1
|
Aboseif A, Roos I, Krieger S, Kalincik T, Hersh CM. Leveraging Real-World Evidence and Observational Studies in Treating Multiple Sclerosis. Neurol Clin 2024; 42:203-227. [PMID: 37980116 DOI: 10.1016/j.ncl.2023.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Randomized controlled trials (RCTs) are essential for regulatory approval of disease-modifying therapies (DMTs), yet their strict selection criteria often lead to limited generalizability. Observational studies using real-world data (RWD) allow for more inclusive heterogeneous cohorts resulting in higher external validity to inform treatment practices. As reviewed in this article, well-designed comparative effectiveness studies are an important application of RWD. Although, like RCTs, observational studies have their own set of limitations, including various biases that may confound results, advanced statistical methods can mitigate many of these limitations. A focus on personalized treatment will continue to add value to individualize MS care.
Collapse
Affiliation(s)
- Albert Aboseif
- Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue S10, Cleveland, OH 44195, USA
| | - Izanne Roos
- Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, L7 635 Elizabeth Street, Melbourne 3000, Australia; Department of Medicine, CORe, University of Melbourne, Melbourne, Australia
| | - Stephen Krieger
- Corinne Goldsmith Dickinson Center for MS Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1138, New York, NY 10029, USA
| | - Tomas Kalincik
- Department of Medicine, CORe, University of Melbourne, Melbourne, Australia; Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, L6 635 Elizabeth Street, Melbourne 3000, Australia
| | - Carrie M Hersh
- Lou Ruvo Center for Brain Health, Cleveland Clinic, 888 West Bonneville Avenue, Las Vegas, NV 89106, USA.
| |
Collapse
|
2
|
Effectiveness of first generation disease-modifying therapy to prevent conversion to secondary progressive multiple sclerosis. Mult Scler Relat Disord 2022; 68:104220. [PMID: 36242804 DOI: 10.1016/j.msard.2022.104220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The use of disease-modifying therapies (DMTs) in multiple sclerosis (MS) has been associated with reduced relapse rates and accumulation of disability. However, studies examining impact of DMT on risk of transition to secondary progressive MS (SPMS) leveraging population-based nationwide data are still rare. Here, we determine the population incidence of conversion to SPMS using two consecutive nation-wide cohorts, one immediately before and one after the introduction of DMT in Sweden. METHODS We included two consecutive population cohorts of relapsing-remitting MS (RRMS) from the Swedish national MS register for the periods 1975-1994 (n = 2161), before DMT availability, and 1995-2011 (n = 3510), in which DMTs, mainly first generation DMT (injectables), became available and eventually were used by 70% of patients. We explored the risk of transition to SPMS as a calendar year function encompassing the two cohorts. In addition, we determined the incidence of transition to SPMS through age strata below and above 50 years in untreated and treated patient subgroups. RESULTS The risk of conversion to SPMS (adjusted for current age, current time since onset, calendar year and sex) was significantly lower in the second compared with the first population cohort (hazard ratio 0.58; CI 0.48, 0.70). The risk of SPMS conversion per calendar year decreased by 2.6% annually (p < 0.001) after 1995. The risk of SPMS conversion increased with age until age 50. Thereafter, it was unchanged or decreased among those with early MS onset age (<35 years), but continued to increase with onset at higher age, with similar trends in treated and untreated subgroups. CONCLUSION The incidence of SPMS conversion significantly decreased at the population level after introduction of first generation DMTs by 1995. DMT efficiency was confirmed by a downward turn of the annual trajectory of the risk of SPMS conversion after 1995. An onset age determined pattern of variable SPMS incidence in higher age appeared in both treated and untreated strata. While first generation DMT delayed conversion to SPMS, their long-term effect was only moderate.
Collapse
|
3
|
Tan PH, Ji J, Hsing CH, Tan R, Ji RR. Emerging Roles of Type-I Interferons in Neuroinflammation, Neurological Diseases, and Long-Haul COVID. Int J Mol Sci 2022; 23:ijms232214394. [PMID: 36430870 PMCID: PMC9696119 DOI: 10.3390/ijms232214394] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Interferons (IFNs) are pleiotropic cytokines originally identified for their antiviral activity. IFN-α and IFN-β are both type I IFNs that have been used to treat neurological diseases such as multiple sclerosis. Microglia, astrocytes, as well as neurons in the central and peripheral nervous systems, including spinal cord neurons and dorsal root ganglion neurons, express type I IFN receptors (IFNARs). Type I IFNs play an active role in regulating cognition, aging, depression, and neurodegenerative diseases. Notably, by suppressing neuronal activity and synaptic transmission, IFN-α and IFN-β produced potent analgesia. In this article, we discuss the role of type I IFNs in cognition, neurodegenerative diseases, and pain with a focus on neuroinflammation and neuro-glial interactions and their effects on cognition, neurodegenerative diseases, and pain. The role of type I IFNs in long-haul COVID-associated neurological disorders is also discussed. Insights into type I IFN signaling in neurons and non-neuronal cells will improve our treatments of neurological disorders in various disease conditions.
Collapse
Affiliation(s)
- Ping-Heng Tan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan 701, Taiwan
- Correspondence: (P.-H.T.); (C.-H.H.)
| | - Jasmine Ji
- Neuroscience Department, Wellesley College, Wellesley, MA 02482, USA
| | - Chung-Hsi Hsing
- Department of Anesthesiology, Chi Mei Medical Center, Tainan 701, Taiwan
- Correspondence: (P.-H.T.); (C.-H.H.)
| | - Radika Tan
- Kaohsiung American School, Kaohsiung 81354, Taiwan
| | - Ru-Rong Ji
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
- Departments of Cell Biology and Neurobiology, Duke University Medical Center, Durham, NC 27710, USA
| |
Collapse
|
4
|
Simonsen CS, Flemmen HØ, Broch L, Brekke K, Brunborg C, Berg-Hansen P, Celius EG. Rebaseline no evidence of disease activity (NEDA-3) as a predictor of long-term disease course in a Norwegian multiple sclerosis population. Front Neurol 2022; 13:1034056. [PMID: 36452173 PMCID: PMC9702815 DOI: 10.3389/fneur.2022.1034056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/24/2022] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION No evidence of disease activity with three components (NEDA-3) is achieved if the person with MS (pwMS) has no new MRI lesions, no new relapses and no change in Expanded disability status scale (EDSS) over 1 year. Whether NEDA-3 is a good tool in measuring disease activity is up for discussion, but it is superior to the individual parameters separately and user-friendly. There is disagreement on whether NEDA-3 is a good predictor of long-term disability. METHODS This is a retrospective cohort study using real-world data with limited selection bias from the complete MS population at two hospitals in the southeast of Norway. We included pwMS diagnosed between 2006 and 2017 who had enough information to determine time to failure of NEDA-3 after diagnosis. RESULTS Of 536 pwMS, only 38% achieved NEDA 1 year after diagnosis. PwMS achieving NEDA were more likely to be started on a high efficacy drug as the initial drug, but there were no demographic differences. Mean time to NEDA failure was 3.3 (95% CI 2.9-3.7) years. Starting a high efficiacy therapy was associated with an increased risk of sustaining NEDA as compared to those receiving moderate efficacy therapy. PwMS who achieved NEDA at year one had a mean time to EDSS 6 of 33.8 (95% CI 30.9-36.8) years vs. 30.8 (95% CI 25.0-36.6) years in pwMS who did not achieve NEDA, p < 0.001. When rebaselining NEDA 1 year after diagnosis, 52.2% achieved NEDA in the 1st year after rebaseline, mean time to NEDA failure was 3.4 (95% CI 3.0-3.7) years and mean time to EDSS 6 was 44.5 (95% CI 40.4-48.5) years in pwMS achieving NEDA vs. 29.6 (95% CI 24.2-35.0) years in pwMS not achieving NEDA, p < 0.001. After rebaseline, pwMS with a high efficacy therapy as the initial drug had a mean time from diagnosis to NEDA fail of 4.8 years (95% CI 3.9-5.8) vs. 3.1 years (95% CI 2.7-3.5) in pwMS started on a moderate efficacy therapy, p < 0.001. In pwMS with NEDA failure at year one, 70% failed one, 28% failed two and 2% failed three components. New MRI lesions were the most common cause of NEDA failure (63%), followed by new relapses (50%) and EDSS change (25%). CONCLUSION NEDA-3 from rebaseline after 1 year, once treatment is stabilized, can predict the long-term disease course in MS. Starting a high efficacy DMT is associated with longer time to NEDA failure than moderate therapies. Finally, most pwMS only fail one component and new MRI lesions are the most likely cause of NEDA failure.
Collapse
Affiliation(s)
| | - Heidi Øyen Flemmen
- Department of Neurology, Hospital Telemark HF, Skien, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Line Broch
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Kamilla Brekke
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway
- Department of Neurology, Hospital Vestfold, Tønsberg, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Pål Berg-Hansen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Gulowsen Celius
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
5
|
Lehnert T, Röver C, Köpke S, Rio J, Chard D, Fittipaldo AV, Friede T, Heesen C, Rahn AC. Immunotherapy for people with clinically isolated syndrome or relapsing-remitting multiple sclerosis: treatment response by demographic, clinical, and biomarker subgroups (PROMISE)-a systematic review protocol. Syst Rev 2022; 11:134. [PMID: 35778721 PMCID: PMC9250266 DOI: 10.1186/s13643-022-01997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system with an increasing worldwide prevalence. Since 1993, more than 15 disease-modifying immunotherapies (DMTs) have been licenced and have shown moderate efficacy in clinical trials. Based on the heterogeneity of the disease and the partial effectiveness of therapies, a personalised medicine approach would be valuable taking individual prognosis and suitability of a chosen therapy into account to gain the best possible treatment effect. The primary objective of this review is to assess the differential treatment effects of all approved DMTs in subgroups of adults with clinically isolated syndrome or relapsing forms of MS. We will analyse possible treatment effect modifiers (TEM) defined by baseline demographic characteristics (gender, age), and diagnostic (i.e. MRI measures) and clinical (i.e. relapses, disability level) measures of MS disease activity. METHODS We will include all published and accessible unpublished primary and secondary analyses of randomised controlled trials (RCTs) with a follow-up of at least 12 months investigating the efficacy of at least one approved DMT, with placebo or other approved DMTs as control intervention(s) in subgroups of trial participants. As the primary outcome, we will address disability as defined by the Expanded Disability Status Scale or multiple sclerosis functional composite scores followed by relapse frequency, quality of life measures, and side effects. MRI data will be analysed as secondary outcomes. MEDLINE, EMBASE, CINAHL, LILACS, CENTRAL and major trial registers will be searched for suitable studies. Titles and abstracts and full texts will be screened by two persons independently using Covidence. The risk of bias will be analysed based on the Cochrane "Risk of Bias 2" tool, and the certainty of evidence will be assessed using GRADE. Treatment effects will be reported as rate ratio or odds ratio. Primary analyses will follow the intention-to-treat principle. Meta-analyses will be carried out using random-effects models. DISCUSSION Given that individual patient data from clinical studies are often not available, the review will allow to analyse the evidence on TEM in MS immunotherapy and thus support clinical decision making in individual cases. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021279665 .
