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Stępnik K, Kukula-Koch W, Płaziński W. Molecular and Pharmacokinetic Aspects of the Acetylcholinesterase-Inhibitory Potential of the Oleanane-Type Triterpenes and Their Glycosides. Biomolecules 2023; 13:1357. [PMID: 37759757 PMCID: PMC10526139 DOI: 10.3390/biom13091357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The acetylcholinesterase-inhibitory potential of the oleanane-type triterpenes and their glycosides from thebark of Terminalia arjuna (Combreatceae), i.e.,arjunic acid, arjunolic acid, arjungenin, arjunglucoside I, sericic acid and arjunetin, is presented. The studies are based on in silico pharmacokinetic and biomimetic studies, acetylcholinesterase (AChE)-inhibitory activity tests and molecular-docking research. Based on the calculated pharmacokinetic parameters, arjunetin and arjunglucoside I are indicated as able to cross the blood-brain barrier. The compounds of interest exhibit a marked acetylcholinesterase inhibitory potential, which was tested in the TLC bioautography test. The longest time to reach brain equilibrium is observed for both the arjunic and arjunolic acids and the shortest one for arjunetin. All of the compounds exhibit a high and relatively similar magnitude of binding energies, varying from ca. -15 to -13 kcal/mol. The superposition of the most favorable positions of all ligands interacting with AChE is analyzed. The correlation between the experimentally determined IC50 values and the steric parameters of the molecules is investigated. The inhibition of the enzyme by the analyzed compounds shows their potential to be used as cognition-enhancing agents. For the most potent compound (arjunglucoside I; ARG), the kinetics of AChE inhibition were tested. The Michaelis-Menten constant (Km) for the hydrolysis of the acetylthiocholine iodide substrate was calculated to be 0.011 mM.
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Affiliation(s)
- Katarzyna Stępnik
- Department of Physical Chemistry, Institute of Chemical Sciences, Faculty of Chemistry, Maria Curie-Sklodowska University in Lublin, Pl. M. Curie-Skłodowskiej 3, 20-031 Lublin, Poland
- Department of Pharmacognosy with Medicinal Plants Garden, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland;
| | - Wirginia Kukula-Koch
- Department of Pharmacognosy with Medicinal Plants Garden, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland;
| | - Wojciech Płaziński
- Department of Biopharmacy, Medical University of Lublin, ul. Chodźki 4a, 20-093 Lublin, Poland;
- Jerzy Haber Institute of Catalysis and Surface Chemistry, Polish Academy of Sciences, ul. Niezapominajek 8, 30-239 Kraków, Poland
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Berthele A, Levy M, Wingerchuk DM, Pittock SJ, Shang S, Kielhorn A, Royston M, Sabatella G, Palace J. A single relapse induces worsening of disability and health-related quality of life in patients with neuromyelitis optica spectrum disorder. Front Neurol 2023; 14:1099376. [PMID: 37114235 PMCID: PMC10126826 DOI: 10.3389/fneur.2023.1099376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/08/2023] [Indexed: 04/29/2023] Open
Abstract
Background Cumulative damage from multiple relapses in neuromyelitis optica spectrum disorder (NMOSD) is associated with poor health-related quality of life (HRQoL) and long-term disability in patients positive for anti-aquaporin 4 antibodies (AQP4+). This study assessed the effect of an individual relapse on HRQoL and disability outcomes in AQP4+ NMOSD. Methods Post hoc analyses of data pooled from the PREVENT study and its open-label extension, which evaluated the efficacy and safety of eculizumab in AQP4+ NMOSD, examined the effect of a single relapse on 3 disability and 4 HRQoL outcome measures. Assuming the effect of 1 relapse extends to multiple relapses, an extrapolation was done to assess the effect of 2 relapses on these outcomes. Results In 27 patients (placebo: n = 20; eculizumab: n = 7) experiencing an independently adjudicated relapse, 1 relapse led to significantly worse disability (modified Rankin Scale and Expanded Disability Status Scale [EDSS]) and HRQoL (36-item Short-Form Health Survey mental and physical component summaries; European Quality of Life 5-Dimension questionnaire 3-Level visual analogue scale and utility index) scores. In 4 of 7 outcomes, clinically meaningful worsening was more likely for relapsing versus non-relapsing patients (n = 116). Extrapolating the effect of 2 relapses predicted that clinically meaningful worsening was more likely in 6 out of 7 outcomes, including EDSS, for patients experiencing multiple relapses versus patients experiencing no relapses. Conclusion Findings from these clinical trial data demonstrate that a single NMOSD relapse can worsen disability and HRQoL, underscoring the role of relapse prevention in improving long-term outcomes in patients with AQP4+ NMOSD.
