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Freedman MS, Coyle PK, Hellwig K, Singer B, Wynn D, Weinstock-Guttman B, Markovic-Plese S, Galazka A, Dangond F, Korich J, Reder AT. Twenty Years of Subcutaneous Interferon-Beta-1a for Multiple Sclerosis: Contemporary Perspectives. Neurol Ther 2024; 13:283-322. [PMID: 38206453 PMCID: PMC10951191 DOI: 10.1007/s40120-023-00565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 01/12/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic, progressive, inflammatory disorder of the central nervous system. Relapsing-remitting MS (RRMS), the most common form of the disease, is characterized by transient neurological dysfunction with concurrent accumulation of disability. Over the past three decades, disease-modifying therapies (DMTs) capable of reducing the frequency of relapses and slowing disability worsening have been studied and approved for use in patients with RRMS. The first DMTs were interferon-betas (IFN-βs), which were approved in the 1990s. Among them was IFN-β-1a for subcutaneous (sc) injection (Rebif®), which was approved for the treatment of MS in Europe and Canada in 1998 and in the USA in 2002. Twenty years of clinical data and experience have supported the efficacy and safety of IFN-β-1a sc in the treatment of RRMS, including pivotal trials, real-world data, and extension studies lasting up to 15 years past initial treatment. Today, IFN-β-1a sc remains an important therapeutic option in clinical use, especially around pregnancy planning and lactation, and may also be considered for aging patients, in which MS activity declines and long-term immunosuppression associated with some alternative therapies is a concern. In addition, IFN-β-1a sc is used as a comparator in many clinical studies and provides a framework for research into the mechanisms by which MS begins and progresses.
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Affiliation(s)
- Mark S Freedman
- Department of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
- The Ottawa Hospital Research Institute, 501 Smyth, Ottawa, ON, K1H 8L6, Canada.
| | - Patricia K Coyle
- Department of Neurology, Renaissance School of Medicine, Stony Brook University, New York, NY, 11794, USA
| | - Kerstin Hellwig
- Katholisches Klinikum Bochum, Ruhr University, 44787, Bochum, Germany
| | - Barry Singer
- The MS Center for Innovations in Care, Missouri Baptist Medical Center, 3009 N. Ballas Road, Suite 105B, St. Louis, MO, 63131, USA
| | - Daniel Wynn
- Neurology MS Center, Consultants in Neurology, Ltd, 1535 Lake Cook Road, Suite 601, Northbrook, IL, 60062, USA
| | - Bianca Weinstock-Guttman
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, 14215, USA
- Jacobs MS Center for Treatment and Research, Buffalo, NY, 14202, USA
- Pediatric MS Center, NY State MS Consortium, 1010 Main Street, Buffalo, NY, 14203, USA
| | - Silva Markovic-Plese
- Division of Neuroimmunology, Department of Neurology, Thomas Jefferson University, 900 Walnut St, Rm 305-B, Philadelphia, PA, 19107, USA
| | | | - Fernando Dangond
- EMD Serono Research & Development Institute Inc., an affiliate of Merck GKaA, Billerica, MA, 01821, USA
| | - Julie Korich
- EMD Serono Inc., an affiliate of Merck KGaA, Rockland, MA, 02370, USA
| | - Anthony T Reder
- Department of Neurology A-205, University of Chicago Medicine, MC-2030, 5841 S Maryland Ave, Chicago, IL, 60637, USA
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Koch-Henriksen NI, Thygesen LC, Sørensen PS, Magyari M. Using instrumental variables to correct for bias in real-world cohort studies of the effects of disease-modifying treatment in MS. Mult Scler 2024; 30:113-120. [PMID: 37787012 DOI: 10.1177/13524585231201423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Estimating the effect of disease-modifying treatment of MS in observational studies is impaired by bias from unmeasured confounders, in particular indication bias. OBJECTIVE To show how instrumental variables (IVs) reduce bias. METHODS All patients with relapsing onset of MS 1996-2010, identified by the nationwide Danish Multiple Sclerosis Registry, were followed from onset. Exposure was treatment index throughout the first 12 years from onset, defined as a cumulative function of months without and with medium- or high-efficacy treatment, and outcomes were hazard ratios (HRs) per unit treatment index for sustained Expanded Disability Scale Score (EDSS) 4 and 6 adjusted for age at onset and sex, without and with an IV. We used the onset cohort (1996-2000; 2001-2005; 2006-2010) as an IV because treatment index increased across the cohorts. RESULTS We included 6014 patients. With conventional Cox regression, HRs for EDSS 4 and 6 were 1.15 [95% CI: 1.13-1.18] and 1.17 [1.13-1.20] per unit treatment index. Only with IVs, we confirmed a beneficial effect of treatment with HRs of 0.86 [0.81-0.91] and 0.82 [0.74-0.90]. CONCLUSION The use of IVs eliminates indication bias and confirms that treatment is effective in delaying disability. IVs could, under some circumstances, be an alternative to marginal structural models.
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Affiliation(s)
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Per Soelberg Sørensen
- The Danish Multiple Sclerosis Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark
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Ferrand M, Epstein J, Soudant M, Guillemin F, Pittion-Vouyovitch S, Debouverie M, Mathey G. Real-life evaluation of the 2017 McDonald criteria for relapsing-remitting multiple sclerosis after a clinically isolated syndrome confirms a gain in time-to-diagnosis. J Neurol 2024; 271:125-133. [PMID: 37650895 DOI: 10.1007/s00415-023-11905-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Previous cohort studies evaluating the performances of the McDonald criteria suffered from bias regarding real-life conditions. We aimed to evaluate the probability of diagnosing relapsing-remitting multiple sclerosis (MS) at several timepoints from the first medical evaluation and the gain in time-to-diagnosis with the 2017 McDonald criteria compared with the 2001, 2005 and 2010 versions in real life. METHODS Patients with a first demyelinating event suggestive of MS between 2002 and 2020 were included in the ReLSEP, an exhaustive and prospectively incremented registry of MS patients in North-Eastern France. We estimated the probability of being positive at the first medical evaluation and at five timepoints according to the four versions of criteria using Kaplan-Meier estimators and Cox models. RESULTS A total of 2220 patients were followed up for a median of 7.1 years. At baseline, 31.7%, 32.1%, 36.6% and 54.0% of patients, respectively, fulfilled the 2001, 2005, 2010 and 2017 McDonald criteria. Using the 2017 criteria, the gain in time-to-diagnosis was 3.7 months compared with the 2010 criteria. The presence of intrathecal synthesis of immunoglobulin G in the McDonald 2017 criteria led to a 1.8-month reduction in median time-to-diagnosis compared to a version of McDonald 2017 without this criteria. CONCLUSIONS In real-life, the 2017 McDonald criteria revision undoubtedly shortened time-to-diagnosis.
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Affiliation(s)
- Mickaël Ferrand
- Department of Neurology, Nancy University Hospital, 54035, Nancy, France
| | - Jonathan Epstein
- Université de Lorraine, APEMAC, 54000, Nancy, France
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, 54000, Nancy, France
| | - Marc Soudant
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, 54000, Nancy, France
| | - Francis Guillemin
- Université de Lorraine, APEMAC, 54000, Nancy, France
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, 54000, Nancy, France
| | | | - Marc Debouverie
- Department of Neurology, Nancy University Hospital, 54035, Nancy, France
- Université de Lorraine, APEMAC, 54000, Nancy, France
| | - Guillaume Mathey
- Department of Neurology, Nancy University Hospital, 54035, Nancy, France.
- Université de Lorraine, APEMAC, 54000, Nancy, France.
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Ricotti S, Garay AS, Etcheverrigaray M, Amadeo GI, De Groot AS, Martin W, Mufarrege EF. Development of IFNβ-1a versions with reduced immunogenicity and full in vitro biological activity for the treatment of multiple sclerosis. Clin Immunol 2023; 257:109831. [PMID: 37931868 DOI: 10.1016/j.clim.2023.109831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/18/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
IFNβ (recombinant interferon Beta) has been widely used for the treatment of Multiple sclerosis for the last four decades. Despite the human origin of the IFNβ sequence, IFNβ is immunogenic, and unwanted immune responses in IFNβ-treated patients may compromise its efficacy and safety in the clinic. In this study, we applied the DeFT (De-immunization of Functional Therapeutics) approach to producing functional, de-immunized versions of IFNβ-1a. Two de-immunized versions of IFNβ-1a were produced in CHO cells and designated as IFNβ-1a(VAR1) and IFNβ-1a(VAR2). First, the secondary and tertiary protein structures were analyzed by circular dichroism spectroscopy. Then, the variants were also tested for functionality. While IFNβ-1a(VAR2) showed similar in vitro antiviral activity to the original protein, IFNβ-1a(VAR1) exhibited 40% more biological potency. Finally, in vivo assays using HLA-DR transgenic mice revealed that the de-immunized variants showed a markedly reduced immunogenicity when compared to the originator.
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Affiliation(s)
- Sonia Ricotti
- UNL, CONICET, FBCB (School of Biochemistry and Biological Sciences), CBL (Biotechnological Center of Litoral), Ciudad Universitaria, Ruta Nacional 168, Km 472.4, C.C. 242, Santa Fe S3000ZAA, Argentina
| | - Alberto Sergio Garay
- Laboratory of Molecular Modeling, FBCB (School of Biochemistry and Biological Sciences), Ciudad Universitaria, Ruta Nacional 168, Km 472.4, C.C. 242, Santa Fe S3000ZAA, Argentina
| | - Marina Etcheverrigaray
- UNL, CONICET, FBCB (School of Biochemistry and Biological Sciences), CBL (Biotechnological Center of Litoral), Ciudad Universitaria, Ruta Nacional 168, Km 472.4, C.C. 242, Santa Fe S3000ZAA, Argentina
| | - Gabriel Ignacio Amadeo
- Ciudad Universitaria, Ruta Nacional 168, Km 472.4, C.C. 242, Santa Fe S3000ZAA, Argentina
| | - Anne S De Groot
- EpiVax, Inc., Providence, RI 02903, USA; Center for Vaccines and Immunology, University of Georgia, Athens, GA, United States of America
| | | | - Eduardo Federico Mufarrege
- UNL, CONICET, FBCB (School of Biochemistry and Biological Sciences), CBL (Biotechnological Center of Litoral), Ciudad Universitaria, Ruta Nacional 168, Km 472.4, C.C. 242, Santa Fe S3000ZAA, Argentina.
