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Foley JF, Defer G, Ryerson LZ, Cohen JA, Arnold DL, Butzkueven H, Cutter G, Giovannoni G, Killestein J, Wiendl H, Smirnakis K, Xiao S, Kong G, Kuhelj R, Campbell N, Dwyer C, Buzzard K, Spies J, Parratt J, van Pesch V, Willekens B, Perrotta G, Bartholomé E, Grand'Maison F, Jacques F, Giacomini P, Vosoughi R, Girard JM, de Seze J, Lebrun Frenay C, Ruet A, Laplaud DA, Reifschneider G, Wagner B, Rauer S, Pul R, Seipelt M, Berthele A, Klotz L, Kallmann BA, Paul F, Achiron A, Lus G, Centonze D, Patti F, Grimaldi L, Hupperts R, Frequin S, Fermont J, Madueno SE, Alonso Torres AM, Costa-Frossard França L, Meca-Lallana JE, Ruiz LB, Pearson O, Rog D, Evangelou N, Ismail A, Lathi E, Fox E, Leist T, Sloane J, Wu G, Khatri B, Steingo B, Thrower B, Gudesblatt M, Calkwood J, Bandari D, Scagnelli J, Laganke C, Robertson D, Kipp L, Belkin M, Cohan S, Goldstick L, Courtney A, Vargas W, Sylvester A, Srinivasan J, Kannan M, Picone M, English J, Napoli S, Balabanov R, Zaydan I, Nicholas J, Kaplan J, Lublin F, Riser E, Miller T, Alvarez E, Wray S, Gross J, Pawate S, Hersh C, McCarthy L, Crayton H, Graves J. Comparison of switching to 6-week dosing of natalizumab versus continuing with 4-week dosing in patients with relapsing-remitting multiple sclerosis (NOVA): a randomised, controlled, open-label, phase 3b trial. Lancet Neurol 2022; 21:608-619. [PMID: 35483387 DOI: 10.1016/s1474-4422(22)00143-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/28/2022] [Accepted: 03/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Treatment with natalizumab once every 4 weeks is approved for patients with relapsing-remitting multiple sclerosis, but is associated with a risk of progressive multifocal leukoencephalopathy. Switching to extended-interval dosing is associated with lower progressive multifocal leukoencephalopathy risk, but the efficacy of this approach is unclear. We aimed to assess the safety and efficacy of natalizumab once every 6 weeks compared with once every 4 weeks in patients with relapsing-remitting multiple sclerosis. METHODS We did a randomised, controlled, open-label, phase 3b trial (NOVA) at 89 multiple sclerosis centres across 11 countries in the Americas, Europe, and Western Pacific. Included participants were aged 18-60 years with relapsing-remitting multiple sclerosis and had been treated with intravenous natalizumab 300 mg once every 4 weeks with no relapses for at least 12 months before randomisation, with no missed doses in the previous 3 months. Participants were randomly assigned (1:1), using a randomisation sequence generated by the study funder and contract personnel with interactive response technology, to switch to natalizumab once every 6 weeks or continue with once every 4 weeks. The centralised MRI reader, independent neurology evaluation committee, site examining neurologists, site backup examining neurologists, and site examining technicians were masked to study group assignments. The primary endpoint was the number of new or newly enlarging T2 hyperintense lesions at week 72, assessed in all participants who received at least one dose of assigned treatment and had at least one postbaseline MRI, relapse, or neurological examination or efficacy assessment. Missing primary endpoint data were handled under prespecified primary and secondary estimands: the primary estimand included all data, regardless of whether participants remained on the assigned treatment; the secondary estimand classed all data obtained after treatment discontinuation or study withdrawal as missing. Safety was assessed in all participants who received at least one dose of study treatment. Study enrolment is closed and an open-label extension study is ongoing. This study is registered with EudraCT, 2018-002145-11, and ClinicalTrials.gov, NCT03689972. FINDINGS Between Dec 26, 2018, and Aug 30, 2019, 605 patients were assessed for eligibility and 499 were enrolled and assigned to receive natalizumab once every 6 weeks (n=251) or once every 4 weeks (n=248). After prespecified adjustments for missing data, mean numbers of new or newly enlarging T2 hyperintense lesions at week 72 were 0·20 (95% CI 0·07-0·63) in the once every 6 weeks group and 0·05 (0·01-0·22) in the once every 4 weeks group (mean lesion ratio 4·24 [95% CI 0·86-20·85]; p=0·076) under the primary estimand, and 0·31 (95% CI 0·12-0·82) and 0·06 (0·01-0·31; mean lesion ratio 4·93 [95% CI 1·05-23·20]; p=0·044) under the secondary estimand. Two participants in the once every 6 weeks group with extreme new or newly enlarging T2 hyperintense lesion numbers (≥25) contributed most of the excess lesions. Adverse events occurred in 