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Zanghì A, Ferraro D, Callari G, Valentino P, Granella F, Patti F, Lus G, Bonavita S, Moretti MC, Avolio C, D’Amico E. Ocrelizumab Extended Interval Dosing in Primary Progressive Multiple Sclerosis: An Italian Experience. Curr Neuropharmacol 2024; 22:339-345. [PMID: 37876043 PMCID: PMC10788893 DOI: 10.2174/1570159x22666231002142709] [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: 04/07/2023] [Revised: 06/17/2023] [Accepted: 06/30/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The intervals between two courses of anti CD20 therapies in the COVID19 pandemic era provided the opportunity to individually delay therapy, known as extended interval dosing (EID). METHODS We collect real-world data on patients with primary progressive MS (PPMS) treated with Ocrelizumab (OCR) during the COVID'19 pandemic. The observation period in which the standard interval dosing (SID) or EID occurred (always a maintenance cycle, 600 mg) was from January 2020 to June 2021. All patients had two infusions during the observation period. Our first aim was to compare confirmed disability progression (CDP) between SID and EID patients. RESULTS From a total cohort of 410 patients treated with OCR, 96 patients fulfilled the inclusion criteria. All patients received two infusions during the index window, 71 received only SID infusions whilst 25 received at least one EID infusion throughout the entire follow-up. During the entire available follow-up (median 10 months, IQR 7-11), CDP was recorded in 5 patients (3/71, 4.2% SID and 2/25, 8% EID, V-Cramer = 0.141, p-value = 0.167). EID regimen did not influence the risk of CDP during the investigated follow up. CONCLUSION In our multicentre real-world cohort, the EID regimen in PPMS patients did not result in increased CDP during the available follow-up.
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Affiliation(s)
- Aurora Zanghì
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Diana Ferraro
- University of Modena and Reggio Emilia, Moderna, Emilia-Ronagna, Italy
| | | | - Paola Valentino
- Azienda Ospedaliera Universitaria “Mater Domini”, Catanzaro, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy and Multiple Sclerosis Centre, Department of General Medicine, Parma University Hospital, Parma, Italy
| | - Francesco Patti
- Department “G.F. Ingrassia”, MS Center University of Catania, Catania, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Simona Bonavita
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138 Naples, Italy
| | | | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Emanuele D’Amico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Zanghì A, Avolio C, Hartung HP, D'Amico E. Editorial: Immunosenescence and multiple sclerosis: Prognostic and therapeutic implications. Front Neurol 2022; 13:996342. [PMID: 36119682 PMCID: PMC9481414 DOI: 10.3389/fneur.2022.996342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aurora Zanghì
- Unitá Operativa Complessa (UOC) Neurology, Sant'Elia Hospital, Caltanissetta, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Department of Neurosciences, Head of Multiple Sclerosis Center, Policlinico Riuniti Hospital, Foggia, Italy
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Brain and Mind Center, The University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Palacky University Olomouc, Olomouc, Czechia
| | - Emanuele D'Amico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- *Correspondence: Emanuele D'Amico
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Brain Structural and Functional Alterations in Multiple Sclerosis-Related Fatigue: A Systematic Review. Neurol Int 2022; 14:506-535. [PMID: 35736623 PMCID: PMC9228847 DOI: 10.3390/neurolint14020042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 01/27/2023] Open
Abstract
Fatigue is one of the most disabling symptoms of multiple sclerosis (MS); it influences patients’ quality of life. The etiology of fatigue is complex, and its pathogenesis is still unclear and debated. The objective of this review was to describe potential brain structural and functional dysfunctions underlying fatigue symptoms in patients with MS. To reach this purpose, a systematic review was conducted of published studies comparing functional brain activation and structural brain in MS patients with and without fatigue. Electronic databases were searched until 24 February 2021. The structural and functional outcomes were extracted from eligible studies and tabulated. Fifty studies were included: 32 reported structural brain differences between patients with and without fatigue; 14 studies described functional alterations in patients with fatigue compared to patients without it; and four studies showed structural and functional brain alterations in patients. The results revealed structural and functional abnormalities that could correlate to the symptom of fatigue in patients with MS. Several studies reported the differences between patients with fatigue and patients without fatigue in terms of conventional magnetic resonance imaging (MRI) outcomes and brain atrophy, specifically in the thalamus. Functional studies showed abnormal activation in the thalamus and in some regions of the sensorimotor network in patients with fatigue compared to patients without it. Patients with fatigue present more structural and functional alterations compared to patients without fatigue. Specifically, abnormal activation and atrophy of the thalamus and some regions of the sensorimotor network seem linked to fatigue.
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Stopping Interferon Beta 1b Does Not Influence the Risk of Disability Accrual in Non-Active SPMS: Results from an Italian Real-World Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106069. [PMID: 35627605 PMCID: PMC9140489 DOI: 10.3390/ijerph19106069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 12/10/2022]
Abstract
Background: No consensus exists on the possibility to stop disease modifying therapies (DMTs) in Secondary Progressive Multiple Sclerosis (SPMS). Methods: The primary outcome was the time to reach 24-weeks confirmed Expanded Disability Status Scale (EDSS) 7.0. We enrolled all patients with a confirmed diagnosis of non-active SPMS (here, absence of clinical or radiological activity for at least 24 months before the conversion) between 1 January 2010 and 31 December 2015, at MS centers of Catania and Foggia, Italy. Patients were divided into two groups, according to the shared decision to stop DMTs (group A) or to maintain/switch to licensed interferon beta 1b for SPMS (group B). A Cox model adjusted with an inverse probability weighted propensity score (IPTW-PS) was employed. Results: A cohort of 311 patients was enrolled, 165 were in group A and 146 were in group B. Patients in the two groups were similar for baseline characteristics. The IPTW-PS adjusted Cox model for the event time to 24-weeks confirmed EDSS 7.0 did not show differences between the two groups (ExpB 0.96, CI 0.739–1.271, p = 0.819). Conclusions: In a real-world setting, in patients with non-active SPMS, the maintaining or switching to the licensed interferon beta 1b did not reduce the risk of reaching confirmed EDSS 7.0.
