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Aliyu M, Zohora FT, Ceylan A, Hossain F, Yazdani R, Azizi G. Immunopathogenesis of multiple sclerosis: molecular and cellular mechanisms and new immunotherapeutic approaches. Immunopharmacol Immunotoxicol 2024; 46:355-377. [PMID: 38634438 DOI: 10.1080/08923973.2024.2330642] [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: 09/21/2023] [Accepted: 03/09/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a central nervous system (CNS) demyelinating autoimmune disease with increasing global prevalence. It predominantly affects females, especially those of European descent. The interplay between environmental factors and genetic predisposition plays a crucial role in MS etiopathogenesis. METHODS We searched recent relevant literature on reputable databases, which include, PubMed, Embase, Web of Science, Scopus, and ScienceDirect using the following keywords: multiple sclerosis, pathogenesis, autoimmunity, demyelination, therapy, and immunotherapy. RESULTS Various animal models have been employed to investigate the MS etiopathogenesis and therapeutics. Autoreactive T cells within the CNS recruit myeloid cells through chemokine expression, leading to the secretion of inflammatory cytokines driving the MS pathogenesis, resulting in demyelination, gliosis, and axonal loss. Key players include T cell lymphocytes (CD4+ and CD8+), B cells, and neutrophils. Signaling dysregulation in inflammatory pathways and the immunogenetic basis of MS are essential considerations for any successful therapy to MS. Data indicates that B cells and neutrophils also have significant roles in MS, despite the common belief that T cells are essential. High neutrophil-to-lymphocyte ratios correlate with MS severity, indicating their contribution to disease progression. Dysregulated signaling pathways further exacerbate MS progression. CONCLUSION MS remains incurable, but disease-modifying therapies, monoclonal antibodies, and immunomodulatory drugs offer hope for patients. Research on the immunogenetics and immunoregulatory functions of gut microbiota is continuing to provide light on possible treatment avenues. Understanding the complex interplay between genetic predisposition, environmental factors, and immune dysregulation is critical for developing effective treatments for MS.
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Affiliation(s)
- Mansur Aliyu
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, International Campus, TUMS-IC, Tehran, Iran
- Department of Medical Microbiology, Faculty of Clinical Science, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Fatema Tuz Zohora
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Ayca Ceylan
- Medical Faculty, Department of Pediatrics, Division of Immunology and Allergy, Selcuk University, Konya, Turkey
| | - Fariha Hossain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Reza Yazdani
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gholamreza Azizi
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
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Amirkhani N, Khalaji A, Alehossein P, Safaei M, Aletaha N, Miroliaee A. Drug-induced liver injury by glatiramer acetate leading to liver transplant: A case report. JGH Open 2023; 7:591-593. [PMID: 37649866 PMCID: PMC10463015 DOI: 10.1002/jgh3.12938] [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: 04/20/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 09/01/2023]
Abstract
Glatiramer acetate (GA) is a widely used immune-modulating drug in relapsing multiple sclerosis (MS). Although a few cases of drug-induced liver injury during GA therapy have been reported earlier, herein we present the case of a 43-year-old woman with relapsing MS who experienced acute liver failure after GA therapy, ultimately leading to liver transplant.
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Affiliation(s)
- Nikan Amirkhani
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Amirmohammad Khalaji
- School of MedicineTehran University of Medical SciencesTehranIran
- Non‐communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Parsa Alehossein
- School of MedicineTehran University of Medical SciencesTehranIran
- Neuroscience Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Masoomeh Safaei
- Department of Pathology, Cancer Institute, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Najme Aletaha
- Division of Gastroenterology and Hepatology, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Arash Miroliaee
- Division of Gastroenterology and Hepatology, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
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3
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Ma X, Ma R, Zhang M, Qian B, Wang B, Yang W. Recent Progress in Multiple Sclerosis Treatment Using Immune Cells as Targets. Pharmaceutics 2023; 15:pharmaceutics15030728. [PMID: 36986586 PMCID: PMC10057470 DOI: 10.3390/pharmaceutics15030728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune-mediated demyelinating disease of the central nervous system. The main pathological features are inflammatory reaction, demyelination, axonal disintegration, reactive gliosis, etc. The etiology and pathogenesis of the disease have not been clarified. The initial studies believed that T cell-mediated cellular immunity is the key to the pathogenesis of MS. In recent years, more and more evidence has shown that B cells and their mediated humoral immune and innate immune cells (such as microglia, dendritic cells, macrophages, etc.) also play an important role in the pathogenesis of MS. This article mainly reviews the research progress of MS by targeting different immune cells and analyzes the action pathways of drugs. The types and mechanisms of immune cells related to the pathogenesis are introduced in detail, and the mechanisms of drugs targeting different immune cells are discussed in depth. This article aims to clarify the pathogenesis and immunotherapy pathway of MS, hoping to find new targets and strategies for the development of therapeutic drugs for MS.
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Affiliation(s)
- Xiaohong Ma
- Department of Neuroscience, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
- The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou 450046, China
| | - Rong Ma
- School of Pharmaceutical Sciences, Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases, Zhengzhou University, Zhengzhou 450001, China
| | - Mengzhe Zhang
- School of Pharmaceutical Sciences, Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases, Zhengzhou University, Zhengzhou 450001, China
| | - Baicheng Qian
- Department of Neuroscience, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
| | - Baoliang Wang
- Department of Neuroscience, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
- Correspondence: (B.W.); (W.Y.)
| | - Weijing Yang
- School of Pharmaceutical Sciences, Henan Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases, Zhengzhou University, Zhengzhou 450001, China
- Correspondence: (B.W.); (W.Y.)
