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Selmaj K, Roth K, Höfler J, Vitzithum K, Derlacz R, von Richter O, Hornuss C, Poetzl J, Singer B, Jacobs L. Introducing the Biosimilar Paradigm to Neurology: The Totality of Evidence for the First Biosimilar Natalizumab. BioDrugs 2024:10.1007/s40259-024-00671-4. [PMID: 39343860 DOI: 10.1007/s40259-024-00671-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 10/01/2024]
Abstract
A biosimilar medicine is a successor to a reference ('originator'/'original-brand') biologic medicine brought to market once the patent and exclusive marketing rights for the reference have expired. Biosimilar natalizumab (PB006 [biosim-NTZ]; developed by Polpharma Biologics S.A. and marketed globally as Tyruko®; Sandoz) has been developed as a successor to reference natalizumab (Tysabri® [ref-NTZ]; Biogen) and is the first US Food and Drug Administration (FDA)-approved and European Medicines Agency (EMA)-approved biosimilar in neurology. As per the FDA and EMA indications for ref-NTZ, biosim-NTZ is approved to treat relapsing forms of multiple sclerosis (USA, EU) and Crohn's disease (USA only). Approval of biosim-NTZ was based on the 'totality of evidence', a comprehensive body of data collected during the development process, demonstrating similarity to its reference medicine. The foundational step of demonstrating structural and functional similarity between biosim-NTZ and ref-NTZ confirmed identical primary and indistinguishable higher order structures, as well as matching binding affinity to α4β1/α4β7 integrins. Following the confirmation of matching structure and function, pharmacokinetic/pharmacodynamic similarity of biosim-NTZ to ref-NTZ in healthy subjects was demonstrated, with no clinically meaningful differences identified in safety and immunogenicity. A comparative, double-blind, randomized study (Antelope) was also conducted in patients with relapsing-remitting multiple sclerosis and demonstrated matching efficacy, safety, and immunogenicity with no clinically meaningful differences between biosim-NTZ and ref-NTZ. This review presents the totality of evidence that confirmed the biosimilarity of biosimilar natalizumab to its reference medicine, which supported its approval by the FDA and the EMA. [Graphical plain language summary available].
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Affiliation(s)
- Krzysztof Selmaj
- Department of Neurology, Center of Neurology, University of Warmia & Mazury, Olsztyn, Lodz, Poland
| | | | | | | | | | | | | | | | - Barry Singer
- The MS Center for Innovations in Care, Missouri Baptist Medical Center, St Louis, MO, USA
| | - Laura Jacobs
- Hexal AG (a Sandoz company), Holzkirchen, Germany.
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2
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Niazi SK. Bioavailability as Proof to Authorize the Clinical Testing of Neurodegenerative Drugs-Protocols and Advice for the FDA to Meet the ALS Act Vision. Int J Mol Sci 2024; 25:10211. [PMID: 39337696 PMCID: PMC11432374 DOI: 10.3390/ijms251810211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
Although decades of intensive drug discovery efforts to treat neurodegenerative disorders (NDs) have failed, around half a million patients in more than 2000 studies continue being tested, costing over USD 100 billion, despite the conclusion that even those drugs which have been approved have no better effect than a placebo. The US Food and Drug Administration (FDA) has established multiple programs to innovate the treatment of rare diseases, particularly NDs, providing millions of USD in funding primarily by encouraging novel clinical trials to account for issues related to study sizes and adopting multi-arm studies to account for patient dropouts. Instead, the FDA should focus on the primary reason for failure: the poor bioavailability of drugs reaching the brain (generally 0.1% at most) due to the blood-brain barrier (BBB). There are several solutions to enhance entry into the brain, and the FDA must require proof of significant entry into the brain as the prerequisite to approving Investigational New Drug (IND) applications. The FDA should also rely on factors other than biomarkers to confirm efficacy, as these are rarely relevant to clinical use. This study summarizes how the drugs used to treat NDs can be made effective and how the FDA should change its guidelines for IND approval of these drugs.
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Affiliation(s)
- Sarfaraz K Niazi
- College of Pharmacy, University of Illinois, Chicago, IL 60612, USA
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Cui Y, Rolova T, Fagerholm SC. The role of integrins in brain health and neurodegenerative diseases. Eur J Cell Biol 2024; 103:151441. [PMID: 39002282 DOI: 10.1016/j.ejcb.2024.151441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024] Open
Abstract
Integrins are heterodimeric membrane proteins expressed on the surface of most cells. They mediate adhesion and signaling processes relevant for a wealth of physiological processes, including nervous system development and function. Interestingly, integrins are also recognized therapeutic targets for inflammatory diseases, such as multiple sclerosis. Here, we discuss the role of integrins in brain development and function, as well as in neurodegenerative diseases affecting the brain (Alzheimer's disease, multiple sclerosis, stroke). Furthermore, we discuss therapeutic targeting of these adhesion receptors in inflammatory diseases of the brain.
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Affiliation(s)
- Yunhao Cui
- Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki 00790, Finland
| | - Taisia Rolova
- Neuroscience Center, HiLIFE, University of Helsinki, Helsinki 00290, Finland
| | - Susanna C Fagerholm
- Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki 00790, Finland.
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4
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Roos I, Sharmin S, Malpas C, Ozakbas S, Lechner-Scott J, Hodgkinson S, Alroughani R, Eichau Madueño S, Boz C, van der Walt A, Butzkueven H, Buzzard K, Skibina O, Foschi M, Grand'Maison F, John N, Grammond P, Terzi M, Prévost J, Barnett M, Laureys G, Van Hijfte L, Luis Sanchez-Menoyo J, Blanco Y, Oh J, McCombe P, Ramo Tello C, Soysal A, Prat A, Duquette P, Yamout BI, Khoury S, van Pesch V, Macdonell R, José Sá M, Slee M, Kuhle J, Maimone D, Spitaleri DLA, Willekens B, Asmi AA, Tallantyre E, Robertson NP, Coles A, L Brown JW, Kalincik T. Effectiveness of cladribine compared to fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting multiple sclerosis. Mult Scler 2024; 30:1163-1175. [PMID: 39087208 DOI: 10.1177/13524585241267211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND Comparisons between cladribine and other potent immunotherapies for multiple sclerosis (MS) are lacking. OBJECTIVES To compare the effectiveness of cladribine against fingolimod, natalizumab, ocrelizumab and alemtuzumab in relapsing-remitting MS. METHODS Patients with relapsing-remitting MS treated with cladribine, fingolimod, natalizumab, ocrelizumab or alemtuzumab were identified in the global MSBase cohort and two additional UK centres. Patients were followed for ⩾6/12 and had ⩾3 in-person disability assessments. Patients were matched using propensity score. Four pairwise analyses compared annualised relapse rates (ARRs) and disability outcomes. RESULTS The eligible cohorts consisted of 853 (fingolimod), 464 (natalizumab), 1131 (ocrelizumab), 123 (alemtuzumab) or 493 (cladribine) patients. Cladribine was associated with a lower ARR than fingolimod (0.07 vs. 0.12, p = 0.006) and a higher ARR than natalizumab (0.10 vs. 0.06, p = 0.03), ocrelizumab (0.09 vs. 0.05, p = 0.008) and alemtuzumab (0.17 vs. 0.04, p < 0.001). Compared to cladribine, the risk of disability worsening did not differ in patients treated with fingolimod (hazard ratio (HR) 1.08, 95% confidence interval (CI) 0.47-2.47) or alemtuzumab (HR 0.73, 95% CI 0.26-2.07), but was lower for patients treated with natalizumab (HR 0.35, 95% CI 0.13-0.94) and ocrelizumab (HR 0.45, 95% CI 0.26-0.78). There was no evidence for a difference in disability improvement. CONCLUSION Cladribine is an effective therapy that can be viewed as a step up in effectiveness from fingolimod, but is less effective than the most potent intravenous MS therapies.
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Affiliation(s)
- Izanne Roos
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sifat Sharmin
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Charles Malpas
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia/John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia
| | - Suzanne Hodgkinson
- Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, NSW, Australia
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | | | - Cavit Boz
- Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Anneke van der Walt
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Katherine Buzzard
- Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia
- Department of Neurosciences, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Olga Skibina
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, VIC, Australia
- Department of Neurosciences, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Matteo Foschi
- Department of Neuroscience, Multiple Sclerosis Center, S. Maria delle Croci Hospital of Ravenna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | | | - Nevin John
- Department of Neurology, Monash Health, Melbourne, VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | | | - Murat Terzi
- Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | | | | | - Guy Laureys
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | | | - Jose Luis Sanchez-Menoyo
- Department of Neurology, Hospital de Galdakao-Usansolo, Biocruces-Bizkaia Health Research Institute, Galdakao, Spain
| | - Yolanda Blanco
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Jiwon Oh
- St. Michael's Hospital, Toronto, ON, Canada
| | - Pamela McCombe
- The University of Queensland, Brisbane, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, OLD, Australia
| | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Alexandre Prat
- CHUM MS Center and Universite de Montreal, Montreal, QC, Canada
| | - Pierre Duquette
- CHUM MS Center and Universite de Montreal, Montreal, QC, Canada
| | - Bassem I Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Maria José Sá
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal; Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - Mark Slee
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jens Kuhle
- Neurology, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Biomedicine and Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, ARNAS Garibaldi, Catania, Italy
| | - Daniele LA Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Abdallah Al Asmi
- College of Medicine and Health Sciences, Sultan Qaboos University Hospital, Sultan Qaboos University, Al-Khodh, Oman
| | - Emma Tallantyre
- Department of Neurology, University Hospital of Wales; Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Neil P Robertson
- Department of Neurology, University Hospital of Wales; Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Alasdair Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Neuroimmunology Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
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5
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de Goër de Herve MG, Dekeyser M, Hendel-Chavez H, Maillart E, Labeyrie C, Adams D, Moreau T, Lubetzki C, Papeix C, Stankoff B, Gasnault J, Taoufik Y. Frequent detection of IFN-gamma -producing memory effector and effector T cells in patients with progressive multifocal leukoencephalopathy. Front Immunol 2024; 15:1416074. [PMID: 39086476 PMCID: PMC11289500 DOI: 10.3389/fimmu.2024.1416074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Progressive Multifocal Leukoencephalopathy (PML) is a rare and deadly demyelinating disease caused by JC virus (JCV) replication in the central nervous system. PML occurs exclusively in patients with severe underlying immune deficiencies, including AIDS and hematological malignancies. PML has also emerged as a significant threat to patients on potent new immunosuppressive biologics, including natalizumab in multiple sclerosis. Methods Here, we developed an IFN-γ release assay (IGRA) that mainly detects JCV-specific effector memory T cells and effectors T cells in the blood. Results This assay was frequently positive in patients with active PML (with a positive JCV PCR in CSF) of various underlying immunosuppression causes (84% sensitivity). Only 3% of healthy donors had a positive response (97% specificity). The frequency of positivity also increased in multiple sclerosis patients according to the time on natalizumab (up to 36% in patients treated for more than 48 months, who are considered at a higher risk of PML). Discussion The results show this assay's frequent or increased positivity in patients with PML or an increased risk of PML, respectively. The assay may help to stratify the risk of PML.
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Affiliation(s)
| | - Manon Dekeyser
- INSERM 1186, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Houria Hendel-Chavez
- INSERM 1186, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Elisabeth Maillart
- Department of Neurology, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Céline Labeyrie
- Department of Neurology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - David Adams
- Department of Neurology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Catherine Lubetzki
- Department of Neurology, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Caroline Papeix
- Department of Neurology, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Bruno Stankoff
- Department of Neurology, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jacques Gasnault
- INSERM 1186, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Unité de Suite et Réadaptation, Department of Internal Medicine, Hôpital de Bicêtre, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Yassine Taoufik
- INSERM 1186, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
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6
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Mokmued K, Obeng G, Kawamoto E, Caidengbate S, Leangpanich S, Akama Y, Gaowa A, Shimaoka M, Park EJ. miR-200c-3p regulates α4 integrin-mediated T cell adhesion and migration. Exp Cell Res 2024; 440:114146. [PMID: 38936759 DOI: 10.1016/j.yexcr.2024.114146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/01/2024] [Accepted: 06/22/2024] [Indexed: 06/29/2024]
Abstract
A microRNA miR-200c-3p is a regulator of epithelial-mesenchymal transition to control adhesion and migration of epithelial and mesenchymal cells. However, little is known about whether miR-200c-3p affects lymphocyte adhesion and migration mediated by integrins. Using TK-1 (a T lymphoblast cell) as a model of T cell, here we show that repressed expression of miR-200c-3p upregulated α4 integrin-mediated adhesion to and migration across mucosal addressin cell adhesion molecule-1 (MAdCAM-1). Conversely, overexpression of miR-200c-3p downregulated α4 integrin-mediated adhesion and migration. Unlike in epithelial cells, miR-200c-3p did not target talin, a conformation activator of integrin, but, targeted E26-transformation-specific sequence 1 (ETS1), a transcriptional activator of α4 integrin, in T cells. Treatment of the miR-200c-3p-low-expressing TK-1 cells that possessed elevated α4 integrin with ETS1 small interfering RNA (siRNA) resulted in the reversion of the α4 integrin expression, supporting that ETS1 is a target of miR-200c-3p. A potential proinflammatory immune-modulator retinoic acid (RA) treatment of TK-1 cells elicited a significant reduction of miR-200c-3p and simultaneously a marked increase in ETS1 and α4 integrin expression. An anti-inflammatory cytokine TGF-β1 treatment elevated miR-200c-3p, thereby downregulating ETS1 and α4 integrin expression. These results suggest that miR-200c-3p is an important regulator of α4 integrin expression and functions and may be controlled by RA and TGF-β1 in an opposite way. Overexpression of miR-200c-3p could be a novel therapeutic option for treatment of gut inflammation through suppressing α4 integrin-mediated T cell migration.
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Affiliation(s)
- Khwanchanok Mokmued
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Gideon Obeng
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Eiji Kawamoto
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan; Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Siqingaowa Caidengbate
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Supasuta Leangpanich
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yuichi Akama
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan; Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Arong Gaowa
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Eun Jeong Park
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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7
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Rohekar S, Boyd T, Lambert RG, Beaton M, Chande N, Gregor J, Lennox H, Mcintosh K, Ponich T, Rahman A, Sharma T, Sey M, Tauqir M, Jairath V. Initiation of vedolizumab did not provoke new-onset spondylarthritis in patients with inflammatory bowel disease: A prospective 24-week study with imaging assessments. United European Gastroenterol J 2024. [PMID: 38965810 DOI: 10.1002/ueg2.12621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/31/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND A temporal relationship between vedolizumab and new-onset spondyloarthritis (SpA) has been suggested. AIMS We evaluated the relationship between vedolizumab initiation and development of new-onset SpA in patients with inflammatory bowel disease (IBD) through serial clinical evaluation and magnetic resonance imaging (MRI). METHODS A single-centre prospective observational study of 24 patients with IBD. Patients were eligible if they had active ulcerative colitis or Crohn's disease (CD), were initiating vedolizumab, had no prior history of arthritis or SpA and were suitable for serial MRI. A rheumatologist performed clinical evaluation prior to the first dose and 8 and 24 weeks. Axial MRI was evaluated by a blinded central reader and performed at baseline 8 and 24 weeks. RESULTS Nine tumor necrosis factor (TNF) inhibitor-naïve patients (4 male; mean age 53.2 years; 6 UC; 3 CD) and eight TNF inhibitor-experienced patients (7 male; mean age 48 years; 3 UC; 5 CD) completed all assessments. No patients developed new features of axial arthritis or features of peripheral SpA (inflammatory oligoarthritis, enthesitis, dactylitis, or psoriasis (nail, body, or scalp)). Both groups demonstrated a good intestinal response. CONCLUSION Vedolizumab initiation did not induce new features of axial or peripheral SpA after 24 weeks of treatment in TNF inhibitor-experienced or TNF inhibitor-naive patients with IBD.
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Affiliation(s)
- Sherry Rohekar
- Department of Medicine, Division of Rheumatology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Tristan Boyd
- Department of Medicine, Division of Rheumatology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Melanie Beaton
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Nilesh Chande
- Southwestern Ontario Inflammatory Bowel Disease Clinic, London, Ontario, Canada
| | - Jamie Gregor
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | | | - Keith Mcintosh
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Terry Ponich
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Adam Rahman
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | | | - Michael Sey
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Maria Tauqir
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Vipul Jairath
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
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8
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Chisari CG, Aguglia U, Amato MP, Bergamaschi R, Bertolotto A, Bonavita S, Morra VB, Cavalla P, Cocco E, Conte A, Cottone S, De Luca G, Di Sapio A, Filippi M, Gallo A, Gasperini C, Granella F, Lus G, Maimone D, Maniscalco GT, Marfia G, Moiola L, Paolicelli D, Pesci I, Ragonese P, Rovaris M, Salemi G, Solaro C, Totaro R, Trojano M, Vianello M, Zaffaroni M, Lepore V, Patti F. Long-term effectiveness of natalizumab in secondary progressive multiple sclerosis: A propensity-matched study. Neurotherapeutics 2024; 21:e00363. [PMID: 38714462 PMCID: PMC11284548 DOI: 10.1016/j.neurot.2024.e00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/12/2024] [Indexed: 05/09/2024] Open
Abstract
Treatment options for secondary progressive MS (SPMS) are limited, especially considering that the new drugs recently approved are licensed for actively relapsing patients. We aimed to compare the disability progression in a real-world cohort of SPMS patients treated with natalizumab (NTZ) or interferon beta-1b (IFNb-1b). This multicenter retrospective enrolled patients with a diagnosis of SPMS according to 2014 Lublin criteria, who received NTZ or IFNb-1b for at least 48 months between the 1st June 2012 and the 15th May 2018 at 33 Italian MS centers contributing to the Italian MS Registry NTZ or IFNb-1b. Confirmed Expanded Disability Status Scale worsening (CEW) and progression independent of relapse (PIRA) were evaluated. In order to correct for non-randomization, a propensity score matching of the groups was performed. Out of 5206 MS patients identified at the time of data extraction, 421 SPMS patients treated with NTZ (224 [53.2%] females, mean age 45.3 ± 25.4 years) and 353 with IFNb-1b (133 [37.8%] females, mean age 48.5 ± 19.8 years) were enrolled. After applying the matching procedure, 102 patients were retained in the NTZ group and 98 in the IFNb-2b group. The proportion of patients who reached the 48-month 1-point CEW was significantly higher in IFNb-1b compared to NTZ group (58.2% versus 30.4%, p = 0.01). The proportion of patients who developed PIRA at 48 months were significantly higher in IFNb-1b compared to NTZ (72.4% versus 40.2%, p = 0.01). EDSS before treatment initiation and SPMS duration were risk factors for disability progression in terms of PIRA (HR 2.54, 25%CI 1.67-5.7; p = 0.006 and HR 2.04, 25%CI 1.22-3.35; p = 0.01, respectively). Patients treated with IFNb-1b were 1.64 times more to likely to develop PIRA (HR 1.64, 25%CI 1.04-4.87; p = 0.001). Treatment with NTZ in SPMS patients showed more favorable disability outcomes compared to IFNb-1b with beneficial effects over 48 months.
