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Costa-Frossard França L, Meca Lallana V, Labiano-Fontcuberta A, Blasco R, Monreal E, Martínez Ginés ML, Aguirre C, Sabin Muñoz J, Sainz de la Maza S, Cuello JP, Díaz-Pérez C, Chico García JL, Lozano Ros A, Rodríguez Jorge F, Martínez Martínez S, García Domínguez JM. Real-World Retrospective Analysis of Alemtuzumab Outcomes in Relapsing-Remitting Multiple Sclerosis: The LEMCAM Study. CNS Drugs 2024; 38:231-238. [PMID: 38418770 PMCID: PMC10920415 DOI: 10.1007/s40263-024-01066-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Alemtuzumab is a high-efficacy treatment approved for relapsing-remitting multiple sclerosis (RRMS). Although clinical trials and observational studies are consistent in showing its efficacy and manageable safety profile, further studies under clinical practice conditions are needed to further support its clinical use. OBJECTIVE The aim of this observational retrospective study was to evaluate the effectiveness and safety of alemtuzumab to add to the current real-world evidence on the drug. METHODS A cohort of 115 adult patients with RRMS treated with alemtuzumab between 2014 and 2020 was retrospectively followed up in five centers in Spain. Analysis included annualized relapse rate (ARR), 6-month confirmed disability worsening (CDW), 6-month confirmed disability improvement (CDI), radiological activity, no evidence of disease activity (NEDA-3), and safety signals. Given the different follow-up periods among participants, ARR was calculated using the person-years method. CDI was defined as a ≥ 1.0-point decrease in Expanded Disability Status Scale (EDSS) score assessed in patients with a baseline EDSS score ≥ 2.0 confirmed 6 months apart. CDW was defined as a ≥ 1.0-point increase in EDSS score assessed in patients with a baseline EDSS score ≥ 1.0 (≥ 1.5 if baseline EDSS = 0), confirmed 6 months apart. RESULTS ARR decreased from 1.9 (95% confidence interval 1.60-2.33) in the year prior to alemtuzumab initiation to 0.28 (0.17-0.37) after 1 year of treatment (87% reduction), and to 0.22 (0.13-0.35) after the second year. Over the entire follow-up period, ARR was 0.24 (0.18-0.30). At year 1, 75% of patients showed no signs of magnetic resonance imaging (MRI) activity and 70% at year 5. One percent of patients experienced 6-month CDW at year 1, 2.6% at year 2, 7.4% at year 3, and no patients over years 4 and 5. A total of 7.7% of patients achieved 6-month CDI in year 1, 3.6% in year 2, and maintained it at years 3 and 4. Most patients achieved annual NEDA-3: year 1, 72%; year 2, 79%; year 3, 80%; year 4, 89%; year 5, 75%. Infusion-related reactions were observed in 95% of patients and infections in 74%. Thyroid disorders occurred in 30% of patients, and only three patients developed immune thrombocytopenia. No cases of progressive multifocal leukoencephalopathy were reported. CONCLUSIONS This study shows that alemtuzumab reduced the relapse rate and disability worsening in real-world clinical practice, with many patients achieving and sustaining NEDA-3 over time. The safety profile of alemtuzumab was consistent with previous findings, and no new or unexpected safety signals were observed. As this was an observational and retrospective study, the main limitation of not having all variables comprehensively available for all patients should be considered when interpreting results.
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Affiliation(s)
| | - Virginia Meca Lallana
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Rosario Blasco
- Neuroimmunology Unit, Neurology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- IRYCIS (Ramón y Cajal Institute for Health Research), Madrid, Spain
- REEM (Spanish Network of Multiple Sclerosis), Universidad de Alcalá, Madrid, Spain
| | | | - Clara Aguirre
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | - Julia Sabin Muñoz
- Neuroimmunology Unit, Neurology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- IRYCIS (Ramón y Cajal Institute for Health Research), Madrid, Spain
- REEM (Spanish Network of Multiple Sclerosis), Universidad de Alcalá, Madrid, Spain
| | - Juan Pablo Cuello
- Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Carolina Díaz-Pérez
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Alberto Lozano Ros
- Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Goicochea Briceño H, Higueras Y, Ruiz Pérez I, García Domínguez JM, Cuello JP, Meldaña Rivera A, Martínez Ginés ML. Spasticity-Plus syndrome in multiple sclerosis patients in a tertiary hospital in Spain. Front Neurol 2024; 15:1360032. [PMID: 38469589 PMCID: PMC10926473 DOI: 10.3389/fneur.2024.1360032] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Spasticity is a common symptom in multiple sclerosis (MS) and it is often associated with other symptoms such as spasms/cramps and pain. The concept of Spasticity-Plus syndrome takes into account that spasticity is accompanied by one or more symptoms (spasms/cramps, pain, bladder dysfunction, sleep disorders, fatigue and/or tremor). As these symptoms share a common cannabinoid control, therapy acting on cannabinoid receptors may be useful. The main study objectives were to determine the number of MS patients who met Spasticity-Plus syndrome criteria and to identify the most common symptoms. Methods Clinical records of MS patients treated with nabiximols in a tertiary hospital from 2002 to 2022 were reviewed retrospectively. Results Of the 73 patients included in the study, 53.4% were women, and most had secondary progressive MS (64.4%). All patients met the criteria for Spasticity-Plus syndrome: 100% had spasticity and at least another symptom. Pain was the second most common symptom (91.8%), followed by spasms/cramps (79.4%), and fatigue (76.7%). Sleep disturbances (p < 0.0001) and tremor (p < 0.027) were more frequent in patients with relapsing-remitting MS than in patients with progressive MS. No statistically significant differences were found for spasticity, pain, spasms/cramps, and fatigue between MS phenotypes. Regarding symptoms clusters, 94.4% of the patients had three or more symptoms. Spasticity was more frequently associated with pain (91.8%) and spasms/cramps (79.4%). Conclusion Spasticity-Plus syndrome was present in all the study population of patients with different MS phenotypes, and treated with nabiximols.
