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Montalban X, Gold R, Thompson AJ, Otero‐Romero S, Amato MP, Chandraratna D, Clanet M, Comi G, Derfuss T, Fazekas F, Hartung HP, Havrdova E, Hemmer B, Kappos L, Liblau R, Lubetzki C, Marcus E, Miller DH, Olsson T, Pilling S, Selmaj K, Siva A, Sorensen PS, Sormani MP, Thalheim C, Wiendl H, Zipp F. ECTRIMS
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EAN
guideline on the pharmacological treatment of people with multiple sclerosis. Eur J Neurol 2018; 25:215-237. [DOI: 10.1111/ene.13536] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 01/21/2023]
Affiliation(s)
- X. Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat) Department of Neurology‐Neuroimmunology Vall d'Hebron University Hospital Barcelona Spain
| | - R. Gold
- Department of Neurology Ruhr University, St Josef‐Hospital Bochum Germany
| | - A. J. Thompson
- Department of Brain Repair and Rehabilitation Faculty of Brain Sciences University College London Institute of Neurology London UK
| | - S. Otero‐Romero
- Multiple Sclerosis Centre of Catalonia (Cemcat) Department of Neurology‐Neuroimmunology Vall d'Hebron University Hospital Barcelona Spain
- Preventive Medicine and Epidemiology Department Vall d'Hebron University Hospital Barcelona Spain
| | - M. P. Amato
- Department NEUROFARBA Section Neurosciences University of Florence Florence Italy
| | | | - M. Clanet
- Department of Neurology Toulouse University Hospital Toulouse France
| | - G. Comi
- Neurological Department Institute of Experimental Neurology (INSPE) Scientific Institute Hospital San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - T. Derfuss
- Departments of Neurology and Biomedicine University Hospital Basel Basel Switzerland
| | - F. Fazekas
- Department of Neurology Medical University of Graz Graz Austria
| | - H. P. Hartung
- Department of Neurology Medical Faculty, Multiple Sclerosis Heinrich‐Heine‐University Düsseldorf Germany
| | - E. Havrdova
- Department of Neurology and Centre of Clinical Neuroscience First Faculty of Medicine and General University Hospital Charles University Prague Czech Republic
| | - B. Hemmer
- Department of Neurology Klinikum Rechts der Isar Technische Universität München MunichGermany
- Munich Cluster for Systems Neurology (SyNergy) Munich Germany
| | - L. Kappos
- University Hospital Basel Basel Switzerland
| | - R. Liblau
- INSERM UMR U1043 – CNRS U5282 Centre de Physiopathologie de Toulouse Purpan Université de Toulouse, UPS ToulouseFrance
| | - C. Lubetzki
- ICM‐GHU Pitié‐Salpêtrière Sorbonne Universités UPMC Univ Paris 06, UMR_S 1127 Paris France
| | - E. Marcus
- Centre for Outcomes Research and Effectiveness (CORE) Research Department of Clinical, Educational and Health Psychology University College London LondonUK
| | - D. H. Miller
- NMR Research Unit Queen Square Multiple Sclerosis Centre University College London (UCL) Institute of Neurology London UK
| | - T. Olsson
- Neuroimmunology Unit Centre for Molecular Medicine, L8:04 Karolinska University Hospital (Solna) Stockholm Sweden
| | - S. Pilling
- Centre for Outcomes Research and Effectiveness (CORE) Research Department of Clinical, Educational and Health Psychology University College London LondonUK
| | - K. Selmaj
- Department of Neurology Medical University of Lodz Lodz Poland
| | - A. Siva
- Clinical Neuroimmunology Unit and MS Clinic Department of Neurology Cerrahpasa School of Medicine Istanbul University Istanbul Turkey
| | - P. S. Sorensen
- Danish Multiple Sclerosis Centre Department of Neurology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | | | - C. Thalheim
- European Multiple Sclerosis Platform (EMSP) Schaerbeek/Brussels Belgium
| | - H. Wiendl
- Department of Neurology University of Münster MünsterGermany
| | - F. Zipp
- Department of Neurology Focus Program Translational Neuroscience (FTN) and Immunology (FZI) Rhine‐Main Neuroscience Network (rmn2) University Medical Centre of the Johannes Gutenberg University Mainz Mainz Germany
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Ziemssen T, Arnold D, Bar-Or A, Comi G, Hartung H, Hauser S, Kappos L, Lublin F, Selmaj K, Traboulsee A, Masterman D, Chin P, Garren H, Wolinsky J. P 1 Effect of ocrelizumab on magnetic resonance imaging markers of neurodegeneration in patients with relapsing multiple sclerosis – analysis of the phase III, double-blind, double-dummy, interferon beta-1a- controlled OPERA I and OPERA II studies. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Silber E, Arnold DL, Bar-Or A, Comi G, Hartung HP, Hauser SL, Lublin F, Selmaj K, Traboulsee A, Kappos L. OCRELIZUMAB VS INTERFERON β-1A IN RELAPSING MS: TWO STUDIES. J Neurol Neurosurg Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Radue EW, Sprenger T, Vollmer T, Giovannoni G, Gold R, Havrdova E, Selmaj K, Stefoski D, You X, Elkins J. Daclizumab high-yield process reduced the evolution of new gadolinium-enhancing lesions to T1 black holes in patients with relapsing-remitting multiple sclerosis. Eur J Neurol 2016; 23:412-5. [PMID: 26806217 DOI: 10.1111/ene.12922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 06/04/2015] [Accepted: 11/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE In the SELECT study, treatment with daclizumab high-yield process (DAC HYP) versus placebo reduced the frequency of gadolinium-enhancing (Gd(+) ) lesions in patients with relapsing-remitting multiple sclerosis (RRMS). The objective of this post hoc analysis of SELECT was to evaluate the effect of DAC HYP on the evolution of new Gd(+) lesions to T1 hypointense lesions (T1 black holes). METHODS SELECT was a randomized double-blind study of subcutaneous DAC HYP 150 or 300 mg or placebo every 4 weeks. Magnetic resonance imaging (MRI) scans were performed at baseline and weeks 24, 36 and 52 in all patients and monthly between weeks 4 and 20 in a subset of patients. MRI scans were evaluated for new Gd(+) lesions that evolved to T1 black holes at week 52. Data for the DAC HYP groups were pooled for analysis. RESULTS Daclizumab high-yield process reduced the number of new Gd(+) lesions present at week 24 (P = 0.005) or between weeks 4 and 20 (P = 0.014) that evolved into T1 black holes at week 52 versus placebo. DAC HYP treatment also reduced the percentage of patients with Gd(+) lesions evolving to T1 black holes versus placebo. CONCLUSIONS Treatment with DAC HYP reduced the evolution of Gd(+) lesions to T1 black holes versus placebo, suggesting that inflammatory lesions that evolved during DAC HYP treatment are less destructive than those evolving during placebo treatment.
