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Scheible H, Dyroff M, Seithel‐Keuth A, Harrison‐Moench E, Mammasse N, Port A, Bachmann A, Dong J, van Lier JJ, Tracewell W, Mitchell D. Evobrutinib, a covalent Bruton's tyrosine kinase inhibitor: Mass balance, elimination route, and metabolism in healthy participants. Clin Transl Sci 2021; 14:2420-2430. [PMID: 34374206 PMCID: PMC8604242 DOI: 10.1111/cts.13108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/14/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022] Open
Abstract
The highly selective, covalent Bruton's tyrosine kinase inhibitor evobrutinib is under investigation for treatment of patients with multiple sclerosis (MS). Early clinical studies in healthy participants and patients with relapsing MS indicated that evobrutinib is well-tolerated and effective. We undertook a mass balance study in six men who received a single 75-mg oral dose of evobrutinib containing ~ 3.6 MBq (100 μCi) 14 C-evobrutinib, to determine the absorption, metabolic pathways, and routes of excretion of evobrutinib. The primary objectives of this phase I study (NCT03725072) were to (1) determine the rates and routes of total radioactivity excretion, including the mass balance of total drug-related radioactivity in urine and feces, (2) assess the pharmacokinetics (PKs) of total radioactivity in blood and plasma, and (3) characterize the plasma PKs of evobrutinib. Exploratory end points included identifying and quantifying evobrutinib and its metabolites in plasma and excreta (urine and feces) and exploring key biotransformation pathways and clearance mechanisms. Evobrutinib was primarily eliminated in feces (arithmetic mean percentage, SD, 71.0, 2.1) and, to a lesser extent, in urine (20.6, 2.0), with most of the total radioactivity (85.3%) excreted in the first 72 h after administration. No unchanged evobrutinib was detected in excreta. Evobrutinib was rapidly absorbed and substantially metabolized upon absorption. Only one major metabolite M463-2 (MSC2430422) was identified in plasma above the 10% of total drug exposure threshold, which classifies M463-2 (MSC2430422) as a major metabolite according to the US Food and Drug Administration (FDA; metabolites in safety testing [MIST]) and the European Medicines Agency (EMA; International Conference on Harmonization [ICH] M3). These results support further development of evobrutinib and may help inform subsequent investigations.
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Affiliation(s)
| | | | | | | | | | - Andreas Port
- The healthcare business of Merck KGaADarmstadtGermany
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Novotna M, Tvaroh A, Mares J. Clinical Parameters to Predict Future Clinical Disease Activity After Treatment Change to Higher-Dose Subcutaneous Interferon Beta-1a From Other Platform Injectables in Patients With Relapsing-Remitting Multiple Sclerosis. Front Neurol 2020; 11:944. [PMID: 32982947 PMCID: PMC7492204 DOI: 10.3389/fneur.2020.00944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: To identify predictors of clinical disease activity after treatment change to higher-dose interferon beta-1a in relapsing-remitting multiple sclerosis (MS). Methods: This was a retrospective-prospective observational multicenter study. We enrolled patients with at least one relapse on platform injectable therapy who were changed to 44 μg interferon beta-1a. Our primary endpoint was the clinical disease activity-free (cDAF) status at 6, 12, 18, and 24 months. Secondary endponts included relapse-free status and disability progression-free status at different timepoints. The primary predictor of interest was the monosymptomatic vs. polysymptomatic index relapse, based on the number of affected functional systems from the Kurtzke scale during the last relapse prior to baseline. Other secondary predictors of clinical disease activity were analyzed based on different demographic and relapse characteristics. Kaplan-Meier estimates of the cumulative probability of remaining in cDAF status were performed. The time to clinical disease activity was compared between groups using univariate Kaplan-Meier analysis and multivariate Cox regression. Multivariate analyses were processed in the form of CART (Classification & Regression Trees). Results: A total of 300 patients entered the study; 233 (77.7%) of them completed the 24-month study period and 67 patients (22.3%) terminated early. The proportion of patients in cDAF status was 84.7, 69.5, 57.5, and 54.2% at 6, 12, 18, and 24 months. After 2 years of follow-up, 55.9% of patients remained relapse-free and 87.8% of patients remained disability progression-free. At all timepoints, the polysymptomatic index relapse was the most significant predictor of clinical disease activity of all studied variables. Hazard ratio of cDAF status for patients with monosymptomatic vs. polysymptomatic index relapse was 1.94 (95% CI 1.38–2.73). CART analyses also confirmed the polysymptomatic index relapse being the strongest predictor of clinical disease activity, followed by higher number of pre-baseline relapses with the most significant effect in the monosymptomatic index relapse group. The next strongest predictors of clinical disease activity were cerebellar syndrome as the most disabled Kurtzke functional system for the monosymptomatic relapse group, and age at first MS symptom ≥ 45 for the polysymptomatic relapse group. Conclusions: Patients with a polysymptomatic index relapse and/or higher number of relapses within 2 years prior to baseline are at high risk of clinical disease activity, despite treatment change to higher-dose interferon beta-1a from other platform injectable therapy. Trial registration: State Institute of Drug Control (SUKL), URL: http://www.sukl.eu/modules/nps/index.php?h=study&a=detail&id=958&lang=2, registration number 1205090000.
