Tuberculosis and Biologic Therapies: Anti-Tumor Necrosis Factor-α and Beyond

Biologic drugs have revolutionized the treatment of certain hematologic, autoimmune, and malignant diseases, but they may place patients at risk for reactivation or acquisition of tuberculosis. This risk is highest with the tumor necrosis factor-alpha (TNF-α) inhibitors. Amongst this class of drugs, the monoclonal antibodies (infliximab, adalimumab, golimumab) and antibody fragment (certolizumab) carry an increased risk compared to the soluble receptor fusion molecule, etanercept. Treatment of latent TB is critical to decrease the risk of reactivation. Data continues to emerge regarding tuberculosis risk associated with novel biologics targeting cytokines involved in tuberculosis control.

[Changes in the quality of life in patients with multiple sclerosis treated with ocrelizumab]

AIM

To study the quality of life (QoL) in patients with multiple sclerosis (MS) treated with ocrelizumab for at least 12 months.

MATERIAL AND METHODS

Thirty-eight patients were observed, including 13 with primary progressive MS (PPMS), 15 with highly active relapsing-remitting MS (HAMS) and 10 with secondary progressive MS (SPMS) with relapses. QoL was studied using unspecific SF-36 and MS-specific MusiQoL questionnaires. Depression and fatigue were assessed with the Beck Depression Scale (BDS) and the Modified Fatigue Impact Scale (MFIS).

RESULTS AND CONCLUSION

Basic characteristics of QoL indexes of the patients were similar to those previously reported for these MS variants. After 6 and 12 months, a significant increase in the indexes of the majority of SF-36 and MusiQoL scales was identified that shows a significant improvement in both physical and psychological domains of QoL. The significant and rapid decrease in depression severity after 6-month treatment with ocrelizumab may at least in part be associated with improvement of indexes of vitality, general health, social relations and the total QoL score.

Real-world study of efficacy, risk management and reasons for discontinuation of natalizumab for treatment of multiple sclerosis in Russia

Background

NTZ is approved in Russia for the treatment of highly active relapsing remitting multiple sclerosis and is reimbursed via federal budget program. However, no data about NTZ treatment in Russia and the effect of federal reimbursement have been performed so far.

Objective

To characterize the population of patients receiving natalizumab and assess the efficacy and risk-management plan (RMP) implementation of NTZ therapy in routine clinical practice in Russia.

Methods

We analyzed data for 334 patients, who received at least one infusion of NTZ. Relapse rate, MRI activity, NEDA-3 status after 2 years were assessed. Anti-JC virus antibodies status and RMP implementation were evaluated. Drop-out rate and reasons for therapy discontinuation were analyzed.

Results

Patients switched to natalizumab in Russia are mainly female (63%), with median EDSS score of 3.5 and high disease activity: 93% had at least 1 relapse and 58% had both T1Gd+ and new T2 lesion a year before therapy initiation. Introduction of federal reimbursement allowed patients with less relapses to start therapy with natalizumab. The only predictor of 6-month progression was EDSS score at the baseline of therapy (HR = 2.1375, 95%CI 1.0026–4.5570, p = 0.0492). 82% patients reached NEDA-3 at 24 month of therapy. 25% of patients discontinued NTZ for reasons: tolerability (14.5%), JCV antibody status (61%), and patient’s decision (17%). RMP was implemented in only 36% patients.

Conclusion

Natalizumab appeared to have high efficacy in Russian clinical practice. Federal reimbursement allowed less active patients to start natalizumab. More efforts should be done to improve RMP implementation.

[The influence of catecholamines on Th17-cells in multiple sclerosis]

AIM

Тo investigate the possible association between clinical characteristics of multiple sclerosis (MS), quantitative and qualitative characteristics of Th17, dopamine and norepinephrine concentrations in the serum in patients with multiple sclerosis (MS).

MATERIAL AND METHODS

A comprehensive neurological and immunological examination of 43 patients with relapsing-remitting-MS (RR-MS) was performed. All patients were subjected to a standard neurological examination with assessment of the EDSS score. Dopamine and norepinephrine concentrations in serum were measured by enzyme-linked immunosorbent assay (ELISA). Percentage of Th17-cells was determined by flow cytometry. The functional activity of Th17- and Th1-cells was assessed by the production of interleukin-17 (IL-17) and interferon-gamma (IFN-γ), respectively, by peripheral blood mononuclear cells (PBMC) stimulated with microbeads coated with anti-CD3 and anti-CD28-antibodies.

RESULTS

The percent Th17-cells and cytokine production was significantly higher in MS patients with the exacerbation of disease than in the control group or remission, while the dopamine level was lower. Norepinephrine levels in MS patients in the acute stage and remission were comparable, but nevertheless, reliably lower than in the control group.

CONCLUSION

The results suggest the inhibitory effect of catecholamines on Th17 cells.