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Puthenparampil M, Gaggiola M, Miscioscia A, Mauceri VA, De Napoli F, Zanotelli G, Anglani M, Nosadini M, Sartori S, Perini P, Rinaldi F, Gallo P. Alemtuzumab following natalizumab is more effective in adult-onset than paediatric-onset multiple sclerosis. Ther Adv Neurol Disord 2023; 16:17562864231177196. [PMID: 37808246 PMCID: PMC10559704 DOI: 10.1177/17562864231177196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Paediatric-onset multiple sclerosis (POMS) therapeutic approach derives from of adult-onset multiple sclerosis (AOMS) tailored algorithms. Objectives To evaluate in a common clinical scenario the efficacy and safety of alemtuzumab (ALZ) in POMS and AOMS. Methods All patients switching from natalizumab (NTZ) to ALZ for safety concerns (high anti-John Cunningham Virus Antibody Index value, anti-JCV Index) were enrolled in this single-centre, retrospective, case-control open-label study. Results Ten POMS and 27 AOMS were followed up for 51.3 months. After month 12, we found a lower risk of clinical or radiological relapses among AOMS patients and among patients with older age at ALZ (both p < 0.05). Survival analysis revealed an increased risk of relapse in POMS compared with AOMS (logrank p = 0.00498) and patients starting ALZ before age 22.75 years than the elder ones (logrank p = 0.0018). Survival analysis did not disclose any difference between AOMS and POMS (logrank p = 0.27) in terms of progression independent of any relapse activity (PIRA). In addition, no evidence of relapse-associated worsening was observed. Autoimmune events were reported by 5 AOMS and no POMS (29.4% versus 0.0%, p = 0.057), and survival analysis was not significant (logrank p = 0.0786). Conclusion ALZ seems more effective in AOMS than in POMS following NTZ. These findings underrate ALZ effectiveness when shifting from NTZ in POMS.
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Affiliation(s)
- Marco Puthenparampil
- Multiple Sclerosis Centre, Clinica Neurologica, Dipartimento di Neuroscienze, Università degli Studi di Padova, Via Giustiniani 5, 35128 Padova, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padova, Italy
| | - Marta Gaggiola
- Department of Neurosciences, University of Padua, Padova, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padova, Italy
| | - Alessandro Miscioscia
- Department of Neurosciences, University of Padua, Padova, Italy
- Padua Neuroscience Centre, University of Padua, Padova, Italy
| | - Valentina Annamaria Mauceri
- Department of Neurosciences, University of Padua, Padova, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padova, Italy
| | - Federica De Napoli
- Department of Neurosciences, University of Padua, Padova, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padova, Italy
| | - Giovanni Zanotelli
- Department of Neurosciences, University of Padua, Padova, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padova, Italy
| | | | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, University Hospital of Padova, Padova, Italy
- Neuroimmunology Group, Paediatric Research Institute ‘Città della Speranza’, Padova, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women’s and Children’s Health, University Hospital of Padova, Padova, Italy
- Neuroimmunology Group, Paediatric Research Institute ‘Città della Speranza’, Padova, Italy
| | - Paola Perini
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padova, Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padova, Italy
| | - Paolo Gallo
- Department of Neurosciences, University of Padua, Padova, Italy
- Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padova, Italy
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Mainero C, Treaba CA, Barbuti E. Imaging cortical lesions in multiple sclerosis. Curr Opin Neurol 2023; 36:222-228. [PMID: 37078649 DOI: 10.1097/wco.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
PURPOSE OF REVIEW Cortical lesions are an established pathological feature of multiple sclerosis, develop from the earliest disease stages and contribute to disease progression. Here, we discuss current imaging approaches for detecting cortical lesions in vivo and their contribution for improving our understanding of cortical lesion pathogenesis as well as their clinical significance. RECENT FINDINGS Although a variable portion of cortical lesions goes undetected at clinical field strength and even at ultra-high field MRI, their evaluation is still clinically relevant. Cortical lesions are important for differential multiple sclerosis (MS) diagnosis, have relevant prognostic value and independently predict disease progression. Some studies also show that cortical lesion assessment could be used as a therapeutic outcome target in clinical trials. Advances in ultra-high field MRI not only allow increased cortical lesion detection in vivo but also the disclosing of some interesting features of cortical lesions related to their pattern of development and evolution as well to the nature of associated pathological changes, which might prove relevant for better understanding the pathogenesis of these lesions. SUMMARY Despite some limitations, imaging of cortical lesions is of paramount importance in MS for elucidating disease mechanisms as well as for improving patient management in clinic.