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Cobo-Calvo A, Tur C, Otero-Romero S, Carbonell-Mirabent P, Ruiz M, Pappolla A, Villacieros Alvarez J, Vidal-Jordana A, Arrambide G, Castilló J, Galan I, Rodríguez Barranco M, Midaglia LS, Nos C, Rodriguez Acevedo B, Zabalza de Torres A, Mongay N, Rio J, Comabella M, Auger C, Sastre-Garriga J, Rovira A, Tintore M, Montalban X. Association of Very Early Treatment Initiation With the Risk of Long-term Disability in Patients With a First Demyelinating Event. Neurology 2023; 101:e1280-e1292. [PMID: 37468284 PMCID: PMC10558169 DOI: 10.1212/wnl.0000000000207664] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 06/02/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Early treatment is associated with better long-term outcomes in patients with a first demyelinating event and early multiple sclerosis (MS). However, magnetic resonance (MR) findings are not usually integrated to construct propensity scores (PSs) when evaluating outcomes. We assessed the association of receiving very early treatment with the risk of long-term disability including an MR score (MRS) in patients with a first demyelinating event. METHODS We included 580 patients with a first demyelinating event prospectively collected between 1994 and 2021, who received at least 1 disease-modifying drug (DMD). Patients were classified into tertiles according to the cohort's distribution of the time from the first demyelinating event to the first DMD: first tertile (FT) or very early treatment (6 months; n = 194), second tertile (6.1-16 months, n = 192), and third tertile (TT) (16.1 months, n = 194). A 5-point MRS was built according to the sum of the following indicators: ≥9 brain lesions (1 point); ≥1 infratentorial lesion (1 point); ≥1 spinal cord (SC) lesion (1 point); ≥1 contrast-enhancing (CE) brain lesion (1 point); and ≥1 CE SC lesion (1 point). PS based on covariates and the MRS was computed for each of the outcomes. Inverse PS-weighted Cox and linear regression models assessed the risk of different outcomes between tertile groups. Finally, to confirm the role of MR in treatment decision, we studied the time elapsed from the first demyelinating event to treatment initiation according to the MRS in all patients with radiologic available information, renamed as raw-MRS. RESULTS Very early treatment decreased the risk of reaching Expanded Disability Status Scale 3.0 (hazard ratio [HR] 0.55, 95% CI 0.32-0.97), secondary progressive MS (HR 0.40, 95% CI 0.19-0.85), and sustained disease progression at 12 months after treatment initiation (HR 0.50, 95% CI 0.29-0.84), when compared with patients from the TT group. Patients from the FT group had a lower disability progression rate (β estimate -0.009, 95% CI -0.016 to -0.002) and a lower severe disability measured by the Patient-Determined Disease Step (β estimate -0.52, 95% CI -0.91 to -0.13) than the TT group. Finally, there was a 62.4% reduction in the median time between the first demyelinating event and the first-ever treatment initiation from patients displaying a raw-MRS 1 to patients with a raw-MRS 5. DISCUSSION Using PS models with and without MRS, we showed that treatment initiation at very early stages is associated with a reduction in the risk of long-term disability accrual in patients with a first demyelinating event. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that earlier treatment of patients with MS presenting with a first demyelinating event is associated with improved clinical outcomes.
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Affiliation(s)
- Alvaro Cobo-Calvo
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
| | - Carmen Tur
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Susana Otero-Romero
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Pere Carbonell-Mirabent
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mariano Ruiz
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Agustin Pappolla
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Javier Villacieros Alvarez
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Angela Vidal-Jordana
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Georgina Arrambide
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Joaquín Castilló
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ingrid Galan
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Marta Rodríguez Barranco
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Luciana Soledad Midaglia
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Carlos Nos
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Breogan Rodriguez Acevedo
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ana Zabalza de Torres
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Neus Mongay
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jordi Rio
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Manuel Comabella
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Cristina Auger
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jaume Sastre-Garriga
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Alex Rovira
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mar Tintore
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Xavier Montalban
- From the Centre d'Esclerosi Múltiple de Catalunya (Cemcat) (A.C.-C., C.T., S.O.-R., P.C.-M., A.P., J.V.A., A.V.-J., G.A., J.C., I.G., M.R.B., L.S.M., C.N., B.R.A., A.Z.d.T., N.M., J.R., M.C., J.S.-G., M.T., X.M.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona; Department of Neurology (M.R.), Hospital Universitario Doce de Octubre, Madrid; and Section of Neuroradiology (C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
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Abstract
Progress in understanding of the mechanisms underlying chronic inflammatory skin disorders, such as atopic dermatitis and psoriasis vulgaris, has led to new treatment options with the primary goal of alleviating symptoms. In addition, this knowledge has the potential to inform on new strategies aimed at inducing deep and therapy-free remission, that is, disease modification, potentially impacting on associated comorbidities. However, to reach this goal, key areas require further exploration, including the definitions of disease modification and disease activity index, further understanding of disease mechanisms and systemic spillover effects, potential windows of opportunity, biomarkers for patient stratification and successful intervention, as well as appropriate study design. This Perspective article assesses the opportunities and challenges in the discovery and development of disease-modifying therapies for chronic inflammatory skin disorders.
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Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergy, University Hospital, Bonn, Germany.
- Christine Kühne - Center for Allergy Research and Education, Davos, Switzerland.
- Davos Biosciences, Davos, Switzerland.
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He AH, Manouchehrinia A, Glaser A, Ciccarelli O, Butzkueven H, Hillert J, McKay KA. Association between clinic-level quality of care and patient-level outcomes in multiple sclerosis. Mult Scler 2023; 29:1126-1135. [PMID: 37392018 PMCID: PMC10413789 DOI: 10.1177/13524585231181578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) quality of care guidelines are consensus-based. The effectiveness of the recommendations is unknown. OBJECTIVE To determine whether clinic-level quality of care affects clinical and patient-reported outcomes. METHODS This nationwide observational cohort study included patients with adult-onset MS in the Swedish MS registry with disease onset 2005-2015. Clinic-level quality of care was measured by four indicators: visit density, magnetic resonance imaging (MRI) density, mean time to commencement of disease-modifying therapy, and data completeness. Outcomes were Expanded Disability Status Scale (EDSS) and patient-reported symptoms measured by the Multiple Sclerosis Impact Scale (MSIS-29). Analyses were adjusted for individual patient characteristics and disease-modifying therapy exposure. RESULTS In relapsing MS, all quality indicators benefitted EDSS and physical symptoms. Faster treatment, frequent visits, and higher data completeness benefitted psychological symptoms. After controlling for all indicators and individual treatment exposures, faster treatment remained independently associated with lower EDSS (-0.06, 95% confidence interval (CI): -0.01, -0.10) and more frequent visits were associated with milder physical symptoms (MSIS-29 physical score: -16.2%, 95% CI: -1.8%, -29.5%). Clinic-level quality of care did not affect any outcomes in progressive-onset disease. CONCLUSION Certain quality of care indicators correlated to disability and patient-reported outcomes in relapse-onset but not progressive-onset disease. Future guidelines should consider recommendations specific to disease course.
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Affiliation(s)
- Anna H He
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Kyla Anne McKay
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden/Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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8
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He A, Spelman T, Manouchehrinia A, Ciccarelli O, Hillert J, McKay K. Association between early treatment of multiple sclerosis and patient-reported outcomes: a nationwide observational cohort study. J Neurol Neurosurg Psychiatry 2023; 94:284-289. [PMID: 36600595 PMCID: PMC10086460 DOI: 10.1136/jnnp-2022-330169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Timing of disease-modifying therapy affects clinical disability in multiple sclerosis, but it is not known whether patient reported outcomes are also affected. This study investigates the relationship between treatment timing and patient-reported symptoms and health-related quality of life. METHODS This was a nationwide observational cohort study of adults with relapsing multiple sclerosis, with disease onset between 2001 and 2016, and commenced on disease-modifying treatment within 4 years from disease onset. Patients commencing treatment within 0-2 years were compared with patients commencing treatment at 2-4 years. Indication bias was mitigated by propensity matching. Outcomes were patient-reported symptoms and health-related quality of life as measured by the Multiple Sclerosis Impact Scale (MSIS-29) and EuroQol-5 Dimensions-3 Level (EQ-5D). The follow-up period was 4-10 years from disease onset. RESULTS There were 2648 patients (69% female, median age 32.8) eligible for matching. Mean follow-up time was 3.7 years. Based on 780 matched patients, each year of treatment delay was associated with a worse MSIS physical score by 2.75 points (95% CI 1.29 to 4.20), and worse MSIS psychological score by 2.02 points (95% CI 0.03 to 3.78), in the adjusted models.Among 690 matched patients, earlier treatment start was not associated with EQ-5D score during the follow-up. CONCLUSIONS Earlier commencement of disease-modifying treatment was associated with better patient-reported physical symptoms when measured using a disease-specific metric; however, general quality of life was not affected. This indicates that other factors may inform patients' overall quality of life.
