1
|
de Deus Vieira G, Antônio FF, Damasceno A. Enlargement of the choroid plexus in pediatric multiple sclerosis. Neuroradiology 2024; 66:1199-1202. [PMID: 38668802 DOI: 10.1007/s00234-024-03366-3] [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: 12/22/2023] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Abstract
Some studies have suggested an inflammatory role of the choroid plexus (CP) in the pathophysiology of multiple sclerosis (MS), but mainly in adult patients. We aimed to evaluate clinical and MRI parameters in patients with pediatric-onset multiple sclerosis (POMS). We included 10 patients with POMS and 16 healthy controls (HC), evaluating clinical and neuroimaging variables (cerebral cortex, CP, deep gray matter structures, and demyelinating lesions). Most patients were girls (80%), with a mean age of 15.3 years. POMS individuals had a higher CP volume (p = 0.012) and lower thalamic volume (p = 0.038) compared to HC. This study shows an enlargement of the CP and lower thalamic volume in POMS patients compared to HC.
Collapse
Affiliation(s)
- Gabriel de Deus Vieira
- Department of Neuroimmunology, University of Campinas, Vital Brasil Street 251, Campinas, SP, Brazil.
| | - Fernanda Ferrão Antônio
- Department of Neuroimmunology, University of Campinas, Vital Brasil Street 251, Campinas, SP, Brazil
| | - Alfredo Damasceno
- Department of Neuroimmunology, University of Campinas, Vital Brasil Street 251, Campinas, SP, Brazil
| |
Collapse
|
2
|
de Seze J, Dive D, Ayrignac X, Castelnovo G, Payet M, Rayah A, Gobbi C, Vermersch P, Zecca C. Narrative Review on the Use of Cladribine Tablets as Exit Therapy for Stable Elderly Patients with Multiple Sclerosis. Neurol Ther 2024; 13:519-533. [PMID: 38587749 PMCID: PMC11136913 DOI: 10.1007/s40120-024-00603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
The number of ageing people with relapsing multiple sclerosis (RMS) is increasing. The efficacy of disease-modifying therapies (DMTs) for RMS declines with age. Also, older persons with MS may be more susceptible to infections, hospitalisations and malignancy. Aging people with MS have higher rates of comorbidities versus aged-matched controls, increasing the individual risk of disability. We review the therapeutic properties of cladribine tablets (CladT) in ageing people with RMS, with regard to their utility for allowing these individuals to cease continuous administration of a DMT (i.e. to act as an "exit therapy"). CladT is thought to be an immune reconstitution therapy, in that two short courses of oral treatment 1 year apart provide suppression of MS disease activity in responders that far outlasts the duration of treatment and post-treatment reductions in lymphocyte counts. Post hoc analyses, long-term follow-up of populations with RMS in randomised trials, and real-world evidence suggest that the efficacy of CladT is probably independent of age, although more data in the elderly are still needed. No clear adverse signals for lymphopenia or other adverse safety signals have emerged with increasing age, although immunosenescence in the setting of age-related "inflammaging" may predispose elderly patients to a higher risk of infections. Updating vaccination status is recommended, especially against pneumococci and herpes zoster for older patients, to minimise the risk of these infections. CladT may be a useful alternative treatment for ageing people with MS who often bear a burden of multiple comorbidities and polypharmacy and who are more exposed to the adverse effects of continuous immunosuppressive therapy.
Collapse
Affiliation(s)
- Jerome de Seze
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France.
| | - Dominique Dive
- Department of Neurology, Liège University Hospital, Liège, Belgium
| | - Xavier Ayrignac
- Department of Neurology, University of Montpellier, INM, INSERM, Montpellier University Hospital, Montpellier, France
| | - Giovanni Castelnovo
- Department of Neurology, Nîmes University Hospital, Hopital Caremeau, Nîmes, France
| | - Marianne Payet
- Merck Santé S.A.S., an Affiliate of Merck KGaA, Lyon, France
| | - Amel Rayah
- Merck Santé S.A.S., an Affiliate of Merck KGaA, Lyon, France
| | - Claudio Gobbi
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Patrick Vermersch
- University of Lille, INSERM U1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Chiara Zecca
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| |
Collapse
|
3
|
Young CA, Rog DJ, Sharrack B, Tanasescu R, Kalra S, Harrower T, Tennant A, Mills RJ. Correlates and trajectories of relapses in relapsing-remitting multiple sclerosis. Neurol Sci 2024; 45:2181-2189. [PMID: 37976012 PMCID: PMC11021238 DOI: 10.1007/s10072-023-07155-3] [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: 02/02/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND AIMS In people with relapsing-remitting multiple sclerosis (pwRRMS), data from studies on non-pharmacological factors which may influence relapse risk, other than age, are inconsistent. There is a reduced risk of relapses with increasing age, but little is known about other trajectories in real-world MS care. METHODS We studied longitudinal questionnaire data from 3885 pwRRMS, covering smoking, comorbidities, disease-modifying therapy (DMT), and patient-reported outcome measures, as well as relapses during the past year. We undertook Rasch analysis, group-based trajectory modelling, and multilevel negative binomial regression. RESULTS The regression cohort of 6285 data sets from pwRRMS over time showed that being a current smoker was associated with 43.9% greater relapse risk; having 3 or more comorbidities increased risk and increasing age reduced risk. Those diagnosed within the last 2 years showed two distinct trajectories, both reducing in relapse frequency but 25.8% started with a higher rate and took 4 years to reduce to the rate of the second group. In the cohort with at least three data points completed, there were three groups: 73.7% followed a low stable relapse rate, 21.6% started from a higher rate and decreased, and 4.7% had an increasing then decreasing pattern. These different trajectory groups showed significant differences in fatigue, neuropathic pain, disability, health status, quality of life, self-efficacy, and DMT use. CONCLUSIONS These results provide additional evidence for supporting pwRRMS to stop smoking and underline the importance of timely DMT decisions and treatment initiation soon after diagnosis with RRMS.
Collapse
Affiliation(s)
- Carolyn A Young
- Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK, University of Liverpool, Liverpool, UK.
| | - David J Rog
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Basil Sharrack
- Academic Department of Neurology, University of Sheffield, Sheffield, UK
| | | | - Seema Kalra
- University Hospital of North Midlands NHS Trust, Stoke-On-Trent, UK
| | | | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Roger J Mills
- Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK, University of Liverpool, Liverpool, UK
| |
Collapse
|
4
|
Jouvenot G, Courbon G, Lefort M, Rollot F, Casey R, Le Page E, Michel L, Edan G, de Seze J, Kremer L, Bigaut K, Vukusic S, Mathey G, Ciron J, Ruet A, Maillart E, Labauge P, Zephir H, Papeix C, Defer G, Lebrun-Frenay C, Moreau T, Laplaud DA, Berger E, Stankoff B, Clavelou P, Thouvenot E, Heinzlef O, Pelletier J, Al-Khedr A, Casez O, Bourre B, Cabre P, Wahab A, Magy L, Camdessanché JP, Doghri I, Moulin S, Ben-Nasr H, Labeyrie C, Hankiewicz K, Neau JP, Pottier C, Nifle C, Collongues N, Kerbrat A. High-Efficacy Therapy Discontinuation vs Continuation in Patients 50 Years and Older With Nonactive MS. JAMA Neurol 2024; 81:490-498. [PMID: 38526462 PMCID: PMC10964164 DOI: 10.1001/jamaneurol.2024.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/05/2024] [Indexed: 03/26/2024]
Abstract
Importance A recent randomized clinical trial concluded that discontinuing medium-efficacy therapy might be a reasonable option for older patients with nonactive multiple sclerosis (MS), but there is a lack of data on discontinuing high-efficacy therapy (HET). In younger patients, the discontinuation of natalizumab and fingolimod is associated with a risk of rebound of disease activity. Objective To determine whether discontinuing HET in patients 50 years and older with nonactive MS is associated with an increased risk of relapse compared with continuing HET. Design, Setting, and Participants This observational cohort study used data from 38 referral centers from the French MS registry (Observatoire Français de la Sclérose en Plaques [OFSEP] database). Among 84704 patients in the database, data were extracted for 1857 patients 50 years and older with relapsing-remitting MS treated by HET and with no relapse or magnetic resonance imaging activity for at least 2 years. After verification of the medical records, 1620 patients were classified as having discontinued HET or having remained taking treatment and were matched 1:1 using a dynamic propensity score (including age, sex, disease phenotype, disability, treatment of interest, and time since last inflammatory activity). Patients were included from February 2008 to November 2021, with a mean (SD) follow-up of 5.1 (2.9) years. Data were extracted in June 2022. Exposures Natalizumab, fingolimod, rituximab, and ocrelizumab. Main Outcomes and Measures Time to first relapse. Results Of 1620 included patients, 1175 (72.5%) were female, and the mean (SD) age was 54.7 (4.8) years. Among the 1452 in the HET continuation group and 168 in the HET discontinuation group, 154 patients in each group were matched using propensity scores (mean [SD] age, 57.7 [5.5] years; mean [SD] delay since the last inflammatory activity, 5.6 [3.8] years; mean [SD] follow-up duration after propensity score matching, 2.5 [2.1] years). Time to first relapse was significantly reduced in the HET discontinuation group compared with the HET continuation group (hazard ratio, 4.1; 95% CI, 2.0-8.5; P < .001) but differed between HETs, with a hazard ratio of 7.2 (95% CI, 2.1-24.5; P = .001) for natalizumab, 4.5 (95% CI, 1.3-15.5; P = .02) for fingolimod, and 1.1 (95% CI, 0.3-4.8; P = .85) for anti-CD20 therapy. Conclusion and Relevance As in younger patients, in patients 50 years and older with nonactive MS, the risk of relapse increased significantly after stopping HETs that impact immune cell trafficking (natalizumab and fingolimod). There was no significant increase in risk after stopping HETs that deplete B-cells (anti-CD20 therapy). This result may inform decisions about stopping HETs in clinical practice.
Collapse
Affiliation(s)
- Guillaume Jouvenot
- Center for Clinical Investigation, INSERM U1434, Strasbourg, France
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
| | - Guilhem Courbon
- Department of Neurology, University Hospital of Rennes, Rennes, France
| | - Mathilde Lefort
- University of Rennes, EHESP, CNRS, INSERM, Arènes—UMR 6051, RSMS (Recherche sur les Services et Management en Santé)—U 1309, Rennes, France
| | - Fabien Rollot
- Université de Lyon, Université Claude Bernard, Lyon, France
- Department of Neurology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Bron, France
- Centre de Recherche en Neurosciences de Lyon, Observatoire Français de La Sclérose en Plaques, INSERM 1028 and CNRS UMR 5292, Lyon, France
- Eugène Devic EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Romain Casey
- Université de Lyon, Université Claude Bernard, Lyon, France
- Department of Neurology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Bron, France
- Centre de Recherche en Neurosciences de Lyon, Observatoire Français de La Sclérose en Plaques, INSERM 1028 and CNRS UMR 5292, Lyon, France
- Eugène Devic EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Emmanuelle Le Page
- Department of Neurology, University Hospital of Rennes, Rennes, France
- CIC-P 1414 INSERM, University Hospital of Rennes, Rennes, France
| | - Laure Michel
- Department of Neurology, University Hospital of Rennes, Rennes, France
- CIC-P 1414 INSERM, University Hospital of Rennes, Rennes, France
| | - Gilles Edan
- Department of Neurology, University Hospital of Rennes, Rennes, France
- CIC-P 1414 INSERM, University Hospital of Rennes, Rennes, France
| | - Jérome de Seze
- Center for Clinical Investigation, INSERM U1434, Strasbourg, France
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - Laurent Kremer
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - Kevin Bigaut
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
| | - Sandra Vukusic
- Université de Lyon, Université Claude Bernard, Lyon, France
- Department of Neurology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Bron, France
- Centre de Recherche en Neurosciences de Lyon, Observatoire Français de La Sclérose en Plaques, INSERM 1028 and CNRS UMR 5292, Lyon, France
- Eugène Devic EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Guillaume Mathey
- Department of Neurology, Nancy University Hospital, Nancy, France
- Université de Lorraine, APEMAC, Nancy, France
| | - Jonathan Ciron
- CRC-SEP, Department of Neurology, CHU de Toulouse, Toulouse, France
| | - Aurélie Ruet
- Department of Neurology, CHU de Bordeaux, CIC Bordeaux CIC1401, Bordeaux, France
| | - Elisabeth Maillart
- Département de Neurologie, Hôpital Pitié-Salpêtrière, APHP, Centre de Ressources et de Compétences SEP, Paris, France
| | | | | | - Caroline Papeix
- Department of Neurology, Fondation Rothschild, Paris, France
| | - Gilles Defer
- Department of Neurology, MS Expert Centre, CHU de Caen, Caen, France
| | - Christine Lebrun-Frenay
- Neurology, UR2CA-URRIS, Centre Hospitalier Universitaire Pasteur2, Université Nice Côte d’Azur, Nice, France
| | | | - David Axel Laplaud
- Department of Neurology, CHU de Nantes, Nantes, France
- Nantes Université, CHU Nantes, INSERM, CIC 14131413, Center for Research in Translational Immunology, UMR 1064, Nantes, France
| | - Eric Berger
- Service de Neurologie, CHU de Besançon, Besançon, France
| | - Bruno Stankoff
- Department of Neurology, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Pierre Clavelou
- Department of Neurology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Eric Thouvenot
- Department of Neurology, Nimes University Hospital, Nimes, France
| | | | - Jean Pelletier
- Service de Neurologie, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France
| | | | - Olivier Casez
- CHU Grenoble Alpes, Department of Neurology, Neurology MS Clinic Grenoble, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Philippe Cabre
- Department of Neurology, CHU de la Martinique, Fort-de-France, France
| | - Abir Wahab
- Department of Neurology, APHP, Hôpital Henri Mondor, Créteil, France
| | - Laurent Magy
- Department of Neurology, CHU de Limoges, Hôpital Dupuytren, Limoges, France
| | | | - Ines Doghri
- Department of Neurology, CHU de Tours, Hôpital Bretonneau, Tours, France
| | - Solène Moulin
- Department of Neurology, CHU de Reims, CRC-SEP, Reims, France
| | - Haifa Ben-Nasr
- Hôpital Sud Francilien, Department of Neurology, Corbeil-Essonnes, France
| | - Céline Labeyrie
- Department of Neurology, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Karolina Hankiewicz
- Department of Neurology, Hôpital Pierre Delafontaine, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Jean-Philippe Neau
- Department of Neurology, CHU La Milétrie, Hôpital Jean Bernard, Poitiers, France
| | - Corinne Pottier
- Department of Neurology, CH de Pontoise, Hôpital René Dubos, Pontoise, France
| | - Chantal Nifle
- Departement of Neurology, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Nicolas Collongues
- Center for Clinical Investigation, INSERM U1434, Strasbourg, France
- Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119, Strasbourg, France
- Department of Neurology, University Hospital of Strasbourg, Strasbourg, France
- Department of Pharmacology, Addictology, Toxicology and Therapeutics, Strasbourg University, Strasbourg, France
| | - Anne Kerbrat
- Department of Neurology, University Hospital of Rennes, Rennes, France
- CIC-P 1414 INSERM, University Hospital of Rennes, Rennes, France
- Empenn U1228, University of Rennes, Inria, CNRS, INSERM, IRISA UMR 6074, Rennes, France
| |
Collapse
|
5
|
Fernández Ó, Sörensen PS, Comi G, Vermersch P, Hartung HP, Leocani L, Berger T, Van Wijmeersch B, Oreja-Guevara C. Managing multiple sclerosis in individuals aged 55 and above: a comprehensive review. Front Immunol 2024; 15:1379538. [PMID: 38646534 PMCID: PMC11032020 DOI: 10.3389/fimmu.2024.1379538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple Sclerosis (MS) management in individuals aged 55 and above presents unique challenges due to the complex interaction between aging, comorbidities, immunosenescence, and MS pathophysiology. This comprehensive review explores the evolving landscape of MS in older adults, including the increased incidence and prevalence of MS in this age group, the shift in disease phenotypes from relapsing-remitting to progressive forms, and the presence of multimorbidity and polypharmacy. We aim to provide an updated review of the available evidence of disease-modifying treatments (DMTs) in older patients, including the efficacy and safety of existing therapies, emerging treatments such as Bruton tyrosine kinase (BTKs) inhibitors and those targeting remyelination and neuroprotection, and the critical decisions surrounding the initiation, de-escalation, and discontinuation of DMTs. Non-pharmacologic approaches, including physical therapy, neuromodulation therapies, cognitive rehabilitation, and psychotherapy, are also examined for their role in holistic care. The importance of MS Care Units and advance care planning are explored as a cornerstone in providing patient-centric care, ensuring alignment with patient preferences in the disease trajectory. Finally, the review emphasizes the need for personalized management and continuous monitoring of MS patients, alongside advocating for inclusive study designs in clinical research to improve the management of this growing patient demographic.
