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D'Souza M, Steinheimer S, Dorn J, Morrison C, Boisvert J, Kravalis K, Burggraaff J, van Munster CE, Diederich M, Sellen A, Kamm CP, Dahlke F, Uitdehaag BM, Kappos L. Reference videos reduce variability of motor dysfunction assessments in multiple sclerosis. Mult Scler J Exp Transl Clin 2018; 4:2055217318792399. [PMID: 30116550 PMCID: PMC6088490 DOI: 10.1177/2055217318792399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/27/2018] [Accepted: 07/09/2018] [Indexed: 11/27/2022] Open
Abstract
Motor dysfunction, particularly ataxia, is one of the predominant clinical manifestations in patients with multiple sclerosis (MS). Assessment of motor dysfunction suffers from a high variability. We investigated whether the clinical rating of ataxia can be improved through the use of reference videos, covering the spectrum of severity degrees as defined in the Neurostatus-Expanded Disability Status Scale. Twenty-five neurologists participated. The variability of their assessments was significantly lower when reference videos were used (SD = 0.12; range = 0.40 vs SD = 0.26; range = 0.88 without reference videos; p = 0.013). Reference videos reduced the variability of clinical assessments and may be useful tools to improve the precision and consistency in the clinical assessment of motor functions in MS.
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Kappos L, Bar-Or A, Cree BAC, Fox RJ, Giovannoni G, Gold R, Vermersch P, Arnold DL, Arnould S, Scherz T, Wolf C, Wallström E, Dahlke F. Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomised, phase 3 study. Lancet 2018; 391:1263-1273. [PMID: 29576505 DOI: 10.1016/s0140-6736(18)30475-6] [Citation(s) in RCA: 598] [Impact Index Per Article: 99.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND No treatment has consistently shown efficacy in slowing disability progression in patients with secondary progressive multiple sclerosis (SPMS). We assessed the effect of siponimod, a selective sphingosine 1-phosphate (S1P) receptor1,5 modulator, on disability progression in patients with SPMS. METHODS This event-driven and exposure-driven, double-blind, phase 3 trial was done at 292 hospital clinics and specialised multiple sclerosis centres in 31 countries. Using interactive response technology to assign numbers linked to treatment arms, patients (age 18-60 years) with SPMS and an Expanded Disability Status Scale score of 3·0-6·5 were randomly assigned (2:1) to once daily oral siponimod 2 mg or placebo for up to 3 years or until the occurrence of a prespecified number of confirmed disability progression (CDP) events. The primary endpoint was time to 3-month CDP. Efficacy was assessed for the full analysis set (ie, all randomly assigned and treated patients); safety was assessed for the safety set. This trial is registered with ClinicalTrials.gov, number NCT01665144. FINDINGS 1651 patients were randomly assigned between Feb 5, 2013, and June 2, 2015 (1105 to the siponimod group, and 546 to the placebo group). One patient did not sign the consent form, and five patients did not receive study drug, all of whom were in the siponimod group. 1645 patients were included in the analyses (1099 in the siponimod group and 546 in the placebo). At baseline, the mean time since first multiple sclerosis symptoms was 16·8 years (SD 8·3), and the mean time since conversion to SPMS was 3·8 years (SD 3·5); 1055 (64%) patients had not relapsed in the previous 2 years, and 918 (56%) of 1651 needed walking assistance. 903 (82%) patients receiving siponimod and 424 (78%) patients receiving placebo completed the study. 288 (26%) of 1096 patients receiving siponimod and 173 (32%) of 545 patients receiving placebo had 3-month CDP (hazard ratio 0·79, 95% CI 0·65-0·95; relative risk reduction 21%; p=0·013). Adverse events occurred in 975 (89%) of 1099 patients receiving siponimod versus 445 (82%) of 546 patients receiving placebo; serious adverse events were reported for 197 (18%) patients in the siponimod group versus 83 (15%) patients in the placebo group. Lymphopenia, increased liver transaminase concentration, bradycardia and bradyarrhythmia at treatment initiation, macular oedema, hypertension, varicella zoster reactivation, and convulsions occurred more frequently with siponimod than with placebo. Initial dose titration mitigated cardiac first-dose effects. Frequencies of infections, malignancies, and fatalities did not differ between groups. INTERPRETATION Siponimod reduced the risk of disability progression with a safety profile similar to that of other S1P modulators and is likely to be a useful treatment for SPMS. FUNDING Novartis Pharma AG.