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Mesenchymal Stem Cell-Derived Extracellular Vesicles and Their Therapeutic Use in Central Nervous System Demyelinating Disorders. Int J Mol Sci 2022; 23:ijms23073829. [PMID: 35409188 PMCID: PMC8998258 DOI: 10.3390/ijms23073829] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
Autoimmune demyelinating diseases-including multiple sclerosis, neuromyelitis optica spectrum disorder, anti-myelin oligodendrocyte glycoprotein-associated disease, acute disseminated encephalomyelitis, and glial fibrillary acidic protein (GFAP)-associated meningoencephalomyelitis-are a heterogeneous group of diseases even though their common pathology is characterized by neuroinflammation, loss of myelin, and reactive astrogliosis. The lack of safe pharmacological therapies has purported the notion that cell-based treatments could be introduced to cure these patients. Among stem cells, mesenchymal stem cells (MSCs), obtained from various sources, are considered to be the ones with more interesting features in the context of demyelinating disorders, given that their secretome is fully equipped with an array of anti-inflammatory and neuroprotective molecules, such as mRNAs, miRNAs, lipids, and proteins with multiple functions. In this review, we discuss the potential of cell-free therapeutics utilizing MSC secretome-derived extracellular vesicles-and in particular exosomes-in the treatment of autoimmune demyelinating diseases, and provide an outlook for studies of their future applications.
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Concerto C, Rodolico A, Ciancio A, Messina C, Natale A, Mineo L, Battaglia F, Aguglia E. Vitamin D and Depressive Symptoms in Adults with Multiple Sclerosis: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:199. [PMID: 35010459 PMCID: PMC8750302 DOI: 10.3390/ijerph19010199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Vitamin D deficiency has been correlated with Multiple Sclerosis (MS) risk and disease activity. There is some controversy as to whether vitamin D could have an impact on depressive symptoms in people with MS (pwMS). The aim of this scoping review was to evaluate the association between vitamin D status and depressive symptoms in pwMS. METHODS We searched databases to include studies published up to March 2021 to provide an overview of the available evidence on the correlation between vitamin D status and depressive symptoms in pwMS. The eligibility criteria were as follows: studies evaluating the use of vitamin D measurement on depressive symptoms in patients suffering from MS, including randomized and non-randomized studies; studies written in English; and studies exploring an adult population over the age of 18. RESULTS Eleven studies met our inclusion criteria: two of them were abstracts only; the majority were cross-sectional studies; two were prospective longitudinal studies; one was a retrospective cohort study; and one was a randomized placebo-controlled trial (RCT). Of the eleven studies selected, seven showed a potential correlation between low vitamin D levels and depressive symptoms. CONCLUSION Future RCT studies should include patients with greater severity of depressive symptoms and should consider confounding factors such as sun exposure and seasonal variation of vitamin D.
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Affiliation(s)
- Carmen Concerto
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
| | - Alessandro Rodolico
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
| | - Alessia Ciancio
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
| | - Christian Messina
- MS Center, Department “G.F. Ingrassia”, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy;
| | - Antimo Natale
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
| | - Ludovico Mineo
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
| | - Fortunato Battaglia
- Department of Medical Sciences, Neurology and Psychiatry, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA;
| | - Eugenio Aguglia
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.R.); (A.C.); (A.N.); (L.M.); (E.A.)
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Sharifi MH, Keshani P, Salehi A, Jaladat AM, Mirzaei Z, Nikseresht A. Association between multiple sclerosis and dietary patterns based on the traditional concept of food nature: a case-control study in Iran. BMC Neurol 2021; 21:453. [PMID: 34794406 PMCID: PMC8600729 DOI: 10.1186/s12883-021-02483-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/08/2021] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION It remains a matter of debate whether traditional concepts regarding the nature of food affect the development and progression of multiple sclerosis (MS).To date, there are limited studies that have investigated the association between MS and dietary patterns based on the categories of food nature (hot, cold, or balanced) defined in traditional medicine. METHOD This case-control study was conducted from October 2019 to February 2020. In total, 60 patients diagnosed with MS within the preceding 6 months and referred to our neurology outpatient clinic were included in our case group. The control group included 180 patients who were referred to the same center for general or orthopedic surgery. Dietary intake was assessed in both groups through a reliable and valid semi-quantitative food frequency questionnaire. Data were assessed using principal component analysis. RESULTS The mean age of the participants was 44.9 ± 17.33 years. The analysis showed that four food patterns were distinguished (eigenvalue > 1), namely "additives and cold-natured foods", "hot and balanced foods and nuts", "dairy and legumes", and "hot and balanced starches". These food patterns explained 57.8% of the total variance. After adjusting all confounding factors, individuals in the highest quartile and medium quartile of "additives and cold-natured foods" had an elevated MS risk compared with the lowest quartile (OR = 7.21, 95%CI = 2.01-12.38 and OR = 3.37, 95%CI = 1.02-11.35, respectively). Furthermore, individuals in the highest quartile of the "hot and balanced foods and nuts" group were protected against MS compared with its lowest quartile (OR = 0.28, 95%CI = 0.08-0.90). Moreover, a protective effect against MS was seen in the highest quartile of the "hot and balanced starches" group relative to its lowest quartile (OR = 0.34, 95%CI = 0.12-0.98). No significant association was found between "dairy and legumes" and the risk of MS. CONCLUSION This study revealed that dietary patterns based on the traditional concept of food nature might be associated with the risk of developing MS. This represents the first work in this area, so further research is recommended.
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Affiliation(s)
- Mohammad Hossein Sharifi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Keshani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Salehi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Zahra Mirzaei
- Department of Nutrition, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Alireza Nikseresht
- Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
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Personalizing Medicine and Technologies to Address the Experiences and Needs of People with Multiple Sclerosis. J Pers Med 2021; 11:jpm11080791. [PMID: 34442434 PMCID: PMC8401762 DOI: 10.3390/jpm11080791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 01/23/2023] Open
Abstract
There is enormous variation in the manifestations of disease experienced by people with multiple sclerosis (PwMS). While this variation makes personalized medicine an attractive goal, there are many challenges to be overcome before this opportunity can be realized. Personalized medicine often focuses on targeted therapies and detailed monitoring, but we also need to recognize that there will be variation in acceptance of these approaches by different PwMS. In other words, deep personalization of medicine will encompass targeted therapy, precision monitoring, tailored to variation in personal attitudes to these transformations in health care. In order to meet the promise of personalized medicine for MS, understanding the experiences of PwMS is necessary both to aid in the uptake of personalized medicine, and to ensure that personalized approaches to monitoring disease and treatment provide a net benefit to PwMS rather than placing additional burdens and stressors on them. Here, we describe recent research that identified five experiential themes for PwMS, and then interpret these themes according to the foundations of personalized medicine to provide a road map for implementation of personalized medicine solutions for PwMS.