Collapse
Affiliation(s)
- Óscar Fernández
- Departament of Pharmacology, Faculty of Medicine; Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, Malaga, Spain
- Department of Pharmacology and Pediatry, Faculty of Medicine, University of Malaga, Malaga, Spain
| | - Per Soelberg Sörensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Copenhagen and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Giancarlo Comi
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Patrick Vermersch
- Univ. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Brain and Mind Center, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Palacky University Olomouc, Olomouc, Czechia
| | - Letizia Leocani
- Department of Neurorehabilitation Sciences, Multiple Sclerosis Centre Casa di Cura Igea, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Bart Van Wijmeersch
- University MS Centre, Hasselt-Pelt, Belgium
- Rehabilitation and Multiple Sclerosis (MS), Noorderhart Hospitals, Pelt, Belgium
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clínico Universitario San Carlos, IdISSC, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
6
|
Mahler MR, Magyari M, Pontieri L, Elberling F, Holm RP, Weglewski A, Poulsen MB, Storr LK, Bekyarov PA, Illes Z, Kant M, Sejbaek T, Stilund ML, Rasmussen PV, Brask M, Urbonaviciute I, Sellebjerg F. Prognostic factors for disease activity in newly diagnosed teriflunomide-treated patients with multiple sclerosis: a nationwide Danish study. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-333265. [PMID: 38569873 DOI: 10.1136/jnnp-2023-333265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/17/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Clinicians frequently rely on relapse counts, T2 MRI lesion load (T2L) and Expanded Disability Status Scale (EDSS) scores to guide treatment decisions for individuals diagnosed with multiple sclerosis (MS). This study evaluates how these factors, along with age and sex, influence prognosis during treatment with teriflunomide (TFL). METHODS We conducted a nationwide cohort study using data from the Danish Multiple Sclerosis Registry.Eligible participants had relapsing-remitting MS or clinically isolated syndrome and initiated TFL as their first treatment between 2013 and 2019. The effect of age, pretreatment relapses, T2L and EDSS scores on the risk of disease activity on TFL were stratified by sex. RESULTS In total, 784 individuals were included (57.4% females). A high number of pretreatment relapses (≥2) was associated with an increased risk of disease activity in females only (OR and (95% CI): 1.76 (1.11 to 2.81)). Age group 50+ was associated with a lower risk of disease activity in both sexes (OR females=0.28 (0.14 to 0.56); OR males=0.22 (0.09 to 0.55)), while age 35-49 showed a different impact in males and females (OR females=0.79 (0.50 to 1.23); OR males=0.42 (0.24 to 0.72)). EDSS scores and T2L did not show any consistent associations. CONCLUSION A high number of pretreatment relapses was only associated with an increased risk of disease activity in females, while age had a differential impact on the risk of disease activity according to sex. Clinicians may consider age, sex and relapses when deciding on TFL treatment.
Collapse
Affiliation(s)
- Mie Reith Mahler
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Luigi Pontieri
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Frederik Elberling
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Rolf Pringler Holm
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Arkadiusz Weglewski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Herlev Hospital, Herlev, Denmark
| | - Mai Bang Poulsen
- Department of Neurology, Nordsjaellands Hospital, Hilleroed, Denmark
| | | | | | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Matthias Kant
- Department of Neurology, Hospital of Southern Jutland Soenderborg Branch, Soenderborg, Denmark
| | - Tobias Sejbaek
- Department of Neurology, Esbjerg Central Hospital, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Morten Leif Stilund
- Department of Neurology, Physiotherapy and Occupational Therapy, Goedstrup Hospital, Herning, Denmark
| | - Peter V Rasmussen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Brask
- Department of Neurology, Viborg Regional Hospital, Viborg, Denmark
| | | | - Finn Sellebjerg
- The Danish Multiple Sclerosis Registry, Danish Multiple Sclerosis Research Center, Copenhagen University Hospital, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
Rovira À, Doniselli FM, Auger C, Haider L, Hodel J, Severino M, Wattjes MP, van der Molen AJ, Jasperse B, Mallio CA, Yousry T, Quattrocchi CC. Use of gadolinium-based contrast agents in multiple sclerosis: a review by the ESMRMB-GREC and ESNR Multiple Sclerosis Working Group. Eur Radiol 2024; 34:1726-1735. [PMID: 37658891 DOI: 10.1007/s00330-023-10151-y] [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: 04/24/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023]
Abstract
Magnetic resonance imaging (MRI) is the most sensitive technique for detecting inflammatory demyelinating lesions in multiple sclerosis (MS) and plays a crucial role in diagnosis and monitoring treatment effectiveness, and for predicting the disease course. In clinical practice, detection of MS lesions is mainly based on T2-weighted and contrast-enhanced T1-weighted sequences. Contrast-enhancing lesions (CEL) on T1-weighted sequences are related to (sub)acute inflammation, while new or enlarging T2 lesions reflect the permanent footprint from a previous acute inflammatory demyelinating event. These two types of MRI features provide redundant information, at least in regular monitoring of the disease. Due to the concern of gadolinium deposition after repetitive injections of gadolinium-based contrast agents (GBCAs), scientific organizations and regulatory agencies in Europe and North America have proposed that these contrast agents should be administered only if clinically necessary. In this article, we provide data on the mode of action of GBCAs in MS, the indications of the use of these agents in clinical practice, their value in MS for diagnostic, prognostic, and monitoring purposes, and their use in specific populations (children, pregnant women, and breast-feeders). We discuss imaging strategies that achieve the highest sensitivity for detecting CELs in compliance with the safety regulations established by different regulatory agencies. Finally, we will briefly discuss some alternatives to the use of GBCA for detecting blood-brain barrier disruption in MS lesions. CLINICAL RELEVANCE STATEMENT: Although use of GBCA at diagnostic workup of suspected MS is highly valuable for diagnostic and prognostic purposes, their use in routine monitoring is not mandatory and must be reduced, as detection of disease activity can be based on the identification of new or enlarging lesions on T2-weighted images. KEY POINTS: • Both the EMA and the FDA state that the use of GBCA in medicine should be restricted to clinical scenarios in which the additional information offered by the contrast agent is required. • The use of GBCA is generally recommended in the diagnostic workup in subjects with suspected MS and is generally not necessary for routine monitoring in clinical practice. • Alternative MRI-based approaches for detecting acute focal inflammatory MS lesions are not yet ready to be used in clinical practice.
Collapse
Affiliation(s)
- Àlex Rovira
- Section of Neuroradiology, Department of Radiology, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - Fabio M Doniselli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Lukas Haider
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jerome Hodel
- Department of Radiology, Groupe Hospitalier Paris-Saint Joseph, Paris, France
| | | | - Mike P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | | | - Bas Jasperse
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Carlo A Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK
| | - Carlo C Quattrocchi
- Centre for Medical Sciences CISMed, University of Trento, Trento, Italy
- Radiology, Multizonal Unit of Rovereto and Arco, APSS Provincia Autonoma Di Trento, Trento, Italy
| |
Collapse
|
8
|
Androdias G, Noroy L, Psimaras D, Birzu C, Pelletier J, Beigneux Y, Branger P, Ciron J, Dananchet Y, Depaz R, Froment Tilikete C, Gignoux L, Grosset-Janin C, Joubert B, Kerschen P, Kwiatkowski A, Lebrun-Frenay C, Maillart E, Maureille A, Nicolas P, Roux T, Marignier R, Vukusic S. Impact of Immune Checkpoint Inhibitors on the Course of Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200202. [PMID: 38346268 DOI: 10.1212/nxi.0000000000200202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/29/2023] [Indexed: 02/15/2024]
Abstract
OBJECTIVES Immune checkpoint inhibitors (ICIs) are increasingly used in cancer treatment. Their mechanism of action raises the question of possible exacerbation of preexisting multiple sclerosis (MS). The aim of our study was to assess the risk of increased MS activity, defined by the occurrence of a relapse and/or a new MRI lesion, after ICI initiation. METHODS This French multicentric study collected retrospective and prospective data on patients with MS treated with ICIs after a cancer diagnosis. RESULTS We identified 18 patients with a median age of 48 years. Three of them (17%), all aged 50 years or younger, with a relapsing-remitting course, showed clinical and/or radiologic signs of MS activity 3 to 6 months after ICI initiation. They had stopped disease-modifying treatment (DMT) several months earlier, at the time of cancer diagnosis. Only one had both clinical and MRI activity, with mild severity and complete recovery. DISCUSSION Our study suggests that the overall risk of MS activity under ICI is low and could be mainly driven by DMT discontinuation, as in MS in general. Although larger studies are needed for better risk assessment in younger patients with more active disease, ICI should be considered when needed in patients with MS.
Collapse
Affiliation(s)
- Géraldine Androdias
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Louise Noroy
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Dimitri Psimaras
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Cristina Birzu
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Jean Pelletier
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Ysoline Beigneux
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Pierre Branger
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Jonathan Ciron
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Yannick Dananchet
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Raphael Depaz
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Caroline Froment Tilikete
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Laurence Gignoux
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Clara Grosset-Janin
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Bastien Joubert
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Philippe Kerschen
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Arnaud Kwiatkowski
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Christine Lebrun-Frenay
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Elisabeth Maillart
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Aurelien Maureille
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Philippe Nicolas
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Thomas Roux
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Romain Marignier
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| | - Sandra Vukusic
- From the Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation (G.A., P.N., R.M., S.V.), Centre de Ressources, Recherche et Compétence sur la Sclérose en Plaques et Fondation Eugène Devic EDMUS pour la Scléros; Ramsay Santé (G.A., L.G.), Clinique de la Sauvegarde, Lyon; Centre Hospitalier de Valence (L.N.), Service de Neurologie, Valence, France; Sorbonne Université (D.P., C.B.), Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2- Mazarin, Paris, France; OncoNeuroTox Group; Aix Marseille Université (J.P.), APHM, Hôpital de la Timone, Department of Neurology, Marseille; Neurology Department (Y.B., R.D., E.M., T.R.), CRCSEP Paris, Pitié-Salpêtrière Hôpital, APHP; CHU de Caen Normandie (P.B.), Service de Neurologie, Caen; CHU de Toulouse (J.C.), CRC-SEP, Department of Neurology, F-31059 Toulouse Cedex 9; Université Toulouse III, Infinity, INSERM UMR1291 - CNRS UMR5051, F-31024 Toulouse Cedex 3; Polyclinique des Alpes du Sud (Y.D.), Gap, France; Claude Bernard Lyon 1 University (C.F.T.), Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500 and Neuro-Ophthalmology Unit, Hospices Civils de Lyon, Neurological Hospital; Centre Hospitalier de Chambéry (C.G.-J.), Service de Neurologie, Chambéry; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (B.J.), Université Claude Bernard Lyon 1; ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon; Service de Neurologie (P.K.), Centre Hospitalier de Luxembourg, L-1210 Luxembourg-Ville, Luxembourg; Department of Neurology (A.K.), Lille Catholic University, Lille Catholic Hospitals, FHU PRECISE; CRCSEP Nice (C.L.-F.), UMR2CA-URRIS, Université Nice Côte d'Azur, Neurologie CHU de Nice Pasteur 2; Department of Medical Oncology (A.M.), Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon 1 (R.M.), Villeurbanne; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M., S.V.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon; and Centre des Neurosciences de Lyon (S.V.), INSERM 1028 et CNRS UMR5292, Observatoire Français de la Sclérose en Plaques, Lyon, France
| |
Collapse
|
9
|
Welsh N, Disano K, Linzey M, Pike SC, Smith AD, Pachner AR, Gilli F. CXCL10/IgG1 Axis in Multiple Sclerosis as a Potential Predictive Biomarker of Disease Activity. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200200. [PMID: 38346270 DOI: 10.1212/nxi.0000000000200200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/16/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Multiple sclerosis (MS) is a heterogeneous disease, and its course is difficult to predict. Prediction models can be established by measuring intrathecally synthesized proteins involved in inflammation, glial activation, and CNS injury. METHODS To determine how these intrathecal proteins relate to the short-term, i.e., 12 months, disease activity in relapsing-remitting MS (RRMS), we measured the intrathecal synthesis of 46 inflammatory mediators and 14 CNS injury or glial activation markers in matched serum and CSF samples from 47 patients with MS (pwMS), i.e., 23 RRMS and 24 clinically isolated syndrome (CIS), undergoing diagnostic lumbar puncture. Subsequently, all pwMS were followed for ≥12 months in a retrospective follow-up study and ultimately classified into "active", i.e., developing clinical and/or radiologic disease activity, n = 18) or "nonactive", i.e., not having disease activity, n = 29. Disease activity in patients with CIS corresponded to conversion to RRMS. Thus, patients with CIS were subclassified as "converters" or "nonconverters" based on their conversion status at the end of a 12-month follow-up. Twenty-seven patients with noninflammatory neurologic diseases were included as negative controls. Data were subjected to differential expression analysis and modeling techniques to define the connectivity arrangement (network) between neuroinflammation and CNS injury relevant to short-term disease activity in RRMS. RESULTS Lower age and/or higher CXCL13 levels positively distinguished active/converting vs nonactive/nonconverting patients. Network analysis significantly improved the prediction of short-term disease activity because active/converting patients featured a stronger positive connection between IgG1 and CXCL10. Accordingly, analysis of disease activity-free survival demonstrated that pwMS, both RRMS and CIS, with a lower or negative IgG1-CXCL10 correlation, have a higher probability of activity-free survival than the patients with a significant correlation (p < 0.0001, HR ≥ 2.87). DISCUSSION Findings indicate that a significant IgG1-CXCL10 positive correlation predicts the risk of short-term disease activity in patients with RRMS and CIS. Thus, the present results can be used to develop a predictive model for MS activity and conversion to RRMS.
Collapse
Affiliation(s)
- Nora Welsh
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Krista Disano
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Michael Linzey
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Steven C Pike
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Andrew D Smith
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Andrew R Pachner
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| | - Francesca Gilli
- From the Integrative Neuroscience (N.W., M.L., S.C.P.), Dartmouth College, Hanover, NH; Neurology (N.W., K.D., S.C.P., A.D.S., A.R.P., F.G.), Dartmouth Hitchcock Medical Center, Lebanon, NH; and Veteran Affairs Medical Center (K.D.), White River Junction, VT
| |
Collapse
|
10
|
Jalaleddini K, Bermel RA, Talente B, Weinstein D, Qureshi F, Rasmussen M, Menon S, Amarapala M, Jordan K, Ghoreyshi A, McCurdy S, Edgeworth M. A US payer perspective health economic model assessing value of monitoring disease activity to inform discontinuation and re-initiation of DMT in multiple sclerosis. Mult Scler 2024; 30:432-442. [PMID: 38374525 DOI: 10.1177/13524585241227372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVES We evaluate the potential clinical and cost impacts of discontinuing disease-modifying therapy (DMT) in people with multiple sclerosis (PwMS) when age-related immunosenescence can reduce DMT efficacy while increasing associated risks. METHODS A Markov model simulated clinical and cost impacts to the patient and payers when a proportion of eligible patients with relapsing remitting multiple sclerosis (RRMS) discontinue DMT. Eligibility was defined as age >55 years, an RRMS diagnosis of >5 years, and no history of relapses for 5 years. Increasing the proportion of eligible patients willing to discontinue therapy was also modeled. Clinical and cost inputs were from published literature. RESULTS Difference in EDSS progression between eligible patients who did and did not attempt discontinuation was not significant. After 1 year of eligibility, per-patient costs were $96k lower in the cohort that attempted discontinuation; however a higher proportion of relapses were seen in this group. When the proportion of patients willing to discontinue DMT increased, clinical findings remained consistent while the average cost per patient decreased. CONCLUSION While there are increased clinical and cost benefits as more eligible patients attempt discontinuation, the risk of relapses can increase. Timely disease monitoring is required to manage safe DMT discontinuation.
