1
|
Cauwels A, Van Lint S, Rogge E, Verhee A, Van Den Eeckhout B, Pang S, Prinz M, Kley N, Uzé G, Tavernier J. Targeting IFN activity to both B cells and plasmacytoid dendritic cells induces a robust tolerogenic response and protection against EAE. Sci Rep 2021; 11:21575. [PMID: 34732771 PMCID: PMC8566508 DOI: 10.1038/s41598-021-00891-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023] Open
Abstract
Type I Interferon (IFN) was the very first drug approved for the treatment of Multiple Sclerosis (MS), and is still frequently used as a first line therapy. However, systemic IFN also causes considerable side effects, affecting therapy adherence and dose escalation. In addition, the mechanism of action of IFN in MS is multifactorial and still not completely understood. Using AcTaferons (Activity-on-Target IFNs, AFNs), optimized IFN-based immunocytokines that allow cell-specific targeting, we have previously demonstrated that specific targeting of IFN activity to dendritic cells (DCs) can protect against experimental autoimmune encephalitis (EAE), inducing in vivo tolerogenic protective effects, evidenced by increased indoleamine-2,3-dioxygenase (IDO) and transforming growth factor β (TGFβ) release by plasmacytoid (p) DCs and improved immunosuppressive capacity of regulatory T and B cells. We here report that targeting type I IFN activity specifically towards B cells also provides strong protection against EAE, and that targeting pDCs using SiglecH-AFN can significantly add to this protective effect. The superior protection achieved by simultaneous targeting of both B lymphocytes and pDCs correlated with improved IL-10 responses in B cells and conventional cDCs, and with a previously unseen very robust IDO response in several cells, including all B and T lymphocytes, cDC1 and cDC2.
Collapse
Affiliation(s)
- Anje Cauwels
- Cytokine Receptor Laboratory, VIB Medical Biotechnology Center, Ghent University, A. Baertsoenkaai 3, 9000, Ghent, Belgium. .,Orionis Biosciences, 9052, Ghent, Belgium.
| | - Sandra Van Lint
- Cytokine Receptor Laboratory, VIB Medical Biotechnology Center, Ghent University, A. Baertsoenkaai 3, 9000, Ghent, Belgium
| | - Elke Rogge
- Cytokine Receptor Laboratory, VIB Medical Biotechnology Center, Ghent University, A. Baertsoenkaai 3, 9000, Ghent, Belgium.,Orionis Biosciences, 9052, Ghent, Belgium
| | - Annick Verhee
- Cytokine Receptor Laboratory, VIB Medical Biotechnology Center, Ghent University, A. Baertsoenkaai 3, 9000, Ghent, Belgium
| | - Bram Van Den Eeckhout
- Cytokine Receptor Laboratory, VIB Medical Biotechnology Center, Ghent University, A. Baertsoenkaai 3, 9000, Ghent, Belgium
| | - Shengru Pang
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Marco Prinz
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.,BIOSS Centre for Biological Signalling Studies, University of Freiburg, 79106, Freiburg, Germany
| | - Niko Kley
- Orionis Biosciences, 9052, Ghent, Belgium
| | - Gilles Uzé
- CNRS UMR 5235, University Montpellier, 34095, Montpellier, France
| | - Jan Tavernier
- Cytokine Receptor Laboratory, VIB Medical Biotechnology Center, Ghent University, A. Baertsoenkaai 3, 9000, Ghent, Belgium. .,Orionis Biosciences, 9052, Ghent, Belgium.
| |
Collapse
|
2
|
Tobias Z, Esther D, Niklas S, Dennis W, Alexander W, Helmut R, Michael H, Fahmy AD, Stefanie M, Fritz L, Thomas B, Gabriel B, Klaus ZU, Paulus R. Rituximab versus mitoxantrone: comparing effectiveness and safety in advanced relapsing multiple sclerosis. Ther Adv Chronic Dis 2021; 12:20406223211024366. [PMID: 34377385 PMCID: PMC8323410 DOI: 10.1177/20406223211024366] [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: 02/23/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Rituximab (RTX), a CD20 depleting agent, is a frequently used off-label treatment for multiple sclerosis (MS), while mitoxantrone (MTX) is approved, albeit rarely used for active relapsing MS (RMS). However, observational data comparing RTX and MTX effectiveness and safety are scarce. Objective: We aimed to compare effectiveness and safety of MTX and RTX in patients with active RMS. Methods: From combined retrospective clinical data of three MS centers, we selected patients who had received at least one infusion of RTX or MTX and had at least a 6-month clinical follow-up available. Treatment groups were compared by propensity score (PS)-adjusted regression and inverse PS-weighted generalized estimated equation models regarding disability progression, relapse activity, and adverse events (AEs). Results: We included 292 RMS patients (mean age 41.8 years, 71.6% female) who received RTX (119 patients, mean age 36.8 years, 74.8% female) or MTX (173 patients mean age 45.3 years, 69.4% female). Using both PS methods, we did not find a significant effect favoring RTX or MTX treatment regarding the probability of disability worsening or relapse occurrence. However, RTX treatment was associated with a significantly lower probability of severe AEs and AEs. Conclusions: RTX shows comparable effectiveness but a favorable safety profile compared with MTX in active RMS.
