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Graf A, Risson V, Gustavsson A, Bezlyak V, Caputo A, Tariot PN, Langbaum JB, Lopez Lopez C, Viglietta V. Assessment of Clinical Meaningfulness of Endpoints in the Generation Program by the Insights to Model Alzheimer's Progression in Real Life (iMAP) Study. J Prev Alzheimers Dis 2020; 6:85-89. [PMID: 30756114 DOI: 10.14283/jpad.2018.49] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We are launching the Insights to Model Alzheimer's Progression in Real Life study in parallel with the Alzheimer Prevention Initiative Generation Program. This is a 5-year, multinational, prospective, longitudinal, non-interventional cohort study that will collect data across the spectrum of Alzheimer's disease. The primary objective is to assess the ability of the Alzheimer's Prevention Initiative Cognitive Composite Test Score and Repeatable Battery for the Assessment of Neuropsychological Status to predict clinically meaningful outcomes such as diagnosis of mild cognitive impairment or dementia due to Alzheimer's disease, and change in Clinical Dementia Rating - Global Score. This study is the first large-scale, prospective effort to establish the clinical meaningfulness of cognitive test scores that track longitudinal decline in preclinical Alzheimer's disease. This study is also expected to contribute to our understanding of the relationships among outcomes in different stages of Alzheimer's disease as well as models of individual trajectories during the course of the disease.
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Affiliation(s)
- A Graf
- Ana Graf, Senior Global Program Head, Novartis Pharma AG, Fabrikstrasse 12-4.03.35A, CH-4002 Basel, Switzerland, E-mail:
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Kappos L, Giovannoni G, Gold R, Phillips JT, Arnold DL, Hotermans C, Zhang A, Viglietta V, Fox RJ. Time course of clinical and neuroradiological effects of delayed-release dimethyl fumarate in multiple sclerosis. Eur J Neurol 2015; 22:664-71. [PMID: 25557371 PMCID: PMC4674988 DOI: 10.1111/ene.12624] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/17/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Delayed-release dimethyl fumarate (DMF, also known as gastro-resistant DMF), demonstrated efficacy and safety in relapsing-remitting multiple sclerosis in the 2-year, randomized, placebo-controlled, phase 3 DEFINE and CONFIRM trials. A post hoc analysis of integrated data from DEFINE and CONFIRM was conducted to determine the temporal profile of the clinical and neuroradiological effects of DMF. METHODS Eligible patients were randomized to receive placebo, DMF 240 mg twice (BID) or three times (TID) daily or glatiramer acetate (GA; reference comparator; CONFIRM only) for up to 96 weeks. Patients in the GA group were excluded from this analysis. RESULTS A total of 2301 patients were randomized and received treatment with placebo (n = 771) or DMF BID (n = 769) or TID (n = 761). DMF significantly reduced the annualized relapse rate beginning in weeks 0-12 (BID, P = 0.0159; TID, P = 0.0314); the proportion of patients relapsed beginning at week 10 (BID, P = 0.0427) and week 12 (TID, P = 0.0451); and the proportion of patients with 12-week confirmed disability progression beginning at week 62 (BID, P = 0.0454) and week 72 (TID, P = 0.0399), compared with placebo. These effects were sustained throughout the 2-year study period. DMF significantly reduced the odds of having a higher number of gadolinium-enhancing lesions by 88% (BID) and 75% (TID) and the mean number of new or enlarging T2 lesions by 72% (BID) and 67% (TID), from the first post-baseline magnetic resonance imaging assessment at 24 weeks (all P < 0.0001 versus placebo). CONCLUSIONS In phase 3 clinical trials, DMF demonstrated rapid and sustained clinical and neuroradiological efficacy in relapsing-remitting multiple sclerosis.