194 (78%) of 250 participants in the once every 6 weeks group and 190 (77%) of 247 in the once every 4 weeks group, and serious adverse events occurred in 17 (7%) and 17 (7%), respectively. No deaths were reported. There was one case of asymptomatic progressive multifocal leukoencephalopathy (without clinical signs) in the once every 6 weeks group, and no cases in the once every 4 weeks group; 6 months after diagnosis, the participant was without increased disability and remained classified as asymptomatic. INTERPRETATION We found a numerical difference in the mean number of new or newly enlarging T2 hyperintense lesions at week 72 between the once every 6 weeks and once every 4 weeks groups, which reached significance under the secondary estimand, but interpretation of statistical differences (or absence thereof) is limited because disease activity in the once every 4 weeks group was lower than expected. The safety profiles of natalizumab once every 6 weeks and once every 4 weeks were similar. Although this trial was not powered to assess differences in risk of progressive multifocal leukoencephalopathy, the occurrence of the (asymptomatic) case underscores the importance of monitoring and risk factor consideration in all patients receiving natalizumab. FUNDING Biogen.
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Affiliation(s)
- John F Foley
- Rocky Mountain MS Clinic, Salt Lake City, UT, USA.
| | - Gilles Defer
- Department of Neurology, Centre Hospitalier Universitaire de Caen, Caen, France
| | | | - Jeffrey A Cohen
- Mellen MS Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montréal, QC, Canada; NeuroRx Research, Montréal, QC, Canada
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Gary Cutter
- University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; Queen Mary University of London, London, UK
| | - Joep Killestein
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
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van Gorp DAM, van der Klink JJL, Abma FI, Jongen PJ, van Lieshout I, Arnoldus EPJ, Beenakker EAC, Bos HM, van Eijk JJJ, Fermont J, Frequin STFM, de Gans K, Hengstman GJD, Hupperts RMM, Mostert JP, Pop PHM, Verhagen WIM, Zemel D, Heerings MAP, Reneman MF, Middelkoop HAM, Visser LH, van der Hiele K. The capability set for work - correlates of sustainable employability in workers with multiple sclerosis. Health Qual Life Outcomes 2018; 16:113. [PMID: 29859113 PMCID: PMC5984791 DOI: 10.1186/s12955-018-0942-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/22/2018] [Indexed: 01/17/2023] Open
Abstract
Background The aim of this study was to examine whether work capabilities differ between workers with Multiple Sclerosis (MS) and workers from the general population. The second aim was to investigate whether the capability set was related to work and health outcomes. Methods A total of 163 workers with MS from the MS@Work study and 163 workers from the general population were matched for gender, age, educational level and working hours. All participants completed online questionnaires on demographics, health and work functioning. The Capability Set for Work Questionnaire was used to explore whether a set of seven work values is considered valuable (A), is enabled in the work context (B), and can be achieved by the individual (C). When all three criteria are met a work value can be considered part of the individual’s ‘capability set’. Results Group differences and relationships with work and health outcomes were examined. Despite lower physical work functioning (U = 4250, p = 0.001), lower work ability (U = 10591, p = 0.006) and worse self-reported health (U = 9091, p ≤ 0.001) workers with MS had a larger capability set (U = 9649, p ≤ 0.001) than the general population. In workers with MS, a larger capability set was associated with better flexible work functioning (r = 0.30), work ability (r = 0.25), self-rated health (r = 0.25); and with less absenteeism (r = − 0.26), presenteeism (r = − 0.31), cognitive/neuropsychiatric impairment (r = − 0.35), depression (r = − 0.43), anxiety (r = − 0.31) and fatigue (r = − 0.34). Conclusions Workers with MS have a larger capability set than workers from the general population. In workers with MS a larger capability set was associated with better work and health outcomes. Trial registration This observational study is registered under NL43098.008.12: ‘Voorspellers van arbeidsparticipatie bij mensen met relapsing-remitting Multiple Sclerose’. The study is registered at the Dutch CCMO register (https://www.toetsingonline.nl). This study is approved by the METC Brabant, 12 February 2014. First participants are enrolled 1st of March 2014.