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Affiliation(s)
- Anna He
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden .,Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Olga Ciccarelli
- Department of Neuroinflammation, UCL Institute of Neurology, London, UK
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Kyla McKay
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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9
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Iversen L, Conrad C, Eidsmo L, Costanzo A, Narbutt J, Pinter A, Kingo K, Rivera Diaz R, Kolbinger F, Nanna M, Frueh JA, Jagiello P. Secukinumab demonstrates superiority over narrow-band ultraviolet B phototherapy in new-onset moderate to severe plaque psoriasis patients: Week 52 results from the STEPIn study. J Eur Acad Dermatol Venereol 2023; 37:1004-1016. [PMID: 36606536 DOI: 10.1111/jdv.18846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Biologic treatments have been studied mainly in patients with a long-term history of psoriasis and previous treatment failures. OBJECTIVES The purpose of this primary analysis of the STEPIn study is to determine whether early intervention with secukinumab in patients with new-onset moderate to severe plaque psoriasis is superior to standard of care treatment with narrow band ultraviolet B (nb-UVB) phototherapy. METHODS The STEPIn study is a randomized, open-label, multicentre study to investigate early intervention with 52 weeks of secukinumab 300 mg administered subcutaneously versus standard treatment with nb-UVB phototherapy in patients with new-onset (≤12 months) moderate to severe plaque psoriasis (NCT03020199). The primary and additional secondary endpoints were ≥90% improvement in Psoriasis Area and Severity Index (PASI 90) at Week 52 and Investigator's Global Assessment (IGA mod 2011) 0/1 response at Week 52, respectively. RESULTS In the secukinumab and nb-UVB study arms, 77/80 and 76/80 randomized patients received at least one dose of study treatment, respectively. The primary endpoint was achieved: 91.1% (70/77) of patients achieved a PASI 90 response at Week 52 in the secukinumab arm versus 42.3% (32/76) in the nb-UVB arm (p < 0.0001, odds ratio [OR] estimate [95% confidence intervals, CI] = 16.3 [5.6, 46.9]). The additional secondary endpoint was also achieved: 85.7% of patients achieved an IGA 0/1 response at Week 52 in the secukinumab arm versus 36.8% in the nb-UVB arm (p < 0.0001). The safety data were consistent with the safety profiles of secukinumab and nb-UVB with no new or unexpected safety signals. CONCLUSIONS Secukinumab was superior to nb-UVB in treating patients with new-onset moderate to severe plaque psoriasis. The high and sustained skin clearance observed indicates that biologic treatment for psoriasis may be more effective if used early in the disease course.
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Affiliation(s)
- Lars Iversen
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Curdin Conrad
- Department of Dermatology, CHUV University Hospital and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Liv Eidsmo
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.,Leo Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Antonio Costanzo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, Goethe-Universität Frankfurt am Main, Frankfurt, Germany
| | - Külli Kingo
- Department of Dermatology, University of Tartu, Dermatology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Raquel Rivera Diaz
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Frank Kolbinger
- Department of Autoimmunity, Transplantation & Immunology, Novartis Institutes for Biomedical Research, Basel, Switzerland
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10
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Bergamaschi R, Beghi E, Bosetti C, Ponzio M, Santucci C, Lepore V, Mosconi P, Aguglia U, Amato MP, Ancona AL, Ardito B, Avolio C, Balgera R, Banfi P, Barcella V, Barone P, Bellantonio P, Berardinelli A, Bergamaschi R, Bertora P, Bianchi M, Bramanti P, Morra VB, Brichetto G, Brioschi AM, Buccafusca M, Bucello S, Busillo V, Calchetti B, Cantello R, Capobianco M, Capone F, Capone L, Cargnelutti D, Carrozzi M, Cartechini E, Cavaletti G, Cavalla P, Celani MG, Clerici R, Clerico M, Cocco E, Confalonieri P, Coniglio MG, Conte A, Corea F, Cottone S, Crociani P, D’andrea F, Danni MC, De Luca G, de Pascalis D, De Riz M, De Robertis F, De Rosa G, De Stefano N, Corte MD, Di Sapio A, Docimo R, Falcini M, Falcone N, Fermi S, Ferraro E, Ferrò MT, Fortunato M, Foschi M, Gajofatto A, Gallo A, Gallo P, Gatto M, Gazzola P, Giordano A, Granella F, Grasso MF, Grasso MG, Grimaldi LME, Iaffaldano P, Imperiale D, Inglese M, Iodice R, Leva S, Luezzi V, Lugaresi A, Lus G, Maimone D, Mancinelli L, Maniscalco GT, Marfia GA, Marini B, Marson A, Mascoli N, Massacesi L, Melani F, Merello M, Meucci G, Mirabella M, Montepietra S, Nasuelli D, Nicolao P, Passantino F, Patti F, Peresson M, Pesci I, Piantadosi C, Piras ML, Pizzorno M, Plewnia K, Pozzilli C, Protti A, Quatrale R, Realmuto S, Ribizzi G, Rinalduzzi S, Rini A, Romano S, Romeo M, Ronzoni M, Rossi P, Rovaris M, Salemi G, Santangelo G, Santangelo M, Santuccio G, Sarchielli P, Sinisi L, Sola P, Solaro C, Spitaleri D, Strumia S, Tassinari T, Tonietti S, Tortorella C, Totaro R, Tozzo A, Trivelli G, Ulivelli M, Valentino P, Venturi S, Vianello M, Zaffaroni M, Zarbo R, Trojano M, Battaglia MA, Capobianco M, Pugliatti M, Ulivelli M, Mosconi P, Gasperini C, Patti F, Amato MP, Bergamaschi R, Comi G, on behalf of the Italian Multiple Sclerosis and Related Disorders Register Centers Group and the Scientific Committee of Italian SM and Related Disorders Register. Do patients’ and referral centers’ characteristics influence multiple sclerosis phenotypes? Results from the Italian multiple sclerosis and related disorders register. Neurol Sci 2022; 43:5459-5469. [PMID: 35672479 PMCID: PMC9385759 DOI: 10.1007/s10072-022-06169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022]
Abstract
Background
Multiple sclerosis (MS) is characterized by phenotypical heterogeneity, partly resulting from demographic and environmental risk factors. Socio-economic factors and the characteristics of local MS facilities might also play a part. Methods This study included patients with a confirmed MS diagnosis enrolled in the Italian MS and Related Disorders Register in 2000–2021. Patients at first visit were classified as having a clinically isolated syndrome (CIS), relapsing–remitting (RR), primary progressive (PP), progressive-relapsing (PR), or secondary progressive MS (SP). Demographic and clinical characteristics were analyzed, with centers’ characteristics, geographic macro-areas, and Deprivation Index. We computed the odds ratios (OR) for CIS, PP/PR, and SP phenotypes, compared to the RR, using multivariate, multinomial, mixed effects logistic regression models. Results In all 35,243 patients from 106 centers were included. The OR of presenting more advanced MS phenotypes than the RR phenotype at first visit significantly diminished in relation to calendar period. Females were at a significantly lower risk of a PP/PR or SP phenotype. Older age was associated with CIS, PP/PR, and SP. The risk of a longer interval between disease onset and first visit was lower for the CIS phenotype, but higher for PP/PR and SP. The probability of SP at first visit was greater in the South of Italy. Discussion Differences in the phenotype of MS patients first seen in Italian centers can be only partly explained by differences in the centers’ characteristics. The demographic and socio-economic characteristics of MS patients seem to be the main determinants of the phenotypes at first referral. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06169-7.
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Lefort M, Vukusic S, Casey R, Edan G, Leray E. Disability Progression in Multiple Sclerosis Patients using Early First-line Treatments. Eur J Neurol 2022; 29:2761-2771. [PMID: 35617144 PMCID: PMC9544933 DOI: 10.1111/ene.15422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Therapeutic management of relapsing-remitting multiple sclerosis (RRMS) has evolved towards early treatment. The objective was to assess the impact of early treatment initiation on disability progression among RRMS first-line treated patients. METHODS This study included all incident RRMS cases starting interferon or glatiramer acetate for the first time from 1996/01/01 to 2012/31/12 (N=5,279) from ten MS expert OFSEP centers (Observatoire Français de la Sclérose en Plaques). The delay from treatment start to attain an irreversible Expanded Disability Status Scale score of 3.0 were compared between "Early" group (N= 1,882; treated within 12 months following MS clinical onset) and "Later" group using propensity score weighted Kaplan-Meier methods, overall and stratified by age. RESULTS Overall, the restricted mean time before reaching EDSS 3.0 (RMST) from treatment start was 11 years and two months for patients treated within the year following MS clinical onset and 10 years and seven months for patients treated later. Thus, early treated patients gained 7 months (95% CI: [4-11] months) in the time to reach EDSS 3.0 compared to patients treated later (treatment start delayed by 28 months). The difference in RMST was respectively six months (95% CI: [1-10] months) and 14 months (95% CI: [4-24] months) in the "≤40 years" age group and in the ">40 years" age group, in favour of early group. . CONCLUSIONS Early treatment initiation resulted in a significant reduction of disability progression among patients with RRMS, and also among older patients.