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Jafari A, Babajani A, Rezaei-Tavirani M. Multiple Sclerosis Biomarker Discoveries by Proteomics and Metabolomics Approaches. Biomark Insights 2021; 16:11772719211013352. [PMID: 34017167 PMCID: PMC8114757 DOI: 10.1177/11772719211013352] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/05/2021] [Indexed: 12/22/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune inflammatory disorder of the central nervous system (CNS) resulting in demyelination and axonal loss in the brain and spinal cord. The precise pathogenesis and etiology of this complex disease are still a mystery. Despite many studies that have been aimed to identify biomarkers, no protein marker has yet been approved for MS. There is urgently needed for biomarkers, which could clarify pathology, monitor disease progression, response to treatment, and prognosis in MS. Proteomics and metabolomics analysis are powerful tools to identify putative and novel candidate biomarkers. Different human compartments analysis using proteomics, metabolomics, and bioinformatics approaches has generated new information for further clarification of MS pathology, elucidating the mechanisms of the disease, finding new targets, and monitoring treatment response. Overall, omics approaches can develop different therapeutic and diagnostic aspects of complex disorders such as multiple sclerosis, from biomarker discovery to personalized medicine.
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Affiliation(s)
- Ameneh Jafari
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhesam Babajani
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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D'Amico E, Zanghì A, Romeo M, Cocco E, Maniscalco GT, Brescia Morra V, Paolicelli D, De Luca G, Galgani S, Amato MP, Salemi G, Inglese M, Confalonieri PA, Lus G, Avolio C, Gallo A, Vianello M, Onofrj M, Filippi M, Trojano M, Patti F. Injectable Versus Oral First-Line Disease-Modifying Therapies: Results from the Italian MS Register. Neurotherapeutics 2021; 18:905-919. [PMID: 33528815 PMCID: PMC8423935 DOI: 10.1007/s13311-020-01001-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
The current study aims to compare injectable and oral first-line disease-modifying therapies (DMTs) for time to first relapse, time to confirmed disability progression (CDP), and time to discontinuation using a cohort of relapsing remitting multiple sclerosis (RRMS) patients, with data extracted from the Italian MS Register. This multicenter, observational, retrospectively acquired, and propensity-adjusted cohort study utilized RRMS-naïve patients from the Italian MS Register who started either injectable or oral first-line DMTs between January 1, 2010, and December 31, 2017, to evaluate the impact on disability outcomes in patients. Enrolled patients were divided into two groups, namely the injectable group (IG) and the oral group (OG). Of a cohort of 11,416 patients, 4602 were enrolled (3919 in the IG and 683 in the OG). The IG had a higher rate of women (67.3% vs 63.4%, p < 0.05) and a lower mean age (36.1 ± 10.9 vs 38.9 ± 11.8, p < 0.001). The event time to first relapse demonstrated a lower risk in the OG (HR = 0.58; CI 95% 0.48-0.72, p < 0.001). However, no differences were found between the two groups with respect to the risk of CDP (HR = 0.94; CI 95% 0.76-1.29, p = 0.941), while a lower risk of DMT was found in the OG (HR = 0.72; CI 95% 0.58-0.88, p = 0.002) for the event time to discontinuation. Real-world data from the Italian MS Register suggests that first-line oral DMTs are associated with a lower risk of experiencing a new relapse and of therapy discontinuation compared to injectable DMTs.
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Affiliation(s)
- Emanuele D'Amico
- Department "G.F. Ingrassia", MS center, University of Catania, Policlinico G. Rodolico, V. Santa Sofia 78, 95123, Catania, Italy.
| | - Aurora Zanghì
- Department "G.F. Ingrassia", MS center, University of Catania, Policlinico G. Rodolico, V. Santa Sofia 78, 95123, Catania, Italy
| | - Marzia Romeo
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eleonora Cocco
- Department "Medical Science and Public Health", University of Cagliari, Cagliari, Italy
| | - Giorgia Teresa Maniscalco
- Multiple Sclerosis Center and Neurological Clinic Stroke Unit , "A. Cardarelli" Hospital, Naples, Italy
| | | | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Policlinico, Bari, Italy
| | - Giovanna De Luca
- Neurology Unit, University G. D'Annunzio, Policlinico SS Annunziata, Chieti, Italy
| | - Simonetta Galgani
- Multiple Sclerosis Center - Az. Osp. S. Camillo Forlanini, Rome, Italy
| | - Maria Pia Amato
- Department NEUROFARBA University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Matilde Inglese
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno - Infantili, Clinica Neurologica (DiNOGMI), Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | | | - Giacomo Lus
- MS Center, II Division of Neurology, University della Campania "L. Vanvitelli", Naples, Italy
| | - Carlo Avolio
- Centro Interdipartimentale Malattie Demielinizzanti, AOU Ospedali Riuniti Di Foggia, Foggia, Italy
| | - Antonio Gallo
- MS Center, I Division of Neurology, University della Campania "L. Vanvitelli", Naples, Italy
| | - Marika Vianello
- O.U. Neurology "Ca' Foncello" Hospital - Treviso - MS Unit, Treviso, Italy
| | - Marco Onofrj
- Neurology Unit, University G. D'Annunzio, Policlinico SS Annunziata, Chieti, Italy
| | - Massimo Filippi
- Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Policlinico, Bari, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", MS center, University of Catania, Policlinico G. Rodolico, V. Santa Sofia 78, 95123, Catania, Italy
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Zanghì A, Gallo A, Avolio C, Capuano R, Lucchini M, Petracca M, Bonavita S, Lanzillo R, Ferraro D, Curti E, Buccafusca M, Callari G, Barone S, Pontillo G, Abbadessa G, Di Francescantonio V, Signoriello E, Lus G, Sola P, Granella F, Valentino P, Mirabella M, Patti F, D'Amico E. Exit Strategies in Natalizumab-Treated RRMS at High Risk of Progressive Multifocal Leukoencephalopathy: a Multicentre Comparison Study. Neurotherapeutics 2021; 18:1166-1174. [PMID: 33844155 PMCID: PMC8423885 DOI: 10.1007/s13311-021-01037-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/27/2022] Open
