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Muros-Le Rouzic E, Heer Y, Yiu S, Tozzi V, Braune S, van Hövell P, Bergmann A, Bernasconi C, Model F, Craveiro L. Five-year efficacy outcomes of ocrelizumab in relapsing multiple sclerosis: A propensity-matched comparison of the OPERA studies with other disease-modifying therapies in real-world lines of treatments. J Cent Nerv Syst Dis 2024; 16:11795735241260563. [PMID: 39290861 PMCID: PMC11406495 DOI: 10.1177/11795735241260563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/17/2024] [Indexed: 09/19/2024] Open
Abstract
Background Clinical trials comparing the efficacy of ocrelizumab (OCR) with other disease-modifying therapies (DMTs) other than interferon (IFN) β-1a in relapsing multiple sclerosis (RMS) are lacking. Objectives To compare the treatment effect of OCR vs six DMTs' (IFN β-1a, glatiramer acetate, fingolimod, dimethyl fumarate, teriflunomide, natalizumab) treatment pathways used in clinical practice by combining clinical trial and real-world data. Methods Patient-level data from OPERA trials and open-label extension phase, and from the German NeuroTransData (NTD) MS registry, were used to build 1:1 propensity score-matched (PSM) cohorts controlling for seven baseline covariates, including brain imaging activity. Efficacy outcomes were time to first relapse and time to 24-week confirmed disability progression over 5.5 years of follow-up. Intention-to-treat analysis using all outcome data irrespective of treatment switch was applied. Results The analyses included 611 OPERA patients and 7141 NTD patients. We built 12 paired-matched cohorts (six for each outcome, two for each DMT) to compare efficacy of OCR in OPERA with each DMT treatment pathway in NTD. Post-matching, baseline covariates and PS were well balanced (standardized mean difference <.2 for all cohorts). Over 5.5 years, patients treated with OCR showed a statistically significant reduction in the risk of relapse (hazard ratios [HRs] .30 to .54) and disability progression (HRs .51 to .67) compared with all index therapies and their treatment switching pathways in NTD. Treatment switch and/or discontinuation occurred frequently in NTD cohorts. Conclusion OCR demonstrates superiority in controlling relapses and disability progression in RMS compared with real-world treatment pathways over a 5.5-year period. These analyses suggest that high-efficacy DMTs and high treatment persistence are critical to achieve greatest clinical benefit in RMS. Registration OPERA I (NCT01247324), OPERA II (NCT01412333).
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Affiliation(s)
| | - Yanic Heer
- PricewaterhouseCoopers AG, Zürich, Switzerland
| | - Sean Yiu
- Roche Products Limited, Welwyn Garden City, UK
| | - Viola Tozzi
- PricewaterhouseCoopers AG, Zürich, Switzerland
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Tallantyre EC, Dobson R, Froud JLJ, St John FA, Anderson VM, Arun T, Buckley L, Evangelou N, Ford HL, Galea I, George S, Gray OM, Hibbert AM, Hu M, Hughes SE, Ingram G, Kalra S, Lim CE, Mathews JTM, McDonnell GV, Mescall N, Norris S, Ramsay SJ, Rice CM, Russell MJ, Shawe‐Taylor MJ, Williams TE, Harding KE, Robertson NP. Real-world persistence of multiple sclerosis disease-modifying therapies. Eur J Neurol 2024; 31:e16289. [PMID: 38567516 PMCID: PMC11235620 DOI: 10.1111/ene.16289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/26/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND PURPOSE Treatment persistence is the continuation of therapy over time. It reflects a combination of treatment efficacy and tolerability. We aimed to describe real-world rates of persistence on disease-modifying therapies (DMTs) for people with multiple sclerosis (pwMS) and reasons for DMT discontinuation. METHODS Treatment data on 4366 consecutive people with relapse-onset multiple sclerosis (MS) were pooled from 13 UK specialist centres during 2021. Inclusion criteria were exposure to at least one MS DMT and a complete history of DMT prescribing. PwMS in blinded clinical trials were excluded. Data collected included sex, age at MS onset, age at DMT initiation, DMT treatment dates, and reasons for stopping or switching DMT. For pwMS who had received immune reconstituting therapies (cladribine/alemtuzumab), discontinuation date was defined as starting an alternative DMT. Kaplan-Meier survival analyses were used to express DMT persistence. RESULTS In 6997 treatment events (1.6 per person with MS), median time spent on any single maintenance DMT was 4.3 years (95% confidence interval = 4.1-4.5 years). The commonest overall reasons for DMT discontinuation were adverse events (35.0%) and lack of efficacy (30.3%). After 10 years, 20% of people treated with alemtuzumab had received another subsequent DMT, compared to 82% of people treated with interferon or glatiramer acetate. CONCLUSIONS Immune reconstituting DMTs may have the highest potential to offer a single treatment for relapsing MS. Comparative data on DMT persistence and reasons for discontinuation are valuable to inform treatment decisions and in personalizing treatment in MS.
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Affiliation(s)
- Emma C. Tallantyre
- Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
- Department of NeurologyUniversity Hospital of WalesCardiffUK
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Population HealthQueen Mary University LondonLondonUK
- Department of Neurology, Royal London HospitalBarts Health NHS TrustLondonUK
| | - Joseph L. J. Froud
- Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
- Postgraduate DepartmentSt Thomas' HospitalLondonUK
| | - Frederika A. St John
- Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | - Valerie M. Anderson
- Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | - Tarunya Arun
- Department of NeuroscienceUniversity Hospitals Coventry and WarwickshireCoventryUK
| | - Lauren Buckley
- Department of Neurology, Southmead HospitalNorth Bristol NHS TrustBristolUK
| | - Nikos Evangelou
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Queen's Medical CentreUniversity Hospitals NHS TrustNottinghamUK
- University of NottinghamNottinghamUK
| | - Helen L. Ford
- Centre for Neurosciences, Leeds Teaching Hospitals NHS TrustLeeds General InfirmaryLeedsUK
- Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
- Department of Neurology, Wessex Neurological CentreUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Sumi George
- Department of NeurologyUlster HospitalDundonaldUK
| | - Orla M. Gray
- Department of NeurologyUlster HospitalDundonaldUK
| | - Aimee M. Hibbert
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Queen's Medical CentreUniversity Hospitals NHS TrustNottinghamUK
| | - Mo Hu
- Department of NeurologySwansea University Health BoardSwanseaUK
| | | | - Gillian Ingram
- Department of NeurologySwansea University Health BoardSwanseaUK
| | - Seema Kalra
- Neurology DepartmentUniversity Hospital North Midlands NHS TrustStoke‐on‐TrentUK
| | - Chia‐Hui E. Lim
- Department of Neurology, Wessex Neurological CentreUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| | | | | | - Naomi Mescall
- Queen Square Multiple Sclerosis Centre, Department of NeuroinflammationUniversity College LondonLondonUK
| | - Sam Norris
- Aneurin Bevan University Health Board, Department of NeurologyRoyal Gwent HospitalNewportUK
| | | | - Claire M. Rice
- Department of Neurology, Southmead HospitalNorth Bristol NHS TrustBristolUK
- Transplantation Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Melanie J. Russell
- Centre for Neurosciences, Leeds Teaching Hospitals NHS TrustLeeds General InfirmaryLeedsUK
| | - Marianne J. Shawe‐Taylor
- Queen Square Multiple Sclerosis Centre, Department of NeuroinflammationUniversity College LondonLondonUK
| | - Thomas E. Williams
- Queen Square Multiple Sclerosis Centre, Department of NeuroinflammationUniversity College LondonLondonUK
- Faculty of Brain Sciences, Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Katharine E. Harding
- Aneurin Bevan University Health Board, Department of NeurologyRoyal Gwent HospitalNewportUK
| | - Neil P. Robertson
- Division of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
- Department of NeurologyUniversity Hospital of WalesCardiffUK
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Lepore V, Paletta P, Bosetti C, Santucci C, Ponzio M, Pupillo E, Leone MA, Bergamaschi R, Mosconi P. Temporal and spatial patterns in the prescriptions of disease-modifying therapies for multiple sclerosis. Results from the Italian Multiple Sclerosis and Related Disorders Register. Mult Scler Relat Disord 2024; 87:105638. [PMID: 38713966 DOI: 10.1016/j.msard.2024.105638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/02/2024] [Accepted: 04/18/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND The therapeutic scenario in multiple sclerosis (MS) has evolved over recent years with the progressive introduction of new drugs focused to better balance efficacy, safety and management requirements. The objective of this study was to examine the prescribing patterns of disease-modifying therapies (DMT) over time and across different geographic areas, and the latency between disease onset, first Register center visit, disease diagnosis, and the start of treatment in a large cohort of persons with MS from the Italian Multiple Sclerosis and Related Disorders Register. METHODS Up to 2022, the Register collected data from 124 centers on more than 78,000 persons, of whom 56,872 received at least one DMT prescription. Beside baseline demographic and clinical characteristics, we focused on DMT according to their efficacy distinguishing between moderate-efficacy (ME), or high-efficacy (HE). RESULTS There was a higher probability of prescribing HE-DMT for increasing calendar years (multivariable odds ratio, OR=11.51 in 2021 or thereafter vs before 2000), in males (OR=1.08 vs females), patients with primary progressive with or without relapse (OR=3.00 vs clinically isolated syndrome), those with a higher Expanded Disability Status Scale score (OR=3.85 for >4 versus 0-1), and those from larger referral centers (OR=1.89 vs smaller ones). Conversely, higher age at onset was associated to a lower probability of prescribing HE-DMT (OR=0.74 at 40 or more vs <20 years). A trend to shorter times was observed in subsequent calendar years for disease onset, first center visit, diagnosis and first DMT prescription. No trend was detected based on the location of the geographic referral centers. The times between disease onset, first center visit, and diagnosis and the first DMT prescription showed significant decreases according to the year, while differences were less evident for the geographic areas. CONCLUSION This study highlights some factors influencing the choice of HE-DMT, including aspects of both healthcare and clinical phenotype. The absence of a geographic pattern may indicate some homogeneity in DMT prescriptions across different Italian MS centers.
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Affiliation(s)
- Vito Lepore
- Dipartimento di Epidemiologia Medica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milano, Italy
| | - Pasquale Paletta
- Dipartimento di Epidemiologia Medica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milano, Italy
| | - Cristina Bosetti
- Dipartimento di Epidemiologia Medica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milano, Italy
| | - Claudia Santucci
- Dipartimento di Epidemiologia Medica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milano, Italy; Department of Clinical Sciences and Community Health, University of Milan, Via Giovanni Celoria 22, 20133 Milano, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Via Operai 40, 16149 Genova, Italy
| | - Elisabetta Pupillo
- Dipartimento di Neuroscienze, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milano, Italy
| | - Maurizio A Leone
- Dipartimento di Neuroscienze, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milano, Italy
| | - Roberto Bergamaschi
- Centro Sclerosi Multipla, IRCCS Fondazione Mondino, Via Mondino 2, 27100 Pavia, Italy
| | - Paola Mosconi
- Dipartimento di Epidemiologia Medica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milano, Italy.
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Glaser A, Butzkueven H, van der Walt A, Gray O, Spelman T, Zhu C, Trojano M, Iaffaldano P, Battaglia MA, Lucisano G, Vukusic S, Vukusic I, Casey R, Horakova D, Drahota J, Magyari M, Joensen H, Pontieri L, Elberling F, Klyve P, Mouresan EF, Forsberg L, Hillert J. Big Multiple Sclerosis Data network: an international registry research network. J Neurol 2024; 271:3616-3624. [PMID: 38561543 PMCID: PMC11136763 DOI: 10.1007/s00415-024-12303-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The Big Multiple Sclerosis Data (BMSD) network ( https://bigmsdata.org ) was initiated in 2014 and includes the national multiple sclerosis (MS) registries of the Czech Republic, Denmark, France, Italy, and Sweden as well as the international MSBase registry. BMSD has addressed the ethical, legal, technical, and governance-related challenges for data sharing and so far, published three scientific papers on pooled datasets as proof of concept for its collaborative design. DATA COLLECTION Although BMSD registries operate independently on different platforms, similarities in variables, definitions and data structure allow joint analysis of data. Certain coordinated modifications in how the registries collect adverse event data have been implemented after BMSD consensus decisions, showing the ability to develop together. DATA MANAGEMENT Scientific projects can be proposed by external sponsors via the coordinating centre and each registry decides independently on participation, respecting its governance structure. Research datasets are established in a project-to-project fashion and a project-specific data model is developed, based on a unifying core data model. To overcome challenges in data sharing, BMSD has developed procedures for federated data analysis. FUTURE PERSPECTIVES Presently, BMSD is seeking a qualification opinion from the European Medicines Agency (EMA) to conduct post-authorization safety studies (PASS) and aims to pursue a qualification opinion also for post-authorization effectiveness studies (PAES). BMSD aspires to promote the advancement of real-world evidence research in the MS field.
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Affiliation(s)
- Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Orla Gray
- South Eastern Health and Social Care Trust, Belfast, UK
| | - Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Maria Trojano
- School of Medicine, University "Aldo Moro", Bari, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences, DiBraiN University of Bari Aldo Moro, Bari, Italy
| | - Mario A Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Giuseppe Lucisano
- Department of Translational Biomedicine and Neurosciences, DiBraiN University of Bari Aldo Moro, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology-CORESEARCH, Pescara, Italy
| | - Sandra Vukusic
- Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69677, Bron, France
- INSERM 1028 et CNRS UMR 5292, Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, 69003, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, 69000, Lyon, France
- Eugène Devic EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, 69677, Bron, France
| | - Irena Vukusic
- Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69677, Bron, France
- INSERM 1028 et CNRS UMR 5292, Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, 69003, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, 69000, Lyon, France
- Eugène Devic EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, 69677, Bron, France
| | - Romain Casey
- Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69677, Bron, France
- INSERM 1028 et CNRS UMR 5292, Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, 69003, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, 69000, Lyon, France
- Eugène Devic EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, 69677, Bron, France
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jiri Drahota
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic
- IMPULS Endowment Fund, Prague, Czech Republic
| | - Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital Rigshospitalet, 2100, Copenhagen, Denmark
| | - Hanna Joensen
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Luigi Pontieri
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik Elberling
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pernilla Klyve
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | | | - Lars Forsberg
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
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Earla JR, Li J, Hutton GJ, Bentley JP, Aparasu RR. Association of oral disease-modifying agents and their adherence trajectories with annual relapses in multiple sclerosis. Mult Scler Relat Disord 2024; 85:105539. [PMID: 38574721 DOI: 10.1016/j.msard.2024.105539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/15/2024] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Real-world effectiveness can vary across oral disease-modifying agents (DMAs) and their adherence trajectories in patients with multiple sclerosis (MS). However, previous studies have not considered longitudinal adherence patterns while evaluating oral DMAs. OBJECTIVES This study aimed to evaluate the association of oral DMAs and their adherence trajectories with annualized relapse rate (ARR) in patients with MS. METHODS This retrospective observational cohort study based on the 2015-2019 MarketScan Commercial Claims and Encounters Database involved continuous enrolled adults (18-64 years) with ≥1 MS diagnosis (ICD-9/10-CM:340/G35) and ≥ 1 oral DMA prescription. Patients were grouped into incident fingolimod (FIN), teriflunomide (TER), and dimethyl fumarate (DMF) users based on the index DMA with a one-year washout period. Annual DMA adherence trajectories based on the monthly Proportion of Days Covered (PDC) one year after treatment initiation were identified using Group-Based Trajectory Modeling (GBTM). The validated claims-based ARR was evaluated during the one-year follow-up period using generalized boosted model-based inverse probability treatment weights with negative binomial regression model. RESULTS The study cohort consisted of 994 MS patients who initiated with FIN (23.0%), TER (22.3%), and DMF (54.7%) during the study period. GBTM grouped eligible patients into three adherence trajectories: complete adherers (59.2%), slow decliners (23.8%), and rapid decliners (17.0%). The proportion of complete adherers varied across the oral DMAs (FIN: 67.1%, TER: 55.4%, and DMF: 57.4%). The negative binomial regression modeling revealed that, while there was no difference in ARR across the three DMAs, rapid decliners (adjusted incidence rate ratio[aIRR]: 1.6, 95% CI: 1.1-2.4) had a higher rate of relapses compared to completely adherent patients. The type of oral DMAs did not moderate the relationship between ARR and the adherence trajectory groups. CONCLUSIONS Adherence trajectories classified as rapid decliners were associated with a higher ARR than complete adherers after adjusting for their type of oral DMAs. Longitudinal medication adherence patterns are critical in reducing relapse rates in MS.
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Affiliation(s)
- Jagadeswara Rao Earla
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA
| | - Jieni Li
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA
| | | | - John P Bentley
- Department of Pharmacy Administration, University of Mississippi, Oxford, MS, USA
| | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA.
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Nociti V, Romozzi M, Mirabella M. Challenges in Diagnosis and Therapeutic Strategies in Late-Onset Multiple Sclerosis. J Pers Med 2024; 14:400. [PMID: 38673027 PMCID: PMC11051411 DOI: 10.3390/jpm14040400] [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: 03/17/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and degenerative demyelinating disease of the central nervous system of unknown etiology, which affects individuals in their early adulthood. However, nearly 5-10% of people with MS can be diagnosed at ages above 50 years old, referred to as late-onset multiple sclerosis (LOMS). Some studies have reported a distinctive presentation, clinical course, and prognosis for LOMS, implicating a different diagnostic and therapeutic approach for this population. Furthermore, similar manifestations between LOMS and other age-related conditions may lead to potential misdiagnosis and diagnostic delays, and a higher burden of multimorbidity associated with aging can further complicate the clinical picture. This review aims to explore the clinical characteristics, the disease course, and the differential diagnosis of LOMS and addresses therapeutic considerations for this population.