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Affiliation(s)
- E-W Radue
- Department of Neurology and Medical Image Analysis Center, MIAC, University Hospital Basel, Basel, Switzerland
| | - T Sprenger
- Department of Neurology and Medical Image Analysis Center, MIAC, University Hospital Basel, Basel, Switzerland.,DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
| | - T Vollmer
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - G Giovannoni
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - R Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - E Havrdova
- Department of Neurology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - K Selmaj
- Department of Neurology, Medical University of Lodz, Lodz, Poland
| | - D Stefoski
- Department of Neurology, Rush University Medical Center, Chicago, IL, USA
| | - X You
- Biogen, Cambridge, MA, USA
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Kappos L, Mehling M, Arroyo R, Izquierdo G, Selmaj K, Curovic-Perisic V, Keil A, Bijarnia M, Singh A, von Rosenstiel P. Randomized trial of vaccination in fingolimod-treated patients with multiple sclerosis. Neurology 2015; 84:872-9. [DOI: 10.1212/wnl.0000000000001302] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Elkins J, Sheridan J, Amaravadi L, Riester K, Selmaj K, Bielekova B, Parr E, Giovannoni G. CD56(bright) natural killer cells and response to daclizumab HYP in relapsing-remitting MS. Neurol Neuroimmunol Neuroinflamm 2015; 2:e65. [PMID: 25635261 PMCID: PMC4309527 DOI: 10.1212/nxi.0000000000000065] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 12/11/2014] [Indexed: 11/18/2022]
Abstract
Objective: To assess the relationship between CD56bright natural killer (NK) cells and multiple sclerosis (MS) disease activity in patients with relapsing-remitting MS treated with daclizumab high-yield process (DAC HYP). Methods: Data were from patients enrolled in a 52-week randomized, double-blind, placebo-controlled study of DAC HYP and its extension study. Assessments included relationships of CD56bright NK cell numbers (identified using fluorescence-activated cell sorting) at weeks 4 and 8 with the numbers of new or newly enlarging T2-hyperintense lesions between weeks 24 and 52 and the annualized relapse rate. Results: In DAC HYP–treated patients but not placebo-treated patients, the numbers of CD56bright NK cells increased over 52 weeks of treatment, and their numbers at weeks 4 and 8 predicted the number of new or newly enlarging T2-hyperintense lesions between weeks 24 and 52 of treatment (p ≤ 0.005 for each comparison). Similar but nonsignificant trends were observed between CD56bright NK cell counts and the annualized relapse rate in DAC HYP–treated patients. DAC HYP–treated patients who showed lower levels of expansion of CD56bright NK cells still developed fewer new or newly enlarging T2-hyperintense lesions than placebo-treated patients during the first year of treatment. Conclusions: CD56bright NK cells appear to mediate some of the treatment-related effects of DAC HYP, but their numbers do not account for the full effect of DAC HYP on MS-related outcomes.
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Affiliation(s)
- J Elkins
- Biogen Idec (J.E., L.A., K.R.), Cambridge, MA; AbbVie Biotherapeutics Inc. (J.S.), Redwood City, CA; Medical University of Lodz (K.S.), Poland; Neuroimmunology Branch (B.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Excel Scientific Solutions (E.P.), Southport, CT; and Blizard Institute (G.G.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - J Sheridan
- Biogen Idec (J.E., L.A., K.R.), Cambridge, MA; AbbVie Biotherapeutics Inc. (J.S.), Redwood City, CA; Medical University of Lodz (K.S.), Poland; Neuroimmunology Branch (B.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Excel Scientific Solutions (E.P.), Southport, CT; and Blizard Institute (G.G.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - L Amaravadi
- Biogen Idec (J.E., L.A., K.R.), Cambridge, MA; AbbVie Biotherapeutics Inc. (J.S.), Redwood City, CA; Medical University of Lodz (K.S.), Poland; Neuroimmunology Branch (B.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Excel Scientific Solutions (E.P.), Southport, CT; and Blizard Institute (G.G.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - K Riester
- Biogen Idec (J.E., L.A., K.R.), Cambridge, MA; AbbVie Biotherapeutics Inc. (J.S.), Redwood City, CA; Medical University of Lodz (K.S.), Poland; Neuroimmunology Branch (B.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Excel Scientific Solutions (E.P.), Southport, CT; and Blizard Institute (G.G.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - K Selmaj
- Biogen Idec (J.E., L.A., K.R.), Cambridge, MA; AbbVie Biotherapeutics Inc. (J.S.), Redwood City, CA; Medical University of Lodz (K.S.), Poland; Neuroimmunology Branch (B.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Excel Scientific Solutions (E.P.), Southport, CT; and Blizard Institute (G.G.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - B Bielekova
- Biogen Idec (J.E., L.A., K.R.), Cambridge, MA; AbbVie Biotherapeutics Inc. (J.S.), Redwood City, CA; Medical University of Lodz (K.S.), Poland; Neuroimmunology Branch (B.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Excel Scientific Solutions (E.P.), Southport, CT; and Blizard Institute (G.G.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - E Parr
- Biogen Idec (J.E., L.A., K.R.), Cambridge, MA; AbbVie Biotherapeutics Inc. (J.S.), Redwood City, CA; Medical University of Lodz (K.S.), Poland; Neuroimmunology Branch (B.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Excel Scientific Solutions (E.P.), Southport, CT; and Blizard Institute (G.G.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - G Giovannoni
- Biogen Idec (J.E., L.A., K.R.), Cambridge, MA; AbbVie Biotherapeutics Inc. (J.S.), Redwood City, CA; Medical University of Lodz (K.S.), Poland; Neuroimmunology Branch (B.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Excel Scientific Solutions (E.P.), Southport, CT; and Blizard Institute (G.G.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
