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Makkawi S, Maglan A, Khojah O, Allaf F, Alamoudi S, Ahmed ME, Alsharif R, Altayeb M, Alharthi A, Abulaban A, Al Malik Y. Patterns of multiple sclerosis presentation to the emergency department. Front Neurol 2024; 15:1395822. [PMID: 38737348 PMCID: PMC11082281 DOI: 10.3389/fneur.2024.1395822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Background Multiple sclerosis (MS) patients are no strangers to the emergency department (ED) due to the relapsing and progressive nature of the disease and the associated complications. This study aimed to identify patterns of ED visits among patients diagnosed with MS, the underlying causes of these visits, and the factors associated with these visits. Methods This was a single center retrospective cohort study which utilized a non-probability consecutive sampling technique to include all patients diagnosed with MS (471 patients) from March 2016 to October 2021 in King Abdulaziz Medical City, Jeddah, Saudi Arabia. ED visits were categorized as directly related to MS, indirectly related to MS, or unrelated to MS. Results One in four people with MS visited the ED at least once with a total of 280 ED visits. Most ED visits were ones directly related to MS 43.6%, closely followed by unrelated to MS 41.1%, and then indirectly-related MS visits 15.4%. The most common presenting symptoms in directly-related MS visits were weakness 56.6% and numbness/tingling 56.6% followed by gait impairment 29.5%. Indirectly related to MS or unrelated to MS ED visits were commonly due to neurological 17.7% and gastrointestinal 17.1% causes. Using disease modifying therapy (DMT) was significantly associated with no ED visits (p < 0.001). The use of high-efficacy DMTs was significantly associated with no ED visits than using moderate efficacy DMT (p < 0.001). The use of B-cell depleting therapy (ocrelizumab and rituximab) was significantly associated with no visits to the ED than using any other DMT (p < 0.001). Evidence of brain atrophy on imaging was significantly associated with patients who presented to the ED ≥3 times (p = 0.006, UOR = 3.92). Conclusion Due to the nature of the disease, many MS patients find themselves visiting the ED due to MS related and unrelated issues. These patients are not only required to be treated by neurologists but also by multiple disciplines. The use of high-efficacy DMTs and B-cell depleting therapy may reduce the total frequency of ED visits. Special attention should be paid to patients who have evidence of brain atrophy on imaging.
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Affiliation(s)
- Seraj Makkawi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Alaa Maglan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Osama Khojah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Faris Allaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Saeed Alamoudi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Fellowship and Residency Training Program, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mohamed Eldigire Ahmed
- College of Basic Sciences and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Rawaf Alsharif
- Department of Neurology, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Meral Altayeb
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Surgery, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Abdulrhman Alharthi
- Department of Neurosciences, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Ahmad Abulaban
- Department of Neurology, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaser Al Malik
- Department of Neurology, Ministry of the National Guard-Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Mitsikostas DD, Orologas A, Dardiotis E, Fakas N, Doskas T, Karageorgiou K, Maltezou M, Iliopoulos I, Vikelis M, Grigoriadis N. A Prospective, Observational Study Assessing Effectiveness, Safety, and QoL of Greek Patients with Multiple Sclerosis Under Treatment with Fingolimod. Adv Ther 2023; 40:2217-2233. [PMID: 36897520 DOI: 10.1007/s12325-022-02388-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/24/2022] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Fingolimod is the first approved oral therapy for relapsing-remitting multiple sclerosis (RRMS). The present study aimed to further characterize fingolimod's safety profile, and to assess the patient-reported treatment satisfaction and impact of fingolimod on the quality of life (QoL) of patients with multiple sclerosis (MS) treated in routine care in Greece. METHODS This was a multicenter, prospective, observational, 24-month study conducted in Greece by hospital-based and private practice neurologists who specialize in MS. Eligible patients had initiated fingolimod within 15 days in accordance with the locally approved label. Safety outcomes included any adverse event (AE) observed during the study period and efficacy outcomes included both objective (disability progression and 2-year annualized relapse rate) and patient-reported assessments (Treatment Satisfaction