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Affiliation(s)
- Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
| | - Marina Romozzi
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
| | - Massimiliano Mirabella
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
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Moccia M, Affinito G, Marrazzo G, Ciarambino T, Di Procolo P, Confalonieri L, Carotenuto A, Petracca M, Lanzillo R, Triassi M, Brescia Morra V, Palladino R. Utilization of Ocrelizumab within Different Treatment Strategies for Multiple Sclerosis: A 5-Year Population-Based Study. Neurol Int 2024; 16:394-405. [PMID: 38668126 PMCID: PMC11054722 DOI: 10.3390/neurolint16020029] [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: 02/20/2024] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND We aim to provide up-to-date real-world evidence on the persistence, adherence, healthcare resource utilization, and costs of multiple sclerosis (MS) by comparing ocrelizumab to other disease-modifying treatments (DMTs) and within different DMT sequences. METHODS We included 3371 people with MS who first received or switched DMT prescriptions from January 2018 to December 2022; they were identified through hospital discharge records, drug prescriptions, and exemption codes from the Campania Region (South Italy). We calculated persistence (time from the first prescription to discontinuation or switching to another DMT), adherence (proportion of days covered (PDC)), DMT costs, and MS hospital admissions and related costs. RESULTS The most frequently prescribed DMT was dimethyl fumarate (n = 815; age 38.90 ± 11.91 years; 69.5% females), followed by ocrelizumab (n = 682; age 46.46 ± 11.29 years; 56.3%); 28.8% of the patients treated with ocrelizumab were naïve to DMTs. Using ocrelizumab as a statistical reference, the risk of discontinuation was higher for other highly active (HR = 6.32; 95%CI = 3.16, 12.63; p < 0.01) and low-/medium-efficacy DMTs (HR = 10.10; 95%CI = 5.10, 19.77; p < 0.01); adherence was lower for other highly active DMTs (Coeff = -0.07; 95%CI = -0.10, -0.04; p < 0.01) and low-/medium-efficacy DMTs (Coeff = -0.16; 95%CI = -0.19, -0.14; p < 0.01). monthly DMT costs were higher for other highly active DMTs (Coeff = 77.45; 95%CI = 29.36, 125.53; p < 0.01) but lower for low-/medium-efficacy DMTs (Coeff = -772.31; 95%CI = -816.95, -727.66; p < 0.01). The hospital admissions and related costs of MS were similar between ocrelizumab, other highly active DMTs, and other low-/medium-efficacy DMTs, and with ocrelizumab as the first-line DMT after other highly active DMTs and after low-/medium-efficacy DMTs, which was possibly due to the low number of observations. CONCLUSIONS From 2018 to 2022, ocrelizumab was among the most frequently prescribed DMTs, with 28.8% prescriptions to incident MS patients, confirming its relevance in clinical practice. Ocrelizumab was associated with the highest persistence and adherence, pointing towards its favorable benefit-risk profile. The costs of ocrelizumab were lower than those of other highly active DMTs.
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Affiliation(s)
- Marcello Moccia
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy; (A.C.); (R.L.); (V.B.M.)
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
| | - Giuseppina Affinito
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (G.A.); (M.T.); (R.P.)
| | | | - Tiziana Ciarambino
- General Directorate for Healthcare Protection and Management of the Regional Healthcare Service, Strategic Management Office, Caserta Healthcare Authority, 81100 Caserta, Italy;
| | | | | | - Antonio Carotenuto
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy; (A.C.); (R.L.); (V.B.M.)
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Maria Petracca
- Department of Human Neurosciences, Sapienza University, 00185 Rome, Italy;
| | - Roberta Lanzillo
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy; (A.C.); (R.L.); (V.B.M.)
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Maria Triassi
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (G.A.); (M.T.); (R.P.)
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Via Sergio Pansini 5, 80131 Naples, Italy; (A.C.); (R.L.); (V.B.M.)
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (G.A.); (M.T.); (R.P.)
- Department of Primary Care and Public Health, Imperial College, London W6 8RP, UK
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Teniou A, Rhouati A, Marty JL. Recent Advances in Biosensors for Diagnosis of Autoimmune Diseases. SENSORS (BASEL, SWITZERLAND) 2024; 24:1510. [PMID: 38475046 DOI: 10.3390/s24051510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/01/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024]
Abstract
Over the last decade, autoimmune diseases (ADs) have undergone a significant increase because of genetic and/or environmental factors; therefore, their simple and fast diagnosis is of high importance. The conventional diagnostic techniques for ADs require tedious sample preparation, sophisticated instruments, a dedicated laboratory, and qualified personnel. For these reasons, biosensors could represent a useful alternative to these methods. Biosensors are considered to be promising tools that can be used in clinical analysis for an early diagnosis due to their high sensitivity, simplicity, low cost, possible miniaturization (POCT), and potential ability for real-time analysis. In this review, recently developed biosensors for the detection of autoimmune disease biomarkers are discussed. In the first part, we focus on the main AD biomarkers and the current methods of their detection. Then, we discuss the principles and different types of biosensors. Finally, we overview the characteristics of biosensors based on different bioreceptors reported in the literature.
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Affiliation(s)
- Ahlem Teniou
- Bioengineering Laboratory, Higher National School of Biotechnology, Constantine 25100, Algeria
| | - Amina Rhouati
- Bioengineering Laboratory, Higher National School of Biotechnology, Constantine 25100, Algeria
| | - Jean-Louis Marty
- Laboratoire BAE, Université de Perpignan through Domitia, 66860 Perpignan, France
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Haki M, AL-Biati HA, Al-Tameemi ZS, Ali IS, Al-hussaniy HA. Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment. Medicine (Baltimore) 2024; 103:e37297. [PMID: 38394496 PMCID: PMC10883637 DOI: 10.1097/md.0000000000037297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic autoimmune disease with demyelination, inflammation, neuronal loss, and gliosis (scarring). Our object to review MS pathophysiology causes and treatment. A Narrative Review article was conducted by searching on Google scholar, PubMed, Research Gate about relevant keywords we exclude any unique cases and case reports. The destruction of myelinated axons in the central nervous system reserves this brunt. This destruction is generated by immunogenic T cells that produce cytokines, copying a proinflammatory T helper cells1-mediated response. Autoreactive cluster of differentiation 4 + cells, particularly the T helper cells1 subtype, are activated outside the system after viral infections. T-helper cells (cluster of differentiation 4+) are the leading initiators of MS myelin destruction. The treatment plan for individuals with MS includes managing acute episodes, using disease-modifying agents to decrease MS biological function of MS, and providing symptom relief. Management of spasticity requires physiotherapy, prescription of initial drugs such as baclofen or gabapentin, secondary drug options such as tizanidine or dantrolene, and third-line treatment such as benzodiazepines. To treat urinary incontinence some options include anticholinergic medications such as oxybutynin hydrochloride, tricyclic antidepressants (such as amitriptyline), and intermittent self-catheterization. When it comes to bowel problems, one can try to implement stool softeners and consume a high roughage diet. The review takes about MS causes Pathophysiology and examines current treatment strategies, emphasizing the advancements in disease-modifying therapies and symptomatic treatments. This comprehensive analysis enhances the understanding of MS and underscores the ongoing need for research to develop more effective treatments.
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Affiliation(s)
- Maha Haki
- Department of Pharmacy, Bilad Alrafidain University College, Diyala, Iraq
| | - Haeder A. AL-Biati
- Department of Pharmacy, Bilad Alrafidain University College, Diyala, Iraq
| | - Zahraa Salam Al-Tameemi
- Department of Pharmacy, Bilad Alrafidain University College, Diyala, Iraq
- Dr. Hany Akeel Institute, Iraqi Medical Research Center, Baghdad, Iraq
| | - Inas Sami Ali
- Department of Pharmacy, Bilad Alrafidain University College, Diyala, Iraq
| | - Hany A. Al-hussaniy
- Department of Pharmacy, Bilad Alrafidain University College, Diyala, Iraq
- Dr. Hany Akeel Institute, Iraqi Medical Research Center, Baghdad, Iraq
- Department of Pharmacology, College of Medicine, University of Baghdad, Baghdad, Iraq
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Aboseif A, Roos I, Krieger S, Kalincik T, Hersh CM. Leveraging Real-World Evidence and Observational Studies in Treating Multiple Sclerosis. Neurol Clin 2024; 42:203-227. [PMID: 37980116 DOI: 10.1016/j.ncl.2023.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Randomized controlled trials (RCTs) are essential for regulatory approval of disease-modifying therapies (DMTs), yet their strict selection criteria often lead to limited generalizability. Observational studies using real-world data (RWD) allow for more inclusive heterogeneous cohorts resulting in higher external validity to inform treatment practices. As reviewed in this article, well-designed comparative effectiveness studies are an important application of RWD. Although, like RCTs, observational studies have their own set of limitations, including various biases that may confound results, advanced statistical methods can mitigate many of these limitations. A focus on personalized treatment will continue to add value to individualize MS care.
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Affiliation(s)
- Albert Aboseif
- Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue S10, Cleveland, OH 44195, USA
| | - Izanne Roos
- Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, L7 635 Elizabeth Street, Melbourne 3000, Australia; Department of Medicine, CORe, University of Melbourne, Melbourne, Australia
| | - Stephen Krieger
- Corinne Goldsmith Dickinson Center for MS Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1138, New York, NY 10029, USA
| | - Tomas Kalincik
- Department of Medicine, CORe, University of Melbourne, Melbourne, Australia; Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, L6 635 Elizabeth Street, Melbourne 3000, Australia
| | - Carrie M Hersh
- Lou Ruvo Center for Brain Health, Cleveland Clinic, 888 West Bonneville Avenue, Las Vegas, NV 89106, USA.
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11
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Spelman T, Herring WL, Acosta C, Hyde R, Jokubaitis VG, Pucci E, Lugaresi A, Laureys G, Havrdova EK, Horakova D, Izquierdo G, Eichau S, Ozakbas S, Alroughani R, Kalincik T, Duquette P, Girard M, Petersen T, Patti F, Csepany T, Granella F, Grand'Maison F, Ferraro D, Karabudak R, Jose Sa M, Trojano M, van Pesch V, Van Wijmeersch B, Cartechini E, McCombe P, Gerlach O, Spitaleri D, Rozsa C, Hodgkinson S, Bergamaschi R, Gouider R, Soysal A, Castillo-Triviño, Prevost J, Garber J, de Gans K, Ampapa R, Simo M, Sanchez-Menoyo JL, Iuliano G, Sas A, van der Walt A, John N, Gray O, Hughes S, De Luca G, Onofrj M, Buzzard K, Skibina O, Terzi M, Slee M, Solaro C, Oreja-Guevara, Ramo-Tello C, Fragoso Y, Shaygannejad V, Moore F, Rajda C, Aguera Morales E, Butzkueven H. Comparative effectiveness and cost-effectiveness of natalizumab and fingolimod in rapidly evolving severe relapsing-remitting multiple sclerosis in the United Kingdom. J Med Econ 2024; 27:109-125. [PMID: 38085684 DOI: 10.1080/13696998.2023.2293379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
AIM To evaluate the real-world comparative effectiveness and the cost-effectiveness, from a UK National Health Service perspective, of natalizumab versus fingolimod in patients with rapidly evolving severe relapsing-remitting multiple sclerosis (RES-RRMS). METHODS Real-world data from the MSBase Registry were obtained for patients with RES-RRMS who were previously either naive to disease-modifying therapies or had been treated with interferon-based therapies, glatiramer acetate, dimethyl fumarate, or teriflunomide (collectively known as BRACETD). Matched cohorts were selected by 3-way multinomial propensity score matching, and the annualized relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M) were compared between treatment groups. Comparative effectiveness results were used in a cost-effectiveness model comparing natalizumab and fingolimod, using an established Markov structure over a lifetime horizon with health states based on the Expanded Disability Status Scale. Additional model data sources included the UK MS Survey 2015, published literature, and publicly available sources. RESULTS In the comparative effectiveness analysis, we found a significantly lower ARR for patients starting natalizumab compared with fingolimod (rate ratio [RR] = 0.65; 95% confidence interval [CI], 0.57-0.73) or BRACETD (RR = 0.46; 95% CI, 0.42-0.53). Similarly, CDI6M was higher for patients starting natalizumab compared with fingolimod (hazard ratio [HR] = 1.25; 95% CI, 1.01-1.55) and BRACETD (HR = 1.46; 95% CI, 1.16-1.85). In patients starting fingolimod, we found a lower ARR (RR = 0.72; 95% CI, 0.65-0.80) compared with starting BRACETD, but no difference in CDI6M (HR = 1.17; 95% CI, 0.91-1.50). Differences in CDW6M were not found between the treatment groups. In the base-case cost-effectiveness analysis, natalizumab dominated fingolimod (0.302 higher quality-adjusted life-years [QALYs] and £17,141 lower predicted lifetime costs). Similar cost-effectiveness results were observed across sensitivity analyses. CONCLUSIONS This MSBase Registry analysis suggests that natalizumab improves clinical outcomes when compared with fingolimod, which translates to higher QALYs and lower costs in UK patients with RES-RRMS.
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Affiliation(s)
- T Spelman
- MSBase Foundation, Melbourne, VIC, Australia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - W L Herring
- Health Economics, RTI Health Solutions, NC, USA
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - C Acosta
- Value and Access, Biogen, Baar, Switzerland
| | - R Hyde
- Medical, Biogen, Baar, Switzerland
| | - V G Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - E Pucci
- Neurology Unit, AST-Fermo, Fermo, Italy
| | - A Lugaresi
- Dipartamento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - G Laureys
- Department of Neurology, University Hospital Ghent, Ghent, Belgium
| | - E K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - D Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - G Izquierdo
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - S Ozakbas
- Izmir University of Economics, Medical Point Hospital, Izmir, Turkey
| | - R Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - T Kalincik
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - P Duquette
- CHUM and Universite de Montreal, Montreal, Canada
| | - M Girard
- CHUM and Universite de Montreal, Montreal, Canada
| | - T Petersen
- Aarhus University Hospital, Arhus C, Denmark
| | - F Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico "G Rodloico-San Marco", University of Catania, Italy
| | - T Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - F Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Medicine, Parma University Hospital, Parma, Italy
| | | | - D Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | | | - M Jose Sa
- Department of Neurology, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - M Trojano
- School of Medicine, University of Bari, Bari, Italy
| | - V van Pesch
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Université Catholique de Louvain, Belgium
| | - B Van Wijmeersch
- University MS Centre, Hasselt-Pelt and Noorderhart Rehabilitation & MS, Pelt and Hasselt University, Hasselt, Belgium
| | | | - P McCombe
- University of Queensland, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - O Gerlach
- Academic MS Center Zuyd, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - D Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - C Rozsa
- Jahn Ferenc Teaching Hospital, Budapest, Hungary
| | - S Hodgkinson
- Immune Tolerance Laboratory Ingham Institute and Department of Medicine, UNSW, Sydney, Australia
| | | | - R Gouider
- Department of Neurology, LR18SP03 and Clinical Investigation Center Neurosciences and Mental Health, Razi University Hospital -, Mannouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - A Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Castillo-Triviño
- Hospital Universitario Donostia and IIS Biodonostia, San Sebastián, Spain
| | - J Prevost
- CSSS Saint-Jérôme, Saint-Jerome, Canada
| | - J Garber
- Westmead Hospital, Sydney, Australia
| | - K de Gans
- Groene Hart Ziekenhuis, Gouda, Netherlands
| | - R Ampapa
- Nemocnice Jihlava, Jihlava, Czech Republic
| | - M Simo
- Department of Neurology, Semmelweis University Budapest, Budapest, Hungary
| | - J L Sanchez-Menoyo
- Department of Neurology, Galdakao-Usansolo University Hospital, Osakidetza Basque Health Service, Galdakao, Spain
- Biocruces-Bizkaia Health Research Institute, Spain
| | - G Iuliano
- Ospedali Riuniti di Salerno, Salerno, Italy
| | - A Sas
- Department of Neurology and Stroke, BAZ County Hospital, Miskolc, Hungary
| | - A van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | - N John
- Monash University, Clayton, Australia
- Department of Neurology, Monash Health, Clayton, Australia
| | - O Gray
- South Eastern HSC Trust, Belfast, United Kingdom
| | - S Hughes
- Royal Victoria Hospital, Belfast, United Kingdom
| | - G De Luca
- MS Centre, Neurology Unit, "SS. Annunziata" University Hospital, University "G. d'Annunzio", Chieti, Italy
| | - M Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - K Buzzard
- Department of Neurosciences, Box Hill Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
- MS Centre, Royal Melbourne Hospital, Melbourne, Australia
| | - O Skibina
- Department of Neurology, The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
- Department of Neurology, Box Hill Hospital, Melbourne, Australia
| | - M Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - M Slee
- Flinders University, Adelaide, Australia
| | - C Solaro
- Department of Neurology, ASL3 Genovese, Genova, Italy
- Department of Rehabilitation, ML Novarese Hospital Moncrivello
| | - Oreja-Guevara
- Department of Neurology, Hospital Clinico San Carlos, Madrid, Spain
| | - C Ramo-Tello
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Y Fragoso
- Universidade Metropolitana de Santos, Santos, Brazil
| | | | - F Moore
- Department of Neurology, McGill University, Montreal, Canada
| | - C Rajda
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - E Aguera Morales
- Department of Medicine and Surgery, University of Cordoba, Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)
| | - H Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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12
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Spelman T, Magyari M, Butzkueven H, Van Der Walt A, Vukusic S, Trojano M, Iaffaldano P, Horáková D, Drahota J, Pellegrini F, Hyde R, Duquette P, Lechner-Scott J, Sajedi SA, Lalive P, Shaygannejad V, Ozakbas S, Eichau S, Alroughani R, Terzi M, Girard M, Kalincik T, Grand'Maison F, Skibina O, Khoury SJ, Yamout B, Sa MJ, Gerlach O, Blanco Y, Karabudak R, Oreja-Guevara C, Altintas A, Hughes S, McCombe P, Ampapa R, de Gans K, McGuigan C, Soysal A, Prevost J, John N, Inshasi J, Stawiarz L, Manouchehrinia A, Forsberg L, Sellebjerg F, Glaser A, Pontieri L, Joensen H, Rasmussen PV, Sejbaek T, Poulsen MB, Christensen JR, Kant M, Stilund M, Mathiesen H, Hillert J. Predictors of treatment switching in the Big Multiple Sclerosis Data Network. Front Neurol 2023; 14:1274194. [PMID: 38187157 PMCID: PMC10771327 DOI: 10.3389/fneur.2023.1274194] [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: 08/07/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Background Treatment switching is a common challenge and opportunity in real-world clinical practice. Increasing diversity in disease-modifying treatments (DMTs) has generated interest in the identification of reliable and robust predictors of treatment switching across different countries, DMTs, and time periods. Objective The objective of this retrospective, observational study was to identify independent predictors of treatment switching in a population of relapsing-remitting MS (RRMS) patients in the Big Multiple Sclerosis Data Network of national clinical registries, including the Italian MS registry, the OFSEP of France, the Danish MS registry, the Swedish national MS registry, and the international MSBase Registry. Methods In this cohort study, we merged information on 269,822 treatment episodes in 110,326 patients from 1997 to 2018 from five clinical registries. Patients were included in the final pooled analysis set if they had initiated at least one DMT during the relapsing-remitting MS (RRMS) stage. Patients not diagnosed with RRMS or RRMS patients not initiating DMT therapy during the RRMS phase were excluded from the analysis. The primary study outcome was treatment switching. A multilevel mixed-effects shared frailty time-to-event model was used to identify independent predictors of treatment switching. The contributing MS registry was included in the pooled analysis as a random effect. Results Every one-point increase in the Expanded Disability Status Scale (EDSS) score at treatment start was associated with 1.08 times the rate of subsequent switching, adjusting for age, sex, and calendar year (adjusted hazard ratio [aHR] 1.08; 95% CI 1.07-1.08). Women were associated with 1.11 times the rate of switching relative to men (95% CI 1.08-1.14), whilst older age was also associated with an increased rate of treatment switching. DMTs started between 2007 and 2012 were associated with 2.48 times the rate of switching relative to DMTs that began between 1996 and 2006 (aHR 2.48; 95% CI 2.48-2.56). DMTs started from 2013 onwards were more likely to switch relative to the earlier treatment epoch (aHR 8.09; 95% CI 7.79-8.41; reference = 1996-2006). Conclusion Switching between DMTs is associated with female sex, age, and disability at baseline and has increased in frequency considerably in recent years as more treatment options have become available. Consideration of a patient's individual risk and tolerance profile needs to be taken into account when selecting the most appropriate switch therapy from an expanding array of treatment choices.