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Affiliation(s)
- Martina Novotna
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital, Charles University, Prague, Czechia
| | - Ales Tvaroh
- Merck spol. s r.o, Prague, Czechia.,Department of Neurology, Krajska zdravotni, a.s.-Nemocnice Teplice, o.z., Teplice, Czechia
| | - Jan Mares
- Department of Neurology, MS Center, Faculty Hospital, Palacky University, Olomouc, Czechia
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Gerber B, Cowling T, Chen G, Yeung M, Duquette P, Haddad P. The impact of treatment adherence on clinical and economic outcomes in multiple sclerosis: Real world evidence from Alberta, Canada. Mult Scler Relat Disord 2017; 18:218-224. [DOI: 10.1016/j.msard.2017.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/29/2017] [Accepted: 10/04/2017] [Indexed: 12/15/2022]
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Kalincik T, Manouchehrinia A, Sobisek L, Jokubaitis V, Spelman T, Horakova D, Havrdova E, Trojano M, Izquierdo G, Lugaresi A, Girard M, Prat A, Duquette P, Grammond P, Sola P, Hupperts R, Grand'Maison F, Pucci E, Boz C, Alroughani R, Van Pesch V, Lechner-Scott J, Terzi M, Bergamaschi R, Iuliano G, Granella F, Spitaleri D, Shaygannejad V, Oreja-Guevara C, Slee M, Ampapa R, Verheul F, McCombe P, Olascoaga J, Amato MP, Vucic S, Hodgkinson S, Ramo-Tello C, Flechter S, Cristiano E, Rozsa C, Moore F, Luis Sanchez-Menoyo J, Laura Saladino M, Barnett M, Hillert J, Butzkueven H. Towards personalized therapy for multiple sclerosis: prediction of individual treatment response. Brain 2017; 140:2426-2443. [PMID: 29050389 DOI: 10.1093/brain/awx185] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/20/2017] [Indexed: 11/14/2022] Open
Abstract
Timely initiation of effective therapy is crucial for preventing disability in multiple sclerosis; however, treatment response varies greatly among patients. Comprehensive predictive models of individual treatment response are lacking. Our aims were: (i) to develop predictive algorithms for individual treatment response using demographic, clinical and paraclinical predictors in patients with multiple sclerosis; and (ii) to evaluate accuracy, and internal and external validity of these algorithms. This study evaluated 27 demographic, clinical and paraclinical predictors of individual response to seven disease-modifying therapies in MSBase, a large global cohort study. Treatment response was analysed separately for disability progression, disability regression, relapse frequency, conversion to secondary progressive disease, change in the cumulative disease burden, and the probability of treatment discontinuation. Multivariable survival and generalized linear models were used, together with the principal component analysis to reduce model dimensionality and prevent overparameterization. Accuracy of the individual prediction was tested and its internal validity was evaluated in a separate, non-overlapping cohort. External validity was evaluated in a geographically distinct cohort, the Swedish Multiple Sclerosis Registry. In the training cohort (n = 8513), the most prominent modifiers of treatment response comprised age, disease duration, disease course, previous relapse activity, disability, predominant relapse phenotype and previous therapy. Importantly, the magnitude and direction of the associations varied among therapies and disease outcomes. Higher probability of disability progression during treatment with injectable therapies was predominantly associated with a greater disability at treatment start and the previous therapy. For fingolimod, natalizumab or mitoxantrone, it was mainly associated with lower pretreatment relapse activity. The probability of disability regression was predominantly associated with pre-baseline disability, therapy and relapse activity. Relapse incidence was associated with pretreatment relapse activity, age and relapsing disease course, with the strength of these associations varying among therapies. Accuracy and internal validity (n = 1196) of the resulting predictive models was high (>80%) for relapse incidence during the first year and for disability outcomes, moderate for relapse incidence in Years 2-4 and for the change in the cumulative disease burden, and low for conversion to secondary progressive disease and treatment discontinuation. External validation showed similar results, demonstrating high external validity for disability and relapse outcomes, moderate external validity for cumulative disease burden and low external validity for conversion to secondary progressive disease and treatment discontinuation. We conclude that demographic, clinical and paraclinical information helps predict individual response to disease-modifying therapies at the time of their commencement.