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4
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Koc Ü, Haupeltshofer S, Klöster K, Demir S, Gold R, Faissner S. Prophylactic Glatiramer Acetate Treatment Positively Attenuates Spontaneous Opticospinal Encephalomyelitis. Cells 2023; 12:cells12040542. [PMID: 36831209 PMCID: PMC9954767 DOI: 10.3390/cells12040542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Background: Glatiramer acetate (GA) is a well-established treatment option for patients with clinically isolated syndrome and relapsing-remitting multiple sclerosis (MS) with few side effects. The double transgenic mouse model spontaneous opticospinal encephalomyelitis (OSE), based on recombinant myelin oligodendrocyte glycoprotein35-55 reactive T and B cells, mimicks features of chronic inflammation and degeneration in MS and related disorders. Here, we investigated the effects of prophylactic GA treatment on the clinical course, histological alterations and peripheral immune cells in OSE. Objective: To investigate the effects of prophylactic glatiramer acetate (GA) treatment in a mouse model of spontaneous opticospinal encephalomyelitis (OSE). Methods: OSE mice with a postnatal age of 21 to 28 days without signs of encephalomyelitis were treated once daily either with 150 µg GA or vehicle intraperitoneally (i. p.). The animals were scored daily regarding clinical signs and weight. The animals were sacrificed after 30 days of treatment or after having reached a score of 7.0 due to animal care guidelines. We performed immunohistochemistry of spinal cord sections and flow cytometry analysis of immune cells. Results: Preventive treatment with 150 µg GA i. p. once daily significantly reduced clinical disease progression with a mean score of 3.9 ± 1.0 compared to 6.2 ± 0.7 in control animals (p < 0.01) after 30 d in accordance with positive effects on weight (p < 0.001). The immunohistochemistry showed that general inflammation, demyelination or CD11c+ dendritic cell infiltration did not differ. There was, however, a modest reduction of the Iba1+ area (p < 0.05) and F4/80+ area upon GA treatment (p < 0.05). The immune cell composition of secondary lymphoid organs showed a trend towards an upregulation of regulatory T cells, which lacked significance. Conclusions: Preventive treatment with GA reduces disease progression in OSE in line with modest effects on microglia/macrophages. Due to the lack of established prophylactic treatment options for chronic autoimmune diseases with a high risk of disability, our study could provide valuable indications for translational medicine.
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Affiliation(s)
| | | | | | | | | | - Simon Faissner
- Correspondence: ; Tel.: +49-234-5092411; Fax: +49-234-5092414
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5
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Wang L, Wei X. T Cell-Mediated Autoimmunity in Glaucoma Neurodegeneration. Front Immunol 2022; 12:803485. [PMID: 34975917 PMCID: PMC8716691 DOI: 10.3389/fimmu.2021.803485] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023] Open
Abstract
Glaucoma as the leading neurodegenerative disease leads to blindness in 3.6 million people aged 50 years and older worldwide. For many decades, glaucoma therapy has primarily focused on controlling intraocular pressure (IOP) and sound evidence supports its role in delaying the progress of retinal ganglial cell (RGC) damage and protecting patients from vision loss. Meanwhile, accumulating data point to the immune-mediated attack of the neural retina as the underlying pathological process behind glaucoma that may come independent of raised IOP. Recently, some scholars have suggested autoimmune aspects in glaucoma, with autoreactive T cells mediating the chief pathogenic process. This autoimmune process, as well as the pathological features of glaucoma, largely overlaps with other neurodegenerative diseases in the central nervous system (CNS), including Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis. In addition, immune modulation therapy, which is regarded as a potential solution for glaucoma, has been boosted in trials in some CNS neurodegenerative diseases. Thus, novel insights into the T cell-mediated immunity and treatment in CNS neurodegenerative diseases may serve as valuable inspirations for ophthalmologists. This review focuses on the role of T cell-mediated immunity in the pathogenesis of glaucoma and discusses potential applications of relevant findings of CNS neurodegenerative diseases in future glaucoma research.
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Affiliation(s)
- Lixiang Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, Shangjin Nanfu Hospital, Chengdu, China
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Rieckmann P, Zivadinov R, Boyko A, Selmaj K, Alexander JK, Kadosh S, Rubinchick S, Bernstein-Hanlon E, Stark Y, Ashtamker N, Davis MD, Khan O. Long-term efficacy and safety of three times weekly dosing regimen of glatiramer acetate in relapsing multiple sclerosis patients: Seven-year results of the Glatiramer Acetate Low-frequency Administration (GALA) open-label extension study. Mult Scler J Exp Transl Clin 2021; 7:20552173211061550. [PMID: 34925876 PMCID: PMC8671685 DOI: 10.1177/20552173211061550] [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: 06/17/2021] [Accepted: 11/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Describe the long-term outcomes of early-start (ES) and delayed-start (DS) glatiramer acetate 40 mg/mL treatment three times weekly (GA40) for up to seven years in the Glatiramer Acetate Low-frequency Administration (GALA) study in patients with relapsing multiple sclerosis (RMS). Methods Patients were evaluated every three to six months. The primary efficacy endpoint was annualized relapse rate (ARR); additional endpoints were exploratory or post hoc. For efficacy, data from the entire exposure period were used for the ES and DS cohorts. For safety, exposure only under GA40 was considered. Results Of the patients who continued into the open-label extension (OLE), 580/834 (70%) ES and 261/419 (62%) DS completed the OLE. For the entire placebo-controlled and OLE study period, ARR was 0.26 for ES and 0.31 for DS patients (risk ratio = 0.83; 95% confidence interval [CI]: 0.70–0.99). ES prolonged median time to first relapse versus DS (4.9 versus 4.3 years; hazard ratio = 0.82; 95% CI: 0.6–0.96). OLE-only results showed DS patients experienced similar efficacy for relapse and disability outcomes as ES patients. Adverse events were consistent with the well-established GA safety profile. Conclusions GA40 treatment conferred clinical benefit up to seven years, resulting in sustained efficacy and was generally well tolerated in RMS patients.
