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Sørensen PS, Bramow S, Magyari M, Werdelin L, Koch-Henriksen N, Vermersch P, Sellebjerg F. Torben Fog - A Danish pioneer in a multi-faceted spectrum of multiple sclerosis research. Mult Scler 2024; 30:623-629. [PMID: 38523325 DOI: 10.1177/13524585241239506] [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] [Indexed: 03/26/2024]
Abstract
Torben Fog was committed to multiple sclerosis (MS) research for more than four decades, starting before the defence of his thesis in 1948 and lasting until his death in 1987. His research was multi-facetted, making him one of the great pioneers in the study of essential parts of the pathology, immunology and treatment of MS. He has contributed with meticulous studies of the MS plaques, documenting the perivenous distribution of plaques in the spinal cord. He constructed a scoring system for the disability in MS and used a computer programme to calculate a total neurological deficit. Together with his co-workers, Fog in 1972 was the first to report the association between MS and the human leukocyte antigen system. Fog can be considered as the father of immunomodulatory therapy in MS, treating MS patients with the first transfer factor, and as early as 1980, he was the first to treat MS with intramuscular natural interferon.
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Affiliation(s)
- Per Soelberg Sørensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark/Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Bramow
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Melinda Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark/The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark/Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Nils Koch-Henriksen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Patrick Vermersch
- Univ. Lille, Inserm U1172 LIlNCog, CHU Lille, FHU Precise, Lille, France
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark/Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Müller J, Roos I, Kalincik T, Lorscheider J, Galli E, Benkert P, Schädelin S, Sharmin S, Einsiedler M, Hänni P, Schmid J, Kuhle J, Derfuss T, Granziera C, Ziemssen T, Siepmann T, Yaldizli Ö. Escalating to medium- versus high-efficacy disease modifying therapy after low-efficacy treatment in relapsing remitting multiple sclerosis. Brain Behav 2024; 14:e3498. [PMID: 38688877 PMCID: PMC11061202 DOI: 10.1002/brb3.3498] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND In patients with relapsing remitting multiple sclerosis (RRMS) on low-efficacy disease modifying therapies (DMT), the optimal strategy on how to escalate treatment once needed, remains unknown. METHODS We studied RRMS patients on low-efficacy DMTs listed in the Swiss National Treatment Registry, who underwent escalation to either medium- or high-efficacy DMTs. Propensity score-based matching was applied using 12 clinically relevant variables. Both groups were also separately matched with control subjects who did not escalate therapy. Time to relapse and to disability worsening were evaluated using Cox proportional hazard models. RESULTS Of 1037 eligible patients, we 1:1 matched 450 MS patients who switched from low-efficacy to medium-efficacy (n = 225; 76.0% females, aged 42.4 ± 9.9 years [mean ± SD], median EDSS 3.0 [IQR 2-4]) or high-efficacy DMTs (n = 225; 72.4% females, aged 42.2 ± 10.6 years, median EDSS 3.0 [IQR 2-4]). Escalation to high-efficacy DMTs was associated with lower hazards of relapses than medium-efficacy DMTs (HR = 0.67, 95% CI 0.47-0.95, p = .027) or control subjects (HR = 0.61, 95% CI 0.44-0.84, p = .003). By contrast, escalation from low to medium-efficacy DMTs did not alter the hazard for relapses when compared to controls (i.e. patients on low-efficacy DMT who did not escalate DMT during follow-up) CONCLUSION: Our nationwide registry analysis suggests that, once escalation from a low-efficacy DMT is indicated, switching directly to a high-efficacy treatment is superior to a stepwise escalation starting with a moderate-efficacy treatment.
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Affiliation(s)
- Jannis Müller
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
- Division of Health Care SciencesDresden International UniversityDresdenGermany
- CORe, Department of MedicineUniversity of MelbourneMelbourneAustralia
| | - Izanne Roos
- CORe, Department of MedicineUniversity of MelbourneMelbourneAustralia
- Neuroimmunology CentreRoyal Melbourne HospitalMelbourneAustralia
| | - Tomas Kalincik
- CORe, Department of MedicineUniversity of MelbourneMelbourneAustralia
- Neuroimmunology CentreRoyal Melbourne HospitalMelbourneAustralia
| | - Johannes Lorscheider
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Edoardo Galli
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Pascal Benkert
- Department of Clinical ResearchClinical Trial UnitUniversity Hospital BaselBaselSwitzerland
| | - Sabine Schädelin
- Department of Clinical ResearchClinical Trial UnitUniversity Hospital BaselBaselSwitzerland
| | - Sifat Sharmin
- CORe, Department of MedicineUniversity of MelbourneMelbourneAustralia
- Neuroimmunology CentreRoyal Melbourne HospitalMelbourneAustralia
| | - Maximilian Einsiedler
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Peter Hänni
- Swiss Federation for Common Tasks of Health Insurances (SVK)SolothurnSwitzerland
| | - Jürg Schmid
- Swiss Federation for Common Tasks of Health Insurances (SVK)SolothurnSwitzerland
| | - Jens Kuhle
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Tobias Derfuss
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Cristina Granziera
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Tjalf Ziemssen
- Division of Health Care SciencesDresden International UniversityDresdenGermany
- Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Timo Siepmann
- Division of Health Care SciencesDresden International UniversityDresdenGermany
- Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Özgür Yaldizli
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
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Arkar U, Vipotnik Vesnaver T, Osredkar D, Perković Benedik M, Bizjak N. Multiple sclerosis in a 4-year-old boy: a case report and literature review. Front Neurol 2024; 15:1359938. [PMID: 38585366 PMCID: PMC10996918 DOI: 10.3389/fneur.2024.1359938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/12/2024] [Indexed: 04/09/2024] Open
Abstract
Pediatric onset multiple sclerosis (POMS) in the very young is a very rare entity and presents a difficult diagnostic challenge due to overlapping signs and symptoms with other diseases. We present a 4-year-old boy who initially presented with right-sided hemiparesis and demyelinating lesions on MRI. Follow-up MRI examinations 3 and 6 months later revealed new demyelinating lesions. Ten months after initial presentation, he presented with right-sided hemiparesis, central facial nerve palsy on the right side and new demyelinating lesions on MRI. Two clinical events and new MRI lesions on follow-up MRIs confirmed the diagnosis of POMS. He was treated with rituximab and experienced no further relapses or radiological progression during the follow-up period.
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Affiliation(s)
- Ula Arkar
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Damjan Osredkar
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
| | - Mirjana Perković Benedik
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Neli Bizjak
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Arena S, Chisari CG, Toscano S, Bucello S, Grimaldi LM, Ragonese P, Realmuto S, Cottone S, Maimone D, Finocchiaro C, Reitano P, Patti F. Real-World Effectiveness of Cladribine for Patients with Multiple Sclerosis: A Sicilian Multicentric Experience (Rewind Study). Curr Neuropharmacol 2024; 22:1271-1283. [PMID: 36946484 PMCID: PMC10964096 DOI: 10.2174/1570159x21666230322140711] [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: 07/17/2022] [Revised: 09/29/2022] [Accepted: 10/27/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Cladribine tablets are a highly effective option for the treatment of relapsingremitting multiple sclerosis (RRMS). OBJECTIVE The study aims to evaluate the effectiveness of cladribine in a real-world setting. METHODS This prospective real-world study consecutively screened all RRMS patients from seven different MS centers in Sicily (Italy) who completed the 2-year treatment course of cladribine tablets in the period between 11th March 2019 and 31st October 2021. Data about Expanded Disability Status Scale (EDSS), relapses, previous treatments, adverse events (AEs) and magnetic resonance imaging (MRI) were collected. Patients who were previously treated with other DMTs were further stratified into moderately active treatment (MAT) and highly active treatment (HAT) patients. RESULTS A total of 217 patients (70% women, with a mean age of 38.4 ± 11.3 years) were enrolled. Fifty patients (23.0%) were naïve to treatment and 167 (77%) switched from other disease modifying therapies. After the second year of treatment, about 80% were EDSS progression free, 88% remained relapse-free at T24, and 48% of patients were MRI activity-free. Kaplan Meier analyses showed significant differences between MT and HAT in terms of time to first clinical relapse (HR: 2.43, IC 1.02- 5.76; p = 0.04), time to the first new T1-gadolinium enhancing lesion (HR: 3.43, IC 1.35-8.70; p = 0.009) and time to MRI worsening (HR: 2.42, IC 1.15-5.09; p = 0.02). CONCLUSION This study confirmed that cladribine is an effective treatment for MS, particularly in naïve patients and those who have switched from MATs.
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Affiliation(s)
- Sebastiano Arena
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Clara Grazia Chisari
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Simona Toscano
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Sebastiano Bucello
- Multiple Sclerosis
Center- PO Muscatello di Augusta, ASP Siracusa, Siracusa, Italy
| | - Luigi Maria Grimaldi
- Institute Foundation “G. Giglio”, Multiple Sclerosis Centre, Cefalù-Palermo, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Sabrina Realmuto
- Multiple Sclerosis Centre, Neurology Unit and Stroke Unit, AOOR “Villa Sofia-Cervello”, United Hospitals, Palermo, Italy
| | - Salvatore Cottone
- Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione
“Civico Di Cristina e Benfratelli”, Palermo, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, ARNAS Garibaldi,
Catania, Italy
| | - Chiara Finocchiaro
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Paola Reitano
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
| | - Francesco Patti
- Department “GF Ingrassia” Section of Neurosciences, University of Catania, Catania, Italy
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Elkhooly M, Bao F, Bernitsas E. Impact of Disease Modifying Therapy on MS-Related Fatigue: A Narrative Review. Brain Sci 2023; 14:4. [PMID: 38275509 PMCID: PMC10813476 DOI: 10.3390/brainsci14010004] [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] [Received: 11/26/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system by causing inflammation, demyelination and neurodegeneration. Fatigue is the most prevalent and one of the most disabling symptoms among people with MS (pwMS). Due to its complexity and subjective character, fatigue is still little understood despite its frequent occurrence and severe impact. The potential causes, effects, and treatments of fatigue associated with MS have been extensively studied in recent years. Though the benefits of such a variety of contributions are obvious, there have not been many attempts to evaluate the effect of disease modifying therapies (DMTs) on MS-related fatigue. In this review, we summarize clinical trials and research studies, and we discuss the effect of different DMTs on MS-related fatigue.
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Affiliation(s)
- Mahmoud Elkhooly
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL 62702, USA;
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48201, USA
- Department of Neurology and Psychiatry, Minia University, Minia 61519, Egypt
| | - Fen Bao
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Evanthia Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Kania K, Ambrosius W, Kozubski W, Kalinowska-Łyszczarz A. The impact of disease modifying therapies on cognitive functions typically impaired in multiple sclerosis patients: a clinician's review. Front Neurol 2023; 14:1222574. [PMID: 37503514 PMCID: PMC10368887 DOI: 10.3389/fneur.2023.1222574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Objective Over the last few decades clinicians have become aware that cognitive impairment might be a major cause of disability, loss of employment and poor quality of life in patients suffering from multiple sclerosis [MS].The impact of disease modifying therapies [DMTs] on cognition is still a matter of debate. Theoretically, DMTs could exert a substantial beneficial effect by means of reducing neuroinflammation and brain atrophy, which are established correlates of cognitive dysfunction. The aim of the study was to review the evidence concerning the effect of DMTs on cognitive functions. Methods PubMed, Scopus, and the European Committee for Treatment and Research in Multiple Sclerosis [ECTRIMS] Library were searched for articles concerning the pediatric and adult populations of patients with multiple sclerosis, including clinical trials and RWD, where psychometric results were analyzed as secondary or exploratory endpoints. Results We reviewed a total of 44 studies that were found by our search strategy, analyzed the psychological tests that were applied, the length of the follow-up, and possible limitations. We pointed out the difficulties associated with assessing of DMTs' effects on cognitive functions, and pitfalls in cognitive tools used for evaluating of MS patients. Conclusion There is a need to highlight this aspect of MS therapies, and to collect adequate data to make informed therapeutic decisions, to improve our understanding of MS-related cognitive dysfunction and provide new therapeutic targets.
