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Cobo-Calvo Á, Gómez-Ballesteros R, Orviz A, Díaz Sánchez M, Boyero S, Aguado-Valcarcel M, Sepúlveda M, Rebollo P, López-Laiz P, Maurino J, Téllez Lara N. Therapeutic inertia in the management of neuromyelitis optica spectrum disorder. Front Neurol 2024; 15:1341473. [PMID: 38450077 PMCID: PMC10915282 DOI: 10.3389/fneur.2024.1341473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction and objective Limited information is available on how neurologists make therapeutic decisions in neuromyelitis optica spectrum disorder (NMOSD), especially when new treatments with different mechanisms of action, administration, and safety profile are being approved. Decision-making can be complex under this uncertainty and may lead to therapeutic inertia (TI), which refers to lack of treatment initiation or intensification when therapeutic goals are not met. The study aim was to assess neurologists' TI in NMOSD. Methods An online, cross-sectional study was conducted in collaboration with the Spanish Society of Neurology. Neurologists answered a survey composed of demographic characteristics, professional background, and behavioral traits. TI was defined as the lack of initiation or intensification with high-efficacy treatments when there is evidence of disease activity and was assessed through five NMOSD aquaporin-4 positive (AQP4+) simulated case scenarios. A multivariate logistic regression analysis was used to determine the association between neurologists' characteristics and TI. Results A total of 78 neurologists were included (median interquartile range [IQR] age: 36.0 [29.0-46.0] years, 55.1% male, median [IQR] experience managing demyelinating conditions was 5.2 [3.0-11.1] years). The majority of participants were general neurologists (59.0%) attending a median (IQR) of 5.0 NMOSD patients (3.0-12.0) annually. Thirty participants (38.5%) were classified as having TI. Working in a low complexity hospital and giving high importance to patient's tolerability/safety when choosing a treatment were predictors of TI. Conclusion TI is a common phenomenon among neurologists managing NMOSD AQP4+. Identifying TI and implementing specific intervention strategies may be critical to improving therapeutic decisions and patient care.
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Affiliation(s)
- Álvaro Cobo-Calvo
- Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Aida Orviz
- Department of Neurology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - María Díaz Sánchez
- Department of Neurology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Sabas Boyero
- Department of Neurology, Hospital Universitario Cruces, Bilbao, Spain
| | | | - María Sepúlveda
- Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | - Nieves Téllez Lara
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Villacieros-Álvarez J, Espejo C, Cobo-Calvo Á. Reply to "Myelin Oligodendrocyte Glycoprotein Antibody-Positive Patients Meeting the 2017 McDonald Criteria for Multiple Sclerosis: Challenges in Diagnosis and Treatment Decisions". Ann Neurol 2024; 95:415-416. [PMID: 38081749 DOI: 10.1002/ana.26856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Javier Villacieros-Álvarez
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Espejo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
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Coll L, Pareto D, Carbonell-Mirabent P, Cobo-Calvo Á, Arrambide G, Vidal-Jordana Á, Comabella M, Castilló JN, Rodrı Guez-Acevedo B, Zabalza A, Galán I, Midaglia L, Nos C, Auger C, Alberich M, Rı O J, Sastre-Garriga J, Oliver A, Montalban X, Rovira À, Tintoré M, Lladó X, Tur C. Global and Regional Deep Learning Models for Multiple Sclerosis Stratification From MRI. J Magn Reson Imaging 2023. [PMID: 37803817 DOI: 10.1002/jmri.29046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The combination of anatomical MRI and deep learning-based methods such as convolutional neural networks (CNNs) is a promising strategy to build predictive models of multiple sclerosis (MS) prognosis. However, studies assessing the effect of different input strategies on model's performance are lacking. PURPOSE To compare whole-brain input sampling strategies and regional/specific-tissue strategies, which focus on a priori known relevant areas for disability accrual, to stratify MS patients based on their disability level. STUDY TYPE Retrospective. SUBJECTS Three hundred nineteen MS patients (382 brain MRI scans) with clinical assessment of disability level performed within the following 6 months (~70% training/~15% validation/~15% inference in-house dataset) and 440 MS patients from multiple centers (independent external validation cohort). FIELD STRENGTH/SEQUENCE Single vendor 1.5 T or 3.0 T. Magnetization-Prepared Rapid Gradient-Echo and Fluid-Attenuated Inversion Recovery sequences. ASSESSMENT A 7-fold patient cross validation strategy was used to train a 3D-CNN to classify patients into two groups, Expanded Disability Status Scale score (EDSS) ≥ 3.0 or EDSS < 3.0. Two strategies were investigated: 1) a global approach, taking the whole brain volume as input and 2) regional approaches using five different regions-of-interest: white matter, gray matter, subcortical gray matter, ventricles, and brainstem structures. The performance of the models was assessed in the in-house and the independent external cohorts. STATISTICAL TESTS Balanced accuracy, sensitivity, specificity, area under receiver operating characteristic (ROC) curve (AUC). RESULTS With the in-house dataset, the gray matter regional model showed the highest stratification accuracy (81%), followed by the global approach (79%). In the external dataset, without any further retraining, an accuracy of 72% was achieved for the white matter model and 71% for the global approach. DATA CONCLUSION The global approach offered the best trade-off between internal performance and external validation to stratify MS patients based on accumulated disability. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Llucia Coll
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquı N Castilló
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodrı Guez-Acevedo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Alberich
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Rı O
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Oliver
- Research Institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Lladó
- Research Institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Villacieros-Álvarez J, Espejo C, Arrambide G, Castillo M, Carbonell-Mirabent P, Rodriguez M, Bollo L, Castilló J, Comabella M, Galán I, Midaglia L, Mongay-Ochoa N, Nos C, Rio J, Rodríguez-Acevedo B, Sastre-Garriga J, Tur C, Vidal-Jordana A, Vilaseca A, Zabalza A, Auger C, Rovira A, Montalban X, Tintoré M, Cobo-Calvo Á. Myelin Oligodendrocyte Glycoprotein Antibodies in Adults with a First Demyelinating Event Suggestive of Multiple Sclerosis. Ann Neurol 2023. [PMID: 37705507 DOI: 10.1002/ana.26793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) distinguish multiple sclerosis (MS) from MOG-associated disease in most cases. However, studies analyzing MOG-Ab at the time of a first demyelinating event suggestive of MS in adults are lacking. We aimed to (1) evaluate the prevalence of MOG-Ab in a first demyelinating event suggestive of MS and (2) compare clinical and paraclinical features between seropositive (MOG-Ab+) and seronegative (MOG-Ab-) patients. METHODS Six hundred thirty adult patients with available serum samples obtained within 6 months from the first event were included. MOG-Ab were analyzed using a live cell-based assay. Statistical analyses included parametric and nonparametric tests, logistic regression, and survival models. RESULTS MOG-Ab were positive in 17 of 630 (2.7%). Fourteen out of 17 (82.4%) MOG-Ab+ patients presented with optic neuritis (ON) compared to 227of 613 (37.0%) MOG-Ab- patients (p = 0.009). Cerebrospinal fluid-restricted oligoclonal bands (CSF-OBs) were found in 2 of 16 (12.5%) MOG-Ab+ versus 371 of 601 (61.7%) MOG-Ab- subjects (p < 0.001). Baseline brain magnetic resonance imaging (MRI) was normal in 9 of 17 (52.9%) MOG-Ab+ versus 153 of 585 (26.2%) MOG-Ab- patients (p = 0.029). Absence of CSF-OBs and ON at onset were independently associated with MOG-Ab positivity (odds ratio [OR] = 9.03, 95% confidence interval [CI] = 2.04-53.6, p = 0.009; and OR = 4.17, 95% CI = 1.15-19.8, p = 0.042, respectively). Of MOG-Ab+ patients, 22.9% (95% CI = 0.0-42.7) compared to 67.6% (95% CI = 63.3-71.3) of MOG-Ab- patients fulfilled McDonald 2017 criteria at 5 years (log-rank p = 0.003). INTERPRETATION MOG-Ab are infrequent in adults with a first demyelinating event suggestive of MS. However, based on our results, we suggest to determine these antibodies in those patients with ON and absence of CSF-OBs, as long as the brain MRI is not suggestive of MS. ANN NEUROL 2023.
