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Romero-Laorden N, Lorente D, de Velasco G, Lozano R, Herrera B, Puente J, López PP, Medina A, Almagro E, Gonzalez-Billalabeitia E, Villla-Guzman JC, González-Del-Alba A, Borrega P, Laínez N, Fernández-Freire A, Hernández A, Rodriguez-Vida A, Chirivella I, Fernandez-Parra E, López-Campos F, Isabel Pacheco M, Morales-Barrera R, Fernández O, Villatoro R, Luque R, Hernando S, Castellano DC, Castro E, Olmos D. Prospective Assessment of Bone Metabolism Biomarkers and Survival in Metastatic Castration-resistant Prostate Cancer Patients Treated with Radium-223: The PRORADIUM Study. Eur Urol Oncol 2024; 7:447-455. [PMID: 37838555 DOI: 10.1016/j.euo.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Radium-223 is an active therapy option for bone metastatic castration-resistant prostate cancer (mCRPC). The lack of adequate biomarkers for patient selection and response assessment are major drawbacks for its use. OBJECTIVE To assess the prognostic value of bone metabolism biomarkers (BMBs) in ra-223-treated mCRPC patients. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study of mCRPC patients treated with Ra-223 (PRORADIUM study: NCT02925702) was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The main objective of the study was to evaluate the association between high (≥median) baseline values in at least three bone formation (bone alkaline phosphatase [BAP] and C-terminal type-I collagen propeptide) and bone resorption (N-terminal telopeptide and pyridinoline) biomarkers, and survival. The independent prognostic value of each BMB was also assessed. The association with time to radiographic, clinical, and prostate-specific antigen (PSA) progression; time to skeletal-related events; and PSA response were secondary objectives. Multivariable (MV) Cox-regression models were evaluated. RESULTS AND LIMITATIONS A total of 169 patients were included. Of the patients, 70.4% received Ra-223 in second/third line; 144 (85.2%) were Eastern Cooperative Oncology Group 0-1, 126 (74.6%) were in pain, and 80 (47.5%) had more than ten bone metastases. Sixty-seven (39.6%) patients had elevation in at least three BMBs. The median overall survival was 12.1 mo (95% confidence interval [CI]: 10-14.7). No association was observed with other treatment-related secondary outcome parameters. Patients with high values in three or more BMBs had significantly worse survival (9.9 vs 15.2 mo; hazard ratio [HR]: 1.8 [95% CI: 1.3-2.5]; p < 0.001) in the univariate analysis, but not independent in the MV analysis (HR: 1.33; 95% CI: 0.89-2; p = 0.181). High baseline BAP was the only biomarker associated with survival in the MV model (HR: 1.89; 95% CI: 1.28-2.79; p = 0.001). Addition of BAP to the MV clinical model increased the area under the receiver operating characteristic curve 2-yr value from 0.667 to 0.755 (p = 0.003). CONCLUSIONS Biomarkers of bone formation, especially BAP, have prognostic value in mCRPC patients treated with radium-223. Its predictive value remains to be assessed, ideally in prospective, adequately powered, randomised clinical trials. PATIENT SUMMARY In this study, we evaluate the role of bone metabolism biomarkers to help improve the use of radium-223 as therapy for advanced prostate cancer. We found that bone alkaline phosphatase may be a suitable tool.
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Affiliation(s)
- Nuria Romero-Laorden
- Medical Oncology Department, Hospital Universitario La Princesa, Madrid, Spain; Cátedra UAM-Fundación Instituto Roche de Medicina Personalizada de Precisión, Madrid, Spain
| | - David Lorente
- Medical Oncology Department, Hospital Provincial de Castellón, Castellón de la Plana, Spain
| | - Guillermo de Velasco
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Biomarkers in Genito-Urinary Cancers Group, I+12 Biomedical Research Institute, Madrid, Spain
| | - Rebeca Lozano
- Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Bernardo Herrera
- Urology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Genitourinary Cancers Traslational Research Unit, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Javier Puente
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Pedro P López
- Genomics and Therapeutics in Prostate Cancer Group, I+12 Biomedical Research Institute, Madrid, Spain
| | - Ana Medina
- Fundación Centro Oncológico de Galicia, A Coruña, Spain
| | - Elena Almagro
- Hospital Universitario Quirón, Pozuelo de Alarcón, Spain
| | - Enrique Gonzalez-Billalabeitia
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Biomarkers in Genito-Urinary Cancers Group, I+12 Biomedical Research Institute, Madrid, Spain
| | | | | | | | - Nuria Laínez
- Department of Medical Oncology, Navarra University Hospital, Pamplona, Spain
| | | | - Amaia Hernández
- Medical Oncology Department, Gipuzkoa Cancer Unit, OSI Donostialdea - Onkologikoa Foundation, San Sebastián, Spain
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar, CIBERONC, IMIM Research Institute, Barcelona, Spain
| | - Isabel Chirivella
- Medical Oncology Department, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | | | - Fernando López-Campos
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Rafael Morales-Barrera
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ovidio Fernández
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Raquel Luque
- Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
| | | | - Daniel C Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Biomarkers in Genito-Urinary Cancers Group, I+12 Biomedical Research Institute, Madrid, Spain
| | - Elena Castro
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Translational Cancer Genetics Group, I+12 Biomedical Research Institute, Madrid, Spain
| | - David Olmos
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Genomics and Therapeutics in Prostate Cancer Group, I+12 Biomedical Research Institute, Madrid, Spain.
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Manzano JL, Martin-Liberal J, Fernández-Morales LA, Benítez G, Medina Martínez J, Quindós M, García-Castaño A, Fernández O, Simo RV, Majem M, Bellido L, Ayala de Miguel P, Campos B, Espinosa E, Macías Cerrolaza JA, Gil-Arnaiz I, Lorente D, Rodriguez-Lescure A, Perez VN, López Castro R, Gramaje MG, Puértolas T, Rodriguez Moreno JF, Espasa Font L, Belaustegui Ferrández G, Cerezuela-Fuentes P. Adjuvant dabrafenib and trametinib for patients with resected BRAF -mutated melanoma: DESCRIBE-AD real-world retrospective observational study. Melanoma Res 2023; 33:388-397. [PMID: 36988401 PMCID: PMC10470432 DOI: 10.1097/cmr.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/11/2023] [Indexed: 03/30/2023]
Abstract
BRAF and MEK inhibitor, dabrafenib plus trametinib, adjuvant therapy is effective for high-risk resected melanoma patients with BRAF - V600 mutations. However, real-world evidence is limited. We aimed to determine the feasibility of this therapy in routine clinical practice. DESCRIBE-AD, a retrospective observational study, collected real-world data from 25 hospitals in Spain. Histologically confirmed and resected BRAF -mutated melanoma patients aged ≥18 years who were previously treated with dabrafenib plus trametinib adjuvant therapy, were included. The primary objectives were treatment discontinuation rate and time to discontinuation. The secondary objectives included safety and efficacy. From October 2020 to March 2021, 65 patients were included. Dabrafenib and trametinib discontinuation rate due to treatment-related adverse events (TRAEs) of any grade was 9%. Other reasons for discontinuation included patients' decisions (6%), physician decisions (6%), unrelated adverse events (3%), disease progression (5%), and others (5%). The median time to treatment discontinuation was 9 months [95% confidence interval (CI), 5-11]. G3-4 TRAEs occurred in 21.5% of patients, the most common being pyrexia (3%), asthenia (3%), and diarrhoea (3%). Unscheduled hospitalisations and clinical tests occurred in 6 and 22% of patients, respectively. After 20-month median follow-up (95% CI, 18-22), 9% of patients had exitus due to disease progression, with a 12-month relapse-free survival and overall survival rates of 95.3% and 100%, respectively. Dabrafenib and trametinib adjuvant therapy proved effective for melanoma patients in a real-world setting, with a manageable toxicity profile. Toxicity frequencies were low leading to low incidence of unscheduled medical visits, tests, and treatment discontinuations.
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Affiliation(s)
- José L Manzano
- Medical Oncology, Instituto Catalán de Oncología, ICO-Badalona, H. Germans Trias i Pujol, Badalona
| | | | | | - Gretel Benítez
- Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas
| | | | - María Quindós
- Medical Oncology, Complejo Hospitalario Universitario A Coruña, La Coruña
| | | | - Ovidio Fernández
- Medical Oncology, Complejo Hospitalario Universitario de Ourense, Orense
| | - Rocío V Simo
- Medical Oncology, Hospital Arquitecto Marcide, Ferrol
| | - Margarita Majem
- Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona
| | - Lorena Bellido
- Medical Oncology, Complejo Asistencial Universitario de Salamanca, Salamanca
| | | | - Begoña Campos
- Medical Oncology, Hospital Universitario Lucus Augusti de Lugo, Lugo
| | - Enrique Espinosa
- Medical Oncology, Hospital Universitario La Paz - CIBERONC, Madrid
| | | | | | - David Lorente
- Medical Oncology, Hospital Provincial de Castellón, Castellón de la Plana
| | | | | | | | - María G Gramaje
- Medical Oncology, Hospital Universitario Son Llàtzer, Mallorca
| | - Teresa Puértolas
- Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza
| | | | - Laia Espasa Font
- Solid Tumours Medical Department, Novartis Farmacéutica S.A., Barcelona
| | | | - Pablo Cerezuela-Fuentes
- Medical Oncology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Ciudad de Murcia, Spain
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Cerezuela-Fuentes P, Martín-Liberal J, Fernández-Morales L, Benítez G, Medina Martinez J, Quindós M, García Castaño A, Puértolas T, Vilchez Simo R, Fernández O, Majem M, Bellido Hernández L, Ayala de Miguel P, Campos B, Espinosa E, Macías Cerrolaza J, Rodríguez-Lescure A, Espasa Font L, Belaustegui Ferrández G, Manzano Mozo J. 811P Three-years real-world evidence of adjuvant dabrafenib plus trametinib (DT) in patients with resected melanoma in Spain (GEM 1901 - DESCRIBE-AD). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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De Velasco Oria G, García-Carbonero I, Esteban-Gonzalez E, Pinto A, Lorente D, Gómez de Liaño A, Martínez Ortega E, Jimenez Colomo L, Puente J, Gonzalez I, Fernández O, Anguera G. 1741P Atezolizumab (ATZ) with split-doses of cisplatin plus gemcitabine in patients with locally advanced or metastatic urothelial carcinoma (SOGUG-AUREA): A multicentre, single-arm phase II trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Fernández O, Lázaro-Quintela M, Crespo G, Soto de Prado D, Pinto Á, Basterretxea L, Gómez de Liaño A, Etxaniz O, Blasco S, Gabás-Rivera C, Aceituno S, Palomar V, Polanco-Sánchez C. Preferences for Renal Cell Carcinoma Pharmacological Treatment: A Discrete Choice Experiment in Patients and Oncologists. Front Oncol 2022; 11:773366. [PMID: 35070976 PMCID: PMC8777125 DOI: 10.3389/fonc.2021.773366] [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: 09/09/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction The purpose of this investigation was to explore patients’ and oncologists’ preferences for the characteristics of a pharmacological regimen for patients with advanced renal cell carcinoma (aRCC). Material and Methods Cross-sectional observational study based on a discrete choice experiment (DCE) conducted in Spain. A literature review, a focus group with oncologists and interviews with patients informed the DCE design. Five attributes were included: progression survival gain, risk of serious adverse events (SAEs), health-related quality of life (HRQoL), administration mode, and treatment cost. Preferences were analyzed using a mixed-logit model to estimate relative importance (RI) of attributes (importance of an attribute in relation to all others), which was compared between aRCC patients and oncologists treating aRCC. Willingness to pay (WTP, payer: health system) for a benefit in survival or in risk reduction and maximum acceptable risk (MAR) in SAEs for improving survival were estimated from the DCE. Subgroup analyses were performed to identify factors that influence preference. Results A total of 105 patients with aRCC (77.1% male, mean age 65.9 years [SD: 10.4], mean time since RCC diagnosis 6.3 years [SD: 6.1]) and 67 oncologists (52.2% male, mean age 41.9 years [SD: 8.4], mean duration of experience in RCC 10.2 years [SD: 7.5]) participated in the study. The most important attribute for patients and oncologists was survival gain (RI: 43.6% vs. 54.7% respectively, p<0.05), followed by HRQoL (RI: 35.5% vs. 18.0%, respectively, p<0.05). MAR for SAEs was higher among oncologists than patients, while WTP (for the health system) was higher for patients. Differences in preferences were found according to time since diagnosis and education level (patients) or length of professional experience (oncologists). Conclusion Patients’ and oncologists’ preferences for aRCC treatment are determined mainly by the efficacy (survival gain) but also by the HRQoL provided. The results of the study can help to inform decision-making in the selection of appropriate aRCC treatment.
