1
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Spelman T, Herring WL, Acosta C, Hyde R, Jokubaitis VG, Pucci E, Lugaresi A, Laureys G, Havrdova EK, Horakova D, Izquierdo G, Eichau S, Ozakbas S, Alroughani R, Kalincik T, Duquette P, Girard M, Petersen T, Patti F, Csepany T, Granella F, Grand'Maison F, Ferraro D, Karabudak R, Jose Sa M, Trojano M, van Pesch V, Van Wijmeersch B, Cartechini E, McCombe P, Gerlach O, Spitaleri D, Rozsa C, Hodgkinson S, Bergamaschi R, Gouider R, Soysal A, Castillo-Triviño, Prevost J, Garber J, de Gans K, Ampapa R, Simo M, Sanchez-Menoyo JL, Iuliano G, Sas A, van der Walt A, John N, Gray O, Hughes S, De Luca G, Onofrj M, Buzzard K, Skibina O, Terzi M, Slee M, Solaro C, Oreja-Guevara, Ramo-Tello C, Fragoso Y, Shaygannejad V, Moore F, Rajda C, Aguera Morales E, Butzkueven H. Comparative effectiveness and cost-effectiveness of natalizumab and fingolimod in rapidly evolving severe relapsing-remitting multiple sclerosis in the United Kingdom. J Med Econ 2024; 27:109-125. [PMID: 38085684 DOI: 10.1080/13696998.2023.2293379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
AIM To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS). METHODS Real-world data from the MSBase Registry were obtained for patients with RES-RRMS who were previously either naive to disease-modifying therapies or had been treated with interferon-based therapies, glatiramer acetate, dimethyl fumarate, or teriflunomide (collectively known as BRACETD). Matched cohorts were selected by 3-way multinomial propensity score matching, and the annualized relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M) were compared between treatment groups. Comparative effectiveness results were used in a cost-effectiveness model comparing natalizumab and fingolimod, using an established Markov structure over a lifetime horizon with health states based on the Expanded Disability Status Scale. Additional model data sources included the UK MS Survey 2015, published literature, and publicly available sources. RESULTS In the comparative effectiveness analysis, we found a significantly lower ARR for patients starting natalizumab compared with fingolimod (rate ratio [RR] = 0.65; 95% confidence interval [CI], 0.57-0.73) or BRACETD (RR = 0.46; 95% CI, 0.42-0.53). Similarly, CDI6M was higher for patients starting natalizumab compared with fingolimod (hazard ratio [HR] = 1.25; 95% CI, 1.01-1.55) and BRACETD (HR = 1.46; 95% CI, 1.16-1.85). In patients starting fingolimod, we found a lower ARR (RR = 0.72; 95% CI, 0.65-0.80) compared with starting BRACETD, but no difference in CDI6M (HR = 1.17; 95% CI, 0.91-1.50). Differences in CDW6M were not found between the treatment groups. In the base-case cost-effectiveness analysis, natalizumab dominated fingolimod (0.302 higher quality-adjusted life-years [QALYs] and £17,141 lower predicted lifetime costs). Similar cost-effectiveness results were observed across sensitivity analyses. CONCLUSIONS This MSBase Registry analysis suggests that natalizumab improves clinical outcomes when compared with fingolimod, which translates to higher QALYs and lower costs in UK patients with RES-RRMS.
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Affiliation(s)
- T Spelman
- MSBase Foundation, Melbourne, VIC, Australia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - W L Herring
- Health Economics, RTI Health Solutions, NC, USA
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - C Acosta
- Value and Access, Biogen, Baar, Switzerland
| | - R Hyde
- Medical, Biogen, Baar, Switzerland
| | - V G Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - E Pucci
- Neurology Unit, AST-Fermo, Fermo, Italy
| | - A Lugaresi
- Dipartamento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - G Laureys
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - E K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - D Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - G Izquierdo
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Ozakbas
- Izmir University of Economics, Medical Point Hospital, Izmir, Turkey
| | - R Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - T Kalincik
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - P Duquette
- CHUM and Universite de Montreal, Montreal, Canada
| | - M Girard
- CHUM and Universite de Montreal, Montreal, Canada
| | - T Petersen
- Aarhus University Hospital, Arhus C, Denmark
| | - F Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico "G Rodloico-San Marco", University of Catania, Italy
| | - T Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - F Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Medicine, Parma University Hospital, Parma, Italy
| | | | - D Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | | | - M Jose Sa
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - M Trojano
- School of Medicine, University of Bari, Bari, Italy
| | - V van Pesch
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Université Catholique de Louvain, Belgium
| | - B Van Wijmeersch
- University MS Centre, Hasselt-Pelt and Noorderhart Rehabilitation & MS, Pelt and Hasselt University, Hasselt, Belgium
| | | | - P McCombe
- University of Queensland, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - O Gerlach
- Academic MS Center Zuyd, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - D Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - C Rozsa
- Jahn Ferenc Teaching Hospital, Budapest, Hungary
| | - S Hodgkinson
- Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, Australia
| | | | - R Gouider
- Department of Neurology, LR18SP03 and Clinical Investigation Center Neurosciences and Mental Health, Razi University Hospital -, Mannouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - A Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Castillo-Triviño
- Hospital Universitario Donostia and IIS Biodonostia, San Sebastián, Spain
| | - J Prevost
- CSSS Saint-Jérôme, Saint-Jerome, Canada
| | - J Garber
- Westmead Hospital, Sydney, Australia
| | - K de Gans
- Groene Hart Ziekenhuis, Gouda, Netherlands
| | - R Ampapa
- Nemocnice Jihlava, Jihlava, Czech Republic
| | - M Simo
- Department of Neurology, Semmelweis University Budapest, Budapest, Hungary
| | - J L Sanchez-Menoyo
- Department of Neurology, Galdakao-Usansolo University Hospital, Osakidetza Basque Health Service, Galdakao, Spain
- Biocruces-Bizkaia Health Research Institute, Spain
| | - G Iuliano
- Ospedali Riuniti di Salerno, Salerno, Italy
| | - A Sas
- Department of Neurology and Stroke, BAZ County Hospital, Miskolc, Hungary
| | - A van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - N John
- Monash University, Clayton, Australia
- Department of Neurology, Monash Health, Clayton, Australia
| | - O Gray
- South Eastern HSC Trust, Belfast, United Kingdom
| | - S Hughes
- Royal Victoria Hospital, Belfast, United Kingdom
| | - G De Luca
- MS Centre, Neurology Unit, "SS. Annunziata" University Hospital, University "G. d'Annunzio", Chieti, Italy
| | - M Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - K Buzzard
- Department of Neurosciences, Box Hill Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
- MS Centre, Royal Melbourne Hospital, Melbourne, Australia