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Stuve O, Hartung H, Freedman M, Li D, Hemmer B, Kappos L, Rieckmann P, Montalban X, Ziemssen T, Selmaj K. Phase 2 BOLD extension study efficacy results for siponimod (BAF312) in patients with relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2014. [DOI: 10.1016/j.msard.2014.09.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vollmer TL, Sorensen PS, Selmaj K, Zipp F, Havrdova E, Cohen JA, Sasson N, Gilgun-Sherki Y, Arnold DL. A randomized placebo-controlled phase III trial of oral laquinimod for multiple sclerosis. J Neurol 2014; 261:773-83. [PMID: 24535134 DOI: 10.1007/s00415-014-7264-4] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/24/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
The phase III placebo-controlled BRAVO study assessed laquinimod effects in patients with relapsing-remitting MS (RRMS), and descriptively compared laquinimod with interferon beta (IFNβ)-1a (Avonex(®) reference arm). RRMS patients age 18-55 years with Expanded Disability Status Scale (EDSS) scores of 0-5.5 and documented pre-study relapse (≥ 1 in previous year, 2 in previous 2 years, or 1 in previous 1-2 years and ≥ 1 GdE lesion in the previous year) were randomized (1:1:1) to laquinimod 0.6 mg once-daily, matching oral placebo, or IFNβ-1a IM 30 μg once-weekly (rater-blinded design), for 24 months. The primary endpoint was annualized relapse rate (ARR); secondary endpoints included percent brain volume change (PBVC) and 3-month confirmed disability worsening. In all, 1,331 patients were randomized: laquinimod (n = 434), placebo (n = 450), and IFNβ-1a (n = 447). ARR was not significantly reduced with laquinimod [-18 %, risk ratio (RR) = 0.82, 95 % CI 0.66-1.02; p = 0.075] vs. placebo. Laquinimod significantly reduced PBVC (28 %, p < 0.001). Confirmed disability worsening was infrequent (10 % laquinimod, 13 % placebo). The change in confirmed disability worsening with laquinimod measured using EDSS was -31 % [hazard ratio (HR) 0.69, p = 0.063], and using Multiple Sclerosis Functional Composite (MSFC) z-score was -77 % (p = 0.150), vs. placebo. IFNβ-1a reduced ARR 26 % (RR = 0.74, 95 % CI 0.60-0.92, p = 0.007), showed no effect on PBVC loss (+11 %, p = 0.14), and changes in disability worsening were -26 and -66 % as measured using the EDSS (HR 0.742, p = 0.13) and MSFC (p = 0.208), respectively. Adverse events occurred in 75, 82, and 70 % of laquinimod, IFNβ-1a, and placebo patients, respectively. Once-daily oral laquinimod 0.6 mg resulted in statistically nonsignificant reductions in ARR and disability progression, but significant reductions in brain atrophy vs. placebo. Laquinimod was well-tolerated.
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Affiliation(s)
- T L Vollmer
- Department of Neurology, University of Colorado, Aurora, CO, USA,
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Selmaj K, Arnold D, Brinar V, Cohen J, Coles A, Confavreux C, Fox E, Giovannoni G, Hartung H, Havrdova E, Stojanovic M, Weiner H, Lake S, Margolin D, Oyuela P, Panzara M, Compston A. Incidence of Autoimmunity in a Phase 3 Trial: Comparison of Alemtuzumab and Rebif(R) in Multiple Sclerosis I (CARE-MS I) (S41.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s41.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Havrdova E, Arnold D, Cohen J, Coles A, Confavreux C, Fox E, Hartung H, Selmaj K, Weiner H, Brinar V, Giovannoni G, Stojanovic M, Lake S, Margolin D, Oyuela P, Panzara M, Compston A. Infections in Phase 3 Study: Comparison of Alemtuzumab and Rebif(R) Efficacy in Multiple Sclerosis I (CARE-MS I) (S41.007). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s41.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Agarwal S, Kappos L, Gold R, Arnold D, Bar-Or A, Giovannoni G, Selmaj K, Kong J, Sheikh S, Dawson K. Effects of BG-12 on Quality of Life in Patients with Relapsing-Remitting Multiple Sclerosis: Findings from the DEFINE Study (P07.102). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mycko M, Cichalewska M, Machlanska A, Cwiklinska H, Mariasiewicz M, Selmaj K. Mir-301a Regulation of the Development of a Th17 Response Controls Autoimmune Demyelination (P07.085). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Stuve O, Selmaj K, Li D, Hartung HP, Hemmer B, Kappos L, Freedman M, Rieckmann P, Montalban X, Zhang Auberson L, Pohlmann H, Mercier F, Dahlke F, Wallstrom E. BAF312, a Selective Sphingosine-1-Phosphate Receptor Modulator Improves MRI and Clinical Outcomes in Relapsing-Remitting Multiple Sclerosis (RRMS) (S30.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s30.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fox E, Arnold D, Brinar V, Cohen J, Coles A, Confavreux C, Giovannoni G, Hartung H, Havrdova E, Selmaj K, Stojanovic M, Weiner H, Lake S, Margolin D, Panzara M, Compston A. Relapse Outcomes with Alemtuzumab vs. Rebif(R) in Treatment-Naive Relapsing-Remitting Multiple Sclerosis (CARE-MS I): Secondary and Tertiary Endpoints (PD5.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd5.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vollmer T, Comi G, Sorensen PS, Arnold D, Filippi M, Statinova O, Kobys T, Becker E, Jeffery D, Montalban X, Kappos L, Boyko A, Selmaj K, Zipp F, Havrdova E, Cohen J. Clinical Efficacy of Laquinimod for the Treatment of Multiple Sclerosis; Pooled Analyses from the ALLEGRO and BRAVO Phase III Trials (S01.007). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Arnold D, Gold R, Kappos L, Bar-Or A, Giovannoni G, Selmaj K, Zhang R, Stephan M, Dawson K. Effect of BG-12 on Brain Atrophy and Lesions Volume: MRI Results from the DEFINE Study during First and Second Year of Treatment (S11.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jurynczyk M, Jurewicz A, Walczak A, Wodz-Naskiewicz K, Selmaj K. Characterisation of Dendritic Cell Subsets in Lymph Nodes of Multiple Sclerosis Patients Treated with Transdermally Delivered Myelin Peptides (P02.100). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Coles A, Brinar V, Arnold D, Cohen J, Confavreux C, Fox E, Hartung H, Havrdova E, Selmaj K, Weiner H, Giovannoni G, Stojanovic M, Lake S, Margolin D, Panzara M, Compston A. Efficacy and Safety Results from Comparison of Alemtuzumab and Rebif(R) Efficacy in Multiple Sclerosis I (CARE-MS I): A Phase 3 Study in Relapsing-Remitting Treatment-Naive Patients (S01.