Abstract
The main aim of the study is to evaluate the efficacy and safety profile of ocrelizumab (OCR), rituximab (RTX), and cladribine (CLA), employed as natalizumab (NTZ) exit strategies in relapsing-remitting multiple sclerosis (RRMS) patients at high-risk for progressive multifocal leukoencephalopathy (PML). This is a multicentre, retrospective, real-world study on consecutive RRMS patients from eleven tertiary Italian MS centres, who switched from NTZ to OCR, RTX, and CLA from January 1st, 2019, to December 31st, 2019. The primary study outcomes were the annualized relapse rate (ARR) and magnetic resonance imaging (MRI) outcome. Treatment effects were estimated by the inverse probability treatment weighting (IPTW), based on propensity-score (PS) approach. Additional endpoint included confirmed disability progression (CDP) as measured by Expanded Disability Status Scale and adverse events (AEs). Patients satisfying predefined inclusion and exclusion criteria were 120; 64 switched to OCR, 36 to RTX, and 20 to CLA. Patients from the 3 groups did not show differences for baseline characteristics, also after post hoc analysis. The IPTW PS-adjusted models revealed that patients on OCR had a lower risk for ARR than patients on CLA (ExpBOCR 0.485, CI 95% 0.264-0.893, p = 0.020). This result was confirmed also for 12-month MRI activity (ExpBOCR 0.248 CI 95% 0.065-0.948, p = 0.042). No differences were found in other pairwise comparisons (OCR vs RTX and RTX vs CLA) for the investigated outcomes. AEs were similar among the 3 groups. Anti-CD20 drugs were revealed to be effective and safe options as NTZ exit strategies. All investigated DMTs showed a good safety profile.
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Affiliation(s)
- Aurora Zanghì
- Department "G.F. Ingrassia", MS Center, Organization University of Catania, Catania, Italy
| | - Antonio Gallo
- MS Center I Division of Neurology, University Della Campania "L. Vanvitelli", Naples, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Sciences Head of Multiple Sclerosis Center Dept. of Neurosciences, University of Foggia, Foggia, Italy
| | - Rocco Capuano
- MS Center I Division of Neurology, University Della Campania "L. Vanvitelli", Naples, Italy
| | - Matteo Lucchini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Petracca
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Simona Bonavita
- Dipartimento Di Scienze Mediche E Chirurgiche Avanzate, Università Della Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Roberta Lanzillo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Diana Ferraro
- University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Curti
- Multiple Sclerosis Centre, Department of General Medicine, Parma University Hospital, Parma, Italy
| | | | | | - Stefania Barone
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
- Department of Electrical Engineering and Information Technology, , University "Federico II", Naples, Italy
| | - Gianmarco Abbadessa
- Dipartimento Di Scienze Mediche E Chirurgiche Avanzate, Università Della Campania Luigi Vanvitelli, Piazza Miraglia, 2, 80138, Napoli, Italy
| | - Valeria Di Francescantonio
- Department of Medical and Surgical Sciences Head of Multiple Sclerosis Center Dept. of Neurosciences, University of Foggia, Foggia, Italy
| | - Elisabetta Signoriello
- Department of Clinical and Experimental Medicine, Multiple Sclerosis Center, II Division of Neurology, Second University of Naples, Naples, Italy
| | - Giacomo Lus
- Department of Clinical and Experimental Medicine, Multiple Sclerosis Center, II Division of Neurology, Second University of Naples, Naples, Italy
| | - Patrizia Sola
- University of Modena and Reggio Emilia, Modena, Italy
| | - Franco Granella
- Multiple Sclerosis Centre, Department of General Medicine, Parma University Hospital, Parma, Italy
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Valentino
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | - Massimiliano Mirabella
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", MS Center, Organization University of Catania, Catania, Italy
| | - Emanuele D'Amico
- Department "G.F. Ingrassia", MS Center, Organization University of Catania, Catania, Italy.
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12
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Zanghì A, D'Amico E, Lo Fermo S, Patti F. Exploring polypharmacy phenomenon in newly diagnosed relapsing-remitting multiple sclerosis: a cohort ambispective single-centre study. Ther Adv Chronic Dis 2021; 12:2040622320983121. [PMID: 33717425 PMCID: PMC7923988 DOI: 10.1177/2040622320983121] [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: 07/27/2020] [Accepted: 12/02/2020] [Indexed: 01/29/2023] Open
Abstract
Aims: We aimed to examine the frequency of polypharmacy in a large cohort of patients at the time of diagnosis of relapsing–remitting multiple sclerosis (RRMS) and to explore its effects on discontinuation of first disease-modifying treatment (DMT) using survival analysis. Methods: This was a cohort ambispective single-centre study. We enrolled RRMS patients starting their first DMT between 1st January 2013 and 31st December 2015. According to the number of medicines prescribed (except DMTs), we divided the patients into three groups: no-poly RRMS, minor-poly RRMS (from one to three medications), and major-poly RRMS (more than three medications). Results: A total of 392 RRMS patients were enrolled (mean age 41.1). The minor-poly RRMS group included 61 patients (15.6%) and the major-poly RRMS group included 112 (28.6%). Individuals in these groups were older and had higher median body mass index (BMI) than patients in the no-poly RRMS group (p < 0.05). Upon multinomial regression analysis, older age at onset was associated with minor and major polypharmacy (OR 1.050, CI 1.010–1.093, p = 0.015 and OR 1.063, CI 1.026–1.101, p = 0.001, respectively) and higher BMI was associated with major polypharmacy (OR 1.186, CI 1.18–1.29, p = 0.001). The rates of discontinuation of first DMT were similar among the three groups (50.7% for no-Poly RRMS, 50.8% for minor-Poly RRMS, and 53.3% for major-Poly RRMS, p = 0.264). At log-Rank test, there were no differences among the three groups (p = 0.834). Conclusion: Polypharmacy was more common in older RRMS patients with high BMI.