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Affiliation(s)
- Javier Villacieros-Álvarez
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Espejo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Castillo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Marta Rodriguez
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Luca Bollo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carlos Nos
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Rio
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Breogan Rodríguez-Acevedo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Tur
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Andreu Vilaseca
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Auger
- Autonomous University of Barcelona, Barcelona, Spain
- Section of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alex Rovira
- Autonomous University of Barcelona, Barcelona, Spain
- Section of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Xavier Montalban
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
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Coll L, Pareto D, Carbonell-Mirabent P, Cobo-Calvo Á, Arrambide G, Vidal-Jordana Á, Comabella M, Castilló J, Rodríguez-Acevedo B, Zabalza A, Galán I, Midaglia L, Nos C, Salerno A, Auger C, Alberich M, Río J, Sastre-Garriga J, Oliver A, Montalban X, Rovira À, Tintoré M, Lladó X, Tur C. Deciphering multiple sclerosis disability with deep learning attention maps on clinical MRI. Neuroimage Clin 2023; 38:103376. [PMID: 36940621 PMCID: PMC10034138 DOI: 10.1016/j.nicl.2023.103376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
The application of convolutional neural networks (CNNs) to MRI data has emerged as a promising approach to achieving unprecedented levels of accuracy when predicting the course of neurological conditions, including multiple sclerosis, by means of extracting image features not detectable through conventional methods. Additionally, the study of CNN-derived attention maps, which indicate the most relevant anatomical features for CNN-based decisions, has the potential to uncover key disease mechanisms leading to disability accumulation. From a cohort of patients prospectively followed up after a first demyelinating attack, we selected those with T1-weighted and T2-FLAIR brain MRI sequences available for image analysis and a clinical assessment performed within the following six months (N = 319). Patients were divided into two groups according to expanded disability status scale (EDSS) score: ≥3.0 and < 3.0. A 3D-CNN model predicted the class using whole-brain MRI scans as input. A comparison with a logistic regression (LR) model using volumetric measurements as explanatory variables and a validation of the CNN model on an independent dataset with similar characteristics (N = 440) were also performed. The layer-wise relevance propagation method was used to obtain individual attention maps. The CNN model achieved a mean accuracy of 79% and proved to be superior to the equivalent LR-model (77%). Additionally, the model was successfully validated in the independent external cohort without any re-training (accuracy = 71%). Attention-map analyses revealed the predominant role of frontotemporal cortex and cerebellum for CNN decisions, suggesting that the mechanisms leading to disability accrual exceed the mere presence of brain lesions or atrophy and probably involve how damage is distributed in the central nervous system.
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Affiliation(s)
- Llucia Coll
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annalaura Salerno
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Alberich
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Oliver
- Research institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Lladó
- Research institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Tur C, Carbonell-Mirabent P, Cobo-Calvo Á, Otero-Romero S, Arrambide G, Midaglia L, Castilló J, Vidal-Jordana Á, Rodríguez-Acevedo B, Zabalza A, Galán I, Nos C, Salerno A, Auger C, Pareto D, Comabella M, Río J, Sastre-Garriga J, Rovira À, Tintoré M, Montalban X. Association of Early Progression Independent of Relapse Activity With Long-term Disability After a First Demyelinating Event in Multiple Sclerosis. JAMA Neurol 2023; 80:151-160. [PMID: 36534392 PMCID: PMC9856884 DOI: 10.1001/jamaneurol.2022.4655] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Progression independent of relapse activity (PIRA) is the main event responsible for irreversible disability accumulation in relapsing multiple sclerosis (MS). Objective To investigate clinical and neuroimaging predictors of PIRA at the time of the first demyelinating attack and factors associated with long-term clinical outcomes of people who present with PIRA. Design, Setting, and Participants This cohort study, conducted from January 1, 1994, to July 31, 2021, included patients with a first demyelinating attack from multiple sclerosis; patients were recruited from 1 study center in Spain. Patients were excluded if they refused to participate, had alternative diagnoses, did not meet protocol requirements, had inconsistent demographic information, or had less than 3 clinical assessments. Exposures Exposures included (1) clinical and neuroimaging features at the first demyelinating attack and (2) presenting PIRA, ie, confirmed disability accumulation (CDA) in a free-relapse period at any time after symptom onset, within (vs after) the first 5 years of the disease (ie, early/late PIRA), and in the presence (vs absence) of new T2 lesions in the previous 2 years (ie, active/nonactive PIRA). Main Outcomes and Measures Expanded Disability Status Scale (EDSS) yearly increase rates since the first attack and adjusted hazard ratios (HRs) for predictors of time to PIRA and time to EDSS 6.0. Results Of the 1128 patients (mean [SD] age, 32.1 [8.3] years; 781 female individuals [69.2%]) included in the study, 277 (25%) developed 1 or more PIRA events at a median (IQR) follow-up time of 7.2 (4.6-12.4) years (for first PIRA). Of all patients with PIRA, 86 of 277 (31%) developed early PIRA, and 73 of 144 (51%) developed active PIRA. Patients with PIRA were slightly older, had more brain lesions, and were more likely to have oligoclonal bands than those without PIRA. Older age at the first attack was the only predictor of PIRA (HR, 1.43; 95% CI, 1.23-1.65; P < .001 for each older decade). Patients with PIRA had steeper EDSS yearly increase rates (0.18; 95% CI, 0.16-0.20 vs 0.04; 95% CI, 0.02-0.05; P < .001) and an 8-fold greater risk of reaching EDSS 6.0 (HR, 7.93; 95% CI, 2.25-27.96; P = .001) than those without PIRA. Early PIRA had steeper EDSS yearly increase rates than late PIRA (0.31; 95% CI, 0.26-0.35 vs 0.13; 95% CI, 0.10-0.16; P < .001) and a 26-fold greater risk of reaching EDSS 6.0 from the first attack (HR, 26.21; 95% CI, 2.26-303.95; P = .009). Conclusions and Relevance Results of this cohort study suggest that for patients with multiple sclerosis, presenting with PIRA after a first demyelinating event was not uncommon and suggests an unfavorable long-term prognosis, especially if it occurs early in the disease course.