Questionnaire for Medication (TSQM) v1.4 and the EuroQol (EQ)-5-dimension (5D) 3-level instruments). RESULTS A total of 489 eligible patients (age 41.2 ± 9.8 years; 63.7% female; 4.2% treatment-naive) were exposed to fingolimod for a median of 23.7 months. During the observation period, 20.5% of the participants experienced 233 AEs. Lymphopenia (8.8%), leukopenia (4.2%), hepatic enzyme increased (3.4%), and infections (3.0%) were the most common. Most patients (89.3%) did not experience disability progression; the 2-year annualized relapse rate decreased by 94.7% compared to baseline. The median EQ-visual analogue scale (VAS) was 74.5 at month 24 vs. 65.0 at enrollment (p < 0.001) and the EQ-5D index score was 0.80 vs. 0.78, respectively. Significant improvements were noted in the TSQM global satisfaction and effectiveness domain scores between 6 and 24 months post enrollment (median scores at month 24, 71.4 and 66.7, respectively) (p < 0.001). Significant increases from enrollment to the 24th month were also noted in the patients' global satisfaction and effectiveness domain scores [mean change of 7.4 ± 17.7 (p = 0.005) and mean increase of 5.4 ± 16.2) (p = 0.043), respectively]. CONCLUSION In the real-world setting of Greece, fingolimod demonstrates a clinical benefit and a predictable and manageable safety profile, which contribute towards high patient-reported treatment satisfaction and improvements in the QoL of patients with MS.
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Affiliation(s)
| | - Anastasios Orologas
- A' Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Nikolaos Fakas
- Neurology Department, General Military Hospital of Athens, 401, Athens, Greece
| | - Triantafyllos Doskas
- Ntoskas K. Triantafillos Private Practice, K. Papakonstantinou 4, Paiania, 19002, Athens, Greece
| | - Klimentini Karageorgiou
- The Neurological Institute of Athens, 51, Leof. Vasilissis Sofias Ave, 10676, Athens, Greece
| | - Maria Maltezou
- Department of Neurology, General Oncology Hospital of Kifissia "Agioi Anargiroi", Athens, Greece
| | - Ioannis Iliopoulos
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - Nikolaos Grigoriadis
- B' Department of Neurology, School of Medicine, Faculty of Health Sciences, Multiple Sclerosis Center, Aristotle University of Thessaloniki, AHEPA University Hospital, Kiriakidi 1, 54621, Thessaloniki, Greece.
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Tuncer MA, Kürtüncü M, Terzi M, Uygunoğlu U, Göncüoğlu C, Yüceyar AN, Ekmekçi Ö, Türkoğlu R, Soysal A, Köseoğlu M, Boz C, Beckmann Y, Turan ÖF, Demirkıran DM, Akman FG, Altunrende B, Cantürk İA, Birday E, Özcan A, Kamişli Ö, Özen NPA, Çelik RGG, Balcı FB, Efendi H, Sarıkaya C, Akçalı A, Toprak MK, Kabay SC, Kızılay F, Sevim MS, Gazaloğlu GB, Demir CF, Balgetir F, Kıylıoğlu N, Sarıahmetoğlu H, Ölmez Ç, Mavi K, Yüksel S, Işık N, Saip S, Karabudak R, Siva A, Eraksoy M. Retrospective analysis of effectiveness of fingolimod in real life setting in Turkey (REFINE). Turk J Med Sci 2023; 53:323-332. [PMID: 36945929 PMCID: PMC10388089 DOI: 10.55730/1300-0144.5588] [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: 07/06/2022] [Accepted: 11/30/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND During multiple sclerosis (MS) treatment different modes of action such as lateral (interferon beta to glatiramer acetate or glatiramer acetate to interferon beta) or vertical (interferon beta/glatiramer acetate to fingolimod) drug switch can be performed. This study aims to investigate the clinical effectiveness of switching from the first-line injectable disease modifying treatments (iDMTs) to fingolimod (FNG) compared to switching between first-line iDMTs. METHODS This is a multicenter, observational and retrospective study of patients with relapsing-remitting MS who had lateral and vertical switch. The observation period included three key assessment time points (before the switch, at switch, and after the switch). Data were collected from the MS patients' database by neurologists between January 2018 and June 2019. The longest follow-up period of the patients was determined as 24 months after the switch. RESULTS In 462 MS patients that were included in the study, both treatments significantly decreased the number of relapses during the postswitch 12 months versus preswitch one year while patients in the FNG group experienced significantly fewer relapses compared to iDMT cohort in the postswitch 12 months period. FNG cohort experienced fewer relapses than in the iDMT cohort within the postswitch 2 year. The mean time to first relapse after the switch was significantly longer in the FNG group. DISCUSSION The present study revealed superior effectiveness of vertical switch over lateral switch regarding the improvement in relapse outcomes. Patients in the FNG cohort experienced sustainably fewer relapses during the follow-up period after the switch compared the iDMT cohort. Importantly, switching to FNG was more effective in delaying time to first relapse when compared with iDMTs.