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Affiliation(s)
- Clara G Chisari
- Department "GF. Ingrassia"; Section of Neurosciences, University of Catania, Italy; UOS Sclerosi Multipla, AOU Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Antonio Bertolotto
- Department of Neurology and Multiple Sclerosis Regional Referral Centre, AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Italy
| | | | - Paola Cavalla
- Multiple Sclerosis Center, Department of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Torino, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Centre Binaghi Hospital, ATS Sardegna-University of Cagliari, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Pozzili, Italy
| | | | - Giovanna De Luca
- Multiple Sclerosis Center, Neurology Clinic, Policlinico SS Annunziata, University of Chieti-Pescara, Chieti, Italy
| | - Alessia Di Sapio
- Department of Neurology and Multiple Sclerosis Regional Referral Centre, AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Claudio Gasperini
- Department of Neuroscience, UOC Neurology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Franco Granella
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, II Division of Neurology, Multiple Sclerosis Center, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | | | - Girolama Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Paolicelli
- Department of Translational Biomedicines and Neurosciences University of Bari, A. Moro, Bari, Italy
| | - Ilaria Pesci
- Centro Sclerosi Multipla Unità Operativa Neurologia, Azienda Unità Sanitaria Locale, Ospedale Di Vaio, Fidenza, Parma, Italy
| | - Paolo Ragonese
- Unit of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Palermo University, Palermo, Italy
| | | | - Giuseppe Salemi
- Unit of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Palermo University, Palermo, Italy
| | - Claudio Solaro
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone, Moncrivello, (VC), Italy
| | - Rocco Totaro
- Demyelinating Disease Center, Neurology Unit, University of L'Aquila, L'Aquila, Italy
| | - Maria Trojano
- School of Medicine, University "Aldo Moro", Bari, Italy
| | | | - Mauro Zaffaroni
- Multiple Sclerosis Center, ASST della Valle Olona, Ospedale di Gallarate, (VA), Italy
| | - Vito Lepore
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesco Patti
- Department "GF. Ingrassia"; Section of Neurosciences, University of Catania, Italy; UOS Sclerosi Multipla, AOU Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy.
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Collongues N, Durand-Dubief F, Lebrun-Frenay C, Audoin B, Ayrignac X, Bensa C, Bigaut K, Bourre B, Carra-Dallière C, Ciron J, Defer G, Kwiatkowski A, Leray E, Maillart E, Marignier R, Mathey G, Morel N, Thouvenot E, Zéphir H, Boucher J, Boutière C, Branger P, Da Silva A, Demortière S, Guillaume M, Hebant B, Januel E, Kerbrat A, Manchon E, Moisset X, Montcuquet A, Pierret C, Pique J, Poupart J, Prunis C, Roux T, Schmitt P, Androdias G, Cohen M. Cancer and multiple sclerosis: 2023 recommendations from the French Multiple Sclerosis Society. Mult Scler 2024; 30:899-924. [PMID: 38357870 DOI: 10.1177/13524585231223880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Epidemiological data reveal that 45% of persons with multiple sclerosis (PwMS) in France are more than 50 years. This population more than 50 is more susceptible to cancer, and this risk may be increased by frequent use of immunosuppressive drugs. Consequently, concerns have arisen about the potential increased risk of cancer in PwMS and how patients should be screened and managed in terms of cancer risk. OBJECTIVE To develop evidence-based recommendations to manage the coexistence of cancer and multiple sclerosis (MS). METHODS The French Group for Recommendations in MS collected articles from PubMed and university databases covering the period January 1975 through June 2022. The RAND/UCLA method was employed to achieve formal consensus. MS experts comprehensively reviewed the full-text articles and developed the initial recommendations. A group of multidisciplinary health care specialists then validated the final proposal. RESULTS Five key questions were addressed, encompassing various topics such as cancer screening before or after initiating a disease-modifying therapy (DMT), appropriate management of MS in the context of cancer, recommended follow-up for cancer in patients receiving a DMT, and the potential reintroduction of a DMT after initial cancer treatment. A strong consensus was reached for all 31 recommendations. CONCLUSION These recommendations propose a strategic approach to managing cancer risk in PwMS.
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Affiliation(s)
- Nicolas Collongues
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
- Center for Clinical Investigation, INSERM U1434, Strasbourg, France
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
- Department of Pharmacology, Addictology, Toxicology, and Therapeutics, Strasbourg University, Strasbourg, France
| | - Françoise Durand-Dubief
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Christine Lebrun-Frenay
- Department of Neurology, CHU Nice, Nice, France
- Université Côte d'Azur, UMR2CA-URRIS, Nice, France
| | - Bertrand Audoin
- Department of Neurology, CRMBM, APHM, Aix-Marseille University, Marseille, France
| | - Xavier Ayrignac
- Department of Neurology, Montpellier University Hospital, Montpellier, France
- University of Montpellier, Montpellier, France
- INM, INSERM, Montpellier, France
| | - Caroline Bensa
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Kévin Bigaut
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | | | | | - Jonathan Ciron
- CHU de Toulouse, CRC-SEP, Department of Neurology, Toulouse, France
- Université Toulouse III, Infinity, INSERM UMR1291-CNRS UMR5051, Toulouse, France
| | - Gilles Defer
- Department of Neurology, Caen University Hospital, Caen, France
| | - Arnaud Kwiatkowski
- Department of Neurology, Lille Catholic University, Lille Catholic Hospitals, Lille, France
| | - Emmanuelle Leray
- Université de Rennes, EHESP, CNRS, INSERM, ARENES-UMR 6051, RSMS-U1309, Rennes, France
| | | | - Romain Marignier
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Guillaume Mathey
- Department of Neurology, Nancy University Hospital, Nancy, France
| | - Nathalie Morel
- Service de Neurologie, Centre Hospitalier Annecy Genevois, Epagny-Metz-Tessy, France
| | - Eric Thouvenot
- Service de Neurologie, CHU de Nîmes, Nîmes, France
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Hélène Zéphir
- University of Lille, INSERM U1172, CHU de Lille, Lille, France
| | - Julie Boucher
- Department of Neurology, CHU de Lille, Lille, France
| | - Clémence Boutière
- Department of Neurology, University Hospital of Marseille, Marseille, France
| | - Pierre Branger
- Service de Neurologie, CHU de Caen Normandie, Caen, France
| | - Angélique Da Silva
- Breast Cancer Unit, Centre François Baclesse, Institut Normand du Sein, Caen, France
| | - Sarah Demortière
- Department of Neurology, CRMBM, APHM, Aix-Marseille University, Marseille, France
| | | | | | - Edouard Januel
- Sorbonne Université, Paris, France/Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié Salpêtrière, Département de Santé Publique, Paris, France
- Département de Neurologie, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | - Anne Kerbrat
- Service de Neurologie, CHU de Rennes, France
- EMPENN U1228, INSERM-INRIA, Rennes, France
| | - Eric Manchon
- Service de Neurologie, Centre Hospitalier de Gonesse, Gonesse, France
| | - Xavier Moisset
- Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM, Neuro-Dol, Clermont-Ferrand, France
| | | | - Chloé Pierret
- Université de Rennes, EHESP, CNRS, INSERM, ARENES-UMR 6051, RSMS U-1309, Rennes, France
| | - Julie Pique
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Julien Poupart
- Department of Neurology and U995-LIRIC-Lille Inflammation Research International Center, INSERM, University of Lille, CHU Lille, Lille, France
| | - Chloé Prunis
- Department of Neurology, Nancy University Hospital, Nancy, France
| | - Thomas Roux
- Hôpital La Pitié-Salpêtrière, Service de Neurologie, Paris, France
- CRC-SEP Paris. Centre des maladies inflammatoires rares du cerveau et de la moelle de l'enfant et de l'adulte (Mircem)
| | | | - Géraldine Androdias
- Service de Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Service de Neurologie, Hôpital Neurologique Pierre Wertheimer, Bron, France
- Clinique de la Sauvegarde-Ramsay Santé, Lyon, France
| | - Mikael Cohen
- Department of Neurology, CHU Nice, Nice, France/Université Côte d'Azur, UMR2CA-URRIS, Nice, France
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Gold R, Schmidt S, Deisenhammer F, Motte J, Richter N, Taipale K, Salmen HC, Bohland C, Schirduan K. Real-world evidence and patient preference for subcutaneous versus intravenous natalizumab in the treatment of relapsing-remitting multiple sclerosis - initial results from the observational SISTER study. Ther Adv Neurol Disord 2024; 17:17562864241241382. [PMID: 38616781 PMCID: PMC11015759 DOI: 10.1177/17562864241241382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/04/2024] [Indexed: 04/16/2024] Open
Abstract
Background The consideration of patient preference for a certain drug route of administration (RoA) plays an important role in promoting patient adherence in chronic diseases. Natalizumab is an established treatment for relapsing-remitting multiple sclerosis (RRMS) and can be administered as intravenous (IV) infusion or subcutaneous (SC) injection developed to enable a shorter and easier administration versus IV RoA. Study objectives Primary objective is to compare patients' preference for RoA and satisfaction with SC versus IV natalizumab at baseline and subsequent visits up to 12 months. Secondary objectives include drug utilization, clinical outcomes, safety, and treatment satisfaction in a usual care setting. Design and methods SISTER (Subcutaneous: Non-Interventional Study for Tysabri Patient Preference - Experience from Real World) is an ongoing, prospective, observational study where natalizumab is utilized according to local label. RRMS patients are included in three natalizumab cohorts: Patients switching from current IV to SC administration (switcher) and patients newly starting natalizumab on either SC or IV route (starter SC/IV). This interim analysis includes 262 patients (184 switchers, 39 SC starters, and 39 IV starters), median observation period was 9 months. Results 80.8% IV starters and 93.9% SC starters reported at baseline that they prefer the assigned RoA. Although initial satisfaction with chosen RoA was maintained over time from baseline through Month 12 in all three cohorts, the wish for change of the current RoA after 6 and 12 months was more frequently expressed among IV starters than in either SC cohort. Consistently, six patients (23.1%) starting with IV changed their RoA from IV to SC route.Mean global treatment satisfaction according to TSQM-II score at baseline remained high in the switcher group and increased through Month 12 in both IV and SC starter cohorts. Conclusion Based on current data, there is a trend toward patients' preference for the natalizumab SC route over the IV route, which provides valuable insights into patients' preference for natalizumab RoA in routine care and complements available data from clinical studies with real-world data on SC natalizumab. Trial registration This observational (non-interventional) study was registered in the local German PEI register for non-interventional studies (NIS-No. 611) and in the international CTgov register (NCT05304520).
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Affiliation(s)
- Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Gudrunstr. 56, Bochum 44791, Germany
| | | | | | - Jeremias Motte
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - Nils Richter
- Gemeinschaftspraxis für Neurologie, Düsseldorf, Germany
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11
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Dwyer C, Sharmin S, Kalincik T. Rates of John Cunningham virus seroconversion greatly reduced in natalizumab-treated patients during COVID-19-related lockdowns. Eur J Neurol 2024; 31:e16059. [PMID: 37707348 PMCID: PMC11235858 DOI: 10.1111/ene.16059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND AND PURPOSE This study was undertaken to retrospectively compare rates of John Cunningham virus (JCV) seroconversion in natalizumab-treated patients before and during COVID-19-related community restrictions. Natalizumab is highly effective therapy for relapsing-remitting multiple sclerosis. Prolonged exposure to natalizumab in JCV-positive patients can cause progressive multifocal leukoencephalopathy, a potentially fatal brain infection. Serial assessment of JCV status is required for patients receiving natalizumab. METHODS Patients receiving natalizumab at the Royal Melbourne Hospital were assessed for change in JCV serostatus and duration of exposure to natalizumab in two discrete time periods: from 1 February 2012 until 1 February 2017 ("pre-COVID"; n = 128) and from 1 April 2020 until 12 October 2022 ("COVID"; n = 214). A Poisson regression model adjusted for age at natalizumab commencement and sex was used to model seroconversion rate between the two time periods. RESULTS The pre-COVID JCV seroconversion rate among natalizumab-treated patients at the Royal Melbourne Hospital was 9.08%. Conversely, we found a precipitous decline in JCV seroconversion during COVID lockdown. Annualized seroconversion during COVID-19-related restrictions was 2.01%. The annualized seroconversion rate was 4.7 times higher during the pre-COVID-19 period (95% confidence interval = 2.96-7.45, p < 0.0001) compared to the annualized seroconversion rate during COVID lockdown. Males had a 2× higher rate of seroconversion compared to females. CONCLUSIONS JCV seroconversion among natalizumab-treated patients was markedly lower during COVID-19-related community restrictions. Restrictions observed in Melbourne were among the longest and most comprehensive implemented worldwide. This suggests the presence of modifiable risk factors that could lower rates of JCV seroconversion among natalizumab-treated patients.
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Affiliation(s)
- Chris Dwyer
- Neuroimmunology Centre, Department of NeurologyRoyal Melbourne HospitalParkvilleVictoriaAustralia
| | - Sifat Sharmin
- Clinical Outcomes Research Unit (CORe), Department of MedicineUniversity of MelbourneParkvilleVictoriaAustralia
| | - Tomas Kalincik
- Neuroimmunology Centre, Department of NeurologyRoyal Melbourne HospitalParkvilleVictoriaAustralia
- Clinical Outcomes Research Unit (CORe), Department of MedicineUniversity of MelbourneParkvilleVictoriaAustralia
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Del Negro I, Pez S, Versace S, Marziali A, Gigli GL, Tereshko Y, Valente M. Impact of Disease-Modifying Therapies on Gut-Brain Axis in Multiple Sclerosis. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:6. [PMID: 38276041 PMCID: PMC10818907 DOI: 10.3390/medicina60010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Multiple sclerosis is a chronic, autoimmune-mediated, demyelinating disease whose pathogenesis remains to be defined. In past years, in consideration of a constantly growing number of patients diagnosed with multiple sclerosis, the impacts of different environmental factors in the pathogenesis of the disease have been largely studied. Alterations in gut microbiome composition and intestinal barrier permeability have been suggested to play an essential role in the regulation of autoimmunity. Thus, increased efforts are being conducted to demonstrate the complex interplay between gut homeostasis and disease pathogenesis. Numerous results confirm that disease-modifying therapies (DMTs) used for the treatment of MS, in addition to their immunomodulatory effect, could exert an impact on the intestinal microbiota, contributing to the modulation of the immune response itself. However, to date, the direct influence of these treatments on the microbiota is still unclear. This review intends to underline the impact of DMTs on the complex system of the microbiota-gut-brain axis in patients with multiple sclerosis.
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Affiliation(s)
- Ilaria Del Negro
- Clinical Neurology Unit, Udine University Hospital, Piazzale S. Maria della Misericordia, 33100 Udine, Italy
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy
| | - Sara Pez
- Clinical Neurology Unit, Udine University Hospital, Piazzale S. Maria della Misericordia, 33100 Udine, Italy
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy
| | - Salvatore Versace
- Clinical Neurology Unit, Udine University Hospital, Piazzale S. Maria della Misericordia, 33100 Udine, Italy
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy
| | - Alessandro Marziali
- Clinical Neurology Unit, Udine University Hospital, Piazzale S. Maria della Misericordia, 33100 Udine, Italy
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy
| | - Gian Luigi Gigli
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy
| | - Yan Tereshko
- Clinical Neurology Unit, Udine University Hospital, Piazzale S. Maria della Misericordia, 33100 Udine, Italy
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Udine University Hospital, Piazzale S. Maria della Misericordia, 33100 Udine, Italy
- Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy
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13
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Tramacere I, Virgili G, Perduca V, Lucenteforte E, Benedetti MD, Capobussi M, Castellini G, Frau S, Gonzalez-Lorenzo M, Featherstone R, Filippini G. Adverse effects of immunotherapies for multiple sclerosis: a network meta-analysis. Cochrane Database Syst Rev 2023; 11:CD012186. [PMID: 38032059 PMCID: PMC10687854 DOI: 10.1002/14651858.cd012186.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic disease of the central nervous system that affects mainly young adults (two to three times more frequently in women than in men) and causes significant disability after onset. Although it is accepted that immunotherapies for people with MS decrease disease activity, uncertainty regarding their relative safety remains. OBJECTIVES To compare adverse effects of immunotherapies for people with MS or clinically isolated syndrome (CIS), and to rank these treatments according to their relative risks of adverse effects through network meta-analyses (NMAs). SEARCH METHODS We searched CENTRAL, PubMed, Embase, two other databases and trials registers up to March 2022, together with reference checking and citation searching to identify additional studies. SELECTION CRITERIA We included participants 18 years of age or older with a diagnosis of MS or CIS, according to any accepted diagnostic criteria, who were included in randomized controlled trials (RCTs) that examined one or more of the agents used in MS or CIS, and compared them versus placebo or another active agent. We excluded RCTs in which a drug regimen was compared with a different regimen of the same drug without another active agent or placebo as a control arm. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods for data extraction and pairwise meta-analyses. For NMAs, we used the netmeta suite of commands in R to fit random-effects NMAs assuming a common between-study variance. We used the CINeMA platform to GRADE the certainty of the body of evidence in NMAs. We considered a relative risk (RR) of 1.5 as a non-inferiority safety threshold compared to placebo. We assessed the certainty of evidence for primary outcomes within the NMA according to GRADE, as very low, low, moderate or high. MAIN RESULTS This NMA included 123 trials with 57,682 participants. Serious adverse events (SAEs) Reporting of SAEs was available from 84 studies including 5696 (11%) events in 51,833 (89.9%) participants out of 57,682 participants in all studies. Based on the absolute frequency of SAEs, our non-inferiority threshold (up to a 50% increased risk) meant that no more than 1 in 18 additional people would have a SAE compared to placebo. Low-certainty evidence suggested that three drugs may decrease SAEs compared to placebo (relative risk [RR], 95% confidence interval [CI]): interferon beta-1a (Avonex) (0.78, 0.66 to 0.94); dimethyl fumarate (0.79, 0.67 to 0.93), and glatiramer acetate (0.84, 0.72 to 0.98). Several drugs met our non-inferiority criterion versus placebo: moderate-certainty evidence for teriflunomide (1.08, 0.88 to 1.31); low-certainty evidence for ocrelizumab (0.85, 0.67 to 1.07), ozanimod (0.88, 0.59 to 1.33), interferon beta-1b (0.94, 0.78 to 1.12), interferon beta-1a (Rebif) (0.96, 0.80 to 1.15), natalizumab (0.97, 0.79 to 1.19), fingolimod (1.05, 0.92 to 1.20) and laquinimod (1.06, 0.83 to 1.34); very low-certainty evidence for daclizumab (0.83, 0.68 to 1.02). Non-inferiority with placebo was not met due to imprecision for the other drugs: low-certainty evidence for cladribine (1.10, 0.79 to 1.52), siponimod (1.20, 0.95 to 1.51), ofatumumab (1.26, 0.88 to 1.79) and rituximab (1.01, 0.67 to 1.52); very low-certainty evidence for immunoglobulins (1.05, 0.33 to 3.32), diroximel fumarate (1.05, 0.23 to 4.69), peg-interferon beta-1a (1.07, 0.66 to 1.74), alemtuzumab (1.16, 0.85 to 1.60), interferons (1.62, 0.21 to 12.72) and azathioprine (3.62, 0.76 to 17.19). Withdrawals due to adverse events Reporting of withdrawals due to AEs was available from 105 studies (85.4%) including 3537 (6.39%) events in 55,320 (95.9%) patients out of 57,682 patients in all studies. Based on the absolute frequency of withdrawals, our non-inferiority threshold (up to a 50% increased risk) meant that no more than 1 in 31 additional people would withdraw compared to placebo. No drug reduced withdrawals due to adverse events when compared with placebo. There was very low-certainty evidence (meaning that estimates are not reliable) that two drugs met our non-inferiority criterion versus placebo, assuming an upper 95% CI RR limit of 1.5: diroximel fumarate (0.38, 0.11 to 1.27) and alemtuzumab (0.63, 0.33 to 1.19). Non-inferiority with placebo was not met due to imprecision for the following drugs: low-certainty evidence for ofatumumab (1.50, 0.87 to 2.59); very low-certainty evidence for methotrexate (0.94, 0.02 to 46.70), corticosteroids (1.05, 0.16 to 7.14), ozanimod (1.06, 0.58 to 1.93), natalizumab (1.20, 0.77 to 1.85), ocrelizumab (1.32, 0.81 to 2.14), dimethyl fumarate (1.34, 0.96 to 1.86), siponimod (1.63, 0.96 to 2.79), rituximab (1.63, 0.53 to 5.00), cladribine (1.80, 0.89 to 3.62), mitoxantrone (2.11, 0.50 to 8.87), interferons (3.47, 0.95 to 12.72), and cyclophosphamide (3.86, 0.45 to 33.50). Eleven drugs may have increased withdrawals due to adverse events compared with placebo: low-certainty evidence for teriflunomide (1.37, 1.01 to 1.85), glatiramer acetate (1.76, 1.36 to 2.26), fingolimod (1.79, 1.40 to 2.28), interferon beta-1a (Rebif) (2.15, 1.58 to 2.93), daclizumab (2.19, 1.31 to 3.65) and interferon beta-1b (2.59, 1.87 to 3.77); very low-certainty evidence for laquinimod (1.42, 1.01 to 2.00), interferon beta-1a (Avonex) (1.54, 1.13 to 2.10), immunoglobulins (1.87, 1.01 to 3.45), peg-interferon beta-1a (3.46, 1.44 to 8.33) and azathioprine (6.95, 2.57 to 18.78); however, very low-certainty evidence is unreliable. Sensitivity analyses including only studies with low attrition bias, drug dose above the group median, or only patients with relapsing remitting MS or CIS, and subgroup analyses by prior disease-modifying treatments did not change these figures. Rankings No drug yielded consistent P scores in the upper quartile of the probability of being better than others for primary and secondary outcomes. AUTHORS' CONCLUSIONS We found mostly low and very low-certainty evidence that drugs used to treat MS may not increase SAEs, but may increase withdrawals compared with placebo. The results suggest that there is no important difference in the occurrence of SAEs between first- and second-line drugs and between oral, injectable, or infused drugs, compared with placebo. Our review, along with other work in the literature, confirms poor-quality reporting of adverse events from RCTs of interventions. At the least, future studies should follow the CONSORT recommendations about reporting harm-related issues. To address adverse effects, future systematic reviews should also include non-randomized studies.
