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Hernández-Preciado MR, Marquez-Pedroza J, Sánchez-Rosales NA, García-Rivera JDJ, Kobayashi-Gutiérrez A, Torres-Mendoza BM, Chavarría-Avila E, Montaño-Serrano RA, Cortes-Enriquez F, Mireles-Ramírez MA. Effect of Rituximab Compared with Natalizumab and Fingolimod in Patients with Relapsing-Remitting Multiple Sclerosis: A Cohort Study. J Clin Med 2022; 11:jcm11133584. [PMID: 35806869 PMCID: PMC9267823 DOI: 10.3390/jcm11133584] [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: 04/12/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 02/01/2023] Open
Abstract
The objective of this study was to evaluate the clinical files of patients with RRMS who started rituximab (RTX) compared with a second-line treatment (natalizumab (NTZ) or fingolimod (FTY)). This was a historical cohort study. We compared the effect according to the Expanded Disability Status Scale (EDSS) and the number of relapses in RRMS patients receiving these treatments after a mean period of 12 months. We found a statistically significant difference (p < 0.001) when comparing the EDSS scores and the annual relapse rates of patients receiving RTX with those receiving NTZ or FTY. This study is essential for our clinical practice, since patients with limited treatment options represent a challenge with regard to the management of their medical care. However, clinical trials and prospective studies with long follow-up periods are necessary to provide sufficient evidence on the efficacy of RTX and thus include this treatment in the therapeutic profile of patients with MS.
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Affiliation(s)
- Martha Rocio Hernández-Preciado
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
- Neurosciences Division, Western Biomedical Research Center (IMSS), Guadalajara 44340, Mexico
| | - Jazmin Marquez-Pedroza
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - Nayeli Alejandra Sánchez-Rosales
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - José de Jesús García-Rivera
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - Antonio Kobayashi-Gutiérrez
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
| | - Blanca Miriam Torres-Mendoza
- Neurosciences Division, Western Biomedical Research Center (IMSS), Guadalajara 44340, Mexico
- Department of Philosophical and Methodological Disciplines, University Health Sciences Center, University of Guadalajara, Guadalajara 44340, Mexico
| | - Efraín Chavarría-Avila
- Department of Philosophical and Methodological Disciplines, University Health Sciences Center, University of Guadalajara, Guadalajara 44340, Mexico
| | | | - Fernando Cortes-Enriquez
- Department of Neurology, Hospital General Regional No 45 of the Mexican Institute of Social Security, Guadalajara 44910, Mexico
| | - Mario Alberto Mireles-Ramírez
- High Specialty Medical Unit, Western National Medical Center of the Mexican Institute of Social Security, Guadalajara 44340, Mexico
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2
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Collorone S, Cawley N, Grussu F, Prados F, Tona F, Calvi A, Kanber B, Schneider T, Kipp L, Zhang H, Alexander DC, Thompson AJ, Toosy A, Wheeler-Kingshott CAG, Ciccarelli O. Reduced neurite density in the brain and cervical spinal cord in relapsing-remitting multiple sclerosis: A NODDI study. Mult Scler 2020; 26:1647-1657. [PMID: 31682198 DOI: 10.1177/1352458519885107] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) affects both brain and spinal cord. However, studies of the neuraxis with advanced magnetic resonance imaging (MRI) are rare because of long acquisition times. We investigated neurodegeneration in MS brain and cervical spinal cord using neurite orientation dispersion and density imaging (NODDI). OBJECTIVE The aim of this study was to investigate possible alterations, and their clinical relevance, in neurite morphology along the brain and cervical spinal cord of relapsing-remitting MS (RRMS) patients. METHODS In total, 28 RRMS patients and 20 healthy controls (HCs) underwent brain and spinal cord NODDI at 3T. Physical and cognitive disability was assessed. Individual maps of orientation dispersion index (ODI) and neurite density index (NDI) in brain and spinal cord were obtained. We examined differences in NODDI measures between groups and the relationships between NODDI metrics and clinical scores using linear regression models adjusted for age, sex and brain tissue volumes or cord cross-sectional area (CSA). RESULTS Patients showed lower NDI in the brain normal-appearing white matter (WM) and spinal cord WM than HCs. In patients, a lower NDI in the spinal cord WM was associated with higher disability. CONCLUSION Reduced neurite density occurs in the neuraxis but, especially when affecting the spinal cord, it may represent a mechanism of disability in MS.
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Affiliation(s)
- Sara Collorone
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Niamh Cawley
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Francesco Grussu
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Ferran Prados
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Francesca Tona
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Alberto Calvi
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Department of Pathophysiology and Transplantation, Neurodegenerative Disease Unit, La Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, University of Milan, Milan, Italy
| | - Baris Kanber
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Torben Schneider
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Philips UK, Guildford, UK
| | - Lucas Kipp
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Stanford MS Center, Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Hui Zhang
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Daniel C Alexander
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, UK
| | - Alan J Thompson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Ahmed Toosy
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK
| | - Claudia Am Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy/Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Olga Ciccarelli
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College London (UCL), London, UK/National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
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3
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Chitnis T, Banwell B, Krupp L, Arnold DL, Bar-Or A, Brück W, Giovannoni G, Greenberg B, Ghezzi A, Waubant E, Rostasy K, Deiva K, Huppke P, Wolinsky JS, Zhang Y, Azmon A, K-Laflamme A, Karan R, Gärtner J. Temporal profile of lymphocyte counts and relationship with infections with fingolimod therapy in paediatric patients with multiple sclerosis: Results from the PARADIG MS study. Mult Scler 2020; 27:922-932. [PMID: 32633694 DOI: 10.1177/1352458520936934] [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: 01/09/2023]
Abstract
BACKGROUND Reduction in absolute lymphocyte count (ALC) is expected with fingolimod treatment. OBJECTIVE To evaluate the effect of fingolimod 0.5 mg versus intramuscular interferon β-1a (30 μg) on ALC and its relationship with infections in paediatric-onset multiple sclerosis (POMS) up to 4 years. METHODS We assessed ALC at baseline, monthly till 3 months, and every 3 months (core phase) and with variable periodicity (extension phase) of Phase 3 PARADIGMS study (N = 215). Incidence rates (IRs) of infection-related adverse events (infAEs)/100 patient-years were analysed by on-study nadir ALC. RESULTS With fingolimod, ALC rapidly reduced to 29.9%-34.4% of baseline values within 2 weeks and remained stable thereafter; no relevant changes observed with interferon. IRs of infAEs were 67.6 with fingolimod and 61.8 with interferon; IR ratios with respect to interferon, overall: 1.09, by nadir ALC 0.2-0.4 × 109/L: 1.13 and >0.4 × 109/L: 0.91. Three patients had a single episode of ALC <0.2 × 109/L (core phase). No opportunistic infections were observed and infection risk did not increase during the extension phase. CONCLUSION In paediatric patients, the overall incidence of infections was comparable between fingolimod and interferon. No association was observed between nadir ALC and infections in POMS, although sample size may have been too small to rule an association.
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Affiliation(s)
- Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA, USA
| | - Brenda Banwell
- The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Krupp
- Pediatric MS Center, NYU Langone, New York, NY, USA
| | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada/ NeuroRx Research, Montreal, QC, Canada
| | - Amit Bar-Or
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wolfgang Brück
- Department of Neuropathology, University Medical Centre, Göttingen, Germany
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Benjamin Greenberg
- Departments of Neurology and Neurotherapeutics, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Angelo Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Gallarate, Italy
| | - Emmanuelle Waubant
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kevin Rostasy
- Division of Paediatric Neurology, Children's Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - Kumaran Deiva
- Pediatric Neurology Department, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, site Bicêtre, Le Kremlin Bicêtre, France
| | - Peter Huppke
- Division of Paediatric Neurology, Department of Paediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
| | - Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Ying Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Jutta Gärtner
- Division of Paediatric Neurology, Department of Paediatrics and Adolescent Medicine, University Medical Centre Göttingen, Georg August University Göttingen, Göttingen, Germany
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Stampanoni Bassi M, Iezzi E, Drulovic J, Pekmezovic T, Gilio L, Furlan R, Finardi A, Marfia GA, Sica F, Centonze D, Buttari F. IL-6 in the Cerebrospinal Fluid Signals Disease Activity in Multiple Sclerosis. Front Cell Neurosci 2020; 14:120. [PMID: 32655367 PMCID: PMC7324533 DOI: 10.3389/fncel.2020.00120] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 02/17/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
Specific proinflammatory and anti-inflammatory molecules could represent useful cerebrospinal fluid (CSF) biomarkers to predict the clinical course of multiple sclerosis (MS). The proinflammatory molecule interleukin (IL)-6 has been investigated in the pathophysiology of MS and has been associated in previous smaller studies to increased disability and disease activity. Here, we wanted to further address IL-6 as a possible CSF biomarker of MS by investigating its detectability in a large cohort of 534 MS patients and in 103 individuals with other non-inflammatory neurological diseases. In these newly diagnosed patients, we also explored correlations between IL-6 detectability, MS phenotypes, and disease characteristics. We found that IL-6 was more frequently detectable in the CSF of MS patients compared with their control counterparts as significant differences emerged between patients with Clinically isolated syndrome (CIS), Relapsing–remitting (RR), and secondary progressive and primary progressive MS compared to non-inflammatory controls. IL-6 was equally present in the CSF of all MS phenotypes. In RR MS patients, IL-6 detectability was found to signal clinically and/or radiologically defined disease activity, among all other clinical characteristics. Our results add further evidence that CSF proinflammatory cytokines could be useful for the identification of those MS patients who are prone to increased disease activity. In particular, IL-6 could represent an interesting prognostic biomarker of MS, as also demonstrated in other diseases where CSF IL-6 was found to identify patients with worse disease severity.