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Affiliation(s)
- Karolina Kania
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Ambrosius
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Alicja Kalinowska-Łyszczarz
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Poznań, Poland
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Balaji L, Farrar MA, D'Silva AM, Kariyawasam DS. Decision-making and challenges within the evolving treatment algorithm in spinal muscular atrophy: a clinical perspective. Expert Rev Neurother 2023; 23:571-586. [PMID: 37227306 DOI: 10.1080/14737175.2023.2218549] [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: 02/07/2023] [Accepted: 05/23/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The clinical application of disease modifying therapies has dramatically changed the paradigm of the management of people with spinal muscular atrophy (SMA), from sole reliance on symptomatic care directed toward the downstream consequences of muscle weakness, to proactive intervention and even preventative care. AREAS COVERED In this perspective, the authors evaluate the contemporary therapeutic landscape of SMA and discuss the evolution of novel phenotypes and the treatment algorithm, including the key factors that define individual treatment choice and treatment response. The benefits achieved by early diagnosis and treatment through newborn screening are highlighted, alongside an appraisal of emerging prognostic methods and classification frameworks to inform clinicians, patients, and families about disease course, manage expectations, and improve care planning. A future perspective of unmet needs and challenges is provided, emphasizing the key role of research. EXPERT OPINION SMN-augmenting therapies have improved health outcomes for people with SMA and powered the practice of personalized medicine. Within this new proactive diagnostic and treatment paradigm, new phenotypes and different disease trajectories are emerging. Ongoing collaborative research efforts to understand the biology of SMA and define optimal response are critical to refining future approaches.
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Affiliation(s)
- Lakshmi Balaji
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health UNSW, Sydney, Australia
| | - Michelle A Farrar
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health UNSW, Sydney, Australia
- UNSW Kensington Campus, Sydney, Australia
| | - Arlene M D'Silva
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health UNSW, Sydney, Australia
- UNSW Kensington Campus, Sydney, Australia
| | - Didu S Kariyawasam
- Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health UNSW, Sydney, Australia
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Maglione A, Francese R, Arduino I, Rosso R, Matta M, Rolla S, Lembo D, Clerico M. Long-lasting neutralizing antibodies and T cell response after the third dose of mRNA anti-SARS-CoV-2 vaccine in multiple sclerosis. Front Immunol 2023; 14:1205879. [PMID: 37409134 PMCID: PMC10318111 DOI: 10.3389/fimmu.2023.1205879] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Background and objectives Long lasting immune response to anti-SARS-CoV-2 vaccination in people with Multiple Sclerosis (pwMS) is still largely unexplored. Our study aimed at evaluating the persistence of the elicited amount of neutralizing antibodies (Ab), their activity and T cell response after three doses of anti-SARS-CoV-2 vaccine in pwMS. Methods We performed a prospective observational study in pwMS undergoing SARS-CoV-2 mRNA vaccinations. Anti-Region Binding Domain (anti-RBD) of the spike (S) protein immunoglobulin G (IgG) titers were measured by ELISA. The neutralization efficacy of collected sera was measured by SARS-CoV-2 pseudovirion-based neutralization assay. The frequency of Spike-specific IFNγ-producing CD4+ and CD8+ T cells was measured by stimulating Peripheral Blood Mononuclear Cells (PBMCs) with a pool of peptides covering the complete protein coding sequence of the SARS-CoV-2 S. Results Blood samples from 70 pwMS (11 untreated pwMS, 11 under dimethyl fumarate, 9 under interferon-γ, 6 under alemtuzumab, 8 under cladribine, 12 under fingolimod and 13 under ocrelizumab) and 24 healthy donors were collected before and up to six months after three vaccine doses. Overall, anti-SARS-CoV-2 mRNA vaccine elicited comparable levels of anti-RBD IgGs, neutralizing activity and anti-S T cell response both in untreated, treated pwMS and HD that last six months after vaccination. An exception was represented by ocrelizumab-treated pwMS that showed reduced levels of IgGs (p<0.0001) and a neutralizing activity under the limit of detection (p<0.001) compared to untreated pwMS. Considering the occurrence of a SARS-CoV-2 infection after vaccination, the Ab neutralizing efficacy (p=0.04), as well as CD4+ (p=0.016) and CD8+ (p=0.04) S-specific T cells, increased in treated COVID+ pwMS compared to uninfected treated pwMS at 6 months after vaccination. Discussion Our follow-up provides a detailed evaluation of Ab, especially in terms of neutralizing activity, and T cell responses after anti-SARS-CoV-2 vaccination in MS context, over time, considering a wide number of therapies, and eventually breakthrough infection. Altogether, our observations highlight the vaccine response data to current protocols in pwMS and underline the necessity to carefully follow-up anti-CD20- treated patients for higher risk of breakthrough infections. Our study may provide useful information to refine future vaccination strategies in pwMS.
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Affiliation(s)
- Alessandro Maglione
- Laboratory of Neuroimmunology, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Rachele Francese
- Laboratory of Molecular Virology and Antiviral Research, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Irene Arduino
- Laboratory of Molecular Virology and Antiviral Research, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Rachele Rosso
- Laboratory of Neuroimmunology, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Manuela Matta
- San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Simona Rolla
- Laboratory of Neuroimmunology, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - David Lembo
- Laboratory of Molecular Virology and Antiviral Research, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Marinella Clerico
- Laboratory of Neuroimmunology, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
- San Luigi Gonzaga University Hospital, Orbassano, Italy
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Coutinho Costa VG, Araújo SES, Alves-Leon SV, Gomes FCA. Central nervous system demyelinating diseases: glial cells at the hub of pathology. Front Immunol 2023; 14:1135540. [PMID: 37261349 PMCID: PMC10227605 DOI: 10.3389/fimmu.2023.1135540] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023] Open
Abstract
Inflammatory demyelinating diseases (IDDs) are among the main causes of inflammatory and neurodegenerative injury of the central nervous system (CNS) in young adult patients. Of these, multiple sclerosis (MS) is the most frequent and studied, as it affects about a million people in the USA alone. The understanding of the mechanisms underlying their pathology has been advancing, although there are still no highly effective disease-modifying treatments for the progressive symptoms and disability in the late stages of disease. Among these mechanisms, the action of glial cells upon lesion and regeneration has become a prominent research topic, helped not only by the discovery of glia as targets of autoantibodies, but also by their role on CNS homeostasis and neuroinflammation. In the present article, we discuss the participation of glial cells in IDDs, as well as their association with demyelination and synaptic dysfunction throughout the course of the disease and in experimental models, with a focus on MS phenotypes. Further, we discuss the involvement of microglia and astrocytes in lesion formation and organization, remyelination, synaptic induction and pruning through different signaling pathways. We argue that evidence of the several glia-mediated mechanisms in the course of CNS demyelinating diseases supports glial cells as viable targets for therapy development.
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Affiliation(s)
| | - Sheila Espírito-Santo Araújo
- Laboratório de Biologia Celular e Tecidual, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Campos dos Goytacazes, Brazil
| | - Soniza Vieira Alves-Leon
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto Biomédico, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Conway S, Saxena S, Baecher-Allan C, Krishnan R, Houtchens M, Glanz B, Saraceno TJ, Polgar-Turcsanyi M, Bose G, Bakshi R, Bhattacharyya S, Galetta K, Kaplan T, Severson C, Singhal T, Stazzone L, Zurawski J, Paul A, Weiner HL, Healy BC, Chitnis T. Preserved T cell but attenuated antibody response in MS patients on fingolimod and ocrelizumab following 2nd and 3rd SARS-CoV-2 mRNA vaccine. Mult Scler J Exp Transl Clin 2023; 9:20552173231165196. [PMID: 37057191 PMCID: PMC10086198 DOI: 10.1177/20552173231165196] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/06/2023] [Indexed: 04/15/2023] Open
Abstract
Background There is limited knowledge about T cell responses in patients with multiple sclerosis (MS) after 3 doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine. Objectives Assess the SARS-CoV-2 spike antibody and T cell responses in MS patients and healthy controls (HCs) after 2 doses (2-vax) and 3 doses (3-vax) of SARS-CoV-2 mRNA vaccination. Methods We studied seroconversion rates and T cell responses by flow cytometry in HC and MS patients on fingolimod or ocrelizumab. Results After 2-vax, 8/33 (24.2%) patients in ocrelizumab group, 5/7 (71.4%) in fingolimod group, and 29/29 (100%) in HC group (P = 5.7 × 10-11) seroconverted. After 3-vax, 9/22 (40.9%) patients in ocrelizumab group, 19/21 (90.5%) in fingolimod group, and 7/7 (100%) in HC group seroconverted (P = 0.0003). The percentage of SARS-CoV-2 peptide reactive total CD4+ T cells increased in HC and ocrelizumab group but not in fingolimod group after 2-vax and 3-vax (P < 0.0001). The percentage of IFNγ and TNFα producing total CD4+ and CD8+ T cells increased in fingolimod group as compared to HC and ocrelizumab group after 2-vax and 3-vax (P < 0.0001). Conclusions MS patients on ocrelizumab and fingolimod had attenuated humoral responses, but preserved cytokine producing T cell responses compared to HCs after SARS-CoV-2 mRNA vaccination. Clinical Trials Registration NCT05060354.
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Affiliation(s)
- Sarah Conway
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shrishti Saxena
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Clare Baecher-Allan
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rajesh Krishnan
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Maria Houtchens
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Bonnie Glanz
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Taylor J Saraceno
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Mariann Polgar-Turcsanyi
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Gauruv Bose
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shamik Bhattacharyya
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristin Galetta
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tamara Kaplan
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher Severson
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tarun Singhal
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lynn Stazzone
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Jonathan Zurawski
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anu Paul
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Howard L Weiner
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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11
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Sipilä JOT. Treatment Courses of Patients Newly Diagnosed with Multiple Sclerosis in 2012-2018. J Clin Med 2023; 12:595. [PMID: 36675522 DOI: 10.3390/jcm12020595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Treatment options for multiple sclerosis (MS) are now numerous, but it is unclear which Disease-Modifying Treatment (DMT) is the optimal choice for a given patient. Treatment switches are common, both because of side effects and because of lack of efficacy. There are few data available on the treatment courses of patients newly diagnosed with MS in the current DMT era. All patients newly diagnosed with MS in 2012-2018 at North Karelia Central Hospital were identified (N = 55), and those with complete follow-up data available (N = 43) were included. The minimum follow-up from diagnosis was 44 months with a maximum of 9 years. Seven patients (16%) had no DMT at any time during the follow-up. Treatment was most often initiated with interferon or glatiramer acetate (69%), but 72% of these treatments were discontinued. After cladribine, teriflunomide and fingolimod showed the best treatment persistence. Patients who experienced their first MS symptoms at ≥40 years of age all continued with their initial treatment category until the end of the follow-up. In a third of the patients who had received a DMT, at the end of the follow-up, the treatment had been escalated to fingolimod, cladribine or natalizumab. Only 13 patients (28%) continued with their initial DMT until the end of the follow-up.
