1
|
Dominguez-Mozo MI, Galán V, Ramió-Torrentà L, Quiroga A, Quintana E, Villar LM, Costa-Frossard L, Fernández-Velasco JI, Villarrubia N, Garcia-Martinez MA, Arroyo R, Alvarez-Lafuente R. A two-years real-word study with fingolimod: early predictors of efficacy and an association between EBNA-1 IgG titers and multiple sclerosis progression. Front Immunol 2024; 15:1384411. [PMID: 38911861 PMCID: PMC11190074 DOI: 10.3389/fimmu.2024.1384411] [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: 02/09/2024] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
Background Although fingolimod, a sphingosine 1-phosphate receptor agonist, has shown to be an effective treatment reducing relapse rate and also slowing down the disability progression in relapsing-remitting multiple sclerosis (RRMS) patients, it is important to quickly identify those suboptimal responders. Objective The main objective was to assess different clinical, radiological, genetic and environmental factors as possible early predictors of response in MS patients treated with fingolimod for 24 months. The secondary objective was to analyze the possible contribution of the environmental factors analyzed to the progression and activity of the disease along the 2-years of follow-up. Methods A retrospective study with 151 patients diagnosed with MS, under fingolimod treatment for 24 months, with serum samples at initiation and six months later, and with clinical and radiological data at initiation and 24 months later, were included in the study. Clinical and radiological variables were collected to establish NEDA-3 (no evidence of disease activity: patients without relapses, disability progression and new T2 lesions or Gd+ lesions) and EDA (evidence of disease activity: patients with relapses and/or progression and/or new T2 lesions or gadolinium-positive [Gd+] lesions) conditions. Human leukocyte antigen II (HLA-II), EBNA-1 IgG and VCA IgG from Epstein-Barr virus (EBV) and antibody titers against Human herpesvirus 6A/B (HHV-6A/B) were also analyzed. Results A total of 151 MS patients fulfilled the inclusion criteria: 27.8% was NEDA-3 (37.5% among those previously treated with high efficacy therapies >24 months). The following early predictors were statistically significantly associated with NEDA-3 condition: sex (male; p=0.002), age at baseline (older; p=0.009), relapses 2-years before fingolimod initiation ≤1 (p=0.010), and absence of Gd+ lesions at baseline (p=0.006). Regarding the possible contribution of the environmental factors included in the study to the activity or the progression of the disease, we only found that EBNA-1 IgG titers decreased in 20.0% of PIRA (progression independent from relapse activity) patients vs. 73.3% of RAW (relapse-associated worsening) patients (p=0.006; O.R. = 11.0). Conclusion MS patients that are male, older, and with a low clinical and radiological activity at fingolimod initiation have a greater probability to reach NEDA-3 condition after two years with this therapy. An intriguing association of EBV with the progression of the disease has also been described, but it should be further study in a larger cohort to confirm these results.
Collapse
Affiliation(s)
- Maria Inmaculada Dominguez-Mozo
- Grupo de Investigación de Factores Ambientales en Enfermedades Degenerativas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Victoria Galán
- Servicio de Neurología, Hospital Universitario de Toledo, Toledo, Spain
| | - Lluís Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Girona Biomedical Research Institute (IDIBGI), Doctor Josep Trueta University Hospital and Santa Caterina Hospital, Department of Medical Sciences, University of Girona, Red de Enfermedades Inflamatorias (REI), Girona, Spain
| | - Ana Quiroga
- Neuroimmunology and Multiple Sclerosis Unit (UNIEM), Girona Biomedical Research Institute (IDIBGI), Red de Enfermedades Inflamatorias (REI), Girona, Spain
| | - E. Quintana
- Girona Neuroimmunology and Multiple Sclerosis Unit (UNIEM), Girona Biomedical Research Institute (IDIBGI), Department of Medical Sciences, University of Girona, Girona, Spain
| | - Luisa María Villar
- Servicio de Inmunología, Hospital Universitario Ramón y Cajal, Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Lucienne Costa-Frossard
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | | | - Noelia Villarrubia
- Servicio de Inmunología, Hospital Universitario Ramón y Cajal, Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - María Angel Garcia-Martinez
- Grupo de Investigación de Factores Ambientales en Enfermedades Degenerativas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Rafael Arroyo
- Departamento de Neurología, Hospital Universitario Quironsalud Madrid, Red Española de Esclerosis Múltiple (REEM), Madrid, Spain
| | - Roberto Alvarez-Lafuente
- Grupo de Investigación de Factores Ambientales en Enfermedades Degenerativas, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| |
Collapse
|
2
|