Collapse
Affiliation(s)
- Zrzavy Tobias
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Daniels Esther
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Stuka Niklas
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Weber Dennis
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Rauschka Helmut
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders and Diseases, Klinik Donaustadt, Vienna, Austria
| | - Hecker Michael
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Aboulenein-Djamshidian Fahmy
- Department of Neurology, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders and Diseases, Klinik Donaustadt, Vienna, Austria
| | - Meister Stefanie
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Leutmezer Fritz
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Berger Thomas
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Bsteh Gabriel
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Zettl Uwe Klaus
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Rommer Paulus
- Department of Neurology, Medical University of Vienna, Vienna, Austria Department of Neurology, Rostock University Medical Center, Rostock, Germany
| |
Collapse
|
3
|
Jonker MF, Donkers B, Goossens LMA, Hoefman RJ, Jabbarian LJ, de Bekker-Grob EW, Versteegh MM, Harty G, Wong SL. Summarizing Patient Preferences for the Competitive Landscape of Multiple Sclerosis Treatment Options. Med Decis Making 2020; 40:198-211. [PMID: 32065023 DOI: 10.1177/0272989x19897944] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective. Quantitatively summarize patient preferences for European licensed relapsing-remitting multiple sclerosis (RRMS) disease-modifying treatment (DMT) options. Methods. To identify and summarize the most important RRMS DMT characteristics, a literature review, exploratory physician interviews, patient focus groups, and confirmatory physician interviews were conducted in Germany, the United Kingdom, and the Netherlands. A discrete choice experiment (DCE) was developed and executed to measure patient preferences for the most important DMT characteristics. The resulting DCE data (n=799 and n=363 respondents in the United Kingdom and Germany, respectively) were analyzed using Bayesian mixed logit models. The estimated individual-level patient preferences were subsequently summarized using 3 additional analyses: the quality of the choice data was assessed using individual-level R2 estimates, individual-level preferences for the available DMTs were aggregated into DMT-specific preference shares, and a principal component analysis was performed to explain the patients' choice process. Results. DMT usage differed between RRMS patients in Germany and the United Kingdom but aggregate patient preferences were similar. Across countries, 42% of all patients preferred oral medications, 38% infusions, 16% injections, and 4% no DMT. The most often preferred DMT was natalizumab (26%) and oral DMT cladribine tablets (22%). The least often preferred were mitoxantrone and the beta-interferon injections (1%-3%). Patient preferences were strongly correlated with patients' MS disease duration and DMT experience, and differences in patient preferences could be summarized using 8 principle components that together explain 99% of the variation in patients' DMT preferences. Conclusion. This study summarizes patient preferences for the included DMTs, facilitates shared decision making along the dimensions that are relevant to RRMS patients, and introduces methods in the medical DCE literature that are ideally suited to summarize the impact of DMT introductions in preexisting treatment landscapes.
Collapse
Affiliation(s)
- Marcel F Jonker
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Bas Donkers
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Lucas M A Goossens
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Renske J Hoefman
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Lea J Jabbarian
- Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Matthijs M Versteegh
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | | |
Collapse
|
4
|
Boyko AN, Davydovskaya MV, Khachanova NV, Zakharova MN, Spirin NN, Popova EV, Alifirova VM, Vlasov YV, Sivertseva SA, Khabirov FA, Shumilina MV, Evdoshenko EP. Clinical recommendations for the use of ocrelizumab in patients with multiple sclerosis. ACTA ACUST UNITED AC 2019. [DOI: 10.14412/2074-2711-2019-3-16-25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The paper presents a detailed algorithm for the treatment and follow-up of patients with recurrent multiple sclerosis and primary progressive multiple sclerosis in the use of ocrelizumab.