| | - O Skibina
- Department of Neurology, The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, Australia
| | - M Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - M Slee
- Flinders University, Adelaide, Australia
| | - C Solaro
- Department of Neurology, ASL3 Genovese, Genova, Italy
- Department of Rehabilitation, ML Novarese Hospital Moncrivello
| | - Oreja-Guevara
- Department of Neurology, Hospital Clinico San Carlos, Madrid, Spain
| | - C Ramo-Tello
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Y Fragoso
- Universidade Metropolitana de Santos, Santos, Brazil
| | | | - F Moore
- Department of Neurology, McGill University, Montreal, Canada
| | - C Rajda
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - E Aguera Morales
- Department of Medicine and Surgery, University of Cordoba, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)
| | - H Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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Ezcurra Díaz G, Nuñez Marin F, Blanco Guillermo I, Ramo-Tello C. Diagnostic confusion of demyelinating lesions and incidental diagnosis of a new pathogenic mutation of the FLNA gene. Neurologia 2022; 37:818-820. [PMID: 35668010 DOI: 10.1016/j.nrleng.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 01/31/2023] Open
Affiliation(s)
- G Ezcurra Díaz
- Servicio de Neurología, Departamento de Neurociencias, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - F Nuñez Marin
- IDI (Institut de Diagnòstic per la Imatge), Badalona, Barcelona, Spain
| | - I Blanco Guillermo
- Servicio de Genética Clínica, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - C Ramo-Tello
- Unidad de EM-Neuroinmunología, Departamento de Neurociencias, Hospital Universitario Germans Trias I Pujol, Badalona, Barcelona, Spain
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3
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Martín-Aguilar L, Presas-Rodriguez S, Rovira À, Capellades J, Massuet-Vilamajó A, Ramió-Torrentà L, Tintoré M, Brieva-Ruiz L, Moral E, Cano-Orgaz A, Blanco Y, Batlle-Nadal J, Carmona O, Gea M, Hervás-García J, Ramo-Tello C. Gadolinium-enhanced brain lesions in multiple sclerosis relapse. Neurología (English Edition) 2022; 37:557-563. [DOI: 10.1016/j.nrleng.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/28/2021] [Indexed: 10/14/2022] Open
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4
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Rubio-Guerra S, Massuet-Vilamajó A, Presas-Rodríguez S, Ramo-Tello C. Catastrophic demyelinating multifocal encephalitis. Neurologia 2022; 37:159-163. [PMID: 33838947 DOI: 10.1016/j.nrl.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/10/2021] [Accepted: 03/01/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- S Rubio-Guerra
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - A Massuet-Vilamajó
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - S Presas-Rodríguez
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - C Ramo-Tello
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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5
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Rubio-Guerra S, Massuet-Vilamajó A, Presas-Rodríguez S, Ramo-Tello C. Catastrophic demyelinating multifocal encephalitis. Neurologia (Engl Ed) 2021; 37:159-163. [PMID: 34952830 DOI: 10.1016/j.nrleng.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- S Rubio-Guerra
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | | | | | - C Ramo-Tello
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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6
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Mansilla MJ, Presas-Rodríguez S, Teniente-Serra A, González-Larreategui I, Quirant-Sánchez B, Fondelli F, Djedovic N, Iwaszkiewicz-Grześ D, Chwojnicki K, Miljković Đ, Trzonkowski P, Ramo-Tello C, Martínez-Cáceres EM. Paving the way towards an effective treatment for multiple sclerosis: advances in cell therapy. Cell Mol Immunol 2021; 18:1353-1374. [PMID: 33958746 PMCID: PMC8167140 DOI: 10.1038/s41423-020-00618-z] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
Multiple sclerosis (MS) is a leading cause of chronic neurological disability in young to middle-aged adults, affecting ~2.5 million people worldwide. Currently, most therapeutics for MS are systemic immunosuppressive or immunomodulatory drugs, but these drugs are unable to halt or reverse the disease and have the potential to cause serious adverse events. Hence, there is an urgent need for the development of next-generation treatments that, alone or in combination, stop the undesired autoimmune response and contribute to the restoration of homeostasis. This review analyzes current MS treatments as well as different cell-based therapies that have been proposed to restore homeostasis in MS patients (tolerogenic dendritic cells, regulatory T cells, mesenchymal stem cells, and vaccination with T cells). Data collected from preclinical studies performed in the experimental autoimmune encephalomyelitis (EAE) model of MS in animals, in vitro cultures of cells from MS patients and the initial results of phase I/II clinical trials are analyzed to better understand which parameters are relevant for obtaining an efficient cell-based therapy for MS.
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Affiliation(s)
- M J Mansilla
- Division of Immunology, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain. .,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - S Presas-Rodríguez
- Multiple Sclerosis Unit, Department of Neurosciences, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - A Teniente-Serra
- Division of Immunology, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - I González-Larreategui
- Division of Immunology, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - B Quirant-Sánchez
- Division of Immunology, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - F Fondelli
- Division of Immunology, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain.,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - N Djedovic
- Department of Immunology, Institute for Biological Research "Siniša Stanković"- National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - D Iwaszkiewicz-Grześ
- Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland.,Poltreg S.A., Gdańsk, Poland
| | - K Chwojnicki
- Department of Anaesthesiology & Intensive Care, Medical University of Gdańsk, Gdańsk, Poland
| | - Đ Miljković
- Department of Immunology, Institute for Biological Research "Siniša Stanković"- National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - P Trzonkowski
- Department of Medical Immunology, Medical University of Gdańsk, Gdańsk, Poland.,Poltreg S.A., Gdańsk, Poland
| | - C Ramo-Tello
- Multiple Sclerosis Unit, Department of Neurosciences, Germans Trias i Pujol University Hospital, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - E M Martínez-Cáceres
- Division of Immunology, LCMN, Germans Trias i Pujol University Hospital and Research Institute, Barcelona, Spain. .,Department of Cellular Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Spain.
