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Sima DM, Phan TV, Van Eyndhoven S, Vercruyssen S, Magalhães R, Liseune A, Brys A, Frenyo P, Terzopoulos V, Maes C, Guo J, Hughes R, Gabr RE, Huijbers W, Saha-Chaudhuri P, Curiale GG, Becker A, Belachew S, Van Hecke W, Ribbens A, Smeets D. Artificial Intelligence Assistive Software Tool for Automated Detection and Quantification of Amyloid-Related Imaging Abnormalities. JAMA Netw Open 2024; 7:e2355800. [PMID: 38345816 PMCID: PMC10862143 DOI: 10.1001/jamanetworkopen.2023.55800] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/19/2023] [Indexed: 02/15/2024] Open
Abstract
Importance Amyloid-related imaging abnormalities (ARIA) are brain magnetic resonance imaging (MRI) findings associated with the use of amyloid-β-directed monoclonal antibody therapies in Alzheimer disease (AD). ARIA monitoring is important to inform treatment dosing decisions and might be improved through assistive software. Objective To assess the clinical performance of an artificial intelligence (AI)-based software tool for assisting radiological interpretation of brain MRI scans in patients monitored for ARIA. Design, Setting, and Participants This diagnostic study used a multiple-reader multiple-case design to evaluate the diagnostic performance of radiologists assisted by the software vs unassisted. The study enrolled 16 US Board of Radiology-certified radiologists to perform radiological reading with (assisted) and without the software (unassisted). The study encompassed 199 retrospective cases, where each case consisted of a predosing baseline and a postdosing follow-up MRI of patients from aducanumab clinical trials PRIME, EMERGE, and ENGAGE. Statistical analysis was performed from April to July 2023. Exposures Use of icobrain aria, an AI-based assistive software for ARIA detection and quantification. Main Outcomes and Measures Coprimary end points were the difference in diagnostic accuracy between assisted and unassisted detection of ARIA-E (edema and/or sulcal effusion) and ARIA-H (microhemorrhage and/or superficial siderosis) independently, assessed with the area under the receiver operating characteristic curve (AUC). Results Among the 199 participants included in this study of radiological reading performance, mean (SD) age was 70.4 (7.2) years; 105 (52.8%) were female; 23 (11.6%) were Asian, 1 (0.5%) was Black, 157 (78.9%) were White, and 18 (9.0%) were other or unreported race and ethnicity. Among the 16 radiological readers included, 2 were specialized neuroradiologists (12.5%), 11 were male individuals (68.8%), 7 were individuals working in academic hospitals (43.8%), and they had a mean (SD) of 9.5 (5.1) years of experience. Radiologists assisted by the software were significantly superior in detecting ARIA than unassisted radiologists, with a mean assisted AUC of 0.87 (95% CI, 0.84-0.91) for ARIA-E detection (AUC improvement of 0.05 [95% CI, 0.02-0.08]; P = .001]) and 0.83 (95% CI, 0.78-0.87) for ARIA-H detection (AUC improvement of 0.04 [95% CI, 0.02-0.07]; P = .001). Sensitivity was significantly higher in assisted reading compared with unassisted reading (87% vs 71% for ARIA-E detection; 79% vs 69% for ARIA-H detection), while specificity remained above 80% for the detection of both ARIA types. Conclusions and Relevance This diagnostic study found that radiological reading performance for ARIA detection and diagnosis was significantly better when using the AI-based assistive software. Hence, the software has the potential to be a clinically important tool to improve safety monitoring and management of patients with AD treated with amyloid-β-directed monoclonal antibody therapies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Joshua Guo
- Biogen Digital Health, Biogen, Cambridge, Massachusetts
| | | | | | | | | | | | - Andrew Becker
- Biogen Digital Health, Biogen, Cambridge, Massachusetts
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Pang M, Gabelle A, Saha‐Chaudhuri P, Huijbers W, Gafson A, Matthews PM, Tian L, Rubino I, Hughes R, de Moor C, Belachew S, Shen C. Precision medicine analysis of heterogeneity in individual-level treatment response to amyloid beta removal in early Alzheimer's disease. Alzheimers Dement 2024; 20:1102-1111. [PMID: 37882364 PMCID: PMC10917030 DOI: 10.1002/alz.13431] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/27/2023] [Accepted: 07/23/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Alzheimer's disease (AD) is a neurological disorder with variability in pathology and clinical progression. AD patients may differ in individual-level benefit from amyloid beta removal therapy. METHODS Random forest models were applied to the EMERGE trial to create an individual-level treatment response (ITR) score which represents individual-level benefit of high-dose aducanumab relative to the placebo. This ITR score was used to test the existence of heterogeneity in treatment effect (HTE). RESULTS We found statistical evidence of HTE in the Clinical Dementia Rating-Sum of Boxes (CDR-SB;P = 0.034). The observed CDR-SB benefit was 0.79 points greater in the group with the top 25% of ITR score compared to the remaining 75% (P = 0.020). Of note, the highest treatment responders had lower hippocampal volume, higher plasma phosphorylated tau 181 and a shorter duration of clinical AD at baseline. DISCUSSION This ITR analysis provides a proof of concept for precision medicine in future AD research and drug development. HIGHLIGHTS Emerging trials have shown a population-level benefit from amyloid beta (Aβ) removal in slowing cognitive decline in early Alzheimer's disease (AD). This work demonstrates significant heterogeneity of individual-level treatment effect of aducanumab in early AD. The greatest clinical responders to Aβ removal therapy have a pattern of more severe neurodegenerative process.
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Affiliation(s)
- Menglan Pang
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Audrey Gabelle
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | | | - Willem Huijbers
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Arie Gafson
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Paul M. Matthews
- Department of Brain SciencesFaculty of MedicineImperial College LondonLondonUK
- UK Dementia Research Institute at Imperial College LondonLondonUK
| | - Lu Tian
- Biomedical Data Science and StatisticsStanford University School of MedicineStanfordCaliforniaUSA
| | | | - Richard Hughes
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Carl de Moor
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Shibeshih Belachew
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
| | - Changyu Shen
- Biogen Digital HealthBiogenCambridgeMassachusettsUSA
- BiogenCambridgeMassachusettsUSA
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Jiang X, Shen C, Caba B, Arnold DL, Elliott C, Zhu B, Fisher E, Belachew S, Gafson AR. Assessing the utility of magnetic resonance imaging-based "SuStaIn" disease subtyping for precision medicine in relapsing-remitting and secondary progressive multiple sclerosis. Mult Scler Relat Disord 2023; 77:104869. [PMID: 37459715 DOI: 10.1016/j.msard.2023.104869] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/16/2023] [Accepted: 07/01/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Patient stratification and individualized treatment decisions based on multiple sclerosis (MS) clinical phenotypes are arbitrary. Subtype and Staging Inference (SuStaIn), a published machine learning algorithm, was developed to identify data-driven disease subtypes with distinct temporal progression patterns using brain magnetic resonance imaging; its clinical utility has not been assessed. The objective of this study was to explore the prognostic capability of SuStaIn subtyping and whether it is a useful personalized predictor of treatment effects of natalizumab and dimethyl fumarate. METHODS Subtypes were available from the trained SuStaIn model for 3 phase 3 clinical trials in relapsing-remitting and secondary progressive MS. Regression models were used to determine whether baseline SuStaIn subtypes could predict on-study clinical and radiological disease activity and progression. Differences in treatment responses relative to placebo between subtypes were determined using interaction terms between treatment and subtype. RESULTS Natalizumab and dimethyl fumarate reduced inflammatory disease activity in all SuStaIn subtypes (all p < 0.001). SuStaIn MS subtyping alone did not discriminate responder heterogeneity based on new lesion formation and disease progression (p > 0.05 across subtypes). CONCLUSION SuStaIn subtypes correlated with disease severity and functional impairment at baseline but were not predictive of disability progression and could not discriminate treatment response heterogeneity.
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Affiliation(s)
| | - Changyu Shen
- Biogen, 225 Binney Street, Cambridge, MA 02142, USA
| | - Bastien Caba
- Biogen, 225 Binney Street, Cambridge, MA 02142, USA
| | - Douglas L Arnold
- NeuroRx Research, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
| | | | - Bing Zhu
- Biogen, 225 Binney Street, Cambridge, MA 02142, USA
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4
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Jiang X, Shen C, Teunissen CE, Wessels M, Zetterberg H, Giovannoni G, Singh CM, Caba B, Elliott C, Fisher E, de Moor C, Belachew S, Gafson AR. Glial fibrillary acidic protein and multiple sclerosis progression independent of acute inflammation. Mult Scler 2023; 29:1070-1079. [PMID: 37317870 PMCID: PMC10413790 DOI: 10.1177/13524585231176732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND The clinical relevance of serum glial fibrillary acidic protein (sGFAP) concentration as a biomarker of MS disability progression independent of acute inflammation has yet to be quantified. OBJECTIVE To test whether baseline values and longitudinal changes in sGFAP concentration are associated with disability progression without detectable relapse of magnetic resonance imaging (MRI) inflammatory activity in participants with secondary-progressive multiple sclerosis (SPMS). METHODS We retrospectively analyzed longitudinal sGFAP concentration and clinical outcome data from the Phase 3 ASCEND trial of participants with SPMS, with no detectable relapse or MRI signs of inflammatory activity at baseline nor during the study (n = 264). Serum neurofilament (sNfL), sGFAP, T2 lesion volume, Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW), 9-Hole Peg Test (9HPT), and composite confirmed disability progression (CDP) were measured. Linear and logistic regressions and generalized estimating equations were used in the prognostic and dynamic analyses. RESULTS We found a significant cross-sectional association between baseline sGFAP and sNfL concentrations and T2 lesion volume. No or weak correlations between sGFAP concentration and changes in EDSS, T25FW, and 9HPT, or CDP were observed. CONCLUSION Without inflammatory activity, changes in sGFAP concentration in participants with SPMS were neither associated with current nor predictive of future disability progression.
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Affiliation(s)
| | | | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Program Neuroinflammation, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands/Department of Neurology, Amsterdam Neuroscience, Program Neuroinflammation, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mark Wessels
- MS Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, MöIndal, Sweden/Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, MöIndal, Sweden/Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK/UK Dementia Research Institute at UCL, London, UK/Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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5
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Elliott C, Rudko DA, Arnold DL, Fetco D, Elkady AM, Araujo D, Zhu B, Gafson A, Tian Z, Belachew S, Bradley DP, Fisher E. Lesion-level correspondence and longitudinal properties of paramagnetic rim and slowly expanding lesions in multiple sclerosis. Mult Scler 2023; 29:680-690. [PMID: 37036134 PMCID: PMC10176750 DOI: 10.1177/13524585231162262] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Paramagnetic rim lesions (PRLs) and slowly expanding lesions (SELs) have been posited as markers of chronic active lesions (CALs). OBJECTIVE To assess the lesion-level concordance of PRLs and SELs in MS and to characterize changes in brain tissue integrity in CALs over time. METHODS MRIs were analyzed from a substudy of AFFINITY [NCT03222973], a phase 2 trial of opicinumab in relapsing MS. Assessments included (1) identification of SELs based on longitudinal MRIs over 72 weeks, and identification of PRLs on susceptibility-weighted imaging (SWI) filtered phase images at week 72; (2) evaluation of subject-level correlation of SEL and PRL counts, volumes, and degree of lesion-level overlap between SELs and PRLs; and (3) characterization of tissue integrity over time in overlapping and non-overlapping SELs and PRLs. RESULTS In 41 subjects, 119 chronic PRLs and 267 SELs were detected. Of 119 (39.5%) chronic PRLs, 47 co-localized with a SEL; 46/267 (17.2%) SELs co-localized with a PRL. PRLs co-localized with SELs showed expansion and worsening microstructural damage over time. SELs with and without co-localization with PRLs showed ongoing tissue damage. CONCLUSIONS Chronic MS lesions identified as both PRL and SEL were associated with the most severe accumulation of tissue damage. TRIAL REGISTRATION AFFINITY [NCT03222973].
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Affiliation(s)
| | - David A Rudko
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada/McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, Montreal, QC, Canada/Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Douglas L Arnold
- NeuroRx Research, Montreal, QC, Canada/Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Dumitru Fetco
- NeuroRx Research, Montreal, QC, Canada/Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Ahmed M Elkady
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada/McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, Montreal, QC, Canada/Department of Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - David Araujo
- NeuroRx Research, Montreal, QC, Canada/Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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Zajac L, Chiesa P, Deloire M, Scaramozza M, Sun Z, Tang M, Juraver A, Bartholomé E, Saubusse A, Charre-Morrin J, Campbell N, Van Beek J, Guymard T, Scotland A, Brochet B, Belachew S, Ruet A. Performances cognitives variables associées aux codes fixe ou dynamique au sein du test de vitesse de traitement cognitif (CPS) de l’application KonectomTM sur smartphone. Rev Neurol (Paris) 2023. [DOI: 10.1016/j.neurol.2023.01.697] [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: 03/29/2023]
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Pang M, Zhu L, Gabelle A, Gafson AR, Platt RW, Galvin JE, Krolak-Salmon P, Rubino I, de Moor C, Belachew S, Shen C. Effect of reduction in brain amyloid levels on change in cognitive and functional decline in randomized clinical trials: An instrumental variable meta-analysis. Alzheimers Dement 2023; 19:1292-1299. [PMID: 36043526 DOI: 10.1002/alz.12768] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Whether the reduction in brain amyloid beta (Aβ) plaque alone may substantially slow cognitive and functional decline in patients with dementia or mild cognitive impairment due to Alzheimer's disease (AD) remains debated. METHODS An instrumental variable meta-analysis was performed to infer the effect of change in positron emission tomography (PET)-measured Aβ standardized uptake value ratio (SUVR) on cognitive and functional decline. RESULTS Pooling data from 16 randomized trials demonstrates that each 0.1-unit decrease in PET Aβ SUVR is associated with a reduction (95% confidence interval) by 0.09 (0.034-0.15), 0.33 (0.12-0.55), and 0.13 (0.017-0.24) point in the average change of the Clinical Dementia Rating-Sum of Boxes, the Alzheimer's Disease Assessment Scale-Cognitive Subscale, and the Mini-Mental State Examination, respectively. DISCUSSION This meta-analysis provides statistically significant evidence of a likely causal relationship between a reduction in Aβ plaque and a reduction in cognitive and functional decline in patients with AD. HIGHLIGHTS A widely cited meta-analysis article concluded amyloid beta reduction does not substantially improve cognition. We identified data inconsistencies in the initial publication and found new trial data. We repeated the meta-analysis after correcting data inconsistencies and adding new trial data. Updated results suggested statistically significant clinical benefit of amyloid beta reduction. Amyloid beta is a viable biological target for the treatment and prevention of AD.