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Affiliation(s)
- Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- MSBase Foundation, Melbourne, VIC, Australia
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Glostrup, Copenhagen, Denmark
| | - Helmut Butzkueven
- MSBase Foundation, Melbourne, VIC, Australia
- MS and Neuroimmunology Research, Central Clinical School, Alfred and Box Hill Hospitals, Monash University, Melbourne, VIC, Australia
| | - Anneke Van Der Walt
- MSBase Foundation, Melbourne, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Centre des Neurosciences de Lyon, L'Institut national de la santé et de la recherche médicale 1028 et Centre national de la recherche scientifique joint research units5292, Lyon, France
- Faculté de Médicine Lyon-Est, Université Claude Bernard Lyon 1, Villeurbanne, Auvergne-Rhône-Alpes, France
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neuroscience, DiBraiN, University of Bari Aldo Moro, Bari, Italy
| | - Dana Horáková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Jirí Drahota
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Fabio Pellegrini
- Biogen International GmbH, Zug, Switzerland
- Biogen Digital Health, Biogen Spain, Madrid, Spain
| | | | - Pierre Duquette
- University of Montreal Hospital Research Centre and Universite de Montreal, Montreal, QC, Canada
| | - Jeannette Lechner-Scott
- University Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Hunter New England Health, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Seyed Aidin Sajedi
- Department of Neurology, Neuroscience Research Center, Golestan University of Medical Sciences, Gogan, Iran
| | - Patrice Lalive
- Faculty of Medicine, Division of Neurology, Geneva University Hospital, Geneva, Switzerland
| | | | | | - Sara Eichau
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Türkiye
| | - Marc Girard
- University of Montreal Hospital Research Centre and Universite de Montreal, Montreal, QC, Canada
| | - Tomas Kalincik
- Clinical Outcomes Research Unit, Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | | | - Olga Skibina
- MS and Neuroimmunology Research, Central Clinical School, Alfred and Box Hill Hospitals, Monash University, Melbourne, VIC, Australia
| | - Samia J. Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maria Jose Sa
- Department of Neurology, Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - Oliver Gerlach
- Academic MS Center Zuyderland, Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, Netherlands
| | - Yolanda Blanco
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Ayse Altintas
- Department of Neurology, School of Medicine and Koc University Research Center for Translational Medicine (KUTTAM), Koc University, Istanbul, Türkiye
| | | | | | | | | | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Türkiye
| | | | - Nevin John
- Monash Health, Melbourne, VIC, Australia
| | | | - Leszek Stawiarz
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lars Forsberg
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Glostrup, Copenhagen, Denmark
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Luigi Pontieri
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Hanna Joensen
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | | | - Tobias Sejbaek
- Department of Neurology, Southwest Jutland Hospital, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Mai Bang Poulsen
- Department of Neurology, Nordsjællands Hospital, Hillerød, Denmark
| | - Jeppe Romme Christensen
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
| | - Matthias Kant
- Department of Neurology, Hospital of Southern Jutland, University of Southern Denmark, Aabenraa, Denmark
| | - Morten Stilund
- Department of Neurology, Physiotherapy and Occupational Therapy, Gødstrup Hospital, Herning, Denmark
- NIDO | Centre for Research and Education, Gødstrup Hospital, Herning, Denmark
| | - Henrik Mathiesen
- Department of Neurology, Copenhagen University Hospital Herlev and Gentofte, København, Denmark
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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13
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Kalincik T, Roos I, Sharmin S. Observational studies of treatment effectiveness in neurology. Brain 2023; 146:4799-4808. [PMID: 37587541 PMCID: PMC10690012 DOI: 10.1093/brain/awad278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
The capacity and power of data from cohorts, registries and randomized trials to provide answers to contemporary clinical questions in neurology has increased considerably over the past two decades. Novel sophisticated statistical methods are enabling us to harness these data to guide treatment decisions, but their complexity is making appraisal of clinical evidence increasingly demanding. In this review, we discuss several methodological aspects of contemporary research of treatment effectiveness in observational data in neurology, aimed at academic neurologists and analysts specializing in outcomes research. The review discusses specifics of the sources of observational data and their key features. It focuses on the limitations of observational data and study design, as well as statistical approaches aimed to overcome these limitations. Among the examples of leading clinical themes typically studied with analyses of observational data, the review discusses methodological approaches to comparative treatment effectiveness, development of diagnostic criteria and definitions of clinical outcomes. Finally, this review provides a brief summary of key points that will help clinical audience critically evaluate design and analytical aspects of studies of disease outcomes using observational data.
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Affiliation(s)
- Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, VIC, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3000, VIC, Australia
| | - Izanne Roos
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, VIC, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3000, VIC, Australia
| | - Sifat Sharmin
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, VIC, Australia
- Neuroimmunology Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3000, VIC, Australia
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14
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Macaron G, Larochelle C, Arbour N, Galmard M, Girard JM, Prat A, Duquette P. Impact of aging on treatment considerations for multiple sclerosis patients. Front Neurol 2023; 14:1197212. [PMID: 37483447 PMCID: PMC10361071 DOI: 10.3389/fneur.2023.1197212] [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: 03/30/2023] [Accepted: 05/18/2023] [Indexed: 07/25/2023] Open
Abstract
With a rapidly aging global population and improvement of outcomes with newer multiple sclerosis (MS)-specific disease-modifying therapies (DMTs), the epidemiology of MS has shifted to an older than previously described population, with a peak prevalence of the disease seen in the 55-65 years age group. Changes in the pathophysiology of MS appear to be age-dependent. Several studies have identified a consistent phase of disability worsening around the fifth decade of life. The latter appears to be independent of prior disease duration and inflammatory activity and concomitant to pathological changes from acute focal active demyelination to chronic smoldering plaques, slow-expanding lesions, and compartmentalized inflammation within the central nervous system (CNS). On the other hand, decreased CNS tissue reserve and poorer remyelinating capacity with aging lead to loss of relapse recovery potential. Aging with MS may imply longer exposure to DMTs, although treatment efficacy in patients >55 years has not been evaluated in pivotal randomized controlled trials and appears to decrease with age. Older individuals are more prone to adverse effects of DMTs, an important aspect of treatment individualization. Aging with MS also implies a higher global burden of comorbid illnesses that contribute to overall impairments and represent a crucial confounder in interpreting clinical worsening. Discontinuation of DMTs after age 55, when no evidence of clinical or radiological activity is detected, is currently under the spotlight. In this review, we will discuss the impact of aging on MS pathobiology, the effect of comorbidities and other confounders on clinical worsening, and focus on current therapeutic considerations in this age group.
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Affiliation(s)
- Gabrielle Macaron
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Faculté de Médecine, Université Saint-Joseph de Beyrouth, Beirut, Lebanon
| | - Catherine Larochelle
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Nathalie Arbour
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Manon Galmard
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Jean Marc Girard
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Alexandre Prat
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Pierre Duquette
- Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Neuroimmunology Research Laboratory, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
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15
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Keloth VK, Banda JM, Gurley M, Heider PM, Kennedy G, Liu H, Liu F, Miller T, Natarajan K, V Patterson O, Peng Y, Raja K, Reeves RM, Rouhizadeh M, Shi J, Wang X, Wang Y, Wei WQ, Williams AE, Zhang R, Belenkaya R, Reich C, Blacketer C, Ryan P, Hripcsak G, Elhadad N, Xu H. Representing and utilizing clinical textual data for real world studies: An OHDSI approach. J Biomed Inform 2023; 142:104343. [PMID: 36935011 PMCID: PMC10428170 DOI: 10.1016/j.jbi.2023.104343] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 01/21/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
Clinical documentation in electronic health records contains crucial narratives and details about patients and their care. Natural language processing (NLP) can unlock the information conveyed in clinical notes and reports, and thus plays a critical role in real-world studies. The NLP Working Group at the Observational Health Data Sciences and Informatics (OHDSI) consortium was established to develop methods and tools to promote the use of textual data and NLP in real-world observational studies. In this paper, we describe a framework for representing and utilizing textual data in real-world evidence generation, including representations of information from clinical text in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM), the workflow and tools that were developed to extract, transform and load (ETL) data from clinical notes into tables in OMOP CDM, as well as current applications and specific use cases of the proposed OHDSI NLP solution at large consortia and individual institutions with English textual data. Challenges faced and lessons learned during the process are also discussed to provide valuable insights for researchers who are planning to implement NLP solutions in real-world studies.
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Affiliation(s)
- Vipina K Keloth
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Juan M Banda
- Department of Computer Science, Georgia State University, Atlanta, GA, USA
| | - Michael Gurley
- Lurie Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Paul M Heider
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | - Georgina Kennedy
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Hongfang Liu
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Feifan Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Timothy Miller
- Computational Health Informatics Program, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Olga V Patterson
- VA Informatics and Computing Infrastructure, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA; Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA; Verily Life Sciences, Mountain View, CA, USA
| | - Yifan Peng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Kalpana Raja
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ruth M Reeves
- TN Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Masoud Rouhizadeh
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL, USA; Biomedical Informatics and Data Science, Johns Hopkins University, Baltimore, MD, USA
| | - Jianlin Shi
- VA Informatics and Computing Infrastructure, Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA; Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA; Department of Biomedical Informatics, University of Utah, Salt Lake City, USA
| | - Xiaoyan Wang
- Sema4 Mount Sinai Genomics Incorporation, Stamford, CT, USA
| | - Yanshan Wang
- Department of Health Information Management, Department of Biomedical Informatics, and Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Rui Zhang
- Institute for Health Informatics, and Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Clair Blacketer
- Janssen Pharmaceutical Research and Development LLC, Titusville, NJ, USA; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Patrick Ryan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA; Janssen Pharmaceutical Research and Development LLC, Titusville, NJ, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA.
| | - Hua Xu
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, Yale University, New Haven, CT, USA.
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16
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Wilken J, Traboulsee A, Nelson F, Ionete C, Kolind S, Fratto T, Kane R, Gandhi R, Rawlings AM, Roesch N, Ozog MA, DeLuca J. Longitudinal assessment of neurocognitive function in people with relapsing multiple sclerosis initiating alemtuzumab in routine clinical practice: LEM-COG study results. Mult Scler Relat Disord 2023; 73:104677. [PMID: 37028124 DOI: 10.1016/j.msard.2023.104677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/21/2023] [Accepted: 03/26/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Alemtuzumab is effective in reducing relapse rate and disability, but limited data exist on its effect on cognitive function in relapsing multiple sclerosis (RMS). The present study assessed neurocognitive function and safety associated with alemtuzumab treatment in RMS. METHODS This longitudinal, single-arm, prospective study included people with RMS (aged 25-55 years) who were treated with alemtuzumab in clinical practice in the United States of America and Canada. The first participant was enrolled in December 2016. The primary endpoint was the change from baseline to post-baseline (month [M] 12/24) in MS-COGnitive (MS-COG) composite score. Secondary endpoints included Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), Selective Reminding Test (SRT), Controlled Oral Word Association Test (COWAT), and Automated Neuropsychological Assessment Metrics (ANAM) scores. Depression and fatigue were assessed using Hamilton Rating Scale-Depression (HAM-D) and Fatigue Severity Scale (FSS)/Modified Fatigue Impact Scale (MFIS), respectively. Magnetic resonance imaging (MRI) parameters were assessed when available. Safety was assessed throughout the study. Descriptive statistics were used for the pre-specified statistical analyses. Since the study was terminated early (November 2019) because of operational and resource difficulties, post hoc analyses for statistical inference were performed among participants who had a baseline value and at least one complete post-baseline assessment for cognitive parameters, fatigue, or depression. RESULTS Of the 112 participants enrolled, 39 were considered as the primary analysis population at M12. At M12, a mean change of 0.25 (95% confidence interval [CI]: 0.04, 0.45; p = 0.0049; effect size [ES]: 0.39) was observed in the MS-COG composite score. Improvements were observed in processing speed (based on PASAT and SDMT; p < 0.0001; ES: 0.62), as well as in individual PASAT, SDMT and COWAT scores. An improvement was also noted in HAM-D (p = 0.0054; ES: -0.44), but not in fatigue scores. Among MRI parameters, decreases in burden of disease volume (BDV; ES: -0.12), new gadolinium-enhancing lesions (ES: -0.41) and newly active lesions (ES: -0.07) were observed at M12. About 92% of participants showed stable or improved cognitive status at M12. There were no new safety signals reported in the study. The most common adverse events (≥10% of participants) were headache, fatigue, nausea, insomnia, urinary tract infection, pain in extremity, chest discomfort, anxiety, dizziness, arthralgia, flushing, and rash. Hypothyroidism (3.7%) was the most frequent adverse event of special interest. CONCLUSION The findings from this study suggest that alemtuzumab has a positive impact on cognitive function with significant improvements in processing speed and depression in people with RMS over a period of 12 months. The safety profile of alemtuzumab was consistent with previous studies.
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17
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Forsberg L, Spelman T, Klyve P, Manouchehrinia A, Ramanujam R, Mouresan E, Drahota J, Horakova D, Joensen H, Pontieri L, Magyari M, Ellenberger D, Stahmann A, Rodgers J, Witts J, Middleton R, Nicholas R, Bezlyak V, Adlard N, Hach T, Lines C, Vukusic S, Soilu-Hänninen M, van der Walt A, Butzkueven H, Iaffaldano P, Trojano M, Glaser A, Hillert J. Proportion and characteristics of secondary progressive multiple sclerosis in five European registries using objective classifiers. Mult Scler J Exp Transl Clin 2023; 9:20552173231153557. [PMID: 36816812 PMCID: PMC9936396 DOI: 10.1177/20552173231153557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/12/2023] [Indexed: 02/18/2023] Open
Abstract
Background To assign a course of secondary progressive multiple sclerosis (MS) (SPMS) may be difficult and the proportion of persons with SPMS varies between reports. An objective method for disease course classification may give a better estimation of the relative proportions of relapsing-remitting MS (RRMS) and SPMS and may identify situations where SPMS is under reported. Materials and methods Data were obtained for 61,900 MS patients from MS registries in the Czech Republic, Denmark, Germany, Sweden, and the United Kingdom (UK), including date of birth, sex, SP conversion year, visits with an Expanded Disability Status Scale (EDSS) score, MS onset and diagnosis date, relapses, and disease-modifying treatment (DMT) use. We included RRMS or SPMS patients with at least one visit between January 2017 and December 2019 if ≥ 18 years of age. We applied three objective methods: A set of SPMS clinical trial inclusion criteria ("EXPAND criteria") modified for a real-world evidence setting, a modified version of the MSBase algorithm, and a decision tree-based algorithm recently published. Results The clinically assigned proportion of SPMS varied from 8.7% (Czechia) to 34.3% (UK). Objective classifiers estimated the proportion of SPMS from 15.1% (Germany by the EXPAND criteria) to 58.0% (UK by the decision tree method). Due to different requirements of number of EDSS scores, classifiers varied in the proportion they were able to classify; from 18% (UK by the MSBase algorithm) to 100% (the decision tree algorithm for all registries). Objectively classified SPMS patients were older, converted to SPMS later, had higher EDSS at index date and higher EDSS at conversion. More objectively classified SPMS were on DMTs compared to the clinically assigned. Conclusion SPMS appears to be systematically underdiagnosed in MS registries. Reclassified patients were more commonly on DMTs.
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Affiliation(s)
- Lars Forsberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Klyve
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ryan Ramanujam
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Mathematics, Royal Institute of Technology, Stockholm, Sweden
| | - Elena Mouresan
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jiri Drahota
- Czech National Multiple Sclerosis ReMuS, IMPULS Endowment Fund, Prague, Czech Republic
- First Faculty of Medicine and General University Hospital, Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Dana Horakova
- First Faculty of Medicine and General University Hospital, Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Hanna Joensen
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luigi Pontieri
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - James Witts
- Swansea University Medical School, Swansea, UK
| | | | - Richard Nicholas
- Swansea University Medical School, Swansea, UK
- Department of Cellular and Molecular Neuroscience, Imperial College London, London, UK
| | | | | | | | | | - Sandra Vukusic
- Hôpital Neurologique, Service de Neurologie A, the European Database for Multiple Sclerosis (EDMUS), Coordinating Center and INSERM U 433, Lyon, France
| | - Merja Soilu-Hänninen
- Division of Clinical Neurosciences, University Hospital and University of Turku, Turku, Finland
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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18
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Data Resource Profile: The Multiple Sclerosis Documentation System 3D and AOK PLUS Linked Database (MSDS-AOK PLUS). J Clin Med 2023; 12:jcm12041441. [PMID: 36835976 PMCID: PMC9962623 DOI: 10.3390/jcm12041441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Real-world evidence in multiple sclerosis (MS) is limited by the availability of data elements in individual real-world datasets. We introduce a novel, growing database which links administrative claims and medical records from an MS patient management system, allowing for the complete capture of patient profiles. Using the AOK PLUS sickness fund and the Multiple Sclerosis Documentation System MSDS3D from the Center of Clinical Neuroscience (ZKN) in Germany, a linked MS-specific database was developed (MSDS-AOK PLUS). Patients treated at ZKN and insured by AOK PLUS were recruited and asked for informed consent. For linkage, insurance IDs were mapped to registry IDs. After the deletion of insurance IDs, an anonymized dataset was provided to a university-affiliate, IPAM e.V., for further research applications. The dataset combines a complete record of patient diagnoses, treatment, healthcare resource use, and costs (AOK PLUS), with detailed clinical parameters including functional performance and patient-reported outcomes (MSDS3D). The dataset currently captures 500 patients; however, is actively expanding. To demonstrate its potential, we present a use case describing characteristics, treatment, resource use, and costs of a patient subsample. By linking administrative claims to clinical information in medical charts, the novel MSDS-AOK PLUS database can increase the quality and scope of real-world studies in MS.