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Arnold D, Brinar V, Cohen J, Coles A, Confavreux C, Fisher E, Fox E, Giovannoni G, Hartung H, Havrdova E, Selmaj K, Weiner H, Stojanovic M, Lake S, Margolin D, Panzara M, Compston A. Effect of Alemtuzumab vs. Rebif(R) on Brain MRI Measurements: Results of CARE-MS I, a Phase 3 Study (S11.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Li D, Selmaj K, Zhao G, Cheng Y, Mercier F, Rochotte E, Wallstrom E. MRI Findings of BOLD: A Phase 2 Dose-Finding Study Using Adaptive Design and Modeling Methods for BAF312 in Relapsing-Remitting MS (S11.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jasek L, Siger M, Berkowicz T, Selmaj K. Multiparametric MRI Analysis of Patients with Late Multiple Sclerosis (P03.041). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cohen J, Twyman C, Arnold D, Coles A, Confavreux C, Fox E, Hartung H, Havrdova E, Selmaj K, Weiner H, Miller T, Lake S, Margolin D, Panzara M, Compston A. Efficacy and Safety Results from Comparison of Alemtuzumab and Rebif(R) Efficacy in Multiple Sclerosis II (CARE-MS II): A Phase 3 Study in Relapsing-Remitting Multiple Sclerosis Patients Who Relapsed on Prior Therapy (S01.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Siger M, Selmaj K. Brain Atrophy and Proton Magnetic Resonance Spectroscopy in Familial and Sporadic Multiple Sclerosis Patients (P03.043). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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DiMarco J, Selmaj K, Kappos L, Jordaan P, Mendzelevski B, Goncalves J, Zhang Auberson L. Dose Titration Regimen Attenuates Bradyarrhythymic Events with BAF312 during Treatment Initiation (P01.131). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Arnold D, Gold R, Kappos L, Bar-Or A, Giovannoni G, Selmaj K, Zhang R, Stephan M, Dawson K. Effect of BG-12 on Brain Atrophy and Lesions Volume: MRI Results from the DEFINE Study during First and Second Year of Treatment (IN3-2.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in3-2.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bar-Or A, Gold R, Kappos L, Arnold D, Giovannoni G, Selmaj K, O'Gorman J, Stephan M, Dawson K. Effect of BG-12 in Subgroups of Patients with Relapsing-Remitting Multiple Sclerosis: Findings from the DEFINE Study (P01.130). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gold R, Giovannoni G, Selmaj K, Havrdova E, Montalban X, Radue EW, Stefoski D, Robinson R, Riester K, Elkins J, O'Neill G. A Randomized, Double-Blind, Placebo-Controlled Study To Evaluate the Safety and Efficacy of Daclizumab HYP Monotherapy in Relapsing-Remitting Multiple Sclerosis: Primary Results of the SELECT Trial (S01.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Giovannoni G, Gold R, Kappos L, Arnold D, Bar-Or A, Selmaj K, Zhang A, Sheikh S, Dawson K. BG-12 Increases the Proportion of Patients Free of Clinical and Radiologic Disease Activity in Relapsing-Remitting Multiple Sclerosis: Findings from the DEFINE Study (PD5.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd5.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kappos L, Radue EW, O'Connor P, Polman C, Hohlfeld R, Calabresi P, Selmaj K, Agoropoulou C, Jin J, Zhang-Auberson L, Francis G. Long-Term Efficacy and Safety of Fingolimod (FTY720) in Relapsing-Remitting Multiple Sclerosis (RRMS): Results from the Extension of the Phase III FREEDOMS Study (S41.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s41.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Comi G, Vollmer T, Sorensen PS, Arnold D, Filippi M, Statinov O, Kobys T, Becker E, Jeffery D, Montalban X, Kappos L, Boyko A, Selmaj K, Zipp F, Havrdova E, Cohen J. Pooled Analyses from the ALLEGRO and BRAVO Trials on the Safety and Tolerability of Laquinimod as a Multiple Sclerosis Treatment (P04.132). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Selmaj K, Havrdova E, Gold R, Greenberg S, Umans K, Elkins J. Daclizumab HYP Monotherapy Improved Health-Related Quality of Life Parameters in Relapsing-Remitting Multiple Sclerosis: Findings of the SELECT Trial (P07.098). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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32
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Arnold D, Gold R, Kappos L, Bar-Or A, Giovannoni G, Selmaj K, Yang M, Stephan M, Dawson K. Effects of BG-12 on Magnetization Transfer Ratio in Whole Brain and Normal-Appearing Brain Tissue: Findings from the DEFINE Study (S11.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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33
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Comi G, Abramsky O, Arbizu T, Boyko A, Gold R, Havrdová E, Komoly S, Selmaj K, Sharrack B, Filippi M. Oral laquinimod in patients with relapsing-remitting multiple sclerosis: 36-week double-blind active extension of the multi-centre, randomized, double-blind, parallel-group placebo-controlled study. Mult Scler 2010; 16:1360-6. [PMID: 20834039 DOI: 10.1177/1352458510378127] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Laquinimod, an oral novel immunomodulator, was shown to reduce MRI-measured disease activity in relapsing-remitting MS (RRMS) patients. OBJECTIVES To determine whether the safety and efficacy profile of laquinimod, as shown in a placebo-controlled 36-week trial (LAQ/5062), is sustained and reproducible. METHODS Two hundred and fifty seven patients entered the extension phase in which MRI was performed at the beginning and at the end of the active extension phase. Clinical assessments were performed at weeks 4, 12 and every 12 weeks thereafter. RESULTS Two hundred and thirty nine (93%) patients completed the extension phase and 222 (86.3%) had a final scan available. Gadolinium-enhanced (GdE) T1 lesions were significantly reduced for patients switching from placebo to 0.3/ 0.6 mg doses (52%, p = 0.0006). In patients initially randomized to 0.6 mg in LAQ/5062 the reduction of MRI activity observed in the placebo-controlled phase was maintained in the extension. The proportion of GdE-free patients for those who switched from placebo increased from a baseline of 31% to 47% at the end of the extension phase (p = 0.01). The most prominent safety signal was elevations of liver enzymes, reversible in all cases. CONCLUSIONS The good efficacy and the excellent safety and tolerability profiles of laquinimod 0.6 mg/day are confirmed in this extension study.