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D'Souza M, Yaldizli Ö, John R, Vogt DR, Papadopoulou A, Lucassen E, Menegola M, Andelova M, Dahlke F, Schnyder F, Kappos L. Neurostatus e-Scoring improves consistency of Expanded Disability Status Scale assessments: A proof of concept study. Mult Scler 2016; 23:597-603. [PMID: 27364325 DOI: 10.1177/1352458516657439] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To improve the consistency of standardized Expanded Disability Status Scale (EDSS) assessments, an electronic data capture tool and analysis tool was developed, Neurostatus e-Scoring (NESC). This tool allows real-time feedback by comparing entries with established scoring rules. OBJECTIVE To test whether using NESC reduces inconsistencies as compared to the paper-and-pencil version of the Expanded Disability Status Scale (pEDSS). METHODS In all, 100 multiple sclerosis (MS) patients were assessed in random order on the same day by pairs of neurologists, one using pEDSS and one NESC. We compared inter-rater reliability and frequency of inconsistencies in Neurostatus subscores, functional system (FS) scores, ambulation and EDSS steps. RESULTS Inconsistencies of any type were more likely to occur when using pEDSS (mean odds ratio (95% confidence interval (CI)) = 2.93 (1.62; 5.29)). This was also the case for FS score inconsistencies (2.54 (1.40; 4.61)) and more likely for patients in the lower EDSS range (⩽3.5 vs >3.5) (5.32 (1.19; 23.77)). Overall, inter-rater agreement for the assessed Neurostatus subscores was high (median and inter-quartile range = 0.84 (0.73, 0.81)). CONCLUSION Our data provide class II evidence that the use of NESC increases consistency of standardized EDSS assessments, and may thus have the potential to decrease noise and increase power of MS clinical trials.
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Maiorka A, Silva AVF, Santin E, Dahlke F, Bruno LDG, Boleli IC, Macari M, Trautenmuller H. Effect of Broiler Breeder Age and Glutamine Supplementation on the Development of the Intestinal Mucosa of 7-Day-Old Chicks. BRAZILIAN JOURNAL OF POULTRY SCIENCE 2016. [DOI: 10.1590/1516-635x1801017-022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bueno IJM, Surek D, Rocha C, Schramm VG, Muramatsu K, Dahlke F, Maiorka A. Effects of different limestone particle sizes in the diet of broiler breeders post molting on their performance, egg quality, incubation results, and pre-starter performance of their progeny. Poult Sci 2016; 95:860-6. [PMID: 26769267 DOI: 10.3382/ps/pev438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 11/13/2015] [Indexed: 11/20/2022] Open
Abstract
An experiment was conducted to test the hypothesis that a coarse limestone diet improves productivity, reproductive performance and the calcium utilization of molted broiler breeders. In total, 640 broiler breeder females, 73-week-old and sixty-four 27-week-old cockerels, Cobb 500, were evaluated during 10 weeks, according to a randomized block design composed of 4 treatments with 8 replicates each. Treatments consisted of diets with the inclusion of 100% fine limestone-fine PS (0.2 mm GMD-geometric mean diameter); PS1: 30% fine limestone+70% limestone with 1.0 mm GMD; PS2: 30% fine limestone+70% limestone with 2.0 mm GMD; and PS3: 30% fine limestone+70% limestone with 3.0 mm GMD. Calcium retention in the gizzard of the breeders, bone characteristics, and breeder performance, egg characteristics, eggshell quality, incubation performance, chick quality and yield, chick pre-starter live performance, and chick bone characteristics were determined. There was no significant difference (P>0.05) in the rate of lay, percentage of non-settable eggs, egg weight, egg shape index, egg specific gravity, eggshell weight, thickness, and percentage hatchability and egg weight loss of broiler breeders fed with diets with different limestone particle sizes. The chick quality and yield, chick pre-starter live performance, and chick bone characteristics were not affected (P>0.05) by any of the limestone particle sizes. It was concluded that live and reproductive performance parameters of broiler breeders post molting is not affected by limestone particle size in the feed.
