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Noteboom S, Strijbis EMM, Coerver EME, Colato E, van Kempen ZLE, Jasperse B, Vrenken H, Killestein J, Schoonheim MM, Steenwijk MD. Long-term neuroprotective effects of natalizumab and fingolimod in multiple sclerosis: Evidence from real-world clinical data. Mult Scler Relat Disord 2024; 87:105670. [PMID: 38772150 DOI: 10.1016/j.msard.2024.105670] [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: 11/29/2023] [Revised: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The long-term effect of high efficacy disease modifying therapy (DMT) on neurodegeneration in people with multiple sclerosis (pwMS) is largely unknown. The aim of this study was to evaluate the long-term effect of natalizumab (NTZ) or fingolimod (FTY) therapy on the evolution of brain atrophy compared to moderate efficacy DMT in a real-world clinical setting. METHODS A total of 438 pwMS with 2,439 MRI exams during treatment were analyzed: 252 pwMS treated with moderate efficacy DMT, 130 with NTZ and 56 with FTY. Evolution of brain atrophy was analyzed over an average follow-up of 6.6 years after treatment initiation. Brain segmentation was performed on clinical 3D-FLAIRs using SynthSeg and regional brain volume changes over time were compared between the treatment groups. RESULTS Total brain, white matter and deep gray matter atrophy rates did not differ between moderate efficacy DMTs, NTZ and FTY. Annualized ventricle growth rates were lower in pwMS treated with NTZ (1.1 %/year) compared with moderate efficacy DMT (2.4 %/year, p < 0.001) and similar to FTY (2.0 %/year, p = 0.051). Cortical atrophy rates were lower in NTZ (-0.08 %/year) compared with moderate efficacy DMT (-0.16 %/year, p = 0.048). CONCLUSION In a real-world clinical setting, pwMS treated with NTZ had slower ventricular expansion and cortical atrophy compared to those treated with moderate efficacy DMT.
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Affiliation(s)
- S Noteboom
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, the Netherlands.
| | - E M M Strijbis
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - E M E Coerver
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - E Colato
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing, University college London, UK
| | - Z L E van Kempen
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - B Jasperse
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - H Vrenken
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - J Killestein
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - M M Schoonheim
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
| | - M D Steenwijk
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, the Netherlands
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Cooze B, Neal J, Vineed A, Oliveira JC, Griffiths L, Allen KH, Hawkins K, Yadanar H, Gerhards K, Farkas I, Reynolds R, Howell O. Digital Pathology Identifies Associations between Tissue Inflammatory Biomarkers and Multiple Sclerosis Outcomes. Cells 2024; 13:1020. [PMID: 38920650 PMCID: PMC11201856 DOI: 10.3390/cells13121020] [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: 04/15/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a clinically heterogeneous disease underpinned by inflammatory, demyelinating and neurodegenerative processes, the extent of which varies between individuals and over the course of the disease. Recognising the clinicopathological features that most strongly associate with disease outcomes will inform future efforts at patient phenotyping. AIMS We used a digital pathology workflow, involving high-resolution image acquisition of immunostained slides and opensource software for quantification, to investigate the relationship between clinical and neuropathological features in an autopsy cohort of progressive MS. METHODS Sequential sections of frontal, cingulate and occipital cortex, thalamus, brain stem (pons) and cerebellum including dentate nucleus (n = 35 progressive MS, females = 28, males = 7; age died = 53.5 years; range 38-98 years) were immunostained for myelin (anti-MOG), neurons (anti-HuC/D) and microglia/macrophages (anti-HLA). The extent of demyelination, neurodegeneration, the presence of active and/or chronic active lesions and quantification of brain and leptomeningeal inflammation was captured by digital pathology. RESULTS Digital analysis of tissue sections revealed the variable extent of pathology that characterises progressive MS. Microglia/macrophage activation, if found at a higher level in a single block, was typically elevated across all sampled blocks. Compartmentalised (perivascular/leptomeningeal) inflammation was associated with age-related measures of disease severity and an earlier death. CONCLUSION Digital pathology identified prognostically important clinicopathological correlations in MS. This methodology can be used to prioritise the principal pathological processes that need to be captured by future MS biomarkers.