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Affiliation(s)
- G Comi
- Department of Neurology, University Vita-Salute and Scientific Institute San Raffaele, Milan, Italy.
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Bayas A, Stasiolek M, Kruse N, Toyka KV, Selmaj K, Gold R. Altered innate immune response of plasmacytoid dendritic cells in multiple sclerosis. Clin Exp Immunol 2009; 157:332-42. [PMID: 19664140 DOI: 10.1111/j.1365-2249.2009.03964.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Plasmacytoid dendritic cells (pDCs) are of crucial importance in immune regulation and response to microbial factors. In multiple sclerosis (MS), pDCs from peripheral blood showed an immature phenotype, but its role in susceptibility to MS is not determined. Because infectious diseases are established triggers of exacerbations in MS, in this study we have characterized the expression of Toll-like receptors (TLR) and the maturation and functional properties of peripheral blood pDCs from clinically stable, untreated MS patients in response to signals of innate immunity. After stimulation of TLR-9, interferon (IFN)-alpha production by pDCs was significantly lower in MS (n = 12) compared to healthy controls (n = 9). In an allogenic two-step co-culture assay we found an impaired effect of TLR-9 stimulation on IFN-gamma expression of autologous naive T cells in MS patients (n = 4). In peripheral blood mononuclear cells, TLR-9 stimulation with type A CpG ODN resulted in a higher expression of TLR-1, -2, -4, -5 and -8 in MS patients (n = 7) compared with healthy controls (n = 11). These findings suggest an altered innate immune response to microbial stimuli in MS patients and may help understanding of why common infectious agents trigger MS attacks.
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Affiliation(s)
- A Bayas
- Department of Neurology, University of Würzburg, Würzburg, Poland.
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Selmaj K, Jurewicz A, Matysiak M, Raine CS, William Lindsey J. SOLUBLE NOGO-A IN CSF IS NOT A USEFUL BIOMARKER FOR MULTIPLE SCLEROSIS. Neurology 2009; 72:1708; author reply 1708-9. [DOI: 10.1212/01.wnl.0000346741.75149.9d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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36
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Matysiak M, Makosa B, Walczak A, Selmaj K. Patients with multiple sclerosis resisted to glucocorticoid therapy: abnormal expression of heat-shock protein 90 in glucocorticoid receptor complex. Mult Scler 2008; 14:919-26. [PMID: 18573821 DOI: 10.1177/1352458508090666] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The majority of patients with multiple sclerosis (MS) respond favorably to glucocorticoids (GS) for their relapse treatment (steroid-sensitive multiple sclerosis). Unfortunately, a small subset of patients with multiple-sclerosis fails to adequately respond even to high dose of GS (steroid-resistant multiple sclerosis). Mechanism of GS therapeutic unresponsiveness is not resolved. METHODS Transcripts for glucocorticoid receptor (GR) was assessed in peripheral blood mononuclear cells by real-time polymerase chain reaction in patients with steroid-sensitive and steroid-resistant multiple sclerosis. GR expression was assessed by Western blotting. The amount of heat-shock protein 90 (hsp90) in GR cytoplasmic complex was assessed by immunoprecipitation. Hsp90 was shown to stabilize the GR complex, to prevent its translocation to nucleus, and to inhibit GR transcription. RESULTS Peripheral blood mononuclear cells of steroid-resistant multiple sclerosis transcripts for all three isoforms of GR, alpha, beta, and gamma, were reduced by about two-folds compared with patients with steroid-sensitive multiple sclerosis. We have not found an increase in the beta and gamma transcripts of GR, which might serve as a dominant negative mutants, over GR alpha in steroid-resistant multiple sclerosis. The amount of hsp90 in the GR complex in cytoplasm was significantly higher in steroid-resistant multiple sclerosis compared with steroid-sensitive multiple sclerosis. CONCLUSIONS Molecular mechanism of GS unresponsiveness in some patients with multiple sclerosis might be related to increased presence of hsp90 in the GR cytoplasmic complex, leading to the inhibition of GR translocation to nucleus and reduction in its transcription.
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Affiliation(s)
- M Matysiak
- Department of Neurology, Medical University of Lodz, Lodz, Poland
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37
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Abstract
Proton magnetic resonance spectroscopy of normal appearing white matter (NAWM) was performed in 25 first-degree relatives of patients with multiple sclerosis (MS). In relatives of MS patients, insignificant trends in the NAA/Cho ratio (to be lower) and in the Cho/Cr ratio (to be higher) were found when compared with healthy controls. These results demonstrated that there are only minimal, insignificant changes in commonly identified metabolite concentrations in NAWM of relatives of MS patients when compared with healthy subjects.