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Affiliation(s)
- Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Ophthalmology, IRCCS - Fondazione Bietti, Rome, Italy
| | - Vittorio Perduca
- Université Paris Cité, CNRS, MAP5, F-75006 Paris, France
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Ersilia Lucenteforte
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
| | - Maria Donata Benedetti
- UOC Neurologia B - Policlinico Borgo Roma, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Capobussi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Greta Castellini
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | | | - Marien Gonzalez-Lorenzo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Oncology, Laboratory of Clinical Research Methodology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Graziella Filippini
- Scientific Director's Office, Carlo Besta Foundation and Neurological Institute, Milan, Italy
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14
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Schwab N, Wiendl H. Learning CNS immunopathology from therapeutic interventions. Sci Transl Med 2023; 15:eadg7863. [PMID: 37939164 DOI: 10.1126/scitranslmed.adg7863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023]
Abstract
Modulation of immune cell trafficking across the blood-brain barrier has not only introduced a therapeutic avenue for multiple sclerosis (MS) but also represents an example of reverse translational medicine. Data from clinical trials of drugs such as natalizumab and fingolimod have revealed the involvement of different compartments in relapsing versus non-relapsing MS immune biology, contributed to our understanding of central nervous system (CNS) immune surveillance, and stimulated new fields of research. Here, we discuss the results of these trials, as well as patient biomaterial-based scientific projects, and how both have informed our understanding of CNS immunopathology.
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Affiliation(s)
- Nicholas Schwab
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster 48149, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster 48149, Germany
- Brain and Mind Centre, University of Sydney, Camperdown NSW 2050, Australia
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15
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Alping P. Disease-modifying therapies in multiple sclerosis: A focused review of rituximab. Basic Clin Pharmacol Toxicol 2023; 133:550-564. [PMID: 37563891 DOI: 10.1111/bcpt.13932] [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: 03/03/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Treatment for multiple sclerosis (MS), a chronic inflammatory disease of the central nervous system, has changed drastically in the last 30 years. Several different disease-modifying therapies are now available, with off-label use of the B-cell-depleting antibody rituximab becoming an increasingly popular choice, as more and more studies report on its effectiveness. OBJECTIVES The objective of this study was to summarize the current state of evidence for rituximab as a treatment for relapsing-remitting MS (RRMS). METHODS A structured literature search was conducted in PubMed, focusing on peer-reviewed studies of adult populations with RRMS. Ongoing trials with rituximab in MS were identified through Clinicaltrials.gov and additional references were identified through review articles. FINDINGS Despite promising results for rituximab as a treatment of MS, the market-authorization holder switched focus from rituximab and discontinued the industry-sponsored trials programme. However, several observational studies, smaller clinical trials and one large investigator-initiated randomized-controlled trial have continued to report fewer clinical relapses, fewer contrast-enhancing lesions on magnetic resonance imaging and better drug survival with rituximab, compared with MS-approved alternatives. CONCLUSIONS Rituximab should be considered as both a first- and second-line therapy option for most MS patients with active, non-progressive disease. However, as an off-label therapy for MS, regulatory approval remains a barrier for wider adoption in many countries.
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Affiliation(s)
- Peter Alping
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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16
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Alonso-Moreno M, Ladrón-Guevara M, Ciudad-Gutiérrez P. Systematic review of gender bias in clinical trials of monoclonal antibodies for the treatment of multiple sclerosis. Neurologia 2023; 38:695-706. [PMID: 37996214 DOI: 10.1016/j.nrleng.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/01/2021] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION This article analyses the presence of gender bias in clinical trials of monoclonal antibodies used to treat multiple sclerosis. MATERIAL AND METHODS We performed a systematic review of controlled clinical trials of 4 monoclonal antibodies used to treat multiple sclerosis (natalizumab, rituximab, alemtuzumab, and ocrelizumab). We searched the PubMed/MEDLINE database for articles published in English before March 2020. The study was conducted in accordance with the relevant international recommendations. RESULTS The search identified 89 articles, 55 of which met the inclusion criteria. Of all patients included in these trials, 64.6% were women. The lead authors of 10 of the studies were women. Fifteen of the 55 studies included a sex-based analysis of the primary endpoint. Only 8 articles discussed the results separately for men and for women. CONCLUSIONS The clinical trials of these 4 monoclonal antibodies present a significant gender bias. In most cases, the primary and secondary endpoints are not analyzed according to patient sex, despite the fact that international recommendations include this as a minimum requirement for ensuring scientific validity and obtaining appropriate results for extrapolation to the wider population.
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Affiliation(s)
- M Alonso-Moreno
- Pharmacy Service, Hospital Universitario Virgen del Rocío, Avenue Manuel Siurot, 41013 Seville, Spain.
| | - M Ladrón-Guevara
- Pharmacy Service, Hospital Universitario Virgen del Rocío, Avenue Manuel Siurot, 41013 Seville, Spain
| | - P Ciudad-Gutiérrez
- Pharmacy Service, Hospital Universitario Virgen del Rocío, Avenue Manuel Siurot, 41013 Seville, Spain
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17
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O'Leary S, Brugger HT, Wallentine D, Sershon L, Goff E, Saldana-King T, Beavin J, Avila RL, Rutledge D, Moore M. Practical Clinical Guidelines for Natalizumab Treatment in Patients With Relapsing Multiple Sclerosis. JOURNAL OF INFUSION NURSING 2023; 46:347-359. [PMID: 37920108 PMCID: PMC10635346 DOI: 10.1097/nan.0000000000000519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Natalizumab (TYSABRI®) was the first high-efficacy monoclonal antibody disease-modifying therapy (DMT) approved as a monotherapy for the treatment of adults with relapsing forms of multiple sclerosis (MS), including clinically isolated syndrome, relapsing-remitting MS, and active secondary progressive MS. Because natalizumab is administered by intravenous infusion, infusion nurses play a key role in the care of natalizumab-treated patients. In the 16 years since approval, substantial data have been gathered on the long-term, real-world effectiveness and safety of natalizumab. This article provides a synopsis of this data, as well as practical information for optimizing patient care. This includes information on strategies to mitigate the risk of progressive multifocal leukoencephalopathy in natalizumab-treated patients, natalizumab use during pregnancy, and use with vaccines. It also includes guidance on the preparation and administration of natalizumab and monitoring of natalizumab-treated patients.
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Affiliation(s)
- Shirley O'Leary
- Corresponding Author: Shirley O'Leary, MS, APN-C, MSCN, Dallas VA Medical Center, MS Center, 4500 S Lancaster Road, Dallas, TX 75216 ()
| | - Helen T. Brugger
- Dallas VA Medical Center MS Center, Dallas, Texas (Ms O'Leary); Long Ridge Medical Center, Neurology, Greenwich Hospital, Stamford, Connecticut (Ms Brugger); Rocky Mountain MS Clinic, Salt Lake City, Utah (Mr Wallentine); The Regional MS Center & The Center for Neurological Disorders, Milwaukee, Wisconsin (Ms Sershon); University of Alabama at Birmingham, Birmingham, Alabama (Ms Goff); Biogen, Cambridge, Massachusetts (Mss Saldana-King and Beavin; Drs Avila and Rutledge); Novant MS Care Center, Charlotte, North Carolina (Ms Moore)
- Shirley O'Leary, MS, APN-C, MSCN, has practiced as a provider, subinvestigator/researcher, and neurology infusion manager for 7 years at the MS Center of Excellence at the Dallas VA Medical Center. She has 27 years of experience in the area of multiple sclerosis (MS) and has authored articles, given numerous invited talks, and is a longstanding member of the International Organization of MS Nurses
- Helen T. Brugger, DNP, MSN, RN, Coordinator of Long Ridge Infusion Center at Long Ridge Medical Center, Greenwich Hospital, has worked on 2 intravenous teams and currently treats a population of neurological patients at an outpatient infusion center. She is a member of the Eastern Nursing Research Society and Sigma Theta Tau International
- Dale Wallentine, BSN, RN, MSCN, is an infusion nurse and the infusion department operation manager at the Rocky Mountain Multiple Sclerosis Clinic in Salt Lake City. He has more than 13 years of multiple sclerosis infusion experience and is certified in multiple sclerosis nursing
- Lisa Sershon, PA-C, MMS, MSCS,* practiced for 11 years as a physician's assistant specializing in neuroimmunology, at the Center for Neurological Disorders at Ascension St. Francis in Milwaukee, Wisconsin. She participated in the management and protocol development for infusion therapies as a multiple sclerosis–certified specialist
- Erica Goff, PharmD, BCPS, MSCS, is a specialty pharmacist covering the multiple sclerosis population at the outpatient neurology division at University of Alabama at Birmingham Health System. Her professional responsibilities include clinical guidance, oversight, and patient education for pharmacotherapy prescribed in her ambulatory clinic, as well as facilitating access to medication, providing side-effect mitigation strategies and reductions in patient financial burden
- Toni Saldana-King, RN, BSN, MSCN, was a senior medical science liaison at Biogen at the time of submission. Prior to Biogen, she was a practicing nurse at the Maxine Mesinger MS Comprehensive Care Center at Baylor College of Medicine in Houston, Texas, the first Comprehensive Care Center to be recognized by the National MS Society
- Jill Beavin, BSN, RN, MSCN, is a principle medical science liaison at Biogen. Prior to Biogen, she worked as an MS nurse and clinical director in a private neurology practice, where she developed and maintained a 22-chair infusion suite and MS Center
- Robin L. Avila, PhD, is a medical director at Biogen and has been involved in MS clinical research for the last 6 years. Prior to Biogen, she conducted preclinical MS research in the areas of myelin biology, myelin repair, and the development of novel models of MS
- Danette Rutledge, BSP, PhD, is an associate medical director at Biogen, where she has been involved in MS clinical research for the last 3 years. Prior to joining industry, she conducted basic science research in multiple sclerosis for over 10 years
- Marie Moore, FNP-C, MSCN, President of the International Organization of Multiple Sclerosis Nurses, is a nurse practitioner at the Novant Health Multiple Sclerosis Care center in Charlotte, North Carolina, where she participates in research and oversight of the infusion center. She has specialized in the care of multiple sclerosis patients since 2011
| | - Dale Wallentine
- Dallas VA Medical Center MS Center, Dallas, Texas (Ms O'Leary); Long Ridge Medical Center, Neurology, Greenwich Hospital, Stamford, Connecticut (Ms Brugger); Rocky Mountain MS Clinic, Salt Lake City, Utah (Mr Wallentine); The Regional MS Center & The Center for Neurological Disorders, Milwaukee, Wisconsin (Ms Sershon); University of Alabama at Birmingham, Birmingham, Alabama (Ms Goff); Biogen, Cambridge, Massachusetts (Mss Saldana-King and Beavin; Drs Avila and Rutledge); Novant MS Care Center, Charlotte, North Carolina (Ms Moore)
- Shirley O'Leary, MS, APN-C, MSCN, has practiced as a provider, subinvestigator/researcher, and neurology infusion manager for 7 years at the MS Center of Excellence at the Dallas VA Medical Center. She has 27 years of experience in the area of multiple sclerosis (MS) and has authored articles, given numerous invited talks, and is a longstanding member of the International Organization of MS Nurses
- Helen T. Brugger, DNP, MSN, RN, Coordinator of Long Ridge Infusion Center at Long Ridge Medical Center, Greenwich Hospital, has worked on 2 intravenous teams and currently treats a population of neurological patients at an outpatient infusion center. She is a member of the Eastern Nursing Research Society and Sigma Theta Tau International
- Dale Wallentine, BSN, RN, MSCN, is an infusion nurse and the infusion department operation manager at the Rocky Mountain Multiple Sclerosis Clinic in Salt Lake City. He has more than 13 years of multiple sclerosis infusion experience and is certified in multiple sclerosis nursing
- Lisa Sershon, PA-C, MMS, MSCS,* practiced for 11 years as a physician's assistant specializing in neuroimmunology, at the Center for Neurological Disorders at Ascension St. Francis in Milwaukee, Wisconsin. She participated in the management and protocol development for infusion therapies as a multiple sclerosis–certified specialist
- Erica Goff, PharmD, BCPS, MSCS, is a specialty pharmacist covering the multiple sclerosis population at the outpatient neurology division at University of Alabama at Birmingham Health System. Her professional responsibilities include clinical guidance, oversight, and patient education for pharmacotherapy prescribed in her ambulatory clinic, as well as facilitating access to medication, providing side-effect mitigation strategies and reductions in patient financial burden
- Toni Saldana-King, RN, BSN, MSCN, was a senior medical science liaison at Biogen at the time of submission. Prior to Biogen, she was a practicing nurse at the Maxine Mesinger MS Comprehensive Care Center at Baylor College of Medicine in Houston, Texas, the first Comprehensive Care Center to be recognized by the National MS Society
- Jill Beavin, BSN, RN, MSCN, is a principle medical science liaison at Biogen. Prior to Biogen, she worked as an MS nurse and clinical director in a private neurology practice, where she developed and maintained a 22-chair infusion suite and MS Center
- Robin L. Avila, PhD, is a medical director at Biogen and has been involved in MS clinical research for the last 6 years. Prior to Biogen, she conducted preclinical MS research in the areas of myelin biology, myelin repair, and the development of novel models of MS
- Danette Rutledge, BSP, PhD, is an associate medical director at Biogen, where she has been involved in MS clinical research for the last 3 years. Prior to joining industry, she conducted basic science research in multiple sclerosis for over 10 years
- Marie Moore, FNP-C, MSCN, President of the International Organization of Multiple Sclerosis Nurses, is a nurse practitioner at the Novant Health Multiple Sclerosis Care center in Charlotte, North Carolina, where she participates in research and oversight of the infusion center. She has specialized in the care of multiple sclerosis patients since 2011
| | - Lisa Sershon
- Dallas VA Medical Center MS Center, Dallas, Texas (Ms O'Leary); Long Ridge Medical Center, Neurology, Greenwich Hospital, Stamford, Connecticut (Ms Brugger); Rocky Mountain MS Clinic, Salt Lake City, Utah (Mr Wallentine); The Regional MS Center & The Center for Neurological Disorders, Milwaukee, Wisconsin (Ms Sershon); University of Alabama at Birmingham, Birmingham, Alabama (Ms Goff); Biogen, Cambridge, Massachusetts (Mss Saldana-King and Beavin; Drs Avila and Rutledge); Novant MS Care Center, Charlotte, North Carolina (Ms Moore)
- Shirley O'Leary, MS, APN-C, MSCN, has practiced as a provider, subinvestigator/researcher, and neurology infusion manager for 7 years at the MS Center of Excellence at the Dallas VA Medical Center. She has 27 years of experience in the area of multiple sclerosis (MS) and has authored articles, given numerous invited talks, and is a longstanding member of the International Organization of MS Nurses
- Helen T. Brugger, DNP, MSN, RN, Coordinator of Long Ridge Infusion Center at Long Ridge Medical Center, Greenwich Hospital, has worked on 2 intravenous teams and currently treats a population of neurological patients at an outpatient infusion center. She is a member of the Eastern Nursing Research Society and Sigma Theta Tau International
- Dale Wallentine, BSN, RN, MSCN, is an infusion nurse and the infusion department operation manager at the Rocky Mountain Multiple Sclerosis Clinic in Salt Lake City. He has more than 13 years of multiple sclerosis infusion experience and is certified in multiple sclerosis nursing
- Lisa Sershon, PA-C, MMS, MSCS,* practiced for 11 years as a physician's assistant specializing in neuroimmunology, at the Center for Neurological Disorders at Ascension St. Francis in Milwaukee, Wisconsin. She participated in the management and protocol development for infusion therapies as a multiple sclerosis–certified specialist
- Erica Goff, PharmD, BCPS, MSCS, is a specialty pharmacist covering the multiple sclerosis population at the outpatient neurology division at University of Alabama at Birmingham Health System. Her professional responsibilities include clinical guidance, oversight, and patient education for pharmacotherapy prescribed in her ambulatory clinic, as well as facilitating access to medication, providing side-effect mitigation strategies and reductions in patient financial burden
- Toni Saldana-King, RN, BSN, MSCN, was a senior medical science liaison at Biogen at the time of submission. Prior to Biogen, she was a practicing nurse at the Maxine Mesinger MS Comprehensive Care Center at Baylor College of Medicine in Houston, Texas, the first Comprehensive Care Center to be recognized by the National MS Society
- Jill Beavin, BSN, RN, MSCN, is a principle medical science liaison at Biogen. Prior to Biogen, she worked as an MS nurse and clinical director in a private neurology practice, where she developed and maintained a 22-chair infusion suite and MS Center
- Robin L. Avila, PhD, is a medical director at Biogen and has been involved in MS clinical research for the last 6 years. Prior to Biogen, she conducted preclinical MS research in the areas of myelin biology, myelin repair, and the development of novel models of MS
- Danette Rutledge, BSP, PhD, is an associate medical director at Biogen, where she has been involved in MS clinical research for the last 3 years. Prior to joining industry, she conducted basic science research in multiple sclerosis for over 10 years
- Marie Moore, FNP-C, MSCN, President of the International Organization of Multiple Sclerosis Nurses, is a nurse practitioner at the Novant Health Multiple Sclerosis Care center in Charlotte, North Carolina, where she participates in research and oversight of the infusion center. She has specialized in the care of multiple sclerosis patients since 2011
| | - Erica Goff
- Dallas VA Medical Center MS Center, Dallas, Texas (Ms O'Leary); Long Ridge Medical Center, Neurology, Greenwich Hospital, Stamford, Connecticut (Ms Brugger); Rocky Mountain MS Clinic, Salt Lake City, Utah (Mr Wallentine); The Regional MS Center & The Center for Neurological Disorders, Milwaukee, Wisconsin (Ms Sershon); University of Alabama at Birmingham, Birmingham, Alabama (Ms Goff); Biogen, Cambridge, Massachusetts (Mss Saldana-King and Beavin; Drs Avila and Rutledge); Novant MS Care Center, Charlotte, North Carolina (Ms Moore)
- Shirley O'Leary, MS, APN-C, MSCN, has practiced as a provider, subinvestigator/researcher, and neurology infusion manager for 7 years at the MS Center of Excellence at the Dallas VA Medical Center. She has 27 years of experience in the area of multiple sclerosis (MS) and has authored articles, given numerous invited talks, and is a longstanding member of the International Organization of MS Nurses
- Helen T. Brugger, DNP, MSN, RN, Coordinator of Long Ridge Infusion Center at Long Ridge Medical Center, Greenwich Hospital, has worked on 2 intravenous teams and currently treats a population of neurological patients at an outpatient infusion center. She is a member of the Eastern Nursing Research Society and Sigma Theta Tau International
- Dale Wallentine, BSN, RN, MSCN, is an infusion nurse and the infusion department operation manager at the Rocky Mountain Multiple Sclerosis Clinic in Salt Lake City. He has more than 13 years of multiple sclerosis infusion experience and is certified in multiple sclerosis nursing
- Lisa Sershon, PA-C, MMS, MSCS,* practiced for 11 years as a physician's assistant specializing in neuroimmunology, at the Center for Neurological Disorders at Ascension St. Francis in Milwaukee, Wisconsin. She participated in the management and protocol development for infusion therapies as a multiple sclerosis–certified specialist
- Erica Goff, PharmD, BCPS, MSCS, is a specialty pharmacist covering the multiple sclerosis population at the outpatient neurology division at University of Alabama at Birmingham Health System. Her professional responsibilities include clinical guidance, oversight, and patient education for pharmacotherapy prescribed in her ambulatory clinic, as well as facilitating access to medication, providing side-effect mitigation strategies and reductions in patient financial burden