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Affiliation(s)
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, NY, USA
| | - Alexey Boyko
- Federal Centre of Brain Research and Neurotechnology, Moscow, Russia
| | - Krzysztof Selmaj
- Department of Neurology, University of Warmia and Mazury, Olszytn and Center of Neurology, Lodz, Poland
| | | | | | | | | | | | | | | | - Omar Khan
- Wayne State University, Detroit, MI, USA
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Zarzuelo-Romero MJ, Pérez-Ramírez C, Cura Y, Carrasco-Campos MI, Marangoni-Iglecias LM, Ramírez-Tortosa MC, Jiménez-Morales A. Influence of Genetic Polymorphisms on Clinical Outcomes of Glatiramer Acetate in Multiple Sclerosis Patients. J Pers Med 2021; 11:jpm11101032. [PMID: 34683173 PMCID: PMC8540092 DOI: 10.3390/jpm11101032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of autoimmune origin, in which inflammation and demyelination lead to neurodegeneration and progressive disability. Treatment is aimed at slowing down the course of the disease and mitigating its symptoms. One of the first-line treatments used in patients with MS is glatiramer acetate (GA). However, in clinical practice, a response rate of between 30% and 55% is observed. This variability in the effectiveness of the medication may be influenced by genetic factors such as polymorphisms in the genes involved in the pathogenesis of MS. Therefore, this review assesses the impact of genetic variants on the response to GA therapy in patients diagnosed with MS. The results suggest that a relationship exists between the effectiveness of the treatment with GA and the presence of polymorphisms in the following genes: CD86, CLEC16A, CTSS, EOMES, MBP, FAS, TRBC1, IL1R1, IL12RB2, IL22RA2, PTPRT, PVT1, ALOX5AP, MAGI2, ZAK, RFPL3, UVRAG, SLC1A4, and HLA-DRB1*1501. Consequently, the identification of polymorphisms in these genes can be used in the future as a predictive marker of the response to GA treatment in patients diagnosed with MS. Nevertheless, there is a lack of evidence for this and more validation studies need to be conducted to apply this information to clinical practice.
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Affiliation(s)
- María José Zarzuelo-Romero
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Granada, 18001 Granada, Spain;
| | - Cristina Pérez-Ramírez
- Center of Biomedical Research, Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Avda. del Conocimiento s/n., 18016 Armilla, Granada, Spain;
- Pharmacogenetics Unit, Pharmacy Service, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (Y.C.); (M.I.C.-C.); (L.M.M.-I.); (A.J.-M.)
- Correspondence:
| | - Yasmín Cura
- Pharmacogenetics Unit, Pharmacy Service, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (Y.C.); (M.I.C.-C.); (L.M.M.-I.); (A.J.-M.)
| | - María Isabel Carrasco-Campos
- Pharmacogenetics Unit, Pharmacy Service, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (Y.C.); (M.I.C.-C.); (L.M.M.-I.); (A.J.-M.)
| | - Luciana María Marangoni-Iglecias
- Pharmacogenetics Unit, Pharmacy Service, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (Y.C.); (M.I.C.-C.); (L.M.M.-I.); (A.J.-M.)
| | - María Carmen Ramírez-Tortosa
- Center of Biomedical Research, Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology “José Mataix”, University of Granada, Avda. del Conocimiento s/n., 18016 Armilla, Granada, Spain;
| | - Alberto Jiménez-Morales
- Pharmacogenetics Unit, Pharmacy Service, Virgen de las Nieves University Hospital, 18012 Granada, Spain; (Y.C.); (M.I.C.-C.); (L.M.M.-I.); (A.J.-M.)
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Therapeutic Value of Single Nucleotide Polymorphisms on the Efficacy of New Therapies in Patients with Multiple Sclerosis. J Pers Med 2021; 11:jpm11050335. [PMID: 33922540 PMCID: PMC8146426 DOI: 10.3390/jpm11050335] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 12/11/2022] Open
Abstract
The introduction of new therapies for the treatment of multiple sclerosis (MS) is a very recent phenomenon and little is known of their mechanism of action. Moreover, the response is subject to interindividual variability and may be affected by genetic factors, such as polymorphisms in the genes implicated in the pathologic environment, pharmacodynamics, and metabolism of the disease or in the mechanism of action of the medications, influencing the effectiveness of these therapies. This review evaluates the impact of pharmacogenetics on the response to treatment with new therapies in patients diagnosed with MS. The results suggest that polymorphisms detected in the GSTP1, ITGA4, NQO1, AKT1, and GP6 genes, for treatment with natalizumab, ZMIZ1, for fingolimod and dimethyl fumarate, ADA, for cladribine, and NOX3, for dimethyl fumarate, may be used in the future as predictive markers of treatment response to new therapies in MS patients. However, there are few existing studies and their samples are small, making it difficult to generalize the role of these genes in treatment with new therapies. Studies with larger sample sizes and longer follow-up are therefore needed to confirm the results of these studies.
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Giovannoni G, Brex PA, Dhiraj D, Fullarton J, Freddi M, Rodgers-Gray B, Schmierer K. Glatiramer acetate as a clinically and cost-effective treatment of relapsing multiple sclerosis over 10 years of use within the National Health Service: Final results from the UK Risk Sharing Scheme. Mult Scler J Exp Transl Clin 2019; 5:2055217319893103. [PMID: 31839981 PMCID: PMC6896140 DOI: 10.1177/2055217319893103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background The UK Risk Sharing Scheme (RSS) provided information on the effect of first-line multiple sclerosis (MS) disease-modifying treatments on long-term disability. Objective The aim is to provide results specific to glatiramer acetate (GA; Copaxone®) from the final 10-year analysis of the RSS. Methods A Markov model was used to assess clinical effectiveness measured as Expanded Disability Status Scale (EDSS) progression and utility loss. Untreated patients from the British Columbia MS cohort (1980-1995) were used as a 'virtual comparator' group. A separate Markov model assessed cost-effectiveness, based on a 50-year time horizon (with a 50% treatment waning effect imposed at 10 years) and using NHS list price (£513.95 per 28 days). Results were expressed in quality-adjusted life years (QALYs). Results In total, 755 patients with relapsing-remitting MS (RRMS) received GA, with a mean follow-up of 7.1 (standard deviation 1.3) years. EDSS progression was reduced by 23% (progression ratio 76.7, 95% confidence interval [CI] 69.0-84.3) and utility loss by 39% (progression ratio 61.0, 95% CI 52.7-69.3) compared with no treatment. There was no persistent waning in GA treatment effect over time (EDSS: p = 0.093; utilities: p = 0.119). The cost per QALY was £17,841. Conclusion GA had a beneficial effect on long-term disability and was a cost-effective treatment for RRMS.
