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Zinganell A, Göbel G, Berek K, Hofer B, Asenbaum-Nan S, Barang M, Böck K, Bsteh C, Bsteh G, Eger S, Eggers C, Fertl E, Joldic D, Khalil M, Langenscheidt D, Komposch M, Kornek B, Kraus J, Krendl R, Rauschka H, Sellner J, Auer M, Hegen H, Pauli FD, Deisenhammer F. Multiple sclerosis in the elderly: a retrospective cohort study. J Neurol 2024; 271:674-687. [PMID: 37855871 DOI: 10.1007/s00415-023-12041-1] [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: 07/07/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND There is a lack of knowledge of disease course, prognosis, comorbidities and potential treatments of elderly MS patients. OBJECTIVE To characterize the disease course including disability progression and relapses, to quantify the use of DMTs and to identify comorbidities and risk factors for progression in elderly multiple sclerosis (MS) patients. METHODS This is a retrospective study of 1200 Austrian MS patients older than 55 years as of May 1st, 2017 representing roughly one-third of all the MS patients of this age in Austria. Data were collected from 15 MS centers including demographics, first symptom at onset, number of relapses, evolvement of disability, medication, and comorbidities. RESULTS Median observation time was 17.1 years with 957 (80%) relapsing and 243 (20%) progressive onsets. Average age at diagnosis was 45 years with a female predominance of 71%. Three-hundred and twenty-six (27%) patients were never treated with a DMT, while most treated patients received interferons (496; 41%) at some point. At last follow-up, 420 (35%) patients were still treated with a DMT. No difference was found between treated and never-treated patients in terms of clinical outcome; however, patients with worse disability progression had significantly more DMT switches. Pyramidal onset, number of comorbidities, dementia, epilepsy, and psychiatric conditions as well as a higher number of relapses were associated with worse outcome. The risk of reaching EDSS 6 rose with every additional comorbidity by 22%. In late and very-late-onset MS (LOMS, VLOMS) time to diagnosis took nearly twice the time compared to adult and early onset (AEOMS). The overall annualized relapse rate (ARR) decreased over time and patients with AEOMS had significantly higher ARR compared to LOMS and VLOMS. Four percent of MS patients had five medications or more fulfilling criteria of polypharmacy and 20% of psychiatric drugs were administered without a matching diagnosis. CONCLUSIONS In this study, we identified number of comorbidities, pyramidal and cerebellar signs, and a higher number of relapses as unfavorable prognostic factors in elderly MS patients filling gaps of knowledge in patients usually underrepresented in clinical trials and may guide future therapeutic studies.
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Affiliation(s)
- Anne Zinganell
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Georg Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Barbara Hofer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Matin Barang
- Department of Neurology, Hospital of St. Pölten, St. Pölten, Austria
| | - Klaus Böck
- Department of Neurology, Kepler Universitätsklinikum, Linz, Austria
| | | | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stephan Eger
- Department of Neurology, Kepler Universitätsklinikum, Linz, Austria
| | - Christian Eggers
- Department of Neurology, Kepler Universitätsklinikum, Linz, Austria
| | - Elisabeth Fertl
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Damir Joldic
- Department of Neurology, Klinik Landstrasse, Vienna, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Martina Komposch
- Department of Neurology, Hospital of Klagenfurt, Klagenfurt, Austria
| | - Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jörg Kraus
- Neurologist, Zell Am See, Austria
- Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Reinhard Krendl
- Department of Neurology, Hospital of Villach, Villach, Austria
| | - Helmut Rauschka
- Department of Neurology, Klinik Donaustadt, Vienna, Austria
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Department of Neurology, Klinik Donaustadt, Vienna, Austria
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach, Mistelbach, Austria
| | - Michael Auer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Florian Deisenhammer
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Wunram HL, Kasparbauer AM, Oberste M, Bender S. [Movement as a Neuromodulator: How Physical Activity Influences the Physiology of Adolescent Depression]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2023; 52:77-93. [PMID: 37851436 DOI: 10.1024/1422-4917/a000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Movement as a Neuromodulator: How Physical Activity Influences the Physiology of Adolescent Depression Abstract: In the context of adolescent depression, physical activity is becoming increasingly recognized for its positive effects on neuropathology. Current scientific findings indicate that physical training affects the biological effects of depression during adolescence. Yet the pathophysiology of adolescent depression is not yet fully understood. Besides psychosocial and genetic influences, various neurobiological factors are being discussed. One explanation model describes a dysfunction of the hypothalamus-pituitary-adrenal axis (HPA axis) with a sustained elevation in cortisol concentration. Recent studies highlight neuroimmunological processes and a reduced concentration of growth factors as causative factors. These changes appear to lead to a dysregulation of the excitation and inhibition balance of the cerebral cortex as well as to cerebral morphological alterations. Regular physical training can potentially counteract the dysregulation of the HPA axis and normalize cortisol levels. The release of proinflammatory cytokines is inhibited, and the expression of growth factors involved in adult neurogenesis is stimulated. One should ensure the synergistic interaction of biological and psychosocial factors when designing the exercise schedule (endurance or strength training, group or individual sports, frequency, duration, and intensity). Addressing these open questions is essential when integrating physical activity into the guidelines for treating depressive disorders in children and adolescents.
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Affiliation(s)
- Heidrun Lioba Wunram
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
- Kinderklinik Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
- Geteilte Erstautorenschaft
| | - Anna-Maria Kasparbauer
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
- Geteilte Erstautorenschaft
| | - Max Oberste
- Institut für Medizinische Statistik und Bioinformatik, Universität zu Köln, Deutschland
| | - Stephan Bender
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik Köln, Medizinische Fakultät der Universität zu Köln, Deutschland
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Margoni M, Preziosa P, Rocca MA, Filippi M. Depressive symptoms, anxiety and cognitive impairment: emerging evidence in multiple sclerosis. Transl Psychiatry 2023; 13:264. [PMID: 37468462 PMCID: PMC10356956 DOI: 10.1038/s41398-023-02555-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023] Open
Abstract
Neuropsychiatric abnormalities may be broadly divided in two categories: disorders of mood, affect, and behavior and abnormalities affecting cognition. Among these conditions, clinical depression, anxiety and neurocognitive disorders are the most common in multiple sclerosis (MS), with a substantial impact on patients' quality of life and adherence to treatments. Such manifestations may occur from the earliest phases of the disease but become more frequent in MS patients with a progressive disease course and more severe clinical disability. Although the pathogenesis of these neuropsychiatric manifestations has not been fully defined yet, brain structural and functional abnormalities, consistently observed with magnetic resonance imaging (MRI), together with genetic and immunologic factors, have been suggested to be key players. Even though the detrimental clinical impact of such manifestations in MS patients is a matter of crucial importance, at present, they are often overlooked in the clinical setting. Moreover, the efficacy of pharmacologic and non-pharmacologic approaches for their amelioration has been poorly investigated, with the majority of studies showing marginal or no beneficial effect of different therapeutic approaches, possibly due to the presence of multiple and heterogeneous underlying pathological mechanisms and intrinsic methodological limitations. A better evaluation of these manifestations in the clinical setting and improvements in the understanding of their pathophysiology may offer the potential to develop tools for differentiating these mechanisms in individual patients and ultimately provide a principled basis for treatment selection. This review provides an updated overview regarding the pathophysiology of the most common neuropsychiatric symptoms in MS, the clinical and MRI characteristics that have been associated with mood disorders (i.e., depression and anxiety) and cognitive impairment, and the treatment approaches currently available or under investigation.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Impact of Multiple Sclerosis and Its Association with Depression: An Analytical Case-Control Investigation. Healthcare (Basel) 2022; 10:healthcare10112218. [PMID: 36360559 PMCID: PMC9690715 DOI: 10.3390/healthcare10112218] [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: 10/08/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Multiple sclerosis (MS) is a neurological, chronic, inflammatory, and progressive disease with musculoskeletal problems and neurodegenerative disorders that causes worsening of the health status of patients. The aim of this study was to determine the level of depression in MS patients compared to a population of healthy subjects. The established sample size was 116 subjects matched with the same age, sex, and body mass index. The subjects were recruited from different multiple sclerosis associations and neurology clinics in different public health areas (case group n = 58) and healthy subjects from the same locality (control group n = 58). The scores and categories of the Beck Depression Inventory (BDI) in its Spanish version were collected. There was a clear statistically significant difference (p < 0.05) in the BDI scores between both groups. As a result, we found that the subjects with MS presented worse results with BDI = 9.52 ± 7.70 points compared to the healthy subjects with a BDI score = 5.03 ± 5.14. Within the BDI categories, there were statistically significant differences (p < 0.001), which were greater for the MS group. Depression is a dangerous factor for MS patients, being a trigger for a poorer quality of life.