Altunan B, Ünal A, Efendi H, Köseoğlu M, Terzi M, Kotan D, Tamam Y, Boz C, Güler S, Turan ÖF, Altunrende B, Balcı FB, Turgut N, Akçalı A, Yildirim KA, Günal Dİ, Sunter G, Bingöl A. Use of follow-on fingolimod for multiple sclerosis: Analysis of effectiveness and patient reported outcomes in a real-world clinical setting. Mult Scler Relat Disord 2023; 77:104880. [PMID: 37459716 DOI: 10.1016/j.msard.2023.104880] [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: 05/03/2023] [Revised: 06/19/2023] [Accepted: 07/09/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Follow-on disease modifying therapies (FO-DMTs) do not always require Phase III studies. There are concerns that cheaper FO-DMTs are only used to reduce healthcare costs. However, the well-being of people with MS (pwMS) should be a priority. We aimed to evaluate the efficacy, safety and treatment satisfaction of one of the FO- Fingolimod (FTY) used in Turkey with the approval of Turkish Ministry of Health. METHODS PwMS under FTY were recruited from 13 centers and real-world data and answers of satisfaction and adherence statements of pwMS on FTY treatment were analyzed. RESULTS Data of 239 pwMS were obtained. The duration of FTY treatment was 2.5 ± 0.8 (1-4) years in pwMS who were included in the study and whose treatment continued for at least one year. Significant decreases in annual relapse rate (p < 0.001), Expanded Disability Status Scale (p < 0.001) and neuroimaging findings (p < 0.001) were observed. While 64% of the patients were satisfied and 71.5% were found to adherent with this FO-FTY. CONCLUSION This multicenter retrospective study found that the efficacy, safety and treatment adherence of a prescribed FO-FTY were consistent with the results of real-world studies. Studies including real-world data may provide guidance to address issues related to FO-FTY use.
Collapse
Affiliation(s)
- Bengü Altunan
- Department of Neurology, Faculty of Medicine, Tekirdag Namık Kemal University, Kampus street,.Süleymanpasa, Tekirdag 59100, Turkey
| | - Aysun Ünal
- Department of Neurology, Faculty of Medicine, Tekirdag Namık Kemal University, Kampus street,.Süleymanpasa, Tekirdag 59100, Turkey.
| | - Hüsnü Efendi
- Department of Neurology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | | | - Murat Terzi
- Department of Neurology, Ondokuz Mayıs University, Samsun, Turkey
| | - Dilcan Kotan
- Department of Neurology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Yusuf Tamam
- Department of Neurology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Cavit Boz
- Department of Neurology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sibel Güler
- Department of Neurology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Ömer Faruk Turan
- Department of Neurology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Burcu Altunrende
- Bilim University, Florence Nightingale Hospital, Istanbul, Turkey
| | | | - Nilda Turgut
- Department of Neurology, Faculty of Medicine, Tekirdag Namık Kemal University, Kampus street,.Süleymanpasa, Tekirdag 59100, Turkey
| | - Aylin Akçalı
- Department of Neurology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | | | - Dilek İnce Günal
- Department of Neurology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Gulin Sunter
- Department of Neurology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | | |
Collapse
|
3
|
Tuncer MA, Kürtüncü M, Terzi M, Uygunoğlu U, Göncüoğlu C, Yüceyar AN, Ekmekçi Ö, Türkoğlu R, Soysal A, Köseoğlu M, Boz C, Beckmann Y, Turan ÖF, Demirkıran DM, Akman FG, Altunrende B, Cantürk İA, Birday E, Özcan A, Kamişli Ö, Özen NPA, Çelik RGG, Balcı FB, Efendi H, Sarıkaya C, Akçalı A, Toprak MK, Kabay SC, Kızılay F, Sevim MS, Gazaloğlu GB, Demir CF, Balgetir F, Kıylıoğlu N, Sarıahmetoğlu H, Ölmez Ç, Mavi K, Yüksel S, Işık N, Saip S, Karabudak R, Siva A, Eraksoy M. Retrospective analysis of effectiveness of fingolimod in real life setting in Turkey (REFINE). Turk J Med Sci 2023; 53:323-332. [PMID: 36945929 PMCID: PMC10388089 DOI: 10.55730/1300-0144.5588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/30/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND During multiple sclerosis (MS) treatment different modes of action such as lateral (interferon beta to glatiramer acetate or glatiramer acetate to interferon beta) or vertical (interferon beta/glatiramer acetate to fingolimod) drug switch can be performed. This study aims to investigate the clinical effectiveness of switching from the first-line injectable disease modifying treatments (iDMTs) to fingolimod (FNG) compared to switching between first-line iDMTs. METHODS This is a multicenter, observational and retrospective study of patients with relapsing-remitting MS who had lateral and vertical switch. The observation period included three key assessment time points (before the switch, at switch, and after the switch). Data were collected from the MS patients' database by neurologists between January 2018 and June 2019. The longest follow-up period of the patients was determined as 24 months after the switch. RESULTS In 462 MS patients that were included in the study, both treatments significantly decreased the number of relapses during the postswitch 12 months versus preswitch one year while patients in the FNG group experienced significantly fewer relapses compared to iDMT cohort in the postswitch 12 months period. FNG cohort experienced fewer relapses than in the iDMT cohort within the postswitch 2 year. The mean time to first relapse after the switch was significantly longer in the FNG group. DISCUSSION The present study revealed superior effectiveness of vertical switch over lateral switch regarding the improvement in relapse outcomes. Patients in the FNG cohort experienced sustainably fewer relapses during the follow-up period after the switch compared the iDMT cohort. Importantly, switching to FNG was more effective in delaying time to first relapse when compared with iDMTs.