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Affiliation(s)
- Mathilde Lefort
- Univ Rennes; EHESP, CNRS, Inserm, Arènes—UMR 6051RSMS (Recherche sur les Services et Management en Santé)—U 1309RennesFrance
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes)RennesFrance
| | - Sandra Vukusic
- Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro‐inflammationBronFrance
- Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de LyonINSERM 1028 et CNRS UMR 5292LyonFrance
- Université de LyonUniversité Claude Bernard Lyon 1LyonFrance
- Eugène Devic EDMUS Foundation against Multiple Sclerosis (a government approved foundation)BronFrance
| | - Romain Casey
- Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro‐inflammationBronFrance
- Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de LyonINSERM 1028 et CNRS UMR 5292LyonFrance
- Université de LyonUniversité Claude Bernard Lyon 1LyonFrance
- Eugène Devic EDMUS Foundation against Multiple Sclerosis (a government approved foundation)BronFrance
| | - Gilles Edan
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes)RennesFrance
- Department of NeurologyCHU PontchaillouRennesFrance
| | - Emmanuelle Leray
- Univ Rennes; EHESP, CNRS, Inserm, Arènes—UMR 6051RSMS (Recherche sur les Services et Management en Santé)—U 1309RennesFrance
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes)RennesFrance
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Brieva L, Estruch BC, Merino JAG, Meca-Lallana V, Río J, Rodríguez-Antigüedad A, Agüera E, Ara JR, Luque AA, Garcia CA, Blanco Y, Castillo-Triviño T, Costa-Frossard L, Platas MG, Pascual LL, Llaneza-González M, Ginés MLM, Matías-Guiu J, Meca-Lallana JE, Bilbao MM, Sempere AP, Romero-Pinel L, Saiz A, Moral E. DISEASE MODIFYING THERAPY SWITCHING IN RELAPSING MULTIPLE SCLEROSIS: A Delphi consensus of the demyelinating expert group of the Spanish Society of Neurology. Mult Scler Relat Disord 2022; 63:103805. [DOI: 10.1016/j.msard.2022.103805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 03/05/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
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13
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Villaverde-González R. Updated Perspectives on the Challenges of Managing Multiple Sclerosis During Pregnancy. Degener Neurol Neuromuscul Dis 2022; 12:1-21. [PMID: 35023987 PMCID: PMC8743861 DOI: 10.2147/dnnd.s203406] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic immune-mediated, inflammatory, and degenerative disease that is up to three times more frequent in young women. MS does not alter fertility and has no impact on fetal development, the course of pregnancy, or childbirth. The Pregnancy in Multiple Sclerosis Study in 1998 showed that pregnancy, mostly in untreated women, did not adversely affect MS, as disease activity decreased during pregnancy (although it significantly increased in the first trimester postpartum). These findings, together with the limited information available on the potential risks of fetal exposure to disease modifying treatments (DMTs), meant that women were advised to delay the onset of DMTs, stop them prior to conception, or, in case of unplanned pregnancy, discontinue them when pregnancy was confirmed. Now, many women with MS receive DMTs before pregnancy and, despite being considered a period of MS stability, up to 30% of patients could relapse in the first trimester postpartum. Factors associated with an increased risk of relapse and disability during pregnancy and postpartum include relapses before and during pregnancy, a greater disability at the time of conception, the occurrence of relapses after DMT cessation before conception, and the use of high-efficacy DMTs before conception, especially natalizumab or fingolimod. Strategies to prevent postpartum activity are needed in some patients, but consensus is lacking regarding the therapeutic strategies for women with MS of a fertile age. This, along with the increasing number of DMTs, means that the decision-making processes in aspects related to family planning and therapeutic strategies before, during, and after pregnancy are increasingly more complex. The purpose of this review is to provide an update on pregnancy-related issues in women with MS, including recommendations for counseling, general management, use of DMTs in pre-pregnancy, pregnancy, and postpartum periods, and breastfeeding-related aspects of DMTs.
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Abstract
Multiple sclerosis (MS) is an immunological disease that causes acute inflammatory lesions and chronic inflammation in the CNS, leading to tissue damage and disability. As awareness of MS has increased and options for therapy have come into use, a large amount of epidemiological data have been collected, enabling studies of changes in incidence and disease course over time. Overall, these data seem to indicate that the incidence of MS has increased, but the course of the disease has become milder, particularly in the 25 years since the first disease-modifying therapies (DMTs) became available. A clear understanding of these trends and the reasons for them is important for understanding the factors that influence the development and progression of MS, and for clinical management with respect to prevention and treatment decisions. In this Review, we consider the evidence for changes in the epidemiology of MS, focusing on trends in the incidence of the disease over time and trends in the disease severity. In addition, we discuss the factors influencing these trends, including refinement of diagnostic criteria and improvements in health-care systems that have increased diagnosis in people with mild disease, and the introduction and improvement of DMT.
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Affiliation(s)
- Nils Koch-Henriksen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. .,The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Copenhagen, Denmark.,Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
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Claflin SB, Campbell JA, Mason DF, Kalincik T, Simpson-Yap S, Norman R, Butzkueven H, Carroll WM, Palmer AJ, Blizzard CL, van der Mei I, Taylor BV. The effect of national disease-modifying therapy subsidy policy on long-term disability outcomes in people with multiple sclerosis. Mult Scler 2021; 28:831-841. [PMID: 34387513 DOI: 10.1177/13524585211035948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Disease-modifying therapies (DMTs) are used to treat people with relapsing-onset multiple sclerosis (ROMS), but our knowledge is largely limited to their short-term effects. OBJECTIVE To determine (1) the impact of national-level DMT subsidy policy on DMT use and health outcomes in people with MS (PwMS) and (2) the long-term effects of DMT on disability and quality of life (QoL; 5-level EQ-5D version (EQ-5D-5L) utility value). METHODS This observational cohort study compared Australian and New Zealand populations with different levels of DMT availability 10-20 years post-ROMS diagnosis. Between-country differences were assessed using standardised differences. Associations were assessed with multivariable linear regression models. RESULTS We recruited 328 Australians and 256 New Zealanders. The Australian cohort had longer DMT treatment duration, greater proportion of disease course treated and shorter duration between diagnosis and starting DMT. The Australian cohort had lower median Expanded Disability Status Scale (EDSS) (3.5 vs 4.0) and Multiple Sclerosis Severity Score (MSSS) (3.05 vs 3.71) and higher QoL (0.71 vs 0.65). In multivariable models, between-country differences in disability and QoL were largely attributed to differential use of DMT. CONCLUSIONS This study provides evidence for the impact of national-level DMT policy on disability outcomes in PwMS. Where DMTs are more accessible, PwMS experienced less disability progression and improved QoL 10-20 years post-diagnosis.
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Affiliation(s)
- Suzi B Claflin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Deborah F Mason
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Tomas Kalincik
- CORe The University of Melbourne, Melbourne, VIC, Australia/Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Steve Simpson-Yap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Neuroepidemiology Unit, Melbourne School of Population & Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Helmut Butzkueven
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | | | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia/Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - C Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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16
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Kohler M, Kohler E, Vrech C, Pappolla A, Miguez J, Patrucco L, Correale J, Marrodan M, Gaitán MI, Fiol M, Negrotto L, Ysrraelit MC, Cristiano E, Carrá A, Steinberg J, Martinez AD, Curbelo MC, Cohen L, Alonso R, Garcea O, Pita C, Silva B, Luetic G, Deri N, Balbuena ME, Tkachuk V, Carnero Contentti E, Lopez PA, Pettinicchi JP, Caride A, Burgos M, Leguizamon F, Knorre E, Piedrabuena R, Barboza A, Liwacki S, Nofal P, Volman G, Alvez Pinheiro A, Hryb J, Tavolini D, Blaya P, Recchia L, Mainella C, Silva E, Blanche J, Tizio S, Saladino ML, Caceres F, Fernandez Liguori N, Lazaro L, Zanga G, Parada Marcilla M, Fracaro ME, Pagani Cassara F, Vazquez G, Sinay V, Sgrilli G, Divi P, Jacobo M, Reich E, Cabrera LM, Menichini ML, Coppola M, Martos I, Viglione JP, Jose G, Bestoso S, Manzi R, Giunta D, Doldan ML, Alonso Serena M, Rojas JI. Aggressive multiple sclerosis in Argentina: Data from the nationwide registry RelevarEM. J Clin Neurosci 2021; 89:360-364. [PMID: 34088579 DOI: 10.1016/j.jocn.2021.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/09/2020] [Accepted: 05/23/2021] [Indexed: 11/16/2022]
Abstract
The objectives of the present study were to describe the frequency of aggressive multiple sclerosis (aMS) as well as to compare clinical and radiological characteristics in aMS and non-aMS patients included in RelevarEM (NCT03375177). METHODS The eligible study population and cohort selection included adult-onset patients (≥18 years) with definite MS. AMS were defined as those reaching confirmed EDSS ≥ 6 within 5 years from symptom onset. Confirmation was achieved when a subsequent EDSS ≥ 6 was recorded at least six months later but within 5 years of the first clinical presentation. AMS and non-aMS were compared using the χ2 test for categorical and the Mann-Whitney for continuous variables at MS onset and multivariable analysis was performed using forward stepwise logistic regression with baseline characteristics at disease onset. RESULTS A total of 2158 patients with MS were included: 74 aMS and 2084 non-aMS. The prevalence of aMS in our cohort was 3.4% (95%CI 2.7-4.2). AMS were more likely to be male (p = 0.003), older at MS onset (p < 0.001), have primary progressive MS (PPMS) phenotype (p = 0.03), multifocal presentation (p < 0.001), and spinal cord as well as infratentorial lesions at MRI during disease onset (p = 0.004 and p = 0.002, respectively). CONCLUSION 3.4% of our patient population could be considered aMS. Men, patients older at symptom onset, multifocal presentation, PPMS phenotype, and spinal cord as well as brainstem lesions on MRI at clinical presentation all had higher odds of having aMS.