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Selective Cerebellar Atrophy Associates with Depression and Fatigue in the Early Phases of Relapse-Onset Multiple Sclerosis. THE CEREBELLUM 2020; 19:192-200. [PMID: 31898280 DOI: 10.1007/s12311-019-01096-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cerebellar dysfunctions have been associated to depressive disorders and cognitive impairment in neurodegenerative diseases. The objective is to analyze the associations between cerebellar atrophy, depression, and fatigue in the early phases of relapse-onset multiple sclerosis (RRMS). Sixty-one RRMS patients and 50 healthy controls (HC) were enrolled and clinically evaluated by means of expanded disability status scale (EDSS), Rao's brief repeatable battery of neuropsychological tests (BRB-NT), Delis-Kaplan executive function system sorting test, beck depression inventory II (BDI-II), and fatigue severity scale (FSS). The relationships between MRI variables and clinical scores were assessed. Depressed RRMS (dRRMS) had significantly lower Vermis Crus I volume compared with not depressed RRMS (ndRRMS) (p = 0.009). Vermis Crus I volume was lower in dRRMS suffering from fatigue than in ndRRMS without fatigue (p = 0.01). The hierarchical regression models which included demographic and clinical data (age, sex, and disease duration, FSS or BDI-II) and cerebellar volumes disclosed that cerebellar lobule right V atrophy explained an increase of 4% of the variability in FSS (p = 0.25) and Vermis Crus I atrophy explained an increase of 6% of variability in BDI-II (p = 0.049). Since clinical onset, atrophy of specific cerebellar lobules associates with important clinical aspects of RRMS. Cerebellar pathology may be one of the determinants of fatigue and depression that contribute to worsen disability in RRMS.
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Jakimovski D, Vaughn CB, Eckert S, Zivadinov R, Weinstock-Guttman B. Long-term drug treatment in multiple sclerosis: safety success and concerns. Expert Opin Drug Saf 2020; 19:1121-1142. [PMID: 32744073 DOI: 10.1080/14740338.2020.1805430] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The portfolio of multiple sclerosis (MS) disease modifying treatments (DMTs) has significantly expanded over the past two decades. Given the lifelong use of MS pharmacotherapy, understanding their long-term safety profiles is essential in determining suitable and personalized treatment. AREAS COVERED In this narrative review, we summarize the short-, mid-, and long-term safety profile of currently available MS DMTs categories. In addition to the initial trial findings, safety outcomes derived from long-term extension studies (≥5-20 years) and safety-based prescription programs have been reviewed. In order to better understand the risk-benefit ratio for each particular DMT group, a short description of the DMT-based efficacy outcomes has been included. EXPERT OPINION Long-term extension trials, large observational studies and real-world databases allow detection of rare and potentially serious adverse events. Two-year-long trials are unable to fully capture the positive and negative effects of immune system modulation and reconstitution. DMT-based monitoring programs can provide greater insights regarding safe use of MS medications in different patient populations and clinical settings. During the process of shared DMT decision, both MS care providers and their patients should be aware of an ever-expanding number of drug-based adverse events and their influence on the risk-benefit analysis.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York , Buffalo, NY, USA
| | - Caila B Vaughn
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo , Buffalo, NY, USA
| | - Svetlana Eckert
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo , Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York , Buffalo, NY, USA.,Translational Imaging Center at Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Stat37$e University of New York , Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo , Buffalo, NY, USA
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Ouallet JC, Radat F, Creange A, Abdellaoui M, Heinzlef O, Giannesini C, Hautecoeur P, Lamargue Hamel D, Deloire M, Brochet B, Jean Deleglise AS, Lehert P. Evaluation of emotional disorders before and during treatment with interferon beta in patients with multiple sclerosis. J Neurol Sci 2020; 413:116739. [PMID: 32151852 DOI: 10.1016/j.jns.2020.116739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/14/2020] [Accepted: 02/15/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Domains encompassing emotional disorders in relapsing-remitting MS (RRMS) patients are still unclear. METHODS We performed a 24-month, multicenter, single-arm, prospective study. RRMS patients started IFN-β treatment at baseline. The primary endpoint was lack of emotional control, measured using the "Echelle d'HumeurDépressive" (EHD) scale three times at baseline and at 10 post-treatment visits. Secondary endpoints were emotional blunting, irritability, fatigue, depression and anxiety. A linear mixed covariance model assessed change from baseline on an intention-to-treat basis, under the assumption of no mood disorder effect (one-sided 97.5% level), in which autoregressive type of autocorrelation was tested. RESULTS Out of 79 recruited patients, 70 were analyzed: 80% female; mean (SD) age, 37.0 (11.5) years. Mean (SD) lack of emotional control score at baseline and Month 24 was 12.7 (4.4) and 12.6 (5.5), respectively, versus 10.1 (3.2) in a healthy control population matched for age and sex. Stepwise analysis identified younger age, male sex and antidepressant use as significant predictors of higher lack of emotional control values. CONCLUSIONS Based on 24 months of prospective follow-up, the results of this study highlights a broad spectrum of emotional disorders in the MS population at the time of disease modifying drugs initiation but no major IFN-β-related emotional disorders (mood dyscontrol, anxiety, depression) were observed. However, sporadic occurrences of severe mood disorders and suicidality cannot be excluded.
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Affiliation(s)
- Jean-Christophe Ouallet
- Service de Neurologie, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France.
| | - Françoise Radat
- Service de Neurologie, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Alain Creange
- Service de Neurologie, Groupe Hospitalier Henri Mondor, APHP, Université Paris Est-Créteil, Creteil, France
| | - Mohamed Abdellaoui
- Service de Neurologie, Groupe Hospitalier Henri Mondor, APHP, Université Paris Est-Créteil, Creteil, France
| | - Olivier Heinzlef
- Service de Neurologie, Centre Hospitalier de Poissy, Poissy, France
| | - Claire Giannesini
- Service de Neurologie, Centre Hospitalier Universitaire St Antoine, APHP, Paris, France
| | | | | | - Mathilde Deloire
- Service de Neurologie, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Bruno Brochet
- Service de Neurologie, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France; NeuroCentre Magendie, INSERM U862, University of Bordeaux, Bordeaux, France
| | | | - Philippe Lehert
- Faculty of Economics, Louvain University, Belgium; Faculty of Medicine, University of Melbourne, Australia
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The Main Determinants for Suicidal Ideation in a Romanian Cohort of Multiple Sclerosis Patients. Behav Neurol 2020; 2020:2594702. [PMID: 32399081 PMCID: PMC7201511 DOI: 10.1155/2020/2594702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/26/2019] [Accepted: 12/06/2019] [Indexed: 11/18/2022] Open
Abstract
Objective To determine the prevalence of suicidal concerns (SC) in a large multiple sclerosis (MS) patient group and to assess the major determinants that are implicated in their occurrence. Methods A total of 349 patients were included in the study. They completed a survey about their demographic characteristics, psycho-socio-economic data, and disease-related information. Their disability level was assessed using the Expanded Disability Status Scale (EDSS) based on the neurological examination performed by the same doctor for every patient and the SC were documented with the Beck Depression Inventory-II questionnaire. Results The study included 112 men and 237 women, with a mean age around 42 years old. Suicidal thoughts were more frequent in men, while suicidal intentions in women. Positive correlations were found between SC and depression, EDSS, total number of relapses, disease duration, and level of education. From the EDSS functional scores, only the pyramidal score and the cerebellar score presented a significant correlation with SC. None of the patients with clinically isolated syndrome had SC. The type of disease-modifying therapy, marital and occupational status, and the presence of children did not influence the presence of SC. Conclusions The prevalence of SC is higher in patients with MS compared to the general population. Their occurrence is mostly influenced by the disease itself (duration, relapses, acquired disability) and also by depression and lack of education.
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Rotstein D, Montalban X. Reaching an evidence-based prognosis for personalized treatment of multiple sclerosis. Nat Rev Neurol 2020; 15:287-300. [PMID: 30940920 DOI: 10.1038/s41582-019-0170-8] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Personalized treatment is ideal for multiple sclerosis (MS) owing to the heterogeneity of clinical features, but current knowledge gaps, including validation of biomarkers and treatment algorithms, limit practical implementation. The contemporary approach to personalized MS therapy depends on evidence-based prognostication, an initial treatment choice and evaluation of early treatment responses to identify the need to switch therapy. Prognostication is directed by baseline clinical, environmental and demographic factors, MRI measures and biomarkers that correlate with long-term disability measures. The initial treatment choice should be a shared decision between the patient and physician. In addition to prognosis, this choice must account for patient-related factors, including comorbidities, pregnancy planning, preferences of the patients and their comfort with risk, and drug-related factors, including safety, cost and implications for treatment sequencing. Treatment response has traditionally been assessed on the basis of relapse rate, MRI lesions and disability progression. Larger longitudinal data sets have enabled development of composite outcome measures and more stringent standards for disease control. Biomarkers, including neurofilament light chain, have potential as early surrogate markers of prognosis and treatment response but require further validation. Overall, attainment of personalized treatment for MS is complex but will be refined as new data become available.