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19
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Spelman T, Horakova D, Ozakbas S, Alroughani R, Onofrj M, Kalincik T, Prat A, Terzi M, Grammond P, Patti F, Csepany T, Boz C, Lechner-Scott J, Granella F, Grand'Maison F, van der Walt A, Zhu C, Butzkueven H. Switching to natalizumab or fingolimod in multiple sclerosis: Comparative effectiveness and effect of pre-switch disease activity. Mult Scler Relat Disord 2023; 70:104477. [PMID: 36746088 DOI: 10.1016/j.msard.2022.104477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients with relapsing-remitting multiple sclerosis (RRMS) who experience relapses on a first-line therapy (interferon, glatiramer acetate, dimethyl fumarate, or teriflunomide; collectively, "BRACETD") often switch to another therapy, including natalizumab or fingolimod. Here we compare the effectiveness of switching from a first-line therapy to natalizumab or fingolimod after ≥1 relapse. METHODS Data collected prospectively in the MSBase Registry, a global, longitudinal, observational registry, were extracted on February 6, 2018. Included patients were adults with RRMS with ≥1 relapse on BRACETD therapy in the year before switching to natalizumab or fingolimod. Included patients received natalizumab or fingolimod for ≥3 months after the switch. RESULTS Following 1:1 propensity score matching, 1000 natalizumab patients were matched to 1000 fingolimod patients. Mean (standard deviation) follow-up time was 3.02 (2.06) years after switching to natalizumab and 2.58 (1.64) years after switching to fingolimod. Natalizumab recipients had significantly lower annualized relapse rate (relative risk=0.66; 95% confidence interval [CI], 0.59-0.74), lower risk of first relapse (hazard ratio [HR]=0.69; 95% CI, 0.60-0.80), and higher confirmed disability improvement (HR=1.27; 95% CI, 1.03-1.57) than fingolimod recipients. No difference in confirmed disability worsening was observed. CONCLUSIONS Patients with RRMS switching from BRACETD demonstrated better outcomes with natalizumab than with fingolimod.
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Affiliation(s)
- Tim Spelman
- Central Clinical School, Monash University, Melbourne, VIC, Australia, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d'Annunzio, Chieti, Italy
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, and Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Alexandre Prat
- Hôpital Notre Dame, Montreal, QC, Canada, and CHUM and Université de Montréal, Montreal, QC, Canada
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, AOU Policlinico Vittorio Emanuele, and Policlinico G. Rodolico, Catania, Italy
| | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, and Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia
| | - Franco Granella
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Chao Zhu
- Department of Neurology, Monash University, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Central Clinical School and Department of Neurology, Monash University, and Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
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20
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Hapfelmeier A, On BI, Mühlau M, Kirschke JS, Berthele A, Gasperi C, Mansmann U, Wuschek A, Bussas M, Boeker M, Bayas A, Senel M, Havla J, Kowarik MC, Kuhn K, Gatz I, Spengler H, Wiestler B, Grundl L, Sepp D, Hemmer B. Retrospective cohort study to devise a treatment decision score predicting adverse 24-month radiological activity in early multiple sclerosis. Ther Adv Neurol Disord 2023; 16:17562864231161892. [PMID: 36993939 PMCID: PMC10041597 DOI: 10.1177/17562864231161892] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/19/2023] [Indexed: 03/31/2023] Open
Abstract
Background Multiple sclerosis (MS) is a chronic neuroinflammatory disease affecting about 2.8 million people worldwide. Disease course after the most common diagnoses of relapsing-remitting multiple sclerosis (RRMS) and clinically isolated syndrome (CIS) is highly variable and cannot be reliably predicted. This impairs early personalized treatment decisions. Objectives The main objective of this study was to algorithmically support clinical decision-making regarding the options of early platform medication or no immediate treatment of patients with early RRMS and CIS. Design Retrospective monocentric cohort study within the Data Integration for Future Medicine (DIFUTURE) Consortium. Methods Multiple data sources of routine clinical, imaging and laboratory data derived from a large and deeply characterized cohort of patients with MS were integrated to conduct a retrospective study to create and internally validate a treatment decision score [Multiple Sclerosis Treatment Decision Score (MS-TDS)] through model-based random forests (RFs). The MS-TDS predicts the probability of no new or enlarging lesions in cerebral magnetic resonance images (cMRIs) between 6 and 24 months after the first cMRI. Results Data from 65 predictors collected for 475 patients between 2008 and 2017 were included. No medication and platform medication were administered to 277 (58.3%) and 198 (41.7%) patients. The MS-TDS predicted individual outcomes with a cross-validated area under the receiver operating characteristics curve (AUROC) of 0.624. The respective RF prediction model provides patient-specific MS-TDS and probabilities of treatment success. The latter may increase by 5-20% for half of the patients if the treatment considered superior by the MS-TDS is used. Conclusion Routine clinical data from multiple sources can be successfully integrated to build prediction models to support treatment decision-making. In this study, the resulting MS-TDS estimates individualized treatment success probabilities that can identify patients who benefit from early platform medication. External validation of the MS-TDS is required, and a prospective study is currently being conducted. In addition, the clinical relevance of the MS-TDS needs to be established.
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Affiliation(s)
| | - Begum Irmak On
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität in Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar School of Medicine, Technical University of Munich, Munich, Germany
| | - Christiane Gasperi
- Department of Neurology, Klinikum rechts der Isar School of Medicine, Technical University of Munich, Munich, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität in Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Alexander Wuschek
- Department of Neurology, Klinikum rechts der Isar School of Medicine, Technical University of Munich, Munich, Germany
| | - Matthias Bussas
- Department of Neurology, Klinikum rechts der Isar School of Medicine, Technical University of Munich, Munich, Germany
| | - Martin Boeker
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Antonios Bayas
- Department of Neurology, Medical Faculty, University of Augsburg, Augsburg, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Makbule Senel
- Department of Neurology, Ulm University Hospital, Ulm, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität in Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Markus C. Kowarik
- Department of Neurology & Stroke and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Klaus Kuhn
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Ingrid Gatz
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Helmut Spengler
- Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lioba Grundl
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dominik Sepp
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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21
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High persistence and low adverse events burden in cladribine treated MS patients from Argentina. Mult Scler Relat Disord 2022; 68:104403. [PMID: 36544327 DOI: 10.1016/j.msard.2022.104403] [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: 07/28/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Early initiation with high efficacy therapies seems to be better than an escalation approach in terms of disability prevention in patients with relapsing-remitting MS (RRMS). Although efficacy and safety of cladribine tablets have been shown in clinical trials, real-world evidence (RWE) studies from Latin America are scarce. OBJECTIVE To describe the baseline characteristics of patients enrolled in the Argentina Patient Support Program (PSP) for cladribine tablets (Adveva®), with at least 1 treatment course, evaluate treatment persistence, adverse event reports from PSP patients and reported relapses characterization. METHODS Anonymized data routinely collected by Adveva® team of patients that received the first dose of cladribine from April 16th 2018 to March 31st 2021 were analyzed. Treatment persistence was defined as the percentage of patients that initiated year 2 (Y2) from the population of patients with elapsed time since year 1 (Y1) cladribine tablet initiation of at least 18 months. In addition, using the pharmacovigilance data, reported adverse events and the time elapsed from treatment initiation to relapse were analyzed. RESULTS The present analysis included 269 patients (mean age: 41.7 ± 16 years) that had initiated Y1 of cladribine tablets treatment between April 16th 2018 and March 31st 2021. Although only 29.4% (79/269) of our population was treatment naïve, the ratio of naïve/switch patients that initiated cladribine tablets increased from April 2018-March 2019 to April 2020-March 2021. From the 110 patients with elapsed time since treatment initiation ≥18 months, 101 patients initiated Y2 indicating a persistence level of 91.8%. During follow-up, 425 adverse events were reported, mainly MS relapse (8.9%, 38/425), fatigue (3.8%, 16/425) and headache (3.5%, 15/425). Lymphopenia and infections were rarely reported by RRMS patients treated with cladribine tablets. MS relapse was more frequently reported in patients switching from a previous treatment (87.5%, 27/32) than in the naïve cohort (12.5%, 5/32). CONCLUSIONS The first real life experience in RRMS patients from Latin America demonstrated that the Adveva® enrolled support program patients have a high persistence level to oral treatment with cladribine tablets. Our results also confirmed the known safety profile of cladribine tablets, with a low incidence of lymphopenia and infections.
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22
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Dardiotis E, Perpati G, Borsos M, Nikolaidis I, Tzanetakos D, Deretzi G, Koutlas E, Kilidireas C, Mitsikostas DD, Hadjigeorgiou G, Grigoriadis N. Real-World Assessment of Quality of Life in Patients with Relapsing Remitting Multiple Sclerosis Treated with Teriflunomide for Two Years: Patient-Reported Outcomes from the AURELIO Study in Greece. Neurol Ther 2022; 11:1375-1390. [PMID: 35829919 PMCID: PMC9338205 DOI: 10.1007/s40120-022-00384-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is a highly heterogeneous inflammatory disease of the central nervous system. Patient-reported outcomes (PROs) in a real-world clinical setting can provide detailed information about MS from the patient's perspective. PROs were used here to assess quality of life (QoL), treatment satisfaction, clinical efficacy, and safety outcomes in a Greek cohort of relapsing remitting MS (RRMS) patients treated with oral teriflunomide (14 mg/day). METHODS AURELIO was a 2-year, prospective, observational study whose QoL primary endpoint was assessed with the Multiple Sclerosis Impact Scale (MSIS-29). Secondary endpoints included analyses of Patient Determined Disease Steps (PDDS), Treatment Satisfaction Questionnaire for Medication (TSQM), Expanded Disability Status Scale (EDSS), annualized relapse rate (ARR), adherence, and safety outcomes. RESULTS AURELIO enrolled 282 patients (62.8% female; mean age 44.8 [SD ± 11] years; EDSS 2.0 [SD ± 1.6]; 44.6% treatment-naïve), with 212 patients (75%) remaining on treatment at study end. MSIS-29 total scores remained stable, while the MSIS-29 psychological scale showed significant improvement (p = 0.0015) at 2 years vs. baseline. TSQM scores at 2 years showed significant improvements in effectiveness (+ 6.6, p = 0.0001), convenience (+ 1.9, p = 0.0256), and global satisfaction (+ 8.1, p = 0.0001) vs. baseline. Disease progression was stable as indicated by non-significant changes in PDDS and EDSS vs. baseline. The ARR was low at 0.065, with a slightly higher ARR in previously treated (0.070) vs. naïve patients (0.058). Adherence was high at > 90%. Overall, 91 patients (32.3%) in the study reported a total of 215 safety events (32 serious, of which 21 were classified as mild-moderate). No new safety signals were observed. CONCLUSIONS These data highlight the importance of PROs to facilitate personalized treatment strategies in MS. In line with other teriflunomide studies, AURELIO showed stable QoL, efficacy and safety outcomes, and good treatment satisfaction both in treatment-naïve and previously treated patients in this Greek cohort of patients with RRMS.
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Affiliation(s)
- Efthymios Dardiotis
- Department of Neurology, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | | | - Mariann Borsos
- AdWare Research Development and Consulting Ltd, Balatonfüred, Hungary
| | - Ioannis Nikolaidis
- 2nd Neurology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Tzanetakos
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Deretzi
- Neurology Clinic, Papageorgiou Hospital, Thessaloniki, Greece
| | | | - Constantinos Kilidireas
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimos Dimitrios Mitsikostas
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Hadjigeorgiou
- Department of Neurology, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Nikolaos Grigoriadis
- 2nd Neurology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Dobson R, Craner M, Waddingham E, Miller A, Pindoria J, Cavey A, Blain C, De Luca G, Evangelou N, Ford H, Gallagher P, George K, Geraldes Ramos Dias R, Harman P, Hobart J, King T, Linighan R, MacDougall N, Marta M, Mitchell S, Nicholas R, Rog D, Scalfari A, Scolding N, Webb S, White S, Wilton J, Young C, Matthews PM. Evaluating the feasibility of a real world pharmacovigilance study (OPTIMISE:MS). Mult Scler Relat Disord 2022; 63:103894. [DOI: 10.1016/j.msard.2022.103894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
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Interrogating large multiple sclerosis registries and databases: what information can be gained? Curr Opin Neurol 2022; 35:271-277. [PMID: 35674068 DOI: 10.1097/wco.0000000000001057] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Although substantial progress has been made in understanding the natural history of multiple sclerosis (MS) and the development of new therapies, many questions concerning disease behavior and therapeutics remain to be answered. Data generated from real-world observational studies, based on large MS registries and databases and analyzed with advanced statistical methods, are offering the scientific community answers to some of these questions that are otherwise difficult or impossible to address. This review focuses on observational studies published in the last 2 years designed to compare the effectiveness of escalation vs. induction treatment strategies, to assess the effectiveness of treatment in pediatric-onset and late-onset MS, and to identify the clinical phenotype of secondary progressive (SP)MS. RECENT FINDINGS The main findings originating from real-world studies suggest that MS patients who will qualify for high-efficacy disease-modifying therapies (DMTs) should be offered these as early as possible to prevent irreversible accumulation of neurological disability. Especially pediatric patients derive substantial benefits from early treatment. In patients with late-onset MS, sustained exposure to DMTs may result in more favorable outcomes. Data-driven definitions are more accurate in defining transition to SPMS than diagnosis based solely on neurologists' judgment. SUMMARY Patients, physicians, industry, and policy-makers have all benefited from real-world evidence based on registry data, in answering questions of diagnostics, choice of treatment, and timing of treatment decisions.
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GÜNDÜZ T, ÖZTÜRK ERDEN S, ERAKSOY M, KÜRTÜNCÜ M. Dimethyl Fumarate in Multiple Sclerosis Patients: A Real World Study. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.30934/kusbed.1012701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Amaç: Çalışmamızda dimetil fumarat (DMF) kullanan ya da daha önce kullanmış olan ataklı multipl skleroz (MS) hastalarında etkinlik ve güvenlik verilerinin elde edilmesi amaçlandı.
Yöntem: Çalışma gözlemsel retrospektif kohort çalışması olarak tasarlandı. İstanbul Tıp Fakültesi Nöroloji Ana Bilim Dalında takip edilen ve 2014–2021 yılları arasında DMF kullanmış ataklı yineleyici (RRMS) ve ataklı progresif (RPMS) MS hastalarının verileri incelendi. Hastalarda DMF başlandıktan sonraki ilk genişletilmiş özürlülük durum ölçeği (EDSS) kötüleşmesi, ilk atak ve ilk yeni MRG lezyonu bilgileri elde edilerek hastalık aktivitesi olmaması durumu (NEDA-3) belirlendi.
Bulgular: Toplam 126 ataklı MS hastası (85 kadın, 41 erkek; 116 RRMS, 10 RPMS) çalışmaya dahil edildi. DMF öncesi başka bir tedavi kullanmış olan, ataklı progresif olan ve DMF öncesi hastalık süresi daha uzun olan hastalarda DMF daha yüksek oranda kesilmişti (p=0,002, p=0,03 ve p=0,002). Beyin MRG bilgisi olan 65 RRMS ve RPMS tanılı hastanın %25’inde DMF başlandıktan sonraki takip döneminde NEDA-3 durumu sağlandığı görüldü. DMF öncesinde EDSS skorunun 3’ün altında olması NEDA-3 durumunun yitimine, ilk atağa ve ilk özürlülük birikiminin olmasına kadar geçen süreleri anlamlı ölçüde uzattı (NEDA-3 için p=0,008, HR=1,95).
Sonuç: Çalışmamızda elde edilen gerçek yaşam verileri güncel bilgiler ile büyük oranda benzerlik göstermektedir. Elde ettiğimiz bulgular EDSS skoru 3’ün altında olan hastalarda başlanan DMF’nin atak, yeni beyin MRG lezyonu ve engellilik birikimi gelişme riskinin azalttığına işaret etmektedir.
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Zehravi M, Kabir J, Akter R, Malik S, Ashraf GM, Tagde P, Ramproshad S, Mondal B, Rahman MH, Mohan AG, Cavalu S. A Prospective Viewpoint on Neurological Diseases and Their Biomarkers. Molecules 2022; 27:molecules27113516. [PMID: 35684455 PMCID: PMC9182418 DOI: 10.3390/molecules27113516] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
Neurodegenerative diseases (NDDs) are disorders that affect both the central and peripheral nervous systems. To name a few causes, NDDs can be caused by ischemia, oxidative and endoplasmic reticulum (ER) cell stress, inflammation, abnormal protein deposition in neural tissue, autoimmune-mediated neuron loss, and viral or prion infections. These conditions include Alzheimer's disease (AD), Lewy body dementia (LBD), and Parkinson's disease (PD). The formation of β-sheet-rich aggregates of intra- or extracellular proteins in the CNS hallmarks all neurodegenerative proteinopathies. In systemic lupus erythematosus (SLE), numerous organs, including the central nervous system (CNS), are affected. However, the inflammatory process is linked to several neurodegenerative pathways that are linked to depression because of NDDs. Pro-inflammatory signals activated by aging may increase vulnerability to neuropsychiatric disorders. Viruses may increase macrophages and CCR5+ T cells within the CNS during dementia formation and progression. Unlike medical symptoms, which are just signs of a patient's health as expressed and perceived, biomarkers are reproducible and quantitative. Therefore, this current review will highlight and summarize the neurological disorders and their biomarkers.
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Affiliation(s)
- Mehrukh Zehravi
- Department of Clinical Pharmacy Girls Section, Prince Sattam Bin Abdul Aziz University, Alkharj 11942, Saudi Arabia
- Correspondence: (M.Z.); (M.H.R.); (S.C.)
| | - Janisa Kabir
- Key Laboratory of Modern Chinese Medicines, China Pharmaceutical University, Nanjing 210009, China;
| | - Rokeya Akter
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Gangwon-do, Wonju 26426, Korea;
| | - Sumira Malik
- Amity Institute of Biotechnology, Amity University Jharkhand, Ranchi, Jharkhand 834001, India;
| | - Ghulam Md. Ashraf
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Priti Tagde
- Amity Institute of Pharmacy, Amity University, Noida 201301, India;
| | - Sarker Ramproshad
- Department of Pharmacy, Ranada Prasad Shaha University, Narayanganj 1400, Bangladesh; (S.R.); (B.M.)
| | - Banani Mondal
- Department of Pharmacy, Ranada Prasad Shaha University, Narayanganj 1400, Bangladesh; (S.R.); (B.M.)
| | - Md. Habibur Rahman
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Gangwon-do, Wonju 26426, Korea;
- Correspondence: (M.Z.); (M.H.R.); (S.C.)
| | - Aurel George Mohan
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania;
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania;
- Correspondence: (M.Z.); (M.H.R.); (S.C.)