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Affiliation(s)
- G Giovannoni
- Blizard Institute, Barts, and The London School of Medicine and Dentistry, Queen Mary University London, UK
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, UK
| | - P A Brex
- King's College Hospital NHS Foundation Trust, UK
| | | | | | | | | | - K Schmierer
- Blizard Institute, Barts, and The London School of Medicine and Dentistry, Queen Mary University London, UK
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, UK
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Skovdal SM, Christiansen SH, Johansen KS, Viborg O, Bruun NH, Jensen-Fangel S, Holm IE, Vorup-Jensen T, Petersen E. Inhaled nebulized glatiramer acetate against Gram-negative bacteria is not associated with adverse pulmonary reactions in healthy, young adult female pigs. PLoS One 2019; 14:e0223647. [PMID: 31600340 PMCID: PMC6786617 DOI: 10.1371/journal.pone.0223647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/25/2019] [Indexed: 11/18/2022] Open
Abstract
The developmental speed of new antimicrobials does not meet the emergence of multidrug-resistant bacteria sufficiently. A potential shortcut is assessing the antimicrobial activity of already approved drugs. Intrudingly, the antibacterial action of glatiramer acetate (GA) has recently been discovered. GA is a well-known and safe immunomodulatory drug particular effective against Gram-negative bacteria, which disrupts biological membranes by resembling the activity of antimicrobial peptides. Thus, GA can potentially be included in treatment strategies used to combat infections caused by multidrug-resistant Gram-negatives. One potential application is chronic respiratory infections caused by Pseudomonas aeruginosa, however the safety of GA inhalation has never been assessed. Here, the safety of inhaling nebulized GA is evaluated in a preclinical pig model. The potential side effects, i.e., bronchoconstriction, respiratory tract symptoms and systemic- and local inflammation were assessed by ventilator monitoring, clinical observation, biochemistry, flowcytometry, and histopathology. No signs of bronchoconstriction assessed by increased airway peak pressure, Ppeak, or decreased oxygen pressure were observed. Also, there were no signs of local inflammation in the final histopathology examination of the pulmonary tissue. As we did not observe any potential pulmonary side effects of inhaled GA, our preliminary results suggest that GA inhalation is safe and potentially can be a part of the treatment strategy targeting chronic lung infections caused by multidrug-resistant Gram-negative bacteria.
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Affiliation(s)
- Sandra M. Skovdal
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
- Interdisciplinary Nanoscience Center (iNANO), Faculty of Science and Technology, Aarhus University, Aarhus, Denmark
| | - Stig Hill Christiansen
- Biophysical Immunology Laboratory, Department of Biomedicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Ole Viborg
- Intensive Care Unit, Department of Anesthesiology, Aarhus University Hospital, Skejby, Denmark
| | - Niels Henrik Bruun
- Biostatistical Advisory Service (BIAS), Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Søren Jensen-Fangel
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | | | - Thomas Vorup-Jensen
- Biophysical Immunology Laboratory, Department of Biomedicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- * E-mail:
| | - Eskild Petersen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
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11
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Use of glatiramer acetate between 2010-2015: effectiveness, safety and reasons to start GA as first or second line treatment in Swiss multiple sclerosis patients. BMC Neurol 2019; 19:159. [PMID: 31299922 PMCID: PMC6626416 DOI: 10.1186/s12883-019-1383-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 06/27/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Glatiramer acetate (GA) is one of the first therapies approved for multiple sclerosis (MS). We prospectively included and monitored drug-naïve and pre-treated MS patients who had been prescribed GA for 1 year, to investigate reasons for GA prescription, its effectiveness and safety in real life clinical practice. METHODS One year, prospective, multicentre, observational study performed between 2010 and 2015 in consecutive MS and clinically isolated syndrome patients starting GA as a first ("naïve") or second ("switcher") line therapy. Primary endpoint was the annualized relapse rate (ARR) over 1 year of GA treatment (from baseline, V1, to 12 months, V2) in naïve and switchers compared to previous 24 months. Secondary endpoints were: EDSS changes between V1 and V2, frequency of adverse events, and reasons for prescribing and discontinuing GA. Baseline demographics and clinical characteristics were retrieved from medical records, and outcome measures were documented at V1 and V2, and in case of clinical worsening. RESULTS One hundred ninety-four consecutive patients were monitored over 12 months (N = 64 naïve, N = 130 switchers). Side effect profile (naïve = 36%, switchers = 28%) and comorbidities (naïve = 31%, switchers = 15%) were the most frequent reasons to start GA. The ARR was reduced in both naïve and switchers during V1-2 as compared to the 24 months preceding V1 [naïve: 0.0 (0.0-0.0) vs 0.5 (0.5-1.0, p = 2.9e-10); switchers: 0.0 (0.0-0.0) vs 0.5 (0.0-0.5, p = 0.022)]. EDSS at V2 was significantly reduced only in naïve [(1.5 (1.0-2.5) vs 2.0 (1.5-2.5), p = 0.003)]. Naïve status and EDSS at V1 were negatively associated with EDSS change between V1-V2 in multivariable analysis (regression coefficient = - 0.436, p = 0.008, and regression coefficient = - 0.263, p = 6.18e-05, respectively). No new unexpected AE was reported. CONCLUSION In our Swiss cohort, GA was prescribed mainly to naïve or switcher MS patients fearing interferon related side effects, with various comorbidities or considering pregnancy, and showed effectiveness and safety comparable with data of previous GA studies.
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12
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Fox EJ, Buckle GJ, Singer B, Singh V, Boster A. Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist. Neurol Clin Pract 2019; 9:53-63. [PMID: 30859008 PMCID: PMC6382377 DOI: 10.1212/cpj.0000000000000567] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose of review To provide neurologists with an update on the proposed mechanisms of action (MOAs) of disease-modifying therapies (DMTs) for the treatment of relapsing MS, and their effect on peripheral blood leukocytes, in order to inform treatment decisions. Recent findings DMTs have vastly differing MOAs, including effects on peripheral blood leukocyte counts, particularly lymphocytes. The clinical implications of changes in lymphocyte counts need to be understood in the context of the underlying MOAs of each respective DMT, with treatment tailored to individual patient needs. Summary DMTs can alter lymphocyte counts, subsets, activation, and distribution, and thus can influence immune surveillance. Serial monitoring of total leukocytes and absolute lymphocyte counts (ALCs) is advisable in patients receiving DMTs. ALCs should be interpreted regarding expected immunologic changes and individual patient characteristics. Any decision to switch DMTs should consider these factors, along with drug efficacy, safety, and effect on quality of life.
