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Reeve K, On BI, Havla J, Burns J, Gosteli-Peter MA, Alabsawi A, Alayash Z, Götschi A, Seibold H, Mansmann U, Held U. Prognostic models for predicting clinical disease progression, worsening and activity in people with multiple sclerosis. Cochrane Database Syst Rev 2023; 9:CD013606. [PMID: 37681561 PMCID: PMC10486189 DOI: 10.1002/14651858.cd013606.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that affects millions of people worldwide. The disease course varies greatly across individuals and many disease-modifying treatments with different safety and efficacy profiles have been developed recently. Prognostic models evaluated and shown to be valid in different settings have the potential to support people with MS and their physicians during the decision-making process for treatment or disease/life management, allow stratified and more precise interpretation of interventional trials, and provide insights into disease mechanisms. Many researchers have turned to prognostic models to help predict clinical outcomes in people with MS; however, to our knowledge, no widely accepted prognostic model for MS is being used in clinical practice yet. OBJECTIVES To identify and summarise multivariable prognostic models, and their validation studies for quantifying the risk of clinical disease progression, worsening, and activity in adults with MS. SEARCH METHODS We searched MEDLINE, Embase, and the Cochrane Database of Systematic Reviews from January 1996 until July 2021. We also screened the reference lists of included studies and relevant reviews, and references citing the included studies. SELECTION CRITERIA We included all statistically developed multivariable prognostic models aiming to predict clinical disease progression, worsening, and activity, as measured by disability, relapse, conversion to definite MS, conversion to progressive MS, or a composite of these in adult individuals with MS. We also included any studies evaluating the performance of (i.e. validating) these models. There were no restrictions based on language, data source, timing of prognostication, or timing of outcome. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened titles/abstracts and full texts, extracted data using a piloted form based on the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS), assessed risk of bias using the Prediction Model Risk Of Bias Assessment Tool (PROBAST), and assessed reporting deficiencies based on the checklist items in Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD). The characteristics of the included models and their validations are described narratively. We planned to meta-analyse the discrimination and calibration of models with at least three external validations outside the model development study but no model met this criterion. We summarised between-study heterogeneity narratively but again could not perform the planned meta-regression. MAIN RESULTS We included 57 studies, from which we identified 75 model developments, 15 external validations corresponding to only 12 (16%) of the models, and six author-reported validations. Only two models were externally validated multiple times. None of the identified external validations were performed by researchers independent of those that developed the model. The outcome was related to disease progression in 39 (41%), relapses in 8 (8%), conversion to definite MS in 17 (18%), and conversion to progressive MS in 27 (28%) of the 96 models or validations. The disease and treatment-related characteristics of included participants, and definitions of considered predictors and outcome, were highly heterogeneous amongst the studies. Based on the publication year, we observed an increase in the percent of participants on treatment, diversification of the diagnostic criteria used, an increase in consideration of biomarkers or treatment as predictors, and increased use of machine learning methods over time. Usability and reproducibility All identified models contained at least one predictor requiring the skills of a medical specialist for measurement or assessment. Most of the models (44; 59%) contained predictors that require specialist equipment likely to be absent from primary care or standard hospital settings. Over half (52%) of the developed models were not accompanied by model coefficients, tools, or instructions, which hinders their application, independent validation or reproduction. The data used in model developments were made publicly available or reported to be available on request only in a few studies (two and six, respectively). Risk of bias We rated all but one of the model developments or validations as having high overall risk of bias. The main reason for this was the statistical methods used for the development or evaluation of prognostic models; we rated all but two of the included model developments or validations as having high risk of bias in the analysis domain. None of the model developments that were externally validated or these models' external validations had low risk of bias. There were concerns related to applicability of the models to our research question in over one-third (38%) of the models or their validations. Reporting deficiencies Reporting was poor overall and there was no observable increase in the quality of reporting over time. The items that were unclearly reported or not reported at all for most of the included models or validations were related to sample size justification, blinding of outcome assessors, details of the full model or how to obtain predictions from it, amount of missing data, and treatments received by the participants. Reporting of preferred model performance measures of discrimination and calibration was suboptimal. AUTHORS' CONCLUSIONS The current evidence is not sufficient for recommending the use of any of the published prognostic prediction models for people with MS in clinical routine today due to lack of independent external validations. The MS prognostic research community should adhere to the current reporting and methodological guidelines and conduct many more state-of-the-art external validation studies for the existing or newly developed models.