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Affiliation(s)
- Dalia Rotstein
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Xavier Montalban
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. .,Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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Kalb R, Feinstein A, Rohrig A, Sankary L, Willis A. Depression and Suicidality in Multiple Sclerosis: Red Flags, Management Strategies, and Ethical Considerations. Curr Neurol Neurosci Rep 2019; 19:77. [PMID: 31463644 PMCID: PMC6713681 DOI: 10.1007/s11910-019-0992-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Multiple sclerosis (MS) causes physical, emotional, and cognitive changes that impact function and quality of life (QoL). Risk factors for suicidality in MS patients include a high incidence of depression, increased isolation, and reduced function/independence. PURPOSE OF REVIEW: To describe the epidemiology of depression and suicidality in this population, highlight warning signs for suicidal behavior, provide recommendations and resources for clinicians, and discuss ethical decisions related to patient safety vs. right to privacy. RECENT FINDINGS: Fifty percent of MS patients will experience a major depression related to brain MRI factors and disease-related psychosocial challenges. Nevertheless, depression is under-recognized/treated. The standardized mortality ratio (SMR) indicates a suicide risk in the MS population that is twice that in the general population. Given the prevalence of depression and the increased risk of suicide in the MS population, any clinician providing care for these patients must be prepared to recognize and respond to potential warning signs.
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Affiliation(s)
- Rosalind Kalb
- , West Bath, ME, USA.
- Can Do Multiple Sclerosis, Edwards, Avon, CO, USA.
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amanda Rohrig
- Can Do Multiple Sclerosis, Edwards, Avon, CO, USA
- Horizon Rehabilitation Centers, Omaha, NE, USA
| | - Lauren Sankary
- Cleveland Clinic Center for Bioethics, Cleveland, OH, USA
| | - Alissa Willis
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, USA
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Pfaff L, Lamy J, Noblet V, Gounot D, Chanson JB, de Seze J, Blanc F. Emotional disturbances in multiple sclerosis: A neuropsychological and fMRI study. Cortex 2019; 117:205-216. [DOI: 10.1016/j.cortex.2019.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 08/02/2018] [Accepted: 02/20/2019] [Indexed: 01/21/2023]
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Rupert DD, Jones TS, Young RA. Interferon-Beta 1a–Induced Bipolar Disorder with Psychotic Features. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20181203-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Depressive disorders are common in patients with multiple sclerosis, influencing their quality of life and adherence to treatments, as well as becoming more frequent with the progression of the disease and in the secondary progressive form of multiple sclerosis. Patients with multiple sclerosis often experience a typical cluster of symptoms in association with depression, such as fatigue, pain and cognitive impairment. However, the pathogenesis of multiple sclerosis-related depression remains partially unclear, even though genetic, immune-inflammatory and psychosocial factors might be seen to play a role, in addition to the brain structural alterations documented by magnetic resonance imaging studies. The high incidence and burden of depression in people affected with multiple sclerosis are matters of crucial importance. Despite such importance, the efficacy of pharmacologic treatments has been poorly studied and, for the most part, the access to non-pharmacological treatments is partially dependent on the local health system availability. It has been determined that interferon-beta and glatiramer acetate do not cause depressive symptoms; however, no definitive data in this regard are avaible for the newer disease-modifyng medications. In this review, we discuss the diagnosis, prevalence, pathogenesis, clinical aspects, magnetic resonance imaging findings and treatments available in patients experiencing multiple sclerosis-related depression.
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Alba Palé L, León Caballero J, Samsó Buxareu B, Salgado Serrano P, Pérez Solà V. Systematic review of depression in patients with multiple sclerosis and its relationship to interferonβ treatment. Mult Scler Relat Disord 2017; 17:138-143. [DOI: 10.1016/j.msard.2017.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/30/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
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Abstract
Depressive disorders occur in up to 50% of people living with multiple sclerosis (MS). Prevalence estimates are generally 2-3-times higher than those of the general population. Myriad aetiologic factors may contribute to the aetiology of depression in MS including biological mechanisms (e.g. hippocampal microglial activation, lesion burden, regional atrophy), as well as the stressors, threats, and losses that accompany living with an unpredictable and often disabling disease. Some prominent risk factors for depression such as (younger) age, (female) sex, and family history of depression are less consistently associated with depression in MS than they are in the general population. Management of depression in MS has not been well studied, but available data on detection and treatment align with general principles of depression management. While the validity of standard measurement scales has often been questioned, available evidence suggests that standard scales provide valid ratings. Evidence for the effectiveness of depression treatments in MS is limited, but available evidence supports the effectiveness of standard treatment approaches, including both cognitive behavioural therapies and antidepressant medications.
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Affiliation(s)
- Scott B Patten
- a Department of Community Health Sciences , University of Calgary, Calgary , Alberta , Canada
| | - Ruth Ann Marrie
- b Department of Internal Medicine (Neurology) , University of Manitoba , Manitoba , Canada.,c Department of Community Health Sciences , University of Manitoba , Manitoba , Canada
| | - Mauro G Carta
- d Department of Medical Sciences and Public Health , Quality of Care, University of Cagliari , Cagliari , Italy
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16
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Furber KL, Van Agten M, Evans C, Haddadi A, Doucette JR, Nazarali AJ. Advances in the treatment of relapsing-remitting multiple sclerosis: the role of pegylated interferon β-1a. Degener Neurol Neuromuscul Dis 2017; 7:47-60. [PMID: 30050377 PMCID: PMC6053102 DOI: 10.2147/dnnd.s71986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is a progressive, neurodegenerative disease with unpredictable phases of relapse and remission. The cause of MS is unknown, but the pathology is characterized by infiltration of auto-reactive immune cells into the central nervous system (CNS) resulting in widespread neuroinflammation and neurodegeneration. Immunomodulatory-based therapies emerged in the 1990s and have been a cornerstone of disease management ever since. Interferon β (IFNβ) was the first biologic approved after demonstrating decreased relapse rates, disease activity and progression of disability in clinical trials. However, frequent dosing schedules have limited patient acceptance for long-term therapy. Pegylation, the process by which molecules of polyethylene glycol are covalently linked to a compound, has been utilized to increase the half-life of IFNβ and decrease the frequency of administration required. To date, there has been one clinical trial evaluating the efficacy of pegylated IFN. The purpose of this article is to provide an overview of the role of IFN in the treatment of MS and evaluate the available evidence for pegylated IFN therapy in MS.
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Affiliation(s)
- Kendra L Furber
- Laboratory of Molecular Cell Biology, .,College of Pharmacy and Nutrition, .,Neuroscience Research Cluster, University of Saskatchewan,
| | - Marina Van Agten
- Laboratory of Molecular Cell Biology, .,College of Pharmacy and Nutrition, .,Neuroscience Research Cluster, University of Saskatchewan,
| | - Charity Evans
- College of Pharmacy and Nutrition, .,Cameco Multiple Sclerosis Neuroscience Research Center, City Hospital,
| | | | - J Ronald Doucette
- Neuroscience Research Cluster, University of Saskatchewan, .,Cameco Multiple Sclerosis Neuroscience Research Center, City Hospital, .,Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Adil J Nazarali
- Laboratory of Molecular Cell Biology, .,College of Pharmacy and Nutrition, .,Neuroscience Research Cluster, University of Saskatchewan, .,Cameco Multiple Sclerosis Neuroscience Research Center, City Hospital,
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17
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Abstract
Mortality rates are elevated in people with multiple sclerosis (MS) relative to the general population. There is, however, some uncertainty whether suicide contributes to this. Epidemiological data suggest that the standardized mortality ratio (SMR) for suicide in MS is approximately twice that of the general population with younger males in the first few years following diagnosis most at risk. Rates of suicidal intent, a potential harbinger of more self-destructive behavior, are also elevated, but the frequency with which intent is followed by suicide is not known. Depression, severity of depression, social isolation, and alcohol abuse are associated with thoughts of suicide. The variables linked with suicide and suicidal intent are therefore well defined and should be readily available from routine clinical inquiry. While vigilance on the part of clinicians is required, particularly in the context of high-risk patients, it is also recognized that prevention is dependent on full disclosure of intent.
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Affiliation(s)
- Anthony Feinstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada
| | - Bennis Pavisian
- Department of Psychiatry, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON, Canada
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18
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Ottenlinger FM, Mayer CA, Ferreirós N, Schreiber Y, Schwiebs A, Schmidt KG, Ackermann H, Pfeilschifter JM, Radeke HH. Interferon-Beta Increases Plasma Ceramides of Specific Chain Length in Multiple Sclerosis Patients, Unlike Fingolimod or Natalizumab. Front Pharmacol 2016; 7:412. [PMID: 27857690 PMCID: PMC5093125 DOI: 10.3389/fphar.2016.00412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
Fingolimod is used for the treatment of multiple sclerosis (MS) and targets receptors for the bioactive sphingolipid sphingosine-1-phosphate (S1P). Whether fingolimod or other MS therapies conversely affect plasma concentrations of sphingolipids has, however, not yet been analyzed. Herein, we quantified 15 representative sphingolipid species by mass spectrometry in plasma from relapsing-remitting MS patients currently under fingolimod (n = 24), natalizumab (n = 16), or IFN-β (n = 18) treatment. Healthy controls (n = 21) and untreated MS patients (n = 11) served as control groups. IFN-ß treatment strongly increased plasma level of C16:0, C18:0, C20:0, and C24:1 ceramides compared to healthy controls, untreated patients, or patients receiving fingolimod or natalizumab medication. Natalizumab treatment increased plasma concentrations of both S1P and sphinganine-1-phosphate, whereas fingolimod treatment did not affect any of these lipids. Correlations of sphingolipids with the Expanded Disability Status Scale and other disease specific parameters revealed no systemic change of sphingolipids in MS, independent of the respective treatment regime. These results indicate type I interferon treatment to cause a strong and specific increase in ceramide level. If confirmed in larger cohorts, these data have implications for the efficacy and adverse effects of IFN-β. Moreover, quantification of ceramides soon after therapy initiation may help to identify therapy-responsive patients.