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Affiliation(s)
- Aurora Zanghì
- Department "G.F. Ingrassia"; University of Catania, Catania, Italy
| | - Emanuele D'Amico
- Department "G.F. Ingrassia", Policlinico G. Rodolico, V. Santa Sofia 78, Catania, 95123, Italy
| | | | - Francesco Patti
- Department "G.F. Ingrassia"; University of Catania, Catania, Italy
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13
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Kalafatakis I, Patellis A, Charalampopoulos I, Gravanis A, Karagogeos D. The beneficial role of the synthetic microneurotrophin BNN20 in a focal demyelination model. J Neurosci Res 2021; 99:1474-1495. [PMID: 33583101 DOI: 10.1002/jnr.24809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/08/2022]
Abstract
BNN20, a C17-spiroepoxy derivative of the neurosteroid dehydroepiandrosterone, has been shown to exhibit strong neuroprotective properties but its role in glial populations has not been assessed. Our aim was to investigate the effect of BNN20 on glial populations by using in vitro and in vivo approaches, taking advantage of the well-established lysophosphatidylcholine (LPC)-induced focal demyelination mouse model. Our in vivo studies, performed in male mice, showed that BNN20 treatment leads to an increased number of mature oligodendrocytes (OLs) in this model. It diminishes astrocytic accumulation during the demyelination phase leading to a faster remyelination process, while it does not affect oligodendrocyte precursor cell recruitment or microglia/macrophage accumulation. Additionally, our in vitro studies showed that BNN20 acts directly to OLs and enhances their maturation even after they were treated with LPC. This beneficial effect of BNN20 is mediated, primarily, through the neurotrophin receptor TrkA. In addition, BNN20 reduces microglial activation and their transition to their pro-inflammatory state upon lipopolysaccharides stimulation in vitro. Taken together our results suggest that BNN20 could serve as an important molecule to develop blood-brain barrier-permeable synthetic agonists of neurotrophin receptors that could reduce inflammation, protect and increase the number of functional OLs by promoting their differentiation/maturation.
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Affiliation(s)
- Ilias Kalafatakis
- Department of Basic Science, Faculty of Medicine, University of Crete, Crete, Greece.,Institute of Molecular Biology & Biotechnology - FoRTH, Heraklion, Crete, Greece
| | | | - Ioannis Charalampopoulos
- Institute of Molecular Biology & Biotechnology - FoRTH, Heraklion, Crete, Greece.,Department of Pharmacology, Faculty of Medicine, University of Crete, Crete, Greece
| | - Achille Gravanis
- Institute of Molecular Biology & Biotechnology - FoRTH, Heraklion, Crete, Greece.,Department of Pharmacology, Faculty of Medicine, University of Crete, Crete, Greece
| | - Domna Karagogeos
- Department of Basic Science, Faculty of Medicine, University of Crete, Crete, Greece.,Institute of Molecular Biology & Biotechnology - FoRTH, Heraklion, Crete, Greece
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14
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Recent Advances in Antigen-Specific Immunotherapies for the Treatment of Multiple Sclerosis. Brain Sci 2020; 10:brainsci10060333. [PMID: 32486045 PMCID: PMC7348736 DOI: 10.3390/brainsci10060333] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system and is considered to be the leading non-traumatic cause of neurological disability in young adults. Current treatments for MS comprise long-term immunosuppressant drugs and disease-modifying therapies (DMTs) designed to alter its progress with the enhanced risk of severe side effects. The Holy Grail for the treatment of MS is to specifically suppress the disease while at the same time allow the immune system to be functionally active against infectious diseases and malignancy. This could be achieved via the development of immunotherapies designed to specifically suppress immune responses to self-antigens (e.g., myelin antigens). The present study attempts to highlight the various antigen-specific immunotherapies developed so far for the treatment of multiple sclerosis (e.g., vaccination with myelin-derived peptides/proteins, plasmid DNA encoding myelin epitopes, tolerogenic dendritic cells pulsed with encephalitogenic epitopes of myelin proteins, attenuated autologous T cells specific for myelin antigens, T cell receptor peptides, carriers loaded/conjugated with myelin immunodominant peptides, etc), focusing on the outcome of their recent preclinical and clinical evaluation, and to shed light on the mechanisms involved in the immunopathogenesis and treatment of multiple sclerosis.
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15
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Isaiah S, Loots DT, Solomons R, van der Kuip M, Tutu Van Furth AM, Mason S. Overview of Brain-to-Gut Axis Exposed to Chronic CNS Bacterial Infection(s) and a Predictive Urinary Metabolic Profile of a Brain Infected by Mycobacterium tuberculosis. Front Neurosci 2020; 14:296. [PMID: 32372900 PMCID: PMC7186443 DOI: 10.3389/fnins.2020.00296] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/16/2020] [Indexed: 12/12/2022] Open
Abstract
A new paradigm in neuroscience has recently emerged - the brain-gut axis (BGA). The contemporary focus in this paradigm has been gut → brain ("bottom-up"), in which the gut-microbiome, and its perturbations, affects one's psychological state-of-mind and behavior, and is pivotal in neurodegenerative disorders. The emerging brain → gut ("top-down") concept, the subject of this review, proposes that dysfunctional brain health can alter the gut-microbiome. Feedback of this alternative bidirectional highway subsequently aggravates the neurological pathology. This paradigm shift, however, focuses upon non-communicable neurological diseases (progressive neuroinflammation). What of infectious diseases, in which pathogenic bacteria penetrate the blood-brain barrier and interact with the brain, and what is this effect on the BGA in bacterial infection(s) that cause chronic neuroinflammation? Persistent immune activity in the CNS due to chronic neuroinflammation can lead to irreversible neurodegeneration and neuronal death. The properties of cerebrospinal fluid (CSF), such as immunological markers, are used to diagnose brain disorders. But what of metabolic markers for such purposes? If a BGA exists, then chronic CNS bacterial infection(s) should theoretically be reflected in the urine. The premise here is that chronic CNS bacterial infection(s) will affect the gut-microbiome and that perturbed metabolism in both the CNS and gut will release metabolites into the blood that are filtered (kidneys) and excreted in the urine. Here we assess the literature on the effects of chronic neuroinflammatory diseases on the gut-microbiome caused by bacterial infection(s) of the CNS, in the context of information attained via metabolomics-based studies of urine. Furthermore, we take a severe chronic neuroinflammatory infectious disease - tuberculous meningitis (TBM), caused by Mycobacterium tuberculosis, and examine three previously validated CSF immunological biomarkers - vascular endothelial growth factor, interferon-gamma and myeloperoxidase - in terms of the expected changes in normal brain metabolism. We then model the downstream metabolic effects expected, predicting pivotal altered metabolic pathways that would be reflected in the urinary profiles of TBM subjects. Our cascading metabolic model should be adjustable to account for other types of CNS bacterial infection(s) associated with chronic neuroinflammation, typically prevalent, and difficult to distinguish from TBM, in the resource-constrained settings of poor communities.