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Affiliation(s)
| | | | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba, 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
| | | | | | | | - Marcela Fiol
- Departamento de Neurología - FLENI, CABA, Argentina
| | | | | | | | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina; Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, Argentina
| | - Judith Steinberg
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | | | - María C Curbelo
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Leila Cohen
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina; Sanatorio Güemes, CABA, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Cecilia Pita
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | | | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | - Maria E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Juan P Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | | | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Argentina
| | - Raúl Piedrabuena
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Instituto Lennox, Córdoba, Argentina
| | | | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología - Hospital Córdoba, Córdoba, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, San Miguel de Tucumán, Tucumán, Argentina
| | - Gabriel Volman
- Hospital Presidente Perón de Avellaneda, Buenos Aires, Argentina
| | | | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | - Dario Tavolini
- INECO Neurociencias Oroño - Fundación INECO, Rosario, Santa Fe, Argentina
| | | | | | | | - Emanuel Silva
- Predigma - Centro de Medicina Preventiva, Posadas, Misiones, Argentina
| | - Jorge Blanche
- IRNEC (Instituto Regional de Neurociencias), San Miguel de Tucumán, Argentina
| | | | | | | | | | | | - Gisela Zanga
- Unidad asistencial César Milstein, CABA, Argentina
| | | | | | | | - Guido Vazquez
- Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, Argentina
| | - Vladimiro Sinay
- Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, 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
| | - Edgardo Reich
- Servicio de Neurologia, Hospital Municipal Dr. Julio Méndez, CABA, Argentina
| | - Lorena M Cabrera
- Servicio de Neurología - Hospital Militar Central, CABA, Argentina; Hospital Militar Campo de Mayo, CABA, Argentina
| | | | - Mariano Coppola
- Servicio de Neurología, Hospital Ramón Santamarina, Tandil, Buenos Aires, Argentina
| | - Ivan Martos
- Clinica San Jorge, Ushuaia, Tierra del fuego, Argentina
| | | | - Gustavo Jose
- 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
| | | | - Diego Giunta
- Servicio de clínica médica, Hospital Italiano de Buenos Aires, CABA, Argentina
| | - Maria L Doldan
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina
| | | | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina.
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Iaffaldano P, Lucisano G, Butzkueven H, Hillert J, Hyde R, Koch-Henriksen N, Magyari M, Pellegrini F, Spelman T, Sørensen PS, Vukusic S, Trojano M. Early treatment delays long-term disability accrual in RRMS: Results from the BMSD network. Mult Scler 2021; 27:1543-1555. [PMID: 33900144 DOI: 10.1177/13524585211010128] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The optimal timing of treatment starts for achieving the best control on the long-term disability accumulation in multiple sclerosis (MS) is still to be defined. OBJECTIVE The aim of this study was to estimate the optimal time to start disease-modifying therapies (DMTs) to prevent the long-term disability accumulation in MS, using a pooled dataset from the Big Multiple Sclerosis Data (BMSD) network. METHODS Multivariable Cox regression models adjusted for the time to first treatment start from disease onset (in quintiles) were used. To mitigate the impact of potential biases, a set of pairwise propensity score (PS)-matched analyses were performed. The first quintile, including patients treated within 1.2 years from onset, was used as reference. RESULTS A cohort of 11,871 patients (median follow-up after treatment start: 13.2 years) was analyzed. A 3- and 12-month confirmed disability worsening event and irreversible Expanded Disability Status Scale (EDSS) 4.0 and 6.0 scores were reached by 7062 (59.5%), 4138 (34.9%), 3209 (31.1%), and 1909 (16.5%) patients, respectively. The risk of reaching all the disability outcomes was significantly lower (p < 0.0004) for the first quintile patients' group. CONCLUSION Real-world data from the BMSD demonstrate that DMTs should be commenced within 1.2 years from the disease onset to reduce the risk of disability accumulation over the long term.
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Affiliation(s)
- Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Lucisano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy/Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Helmut Butzkueven
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, VIC, Australia
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Nils Koch-Henriksen
- Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark
| | - Melinda Magyari
- Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark
| | | | - Tim Spelman
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, VIC, Australia/Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Soelberg Sørensen
- Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark
| | - Sandra Vukusic
- Neurology, Multiple Sclerosis, Myelin Disorders and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France/Observatoire Français de la Sclérose en Plaques (OFSEP), Lyon, France
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Sánchez RC, de la Fe AD, Suarez AP, Grass D, Vega TM, Canal AS, Siniscalco D, de Los Angeles Robinson Agramonte M. Interferon beta 1a (Rebif®) in relapsing remitting multiple sclerosis. Drug Dev Res 2021; 82:707-715. [PMID: 33586209 DOI: 10.1002/ddr.21798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/10/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune neurodegenerative disease that affects the central nervous system. It is the second cause of neurological disability in young adults. The exact cause of the disease remains unknown and there is no curative treatment. It is imperative to evaluate the efficacy of newest, biotechnological products modifying the disease. This study was designed to evaluate the use of interferon beta 1a (Rebif®) in patients with relapsing remitting MS treated at International Center for Neurological Restoration. Thirty-one patients with relapsing remitting MS, between 10 and 65 years of age, four males and 27 females, were treated with Rebif® three times per week during 1 year. The safety of the treatment was evaluated based on the adverse events and the efficacy based on the disability scale score, the number of attacks and the number of lesions at magnetic resonance imaging (MRI). The public clinical trial is registered in Cuba (Number B-10-030-L03). Adverse effects occurred in 75% of the cases, but they were mild. A significant reduction in the number of attacks, the disability scale score and the number of lesions at MRI were observed in patients with relapsing remitting MS treated with Rebif®. The use of interferon beta 1a showed safety and efficacy in the treatment of patients with relapsing remitting MS.
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Affiliation(s)
| | - Amado Díaz de la Fe
- Neuromuscular Diseases Clinic, International Center for Neurological Restoration, Habana, Cuba
| | - Alejandro Peláez Suarez
- Neuromuscular Diseases Clinic, International Center for Neurological Restoration, Habana, Cuba
| | - Dayme Grass
- Neuromuscular Diseases Clinic, International Center for Neurological Restoration, Habana, Cuba
| | - Teresa Morgado Vega
- Neuromuscular Diseases Clinic, International Center for Neurological Restoration, Habana, Cuba
| | - Armando Sánchez Canal
- Division of Neuromuscular Diseases Clinic, Abel Santamaria Cuadrado University Hospital, Pinar del Río, Cuba
| | - Dario Siniscalco
- Department of Experimental Medicine, Division of Biotechnology, Molecular Biology and Histology, University of Campania L. Vanvitelli, Naples, Italy
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Rollot F, Casey R, Leray E, Debouverie M, Edan G, Wiertlewski S, Vukusic S, Laplaud DA. Cumulative effects of therapies on disability in relapsing multiple sclerosis. Mult Scler 2021; 27:1760-1770. [DOI: 10.1177/1352458520980366] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Long-term effectiveness of treatment remains a key question in multiple sclerosis (MS) and the cumulative effects of past treatment have not been investigated so far. Objective: Explore the relationship between treatment exposure and disability risk in patients with relapsing-remitting multiple sclerosis (RRMS). Methods: A total of 2285 adult patients from the French nationwide cohort were included. Outcomes were irreversible EDSS4, and conversion to secondary progression of multiple sclerosis (SPMS). Associations between treatments and risk of disability were assessed using a novel weighted cumulative exposure model, assuming a 3-year lag to account for reverse causality. This flexible approach accounts for past exposure in a multivariate Cox proportional hazards model by computing a weight function. Results: At baseline, mean ± standard deviation age of patients was 33.4 ± 8.9 years and 75.0% were women. A 15-year continuous treatment starting 20 years ago was associated with a decrease in risk of 26% for irreversible EDSS4, and 34% for SPMS compared to a 5-year treatment starting 10 years ago. The risk of disability decreased with increasing duration of exposure to disease-modifying treatment (DMT). Conclusion: Long-term use of treatments in RRMS has a stronger beneficial cumulative impact than only early uses and delays the occurrence of moderate disability and conversion to SPMS.