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Affiliation(s)
- Florian M Ottenlinger
- Pharmazentrum Frankfurt, Institute of Pharmacology and Toxicology, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Christoph A Mayer
- Center for Neurology and Neurosurgery, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Nerea Ferreirós
- Pharmazentrum Frankfurt/ZAFES, Institute for Clinical Pharmacology, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Yannick Schreiber
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group TMP, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Anja Schwiebs
- Pharmazentrum Frankfurt, Institute of Pharmacology and Toxicology, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Katrin G Schmidt
- Pharmazentrum Frankfurt, Institute of Pharmacology and Toxicology, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Hanns Ackermann
- Institute for Biostatistics and Mathematical Modelling, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Josef M Pfeilschifter
- Pharmazentrum Frankfurt, Institute of Pharmacology and Toxicology, Goethe University Frankfurt Frankfurt am Main, Germany
| | - Heinfried H Radeke
- Pharmazentrum Frankfurt, Institute of Pharmacology and Toxicology, Goethe University Frankfurt Frankfurt am Main, Germany
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19
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Mirsky MM, Marrie RA, Rae-Grant A. Antidepressant Drug Treatment in Association with Multiple Sclerosis Disease-Modifying Therapy: Using Explorys in the MS Population. Int J MS Care 2016; 18:305-310. [PMID: 27999525 DOI: 10.7224/1537-2073.2016-056] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The Explorys Enterprise Performance Management (EPM) database contains de-identified clinical data for 50 million patients. Multiple sclerosis (MS) disease-modifying therapies (DMTs), specifically interferon beta (IFNβ) treatments, may potentiate depression. Conflicting data have emerged, and a large-scale claims-based study by Patten et al. did not support such an association. This study compares the results of Patten et al. with those using the EPM database. Methods: "Power searches" were built to test the relationship between antidepressant drug use and DMT in the MS population. Searches were built to produce a cohort of individuals diagnosed as having MS in the past 3 years taking a specific DMT who were then given any antidepressant drug. The antidepressant drug therapy prevalence was tested in the MS population on the following DMTs: IFNβ-1a, IFNβ-1b, combined IFNβ, glatiramer acetate, natalizumab, fingolimod, and dimethyl fumarate. Results: In patients with MS, the rate of antidepressant drug use in those receiving DMTs was 40.60% to 44.57%. The rate of antidepressant drug use for combined IFNβ DMTs was 41.61% (males: 31.25%-39.62%; females: 43.10%-47.33%). Antidepressant drug use peaked in the group aged 45 to 54 years for five of six DMTs. Conclusions: We found no association between IFNβ treatment and antidepressant drug use in the MS population compared with other DMTs. The EPM database has been validated against the Patten et al. data for future use in the MS population.
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20
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Schippling S, O'Connor P, Knappertz V, Pohl C, Bogumil T, Suarez G, Cook S, Filippi M, Hartung HP, Comi G, Jeffery DR, Kappos L, Goodin DS, Arnason B. Incidence and course of depression in multiple sclerosis in the multinational BEYOND trial. J Neurol 2016; 263:1418-26. [PMID: 27177997 PMCID: PMC4929160 DOI: 10.1007/s00415-016-8146-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
Early experience in MS generated concerns that interferon beta treatment might provoke onset or worsening of depression. The objective of the study was to compare depression incidence in relapsing-remitting MS patients receiving interferon beta-1b (IFNB-1b) or glatiramer acetate (GA) in the BEYOND trial. 891/897 (99 %) of English, French, Spanish and Italian speakers among 2244 patients randomized (2:2:1) to receive either IFNB-1b 500 µg, 250 µg, or GA 20 mg QD for 2-3.5 years submitted Beck Depression Inventory Second Edition (BDI-II) scores at screening and serially thereafter, in which scores ≥14 indicated depression. Baseline BDI-II scores ≥14 were reported in 232/891 patients (26.3 %), with no meaningful difference among the three treatment arms noted at this or at any other time during the study including trial end. Percentages of patients depressed by BDI-II scores deviated little in any arm at any time (IFNB-1b 500 µg: 24.7 %, IFNB-1b 250 µg: 24.4 %, GA: 32.4 %). Antidepressant usage was likewise similar among the three treatment arms (IFNB-1b 500 µg: 33.7 %, IFNB-1b 250 µg: 31.8 %, GA: 28.8 %) as was depression severity and the frequency with which non-blinded treating physicians recorded depression as an adverse event (IFNB-1b 500 µg: 17.2 %, IFNB-1b 250 µg: 17.0 %, GA: 14.4 %). Treating physicians attributed depression to IFNB-1b 250 µg therapy in 53.6 % and to GA in 21.9 % of instances. This large, prospective, randomized-controlled MS dataset showed no increased risk of depression above baseline values with standard or double-dose IFNB-1b or GA QD treatment.
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Affiliation(s)
- Sven Schippling
- Department of Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Medical Center Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland.
| | | | - Volker Knappertz
- Teva Pharmaceuticals, Frazer, PA, USA.,Department of Neurology, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Christoph Pohl
- Bayer HealthCare AG/Bayer Pharma AG, Berlin, Germany.,University Hospital Bonn, Bonn, Germany
| | - Timon Bogumil
- Bayer HealthCare AG/Bayer Pharma AG, Berlin, Germany
| | | | - Stuart Cook
- Rutgers-New Jersey Medical School, Newark, NJ, USA
| | | | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Germany
| | | | | | - Ludwig Kappos
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Douglas S Goodin
- University of California at San Francisco, San Francisco, CA, USA
| | - Barry Arnason
- Department of Neurology, University of Chicago, Chicago, IL, USA
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21
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Zhang T, Tremlett H, Leung S, Zhu F, Kingwell E, Fisk JD, Bhan V, Campbell TL, Stadnyk K, Yu BN, Marrie RA. Examining the effects of comorbidities on disease-modifying therapy use in multiple sclerosis. Neurology 2016; 86:1287-1295. [PMID: 26944268 PMCID: PMC4826339 DOI: 10.1212/wnl.0000000000002543] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 12/21/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Comorbidities are common in multiple sclerosis (MS) and adversely affect health outcomes. However, the effect of comorbidity on treatment decisions in MS remains unknown. We aimed to examine the effects of comorbidity on initiation of injectable disease-modifying therapies (DMTs) and on the choice of the initial DMT in MS. METHODS We conducted a retrospective observational analysis using population-based health administrative and linked clinical databases in 3 Canadian provinces. MS cases were defined as any individual with ≥3 diagnostic codes for MS. Cohort entry (index date) was the first recorded demyelinating disease-related claim. The outcomes included choice of initial first-line DMTs and time to initiating a DMT. Logistic and Cox regression models were used to examine the association between comorbidity status and study outcomes, adjusting for sex, age, year of index date, and socioeconomic status. Meta-analysis was used to estimate overall effects across the 3 provinces. RESULTS We identified 10,698 persons with incident MS, half of whom had ≥1 comorbidities. As the total number of comorbidities increased, the likelihood of initiating a DMT decreased. Comorbid anxiety and ischemic heart disease were associated with reduced initiation of a DMT. However, patients with depression were 13% more likely to initiate a DMT compared to those without depression at the index date (adjusted hazard ratio 1.13; 95% confidence interval 1.00-1.27). CONCLUSIONS Comorbidities are associated with treatment decisions regarding DMTs in MS. A better understanding of the effects of comorbidity on effectiveness and safety of DMTs is needed.