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Affiliation(s)
- Menglan Pang
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Ling Zhu
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Audrey Gabelle
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Arie R Gafson
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - James E Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Center of Lyon (CMRR Lyon), Lyon Institute for Aging, University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France
- Neuroscience Research Centre of Lyon, Inserm, Lyon, France
| | | | - Carl de Moor
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Shibeshih Belachew
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Changyu Shen
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
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Colloud S, Metcalfe T, Askin S, Belachew S, Ammann J, Bos E, Kilchenmann T, Strijbos P, Eggenspieler D, Servais L, Garay C, Konstantakopoulos A, Ritzhaupt A, Vetter T, Vincenzi C, Cerreta F. Evolving regulatory perspectives on digital health technologies for medicinal product development. NPJ Digit Med 2023; 6:56. [PMID: 36991116 DOI: 10.1038/s41746-023-00790-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/05/2023] [Indexed: 03/31/2023] Open
Abstract
Digital health technology tools (DHTTs) present real opportunities for accelerating innovation, improving patient care, reducing clinical trial duration and minimising risk in medicines development. This review is comprised of four case studies of DHTTs used throughout the lifecycle of medicinal products, starting from their development. These cases illustrate how the regulatory requirements of DHTTs used in medicines development are based on two European regulatory frameworks (medical device and the medicinal product regulations) and highlight the need for increased collaboration between various stakeholders, including regulators (medicines regulators and device bodies), pharmaceutical sponsors, manufacturers of devices and software, and academia. As illustrated in the examples, the complexity of the interactions is further increased by unique challenges related to DHTTs. These case studies are the main examples of DHTTs with a regulatory assessment thus far, providing an insight into the applicable current regulatory approach; they were selected by a group of authors, including regulatory specialists from pharmaceutical sponsors, technology experts, academic researchers and employees of the European Medicines Agency. For each case study, the challenges faced by sponsors and proposed potential solutions are discussed, and the benefit of a structured interaction among the different stakeholders is also highlighted.
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Affiliation(s)
| | | | | | | | | | - Ernst Bos
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | | | | | - Laurent Servais
- Muscular Dystrophy UK Oxford Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK
- Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Paediatrics, University Hospital Liège and University of Liège, Liège, Belgium
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9
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Bühler A, Wolbers M, Model F, Wang Q, Belachew S, Manfrini M, Lorscheider J, Kappos L, Beyersmann J. Recurrent disability progression endpoints in multiple sclerosis clinical trials. Mult Scler 2023; 29:130-139. [PMID: 36177953 PMCID: PMC9896250 DOI: 10.1177/13524585221125382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The current standard endpoint to assess disability accumulation in multiple sclerosis (MS) clinical trials is the time to the first confirmed disability progression, which excludes subsequent progression events. Including recurrent progression events may permit a more comprehensive assessment of treatment effects on disability progression. OBJECTIVE To propose a definition of recurrent disability progression events and to compare time-to-first and recurrent event analysis. METHODS Recurrent disability progression events were defined by expanding the recommended first event definition. Marginal recurrent event methods (negative binomial model, Lin-Wei-Yang-Ying model) were compared with Cox regression in data from three randomized controlled trials in relapsing multiple sclerosis (RMS) and primary progressive multiple sclerosis (PPMS), and in simulated randomized controlled trial data. RESULTS The recurrent event analyses included a substantially larger number of progression events compared with the time-to-first-event analyses (+7.5% and +9.9% in the RMS trials and +22.7% in the PPMS trial). The increase in the number of events resulted in more precise treatment effect estimates and a corresponding gain in statistical power. CONCLUSION Our results support the use of recurrent event data analysis, especially in progressive MS trials, to improve estimates of treatment effects, increase statistical power, and better capture the clinically meaningful long-term disability progression experience.
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Affiliation(s)
| | | | | | - Qing Wang
- Q Wang F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, Basel CH-4070 Switzerland.
| | | | | | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
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Graves JS, Ganzetti M, Dondelinger F, Lipsmeier F, Belachew S, Bernasconi C, Montalban X, van Beek J, Baker M, Gossens C, Lindemann M. Preliminary validity of the Draw a Shape Test for upper extremity assessment in multiple sclerosis. Ann Clin Transl Neurol 2022; 10:166-180. [PMID: 36563127 PMCID: PMC9930424 DOI: 10.1002/acn3.51705] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/15/2022] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To validate the smartphone sensor-based Draw a Shape Test - a part of the Floodlight Proof-of-Concept app for remotely assessing multiple sclerosis-related upper extremity impairment by tracing six different shapes. METHODS People with multiple sclerosis, classified functionally normal/abnormal via their Nine-Hole Peg Test time, and healthy controls participated in a 24-week, nonrandomized study. Spatial (trace accuracy), temporal (mean and variability in linear, angular, and radial drawing velocities, and dwell time ratio), and spatiotemporal features (trace celerity) were cross-sectionally analyzed for correlation with standard clinical and brain magnetic resonance imaging (normalized brain volume and total lesion volume) disease burden measures, and for capacity to differentiate people with multiple sclerosis from healthy controls. RESULTS Data from 69 people with multiple sclerosis and 18 healthy controls were analyzed. Trace accuracy (all shapes), linear velocity variability (circle, figure-of-8, spiral shapes), and radial velocity variability (spiral shape) had a mostly fair/moderate-to-good correlation (|r| = 0.14-0.66) with all disease burden measures. Trace celerity also had mostly fair/moderate-to-good correlation (|r| = 0.18-0.41) with Nine-Hole Peg Test performance, cerebellar functional system score, and brain magnetic resonance imaging. Furthermore, partial correlation analysis related these results to motor impairment. People with multiple sclerosis showed greater drawing velocity variability, though slower mean velocity, than healthy controls. Linear velocity (spiral shape) and angular velocity (circle shape) potentially differentiate functionally normal people with multiple sclerosis from healthy controls. INTERPRETATION The Draw a Shape Test objectively assesses upper extremity impairment and correlates with all disease burden measures, thus aiding multiple sclerosis-related upper extremity impairment characterization.
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Affiliation(s)
- Jennifer S. Graves
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCaliforniaUSA
| | | | | | | | | | | | - Xavier Montalban
- Department of Neurology‐Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat)Hospital Universitari Vall d'HebronBarcelonaSpain
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Guo CC, Chiesa PA, de Moor C, Fazeli MS, Schofield T, Hofer K, Belachew S, Scotland A. Digital Devices for Assessing Motor Functions in Mobility-Impaired and Healthy Populations: Systematic Literature Review. J Med Internet Res 2022; 24:e37683. [DOI: 10.2196/37683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/18/2022] [Accepted: 10/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background
With the advent of smart sensing technology, mobile and wearable devices can provide continuous and objective monitoring and assessment of motor function outcomes.
Objective
We aimed to describe the existing scientific literature on wearable and mobile technologies that are being used or tested for assessing motor functions in mobility-impaired and healthy adults and to evaluate the degree to which these devices provide clinically valid measures of motor function in these populations.
Methods
A systematic literature review was conducted by searching Embase, MEDLINE, CENTRAL (January 1, 2015, to June 24, 2020), the United States and European Union clinical trial registries, and the United States Food and Drug Administration website using predefined study selection criteria. Study selection, data extraction, and quality assessment were performed by 2 independent reviewers.
Results
A total of 91 publications representing 87 unique studies were included. The most represented clinical conditions were Parkinson disease (n=51 studies), followed by stroke (n=5), Huntington disease (n=5), and multiple sclerosis (n=2). A total of 42 motion-detecting devices were identified, and the majority (n=27, 64%) were created for the purpose of health care–related data collection, although approximately 25% were personal electronic devices (eg, smartphones and watches) and 11% were entertainment consoles (eg, Microsoft Kinect or Xbox and Nintendo Wii). The primary motion outcomes were related to gait (n=30), gross motor movements (n=25), and fine motor movements (n=23). As a group, sensor-derived motion data showed a mean sensitivity of 0.83 (SD 7.27), a mean specificity of 0.84 (SD 15.40), a mean accuracy of 0.90 (SD 5.87) in discriminating between diseased individuals and healthy controls, and a mean Pearson r validity coefficient of 0.52 (SD 0.22) relative to clinical measures. We did not find significant differences in the degree of validity between in-laboratory and at-home sensor-based assessments nor between device class (ie, health care–related device, personal electronic devices, and entertainment consoles).
Conclusions
Sensor-derived motion data can be leveraged to classify and quantify disease status for a variety of neurological conditions. However, most of the recent research on digital clinical measures is derived from proof-of-concept studies with considerable variation in methodological approaches, and much of the reviewed literature has focused on clinical validation, with less than one-quarter of the studies performing analytical validation. Overall, future research is crucially needed to further consolidate that sensor-derived motion data may lead to the development of robust and transformative digital measurements intended to predict, diagnose, and quantify neurological disease state and its longitudinal change.
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12
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Pang M, Zhu L, Gabelle A, Gafson AR, Platt RW, Galvin JE, Krolak-Salmon P, Rubino I, de Moor C, Belachew S, Shen C. Toward the end of a controversy on the effect of reduction in brain amyloid levels on change in cognitive and functional decline in Alzheimer's disease-Reply to a letter. Alzheimers Dement 2022; 19:1101-1103. [PMID: 36383475 DOI: 10.1002/alz.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2023]
Affiliation(s)
- Menglan Pang
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Ling Zhu
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Audrey Gabelle
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Arie R Gafson
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Robert W Platt
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - James E Galvin
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Center of Lyon (CMRR Lyon), Lyon Institute for Aging, University Hospital of Lyon (Hospices Civils de Lyon), Lyon, France
- Neuroscience Research Centre of Lyon, Lyon, France
| | | | - Carl de Moor
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Shibeshih Belachew
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
| | - Changyu Shen
- Biogen Digital Health, Biogen, Cambridge, Massachusetts, USA
- Biogen, Cambridge, Massachusetts, USA
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13
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Chang I, Kappos L, Giovannoni G, Calabresi PA, Sandrock A, Cheng W, Xiao S, Riester K, Belachew S, Deykin A, Zhu B. Overall Disability Response Score: An integrated endpoint to assess disability improvement and worsening over time in patients with multiple sclerosis. Mult Scler 2022; 28:2263-2273. [PMID: 36131595 DOI: 10.1177/13524585221114997] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Overall Disability Response Score (ODRS) is a composite endpoint including Expanded Disability Status Scale, Timed 25-foot Walk, and 9-Hole Peg Test, designed to quantify both disability improvement and worsening in multiple sclerosis (MS). OBJECTIVE To assess the sensitivity and clinical meaningfulness of ODRS using natalizumab Phase 3 data sets (AFFIRM in relapsing-remitting MS and ASCEND in secondary progressive MS). METHODS Differences in ODRS over 96 weeks, ODRS at Week 96, and slope of ODRS change per year between natalizumab and placebo groups were analyzed. Correlation between ODRS and changes in patient-reported outcomes was also analyzed. RESULTS The difference (95% confidence interval (CI)) in the ODRS over 96 weeks between natalizumab and placebo groups was 0.34 (0.21-0.46) in AFFIRM (p < 0.001), and 0.18 (0.03-0.34) in ASCEND (p = 0.021). Significant differences between treatment arms were also observed in ODRS at Week 96 and in the slope of change per year in both studies. There was a significant linear correlation between ODRS at Week 96 and the change from baseline in both the physical and mental components of the 36-item Short Form Survey (SF-36) in both studies. CONCLUSION This analysis supports ODRS as a sensitive and potentially clinically meaningful disability outcome measure in MS.
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Affiliation(s)
- Ih Chang
- Cerevel Therapeutics, Cambridge, MA, USA
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gavin Giovannoni
- Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | | | | | | | - Shan Xiao
- Takeda Pharmaceuticals, Lexington, MA, USA
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14
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Beynon V, George IC, Elliott C, Arnold DL, Ke J, Chen H, Zhu L, Ke C, Giovannoni G, Scaramozza M, Campbell N, Bradley DP, Franchimont N, Gafson A, Belachew S. Chronic lesion activity and disability progression in secondary progressive multiple sclerosis. BMJ Neurol Open 2022; 4:e000240. [PMID: 35720980 PMCID: PMC9185385 DOI: 10.1136/bmjno-2021-000240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/02/2021] [Accepted: 05/15/2022] [Indexed: 11/04/2022] Open
Abstract
Objective Slowly expanding lesions (SELs), a subgroup of chronic white matter lesions that gradually expand over time, have been shown to predict disability accumulation in primary progressive multiple sclerosis (MS) disease. However, the relationships between SELs, acute lesion activity (ALA), overall chronic lesion activity (CLA) and disability progression are not well understood. In this study, we examined the ASCEND phase III clinical trial, which compared natalizumab with placebo in secondary progressive MS (SPMS). Methods Patients with complete imaging datasets between baseline and week 108 (N=600) were analysed for SEL prevalence (the number and volume of SELs), disability progression, ALA (assessed by gadolinium-enhancing lesions and new T2-hyperintense lesions) and CLA (assessed by T1-hypointense lesion volume increase within baseline T2-non-enhancing lesions identified as SELs and non-SELs). Results CLA in both SELs and non-SELs was greater in patients with SPMS with confirmed disability progression than in those with no progression. In the complete absence of ALA at baseline and on study, SEL prevalence was significantly lower, while CLA within non-SELs remained associated with disability progression. Natalizumab decreased SEL prevalence and CLA in SELs and non-SELs compared with placebo. Conclusions This study shows that CLA in patients with SPMS is decreased but persists in the absence of ALA and is associated with disability progression, highlighting the need for therapeutics targeting all mechanisms of CLA, including smouldering inflammation and neurodegeneration. Trial registration number NCT01416181.
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Affiliation(s)
- Vanessa Beynon
- Global Research & Development, Biogen, Cambridge, Massachusetts, USA
| | - Ilena C George
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Douglas L Arnold
- NeuroRx Research, Montreal, Quebec, Canada.,McConnell Brain Imaging Centre, McGill University, Montreal, Quebec, Canada
| | - Jun Ke
- Biostatistics, Biogen Inc, Cambridge, Massachusetts, USA
| | - Huaihou Chen
- Biostatistics, Biogen Inc, Cambridge, Massachusetts, USA
| | - Li Zhu
- Biostatistics, Biogen Inc, Cambridge, Massachusetts, USA
| | - Chunlei Ke
- Biostatistics, Biogen Inc, Cambridge, Massachusetts, USA
| | - Gavin Giovannoni
- Neuroscience and Trauma, Barts and The London School of Medicine and Dentistry Blizard Institute, London, UK
| | | | - Nolan Campbell
- Global Medical, Biogen Inc, Cambridge, Massachusetts, USA
| | | | | | - Arie Gafson
- Digital Health, Biogen Inc, Cambridge, Massachusetts, USA
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15
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Abstract
This cohort study investigates serum neurofilament light concentration as a biomarker associated with disability progression in multiple sclerosis in the absence of acute inflammation.