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Affiliation(s)
- Fabien Rollot
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Bron, France; Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon, France; EUGENE DEVIC EDMUS Foundation, Bron, France
| | - Romain Casey
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Bron, France; Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon, France; EUGENE DEVIC EDMUS Foundation, Bron, France
| | - Emmanuelle Leray
- Univ Rennes/EHESP, REPERES – EA 7449, Rennes, France; CIC-P 1414, CHU Rennes, Rennes, France
| | - Marc Debouverie
- Département de Neurologie, CHU Nancy, Nancy, France; EA 4360 APEMAC, Université Lorraine, Nancy, France
| | - Gilles Edan
- CIC-P 1414, CHU Rennes, Rennes, France; Département de Neurologie, CHU Rennes, Rennes, France
| | - Sandrine Wiertlewski
- Département de Neurologie, CHU Nantes, Nantes, France; CIC Inserm 1415, CHU Nantes, Nantes, France
| | - Sandra Vukusic
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Bron, France; Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, INSERM 1028 et CNRS UMR 5292, Lyon, France; EUGENE DEVIC EDMUS Foundation, Bron, France
| | - David-Axel Laplaud
- Département de Neurologie, CHU Nantes, Nantes, France; CIC Inserm 1415, CHU Nantes, Nantes, France; Centre de Recherche en Transplantation et Immunologie, Inserm U1064, Nantes, France
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20
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Roos I, Leray E, Frascoli F, Casey R, Brown JWL, Horakova D, Havrdova EK, Trojano M, Patti F, Izquierdo G, Eichau S, Onofrj M, Lugaresi A, Prat A, Girard M, Grammond P, Sola P, Ferraro D, Ozakbas S, Bergamaschi R, Sá MJ, Cartechini E, Boz C, Granella F, Hupperts R, Terzi M, Lechner-Scott J, Spitaleri D, Van Pesch V, Soysal A, Olascoaga J, Prevost J, Aguera-Morales E, Slee M, Csepany T, Turkoglu R, Sidhom Y, Gouider R, Van Wijmeersch B, McCombe P, Macdonell R, Coles A, Malpas CB, Butzkueven H, Vukusic S, Kalincik T, Duquette P, Grand'Maison F, Iuliano G, Ramo-Tello C, Solaro C, Cabrera-Gomez JA, Rio ME, Bolaños RF, Shaygannejad V, Oreja-Guevara C, Sanchez-Menoyo JL, Petersen T, Altintas A, Barnett M, Flechter S, Fragoso Y, Amato MP, Moore F, Ampapa R, Verheul F, Hodgkinson S, Cristiano E, Yamout B, Laureys G, Dominguez JA, Zwanikken C, Deri N, Dobos E, Vrech C, Butler E, Rozsa C, Petkovska-Boskova T, Karabudak R, Rajda C, Alkhaboori J, Saladino ML, Shaw C, Shuey N, Vucic S, Sempere AP, Campbell J, Piroska I, Taylor B, van der Walt A, Kappos L, Roullet E, Gray O, Simo M, Sirbu CA, Brochet B, Cotton F, De Sèze J, Dion A, Douek P, Guillemin F, Laplaud D, Lebrun-Frenay C, Moreau T, Olaiz J, Pelletier J, Rigaud-Bully C, Stankoff B, Marignier R, Debouverie M, Edan G, Ciron J, Ruet A, Collongues N, Lubetzki C, Vermersch P, Labauge P, Defer G, Cohen M, Fromont A, Wiertlewsky S, Berger E, Clavelou P, Audoin B, Giannesini C, Gout O, Thouvenot E, Heinzlef O, Al-Khedr A, Bourre B, Casez O, Cabre P, Montcuquet A, Créange A, Camdessanché JP, Faure J, Maurousset A, Patry I, Hankiewicz K, Pottier C, Maubeuge N, Labeyrie C, Nifle C. Delay from treatment start to full effect of immunotherapies for multiple sclerosis. Brain 2020; 143:2742-2756. [DOI: 10.1093/brain/awaa231] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/30/2020] [Accepted: 06/01/2020] [Indexed: 01/21/2023] Open
Abstract
Abstract
In multiple sclerosis, treatment start or switch is prompted by evidence of disease activity. Whilst immunomodulatory therapies reduce disease activity, the time required to attain maximal effect is unclear. In this study we aimed to develop a method that allows identification of the time to manifest fully and clinically the effect of multiple sclerosis treatments (‘therapeutic lag’) on clinical disease activity represented by relapses and progression-of-disability events. Data from two multiple sclerosis registries, MSBase (multinational) and OFSEP (French), were used. Patients diagnosed with multiple sclerosis, minimum 1-year exposure to treatment, minimum 3-year pretreatment follow-up and yearly review were included in the analysis. For analysis of disability progression, all events in the subsequent 5-year period were included. Density curves, representing incidence of relapses and 6-month confirmed progression events, were separately constructed for each sufficiently represented therapy. Monte Carlo simulations were performed to identify the first local minimum of the first derivative after treatment start; this point represented the point of stabilization of treatment effect, after the maximum treatment effect was observed. The method was developed in a discovery cohort (MSBase), and externally validated in a separate, non-overlapping cohort (OFSEP). A merged MSBase-OFSEP cohort was used for all subsequent analyses. Annualized relapse rates were compared in the time before treatment start and after the stabilization of treatment effect following commencement of each therapy. We identified 11 180 eligible treatment epochs for analysis of relapses and 4088 treatment epochs for disability progression. External validation was performed in four therapies, with no significant difference in the bootstrapped mean differences in therapeutic lag duration between registries. The duration of therapeutic lag for relapses was calculated for 10 therapies and ranged between 12 and 30 weeks. The duration of therapeutic lag for disability progression was calculated for seven therapies and ranged between 30 and 70 weeks. Significant differences in the pre- versus post-treatment annualized relapse rate were present for all therapies apart from intramuscular interferon beta-1a. In conclusion we have developed, and externally validated, a method to objectively quantify the duration of therapeutic lag on relapses and disability progression in different therapies in patients more than 3 years from multiple sclerosis onset. Objectively defined periods of expected therapeutic lag allows insights into the evaluation of treatment response in randomized clinical trials and may guide clinical decision-making in patients who experience early on-treatment disease activity. This method will subsequently be applied in studies that evaluate the effect of patient and disease characteristics on therapeutic lag.
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Affiliation(s)
- Izanne Roos
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, Australia
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3050, Australia
| | - Emmanuelle Leray
- Rennes University, EHESP, REPERES (Pharmaco-epidemiology and Health services research) - EA 7449, Rennes, France
| | - Federico Frascoli
- Faculty of Science, Engineering and Technology, School of Science, Department of Mathematics, Swinburne University of Technology, Melbourne, 3122, Australia
| | - Romain Casey
- University of Lyon, Claude Bernard University Lyon 1, F-69000 Lyon, France
- Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, F-69677 Bron, France
- Observatoire Français de la Sclérose en Plaques, Lyon Neuroscience Research Centre, INSERM 1028 et CNRS UMR 5292, F-69003 Lyon, France
- EUGENE DEVIC EDMUS Foundation against multiple sclerosis, state-approved foundation, F-69677 Bron, France
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, 12808, Czech Republic
| | - Eva K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, 12808, Czech Republic
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, 70122, Italy
| | - Francesco Patti
- GF Ingrassia Department, University of Catania, Catania, 95123, Italy
- Policlinico G Rodolico, 95123, Catania, Italy
| | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, 41009, Spain
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d’Annunzio, 66100 Chieti, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla, Bologna, 40139, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alexandre Prat
- CHUM MS Center and Universite de Montreal, Montreal, H2L 4M1, Canada
| | - Marc Girard
- CHUM MS Center and Universite de Montreal, Montreal, H2L 4M1, Canada
| | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, 41100, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, 41100, Italy
| | | | | | - Maria José Sá
- Centro Hospitalar Universitário de São João and Universidade Fernando Pessoa, 4249-004 Porto, Portugal
| | - Elisabetta Cartechini
- UOC Neurologia, Azienda Sanitaria Unica Regionale Marche - AV3, Macerata, 62100, Italy
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Karadeniz Technical University, Trabzon, 61080, Turkey
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, 43126, Italy
- Department of General Medicine, Parma University Hospital, Parma, 43126, Italy
| | - Raymond Hupperts
- Zuyderland Ziekenhuis, Sittard, Sittard, 6131 BK, The Netherlands
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Kurupelit, Samsun, 55160, Turkey
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, 2308, Australia
- Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, 2305, Australia
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Contrada Amoretta, Avellino, 83100, Italy
| | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, 34142, Turkey
| | - Javier Olascoaga
- Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario Donostia, San San Sebastián, Spain, 20014, Spain
| | | | | | - Mark Slee
- Flinders University, Adelaide, 5042, Australia
| | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary
| | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Selimiye Mahallesi, Istanbul, 34668, Turkey
| | - Youssef Sidhom
- Department of Neurology, Razi Hospital, 2010, Tunis, Manouba, Tunisia
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, 2010, Tunis, Manouba, Tunisia
| | - Bart Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, 3900, Belgium
| | - Pamela McCombe
- University of Queensland, St Lucia, 4072, Australia
- Royal Brisbane and Women's Hospital, Herston, 4029, Australia
| | - Richard Macdonell
- Department of Neurology, Austin Health, Heidlberg, 3084, Australia
- Faculty of Medicine and Dental Health Sciences, University of Melbourne, Melbourne, 3050, Australia
| | - Alasdair Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Charles B Malpas
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, Australia
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3050, Australia
| | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, 3004, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, 3004, Australia
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, 3128, Australia
| | - Sandra Vukusic
- University of Lyon, Claude Bernard University Lyon 1, F-69000 Lyon, France
- Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, F-69677 Bron, France
- Observatoire Français de la Sclérose en Plaques, Lyon Neuroscience Research Centre, INSERM 1028 et CNRS UMR 5292, F-69003 Lyon, France
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, Australia
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3050, Australia
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21
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Villaverde-González R, Candeliere-Merlicco A, Alonso-Frías MA, Aparicio Castro E, Carrillo Alcaraz A, Mallada Frechín J, Pérez Sempere Á. Discontinuation of disease-modifying treatments in multiple sclerosis to plan a pregnancy: A retrospective registry study. Mult Scler Relat Disord 2020; 46:102518. [PMID: 32977075 DOI: 10.1016/j.msard.2020.102518] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND For safety reasons multiple sclerosis (MS) treatment guidelines recommend stopping or delaying the onset of disease-modifying therapies (DMT) before a planned pregnancy, but disease stability after DMT discontinuation is not well studied. The objective of this study is to describe the course of MS in patients who interrupted DMT before a planned pregnancy. METHODS This was a retrospective study using 2008-2016 data from a multicenter register of pregnancies in women with MS. In this paper, we present data from the subgroup of women with relapsing-remitting MS (RRMS) who interrupted DMT to try to conceive. Data from 1 and 3 years before DMT interruption, the period between DMT interruption and conception or resuming DMT, during pregnancy and one year postpartum were analyzed. Annualized relapse rates (ARR), Expanded Disability Status Scale (EDSS) scores, and magnetic resonance imaging (MRI), obstetric, and neonatal data were collected. RESULTS Twenty-seven women interrupted DMT (19 β-interferon, 5 glatiramer acetate, 2 natalizumab and 1 fingolimod) to try to conceive. After a mean of 10.6 months 6 women stopped trying to conceive and resumed DMT, while 21 women became pregnant after a mean of 7.0 months. In the overall cohort, in the period from when DMT was discontinued to when pregnancy was confirmed or DMT resumed, the ARR was 1.08, which was significantly higher than the ARR 1 year (0.44; p = 0.01) and 3 years (0.4; p = 0.06) before DMT discontinuation. The mean EDSS score when pregnancy was confirmed or DMT resumed was significantly higher than at DMT discontinuation (1.8 vs 1.36, p = 0.011). In the subgroup of patients who became pregnant, the ARR in the untreated period before pregnancy was 0.98, which was significantly higher than the ARR 1 year (0.38; p = 0.03) and 3 years (0.39; p = 0.0077) before DMT discontinuation. The ARR decreased to 0.51 during pregnancy and then increased to 0.76 during the first postpartum trimester (not significant). One year after delivery, the mean EDSS score (1.86) was significantly higher than at DMT cessation (1.35, p = 0.027) or pregnancy confirmation (1.45, p = 0.026). Patients who suffered relapses following DMT cessation before becoming pregnant had an 11-fold higher risk of relapse during pregnancy (relative risk [RR] = 11.1 [95%CI 1.6, 75], p = 0.002) and a 3-fold higher risk during the postpartum year (RR = 3.0 [95%CI 1.3,6.6], p = 0.007) than those who did not suffer relapses in period between DMT withdrawal and pregnancy. CONCLUSIONS In this retrospective registry study, discontinuation of DMT (mostly immunomodulatory drugs), to try to conceive resulted in an increase in MS relapse rates and disability progression.