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Affiliation(s)
- Tingting Zhang
- From the Department of Medicine, Division of Neurology and Centre for Brain Health (T.Z., H.T., F.Z., E.K.), University of British Columbia, Vancouver; Department of Community Health Sciences (S.L., B.N.Y., R.A.M.), University of Manitoba, Winnipeg; Departments of Medicine (J.D.F., V.B., T.L.C.) and Psychiatry (J.D.F.) and School of Nursing (T.L.C.), Dalhousie University, Halifax, Nova Scotia; and Queen Elizabeth II Health Sciences Centre (J.D.F., V.B., T.L.C., K.S.), Nova Scotia Health Authority, Halifax, Canada
| | - Helen Tremlett
- From the Department of Medicine, Division of Neurology and Centre for Brain Health (T.Z., H.T., F.Z., E.K.), University of British Columbia, Vancouver; Department of Community Health Sciences (S.L., B.N.Y., R.A.M.), University of Manitoba, Winnipeg; Departments of Medicine (J.D.F., V.B., T.L.C.) and Psychiatry (J.D.F.) and School of Nursing (T.L.C.), Dalhousie University, Halifax, Nova Scotia; and Queen Elizabeth II Health Sciences Centre (J.D.F., V.B., T.L.C., K.S.), Nova Scotia Health Authority, Halifax, Canada
| | - Stella Leung
- From the Department of Medicine, Division of Neurology and Centre for Brain Health (T.Z., H.T., F.Z., E.K.), University of British Columbia, Vancouver; Department of Community Health Sciences (S.L., B.N.Y., R.A.M.), University of Manitoba, Winnipeg; Departments of Medicine (J.D.F., V.B., T.L.C.) and Psychiatry (J.D.F.) and School of Nursing (T.L.C.), Dalhousie University, Halifax, Nova Scotia; and Queen Elizabeth II Health Sciences Centre (J.D.F., V.B., T.L.C., K.S.), Nova Scotia Health Authority, Halifax, Canada
| | - Feng Zhu
- From the Department of Medicine, Division of Neurology and Centre for Brain Health (T.Z., H.T., F.Z., E.K.), University of British Columbia, Vancouver; Department of Community Health Sciences (S.L., B.N.Y., R.A.M.), University of Manitoba, Winnipeg; Departments of Medicine (J.D.F., V.B., T.L.C.) and Psychiatry (J.D.F.) and School of Nursing (T.L.C.), Dalhousie University, Halifax, Nova Scotia; and Queen Elizabeth II Health Sciences Centre (J.D.F., V.B., T.L.C., K.S.), Nova Scotia Health Authority, Halifax, Canada
| | - Elaine Kingwell
- From the Department of Medicine, Division of Neurology and Centre for Brain Health (T.Z., H.T., F.Z., E.K.), University of British Columbia, Vancouver; Department of Community Health Sciences (S.L., B.N.Y., R.A.M.), University of Manitoba, Winnipeg; Departments of Medicine (J.D.F., V.B., T.L.C.) and Psychiatry (J.D.F.) and School of Nursing (T.L.C.), Dalhousie University, Halifax, Nova Scotia; and Queen Elizabeth II Health Sciences Centre (J.D.F., V.B., T.L.C., K.S.), Nova Scotia Health Authority, Halifax, Canada
| | - John D Fisk
- From the Department of Medicine, Division of Neurology and Centre for Brain Health (T.Z., H.T., F.Z., E.K.), University of British Columbia, Vancouver; Department of Community Health Sciences (S.L., B.N.Y., R.A.M.), University of Manitoba, Winnipeg; Departments of Medicine (J.D.F., V.B., T.L.C.) and Psychiatry (J.D.F.) and School of Nursing (T.L.C.), Dalhousie University, Halifax, Nova Scotia; and Queen Elizabeth II Health Sciences Centre (J.D.F., V.B., T.L.C., K.S.), Nova Scotia Health Authority, Halifax, Canada
| | - Virender Bhan
- From the Department of Medicine, Division of Neurology and Centre for Brain Health (T.Z., H.T., F.Z., E.K.), University of British Columbia, Vancouver; Department of Community Health Sciences (S.L., B.N.Y., R.A.M.), University of Manitoba, Winnipeg; Departments of Medicine (J.D.F., V.B., T.L.C.) and Psychiatry (J.D.F.) and School of Nursing (T.L.C.), Dalhousie University, Halifax, Nova Scotia; and Queen Elizabeth II Health Sciences Centre (J.D.F., V.B., T.L.C., K.S.), Nova Scotia Health Authority, Halifax, Canada
| | - Trudy L Campbell
- From the Department of Medicine, Division of Neurology and Centre for Brain Health (T.Z., H.T., F.Z., E.K.), University of British Columbia, Vancouver; Department of Community Health Sciences (S.L., B.N.Y., R.A.M.), University of Manitoba, Winnipeg; Departments of Medicine (J.D.F., V.B., T.L.C.) and Psychiatry (J.D.F.) and School of Nursing (T.L.C.), Dalhousie University, Halifax, Nova Scotia; and Queen Elizabeth II Health Sciences Centre (J.D.F., V.B., T.L.C., K.S.), Nova Scotia Health Authority, Halifax, Canada
| | - Karen Stadnyk
- From the Department of Medicine, Division of Neurology and Centre for Brain Health (T.Z., H.T., F.Z., E.K.), University of British Columbia, Vancouver; Department of Community Health Sciences (S.L., B.N.Y., R.A.M.), University of Manitoba, Winnipeg; Departments of Medicine (J.D.F., V.B., T.L.C.) and Psychiatry (J.D.F.) and School of Nursing (T.L.C.), Dalhousie University, Halifax, Nova Scotia; and Queen Elizabeth II Health Sciences Centre (J.D.F., V.B., T.L.C., K.S.), Nova Scotia Health Authority, Halifax, Canada
| | - B Nancy Yu
- From the Department of Medicine, Division of Neurology and Centre for Brain Health (T.Z., H.T., F.Z., E.K.), University of British Columbia, Vancouver; Department of Community Health Sciences (S.L., B.N.Y., R.A.M.), University of Manitoba, Winnipeg; Departments of Medicine (J.D.F., V.B., T.L.C.) and Psychiatry (J.D.F.) and School of Nursing (T.L.C.), Dalhousie University, Halifax, Nova Scotia; and Queen Elizabeth II Health Sciences Centre (J.D.F., V.B., T.L.C., K.S.), Nova Scotia Health Authority, Halifax, Canada
| | - Ruth Ann Marrie
- From the Department of Medicine, Division of Neurology and Centre for Brain Health (T.Z., H.T., F.Z., E.K.), University of British Columbia, Vancouver; Department of Community Health Sciences (S.L., B.N.Y., R.A.M.), University of Manitoba, Winnipeg; Departments of Medicine (J.D.F., V.B., T.L.C.) and Psychiatry (J.D.F.) and School of Nursing (T.L.C.), Dalhousie University, Halifax, Nova Scotia; and Queen Elizabeth II Health Sciences Centre (J.D.F., V.B., T.L.C., K.S.), Nova Scotia Health Authority, Halifax, Canada.
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di Nuzzo L, Orlando R, Tognoli C, Di Pietro P, Bertini G, Miele J, Bucci D, Motolese M, Scaccianoce S, Caruso A, Mauro G, De Lucia C, Battaglia G, Bruno V, Fabene PF, Nicoletti F. Antidepressant activity of fingolimod in mice. Pharmacol Res Perspect 2015; 3:e00135. [PMID: 26171219 PMCID: PMC4492751 DOI: 10.1002/prp2.135] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 02/05/2015] [Accepted: 02/11/2015] [Indexed: 01/22/2023] Open
Abstract
Recent findings indicate that fingolimod, the first oral drug approved for the treatment of multiple sclerosis (MS), acts as a direct inhibitor of histone deacetylases (HDACs) and enhances the production of brain-derived neurotrophic factor (BDNF) in the CNS. Both mechanisms are relevant to the pathophysiology and treatment of major depression. We examined the antidepressant activity of fingolimod in mice subjected to chronic unpredictable stress (CUS), a model of reactive depression endowed with face and pharmacological validity. Chronic treatment with fingolimod (3 mg kg(-1), i.p., once a day for 4 weeks) reduced the immobility time in the forced swim test (FST) in a large proportion of CUS mice. This treatment also caused anxiogenic-like effects in the social interaction test without affecting anxiety-like behavior in the elevated plus maze or spatial learning in the water maze. CUS mice showed reduced BDNF levels and enhanced HDAC2 levels in the hippocampus. These changes were reversed by fingolimod exclusively in mice that showed a behavioral response to the drug in the FST. Fingolimod treatment also enhanced H3 histone K14-acetylation and adult neurogenesis in the hippocampus of CUS mice. Fingolimod did not affect most of the parameters we have tested in unstressed control mice. The antidepressant-like activity of fingolimod was confirmed in mice chronically treated with corticosterone. These findings show for the first time that fingolimod exerts antidepressant-like effect acting in a "disease-dependent" manner, and raise the interesting possibility that the drug could relieve depressive symptoms in MS patients independently of its disease-modifying effect on MS.
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Affiliation(s)
- Luigi di Nuzzo
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy
| | - Rosamaria Orlando
- IRCCS Associazione Oasi Maria S.S., Institute for Research on Mental Retardation and Brain Aging Troina, Italy
| | - Cristina Tognoli
- Department of Neurological and Movement Sciences, University of Verona Verona, Italy
| | | | - Giuseppe Bertini
- Department of Neurological and Movement Sciences, University of Verona Verona, Italy
| | - Jessica Miele
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy
| | | | | | - Sergio Scaccianoce
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy
| | - Alessandra Caruso
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy
| | - Gianluca Mauro
- Institute of Psychiatry, Catholic University of Sacred Heart Rome, Italy
| | - Carmine De Lucia
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy
| | | | - Valeria Bruno
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy ; IRCCS Neuromed Pozzilli, Italy
| | | | - Ferdinando Nicoletti
- Department of Physiology and Pharmacology, University Sapienza of Rome Rome, Italy ; IRCCS Neuromed Pozzilli, Italy
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23
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Abstract
Depression--be it a formal diagnosis based on consensus clinical criteria, or a collection of symptoms revealed by a self-report rating scale--is common in patients with multiple sclerosis (MS) and adds substantially to the morbidity and mortality associated with this disease. This Review discusses the prevalence and epidemiology of depression in patients with MS, before covering aetiological factors, including genetics, brain pathology, immunological changes, dysregulation of the hypothalamic-pituitary-adrenal axis, and psychosocial influences. Treatment options such as antidepressant drugs, cognitive-behavioural therapy, mindfulness-based therapy, exercise and electroconvulsive therapy are also reviewed in the context of MS-related depression. Frequent comorbid conditions, namely pain, fatigue, anxiety, cognitive dysfunction and alcohol use, are also summarized. The article then explores three key challenges facing researchers and clinicians: what is the optimal way to define depression in the context of diseases such as MS, in which the psychiatric and neurological symptoms overlap; how can current knowledge about the biological and psychological underpinnings of MS-related depression be used to boost the validity of this construct; and can intervention be made more effective through use of combination therapies with additive or synergistic effects, which might exceed the modest benefits derived from their individual components?