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Affiliation(s)
- Kelly Reeve
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - Begum Irmak On
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Joachim Havla
- lnstitute of Clinical Neuroimmunology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | | | - Albraa Alabsawi
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Zoheir Alayash
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Health Services Research in Dentistry, University of Münster, Muenster, Germany
| | - Andrea Götschi
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | | | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
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2
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Correale J, Rush CA, Barboza A. Are highly active and aggressive multiple sclerosis the same entity? Front Neurol 2023; 14:1132170. [PMID: 36937521 PMCID: PMC10020517 DOI: 10.3389/fneur.2023.1132170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Jorge Correale
- Departamento de Neurología, Fleni, Buenos Aires, Argentina
- Instituto de Química y Fisicoquímica Biológicas (IQUIFIB), Universidad de Buenos Aires-CONICET, Buenos Aires, Argentina
- *Correspondence: Jorge Correale ;
| | - Carolina A. Rush
- Department of Medicine-Neurosciences, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrés Barboza
- Departamento de Neurologia, Hospital Central de Mendoza, Mendoza, Argentina
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3
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Hamdy E, Galeel AA, Ramadan I, Gaber D, Mustafa H, Mekky J. Iron deposition in multiple sclerosis: overall load or distribution alteration? Eur Radiol Exp 2022; 6:49. [PMID: 36074209 PMCID: PMC9458829 DOI: 10.1186/s41747-022-00279-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/14/2022] [Indexed: 11/14/2022] Open
Abstract
Background Though abnormal iron deposition has been reported in specific brain regions in multiple sclerosis (MS), no data exist about whether the overall quantity of iron in the brain is altered or not. We aimed to determine whether the noted aberrant iron deposition in MS brains was a problem of overall load or regional distribution in a cohort of MS patients. Methods An experienced neuroradiologist, a radiology software engineer, and four neurologists analysed data from quantitative susceptibility maps reconstructed from 3-T magnetic resonance brain images of 30 MS patients and 15 age- and sex-matched healthy controls. Global brain iron load was calculated, and the regional iron concentrations were assessed in 1,000 regions of interest placed in MS lesions in different locations, normal appearing white matter, thalami, and basal ganglia. Results Global brain iron load was comparable between patients and controls after adjustment for volume (p = 0.660), whereas the regional iron concentrations were significantly different in patients than in control (p ≤ 0.031). There was no significant correlation between global iron load and clinical parameters, whereas regional iron concentrations correlated with patients’ age, disease duration, and disability grade (p ≤ 0.039). Conclusions The aberrant iron deposition noted in MS seems to be a problem of regional distribution rather than an altered global brain iron load. Supplementary Information The online version contains supplementary material available at 10.1186/s41747-022-00279-9.
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Affiliation(s)
- Eman Hamdy
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Aya Abdel Galeel
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ismail Ramadan
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Dina Gaber
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Jaidaa Mekky
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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4
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Predictive MRI Biomarkers in MS—A Critical Review. Medicina (B Aires) 2022; 58:medicina58030377. [PMID: 35334554 PMCID: PMC8949449 DOI: 10.3390/medicina58030377] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: In this critical review, we explore the potential use of MRI measurements as prognostic biomarkers in multiple sclerosis (MS) patients, for both conventional measurements and more novel techniques such as magnetization transfer, diffusion tensor, and proton spectroscopy MRI. Materials and Methods: All authors individually and comprehensively reviewed each of the aspects listed below in PubMed, Medline, and Google Scholar. Results: There are numerous MRI metrics that have been proven by clinical studies to hold important prognostic value for MS patients, most of which can be readily obtained from standard 1.5T MRI scans. Conclusions: While some of these parameters have passed the test of time and seem to be associated with a reliable predictive power, some are still better interpreted with caution. We hope this will serve as a reminder of how vast a resource we have on our hands in this versatile tool—it is up to us to make use of it.