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Affiliation(s)
| | - Ennio Iezzi
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Jelena Drulovic
- Clinic of Neurology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Belgrade, Serbia
| | - Luana Gilio
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Roberto Furlan
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Annamaria Finardi
- Clinical Neuroimmunology Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Girolama Alessandra Marfia
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy.,Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Sica
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Diego Centonze
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy.,Synaptic Immunopathology Lab, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Fabio Buttari
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
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5
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Arrambide G, Iacobaeus E, Amato MP, Derfuss T, Vukusic S, Hemmer B, Brundin L, Tintore M. Aggressive multiple sclerosis (2): Treatment. Mult Scler 2020; 26:1352458520924595. [PMID: 32530366 PMCID: PMC7412878 DOI: 10.1177/1352458520924595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/13/2019] [Revised: 03/18/2020] [Accepted: 04/16/2020] [Indexed: 01/04/2023]
Abstract
The natural history of multiple sclerosis (MS) is highly heterogeneous. A subgroup of patients has what might be termed aggressive MS. These patients may have frequent, severe relapses with incomplete recovery and are at risk of developing greater and permanent disability at the earlier stages of the disease. Their therapeutic window of opportunity may be narrow, and while it is generally considered that they will benefit from starting early with a highly efficacious treatment, a unified definition of aggressive MS does not exist and data on its treatment are largely lacking. Based on discussions at an international focused workshop sponsored by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), we review our current knowledge about treatment of individuals with aggressive MS. We analyse the available evidence, identify gaps in knowledge and suggest future research needed to fill those gaps. A companion paper details the difficulties in developing a consensus about what defines aggressive MS.
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Affiliation(s)
- Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ellen Iacobaeus
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Tobias Derfuss
- Departments of Neurology and Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sandra Vukusic
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Centre des Neurosciences de Lyon, Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France/Faculté de médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany/Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Lou Brundin
- Division of Neurology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Mar Tintore
- Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (Cemcat), Vall d’Hebron Institut de Recerca, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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6
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Berger T, Brochet B, Brambilla L, Giacomini PS, Montalbán X, Vasco Salgado A, Su R, Bretagne A. Effectiveness of delayed-release dimethyl fumarate on patient-reported outcomes and clinical measures in patients with relapsing-remitting multiple sclerosis in a real-world clinical setting: PROTEC. Mult Scler J Exp Transl Clin 2019; 5:2055217319887191. [PMID: 31832225 PMCID: PMC6891011 DOI: 10.1177/2055217319887191] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/11/2019] [Accepted: 09/19/2019] [Indexed: 11/16/2022] Open
Abstract
Background Patient-reported outcomes (PRO) and clinical outcomes give a broad assessment of relapsing-remitting multiple sclerosis (RRMS) disease. Objective The aim is to evaluate the effectiveness of delayed-release dimethyl fumarate (DMF) on disease activity and PROs in patients with RRMS in the clinic. Methods PROTEC, a phase 4, open-label, 12-month observational study, assessed annualized relapse rate (ARR), proportion of patients relapsed, and changes in PROs. Newly diagnosed and early MS (≤3.5 EDSS and ≤1 relapse in the prior year) patient subgroups were evaluated. Results Unadjusted ARR at 12 months post-DMF versus 12 months before DMF initiation was 75% lower (0.161 vs. 0.643, p < 0.0001) overall (n = 1105) and 84%, 77%, and 71% lower in newly diagnosed, ≤3.5 EDSS, and ≤1 relapse subgroups, respectively. Overall, 88% of patients were relapse-free 12 months after DMF initiation (84%, newly diagnosed; 88%, ≤3.5 EDSS; 88%, ≤1 relapse). PRO measures for fatigue, treatment satisfaction, daily living, and work improved significantly over 12 months of DMF versus baseline. Conclusion At 12 months after versus 12 months before DMF initiation, ARR was significantly lower, the majority of patients were relapse-free, and multiple PRO measures showed improvement (overall and for subgroups), suggesting that DMF is effective based on clinical outcomes and from a patient perspective.Clinical trial: A Study Evaluating the Effectiveness of Tecfidera (Dimethyl Fumarate) on Multiple Sclerosis (MS) Disease Activity and Patient-Reported Outcomes (PROTEC), NCT01930708, https://clinicaltrials.gov/ct2/show/NCT01930708.
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Affiliation(s)
- T Berger
- Universitätsklinik für Neurologie, Medizinische Universität, Austria
| | - B Brochet
- Groupe Hospitalier Pellegrin Hôpital Pellegrin, France
| | - L Brambilla
- IRCCS Foundation Neurological Institute Carlo Besta, Italy
| | - P S Giacomini
- Montreal Neurological Institute & Hospital, McGill University Health Center, Canada
| | - X Montalbán
- Division of Neurology, St Michael's Hospital, University of Toronto, Canada.,Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Spain
| | - A Vasco Salgado
- Hospital Professor Doutor Fernando Fonseca, E.P.E., Portugal
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7
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Zecca C, Bovis F, Novi G, Capobianco M, Lanzillo R, Frau J, Repice AM, Hakiki B, Realmuto S, Bonavita S, Curti E, Brambilla L, Mataluni G, Cavalla P, Di Sapio A, Signoriello E, Barone S, Maniscalco GT, Maietta I, Maraffi I, Boffa G, Malucchi S, Nozzolillo A, Coghe G, Mechi C, Salemi G, Gallo A, Sacco R, Cellerino M, Malentacchi M, De Angelis M, Lorefice L, Magnani E, Prestipino E, Sperli F, Brescia Morra V, Fenu G, Barilaro A, Abbadessa G, Signori A, Granella F, Amato MP, Uccelli A, Gobbi C, Sormani MP. Treatment of multiple sclerosis with rituximab: A multicentric Italian-Swiss experience. Mult Scler 2019; 26:1519-1531. [PMID: 31573386 DOI: 10.1177/1352458519872889] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 12/23/2022]
Abstract
BACKGROUND Rituximab, an anti-CD20 monoclonal antibody leading to B lymphocyte depletion, is increasingly used as an off-label treatment option for multiple sclerosis (MS). OBJECTIVE To investigate the effectiveness and safety of rituximab in relapsing-remitting (RR) and progressive MS. METHODS This is a multicenter, retrospective study on consecutive MS patients treated off-label with rituximab in 22 Italian and 1 Swiss MS centers. Relapse rate, time to first relapse, Expanded Disability Status Scale (EDSS) progression, incidence of adverse events, and radiological outcomes from 2009 to 2019 were analyzed. RESULTS A total of 355/451 enrolled subjects had at least one follow-up visit and were included in the outcome analysis. Annualized relapse rate significantly decreases after rituximab initiation versus the pre-rituximab start year in RRMS (from 0.86 to 0.09, p < .0001) and in secondary-progressive (SP) MS (from 0.34 to 0.06, p < .0001) and had a slight decrease in primary-progressive (PP) MS patients (from 0.12 to 0.07, p = 0.45). After 3 years from rituximab start, the proportion of patients with a confirmed EDSS progression was 14.6% in the RRMS group, 24.7% in the SPMS group, and 41.5% in the PPMS group. No major safety concerns arose. CONCLUSION Consistently with other observational studies, our data show effectiveness of rituximab in reducing disease activity in patients with MS.
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Affiliation(s)
- Chiara Zecca
- Neurocentre of Southern Switzerland, Department of Neurology, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Giovanni Novi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Capobianco
- SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla, AOU San Luigi, Orbassano, Italy
| | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Jessica Frau
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Sabrina Realmuto
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy/AOOR Villa Sofia-Cervello, Centro di Neuroimmunologia, UOC di Neurologia e Stroke Unit, Palermo, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Erica Curti
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Laura Brambilla
- Department of Neuroimmunology and Neuromuscular Diseases, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | - Giorgia Mataluni
- Multiple Sclerosis Unit, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Cavalla
- Multiple Sclerosis Center, Department of Neurosciences and Mental Health, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Alessia Di Sapio
- Department of Neurology, Ospedale Regina Montis Regalis-ASLCN1, Mondovì, Italy
| | - Elisabetta Signoriello
- Multiple Sclerosis Center, II Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefania Barone
- Institute of Neurology, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giorgia T Maniscalco
- Neurological Clinic and Multiple Sclerosis Center, "AORN A.Cardarelli," Naples, Italy
| | - Ilaria Maietta
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Isabella Maraffi
- Neurocentre of Southern Switzerland, Department of Neurology, Ospedale Civico, Lugano, Switzerland
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simona Malucchi
- SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla, AOU San Luigi, Orbassano, Italy
| | - Agostino Nozzolillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Claudia Mechi
- Regional MS Center, Careggi University Hospital, Florence, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Rosaria Sacco
- Neurocentre of Southern Switzerland, Department of Neurology, Ospedale Civico, Lugano, Switzerland
| | - Maria Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Malentacchi
- SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla, AOU San Luigi, Orbassano, Italy
| | - Marcello De Angelis
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lorena Lorefice
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eliana Magnani
- Regional MS Center, Careggi University Hospital, Florence, Italy
| | - Elio Prestipino
- NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Francesca Sperli
- SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla, AOU San Luigi, Orbassano, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Fenu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Gianmarco Abbadessa
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Franco Granella
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria Pia Amato
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy/NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Gobbi
- Neurocentre of Southern Switzerland, Department of Neurology, Ospedale Civico, Lugano, Switzerland
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy/IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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8
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Abstract
Multiple sclerosis (MS), a chronic autoimmune disorder, affects the central nervous system (CNS). It affects the brain, spinal cord, and optic nerve, leading to problems with vision, balance, muscle control, and other basic bodily functions. MS relapse (MSR) involves an acute inflammatory demyelinating reaction within the CNS. This review focuses on the main factors involved in MSR based on a detailed literature search. Evidence suggests that MSR is influenced by age, sex, pregnancy, serum levels of Vitamin D, interactions between genetic and environmental factors, and infectious diseases. Many of these factors are modifiable and require the attention of patients and health-care providers if favorable outcomes are to be realized. Identification of MSR risk factors can help in the development of therapies that could be used to manage MS and MSR.