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Affiliation(s)
- Benjamin Cooze
- Faculty of Medicine, Health & Life and Health Sciences, Swansea University, Swansea SA2 8PP, UK; (B.C.); (A.V.); (J.C.O.); (L.G.); (K.H.A.); (K.H.); (H.Y.); (K.G.); (O.H.)
| | - James Neal
- Faculty of Medicine, Health & Life and Health Sciences, Swansea University, Swansea SA2 8PP, UK; (B.C.); (A.V.); (J.C.O.); (L.G.); (K.H.A.); (K.H.); (H.Y.); (K.G.); (O.H.)
| | - Alka Vineed
- Faculty of Medicine, Health & Life and Health Sciences, Swansea University, Swansea SA2 8PP, UK; (B.C.); (A.V.); (J.C.O.); (L.G.); (K.H.A.); (K.H.); (H.Y.); (K.G.); (O.H.)
| | - J. C. Oliveira
- Faculty of Medicine, Health & Life and Health Sciences, Swansea University, Swansea SA2 8PP, UK; (B.C.); (A.V.); (J.C.O.); (L.G.); (K.H.A.); (K.H.); (H.Y.); (K.G.); (O.H.)
| | - Lauren Griffiths
- Faculty of Medicine, Health & Life and Health Sciences, Swansea University, Swansea SA2 8PP, UK; (B.C.); (A.V.); (J.C.O.); (L.G.); (K.H.A.); (K.H.); (H.Y.); (K.G.); (O.H.)
| | - K. H. Allen
- Faculty of Medicine, Health & Life and Health Sciences, Swansea University, Swansea SA2 8PP, UK; (B.C.); (A.V.); (J.C.O.); (L.G.); (K.H.A.); (K.H.); (H.Y.); (K.G.); (O.H.)
| | - Kristen Hawkins
- Faculty of Medicine, Health & Life and Health Sciences, Swansea University, Swansea SA2 8PP, UK; (B.C.); (A.V.); (J.C.O.); (L.G.); (K.H.A.); (K.H.); (H.Y.); (K.G.); (O.H.)
| | - Htoo Yadanar
- Faculty of Medicine, Health & Life and Health Sciences, Swansea University, Swansea SA2 8PP, UK; (B.C.); (A.V.); (J.C.O.); (L.G.); (K.H.A.); (K.H.); (H.Y.); (K.G.); (O.H.)
| | - Krisjanis Gerhards
- Faculty of Medicine, Health & Life and Health Sciences, Swansea University, Swansea SA2 8PP, UK; (B.C.); (A.V.); (J.C.O.); (L.G.); (K.H.A.); (K.H.); (H.Y.); (K.G.); (O.H.)
| | - Ildiko Farkas
- Division of Brain Sciences, Imperial College London, London SW7 2AZ, UK; (I.F.); (R.R.)
| | - Richard Reynolds
- Division of Brain Sciences, Imperial College London, London SW7 2AZ, UK; (I.F.); (R.R.)
| | - Owain Howell
- Faculty of Medicine, Health & Life and Health Sciences, Swansea University, Swansea SA2 8PP, UK; (B.C.); (A.V.); (J.C.O.); (L.G.); (K.H.A.); (K.H.); (H.Y.); (K.G.); (O.H.)
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Mahler MR, Magyari M, Pontieri L, Elberling F, Holm RP, Weglewski A, Poulsen MB, Storr LK, Bekyarov PA, Illes Z, Kant M, Sejbaek T, Stilund ML, Rasmussen PV, Brask M, Urbonaviciute I, Sellebjerg F. Prognostic factors for disease activity in newly diagnosed teriflunomide-treated patients with multiple sclerosis: a nationwide Danish study. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-333265. [PMID: 38569873 DOI: 10.1136/jnnp-2023-333265] [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: 12/21/2023] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Clinicians frequently rely on relapse counts, T2 MRI lesion load (T2L) and Expanded Disability Status Scale (EDSS) scores to guide treatment decisions for individuals diagnosed with multiple sclerosis (MS). This study evaluates how these factors, along with age and sex, influence prognosis during treatment with teriflunomide (TFL). METHODS We conducted a nationwide cohort study using data from the Danish Multiple Sclerosis Registry.Eligible participants had relapsing-remitting MS or clinically isolated syndrome and initiated TFL as their first treatment between 2013 and 2019. The effect of age, pretreatment relapses, T2L and EDSS scores on the risk of disease activity on TFL were stratified by sex. RESULTS In total, 784 individuals were included (57.4% females). A high number of pretreatment relapses (≥2) was associated with an increased risk of disease activity in females only (OR and (95% CI): 1.76 (1.11 to 2.81)). Age group 50+ was associated with a lower risk of disease activity in both sexes (OR females=0.28 (0.14 to 0.56); OR males=0.22 (0.09 to 0.55)), while age 35-49 showed a different impact in males and females (OR females=0.79 (0.50 to 1.23); OR males=0.42 (0.24 to 0.72)). EDSS scores and T2L did not show any consistent associations. CONCLUSION A high number of pretreatment relapses was only associated with an increased risk of disease activity in females, while age had a differential impact on the risk of disease activity according to sex. Clinicians may consider age, sex and relapses when deciding on TFL treatment.