Collapse
Affiliation(s)
| | - Robert A Bermel
- Mellen Center for Multiple Sclerosis, Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | - Sreeranjani Menon
- Boston Healthcare Associates, Inc. (now a Veranex company), Boston, MA, USA
| | - Miyuru Amarapala
- Boston Healthcare Associates, Inc. (now a Veranex company), Boston, MA, USA
| | | | | | | | | |
Collapse
|
11
|
Gonzalez-Lorenzo M, Ridley B, Minozzi S, Del Giovane C, Peryer G, Piggott T, Foschi M, Filippini G, Tramacere I, Baldin E, Nonino F. Immunomodulators and immunosuppressants for relapsing-remitting multiple sclerosis: a network meta-analysis. Cochrane Database Syst Rev 2024; 1:CD011381. [PMID: 38174776 PMCID: PMC10765473 DOI: 10.1002/14651858.cd011381.pub3] [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] [Indexed: 01/05/2024]
Abstract
BACKGROUND Different therapeutic strategies are available for the treatment of people with relapsing-remitting multiple sclerosis (RRMS), including immunomodulators, immunosuppressants and biological agents. Although each one of these therapies reduces relapse frequency and slows disability accumulation compared to no treatment, their relative benefit remains unclear. This is an update of a Cochrane review published in 2015. OBJECTIVES To compare the efficacy and safety, through network meta-analysis, of interferon beta-1b, interferon beta-1a, glatiramer acetate, natalizumab, mitoxantrone, fingolimod, teriflunomide, dimethyl fumarate, alemtuzumab, pegylated interferon beta-1a, daclizumab, laquinimod, azathioprine, immunoglobulins, cladribine, cyclophosphamide, diroximel fumarate, fludarabine, interferon beta 1-a and beta 1-b, leflunomide, methotrexate, minocycline, mycophenolate mofetil, ofatumumab, ozanimod, ponesimod, rituximab, siponimod and steroids for the treatment of people with RRMS. SEARCH METHODS CENTRAL, MEDLINE, Embase, and two trials registers were searched on 21 September 2021 together with reference checking, citation searching and contact with study authors to identify additional studies. A top-up search was conducted on 8 August 2022. SELECTION CRITERIA Randomised controlled trials (RCTs) that studied one or more of the available immunomodulators and immunosuppressants as monotherapy in comparison to placebo or to another active agent, in adults with RRMS. DATA COLLECTION AND ANALYSIS Two authors independently selected studies and extracted data. We considered both direct and indirect evidence and performed data synthesis by pairwise and network meta-analysis. Certainty of the evidence was assessed by the GRADE approach. MAIN RESULTS We included 50 studies involving 36,541 participants (68.6% female and 31.4% male). Median treatment duration was 24 months, and 25 (50%) studies were placebo-controlled. Considering the risk of bias, the most frequent concern was related to the role of the sponsor in the authorship of the study report or in data management and analysis, for which we judged 68% of the studies were at high risk of other bias. The other frequent concerns were performance bias (34% judged as having high risk) and attrition bias (32% judged as having high risk). Placebo was used as the common comparator for network analysis. Relapses over 12 months: data were provided in 18 studies (9310 participants). Natalizumab results in a large reduction of people with relapses at 12 months (RR 0.52, 95% CI 0.43 to 0.63; high-certainty evidence). Fingolimod (RR 0.48, 95% CI 0.39 to 0.57; moderate-certainty evidence), daclizumab (RR 0.55, 95% CI 0.42 to 0.73; moderate-certainty evidence), and immunoglobulins (RR 0.60, 95% CI 0.47 to 0.79; moderate-certainty evidence) probably result in a large reduction of people with relapses at 12 months. Relapses over 24 months: data were reported in 28 studies (19,869 participants). Cladribine (RR 0.53, 95% CI 0.44 to 0.64; high-certainty evidence), alemtuzumab (RR 0.57, 95% CI 0.47 to 0.68; high-certainty evidence) and natalizumab (RR 0.56, 95% CI 0.48 to 0.65; high-certainty evidence) result in a large decrease of people with relapses at 24 months. Fingolimod (RR 0.54, 95% CI 0.48 to 0.60; moderate-certainty evidence), dimethyl fumarate (RR 0.62, 95% CI 0.55 to 0.70; moderate-certainty evidence), and ponesimod (RR 0.58, 95% CI 0.48 to 0.70; moderate-certainty evidence) probably result in a large decrease of people with relapses at 24 months. Glatiramer acetate (RR 0.84, 95%, CI 0.76 to 0.93; moderate-certainty evidence) and interferon beta-1a (Avonex, Rebif) (RR 0.84, 95% CI 0.78 to 0.91; moderate-certainty evidence) probably moderately decrease people with relapses at 24 months. Relapses over 36 months findings were available from five studies (3087 participants). None of the treatments assessed showed moderate- or high-certainty evidence compared to placebo. Disability worsening over 24 months was assessed in 31 studies (24,303 participants). Natalizumab probably results in a large reduction of disability worsening (RR 0.59, 95% CI 0.46 to 0.75; moderate-certainty evidence) at 24 months. Disability worsening over 36 months was assessed in three studies (2684 participants) but none of the studies used placebo as the comparator. Treatment discontinuation due to adverse events data were available from 43 studies (35,410 participants). Alemtuzumab probably results in a slight reduction of treatment discontinuation due to adverse events (OR 0.39, 95% CI 0.19 to 0.79; moderate-certainty evidence). Daclizumab (OR 2.55, 95% CI 1.40 to 4.63; moderate-certainty evidence), fingolimod (OR 1.84, 95% CI 1.31 to 2.57; moderate-certainty evidence), teriflunomide (OR 1.82, 95% CI 1.19 to 2.79; moderate-certainty evidence), interferon beta-1a (OR 1.48, 95% CI 0.99 to 2.20; moderate-certainty evidence), laquinimod (OR 1.49, 95 % CI 1.00 to 2.15; moderate-certainty evidence), natalizumab (OR 1.57, 95% CI 0.81 to 3.05), and glatiramer acetate (OR 1.48, 95% CI 1.01 to 2.14; moderate-certainty evidence) probably result in a slight increase in the number of people who discontinue treatment due to adverse events. Serious adverse events (SAEs) were reported in 35 studies (33,998 participants). There was probably a trivial reduction in SAEs amongst people with RRMS treated with interferon beta-1b as compared to placebo (OR 0.92, 95% CI 0.55 to 1.54; moderate-certainty evidence). AUTHORS' CONCLUSIONS We are highly confident that, compared to placebo, two-year treatment with natalizumab, cladribine, or alemtuzumab decreases relapses more than with other DMTs. We are moderately confident that a two-year treatment with natalizumab may slow disability progression. Compared to those on placebo, people with RRMS treated with most of the assessed DMTs showed a higher frequency of treatment discontinuation due to AEs: we are moderately confident that this could happen with fingolimod, teriflunomide, interferon beta-1a, laquinimod, natalizumab and daclizumab, while our certainty with other DMTs is lower. We are also moderately certain that treatment with alemtuzumab is associated with fewer discontinuations due to adverse events than placebo, and moderately certain that interferon beta-1b probably results in a slight reduction in people who experience serious adverse events, but our certainty with regard to other DMTs is lower. Insufficient evidence is available to evaluate the efficacy and safety of DMTs in a longer term than two years, and this is a relevant issue for a chronic condition like MS that develops over decades. More than half of the included studies were sponsored by pharmaceutical companies and this may have influenced their results. Further studies should focus on direct comparison between active agents, with follow-up of at least three years, and assess other patient-relevant outcomes, such as quality of life and cognitive status, with particular focus on the impact of sex/gender on treatment effects.
Collapse
Affiliation(s)
- Marien Gonzalez-Lorenzo
- Laboratorio di Metodologia delle revisioni sistematiche e produzione di Linee Guida, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ben Ridley
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Cochrane Italy, Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Guy Peryer
- School of Health Sciences, University of East Anglia (UEA), Norwich, UK
| | - Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, Queens University, Kingston, Ontario, Canada
| | - Matteo Foschi
- Department of Neuroscience, Multiple Sclerosis Center - Neurology Unit, S.Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Graziella Filippini
- Scientific Director's Office, Carlo Besta Foundation and Neurological Institute, Milan, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisa Baldin
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Nonino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| |
Collapse
|
12
|
Kondo A, Ikeguchi R, Kitagawa K, Shimizu Y. Disease Activity and Progression of Disability in Multiple Sclerosis Patients Aged Over 50 With or Without Disease-Modifying Drug Treatment: A Retrospective Cohort Study. Cureus 2023; 15:e49927. [PMID: 38058522 PMCID: PMC10697689 DOI: 10.7759/cureus.49927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 12/08/2023] Open
Abstract
Background This study aimed to clarify the need for disease-modifying drug (DMD) treatment in elderly patients with multiple sclerosis (MS) aged 50 years or older. MS is an autoimmune, demyelinating disease of the central nervous system that predominantly affects young women. Various DMDs are effective in preventing relapses and slowing the progression of disability in patients with MS. Although disease activity in MS is believed to decrease with aging, a consensus on the appropriate DMD treatment for elderly patients with MS is lacking. Methodology This study included elderly patients with MS (>50 years old). We compared the occurrence of relapses, worsening of disability, and conversion to secondary progressive MS (SPMS) between patients with DMD treatment and those without. Logistic regression analysis was performed to determine the predictors of these outcomes. Confounding factors were adjusted using propensity scores. Results From January 1991 to October 2022, 76 elderly patients with MS were included. The mean age at the last visit was 57.4 ± 6.3 years, with 51 patients being female. The mean age of onset of MS was 37.1 ± 10.1 years. Fifty-four patients were included in the DMD treatment group. The overall relapse rate was 38% (33% and 48% in the DMD treatment and untreated groups, respectively). No significant differences in relapse rates (p = 0.72) or in the Expanded Disability Status Scale (EDSS) scores were identified between the two groups. Kaplan-Meier curves showed no differences in the time to first relapse within five years between the two groups. Additionally, no significant predictors of relapse were identified. Among 61 patients with relapsing-remitting MS, 25% converted to SPMS during the observation period. Logistic regression analysis showed that older age at the final visit and the presence of brainstem lesions at the age of 50 years were associated with a higher rate of transition to SPMS. Conclusions In the present study, no significant difference was found in the rate of relapse, disability progression, and conversion to SPMS between the DMD treatment and untreated groups in elderly patients with MS. Therefore, in patients without long-term relapse, no poor prognostic functional factors or predictors of conversion to SPMS, discontinuation of DMDs may be considered. In addition, the presence of brainstem lesions at 50 years of age may predict the conversion to SPMS. Thus, the continuation of DMD or conversion to an appropriate DMD should be considered in patients with brainstem lesions at 50 years of age.
Collapse
Affiliation(s)
- Akihiro Kondo
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
| | - Ryotaro Ikeguchi
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
| | - Yuko Shimizu
- Department of Neurology, Tokyo Women's Medical University, Tokyo, JPN
| |
Collapse
|
13
|
Lebel Y, Milo T, Bar A, Mayo A, Alon U. Excitable dynamics of flares and relapses in autoimmune diseases. iScience 2023; 26:108084. [PMID: 37915612 PMCID: PMC10616393 DOI: 10.1016/j.isci.2023.108084] [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: 05/03/2023] [Revised: 08/04/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
Many autoimmune disorders exhibit flares in which symptoms erupt and then decline, as exemplified by multiple sclerosis (MS) in its relapsing-remitting form. Existing mathematical models of autoimmune flares often assume regular oscillations, failing to capture the stochastic and non-periodic nature of flare-ups. We suggest that autoimmune flares are driven by excitable dynamics triggered by stochastic events auch as stress, infection and other factors. Our minimal model, involving autoreactive and regulatory T-cells, demonstrates this concept. Autoimmune response initiates antigen-induced expansion through positive feedback, while regulatory cells counter the autoreactive cells through negative feedback. The model explains the decrease in MS relapses during pregnancy and the subsequent surge postpartum, based on lymphocyte dynamics. Additionally, it identifies potential therapeutic targets, predicting significant reduction in relapse rate from mild adjustments of regulatory T cell activity or production. These findings indicate that excitable dynamics may underlie flare-ups across various autoimmune disorders, potentially informing treatment strategies.
Collapse
Affiliation(s)
- Yael Lebel
- Department Molecular Cell Biology, Weizmann Institute of Science, Rehovot 76100 Israel
| | - Tomer Milo
- Department Molecular Cell Biology, Weizmann Institute of Science, Rehovot 76100 Israel
| | - Alon Bar
- Department Molecular Cell Biology, Weizmann Institute of Science, Rehovot 76100 Israel
| | - Avi Mayo
- Department Molecular Cell Biology, Weizmann Institute of Science, Rehovot 76100 Israel
| | - Uri Alon
- Department Molecular Cell Biology, Weizmann Institute of Science, Rehovot 76100 Israel
| |
Collapse
|
14
|
Mohammadi M, Kankam SB, Salehi S, Mohamadi M, Mohammadi A, Firoozabadi SRD, Shaygannejad V, Mirmosayyeb O. The association between multiple sclerosis and migraine: A meta-analysis. Mult Scler Relat Disord 2023; 79:104954. [PMID: 37714098 DOI: 10.1016/j.msard.2023.104954] [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: 05/23/2023] [Revised: 07/19/2023] [Accepted: 08/20/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic progressive condition marked by the deterioration of myelin and impairment of neurological function. The global prevalence of MS is approximately 2.2 million. Migraines are common in MS patients, with inconclusive data on their relationship. Our systematic review aimed to assess the prevalence and odds of migraine in pwMS and investigate the potential factors that may influence these associations. METHOD Through an extensive search and meticulous study selection, we identified pertinent literature investigating the occurrence and odds of migraines among pwMS. Additionally, we explored the comparative risk of migraines in MS patients compared to healthy controls. Data were extracted, including publication details, diagnostic criteria, and migraine prevalence in MS patients. RESULTS A total of 35 studies were included, involving 279,620 pwMS and 279,603 healthy controls. The overall prevalence of migraine in pwMS was 0.24 (95% CI: 0.21-0.28). Subgroup analyses and meta-regression were conducted to investigate the potential impact of various factors on the relationship between migraine and MS. These factors included age, duration of MS, study design, and the Expanded Disability Status Scale (EDSS), migraine diagnosis method, study design, publication year of the study, country and continent of the study population. The results of these analyses revealed no significant influence of these factors on the relationship between migraine and MS. The meta-analysis indicated that pwMS had significantly increased odds of having migraine compared to healthy controls (OR = 1.96, 95% CI: 1.20-3.20). Sensitivity analyses supported the robustness of the findings. CONCLUSIONS Our study highlights that approximately 24% of pwMS experience migraine. The method of diagnosis significantly affects the reported prevalence, with questionnaires yielding higher rates. Furthermore, pwMS have a 1.96-fold increased odds of having migraine compared to healthy individuals. These findings emphasize the importance of further research and interventions to address the significant burden of migraine in the MS population.
Collapse
Affiliation(s)
| | | | - Sadaf Salehi
- Iran University of Medical Sciences, Tehran, Iran
| | - Mobin Mohamadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Aynaz Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
15
|
Thakolwiboon S, Mills EA, Yang J, Doty J, Belkin MI, Cho T, Schultz C, Mao-Draayer Y. Immunosenescence and multiple sclerosis: inflammaging for prognosis and therapeutic consideration. FRONTIERS IN AGING 2023; 4:1234572. [PMID: 37900152 PMCID: PMC10603254 DOI: 10.3389/fragi.2023.1234572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023]
Abstract
Aging is associated with a progressive decline of innate and adaptive immune responses, called immunosenescence. This phenomenon links to different multiple sclerosis (MS) disease courses among different age groups. While clinical relapse and active demyelination are mainly related to the altered adaptive immunity, including invasion of T- and B-lymphocytes, impairment of innate immune cell (e.g., microglia, astrocyte) function is the main contributor to disability progression and neurodegeneration. Most patients with MS manifest the relapsing-remitting phenotype at a younger age, while progressive phenotypes are mainly seen in older patients. Current disease-modifying therapies (DMTs) primarily targeting adaptive immunity are less efficacious in older patients, suggesting that immunosenescence plays a role in treatment response. This review summarizes the recent immune mechanistic studies regarding immunosenescence in patients with MS and discusses the clinical implications of these findings.
Collapse
Affiliation(s)
| | - Elizabeth A. Mills
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer Yang
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Jonathan Doty
- Michigan Institute for Neurological Disorders, Farmington Hills, MI, United States
| | - Martin I. Belkin
- Michigan Institute for Neurological Disorders, Farmington Hills, MI, United States
| | - Thomas Cho
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Charles Schultz
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States
- Michigan Institute for Neurological Disorders, Farmington Hills, MI, United States
- Autoimmune Center of Excellence, University of Michigan, Ann Arbor, MI, United States
- Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
16
|
Wang Y, Duan Y, Wu Y, Zhuo Z, Zhang N, Han X, Zeng C, Chen X, Huang M, Zhu Y, Li H, Cao G, Sun J, Li Y, Zhou F, Li Y. Male and female are not the same: a multicenter study of static and dynamic functional connectivity in relapse-remitting multiple sclerosis in China. Front Immunol 2023; 14:1216310. [PMID: 37885895 PMCID: PMC10597802 DOI: 10.3389/fimmu.2023.1216310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/30/2023] [Indexed: 10/28/2023] Open
Abstract
Background Sex-related effects have been observed in relapsing-remitting multiple sclerosis (RRMS), but their impact on functional networks remains unclear. Objective To investigate the sex-related differences in connectivity strength and time variability within large-scale networks in RRMS. Methods This is a multi-center retrospective study. A total of 208 RRMS patients (135 females; 37.55 ± 11.47 years old) and 228 healthy controls (123 females; 36.94 ± 12.17 years old) were included. All participants underwent clinical and MRI assessments. Independent component analysis was used to extract resting-state networks (RSNs). We assessed the connectivity strength using spatial maps (SMs) and static functional network connectivity (sFNC), evaluated temporal properties and dynamic functional network connectivity (dFNC) patterns of RSNs using dFNC, and investigated their associations with structural damage or clinical variables. Results For static connectivity, only male RRMS patients displayed decreased SMs in the attention network and reduced sFNC between the sensorimotor network and visual or frontoparietal networks compared with healthy controls [P<0.05, false discovery rate (FDR) corrected]. For dynamic connectivity, three recurring states were identified for all participants: State 1 (sparse connected state; 42%), State 2 (middle-high connected state; 36%), and State 3 (high connected state; 16%). dFNC analyses suggested that altered temporal properties and dFNC patterns only occurred in females: female patients showed a higher fractional time (P<0.001) and more dwell time in State 1 (P<0.001) with higher transitions (P=0.004) compared with healthy females. Receiver operating characteristic curves revealed that the fraction time and mean dwell time of State 1 could significantly distinguish female patients from controls (area under the curve: 0.838-0.896). In addition, female patients with RRMS also mainly showed decreased dFNC in all states, particularly within cognitive networks such as the default mode, frontoparietal, and visual networks compared with healthy females (P < 0.05, FDR corrected). Conclusion Our results observed alterations in connectivity strength only in male patients and time variability in female patients, suggesting that sex-related effects may play an important role in the functional impairment and reorganization of RRMS.
Collapse
Affiliation(s)
- Yao Wang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center For Medical Imaging In Jiangxi Province, Nanchang, Jiangxi, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuling Wu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center For Medical Imaging In Jiangxi Province, Nanchang, Jiangxi, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ningnannan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Xuemei Han
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Chun Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoya Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Muhua Huang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center For Medical Imaging In Jiangxi Province, Nanchang, Jiangxi, China
| | - Yanyan Zhu
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center For Medical Imaging In Jiangxi Province, Nanchang, Jiangxi, China
| | - Haiqing Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Guanmei Cao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Sun
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, China
- Clinical Research Center For Medical Imaging In Jiangxi Province, Nanchang, Jiangxi, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
17
|
Strijbis EM, Coerver E, Mostert J, van Kempen ZLE, Killestein J, Comtois J, Repovic P, Bowen JD, Cutter G, Koch M. Association of age and inflammatory disease activity in the pivotal natalizumab clinical trials in relapsing-remitting multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:792-799. [PMID: 37173129 DOI: 10.1136/jnnp-2022-330887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Focal inflammatory disease activity in relapsing-remitting multiple sclerosis (RRMS) diminishes with increasing age. Here we use patient-level data from randomised controlled trials (RCTs) of natalizumab treatment in RRMS to investigate the association of age and inflammatory disease activity. METHODS We used patient-level data from the AFFIRM (natalizumab vs placebo in relapsing-remitting MS, NCT00027300) and SENTINEL (natalizumab plus interferon beta vs interferon beta in relapsing remitting MS, NCT00030966) RCTs. We determined the proportion of participants developing new T2 lesions, contrast-enhancing lesions (CELs) and relapses over 2 years of follow-up as a function of age, and investigated the association of age with time to first relapse using time-to-event analyses. RESULTS At baseline, there were no differences between age groups in T2 lesion volume and number of relapses in the year before inclusion. In SENTINEL, older participants had a significantly lower number of CELs. During both trials, the number of new CELs and the proportion of participants developing new CELs were significantly lower in older age groups. The number of new T2 lesions and the proportion of participants with any radiological disease activity during follow-up were also lower in older age groups, especially in the control arms. CONCLUSIONS Older age is associated with a lower prevalence and degree of focal inflammatory disease activity in treated and untreated RRMS. Our findings inform the design of RCTs, and suggest that patient age should be taken into consideration when deciding on immunomodulatory treatment in RRMS.