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Kappos L, Radue EW, Comi G, Montalban X, Butzkueven H, Wiendl H, Giovannoni G, Hartung HP, Derfuss T, Naegelin Y, Sprenger T, Mueller-Lenke N, Griffiths S, von Rosenstiel P, Gottschalk R, Zhang Y, Dahlke F, Tomic D. Switching from natalizumab to fingolimod: A randomized, placebo-controlled study in RRMS. Neurology 2015; 85:29-39. [PMID: 26024899 PMCID: PMC4501941 DOI: 10.1212/wnl.0000000000001706] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/21/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the effect of different natalizumab washout (WO) periods on recurrence of MRI and clinical disease activity in patients switching from natalizumab to fingolimod. METHODS In this multicenter, double-blind, placebo-controlled trial (TOFINGO), patients with relapsing-remitting multiple sclerosis (RRMS) were randomized 1:1:1 to 8-, 12-, or 16-week WO followed by fingolimod treatment over 32 weeks from last natalizumab infusion (LNI). Brain MRI was performed at baseline and weeks 8, 12, 16, 20, and 24. RESULTS Of 142 enrolled and randomized patients, 112 (78.9%) completed the study (8 weeks, n = 41/50; 12 weeks, n = 31/42; 16 weeks, n = 40/50). Number (95% confidence interval [CI]) of active (new/newly enlarged T2) lesions from LNI through 8 weeks of fingolimod treatment (primary outcome) was similar in the 8-week (2.1 [1.7-2.6]) and 12-week WO groups (1.7 [1.3-2.2]) and higher in the 16-week WO group (8.2 [7.3-9.1]). During the WO period only, the number (95% CI) of active lesions increased with increasing WO duration (8 weeks, 0.4 [0.2-0.6]; 12 weeks, 2.1 [1.6-2.6]; 16 weeks, 3.6 [3.0-4.2]). Over the 24 weeks from LNI, gadolinium-enhancing T1 lesion counts were lower in the 8-week WO group (14.1 [5.67-22.53]) than in the 12-week (21.3 [1.41-41.19]) or 16-week (18.5 [8.40-28.60]) WO groups. More patients were relapse-free in the 8-week (88%) and 12-week (91%) WO groups than the 16-week WO group (84%). Sixty-eight percent of patients experienced adverse events (mostly mild/moderate), with similar incidence across groups. No unusually severe relapses or opportunistic infections occurred. CONCLUSIONS Initiating fingolimod therapy 8-12 weeks after natalizumab discontinuation is associated with a lower risk of MRI and clinical disease reactivation than initiation after 16-week WO. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with RRMS switching from natalizumab to fingolimod, shorter natalizumab WO periods are associated with less MRI disease activity than are longer WO periods.