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Affiliation(s)
- Mie Reith Mahler
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Luigi Pontieri
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Frederik Elberling
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Rolf Pringler Holm
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Arkadiusz Weglewski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Herlev Hospital, Herlev, Denmark
| | - Mai Bang Poulsen
- Department of Neurology, Nordsjaellands Hospital, Hilleroed, Denmark
| | | | | | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Matthias Kant
- Department of Neurology, Hospital of Southern Jutland Soenderborg Branch, Soenderborg, Denmark
| | - Tobias Sejbaek
- Department of Neurology, Esbjerg Central Hospital, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Morten Leif Stilund
- Department of Neurology, Physiotherapy and Occupational Therapy, Goedstrup Hospital, Herning, Denmark
| | - Peter V Rasmussen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Brask
- Department of Neurology, Viborg Regional Hospital, Viborg, Denmark
| | | | - Finn Sellebjerg
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kondo A, Ikeguchi R, Kitagawa K, Shimizu Y. Disease Activity and Progression of Disability in Multiple Sclerosis Patients Aged Over 50 With or Without Disease-Modifying Drug Treatment: A Retrospective Cohort Study. Cureus 2023; 15:e49927. [PMID: 38058522 PMCID: PMC10697689 DOI: 10.7759/cureus.49927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 12/08/2023] Open
Abstract
Background This study aimed to clarify the need for disease-modifying drug (DMD) treatment in elderly patients with multiple sclerosis (MS) aged 50 years or older. MS is an autoimmune, demyelinating disease of the central nervous system that predominantly affects young women. Various DMDs are effective in preventing relapses and slowing the progression of disability in patients with MS. Although disease activity in MS is believed to decrease with aging, a consensus on the appropriate DMD treatment for elderly patients with MS is lacking. Methodology This study included elderly patients with MS (>50 years old). We compared the occurrence of relapses, worsening of disability, and conversion to secondary progressive MS (SPMS) between patients with DMD treatment and those without. Logistic regression analysis was performed to determine the predictors of these outcomes. Confounding factors were adjusted using propensity scores. Results From January 1991 to October 2022, 76 elderly patients with MS were included. The mean age at the last visit was 57.4 ± 6.3 years, with 51 patients being female. The mean age of onset of MS was 37.1 ± 10.1 years. Fifty-four patients were included in the DMD treatment group. The overall relapse rate was 38% (33% and 48% in the DMD treatment and untreated groups, respectively). No significant differences in relapse rates (p = 0.72) or in the Expanded Disability Status Scale (EDSS) scores were identified between the two groups. Kaplan-Meier curves showed no differences in the time to first relapse within five years between the two groups. Additionally, no significant predictors of relapse were identified. Among 61 patients with relapsing-remitting MS, 25% converted to SPMS during the observation period. Logistic regression analysis showed that older age at the final visit and the presence of brainstem lesions at the age of 50 years were associated with a higher rate of transition to SPMS. Conclusions In the present study, no significant difference was found in the rate of relapse, disability progression, and conversion to SPMS between the DMD treatment and untreated groups in elderly patients with MS. Therefore, in patients without long-term relapse, no poor prognostic functional factors or predictors of conversion to SPMS, discontinuation of DMDs may be considered. In addition, the presence of brainstem lesions at 50 years of age may predict the conversion to SPMS. Thus, the continuation of DMD or conversion to an appropriate DMD should be considered in patients with brainstem lesions at 50 years of age.
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Affiliation(s)
- Akihiro Kondo
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
| | - Ryotaro Ikeguchi
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
| | - Yuko Shimizu
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
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Segal BM. Inverse association between age and inflammatory disease activity in multiple sclerosis. Nat Rev Neurol 2023; 19:577-578. [PMID: 37563265 DOI: 10.1038/s41582-023-00844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Benjamin M Segal
- Department of Neurology, The Ohio State University, Columbus, OH, USA.
- Neuroscience Research Institute, The Ohio State University, Columbus, OH, USA.
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