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7
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Zhu N, Presas-Rodríguez S, Núñez-Marín F, Quirant-Sánchez B, Ramo-Tello C. Single pseudotumour lesion, a rare debut presentation of optic neuromyelitis spectrum disorder. Neurología (English Edition) 2021; 36:396-398. [DOI: 10.1016/j.nrleng.2020.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/09/2020] [Indexed: 11/15/2022] Open
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8
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Zhu N, Presas-Rodríguez S, Núñez-Marín F, Quirant-Sánchez B, Ramo-Tello C. [Single pseudotumour lesion, a rare debut presentation of optic neuromyelitis spectrum disorder]. Neurologia 2020. [PMID: 32912746 DOI: 10.1016/j.nrl.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- N Zhu
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Badalona, España.
| | - S Presas-Rodríguez
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Badalona, España
| | - F Núñez-Marín
- Instituto de Diagnóstico por la Imagen, Hospital Universitario Germans Trias i Pujol, Badalona, España
| | - B Quirant-Sánchez
- Servicio de Inmunología, Hospital Universitario Germans Trias i Pujol, Badalona, España
| | - C Ramo-Tello
- Servicio de Neurología, Hospital Universitario Germans Trias i Pujol, Badalona, España
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9
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Lorscheider J, Kuhle J, Izquierdo G, Lugaresi A, Havrdova E, Horakova D, Hupperts R, Duquette P, Girard M, Prat A, Grand'Maison F, Grammond P, Sola P, Ferraro D, Trojano M, Ramo-Tello C, Lechner-Scott J, Pucci E, Solaro C, Slee M, Van Pesch V, Sanchez Menoyo JL, van der Walt A, Butzkueven H, Kappos L, Kalincik T. Anti-inflammatory disease-modifying treatment and disability progression in primary progressive multiple sclerosis: a cohort study. Eur J Neurol 2018; 26:363-370. [PMID: 30298572 DOI: 10.1111/ene.13824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 04/27/2018] [Accepted: 10/04/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Treatment options in primary progressive multiple sclerosis (PPMS) are scarce and, with the exception of ocrelizumab, anti-inflammatory agents have failed to show efficacy in ameliorating disability progression. The aim of this study was to investigate a potential effect of anti-inflammatory disease-modifying treatment on disability outcomes in PPMS. METHODS Using MSBase, a large, international, observational database, we identified patients with PPMS who were either never treated or treated with a disease-modifying agent. Propensity score matching was used to select subpopulations with similar baseline characteristics. Expanded Disability Status Scale (EDSS) outcomes were compared with an intention-to-treat and an as-treated approach in paired, pairwise-censored analyses. RESULTS Of the 1284 included patients, 533 were matched (treated, n = 195; untreated n = 338). Median on-study pairwise-censored follow-up was 3.4 years (quartiles 1.2-5.5). No difference in the hazard of experiencing 3-month confirmed EDSS progression events was observed between the groups [hazard ratio (HR), 1.0; 95% confidence interval (CI), 0.6-1.7, P = 0.87]. We did not find significant differences in the hazards of confirmed EDSS improvement (HR, 1.0; 95% CI, 0.6-1.6, P = 0.91) or reaching a confirmed EDSS step ≥7 (HR, 1.1; 95% CI, 0.7-1.6, P = 0.69). CONCLUSION Our pooled analysis of disease-modifying agents suggests that these therapies have no substantial effect on short- to medium-term disability outcomes in PPMS.
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Affiliation(s)
- J Lorscheider
- Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, Neurologic Clinic and Policlinic, University Hospital and University of Basel, Basel, Switzerland
| | - J Kuhle
- Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, Neurologic Clinic and Policlinic, University Hospital and University of Basel, Basel, Switzerland
| | - G Izquierdo
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - A Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - E Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - D Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - R Hupperts
- Orbis Medical Center, Sittard, The Netherlands
| | | | - M Girard
- Hôpital Notre Dame, Montreal, Quebec
| | - A Prat
- Hôpital Notre Dame, Montreal, Quebec
| | - F Grand'Maison
- Neuro Rive-Sud, Hôpital Charles LeMoyne, Greenfield Park, Quebec
| | - P Grammond
- Hôtel-Dieu de Lévis, Lévis, Quebec, Canada
| | - P Sola
- Nuovo Ospedale Civile S.Agostino/Estense, Modena
| | - D Ferraro
- Nuovo Ospedale Civile S.Agostino/Estense, Modena
| | - M Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | | | - J Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, NSW.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - E Pucci
- Neurology Unit, ASUR Marche, AV3, Macerata
| | - C Solaro
- Hospedale P. A. Micone, Genova, Italy
| | - M Slee
- Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - V Van Pesch
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - A van der Walt
- Department of Medicine, University of Melbourne, Melbourne, VIC.,Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC.,Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC
| | - H Butzkueven
- Department of Medicine, University of Melbourne, Melbourne, VIC.,Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC.,Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, VIC
| | - L Kappos
- Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, Neurologic Clinic and Policlinic, University Hospital and University of Basel, Basel, Switzerland
| | - T Kalincik
- Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC.,CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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Hervás-García JV, Ramió-Torrentà L, Brieva-Ruiz L, Batllé-Nadal J, Moral E, Blanco Y, Cano-Orgaz A, Presas-Rodríguez S, Torres F, Capellades J, Ramo-Tello C. Comparison of two high doses of oral methylprednisolone for multiple sclerosis relapses: a pilot, multicentre, randomized, double-blind, non-inferiority trial. Eur J Neurol 2018; 26:525-532. [PMID: 30351511 DOI: 10.1111/ene.13851] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/18/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Oral or intravenous methylprednisolone (≥500 mg/day for 5 days) is recommended for multiple sclerosis (MS) relapses. Nonetheless, the optimal dose remains uncertain. We compared clinical and radiological effectiveness, safety and quality of life (QoL) of oral methylprednisolone [1250 mg/day (standard high dose)] versus 625 mg/day (lesser high dose), both for 3 days] in MS relapses. METHODS A total of 49 patients with moderate to severe MS relapse within the previous 15 days were randomized in a pilot, double-blind, multicentre, non-inferiority trial (ClinicalTrial.gov, NCT01986998). The primary endpoint was non-inferiority of the lesser high dose by Expanded Disability Status Scale (EDSS) score improvement on day 30 (non-inferiority margin, 1 point). The secondary endpoints were EDSS score change on days 7 and 90, changes in T1 gadolinium-enhanced and new/enlarged T2 lesions on days 7 and 30, and safety and QoL results. RESULTS The primary outcome was achieved [mean (95% confidence interval) EDSS score difference, -0.26 (-0.7 to 0.18) at 30 days (P = 0.246)]. The standard high dose yielded a superior EDSS score improvement on day 7 (P = 0.028). No differences were observed in EDSS score on day 90 (P = 0.352) or in the number of T1 gadolinium-enhanced or new/enlarged T2 lesions on day 7 (P = 0.401, 0.347) or day 30 (P = 0.349, 0.529). Safety and QoL were good at both doses. CONCLUSIONS A lesser high-dose oral methylprednisolone regimen may not be inferior to the standard high dose in terms of clinical and radiological response.