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Affiliation(s)
- Edward J Fox
- Multiple Sclerosis Clinic of Central Texas (EJF), Central Texas Neurology Consultants, Round Rock, TX; MS Institute at Shepherd Center (GJB), Atlanta, GA; The MS Center for Innovations in Care (BS), Missouri Baptist Medical Center, St Louis, MO; Indicia Medical Ltd. (VS), Part of the Fishawack Group of Companies, Hyderabad, India; and OhioHealth Multiple Sclerosis Center (AB), Riverside Methodist Hospital, Columbus, OH
| | - Guy J Buckle
- Multiple Sclerosis Clinic of Central Texas (EJF), Central Texas Neurology Consultants, Round Rock, TX; MS Institute at Shepherd Center (GJB), Atlanta, GA; The MS Center for Innovations in Care (BS), Missouri Baptist Medical Center, St Louis, MO; Indicia Medical Ltd. (VS), Part of the Fishawack Group of Companies, Hyderabad, India; and OhioHealth Multiple Sclerosis Center (AB), Riverside Methodist Hospital, Columbus, OH
| | - Barry Singer
- Multiple Sclerosis Clinic of Central Texas (EJF), Central Texas Neurology Consultants, Round Rock, TX; MS Institute at Shepherd Center (GJB), Atlanta, GA; The MS Center for Innovations in Care (BS), Missouri Baptist Medical Center, St Louis, MO; Indicia Medical Ltd. (VS), Part of the Fishawack Group of Companies, Hyderabad, India; and OhioHealth Multiple Sclerosis Center (AB), Riverside Methodist Hospital, Columbus, OH
| | - Vibhuti Singh
- Multiple Sclerosis Clinic of Central Texas (EJF), Central Texas Neurology Consultants, Round Rock, TX; MS Institute at Shepherd Center (GJB), Atlanta, GA; The MS Center for Innovations in Care (BS), Missouri Baptist Medical Center, St Louis, MO; Indicia Medical Ltd. (VS), Part of the Fishawack Group of Companies, Hyderabad, India; and OhioHealth Multiple Sclerosis Center (AB), Riverside Methodist Hospital, Columbus, OH
| | - Aaron Boster
- Multiple Sclerosis Clinic of Central Texas (EJF), Central Texas Neurology Consultants, Round Rock, TX; MS Institute at Shepherd Center (GJB), Atlanta, GA; The MS Center for Innovations in Care (BS), Missouri Baptist Medical Center, St Louis, MO; Indicia Medical Ltd. (VS), Part of the Fishawack Group of Companies, Hyderabad, India; and OhioHealth Multiple Sclerosis Center (AB), Riverside Methodist Hospital, Columbus, OH
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13
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Affiliation(s)
- Floriana De Angelis
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
| | - Nevin A John
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
| | - Wallace J Brownlee
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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14
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Gholamzad M, Ebtekar M, Ardestani MS, Azimi M, Mahmodi Z, Mousavi MJ, Aslani S. A comprehensive review on the treatment approaches of multiple sclerosis: currently and in the future. Inflamm Res 2018; 68:25-38. [DOI: 10.1007/s00011-018-1185-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/13/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022] Open
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15
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Vaughn C, Bushra A, Kolb C, Weinstock-Guttman B. An Update on the Use of Disease-Modifying Therapy in Pregnant Patients with Multiple Sclerosis. CNS Drugs 2018; 32:161-178. [PMID: 29508244 DOI: 10.1007/s40263-018-0496-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The active management of multiple sclerosis (MS) has been made possible during the last two decades with the advent of disease-modifying therapies (DMTs), leading to improved clinical outcomes for many patients. Furthermore, with the realization that MS does not adversely affect pregnancy outcome and that pregnancy does not have an overall negative impact on the long-term disease course of MS, the importance of appropriate counseling and discussion of future pregnancy plans with women of childbearing age is greater than ever. Although several DMTs are licensed for the treatment of MS, none are specifically approved for use during pregnancy or breastfeeding and the use of DMTs during these periods frequently gives rise to concerns regarding potential risks to the fetus. The outcomes of studies in patients with MS treated with DMTs during pregnancy and immediately postpartum have been the focus of several recently published papers. Given the high level of interest surrounding the prescribing of DMTs for MS patients of childbearing age, and the lack of clear guidance in this respect, the current review presents an up-to-date overview of new data, including observational data on real-world outcomes, that have been published during the last 2 years, and could inform future prescribing decisions.
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Affiliation(s)
- Caila Vaughn
- Department of Neurology, Jacobs MS Center for Treatment and Research, University at Buffalo, Buffalo, NY, USA.
| | - Aisha Bushra
- Department of Neurology, Jacobs MS Center for Treatment and Research, University at Buffalo, Buffalo, NY, USA
| | - Channa Kolb
- Department of Neurology, Jacobs MS Center for Treatment and Research, University at Buffalo, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs MS Center for Treatment and Research, University at Buffalo, Buffalo, NY, USA.