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Affiliation(s)
- Caterina Mainero
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | - Constantina A Treaba
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elena Barbuti
- A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital
- Ospedale Sant'Andrea, University "La Sapienza", Rome, Italy
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Jamroz-Wiśniewska A, Zajdel R, Słowik A, Marona M, Wnuk M, Adamczyk-Sowa M, Adamczyk B, Lasek-Bal A, Puz P, Stęposz A, Krzystanek E, Patalong-Ogiewa M, Pokryszko-Dragan A, Budrewicz S, Koziarska D, Karbicka A, Wawrzyniak S, Fryze W, Furtak-Niczyporuk M, Rejdak K. Modified Rio Score with Platform Therapy Predicts Treatment Success with Fingolimod and Natalizumab in Relapsing-Remitting Multiple Sclerosis Patients. J Clin Med 2021; 10:jcm10091830. [PMID: 33922368 PMCID: PMC8122749 DOI: 10.3390/jcm10091830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Reliable markers of disease outcomes in multiple sclerosis (MS) would help to predict the response to treatment in patients treated with high efficacy drugs. No evidence of disease activity (NEDA) has become a treatment goal whereas the modified Rio score (MRS) predicts future suboptimal responders to treatment. The aim of our study was to identify factors that would predict poor response to treatment with natalizumab and fingolimod. Methods: In the multicenter prospective trial, 336 subjects were enrolled, initiating therapy with natalizumab (n = 135) or fingolimod (n = 201). Data on relapse rate, the expanded disability status scale, and MRI results were collected, and MRS was estimated. Results: NEDA-3 after the first year of therapy was 73.9% for natalizumab and 54.8% for fingolimod (p < 0.0001). Patients with MRS = 0 in the last year on platform therapy had the best NEDA-3 (71%) and patients with MRS = 3 had the worst NEDA-3 (41%) in the first year of treatment with the second-line therapy. Conclusion: We conclude that switching to the second-line therapy should occur earlier to enable better results for patients treated with natalizumab or fingolimod. The outcome on both drugs is better with better neurological conditions and lower MRS of the patient on the platform therapy.
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Affiliation(s)
- Anna Jamroz-Wiśniewska
- Department of Neurology, Medical University of Lublin, Jaczewskiego 8, 20-054 Lublin, Poland;
- Correspondence: ; Tel.: +48-81-72-44-720
| | - Radosław Zajdel
- Chair of Informatics in Business, University of Lodz, Rewolucji 1905 Roku 37/39, 91-001 Lodz, Poland;
| | - Agnieszka Słowik
- Department of Neurology, Collegium Medicum, Jagiellonian University, Jakubowskiego 2, 30-688 Krakow, Poland; (A.S.); (M.M.); (M.W.)
| | - Monika Marona
- Department of Neurology, Collegium Medicum, Jagiellonian University, Jakubowskiego 2, 30-688 Krakow, Poland; (A.S.); (M.M.); (M.W.)
| | - Marcin Wnuk
- Department of Neurology, Collegium Medicum, Jagiellonian University, Jakubowskiego 2, 30-688 Krakow, Poland; (A.S.); (M.M.); (M.W.)
| | - Monika Adamczyk-Sowa
- Department of Neurology, School of Health Sciences in Zabrze, Medical University of Silesia in Katowice, 3-go Maja 13-15, 41-800 Zabrze, Poland; (M.A.-S.); (B.A.)
| | - Bożena Adamczyk
- Department of Neurology, School of Health Sciences in Zabrze, Medical University of Silesia in Katowice, 3-go Maja 13-15, 41-800 Zabrze, Poland; (M.A.-S.); (B.A.)