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Biernacki T, Sandi D, Füvesi J, Fricska-Nagy Z, Kincses TZ, Ács P, Rózsa C, Dobos E, Cseh B, Horváth L, Nagy Z, Csányi A, Kovács K, Csépány T, Vécsei L, Bencsik K. The safety and efficacy of fingolimod: Real-world data from a long-term, non-interventional study on the treatment of RRMS patients spanning up to 5 years from Hungary. PLoS One 2022; 17:e0267346. [PMID: 35452476 PMCID: PMC9032373 DOI: 10.1371/journal.pone.0267346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/07/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Fingolimod was approved and reimbursed by the healthcare provider in Hungary for the treatment of highly active relapsing-remitting multiple sclerosis (RRMS) in 2012. The present study aimed to assess the effectiveness, safety profile, and persistence to fingolimod in a real-life setting in Hungary in RRMS patients who were either therapy naïve before enrollment or have changed to fingolimod from another disease-modifying therapy (DMT) for any reason. METHODS This cross-sectional, observational study with prospective data collection was performed nationwide at 21 sites across Hungary. To avoid selection bias, sites were asked to document eligible patients in consecutive chronological order. Demographic, clinical, safety and efficacy data were analysed for up to 5 years from 570 consenting adult patients with RRMS who had received treatment with fingolimod for at least one year. RESULTS 69.6% of patients remained free from relapses for the whole study duration; in the first year, 85.1% of patients did not experience a relapse, which rose to 94.6% seen in the 5th year. Compared to baseline at study end, 28.2% had higher, and 9.1% had lower, meanwhile, 62.7% of the patients had stable EDSS scores. Overall, the annualized relapse rate decreased from 0.804 observed at baseline to 0.185, 0.149, 0.122, 0.091, and 0.097 (77.0%, 82.1%, 85.2%, 89.7%, and 89.0% relative reduction, respectively) after 1, 2, 3, 4, and 5 years of treatment. The greatest reduction rate was seen in the group of therapy naïve patients. Treatment persistence on fingolimod after 60 months was 73.4%. CONCLUSION In this nationwide Hungarian cohort, most patients under fingolimod treatment were free from relapses and disability progression. In addition, fingolimod has proven to be a well-tolerated DMT that has sustained its manageable safety profile, high efficacy, and positive benefit/risk ratio for up to 5 years in a real-life setting.
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Affiliation(s)
- Tamás Biernacki
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Dániel Sandi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Judit Füvesi
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Zsanett Fricska-Nagy
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Tamás Zsigmond Kincses
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Péter Ács
- Department of Neurology, Faculty of General Medicine, University of Pécs, Pécs, Hungary
| | - Csilla Rózsa
- Jahn Ferenc South-Pest Hospital and Clinic, Budapest, Hungary
| | | | - Botond Cseh
- Borsod-Abaúj-Zemplén County Hospital, Miskolc, Hungary
| | | | - Zsuzsanna Nagy
- Szent Rafael Zala County Hospital, Zalaegerszeg, Hungary
| | | | | | - Tünde Csépány
- Department of Neurology, Faculty of General Medicine, University of Debrecen, Deberecen, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
| | - Krisztina Bencsik
- Department of Neurology, Faculty of General Medicine, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary
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Amato MP, De Stefano N, Inglese M, Morena E, Ristori G, Salvetti M, Trojano M. Secondary Prevention in Radiologically Isolated Syndromes and Prodromal Stages of Multiple Sclerosis. Front Neurol 2022; 13:787160. [PMID: 35359637 PMCID: PMC8964010 DOI: 10.3389/fneur.2022.787160] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
Following the extraordinary progress in the treatment of multiple sclerosis (MS), two major unmet needs remain: understanding the etiology of the disease and, hence, designing definitive cures (this perspective is neither at hand, nor it can be taken for granted that the etiologic targets will be readily treatable); the prevention of an overt and disabling disease, which seems to be a more realistic and pragmatic perspective, as the integration of genetic data with endophenotypes, MRI, and other biomarkers ameliorates our ability to identify early neuroinflammation. Radiologically isolated syndrome (RIS; diagnosed when the unanticipated MRI finding of brain spatial dissemination of focal white matter lesions highly suggestive of MS occurs in subjects without symptoms of MS, and with normal neurological examinations) and the recently focused “prodromal MS” are conditions at risk of conversion toward overt disease. Here, we explore the possibility of secondary prevention approaches in these early stages of neuroinflammation. RIS and prodromal MS are rare conditions, which suggest the importance of Study Groups and Disease Registry to implement informative clinical trials. We summarize ongoing preventive approaches in the early stages of the demyelinating process, especially in RIS conditions. Moreover, we highlight the importance of the biomarkers and the predictors of evolution to overt disease, which may be useful to select the individuals at risk of conversion to clinically isolated syndrome (CIS) and/or clinically definite MS. Finally, we illustrate the importance of the endophenotypes to test the frontline immunomodulatory approach for preventive strategies. Future investigations, especially in relatives of patients, based on MRI techniques and biological studies (better with integrated approaches) may provide opportunities to understand the MS early causal cascade and may help to identify a “therapeutic window” to potentially reverse early disease processes.
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Affiliation(s)
- Maria Pia Amato
- Department of Neurosciences, Psycology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.,Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,San Martino Hospital-IRCCS, Genoa, Italy
| | - Emanuele Morena
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy
| | - Giovanni Ristori
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy.,Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Ruggieri S, Quartuccio ME, Prosperini L. Ponesimod in the Treatment of Relapsing Forms of Multiple Sclerosis: An Update on the Emerging Clinical Data. Degener Neurol Neuromuscul Dis 2022; 12:61-73. [PMID: 35356493 PMCID: PMC8958267 DOI: 10.2147/dnnd.s313825] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023] Open
Abstract
Sphingosine 1-phosphate (S1P) receptors are bioactive lipid metabolites that bind five different types of receptors expressed ubiquitously in human body and mediate a broad range of biological functions. Targeting S1P receptors is nowadays a well-established pharmacological strategy to treat multiple sclerosis (MS). However, the adverse events associated with the ancestor (fingolimod), especially in terms of heart conduction and slow reversibility of its pharmacodynamics effect on lymphocytes, have stimulated a search for a S1P modulator with greater selectivity for S1P1 (the most important immune mechanism to prevent MS-related neuroinflammation). Ponesimod is a second-generation, orally active, directly bioavailable, highly selective, and rapidly reversible modulator of the S1P1 receptor. Gradual 14-day up-titration of ponesimod mitigates its first-dose effects on heart rate and facilitates its use over fingolimod, as it does not require first-dose cardiac monitoring. Ponesimod is rapidly eliminated within 1 week of discontinuation, thereby representing a more manageable approach in case of vaccination, pregnancy, or adverse events. However, the fast reversibility of ponesimod may also raise concerns about the possibility of a rapid reactivation of disease activity following its discontinuation. Ponesimod was recently approved for the treatment of relapsing MS forms on the basis of a Phase III, double-blind, double-dummy, randomized clinical trial (OPTIMUM) that demonstrated the superiority of ponesimod over teriflunomide on disease activity markers, without unexpected safety concerns. This review summarizes the pharmacodynamic and pharmacokinetic characteristics of ponesimod, and the main Phase II and III studies that led to its approval. Comparisons of ponesimod with other S1P receptor modulators currently available for MS (fingolimod, ozanimod, siponimod) are also provided.
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Affiliation(s)
- Serena Ruggieri
- Department of Human Neurosciences, Sapienza University, Rome, 00185, Italy
- Neuroimmunology Unit, Santa Lucia Foundation, Rome, 00143, Italy
| | | | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, 00152, Italy
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Spelman T, Herring WL, Zhang Y, Tempest M, Pearson I, Freudensprung U, Acosta C, Dort T, Hyde R, Havrdova E, Horakova D, Trojano M, De Luca G, Lugaresi A, Izquierdo G, Grammond P, Duquette P, Alroughani R, Pucci E, Granella F, Lechner-Scott J, Sola P, Ferraro D, Grand'Maison F, Terzi M, Rozsa C, Boz C, Hupperts R, Van Pesch V, Oreja-Guevara C, van der Walt A, Jokubaitis VG, Kalincik T, Butzkueven H. Comparative Effectiveness and Cost-Effectiveness of Natalizumab and Fingolimod in Patients with Inadequate Response to Disease-Modifying Therapies in Relapsing-Remitting Multiple Sclerosis in the United Kingdom. PHARMACOECONOMICS 2022; 40:323-339. [PMID: 34921350 PMCID: PMC8866337 DOI: 10.1007/s40273-021-01106-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patients with highly active relapsing-remitting multiple sclerosis inadequately responding to first-line therapies (interferon-based therapies, glatiramer acetate, dimethyl fumarate, and teriflunomide, known collectively as "BRACETD") often switch to natalizumab or fingolimod. OBJECTIVE The aim was to estimate the comparative effectiveness of switching to natalizumab or fingolimod or within BRACETD using real-world data and to evaluate the cost-effectiveness of switching to natalizumab versus fingolimod using a United Kingdom (UK) third-party payer perspective. METHODS Real-world data were obtained from MSBase for patients relapsing on BRACETD in the year before switching to natalizumab or fingolimod or within BRACETD. Three-way-multinomial-propensity-score-matched cohorts were identified, and comparisons between treatment groups were conducted for annualised relapse rate (ARR) and 6-month-confirmed disability worsening (CDW6M) and improvement (CDI6M). Results were applied in a cost-effectiveness model over a lifetime horizon using a published Markov structure with health states based on the Expanded Disability Status Scale. Other model parameters were obtained from the UK MS Survey 2015, published literature, and publicly available UK sources. RESULTS The MSBase analysis found a significant reduction in ARR (rate ratio [RR] = 0.64; 95% confidence interval [CI] 0.57-0.72; p < 0.001) and an increase in CDI6M (hazard ratio [HR] = 1.67; 95% CI 1.30-2.15; p < 0.001) for switching to natalizumab compared with BRACETD. For switching to fingolimod, the reduction in ARR (RR = 0.91; 95% CI 0.81-1.03; p = 0.133) and increase in CDI6M (HR = 1.30; 95% CI 0.99-1.72; p = 0.058) compared with BRACETD were not significant. Switching to natalizumab was associated with a significant reduction in ARR (RR = 0.70; 95% CI 0.62-0.79; p < 0.001) and an increase in CDI6M (HR = 1.28; 95% CI 1.01-1.62; p = 0.040) compared to switching to fingolimod. No evidence of difference in CDW6M was found between treatment groups. Natalizumab dominated (higher quality-adjusted life-years [QALYs] and lower costs) fingolimod in the base-case cost-effectiveness analysis (0.453 higher QALYs and £20,843 lower costs per patient). Results were consistent across sensitivity analyses. CONCLUSIONS This novel real-world analysis suggests a clinical benefit for therapy escalation to natalizumab versus fingolimod based on comparative effectiveness results, translating to higher QALYs and lower costs for UK patients inadequately responding to BRACETD.
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Affiliation(s)
- Timothy Spelman
- Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | | | - Yuanhui Zhang
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | | | - Carlos Acosta
- Value and Market Access, Biogen International GmbH, Neuhofstrasse 30, 6340, Baar, Switzerland.
| | - Thibaut Dort
- Value and Market Access, Biogen International GmbH, Neuhofstrasse 30, 6340, Baar, Switzerland
| | | | - Eva Havrdova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, General University Hospital and Charles University, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, General University Hospital and Charles University, Prague, Czech Republic
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Neurology Unit, SS Annunziata Hospital, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | - Pierre Grammond
- Centre de Réadaptation Déficience Physique Chaudière-Appalache, Lévis, Canada
| | | | | | | | | | | | - Patrizia Sola
- Azienda Ospedaliero Universitaria Policlinico/OCB, Neurology Unit, Modena, Italy
| | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Csilla Rozsa
- Jahn Ferenc Teaching Hospital, Budapest, Hungary
| | - Cavit Boz
- Karadeniz Technical University, Trabzon, Turkey
| | | | | | | | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Vilija G Jokubaitis
- Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
- MS Centre, Royal Melbourne Hospital, Melbourne, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School Alfred Hospital, Monash University, Melbourne, VIC, Australia
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Long-term real-world effectiveness and safety of fingolimod over 5 years in Germany. J Neurol 2022; 269:3276-3285. [PMID: 34982201 PMCID: PMC9120082 DOI: 10.1007/s00415-021-10931-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the 5-year real-world benefit–risk profile of fingolimod in patients with relapsing–remitting MS (RRMS) in Germany. Methods Post-Authorization Non-interventional German sAfety study of GilEnyA (PANGAEA) is a non-interventional real-world study to prospectively assess the effectiveness and safety of fingolimod in routine clinical practice in Germany. The follow-up period comprised 5 years. Patients were included if they had been diagnosed with RRMS and had been prescribed fingolimod as part of clinical routine. There were no exclusion criteria except the contraindications for fingolimod as defined in the European label. The effectiveness and safety analysis set comprised 4032 and 4067 RRMS patients, respectively. Results At the time of the 5-year follow-up of PANGAEA, 66.57% of patients still continued fingolimod therapy. Annualized relapse rates decreased from baseline 1.5 ± 1.15 to 0.42 ± 0.734 at year 1 and 0.21 ± 0.483 at year 5, and the disability status remained stable, as demonstrated by the Expanded Disability Status Scale mean change from baseline (0.1 ± 2.51), the decrease of the Multiple Sclerosis Severity Score from 5.1 ± 2.59 at baseline to 3.9 ± 2.31 at the 60-months follow-up, and the percentage of patients with ‘no change’ in the Clinical Global Impression scale at the 60-months follow-up (78.11%). Adverse events (AE) occurring in 75.04% of patients were in line with the known safety profile of fingolimod and were mostly non-serious AE (33.62%) and non-serious adverse drug reactions (50.59%; serious AE 4.98%; serious ADR 10.82%). Conclusions PANGAEA demonstrated the sustained beneficial effectiveness and safety of fingolimod in the long-term real-world treatment of patients with RRMS. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10931-w.
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Zanghì A, Avolio C, Amato MP, Filippi M, Trojano M, Patti F, D’Amico E. First-line therapies in late-onset multiple sclerosis: An Italian registry study. Eur J Neurol 2021; 28:4117-4123. [PMID: 34216532 PMCID: PMC9291454 DOI: 10.1111/ene.15006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/24/2021] [Accepted: 06/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE The diagnosis of late-onset (age ≥50 years old) relapsing remitting multiple sclerosis (LORRMS) has been increasingly described in clinical practice, whereas data focusing on the specific therapeutic management of LORRMS are scarce. Our objective was to compare the effectiveness of injectable and oral first-line disease-modifying therapies (DMTs) in a cohort of LORRMS patients with time to first relapse, time to confirmed disability progression (CDP), and time to discontinuation. METHODS This is a multicenter, observational, retrospectively acquired cohort study on LORRMS-naïve patients from the Italian MS Register who started either injectable or oral first-line DMTs between January 1, 2013 and December 31, 2017. LORRMS patients were divided into two groups, namely the injectable group (IG) and oral group (OG). Cox models adjusted with inverse probability-weighted propensity score were built for the investigated outcomes. RESULTS Of a cohort of 3989 patients, 302 were enrolled (203 in the IG and 99 in the OG). The two cohorts did not differ in baseline characteristics. Time to first relapse did not show any difference between the two groups (hazard ratio [HR]: 1.10; 95% confidence interval [CI]: 0.50-2.46, p = 0.797). Furthermore, no differences were found between the two groups with respect to the risk of CDP (HR: 1.04; 95% CI: 0.35-3.06, p = 0.939), nor for the risk of DMT discontinuation (HR: 0.90; 95% CI: 0.17-2.08, p = 0.425). CONCLUSIONS Real-world data from the Italian MS Register suggested that both injectables and oral first-line DMTs similarly controlled the investigated outcomes in LORRMS.