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Affiliation(s)
- Carmen Tur
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Otero-Romero
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annalaura Salerno
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d’Hebron University Hospital, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Arrambide G, Espejo C, Carbonell-Mirabent P, Dieli-Crimi R, Rodríguez-Barranco M, Castillo M, Auger C, Cárdenas-Robledo S, Castilló J, Cobo-Calvo Á, Galán I, Midaglia L, Nos C, Otero-Romero S, Río J, Rodríguez-Acevedo B, Ruiz-Ortiz M, Salerno A, Tagliani P, Tur C, Vidal-Jordana A, Zabalza A, Sastre-Garriga J, Rovira A, Comabella M, Hernández-González M, Montalban X, Tintore M. The kappa free light chain index and oligoclonal bands have a similar role in the McDonald criteria. Brain 2022; 145:3931-3942. [PMID: 35727945 DOI: 10.1093/brain/awac220] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/10/2022] [Accepted: 05/29/2022] [Indexed: 11/13/2022] Open
Abstract
Intrathecal production of kappa free light chains (KFLC) occurs in multiple sclerosis and can be measured using the KFLC index. KFLC index values can be determined more easily than oligoclonal bands (OB) detection and seem more sensitive than the immunoglobulin (Ig)G index to diagnose multiple sclerosis. We assessed the value of OB, KFLC index cut-offs 5.9, 6.6, and 10.61, and IgG index to diagnose multiple sclerosis with prospectively acquired data from a clinically isolated syndrome (CIS) inception cohort. We selected patients with sufficient data to determine OB positivity, MRI dissemination in space (DIS) and time (DIT), IgG index, and sufficient quantities of paired CSF and blood samples to determine KFLC indexes (n = 214). We used Kendall´s Tau coefficient to estimate concordance; calculated the number of additional diagnoses when adding each positive index to DIS and positive OB; performed survival analyses for OB and each index with the outcomes second attack and 2017 MRI DIS and DIT; and estimated the diagnostic properties of OB and the different indexes for the abovementioned outcomes at five years. OB were positive in 138 patients (64.5%), KFLC-5.9 in 136 (63.6%), KFLC-6.6 in 135 (63.1%), KFLC-10.61 in 126 (58.9%) and IgG index in 101 (47.2%). The highest concordance was between OB and KFLC-6.6 (τ=0.727) followed by OB and KFLC-5.9 (τ=0.716). Combining DIS plus OB or KFLC-5.9 increased the number of diagnosed patients by 11 (5.1%), with KFLC-6.6 by 10 (4.7%), with KFLC-10.61 by 9 (4.2%), and with IgG index by 3 (1.4%). Patients with positive OB or indexes reached second attack and MRI DIS and DIT faster than patients with negative results (P < 0.0001 except IgG index in second attack: P = 0.016). In multivariable Cox models [aHR (95% CI)], the risk for second attack was very similar between KFLC-5.9 [2.0 (0.9-4.3), P = 0.068] and KFLC-6.6 [2.1 (1.1-4.2), P = 0.035]. The highest risk for MRI DIS and DIT was demonstrated with KFLC-5.9 [4.9 (2.5-9.6), P < 0.0001], followed by KFLC-6.6 [3.4 (1.9-6.3), P < 0.0001]. KFLC-5.9 and KFLC-6.6 had a slightly higher diagnostic accuracy than OB for second attack (70.5, 71.1, and 67.8) and MRI DIS and DIT (85.7, 85.1, and 81.0). KFLC indexes 5.9 and 6.6 performed slightly better than OB to assess multiple sclerosis risk and in terms of diagnostic accuracy. Given the concordance between OB and these indexes, we suggest using DIS plus positive OB or positive KFLC index as a modified criterion to diagnose multiple sclerosis.