Collapse
Affiliation(s)
- Eva M Strijbis
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Eline Coerver
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jop Mostert
- Department of Neurology, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
| | - Zoé L E van Kempen
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Joep Killestein
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jacynthe Comtois
- Department of Medicine, Neurology service, Maisonneuve-Rosemont Hospital, Montreal, Québec, Canada
| | - Pavle Repovic
- Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, Washington, USA
| | - James D Bowen
- Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marcus Koch
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
18
|
Segal BM. Inverse association between age and inflammatory disease activity in multiple sclerosis. Nat Rev Neurol 2023; 19:577-578. [PMID: 37563265 DOI: 10.1038/s41582-023-00844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Benjamin M Segal
- Department of Neurology, The Ohio State University, Columbus, OH, USA.
- Neuroscience Research Institute, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
19
|
Papathanasiou A, Hibbert A, Tallantyre E, Harding K, Selvam AP, Morgan M, Quainton C, Talaei M, Arun T, Ingram G, Law GR, Evangelou N. Real-world annualized relapse rates from contemporary multiple sclerosis clinics in the UK: a retrospective multicentre cohort study. Neurol Sci 2023; 44:3629-3635. [PMID: 37208584 PMCID: PMC10198787 DOI: 10.1007/s10072-023-06838-1] [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: 02/02/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Annualized relapse rate (ARR) is used as an outcome measure in multiple sclerosis (MS) clinical trials. Previous studies demonstrated that ARR has reduced in placebo groups between 1990 and 2012. This study aimed to estimate real-world ARRs from contemporary MS clinics in the UK, in order to improve the feasibility estimations for clinical trials and facilitate MS service planning. METHODS A multicentre observational, retrospective study of patients with MS from 5 tertiary neuroscience centres in the UK. We included all adult patients with a diagnosis of MS that had a relapse between 01/04/2020 and 30/06/2020. RESULTS One hundred thirteen out of 8783 patients had a relapse during the 3-month study period. Seventy-nine percent of the patients with a relapse were female, the mean age was 39 years, and the median disease duration was 4.5 years; 36% of the patients that had a relapse were on disease-modifying treatment. The ARR from all study sites was estimated at 0.05. The ARR for relapsing remitting MS (RRMS) was estimated at 0.08, while the ARR for secondary progressive MS (SPMS) was 0.01. CONCLUSIONS We report a lower ARR compared to previously reported rates in MS.
Collapse
Affiliation(s)
- Athanasios Papathanasiou
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Aimee Hibbert
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Emma Tallantyre
- Helen Durham Centre for Neuroinflammatory Disease, University Hospital of Wales, Cardiff, UK
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Katharine Harding
- Department of Neurology, Aneurin Bevan University Health Board, Newport, UK
| | - Adithya Panneer Selvam
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Morgan
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Charlotte Quainton
- Department of Neurology, Aneurin Bevan University Health Board, Newport, UK
| | - Maryam Talaei
- Department of Neurology, Morriston Hospital, Swansea, UK
| | - Tarunya Arun
- Department of Neurosciences, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Gillian Ingram
- Department of Neurology, Morriston Hospital, Swansea, UK
| | - Graham R Law
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Nikos Evangelou
- Mental Health and Clinical Neurosciences Academic Unit, University of Nottingham, Nottingham, UK
| |
Collapse
|
20
|
Adamec I, Brecl Jakob G, Rajda C, Drulović J, Radulović L, Bašić Kes V, Lazibat I, Rimac J, Cindrić I, Gržinčić T, Abičić A, Barun B, Gabelić T, Gomezelj S, Mesaroš Š, Pekmezović T, Klivényi P, Krbot Skorić M, Habek M. Cladribine tablets in people with relapsing multiple sclerosis: A real-world multicentric study from southeast European MS centers. J Neuroimmunol 2023; 382:578164. [PMID: 37536052 DOI: 10.1016/j.jneuroim.2023.578164] [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: 05/09/2023] [Revised: 06/29/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Cladribine is an oral disease-modifying drug authorized by the European Medicine Agency for the treatment of highly active relapsing multiple sclerosis (MS). OBJECTIVES To provide real-world evidence of cladribine's effectiveness and safety in people with MS (pwMS). METHODS A retrospective observational multi-center, multi-national study of pwMS who were started on cladribine tablets in ten centers from five European countries. RESULTS We identified 320 pwMS treated with cladribine tablets. The most common comorbidities were arterial hypertension and depression. Three patients had resolved hepatitis B infection, while eight had positive Quantiferon test prior to cladribine commencement. There were six pwMS who had malignant diseases, but all were non-active. During year 1, 91.6% pwMS did not have EDSS worsening, 86.9% were relapse-free and 72.9% did not have MRI activity. During the second year, 90.2% did not experience EDSS worsening, 86.5% were relapse-free and 75.5% did not have MRI activity. NEDA-3 was present in 58.0% pwMS in year 1 and in 54.2% in year 2. In a multivariable logistic regression model age positively predicted NEDA-3 in year 1. The most common adverse events were infections and skin-related adverse events. Lymphopenia was noted in 54.7% of pwMS at month 2 and in 35.0% at month 6. Two pwMS had a newly discovered malignant disease, one breast cancer, and one melanoma, during the first year of treatment. CONCLUSION Our real-world data on the effectiveness and safety of cladribine tablets are comparable to the pivotal study and other real-world data with no new safety signals.
Collapse
Affiliation(s)
- Ivan Adamec
- Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Gregor Brecl Jakob
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Cecilia Rajda
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Jelena Drulović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ljiljana Radulović
- Department of Neurology, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Vanja Bašić Kes
- Department of Neurology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ines Lazibat
- Department of Neurology, University Hospital Dubrava, Zagreb, Croatia
| | - Julija Rimac
- Department of Neurology, National Memorial Hospital "dr. Juraj Njavro" Vukovar, Vukovar, Croatia
| | - Igor Cindrić
- Department of Neurology, General Hospital Virovitica, Virovitica, Croatia
| | - Tihana Gržinčić
- Department of Neurology, General Hospital Bjelovar, Bjelovar, Croatia
| | | | - Barbara Barun
- Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tereza Gabelić
- Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sarah Gomezelj
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Šarlota Mesaroš
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Neurology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Tatjana Pekmezović
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Belgrade, Serbia
| | - Péter Klivényi
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Magdalena Krbot Skorić
- Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia; Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia
| | - Mario Habek
- Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
| |
Collapse
|
21
|
Coerver E, Janssens S, Ahmed A, Wessels M, van Kempen Z, Jasperse B, Barkhof F, Koch M, Mostert J, Uitdehaag B, Killestein J, Strijbis E. Association between age and inflammatory disease activity on magnetic resonance imaging in relapse onset multiple sclerosis during long-term follow-up. Eur J Neurol 2023; 30:2385-2392. [PMID: 37170817 DOI: 10.1111/ene.15862] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/28/2023] [Accepted: 05/09/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND PURPOSE Inflammatory disease activity in multiple sclerosis (MS) decreases with advancing age. Previous work found a decrease in contrast-enhancing lesions (CELs) with age. Here, we describe the relation of age and magnetic resonance imaging (MRI) measures of inflammatory disease activity during long-term follow-up in a large real-world cohort of people with relapse onset MS. METHODS We investigated MRI data from the long-term observational Amsterdam MS cohort. We used logistic regression models and negative binomial generalized estimating equations to investigate the associations between age and radiological disease activity after a first clinical event. RESULTS We included 1063 participants and 10,651 cranial MRIs. Median follow-up time was 6.1 years (interquartile range = 2.4-10.9 years). Older participants had a significantly lower risk of CELs on baseline MRI (40-50 years vs. <40 years: odds ratio [OR] = 0.640, 95% confidence interval [CI] = 0.45-0.90; >50 years vs. <40 years: OR = 0.601, 95% CI = 0.33-1.08) and a lower risk of new T2 lesions or CELs during follow-up (40-50 years vs. <40 years: OR = 0.563, 95% CI = 0.47-0.67; >50 years vs. <40 years: OR = 0.486, 95% CI = 0.35-0.68). CONCLUSIONS Greater age is associated with a lower risk of inflammatory MRI activity at baseline and during long-term follow-up. In patients aged >50 years, a less aggressive treatment strategy might be appropriate compared to younger patients.
Collapse
Affiliation(s)
- Eline Coerver
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, Amsterdam, the Netherlands
| | - Sophie Janssens
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, Amsterdam, the Netherlands
| | - Aroosa Ahmed
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, Amsterdam, the Netherlands
| | - Mark Wessels
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, Amsterdam, the Netherlands
| | - Zoé van Kempen
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, Amsterdam, the Netherlands
| | - Bas Jasperse
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, Amsterdam, the Netherlands
| | - Frederik Barkhof
- MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, Amsterdam, the Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Marcus Koch
- Departments of Clinical Neurosciences and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jop Mostert
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Bernard Uitdehaag
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, Amsterdam, the Netherlands
| | - Joep Killestein
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, Amsterdam, the Netherlands
| | - Eva Strijbis
- MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC location VUmc, Amsterdam, The Netherlands, Amsterdam, the Netherlands
| |
Collapse
|
22
|
Fuh-Ngwa V, Charlesworth JC, Zhou Y, van der Mei I, Melton PE, Broadley SA, Ponsonby AL, Simpson-Yap S, Lechner-Scott J, Taylor BV. The association between disability progression, relapses, and treatment in early relapse onset MS: an observational, multi-centre, longitudinal cohort study. Sci Rep 2023; 13:11584. [PMID: 37463930 DOI: 10.1038/s41598-023-38415-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
The indirect contribution of multiple sclerosis (MS) relapses to disability worsening outcomes, and vice-versa, remains unclear. Disease modifying therapies (DMTs) are potential modulators of this association. Understanding how these endo-phenotypes interact may provide insights into disease pathogenesis and treatment practice in relapse-onset MS (ROMS). Utilising a unique, prospectively collected clinical data from a longitudinal cohort of 279 first demyelinating event cases followed for up to 15 years post-onset, we examined indirect associations between relapses and treatment and the risk of disability worsening, and vice-versa. Indirect association parameters were estimated using joint models for longitudinal and survival data. Early relapses within 2.5 years of MS onset predicted early disability worsening outcomes (HR = 3.45, C.I 2.29-3.61) per relapse, but did not contribute to long-term disability worsening thereinafter (HR = 0.21, C.I 0.15-0.28). Conversely, disability worsening outcomes significantly contributed to relapse risk each year (HR = 2.96, C.I 2.91-3.02), and persisted over time (HR = 3.34, C.I 2.90-3.86), regardless of DMT treatments. The duration of DMTs significantly reduced the hazards of relapses (1st-line DMTs: HR = 0.68, C.I 0.58-0.79; 3rd-line DMTs: HR = 0.37, C.I 0.32-0.44) and disability worsening events (1st-line DMTs: HR = 0.74, C.I 0.69-0.79; 3rd-line DMTs: HR = 0.90, C.I 0.85-0.95), respectively. Results from time-dynamic survival probabilities further revealed individuals having higher risk of future relapses and disability worsening outcomes, respectively. The study provided evidence that in ROMS, relapses accrued within 2.5 years of MS onset are strong indicators of disability worsening outcomes, but late relapses accrued 2.5 years post onset are not overt risk factors for further disability worsening. In contrast, disability worsening outcomes are strong positive predictors of current and subsequent relapse risk. Long-term DMT use and older age strongly influence the individual outcomes and their associations.
Collapse
Affiliation(s)
- Valery Fuh-Ngwa
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia.
| | - Jac C Charlesworth
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Yuan Zhou
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Phillip E Melton
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
| | - Simon A Broadley
- Menzies Health Institute Queensland and School of Medicine, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Anne-Louise Ponsonby
- Florey Institute for Neuroscience and Mental Health, Parkville, VIC, 3052, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia
- Neuroepidemiology Unit, Center for Epidemiology and Biostatistics, The University of Melbourne School of Population & Global Health, Melbourne, VIC, 3053, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health New Lambton, Hunter New England Health, New Lambton Heights, NSW, Australia
- Department of Neurology, The University of Newcastle Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, TAS, 7000, Australia.
| |
Collapse
|
23
|
Ahmed MAEK, Zakaria MF, Elaziz AAEA, Fouad MM, Elbokl AM, Swelam MS. Assessment of the role of telemedicine in the outcome of multiple sclerosis patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023; 59:99. [DOI: 10.1186/s41983-023-00690-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/16/2023] [Indexed: 09/01/2023] Open
Abstract
Abstract
Background
Multiple sclerosis (MS) is a chronic autoimmune disease, affecting about 2.5 million people worldwide. Telemedicine is a relatively recent telecommunication tool that has multiple formats such as store-and-forward, interactive video conferencing, remote medical record access, and remote patient monitoring. Telemedicine can be used to assess individuals with MS regarding their disease process, the development and impact of new symptoms as well as inquire about health behaviors that promote effective self-management. In this study, we aimed to evaluate the effect of telemedicine on patient satisfaction, clinical outcome and financial feasibility for MS patients.
Results
Sixty MS patients from the MS unit, at Kafr Elshikh General Hospital, were recruited and divided into 2 groups; 30 in the telemedicine group and 30 in the control group. Both groups were followed up for 12 months. We found a significant difference between the telemedicine group compared to controls as it showed less severe visual symptoms (p 0.006), a smaller number of dropouts (p 0.034) and higher patient satisfaction, with no significant difference between the two groups in the number of relapses, gait, bowel and bladder, lower limb weakness.
Conclusion
Telemedicine was found to be a promising practice that can be used to promote, coordinate and adjust ongoing clinical services of MS patients.
Collapse
|
24
|
Corboy JR, Fox RJ, Kister I, Cutter GR, Morgan CJ, Seale R, Engebretson E, Gustafson T, Miller AE. Risk of new disease activity in patients with multiple sclerosis who continue or discontinue disease-modifying therapies (DISCOMS): a multicentre, randomised, single-blind, phase 4, non-inferiority trial. Lancet Neurol 2023; 22:568-577. [PMID: 37353277 DOI: 10.1016/s1474-4422(23)00154-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/15/2023] [Accepted: 04/14/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Multiple sclerosis typically has onset in young adults and new disease activity diminishes with age. Most clinical trials of disease-modifying therapies for multiple sclerosis have not enrolled individuals older than 55 years. Observational studies suggest that risk of return of disease activity after discontinuation of a disease-modifying therapies is greatest in younger patients with recent relapses or MRI activity. We aimed to determine whether risk of disease recurrence in older patients with no recent disease activity who discontinue disease-modifying therapy is increased compared to those who remain on disease-modifying therapy. METHODS DISCOMS was a multicentre, randomised, controlled, rater-blinded, phase 4, non-inferiority trial. Individuals with multiple sclerosis of any subtype, 55 years or older, with no relapse within the past 5 years or new MRI lesion in the past 3 years while continuously taking an approved disease-modifying therapy were enrolled at 19 multiple sclerosis centres in the USA. Participants were randomly assigned (1:1 by site) with an interactive response technology system to either continue or discontinue disease-modifying therapy. Relapse assessors and MRI readers were masked to patient assignment; patients and treating investigators were not masked. The primary outcome was percentage of individuals with a new disease event, defined as a multiple sclerosis relapse or a new or expanding T2 brain MRI lesion, over 2 years. We assessed whether discontinuation of disease-modifying therapy was non-inferior to continuation using a non-inferiority, intention-to-treat analysis of all randomly assigned patients, with a predefined non-inferiority margin of 8%. This trial is registered at ClinicalTrials.gov, NCT03073603, and is completed. FINDINGS 259 participants were enrolled between May 22, 2017, and Feb 3, 2020; 128 (49%) were assigned to the continue group and 131 (51%) to the discontinue group. Five participants were lost to follow-up (continue n=1, discontinue n=4). Six (4·7%) of 128 participants in the continue group and 16 (12·2%) of 131 in the discontinue group had a relapse or a new or expanding brain MRI lesion within 2 years. The difference in event rates was 7·5 percentage points (95% CI 0·6-15·0). Similar numbers of participants had adverse events (109 [85%] of 128 vs 104 [79%] of 131) and serious adverse events (20 [16%] vs 18 [14%]), but more adverse events (422 vs 347) and serious adverse events (40 vs 30) occurred in the discontinue group. The most common adverse events were upper respiratory infections (20 events in 19 [15%] participants in the continue group and 37 events in 30 [23%] participants in the discontinue group). Three participants in the continue group and four in the discontinue group had treatment-related adverse events, of which one in each group was a serious adverse event (multiple sclerosis relapse requiring admission to hospital). One participant in the continue group and two in the discontinue group died; no deaths were deemed to be related to treatment. INTERPRETATION We were unable to reject the null hypothesis and could not conclude whether disease-modifying therapy discontinuation is non-inferior to continuation in patients older than 55 years with multiple sclerosis and no recent relapse or new MRI activity. Discontinuation of disease-modifying therapy might be a reasonable option in patients older than 55 years who have stable multiple sclerosis, but might be associated with a small increased risk of new MRI activity. FUNDING Patient-Centered Outcomes Research Institute and the National Multiple Sclerosis Society.