Collapse
Affiliation(s)
- Thomas Lehnert
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christian Röver
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jordi Rio
- Neurology/Neuroimmunology, Centre d’Esclerosi Multiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Declan Chard
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research (NIHR), University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
| | - Andrea V. Fittipaldo
- Department of Oncology, Istituto Ricerche Farmacologiche “Mario Negri” IRCCS, Milano, Italy
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne C. Rahn
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| |
Collapse
|
6
|
Lefort M, Sharmin S, Andersen JB, Vukusic S, Casey R, Debouverie M, Edan G, Ciron J, Ruet A, De Sèze J, Maillart E, Zephir H, Labauge P, Defer G, Lebrun-Frenay C, Moreau T, Berger E, Clavelou P, Pelletier J, Stankoff B, Gout O, Thouvenot E, Heinzlef O, Al-Khedr A, Bourre B, Casez O, Cabre P, Montcuquet A, Wahab A, Camdessanché JP, Maurousset A, Ben Nasr H, Hankiewicz K, Pottier C, Maubeuge N, Dimitri-Boulos D, Nifle C, Laplaud DA, Horakova D, Havrdova EK, Alroughani R, Izquierdo G, Eichau S, Ozakbas S, Patti F, Onofrj M, Lugaresi A, Terzi M, Grammond P, Grand'Maison F, Yamout B, Prat A, Girard M, Duquette P, Boz C, Trojano M, McCombe P, Slee M, Lechner-Scott J, Turkoglu R, Sola P, Ferraro D, Granella F, Shaygannejad V, Prevost J, Maimone D, Skibina O, Buzzard K, Van der Walt A, Karabudak R, Van Wijmeersch B, Csepany T, Spitaleri D, Vucic S, Koch-Henriksen N, Sellebjerg F, Soerensen PS, Hilt Christensen CC, Rasmussen PV, Jensen MB, Frederiksen JL, Bramow S, Mathiesen HK, Schreiber KI, Butzkueven H, Magyari M, Kalincik T, Leray E. Impact of methodological choices in comparative effectiveness studies: application in natalizumab versus fingolimod comparison among patients with multiple sclerosis. BMC Med Res Methodol 2022; 22:155. [PMID: 35637426 PMCID: PMC9150358 DOI: 10.1186/s12874-022-01623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Natalizumab and fingolimod are used as high-efficacy treatments in relapsing–remitting multiple sclerosis. Several observational studies comparing these two drugs have shown variable results, using different methods to control treatment indication bias and manage censoring. The objective of this empirical study was to elucidate the impact of methods of causal inference on the results of comparative effectiveness studies. Methods Data from three observational multiple sclerosis registries (MSBase, the Danish MS Registry and French OFSEP registry) were combined. Four clinical outcomes were studied. Propensity scores were used to match or weigh the compared groups, allowing for estimating average treatment effect for treated or average treatment effect for the entire population. Analyses were conducted both in intention-to-treat and per-protocol frameworks. The impact of the positivity assumption was also assessed. Results Overall, 5,148 relapsing–remitting multiple sclerosis patients were included. In this well-powered sample, the 95% confidence intervals of the estimates overlapped widely. Propensity scores weighting and propensity scores matching procedures led to consistent results. Some differences were observed between average treatment effect for the entire population and average treatment effect for treated estimates. Intention-to-treat analyses were more conservative than per-protocol analyses. The most pronounced irregularities in outcomes and propensity scores were introduced by violation of the positivity assumption. Conclusions This applied study elucidates the influence of methodological decisions on the results of comparative effectiveness studies of treatments for multiple sclerosis. According to our results, there are no material differences between conclusions obtained with propensity scores matching or propensity scores weighting given that a study is sufficiently powered, models are correctly specified and positivity assumption is fulfilled. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01623-8.
Collapse
Affiliation(s)
- M Lefort
- Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Univ Rennes, EHESP, CNRS, Inserm, Rennes, France.,Univ Rennes, CHU Rennes, Investigation Clinique de Rennes)], CIC 1414 [(Centre d, 35000, InsermRennes, France
| | - S Sharmin
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - J B Andersen
- Department of Neurology, The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet Glostrup, Denmark
| | - S Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de La Myéline Et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677, Lyon/Bron, France.,Centre Des Neurosciences de Lyon, UMR5292, Observatoire Français de La Sclérose en Plaques, INSERM, 1028 et CNRS, 69003, Lyon, France.,Université, Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69000, Lyon, France
| | - R Casey
- Service de Neurologie, Sclérose en Plaques, Pathologies de La Myéline Et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677, Lyon/Bron, France.,Centre Des Neurosciences de Lyon, UMR5292, Observatoire Français de La Sclérose en Plaques, INSERM, 1028 et CNRS, 69003, Lyon, France.,Université, Claude Bernard Lyon 1, Faculté de médecine Lyon Est, 69000, Lyon, France.,Eugene Devic EDMUS Foundation, 69677, Lyon/Bron, France
| | - M Debouverie
- Centre Hospitalier Régional Universitaire de Nancy, Hôpital Central, Service de neurologie, Nancy, France
| | - G Edan
- Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, Service de neurologie, Rennes, France
| | - J Ciron
- Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, CRC-SEP, Département de neurologie, Toulouse, France
| | - A Ruet
- Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Service de neurologie, Bordeaux, France
| | - J De Sèze
- Service des maladies inflammatoires du système nerveux - neurologie, centre d'investigation clinique de Strasbourg, Hôpitaux Universitaire de Strasbourg, Hôpital de Hautepierre, INSERM 1434, Strasbourg, France
| | - E Maillart
- Assistance Publique Des Hôpitaux de Paris, Hôpital de La Pitié-Salpêtrière, Service de neurologie, Paris, France
| | - H Zephir
- Centre Hospitalier Universitaire de Lille, Hôpital Salengro, Service de neurologie D, Lille, France
| | - P Labauge
- Centre Hospitalier Universitaire de Montpellier, Hôpital Gui de Chauliac, Service de neurologie, Montpellier, France
| | - G Defer
- Centre Hospitalier Universitaire de Caen Normandie, Hôpital Côte de Nacre, Service de neurologie, Caen, France
| | - C Lebrun-Frenay
- Centre Hospitalier Universitaire de Nice, UR2CA-URRIS,, Université Nice Côte d'Azur, Hôpital, Pasteur 2, Service de neurologie, Nice, France
| | - T Moreau
- Centre Hospitalier Universitaire Dijon Bourgogne, Hôpital François Mitterrand, Maladies Inflammatoires du Système Nerveux Et Neurologie Générale, Service de neurologie, Dijon, France
| | - E Berger
- Centre Hospitalier Régional Universitaire de Besançon, Hôpital Jean Minjoz, Service de neurologie, Besançon, France
| | - P Clavelou
- Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Gabriel-Montpied, Service de neurologie, Clermont-Ferrand, France
| | - J Pelletier
- Service de Neurologie, Aix Marseille Univ, APHM, Hôpital de La Timone, Pôle de Neurosciences Cliniques, 13005, Marseille, France
| | - B Stankoff
- Assistance Publique Des Hôpitaux de Paris, Hôpital Saint-Antoine, Service de neurologie, Paris, France
| | - O Gout
- Fondation Adolphe de Rothschild de L'œil Et du Cerveau, Service de neurologie, Paris, France
| | - E Thouvenot
- Centre Hospitalier Universitaire de Nîmes, Hôpital Carémeau, Service de neurologie, Nîmes, France
| | - O Heinzlef
- Centre Hospitalier Intercommunal de Poissy Saint-Germain-en-Laye, Service de neurologie, Poissy, France
| | - A Al-Khedr
- Centre Hospitalier Universitaire d'Amiens Picardie, Site sud, Service de neurologie, Amiens, France
| | - B Bourre
- Rouen University Hospital, 76000, Rouen, France
| | - O Casez
- Centre Hospitalier Universitaire Grenoble-Alpes, Site nord, Service de neurologie, Grenoble/La Tronche, France
| | - P Cabre
- Centre Hospitalier Universitaire de Martinique, Hôpital Pierre Zobda-Quitman, Service de neurologie, Fort-de-France, France
| | - A Montcuquet
- Centre Hospitalier Universitaire Limoges, Hôpital Dupuytren, Service de neurologie, Limoges, France
| | - A Wahab
- Assistance Publique Des Hôpitaux de Paris, Hôpital Henri Mondor, Service de neurologie, Créteil, France
| | - J P Camdessanché
- Centre Hospitalier Universitaire de Saint-Étienne, Hôpital Nord, Service de neurologie, Saint-Étienne, France
| | - A Maurousset
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Service de neurologie, Tours, France
| | - H Ben Nasr
- Centre Hospitalier Sud Francilien, Service de neurologie, Corbeil-Essonnes, France
| | - K Hankiewicz
- Centre Hospitalier de Saint-Denis, Hôpital Casanova, Service de neurologie, Saint-Denis, France
| | - C Pottier
- Centre Hospitalier de Pontoise, Service de neurologie, Pontoise, France
| | - N Maubeuge
- Centre Hospitalier Universitaire de Poitiers, Site de La Milétrie, Service de neurologie, Poitiers, France
| | - D Dimitri-Boulos
- Assistance Publique Des Hôpitaux de Paris, Hôpital Bicêtre, Service de neurologie, Le Kremlin-Bicêtre, France
| | - C Nifle
- Centre Hospitalier de Versailles, Hôpital André-Mignot, Service de neurologie, Le Chesnay, France
| | - D A Laplaud
- CHU de Nantes, Service de Neurologie & CIC015 INSERM, 44093, Nantes, France.,INSERM CR1064, 44000, Nantes, France
| | - D Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - E K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - R Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - G Izquierdo
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Eichau
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Ozakbas
- Dokuz Eylul University, Konak/Izmir, Turkey
| | - F Patti
- GF Ingrassia Department, University of Catania, Catania, Italy.,Policlinico G Rodolico, Catania, Italy
| | - M Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - A Lugaresi
- Dipartimento Di Scienze Biomediche E Neuromotorie, Università Di Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - M Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - P Grammond
- CISSS Chaudiere-Appalache, Levis, Canada
| | | | - B Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - A Prat
- Hopital Notre Dame, Montreal, Canada.,CHUM and Universite de Montreal, Montreal, Canada
| | - M Girard
- Hopital Notre Dame, Montreal, Canada.,CHUM and Universite de Montreal, Montreal, Canada
| | - P Duquette
- Hopital Notre Dame, Montreal, Canada.,CHUM and Universite de Montreal, Montreal, Canada
| | - C Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - M Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - P McCombe
- University of Queensland, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Herston, Australia
| | - M Slee
- Flinders University, Adelaide, Australia
| | - J Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, Australia.,Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - R Turkoglu
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - P Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - D Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - F Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Emergency and General Medicine, Parma University Hospital, Parma, Italy
| | | | - J Prevost
- CSSS Saint-Jérôme, Saint-Jerome, Canada
| | | | - O Skibina
- Monash University, Melbourne, Australia
| | - K Buzzard
- Monash University, Melbourne, Australia
| | | | | | - B Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium
| | - T Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - D Spitaleri
- Azienda Ospedaliera Di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - S Vucic
- Westmead Hospital, Sydney, Australia
| | - N Koch-Henriksen
- Department of Clinical Epidemiology, Aarhus University Hospital Aarhus, Aarhus, Denmark
| | - F Sellebjerg
- Danish Multiple Sclerosis Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | - P S Soerensen
- Danish Multiple Sclerosis Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | - C C Hilt Christensen
- Department of Neurology, Aalborg University Hospital, Multiple Sclerosis Unit, Aalborg, Denmark
| | - P V Rasmussen
- Aarhus University Hospital, Neurology, PJJ Boulevard, DK-8200, Aarhus N, Denmark
| | - M B Jensen
- Department of Neurology, University Hospital of Northern Sealand, Copenhagen, Denmark
| | - J L Frederiksen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - S Bramow
- Danish Multiple Sclerosis Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | - H K Mathiesen
- Department of Neurology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - K I Schreiber
- Danish Multiple Sclerosis Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | - H Butzkueven
- Central Clinical School, Monash University, Melbourne, Australia.,Department of Neurology, The Alfred Hospital, Melbourne, Australia.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia
| | - M Magyari
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia.,Danish Multiple Sclerosis Centre, Department of Neurology, Copenhagen University Hospital, Rigshospitalet Glostrup, 2600, Glostrup, Denmark
| | - T Kalincik
- Department of Medicine, University of Melbourne, Melbourne, Australia.
| | - E Leray
- Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Univ Rennes, EHESP, CNRS, Inserm, Rennes, France. .,Univ Rennes, CHU Rennes, Investigation Clinique de Rennes)], CIC 1414 [(Centre d, 35000, InsermRennes, France.
| |
Collapse
|
7
|
Rieckmann P, Zivadinov R, Boyko A, Selmaj K, Alexander JK, Kadosh S, Rubinchick S, Bernstein-Hanlon E, Stark Y, Ashtamker N, Davis MD, Khan O. Long-term efficacy and safety of three times weekly dosing regimen of glatiramer acetate in relapsing multiple sclerosis patients: Seven-year results of the Glatiramer Acetate Low-frequency Administration (GALA) open-label extension study. Mult Scler J Exp Transl Clin 2021; 7:20552173211061550. [PMID: 34925876 PMCID: PMC8671685 DOI: 10.1177/20552173211061550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Describe the long-term outcomes of early-start (ES) and delayed-start (DS) glatiramer acetate 40 mg/mL treatment three times weekly (GA40) for up to seven years in the Glatiramer Acetate Low-frequency Administration (GALA) study in patients with relapsing multiple sclerosis (RMS). Methods Patients were evaluated every three to six months. The primary efficacy endpoint was annualized relapse rate (ARR); additional endpoints were exploratory or post hoc. For efficacy, data from the entire exposure period were used for the ES and DS cohorts. For safety, exposure only under GA40 was considered. Results Of the patients who continued into the open-label extension (OLE), 580/834 (70%) ES and 261/419 (62%) DS completed the OLE. For the entire placebo-controlled and OLE study period, ARR was 0.26 for ES and 0.31 for DS patients (risk ratio = 0.83; 95% confidence interval [CI]: 0.70–0.99). ES prolonged median time to first relapse versus DS (4.9 versus 4.3 years; hazard ratio = 0.82; 95% CI: 0.6–0.96). OLE-only results showed DS patients experienced similar efficacy for relapse and disability outcomes as ES patients. Adverse events were consistent with the well-established GA safety profile. Conclusions GA40 treatment conferred clinical benefit up to seven years, resulting in sustained efficacy and was generally well tolerated in RMS patients.