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Morrison C, D'Souza M, Huckvale K, Dorn JF, Burggraaff J, Kamm CP, Steinheimer SM, Kontschieder P, Criminisi A, Uitdehaag B, Dahlke F, Kappos L, Sellen A. Usability and Acceptability of ASSESS MS: Assessment of Motor Dysfunction in Multiple Sclerosis Using Depth-Sensing Computer Vision. JMIR Hum Factors 2015; 2:e11. [PMID: 27025782 PMCID: PMC4797664 DOI: 10.2196/humanfactors.4129] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/09/2015] [Accepted: 05/07/2015] [Indexed: 11/13/2022] Open
Abstract
Background Sensor-based recordings of human movements are becoming increasingly important for the assessment of motor symptoms in neurological disorders beyond rehabilitative purposes. ASSESS MS is a movement recording and analysis system being developed to automate the classification of motor dysfunction in patients with multiple sclerosis (MS) using depth-sensing computer vision. It aims to provide a more consistent and finer-grained measurement of motor dysfunction than currently possible. Objective To test the usability and acceptability of ASSESS MS with health professionals and patients with MS. Methods A prospective, mixed-methods study was carried out at 3 centers. After a 1-hour training session, a convenience sample of 12 health professionals (6 neurologists and 6 nurses) used ASSESS MS to capture recordings of standardized movements performed by 51 volunteer patients. Metrics for effectiveness, efficiency, and acceptability were defined and used to analyze data captured by ASSESS MS, video recordings of each examination, feedback questionnaires, and follow-up interviews. Results All health professionals were able to complete recordings using ASSESS MS, achieving high levels of standardization on 3 of 4 metrics (movement performance, lateral positioning, and clear camera view but not distance positioning). Results were unaffected by patients’ level of physical or cognitive disability. ASSESS MS was perceived as easy to use by both patients and health professionals with high scores on the Likert-scale questions and positive interview commentary. ASSESS MS was highly acceptable to patients on all dimensions considered, including attitudes to future use, interaction (with health professionals), and overall perceptions of ASSESS MS. Health professionals also accepted ASSESS MS, but with greater ambivalence arising from the need to alter patient interaction styles. There was little variation in results across participating centers, and no differences between neurologists and nurses. Conclusions In typical clinical settings, ASSESS MS is usable and acceptable to both patients and health professionals, generating data of a quality suitable for clinical analysis. An iterative design process appears to have been successful in accounting for factors that permit ASSESS MS to be used by a range of health professionals in new settings with minimal training. The study shows the potential of shifting ubiquitous sensing technologies from research into the clinic through a design approach that gives appropriate attention to the clinic environment.
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Urso U, Dahlke F, Maiorka A, Bueno I, Schneider A, Surek D, Rocha C. Vitamin E and selenium in broiler breeder diets: Effect on live performance, hatching process, and chick quality. Poult Sci 2015; 94:976-83. [DOI: 10.3382/ps/pev042] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/20/2022] Open
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Capkun G, Lahoz R, Verdun E, Song X, Chen W, Korn JR, Dahlke F, Freitas R, Fraeman K, Simeone J, Johnson BH, Nordstrom B. Expanding the use of administrative claims databases in conducting clinical real-world evidence studies in multiple sclerosis. Curr Med Res Opin 2015; 31:1029-39. [PMID: 25661016 DOI: 10.1185/03007995.2015.1014029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Administrative claims databases provide a wealth of data for assessing the effect of treatments in clinical practice. Our aim was to propose methodology for real-world studies in multiple sclerosis (MS) using these databases. RESEARCH DESIGN AND METHODS In three large US administrative claims databases: MarketScan, PharMetrics Plus and Department of Defense (DoD), patients with MS were selected using an algorithm identified in the published literature and refined for accuracy. Algorithms for detecting newly diagnosed ('incident') MS cases were also refined and tested. Methodology based on resource and treatment use was developed to differentiate between relapses with and without hospitalization. RESULTS When various patient selection criteria were applied to the MarketScan database, an algorithm requiring two MS diagnoses at least 30 days apart was identified as the preferred method of selecting patient cohorts. Attempts to detect incident MS cases were confounded by the limited continuous enrollment of patients in these databases. Relapse detection algorithms identified similar proportions of patients in the MarketScan and PharMetrics Plus databases experiencing relapses with (2% in both databases) and without (15-20%) hospitalization in the 1 year follow-up period, providing findings in the range of those in the published literature. LIMITATION Additional validation of the algorithms proposed here would increase their credibility. CONCLUSIONS The methods suggested in this study offer a good foundation for performing real-world research in MS using administrative claims databases, potentially allowing evidence from different studies to be compared and combined more systematically than in current research practice.