Collapse
Affiliation(s)
- Meryem Aslı Tuncer
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Kürtüncü
- Department of Neurology, İstanbul Faculty of Medicine (ÇAPA), İstanbul University, İstanbul, Turkey
| | - Murat Terzi
- Department of Neurology, Faculty of Medicine, Samsun Ondokuz Mayıs University, Samsun, Turkey
| | - Uğur Uygunoğlu
- Department of Neurology, Faculty of Medicine, İstanbul University Cerrahpaşa, İstanbul, Turkey
| | - Cansu Göncüoğlu
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Ayşe Nur Yüceyar
- Department of Neurology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Özgül Ekmekçi
- Department of Neurology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Recai Türkoğlu
- İstanbul Haydarpasa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Aysun Soysal
- Bakırköy Psychiatric and Neurological Diseases Hospital, İstanbul, Turkey
| | - Mesrure Köseoğlu
- Bakırköy Psychiatric and Neurological Diseases Hospital, İstanbul, Turkey
| | - Cavit Boz
- Department of Neurology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Yeşim Beckmann
- Department of Neurology, Faculty of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Ömer Faruk Turan
- Department of Neurology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | | | | | - Burcu Altunrende
- Florence Nightingale Hospital, Science University, İstanbul, Turkey
| | | | - Erkingül Birday
- Department of Neurology, Faculty of Medicine, Medipol University, İstanbul, Turkey
| | - Abdulcemal Özcan
- Department of Neurology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Özden Kamişli
- Department of Neurology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | | | | | | | - Hüsnü Efendi
- Department of Neurology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Cansu Sarıkaya
- Department of Neurology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Aylin Akçalı
- Department of Neurology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | | | - Sibel Canbaz Kabay
- Department of Neurology, Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
| | - Ferah Kızılay
- Department of Neurology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | | | - Caner Feyzi Demir
- Department of Neurology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Ferhat Balgetir
- Department of Neurology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Nefati Kıylıoğlu
- Department of Neurology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | | | - Çağcan Ölmez
- Novartis Health Food and Agriculture Products Industry and Trade Inc., İstanbul, Turkey
| | - Kamil Mavi
- Novartis Health Food and Agriculture Products Industry and Trade Inc., İstanbul, Turkey
| | - Süha Yüksel
- Novartis Health Food and Agriculture Products Industry and Trade Inc., İstanbul, Turkey
| | - Nihal Işık
- Okan University Hospital, İstanbul, Turkey
| | - Sabahattin Saip
- Department of Neurology, Faculty of Medicine, İstanbul University Cerrahpaşa, İstanbul, Turkey
| | - Rana Karabudak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aksel Siva
- Department of Neurology, Faculty of Medicine, İstanbul University Cerrahpaşa, İstanbul, Turkey
| | - Mefküre Eraksoy
- Department of Neurology, İstanbul Faculty of Medicine (ÇAPA), İstanbul University, İstanbul, Turkey
| |
Collapse
|
4
|
Liu X, Tang Z, Wang B, Chen Y. Clinical Observation of MRI Image in Floating Needle Therapy for Cervical Spondylosis of Cervical Type. SCANNING 2022; 2022:1340192. [PMID: 35795613 PMCID: PMC9155925 DOI: 10.1155/2022/1340192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
In order to solve the problem of cervical spondylosis in the early stage of various cervical spondylosis, effective treatment can prevent the deterioration of the disease. This paper presents the results of a clinical trial examining magnetic resonance imaging in the treatment of cervical spondylosis with flotation therapy and selected 68 patients with cervical spondylosis. According to research commodity, using a rigorous randomized controlled trial, 34 cases were divided into a control group (acupuncture group). The needles were kept for 30 minutes once a day. The treatment group (acupuncture combined with floating acupuncture group) was treated with acupuncture on the 1st, 3rd, and 5th days and floating acupuncture on the 2nd, 4th, and 6th days, respectively. Both groups were treated for 6 consecutive days and rested for 1 day. After 2 weeks of treatment, the simplified McGill Pain Scale (MPQ), visual analogue scale (VAS), and neck pain scale (NPQ) were observed and recorded to compare the curative effects. Finally, Excel software is used to manage the data, and SPSS21.0 is used for statistical analysis. Measurements of gender, age, disease, VAS, simple MPQ, and NPQ of the two groups were compared in the two groups, P > 0.05, which was not significant and comparable. After treatment, VAS, simple MPQ, and NPQ of the two groups were compared in and between groups, the total P < 0.05, with the mean data. Topics. Acupuncture combined with float needle and acupuncture therapy can improve the pain and breathing of cervical spondylosis and improve the quality of life of patients, but acupuncture combined with needle float is more pronounced than acupuncture groups.