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Affiliation(s)
- Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, 300 Grattan St, Melbourne, 3050, Australia.,Department of Neurology, Royal Melbourne Hospital, 300 Grattan St, Melbourne, 3050, Australia
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SE-17177, Sweden
| | - Lukas Sobisek
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and Charles University in Prague, Katerinska 30, Prague, 12808, Czech Republic.,Department of Statistics and Probability, University of Economics in Prague, Winston Churchill Sq 1938/4, Prague, 13067, Czech Republic
| | - Vilija Jokubaitis
- Department of Neurology, Royal Melbourne Hospital, 300 Grattan St, Melbourne, 3050, Australia.,Department of Medicine, University of Melbourne, 300 Grattan St, Melbourne, 3050, Australia
| | - Tim Spelman
- Department of Neurology, Royal Melbourne Hospital, 300 Grattan St, Melbourne, 3050, Australia.,Department of Medicine, University of Melbourne, 300 Grattan St, Melbourne, 3050, Australia
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and Charles University in Prague, Katerinska 30, Prague, 12808, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, General University Hospital and Charles University in Prague, Katerinska 30, Prague, 12808, Czech Republic
| | - Maria Trojano
- University of Bari, Via Calefati 53, Bari, 70122, Italy
| | - Guillermo Izquierdo
- Hospital Universitario Virgen Macarena, Amador de los Rios 48-50. 4a, Sevilla, 41003, Spain
| | - Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, University 'G. d'Annunzio', Via dei Vestini, Chieti, 66100, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Via dei Vestini, Bologna, 66100, Italy
| | - Marc Girard
- Hopital Notre Dame, 1560 Sherbrooke East, Montreal, H2L 4M1, Canada; CHUM and Universite de Montreal, Montreal, Canada
| | - Alexandre Prat
- Hopital Notre Dame, 1560 Sherbrooke East, Montreal, H2L 4M1, Canada; CHUM and Universite de Montreal, Montreal, Canada
| | - Pierre Duquette
- Hopital Notre Dame, 1560 Sherbrooke East, Montreal, H2L 4M1, Canada; CHUM and Universite de Montreal, Montreal, Canada
| | - Pierre Grammond
- Centre de réadaptation déficience physique Chaudière-Appalache, 9500 blvd Centre-Hospitalier, Levis, G6X 0A1, Canada
| | - Patrizia Sola
- Nuovo Ospedale Civile Sant'Agostino/Estense, via giardini 1355, Modena, 41100, Italy
| | - Raymond Hupperts
- Zuyderland Ziekenhuis, Walramstraat 23, Sittard, 6131 BK, The Netherlands
| | | | - Eugenio Pucci
- Azienda Sanitaria Unica Regionale Marche - AV3, Via Santa Lucia 2, Macerata, 62100, Italy
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Karadeniz Technical University, Trabzon, 61080, Turkey
| | - Raed Alroughani
- Amiri Hospital, P.O. Box 1661. Qurtoba, Kuwait, 73767, Kuwait
| | - Vincent Van Pesch
- Cliniques Universitaires Saint-Luc, avenue Hippocrate, 10 UCL10/80, Brussels, 1200 BXL, Belgium
| | | | - Murat Terzi
- Ondokuz Mayis University, Medical Faculty, Kurupelit, Samsun, 55160, Turkey
| | - Roberto Bergamaschi
- C. Mondino National Neurological Institute, via Mondino 2, Pavia, 27100, Italy
| | - Gerardo Iuliano
- Ospedali Riuniti di Salerno, Via s. Leonardo, Salerno, 84100, Italy
| | | | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Contrada Amoretta, Avellino, 83100, Italy
| | | | - Celia Oreja-Guevara
- Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, 28050, Spain
| | - Mark Slee
- Flinders Medical Centre, Flinders Drive, Adelaide, 5042, Australia
| | - Radek Ampapa
- Nemocnice Jihlava, Vrchlickeho 59, Jihlava, 58633, Czech Republic
| | - Freek Verheul
- Groene Hart ziekenhuis, bleulandweg 10, Gouda, 2800 BB, The Netherlands
| | - Pamela McCombe
- Royal Brisbane and Women's Hospital, 33 North Street, Spring Hill, QLD 4000, Australia
| | - Javier Olascoaga
- Hospital Donostia, Paseo de Begiristain, San Sebastián, 20014, Spain
| | - Maria Pia Amato
- University of Florence, Viale Morgagni 85, Florence, 50134, Italy
| | - Steve Vucic
- Westmead Hospital, Hawkesbury Rd, Sydney, 2145, Australia
| | | | | | - Shlomo Flechter
- Assaf Harofeh Medical Center, Zerifin, Beer-Yaakov, 70100, Israel
| | | | - Csilla Rozsa
- Jahn Ferenc Teaching Hospital, Köves u. 1., Budapest, 1101, Hungary
| | - Fraser Moore
- Jewish General Hospital, 3755 Cote-Sainte-Catherine, Montreal, J7A 4T8, Canada
| | | | - Maria Laura Saladino
- INEBA - Institute of Neuroscience Buenos Aires, Guardia Vieja 4435, Buenos Aires, C1192AAW, Argentina
| | - Michael Barnett
- Brain and Mind Centre, University of Sydney, 100 Mallett, Camperdown, 2050, Australia
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SE-17177, Sweden
| | - Helmut Butzkueven
- Department of Neurology, Royal Melbourne Hospital, 300 Grattan St, Melbourne, 3050, Australia.,Department of Medicine, University of Melbourne, 300 Grattan St, Melbourne, 3050, Australia.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia
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Retraction notice. Muscle Nerve 2017; 55:766. [DOI: 10.1002/mus.21394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Moccia M, Lanzillo R, Cerullo G, De Rosa A, Brescia Morra V. The importance of being persistent to multiple sclerosis treatments. J Clin Neurosci 2017; 40:198-199. [PMID: 28246007 DOI: 10.1016/j.jocn.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Marcello Moccia
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy.