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, Ziolowa 45-47, 40-635 Katowice, Poland; (A.L.-B.); (P.P.); (A.S.)
| | - Przemysław Puz
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, Ziolowa 45-47, 40-635 Katowice, Poland; (A.L.-B.); (P.P.); (A.S.)
| | - Arkadiusz Stęposz
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, Ziolowa 45-47, 40-635 Katowice, Poland; (A.L.-B.); (P.P.); (A.S.)
| | - Ewa Krzystanek
- Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 14, 40-752 Katowice, Poland;
| | - Maja Patalong-Ogiewa
- Department of Neurorehabilitation, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 14, 40-752 Katowice, Poland;
| | - Anna Pokryszko-Dragan
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-566 Wroclaw, Poland; (A.P.-D.); (S.B.)
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-566 Wroclaw, Poland; (A.P.-D.); (S.B.)
| | - Dorota Koziarska
- Department of Neurology, Pomeranian Medical University in Szczecin, Unii Lubelskiej 1, 71-252 Szczecin, Poland;
| | - Anna Karbicka
- Department of Neurology, Regional Hospital, Arkonska 4, 71-455 Szczecin, Poland;
| | - Sławomir Wawrzyniak
- Department of Neurology, 10th Military Research Hospital and Polyclinic, Powstancow Warszawy 5, 85-681 Bydgoszcz, Poland;
| | - Waldemar Fryze
- Department of Neurology, Copernicus Pl, M. Kopernik Hospital, Nowe Ogrody 1-6, 80-803 Gdansk, Poland;
| | | | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Jaczewskiego 8, 20-054 Lublin, Poland;
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Pantazou V, Du Pasquier R, Pot C, Le Goff G, Théaudin M. Is disease activity prior to fingolimod initiation predictive of response? Fingolimod as a "common" first line treatment. Rev Neurol (Paris) 2021; 177:935-940. [PMID: 33637293 DOI: 10.1016/j.neurol.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In countries where fingolimod is available as first-line therapy without restrictions, we have an opportunity to observe long-term efficacy profile of this drug in treatment-naive patients according to their initial disease activity. METHODS We retrospectively analysed the data of RRMS patients treated with FTY, focusing on 2 groups: 17 highly active patients (HA) defined as follows: ≥2 relapses in the year before treatment initiation and either≥1 Gd-enhancing T1 lesion or a significant increase in T2 lesion load from a baseline MRI; and 37 "not highly active" (NHA). We reviewed treatment efficacy (defined as NEDA-3), reasons for discontinuation and treatment tolerance in both groups. RESULTS Mean follow-up duration was 48.2 months, SD 18.4. Fingolimod efficiently reduced relapses (NHA 90.3% reduction, P<0.001, HA 84.9%, P<0.001), and new Gd enhancing lesions (NHA 85.4% reduction, P=0.019, HA 92.3%, P=0.043). The proportion of patients reaching NEDA-3 status was higher in the NHA group (NHA: 80% at 2 years and 66% at 4 years, HA: 58% at 2 years and 38% at 4 years, P=0.042). Fingolimod was discontinued in 20 cases, mainly because of lack of efficacy (n=15). CONCLUSIONS FTY is efficient in reducing relapses and new Gd enhancing lesions in both HA and NHA patients although the probability of achieving NEDA-3 over time is higher in early-treated treatment-naive NHA patients.