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24
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Grimaldi LME, Zappalà G, Iemolo F, Castellano AE, Ruggieri S, Bruno G, Paolillo A. A pilot study on the use of interferon beta-1a in early Alzheimer's disease subjects. J Neuroinflammation 2014; 11:30. [PMID: 24524367 PMCID: PMC3931325 DOI: 10.1186/1742-2094-11-30] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/26/2014] [Indexed: 11/10/2022] Open
Abstract
Despite the fact that multiple sclerosis (MS) and Alzheimer’s disease (AD) share common neuroimmunological features, interferon beta 1a (IFNβ1a), the well-established treatment for the prevention of disease progression and cognitive decline in MS patients, has never been used in AD. We evaluated the safety and efficacy of IFNβ1a in subjects affected by mild-to-moderate AD in a double-blind, randomized, placebo-controlled, multicenter pilot study. Forty-two early Alzheimer’s patients were randomized to receive either a 22 mcg subcutaneous injection of IFNβ1a or placebo three times per week. A treatment period of 28 weeks was followed by 24 weeks of observation. IFNβ1a was well tolerated and adverse events were infrequent and mild to moderate. Although not statistically significant, a reduction in disease progression during follow-up was measured in IFNβ1a-treated patients by the Alzheimer’s Disease Assessment Scale cognitive subscale. Interestingly, the treatment group showed significant improvements in the Instrumental Activities of Daily Living and Physical Self-maintenance Scale. This study suggests that IFNβ1a is safe and well tolerated in early AD patients, and its possible beneficial role should be further investigated in larger studies.
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Affiliation(s)
- Luigi Maria Edoardo Grimaldi
- U,O, di Neurologia, Fondazione Istituto San Raffaele "G, Giglio" di Cefalù, Contrada Pietrapollastra, 90015 Cefalù, PA, Italy.
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25
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Wingerchuk DM. Multiple sclerosis disease-modifying therapies: adverse effect surveillance and management. Expert Rev Neurother 2014; 6:333-46. [PMID: 16533138 DOI: 10.1586/14737175.6.3.333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are five approved, partially effective, parenteral disease-modifying therapies for multiple sclerosis (MS), including three interferon-beta preparations, glatiramer acetate and the antineoplastic agent mitoxantrone. A sixth drug, natalizumab, was withdrawn from the market in 2005 but could return with increased safety measures. Careful surveillance for, and management of, the minor and serious adverse effects associated with these therapies in routine practice provides the best opportunity for maintaining compliance and achieving maximal therapeutic efficacy. This review outlines the strategies for the prevention, identification and management of the complications associated with administration and ongoing use of current MS therapies. These skills will become increasingly important to those caring for MS patients as contemporary treatment regimens become increasingly complex.
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Koffman J, Gao W, Goddard C, Burman R, Jackson D, Shaw P, Barnes F, Silber E, Higginson IJ. Progression, symptoms and psychosocial concerns among those severely affected by multiple sclerosis: a mixed-methods cross-sectional study of Black Caribbean and White British people. PLoS One 2013; 8:e75431. [PMID: 24098384 PMCID: PMC3788806 DOI: 10.1371/journal.pone.0075431] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 08/15/2013] [Indexed: 11/19/2022] Open
Abstract
Objective Multiple sclerosis is now more common among minority ethnic groups in the UK but little is known about their experiences, especially in advanced stages. We examine disease progression, symptoms and psychosocial concerns among Black Caribbean (BC) and White British (WB) people severely affected by MS. Design Mixed methods study of 43 BC and 43 WB people with MS (PwMS) with an Expanded Disability Status Scale (EDSS) ≥6 involving data from in clinical records, face-to-face structured interviews and a nested-qualitative component. Progression Index (PI) and Multiple Sclerosis Severity Score (MSSS) were calculated. To control for selection bias, propensity scores were derived for each patient and adjusted for in the comparative statistical analysis; qualitative data were analysed using the framework approach. Results Median EDSS for both groups was (6.5; range: 6.0–9.0). Progression Index (PI) and Multiple Sclerosis Severity Score (MSSS) based on neurological assessment of current EDSS scores identified BC PwMS were more likely to have aggressive disease (PI F = 4.04, p = 0.048, MSSS F = 10.30, p<0.001). Patients’ reports of the time required to reach levels of functional decline equivalent to different EDSS levels varied by group; EDSS 4: BC 2.7 years v/s WB 10.2 years (U = 258.50, p = 0.013), EDSS 6∶6.1 years BC v/s WB 12.7 years (U = 535.500, p = 0.011), EDSS 8: BC 8.7 years v/s WB 10.2 years. Both groups reported high symptom burden. BC PwMS were more cognitively impaired than WB PwMS (F = 9.65, p = 0.003). Thematic analysis of qualitative interviews provides correspondence with quantitative findings; more BC than WB PwMS referred to feelings of extreme frustration and unresolved loss/confusion associated with their rapidly advancing disease. The interviews also reveal the centrality, meanings and impact of common MS-related symptoms. Conclusions Delays in diagnosis should be avoided and more frequent reviews may be justified by healthcare services. Culturally acceptable interventions to better support people who perceive MS as an assault on identity should be developed to help them achieve normalisation and enhance self-identity.
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Affiliation(s)
- Jonathan Koffman
- King’s College London, School of Medicine, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
- * E-mail:
| | - Wei Gao
- King’s College London, School of Medicine, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Cassie Goddard
- King’s College London, School of Medicine, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Rachel Burman
- King’s College London, School of Medicine, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Diana Jackson
- King’s College London, School of Medicine, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Pauline Shaw
- King’s College Hospital NHS Foundation Trust, Neurology Department, London, United Kingdom
| | - Fiona Barnes
- King’s College Hospital NHS Foundation Trust, Neurology Department, London, United Kingdom
| | - Eli Silber
- King’s College Hospital NHS Foundation Trust, Neurology Department, London, United Kingdom
| | - Irene J. Higginson
- King’s College London, School of Medicine, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom
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Abstract
OBJECTIVE Suicidal ideation and behavior have been associated with a variety of neurological illnesses. Studies are ongoing in combat veterans and other groups to examine possible mechanisms and pathways that account for such associations. METHOD This article provides a review of the literature on suicide ideation and suicidal behavior in patients with neurological illnesses including publications on veteran's health and military medicine. Studies of suicide attempts and deaths in people with neurological illnesses are also reviewed. RESULTS The studies summarized in this review indicate that there are important linkages between suicidal ideation and behavior and neurological conditions, including epilepsy, multiple sclerosis, and amyotrophic lateral sclerosis. CONCLUSION Additional studies are needed to further clarify why suicide ideation and suicidal behavior are associated with neurological diseases, in order to improve quality of life, alleviate patient distress, and prevent nonfatal and fatal suicide attempts in veteran and non-veteran populations.
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Affiliation(s)
- Steven S Coughlin
- Post-Deployment Health Epidemiology Program, Office of Public Health, Department of Veterans Affairs, Washington, DC, USA
| | - Leo Sher
- James J. Peters Veterans’ Affairs Medical Center, New York, USA
- Mount Sinai School of Medicine, New York, USA
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de Sa JCC, Airas L, Bartholome E, Grigoriadis N, Mattle H, Oreja-Guevara C, O'Riordan J, Sellebjerg F, Stankoff B, Vass K, Walczak A, Wiendl H, Kieseier BC. Symptomatic therapy in multiple sclerosis: a review for a multimodal approach in clinical practice. Ther Adv Neurol Disord 2011; 4:139-68. [PMID: 21694816 DOI: 10.1177/1756285611403646] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
As more investigations into factors affecting the quality of life of patients with multiple sclerosis (MS) are undertaken, it is becoming increasingly apparent that certain comorbidities and associated symptoms commonly found in these patients differ in incidence, pathophysiology and other factors compared with the general population. Many of these MS-related symptoms are frequently ignored in assessments of disease status and are often not considered to be associated with the disease. Research into how such comorbidities and symptoms can be diagnosed and treated within the MS population is lacking. This information gap adds further complexity to disease management and represents an unmet need in MS, particularly as early recognition and treatment of these conditions can improve patient outcomes. In this manuscript, we sought to review the literature on the comorbidities and symptoms of MS and to summarize the evidence for treatments that have been or may be used to alleviate them.