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Giovanni Cerullo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Anna De Rosa
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
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7
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Healthcare Costs for Treating Relapsing Multiple Sclerosis and the Risk of Progression: A Retrospective Italian Cohort Study from 2001 to 2015. PLoS One 2017; 12:e0169489. [PMID: 28056103 PMCID: PMC5215923 DOI: 10.1371/journal.pone.0169489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 12/16/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Disease modifying treatments (DMTs) are the main responsible for direct medical costs in multiple sclerosis (MS). The current investigation aims at evaluating possible associations between healthcare costs for treating relapsing remitting MS (RRMS) and disease evolution. METHODS The present cohort study retrospectively included 544 newly diagnosed RRMS patients, prospectively followed up for 10.1±3.3 years. Costs for DMT administration and management were calculated for each year of observation. Following clinical endpoints were recorded: time to first relapse, 1-point EDSS progression, reaching of EDSS 4.0, reaching of EDSS 6.0, and conversion to secondary progressive MS (SP). Covariates for statistical analyses were age, gender, disease duration and EDSS at diagnosis. RESULTS At time varying Cox regression models, 10% increase in annual healthcare costs was associated with 1.1% reduction in 1-point EDSS progression (HR = 0.897; p = 0.018), with 0.7% reduction in reaching EDSS 6.0 (HR = 0.925; p = 0.030), and with 1.0% reduction in SP conversion (HR = 0.902; p = 0.006). CONCLUSION Higher healthcare costs for treating MS have been associated with a milder disease evolution after 10 years, with possible reduction of long-term non-medical direct and indirect costs.
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Robertson KA, Ghazal P. Interferon Control of the Sterol Metabolic Network: Bidirectional Molecular Circuitry-Mediating Host Protection. Front Immunol 2016; 7:634. [PMID: 28066443 PMCID: PMC5179542 DOI: 10.3389/fimmu.2016.00634] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/12/2016] [Indexed: 12/12/2022] Open
Abstract
The sterol metabolic network is emerging center stage in inflammation and immunity. Historically, observational clinical studies show that hypocholesterolemia is a common side effect of interferon (IFN) treatment. More recently, comprehensive systems-wide investigations of the macrophage IFN response reveal a direct molecular link between cholesterol metabolism and infection. Upon infection, flux through the sterol metabolic network is acutely moderated by the IFN response at multiple regulatory levels. The precise mechanisms by which IFN regulates the mevalonate-sterol pathway—the spine of the network—are beginning to be unraveled. In this review, we discuss our current understanding of the multifactorial mechanisms by which IFN regulates the sterol pathway. We also consider bidirectional communications resulting in sterol metabolism regulation of immunity. Finally, we deliberate on how this fundamental interaction functions as an integral element of host protective responses to infection and harmful inflammation.