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Affiliation(s)
- Meryem Aslı Tuncer
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Kürtüncü
- Department of Neurology, İstanbul Faculty of Medicine (ÇAPA), İstanbul University, İstanbul, Turkey
| | - Murat Terzi
- Department of Neurology, Faculty of Medicine, Samsun Ondokuz Mayıs University, Samsun, Turkey
| | - Uğur Uygunoğlu
- Department of Neurology, Faculty of Medicine, İstanbul University Cerrahpaşa, İstanbul, Turkey
| | - Cansu Göncüoğlu
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Ayşe Nur Yüceyar
- Department of Neurology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Özgül Ekmekçi
- Department of Neurology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Recai Türkoğlu
- İstanbul Haydarpasa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Aysun Soysal
- Bakırköy Psychiatric and Neurological Diseases Hospital, İstanbul, Turkey
| | - Mesrure Köseoğlu
- Bakırköy Psychiatric and Neurological Diseases Hospital, İstanbul, Turkey
| | - Cavit Boz
- Department of Neurology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Yeşim Beckmann
- Department of Neurology, Faculty of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Ömer Faruk Turan
- Department of Neurology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | | | | | - Burcu Altunrende
- Florence Nightingale Hospital, Science University, İstanbul, Turkey
| | | | - Erkingül Birday
- Department of Neurology, Faculty of Medicine, Medipol University, İstanbul, Turkey
| | - Abdulcemal Özcan
- Department of Neurology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Özden Kamişli
- Department of Neurology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | | | | | | | - Hüsnü Efendi
- Department of Neurology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Cansu Sarıkaya
- Department of Neurology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Aylin Akçalı
- Department of Neurology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | | | - Sibel Canbaz Kabay
- Department of Neurology, Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Turkey
| | - Ferah Kızılay
- Department of Neurology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | | | - Caner Feyzi Demir
- Department of Neurology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Ferhat Balgetir
- Department of Neurology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Nefati Kıylıoğlu
- Department of Neurology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | | | - Çağcan Ölmez
- Novartis Health Food and Agriculture Products Industry and Trade Inc., İstanbul, Turkey
| | - Kamil Mavi
- Novartis Health Food and Agriculture Products Industry and Trade Inc., İstanbul, Turkey
| | - Süha Yüksel
- Novartis Health Food and Agriculture Products Industry and Trade Inc., İstanbul, Turkey
| | - Nihal Işık
- Okan University Hospital, İstanbul, Turkey
| | - Sabahattin Saip
- Department of Neurology, Faculty of Medicine, İstanbul University Cerrahpaşa, İstanbul, Turkey
| | - Rana Karabudak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aksel Siva
- Department of Neurology, Faculty of Medicine, İstanbul University Cerrahpaşa, İstanbul, Turkey
| | - Mefküre Eraksoy
- Department of Neurology, İstanbul Faculty of Medicine (ÇAPA), İstanbul University, İstanbul, Turkey
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Meca-Lallana JE, Oreja-Guevara C, Muñoz D, Olascoaga J, Pato A, Ramió-Torrentà L, Meca-Lallana V, Hernández MA, Marzo ME, Álvarez- Cermeño JC, Rodríguez-Antigüedad A, Montalbán X, Fernández O. Four-year safety and effectiveness data from patients with multiple sclerosis treated with fingolimod: The Spanish GILENYA registry. PLoS One 2021; 16:e0258437. [PMID: 34644366 PMCID: PMC8513911 DOI: 10.1371/journal.pone.0258437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To describe the profile of patients with multiple sclerosis (MS) treated with fingolimod in Spain and to assess the effectiveness and safety of fingolimod after 4 years of inclusion in the Spanish Gilenya Registry. Methods An observational, retrospective/prospective, multicenter case registry, including all patients with relapsing-remitting MS (RRMS) starting treatment with fingolimod in 43 centers in Spain. Analyses were performed in the overall population and in