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Affiliation(s)
- M Siger-Zajdel
- Department of Neurology, Medical University of Lodz, Lodz, Poland
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Sellebjerg F, Barnes D, Filippini G, Midgard R, Montalban X, Rieckmann P, Selmaj K, Visser LH, Sørensen PS. EFNS guideline on treatment of multiple sclerosis relapses: report of an EFNS task force on treatment of multiple sclerosis relapses. Eur J Neurol 2006; 12:939-46. [PMID: 16324087 DOI: 10.1111/j.1468-1331.2005.01352.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [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: 11/28/2022]
Abstract
Relapses, exacerbations or attacks of multiple sclerosis are the dominating feature of relapsing-remitting multiple sclerosis (MS), but are also observed in patients with secondary progressive MS. High-dose methylprednisolone is the routine therapy for relapses at present, but other treatments are also in current use. The objective of the task force was to review the literature on treatment of MS relapses to provide evidence-based treatment recommendations. Review was carried out on the literature with classification of evidence according to the EFNS guidelines for scientific task forces. Short-term, high-dose methylprednisolone treatment should be considered for the treatment of relapses of MS (level A recommendation). The optimal glucocorticoid treatment regimen, in terms of clinical efficacy and adverse events, remains to be established. A more intense, interdisciplinary rehabilitation programme should be considered as this probably further improves recovery after treatment with methylprednisolone (level B recommendation). Plasma exchange is probably efficacious in a subgroup of patients with severe relapses not responding to methylprednisolone therapy, and should be considered in this patient subgroup (level B recommendation). There is a need for further randomized, controlled trials in order to establish the optimal treatment regimen for relapses of MS.
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Affiliation(s)
- F Sellebjerg
- Danish MS Centre, Copenhagen University Hospital, Denmark.
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Rieckmann P, Toyka KV, Bassetti C, Beer K, Beer S, Buettner U, Chofflon M, Götschi-Fuchs M, Hess K, Kappos L, Kesselring J, Goebels N, Ludin HP, Mattle H, Schluep M, Vaney C, Baumhackl U, Berger T, Deisenhammer F, Fazekas F, Freimüller M, Kollegger H, Kristoferitsch W, Lassmann H, Markut H, Strasser-Fuchs S, Vass K, Altenkirch H, Bamborschke S, Baum K, Benecke R, Brück W, Dommasch D, Elias WG, Gass A, Gehlen W, Haas J, Haferkamp G, Hanefeld F, Hartung HP, Heesen C, Heidenreich F, Heitmann R, Hemmer B, Hense T, Hohlfeld R, Janzen RWC, Japp G, Jung S, Jügelt E, Koehler J, Kölmel W, König N, Lowitzsch K, Manegold U, Melms A, Mertin J, Oschmann P, Petereit HF, Pette M, Pöhlau D, Pohl D, Poser S, Sailer M, Schmidt S, Schock G, Schulz M, Schwarz S, Seidel D, Sommer N, Stangel M, Stark E, Steinbrecher A, Tumani H, Voltz R, Weber F, Weinrich W, Weissert R, Wiendl H, Wiethölter H, Wildemann U, Zettl UK, Zipp F, Zschenderlein R, Izquierdo G, Kirjazovas A, Packauskas L, Miller D, Koncan Vracko B, Millers A, Orologas A, Panellus M, Sindic CJM, Bratic M, Svraka A, Vella NR, Stelmasiak Z, Selmaj K, Bartosik-Psujik H, Mitosek-Szewczyk K, Belniak E, Mochecka A, Bayas A, Chan A, Flachenecker P, Gold R, Kallmann B, Leussink V, Mäurer M, Ruprecht K, Stoll G, Weilbach FX. Escalating immunotherapy of multiple sclerosis--new aspects and practical application. J Neurol 2005; 251:1329-39. [PMID: 15592728 DOI: 10.1007/s00415-004-0537-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Revised: 05/07/2004] [Accepted: 05/17/2004] [Indexed: 11/24/2022]
Abstract
Recent clinical studies in multiple sclerosis (MS) provide new data on the treatment of clinically isolated syndromes, on secondary progression, on direct comparison of immunomodulatory treatments and on dosing issues. All these studies have important implications for the optimized care of MS patients. The multiple sclerosis therapy consensus group (MSTCG) critically evaluated the available data and provides recommendations for the application of immunoprophylactic therapies. Initiation of treatment after the first relapse may be indicated if there is clear evidence on MRI for subclinical dissemination of disease. Recent trials show that the efficacy of interferon beta treatment is more likely if patients in the secondary progressive phase of the disease still have superimposed bouts or other indicators of inflammatory disease activity than without having them. There are now data available, which suggest a possible dose-effect relation for recombinant beta-interferons. These studies have to be interpreted with caution, as some potentially important issues in the design of these studies (e. g. maintenance of blinding in the clinical part of the study) were not adequately addressed. A meta-analysis of selected interferon trials has been published challenging the value of recombinant IFN beta in MS. The pitfalls of that report are discussed in the present review as are other issues relevant to treatment including the new definition of MS, the problem of treatment failure and the impact of cost-effectiveness analyses. The MSTCG panel recommends that the new diagnostic criteria proposed by McDonald et al. should be applied if immunoprophylactic treatment is being considered. The use of standardized clinical documentation is now generally proposed to facilitate the systematic evaluation of individual patients over time and to allow retrospective evaluations in different patient cohorts. This in turn may help in formulating recommendations for the application of innovative products to patients and to health care providers. Moreover, in long-term treated patients, secondary treatment failure should be identified by pre-planned follow-up examinations, and other treatment options should then be considered.
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Affiliation(s)
- P Rieckmann
- Dept. of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
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Brainin M, Barnes M, Baron JC, Gilhus NE, Hughes R, Selmaj K, Waldemar G. Guidance for the preparation of neurological management guidelines by EFNS scientific task forces - revised recommendations 2004*. Eur J Neurol 2004; 11:577-81. [PMID: 15379736 DOI: 10.1111/j.1468-1331.2004.00867.x] [Citation(s) in RCA: 221] [Impact Index Per Article: 11.1] [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
Since the publication of the first EFNS task force reports in 1997, a total of 20 evidence-based guidelines for the treatment and management of neurological diseases have been published by the EFNS (http://www.efns.org/guidelines). In 2001, recommendations for the preparation of neurological guidelines were issued by the EFNS Scientific Committee (Eur J Neurol 2001; 8: 549-550). These have now been updated and revised. More unified criteria for standards of reporting are set up which include classes of scientific evidence and predefined levels of recommendation. These criteria as well as others listed below should be used for all working groups that aim at recommending treatment, diagnostic procedures or other interventions within the framework of the EFNS.
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Affiliation(s)
- M Brainin
- Department of Neurology, Donauklinikum and Donau-Universität, Maria Gugging, Austria.