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Affiliation(s)
- J V Hervás-García
- Neuroscience Department, Hospital Germans Trias-i-Pujol, Badalona, Spain
| | - L Ramió-Torrentà
- Neurology Department, Hospital Doctor Josep Trueta, Girona, Spain
| | - L Brieva-Ruiz
- Neurology Department, Hospital Arnau Vilanova, Lleida, Spain
| | - J Batllé-Nadal
- Neurology Department, Xarxa Sanitaria i Social Santa Tecla, Tarragona, Spain
| | - E Moral
- Neurology Department, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - Y Blanco
- Institut Biomedical Research August-Pi-Sunyer, Hospital Clinic, Barcelona, Spain
| | - A Cano-Orgaz
- Neurology Department, Hospital Mataro, Mataro, Spain
| | - S Presas-Rodríguez
- Neuroscience Department, Hospital Germans Trias-i-Pujol, Badalona, Spain
| | - F Torres
- Institut Biomedical Research August-Pi-Sunyer, Hospital Clinic, Barcelona, Spain
| | - J Capellades
- Neuroradiology department, Hospital Mar, Barcelona, Spain
| | - C Ramo-Tello
- Neuroscience Department, Hospital Germans Trias-i-Pujol, Badalona, Spain
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Hervás-García J, Montané E, Serrado-Iglesias A, Ramo-Tello C. Toxic hepatitis after concomitant interferon beta and aloe vera treatment in a patient with multiple sclerosis: A case report. Neurología (English Edition) 2017. [DOI: 10.1016/j.nrleng.2015.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Presas-Rodríguez S, Grau-López L, Hervás-García J, Massuet-Vilamajó A, Ramo-Tello C. Myelitis: Differences between multiple sclerosis and other aetiologies. Neurología (English Edition) 2016. [DOI: 10.1016/j.nrleng.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hervás-García JV, Montané E, Serrado-Iglesias A, Ramo-Tello C. Toxic hepatitis after concomitant interferon beta and aloe vera treatment in a patient with multiple sclerosis: A case report. Neurologia 2016; 32:546-547. [PMID: 26874569 DOI: 10.1016/j.nrl.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 12/07/2015] [Accepted: 12/07/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
- J V Hervás-García
- Servicio de Neurología, Departamento de Neurociencias, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
| | - E Montané
- Departamento de Farmacología Clínica, Hospital Germans Trias i Pujol, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - A Serrado-Iglesias
- Servicio de Medicina Interna, Hospital Municipal de Badalona, Badalona, Barcelona, España
| | - C Ramo-Tello
- Servicio de Neurología, Departamento de Neurociencias, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
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Presas-Rodríguez S, Grau-López L, Hervás-García JV, Massuet-Vilamajó A, Ramo-Tello C. Myelitis: Differences between multiple sclerosis and other aetiologies. Neurologia 2015; 31:71-5. [PMID: 26383061 DOI: 10.1016/j.nrl.2015.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/01/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Myelitis can appear as an initial symptom in the context of demyelinating diseases, systemic inflammatory diseases, and infectious diseases. We aim to analyse the differences between myelitis associated with multiple sclerosis (MS) and myelitis resulting from other aetiologies. METHODS Single-centre, retrospective analysis of patients with initial myelitis (2000-2013). Demographic, aetiological, clinical, radiological and prognostic variables were analysed and compared between patients with myelitis from MS and those with myelitis due to other aetiologies. RESULTS We included 91 patients; mean follow-up was 7 years. Diagnoses were as follows: MS 57 (63%), idiopathic transverse myelitis 22 (24%), associated systemic diseases 6 (7%), and other diagnoses (6%). Myelitis due to MS was associated with younger age of onset (35 ± 11 vs. 41 ± 13; P = .02), more pronounced sphincter involvement (40.4 vs. 27.3%; P=.05), greater multifocal involvement in spinal MRI (77.2 vs. 26.5%; P=.001), shorter lesion extension (2.4 vs. 1.4 vertebral segments; P=.001), cervical location (82.5 vs. 64.7%; P=.05) and posterior location (89.5 vs. 41.2%; P=.001). Myelitis due to other aetiologies more frequently showed anterior location (47.1 vs. 24.6%; P=.02), and central cord involvement (47.1 vs. 14.1%; P=.001), with better recovery at one year of follow up (EDSS 2.0 vs. 1.5; P=.01). Multivariate analysis showed that multifocal spinal cord involvement (OR 9.38, 95% CI: 2.04-43.1) and posterior cord involvement (OR 2.16, 95% CI: 2.04-2.67) were independently associated with the diagnosis of MS. CONCLUSIONS A high percentage of patients with an initial myelitis event will be diagnosed with MS. The presence of multifocal and posterior spinal cord lesions was significantly associated with the diagnosis of MS.
