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Scavone C, Liguori V, Adungba OJ, Cesare DDG, Sullo MG, Andreone V, Sportiello L, Maniscalco GT, Capuano A. Disease-modifying therapies and hematological disorders: a systematic review of case reports and case series. Front Neurol 2024; 15:1386527. [PMID: 38957352 PMCID: PMC11217193 DOI: 10.3389/fneur.2024.1386527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024] Open
Abstract
IntroductionDisease modifying therapies (DMTs) used to treat multiple sclerosis (MS) can be associated to the occurrence of hematological disorders. This systematic review aims to provide an overview of these events occurring in real-life conditions, by describing case reports and series published in the literature.MethodsA literature search of all publications up to January 5th 2024 on the Medline and Embase databases was carried out. The results were presented both in the text and in tables.ResultsSixty-seven case reports/series were included in this review, of which more than half related to alemtuzumab, natalizumab and ocrelizumab. The publication date of included studies ranged from 2006 to 2024. The majority of case reports and series described the occurrence of late-onset hematological disorders (events that occurred more than 30 days after the first DMT administration), mainly represented by case of neutropenia, autoimmune hemolytic anemia and immune thrombocytopenia. All cases reported a favorable outcome, apart one case report that described a fatal case. Among included cases, 4 articles, all related to natalizumab, described the occurrence of myeloid disorders in 13 newborns from mother receiving the DMT.DiscussionConsidering the limitations identified in the majority of included studies, further ad hoc studies are strongly needed to better evaluate the hematological disorders of DMTs. Meantime, the strict monitoring of treated patients for the occurrence of these toxicities should be highly recommended.
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Affiliation(s)
- Cristina Scavone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, Naples, Italy
| | - Valerio Liguori
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, Naples, Italy
| | | | | | - Maria Giuseppa Sullo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vincenzo Andreone
- Neurological Clinic and Stroke Unit, “A. Cardarelli” Hospital, Naples, Italy
| | - Liberata Sportiello
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, Naples, Italy
| | - Giorgia Teresa Maniscalco
- Multiple Sclerosis Regional Center, “A. Cardarelli” Hospital, Naples, Italy
- Neurological Clinic and Stroke Unit, “A. Cardarelli” Hospital, Naples, Italy
| | - Annalisa Capuano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, Naples, Italy
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Dubuisson N, de Maere d'Aertrijcke O, Marta M, Gnanapavan S, Turner B, Baker D, Schmierer K, Giovannoni G, Verma V, Docquier MA. Anaesthetic management of people with multiple sclerosis. Mult Scler Relat Disord 2023; 80:105045. [PMID: 37866022 DOI: 10.1016/j.msard.2023.105045] [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: 02/09/2023] [Revised: 08/27/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023]
Abstract
There is a lack of published guidelines on the management of patients with multiple sclerosis (MS) undergoing procedures that require anaesthesia and respective advice is largely based on retrospective studies or case reports. The aim of this paper is to provide recommendations for anaesthetists and neurologists for the management of patients with MS requiring anaesthesia. This review covers issues related to the anaesthetic management of patients with MS, with a focus on preoperative assessment, choice of anaesthetic techniques and agents, side-effects of drugs used during anaesthesia and their potential impact on the disease evolution, drug interactions that may occur, and the need to use monitoring devices. A systematic PubMed research was performed to retrieve relevant articles.
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Affiliation(s)
- N Dubuisson
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Neuromuscular Reference Center, Department of Neurology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels 1200, Belgium.
| | - O de Maere d'Aertrijcke
- Department of Anesthesia and Perioperative Medicine, Cliniques Universitaires Saint-Luc, St Luc Hospital, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - M Marta
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S Gnanapavan
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - B Turner
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - D Baker
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK
| | - K Schmierer
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - G Giovannoni
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - V Verma
- Department of Anesthesia, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M-A Docquier
- Department of Anesthesia and Perioperative Medicine, Cliniques Universitaires Saint-Luc, St Luc Hospital, Avenue Hippocrate 10, Brussels 1200, Belgium
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Long-term real-world effectiveness and safety of fingolimod over 5 years in Germany. J Neurol 2022; 269:3276-3285. [PMID: 34982201 PMCID: PMC9120082 DOI: 10.1007/s00415-021-10931-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the 5-year real-world benefit–risk profile of fingolimod in patients with relapsing–remitting MS (RRMS) in Germany. Methods Post-Authorization Non-interventional German sAfety study of GilEnyA (PANGAEA) is a non-interventional real-world study to prospectively assess the effectiveness and safety of fingolimod in routine clinical practice in Germany. The follow-up period comprised 5 years. Patients were included if they had been diagnosed with RRMS and had been prescribed fingolimod as part of clinical routine. There were no exclusion criteria except the contraindications for fingolimod as defined in the European label. The effectiveness and safety analysis set comprised 4032 and 4067 RRMS patients, respectively. Results At the time of the 5-year follow-up of PANGAEA, 66.57% of patients still continued fingolimod therapy. Annualized relapse rates decreased from baseline 1.5 ± 1.15 to 0.42 ± 0.734 at year 1 and 0.21 ± 0.483 at year 5, and the disability status remained stable, as demonstrated by the Expanded Disability Status Scale mean change from baseline (0.1 ± 2.51), the decrease of the Multiple Sclerosis Severity Score from 5.1 ± 2.59 at baseline to 3.9 ± 2.31 at the 60-months follow-up, and the percentage of patients with ‘no change’ in the Clinical Global Impression scale at the 60-months follow-up (78.11%). Adverse events (AE) occurring in 75.04% of patients were in line with the known safety profile of fingolimod and were mostly non-serious AE (33.62%) and non-serious adverse drug reactions (50.59%; serious AE 4.98%; serious ADR 10.82%). Conclusions PANGAEA demonstrated the sustained beneficial effectiveness and safety of fingolimod in the long-term real-world treatment of patients with RRMS. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10931-w.