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Affiliation(s)
- L Kappos
- Neurology, University Hospital, Basel, Switzerland
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Viglietta V, O'Gorman J, Yang M, Zhang R, Raghupathi K. Evaluation of Disability Progression as an Endpoint in Clinical Trials for Relapsing-Remitting Multiple Sclerosis (RRMS): Comparison of the Define and Confirm Studies. Value Health 2014; 17:A392. [PMID: 27200907 DOI: 10.1016/j.jval.2014.08.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - M Yang
- Biogen Idec Inc., Cambridge, MA, USA
| | - R Zhang
- Biogen Idec Inc., Cambridge, MA, USA
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Kita M, Fox R, Gold R, Giovannoni G, Phillips J, Sarda S, Kong J, Kurukulasuriya N, Viglietta V, Sheikh S, Dawson K, Kappos L. BG-12 effects on quality of life in relapsing–/INS;remitting ms patients: Integrated analysis of the Phase 3 DEFINE and CONFIRM studies. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gold R, Phillips J, Havrdova E, Bar-Or A, Kappos L, Clarke J, Yuan H, Novas M, Sweetser M, Kurukulasuriya N, Viglietta V, Fox R. BG-12 (dimethyl fumarate) and pregnancy: Preclinical studies and pregnancy outcomes reported during the clinical development program. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1388] [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: 10/26/2022]
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Phillips JT, Fox R, Miller D, Kita M, Hutchinson M, Havrdova E, Raghupathi K, Yuan H, Novas M, Viglietta V, Dawson K. Safety and Tolerability of BG-12 in Patients with Relapsing-Remitting Multiple Sclerosis (RRMS): Analyses From the CONFIRM Study (S41.005). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s41.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Miller D, Fox R, Phillips JT, Kita M, Hutchinson M, Havrdova E, Zhang R, Viglietta V, Dawson K. Effects of BG-12 on Magnetic Resonance Imaging (MRI) Endpoints in Patients with Relapsing-Remitting Multiple Sclerosis (RRMS): Data From the Phase 3 CONFIRM Study (S11.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fox R, Miller D, Phillips JT, Kita M, Hutchinson M, Havrdova E, Yang M, Zhang R, Viglietta V, Dawson K. Clinical Efficacy of BG-12 in Relapsing-Remitting Multiple Sclerosis (RRMS): Data from the Phase 3 CONFIRM Study (S01.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cook S, Vermersch P, Comi G, Giovannoni G, Rammohan K, Rieckmann P, Sørensen PS, Hamlett A, Miret M, Weiner J, Viglietta V, Musch B, Greenberg SJ. Safety and tolerability of cladribine tablets in multiple sclerosis: the CLARITY (CLAdRIbine Tablets treating multiple sclerosis orallY) study. Mult Scler 2011; 17:578-93. [PMID: 21228029 DOI: 10.1177/1352458510391344] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cladribine is a synthetic deoxyadenosine analogue in development as an oral multiple sclerosis (MS) therapy. OBJECTIVE To report in detail the safety findings from the 96-week, phase III, double-blind CLARITY study, which evaluated treatment with cladribine tablets in relapsing-remitting MS. METHODS A total of 1,326 patients were randomized 1:1:1 to two short-course regimens of cladribine tablets (3.5 or 5.25 mg/kg cumulative dose over 96 weeks) or placebo. Safety assessments included monitoring for adverse events (AEs), routine physical and neurologic examinations and frequent laboratory parameter assessments. RESULTS Of the randomized patients, 88.6% completed treatment with cladribine tablets versus 86.3% with placebo. Lymphopenia was the most commonly reported AE in patients treated with cladribine tablets and was anticipated based on the mechanism of action. The incidence of infections was 48.3% with cladribine tablets and 42.5% with placebo, with 99.1% and 99.0% rated mild-to-moderate by investigators. Herpes zoster infections developed in 20 (2.3%) cladribine-treated patients; all cases were dermatomal. There were no herpes zoster infections in the placebo group. Nine (1.0%) patients experienced events related to uterine leiomyomas in the cladribine tablets groups versus one (0.2%) with placebo. Three isolated cases of malignancy were reported in cladribine-treated patients during the study; a fourth was reported during post-study surveillance. A pre-malignant cervical carcinoma in situ was also reported. The incidence of malignancies during the study did not exceed the expected rate in a population standardized for country, gender and age. CONCLUSION The safety and tolerability profile observed in the CLARITY study together with the reported efficacy support the potential for cladribine tablets as an MS therapy.
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Affiliation(s)
- S Cook
- University of Medicine and Dentistry, New Jersey Medical School, Newark, NJ 07101, USA.