subgroups according to prior disease-modifying therapy (DMT): glatiramer acetate/interferon beta-1 (BRACE), natalizumab, other treatment, or naïve. Results Six hundred and sixty-six evaluable patients were included (91.1% previously treated with at least one DMT). The mean annualized relapse rate (ARR) prior to fingolimod was 1.12, and the mean EDSS at fingolimod initiation was 3.03. Fingolimod reduced the ARR by 71.4%, 75%, 75.5%, and 80.3%, after 1, 2, 3 and 4 years, respectively (p<0.001). This significant reduction in the ARR continued to be observed in all subgroups. After 4 years, the EDSS showed a minimal deterioration, with the EDSS scores from year 1 to year 4 remaining mostly stable. The percentage of patients without T1 Gd+ lesions progressively increased from 45.6% during the year prior to fingolimod initiation to 88.2% at year 4. The proportion of patients free from new/enlarged T2 lesions after 4 years of fingolimod treatment was 80.3%. This trend in both radiological measures was also observed in the subgroups. Adverse events (AEs) were experienced by up to 41.6% of patients (most commonly: lymphopenia [12.5%] and urinary tract infection [3.7%]). Most AEs were mild in severity, 3.6% of patients had serious AEs. Conclusions The patient profile was similar to other observational studies. The results obtained from the long-term use of fingolimod showed that it was effective, regardless of prior DMT, and it had adequate safety results, with a positive benefit-risk balance.
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Affiliation(s)
- J. E. Meca-Lallana
- Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - C. Oreja-Guevara
- Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - D. Muñoz
- Neurology Department, Hospital Xeral de Vigo, Vigo, Spain
| | - J. Olascoaga
- Neurology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - A. Pato
- Neurology Department, Hospital Povisa, Vigo, Spain
| | - L. Ramió-Torrentà
- Neurology Department, Hospital Universitari de Girona Dr. Josep Trueta, IDIBGI; Medical Sciences Department, University of Girona, Girona, Spain
| | - V. Meca-Lallana
- Neurology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - M. A. Hernández
- Neurology Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | | | - X. Montalbán
- Neurology Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - O. Fernández
- Department of Pharmacology, Faculty of Medicine, Universidad de Málaga; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- * E-mail:
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Uzunköprü C, Beckmann Y, Türe S. Long-Term Effectiveness of Fingolimod for Multiple Sclerosis in a Real-World Clinical Setting. Eur Neurol 2021; 84:200-205. [PMID: 33827097 DOI: 10.1159/000514828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 01/27/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The primary aim of the present study was to evaluate the long-term efficacy of fingolimod in patients with multiple sclerosis (MS); secondary aims were to describe the safety of fingolimod with the evaluation of treatment satisfaction and impact on the quality of life in real life. METHODS We collected clinical, demographical, neuroradiological, and treatment data, including pre- and posttreatment status health-related quality of life from 286 MS patients consecutively treated with fingolimod. Clinical assessment was based on the Expanded Disability Status Scale (EDSS), and quality of life assessment was performed with MS-related quality of life inventory (MSQOLI). The data were recorded at baseline and every 6 months for 2 years. RESULTS One hundred and fourteen males and 172 females were enrolled. The annualized relapse rate and EDSS showed a statistically significant reduction during the observation period (p < 0.001). The patients also demonstrated substantial improvements in magnetic resonance imaging (MRI) outcomes (p < 0.001). Health-related quality of life scores improved significantly between baseline and 24-month visit (p < 0.001). No serious adverse events occurred. CONCLUSION In our cohort, fingolimod treatment was associated with reduced relapse, MRI activity, and improved EDSS and MSQOLI scores. Additionally, fingolimod has been able to maintain its effectiveness over a considerable long period of treatment.