- Toni Saldana-King, RN, BSN, MSCN, was a senior medical science liaison at Biogen at the time of submission. Prior to Biogen, she was a practicing nurse at the Maxine Mesinger MS Comprehensive Care Center at Baylor College of Medicine in Houston, Texas, the first Comprehensive Care Center to be recognized by the National MS Society
- Jill Beavin, BSN, RN, MSCN, is a principle medical science liaison at Biogen. Prior to Biogen, she worked as an MS nurse and clinical director in a private neurology practice, where she developed and maintained a 22-chair infusion suite and MS Center
- Robin L. Avila, PhD, is a medical director at Biogen and has been involved in MS clinical research for the last 6 years. Prior to Biogen, she conducted preclinical MS research in the areas of myelin biology, myelin repair, and the development of novel models of MS
- Danette Rutledge, BSP, PhD, is an associate medical director at Biogen, where she has been involved in MS clinical research for the last 3 years. Prior to joining industry, she conducted basic science research in multiple sclerosis for over 10 years
- Marie Moore, FNP-C, MSCN, President of the International Organization of Multiple Sclerosis Nurses, is a nurse practitioner at the Novant Health Multiple Sclerosis Care center in Charlotte, North Carolina, where she participates in research and oversight of the infusion center. She has specialized in the care of multiple sclerosis patients since 2011
| | - Toni Saldana-King
- Dallas VA Medical Center MS Center, Dallas, Texas (Ms O'Leary); Long Ridge Medical Center, Neurology, Greenwich Hospital, Stamford, Connecticut (Ms Brugger); Rocky Mountain MS Clinic, Salt Lake City, Utah (Mr Wallentine); The Regional MS Center & The Center for Neurological Disorders, Milwaukee, Wisconsin (Ms Sershon); University of Alabama at Birmingham, Birmingham, Alabama (Ms Goff); Biogen, Cambridge, Massachusetts (Mss Saldana-King and Beavin; Drs Avila and Rutledge); Novant MS Care Center, Charlotte, North Carolina (Ms Moore)
- Shirley O'Leary, MS, APN-C, MSCN, has practiced as a provider, subinvestigator/researcher, and neurology infusion manager for 7 years at the MS Center of Excellence at the Dallas VA Medical Center. She has 27 years of experience in the area of multiple sclerosis (MS) and has authored articles, given numerous invited talks, and is a longstanding member of the International Organization of MS Nurses
- Helen T. Brugger, DNP, MSN, RN, Coordinator of Long Ridge Infusion Center at Long Ridge Medical Center, Greenwich Hospital, has worked on 2 intravenous teams and currently treats a population of neurological patients at an outpatient infusion center. She is a member of the Eastern Nursing Research Society and Sigma Theta Tau International
- Dale Wallentine, BSN, RN, MSCN, is an infusion nurse and the infusion department operation manager at the Rocky Mountain Multiple Sclerosis Clinic in Salt Lake City. He has more than 13 years of multiple sclerosis infusion experience and is certified in multiple sclerosis nursing
- Lisa Sershon, PA-C, MMS, MSCS,* practiced for 11 years as a physician's assistant specializing in neuroimmunology, at the Center for Neurological Disorders at Ascension St. Francis in Milwaukee, Wisconsin. She participated in the management and protocol development for infusion therapies as a multiple sclerosis–certified specialist
- Erica Goff, PharmD, BCPS, MSCS, is a specialty pharmacist covering the multiple sclerosis population at the outpatient neurology division at University of Alabama at Birmingham Health System. Her professional responsibilities include clinical guidance, oversight, and patient education for pharmacotherapy prescribed in her ambulatory clinic, as well as facilitating access to medication, providing side-effect mitigation strategies and reductions in patient financial burden
- Toni Saldana-King, RN, BSN, MSCN, was a senior medical science liaison at Biogen at the time of submission. Prior to Biogen, she was a practicing nurse at the Maxine Mesinger MS Comprehensive Care Center at Baylor College of Medicine in Houston, Texas, the first Comprehensive Care Center to be recognized by the National MS Society
- Jill Beavin, BSN, RN, MSCN, is a principle medical science liaison at Biogen. Prior to Biogen, she worked as an MS nurse and clinical director in a private neurology practice, where she developed and maintained a 22-chair infusion suite and MS Center
- Robin L. Avila, PhD, is a medical director at Biogen and has been involved in MS clinical research for the last 6 years. Prior to Biogen, she conducted preclinical MS research in the areas of myelin biology, myelin repair, and the development of novel models of MS
- Danette Rutledge, BSP, PhD, is an associate medical director at Biogen, where she has been involved in MS clinical research for the last 3 years. Prior to joining industry, she conducted basic science research in multiple sclerosis for over 10 years
- Marie Moore, FNP-C, MSCN, President of the International Organization of Multiple Sclerosis Nurses, is a nurse practitioner at the Novant Health Multiple Sclerosis Care center in Charlotte, North Carolina, where she participates in research and oversight of the infusion center. She has specialized in the care of multiple sclerosis patients since 2011
| | - Jill Beavin
- Dallas VA Medical Center MS Center, Dallas, Texas (Ms O'Leary); Long Ridge Medical Center, Neurology, Greenwich Hospital, Stamford, Connecticut (Ms Brugger); Rocky Mountain MS Clinic, Salt Lake City, Utah (Mr Wallentine); The Regional MS Center & The Center for Neurological Disorders, Milwaukee, Wisconsin (Ms Sershon); University of Alabama at Birmingham, Birmingham, Alabama (Ms Goff); Biogen, Cambridge, Massachusetts (Mss Saldana-King and Beavin; Drs Avila and Rutledge); Novant MS Care Center, Charlotte, North Carolina (Ms Moore)
- Shirley O'Leary, MS, APN-C, MSCN, has practiced as a provider, subinvestigator/researcher, and neurology infusion manager for 7 years at the MS Center of Excellence at the Dallas VA Medical Center. She has 27 years of experience in the area of multiple sclerosis (MS) and has authored articles, given numerous invited talks, and is a longstanding member of the International Organization of MS Nurses
- Helen T. Brugger, DNP, MSN, RN, Coordinator of Long Ridge Infusion Center at Long Ridge Medical Center, Greenwich Hospital, has worked on 2 intravenous teams and currently treats a population of neurological patients at an outpatient infusion center. She is a member of the Eastern Nursing Research Society and Sigma Theta Tau International
- Dale Wallentine, BSN, RN, MSCN, is an infusion nurse and the infusion department operation manager at the Rocky Mountain Multiple Sclerosis Clinic in Salt Lake City. He has more than 13 years of multiple sclerosis infusion experience and is certified in multiple sclerosis nursing
- Lisa Sershon, PA-C, MMS, MSCS,* practiced for 11 years as a physician's assistant specializing in neuroimmunology, at the Center for Neurological Disorders at Ascension St. Francis in Milwaukee, Wisconsin. She participated in the management and protocol development for infusion therapies as a multiple sclerosis–certified specialist
- Erica Goff, PharmD, BCPS, MSCS, is a specialty pharmacist covering the multiple sclerosis population at the outpatient neurology division at University of Alabama at Birmingham Health System. Her professional responsibilities include clinical guidance, oversight, and patient education for pharmacotherapy prescribed in her ambulatory clinic, as well as facilitating access to medication, providing side-effect mitigation strategies and reductions in patient financial burden
- Toni Saldana-King, RN, BSN, MSCN, was a senior medical science liaison at Biogen at the time of submission. Prior to Biogen, she was a practicing nurse at the Maxine Mesinger MS Comprehensive Care Center at Baylor College of Medicine in Houston, Texas, the first Comprehensive Care Center to be recognized by the National MS Society
- Jill Beavin, BSN, RN, MSCN, is a principle medical science liaison at Biogen. Prior to Biogen, she worked as an MS nurse and clinical director in a private neurology practice, where she developed and maintained a 22-chair infusion suite and MS Center
- Robin L. Avila, PhD, is a medical director at Biogen and has been involved in MS clinical research for the last 6 years. Prior to Biogen, she conducted preclinical MS research in the areas of myelin biology, myelin repair, and the development of novel models of MS
- Danette Rutledge, BSP, PhD, is an associate medical director at Biogen, where she has been involved in MS clinical research for the last 3 years. Prior to joining industry, she conducted basic science research in multiple sclerosis for over 10 years
- Marie Moore, FNP-C, MSCN, President of the International Organization of Multiple Sclerosis Nurses, is a nurse practitioner at the Novant Health Multiple Sclerosis Care center in Charlotte, North Carolina, where she participates in research and oversight of the infusion center. She has specialized in the care of multiple sclerosis patients since 2011
| | - Robin L. Avila
- Dallas VA Medical Center MS Center, Dallas, Texas (Ms O'Leary); Long Ridge Medical Center, Neurology, Greenwich Hospital, Stamford, Connecticut (Ms Brugger); Rocky Mountain MS Clinic, Salt Lake City, Utah (Mr Wallentine); The Regional MS Center & The Center for Neurological Disorders, Milwaukee, Wisconsin (Ms Sershon); University of Alabama at Birmingham, Birmingham, Alabama (Ms Goff); Biogen, Cambridge, Massachusetts (Mss Saldana-King and Beavin; Drs Avila and Rutledge); Novant MS Care Center, Charlotte, North Carolina (Ms Moore)
- Shirley O'Leary, MS, APN-C, MSCN, has practiced as a provider, subinvestigator/researcher, and neurology infusion manager for 7 years at the MS Center of Excellence at the Dallas VA Medical Center. She has 27 years of experience in the area of multiple sclerosis (MS) and has authored articles, given numerous invited talks, and is a longstanding member of the International Organization of MS Nurses
- Helen T. Brugger, DNP, MSN, RN, Coordinator of Long Ridge Infusion Center at Long Ridge Medical Center, Greenwich Hospital, has worked on 2 intravenous teams and currently treats a population of neurological patients at an outpatient infusion center. She is a member of the Eastern Nursing Research Society and Sigma Theta Tau International
- Dale Wallentine, BSN, RN, MSCN, is an infusion nurse and the infusion department operation manager at the Rocky Mountain Multiple Sclerosis Clinic in Salt Lake City. He has more than 13 years of multiple sclerosis infusion experience and is certified in multiple sclerosis nursing
- Lisa Sershon, PA-C, MMS, MSCS,* practiced for 11 years as a physician's assistant specializing in neuroimmunology, at the Center for Neurological Disorders at Ascension St. Francis in Milwaukee, Wisconsin. She participated in the management and protocol development for infusion therapies as a multiple sclerosis–certified specialist
- Erica Goff, PharmD, BCPS, MSCS, is a specialty pharmacist covering the multiple sclerosis population at the outpatient neurology division at University of Alabama at Birmingham Health System. Her professional responsibilities include clinical guidance, oversight, and patient education for pharmacotherapy prescribed in her ambulatory clinic, as well as facilitating access to medication, providing side-effect mitigation strategies and reductions in patient financial burden
- Toni Saldana-King, RN, BSN, MSCN, was a senior medical science liaison at Biogen at the time of submission. Prior to Biogen, she was a practicing nurse at the Maxine Mesinger MS Comprehensive Care Center at Baylor College of Medicine in Houston, Texas, the first Comprehensive Care Center to be recognized by the National MS Society
- Jill Beavin, BSN, RN, MSCN, is a principle medical science liaison at Biogen. Prior to Biogen, she worked as an MS nurse and clinical director in a private neurology practice, where she developed and maintained a 22-chair infusion suite and MS Center
- Robin L. Avila, PhD, is a medical director at Biogen and has been involved in MS clinical research for the last 6 years. Prior to Biogen, she conducted preclinical MS research in the areas of myelin biology, myelin repair, and the development of novel models of MS
- Danette Rutledge, BSP, PhD, is an associate medical director at Biogen, where she has been involved in MS clinical research for the last 3 years. Prior to joining industry, she conducted basic science research in multiple sclerosis for over 10 years
- Marie Moore, FNP-C, MSCN, President of the International Organization of Multiple Sclerosis Nurses, is a nurse practitioner at the Novant Health Multiple Sclerosis Care center in Charlotte, North Carolina, where she participates in research and oversight of the infusion center. She has specialized in the care of multiple sclerosis patients since 2011
| | - Danette Rutledge
- Dallas VA Medical Center MS Center, Dallas, Texas (Ms O'Leary); Long Ridge Medical Center, Neurology, Greenwich Hospital, Stamford, Connecticut (Ms Brugger); Rocky Mountain MS Clinic, Salt Lake City, Utah (Mr Wallentine); The Regional MS Center & The Center for Neurological Disorders, Milwaukee, Wisconsin (Ms Sershon); University of Alabama at Birmingham, Birmingham, Alabama (Ms Goff); Biogen, Cambridge, Massachusetts (Mss Saldana-King and Beavin; Drs Avila and Rutledge); Novant MS Care Center, Charlotte, North Carolina (Ms Moore)
- Shirley O'Leary, MS, APN-C, MSCN, has practiced as a provider, subinvestigator/researcher, and neurology infusion manager for 7 years at the MS Center of Excellence at the Dallas VA Medical Center. She has 27 years of experience in the area of multiple sclerosis (MS) and has authored articles, given numerous invited talks, and is a longstanding member of the International Organization of MS Nurses
- Helen T. Brugger, DNP, MSN, RN, Coordinator of Long Ridge Infusion Center at Long Ridge Medical Center, Greenwich Hospital, has worked on 2 intravenous teams and currently treats a population of neurological patients at an outpatient infusion center. She is a member of the Eastern Nursing Research Society and Sigma Theta Tau International
- Dale Wallentine, BSN, RN, MSCN, is an infusion nurse and the infusion department operation manager at the Rocky Mountain Multiple Sclerosis Clinic in Salt Lake City. He has more than 13 years of multiple sclerosis infusion experience and is certified in multiple sclerosis nursing
- Lisa Sershon, PA-C, MMS, MSCS,* practiced for 11 years as a physician's assistant specializing in neuroimmunology, at the Center for Neurological Disorders at Ascension St. Francis in Milwaukee, Wisconsin. She participated in the management and protocol development for infusion therapies as a multiple sclerosis–certified specialist
- Erica Goff, PharmD, BCPS, MSCS, is a specialty pharmacist covering the multiple sclerosis population at the outpatient neurology division at University of Alabama at Birmingham Health System. Her professional responsibilities include clinical guidance, oversight, and patient education for pharmacotherapy prescribed in her ambulatory clinic, as well as facilitating access to medication, providing side-effect mitigation strategies and reductions in patient financial burden
- Toni Saldana-King, RN, BSN, MSCN, was a senior medical science liaison at Biogen at the time of submission. Prior to Biogen, she was a practicing nurse at the Maxine Mesinger MS Comprehensive Care Center at Baylor College of Medicine in Houston, Texas, the first Comprehensive Care Center to be recognized by the National MS Society
- Jill Beavin, BSN, RN, MSCN, is a principle medical science liaison at Biogen. Prior to Biogen, she worked as an MS nurse and clinical director in a private neurology practice, where she developed and maintained a 22-chair infusion suite and MS Center
- Robin L. Avila, PhD, is a medical director at Biogen and has been involved in MS clinical research for the last 6 years. Prior to Biogen, she conducted preclinical MS research in the areas of myelin biology, myelin repair, and the development of novel models of MS
- Danette Rutledge, BSP, PhD, is an associate medical director at Biogen, where she has been involved in MS clinical research for the last 3 years. Prior to joining industry, she conducted basic science research in multiple sclerosis for over 10 years
- Marie Moore, FNP-C, MSCN, President of the International Organization of Multiple Sclerosis Nurses, is a nurse practitioner at the Novant Health Multiple Sclerosis Care center in Charlotte, North Carolina, where she participates in research and oversight of the infusion center. She has specialized in the care of multiple sclerosis patients since 2011
| | - Marie Moore
- Dallas VA Medical Center MS Center, Dallas, Texas (Ms O'Leary); Long Ridge Medical Center, Neurology, Greenwich Hospital, Stamford, Connecticut (Ms Brugger); Rocky Mountain MS Clinic, Salt Lake City, Utah (Mr Wallentine); The Regional MS Center & The Center for Neurological Disorders, Milwaukee, Wisconsin (Ms Sershon); University of Alabama at Birmingham, Birmingham, Alabama (Ms Goff); Biogen, Cambridge, Massachusetts (Mss Saldana-King and Beavin; Drs Avila and Rutledge); Novant MS Care Center, Charlotte, North Carolina (Ms Moore)
- Shirley O'Leary, MS, APN-C, MSCN, has practiced as a provider, subinvestigator/researcher, and neurology infusion manager for 7 years at the MS Center of Excellence at the Dallas VA Medical Center. She has 27 years of experience in the area of multiple sclerosis (MS) and has authored articles, given numerous invited talks, and is a longstanding member of the International Organization of MS Nurses
- Helen T. Brugger, DNP, MSN, RN, Coordinator of Long Ridge Infusion Center at Long Ridge Medical Center, Greenwich Hospital, has worked on 2 intravenous teams and currently treats a population of neurological patients at an outpatient infusion center. She is a member of the Eastern Nursing Research Society and Sigma Theta Tau International
- Dale Wallentine, BSN, RN, MSCN, is an infusion nurse and the infusion department operation manager at the Rocky Mountain Multiple Sclerosis Clinic in Salt Lake City. He has more than 13 years of multiple sclerosis infusion experience and is certified in multiple sclerosis nursing
- Lisa Sershon, PA-C, MMS, MSCS,* practiced for 11 years as a physician's assistant specializing in neuroimmunology, at the Center for Neurological Disorders at Ascension St. Francis in Milwaukee, Wisconsin. She participated in the management and protocol development for infusion therapies as a multiple sclerosis–certified specialist
- Erica Goff, PharmD, BCPS, MSCS, is a specialty pharmacist covering the multiple sclerosis population at the outpatient neurology division at University of Alabama at Birmingham Health System. Her professional responsibilities include clinical guidance, oversight, and patient education for pharmacotherapy prescribed in her ambulatory clinic, as well as facilitating access to medication, providing side-effect mitigation strategies and reductions in patient financial burden
- Toni Saldana-King, RN, BSN, MSCN, was a senior medical science liaison at Biogen at the time of submission. Prior to Biogen, she was a practicing nurse at the Maxine Mesinger MS Comprehensive Care Center at Baylor College of Medicine in Houston, Texas, the first Comprehensive Care Center to be recognized by the National MS Society
- Jill Beavin, BSN, RN, MSCN, is a principle medical science liaison at Biogen. Prior to Biogen, she worked as an MS nurse and clinical director in a private neurology practice, where she developed and maintained a 22-chair infusion suite and MS Center
- Robin L. Avila, PhD, is a medical director at Biogen and has been involved in MS clinical research for the last 6 years. Prior to Biogen, she conducted preclinical MS research in the areas of myelin biology, myelin repair, and the development of novel models of MS
- Danette Rutledge, BSP, PhD, is an associate medical director at Biogen, where she has been involved in MS clinical research for the last 3 years. Prior to joining industry, she conducted basic science research in multiple sclerosis for over 10 years
- Marie Moore, FNP-C, MSCN, President of the International Organization of Multiple Sclerosis Nurses, is a nurse practitioner at the Novant Health Multiple Sclerosis Care center in Charlotte, North Carolina, where she participates in research and oversight of the infusion center. She has specialized in the care of multiple sclerosis patients since 2011
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18
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Rocchi A, Sariyer IK, Berger JR. Revisiting JC virus and progressive multifocal leukoencephalopathy. J Neurovirol 2023; 29:524-537. [PMID: 37659983 DOI: 10.1007/s13365-023-01164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 09/04/2023]
Abstract
Since its definition 65 years ago, progressive multifocal leukoencephalopathy (PML) has continued to devastate a growing population of immunosuppressed patients despite major advances in our understanding of the causative JC virus (JCV). Unless contained by the immune system, JCV lyses host oligodendrocytes collateral to its life cycle, leading to demyelination, neurodegeneration, and death. Novel treatments have stagnated in the absence of an animal model while current antiviral agents fail to address the now ubiquitous polyomavirus. In this review, we highlight the established pathogenesis by which JCV infection progresses to PML, highlighting major challenges that must be overcome to eliminate the underlying virus and, therefore, the debilitating disease.