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Affiliation(s)
- Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carmen Espejo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Romina Dieli-Crimi
- Immunology Department, Vall d'Hebron Hospital Universitari. 08035 Barcelona, Spain
| | - Marta Rodríguez-Barranco
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mireia Castillo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Simón Cárdenas-Robledo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain.,Department of Neurology, Multiple Sclerosis Center (CEMHUN), Hospital Universitario Nacional de Colombia. 111321 Bogotá, Colombia
| | - Joaquín Castilló
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Ingrid Galán
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carlos Nos
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Susana Otero-Romero
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mariano Ruiz-Ortiz
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain.,Department of Neurology, Hospital Universitario Doce de Octubre, 28041 Madrid, Spain
| | - Annalaura Salerno
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Paula Tagliani
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Angela Vidal-Jordana
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Ana Zabalza
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Alex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit. Department of Radiology (IDI). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Manuel Hernández-González
- Immunology Department, Vall d'Hebron Hospital Universitari. 08035 Barcelona, Spain.,Diagnostic Immunology Research Group, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
| | - Mar Tintore
- Servei de Neurologia-Neuroimmunologia. Centre d'Esclerosi Múltiple de Catalunya, (Cemcat). Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari. Universitat Autònoma de Barcelona. 08035 Barcelona, Spain
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Lallana S, Sánchez-Tejerina D, Auger C, Callejo A, Rio J, Cobo-Calvo Á. Herpes simplex encephalitis in the context of immune checkpoint inhibitors: a complex interplay. Acta Neurol Belg 2022; 122:823-825. [PMID: 34988947 DOI: 10.1007/s13760-021-01864-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/29/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Sofía Lallana
- Neurology Department, Hospital Universitari Vall d ́Hebron, Barcelona, Spain
| | | | - Cristina Auger
- Section of Neuroradiology Department of Radiology (IDI). Vall d ́Hebron Institut de Recerca, Hospital Universitari Vall d ́Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Callejo
- Thoracic Tumors Unit Medical Oncology, Department. Hospital, Universitari Vall d ́Hebron, Barcelona, Spain
| | - Jordi Rio
- Department of Neurology /Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d ́Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Department of Neurology /Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d ́Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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9
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Zabalza A, Arrambide G, Otero-Romero S, Pappolla A, Tagliani P, López-Maza S, Cárdenas-Robledo S, Esperalba J, Fernández-Naval C, Martínez-Gallo M, Castillo M, Bonastre M, Resina-Salles M, Bertran J, Rodriguez-Barranco M, Carbonell-Mirabent P, Gonzalez M, Merchan M, Quiroga-Varela A, Miguela A, Gómez I, Álvarez G, Robles R, Perez Del Campo D, Queralt X, Soler MJ, Agraz I, Martinez-Valle F, Rodríguez-Acevedo B, Midaglia L, Vidal-Jordana Á, Cobo-Calvo Á, Tur C, Galan I, Castillo J, Río J, Espejo C, Comabella M, Nos C, Sastre-Garriga J, Ramió-Torrentà L, Tintoré M, Montalban X. Is humoral and cellular response to SARS-CoV-2 vaccine modified by DMT in patients with multiple sclerosis and other autoimmune diseases? Mult Scler 2022; 28:1138-1145. [PMID: 35475363 DOI: 10.1177/13524585221089540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The effect of disease-modifying therapies on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine response is unclear. OBJECTIVES We aim to determine the immunological responses to SARS-CoV-2 in multiple sclerosis (MS) and anti-CD20-treated patients with other autoimmune diseases (AID). METHODS Humoral and cellular responses we determined before and 30-90 days after vaccination in patients with MS and anti-CD20-treated patients with other AID in two Catalan centers. RESULTS 457 patients were enrolled. Findings showed that humoral response decreased under anti-CD20s or sphingosine 1-phosphate receptor modulators (S1PRM) and with longer treatment duration and increased after 4.5 months from the last anti-CD20 infusion. Cellular response decreased in S1PRM-treated. Patients on anti-CD20 can present cellular responses even in the absence of antibodies. CONCLUSION Anti-CD20s and S1PRM modify the immunological responses to SARS-CoV-2 vaccines.
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Affiliation(s)
- Ana Zabalza
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Susana Otero-Romero
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Preventive Medicine and Epidemiology Department, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Agustín Pappolla
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Paula Tagliani
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Samuel López-Maza
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Simón Cárdenas-Robledo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Juliana Esperalba
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Candela Fernández-Naval
- Microbiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Monica Martínez-Gallo
- Immunology Division, Hospital Universitari Vall d'Hebron and Diagnostic Immunology Research Group, Valld'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Mireia Castillo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Mercè Bonastre
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Mireia Resina-Salles
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Jordina Bertran
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Marta Rodriguez-Barranco
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Marina Gonzalez
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr, Josep Trueta Hospital and Santa Caterina Hospital, Girona, Spain Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain
| | - Miguel Merchan
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr, Josep Trueta Hospital and Santa Caterina Hospital, Girona, Spain Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain
| | - Ana Quiroga-Varela
- Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Albert Miguela
- Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain
| | - Imma Gómez
- Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain
| | - Gary Álvarez
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr, Josep Trueta Hospital and Santa Caterina Hospital, Girona, Spain Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain
| | - René Robles
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr, Josep Trueta Hospital and Santa Caterina Hospital, Girona, Spain Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain Medical Sciences Department, University of Girona, Girona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Dúnia Perez Del Campo
- Girona Clinical Laboratory, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Xavier Queralt
- Girona Clinical Laboratory, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Maria José Soler
- Department of Nephrology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Irene Agraz
- Department of Nephrology, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Martinez-Valle
- Department of Internal Medicine, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Ángela Vidal-Jordana
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Ingrid Galan
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Joaquín Castillo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Carmen Espejo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Carlos Nos
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Lluís Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Dr, Josep Trueta Hospital and Santa Caterina Hospital, Girona, Spain Neurodegeneration and Neuroinflammation Research Group, IDIBGI, Girona, Spain Medical Sciences Department, University of Girona, Girona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
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10
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Zabalza A, Cárdenas-Robledo S, Tagliani P, Arrambide G, Otero-Romero S, Carbonell-Mirabent P, Rodriguez-Barranco M, Rodríguez-Acevedo B, Restrepo Vera JL, Resina-Salles M, Midaglia L, Vidal-Jordana A, Río J, Galan I, Castillo J, Cobo-Calvo Á, Comabella M, Nos C, Sastre-Garriga J, Tintore M, Montalban X. COVID-19 in multiple sclerosis patients: susceptibility, severity risk factors and serological response. Eur J Neurol 2021; 28:3384-3395. [PMID: 33340215 DOI: 10.1111/ene.14690] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/07/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE Information regarding multiple sclerosis (MS) patients with the 2019 novel coronavirus disease (COVID-19) is scarce. The study objective was to describe the incidence and characteristics of MS patients with COVID-19, to identify susceptibility and severity risk factors and to assess the proportion of positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologies according to disease-modifying treatments. METHODS This was a retrospective study of an MS cohort analysing data collected between February and May 2020. Cases were identified through an email survey and clinical visits. The relationship of demographic and MS characteristics with COVID-19 and of the disease-modifying treatments with SARS-CoV-2 serostatus were examined. RESULTS Data from 48 suspected cases out of 758 valid respondents and from 45 COVID-19 cases identified through clinical visits were collected. Incidence was 6.3%. Nineteen (20.3%) patients were hospitalized and two (2.2%) died. Multivariable models determined that age (odds ratio [OR] per 10 years 0.53, 95% confidence interval [CI] 0.34-0.85), contact with a confirmed case (OR 197.02, 95% CI 56.36-688.79), residence in Barcelona (OR 2.23, 95% CI 1.03-4.80), MS duration (OR per 5 years 1.41, 95% CI 1.09-1.83) and time on anti-CD20 treatment (OR per 2 years 3.48, 95% CI 1.44-8.45) were independent factors for presenting COVID-19 and age (OR per 10 years 2.71, 95% CI 1.13-6.53) for a severe COVID-19. Out of the 79 (84.9%) with serological test, 45.6% generated antibodies, but only 17.6% of those on anti-CD20 therapies. Lymphopaenia or immunoglobulin levels did not relate to COVID-19. CONCLUSIONS Multiple sclerosis patients present similar incidence, risk factors and outcomes for COVID-19 as the general population. Patients treated with an anti-CD20 therapy for a longer period of time might be at a higher risk of COVID-19 and less than 20% generate an antibody response. Only age was related to severity.