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Affiliation(s)
- Fatemah Omar Kamel
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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9
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Maltby VE, Lea RA, Ribbons KA, Sanders KA, Kennedy D, Min M, Scott RJ, Lechner-Scott J. DNA methylation changes in CD4 + T cells isolated from multiple sclerosis patients on dimethyl fumarate. Mult Scler J Exp Transl Clin 2018; 4:2055217318787826. [PMID: 30038789 PMCID: PMC6050818 DOI: 10.1177/2055217318787826] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/23/2018] [Accepted: 05/24/2018] [Indexed: 12/26/2022] Open
Abstract
Background Dimethyl fumarate is an oral treatment for multiple sclerosis, whose mechanism of action is not fully understood. Objective To investigate the effects of dimethyl fumarate on DNA methylation in the CD4+ T cells of multiple sclerosis patients. Methods We performed Illumina EPIC arrays to investigate the DNA methylation profiles of CD4+ T cells derived from multiple sclerosis patients before and after dimethyl fumarate treatment. Results Treatment with dimethyl fumarate resulted in 97% of differentially methylated positions showing hypermethylation. Four genes, SNORD1A, SHTN1, MZB1 and TNF had a differentially methylated region located within the transcriptional start site. Conclusion This study investigates the effect of dimethyl fumarate on DNA methylation in multiple sclerosis patients.
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Affiliation(s)
- Vicki E Maltby
- School of Medicine and Public Health, University of Newcastle, Australia.,Brain and Mental Health, Hunter Medical Research Institute, Australia
| | - Rodney A Lea
- Brain and Mental Health, Hunter Medical Research Institute, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia
| | - Karen A Ribbons
- Brain and Mental Health, Hunter Medical Research Institute, Australia.,Department of Neurology, John Hunter Hospital, Australia
| | | | - Daniel Kennedy
- ARC Centre of Excellence for the Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Australia
| | - Myintzu Min
- Brain and Mental Health, Hunter Medical Research Institute, Australia.,Department of Neurology, John Hunter Hospital, Australia
| | - Rodney J Scott
- Brain and Mental Health, Hunter Medical Research Institute, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Australia.,Department of Medical Genetics, John Hunter Hospital, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University of Newcastle, Australia.,Brain and Mental Health, Hunter Medical Research Institute, Australia.,Department of Neurology, John Hunter Hospital, Australia
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10
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Zipser CM, Premoli I, Belardinelli P, Castellanos N, Rivolta D, Heidegger T, Müller-Dahlhaus F, Ziemann U. Cortical Excitability and Interhemispheric Connectivity in Early Relapsing-Remitting Multiple Sclerosis Studied With TMS-EEG. Front Neurosci 2018; 12:393. [PMID: 29937712 PMCID: PMC6002497 DOI: 10.3389/fnins.2018.00393] [Citation(s) in RCA: 23] [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: 01/31/2018] [Accepted: 05/22/2018] [Indexed: 12/26/2022] Open
Abstract
Evoked potentials (EPs) are well established in clinical practice for diagnosis and prognosis in multiple sclerosis (MS). However, their value is limited to the assessment of their respective functional systems. Here, we used transcranial magnetic stimulation (TMS) coupled with electroencephalography (TMS-EEG) to investigate cortical excitability and spatiotemporal dynamics of TMS-evoked neural activity in MS patients. Thirteen patients with early relapsing–remitting MS (RRMS) with a median Expanded Disability Status Scale (EDSS) of 1.0 (range 0–2.5) and 16 age- and gender-matched healthy controls received single-pulse TMS of left and right primary motor cortex (L-M1 and R-M1), respectively. Resting motor threshold for L-M1 and R-M1 was increased in MS patients. Latencies and amplitudes of N45, P70, N100, P180, and N280 TMS-evoked EEG potentials (TEPs) were not different between groups, except a significantly increased amplitude of the N280 TEP in the MS group, both for L-M1 and R-M1 stimulation. Interhemispheric signal propagation (ISP), estimated from the area under the curve of TEPs in the non-stimulated vs. stimulated M1, also did not differ between groups. In summary, findings show that ISP and TEPs were preserved in early-stage RRMS, except for an exaggerated N280 amplitude. Our findings indicate that TMS-EEG is feasible in testing excitability and connectivity in cortical neural networks in MS patients, complementary to conventional EPs. However, relevance and pathophysiological correlates of the enhanced N280 will need further study.
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Affiliation(s)
- Carl M Zipser
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Isabella Premoli
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Paolo Belardinelli
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Nazareth Castellanos
- Nirakara: Instituto de Investigación y Formación en Ciencias Cognitivas, Madrid, Spain
| | - Davide Rivolta
- Department of Education Science, Psychology and Communication Science, University of Bari Aldo Moro, Bari, Italy
| | - Tonio Heidegger
- Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Müller-Dahlhaus
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Tübingen, Germany
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11
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Gärtner J, Brück W, Weddige A, Hummel H, Norenberg C, Bugge JP. Interferon beta-1b in treatment-naïve paediatric patients with relapsing-remitting multiple sclerosis: Two-year results from the BETAPAEDIC study. Mult Scler J Exp Transl Clin 2018; 3:2055217317747623. [PMID: 29318028 PMCID: PMC5753955 DOI: 10.1177/2055217317747623] [Citation(s) in RCA: 4] [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: 03/27/2017] [Revised: 09/27/2017] [Accepted: 11/05/2017] [Indexed: 11/15/2022] Open
Abstract
Background and objective Study evaluating Betaferon(R)'s safety and tolerability in paediatric patients with multiple sclerosis (BETAPAEDIC) is a prospective, open-label observational multicentre study to assess the safety and effectiveness of interferon beta-1b in paediatric patients with relapsing-remitting multiple sclerosis. Methods Treatment-naïve patients (12-16 years) scheduled to start interferon beta-1b were enrolled with follow-up visits every six months for two years. Effectiveness was evaluated by annualised relapse rate, Expanded Disability Status Scale progression, cranial magnetic resonance imaging and cognitive testing. Fatigue was assessed by the Fatigue Severity Scale. Results Sixty-eight patients were screened and 67 enrolled, with mean (standard deviation) age 14.2 (1.3) years (n=65 in the effectiveness analysis). Mean disease duration was 11 months before study enrolment; at baseline, mean (standard deviation) Expanded Disability Status Scale was 0.6 (1.0); T2 lesion number 18.3 (15.1). Mean annualised relapse rate during the study was 0.7 (n=57), 28/57 patients (49.1%) had no relapses and for 40/52 (76.9%) no Expanded Disability Status Scale progression was observed; 23/56 (41.1%) were relapse- and progression-free to last follow-up. Neuropsychological test and fatigue scores were within normal ranges (baseline and last follow-up). Eighteen patients had fatigue at some point. New T2 and gadolinium-enhancing (Gd+) lesions were seen in 43/55 (66.2%) and 29/55 (52.7%) patients respectively. Most frequent adverse events were influenza-like illness, headache, injection-site reactions and elevated liver enzymes. Conclusion Interferon beta-1b is an effective treatment with a favourable safety profile for paediatric patients.