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Affiliation(s)
- S Presas-Rodríguez
- Servicio de Neurología, Departamento de Neurociencias, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España.
| | - L Grau-López
- Servicio de Neurología, Departamento de Neurociencias, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España
| | - J V Hervás-García
- Servicio de Neurología, Departamento de Neurociencias, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España
| | - A Massuet-Vilamajó
- Institut de Diagnòstic per la Imatge, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España
| | - C Ramo-Tello
- Servicio de Neurología, Departamento de Neurociencias, Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), España
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Grau-López L, Teniente-Serra A, Tintoré M, Rovira A, Ramió-Torrenta L, Brieva L, Saiz A, Cano A, Carmona O, Hervás JV, Martínez-Cáceres EM, Ramo-Tello C. Similar biological effect of high-dose oral versus intravenous methylprednisolone in multiple sclerosis relapses. Mult Scler 2014; 21:646-50. [PMID: 25145693 DOI: 10.1177/1352458514546786] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Our aim was to investigate differences in immune mechanisms in multiple sclerosis (MS) relapse, after high-dose oral methylprednisolone (oMP) or intravenous methylprednisolone (ivMP). We measured serum cytokines (IL-2, IL-4, IL-6, IL-10, IL-17, TNF-α and IFN-γ) in 39 of 49 MS patients with moderate-severe relapse, whom were treated with ivMP or oMP in a placebo-controlled, non-inferiority clinical trial. We assessed these cytokine levels at baseline and at 1 and 4 weeks post-treatment. The cytokine levels between oMP and ivMP were similar at any time. Proinflammatory cytokines (IL-6 and IFN-γ) were significantly decreased in both groups at week 1 (p = 0.05 / p = 0.03) and at week 4 (p = 0.04 / p = 0.05). This study provides further confirmatory evidence that oMP is not inferior to ivMP. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT00753792.
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Affiliation(s)
- L Grau-López
- Hospital Germans Trias i Pujol, Badalona, Spain/Universitat Autònoma de Barcelona, Spain
| | - A Teniente-Serra
- Hospital Germans Trias i Pujol, Badalona, Spain/Universitat Autònoma de Barcelona, Spain
| | - M Tintoré
- Hospital Vall D' Hebron, Barcelona, Spain
| | - A Rovira
- Hospital Vall D' Hebron, Barcelona, Spain
| | | | - L Brieva
- Hospital Arnau de Vilanova, Lleida, Spain
| | - A Saiz
- Hospital Clinic, Barcelona, Spain
| | - A Cano
- Hospital de Mataró, Mataró, Spain
| | - O Carmona
- Hospital de Figueres, Figueres, Spain
| | - J V Hervás
- Hospital Germans Trias i Pujol, Badalona, Spain/Universitat Autònoma de Barcelona, Spain
| | - E M Martínez-Cáceres
- Hospital Germans Trias i Pujol, Badalona, Spain/Universitat Autònoma de Barcelona, Spain
| | - C Ramo-Tello
- Hospital Germans Trias i Pujol, Badalona, Spain/Universitat Autònoma de Barcelona, Spain
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Ramo-Tello C, Grau-López L, Tintoré M, Rovira A, Ramió i Torrenta L, Brieva L, Cano A, Carmona O, Saiz A, Torres F, Giner P, Nos C, Massuet A, Montalbán X, Martínez-Cáceres E, Costa J. A randomized clinical trial of oral versus intravenous methylprednisolone for relapse of MS. Mult Scler 2013; 20:717-25. [DOI: 10.1177/1352458513508835] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Steroids improve multiple sclerosis (MS) relapses but therapeutic window and dose, frequency and administration route remain uncertain. Objective: The objective of this paper is to compare the clinical and radiologic efficacy, tolerability and safety of intravenous methylprednisolone (ivMP) vs oral methylprednisolone (oMP), at equivalent high doses, for MS relapse. Methods: Forty-nine patients with moderate or severe relapse within the previous 15 days were randomized in a double-blind, noninferiority, multicenter trial to receive ivMP or oMP and their matching placebos. Expanded Disability Status Scale (EDSS) scores were determined at baseline and weeks 1, 4 and 12. Brain MRI were assessed at baseline and at weeks 1 and 4. Primary endpoint was a noninferiority assessment of EDSS improvement at four weeks (noninferiority margin of one point), with further key efficacy assessments of number and volume of T1 gadolinium-enhancing (Gd+), and new or enlarged T2 lesions at four weeks’ post-treatment initiation. Secondary outcomes were safety and tolerability. Results: The study achieved the main outcome of noninferiority at four weeks for improved EDSS score. No differences were found between ivMP and oMP in the number of Gd+ lesions (0 (0–1) vs 0 (0–0.5), p = 0.630), volume of Gd+ lesions (0 (0–88.0) vs 0 (0–32.9) mm3, p = 0.735), or new or enlarged T2 lesions (0 (0–194) vs 0 (0–123), p = 0.769). MP was well tolerated, and no serious adverse events were reported. Conclusions: This study provides confirmatory evidence that oMP is not inferior to ivMP in reducing EDSS, similar in MRI lesions at four weeks for MS relapses and is equally well tolerated and safe. Trial registration: clinicaltrials.gov identifier: NCT00753792
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Affiliation(s)
| | | | | | | | | | - L Brieva
- Hospital Arnau de Vilanova, Spain
| | - A Cano
- Hospital de Mataró, Spain
| | | | - A Saiz
- Hospital Clínic i Provincial, Spain
| | - F Torres
- Hospital Clínic i Provincial, Spain
| | - P Giner
- Hospital Germans Trias i Pujol, Spain
| | - C Nos
- Hospital Vall d’Hebron, Spain
| | - A Massuet
- Hospital Germans Trias i Pujol, Spain
| | | | | | - J Costa
- Hospital Germans Trias i Pujol, Spain