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Affiliation(s)
- Ana Zabalza
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Simón Cárdenas-Robledo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paula Tagliani
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Otero-Romero
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rodriguez-Barranco
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Luis Restrepo Vera
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mireia Resina-Salles
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galan
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquin Castillo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintore
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Cobo-Calvo Á, d'Indy H, Ruiz A, Collongues N, Kremer L, Durand-Dubief F, Rollot F, Casey R, Vukusic S, De Seze J, Marignier R. Frequency of myelin oligodendrocyte glycoprotein antibody in multiple sclerosis: A multicenter cross-sectional study. Neurol Neuroimmunol Neuroinflamm 2019; 7:7/2/e649. [PMID: 31836640 PMCID: PMC6943364 DOI: 10.1212/nxi.0000000000000649] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/05/2019] [Indexed: 12/03/2022]
Abstract
Objective To address the frequency of myelin oligodendrocyte glycoprotein (MOG) antibody (Ab) in an unselected large cohort of adults with MS. Methods This is a cross-sectional study in 2 MS expert centers (Lyon and Strasbourg University Hospitals, France) between December 1, 2017, and June 31, 2018. Patients aged ≥18 years with a definite diagnosis of MS according to 2010 McDonald criteria were tested for MOG-Ab by using a cell-based assay (CBA) in Lyon and subsequently included. Positive samples were tested by investigators blinded to the first result with a second assay in a different laboratory (Barcelona, Spain) by using the same plasmid and secondary Ab. Results Serum samples from 685 consecutive patients with MS were analyzed for MOG-Ab. Median disease duration at sampling was 11.5 (interquartile range, 5.8–17.7) years, and 72% were women. Two (0.3%) patients resulted to be MOG-Ab-positive. The 2 patients were women aged 42 and 38 at disease onset and were diagnosed with secondary and primary progressive forms of MS, respectively. This positive result was confirmed by the CBA in Barcelona. Conclusion Our findings indicate that MOG-Ab are exceptional in MS phenotype, suggesting that the MOG-Ab testing should not be performed in typical MS presentation.
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Affiliation(s)
- Álvaro Cobo-Calvo
- From the Service de Neurologie (Á.C.-C., F.D.-D., S.V., R.M.), Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Référence pour Les Maladies Inflammatoires Rares Du Cerveau et de La Moelle (MIRCEM) (Á.C.-C., F.D.-D., S.V., R.M.), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (Á.C.-C., H.I., A.R., R.M.), U1028 INSERM, UMR5292 CNRS, Lyon, France; Département de Neurologie (N.C., L.K., J.D.S.), Centre Hospitalier Universitaire de Strasbourg, France; Biopathologie de La Myéline (N.C., J.D.S.), Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France; Centre D'investigation Clinique (N.C., J.D.S.), INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, France; Centre de Recherche en Neurosciences de Lyon (F.R., R.C., S.V.), Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; and Université Claude Bernard Lyon 1 (F.R., R.C., S.V.), F-69000 Lyon, France; Hospices Civils de Lyon, Lyon, France
| | - Hyacintha d'Indy
- From the Service de Neurologie (Á.C.-C., F.D.-D., S.V., R.M.), Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Référence pour Les Maladies Inflammatoires Rares Du Cerveau et de La Moelle (MIRCEM) (Á.C.-C., F.D.-D., S.V., R.M.), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (Á.C.-C., H.I., A.R., R.M.), U1028 INSERM, UMR5292 CNRS, Lyon, France; Département de Neurologie (N.C., L.K., J.D.S.), Centre Hospitalier Universitaire de Strasbourg, France; Biopathologie de La Myéline (N.C., J.D.S.), Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France; Centre D'investigation Clinique (N.C., J.D.S.), INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, France; Centre de Recherche en Neurosciences de Lyon (F.R., R.C., S.V.), Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; and Université Claude Bernard Lyon 1 (F.R., R.C., S.V.), F-69000 Lyon, France; Hospices Civils de Lyon, Lyon, France
| | - Anne Ruiz
- From the Service de Neurologie (Á.C.-C., F.D.-D., S.V., R.M.), Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Référence pour Les Maladies Inflammatoires Rares Du Cerveau et de La Moelle (MIRCEM) (Á.C.-C., F.D.-D., S.V., R.M.), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (Á.C.-C., H.I., A.R., R.M.), U1028 INSERM, UMR5292 CNRS, Lyon, France; Département de Neurologie (N.C., L.K., J.D.S.), Centre Hospitalier Universitaire de Strasbourg, France; Biopathologie de La Myéline (N.C., J.D.S.), Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France; Centre D'investigation Clinique (N.C., J.D.S.), INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, France; Centre de Recherche en Neurosciences de Lyon (F.R., R.C., S.V.), Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; and Université Claude Bernard Lyon 1 (F.R., R.C., S.V.), F-69000 Lyon, France; Hospices Civils de Lyon, Lyon, France
| | - Nicolas Collongues
- From the Service de Neurologie (Á.C.-C., F.D.-D., S.V., R.M.), Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Référence pour Les Maladies Inflammatoires Rares Du Cerveau et de La Moelle (MIRCEM) (Á.C.-C., F.D.-D., S.V., R.M.), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (Á.C.-C., H.I., A.R., R.M.), U1028 INSERM, UMR5292 CNRS, Lyon, France; Département de Neurologie (N.C., L.K., J.D.S.), Centre Hospitalier Universitaire de Strasbourg, France; Biopathologie de La Myéline (N.C., J.D.S.), Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France; Centre D'investigation Clinique (N.C., J.D.S.), INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, France; Centre de Recherche en Neurosciences de Lyon (F.R., R.C., S.V.), Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; and Université Claude Bernard Lyon 1 (F.R., R.C., S.V.), F-69000 Lyon, France; Hospices Civils de Lyon, Lyon, France
| | - Laurent Kremer