Collapse
Affiliation(s)
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, NY, USA
| | - Alexey Boyko
- Federal Centre of Brain Research and Neurotechnology, Moscow, Russia
| | - Krzysztof Selmaj
- Department of Neurology, University of Warmia and Mazury, Olszytn and Center of Neurology, Lodz, Poland
| | | | | | | | | | | | | | | | - Omar Khan
- Wayne State University, Detroit, MI, USA
| |
Collapse
|
8
|
Tan PH, Ji J, Yeh CC, Ji RR. Interferons in Pain and Infections: Emerging Roles in Neuro-Immune and Neuro-Glial Interactions. Front Immunol 2021; 12:783725. [PMID: 34804074 PMCID: PMC8602180 DOI: 10.3389/fimmu.2021.783725] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022] Open
Abstract
Interferons (IFNs) are cytokines that possess antiviral, antiproliferative, and immunomodulatory actions. IFN-α and IFN-β are two major family members of type-I IFNs and are used to treat diseases, including hepatitis and multiple sclerosis. Emerging evidence suggests that type-I IFN receptors (IFNARs) are also expressed by microglia, astrocytes, and neurons in the central and peripheral nervous systems. Apart from canonical transcriptional regulations, IFN-α and IFN-β can rapidly suppress neuronal activity and synaptic transmission via non-genomic regulation, leading to potent analgesia. IFN-γ is the only member of the type-II IFN family and induces central sensitization and microglia activation in persistent pain. We discuss how type-I and type-II IFNs regulate pain and infection via neuro-immune modulations, with special focus on neuroinflammation and neuro-glial interactions. We also highlight distinct roles of type-I IFNs in the peripheral and central nervous system. Insights into IFN signaling in nociceptors and their distinct actions in physiological vs. pathological and acute vs. chronic conditions will improve our treatments of pain after surgeries, traumas, and infections.
Collapse
Affiliation(s)
- Ping-Heng Tan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jasmine Ji
- Neuroscience Department, Wellesley College, Wellesley, Massachusetts, MA, United States
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
| | - Chun-Chang Yeh
- Department of Anesthesiology of Tri-Service General Hospital & National Defense Medical Center, Taipei City, Taiwan
| | - Ru-Rong Ji
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
- Department of Neurobiology, Duke University Medical Center, Durham, NC, United States
- Department of Cell Biology, Duke University Medical Center, Durham, NC, United States
| |
Collapse
|
9
|
Claflin SB, Campbell JA, Mason DF, Kalincik T, Simpson-Yap S, Norman R, Butzkueven H, Carroll WM, Palmer AJ, Blizzard CL, van der Mei I, Taylor BV. The effect of national disease-modifying therapy subsidy policy on long-term disability outcomes in people with multiple sclerosis. Mult Scler 2021; 28:831-841. [PMID: 34387513 DOI: 10.1177/13524585211035948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Disease-modifying therapies (DMTs) are used to treat people with relapsing-onset multiple sclerosis (ROMS), but our knowledge is largely limited to their short-term effects. OBJECTIVE To determine (1) the impact of national-level DMT subsidy policy on DMT use and health outcomes in people with MS (PwMS) and (2) the long-term effects of DMT on disability and quality of life (QoL; 5-level EQ-5D version (EQ-5D-5L) utility value). METHODS This observational cohort study compared Australian and New Zealand populations with different levels of DMT availability 10-20 years post-ROMS diagnosis. Between-country differences were assessed using standardised differences. Associations were assessed with multivariable linear regression models. RESULTS We recruited 328 Australians and 256 New Zealanders. The Australian cohort had longer DMT treatment duration, greater proportion of disease course treated and shorter duration between diagnosis and starting DMT. The Australian cohort had lower median Expanded Disability Status Scale (EDSS) (3.5 vs 4.0) and Multiple Sclerosis Severity Score (MSSS) (3.05 vs 3.71) and higher QoL (0.71 vs 0.65). In multivariable models, between-country differences in disability and QoL were largely attributed to differential use of DMT. CONCLUSIONS This study provides evidence for the impact of national-level DMT policy on disability outcomes in PwMS. Where DMTs are more accessible, PwMS experienced less disability progression and improved QoL 10-20 years post-diagnosis.
Collapse
Affiliation(s)
- Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Deborah F Mason
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Tomas Kalincik
- CORe The University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Neuroepidemiology Unit, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Helmut Butzkueven
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | | | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - C Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| |
Collapse
|
10
|
Simonsen CS, Flemmen HØ, Broch L, Brunborg C, Berg-Hansen P, Moen SM, Celius EG. Early High Efficacy Treatment in Multiple Sclerosis Is the Best Predictor of Future Disease Activity Over 1 and 2 Years in a Norwegian Population-Based Registry. Front Neurol 2021; 12:693017. [PMID: 34220694 PMCID: PMC8248666 DOI: 10.3389/fneur.2021.693017] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Moderate and high efficacy disease modifying therapies (DMTs) have a profound effect on disease activity. The current treatment guidelines only recommend high efficacy DMTs for patients with highly active MS. The objective was to examine the impact of initial treatment choice in achieving no evidence of disease activity (NEDA) at year 1 and 2. Methods: Using a real-world population-based registry with limited selection bias from the southeast of Norway, we determined how many patients achieved NEDA on moderate and high efficacy DMTs. Results: 68.0% of patients who started a high efficacy DMT as the first drug achieved NEDA at year 1 and 52.4% at year 2 as compared to 36.0 and 19.4% of patients who started a moderate efficacy DMT as a first drug. The odds ratio (OR) of achieving NEDA on high efficacy drugs compared to moderate efficacy drugs as a first drug at year 1 was 3.9 (95% CI 2.4–6.1, p < 0.001). The OR for high efficacy DMT as the second drug was 2.5 (95% CI 1.7–3.9, p < 0.001), and was not significant for the third drug. Patients with a medium or high risk of disease activity were significantly more likely to achieve NEDA on a high efficacy therapy as a first drug compared to moderate efficacy therapy as a first drug. Conclusions: Achieving NEDA at year 1 and 2 is significantly more likely in patients on high-efficacy disease modifying therapies than on moderate efficacy therapies, and the first choice of treatment is the most important. The immunomodulatory treatment guidelines should be updated to ensure early, high efficacy therapy for the majority of patients diagnosed with MS.
Collapse
Affiliation(s)
- Cecilia Smith Simonsen
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Heidi Øyen Flemmen
- Department of Neurology, Telemark Hospital Trust, Skien, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Line Broch
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Pål Berg-Hansen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
11
|
Kallmann BA, Ries S, Kullmann JS, Quint LM, Engelmann U, Chan A. Teriflunomide in relapsing-remitting multiple sclerosis: outcomes by age and pre-treatment status. Ther Adv Neurol Disord 2021; 14:17562864211005588. [PMID: 34046085 PMCID: PMC8135216 DOI: 10.1177/17562864211005588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background and aims: To investigate effectiveness and safety of teriflunomide (14 mg once daily) in association with age and pre-treatment in unselected MS patients. Methods: Prespecified analysis of a non-interventional, prospective, real-world study in Germany. Results: A total of 558 (49.5%) patients were above 45 years old, and 593 patients (52.6%) had been pre-treated within 6 months prior to teriflunomide. Baseline Expanded Disability Status Scale (EDSS) was higher with older age, with lower number of relapses. Relapse rate decreased in all age groups, and in both treatment-naïve (0.82 ± 0.73 at baseline; 0.25 ± 0.55 under teriflunomide) and pre-treated (from 0.48 ± 0.76; 0.22 ± 0.50) patients after 12 months compared with the year before teriflunomide initiation. EDSS remained stable in patients of all age groups as well as in therapy-naïve and pre-treated patients over 24 months. The percentage of patients with adverse events (AEs) ranged between 29.2% (age group >25–35) and 38.9% (age group >55–65), with an increased discontinuation rate (most commonly due to diarrhoea, alopecia and nausea) in the higher age groups. AE rates were lower in pre-treated compared with treatment-naïve patients. Conclusion: Overall, patients of all age groups including older patients, and irrespective of pre-treatment, benefit from teriflunomide treatment in routine clinical practice. Registration: BfArM public study database number 2075.
Collapse
Affiliation(s)
| | | | | | - Laura M Quint
- Medical Affairs, Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
| | - Ulrich Engelmann
- Country MS Medical Head SGZ, Medical Affairs, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, K703, 65926 Frankfurt, Germany
| | - Andrew Chan
- Department of Neurology, Bern University Hospital, University of Bern, Switzerland
| |
Collapse
|
12
|
Rollot F, Casey R, Leray E, Debouverie M, Edan G, Wiertlewski S, Vukusic S, Laplaud DA. Cumulative effects of therapies on disability in relapsing multiple sclerosis. Mult Scler 2021; 27:1760-1770. [DOI: 10.1177/1352458520980366] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Long-term effectiveness of treatment remains a key question in multiple sclerosis (MS) and the cumulative effects of past treatment have not been investigated so far. Objective: Explore the relationship between treatment exposure and disability risk in patients with relapsing-remitting multiple sclerosis (RRMS). Methods: A total of 2285 adult patients from the French nationwide cohort were included. Outcomes were irreversible EDSS4, and conversion to secondary progression of multiple sclerosis (SPMS). Associations between treatments and risk of disability were assessed using a novel weighted cumulative exposure model, assuming a 3-year lag to account for reverse causality. This flexible approach accounts for past exposure in a multivariate Cox proportional hazards model by computing a weight function. Results: At baseline, mean ± standard deviation age of patients was 33.4 ± 8.9 years and 75.0% were women. A 15-year continuous treatment starting 20 years ago was associated with a decrease in risk of 26% for irreversible EDSS4, and 34% for SPMS compared to a 5-year treatment starting 10 years ago. The risk of disability decreased with increasing duration of exposure to disease-modifying treatment (DMT). Conclusion: Long-term use of treatments in RRMS has a stronger beneficial cumulative impact than only early uses and delays the occurrence of moderate disability and conversion to SPMS.
Collapse
Affiliation(s)
- Fabien Rollot
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Bron, France; Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon, France; EUGENE DEVIC EDMUS Foundation, Bron, France
| | - Romain Casey
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Bron, France; Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon, France; EUGENE DEVIC EDMUS Foundation, Bron, France
| | - Emmanuelle Leray
- Univ Rennes/EHESP, REPERES – EA 7449, Rennes, France; CIC-P 1414, CHU Rennes, Rennes, France
| | - Marc Debouverie
- Département de Neurologie, CHU Nancy, Nancy, France; EA 4360 APEMAC, Université Lorraine, Nancy, France
| | - Gilles Edan
- CIC-P 1414, CHU Rennes, Rennes, France; Département de Neurologie, CHU Rennes, Rennes, France
| | - Sandrine Wiertlewski
- Département de Neurologie, CHU Nantes, Nantes, France; CIC Inserm 1415, CHU Nantes, Nantes, France
| | - Sandra Vukusic
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Bron, France; Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon, France; EUGENE DEVIC EDMUS Foundation, Bron, France
| | - David-Axel Laplaud
- Département de Neurologie, CHU Nantes, Nantes, France; CIC Inserm 1415, CHU Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie, Inserm U1064, Nantes, France
| |
Collapse
|
13
|
The course of multiple sclerosis rewritten: a Norwegian population-based study on disease demographics and progression. J Neurol 2020; 268:1330-1341. [PMID: 33090270 PMCID: PMC7990804 DOI: 10.1007/s00415-020-10279-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Over the past few decades, there has been an improvement in the rate of disability progression in multiple sclerosis (MS) patients, and most studies relate this evolvement to the introduction of disease-modifying therapies. However, several other factors have changed over this period, including access to MRI and newer diagnostic criteria. The aim of this study is to investigate changes in the natural course of MS over time in a near-complete and geographically well-defined population from the south-east of Norway. METHODS We examined disease progression and demographics over two decades and assessed the effect of disease-modifying therapies using linear mixed-effect models. RESULTS In a cohort of 2097 patients, we found a significant improvement in disability as measured by the Expanded Disability Status Scale (EDSS) stratified by age, and the improvement remained significant after adjusting for time on disease-modifying medications, gender and progressive MS at onset. The time from disease onset to EDSS 6 in the total cohort was 29.8 years (95% CI 28.5-31.1) and was significantly longer in patients diagnosed after 2006 compared to patients diagnosed before. There are significant differences between patient demographics, as well as time to EDSS 6, in the near-complete, geographically well-defined population compared to an additional cohort from the capital Oslo and its suburbs. CONCLUSION The natural course of MS is improving, but the improvement seen in disease progression has multifaceted explanations. Our study underlines the importance of completeness of data, relevant timeframes and demographics when comparing different MS populations. Studies on incomplete populations should be interpreted with caution.