Collapse
Affiliation(s)
- A. N. Boyko
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia Federal Center for Cerebrovascular Disease and Stroke, Ministry of Health of Russia
| | - M. V. Davydovskaya
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
| | - N. V. Khachanova
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
| | | | - N. N. Spirin
- Yaroslavl State Medical University, Ministry of Health of Russia
| | - E. V. Popova
- City Clinical Hospital Twenty-Four, Moscow Healthcare Department
| | - V. M. Alifirova
- Siberian State Medical University, Ministry of Health of Russia
| | - Ya. V. Vlasov
- Samara State Medical University, Ministry of Health of Russia
| | | | - F. A. Khabirov
- Republican Clinical and Diagnostic Center for Demyelinating Diseases, Ministry of Health of the Republic of Tatarstan
| | - M. V. Shumilina
- City Clinical Hospital Thirty-One, City Center for Multiple Sclerosis Treatment
| | - E. P. Evdoshenko
- City Clinical Hospital Thirty-One, City Center for Multiple Sclerosis Treatment
| |
Collapse
|
5
|
Cauwels A, Van Lint S, Catteeuw D, Pang S, Paul F, Rogge E, Verhee A, Prinz M, Kley N, Uzé G, Tavernier J. Targeting interferon activity to dendritic cells enables in vivo tolerization and protection against EAE in mice. J Autoimmun 2019; 97:70-76. [DOI: 10.1016/j.jaut.2018.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
|
6
|
Oliveira IBN, Gomes RS, Gomides LF, Dos Santos JC, Carneiro MAD, Ribeiro-Dias F, Diniz DS. Interferon-Beta Treatment Differentially Alters TLR2 and TLR4-Dependent Cytokine Production in Multiple Sclerosis Patients. Neuroimmunomodulation 2019; 26:77-83. [PMID: 30897575 DOI: 10.1159/000495787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/22/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Multiple sclerosis (MS) is a multifactorial chronic disease that affects the central nervous system (CNS). Toll-like receptors (TLRs) play a central role in cytokine production after pathogen- and danger-associated molecular patterns (PAMPs and DAMPs) and contribute to CNS damage in MS patients. Here, we evaluated the effects of interferon (IFN)-β treatment in TLR2 and TLR4-dependent cytokine production and mRNA expression in whole-blood cell cultures from MS patients. METHODS We evaluated cytokine production by ELISA from whole-blood cell culture supernatants and mRNA expression by real-time polymerase chain reaction in peripheral blood mononuclear cells (PBMCs). RESULTS In patients treated with IFN-β, tumor necrosis factor (TNF)-α production after exposure to TLR2 agonist (Pam3Cys) was lower than in healthy controls and untreated MS patients. However, IFN-β treatment had no significant effect on TNF-α production after TLR4 agonist (LPS) stimulation. On the other hand, interleukin (IL)-10 production was increased in TLR4- but not in TLR2-stimulated whole-blood cell culture from MS patients under IFN-β treatment when compared to the controls. No differences in TNF-α or IL-10 mRNA expression in PBMCs from healthy controls and untreated or treated MS patients were detected, although PBMCs from treated patients presented higher levels of IL-32γ mRNA than those from controls. CONCLUSIONS Our data suggest that IFN-β treatment alters the TLR-dependent immune response of PBMCs from MS patients. This may contribute to the beneficial effects of IFN-β treatment.
Collapse
Affiliation(s)
| | - Rodrigo Saar Gomes
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | - Larissa Fonseca Gomides
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | | | | | - Fátima Ribeiro-Dias
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brazil
| | | |
Collapse
|
7
|
Brown H, Gabriele S, White J. Physician and patient treatment decision-making in relapsing-remitting multiple sclerosis in Europe and the USA. Neurodegener Dis Manag 2018; 8:371-376. [DOI: 10.2217/nmt-2018-0023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To assess factors used in treatment decision-making for relapsing-remitting multiple sclerosis in both the 5EU (UK/Germany/France/Italy/Spain) and the USA. Methods: Data were abstracted from the Ipsos Healthcare Global Multiple Sclerosis Therapy Monitor (data abstracted September–December, 2015–2017) a bi-annual online chart-review study of patients with multiple sclerosis. Results: Treatment choices were primarily due to efficacy for relapses while convenience factors, other than oral administration, were uncommon. Predominantly, the choice of disease modifying therapy at first line was jointly made, with patient involvement decreasing at later lines of treatment. Conclusion: Relapsing-remitting multiple sclerosis patients are highly engaged in their treatment decisions, particularly early in the pathway. The majority were made jointly between the physician and patient, driven by efficacy.
Collapse
|
8
|
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
|
9
|
Managing Multiple Sclerosis: Treatment Initiation, Modification, and Sequencing. Can J Neurol Sci 2018; 45:489-503. [DOI: 10.1017/cjn.2018.17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AbstractRecent therapeutic advances in the management of multiple sclerosis (MS) have raised questions about the selection of appropriate patient candidates for various treatments and, if the plan is to move from one treatment to another, the appropriate sequencing of these therapies. The selected approach should provide optimal disease management without limiting future therapeutic options based on safety concerns, and recognize potential future treatments and the possibility of combination therapies. Additional challenges include incorporation of patient needs and preferences into the overall therapeutic approach, in order to ensure optimal outcomes in the short and long term. The objective of this manuscript is to provide an overview of what is currently known regarding the impact of various therapies for MS on future therapeutic choices (sequencing). In this context, we reviewed the available evidence in support of various treatments and, based on the presence of disease activity, suggested a scheme for switching or escalating therapy with the main focus on sequencing of therapeutic approaches.