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Kuhle J, Disanto G, Lorscheider J, Stites T, Chen Y, Dahlke F, Francis G, Shrinivasan A, Radue EW, Giovannoni G, Kappos L. Fingolimod and CSF neurofilament light chain levels in relapsing-remitting multiple sclerosis. Neurology 2015; 84:1639-43. [PMID: 25809304 PMCID: PMC4409586 DOI: 10.1212/wnl.0000000000001491] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 12/15/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We assessed CSF levels of the light chain subunit of neurofilaments (NfL) at baseline and after fingolimod therapy or placebo in patients with relapsing-remitting multiple sclerosis (RRMS). Changes in NfL levels were also correlated with relapse and MRI outcomes. METHODS CSF samples were available, at baseline and 12 months after treatment initiation, from a subset of 36 patients with RRMS (fingolimod 0.5 mg: n = 9; fingolimod 1.25 mg: n = 15; placebo: n = 12) participating in the 2-year, phase 3 Fingolimod (FTY720) Research Evaluating Effects of Daily Oral Therapy in Multiple Sclerosis (FREEDOMS) study. NfL levels were determined in a blinded fashion using a commercial ELISA kit. RESULTS Median NfL levels did not differ between treatment groups at baseline (0.5 mg: 644 pg/mL; 1.25 mg: 659 pg/mL; pooled 0.5/1.25 mg: 652 pg/mL, placebo: 886 pg/mL; p value [fingolimod vs placebo] = 0.619, 0.495, and 0.481, respectively). Following 12 months of treatment, median changes from baseline in NfL levels were lower than zero in the fingolimod groups (0.5 mg: -346 pg/mL, p = 0.039; 1.25 mg: -313 pg/mL, p = 0.035) and pooled 0.5/1.25 mg fingolimod group (-326 pg/mL, 83.3% with reduction, p = 0.002) but not in the placebo group (-214 pg/mL, 66.7% with reduction, p = 0.388). Reductions in NfL levels at month 12 correlated with an improvement in relapse and MRI outcomes. CONCLUSIONS Our results suggest a beneficial effect of fingolimod on this marker of axonal injury and support the utility of NfL as a quantitative biomarker in multiple sclerosis.
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Muramatsu K, Maiorka A, Dahlke F, Lopes AS, Pasche M. Impact of particle size, thermal processing, fat inclusion, and moisture addition on starch gelatinization of broiler feeds. BRAZILIAN JOURNAL OF POULTRY SCIENCE 2014. [DOI: 10.1590/1516-635x1604367-374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Comi G, Gold R, Dahlke F, Sinha A, von Rosenstiel P, Tomic D, Kappos L. Relapses in patients treated with fingolimod after previous exposure to natalizumab. Mult Scler 2014; 21:786-90. [PMID: 25257618 DOI: 10.1177/1352458514549404] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/29/2014] [Indexed: 11/15/2022]
Abstract
In post hoc analyses of an open-label, phase 3b study (FIRST), relapse rates during 4 months of fingolimod therapy were compared in patients with and without previous natalizumab exposure. Reductions in the proportion of patients experiencing relapses and annualized relapse rates (ARRs) from years 1 and 1-2 pre-study were evident between months 1 and 2 of fingolimod treatment, and were most pronounced in natalizumab-naïve patients and those who discontinued natalizumab >6 months pre-study. Patients who discontinued natalizumab 3-6 months pre-study had a peak ARR during month 1 of fingolimod treatment, followed by a decrease during months 2-4. These data indicate that fingolimod has the potential to reduce disease reactivation but that timing of treatment initiation may be critical for achieving an optimal effect.