- From the Service de Neurologie (Á.C.-C., F.D.-D., S.V., R.M.), Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Référence pour Les Maladies Inflammatoires Rares Du Cerveau et de La Moelle (MIRCEM) (Á.C.-C., F.D.-D., S.V., R.M.), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (Á.C.-C., H.I., A.R., R.M.), U1028 INSERM, UMR5292 CNRS, Lyon, France; Département de Neurologie (N.C., L.K., J.D.S.), Centre Hospitalier Universitaire de Strasbourg, France; Biopathologie de La Myéline (N.C., J.D.S.), Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France; Centre D'investigation Clinique (N.C., J.D.S.), INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, France; Centre de Recherche en Neurosciences de Lyon (F.R., R.C., S.V.), Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; and Université Claude Bernard Lyon 1 (F.R., R.C., S.V.), F-69000 Lyon, France; Hospices Civils de Lyon, Lyon, France
| | - Françoise Durand-Dubief
- From the Service de Neurologie (Á.C.-C., F.D.-D., S.V., R.M.), Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Référence pour Les Maladies Inflammatoires Rares Du Cerveau et de La Moelle (MIRCEM) (Á.C.-C., F.D.-D., S.V., R.M.), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (Á.C.-C., H.I., A.R., R.M.), U1028 INSERM, UMR5292 CNRS, Lyon, France; Département de Neurologie (N.C., L.K., J.D.S.), Centre Hospitalier Universitaire de Strasbourg, France; Biopathologie de La Myéline (N.C., J.D.S.), Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France; Centre D'investigation Clinique (N.C., J.D.S.), INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, France; Centre de Recherche en Neurosciences de Lyon (F.R., R.C., S.V.), Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; and Université Claude Bernard Lyon 1 (F.R., R.C., S.V.), F-69000 Lyon, France; Hospices Civils de Lyon, Lyon, France
| | - Fabien Rollot
- From the Service de Neurologie (Á.C.-C., F.D.-D., S.V., R.M.), Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Référence pour Les Maladies Inflammatoires Rares Du Cerveau et de La Moelle (MIRCEM) (Á.C.-C., F.D.-D., S.V., R.M.), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (Á.C.-C., H.I., A.R., R.M.), U1028 INSERM, UMR5292 CNRS, Lyon, France; Département de Neurologie (N.C., L.K., J.D.S.), Centre Hospitalier Universitaire de Strasbourg, France; Biopathologie de La Myéline (N.C., J.D.S.), Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France; Centre D'investigation Clinique (N.C., J.D.S.), INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, France; Centre de Recherche en Neurosciences de Lyon (F.R., R.C., S.V.), Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; and Université Claude Bernard Lyon 1 (F.R., R.C., S.V.), F-69000 Lyon, France; Hospices Civils de Lyon, Lyon, France
| | - Romain Casey
- From the Service de Neurologie (Á.C.-C., F.D.-D., S.V., R.M.), Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Référence pour Les Maladies Inflammatoires Rares Du Cerveau et de La Moelle (MIRCEM) (Á.C.-C., F.D.-D., S.V., R.M.), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (Á.C.-C., H.I., A.R., R.M.), U1028 INSERM, UMR5292 CNRS, Lyon, France; Département de Neurologie (N.C., L.K., J.D.S.), Centre Hospitalier Universitaire de Strasbourg, France; Biopathologie de La Myéline (N.C., J.D.S.), Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France; Centre D'investigation Clinique (N.C., J.D.S.), INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, France; Centre de Recherche en Neurosciences de Lyon (F.R., R.C., S.V.), Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; and Université Claude Bernard Lyon 1 (F.R., R.C., S.V.), F-69000 Lyon, France; Hospices Civils de Lyon, Lyon, France
| | - Sandra Vukusic
- From the Service de Neurologie (Á.C.-C., F.D.-D., S.V., R.M.), Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Référence pour Les Maladies Inflammatoires Rares Du Cerveau et de La Moelle (MIRCEM) (Á.C.-C., F.D.-D., S.V., R.M.), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (Á.C.-C., H.I., A.R., R.M.), U1028 INSERM, UMR5292 CNRS, Lyon, France; Département de Neurologie (N.C., L.K., J.D.S.), Centre Hospitalier Universitaire de Strasbourg, France; Biopathologie de La Myéline (N.C., J.D.S.), Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France; Centre D'investigation Clinique (N.C., J.D.S.), INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, France; Centre de Recherche en Neurosciences de Lyon (F.R., R.C., S.V.), Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; and Université Claude Bernard Lyon 1 (F.R., R.C., S.V.), F-69000 Lyon, France; Hospices Civils de Lyon, Lyon, France
| | - Jérôme De Seze
- From the Service de Neurologie (Á.C.-C., F.D.-D., S.V., R.M.), Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Référence pour Les Maladies Inflammatoires Rares Du Cerveau et de La Moelle (MIRCEM) (Á.C.-C., F.D.-D., S.V., R.M.), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (Á.C.-C., H.I., A.R., R.M.), U1028 INSERM, UMR5292 CNRS, Lyon, France; Département de Neurologie (N.C., L.K., J.D.S.), Centre Hospitalier Universitaire de Strasbourg, France; Biopathologie de La Myéline (N.C., J.D.S.), Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France; Centre D'investigation Clinique (N.C., J.D.S.), INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, France; Centre de Recherche en Neurosciences de Lyon (F.R., R.C., S.V.), Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; and Université Claude Bernard Lyon 1 (F.R., R.C., S.V.), F-69000 Lyon, France; Hospices Civils de Lyon, Lyon, France
| | - Romain Marignier
- From the Service de Neurologie (Á.C.-C., F.D.-D., S.V., R.M.), Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Référence pour Les Maladies Inflammatoires Rares Du Cerveau et de La Moelle (MIRCEM) (Á.C.-C., F.D.-D., S.V., R.M.), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France; Centre de Recherche en Neurosciences de Lyon (Á.C.-C., H.I., A.R., R.M.), U1028 INSERM, UMR5292 CNRS, Lyon, France; Département de Neurologie (N.C., L.K., J.D.S.), Centre Hospitalier Universitaire de Strasbourg, France; Biopathologie de La Myéline (N.C., J.D.S.), Neuroprotection et Stratégies Thérapeutiques, INSERM U1119, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France; Centre D'investigation Clinique (N.C., J.D.S.), INSERM U1434, Centre Hospitalier Universitaire de Strasbourg, France; Centre de Recherche en Neurosciences de Lyon (F.R., R.C., S.V.), Observatoire Français de La Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; and Université Claude Bernard Lyon 1 (F.R., R.C., S.V.), F-69000 Lyon, France; Hospices Civils de Lyon, Lyon, France.