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Affiliation(s)
- Cihat Uzunköprü
- Department of Neurology, Izmir Katip Çelebi University, Izmir, Turkey
| | - Yesim Beckmann
- Department of Neurology, Izmir Katip Çelebi University, Izmir, Turkey
| | - Sabiha Türe
- Department of Neurology, Izmir Katip Çelebi University, Izmir, Turkey
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Bourdin A, Schneider MP, Locatelli I, Schluep M, Bugnon O, Berger J. Longitudinal analysis of safety and medication adherence of patients in the Fingolimod patient support program: a real-world observational study. Sci Rep 2021; 11:4107. [PMID: 33603005 PMCID: PMC7892872 DOI: 10.1038/s41598-021-83220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/28/2021] [Indexed: 11/12/2022] Open
Abstract
The Fingolimod Patient Support Program (F-PSP) is an interprofessional specialty pharmacy service designed to ensure responsible use of fingolimod by promoting patient safety and medication adherence. This study aims to evaluate the safety and medication adherence of patients who joined the F-PSP between 2013 and 2016. Sociodemographic and medical characteristics, patient safety data (patient-reported symptoms, discontinuations due to adverse events (AEs), repeated first-dose monitoring), and medication adherence (implementation, persistence, reasons for discontinuation, influence of covariates, barriers and facilitators) were described. Sixty-seven patients joined the F-PSP. Patients reported a high frequency of symptoms. Due to AEs, 7 patients discontinued fingolimod, 3 took therapeutic breaks, and 1 reduced the regimen temporarily. Three patients repeated the first-dose monitoring. Patients had a high medication adherence over the 18-month analysis period: implementation decreased from 98.8 to 93.7%, and fingolimod persistence was 83.2% at 18 months. The patients’ level of education, professional situation, and living with child(ren) influenced implementation. Patients reported more facilitators of medication adherence than barriers. The F-PSP seems valuable for supporting individual patients (ensuring responsible use of fingolimod and inviting patients for shared-decision making) and public health (indirectly gathering real-world evidence).
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Affiliation(s)
- Aline Bourdin
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland. .,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland. .,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland.
| | - Marie Paule Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Isabella Locatelli
- DFRI, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Myriam Schluep
- Division of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Jérôme Berger
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
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REALMS study: real-world effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis in Portugal. Neurol Sci 2020; 42:1995-2003. [PMID: 32997282 PMCID: PMC8043899 DOI: 10.1007/s10072-020-04726-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 09/15/2020] [Indexed: 01/09/2023]
Abstract
Background Fingolimod, an oral sphingosine 1-phosphate receptor modulator, is approved by EMA for relapsing-remitting multiple sclerosis (RRMS). Objectives To assess the effectiveness and safety of fingolimod in patients with RRMS in real-world clinical practice in Portugal. Methods Retrospective, multicentre, non-interventional study, reporting 3 years follow-up of data collected from October 2015 to July 2016. Sociodemographic data and previous treatments at baseline and data regarding disease evolution, including number of relapses, annualised relapse rates (ARR) and Expanded Disability Status Scale (EDSS), were collected. Results Two-hundred and seventy-five participants were enrolled in the REALMS study. Results showed that the main reason to switch to fingolimod was failure of previous treatment (56.7%) and only 3.6% were naïve patients. In the total population, there was a significant decrease in ARR of 64.6% in the first year of treatment, 79.7% in the second year and 82.3% in the third year, compared with baseline. More than 67.0% of patients had no relapses during the 3 years after switching to fingolimod. EDSS remained stable throughout the study. Conclusions Therapy with fingolimod showed a sustained effectiveness and safety over the 3 years, particularly on patients switched from first-line drugs (BRACE). No new safety issues were reported.
