1
|
Annovazzi P, Capobianco M, Moiola L, Patti F, Frau J, Uccelli A, Centonze D, Perini P, Tortorella C, Prosperini L, Lus G, Fuiani A, Falcini M, Martinelli V, Comi G, Ghezzi A. Rituximab in the treatment of Neuromyelitis optica: a multicentre Italian observational study. J Neurol 2016; 263:1727-35. [PMID: 27286847 DOI: 10.1007/s00415-016-8188-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 03/16/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 01/10/2023]
Abstract
Rituximab (RTX) efficacy in NMO is suggested by several case series. No consensus exists on optimal dosing strategies. At present the treatment schedules more frequently used are 375 mg/m2/week iv for 4 weeks (RTX-A) and 1000 mg iv twice, 2 weeks apart (RTX-B). Aim of this study is to confirm RTX efficacy and safety in the treatment of NMO and to evaluate whether a most favourable dosage regimen exists. Data on RTX-treated NMO patients were collected from 13 Italian Hospitals. 73 patients (64 F), were enlisted. RTX-A was administered in 42/73 patients, RTX-B in 31/73. Median follow-up was 27 months (range 7-106). Mean relapse rate in the previous year before RTX start was 2.2 ± 1.3 for RTX-A and 2.3 ± 1.2 for RTX-B. ARR in the first year of treatment was 0.8 ± 0.9 for RTX-A and 0.2 ± 0.4 for RTX-B, in the second year of treatment was 0.9 ± 1.5 for RTX-A and 0.4 ± 0.8 for RTX-B patients (p = 0.001 for the first year, ns (0.09) for the second year). RTX-B was more effective in delaying the occurrence of a relapse (HR 2.2 (95 % IC 1.08-4.53) p = 0.02). Adverse events were described in 19/73 patients (mainly urinary tract and respiratory infections, and infusion reactions). Two deaths were reported in severely disabled patients. Though with the limitations of an observational study, our data support RTX efficacy in NMO and suggest that high dose pulses might be more effective than a more fractioned dose.
Collapse
Affiliation(s)
- Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy.
| | - M Capobianco
- Regional MS Center, University Hospital S. Luigi Gonzaga, Orbassano (TO), Italy
| | - L Moiola
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - F Patti
- Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - J Frau
- Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - A Uccelli
- Department of Neurosciences Ophtalmology and Genetics, University of Genoa, Genoa, Italy
| | - D Centonze
- Department of Neurology I and neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - P Perini
- Department of Neurology, AO University of Padova, Padua, Italy
| | - C Tortorella
- Departments of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - L Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - G Lus
- Department of Neurological Sciences, School of Medicine, Second University of Naples, Policlinico Federico II, Naples, Italy
| | - A Fuiani
- Department of Neurosciences, Multiple Sclerosis Unit, General Hospital, "OORR", Foggia, Italy
| | - M Falcini
- Multiple Sclerosis Center, Ospedale Misericordia e Dolce, Prato, Italy
| | - V Martinelli
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - G Comi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - A Ghezzi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy
| |
Collapse
|
2
|
Trojano M, Pellegrini F, Paolicelli D, Fuiani A, Zimatore GB, Tortorella C, Simone IL, Patti F, Ghezzi A, Zipoli V, Rossi P, Pozzilli C, Salemi G, Lugaresi A, Bergamaschi R, Millefiorini E, Clerico M, Lus G, Vianello M, Avolio C, Cavalla P, Lepore V, Livrea P, Comi G, Amato MP. Real-life impact of early interferon beta therapy in relapsing multiple sclerosis. Ann Neurol 2009; 66:513-20. [PMID: 19847899 DOI: 10.1002/ana.21757] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent findings support greater efficacy of early vs. delayed interferon beta (IFNbeta) treatment in patients with a first clinical event suggestive of multiple sclerosis (MS). We aimed to evaluate the effectiveness of early IFNbeta treatment in definite relapsing-remitting MS (RRMS) and to assess the optimal time to initiate IFNbeta treatment with regard to the greatest benefits on disability progression. METHODS A cohort of 2,570 IFNbeta-treated RRMS patients was prospectively followed for up to 7 years in 15 Italian MS Centers. A Cox proportional hazards regression model adjusted for propensity score (PS) quintiles was used to assess differences between groups of patients with early vs. delayed IFNbeta treatment on risk of reaching a 1-point progression in the Expanded Disability Status Scale (EDSS) score, and the EDSS 4.0 and 6.0 milestones. A set of PS-adjusted Cox hazards regression models were calculated according to different times of treatment initiation (within 1 year up to within 5 years from disease onset). A sensitivity analysis was performed to assess the robustness of findings. RESULTS The lowest hazard ratios (HRs) for the three PS quintiles-adjusted models were obtained by a cutoff of treatment initiation within 1 year from disease onset. Early treatment significantly reduced the risk of reaching a 1-point progression in EDSS score (HR = 0.63; 95% CI = 0.48-0.85; p < 0.002), and the EDSS 4.0 milestone (HR = 0.56; 95% CI = 0.36-0.90; p = 0.015). Sensitivity analysis showed the bound of significance for unmeasured confounders. INTERPRETATION Greater benefits on disability progression may be obtained by an early IFNbeta treatment in RRMS.