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Affiliation(s)
- Kevin A Robertson
- Division of Infection and Pathway Medicine, University of Edinburgh , Edinburgh , UK
| | - Peter Ghazal
- Division of Infection and Pathway Medicine, University of Edinburgh , Edinburgh , UK
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9
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Moccia M, Palladino R, Carotenuto A, Russo CV, Triassi M, Lanzillo R, Brescia Morra V. Predictors of long-term interferon discontinuation in newly diagnosed relapsing multiple sclerosis. Mult Scler Relat Disord 2016; 10:90-96. [DOI: 10.1016/j.msard.2016.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/25/2016] [Accepted: 09/27/2016] [Indexed: 01/17/2023]
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Interferon Beta-1a (AVONEX®) as a Treatment Option for Untreated Patients with Multiple Sclerosis (AXIOM): A Prospective, Observational Study. Int J Mol Sci 2015; 16:15271-86. [PMID: 26154767 PMCID: PMC4519899 DOI: 10.3390/ijms160715271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 11/25/2022] Open
Abstract
The efficacy and safety of first-line disease-modifying therapies (DMT) for relapsing-remitting multiple sclerosis (RRMS) has been demonstrated in pivotal, randomized trials, but these studies do not reflect the routine care setting where treatment gaps or switches are common. The Avonex as Treatment Option for Untreated MS Patients (AXIOM) trial assessed the efficacy of newly-initiated intramuscular interferon beta-1a (IM IFNb-1a) after a treatment-free interval, with particular consideration of the previous course of disease and therapy. The AXIOM trial was an open, 12-month, observational, non-interventional study with a retrospective and a prospective part conducted in Germany. RRMS patients with a treatment-free interval of at least three months were included and treated with IFNb-1a for up to 12 months. Relapse rate, disability progression, injection-related parameters and quality of life observed during the prospective part were compared with retrospectively-collected data. Two hundred and thirty five RRMS patients participated in AXIOM. The mean relapse rate decreased from 1.1 in the three months before baseline to 0.2 per quarter during the twelve-month observational period; the Multiple Sclerosis Functional Composite score improved during twelve months of IM IFNb-1a treatment, while the Expanded Disability Status Scale score did not change over the course of this study. Compared to previous DMTs (IM IFNb-1a, subcutaneous IFNb-1a (SC IFNb-1a), SC IFNb-1b, glatiramer acetate), the patients experienced less injection site reactions and flu-like symptoms, with a stated improved quality of life. IM IFNb-1a was effective and well accepted in RRMS patients with no or discontinued previous therapy. These results from the routine care setting may inform optimization of DMT treatment in RRMS, but need confirmation in further studies.
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Kowalec K, Kingwell E, Yoshida EM, Marrie RA, Kremenchutzky M, Campbell TL, Wadelius M, Carleton B, Tremlett H. Characteristics associated with drug-induced liver injury from interferon beta in multiple sclerosis patients. Expert Opin Drug Saf 2014; 13:1305-17. [DOI: 10.1517/14740338.2014.947958] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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12
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Evans C, Zhu F, Kingwell E, Shirani A, van der Kop ML, Petkau J, Gustafson P, Zhao Y, Oger J, Tremlett H. Association between beta-interferon exposure and hospital events in multiple sclerosis. Pharmacoepidemiol Drug Saf 2014; 23:1213-22. [DOI: 10.1002/pds.3667] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/22/2014] [Accepted: 05/28/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Charity Evans
- College of Pharmacy and Nutrition; University of Saskatchewan; Saskatoon SK Canada
| | - Feng Zhu
- Department of Medicine (Neurology); University of British Columbia, UBC Hospital; Vancouver BC Canada
| | - Elaine Kingwell
- Department of Medicine (Neurology); University of British Columbia, UBC Hospital; Vancouver BC Canada
| | - Afsaneh Shirani
- Department of Medicine (Neurology); University of British Columbia, UBC Hospital; Vancouver BC Canada
| | - Mia L. van der Kop
- Department of Public Health Sciences; Karolinska Institutet; Stockholm Sweden
- Centre of Disease Control; University of British Columbia; Vancouver BC Canada
| | - John Petkau
- Department of Statistics; University of British Columbia; Vancouver BC Canada
| | - Paul Gustafson
- Department of Statistics; University of British Columbia; Vancouver BC Canada
| | - Yinshan Zhao
- Department of Medicine (Neurology); University of British Columbia, UBC Hospital; Vancouver BC Canada
| | - Joel Oger
- Department of Medicine (Neurology); University of British Columbia, UBC Hospital; Vancouver BC Canada
| | - Helen Tremlett
- Department of Medicine (Neurology); University of British Columbia, UBC Hospital; Vancouver BC Canada
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Prosperini L, Capobianco M, Giannì C. Identifying responders and nonresponders to interferon therapy in multiple sclerosis. Degener Neurol Neuromuscul Dis 2014; 4:75-85. [PMID: 32669902 PMCID: PMC7337239 DOI: 10.2147/dnnd.s42734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/06/2014] [Indexed: 12/16/2022] Open
Abstract
Interferon beta is a well established disease-modifying agent used for relapsing-remitting multiple sclerosis. Despite treatment, a relevant proportion of patients continue to experience clinical (ie, relapses, worsening of disability) and magnetic resonance imaging (MRI) activity. Early identification of responders and nonresponders to interferon beta is strongly recommended to select patients who need a prompt switch to another disease-modifying agent and to ultimately avoid accumulation of fixed disability over time. Detecting responders and nonresponders to interferon beta can be challenging, mainly because of the lack of a clear and shared clinical definition of response to treatment. Clinical features at the start of treatment should be considered as prognostic factors, but MRI parameters assessed during treatment, such as contrast-enhancing lesions or new T2-hyperintense lesions, may be sensitive markers of response to interferon beta. Quantitative scoring systems derived from a combination of relapses and MRI activity have recently been proposed as practical tools for use in the everyday clinical setting. Blood biomarkers, such as neutralizing antibodies to interferon beta and Myxovirus resistance protein A, provide further useful information for detecting responders and nonresponders to interferon beta. However, since the presence of neutralizing antibodies can only partially explain the nonresponse to interferon beta, biomarkers of interferon beta activity possibly related to the pathogenesis of the disease could represent a future step toward a tailored, long-lasting effective treatment against multiple sclerosis.
