1
|
Papp V, Buron MD, Siersma V, Rasmussen PV, Illes Z, Kant M, Hilt C, Mezei Z, Roshanisefat H, Sejbæk T, Weglewski A, van Wingerden J, Geertsen SS, Bramow S, Sellebjerg F, Magyari M. Real-world outcomes for a complete nationwide cohort of more than 3200 teriflunomide-treated multiple sclerosis patients in The Danish Multiple Sclerosis Registry. PLoS One 2021; 16:e0250820. [PMID: 34003862 PMCID: PMC8130956 DOI: 10.1371/journal.pone.0250820] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/15/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Teriflunomide is a once-daily, oral disease-modifying therapy (DMT) for relapsing forms of multiple sclerosis (MS). We studied clinical outcomes in a real-world setting involving a population-based large cohort of unselected patients enrolled in The Danish Multiple Sclerosis Registry (DMSR) who started teriflunomide treatment between 2013–2019. Methods This was a complete nationwide population-based cohort study with prospectively enrolled unselected cases. Demographic and disease-specific patient parameters related to treatment history, efficacy outcomes, and discontinuation and switching rates among other clinical variables were assessed at baseline and during follow-up visits. Results A total of 3239 patients (65.4% female) started treatment with teriflunomide during the study period, 56% of whom were treatment-naïve. Compared to previously treated patients, treatment-naïve patients were older on average at disease onset, had a shorter disease duration, a lower Expanded Disability Status Scale score at teriflunomide treatment start and more frequently experienced a relapse in the 12 months prior to teriflunomide initiation. In the 3001 patients initiating teriflunomide treatment at least 12 months before the cut-off date, 72.7% were still on treatment one year after treatment start. Discontinuations in the first year were due mainly to adverse events (15.6%). Over the full follow-up period, 47.5% of patients discontinued teriflunomide treatment. Sixty-three percent of the patients treated with teriflunomide for 5 years were relapse-free, while significantly more treatment-naïve versus previously treated patients experienced a relapse during the follow-up (p<0.0001). Furthermore, 85% of the patients with available data were free of disability worsening at the end of follow-up. Conclusions Solid efficacy and treatment persistence data consistent with other real-world studies were obtained over the treatment period. Treatment outcomes in this real-world scenario of the population-based cohort support previous findings that teriflunomide is an effective and generally well-tolerated DMT for relapsing MS patients with mild to moderate disease activity.
Collapse
Affiliation(s)
- Viktoria Papp
- Odense University Hospital, Odense, Denmark
- * E-mail:
| | - Mathias Due Buron
- The Danish Multiple Sclerosis Registry, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Danish Multiple Sclerosis Center, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Zsolt Mezei
- Aalborg University Hospital, Aalborg, Denmark
| | | | - Tobias Sejbæk
- Department of Neurology, Hospital of South West Jutland, Esbjerg, Denmark
| | | | | | | | - Stephan Bramow
- Danish Multiple Sclerosis Center, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Danish Multiple Sclerosis Center, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
2
|
Nandy A, Nielsen M, Hilt C, Mogensen PH, Yavarian Y. A case report revealing acute onset psychosis and cognitive impairment as primary manifestation in relapsing-remitting multiple sclerosis. Clin Case Rep 2020; 8:833-836. [PMID: 32477527 PMCID: PMC7250979 DOI: 10.1002/ccr3.2781] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Acute psychosis and cognitive impairment is a significant problem in RRMS. As it concerns in relatively young age group, our case report underscores the importance of early recognition which could impose diagnostic challenge in multiple sclerosis.
Collapse
Affiliation(s)
- Anirban Nandy
- Department of NeurologyAalborg University HospitalAalborgDenmark
| | - Michael Nielsen
- Department of NeurologyAalborg University HospitalAalborgDenmark
| | - Claudia Hilt
- Department of NeurologyAalborg University HospitalAalborgDenmark
| | | | - Yousef Yavarian
- Department of RadiologyAalborg University HospitalAalborgDenmark
| |
Collapse
|
3
|
Nørgaard TL, Andersen CU, Hilt C, Andersen CU. Macular oedema and changes in macular thickness in multiple sclerosis patients treated with fingolimod. Basic Clin Pharmacol Toxicol 2020; 126:492-497. [PMID: 31880065 DOI: 10.1111/bcpt.13381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/20/2019] [Revised: 12/07/2019] [Accepted: 12/19/2019] [Indexed: 11/30/2022]
Abstract
Macular oedema is a known side effect to fingolimod, but changes in specific areas of the retina are only sparsely described. Our aim was to investigate the prevalence of macular oedema and characterize macular changes after initiation of fingolimod based on routine ophthalmological examinations in all consecutive patients treated at our hospital. We evaluated macular thickness change from baseline to 3-4 months after initiation of treatment. Central retinal thickness, total macular volume, total macular thickness, average thickness and inner-/outer macular thickness were automatically measured using optical coherence tomography (OCT). A total of 190 eyes completed the study, and none of those developed visible macular oedema. All macular areas showed a small, but statistically significant increase in thickness. Total macular volume increased by a mean of 0.05 mm3 (P = <.001). Mean best-corrected visual acuity only changed by .03 (P = .074). We observed a minimal change in macular thickness and no clinically relevant affection on visual acuity after 3-4 months of fingolimod treatment. Thus, our results do not underpin the need for routine screening for macular oedema in asymptomatic MS patients without diabetes or uveitis receiving 0.5 mg fingolimod daily.
Collapse
Affiliation(s)
| | - Carl Uggerhøj Andersen
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark.,Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
| | - Claudia Hilt
- Department of Neurology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Charlotte Uggerhøj Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|