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16
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Sandberg-Wollheim M, Neudorfer O, Grinspan A, Weinstock-Guttman B, Haas J, Izquierdo G, Riley C, Ross AP, Baruch P, Drillman T, Coyle PK. Pregnancy Outcomes from the Branded Glatiramer Acetate Pregnancy Database. Int J MS Care 2018; 20:9-14. [PMID: 29507538 DOI: 10.7224/1537-2073.2016-079] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Appropriate counseling and treatment for women with multiple sclerosis (MS) who may become pregnant requires an understanding of the effects of exposure to disease-modifying therapies (DMTs) during pregnancy. Current reports and studies are limited in their usefulness, mostly by small sample size. Branded glatiramer acetate (GA) is a DMT approved for the treatment of relapsing forms of MS. For more than 2 decades, it has been shown to be efficacious and to have a favorable safety profile. The Teva Pharmaceutical Industries Ltd global pharmacovigilance database comprises data from more than 7000 pregnancies, during which women with MS were exposed to treatment with branded GA. Methods We analyzed data from Teva's global pharmacovigilance database. Pregnancy outcomes for patients treated with branded GA were compared with reference rates of abnormal pregnancy outcomes reported in two large registries representing the general population. Results Pregnancies exposed to branded GA were not at higher risk for congenital anomalies than what is expected in the general population. Conclusions These data provide evidence that branded GA exposure during pregnancy seems safe, without teratogenic effect.
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17
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Christiansen SH, Murphy RA, Juul-Madsen K, Fredborg M, Hvam ML, Axelgaard E, Skovdal SM, Meyer RL, Sørensen UBS, Möller A, Nyengaard JR, Nørskov-Lauritsen N, Wang M, Gadjeva M, Howard KA, Davies JC, Petersen E, Vorup-Jensen T. The Immunomodulatory Drug Glatiramer Acetate is Also an Effective Antimicrobial Agent that Kills Gram-negative Bacteria. Sci Rep 2017; 7:15653. [PMID: 29142299 PMCID: PMC5688084 DOI: 10.1038/s41598-017-15969-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/06/2017] [Indexed: 12/31/2022] Open
Abstract
Classic drug development strategies have failed to meet the urgent clinical needs in treating infections with Gram-negative bacteria. Repurposing drugs can lead to timely availability of new antibiotics, accelerated by existing safety profiles. Glatiramer acetate (GA) is a widely used and safe formulation for treatment of multiple sclerosis. It contains a large diversity of essentially isomeric polypeptides with the cationic and amphiphilic character of many antimicrobial peptides (AMP). Here, we report that GA is antibacterial, targeting Gram-negative organisms with higher activity towards Pseudomonas aeruginosa than the naturally-occurring AMP LL-37 in human plasma. As judged from flow cytometric assays, bacterial killing by GA occurred within minutes. Laboratory strains of Escherichia coli and P. aeruginosa were killed by a process of condensing intracellular contents. Efficient killing by GA was also demonstrated in Acinetobacter baumannii clinical isolates and approximately 50% of clinical isolates of P. aeruginosa from chronic airway infection in CF patients. By contrast, the Gram-positive Staphylococcus aureus cells appeared to be protected from GA by an increased formation of nm-scale particulates. Our data identify GA as an attractive drug repurposing candidate to treat infections with Gram-negative bacteria.
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Affiliation(s)
- Stig Hill Christiansen
- Biophysical Immunology Laboratory, Dept. of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Ronan A Murphy
- CF and Chronic Lung Infection, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kristian Juul-Madsen
- Biophysical Immunology Laboratory, Dept. of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Marlene Fredborg
- Dept. of Clinical Microbiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Michael Lykke Hvam
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark.,Dept. of Molecular Biology & Genetics, Aarhus University, Aarhus, Denmark
| | - Esben Axelgaard
- Biophysical Immunology Laboratory, Dept. of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Sandra M Skovdal
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark
| | - Rikke Louise Meyer
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark.,Dept. of Bioscience, Aarhus University, Aarhus, Denmark
| | - Uffe B Skov Sørensen
- Biophysical Immunology Laboratory, Dept. of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Arne Möller
- Dept. of Structural Biology, Max Planck Institute of Biophysics, Frankfurt, Germany
| | - Jens Randel Nyengaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Center for Stochastic Geometry and Advanced Bioimaging, Aarhus University, Aarhus, Denmark
| | - Niels Nørskov-Lauritsen
- Dept. of Clinical Microbiology, Aarhus University Hospital Skejby, Aarhus, Denmark.,Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mikala Wang
- Dept. of Clinical Microbiology, Aarhus University Hospital Skejby, Aarhus, Denmark.,Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mihaela Gadjeva
- Dept. of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth A Howard
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark.,Dept. of Molecular Biology & Genetics, Aarhus University, Aarhus, Denmark
| | - Jane C Davies
- CF and Chronic Lung Infection, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Dept. of Paediatric Respiratory Medicine, Royal Brompton & Harefield Foundation Trust, London, UK
| | - Eskild Petersen
- Dept. of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Aarhus University Network for Interdisciplinary Drug Resistance Research, Aarhus, Denmark.,Dept. of Infectious Diseases, The Royal Hospital, Muscat, Sultanate of Oman
| | - Thomas Vorup-Jensen
- Biophysical Immunology Laboratory, Dept. of Biomedicine, Aarhus University, Aarhus, Denmark. .,Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark. .,Aarhus University Network for Interdisciplinary Drug Resistance Research, Aarhus, Denmark.