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5
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Caparó-Zamalloa C, Velásquez-Rimachi V, Mori N, Dueñas-Pacheco WI, Huerta-Rosario A, Farroñay-García C, Molina RA, Alva-Díaz C. Clinical Pathway for the Diagnosis and Management of Patients With Relapsing-Remitting Multiple Sclerosis: A First Proposal for the Peruvian Population. Front Neurol 2021; 12:667398. [PMID: 34744956 PMCID: PMC8567844 DOI: 10.3389/fneur.2021.667398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Relapsing–remitting multiple sclerosis (RRMS) is a subtype of degenerative inflammatory demyelinating disease of multifactorial origin that affects the central nervous system and leads to multifocal neurological impairment. Objectives: To develop a clinical pathway (CP) for the management of Peruvian patients with RRMS. Methods: First, we performed a literature review using Medline, Embase, Cochrane, ProQuest, and Science direct. Then, we structured the information as an ordered and logical series of five topics in a defined timeline: (1) How should MS be diagnosed? (2) How should a relapse be treated? (3) How should a DMT be initiated? (4) How should each DMT be used? and (5) How should the patients be followed? Results: The personnel involved in the care of patients with RRMS can use a series of flowcharts and diagrams that summarize the topics in paper or electronic format. Conclusions: We propose the first CP for RRMS in Peru that shows the essential steps for diagnosing, treating, and monitoring RRMS patients based on an evidence-based medicine method and local expert opinions. This CP will allow directing relevant clinical actions to strengthen the multidisciplinary management of RRMS in Peru.
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Affiliation(s)
- César Caparó-Zamalloa
- Basic Research Center in Dementias and Central Nervous System Demyelinating Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru.,Neurosonología, Clínica Delgado, Lima, Peru.,Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Victor Velásquez-Rimachi
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru.,Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru.,Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
| | - Nicanor Mori
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
| | | | - Andrely Huerta-Rosario
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru.,Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru.,Facultad de Medicina Hipólito Unanue, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Chandel Farroñay-García
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru.,Instituto Nacional de Salud (INS), Lima, Peru
| | - Roberto A Molina
- Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru.,Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru.,Servicio de Neurología, Hospital Nacional María Auxiliadora, Lima, Peru
| | - Carlos Alva-Díaz
- Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru
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6
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Ellenberger D, Flachenecker P, Fneish F, Frahm N, Hellwig K, Paul F, Stahmann A, Warnke C, Rommer PS, Zettl UK. Aggressive multiple sclerosis: a matter of measurement and timing. Brain 2021; 143:e97. [PMID: 33175163 PMCID: PMC7719018 DOI: 10.1093/brain/awaa306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- David Ellenberger
- German MS-Register by the German MS Society, MS Research and Project Development gGmbH [MSFP], Hanover, Germany
| | | | - Firas Fneish
- German MS-Register by the German MS Society, MS Research and Project Development gGmbH [MSFP], Hanover, Germany
| | - Niklas Frahm
- German MS-Register by the German MS Society, MS Research and Project Development gGmbH [MSFP], Hanover, Germany.,Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef-Hospital, University clinic of the Ruhr-University Bochum, Bochum, Germany
| | - Friedemann Paul
- Charité - Universitatsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, NeuroCure Clinical Research Center NCRC and Experimental and Clinical Research Center ECRC, Berlin, Germany
| | - Alexander Stahmann
- German MS-Register by the German MS Society, MS Research and Project Development gGmbH [MSFP], Hanover, Germany
| | - Clemens Warnke
- Department of Neurology, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Paulus S Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
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7
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Bose G, Freedman MS. Recent advances and remaining questions of autologous hematopoietic stem cell transplantation in multiple sclerosis. J Neurol Sci 2021; 421:117324. [PMID: 33497951 DOI: 10.1016/j.jns.2021.117324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/29/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