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41
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Abstract
We performed a double-blind, placebo-controlled study to evaluate the efficacy of low and high dose of intravenous immunoglobulins (IVIG) in relapsing/remitting (RR) multiple sclerosis (MS). Patients (n = 49) with clinical definite RR MS were randomly allocated to three groups and treated with 0.2 g/kg (n = 17) or 0.4 g/kg (n = 15) once a month of IVIG and placebo (n = 17) for 12 months. Clinical data were assessed monthly and magnetic resonance imaging (MRI) was performed every 3 months during the study period. Annual relapse rate (ARR) and change of the mean Expanded Disability Status Scale (EDSS) and Neurological Rating Scale Score (NRSS) from baseline to study conclusion were used as the clinical end-points. For MRI activity total lesion volume on T2-weighted image (T2WI), new lesions and gadolinium (Gd)-enhanced lesions on T1WI were analysed. ARR in both IVIG groups (0.88 for 0.2 g/kg and 0.86 for 0.4 g/kg) was reduced compared with placebo (1.24) during treatment period. Neurological disability measured with EDSS decreased slightly in both the IVIG groups (0.029 and 0.066, respectively) and increased by 0.29 in placebo (P = 0.0117). The neurologic impairment measured by NRSS showed similar trend. The total lesion volume on T2WI increased by 13.56% in placebo whereas in the 0.4 g/kg IVIG group decreased by -3.95% and in the 0.2 g/kg IVIG group increased by 3.6%. The cumulative numbers of Gd-enhancing lesions and new T2WI lesions in the IVIG groups were reduced in comparison with the placebo group. Our findings suggest that the dose 0.2 g/kg of IVIG is equally effective as 0.4 g/kg in reducing MS activity.
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Affiliation(s)
- M Lewańska
- Department of Neurology, Medical University of Lodz, Lodz, Poland
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42
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Affiliation(s)
- G Galazka
- Department of Neurology, Laboratory of Neuroimmunology, Medical Academy of Lodz, Kopcinskiego Street, Poland
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Siger-Zajdel M, Selmaj K. Magnetisation transfer ratio analysis of normal appearing white matter in patients with familial and sporadic multiple sclerosis. J Neurol Neurosurg Psychiatry 2001; 71:752-6. [PMID: 11723195 PMCID: PMC1737649 DOI: 10.1136/jnnp.71.6.752] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess differences in magnetisation transfer ratio (MTR) analysis of normal appearing white matter (NAWM) in patients with familial multiple sclerosis (MS) and those with sporadic MS. METHODS 10 patients with familial MS, 10 patients with sporadic MS, and 10 healthy subjects were included in the study. Groups were matched according to the sex, age, disease duration, type of disease, EDSS, and MRI T1 and T2 lesion load. Magnetisation transfer imaging (MTI) with and without saturation pulse were performed. On the MTR map 16 different regions of interest of normal appearing white matter were analyzed. RESULTS The mean MTR value of normal appearing white matter was significantly lower both in familial patients and those with sporadic MS compared with healthy subjects (33.8% v 46.4%; 38.6% v 46.4% respectively, p< 0.05). Additionally, patients with familial MS showed significantly lower mean MTR value than patients with sporadic MS (33.8% v 38.6%, p<0.05). There was also significant regional variation of MTR values between these two groups of patients. CONCLUSIONS Lower and more widespread MTR abnormalities in patients with familial MS might indicate differences in the extent and nature of white matter pathology between familial and sporadic MS.
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Affiliation(s)
- M Siger-Zajdel
- Department of Neurology, Medical Academy of Lodz, Poland
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Abstract
Chemokines are small proinflammatory cytokines that possess the ability to stimulate migration of inflammatory cells towards the tissue site of inflammation. Previous reports showed that several chemokines may be involved in the pathogenesis of experimental autoimmune encephalomyelitis (EAE), an animal model of autoimmune central nervous system (CNS) inflammation. Inflammatory cells respond to chemotactic chemokine gradient through the chemokine receptors (ChRs). The goal of this study was to analyze expression of ChRs belonging to CXC subfamily during different stages of chronic relapsing EAE. We found significantly increased expression of CXCR2 and CXCR4 in the spinal cord during the first and second disease attacks. The kinetics of this expression in CNS and blood suggests that CXCR2 is expressed by leukocytes migrating from the blood, but CXCR4 is expressed mainly by CNS parenchymal cells. Those results support the interpretation that chemokine-chemokine receptor interactions may play an important role in the development of CNS autoimmune inflammation.
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Affiliation(s)
- A R Glabinski
- Department of Neurology, Medical University of Lodz, ul. Kopcinskiego 22, 90-153 Lodz, Poland.
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Selmaj K, Kowal C, Walczak A, Nowicka J, Raine CS. Naked DNA vaccination differentially modulates autoimmune responses in experimental autoimmune encephalomyelitis. J Neuroimmunol 2000; 111:34-44. [PMID: 11063819 DOI: 10.1016/s0165-5728(00)00329-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [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: 11/21/2022]
Abstract
Vaccination with naked DNA represents a therapeutic strategy currently under consideration in multiple sclerosis (MS). In this study, we tested the potential therapeutic effect of vaccination with a naked DNA construct encoding proteolipid protein (pRc/CMV-PLP) upon the outcome of subsequent sensitization for experimental autoimmune encephalomyelitis (EAE) actively-induced in SJL mice with PLP139-151 peptide in adjuvant. Intramuscular vaccination with the naked DNA pRc/CMV-PLP construct led to PLP expression in local muscle tissue that persisted for about 8 weeks. Early sensitization for EAE (4 weeks after DNA vaccination) caused recipient mice to develop a severe, exacerbated form of disease (in comparison to control mice), while late sensitization (>10 weeks) resulted in a milder, ameliorated form. In the groups sensitized <10 weeks post-DNA vaccination with pRc/CMV-PLP induction of a Th1-type cytokine response was noted. In contrast, sensitization >10 weeks post-DNA vaccination led to peripheral tolerance as evidenced by a decrease in T cell proliferation and cytotoxic T cell response, no Th2 response, and no increase in apoptosis. These data are novel in that they demonstrate a differential effect of DNA vaccination and have important implications for its use as a mechanism to enhance or modulate immune reactivity.