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Guillamó E, Cobo-Calvo Á, Oviedo GR, Travier N, Álamo J, Niño-Mendez OA, Martínez-Yelamos A, Martínez-Yelamos S, Javierre C. Feasibility and Effects of Structured Physical Exercise Interventions in Adults with Relapsing-Remitting Multiple Sclerosis: A Pilot Study. J Sports Sci Med 2018; 17:426-436. [PMID: 30116116 PMCID: PMC6090399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
Multiple sclerosis (MS) is a chronic neurological disease which affects young adults at a time of maximum personal, professional and social growth. Recent guidelines on physical activity have established that exercise is an essential component of the clinical management of people with MS with mild or moderate degree of disability. The main purpose of this study was to test the feasibility and the effects of two different 40-week structured physical exercise interventions (a supervised high intensity interval training plus home exercise program and a self-applied home-based exercise program) on clinical evolution, psychological wellbeing, quality of life, fatigue, cardiorespiratory fitness, strength and balance of people with MS. Twenty-nine participants with relapsing-remitting MS (RRMS) participated in this study. All of them were fully ambulatory and with minimal disability (Expanded Disability Status Scale <3), for at least the last six months. Participants selected to be part of a combined face-to-face plus home exercise group (CFTFG; n = 8); a self-applied home-based exercise group (HG; n = 11) or a control group (CG; n = 10). A total of 23 participants completed the protocol (79.3%), of which 8 participants (100%) from the CFTFG, 7 (63.6%) from the HG and 8 (80%) from the CG. During the first 20-weeks of training, adherence from the CFTFG reached 77.5% and from the HG reached 50 %. During the second 20-weeks of training, adherence from the CFTFG reached 62.5% and from the HG reached 45.4%. After 20-weeks of training, a significant improvement in the absolute VO2 peak and in the 30-second sit to stand test was observed in the CFTFG (all p < .05). This study confirms that offering a 40-week structured exercise programme to a group of fully ambulatory and minimally disabled persons with RRMS is feasible and safe. Any adverse event related to the trial was reported by the participants.
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Affiliation(s)
- Elisabet Guillamó
- Department of Physiological Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Department of Neurology, Bellvitge University Hospital, Barcelona, Spain
- Service de Neurologie, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France
| | - Guillermo R Oviedo
- Faculty of Psychology, Education and Sport Science Blanquerna, University Ramon Llull, Barcelona, Spain
- Blanquerna School of Health Science, University Ramon Llull, Barcelona, Spain
| | - Noémie Travier
- Breast Cancer Screening Unit. Cancer Prevention and Control Program, Catalan Institute of Oncology, Spain
| | - Juan Álamo
- Department of Physiological Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Oscar A Niño-Mendez
- Faculty of Sport Science and Physical Education, University of Cundinamarca, Colombia
| | | | | | - Casimiro Javierre
- Department of Physiological Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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Mañé-Martínez M, Olsson B, Bau L, Matas E, Cobo-Calvo Á, Andreasson U, Blennow K, Romero-Pinel L, Martínez-Yélamos S, Zetterberg H. Glial and neuronal markers in cerebrospinal fluid in different types of multiple sclerosis. J Neuroimmunol 2016; 299:112-117. [DOI: 10.1016/j.jneuroim.2016.08.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/17/2016] [Accepted: 08/04/2016] [Indexed: 11/29/2022]
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Matas E, Bau L, Martínez-Iniesta M, Romero-Pinel L, Mañé-Martínez MA, Cobo-Calvo Á, Martínez-Yélamos S. MxA mRNA expression as a biomarker of interferon beta response in multiple sclerosis patients. J Neuroimmunol 2016; 291:73-7. [PMID: 26857498 DOI: 10.1016/j.jneuroim.2015.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/22/2015] [Accepted: 12/28/2015] [Indexed: 11/16/2022]
Abstract
Myxovirus resistance protein A (MxA) is a molecule induced after interferon-β injection. The aim of this study was to investigate whether MxA determination one year after starting interferon-β can predict treatment response in multiple sclerosis patients. MxA mRNA expression was evaluated in blood samples obtained at baseline and at month 12. Clinical variables were prospectively recorded. A threshold of 5 was defined to establish MxA induction. On survival analysis, time to the next relapse and to EDSS progression were significantly longer in patients showing MxA induction, suggesting that MxA induction after one year may be useful to identify interferon-β responders.
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Affiliation(s)
- Elisabet Matas
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge-IDIBELL, Edifici Tècnic-Quirúrgic, Planta 1, mòdul E, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Spain.
| | - Laura Bau
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge-IDIBELL, Edifici Tècnic-Quirúrgic, Planta 1, mòdul E, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Spain.
| | - María Martínez-Iniesta
- Translational Research Laboratory, Institut Català d'Oncologia-IDIBELL, Gran via s/n, L'Hospitalet de Llobregat 08907, Spain.
| | - Lucía Romero-Pinel
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge-IDIBELL, Edifici Tècnic-Quirúrgic, Planta 1, mòdul E, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Spain.
| | - M Alba Mañé-Martínez
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge-IDIBELL, Edifici Tècnic-Quirúrgic, Planta 1, mòdul E, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Spain; Department of Neurology, Joan XXIII University Hospital, Universitat Rovira i Virgili, Dr. Mallafrè Guasch, 4, Tarragona 43005, Spain.
| | - Álvaro Cobo-Calvo
- Department of Neurology, Hospital del Mar Medical Research Institute, Dr. Aiguader, 88, Barcelona 08003, Spain.
| | - Sergio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge-IDIBELL, Edifici Tècnic-Quirúrgic, Planta 1, mòdul E, Feixa Llarga s/n, L'Hospitalet de Llobregat 08907, Spain.