The judicious use of autologous hematopoietic stem cell transplantation (AHSCT) for MS requires understanding the potential benefits, identifying the most appropriate patient, and acknowledging the risks and differences between different protocols. Recently, AHSCT for MS is occurring more frequently, with a better safety profile than earlier studies. This review assesses recently published studies to determine the advances that have been made and remaining questions that future studies are poised to answer. We included studies from January 2016 to November 2020 with 20 or more patients. The benefits of AHSCT, including "no evidence of disease activity", functional and patient-reported outcomes, novel biomarkers such as brain atrophy or neurofilament light chain, and cost-effectiveness were assessed. The patient selection, treatment protocols, and safety outcomes differ between reports. The overall efficacy of AHSCT is better than standard treatments. Younger patients with highly active disease have greater chance for improvement, while patients who have comorbidities, failed more treatments, and are transitioning to a more progressive phase may not respond as well to AHSCT. The safety profiles for all AHSCT protocols is improving, however the durability of treatment response may not be the same for all protocols. The goal of AHSCT is to stop disease activity, avoid worsening disability, and obviate the need for further disease-modifying treatment, while improving patient quality of life and minimizing treatment-related risk. Results from currently enrolling randomized controlled trials, as well as ongoing registries, will provide more evidence for the safe and appropriate use of AHSCT.
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Affiliation(s)
- Gauruv Bose
- University of Ottawa, The Ottawa Hospital Research Institute, Department of Medicine, The Ottawa Hospital Civic Campus, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada.
| | - Mark S Freedman
- University of Ottawa, The Ottawa Hospital Research Institute, Department of Medicine, The Ottawa Hospital General Campus, 501 Smyth Road, Box 606, Ottawa, ON K1H 8L6, Canada.
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8
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Eliseeva DD, Vasiliev AV, Abramova AA, Kochergin IA, Zakharova MN. [Monoclonal antibody therapies for rapidly progressive and highly active multiple sclerosis in the era of the COVID-19 pandemic]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:31-36. [PMID: 34387443 DOI: 10.17116/jnevro202112107231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the COVID-19 pandemic continues, reducing the risk of infection for immunocompromised patients remains an important issue. Patients with aggressive multiple sclerosis (MS) require immunosuppressive therapy in order to control the overactive autoimmune response. Preliminary international and national trials demonstrate that older age, higher disability status and progressive MS are generally associated with a more severe clinical course of COVID-19. However, uncertainty remains about the effect of disease-modifying therapies on the COVID-19 clinical presentation. In this article, we pay special attention to monoclonal antibodies used for immune reconstitution therapy, which results in significant changes to the T-cell and/or B-cell repertoire. Based on the published data from registries in different countries, we attempted to estimate the benefits and risks of these therapies in a complicated epidemiological setting.
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Affiliation(s)
| | - A V Vasiliev
- «Neuroclinic» (Yusupov Hospital), Moscow, Russia
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9
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Khachanova NV, Bakhtiyarova KZ, Boyko AN, Vlasov YV, Davydovskaya MV, Evdoshenko EP, Zakharova MN, Kotov SV, Popova EV, Sivertseva SA, Totolyan NA, Khabirov FA. [Updated recommendations of the Council of Experts on the use and safety of alemtuzumab (Lemtrada)]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:82-91. [PMID: 32323949 DOI: 10.17116/jnevro202012003182] [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] [Indexed: 11/17/2022]
Abstract
Alemtuzumab (Lemtrada) is a recombinant humanized IgG1 kappa monoclonal antibody to the surface cell glycoprotein, a CD52 differentiation cluster. The drug is approved for use in more than 65 countries, including the Russian Federation. The drug is one of the most effective methods of treating patients with aggressive multiple sclerosis, but the risk management plan should be followed. The safety profile of the drug includes infusion-associated reactions, thyroid dysfunction, immune cytopenia, acute cardiovascular events, infections, and other autoimmune diseases. This publication provides updated practical recommendations for the use of the drug and ensuring the safety of patients treated with alemtuzumab.