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Affiliation(s)
- Ovidio Fernández
- Department of Oncology, Complejo Hospitalario Universitario de Orense, Orense, Spain
| | - Martín Lázaro-Quintela
- Department of Oncology, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain.,Translational Oncology Research Group (ONCO-INVES), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
| | - Guillermo Crespo
- Department of Oncology, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - Diego Soto de Prado
- Department of Oncology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Álvaro Pinto
- Department of Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Basterretxea
- Department of Oncology, Donostialdea ESI/OSI Donostialdea, Donostia, Unibertsitate Ospitalea/Hospital Universitario Donostia, Donostia, Spain
| | - Alfonso Gómez de Liaño
- Department of Oncology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Olatz Etxaniz
- Department of Oncology, Institut Català d'Oncologia, Badalona, Spain
| | - Sara Blasco
- Department of Oncology, Hospital de Sagunto, Valencia, Spain
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Pinto Á, Reig O, Iglesias C, Gallardo E, García-Del Muro X, Alonso T, Anguera G, Suárez C, Muñoz-Langa J, Villalobos-León L, Rodríguez-Sánchez Á, Lainez N, Martínez-Ortega E, Campayo M, Velastegui A, Rodriguez-Vida A, Villa-Guzmán JC, Méndez-Vidal MJ, Rubio G, García I, Capdevila L, Lambea J, Vázquez S, Fernández O, Hernando-Polo S, Cerezo S, Santander C, García-Marrero R, Zambrana F, González-Del Alba A, Lazaro-Quintela M, Castellano D, Chirivella I, Anido U, Viana A, García A, Sotelo M, Arévalo MG, García-Donas J, Hernández C, Bolós MV, Llinares J, Climent MA. Clinical Factors Associated With Long-Term Benefit in Patients With Metastatic Renal Cell Carcinoma Treated With Axitinib: Real-World AXILONG Study. Clin Genitourin Cancer 2021; 20:25-34. [PMID: 34789409 DOI: 10.1016/j.clgc.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/28/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Axitinib monotherapy obtained approval in pre-treated mRCC patients and recently in combination with pembrolizumab or avelumab in the first-line setting. However, patient profiles that may obtain increased benefit from this drug and its combinations still need to be identified. PATIENTS AND METHODS Retrospective multicentre analysis describing clinical characteristics associated with axitinib long-responder (LR) population by comparing two extreme-response sub-groups (progression-free survival [PFS] ≥9 months vs. disease progression/refractory patients [RP]). A multivariate logistic-regression model was used to analyse clinical factors. Efficacy and safety were also analysed. RESULTS In total, 157 patients who received axitinib in second or subsequent line were evaluated (91 LR and 66 RP). Older age at start of axitinib and haemoglobin levels > LLN were independent predictive factors for LR in multivariate analyses. In LR patients, median (m) PFS was 18.1 months, median overall survival was 36.0 months and objective response rate (ORR) was 45.5%. In 59 LR patients receiving axitinib in second-line, mPFS was 18.7 months, mOS was 44.8 months and ORR was 43.9%. mOS was significantly longer in second line compared to subsequent lines (44.8 vs. 26.5 months; P = .009). In LR vs. RP, mPFS with sunitinib in first-line was correlated with mPFS with axitinib in second-line (27.2 vs. 10.9 months P < .001). The safety profile was manageable and consistent with known data. CONCLUSIONS This study confirms the long-term benefits of axitinib in a selected population, helping clinicians to select the best sequential approach and patients who could obtain a greater benefit from axitinib.
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Affiliation(s)
- Álvaro Pinto
- Medical Oncology Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Oscar Reig
- Medical Oncology Department, Hospital Clinic i Provincial, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Clara Iglesias
- Medical Oncology Department, Hospital Universitario Central de Asturias, Avenida Roma, s/n, 33011 Oviedo, Spain
| | - Enrique Gallardo
- Medical Oncology Department, Hospital Universitario Parc Taulí de Sabadell, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain
| | - Xavier García-Del Muro
- Medical Oncology Department, Institut Català d'Oncologia Hospitalet, IDIBELL Institute of Researh, University of Barcelona, 1, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Alonso
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, M-607, km. 9, 100, 28034 Madrid, Spain
| | - Georgia Anguera
- Medical Oncology Department, Nou Hospital De La Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Spain
| | - Cristina Suárez
- Medical Oncology Department, Hospital Universitario Vall de Hebrón, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - José Muñoz-Langa
- Medical Oncology Department, Hospital Universitario La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Laura Villalobos-León
- Medical Oncology Department, Hospital Universitario Príncipe de Asturias, Carretera de Alcalá, s/n, 28805 Meco, Madrid, Spain
| | - Ángel Rodríguez-Sánchez
- Medical Oncology Department, Hospital Universitario de León, Calle Altos de Nava, s/n, 24071 León, Spain
| | - Nuria Lainez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Calle de Irunlarrea, 3, 31008 Pamplona, Spain
| | - Esther Martínez-Ortega
- Medical Oncology Department , Complejo Hospitalario de Jaén, Avenida del Ejército Español, 10, 23007 Jaén, Spain
| | - Marc Campayo
- Medical Oncology Department, Hospital Universitario MútuaTerrassa, Plaza del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Alejandro Velastegui
- Medical Oncology Department, Hospital Universitario Rey Juan Carlos, Calle Gladiolo, s/n, 28933 Móstoles, Madrid, Spain
| | - Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar, Passeig Marítim 25-29, 08001, Barcelona, Spain
| | - José C Villa-Guzmán
- Medical Oncology Department, Hospital General Universitario de Ciudad Real General, Calle Obispo Rafael Torija, s/n, 13005 Ciudad Real, Spain
| | - Maria J Méndez-Vidal
- Medical Oncology Department, Hospital Universitario Reina Sofía, Avenida Menendez Pidal, 14004, Córdoba, Spain
| | - Gustavo Rubio
- Medical Oncology Department, Hospital Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos, 2, 28040, Madrid, Spain
| | - Iciar García
- Medical Oncology Department, Hospital Virgen de la Salud, Av. de Barber, 30, 45004 Toledo, Spain
| | - Laia Capdevila
- Medical Oncology Department, Hospital San Pablo y Santa Tecla, Rambla Vella, 14, 43003 Tarragona, Spain
| | - Julio Lambea
- Medical Oncology Department, Hospital Clínico Universitario Lozano Blesa, Avda, Calle de San Juan Bosco, 15, 50009 Zaragoza, Spain
| | - Sergio Vázquez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Rúa Dr. Ulises Romero, 1, 27003 Lugo, Spain
| | - Ovidio Fernández
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Calle Ramon Puga Noguerol, 54, 32005 Ourense, Spain
| | - Susana Hernando-Polo
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain
| | - Sara Cerezo
- Medical Oncology Department, Hospital General La Mancha Centro, Av. Constitución, 3, 13600 Alcázar de San Juan, Ciudad Real, Spain
| | - Carmen Santander
- Medical Oncology Department, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Rosa García-Marrero
- Medical Oncology Department, Hospital Universitario de Canarias, Carretera Ofra S/N, 38320 San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Francisco Zambrana
- Medical Oncology Department, Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28703 San Sebastián de los Reyes, Madrid, Spain
| | - Aranzazu González-Del Alba
- Medical Oncology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - Martin Lazaro-Quintela
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, 36213 Vigo, Spain
| | - Daniel Castellano
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain
| | - Isabel Chirivella
- Medical Oncology Department, Hospital Clínico Universitario de Valencia, Av. de Blasco Ibáñez, 17, 46010 Valencia, Spain
| | - Urbano Anido
- Medical Oncology Department, Hospital Clínico Universitario de Santiago de Compostela, Rúa da Choupana, s/n, 15706 Santiago de Compostela, A Coruña, Spain
| | - Antonio Viana
- Medical Oncology Department, Hospital Nuestra Señora del Prado, Carretera de Madrid Km. 114, 45600 Talavera de la Reina, Toledo, Spain
| | - Arancha García
- TFS Trial Form Support S.L., Passeig de Gràcia, 11, 08007 Barcelona, Spain
| | - Miguel Sotelo
- Medical Oncology Department, Hospital Universitario Infanta Cristina, Av. 9 de Junio, 2, 28981 Parla, Madrid, Spain
| | - María Garrido Arévalo
- Medical Oncology Department, Hospital Universitario Severo Ochoa, Av. de Orellana, s/n, 28911 Leganés, Madrid, Spain
| | - Jesús García-Donas
- Medical Oncology Department, Hospital Universitario Clara Campal, Calle de Oña, 10, 28050 Madrid, Spain
| | - Carolina Hernández
- Medical Oncology Department, Hospital Universitario Nuestra Señora de la Candelaria, Ctra. Gral. del Rosario, 145, 38010 Santa Cruz de Tenerife, Spain
| | | | - Julia Llinares
- Pfizer S.L.U. Avenida de Europa, 20, 28108, Madrid, Spain
| | - Miguel A Climent
- Medical Oncology Department, Instituto Valenciano De Oncología, Carrer del Professor Beltrán Báguena, 8, 46009 Valencia, Spain
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Meca-Lallana JE, Oreja-Guevara C, Muñoz D, Olascoaga J, Pato A, Ramió-Torrentà L, Meca-Lallana V, Hernández MA, Marzo ME, Álvarez- Cermeño JC, Rodríguez-Antigüedad A, Montalbán X, Fernández O. Four-year safety and effectiveness data from patients with multiple sclerosis treated with fingolimod: The Spanish GILENYA registry. PLoS One 2021; 16:e0258437. [PMID: 34644366 PMCID: PMC8513911 DOI: 10.1371/journal.pone.0258437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To describe the profile of patients with multiple sclerosis (MS) treated with fingolimod in Spain and to assess the effectiveness and safety of fingolimod after 4 years of inclusion in the Spanish Gilenya Registry. Methods An observational, retrospective/prospective, multicenter case registry, including all patients with relapsing-remitting MS (RRMS) starting treatment with fingolimod in 43 centers in Spain. Analyses were performed in the overall population and in subgroups according to prior disease-modifying therapy (DMT): glatiramer acetate/interferon beta-1 (BRACE), natalizumab, other treatment, or naïve. Results Six hundred and sixty-six evaluable patients were included (91.1% previously treated with at least one DMT). The mean annualized relapse rate (ARR) prior to fingolimod was 1.12, and the mean EDSS at fingolimod initiation was 3.03. Fingolimod reduced the ARR by 71.4%, 75%, 75.5%, and 80.3%, after 1, 2, 3 and 4 years, respectively (p<0.001). This significant reduction in the ARR continued to be observed in all subgroups. After 4 years, the EDSS showed a minimal deterioration, with the EDSS scores from year 1 to year 4 remaining mostly stable. The percentage of patients without T1 Gd+ lesions progressively increased from 45.6% during the year prior to fingolimod initiation to 88.2% at year 4. The proportion of patients free from new/enlarged T2 lesions after 4 years of fingolimod treatment was 80.3%. This trend in both radiological measures was also observed in the subgroups. Adverse events (AEs) were experienced by up to 41.6% of patients (most commonly: lymphopenia [12.5%] and urinary tract infection [3.7%]). Most AEs were mild in severity, 3.6% of patients had serious AEs. Conclusions The patient profile was similar to other observational studies. The results obtained from the long-term use of fingolimod showed that it was effective, regardless of prior DMT, and it had adequate safety results, with a positive benefit-risk balance.
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Affiliation(s)
- J. E. Meca-Lallana
- Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - C. Oreja-Guevara
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - D. Muñoz
- Neurology Department, Hospital Xeral de Vigo, Vigo, Spain
| | - J. Olascoaga
- Neurology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - A. Pato
- Neurology Department, Hospital Povisa, Vigo, Spain
| | - L. Ramió-Torrentà
- Neurology Department, Hospital Universitari de Girona Dr. Josep Trueta, IDIBGI; Medical Sciences Department, University of Girona, Girona, Spain
| | - V. Meca-Lallana
- Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - M. A. Hernández
- Neurology Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | | | - X. Montalbán
- Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - O. Fernández
- Department of Pharmacology, Faculty of Medicine, Universidad de Málaga; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- * E-mail:
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Manzano J, Martín-Liberal J, Fernandez-Morales L, Benítez G, Medina J, Quindós M, García-Castaño A, Fernández O, Vilchez Simo R, Majem M, Bellido Hernández L, Ayala de Miguel P, Campos B, Espinosa E, Macías Cerrolaza J, Gil-Arnaiz I, Lorente D, Martínez-Fernández A, Martín-Sánchez E, Cerezuela-Fuentes P. 1088P Adjuvant dabrafenib plus trametinib (DT) treatment completion in patients with resected melanoma in Spain: A retrospective observational study (GEM 1901 - DESCRIBE-AD). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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9
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Fernández O, Aladro Y, Arroyo R, Brieva L, Calles-Hernández MC, Carrascal P, Comabella M, Costa-Frossard L, Eichau S, García-Merino JA, Ginestal R, González I, Izquierdo G, Martínez-Ginés ML, Meca-Lallana JE, Mendibe-Bilbao MM, Oterino A, Prieto JM, Río J, Ramió-Torrentà L, Romero-Pinel L, Téllez N, Rodríguez-Antigüedad A. [12th Post-ECTRIMS Meeting: review of the novelties from the 2019 ECTRIMS Congress (I)]. Rev Neurol 2021; 70:379-390. [PMID: 32390131 DOI: 10.33588/rn.7010.2020121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Like every year, after the ECTRIMS Congress, renowned Spanish neurologists who are experts in multiple sclerosis presented the main novelties in research in this field at the Post-ECTRIMS Meeting. AIM To summarise the content presented at the 12th edition of the Post-ECTRIMS Meeting, which took place in September 2019 in Sevilla and is presented in two parts. DEVELOPMENT This first part addresses the latest studies on vitamin D deficiency and the discrepancies that currently exist regarding its treatment. The advances made in epigenetics allow us to present this approach as a possible biomarker of multiple sclerosis. An account is provided to explain the growing importance of imaging techniques to detect atrophy and other phenomena that occur during the disease, such as changes in iron concentration or remyelination processes, which allow us to further our understanding of the mechanisms of cortical pathology, and the dimensionality of neurodegeneration during its course. Findings related to immunological mechanisms and advances in potential antigen-specific therapies are discussed. The contribution presents the latest studies on the assessment of cognitive impairment and its rehabilitation, which are becoming increasingly important due to the high prevalence of these disorders and the absence of their systematic assessment in clinical practice. Finally, the unmet social and health needs of multiple sclerosis patients in our country are presented, with emphasis on the current deficits in the system of social protection.