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Affiliation(s)
- V Pantazou
- Division of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; Laboratories of Neuroimmunology, Neuroscience Research Center , Lausanne University, Epalinges, Switzerland
| | - R Du Pasquier
- Division of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; Laboratories of Neuroimmunology, Neuroscience Research Center , Lausanne University, Epalinges, Switzerland
| | - C Pot
- Division of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland; Laboratories of Neuroimmunology, Neuroscience Research Center , Lausanne University, Epalinges, Switzerland
| | - G Le Goff
- Division of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - M Théaudin
- Division of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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Kolcava J, Hulova M, Rihova L, Bednarik J, Stourac P. The impact of lymphocytosis and CD4/CD8 ratio on the anti-JCV antibody index and clinical data in patients treated with natalizumab. Neurol Sci 2020; 42:2847-2853. [PMID: 33201361 DOI: 10.1007/s10072-020-04897-2] [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: 08/18/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Natalizumab is an effective therapy in the treatment of relapsing-remitting multiple sclerosis; it induces lymphocytosis (NIL, natalizumab-induced lymphocytosis) and changes the peripheral lymphocyte pattern. METHODS This study aims to evaluate NIL, peripheral blood lymphocyte subsets, CD4/CD8 ratio, and their impacts on JCV index and clinical data-No Evidence of Disease Activity (NEDA-3) and annualized relapse rate (ARR) in patients treated with natalizumab. RESULTS Forty-one patients (33 women) were included in the study. The mean duration of follow-up on natalizumab treatment was 6.7 ± 3.2 years. Significant increases in relative lymphocytosis after 1 month, with a median of 40.4% (- 34.1 to + 145.5%) (p < 0.001), and after 1 year (49.0% (- 9.3 to + 127.6%)) (p < 0.001) were found. Significant differences were found after 1 month when comparing NIL between patients JCV-seroconverting (20.6% (- 17.7 to 72.7%)) and stable JCV-seronegative ones (43.5% (- 6.3 to +96.3%)) (p = 0.04). No significant difference NIL level was found between the patients exhibiting NEDA-3 status and those without it. ARR on natalizumab treatment correlated with CD4/CD8 ratio (r = 0.356; p = 0.021); patients who maintained NEDA-3 status over the whole treatment period exhibited a lower CD4/CD8 ratio (1.89 ± 1.08 vs. 2.5 ± 0.73; p < 0.04). CONCLUSION This contribution reports the CD4/CD8 ratio as a possible biomarker for better clinical efficacy of natalizumab in patients exhibiting a lower CD4/CD8 ratio. NIL did not correlate with long-term therapeutic efficacy in patients treated with natalizumab, but was demonstrated as lower in patients JCV-seroconverting in the course of follow-up.
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Affiliation(s)
- Jan Kolcava
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Neurology, University Hospital Brno, Jihlavská 340/20, 625 00, Brno, Czech Republic
| | - Monika Hulova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Neurology, University Hospital Brno, Jihlavská 340/20, 625 00, Brno, Czech Republic
| | - Lucie Rihova
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Josef Bednarik
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Neurology, University Hospital Brno, Jihlavská 340/20, 625 00, Brno, Czech Republic
| | - Pavel Stourac
- Faculty of Medicine, Masaryk University, Brno, Czech Republic. .,Department of Neurology, University Hospital Brno, Jihlavská 340/20, 625 00, Brno, Czech Republic.