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18
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Amrouche K, Jamin C. Influence of drug molecules on regulatory B cells. Clin Immunol 2017; 184:1-10. [DOI: 10.1016/j.clim.2017.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/27/2017] [Indexed: 02/07/2023]
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Ross CJ, Towfic F, Shankar J, Laifenfeld D, Thoma M, Davis M, Weiner B, Kusko R, Zeskind B, Knappertz V, Grossman I, Hayden MR. A pharmacogenetic signature of high response to Copaxone in late-phase clinical-trial cohorts of multiple sclerosis. Genome Med 2017; 9:50. [PMID: 28569182 PMCID: PMC5450152 DOI: 10.1186/s13073-017-0436-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/08/2017] [Indexed: 01/18/2023] Open
Abstract
Background Copaxone is an efficacious and safe therapy that has demonstrated clinical benefit for over two decades in patients with relapsing forms of multiple sclerosis (MS). On an individual level, patients show variability in their response to Copaxone, with some achieving significantly higher response levels. The involvement of genes (e.g., HLA-DRB1*1501) with high inter-individual variability in Copaxone’s mechanism of action (MoA) suggests the potential contribution of genetics to treatment response. This study aimed to identify genetic variants associated with Copaxone response in patient cohorts from late-phase clinical trials. Methods Single nucleotide polymorphisms (SNPs) associated with high and low levels of response to Copaxone were identified using genome-wide SNP data in a discovery cohort of 580 patients from two phase III clinical trials of Copaxone. Multivariable Bayesian modeling on the resulting SNPs in an expanded discovery cohort with 1171 patients identified a multi-SNP signature of Copaxone response. This signature was examined in 941 Copaxone-treated MS patients from seven independent late-phase trials of Copaxone and assessed for specificity to Copaxone in 310 Avonex-treated and 311 placebo-treated patients, also from late-phase trials. Results A four-SNP signature consisting of rs80191572 (in UVRAG), rs28724893 (in HLA-DQB2), rs1789084 (in MBP), and rs139890339 (in ZAK(CDCA7)) was identified as significantly associated with Copaxone response. Copaxone-treated signature-positive patients had a greater reduction in annualized relapse rate (ARR) compared to signature-negative patients in both discovery and independent cohorts, an effect not observed in Avonex-treated patients. Additionally, signature-positive placebo-treated cohorts did not show a reduction in ARR, demonstrating the predictive as opposed to prognostic nature of the signature. A 10% subset of patients, delineated by the signature, showed marked improvements across multiple clinical parameters, including ARR, MRI measures, and higher proportion with no evidence of disease activity (NEDA). Conclusions This study is the largest pharmacogenetic study in MS reported to date. Gene regions underlying the four-SNP signature have been linked with pathways associated with either Copaxone’s MoA or the pathophysiology of MS. The pronounced association of the four-SNP signature with clinical improvements in a ~10% subset of the MS patient population demonstrates the complex interplay of immune mechanisms and the individualized nature of response to Copaxone. Electronic supplementary material The online version of this article (doi:10.1186/s13073-017-0436-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colin J Ross
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | | | - Iris Grossman
- Teva Pharmaceutical Industries Ltd, Petach Tikva, Israel.
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20
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Yamamura T, Ashtamker N, Ladkani D, Fukazawa T, Houzen H, Tanaka M, Miura T, Knappertz V. Once-daily glatiramer acetate decreases magnetic resonance imaging disease activity in Japanese patients with relapsing-remitting multiple sclerosis. ACTA ACUST UNITED AC 2017; 8:129-137. [PMID: 28706565 PMCID: PMC5485168 DOI: 10.1111/cen3.12383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) prevalence, clinical patterns, and treatment responses vary between races and geographical latitudes. Glatiramer acetate (GA; Copaxone) has provided a safe, effective treatment option for relapsing-remitting MS patients in the USA, European nations, and other countries for decades. The objective of the present study was to assess the safety and efficacy of GA in reducing magnetic resonance imaging disease activity in Japanese patients with active relapsing-remitting MS. METHODS This phase 2, multicenter, open-label, single-arm, 52-week study measured the effect of GA 20 mg once-daily on magnetic resonance imaging disease activity. GA efficacy was evaluated through week 36, and safety through week 52. The primary end-point was change in the mean number of T1-weighted gadolinium-enhancing (GdE) lesions from pretreatment (weeks -8, -4 and baseline) to weeks 28, 32 and 36. Secondary end-points included a change in mean number of new T2-weighted lesions, GdE lesion and T2 lesion volumes, annualized relapse rate, and Expanded Disability Status Scale scores. RESULTS GA therapy reduced the number of new GdE lesions by 65.66% (95% CI 33.19-82.35%). The number of new T2 lesions and GdE lesion volume were also reduced from pretreatment. The annualized relapse rate was reduced by 42% compared with the 1 year before treatment. Changes in T2 lesion volume and Expanded Disability Status Scale scores were favorable, but less pronounced. Most common adverse events were injection-site reactions. CONCLUSIONS The present study confirmed the well-established safety, tolerability and efficacy profile of GA in Japanese MS patients.
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Affiliation(s)
- Takashi Yamamura
- Department of Immunology National Center of Neurology and Psychiatry National Institute of Neuroscience, and Multiple Sclerosis Center Tokyo Japan
| | - Natalia Ashtamker
- Research and Development Teva Pharmaceutical Industries Netanya Israel
| | - David Ladkani
- Research and Development Teva Pharmaceutical Industries Netanya Israel
| | | | - Hideki Houzen
- Department of Neurology Obihiro Kosei General Hospital Hokkaido Japan
| | - Masami Tanaka
- Multiple Sclerosis Center Kyoto Min-iren Chuo Hospital Kyoto Japan.,Department of Neurology Kaikoukai Josai Hospital Nagoya Japan.,Department of Neurology School of Medicine Fujita Health University Aichi Japan
| | - Toshiro Miura
- Research and Development Teva Pharmaceutical K.K. Tokyo Japan
| | - Volker Knappertz
- Research and Development Teva Pharmaceutical Industries Frazer PA USA.,Department of Neurology Heinrich Heine University Düsseldorf Germany
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21
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A Potential Life-Threatening Reaction to Glatiramer Acetate in Rett Syndrome. Pediatr Neurol 2017; 68:40-43. [PMID: 28254244 DOI: 10.1016/j.pediatrneurol.2016.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/23/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rett syndrome is an X-linked dominant neurodevelopmental disorder manifesting with severe intellectual disability in females caused by various mutations in the MECP2 gene. Brain-derived neurotrophic factor (BDNF) is one of the main proteins regulated by the MECP2 protein; its overexpression in the MeCP2 mouse model partially corrects the Rett phenotype. Pharmacologic manipulations that lead to increased BDNF in individuals with Rett syndrome are expected to have a positive effect on the disorder. Glatiramer acetate, a well-known and safe multiple sclerosis immune modulator, increases BDNF levels in multiple sclerosis animal models and patients responding to treatment, as well as in Rett mouse models. METHODS Fourteen patients with mutation-proven Rett syndrome were recruited for a clinical trial with glatiramer acetate. Baseline data and follow-up data were collected during the trial, which had to be stopped because of a severe adverse event. Our objective is to describe this unexpected potentially life-threatening event in response to glatiramer in patients with Rett syndrome. RESULTS Four of 14 patients with Rett syndrome who were recruited and treated with daily injections of glatiramer acetate as part of an open-label clinical trial developed an exaggerated immediate postinjection response, which was experienced as life threatening in three of the patients, necessitating arrest of the trial. CONCLUSION Despite the known safety profile of glatiramer acetate in adult and pediatric patients with multiple sclerosis, its use in Rett syndrome should be cautiously reconsidered. The described severe adverse event can be related to these patients' primary autonomic nervous system dysfunction.