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Affiliation(s)
| | | | - Changyu Shen
- Biogen Digital Health, Biogen, Cambridge, Massachusetts
| | - Raj Kapoor
- Department of Neuroinflammation, University College London Queen Square Institute of Neurology, London, United Kingdom
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, University College London Institute of Neurology, Queen Square, London, United Kingdom
| | - Robert J. Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, Ohio
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16
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Elliott C, Momayyezsiahkal P, Arnold DL, Liu D, Ke J, Zhu L, Zhu B, George IC, Bradley DP, Fisher E, Cahir-McFarland E, Stys PK, Geurts JJG, Franchimont N, Gafson A, Belachew S. Abnormalities in normal-appearing white matter from which multiple sclerosis lesions arise. Brain Commun 2021; 3:fcab176. [PMID: 34557664 PMCID: PMC8453433 DOI: 10.1093/braincomms/fcab176] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/05/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
Normal-appearing white matter is far from normal in multiple sclerosis; little is known about the precise pathology or spatial pattern of this alteration and its relation to subsequent lesion formation. This study was undertaken to evaluate normal-appearing white matter abnormalities in brain areas where multiple sclerosis lesions subsequently form, and to investigate the spatial distribution of normal-appearing white matter abnormalities in persons with multiple sclerosis. Brain MRIs of pre-lesion normal-appearing white matter were analysed in participants with new T2 lesions, pooled from three clinical trials: SYNERGY (NCT01864148; n = 85 with relapsing multiple sclerosis) was the test data set; ASCEND (NCT01416181; n = 154 with secondary progressive multiple sclerosis) and ADVANCE (NCT00906399; n = 261 with relapsing-remitting multiple sclerosis) were used as validation data sets. Focal normal-appearing white matter tissue state was analysed prior to lesion formation in areas where new T2 lesions later formed (pre-lesion normal-appearing white matter) using normalized magnetization transfer ratio and T2-weighted (nT2) intensities, and compared with overall normal-appearing white matter and spatially matched contralateral normal-appearing white matter. Each outcome was analysed using linear mixed-effects models. Follow-up time (as a categorical variable), patient-level characteristics (including treatment group) and other baseline variables were treated as fixed effects. In SYNERGY, nT2 intensity was significantly higher, and normalized magnetization transfer ratio was lower in pre-lesion normal-appearing white matter versus overall and contralateral normal-appearing white matter at all time points up to 24 weeks before new T2 lesion onset. In ASCEND and ADVANCE (for which normalized magnetization transfer ratio was not available), nT2 intensity in pre-lesion normal-appearing white matter was significantly higher compared to both overall and contralateral normal-appearing white matter at all pre-lesion time points extending up to 2 years prior to lesion formation. In all trials, nT2 intensity in the contralateral normal-appearing white matter was also significantly higher at all pre-lesion time points compared to overall normal-appearing white matter. Brain atlases of normal-appearing white matter abnormalities were generated using measures of voxel-wise differences in normalized magnetization transfer ratio of normal-appearing white matter in persons with multiple sclerosis compared to scanner-matched healthy controls. We observed that overall spatial distribution of normal-appearing white matter abnormalities in persons with multiple sclerosis largely recapitulated the anatomical distribution of probabilities of T2 hyperintense lesions. Overall, these findings suggest that intrinsic spatial properties and/or longstanding precursory abnormalities of normal-appearing white matter tissue may contribute to the risk of autoimmune acute demyelination in multiple sclerosis.
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Affiliation(s)
| | - Parya Momayyezsiahkal
- NeuroRx Research, Montreal, QC H2X 3P9, Canada.,McGill University, Montreal, QC H3A 0G4, Canada
| | - Douglas L Arnold
- NeuroRx Research, Montreal, QC H2X 3P9, Canada.,McGill University, Montreal, QC H3A 0G4, Canada
| | - Dawei Liu
- Biogen Digital Health, Biogen, Cambridge, MA 02142, USA
| | - Jun Ke
- Biogen, Cambridge, MA 02142, USA
| | - Li Zhu
- Biogen, Cambridge, MA 02142, USA
| | - Bing Zhu
- Biogen, Cambridge, MA 02142, USA
| | - Ilena C George
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | | - Peter K Stys
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam UMC, 1081 HV Amsterdam, Netherlands
| | | | - Arie Gafson
- Biogen Digital Health, Biogen, Cambridge, MA 02142, USA
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17
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Affiliation(s)
- Douglas L Arnold
- NeuroRx Research, Montreal, QC, Canada/McGill University, Montreal, QC, Canada
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18
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Montalban X, Graves J, Midaglia L, Mulero P, Julian L, Baker M, Schadrack J, Gossens C, Ganzetti M, Scotland A, Lipsmeier F, van Beek J, Bernasconi C, Belachew S, Lindemann M, Hauser SL. A smartphone sensor-based digital outcome assessment of multiple sclerosis. Mult Scler 2021; 28:654-664. [PMID: 34259588 PMCID: PMC8961252 DOI: 10.1177/13524585211028561] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Sensor-based monitoring tools fill a critical gap in multiple sclerosis (MS)
research and clinical care. Objective: The aim of this study is to assess performance characteristics of the
Floodlight Proof-of-Concept (PoC) app. Methods: In a 24-week study (clinicaltrials.gov: NCT02952911), smartphone-based active
tests and passive monitoring assessed cognition (electronic Symbol Digit
Modalities Test), upper extremity function (Pinching Test, Draw a Shape
Test), and gait and balance (Static Balance Test, U-Turn Test, Walk Test,
Passive Monitoring). Intraclass correlation coefficients (ICCs) and age- or
sex-adjusted Spearman’s rank correlation determined test–retest reliability
and correlations with clinical and magnetic resonance imaging (MRI) outcome
measures, respectively. Results: Seventy-six people with MS (PwMS) and 25 healthy controls were enrolled. In
PwMS, ICCs were moderate-to-good (ICC(2,1) = 0.61–0.85) across tests.
Correlations with domain-specific standard clinical disability measures were
significant for all tests in the cognitive (r = 0.82,
p < 0.001), upper extremity function (|r|=
0.40–0.64, all p < 0.001), and gait and balance domains
(r = −0.25 to −0.52, all p < 0.05;
except for Static Balance Test: r = −0.20,
p > 0.05). Most tests also correlated with Expanded
Disability Status Scale, 29-item Multiple Sclerosis Impact Scale items or
subscales, and/or normalized brain volume. Conclusion: The Floodlight PoC app captures reliable and clinically relevant measures of
functional impairment in MS, supporting its potential use in clinical
research and practice.
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Affiliation(s)
- Xavier Montalban
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jennifer Graves
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Luciana Midaglia
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain and Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Patricia Mulero
- Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Stephen L Hauser
- UCSF Weill Institute for Neurosciences and Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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19
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Bame E, Tang H, Burns JC, Arefayene M, Michelsen K, Ma B, Marx I, Prince R, Roach AM, Poreci U, Donaldson D, Cullen P, Casey F, Zhu J, Carlile TM, Sangurdekar D, Zhang B, Trapa P, Santoro J, Muragan P, Pellerin A, Rubino S, Gianni D, Bajrami B, Peng X, Coppell A, Riester K, Belachew S, Mehta D, Palte M, Hopkins BT, Scaramozza M, Franchimont N, Mingueneau M. Next-generation Bruton's tyrosine kinase inhibitor BIIB091 selectively and potently inhibits B cell and Fc receptor signaling and downstream functions in B cells and myeloid cells. Clin Transl Immunology 2021; 10:e1295. [PMID: 34141433 PMCID: PMC8204096 DOI: 10.1002/cti2.1295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/22/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives Bruton's tyrosine kinase (BTK) plays a non-redundant signaling role downstream of the B-cell receptor (BCR) in B cells and the receptors for the Fc region of immunoglobulins (FcR) in myeloid cells. Here, we characterise BIIB091, a novel, potent, selective and reversible small-molecule inhibitor of BTK. Methods BIIB091 was evaluated in vitro and in vivo in preclinical models and in phase 1 clinical trial. Results In vitro, BIIB091 potently inhibited BTK-dependent proximal signaling and distal functional responses in both B cells and myeloid cells with IC50s ranging from 3 to 106 nm, including antigen presentation to T cells, a key mechanism of action thought to be underlying the efficacy of B cell-targeted therapeutics in multiple sclerosis. BIIB091 effectively sequestered tyrosine 551 in the kinase pocket by forming long-lived complexes with BTK with t 1/2 of more than 40 min, thereby preventing its phosphorylation by upstream kinases. As a key differentiating feature of BIIB091, this property explains the very potent whole blood IC50s of 87 and 106 nm observed with stimulated B cells and myeloid cells, respectively. In vivo, BIIB091 blocked B-cell activation, antibody production and germinal center differentiation. In phase 1 healthy volunteer trial, BIIB091 inhibited naïve and unswitched memory B-cell activation, with an in vivo IC50 of 55 nm and without significant impact on lymphoid or myeloid cell survival after 14 days of dosing. Conclusion Pharmacodynamic results obtained in preclinical and early clinical settings support the advancement of BIIB091 in phase 2 clinical trials.
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Affiliation(s)
- Eris Bame
- Clinical Sciences Biogen Cambridge MA USA
| | - Hao Tang
- Biogen Research Biogen Cambridge MA USA
| | | | | | - Klaus Michelsen
- Biotherapeutics and Medicinal Sciences Biogen Cambridge MA USA.,Present address: Relay Therapeutics Cambridge MA USA
| | - Bin Ma
- Biotherapeutics and Medicinal Sciences Biogen Cambridge MA USA
| | - Isaac Marx
- Biotherapeutics and Medicinal Sciences Biogen Cambridge MA USA
| | - Robin Prince
- Biotherapeutics and Medicinal Sciences Biogen Cambridge MA USA
| | - Allie M Roach
- Biogen Research Biogen Cambridge MA USA.,Present address: Gilead Sciences Seattle WA USA
| | - Urjana Poreci
- Clinical Sciences Biogen Cambridge MA USA.,Present address: Pandion Therapeutics Watertown MA USA
| | - Douglas Donaldson
- Clinical Sciences Biogen Cambridge MA USA.,Present address: Giner Labs Newton MA USA
| | | | | | - Jing Zhu
- Biogen Research Biogen Cambridge MA USA
| | | | - Dipen Sangurdekar
- Biogen Research Biogen Cambridge MA USA.,Present address: Takeda Cambridge MA USA
| | | | - Patrick Trapa
- Biotherapeutics and Medicinal Sciences Biogen Cambridge MA USA
| | - Joseph Santoro
- Biotherapeutics and Medicinal Sciences Biogen Cambridge MA USA
| | - Param Muragan
- Biotherapeutics and Medicinal Sciences Biogen Cambridge MA USA
| | | | | | - Davide Gianni
- Biotherapeutics and Medicinal Sciences Biogen Cambridge MA USA
| | - Bekim Bajrami
- Biotherapeutics and Medicinal Sciences Biogen Cambridge MA USA
| | - Xiaomei Peng
- Global Safety and Regulatory Sciences Biogen Cambridge MA USA
| | | | | | | | - Devangi Mehta
- Clinical Sciences Biogen Cambridge MA USA.,Present address: Immunologix Laboratories Cambridge MA USA
| | - Mike Palte
- MS Development Unit Biogen Cambridge MA USA
| | - Brian T Hopkins
- Biotherapeutics and Medicinal Sciences Biogen Cambridge MA USA
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20
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Guo C, Cahir-Mcfarland E, Dumail J, Guymard T, Mcloughlin J, Bieuvelet S, Vallée M, Zinai S, Beynon V, Scaramozza M, Franchimont N, Belachew S. Konectom™ évaluation numérique sur smartphone des performances fonctionnelles cognitives et motrices dans la sclérose en plaques. Rev Neurol (Paris) 2021. [DOI: 10.1016/j.neurol.2021.02.360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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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21
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Kappos L, Wolinsky JS, Giovannoni G, Arnold DL, Wang Q, Bernasconi C, Model F, Koendgen H, Manfrini M, Belachew S, Hauser SL. Contribution of Relapse-Independent Progression vs Relapse-Associated Worsening to Overall Confirmed Disability Accumulation in Typical Relapsing Multiple Sclerosis in a Pooled Analysis of 2 Randomized Clinical Trials. JAMA Neurol 2021; 77:1132-1140. [PMID: 32511687 PMCID: PMC7281382 DOI: 10.1001/jamaneurol.2020.1568] [Citation(s) in RCA: 218] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Question What are the relative contributions of progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW) to overall accumulating disability in patients with relapsing multiple sclerosis? Findings Applying a composite outcome measure to a typical population with active relapsing multiple sclerosis, this pooled analysis of 2 randomized clinical trials shows that the most part of confirmed disability accumulation occurs independently of relapse activity. Distinct prognostic factors were associated with PIRA vs RAW, and ocrelizumab had a beneficial outcome in both. Meaning These findings clearly demonstrate underlying progression in this relapsing multiple sclerosis population and challenge the current clinical distinction of relapsing and progressive forms of multiple sclerosis. Importance Accumulation of disability in multiple sclerosis may occur as relapse-associated worsening (RAW) or steady progression independent of relapse activity (PIRA), with PIRA regarded as a feature of primary and secondary progressive multiple sclerosis. Objective To investigate the contributions of relapse-associated worsening vs relapse-independent progression to overall confirmed disability accumulation (CDA) and assess respective baseline prognostic factors and outcomes of 2 treatments. Design, Setting, and Participants Analyses occurred from July 2015 to February 2020 on pooled data from the intention-to-treat population of 2 identical, phase 3, multicenter, double-blind, double-dummy, parallel-group randomized clinical trials (OPERA I and II) conducted between August 2011 and April 2015. In the trials, patients with relapsing multiple sclerosis (RMS), diagnosed using the 2010 revised McDonald criteria, were randomized from 307 trial sites in 56 countries; resulting data were analyzed in the pooled data set. Interventions Participants were randomized 1:1 to receive 600 mg of ocrelizumab by intravenous infusion every 24 weeks or subcutaneous interferon β-1a 3 times a week at a dose of 44 μg throughout a 96-week treatment period. Main Outcomes and Measures Confirmed disability accumulation was defined by an increase in 1 or more of 3 measures (Expanded Disability Status Scale, timed 25-ft walk, or 9-hole peg test), confirmed after 3 or 6 months, and classified per temporal association with confirmed clinical relapses (PIRA or RAW). Results In the pooled OPERA I and II population (1656 of 2096 eligible participants), baseline demographics and disease characteristics were similar for patients randomized to interferon β-1a vs ocrelizumab (mean [SD] age, 37.2 [9.2] vs 37.1 [9.2] years; 552 [66.6%] vs 541 women [65.4%]). After 96 weeks, 12-week composite CDA had occurred in 223 (29.6% by Kaplan-Meier estimate) randomized to interferon β-1a and 167 (21.1%) randomized to ocrelizumab; 24-week composite CDA had occurred in 170 (22.7%) taking interferon β-1a and 129 (16.2%) taking ocrelizumab. The PIRA events were the main contributors to 12-week and 24-week composite CDA after 96 weeks in patients treated with interferon β-1a (174 of 223 [78.0%] and 137 of 170 [80.6%], respectively) and ocrelizumab (147 of 167 [88.0%] and 115 of 129 [89.1%], respectively); a minority had CDA explained by RAW events (69 of 390 [17.7%] and 52 of 299 [17.4%], respectively). Very few patients with composite CDA experienced both RAW and PIRA events (17 of 390 [4.4%] for 12-week and 15 of 299 [5.0%] for 24-week composite CDA). Ocrelizumab (vs interferon β-1a) was associated with reduced risk of composite CDA (hazard ratio [HR], 0.67) and confirmed PIRA (HR, 0.78) and RAW (HR, 0.47) events. Conclusions and Relevance Most disability accumulation in RMS is not associated with overt relapses. This indicates an underlying progression in this typical RMS population and challenges the current clinical distinction of relapsing and progressive forms of multiple sclerosis. Ocrelizumab was superior to interferon β-1a in preventing both RAW and PIRA. Trial Registration ClinicalTrials.gov Identifiers: OPERA I (NCT01247324) and OPERA II (NCT01412333).