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Affiliation(s)
- Simon Isaiah
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
| | - Du Toit Loots
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
| | - Regan Solomons
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Martijn van der Kuip
- Pediatric Infectious Diseases and Immunology, Amsterdam University Medical Center, Academic Medical Center, Emma Children’s Hospital, Amsterdam, Netherlands
| | - A. Marceline Tutu Van Furth
- Pediatric Infectious Diseases and Immunology, Amsterdam University Medical Center, Academic Medical Center, Emma Children’s Hospital, Amsterdam, Netherlands
| | - Shayne Mason
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
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16
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Stühler E, Braune S, Lionetto F, Heer Y, Jules E, Westermann C, Bergmann A, van Hövell P. Framework for personalized prediction of treatment response in relapsing remitting multiple sclerosis. BMC Med Res Methodol 2020; 20:24. [PMID: 32028898 PMCID: PMC7006411 DOI: 10.1186/s12874-020-0906-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 01/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Personalized healthcare promises to successfully advance the treatment of heterogeneous neurological disorders such as relapsing remitting multiple sclerosis by addressing the caveats of traditional healthcare. This study presents a framework for personalized prediction of treatment response based on real-world data from the NeuroTransData network. METHODS A framework for personalized prediction of response to various treatments currently available for relapsing remitting multiple sclerosis patients was proposed. Two indicators of therapy effectiveness were used: number of relapses, and confirmed disability progression. The following steps were performed: (1) Data preprocessing and selection of predictors according to quality and inclusion criteria; (2) Implementation of hierarchical Bayesian generalized linear models for estimating treatment response; (3) Validation of the resulting predictive models based on several performance measures and routines, together with additional analyses that focus on evaluating the usability in clinical practice, such as comparing predicted treatment response with the empirically observed course of multiple sclerosis for different adherence profiles. RESULTS The results revealed that the predictive models provide robust and accurate predictions and generalize to new patients and clinical sites. Three different out-of-sample validation schemes (10-fold cross-validation, leave-one-site-out cross-validation, and excluding a test set) were employed to assess generalizability based on three different statistical performance measures (mean squared error, Harrell's concordance statistic, and negative log-likelihood). Sensitivity to different choices of the priors, to the characteristics of the underlying patient population, and to the sample size, was assessed. Finally, it was shown that model predictions are clinically meaningful. CONCLUSIONS Applying personalized predictive models in relapsing remitting multiple sclerosis patients is still new territory that is rapidly evolving and has many challenges. The proposed framework addresses the following challenges: robustness and accuracy of the predictions, generalizability to new patients and clinical sites and comparability of the predicted effectiveness of different therapies. The methodological and clinical soundness of the results builds the basis for a future support of patients and doctors when the current treatment is not generating the desired effect and they are considering a therapy switch. (A) The framework is developed using quality-proven real-world data of patients with relapsing remitting multiple sclerosis. Patients have heterogeneous individual characteristics and diverse disease profiles, indicated for example by variations in frequency of relapses and degree of disability. Longitudinal characteristics regarding disease history (e.g. number of previous relapses in the last 12 months) are extracted at the time of an intended therapy switch, i.e. at time point "Today" (left). All clinical parameters are captured in a standardized way (right). (B) The model predicts the course of the disease based on the observed data (panel A), and is able to account for the impact of various available therapies on chosen clinical endpoints. The resulting ranking of therapies has a dependency on patient characteristics, illustrated here by a different highest ranked therapy depending on the number of relapse in the previous 12 months. (C) The model is evaluated for various generalization properties. Compared to performance on the training set (gray) it is able to predict for new patients not part of the training set (red).Top: Prediction for new patients. Middle: Prediction for new clinical sites. Bottom: Prediction for different time windows. (D) In order to assess the clinical impact of the model, disease activity is compared between patients treated with the highest ranked therapy and those treated with any of the other therapies. Patients adhering to the highest ranked therapy are associated with a better disease outcome when compared to those who did not.
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Affiliation(s)
- E Stühler
- PwC Digital Services, Zürich, Switzerland
| | - S Braune
- NeuroTransData, Neuburg an der Donau, Germany.
| | - F Lionetto
- PwC Digital Services, Zürich, Switzerland
| | - Y Heer
- PwC Digital Services, Zürich, Switzerland
| | - E Jules
- PwC Digital Services, Zürich, Switzerland
| | | | - A Bergmann
- NeuroTransData, Neuburg an der Donau, Germany
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17
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Zanghì A, D'Amico E, Patti F. Immunosuppression in relapsing remitting multiple sclerosis: moving towards personalized treatment. Expert Rev Neurother 2020; 20:771-782. [PMID: 31971026 DOI: 10.1080/14737175.2020.1721282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Therapeutic armamentarium in Multiple Sclerosis (MS) has radically changed in the last few decades due to the development of disease modifying treatments (DMTs) with highly selective mechanisms of action. AREAS COVERED In this review, the authors will focus on the current role of immunosuppressive DMTs in the management of the relapsing-remitting form of MS (RRMS), moving from the rationale of its use and looking at the possibility to design an idealistic scenario of a personalized approach for each single patient. EXPERT OPINION Questions remain open about whether initial high-efficacy immunosuppressive DMTs improve long-term outcomes, whether prolonged exposure to these agents increases adverse events and what the strongest early surrogate markers are for predicting long-term treatment responses to high-efficacy drugs. In this way, the immunosuppressive DMTs, are used to hit the immune system early and hard with the idealistic goal of striking the autoimmune activities before the neurological damage becomes irreversible.