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Barrero F, Mallada-Frechin J, Martínez-Ginés ML, Marzo ME, Meca-Lallana V, Izquierdo G, Ara JR, Oreja-Guevara C, Meca-Lallana J, Forero L, Sánchez-Vera I, Moreno MJ. Spanish real-world experience with fingolimod in relapsing-remitting multiple sclerosis patients: MS NEXT study. PLoS One 2020; 15:e0230846. [PMID: 32240213 PMCID: PMC7117743 DOI: 10.1371/journal.pone.0230846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose The objective of this study was to characterize the demographic and clinical profile of RRMS patients receiving fingolimod in Spain, and to evaluate drug effectiveness and safety in clinical practice. Methods This observational, retrospective, multicentre, nationwide study was performed at 56 Spanish hospitals and involved 804 RRMS patients who received oral fingolimod (0.5 mg) since November 2011, with a minimum follow-up of 12 months. Results The mean annualized relapse rate (ARR) in the year before fingolimod was 1.08 and the median EDSS was 3; patients were exposed to fingolimod for 2.2 years as average; regarding magnetic resonance imaging (MRI) activity, more than half of the patients had >20 lesions at baseline. Patients were previously treated with first-line injectable DMTs (60.3%), or natalizumab (31.3%), and 8.3% were naïve patients. Overall, the ARR significantly decreased to 0.28, 0.22 and 0.17 (74.1%, 79.7% and 83.5% of relative reduction, respectively) after 12, 24 and 36 months of treatment, P<0.001. The ARR of patients who switched from natalizumab to fingolimod was stable over the study. Most of the patients (88.7%) were free from confirmed disability and MRI activity (67.3%) after 24 months. The persistence after 12 months on fingolimod was 93.9%. Conclusions The subgroups of patients analysed showed differential baseline demographic and clinical characteristics. The analysis of patients who received fingolimod in routine clinical practice confirmed adequate efficacy and safety, even for long-term treatment. The present data also confirmed the positive benefit/risk balance with fingolimod in real-world clinical practice setting.
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Affiliation(s)
- Francisco Barrero
- Neurology Department, Hospital Uniersitario San Cecilio de Granada, Granada, Spain
| | | | | | | | | | - Guillermo Izquierdo
- Neurology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - José Ramón Ara
- Neurology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Celia Oreja-Guevara
- Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Lucía Forero
- Neurology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
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Demir S, Atmaca MM, Togrol RE. The First Cure Experience of A Clinic: Approach to The Patient to Start Ocrelizumab. ACTA ACUST UNITED AC 2019; 58:52-56. [PMID: 33795953 DOI: 10.29399/npa.23564] [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: 01/01/2019] [Accepted: 02/11/2019] [Indexed: 11/07/2022]
Abstract
Introduction Ocrelizumab is a newly introduced treatment in multiple sclerosis (MS). There is no data in the pivotal trials about in which extent liver function tests (LFTs) and lymphocyte count are affected before second-half dose of ocrelizumab and in which extent these results will prevent us giving the second-half dose. This study was designed for better understanding of the patient management and to support the data that showed no safety issues about ocrelizumab with real-life data. Methods The patients treated with ocrelizumab between May 20 and December 21, 2018 were retrospectively reviewed. Demographic and clinical data, side-effects due to ocrelizumab, laboratory results before and after the treatment were recorded. Results There were 30 (58.8%) females and 21 (41.2%) males. The mean age was 44.02±9.62 (24-65) years. Twenty-six (51%) of them were followed up with relapsing-remitting MS (RRMS), 18 (35.3%) with secondary progressive MS (SPMS) and 7 (13.7%) with primary progressive MS (PPMS). The mean lymphocyte value one day after the first half-dose was lower than the value before the treatment (p<0.001). The mean lymphocyte level one month after the second half-dose was higher than the value one day after the first half-dose (p=0.001), while it was still lower than the value before treatment (p=0.006). No changes were seen in LFTs. Mild infusion-related reactions were observed in 4 patients. Conclusion From our data, it is evident that ocrelizumab is safe in the short term. Long-term real-life studies are needed to assess the safety of ocrelizumab in the long term.
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Affiliation(s)
- Serkan Demir
- Sultan Abdulhamid Han Training and Research Hospital, Neurology Clinic, İstanbul, Turkey
| | - Murat Mert Atmaca
- Sultan Abdulhamid Han Training and Research Hospital, Neurology Clinic, İstanbul, Turkey
| | - Rıfat Erdem Togrol
- Sultan Abdulhamid Han Training and Research Hospital, Neurology Clinic, İstanbul, Turkey
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