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Affiliation(s)
- Angela Rocchi
- Department of Microbiology, Immunology and Inflammation, Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, 19140, USA
| | - Ilker K Sariyer
- Department of Microbiology, Immunology and Inflammation, Center for Neurovirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, PA, 19140, USA.
| | - Joseph R Berger
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3400 Convention Avenue, Philadelphia, PA, 19104, USA.
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19
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Lafontaine JC, Boucher J, Giovannelli J, Petit J, Outteryck O, Balagny S, Zéphir H. Evaluation of risk management in a natalizumab home infusion procedure. Rev Neurol (Paris) 2023; 179:894-901. [PMID: 37202259 PMCID: PMC10186396 DOI: 10.1016/j.neurol.2023.01.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/21/2023] [Accepted: 01/26/2023] [Indexed: 05/20/2023]
Abstract
Natalizumab is a well-established disease-modifying therapy used in active multiple sclerosis (MS). The most serious adverse event is progressive multifocal leukoencephalopathy. For safety reasons, hospital implementation is mandatory. The SARS-CoV-2 pandemic has deeply affected hospital practices leading French authorities to temporarily authorize to administer the treatment at home. The safety of natalizumab home administration should be assessed to allow ongoing home infusion. The aim of the study is to describe the procedure and assess the safety in a home infusion natalizumab model. Patients presenting relapsing-remitting MS treated by natalizumab for over two years, non-exposed to John Cunningham Virus (JCV) and living in the Lille area (France) were included from July 2020 to February 2021 to receive natalizumab infusion at home every four weeks for 12 months. Teleconsultation occurrence, infusion occurrence, infusion cancelling, JCV risk management, annual MRI completion were analyzed. The number of teleconsultations allowing infusion was 365 (37 patients included in the analysis), all home infusions were preceded by a teleconsultation. Nine patients did not complete the one-year home infusion follow-up. Two teleconsultations canceled infusions. Two teleconsultations led to a hospital visit to assess a potential relapse. No severe adverse event was reported. All 28 patients who have completed the follow-up benefited from biannual hospital examination and JCV serologies and annual MRI. Our results suggested that the established home natalizumab procedure was safe using the university hospital home-care department. However, the procedure should be evaluated using home-based services outside the university hospital.
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Affiliation(s)
- J-C Lafontaine
- Université de Lille, Lille, France; Department of neurology, CHU de Lille, Lille, France
| | - J Boucher
- Department of neurology, CHU de Lille, Lille, France
| | - J Giovannelli
- GIOVANNELLI Epidemiology and clinical research counselling, Lille, France
| | - J Petit
- Department of neurology, CHU de Lille, Lille, France
| | - O Outteryck
- Department of neuroradiology, CHU de Lille, Inserm U1171 Lille, Lille, France
| | - S Balagny
- Home care department CHU de Lille, Lille, France
| | - H Zéphir
- Université de Lille, Lille, France; Department of neurology, CHU de Lille, Lille, France; Inserm U1172, Lille, France.
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20
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Webb EJD, Meads D, Eskytė I, Ford HL, Bekker HL, Chataway J, Pepper G, Marti J, Okan Y, Pavitt SH, Schmierer K, Manzano A. Decision Making About Disease-Modifying Treatments for Relapsing-Remitting Multiple Sclerosis: Stated Preferences and Real-World Choices. THE PATIENT 2023; 16:457-471. [PMID: 37072663 DOI: 10.1007/s40271-023-00622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND People with relapsing-remitting multiple sclerosis can benefit from disease-modifying treatments (DMTs). Several DMTs are available that vary in their efficacy, side-effect profile and mode of administration. OBJECTIVE We aimed to measure the preferences of people with relapsing-remitting multiple sclerosis for DMTs using a discrete choice experiment and to assess which stated preference attributes correlate with the attributes of the DMTs they take in the real world. METHODS Discrete choice experiment attributes were developed from literature reviews, interviews and focus groups. In a discrete choice experiment, participants were shown two hypothetical DMTs, then chose whether they preferred one of the DMTs or no treatment. A mixed logit model was estimated from responses and individual-level estimates of participants' preferences conditional on their discrete choice experiment choices calculated. Logit models were estimated with stated preferences predicting current real-world on-treatment status, DMT mode of administration and current DMT. RESULTS A stated intrinsic preference for taking a DMT was correlated with currently taking a DMT, and stated preferences for mode of administration were correlated with the modes of administration of the DMTs participants were currently taking. Stated preferences for treatment effectiveness and adverse effects were not correlated with real-world behaviour. CONCLUSIONS There was variation in which discrete choice experiment attributes correlated with participants' real-world DMT choices. This may indicate patient preferences for treatment efficacy/risk are not adequately taken account of in prescribing. Treatment guidelines must ensure they take into consideration patients' preferences and improve communication around treatment efficacy/risk.
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Affiliation(s)
- Edward J D Webb
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ieva Eskytė
- School of Law, University of Leeds, Leeds, UK
| | | | - Hilary L Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- The Research Centre for Patient Involvement, Central Denmark Region, Aarhus, Denmark
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK
- Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | | | - Joachim Marti
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yasmina Okan
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
- Department of Communication, Pompeu Fabra University, Barcelona, Spain
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Klaus Schmierer
- Blizard Institute (Neuroscience) Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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21
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Vasileiou ES, Fitzgerald KC. Multiple Sclerosis Pathogenesis and Updates in Targeted Therapeutic Approaches. Curr Allergy Asthma Rep 2023; 23:481-496. [PMID: 37402064 DOI: 10.1007/s11882-023-01102-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE OF REVIEW In this review, we provide a comprehensive update on current scientific advances and emerging therapeutic approaches in the field of multiple sclerosis. RECENT FINDINGS Multiple sclerosis (MS) is a common disorder characterized by inflammation and degeneration within the central nervous system (CNS). MS is the leading cause of non-traumatic disability in the young adult population. Through ongoing research, an improved understanding of the disease underlying mechanisms and contributing factors has been achieved. As a result, therapeutic advancements and interventions have been developed specifically targeting the inflammatory components that influence disease outcome. Recently, a new type of immunomodulatory treatment, known as Bruton tyrosine kinase (BTK) inhibitors, has surfaced as a promising tool to combat disease outcomes. Additionally, there is a renewed interested in Epstein-Barr virus (EBV) as a major potentiator of MS. Current research efforts are focused on addressing the gaps in our understanding of the pathogenesis of MS, particularly with respect to non-inflammatory drivers. Significant and compelling evidence suggests that the pathogenesis of MS is complex and requires a comprehensive, multilevel intervention strategy. This review aims to provide an overview of MS pathophysiology and highlights the most recent advances in disease-modifying therapies and other therapeutic interventions.
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Affiliation(s)
- Eleni S Vasileiou
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
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22
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Saida T, Hao Q, Kanda M, Tani Y. Long-term effects of natalizumab on MRI activity and clinical outcomes in Japanese patients with relapsing-remitting multiple sclerosis. BMC Neurol 2023; 23:311. [PMID: 37644415 PMCID: PMC10463665 DOI: 10.1186/s12883-023-03297-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Relapsing-remitting multiple sclerosis (RRMS) is the most common phenotype of multiple sclerosis (MS), and its active stage is characterized by active T2 lesions with or without gadolinium (Gd) enhancement on magnetic resonance imaging (MRI). Natalizumab is indicated as monotherapy in adults with active RRMS in Japan. The main objective of this study was to investigate the long-term effect of natalizumab on disease progression in Japanese patients with RRMS using MRI data. METHODS This retrospective, chart review study was conducted at a single center in Japan. The main study outcome was the yearly proportion of patients with active T2-weighted image lesions detected with or without Gd enhancement on brain MRI (incidence rate) after treatment initiation for up to 5 years. Additional endpoints included annual relapse rate (ARR) and expanded disability status scale (EDSS) score. RESULTS This study included data from 85 patients with RRMS who had received natalizumab for ≥ 1 year; of these, 65 (76.5%) were female and the mean ± standard deviation (SD) age at baseline was 37.5 ± 10.0 years. The incidence rate of active T2 lesions was 52.9% (45/85) in the year prior to natalizumab treatment (Year - 1), which decreased to 2.4% and 1.6% in Year 0.5-1.5 and Year 1.5-2.5, respectively. No active T2 lesions were detected in Year 2.5-5.5 in patients who continued natalizumab treatment. EDSS score was stable, improved, and worsened in 61.8%, 26.3%, and 11.8% of patients, respectively. The median (range) EDSS score was 2.0 (0.0-7.0) at baseline (n = 85) and remained within a similar range (median score between 1.0 and 2.25 during Years 1-5). ARR decreased from 1.12 relapses per year at baseline to 0.12 relapses per year during Year 1 and remained below 0.15 relapses per year up to Year 5. CONCLUSION The results of this first long-term study evaluating the effect of natalizumab on MRI activity and clinical outcomes in Japanese patients with RRMS suggest that natalizumab markedly reduced disease activity and maintained effectiveness over several years.
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Affiliation(s)
- Takahiko Saida
- Kansai Multiple Sclerosis Centre, Irino Clinic Inc, TCA Building 4F, 2-3-19 Motomachi, Naniwa-ku, Osaka-shi, Osaka, Japan.
- Kansai Multiple Sclerosis Centre, Kyoto Neurology Clinic, Ukyo-ku, Uzumasa-Yurigamoto-cho 8-32, Kyoto, 616-8144, Japan.
| | - Qi Hao
- Kansai Multiple Sclerosis Centre, Irino Clinic Inc, TCA Building 4F, 2-3-19 Motomachi, Naniwa-ku, Osaka-shi, Osaka, Japan
| | - Michihiro Kanda
- Biogen Japan Ltd, Nihonbashi 1-chome Mitsui Building 14F 1-4-1, Nihonbashi, Chuo-ku, Tokyo, Japan
| | - Yumiko Tani
- Biogen Japan Ltd, Nihonbashi 1-chome Mitsui Building 14F 1-4-1, Nihonbashi, Chuo-ku, Tokyo, Japan
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Zhu C, Kalincik T, Horakova D, Zhou Z, Buzzard K, Skibina O, Alroughani R, Izquierdo G, Eichau S, Kuhle J, Patti F, Grand’Maison F, Hodgkinson S, Grammond P, Lechner-Scott J, Butler E, Prat A, Girard M, Duquette P, Macdonell RAL, Weinstock-Guttman B, Ozakbas S, Slee M, Sa MJ, Van Pesch V, Barnett M, Van Wijmeersch B, Gerlach O, Prevost J, Terzi M, Boz C, Laureys G, Van Hijfte L, Kermode AG, Garber J, Yamout B, Khoury SJ, Merlo D, Monif M, Jokubaitis V, van der Walt A, Butzkueven H. Comparison Between Dimethyl Fumarate, Fingolimod, and Ocrelizumab After Natalizumab Cessation. JAMA Neurol 2023; 80:739-748. [PMID: 37273217 PMCID: PMC10242509 DOI: 10.1001/jamaneurol.2023.1542] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/27/2023] [Indexed: 06/06/2023]
Abstract
Importance Natalizumab cessation is associated with a risk of rebound disease activity. It is important to identify the optimal switch disease-modifying therapy strategy after natalizumab to limit the risk of severe relapses. Objectives To compare the effectiveness and persistence of dimethyl fumarate, fingolimod, and ocrelizumab among patients with relapsing-remitting multiple sclerosis (RRMS) who discontinued natalizumab. Design, Setting, and Participants In this observational cohort study, patient data were collected from the MSBase registry between June 15, 2010, and July 6, 2021. The median follow-up was 2.7 years. This was a multicenter study that included patients with RRMS who had used natalizumab for 6 months or longer and then were switched to dimethyl fumarate, fingolimod, or ocrelizumab within 3 months after natalizumab discontinuation. Patients without baseline data were excluded from the analysis. Data were analyzed from May 24, 2022, to January 9, 2023. Exposures Dimethyl fumarate, fingolimod, and ocrelizumab. Main Outcomes and Measures Primary outcomes were annualized relapse rate (ARR) and time to first relapse. Secondary outcomes were confirmed disability accumulation, disability improvement, and subsequent treatment discontinuation, with the comparisons for the first 2 limited to fingolimod and ocrelizumab due to the small number of patients taking dimethyl fumarate. The associations were analyzed after balancing covariates using an inverse probability of treatment weighting method. Results Among 66 840 patients with RRMS, 1744 had used natalizumab for 6 months or longer and were switched to dimethyl fumarate, fingolimod, or ocrelizumab within 3 months of natalizumab discontinuation. After excluding 358 patients without baseline data, a total of 1386 patients (mean [SD] age, 41.3 [10.6] years; 990 female [71%]) switched to dimethyl fumarate (138 [9.9%]), fingolimod (823 [59.4%]), or ocrelizumab (425 [30.7%]) after natalizumab. The ARR for each medication was as follows: ocrelizumab, 0.06 (95% CI, 0.04-0.08); fingolimod, 0.26 (95% CI, 0.12-0.48); and dimethyl fumarate, 0.27 (95% CI, 0.12-0.56). The ARR ratio of fingolimod to ocrelizumab was 4.33 (95% CI, 3.12-6.01) and of dimethyl fumarate to ocrelizumab was 4.50 (95% CI, 2.89-7.03). Compared with ocrelizumab, the hazard ratio (HR) of time to first relapse was 4.02 (95% CI, 2.83-5.70) for fingolimod and 3.70 (95% CI, 2.35-5.84) for dimethyl fumarate. The HR of treatment discontinuation was 2.57 (95% CI, 1.74-3.80) for fingolimod and 4.26 (95% CI, 2.65-6.84) for dimethyl fumarate. Fingolimod use was associated with a 49% higher risk for disability accumulation compared with ocrelizumab. There was no significant difference in disability improvement rates between fingolimod and ocrelizumab. Conclusion and Relevance Study results show that among patients with RRMS who switched from natalizumab to dimethyl fumarate, fingolimod, or ocrelizumab, ocrelizumab use was associated with the lowest ARR and discontinuation rates, and the longest time to first relapse.
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Affiliation(s)
- Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tomas Kalincik
- Clinical Outcomes Research Unit (CORe), Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Dana Horakova
- Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Zhen Zhou
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Katherine Buzzard
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Olga Skibina
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | | | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Jens Kuhle
- University Hospital and University of Basel, Basel, Switzerland
| | - Francesco Patti
- Multiple Sclerosis Center, University of Catania, Catania, Italy
| | | | | | | | | | - Ernest Butler
- Monash Medical Centre, Melbourne, Victoria, Australia
| | - Alexandre Prat
- CHUM MS Center and Université de Montréal, Montréal, Québec, Canada
| | - Marc Girard
- CHUM MS Center and Université de Montréal, Montréal, Québec, Canada
| | - Pierre Duquette
- CHUM MS Center and Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Mark Slee
- Flinders University, Adelaide, South Australia, Australia
| | - Maria Jose Sa
- Centro Hospitalar Universitario de São João, Porto, Portugal
| | | | | | - Bart Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium
| | - Oliver Gerlach
- Zuyderland Medical Center, Sittard-Geleen, the Netherlands
| | | | | | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | | | - Allan G. Kermode
- University of Western Australia, Nedlands, Western Australia, Australia
| | - Justin Garber
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Bassem Yamout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J. Khoury
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Daniel Merlo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
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Costa GD, Comi G. A safety review of current monoclonal antibodies used to treat multiple sclerosis. Expert Opin Drug Saf 2023; 22:1011-1024. [PMID: 37314699 DOI: 10.1080/14740338.2023.2224556] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system. Monoclonal antibodies (mAbs) have shown efficacy in reducing MS relapse rates, disease progression, and brain lesion activity. AREAS COVERED This article reviews the literature on the use of mAbs for the treatment of MS, including their mechanisms of action, clinical trial data, safety profiles, and long-term outcomes. The review focuses on the three main categories of mAbs used in MS: alemtuzumab, natalizumab, and anti-CD20 drugs. A literature search was conducted using relevant keywords and guidelines and reports from regulatory agencies were reviewed. The search covered studies published from inception to 31 December 202231 December 2022. The article also discusses the potential risks and benefits of these therapies, including their effects on infection rates, malignancies, and vaccination efficacy. EXPERT OPINION Monoclonal antibodies have revolutionized the treatment of MS, but safety concerns must be considered, particularly with regards to infection rates, malignancy risk, and vaccination efficacy. Clinicians must weigh the potential benefits and risks of mAbs on an individual patient basis, taking into account factors such as age, disease severity, and comorbidities. Ongoing monitoring and surveillance are essential to ensure the long-term safety and effectiveness of monoclonal antibody therapies in MS.
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Affiliation(s)
| | - Giancarlo Comi
- Vita-Salute San Raffaele University, Milan, Italy
- Multiple Sclerosis Center, Casa di Cura Igea, Milan, Italy
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Duda-Madej A, Kozłowska J, Baczyńska D, Krzyżek P. Ether Derivatives of Naringenin and Their Oximes as Factors Modulating Bacterial Adhesion. Antibiotics (Basel) 2023; 12:1076. [PMID: 37370395 PMCID: PMC10294875 DOI: 10.3390/antibiotics12061076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
Because of the close connection between adhesion and many vital cellular functions, the search for new compounds modulating the adhesion of bacteria belonging to the intestinal microbiota is a great challenge and a clinical need. Based on our previous studies, we discovered that O-lkyl naringenin derivatives and their oximes exhibit antimicrobial activity against antibiotic-resistant pathogens. The current study was aimed at determining the modulatory effect of these compounds on the adhesion of selected representatives of the intestinal microbiota: Escherichia coli, a commensal representative of the intestinal microbiota, and Enterococcus faecalis, a bacterium that naturally colonizes the intestines but has disease-promoting potential. To better reflect the variety of real-life scenarios, we performed these studies using two different intestinal cell lines: the physiologically functioning ("healthy") 3T3-L1 cell line and the disease-mimicking, cancerous HT-29 line. The study was performed in vitro under static and microfluidic conditions generated by the Bioflux system. We detected the modulatory effect of the tested O-alkyl naringenin derivatives on bacterial adhesion, which was dependent on the cell line studied and was more significant for E. coli than for E. faecalis. In addition, it was noticed that this activity was affected by the concentration of the tested compound and its structure (length of the carbon chain). In summary, O-alkyl naringenin derivatives and their oximes possess a promising modulatory effect on the adhesion of selected representatives of the intestinal microbiota.