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Affiliation(s)
- O Fernández
- Instituto de Investigación Biomédica de Málaga. IBIMA, Málaga, España
| | - Y Aladro
- Hospital Universitario de Getafe, 28905 Getafe, España
| | - R Arroyo
- Hospital Quirón, Pozuelo de Alarcón, España
| | - Ll Brieva
- Hospital Arnau de Vilanova, 25198 Lleida, España
| | | | | | - M Comabella
- Hospitals Vall d'Hebron, 08035 Barcelona, España
| | | | - S Eichau
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
| | - J A García-Merino
- Hospital Universitario Puerta de Hierro-Majadahonda, 28035 Majadahonda, España
| | - R Ginestal
- Fundación Jiménez Díaz, 28040 Madrid, España
| | | | | | | | | | | | - A Oterino
- Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J M Prieto
- Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, España
| | - J Río
- Hospitals Vall d'Hebron, 08035 Barcelona, España
| | | | - L Romero-Pinel
- Hospital General Universitari de Bellvitge, 08907 Hospitalet de Ll., España
| | - N Téllez
- Hospital Clínico Universitario, 47005 Valladolid, España
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10
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Fernández O, Montalban X, Aladro Y, Alonso A, Arroyo R, Calles C, Castillo-Triviño T, Comabella M, Costa-Frossard L, Forero L, Ginestal R, Landete L, Llaneza M, Llufriu S, Martínez-Ginés ML, Meca-Lallana J, Mendibe M, Oreja-Guevara C, Oterino A, Prieto JM, Ramió-Torrentà L, Romero-Pinel L, Téllez N, Rodríguez-Antigüedad A. 13th Post-ECTRIMS Meeting: review of the new developments presented at the 2020 ECTRIMS Congress (I). Rev Neurol 2021; 72:397-406. [PMID: 34042168 DOI: 10.33588/rn.7211.2021172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION For more than a decade, following the ECTRIMS Congress, the Post-ECTRIMS Meeting has been held in Spain, where neurologists with expertise in multiple sclerosis (MS) from all over the country meet to review the most relevant latest developments presented at the ECTRIMS congress (on this occasion held together with ACTRIMS). AIM This article, published in two parts, summarises the presentations that took place at the Post-ECTRIMS Meeting, held online on 16 and 17 October 2020. DEVELOPMENT This first part includes the latest results regarding the impact of the environment and lifestyle on risk of MS and its clinical course, and the role of epigenetics and genetic factors on these processes. Findings from preclinical and clinical research on the lymphocyte subtypes identified and the involvement of lymphoid follicles and meningeal involvement in the disease are discussed. Changes in brain structure are addressed at the microscopic and macroscopic levels, including results from high-resolution imaging techniques. The latest advances on biomarkers for the diagnosis and prognosis of MS, and on the involvement of the microbiome in these patients are also reported. Finally, results from patient registries on the impact of COVID-19 in MS patients are outlined. CONCLUSIONS There have been new data on MS risk factors, the impact of MS at the cellular and structural level, the role of the microbiome in the disease, biomarkers, and the relationship between COVID-19 and MS.
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Affiliation(s)
- O Fernández
- Hospital Regional Universitario de Málaga, Málaga, España
| | - X Montalban
- Hospital Universitario Vall d'Hebron-CEMCAT, Barcelona, España
| | - Y Aladro
- Hospital Universitario de Getafe, 28905 Getafe, España
| | - A Alonso
- Hospital Regional Universitario de Málaga, Málaga, España
| | - R Arroyo
- Hospital Universitario Quirónsalud, Madrid, España
| | - C Calles
- Hospital Universitari Son Espases, Palma de Mallorca, España
| | | | - M Comabella
- Hospital Universitario Vall d'Hebron-CEMCAT, Barcelona, España
| | | | - L Forero
- Hospital Universitario Puerta del Mar, 11009 Cádiz, España
| | - R Ginestal
- Hospital Universitario Clínico de Madrid, Madrid, España
| | - L Landete
- Hospital Universitario Doctor Peset, Valencia, España
| | - M Llaneza
- Complejo Hospitalario Universitario de Ferrol, Ferrol, España
| | - S Llufriu
- Hospital Clínic de Barcelona, 08036 Barcelona, España
| | | | - J Meca-Lallana
- Hospital Clínico Universitario Virgen de la Arrixaca. IMIB-Arrixaca, Murcia, España
| | - M Mendibe
- Hospital Universitario de Cruces, Bilbao, España
| | | | - A Oterino
- Hospital Universitario Central de Asturias, Oviedo, España
| | - J M Prieto
- Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, España
| | - Ll Ramió-Torrentà
- Hospital Universitari Dr. Josep Trueta, 17007 Girona, España.,Hospital de Santa Caterina-IDIBGI, Salt, España
| | - L Romero-Pinel
- Hospital Universitario de Bellvitge , Hospitalet de Ll., España
| | - N Téllez
- Hospital Clínico Universitario de Valladolid, Valladolid, España
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11
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Fernández O, Montalban X, Aladro Y, Alonso A, Arroyo R, Calles C, Castillo-Triviño T, Comabella M, Costa-Frossard L, Forero L, Ginestal R, Landete L, Llaneza M, Llufriu S, Martínez-Ginés ML, Meca-Lallana J, Mendibe M, Oreja-Guevara C, Oterino A, Prieto JM, Ramió-Torrentà L, Romero-Pinel L, Téllez N, Rodríguez-Antigüedad A. 13th Post-ECTRIMS Meeting: review of the new developments presented at the 2020 ECTRIMS Congress (II). Rev Neurol 2021; 72:433-442. [PMID: 34109999 DOI: 10.33588/rn.7212.2021173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION For more than a decade, after the ECTRIMS Congress, Spain has hosted the Post-ECTRIMS meeting, where neurologists with expertise in multiple sclerosis (MS) meet to review the new developments presented at the ECTRIMS. AIM This article, published in two parts, summarises the presentations of the post-ECTRIMS meeting, held online on 16 and 17 October 2020. DEVELOPMENT This second part highlights the importance of gender and age in understanding the pathology of the disease and optimising its management. The advances made in paediatric MS, from a neuropsychological and neuroimaging point of view, are presented. In turn, special attention is paid to the findings that contribute to a more personalised approach to therapy and to choosing the best treatment strategy (pharmacological and non-pharmacological) for each patient. Similarly, results related to possible strategies to promote remyelination are addressed. Although there are no major advances in the treatment of progressive forms, some quantitative methods for the classification of these patients are highlighted. In addition, the study also includes results on potential tools for assessment and treatment of cognitive deficits, and some relevant aspects observed in the spectrum of neuromyelitis optica disorders. Finally, the results of the papers considered as breaking news at the ECTRIMS-ACTRIMS are detailed. CONCLUSIONS Most of the advances presented were related to the knowledge of paediatric MS, remyelination strategies and cognitive assessment in MS.
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Affiliation(s)
- O Fernández
- Hospital Regional Universitario de Málaga, Málaga, España
| | - X Montalban
- Hospital Universitario Vall d'Hebron-CEMCAT, Barcelona, España
| | - Y Aladro
- Hospital Universitario de Getafe, 28905 Getafe, España
| | - A Alonso
- Hospital Regional Universitario de Málaga, Málaga, España
| | - R Arroyo
- Hospital Universitario Quirónsalud, Madrid, España
| | - C Calles
- Hospital Universitari Son Espases, Palma de Mallorca, España
| | | | - M Comabella
- Hospital Universitario Vall d'Hebron-CEMCAT, Barcelona, España
| | | | - L Forero
- Hospital Universitario Puerta del Mar, 11009 Cádiz, España
| | - R Ginestal
- Hospital Universitario Clínico de Madrid, Madrid, España
| | - L Landete
- Hospital Universitario Doctor Peset, Valencia, España
| | - M Llaneza
- Complejo Hospitalario Universitario de Ferrol, Ferrol, España
| | - S Llufriu
- Hospital Clínic de Barcelona, 08036 Barcelona, España
| | | | - J Meca-Lallana
- Hospital Clínico Universitario Virgen de la Arrixaca. IMIB-Arrixaca, Murcia, España
| | - M Mendibe
- Hospital Universitario de Cruces, Bilbao, España
| | | | - A Oterino
- Hospital Universitario Central de Asturias, Oviedo, España
| | - J M Prieto
- Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, España
| | - Ll Ramió-Torrentà
- Hospital Universitari Dr. Josep Trueta, 17007 Girona, España.,Hospital de Santa Caterina-IDIBGI, Salt, España
| | - L Romero-Pinel
- Hospital Universitario de Bellvitge , Hospitalet de Ll., España
| | - N Téllez
- Hospital Clínico Universitario de Valladolid, Valladolid, España
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12
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Fernández O, Aladro Y, Arroyo R, Brieva L, Calles-Hernández MC, Carrascal P, Comabella M, Costa-Frossard L, Eichau S, García-Merino JA, Ginestal R, González I, Izquierdo G, Martínez-Ginés ML, Meca-Lallana JE, Mendibe-Bilbao MM, Oterino A, Prieto JM, Río J, Ramió-Torrentà L, Romero-Pinel L, Téllez N, Rodríguez-Antigüedad A. 12th Post-ECTRIMS Meeting: review of the novelties from the 2019 ECTRIMS Congress (II). Rev Neurol 2020; 70:417-429. [PMID: 32436209 DOI: 10.33588/rn.7011.2020122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Like every year, after the ECTRIMS Congress, renowned Spanish neurologists who are experts in multiple sclerosis presented the main novelties in research in this field at the Post-ECTRIMS Meeting. AIM To summarise the content presented at the 12th edition of the Post-ECTRIMS Meeting, which took place in September 2019 in Sevilla and is presented in two parts. DEVELOPMENT In this second part, the most recent evidence on the use of disease-modifying treatments during pregnancy is presented. Details are provided concerning the results of phase 3 clinical trials conducted to evaluate the efficacy and safety of two potential disease-modifying treatments for relapsing-remitting multiple sclerosis: ponesimod and ofatumumab. For the progressive forms, both available disease modifying treatments and others still in the research phase are reviewed. In the field of stem cell therapies, the article includes the results of the only clinical trial carried out to date comparing patients with relapsing-remitting multiple sclerosis treated with autologous haematopoietic stem cell transplantation and those treated with disease-modifying therapies. There are no important developments as regards symptomatic treatments, although the European Academy of Neurology has published a guide on palliative care. The various sources of information that collect pharmacovigilance data in the post-marketing setting are reviewed. CONCLUSIONS Patients diagnosed in recent years tend to have less severe multiple sclerosis, probably due to the fact that it is diagnosed in its milder stages together with the steady increase in the number of treatments available.
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Affiliation(s)
- O Fernández
- Instituto de Investigación Biomédica de Málaga. IBIMA, Málaga, España
| | - Y Aladro
- Hospital Universitario de Getafe, 28905 Getafe, España
| | - R Arroyo
- Hospital Quirón, Pozuelo de Alarcón, España
| | - Ll Brieva
- Hospital Arnau de Vilanova, 25198 Lleida, España
| | | | | | - M Comabella
- Hospitals Vall d'Hebron, 08035 Barcelona, España
| | | | - S Eichau
- Hospital Universitario Virgen Macarena, 41003 Sevilla, España
| | - J A García-Merino
- Hospital Universitario Puerta de Hierro-Majadahonda, 28035 Majadahonda, España
| | - R Ginestal
- Fundación Jiménez Díaz, 28040 Madrid, España
| | | | | | | | | | | | - A Oterino
- Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J M Prieto
- Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, España
| | - J Río
- Hospitals Vall d'Hebron, 08035 Barcelona, España
| | | | - L Romero-Pinel
- Hospital General Universitari de Bellvitge, 08907 Hospitalet de Ll., España
| | - N Téllez
- Hospital Clínico Universitario, 47005 Valladolid, España
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Vázquez Estévez S, Anido U, Lázaro M, Fernández O, Fernández Núñez N, de Dios Álvarez N, Varela V, Campos Balea B, Agraso S, Areses MC, Iglesias L, Blanco M, Maciá S, Anton Aparicio LM. A new scenario in metastatic renal cell carcinoma: a SOG-GU consensus. Clin Transl Oncol 2020; 22:1565-1579. [PMID: 32062835 DOI: 10.1007/s12094-020-02300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND This article describes and compares approved targeted therapies and the newer immunotherapy agents. MATERIALS AND METHODS This article especially performs an in-depth review of currently available data for tivozanib, explaining its mechanism of action, its safety profile and its role as an efficacy drug in the management of renal cancer. RESULTS Despite the fact that the treatment of advanced RCC has been dramatically modified in recent years, durable remissions are scarce and it remains a lethal disease. For first- and second-line therapy, there is now growing evidence to guide the selection of the appropriate treatment. CONCLUSIONS Several TKIs are standard of care at different settings. Among those approved TKIs, tivozanib has similar efficacy than others with a better safety profile. The use of prognostic factors is critical to the selection of optimal therapy.