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Affiliation(s)
- Aurora Zanghì
- Department “G.F. Ingrassia,”MS Center University of CataniaCataniaItaly
| | - Carlo Avolio
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
- Department of NeurosciencesHead of Multiple Sclerosis CenterPoliclinico Riuniti HospitalFoggiaItaly
| | - Maria Pia Amato
- Department NEUROFARBA, University of FlorenceFlorenceItaly
- IRCCS Fondazione Don Carlo GnocchiFlorenceItaly
| | - Massimo Filippi
- Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, and Neuroimaging Research UnitDivision of NeuroscienceIRCCS San Raffaele Scientific InstituteMilanItaly
- Vita‐Salute San Raffaele UniversityMilanItaly
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense OrgansUniversity of Bari “Aldo Moro,”BariItaly
| | - Francesco Patti
- Department “G.F. Ingrassia,”MS Center University of CataniaCataniaItaly
| | - Emanuele D’Amico
- Department “G.F. Ingrassia,”MS Center University of CataniaCataniaItaly
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Abstract
BACKGROUND Multiple sclerosis (MS) is the most common neurological cause of disability in young adults. Off-label rituximab for MS is used in most countries surveyed by the International Federation of MS, including high-income countries where on-label disease-modifying treatments (DMTs) are available. OBJECTIVES: To assess beneficial and adverse effects of rituximab as 'first choice' and as 'switching' for adults with MS. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, and trial registers for completed and ongoing studies on 31 January 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled non-randomised studies of interventions (NRSIs) comparing rituximab with placebo or another DMT for adults with MS. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. We used the Cochrane Collaboration's tool for assessing risk of bias. We rated the certainty of evidence using GRADE for: disability worsening, relapse, serious adverse events (SAEs), health-related quality of life (HRQoL), common infections, cancer, and mortality. We conducted separate analyses for rituximab as 'first choice' or as 'switching', relapsing or progressive MS, comparison versus placebo or another DMT, and RCTs or NRSIs. MAIN RESULTS We included 15 studies (5 RCTs, 10 NRSIs) with 16,429 participants of whom 13,143 were relapsing MS and 3286 progressive MS. The studies were one to two years long and compared rituximab as 'first choice' with placebo (1 RCT) or other DMTs (1 NRSI), rituximab as 'switching' against placebo (2 RCTs) or other DMTs (2 RCTs, 9 NRSIs). The studies were conducted worldwide; most originated from high-income countries, six from the Swedish MS register. Pharmaceutical companies funded two studies. We identified 14 ongoing studies. Rituximab as 'first choice' for relapsing MS Rituximab versus placebo: no studies met eligibility criteria for this comparison. Rituximab versus other DMTs: one NRSI compared rituximab with interferon beta or glatiramer acetate, dimethyl fumarate, natalizumab, or fingolimod in active relapsing MS at 24 months' follow-up. Rituximab likely results in a large reduction in relapses compared with interferon beta or glatiramer acetate (hazard ratio (HR) 0.14, 95% confidence interval (CI) 0.05 to 0.39; 335 participants; moderate-certainty evidence). Rituximab may reduce relapses compared with dimethyl fumarate (HR 0.29, 95% CI 0.08 to 1.00; 206 participants; low-certainty evidence) and natalizumab (HR 0.24, 95% CI 0.06 to 1.00; 170 participants; low-certainty evidence). It may make little or no difference on relapse compared with fingolimod (HR 0.26, 95% CI 0.04 to 1.69; 137 participants; very low-certainty evidence). The study reported no deaths over 24 months. The study did not measure disability worsening, SAEs, HRQoL, and common infections. Rituximab as 'first choice' for progressive MS One RCT compared rituximab with placebo in primary progressive MS at 24 months' follow-up. Rituximab likely results in little to no difference in the number of participants who have disability worsening compared with placebo (odds ratio (OR) 0.71, 95% CI 0.45 to 1.11; 439 participants; moderate-certainty evidence). Rituximab may result in little to no difference in recurrence of relapses (OR 0.60, 95% CI 0.18 to 1.99; 439 participants; low-certainty evidence), SAEs (OR 1.25, 95% CI 0.71 to 2.20; 439 participants; low-certainty evidence), common infections (OR 1.14, 95% CI 0.75 to 1.73; 439 participants; low-certainty evidence), cancer (OR 0.50, 95% CI 0.07 to 3.59; 439 participants; low-certainty evidence), and mortality (OR 0.25, 95% CI 0.02 to 2.77; 439 participants; low-certainty evidence). The study did not measure HRQoL. Rituximab versus other DMTs: no studies met eligibility criteria for this comparison. Rituximab as 'switching' for relapsing MS One RCT compared rituximab with placebo in relapsing MS at 12 months' follow-up. Rituximab may decrease recurrence of relapses compared with placebo (OR 0.38, 95% CI 0.16 to 0.93; 104 participants; low-certainty evidence). The data did not confirm or exclude a beneficial or detrimental effect of rituximab relative to placebo on SAEs (OR 0.90, 95% CI 0.28 to 2.92; 104 participants; very low-certainty evidence), common infections (OR 0.91, 95% CI 0.37 to 2.24; 104 participants; very low-certainty evidence), cancer (OR 1.55, 95% CI 0.06 to 39.15; 104 participants; very low-certainty evidence), and mortality (OR 1.55, 95% CI 0.06 to 39.15; 104 participants; very low-certainty evidence). The study did not measure disability worsening and HRQoL. Five NRSIs compared rituximab with other DMTs in relapsing MS at 24 months' follow-up. The data did not confirm or exclude a beneficial or detrimental effect of rituximab relative to interferon beta or glatiramer acetate on disability worsening (HR 0.86, 95% CI 0.52 to 1.42; 1 NRSI, 853 participants; very low-certainty evidence). Rituximab likely results in a large reduction in relapses compared with interferon beta or glatiramer acetate (HR 0.18, 95% CI 0.07 to 0.49; 1 NRSI, 1383 participants; moderate-certainty evidence); and fingolimod (HR 0.08, 95% CI 0.02 to 0.32; 1 NRSI, 256 participants; moderate-certainty evidence). The data did not confirm or exclude a beneficial or detrimental effect of rituximab relative to natalizumab on relapses (HR 1.0, 95% CI 0.2 to 5.0; 1 NRSI, 153 participants; very low-certainty evidence). Rituximab likely increases slightly common infections compared with interferon beta or glatiramer acetate (OR 1.71, 95% CI 1.11 to 2.62; 1 NRSI, 5477 participants; moderate-certainty evidence); and compared with natalizumab (OR 1.58, 95% CI 1.08 to 2.32; 2 NRSIs, 5001 participants; moderate-certainty evidence). Rituximab may increase slightly common infections compared with fingolimod (OR 1.26, 95% CI 0.90 to 1.77; 3 NRSIs, 5187 participants; low-certainty evidence). It may make little or no difference compared with ocrelizumab (OR 0.02, 95% CI 0.00 to 0.40; 1 NRSI, 472 participants; very low-certainty evidence). The data did not confirm or exclude a beneficial or detrimental effect of rituximab on mortality compared with fingolimod (OR 5.59, 95% CI 0.22 to 139.89; 1 NRSI, 136 participants; very low-certainty evidence) and natalizumab (OR 6.66, 95% CI 0.27 to 166.58; 1 NRSI, 153 participants; very low-certainty evidence). The included studies did not measure SAEs, HRQoL, and cancer. AUTHORS' CONCLUSIONS For preventing relapses in relapsing MS, rituximab as 'first choice' and as 'switching' may compare favourably with a wide range of approved DMTs. A protective effect of rituximab against disability worsening is uncertain. There is limited information to determine the effect of rituximab for progressive MS. The evidence is uncertain about the effect of rituximab on SAEs. They are relatively rare in people with MS, thus difficult to study, and they were not well reported in studies. There is an increased risk of common infections with rituximab, but absolute risk is small. Rituximab is widely used as off-label treatment in people with MS; however, randomised evidence is weak. In the absence of randomised evidence, remaining uncertainties on beneficial and adverse effects of rituximab for MS might be clarified by making real-world data available.
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Affiliation(s)
- Graziella Filippini
- Scientific Director's Office, Carlo Besta Foundation and Neurological Institute, Milan, Italy
| | - Jera Kruja
- Neurology, UHC Mother Theresa, University of Medicine, Tirana, Albania
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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Dahlke F, Arnold DL, Aarden P, Ganjgahi H, Häring DA, Čuklina J, Nichols TE, Gardiner S, Bermel R, Wiendl H. Characterisation of MS phenotypes across the age span using a novel data set integrating 34 clinical trials (NO.MS cohort): Age is a key contributor to presentation. Mult Scler 2021; 27:2062-2076. [PMID: 33507835 PMCID: PMC8564259 DOI: 10.1177/1352458520988637] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/14/2020] [Accepted: 12/24/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Oxford Big Data Institute, multiple sclerosis (MS) physicians and Novartis aim to address unresolved questions in MS with a novel comprehensive clinical trial data set. OBJECTIVE The objective of this study is to describe the Novartis-Oxford MS (NO.MS) data set and to explore the relationships between age, disease activity and disease worsening across MS phenotypes. METHODS We report key characteristics of NO.MS. We modelled MS lesion formation, relapse frequency, brain volume change and disability worsening cross-sectionally, as a function of patients' baseline age, using phase III study data (≈8000 patients). RESULTS NO.MS contains data of ≈35,000 patients (>200,000 brain images from ≈10,000 patients), with >10 years follow-up. (1) Focal disease activity is highest in paediatric patients and decreases with age, (2) brain volume loss is similar across age and phenotypes and (3) the youngest patients have the lowest likelihood (<25%) of disability worsening over 2 years while risk is higher (25%-75%) in older, disabled or progressive MS patients. Young patients benefit most from treatment. CONCLUSION NO.MS will illuminate questions related to MS characterisation, progression and prognosis. Age modulates relapse frequency and, thus, the phenotypic presentation of MS. Disease worsening across all phenotypes is mediated by age and appears to some extent be independent from new focal inflammatory activity.
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Affiliation(s)
| | - Douglas L Arnold
- Brain Imaging Centre, Montreal Neurological
Institute and Hospital, McGill University, Montréal, QC, Canada
| | | | - Habib Ganjgahi
- Oxford Big Data Institute, Li Ka Shing Centre
for Health Information and Discovery, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
| | | | | | - Thomas E Nichols
- Oxford Big Data Institute, Li Ka Shing Centre
for Health Information and Discovery, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
| | | | - Robert Bermel
- Department of Neurology, Mellen MS Center,
Cleveland Clinic, Cleveland, OH, USA
| | - Heinz Wiendl
- Department of Neurology, University Hospital
Münster, Münster, Germany
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Maltby VE, Lea RA, Monif M, Fabis-Pedrini MJ, Buzzard K, Kalincik T, Kermode AG, Taylor B, Hodgkinson S, McCombe P, Butzkueven H, Barnett M, Lechner-Scott J. Efficacy of Cladribine Tablets as a Treatment for People With Multiple Sclerosis: Protocol for the CLOBAS Study (Cladribine, a Multicenter, Long-term Efficacy and Biomarker Australian Study). JMIR Res Protoc 2021; 10:e24969. [PMID: 34665152 PMCID: PMC8564661 DOI: 10.2196/24969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/04/2021] [Accepted: 05/28/2021] [Indexed: 01/26/2023] Open
Abstract
Background Cladribine tablets (marketed as Mavenclad) are a new oral therapy, which has recently been listed on the pharmaceutical benefits scheme in Australia for the treatment of relapsing multiple sclerosis (MS). The current dosing schedule is for 2 courses given a year apart, which has been shown to be effective for treatment of MS for up to 4 years in 75% of patients (based on annualized relapse rate). However, the reinitiation of therapy after year 4 has not been studied. Objective This study aims to evaluate the safety and efficacy of cladribine tablets over a 6-year period, according to no evidence of disease activity 3. Methods This will be a multicenter, 6-year, phase IV, low interventional, observational study that incorporates clinical, hematological, biochemical, epigenetic, radiological and cognitive biomarkers of disease. Participants considered for treatment with cladribine as part of their routine clinical care will be consented to take part in the study. They will be monitored at regular intervals during the initial course of medication administration in years 1 and 2. After year 3, patients will have the option of redosing, if clinically indicated, or to switch to another disease-modifying therapy. Throughout the duration of the study, we will assess blood-based biomarkers including lymphocyte subsets, serum neurofilament light chain, DNA methylation, and RNA analysis as well as magnetic resonance imaging findings (brain volume and/or lesion load) and cognitive performance. Results This study has been approved by the Hunter New England Local Health District Human Research Ethics Committee. Recruitment began in March of 2019 and was completed by June 2021. Conclusions This will be the first long-term efficacy trial of cladribine, which offers reinitiation of therapy in the 3rd year, based on disease activity, after the initial 2 courses. We expect that this study will indicate whether any of the assessed biomarkers can be used to predict treatment efficacy or the need for future reinitiation of cladribine in people with MS. Trial Registration This study is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619000257167) with Universal Trial Number (U1111-1228-2165). International Registered Report Identifier (IRRID) DERR1-10.2196/24969
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Affiliation(s)
- Vicki E Maltby
- Department of Neurology, John Hunter Hospital, New Lambton Heights, Australia.,School for Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Rodney A Lea
- School for Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Institute of Health and Biomedical Innovations, Genomics Research Centre, Queensland University of Technology, Kelvin Grove, Australia
| | - Mastura Monif
- Department of Neurosciences, Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, Australia.,Department of Neurology, Alfred Health, Melbourne, Australia.,Department of Neurology, Melbourne Multiple Sclerosis Centre, Melbourne Health, Melbourne, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, University of Western Australia, Perth, Australia
| | - Katherine Buzzard
- Department of Neurosciences, Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, Australia.,Department of Neurology, Melbourne Multiple Sclerosis Centre, Melbourne Health, Melbourne, Australia
| | - Tomas Kalincik
- Department of Neurology, Melbourne Multiple Sclerosis Centre, Melbourne Health, Melbourne, Australia.,Clinical Outcomes Research (CORe) Unit, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, University of Western Australia, Perth, Australia.,Institute for Immunology and Infectious Disease, Murdoch University, Perth, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Suzanne Hodgkinson
- Department of Medicine, University of New South Wales, Sydney, Australia.,Department of Neurology, Liverpool Hospital, Sydney, Australia.,Immune Tolerance Laboratory, Ingham Institute, Sydney, Australia
| | - Pamela McCombe
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Helmut Butzkueven
- Department of Neurology, Alfred Health, Melbourne, Australia.,Clinical Outcomes Research (CORe) Unit, Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Michael Barnett
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Sydney Neuroimaging Analysis Centre, Sydney, Australia
| | - Jeannette Lechner-Scott
- Department of Neurology, John Hunter Hospital, New Lambton Heights, Australia.,School for Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
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Cristiano E, Abad P, Becker J, Carrá A, Correale J, Flores J, Fruns M, Garcea O, Garcia Bónitto J, Gracia F, Hamuy F, Navas C, Patrucco L, Rivera V, Velazquez M, Rojas JI. Multiple sclerosis care units in Latin America: Consensus recommendations about its objectives and functioning implementation. J Neurol Sci 2021; 429:118072. [PMID: 34509134 DOI: 10.1016/j.jns.2021.118072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/23/2021] [Accepted: 09/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Currently, there are several reasons to promote worldwide the concept of multiple sclerosis care units (MSCU) for a better management of affected patients. Ideally, the MSCU should have some human and technical resources that distinguish and improve the care of affected patients; however, local, and regional aspects should be considered when recommending how these units should operate. The objective of these consensus recommendations was to review how MSCU should work in Latin America to improve long-term outcomes in MS patients. METHODS A panel of neurology experts from Latin America dedicated to the diagnosis and care of MS patients gathered virtually during 2019 and 2020 to carry out a consensus recommendation about objectives and functioning implementation of MSCU in Latin America. To achieve consensus, the methodology of "formal consensus-RAND/UCLA method" was used. RESULTS Recommendations focused on the objectives, human and technical resources, and the general functioning that MSCU should have in Latin America. CONCLUSIONS The recommendations of these consensus guidelines attempt to optimize the health care and management of MS patients by setting how MSCU should work in our region.
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Affiliation(s)
- Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Patricio Abad
- Servicio Neurologia, Hospital Metropolitano de Quito, Ecuador, Profesor de Neurología PUCE, Ecuador
| | - Jefferson Becker
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Adriana Carrá
- MS Section Hospital Britanico Buenos Aires, Argentina; Neurociencias Fundación Favaloro/INECO, Buenos Aires, Argentina
| | | | - José Flores
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico; Centro Neurológico ABC Santa Fé, Ciudad de México, Mexico
| | | | - Orlando Garcea
- Clínica de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Fernando Gracia
- Clinica de Esclerosis Multiple, Servicio de Neurologia Hospital Santo Tomas, Panama. Universidad Interamericana de Panama, Panama
| | - Fernando Hamuy
- Departamento de Neurologia, Hospital IMT, Paraguay; Departamento de Neurologia de Diagnóstico Codas Thompson, Paraguay
| | - Cárlos Navas
- Clinica Enfermedad Desmielinizante Clinica Universitaria Colombia, Colombia
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina
| | | | | | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina.
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Pontieri L, Blinkenberg M, Bramow S, Papp V, Rasmussen PV, Kant M, Schäfer J, Mathiesen HK, Jensen MB, Sirakov G, Berg JM, Kopp TI, Joensen H, Sellebjerg F, Magyari M. Ocrelizumab treatment in multiple sclerosis: A Danish population-based cohort study. Eur J Neurol 2021; 29:496-504. [PMID: 34644452 DOI: 10.1111/ene.15142] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/14/2021] [Accepted: 10/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Real-world evidence regarding the effectiveness and safety of ocrelizumab for the treatment of multiple sclerosis (MS) is limited. The aim was to evaluate the effectiveness and safety of ocrelizumab treatment for MS in a real-world setting. METHODS A nationwide population-based cohort study was conducted where clinical and magnetic resonance imaging data of MS patients enrolled prospectively in the Danish Multiple Sclerosis Registry who initiated ocrelizumab treatment between January 2018 and November 2020 were analyzed. RESULTS A total of 1104 patients (85.7% relapsing-remitting MS [RRMS], 8.8% secondary progressive MS [SPMS], 5.5% primary progressive MS [PPMS]) were included, with a median follow-up period of 1.3 years. At baseline, the mean age was 41.4 years in the RRMS group, 44.5 years in the PPMS group and 50.3 years in the SPMS group. Median Expanded Disability Status Scale score was 2.5, 3.5 and 5.5, respectively. Most RRMS and SPMS patients had received previous disease-modifying therapies (87.5% and 91.8%, respectively), whereas PPMS patients were mostly treatment naïve (78.7%). After ocrelizumab initiation, 9.3% of the patients experienced a relapse and 8.7% a 24 weeks confirmed disability worsening. Conversely, 16.7% showed a 24 weeks confirmed disability improvement. After ~1 year of treatment, most patients (94.5%) were free of magnetic resonance imaging activity. Ocrelizumab was generally well tolerated, as side effects were only reported for 10% of patients, mostly consisting of infusion-related reactions and infections. CONCLUSIONS It is shown that most MS patients treated with ocrelizumab are clinically stabilized and with an adverse event profile consistent with the experience from the pivotal clinical trials.
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Affiliation(s)
- Luigi Pontieri
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Morten Blinkenberg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Stephan Bramow
- Danish Multiple Sclerosis Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Jakob Schäfer
- Department of Neurology, University Hospital Aalborg, Aalborg, Denmark
| | - Henrik K Mathiesen
- Department of Neurology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Michael B Jensen
- Department of Neurology, University Hospital of Northern Sealand, Hillerød, Denmark
| | | | | | - Tine I Kopp
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Hanna Joensen
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Danish Multiple Sclerosis Center, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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38
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Moccia M, Affinito G, Capacchione A, Lanzillo R, Carotenuto A, Montella E, Triassi M, Morra VB, Palladino R. Interferon beta for the treatment of multiple sclerosis in the Campania Region of Italy: Merging the real-life to routinely collected healthcare data. PLoS One 2021; 16:e0258017. [PMID: 34587188 PMCID: PMC8480611 DOI: 10.1371/journal.pone.0258017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background We aim to overcome limitations of previous clinical and population-based studies by merging a clinical registry to routinely-collected healthcare data, and to specifically describe differences in clinical outcomes, healthcare resource utilization and costs between interferon beta formulations for multiple sclerosis (MS). Methods We included 850 patients with MS treated with interferon beta formulations, from 2015 to 2019, seen at the MS Clinical Care and Research Centre (Federico II University of Naples, Italy) and with linkage to routinely-collected healthcare data (prescription data, hospital admissions, outpatient services). We extracted and computed clinical outcomes (relapses, 6-month EDSS progression using a roving EDSS as reference), persistence (time spent on a specific interferon beta formulation), adherence (medication possession ratio (MPR)), healthcare resource utilization and costs (annualized hospitalization rate (AHR), costs for hospital admissions and DMTs). To evaluate differences between interferon beta formulations, we used linear regression (adherence), Poisson regression (AHR), mixed-effect regression (costs), and Cox-regression models (time varying variables); covariates were age, sex, treatment duration, baseline EDSS and adherence. Results Looking at clinical outcomes, rates of relapses and EDSS progression were lower than studies run on previous cohorts; there was no differences in relapse risk between interferon beta formulations. Risk of discontinuation was higher for Betaferon®/Extavia® (HR = 3.28; 95%CI = 2.11, 5.12; p<0.01). Adherence was lower for Betaferon®/Extavia® (Coeff = -0.05; 95%CI = -0.10, -0.01; p = 0.02), and Avonex® (Coeff = -0.06; 95%CI = -0.11, -0.02; p<0.01), when compared with Rebif® and Plegridy® (Coeff = 0.08; 95%CI = 0.01, 0.16; p = 0.02). AHR and costs for MS hospital admissions were higher for Betaferon®/Extavia® (IRR = 2.38; 95%CI = 1.01, 5.55; p = 0.04; Coeff = 14.95; 95%CI = 1.39, 28.51; p = 0.03). Conclusions We have showed the feasibility of merging routinely-collected healthcare data to a clinical registry for future MS research, and have confirmed interferon beta formulations play an important role in the management of MS, with positive clinical outcomes. Differences between interferon beta formulations are mostly driven by adherence and healthcare resource utilization.