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Affiliation(s)
- Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum Rechts der Isar, München, Germany
- *Correspondence: Achim Berthele,
| | - Michael Levy
- Massachusetts General Hospital and Harvard Medical School, Mass General Neurology, Boston, MA, United States
| | | | | | - Shulian Shang
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Adrian Kielhorn
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Minying Royston
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Guido Sabatella
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Jacqueline Palace
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford, United Kingdom
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Knowledge about multiple sclerosis among Palestinian community dwellers in the West Bank. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Masanneck L, Rolfes L, Regner-Nelke L, Willison A, Räuber S, Steffen F, Bittner S, Zipp F, Albrecht P, Ruck T, Hartung HP, Meuth SG, Pawlitzki M. Detecting ongoing disease activity in mildly affected multiple sclerosis patients under first-line therapies. Mult Scler Relat Disord 2022; 63:103927. [DOI: 10.1016/j.msard.2022.103927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/19/2022] [Accepted: 05/27/2022] [Indexed: 12/12/2022]
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Huntemann N, Vogelsang A, Groeneweg L, Willison A, Herrmann AM, Meuth SG, Eichler S. An optimized and validated protocol for inducing chronic experimental autoimmune encephalomyelitis in C57BL/6J mice. J Neurosci Methods 2022; 367:109443. [PMID: 34920025 DOI: 10.1016/j.jneumeth.2021.109443] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein induced experimental autoimmune encephalomyelitis (EAE) is the most commonly used animal model of multiple sclerosis. However, variations in the induction protocol can affect EAE progression, and may reduce the comparability of data. OPTIMIZED METHOD In the present study, we investigated the influence of the different components used for EAE induction in C57BL/6J mice on disease progression. In the present study, MOG35-55-induced chronic EAE in C57BL/6J mice has been applied as a model to challenge optimal pertussis toxin (PTx) dosing, while considering variations in batch potency. RESULTS We demonstrate that the dosage of PTx, adjusted to its potency, influences EAE development in a dose-dependent manner. Our data show that with our protocol, which considers PTx potency, C57BL/6J mice consistently develop symptoms of EAE. The mice show a typical chronic course with symptom onset after 10.5 ± 1.08 days and maximum severity around day 16 postimmunization followed by a mild remission of symptoms. COMPARISON WITH EXISTING METHODS Previously studies reveal that alterations in PTx dosing directly modify EAE progression. Our present study highlights that PTx batches differ in potency, resulting in inconsistent EAE induction. We also provide a clear protocol that allows a reduction in the number of mice used in EAE experiments, while maintaining consistent results. CONCLUSION Higher standards for comparability and reproducibility are needed to ensure and maximize the generation of reliable EAE data. Specifically, consideration of PTx potency. With our method of establishing consistent EAE pathogenesis, improved animal welfare standards and a reduction of mice used in experimentation can be achieved.
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Affiliation(s)
- Niklas Huntemann
- Department of Neurology, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany; Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Anna Vogelsang
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany.
| | - Linda Groeneweg
- Institute of Immunology, University of Muenster, Muenster, Germany
| | - Alice Willison
- The Northern Foundation School, Newcastle-upon-Tyne University Hospitals, Newcastle-upon-Tyne, United Kingdom
| | - Alexander M Herrmann
- Department of Neurology, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Susann Eichler
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
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Long-Term Disease Stability Assessed by the Expanded Disability Status Scale in Patients Treated with Cladribine Tablets 3.5 mg/kg for Relapsing Multiple Sclerosis: An Exploratory Post Hoc Analysis of the CLARITY and CLARITY Extension Studies. Adv Ther 2021; 38:4975-4985. [PMID: 34370275 PMCID: PMC8408069 DOI: 10.1007/s12325-021-01865-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/16/2021] [Indexed: 01/22/2023]
Abstract
INTRODUCTION In the Cladribine Tablets Treating Multiple Sclerosis Orally (CLARITY) study, cladribine tablets significantly reduced relapse rates and improved findings on magnetic resonance imaging versus placebo in patients with relapsing multiple sclerosis. In the CLARITY Extension study, treatment with cladribine tablets for 2 years followed by placebo for 2 years produced similar clinical benefits to 4 years of cladribine tablets. The objective of this exploratory post hoc analysis was to evaluate long-term disease stability (assessed by the Expanded Disability Status Scale [EDSS] score) after treatment with cladribine tablets. METHODS Patients enrolled into CLARITY Extension who were previously randomized to cladribine tablets 3.5 mg/kg in the CLARITY study were included in this post hoc analysis. Two treatment groups were investigated-patients randomized to cladribine tablets 3.5 mg/kg in CLARITY and thereafter randomized to placebo in CLARITY Extension (the CP3.5 group) or to cladribine tablets 3.5 mg/kg in CLARITY Extension (the CC7 group). In each treatment group, EDSS scores at 6-month intervals, EDSS score improvement/worsening each year, and time to 3- and 6-month confirmed EDSS progression were assessed from CLARITY baseline over 5 years of follow-up (including a variable bridging interval between studies). All analyses are descriptive, and no statistical comparisons were performed for between-treatment group differences. RESULTS The median (95% confidence interval [CI]) EDSS score for patients in the CP3.5 group at 5 years was 2.5 (2.0-3.5) compared with 3.0 (2.5-3.5) at baseline. In the CC7 group, median EDSS score (95% CI) at 5 years was 2.0 (2.0-3.0) compared with 2.5 (2.5-3.0) at baseline. During year 5 for the CP3.5 group, and based on changes in minimum score each year, EDSS score stability was observed in 53.9% of patients, improvement in 21.3%, and worsening in 24.7%. In the CC7 group, EDSS score remained stable in 66.1%, improved in 18.1%, and worsened in 15.8% of patients. Over 70% of patients in both treatment groups did not show 3- or 6-month confirmed EDSS progression at 5 years from CLARITY baseline. CONCLUSIONS These findings confirm long-term beneficial effects on disability afforded by either the recommended dose of cladribine tablets over 4 years (cumulative dose, 3.5 mg/kg) or a higher cumulative dose. TRIAL REGISTRATION ClinicalTrials.gov NCT00213135 (CLARITY); NCT00641537 (CLARITY Extension).
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Krasnov VS, Kolontareva YM. [Siponimod: a new view at the therapy of secondary progressive multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:124-129. [PMID: 34460168 DOI: 10.17116/jnevro2021121071124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Siponimod is a selective modulator of sphingosine-1-phosphate (S1P) receptors of types 1 and 5, registered in the Russian Federation for the treatment of patients with secondary progressive multiple sclerosis (SPMS), regardless of the presence or absence of exacerbations. The effectiveness of the drug in comparison with placebo was demonstrated in patients with SPMS in the international clinical trial EXPAND (phase III). This review devotes actual problems in the treatment of patients with SPMS, discusses the pathophysiology of multiple sclerosis progression, describes the peripheral and central mechanisms of siponimod action and its differences from fingolimod. According to analysis of scientific literature experimental, clinical and neuroimaging data are presented, which could explain the reasons for the successful use of siponimod in patients with SPMS, taking into account the pathophysiological mechanisms of the development of progression and the mechanisms of drug action.