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Affiliation(s)
| | | | | | | | - Andrés Carrillo Alcaraz
- Intensive Care Unit, Hospital General Universitario José María Morales Meseguer, Murcia, Spain.
| | | | - Ángel Pérez Sempere
- Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain.
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22
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Amato MP, Fonderico M, Portaccio E, Pastò L, Razzolini L, Prestipino E, Bellinvia A, Tudisco L, Fratangelo R, Comi G, Patti F, De Luca G, Brescia Morra V, Cocco E, Pozzilli C, Sola P, Bergamaschi R, Salemi G, Inglese M, Millefiorini E, Galgani S, Zaffaroni M, Ghezzi A, Salvetti M, Lus G, Florio C, Totaro R, Granella F, Vianello M, Gatto M, Di Battista G, Aguglia U, Logullo FO, Simone M, Lucisano G, Iaffaldano P, Trojano M. Disease-modifying drugs can reduce disability progression in relapsing multiple sclerosis. Brain 2020; 143:3013-3024. [DOI: 10.1093/brain/awaa251] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/30/2020] [Accepted: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
An ever-expanding number of disease-modifying drugs for multiple sclerosis have become available in recent years, after demonstrating efficacy in clinical trials. In the real-world setting, however, disease-modifying drugs are prescribed in patient populations that differ from those included in pivotal studies, where extreme age patients are usually excluded or under-represented. In this multicentre, observational, retrospective Italian cohort study, we evaluated treatment exposure in three cohorts of patients with relapsing-remitting multiple sclerosis defined by age at onset: paediatric-onset (≤18 years), adult-onset (18–49 years) and late-onset multiple sclerosis (≥50 years). We included patients with a relapsing-remitting phenotype, ≥5 years follow-up, ≥3 Expanded Disability Status Scale (EDSS) evaluations and a first neurological evaluation within 3 years from the first demyelinating event. Multivariate Cox regression models (adjusted hazard ratio with 95% confidence intervals) were used to assess the risk of reaching a first 12-month confirmed disability worsening and the risk of reaching a sustained EDSS of 4.0. The effect of disease-modifying drugs was assessed as quartiles of time exposure. We found that disease-modifying drugs reduced the risk of 12-month confirmed disability worsening, with a progressive risk reduction in different quartiles of exposure in paediatric-onset and adult-onset patients [adjusted hazard ratios in non-exposed versus exposed >62% of the follow-up time: 8.0 (3.5–17.9) for paediatric-onset and 6.3 (4.9–8.0) for adult-onset, P < 0.0001] showing a trend in late-onset patients [adjusted hazard ratio = 1.9 (0.9–4.1), P = 0.07]. These results were confirmed for a sustained EDSS score of 4.0. We also found that relapses were a risk factor for 12-month confirmed disability worsening in all three cohorts, and female sex exerted a protective role in the late-onset cohort. This study provides evidence that sustained exposure to disease-modifying drugs decreases the risk of disability accumulation, seemingly in a dose-dependent manner. It confirms that the effectiveness of disease-modifying drugs is lower in late-onset patients, although still detectable.
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Affiliation(s)
- Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Emilio Portaccio
- SOC Neurologia, Ospedale San Giovanni di Dio, AUSL Toscana Centro1, Florence, Italy
| | - Luisa Pastò
- Department NEUROFARBA, University of Florence, Florence, Italy
| | | | - Elio Prestipino
- Department NEUROFARBA, University of Florence, Florence, Italy
| | | | - Laura Tudisco
- Department NEUROFARBA, University of Florence, Florence, Italy
| | | | - Giancarlo Comi
- San Raffaele Hospital - INSPE; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, University of Catania, Catania, Sicily, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS Annunziata, Università ‘G. d'Annunzio’, Chieti-Pescara, Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Napoli, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla, ASSL Cagliari (ATS Sardegna); Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, S. Andrea Hospital, Dept. of Human Neuroscience, Sapienza University, Rome, Italy
| | - Patrizia Sola
- Centro Malattie Demielinizzanti - Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria/OCSAE, UO Neurologia, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Sicily, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Enrico Millefiorini
- Multiple Sclerosis Center, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Simonetta Galgani
- multiple sclerosis Centre, Department of Neurosciences, S. Camillo - Forlanini Hospital, Rome, Italy
| | - Mauro Zaffaroni
- ASST della Valle Olona, Multiple Sclerosis Center, S. Antonio Abate Hospital of Gallarate, Gallarate, Italy
| | - Angelo Ghezzi
- ASST della Valle Olona, Multiple Sclerosis Center, S. Antonio Abate Hospital of Gallarate, Gallarate, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, S. Andrea Hospital/Sapienza University, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Rome, Italy
| | - Giacomo Lus
- Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Ciro Florio
- Multiple Sclerosis Center, Cardarelli Hospital, Naples, Italy
| | - Rocco Totaro
- Demyelinating Diseases Center, Department of Neurology, San Salvatore Hospital, L'Aquila, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Italy
| | - Marika Vianello
- Centro Sclerosi Multipla - Ospedale Regionale ‘Ca’ Foncello', Neurology Unit, Treviso, Italy
| | - Maurizia Gatto
- Ospedale Generale Regionale ‘F. Miulli’, Neurology Unit, Acquaviva delle Fonti (BA), Italy
| | | | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Neurology Unit, Catanzaro, Italy
| | | | - Marta Simone
- Child Neuropsychiatric Unit, Department of Biomedical Sciences and Human Oncology, University ‘Aldo Moro’ of Bari, Policlinico Piazza G. Cesare, 11, 70121, Bari, Italy
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari ‘Aldo Moro’ Policlinico, Bari, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari ‘Aldo Moro’ Policlinico, Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari ‘Aldo Moro’ Policlinico, Bari, Italy
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23
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Buron MD, Chalmer TA, Sellebjerg F, Barzinji I, Danny B, Christensen JR, Christensen MK, Hansen V, Illes Z, Jensen HB, Kant M, Papp V, Petersen T, Prakash S, Rasmussen PV, Schäfer J, Theódórsdóttir Á, Weglewski A, Sorensen PS, Magyari M. Initial high-efficacy disease-modifying therapy in multiple sclerosis: A nationwide cohort study. Neurology 2020; 95:e1041-e1051. [PMID: 32636328 DOI: 10.1212/wnl.0000000000010135] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/16/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the effectiveness of high-efficacy disease-modifying therapies (heDMTs) vs medium-efficacy disease-modifying therapies (meDMT) as the first treatment choice in treatment-naive patients with multiple sclerosis (MS) on disability worsening and relapses. We assessed this using a nationwide population-based MS registry. METHODS We identified all patients starting a heDMT as first-time treatment from the Danish Multiple Sclerosis Registry and compared treatment outcomes with a propensity score matched sample of patients starting meDMT. RESULTS We included 388 patients in the study: 194 starting initial therapy with heDMT matched to 194 patients starting meDMT. At 4 years of follow-up, the probabilities of a 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening were 16.7% (95% confidence interval [CI] 10.4%-23.0%) and 30.1% (95% CI 23.1%-37.1%) for heDMT and meDMT initiators, respectively (hazard ratio [HR] 0.53, 95% CI 0.33-0.83, p = 0.006). Patients initiating heDMT also had a lower probability of a first relapse (HR 0.50, 95% CI 0.37-0.67). Results were similar after pairwise censoring and in subgroups with high baseline activity, diagnosis after 2006, or information on baseline T2 lesion load. CONCLUSION We found a lower probability of 6-month confirmed EDSS score worsening and lower probability of a first relapse in patients starting a heDMT as first therapy, compared to a matched sample starting meDMT. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for patients with MS, starting heDMT lowers the risk of EDSS worsening and relapses compared to starting meDMT.
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Affiliation(s)
- Mathias Due Buron
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark.