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12
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Greene N, Higuchi K, Bognar K, Chang E, Broder MS. Medication Adherence and Healthcare Utilization in Relapsing-Remitting Multiple Sclerosis Patients Using Teriflunomide. Clinicoecon Outcomes Res 2022; 14:755-761. [PMID: 36578311 PMCID: PMC9791931 DOI: 10.2147/ceor.s383934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Multiple sclerosis (MS) is a costly, immune-mediated disease of the central nervous system. Most patients have relapsing-remitting MS (RRMS) for which disease-modifying therapies (DMTs) provide an effective treatment option by reducing relapse rates. However, adherence to DMTs is suboptimal. This study examines the association between adherence to teriflunomide and clinical and healthcare utilization outcomes. Patients and Methods Patients with RRMS who started treatment with teriflunomide between 1/1/2018 and 12/31/2019 were analyzed using IQVIA PharMetrics® Plus data. RRMS patients were identified via diagnosis codes and treatment types; the first prescription date for teriflunomide was the index date. Highly and poorly adherent patients were identified based on the proportion of days covered (PDC) post-index (PDC ≥0.8 and PDC ≤0.5, respectively). Patient demographics, clinical characteristics, healthcare utilization during the year pre- and post-index, and relapse rate post-index were reported descriptively. Outcomes were compared between highly and poorly adherent patients through logistic regression. Models were adjusted for demographics, comorbidities, and utilization measures during the baseline period. Results Among the 922 RRMS patients identified, 534 (57.9%) were highly adherent to teriflunomide, while 249 (27.0%) had PDC ≤0.5. The two groups were not statistically different in terms of demographic characteristics and comorbidities; however, poorly adherent patients were more likely to have emergency department (ED) or inpatient visits during baseline (36.9% versus 26.8%, P=0.004; 17.3% versus 10.9%, P=0.013, respectively). Unadjusted results suggested lower likelihood of both relapses and utilization during follow-up among highly adherent patients compared to poorly adherent patients. Adjusted results confirmed that high adherence was associated with decreased likelihood of post-index relapses, ED utilization, and inpatient utilization (OR [95% CI]: 0.55 [0.39-0.76], 0.49 [0.34-0.71], and 0.51 [0.27-0.97], respectively) even after controlling for baseline utilization. Conclusion High adherence to teriflunomide was found to be associated with fewer relapses and lower healthcare utilization among patients with RRMS.
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Affiliation(s)
- Nupur Greene
- Neurology & Immunology (N&I), Sanofi, Cambridge, MA, USA,Correspondence: Nupur Greene, Global HEVA Business Partner, N&I, Sanofi, 450 Water Street, Cambridge, MA, USA, Tel +1 857 259 0037, Email
| | - Keiko Higuchi
- Neurology & Immunology (N&I), Sanofi, Cambridge, MA, USA
| | - Katalin Bognar
- Real World Evidence, PHAR (Partnership for Health Analytic Research), Beverly Hills, CA, USA
| | - Eunice Chang
- Real World Evidence, PHAR (Partnership for Health Analytic Research), Beverly Hills, CA, USA
| | - Michael S Broder
- Real World Evidence, PHAR (Partnership for Health Analytic Research), Beverly Hills, CA, USA
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13
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Barbieri MA, Sorbara EE, Battaglia A, Cicala G, Rizzo V, Spina E, Cutroneo PM. Adverse Drug Reactions with Drugs Used in Multiple Sclerosis: An Analysis from the Italian Pharmacovigilance Database. Front Pharmacol 2022; 13:808370. [PMID: 35281926 PMCID: PMC8904918 DOI: 10.3389/fphar.2022.808370] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 11/03/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022] Open
Abstract
Given the importance of inflammation at the onset of multiple sclerosis (MS), therapy is mainly based on the use of anti-inflammatory drugs including disease modifying therapies (DMTs). Considering the recent approval of some DMTs, pharmacovigilance becomes a fundamental tool for the acquisition of new safety data. The aim of the study was to analyze adverse drug reactions (ADRs) related to the use of drugs approved for MS. All national publicly-available aggregated ADR reports recorded from 2002 to 2020 into the Reports of Adverse Reactions of Medicines (RAM) system and all complete Sicilian data reported into the Italian spontaneous reporting system (SRS) database having as suspected drugs interferon β-1a (IFN β-1a), interferon β-1b (IFN β-1b), peginterferon β-1a (PEG-IFN β-1a), glatiramer acetate (GA), natalizumab (NTZ), fingolimod (FNG), teriflunomide (TRF), dimethyl fumarate (DMF), alemtuzumab (Alem), ocrelizumab (OCZ), or cladribine (Cladr), were collected. Descriptive analyses of national, publicly-available aggregated data and full-access regional data were performed to assess demographic characteristics and drug-related variables followed by a more in-depth analysis of all Sicilian ADRs with a case-by-case assessment and a disproportionality analysis of unexpected ADRs. A total of 13,880 national reports have been collected from 2002 to 2020: they were mainly not serious ADRs (67.9% vs. 26.1%) and related to females (71.7% vs. 26.3%) in the age group 18–65 years (76.5%). The most reported ADRs were general and administration site conditions (n = 6,565; 47.3%), followed by nervous (n = 3,090; 22.3%), skin (n = 2,763; 19.9%) and blood disorders (n = 2,180; 15.7%). Some unexpected Sicilian ADRs were shown, including dyslipidemia for FNG (n = 10; ROR 28.5, CI 14.3–59.6), NTZ (n = 5; 10.3, 4.1–25.8), and IFN β-1a (n = 4; 8.7, 3.1–24.1), abortion and alopecia for NTZ (n = 9; 208.1, 73.4–590.1; n = 3; 4.9, 1.5–15.7), and vitamin D deficiency for GA (n = 3; 121.2, 30.9–475.3). Moreover, breast cancer with DMF (n = 4, 62.8, 20.5–191.9) and hypothyroidism with Cladr (n = 3; 89.2, 25.9–307.5) were also unexpected. The reporting of drugs-related ADRs in MS were mostly reported in the literature, but some unknown ADRs were also found. However, further studies are necessary to increase the awareness about the safety profiles of new drugs on the market.
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Affiliation(s)
| | | | - Alessandro Battaglia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenzo Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Centre, University Hospital of Messina, Messina, Italy
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14
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Trümpelmann S, Schulte-Mecklenbeck A, Steinberg OV, Wirth T, Fobker M, Lohmann L, Lünemann JD, Wiendl H, Gross CC, Klotz L. Impact of disease-modifying therapies on humoral and cellular immune-responses following SARS-CoV-2 vaccination in MS patients. Clin Transl Sci 2022; 15:1606-1612. [PMID: 35213793 PMCID: PMC9111759 DOI: 10.1111/cts.13256] [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: 01/20/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022] Open
Abstract
The impact of distinct disease‐modifying therapies (DMTs) on severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccination efficacy in patients with multiple sclerosis (MS) is still enigmatic. In this prospective comparative study, we investigated humoral and cellular immune‐responses in patients with MS receiving interferon beta, natalizumab, and ocrelizumab pre‐vaccination and 6 weeks post second SARS‐CoV‐2 vaccination. Healthy individuals and interferon beta‐treated patients generated robust humoral and cellular immune‐responses. Although humoral immune responses were diminished in ocrelizumab‐treated patients, cellular immune‐responses were reduced in natalizumab‐treated patients. Thus, both humoral and cellular immune responses should be closely monitored in patients on DMTs. Whereas patients with a poor cellular immune‐response may benefit from additional vaccination cycles, patients with a diminished humoral immune‐response may benefit from a treatment with SARS‐CoV‐2 antibodies in case of an infection.
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Affiliation(s)
- Susan Trümpelmann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Andreas Schulte-Mecklenbeck
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Olga V Steinberg
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Timo Wirth
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Manfred Fobker
- Central Laboratories, University Hospital Münster, Münster, Germany
| | - Lisa Lohmann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Jan D Lünemann
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Catharina C Gross
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
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15
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Czarnowska A, Kapica-Topczewska K, Zajkowska O, Adamczyk-Sowa M, Kubicka-Bączyk K, Niedziela N, Warmus P, Kalinowska-Łyszczarz A, Kania K, Słowik A, Wnuk M, Marona M, Nowak K, Bartosik-Psujek H, Lech B, Perenc A, Popiel M, Kucharska-Lipowska M, Chorąży M, Tarasiuk J, Mirończuk A, Kochanowicz J, Lasek-Bal A, Puz P, Maciejowska K, Wawrzyniak S, Niezgodzińska-Maciejek A, Pokryszko-Dragan A, Gruszka E, Budrewicz S, Białek M, Zwiernik J, Michałowska A, Nosek K, Zwiernik B, Lewańczyk B, Brola W, Kułakowska A. Symptoms after COVID-19 Infection in Individuals with Multiple Sclerosis in Poland. J Clin Med 2021; 10:jcm10225225. [PMID: 34830507 PMCID: PMC8618380 DOI: 10.3390/jcm10225225] [Citation(s) in RCA: 4] [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: 09/15/2021] [Revised: 10/14/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Background: To report and analyze the presence of residual symptoms after SARS-CoV-2 infection among Polish patients with multiple sclerosis (MS) treated with different disease-modifying therapies (DMTs). (2) Methods: The study included 426 individuals with MS treated with DMTs and confirmed SARS-CoV-2 infection from 12 Polish MS centers. The data were collected through to 31 May 2021. The information included demographics, specific MS characteristics, course of SARS-CoV-2 infection, and residual (general and neurological) symptoms lasting more than four and 12 weeks after the initial infection. The results were obtained using maximum likelihood estimates for odds ratio and logistic regression. (3) Results: A total of 44.84% patients with MS reported symptoms lasting between four and 12 weeks after the initial infection; 24.41% people had symptoms that resolved up to 12 weeks, and 20.42% patients had symptoms that lasted over 12 weeks. The most common symptoms were: fatigue, disturbance of concentration, attention, and memory, cognitive complaints, and headache. None of the DMTs were predisposed to the development of residual symptoms after the initial infection. A total of 11.97% of patients had relapse three months prior or after SARS-CoV-2 infection. (4) Conclusion: Almost half of individuals with MS treated with different DMTs had residual symptoms after SARS-CoV-2 infection. None of the DMTs raised the probability of developing post-acute COVID symptoms.
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Affiliation(s)
- Agata Czarnowska
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
- Correspondence: ; Tel.: +48-85-746-83-26; Fax: +48-85-746-86-08
| | - Katarzyna Kapica-Topczewska
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
| | - Olga Zajkowska
- Faculty of Economic Sciences, University of Warsaw, 00-241 Warszawa, Poland;
| | - Monika Adamczyk-Sowa
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.A.-S.); (K.K.-B.); (N.N.); (P.W.)
| | - Katarzyna Kubicka-Bączyk
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.A.-S.); (K.K.-B.); (N.N.); (P.W.)
| | - Natalia Niedziela
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.A.-S.); (K.K.-B.); (N.N.); (P.W.)
| | - Paweł Warmus
- Department of Neurology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.A.-S.); (K.K.-B.); (N.N.); (P.W.)
| | - Alicja Kalinowska-Łyszczarz
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (A.K.-Ł.); (K.K.)
| | - Karolina Kania
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 61-701 Poznań, Poland; (A.K.-Ł.); (K.K.)