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Affiliation(s)
| | - Yolanda Higueras
- Facultad de Psicología, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Irene Ruiz Pérez
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Juan Pablo Cuello
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ariana Meldaña Rivera
- Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Cuello JP, Martínez Ginés ML, García Domínguez JM, Tejeda-Velarde A, Lozano Ros A, Higueras Y, Meldaña Rivera A, Goicochea Briceño H, Garcia-Tizon S, de León-Luis J, Medina Heras S, Fernández Velasco JI, Pérez-Pérez S, García-Martínez MÁ, Pardo-Rodríguez B, Domínguez-Mozo MI, García-Calvo E, Estévez H, Luque-García JL, Villar LM, Alvarez-Lafuente R. Short-chain fatty acids during pregnancy in multiple sclerosis: A prospective cohort study. Eur J Neurol 2021; 29:895-900. [PMID: 34662474 DOI: 10.1111/ene.15150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/27/2021] [Accepted: 10/07/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Short-chain fatty acids (SCFAs) can have pro- or anti-inflammatory properties, but their relationship with multiple sclerosis (MS) relapses during pregnancy remains unknown. This study aimed to explore SCFA profiles in MS patients during pregnancy and to assess their association with the appearance of relapses during pregnancy and postpartum. METHODS We prospectively included 53 pregnant MS patients and 21 healthy control women. Patients were evaluated during pregnancy and puerperium. SCFAs were measured by liquid chromatography-mass spectrometry. RESULTS Sixteen patients (32%) had relapses during pregnancy or puerperium, and 37 (68%) did not. All MS patients showed significant increases in acetate levels during pregnancy and the postpartum period compared to non-MS women. However, propionate and butyrate values were associated with disease activity. Their values were higher in nonrelapsing patients and remained similar to the control group in relapsing patients. The variable that best identified active patients was the propionate/acetate ratio. Ratios of <0.36 during the first trimester were associated with higher inflammatory activity (odds ratio = 165, 95% confidence interval = 10.2-239.4, p < 0.01). Most nonrelapsing patients showed values of >0.36, which were similar to those in healthy pregnant women. CONCLUSIONS Low propionate/acetate ratio values during the first trimester of gestation identified MS patients at risk of relapses during pregnancy and the postpartum period.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Silvia Pérez-Pérez
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - María Ángel García-Martínez
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - Beatriz Pardo-Rodríguez
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - María Inmaculada Domínguez-Mozo
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - Estefanía García-Calvo
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid, Spain
| | - Héctor Estévez
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid, Spain
| | - Jose Luis Luque-García
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid, Spain
| | | | - Roberto Alvarez-Lafuente
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
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Moreno-Torres I, Meca Lallana V, Costa-Frossard L, Oreja-Guevara C, Aguirre C, Alba Suárez EM, Gómez Moreno M, Borrega Canelo L, Sabín Muñoz J, Aladro Y, Cárcamo A, Rodríguez García E, Cuello JP, Monreal E, Sainz de la Maza S, Pérez Parra F, Valenzuela Rojas F, López de Silanes de Miguel C, Casanova I, Martínez Gines ML, Blasco R, Orviz García A, Villar-Guimerans LM, Fernández-Dono G, Elvira V, Santiuste C, Espiño M, García Domínguez JM. Risk and outcomes of COVID-19 in patients with multiple sclerosis. Eur J Neurol 2021; 28:3712-3721. [PMID: 34152073 PMCID: PMC8444942 DOI: 10.1111/ene.14990] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/21/2020] [Revised: 03/30/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
Background and purpose Limited information is available on incidence and outcomes of COVID‐19 in patients with multiple sclerosis (MS). This study investigated the risks of SARS‐CoV‐2 infection and COVID‐19‐related outcomes in patients with MS, and compared these with the general population. Methods A regional registry was created to collect data on incidence, hospitalization rates, intensive care unit admission, and death in patients with MS and COVID‐19. National government outcomes and seroprevalence data were used for comparison. The study was conducted at 14 specialist MS treatment centers in Madrid, Spain, between February and May 2020. Results Two‐hundred nineteen patients were included in the registry, 51 of whom were hospitalized with COVID‐19. The mean age ± standard deviation was 45.3 ± 12.4 years, and the mean duration of MS was 11.9 ± 8.9 years. The infection incidence rate was lower in patients with MS than the general population (adjusted incidence rate ratio = 0.78, 95% confidence interval [CI] = 0.70–0.80), but hospitalization rates were higher (relative risk = 5.03, 95% CI = 3.76–6.62). Disease severity was generally low, with only one admission to an intensive care unit and five deaths. Males with MS had higher incidence rates and risk of hospitalization than females. No association was found between the use of any disease‐modifying treatment and hospitalization risk. Conclusions Patients with MS do not appear to have greater risks of SARS‐CoV‐2 infection or severe COVID‐19 outcomes compared with the general population. The decision to start or continue disease‐modifying treatment should be based on a careful risk–benefit assessment.