Collapse
|
10
|
Acharya S, Timilshina M, Jiang L, Neupane S, Choi DY, Park SW, Lee SY, Jeong BS, Kim JA, Nam TG, Chang JH. Amelioration of Experimental autoimmune encephalomyelitis and DSS induced colitis by NTG-A-009 through the inhibition of Th1 and Th17 cells differentiation. Sci Rep 2018; 8:7799. [PMID: 29773813 PMCID: PMC5958108 DOI: 10.1038/s41598-018-26088-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/04/2018] [Indexed: 12/13/2022] Open
Abstract
CD4+ T cells are the central for the mammalian adaptive immune system. Naïve CD4+ T cells mainly differentiate in to pro-inflammatory Th1, Th2 and Th17 cells upon antigenic stimulation. IFN-γ secreting Th1 cells and IL-17 secreting Th17 cells are found to play key roles in autoimmune diseases like multiple sclerosis (MS) and ulcerative colitis (UC). In this study we found NTG-A-009, 6-aminopyridin-3-ol, has great inhibitory effect on in vitro differentiation of Th1 and Th17 cells without affecting regulatory T cells. Moreover, NTG-A-009 had no effect on CD4+ T cell proliferation and viability. In vivo treatment has shown that NTG-A-009 has ameliorated experimental autoimmune encephalomyelitis (EAE) and dextran sulfate sodium (DSS) induced colitis through the inhibition of Th1 and Th17 cells differentiation. Mechanistically, NTG-A-009 suppressed Th1 and Th17 cells differentiation via the modulation of JAK/STAT signaling pathway. Thus, our data demonstrated that NTG-A-009 ameliorated inflammation through the inhibition of Th1 and Th17 cells generation making it a potential therapeutic candidate for the treatment of inflammatory diseases.
Collapse
Affiliation(s)
- Suman Acharya
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | | | - Liyuan Jiang
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Sabita Neupane
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Dong-Young Choi
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Sang Won Park
- Department of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, 15588, Republic of Korea
| | - Sang Yeul Lee
- Department of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, 15588, Republic of Korea
| | - Byeong-Seon Jeong
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Jung-Ae Kim
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Tae-Gyu Nam
- Department of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, 15588, Republic of Korea.
| | - Jae-Hoon Chang
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
| |
Collapse
|
11
|
Rieckmann P, Centonze D, Elovaara I, Giovannoni G, Havrdová E, Kesselring J, Kobelt G, Langdon D, Morrow SA, Oreja-Guevara C, Schippling S, Thalheim C, Thompson H, Vermersch P, Aston K, Bauer B, Demory C, Giambastiani MP, Hlavacova J, Nouvet-Gire J, Pepper G, Pontaga M, Rogan E, Rogalski C, van Galen P, Ben-Amor AF. Unmet needs, burden of treatment, and patient engagement in multiple sclerosis: A combined perspective from the MS in the 21st Century Steering Group. Mult Scler Relat Disord 2017; 19:153-160. [PMID: 29241142 DOI: 10.1016/j.msard.2017.11.013] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/11/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patient engagement is vital in multiple sclerosis (MS) in order to optimise outcomes for patients, society and healthcare systems. It is essential to involve all stakeholders in potential solutions, working in a multidisciplinary way to ensure that people with MS (PwMS) are included in shared decision-making and disease management. To start this process, a collaborative, open environment between PwMS and healthcare professionals (HCPs) is required so that similarities and disparities in the perception of key areas in patient care and unmet needs can be identified. With this patient-centred approach in mind, in 2016 the MS in the 21st Century Steering Group formed a unique collaboration to include PwMS in the Steering Group to provide a platform for the patient voice. METHODS The MS in the 21st Century initiative set out to foster engagement through a series of open-forum joint workshops. The aims of these workshops were: to identify similarities and disparities in the perception and prioritisation in three key areas (unmet needs, the treatment burden in MS, and factors that impact patient engagement), and to provide practical advice on how the gaps in perception and understanding in these key areas could be bridged. RESULTS Combined practical advice and direction are provided here as eight actions: 1. Improve communication to raise the quality of HCP-patient interaction and optimise the limited time available for consultations. 2. Heighten the awareness of 'hidden' disease symptoms and how these can be managed. 3. Improve the dialogue surrounding the benefit versus risk issues of therapies to help patients become fully informed and active participants in their healthcare decisions. 4. Provide accurate, lucid information in an easily accessible format from reliable sources. 5. Encourage HCPs and multidisciplinary teams to acquire and share new knowledge and information among their teams and with PwMS. 6. Foster greater understanding and awareness of challenges faced by PwMS and HCPs in treating MS. 7. Collaborate to develop local education, communication and patient-engagement initiatives. 8. Motivate PwMS to become advocates for self-management in MS care. CONCLUSION Our study of PwMS and HCPs in the MS in the 21st Century initiative has highlighted eight practical actions. These actions identify how differences and gaps in unmet needs, treatment burden, and patient engagement between PwMS and HCPs can be bridged to improve MS disease management. Of particular interest now are patient-centred educational resources that can be used during time-limited consultations to enhance understanding of disease and improve communication. Actively bridging these gaps in a joint approach enables PwMS to take part in shared decision-making; with improved communication and reliable information, patients can make informed decisions with their HCPs, as part of their own personalised disease management.