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Affiliation(s)
- N V Khachanova
- Russian National Medical Research University named after N.I. Pirogov, Moscow, Russia
| | | | - A N Boyko
- Russian National Medical Research University named after N.I. Pirogov, Moscow, Russia.,Federal Center for Cerebrovascular Pathology and Stroke, Moscow, Russia
| | - Y V Vlasov
- Samara State Medical University, Samara, Russia
| | - M V Davydovskaya
- Russian National Medical Research University named after N.I. Pirogov, Moscow, Russia.,State Budgetary Institution of the Moscow region «Clinical and Economic Analysis Scientific-Practical Center of the Moscow Region Healthcare Ministry, Moscow, Russia
| | - E P Evdoshenko
- SPb Centre of Multiple Sclerosis and AID (City Clinical Hospital No31), St. Petersburg, Russia
| | | | - S V Kotov
- State Budgetary Healthcare Institution of Moscow Region Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - E V Popova
- Russian National Medical Research University named after N.I. Pirogov, Moscow, Russia.,Interdistrict Division of Multiple Sclerosis a the 24th City Hospital of Moscow, Moscow, Russia
| | - S A Sivertseva
- Tyumen Regional Centre of the Multiple Sclerosis, Tyumen, Russia
| | - N A Totolyan
- Federal State Budgetary Educational Institution of Higher Education First Saint Petersburg State Medical University named after Academician I.P. Pavlov of the Ministry of Healthcare of the Russian Federation, Saint Petersburg, Russia
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10
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Kern DM, Cepeda MS. Treatment patterns and comorbid burden of patients newly diagnosed with multiple sclerosis in the United States. BMC Neurol 2020; 20:296. [PMID: 32781983 PMCID: PMC7418327 DOI: 10.1186/s12883-020-01882-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 01/15/2023] Open
Abstract
Background The treatment landscape for multiple sclerosis (MS) is quickly evolving. Understanding real-world treatment patterns of patients is necessary to identifying potential gaps in care. Methods Patients with incident MS were identified from a large national claims database during 1/1/2014–6/30/2019. Patients had ≥2 diagnoses for MS or an inpatient hospitalization with a primary diagnosis of MS. Patients were required to have enrollment in the database ≥1 year prior to and ≥ 1 year following their first MS diagnosis. Treatment sequences were captured for all available disease modifying therapies (DMTs) during all available follow-up. Presence of comorbid conditions were captured during the one year prior to and following (and including) the index date; absolute change in prevalence from the pre- to post-index periods was calculated. Results We identified 5691 patients with incident MS. Common comorbidities included physical symptoms (e.g., pain, weakness, fatigue), mental health conditions (anxiety, depression), and cardiovascular/metabolic conditions (hypertension, hyperlipidemia, diabetes, obesity). Just 1994 (35.0%) of patients received a DMT at any time during follow-up. Of those receiving a DMT, 28.2% went on to receive a second line of therapy, 5.8% received a third, and just 0.9% went on to a fourth line. Use of more than one DMT concomitantly occurred in just 1.8% of all treated patients. Glatiramer and dimethyl fumarate were by far the most common first-line treatments received accounting for nearly 62% of patients receiving a DMT. Conclusion Approximately two-thirds of patients newly diagnosed with MS did not receive a DMT and the disease is accompanied by a significant comorbid burden.
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Affiliation(s)
- David M Kern
- Janssen Research and Development, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA.