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Affiliation(s)
- S Vázquez Estévez
- Medical Oncology Department, Hospital Universitario Lucus Augusti (Lugo), Dr. Ulises Romero, s/n, 27003, Lugo, Spain.
| | - U Anido
- Medical Oncology Department, Complejo Hospitalario Universitario Santiago de Compostela, Trav. da Choupana, s/n, 15702, Santiago de Compostela, Spain
| | - M Lázaro
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Camiño dos Cañotais 44, 36312, Vigo, Spain
| | - O Fernández
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ramón Puga Noguerol, 54, 32005, Ourense, Spain
| | - N Fernández Núñez
- Medical Oncology Department, Hospital Universitario Lucus Augusti (Lugo), Dr. Ulises Romero, s/n, 27003, Lugo, Spain
| | - N de Dios Álvarez
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Camiño dos Cañotais 44, 36312, Vigo, Spain
| | - V Varela
- Medical Oncology Department, Complejo Hospitalario Universitario Santiago de Compostela, Trav. da Choupana, s/n, 15702, Santiago de Compostela, Spain
| | - B Campos Balea
- Medical Oncology Department, Hospital Universitario Lucus Augusti (Lugo), Dr. Ulises Romero, s/n, 27003, Lugo, Spain
| | - S Agraso
- Medical Oncology Department, Hospital Álvaro Cunqueiro, Camiño dos Cañotais 44, 36312, Vigo, Spain
| | - M C Areses
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ramón Puga Noguerol, 54, 32005, Ourense, Spain
| | - L Iglesias
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, Ramón Puga Noguerol, 54, 32005, Ourense, Spain
| | - M Blanco
- Medical Oncology Department, Complejo Hospitalario Universitario Santiago de Compostela, Trav. da Choupana, s/n, 15702, Santiago de Compostela, Spain
| | - S Maciá
- Oncology Medical Department, Pivotal, Calle Gobelas, no 19, 28023, Madrid, Spain
| | - L M Anton Aparicio
- Medical Oncology Department, Complejo Hospitalario Universitario A Coruña, As Xubias, 84, 15006, A Coruña, Spain
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Oreja-Guevara C, García-Merino JA, Saiz A, Rodríguez-Antigüedad A, Álvarez-Cermeño JC, Estrada-Pérez V, Izquierdo G, Fernández O. [Recommendations for the use of cladribine tablets in recurring multiple sclerosis]. Rev Neurol 2019; 69:1-9. [PMID: 31933293 DOI: 10.33588/rn.69s02.2019380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cladribine is a prodrug, a synthetic analogue of deoxyadenosine, approved for use as selective immune reconstitution therapy in very active recurring multiple sclerosis in adults. AIMS To review the development of the drug, its mechanism of action and the efficacy and safety data obtained to date, as well as to establish recommendations of Spanish experts for its use in clinical practice. DEVELOPMENT The treatment of multiple sclerosis has been simplified with cladribine tablets, and two short courses of administration for two consecutive years (maximum 20 days) are needed to maintain an efficacy of up to four years after the first dose. Results of clinical trials have demonstrated the safety, tolerability and long-term efficacy of cladribine tablets in patients with recurring multiple sclerosis. Thus, patients treated with cladribine presented a significant reduction in the rate of flare-ups, in the risk of disability progression and in the development of new lesions in magnetic resonance imaging compared to those treated with placebo. In terms of safety, the treated patients had a higher frequency of lymphopenia, in relation to its mechanism of action, and of infections by herpes zoster virus. Long-term results with eight years' follow-up have shown that treated patients are not at greater risk of developing serious events, such as malignant neoplasms or opportunistic infections. CONCLUSIONS Cladribine is the first short-course oral therapy that has been shown to be effective and safe in patients with very active recurring multiple sclerosis, and with a sustained effect over time. The recommendations of Spanish experts on its usage are a fundamental complement to the considerations described by the regulatory agencies.
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Affiliation(s)
| | - J A García-Merino
- Hospital Universitario Puerta de Hierro-Majadahonda, 28035 Majadahonda, España
| | - A Saiz
- Hospital Clínic de Barcelona. Institut Clínic de Malalties del Sistema Nerviós, 08036 Barcelona, España
| | | | | | | | | | - O Fernández
- Instituto de Investigación Biomédica de Málaga. IBIMA, Málaga, España
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Ramió-Torrentà L, Álvarez-Cermeño J, Arroyo R, Casanova-Estruch B, Fernández O, García-Merino J, Hernández M, Izquierdo G, Martínez-Yélamos S, Meca J, Moral E, Olascoaga J, Prieto J, Saiz A. A guide to treating gait impairment with prolonged-release fampridine (Fampyra ® ) in patients with multiple sclerosis. Neurología (English Edition) 2018. [DOI: 10.1016/j.nrleng.2015.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fernández O, Delvecchio M, Edan G, Fredrikson S, Giovannoni G, Hartung HP, Havrdova E, Kappos L, Pozzilli C, Soerensen PS, Tackenberg B, Vermersch P, Comi G. Survey of diagnostic and treatment practices for multiple sclerosis (MS) in Europe. Part 2: Progressive MS, paediatric MS, pregnancy and general management. Eur J Neurol 2018; 25:739-746. [DOI: 10.1111/ene.13581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/08/2018] [Indexed: 12/01/2022]
Affiliation(s)
- O. Fernández
- Department of Neurology; Instituto de Investigación Biomédica de Malaga; Hospital Regional Universitario; Malaga University; Malaga Spain
| | - M. Delvecchio
- Public Management and Policy; SDA Bocconi Scuola di Direzione Aziendale; Milano Italy
| | - G. Edan
- Neurology; Institut des Neurosciences Cliniques de Rennes; Rennes France
| | - S. Fredrikson
- Division of Neurology; Karolinska Institute; Stockholm Sweden
| | - G. Giovannoni
- Department of Neurology; Centre for Neuroscience and Trauma; Barts and the London School of Medicine and Dentistry; Blizard Institute of Cell and Molecular Science; Queen Mary University of London; London UK
| | - H.-P. Hartung
- Neurology; Heinrich Heine University Düsseldorf; Düsseldorf Germany
| | - E. Havrdova
- Department of Neurology; Charles University; Prague Czech Republic
| | - L. Kappos
- Neurology and Department of Biomedicine; Universitatsspital Basel; Basel Switzerland
| | - C. Pozzilli
- Neurological Sciences; MS Centre; Rome Italy
| | - P. S. Soerensen
- Department of Neurology; Danish Multiple Sclerosis Research Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - B. Tackenberg
- Klinik für Neurologie; Phillipps-Universitat Marburg Fachgebiet Indologie und Tibetologie; Marburg Germany
| | | | - G. Comi
- Neuroimaging Research Unit; Osepdale San Raffaele; Milan Italy
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Martín Algarra S, Soriano V, Fernández-Morales L, Berciano-Guerrero MÁ, Mujika K, Manzano JL, Puértolas Hernández T, Soria A, Rodríguez-Abreu D, Espinosa Arranz E, Medina Martínez J, Márquez-Rodas I, Rubió-Casadevall J, Ortega ME, Jurado García JM, Lecumberri Biurrun MJ, Palacio I, Rodríguez de la Borbolla Artacho M, Altozano JP, Castellón Rubio VE, García A, Luna P, Ballesteros A, Fernández O, López Martín JA, Berrocal A, Arance A. Dabrafenib plus trametinib for compassionate use in metastatic melanoma: A STROBE-compliant retrospective observational postauthorization study. Medicine (Baltimore) 2017; 96:e9523. [PMID: 29384960 PMCID: PMC6393118 DOI: 10.1097/md.0000000000009523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The main objective of the study was to evaluate the efficacy and safety of dabrafenib alone or combined with trametinib for compassionate use in patients with metastatic melanoma.This retrospective, observational study involved 135 patients with unresectable stage IIIC or stage IV melanoma from an expanded-access program at 30 Spanish centers.Forty-eight patients received dabrafenib monotherapy and 87 received combination dabrafenib and trametinib; 4.4% and 95.6% of the patients had stage IIIC and IV melanoma, respectively. All patients showed BRAF mutations in their primary or metastatic lesions; 3 were positive for V600K while the remainder had V600E or V600+. A positive response to treatment was reported in 89.3% of the patients. Overall survival rates at 12 and 24 months were 59.6% (95% confidence interval [CI], 52.5-68.9%) and 36.4% (95% CI, 27.8-45%), respectively. Progression-free survival rates at 12 and 24 months were 39.3% (95% CI, 31.1-47.5%) and 21.6% (95% CI, 14.5-28.7%), respectively. Fifty-seven patients (42.2%) reported cutaneous toxicity of any type, mainly hyperkeratosis (14.8%) and rash (11.9%). The most frequent adverse events were pyrexia (27.4%), asthenia (19.3%), arthralgia (16.9%), and diarrhoea (13.2%).Our results suggest that both dabrafenib alone or in combination with trametinib are effective for compassionate use in terms of response and/or survival rates. However, differences in patients' prognostic features ought to be considered. No new findings were revealed regarding the safety profiles of either regimen. This is the first study to evaluate the efficacy of these 2 selective BRAF and mitogen-activated extracellular signal-regulated kinase inhibitors in a real-world setting in Spain.
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Affiliation(s)
| | | | | | - Miguel-Ángel Berciano-Guerrero
- Oncología Intercentros, Hospitales Universitarios Regional y Virgen de la Victoria (HURyVV) and Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga
| | - Karmele Mujika
- Onkologikoa, Instituto Oncológico de Kutxa, San Sebastian
| | - José Luis Manzano
- Instituto Catalán de Oncología, ICO-Badalona, Hospital Germans Trías I Pujol, Barcelona
| | | | - Ainara Soria
- Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid
| | - Delvys Rodríguez-Abreu
- Medical Oncology, Complejo Hospitalario Universitario Insular—Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria
| | | | | | - Ivan Márquez-Rodas
- Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid
| | | | | | | | | | - Isabel Palacio
- Medical Oncology, Hospital Universitario Central de Asturias, Oviedo
| | | | | | | | | | - Pablo Luna
- Medical Oncology, Hospital Universitario Son Espases, Palma de Mallorca
| | | | - Ovidio Fernández
- Medical Oncology, Complejo Hospitalario Universitario Ourense, Ourense
| | | | - Alfonso Berrocal
- Medical Oncology, Hospital General Universitario de Valencia, Valencia
| | - Ana Arance
- Medical Oncology, Hospital Clínic Barcelona, Barcelona, Spain
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18
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Cáceres LD, Blanco-Aparicio M, Carro LM, García-Clemente M, Luna-Paredes C, Mondejar-Lopez P, Ruiz-de-Valbuena M, Fernández O, González M, López-Neyra A, Girón-Moreno R. 46 Lumacaftor-ivacaftor and cystic fibrosis: Spanish experience in 2016. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30411-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Fernández O, Delvecchio M, Edan G, Fredrikson S, Gionvannoni G, Hartung HP, Havrdova E, Kappos L, Pozzilli C, Soerensen PS, Tackenberg B, Vermersch P, Comi G. Survey of diagnostic and treatment practices for multiple sclerosis in Europe. Eur J Neurol 2017; 24:516-522. [DOI: 10.1111/ene.13236] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/28/2016] [Indexed: 11/30/2022]
Affiliation(s)
- O. Fernández
- Department of Neurology; Instituto de Investigación Biomédica de Malaga; Hospital Regional Universitario; Malaga University; Malaga Spain
| | - M. Delvecchio
- Public Management and Policy; SDA Bocconi Scuola di Direzione Aziendale; Milano Italy
| | - G. Edan
- Neurology; Institut des Neurosciences Cliniques de Rennes; Rennes France
| | - S. Fredrikson
- Division of Neurology; Karolinska Institute; Stockholm Sweden
| | - G. Gionvannoni
- Centre for Neuroscience and Trauma; Department of Neurology; Blizard Institute of Cell and Molecular Science; Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - H.-P. Hartung
- Neurology; Heinrich Heine University Düsseldorf; Düsseldorf Germany
| | - E. Havrdova
- Department of Neurology; Charles University; Prague Czech Republic
| | - L. Kappos
- Neurology and Department of Biomedicine; Universitatsspital Basel; Basel Switzerland
| | - C. Pozzilli
- Neurological Sciences; MS Centre; Rome Italy
| | - P. S. Soerensen
- Department of Neurology; Danish Multiple Sclerosis Research Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - B. Tackenberg
- Klinik für Neurologie; Phillipps-Universitat Marburg Fachgebiet Indologie und Tibetologie; Marburg Germany
| | | | - G. Comi
- Neuroimaging Research Unit; Osepdale San Raffaele; Milan Italy
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20
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Marin-Bañasco C, Benabdellah K, Melero-Jerez C, Oliver B, Pinto-Medel MJ, Hurtado-Guerrero I, de Castro F, Clemente D, Fernández O, Martin F, Leyva L, Suardíaz M. Gene therapy with mesenchymal stem cells expressing IFN-ß ameliorates neuroinflammation in experimental models of multiple sclerosis. Br J Pharmacol 2017; 174:238-253. [PMID: 27882538 DOI: 10.1111/bph.13674] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Recombinant IFN-ß is one of the first-line treatments in multiple sclerosis (MS), despite its lack of efficacy in some patients. In this context, mesenchymal stem cells (MSCs) represent a promising therapeutic alternative due to their immunomodulatory properties and multipotency. Moreover, by taking advantage of their pathotropism, these cells can be genetically modified to be used as carriers for delivering or secreting therapeutic drugs into injured tissues. Here, we report the therapeutic effect of systemic delivery of adipose-derived MSCs (AdMSCs), transduced with the IFN-β gene, into mice with experimental autoimmune encephalomyelitis (EAE). EXPERIMENTAL APPROACH Relapsing-remitting and chronic progressive EAE were induced in mice. Cells were injected i.v. Disease severity, inflammation and tissue damage were assessed clinically, by flow cytometry of spleens and histopathological evaluation of the CNS respectively. KEY RESULTS Genetic engineering did not modify the biological characteristics of these AdMSCs (morphology, growth rate, immunophenotype and multipotency). Furthermore, the transduction of IFN-ß to AdMSCs maintained and, in some cases, enhanced the functional properties of AdMSCs by ameliorating the symptoms of MS in EAE models and by decreasing indications of peripheral and central neuro-inflammation. CONCLUSION AND IMPLICATIONS Gene therapy was found to be more effective than cell therapy in ameliorating several clinical parameters in both EAE models, presumably due to the continuous expression of IFN-β. Furthermore, it has significant advantages over AdMSC therapy, and also over systemic IFN-ß treatment, by providing long-term expression of the cytokine at therapeutic concentrations and reducing the frequency of injections, while minimizing dose-limiting side effects.