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Affiliation(s)
- Ludwig Kappos
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston
| | | | - Douglas L Arnold
- McGill University, Montreal, Quebec, Canada.,NeuroRx Research, Montreal, Quebec, Canada
| | - Qing Wang
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | | | | | - Shibeshih Belachew
- F. Hoffmann-La Roche Ltd, Basel, Switzerland.,Now with Biogen, Cambridge, Massachusetts
| | - Stephen L Hauser
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco
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22
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Cheng WY, Bourke AK, Lipsmeier F, Bernasconi C, Belachew S, Gossens C, Graves JS, Montalban X, Lindemann M. U-turn speed is a valid and reliable smartphone-based measure of multiple sclerosis-related gait and balance impairment. Gait Posture 2021; 84:120-126. [PMID: 33310432 DOI: 10.1016/j.gaitpost.2020.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/13/2020] [Accepted: 11/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND People living with multiple sclerosis (MS) experience impairments in gait and mobility, that are not fully captured with manually timed walking tests or rating scales administered during periodic clinical visits. We have developed a smartphone-based assessment of ambulation performance, the 5 U-Turn Test (5UTT), a quantitative self-administered test of U-turn ability while walking, for people with MS (PwMS). RESEARCH QUESTION What is the test-retest reliability and concurrent validity of U-turn speed, an unsupervised self-assessment of gait and balance impairment, measured using a body-worn smartphone during the 5UTT? METHODS 76 PwMS and 25 healthy controls (HCs) participated in a cross-sectional non-randomised interventional feasibility study. The 5UTT was self-administered daily and the median U-turn speed, measured during a 14-day session, was compared against existing validated in-clinic measures of MS-related disability. RESULTS U-turn speed, measured during a 14-day session from the 5UTT, demonstrated good-to-excellent test-retest reliability in PwMS alone and combined with HCs (intraclass correlation coefficient [ICC] = 0.87 [95 % CI: 0.80-0.92]) and moderate-to-excellent reliability in HCs alone (ICC = 0.88 [95 % CI: 0.69-0.96]). U-turn speed was significantly correlated with in-clinic measures of walking speed, physical fatigue, ambulation impairment, overall MS-related disability and patients' self-perception of quality of life, at baseline, Week 12 and Week 24. The minimal detectable change of the U-turn speed from the 5UTT was low (19.42 %) in PwMS and indicates a good precision of this measurement tool when compared with conventional in-clinic measures of walking performance. SIGNIFICANCE The frequent self-assessment of turn speed, as an outcome measure from a smartphone-based U-turn test, may represent an ecologically valid digital solution to remotely and reliably monitor gait and balance impairment in a home environment during MS clinical trials and practice.
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Affiliation(s)
- Wei-Yi Cheng
- F. Hoffmann-La Roche Ltd, Basel, 4070, Switzerland.
| | | | | | | | | | | | - Jennifer S Graves
- Department of Neurosciences, University of California, San Diego, San Diego, CA, 92093, USA; University of California, San Francisco, San Francisco, CA, 94143, USA.
| | - Xavier Montalban
- Division of Neurology, University of Toronto, Toronto, ON, M5S 1A1, Canada; Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia (CEMCAT), Vall d'Hebron University Hospital, Barcelona, 08035, Spain.
| | - Michael Lindemann
- F. Hoffmann-La Roche Ltd, Basel, 4070, Switzerland; Department of Economics, Baden-Wuerttemberg Cooperative State University, Loerrach, 79539, Germany.
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23
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Elliott C, Arnold DL, Chen H, Ke C, Zhu L, Chang I, Cahir-McFarland E, Fisher E, Zhu B, Gheuens S, Scaramozza M, Beynon V, Franchimont N, Bradley DP, Belachew S. Patterning Chronic Active Demyelination in Slowly Expanding/Evolving White Matter MS Lesions. AJNR Am J Neuroradiol 2020; 41:1584-1591. [PMID: 32819894 DOI: 10.3174/ajnr.a6742] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/31/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Slowly expanding/evolving lesions measured by conventional T1-weighted/T2-weighted brain MR imaging may contribute to progressive disability accumulation in MS. We evaluated the longitudinal change in myelin and axonal tissue integrity in white matter slowly expanding/evolving lesions by means of the magnetization transfer ratio and DTI radial diffusivity. MATERIALS AND METHODS Slowly expanding/evolving lesions were detected within the Study to Assess the Efficacy, Safety, Tolerability, and Pharmacokinetics of BIIB033 in Participants With Relapsing Forms of Multiple Sclerosis When Used Concurrently With Avonex (SYNERGY) Phase 2 clinical trial dataset (NCT01864148), comprising patients with relapsing-remitting and secondary-progressive MS (n = 299) with T1-weighted/T2-weighted MR imaging at all trial time points (baseline to week 72). RESULTS Compared with non-slowly expanding/evolving lesions (areas not classified as slowly expanding/evolving lesion) of baseline nonenhancing T2 lesions, slowly expanding/evolving lesions had a lower normalized magnetization transfer ratio and greater DTI radial diffusivity, both in patients with relapsing-remitting MS (n = 242) and secondary-progressive MS (n = 57, P < .001 for all). Although the changes with time in both the normalized magnetization transfer ratio and DTI radial diffusivity between slowly expanding/evolving lesions and non-slowly expanding/evolving lesions were positively correlated (P < .001), a decrease in the normalized magnetization transfer ratio and a greater increase in DTI radial diffusivity were observed in slowly expanding/evolving lesions versus non-slowly expanding/evolving lesions from baseline to week 72 in relapsing-remitting MS and secondary-progressive MS (P < .001 for all). CONCLUSIONS Patterns of longitudinal change in the normalized magnetization transfer ratio and DTI radial diffusivity in slowly expanding/evolving lesions were consistent with progressive demyelination and tissue loss, as seen in smoldering white matter MS plaques.
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Affiliation(s)
- C Elliott
- From the NeuroRx Research (C.E., D.L.A.) Montreal, Quebec, Canada
| | - D L Arnold
- From the NeuroRx Research (C.E., D.L.A.) Montreal, Quebec, Canada.,McGill University (D.L.A.) Montreal, Quebec, Canada
| | - H Chen
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - C Ke
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - L Zhu
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - I Chang
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - E Cahir-McFarland
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - E Fisher
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - B Zhu
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - S Gheuens
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - M Scaramozza
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - V Beynon
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - N Franchimont
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - D P Bradley
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - S Belachew
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
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24
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Hauser SL, Kappos L, Arnold DL, Bar-Or A, Brochet B, Naismith RT, Traboulsee A, Wolinsky JS, Belachew S, Koendgen H, Levesque V, Manfrini M, Model F, Hubeaux S, Mehta L, Montalban X. Five years of ocrelizumab in relapsing multiple sclerosis: OPERA studies open-label extension. Neurology 2020; 95:e1854-e1867. [PMID: 32690791 PMCID: PMC7682822 DOI: 10.1212/wnl.0000000000010376] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 04/10/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess over 3 years of follow-up the effects of maintaining or switching to ocrelizumab (OCR) therapy on clinical and MRI outcomes and safety measures in the open-label extension (OLE) phase of the pooled OPERA: I/II studies in relapsing multiple sclerosis. METHODS After 2 years of double-blind, controlled treatment, patients continued OCR (600 mg infusions every 24 weeks) or switched from interferon (IFN)-β-1a (44 μg 3 times weekly) to OCR when entering the OLE phase (3 years). Adjusted annualized relapse rate, time to onset of 24-week confirmed disability progression (CDP)/improvement (CDP), brain MRI activity (gadolinium-enhanced and new/enlarging T2 lesions), and percentage brain volume change were analyzed. RESULTS Of patients entering the OLE phase, 88.6% completed year 5. The cumulative proportion with 24-week CDP was lower in patients who initiated OCR earlier vs patients initially receiving IFN-β-1a (16.1% vs 21.3% at year 5; p = 0.014). Patients continuing OCR maintained and those switching from IFN-β-1a to OCR attained near complete and sustained suppression of new brain MRI lesion activity from years 3-5. Over the OLE phase, patients continuing OCR exhibited less whole brain volume loss from double-blind study baseline vs those switching from IFN-β-1a (-1.87% vs -2.15% at year 5; p < 0.01). Adverse events were consistent with past reports and no new safety signals emerged with prolonged treatment. CONCLUSION Compared with patients switching from IFN-β-1a, earlier and continuous OCR treatment up to 5 years provided sustained benefit on clinical and MRI measures of disease progression. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that earlier and continuous treatment with OCR provided sustained benefit on clinical and MRI outcomes of disease activity and progression compared with patients switching from IFN-β-1a. The study is rated Class III because of the initial treatment randomization disclosure that occurred after inclusion in OLE. CLINICAL TRIAL IDENTIFIERS NCT01247324/NCT01412333.
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Affiliation(s)
- Stephen L Hauser
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Ludwig Kappos
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Douglas L Arnold
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Amit Bar-Or
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Bruno Brochet
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Robert T Naismith
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Anthony Traboulsee
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Jerry S Wolinsky
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Shibeshih Belachew
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Harold Koendgen
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA.
| | - Victoria Levesque
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Marianna Manfrini
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Fabian Model
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Stanislas Hubeaux
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Lahar Mehta
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
| | - Xavier Montalban
- From the Department of Neurology (S.L.H.), University of California, San Francisco; Neurologic Clinic and Policlinic (L.K.), Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; NeuroRx Research (D.L.A.); Departments of Neurology and Neurosurgery (D.L.A.), McGill University, Montreal, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology (B.B.), CHU de Bordeaux, France; Department of Neurology (R.T.N.), Washington University School of Medicine, St. Louis, MO; Division of Neurology (A.T.), Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Neurology (J.S.W.), McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth); F. Hoffmann-La Roche Ltd (S.B., H.K., M.M., F.M., S.H.), Basel, Switzerland; Genentech, Inc. (V.L., L.M.), South San Francisco, CA; Division of Neurology (X.M.), University of Toronto, Canada; and Department of Neurology-Neuroimmunology (X.M.), Vall d'Hebron University Hospital, Barcelona, Spain. During completion of the work related to this article, S.B. and L.M. were employees of F. Hoffmann-La Roche Ltd; current affiliations are Biogen (S.B.), Cambridge, MA; and Alder Biopharmaceuticals Inc. (L.M.), Bothell, WA
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Creagh AP, Simillion C, Scotland A, Lipsmeier F, Bernasconi C, Belachew S, van Beek J, Baker M, Gossens C, Lindemann M, De Vos M. Smartphone-based remote assessment of upper extremity function for multiple sclerosis using the Draw a Shape Test. Physiol Meas 2020; 41:054002. [DOI: 10.1088/1361-6579/ab8771] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Elliott C, Belachew S, Wolinsky JS, Hauser SL, Kappos L, Barkhof F, Bernasconi C, Fecker J, Model F, Wei W, Arnold DL. Chronic white matter lesion activity predicts clinical progression in primary progressive multiple sclerosis. Brain 2020; 142:2787-2799. [PMID: 31497864 PMCID: PMC6736181 DOI: 10.1093/brain/awz212] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [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: 12/05/2018] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 12/18/2022] Open
Abstract
Chronic active and slowly expanding lesions with smouldering inflammation are neuropathological correlates of progressive multiple sclerosis pathology. T1 hypointense volume and signal intensity on T1-weighted MRI reflect brain tissue damage that may develop within newly formed acute focal inflammatory lesions or in chronic pre-existing lesions without signs of acute inflammation. Using a recently developed method to identify slowly expanding/evolving lesions in vivo from longitudinal conventional T2- and T1-weighted brain MRI scans, we measured the relative amount of chronic lesion activity as measured by change in T1 volume and intensity within slowly expanding/evolving lesions and non-slowly expanding/evolving lesion areas of baseline pre-existing T2 lesions, and assessed the effect of ocrelizumab on this outcome in patients with primary progressive multiple sclerosis participating in the phase III, randomized, placebo-controlled, double-blind ORATORIO study (n = 732, NCT01194570). We also assessed the predictive value of T1-weighted measures of chronic lesion activity for clinical multiple sclerosis progression as reflected by a composite disability measure including the Expanded Disability Status Scale, Timed 25-Foot Walk and 9-Hole Peg Test. We observed in this clinical trial population that most of total brain non-enhancing T1 hypointense lesion volume accumulation was derived from chronic lesion activity within pre-existing T2 lesions rather than new T2 lesion formation. There was a larger decrease in mean normalized T1 signal intensity and greater relative accumulation of T1 hypointense volume in slowly expanding/evolving lesions compared with non-slowly expanding/evolving lesions. Chronic white matter lesion activity measured by longitudinal T1 hypointense lesion volume accumulation in slowly expanding/evolving lesions and in non-slowly expanding/evolving lesion areas of pre-existing lesions predicted subsequent composite disability progression with consistent trends on all components of the composite. In contrast, whole brain volume loss and acute lesion activity measured by longitudinal T1 hypointense lesion volume accumulation in new focal T2 lesions did not predict subsequent composite disability progression in this trial at the population level. Ocrelizumab reduced longitudinal measures of chronic lesion activity such as T1 hypointense lesion volume accumulation and mean normalized T1 signal intensity decrease both within regions of pre-existing T2 lesions identified as slowly expanding/evolving and in non-slowly expanding/evolving lesions. Using conventional brain MRI, T1-weighted intensity-based measures of chronic white matter lesion activity predict clinical progression in primary progressive multiple sclerosis and may qualify as a longitudinal in vivo neuroimaging correlate of smouldering demyelination and axonal loss in chronic active lesions due to CNS-resident inflammation and/or secondary neurodegeneration across the multiple sclerosis disease continuum.