Collapse
Affiliation(s)
- John R Corboy
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Ilya Kister
- NYU MS Comprehensive Care Center, Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Gary R Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Charity J Morgan
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rebecca Seale
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Eric Engebretson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Aaron E Miller
- The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
25
|
Amezcua L, Mao-Draayer Y, Vargas WS, Farber R, Schaefer S, Branco F, England SM, Belviso N, Lewin JB, Mendoza JP, Shankar SL. Efficacy of Dimethyl Fumarate in Young Adults with Relapsing-Remitting Multiple Sclerosis: Analysis of the DEFINE, CONFIRM, and ENDORSE Studies. Neurol Ther 2023; 12:883-897. [PMID: 37061656 DOI: 10.1007/s40120-023-00475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/27/2023] [Indexed: 04/17/2023] Open
Abstract
INTRODUCTION Dimethyl fumarate (DMF) showed favorable benefit-risk in patients with relapsing-remitting multiple sclerosis (MS) in phase 3 DEFINE and CONFIRM trials and in the ENDORSE extension study. Disease activity can differ in younger patients with MS compared with the overall population. METHODS Randomized patients received DMF 240 mg twice daily or placebo (PBO; years 0-2 DEFINE/CONFIRM), then DMF (years 3-10; continuous DMF/DMF or PBO/DMF; ENDORSE); maximum follow-up (combined studies) was 13 years. This integrated post hoc analysis evaluated safety and efficacy of DMF in a subgroup of young adults aged 18-29 years. RESULTS Of 1736 patients enrolled in ENDORSE, 125 were young adults, 86 treated continuously with DMF (DMF/DMF) and 39 received delayed DMF (PBO/DMF) in DEFINE/CONFIRM. Most (n = 116 [93%]) young adults completed DMF treatment in DEFINE/CONFIRM. Median (range) follow-up time in ENDORSE was 6.5 (2.0-10.0) years. Young adults entering ENDORSE who had been treated with DMF in DEFINE/CONFIRM had a model-based Annualized Relapse Rate (ARR; 95% CI) of 0.24 (0.16-0.35) vs. 0.56 (0.35-0.88) in PBO patients. ARR remained low in ENDORSE: 0.07 (0.01-0.47) at years 9-10 (DMF/DMF group). At year 10 of ENDORSE, EDSS scores were low in young adults: DMF/DMF, 1.9 (1.4); PBO/DMF, 2.4 (1.6). At ~ 7 years, the proportion of young adults with no confirmed disability progresion was 81% for DMF/DMF and 72% for PBO/DMF. Patient-reported outcomes (PROs) (SF-36 and EQ-5D) generally remained stable during ENDORSE. The most common adverse events (AEs) in young adults during ENDORSE were MS relapse (n = 53 [42%]). Most AEs were mild (n = 20 [23.3%], n = 7 [17.9%]) to moderate (n = 45 [52.3%], n = 23 [59.0%]) in the DMF/DMF and PBO/DMF groups, respectively. The most common serious AE (SAE) was MS relapse (n = 19 [15%]). CONCLUSION The data support a favorable benefit-risk profile of DMF in young adults, as evidenced by well-characterized safety, sustained efficacy, and stable PROs. CLINICAL TRIAL INFORMATION Clinical trials.gov, DEFINE (NCT00420212), CONFIRM (NCT00451451), and ENDORSE (NCT00835770).
Collapse
Affiliation(s)
- Lilyana Amezcua
- Multiple Sclerosis Comprehensive Care Center, University of Southern California, Los Angeles, CA, USA
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yang Mao-Draayer
- Autoimmunity Center of Excellence, Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
- Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Wendy S Vargas
- Columbia Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rebecca Farber
- Columbia Multiple Sclerosis Center, Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sara Schaefer
- Multiple Sclerosis Comprehensive Care Center, UC-Health Neurology Clinic, Fort Collins, CO, USA
| | | | | | | | | | | | - Sai L Shankar
- Biogen, Cambridge, MA, USA.
- , 133 Boston Post Road, Weston, MA, 02493, USA.
| |
Collapse
|
26
|
Coerver E, Bourass A, Wessels M, van Kempen Z, Jasperse M, Tonino B, Barkhof F, Mostert J, Uitdehaag B, Killestein J, Strijbis E. Discontinuation of first-line disease-modifying therapy in relapse onset multiple sclerosis. Mult Scler Relat Disord 2023; 74:104706. [PMID: 37068370 DOI: 10.1016/j.msard.2023.104706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/22/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND It is not known if and when first-line disease modifying therapy (DMT) can safely be discontinued in relapse onset multiple sclerosis (MS) patients. OBJECTIVES To investigate the characteristics of patients who discontinued first-line DMT, and the occurrence of clinical and radiological inflammatory disease activity after discontinuation. METHODS We collected clinical and MRI parameters from patients with relapse onset MS in the MS Center Amsterdam and Rijnstate Hospital Arnhem who discontinued first-line DMT with no intention of restarting or switching treatment. RESULTS In total, 130 patients were included in the analyses. After discontinuation, 78 patients (60%) experienced disease activity. Sixty-three patients (48.5%) showed MRI activity after DMT discontinuation, 40 patients (30.8%) experienced relapse(s), and 29 patients (22.3%) restarted DMT. Higher age at DMT discontinuation was associated with a lower risk of MRI activity (45 -55 vs. <45 years: OR 0.301, p = 0.007, >55 vs. <45 years, OR: 0.296, p = 0.044), and with a lower risk of relapse(s) after discontinuation (45-55 vs. <45 years: OR=0.495, p = 0.106, >55 vs. <45 years: OR=0.081, p = 0.020). CONCLUSION Higher age at first-line DMT discontinuation is associated with lower risk and severity of radiological disease activity in MS, and a lower risk of relapse(s) after discontinuation.
Collapse
|
27
|
Cuthbert M, Lewandowska M, Freeman L, Devine C, Lee K, Kassam S. The Impact of Stopping Medications and Introducing a Whole Food Plant-Based Diet on Patients Living with Multiple Sclerosis - A Report of Two Cases. Am J Lifestyle Med 2023; 17:206-212. [PMID: 36896042 PMCID: PMC9989497 DOI: 10.1177/15598276221141403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
More than 2 million people live with multiple sclerosis worldwide and the prevalence has been increasing over time. Patients living with multiple sclerosis often explore diet and lifestyle interventions as a means of managing their symptoms and reducing reliance on medication; yet, these approaches are rarely discussed with their physicians. Currently, there is a lack of evidence on when to stop disease-modifying therapies (DMT), and recent research showed no statistically significant difference in the time between relapses when comparing participants who stopped DMT to those who did not, especially over the age of 45. This case report presents 2 patients with multiple sclerosis who made an informed decision to stop their DMT medications and have been managing their condition with a whole food plant-based diet and a healthy lifestyle approach. Over the period of 5 to 6 years since stopping the medications, each patient only had 1 multiple sclerosis flare-up to date. In the report, the focus is on the impact of diet on multiple sclerosis. It adds to currently available literature and encourages further research in the field of managing multiple sclerosis with lifestyle interventions.
Collapse
Affiliation(s)
- Monty Cuthbert
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
| | - Marta Lewandowska
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
| | - Laura Freeman
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
| | - Conor Devine
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
| | - Karen Lee
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
| | - Shireen Kassam
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
| |
Collapse
|
28
|
Gisela Z, Carla P, Josefina B, Tomas I, Lucia B, Pappolla A, Miguez J, Patrucco L, Cristiano E, Norma D, Verónica T, Carlos V, Leila C, Alonso R, Garcea O, Silva B, Celica Y, Marrodan M, Gaitán MI, Correale J, Marcos B, Luciana L, Anibal C, Emanuel S, Eduardo K, Judith S, Dario T, Javier H, Pedro N, Felisa L, Pablo LA, Susana L, Patricio B, Raul P, Adriana C, Alejandra M, María Eugenia B, Contentti Edgar C, Amelia AP, Carolina M, Mariano C, Luciano R, Matias K, Eduardo K, María Celeste C, Maria Laura M, Santiago T, Mariela C, Fatima PC, Andres B, Geraldine L, Alonso Serena M, Juan Ignacio R, Marcos S. Disease activity after discontinuation of disease-modifying therapies in patients with multiple sclerosis in Argentina: data from the nationwide registry RelevarEM. Neurol Res 2023; 45:112-117. [PMID: 36184106 DOI: 10.1080/01616412.2022.2124792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The discontinuation of disease-modifying therapies (DMTs) in multiple sclerosis (MS) is commonly seen in real-world settings due to several factors. AREA COVER The aim of this study is to describe the frequency of disease activity after discontinuation of DMTs in MS patients included in the Argentinean MS and NMOSD registry. DISCUSION Patients with relapsing remitting MS (RRMS) and active secondary progressive MS (SPMS) were included based on the following criteria: they discontinued treatment for more than 6 months, they had been treated with a DMT for ≥2 years, and they had at least 6 months of follow-up in the registry after discontinuation. Demographic and clinical data were collected. Disease activity during follow-up was defined as the presence of a clinical relapse or a new magnetic resonance (MRI) lesion (either new lesions on T2-weighted sequence and/or contrast enhancement). Bivariate analysis was applied to identify clinical and demographic factors related to disease activity. CONCLUSION We included 377 patients (75.5% RRMS, 22.5% SPMS) who had discontinued DMTs. The mean (SD) follow-up after discontinuation was 15.7 (7.9) months. After discontinuation, the presence of relapse was detected in 18.8% and 3.5% in RRMS and SPMS, respectively; and new MRI activity in 22% and 3.5%, respectively. We found that higher risk of relapse and MRI activity was associated with younger age (p < 0.001), shorter disease duration (p < 0.001), and RRMS phenotype (p = 0.006). Males showed higher MRI activity (p 0.011). This study provides real-world data that can guide physicians when considering discontinuation of DMTs.
Collapse
Affiliation(s)
- Zanga Gisela
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Portinari Carla
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Barber Josefina
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Ibañez Tomas
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Brolese Lucia
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de esclerosis múltiple de Buenos Aires, CABA, Buenos Aires, Argentina
| | | | - Tkachuk Verónica
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA
| | - Vrech Carlos
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba
| | - Cohen Leila
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, CABA
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, CABA
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, CABA
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, CABA
| | | | | | | | | | - Burgos Marcos
- Servicio de Neurología - Hospital San Bernardo, Salta
| | | | - Chertcoff Anibal
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA
| | | | | | - Steinberg Judith
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA
| | | | - Hryb Javier
- Servicio de Neurología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Nofal Pedro
- Hospital de Clínicas Nuestra Señora del Carmen, Tucuman, Argentina
| | | | - Lopez A Pablo
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Liwacki Susana
- Clínica Universitaria Reina Fabiola, Córdoba.,Servicio de Neurología - Hospital Córdoba, Córdoba
| | - Blaya Patricio
- Hospital Presidente Perón de Avellaneda, Avellaneda, Argentina.,Neurocomp, Buenos Aires, Argentina
| | - Piedrabuena Raul
- Clínica Universitaria Reina Fabiola, Córdoba.,Instituto Lennox, Córdoba
| | - Carra Adriana
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA
| | - Martinez Alejandra
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA.,Servicio de Neurología, Hospital Posadas, Buenos Aires, Argentina
| | - Balbuena María Eugenia
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rojas Juan Ignacio
- Centro de esclerosis múltiple de Buenos Aires, CABA, Buenos Aires, Argentina.,Servicio de Neurología, Hospital Universitario de CEMIC, CABA
| | - Sorbara Marcos
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
| | | |
Collapse
|
29
|
Discontinuation of disease-modifying therapy in MS patients over 60 years old and its impact on relapse rate and disease progression. Clin Neurol Neurosurg 2023; 225:107612. [PMID: 36701940 DOI: 10.1016/j.clineuro.2023.107612] [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: 08/15/2021] [Revised: 11/28/2022] [Accepted: 01/21/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND / AIMS The benefit of disease-modifying therapy (DMT) is unclear for older patients with multiple sclerosis (MS), namely those who have not experienced clinical disease activity for a prolonged time. We aimed to compare baseline differences and clinical outcomes between DMT discontinuers and continuers in a cohort of MS patients older than 60 years. METHODS Retrospective, observational study identifying MS patients aged over 60 years, stable on DMT> 24 months. Additional inclusion criteria were a previous diagnosis of relapsing MS and a minimum follow-up period of 24 months. Differences between groups (continuers/discontinuers) were assessed. For risk of relapse and of confirmed disability worsening at follow up, a time to outcome survival model was constructed using Cox proportional hazards regression, testing for possible risk predictors. RESULTS Thirty-five patients were included (68.6% female), with a mean age at diagnosis of 42.1 ( ± 9.5) years and a median EDSS score of 3 (IQR 2) at the age of 60 years (baseline). Thirteen patients discontinued DMT after baseline, in a mean follow-up time of 77.1 months ( ± 40.2). No differences were found between DMT continuers vs discontinuers. DMT discontinuation did not predict risk to relapse (HR 0.38, 95%CI 0.04-3.80, p = 0.408) or disability worsening at follow-up (HR 0.83, 95%CI 0.31-2.22, p = 0.712). MRI gadolinium-enhancing lesions and EDSS score > 3 at baseline were found to be independent predictors of risk to relapse and disability worsening at follow-up, respectively. CONCLUSION DMT discontinuation did not seem to influence clinical outcome, equating with the perceived limited effect of continued immunomodulation on older stable and/or progressive patients.
Collapse
|
30
|
Chappuis M, Rousseau C, Bajeux E, Wiertlewski S, Laplaud D, Le Page E, Michel L, Edan G, Kerbrat A. Discontinuation of second- versus first-line disease-modifying treatment in middle-aged patients with multiple sclerosis. J Neurol 2023; 270:413-422. [PMID: 36121558 DOI: 10.1007/s00415-022-11341-2] [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: 07/13/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE There has been scant research on the consequences of discontinuing second-line disease-modifying treatment (DMT) in middle-aged patients with multiple sclerosis (MS). The objective was therefore to examine the occurrence of focal inflammatory activity after the discontinuation of second versus first-line DMT in patients over 45 years. METHODS Patients who had been treated for at least 6 months with second (natalizumab, fingolimod, anti CD20) or first-line DMT and who stopped their DMT were retrospectively included. Kaplan-Meier survival curves were used to study the occurrence of relapse and MRI activity according to the type of DMT stopped. Proportional hazard Cox models were calculated to identify factors associated with focal inflammatory activity. The annualized relapse rate was calculated under treatment and for every 3 months after DMT discontinuation. RESULTS We included 232 patients (median age: 52.8 years), 49 of whom stopped second-line DMT. The probability of having a relapse within the year following discontinuation was 6% for first-line DMT, 9% for fingolimod and 43% for natalizumab. In multivariate analysis, the probability of relapse after DMT discontinuation was significantly increased with natalizumab compared to first-line DMT (HR = 3.24; 95% CI [1.52; 6.90]). A peak of relapse was observed at 0-3 months after stopping natalizumab or fingolimod. CONCLUSION Our study suggests that the risk of inflammatory activity is greater after discontinuation of natalizumab compared to other DMT even in middle-aged patients. As for younger patients, natalizumab discontinuation should only be considered if there is an adequate substitution of a different therapy. .
Collapse
Affiliation(s)
- Maëlle Chappuis
- Department of Neurology, University Hospital, Rennes, France.
| | - Chloé Rousseau
- Research Management Department, University Hospital, Rennes, France
| | - Emma Bajeux
- Department of Epidemiology and Public Health, University Hospital, Rennes, France
| | | | - David Laplaud
- Department of Neurology, University Hospital, Nantes, France
| | - Emmanuelle Le Page
- Department of Neurology, University Hospital, Rennes, France.,CIC-P 1414 Inserm, University Hospital, Rennes, France
| | - Laure Michel
- Department of Neurology, University Hospital, Rennes, France.,CIC-P 1414 Inserm, University Hospital, Rennes, France
| | - Gilles Edan
- Department of Neurology, University Hospital, Rennes, France.,CIC-P 1414 Inserm, University Hospital, Rennes, France
| | - Anne Kerbrat
- Department of Neurology, University Hospital, Rennes, France.,CIC-P 1414 Inserm, University Hospital, Rennes, France
| |
Collapse
|
31
|
Graves JS, Krysko KM, Hua LH, Absinta M, Franklin RJM, Segal BM. Ageing and multiple sclerosis. Lancet Neurol 2023; 22:66-77. [PMID: 36216015 DOI: 10.1016/s1474-4422(22)00184-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/09/2022] [Accepted: 04/20/2022] [Indexed: 11/07/2022]
Abstract
The factor that is most relevant and strongly associated with the clinical course of multiple sclerosis is chronological age. Very young patients exclusively have relapsing remitting disease, whereas those with later onset disease face a more rapid development of permanent disability. For people with progressive multiple sclerosis, the poor response to current disease modifying therapies might be related to ageing in the immune system and CNS. Ageing is also associated with increased risks of side-effects caused by some multiple sclerosis therapies. Both somatic and reproductive ageing processes might contribute to development of progressive multiple sclerosis. Understanding the role of ageing in immune and neural cell function in patients with multiple sclerosis might be key to halting non-relapse-related progression. The growing literature on potential therapies that target senescent cells and ageing processes might provide effective strategies for remyelination and neuroprotection.