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Stenager EN, Jensen B, Stenager M, Stenager K, Stenager E. Suicide attempts in multiple sclerosis. Mult Scler 2011; 17:1265-8. [PMID: 21511689 DOI: 10.1177/1352458511401942] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purposes of the study were (1) to estimate the risk of suicide attempts in multiple sclerosis (MS) patients in Denmark and compare the risk to the background population in the County of Funen, Denmark; (2) to estimate the risk of suicide attempts in MS patients receiving immunomodulating therapy compared with untreated patients. The Danish MS Registry, the Danish MS Treatment Registry and the Suicide Attempt Registry are linked and merged together using a person identification number given to all persons residing in Denmark. Among 404 MS patients, 15 patients had attempted suicide, although no increased risk for suicide attempts was found in MS patients. No difference in number of suicide attempts in treated and untreated patients was found.
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Affiliation(s)
- Elsebeth Nylev Stenager
- Department of Psychiatry, Odense and Augustenborg, The Psychiatry of Southern Denmark, Denmark.
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Aydar G, Kurt S, Karaer Unaldi H, Erkorkmaz U. Restless Legs Syndrome in Multiple Sclerosis. Eur Neurol 2011; 65:302-6. [DOI: 10.1159/000327315] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 03/14/2011] [Indexed: 11/19/2022]
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Rudick RA, Kappos L, Kinkel R, Clanet M, Phillips JT, Herndon RM, Sandrock AW, Munschauer FE. Gender effects on intramuscular interferon beta-1a in relapsing–remitting multiple sclerosis: analysis of 1406 patients. Mult Scler 2010; 17:353-60. [DOI: 10.1177/1352458510384605] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: We aimed to evaluate effects of gender on efficacy and safety of intramuscular (IM) interferon beta (IFNβ)-1a in patients with relapsing–remitting MS (RRMS) or clinically isolated syndromes (CIS) characteristic of early MS. Methods: Pooled data from 1406 (1027 women; 379 men) patients enrolled in five clinical studies of IM IFNβ-1a were analyzed. One analysis examined data for all patients treated with IM IFNβ-1a from all studies. Separate analyses were conducted of pooled IM IFNβ-1a-treated groups from all studies and pooled IFNβ-1a-treated and placebo-treated patients from the placebo-controlled studies. Outcome measures included time to first relapse, annualized relapse rate, time to disability progression, number of gadolinium-enhanced lesions, adverse events, laboratory evaluations, and neutralizing antibodies. Results: All efficacy assessments indicated similar treatment effects of IM IFNβ-1a in men and women with no significant treatment-by-gender interactions. Women reported more headaches, urinary tract infections, and depression in the analysis; however, these were also common in women who received placebo. Men reported more frequent flu-like symptoms in the placebo-controlled studies only. There were no other differences in the safety profile of IM IFNβ-1a between men and women. Conclusions: We conclude that no significant gender-related differences were found in the efficacy and safety of IM IFNβ-1a in patients with RRMS or CIS.
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Affiliation(s)
- RA Rudick
- Mellen Center for Treatment and Research (Neurological Institute), The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - L Kappos
- University Hospitals Kantonsspital, Basel, Switzerland
| | - R Kinkel
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M Clanet
- CHU Purpan Hospital, Toulouse, France
| | - JT Phillips
- Multiple Sclerosis Center at Texas Neurology, Dallas, TX, USA
| | - RM Herndon
- University of Mississippi, VA Medical Center, Jackson, MS, USA
| | | | - FE Munschauer
- Biogen Idec, Inc., Cambridge, MA, USA
- State University of New York at Buffalo, Buffalo, NY, USA
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Yamout BI, Dahdaleh M, Al Jumah MA, Al-Shammri S, Al Sharoqi I, Al-Tahan AR, Bohlega S, Deleu D, Inshasi J, Khalifa A, Szólics M. Adherence to disease-modifying drugs in patients with multiple sclerosis: a consensus statement from the Middle East MS Advisory Group. Int J Neurosci 2010; 120:273-9. [PMID: 20374075 DOI: 10.3109/00207450903541087] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adherence to therapy is a key issue in chronic illnesses. In addition, several features of multiple sclerosis (MS) and its treatment may increase the likelihood of patient nonadherence and discontinuation of treatment. Nonadherence will obviously compromise the efficacy of disease-modifying drugs in patients with MS. This subject was discussed by a group of local MS specialists from the Middle East. The group debated several key questions about the features and causes of patient nonadherence and its management. Further, they made recommendations for optimizing treatment adherence in this area.
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Affiliation(s)
- Bassem I Yamout
- Internal Medicine, American University of Beirut, Beirut, Lebanon.
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Castelli-Haley J, Oleen-Burkey MA, Lage MJ, Johnson K. Glatiramer acetate and interferon beta-1a for intramuscular administration: a study of outcomes among multiple sclerosis intent-to-treat and persistent-use cohorts. J Med Econ 2010; 13:464-71. [PMID: 20662760 DOI: 10.3111/13696998.2010.496650] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To study outcomes of multiple sclerosis (MS) patients treated with either glatiramer acetate (Copaxone) or interferon beta-1a for once-weekly, intramuscular administration (Avonex). METHODS An 'intent-to-treat' (ITT) cohort (n=1282) was established, consisting of patients diagnosed with MS who began therapy on either glatiramer acetate (GA) or intramuscular interferon beta-1a (IFN beta-1a-IM) and had continuous insurance coverage from 6 months before to 24 months after the date when they began taking the medication. A 'persistent use' (PU) cohort (n=639) was also constructed, consisting of individuals who, in addition to the criteria listed above, had a claim for GA or IFN beta-1a-IM within 28 days of the end of the 2-year post-period. Data were obtained from the i3 InVision Data Mart Database from July 2001 to June 2006. Multivariate regressions were used to examine both the 2-year total direct medical costs and the likelihood of relapse associated with the use of each of these alternative MS medications. A relapse was defined as either being hospitalized with a principal diagnosis of MS or having an outpatient visit with a MS diagnosis followed within 7 days by a claim for a corticosteroid. All regressions controlled a wide range of factors that may potentially affect outcomes. RESULTS In the ITT cohort, patients who started therapy on GA had a significantly lower 2-year risk of relapse (10.01 vs. 5.18%; p=0.0034) as well as significantly lower 2-year total medical costs ($44,201 vs. $41,121; p=0.0294). In the PU cohort, patients who used GA also had a significantly lower 2-year risk of relapse (7.25 vs. 2.16%; p=0.0048) as well as significantly lower total medical costs ($67,744 vs. 63,714; p=0.0445). LIMITATIONS The analyses relies on an administrative claims database of an insured population and hence, may not be generalizeable to other populations. In addition, such a database precludes measurement of lost work time, unemployment, caregiver burden or other costs associated with MS. CONCLUSIONS Results from this study indicate that the use of GA is associated with significantly lower probability of relapse as well as significantly lower 2-year total direct medical costs than IFN beta-1a-IM.
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Hartung HP. High-dose, high-frequency recombinant interferon beta-1a in the treatment of multiple sclerosis. Expert Opin Pharmacother 2009; 10:291-309. [PMID: 19236200 DOI: 10.1517/14656560802677882] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is at present no cure for multiple sclerosis (MS), and existing therapies are designed primarily to prevent lesion formation, decrease the rate and severity of relapses and delay the resulting disability by reducing levels of inflammation. OBJECTIVE The aim of this review was to assess the treatment of relapsing MS with particular focus on subcutaneous (s.c.) interferon (IFN) beta-1a. METHOD The literature on IFN beta-1a therapy of MS was reviewed based on a PubMed search (English-language publications from 1990) including its pharmacodynamics and pharmacokinetics, clinical efficacy in relapsing MS as shown in placebo-controlled studies and in comparative trials, efficacy in secondary progressive MS, safety and tolerability, and the impact of neutralizing antibodies. CONCLUSION The literature suggests that high-dose, high-frequency s.c. IFN beta-1a offers an effective option for treating patients with relapsing MS, with proven long-term safety and tolerability, and has a favourable benefit-to-risk ratio compared with other forms of IFN beta.
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Affiliation(s)
- Hans-Peter Hartung
- Heinrich-Heine-University, Department of Neurology, Moorenstreet 5, D-40225 Düsseldorf, Germany.