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Affiliation(s)
| | | | - Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | | | - Ludwig Kappos
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Frederik Barkhof
- VU University Medical Centre, Amsterdam, The Netherlands.,UCL Institutes of Biomedical Engineering and Neurology, London, UK
| | | | | | | | - Wei Wei
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Douglas L Arnold
- NeuroRx Research, Montreal, QC, Canada.,McGill University, Montreal, QC, Canada
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Midaglia L, Mulero P, Montalban X, Graves J, Hauser SL, Julian L, Baker M, Schadrack J, Gossens C, Scotland A, Lipsmeier F, van Beek J, Bernasconi C, Belachew S, Lindemann M. Correction: Adherence and Satisfaction of Smartphone- and Smartwatch-Based Remote Active Testing and Passive Monitoring in People With Multiple Sclerosis: Nonrandomized Interventional Feasibility Study. J Med Internet Res 2019; 21:e16287. [PMID: 31596725 PMCID: PMC6914226 DOI: 10.2196/16287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.2196/14863.].
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Affiliation(s)
- Luciana Midaglia
- Department of Neurology-NeuroimmunologyMultiple Sclerosis Centre of CataloniaVall d’Hebron University HospitalBarcelonaSpain,Department of MedicineAutonomous University of BarcelonaBarcelonaSpain
| | - Patricia Mulero
- Department of Neurology-NeuroimmunologyMultiple Sclerosis Centre of CataloniaVall d’Hebron University HospitalBarcelonaSpain
| | - Xavier Montalban
- Department of Neurology-NeuroimmunologyMultiple Sclerosis Centre of CataloniaVall d’Hebron University HospitalBarcelonaSpain,Division of NeurologyUniversity of TorontoToronto, ONCanada
| | - Jennifer Graves
- Department of NeurologyUniversity of California, San DiegoSan Diego, CAUnited States
| | - Stephen L Hauser
- Department of NeurologyUniversity of California, San FranciscoSan Francisco, CAUnited States
| | - Laura Julian
- Genentech IncSouth San Francisco, CAUnited States
| | | | | | | | | | | | | | | | | | - Michael Lindemann
- F Hoffmann–La Roche LtdBaselSwitzerland,Department of EconomicsBaden-Wuerttemberg Cooperative State UniversityLoerrachGermany
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Barkhof F, Kappos L, Wolinsky JS, Li DKB, Bar-Or A, Hartung HP, Belachew S, Han J, Julian L, Sauter A, Napieralski J, Koendgen H, Hauser SL. Onset of clinical and MRI efficacy of ocrelizumab in relapsing multiple sclerosis. Neurology 2019; 93:e1778-e1786. [PMID: 31484710 PMCID: PMC6946481 DOI: 10.1212/wnl.0000000000008189] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 05/30/2019] [Indexed: 01/21/2023] Open
Abstract
Objective To assess the onset of ocrelizumab efficacy on brain MRI measures of disease activity in the phase II study in relapsing-remitting multiple sclerosis (RRMS), and relapse rate in the pooled phase III studies in relapsing multiple sclerosis (RMS). Methods Brain MRI activity was determined in the phase II trial at monthly intervals in patients with RRMS receiving placebo, ocrelizumab (600 mg), or intramuscular interferon (IFN) β-1a (30 μg). Annualized relapse rate (ARR; over various epochs) and time to first relapse were analyzed in the pooled population of the phase III OPERA (A Study of Ocrelizumab in Comparison With Interferon Beta-1a [Rebif] in Participants With Relapsing Multiple Sclerosis) I and OPERA II trials in patients with RMS receiving ocrelizumab (600 mg) or subcutaneous IFN-β-1a (44 μg). Results In patients with RRMS, ocrelizumab reduced the number of new T1 gadolinium-enhancing lesions by week 4 vs placebo (p = 0.042) and by week 8 vs intramuscular IFN-β-1a (p < 0.001). Ocrelizumab also reduced the number of new or enlarging T2 lesions appearing between weeks 4 and 8 vs both placebo and IFN-β-1a (both p < 0.001). In patients with RMS, ocrelizumab significantly reduced ARR (p = 0.005) and the probability of time to first protocol-defined relapse (p = 0.014) vs subcutaneous IFN-β-1a within the first 8 weeks. Conclusion Epoch analysis of MRI-measured lesion activity in the phase II study and relapse rate in the phase III studies consistently revealed a rapid suppression of acute MRI and clinical disease activity following treatment initiation with ocrelizumab in patients with RRMS and RMS, respectively. Classification of evidence This study provides Class II evidence that for patients with RRMS and RMS, ocrelizumab suppressed MRI activity within 4 weeks and clinical disease activity within 8 weeks.
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Affiliation(s)
- Frederik Barkhof
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA.
| | - Ludwig Kappos
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Jerry S Wolinsky
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - David K B Li
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Amit Bar-Or
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Hans-Peter Hartung
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Shibeshih Belachew
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Jian Han
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Laura Julian
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Annette Sauter
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Julie Napieralski
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Harold Koendgen
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
| | - Stephen L Hauser
- From the Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; UCL Institutes of Healthcare Engineering and Neurology (F.B.), London, UK; Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering (L.K.), University Hospital Basel, University of Basel, Switzerland; Department of Neurology (J.S.W.), McGovern Medical School, UTHealth, Houston, TX; Department of Radiology (D.K.B.L.), University of British Columbia, Vancouver, Canada; Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics (A.B.-O.), University of Pennsylvania, Philadelphia; Department of Neurology, Medical Faculty (H.-P.H.), Heinrich-Heine University Düsseldorf, Germany; F. Hoffmann-La Roche Ltd. (S.B., A.S., J.N., H.K.), Basel, Switzerland; Genentech, Inc. (J.H., L.J.), South San Francisco; and Department of Neurology (S.L.H.), University of California, San Francisco. During completion of the work related to this article, S. Belachew was an employee of F. Hoffmann-La Roche Ltd.; his current affiliation is Biogen, Cambridge, MA
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Midaglia L, Mulero P, Montalban X, Graves J, Hauser SL, Julian L, Baker M, Schadrack J, Gossens C, Scotland A, Lipsmeier F, van Beek J, Bernasconi C, Belachew S, Lindemann M. Adherence and Satisfaction of Smartphone- and Smartwatch-Based Remote Active Testing and Passive Monitoring in People With Multiple Sclerosis: Nonrandomized Interventional Feasibility Study. J Med Internet Res 2019; 21:e14863. [PMID: 31471961 PMCID: PMC6743265 DOI: 10.2196/14863] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [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: 06/11/2019] [Revised: 07/11/2019] [Accepted: 07/19/2019] [Indexed: 12/04/2022] Open
Abstract
Background Current clinical assessments of people with multiple sclerosis are episodic and may miss critical features of functional fluctuations between visits. Objective The goal of the research was to assess the feasibility of remote active testing and passive monitoring using smartphones and smartwatch technology in people with multiple sclerosis with respect to adherence and satisfaction with the FLOODLIGHT test battery. Methods People with multiple sclerosis (aged 20 to 57 years; Expanded Disability Status Scale 0-5.5; n=76) and healthy controls (n=25) performed the FLOODLIGHT test battery, comprising active tests (daily, weekly, every two weeks, or on demand) and passive monitoring (sensor-based gait and mobility) for 24 weeks using a smartphone and smartwatch. The primary analysis assessed adherence (proportion of weeks with at least 3 days of completed testing and 4 hours per day passive monitoring) and questionnaire-based satisfaction. In-clinic assessments (clinical and magnetic resonance imaging) were performed. Results People with multiple sclerosis showed 70% (16.68/24 weeks) adherence to active tests and 79% (18.89/24 weeks) to passive monitoring; satisfaction score was on average 73.7 out of 100. Neither adherence nor satisfaction was associated with specific population characteristics. Test-battery assessments had an at least acceptable impact on daily activities in over 80% (61/72) of people with multiple sclerosis. Conclusions People with multiple sclerosis were engaged and satisfied with the FLOODLIGHT test battery. FLOODLIGHT sensor-based measures may enable continuous assessment of multiple sclerosis disease in clinical trials and real-world settings. Trial Registration ClinicalTrials.gov: NCT02952911; https://clinicaltrials.gov/ct2/show/NCT02952911
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Affiliation(s)
- Luciana Midaglia
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Patricia Mulero
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology, Multiple Sclerosis Centre of Catalonia, Vall d'Hebron University Hospital, Barcelona, Spain.,Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Jennifer Graves
- Department of Neurology, University of California, San Diego, San Diego, CA, United States
| | - Stephen L Hauser
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Laura Julian
- Genentech Inc, South San Francisco, CA, United States
| | | | | | | | | | | | | | | | | | - Michael Lindemann
- F Hoffmann-La Roche Ltd, Basel, Switzerland.,Department of Economics, Baden-Wuerttemberg Cooperative State University, Loerrach, Germany
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Wolinsky JS, Montalban X, Hauser SL, Giovannoni G, Vermersch P, Bernasconi C, Deol-Bhullar G, Garren H, Chin P, Belachew S, Kappos L. Evaluation of no evidence of progression or active disease (NEPAD) in patients with primary progressive multiple sclerosis in the ORATORIO trial. Ann Neurol 2019; 84:527-536. [PMID: 30155979 PMCID: PMC6220799 DOI: 10.1002/ana.25313] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/08/2018] [Accepted: 08/12/2018] [Indexed: 12/15/2022]
Abstract
Objective No evidence of progression or active disease (NEPAD) is a novel combined endpoint defined by the absence of both progression and inflammatory disease activity in primary progressive multiple sclerosis (PPMS). In the placebo‐controlled phase III ORATORIO study (NCT01194570), we investigated the effect of ocrelizumab on this comprehensive outcome and its components in a post‐hoc analysis. Methods The proportion of patients with NEPAD (no evidence of progression [NEP; no 12‐week confirmed progression of ≥1/≥0.5 points on the Expanded Disability Status Scale if the baseline score was ≤5.5/>5.5 points, respectively; no 12‐week confirmed progression of ≥20% on the Timed 25‐Foot Walk test and 9‐Hole Peg Test], no brain magnetic resonance imaging activity [no new/enlarging T2 lesions and no T1 gadolinium‐enhancing lesions], and no protocol‐defined relapse) from baseline to week 120 was determined in ocrelizumab‐ (600 mg; n = 465) and placebo‐treated (n = 234) patients. Results The majority of ORATORIO study patients with PPMS experienced clinical progression or evidence of disease activity. From baseline to week 120, 29.9% and 42.7% ocrelizumab‐treated compared to 9.4% and 29.1% placebo‐treated patients maintained NEPAD (relative risk [95% confidence interval {CI}], 3.15 [2.07–4.79]; p < 0.001) and NEP (relative risk [95% CI], 1.47 [1.17–1.84]; p < 0.001), respectively. Effects on the individual components of both measures were consistent with the compound outcomes. Interpretation Compared to placebo, ocrelizumab enhanced 3‐fold the proportion of PPMS patients with no evidence of either progression or inflammatory disease activity. NEPAD may represent a sensitive and meaningful comprehensive measure of disease control in patients with PPMS. Ann Neurol 2018;84:527–536
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Affiliation(s)
- Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Xavier Montalban
- Division of Neurology, University of Toronto, Toronto, ON, Canada.,Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | | | | | | | - Peter Chin
- Genentech, Inc., South San Francisco, CA
| | | | - Ludwig Kappos
- University Hospital Basel, University of Basel, Basel, Switzerland
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31
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Elliott C, Wolinsky JS, Hauser SL, Kappos L, Barkhof F, Bernasconi C, Wei W, Belachew S, Arnold DL. Slowly expanding/evolving lesions as a magnetic resonance imaging marker of chronic active multiple sclerosis lesions. Mult Scler 2018; 25:1915-1925. [PMID: 30566027 PMCID: PMC6876256 DOI: 10.1177/1352458518814117] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [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] [Indexed: 11/15/2022]
Abstract
Background: Chronic lesion activity driven by smoldering inflammation is a pathological hallmark of progressive forms of multiple sclerosis (MS). Objective: To develop a method for automatic detection of slowly expanding/evolving lesions (SELs) on conventional brain magnetic resonance imaging (MRI) and characterize such SELs in primary progressive MS (PPMS) and relapsing MS (RMS) populations. Methods: We defined SELs as contiguous regions of existing T2 lesions showing local expansion assessed by the Jacobian determinant of the deformation between reference and follow-up scans. SEL candidates were assigned a heuristic score based on concentricity and constancy of change in T2- and T1-weighted MRIs. SELs were examined in 1334 RMS patients and 555 PPMS patients. Results: Compared with RMS patients, PPMS patients had higher numbers of SELs (p = 0.002) and higher T2 volumes of SELs (p < 0.001). SELs were devoid of gadolinium enhancement. Compared with areas of T2 lesions not classified as SEL, SELs had significantly lower T1 intensity at baseline and larger decrease in T1 intensity over time. Conclusion: We suggest that SELs reflect chronic tissue loss in the absence of ongoing acute inflammation. SELs may represent a conventional brain MRI correlate of chronic active MS lesions and a candidate biomarker for smoldering inflammation in MS.