Collapse
|
14
|
Lefort M, Foucher Y, Lenain R, Vukusic S, Edan G, Leray E. Long-term effect of first-line injectable multiple sclerosis treatments: Input of a time-dependent propensity score. Pharmacoepidemiol Drug Saf 2020; 29:1680-1688. [PMID: 33078476 DOI: 10.1002/pds.5154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/04/2020] [Accepted: 10/14/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE The long-term effect of beta-interferon and glatiramer acetate on multiple sclerosis (MS) disability progression has resulted in controversial results, probably due to a lack of appropriate control of biases as raised in observational studies. In particular, the time of the therapeutic decision is difficult to define when the controls are not treated. METHODS This retrospective observational study was based on a series of patients from the MS expert center in Rennes, France. We used a time-dependent propensity score defined as the linear predictor of a Cox model estimating the hazard of being treated at each time from MS onset. The matching procedure resulted in two groups: patients matched as treated and as not yet treated. The restricted mean times (RMST) to reach a moderate level of disability or worsening of the disability were compared between the two groups in an intention-to-treat analysis. RESULTS Of the 2383 patients included in the study, 556 were matched as treated. The matching procedure provided a good balance of both the time-fixed and the time-dependent covariates. A slight difference was observed for the time to reach a moderate level of disability, in favor of the "not yet treated" group (difference in the RMST: -0.62 [-0.91; -0.33]) while no difference was found in terms of worsening of the disability (-0.03 [-0.24; 0.33]). CONCLUSION This unexpected result is probably due to unmeasured confounders. However, this time-dependent PS warrants consideration in long-term effectiveness studies.
Collapse
Affiliation(s)
- Mathilde Lefort
- Pharmaco-epidemiology and health Services Research Department, Rennes University, EHESP, REPERES - EA 7449, Rennes, France.,Neurology Department, Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], Rennes, France
| | - Yohann Foucher
- Biostatistic Department, INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France.,Nephrology Department, Nantes University Hospital, Nantes, France
| | - Remi Lenain
- Biostatistic Department, INSERM UMR 1246 - SPHERE, Nantes University, Tours University, Nantes, France.,Nephrology Department, Lille University Hospital, Lille, France
| | - Sandra Vukusic
- Neurology Department, Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Bron, France.,Neurology Department, Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon, France.,Neurology Department, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,Neurology Department, Eugène Devic EDMUS Foundation against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Gilles Edan
- Neurology Department, Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], Rennes, France.,Neurology Department, CHU Pontchaillou, Rennes, France
| | - Emmanuelle Leray
- Pharmaco-epidemiology and health Services Research Department, Rennes University, EHESP, REPERES - EA 7449, Rennes, France.,Neurology Department, Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], Rennes, France.,METIS Department, EHESP French School of Public Health, Rennes, France
| |
Collapse
|
15
|
Kavaliunas A, Manouchehrinia A, Gyllensten H, Alexanderson K, Hillert J. Importance of early treatment decisions on future income of multiple sclerosis patients. Mult Scler J Exp Transl Clin 2020; 6:2055217320959116. [PMID: 33110615 PMCID: PMC7564625 DOI: 10.1177/2055217320959116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background Early initiation of disease-modifying treatment (DMT) is associated with
better disability outcomes in multiple sclerosis (MS). However, little is
known of how treatment decisions affect socio-economic outcomes. Objective To estimate the long-term impact of early initiation of DMT on the income of
MS patients. Methods In total, 3610 MS patients were included in this register-based cohort study.
We measured the association between the time to treatment and the outcome,
defined as time from treatment initiation to a 95% decrease in annual
earnings compared to each patient´s baseline level. Additionally, the
association between time to treatment and increase of social benefits
(sickness absence, disability pension) was investigated. A Cox model was
adjusted for sex, onset age, education, family situation, country of birth,
living area, and disability. Results MS patients initiating treatment later had a higher risk of reaching the
outcome- those who started treatment after 2 years from MS onset lost 95% of
their earnings sooner (HR, 1.19; 95% CI, 1.04–1.37). Furthermore, risk to
receive an annual compensation of SEK 100,000 (≈EUR 10,500) was higher for
the delayed treatment group. Conclusion Early treatment initiation in MS is associated with better socioeconomic
outcome, adding to previous studies showing benefits regarding
disability.
Collapse
Affiliation(s)
- Andrius Kavaliunas
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Gyllensten
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Labauge P. Do disease-modifying drugs (DMD) have a positive impact on the occurrence of secondary progressive multiple sclerosis? No. Rev Neurol (Paris) 2020; 176:494-496. [PMID: 32334842 DOI: 10.1016/j.neurol.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/13/2019] [Indexed: 11/16/2022]
Abstract
RR MS evolution has changed since the beginning of the availability of MS disease-modifying drugs (DMD). Before concluding a unique impact of the efficiency of DMD, careful analysis of long-term studies has to be conducted. Analysis of the literature points out a few bias in the long-term follow of MS patients under DMD: indication of DMD has changed since 20 years, diagnosis criteria are not the same (including the Will Rogers phenomen), and so far population are not homogeneous and comparable. Analysis criteria of the efficiency of the treatments are not the same, pending on the date of the publications. References concerning the long-term impact of DMD are in fact very limited. In addition, long-term efficiency of 2nd line treatments is not available. Another explanation of the change of MS evolution could be the lower evolutivity of MS patients since 2 decades. Analysis of placebo group in pivotal studies, argues to a decrease of the relapse annual rate and mean EDSS score in the more recent studies and recent MS diagnosed patients. To conclude, long-term evolution of MS patients is more favorable, influence of DMD is likely, but not unique.
Collapse
Affiliation(s)
- P Labauge
- CRC SEP, Department of Neurology, Montpellier University Hospital, CHU de Montpellier, 34295 Montpellier cedex 5, France.
| |
Collapse
|
18
|
Do disease-modifying drugs (DMD) have a positive impact on the occurrence of secondary progressive multiple sclerosis? Comment. Rev Neurol (Paris) 2020; 176:500-504. [PMID: 32278541 DOI: 10.1016/j.neurol.2020.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Very recent data from cohorts, such as that of the French Observatory of Multiple Sclerosis (OFSEP) and the MSBase cohort, are the subject of new statistical analyses using propensity scores that enable the matching of relapses frequency, EDSS, age, and sex ratio in patient populations for comparisons with each other, which reduces selection biases. The first data from these cohorts revealed a decline in transition to secondary progressive MS with the most effective disease-modifying drugs currently available, especially when these drugs were used early in the disease. However, these studies remain limited regarding the number of patients, the duration of follow-up, the use of imperfect methodologies, and the level of evidence remains low. The Gothenburg cohort in Sweden, which has been followed since the 1950s, found that 14% of benign non-progressive multiple sclerosis (MS) never evolved to secondary progression after more than 45 years of evolution. EDSS 7 was reached after 48 years of disease (median), and 50% evolved to secondary progressive MS after 15 years (consistent with data from the historic London, Ontario cohort). These data demonstrate that most people living with MS evolve without treatment to a significant long-term disability and that this evolution is closely linked to secondary progression (more than the relapse frequency). Benign forms appear as MS that never passes into secondary progressive MS. Recent data demonstrate that the delay until transition to secondary progression (more than 30 years in the MSBase cohort) and the delay in reaching EDSS 6 decreased since the introduction of disease-modifying drugs 20 years ago. However, randomized placebo-controlled trials do not last more than 2 or 3 years, and many biases may be involved in long-term follow-up studies: worsening patients who are lost to follow-up ("informative censoring" bias: only good responders to treatment remain primarily under the same long-term treatment and are followed); changes in the populations in the most recent studies with a lower rate of relapse and lower progression of disability at the beginning of the disease prior to initiating treatments; and environmental changes that remain largely misunderstood and may contribute to a natural evolution towards less severe disease.
Collapse
|
19
|
de Seze J, Bigaut K. Do disease-modifying drugs (DMD) have a positive impact on the occurrence of secondary progressive multiple sclerosis? Yes. Rev Neurol (Paris) 2020; 176:497-499. [PMID: 32265072 DOI: 10.1016/j.neurol.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/12/2019] [Indexed: 11/19/2022]
Abstract
During the 20 past years, the management of multiple sclerosis (MS) has largely changed especially concerning therapeutical approach. Before 1996, treatments were restricted to corticosteroids for relapses, several symptomatic treatments and unselective immunosuppressive drugs (azathioprine, cyclophosphamide, methotrexate) with a low evidence of any efficacy. In the present review, we analyze the principal real-life cohorts of MS during several periods (before therapeutical modern area, first-generation treatment area and most recent period). Despite many methodological problems, we observe globally a delay of around 3-5 years between untreated cohorts and first-generation treatments for going to EDSS 6 which is probably the most robust score. This delay is clearly increase to at least 15 years with the most recent cohort treated first and second-line treatments confirming that early and more intensive treatment are necessary to have a long-term efficacy on disability progression and especially on severe disability represent by EDSS 6. Larger cohorts with longer follow-up is necessary to confirm these tendencies and OFSEP observatory or MS base will probably provide us the possibility to conclude in a couple of years.
Collapse
Affiliation(s)
- J de Seze
- MS Clinic, CHU de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - K Bigaut
- MS Clinic, CHU de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| |
Collapse
|
20
|
Kingwell E, Leray E, Zhu F, Petkau J, Edan G, Oger J, Tremlett H. Multiple sclerosis: effect of beta interferon treatment on survival. Brain 2020; 142:1324-1333. [PMID: 30883636 DOI: 10.1093/brain/awz055] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/12/2018] [Accepted: 01/13/2019] [Indexed: 11/13/2022] Open
Abstract
Worldwide, the beta interferons remain the most commonly prescribed disease-modifying drugs for multiple sclerosis. However, it is unclear if they alter survival. We investigated the association between beta interferon and mortality in the 'real-world' setting. This was a multi-centre population-based observational study of patients with relapsing-onset multiple sclerosis who were initially registered at a clinic in British Columbia, Canada (1980-2004) or Rennes, France (1976-2013). Data on this cohort were accessed from the clinical multiple sclerosis databases and from individually linked health administrative data; all data were collected prospectively. Participants were followed from the latter of their first multiple sclerosis clinic visit, 18th birthday or 1 January 1996; until death, emigration or 31 December 2013. Only those who were naïve to disease-modifying therapy and immunosuppressant treatment of multiple sclerosis at the start of their follow-up were included in the analysis. A nested case-control approach was used. Up to 20 controls, matched to cases (deaths) by country, sex, age ± 5 years, year and disability level at study entry, were randomly selected from the cohort by incidence density sampling. The associations between all-cause mortality and at least 6 months beta interferon exposure, and also cumulative exposure ('low', 6 months to 3 years; and 'high', >3 years), were estimated by conditional logistic regression adjusting for treatment with other disease-modifying therapies and age in years. Further analyses included separate analyses by sex and country, additional adjustment for comorbidity burden in the Canadian cohort, and estimation of the association between beta interferon and multiple sclerosis-related death in both countries. Among 5989 participants (75% female) with a mean age of 42 (standard deviation, SD 11) years at study entry, there were 742 deaths (70% female) and the mean age at death was 61 (SD 13) years. Of these cases, 649 were matched to between one and 20 controls. Results of the conditional logistic regression analyses are expressed as adjusted odds ratios with 95% confidence intervals. The odds of beta interferon exposure were 32% lower among cases than controls (0.68; 0.53-0.89). Increased survival was associated with >3 years beta interferon exposure (0.44; 0.30-0.66), but not between 6 months and 3 years exposure (1.00; 0.73-1.38). Findings were similar within sex and country, and for multiple sclerosis-related death. Beta interferon treatment was associated with a lower mortality risk among people with relapsing-onset multiple sclerosis. Findings were consistent between two geographically distinct regions in North America and Europe.
Collapse
Affiliation(s)
- Elaine Kingwell
- Faculty of Medicine (Neurology) and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emmanuelle Leray
- EA 7449 REPERES, Ecole des Hautes Etudes en Santé Publique (EHESP), Rennes, Rennes Cedex, France
| | - Feng Zhu
- Faculty of Medicine (Neurology) and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Petkau
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gilles Edan
- Centre Hospitalier Universitaire (CHU) de Rennes, Rennes, Rennes Cedex, France
| | - Joel Oger
- Faculty of Medicine (Neurology) and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Tremlett
- Faculty of Medicine (Neurology) and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
21
|
Stander M, Stander J. A simple method for correcting for the Will Rogers phenomenon with biometrical applications. Biom J 2020; 62:1080-1089. [PMID: 31957083 DOI: 10.1002/bimj.201900199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 11/07/2022]
Abstract
In its basic form, the Will Rogers phenomenon takes place when an increase in the average value of each of two sets is achieved by moving an element from one set to another. This leads to the conclusion that there has been an improvement, when in fact essentially nothing has changed. Extended versions of this phenomenon can occur in epidemiological studies, rendering their results unreliable. After describing epidemiological and clinical studies that have been affected by the Will Rogers phenomenon, this paper presents a simple method to correct for it. The method involves introducing a transition matrix between the two sets and taking probability weighted expectations. Two real-world biometrical examples, based on migration economics and breast cancer epidemiology, are given and improvements against a naïve analysis are demonstrated. In the cancer epidemiology example, we take account of estimation uncertainty. We also discuss briefly some limitations associated with our method.