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Affiliation(s)
- Aurora Zanghì
- Department "G.F. Ingrassia", MS Center, University of Catania , Catania, Italy
| | - Emanuele D'Amico
- Department "G.F. Ingrassia", MS Center, University of Catania , Catania, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", MS Center, University of Catania , Catania, Italy
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18
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Zanghì A, D’Amico E. New treatment targets in multiple sclerosis therapy. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2019. [DOI: 10.1080/23808993.2019.1627870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A. Zanghì
- Department “G.F. Ingrassia”, MS center University of Catania, Catania, Italy
| | - E. D’Amico
- Department “G.F. Ingrassia”, MS center University of Catania, Catania, Italy
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D'Amico E, Chisari CG, Gitto L, Zanghì A, Toscano S, Patti F. Pharmacoeconomics of synthetic therapies for multiple sclerosis. Expert Opin Pharmacother 2019; 20:1331-1340. [PMID: 31090469 DOI: 10.1080/14656566.2019.1615880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Recently, the economic impact of multiple sclerosis (MS), which includes both direct and indirect costs, has been increasing. While direct costs comprise health-care costs, such as the cost of pharmaceuticals, additional treatments such as physiotherapy, and medical aids, indirect costs are triggered by the productivity loss of patients and caregivers. Although new drugs for MS have changed the therapeutic scenario, they have increased the direct costs of health-care services. Areas covered: This review describes the pharmacoeconomic aspects of synthetic therapies for MS. Additionally, it discusses the economic impact of the various classes of licensed disease-modifying treatments (DMTs) for relapsing forms of MS. Expert opinion: The emerging and more expensive DMTs for MS represent a considerable challenge for health-care systems and resource consumption. Future research should focus on the long-term efficacy of DMTs and the cost of treating MS in a real-life setting. Future biological and radiological biomarkers could help stratify patients at early stages of MS, helping physicians design a personalized therapeutic approach that could have a positive impact in economic terms.
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Affiliation(s)
- Emanuele D'Amico
- a Department "G.F. Ingrassia"; MS center , University of Catania , Catania , Italy
| | - Clara G Chisari
- a Department "G.F. Ingrassia"; MS center , University of Catania , Catania , Italy
| | - Lara Gitto
- b Department of Economy , University of Messina , Messina , Italy
| | - Aurora Zanghì
- a Department "G.F. Ingrassia"; MS center , University of Catania , Catania , Italy
| | - Simona Toscano
- a Department "G.F. Ingrassia"; MS center , University of Catania , Catania , Italy
| | - Francesco Patti
- a Department "G.F. Ingrassia"; MS center , University of Catania , Catania , Italy
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20
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Bolaños-Díaz R, Sanabria-Montañez C, Custodio-Capuñay N. Cost-effectiveness of interferon therapy for multiple sclerosis in Peru: impact of treatment adherence. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Objective
To analyse the cost-effectiveness (C-E) of interferon therapy for MS and the impact of adherence associated with a patient support programme (PSP).
Methods
Markov model was structured based on systematic review of the evidence and the opinion of local experts. The model has three health states: (1) Baseline treatment (BT), (2) Interferon-β (IFN) with patient support programme (PSP) and (3) IFN without PSP. Annual cycles were considered, with a time horizon of 30 years. The analysis perspective was based on the Ministry of Health (MoH).
Key findings
Interferon-β + PSP dominates the treatment of IFN without PSP. The incremental C-E rate (ICER) for IFN + PSP was estimated at S/. 26 408 per Quality Adjusted Life Year (QALY) in relation to BT. IFN without PSP was dominated by the IFN + PSP treatment. The cost per QALY of IFN + PSP was below the payment threshold in almost 100% of the model simulations. The acceptability curves show that the treatment with PSP + IFN is probabilistically more cost effective from a payment threshold of 1.25 annual Gross Domestic Product per capita (GDP-pc). The Tornado analysis for the ICER between IFN + PSP and BT shows that the most sensitive variables of the model are the relative risk (RR) for treatment adherence and the cost of IFN + PSP treatment.
Conclusion
The addition of a PSP had a significant effect on adherence and C-E of the intervention. The ICER for IFN + PSP was below 1.5 annual GDP-pc of payment threshold with an incremental cost near to 3 GDP-pc. IFN without PSP was dominated by the IFN + PSP.
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D'Amico E, Zanghì A, Serra A, Murabito P, Zappia M, Patti F, Cocuzza S. Management of dysphagia in multiple sclerosis: current best practice. Expert Rev Gastroenterol Hepatol 2019; 13:47-54. [PMID: 30791843 DOI: 10.1080/17474124.2019.1544890] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiple sclerosis (MS) is characterized by extreme variability in both severity and clinical course. It can show severe disabling symptoms, and among them dysphagia is frequently described. However, its management still represents a challenge in the daily care. Areas covered: In this review, we will focus on the clinical recognition and therapeutic strategies to identify and manage dysphagia in people with MS. In the view of a personalized approach, different interventions should be tailored to every single patient. Expert commentary: Multidisciplinary evaluation is mandatory in MS management, and dysphagia represents a perfect model of taking care of a disabling symptom in a chronic disease. Further research is required to better organize a personalized and long-term management of dysphagia phenomenon, through the different subtypes of MS.