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35
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Brandes DW, Callender T, Lathi E, O'Leary S. A review of disease-modifying therapies for MS: maximizing adherence and minimizing adverse events. Curr Med Res Opin 2009; 25:77-92. [PMID: 19210141 DOI: 10.1185/03007990802569455] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In a chronic disabling disorder such as multiple sclerosis (MS), adherence to treatment is of critical importance in maximizing benefits of therapy over the long term. Adverse events (AEs) are often cited by patients who discontinue therapy. METHODS Databases including Medline, CINAHL, and International Pharmaceutical Abstracts were searched for literature pertaining to adherence and AEs in MS published between January 1970 and August 2008. Clinical studies and case reports of AEs were included, as were papers that outlined factors that influence adherence. An advisory board with extensive experience in managing patients with MS developed guidelines to assist healthcare providers in maximizing adherence to disease-modifying therapy. DISCUSSION Internally based factors such as self-image, and externally based factors such as AEs, may influence patients' willingness and ability to adhere to therapy. Management of AEs associated with disease-modifying therapies and other therapies is reviewed, including intramuscular and subcutaneous interferon beta (IFNbeta)-1a, IFNbeta-1b, glatiramer acetate, natalizumab, methylprednisolone, mitoxantrone, cyclophosphamide, methotrexate, azathioprine, and intravenous immunoglobulin. CONCLUSIONS Effective management of MS is an ongoing, dynamic process that can enhance patients' adherence to therapy. Healthcare practitioners may address factors influencing adherence among patients with MS by managing treatment expectations, maintaining good communication with the patient, and managing AEs of treatment. Although the guidelines proposed herein originate from a single advisory board, it seems clear that by addressing patient concerns, healthcare practitioners can work with patients to enhance their ability to continue to adhere to their therapies and thereby gain the benefits of their treatment over the long term.
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36
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Elman LB, Houghton DJ, Wu GF, Hurtig HI, Markowitz CE, McCluskey L. Palliative care in amyotrophic lateral sclerosis, Parkinson's disease, and multiple sclerosis. J Palliat Med 2007; 10:433-57. [PMID: 17472516 DOI: 10.1089/jpm.2006.9978] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis, Parkinson's disease, atypical parkinsonian syndromes, and multiple sclerosis are progressive neurologic disorders that cumulatively afflict a large number of people. Effective end-of-life palliative care depends upon an understanding of the clinical aspects of each of these disorders. OBJECTIVES The authors review the unique and overlapping aspects of each of these disorders with an emphasis upon the clinical management of symptoms. DESIGN The authors review current management and the supporting literature. CONCLUSIONS Clinicians have many effective therapeutic options to choose from when managing the symptoms produced by these disorders.
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Affiliation(s)
- Lauren B Elman
- ALS Association Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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37
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Patten SB, Williams JVA, Metz LM. Anti-depressant use in association with interferon and glatiramer acetate treatment in multiple sclerosis. Mult Scler 2007; 14:406-11. [PMID: 17986504 DOI: 10.1177/1352458507082942] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Randomized controlled trials incorporating validated depression scales have failed to identify an association between interferon beta treatment and depression in MS. This is surprising since interferons used in other clinical contexts are considered capable of causing depression. The negative results in MS could be due inadequate power in the published trials. METHODS In this study, longitudinal data from an IMS Health Canada database called the Therapy Dynamics database were analyzed. The database contains information about prescriptions filled at outpatient pharmacies in Canada, linked at the individual level over time periods as long as 36 months. Antidepressant prescriptions were used as a proxy indicator for depressive disorders. The frequency of antidepressant use was compared in cohorts treated with glatiramer acetate and interferon beta. RESULTS No differences in the frequency of antidepressant treatment were observed. A large proportion (approximately 40%) in all treatment cohorts were treated with antidepressants at some time over the study interval. The proportions remained comparable after adjustment for age and sex and in a time-to-event analysis of new antidepressant prescriptions. Among patients receiving prescriptions exclusively from Neurologists, the frequency of exposure to antidepressants was much lower (2.4%). CONCLUSIONS This analysis uncovered no evidence that antidepressant treatment occurs more often in people treated with interferon beta than in those treated with glatiramer acetate. These results help to confirm that depression is not associated with interferon beta treatment in MS.
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Affiliation(s)
- S B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada T2N 4N1.
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Pucak ML, Carroll KAL, Kerr DA, Kaplin AI. Neuropsychiatric manifestations of depression in multiple sclerosis: neuroinflammatory, neuroendocrine, and neurotrophic mechanisms in the pathogenesis of immune-mediated depression. DIALOGUES IN CLINICAL NEUROSCIENCE 2007. [PMID: 17726912 PMCID: PMC3181849 DOI: 10.31887/dcns.2007.9.2/mpucak] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Evidence suggests that depression in multiple sclerosis (MS) is largely biologically mediated by some of the same processes involved in the immunopathogenesis of this neurologic disease. In particular, the increase in proinflammatory cytokines, activation of the hypothalamic-pituitary-adrenal (HPA) axis, and reduction in neurotrophic factors that occur in MS may each account for the increased rate of depression seen in MS. The possible contributions of these neuroinflammatory, neuroendocrine, and neurotrophic mechanisms suggest a diverse array of novel treatment strategies for depression, both in the context of inflammatory conditions as well as in idiopathic depression. Furthermore, if such processes in MS play a causative role in the pathogenesis of depression, and depression in turn has affects on neurophysiological processes related to immune function, then treatment of depression might have a positive effect on MS disease progression. This makes treating MS depression a neuropsychiatric imperative.
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Affiliation(s)
- Michele L Pucak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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39
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Müller N, Schwarz M. Immunologische Aspekte bei depressiven Störungen. DER NERVENARZT 2007; 78:1261-73. [DOI: 10.1007/s00115-007-2311-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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40
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Schwid SR. SYMPTOMATIC MANAGEMENT OF MULTIPLE SCLEROSIS. Continuum (Minneap Minn) 2007. [DOI: 10.1212/01.con.0000293645.20988.3c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Acute relapses of multiple sclerosis (MS) are experienced as crises that disrupt the status quo for individuals with MS and their families. These unpredictable--and always unexpected--events elicit strong reactions, including grief, anxiety, anger, and guilt, as people struggle to understand why they occur. Although early relapses are a signal for most MS specialists to recommend treatment with one of the approved disease-modifying therapies, the remissions that follow contribute to patient and family denial about the realities of the disease, making it difficult for patients to begin and to adhere to ongoing treatment. Each ensuing attack confronts this denial, forcing patients and families to acknowledge the MS diagnosis and begin adapting to the demands of the illness in their daily lives. This paper discusses the meaning attributed by individuals and families to relapses leading to the MS diagnosis and the recommendation for disease-modifying therapy, the adjustments that are made by patients and their families to residual deficits following acute episodes, and suggestions for clinicians on how they might facilitate the adjustment process.
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Affiliation(s)
- Rosalind Kalb
- Professional Resource Center, National Multiple Sclerosis Society, 733 Third Avenue, New York, New York, 10017, USA.
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42
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Ron MA. Do neurologists provide adequate care for depression in patients with multiple sclerosis? NATURE CLINICAL PRACTICE. NEUROLOGY 2006; 2:534-5. [PMID: 16990825 DOI: 10.1038/ncpneuro0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 07/31/2006] [Indexed: 05/11/2023]
Affiliation(s)
- Maria A Ron
- Institute of Neurology, University College London, London, UK.
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43
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Müller N, Schwarz MJ. Neuroimmune-endocrine crosstalk in schizophrenia and mood disorders. Expert Rev Neurother 2006; 6:1017-38. [PMID: 16831116 DOI: 10.1586/14737175.6.7.1017] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review focuses on possible causes and the impact of different immune states in schizophrenia and major depression. It discusses the fact that, in schizophrenia, an over-activation of the type 2 immune response may dominate, while the type 1 and the pro-inflammatory immune responses are over-activated in major depression. The consequence of these diverse immune states is the activation and, respectively, inhibition of different enzymes in tryptophan/kynurenine metabolism, which may lead to an overemphasis of N-methyl-D-aspartate (NMDA) receptor antagonism in schizophrenia and of NMDA-receptor agonism in depression, resulting in glutamatergic hypofunction in schizophrenia and glutamatergic hyperfunction in major depression. In addition, the activation of the type 1 and the pro-inflammatory immune responses in major depression result in increased serotonin degradation and a serotonergic deficit. While antipsychotics and antidepressants today mainly act on the dopaminergic-glutamatergic and the noradrenergic-serotonergic neurotransmission, anti-inflammatory and immune-modulating therapies might act more basically at the pathophysiological mechanism. The limitations of this concept, however, are critically discussed.
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Affiliation(s)
- Norbert Müller
- Ludwig-Maximilians-Universität München, Hospital for Psychiatry and Psychotherapy, 80336 München, Germany.
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44
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Sobel RM, Lotkowski S, Mandel S. Update on depression in neurologic illness: stroke, epilepsy, and multiple sclerosis. Curr Psychiatry Rep 2005; 7:396-403. [PMID: 16216161 DOI: 10.1007/s11920-005-0043-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The risk of depression is increased in chronic neurologic illness and can adversely affect the course of disease. Recent literature is reviewed for depression in stroke, epilepsy, and multiple sclerosis. Depression can share pathophysiologic aspects of the comorbid illness, such as neurotransmitter pathway disturbances, hypothalamus-pituitary-adrenal pathway disturbances, and changes in immunologic function. Depression also can be a psychologic reaction to the burden of the neurologic condition. Risk factors for development of depression are reviewed. Depression and other medical conditions can have shared symptoms (eg, fatigue, psychomotor retardation) that can complicate the diagnosis of depression in neurologic illness. Proper selection of antidepressant treatment is necessary to avoid worsening the neurologic disorder.
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Affiliation(s)
- Richard M Sobel
- Department of Psychiatry, Jefferson Medical College, 1518 Walnut Street, Suite 1110, Philadelphia, PA 19102, USA.
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45
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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