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Affiliation(s)
- V S Krasnov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
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Trentzsch K, Schumann P, Śliwiński G, Bartscht P, Haase R, Schriefer D, Zink A, Heinke A, Jochim T, Malberg H, Ziemssen T. Using Machine Learning Algorithms for Identifying Gait Parameters Suitable to Evaluate Subtle Changes in Gait in People with Multiple Sclerosis. Brain Sci 2021; 11:brainsci11081049. [PMID: 34439668 PMCID: PMC8391565 DOI: 10.3390/brainsci11081049] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022] Open
Abstract
In multiple sclerosis (MS), gait impairment is one of the most prominent symptoms. For a sensitive assessment of pathological gait patterns, a comprehensive analysis and processing of several gait analysis systems is necessary. The objective of this work was to determine the best diagnostic gait system (DIERS pedogait, GAITRite system, and Mobility Lab) using six machine learning algorithms for the differentiation between people with multiple sclerosis (pwMS) and healthy controls, between pwMS with and without fatigue and between pwMS with mild and moderate impairment. The data of the three gait systems were assessed on 54 pwMS and 38 healthy controls. Gaussian Naive Bayes, Decision Tree, k-Nearest Neighbor, and Support Vector Machines (SVM) with linear, radial basis function (rbf) and polynomial kernel were applied for the detection of subtle walking changes. The best performance for a healthy-sick classification was achieved on the DIERS data with a SVM rbf kernel (κ = 0.49 ± 0.11). For differentiating between pwMS with mild and moderate disability, the GAITRite data with the SVM linear kernel (κ = 0.61 ± 0.06) showed the best performance. This study demonstrates that machine learning methods are suitable for identifying pathologic gait patterns in early MS.
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Affiliation(s)
- Katrin Trentzsch
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (K.T.); (P.B.); (R.H.); (D.S.); (A.Z.)
| | - Paula Schumann
- Institute of Biomedical Engineering, TU Dresden, Fetscherstr. 29, 01307 Dresden, Germany; (P.S.); (G.Ś.); (A.H.); (T.J.); (H.M.)
| | - Grzegorz Śliwiński
- Institute of Biomedical Engineering, TU Dresden, Fetscherstr. 29, 01307 Dresden, Germany; (P.S.); (G.Ś.); (A.H.); (T.J.); (H.M.)
| | - Paul Bartscht
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (K.T.); (P.B.); (R.H.); (D.S.); (A.Z.)
| | - Rocco Haase
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (K.T.); (P.B.); (R.H.); (D.S.); (A.Z.)
| | - Dirk Schriefer
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (K.T.); (P.B.); (R.H.); (D.S.); (A.Z.)
| | - Andreas Zink
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (K.T.); (P.B.); (R.H.); (D.S.); (A.Z.)
| | - Andreas Heinke
- Institute of Biomedical Engineering, TU Dresden, Fetscherstr. 29, 01307 Dresden, Germany; (P.S.); (G.Ś.); (A.H.); (T.J.); (H.M.)
| | - Thurid Jochim
- Institute of Biomedical Engineering, TU Dresden, Fetscherstr. 29, 01307 Dresden, Germany; (P.S.); (G.Ś.); (A.H.); (T.J.); (H.M.)
| | - Hagen Malberg
- Institute of Biomedical Engineering, TU Dresden, Fetscherstr. 29, 01307 Dresden, Germany; (P.S.); (G.Ś.); (A.H.); (T.J.); (H.M.)
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307 Dresden, Germany; (K.T.); (P.B.); (R.H.); (D.S.); (A.Z.)
- Correspondence: ; Tel.: +49-351-458-4465; Fax: +49-351-458-5717
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The STING-IFN-β-Dependent Axis Is Markedly Low in Patients with Relapsing-Remitting Multiple Sclerosis. Int J Mol Sci 2020; 21:ijms21239249. [PMID: 33291536 PMCID: PMC7730283 DOI: 10.3390/ijms21239249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022] Open
Abstract
Cyclic GMP-AMP-synthase is a sensor of endogenous nucleic acids, which subsequently elicits a stimulator of interferon genes (STING)-dependent type I interferon (IFN) response defending us against viruses and other intracellular pathogens. This pathway can drive pathological inflammation, as documented for type I interferonopathies. In contrast, specific STING activation and subsequent IFN-β release have shown beneficial effects on experimental autoimmune encephalomyelitis (EAE) as a model for multiple sclerosis (MS). Although less severe cases of relapse-remitting MS (RRMS) are treated with IFN-β, there is little information correlating aberrant type I IFN signaling and the pathologic conditions of MS. We hypothesized that there is a link between STING activation and the endogenous production of IFN-β during neuroinflammation. Gene expression analysis in EAE mice showed that Sting level decreased in the peripheral lymphoid tissue, while its level increased within the central nervous system over the course of the disease. Similar patterns could be verified in peripheral immune cells during the acute phases of RRMS in comparison to remitting phases and appropriately matched healthy controls. Our study is the first to provide evidence that the STING/IFN-β-axis is downregulated in RRMS patients, meriting further intensified research to understand its role in the pathophysiology of MS and potential translational applications.