Collapse
Affiliation(s)
- Xianqiang Liu
- Gradute School, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Department of Orthopedics, Tianjin Beichen Traditional Chinese Medicine Hospital, Tianjin 300400, China
| | - Zhenyi Tang
- Department of Orthopedics, Tianjin Beichen Traditional Chinese Medicine Hospital, Tianjin 300400, China
| | - Botao Wang
- Department of Orthopedics, Tianjin Beichen Traditional Chinese Medicine Hospital, Tianjin 300400, China
| | - Yongshuai Chen
- Department of Orthopedics, Tianjin Beichen Traditional Chinese Medicine Hospital, Tianjin 300400, China
| |
Collapse
|
5
|
Biernacki T, Sandi D, Füvesi J, Fricska-Nagy Z, Kincses TZ, Ács P, Rózsa C, Dobos E, Cseh B, Horváth L, Nagy Z, Csányi A, Kovács K, Csépány T, Vécsei L, Bencsik K. The safety and efficacy of fingolimod: Real-world data from a long-term, non-interventional study on the treatment of RRMS patients spanning up to 5 years from Hungary. PLoS One 2022; 17:e0267346. [PMID: 35452476 PMCID: PMC9032373 DOI: 10.1371/journal.pone.0267346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/07/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Fingolimod was approved and reimbursed by the healthcare provider in Hungary for the treatment of highly active relapsing-remitting multiple sclerosis (RRMS) in 2012. The present study aimed to assess the effectiveness, safety profile, and persistence to fingolimod in a real-life setting in Hungary in RRMS patients who were either therapy naïve before enrollment or have changed to fingolimod from another disease-modifying therapy (DMT) for any reason. METHODS This cross-sectional, observational study with prospective data collection was performed nationwide at 21 sites across Hungary. To avoid selection bias, sites were asked to document eligible patients in consecutive chronological order. Demographic, clinical, safety and efficacy data were analysed for up to 5 years from 570 consenting adult patients with RRMS who had received treatment with fingolimod for at least one year. RESULTS 69.6% of patients remained free from relapses for the whole study duration; in the first year, 85.1% of patients did not experience a relapse, which rose to 94.6% seen in the 5th year. Compared to baseline at study end, 28.2% had higher, and 9.1% had lower, meanwhile, 62.7% of the patients had stable EDSS scores. Overall, the annualized relapse rate decreased from 0.804 observed at baseline to 0.185, 0.149, 0.122, 0.091, and 0.097 (77.0%, 82.1%, 85.2%, 89.7%, and 89.0% relative reduction, respectively) after 1, 2, 3, 4, and 5 years of treatment. The greatest reduction rate was seen in the group of therapy naïve patients. Treatment persistence on fingolimod after 60 months was 73.4%. CONCLUSION In this nationwide Hungarian cohort, most patients under fingolimod treatment were free from relapses and disability progression. In addition, fingolimod has proven to be a well-tolerated DMT that has sustained its manageable safety profile, high efficacy, and positive benefit/risk ratio for up to 5 years in a real-life setting.
Collapse
Affiliation(s)
- Tamás Biernacki
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Judit Füvesi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zsanett Fricska-Nagy
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Tamás Zsigmond Kincses
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Péter Ács
- Department of Neurology, Faculty of General Medicine, University of Pécs, Pécs, Hungary
| | - Csilla Rózsa
- Jahn Ferenc South-Pest Hospital and Clinic, Budapest, Hungary
| | | | - Botond Cseh
- Borsod-Abaúj-Zemplén County Hospital, Miskolc, Hungary
| | | | - Zsuzsanna Nagy
- Szent Rafael Zala County Hospital, Zalaegerszeg, Hungary
| | | | | | - Tünde Csépány
- Department of Neurology, Faculty of General Medicine, University of Debrecen, Deberecen, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | | |
Collapse
|