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22
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Davis MD, Ashtamker N, Steinerman JR, Knappertz V. Time course of glatiramer acetate efficacy in patients with RRMS in the GALA study. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e327. [PMID: 28210662 PMCID: PMC5299631 DOI: 10.1212/nxi.0000000000000327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/27/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the time to efficacy onset of glatiramer acetate (GA) 40 mg/mL 3-times-weekly formulation (GA40). METHODS This post hoc analysis of data from the 1-year, double-blind, placebo-controlled phase of the Glatiramer Acetate Low-Frequency Administration study (NCT01067521) of GA40 in patients with relapsing-remitting MS (RRMS) sought to determine the timing of efficacy onset using a novel data-censoring approach. RESULTS Compared with placebo-treated patients, those receiving GA40 exhibited a >30% reduction in the accumulated annualized relapse rate (ARR) within 2 months of initiating treatment and generally sustained this treatment difference during the 1-year study. Similarly, the proportion of GA40-treated patients who remained relapse-free was distinctly greater by month 2 and continued to increase up to a 10.8% difference at the end of the study. In addition, GA40 treatment was associated with a significant reduction in the number of gadolinium-enhancing T1 lesions and new/enlarging T2 lesions by month 6, with full treatment effect observed after 1 year. CONCLUSIONS GA40 contributes to efficacy within 2 months of the start of treatment in patients with RRMS. These results are consistent with the observed time to efficacy onset for patients treated with GA 20 mg/mL daily in previous randomized, placebo-controlled clinical trials. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with RRMS, a 3-times-weekly formulation of GA 40 mg/mL leads to a >30% reduction in the ARR within 2 months.
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Affiliation(s)
- Mat D Davis
- Teva Pharmaceutical Industries (M.D.D., J.R.S., V.K.), Frazer, PA; Teva Pharmaceutical Industries (N.A.), Netanya, Israel; and Heinrich-Heine Universität Düsseldorf (V.K.), Germany
| | - Natalia Ashtamker
- Teva Pharmaceutical Industries (M.D.D., J.R.S., V.K.), Frazer, PA; Teva Pharmaceutical Industries (N.A.), Netanya, Israel; and Heinrich-Heine Universität Düsseldorf (V.K.), Germany
| | - Joshua R Steinerman
- Teva Pharmaceutical Industries (M.D.D., J.R.S., V.K.), Frazer, PA; Teva Pharmaceutical Industries (N.A.), Netanya, Israel; and Heinrich-Heine Universität Düsseldorf (V.K.), Germany
| | - Volker Knappertz
- Teva Pharmaceutical Industries (M.D.D., J.R.S., V.K.), Frazer, PA; Teva Pharmaceutical Industries (N.A.), Netanya, Israel; and Heinrich-Heine Universität Düsseldorf (V.K.), Germany
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23
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Boyko AN, Alifirova VM. Efficacy, safety and tolerability of glatiramer acetate injections in dose 40 mg/ml in patients with relapsing-remitting multiple sclerosis. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:135-139. [DOI: 10.17116/jnevro2017117111135-139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Galán Sánchez-Seco V, Casanova-Peño I, Álvarez-Lafuente R, Sánchez-Jiménez M, García-Martínez Á, Domínguez-Mozo MI, Arias-Leal AM, García-Montojo M, Arroyo-González R. Fingolimod Use for the Treatment of Multiple Sclerosis in a Clinical Practice Setting in Madrid. Clin Neuropharmacol 2016; 40:29-33. [PMID: 27879549 DOI: 10.1097/wnf.0000000000000196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the effectiveness and safety of fingolimod use in a Spanish clinical practice setting. METHODS Retrospective study with multiple sclerosis patients who received at least 1 fingolimod dose between January 2004 and January 2015. Effectiveness and safety data were collected during the entire treatment of each patient. Analysis was performed for the total population and stratified according to prior treatment, sex, and age at treatment initiation. RESULTS A total of 167 patients were included, 50.9% had prior immunomodulator use, 33.5% natalizumab use, and 15.6% were naive patients. The annual relapse rate (ARR) decreased for the total population at month 12 (62%) and month 24 (84%) (P < 0.0001, in both cases); for naive patients (P < 0.05) and patients with prior immunomodulator use (P < 0.0001); for patients with prior natalizumab use, the ARR kept low after treatment initiation (0.23). After 24 months, the proportion of relapse-free patients was 70% or greater and disability progression-free patients was 80% or greater. No significant differences were observed when the results were compared by prior treatment, sex, or age. Thirty-two patients (19.2%) reported adverse drug reactions and 9.6% discontinued: 4.8% due to adverse drug reactions and 4.8% for lack of effectiveness. CONCLUSIONS The results support fingolimod use due to clinical effectiveness, tolerability, and ease of administration.
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Affiliation(s)
- Victoria Galán Sánchez-Seco
- *Hospital Universitario Príncipe de Asturias, Servicio de Neurología, Alcalá de Henares; †Hospital Universitario de Torrejón, Servicio de Neurología, Torrejón de Ardoz; ‡Instituto de Investigación Sanitaria del Hopsital Clínico San Carlos (IdISSC); and §Hospital Universitario Quirón Madrid, Servicio de Neurología, Madrid, Spain
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Coclitu C, Constantinescu CS, Tanasescu R. The future of multiple sclerosis treatments. Expert Rev Neurother 2016; 16:1341-1356. [DOI: 10.1080/14737175.2016.1243056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Yokoyama K, Hattori N. Immunomodulatory effects of glatiramer acetate as they relate to stage-specific immune dysregulation in multiple sclerosis. Nihon Yakurigaku Zasshi 2016; 148:105-20. [PMID: 27478050 DOI: 10.1254/fpj.148.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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