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Abraira V, Alvarez-Cermeño J, Arroyo R, Cámara C, Casanova B, Cubillo S, de Andrés C, Espejo C, Fernández O, Ferrer J, Figueredo M, García-Merino A, García-Sánchez M, García-Trujillo J, Gómez M, González-Oria C, Gosis A, Izquierdo G, Jímenez J, López-Trascasa M, Montalbán X, Moreno M, Muñoz D, Nuñez V, Muriel A, Navarro J, Olascoaga J, Oreja-Guevara C, Prada A, Ramil E, Ramo-Tello C, Rodríguez C, Rodríguez E, Rodríguez-Frías F, Rodríguez-Antigüedad A, Rodríguez-Molina J, Ruiz E, Saiz A, Sarasola E, Simó M, Yagüe J, Villar L. Utility of oligoclonal IgG band detection for MS diagnosis in daily clinical practice. J Immunol Methods 2011; 371:170-3. [DOI: 10.1016/j.jim.2011.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 06/06/2011] [Accepted: 06/08/2011] [Indexed: 11/29/2022]
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Blanco Y, Ercilla-González G, Llufriu S, Casanova-Estruch B, Magraner MJ, Ramió-Torrentá L, Mendibe-Bilbao MM, Uclés-Sánchez AJ, Casado-Chocán JL, López de Munain A, Ramo-Tello C, Santos-Lasaosa S, Fernández-Bolaños Porras R, Segura-Bruna N, Sepulveda-Gázquez M, Villoslada P, Graus F, Saiz A. [HLA-DRB1 typing in Caucasians patients with neuromyelitis optica]. Rev Neurol 2011; 53:146-152. [PMID: 21748712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The existence of antibodies to aquaporin-4 (AQP-4-ab) has identified neuromyelitis optica (NMO) and multiple sclerosis (MS) as different diseases. Although HLA-DRB1 alleles contribute to MS risk, recent studies suggest that HLA back-ground differs between patients with NMO or MS in non-Caucasians populations. Our study was aimed to analyze HLA-DRB1 distribution in Caucasians NMO patients. SUBJECTS AND METHODS We recruited a cohort of 22 NMO patients (73% were AQP-4-ab positive), 228 MS patients and 225 healthy controls from Spain and we genotyped the HLA-DRB1 locus. Then, we performed a pool analysis using reported data from 45 NMO patients (53% were AQP-4-ab positive), 156 MS patients and 310 healthy controls from Caucasian French population. RESULTS In the Spanish cohort, NMO was associated with increased frequency of DRB1*10 allele compared with MS (odds ratio, OR = 15.1; 95% confidence interval, 95% CI = 3.26-69.84; p = 0.012). In the pooled analysis, by comparison with healthy controls, NMO was associated with increased frequency of DRB1*03 allele (OR = 2.27; 95% CI = 1.44-3.58; p < 0.0008) which was related to AQP-4-ab seropositivity (OR = 2.74; 95% CI = 1.58-4.77; p < 0.0008). By contrast, MS was associated with increased frequency of DRB1*15 allele (OR = 2.09; 95% CI = 1.62-2.68; p < 0.0008) and decreased frequency of DRB1*07 allele (OR = 0.58; 95% CI = 0.44-0.78; p < 0.0008). CONCLUSIONS Caucasian patients with NMO and MS have a different HLA-DRB1 allelic distribution. DRB1*03 allele seems to contribute to NMO seropositivity. Multicenter collaborative efforts are needed to adequately address the genetic contribution to NMO susceptibility.
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Affiliation(s)
- Y Blanco
- Servicio de Neurología, Hospital Clínicm, Barcelona, España
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Naranjo-Gómez M, Raïch-Regué D, Oñate C, Grau-López L, Ramo-Tello C, Pujol-Borrell R, Martínez-Cáceres E, Borràs FE. Comparative study of clinical grade human tolerogenic dendritic cells. J Transl Med 2011; 9:89. [PMID: 21658226 PMCID: PMC3141500 DOI: 10.1186/1479-5876-9-89] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 06/09/2011] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The use of tolerogenic DCs is a promising therapeutic strategy for transplantation and autoimmune disorders. Immunomodulatory DCs are primarily generated from monocytes (MDDCs) for in vitro experiments following protocols that fail to fulfil the strict regulatory rules of clinically applicable products. Here, we compared the efficacy of three different tolerance-inducing agents, dexamethasone, rapamycin and vitamin D3, on DC biology using GMP (Good Manufacturing Practice) or clinical grade reagents with the aim of defining their use for human cell therapy. METHODS Tolerogenic MDDCs were generated by adding tolerogenic agents prior to the induction of maturation using TNF-α, IL-β and PGE2. We evaluated the effects of each agent on viability, efficiency of differentiation, phenotype, cytokine secretion and stability, the stimulatory capacity of tol-DCs and the T-cell profiles induced. RESULTS Differences relevant to therapeutic applicability were observed with the cellular products that were obtained. VitD3-induced tol-DCs exhibited a slightly reduced viability and yield compared to Dexa-and Rapa-tol-DCs. Phenotypically, while Dexa-and VitD3-tol-DCs were similar to immature DCs, Rapa-tol-DCs were not distinguishable from mature DCs. In addition, only Dexa-and moderately VitD3-tol-DCs exhibited IL-10 production. Interestingly, in all cases, the cytokine secretion profiles of tol-DCs were not modified by a subsequent TLR stimulation with LPS, indicating that all products had stable phenotypes. Functionally, clearly reduced alloantigen T cell proliferation was induced by tol-DCs obtained using any of these agent. Also, total interferon-gamma (IFN-γ) secretion by T cells stimulated with allogeneic tol-DCs was reduced in all three cases, but only T cells co-cultured with Rapa-tol-DCs showed impaired intracellular IFN-γ production. In addition, Rapa-DCs promoted CD4+ CD127 low/negative CD25high and Foxp3+ T cells. CONCLUSIONS Our results demonstrate contrasting influences of different clinical-grade pharmacological agents on human tol-DC generation. This should be taken into account for decisions on the use of a specific agent for the appropriate cellular therapy in the context of a particular disease.
