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Oreja-Guevara C, Tintoré M, Meca V, Prieto JM, Meca J, Mendibe M, Rodríguez-Antigüedad A. Family Planning in Fertile-Age Patients With Multiple Sclerosis (MS) (ConPlanEM Study): Delphi Consensus Statements. Cureus 2023; 15:e44056. [PMID: 37746391 PMCID: PMC10517726 DOI: 10.7759/cureus.44056] [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] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
Family planning is essential for establishing Multiple Sclerosis (MS) prognosis, treatment decision, and disease monitoring. We aimed to generate an expert consensus addressing recommendations for family planning in MS patients of childbearing age. Initially, a committee comprising seven neurologists, experts in the MS field, identified the topics to be addressed. Then, the committee elaborated on different evidence-based preliminary statements. Next, using the Delphi methodology, a panel of neurologists manifested their level of agreement on the different statements using a Likert-type scale. Consensus was reached when ⩾70% of respondents expressed an agreement or disagreement using a five-point scale. Consensus was achieved on 47 out of 63 recommendations after three rounds of evaluations. The panel considered it essential to address family planning in all patients of childbearing age. There was also consensus that treatment should not be delayed due to the patient's desire for pregnancy. Additionally, in highly active patients, planning the pregnancy in the medium to long term using depletory drugs such as cladribine or alemtuzumab might represent a useful strategy. However, risks of adverse effects on the fetus due to drug-associated secondary autoimmunity should be addressed when alemtuzumab is considered. Moreover, the maintenance of natalizumab during pregnancy in very active patients reached expert consensus. Also, the panel supported the use of certain disease-modifying treatment (DMT) during lactation in selected cases. Our results identified specific areas of pregnancy planning in MS patients, where different treatment strategies might be considered to facilitate a safe and successful pregnancy while maintaining clinical and radiological stability.
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Affiliation(s)
| | - Mar Tintoré
- Neurology, Multiple Sclerosis Center of Catalonia (Cemcat) Vall d'Hebrón University Hospital, Barcelona, ESP
| | - Virginia Meca
- Neurology, Princess University Hospital, Madrid, ESP
| | - José María Prieto
- Neurology, University Clinical Hospital of Santiago de Compostela, Madrid, ESP
| | - José Meca
- Neurology, Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit, Virgen de la Arrixaca Clinical University Hospital, Cartagena, ESP
| | - Mar Mendibe
- Neurology, Neuroimmunology Group, Biocruces Bizkaia Research Institute, Cruces University Hospital, Bizkaia, ESP
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Espiño M, Abraira V, Arroyo R, Bau L, Cámara C, Campos-Ruiz L, Casanova B, Espejo C, Fernández O, García-Merino A, García-Sánchez MI, Gómez M, Gosis A, Izquierdo G, Meca J, Montalban X, Morandeira F, Olascoaga J, Prada A, Quintana E, Ramió-Torrentà L, Rodríguez-Antigüedad A, Salgado G, Santiago JL, Sarasola E, Simó-Castelló M, Alvarez-Cermeño JC, Villar LM. Assessment of the reproducibility of oligoclonal IgM band detection for its application in daily clinical practice. Clin Chim Acta 2014; 438:67-9. [PMID: 25110815 DOI: 10.1016/j.cca.2014.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 06/27/2014] [Revised: 07/18/2014] [Accepted: 08/03/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND The presence of oligoclonal IgM bands (OCMB) in cerebrospinal fluid (CSF) is an unfavourable prognostic marker in multiple sclerosis. There is no commercial test to investigate OCMB status. However, a sensitive and specific isoelectrofocusing (IEF) and western blot method was described. We aimed to study the inter-centre reproducibility of this technique, a necessary condition for a reliable test to be incorporated into clinical practice. METHODS The presence of OCMB was analysed by IEF and western blot with prior reduction of pentameric IgM. We assayed the reproducibility of this test in a blinded multicentre study performed in 13 university hospitals. Paired-CSF and serum samples from 52 neurological patients were assayed at every centre. RESULTS Global analysis rendered a concordance of 89.8% with a kappa value of 0.71. CONCLUSION These data indicate that OCMB detection by means of IEF and western blot with IgM reduction shows a good interlaboratory reproducibility and thus can be used in daily clinical setting.