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Affiliation(s)
| | - Jerry S Wolinsky
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Stephen L Hauser
- Department of Neurology, University of California-San Francisco, San Francisco, CA, USA
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands/Institutes of Biomedical Engineering and Neurology, University College London (UCL), London, UK
| | | | - Wei Wei
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Douglas L Arnold
- NeuroRx Research, Montreal, QC, Canada/Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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Fox EJ, Markowitz C, Applebee A, Montalban X, Wolinsky JS, Belachew S, Fiore D, Pei J, Musch B, Giovannoni G. Ocrelizumab reduces progression of upper extremity impairment in patients with primary progressive multiple sclerosis: Findings from the phase III randomized ORATORIO trial. Mult Scler 2018; 24:1862-1870. [PMID: 30415593 PMCID: PMC6282157 DOI: 10.1177/1352458518808189] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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] [Indexed: 12/30/2022]
Abstract
Background: Upper extremity (UE) impairment is common with primary progressive multiple
sclerosis (PPMS). Objective: This exploratory analysis examined the effects of ocrelizumab on confirmed
progression (CP) and confirmed improvement (CI) in UE impairment in patients
from ORATORIO. Methods: Patients with PPMS received ocrelizumab 600 mg or placebo every 24 weeks for
⩾120 weeks. The Nine-Hole Peg Test (9HPT) was administered at baseline (BL)
and every 12 weeks thereafter. Prespecified exploratory endpoints included
change in 9HPT time and proportion of patients with CP of ⩾20% in 9HPT.
Analysis populations included intention-to-treat (ITT) patients and
subgroups stratified by BL 9HPT time and Expanded Disability Status Scale.
Post hoc analyses included the proportion of patients achieving more severe
thresholds of CP and the proportion achieving CI in 9HPT. Results: Among ITT patients, ocrelizumab significantly reduced the change in 9HPT time
over 120 weeks, the risk of CP of ⩾20% in 9HPT time for both hands and the
risk of more severe 9HPT progression versus placebo. Numerical trends also
favoured ocrelizumab versus placebo with respect to achieving CI. Consistent
directional trends were observed in subgroup analyses. Conclusion: Ocrelizumab reduces the risk of UE disability progression and may increase
the possibility of improvement versus placebo in PPMS.
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Affiliation(s)
- Edward J Fox
- Central Texas Neurology Consultants and Dell Medical School, The University of Texas at Austin, Round Rock, TX, USA
| | - Clyde Markowitz
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela Applebee
- Department of Neurology, St. Peter's Health Partners, Albany, NY, USA
| | - Xavier Montalban
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada/ Department of Neurology/Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | | | | | - Jinglan Pei
- Genentech, Inc., South San Francisco, CA, USA
| | - Bruno Musch
- Genentech, Inc., South San Francisco, CA, USA
| | - Gavin Giovannoni
- Department of Neurology, Queen Mary University of London, London, UK
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Trojano M, Butzkueven H, Kappos L, Wiendl H, Spelman T, Pellegrini F, Chen Y, Dong Q, Koendgen H, Belachew S, Correale J, Caride A, Deri NH, Ballario C, Broadley S, Kneebone C, Barnett M, Pollard J, Hodgkinson S, Kermode A, Macdonell R, King J, Butzkueven H, Lechner-Scott J, Saines N, Slee M, Plummer C, Willekens B, Vanopdenbosch L, Belachew S, Phan-Ba R, Delvaux V, Bissay V, Debruyne J, Decoo D, Crols R, Symons A, Nagels G, Van Pesch V, Sindic C, Dubois B, Medaer R, D'Hooghe M, Guillaume D, De Smet E, Seeldrayers P, Lysandropoulos A, Vokaer M, Geens K, Willems C, Denayer P, Bureau M, Retif C, Dupuis M, Bouquiaux O, Vanderdonckt P, van Landegem W, Caekebeke J, Van Ingelghem E, Peeters K, Gerard P, de Noordhout AM, Desfontaines P, Urbain E, Declercq I, Van Wijmeersch B, Vanroose E, Wibail A, Barthomolé E, Ursell M, Sweet ME, Howse D, Jichici D, Shawush M, Namaka M, Traboulsee A, Hashimoto S, Lo R, Marchetti P, Lapierre Y, Jacques F, MacLean G, Bhan V, Duquette P, Stewart B, Paulseth J, Kremenchutzky M, Vorobeychik G, O'Connor P, Grand'Maison F, Havrdova E, Meluzinová E, Valis M, Talab R, Stourac P, Zapletalová O, Dufek M, Sládková V, Novotna A, Vancurová R, Lhotaková L, Fiedler J, Vachova M, Dolezil D, Stetkarova I, Rehankova A, Psenica P, Ulehlova V, Feketova S, Skoda O, Färkkilä M, Taneli S, Koivisto K, Seppä JM, Airas L, Elovaara I, Hartikainen P, Pirttila T, Louchart P, Ille O, Thenint JP, Godet E, Vioud MM, Colamarino R, Gugenheim M, Grimaud J, Kopf A, Billy C, Huttin B, Borsotti JP, Devos P, Kendjuo JBN, Verier A, Chapuis S, Daluzeau N, Angibaud G, Uriot MSA, Ziegler F, Sellal F, Moulignier A, Lavenu I, Ismail S, Devy R, Suceveanu M, Wagner M, Marcel S, Derouiche F, Mostoufizadehghalamfarsa S, Delalande S, Ruggieri I, Van Nieuwenhuyse CB, Nifle C, Ondze B, Vasilescu CG, Vongsouthi C, Coustans M, Anne O, Amevigbe J, Servan J, Merienne M, Eck P, Berroir S, Busson P, Barroso B, Larrieu JM, Giendaj CL, Malkoun I, Hautecoeur P, Kwiatkowski A, Pouliquen A, Garrigues G, Delerue O, Giraud P, Gere J, Vaunaize J, Dereeper O, Seiller N, Alsassa R, Vlaicu M, Neuville V, Faucheux JM, Bernady P, Fanjaud G, Viallet F, Schroeter M, Schlemilch-Paschen S, Lange T, Bohr KA, Jendroska K, Rehkopf E, Bergmann A, Kleinschnitz C, Postert T, Scholz P, Mauz U, Stratmann H, Siefjediers V, Prantl M, Gehring K, Zellner R, Junge K, Zellner A, Bacay V, Schlegel E, Polzer U, Strauss E, Link A, Stenzel C, Freidel M, Drews J, Neudert C, Schmitz F, Jaeger J, Masri S, Heuberger W, Trausch B, Ruhnke O, Scarel S, Bach K, Ernst M, Landefeld H, Richter N, Schmidt S, Krause M, Dressel A, Ruth R, Anvari K, Gossling J, Schenk C, Tiedge O, Bode L, Eder HT, Pfeffer O, Krug R, Lassek C, Fleischer E, Meuth S, Klotz LH, Peglau I, Kukowski B, Herting B, Guthke K, Schierenbeck J, Brockmeier B, Albrecht H, Wuttke M, Augspach-Hofmann R, Gunther S, Redbrake M, Franke C, Buchner K, Gratz T, Horn R, Doemges F, Schreiber M, Brosch T, Horn M, Kittlitz M, Vulturius G, Hinse P, Malessa R, Wiehler S, Katsarava Z, Kastrup O, Kausch U, Gullekes M, Fickinger M, Wenzel W, Botefur IC, Reifschneider G, Rauer S, Lang M, Harms L, Eckhardt U, Cursiefen S, Linker R, Angstwurm K, Haas J, Schuetze I, Rohm E, Stienker-Fisse H, Sailer M, Bohringer J, Maurer M, Bause E, Wersching R, Dachsel R, Domke S, Hoffman F, Tackenberg B, Roch K, Ziebold U, Kallmann B, Buehler B, Faiss J, Faiss J, Schimrigk S, Menges C, Knop KC, Koehler W, Siever A, Bufler J, Gramsl G, Kuhnler B, Maschke M, Stogbauer F, Staude L, Bethke F, Bitsch A, Harmjanz AD, Windsheimer J, Kieseier BC, Berkenfeld R, Tumani H, Kirsch M, Wildemann B, Daniels R, Gottwald K, Elias WG, Hoffmann O, Schwab M, Pilz C, Klostermann F, Hellwig K, Berthele A, Bayas A, Molitor D, Grothe C, Wagner B, Karageorgiou K, Mitsikostas D, Kodounis A, Plaitakis A, Papadimitriou A, Grigoriadis N, Vlaikidis N, Koutlas E, Kyritsis A, Papathanassopoulos P, Makris N, Tavernarakis A, Scarpini E, Montanari E, Marrosu MG, Trojano M, Amato MP, Rottoli M, Lugaresi A, Florio C, Gasperini C, Grimaldi L, Millefiorini E, Koudriavtseva T, Perla F, Mantegazza R, Bertolotto A, Ghezzi A, Aguilar SQ, Eisenberg ES, Lopez LL, Estudillo RM, Schrijver H, Wittebol M, Baart J, van Golde A, Hengstman G, Pop P, Bos (Geldrop) M, Medaer R, Schyns-Soeterboek A, van der Zwart A, van Diepen A, Verheul G, Verhagen W, Bos (Helmond) M, Witjes R, Sinnige L, van Munster E, Sanders E, van Dijl R, Hupperts R, Frequin S, Visser L, Henselmans J, Moll J, Midgard R, Myhr KM, Edland A, Telstad W, Hognestad T, Lund C, Hovdal H, Kamaljit K, Schepel J, Hogenesch RI, Schüler S, Odeh F, Alstadhaug KB, Korsgaard O, Farbu E, Ingvaldsen TB, Soares (SCO) D, Rente J, Guerra JMC, Morganho A, Leitão A, de Sá J, Sá MJ, Marques P, Veloso M, Baptista MV, Szilasiová J, Copikova-Cudrakova D, Prochazkova L, Klimová E, Donath V, Brozman M, Ramo C, Ruiz DP, Hernández CC, Sola MEM, Moro RS, Vidal JA, Rodríguez ABC, Ozaeta GM, Nadal JB, Esquide AADA, Urtaza JO, Martínez-Yélamos S, Arbizu T, Torrenta LRI, Boggild M, Wilson M, Al-Araji A, Nicholas R, Harrower T, Redmond I, Wolf T, Osei-Bonsu M, Mazibrada G, Rog D, Cottrell D, Constantinescu C, Gray O, Belhag M, Shehu A, Rashid W, Duddy M. Natalizumab treatment shows low cumulative probabilities of confirmed disability worsening to EDSS milestones in the long-term setting. Mult Scler Relat Disord 2018; 24:11-19. [DOI: 10.1016/j.msard.2018.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 11/30/2022]
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Kappos L, Wolinsky JS, Giovannoni G, Arnold DL, Lublin F, Wang Q, Model F, Wei W, Garren H, Manfrini M, Belachew S, Hauser S. 061 Ocrelizumab reduces disability progression independent of relapse activity in patients with relapsing multiple sclerosis (RMS) (ENCORE). J Neurol Neurosurg Psychiatry 2018. [DOI: 10.1136/jnnp-2018-anzan.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionOcrelizumab-(OCR) showed superior efficacy vs interferon beta-1a-(IFNβ1a) in OPERA I/II trials in RMS. Confirmed disability progression-(CDP) based on composite of Expanded Disability Status Scale-(EDSS), timed 25-foot walk-(T25FW) and 9-hole peg test-(9HPT) may better characterise aspects of disability progression than EDSS alone and has improved sensitivity for assessing progression in secondary progressive MS-(SPMS).MethodsRMS patients, including relapsing SPMS patients, in OPERA I/II-(NCT01247324/NCT01412333) received IV-OCR 600 mg (q24w) or SC-IFNβ1a 44 µg (tiw) over 96 weeks. CCDP was defined as disability progression measured by EDSS (increase ≥1.0 or 0.5 if baseline >5.5) or ≥20% T25FW increase or ≥20% 9 HPT increase, confirmed after ≥12/≥24 weeks. Definition-1 of CCDP-IRA=reference EDSS/T25FW/9HPT was re-baselined at first available assessment ≥30 days, after each relapse and no relapse should occur between baseline and initial disability progression [IDP], and within 30 days post-IDP and 30 days prior to IDP confirmation. Definition-2=period of no relapse for 30 days post-IDP confirmation. Subgroup analysis included patients at potentially higher SPMS risk based on baseline-EDSS ≥4.0 and pyramidal Kurtzke Functional Systems Score ≥2.ResultsIn the pooled intention-to-treat (ITT) cohort (n=1,656), risk reduction (RR; OCR vs IFNβ1a) for 12-/24 week CCDP was 34% (30.7% vs 21.5%; p<0.001) and 31% (22.6% vs 16.1%; p=0.002). The 12-/24 week CCDP-IRA RRs for Definition-1 were 24% (25.4% vs 19.6%; p=0.010) and 22% (19.2% vs 14.9%; p=0.046); and for Definition-2, 25% (25.4% vs 19.5%; p=0.008) and 23% (19.2% vs 14.8%; p=0.039). In the subgroup at higher SPMS risk, 12-/24 week RRs for CCDP-IRA (Definition-2) were 40% (31.2% vs 19.1%; p=0.022) and 36% (26.9% vs 16.6%; p=0.064). All CCDP-IRA components in the ITT and subgroups followed similar trends.ConclusionResults show that considerable disability progression in RMS occurs independently of protocol-defined relapses. Ocrelizumab significantly reduced progression vs IFNβ1a in the OPERA ITT population of RMS patients and more so in the subgroup at higher SPMS risk.
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Havrdová E, Arnold DL, Bar-Or A, Comi G, Hartung HP, Kappos L, Lublin F, Selmaj K, Traboulsee A, Belachew S, Bennett I, Buffels R, Garren H, Han J, Julian L, Napieralski J, Hauser SL, Giovannoni G. No evidence of disease activity (NEDA) analysis by epochs in patients with relapsing multiple sclerosis treated with ocrelizumab vs interferon beta-1a. Mult Scler J Exp Transl Clin 2018; 4:2055217318760642. [PMID: 29568544 PMCID: PMC5858626 DOI: 10.1177/2055217318760642] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 11/22/2017] [Revised: 01/16/2018] [Accepted: 01/28/2018] [Indexed: 12/13/2022] Open
Abstract
Background No evidence of disease activity (NEDA; defined as no 12-week confirmed disability progression, no protocol-defined relapses, no new/enlarging T2 lesions and no T1 gadolinium-enhancing lesions) using a fixed-study entry baseline is commonly used as a treatment outcome in multiple sclerosis (MS). Objective The objective of this paper is to assess the effect of ocrelizumab on NEDA using re-baselining analysis, and the predictive value of NEDA status. Methods NEDA was assessed in a modified intent-to-treat population (n = 1520) from the pooled OPERA I and OPERA II studies over various epochs in patients with relapsing MS receiving ocrelizumab (600 mg) or interferon beta-1a (IFN β‐1a; 44 μg). Results NEDA was increased with ocrelizumab vs IFN β-1a over 96 weeks by 75% (p < 0.001), from Week 0‒24 by 33% (p < 0.001) and from Week 24‒96 by 72% (p < 0.001). Among patients with disease activity during Weeks 0‒24, 66.4% vs 24.3% achieved NEDA during Weeks 24‒96 in the ocrelizumab and IFN β-1a groups (relative increase: 177%; p < 0.001). Conclusion Superior efficacy with ocrelizumab compared with IFN β-1a was consistently seen in maintaining NEDA status in all epochs evaluated. By contrast with IFN β-1a, the majority of patients with disease activity early in the study subsequently attained NEDA status with ocrelizumab.