Collapse
Affiliation(s)
| | - Julian Stander
- School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, UK
| |
Collapse
|
22
|
Horakova D, Rockova P, Jircikova J, Dolezal T, Vachova M, Hradilek P, Valis M, Sucha J, Martinkova A, Ampapa R, Grunermelova M, Stetkarova I, Stourac P, Mares J, Dufek M, Kmetova E, Adamkova J, Hrnciarova T. Initiation of first disease-modifying treatment for multiple sclerosis patients in the Czech republic from 2013 to 2016: Data from the national registry ReMuS. Mult Scler Relat Disord 2019; 35:196-202. [DOI: 10.1016/j.msard.2019.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 06/05/2019] [Accepted: 08/02/2019] [Indexed: 01/05/2023]
|
23
|
Cohen JA, Tenenbaum N, Bhatt A, Zhang Y, Kappos L. Extended treatment with fingolimod for relapsing multiple sclerosis: the 14-year LONGTERMS study results. Ther Adv Neurol Disord 2019; 12:1756286419878324. [PMID: 31598139 PMCID: PMC6763939 DOI: 10.1177/1756286419878324] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/31/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Multiple sclerosis (MS) is a chronic disease that may require decades of
ongoing treatment. Therefore, the long-term safety and efficacy of
disease-modifying therapies is an important consideration. Methods: The LONGTERMS study evaluated the safety and efficacy of fingolimod in
patients with relapsing MS (RMS) with up to 14 years of exposure. This phase
IIIb, open-label extension study included patients aged ⩾ 18 years with
confirmed RMS diagnosis who completed previous phase II/III/IIIb
core/extension studies of fingolimod. Patients received fingolimod 0.5 mg
orally once daily; safety and efficacy (clinical and magnetic resonance
imaging) were the main outcomes. Results: Of 4086 patients from the core studies who entered LONGTERMS, 3480 (85.2%)
completed the study. The median age (range) was 38 (17–65) years and median
fingolimod exposure was 944.5 (range 75–4777) days. Overall, 85.5% of
patients experienced at least one adverse event (AE); most common AEs (⩾10%)
were viral upper respiratory tract infection (17.3%), headache (13.3%),
hypertension (11.0%) and lymphopenia (10.7%). Among patients with serious
AEs (12.6%), basal cell carcinoma and MS relapse (0.9% each) were most
frequently reported. The aggregate annualized relapse rate decreased from
0.22 (in years 0–2) to 0.17 (years 0–10); 45.5% of patients remained relapse
free after 10 years. At year 10, 63.2% of patients were free from 6-month
confirmed disability worsening. Conclusion: This long-term observational study of patients treated for up to 14 years
with fingolimod confirmed its established safety profile with no new safety
concerns. Patients with RMS receiving fingolimod had sustained low levels of
disease activity and progression. Trial Registration: ClinicalTrials.gov identifier: NCT01201356.
Collapse
Affiliation(s)
- Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, 9500 Euclid Avenue/U10, Cleveland, OH 44195, USA
| | | | - Alit Bhatt
- Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | - Ying Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Ludwig Kappos
- Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
| |
Collapse
|
24
|
Paolicelli D, Lucisano G, Manni A, Avolio C, Bonavita S, Brescia Morra V, Capobianco M, Cocco E, Conte A, De Luca G, De Robertis F, Gasperini C, Gatto M, Gazzola P, Lus G, Iaffaldano A, Iaffaldano P, Maimone D, Mallucci G, Maniscalco GT, Marfia GA, Patti F, Pesci I, Pozzilli C, Rovaris M, Salemi G, Salvetti M, Spitaleri D, Totaro R, Zaffaroni M, Comi G, Amato MP, Trojano M. Retrospectively acquired cohort study to evaluate the long-term impact of two different treatment strategies on disability outcomes in patients with relapsing multiple sclerosis (RE.LO.DI.MS): data from the Italian MS Register. J Neurol 2019; 266:3098-3107. [PMID: 31535270 DOI: 10.1007/s00415-019-09531-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND The increase in disease-modifying drugs (DMDs) allows individualization of treatment in relapsing multiple sclerosis (RMS); however, the long-term impact of different treatment sequences is not well established. This is particularly relevant for MS patients who may need to postpone more aggressive DMD strategies. OBJECTIVE To evaluate different therapeutic strategies and their long-term outcomes, measured as relapses and confirmed disability progression (CDP), in MS 'real-world' settings. METHODS Multicentre, observational, retrospectively acquired cohort study evaluating the long-term impact of different treatment strategies on disability outcomes in patients with RMS in the Italian MS Register. RESULTS We evaluated 1152 RMS-naïve patients after propensity-score adjustment. Patients included were receiving: interferon beta-1a (IFN-β1a) 44 µg switching to fingolimod (FTY; IFN-switchers; n = 97); FTY only (FTY-stayers; n = 157); IFN-β1a only (IFN-stayers; n = 849). CDP and relapses did not differ between FTY-stayers and IFN-switchers [HR (95% CI) 0.99 (0.48-2.04), p = 0.98 and 0.81 (0.42-1.58), p = 0.55, respectively]. However, IFN-stayers showed increased risk of relapses compared with FTY-stayers [HR (95% CI) 1.46 (1.00-2.12), p = 0.05]. CONCLUSION The ideal treatment option for MS is becoming increasingly complex, with the need to balance benefit and risks. Our results suggest that starting with FTY affects the long-term disease outcome similarly to escalating from IFN-β1a to FTY.
Collapse
Affiliation(s)
- Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy.
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Alessia Manni
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University of Naples, Naples, Italy
| | - Marco Capobianco
- Department of Neurology and Regional Multiple Sclerosis Centre, University Hospital San Luigi, Orbassano, TO, Italy
| | - Eleonora Cocco
- Department of Medical Science and Public Health, University of Cagliari and Multiple Sclerosis Center, Cagliari, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, IS, Italy
| | - Giovanna De Luca
- Neurology Clinic, Multiple Sclerosis Centre, SS Annunziata Hospital, Chieti, Italy
| | | | | | - Maurizia Gatto
- Neurology Unit, "F. Miulli" Hospital, Acquaviva delle Fonti BA, Italy
| | - Paola Gazzola
- Departemental Center for the Diagnosis and Treatment of Demyelinating Diseases, Sestri Ponente, Genoa, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Antonio Iaffaldano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
| | - Davide Maimone
- Multiple Sclerosis Center, Garibaldi Hospital, Catania, Italy
| | - Giulia Mallucci
- Multiple Sclerosis Center of IRCCS Mondino Foundation, Pavia, Italy
| | | | - Girolama A Marfia
- Department of Systems Medicine, Multiple Sclerosis Clinical and Research Center, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, Ospedale di Vaio (I.P.), Fidenza, PR, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.,Department of Neurology, University La Sapienza, Rome, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Palermo University, Palermo, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, Rome, Italy.,Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Isernia, Italy
| | | | - Rocco Totaro
- Department of Neurology, Demyelinating Disease Center, San Salvatore Hospital, L'Aquila, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate, Gallarate, Italy
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy.,IRCCS and Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
| | | |
Collapse
|
25
|
Claflin SB, Tan B, Taylor BV. The long-term effects of disease modifying therapies on disability in people living with multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2019; 36:101374. [PMID: 31450158 DOI: 10.1016/j.msard.2019.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Disease modifying therapies (DMT) are a common medication class for treating people living with MS. However, although treatment with DMT can extend over more than a decade, little is known about their long-term effects. Here, we systematically review long-term (≥4 years) studies on the effect of DMT on disability progression and relapse in people living with MS. METHODS We searched the EMBASE and Medline databases in January 2018, using search terms that included DMT and relevant outcome measures. Two authors screened all resulting studies and evaluated the risk of bias of included studies using the ROBINS-I tool for non-randomized studies. Where there was sufficient data, we performed meta-analyses using RevMan 5. Studies that could not be included in a meta-analysis were included in data synthesis. RESULTS Our search returned 7,766 unique articles for review. After screening, 18 articles were included. Follow-up in these studies ranged from a mean of 3.9 years to a median of 17.8 years. Fifteen (83.3%) of the included studies had a moderate risk of bias and three (16.7%) had a serious risk of bias. Meta-analysis showed that DMT significantly reduced the risk of EDSS 6.0 and SPMS compared to no treatment. CONCLUSION There is some evidence that long-term treatment with interferon beta reduces the risk of EDSS 6.0 and SPMS compared to no treatment or placebo. More work is needed on the effect of second generation DMT and the relative effect of DMT on health outcomes.
Collapse
Affiliation(s)
- Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia
| | - Brian Tan
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia.
| |
Collapse
|
26
|
Observational designs in clinical multiple sclerosis research: Particulars, practices and potentialities. Mult Scler Relat Disord 2019; 35:142-149. [PMID: 31394404 DOI: 10.1016/j.msard.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/03/2019] [Accepted: 07/19/2019] [Indexed: 11/24/2022]
Abstract
Observational studies investigate a wide range of topics in multiple sclerosis research. This paper presents an overview of the various observational designs and their applications in clinical studies. Observational studies are well suited for making discoveries and assessing new explanations of phenomena, but less so for establishing causal relationships, due to confounding by indication (selection bias), co-morbidity, socio-economic or other factors. Whether observational findings are demonstrative, indicative or only suggestive, depends on the research question, whether and how the design fits this question, analytical techniques, and the quality of data. Observational studies may be cross-sectional vs. longitudinal, and prospective vs. retrospective. The term 'retrograde' is proposed to explicate that cross-sectional studies may obtain data that cover (long) preceding periods. Case reports and case series are usually based on accidental observations or routinely collected data. Cross-sectional studies, by simultaneously assessing clinical phenomena and external factors, enable the discovery and quantification of associations. In ecological studies the unit of analysis is population or group, and relationships on patient level cannot be established. A cohort study is a longitudinal study that investigates patients with a defining characteristic, e.g. diagnosis or specific treatment, by analyzing data acquired at various intervals. Prospective cohort studies use (some) data that are not yet available at the time the research is conceived, whereas in retrospective studies the data already exist. In a case-control study a representative group of patients with a specific clinical feature is compared with controls, and the frequencies at which an external factor, e.g. infection, has occurred in each group is compared; in a nested case-control study controls are drawn from a fully known cohort. Randomized controlled trial (RCT)-extension studies are informative because, due to RCT randomization, they are free from confounding by indication. Patient or disease registries are organised systems for the long-term collection of uniform data on a population that is defined by a particular disease, condition or exposure, with the purpose to study changes over time. In pharmacotherapeutic research, accidental observations of unexpected beneficial effects may lead to further research into a drug's efficacy in other conditions. Uncontrolled phase 1 studies investigate safety and dosing aspects. Observational studies are alternatives to RCTs when these are not feasible for ethical or practical reasons. Phase 4 observational studies play a crucial role in the evaluation of the effectiveness of treatments in daily practice, the validation of RCT-based side effect profiles, and the discovery of late occurring or rare, potentially life-threatening side effects. Combinations of multidisciplinary longitudinal data bases into large data sets enable the development of algorithms for personalized treatments. To improve the reporting of observational findings on treatment effectiveness, it is proposed that abstracts define the research question(s) the study was meant to answer, study design and analytical methods, and identify and quantify the patient population, treatment of interest, relevant outcomes and the study's strengths and limitations. The development of guidelines for Strengthening the Reporting of Observational Studies in Effectiveness Research (STROBER), as an extension of the guidelines used in epidemiology, is wanted.
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Kallmann BA, Tiel-Wilck K, Kullmann JS, Engelmann U, Chan A. Real-life outcomes of teriflunomide treatment in patients with relapsing multiple sclerosis: TAURUS-MS observational study. Ther Adv Neurol Disord 2019; 12:1756286419835077. [PMID: 30944584 PMCID: PMC6437319 DOI: 10.1177/1756286419835077] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/08/2019] [Indexed: 01/06/2023] Open
Abstract
Background Teriflunomide is a once-daily oral immunomodulatory agent approved for the treatment of relapsing-remitting multiple sclerosis (MS). We aimed to obtain data on the effectiveness, tolerability, and subject satisfaction with teriflunomide (Aubagio®) under clinical practice conditions in unselected MS patients. Methods This work was a non-interventional, prospective, longitudinal, observational study in 307 sites in Germany. Results A total of 1128 patients were eligible for the efficacy analysis [67.5% female; mean age (± standard deviation) 44.9 ± 9.7 years, range 20-73 years]. Time since first MS symptoms was 10.6 ± 8.2 years, and time since MS diagnosis was 8.9 ± 7.6 years. Expanded Disability Status Scale (EDSS) score at inclusion was 2.3 ± 1.5 (70.4% with score < 3.5). The mean observation period was 16.3 ± 9.1 months. A total of 75.2% had received previous disease-modifying therapies (DMTs) at any time. Of these patients, 504 (44.7%) received no DMT within 6 months of study entry, 593 patients (52.6%) had DMT discontinued prior to study entry [glatiramer acetate in 10.6%, subcutaneous interferon-beta 1a (IFNβ-1a) in 9.3%, intramuscular IFNβ-1a or IFNβ-1b in 6.6% each, azathioprine oral in 0.4%, other in 7.3%, last medication not known in 12.0%]. The mean annualized relapse rate decreased from 0.87 in the 24 months prior to study entry to 0.35 in the 24 months after study entry (n = 468; p ⩽ 0.001). EDSS and Fatigue Severity Scale remained stable. In patients who received previous MS treatments, Treatment Satisfaction Questionnaire (TSQM-9) values (maximum = 100), for the observation at 24 months improved by 8.1 points for effectiveness, 17.0 points for convenience, and 15.3 points for global satisfaction (p ⩽ 0.001 each, compared with study entry). In the safety cohort (n = 1139), the proportion of patients with adverse events (AEs) of any severity was 35.8%, and with serious events 13.0%. The most frequently reported AEs were diarrhea (n = 55), followed by MS relapse (n = 48), hair thinning (n = 38), and viral upper respiratory tract infection (n = 31). Conclusions Relapse rate was halved during the observation period in comparison with the same time period before study entry. Patient satisfaction with teriflunomide was high in this real-world observation of patients, the majority of whom switched from other DMTs. The safety and tolerability profile of teriflunomide was similar to that reported in previous clinical trials.