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Sans ECO, Federici JF, Dahlke F, Molento CFM. Evaluation of Free-Range broilers using the welfare quality® protocol. BRAZILIAN JOURNAL OF POULTRY SCIENCE 2014. [DOI: 10.1590/1516-635x1603297-306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rocha C, Durau J, Barrilli L, Dahlke F, Maiorka P, Maiorka A. The effect of raw and roasted soybeans on intestinal health, diet digestibility, and pancreas weight of broilers. J APPL POULTRY RES 2014. [DOI: 10.3382/japr.2013-00829] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kontschieder P, Dorn JF, Morrison C, Corish R, Zikic D, Sellen A, D’Souza M, Kamm CP, Burggraaff J, Tewarie P, Vogel T, Azzarito M, Glocker B, Chin P, Dahlke F, Polman C, Kappos L, Uitdehaag B, Criminisi A. Quantifying Progression of Multiple Sclerosis via Classification of Depth Videos. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION – MICCAI 2014 2014; 17:429-37. [DOI: 10.1007/978-3-319-10470-6_54] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Selmaj K, Li DKB, Hartung HP, Hemmer B, Kappos L, Freedman MS, Stüve O, Rieckmann P, Montalban X, Ziemssen T, Auberson LZ, Pohlmann H, Mercier F, Dahlke F, Wallström E. Siponimod for patients with relapsing-remitting multiple sclerosis (BOLD): an adaptive, dose-ranging, randomised, phase 2 study. Lancet Neurol 2013; 12:756-67. [PMID: 23764350 DOI: 10.1016/s1474-4422(13)70102-9] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Siponimod is an oral selective modulator of sphingosine 1-phosphate receptor types 1 and type 5, with an elimination half-life leading to washout in 7 days. We aimed to determine the dose-response relation of siponimod in terms of its effects on brain MRI lesion activity and characterise safety and tolerability in patients with relapsing-remitting multiple sclerosis. METHODS In this double-blind, adaptive dose-ranging phase 2 study, we enrolled adults (aged 18-55 years) with relapsing-remitting multiple sclerosis at 73 medical centres in Europe and North America. We tested two patient cohorts sequentially, separated by an interim analysis at 3 months. We randomly allocated patients in cohort 1 (1:1:1:1) to receive once-daily siponimod 10 mg, 2 mg, or 0·5 mg, or placebo for 6 months. We randomly allocated patients in cohort 2 (4:4:1) to siponimod 1·25 mg, siponimod 0·25 mg, or placebo once-daily for 3 months. Randomisation was done with a central, automated system and patients and investigators were masked to treatment assignment. The primary endpoint was dose-response, assessed by percentage reduction in monthly number of combined unique active lesions at 3 months for siponimod versus placebo; this endpoint was analysed by a multiple comparison procedure with modelling techniques in all patients with at least one MRI scan up to 3 months. We assessed safety in all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT00879658. FINDINGS Between March 30, 2009, and Oct 22, 2010, we recruited 188 patients into cohort 1 and 109 patients into cohort 2. We showed a dose-response relation (p=0·0001) across the five doses of siponimod, with reductions in combined unique active lesions at 3 months compared with placebo of 35% (95% CI 17-57) for siponimod 0·25 mg (51 patients included in the primary endpoint analysis), 50% (29-69) for siponimod 0·5 mg (43 patients), 66% (48-80) for siponimod 1·25 mg (42 patients), 72% (57-84) for siponimod 2 mg (45 patients), and 82% (70-90) for siponimod 10 mg (44 patients). In patients treated for 6 months, 37 (86%) of 43 patients who received siponimod 0·5 mg had adverse events (eight serious), as did 48 (98%) of 49 patients who received siponimod 2 mg (four serious), 48 (96%) of 50 patients who received siponimod 10 mg (three serious), and 36 (80%) of 45 controls (none serious). For individuals treated to 3 months, 38 (74%) of 51 patients who received siponimod 0·25 mg had adverse events (none serious), as did 29 (69%) of 42 patients who received siponimod 1·25 mg (two serious) and 13 (81%) of 16 controls (none serious). INTERPRETATION Therapeutic effects of siponimod on MRI lesion activity in model-based analyses and its tolerability in relapsing-remitting multiple sclerosis warrant investigation in a phase 3 trial. FUNDING Novartis Pharma AG.