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Cohen M, Mondot L, Bucciarelli F, Pignolet B, Laplaud DA, Wiertlewski S, Brochet B, Ruet A, Defer G, Derache N, Vermersch P, Zephir H, Debouverie M, Mathey G, Berger E, Cappé C, Labauge P, Carra C, De Seze J, Bigaut K, Brassat D, Lebrun-Frenay C. BEST-MS: A prospective head-to-head comparative study of natalizumab and fingolimod in active relapsing MS. Mult Scler 2020; 27:1556-1563. [PMID: 33124504 DOI: 10.1177/1352458520969145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are few head-to-head studies to compare highly active treatments in multiple sclerosis (MS). OBJECTIVE The aim of this study was to compare the effectiveness between natalizumab (NTZ) and fingolimod (FTY) in active relapsing-remitting MS. METHOD Best Escalation STrategy in Multiple Sclerosis (BEST-MS) is a multicentric, prospective study with a 12-month follow-up including patients with active MS. Treatment choice was at the discretion of physician. Clinical and magnetic resonance imaging (MRI) data were collected at baseline and at 12 months. The primary outcome was the proportion of patients reaching no evidence of disease activity (NEDA) at 12 months. Secondary outcomes included annualized relapse rate and MRI activity. RESULTS A total of 223 patients were included (NTZ: 109 and FTY: 114). Treatment groups were well balanced at baseline. Proportion of NEDA patients was 47.8% in NTZ group versus 30.4% in FTY group (p = 0.015). This superiority was driven by annualized relapse rate and MRI activity. In the multivariate analysis, treatment group was the only factor associated with NEDA at 12 months with a lower probability in FTY group (odds ratio (OR) = 0.49, p = 0.029). CONCLUSION BEST-MS is a prospective study that compared head-to-head the effectiveness of NTZ and FTY in active relapsing-remitting MS. Our results suggest a superiority of NTZ over FTY.
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Affiliation(s)
- Mikael Cohen
- Service de Neurologie, CRCSEP, Unité de Recherche Clinique Cote d'Azur (UR2CA), Centre Hospitalier Universitaire Pasteur 2, Nice, France
| | - Lydiane Mondot
- Service de Radiologie, Unité de Recherche Clinique Cote d'Azur (UR2CA), Centre Hospitalier Universitaire Pasteur 2, Nice, France
| | - Florence Bucciarelli
- Neurosciences Department, CRCSEP, University Hospital of Toulouse, Toulouse, France/INSERM U1043-CNRS UMR 5282, Centre de Physiopathologie Toulouse, Toulouse, France
| | - Béatrice Pignolet
- Neurosciences Department, CRCSEP, University Hospital of Toulouse, Toulouse, France/INSERM U1043-CNRS UMR 5282, Centre de Physiopathologie Toulouse, Toulouse, France
| | - David-Axel Laplaud
- CRTI-INSERM U1064, CIC 1413, Service de Neurologie, CHU Nantes, Nantes, France
| | | | - Bruno Brochet
- Service de Neurologie, CRC SEP, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Aurélie Ruet
- Service de Neurologie, CRC SEP, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Gilles Defer
- Service de Neurologie, CHU de Caen, Avenue de la Côte de Nacre, Caen, France
| | - Nathalie Derache
- Service de Neurologie, CHU de Caen, Avenue de la Côte de Nacre, Caen, France
| | | | - Hélène Zephir
- Univ. Lille, INSERM U1172, CHU Lille, FHU Imminent, Lille, France
| | - Marc Debouverie
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France
| | - Guillaume Mathey
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France
| | - Eric Berger
- Service de Neurologie, CHU de Besançon, Besançon, France
| | - Chrystelle Cappé
- Centre d'investigation clinique, CHU de Besançon, Besançon, France
| | | | | | - Jérôme De Seze
- Clinical Investigation Center, Department of Neurology, CHU de Strasbourg, INSERM 1434, Strasbourg, France
| | - Kevin Bigaut
- Clinical Investigation Center, Department of Neurology, CHU de Strasbourg, INSERM 1434, Strasbourg, France
| | - David Brassat
- Neurosciences Department, CRCSEP, University Hospital of Toulouse, Toulouse, France/INSERM U1043-CNRS UMR 5282, Centre de Physiopathologie Toulouse, Toulouse, France
| | - Christine Lebrun-Frenay
- Service de Neurologie, CRCSEP, Unité de Recherche Clinique Cote d'Azur (UR2CA), Centre Hospitalier Universitaire Pasteur 2, Nice, France