Collapse
Affiliation(s)
| | - Klaus Tiel-Wilck
- Neurologisches Facharztzentrum Berlin, Berlin, Germany, for the NeuroTransData Study Group
| | - Jennifer S Kullmann
- Medical Management MS, Medical Affairs, Sanofi-Aventis Deutschland GmbH, Siemensstraße 5b, 63263 Neu-Isenburg, Germany
| | - Ulrich Engelmann
- Medical Affairs, Sanofi-Aventis Deutschland GmbH, Neu-Isenburg, Germany
| | - Andrew Chan
- Department of Neurology, Bern University Hospital, University of Bern, Switzerland
| |
Collapse
|
29
|
Gitto L. Long Term Compliance for MS Patients in Treatment with Disease Modifying Drugs (DMDs). Open Neurol J 2019. [DOI: 10.2174/1874205x01913010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Multiple Sclerosis (MS) is one of the most common causes of neurological disability in young and middle-aged adults. Patients with MS face many challenges, both physical and emotional, and see an overall reduction in their autonomy.
There is no definitive treatment for MS, though Disease Modifying Drugs (DMDs) have proved effective in reducing the frequency and severity of relapses. Unfortunately, long-term adherence to these therapies is a significant challenge due to practical difficulties as well as a general distrust towards the drugs
.
Objective:
This study follows an original research carried out in 2008. In the first study, patients answered questions on their clinical history and expressed their judgment on the pharmacological treatment, their perceived effectiveness and factors that may undermine compliance. They have been recalled after two years to verify if the reported symptoms have changed and to assess how their knowledge of the disease and “acceptance” of the treatment have been modified.
Methods:
In spite of the relatively high number of patients participating in the first study (141 patients followed at a single neurological centre), only 16 patients have completed the questionnaire for the long-term survey. A detailed descriptive analysis has been carried out, as well as a pairwise correlation analysis.
Results and Conclusions:
The interviews carried out gave an insight into how patients’ behavior may have changed over time. Compliance rate is different in newly-diagnosed patients and long-term patients; the latter are more likely to be compliant, given their personal experience with the disease. Communications with neurologists and health personnel should aim at forming therapeutic alliances with patients and detecting their preferences for a qualitatively adequate assistance throughout their illness.
Collapse
|
30
|
Sotirchos ES, Gonzalez-Caldito N, Dewey BE, Fitzgerald KC, Glaister J, Filippatou A, Ogbuokiri E, Feldman S, Kwakyi O, Risher H, Crainiceanu C, Pham DL, Van Zijl PC, Mowry EM, Reich DS, Prince JL, Calabresi PA, Saidha S. Effect of disease-modifying therapies on subcortical gray matter atrophy in multiple sclerosis. Mult Scler 2019; 26:312-321. [PMID: 30741108 DOI: 10.1177/1352458519826364] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The effects of disease-modifying therapies (DMTs) on region-specific brain atrophy in multiple sclerosis (MS) are unclear. OBJECTIVE To determine the effects of higher versus lower efficacy DMTs on rates of brain substructure atrophy in MS. METHODS A non-randomized, observational cohort of people with MS followed with annual brain magnetic resonance imaging (MRI) was evaluated retrospectively. Whole brain, subcortical gray matter (GM), cortical GM, and cerebral white matter (WM) volume fractions were obtained. DMTs were categorized as higher (DMT-H: natalizumab and rituximab) or lower (DMT-L: interferon-beta and glatiramer acetate) efficacy. Follow-up epochs were analyzed if participants had been on a DMT for ⩾6 months prior to baseline and had at least one follow-up MRI while on DMTs in the same category. RESULTS A total of 86 DMT epochs (DMT-H: n = 32; DMT-L: n = 54) from 78 participants fulfilled the study inclusion criteria. Mean follow-up was 2.4 years. Annualized rates of thalamic (-0.15% vs -0.81%; p = 0.001) and putaminal (-0.27% vs -0.73%; p = 0.001) atrophy were slower during DMT-H compared to DMT-L epochs. These results remained significant in multivariate analyses including demographics, clinical characteristics, and T2 lesion volume. CONCLUSION DMT-H treatment may be associated with slower rates of subcortical GM atrophy, especially of the thalamus and putamen. Thalamic and putaminal volumes are promising imaging biomarkers in MS.
Collapse
Affiliation(s)
- Elias S Sotirchos
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Blake E Dewey
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.,F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Glaister
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Angeliki Filippatou
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Esther Ogbuokiri
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sydney Feldman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ohemaa Kwakyi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hunter Risher
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Dzung L Pham
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.,Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA.,Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Peter C Van Zijl
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel S Reich
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA.,Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.,Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
31
|
Hartung HP, Graf J, Kremer D. Long-term follow-up of multiple sclerosis studies and outcomes from early treatment of clinically isolated syndrome in the BENEFIT 11 study. J Neurol 2019; 267:308-316. [PMID: 30610426 DOI: 10.1007/s00415-018-09169-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 01/03/2023]
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) with a diverse disease course involving inflammation and degeneration of neurons and axons. Multiple sclerosis results from a complex interaction of genetic and environmental factors and clinically several disease subtypes with marked variation in symptoms can be discerned. Disease-modifying therapies (DMTs) impact disease activity and outcome. Long-term follow-up studies of DMTs in MS have generally shown that the short-term effects in clinical trials are maintained for up to 21 years, e.g. in the case of interferon beta-1b. However, attainment can be a problem in these studies. On the one hand, so-called real-world studies can augment clinical trials by providing data on the long-term effectiveness and safety of DMTs but lack, on the other hand, randomization and may, in addition, also yield biased findings as a result of compliance issues. Long-term data from clinical trials in clinically isolated syndrome (CIS) patients have been limited but in the case of interferon beta-1b this aspect has been addressed over 11 years in the BENEFIT 11 trial. The results suggest that early treatment results in persistent long-term benefits including conversion to clinically definite MS (CDMS) as well as time to and risk of a first relapse. Here we primarily review the findings of the BENEFIT 11 trial in the context of long-term studies.
Collapse
Affiliation(s)
- Hans-Peter Hartung
- Department of Neurology, UKD, Center for Neurology and Neuropsychiatry, LVR Klinikum Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Jonas Graf
- Department of Neurology, UKD, Center for Neurology and Neuropsychiatry, LVR Klinikum Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - David Kremer
- Department of Neurology, UKD, Center for Neurology and Neuropsychiatry, LVR Klinikum Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| |
Collapse
|
32
|
Abstract
INTRODUCTION In the past decade, the role of B cells in the pathogenesis of multiple sclerosis (MS) is coming to the forefront. Depletion of B cells by anti-CD20 monoclonal antibodies (mAbs) has proved to decrease the activity of the relapsing-remitting MS (RRMS) and the progression of primary progressive MS (PPMS). Areas covered: In this review, the authors discuss the rationale of the depletion of B cells in RRMS and PPMS across recent studies on the role of B cells in the pathogenesis of MS; previous clinical trials with treatments targeting B cells; the mechanism of action of ocrelizumab - a second generation anti-CD20 mAb - and recent phase III clinical trials with ocrelizumab in RRMS and PPMS. Expert commentary: Ocrelizumab is the first anti-CD20 monoclonal antibody approved for RRMS and the first treatment approved for PPMS. The long-term effect and safety profile need to be evaluated in extension of clinical trials and in real-world studies.
Collapse
Affiliation(s)
- Kévin Bigaut
- a Département de Neurologie , Centre Hospitalier Universitaire de Strasbourg, Avenue Moliére , 67200 Strasbourg , France
| | - Jérôme De Seze
- a Département de Neurologie , Centre Hospitalier Universitaire de Strasbourg, Avenue Moliére , 67200 Strasbourg , France.,b Biopathologie de la Myéline,Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS) , Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine , 11 rue Humann, 67000 Strasbourg , France.,c Centre d'investigation clinique , INSERM U1434, Centre Hospitalier Universitaire de Strasbourg , 1 Place de l'Hôpital, 67000 Strasbourg , France
| | - Nicolas Collongues
- a Département de Neurologie , Centre Hospitalier Universitaire de Strasbourg, Avenue Moliére , 67200 Strasbourg , France.,b Biopathologie de la Myéline,Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS) , Université de Strasbourg, Bâtiment 3 de la Faculté de Médecine , 11 rue Humann, 67000 Strasbourg , France.,c Centre d'investigation clinique , INSERM U1434, Centre Hospitalier Universitaire de Strasbourg , 1 Place de l'Hôpital, 67000 Strasbourg , France
| |
Collapse
|
33
|
Edan G, Vukusic S. Where there is inflammation, treatment may reduce disability progression - No. Mult Scler 2018; 24:1352458518795417. [PMID: 30295565 DOI: 10.1177/1352458518795417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gilles Edan
- CICP 1414 INSERM, Équipe Neurosciences, CHU Hôpital Pontchaillou, Rennes, France/ CRC-SEP, Pôle Neurosciences, CHU Hôpital Pontchaillou, Rennes, France/ Institut des Neurosciences Cliniques de Rennes, Rennes, France/ Université Rennes 1 and Université Bretagne Loire (UBL), Rennes, France
| | - Sandra Vukusic
- Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation and Fondation Eugène Devic EDMUS contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Centre des Neurosciences de Lyon, Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France/ Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, Villeurbanne, France
| |
Collapse
|
34
|
Chalmer TA, Baggesen LM, Nørgaard M, Koch-Henriksen N, Magyari M, Sorensen PS. Early versus later treatment start in multiple sclerosis: a register-based cohort study. Eur J Neurol 2018; 25:1262-e110. [PMID: 29847005 DOI: 10.1111/ene.13692] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/23/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE To assess long-term treatment effectiveness of disease-modifying therapy (DMT) initiated early in disease course versus later treatment start. METHODS We included all Danish patients with multiple sclerosis (MS) treated with DMT through two nationwide population-based MS registries. Patients were categorized as early treated if treatment started within 2 years after the first MS symptom (n = 2316) and later treated if treatment started between 2 and 8 years after clinical onset (n = 1479). We compared time from treatment start to progression to an Expanded Disability Status Scale (EDSS) score of 6 and mortality between cohorts as hazard ratio (HR) using a Cox proportional hazards model with adjustment for stabilized inverse probability of treatment weights. Several sensitivity analyses were conducted. RESULTS The median follow-up time of 3795 patients was 7.0 (range 0.6-19.5) years for the EDSS score of 6 outcome and 10.4 (range 1.2-20.1) years for the mortality outcome. Patients with later treatment start showed a 42% increased hazard rate of reaching an EDSS score of 6 compared with the early-treated patients [HR, 1.42; 95% confidence interval (CI), 1.18-1.70; P < 0.001]. When stratified by sex, the increased hazard among later-treated women persisted (HR, 1.53; 95% CI, 1.22-1.93; P < 0.001), whereas the HR was lower in men (1.25; 95% CI, 0.93-1.69; P = 0.15). Mortality was increased by 38% in later starters (HR, 1.38; 95% CI, 0.96-1.99; P = 0.08). CONCLUSIONS Patients who started treatment with DMT later reached an EDSS score of 6 more quickly compared with patients who started early and the delay showed a tendency to shorten time to death. Our results support the use of early treatment.