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Affiliation(s)
- Jutta Gärtner
- Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Germany
| | - Wolfgang Brück
- Department of Neuropathology, University Medical Center Göttingen, Germany
| | - Almuth Weddige
- Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Germany
| | - Hannah Hummel
- Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Germany
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12
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Parsons ME, O'Connell K, Allen S, Egan K, Szklanna PB, McGuigan C, Ní Áinle F, Maguire PB. Thrombin generation correlates with disease duration in multiple sclerosis (MS): Novel insights into the MS-associated prothrombotic state. Mult Scler J Exp Transl Clin 2017; 3:2055217317747624. [PMID: 29318029 PMCID: PMC5753921 DOI: 10.1177/2055217317747624] [Citation(s) in RCA: 9] [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: 05/30/2017] [Revised: 11/08/2017] [Accepted: 11/12/2017] [Indexed: 11/18/2022] Open
Abstract
Background Thrombin is well recognised for its role in the coagulation cascade but it also plays a role in inflammation, with enhanced thrombin generation observed in several inflammatory disorders. Although patients with multiple sclerosis (MS) have a higher incidence of thrombotic disease, thrombin generation has not been studied to date. Objectives The aim of this study was to characterise calibrated automated thrombography parameters in patients with relapsing–remitting MS (RRMS) and primary progressive MS (PPMS) in comparison to healthy controls (HCs). Methods Calibrated automated thrombography was performed on platelet poor plasma from 15 patients with RRMS, 15 with PPMS and 19 HCs. Results We found that patients with RRMS generate thrombin at a significantly faster rate than the less inflammatory subtype, PPMS or HCs. In addition, the speed of thrombin generation was significantly correlated with time from clinical diagnosis in both subtypes. However, in RRMS the rate of thrombin generation was increased with increased time from clinical diagnosis, while in PPMS the rate of thrombin generation decreased with increased time from clinical diagnosis. Conclusions These data likely reflect the differential active proinflammatory states in each MS subtype and provide novel mechanistic insights into the clinically relevant prothrombotic state observed in these patients.
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13
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Furber KL, Van Agten M, Evans C, Haddadi A, Doucette JR, Nazarali AJ. Advances in the treatment of relapsing-remitting multiple sclerosis: the role of pegylated interferon β-1a. Degener Neurol Neuromuscul Dis 2017; 7:47-60. [PMID: 30050377 PMCID: PMC6053102 DOI: 10.2147/dnnd.s71986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is a progressive, neurodegenerative disease with unpredictable phases of relapse and remission. The cause of MS is unknown, but the pathology is characterized by infiltration of auto-reactive immune cells into the central nervous system (CNS) resulting in widespread neuroinflammation and neurodegeneration. Immunomodulatory-based therapies emerged in the 1990s and have been a cornerstone of disease management ever since. Interferon β (IFNβ) was the first biologic approved after demonstrating decreased relapse rates, disease activity and progression of disability in clinical trials. However, frequent dosing schedules have limited patient acceptance for long-term therapy. Pegylation, the process by which molecules of polyethylene glycol are covalently linked to a compound, has been utilized to increase the half-life of IFNβ and decrease the frequency of administration required. To date, there has been one clinical trial evaluating the efficacy of pegylated IFN. The purpose of this article is to provide an overview of the role of IFN in the treatment of MS and evaluate the available evidence for pegylated IFN therapy in MS.
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Affiliation(s)
- Kendra L Furber
- Laboratory of Molecular Cell Biology, .,College of Pharmacy and Nutrition, .,Neuroscience Research Cluster, University of Saskatchewan,
| | - Marina Van Agten
- Laboratory of Molecular Cell Biology, .,College of Pharmacy and Nutrition, .,Neuroscience Research Cluster, University of Saskatchewan,
| | - Charity Evans
- College of Pharmacy and Nutrition, .,Cameco Multiple Sclerosis Neuroscience Research Center, City Hospital,
| | | | - J Ronald Doucette
- Neuroscience Research Cluster, University of Saskatchewan, .,Cameco Multiple Sclerosis Neuroscience Research Center, City Hospital, .,Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Adil J Nazarali
- Laboratory of Molecular Cell Biology, .,College of Pharmacy and Nutrition, .,Neuroscience Research Cluster, University of Saskatchewan, .,Cameco Multiple Sclerosis Neuroscience Research Center, City Hospital,
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14
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Watson C, Prosser C, Braun S, Landsman-Blumberg PB, Gleissner E, Naoshy S. Health care resource utilization before and after natalizumab initiation among patients with multiple sclerosis in Germany. Clinicoecon Outcomes Res 2017; 9:85-97. [PMID: 28203098 PMCID: PMC5293187 DOI: 10.2147/ceor.s117962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/03/2022] Open
Abstract
Background Multiple sclerosis (MS), a progressive neurodegenerative disease, greatly impacts the quality of life and economic status of people affected by this disease. In Germany, the total annual cost of MS is estimated at €40,000 per person with MS. Natalizumab has shown to slow MS disease progression, reduce relapses, and improve the quality of life of people with MS. Objective To evaluate MS-related and all-cause health care resource utilization and costs among German MS patients during the 12 months before and after initiation of natalizumab in a real-world setting. Methods The current analysis was conducted using the Health Risk Institute research database. Identified patients were aged ≥18 years with ≥1 diagnosis of MS and had initiated natalizumab therapy (index), with 12-month pre– and post–index-period data. Patients were stratified by prior disease-modifying therapy (DMT) usage or no DMT usage in the pre-index period. Outcome measures included corticosteroid use and number of sick/disability days, inpatient stays, and outpatient visits. Health care costs were calculated separately for pre- and post-index periods on a per-patient basis and adjusted for inflation. Results In a final sample of 193 natalizumab-treated patients, per-patient MS-related corticosteroid use was reduced by 62.3%, MS-related sick days by 27.6%, and inpatient costs by 78.3% from the pre- to post-index period. Furthermore, the proportion of patients with MS-related hospitalizations decreased from 49.7% to 14.0% (P<0.001); this reduction was seen for patients with and without prior DMT use. Conclusions In a real-world setting in Germany, initiation of natalizumab treatment in people with MS significantly reduced MS-related hospitalizations, corticosteroid use, sick days, and associated costs.
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Affiliation(s)
- Crystal Watson
- Health Economics and Outcomes Research, Global Market Access, Biogen, Cambridge, MA, USA
| | | | | | | | | | - Sarah Naoshy
- Health Economics and Outcomes Research, Global Market Access, Biogen, Cambridge, MA, USA
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15
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Bhargava P, Newsome SD. An update on the evidence base for peginterferon β1a in the treatment of relapsing-remitting multiple sclerosis. Ther Adv Neurol Disord 2016; 9:483-490. [PMID: 27800024 DOI: 10.1177/1756285616656296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Peginterferon β1a is a modified form of interferon β1a with a polyethylene glycol (PEG) group attached to the α-amino group of the N terminus of the interferon molecule. This modification alters the pharmacokinetic and pharmacodynamic properties of interferon β1a, enabling reduced frequency of dosing and may also result in reduced immunogenicity of the interferon β1a molecule. The efficacy of peginterferon β1a 125 µg administered subcutaneously every 2 or 4 weeks was demonstrated at the end of the placebo-controlled period in the phase III ADVANCE study; both dosing regimens met their primary endpoint of reducing annualized relapse rate (ARR) compared with placebo. Peginterferon β1a administered every 2 weeks resulted in a more robust treatment effect on ARR, sustained disability progression and magnetic resonance imaging endpoints (new or enlarging T2 lesions and gadolinium-enhanced lesions) than peginterferon β1a every 4 weeks. Further reductions in the ARR with additional positive impact on magnetic resonance imaging outcomes were noted in year 2 of the ADVANCE study with the every 2-week dosing regimen. An adverse-effect profile similar to other interferon β formulations coupled with the advantage of a significant reduction in the number of injections, could lead to improved long-term adherence to peginterferon β1a. We review the evidence base for the role of peginterferon β1a in the treatment of relapsing-remitting multiple sclerosis.
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Affiliation(s)
- Pavan Bhargava
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Scott D Newsome
- Johns Hopkins Hospital, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA
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16
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Buscarinu MC, Cerasoli B, Annibali V, Policano C, Lionetto L, Capi M, Mechelli R, Romano S, Fornasiero A, Mattei G, Piras E, Angelini DF, Battistini L, Simmaco M, Umeton R, Salvetti M, Ristori G. Altered intestinal permeability in patients with relapsing-remitting multiple sclerosis: A pilot study. Mult Scler 2016; 23:442-446. [PMID: 27270497 DOI: 10.1177/1352458516652498] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [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: 12/11/2022]
Abstract
BACKGROUND Alterations of intestinal permeability (IP) may contribute to the pathophysiology of immune-mediated diseases. OBJECTIVE We investigated the possible association between IP changes and multiple sclerosis (MS). METHODS We studied 22 patients with relapsing-remitting multiple sclerosis (RRMS) and 18 age- and sex-matched healthy donors (HDs), including five twin pairs (one concordant, and four discordant for disease). Measurement of lactulose (L) and mannitol (M; two non-metabolized sugars) levels in urine samples, after an oral load, allowed to quantify gut dysfunction. RESULTS The proportion of participants with increased IP was significantly higher in patients than in HDs (16/22 (73%) versus 5/18 (28%); p = 0.001). Accordingly, the L/M urinary ratio showed significantly higher values in patients than in controls ( p = 0.0284). Urinary mannitol concentration was significantly lower in patients than in controls ( p = 0.022), suggesting a deficit of absorption from intestinal lumen. Such changes did not appear related to patients' clinical-radiological features. CONCLUSION The relatively high proportion of IP changes in RR-MS patients seems to confirm our work hypothesis and warrants more work to confirm the result on a larger sample, and to understand the implications for related immunological disturbances and intestinal microbiota alterations. Our finding may also have relevance for oral treatments, recently introduced in clinical practice.