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Comi G, Cook S, Giovannoni G, Rammohan K, Rieckmann P, Soelberg-Sørensen P, Vermersch P, Chang P, Hamlett A, Musch B, Fevr T, Viglietta V, Greenberg S. FP36-WE-03 MRI outcomes of short-course oral treatment with cladribine tablets for relapsing-remitting multiple sclerosis (RRMS) in the 96-week, phase III, double-blind, placebo-controlled CLARITY study. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70458-7] [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: 10/20/2022]
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Cook S, Vermersch P, Comi G, Giovannoni G, Rammohan K, Rieckmann P, Soelberg-Sørensen P, Chang P, Hamlett A, Musch B, Viglietta V, Greenberg S. PO10-TU-39 Safety and tolerability of short-course oral treatment with cladribine tablets for relapsing-remitting multiple sclerosis (RRMS) in the 96-week, phase III, double-blind, placebo-controlled CLARITY study. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70788-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kivisäkk P, Healy BC, Viglietta V, Quintana FJ, Hootstein MA, Weiner HL, Khoury SJ. Natalizumab treatment is associated with peripheral sequestration of proinflammatory T cells. Neurology 2009; 72:1922-30. [PMID: 19487650 DOI: 10.1212/wnl.0b013e3181a8266f] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Natalizumab is an antibody directed against integrin alpha4 that reduces disease activity in patients with multiple sclerosis (MS) by blocking migration of T and B cells into the CNS. The goal of this study was to characterize the effects of natalizumab treatment on cytokine production and expression of activation markers, costimulatory molecules, and trafficking determinants on CD4+ and CD8+ T cells. METHODS In a longitudinal study, we investigated the expression of surface makers and cytokine expression on peripheral blood lymphocytes from 28 patients with MS who started natalizumab treatment and were followed for 1 year. A mixed effects model was used to compare pretreatment to on-treatment measurements. RESULTS The frequency of CD4+ T cells producing interferon-gamma, tumor necrosis factor, and interleukin (IL)-17 upon anti-CD3 stimulation increased 6 months after initiation of natalizumab treatment and remained elevated throughout the follow-up. The frequency of CD4+ T cells expressing CD25, HLA-DR, and CCR6 ex vivo was increased at one or more time points during treatment. Among CD8+ T cells, the frequency of cells producing IL-2 and IL-17 after stimulation was increased during natalizumab treatment, as was the frequency of CD8+ T cells expressing CD58 and CCR5 ex vivo. The increase in the frequency of activated cells could not be replicated by in vitro exposure to natalizumab. CONCLUSION Natalizumab treatment increases the percentage of activated leukocytes producing proinflammatory cytokines in blood, presumably due to sequestration of activated cells in the peripheral circulation.
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Affiliation(s)
- P Kivisäkk
- Center for Neurological Diseases, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Viglietta V, Bourcier K, Buckle GJ, Healy B, Weiner HL, Hafler DA, Egorova S, Guttmann CRG, Rusche JR, Khoury SJ. CTLA4Ig treatment in patients with multiple sclerosis: an open-label, phase 1 clinical trial. Neurology 2008; 71:917-24. [PMID: 18794494 DOI: 10.1212/01.wnl.0000325915.00112.61] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The modulation of costimulatory pathways represents an original therapeutic approach to regulate T cell-mediated autoimmune diseases by preventing or reducing autoantigen-driven T-cell activation in humans. Autoreactive CD4(+) T cells play a critical role in initiating the immune response leading to the chronic inflammation and demyelination characteristic of multiple sclerosis (MS). METHODS We used IV infusions of CTLA4Ig to block the CD28/B7 T-cell costimulatory pathway in a phase 1 dose-escalation study in MS. Sixteen patients with relapsing-remitting MS received a single CTLA4Ig infusion and were monitored for up to 3 months after treatment. In an extension study, four additional subjects received four doses of CTLA4Ig. RESULTS CTLA4Ig was well tolerated in patients with MS, and most adverse events were rated as mild. Immunologic assessment of the patients showed a reduction in myelin basic protein (MBP) proliferation within 2 months of infusion and decreased interferon-gamma production by MBP-specific lines. CONCLUSIONS Inhibiting costimulatory molecule interactions by using CTLA4Ig seems safe in multiple sclerosis (MS), and the immunologic effects suggest that it may be a promising approach to regulate the inflammatory process associated with MS.