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Cobo-Calvo Á, Sepúlveda M, Bernard-Valnet R, Ruiz A, Brassat D, Martínez-Yélamos S, Saiz A, Marignier R. Antibodies to myelin oligodendrocyte glycoprotein in aquaporin 4 antibody seronegative longitudinally extensive transverse myelitis: Clinical and prognostic implications. Mult Scler 2015. [DOI: 10.1177/1352458515591071] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We aimed to investigate the frequency and clinical significance of antibodies to myelin oligodendrocyte glycoprotein (MOG-abs) in patients who presented with a first episode of seronegative aquaporin 4 antibody (AQP4-ab) longitudinally extensive transverse myelitis (LETM). Methods: Epidemiological, clinical, and paraclinical data of 56 patients from three European centres were analysed. Patients were retrospectively tested for MOG-abs and AQP4-abs, by cell-based assays. Findings: Thirteen (23.2%) patients were MOG-ab positive. Among the 56 patients, six (10.7%) converted to neuromyelitis optica (NMO), one (1.8%) to multiple sclerosis (MS), nine (16.1%) had recurrent LETM, and 40 (71.4%) remained as monophasic LETM. Compared with seronegative patients, those with MOG-abs were younger (median: 32.5 vs 44 years; p=0.007), had cerebrospinal fluid pleocytosis more frequently (94% vs 45%, p=0.003) and had better outcome (median Expanded Disability Status Scale (EDSS) 2.0 vs 3.0, p=0.027). MOG-ab positive patients also showed an increase risk of optic neuritis relapse and NMO conversion ( p=0.010). Conclusion: Patients with MOG-abs in AQP4-ab seronegative LETM have clinical distinctive features, higher risk of optic neuritis relapses, and better outcome than patients seronegative.
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Affiliation(s)
| | - María Sepúlveda
- Center of Neuroimmunology, Service of Neurology, Hospital Clínic and Institut d′Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Raphael Bernard-Valnet
- Neurology Department, CHU Toulouse, France/Center for Pathophysiology of Toulouse Purpan, INSERM U1028/CNRS 5282, France
| | - Anne Ruiz
- Lyon Neuroscience Research Center, INSERM U1028/CNRS 5292, France
| | - David Brassat
- Neurology Department, CHU Toulouse, France/Center for Pathophysiology of Toulouse Purpan, INSERM U1028/CNRS 5282, France
| | | | - Albert Saiz
- Center of Neuroimmunology, Service of Neurology, Hospital Clínic and Institut d′Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Romain Marignier
- Lyon Neuroscience Research Center, INSERM U1028/CNRS 5292, France/Service de Neurologie A, Hôpital Neurologique Pierre Wertheimer, France
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Cobo-Calvo Á, Bau L, Matas E, Romero-Pinel L, Mañé Martínez MA, Majós C, Martínez Yélamos S. Effectiveness of Natalizumab in Patients with Highly Active Relapsing Remitting Multiple Sclerosis. Eur Neurol 2015; 73:220-229. [DOI: 10.1159/000375371] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/18/2015] [Indexed: 11/19/2022]
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Matas E, Bau L, Martínez-Iniesta M, Romero-Pinel L, Mañé MA, Cobo-Calvo Á, Martínez-Yélamos S. Baseline MxA mRNA expression predicts interferon beta response in multiple sclerosis patients. PLoS One 2014; 9:e112758. [PMID: 25396411 PMCID: PMC4232440 DOI: 10.1371/journal.pone.0112758] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/14/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Myxovirus resistance protein A (MxA) is a molecule induced after interferon-beta injection, mostly used to evaluate its bioactivity. There is little available data on clinical utility of baseline MxA mRNA status. The objective of the study is to investigate whether baseline MxA mRNA expression can predict relapse and disease progression in multiple sclerosis patients treated with interferon-beta. METHODS Baseline blood samples were obtained before the first interferon-beta dose was administered to evaluate MxA mRNA expression using real-time polymerase chain reaction (PCR). Demographic and clinical variables were prospectively recorded to define treatment responder and non responder groups. RESULTS 104 patients were included in the study. Baseline MxA mRNA expression was significantly lower in the group of patients who met the definition of responders (1.07 vs 1.95, Student t test, p<0.0001). A threshold of 1.096 was established using Receiver Operating Characteristic analysis to differentiate between responders and non-responders (sensitivity 73.9%, specificity 69.0%). Survival analysis using this threshold showed that time to next relapse (p<0.0001) and to EDSS progression (p = 0.01) were significantly higher in patients with lower MxA titers. CONCLUSION The results suggest that baseline MxA mRNA levels may be useful for predicting whether multiple sclerosis patients will respond or not to interferon-beta treatment.
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Affiliation(s)
- Elisabet Matas
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Bau
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María Martínez-Iniesta
- Translational Research Laboratory, Institut Català d'Oncologia- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lucía Romero-Pinel
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M. Alba Mañé
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Neurology, Joan XXIII University Hospital, Universitat Rovira I Virgili, Tarragona, Spain
| | - Álvaro Cobo-Calvo
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Cobo-Calvo Á, Alentorn A, Mañé Martínez MA, Bau L, Matas E, Bruna J, Romero-Pinel L, Martínez-Yélamos S. Etiologic spectrum and prognosis of longitudinally extensive transverse myelopathies. Eur Neurol 2014; 72:86-94. [PMID: 24942967 DOI: 10.1159/000358512] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/08/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with a first episode of longitudinal extensive transverse myelopathy (LETM) were reviewed with two objectives: to evaluate the clinical spectrum of LETM and to analyze the related clinical and laboratory variables that can be used as functional prognostic markers. METHODS A retrospective review was conducted of clinical, radiologic and biochemical data of patients admitted for LETM between 1993 and 2011. RESULTS Our cohort included 72 patients [median age 41 years, interquartile range (IQR) 29-61.5]. Median follow-up was 34 months (IQR 17.2-63). The modified Rankin Scale (mRS) score was ≥2 at the end of follow-up in 72.2%. The final diagnosis was idiopathic LETM in 22 patients, multiple sclerosis in 18, parainfectious disease in 11, systemic disease in 9, spinal cord infarction and neuromyelitis optica spectrum disorders in 3 patients each, and acute demyelinating encephalomyelitis, dural fistula, and tumor-related LETM in 2 patients each. Unfavorable outcome was associated with mRS ≥2 at admission [odds ratio (OR) 1.39, 95% confidence interval (CI) 1.16-1.66] and older age (OR 1.06, 95% CI 1.01-1.11). CONCLUSION Idiopathic LETM was the most frequent diagnosis at the end of follow-up. Older age and clinically severe disease at onset were independent prognostic factors of poorer functional recovery.
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Affiliation(s)
- Álvaro Cobo-Calvo
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
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