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Affiliation(s)
- Maria Chiara Buscarinu
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Benedetta Cerasoli
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Viviana Annibali
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Claudia Policano
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Luana Lionetto
- Advanced Molecular Diagnostics Unit, IDI-IRCCS, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - Matilde Capi
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Rosella Mechelli
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Silvia Romano
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Arianna Fornasiero
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Gianluca Mattei
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Eleonora Piras
- Neuroimmunology Unit, Fondazione Santa Lucia, Rome, Italy
| | | | | | - Maurizio Simmaco
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Renato Umeton
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Salvetti
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Giovanni Ristori
- Center for Experimental Neurological Therapies, Sant'Andrea Hospital, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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17
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Jacques FH, Harel BT, Schembri AJ, Paquette C, Bilodeau B, Kalinowski P, Roy R. Cognitive evolution in natalizumab-treated multiple sclerosis patients. Mult Scler J Exp Transl Clin 2016; 2:2055217316657116. [PMID: 28607732 PMCID: PMC5408753 DOI: 10.1177/2055217316657116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/05/2016] [Accepted: 06/06/2016] [Indexed: 11/23/2022] Open
Abstract
Background Cognitive dysfunction affects up to 65% of multiple sclerosis (MS) patients and progresses over time. Natalizumab has been shown to be superior to placebo in preserving cognition for the first two years of therapy. Objectives The objectives of this study are to understand the impact of natalizumab on cognition beyond two years of therapy and to investigate whether baseline characteristics are predictive of clinical response. Methods This is a single-center, 24-month, observational study. Sixty-three patients treated with natalizumab were assessed prior to monthly infusions using a Cogstate battery and the Symbol Digit Modalities Test (SDMT). Patient demographics were collected at baseline. A linear mixed model was conducted with duration of natalizumab therapy as a between-subjects factor (≤2 or >2 years), assessment as a within-subjects factor, and Multiple Sclerosis Severity Score (MSSS) as a covariate. Results Aside from the MSSS (p = 0.0074), the two groups were identical. No patient showed evidence of sustained cognitive deterioration over the 24-month period. Baseline parameters including impaired cognition did not influence the trajectory of cognitive change over 24 months. Conclusions Our results suggest that natalizumab preserves cognition following four to seven years of continuous therapy. This occurs irrespective of baseline characteristics, including impaired cognition.
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18
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Guttmann CR, Rousset M, Roch JA, Hannoun S, Durand-Dubief F, Belaroussi B, Cavallari M, Rabilloud M, Sappey-Marinier D, Vukusic S, Cotton F. Multiple sclerosis lesion formation and early evolution revisited: A weekly high-resolution magnetic resonance imaging study. Mult Scler 2015; 22:761-9. [PMID: 26362901 DOI: 10.1177/1352458515600247] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several magnetic resonance imaging (MRI) studies investigated the evolution of multiple sclerosis (MS) lesions to understand the pathophysiological mechanisms leading to blood-brain barrier breakdown and lesion formation. Only a few assessed the early natural history of MS lesions using short-interval longitudinal MRI. OBJECTIVE The purpose of this study was to characterize MS lesion occurrence and early evolution on high-resolution MRI acquired at weekly intervals. METHODS Active lesions were characterized on 3D fluid attenuation inversion recovery (FLAIR) and gadolinium-enhanced 3D T1-weighted MRI performed weekly (seven weeks) on five untreated patients with relapsing-remitting MS (RRMS). RESULTS Active lesions (n=212) were detected in all patients. All showed contrast-enhancement on at least one time-point. Most new lesions (83.5%) were visible on FLAIR and post-contrast T1-weighted images at first detection; 11.2% showed activity on FLAIR images, one or more weeks before the appearance of contrast-enhancement; 12.5% enhanced before being apparent on FLAIR. CONCLUSION Blood brain barrier disruption is a constant step in the natural history of active MS lesions, but does not always constitute the initial event. These findings are consistent with the existence of a subpopulation of lesions with an 'inside-out' genesis, where neurodegenerative processes might precede microglial activation, and a subsequent adaptive immune response.
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Affiliation(s)
| | | | - Jean A Roch
- Service de Radiologie, Centre Hospitalier Lyon-Sud, France/CREATIS, Université de Lyon, France
| | | | | | | | | | | | | | | | - François Cotton
- Service de Radiologie, Centre Hospitalier Lyon-Sud, France/CREATIS, Université de Lyon, France
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19
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Abstract
BACKGROUND Multiple sclerosis (MS) predominantly affects women with a sex ratio of 3:1 in contrast with a 1:1 sex ratio seen in pre-pubertal onset. Thus, puberty may influence MS risk differentially in males and females. How puberty may be associated with MS clinical features and disease course remains unknown. OBJECTIVE The objective of this paper is to determine the association of menarche with disease course in girls with MS. METHODS This is a longitudinal retrospective study from the UCSF Regional Pediatric MS Center database. We categorized patients by time of disease onset: pre-menarche, peri-menarche and post-menarche. Poisson regression models were used for within-subject relapse analyses offset by follow-up time. RESULTS Seventy-six girls were included (pre-menarche onset = 17; peri-menarche onset = 9; post-menarche onset = 50). Age of menarche was similar in all groups (Kruskal-Wallis p = 0.19). Relapse rate was the same in all three groups during the first two years of follow-up. In girls with follow-up overlapping at least two time periods, within-subject analyses showed increased relapses during the peri-menarche compared to post-menarche period (adjusted IRR = 8.5, 95% CI 2.5-28.7, p = 0.001). CONCLUSION Pubertal status may influence MS course at least in female patients. Understanding how puberty influences MS clinical features may offer new insights into important factors regulating disease processes.
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20
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Lopez de Lapuente A, Pinto-Medel MJ, Astobiza I, Alloza I, Comabella M, Malhotra S, Montalban X, Zettl UK, Rodríguez-Antigüedad A, Fernández O, Vandenbroeck K. Cell-specific effects in different immune subsets associated with SOCS1 genotypes in multiple sclerosis. Mult Scler 2015; 21:1498-512. [PMID: 25623250 DOI: 10.1177/1352458514566418] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/19/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Single nucleotide polymorphisms (SNPs) near SOCS1 are associated with multiple sclerosis (MS), but the most important SNPs in the area and mechanisms by which they influence the disease are unknown. METHODS A haplotype-tagging association study was performed covering 60.5kbp around SOCS1, and the index SNP was validated in a total of 2292 individuals. mRNA expression of SOCS1 and nearby genes was measured in MS patients with different disease courses and healthy controls. SOCS1 protein expression was studied by flow cytometry in a separate cohort of patients and controls. Differentiation and maturation of monocyte-derived dendritic cells (moDCs) were also studied. RESULTS One SNP, rs423674, reached genome-wide significance. No genotype-specific mRNA expression differences were seen, but, by flow cytometry, significant interactions were observed between genotypes for rs423674 and disease activity (relapse or remission) in B cells and regulatory T cells. Furthermore, homozygotes for the risk allele (GG) showed higher levels of CD1a and CD86 than carriers of the protective allele (GT) in immature moDCs and a greater increase of HLA-DR+ cell percentage than GT heterozygotes upon maturation. CONCLUSIONS rs423674, or its genetic proxies, may influence MS risk by modulating SOCS1 expression in a cell-specific manner and by influencing dendritic cell function.
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Affiliation(s)
- Aitzkoa Lopez de Lapuente
- Neurogenomiks Group, Universidad del País Vasco (UPV/EHU), Spain/Achucarro Basque Center for Neuroscience, Spain
| | - María Jesús Pinto-Medel
- Research Laboratory, Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya and Fundación IMABIS
| | - Ianire Astobiza
- Neurogenomiks Group, Universidad del País Vasco (UPV/EHU), Spain/Achucarro Basque Center for Neuroscience, Spain
| | - Iraide Alloza
- Neurogenomiks Group, Universidad del País Vasco (UPV/EHU), Spain/ Achucarro Basque Center for Neuroscience, Spain/ IKERBASQUE, Basque Foundation for Science, Spain
| | - Manuel Comabella
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Sunny Malhotra
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Institut de Recerca Vall d'Hebron (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Uwe K Zettl
- University of Rostock, Department of Neurology, Germany
| | | | - Oscar Fernández
- Research Laboratory, Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya and Fundación IMABIS
| | - Koen Vandenbroeck
- Neurogenomiks Group, Universidad del País Vasco (UPV/EHU), Spain/ Achucarro Basque Center for Neuroscience, Spain/ IKERBASQUE, Basque Foundation for Science, Spain
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21
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Sorosina M, Esposito F, Guaschino C, Clarelli F, Barizzone N, Osiceanu AM, Brambilla P, Mascia E, Cavalla P, Gallo P, Martinelli V, Leone M, Comi G, D'Alfonso S, Martinelli Boneschi F. Inverse correlation of genetic risk score with age at onset in bout-onset and progressive-onset multiple sclerosis. Mult Scler 2014; 21:1463-7. [PMID: 25533292 DOI: 10.1177/1352458514561910] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/14/2014] [Indexed: 11/15/2022]
Abstract
We correlated the weighted genetic risk score measured using 107 established susceptibility variants for multiple sclerosis (MS) with the age at onset in bout-onset (BOMS, n=906) and progressive-onset MS Italian patients (PrMS) (n=544). We observed an opposite relationship in the two disease courses: a higher weighted genetic risk score was associated with an earlier age at onset in BOMS (rho= -0.1; p=5 × 10(-3)) and a later age at onset in PrMS cases (rho=0.07; p=0.15) (p of difference of regression=1.4 × 10(-2)). These findings suggest that established MS risk variants anticipate the onset of the inflammatory phase, while they have no impact on, or even delay, the onset of the progressive phase.