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Affiliation(s)
- Anna Duda-Madej
- Department of Microbiology, Faculty of Medicine, Wroclaw Medical University, Chałubińskiego 4, 50-368 Wrocław, Poland
| | - Joanna Kozłowska
- Department of Food Chemistry and Biocatalysis, Faculty of Biotechnology and Food Science, Wrocław University of Environmental and Life Sciences, C.K. Norwida 25, 50-375 Wrocław, Poland;
| | - Dagmara Baczyńska
- Department of Molecular and Cellular Biology, Faculty of Pharmacy, Wroclaw Medical University, Borowska 211A, 50-556 Wrocław, Poland;
| | - Paweł Krzyżek
- Department of Microbiology, Faculty of Medicine, Wroclaw Medical University, Chałubińskiego 4, 50-368 Wrocław, Poland
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Soldati S, Bär A, Vladymyrov M, Glavin D, McGrath JL, Gosselet F, Nishihara H, Goelz S, Engelhardt B. High levels of endothelial ICAM-1 prohibit natalizumab mediated abrogation of CD4 + T cell arrest on the inflamed BBB under flow in vitro. J Neuroinflammation 2023; 20:123. [PMID: 37221552 DOI: 10.1186/s12974-023-02797-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/02/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION The humanized anti-α4 integrin blocking antibody natalizumab (NTZ) is an effective treatment for relapsing-remitting multiple sclerosis (RRMS) that is associated with the risk of progressive multifocal leukoencephalopathy (PML). While extended interval dosing (EID) of NTZ reduces the risk for PML, the minimal dose of NTZ required to maintain its therapeutic efficacy remains unknown. OBJECTIVE Here we aimed to identify the minimal NTZ concentration required to inhibit the arrest of human effector/memory CD4+ T cell subsets or of PBMCs to the blood-brain barrier (BBB) under physiological flow in vitro. RESULTS Making use of three different human in vitro BBB models and in vitro live-cell imaging we observed that NTZ mediated inhibition of α4-integrins failed to abrogate T cell arrest to the inflamed BBB under physiological flow. Complete inhibition of shear resistant T cell arrest required additional inhibition of β2-integrins, which correlated with a strong upregulation of endothelial intercellular adhesion molecule (ICAM)-1 on the respective BBB models investigated. Indeed, NTZ mediated inhibition of shear resistant T cell arrest to combinations of immobilized recombinant vascular cell adhesion molecule (VCAM)-1 and ICAM-1 was abrogated in the presence of tenfold higher molar concentrations of ICAM-1 over VCAM-1. Also, monovalent NTZ was less potent than bivalent NTZ in inhibiting T cell arrest to VCAM-1 under physiological flow. In accordance with our previous observations ICAM-1 but not VCAM-1 mediated T cell crawling against the direction of flow. CONCLUSION Taken together, our in vitro observations show that high levels of endothelial ICAM-1 abrogate NTZ mediated inhibition of T cell interaction with the BBB. EID of NTZ in MS patients may thus require consideration of the inflammatory status of the BBB as high levels of ICAM-1 may provide an alternative molecular cue allowing for pathogenic T cell entry into the CNS in the presence of NTZ.
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Affiliation(s)
- Sasha Soldati
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland
| | - Alexander Bär
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland
| | - Mykhailo Vladymyrov
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland
| | - Dale Glavin
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - James L McGrath
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, USA
| | - Fabien Gosselet
- Blood-Brain Barrier Laboratory, University of Artois, Lens, France
| | - Hideaki Nishihara
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland
- Department of Neurotherapeutics, Yamaguchi University, Yamaguchi, Japan
| | | | - Britta Engelhardt
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland.
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Sabahi Z, Daei Sorkhabi A, Sarkesh A, Naseri A, Asghar-Rezaei N, Talebi M. A systematic review of the safety and efficacy of monoclonal antibodies for progressive multiple sclerosis. Int Immunopharmacol 2023; 120:110266. [PMID: 37209514 DOI: 10.1016/j.intimp.2023.110266] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Progressive multiple sclerosis (PMS) is a debilitating condition characterized by progressively worsening symptoms. Monoclonal antibodies are novel therapies for MS, but their safety and efficacy in the progressive form have not been comprehensively studied. In this systematic review, we aimed to evaluate the available evidence regarding monoclonal antibody treatment for PMS. METHODS After registration of the study protocol in PROSPERO, we systematically searched three major databases for clinical trials involving monoclonal antibodies administration for PMS treatment. All the retrieved results were imported into the EndNote reference manager. After removing the duplicates, two independent researchers did the study selection and data extraction. The risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist. RESULTS Of the 1846 studies in the preliminary search, 13 clinical trials investigating monoclonal antibodies (Ocrelizumab, Natalizumab, Rituximab, and Alemtuzumab) in PMS patients were included. Ocrelizumab was significantly effective in reducing clinical disease progression measures in primary PMS patients. The results for Rituximab were not completely reassuring and only showed significant changes for some endpoints on MRI and clinical measures. Natalizumab decreased the relapse rate and improved MRI features for secondary PMS patients, but not clinical endpoints. The studies on Alemtuzumab treatment revealed conflicting outcomes, with improvements observed in MRI endpoints but clinical worsening in patients. Additionally, among the studied adverse events, upper respiratory infections, urinary tract infections, and nasopharyngitis were frequently reported. CONCLUSION Based on our findings, Ocrelizumab is the most efficient monoclonal antibody for primary PMS, although it is associated with a higher risk of infection. While other monoclonal antibodies did not show significant promise in treating PMS, more research is necessary.
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Affiliation(s)
- Zahra Sabahi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Daei Sorkhabi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aila Sarkesh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazli Asghar-Rezaei
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahnaz Talebi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Alakhras NS, Kaplan MH. Dendritic Cells as a Nexus for the Development of Multiple Sclerosis and Models of Disease. Adv Biol (Weinh) 2023:e2300073. [PMID: 37133870 DOI: 10.1002/adbi.202300073] [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: 02/12/2023] [Revised: 04/13/2023] [Indexed: 05/04/2023]
Abstract
Multiple sclerosis (MS) results from an autoimmune attack on the central nervous system (CNS). Dysregulated immune cells invade the CNS, causing demyelination, neuronal and axonal damage, and subsequent neurological disorders. Although antigen-specific T cells mediate the immunopathology of MS, innate myeloid cells have essential contributions to CNS tissue damage. Dendritic cells (DCs) are professional antigen-presenting cells (APCs) that promote inflammation and modulate adaptive immune responses. This review focuses on DCs as critical components of CNS inflammation. Here, evidence from studies is summarized with animal models of MS and MS patients that support the critical role of DCs in orchestrating CNS inflammation.
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Affiliation(s)
- Nada S Alakhras
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, 635 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Mark H Kaplan
- Department of Microbiology and Immunology, Indiana University School of Medicine, 635 Barnhill Dr, MS420, Indianapolis, IN, 46202, USA
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Hemmer B, Wiendl H, Roth K, Wessels H, Höfler J, Hornuss C, Liedert B, Selmaj K. Efficacy and Safety of Proposed Biosimilar Natalizumab (PB006) in Patients With Relapsing-Remitting Multiple Sclerosis: The Antelope Phase 3 Randomized Clinical Trial. JAMA Neurol 2023; 80:298-307. [PMID: 36689214 PMCID: PMC9871944 DOI: 10.1001/jamaneurol.2022.5007] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/10/2022] [Indexed: 01/24/2023]
Abstract
Importance Proposed biosimilar natalizumab (biosim-NTZ) PB006 is the first biosimilar monoclonal antibody therapy developed for multiple sclerosis (MS) treatment. Objective To evaluate matching efficacy, safety, and immunogenicity between biosim-NTZ and reference natalizumab (ref-NTZ) in patients with relapsing-remitting MS (RRMS). Design, Setting, and Participants The Antelope trial was a phase 3, parallel-group, randomized, active-controlled study, conducted between October 2019 and March 2021, with last patient follow-up visit on August 23, 2021. The study took place in 48 centers in 7 countries. Of 531 patients with RRMS aged 18 to 60 years screened, 266 were excluded before randomization in line with study criteria. Eligible participants had 1 or more documented relapse within the previous year and either 1 or more gadolinium-enhancing T1-weighted or 9 or more T2-weighted brain lesions, Kurtzke Expanded Disability Status Scale score of 0 to 5.0 (inclusive), and John Cunningham virus index of 1.5 or less at screening. One patient withdrew consent before dosing. Interventions Intravenous infusions every 4 weeks of biosim-NTZ, 300 mg, or ref-NTZ, 300 mg (1:1 randomization), from week 0 to week 44 (end-of-study visit: week 48). At week 24, the ref-NTZ group was rerandomized and 30 patients were switched to biosim-NTZ for the remainder of the study. Main Outcomes and Measures The primary end point was the cumulative number of new active lesions on magnetic resonance imaging (new gadolinium-enhancing T1-weighted lesions and new/enlarging T2-weighted lesions without double counting) over 24 weeks. Additional end points included further magnetic resonance imaging parameters, annualized relapse rate, and Kurtzke Expanded Disability Status Scale score. Safety, tolerability, and immunogenicity assessments included adverse events, laboratory evaluations, and positivity for anti-John Cunningham virus antibodies and antinatalizumab antibodies. Results A total of 264 participants (mean [SD] age, 36.7 [9.38] years; 162 [61.4%] female) received treatment with biosim-NTZ (n = 131) or ref-NTZ (n = 133). At week 24, the model-based mean difference in cumulative number of new active lesions between biosim-NTZ and ref-NTZ treatment groups was 0.17 (least square means [SE]: biosim-NTZ, 0.34 [0.34]; ref-NTZ, 0.45 [0.28]; 95% CI, -0.61 to 0.94 within the prespecified margins of ±2.1). No significant differences between treatment groups were observed across secondary efficacy end points, safety, tolerability, or immunogenicity assessments. Conclusions and Relevance Biosim-NTZ matched ref-NTZ in efficacy, safety, and immunogenicity for patients with RRMS in the tested setting. This phase 3 trial supports proposed biosim-NTZ as a biosimilar alternative to ref-NTZ for treating RRMS. Trial Registration ClinicalTrials.gov Identifier: NCT04115488.
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Affiliation(s)
- Bernhard Hemmer
- Department of Neurology, Technical University of Munich, Klinikum rechts der Isar, Munich & Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | | | | | | | | | | | - Krzysztof Selmaj
- Department of Neurology, University of Warmia & Mazury, Olsztyn, and Center of Neurology, Lodz, Poland
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Ma X, Ma R, Zhang M, Qian B, Wang B, Yang W. Recent Progress in Multiple Sclerosis Treatment Using Immune Cells as Targets. Pharmaceutics 2023; 15:pharmaceutics15030728. [PMID: 36986586 PMCID: PMC10057470 DOI: 10.3390/pharmaceutics15030728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune-mediated demyelinating disease of the central nervous system. The main pathological features are inflammatory reaction, demyelination, axonal disintegration, reactive gliosis, etc. The etiology and pathogenesis of the disease have not been clarified. The initial studies believed that T cell-mediated cellular immunity is the key to the pathogenesis of MS. In recent years, more and more evidence has shown that B cells and their mediated humoral immune and innate immune cells (such as microglia, dendritic cells, macrophages, etc.) also play an important role in the pathogenesis of MS. This article mainly reviews the research progress of MS by targeting different immune cells and analyzes the action pathways of drugs. The types and mechanisms of immune cells related to the pathogenesis are introduced in detail, and the mechanisms of drugs targeting different immune cells are discussed in depth. This article aims to clarify the pathogenesis and immunotherapy pathway of MS, hoping to find new targets and strategies for the development of therapeutic drugs for MS.
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Affiliation(s)
- Xiaohong Ma
- Department of Neuroscience, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Rong Ma
- School of Pharmaceutical Sciences, Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases, Zhengzhou University, Zhengzhou 450001, China
| | - Mengzhe Zhang
- School of Pharmaceutical Sciences, Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases, Zhengzhou University, Zhengzhou 450001, China
| | - Baicheng Qian
- Department of Neuroscience, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
| | - Baoliang Wang
- Department of Neuroscience, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
- Correspondence: (B.W.); (W.Y.)
| | - Weijing Yang
- School of Pharmaceutical Sciences, Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases, Zhengzhou University, Zhengzhou 450001, China
- Correspondence: (B.W.); (W.Y.)
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Pelle J, Briant AR, Branger P, Derache N, Arnaud C, Lebrun-Frenay C, Cohen M, Mondot L, De Seze J, Bigaut K, Collongues N, Kremer L, Ricard D, Bompaire F, Ohlmann C, Sallansonnet-Froment M, Ciron J, Biotti D, Pignolet B, Parienti JJ, Defer G. Real-World Effectiveness of Natalizumab Extended Interval Dosing in a French Cohort. Neurol Ther 2023; 12:529-542. [PMID: 36763307 PMCID: PMC10043118 DOI: 10.1007/s40120-023-00440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Natalizumab, a therapy for relapsing-remitting multiple sclerosis (RRMS), is associated with a risk of progressive multifocal leukoencephalopathy (PML). Over the last several years, practitioners have used off-label extended interval dosing (EID) of natalizumab to reduce PML risk, despite the absence of a large-scale efficacy evaluation. METHODS We conducted a retrospective, multicenter cohort study among adults with RRMS receiving stable standard interval dosing (SID), defined as a ≥ 12-month consecutive period of ≥ 11 natalizumab infusions/year in France. We compared the 12-month risk difference of remaining relapse-free (primary endpoint) between patients who switched to EID (≤ 9 natalizumab infusions) and those who remained on SID, with a noninferiority margin of - 11%. We used propensity score methods such as inverse probability treatment weighting (IPTW) and 1:1 propensity score matching (PSM). Secondary endpoints were annualized relapse rate, disease progression, and safety. RESULTS Baseline characteristics were similar between patients receiving EID (n = 147) and SID (n = 156). The proportion of relapse-free patients 12 months postbaseline was 142/147 in the EID (96.6%) and 144/156 in the SID group (92.3%); risk difference (95% CI) 4.3% (- 1.3 to 9.8%); p < 0.001 for non-inferiority. There were no significant differences between relapse rates (0.043 vs. 0.083 per year, respectively; p = 0.14) or Expanded Disability Status Scale mean scores (2.43 vs. 2.72, respectively; p = 0.18); anti-JC virus index values were similar (p = 0.23); and no instances of PML were reported. The comparisons using IPTW (n = 306) and PSM (n = 204) were consistent. CONCLUSION These results support the pertinence of using an EID strategy for RRMS patients treated with natalizumab. CLINICAL TRIALS gov identifier (NCT04580381).
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Affiliation(s)
- Juliette Pelle
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Service de Neurologie, CHU de la Côte de Nacre, 14000, Caen, France
| | - Anais R Briant
- Unité de Biostatistiques et de Recherche Clinique, CHU de Caen-Cote de Nacre, Caen, France
| | - Pierre Branger
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Service de Neurologie, CHU de la Côte de Nacre, 14000, Caen, France
| | - Nathalie Derache
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Service de Neurologie, CHU de la Côte de Nacre, 14000, Caen, France
| | - Charlotte Arnaud
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Service de Neurologie, CHU de la Côte de Nacre, 14000, Caen, France
| | - Christine Lebrun-Frenay
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Unité de Recherche Clinique Côte d'azur (UR2CA), Équipe URRIS, CHU Pasteur 2, Nice, France
| | - Mikael Cohen
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Unité de Recherche Clinique Côte d'azur (UR2CA), Équipe URRIS, CHU Pasteur 2, Nice, France
| | - Lydiane Mondot
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Unité de Recherche Clinique Côte d'azur (UR2CA), Équipe URRIS, CHU Pasteur 2, Nice, France
| | - Jerome De Seze
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Département de Neurologie, CHRU de Strasbourg Hôpital de Hautepierre, Strasbourg, France
| | - Kevin Bigaut
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Département de Neurologie, CHRU de Strasbourg Hôpital de Hautepierre, Strasbourg, France
| | - Nicolas Collongues
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Département de Neurologie, CHRU de Strasbourg Hôpital de Hautepierre, Strasbourg, France
| | - Laurent Kremer
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Département de Neurologie, CHRU de Strasbourg Hôpital de Hautepierre, Strasbourg, France
| | - Damien Ricard
- Département de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Flavie Bompaire
- Département de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Charlotte Ohlmann
- Département de Radiologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Magali Sallansonnet-Froment
- Département de Neurologie, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
| | - Jonathan Ciron
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP)-Département des Neurosciences, CHU Toulouse-Purpan, and Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France
| | - Damien Biotti
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP)-Département des Neurosciences, CHU Toulouse-Purpan, and Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France
| | - Beatrice Pignolet
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP)-Département des Neurosciences, CHU Toulouse-Purpan, and Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University of Toulouse, CNRS, INSERM, UPS, Toulouse, France
| | - Jean-Jacques Parienti
- Unité de Biostatistiques et de Recherche Clinique, CHU de Caen-Cote de Nacre, Caen, France
| | - Gilles Defer
- Centre de Ressources et Compétence Sclérose en Plaques (CRCSEP), Service de Neurologie, CHU de la Côte de Nacre, 14000, Caen, France.
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Angelini G, Bani A, Constantin G, Rossi B. The interplay between T helper cells and brain barriers in the pathogenesis of multiple sclerosis. Front Cell Neurosci 2023; 17:1101379. [PMID: 36874213 PMCID: PMC9975172 DOI: 10.3389/fncel.2023.1101379] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
The blood-brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCSFB) represent two complex structures protecting the central nervous system (CNS) against potentially harmful agents and circulating immune cells. The immunosurveillance of the CNS is governed by immune cells that constantly patrol the BCSFB, whereas during neuroinflammatory disorders, both BBB and BCSFB undergo morphological and functional alterations, promoting leukocyte intravascular adhesion and transmigration from the blood circulation into the CNS. Multiple sclerosis (MS) is the prototype of neuroinflammatory disorders in which peripheral T helper (Th) lymphocytes, particularly Th1 and Th17 cells, infiltrate the CNS and contribute to demyelination and neurodegeneration. Th1 and Th17 cells are considered key players in the pathogenesis of MS and its animal model, experimental autoimmune encephalomyelitis. They can actively interact with CNS borders by complex adhesion mechanisms and secretion of a variety of molecules contributing to barrier dysfunction. In this review, we describe the molecular basis involved in the interactions between Th cells and CNS barriers and discuss the emerging roles of dura mater and arachnoid layer as neuroimmune interfaces contributing to the development of CNS inflammatory diseases.
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Affiliation(s)
- Gabriele Angelini
- Department of Medicine, Section of General Pathology, University of Verona, Verona, Italy
| | - Alessandro Bani
- Department of Medicine, Section of General Pathology, University of Verona, Verona, Italy
| | - Gabriela Constantin
- Department of Medicine, Section of General Pathology, University of Verona, Verona, Italy.,The Center for Biomedical Computing (CBMC), University of Verona, Verona, Italy
| | - Barbara Rossi
- Department of Medicine, Section of General Pathology, University of Verona, Verona, Italy
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Verreycken J, Baeten P, Broux B. Regulatory T cell therapy for multiple sclerosis: Breaching (blood-brain) barriers. Hum Vaccin Immunother 2022; 18:2153534. [PMID: 36576251 PMCID: PMC9891682 DOI: 10.1080/21645515.2022.2153534] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disorder causing demyelination and neurodegeneration in the central nervous system. MS is characterized by disturbed motor performance and cognitive impairment. Current MS treatments delay disease progression and reduce relapse rates with general immunomodulation, yet curative therapies are still lacking. Regulatory T cells (Tregs) are able to suppress autoreactive immune cells, which drive MS pathology. However, Tregs are functionally impaired in people with MS. Interestingly, Tregs were recently reported to also have regenerative capacity. Therefore, experts agree that Treg cell therapy has the potential to ameliorate the disease. However, to perform their local anti-inflammatory and regenerative functions in the brain, they must first migrate across the blood-brain barrier (BBB). This review summarizes the reported results concerning the migration of Tregs across the BBB and the influence of Tregs on migration of other immune subsets. Finally, their therapeutic potential is discussed in the context of MS.