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Affiliation(s)
- M Naranjo-Gómez
- Laboratory of Immunobiology for Research and Diagnosis, Blood and Tissue Bank, Dept. of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Institut Investigació Germans Trias i Pujol, Spain
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Devonshire V, Lapierre Y, Macdonell R, Ramo-Tello C, Patti F, Fontoura P, Suchet L, Hyde R, Balla I, Frohman EM, Kieseier BC. The Global Adherence Project (GAP): a multicenter observational study on adherence to disease-modifying therapies in patients with relapsing-remitting multiple sclerosis. Eur J Neurol 2011; 18:69-77. [PMID: 20561039 DOI: 10.1111/j.1468-1331.2010.03110.x] [Citation(s) in RCA: 270] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND most disease-modifying therapies (DMTs) for multiple sclerosis (MS) are self-injectable medications that must be taken on an ongoing basis to reduce disease activity. Thus, adherence to therapy becomes an important challenge that must be addressed to maximize benefits of therapy. This study evaluated rates of adherence to prescribed treatment and explored factors affecting adherence amongst patients with relapsing-remitting MS. METHODS this was an observational, multicenter, multinational, phase 4 study. Patients and physicians received paper questionnaires regarding adherence to DMTs approved at the time of the study, including intramuscular interferon beta-1a (IFNβ-1a), subcutaneous IFNβ-1a, IFNβ-1b, and glatiramer acetate. Quality of life and cognition data also were collected. Multivariate analysis was conducted to identify factors associated with adherence to long-term DMTs. RESULTS two thousand six hundred and forty-eight patients were studied, revealing an average treatment duration of 31 months. Seventy-five percent of patients (n = 1923) were adherent to therapy. The most common reasons for non-adherence were forgetting to administer the injection (50.2%) and other injection-related reasons (32.0%). Adherent patients reported better quality of life (P < 0.05) and fewer neuropsychological issues (P < 0.001) than non-adherent patients. Adherent patients had significantly shorter duration of disease (P < 0.001) and shorter duration of therapy (P = 0.005) than non-adherent patients. Women were more likely than men to adhere to treatment. CONCLUSION identifying factors that affect adherence to prescribed treatments is the first step in improving adherence of patients with MS to therapy, thereby helping maximize the benefits of long-term DMTs.
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Affiliation(s)
- V Devonshire
- University of British Columbia Hospital MS Clinic, Canada
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Arroyo E, Grau C, Ramo-Tello C, Parra J, Sánchez-Soliño O. Adherence to disease-modifying therapies in spanish patients with relapsing multiple sclerosis: two-year interim results of the global adherence project. Eur Neurol 2011; 65:59-67. [PMID: 21212677 DOI: 10.1159/000323216] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 11/29/2010] [Indexed: 11/19/2022]
Abstract
The post-marketing international Global Adherence Project investigated adherence to disease-modifying therapy for relapsing-remitting multiple sclerosis. We report adherence data from the first 2 years in the Spanish subset of patients (n = 254 at baseline). The overall adherence rate was 85.4%. Patients taking intramuscular (IM) interferon-β (IFNβ)-1a were significantly more adherent (96.4%) compared with patients taking subcutaneous (SC) IFNβ-1a 22 μg (79.1%; p = 0.0064), SC IFNβ-1a 44 μg (79.6%; p = 0.0064) and glatiramer acetate (82.7%; p = 0.0184). At year 1 (n = 142), the overall adherence rate was 86.6%. Patients on IM IFNβ-1a were significantly more adherent than patients on SC IFNβ-1a 22 μg (93.9 vs. 66.7%; p = 0.0251). At year 2 (n = 131), the overall adherence rate was 82% (87.5% for IM IFNβ-1a, 80.0% for SC IFNβ-1a 22 μg, 77.8% for SC IFNβ-1a 44 μg, 85.2% for IFNβ-1b, and 80.0% for glatiramer acetate). In conclusion, adherence remained high among all disease-modifying therapies over the first 2 years of the study and was significantly higher for IM IFNβ-1a, at visit 1, compared with SC IFNβ-1a.
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Affiliation(s)
- E Arroyo
- Biogen Idec Iberia SL, Madrid, Spain.
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Grau-López L, Raïch D, Ramo-Tello C, Naranjo-Gómez M, Dávalos A, Pujol-Borrell R, Borràs FE, Martínez-Cáceres E. Specific T-cell proliferation to myelin peptides in relapsing-remitting multiple sclerosis. Eur J Neurol 2010; 18:1101-4. [PMID: 21749576 DOI: 10.1111/j.1468-1331.2010.03307.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The identification of major immunogenic peptides in multiple sclerosis (MS) is of great importance for the development of antigen-specific therapies. Cellular reactivity against a selected mix of seven myelin peptides was evaluated in vitro. The evolution of this reactivity over time and its correlation with clinical variables was also analysed. MATERIAL AND METHODS Forty-two patients with MS, 15 with other demyelinating diseases and 40 healthy donors (HD) were studied. Cell proliferation was measured by 3[H] thymidine incorporation into samples obtained at 0, 3, 6 and 12months of MS patient follow-up. RESULTS A positive reaction to the peptide mix was detected in 31 of the 42 patients (74%), 12 of the 40 HD (30%) and 6 of the 15 (40%) patients with other demyelinating diseases. Patients with positive proliferation had greater disability (EDSS score, 3 [1-5.5] vs. 1.0[1-2], P=0.021), higher number of relapses (7±4.1 vs. 3±1.2, P<0.001) and shorter time since the last relapse (9±7.5 vs. 32±12.3months, P=0.036). After 12months of follow-up, cell reactivity was maintained in 33 patients (78%). CONCLUSION A high percentage of patients exhibit a significant and maintained reactivity to myelin peptides over time. Therefore, this mix may be useful as a source of antigen in the development of protocols aimed at inducing specific tolerance in MS.