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Tanabe S, Shirakawa Y, Maeda N, Sakurama K, Noma K, Fujiwara T. Paraesophageal hernia repair can decrease BNP levels. Surg Endosc 2021; 35:6921-6929. [PMID: 33398557 DOI: 10.1007/s00464-020-08202-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the main manifestation of giant paraesophageal hernia (PEH) is disordered meal passage due to gastric torsion, the contents of the hernia sometimes squeeze the heart and lungs and induce the symptoms of respiratory or heart failure. Furthermore, the quality of life (QOL) of patients with a heavy cardiac load deteriorates. In this study, changes in a heart failure marker and symptoms of cases with a giant PEH from before to after laparoscopic surgery were examined. METHODS Levels of brain natriuretic peptide (BNP) as a heart failure marker were measured before and after radical laparoscopic surgery in cases of type III, IV type of giant PEH. Changes of the symptoms due to heart failure were also investigated. RESULTS A total of 75 hiatal hernia surgeries were performed in 2012-2019. Of them, 50 had a giant PEH, and 20 (40.0%) had heart failure symptoms such as fatigue and exertional dyspnea. In the giant PEH cases, BNP could be measured before and after surgery to evaluate the presence of heart failure in 23 cases; postoperative BNP levels decreased from the preoperative values in 18 of them. Furthermore, in many cases, chest symptoms also improved. CONCLUSIONS Radical laparoscopic surgery can reduce heart failure due to giant PEH. Therefore, in addition to conventional surgical indication criteria such as vomiting and food loss, increased cardiac load may be added to the new surgical indication criteria.
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Affiliation(s)
- Shunsuke Tanabe
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yasuhiro Shirakawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan.
| | - Naoaki Maeda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kazufumi Sakurama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kazuhiro Noma
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Ghadiri M, Rezk A, Li R, Evans A, Giacomini PS, Barnett MH, Antel J, Bar-Or A. Pre-treatment T-cell subsets associate with fingolimod treatment responsiveness in multiple sclerosis. Sci Rep 2020; 10:356. [PMID: 31941953 PMCID: PMC6962338 DOI: 10.1038/s41598-019-57114-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 12/16/2019] [Indexed: 01/01/2023] Open
Abstract
Biomarkers predicting fingolimod (FTY) treatment response in relapsing-remitting multiple sclerosis (RRMS) are lacking. Here, we performed extensive functional immunophenotyping using multiparametric flow cytometry to examine peripheral immune changes under FTY treatment and explore biomarkers of FTY treatment response. From among 135 RRMS patients who initiated FTY in a 2-year multicentre observational study, 36 were classified as ‘Active’ or ‘Stable’ based on clinical and/or radiological activity on-treatment. Flow cytometric analysis of immune cell subsets was performed on pre- and on-treatment peripheral blood mononuclear cells (PBMC) samples. Decreased absolute counts of B cells and most T-cell subsets were seen on-treatment. Senescent CD8 + T cells, CD56 + T cells, CD56dim natural killer cells, monocytes and dendritic cells were not reduced in number and hence relatively increased in frequency on-treatment. An unbiased multiparametric and traditional manual analysis of T-cell subsets suggested a higher pre-treatment frequency of CD4 + central memory T cells (TCM) in patients who were subsequently Active versus Stable on-treatment. Lower pre-treatment terminally differentiated effector memory (TEMRA) cell frequencies were also seen in the subsequently Active cohort. Together, our data highlight differential effects of FTY on peripheral immune cell subsets and suggest that pre-treatment T-cell subset frequencies may have value in predicting FTY treatment response.