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Affiliation(s)
- Janne Verreycken
- Neuro-Immune Connections and Repair Lab, Department of Immunology and Infection, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium,University MS Center, Campus Diepenbeek, Diepenbeek, Belgium
| | - Paulien Baeten
- Neuro-Immune Connections and Repair Lab, Department of Immunology and Infection, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium,University MS Center, Campus Diepenbeek, Diepenbeek, Belgium
| | - Bieke Broux
- Neuro-Immune Connections and Repair Lab, Department of Immunology and Infection, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium,University MS Center, Campus Diepenbeek, Diepenbeek, Belgium,CONTACT Bieke Broux Neuro-Immune Connections and Repair Lab, Department of Immunology and Infection, Biomedical Research Institute, Hasselt University, Diepenbeek, Martelarenlaan 42, Hasselt 3500, Belgium
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Zhu C, Zhou Z, Roos I, Merlo D, Kalincik T, Ozakbas S, Skibina O, Kuhle J, Hodgkinson S, Boz C, Alroughani R, Lechner-Scott J, Barnett M, Izquierdo G, Prat A, Horakova D, Kubala Havrdova E, Macdonell R, Patti F, Khoury SJ, Slee M, Karabudak R, Onofrj M, Van Pesch V, Prevost J, Monif M, Jokubaitis V, van der Walt A, Butzkueven H. Comparing switch to ocrelizumab, cladribine or natalizumab after fingolimod treatment cessation in multiple sclerosis. J Neurol Neurosurg Psychiatry 2022; 93:1330-1337. [PMID: 36261289 DOI: 10.1136/jnnp-2022-330104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/26/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND To compare the effectiveness and treatment persistence of ocrelizumab, cladribine and natalizumab in patients with relapsing-remitting multiple sclerosis switching from fingolimod. METHODS Using data from MSBase registry, this multicentre cohort study included subjects who had used fingolimod for ≥6 months and then switched to ocrelizumab, cladribine or natalizumab within 3 months after fingolimod discontinuation. We analysed relapse and disability outcomes after balancing covariates using an inverse-probability-treatment-weighting method. Propensity scores for the three treatments were obtained using multinomial-logistic regression. Due to the smaller number of cladribine users, comparisons of disability outcomes were limited to natalizumab and ocrelizumab. RESULTS Overall, 1045 patients switched to ocrelizumab (n=445), cladribine (n=76) or natalizumab (n=524) after fingolimod. The annualised relapse rate (ARR) for ocrelizumab was 0.07, natalizumab 0.11 and cladribine 0.25. Compared with natalizumab, the ARR ratio (95% confidence interval [CI]) was 0.67 (0.47 to 0.96) for ocrelizumab and 2.31 (1.30 to 4.10) for cladribine; the hazard ratio (95% CI) for time to first relapse was 0.57 (0.40 to 0.83) for ocrelizumab and 1.18 (0.47 to 2.93) for cladribine. Ocrelizumab users had an 89% lower discontinuation rate (95% CI, 0.07 to 0.20) than natalizumab, but also a 51% lower probability of confirmed disability improvement (95% CI, 0.32 to 0.73). There was no difference in disability accumulation. CONCLUSION After fingolimod cessation, ocrelizumab and natalizumab were more effective in reducing relapses than cladribine. Due to the low ARRs in all three treatment groups, additional observation time is required to determine if statistical difference in ARRs results in long-term disability differences.
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Affiliation(s)
- Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Izanne Roos
- Clinical Outcomes Research Unit, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Daniel Merlo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tomas Kalincik
- Clinical Outcomes Research Unit, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Olga Skibina
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Suzanne Hodgkinson
- Departments of Nephrology and Neurology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | - Jeannette Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University Newcastle, Newcastle, New South Wales, Australia
| | - Michael Barnett
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Alexandre Prat
- Hôpital Notre Dame, CHUM and Universite de Montreal, Montreal, Québec, Canada
| | - 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
| | - 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
| | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy.,Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Samia Joseph Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mark Slee
- Flinders University, Adelaide, South Australia, Australia
| | - Rana Karabudak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | | | - Julie Prevost
- Centre integre de sante et de services sociaux des Laurentides point de service de Saint-Jerome, Saint-Jerome, Quebec, Canada
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
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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: 5] [Impact Index Per Article: 2.5] [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.
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36
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Qin L, Tang LF, Cheng L, Wang HY. The clinical significance of allergen-specific IgG4 in allergic diseases. Front Immunol 2022; 13:1032909. [PMID: 36389804 PMCID: PMC9648126 DOI: 10.3389/fimmu.2022.1032909] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/20/2022] [Indexed: 09/10/2023] Open
Abstract
IgG4 is a subclass of IgG antibody with a unique molecular feature of (Fragment antigen- binding) Fab-arm exchange, allowing bispecific antigen binding in a mono-valent manner. With low binding affinity to C1q and Fcγreceptors, IgG4 is incapable of forming immune complexes and activating the complement pathway, exhibiting a non-inflammatory feature. IgG4 is produced similarly to IgE and is considered a modified reaction to IgE class-switching response under certain conditions. It could also counteract IgE-activated inflammation. However, the clinical significance of IgG4 in allergic diseases is complex and controversial. Three viewpoints have been suggested to describe the role of IgG4. IgG4 can act as a tolerance-inducer to play a protective role under repeated and rapid incremental dosing of allergen exposure in allergen immunotherapy (AIT), supported by allergies in cat raisers and venom desensitization in beekeepers. Another viewpoint accepted by mainstream specialists and guidelines of Food Allergy and Management in different countries points out that food-specific IgG4 is a bystander in food allergy and should not be used as a diagnostic tool in clinical work. However, eosinophilic esophagitis (EoE) investigation revealed a direct clinical relevance between physiopathology and serum IgG4 in cow milk and wheat. These factors indicate that allergen-specific IgG4 plays a multifaceted role in allergic diseases that is protective or pathogenic depending on different allergens or exposure conditions.
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Affiliation(s)
- Lu Qin
- Department of Pulmonology, the Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lan-Fang Tang
- Department of Pulmonology, the Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Hui-Ying Wang
- Department of Allergy and Clinical Immunology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Perncezky J, Sellner J. Natalizumab extended-interval dosing in multiple sclerosis to mitigate progressive multifocal leukoencephalopathy risk: initial study evidence and real-world experience. J Cent Nerv Syst Dis 2022; 14:11795735221135485. [PMID: 36277271 PMCID: PMC9580073 DOI: 10.1177/11795735221135485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The high efficacy of natalizumab in the treatment of relapsing-remitting multiple sclerosis (MS) is without controversy. Indeed, effective disease control was not only demonstrated in the pivotal trials but has been corroborated impressively in real-world observations. This monoclonal IgG4 antibody blocks the α4β1 integrin-mediated leukocyte-endothelial interaction and thereby inhibits the migration of immune cells to the brain parenchyma. However, treatment with natalizumab carries the risk of progressive multifocal leukoencephalopathy (PML). This potentially lethal side effect is a significant limitation for treatment initiation and long-term therapy. Natalizumab is given intravenously or subcutaneously in the standard dose of 300 mg every 4 weeks, allowing drug concentrations at levels that ensure continuous α4β1 integrin receptor saturation on the surface of immune cells. Extended-interval dosing (EID) is an emerging treatment approach that aims to mitigate the natalizumab-related PML risk by prolonging the standard infusion intervals to 6 weeks or even more. This treatment approach may abrogate the PML risk due to improved immune surveillance within the central nervous system while maintaining clinical efficacy. Moreover, even an individual interval dosing can be envisioned based on the availability of a biomarker that is capable of monitoring both safety and efficacy aspects. This review summarizes the early and encouraging evidence for EID from observational and randomized-controlled trials and discusses current limitations and upcoming challenges for introducing a tailored treatment approach.
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Affiliation(s)
- Julian Perncezky
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria,Johann Sellner, Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Liechtensteinstr 67, Mistelbach 2130, Austria.
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Mathew T, Kamath V, John SK, Netravathi M, Iyer RB, Raghavendra S, Kumar S, Neeharika ML, Gupta S, Murgod U, Shivakumar R, Annadure RK, Ichaporia N, Rohatgi A, Nair SS, Yareeda S, Anand B, Singh P, Renukaradhya U, Arulselvan V, Reddy YM, Surya N, Sarma GRK, Nadig R, Deepalam S, Sharath Kumar GG, Satishchandra P, Singhal BS, Parry G. A real world multi center study on efficacy and safety of natalizumab in Indian patients with multiple sclerosis. Mult Scler Relat Disord 2022; 66:104059. [PMID: 35908446 DOI: 10.1016/j.msard.2022.104059] [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: 06/18/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Natalizumab (NTZ) is increasingly being used in Indian multiple sclerosis (MS) patients. There are no reports on its safety and efficacy, especially with respect to the occurrence of progressive multifocal leukoencephalopathy (PML). OBJECTIVES To describe the patient characteristics, treatment outcomes, and adverse events, especially the occurrence of PML in NTZ-treated patients. METHODS A multicentre ambispective study was conducted across 18 centres, from Jan 2012 to Dec 2021. Patients at and above the age of 18 years treated with NTZ were included. Descriptive and comparative statistics were applied to analyze data. RESULTS During the study period of 9 years, 116 patients were treated with NTZ. Mean age of the cohort was 35.6 ± 9.7 years; 83/116 (71.6%) were females. Relapse rate for the entire cohort in the year before NTZ was 3.1 ± 1.51 while one year after was 0.20±0.57 (p = 0.001; CI 2.45 -3.35). EDSS of the entire cohort in the year before NTZ was 4.5 ± 1.94 and one year after was 3.8 ± 2.7 (p = 0.013; CI 0.16-1.36). At last follow up (38.3 ± 22.78 months) there were no cases of PML identified. CONCLUSIONS Natalizumab is highly effective and safe in Indian MS patients, with no cases of PML identified at last follow up.
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Affiliation(s)
- Thomas Mathew
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India.
| | - Vikram Kamath
- Department of Neurology, Trustwell Hospitals, Chandrika tower 5 JC Road Sudama Nagar, Bengaluru, Karnataka 560002, India
| | - Saji K John
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - M Netravathi
- Department of Neurology, NIMHANS, Hosur Road, Near Banglore Milk Dairy, Hombegowda Nagar, Bengaluru 560029, India
| | - Rajesh B Iyer
- Department of Neurology, Manipal Hospital, Millers Road 71/1 Millers Road Opp to St Annes College, Vasant Nagar, Bengaluru 560052
| | - S Raghavendra
- Department of Neurology, Manipal Hospital, Millers Road 71/1 Millers Road Opp to St Annes College, Vasant Nagar, Bengaluru 560052
| | - Suresh Kumar
- Department of Neurology, Renai Medicity Multi Super Speciality Hospital, Palarivattom Edapally, Road Near Palarivattom Metro Station Palarivattom, Kochi, Kerala 682025, India
| | - M L Neeharika
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta rd, Punjagutta market, Hyderabad, Telengana 500082
| | - Salil Gupta
- Department of Neurology, Command Hospital Air force, Agram post, Bengaluru 560007, India
| | - Uday Murgod
- Department of Neurology, Manipal Hospital, HAL Airport Road, Banglore 560017, India
| | - R Shivakumar
- Department of Neurology, Sakra World Hospital, Devarabeesanahalli Varthur Hobli Opp intel, Outer Ring Road, Marathahalli, Bengaluru 560103, India
| | - Ravi K Annadure
- Department of Neurology, AFC Delhi, Defence Office Complex, Central Vista, KG Marg, New Delhi 110011
| | - Nasli Ichaporia
- Department of Neurology, Sahyadri Super Speciality Hospital Nagar Raod Shastrinagar, Yerawada, Pune, Maharashtra 411006, India
| | - Anshu Rohatgi
- Department of Neurology, Sir Ganga Ram Hospital, Rajinder Nagar New Delhi 110060, India
| | - Sruthi S Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, GWCG, Jai nagar w Rd chalakkuzhi, Thiruvananthapuram, Kerala 695011, India
| | - Sireesha Yareeda
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta rd, Punjagutta market, Hyderabad, Telengana 500082
| | - Bawani Anand
- Department of Neurology, Manipal Hospital, HAL Airport Road, Banglore 560017, India; Department of Neurology, Sakra World Hospital, Devarabeesanahalli Varthur Hobli Opp intel, Outer Ring Road, Marathahalli, Bengaluru 560103, India
| | - Prabhjeet Singh
- Department of Neurology, Dr Prabhjeets Neuro Centre, F-1/338, Kashmir Avenue, Amritsar 143001, India
| | - Umashankar Renukaradhya
- Department of Neurology, Bengaluru Neuro Centre, 10th Cross Margosa road, Malleshwaram, Banglore 560003, India
| | - V Arulselvan
- Department of Neurology, Royal Care Super Speciality Hospital, NO 1/520, L&T Road Neelambur, Coimbatore 641062, India
| | - Y Muralidhar Reddy
- Department of Neurology, Care Hospital, Rd Number 1 Prem Nagar, Banjara Hills, Hyderabad, Telangana 500034, India
| | - Nirmal Surya
- Department of Neurology, Bombay Hospital and Medical Research Centre, 12 Vitthaldas, Thackersey Marg, Near Liberty Cinema, New Marine Lines Mumbai 400020, India
| | - G R K Sarma
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - Raghunandan Nadig
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - Saikanth Deepalam
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - G G Sharath Kumar
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
| | - P Satishchandra
- Department of Neurology, Apollo Speciality Hospital, 14 th Cross 3rd Block Near Madhavan Park, Jaynagar, Bengaluru 560011, India
| | - Bhim Sen Singhal
- Department of Neurology, Bombay Hospital and Medical Research Centre, 12 Vitthaldas, Thackersey Marg, Near Liberty Cinema, New Marine Lines Mumbai 400020, India
| | - Gareth Parry
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka 560034, India
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Matsuoka K, Watanabe M, Ohmori T, Nakajima K, Ishida T, Ishiguro Y, Kanke K, Kobayashi K, Hirai F, Watanabe K, Mizusawa H, Kishida S, Miura Y, Ohta A, Kajioka T, Hibi T. AJM300 (carotegrast methyl), an oral antagonist of α4-integrin, as induction therapy for patients with moderately active ulcerative colitis: a multicentre, randomised, double-blind, placebo-controlled, phase 3 study. Lancet Gastroenterol Hepatol 2022; 7:648-657. [PMID: 35366419 DOI: 10.1016/s2468-1253(22)00022-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Katsuyoshi Matsuoka
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Toho University Sakura Medical Center, Sakura, Japan
| | - Mamoru Watanabe
- Tokyo Medical and Dental University, Advanced Research Institute and Department of Gastroenterology and Hepatology, Tokyo, Japan.
| | - Toshihide Ohmori
- Department of Gastroenterology, Ohmori Toshihide Gastro-intestinal Clinic, Ageo, Japan
| | - Koichi Nakajima
- Department of Gastrointestinal Division, Matsushima Clinic, Yokohama, Japan
| | - Tetsuya Ishida
- Department of IBD and Gastroenterology, Ishida Clinic of IBD and Gastroenterology, Oita, Japan
| | - Yoh Ishiguro
- Department of Gastroenterology and Hematology, National Hospital Organization Hirosaki National Hospital, Hirosaki, Japan
| | - Kazunari Kanke
- Gastrointestinal Division, Kanke Gastrointestinal Clinic, Utsunomiya, Japan
| | - Kiyonori Kobayashi
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kenji Watanabe
- Division of Internal Medicine, Center for Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hidehiro Mizusawa
- Department of Neurology, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Shuji Kishida
- Cranial Nerve Internal Medicine Department, Narita Tomisato Tokushukai Hospital, Tomisato, Japan
| | - Yoshiharu Miura
- Department of Neurology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Akira Ohta
- Clinical Development Department, EA Pharma, Tokyo, Japan
| | | | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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40
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de Stefano N, Barkhof F, Montalban X, Achiron A, Derfuss T, Chan A, Hodgkinson S, Prat A, Leocani L, Schmierer K, Sellebjerg F, Vermersch P, Wiendl H, Keller B, Roy S. Early Reduction of MRI Activity During 6 Months of Treatment With Cladribine Tablets for Highly Active Relapsing Multiple Sclerosis: MAGNIFY-MS. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/4/e1187. [PMID: 35701185 PMCID: PMC9197134 DOI: 10.1212/nxi.0000000000001187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
Background and Objectives The onset of action for high-efficacy immunotherapies in multiple sclerosis (MS) is an important parameter. This study (MAGNIFY-MS) evaluates the onset of action of cladribine tablets by observing changes in combined unique active (CUA) MRI lesion counts during the first 6 months of treatment in patients with highly active relapsing MS. Methods MRI was performed at screening, baseline, and at months 1, 2, 3, and 6 after initiating treatment with cladribine tablets 3.5 mg/kg. CUA lesion counts, defined as the sum of T1 gadolinium-enhancing (Gd+) lesions and new or enlarging active T2 lesions (without T1 Gd+), were compared between postbaseline and the baseline period and standardized to the period length and the number of MRIs performed. Results Included in this analysis were 270 patients who received ≥1 dose of cladribine tablets. After treatment initiation, significant reductions in mean CUA lesion counts were observed from month 1 onward compared with the baseline period (−1.193 between month 1 and month 6, −1.500 between month 2 and month 6, and −1.692 between month 3 and month 6; all p < 0.0001). Mean T1 Gd+ lesion counts were decreased from month 2 onward compared with baseline (−0.857 at month 2, −1.355 at month 3, and −1.449 at month 6; all p < 0.0001), whereas the proportion of patients without any CUA lesions increased from 52.0% between month 1 and month 6 to 80.5% between month 3 and month 6. Discussion Findings suggest an early onset of action for cladribine tablets, with an increasing reduction in active MRI lesions over time. Trial Registration Information NCT03364036; Date registered: December 06, 2017. Classification of Evidence Using frequent MRI assessments of the brain over the first 6 months of the MAGNIFY-MS study (NCT03364036), we aimed to determine the onset of action of cladribine tablets 3.5 mg/kg in adult patients with highly active relapsing MS. This study provides Class IV evidence that, in such patients, treatment with cladribine tablets is associated with an early onset of action with reductions in active MRI lesion counts from month 2 (day 60) onward, with an increasing reduction in such lesions over time.
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Affiliation(s)
- Nicola de Stefano
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany).
| | - Frederik Barkhof
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Xavier Montalban
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Anat Achiron
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Tobias Derfuss
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Andrew Chan
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Suzanne Hodgkinson
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Alexandre Prat
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Letizia Leocani
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Klaus Schmierer
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Finn Sellebjerg
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Patrick Vermersch
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Heinz Wiendl
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Birgit Keller
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
| | - Sanjeev Roy
- From the Department of Medicine (N.S.), Surgery and Neuroscience, University of Siena, Siena, Italy; Department of Radiology (F.B.), VU University Medical Center, Amsterdam, The Netherlands; UCL Institute of Neurology (F.B.), London, UK; Department of Neurology-Neuroimmunology (X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Multiple Sclerosis Center (A.A.), Sheba Academic Medical Center, Ramat Gan, Israel; Department of Neurology (T.D.), University Hospital Basel, Switzerland; Department of Neurology (A.C.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Ingham Institute for Applied Medical Research (S.H.), University of New South Wales Medicine, Sydney, Australia; Department of Neurosciences (A.P.), Université de Montréal, QC, Canada; Experimental Neurophysiology Unit (L.L.), Vita-Salute San Raffaele University, Milan, Italy; The Blizard Institute (K.S.), Centre for Neuroscience, Surgery & Trauma, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK and; Clinical Board Medicine (Neuroscience) (K.S.), The Royal London Hospital, Barts Health NHS Trust, UK; Danish MS Center (F.S.), Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine (F.S.), University of Copenhagen, Denmark; Univ. Lille (P.V.), Inserm U1172 LilNCog, CHU Lille, FHU Precise, France; Department of Neurology (H.W.), Institute of Translational Neurology, University of Münster, Germany; the healthcare business of Merck KGaA (B.K.), Darmstadt, Germany; and Ares Trading S.A. (S.R.), Eysins, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)
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Morrow SA, Clift F, Devonshire V, Lapointe E, Schneider R, Stefanelli M, Vosoughi R. Use of natalizumab in persons with multiple sclerosis: 2022 update. Mult Scler Relat Disord 2022; 65:103995. [DOI: 10.1016/j.msard.2022.103995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/04/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
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Heng AHS, Han CW, Abbott C, McColl SR, Comerford I. Chemokine-Driven Migration of Pro-Inflammatory CD4 + T Cells in CNS Autoimmune Disease. Front Immunol 2022; 13:817473. [PMID: 35250997 PMCID: PMC8889115 DOI: 10.3389/fimmu.2022.817473] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/25/2022] [Indexed: 12/13/2022] Open
Abstract
Pro-inflammatory CD4+ T helper (Th) cells drive the pathogenesis of many autoimmune conditions. Recent advances have modified views of the phenotype of pro-inflammatory Th cells in autoimmunity, extending the breadth of known Th cell subsets that operate as drivers of these responses. Heterogeneity and plasticity within Th1 and Th17 cells, and the discovery of subsets of Th cells dedicated to production of other pro-inflammatory cytokines such as GM-CSF have led to these advances. Here, we review recent progress in this area and focus specifically upon evidence for chemokine receptors that drive recruitment of these various pro-inflammatory Th cell subsets to sites of autoimmune inflammation in the CNS. We discuss expression of specific chemokine receptors by subsets of pro-inflammatory Th cells and highlight which receptors may be tractable targets of therapeutic interventions to limit pathogenic Th cell recruitment in autoimmunity.