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Affiliation(s)
- Luca Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Marco Capobianco
- Regional Multiple Sclerosis Centre, University Hospital San Luigi Gonzaga, Orbassano, Italy
| | - Costanza Giannì
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
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Drulovic J, Kostic J, Mesaros S, Dujmovic Basuroski I, Stojsavljevic N, Kisic-Tepavcevic D, Pekmezovic T. Interferon-beta and disability progression in relapsing-remitting multiple sclerosis. Clin Neurol Neurosurg 2013; 115 Suppl 1:S65-9. [DOI: 10.1016/j.clineuro.2013.09.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Carvalho AT, Sá MJ. Switching and escalating therapy in long-lasting multiple sclerosis: not always necessary. ISRN NEUROLOGY 2013; 2012:451457. [PMID: 23316389 PMCID: PMC3539327 DOI: 10.5402/2012/451457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/03/2012] [Indexed: 12/04/2022]
Abstract
Although therapy switch is common among patients with multiple sclerosis (MS), sometimes the initial prescribed treatment is maintained for a long period with clinical stability, low disability, and nonsignificant side effects. We aim to describe demographic and clinical characteristics of patients treated in our MS clinic with the same disease-modifying drug (DMD) lasting for >12 years. From the cohort of 51 patients followed in our MS clinic with relapse-remitting MS who started an DMD between 1996 and 1999, we found a high percentage (51%) of patients who were efficiently treated with the first DMD. These patients were mainly females, with low annualized relapse rate and Multiple Sclerosis Severity Score (MSSS). Our results may be related to the open and multidisciplinary model of our MS clinic organization. Identifying characteristics associated with therapy persistence may be useful in developing strategies to improve therapy effectiveness.
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Affiliation(s)
- Ana Teresa Carvalho
- MS Clinic, Department of Neurology, Centro Hospitalar de São João, 4200-319 Porto, Portugal ; Department of Neurology, Centro Hospitalar de Vila Nova Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal
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Horakova D, Kalincik T, Dolezal O, Krasensky J, Vaneckova M, Seidl Z, Havrdova E. Early predictors of non-response to interferon in multiple sclerosis. Acta Neurol Scand 2012; 126:390-7. [PMID: 22428845 DOI: 10.1111/j.1600-0404.2012.01662.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify early clinical and MRI predictors of non-response to interferon (IFN) treatment in multiple sclerosis (MS). METHODS In 172 patients with relapsing-remitting MS treated with IFNβ, we evaluated prediction of future treatment non-response. Candidate predictors comprised disability and its sustained progression, relapse score (combining frequency and severity of relapses), brain volume change, brain parenchymal fraction, number of new T2 lesions, and T2 and T1 lesion volume within the initial year of treatment. Treatment non-response was evaluated as confirmed disability progression or overall average annual relapse score exceeding 1 over the following 5 years. Logistic regression model was adjusted for patient age, gender, disease duration and changes in treatment. RESULTS Ninety patients (52%) reached the status of IFN non-responders in years 2-6. Patients with ≥1 new T2 lesion and relapse score ≥2 (odds ratio ≥5.7) or those with ≥3 new T2 lesions regardless of the relapse score (odds ratio = 3) were in a significantly higher risk of future treatment non-response. CONCLUSIONS In patients with MS treated with IFNβ for 1 year, number of new T2 lesions and annualized relapse score predict individual risk of treatment non-response over the following 5 years.
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Affiliation(s)
- D. Horakova
- Department of Neurology and Center of Clinical Neuroscience; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - T. Kalincik
- Department of Neurology and Center of Clinical Neuroscience; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - O. Dolezal
- Department of Neurology and Center of Clinical Neuroscience; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - J. Krasensky
- Department of Radiology; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - M. Vaneckova
- Department of Radiology; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - Z. Seidl
- Department of Radiology; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
| | - E. Havrdova
- Department of Neurology and Center of Clinical Neuroscience; 1st Faculty of Medicine and General University Hospital; Charles University; Prague; Czech Republic
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Ticha V, Kalincik T, Havrdova E. Interferon-β or azathioprine as add-on therapies in patients with active multiple sclerosis. Neurol Res 2012; 34:923-30. [PMID: 22910063 DOI: 10.1179/1743132812y.0000000090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To evaluate safety and efficacy of add-on low-dose azathioprine or interferon (IFN)-beta in patients with active multiple sclerosis despite monotherapy. METHODS This retrospective observational study evaluated 5-year data from 85 patients with active multiple sclerosis despite monotherapy with either IFN-beta or azathioprine, who received add-on azathioprine or IFN-beta, respectively. In a subgroup of 23 patients, 10-year data were analysed. Clinical (relapse frequency, disability) and laboratory effects were compared preceding and following the addition of second drug and between the two treatment regimens. Potential serious adverse events were evaluated. RESULTS The add-on treatment triggered a drop in annualised relapse rate by approximately 1.5 points sustained over 5 and 10 years. No effect on disability was observed. Simultaneously, white blood cell and lymphocyte counts decreased, being below the physiological levels in 8-26% and 13-52% of patients at each time point, respectively. The drop in relapse rate was independent from the dosage of azathioprine or changes in lymphocyte count. Comparison between the two treatment regimens showed that, with the exception of lymphocyte count, these effects were triggered by the add-on of interferon but not azathioprine. The combination therapy was well tolerated; however, after 5 years on treatment a moderately increased incidence of cancer was observed. CONCLUSIONS IFN-beta as add-on to azathioprine decreases relapse activity in active multiple sclerosis. In contrast, azathioprine add-on in patients with suboptimal response to IFN-beta does not improve the control over the disease activity.