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Affiliation(s)
- Eva Havrdová
- Department of Neurology and Center for Clinical Neuroscience, Charles University, Czech Republic
| | - Douglas L Arnold
- Department of Neurology and Neurosurgery, McGill University, Canada.,NeuroRx Research, Canada
| | - Amit Bar-Or
- Department of Neurology and Center for Neuroinflammation and Experimental Therapeutics, University of Pennsylvania, USA
| | - Giancarlo Comi
- Neurology Department and INSPE-Institute of Experimental Neurology, Vita-Salute San Raffaele University, Italy
| | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Switzerland
| | - Fred Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, USA
| | | | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, University of British Columbia, Canada
| | | | | | | | | | | | | | | | - Stephen L Hauser
- Department of Neurology University of California, San Francisco, USA
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, UK
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Abstract
Shibeshih Belachew speaks to Laura Dormer, Commissioning Editor: Dr Shibeshih Belachew, MD, PhD, is a Senior Medical Director for Multiple Sclerosis (MS) Disease Area in Global Product Development Medical Affairs at Roche (Basel, Switzerland). Prior to joining Roche in January 2016, he was Director of MS Franchise and Head of Medical Director's office for Biogen Region Europe and Canada. Previously at Biogen he also served as a Director in Global Neurology for the natalizumab program in Cambridge (MA, USA). Prior to joining industry, he was a Clinical Professor of Neurology at the University of Liège in Belgium. Shibeshih completed neurology postgraduate training at the University of Liège and has a PhD in Biomedical Science in the field of Developmental Neurobiology. Shibeshih has been a post-doctoral fellow in the Laboratory of Cellular and Synaptic Neurophysiology at the National Institutes of Health (Bethesda, MD, USA) and later at the Center for Neuroscience Research of Children's National Medical Center in Washington DC. He is a member of the Belgian Neurological Society.
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Affiliation(s)
- Shibeshih Belachew
- Senior International Medical Director for Global Product Development Medical Affairs at F Hoffmann-La Roche Ltd, Basel, Switzerland
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Giovannoni G, Arnold DL, Bar-Or A, Havrdová E, Kappos L, Lublin F, Traboulsee A, Belachew S, Han J, Hauser SL. PO129 Neda analysis by epoch in the opera studies of ocrelizumab. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.159] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Giovannoni G, Arnold DL, Bar-Or A, Seze JD, Hemmer B, Montalban X, Belachew S, Bernasconi C, Garren H, Wolinsky J. PO127 Composite confirmed disability progression in oratorio. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.157] [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: 11/03/2022]
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Kappos L, Butzkueven H, Wiendl H, Spelman T, Pellegrini F, Chen Y, Dong Q, Koendgen H, Belachew S, Trojano M. Greater sensitivity to multiple sclerosis disability worsening and progression events using a roving versus a fixed reference value in a prospective cohort study. Mult Scler 2017; 24:963-973. [PMID: 28554238 PMCID: PMC6029149 DOI: 10.1177/1352458517709619] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Confirmed Expanded Disability Status Scale (EDSS) progression occurring after
a fixed-study entry baseline is a common measure of disability increase in
relapsing-remitting multiple sclerosis (RRMS) studies but may not detect all
disability progression events, especially those unrelated to overt
relapses. Objective: To evaluate possible measures of disability progression unrelated to relapse
using EDSS data over ≈5.5 years from the Tysabri® Observational
Program (TOP). Methods: TOP is an ongoing, prospective, open-label study in RRMS patients receiving
intravenous 300 mg natalizumab every 4 weeks. Measures of increasing
disability were assessed using as a reference either study baseline score or
a “roving” system that resets the reference score after ⩾24- or ⩾48-week
confirmation of a new score. Results: This analysis included 5562 patients. Approximately 70% more EDSS progression
events unrelated to relapse and 50% more EDSS worsening events overall were
detected with a roving reference score (cumulative probability: 17.6% and
29.7%, respectively) than with a fixed reference baseline score (cumulative
probability: 10.1% and 20.3%, respectively). Conclusion: In this long-term observational RRMS dataset, a roving EDSS reference value
was more efficient than a study baseline EDSS reference in detecting
progression/worsening events unrelated to relapses and thus the transition
to secondary progressive disease.
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Affiliation(s)
- Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | - Helmut Butzkueven
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia/Department of Neurology, Box Hill Hospital, Monash University, Box Hill, VIC, Australia
| | - Heinz Wiendl
- Department of Neurology-Inflammatory Disorders of the Nervous System and Neurooncology, University of Münster, Münster, Germany
| | - Timothy Spelman
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | | | | | | | | | | | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Wolinsky J, Montalban X, Kappos L, Hauser S, Giovannoni G, Seze JD, Bar-Or A, Masterman D, Bernasconi C, Wei W, Garren H, Chin P, Belachew S, Arnold DL. Evaluation of no evidence of progression or active disease (nepad) in patients with primary progressive multiple sclerosis in the oratorio trial. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-316074.83] [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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Vermesch P, De Seze J, Bernasconi C, Wei W, Belachew S, Chin P, Montalban X. Évaluation de l’absence de progression (NEP) en utilisant une mesure composite du handicap, chez les patients atteints de primaire progressive (SEP-PP) traités par ocrelizumab. Rev Neurol (Paris) 2017. [DOI: 10.1016/j.neurol.2017.01.203] [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: 11/17/2022]
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Hauser SL, Bar-Or A, Comi G, Giovannoni G, Hartung HP, Hemmer B, Lublin F, Montalban X, Rammohan KW, Selmaj K, Traboulsee A, Wolinsky JS, Arnold DL, Klingelschmitt G, Masterman D, Fontoura P, Belachew S, Chin P, Mairon N, Garren H, Kappos L. Ocrelizumab versus Interferon Beta-1a in Relapsing Multiple Sclerosis. N Engl J Med 2017; 376:221-234. [PMID: 28002679 DOI: 10.1056/nejmoa1601277] [Citation(s) in RCA: 1123] [Impact Index Per Article: 160.4] [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: 11/19/2022]
Abstract
BACKGROUND B cells influence the pathogenesis of multiple sclerosis. Ocrelizumab is a humanized monoclonal antibody that selectively depletes CD20+ B cells. METHODS In two identical phase 3 trials, we randomly assigned 821 and 835 patients with relapsing multiple sclerosis to receive intravenous ocrelizumab at a dose of 600 mg every 24 weeks or subcutaneous interferon beta-1a at a dose of 44 μg three times weekly for 96 weeks. The primary end point was the annualized relapse rate. RESULTS The annualized relapse rate was lower with ocrelizumab than with interferon beta-1a in trial 1 (0.16 vs. 0.29; 46% lower rate with ocrelizumab; P<0.001) and in trial 2 (0.16 vs. 0.29; 47% lower rate; P<0.001). In prespecified pooled analyses, the percentage of patients with disability progression confirmed at 12 weeks was significantly lower with ocrelizumab than with interferon beta-1a (9.1% vs. 13.6%; hazard ratio, 0.60; 95% confidence interval [CI], 0.45 to 0.81; P<0.001), as was the percentage of patients with disability progression confirmed at 24 weeks (6.9% vs. 10.5%; hazard ratio, 0.60; 95% CI, 0.43 to 0.84; P=0.003). The mean number of gadolinium-enhancing lesions per T1-weighted magnetic resonance scan was 0.02 with ocrelizumab versus 0.29 with interferon beta-1a in trial 1 (94% lower number of lesions with ocrelizumab, P<0.001) and 0.02 versus 0.42 in trial 2 (95% lower number of lesions, P<0.001). The change in the Multiple Sclerosis Functional Composite score (a composite measure of walking speed, upper-limb movements, and cognition; for this z score, negative values indicate worsening and positive values indicate improvement) significantly favored ocrelizumab over interferon beta-1a in trial 2 (0.28 vs. 0.17, P=0.004) but not in trial 1 (0.21 vs. 0.17, P=0.33). Infusion-related reactions occurred in 34.3% of the patients treated with ocrelizumab. Serious infection occurred in 1.3% of the patients treated with ocrelizumab and in 2.9% of those treated with interferon beta-1a. Neoplasms occurred in 0.5% of the patients treated with ocrelizumab and in 0.2% of those treated with interferon beta-1a. CONCLUSIONS Among patients with relapsing multiple sclerosis, ocrelizumab was associated with lower rates of disease activity and progression than interferon beta-1a over a period of 96 weeks. Larger and longer studies of the safety of ocrelizumab are required. (Funded by F. Hoffmann-La Roche; OPERA I and II ClinicalTrials.gov numbers, NCT01247324 and NCT01412333 , respectively.).
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Affiliation(s)
- Stephen L Hauser
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Amit Bar-Or
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Giancarlo Comi
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Gavin Giovannoni
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Hans-Peter Hartung
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Bernhard Hemmer
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Fred Lublin
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Xavier Montalban
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Kottil W Rammohan
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Krzysztof Selmaj
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Anthony Traboulsee
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Jerry S Wolinsky
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Douglas L Arnold
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Gaelle Klingelschmitt
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Donna Masterman
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Paulo Fontoura
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Shibeshih Belachew
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Peter Chin
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Nicole Mairon
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Hideki Garren
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
| | - Ludwig Kappos
- From the University of California, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., P.C., H.G.) - both in California; McGill University (A.B.-O., D.L.A.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver, BC (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and the Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); Hospital Vall d'Hebron University, Barcelona (X.M.); University of Miami, Miami (K.W.R.); Medical University of Lodz and Center for Neurology, Lodz, Poland (K.S.); McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.); and F. Hoffmann-La Roche (G.K., P.F., S.B., N.M.) and University Hospital Basel, University of Basel (L.K.), Basel, Switzerland
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Montalban X, Hauser SL, Kappos L, Arnold DL, Bar-Or A, Comi G, de Seze J, Giovannoni G, Hartung HP, Hemmer B, Lublin F, Rammohan KW, Selmaj K, Traboulsee A, Sauter A, Masterman D, Fontoura P, Belachew S, Garren H, Mairon N, Chin P, Wolinsky JS. Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis. N Engl J Med 2017; 376:209-220. [PMID: 28002688 DOI: 10.1056/nejmoa1606468] [Citation(s) in RCA: 1115] [Impact Index Per Article: 159.3] [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: 11/19/2022]
Abstract
BACKGROUND An evolving understanding of the immunopathogenesis of multiple sclerosis suggests that depleting B cells could be useful for treatment. We studied ocrelizumab, a humanized monoclonal antibody that selectively depletes CD20-expressing B cells, in the primary progressive form of the disease. METHODS In this phase 3 trial, we randomly assigned 732 patients with primary progressive multiple sclerosis in a 2:1 ratio to receive intravenous ocrelizumab (600 mg) or placebo every 24 weeks for at least 120 weeks and until a prespecified number of confirmed disability progression events had occurred. The primary end point was the percentage of patients with disability progression confirmed at 12 weeks in a time-to-event analysis. RESULTS The percentage of patients with 12-week confirmed disability progression was 32.9% with ocrelizumab versus 39.3% with placebo (hazard ratio, 0.76; 95% confidence interval [CI], 0.59 to 0.98; P=0.03). The percentage of patients with 24-week confirmed disability progression was 29.6% with ocrelizumab versus 35.7% with placebo (hazard ratio, 0.75; 95% CI, 0.58 to 0.98; P=0.04). By week 120, performance on the timed 25-foot walk worsened by 38.9% with ocrelizumab versus 55.1% with placebo (P=0.04); the total volume of brain lesions on T2-weighted magnetic resonance imaging (MRI) decreased by 3.4% with ocrelizumab and increased by 7.4% with placebo (P<0.001); and the percentage of brain-volume loss was 0.90% with ocrelizumab versus 1.09% with placebo (P=0.02). There was no significant difference in the change in the Physical Component Summary score of the 36-Item Short-Form Health Survey. Infusion-related reactions, upper respiratory tract infections, and oral herpes infections were more frequent with ocrelizumab than with placebo. Neoplasms occurred in 2.3% of patients who received ocrelizumab and in 0.8% of patients who received placebo; there was no clinically significant difference between groups in the rates of serious adverse events and serious infections. CONCLUSIONS Among patients with primary progressive multiple sclerosis, ocrelizumab was associated with lower rates of clinical and MRI progression than placebo. Extended observation is required to determine the long-term safety and efficacy of ocrelizumab. (Funded by F. Hoffmann-La Roche; ORATORIO ClinicalTrials.gov number, NCT01194570 .).
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Affiliation(s)
- Xavier Montalban
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Stephen L Hauser
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Ludwig Kappos
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Douglas L Arnold
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Amit Bar-Or
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Giancarlo Comi
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Jérôme de Seze
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Gavin Giovannoni
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Hans-Peter Hartung
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Bernhard Hemmer
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Fred Lublin
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Kottil W Rammohan
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Krzysztof Selmaj
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Anthony Traboulsee
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Annette Sauter
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Donna Masterman
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Paulo Fontoura
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Shibeshih Belachew
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Hideki Garren
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Nicole Mairon
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Peter Chin
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
| | - Jerry S Wolinsky
- From Hospital Vall d'Hebron University, Barcelona (X.M.); University of California, San Francisco, San Francisco (S.L.H.), and Genentech, South San Francisco (D.M., H.G., P.C.) - both in California; University Hospital Basel, University of Basel (L.K.), and F. Hoffmann-La Roche (A.S., P.F., S.B., N.M.), Basel, Switzerland; McGill University (D.L.A., A.B.-O.) and NeuroRx Research (D.L.A.), Montreal, and University of British Columbia, Vancouver (A.T.) - both in Canada; University Vita-Salute San Raffaele, Milan (G.C.); University Hospital of Strasbourg, Clinical Investigation Center (INSERM Unité 1434), Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France (J.S.); Barts and the London School of Medicine and Dentistry, London (G.G.); Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf (H.-P.H.), and Technical University of Munich and Munich Cluster for Systems Neurology, Munich (B.H.) - both in Germany; Icahn School of Medicine at Mount Sinai, New York (F.L.); University of Miami, Miami (K.W.R.); Medical University of Łódź, Łódź, Poland (K.S.); and McGovern Medical School, University of Texas Health Science Center at Houston, Houston (J.S.W.)