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, University Hospital, 30-688 Krakow, Poland; (A.S.); (M.W.); (M.M.); (K.N.)
| | - Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, University Hospital, 30-688 Krakow, Poland; (A.S.); (M.W.); (M.M.); (K.N.)
| | - Monika Marona
- Department of Neurology, Jagiellonian University Medical College, University Hospital, 30-688 Krakow, Poland; (A.S.); (M.W.); (M.M.); (K.N.)
| | - Klaudia Nowak
- Department of Neurology, Jagiellonian University Medical College, University Hospital, 30-688 Krakow, Poland; (A.S.); (M.W.); (M.M.); (K.N.)
| | - Halina Bartosik-Psujek
- Department of Neurology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszów, Poland;
| | - Beata Lech
- Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, 35-301 Rzeszów, Poland; (B.L.); (A.P.); (M.P.)
| | - Adam Perenc
- Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, 35-301 Rzeszów, Poland; (B.L.); (A.P.); (M.P.)
| | - Małgorzata Popiel
- Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, 35-301 Rzeszów, Poland; (B.L.); (A.P.); (M.P.)
| | | | - Monika Chorąży
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
| | - Joanna Tarasiuk
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
| | - Anna Mirończuk
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (A.L.-B.); (P.P.); (K.M.)
| | - Przemysław Puz
- Department of Neurology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (A.L.-B.); (P.P.); (K.M.)
| | - Katarzyna Maciejowska
- Department of Neurology, School of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (A.L.-B.); (P.P.); (K.M.)
| | - Sławomir Wawrzyniak
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Independent Public Healthcare Centre, 85-681 Bydgoszcz, Poland; (S.W.); (A.N.-M.)
| | - Anna Niezgodzińska-Maciejek
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Independent Public Healthcare Centre, 85-681 Bydgoszcz, Poland; (S.W.); (A.N.-M.)
| | - Anna Pokryszko-Dragan
- Department of Neurology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.P.-D.); (E.G.); (S.B.)
| | - Ewa Gruszka
- Department of Neurology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.P.-D.); (E.G.); (S.B.)
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.P.-D.); (E.G.); (S.B.)
| | - Marta Białek
- Department of Neurology, Regional Specialised Hospital No. 4 in Bytom, 41-902 Bytom, Poland;
| | - Jacek Zwiernik
- Neurology Ward, Provincial Specialist Hospital, 10-561 Olsztyn, Poland; (J.Z.); (A.M.)
- Department of Neurology, University of Warmia and Mazury, 10-719 Olsztyn, Poland;
| | - Anna Michałowska
- Neurology Ward, Provincial Specialist Hospital, 10-561 Olsztyn, Poland; (J.Z.); (A.M.)
| | - Krzysztof Nosek
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Warmia and Mazury, 10-719 Olsztyn, Poland;
| | - Beata Zwiernik
- Department of Neurology, University of Warmia and Mazury, 10-719 Olsztyn, Poland;
- Clinic of Neurology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Bożena Lewańczyk
- Neurology Ward, Provincial Integrated Hospital, 82-300 Elbląg, Poland;
| | - Waldemar Brola
- Department of Neurology, Specialist Hospital in Końskie, Collegium Medicum, Jan Kochanowski University Kielce, 26-200 Końskie, Poland;
| | - Alina Kułakowska
- Department of Neurology, Medical University of Białystok, M. Skłodowskiej-Curie 24A, 15-276 Białystok, Poland; (K.K.-T.); (M.C.); (J.T.); (A.M.); (J.K.); (A.K.)
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16
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Oh J, Walker B, Giovannoni G, Jack D, Dangond F, Nolting A, Aldridge J, Lebson LA, Leist TP. Treatment-emergent adverse events occurring early in the treatment course of cladribine tablets in two phase 3 trials in multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:20552173211024298. [PMID: 34345436 PMCID: PMC8283088 DOI: 10.1177/20552173211024298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/15/2021] [Indexed: 11/15/2022] Open
Abstract
Background Treatment-emergent adverse events (TEAEs) that occur close to treatment initiation may negatively affect overall tolerability and adherence. It is important to develop a clear understanding of potential early TEAEs after initiating treatment with cladribine tablets. Objective To identify TEAEs that begin early in the course of treatment in patients enrolled in CLARITY and ORACLE-MS studies. Methods This post hoc analysis of CLARITY and ORACLE-MS safety populations assessed the incidence of TEAEs, serious TEAEs, drug-related TEAEs, and TEAEs leading to discontinuation in patients receiving cladribine tablets or placebo within 2, 6, and 12 weeks after treatment initiation. Results By Week 12, 61.3% of patients treated with cladribine tablets 3.5 mg/kg and 55.2% treated with placebo experienced a TEAE. More patients receiving cladribine tablets versus placebo experienced a drug-related TEAE by Week 12 (34.7% vs. 23.2%). The most common TEAEs reported with cladribine tablets were: headache (7.2%), lymphopenia (6.8%), and nausea (6.0%). Patients receiving cladribine tablets and placebo reported similar proportions of serious TEAEs (2.2% vs. 1.7%) and TEAEs leading to treatment discontinuation (1.6% vs. 1.4%). Conclusion Cladribine tablets were well tolerated during the first 12 weeks as evidenced by a low incidence of TEAEs leading to treatment discontinuation.
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Affiliation(s)
- Jiwon Oh
- Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Bryan Walker
- Duke University School of Medicine, Durham, NC, USA
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Dominic Jack
- the healthcare business of Merck KGaA, Darmstadt, Germany
| | | | - Axel Nolting
- the healthcare business of Merck KGaA, Darmstadt, Germany
| | | | | | - Thomas P Leist
- Comprehensive Multiple Sclerosis Center, Jefferson University, Philadelphia, PA, USA
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17
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Sadovnick D, Criscuoli M, Yee I, Carruthers R, Schabas A, Smyth P. The road to conception for women with multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:20552173211032313. [PMID: 34350028 PMCID: PMC8287372 DOI: 10.1177/20552173211032313] [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] [Received: 02/25/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of this prospective “real world” study is to gain insight into
the different “roads to conception” that women with MS take as part of the
prospective Canadian Multiple Sclerosis Pregnancy Study (CANPREG-MS). Methods Participants are women with MS who are planning a pregnancy. Data cut-off for
analyses was April 30, 2020. Results We believe this is the first prospective National study of women with MS
planning pregnancies. The data are for the first 44 women enrolled of whom 26 achieved pregnancy by
cut-off date. Seven women used assisted reproductive technologies (ARTs); 6
stopped disease modifying therapy (DMT) against their neurologists’
recommendations; 6 had an interruption(s) in trying to conceive due to MS
relapses, MRI-detected inflammation, or limited “windows of opportunity”
between DMT courses. Conclusion The study illustrates the roads that women take to conception, even if they
are on the same therapy and have similar clinical expression of MS. Advice
given by treating neurologists on washout periods show discrepancies. This
paper highlights the real problem that there is no definitive, international
consensus on managing these women due to the lack of “real world” data and
thus the goal of CANPREG-MS is to provide such real world data.
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Affiliation(s)
- Dessa Sadovnick
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Maria Criscuoli
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Irene Yee
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Robert Carruthers
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
| | - Alice Schabas
- Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Penelope Smyth
- Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada
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18
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Simonsen CS, Flemmen HØ, Broch L, Brunborg C, Berg-Hansen P, Moen SM, Celius EG. Early High Efficacy Treatment in Multiple Sclerosis Is the Best Predictor of Future Disease Activity Over 1 and 2 Years in a Norwegian Population-Based Registry. Front Neurol 2021; 12:693017. [PMID: 34220694 PMCID: PMC8248666 DOI: 10.3389/fneur.2021.693017] [Citation(s) in RCA: 43] [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] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Moderate and high efficacy disease modifying therapies (DMTs) have a profound effect on disease activity. The current treatment guidelines only recommend high efficacy DMTs for patients with highly active MS. The objective was to examine the impact of initial treatment choice in achieving no evidence of disease activity (NEDA) at year 1 and 2. Methods: Using a real-world population-based registry with limited selection bias from the southeast of Norway, we determined how many patients achieved NEDA on moderate and high efficacy DMTs. Results: 68.0% of patients who started a high efficacy DMT as the first drug achieved NEDA at year 1 and 52.4% at year 2 as compared to 36.0 and 19.4% of patients who started a moderate efficacy DMT as a first drug. The odds ratio (OR) of achieving NEDA on high efficacy drugs compared to moderate efficacy drugs as a first drug at year 1 was 3.9 (95% CI 2.4–6.1, p < 0.001). The OR for high efficacy DMT as the second drug was 2.5 (95% CI 1.7–3.9, p < 0.001), and was not significant for the third drug. Patients with a medium or high risk of disease activity were significantly more likely to achieve NEDA on a high efficacy therapy as a first drug compared to moderate efficacy therapy as a first drug. Conclusions: Achieving NEDA at year 1 and 2 is significantly more likely in patients on high-efficacy disease modifying therapies than on moderate efficacy therapies, and the first choice of treatment is the most important. The immunomodulatory treatment guidelines should be updated to ensure early, high efficacy therapy for the majority of patients diagnosed with MS.
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Affiliation(s)
- Cecilia Smith Simonsen
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Heidi Øyen Flemmen
- Department of Neurology, Telemark Hospital Trust, Skien, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Line Broch
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Pål Berg-Hansen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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19
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Piquet AL, Corboy JR, Vollmer TL. Correspondence to: Humoral immune response to COVID-19 mRNA vaccine in patients with multiple sclerosis treated with high-efficacy disease-modifying therapies. Ther Adv Neurol Disord 2021; 14:17562864211019567. [PMID: 34104219 PMCID: PMC8170321 DOI: 10.1177/17562864211019567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Amanda L Piquet
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17th Ave., Mail Stop B185, Aurora, CO 80045, USA
| | - John R Corboy
- Department of Neurology, University of Colorado, Aurora, CO, USA
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20
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Zhang Y, Yin H, Xu Y, Xu T, Peng B, Cui L, Zhang S. The Epidemiology of COVID-19 and MS-Related Characteristics in a National Sample of People With MS in China. Front Neurol 2021; 12:682729. [PMID: 34122322 PMCID: PMC8193356 DOI: 10.3389/fneur.2021.682729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/23/2021] [Indexed: 01/21/2023] Open
Abstract
Few studies have focused on immune status and disease activity in MS patients during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study is to investigate immune status, COVID-19 infection, and attacks in MS patients during the pandemic. An online questionnaire about COVID-19 infection, MS attack, and MS treatment during the pandemic was administered to all 525 MS patients registered in our hospital database from January 1, 2011, to June 1, 2020. Only 384 responded, of which 361 patients could be included in the final analysis. During the pandemic, 42.1% of the 361 patients and 65.0% of the 234 patients on immunotherapies were exposed to teriflunomide. Compared to patients who didn't receive treatment, patients exposed to DMTs had significantly lower levels of neutrophils (P < 0.01) and immunoglobulin G (P < 0.01), and patients exposed to immunosuppressants had significantly lower levels of immunoglobulin G (P < 0.05). Over 80% of our patients followed effective protective measures and none of the 361 MS patients in our cohort contracted COVID-19. Patients whose treatment was disrupted had a significantly higher annualized relapse rate (ARR) during than before the pandemic (P < 0.01), while the ARR of patients with continuous treatment or without treatment remained unchanged. During the pandemic, the risk of MS attack due to treatment disruption possibly outweighs the risk of COVID-19 infection under preventive measures, and MS treatment maintenance might be necessary.