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Lepore V, Bosetti C, Santucci C, Iaffaldano P, Trojano M, Mosconi P. Detection of disability worsening in relapsing-remitting multiple sclerosis patients: a real-world roving Expanded Disability Status Scale reference analysis from the Italian Multiple Sclerosis Register. Eur J Neurol 2020; 28:567-578. [PMID: 33058344 DOI: 10.1111/ene.14589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE In relapsing-remitting multiple sclerosis patients (RRMS) disability progressively accumulates over time. To compare the cumulative probability of 6-month confirmed disability-worsening events using a fixed baseline or a roving Expanded Disability Status Scale (EDSS) reference, in a real-world setting. METHODS A cohort of 7964 RRMS patients followed for 2 or more years, with EDSS scores recorded every 6 months, was selected from the Italian Multiple Sclerosis Register. The overall probability of confirmed disability-worsening events and of confirmed disability-worsening events unrelated to relapse was evaluated using as reference a fixed baseline EDSS score or a roving EDSS score in which the increase had to be separated from the last EDSS assessment by at least 6 or 12 months. RESULTS Using a fixed baseline EDSS reference, the cumulative probability of 6-year overall confirmed disability-worsening events was 33.2%, and that of events unrelated to relapse was 10.9% (33% of overall confirmed disability-worsening events). Using a roving EDSS, the proportions were respectively 35.2% and 21.3% (61% of overall confirmed disability-worsening events). CONCLUSIONS In a real-world setting, roving EDSS reference scores appear to be more sensitive for detecting confirmed disability-worsening events unrelated to relapse in RRMS patients.
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Affiliation(s)
- V Lepore
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - C Bosetti
- Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - C Santucci
- Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - P Iaffaldano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University Bari "Aldo Moro", Bari, Italy
| | - M Trojano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, University Bari "Aldo Moro", Bari, Italy
| | - P Mosconi
- Laboratory for Medical Research and Consumer Involvement, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Ness NH, Schriefer D, Haase R, Ettle B, Cornelissen C, Ziemssen T. Differentiating societal costs of disability worsening in multiple sclerosis. J Neurol 2019; 267:1035-1042. [DOI: 10.1007/s00415-019-09676-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/15/2022]
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de Carvalho Jennings Pereira WL, Flauzino T, Alfieri DF, Oliveira SR, Kallaur AP, Simão ANC, Lozovoy MAB, Kaimen-Maciel DR, Maes M, Reiche EMV. Immune-inflammatory, metabolic and hormonal biomarkers are associated with the clinical forms and disability progression in patients with multiple sclerosis: A follow-up study. J Neurol Sci 2019; 410:116630. [PMID: 31887671 DOI: 10.1016/j.jns.2019.116630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 12/26/2022]
Abstract
The objective of this study was to evaluate the role of immune-inflammatory, metabolic, hormonal, and oxidative stress biomarkers in disability progression (DP) and clinical forms of multiple sclerosis (MS). The study evaluated 140 MS patients at admission (T0), and eight (T8) and 16 months (T16) later. The Expanded Disability Status Score (EDSS) and biomarkers were determined at T0, T8, and T16. A DP index (DPI) defined as an increase of ≥1 rank on the EDSS score indicated that 39.3% of the patients had significant DP. Quantification of the ordinal EDSS rank score was performed using optimal scaling methods. Categorical regression showed that the quantitative T16 EDSS score was predicted by T0 homocysteine (Hcy), T0 parathormone (PTH), T0 advanced oxidized protein products (AOPP) (all positively), low T0 vitamin D (<18.3 ng/mL) and T8 folic acid (<5 ng/mL) concentrations while higher T8 calcium concentrations (≥8.90 mg/dL) had protective effects. Linear Mixed Models showed that the change in EDSS from T0 to T16 was significantly associated with changes in IL-17 (positively) and IL-4 (inversely) independently from the significant effects of clinical MS forms, treatment modalities, smoking, age and systemic arterial hypertension. Hcy, PTH, IL-6, and IL-4 were positively associated with progressive versus relapsing-remitting MS while 25(OH)D was inversely associated. In conclusion, the ordinal EDSS scale is an adequate instrument to assess DP after category value estestimation. Aberrations in immune-inflammatory, metabolic and hormonal biomarkers are associated with DP and with the progressive form of MS.
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Affiliation(s)
- Wildéa Lice de Carvalho Jennings Pereira
- Laboratory of Applied Immunology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil; Outpatient Clinic for Neurology, University Hospital, State University of Londrina, Londrina, Paraná, Brazil
| | - Tamires Flauzino
- Laboratory of Applied Immunology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil
| | - Daniela Frizon Alfieri
- Laboratory of Applied Immunology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil
| | - Sayonara Rangel Oliveira
- Laboratory of Applied Immunology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil; Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil
| | - Ana Paula Kallaur
- Laboratory of Applied Immunology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil
| | - Andrea Name Colado Simão
- Laboratory of Applied Immunology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil; Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil
| | - Marcell Alysson Batisti Lozovoy
- Laboratory of Applied Immunology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil; Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil
| | - Damacio Ramón Kaimen-Maciel
- Outpatient Clinic for Neurology, University Hospital, State University of Londrina, Londrina, Paraná, Brazil; Clinical Neurology, Santa Casa de Misericórdia de Londrina, Londrina, Paraná, Brazil
| | - Michael Maes
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia; Department of Psychiatry, King Chulalongkorn Memorial Hospital, Chulalongkorn, Bangkok, Thailand
| | - Edna Maria Vissoci Reiche
- Laboratory of Applied Immunology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil; Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, University of Londrina, Londrina, Paraná, Brazil.
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Ozakbas S, Cinar BP, Kahraman T. The 20-year history: Change of multiple sclerosis patient profile over 20 years. Mult Scler Relat Disord 2019; 33:1-4. [PMID: 31128520 DOI: 10.1016/j.msard.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/15/2019] [Accepted: 05/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients attending multiple sclerosis (MS) clinics experience less disability compared to previous years. OBJECTIVE This study was conducted retrospectively examining the patient records of our MS Clinic. The patient records in 1996 were compared to those in 2016. METHODS Demographic data, duration of disease, time to diagnosis, course of the disease, Expanded Disability Status Scale (EDSS) scores, and whether or not patients used disease modifying therapies were recorded in both 1996 and 2016. RESULTS The mean frequency of visits were significantly higher in 1996 compared to 2016 (p = 0.003). There were significantly more number of patients with clinically isolated syndrome (p = 0.004) and secondary progressive MS (p = 0.001) in 1996; however, significantly less number of patients with relapsing-remitting MS (p < 0.001). EDSS scores of ≤3 were significantly higher in 2016 (p < 0.001). On the other hand, the number of patients with the EDSS scores of 6-6.5 and ≥7 were significantly less in 2016 (p < 0.001). Significantly more patients with secondary progressive MS, EDSS scores of 6-6.5 and ≥7 (wheel-chair dependent patients) came to the clinic in 1996 compared to 2016. CONCLUSION The emergence of treatment options in MS and the increasing availability of new treatment options for patients with no/inadequate treatment response have changed the MS patient profile over the 20 years. The number of wheelchair-dependent patients dramatically reduced.