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Affiliation(s)
- C Marin-Bañasco
- Unidad de Gestión Clínica Inter-centros de Neurociencias, Laboratorio de Investigación y Servicio de Neurología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Spain
| | - K Benabdellah
- Cell and Gene Therapy Group, Genomic Medicine Department, GENYO, Centre for Genomics and Oncological Research, Pfizer-University of Granada-Andalusian Regional Government, Granada, Spain
| | - C Melero-Jerez
- Grupo de Neurobiología del Desarrollo-GNDe, Instituto Cajal-CSIC, 28002, Madrid, Spain.,Grupo de Neuroinmuno-Reparación, Hospital Nacional de Parapléjicos, 45071, Toledo, Spain.,Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - B Oliver
- Unidad de Gestión Clínica Inter-centros de Neurociencias, Laboratorio de Investigación y Servicio de Neurología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Spain.,Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - M J Pinto-Medel
- Unidad de Gestión Clínica Inter-centros de Neurociencias, Laboratorio de Investigación y Servicio de Neurología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Spain.,Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - I Hurtado-Guerrero
- Unidad de Gestión Clínica Inter-centros de Neurociencias, Laboratorio de Investigación y Servicio de Neurología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Spain
| | - F de Castro
- Grupo de Neurobiología del Desarrollo-GNDe, Instituto Cajal-CSIC, 28002, Madrid, Spain.,Grupo de Neurobiología del Desarrollo-GNDe, Hospital Nacional de Parapléjicos, 45071, Toledo, Spain.,Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - D Clemente
- Grupo de Neuroinmuno-Reparación, Hospital Nacional de Parapléjicos, 45071, Toledo, Spain.,Grupo de Neurobiología del Desarrollo-GNDe, Hospital Nacional de Parapléjicos, 45071, Toledo, Spain.,Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - O Fernández
- Unidad de Gestión Clínica Inter-centros de Neurociencias, Laboratorio de Investigación y Servicio de Neurología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Spain.,Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - F Martin
- Cell and Gene Therapy Group, Genomic Medicine Department, GENYO, Centre for Genomics and Oncological Research, Pfizer-University of Granada-Andalusian Regional Government, Granada, Spain
| | - L Leyva
- Unidad de Gestión Clínica Inter-centros de Neurociencias, Laboratorio de Investigación y Servicio de Neurología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Spain.,Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
| | - M Suardíaz
- Unidad de Gestión Clínica Inter-centros de Neurociencias, Laboratorio de Investigación y Servicio de Neurología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Spain.,Red Española de Esclerosis Múltiple (REEM), Barcelona, Spain
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21
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Lázaro M, Gallardo E, Doménech M, Pinto Á, González-del-Alba A, Del Alba AG, Puente J, Fernández O, Font A, Lainez N, Vázquez S. SEOM Clinical Guideline for treatment of muscle-invasive and metastatic urothelial bladder cancer (2016). Clin Transl Oncol 2016; 18:1197-1205. [PMID: 27900539 PMCID: PMC5138255 DOI: 10.1007/s12094-016-1584-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 11/15/2016] [Indexed: 12/21/2022]
Abstract
The goal of this article is to provide recommendations for the diagnosis and treatment of muscle-invasive and metastatic bladder cancer. The diagnosis of muscle-invasive bladder cancer is made by pathologic evaluation after transurethral resection. Recently, a molecular classification has been proposed. Staging of muscle-invasive bladder cancer must be done by computed tomography scans of the chest, abdomen and pelvis and classified on the basis of UICC system. Radical cystectomy and lymph node dissection are the treatment of choice. In muscle-invasive bladder cancer, neoadjuvant chemotherapy should be recommended in patients with good performance status and no renal function impairment. Although there is insufficient evidence for use of adjuvant chemotherapy, its use must be considered when neoadjuvant therapy had not been administered in high-risk patients. Multimodality bladder-preserving treatment in localized disease is an alternative in selected and compliant patients for whom cystectomy is not considered for clinical or personal reasons. In metastatic disease, the first-line treatment for patients must be based on cisplatin-containing combination. Vinflunine is the only drug approved for use in second line in Europe. Recently, immunotherapy treatment has demonstrated activity in this setting.
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Affiliation(s)
- M Lázaro
- Medical Oncology Department, Hospital Álvaro Cunqueiro-Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 34136312, Vigo, Spain.
| | - E Gallardo
- Medical Oncology Department, Parc Taulí Sabadell Hospital Universitari, Sabadell, Spain
| | - M Doménech
- Medical Oncology Department, Althaia, Xarxa Assisencial i Universitària de Manresa, Manresa, Spain
| | - Á Pinto
- Medical Oncology Department, Hospital Universitario La Paz-Idipaz, Madrid, Spain
| | | | - A González Del Alba
- Medical Oncology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - J Puente
- Medical Oncology Department, Hospital Universitario San Carlos, Madrid, Spain
| | - O Fernández
- Complexo Hospitalario Universitario de Ourense, Badalona, Spain
| | - A Font
- Medical Oncology Department, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - N Lainez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - S Vázquez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
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22
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Fernández O, Arroyo R, Martínez-Yélamos S, Marco M, Merino JAG, Muñoz D, Merino E, Roque A. Long-Term Adherence to IFN Beta-1a Treatment when Using RebiSmart® Device in Patients with Relapsing-Remitting Multiple Sclerosis. PLoS One 2016; 11:e0160313. [PMID: 27526201 PMCID: PMC4985132 DOI: 10.1371/journal.pone.0160313] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/18/2016] [Indexed: 12/26/2022] Open
Abstract
The effectiveness of disease-modifying drugs in the treatment of multiple sclerosis is associated with adherence. RebiSmart® electronic device provides useful information about adherence to the treatment with subcutaneous (sc) interferon (IFN) β-1a (Rebif®). The aim of the study was to determine long-term adherence to this treatment in patients with relapsing-remitting multiple sclerosis (RRMS). This retrospective multicentre observational study analysed 258 patients with RRMS who were receiving sc IFN β-1a (Rebif®) treatment by using RebiSmart® until replacement (36 months maximum lifetime) or treatment discontinuation. Adherence was calculated with data (injection dosage, time, and date) automatically recorded by RebiSmart®. Patients in the study had a mean age of 41 years with a female proportion of 68%. Mean EDSS score at start of treatment was 1.8 (95% CI, 1.6-1.9). Overall adherence was 92.6% (95% CI, 90.6-94.5%). A total of 30.2% of patients achieved an adherence rate of 100%, 80.6% at least 90%, and only 13.2% of patients showed a suboptimal adherence (<80%). A total of 59.9% of subjects were relapse-free after treatment initiation. Among 106 subjects (41.1%) who experienced, on average, 1.4 relapses, the majority were mild (40.6%) or moderate (47.2%). Having experienced relapses from the beginning of the treatment was the only variable significantly related to achieving an adherence of at least 80% (OR = 3.06, 1.28-7.31). Results of this study indicate that sc IFN β-1a administration facilitated by RebiSmart® could lead to high rates of adherence to a prescribed dose regimen over 36 months.
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Affiliation(s)
- O. Fernández
- Hospitales Universitarios Regional de Málaga y Virgen de la Victoria, Universidad de Málaga, IBIMA
| | - R. Arroyo
- Hospital U. Clínico San Carlos, Madrid
| | | | - M. Marco
- Corporació Sanitaria Parc Taulí, Barcelona
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23
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Gόmez C, García M, Galindez E, Fernández O, Ruíz E, Calvo I, Guerrero E, Blanco J, Torre I, García J, Gorostiza I, Alvarez M, Alonso M. AB0304 Adherence To DMARD and Subcutaneous Biological Therapy among Rheumatoid Arthritis and Psoriatic Arthritis Patients at Basurto University Hospital. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fernández V, Postigo M, Gonzalez A, Urbaneja P, León A, Alonso A, Guerrero M, Fernández O. ID 94 – Clinically isolated syndrome (CIS): Measure of axonal status. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Fernández V, Romero L, Muñoz T, López I, Giacometti S, Fernández O, Arraez M. ID 97 – Correlations between intraoperative microelectrode recording, microstimulation and macrostimulation with optimal post-operative programming of deep brain stimulation. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.340] [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]
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26
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Lainez N, García-Donas J, Esteban E, Puente J, Sáez MI, Gallardo E, Pinto-Marín Á, Vázquez-Estévez S, León L, García-Carbonero I, Suárez-Rodríguez C, Molins C, Climent-Duran MA, Lázaro-Quintela M, González Del Alba A, Méndez-Vidal MJ, Chirivella I, Afonso FJ, López-Brea M, Sala-González N, Domenech M, Basterretxea L, Santander-Lobera C, Gil-Arnáiz I, Fernández O, Caballero-Díaz C, Mellado B, Marrupe D, García-Sánchez J, Sánchez-Escribano R, Fernández Parra E, Villa Guzmán JC, Martínez-Ortega E, Belén González M, Morán M, Suarez-Paniagua B, Lecumberri MJ, Castellano D. Impact on clinical practice of the implementation of guidelines for the toxicity management of targeted therapies in kidney cancer. The protect-2 study. BMC Cancer 2016; 16:135. [PMID: 26906039 PMCID: PMC4763443 DOI: 10.1186/s12885-016-2084-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/25/2016] [Indexed: 12/21/2022] Open
Abstract
Background The impact of such recommendations after their implementation of guidelines has not usually been evaluated. Herein, we assessed the impact and compliance with the Spanish Oncology Genitourinary Group (SOGUG) Guidelines for toxicity management of targeted therapies in metastatic renal cell carcinoma (mRCC) in daily clinical practice. Methods Data on 407 mRCC patients who initiated first-line targeted therapy during the year before and the year after publication and implementation of the SOGUG guideline program were available from 34 Spanish Hospitals. Adherence to SOGUG Guidelines was assessed in every cycle. Results Adverse event (AE) management was consistent with the Guidelines as a whole for 28.7 % out of 966 post-implementation cycles compared with 23.1 % out of 892 pre-implementation cycles (p = 0.006). Analysis of adherence by AE in non-compliant cycles showed significant changes in appropriate management of hypertension (33 % pre-implementation vs. 44.5 % post-implementation cycles; p < 0.0001), diarrhea (74.0 % vs. 80.5 %; p = 0.011) and dyslipemia (25.0 % vs. 44.6 %; p < 0.001). Conclusions Slight but significant improvements in AE management were detected following the implementation of SOGUG recommendations. However, room for improvement in the management of AEs due to targeted agents still remains and could be the focus for further programs in this direction.
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Affiliation(s)
- Nuria Lainez
- Department of oncology, Complejo Hospitalario de Navarra, Servicio Oncología Médica. Pabellón B 2ª planta. Hospital de día, C/ Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| | - Jesús García-Donas
- Department of oncology, Hospital Sanchinarro, C/ Oña, 10, 28050, Madrid, Spain.
| | - Emilio Esteban
- Department of oncology, Hospital Universitario Central de Asturias, Julián Clavería s/n, 33006, Oviedo, Spain.
| | - Javier Puente
- Department of oncology, Hospital Clínico de Madrid, C/ Doctor Martín Lagos s/n, 28040, Madrid, Spain.
| | - M Isabel Sáez
- Department of oncology, Hospital Universitario Clínico Virgen de la Victoria, Campus Universitario de Teatinos, s/n, 29010, Málaga, Spain.
| | - Enrique Gallardo
- Department of oncology, Parc Taulí Sabadell Hospital Universitari, Parc Taulí 1, 08208, Sabadell, Spain.
| | - Álvaro Pinto-Marín
- Department of oncology, Hospital Universitario La Paz, P de la Castellana 261, 28046, Madrid, Spain.
| | - Sergio Vázquez-Estévez
- Department of oncology, Hospital Universitario Lucus Augusti, Lugar San Cibrao, S/N, 27003, Lugo, Spain.
| | - Luis León
- Department of oncology, Hospital Santiago de Compostela, Travesía da Choupana, s/n, 15706, Santiago de Compostela, Spain.
| | - Icíar García-Carbonero
- Department of oncology, Hospital Virgen de la Salud, Adva. De Barber, 30, 45004, Toledo, Spain.
| | | | - Carmen Molins
- Department of oncology, Hospital Universitario Dr. Peset, Avda. Gaspar Aguilar 90, 46017, Valencia, Spain.
| | - Miguel A Climent-Duran
- Department of oncology, Instituto Valenciano de Oncología, Gregorio Gea, 31-1° Planta, 46009, Valencia, Spain.
| | - Martín Lázaro-Quintela
- Department of oncology, Complexo Hospitalario Universitario de Vigo, Pizarro 22, 36204, Vigo, Spain.
| | - Aranzazu González Del Alba
- Department of oncology, Hospital Universitario Son Espases, Ctra Valldemossa, 79, 07010, Palma de Mallorca, Spain.