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Affiliation(s)
- V Viglietta
- Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Dotta F, Dionisi S, Viglietta V, Tiberti C, Matteoli MC, Cervoni M, Bizzarri C, Marietti G, Testi M, Multari G, Lucentini L, Di Mario U. T-cell mediated autoimmunity to the insulinoma-associated protein 2 islet tyrosine phosphatase in type 1 diabetes mellitus. Eur J Endocrinol 1999; 141:272-8. [PMID: 10474125 DOI: 10.1530/eje.0.1410272] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/08/2022]
Abstract
The target molecules of the T-cell response in type 1 diabetes, despite their pathogenic importance, remain largely uncharacterized, especially in humans. Interestingly, molecules such as insulin and glutamic acid decarboxylase (GAD) have been shown to be a target not only of autoantibodies, but also of autoreactive T-lymphocytes both in man and in the non-obese diabetic (NOD) mouse. In the present study we aimed to determine the existence of a specific T-cell response towards the insulinoma-associated protein 2 (IA-2) islet tyrosine phosphatase, a recently identified autoantigen which is the target of autoantibodies strongly associated with diabetes development. Human recombinant IA-2 produced in Escherichia coli, was tested for its reactivity with peripheral blood lymphocytes obtained from 16 newly diagnosed type 1 diabetic patients and from 25 normal controls, 15 of whom were HLA-DR-matched. A T-cell proliferation assay was performed in triplicate employing freshly isolated cells in the absence or in the presence of the antigen to be tested (at two different concentrations: 2 microg/ml and 10 microg/ml). A specific T-cell proliferation (defined as a stimulation index (S.I.) >/=3) was observed against IA-2 used at a concentration of 10 microg/ml (but not of 2 microg/ml) in 8/16 diabetic patients, in 1/15 HLA-DR-matched control subjects (P<0.01 by Fisher exact test) and in 0/10 of the remaining normal individuals. A statistically significant difference (P<0.003 by Mann-Whitney U test) was also observed in S.I. values between patients (3.1+/-1.4) and HLA-DR-matched controls (1.7+/-0.54) employing IA-2 at a concentration of 10 microg/ml. However, when IA-2 was used at a concentration of 2 microg/ml, the difference in S. I. between patients (1.65+/-0.8) and controls (1.0+/-0.3) did not reach statistical significance. In conclusion, these data show the presence of a specific, dose-dependent T-lymphocyte response against the IA-2 islet tyrosine phosphatase at the onset of type 1 diabetes. Consequently, this molecule appears to be a target not only at the B-lymphocyte but also at the T-lymphocyte level, reinforcing the potential pathogenic role of this autoantigen in the islet destructive process.
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Affiliation(s)
- F Dotta
- Department of Endocrinology, University 'La Sapienza', Rome, Italy
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Dionisi S, Dotta F, Diaz-Horta O, Carabba B, Viglietta V, Di Mario U. Target antigens in autoimmune diabetes: pancreatic gangliosides. Ann Ist Super Sanita 1998; 33:433-5. [PMID: 9542277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Type 1 diabetes mellitus is a disease caused by the autoimmune destruction of insulin-producing pancreatic beta-cells that takes place in genetically prodisposed individuals. Autoantibodies and autoreactive T lymphocytes reacting with islet target molecules or protein of glycolipid nature have been shown in the circulation of individuals and of animal models of type 1 diabetes (NOD mouse and BB rat) before and at the onset of the disease. As far as autoantigens of glycolipid nature is concerned, gangliosides such as GT3, GD3 and especially GM-1, have been shown to be target of autoantibodies associated to autoimmune diabetes. Of particular interest is the islet-specific monosialo-ganglioside GM2-1, which is target of an autoimmune response highly associated to future progression to diabetes development in first degree relatives of type 1 diabetic individuals. This molecule is recognized by IgG autoantibodies which have been detected before the appearance if clinical diabetes both in man and in the NOD mouse, representing a novel marker of beta-cell autoimmunity.
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Affiliation(s)
- S Dionisi
- II Clinica Medica-Endocrinologia, Università degli Studi La Sapienza, Rome, Italy
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