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Affiliation(s)
- Serkan Ozakbas
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Bilge Piri Cinar
- Department of Neurology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey.
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
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14
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D'Souza M, Heikkilä A, Lorscheider J, Haller V, Kravalis K, Gysin S, Fuertes NAC, Fricker E, Lam E, Higgins P, Tomic D, Papadopoulou A, Kappos L. Electronic Neurostatus-EDSS increases the quality of expanded disability status scale assessments: Experience from two phase 3 clinical trials. Mult Scler 2019; 26:993-996. [PMID: 31060429 DOI: 10.1177/1352458519845108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Neurostatus-eEDSS is an electronic tool providing automated real-time feedback on inconsistencies of Neurostatus-EDSS calculations. OBJECTIVE To analyze the performance of the Neurostatus-eEDSS in two multicenter phase 3 multiple sclerosis (MS) trials. METHODS All assessments captured with the Neurostatus-eEDSS web service during a period of 2.5 years were analyzed. RESULTS Of the total 10,789 assessments, 40.1% had inconsistencies after first entry, reduced to 22.1% due to the real-time feedback. The entire checking process resulted in a change of the expanded disability status scale (EDSS) score in 14.8% of the assessments. CONCLUSION The Neurostatus-eEDSS can increase consistency and reliability of EDSS assessments in clinical MS trials.
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Affiliation(s)
- Marcus D'Souza
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland/NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Johannes Lorscheider
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - Vanessa Haller
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - Kristina Kravalis
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - Shauna Gysin
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - Nuria Alicia Cerdá Fuertes
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - Evy Fricker
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - Elaine Lam
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | - Athina Papadopoulou
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland/NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ludwig Kappos
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland
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15
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Scheu S, Ali S, Mann-Nüttel R, Richter L, Arolt V, Dannlowski U, Kuhlmann T, Klotz L, Alferink J. Interferon β-Mediated Protective Functions of Microglia in Central Nervous System Autoimmunity. Int J Mol Sci 2019; 20:E190. [PMID: 30621022 PMCID: PMC6337097 DOI: 10.3390/ijms20010190] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/23/2018] [Accepted: 12/28/2018] [Indexed: 02/07/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) leading to demyelination and axonal damage. It often affects young adults and can lead to neurological disability. Interferon β (IFNβ) preparations represent widely used treatment regimens for patients with relapsing-remitting MS (RRMS) with therapeutic efficacy in reducing disease progression and frequency of acute exacerbations. In mice, IFNβ therapy has been shown to ameliorate experimental autoimmune encephalomyelitis (EAE), an animal model of MS while genetic deletion of IFNβ or its receptor augments clinical severity of disease. However, the complex mechanism of action of IFNβ in CNS autoimmunity has not been fully elucidated. Here, we review our current understanding of the origin, phenotype, and function of microglia and CNS immigrating macrophages in the pathogenesis of MS and EAE. In addition, we highlight the emerging roles of microglia as IFNβ-producing cells and vice versa the impact of IFNβ on microglia in CNS autoimmunity. We finally discuss recent progress in unraveling the underlying molecular mechanisms of IFNβ-mediated effects in EAE.
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Affiliation(s)
- Stefanie Scheu
- Institute of Medical Microbiology and Hospital Hygiene, University of Düsseldorf, 40225 Düsseldorf, Germany.
| | - Shafaqat Ali
- Institute of Medical Microbiology and Hospital Hygiene, University of Düsseldorf, 40225 Düsseldorf, Germany.
- Department of Psychiatry and Psychotherapy, University of Münster, 48149 Münster, Germany.
- Cells in Motion, Cluster of Excellence, University of Münster, 48149 Münster, Germany.
| | - Ritu Mann-Nüttel
- Institute of Medical Microbiology and Hospital Hygiene, University of Düsseldorf, 40225 Düsseldorf, Germany.
| | - Lisa Richter
- Institute of Medical Microbiology and Hospital Hygiene, University of Düsseldorf, 40225 Düsseldorf, Germany.
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University of Münster, 48149 Münster, Germany.
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Münster, 48149 Münster, Germany.
| | - Tanja Kuhlmann
- Institute of Neuropathology, University Hospital Münster, 48149, Münster, Germany.
| | - Luisa Klotz
- Department of Neurology, University of Münster, 48149 Münster, Germany.
| | - Judith Alferink
- Department of Psychiatry and Psychotherapy, University of Münster, 48149 Münster, Germany.
- Cells in Motion, Cluster of Excellence, University of Münster, 48149 Münster, Germany.