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Affiliation(s)
- Yao Zhang
- Center of Multiple Sclerosis and Related Disorders, Beijing, China.,Department of Neurology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hexiang Yin
- Center of Multiple Sclerosis and Related Disorders, Beijing, China.,Department of Neurology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Xu
- Center of Multiple Sclerosis and Related Disorders, Beijing, China.,Department of Neurology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, School of Basic Medicine, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Neurosciences Center, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,National Rare Diseases Registry System of China, Beijing, China
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21
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Torgauten HM, Myhr KM, Wergeland S, Bø L, Aarseth JH, Torkildsen Ø. Safety and efficacy of rituximab as first- and second line treatment in multiple sclerosis - A cohort study. Mult Scler J Exp Transl Clin 2021; 7:2055217320973049. [PMID: 33796328 PMCID: PMC7970692 DOI: 10.1177/2055217320973049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/11/2020] [Accepted: 10/17/2020] [Indexed: 12/04/2022] Open
Abstract
Background Rituximab is increasingly used as off-label therapy in multiple sclerosis (MS). More data are needed on safety and efficacy of rituximab, particularly in cohorts of de novo patients and patients in early therapy escalation. Objective To investigate the safety and efficacy of off-label treatment with rituximab in an MS-cohort of predominantly de novo patients or as therapy escalation. Methods We retrieved safety and efficacy data from the Norwegian MS-registry and biobank for all MS-patients treated with rituximab at Haukeland University Hospital, Bergen, Norway, during a four year period. Results In the 365 MS-patients (320 relapsing-remitting MS (RRMS), 23 secondary progressive MS (SPMS), and 22 primary progressive MS (PPMS)), the overall annualized relapse rate (ARR) was 0.03 and annualized drug discontinuation rate (ADDR) was 0.05. NEDA-3 was achived in 79% of patients with available data (n=351). Sixty-one patients experienced infusion-related adverse events of which two were serious (CTCAE grade 3–4). Eighteen patients experienced serious non-infusion related adverse events, of which 16 were infections. Infections (n = 34; 9.3%, CTCAE grade 2-5), hypogammaglobulinemia (n = 19, 5.2%) and neutropenia (n = 16; 4.4%) were the most common non-infusion-related adverse events. Conclusion Rituximab was a safe and highly efficient disease modifying therapy in this cohort of MS-patients; however, infections and neutropenia need to be monitored.
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Affiliation(s)
- Hilde Marie Torgauten
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kjell-Morten Myhr
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Stig Wergeland
- Norwegian Multiple Sclerosis Registry, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Lars Bø
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Jan H Aarseth
- Norwegian Multiple Sclerosis Registry, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Øivind Torkildsen
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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22
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Diem L, Chan A. Persisting lymphopenia and dimethyl fumarate: A clinical commentary. Mult Scler 2021; 27:1309-1310. [PMID: 33620267 DOI: 10.1177/1352458521996698] [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
Severe prolonged lymphopenia as rare side-effect of dimethyl fumarate is mostly reversible. Caldito et al. report a case of persistent severe lymphopenia over 5 years after discontinuation of dimethyl fumarate. We discuss several clinical implications. Safe withdrawal of disease modifying therapies in terms of reoccurrence of disease activity and drug related adverse events need further attention as our treatment armamentarium continues to grow.
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Affiliation(s)
- Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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23
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Jalkh G, Abi Nahed R, Macaron G, Rensel M. Safety of Newer Disease Modifying Therapies in Multiple Sclerosis. Vaccines (Basel) 2020; 9:12. [PMID: 33375365 PMCID: PMC7823546 DOI: 10.3390/vaccines9010012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022] Open
Abstract
In the past decade, the therapeutic arsenal for multiple sclerosis has expanded greatly. Newer more potent disease modifying therapies (DMTs) with varying mechanisms of actions are increasingly used early in the disease course. These newer DMTs include oral therapies (teriflunomide, dimethyl fumarate, fingolimod, siponimod, ozanimod, and cladribine) and infusion therapies (natalizumab, alemtuzumab, and ocrelizumab), and are associated with better control of disease activity and long-term outcomes in patients with MS compared to older injectable therapies (interferon beta and glatiramer acetate). However, they are associated with safety concerns and subsequent monitoring requirements. Adverse events are initially observed in phase 2 and 3 clinical trials, and further long-term data are collected in phase 3 extension studies, case series, and post-marketing reports, which highlight the need to periodically re-evaluate and adjust monitoring strategies to optimize treatment safety in an individualized approach.
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Affiliation(s)
- Georges Jalkh
- Department of Neurology, Faculty of Medicine, Université Saint Joseph, Beirut B.P. 11-5076, Lebanon; (G.J.); (R.A.N.); (G.M.)
- Department of Neurology, Hotel-Dieu de France Hospital, Beirut 16-6830, Lebanon
| | - Rachelle Abi Nahed
- Department of Neurology, Faculty of Medicine, Université Saint Joseph, Beirut B.P. 11-5076, Lebanon; (G.J.); (R.A.N.); (G.M.)
- Department of Neurology, Hotel-Dieu de France Hospital, Beirut 16-6830, Lebanon
| | - Gabrielle Macaron
- Department of Neurology, Faculty of Medicine, Université Saint Joseph, Beirut B.P. 11-5076, Lebanon; (G.J.); (R.A.N.); (G.M.)
- Department of Neurology, Hotel-Dieu de France Hospital, Beirut 16-6830, Lebanon
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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24
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Wilkie DD, Solari A, Nicholas RSJ. The impact of the face-to-face consultation on decisional conflict in complex decision-making in multiple sclerosis: A pilot study. Mult Scler J Exp Transl Clin 2020; 6:2055217320959802. [PMID: 33194220 PMCID: PMC7594484 DOI: 10.1177/2055217320959802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/02/2020] [Accepted: 08/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background The role of face-to-face consultations in medicine is increasingly being
challenged. Disease activity, national guidelines, life goals e.g.
pregnancy, multiple therapies and side effects need to be considered on
starting disease modifying treatments (DMTs) in people with multiple
sclerosis (pwMS). Objectives We studied the impact of a face-to-face consultation on decision making,
using decisional conflict (DC) as the primary outcome. Methods Prospective cohort study of 73 pwMS attending clinics who were making
decisions about DMTs followed for one year. Prerequisites and consultation
features were measured with the SURE scale for DC used as the primary
outcome at baseline and at one year. Results The patient activation measure (PAM) was the only driver prior to the
consultation associated with DC (p = 0.02) showing those less engaged were
more likely to have DC. Overall, 51/73 (70%) of people made their treatment
decision or reinforced a former decision during the consultation. We found
making a treatment decision between the original consultation and the
follow-up was associated with resolving DC (p = 0.008). Conclusions Patient engagement impacts DC but the HCP delivering the optimal Shared
Decision Making (SDM) approach is additionally significant in reducing DC.
In complex decisions there is a clear role for face-to-face consultations in
current practice.
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Affiliation(s)
- David Daniel Wilkie
- Centre for Neuroscience, Faculty of Medicine, Imperial College London, London, UK
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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25
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Alroughani R, Van Wijmeersch B, Al Khaboori J, Alsharoqi IA, Ahmed SF, Hassan A, Inshasi J, Krieger DW, Shakra M, Shatila AO, Szolics M, Khallaf M, Ezzat A. The use of alemtuzumab in patients with relapsing-remitting multiple sclerosis: the Gulf perspective. Ther Adv Neurol Disord 2020; 13:1756286420954119. [PMID: 32973927 PMCID: PMC7498833 DOI: 10.1177/1756286420954119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 08/03/2020] [Indexed: 12/11/2022] Open
Abstract
Over the past decade, the development of high-efficacy disease-modifying therapies (DMTs) has been responsible for more effective management of relapsing-remitting multiple sclerosis (RRMS). However, the gaps in optimal care for this complex disease remain. Alemtuzumab (Lemtrada®) is a highly efficacious DMT that shows better patient outcomes and therapeutic benefits, but its use is under-recognized in the Gulf region. Experts in the care of multiple sclerosis shared their opinions based on study data and daily clinical experience in identifying the appropriate patient profile suitable for alemtuzumab's therapeutic benefits. Age, disease activity and severity, disability status, physician experience, and economic condition are some of the key indicators for alemtuzumab use.
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Affiliation(s)
- Raed Alroughani
- Division of Neurology, Department of Medicine,
Al Amiri Hospital, Kuwait
| | | | | | | | | | - Ali Hassan
- Tawam Hospital, Al Ain, Abu Dhabi, United Arab
Emirates
| | | | | | - Mustafa Shakra
- Sheikh Khalifa Medical City, Abu Dhabi, United
Arab Emirates
| | | | | | | | - Aly Ezzat
- Sanofi Genzyme, Dubai, United Arab
Emirates
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26
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Moss BP, Mahajan KR, Bermel RA, Hellisz K, Hua LH, Hudec T, Husak S, McGinley MP, Ontaneda D, Wang Z, Weber M, Tagliani P, Cárdenas-Robledo S, Zabalza A, Arrambide G, Carbonell-Mirabent P, Rodríguez-Barranco M, Sastre-Garriga J, Tintore M, Montalban X, Douglas M, Ogbuokiri E, Aravidis B, Cohen JA, Mowry EM, Fitzgerald KC. Multiple sclerosis management during the COVID-19 pandemic. Mult Scler 2020; 26:1163-1171. [PMID: 32772807 PMCID: PMC7424611 DOI: 10.1177/1352458520948231] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [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: 12/28/2022]
Abstract
Background: People with multiple sclerosis (MS) may be at higher risk for complications from the 2019 coronavirus (COVID-19) pandemic due to use of immunomodulatory disease modifying therapies (DMTs) and greater need for medical services. Objectives: To evaluate risk factors for COVID-19 susceptibility and describe the pandemic’s impact on healthcare delivery. Methods: Surveys sent to MS patients at Cleveland Clinic, Johns Hopkins, and Vall d’Hebron-Centre d’Esclerosi Múltiple de Catalunya in April and May 2020 collected information about comorbidities, DMTs, exposures, COVID-19 testing/outcomes, health behaviors, and disruptions to MS care. Results: There were 3028/10,816 responders. Suspected or confirmed COVID-19 cases were more likely to have a known COVID-19 contact (odds ratio (OR): 4.38; 95% confidence interval (CI): 1.04, 18.54). In multivariable-adjusted models, people who were younger, had to work on site, had a lower education level, and resided in socioeconomically disadvantaged areas were less likely to follow social distancing guidelines. 4.4% reported changes to therapy plans, primarily delays in infusions, and 15.5% a disruption to rehabilitative services. Conclusion: Younger people with lower socioeconomic status required to work on site may be at higher exposure risk and are potential targets for educational intervention and work restrictions to limit exposure. Providers should be mindful of potential infusion delays and MS care disruption.
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Affiliation(s)
- Brandon P Moss
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Kedar R Mahajan
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Kelsey Hellisz
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Le H Hua
- Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA
| | - Timothy Hudec
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Scott Husak
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Marisa P McGinley
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Zhini Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Malory Weber
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Paula Tagliani
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Simón Cárdenas-Robledo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rodríguez-Barranco
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintore
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Morgan Douglas
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins University, Baltimore, MA, USA
| | - Esther Ogbuokiri
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins University, Baltimore, MA, USA
| | - Berna Aravidis
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins University, Baltimore, MA, USA
| | - Jeffrey A Cohen
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Ellen M Mowry
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins University, Baltimore, MA, USA
| | - Kathryn C Fitzgerald
- Division of Neuroimmunology and Neurological Infections, Johns Hopkins University, Baltimore, MA, USA
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27
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Bross M, Hackett M, Bernitsas E. Approved and Emerging Disease Modifying Therapies on Neurodegeneration in Multiple Sclerosis. Int J Mol Sci 2020; 21:E4312. [PMID: 32560364 DOI: 10.3390/ijms21124312] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune, chronic, progressive disease leading to a combination of inflammation, demyelination, and neurodegeneration throughout the central nervous system (CNS). The outcome of these processes can be visualized in magnetic resonance imaging (MRI) scans as brain atrophy, or brain volume loss (BVL), as well as lesions, “black holes” and spinal cord atrophy. MRI outcomes such as BVL have been used as biomarkers of neurodegeneration and other measures of MS disease progression in clinical research settings. Several FDA-approved medications seek to alleviate disease progression by reducing the impact of such factors as demyelination and neurodegeneration, but there are still many shortcomings that current clinical research aims to mitigate. This review attempts to provide an overview of the FDA-approved medications available for treating multiple sclerosis and their effect on neurodegeneration, measured by BVL.