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45
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Giovannoni G, Cutter G, Sormani MP, Belachew S, Hyde R, Koendgen H, Knappertz V, Tomic D, Leppert D, Herndon R, Wheeler-Kingshott CAM, Ciccarelli O, Selwood D, di Cantogno EV, Ben-Amor AF, Matthews P, Carassiti D, Baker D, Schmierer K. Is multiple sclerosis a length-dependent central axonopathy? The case for therapeutic lag and the asynchronous progressive MS hypotheses. Mult Scler Relat Disord 2017; 12:70-78. [PMID: 28283111 DOI: 10.1016/j.msard.2017.01.007] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 01/06/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
Trials of anti-inflammatory therapies in non-relapsing progressive multiple sclerosis (MS) have been stubbornly negative except recently for an anti-CD20 therapy in primary progressive MS and a S1P modulator siponimod in secondary progressive MS. We argue that this might be because trials have been too short and have focused on assessing neuronal pathways, with insufficient reserve capacity, as the core component of the primary outcome. Delayed neuroaxonal degeneration primed by prior inflammation is not expected to respond to disease-modifying therapies targeting MS-specific mechanisms. However, anti-inflammatory therapies may modify these damaged pathways, but with a therapeutic lag that may take years to manifest. Based on these observations we propose that clinically apparent neurodegenerative components of progressive MS may occur in a length-dependent manner and asynchronously. If this hypothesis is confirmed it may have major implications for the future design of progressive MS trials.
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Affiliation(s)
- Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK.
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | | | | | | | | | | | | | - Robert Herndon
- University of Mississippi Medical Center, Jackson, MS, USA.
| | - Claudia A M Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Queen Square, London, UK.
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Queen Square, London, UK; NIHR University College Hospitals Biomedical Research Centre (BRC), UK.
| | - David Selwood
- Wolfson Institute for Biomedical Research, UCL, London, UK.
| | | | | | - Paul Matthews
- Department of Medicine, Imperial College, London, UK.
| | - Daniele Carassiti
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK.
| | - David Baker
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK.
| | - Klaus Schmierer
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK.
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46
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Spelman T, Kalincik T, Jokubaitis V, Zhang A, Pellegrini F, Wiendl H, Belachew S, Hyde R, Verheul F, Lugaresi A, Havrdová E, Horáková D, Grammond P, Duquette P, Prat A, Iuliano G, Terzi M, Izquierdo G, Hupperts RMM, Boz C, Pucci E, Giuliani G, Sola P, Spitaleri DLA, Lechner-Scott J, Bergamaschi R, Grand'Maison F, Granella F, Kappos L, Trojano M, Butzkueven H. Comparative efficacy of first-line natalizumab vs IFN-β or glatiramer acetate in relapsing MS. Neurol Clin Pract 2016; 6:102-115. [PMID: 27104064 PMCID: PMC4828679 DOI: 10.1212/cpj.0000000000000227] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 11/25/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND We compared efficacy and treatment persistence in treatment-naive patients with relapsing-remitting multiple sclerosis (RRMS) initiating natalizumab compared with interferon-β (IFN-β)/glatiramer acetate (GA) therapies, using propensity score-matched cohorts from observational multiple sclerosis registries. METHODS The study population initiated IFN-β/GA in the MSBase Registry or natalizumab in the Tysabri Observational Program, had ≥3 months of on-treatment follow-up, and had active RRMS, defined as ≥1 gadolinium-enhancing lesion on cerebral MRI at baseline or ≥1 relapse within the 12 months prior to baseline. Baseline demographics and disease characteristics were balanced between propensity-matched groups. Annualized relapse rate (ARR), time to first relapse, treatment persistence, and disability outcomes were compared between matched treatment arms in the total population (n = 366/group) and subgroups with higher baseline disease activity. RESULTS First-line natalizumab was associated with a 68% relative reduction in ARR from a mean (SD) of 0.63 (0.92) on IFN-β/GA to 0.20 (0.63) (p [signed-rank] < 0.0001), a 64% reduction in the rate of first relapse (hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.28-0.47; p < 0.001), and a 27% reduction in the rate of discontinuation (HR 0.73, 95% CI 0.58-0.93; p = 0.01), compared with first-line IFN-β/GA therapy. Confirmed disability progression and area under the Expanded Disability Status Scale-time curve analyses were not significant. Similar relapse and treatment persistence results were observed in each of the higher disease activity subgroups. CONCLUSIONS This study provides Class IV evidence that first-line natalizumab for RRMS improves relapse and treatment persistence outcomes compared to first-line IFN-β/GA. This needs to be balanced against the risk of progressive multifocal leukoencephalopathy in natalizumab-treated patients. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that first-line natalizumab for RRMS improves relapse rates and treatment persistence outcomes compared to first-line IFN-β/GA.
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Affiliation(s)
- Tim Spelman
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Tomas Kalincik
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Vilija Jokubaitis
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Annie Zhang
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Fabio Pellegrini
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Heinz Wiendl
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Shibeshih Belachew
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Robert Hyde
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Freek Verheul
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Alessandra Lugaresi
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Eva Havrdová
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Dana Horáková
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Pierre Grammond
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Pierre Duquette
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Alexandre Prat
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Gerardo Iuliano
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Murat Terzi
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Guillermo Izquierdo
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Raymond M M Hupperts
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Cavit Boz
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Eugenio Pucci
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Giorgio Giuliani
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Patrizia Sola
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Daniele L A Spitaleri
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Jeannette Lechner-Scott
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Roberto Bergamaschi
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - François Grand'Maison
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Franco Granella
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Ludwig Kappos
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Maria Trojano
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
| | - Helmut Butzkueven
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital (TS, TK, VJ, HB), University of Melbourne, Australia; Biogen Idec Inc. (AZ, FP, SB, RH), Cambridge, MA; Department of Neurology (HW), University of Münster, Germany; Groene Hart Ziekenhuis (FV), Gouda, the Netherlands; MS Center, Department of Neuroscience, Imaging and Clinical Sciences (AL), University "G. d'Annunzio," Chieti, Italy; MS Center, Department of Neurology, First Medical Faculty (EH, DH), Charles University, Prague, Czech Republic; Center de Réadaptation Déficience Physique Chaudière-Appalache (PG), Levis; Hôpital Notre Dame (PD, AP), Montreal, Canada; Ospedali Riuniti di Salerno (G. Iuliano), Salerno, Italy; 19 Mayis University (M. Terzi), Medical Faculty, Turkey; Hospital Universitario Virgen Macarena (G. Izquierdo), Sevilla, Spain; Orbis Medical Centre (RMMH), Sittard-Geleen, the Netherlands; KTU Medical Faculty Farabi Hospital (CB), Trabzon, Turkey; Neurology Unit (EP, GG), ASUR Marche-AV3, Macerata; Nuovo Ospedale Civile S. Agostino (PS), Modena; AORN San Giuseppe Moscati (DLAS), Avellino, Italy; John Hunter Hospital (JL-S), Newcastle, Australia; Neurological Institute IRCCS Mondino (RB), Pavia, Italy; Neuro Rive-Sud (F. Grand'Maison), Hôpital Charles LeMoyne, Quebec, Canada; University of Parma (F. Granella), Italy; Department of Neurology (LK), University Hospital Basel, Switzerland; Department of Basic Medical Sciences, Neuroscience and Sense Organs (M. Trojano), University of Bari, Italy; and Department of Neurology (HB), Eastern Health, Monash University, Australia
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Spelman T, Kalincik T, Zhang A, Pellegrini F, Wiendl H, Kappos L, Tsvetkova L, Belachew S, Hyde R, Verheul F, Grand-Maison F, Izquierdo G, Grammond P, Duquette P, Lugaresi A, Lechner-Scott J, Oreja-Guevara C, Hupperts R, Petersen T, Barnett M, Trojano M, Butzkueven H. Comparative efficacy of switching to natalizumab in active multiple sclerosis. Ann Clin Transl Neurol 2015; 2:373-87. [PMID: 25909083 PMCID: PMC4402083 DOI: 10.1002/acn3.180] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/09/2014] [Accepted: 01/08/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To compare treatment efficacy and persistence in patients who switched to natalizumab versus those who switched between glatiramer acetate (GA) and interferon-beta (IFNβ) after an on-treatment relapse on IFNβ or GA using propensity score matched real-world datasets. METHODS Patients included were registered in MSBase or the TYSABRI Observational Program (TOP), had relapsed on IFNβ or GA within 12 months prior to switching to another therapy, and had initiated natalizumab or IFNβ/GA treatment ≤6 months after discontinuing prior therapy. Covariates were balanced across post switch treatment groups by propensity score matching at treatment initiation. Relapse, persistence, and disability measures were compared between matched treatment arms in the total population (n = 869/group) and in subgroups defined by prior treatment history (IFNβ only [n = 578/group], GA only [n = 165/group], or both IFNβ and GA [n = 176/group]). RESULTS Compared to switching between IFNβ and GA, switching to natalizumab reduced annualized relapse rate in year one by 65-75%, the risk of first relapse by 53-82% (mean follow-up 1.7-2.2 years) and treatment discontinuation events by 48-65% (all P ≤ 0.001). In the total population, switching to natalizumab reduced the risk of confirmed disability progression by 26% (P = 0.036) and decreased the total disability burden by 1.54 EDSS-years (P < 0.0001) over the first 24 months post switch. INTERPRETATION Using large, real-world, propensity-matched datasets we demonstrate that after a relapse on IFNβ or GA, switching to natalizumab (rather than between IFNβ and GA) led to superior outcomes for patients in all measures assessed. Results were consistent regardless of the prior treatment identity.
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Affiliation(s)
- Timothy Spelman
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne Melbourne, Australia
| | - Tomas Kalincik
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne Melbourne, Australia
| | | | - Fabio Pellegrini
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Bari, Italy
| | - Heinz Wiendl
- Department of Neurology, University of Münster Münster, Germany
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel Basel, Switzerland
| | | | | | | | | | | | | | - Pierre Grammond
- Center de réadaptation déficience physique Chaudière-Appalache Levis, Canada
| | | | - Alessandra Lugaresi
- MS Center, Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" Chieti, Italy
| | | | | | | | | | | | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Bari, Italy
| | - Helmut Butzkueven
- Department of Medicine and Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne Melbourne, Australia ; Department of Neurology, Eastern Health, Monash University Box Hill, Australia
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Voloshyna N, Havrdová E, Hutchinson M, Nehrych T, You X, Belachew S, Hotermans C, Paes D. Natalizumab improves ambulation in relapsing-remitting multiple sclerosis: results from the prospective TIMER study and a retrospective analysis of AFFIRM. Eur J Neurol 2014; 22:570-7. [PMID: 25511792 PMCID: PMC4365753 DOI: 10.1111/ene.12618] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 06/27/2014] [Accepted: 10/07/2014] [Indexed: 01/21/2023]
Abstract
Background and purpose Impaired ambulation is a prominent disabling symptom of multiple sclerosis and can lead to reduced quality of life. Whether natalizumab, a monoclonal antibody shown to reduce disease activity in relapsing−remitting multiple sclerosis, could impact ambulation performance was examined. Methods A prospective open-label study, TIMER, was conducted in natalizumab-naive patients (n = 215). The timed 25-foot walk (T25FW) and timed 100-m walk (T100MW) were assessed at baseline and at weeks 24 and 48 of natalizumab therapy, together with Expanded Disability Status Scale scores. The effects of natalizumab on T25FW performance were also examined in a retrospective analysis of natalizumab-treated patients (n = 627) and placebo control patients (n = 315) from the AFFIRM study. Results In TIMER, a significant increase from baseline in T25FW speed was seen at week 24 (P = 0.0074) and in T100MW speed at weeks 24 and 48 (both P < 0.001). A greater proportion of patients showed clinically meaningful increases (≥20%) in walking speed on the T100MW (25%) than on the T25FW (13%) at week 48 (P = 0.032). In AFFIRM, natalizumab increased the proportion of patients with ≥20% confirmed improvement in T25FW speed at year 2 by 78% versus placebo (P = 0.0133). Conclusions Natalizumab increased walking speed in patients with relapsing−remitting multiple sclerosis. The T100MW may be more sensitive to changes in ambulation capacity than the T25FW, and both tests appear to detect clinically meaningful improvements in ambulatory function.
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Affiliation(s)
- N Voloshyna
- Institute of Neurology, Psychiatry and Narcology NAMS of Ukraine, Kharkiv, Ukraine
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Butzkueven H, Kappos L, Pellegrini F, Trojano M, Wiendl H, Patel RN, Zhang A, Hotermans C, Belachew S. Efficacy and safety of natalizumab in multiple sclerosis: interim observational programme results. J Neurol Neurosurg Psychiatry 2014; 85:1190-7. [PMID: 24532785 PMCID: PMC4215289 DOI: 10.1136/jnnp-2013-306936] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical trials established the efficacy and safety of natalizumab. Data are needed over longer periods of time and in the clinical practice setting. OBJECTIVE To evaluate long-term safety of natalizumab and its impact on annualised relapse rate and Expanded Disability Status Scale (EDSS) progression in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS The Tysabri (natalizumab) Observational Program (TOP) is an open-label, multinational, 10-year prospective study in clinical practice settings. RESULTS In this 5-year interim analysis, 4821 patients were enrolled. Follow-up for at least 4 years from natalizumab commencement in 468 patients and at least 2 years in 2496 patients revealed no new safety signals. There were 18 cases of progressive multifocal leucoencephalopathy reported, following 11-44 natalizumab infusions. Mean annualised relapse rate decreased from 1.99 in the 12 months prior to baseline to 0.31 on natalizumab therapy (p<0.0001), remaining low at 5 years. Lower annualised relapse rates were observed in patients who used natalizumab as first MS therapy, in patients with lower baseline EDSS scores, and in patients with lower prenatalizumab relapse rates. Mean EDSS scores remained unchanged up to 5 years. CONCLUSIONS Interim TOP data confirm natalizumab's overall safety profile and the low relapse rate and stabilised disability levels in natalizumab-treated patients with RRMS in clinical practice. TRIAL REGISTRATION NUMBER NCT00493298.
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Affiliation(s)
- Helmut Butzkueven
- Department of Medicine, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia Department of Neurology, Box Hill Hospital, Monash University, Victoria, Victoria, Australia
| | - Ludwig Kappos
- Departments of Neurology and Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Fabio Pellegrini
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Chieti, Italy
| | - Maria Trojano
- Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Heinz Wiendl
- Department of Neurology-Inflammatory Disorders of the Nervous System and Neurooncology, University of Münster, Münster, Germany
| | | | - Annie Zhang
- Biogen Idec Inc, Cambridge, Massachusetts, USA
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Borgs L, Beukelaers P, Vandenbosch R, Belachew S, Nguyen L, Malgrange B. Cell “circadian” cycle: New role for mammalian core clock genes. Cell Cycle 2014; 8:832-7. [DOI: 10.4161/cc.8.6.7869] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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