Collapse
Affiliation(s)
| | - Diego Centonze
- Università di Roma Tor Vergata, Rome & IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Gavin Giovannoni
- Blizard Institute, Bart's School of Medicine and Dentistry, London, UK
| | - Eva Havrdová
- Dept of Neurology and Center for Clinical Neuroscience, First Medical Faculty, Charles University, Prague, Czech Republic
| | | | | | | | | | | | | | | | | | | | | | - Birgit Bauer
- European Multiple Sclerosis Platform, Brussels, Belgium
| | | | | | | | | | | | | | - Emma Rogan
- European Multiple Sclerosis Platform, Brussels, Belgium
| | | | | | | |
Collapse
|
12
|
You Z, Timilshina M, Jeong BS, Chang JH. BJ-2266 ameliorates experimental autoimmune encephalomyelitis through down-regulation of the JAK/STAT signaling pathway. Eur J Immunol 2017; 47:1488-1500. [PMID: 28681958 DOI: 10.1002/eji.201646860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 05/11/2017] [Accepted: 07/03/2017] [Indexed: 12/24/2022]
Abstract
CD4+ T cells differentiate into distinct effector subsets upon antigenic stimulation. Cytokines, and micro-environmental factors present during T-cell priming, direct differentiation of naïve CD4+ T cells into pro-inflammatory Th1 and Th17 cells. From extensive screening of 2,4,5-trimethylpyridin-3-ol derivatives with various functional groups at C(6)-position, BJ-2266, a 6-thioureido-derivative, showed potent inhibitory activity on in vitro T helper (Th)-cell differentiation. This compound inhibited IFN-γ and IL-17 production from polyclonal CD4+ T cells and ovalbumin (OVA)-specific CD4+ T cells that were activated by T-cell receptor (TCR) engagement. We assessed the inhibitory effect of BJ-2266 in experimental autoimmune encephalomyelitis (EAE). Our results suggest that BJ-2266 treatment significantly suppresses EAE disease progression with reduced generation of Th1 and Th17 cells. Notably, Th-cell differentiation was significantly suppressed by BJ-2266 treatment with no effect on apoptosis, activation and proliferation of activated T cells. Furthermore, adoptive transfer of BJ-2266 treated MOG-reactive Th1 and Th17 cells led to a lower EAE disease score and better clinical recovery from EAE. The underlying mechanism of BJ-2266 effect involved the inhibition of JAK/STAT phosphorylation that is critical for Th-cell differentiation. We conclude that BJ-2266 regulates the JAK/STAT pathway in response to cytokine signals and subsequently suppresses the differentiation of Th-cell responses.
Collapse
Affiliation(s)
- Zhiwei You
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
| | | | - Byeong-Seon Jeong
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
| | - Jae-Hoon Chang
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
| |
Collapse
|
13
|
Kang Y, Timilshina M, Nam TG, Jeong BS, Chang JH. BJ-1108, a 6-Amino-2,4,5-trimethylpyridin-3-ol analogue, regulates differentiation of Th1 and Th17 cells to ameliorate experimental autoimmune encephalomyelitis. Biol Res 2017; 50:8. [PMID: 28241881 PMCID: PMC5330010 DOI: 10.1186/s40659-017-0113-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/18/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND CD4+ T cells play an important role in the initiation of an immune response by providing help to other cells. Among the helper T subsets, interferon-γ (IFN-γ)-secreting T helper 1 (Th1) and IL-17-secreting T helper 17 (Th17) cells are indispensable for clearance of intracellular as well as extracellular pathogens. However, Th1 and Th17 cells are also associated with pathogenesis and contribute to the progression of multiple inflammatory conditions and autoimmune diseases. RESULTS In the current study, we found that BJ-1108, a 6-aminopyridin-3-ol analogue, significantly inhibited Th1 and Th17 differentiation in vitro in a concentration-dependent manner, with no effect on proliferation or apoptosis of activated T cells. Moreover, BJ-1108 inhibited differentiation of Th1 and Th17 cells in ovalbumin (OVA)-specific OT II mice. A complete Freund's adjuvant (CFA)/OVA-induced inflammatory model revealed that BJ-1108 can reduce generation of proinflammatory Th1 and Th17 cells. Furthermore, in vivo studies showed that BJ-1108 delayed onset of disease and suppressed experimental autoimmune encephalomyelitis (EAE) disease progression by inhibiting differentiation of Th1 and Th17 cells. CONCLUSIONS BJ-1108 treatment ameliorates inflammation and EAE by inhibiting Th1 and Th17 cells differentiation. Our findings suggest that BJ-1108 is a promising novel therapeutic agent for the treatment of inflammation and autoimmune disease.