Collapse
Affiliation(s)
- Jennifer S Graves
- Department of Neurosciences, University of California, San Diego, CA, USA; Pediatric Multiple Sclerosis Center, Rady Children's Hospital, San Diego, CA, USA; Department of Neurology, San Diego VA Hospital, San Diego, CA, USA.
| | - Kristen M Krysko
- Division of Neurology, Department of Medicine, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Le H Hua
- Department of Neurology, Cleveland Clinic, Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Martina Absinta
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA; Division of Neuroscience, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Robin J M Franklin
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Benjamin M Segal
- Department of Neurology and the Neuroscience Research Institute, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
32
|
Zhong M, van der Walt A, Monif M, Hodgkinson S, Eichau S, Kalincik T, Lechner-Scott J, Buzzard K, Skibina O, Van Pesch V, Butler E, Prevost J, Girard M, Oh J, Butzkueven H, Jokubaitis V. Prediction of relapse activity when switching to cladribine for multiple sclerosis. Mult Scler 2023; 29:119-129. [PMID: 35894247 DOI: 10.1177/13524585221111677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with relapsing-remitting multiple sclerosis commonly switch between disease-modifying therapies (DMTs). Identifying predictors of relapse when switching could improve outcomes. OBJECTIVE To determine predictors of relapse hazard when switching to cladribine. METHODS Data of patients who switched to cladribine, grouped by prior disease-modifying therapy (pDMT; interferon-β/glatiramer acetate, dimethyl fumarate, teriflunomide, fingolimod or natalizumab (NTZ)), were extracted from the MSBase Registry. Predictors of relapse hazard during the treatment gap and the first year of cladribine therapy were determined. RESULTS Of 513 patients, 22 relapsed during the treatment gap, and 38 within 1 year of starting cladribine. Relapse in the year before pDMT cessation predicted treatment gap relapse hazard (hazard ratio (HR) = 2.43, 95% confidence interval (CI) = 1.03-5.71). After multivariable adjustment, relapse hazard on cladribine was predicted by relapse before pDMT cessation (HR = 2.00, 95% CI = 1.01-4.02), treatment gap relapse (HR = 6.18, 95% confidence interval (CI) = 2.65-14.41), switch from NTZ (HR compared to injectable therapies 4.08, 95% CI = 1.35-12.33) and age at cladribine start (HR = 0.96, 95% CI = 0.91-0.99). CONCLUSION Relapse during or prior to the treatment gap, and younger age, are of prognostic relevance in the year after switching to cladribine. Switching from NTZ is also independently associated with greater relapse hazard.
Collapse
Affiliation(s)
- Michael Zhong
- Central Clinical School, Monash University, Melbourne, VIC, Australia/Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Anneke van der Walt
- Central Clinical School, Monash University, Melbourne, VIC, Australia/Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Mastura Monif
- Central Clinical School, Monash University, Melbourne, VIC, Australia/Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia/MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Tomas Kalincik
- MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia/CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia/Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia
| | - Katherine Buzzard
- MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia/Department of Neurosciences, Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, VIC, Australia
| | - Olga Skibina
- Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia/Department of Neurosciences, Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, VIC, Australia
| | | | | | | | - Marc Girard
- CHUM and Universite de Montreal, Montreal, QC, Canada
| | - Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, VIC, Australia/Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Vilija Jokubaitis
- Central Clinical School, Monash University, Melbourne, VIC, Australia/Department of Neurology, The Alfred Hospital, Melbourne, VIC, Australia
| |
Collapse
|
33
|
Loonstra FC, de Ruiter LRJ, Koel-Simmelink MJA, Schoonheim MM, Strijbis EMM, Moraal B, Barkhof F, Uitdehaag BMJ, Teunissen C, Killestein J. Neuroaxonal and Glial Markers in Patients of the Same Age With Multiple Sclerosis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 10:10/2/e200078. [PMID: 36543540 PMCID: PMC9773420 DOI: 10.1212/nxi.0000000000200078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The specificity of novel blood biomarkers for multiple sclerosis (MS)-related neurodegeneration is unclear because neurodegeneration also occurs during normal aging. To understand which aspects of neurodegeneration the serum biomarkers neurofilament light (sNfL), serum glial fibrillary acidic protein (sGFAP), and serum contactin-1 (sCNTN1) reflect, we here explore their cross-sectional association with disability outcome measures and MRI volumes in a unique cohort of people with MS (PwMS) of the same age. METHODS sNfL, sGFAP (both singe-molecule array technology) and sCNTN1 (Luminex) were measured in serum samples of 288 PwMS and 125 healthy controls (HCs) of the Project Y cohort, a population-based cross-sectional study of PwMS born in the Netherlands in 1966 and age-matched HC. RESULTS sNfL (9.83 pg/mL [interquartile range {IQR}: 7.8-12.0]) and sGFAP (63.7 pg/mL [IQR: 48.5-84.5]) were higher in PwMS compared with HC (sNfL: 8.8 pg/mL [IQR: 7.0-10.5]; sGFAP: 51.7 pg/mL [IQR: 40.1-68.3]) (p < 0.001), whereas contactin-1 (7,461.3 pg/mL [IQR: 5,951.8-9,488.6]) did not significantly differ between PwMS compared with HC (7,891.2 pg/mL [IQR: 6,120.0-10,265.8]) (p = 0.068). sNfL and sGFAP levels were 1.2-fold higher in secondary progressive patients (SPMS) compared with relapsing remitting patients (p = 0.009 and p = 0.043). Stratified by MS subtype, no relations were seen for CNTN1, whereas sNfL and sGFAP correlated with the Expanded Disability Status Scale (ρ = 0.43 and ρ = 0.39), Nine-Hole Peg Test, Timed 25-Foot Walk Test, and Symbol Digit Modalities Test (average ρ = 0.38) only in patients with SPMS. Parallel to these clinical findings, correlations were only found for sNfL and sGFAP with MRI volumes. The strongest correlations were observed between sNfL and thalamic volume (ρ = -0.52) and between sGFAP with deep gray matter volume (ρ = - 0.56) in primary progressive patients. DISCUSSION In our cohort of patients of the same age, we report consistent correlations of sNfL and sGFAP with a range of metrics, especially in progressive MS, whereas contactin-1 was not related to clinical or MRI measures. This demonstrates the potential of sNfL and sGFAP as complementary biomarkers of neurodegeneration, reflected by disability, in progressive MS.
Collapse
Affiliation(s)
- Floor C Loonstra
- From the MS Center Amsterdam (F.C.L., L.R.J.R., E.M.M.S., B.M.J.U., J.K.), Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; Neurochemistry Laboratory (M.J.A.K.-S., C.T.), Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (M.M.S.), Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (B.M., F.B.), Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; andQueen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom.
| | - Lodewijk R J de Ruiter
- From the MS Center Amsterdam (F.C.L., L.R.J.R., E.M.M.S., B.M.J.U., J.K.), Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; Neurochemistry Laboratory (M.J.A.K.-S., C.T.), Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (M.M.S.), Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (B.M., F.B.), Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; andQueen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom
| | - Marleen J A Koel-Simmelink
- From the MS Center Amsterdam (F.C.L., L.R.J.R., E.M.M.S., B.M.J.U., J.K.), Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; Neurochemistry Laboratory (M.J.A.K.-S., C.T.), Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (M.M.S.), Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (B.M., F.B.), Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; andQueen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom
| | - Menno M Schoonheim
- From the MS Center Amsterdam (F.C.L., L.R.J.R., E.M.M.S., B.M.J.U., J.K.), Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; Neurochemistry Laboratory (M.J.A.K.-S., C.T.), Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (M.M.S.), Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (B.M., F.B.), Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; andQueen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom
| | - Eva M M Strijbis
- From the MS Center Amsterdam (F.C.L., L.R.J.R., E.M.M.S., B.M.J.U., J.K.), Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; Neurochemistry Laboratory (M.J.A.K.-S., C.T.), Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (M.M.S.), Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (B.M., F.B.), Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; andQueen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom
| | - Bastiaan Moraal
- From the MS Center Amsterdam (F.C.L., L.R.J.R., E.M.M.S., B.M.J.U., J.K.), Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; Neurochemistry Laboratory (M.J.A.K.-S., C.T.), Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (M.M.S.), Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (B.M., F.B.), Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; andQueen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom
| | - Frederik Barkhof
- From the MS Center Amsterdam (F.C.L., L.R.J.R., E.M.M.S., B.M.J.U., J.K.), Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; Neurochemistry Laboratory (M.J.A.K.-S., C.T.), Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (M.M.S.), Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (B.M., F.B.), Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; andQueen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom
| | - Bernard M J Uitdehaag
- From the MS Center Amsterdam (F.C.L., L.R.J.R., E.M.M.S., B.M.J.U., J.K.), Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; Neurochemistry Laboratory (M.J.A.K.-S., C.T.), Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (M.M.S.), Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (B.M., F.B.), Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; andQueen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom
| | - Charlotte Teunissen
- From the MS Center Amsterdam (F.C.L., L.R.J.R., E.M.M.S., B.M.J.U., J.K.), Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; Neurochemistry Laboratory (M.J.A.K.-S., C.T.), Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (M.M.S.), Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (B.M., F.B.), Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; andQueen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom
| | - Joep Killestein
- From the MS Center Amsterdam (F.C.L., L.R.J.R., E.M.M.S., B.M.J.U., J.K.), Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; Neurochemistry Laboratory (M.J.A.K.-S., C.T.), Clinical Chemistry, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (M.M.S.), Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; MS Center Amsterdam (B.M., F.B.), Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, The Netherlands; andQueen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom
| |
Collapse
|
34
|
Finkener S, Achtnichts L, Cervenakova M, Nedeltchev K, Findling O. Oral disease modifying therapies - A game changer for treatment decision in untreated patients with RRMS and CIS? - A swiss single center cross-sectional study. Mult Scler Relat Disord 2022; 68:104396. [PMID: 36544325 DOI: 10.1016/j.msard.2022.104396] [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: 07/31/2022] [Revised: 09/19/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Several disease-modifying therapies (DMTs) show efficacy in relapsing-remitting multiple sclerosis (RRMS) and clinically isolated syndrome (CIS). However, there is still a relevant proportion of patients who remain untreated. We provide real-world data on untreated and treated patients and we report whether and how the introduction of oral DMTs changed the treatment decision. Furthermore, we discuss possible reasons for not receiving DMTs. METHODS We conducted a retrospective cross-sectional study and analysed demographic and clinical data of patients with RRMS and CIS at our MS center. Comparison was made between untreated and treated patients in 2010 (before the introduction of oral DMTs) and in 2014 (after the introduction of oral DMTs). Furthermore, we analysed reasons for the decision against DMTs in patients who never received DMTs and patients who discontinued DMTs. RESULTS We analysed datasets of 344 MS patients in 2010 and 253 in 2014. There were more untreated patients in CIS than in RRMS. In RRMS, the proportion of untreated patients decreased significantly between 2010 and 2014 from 23.6% to 11.1%, while the use of oral medications increased significantly from <1% to more than 50% in 2014. In CIS, there was no significant change in untreated patients between 2010 and 2014 (61.1% in 2010 to 52.6% in 2014). Untreated patients with RRMS were significantly older and had lower ARR than treated patients. Patients who never received DMT had lower EDSS compared to patients that had been treated before. The main reasons for the decision against DMT were "belief in a benign course" and "fear of adverse effects". Treatment discontinuation was caused mainly by the adverse effects. DISCUSSION In our data a relevant proportion of patients with RRMS and CIS did not receive any DMT. We hypothesize that in patients with RRMS the introduction of oral DMTs translated to a higher rate of treatment, whereas in CIS there no change was observed. This could be due to limited therapeutic options in CIS. There is more information needed regarding the treatment recommendation for older patients and patients with mild course of the disease.
Collapse
Affiliation(s)
| | - Lutz Achtnichts
- Department of Neurology, Aarau Cantonal Hospital, Aarau, Switzerland
| | | | - Krassen Nedeltchev
- Department of Neurology, Aarau Cantonal Hospital, Aarau, Switzerland; University of Bern, Bern, Switzerland
| | - Oliver Findling
- Department of Neurology, Aarau Cantonal Hospital, Aarau, Switzerland; MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel(RC2NB),Head, Spine and Neuromedicine, Clinical Research and Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
| |
Collapse
|
35
|
Yusuf FLA, Wijnands JMA, Karim ME, Kingwell E, Zhu F, Evans C, Fisk JD, Zhao Y, Marrie RA, Tremlett H. Sex and age differences in the Multiple Sclerosis prodrome. Front Neurol 2022; 13:1017492. [PMID: 36408518 PMCID: PMC9668896 DOI: 10.3389/fneur.2022.1017492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/04/2022] [Indexed: 08/12/2023] Open
Abstract
Background and objectives Little is known of the potential sex and age differences in the MS prodrome. We investigated sex and age differences in healthcare utilization during the MS prodrome. Methods This was a population-based matched cohort study linking administrative and clinical data from British Columbia, Canada (population = 5 million). MS cases in the 5 years preceding a first demyelinating event ("administrative cohort;" n = 6,863) or MS symptom onset ("clinical cohort;" n = 966) were compared to age-, sex- and geographically-matched controls (n = 31,865/4,534). Negative binomial and modified Poisson models were used to compare the rates of physician visits and hospitalizations per international classification of diseases chapter, and prescriptions filled per drug class, between MS cases and controls across sex and age-groups (< 30, 30-49, ≥50 years). Results In the administrative cohort, males with MS had a higher relative rate for genitourinary-related visits (males: adjusted Rate Ratio (aRR) = 1.65, females: aRR = 1.19, likelihood ratio test P = 0.02) and antivertigo prescriptions (males: aRR = 4.72, females: aRR = 3.01 P < 0.01). Injury and infection-related hospitalizations were relatively more frequent for ≥50-year-olds (injuries < 30/30-49/≥50: aRR = 1.16/1.39/2.12, P < 0.01; infections 30-49/≥50: aRR = 1.43/2.72, P = 0.03), while sensory-related visits and cardiovascular prescriptions were relatively more common in younger persons (sensory 30-49/≥50: aRR = 1.67/1.45, P = 0.03; cardiovascular < 30/30-49/≥50: aRR = 1.56/1.39/1.18, P < 0.01). General practitioner visits were relatively more frequent in males (males: aRR = 1.63, females: aRR = 1.40, P < 0.01) and ≥50-year-olds (< 30/≥50: aRR = 1.32/1.55, P = 0.02), while differences in ophthalmologist visits were disproportionally larger among younger persons, < 50-years-old (< 30/30-49/≥50: aRR = 2.25/2.20/1.55, P < 0.01). None of the sex and age-related differences in the smaller clinical cohort reached significance (P ≥ 0.05). Discussion Sex and age-specific differences in healthcare use were observed in the 5 years before MS onset. Findings demonstrate fundamental heterogeneity in the MS prodromal presentation.
Collapse
Affiliation(s)
- Fardowsa L. A. Yusuf
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - José M. A. Wijnands
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Elaine Kingwell
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Feng Zhu
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D. Fisk
- Nova Scotia Health and the Department of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Yinshan Zhao
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Health Sciences Centre, Winnipeg, MB, Canada
| | - Helen Tremlett
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
36
|
Cho EB, Yeo Y, Jung JH, Jeong SM, Han KD, Shin DW, Min JH. Risk of stroke in multiple sclerosis and neuromyelitis optic spectrum disorder: a Nationwide cohort study in South Korea. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329628. [PMID: 36028308 DOI: 10.1136/jnnp-2022-329628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND People with multiple sclerosis (MS) are more likely to develop stroke than those without. However, little is known about the association between neuromyelitis optica spectrum disorder (NMOSD) and the risk of stroke. We aimed to estimate the risk of stroke in patients with MS and NMOSD in South Korea. METHODS Data from the Korean National Health Insurance between January 2010 and December 2017 were analysed. A total of 1541/1687 adult patients with MS/NMOSD, who were free of stroke were included. Matched controls were selected based on age, sex and the presence of hypertension, diabetes mellitus and dyslipidaemia. RESULTS The risk of developing stroke was 2.78 times higher (adjusted HR (aHR), 95% CI 1.91 to 4.05) in patients with MS compared with controls matched by age, sex, hypertension, diabetes mellitus and dyslipidaemia. The risk of stroke in NMOSD was also higher than that in matched controls (aHR=1.69, 95% CI 1.10 to 2.61) and not statistically different from that of MS (p=0.216). The patients with MS had a higher risk for either of ischaemic or haemorrhagic stroke (HR=2.63 and 2.93, respectively), whereas those with NMOSD had a higher risk for ischaemic stroke (HR=1.60) with marginal statistical significance. CONCLUSIONS The risk of stroke is increased in patients with MS and NMOSD and seemed comparable between the two conditions. This is the first study that estimates the risk of stroke in patients with MS and NMOSD within the same population.
Collapse
Affiliation(s)
- Eun Bin Cho
- Department of Neurology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, South Korea
- Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Yohwan Yeo
- Department of Family Medicine, College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Jin Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Su-Min Jeong
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Kyung-do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
- Department of Clinical Research Design & Evaluation and Digital Health, Samsung AdvanceSamsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
- Center for Wireless and Population Health Systems, University of California San Diego, San Diego, CA, USA
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
37
|
Braune S, Bergmann A, Bezlyak V, Adlard N. How do patients with secondary progressive multiple sclerosis enrolled in the EXPAND randomized controlled trial compare with those seen in German clinical practice in the NeuroTransData multiple sclerosis registry? J Cent Nerv Syst Dis 2022; 14:11795735221115912. [PMID: 35958354 PMCID: PMC9358581 DOI: 10.1177/11795735221115912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background In EXPAND (NCT01665144), a phase 3 randomized clinical trial, siponimod reduced disability progression versus placebo in patients with secondary progressive multiple sclerosis (SPMS). Aim To understand how a real-world population with SPMS relates to that in EXPAND, we conducted a retrospective, observational cohort study using the German NeuroTransData (NTD) multiple sclerosis (MS) registry. Methods The NTD MS registry is run by a Germany-wide network of physicians. Two cross-sectional analyses were performed using the NTD MS registry. The first included patients with SPMS, as recorded in the registry, and compared their characteristics between 1 January 2018 and 31 December 2018 with patients in EXPAND. The second described the characteristics of patients in the registry at the time of diagnosis of SPMS between 1 January 2010 and 31 December 2018. Results The first analysis included 773 patients: patients were older in the NTD MS registry than in EXPAND (mean age, 57.9 vs 48.0 years) and had a longer duration of SPMS (mean, 6.2 vs 3.8 years). In the NTD MS registry, median Expanded Disability Status Scale (EDSS) scores were comparable to EXPAND (6.0 versus 6.0), although fewer patients had relapses in the previous 24 months (16% vs 36% [siponimod] and 37% [placebo]). Data on gadolinium-enhancing lesions were only available for 5.8% of patients in the NTD MS registry. The second analysis included 916 patients: at the time of SPMS diagnosis, the mean age was 53.2 years and the median EDSS score was 5.0. Conclusion The population in the NTD MS registry was older to that in EXPAND, but were similar in terms of disability. Differences likely reflect the inclusion criteria of EXPAND but also highlight that real-world populations encompass a wider range of patient characteristics.