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Kapica-Topczewska K, Tarasiuk J, Collin F, Brola W, Chorąży M, Czarnowska A, Kwaśniewski M, Bartosik-Psujek H, Adamczyk-Sowa M, Kochanowicz J, Kułakowska A. The effectiveness of interferon beta versus glatiramer acetate and natalizumab versus fingolimod in a Polish real-world population. PLoS One 2019; 14:e0223863. [PMID: 31647829 PMCID: PMC6812766 DOI: 10.1371/journal.pone.0223863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
Objective The aim of the study was to assess the effectiveness of disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS) patients treated in MS centres in Poland. Methods Demographic and clinical data of all Polish RRMS patients receiving DMTs were prospectively collected from 2014 to 2018 in electronic files using the Therapeutic Program Monitoring System (SMPT). Results The study included 10,764 RRMS patients treated with DMTs in first-line and 1,042 in second-line programmes. IFNβ more effectively lengthened the times to the first relapse, disability progression, and brain MRI activity than GA. After 2 and 4 years of follow-up, more patients on IFNβ showed no evidence of disease activity (NEDA-3) in comparison to GA (66.3% and 44.3% vs 55.2% and 33.2%, respectively; p<0.001). NAT more effectively reduced brain MRI activity than FTY (p = 0.001). More patients under NAT had NEDA-3 after 2 and 4 years of follow-up compared to FTY (66.2% and 42.1% vs 52.1% and 29.5%, respectively; p = 0.03). In adjusted analysis, a higher baseline Expanded Disability Status Score (EDSS) was a predictor of relapse (p<0.001) and NEDA-3 failure (p = 0.003). Conclusion IFNβ compared to GA and NAT compared to FTY more effectively reduced disease activity in a Polish population of RRMS patients.
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Affiliation(s)
| | - Joanna Tarasiuk
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Francois Collin
- Centre for Bioinformatics and Data Analysis, Medical University of Bialystok, Bialystok, Poland
| | - Waldemar Brola
- The Faculty of Medicine and Health Sciences, Institute of Physiotherapy, Jan Kochanowski University, Kielce, Poland
| | - Monika Chorąży
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Agata Czarnowska
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Mirosław Kwaśniewski
- Centre for Bioinformatics and Data Analysis, Medical University of Bialystok, Bialystok, Poland
| | - Halina Bartosik-Psujek
- Neurology Clinic with Brain Stroke Sub-Unit, Clinical Hospital No. 2 in Rzeszow, Medical Faculty, University of Rzeszow, Rzeszów, Poland
| | - Monika Adamczyk-Sowa
- Department of Neurology in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
| | - Alina Kułakowska
- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
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Perumal J, Fox RJ, Balabanov R, Balcer LJ, Galetta S, Makh S, Santra S, Hotermans C, Lee L. Outcomes of natalizumab treatment within 3 years of relapsing-remitting multiple sclerosis diagnosis: a prespecified 2-year interim analysis of STRIVE. BMC Neurol 2019; 19:116. [PMID: 31176355 PMCID: PMC6555913 DOI: 10.1186/s12883-019-1337-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/20/2019] [Indexed: 12/23/2022] Open
Abstract
Background STRIVE is a multicenter, observational, open-label, single-arm study of natalizumab in anti–JC virus (JCV) seronegative patients with early relapsing-remitting multiple sclerosis (RRMS). The objective of this prespecified 2-year interim analysis was to determine the effectiveness of natalizumab in establishing and maintaining no evidence of disease activity (NEDA) in early RRMS. Methods Patients aged 18–65 years had an RRMS diagnosis < 3 years prior to screening, an Expanded Disability Status Scale (EDSS) score ≤ 4.0, and anti-JCV antibody negative status. Magnetic resonance imaging was performed at baseline and yearly thereafter. Cumulative probabilities of 24-week–confirmed EDSS worsening and improvement were evaluated at 2 years. NEDA (no 24-week–confirmed EDSS worsening, no relapses, no gadolinium-enhancing lesions, and no new/newly enlarging T2-hyperintense lesions) was evaluated over 2 years. The Symbol