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Affiliation(s)
- Marcello Moccia
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University of Naples, Naples, Italy
- * E-mail: ,
| | - Giuseppina Affinito
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Antonio Capacchione
- Merck Serono S.p.A (an affiliate of Merck KGaA, Darmstadt, Germany), Rome, Italy
| | - Roberta Lanzillo
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University of Naples, Naples, Italy
| | - Antonio Carotenuto
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University of Naples, Naples, Italy
| | - Emma Montella
- Health Management Office, Federico II University Hospital of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive Science and Odontostomatology, Multiple Sclerosis Clinical Care and Research Centre, Federico II University of Naples, Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, Federico II University of Naples, Naples, Italy
- Department of Primary Care and Public Health, Imperial College, London, United Kingdom
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De Brouwer E, Becker T, Moreau Y, Havrdova EK, Trojano M, Eichau S, Ozakbas S, Onofrj M, Grammond P, Kuhle J, Kappos L, Sola P, Cartechini E, Lechner-Scott J, Alroughani R, Gerlach O, Kalincik T, Granella F, Grand'Maison F, Bergamaschi R, José Sá M, Van Wijmeersch B, Soysal A, Sanchez-Menoyo JL, Solaro C, Boz C, Iuliano G, Buzzard K, Aguera-Morales E, Terzi M, Trivio TC, Spitaleri D, Van Pesch V, Shaygannejad V, Moore F, Oreja-Guevara C, Maimone D, Gouider R, Csepany T, Ramo-Tello C, Peeters L. Longitudinal machine learning modeling of MS patient trajectories improves predictions of disability progression. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106180. [PMID: 34146771 DOI: 10.1016/j.cmpb.2021.106180] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/08/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Research in Multiple Sclerosis (MS) has recently focused on extracting knowledge from real-world clinical data sources. This type of data is more abundant than data produced during clinical trials and potentially more informative about real-world clinical practice. However, this comes at the cost of less curated and controlled data sets. In this work we aim to predict disability progression by optimally extracting information from longitudinal patient data in the real-world setting, with a special focus on the sporadic sampling problem. METHODS We use machine learning methods suited for patient trajectories modeling, such as recurrent neural networks and tensor factorization. A subset of 6682 patients from the MSBase registry is used. RESULTS We can predict disability progression of patients in a two-year horizon with an ROC-AUC of 0.85, which represents a 32% decrease in the ranking pair error (1-AUC) compared to reference methods using static clinical features. CONCLUSIONS Compared to the models available in the literature, this work uses the most complete patient history for MS disease progression prediction and represents a step forward towards AI-assisted precision medicine in MS.
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Affiliation(s)
| | - Thijs Becker
- I-Biostat, Data Science Institute, Hasselt University, Diepenbeek, Belgium.
| | - Yves Moreau
- ESAT-STADIUS, KU Leuven, Leuven 3001, Belgium.
| | | | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | - Jens Kuhle
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | | | | | | | - Tomas Kalincik
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | | | | | | | - Maria José Sá
- Department of Neurology, Centro Hospitalar Universitario de So Joo and University Fernando Pessoa, Porto, Portugal
| | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | | | - Claudio Solaro
- Dept of Rehabilitation mons L Novarese Hospital, Moncrivello, Italy
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | | | | | | | | | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | | | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | | | | | | | | | - Liesbet Peeters
- I-Biostat, Data Science Institute, Hasselt University, Diepenbeek, Belgium; Department of Immunology, Biomedical Research Institute, Hasselt University, Diepenbeek 3590, Belgium; Department of Immunology, Biomedical Research Institute, Hasselt University, Diepenbeek 3590, Belgium; I-Biostat, Data Science Institute, Hasselt University, Diepenbeek, Belgium.
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Wiendl H, Gold R, Berger T, Derfuss T, Linker R, Mäurer M, Aktas O, Baum K, Berghoff M, Bittner S, Chan A, Czaplinski A, Deisenhammer F, Di Pauli F, Du Pasquier R, Enzinger C, Fertl E, Gass A, Gehring K, Gobbi C, Goebels N, Guger M, Haghikia A, Hartung HP, Heidenreich F, Hoffmann O, Kallmann B, Kleinschnitz C, Klotz L, Leussink VI, Leutmezer F, Limmroth V, Lünemann JD, Lutterotti A, Meuth SG, Meyding-Lamadé U, Platten M, Rieckmann P, Schmidt S, Tumani H, Weber F, Weber MS, Zettl UK, Ziemssen T, Zipp F. Multiple Sclerosis Therapy Consensus Group (MSTCG): position statement on disease-modifying therapies for multiple sclerosis (white paper). Ther Adv Neurol Disord 2021; 14:17562864211039648. [PMID: 34422112 PMCID: PMC8377320 DOI: 10.1177/17562864211039648] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/28/2021] [Indexed: 12/20/2022] Open
Abstract
Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, and Switzerland).
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Affiliation(s)
- Heinz Wiendl
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster
| | - Ralf Gold
- Neurologie, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791 Bochum, Germany
| | - Thomas Berger
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Austria
| | - Tobias Derfuss
- Neurologische Klinik und Poliklinik, Universitätsspital Basel, Basel, Switzerland
| | - Ralf Linker
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Mathias Mäurer
- Neurologie und Neurologische Frührehabilitation, Klinikum Würzburg Mitte gGmbH, Standort Juliusspital, Würzburg, Germany
| | - Orhan Aktas
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Karl Baum
- Neurologie, Klinik Hennigsdorf, Hennigsdorf, Germany
| | | | - Stefan Bittner
- Klinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Andrew Chan
- Neurologie, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | | | | | | | | | - Christian Enzinger
- Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz, Austria
| | - Elisabeth Fertl
- Wiener Gesundheitsverbund, Neurologische Abteilung, Wien, Austria
| | - Achim Gass
- Neurologische Klinik, Universitätsmedizin Mannheim/Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Klaus Gehring
- Berufsverband Deutscher Nervenärzte (BVDN), Neurozentrum am Klosterforst, Itzehoe, Germany
| | | | - Norbert Goebels
- Klinik für Neurologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Guger
- Klinik für Neurologie 2, Kepler Universitätsklinikum, Linz, Austria
| | | | - Hans-Peter Hartung
- Klinik für Neurologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany; Klinik für Neurologie, Medizinische Universität Wien, Wien, Austria
| | - Fedor Heidenreich
- Diakovere Krankenhaus, Henriettenstift, Klinik für Neurologie und klinische Neurophysiologie, Hannover, Germany
| | - Olaf Hoffmann
- Klinik für Neurologie, Alexianer St. Josefs-Krankenhaus Potsdam, Potsdam, Germany; NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany; Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Boris Kallmann
- Kallmann Neurologie, Multiple Sklerose Zentrum Bamberg, Bamberg, Germany
| | | | - Luisa Klotz
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Münster, Germany
| | | | - Fritz Leutmezer
- Neurologie, Universitäts-Klinik für Neurologie Wien, Wien, Austria
| | - Volker Limmroth
- Klinik für Neurologie, Krankenhaus Köln-Merheim, Köln, Germany
| | - Jan D Lünemann
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Münster, Germany
| | | | - Sven G Meuth
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | | | - Michael Platten
- Neurologische Klinik, Universitätsmedizin Mannheim/Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Peter Rieckmann
- Medical Park, Fachklinik für Neurologie, Zentrum für Klinische Neuroplastizität, Bischofswiesen, Germany
| | - Stephan Schmidt
- Neurologie, Gesundheitszentrum St. Johannes Hospital, Bonn, Germany
| | - Hayrettin Tumani
- Fachklinik für Neurologie Dietenbronn, Akademisches Krankenhaus der Universität Ulm, Ulm, Germany
| | - Frank Weber
- Neurologie, Sana Kliniken, Cham, Switzerland
| | - Martin S Weber
- Institut für Neuropathologie, Neurologische Klinik, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Uwe K Zettl
- Klinik und Poliklinik für Neurologie, Zentrum für Nervenheilkunde, Universitätsmedizin Rostock, Rostock, Germany
| | - Tjalf Ziemssen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Frauke Zipp
- Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
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Spelman T, Magyari M, Piehl F, Svenningsson A, Rasmussen PV, Kant M, Sellebjerg F, Joensen H, Hillert J, Lycke J. Treatment Escalation vs Immediate Initiation of Highly Effective Treatment for Patients With Relapsing-Remitting Multiple Sclerosis: Data From 2 Different National Strategies. JAMA Neurol 2021; 78:1197-1204. [PMID: 34398221 DOI: 10.1001/jamaneurol.2021.2738] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Treatment strategies for relapsing-remitting multiple sclerosis (RRMS) vary markedly between Denmark and Sweden. The difference in the association of these national strategies with clinical outcomes is unknown. Objective To investigate the association of national differences in disease-modifying treatment (DMT) strategies for RRMS with disability outcomes. Design, Setting, and Participants This cohort study used data on 4861 patients from the Danish and Swedish national multiple sclerosis (MS) registries from the date of index DMT initiation (between January 1, 2013, and December 31, 2016) until the last recorded visit at time of data extraction (October 2, 2019). Exposures All MS-specific DMTs initiated during the observation period were included in the analysis. Main Outcomes and Measures The primary study outcome was time to 24-week confirmed disability worsening. Secondary outcomes were 24-week confirmed disability improvement, milestone Expanded Disability Status Scale scores of 3 and 4, annualized relapse rate, time to first relapse, and treatment switching. Data were analyzed using inverse probability of treatment weighting-based models using a propensity score to weight and correct the comparison for the imbalance of confounders observed at baseline between the 2 countries. Results A total of 2700 patients from the Swedish MS registry (1867 women [69.2%]; mean [SD] age, 36.1 [9.5] years) and 2161 patients from the Danish MS registry (1472 women [68.1%]; mean [SD] age, 37.3 [9.4 years]) started a first DMT between 2013 and 2016, were included in the analysis, and were observed for a mean (SD) of 4.1 (1.5) years. A total of 1994 Danish patients (92.3%) initiated a low to moderately effective DMT (teriflunomide, 907 [42.0%]) and 165 (7.6%) initiated a highly effective DMT, whereas a total of 1769 Swedish patients (65.5%) initiated a low to moderately effective DMT (teriflunomide, 64 [2.4%]) and 931 (34.5%) initiated a highly effective DMT. The Swedish treatment strategy was associated with a 29% reduction in the rate of postbaseline 24-week confirmed disability worsening relative to the Danish treatment strategy (hazard ratio, 0.71; 95% CI, 0.57-0.90; P = .004). The Swedish treatment strategy was also associated with a 24% reduction in the rate of reaching an expanded disability status scale score of 3 (hazard ratio, 0.76; 95% CI, 0.60-0.97; P = .03) and a 25% reduction in the rate of reaching an expanded disability status scale score of 4 (hazard ratio, 0.75; 95% CI, 0.61-0.96; P = .01) relative to Danish patients. Conclusions and Relevance The findings of this study suggest that there is an association between differences in treatment strategies for RRMS and disability outcomes at a national level. Escalation of treatment efficacy was inferior to using more efficacious DMT as initial treatment.
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Affiliation(s)
- Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Anders Svenningsson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Matthias Kant
- Multiple Sclerosis Clinic Southern Denmark, Department of Brain and Nerve Diseases, University of Southern Denmark, Odense, Denmark.,Department of Brain & Nerve Diseases, Hospital of Southern Jutland, Odense, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanna Joensen
- The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Claflin SB, Campbell JA, Mason DF, Kalincik T, Simpson-Yap S, Norman R, Butzkueven H, Carroll WM, Palmer AJ, Blizzard CL, van der Mei I, Taylor BV. The effect of national disease-modifying therapy subsidy policy on long-term disability outcomes in people with multiple sclerosis. Mult Scler 2021; 28:831-841. [PMID: 34387513 DOI: 10.1177/13524585211035948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Disease-modifying therapies (DMTs) are used to treat people with relapsing-onset multiple sclerosis (ROMS), but our knowledge is largely limited to their short-term effects. OBJECTIVE To determine (1) the impact of national-level DMT subsidy policy on DMT use and health outcomes in people with MS (PwMS) and (2) the long-term effects of DMT on disability and quality of life (QoL; 5-level EQ-5D version (EQ-5D-5L) utility value). METHODS This observational cohort study compared Australian and New Zealand populations with different levels of DMT availability 10-20 years post-ROMS diagnosis. Between-country differences were assessed using standardised differences. Associations were assessed with multivariable linear regression models. RESULTS We recruited 328 Australians and 256 New Zealanders. The Australian cohort had longer DMT treatment duration, greater proportion of disease course treated and shorter duration between diagnosis and starting DMT. The Australian cohort had lower median Expanded Disability Status Scale (EDSS) (3.5 vs 4.0) and Multiple Sclerosis Severity Score (MSSS) (3.05 vs 3.71) and higher QoL (0.71 vs 0.65). In multivariable models, between-country differences in disability and QoL were largely attributed to differential use of DMT. CONCLUSIONS This study provides evidence for the impact of national-level DMT policy on disability outcomes in PwMS. Where DMTs are more accessible, PwMS experienced less disability progression and improved QoL 10-20 years post-diagnosis.
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Affiliation(s)
- Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Deborah F Mason
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Tomas Kalincik
- CORe The University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Neuroepidemiology Unit, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Helmut Butzkueven
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | | | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - C Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Abbadessa G, Miele G, Cavalla P, Valentino P, Marfia GA, Signoriello E, Landi D, Bosa C, Vercellino M, De Martino A, Missione R, Sparaco M, Lavorgna L, Lus G, Bonavita S. CD19 Cell Count at Baseline Predicts B Cell Repopulation at 6 and 12 Months in Multiple Sclerosis Patients Treated with Ocrelizumab. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8163. [PMID: 34360456 PMCID: PMC8346113 DOI: 10.3390/ijerph18158163] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The kinetics of B cell repopulation in MS patients treated with Ocrelizumab is highly variable, suggesting that a fixed dosage and time scheduling might be not optimal. We aimed to investigate whether B cell repopulation kinetics influences clinical and radiological outcomes and whether circulating immune asset at baseline affects B cell repopulation kinetics. METHODS 218 MS patients treated with Ocrelizumab were included. Every six months we collected data on clinical and magnetic resonance imaging (MRI) activity and lymphocyte subsets at baseline. According to B cell counts at six and twelve months, we identified two groups of patients, those with fast repopulation rate (FR) and those with slow repopulation rate (SR). RESULTS A significant reduction in clinical and radiological activity was found. One hundred fifty-five patients had complete data and received at least three treatment cycles (twelve-month follow-up). After six months, the FR patients were 41/155 (26.45%) and 10/41 (29.27%) remained non-depleted after twelve months. FR patients showed a significantly higher percentage of active MRI scan at twelve months (17.39% vs. 2.53%; p = 0,008). Furthermore, FR patients had a higher baseline B cell count compared to patients with an SR (p = 0.02 and p = 0.002, at the six- and twelve-month follow-ups, respectively). CONCLUSION A considerable proportion of MS patients did not achieve a complete CD19 cell depletion and these patients had a higher baseline CD19 cell count. These findings, together with the higher MRI activity found in FR patients, suggest that the Ocrelizumab dosage could be tailored depending on CD19 cell counts at baseline in order to achieve complete disease control in all patients.
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Affiliation(s)
- Gianmarco Abbadessa
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.A.); (G.M.); (E.S.); (R.M.); (M.S.); (L.L.); (G.L.)
| | - Giuseppina Miele
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.A.); (G.M.); (E.S.); (R.M.); (M.S.); (L.L.); (G.L.)
| | - Paola Cavalla
- Multiple Sclerosis Center, AOU Città della Salute e della Scienza di Torino, 10147 Turin, Italy; (P.C.); (C.B.); (M.V.)
| | - Paola Valentino
- Institute of Neurology, University “Magna Graecia”, 88100 Catanzaro, Italy; (P.V.); (A.D.M.)
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (G.A.M.); (D.L.)
| | - Elisabetta Signoriello
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.A.); (G.M.); (E.S.); (R.M.); (M.S.); (L.L.); (G.L.)
| | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (G.A.M.); (D.L.)
| | - Chiara Bosa
- Multiple Sclerosis Center, AOU Città della Salute e della Scienza di Torino, 10147 Turin, Italy; (P.C.); (C.B.); (M.V.)
| | - Marco Vercellino
- Multiple Sclerosis Center, AOU Città della Salute e della Scienza di Torino, 10147 Turin, Italy; (P.C.); (C.B.); (M.V.)
| | - Antonio De Martino
- Institute of Neurology, University “Magna Graecia”, 88100 Catanzaro, Italy; (P.V.); (A.D.M.)
| | - Rosanna Missione
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.A.); (G.M.); (E.S.); (R.M.); (M.S.); (L.L.); (G.L.)
| | - Maddalena Sparaco
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.A.); (G.M.); (E.S.); (R.M.); (M.S.); (L.L.); (G.L.)
| | - Luigi Lavorgna
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.A.); (G.M.); (E.S.); (R.M.); (M.S.); (L.L.); (G.L.)
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.A.); (G.M.); (E.S.); (R.M.); (M.S.); (L.L.); (G.L.)
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (G.A.); (G.M.); (E.S.); (R.M.); (M.S.); (L.L.); (G.L.)
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Wiendl H, Gold R, Berger T, Derfuss T, Linker R, Mäurer M, Stangel M, Aktas O, Baum K, Berghoff M, Bittner S, Chan A, Czaplinski A, Deisenhammer F, Di Pauli F, Du Pasquier R, Enzinger C, Fertl E, Gass A, Gehring K, Gobbi C, Goebels N, Guger M, Haghikia A, Hartung HP, Heidenreich F, Hoffmann O, Hunter ZR, Kallmann B, Kleinschnitz C, Klotz L, Leussink V, Leutmezer F, Limmroth V, Lünemann JD, Lutterotti A, Meuth SG, Meyding-Lamadé U, Platten M, Rieckmann P, Schmidt S, Tumani H, Weber MS, Weber F, Zettl UK, Ziemssen T, Zipp F. [Multiple sclerosis treatment consensus group (MSTCG): position paper on disease-modifying treatment of multiple sclerosis 2021 (white paper)]. DER NERVENARZT 2021; 92:773-801. [PMID: 34297142 PMCID: PMC8300076 DOI: 10.1007/s00115-021-01157-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 12/16/2022]
Abstract
Die Multiple Sklerose ist eine komplexe, autoimmun vermittelte Erkrankung des zentralen Nervensystems, charakterisiert durch inflammatorische Demyelinisierung sowie axonalen/neuronalen Schaden. Die Zulassung verschiedener verlaufsmodifizierender Therapien und unser verbessertes Verständnis der Krankheitsmechanismen und -entwicklung in den letzten Jahren haben die Prognose und den Verlauf der Erkrankung deutlich verändert. Diese Aktualisierung der Behandlungsempfehlung der Multiple Sklerose Therapie Konsensus Gruppe konzentriert sich auf die wichtigsten Empfehlungen für verlaufsmodifizierende Therapien der Multiplen Sklerose im Jahr 2021. Unsere Empfehlungen basieren auf aktuellen wissenschaftlichen Erkenntnissen und gelten für diejenigen Medikamente, die in weiten Teilen Europas, insbesondere in den deutschsprachigen Ländern (Deutschland, Österreich, Schweiz), zugelassen sind.