| | - María José Méndez-Vidal
- Department of oncology, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal, s/n, 14004, Córdoba, Spain.
| | - Isabel Chirivella
- Department of oncology, Hospital Clínico de Valencia, Avda Blasco Ibáñez, 17, 46010, Valencia, Spain.
| | - Francisco J Afonso
- Department of oncology, Complejo Hospitalario Arquitecto Marcide, Rúa da residencia s/n. San pedro de Leixa, 15405, Ferrol, Spain.
| | - Marta López-Brea
- Department of oncology, Hospital Marqués de Valdecilla, Avda. Valdecila s/n, 39008, Santander, Spain.
| | | | - Montserrat Domenech
- Department of oncology, Hospital de Althaia Xarxa Asistencial Manresa, Dr. Joan Soler, 1-3, 08243, Barcelona, Spain.
| | - Laura Basterretxea
- Department of oncology, Hospital de Donostia, P° Dr. Beguiristain 109, 20014, San Sebastian, Spain.
| | - Carmen Santander-Lobera
- Department of oncology, Hospital Miguel Servet, Avda Gómez Laguna 25, 50009, Zaragoza, Spain.
| | - Irene Gil-Arnáiz
- Department of oncology, Hospital Reina Sofía, Carretera Tarazona, KM 3, 31500, Tudela, Spain.
| | - Ovidio Fernández
- Department of oncology, Complejo Hospitalario Ourense. Hospital Santa María Nai, Ramón Puga, 52-54, 32005, Orense, Spain.
| | - Cristina Caballero-Díaz
- Department of oncology, Hospital General Universitario de Valencia, Avda Tres Cruces, s/n, 46014, Valencia, Spain.
| | - Begoña Mellado
- Department of oncology, IDIBAPS, Hospital Clinic i Provincial de Barcelona, Villarroel, 170, 08036, Barcelona, Spain.
| | - David Marrupe
- Department of oncology, Hospital Universitario de Móstoles, Río Júcar s/n, 28935, Móstoles, Madrid, Spain.
| | - José García-Sánchez
- Department of oncology, Hospital Arnau de Vilanova, C/ San Clemente n 12, 46015, Valencia, Spain.
| | - Ricardo Sánchez-Escribano
- Department of oncology, Hospital Universitario de Burgos, Avenida Cid Campeador, 96, 09005, Burgos, Spain.
| | - Eva Fernández Parra
- Department of oncology, H.U. Hospital de Valme, Ctra. de Cádiz Km. 548.9, 41014, Sevilla, Spain.
| | - José C Villa Guzmán
- Department of oncology, Hospital de Ciudad Real, Obispo Rafael Torija, 13005, Ciudad Real, Spain.
| | - Esther Martínez-Ortega
- Department of oncology, Hospital Ciudad de Jaén, Avenida Ejercito Español 10, 23007, Jaén, Spain.
| | - María Belén González
- Department of oncology, Hospital Son Llatzer, Ctra. Manacor, km.4, Sont Frriol, 07198, Palma de Mallorca, Spain.
| | - Marina Morán
- Pfizer Madrid, Avda. de Europa, 20B, 28108, Alcobendas, Madrid, Spain.
| | | | - María J Lecumberri
- Department of oncology, Complejo Hospitalario de Navarra, Servicio Oncología Médica. Pabellón B 2ª planta. Hospital de día, C/ Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| | - Daniel Castellano
- Department of oncology, Hospital 12 de Octubre, Av. de Córdoba s/n, 28041, Madrid, Spain.
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Maroto P, Ruiz A, Esteban E, León L, Munarriz J, Su´rez C, Pinto A, Mellado B, Durán I, García-Carbonero I, Arranz J, Sala N, Fernández O, Lainez N, Peláez I, López A, Viqueira A. 2616 Efficacy and safety of Temsirolimus in patients with metastatic renal cell carcinoma: Final results from the Spanish experience. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31434-4] [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]
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Castellano D, Puente J, de Velasco G, Chirivella I, López-Criado P, Mohedano N, Fernández O, García-Carbonero I, González MB, Grande E. Safety and effectiveness of vinflunine in patients with metastatic transitional cell carcinoma of the urothelial tract after failure of one platinum-based systemic therapy in clinical practice. BMC Cancer 2014; 14:779. [PMID: 25342282 PMCID: PMC4216839 DOI: 10.1186/1471-2407-14-779] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 10/02/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients with transitional cell carcinoma of the urothelial tract (TCCU) who fail initial platinum-based chemotherapy for advanced disease represent a challenge in daily clinical practice. Vinflunine is approved by the European Medicine Agency (EMA) but, up to now, limited experience has been reported outside clinical trials. METHODS We assessed the efficacy and safety of vinflunine in an unselected group of 102 consecutive patients with metastatic TCCU. RESULTS The median age was 67 years (range 45-83). Among the most common comorbidities that patients presented at baseline were hypertension (50.5%) and diabetes (20.7%).Distant metastases were present in retroperitoneal nodes (58%), lung (29.3%), and bone (20.2%). The ECOG 0, 1 and 2 performance status at the start of vinflunine were 31.3%, 60.6% and 8.1%, respectively. The most commonly reported adverse events of any grade were constipation 70.6% (5.9% grade 3-4), vomiting 49.1% (2% grade 3-4), neutropenia 48.1% (12.8% grade 3-4) and abdominal pain 34.3% (4.9% grade 3-4). A median of 4 cycles of vinflunine was administered per patient (range 1-18). Median progression free and overall survival for all patients (N = 102) were 3.9 months (2.3-5.5) and 10 months (7.3-12.8), respectively. Time to tumor progression was 4.3 months (2.6-5.9). Two patients (2%) achieved CR, 23 (22.5%) patients had PR, and 42 (41.2%) presented SD as best response. The clinical benefit rate with vinflunine was 65.7%. CONCLUSIONS Our results show that the behavior of vinflunine in routine clinical practice resembles that of the pivotal phase III randomized study.
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Affiliation(s)
- Daniel Castellano
- />Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Javier Puente
- />Medical Oncology Department, Clínico San Carlos University Hospital, Madrid, Spain
| | - Guillermo de Velasco
- />Research Fellow in Uro-Oncology, Cambridge University Health Partners, Cambridge, UK
| | - Isabel Chirivella
- />Medical Oncology Department, Clínico de Valencia University Hospital, Valencia, Spain
| | | | - Nicolás Mohedano
- />Medical Oncology Department, Guadalajara University Hospital, Guadalajara, Spain
| | - Ovidio Fernández
- />Medical Oncology Department, Orense Hospital Complex, Orense, Spain
| | | | | | - Enrique Grande
- />Medical Oncology Department, Ramón y Cajal University Hospital, Ctra. de Colmenar Viejo km. 9,100, 28034 Madrid, Spain
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Espiño M, Abraira V, Arroyo R, Bau L, Cámara C, Campos-Ruiz L, Casanova B, Espejo C, Fernández O, García-Merino A, García-Sánchez MI, Gómez M, Gosis A, Izquierdo G, Meca J, Montalban X, Morandeira F, Olascoaga J, Prada A, Quintana E, Ramió-Torrentà L, Rodríguez-Antigüedad A, Salgado G, Santiago JL, Sarasola E, Simó-Castelló M, Alvarez-Cermeño JC, Villar LM. Assessment of the reproducibility of oligoclonal IgM band detection for its application in daily clinical practice. Clin Chim Acta 2014; 438:67-9. [PMID: 25110815 DOI: 10.1016/j.cca.2014.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 07/18/2014] [Accepted: 08/03/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND The presence of oligoclonal IgM bands (OCMB) in cerebrospinal fluid (CSF) is an unfavourable prognostic marker in multiple sclerosis. There is no commercial test to investigate OCMB status. However, a sensitive and specific isoelectrofocusing (IEF) and western blot method was described. We aimed to study the inter-centre reproducibility of this technique, a necessary condition for a reliable test to be incorporated into clinical practice. METHODS The presence of OCMB was analysed by IEF and western blot with prior reduction of pentameric IgM. We assayed the reproducibility of this test in a blinded multicentre study performed in 13 university hospitals. Paired-CSF and serum samples from 52 neurological patients were assayed at every centre. RESULTS Global analysis rendered a concordance of 89.8% with a kappa value of 0.71. CONCLUSION These data indicate that OCMB detection by means of IEF and western blot with IgM reduction shows a good interlaboratory reproducibility and thus can be used in daily clinical setting.
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Affiliation(s)
- M Espiño
- Department of Immunology, Hospital Universitario Ramón y Cajal, Ctra de Colmenar Viejo km 9.100, 28034 Madrid, IRYCIS, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - V Abraira
- Department of Biostatistics, Hospital Universitario Ramón y Cajal, Ctra de Colmenar Viejo km 9.100, 28034 Madrid, IRYCIS, Spain
| | - R Arroyo
- Department of Neurology, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, s/n, 28040 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - L Bau
- Department of Neurology, Hospital Universitari de Bellvitge, Av. Granvia s/n, Hospitalet de Llobregat, Barcelona, Spain
| | - C Cámara
- Department of Immunology, Hospital San Pedro de Alcántara, Avenida Pablo Naranjo s/n, 10003 Cáceres, Spain
| | - L Campos-Ruiz
- Department of Neurology, Hospital Universitario Puerta de Hierro, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - B Casanova
- Department of Neurology, Hospital Universitari La Fe, Avinguda Fernando Abril Martorell, 46026 Valencia, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - C Espejo
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - O Fernández
- Department of Neurology, Hospital Regional Universitario, Avda Carlos Haya, s/n, 29010 Málaga, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - A García-Merino
- Department of Neurology, Hospital Universitario Puerta de Hierro, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - M I García-Sánchez
- Department of Neurology, Hospital Universitario Virgen Macarena, Avd. Dr. Fedriani, 3, 41007 Sevilla, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - M Gómez
- Department of Neurology, Hospital San Pedro de Alcántara, Avenida Pablo Naranjo s/n, 10003 Cáceres, Spain
| | - A Gosis
- Red Española de Esclerosis Múltiple (REEM), Spain; Immunology, Hospital Regional Universitario, Avda Carlos Haya, s/n, 29010 Málaga, Spain
| | - G Izquierdo
- Department of Neurology, Hospital Universitario Virgen Macarena, Avd. Dr. Fedriani, 3, 41007 Sevilla, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - J Meca
- Department of Neurology, Hospital Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - X Montalban
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya, Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-129, 08035 Barcelona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - F Morandeira
- Immunology, Hospital Universitari de Bellvitge, Av. Granvia s/n, Hospitalet de Llobregat, Barcelona, Spain
| | - J Olascoaga
- Department of Neurology, Hospital Universitario Donostia, P° Dr. Beguiristain, 107-111, 20014 San Sebastián, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - A Prada
- Red Española de Esclerosis Múltiple (REEM), Spain; Department of Neurology, Hospital Universitario Donostia, P° Dr. Beguiristain, 107-111, 20014 San Sebastián, Spain
| | - E Quintana
- Unitat de Neuroimmunologia i Esclerosi Múltiple, Hospital Universitari Dr. Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Avenida França, s/n, 17007 Girona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - Ll Ramió-Torrentà
- Unitat de Neuroimmunologia i Esclerosi Múltiple, Hospital Universitari Dr. Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Avenida França, s/n, 17007 Girona, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - A Rodríguez-Antigüedad
- Department of Neurology, Hospital Universitario Basurto, Av de Montevideo, 18, 48013 Bilbao, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - G Salgado
- Immunology, Hospital Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, s/n, 30120 El Palmar, Murcia, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - J L Santiago
- Department of Neurology, Hospital Clínico San Carlos, Calle Profesor Martín Lagos, s/n, 28040 Madrid, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - E Sarasola
- Department of Neurology, Hospital Universitario Basurto, Av de Montevideo, 18, 48013 Bilbao, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - M Simó-Castelló
- Department of Neurology, Hospital Universitari La Fe, Avinguda Fernando Abril Martorell, 46026 Valencia, Spain; Red Española de Esclerosis Múltiple (REEM), Spain
| | - J C Alvarez-Cermeño
- Red Española de Esclerosis Múltiple (REEM), Spain; Department of Neurology, Hospital Universitario Ramón y Cajal, Ctra de Colmenar Viejo km 9.100, 28034 Madrid, IRYCIS, Spain
| | - L M Villar
- Department of Immunology, Hospital Universitario Ramón y Cajal, Ctra de Colmenar Viejo km 9.100, 28034 Madrid, IRYCIS, Spain; Red Española de Esclerosis Múltiple (REEM), Spain.
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Ferrer E, Alfonso P, Ippoliti C, Abeledo M, Calistri P, Blanco P, Conte A, Sánchez B, Fonseca O, Percedo M, Pérez A, Fernández O, Giovannini A. Development of an active risk-based surveillance strategy for avian influenza in Cuba. Prev Vet Med 2014; 116:161-7. [PMID: 24938174 DOI: 10.1016/j.prevetmed.2014.05.012] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 05/09/2014] [Accepted: 05/25/2014] [Indexed: 11/16/2022]
Abstract
The authors designed a risk-based approach to the selection of poultry flocks to be sampled in order to further improve the sensitivity of avian influenza (AI) active surveillance programme in Cuba. The study focused on the western region of Cuba, which harbours nearly 70% of national poultry holdings and comprise several wetlands where migratory waterfowl settle (migratory waterfowl settlements - MWS). The model took into account the potential risk of commercial poultry farms in western Cuba contracting from migratory waterfowl of the orders Anseriformes and Charadriiformes through dispersion for pasturing of migratory birds around the MWS. We computed spatial risk index by geographical analysis with Python scripts in ESRI(®) ArcGIS 10 on data projected in the reference system NAD 1927-UTM17. Farms located closer to MWS had the highest values for the risk indicator pj and in total 31 farms were chosen for targeted surveillance during the risk period. The authors proposed to start active surveillance in the study area 3 weeks after the onset of Anseriformes migration, with additional sampling repeated twice in the same selected poultry farms at 15 days interval (Comin et al., 2012; EFSA, 2008) to cover the whole migration season. In this way, the antibody detectability would be favoured in case of either a posterior AI introduction or enhancement of a previous seroprevalence under the sensitivity level. The model identified the areas with higher risk for AIV introduction from MW, aiming at selecting poultry premises for the application of risk-based surveillance. Given the infrequency of HPAI introduction into domestic poultry populations and the relative paucity of occurrences of LPAI epidemics, the evaluation of the effectiveness of this approach would require its application for several migration seasons to allow the collection of sufficient reliable data.