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Affiliation(s)
- L Grau-López
- Department of Cell Biology, Physiology and Immunology Institut Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
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Grau-López L, Sierra S, Martínez-Cáceres E, Ramo-Tello C. Analysis of the pain in multiple sclerosis patients. Neurologia 2010; 26:208-13. [PMID: 21163193 DOI: 10.1016/j.nrl.2010.07.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Despite pain being a disabling symptom in patients with multiple sclerosis (MS), its prevalence and characteristics are not well established. The aim of this study is to describe the characteristics and prevalence of pain in patients with MS, and to assess the associated clinical variables and radiological findings. METHODS We prospectively studied patients with MS. A structured questionnaire which evaluated depression symptoms, type of pain, location, intensity (defined according to a visual analogue scale (VAS) as severe (VAS 7-10), moderate (VAS 4-6) and mild (VAS 0-4), and pain therapy was recorded in patients who referred to pain at the time of interview. Protocol variables were demographic data, MS clinical forms (remitting-relapsing, progressive-secondary and progressive-primary), neurological dysfunction (defined according to EDSS scale), symptoms at onset, attack frequency, illness duration, disease modifying treatment, fatigue, spasticity, oligoclonal bands in CSF, visual evoked potentials, depression symptoms (Hamilton test) and presence of lesions in spinal cord MRI. RESULTS A total of 134 MS patients were included, and MRI was performed on 105 of them. Pain was reported by 74 (55%) patients and was most frequently neuropathic, located in limbs, severe and burning/spiky. Of these 28 (38%) received therapy for their pain, based predominantly in anti-inflammatory drugs. Patients with pain had a worse functional state (EDSS score, 4.5 [3-6] vs 1.5 [1-2], p<0.001), higher number of relapses (7.13±3.4 vs 3.75±2.9, p<0.001), progressive forms of MS (86.7% vs 13.3%, p<0.001), depression (91.9% vs 8.1%, p<0.001), spinal cord involvement at onset (79.2% vs 20.8%, p=0.009), spinal cord lesions by MRI (84.3% vs 15.7%, p<0.001) and longer duration of disease (14.6±7.8 vs 8.43±5.9 months, p<0.001). In a logistic regression model, the presence of lesions in spinal cord MRI (OR 3.5 [1.5-24.5]) and higher EDSS score (OR 1.7 [1.1-2.7]) were independently associated with pain. CONCLUSIONS Pain is a frequent disabling symptom in MS and is associated with disability and spinal cord lesions.
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Affiliation(s)
- L Grau-López
- Departamento de Neurociencias, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
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Otero S, Batlle J, Bonaventura I, Brieva L, Bufill E, Cano A, Carmona O, Escartín A, Marco M, Moral E, Munteis E, Nos C, Pericot I, Perkal H, Ramió-Torrentà L, Ramo-Tello C, Saiz A, Sastre-Garriga J, Tintoré M, Vaqué J, Montalban X. [Multiple sclerosis epidemiological situation update: pertinence and set-up of a population based registry of new cases in Catalonia]. Rev Neurol 2010; 50:623-633. [PMID: 20473839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The first epidemiological studies on multiple sclerosis (MS) around the world pictured a north to south latitudinal gradient that led to the first genetic and environmental pathogenic hypothesis. MS incidence seems to be increasing during the past 20 years based on recent data from prospective studies performed in Europe, America and Asia. This phenomenon could be explained by a better case ascertainment as well as a change in causal factors. The few prospective studies in our area together with the increase in the disease in other regions, justifies an epidemiological MS project in order to describe the incidence and temporal trends of MS. DEVELOPMENT A prospective multicenter MS registry has been established according to the actual requirements of an epidemiological surveillance system. Case definition is based on the fulfillment of the McDonald diagnostic criteria. The registry setting is the geographical area of Cataluna (northeastern Spain), using a wide network of hospitals specialized in MS management. CONCLUSION Recent epidemiological studies have described an increase in MS incidence. In order to contrast this finding in our area, we consider appropriate to set up a population based registry.
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Affiliation(s)
- S Otero
- Servicio de Medicina Preventiva y Epidemiología, Hospital General Universitari Vall d'Hebron, Barcelona, España.
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Grau-López L, Raïch D, Ramo-Tello C, Naranjo-Gómez M, Dàvalos A, Pujol-Borrell R, Borràs FE, Martínez-Cáceres E. Myelin peptides in multiple sclerosis. Autoimmun Rev 2009; 8:650-3. [PMID: 19393199 DOI: 10.1016/j.autrev.2009.02.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Accepted: 02/06/2009] [Indexed: 11/29/2022]
Abstract
The development of specific therapies for organ-specific autoimmune diseases requires the identification of relevant immunogenic epitopes, recognized by both pathogenic T cells and autoantibodies. Here, we review the most relevant studies focused in the identification of peptides in multiple sclerosis (MS) and the distinct T cell reactivity induced in patients compared to controls. Only a few studies reported significant differences in terms of T cell reactivity to them. The current knowledge on this issue, and the diagnostic and therapeutic possibilities opened by the identification of pathogenic MS epitopes are discussed in this paper.
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Affiliation(s)
- L Grau-López
- Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Ramo-Tello C, León-Colombo T. [What treatment should be given for multiple sclerosis at the present time?]. Rev Neurol 2000; 30:993-5. [PMID: 10919203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE This communication aims to describe an approach suitable for the general neurologist or neurologist specialized in treating other disorders, to the current treatment of multiple sclerosis. DEVELOPMENT AND CONCLUSIONS We discuss the treatments for recovery from the symptoms of an acute attack and those which modify the natural course of the illness (reduce the frequency and severity of attacks and/or prevent their progression). The attacks are treated with corticosteroids or ACTH. Both treatments have been shown on clinical trials to cause rapid improvement of the acute symptoms of an attack. In the progressive forms, the usefulness of high doses of corticosteroids has not been shown. Nor is there evidence that long term corticosteroid treatment, either daily or monthly, is of use in reducing the number of attacks or progression of the disease, although serious side-effects have been seen. At the moment, the interferons are the most popular treatment for multiple sclerosis. They have been the first drugs to modify the course of the disorder. Finally, we describe some of the most generally used treatments and some under investigation, although they are not widely used since it is still not clear exactly how they affect the course of the disease.
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Affiliation(s)
- C Ramo-Tello
- Servicio de Neurología, Hospital de la Princesa, Madrid, España.
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