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Abstract
INTRODUCTION In recent years there has been a dramatic rise in available disease-modifying therapies for the treatment of relapsing multiple sclerosis (MS). Dimethyl fumarate (DMF) is an oral drug approved by the FDA for relapsing MS with unique immunomodulatory and cytoprotective effects. AREAS COVERED Herein, the authors provide the reader with a review of the literature obtained via a PubMed database search and provide their expert opinion on the use of DMF in clinical practice. The article details DMF's mechanism of action, long-term data on efficacy, tolerability and safety. EXPERT OPINION Since approval, growing experience with DMF in clinical practice demonstrates a combination of efficacy, ease of administration along with an acceptable safety profile. The authors believe that DMF is a valuable long-term treatment option in patients with relapsing MS. However, long-term follow up studies are needed to provide further data on progressive multifocal leukoencephalopathy (PML) risk stratification for MS patients on treatment with DMF. Indeed, despite the strong association with lymphopenia, not all patients with DMF associated PML experienced prolonged overall lymphopenia, suggesting that additional predictive metrics are still needed.
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Affiliation(s)
- Cristina Valencia-Sanchez
- Department of Neurology, Mayo Clinic Arizona, Mayo Foundation for Medical Education and Research , Scottsdale, AZ, USA
| | - Jonathan L Carter
- Department of Neurology, Mayo Clinic Arizona, Mayo Foundation for Medical Education and Research , Scottsdale, AZ, USA
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Abdel-Mannan O, Cortese R, Wassmer E, Hemingway C, Thompson A, Brownlee W, Ciccarelli O, Hacohen Y. Primary progressive multiple sclerosis presenting under the age of 18 years: Fact or fiction? Mult Scler 2020; 27:309-314. [PMID: 32124676 DOI: 10.1177/1352458520910361] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous cohort studies on paediatric multiple sclerosis (MS) have reported very low frequencies for a primary progressive MS (PPMS) course ranging from 0% to 7%. We identified six patients presenting prior to the age of 18 years and fulfilling the 2017 McDonald Criteria for PPMS. Presentation with progressive neurological symptoms and signs in young people should prompt evaluation for genetic causes such as leukodystrophies, hereditary spastic paraparesis and mitochondrial diseases given the rarity of primary progressive course in paediatric MS. In the absence of an alternative diagnosis, with new therapeutic options becoming available for PPMS, this diagnosis should then be considered.
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Affiliation(s)
- Omar Abdel-Mannan
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Rosa Cortese
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Alan Thompson
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/NIHR UCLH Biomedical Research Centre, London, UK
| | - Wallace Brownlee
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/NIHR UCLH Biomedical Research Centre, London, UK
| | - Yael Hacohen
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK/Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
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Mäurer M, Tiel-Wilck K, Oehm E, Richter N, Springer M, Oschmann P, Manzel A, Hieke-Schulz S, Zingler V, Kandenwein JA, Ziemssen T, Linker RA. Reasons to switch: a noninterventional study evaluating immunotherapy switches in a large German multicentre cohort of patients with relapsing-remitting multiple sclerosis. Ther Adv Neurol Disord 2019; 12:1756286419892077. [PMID: 31903096 PMCID: PMC6923693 DOI: 10.1177/1756286419892077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Received: 04/08/2019] [Accepted: 10/22/2019] [Indexed: 01/05/2023] Open
Abstract
Background: With a large array of disease modifying therapies (DMTs) for
relapsing-remitting MS (RRMS), identifying the optimal treatment option for
the individual patient is challenging and switching of immunotherapies is
often required. The objective of this study was to systematically
investigate reasons for DMT switching in patients on immunotherapies for
mild/moderate MS, and provide real-life insights into currently applied
therapeutic strategies. Methods: This noninterventional, cross-sectional study (ML29913) at 50 sites in
Germany included RRMS patients on therapies for mild/moderate MS who
switched immunotherapy in the years 2014–2017. The key outcome variable was
the reason to switch, as documented in the medical charts, based on failure
of current therapy, cognitive decline, adverse events (AEs), patient wish,
or a woman’s wish to become pregnant. Expectations of the new DMT and
patients’ assessment of the decision maker were also recorded. Results: The core analysis population included 595 patients, with a mean age of
41.6 years, of which 69.7% were female. More than 60% of patients had at
least one relapse within 12 months prior to the switch. The main reasons to
switch DMT were failure of current therapy (53.9%), patient wish (22.4%),
and AEs (19.0%). Most patients (54.3%) were switched within DMTs for
mild/moderate MS; only 43.5% received a subsequent DMT for active/highly
active MS. While clinical and outcome-oriented aspects were the most
frequently mentioned expectations of the new DMT for physicians, aspects
relating to quality of life played a major role for patients. Conclusions: Our data indicate suboptimal usage of DMTs, including monoclonal antibodies,
for active/highly active MS in German patients. This illustrates the medical
need for DMTs combining high efficacy, low safety risk, and low therapy
burden.
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Affiliation(s)
- Mathias Mäurer
- Klinikum Würzburg Mitte, Standort Juliusspital, Würzburg, Germany
| | | | - Eckard Oehm
- Group practice for Neurology, Psychiatry and Psychotherapy, Freiburg, Germany
| | - Nils Richter
- Group practice for Neurology, Düsseldorf, Germany
| | | | | | | | | | | | | | - Tjalf Ziemssen
- Universitätsklinikum Carl Gustav Carus, Centre for Clinical Neuroscience, Dresden, Germany
| | - Ralf A Linker
- Neurologische Klinik der Universität Regensburg, Universitätsstraße 84, Regensburg, 93053, Germany
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Kartau M, Sipilä JO, Auvinen E, Palomäki M, Verkkoniemi-Ahola A. Progressive Multifocal Leukoencephalopathy: Current Insights. Degener Neurol Neuromuscul Dis 2019; 9:109-121. [PMID: 31819703 PMCID: PMC6896915 DOI: 10.2147/dnnd.s203405] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 08/29/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022] Open
Abstract
Cases of PML should be evaluated according to predisposing factors, as these subgroups differ by incidence rate, clinical course, and prognosis. The three most significant groups at risk of PML are patients with hematological malignancies mostly previously treated with immunotherapies but also untreated, patients with HIV infection, and patients using monoclonal antibody (mAb) treatments. Epidemiological data is scarce and partly conflicting, but the distribution of the subgroups appears to have changed. While there is no specific anti-JCPyV treatment, restoration of the immune function is the most effective approach to PML treatment. Research is warranted to determine whether immune checkpoint inhibitors could benefit certain PML subgroups. There are no systematic national or international records of PML diagnoses or a risk stratification algorithm, except for MS patients receiving natalizumab (NTZ). These are needed to improve PML risk assessment and to tailor better prevention strategies.
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Affiliation(s)
- Marge Kartau
- Clinical Neurosciences, Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jussi Ot Sipilä
- Department of Neurology, Siun Sote, North Carelia Central Hospital, Joensuu, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.,Clinical Neurosciences, University of Turku, Turku, Finland
| | - Eeva Auvinen
- Department of Virology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Palomäki
- Neuroradiology, HUS Medical Imaging Center, Helsinki, Finland
| | - Auli Verkkoniemi-Ahola
- Clinical Neurosciences, Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
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Hijikata Y, Hashizume A, Yamada S, Ito D, Banno H, Suzuki K, Sobue G, Katsuno M. Long-term Effects of Androgen Deprivation in a Patient with Spinal and Bulbar Muscular Atrophy - A Case Report with 14 Years of Follow-up. Intern Med 2019; 58:2231-2234. [PMID: 30996158 PMCID: PMC6709315 DOI: 10.2169/internalmedicine.1592-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Spinal and bulbar muscular atrophy (SBMA) is a progressive hereditary neuromuscular disease caused by the testosterone-dependent accumulation of pathogenic polyglutamine-expanded androgen receptor protein. A 41-year-old man with SBMA received the androgen deprivation agent leuprorelin acetate for 7 years in clinical trials and underwent castration following the trial. Suppression of testosterone levels for 14 years resulted in a slower disease progression, as measured prospectively with quantitative measurements, than the historical control data reported in previous studies. This suggests that long-term androgen deprivation delays disease progression in SBMA.
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Affiliation(s)
- Yasuhiro Hijikata
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Atsushi Hashizume
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Shinichiro Yamada
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Daisuke Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Haruhiko Banno
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Keisuke Suzuki
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Japan
| | - Gen Sobue
- Research Division of Dementia and Neurodegenerative Disease, Nagoya University Graduate School of Medicine, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
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Cummings J, Ritter A, Zhong K. Clinical Trials for Disease-Modifying Therapies in Alzheimer's Disease: A Primer, Lessons Learned, and a Blueprint for the Future. J Alzheimers Dis 2019; 64:S3-S22. [PMID: 29562511 PMCID: PMC6004914 DOI: 10.3233/jad-179901] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [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: 02/07/2023]
Abstract
Alzheimer’s disease (AD) has no currently approved disease-modifying therapies (DMTs), and treatments to prevent, delay the onset, or slow the progression are urgently needed. A delay of 5 years if available by 2025 would decrease the total number of patients with AD by 50% in 2050. To meet the definition of DMT, an agent must produce an enduring change in the course of AD; clinical trials of DMTs have the goal of demonstrating this effect. AD drug discovery entails target identification followed by high throughput screening and lead optimization of drug-like compounds. Once an optimized agent is available and has been assessed for efficacy and toxicity in animals, it progresses through Phase I testing with healthy volunteers, Phase II learning trials to establish proof-of-mechanism and dose, and Phase III confirmatory trials to demonstrate efficacy and safety in larger populations. Phase III is followed by Food and Drug Administration review and, if appropriate, market access. Trial populations include cognitively normal at-risk participants in prevention trials, mildly impaired participants with biomarker evidence of AD in prodromal AD trials, and subjects with cognitive and functional impairment in AD dementia trials. Biomarkers are critical in trials of DMTs, assisting in participant characterization and diagnosis, target engagement and proof-of-pharmacology, demonstration of disease-modification, and monitoring side effects. Clinical trial designs include randomized, parallel group; delayed start; staggered withdrawal; and adaptive. Lessons learned from completed trials inform future trials and increase the likelihood of success.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Kate Zhong
- Global Alzheimer Platform, Washington, DC, USA
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34
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D'Amico E, Chisari CG, Arena S, Zanghì A, Toscano S, Lo Fermo S, Maimone D, Castaing M, Sciacca S, Zappia M, Patti F. Cancer Risk and Multiple Sclerosis: Evidence From a Large Italian Cohort. Front Neurol 2019; 10:337. [PMID: 31024431 PMCID: PMC6469363 DOI: 10.3389/fneur.2019.00337] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Received: 01/04/2019] [Accepted: 03/19/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: The complexity of understanding cancer risk in MS is increased by inconsistencies in study design, and the lack of age-, sex-, and ethnicity-specific risk estimates. Aims of our study were to estimate the incidence of cancers in the MS population of Catania (Italy) and to evaluate the impact of disease-modifying treatments (DMTs) in cancer risk. Materials and Methods: We screened 2,730 PwMS according to the MS criteria of Mc Donald 2010 referring to MS center of Catania in the period between 2003 and 2013. We matched database of MS patients with the Integrated Cancer of Catania-Messina-Siracusae-Enna. We calculated age and sex specific standardized incidence ratios (SIR) and the relative risk (RR) of developing cancer in MS patients treated with at least two different DMTs compared to who received one or no treatment. Results: Out of 2,730, 1,180 MS patients (67.1% females; mean age 41.2 ± 12.9) were enrolled. We found 36 cancers. Global SIR was 1.18 (CI95% 0.78–1.58), with a significantly higher risk in men with a range age of 20 to 50 years [2.84; (CI95% 1.59–4.09)] and in women over 50 years [1.82 (CI95% 1.08–2.55)]. RR of developing cancer was 1.99 (CI95% 1.14–3.45) in MS patients switching one DMT and 3.38 (CI95% 1.83–6.22) in who switched at least twice. Discussion: Our results demonstrated that cancer risk was not increased in our MS population; but age and sex different distribution may partly drive cancer risk. Higher cancer risk in MS patients switching more than two DMTs should take into account in treatment decision making.