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Affiliation(s)
- Emanuele D'Amico
- a Department "G.F. Ingrassia", MS center , University of Catania , Catania , Italy
| | - Aurora Zanghì
- a Department "G.F. Ingrassia", MS center , University of Catania , Catania , Italy
| | - Agostino Serra
- b Department of Medical and Surgery Specialties , University of Catania , Catania , Italy
| | - Paolo Murabito
- c MED/41 Anesthesiology , University of Catania , Catania , Italy
| | - Mario Zappia
- a Department "G.F. Ingrassia", MS center , University of Catania , Catania , Italy
| | - Francesco Patti
- a Department "G.F. Ingrassia", MS center , University of Catania , Catania , Italy
| | - Salvatore Cocuzza
- b Department of Medical and Surgery Specialties , University of Catania , Catania , Italy
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22
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D'Amico E, Zanghì A, Sciandra M, Borriello G, Callari G, Gallo A, Salemi G, Cottone S, Buccafusca M, Valentino P, Bossio RB, Grimaldi LME, Pozzilli C, Tedeschi G, Zappia M, Patti F. Discontinuation of teriflunomide and dimethyl fumarate in a large Italian multicentre population: a 24-month real-world experience. J Neurol 2018; 266:411-416. [PMID: 30515629 DOI: 10.1007/s00415-018-9144-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/07/2018] [Accepted: 11/26/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Teriflunomide (TRF) and Dimethyl fumarate (DMF) are licensed drugs for relapsing-remitting Multiple Sclerosis (RRMS). OBJECTIVES We aimed to compare the rate and the time to discontinuation among persons with RRMS (pwRRMS), newly treated with TRF and DMF. MATERIALS AND METHODS A retrospective study on prospectively collected data was performed in nine tertiary MS centers, in Italy. The 24-month discontinuation rate in the two cohorts was the primary study outcome. We also assessed the time to discontinuation and reasons of therapy withdrawn. Discontinuation of TRF and DMF was defined as a gap of treatment ≥ 60 days. RESULTS A cohort of 903 pwRRMS (316 on TRF and 587 on DMF) was analyzed. During 24 months of follow-up, pwRRMS on TRF and DMF showed similar discontinuation rates. The analysis of predictors with Cox regression model showed differences between the two groups (p for log-rank test = 0.007); male gender [HR 2.21 (1.00-4.90); p = 0.01] and the number of previous switches [HR 1.47 (1.16-1.86); p = 0.01] were associated with higher hazard of discontinuation in the DMF group. CONCLUSIONS In a real-world setting, pwRRMS on TRF and DMF had similar discontinuation rates over 24 months. Male pwRRMS on DMF with a previous history of therapeutic failure are at more risk of discontinuation therapy.
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Affiliation(s)
- E D'Amico
- Department "G.F. Ingrassia", MS centre University of Catania, Catania, Italy
| | - A Zanghì
- Department "G.F. Ingrassia", MS centre University of Catania, Catania, Italy
| | - M Sciandra
- Department of Economics, Business and Statistics, University of Palermo, Palermo, Italy
| | - G Borriello
- University of Rome "La Sapienza"-S. Andrea Hospital, Rome, Italy
| | - G Callari
- Institute Foundation "G. Giglio", Cefalù, Italy
| | - A Gallo
- University "Federico II"-I Neurologic Clinic, Naples, Italy
| | - G Salemi
- Policlinico "P. Giaccone", Palermo, Italy
| | - S Cottone
- Villa Sofia Cervello Hospital, Palermo, Italy
| | - M Buccafusca
- Azienda Ospedaliera Universitaria "G. Martino", Messina, Italy
| | - P Valentino
- Azienda Ospedaliera Universitaria "Mater Domini", Catanzaro, Italy
| | - R B Bossio
- Azienda Sanitaria Provinciale U. O. di Neurologia, Cosenza, Italy
| | | | - C Pozzilli
- University of Rome "La Sapienza"-S. Andrea Hospital, Rome, Italy
| | - G Tedeschi
- University "Federico II"-I Neurologic Clinic, Naples, Italy
| | - M Zappia
- Department "G.F. Ingrassia", MS centre University of Catania, Catania, Italy
| | - F Patti
- Department "G.F. Ingrassia", MS centre University of Catania, Catania, Italy.
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The Gut Microbiome in Multiple Sclerosis: A Potential Therapeutic Avenue. Med Sci (Basel) 2018; 6:medsci6030069. [PMID: 30149548 PMCID: PMC6163724 DOI: 10.3390/medsci6030069] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/27/2018] [Accepted: 08/22/2018] [Indexed: 02/07/2023] Open
Abstract
Recently, there has been a substantial increase in the number of studies focused upon connecting the gut microbiome with cases of central nervous system (CNS) autoimmunity. Multiple sclerosis (MS) is a neurodegenerative autoimmune disorder of the CNS. Recent experimental and clinical evidence suggests the presence of microbial imbalances in the gut of MS sufferers. The gut microbiome is defined as the summation of all the microbial entities as well as their genes, proteins, and metabolic products in a given space and time. Studies show the MS gut microbiome as having general alterations in specific taxa, some associated with the promotion of inflammatory cytokines and overall inflammation. In conjunction with these findings, experimental models of the disease have reported that T regulatory (Treg) cells have deficits in their function as a result of the aberrant gut microbiota composition. The findings suggest that the interactions between the host and the microbiota are reciprocal, although more extensive work is required to confirm this. Moreover, evidence indicates that changes in microbiota composition may result in imbalances that could result in disease, with the gut as a potential novel therapeutic avenue. By understanding the biological effects of aberrant gut microbiome composition, it is possible to contemplate current therapeutic options and their efficacy. Ultimately, more research is necessary in this field, but targeting the gut microbiota may lead to the development of novel therapeutic strategies.
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Up-to-date knowledge about the association between multiple sclerosis and the reactivation of human endogenous retrovirus infections. J Neurol 2018; 265:1733-1739. [DOI: 10.1007/s00415-018-8783-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 12/12/2022]
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Khezri S, Abtahi Froushani SM, Shahmoradi M. Nicotine Augments the Beneficial Effects of Mesenchymal Stem Cell-based Therapy in Rat Model of Multiple Sclerosis. Immunol Invest 2017; 47:113-124. [DOI: 10.1080/08820139.2017.1391841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Shiva Khezri
- Department of biology, Faculty of science, Urmia University, Urmia, Iran
| | | | - Mozhgan Shahmoradi
- Department of biology, Faculty of science, Urmia University, Urmia, Iran
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