Collapse
Affiliation(s)
- Youra Kang
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | | | - Tae-Gyu Nam
- Department of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan, Gyeonggi-do, 15588, Republic of Korea
| | - Byeong-Seon Jeong
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
| | - Jae-Hoon Chang
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
| |
Collapse
|
14
|
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]
|
15
|
A Personalized Approach in Progressive Multiple Sclerosis: The Current Status of Disease Modifying Therapies (DMTs) and Future Perspectives. Int J Mol Sci 2016; 17:ijms17101725. [PMID: 27763513 PMCID: PMC5085756 DOI: 10.3390/ijms17101725] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/29/2016] [Accepted: 10/02/2016] [Indexed: 12/20/2022] Open
Abstract
Using the term of progressive multiple sclerosis (PMS), we considered a combined population of persons with secondary progressive MS (SPMS) and primary progressive MS (PPMS). These forms of MS cannot be challenged with efficacy by the licensed therapy. In the last years, several measures of risk estimation were developed for predicting clinical course in MS, but none is specific for the PMS forms. Personalized medicine is a therapeutic approach, based on identifying what might be the best therapy for an individual patient, taking into account the risk profile. We need to achieve more accurate estimates of useful predictors in PMS, including unconventional and qualitative markers which are not yet currently available or practicable routine diagnostics. The evaluation of an individual patient is based on the profile of disease activity.Within the neurology field, PMS is one of the fastest-moving going into the future.
Collapse
|
16
|
D’Amico E, Zanghì A, Leone C, Tumani H, Patti F. Treatment-Related Progressive Multifocal Leukoencephalopathy in Multiple Sclerosis: A Comprehensive Review of Current Evidence and Future Needs. Drug Saf 2016; 39:1163-1174. [DOI: 10.1007/s40264-016-0461-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
17
|
Garcia-Dominguez JM, Muñoz D, Comellas M, Gonzalbo I, Lizán L, Polanco Sánchez C. Patient preferences for treatment of multiple sclerosis with disease-modifying therapies: a discrete choice experiment. Patient Prefer Adherence 2016; 10:1945-1956. [PMID: 27713622 PMCID: PMC5045232 DOI: 10.2147/ppa.s114619] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To assess disease-modifying therapy (DMT) preferences in a population of patients with multiple sclerosis (MS) and to estimate the association between sociodemographic and clinical factors and these preferences. METHODS Preferences for DMTs attributes were measured using a discrete choice experiment. Analysis of preferences was assessed using mixed-logit hierarchical Bayes regression. A multilinear regression was used to evaluate the association between the preferences for each attribute and patients' demographic and clinical characteristics. A Student's t-test or Welch's t-test was used for subgroup comparisons. RESULTS A total of 125 patients were included in the final analysis (62.9% female, mean age 44.5 years, 71.5% with relapsing-remitting MS diagnosis). The most important factor for patients was the possibility of suffering from the side effects of the treatment (relative importance [RI] =50%), followed by a delay in disease progression (RI =19.4%), and route and frequency of administration (RI =14.3%). According to maximum acceptable risk, patients were willing to accept an increase of 3.8% in severity of side effects, for a delay of 1 year in disease progression. Treatment duration was the most prevalent factor affecting preferences, followed by the age of patients, type of MS, level of education, and the type of current treatment. Patients treated orally were significantly more concerned about the route and frequency of administration (P=0.026) than patients on injectable therapy. Naïve patients stated significantly less importance to prevention of relapses (P=0.021) and deterioration of the capacity for performing usual daily life activities (P=0.015). Finally, patients with >5 years since diagnosis were significantly less concerned about preventing disease progression (P=0.021), and more concerned about treatment side effects (P=0.052) than compared with patients with <5 years of MS history. CONCLUSION The most important attribute for MS patients was side effects of DMTs, followed by delay in disability progression. Experience with DMTs and time since MS diagnosis changed patients' preferences. These results give information to adjust new DMT treatment in order to satisfy patients' preferences and therefore, improve adherence to treatment.
Collapse
Affiliation(s)
| | - Delicias Muñoz
- Neurology Department, Hospital Universitario Alvaro Cunqueiro, Vigo
| | | | | | - Luis Lizán
- Outcomes’10, Jaime I University, Castellón
| | | |
Collapse
|
18
|
Cocco E, Caoci A, Lorefice L, Marrosu MG. Perception of risk and shared decision making process in multiple sclerosis. Expert Rev Neurother 2016; 17:173-180. [PMID: 27467681 DOI: 10.1080/14737175.2016.1217155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) treatment has changed considerably in recent years thanks to the introduction of ever-more-powerful drugs. Unfortunately, the higher efficacies of these therapies are associated with increased risks of severe adverse events. In this scenario, neurologists and persons with MS (pwMSs) must now balance benefits and risks when making decisions regarding MS management. Areas covered: This review highlights the importance of the risk perception of pwMSs and their neurologists in the shared decision-making process in MS management, taking into account different ways improve the empowerment and engagement of pwMSs. Expert commentary: The shared decision-making process in MS is strongly influenced by an individual's risk perception, which is dynamic and influenced by the personal, emotional, social, and experiential factors of both the pwMSs and neurologists.
