs dimethyl fumarate in multiple sclerosis: A real-world propensity score-matched study. Neurology 2018; 91:e153-e161. [PMID: 29875218 DOI: 10.1212/wnl.0000000000005772] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/06/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To directly compare fingolimod (FNG) and dimethyl fumarate (DMF) on no evident disease activity (NEDA) status in patients with relapsing-remitting multiple sclerosis (RRMS) from 7 multiple sclerosis outpatient clinics in Central Italy. METHODS We analyzed data of patients with RRMS who started an oral agent, namely DMF or FNG, either as first treatment (naives) or after switching from self-injectable drugs (switchers). We performed a propensity score (PS)-based nearest-neighbor matching within a caliper of 0.05 to select patients with homogeneous baseline characteristics. Pairwise censoring was adopted to adjust for difference in length of follow-up between the 2 treatment groups. Comparisons were then conducted in matched samples with Cox models (stratified by center) with NEDA-3 as the main outcome. NEDA-3 was defined as no relapses, no disability worsening, and no MRI activity. RESULTS Overall, 483 and 456 patients eligible for analysis started on FNG and DMF, respectively. The PS-matching procedure retained a total of 550 patients (275 per group). After a median on-study follow-up of 18 months, the proportions of patients with NEDA-3 were similar (FNG 73%, DMF 70%; hazard ratio [HR] 0.74, p = 0.078). Subgroup analyses showed a comparable effectiveness of the 2 drugs in naives (n = 170, HR 1.15, p = 0.689), whereas FNG was superior to DMF in the achievement of NEDA-3 status among switchers (n = 380, HR 0.57, p = 0.007). CONCLUSION We found no significant difference between FNG and DMF on NEDA-3 status, while subgroup analyses suggest the superiority of FNG over DMF in patients switching from self-injectable drugs. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with RRMS, DMF and FNG have comparable efficacy in treatment-naive patients and that FNG is superior to DMF in patients switching from self-injectable drugs.
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Affiliation(s)
- Luca Prosperini
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy.
| | - Matteo Lucchini
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Shalom Haggiag
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Paolo Bellantonio
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Assunta Bianco
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Maria Chiara Buscarinu
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Fabio Buttari
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Diego Centonze
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Antonio Cortese
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Laura De Giglio
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Roberta Fantozzi
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Elisabetta Ferraro
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Arianna Fornasiero
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Ada Francia
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Simonetta Galgani
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Claudio Gasperini
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Girolama Alessandra Marfia
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Enrico Millefiorini
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Viviana Nociti
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Simona Pontecorvo
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Carlo Pozzilli
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Serena Ruggieri
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Marco Salvetti
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Eleonora Sgarlata
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
| | - Massimiliano Mirabella
- From the Department of Neurosciences (L.P., S.H., S.G., C.G., S.R.), S. Camillo-Forlanini Hospital; Department of Neurology and Psychiatry (A.C., L.D.G., A. Francia, E.M., S.P., C.P., S.R., E.S.), Sapienza University; Fondazione Policlinico Universitario IRCCS "A. Gemelli" (M.L., A.B., V.N., M.M.), Università Cattolica del Sacro Cuore, Rome; Unit of Neurology and of Neurorehabilitation (P.B., F.B., D.C., R.F., M.S.), IRCCS Neuromed, Pozzilli (IS); Center for Experimental Neurological Therapies (M.C.B., A. Fornasiero, M.S.), S. Andrea Hospital, Deptartment of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome; Department of Systems Medicine (F.B., D.C., G.A.M.), MS Clinical and Research Center, Tor Vergata University; Neurology Unit (E.F.), S. Filippo Neri Hospital, Rome; and Don Carlo Gnocchi Foundation Onlus (V.N.), Milan, Italy
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