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Affiliation(s)
- Aaron H S Heng
- The Chemokine Biology Laboratory, Department of Molecular and Biomedical Science, School of Biological Sciences, Faculty of Science, The University of Adelaide, Adelaide, SA, Australia
| | - Caleb W Han
- The Chemokine Biology Laboratory, Department of Molecular and Biomedical Science, School of Biological Sciences, Faculty of Science, The University of Adelaide, Adelaide, SA, Australia
| | - Caitlin Abbott
- The Chemokine Biology Laboratory, Department of Molecular and Biomedical Science, School of Biological Sciences, Faculty of Science, The University of Adelaide, Adelaide, SA, Australia
| | - Shaun R McColl
- The Chemokine Biology Laboratory, Department of Molecular and Biomedical Science, School of Biological Sciences, Faculty of Science, The University of Adelaide, Adelaide, SA, Australia
| | - Iain Comerford
- The Chemokine Biology Laboratory, Department of Molecular and Biomedical Science, School of Biological Sciences, Faculty of Science, The University of Adelaide, Adelaide, SA, Australia
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Mahadik R, Kiptoo P, Tolbert T, Siahaan TJ. Immune Modulation by Antigenic Peptides and Antigenic Peptide Conjugates for Treatment of Multiple Sclerosis. MEDICAL RESEARCH ARCHIVES 2022; 10:10.18103/mra.v10i5.2804. [PMID: 36381196 PMCID: PMC9648198 DOI: 10.18103/mra.v10i5.2804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The immune system defends our body by fighting infection from pathogens utilizing both the innate and adaptive immune responses. The innate immune response is generated rapidly as the first line of defense. It is followed by the adaptive immune response that selectively targets infected cells. The adaptive immune response is generated more slowly, but selectively, by targeting a wide range of foreign particles (i.e., viruses or bacteria) or molecules that enter the body, known as antigens. Autoimmune diseases are the results of immune system glitches, where the body's adaptive system recognizes self-antigens as foreign. Thus, the host immune system attacks the self-tissues or organs with a high level of inflammation and causes debilitation in patients. Many current treatments for autoimmune diseases (i.e., multiple sclerosis (MS), rheumatoid arthritis (RA)) have been effective but lead to adverse side effects due to general immune system suppression, which makes patients vulnerable to opportunistic infections. To counter these negative effects, many different avenues of antigen specific treatments are being developed to selectively target the autoreactive immune cells for a specific self-antigen or set of self-antigens while not compromising the general immune system. These approaches include soluble antigenic peptides, bifunctional peptide inhibitors (BPI) including IDAC and Fc-BPI, polymer conjugates, and peptide-drug conjugates. Here, various antigen-specific methods of potential treatments, their efficacy, and limitations will be discussed along with the potential mechanisms of action.
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Affiliation(s)
- Rucha Mahadik
- Department of Pharmaceutical Chemistry, School of Pharmacy, The University of Kansas, 2093 Constant Avenue, Lawrence, KS 66047
| | | | - Tom Tolbert
- Department of Pharmaceutical Chemistry, School of Pharmacy, The University of Kansas, 2093 Constant Avenue, Lawrence, KS 66047
| | - Teruna J Siahaan
- Department of Pharmaceutical Chemistry, School of Pharmacy, The University of Kansas, 2093 Constant Avenue, Lawrence, KS 66047
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Mollasalehi N, Francois-Moutal L, Porciani D, Burke DH, Khanna M. Aptamers Targeting Hallmark Proteins of Neurodegeneration. Nucleic Acid Ther 2022; 32:235-250. [PMID: 35452303 DOI: 10.1089/nat.2021.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Neurodegeneration is a progressive deterioration of neural structures leading to cognitive or motor impairment of the affected patient. There is still no effective therapy for any of the most common neurodegenerative diseases (NDs) such as Alzheimer's or Parkinson's disease. Although NDs exhibit distinct clinical characteristics, many are characterized by the accumulation of misfolded proteins or peptide fragments in the brain and/or spinal cord. The presence of similar inclusion bodies in patients with diverse NDs provides a rationale for developing therapies directed at overlapping disease mechanisms. A novel targeting strategy involves the use of aptamers for therapeutic development. Aptamers are short nucleic acid ligands able to recognize molecular targets with high specificity and high affinity. Despite the fact that several academic groups have shown that aptamers have the potential to be used in therapeutic and diagnostic applications, their clinical translation is still limited. In this study, we describe aptamers that have been developed against proteins relevant to NDs, including prion protein and amyloid beta (Aβ), cell surface receptors and other cytoplasmic proteins. This review also describes advances in the application of these aptamers in imaging, protein detection, and protein quantification, and it provides insights about their accelerated clinical use for disease diagnosis and therapy.
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Affiliation(s)
- Niloufar Mollasalehi
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, Arizona, USA.,Center for Innovation in Brain Science, Tucson, Arizona, USA
| | - Liberty Francois-Moutal
- Center for Innovation in Brain Science, Tucson, Arizona, USA.,Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - David Porciani
- Department of Molecular Microbiology & Immunology, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA.,MU Bond Life Sciences Center, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Donald H Burke
- Department of Molecular Microbiology & Immunology, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA.,MU Bond Life Sciences Center, University of Missouri-Columbia, Columbia, Missouri, USA
| | - May Khanna
- Center for Innovation in Brain Science, Tucson, Arizona, USA.,Department of Pharmacology, College of Medicine, University of Arizona, Tucson, Arizona, USA
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Caban M, Omulecki W, Latecka-Krajewska B. Dry eye in Sjögren's syndrome - characteristics and therapy. Eur J Ophthalmol 2022; 32:3174-3184. [PMID: 35354331 DOI: 10.1177/11206721221091375] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Sjögren's syndrome is an autoimmune disease, and its important feature is the lymphocyte infiltration of exocrine glands, including lacrimal glands. It contributes to defects of their activity and causes that one of the main manifestation of Sjögren's syndrome is dry eye. Unfortunately, the discrimination between dry eye related and non-related to Sjögren's syndrome is difficult at the initial stages of diseases. In addition, the available agents for the treatment of Sjögren's syndrome-related dry eye have limited efficacy. AIM The purpose of this study was to describe and emphasize differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye together with the determination of novel therapeutic options for Sjögren's Syndrome-related dry eye. METHOD A review of the relevant papers describing characteristics of Sjögren's Syndrome-related dry eye and its therapy was conducted. This article is based on both pre-clinical and clinical evidences. RESULTS On the basis of our analysis, we indicated differences between Sjögren's Syndrome-related dry eye and non-Sjögren's Syndrome-related dry eye. Moreover, there are some novel markers that could be used in the diagnosis of Sjögren's Syndrome-related dry eye. In addition, expect artificial tear, other agents e.g. hydroxychloroquine can be effective in therapy of disease. CONCLUSIONS Sjögren's Syndrome-related dry eye is a disorder, whose diagnosis may be difficult and mistaken for non-Sjögren's Syndrome-related dry eye. However, Sjögren's Syndrome-related dry eye has some specific features. In addition, the development of newer and safer therapeutic agents for Sjögren's syndrome-related dry eye is needed, and therefore further clinical, randomized studies are necessary.
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Affiliation(s)
- Miłosz Caban
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
| | - Wojciech Omulecki
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
| | - Beata Latecka-Krajewska
- Department of Ophthalmology, Medical University Barlicki Hospital No. 1, 37808Medical University of Lodz, Lodz, Poland
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Wang JP, Li C, Ding WC, Peng G, Xiao GL, Chen R, Cheng Q. Research Progress on the Inflammatory Effects of Long Non-coding RNA in Traumatic Brain Injury. Front Mol Neurosci 2022; 15:835012. [PMID: 35359568 PMCID: PMC8961287 DOI: 10.3389/fnmol.2022.835012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 11/29/2022] Open
Abstract
Globally, traumatic brain injury (TBI) is an acute clinical event and an important cause of death and long-term disability. However, the underlying mechanism of the pathophysiological has not been fully elucidated and the lack of effective treatment a huge burden to individuals, families, and society. Several studies have shown that long non-coding RNAs (lncRNAs) might play a crucial role in TBI; they are abundant in the central nervous system (CNS) and participate in a variety of pathophysiological processes, including oxidative stress, inflammation, apoptosis, blood-brain barrier protection, angiogenesis, and neurogenesis. Some lncRNAs modulate multiple therapeutic targets after TBI, including inflammation, thus, these lncRNAs have tremendous therapeutic potential for TBI, as they are promising biomarkers for TBI diagnosis, treatment, and prognosis prediction. This review discusses the differential expression of different lncRNAs in brain tissue during TBI, which is likely related to the physiological and pathological processes involved in TBI. These findings may provide new targets for further scientific research on the molecular mechanisms of TBI and potential therapeutic interventions.
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Affiliation(s)
- Jian-peng Wang
- Department of Neurosurgery, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Chong Li
- Department of Neurosurgery, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Wen-cong Ding
- Department of Neurosurgery, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Gang Peng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Ge-lei Xiao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Rui Chen
- Department of Neurosurgery, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China
- *Correspondence: Rui Chen,
| | - Quan Cheng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Quan Cheng,
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47
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Song YC, Liu CT, Lee HJ, Yen HR. Cordycepin prevents and ameliorates experimental autoimmune encephalomyelitis by inhibiting leukocyte infiltration and reducing neuroinflammation. Biochem Pharmacol 2022; 197:114918. [DOI: 10.1016/j.bcp.2022.114918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
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48
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Trümpelmann S, Schulte-Mecklenbeck A, Steinberg OV, Wirth T, Fobker M, Lohmann L, Lünemann JD, Wiendl H, Gross CC, Klotz L. Impact of disease-modifying therapies on humoral and cellular immune-responses following SARS-CoV-2 vaccination in MS patients. Clin Transl Sci 2022; 15:1606-1612. [PMID: 35213793 PMCID: PMC9111759 DOI: 10.1111/cts.13256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022] Open
Abstract
The impact of distinct disease‐modifying therapies (DMTs) on severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccination efficacy in patients with multiple sclerosis (MS) is still enigmatic. In this prospective comparative study, we investigated humoral and cellular immune‐responses in patients with MS receiving interferon beta, natalizumab, and ocrelizumab pre‐vaccination and 6 weeks post second SARS‐CoV‐2 vaccination. Healthy individuals and interferon beta‐treated patients generated robust humoral and cellular immune‐responses. Although humoral immune responses were diminished in ocrelizumab‐treated patients, cellular immune‐responses were reduced in natalizumab‐treated patients. Thus, both humoral and cellular immune responses should be closely monitored in patients on DMTs. Whereas patients with a poor cellular immune‐response may benefit from additional vaccination cycles, patients with a diminished humoral immune‐response may benefit from a treatment with SARS‐CoV‐2 antibodies in case of an infection.
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Affiliation(s)
- Susan Trümpelmann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Olga V Steinberg
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Timo Wirth
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Manfred Fobker
- Central Laboratories, University Hospital Münster, Münster, Germany
| | - Lisa Lohmann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Jan D Lünemann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Catharina C Gross
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
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Tur C, Dubessy AL, Otero-Romero S, Amato MP, Derfuss T, Di Pauli F, Iacobaeus E, Mycko M, Abboud H, Achiron A, Bellinvia A, Boyko A, Casanova JL, Clifford D, Dobson R, Farez MF, Filippi M, Fitzgerald KC, Fonderico M, Gouider R, Hacohen Y, Hellwig K, Hemmer B, Kappos L, Ladeira F, Lebrun-Frénay C, Louapre C, Magyari M, Mehling M, Oreja-Guevara C, Pandit L, Papeix C, Piehl F, Portaccio E, Ruiz-Camps I, Selmaj K, Simpson-Yap S, Siva A, Sorensen PS, Sormani MP, Trojano M, Vaknin-Dembinsky A, Vukusic S, Weinshenker B, Wiendl H, Winkelmann A, Zuluaga Rodas MI, Tintoré M, Stankoff B. The risk of infections for multiple sclerosis and neuromyelitis optica spectrum disorder disease-modifying treatments: Eighth European Committee for Treatment and Research in Multiple Sclerosis Focused Workshop Review. April 2021. Mult Scler 2022; 28:1424-1456. [PMID: 35196927 DOI: 10.1177/13524585211069068] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the recent years, the treatment of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) has evolved very rapidly and a large number of disease-modifying treatments (DMTs) are now available. However, most DMTs are associated with adverse events, the most frequent of which being infections. Consideration of all DMT-associated risks facilitates development of risk mitigation strategies. An international focused workshop with expert-led discussions was sponsored by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and was held in April 2021 to review our current knowledge about the risk of infections associated with the use of DMTs for people with MS and NMOSD and corresponding risk mitigation strategies. The workshop addressed DMT-associated infections in specific populations, such as children and pregnant women with MS, or people with MS who have other comorbidities or live in regions with an exceptionally high infection burden. Finally, we reviewed the topic of DMT-associated infectious risks in the context of the current SARS-CoV-2 pandemic. Herein, we summarize available evidence and identify gaps in knowledge which justify further research.
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Affiliation(s)
- Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Anne-Laure Dubessy
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/ Department of Neurology, Saint Antoine Hospital, AP-HP, Paris, France
| | - Susana Otero-Romero
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Tobias Derfuss
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Franziska Di Pauli
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ellen Iacobaeus
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Marcin Mycko
- Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Hesham Abboud
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Cleveland Medical Center, Cleveland, OH, USA
| | - Anat Achiron
- Sheba Medical Center at Tel Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Angelo Bellinvia
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Alexey Boyko
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia/Institute of Clinical Neurology and Department of Neuroimmunology, Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - David Clifford
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK/Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Mauricio F Farez
- Center for Research on Neuroimmunological Diseases, FLENI, Buenos Aires, Argentina
| | - Massimo Filippi
- Neurology Unit, Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Kathryn C Fitzgerald
- Department of Neurology and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Mattia Fonderico
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, Tunis, Tunisia
| | - Yael Hacohen
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Filipa Ladeira
- Neurology Department, Hospital Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Christine Lebrun-Frénay
- CRCSEP Côte d'Azur, CHU de Nice Pasteur 2, UR2CA-URRIS, Université Nice Côte d'Azur, Nice, France
| | - Céline Louapre
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/Sorbonne University, Paris Brain Institute-ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Paris, France
| | - Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Copenhagen, Denmark
| | - Matthias Mehling
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine and Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico San Carlos, Idissc, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Lekha Pandit
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, India
| | - Caroline Papeix
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/Sorbonne University, Paris Brain Institute-ICM, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Paris, France
| | - Fredrik Piehl
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Isabel Ruiz-Camps
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Krzysztof Selmaj
- Collegium Medicum, Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland/Center of Neurology, Lodz, Poland
| | - Steve Simpson-Yap
- Clinical Outcomes Research Unit, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Aksel Siva
- Department of Neurology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Per Soelberg Sorensen
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Adi Vaknin-Dembinsky
- Hadassah-Hebrew University Medical Center, Department of Neurology, The Agnes-Ginges Center for Neurogenetics Jerusalem, Jerusalem, Israel
| | - Sandra Vukusic
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, 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/Université Claude Bernard Lyon 1, Faculté de médecine Lyon Est, Lyon, France
| | | | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Muenster, Münster, Germany
| | | | | | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Bruno Stankoff
- Sorbonne Université, Inserm, CNRS, UMR7225, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France/ Department of Neurology, Saint Antoine Hospital, AP-HP, Paris, France
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50
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Cencioni MT, Genchi A, Brittain G, de Silva TI, Sharrack B, Snowden JA, Alexander T, Greco R, Muraro PA. Immune Reconstitution Following Autologous Hematopoietic Stem Cell Transplantation for Multiple Sclerosis: A Review on Behalf of the EBMT Autoimmune Diseases Working Party. Front Immunol 2022; 12:813957. [PMID: 35178046 PMCID: PMC8846289 DOI: 10.3389/fimmu.2021.813957] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/29/2021] [Indexed: 12/18/2022] Open
Abstract
Multiple sclerosis (MS) is a central nervous system (CNS) disorder, which is mediated by an abnormal immune response coordinated by T and B cells resulting in areas of inflammation, demyelination, and axonal loss. Disease-modifying treatments (DMTs) are available to dampen the inflammatory aggression but are ineffective in many patients. Autologous hematopoietic stem cell transplantation (HSCT) has been used as treatment in patients with a highly active disease, achieving a long-term clinical remission in most. The rationale of the intervention is to eradicate inflammatory autoreactive cells with lympho-ablative regimens and restore immune tolerance. Immunological studies have demonstrated that autologous HSCT induces a renewal of TCR repertoires, resurgence of immune regulatory cells, and depletion of proinflammatory T cell subsets, suggesting a "resetting" of immunological memory. Although our understanding of the clinical and immunological effects of autologous HSCT has progressed, further work is required to characterize the mechanisms that underlie treatment efficacy. Considering that memory B cells are disease-promoting and stem-like T cells are multipotent progenitors involved in self-regeneration of central and effector memory cells, investigating the reconstitution of B cell compartment and stem and effector subsets of immunological memory following autologous HSCT could elucidate those mechanisms. Since all subjects need to be optimally protected from vaccine-preventable diseases (including COVID-19), there is a need to ensure that vaccination in subjects undergoing HSCT is effective and safe. Additionally, the study of vaccination in HSCT-treated subjects as a means of evaluating immune responses could further distinguish broad immunosuppression from immune resetting.
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Affiliation(s)
- Maria Teresa Cencioni
- Division of Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Angela Genchi
- Department of Neurology, Neurology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Gavin Brittain
- South Yorkshire Regional Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals National Health Service (NHS) Foundation Trust, Sheffield, United Kingdom.,Institute for Translational Neuroscience and Sheffield Neuroscience Biomedical Research Centre (BRC), Sheffield, United Kingdom
| | - Thushan I de Silva
- South Yorkshire Regional Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals National Health Service (NHS) Foundation Trust, Sheffield, United Kingdom.,Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Basil Sharrack
- South Yorkshire Regional Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals National Health Service (NHS) Foundation Trust, Sheffield, United Kingdom.,Institute for Translational Neuroscience and Sheffield Neuroscience Biomedical Research Centre (BRC), Sheffield, United Kingdom
| | - John Andrew Snowden
- Department of Haematology, Sheffield Teaching Hospitals National Health Service (NHS) Foundation Trust, Sheffield, United Kingdom.,Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Tobias Alexander
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany.,Deutsches Rheuma-Forschungszentrum, ein Leibniz Institut, Berlin, Germany
| | - Raffaella Greco
- Unit of Haematology and Bone Marrow Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo A Muraro
- Division of Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
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