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Affiliation(s)
- M Espiño
- Department of Immunology, Hospital Universitario Ramón y Cajal, Ctra de Colmenar Viejo km 9.100, 28034 Madrid, IRYCIS, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - V Abraira
- Department of Biostatistics, Hospital Universitario Ramón y Cajal, Ctra de Colmenar Viejo km 9.100, 28034 Madrid, IRYCIS, Spain
| | - R Arroyo
- Department of Neurology, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, s/n, 28040 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - L Bau
- Department of Neurology, Hospital Universitari de Bellvitge, Av. Granvia s/n, Hospitalet de Llobregat, Barcelona, Spain
| | - C Cámara
- Department of Immunology, Hospital San Pedro de Alcántara, Avenida Pablo Naranjo s/n, 10003 Cáceres, Spain
| | - L Campos-Ruiz
- Department of Neurology, Hospital Universitario Puerta de Hierro, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - B Casanova
- Department of Neurology, Hospital Universitari La Fe, Avinguda Fernando Abril Martorell, 46026 Valencia, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - C Espejo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - O Fernández
- Department of Neurology, Hospital Regional Universitario, Avda Carlos Haya, s/n, 29010 Málaga, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - A García-Merino
- Department of Neurology, Hospital Universitario Puerta de Hierro, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - M I García-Sánchez
- Department of Neurology, Hospital Universitario Virgen Macarena, Avd. Dr. Fedriani, 3, 41007 Sevilla, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - M Gómez
- Department of Neurology, Hospital San Pedro de Alcántara, Avenida Pablo Naranjo s/n, 10003 Cáceres, Spain
| | - A Gosis
- Red Española de Esclerosis Múltiple (REEM), Spain; Immunology, Hospital Regional Universitario, Avda Carlos Haya, s/n, 29010 Málaga, Spain
| | - G Izquierdo
- Department of Neurology, Hospital Universitario Virgen Macarena, Avd. Dr. Fedriani, 3, 41007 Sevilla, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - J Meca
- Department of Neurology, Hospital Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - X Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - F Morandeira
- Immunology, Hospital Universitari de Bellvitge, Av. Granvia s/n, Hospitalet de Llobregat, Barcelona, Spain
| | - J Olascoaga
- Department of Neurology, Hospital Universitario Donostia, P° Dr. Beguiristain, 107-111, 20014 San Sebastián, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - A Prada
- Red Española de Esclerosis Múltiple (REEM), Spain; Department of Neurology, Hospital Universitario Donostia, P° Dr. Beguiristain, 107-111, 20014 San Sebastián, Spain
| | - E Quintana
- Unitat de Neuroimmunologia i Esclerosi Múltiple, Hospital Universitari Dr. Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Avenida França, s/n, 17007 Girona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - Ll Ramió-Torrentà
- Unitat de Neuroimmunologia i Esclerosi Múltiple, Hospital Universitari Dr. Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Avenida França, s/n, 17007 Girona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - A Rodríguez-Antigüedad
- Department of Neurology, Hospital Universitario Basurto, Av de Montevideo, 18, 48013 Bilbao, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - G Salgado
- Immunology, Hospital Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - J L Santiago
- Department of Neurology, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, s/n, 28040 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - E Sarasola
- Department of Neurology, Hospital Universitario Basurto, Av de Montevideo, 18, 48013 Bilbao, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - M Simó-Castelló
- Department of Neurology, Hospital Universitari La Fe, Avinguda Fernando Abril Martorell, 46026 Valencia, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - J C Alvarez-Cermeño
- Red Española de Esclerosis Múltiple (REEM), Spain; Department of Neurology, Hospital Universitario Ramón y Cajal, Ctra de Colmenar Viejo km 9.100, 28034 Madrid, IRYCIS, Spain
| | - L M Villar
- Department of Immunology, Hospital Universitario Ramón y Cajal, Ctra de Colmenar Viejo km 9.100, 28034 Madrid, IRYCIS, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
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Fernández O, García-Merino JA, Arroyo R, Álvarez-Cermeño JC, Izquierdo G, Saiz A, Olascoaga J, Rodríguez-Antigüedad A, Prieto JM, Oreja-Guevara C, Hernández MA, Moral E, Meca J, Montalbán X. Spanish consensus on the use of natalizumab (Tysabri®)-2013. Neurologia 2013; 30:302-14. [PMID: 24360652 DOI: 10.1016/j.nrl.2013.10.004] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 10/13/2013] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Natalizumab treatment has been shown to be very efficacious in clinical trials and very effective in clinical practice in patients with relapsing-remitting multiple sclerosis, by reducing relapses, slowing disease progression, and improving magnetic resonance imaging patterns. However, the drug has also been associated with a risk of progressive multifocal leukoencephalopathy (PML). The first consensus statement on natalizumab use, published in 2011, has been updated to include new data on diagnostic