Collapse
|
38
|
Sattarnezhad N, Healy BC, Baharnoori M, Diaz-Cruz C, Stankiewicz J, Weiner HL, Chitnis T. Comparison of dimethyl fumarate and interferon outcomes in an MS cohort. BMC Neurol 2022; 22:252. [PMID: 35820822 PMCID: PMC9277810 DOI: 10.1186/s12883-022-02761-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background To compare the effectiveness of dimethyl fumarate (DMF) with subcutaneous interferon beta-1a (IFNβ-1a) in controlling disease activity in patients with relapsing–remitting Multiple Sclerosis (MS). Methods Clinical and imaging data from patients treated with either IFNβ-1a or DMF for at least one year were reviewed. The proportion of patients with at least one clinical relapse within 3–15 months after treatment onset, the proportion of patients with new T2 or gadolinium-enhancing lesions, and the proportion of subjects who achieved no evidence of disease activity (NEDA) status were assessed. Results Three hundred sixteen (98 on IFNβ-1a, 218 on DMF) subjects were included. Baseline demographics were comparable between groups except for age, disease duration, and the number of previous treatments being higher and relapse rate in the prior year being lower in the DMF-treated group. The proportion of patients having a clinical relapse (24.5% vs. 9.6%; OR = 3.04; P < 0.001) or a new MRI lesion (28.6% vs. 8.7%; OR = 4.19, P < 0.001) at 15 months were higher on IFNβ-1a. 79.9% of the patients achieved NEDA status at 15 months on DMF (vs. 51.1% for IFNβ-1a; OR = 0.26, P < 0.001). Further adjustment for demographics, disease characteristics, treatment and relapse history, and subgroup analyses confirmed these findings. Conclusion DMF was associated with less clinical and radiological disease activity compared to IFNβ-1a. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02761-8.
Collapse
Affiliation(s)
- Neda Sattarnezhad
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA
| | - Brian C Healy
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA.,Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Moogeh Baharnoori
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA
| | - Camilo Diaz-Cruz
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA
| | - James Stankiewicz
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA
| | - Howard L Weiner
- Harvard Medical School, Boston, Massachusetts, 02115, USA.,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA
| | - Tanuja Chitnis
- Harvard Medical School, Boston, Massachusetts, 02115, USA. .,Brigham Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, 02115, USA.
| |
Collapse
|
39
|
Cho EB, Yeo Y, Jung JH, Jeong SM, Han K, Yang JH, Shin DW, Min JH. Acute myocardial infarction risk in multiple sclerosis and neuromyelitis optica spectrum disorder: A nationwide cohort study in South Korea. Mult Scler 2022; 28:1849-1858. [PMID: 35695204 DOI: 10.1177/13524585221096964] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The link between neuromyelitis optica spectrum disorder (NMOSD) and cardiovascular disease is currently unclear. OBJECTIVE To determine the acute myocardial infarction (MI) risk in patients with MS and NMOSD. METHODS This study analyzed the Korean National Health Insurance Service database between January 2010 and December 2017. The included patients comprised 1503/1675 adults with MS/NMOSD who had not experienced ischemic heart disease or ischemic stroke at the index date. Matched controls were selected based on age, sex, and the presence of hypertension, diabetes mellitus (DM), and dyslipidemia. RESULTS The risks of developing MI were 2.61 (hazard ratio (HR), 95% confidence interval (CI) 1.73-3.95) and 1.95 (95% CI = 1.18-3.22) times higher in MS and NMOSD compared with the control populations. Patients with NMOSD had a similar MI risk compared with patients with MS, after adjusting for age, sex, income, hypertension, DM, and dyslipidemia (HR = 0.59, 95% CI = 0.34-1.02, p = 0.059). Among each patient group, the MI risk did not differ significantly with age (20-39, 40-64 or ⩾65 years), sex, or the presence of hypertension, DM, or dyslipidemia. CONCLUSION The MI risk increased in MS and NMOSD and seemed to be comparable between NMOSD and MS.
Collapse
Affiliation(s)
- Eun Bin Cho
- Department of Neurology, College of Medicine, Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, South Korea/Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Yohwan Yeo
- Department of Family Medicine, College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Su-Min Jeong
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea/Department of Clinical Research Design & Evaluation and Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea/Center for Wireless and Population Health Systems, University of California San Diego, San Diego, CA, USA
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea/Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea/Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
40
|
Zhang Y, Cofield S, Cutter G, Krieger S, Wolinsky JS, Lublin F. Predictors of Disease Activity and Worsening in Relapsing-Remitting Multiple Sclerosis. Neurol Clin Pract 2022; 12:e58-e65. [DOI: 10.1212/cpj.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022]
Abstract
Background and Objectives:Disease activity in multiple sclerosis (MS) is highly variable, and there are limited prospective studies on predictors of disease outcomes. The goal of the study is to identify and assess patient characteristics in MS that predict disease activity and worsening.Methods:The study population consisted of a prospective cohort of 1,008 participants with relapsing-remitting (RR) onset MS enrolled in the CombiRx trial. Cox regression analysis was used to determine hazard ratio (HR) associations between baseline (BL) demographics, clinical history, MRI metrics, and treatment; with outcomes of time to first new disease activity over up to 7-years of follow-up including relapse, MRI activity, and disease worsening.Results:1,008 participants were randomized, with 959 eligible for assessment of disease activity and worsening on follow-up. In the multivariable models, risk of relapse was higher in participants younger than 38 at BL vs. older (HR range 1.36-1.43), with presence of Gd+ lesions at baseline (HR 1.38, [95%CI: 1.14, 1.67]), and with BL EDSS ≥3.5 vs. <3.5 (HR range 1.63-1.67). Risk of new MRI activity was higher in younger participants (HR range 1.58-1.84), with higher preexisting lesion counts greater than the median lesion count with ≥71 T2 hyperintense lesions vs. <71 (HR 1.50, [95%CI 1.27, 1.77]), with presence of BL Gd+ lesions (HR 1.75, [95%CI: 1.49, 2.06]), and higher baseline T2 lesion volume (HR 1.02 for every unit increase in baseline volume, [95% CI 1.01, 1.03]). Risk of new MRI activity was lower in those receiving combination therapy compared to either GA (HR range 0.67-0.68) or IFN (HR range 0.68-0.70). Risk of disease worsening was higher for those with higher T2 volume (HR for 1 unit increase in volume 1.01, 95% CI 1.004, 1.03) and BL EDSS <2 (HR range 2.79-2.96). There were no associations between sex, race, and disease duration on relapse, MRI activity, or disease worsening in multivariable analysis.Conclusion:Prospective data from a large clinical trial cohort shows that younger MS patients with high baseline relapses and MRI lesion burden have the highest risk of subsequent disease activity.CombiRx was registered at ClinicalTrials.gov (NCT00211887) on September 21, 2005. Study enrollment began in January 2005.
Collapse
|
41
|
Atkinson JR, Jerome AD, Sas AR, Munie A, Wang C, Ma A, Arnold WD, Segal BM. Biological aging of CNS-resident cells alters the clinical course and immunopathology of autoimmune demyelinating disease. JCI Insight 2022; 7:158153. [PMID: 35511417 PMCID: PMC9309055 DOI: 10.1172/jci.insight.158153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
Biological aging is the strongest factor associated with the clinical phenotype of multiple sclerosis (MS). Relapsing-remitting MS typically presents in the third or fourth decade, whereas the mean age of presentation of progressive MS (PMS) is 45 years old. Here, we show that experimental autoimmune encephalomyelitis (EAE), induced by the adoptive transfer of encephalitogenic CD4+ Th17 cells, was more severe, and less likely to remit, in middle-aged compared with young adult mice. Donor T cells and neutrophils were more abundant, while B cells were relatively sparse, in CNS infiltrates of the older mice. Experiments with reciprocal bone marrow chimeras demonstrated that radio-resistant, nonhematopoietic cells played a dominant role in shaping age-dependent features of the neuroinflammatory response, as well as the clinical course, during EAE. Reminiscent of PMS, EAE in middle-aged adoptive transfer recipients was characterized by widespread microglial activation. Microglia from older mice expressed a distinctive transcriptomic profile suggestive of enhanced chemokine synthesis and antigen presentation. Collectively, our findings suggest that drugs that suppress microglial activation, and acquisition or expression of aging-associated properties, may be beneficial in the treatment of progressive forms of inflammatory demyelinating disease.
Collapse
Affiliation(s)
- Jeffrey R Atkinson
- Department of Neurology, The Ohio State University, Columbus, United States of America
| | - Andrew D Jerome
- Department of Neurology, The Ohio State University, Columbus, United States of America
| | - Andrew R Sas
- Department of Neurology, The Ohio State University, Columbus, United States of America
| | - Ashley Munie
- Department of Neurology, The Ohio State University, Columbus, United States of America
| | - Cankun Wang
- Department of Biomedical Informatics, The Ohio Sate University, Columbus, United States of America
| | - Anjun Ma
- Department of Biomedical Informatics, The Ohio State University, Columbus, United States of America
| | - William D Arnold
- Department of Neurology, The Ohio State University, Columbus, United States of America
| | - Benjamin M Segal
- Department of Neurology, The Ohio State University, Columbus, United States of America
| |
Collapse
|
42
|
Immune Cell Contributors to the Female Sex Bias in Multiple Sclerosis and Experimental Autoimmune Encephalomyelitis. Curr Top Behav Neurosci 2022; 62:333-373. [PMID: 35467295 DOI: 10.1007/7854_2022_324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Multiple sclerosis (MS) is a chronic, autoimmune, demyelinating disease of the central nervous system (CNS) that leads to axonal damage and accumulation of disability. Relapsing-remitting MS (RR-MS) is the most frequent presentation of MS and this form of MS is three times more prevalent in females than in males. This female bias in MS is apparent only after puberty, suggesting a role for sex hormones in this regulation; however, very little is known of the biological mechanisms that underpin the sex difference in MS onset. Experimental autoimmune encephalomyelitis (EAE) is an animal model of RR-MS that presents more severely in females in certain mouse strains and thus has been useful to study sex differences in CNS autoimmunity. Here, we overview the immunopathogenesis of MS and EAE and how immune mechanisms in these diseases differ between a male and female. We further describe how females exhibit more robust myelin-specific T helper (Th) 1 immunity in MS and EAE and how this sex bias in Th cells is conveyed by sex hormone effects on the T cells, antigen presenting cells, regulatory T cells, and innate lymphoid cell populations.
Collapse
|
43
|
Shu MJ, Li J, Zhu YC. Genetically predicted telomere length and multiple sclerosis. Mult Scler Relat Disord 2022; 60:103731. [PMID: 35339005 DOI: 10.1016/j.msard.2022.103731] [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: 11/26/2021] [Revised: 02/22/2022] [Accepted: 03/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous epidemiological studies have indicated a role for telomere length in multiple sclerosis (MS) severity and phenotype. However, these studies failed to establish the causality between telomere length and MS susceptibility. Hence, we performed two-sample Mendelian randomization (MR) analysis to explore the causal relationship between telomere length and MS susceptibility. METHODS We used data of genetic variants associated with leukocyte telomere length as instrumental variables (IVs), which was identified from the largest and latest genome-wide association study (GWAS) from UK Biobank (UKB) with 472,174 participants. Summary data of MS was obtained from the International Multiple Sclerosis Genetics Consortium. We performed two-sample MR analyses using the inverse-variance weighted method as the primary approach. Other MR approaches, including the MR-Egger, the inverse variance weighted (multiplicative random effects), weighted median, simple median, weighted mode-based methods, and Causal Analysis Using Summary Effect estimates (CAUSE), were also conducted to detect the result robustness. RESULTS The genetic liability to longer telomere length was associated with a higher risk of MS susceptibility (odds ratio [OR] per one-SD telomere length, 1.91; 95% confidence interval [CI], 1.48-2.47; P = 8.04 × 10-7). The results remained consistent across multiple sensitivity analyses. CONCLUSIONS Our study supports the causal relationship between longer telomere length and increased risk of MS susceptibility.
Collapse
Affiliation(s)
- Mei-Jun Shu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, No.1 Shuaifuyuan, Wangfujing, Beijing 10073, China
| | - Jiarui Li
- Department of Medical Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 10073, China
| | - Yi-Cheng Zhu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, No.1 Shuaifuyuan, Wangfujing, Beijing 10073, China.
| |
Collapse
|
44
|
McCombe PA. The role of sex and pregnancy in multiple sclerosis: what do we know and what should we do? Expert Rev Neurother 2022; 22:377-392. [PMID: 35354378 DOI: 10.1080/14737175.2022.2060079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is more prevalent in women than in men. The sex of the patient, and pregnancy, are reported to be associated with the clinical features of MS. The mechanism of this is unclear. AREAS COVERED This review summarizes data about sex differences in MS and the role of pregnancy. Possible mechanisms for the effects of sex and pregnancy are summarized, and practical suggestions for addressing these issues are provided. EXPERT OPINION There is considerable interdependence of the variables that are associated with MS. Men have a worse outcome of MS, and this could be due to the same factors that lead to greater incidence of neurodegenerative disease in men. The possible role of parity on the long-term outcome of MS is of interest. Future studies that look at the mechanisms of the effects of the sex of the patient on the outcome of MS are required. However, there are some actions that can be taken without further research. We can concentrate on public health measures that address the modifiable risk factors for MS and ensure that disease is controlled in women who intend to become pregnant and use appropriate disease modifying agents during pregnancy.
Collapse
Affiliation(s)
- Pamela A McCombe
- The University of Queensland, Centre for Clinical Research, Royal Brisbane and Women's Hospital, Herston, Australia
| |
Collapse
|
45
|
Portaccio E, Bellinvia A, Fonderico M, Pastò L, Razzolini L, Totaro R, Spitaleri D, Lugaresi A, Cocco E, Onofrj M, Di Palma F, Patti F, Maimone D, Valentino P, Confalonieri P, Protti A, Sola P, Lus G, Maniscalco GT, Brescia Morra V, Salemi G, Granella F, Pesci I, Bergamaschi R, Aguglia U, Vianello M, Simone M, Lepore V, Iaffaldano P, Filippi M, Trojano M, Amato MP. Progression is independent of relapse activity in early multiple sclerosis: a real-life cohort study. Brain 2022; 145:2796-2805. [PMID: 35325059 DOI: 10.1093/brain/awac111] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/12/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Disability accrual in multiple sclerosis may occur as relapse-associated worsening or progression independent of relapse activity. The role of progression independent of relapse activity in early MS is yet to be established. The objective of this multicentre, observational, retrospective cohort study was to investigate the contribution of relapse-associated worsening and progression independent of relapse activity to confirmed disability accumulation in patients with clinically isolated syndrome and early relapsing-remitting multiple sclerosis, assessed within one year from onset and with follow-up >/= 5 years (n = 5169). Data were extracted from the Italian Multiple Sclerosis Register. Confirmed disability accumulation was defined by an increase in Expanded Disability Status Scale score confirmed at 6 months, and classified per temporal association with relapses. Factors associated with progression independent of relapse activity and relapse-associated worsening were assessed using multivariable Cox regression models. Over a follow-up period of 11.5 ± 5.5 years, progression independent of relapse activity occurred in 1427 (27.6%) and relapse-associated worsening in 922 (17.8%) patients. Progression independent of relapse activity was associated with older age at baseline (HR = 1.19; 95CI 1.13-1.25, p < 0.001), having a relapsing-remitting course at baseline (HR = 1.44; 95CI 1.28-1.61, p < 0.001), longer disease duration at baseline (HR = 1.56; 95%CI 1.28-1.90, p < 0.001), lower Expanded Disability Status Scale at baseline (HR = 0.92; 95CI 0.88-0.96, p < 0.001), lower number of relapses before the event (HR = 0.76; 95CI 0.73-0.80, p < 0.001). Relapse-associated worsening was associated with younger age at baseline (HR = 0.87; 95CI 0.81-0.93, p < 0.001), having a relapsing-remitting course at baseline (HR = 1.55; 95CI 1.35-1.79, p < 0.001), lower Expanded Disability Status Scale at baseline (HR = 0.94; 95CI 0.89-0.99, p = 0.017), higher number of relapses before the event (HR = 1.04; 95CI 1.01-1.07, p < 0.001). Longer exposure to disease modifying drugs was associated with a lower risk of both progression independent of relapse activity and relapse-associated worsening (p < 0.001). This study provides evidence that in early relapsing-onset multiple sclerosis cohort, progression independent of relapse activity was an important contributor to confirmed disability accumulation. Our findings indicate that insidious progression appears even in the earliest phases of the disease, suggesting that inflammation and neurodegeneration can represent a single disease continuum, in which age is one of the main determinants of disease phenomenology.