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Affiliation(s)
- Veronika Ticha
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic.
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Giovannoni G, Southam E, Waubant E. Systematic review of disease-modifying therapies to assess unmet needs in multiple sclerosis: tolerability and adherence. Mult Scler 2012; 18:932-46. [PMID: 22249762 DOI: 10.1177/1352458511433302] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reviews of therapeutic drugs usually focus on the highly selected and closely monitored patient populations from randomized controlled trials. The objective of this study was to review systematically the tolerability and adherence of multiple sclerosis disease-modifying therapies, using data from both randomized controlled trials and observational settings. Relevant literature was identified using predefined search terms, and adverse event and study discontinuation data were extracted and categorized according to study type (randomized controlled trial or observational) and study duration. A total of 151 papers were selected for analysis; 33% were classified as randomized controlled trials and 62% as observational studies. Most of the papers concerned interferon preparations and glatiramer acetate; the limited available information on mitoxantrone and natalizumab precluded extensive examination of these. The most common adverse events were flu-like symptoms (interferon therapies only) and injection-site reactions. Mean discontinuation rates ranged from 16% to 27%. There were no marked differences in tolerability or adherence data from randomized controlled trials and observational studies, but the incidence of adverse events remained high in lengthy studies and discontinuations accumulated with time. The present systematic review of randomized clinical trial and observational data highlights the tolerability and adherence issues associated with commonly used first-line multiple sclerosis treatments.
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Affiliation(s)
- G Giovannoni
- Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Jongen PJ, Sindic C, Sanders E, Hawkins S, Linssen W, van Munster E, Frequin S, Borm G. Adverse events of interferon beta-1a: a prospective multi-centre international ICH-GCP-based CRO-supported external validation study in daily practice. PLoS One 2011; 6:e26568. [PMID: 22046309 PMCID: PMC3201962 DOI: 10.1371/journal.pone.0026568] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 09/29/2011] [Indexed: 11/18/2022] Open
Abstract
Background Due to methodological shortcomings the available post-registration data on the adverse events (AEs) occurring in interferon beta-1a (INFb-1a)-treated patients fail to adequately validate phase III data and only partially inform on safety in daily practice. We assessed AEs in relapsing remitting multiple sclerosis (RRMS) patients treated with intramuscular (IM) INFb-1a in daily practice using data quality assurance measures similar to those in phase III trials. Methods A prospective, International Conference on Harmonization (ICH) - Good Clinical Practice (GCP)-based, clinical research organization (CRO)-supported study in 36 practices in the Netherlands, Belgium, the United Kingdom and Luxembourg. During 24 months after start of IM INFb-1a treatment 275 RRMS patients were assessed for AEs' severity (mild, moderate, severe) and relationship to treatment (not, unlikely, likely, definite). Data were compared with those reported in the pivotal phase III trial. Findings 75.3% of the patients experienced one or more AEs that were likely or definitely related to INFb-1a. Of all AEs 40.5% were likely or definitely treatment-related; 68.5% of these were mild, and 3% severe. 6.6% of the patients discontinued treatment because of an AE. Compared to the pivotal phase III trial, we found statistically significantly lower incidences for most of the common AEs: headache, muscle ache, fatigue, fever, chills, nausea. One patient died following two cerebral vascular events in study month 22, both AEs were assessed as not related to INFb-1a. Conclusion Three out of four RRMS patients treated with IM INFb-1a in daily practice experience treatment-related AEs, most of these being mild. Our data externally validate the favorable phase III safety profile of IM INFb-1a and suggest that the real-life incidence of treatment-related AEs is less than reported in the pivotal phase III trial. Larger studies are needed to detect rare, potentially hazardous AEs of IM INFb-1a.