| | - M Soledad Cepeda
- Janssen Research and Development, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA
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11
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On Seker BI, Reeve K, Havla J, Burns J, Gosteli MA, Lutterotti A, Schippling S, Mansmann U, Held U. Prognostic models for predicting clinical disease progression, worsening and activity in people with multiple sclerosis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013606] [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]
Affiliation(s)
- Begum Irmak On Seker
- Institute for Medical Information Processing, Biometry and Epidemiology; Ludwig-Maximilians-Universität München; Munich Germany
| | - Kelly Reeve
- Epidemiology, Biostatistics and Prevention Institute; University of Zürich; Zurich Switzerland
| | - Joachim Havla
- lnstitute of Clinical Neuroimmunology; Ludwig-Maximilians-Universität München; Munich Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology; Ludwig-Maximilians-Universität München; Munich Germany
- Pettenkofer School of Public Health; Munich Germany
| | | | | | - Sven Schippling
- Clinic for Neurology; University Hospital Zurich; Zurich Switzerland
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology; Ludwig-Maximilians-Universität München; Munich Germany
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute; University of Zürich; Zurich Switzerland
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12
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Pappolla A, Sánchez F, Caro F, Miguez J, Patrucco L, Cristiano E, Rojas JI. Differential white and gray matter damage in highly active multiple sclerosis: A prospective cohort study. J Clin Neurosci 2020; 74:65-68. [PMID: 32001112 DOI: 10.1016/j.jocn.2020.01.062] [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: 11/04/2019] [Accepted: 01/12/2020] [Indexed: 11/30/2022]
Abstract
We analyze the differential brain volume changes in highly active multiple sclerosis (HAMS) vs. non-HAMS patients during the disease onset. METHODS HAMS was defined as: a) patients with 1 relapse in the previous year and at least 1 T1 gadolinium-enhancing lesion or 9 or more T2 lesions while on therapy with other disease modifying treatment (DMD); or b) patients with 2 or more relapses in the previous year, whether on DMD or not. High-resolution T1 weighted MRI scans were acquired at onset and every 12 months for 2 years. Lesion load and brain volume measurements were determined. At onset, gray matter volume (GMV) and white matter volume (WMV) tissue volumes were calculated using the SIENAX. Longitudinal changes were estimated by using SIENA to calculate the percentage of brain volume loss. Differences between volumes per group at onset and at the end of the follow up were established. RESULTS 64 patients, mean age 38.4 years, 35 (57%) women were included. A total of 14 (21%) were classified as HAMS. At onset, HAMS patients showed lower GMV and WMV volume compared with non-HAMS patients (p = 0.003 and p = 0.01, respectively). During the follow up, HAMS patients showed a higher decrease in GM volume compared with non-HAMS patients (-0.61 vs. - 0.77, p < 0.001) independent from new lesion as well as relapse rate activity during follow up. CONCLUSION HAMS increased rates of GMV atrophy over 24 months compared to non-HAMS patients independent from relapse rate and new T2 lesions.
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Affiliation(s)
- Agustín Pappolla
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - Francisco Sánchez
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina; Laboratory of Immunomodulators - Center for Pharmacological and Botanical Studies (CEFYBO), School of Medicine, University of Buenos Aires - National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Fiorella Caro
- Laboratory of Immunomodulators - Center for Pharmacological and Botanical Studies (CEFYBO), School of Medicine, University of Buenos Aires - National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Jimena Miguez
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina.
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Alroughani R, Qadi N, Inshasi J, Shosha E. Neuromyelitis optica spectrum disorders in the Arabian Gulf: challenges and growing experience. Mult Scler J Exp Transl Clin 2020; 6:2055217319850195. [PMID: 31976082 PMCID: PMC6956599 DOI: 10.1177/2055217319850195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/06/2019] [Accepted: 04/21/2019] [Indexed: 01/09/2023] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) have been studied in different ethnic groups, including Asians, African-Americans, and Caucasians. Demonstrating the clinical features among diverse communities is important to understand the variable disease phenotypes, which will lead to further classification and better clinical management. Testing for antibody against aquaporin-4 (AQP4), the most common target antigen in NMOSD, is not available in many countries and tests use different methods, with variable sensitivity. With negative antibody results, the diagnosis of NMOSD becomes challenging and may affect the outcomes of patients with NMOSD. There are no adequate studies that assess NMOSD cohorts in the Arabian Gulf region, despite the increasing number of diagnosed cases. It is worth assessing NMOSD cohorts in the Arabian Gulf population to study the natural history of disease and to establish an epidemiological background for future perspectives. Various challenges to implement such a mission are outlined, including disease rarity, overlapping presenting symptoms and signs, which posed the issue of mimickers in the differential diagnosis, lack of specialized clinics, absence of highly sensitive testing methods for diagnosis, and the indefinite agreement on the negative AQP4 NMOSD criteria. Collaborative efforts started to take a place among many experts in the region to establish a registry of NMOSD patients for better perception of the disease pattern.