Collapse
Affiliation(s)
- Eleonora Cocco
- a Department of Public health, Clinical and Molecular Medicine , University of Cagliari , Cagliari , Italy
| | - Alberto Caoci
- a Department of Public health, Clinical and Molecular Medicine , University of Cagliari , Cagliari , Italy
| | - Lorena Lorefice
- b Department of Medical Science , University of Cagliari , Cagliari , Italy
| | | |
Collapse
|
19
|
D’Amico E, Zanghì A, Patti F. Personalized therapy in multiple sclerosis: state of art and future perspectives. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1199950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Emanuele D’Amico
- Multiple Sclerosis Center, Policlinico G. Rodolico, Catania, Italy
| | - Aurora Zanghì
- Multiple Sclerosis Center, Policlinico G. Rodolico, Catania, Italy
| | - Francesco Patti
- Multiple Sclerosis Center, Policlinico G. Rodolico, Catania, Italy
| |
Collapse
|
20
|
Del Boccio P, Rossi C, di Ioia M, Cicalini I, Sacchetta P, Pieragostino D. Integration of metabolomics and proteomics in multiple sclerosis: From biomarkers discovery to personalized medicine. Proteomics Clin Appl 2016; 10:470-84. [DOI: 10.1002/prca.201500083] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/17/2015] [Accepted: 12/30/2015] [Indexed: 01/04/2023]
Affiliation(s)
- Piero Del Boccio
- Department of Medical Oral and Biotechnological Sciences; University “G. d'Annunzio” of Chieti- Pescara; Chieti Italy
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| | - Claudia Rossi
- Department of Medical Oral and Biotechnological Sciences; University “G. d'Annunzio” of Chieti- Pescara; Chieti Italy
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| | - Maria di Ioia
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
- Department of Neurosciences and Imaging; University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| | - Ilaria Cicalini
- Department of Medical Oral and Biotechnological Sciences; University “G. d'Annunzio” of Chieti- Pescara; Chieti Italy
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| | - Paolo Sacchetta
- Department of Medical Oral and Biotechnological Sciences; University “G. d'Annunzio” of Chieti- Pescara; Chieti Italy
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| | - Damiana Pieragostino
- Department of Medical Oral and Biotechnological Sciences; University “G. d'Annunzio” of Chieti- Pescara; Chieti Italy
- Analytical Biochemistry and Proteomics Unit, Research Centre on Aging (Ce.S.I); University “G. d'Annunzio” of Chieti-Pescara; Chieti Italy
| |
Collapse
|
21
|
Spelman T, Mekhael L, Burke T, Butzkueven H, Hodgkinson S, Havrdova E, Horakova D, Duquette P, Izquierdo G, Grand'Maison F, Grammond P, Barnett M, Lechner-Scott J, Alroughani R, Trojano M, Lugaresi A, Granella F, Pucci E, Vucic S. Risk of early relapse following the switch from injectables to oral agents for multiple sclerosis. Eur J Neurol 2016; 23:729-36. [DOI: 10.1111/ene.12929] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 11/04/2015] [Indexed: 02/04/2023]
Affiliation(s)
- T. Spelman
- Department of Neurology; Royal Melbourne Hospital; Parkville Vic. Australia
- Department of Medicine (RMH); University of Melbourne; Parkville Vic. Australia
| | | | - T. Burke
- Westmead Hospital; Sydney NSW Australia
| | - H. Butzkueven
- Department of Neurology; Royal Melbourne Hospital; Parkville Vic. Australia
- Department of Medicine (RMH); University of Melbourne; Parkville Vic. Australia
| | | | | | | | | | - G. Izquierdo
- Hospital Universitario Virgen Macarena; Sevilla Spain
| | | | - P. Grammond
- Center de réadaptation déficience physique Chaudière-Appalache; Levis QC Canada
| | - M. Barnett
- Brain and Mind Research Institute; Sydney NSW Australia
| | | | | | - M. Trojano
- Department of Basic Medical Sciences; Neuroscience and Sense Organs; University of Bari; Bari Italy
| | - A. Lugaresi
- MS Center; Department of Neuroscience, Imaging and Clinical Sciences; University ‘G. d'Annunzio’; Chieti Italy
| | - F. Granella
- Department of Neurosciences; University of Parma; Parma Italy
| | - E. Pucci
- Neurology Unit; ASUR Marche - AV3; Macerata Italy
| | - S. Vucic
- Westmead Hospital; Sydney NSW Australia
| | | |
Collapse
|
22
|
Constantinescu SE, Constantinescu CS. Laquinimod (ABR-215062) for the treatment of relapsing multiple sclerosis. Expert Rev Clin Pharmacol 2015; 9:49-57. [DOI: 10.1586/17512433.2016.1108189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
23
|
D’Amico E, Caserta C, Patti F. Monoclonal antibody therapy in multiple sclerosis: critical appraisal and new perspectives. Expert Rev Neurother 2015; 15:251-68. [DOI: 10.1586/14737175.2015.1008458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
24
|
Ulivieri C, Baldari CT. Statins: From cholesterol-lowering drugs to novel immunomodulators for the treatment of Th17-mediated autoimmune diseases. Pharmacol Res 2014; 88:41-52. [DOI: 10.1016/j.phrs.2014.03.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 12/13/2022]