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Affiliation(s)
- Melissa Sorosina
- Laboratory of Genetics of Neurological complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Federica Esposito
- Laboratory of Genetics of Neurological complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy/Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Clara Guaschino
- Laboratory of Genetics of Neurological complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy/Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Ferdinando Clarelli
- Laboratory of Genetics of Neurological complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Barizzone
- Interdisciplinary Research Centre of Autoimmune Disease IRCAD, University of Eastern Piedmont, Novara, Italy/Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Ana Maria Osiceanu
- Laboratory of Genetics of Neurological complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Paola Brambilla
- Laboratory of Genetics of Neurological complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Mascia
- Laboratory of Genetics of Neurological complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Paola Cavalla
- Multiple Sclerosis Centre, AOUS Giovanni Battista di Torino, Department of Neurosciences, University of Turin, Italy
| | - Paolo Gallo
- The Multiple Sclerosis Centre of Veneto Region, First Neurology Clinic, Department of Neurosciences, University Hospital of Padova, Padua, Italy
| | | | | | - Vittorio Martinelli
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Leone
- Interdisciplinary Research Centre of Autoimmune Disease IRCAD, University of Eastern Piedmont, Novara, Italy
| | - Giancarlo Comi
- Laboratory of Genetics of Neurological complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy/Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Sandra D'Alfonso
- Interdisciplinary Research Centre of Autoimmune Disease IRCAD, University of Eastern Piedmont, Novara, Italy/Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Filippo Martinelli Boneschi
- Laboratory of Genetics of Neurological complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy/Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
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22
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Verdun di Cantogno E, Tomlinson M, Manuel L, Thakur K. Autoinjector preference in multiple sclerosis and the role of nurses in treatment decisions: results from an international survey in Europe and the USA. Pragmat Obs Res 2014; 5:53-64. [PMID: 27774029 PMCID: PMC5045021 DOI: 10.2147/por.s72012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose This international survey recorded the opinions of multiple sclerosis (MS) nurses about their role in treatment decision making and about the importance of different attributes of autoinjectors used to deliver first-line parenteral therapy. Methods The survey involved 52 MS nurses in different practice settings in France, Germany, Italy, the UK, and the USA. Nurses described their role in patient education and in treatment decision making. They also rated the importance of nine prespecified attributes of autoinjectors and stated their preference, both overall and by attribute, for one of two autoinjectors used to deliver interferon β-1b (ExtaviPro® 30G and Betacomfort®). Nurses’ preferences were compared with those previously collected from patients using an identical questionnaire. Results There were pronounced differences between practice settings and between countries in the opinions of MS nurses about their influence on treatment decision making. Nurses considered themselves instrumental in helping patients decide between treatment options offered by neurologists. Of the nine autoinjector attributes, nurses rated “reliable to use” as most important, followed by attributes associated with convenience (“easy to operate,” “ergonomic shape,” “reach” [of injection sites], and “one-handed injection”). Nurses’ and patients’ rankings of attributes were closely aligned. For the nine attributes, 74%–98% of nurses preferred ExtaviPro® 30G to Betacomfort®, 94% preferring ExtaviPro® 30G overall. Nurses showed a greater preference than patients for ExtaviPro® 30G with respect to “easy to operate” (92% vs 78%), “intuitive to use” (98% vs 78%), and “attractive design” (98% vs 83%; P<0.05, all), but preference rates were otherwise similar across the two groups. The most common reasons in both groups for preferring ExtaviPro® 30G to Betacomfort® were “easy to use” and “ergonomic shape.” Conclusion MS nurses play a key role in patient guidance and education. Their preferences for ExtaviPro® 30G likely reflect their understanding of the challenges patients face when self-administering treatment.
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23
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Benedict RH, Morrow S, Rodgers J, Hojnacki D, Bucello MA, Zivadinov R, Weinstock-Guttman B. Characterizing cognitive function during relapse in multiple sclerosis. Mult Scler 2014; 20:1745-52. [PMID: 24842959 DOI: 10.1177/1352458514533229] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To characterize neuropsychological (NP) test performance during multiple sclerosis (MS) relapse and recovery. METHODS Clinical status was assessed with NP testing and Expanded Disability Status Scale (EDSS) in 24 relapsing patients, and 24 individually-matched, stable controls. All presented with cognitive symptoms as indicated by patient, clinician or caregiver perceived decline, but were free of optic neuritis, ataxia and upper extremity weakness that could compromise NP testing. The presence of enhancing magnetic resonance imaging (MRI) lesions was considered confirmatory of relapse. Relapsing patients were treated with corticosteroids. NP testing and EDSS were compared to pre-relapse baseline levels, and three-month, post-relapse, follow-up. RESULTS Analyses revealed significant decline on the Symbol Digit Modalities Test (SDMT) (p=0.005) and worsening on EDSS (p=0.019). Impairment was observed at the point of relapse in cases but not controls. The groups were no longer different at three-month follow-up. The increment of decline on SDMT was 3.5 raw score points, or roughly 6%. CONCLUSIONS This is the first study to assess NP status changes during MS relapse using well established, reliable metrics. The presence of a clinically meaningful event is substantiated by decline in NP testing, observed or reported cognitive change, and in a subset of patients, gadolinium-enhancing MRI lesions.
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Affiliation(s)
- Ralph Hb Benedict
- Buffalo General Hospital, Suite E2, 100 High Street, Buffalo, New York, 14203, USA
| | | | | | - David Hojnacki
- University at Buffalo, State University of New York, USA
| | | | - Robert Zivadinov
- State University of New York, USA/Buffalo Neuroimaging Analysis Center, State University of New York, USA/MRI Clinical Translational Research Center, State University of New York, USA
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24
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Kvistad S, Myhr KM, Holmøy T, Bakke S, Beiske AG, Bjerve KS, Hovdal H, Løken-Amsrud KI, Lilleås F, Midgard R, Njølstad G, Pedersen T, Benth JŠ, Wergeland S, Torkildsen O. Antibodies to Epstein-Barr virus and MRI disease activity in multiple sclerosis. Mult Scler 2014; 20:1833-40. [PMID: 24842958 DOI: 10.1177/1352458514533843] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 12/24/2022]
Abstract
BACKGROUND Previous reports indicate an association between Epstein-Barr virus (EBV) antibody levels and multiple sclerosis (MS) disease activity, but the results have been conflicting. OBJECTIVES The objective of this paper is to study if EBV antibody levels reflect MRI disease activity in MS and examine the potential for EBV antibody levels as biomarkers for treatment response. METHODS A total of 87 MS patients were followed for two years prior to and during interferon beta (IFNB) treatment, with MRI examinations and serum measurement of IgM and IgG antibodies to viral capsid antigen (VCA), EBV nuclear antigen 1 (EBNA-1) and early antigen (EA). Associations between EBV antibody levels and MRI activity were assessed by a logistic regression model. RESULTS Higher anti-EBNA-1 IgG levels were associated with increased MRI activity, OR = 2.95 (95% CI 1.07-8.10; p = 0.036) for combined unique activity (CUA; the sum of T1Gd+ lesions and new or enlarging T2 lesions). Although most patients were anti-VCA IgM negative, there was an inverse association, OR = 0.32 (95% CI 0.12-0.84; p = 0.021) with CUA during IFNB treatment. CONCLUSIONS This study supports an association between anti-EBNA-1 IgG levels and MS disease activity. We also found an inverse association with anti-VCA IgM levels during IFNB treatment not previously described, indicating anti-VCA IgM as a possible biomarker for IFNB treatment response.