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16
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D'hooghe MB, Gielen J, Van Remoortel A, D'haeseleer M, Peeters E, Cambron M, De Keyser J, Nagels G. Single MRI-Based Volumetric Assessment in Clinical Practice Is Associated With MS-Related Disability. J Magn Reson Imaging 2018; 49:1312-1321. [DOI: 10.1002/jmri.26303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Marie B. D'hooghe
- National MS Center, Neurology; Melsbroek Belgium
- Vrije Universiteit Brussel (VUB), Center for Neurosciences; Brussels Belgium
| | - Jeroen Gielen
- National MS Center, Neurology; Melsbroek Belgium
- Vrije Universiteit Brussel (VUB), Center for Neurosciences; Brussels Belgium
| | | | | | | | - Melissa Cambron
- National MS Center, Neurology; Melsbroek Belgium
- University Hospital Brussels, Vrije Universiteit Brussels (VUB), Neurology; Brussels Belgium
| | - Jacques De Keyser
- University Hospital Brussels, Vrije Universiteit Brussels (VUB), Neurology; Brussels Belgium
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, Neurology; Groningen Netherlands
| | - Guy Nagels
- National MS Center, Neurology; Melsbroek Belgium
- Vrije Universiteit Brussel (VUB), Center for Neurosciences; Brussels Belgium
- Vrije Universiteit Brussel (VUB), ETRO, Faculty of Engineering; Brussels Belgium
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17
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Defer G, de Seze J, Bouee S, Courouve L, Longin J, Payet M, Deleglise AJ. Outcomes and treatment management of a French cohort suffering from multiple sclerosis: A retrospective epidemiological study. Mult Scler Relat Disord 2018; 25:276-281. [DOI: 10.1016/j.msard.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/13/2018] [Accepted: 08/03/2018] [Indexed: 11/26/2022]
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18
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Kumar S, Rohatgi A, Chaudhari H, Thakor P. Evolving Landscape of Multiple Sclerosis in India: Challenges in the Management. Ann Indian Acad Neurol 2018; 21:107-115. [PMID: 30122834 PMCID: PMC6073961 DOI: 10.4103/aian.aian_33_18] [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] [Indexed: 01/21/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic neurological disease which often leads to disability. The complex etiology and progressive nature pose challenges in the management of patients with MS, particularly in developing countries like India. Lack of data on prevalence further complicates estimation of the magnitude of MS in India. There are various other challenges associated with management of patients with MS due to which the therapy is utilized by only a small segment of population in India. This article encapsulates the gaps and challenges in the management of patients with MS and presents suggestions and recommendations of the members of advisory boards held to discuss these challenges. The advisory board members suggested that an early diagnosis of MS and an early initiation of treatment are essential to achieve better results for tackling MS-related challenges. In addition, awareness and education about MS among people, regular training to physicians, emphasis on the use of revised 2010 McDonald criteria, and utilization of advanced diagnostic modalities in magnetic resonance imaging would help to achieve desirable as well as effective therapeutic outcomes. Further, access to an easy-to-use therapy delivery system could also be beneficial in attaining an adequate treatment adherence and related health benefits.
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Affiliation(s)
- Sudhir Kumar
- Department of Neurology, Apollo Hospitals, Hyderabad, Telangana, India
| | - Anshu Rohatgi
- Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
| | - Harshal Chaudhari
- Medical Affairs, Merck Ltd., Merck Specialties Pvt. Ltd., Mumbai, Maharashtra, India
| | - Priti Thakor
- Medical Affairs, Merck Ltd., Merck Specialties Pvt. Ltd., Mumbai, Maharashtra, India
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19
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Boogar IR, Talepasand S, Jabari M. Psychosocial and Medical Determinants of Health-related Quality of Life in Patients with Relapsing-Remitting Multiple Sclerosis. Noro Psikiyatr Ars 2018; 55:29-35. [PMID: 30042638 PMCID: PMC6045807 DOI: 10.29399/npa.16983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/30/2016] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Relapsing-remitting multiple sclerosis is a debilitating neurological disease accompanied with adverse consequences for quality of life. The purpose of this study was to investigate the role of relapsing-remitting multiple sclerosis on psychological, disease-related, socioeconomic, and demographic determinants of health-related quality of life of patients. METHODS In this cross-sectional descriptive study, 193 patients with relapsing-remitting multiple sclerosis were selected by compliance sampling method among the patients who attended the Iranian Multiple Sclerosis Association in Tehran from March 2014 to July 2014; and they completed the Multiple Sclerosis Quality of Life Questionnaire, the Depression Anxiety and Stress Scales, and the Socio-demographical Questionnaire. Then, a hierarchical multiple regression analysis with the stepwise method is used for data analysis by the PASW-18. RESULTS According to the findings, in model 1, low socioeconomic status (SES) had a negative coefficient (beta=-0.30, p<0.01), and treatment history had a positive coefficient (beta=0.22, p<0.01). In model 2, while all variables of model 1 were controlled, depression had a negative coefficient (beta=-0.26, p<0.05), while disorder severity of multiple sclerosis had positive coefficients in lower level (beta=0.35, p<0.001), moderate level (beta=0.23, p<0.01), and severe level (beta=0.22, p<0.01). Other studied variables in model 1, and stress and anxiety in model 2 were not predicted in terms of the quality of life (p>0.05). CONCLUSION Unfavorable SES, lack of effective treatment history, higher depression, and signs and symptoms severity of multiple sclerosis significantly predict decreased health-related quality of life in patients with relapsing-remitting multiple sclerosis. Thus, it is consequential to emphasize the value of tailored intervention for attending to these factors in the treatment and rehabilitation agendas for improvement of health-related quality of life in relapsing-remitting multiple sclerosis.
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20
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Kroth J, Ciolac D, Fleischer V, Koirala N, Krämer J, Muthuraman M, Luessi F, Bittner S, Gonzalez-Escamilla G, Zipp F, Meuth SG, Groppa S. Increased cerebrospinal fluid albumin and immunoglobulin A fractions forecast cortical atrophy and longitudinal functional deterioration in relapsing-remitting multiple sclerosis. Mult Scler 2017; 25:338-343. [PMID: 29226779 DOI: 10.1177/1352458517748474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Currently, no unequivocal predictors of disease evolution exist in patients with multiple sclerosis (MS). Cortical atrophy measurements are, however, closely associated with cumulative disability. OBJECTIVE Here, we aim to forecast longitudinal magnetic resonance imaging (MRI)-driven cortical atrophy and clinical disability from cerebrospinal fluid (CSF) markers. METHODS We analyzed CSF fractions of albumin and immunoglobulins (Ig) A, G, and M and their CSF to serum quotients. RESULTS Widespread atrophy was highly associated with increased baseline CSF concentrations and quotients of albumin and IgA. Patients with increased CSFIgA and CSFIgM showed higher functional disability at follow-up. CONCLUSION CSF markers of blood-brain barrier integrity and specific immune response forecast emerging gray matter pathology and disease progression in MS.