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Affiliation(s)
- D A M van Gorp
- National Multiple Sclerosis Foundation, Mathenesserlaan 378, Rotterdam, 3023 HB, The Netherlands. .,Department of Psychology, Section Health, Medical and Neuropsychology, Leiden University, PO Box 9555, Leiden, 2300 RB, The Netherlands. .,Department of Neurology, Elisabeth-TweeSteden Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands. .,Department of Care Ethics, University of Humanistic Studies, PO Box 797, Utrecht, 3500 AT, The Netherlands.
| | - J J L van der Klink
- Tilburg School of Social and Behavioural Sciences, Tranzo Scientific Centre for Care and Welfare, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands
| | - F I Abma
- Department of Community & Occupational Medicine, University of Groningen, University Medical Centre Groningen, PO Box 30001, Groningen, 9700 RB, The Netherlands
| | - P J Jongen
- Department of Community & Occupational Medicine, University of Groningen, University Medical Centre Groningen, PO Box 30001, Groningen, 9700 RB, The Netherlands.,MS4 Research Institute, Ubbergseweg 34, Nijmegen, 9522 KJ, The Netherlands
| | - I van Lieshout
- van Lieshout Arbo Advies, PO Box 325, Uden, 5400 AH, The Netherlands
| | - E P J Arnoldus
- Department of Neurology, Elisabeth-TweeSteden Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands
| | - E A C Beenakker
- Department of Neurology, Medical Centre Leeuwarden, PO Box 888, Leeuwarden, 8901 BR, The Netherlands
| | - H M Bos
- Department of Neurology, St. Anna Hospital, PO Box 90, Geldrop, 5660 AB, The Netherlands
| | - J J J van Eijk
- Department of Neurology, Jeroen Bosch Hospital, PO Box 90153, s-Hertogenbosch, 2000 ME, The Netherlands
| | - J Fermont
- Department of Neurology, Amphia Hospital, PO Box 90158, Breda, 4800 RK, The Netherlands
| | - S T F M Frequin
- Department of Neurology, St. Antonius Hospital, PO Box 2500, Nieuwegein, 3430 EM, The Netherlands
| | - K de Gans
- Department of Neurology, Groene Hart Hospital, PO Box 1098, Gouda, 2800 BB, The Netherlands
| | - G J D Hengstman
- Department of Neurology, Catharina Hospital, PO Box 1350, Eindhoven, 5602 ZA, The Netherlands
| | - R M M Hupperts
- Department of Neurology, Zuyderland Medical Centre, PO Box 5500, Sittard, 6130 MB, The Netherlands
| | - J P Mostert
- Department of Neurology, Rijnstate Hospital, PO Box 9555, Arnhem, 6800 TA, The Netherlands
| | - P H M Pop
- Department of Neurology, VieCuri Medical Centre, PO Box 1926, Venlo, 5900 BX, The Netherlands
| | - W I M Verhagen
- Department of Neurology, Canisius-Wilhelmina Hospital, PO Box 9015, Nijmegen, 6500 GS, The Netherlands
| | - D Zemel
- Department of Neurology, Albert Schweitzer Hospital, PO Box 444, Dordrecht, 3300 AK, the Netherlands
| | - M A P Heerings
- National Multiple Sclerosis Foundation, Mathenesserlaan 378, Rotterdam, 3023 HB, The Netherlands
| | - M F Reneman
- Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, PO Box 30.002, Haren, 9750 RA, the Netherlands
| | - H A M Middelkoop
- Department of Psychology, Section Health, Medical and Neuropsychology, Leiden University, PO Box 9555, Leiden, 2300 RB, The Netherlands.,Department of Neurology, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | - L H Visser
- Department of Neurology, Elisabeth-TweeSteden Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands.,Department of Care Ethics, University of Humanistic Studies, PO Box 797, Utrecht, 3500 AT, The Netherlands
| | - K van der Hiele
- National Multiple Sclerosis Foundation, Mathenesserlaan 378, Rotterdam, 3023 HB, The Netherlands.,Department of Psychology, Section Health, Medical and Neuropsychology, Leiden University, PO Box 9555, Leiden, 2300 RB, The Netherlands.,Department of Neurology, Elisabeth-TweeSteden Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands