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Affiliation(s)
- Emanuele D'Amico
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Clara G Chisari
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Sebastiano Arena
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Aurora Zanghì
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Simona Toscano
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Salvatore Lo Fermo
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | | | - Marine Castaing
- Department of Hygiene, University of Catania, Catania, Italy
| | | | - Mario Zappia
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
| | - Francesco Patti
- Section of Neurosciences, Department "GF Ingrassia", University of Catania, Catania, Italy
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35
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Claflin SB, Broadley S, Taylor BV. The Effect of Disease Modifying Therapies on Disability Progression in Multiple Sclerosis: A Systematic Overview of Meta-Analyses. Front Neurol 2019; 9:1150. [PMID: 30687214 PMCID: PMC6335290 DOI: 10.3389/fneur.2018.01150] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/11/2018] [Indexed: 12/28/2022] Open
Abstract
Background: Disease modifying therapy (DMT) efficacy trials make an essential contribution to the development of evidence-based clinical treatments and practices for people with multiple sclerosis (MS). Meta-analysis is a critical part of this process and provides a powerful tool to assess the effects of DMT on MS progression. However, although there have been several meta-analyses on the effect of DMT on MS disease progression, they often do not reach the same conclusions. Objective: Our aim was to better understand and contextualize the results of meta-analyses evaluating DMT, identify differences in methodology that might explain their differing conclusions, and highlight areas for future research that will improve our ability to develop clinical recommendations. Methods: We conducted an overview of systematic reviews with meta-analyses assessing the efficacy of DMT on disability progression in people with MS in PubMed (Medline) and the Cochrane Database of Systematic Reviews. Results: We included 22 meta-analyses in this overview: eight general (on >3 DMT), 11 specific (on ≤3 DMT), 2 that evaluated subsets, and 1 that evaluated long-term effects. We found that there is good evidence that DMT improve short-term (≤2–3 years) disability progression outcomes relative to placebo in people with relapsing-remitting MS. However, results varied substantially between meta-analyses, and there is little evidence of their efficacy in other populations or over longer periods. The relative effects of individual DMT also remain unclear. The variance in results between meta-analyses may be related to the substantial differences in inclusion criteria, which was reflected in the limited overlap in included studies, as well as the year of meta-analysis publication. Of the 123 total unique studies included in the general meta-analyses, 77 (62.6%) were included in only one meta-analysis. This incongruence was also evident in the included DMT. Six of the 16 (37.5%) DMT evaluated in the general meta-analyses were only included in one meta-analysis. Conclusions: Translating DMT efficacy studies into evidence-based clinical practice requires greater methodological consistency in meta-analyses, more data on the relative effects of DMT through head-to-head clinical trials, and better reporting of adverse events.
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Affiliation(s)
- Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
| | - Simon Broadley
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmanian, Hobart, TAS, Australia
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Rivera VM. Multiple Sclerosis: A Global Concern with Multiple Challenges in an Era of Advanced Therapeutic Complex Molecules and Biological Medicines. Biomedicines 2018; 6:E112. [PMID: 30513578 PMCID: PMC6316848 DOI: 10.3390/biomedicines6040112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/25/2022] Open
Abstract
Multiple sclerosis (MS) has become a common neurological disorder involving populations previously considered to be infrequently affected. Genetic dissemination from high- to low-risk groups is a determining influence interacting with environmental and epigenetic factors, mostly unidentified. Disease modifying therapies (DMT) are effective in treating relapsing MS in variable degrees; one agent is approved for primary progressive disease, and several are in development. In the era of high-efficacy medications, complex molecules, and monoclonal antibodies (MAB), including anti-VLA4 (natalizumab), anti-CD52 (alemtuzumab), and anti-CD20 (ocrelizumab), obtaining NEDA (no evidence of disease activity) becomes an elusive accomplishment in areas of the world where access to MS therapies and care are generally limited. Countries' income and access to public MS care appear to be a shared socioeconomic challenge. This disparity is also notable in the utilization of diagnostic tools to adhere to the proposed elements of the McDonald Criteria. The impact of follow-on medications ("generics"); injectable non-biological complex drugs (NBCD), oral sphingosine-1-phosphate receptor modulators, and biosimilars (interferon 1-a and 1-b), utilized in many areas of the world, is disconcerting considering these products generally lack data documenting their efficacy and safety. Potential strategies addressing these concerns are discussed from an international point of view.
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Affiliation(s)
- Victor M Rivera
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA.
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DiFrancesco JC, Tremolizzo L, Polonia V, Giussani G, Bianchi E, Franchi C, Nobili A, Appollonio I, Beghi E, Ferrarese C. Adult-Onset Epilepsy in Presymptomatic Alzheimer's Disease: A Retrospective Study. J Alzheimers Dis 2018; 60:1267-1274. [PMID: 28968234 DOI: 10.3233/jad-170392] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 01/08/2023]
Abstract
BACKGROUND The prevalence of epilepsy with onset in adulthood increases with age, mainly due to the accumulation of brain damage. However, a significant proportion of patients experience seizures of unknown cause. Alzheimer's disease (AD) is associated with an increased risk of seizures. Seizure activity is interpreted as a secondary event related to hyperexcitability caused by amyloid-β aggregation. OBJECTIVE Since neurodegenerative processes begin several years before clinical symptoms, epilepsy could be more frequent in the presymptomatic stages of dementia. METHODS We retrospectively reviewed the prevalence of epilepsy of unknown origin with adult onset before cognitive decline in a large cohort of AD patients (EPS-AD) recruited based on clinical and neuropsychological data. Data of patients with epilepsy followed by AD were compared with two control groups: patients with AD without seizures (no EPS-AD) and a large reference population (RP). RESULTS In AD patients, the prevalence of epilepsy of unknown origin, with onset in the adulthood before cognitive decline is 17.1 times higher compared with the RP (95% CI: 10.3-28.3). In EPS-AD, seizures begin on average 4.6 years (median 2.0) before the onset of cognitive symptoms and cognitive decline starts 3.6 years earlier compared with noEPS-AD. CONCLUSIONS Neurodegenerative processes of dementia could play a key role in the pathogenesis of epilepsy in a subgroup of individuals intended to develop cognitive decline. Adult-onset epilepsy of undefined cause could thus represent a risk factor for the ongoing neurodegenerative damage, even preceding by years the onset of clinical symptoms of dementia.
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Affiliation(s)
- Jacopo C DiFrancesco
- Department of Neurology, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Monza, Italy
| | - Lucio Tremolizzo
- Department of Neurology, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Monza, Italy
| | - Valeria Polonia
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Monza, Italy
| | - Giorgia Giussani
- Department of Neuroscience, IRCCS-Institute for Pharmacological Research "Mario Negri", Milan, Italy
| | - Elisa Bianchi
- Department of Neuroscience, IRCCS-Institute for Pharmacological Research "Mario Negri", Milan, Italy
| | - Carlotta Franchi
- Department of Neuroscience, IRCCS-Institute for Pharmacological Research "Mario Negri", Milan, Italy
| | - Alessandro Nobili
- Department of Neuroscience, IRCCS-Institute for Pharmacological Research "Mario Negri", Milan, Italy
| | - Ildebrando Appollonio
- Department of Neurology, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Monza, Italy
| | - Ettore Beghi
- Department of Neuroscience, IRCCS-Institute for Pharmacological Research "Mario Negri", Milan, Italy
| | - Carlo Ferrarese
- Department of Neurology, San Gerardo Hospital, Monza, Italy.,School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Monza, Italy
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38
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Abstract
Up to very recently, no treatments had proved effective in progressive multiple sclerosis (MS). In 2016, four drugs, two tested in phase 3 and two in phase 2 trials, showed a beneficial effect in primary or secondary progressive MS. Although this could indicate a turning point in progressive MS treatment, most of these successes have been modest and mainly restricted to patients with active inflammation, in the context of trials with powerful anti-inflammatory agents. This paper summarises these reasons, particularly focusing on the main lessons learned for the design of future trials. First, a drug's mechanism of action should tackle the specific pathogenic mechanisms that characterise progressive MS. Second, trial populations where new drugs are to be tested should be carefully chosen, possibly including younger patients with shorter disease durations, which have greater chances of showing active deterioration during the trial, therefore increasing the power to detect treatment effects. Third, outcome measures used in future phase 2 and phase 3 trials should be highly sensitive and be accompanied by smart trial designs.
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Affiliation(s)
- Carmen Tur
- The Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK/Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Balasa R, Maier S, Voidazan S, Hutanu A, Bajko Z, Motataianu A, Tilea B, Tiu C. Assessment of Interleukin-17A, Interleukin-10 and Transforming Growth Factor-Beta1 Serum Titers in Relapsing Remitting Multiple Sclerosis Patients Treated with Avonex, Possible Biomarkers for Treatment Response. CNS Neurol Disord Drug Targets 2018; 16:93-101. [PMID: 27306062 DOI: 10.2174/1871527315666160615110739] [Citation(s) in RCA: 8] [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] [Received: 03/07/2016] [Revised: 05/25/2016] [Accepted: 06/11/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Individual response to interferon beta (IFN-β) 1a treatment is heterogeneous in multiple sclerosis (MS). Our objective was to find a connection between serum levels of interleukin (IL)-10, IL-17 and transforming growth factor beta (TGF-β)1 in MS patients treated with IFN-β in order to identify the nonresponders (NR). MATERIAL AND METHODS We included in the study 32 healthy subjects and 32 MS patients: 10 naive, 10 early treated and 12 late treated with INF-β1a. Serum determination of cytokines and brain MRI were performed at the beginning of the study, after 6 and 12 months. Rio score was calculated at the end of the study. RESULTS MS patients had initially a significant higher level of IL-17 and a lower level of TGF-β1 compared to healthy subjects. IL-17 level in early treated patients was significantly lower compared to the naive and late treated groups. INF-β1a treatment significantly increased IL-10 and decreased IL-17 levels. Initial low levels of IL-10 were associated with an increase in physical disability. IL-17 levels positively correlated with the number of relapses and MRI activity. Nine patients were NR to Avonex. Patients with a Rio score of 3 had higher initial levels of IL-17 and those with a Rio score of 0 had higher initial levels of IL-10 and TGF-β1. CONCLUSION IFN-β1a decreased IL-17 and increased IL-10 seric levels; IL-17 significantly correlated with MS activity; TGF-β1 activity is titer-dependent, increased levels were associated with IL-17 inhibition; NR patients to IFN-β1a will have initial high IL-17 and low IL-10 and TGF-β seric levels.