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Affiliation(s)
- Silje Kvistad
- Norwegian MS Competence Centre, Haukeland University Hospital, Jonas Lies vei 65, 5053 Bergen, Norway
| | - Kjell-Morten Myhr
- Norwegian MS Competence Centre, Haukeland University Hospital, Norway/KG Jebsen Center for MS Research, University of Bergen, Norway/Norwegian MS Registry and Biobank, Haukeland University Hospital, Norway
| | - Trygve Holmøy
- Institute of Clinical Medicine, University of Oslo, Norway/Akershus University Hospital, Norway
| | | | | | - Kristian S Bjerve
- St. Olav's Hospital, Trondheim University Hospital, Norway/Children's and Women's Health, Norwegian University of Science and Technology, Norway
| | - Harald Hovdal
- St Olav's Hospital, Trondheim University Hospital, Norway
| | - Kristin I Løken-Amsrud
- Institute of Clinical Medicine, University of Oslo, Norway/Innlandet Hospital Trust, Norway
| | | | - Rune Midgard
- Molde Hospital, Norway/Unit for Applied Clinical Research, Norwegian University of Science and Technology, Norway
| | | | | | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Norway/Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Norway
| | - Stig Wergeland
- Norwegian MS Competence Centre, Haukeland University Hospital, Norway/KG Jebsen Center for MS Research, University of Bergen, Norway
| | - Oivind Torkildsen
- Norwegian MS Competence Centre, Haukeland University Hospital, Norway/KG Jebsen Center for MS Research, University of Bergen, Norway
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25
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Paling D, Thade Petersen E, Tozer DJ, Altmann DR, Wheeler-Kingshott CAM, Kapoor R, Miller DH, Golay X. Cerebral arterial bolus arrival time is prolonged in multiple sclerosis and associated with disability. J Cereb Blood Flow Metab 2014; 34:34-42. [PMID: 24045400 PMCID: PMC3887342 DOI: 10.1038/jcbfm.2013.161] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/17/2013] [Accepted: 08/14/2013] [Indexed: 12/20/2022]
Abstract
Alterations in the overall cerebral hemodynamics have been reported in multiple sclerosis (MS); however, their cause and significance is unknown. While potential venous causes have been examined, arterial causes have not. In this study, a multiple delay time arterial spin labeling magnetic resonance imaging sequence at 3T was used to quantify the arterial hemodynamic parameter bolus arrival time (BAT) and cerebral blood flow (CBF) in normal-appearing white matter (NAWM) and deep gray matter in 33 controls and 35 patients with relapsing-remitting MS. Bolus arrival time was prolonged in MS in NAWM (1.0±0.2 versus 0.9±0.2 seconds, P=0.031) and deep gray matter (0.90±0.18 versus 0.80±0.14 seconds, P=0.001) and CBF was increased in NAWM (14±4 versus 10±2 mL/100 g/min, P=0.001). Prolonged BAT in NAWM (P=0.042) and deep gray matter (P=0.01) were associated with higher expanded disability status score. This study demonstrates alteration in cerebral arterial hemodynamics in MS. One possible cause may be widespread inflammation. Bolus arrival time was longer in patients with greater disability independent of atrophy and T2 lesion load, suggesting alterations in cerebral arterial hemodynamics may be a marker of clinically relevant pathology.
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Affiliation(s)
- David Paling
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - Esben Thade Petersen
- Department of Radiology and Radiotherapy E01.132, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Daniel J Tozer
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - Daniel R Altmann
- 1] Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK [2] Medical Statistics Department, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Raju Kapoor
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - David H Miller
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
| | - Xavier Golay
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square MS Centre, London, UK
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26
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Mangia S, Carpenter AF, Tyan AE, Eberly LE, Garwood M, Michaeli S. Magnetization transfer and adiabatic T1ρ MRI reveal abnormalities in normal-appearing white matter of subjects with multiple sclerosis. Mult Scler 2013; 20:1066-73. [PMID: 24336350 DOI: 10.1177/1352458513515084] [Citation(s) in RCA: 25] [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: 08/09/2013] [Accepted: 11/04/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Diffuse abnormalities are known to occur within the brain tissue of multiple sclerosis (MS) patients that is "normal appearing" on T1-weighted and T2-weighted magnetic resonance images. OBJECTIVES With the goal of exploring the sensitivity of novel MRI parameters to detect such abnormalities, we implemented an inversion-prepared magnetization transfer (MT) protocol and adiabatic T1ρ and T2ρ rotating frame relaxation methods. METHODS Nine relapsing-remitting MS patients and seven healthy controls were recruited. Relaxation parameters were measured in a single slice just above the lateral ventricles and approximately parallel to the AC-PC line. RESULTS The MT ratio of regions encompassing the normal-appearing white matter (NAWM) was different in MS patients as compared with controls (p = 0.043); however, the T1 measured during off-resonance irradiation (T1sat) was substantially more sensitive than the MT ratio for detecting differences between groups (p = 0.0006). Adiabatic T1ρ was significantly prolonged in the NAWM of MS patents as compared to controls (by 6%, p = 0.026), while no differences were found among groups for T2ρ. No differences among groups were observed in the cortical gray matter for any relaxation parameter. CONCLUSIONS The results suggest degenerative processes occurring in the NAWM of MS, likely not accompanied by significant abnormalities in iron content.
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Affiliation(s)
- Silvia Mangia
- Center for Magnetic Resonance Research (CMRR), Department of Radiology, University of Minnesota, USA
| | - Adam F Carpenter
- Department of Neurology, University of Minnesota, USA Brain Sciences Center, VA Medical Center, USA
| | - Andy E Tyan
- Department of Neurology, University of Minnesota, USA
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, USA
| | - Michael Garwood
- Center for Magnetic Resonance Research (CMRR), Department of Radiology, University of Minnesota, USA
| | - Shalom Michaeli
- Center for Magnetic Resonance Research (CMRR), Department of Radiology, University of Minnesota, USA
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27
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Sorosina M, Brambilla P, Clarelli F, Barizzone N, Lupoli S, Guaschino C, Osiceanu AM, Moiola L, Ghezzi A, Coniglio G, Patti F, Mancardi G, Manunta P, Glorioso N, Guerini FR, Bergamaschi R, Perla F, Martinelli V, Cusi D, Leone M, Comi G, D'Alfonso S, Martinelli-Boneschi F. Genetic burden of common variants in progressive and bout-onset multiple sclerosis. Mult Scler 2013; 20:802-11. [PMID: 24277324 DOI: 10.1177/1352458513512707] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 10/21/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The contribution of genetic variants underlying the susceptibility to different clinical courses of multiple sclerosis (MS) is still unclear. OBJECTIVE The aim of the study is to evaluate and compare the proportion of liability explained by common SNPs and the genetic burden of MS-associated SNPs in progressive onset (PrMS) and bout-onset (BOMS) cases. METHODS We estimated the proportion of variance in disease liability explained by 296,391 autosomal SNPs in cohorts of Italian PrMS and BOMS patients using the genome-wide complex trait analysis (GCTA) tool, and we calculated a weighted genetic risk score (wGRS) based on the known MS-associated loci. RESULTS Our results identified that common SNPs explain a greater proportion of phenotypic variance in BOMS (36.5%±10.1%) than PrMS (20.8%±6.0%) cases, and a trend of decrease was observed when testing primary progressive (PPMS) without brain MRI inflammatory activity (p = 7.9 × 10(-3)). Similarly, the wGRS and the variance explained by MS-associated SNPs were higher in BOMS than PPMS in males (wGRS: 6.63 vs 6.51, p = 0.04; explained variance: 4.8%±1.5% vs 1.7%±0.6%; p = 0.05). CONCLUSIONS Our results suggest that the liability of disease is better captured by common genetic variants in BOMS than PrMS cases. The absence of inflammatory activity and male gender further raise the difference between clinical courses.
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Affiliation(s)
- Melissa Sorosina
- Laboratory of Genetics of Neurological Complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Paola Brambilla
- Laboratory of Genetics of Neurological Complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Ferdinando Clarelli
- Laboratory of Genetics of Neurological Complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Nadia Barizzone
- Interdisciplinary Research Center of Autoimmune Disease IRCAD, University of Eastern Piedmont, Italy Department of Health Sciences, University of Eastern Piedmont, Italy
| | - Sara Lupoli
- Department of Health Sciences, University of Milan and Genomics & Bioinformatics Unit, c/o Fondazione Filarete, Italy
| | - Clara Guaschino
- Laboratory of Genetics of Neurological Complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Ana Maria Osiceanu
- Laboratory of Genetics of Neurological Complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Lucia Moiola
- Laboratory of Genetics of Neurological Complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Angelo Ghezzi
- Department of Neurology, S. Antonio Abate Hospital, Italy
| | | | - Francesco Patti
- Department DANA, G.F. Ingrassia, Neurosciences Section, Multiple Sclerosis Center, PO "G. Rodolico", Italy
| | - Gianluigi Mancardi
- Department of Neuroscience, Ophthalmology and Genetics, University of Genova, Italy
| | - Paolo Manunta
- Division of Nephrology and Dialysis, San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, Italy
| | - Nicola Glorioso
- Hypertension and Related Diseases Centre-AOU, University of Sassari, Italy
| | | | | | - Franco Perla
- Department of Neurology, Mondovì Hospital, Italy
| | - Vittorio Martinelli
- Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Daniele Cusi
- Department of Health Sciences, University of Milan and Genomics & Bioinformatics Unit, c/o Fondazione Filarete, Italy
| | - Maurizio Leone
- Interdisciplinary Research Center of Autoimmune Disease IRCAD, University of Eastern Piedmont, Italy
| | - Giancarlo Comi
- Laboratory of Genetics of Neurological Complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy
| | - Sandra D'Alfonso
- Interdisciplinary Research Center of Autoimmune Disease IRCAD, University of Eastern Piedmont, Italy Department of Health Sciences, University of Eastern Piedmont, Italy
| | - Filippo Martinelli-Boneschi
- Laboratory of Genetics of Neurological Complex Disorders, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy Department of Neurology, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Italy
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Kita M, Fox RJ, Phillips JT, Hutchinson M, Havrdova E, Sarda SP, Agarwal S, Kong J, Zhang A, Viglietta V, Sheikh SI, Seidman E, Dawson KT. Effects of BG-12 (dimethyl fumarate) on health-related quality of life in patients with relapsing-remitting multiple sclerosis: findings from the CONFIRM study. Mult Scler 2013; 20:253-7. [PMID: 24150778 DOI: 10.1177/1352458513507818] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [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: 01/22/2023]
Abstract
Multiple sclerosis (MS) has a significant impact on health-related quality of life (HRQoL) with symptoms adversely affecting many aspects of everyday living. BG-12 (dimethyl fumarate) demonstrated significant efficacy in the phase III studies DEFINE and CONFIRM in patients with relapsing-remitting MS. In CONFIRM, HRQoL was worse in patients with greater disability at baseline, and who relapsed during the study, and improved with BG-12 treatment. Mean Short Form-36 Physical Component Summary scores for BG-12 increased over 2 years and scores for placebo decreased. Coupled with clinical and neuroradiological benefits, these HRQoL results further support BG-12 as an effective oral treatment for relapsing MS.