|
25
|
Wilson L, Loucks A, Bui C, Gipson G, Zhong L, Schwartzburg A, Crabtree E, Goodin D, Waubant E, McCulloch C. Patient centered decision making: use of conjoint analysis to determine risk-benefit trade-offs for preference sensitive treatment choices. J Neurol Sci 2014; 344:80-7. [PMID: 25037284 DOI: 10.1016/j.jns.2014.06.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/28/2014] [Accepted: 06/15/2014] [Indexed: 11/27/2022]
Abstract
UNLABELLED Understanding patient preferences facilitates shared decision-making and focuses on patient-centered outcomes. Little is known about relapsing-remitting multiple sclerosis (RRMS) patient preferences for disease modifying therapies (DMTs). We use choice based conjoint (CBC) analysis to calculate patient preferences for risk/benefit trade-offs for hypothetical DMTs. METHODS Patients with RRMS were surveyed between 2012 and 2013. Our CBC survey mimicked the decision-making process and trade-offs of patients choosing DMTs, based on all possible DMT attributes. Mixed-effects logistic regression analyzed preferences. We estimated maximum acceptable risk trade-offs for various DMT benefits. RESULTS Severe side-effect risks had the biggest impact on patient preference with a 1% risk, decreasing patient preference five-fold compared to no risk. (OR=0.22, p<0.001). Symptom improvement was the most preferred benefit (OR=3.68, p<0.001), followed by prevention of progression of 10 years (OR=2.4, p<0.001). Daily oral administration had the third highest DMT preference rating (OR=2.08, p<0.001). Patients were willing to accept 0.08% severe risk for a year delayed relapse, and 0.22% for 4 vs 2 year prevented progression. CONCLUSION We provided patient preferences and risk-benefit trade-offs for attributes of all available DMTs. Evaluation of patient preferences is a key step in shared decision making and may significantly impact early drug initiation and compliance.
Collapse
Affiliation(s)
- Leslie Wilson
- Health Policy and Economics, University of California San Francisco, Departments of Medicine and Pharmacy, 3333 California Street, San Francisco, CA 94143, USA.
| | - Aimee Loucks
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA.
| | - Christine Bui
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA
| | - Greg Gipson
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA
| | - Lixian Zhong
- University of California San Francisco, Department of Clinical Pharmacy, 3333 California Street, San Francisco, CA 94143, USA
| | - Amy Schwartzburg
- University of California San Francisco, Department of Neurology, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Elizabeth Crabtree
- UCSF Multiple Sclerosis Center, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Douglas Goodin
- UCSF Multiple Sclerosis Center, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Emmanuelle Waubant
- University of California San Francisco, Regional Pediatric MS Center Director, 1500 Owens Street, Suite 320, San Francisco, CA 94158, USA.
| | - Charles McCulloch
- Division of Biostatistics, University of California San Francisco, Department of Epidemiology and Biostatistics, 185 Berry Street, Suite 5700, Box 0560, San Francisco, CA 94107-1762, USA.
| |
Collapse
|
26
|
Tanasescu R, Constantinescu CS. Pharmacokinetic evaluation of fingolimod for the treatment of multiple sclerosis. Expert Opin Drug Metab Toxicol 2014; 10:621-30. [PMID: 24579791 DOI: 10.1517/17425255.2014.894019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Fingolimod is a sphingosine 1-phosphate receptor modulator with a novel mechanism of action and the first oral drug approved for the treatment of relapsing forms of multiple sclerosis (MS). Fingolimod reduces relapses more effectively than intramuscular interferon β1a and delays disability progression. Associated safety risks are bradyarrhythmia and atrioventricular block following the initial dose, requiring monitoring. AREAS COVERED This article examines the characteristics of fingolimod, its pharmacokinetic properties and the efficacy and tolerability in MS. Information on the pharmacology and mechanisms of action is also provided. EXPERT OPINION Fingolimod is an effective therapy for relapsing forms of MS in a convenient oral dose. Fingolimod may target not only inflammation but potentially also neurodegeneration. Antagonizing astrocyte sphingosine signaling may help explain the reduction in cerebral atrophy observed in Phase III trials. Long-term data about the safety of fingolimod are needed.
Collapse
Affiliation(s)
- Radu Tanasescu
- University of Nottingham, Queen's Medical Centre, Academic Division of Clinical Neurology , C Floor, South Block, Nottingham, NG7 2UH , UK +44 115 8754597/98 ; +44 115 823 1443 ;
| | | |
Collapse
|