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Affiliation(s)
| | - Najeeb Qadi
- Department of Neuroscience, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Jihad Inshasi
- Department of Neurology, Rashed Hospital, Dubai, United Arab Emirates
| | - Eslam Shosha
- Department of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Abstract
Multiple sclerosis is the leading non-traumatic cause of disability in young adults, affecting up to 100,000 Canadians. This chronic inflammatory and neurodegenerative disease of the central nervous system leads to irreversible neurologic disability if inadequately controlled. Though many current medications are available that reduce inflammatory damage, most patients continue to show some evidence of disease activity and accrue disability. In this review, we discuss the role of immune ablation followed by autologous hematopoietic stem cell transplantation (AHSCT), a therapeutic option for select patients with a more aggressive disease course. By "resetting" the immune system with a variety of ablative conditioning regimens, followed by immune reconstitution, this therapy has shown a durable response in halting evidence of inflammatory activity in most patients, without the need for continued disease-modifying therapies (DMT). Since the introduction of this therapy, there have been advances in patient selection and supportive care, such that morbidity has significantly declined and treatment-related mortality is minimized. Recent phase-II trials have shown excellent results in efficacy and safety of AHSCT; however, challenges exist which require ongoing study. The future challenges include comparing the variety of AHSCT conditioning regimens with each other as well as with existing highly effective DMT; identifying patients with an aggressive disease course through novel biomarkers who may benefit the most from AHSCT; and surveillance of long-term outcomes of different treatment protocols. In select patients, replacing the immune system with AHSCT holds promise of fundamentally altering the trajectory of their aggressive disease course.
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15
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Díaz C, Zarco LA, Rivera DM. Highly active multiple sclerosis: An update. Mult Scler Relat Disord 2019; 30:215-224. [DOI: 10.1016/j.msard.2019.01.039] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
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16
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Khachanova NV. Highly active multiple sclerosis: options for monoclonal antibody therapy. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:49-57. [DOI: 10.17116/jnevro20191191049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Sedal L, Winkel A, Laing J, Law LY, McDonald E. Current concepts in multiple sclerosis therapy. Degener Neurol Neuromuscul Dis 2017; 7:109-125. [PMID: 30050382 PMCID: PMC6053095 DOI: 10.2147/dnnd.s109251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Over the past 20 years, the available therapies for multiple sclerosis have expanded exponentially. With several more agents likely to be approved for public funding in Australia in the next 12 months on top of the existing multitude of Australian Pharmaceutical Benefits Scheme-subsidized therapies, the choice is becoming even more complex. This review summarizes the current state of available therapies and anticipates likely future directions, including an important focus on contemporary symptom management. For each agent, the major trials, side effects, and clinical utility are summarized, with a particular focus on the Australian experience of these therapies. It is hoped this review provides an up-to-date reference of the exciting current state of multiple sclerosis therapy.
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Affiliation(s)
- Leslie Sedal
- Department of Neurology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia,
| | - Antony Winkel
- Department of Neurology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia,
| | - Joshua Laing
- Department of Neurology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia,
| | - Lai Yin Law
- Department of Neurology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia,
| | - Elizabeth McDonald
- Department of Neurology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia,
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18
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Alifirova VM, Bisaga GN, Boyko AN, Bryukhov VV, Davydovskay MV, Zakharova MN, Zakharova EV, Malkova NA, Popova EV, Salogub GN, Sivertseva SA, Troshina EA, Khachanova NV, Schmidt TE. Clinical recommendations on the use of alemtuzumab (lemtrada). Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:115-126. [DOI: 10.17116/jnevro201711722115-126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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