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Affiliation(s)
- Heinz Wiendl
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland. .,Steuerungsgruppe der MSTKG, Münster, Deutschland. .,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.
| | - Ralf Gold
- Steuerungsgruppe der MSTKG, Münster, Deutschland. .,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland. .,Neurologie, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
| | - Thomas Berger
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Österreich
| | - Tobias Derfuss
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Neurologische Klinik und Poliklinik, Universitätsspital Basel, Basel, Schweiz
| | - Ralf Linker
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Mathias Mäurer
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Neurologie und Neurologische Frührehabilitation, Klinikum Würzburg Mitte gGmbH, Standort Juliusspital, Würzburg, Deutschland
| | - Martin Stangel
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Klinische Neuroimmunologie und Neurochemie, Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Orhan Aktas
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Karl Baum
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Martin Berghoff
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Stefan Bittner
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Andrew Chan
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Adam Czaplinski
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | | | - Franziska Di Pauli
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Renaud Du Pasquier
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Christian Enzinger
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Elisabeth Fertl
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Achim Gass
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Klaus Gehring
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Claudio Gobbi
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Norbert Goebels
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Michael Guger
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Aiden Haghikia
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Hans-Peter Hartung
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Fedor Heidenreich
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Olaf Hoffmann
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Zoë R Hunter
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Boris Kallmann
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | | | - Luisa Klotz
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Verena Leussink
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Fritz Leutmezer
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Volker Limmroth
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Jan D Lünemann
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Andreas Lutterotti
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Sven G Meuth
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Uta Meyding-Lamadé
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Michael Platten
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Peter Rieckmann
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Stephan Schmidt
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Hayrettin Tumani
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Martin S Weber
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Frank Weber
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Uwe K Zettl
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Tjalf Ziemssen
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Frauke Zipp
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
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45
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Nonino F, Baldin E, Ridley B, Casetta I, Iuliano G, Filippini G. Azathioprine for people with multiple sclerosis. Hippokratia 2021. [DOI: 10.1002/14651858.cd015005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Francesco Nonino
- IRCCS Istituto delle Scienze Neurologiche di Bologna; Bologna Italy
| | - Elisa Baldin
- IRCCS Istituto delle Scienze Neurologiche di Bologna; Bologna Italy
| | - Ben Ridley
- IRCCS Istituto delle Scienze Neurologiche di Bologna; Bologna Italy
| | - Ilaria Casetta
- Sezione di Clinica Neurologica; Dip.to di Discipline Medico Chirurgiche della Comunicazione e del Comportamento; Universita degli Studi di Ferrara; Ferrara Italy
| | | | - Graziella Filippini
- Scientific Director’s Office; Carlo Besta Foundation and Neurological Institute; Milan Italy
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Roos I, Leray E, Casey R, Horakova D, Havrdova E, Izquierdo G, Madueño SE, Patti F, Edan G, Debouverie M, Pelletier J, Ozakbas S, Amato MP, Clavelou P, Grammond P, Boz C, Buzzard K, Skibina O, Ciron J, Gerlach O, Grand'Maison F, Lechner-Scott J, Malpas MPsych CliNeuro C, Butzkueven H, Vukusic S, Kalincik T. Effects of High and Low Efficacy Therapy in Secondary Progressive Multiple Sclerosis. Neurology 2021; 97:e869-e880. [PMID: 34193589 DOI: 10.1212/wnl.0000000000012354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/19/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To compare the clinical effectiveness of high- and low-efficacy treatments in patients with recently active and inactive secondary progressive multiple sclerosis (SPMS) after accounting for therapeutic lag. METHODS Patients treated with high- (natalizumab, alemtuzumab, mitoxantrone, ocrelizumab, rituximab, cladribine, fingolimod) or low-efficacy (interferon β, glatiramer acetate, teriflunomide) therapies after SPMS onset were selected from MSBase and OFSEP, two large observational cohorts. Therapeutic lag was estimated for each patient based on their demographic and clinical characteristics. Propensity score was used to match patients treated with high and low-efficacy therapies. Outcomes after disregarding the period of therapeutic lag were compared in paired, pairwise-censored analyses. RESULTS 1000 patients were included in the primary analysis. Patients with active SPMS treated with high-efficacy therapy experienced less frequent relapses than those on low-efficacy therapy (hazard ratio [HR] 0.7, p=0.006). In patients with inactive SPMS, there was no evidence for a difference in relapse frequency between groups (HR=0.8,p=0.39). No evidence for a difference in the risk of disability progression was observed. CONCLUSION In treated patients with SPMS, high-efficacy therapy is superior to low-efficacy therapy in reducing relapses in patients with active, but not those with inactive, SPMS. However, more potent therapies do not offer an advantage in reducing disability progression in this patient group. CLASSIFICATION OF EVIDENCE This study provides class III evidence that high-efficacy therapy is superior to low-efficacy therapy in reducing relapses in patients with active SPMS whilst we did not find a difference in disability progression between patients treated with high- and low-efficacy therapy.
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Affiliation(s)
- Izanne Roos
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne
| | - Emmanuelle Leray
- Rennes University, EHESP, REPERES EA 7449, F-35000 Rennes, France.,Univ Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], F-35000 Rennes, France
| | | | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | | | - Francesco Patti
- Department of Medical and Surgical Sciences and Advanced Technologies, GF Ingrassia, Catania, Italy.,Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Gilles Edan
- Centre hospitalier universitaire de Rennes, Hôpital Pontchaillou, Service de neurologie, CIC1414 INSERM, F-35000 Rennes, France
| | - Marc Debouverie
- Nancy University Hospital, Department of Neurology, Nancy, France. Université de Lorraine, APEMAC, F-54000 Nancy, France
| | - Jean Pelletier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005 Marseille, France
| | | | - Maria Pia Amato
- Department of Neurosciences, Psychology, Drugs and Child Health Area (NEUROFARBA), Section Neurosciences, University of Florence, Florence, Italy
| | - Pierre Clavelou
- CHU Clermont-Ferrand, Department of Neurology, F-63000 Clermont-Ferrand.,Université Clermont Auvergne, Inserm, Neuro-Dol, F-63000 Clermont-Ferrand, France France
| | | | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - Katherine Buzzard
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia
| | - Olga Skibina
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia.,The Alfred Hospital, Melbourne, Australia
| | - Jonathan Ciron
- CHU de Toulouse, Hôpital Pierre-Paul Riquet, Department of Neurology, CRC-SEP, F-31059 Toulouse Cedex 9, France
| | - Oliver Gerlach
- Department of Neurology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, Australia.,Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia
| | - Charles Malpas MPsych CliNeuro
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia.,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne
| | - Helmut Butzkueven
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia.,Department of Neurology, The Alfred Hospital, Melbourne, Australia
| | | | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Australia .,Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne
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Rojas JI, Patrucco L, Fruns M, Hornung G, Flores J, Carnero Contentti E, Lopez PA, Pettinicchi JP, Caride A, Galleguillos L, Barahona J, Diaz V, Hernández M, Alonso R, Cristiano E. Real-world experience of ocrelizumab in multiple sclerosis patients in Latin America. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:305-309. [PMID: 34133511 DOI: 10.1590/0004-282x-anp-2020-0339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the abundance of information concerning ocrelizumab in phase III clinical trials, there is scarce evidence regarding real-world patient profiles. OBJECTIVE The aim of this study was to investigate patient profiles, effectiveness and persistence with treatment among patients who used ocrelizumab for treatment of multiple sclerosis in Latin America. METHODS This was a retrospective multicenter study in Argentina, Chile and Mexico. Medical record databases on patients who received ocrelizumab were analyzed. Demographic and clinical variables were described, along with effectiveness outcomes, which included the proportions of patients free from clinical relapses, from disability progression and from new or enlarging T2 or T1 gadolinium-enhancing lesions, on annual magnetic resonance imaging. RESULTS A total of 81 patients were included. The most frequent phenotype was relapsing-remitting MS, in 64.2% of the patients. The mean age at study entry was 41.3 ± 12.0 years and 51.8% were women. A total of 38% had had relapse activity during the 12 months before starting on ocrelizumab, with a mean relapse rate of 1.3 ± 0.6 during that period. 75% were free from clinical relapses and 91% were free from gadolinium-enhancing lesions in the relapsing-remitting course. Ocrelizumab discontinuation during the first 12 months was observed in three patients (3.7%). The mean persistence observed during the first-year follow-up was 338 ± 24 days. CONCLUSIONS Our study is in line with previous randomized clinical trials and recent real-world studies describing patient profiles, effectiveness and persistence regarding ocrelizumab treatment in multiple sclerosis patients in Latin America.
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Affiliation(s)
- Juan Ignacio Rojas
- Hospital Universitario de CEMIC, Servicio de Neurología, Buenos Aires, Argentina.,Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina.,Hospital Italiano de Buenos Aires, Servicio de Neurología, Buenos Aires, Argentina
| | | | | | - José Flores
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México.,Centro Neurológico ABC Santa Fé, Ciudad de México, México
| | | | - Pablo Adrian Lopez
- Hospital Alemán, Department of Neuroscience, Neuroimmunology Unit, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Hospital Alemán, Department of Neuroscience, Neuroimmunology Unit, Buenos Aires, Argentina
| | - Alejandro Caride
- Hospital Alemán, Department of Neuroscience, Neuroimmunology Unit, Buenos Aires, Argentina
| | - Lorna Galleguillos
- Clínica Alemana de Santiago, Unidad de Neuroinmunología, Santiago, Región Metropolitana, Chile
| | - Jorge Barahona
- Clínica Alemana de Santiago, Unidad de Neuroinmunología, Santiago, Región Metropolitana, Chile
| | - Violeta Diaz
- Clínica Alemana de Santiago, Unidad de Neuroinmunología, Santiago, Región Metropolitana, Chile
| | - Marianella Hernández
- Clínica Alemana de Santiago, Unidad de Neuroinmunología, Santiago, Región Metropolitana, Chile
| | - Ricardo Alonso
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina.,Hospital Universitario Sanatorio Guemes, Servicio de Neurología, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
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48
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Ohle LM, Ellenberger D, Flachenecker P, Friede T, Haas J, Hellwig K, Parciak T, Warnke C, Paul F, Zettl UK, Stahmann A. Chances and challenges of a long-term data repository in multiple sclerosis: 20th birthday of the German MS registry. Sci Rep 2021; 11:13340. [PMID: 34172792 PMCID: PMC8233364 DOI: 10.1038/s41598-021-92722-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/15/2021] [Indexed: 01/25/2023] Open
Abstract
In 2001, the German Multiple Sclerosis Society, facing lack of data, founded the German MS Registry (GMSR) as a long-term data repository for MS healthcare research. By the establishment of a network of participating neurological centres of different healthcare sectors across Germany, GMSR provides observational real-world data on long-term disease progression, sociodemographic factors, treatment and the healthcare status of people with MS. This paper aims to illustrate the framework of the GMSR. Structure, design and data quality processes as well as collaborations of the GMSR are presented. The registry’s dataset, status and results are discussed. As of 08 January 2021, 187 centres from different healthcare sectors participate in the GMSR. Following its infrastructure and dataset specification upgrades in 2014, more than 196,000 visits have been recorded relating to more than 33,000 persons with MS (PwMS). The GMSR enables monitoring of PwMS in Germany, supports scientific research projects, and collaborates with national and international MS data repositories and initiatives. With its recent pharmacovigilance extension, it aligns with EMA recommendations and helps to ensure early detection of therapy-related safety signals.
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Affiliation(s)
- Lisa-Marie Ohle
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Projectdevelopment gGmbH [MSFP]), Krausenstr 50, 30171, Hannover, Germany
| | - David Ellenberger
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Projectdevelopment gGmbH [MSFP]), Krausenstr 50, 30171, Hannover, Germany
| | | | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Judith Haas
- Deutsche Multiple Sklerose Gesellschaft, Bundesverband e.V. (German Multiple Sclerosis Society, Federal Association), Hannover, Germany
| | - Kerstin Hellwig
- Department of Neurology, Katholisches Klinikum, St. Joseph Hospital, Ruhr University Bochum, Bochum, Germany
| | - Tina Parciak
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Clemens Warnke
- Department of Neurology, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University Medical Center Rostock, Rostock, Germany
| | - Alexander Stahmann
- MS Forschungs- und Projektentwicklungs-gGmbH (MS Research and Projectdevelopment gGmbH [MSFP]), Krausenstr 50, 30171, Hannover, Germany.
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Natural history of relapsing remitting multiple sclerosis in a long-lasting cohort from a tertiary MS centre in Portugal. Mult Scler Relat Disord 2021; 54:103091. [PMID: 34246020 DOI: 10.1016/j.msard.2021.103091] [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: 11/25/2020] [Revised: 05/27/2021] [Accepted: 06/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several disease-modifying therapies (DMTs) have emerged in the last two decades for the treatment of multiple sclerosis (MS). The increasing use of these therapies has enhanced the need to study its impact on long-term disease progression and on the natural history of MS. This study aimed to characterize a Portuguese MS patient cohort in what concerns the natural history of disease by exploring differences throughout 3 decades. METHODS Longitudinal, retrospective, non-interventional study. Patients aged ≥ 18 years old, with confirmed diagnosis of relapsing-remitting MS (RRMS), were included. Biodemographic and clinical characteristics (MS diagnosis, patient follow-up, relapses, treatment, and exams) were assessed and compared according to the first appointment date throughout 10-year spans (1987-1996; 1997-2006; 2007-2016). RESULTS 548 patients were included in this analysis. Significant differences were observed between decades for evoked potential (EP) and cerebrospinal fluid (CSF) exams conducted at diagnosis, the first with less expression on the last decade; the median number of relapses per year (higher in the subgroup 07-16); EDSS at baseline and at last appointment (both higher in the subgroup 87-96); and the percentage of patients achieving EDSS 3.0 and EDSS 6.0 (increased in the subgroup 87-96). Additionally, time from diagnosis to first treatment was significantly lower in patients from the most recent decade, and a greater percentage of such patients, compared to the other two subgroups, was, at last appointment, under a second line DMT. CONCLUSION In general, our study reflects findings from longitudinal studies on MS progression already published in the literature. In recent years, the growing number of more effective DMTs, along with earlier disease detection, and improvements in access to healthcare appear to have had a positive impact on patients' access to treatment and, consequently, disease progression. Additional studies, with increased follow up time, are needed to further investigate the effect of treatment improvement in the natural history of MS.
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Portaccio E, Tudisco L, Pastò L, Razzolini L, Fonderico M, Bellinvia A, Ghezzi A, Annovazzi P, Zaffaroni M, Moiola L, Martinelli V, Chisari CG, Patti F, Mancardi G, Pozzilli C, De Giglio L, Totaro R, Lugaresi A, Di Tommaso V, Paolicelli D, Cocco E, Marrosu MG, Comi G, Filippi M, Trojano M, Amato MP. Pregnancy in multiple sclerosis women with relapses in the year before conception increases the risk of long-term disability worsening. Mult Scler 2021; 28:472-479. [PMID: 34132146 DOI: 10.1177/13524585211023365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The influence of pregnancy on long-term disability in multiple sclerosis (MS) is still controversial. OBJECTIVE To assess the risk of long-term disability worsening after pregnancy in MS women as compared with a propensity-score (PS) matched group of MS women without pregnancy. METHODS In the setting of the Italian Pregnancy Dataset, MS patients with (pregnancy group (PG)) and without pregnancy (control group (CG)) were recruited. Time to disability worsening on the Expanded Disability Status Scale (EDSS) was assessed through a multivariable Cox regression model. RESULTS The PS-matching retained 230 PG and 102 CG patients. After a follow-up of 6.5 +/- 3.1 years, disability worsening occurred in 87 (26.2%) women. In the multivariable analysis, disability worsening was associated with pregnancy in women with relapses in the year before conception (adjusted hazard ratio (aHR) = 1.74; 95% confidence interval (CI) 1.06-2.84; p = 0.027), higher EDSS (aHR = 1.39; 95% CI 1.12-1.74; p = 0.003), younger age (aHR = 0.95; 95% CI 0.91-0.99; p = 0.022) and shorter DMD exposure over the follow-up (p < 0.008). CONCLUSION Pregnancy in MS women with relapses in the year before conception increases the risk of long-term disability worsening. Our findings underscore the importance of counselling in MS women facing a pregnancy that should be planned after a period of clinical stability, favouring treatment optimization in patients with recent disease activity.
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Affiliation(s)
- Emilio Portaccio
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Laura Tudisco
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Luisa Pastò
- Division Neurological Rehabilitation, Careggi University Hospital, Florence, Italy
| | - Lorenzo Razzolini
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Mattia Fonderico
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Angelo Bellinvia
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Angelo Ghezzi
- Multiple Sclerosis Center, ASST Valle Olona, Gallarate Hospital (VA), Gallarate, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Center, ASST Valle Olona, Gallarate Hospital (VA), Gallarate, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, ASST Valle Olona, Gallarate Hospital (VA), Gallarate, Italy
| | - Lucia Moiola
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vittorio Martinelli
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Francesco Patti
- Department of Neurology, University of Catania, Catania, Italy
| | | | - Carlo Pozzilli
- Department of Neurology and Psychiatry, 'La Sapienza' University, Rome, Italy
| | - Laura De Giglio
- Department of Neurology and Psychiatry, 'La Sapienza' University, Rome, Italy
| | - Rocco Totaro
- Demyelinating Disease Center, Department of Neurology, San Salvatore Hospital, L'Aquila, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy/Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Valeria Di Tommaso
- Department of Neuroscience and Imaging, University 'G. d'Annunzio' of Chieti, Chieti, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Eleonora Cocco
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Maria Giovanna Marrosu
- Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Giancarlo Comi
- Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy/Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Neurophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Maria Pia Amato
- Division Neurological Rehabilitation, Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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