Digit Modalities Test (SDMT) and Multiple Sclerosis Impact Score (MSIS-29) were assessed at baseline and 1 and 2 years. Statistical analysis used summary statistics and frequency distributions. Results The study population (N = 222) had early RRMS, with mean (standard deviation [SD]) time since diagnosis of 1.6 (0.77) years and mean (SD) baseline EDSS score of 2.0 (1.13). NEDA was achieved in 105 of 187 patients (56.1%) during year 1 and 120 of 163 (73.6%) during year 2. Over 2 years, 76 of 171 patients (44.4%) attained overall NEDA. Probabilities of 24-week–confirmed EDSS worsening and improvement were 14.1% and 28.4%, respectively. After 2 years, patients exhibited significant improvements from baseline in SDMT (n = 158; mean [SD]: 4.3 [11.8]; p < 0.001) and MSIS-29 physical (n = 153; mean [SD]: − 3.9 [14.7]; p = 0.001), psychological (n = 152; mean [SD]: − 2.0 [7.9]; p < 0.001), and quality-of-life (n = 153; mean [SD]: − 6.0 [21.3]; p < 0.001) scores. Conclusions These results support natalizumab’s effectiveness over 2 years, during which nearly half of early RRMS patients achieved NEDA. During year 2, nearly 75% of patients exhibited NEDA. Over 2 years, patients continued to experience significant cognitive and quality-of-life benefits. These results are limited by the lack of a comparator group to determine the extent of a placebo effect. Trial registration clinicaltrials.gov, NCT01485003, registered 5 December 2011. Electronic supplementary material The online version of this article (10.1186/s12883-019-1337-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jai Perumal
- Weill Cornell Multiple Sclerosis Center, New York, NY, USA
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | | | - Laura J Balcer
- New York University School of Medicine, New York, NY, USA
| | - Steven Galetta
- New York University School of Medicine, New York, NY, USA
| | - Shavy Makh
- Biogen, 225 Binney St, Cambridge, MA, 02142, USA
| | | | | | - Lily Lee
- Biogen, 225 Binney St, Cambridge, MA, 02142, USA.
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Rensel M. Long-Term Treatment Strategies of Pediatric Multiple Sclerosis, Including the use of Disease Modifying Therapies. CHILDREN-BASEL 2019; 6:children6060073. [PMID: 31159312 PMCID: PMC6617229 DOI: 10.3390/children6060073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 01/20/2023]
Abstract
Multiple sclerosis (MS) presenting in the pediatric years can lead to landmark disability levels younger in life than adult onset MS and so therefore early and effective treatment remains paramount for long-term outcomes. The goals of MS therapeutics in adults have widened to address multiple mechanisms: anti-inflammatory, neuroprotective, and myelin repair, yet the optimal paradigm for MS therapies in the pediatric population is not known. Pediatric onset MS add complexities due to the ongoing development of the central nervous system and the immune system. Clinical trials have led to an increasing number of pharmaceutical therapies for adult onset MS (AOMS), one POMS randomized controlled trial is completed and other trials are ongoing, yet due to the low prevalence of POMS, the dynamic landscape and risk management of the MS disease modifying therapies (DMT) it remains more difficult to complete trials in POMS. There is consensus that controlled clinical trials leading to appropriate and safe therapies for POMS are important for a multitude of reasons that include unique pediatric pharmacokinetics, short and long-term safety, developmental issues, clinical benefits, and regulatory approval. This review will focus on new treatment goals, paradigm, strategies, monitoring, compliance, and products in the long-term treatment of POMS. The discussion will focus on these new concepts and the published data related to DMT use in POMS. This review provides significant insight into new concepts of treatment goals and current approaches to enhance the lives of the POMS patients now and in the future.
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Affiliation(s)
- Mary Rensel
- The Mellen Center, Department of Neurology, Cleveland Clinic, Cleveland, OH 44195, USA.
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