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Affiliation(s)
- Mahtab Ghadiri
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Ayman Rezk
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Center for Neuroinflammation and Experimental Therapeutics, and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rui Li
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Center for Neuroinflammation and Experimental Therapeutics, and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Paul S Giacomini
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Jack Antel
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Amit Bar-Or
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada. .,Center for Neuroinflammation and Experimental Therapeutics, and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Watson LR, Slade CA, Ojaimi S, Barnes S, Fedele P, Smith P, Marum J, Lunke S, Stark Z, Hunter MF, Bryant VL, Low MSY. Pitfalls of immunotherapy: lessons from a patient with CTLA-4 haploinsufficiency. Allergy Asthma Clin Immunol 2018; 14:65. [PMID: 30377434 PMCID: PMC6196561 DOI: 10.1186/s13223-018-0272-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/22/2018] [Indexed: 01/24/2023] Open
Abstract
Background Daclizumab is a humanized monoclonal antibody that blocks CD25, the high affinity alpha subunit of the interleukin-2 receptor. Daclizumab therapy targets T regulatory cell and activated effector T cell proliferation to suppress autoimmune disease activity, in inflammatory conditions like relapsing and remitting multiple sclerosis. Here, we present the first report of agranulocytosis with daclizumab therapy in a patient with relapsing and remitting multiple sclerosis. Case presentation Our patient was a 24-year-old Australian female with a clinical history of atopy, lymphocytic enteritis complicated by B12 deficiency, relapsing and remitting multiple sclerosis, recurrent lower respiratory tract infections, vulval/cervical intraepithelial neoplasia and melanoma. She was commenced on daclizumab therapy after failing several lines of treatment for relapsing and remitting multiple sclerosis. During a hospital admission for lymphocytic enteritis, she was incidentally diagnosed with combined immunodeficiency with hypogammaglobulinaemia and declined proposed regular intravenous immunoglobulin infusions. Following six months of daclizumab therapy, our patient presented to hospital with febrile neutropenia. No clear infective cause was found, despite numerous investigations. However, bone marrow biopsy revealed agranulocytosis with an apparent maturation block at the myeloblasts stage. Neustrophil recovery occurred following cessation of daclizumab and the initiation of T cell immunosuppressive agents including systemic corticosteroids and methotrexate. The patient was further investigated for combined immunodeficiency and whole exome sequencing revealed a novel heterozygous missense variant in cytotoxic T lymphocyte antigen 4 (CTLA4), leading to a diagnosis of CTLA-4 haploinsufficiency with autoimmune infiltration (CHAI). Conclusion This case demonstrates that autoimmune disease may be the presenting feature of primary immunodeficiency and should be appropriately investigated prior to the commencement of immunotherapy. Genetic clarification of underlying primary immunodeficiency may provide critical clinical information that alters the safety of the proposed treatment strategy.
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Affiliation(s)
- Leisa Rebecca Watson
- 1Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC Australia
| | - Charlotte A Slade
- 2Immunology Division, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC Australia.,3Department of Medical Biology, The University of Melbourne, Parkville, VIC Australia.,4Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, VIC Australia
| | - Samar Ojaimi
- 1Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC Australia.,5Department of Immunology and Allergy, Monash Health, 246 Clayton Road, Clayton, VIC Australia
| | - Sara Barnes
- 1Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC Australia.,5Department of Immunology and Allergy, Monash Health, 246 Clayton Road, Clayton, VIC Australia
| | - Pasquale Fedele
- 2Immunology Division, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC Australia.,3Department of Medical Biology, The University of Melbourne, Parkville, VIC Australia.,6Monash Haematology, Monash Health, 246 Clayton Road, Clayton, VIC Australia
| | - Prudence Smith
- 6Monash Haematology, Monash Health, 246 Clayton Road, Clayton, VIC Australia
| | - Justine Marum
- 7Victorian Clinical Genetics Service, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC Australia
| | - Sebastian Lunke
- 7Victorian Clinical Genetics Service, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC Australia.,8Department of Pathology, The University of Melbourne, Parkville, VIC Australia
| | - Zornitza Stark
- 7Victorian Clinical Genetics Service, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC Australia.,9Department of Paediatrics, The University of Melbourne, Parkville, VIC Australia
| | - Matthew F Hunter
- 10Monash Genetics, Monash Health, 246 Clayton Road, Clayton, VIC Australia.,11Department of Paediatrics, Monash University, Clayton, VIC Australia
| | - Vanessa L Bryant
- 2Immunology Division, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC Australia.,3Department of Medical Biology, The University of Melbourne, Parkville, VIC Australia.,4Department of Clinical Immunology and Allergy, The Royal Melbourne Hospital, Parkville, VIC Australia
| | - Michael Sze Yuan Low
- 1Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC Australia.,2Immunology Division, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC Australia.,3Department of Medical Biology, The University of Melbourne, Parkville, VIC Australia.,6Monash Haematology, Monash Health, 246 Clayton Road, Clayton, VIC Australia
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