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van der Hiele K, van Gorp D, Benedict R, Jongen PJ, Arnoldus E, Beenakker E, Bos HM, van Eijk J, Fermont J, Frequin S, van Geel BM, Hengstman G, Hoitsma E, Hupperts R, Mostert JP, Pop P, Verhagen W, Zemel D, Frndak SE, Heerings M, Middelkoop H, Visser LH. Coping strategies in relation to negative work events and accommodations in employed multiple sclerosis patients. Mult Scler J Exp Transl Clin 2016; 2:2055217316680638. [PMID: 28607745 PMCID: PMC5408754 DOI: 10.1177/2055217316680638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/12/2016] [Accepted: 10/29/2016] [Indexed: 12/02/2022] Open
Abstract
Background Job loss is common in multiple sclerosis (MS) and is known to exert a negative effect on quality of life. The process leading up to job loss typically includes negative work events, productivity losses and a need for accommodations. By using active coping strategies job loss may be prevented or delayed. Objective Our goal was to examine negative work events and accommodations in relation to coping strategies in employed relapsing–remitting MS patients. Methods Ninety-seven MS patients (77% females; 21–59 years old) completed questionnaires concerning the patient’s work situation, coping strategies, demographics, physical, psychological and cognitive functioning. Forward binary logistic regression analyses were conducted to examine coping strategies and other (disease) characteristics predictive of reported negative work events and accommodations. Results Nineteen per cent of the employed MS patients reported one or more negative work events, associated with a higher use of emotion-oriented coping and more absenteeism. Seventy-three per cent reported using one or more work accommodations, associated with a higher educational level and more presenteeism. MS patients reporting physical changes to the workplace employed more emotion-oriented coping, while flexible scheduling was associated with task-oriented coping. Conclusion Emotion-oriented and task-oriented coping strategies are associated with negative work events and the use of accommodations.
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Affiliation(s)
| | - Dam van Gorp
- University of Humanistic Studies, the Netherlands
| | - Rhb Benedict
- Buffalo General Hospital, Department of Neurology, USA
| | | | - Epj Arnoldus
- Elisabeth-TweeSteden Hospital, Department of Neurology, the Netherlands
| | - Eac Beenakker
- Medical Centre Leeuwarden, Department of Neurology, the Netherlands
| | - H M Bos
- St. Anna Hospital, Department of Neurology, the Netherlands
| | - Jjj van Eijk
- Jeroen Bosch Hospital, Department of Neurology, the Netherlands
| | - J Fermont
- Amphia Hospital, Department of Neurology, the Netherlands
| | - Stfm Frequin
- St. Antonius Hospital, Department of Neurology, the Netherlands
| | - B M van Geel
- Medical Centre Alkmaar, Department of Neurology, the Netherlands
| | - Gjd Hengstman
- Catharina Hospital, Department of Neurology, the Netherlands
| | - E Hoitsma
- Alrijne Hospital Leiden, Department of Neurology, the Netherlands
| | - Rmm Hupperts
- Zuyderland Medical Centre, Department of Neurology, the Netherlands
| | - J P Mostert
- Rijnstate Hospital, Department of Neurology, the Netherlands
| | - Phm Pop
- VieCuri, Department of Neurology, the Netherlands
| | - Wim Verhagen
- Canisius-Wilhelmina Hospital, Department of Neurology, the Netherlands
| | - D Zemel
- Albert Schweitzer Hospital, Department of Neurology, the Netherlands
| | - S E Frndak
- University at Buffalo, State University of New York (SUNY), USA
| | - Map Heerings
- National Multiple Sclerosis Foundation, the Netherlands
| | - Ham Middelkoop
- Leiden University Medical Centre, Department of Neurology, the Netherlands
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