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Affiliation(s)
- E Ferrer
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - P Alfonso
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - C Ippoliti
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise "G. Caporale", Via Campo Boario, 64100 Teramo, Italy
| | - M Abeledo
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - P Calistri
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise "G. Caporale", Via Campo Boario, 64100 Teramo, Italy
| | - P Blanco
- Instituto de Ecología y Sistemática (IES), Carretera Varona, Km 6, La Habana, Cuba
| | - A Conte
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise "G. Caporale", Via Campo Boario, 64100 Teramo, Italy
| | - B Sánchez
- Instituto de Ecología y Sistemática (IES), Carretera Varona, Km 6, La Habana, Cuba
| | - O Fonseca
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - M Percedo
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - A Pérez
- Instituto de Medicina Veterinaria, Calle 12 No. 355, e/15 y 17 Vedado, 10400 La Habana, Cuba
| | - O Fernández
- Centro Nacional de Sanidad Agropecuaria (CENSA), San José de Las Lajas 32700, Mayabeque, Cuba
| | - A Giovannini
- Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise "G. Caporale", Via Campo Boario, 64100 Teramo, Italy.
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Fernandez V, Postigo M, Urbaneja P, Leon A, Alonso A, Guerrero M, Fernández O. P202: Comparing objective measures of neurodegeneration in multiple sclerosis (MS). Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50334-3] [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: 10/25/2022]
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Irizar I, Beltrán S, Urchegui G, Izko G, Fernández O, Maiza M. Lessons learnt from the application of a multi-variable controller for nitrogen removal in the Mekolalde wastewater treatment plant: good simulation practices in control. Water Sci Technol 2014; 69:1289-1297. [PMID: 24647196 DOI: 10.2166/wst.2014.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although often perceived as tools for use by scientists, mathematical modelling and simulation become indispensable when control engineers have to design controllers for real-life wastewater treatment plants (WWTPs). Nonetheless, the design of effective controllers in the wastewater domain using simulations requires effects, such as the nonlinearity of actuators, the time response of sensors, plant model uncertainties, etc. to have been reproduced beforehand. Otherwise, control solutions verified by simulation can completely underperform under real conditions. This study demonstrates that, when all the above effects are included at the outset, a systematic use of simulations guarantees high quality controllers in a relatively short period of time. The above is exemplified through the Mekolalde WWTP, where a comprehensive simulation study was conducted in order to develop a control product for nitrogen removal. Since its activation in May 2011, the designed controller has been permanently working in the plant which, from this time onwards, has experienced significant improvements in the quality of water discharges combined with a lower utilization of electricity for wastewater treatment.
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Affiliation(s)
- I Irizar
- CEIT and TECNUN. P° de Manuel Lardizabal 15, 20018 San Sebastián, Spain E-mail:
| | - S Beltrán
- CEIT and TECNUN. P° de Manuel Lardizabal 15, 20018 San Sebastián, Spain E-mail:
| | - G Urchegui
- MSI, Ama Kandida 21, 20140 Andoain, Spain
| | - G Izko
- Consorcio Aguas Gipuzkoa, Portuetxe 16, 20018 San Sebastián, Spain
| | - O Fernández
- Consorcio Aguas Gipuzkoa, Portuetxe 16, 20018 San Sebastián, Spain
| | - M Maiza
- CONAQUA, P° de Manuel Lardizabal 15, 20018 San Sebastián, Spain
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Fernández O, García-Merino JA, Arroyo R, Álvarez-Cermeño JC, Izquierdo G, Saiz A, Olascoaga J, Rodríguez-Antigüedad A, Prieto JM, Oreja-Guevara C, Hernández MA, Moral E, Meca J, Montalbán X. Spanish consensus on the use of natalizumab (Tysabri®)-2013. Neurologia 2013; 30:302-14. [PMID: 24360652 DOI: 10.1016/j.nrl.2013.10.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 10/13/2013] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Natalizumab treatment has been shown to be very efficacious in clinical trials and very effective in clinical practice in patients with relapsing-remitting multiple sclerosis, by reducing relapses, slowing disease progression, and improving magnetic resonance imaging patterns. However, the drug has also been associated with a risk of progressive multifocal leukoencephalopathy (PML). The first consensus statement on natalizumab use, published in 2011, has been updated to include new data on diagnostic procedures, monitoring for patients undergoing treatment, PML management, and other topics of interest including the management of patients discontinuing natalizumab. MATERIAL AND METHODS This updated version followed the method used in the first consensus. A group of Spanish experts in multiple sclerosis (the authors of the present document) reviewed all currently available literature on natalizumab and identified the relevant topics would need updating based on their clinical experience. The initial draft passed through review cycles until the final version was completed. RESULTS AND CONCLUSIONS Studies in clinical practice have demonstrated that changing to natalizumab is more effective than switching between immunomodulators. They favour early treatment with natalizumab rather than using natalizumab in a later stage as a rescue therapy. Although the drug is very effective, its potential adverse effects need to be considered, with particular attention to the patient's likelihood of developing PML. The neurologist should carefully explain the risks and benefits of the treatment, comparing them to the risks of multiple sclerosis in terms the patient can understand. Before treatment is started, laboratory tests and magnetic resonance images should be available to permit proper follow-up. The risk of PML should be stratified as high, medium, or low according to presence or absence of anti-JC virus antibodies, history of immunosuppressive therapy, and treatment duration. Although the presence of anti-JC virus antibodies is a significant finding, it should not be considered an absolute contraindication for natalizumab. This update provides general recommendations, but neurologists must use their clinical expertise to provide personalised follow-up for each patient.
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Affiliation(s)
- O Fernández
- Instituto de Neurociencias Clínicas, Servicio de Neurología, Hospital Regional Universitario Carlos Haya, Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud, Málaga, España.
| | - J A García-Merino
- Servicio de Neurología, Hospital Universitario Puerta de Hierro, Madrid, España
| | - R Arroyo
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, España
| | - J C Álvarez-Cermeño
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - G Izquierdo
- Servicio de Neurología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - A Saiz
- Servicio de Neurología, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, España
| | - J Olascoaga
- Servicio de Neurología, Hospital Universitario de Donostia, San Sebastián, España
| | | | - J M Prieto
- Servicio de Neurología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, España
| | - C Oreja-Guevara
- Servicio de Neurología, Hospital Clínico Universitario San Carlos, Madrid, España
| | - M A Hernández
- Servicio de Neurología, Hospital Universitario Ntra. Sra. de la Candelaria, Tenerife, España
| | - E Moral
- Servicio de Neurología, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, España
| | - J Meca
- Servicio de Neurología, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - X Montalbán
- Centre d'Esclerosi Múltiple de Catalunya (CEMCAT), Hospital Universitari Vall d'Hebron, Barcelona, España
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Fernández V, Valls-Sole J, Relova J, Raguer N, Miralles F, Dinca L, Taramundi S, Costa-Frossard L, Ferrandiz M, Ramió-Torrentà L, Villoslada P, Saiz A, Calles C, Antigüedad A, Alvarez-Cermeño J, Prieto J, Izquierdo G, Montalbán X, Fernández O. Recommendations for the clinical use of motor evoked potentials in multiple sclerosis. Neurología (English Edition) 2013. [DOI: 10.1016/j.nrleng.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Oliver-Martos B, Órpez-Zafra T, Urbaneja P, Maldonado-Sanchez R, Leyva L, Fernández O. Early development of anti-natalizumab antibodies in MS patients. J Neurol 2013; 260:2343-7. [DOI: 10.1007/s00415-013-6991-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/30/2013] [Accepted: 06/01/2013] [Indexed: 10/26/2022]
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García-Merino A, Fernández O, Montalbán X, de Andrés C, Oreja-Guevara C, Rodríguez-Antigüedad A, Arbizu T. Consensus Statement on medication use in multiple sclerosis by the Spanish Society of Neurology's study group for demyelinating diseases. Neurologia 2013; 28:375-8. [PMID: 23643683 DOI: 10.1016/j.nrl.2013.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 01/22/2013] [Indexed: 11/28/2022] Open
Abstract
Treatments for multiple sclerosis therapy are rapidly evolving. It is believed that new drugs will be approved in the near future, thereby changing current indications for treatment. In this context, the Spanish Society of Neurology's study group on demyelinating diseases, which evaluates medication use in MS, has decided to draw up a consensus statement on the current indications and guidelines for multiple sclerosis treatment.
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Affiliation(s)
- A García-Merino
- Servicio de Neurología/Unidad de Neuroinmunología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
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Baumstarck K, Pelletier J, Butzkueven H, Fernández O, Flachenecker P, Idiman E, Stecchi S, Boucekine M, Auquier P. Health-related quality of life as an independent predictor of long-term disability for patients with relapsing-remitting multiple sclerosis. Eur J Neurol 2013; 20:907-14, e78-9. [PMID: 23347258 DOI: 10.1111/ene.12087] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/29/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Predictive factors of long-term disability in patients with relapsing-remitting multiple sclerosis (RR-MS) are well known, but the weight of these factors does not explain the entire change of disability. Few studies have examined the predictive value of quality of life (QoL). OBJECTIVES To determine the value of the initial level of QoL to predict changes in the disability status of patients with MS and to determine if specific-MS questionnaires predict more accuracy in these changes than generic questionnaires. METHODS DESIGN multicenter, multi-regional, and longitudinal study. Main inclusion criteria: patients with RR-MS subtype and an Expanded Disability Status Scale (EDSS) score lower than 7.0. Sociodemographic and clinical data were recorded at baseline. Every 6 months up to month 24, QoL (MusiQoL and SF-36) was recorded. At 24 months, individuals were defined into two 'disability change' groups: the worsened and not worsened patients. RESULTS Five-hundred and twenty-six patients were enrolled: 386 (83.7%) not worsened and 75 (16.3%) worsened patients at 24 months. The activity of daily living and the relationship with healthcare workers dimensions of MusiQoL questionnaire were independent predictors of change in the EDSS score after 24 months. The physical-functioning dimension of the SF-36 questionnaire predicted independently disability change after 24 months. CONCLUSIONS Patient-reported baseline QoL levels provide additional prognostic information on MS disability beyond traditional clinical or sociodemographic factors. These findings reinforce the importance of incorporating a patient's evaluation of their own QoL level during patient monitoring and the assessment of treatment effects.
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Affiliation(s)
- K Baumstarck
- EA3279 Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseille Université, Marseille, France
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Maiza M, Bengoechea A, Grau P, De Keyser W, Nopens I, Brockmann D, Steyer JP, Claeys F, Urchegui G, Fernández O, Ayesa E. Add Control: plant virtualization for control solutions in WWTP. Water Sci Technol 2013; 68:296-302. [PMID: 23863420 DOI: 10.2166/wst.2013.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper summarizes part of the research work carried out in the Add Control project, which proposes an extension of the wastewater treatment plant (WWTP) models and modelling architectures used in traditional WWTP simulation tools, addressing, in addition to the classical mass transformations (transport, physico-chemical phenomena, biological reactions), all the instrumentation, actuation and automation & control components (sensors, actuators, controllers), considering their real behaviour (signal delays, noise, failures and power consumption of actuators). Its ultimate objective is to allow a rapid transition from the simulation of the control strategy to its implementation at full-scale plants. Thus, this paper presents the application of the Add Control simulation platform for the design and implementation of new control strategies at the WWTP of Mekolalde.
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Affiliation(s)
- M Maiza
- CEIT and Tecnun (University of Navarra), Manuel de Lardizabal 15, 20018 San Sebastián, Spain.
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Vázquez S, León L, Fernández O, Lázaro M, Grande E, Aparicio L. Sunitinib: the first to arrive at first-line metastatic renal cell carcinoma. Adv Ther 2012; 29:202-17. [PMID: 22328304 DOI: 10.1007/s12325-011-0099-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Indexed: 10/14/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) are beneficial for the treatment of renal cell carcinoma (RCC), gastrointestinal stromal tumors (GIST), pancreatic neuroendocrine tumors (pNETs), and other tumors. The antitumor activity of sunitinib has been based on time-related parameters such as progression-free survival (PFS) and overall survival (OS). Advances in knowledge of the molecular mechanisms and oncogenic processes associated with RCC have enabled the availability of rational targets for pharmacotherapy. Although each small molecule is modeled to block the activity of selected kinase signaling enzymes, it is increasingly evident that many have nontargeted effects (on other kinases) that may cause unexpected complications. The recommended dose for sunitinib in patients with advanced RCC is a 50 mg oral daily dose, with or without food, on a 4/2 week schedule (4 weeks "on" vs. 2 weeks "off") until progression. An alternative continuous 37.5 mg/day dosing schedule has also been evaluated and appears to be well tolerated, allowing the maintenance of the dose density of sunitinib with a similar outcome. The continuous administration schedule provides a constant exposure to the drug, and may prevent potential tumor regrowth and angiogenesis recovery. Most side effects are reversible and should not result in sunitinib discontinuation. In this article, the body of evidence behind the use of sunitinib in metastatic RCC (mRCC) compared to other targeted agents that have recently come into the field is summarized, and the need for correct management of an adverse event profile in order to better optimize available treatment options is underlined.