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Affiliation(s)
| | - Smaranda Maier
- University of Medicine and Pharmacy Targu Mures, Department of Neurology, Targu Mures, Romania, Gh Marinescu 50, 540136,. Romania
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Ehler J, Blechinger S, Rommer PS, Koball S, Mitzner S, Hartung HP, Leutmezer F, Sauer M, Zettl UK. Treatment of the First Acute Relapse Following Therapeutic Plasma Exchange in Formerly Glucocorticosteroid-Unresponsive Multiple Sclerosis Patients-A Multicenter Study to Evaluate Glucocorticosteroid Responsiveness. Int J Mol Sci 2017; 18:ijms18081749. [PMID: 28800066 PMCID: PMC5578139 DOI: 10.3390/ijms18081749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/01/2017] [Accepted: 08/08/2017] [Indexed: 12/21/2022] Open
Abstract
Therapeutic options to treat multiple sclerosis (MS) relapses comprise glucocorticosteroids (GCS) as first-line and therapeutic plasma exchange (TPE) as second-line treatments in GCS-unresponsive patients. No guidelines exist for the treatment of another relapse following TPE. We retrospectively analyzed the responsiveness to GCS in a subsequent relapse following TPE in previously GCS-unresponsive MS patients. Thirty-seven patients with GCS-unresponsive MS relapses received TPE (relapse A). All patients developed another relapse after the completion of TPE and received GCS again (relapse B). The primary study endpoint was the clinical response to GCS and TPE. Marked improvement was defined as clinically significant improvement in function, moderate improvement as a definite change of symptoms without significant impact on function, no effect comprised unchanged symptoms, and deterioration a worsening of symptoms or new deficits. The secondary endpoint was an improvement in expanded disability status scale (EDSS) scoring. All patients were GCS-unresponsive during relapse A and received TPE. During GCS treatment of relapse B, marked improvement was observed in 10, moderate improvement in 24, and no effect in three patients. The EDSS decreased in 15 patients. GCS might remain the first-line relapse treatment following TPE in formerly GCS-unresponsive MS patients.
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Affiliation(s)
- Johannes Ehler
- Department of Anaesthesiology and Intensive Care Medicine, University of Rostock, 18057 Rostock, Germany.
- Department of Neurology, Neuroimmunology Section, University of Rostock, 18147 Rostock, Germany.
| | - Stephan Blechinger
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria.
| | - Paulus S Rommer
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria.
| | - Sebastian Koball
- Division of Nephrology, Department of Internal Medicine, University of Rostock, 18057 Rostock, Germany.
| | - Steffen Mitzner
- Division of Nephrology, Department of Internal Medicine, University of Rostock, 18057 Rostock, Germany.
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany.
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria.
| | - Martin Sauer
- Department of Anaesthesiology and Intensive Care Medicine, University of Rostock, 18057 Rostock, Germany.
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunology Section, University of Rostock, 18147 Rostock, Germany.
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Wencel-Warot A, Michalak S, Warot M, Kalinowska-Lyszczarz A, Kazmierski R. The cross-reactivity of binding antibodies with different interferon beta formulations used as disease-modifying drugs in multiple sclerosis patients. Medicine (Baltimore) 2016; 95:e5337. [PMID: 27828855 PMCID: PMC5106061 DOI: 10.1097/md.0000000000005337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 11/26/2022] Open
Abstract
Interferon beta (IFNb) preparations are commonly used as first-line therapy in relapsing-remitting multiple sclerosis (RRMS). They are, however, characterized by limited efficacy, partly due to the formation of anti-IFNb antibodies in patients.In this pilot study, we assessed with the ELISA method the presence of the binding antibodies (BAbs) against interferon beta after 2 years of therapy with subcutaneous interferon beta 1a (Rebif) in 49 RRMS patients. Antibody levels were established again within 1 year after treatment withdrawal. We used 3 interferons that are commercially available for MS therapy, namely Avonex (Biogen Idec Limited), Rebif (Merck Serono), and Betaferon (Bayer Pharma AG), as antigens.BAbs reacting with Rebif were found in 24.4% to 55% of patients, depending on the units of their expression. The levels of anti-Rebif antibodies remained high in 8 patients and in 4 patients they dropped significantly. Strong correlations were obtained in all assays (anti-Rebif-anti-Avonex, anti-Rebif-anti-Betaferon, and anti-Betaferon-anti-Avonex) and the existence of cross-reactivity in the formation of antibodies against all the tested formulations of interferon beta was confirmed. The levels of BAbs remain significant in the clinical context, and their assessment is the first choice screening; however, methods of BAbs evaluation can be crucial for further decisions. More studies are needed to confirm our results; specifically it would be of interest to evaluate methods of neutralizing antibodies identification, as we only assessed the binding antibodies. Nevertheless, our results support the concept that in interferon nonresponders, that are positive for binding antibodies, switching the therapy to alternative disease-modifying agent (for example glatiramer acetate, fingolimod, or natalizumab) is justified, whereas the switch to another interferon formulation will probably be of no benefit.
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Affiliation(s)
- Agnieszka Wencel-Warot
- Department of Developmental Neurology, Poznan University of Medical Sciences, Przybyszewskiego
| | - Slawomir Michalak
- Department of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, Przybyszewskiego
| | - Marcin Warot
- Department of General and Vascular Surgery and Angiology, Poznan University of Medical Sciences, prof. L. Bierkowski Hospital
| | | | - Radoslaw Kazmierski
- Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, prof. L. Bierkowski Hospital, Poznan, Poland
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Abstract
INTRODUCTION Parkinson's disease (PD) is one of the most challenging neurodegenerative disorders to treat as it manifests with a large variety of troublesome, and often disabling, motor and non-motor symptoms. Despite limitations, such as motor and other complications, levodopa remains the most effective drug in the treatment of PD. AREAS COVERED In this review, we focus on phase 2 and 3 studies describing new and emerging medical therapies in PD. We discuss new formulations of levodopa, medications that prolong levodopa response and ameliorate levodopa-induced dyskinesias, and innovative delivery methods that are currently being evaluated in clinical trials or are in development with the promise of better efficacy and tolerability. We also describe novel non-dopaminergic drugs that have been identified for treatment of motor and non-motor symptoms. A specific section is designated for potential disease modifying therapies. EXPERT OPINION Alternative formulations of levodopa appear to be promising especially to help with the motor fluctuations either by providing sustained benefits with controlled released formulations or ameliorate sudden OFF by formulations such as inhaled levodopa. Several different medications affecting non-dopaminergic pathways are being evaluated which may aide levodopa. As the understanding of the disease grows further, numerous novel neuroprotective or disease modifying therapies have been suggested. This along with development of medications to treat various non-motor symptoms will help improve quality of life of patients with PD.
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Affiliation(s)
- Mitesh Lotia
- a Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology , Baylor College of Medicine , Houston , TX , USA
| | - Joseph Jankovic
- a Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology , Baylor College of Medicine , Houston , TX , USA
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Abstract
BACKGROUND The diagnosis of Parkinson's disease (PD), which is needed for useful symptomatic therapy, is based on clinical criteria. However, it became quite clear in recent years that the same features can occur through different etiopathogenic mechanisms. Even a pathological diagnosis of PD, based on the demonstration of α-synuclein deposits in a typical distribution, can result from different causes and, vice versa, nigral cell loss can occur without α-synuclein deposition. DISCUSSION Thus far, attempts to influence the progression of PD have failed. However, since the clinical manifestations of PD can be the result of diverse mechanisms, a single intervention may not be able to slow the course of the disease in all patients. Indeed, targeting the underlying pathogenic processes, which differ among cases, may be more effective. PD may develop as a consequence of mitochondrial damage, which itself may result from a variety of genetic or environmental factors. Correction of the ensuing oxidative stress may theoretically be useful in these PD patients, but will not affect the progression of the disease among other PD patients in whom an identical clinical syndrome derives from defects in other pathways such as the ubiquitin-proteasome system and lysosomal dysfunction, among others. Precision medicine can now be used to identify the underlying pathogenic mechanisms in individual patients, paving the way to the development of real disease modification through a pathway-oriented approach, aimed at the underlying biologic processes of disease occurrence and evolution.
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Affiliation(s)
- Amos D Korczyn
- Department of Neurology, Tel Aviv University Medical School, Ramat Aviv, Tel Aviv, Israel.
| | - Sharon Hassin-Baer
- The Movement Disorders Institute, Sagol Neuroscience Center and Department of Neurology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.
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Sepúlveda M, Ros C, Martínez-Lapiscina EH, Solà-Valls N, Hervàs M, Llufriu S, La Puma D, Casals E, Blanco Y, Villoslada P, Graus F, Castelo-Branco C, Saiz A. Pituitary-ovary axis and ovarian reserve in fertile women with multiple sclerosis: A pilot study. Mult Scler 2015; 22:564-8. [PMID: 26362892 DOI: 10.1177/1352458515602339] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/26/2015] [Indexed: 11/17/2022]
Abstract
Since a decline in the ovary function might impact the reproductive potential in women with multiple sclerosis (MS), we investigated the pituitary-ovary axis and ovarian reserve, including anti-Müllerian hormone (AMH) levels and ultrasound imaging of the ovaries, of 25 relapsing-remitting MS patients and 25 age-matched healthy controls. Mean levels of pituitary-gonadal hormones and age-adjusted parameters of ovarian reserve markers were not significantly different between both groups. Patients with higher disease activity (annualized relapse rate >0.5; n=9) had significantly lower AMH levels, total antral follicle count and ovarian volume, than those with lower disease activity. The finding of poorer ovarian reserve associated with higher disease activity should be taken into consideration since it may negatively impact the reproductive prognosis.
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Affiliation(s)
- Maria Sepúlveda
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
| | - Cristina Ros
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic and IDIBAPS, Universitat de Barcelona, Spain
| | - Elena H Martínez-Lapiscina
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
| | - Nuria Solà-Valls
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
| | - Mariona Hervàs
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic of Barcelona and Hospital Parc Tauli,Spain
| | - Sara Llufriu
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
| | - Delon La Puma
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
| | - Elena Casals
- Biomedical Diagnostic Center, Hospital Clinic of Barcelona, Spain
| | - Yolanda Blanco
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
| | - Pablo Villoslada
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
| | - Francesc Graus
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
| | - Camil Castelo-Branco
- Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic and IDIBAPS, Universitat de Barcelona, Spain
| | - Albert Saiz
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
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Boster A, Bartoszek MP, O'Connell C, Pitt D, Racke M. Efficacy, safety, and cost-effectiveness of glatiramer acetate in the treatment of relapsing-remitting multiple sclerosis. Ther Adv Neurol Disord 2011; 4:319-32. [PMID: 22010043 DOI: 10.1177/1756285611422108] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [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: 11/15/2022] Open
Abstract
The current Multiple Sclerosis (MS) therapeutic landscape is rapidly growing. Glatiramer acetate (GA) remains unique given its non-immunosuppressive mechanism of action as well as its superior long-term safety and sustained efficacy data. In this review, we discuss proposed mechanisms of action of GA. Then we review efficacy data for reduction of relapses and slowing disability as well as long term safety data. Finally we discuss possible future directions of this unique polymer in the treatment of MS.
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Affiliation(s)
- Aaron Boster
- Multiple Sclerosis Center, Department of Neurology The Ohio State University Medical Center 395 West 12th Avenue, 7th floor Columbus, OH 43210, USA
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