procedures, monitoring for patients undergoing treatment, PML management, and other topics of interest including the management of patients discontinuing natalizumab. MATERIAL AND METHODS This updated version followed the method used in the first consensus. A group of Spanish experts in multiple sclerosis (the authors of the present document) reviewed all currently available literature on natalizumab and identified the relevant topics would need updating based on their clinical experience. The initial draft passed through review cycles until the final version was completed. RESULTS AND CONCLUSIONS Studies in clinical practice have demonstrated that changing to natalizumab is more effective than switching between immunomodulators. They favour early treatment with natalizumab rather than using natalizumab in a later stage as a rescue therapy. Although the drug is very effective, its potential adverse effects need to be considered, with particular attention to the patient's likelihood of developing PML. The neurologist should carefully explain the risks and benefits of the treatment, comparing them to the risks of multiple sclerosis in terms the patient can understand. Before treatment is started, laboratory tests and magnetic resonance images should be available to permit proper follow-up. The risk of PML should be stratified as high, medium, or low according to presence or absence of anti-JC virus antibodies, history of immunosuppressive therapy, and treatment duration. Although the presence of anti-JC virus antibodies is a significant finding, it should not be considered an absolute contraindication for natalizumab. This update provides general recommendations, but neurologists must use their clinical expertise to provide personalised follow-up for each patient.
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Affiliation(s)
- O Fernández
- Instituto de Neurociencias Clínicas, Servicio de Neurología, Hospital Regional Universitario Carlos Haya, Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud, Málaga, España.
| | - J A García-Merino
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Madrid, España
| | - R Arroyo
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, España
| | - J C Álvarez-Cermeño
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - G Izquierdo
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - A Saiz
- Servicio de Neurología, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, España
| | - J Olascoaga
- Servicio de Neurología, Hospital Universitario de Donostia, San Sebastián, España
| | | | - J M Prieto
- Servicio de Neurología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, España
| | - C Oreja-Guevara
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, España
| | - M A Hernández
- Servicio de Neurología, Hospital Universitario Ntra. Sra. de la Candelaria, Tenerife, España
| | - E Moral
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, España
| | - J Meca
- Servicio de Neurología, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - X Montalbán
- Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Hospital Universitari Vall d'Hebron, Barcelona, España
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Blanquer M, Pérez Espejo MA, Iniesta F, Gómez Espuch J, Meca J, Villaverde R, Izura V, de Mingo P, Martínez-Lage J, Martínez S, Moraleda JM. [Bone marrow stem cell transplantation in amyotrophic lateral sclerosis: technical aspects and preliminary results from a clinical trial]. Methods Find Exp Clin Pharmacol 2010; 32 Suppl A:31-37. [PMID: 21381286] [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] [Indexed: 05/30/2023]
Abstract
Patients with amyotrophic lateral sclerosis (ALS) experience progressive and irreversible paralysis as a result of the continued loss of motor neurons, which leads to death in less than five years. To date, there is no treatment that can change the progression of this disease. Bone marrow stem cells have shown neural regenerative and neural repairing properties. Specifically, our group showed in a murine model of the disease that these cells, when injected in the spinal cord, can rescue motor neurons through the secretion of GDNF. Based on these results, we designed a phase I/II clinical trial for the purpose of demonstrating the viability of the intraspinal injection of autologous bone marrow mononuclear cells in patients with bulbar onset ALS, with an evolution between 6 and 36 months, with a forced vital capacity (FVC) 50% and T90 29%. This article describes the technique for extracting 60 mL of bone marrow used for the intervention, processing it by density gradient, and the neurosurgical technique used for implanting it. After 6 months of follow-up, the few adverse events reported in the first seven patients included seem to show that the procedure is safe and viable. Most of these patients, including two with a rapid deterioration, have stabilized the progression of their FVC and the neurologic scales measured. The data obtained so for seem to justify the design of new trials more oriented toward the efficacy of the procedure.
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Affiliation(s)
- M Blanquer
- Unidad de Trasplante y Terapia Celular, Hospital Universitario Virgen de la Arrixaca, Murcia, España
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