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Cantó E, Reverter F, Morcillo-Suárez C, Matesanz F, Fernández O, Izquierdo G, Vandenbroeck K, Rodríguez-Antigüedad A, Urcelay E, Arroyo R, Otaegui D, Olascoaga J, Saiz A, Navarro A, Sanchez A, Domínguez C, Caminero A, Horga A, Tintoré M, Montalban X, Comabella M. Chitinase 3-like 1 plasma levels are increased in patients with progressive forms of multiple sclerosis. Mult Scler 2011; 18:983-90. [DOI: 10.1177/1352458511433063] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Chitinase 3-like 1 (CHI3L1) is upregulated in a wide variety of inflammatory conditions. Recent studies have pointed to a role of CHI3L1 in multiple sclerosis (MS) pathogenesis. Objective: The objective of this study was to investigate the role of plasma CHI3L1 in MS clinical course and disease activity and to evaluate the effect of interferon-beta (IFNβ) treatment on protein levels. Methods: Plasma CHI3L1 levels were determined by ELISA in 57 healthy controls (HC), 220 untreated MS patients [66 primary progressive MS patients (PPMS), 30 secondary progressive MS patients (SPMS), and 124 relapsing–remitting MS patients (RRMS), 94 during clinical remission and 30 during relapse], and 32 MS patients receiving IFNβ treatment. A polymorphism of the CHI3L1 gene, rs4950928, was genotyped in 3274 MS patients and 3483 HC. Results: Plasma CHI3L1 levels were significantly increased in patients with progressive forms of MS compared with RRMS patients and HC. CHI3L1 levels were similar between RRMS patients in relapse and remission. A trend towards decreased CHI3L1 levels was observed in IFNβ-treated patients. Allele C of rs4950928 was significantly associated with PPMS patients and with higher plasma CHI3L1 levels. Conclusions: These findings point to a role of CHI3L1 in patients with progressive forms of MS, particularly in those with PPMS.
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Affiliation(s)
- E Cantó
- Centre d’Esclerosi Múltiple de Catalunya, CEM-Cat, Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d’Hebron (HUVH), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Reverter
- Departament d’Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - C Morcillo-Suárez
- Institute of Evolutionary Biology (UPF-CSIC), PRBB, Barcelona, Spain
- National Institute for Bioinformatics, Universitat Pompeu Fabra, Barcelona, Spain
| | - F Matesanz
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Científicas, Granada, Spain
| | - O Fernández
- Servicio de Neurología, Instituto de Neurociencias Clínicas, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - G Izquierdo
- Unidad de Esclerosis Múltiple, Hospital Virgen Macarena, Sevilla, Spain
| | - K Vandenbroeck
- Neurogenomiks Group, Universidad del País Vasco (UPV/EHU), Leioa, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | | | - E Urcelay
- Servicio de Inmunología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - R Arroyo
- Unidad de Esclerosis Múltiple. Servicio de Neurología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - D Otaegui
- Multiple Sclerosis Unit, Biodonostia Institute, San Sebastián, Spain
| | - J Olascoaga
- Multiple Sclerosis Unit, Biodonostia Institute, San Sebastián, Spain
| | - A Saiz
- Service of Neurology, Hospital Clinic and Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Spain
| | - A Navarro
- National Institute for Bioinformatics, Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - A Sanchez
- Unitat d’Estadística i Bioinformàtica, Institut de Recerca, HUVH, Barcelona, Spain
| | - C Domínguez
- Molecular Biology and Biochemistry Research Center for Nanomedicine, Hospital Universitari Vall d’Hebron (HUVH), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - A Caminero
- Centre d’Esclerosi Múltiple de Catalunya, CEM-Cat, Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d’Hebron (HUVH), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Horga
- Centre d’Esclerosi Múltiple de Catalunya, CEM-Cat, Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d’Hebron (HUVH), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Tintoré
- Centre d’Esclerosi Múltiple de Catalunya, CEM-Cat, Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d’Hebron (HUVH), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- Centre d’Esclerosi Múltiple de Catalunya, CEM-Cat, Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d’Hebron (HUVH), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Comabella
- Centre d’Esclerosi Múltiple de Catalunya, CEM-Cat, Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d’Hebron (HUVH), Universitat Autònoma de Barcelona, Barcelona, Spain
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Fernández O, García-Merino JA, Arroyo R, Álvarez-Cermeño JC, Arbizu T, Izquierdo G, Saiz A, Olascoaga J, Rodríguez-Antigüedad A, Prieto JM, Oreja-Guevara C, Hernández MA, Montalbán X. Spanish consensus on the use of natalizumab (Tysabri(®))--2011. Neurologia 2011; 27:432-41. [PMID: 22078648 DOI: 10.1016/j.nrl.2011.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 09/05/2011] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION Natalizumab is very effective at reducing relapses and delaying disease progression in patients with relapsing-remitting multiple sclerosis (RRMS). However, treatment has also been associated with a risk of progressive multifocal leukoencephalopathy (PML). The aim of this article is to provide a consensus view on the assessment and stratification of these risks, and to improve the management of natalizumab-treated patients. DEVELOPMENT At an initial meeting of experts on multiple sclerosis (the authors of this consensus), the relevant topics of the consensus were determined and assigned for further elaboration. Topics included how to establish benefit and risk in general, stratification for risk of PML, informing patients of benefits/risks, and how to monitor patients during treatment and after discontinuing treatment. During the drafting phase, all available information published or presented at international meetings was reviewed. After a series of review sessions and meetings, the final draft was produced. CONCLUSIONS Although natalizumab is a very effective drug, its use needs to be considered carefully in view of possible adverse effects and the risk of PML in particular. The neurologist should carefully explain the risks and benefits of treatment in terms the patient can best understand. Before starting treatment, baseline laboratory tests and magnetic resonance imaging (MRI) should be available for future comparisons in the event of suspected PML. The risk of PML should be stratified into high, medium and low risk groups according to presence or absence of anti-JC virus antibodies, prior immunosuppressive therapy, and treatment duration. The follow-up, and frequency of MRI scans in particular, should depend on the risk group to which patient belongs. As our understanding of the risk factors for PML develops, it should be possible to offer patients increasingly individualised therapy. This is a consensus that establishes general recommendations, but neurologists must use their clinical expertise to monitor patients individually.
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Affiliation(s)
- O Fernández
- Servicio de Neurología, Instituto de Neurociencias Clínicas, Hospital Regional Universitario Carlos Haya, IMABIS, Málaga, Spain.
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Malhotra S, Morcillo-Suárez C, Brassat D, Goertsches R, Lechner-Scott J, Urcelay E, Fernández O, Drulovic J, García-Merino A, Martinelli Boneschi F, Chan A, Vandenbroeck K, Navarro A, Bustamante MF, Río J, Akkad DA, Giacalone G, Sánchez AJ, Leyva L, Alvarez-Lafuente R, Zettl UK, Oksenberg J, Montalban X, Comabella M. IL28B polymorphisms are not associated with the response to interferon-β in multiple sclerosis. J Neuroimmunol 2011; 239:101-4. [PMID: 21889215 DOI: 10.1016/j.jneuroim.2011.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 08/04/2011] [Accepted: 08/05/2011] [Indexed: 01/09/2023]
Abstract
Recent studies have revealed an association between interleukin 28B (IL28B) and response to IFN-alpha treatment in hepatitis C patients. Here we investigated the influence of IL28B polymorphisms in the response to interferon-beta (IFNβ) in multiple sclerosis (MS) patients. We genotyped two SNPs of the IL28B gene (rs8099917 and rs12979860) in 588 MS patients classified into responders (n=281) and non-responders (n=307) to IFNβ. Combined analysis of the study cohorts showed no significant associations between SNPs rs8099917 and rs12979860 and the response to treatment. These findings do not support a role of IL28B polymorphisms in the response to IFNβ in MS patients.
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Affiliation(s)
- S Malhotra
- Centre d'Esclerosi Múltiple de Catalunya, CEM-Cat, Unitat de Neuroimmunologia Clínica, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, Barcelona, Spain
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Fernández O, Fernández V, Guerrero M, León A, López-Madrona JC, Alonso A, Bustamante R, Tamayo JA, Romero F, Bravo M, Luque G, García L, Sanchís G, Roman CS, Romero M, Papais-Alvarenga M, de Ramon E. Multiple sclerosis prevalence in Malaga, Southern Spain estimated by the capture–recapture method. Mult Scler 2011; 18:372-6. [DOI: 10.1177/1352458511421917] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Although not definitively proven, there is commonly accepted to be a latitudinal gradient in the distribution of multiple sclerosis (MS), which is more frequent in temperate zones. The European Mediterranean countries are situated in a zone of median frequency, although ever increasing figures have been noted in the last decades. Objective: The objective of this study was to assess the current prevalence rate of MS in the province of Malaga, Southern Spain. Methods: The capture–recapture method (CRM) uses independent sources of data and permits the number of non-registered cases of a given disease to be estimated, and by doing so, to avoid ascertainment bias. Results: Use of this method showed the estimated prevalence rate of MS in the province of Malaga, Southern Spain, to be 125/105 (95% confidence interval: 102/105–169/105), higher than the figures published previously. Conclusions: Although we recognize that these data need to be confirmed in further studies and in other areas of the country using a similar method, we believe this study is the first to find such high figure of prevalence, being very similar to the figures reported in recent years in other southern European countries.
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Affiliation(s)
- O Fernández
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - V Fernández
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - M Guerrero
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - A León
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - JC López-Madrona
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - A Alonso
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - R Bustamante
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - JA Tamayo
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - F Romero
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - M Bravo
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - G Luque
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - L García
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - G Sanchís
- Internal Medicine Service, Hospital Comarcal Serranía de Ronda, Spain
| | - C San Roman
- Internal Medicine Service, Hospital Comarcal Vélez-Málaga, Spain
| | - M Romero
- Neurology Service, Hospital Clínico Universitario Virgen de la Victoria, Spain
| | - M Papais-Alvarenga
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, Spain
| | - E de Ramon
- Institute of Clinical Neurosciences, Hospital Regional Universitario Carlos Haya, 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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Fernández O. Oral laquinimod treatment in multiple sclerosis. Neurología (English Edition) 2011. [DOI: 10.1016/s2173-5808(11)70022-0] [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: 10/16/2022] Open
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Oliver-Martos B, Órpez T, Pinto-Medel MJ, Mayorga C, García-León JA, Maldonado-Sanchez R, Suardíaz M, Guerrero M, Luque G, Leyva L, Fernández O. Gene expression in IFNß signalling pathway differs between monocytes, CD4 and CD8 T cells from MS patients. J Neuroimmunol 2010; 230:153-9. [PMID: 21106255 DOI: 10.1016/j.jneuroim.2010.10.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 10/21/2010] [Accepted: 10/22/2010] [Indexed: 11/28/2022]
Abstract
IFNß exerts its activity through the interaction with IFNAR, through activation of the JAK/STAT pathway. We analyzed the changes in IFNAR1, IFNAR2, STAT1, STAT2, Tyk2, JAK1, IRF9 and MxA gene expressions after prolonged IFNß treatment, in isolated mononuclear-cell subpopulations from MS patients, by real time PCR. The effect of IFNß on gene expression differed depending on the subpopulation assessed. The data suggest that CD8+ T cells are the most influenced by prolonged IFNß therapy as IFNAR2, Tyk2, IRF9 and Jak1 expressions were decreased, whereas MxA expression was increased in these cells.
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García Merino A, Fernández O, Montalbán X, de Andrés C, Arbizu T. [Spanish Neurology Society consensus document on the use of drugs in multiple sclerosis: escalating therapy]. Neurologia 2010; 25:378-390. [PMID: 20738958] [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] Open
Abstract
INTRODUCTION Treatment of multiple sclerosis has advanced considerably in the last few years, at the same time as its complexity has increased. The purpose of this consensus document is to provide specific recommendations and rules on the strategy to follow in the treatment of multiple sclerosis in order to modify its course. MATERIAL AND METHODS Experts on the treatment and clinical research on multiple sclerosis proposed by the Demyelinating Diseases Group of the Spanish Neurology Society (SEN) prepared an initial document with recommendations for the treatment of this disease. The final version of this document was submitted to members of the Demyelinating Diseases Group of the SEN, who were able to make modifications and suggest changes to the final manuscript. RESULTS AND CONCLUSIONS A review has been made of the evidence levels and indications for the treatment of the different clinical forms of multiple sclerosis, and recommendations made for the use of drugs. As well as authorised drugs, a review has also been made of other occasionally used products, as well as combined therapy, therapeutic response criteria, levels of treatment changes, and finally a proposal is made on therapeutic escalation.
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Affiliation(s)
- A García Merino
- Grupo de Enfermedades Desmielinizantes de la Sociedad Española de Neurología.
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García Merino A, Fernández O, Montalbán X, de Andrés C, Arbizu T. Documento de consenso de la Sociedad Española de Neurología sobre el uso de medicamentos en esclerosis múltiple: escalado terapéutico. Neurologia 2010. [DOI: 10.1016/j.nrl.2010.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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