Collapse
Affiliation(s)
- M Trojano
- Department of Neurological and Psychiatric Sciences, University of Bari, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Trojano M, Pellegrini F, Paolicelli D, Fuiani A, Zimatore G, Tortorella C, Simone I, Patti F, Ghezzi A, Portaccio E, Rossi P, Pozzilli C, Salemi G, Lugaresi A, Bergamaschi R, Millefiorini E, Clerico M, Lus G, Vianello M, Avolio C, Cavalla P, Iaffaldano P, Direnzo V, D'Onghia M, Lepore V, Livrea P, Comi G, Amato M. Post-marketing of disease modifying drugs in multiple sclerosis: An exploratory analysis of gender effect in interferon beta treatment. J Neurol Sci 2009; 286:109-13. [DOI: 10.1016/j.jns.2009.06.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Revised: 05/23/2009] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
|
4
|
Trojano M, Pellegrini F, Paolicelli D, Fuiani A, Di Renzo V. observational studies: propensity score analysis of non-randomized data. Int MS J 2009; 16:90-97. [PMID: 19878631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Accepted: 03/25/2009] [Indexed: 05/28/2023]
Abstract
The randomized controlled trial (RCT) is considered to be the "gold standard" for providing evidence on drug efficacy. However, particularly for answering long-term questions in chronic diseases such as multiple sclerosis (MS), RCTs are often not feasible because of their size, duration, ethical constraints and costs. Data derived from observational studies complement information provided by RCTs. A major issue is that observational studies are more exposed and prone to biases, which can partly be addressed through rigorous study design or statistical analysis. Propensity score (PS) techniques are the most frequently used. PS is the probability that an individual would receive a certain treatment based on his/her pretreatment characteristics. This score is being widely used in many therapeutic areas and also in MS to adjust for the uncontrolled assignment of treatment in observational studies. However, since PS cannot adjust for unmeasured or unknown confounders, the conclusions from an observational study may not be considered as strong as those from RCTs.
Collapse
Affiliation(s)
- M Trojano
- Department of Neurological and Psychiatric Sciences, University of Bari, Piazza Giulio Cesare 11 70124, Bari, Italy.
| | | | | | | | | |
Collapse
|
5
|
Trojano M, Paolicelli D, Lepore V, Fuiani A, Di Monte E, Pellegrini F, Russo P, Livrea P, Comi G. Italian Multiple Sclerosis Database Network. Neurol Sci 2006; 27 Suppl 5:S358-61. [PMID: 16998720 DOI: 10.1007/s10072-006-0694-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Multiple Sclerosis Database Network (MSDN) is the first Italian multiple sclerosis (MS) registry. The preliminary results on the MSDN cohort demonstrated that the risk of disability progression, in a sample of 2090 MS patients, was reduced by about four- to five-fold in patients exposed to IFNbeta for more than 4 years compared with patients exposed for up to 2 years. More recent results showed, in a subset of 1170 relapsing-remitting MS patients, of whom 918 were treated with IFNbeta and 252 were untreated, that IFNbeta-treated patients had a differential reduction in EDSS score change of -0.055 for each year of follow-up in comparison with the untreated group. These results provide significant information on the effectiveness of IFNbeta treatment on long-term disability progression in MS.
Collapse
Affiliation(s)
- M Trojano
- Department of Neurological and Psychiatric Sciences, University of Bari, Piazza Giulio Cesare 11, I-70124 Bari, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Trojano M, Paolicelli D, Zimatore GB, De Robertis F, Fuiani A, Di Monte E, Livrea P. The IFNβ treatment of multiple sclerosis (MS) in clinical practice: the experience at the MS Center of Bari, Italy. Neurol Sci 2005; 26 Suppl 4:S179-82. [PMID: 16388354 DOI: 10.1007/s10072-005-0511-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This independent, population-based surveillance study monitored, in clinical practice, the efficacy of interferon beta (IFNbeta) products in 1173 patients with multiple sclerosis (MS) from the Department of Neurological and Psychiatric Sciences, University of Bari, Italy. Relapses and Expanded Disability Status Scale (EDSS) scores were evaluated for up to 6 years for Avonex, Betaferon and Rebif 22 groups, and for up to 3 years for the Rebif 44 group. IFNbeta products produced significant reductions from baseline in relapse rates at 2, 4 and >4 years (p<0.0001), with no differences among treatments (p=0.2). A modest significant (p<0.05) increase of EDSS was observed in all treatment groups from baseline to 48 months, followed thereafter by a plateau. The IFNbeta-1b group showed more withdrawals (19%) compared with Avonex (6%) and Rebif (7%) at 6 years.
Collapse
Affiliation(s)
- M Trojano
- Department of Neurological and Psychiatric Sciences, University of Bari, Piazza Giulio Cesare 11, I-70124, Bari, Italy.
| | | | | | | | | | | | | |
Collapse
|
7
|
Trojano M, Paolicelli D, Bellacosa A, Fuiani A, Cataldi S, Di Monte E. Atypical forms of multiple sclerosis or different phases of a same disease? Neurol Sci 2004; 25 Suppl 4:S323-5. [PMID: 15727226 DOI: 10.1007/s10072-004-0334-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Multiple sclerosis (MS) patients complain with the first symptoms of the disease in a range period which varies from childhood to adult life. The extent to which clinical presentation, disease course and demographic features may differ between childhood and adult onset has been the object of investigation. This paper aims to demonstrate that the different clinical phenotypes in young and old patients might simply reflect different phases of a same pathological process.
Collapse
Affiliation(s)
- M Trojano
- Department of Neurological and Psychiatric Sciences, University of Bari, Italy.
| | | | | | | | | | | |
Collapse
|