Collapse
Affiliation(s)
- T A Chalmer
- Department of Neurology, Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen.,Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen
| | - L M Baggesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - M Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - N Koch-Henriksen
- Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - M Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen.,Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen
| | - P S Sorensen
- Department of Neurology, Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen.,Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen
| | | |
Collapse
|
35
|
Corboy JR, Weinshenker BG, Wingerchuk DM. Comment on 2018 American Academy of Neurology guidelines on disease-modifying therapies in MS. Neurology 2018; 90:1106-1112. [DOI: 10.1212/wnl.0000000000005574] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/27/2018] [Indexed: 11/15/2022] Open
Abstract
The American Academy of Neurology has published a comprehensive review and guidelines for the use of disease-modifying therapies (DMTs) in multiple sclerosis (MS) for the first time since 2002. These guidelines represent the work of MS experts, patients, and guideline experts and are based on their review of randomized controlled trials and observational evidence that addresses a set of prespecified questions related to starting, switching, and potentially discontinuing DMTs. Many of the recommendations address decision-making regarding the use of DMTs and incorporate the perspective of patients. Modified Delphi methods were used to establish consensus recommendations that were assigned a level of clinical obligation (actions a clinician must [A], should [B], or may [C] do). Most guideline recommendations are level B. Few reached level A, and several achieved only level C, primarily because of lack of evidence. The guidelines eschew formal treatment algorithms and do not address financial considerations and a variety of other controversies. We identify remaining uncertainties, the most important of which is the choice of available DMTs for the average newly diagnosed patient. We reiterate a number of research needs identified in the guidelines that could affect the use of DMTs, including improved definition of breakthrough disease requiring change in therapy, development of better and universally accepted definitions of both benign and aggressive MS, more and longer-duration comparative effectiveness trials, discovery and validation of biomarkers of disease activity and response to therapy, and development of treatment strategies focused on neuroprotection, remyelination, and neural repair.
Collapse
|
36
|
Abstract
Multiple sclerosis treatment faces tremendous changes as a result of the approval of new medications. The new medications have differing safety considerations and risks after long-term treatment, which are important for treating physicians to optimize and individualize multiple sclerosis care. Since the approval of the first multiple sclerosis capsule, fingolimod, the armamentarium of multiple sclerosis therapy has grown with the orally available medications dimethyl fumarate and teriflunomide. Fingolimod is mainly associated with cardiac side effects, dimethyl fumarate with bowel symptoms. Several reports about progressive multifocal leukoencephalopathy as a result of dimethyl fumarate or fingolimod therapy raised the awareness of fatal opportunistic infections. Alemtuzumab, a CD52-depleting antibody, is highly effective in reducing relapses but leads to secondary immunity with mainly thyroid disorders in about 30% of patients. Development of secondary B-cell-mediated disease might also be a risk of this antibody. The follow-up drug of the B-cell-depleting antibody rituximab, ocrelizumab, is mainly associated with infusion-related reactions; long-term data are scarce. The medication daclizumab high yield process, acting via the activation of CD56bright natural killer cells, can induce the elevation of liver function enzymes, but also fulminant liver failure has been reported. Therefore, daclizumab has been retracted from the market. Long-term data on the purine nucleoside cladribine in MS therapy, recently authorized in the European Union, have been acquired during the long-term follow-up of the cladribine studies. The small molecule laquinimod is currently under development. We review data of clinical trials and their extensions regarding long-term efficacy and side effects, which might be associated with long-term treatment.
Collapse
Affiliation(s)
- Simon Faissner
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, Bochum, 44791, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, Bochum, 44791, Germany.
| |
Collapse
|
37
|
Lanzillo R, Carotenuto A, Moccia M, Saccà F, Russo CV, Massarelli M, De Rosa A, Brescia Morra V. A longitudinal real-life comparison study of natalizumab and fingolimod. Acta Neurol Scand 2017; 136:217-222. [PMID: 27976804 DOI: 10.1111/ane.12718] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Different retrospective studies compared natalizumab and fingolimod in relapsing-remitting multiple sclerosis (RRMS), with conflicting results. We aimed to explore the prescriptive attitude and the clinical outcome of the two therapies. METHODS We retrospectively included all RRMS patients treated with natalizumab (n=101) or fingolimod (n=78) as their first second-line therapy with at least 24-month follow-up. Demographic and clinical features were recorded to calculate the propensity score (PS). Outcomes of interest were annualized relapse rate (ARR), risk of relapse, and change in the EDSS RESULTS: At baseline, natalizumab patients were younger and had a shorter disease duration, a higher number of relapse in 1 year (1yR) and 2 years (2yR) and overall (ARR-PT) pretherapy, compared to fingolimod patients. On therapy, the proportion of relapsing patients and the mean RR were similar in the two groups. However, the change in the ARR was higher in natalizumab than in fingolimod group (P<.002), but, using PS as a covariate, it was comparable (P=.960). Similarly, the change in EDSS was significantly different for the two groups (P<.004), but not after adjusting for the PS (P=.321). CONCLUSION We observed a comparable efficacy on ARR reduction and on EDSS progression with natalizumab and fingolimod correcting through PS, suggesting that the efficacy difference observed before correction might derive from the clinical attitude in prescribing natalizumab in more active MS patients in real life.
Collapse
Affiliation(s)
- R. Lanzillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - A. Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - M. Moccia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - F. Saccà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - C. V. Russo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - M. Massarelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - A. De Rosa
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| | - V. Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; Multiple Sclerosis Clinical Care and Research Centre; Federico II University; Naples Italy
| |
Collapse
|
38
|
Blank T, Prinz M. Type I interferon pathway in CNS homeostasis and neurological disorders. Glia 2017; 65:1397-1406. [PMID: 28519900 DOI: 10.1002/glia.23154] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 04/01/2017] [Accepted: 04/04/2017] [Indexed: 01/12/2023]
Abstract
Type I interferons (IFNs), IFN-α and IFN-β, represent the major effector cytokines of the host immune response against viruses and other intracellular pathogens. These cytokines are produced via activation of numerous pattern recognition receptors, including the Toll-like receptor signaling network, retinoic acid-inducible gene-1 (RIG-1), melanoma differentiation-associated protein-5 (MDA-5) and interferon gamma-inducible protein-16 (IFI-16). Whilst the contribution of type I IFNs to peripheral immunity is well documented, they can also be produced by almost every cell in the central nervous system (CNS). Furthermore, IFNs can reach the CNS from the periphery to modulate the function of not only microglia and astrocytes, but also neurons and oligodendrocytes, with major consequences for cognition and behavior. Given the pleiotropic nature of type I IFNs, it is critical to determine their exact cellular impact. Inappropriate upregulation of type I IFN signaling and interferon-stimulated gene expression have been linked to several CNS diseases termed "interferonopathies" including Aicardi-Goutieres syndrome and ubiquitin specific peptidase 18 (USP18)-deficiency. In contrast, in the CNS of mice with virus-induced neuroinflammation, type I IFNs can limit production of other cytokines to prevent potential damage associated with chronic cytokine expression. This capacity of type I IFNs could also explain the therapeutic benefits of exogenous type I IFN in chronic CNS autoimmune diseases such as multiple sclerosis. In this review we will highlight the importance of a well-balanced level of type I IFNs for healthy brain physiology, and to what extent dysregulation of this cytokine system can result in brain 'interferonopathies'.
Collapse
Affiliation(s)
- Thomas Blank
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Prinz
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,BIOSS Centre for Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| |
Collapse
|
39
|
Zecca C, Merlini A, Disanto G, Rodegher M, Panicari L, Romeo MAL, Candrian U, Messina MJ, Pravatà E, Moiola L, Stefanin C, Ghezzi A, Perrone P, Patti F, Comi G, Gobbi C, Martinelli V. Half-dose fingolimod for treating relapsing-remitting multiple sclerosis: Observational study. Mult Scler 2017; 24:167-174. [DOI: 10.1177/1352458517694089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: To investigate the efficacy and safety of fingolimod (FTY) 0.5 mg administered every other day (FTY-EOD) compared to every day (FTY-ED) in multiple sclerosis patients. Methods: Multicentre retrospective observational study. Clinical, laboratory and neuroimaging data were consecutively collected from 60 FTY-EOD and 63 FTY-ED patients. Baseline characteristics were compared using logistic regression. Efficacy in preventing occurrence of relapses and demyelinating lesions was tested using propensity score–adjusted Cox and linear regressions. Results: Weight was inversely associated with risk of switch to FTY-EOD because of any reason (odds ratio (OR) = 0.94, 95% confidence interval (95% CI) = 0.89–0.99, p = 0.026), and female sex and lower baseline lymphocyte count were positively associated with switch because of lymphopenia. Compared to FTY-ED patients, FTY-EOD patients were at higher risk of developing relapses (hazard ratio (HR) = 2.98, 95% CI = 1.07–8.27, p = 0.036) and either relapses or new magnetic resonance imaging (MRI) demyelinating lesions (combined outcome, HR = 2.07, 95% CI = 1.06–4.08, p = 0.034). Within FTY-EOD, treatment with natalizumab before FTY and lower age were positively associated with risk of developing relapses and combined outcome, respectively (HR = 25.71, 95% CI = 3.03–217.57, p = 0.002 and HR = 0.85, 95% CI = 0.77–0.96, p = 0.005). FTY-EOD was overall well tolerated. Conclusion: Disease reactivation was observed in a significant proportion of patients treated with FTY-EOD. Neurologists should be cautious when reducing FTY administration to every other day, especially in younger patients and those previously treated with natalizumab.
Collapse
Affiliation(s)
- Chiara Zecca
- Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Arianna Merlini
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Disanto
- Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | | | - Letizia Panicari
- Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | | | - Ursula Candrian
- Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | | | - Emanuele Pravatà
- Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Lucia Moiola
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Catia Stefanin
- Multiple Sclerosis Study Center, Gallarate Hospital, Gallarate, Italy
| | - Angelo Ghezzi
- Multiple Sclerosis Study Center, Gallarate Hospital, Gallarate, Italy
| | | | - Francesco Patti
- Department of Neuroscience, University of Catania, Catania, Italy
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Gobbi
- Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | | |
Collapse
|
40
|
Trojano M, Tintore M, Montalban X, Hillert J, Kalincik T, Iaffaldano P, Spelman T, Sormani MP, Butzkueven H. Treatment decisions in multiple sclerosis — insights from real-world observational studies. Nat Rev Neurol 2017; 13:105-118. [DOI: 10.1038/nrneurol.2016.188] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
41
|
Capra R, Cordioli C, Rasia S, Gallo F, Signori A, Sormani MP. Assessing long-term prognosis improvement as a consequence of treatment pattern changes in MS. Mult Scler 2017; 23:1757-1761. [PMID: 28080255 DOI: 10.1177/1352458516687402] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess whether the age at which multiple sclerosis (MS) patients reach Expanded Disability Status Scale (EDSS) milestones changed as long as new drugs for the treatment of MS became available. METHODS We evaluated the long-term impact of therapies on disability progression assessing whether there is a detectable delay in the age at which patients reached EDSS milestones in more recent years. We used data collected over more than 30 years in the Center of Brescia, Italy. We compared the age at EDSS = 6 among patients diagnosed with relapsing-remitting MS in different time periods, adjusting for age at diagnosis and median interval among EDSS visits, by a multivariate Cox model. RESULTS A total of 1324 MS patients were included. Patients diagnosed in more recent periods reached EDSS = 6 at an older age: the rate at which patients reached EDSS = 6 in those diagnosed in 1991-1995 was similar to those diagnosed in 1980-1990 (hazard ratio ( HR) = 1.09, p = 0.68) and to those diagnosed in 1996-2000 ( HR = 0.85, p = 0.44), it was reduced by 37% in patients diagnosed in 2001-2005 ( HR = 0.63, p = 0.05), by 46% in patients diagnosed in 2006-2010 ( HR = 0.54, p < 0.02). CONCLUSION A clear modification of MS course is observed after 2000; among other causes, this can be associated to the changes in the treatment patterns experienced in those years.
Collapse
Affiliation(s)
- Ruggero Capra
- Multiple Sclerosis Center, Spedali Civili di Brescia, Montichiari Hospital, Montichiari, Italy/University of Genoa, Genoa, Italy
| | - Cinzia Cordioli
- Multiple Sclerosis Center, Spedali Civili di Brescia, Montichiari Hospital, Montichiari, Italy/University of Genoa, Genoa, Italy
| | - Sarah Rasia
- Multiple Sclerosis Center, Spedali Civili di Brescia, Montichiari Hospital, Montichiari, Italy/University of Genoa, Genoa, Italy
| | - Fabio Gallo
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| |
Collapse
|
42
|
Kalincik T, Kuhle J, Pucci E, Rojas JI, Tsolaki M, Sirbu CA, Slee M, Butzkueven H. Data quality evaluation for observational multiple sclerosis registries. Mult Scler 2016; 23:647-655. [DOI: 10.1177/1352458516662728] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: Objective and reproducible evaluation of data quality is of paramount importance for studies of ‘real-world’ observational data. Here, we summarise a standardised data quality, density and generalisability process implemented by MSBase, a global multiple sclerosis (MS) cohort study. Methods: Error rate, data density score and generalisability score were developed using all 35,869 patients enrolled in MSBase as of November 2015. The data density score was calculated across six domains (follow-up, demography, visits, MS relapses, paraclinical data and therapy) and emphasised data completeness. The error rate evaluated syntactic accuracy and consistency of data. The generalisability score evaluated believability of the demographic and treatment information. Correlations among the three scores and the number of patients per centre were evaluated. Results: Errors were identified at the median rate of 3 per 100 patient-years. The generalisability score indicated the samples’ representativeness of the known MS epidemiology. Moderate correlation between the density and generalisability scores (ρ = 0.58) and a weak correlation between the error rate and the other two scores (ρ = −0.32 to −0.33) were observed. The generalisability score was strongly correlated with centre size (ρ = 0.79). Conclusion: The implemented scores enable objective evaluation of the quality of observational MS data, with an impact on the design of future analyses.