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Affiliation(s)
- Irene Moreno-Torres
- Demyelinating Diseases Unit, Jiménez Diaz Foundation University Hospital, Madrid, Spain
| | | | | | - Celia Oreja-Guevara
- Department of Neurology, Department of Medicine, Faculty of Medicine, San Carlos Clinical Hospital, Complutense University of Madrid and San Carlos Institute for Health Research, Madrid, Spain
| | - Clara Aguirre
- Demyelinating Diseases Unit, La Princesa University Hospital, Madrid, Spain
| | | | | | | | - Julia Sabín Muñoz
- Neuroimmunology Unit, Puerta de Hierro University Hospital, Madrid, Spain
| | - Yolanda Aladro
- Demyelinating Diseases Unit, University Hospital of Getafe, Madrid, Spain
| | - Alba Cárcamo
- Demyelinating Diseases Unit, University Hospital of Getafe, Madrid, Spain
| | | | - Juan Pablo Cuello
- Demyelinating Diseases Unit, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Enric Monreal
- Multiple Sclerosis Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | | | | | | | | | | - Rosario Blasco
- Neuroimmunology Unit, Puerta de Hierro University Hospital, Madrid, Spain
| | - Aida Orviz García
- Demyelinating Diseases Unit, Jiménez Diaz Foundation University Hospital, Madrid, Spain
| | | | | | | | - Carmen Santiuste
- Multiple Sclerosis Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | - Mercedes Espiño
- Multiple Sclerosis Unit, Ramón y Cajal University Hospital, Madrid, Spain
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Cuello JP, Martínez Ginés ML, Tejeda-Velarde A, Medina Heras S, García Domínguez JM, Fernández Velasco JI, Lozano Ros A, Higueras Y, Meldaña Rivera A, Goicochea Briceño H, Garcia-Tizon Larroca S, De León-Luis J, de Andrés C, Álvarez Lafuente R, Villar LM. Cytokine profile during pregnancy predicts relapses during pregnancy and postpartum in multiple sclerosis. J Neurol Sci 2020; 414:116811. [DOI: 10.1016/j.jns.2020.116811] [Citation(s) in RCA: 4] [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: 10/28/2019] [Revised: 02/28/2020] [Accepted: 03/27/2020] [Indexed: 12/17/2022]
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Cuello JP, Salgado Cámara P, García Domínguez JM, Lozano Ros A, Mas Serrano M, Martínez Ginés ML. Pregnancy exposure to disease-modifying drugs in multiple sclerosis: a prospective study. Med Clin (Barc) 2019; 154:214-217. [PMID: 31420082 DOI: 10.1016/j.medcli.2019.05.026] [Citation(s) in RCA: 2] [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: 01/22/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In multiple sclerosis (MS), foetal exposure to disease-modifying drugs (DMDs) carries varying degrees of risk. We sought to analyse the clinical and obstetric outcomes of MS patients (MSp) exposed to DMDs during pregnancy. PATIENTS AND METHODS Observational study. We analysed the clinical-obstetric data of a cohort MSp, who became pregnant between 2007-2017. They were prospectively followed up during pregnancy and postpartum. CONTROL GROUP healthy pregnant women (HPW) and MSp unexposed to DMDs. RESULTS Sixty-eight pregnancies in MSp. Fifty-six HPW. Thirteen MSp were exposed to DMDs during pregnancy. Obstetric outcome: 2 (15%) infants had low birth weight, no preterm deliveries. Fifty-five MSp were not exposed to DMDs: 22 (40%) discontinued DMD before pregnancy, 33(60%) naïve. Five infants (9%) had low birth weight and 7 (12%) were preterm. HPW: 56. Low birth weight 6 (11%), preterm delivery 6 (11%). There were no differences in relapse incidence during pregnancy-puerperium between MSp groups. There were no differences in birth weight, gestation time, delivery-caesarean section. We found no special obstetric morbidity in women exposed to DMDs. CONCLUSIONS There were no significant differences in the clinical and obstetric variables analysed between pregnant women exposed to DMDs, unexposed, and HPW.
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Affiliation(s)
- Juan Pablo Cuello
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Paula Salgado Cámara
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - Alberto Lozano Ros
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Miguel Mas Serrano
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
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