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MESH Headings
- Animals
- Apoptosis/immunology
- Autoantigens/immunology
- Cell Division/immunology
- Cytomegalovirus/genetics
- Cytotoxicity Tests, Immunologic
- Demyelinating Diseases/immunology
- Encephalomyelitis, Autoimmune, Experimental/immunology
- Encephalomyelitis, Autoimmune, Experimental/pathology
- Encephalomyelitis, Autoimmune, Experimental/prevention & control
- Female
- Immunotherapy, Active
- Lymph Nodes/cytology
- Mice
- Mice, Inbred Strains
- Multiple Sclerosis/immunology
- Multiple Sclerosis/pathology
- Multiple Sclerosis/prevention & control
- Myelin Proteolipid Protein/genetics
- Myelin Proteolipid Protein/immunology
- Plasmids/immunology
- Spinal Cord/immunology
- Spinal Cord/pathology
- T-Lymphocytes/cytology
- Vaccines, DNA/immunology
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Affiliation(s)
- K Selmaj
- Department of Neurology, Laboratory of Neuroimmunology,Medical Academy of Lodz, 22, Kopcinskiego Street, 90-153, Lodz, Poland
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46
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Stasiolek M, Gavrilyuk V, Sharp A, Horvath P, Selmaj K, Feinstein DL. Inhibitory and stimulatory effects of lactacystin on expression of nitric oxide synthase type 2 in brain glial cells. The role of Ikappa B-beta. J Biol Chem 2000; 275:24847-56. [PMID: 10827092 DOI: 10.1074/jbc.m910284199] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [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: 11/06/2022] Open
Abstract
Expression of inflammatory nitric oxide synthase (NOS2) is mediated by transcription factor NFkappaB. By using the specific proteasome inhibitor lactacystin to examine IkappaB degradation, we observed a paradoxical increase in lipopolysaccharide- and cytokine-dependent NOS2 expression at low concentrations or when lactacystin was added subsequent to cytokines. Lactacystin reduced the initial accumulation of NOS2 mRNA but reduced its subsequent decrease. Lactacystin increased NOS2 promoter activation after 24 h, but not after 4 h, and similarly prevented initial NFkappaB activation and at later times caused NFkappaB reactivation. Lactacystin reduced initial degradation of IkappaB-alpha and IkappaB-beta, however, at later times selectively increased IkappaB-beta, which was predominantly non-phosphorylated. Expression of full-length rat IkappaB-beta, but not a carboxyl-terminal truncated form, inhibited NOS2 induction and potentiation by lactacystin. Lactacystin increased IkappaB-beta expression in the absence of NOS2 inducers, as well as expression of heat shock protein 70, and the heat shock response due to hyperthermia increased IkappaB-beta expression. These results suggest that IkappaB-beta contributes to persistent NFkappaB activation and NOS2 expression in glial cells, that IkappaB-beta is a stress protein inducible by hyperthermia or proteasome inhibitors, and that delayed addition of proteasome inhibitors can have stimulatory rather than inhibitory actions.
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Affiliation(s)
- M Stasiolek
- Department of Neurology, Medical Academy of Lodz, Lodz 90-153, Poland and the Department of Anesthesiology, University of Illinois, Chicago, Illinois 60607, USA
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47
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Siger-Zajdel M, Stradomska TJ, Rozniecki J, Zielińska M, Selmaj K. [Cerebral adrenomyeloneuropathy as a late type of adrenoleukodystrophy: case report]. Neurol Neurochir Pol 2000; 34:579-85. [PMID: 10979550] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Adrenoleukodystrophy (ALD) is a hereditary disease related to abnormalities in the structure and function of peroxisomes. The nature of disorder arises from defective process of beta-oxidation of very-long-chain fatty acids and their accumulation in various organs. ALD may present as a few phenotypes urologic symptomatology of which depends on proportions of the brain, spinal cord and peripheral nerves affection. Below, we present a case (and its family) of a cerebral type of adrenomyeloneuropathy--a rare form of adrenoleukodystrophy, and discuss its clinical manifestation as well as biochemical, hormonal, electrophysiological, neuropsychological and magnetic resonance imaging (MRI) diagnostics.
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48
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Szymanska B, Rajan AJ, Gao YL, Tronczynska E, Brosnan CF, Selmaj K. Evidence for gammadelta T cells with a restricted Vgamma6 junctional region in the normal mouse central nervous system. J Neuroimmunol 1999; 100:260-5. [PMID: 10695736 DOI: 10.1016/s0165-5728(99)00204-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In this study we present evidence that gammadelta T cells are present in the normal mouse central nervous system (CNS). Compared with matching spleen gammadelta T cells, CNS gammadelta T cells expressed only the CD45RBlow phenotype, suggesting that CNS gammadelta T cells belong to the memory cell population. Approximately 20% expressed exclusively the CD8alphabeta heterodimer, consistent with a thymic origin. Gammadelta T cells in both spleen and CNS expressed higher levels of the IL-2rbeta (CD122), as well as Fas and FasL, than alphabeta T cells, suggesting that these cells function as immunoregulatory T cells. RT-PCR analysis showed almost exclusive use of Vdelta6 in the CNS whereas more Vdelta genes were expressed in the spleen. Sequencing of Vdelta6 RT-PCR products demonstrated a polyclonal population of T cells in the spleen but a more clonal population within the CNS. The predominant CNS sequence was found in all animals studied and was also detected in the spleen. From these data we conclude that a selective component of circulating gammadelta T cells traffics through the CNS. Thus, all major populations of lymphocytes can be detected in the normal CNS and as such may play specific roles in the immunological surveillance of that organ.
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Affiliation(s)
- B Szymanska
- Department of Neurology, Medical Academy of Lodz, Poland
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49
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Nowicka J, Kowal C, Walczak A, Glabinski A, Jurewicz A, Selmaj K. Protective effect of naked DNA immunization in experimental autoimmune encephalitis. J Neuroimmunol 1998. [DOI: 10.1016/s0165-5728(98)91787-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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Szymanska B, Rajan A, Battistini L, Selmaj K, Brosnan C. Evidence for gamma-delta T cells in normal mouse central nervous system. J Neuroimmunol 1998. [DOI: 10.1016/s0165-5728(98)91688-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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