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Francis G, Dahlke F, Von Rosenstiel P, Sfikas N. Assessment of Potential Risk of PML with Fingolimod in MS Treated for at Least 24 Months (P04.137). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Stuve O, Selmaj K, Li D, Hartung HP, Hemmer B, Kappos L, Freedman M, Rieckmann P, Montalban X, Zhang Auberson L, Pohlmann H, Mercier F, Dahlke F, Wallstrom E. BAF312, a Selective Sphingosine-1-Phosphate Receptor Modulator Improves MRI and Clinical Outcomes in Relapsing-Remitting Multiple Sclerosis (RRMS) (S30.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s30.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Willemsen H, Kamers B, Dahlke F, Han H, Song Z, Ansari Pirsaraei Z, Tona K, Decuypere E, Everaert N. High- and low-temperature manipulation during late incubation: effects on embryonic development, the hatching process, and metabolism in broilers. Poult Sci 2011; 89:2678-90. [PMID: 21076107 DOI: 10.3382/ps.2010-00853] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Temperatures continuously higher and lower than the standard incubation temperature by 3°C from embryonic d 16 until embryonic d 18.5 result in differential effects on embryonic development, the hatching process, and embryonic metabolism. Embryos in the high-temperature group were forced into a state of malnutrition by the temperature treatment, as reflected by reduced embryo growth and yolk consumption, resulting in a significantly lower chick weight at hatch. In addition, altered air cell and blood gases as well as a retarded hatching process further indicated reduced growth of embryos exposed to higher incubation temperatures during the latter part of incubation. In addition, hatchability was significantly reduced by the high-temperature treatment due to higher embryonic mortality during the treatment period and the hatching process. Levels of blood glucose, lactate, liver glycogen, plasma triglycerides, and nonesterified fatty acids indicated an altered carbohydrate and lipid metabolism for the high-temperature group. Although the hatching process of embryos exposed to lower incubation temperatures was also significantly retarded, their embryonic development and growth were strikingly similar to those of the control group.
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Favero A, Maiorka A, Dahlke F, Meurer R, Oliveira R, Sens R. Influence of feed form and corn particle size on the live performance and digestive tract development of turkeys. J APPL POULTRY RES 2009. [DOI: 10.3382/japr.2009-00069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gonzales E, Stringhini JH, Dahlke F, Cunha WCP, Xavier SAG. Productive consequences of fasting neonatal chicks of different genetic constitutions for growing. BRAZILIAN JOURNAL OF POULTRY SCIENCE 2008. [DOI: 10.1590/s1516-635x2008000400010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bockor L, Dahlke F, Maiorka A, Castro OS, Oliveira EG, Krabbe EL, Warpechowski MB. COMPARAÇÃO DE MEDIDAS DA CAPACIDADE TAMPONANTE DE MATÉRIAS–PRIMAS E DIETAS UTILIZADAS PARA LEITÕES. ARCHIVES OF VETERINARY SCIENCE 2007. [DOI: 10.5380/avs.v12i3.10930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Avaliou-se a capacidade tamponante(CT) de diferentes ingredientes e dietas para leitões,por meio de diferentes medidas: pH inicial (pHi),acidez ou alcalinidade tituláveis (AT) e CT. Foramutilizadas 32 amostras de diferentes ingredientes,pré-misturas e dietas, classificadas como aminoácidos,suplementos minerais, cereais e subprodutos,soja e subprodutos, ingredientes de origem animale dietas completas. O pHi foi mensurado em trêssoluções com 10 g de amostra diluídas em 90 ml deágua destilada e deionizada, nas quais foi adicionadoácido clorídrico, ou ácido fórmico ou um acidificantecomercial à base de ácido fórmico, para reduzir opH até 5,0, ou NaOH, quando o pHi foi menor que5,0. A AT foi definida como a quantidade de ácidoou base necessária para alterar o pH entre o pHie 5,0, expresso em mEq/100 g de matéria seca deamostra. A CT foi calculada dividindo-se os valoresde AT pelo intervalo de pH considerado, sendo osvalores obtidos com cada ácido considerados replicatasde cada amostra. Os resultados com cadamedida foram submetidos à ANOVA considerandoas classificações. A correlação entre o pHi e a CTfoi também avaliada. Os suplementos minerais e osaminoácidos apresentaram valores extremos emtodas as medidas, e foram separados em subgrupos.As classes soja, cereais e dietas mostraram valoressimilares de pHi, mas diferiram quanto às outras medidas(P<0,05). A CT demonstrou mais sensibilidadeque a AT. O pHi apresentou correlação inconsistentecom a CT, não sendo uma estimativa confiável destapropriedade físico-química.