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Affiliation(s)
- Julia Kroth
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Research Center for Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Research Center for Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany/Department of Neurology, Institute of Emergency Medicine, Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Research Center for Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Nabin Koirala
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Research Center for Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Julia Krämer
- Department of Neurology, University of Munster, Munster, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Research Center for Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Felix Luessi
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Research Center for Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Research Center for Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Research Center for Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Research Center for Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sven G Meuth
- Department of Neurology, University of Munster, Munster, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Research Center for Immunology (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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21
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The C-C Chemokines CCL17 and CCL22 and Their Receptor CCR4 in CNS Autoimmunity. Int J Mol Sci 2017; 18:ijms18112306. [PMID: 29099057 PMCID: PMC5713275 DOI: 10.3390/ijms18112306] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system (CNS). It affects more than two million people worldwide, mainly young adults, and may lead to progressive neurological disability. Chemokines and their receptors have been shown to play critical roles in the pathogenesis of experimental autoimmune encephalomyelitis (EAE), a murine disease model induced by active immunization with myelin proteins or transfer of encephalitogenic CD4+ T cells that recapitulates clinical and neuropathological features of MS. Chemokine ligand-receptor interactions orchestrate leukocyte trafficking and influence multiple pathophysiological cellular processes, including antigen presentation and cytokine production by dendritic cells (DCs). The C-C class chemokines 17 (CCL17) and 22 (CCL22) and their C-C chemokine receptor 4 (CCR4) have been shown to play an important role in homeostasis and inflammatory responses. Here, we provide an overview of the involvement of CCR4 and its ligands in CNS autoimmunity. We review key clinical studies of MS together with experimental studies in animals that have demonstrated functional roles of CCR4, CCL17, and CCL22 in EAE pathogenesis. Finally, we discuss the therapeutic potential of newly developed CCR4 antagonists and a humanized anti-CCR4 antibody for treatment of MS.
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Novakova L, Zetterberg H, Sundström P, Axelsson M, Khademi M, Gunnarsson M, Malmeström C, Svenningsson A, Olsson T, Piehl F, Blennow K, Lycke J. Monitoring disease activity in multiple sclerosis using serum neurofilament light protein. Neurology 2017; 89:2230-2237. [PMID: 29079686 PMCID: PMC5705244 DOI: 10.1212/wnl.0000000000004683] [Citation(s) in RCA: 292] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 09/07/2017] [Indexed: 12/03/2022] Open
Abstract
Objective: To examine the effects of disease activity, disability, and disease-modifying therapies (DMTs) on serum neurofilament light (NFL) and the correlation between NFL concentrations in serum and CSF in multiple sclerosis (MS). Methods: NFL concentrations were measured in paired serum and CSF samples (n = 521) from 373 participants: 286 had MS, 45 had other neurologic conditions, and 42 were healthy controls (HCs). In 138 patients with MS, the serum and CSF samples were obtained before and after DMT treatment with a median interval of 12 months. The CSF NFL concentration was measured with the UmanDiagnostics NF-light enzyme-linked immunosorbent assay. The serum NFL concentration was measured with an in-house ultrasensitive single-molecule array assay. Results: In MS, the correlation between serum and CSF NFL was r = 0.62 (p < 0.001). Serum concentrations were significantly higher in patients with relapsing-remitting MS (16.9 ng/L) and in patients with progressive MS (23 ng/L) than in HCs (10.5 ng/L, p < 0.001 and p < 0.001, respectively). Treatment with DMT reduced median serum NFL levels from 18.6 (interquartile range [IQR] 12.6–32.7) ng/L to 15.7 (IQR 9.6–22.7) ng/L (p < 0.001). Patients with relapse or with radiologic activity had significantly higher serum NFL levels than those in remission (p < 0.001) or those without new lesions on MRI (p < 0.001). Conclusions: Serum and CSF NFL levels were highly correlated, indicating that blood sampling can replace CSF taps for this particular marker. Disease activity and DMT had similar effects on serum and CSF NFL concentrations. Repeated NFL determinations in peripheral blood for detecting axonal damage may represent new possibilities in MS monitoring.
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Affiliation(s)
- Lenka Novakova
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden.