Collapse
Affiliation(s)
- Emilio Portaccio
- University of Florence, Department of NEUROFARBA, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Department of Neurology, Florence, Italy
| | - Angelo Bellinvia
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | - Mattia Fonderico
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | - Luisa Pastò
- University of Florence, Department of NEUROFARBA, Florence, Italy
| | | | - Rocco Totaro
- San Salvatore Hospital, Demyelinating Disease Center, L'Aquila, Italy
| | - Daniele Spitaleri
- AORN San G. Moscati di Avellino, Department of Neurology, Avellino, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla, Bologna, Italy.,Università di Bologna, Dipartimento di Scienze Biomediche e Neuromotorie, Bologna, Italy
| | - Eleonora Cocco
- University of Cagliari, Department of Medical Science and Public health, Centro Sclerosi Multipla, Cagliari, Italy
| | - Marco Onofrj
- University G. d'Annunzio di Chieti-Pescara, Neuroscience, Imaging and Clinical Sciences, Chieti, Italy
| | - Franco Di Palma
- ASST Lariana Ospedale S. Anna, Department of Neurology, Como, Italy
| | - Francesco Patti
- University of Catania, Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Catania, Italy
| | - Davide Maimone
- Ospedale Garibaldi Centro, Department of Neurology, Catania, Italy
| | - Paola Valentino
- Institute of Neurology, University "Magna Graecia", Catanzaro, Italy
| | - Paolo Confalonieri
- Fondazione IRCCS Istituto Neurologico C. Besta, Neuroimmunology Unit, Milan, Italy
| | | | - Patrizia Sola
- University of Modena and Reggio Emilia, Department of Neurology, Modena, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Vincenzo Brescia Morra
- Federico II University, Naples, Multiple Sclerosis Clinical Care and Research Center, Department of Neuroscience (NSRO), Naples, Italy
| | - Giuseppe Salemi
- University of Palermo, Department of Biomedicine, Neuroscience and Advanced Diagnostics, Palermo, Italy
| | - Franco Granella
- University of Parma, Unit of Neurosciences, Department of Medicine and Surgery, Parma, Italy
| | - Ilaria Pesci
- Ospedale VAIO di Fidenza AUSL PR, Department of Neurology, Fidenza, Italy
| | | | - Umberto Aguglia
- Magna Graecia University of Catanzaro, Department of Medical and Surgical Sciences, Catanzaro, Italy
| | - Marika Vianello
- Unit of Neurology, Ca' Fancello Hospital, AULSS2, Treviso, Italy
| | - Marta Simone
- University 'Aldo Moro' of Bari, Child Neuropsychiatric Unit, Department of Biomedical Sciences and Human Oncology, Bari, Italy
| | - Vito Lepore
- Public Health Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Pietro Iaffaldano
- University of Bari Aldo Moro, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Bari, Italy
| | - Massimo Filippi
- San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit and MS Center, IRCCS San Raffaele Scientific Institute; Neuroimaging Research Unit, Division of Neuroscience; Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Trojano
- University of Bari Aldo Moro, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Bari, Italy
| | - Maria Pia Amato
- University of Florence, Department of NEUROFARBA, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Department of Neurology, Florence, Italy
| | | |
Collapse
|
46
|
Ng HS, Graf J, Zhu F, Kingwell E, Aktas O, Albrecht P, Hartung HP, Meuth SG, Evans C, Fisk JD, Marrie RA, Zhao Y, Tremlett H. Disease-Modifying Drug Uptake and Health Service Use in the Ageing MS Population. Front Immunol 2022; 12:794075. [PMID: 35095869 PMCID: PMC8792855 DOI: 10.3389/fimmu.2021.794075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background Evidence regarding the efficacy or effectiveness of the disease-modifying drugs (DMDs) in the older multiple sclerosis (MS) population is scarce. This has contributed to a lack of evidence-based treatment recommendations for the ageing MS population in practice guidelines. We examined the relationship between age (<55 and ≥55 years), DMD exposure and health service use in the MS population. Methods We conducted a population-based observational study using linked administrative health data from British Columbia, Canada. We selected all persons with MS and followed from the most recent of their first MS or demyelinating event, 18th birthday or 01-January-1996 (index date) until the earliest of emigration, death or 31-December-2017 (study end). We assessed DMD exposure status over time, initially as any versus no DMD, then by generation (first or second) and finally by each individual DMD. Age-specific analyses were conducted with all-cause hospitalizations and number of physician visits assessed using proportional means model and negative binomial regression with generalized estimating equations. Results We included 19,360 persons with MS (72% were women); 10,741/19,360 (56%) had ever reached their 55th birthday. Person-years of follow-up whilst aged <55 was 132,283, and 93,594 whilst aged ≥55. Any DMD, versus no DMD in the <55-year-olds was associated with a 23% lower hazard of hospitalization (adjusted hazard ratio, aHR0.77; 95%CI 0.72-0.82), but not in the ≥55-year-olds (aHR0.95; 95%CI 0.87-1.04). Similar patterns were observed for the first and second generation DMDs. Exposure to any (versus no) DMD was not associated with rates of physician visits in either age group (<55 years: adjusted rate ratio, aRR1.02; 95%CI 1.00-1.04 and ≥55 years: aRR1.00; 95%CI 0.96-1.03), but variation in aRR was observed across the individual DMDs. Conclusion Our study showed beneficial effects of the DMDs used to treat MS on hospitalizations for those aged <55 at the time of exposure. In contrast, for individuals ≥55 years of age exposed to a DMD, the hazard of hospitalization was not significantly lowered. Our study contributes to the broader understanding of the potential benefits and risks of DMD use in the ageing MS population.
Collapse
Affiliation(s)
- Huah Shin Ng
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Jonas Graf
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Feng Zhu
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Elaine Kingwell
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.,Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Neurology, Palacky University in Olomouc, Olomouc, Czechia
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D Fisk
- Nova Scotia Health Authority and the Departments of Psychiatry, Psychology and Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Yinshan Zhao
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Helen Tremlett
- Department of Medicine, Division of Neurology and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
47
|
Salvetti M, Wray S, Nelles G, Altincatal A, Kumar A, Koster T, Naylor ML. Safety and clinical effectiveness of peginterferon beta-1a for relapsing multiple sclerosis in the real-world setting: Interim results from the Plegridy Observational Program. Mult Scler Relat Disord 2022; 57:103350. [PMID: 35158459 DOI: 10.1016/j.msard.2021.103350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Plegridy Observational Program (POP) is an ongoing, 5-year, phase 4 real-world study of the safety and effectiveness of subcutaneous peginterferon beta-1a in patients with relapsing multiple sclerosis (RMS). METHODS This interim analysis from POP assessed the safety and effectiveness of peginterferon beta-1a, including subgroup analyses of patients aged < 50 and ≥ 50 years, newly diagnosed and non-newly diagnosed patients, and new and experienced peginterferon beta-1a users. RESULTS A total of 1208 patients enrolled in POP. Mean (standard deviation) peginterferon treatment duration in the overall population was 757.0 (529.5) days. The overall incidence of treatment-emergent adverse events (AEs) was 65.5%, and the incidence was higher in new than experienced peginterferon beta-1a users (78.1 vs 52.4%). The overall incidence of treatment-emergent serious AEs was 7.6%, and the incidence was lower in younger than older patients (5.8 vs 11.1%). No new or unexpected safety signals were reported. Overall treatment discontinuation due to AEs occurred in 20.7% of patients, with a higher proportion of new than experienced peginterferon beta-1a users (27.0 vs 14.2%) discontinuing treatment due to AEs. Flu-like symptoms and injection site reactions were significant predictors of time to treatment discontinuation. The adjusted annualized relapse rate (ARR) was 0.12 (95% confidence interval 0.11-0.13) in the overall population and was similar across all subgroups. In the overall population at 4 years, 79.1% of patients were relapse free, the estimated cumulative proportion of patients with confirmed disability worsening was 1.8%, and > 67% of patients achieved clinical no evidence of disease activity (NEDA). CONCLUSIONS Safety data of patients enrolled in POP are consistent with the established clinical safety profile of peginterferon beta-1a. In addition, the low ARR and high proportion of patients achieving clinical NEDA at 4 years across all subgroups indicates the effectiveness of peginterferon beta-1a in treating RMS in real-world clinical settings.
Collapse
Affiliation(s)
- Marco Salvetti
- Sapienza University, S. Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Sibyl Wray
- Hope Neurology MS Center, Knoxville, TN, United States
| | | | - Arman Altincatal
- Biogen, Cambridge, MA, United States, at the time of this analysis
| | - Achint Kumar
- Biogen, 225 Binney Street, Cambridge, MA 02142, United States
| | - Thijs Koster
- Biogen, 225 Binney Street, Cambridge, MA 02142, United States.
| | - Maria L Naylor
- Biogen, Cambridge, MA, United States, at the time of this analysis
| | | |
Collapse
|
48
|
Talwar A, Earla JR, Hutton GJ, Aparasu RR. Prescribing of disease modifying agents in older adults with multiple sclerosis. Mult Scler Relat Disord 2022; 57:103308. [PMID: 35158421 DOI: 10.1016/j.msard.2021.103308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of disease-modifying agents (DMAs) to treat Multiple Sclerosis (MS) in older adults is debated as the disease activity decreases with aging. However, limited data exist regarding prescribing patterns of DMAs among older adults with MS. OBJECTIVE To examine prescribing patterns of DMAs and the factors associated with DMA prescribing practices among older adults with MS using electronic medical records (EMR) data. METHODS A retrospective longitudinal cohort study was conducted using the TriNetX, a federated EMR network from the US, data from 2016 to 2019. The study included older adults (≥60 years) with MS diagnosis and at least one prescription record during the study period. Patients with DMA prescriptions were identified and further classified into injectable, oral, or infusion users based on their last DMA prescription. A multivariable logistic regression model was used to evaluate the factors associated with prescribing of DMAs. A multinomial logistic regression model was also used to determine the factors associated with prescribing a particular dosage form of DMA. RESULTS The study cohort consisted of 12,922 older adults with MS, with 2,455 (18.99%) receiving DMA prescriptions. The commonly prescribed DMAs were injectables (10.46%), followed by orals (6.06%) and infusions (2.40%). Multivariable logistic regression revealed that older adults between 60- to 64 years (Adjusted Odds Ratio [aOR]= 2.38) and 65-69 years (aOR=1.60) had higher odds of receiving DMA compared to older adults of 70 years and above. African Americans (aOR=1.71) had higher odds of receiving DMA prescriptions compared to Caucasians. The presence of symptoms (pain, fatigue, speech, walking difficulty) and use of symptomatic medication (anti-fatigue medication, bladder dysfunction medication, antispasmodics, antidepressants, and relapse medication) increased the odds of being prescribed DMAs. Multinomial logistic regression found that patients 60-64 years of age had higher odds of being prescribed infusion (aOR, 95% Confidence Interval [CI] =2.06, 1.35-3.15) and oral (65-69 years: aOR=1.60, 1.24-2.07) over injectable DMAs compared to the older adults aged 70 years and above.Older males (aOR=1.68, 95% CI: 1.23-2.30) were associated with increased odds of being prescribed infusion DMA over injectable DMA compared to females. The presence of comorbidities such as coagulopathy and peripheral vascular disorders decreased the odds of being prescribed oral DMA over injectable DMA. Patients with cerebellar symptoms had an increased likelihood of being prescribed with an infusion DMA over injectable DMA. Patients using drugs for treating relapses had higher odds of being prescribed an infusion DMA over an injectable DMA. In terms of healthcare utilization, older adults with outpatient visits had higher odds of being prescribed an infusion DMA over an injectable DMA, while older adults with inpatient visits had lower odds of being prescribed an infusion DMA over an injectable DMA. CONCLUSION Nearly one in five older adults with MS are prescribed DMAs, with a majority receiving injectable DMAs. Several demographic and clinical factors were associated with DMA prescribing . This study fills the data gap regarding the utilization of DMAs in older adults with MS.
Collapse
Affiliation(s)
- Ashna Talwar
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, United States
| | | | | | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, United States.
| |
Collapse
|
49
|
An Innovative Approach to Modelling the Optimal Treatment Sequence for Patients with Relapsing-Remitting Multiple Sclerosis: Implementation, Validation, and Impact of the Decision-Making Approach. Adv Ther 2022; 39:892-908. [PMID: 34796464 PMCID: PMC8866358 DOI: 10.1007/s12325-021-01975-5] [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: 05/06/2021] [Accepted: 10/26/2021] [Indexed: 10/24/2022]
Abstract
INTRODUCTION An innovative computational model was developed to address challenges regarding the evaluation of treatment sequences in patients with relapsing-remitting multiple sclerosis (RRMS) through the concept of a 'virtual' physician who observes and assesses patients over time. We describe the implementation and validation of the model, then apply this framework as a case study to determine the impact of different decision-making approaches on the optimal sequence of disease-modifying therapies (DMTs) and associated outcomes. METHODS A patient-level discrete event simulation (DES) was used to model heterogeneity in disease trajectories and outcomes. The evaluation of DMT options was implemented through a Markov model representing the patient's disease; outcomes included lifetime costs and quality of life. The DES and Markov models underwent internal and external validation. Analyses of the optimal treatment sequence for each patient were based on several decision-making criteria. These treatment sequences were compared to current treatment guidelines. RESULTS Internal validation indicated that model outcomes for natural history were consistent with the input parameters used to inform the model. Costs and quality of life outcomes were successfully validated against published reference models. Whereas each decision-making criterion generated a different optimal treatment sequence, cladribine tablets were the only DMT common to all treatment sequences. By choosing treatments on the basis of minimising disease progression or number of relapses, it was possible to improve on current treatment guidelines; however, these treatment sequences were more costly. Maximising cost-effectiveness resulted in the lowest costs but was also associated with the worst outcomes. CONCLUSIONS The model was robust in generating outcomes consistent with published models and studies. It was also able to identify optimal treatment sequences based on different decision criteria. This innovative modelling framework has the potential to simulate individual patient trajectories in the current treatment landscape and may be useful for treatment switching and treatment positioning decisions in RRMS.
Collapse
|
50
|
Luetic GG, Menichini ML, Vrech C, Pappolla A, Patrucco L, Cristiano E, Marrodán M, Ysrraelit MC, Fiol M, Correale J, Cohen L, Alonso R, Silva B, Casas M, Garcea O, Deri N, Burgos M, Liwacki S, Tkachuk V, Barboza A, Piedrabuena R, Blaya P, Steinberg J, Martínez A, Carrá A, Tavolini D, López P, Knorre E, Nofal P, Volman G, Carnero Contentti E, Pinheiro AA, Leguizamon F, Silva E, Hryb J, Balbuena ME, Zanga G, Kohler M, Chertcoff A, Lazaro L, Tizio S, Mainela C, Reich E, Recchia L, Blanche J, Marcilla MP, Fracaro ME, Sgrilli G, Divi P, Jacobo M, Cabrera M, Pagani Cassara F, Sinay V, Curbelo C, Míguez J, Coppola M, Liguori NF, Martos I, Pettinicchi JP, Viglione JP, José G, Bestoso S, Manzi R, Vázquez G, Nadur D, Martínez C, Serena MA, Rojas JI. Clinical and demographic characteristics of male MS patients included in the national registry-RelevarEM. Does sex or phenotype make the difference in the association with poor prognosis? Mult Scler Relat Disord 2022; 58:103401. [PMID: 35216784 DOI: 10.1016/j.msard.2021.103401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/27/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In multiple sclerosis demographics there is a well-known female prevalence and male patients have been less specifically evaluated in clinical studies, though some clinical differences have been reported between sexes. OBJECTIVE The objective of this study was to assess clinical and demographic differences between male and female patients included in the national Argentine MS Registry-RelevarEM. MATERIAL AND METHODS This study was observational, retrospective, and was based on the data of 3099 MS patients included as of 04 April 2021. The statistical analysis plan included bivariate analyses with the crude data and also after adjustment for the MS phenotype, further categorized as progressive-onset MS or relapsing-onset MS. In the adjusted analysis, the Mantel-Haenszel odds ratio was compared to the crude odds ratio, to account for the phenotype as a confounder. RESULTS The data from 1,074 (34.7%) men and 2,025 (65.3%) women with MS diagnosis were analysed. Males presented primary progressive disease two times more often than women (11% and 5%, respectively). In the crude analyses by sex, the presence of exclusively infratentorial lesions in the magnetic resonance imaging studies was more frequent in males than in females, but after adjustment by MS onset phenotype, such difference was only present in males with relapsing-onset MS (p = 0.00006). Similarly, worse Expanded Disability Status Scale scores were confirmed only in men with relapsing-onset disease after phenotype adjustment (p = 0.02). CONCLUSION We did not find any statistically significant clinical or demographic difference between sexes when the progressive MS phenotype was specifically considered. However, the differences we found between the clinical phenotypes are in line with the literature and highlight the importance of stratifying the analyses by sex and phenotype when designing MS studies.
Collapse
Affiliation(s)
- Geraldine G Luetic
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fe 3598, Argentina.
| | - María Laura Menichini
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fe 3598, Argentina; Sanatorio Británico, Rosario, Santa Fe, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | | | | | | | | | | | - Marcela Fiol
- Departamento de Neurología, FLENI, CABA, Argentina
| | | | - Leila Cohen
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Ricardo Alonso
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Berenice Silva
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Magdalena Casas
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Orlando Garcea
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología, Hospital Córdoba, Córdoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | - Raúl Piedrabuena
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Instituto Lennox, Córdoba, Argentina
| | | | - Judith Steinberg
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina
| | - Alejandra Martínez
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina; Hospital Nacional Alejandro Posadas, El Palomar, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina; Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | | | - Pablo López
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, Tucumán, Argentina
| | - Gabriel Volman
- Hospital Pte. Perón, Avellaneda, Buenos Aires, Argentina
| | | | | | | | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - María Eugenia Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Gisela Zanga
- Departamento de Neurología, Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Matías Kohler
- Axis Neurociencias, Bahía Blanca, Buenos Aires, Argentina
| | - Aníbal Chertcoff
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina
| | | | | | | | - Edgardo Reich
- Instituto Médico Especializado, Buenos Aires, Argentina
| | | | - Jorge Blanche
- IRNEC (Instituto Regional de Neurociencias), San Miguel de Tucumán, Tucumán, Argentina
| | | | | | | | - Pablo Divi
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | - Miguel Jacobo
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | | | | | - Vladimiro Sinay
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Celeste Curbelo
- Policlínico Municipal Sofía T. de Santamarina, Buenos Aires, Argentina
| | | | | | - Nora Fernández Liguori
- Sanatorio Güemes, Buenos Aires, Argentina; Hospital Enrique Tornú, Buenos Aires, Argentina
| | - Iván Martos
- Clínica San Jorge, Ushuaia, Tierra del fuego, Argentina
| | - Juan Pablo Pettinicchi
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Buenos Aires, Argentina
| | | | - Gustavo José
- Sección de enfermedades desmielinizantes, Servicio de Neurología, Hospital Padilla, Tucumán, Argentina
| | - Santiago Bestoso
- Servicio Neurología, Hospital Escuela José F. de San Martín Corrientes, Corrientes, Argentina
| | | | - Guido Vázquez
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | | | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina
| |
Collapse
|