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Affiliation(s)
- Mariko Kita
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA
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Vermersch P, Czlonkowska A, Grimaldi LME, Confavreux C, Comi G, Kappos L, Olsson TP, Benamor M, Bauer D, Truffinet P, Church M, Miller AE, Wolinsky JS, Freedman MS, O'Connor P. Teriflunomide versus subcutaneous interferon beta-1a in patients with relapsing multiple sclerosis: a randomised, controlled phase 3 trial. Mult Scler 2013; 20:705-16. [PMID: 24126064 DOI: 10.1177/1352458513507821] [Citation(s) in RCA: 233] [Impact Index Per Article: 21.2] [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: 12/18/2022]
Abstract
BACKGROUND In previous studies, teriflunomide significantly reduced the annualised relapse rate (ARR) and disability progression. OBJECTIVE This phase 3, rater-blinded study (NCT00883337) compared teriflunomide with interferon-beta-1a (IFNβ-1a). METHODS Patients with relapsing multiple sclerosis were randomised (1:1:1) to oral teriflunomide 7-or 14 mg, or subcutaneous IFNβ-1a 44 µg. The primary composite endpoint was time to failure, defined as first occurrence of confirmed relapse or permanent treatment discontinuation for any cause. Secondary endpoints included ARR, Fatigue Impact Scale (FIS) and Treatment Satisfaction Questionnaire for Medication (TSQM). The study was completed 48 weeks after the last patient was randomised. RESULTS Some 324 patients were randomised (IFNβ-1a: 104; teriflunomide 7 mg: 109; teriflunomide 14 mg: 111). No difference in time to failure was observed. There was no difference in ARR between teriflunomide 14 mg and IFNβ-1a, but ARR was significantly higher with teriflunomide 7 mg. FIS scores indicated more frequent fatigue with IFNβ-1a, though differences were only significant with teriflunomide 7 mg. TSQM scores were significantly higher with teriflunomide. There were no unexpected safety findings. CONCLUSION Effects on time to failure were comparable between teriflunomide and IFNβ-1a. There was no difference between teriflunomide 14 mg and IFNβ-1a on ARR, though ARR was higher with teriflunomide 7 mg. The teriflunomide safety profile was consistent with previous studies.
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Abstract
Current standard immunomodulatory therapy with interferons (IFNs) for relapsing-remitting multiple sclerosis (MS) exhibits proven, but limited, efficacy and increased side effects due to the need of frequent application of the drug. Therefore, there is a need for more effective and tolerable drugs. Due to their small size, optimization of therapy with IFNs in MS by PEGylation is feasible. PEGylation of an IFN means that at least one molecule of polyethylene glycol (PEG) is covalently added. This modification is a standard procedure to increase the stability, solubility, half-life, and efficacy of a drug, and is applied in several drugs and diseases. Currently, a therapy regimen applying PEG-IFN beta-1a in MS is being developed to achieve an optimized relationship between therapy-related side effects and pharmacokinetic/pharmacodynamic efficacy. Phase I studies demonstrated that subcutaneous PEG-IFN beta-1a at a dose of 125 μg every 2 or 4 weeks might be at least as efficient and safe as the current standard therapy with IFN beta-1a. A global Phase III clinical study is investigating the efficacy of PEG-IFN beta-1a in terms of reduction of the relapse rate in relapsing-remitting MS patients. The latest primary safety and efficacy analysis after 1 year has revealed a favorable risk-benefit profile with no significant difference between dosing regimens. Compared to placebo, the annualized relapse rate was reduced by about one-third and new or newly enlarging T2 brain lesions were reduced by about one-third when dosing every 4 weeks or by two-thirds when dosing every 2 weeks. This presents a significant effect of the dosing interval, favoring administration every 2 weeks. Chronic administration of PEGylated proteins mostly at toxic concentrations causes vacuolation of renal epithelium in animals, which - along with the issue of occurrence of anti-PEG antibodies - has to be addressed by Phase IV studies.
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Affiliation(s)
- Reinhard Reuss
- Department of Neurology, BKH Bayreuth, Bayreuth, Germany
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Abstract
BACKGROUND Clinical intuition suggests that a sharp increase in the number of enhancing lesions should signal an increased risk of relapse. The 'rule of five' recommends that subjects exhibiting at least five lesions over the baseline level be referred for closer monitoring. This rule has been used as an informal safety criterion with limited formal evaluation. OBJECTIVE The purpose of this study was to determine the best threshold for the rule and to demonstrate its predictive validity for risk of subsequent relapses for multiple sclerosis (MS) trials. METHODS We used logistic regression modeling to apply the rule to patient data from a phase II clinical trial. Predictive validity was ascertained using rate ratios and receiver operating characteristic (ROC) curves. RESULTS We found that, for these data, a threshold of five lesions over the baseline constituted the best definition of a threshold. Overall, 35% of subjects broke the rule at least once. Breaking the rule increased the odds of imminent relapse by a factor of 3.2 (95% confidence interval (CI): 1.8-5.5). CONCLUSION Breaking the rule of five was found to be a significant predictor of an imminent relapse. Length of follow-up and the number of lesions discovered via magnetic resonance imaging (MRI) were also significant predictors of relapse.
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Malmeström C, Gillett A, Jernås M, Khademi M, Axelsson M, Kockum I, Mattsson N, Zetterberg H, Blennow K, Alfredsson L, Wadenvik H, Lycke J, Olsson T, Olsson B. Serum levels of LIGHT in MS. Mult Scler 2012; 19:871-6. [PMID: 23037546 DOI: 10.1177/1352458512463766] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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: 11/16/2022]
Abstract
BACKGROUND Recently, a polymorphism in the LIGHT gene was shown to increase the risk of multiple sclerosis (MS) in a genome-wide association study (GWAS). OBJECTIVE Our aim was to investigate if serum levels of LIGHT were affected by this polymorphism and by the disease itself. METHODS Serum levels of LIGHT were investigated in four cohorts; 1) MS (n = 159) and controls (n = 160) in relation to rs1077667 genotype; 2) MS at relapse (n = 30) vs. healthy controls (n = 26); 3) MS (n = 27) vs. other neurological disease (OND, n = 33); and 4) MS patients before and after one year of treatment with natalizumab (n = 30). RESULTS Carriers of the GG genotype had the lowest serum levels of LIGHT (p=0.02). Serum levels of LIGHT were increased in MS at relapse in two separate cohorts: vs. healthy controls (p=0.00005) and vs. remission (p=0.00006), other neurological disease (OND) (p=0.002) and OND with signs of inflammation (iOND; p=0.00005). Furthermore, serum levels of LIGHT were decreased by natalizumab treatment (p=0.001). CONCLUSION Soluble LIGHT is an inhibitor of T-cell activation and GG carriers of rs1077667, with the highest risk for MS, had the lowest serum levels. The increased levels of LIGHT at times of increased MS activity suggest that soluble LIGHT is protective and may act to limit inflammation.
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Affiliation(s)
- Clas Malmeström
- Department of Neurology, Sahlgrenska Academy at University of Gothenburg, Sweden
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McCarthy DP, Richards MH, Miller SD. Mouse models of multiple sclerosis: experimental autoimmune encephalomyelitis and Theiler's virus-induced demyelinating disease. Methods Mol Biol 2012; 900:381-401. [PMID: 22933080 PMCID: PMC3583382 DOI: 10.1007/978-1-60761-720-4_19] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [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] [Indexed: 12/23/2022]
Abstract
Experimental autoimmune encephalomyelitis (EAE) and Theiler's Murine Encephalitis Virus-Induced Demyelinating Disease (TMEV-IDD) are two clinically relevant murine models of multiple sclerosis (MS). Like MS, both are characterized by mononuclear cell infiltration into the CNS and demyelination. EAE is induced by either the administration of myelin protein or peptide in adjuvant or by the adoptive transfer of encephalitogenic T cell blasts into naïve recipients. The relative merits of each of these protocols are compared. Depending on the type of question being asked, different mouse strains and peptides are used. Different disease courses are observed with different strains and different peptides in active EAE. These variations are also addressed. Additionally, issues relevant to clinical grading of EAE in mice are discussed. In addition to EAE induction, useful references for other disease indicators such as DTH, in vitro proliferation, and immunohistochemistry are provided. TMEV-IDD is a useful model for understanding the possible viral etiology of MS. This section provides detailed information on the preparation of viral stocks and subsequent intracerebral infection of mice. Additionally, virus plaque assay and clinical disease assessment are discussed. Recently, recombinant TMEV strains have been created for the study of molecular mimicry which incorporate various 30 amino acid myelin epitopes within the leader region of TMEV.
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Affiliation(s)
- Derrick P McCarthy
- Department of Microbiology-Immunology and Interdepartmental Immunobiology Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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