| | - Henrik Zetterberg
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden
| | - Peter Sundström
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden
| | - Markus Axelsson
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden
| | - Mohsen Khademi
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden
| | - Martin Gunnarsson
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden
| | - Clas Malmeström
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden
| | - Anders Svenningsson
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden
| | - Tomas Olsson
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden
| | - Fredrik Piehl
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden
| | - Kaj Blennow
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden
| | - Jan Lycke
- From the Department of Clinical Neuroscience (L.N., M.A., C.M., J.L.) and Department of Psychiatry and Neurochemistry (H.Z., K.B.), Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg; Clinical Neurochemistry Laboratory (H.Z., K.B.), Sahlgrenska University Hospital, Mölndal, Sweden; Department of Molecular Neuroscience (H.Z.), UCL Institute of Neurology, London, UK; Department of Pharmacology and Clinical Neuroscience (P.S.), Umeå University; University Department of Clinical Neuroscience (M.K., T.O., F.P.), Neuroimmunology Unit, and Department of Clinical Sciences (A.S.), Danderyd Hospital, Karolinska Institutet, Stockholm; and Department of Neurology (M.G.), Faculty of Medicine and Health, Örebro University, Sweden
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Cohan S, Kappos L, Giovannoni G, Wiendl H, Selmaj K, Havrdová EK, Rose J, Greenberg S, Phillips G, Ma W, Wang P, Lima G, Sabatella G. Efficacy of daclizumab beta versus intramuscular interferon beta-1a on disability progression across patient demographic and disease activity subgroups in DECIDE. Mult Scler 2017; 24:1883-1891. [PMID: 28984179 PMCID: PMC6282160 DOI: 10.1177/1352458517735190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Demonstration of clinical benefits on disability progression measures is an
important attribute of effective multiple sclerosis (MS) treatments. Objective: Examine efficacy of daclizumab beta versus intramuscular (IM) interferon
beta-1a on measures of disability progression in patient subgroups from
DECIDE. Methods: Twenty-four-week confirmed disability progression (CDP), 24-week sustained
worsening on a modified Multiple Sclerosis Functional Composite (MSFCS)
where 3-Second Paced Auditory Serial Addition Test was replaced by Symbol
Digit Modalities Test, and proportion of patients with clinically meaningful
worsening in 29-Item Multiple Sclerosis Impact Scale physical impact
subscale (MSIS-29 PHYS) score from baseline to week 96 were examined in the
overall population and subgroups defined by baseline demographic/disease
characteristics. Results: Daclizumab beta significantly reduced risk of 24-week CDP (hazard ratio (HR),
0.73; 95% confidence interval (95% CI), 0.55–0.98), risk of 24-week
sustained MSFCS progression (HR, 0.80; 95% CI, 0.67–0.95), and odds of
clinically meaningful worsening in MSIS-29 PHYS (odds ratio, 0.76; 95% CI,
0.60–0.95) versus IM interferon beta-1a. Point estimates showed trends
favoring daclizumab beta over IM interferon beta-1a across several patient
subgroups for all three outcome measures. Conclusion: Daclizumab beta showed consistent benefit versus IM interferon beta-1a across
measures assessing patient disability/function and across a range of
clinical baseline characteristics in patients with relapsing-remitting
MS.
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Affiliation(s)
- Stanley Cohan
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence St. Joseph Health, Portland, OR, USA
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Heinz Wiendl
- Department of Neurology, University of Münster, Münster, Germany
| | - Krzysztof Selmaj
- Department of Neurology, Medical University of Lodz, Lodz, Poland
| | - Eva Kubala Havrdová
- Department of Neurology and Center for Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - John Rose
- Department of Neurology, University of Utah and Neurovirology Research Laboratory VASLCHCS, Imaging and Neuroscience Center, Salt Lake City, UT, USA
| | | | | | - Wei Ma
- Biogen, Cambridge, MA, USA
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24
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Multiple sclerosis patients' understanding and preferences for risks and benefits of disease-modifying drugs: A systematic review. J Neurol Sci 2017; 375:107-122. [DOI: 10.1016/j.jns.2016.12.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/17/2022]
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25
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Järvinen E, Multanen J, Atula S. Subcutaneous Interferon β-1a Administration by Electronic Auto-injector is Associated with High Adherence in Patients with Relapsing Remitting Multiple Sclerosis in a Real-life Study. Neurol Int 2017; 9:6957. [PMID: 28286627 PMCID: PMC5337756 DOI: 10.4081/ni.2017.6957] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/15/2017] [Indexed: 11/23/2022] Open
Abstract
The objective was to investigate adherence measured by an electronic auto-injector device, and self-reported adherence and treatment convenience in subjects with relapsing remitting multiple sclerosis (RRMS), using an electronic auto-injector Rebismart® to self-inject interferon β-1a. Thirty one patients with RRMS using the electronic auto-injector Rebismart® for self-injecting interferon β-1a subcutaneously three times weekly were included in a real-life clinical multicenter study for 24 weeks in Finland. Mean adherence reported by the device and mean self-assessment of adherence were studied. Reasons for missing injections and treatment convenience were assessed. Association between adherence and gender and age were studied. The mean adherence calculated from the device data was 93.5%. The mean self-assessment of adherence was 96.6%. The most common reason for missing an injection was forget-fulness. Adherence (measured by the device) was not changed over time. In the high adherence group there were more females and young patients (<30 years of age). The auto-injector was found to substantially ease the treatment by 90% of the patients. The electronic auto-injector was associated with high adherence to treatment. The device was found to ease the patient’s treatment and it was perceived as easy to use. It is a convenient tool to assess patient’s adherence to treatment.
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Affiliation(s)
| | | | - Sari Atula
- Helsinki University Central Hospital , Helsinki, Finland
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26
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Järvinen E, Holmberg M, Sumelahti ML. Injectable Disease Modifying Agents in Multiple Sclerosis: Pattern of Medication Use and Clinical Effectiveness. Neurol Int 2016; 8:6513. [PMID: 27761226 PMCID: PMC5066104 DOI: 10.4081/ni.2016.6513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/13/2016] [Accepted: 08/08/2016] [Indexed: 11/29/2022] Open
Abstract
The objective of this study was to assess long-term use, adherence and efficacy of injectable disease modifying agents (DMAs). Multiple Sclerosis (MS) patients diagnosed during 2002-2010 with early treatment start and at least one year in first choice medication were included in a large university district in Finland. Annualized relapse rates (ARR) during each treatment period were studied, and number of switches by medication evaluated. Use of health care facilities during 2002-2010 was assessed. In the study were included 113 MS patients; 15 (13%) switched medication. The mean duration of treatment period (128) was 3.8 years. In 77% (98/128) the treatment continued with the first DMA for (mean) 3.8 years, in 19% (25/128) with the second for 3.5 years and in 4% (5/128) with the third for 4.8 years. Mean ARR was 0.26, with 54% (69/128) of the periods relapse free. Mean ARR during the treatment periods with product switch was 0.41 before, and 0.28 after the switch, showing a trend towards better efficacy with the second DMA. The usage of health care resources remained within the guidelines. Long-term adherence to first choice DMA was observed, and a switch of product within the DMAs showed continuous adherence and efficacy. The efforts to seek a clinically effective and well tolerated agent within the first-line DMAs is warranted, leading to continued adherence and increased clinical effectiveness.
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