Collapse
Affiliation(s)
- Tomas Kalincik
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jens Kuhle
- Neurology, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, Basel, Switzerland
| | | | | | - Magda Tsolaki
- 3rd Department of Neurology, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Mark Slee
- Flinders University and Medical Centre, Adelaide, SA, Australia
| | - Helmut Butzkueven
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia/Department of Neurology, Box Hill Hospital, Monash University, Melbourne, VIC, Australia
| | | |
Collapse
|
43
|
Kalincik T, Butzkueven H. Observational data: Understanding the real MS world. Mult Scler 2016; 22:1642-1648. [DOI: 10.1177/1352458516653667] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/16/2016] [Indexed: 11/16/2022]
Abstract
Randomised clinical trials are the primary source of evidence, guiding the use of disease-modifying drugs in multiple sclerosis. However, the spectrum of questions that can be answered in the trial setting is relatively narrow. ‘Real-world’ observational data analysis has always been the major source of evidence for epidemiology, aetiology, outcomes and prognostics, but is now also increasingly used to study treatment effectiveness. While analyses of observational cohorts typically offer superior power, generalisability and duration of follow-up relative to prospective randomised trials, they are also subject to multiple biases. It is the role of researchers to mitigate bias and to ensure the results of observational studies are robust and valid. In this review of observational data research, we provide an overview of the inherent biases, the available mitigation strategies, and the state and direction of contemporary treatment outcomes research. The review will help clinicians critically appraise published results of observational studies.
Collapse
Affiliation(s)
- Tomas Kalincik
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia/Box Hill Hospital, Monash University, Box Hill, VIC, Australia
| |
Collapse
|
44
|
Kalincik T, Sormani MP. Reporting treatment outcomes in observational data: A fine balance. Mult Scler 2016; 23:21-22. [DOI: 10.1177/1352458516633902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Analyses of observational data have been gaining momentum in the evaluation of ever increasing spectrum of disease modifying therapies for multiple sclerosis. While high cost-effectiveness and generalisability represent their main advantages, these studies are also burdened with high risk of bias that may lead to erroneous conclusions. In this viewpoint, we highlight the key role of rigorous and transparent statistical methodology in the studies of observational data and encourage its thorough editorial scrutiny.
Collapse
Affiliation(s)
- Tomas Kalincik
- Department of Medicine, University of Melbourne, and Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| |
Collapse
|
45
|
Saposnik G, Sempere AP, Raptis R, Prefasi D, Selchen D, Maurino J. Decision making under uncertainty, therapeutic inertia, and physicians' risk preferences in the management of multiple sclerosis (DIScUTIR MS). BMC Neurol 2016; 16:58. [PMID: 27146451 PMCID: PMC4855476 DOI: 10.1186/s12883-016-0577-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/21/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The management of multiple sclerosis (MS) is rapidly changing by the introduction of new and more effective disease-modifying agents. The importance of risk stratification was confirmed by results on disease progression predicted by different risk score systems. Despite these advances, we know very little about medical decisions under uncertainty in the management of MS. The goal of this study is to i) identify whether overconfidence, tolerance to risk/uncertainty, herding influence medical decisions, and ii) to evaluate the frequency of therapeutic inertia (defined as lack of treatment initiation or intensification in patients not at goals of care) and its predisposing factors in the management of MS. METHODS/DESIGN This is a prospective study comprising a combination of case-vignettes and surveys and experiments from Neuroeconomics/behavioral economics to identify cognitive distortions associated with medical decisions and therapeutic inertia. Participants include MS fellows and MS experts from across Spain. Each participant will receive an individual link using Qualtrics platform(©) that includes 20 case-vignettes, 3 surveys, and 4 behavioral experiments. The total time for completing the study is approximately 30-35 min. Case vignettes were selected to be representative of common clinical encounters in MS practice. Surveys and experiments include standardized test to measure overconfidence, aversion to risk and ambiguity, herding (following colleague's suggestions even when not supported by the evidence), physicians' reactions to uncertainty, and questions from the Socio-Economic Panel Study (SOEP) related to risk preferences in different domains. By applying three different MS score criteria (modified Rio, EMA, Prosperini's scheme) we take into account physicians' differences in escalating therapy when evaluating medical decisions across case-vignettes. CONCLUSIONS The present study applies an innovative approach by combining tools to assess medical decisions with experiments from Neuroeconomics that applies to common scenarios in MS care. Our results will help advance the field by providing a better understanding on the influence of cognitive factors (e.g., overconfidence, aversion to risk and uncertainty, herding) on medical decisions and therapeutic inertia in the management of MS which could lead to better outcomes.
Collapse
Affiliation(s)
- Gustavo Saposnik
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, ON, M5C 1R6, Canada.
- Neuroeconomics and Decision Neuroscience, Department of Economics, University of Zurich, Zurich, Switzerland.
| | - Angel Perez Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Roula Raptis
- Applied Health Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Daniel Prefasi
- Neuroscience Area, Medical Department, Roche Farma, Madrid, Spain
| | - Daniel Selchen
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, ON, M5C 1R6, Canada
| | - Jorge Maurino
- Neuroscience Area, Medical Department, Roche Farma, Madrid, Spain
| |
Collapse
|
46
|
O'Connor P, Comi G, Freedman MS, Miller AE, Kappos L, Bouchard JP, Lebrun-Frenay C, Mares J, Benamor M, Thangavelu K, Liang J, Truffinet P, Lawson VJ, Wolinsky JS. Long-term safety and efficacy of teriflunomide: Nine-year follow-up of the randomized TEMSO study. Neurology 2016; 86:920-30. [PMID: 26865517 PMCID: PMC4782117 DOI: 10.1212/wnl.0000000000002441] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 11/16/2015] [Indexed: 11/15/2022] Open
Abstract
Objective: To report safety and efficacy outcomes from up to 9 years of treatment with teriflunomide in an extension (NCT00803049) of the pivotal phase 3 Teriflunomide Multiple Sclerosis Oral (TEMSO) trial (NCT00134563). Methods: A total of 742 patients entered the extension. Teriflunomide-treated patients continued the original dose; those previously receiving placebo were randomized 1:1 to teriflunomide 14 mg or 7 mg. Results: By June 2013, median (maximum) teriflunomide exposure exceeded 190 (325) weeks per patient; 468 patients (63%) remained on treatment. Teriflunomide was well-tolerated with continued exposure. The most common adverse events (AEs) matched those in the core study. In extension year 1, first AEs of transient liver enzyme increases or reversible hair thinning were generally attributable to patients switching from placebo to teriflunomide. Approximately 11% of patients discontinued treatment owing to AEs. Twenty percent of patients experienced serious AEs. There were 3 deaths unrelated to teriflunomide. Soon after the extension started, annualized relapse rates and gadolinium-enhancing T1 lesion counts fell in patients switching from placebo to teriflunomide, remaining low thereafter. Disability remained stable in all treatment groups (median Expanded Disability Status Scale score ≤2.5; probability of 12-week disability progression ≤0.48). Conclusions: In the TEMSO extension, safety observations were consistent with the core trial, with no new or unexpected AEs in patients receiving teriflunomide for up to 9 years. Disease activity decreased in patients switching from placebo and remained low in patients continuing on teriflunomide. Classification of evidence: This study provides Class III evidence that long-term treatment with teriflunomide is well-tolerated and efficacy of teriflunomide is maintained long-term.
Collapse
Affiliation(s)
- Paul O'Connor
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.).
| | - Giancarlo Comi
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Mark S Freedman
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Aaron E Miller
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Ludwig Kappos
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Jean-Pierre Bouchard
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Christine Lebrun-Frenay
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Jan Mares
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Myriam Benamor
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Karthinathan Thangavelu
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Jinjun Liang
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Philippe Truffinet
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Victoria J Lawson
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | - Jerry S Wolinsky
- From the University of Toronto (P.O.), Ontario, Canada; University Vita-Salute San Raffaele (G.C.), Milan, Italy; University of Ottawa and the Ottawa Hospital Research Institute (M.S.F.), Ontario, Canada; Icahn School of Medicine at Mount Sinai (A.E.M.), New York, NY; University Hospital Basel (L.K.), Switzerland; Laval University, Centre Hospitalier Universitaire de Québec (J.-P.B.), Québec, Canada; Hôpital Pasteur (C.L.-F.), Nice, France; Fakultni Nemocnice Olomouc (J.M.), Olomouc, Czech Republic; Sanofi Genzyme (M.B., P.T.), Chilly-Mazarin, France; Sanofi Genzyme (K.T.), Cambridge, MA; Sanofi (J.L.), Bridgewater, NJ; Fishawack Communications Ltd. (V.J.L.), Abingdon, UK; and University of Texas Health Science Center at Houston (J.S.W.)
| | | |
Collapse
|
47
|
Signori A, Gallo F, Bovis F, Di Tullio N, Maietta I, Sormani MP. Long-term impact of interferon or Glatiramer acetate in multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2016; 6:57-63. [PMID: 27063624 DOI: 10.1016/j.msard.2016.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/20/2016] [Accepted: 01/29/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND In recent years the impact of disease-modifying drugs on long-term progression in multiple sclerosis (MS) was assessed both in observational studies and in extension of randomized controlled trial (RCT). Aim of this work was to quantitatively summarize by a meta-analysis the long-term impact of immunomodulatory drugs (Interferon-Beta (IFN-β) or Glatiramer Acetate (GA)) in relapsing-remitting (RR) MS patients. METHODS We collected all published observational studies reporting the long-term efficacy of IFN-β or GA in RRMS patients. The primary outcome was the treatment effect on progression to a sustained EDSS score of 6 or to the Secondary Progressive (SP) phase. A non-parametric approach was adopted to test the overall treatment effect significance, while a random effect model was used to obtain a pooled quantitative estimate of the treatment benefit, in terms of hazard-ratios (HR) or Relative Risks, with their 95% confidence interval (CI). RESULTS Fourteen studies, on a total of 13,238 RRMS patients, were included in the meta-analysis. All studies but two reported a consistent effect of immunomodulatory treatment on long-term disease progression; the pooled effect on progression to EDSS 6 or SP was significant (p<0.01) when tested by the non-parametric test. The quantitative estimate of the treatment effect in reducing progression to EDSS 6 in the subset of studies reporting this outcome was HRpooled=0.49 (95% CI: 0.34-0.69), p<0.001. CONCLUSIONS Treatment with immunomodulators seems to reduce long-term probability of disability progression. Additional well-designed observational studies could help to confirm these findings.
Collapse
Affiliation(s)
- Alessio Signori
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Fabio Gallo
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Francesca Bovis
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicolò Di Tullio
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Ilaria Maietta
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy.
| |
Collapse
|
48
|
Kornek B. An update on the use of natalizumab in the treatment of multiple sclerosis: appropriate patient selection and special considerations. Patient Prefer Adherence 2015; 9:675-84. [PMID: 26056435 PMCID: PMC4446014 DOI: 10.2147/ppa.s20791] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
In the context of an increasing repertoire of multiple sclerosis (MS) therapeutics, choosing the appropriate treatment for an individual patient is becoming increasingly challenging. Natalizumab, a humanized monoclonal antibody directed against alpha4beta1 integrin, has proven short-term and long-term efficacies in terms of relapse rate reduction, prevention of disability progression, and reduction of magnetic resonance imaging-detectable activity. It is well tolerated and has further been shown to improve patients' quality of life. Its use is limited by the risk of progressive multifocal leukoencephalopathy (PML), which occurs at an overall incidence of 3.78 cases per 1,000 patients. Three major risk factors for the occurrence of natalizumab-associated PML have been identified: John Cunningham virus (JCV) seropositivity, prior use of immunosuppressants, and treatment duration ≥2 years. Therefore, in patients considered for natalizumab therapy, as well as in patients receiving natalizumab, effective control of MS activity has to be balanced against the risk of an opportunistic central nervous system infection associated with a high risk of significant morbidity or death. Discontinuation of natalizumab is an issue in daily clinical practice, since it is an option to reduce the PML risk. However, after cessation of natalizumab therapy, currently, there is no approved strategy for avoiding postnatalizumab disease reactivation available. In this paper, short-term and long-term safety and efficacy data are reviewed. Issues in daily clinical practice, such as selection of patients, monitoring of patients, and natalizumab discontinuation, are discussed.
Collapse
Affiliation(s)
- Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Correspondence: Barbara Kornek, Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria, Tel +43 1 40400 31450, Fax +43 1 40400 31410, Email
| |
Collapse
|