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Affiliation(s)
| | - Christian Sindic
- Service de Neurologie, Cliniques Universitaires St. Luc U.C.L., Brussels, Belgium
| | - Evert Sanders
- Department of Neurology, Amphia Hospital, Breda, The Netherlands
| | - Stanley Hawkins
- Northern Ireland Regional Neurology Service, Royal Victoria Hospital, Belfast, Northern Ireland, United Kingdom
| | - Wim Linssen
- Department of Neurology, St. Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands
| | - Erik van Munster
- Department of Neurology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Stephan Frequin
- Department of Neurology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - George Borm
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Stübgen JP. Drug-induced dysimmune demyelinating neuropathies. J Neurol Sci 2011; 307:1-8. [DOI: 10.1016/j.jns.2011.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 05/05/2011] [Accepted: 05/11/2011] [Indexed: 12/30/2022]
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Devonshire V, Lapierre Y, Macdonell R, Ramo-Tello C, Patti F, Fontoura P, Suchet L, Hyde R, Balla I, Frohman EM, Kieseier BC. The Global Adherence Project (GAP): a multicenter observational study on adherence to disease-modifying therapies in patients with relapsing-remitting multiple sclerosis. Eur J Neurol 2011; 18:69-77. [PMID: 20561039 DOI: 10.1111/j.1468-1331.2010.03110.x] [Citation(s) in RCA: 270] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND most disease-modifying therapies (DMTs) for multiple sclerosis (MS) are self-injectable medications that must be taken on an ongoing basis to reduce disease activity. Thus, adherence to therapy becomes an important challenge that must be addressed to maximize benefits of therapy. This study evaluated rates of adherence to prescribed treatment and explored factors affecting adherence amongst patients with relapsing-remitting MS. METHODS this was an observational, multicenter, multinational, phase 4 study. Patients and physicians received paper questionnaires regarding adherence to DMTs approved at the time of the study, including intramuscular interferon beta-1a (IFNβ-1a), subcutaneous IFNβ-1a, IFNβ-1b, and glatiramer acetate. Quality of life and cognition data also were collected. Multivariate analysis was conducted to identify factors associated with adherence to long-term DMTs. RESULTS two thousand six hundred and forty-eight patients were studied, revealing an average treatment duration of 31 months. Seventy-five percent of patients (n = 1923) were adherent to therapy. The most common reasons for non-adherence were forgetting to administer the injection (50.2%) and other injection-related reasons (32.0%). Adherent patients reported better quality of life (P < 0.05) and fewer neuropsychological issues (P < 0.001) than non-adherent patients. Adherent patients had significantly shorter duration of disease (P < 0.001) and shorter duration of therapy (P = 0.005) than non-adherent patients. Women were more likely than men to adhere to treatment. CONCLUSION identifying factors that affect adherence to prescribed treatments is the first step in improving adherence of patients with MS to therapy, thereby helping maximize the benefits of long-term DMTs.
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Affiliation(s)
- V Devonshire
- University of British Columbia Hospital MS Clinic, Canada
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Incidence and factors associated with treatment failure in the CLIMB multiple sclerosis cohort study. J Neurol Sci 2009; 284:116-9. [DOI: 10.1016/j.jns.2009.04.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 04/10/2009] [Accepted: 04/14/2009] [Indexed: 11/20/2022]
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Recombinant interferon-beta therapy and neuromuscular disorders. J Neuroimmunol 2009; 212:132-41. [DOI: 10.1016/j.jneuroim.2009.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 04/21/2009] [Accepted: 04/22/2009] [Indexed: 11/20/2022]
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Bencsik K, Fricska-Nagy Z, Rajda C, Füvesi J, Török M, Vécsei L, Csépány T, Mátyás K, Dobos E, Rózsa C, Semjén J. Effects of interrupted immunomodulant therapy on the neurological state of multiple sclerosis patients. J Neurol Sci 2007; 260:296-7. [PMID: 17475280 DOI: 10.1016/j.jns.2007.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 03/13/2007] [Accepted: 03/23/2007] [Indexed: 11/22/2022]
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Abstract
PURPOSE OF REVIEW Interferons are used to treat a variety of medical conditions. They are integral players in immunity and a number of immune-mediated complications can arise during interferon therapy. We have reviewed the occurrence of these complications, and the mechanisms behind them. RECENT FINDINGS Case reports and follow-up studies of large cohorts of patients on interferon therapy have confirmed that immune-mediated complications are uncommon but can occur in a number of different organ systems. IFNalpha production is induced by specific autoantibody-nuclear antigen immune complexes, and has a key role in the development and maintenance of autoimmunity in systemic lupus erythematosus. SUMMARY Interferon therapy can precipitate immune-mediated abnormalities de novo or can exacerbate an existing autoimmune tendency. This is manifest in the rise in titre of existing antibodies and in the development of clinical disease in patients with preexisting antibodies. Type I interferons have a key role in the development of systemic lupus erythematosus.
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Affiliation(s)
- Frances A Y Borg
- Department of Rheumatology, University College London Hospital, UK.
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