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Gonçalves M, Maluta RP, Dahlke F, Maiorka A, Ávila FA. Avaliação da capacidade imunoestimulante e da estabilidade de um probiótico empregado em rações de cães. ARCHIVES OF VETERINARY SCIENCE 2007. [DOI: 10.5380/avs.v12i2.9905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Foi avaliado um probiótico termo-resistente,liofilizado e encapsulado, composto de Bacilluscereus (ATCC 9634) 4,0 x l08 UFC/g e Bacillus subtilis(CCT 3131) 4,0 x l08 UFC/g, incorporado emuma ração comercial para cães com o objetivo deavaliar sua viabilidade durante o período de umano, e o seu efeito imunoestimulante quando fornecidoàs dietas. No primeiro experimento, foi avaliadaa sobrevivência das bactérias quantitativamentee qualitativamente depois de 3, 6, 9, 12 meses deestocagem. No segundo ensaio, foram utilizados 10cães (machos e fêmeas) com peso variando de 10a 30 kg, sem raças definidas, divididos em dois gruposde cinco animais cada. Todos os animais semtítulo sorológico anti-leptospira, foram vacinadoscontra os sorovares canicola e icterohaemorrhagiaeno início do experimento e mantidos em canis individuaisdurante 60 dias. Os animais do grupo Ireceberam ração extrusada acrescida de ProbióticoTR e, os animais do grupo II receberam a mesmaração extrusada sem o Probiótico TR, sendo mantidoscomo controles. Os títulos de anticorpos contraos sorovares canicola e icterohaemorrhagiae foramdeterminados antes da vacinação, no 15o, 30o e 60odia após, utilizando a reação de soro-aglutinaçãomicroscópica com antígenos vivos. Pelos resultadosda contagem total de esporos nas rações extrusadae farelada, o probiótico TR é notadamente estávelpor período superior a 12 meses. O estímuloda resposta imune foi verificado pela elevação dostítulos dos animais do grupo I no 15o, 30o e 60o diaapós a vacinação. Este fato é atribuído à ingestãodo probiótico TR, uma vez que entre os animais quenão receberam ração com probiótico TR (grupo II), a resposta imune foi menor e instável.
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Rosa PS, Faria Filho DE, Dahlke F, Vieira BS, Macari M, Furlan RL. Performance and carcass characteristics of broiler chickens with different growth potential and submitted to heat stress. BRAZILIAN JOURNAL OF POULTRY SCIENCE 2007. [DOI: 10.1590/s1516-635x2007000300007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Opalinski M, Maiorka A, Dahlke F, Cunha F, Vargas FSC, Cardozo E. On the use of a probiotic (Bacillus subtilis - strain DSM 17299) as growth promoter in broiler diets. BRAZILIAN JOURNAL OF POULTRY SCIENCE 2007. [DOI: 10.1590/s1516-635x2007000200004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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