| | - Thor Ameri Chalmer
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Finn Sellebjerg
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Ismael Barzinji
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | | | - Jeppe Romme Christensen
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Mette Kirstine Christensen
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Victoria Hansen
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Zsolt Illes
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Henrik Boye Jensen
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Matthias Kant
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Viktoria Papp
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Thor Petersen
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | | | - Peter Vestergaard Rasmussen
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Jakob Schäfer
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Ásta Theódórsdóttir
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Arkadiusz Weglewski
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Per Soelberg Sorensen
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
| | - Melinda Magyari
- From the Danish Multiple Sclerosis Registry (M.D.B., T.A.C., M.M.) and Danish Multiple Sclerosis Center (M.D.B., T.A.C., F.S., J.R.C., R.C., P.S.S., M.M.), Department of Neurology, Rigshospitalet; Department of Neurology (I.B., V.H., J.S.), Aalborg University Hospital; Department of Neurology (M.K.C., T.P., P.V.R.), Aarhus University Hospital; Department of Neurology (Z.I., V.P., Á.T.), Odense University Hospital; Brain and Nerve Diseases (H.B.J.), Lillebaelt Hospital, Kolding; Institute of Regional Health Research (H.B.J.), University of Southern Denmark, Odense; Department of Neurology (M.K.), Hospital of Southern Jutland, Sønderborg; and Department of Neurology (A.W.), Herlev Hospital, Denmark
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Zheng Y, Cai MT, Yang F, Zhou JP, Fang W, Shen CH, Zhang YX, Ding MP. IgG Index Revisited: Diagnostic Utility and Prognostic Value in Multiple Sclerosis. Front Immunol 2020; 11:1799. [PMID: 32973754 PMCID: PMC7468492 DOI: 10.3389/fimmu.2020.01799] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022] Open
Abstract
Objective: Early and accurate diagnosis of multiple sclerosis (MS) remains a clinical challenge. The main objective is to evaluate the diagnostic and prognostic value of the routinely performed immunoglobulin G (IgG) index for MS patients in the Asian population. Methods: A retrospective study was conducted among a cohort of clinically isolated syndrome (CIS) patients in China with known oligoclonal band (OCB) status and IgG index at baseline. We first evaluated the predictive value of IgG index for OCB status. Secondly, the diagnostic utility and prognostic value of IgG index alone were tested. Lastly, we incorporated IgG index into the 2017 McDonald criteria by replacing OCB with either “IgG index or OCB” (modified criteria 1), “IgG index and OCB” (modified criteria 2), or “IgG index” (modified criteria 3). The diagnostic utility of different criteria was calculated and compared. Results: In a CIS cohort in China (n = 105), IgG index > 0.7 forecasted OCB positivity (X2 = 22.90, P < 0.001). An elevated IgG index was highly prognostic of more clinical relapses [1-year adjusted odds ratio [OR] = 1.32, P = 0.015; 2-years adjusted OR = 1.69, P = 0.013] and Expanded Disability Status Scale worsening (1-year adjusted OR = 1.76, P = 0.040; 2-years adjusted OR = 1.85, P = 0.032). Under the 2017 McDonald criteria (Positive Likelihood Ratio = 1.54, Negative Likelihood Ratio = 0.56), an IgG index > 0.7 in CIS patients increased the likelihood of developing MS within 2 years, either when OCB status was unknown (Positive Likelihood Ratio = 2.11) or with OCB positivity (Positive Likelihood Ratio = 2.11) at baseline; An IgG index ≤ 0.7, along with a negative OCB, helped rule out the MS diagnosis (Negative Likelihood Ratio = 0.53). Conclusions: IgG index > 0.7 predicts OCB positivity at the initial attack of MS and is prognostic of early disease activity. IgG index serves as an easily-obtainable and accurate OCB surrogate for MS diagnosis in the Asian population.
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Affiliation(s)
- Yang Zheng
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Meng-Ting Cai
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Fan Yang
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Ji-Ping Zhou
- Harvard University School of Public Health, Boston, MA, United States
| | - Wei Fang
- Department of Neurology, School of Medicine, Fourth Affiliated Hospital, Zhejiang University, Yiwu, China
| | - Chun-Hong Shen
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yin-Xi Zhang
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Mei-Ping Ding
- Department of Neurology, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
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Sorensen PS, Sellebjerg F, Hartung HP, Montalban X, Comi G, Tintoré M. The apparently milder course of multiple sclerosis: changes in the diagnostic criteria, therapy and natural history. Brain 2020; 143:2637-2652. [DOI: 10.1093/brain/awaa145] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 02/06/2023] Open
Abstract
Abstract
In the past decade, changes have occurred in the spectrum of multiple sclerosis courses. The natural history of multiple sclerosis appears milder from the first sign of demyelinating disease to the progressive course, probably as a result of an interplay between several factors including changes in the diagnostic criteria, changes in the epidemiology of multiple sclerosis, impact of early and appropriate disease-modifying treatment and improvement of the general state of health in the population. It has been suggested to regard incidental findings of demyelinating lesions in MRI in individuals without any history of clinical symptoms consistent with neurological dysfunction, so-called radiological isolated syndrome, as the initial course of multiple sclerosis. New diagnostic criteria have enabled the multiple sclerosis diagnosis in many patients at the first clinical demyelinating event, clinically isolated syndrome. The remaining patients with clinically isolated syndrome have a more benign prognosis, and for relapsing-remitting multiple sclerosis, the prognosis has become more favourable. Reduced disease activity in patients with relapsing-remitting multiple sclerosis can partly be ascribed to more efficacious new disease-modifying therapies but decrease in disease activity has also be seen in placebo-treated patients in clinical trials. This may be explained by several factors: change in the diagnostic criteria, more explicit inclusion criteria, exclusion of high-risk patients e.g. patients with co-morbidities, and more rigorous definitions of relapses and disease worsening. However, these factors also make the disease course in patients treated with disease-modifying therapies seem more favourable. In addition, change in the therapeutic target to stable disease (no evidence of disease activity = no relapses, no disease worsening and no MRI activity) could by itself change the course in relapsing-remitting multiple sclerosis. The effectiveness of disease-modifying drugs has reduced the transition from relapsing-remitting to secondary progressive multiple sclerosis. The concept of progressive multiple sclerosis has also evolved from two very distinct categories (primary progressive and secondary progressive multiple sclerosis) to a unified category of progressive multiple sclerosis, which can then be split into the categories of active or inactive. Also, an increasing tendency to treat progressive multiple sclerosis with disease-modifying therapies may have contributed to change the course in progressive multiple sclerosis. In conclusion, during the past decade the entire course of multiple sclerosis from the first sign of a demyelinating disorder through the progressive course appears to be milder due to a complex interplay of several factors.
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Affiliation(s)
- Per Soelberg Sorensen
- Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, University of Copenhagen and Rigshospitalet, Copenhagen, Denmark
| | - Hans-Peter Hartung
- Department of Neurology, University Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Xavier Montalban
- Department of Neurology, Hospital General Universitari Vall D’Hebron, Cemcat, Barcelona, Spain
- Division of Neurology, University of Toronto, St. Michael’s Hospital, Toronto, Canada
| | - Giancarlo Comi
- Department of Neurology and Institute of Experimental Neurology, San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mar Tintoré
- Department of Neurology, Hospital General Universitari Vall D’Hebron, Cemcat, Barcelona, Spain
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26
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Kopp TI, Blinkenberg M, Petersen T, Sorensen PS, Magyari M. Long term effect of delayed treatment on disability in patients with paediatric onset multiple sclerosis: A prospective Danish cohort study. Mult Scler Relat Disord 2020; 40:101956. [DOI: 10.1016/j.msard.2020.101956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/20/2019] [Accepted: 01/17/2020] [Indexed: 01/03/2023]
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de Seze J, Bigaut K. Do disease-modifying drugs (DMD) have a positive impact on the occurrence of secondary progressive multiple sclerosis? Yes. Rev Neurol (Paris) 2020; 176:497-499. [PMID: 32265072 DOI: 10.1016/j.neurol.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/12/2019] [Indexed: 11/19/2022]
Abstract
During the 20 past years, the management of multiple sclerosis (MS) has largely changed especially concerning therapeutical approach. Before 1996, treatments were restricted to corticosteroids for relapses, several symptomatic treatments and unselective immunosuppressive drugs (azathioprine, cyclophosphamide, methotrexate) with a low evidence of any efficacy. In the present review, we analyze the principal real-life cohorts of MS during several periods (before therapeutical modern area, first-generation treatment area and most recent period). Despite many methodological problems, we observe globally a delay of around 3-5 years between untreated cohorts and first-generation treatments for going to EDSS 6 which is probably the most robust score. This delay is clearly increase to at least 15 years with the most recent cohort treated first and second-line treatments confirming that early and more intensive treatment are necessary to have a long-term efficacy on disability progression and especially on severe disability represent by EDSS 6. Larger cohorts with longer follow-up is necessary to confirm these tendencies and OFSEP observatory or MS base will probably provide us the possibility to conclude in a couple of years.
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Affiliation(s)
- J de Seze
- MS Clinic, CHU de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - K Bigaut
- MS Clinic, CHU de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
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28
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Beiki O, Frumento P, Bottai M, Manouchehrinia A, Hillert J. Changes in the Risk of Reaching Multiple Sclerosis Disability Milestones In Recent Decades: A Nationwide Population-Based Cohort Study in Sweden. JAMA Neurol 2020; 76:665-671. [PMID: 30882868 DOI: 10.1001/jamaneurol.2019.0330] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Clinicians' experience and findings from recent natural history studies suggest that multiple sclerosis (MS) may now be running a more slowly progressing course than before. Objective To investigate whether the risk of reaching MS disability milestones has changed over the last decade in Sweden. Design, Setting, and Participants A nationwide population-based retrospective cohort study. By April 2017, 12 512 patients with available information on demographics, MS phenotype, and date of MS onset and diagnosis were registered in the Swedish MS Registry of which 7331 patients with at least 2 recorded Expanded Disability Status Scale scores (EDSS) and diagnosed between January 1995 and December 2010 were included. No further exclusion criteria were applied. Patients were followed up until December 2016 with a median duration follow-up of 8.5 (interquartile range, 4.7-13.8) years. Statistical analysis began in April 2017. Main Outcomes and Measures Patients were followed up from MS onset date to the date of sustained EDSS 3.0, 4.0, and 6.0. To handle interval-censored observations, a Weibull model was fit, and the change in the risk of EDSS 3.0, 4.0, and 6.0 over calendar years was estimated and hazard ratios (HRs) with corresponding CIs were calculated. Results Of 7331 patients, 5196 (70.9%) were women, and the mean (SD) age at diagnosis was 38.3 (11.7) years. Adjusting for sex, number of clinic visits, diagnostic delay, and onset age, a 3% decrease per calendar year of diagnosis for the risk of sustained EDSS 3.0 (HR, 0.97; 95% CI, 0.96-0.97), a 6% decrease for the risk of EDSS 4.0 (HR, 0.94; 95% CI, 0.93-0.95), and a 7% decrease for the risk of EDSS 6.0 (HR, 0.93; 95% CI, 0.91-0.94) among patients with relapsing-onset MS was found. The trends were not significant for patients with progressive-onset MS (EDSS 3.0: HR, 1.01; 95% CI, 0.98-1.03; EDSS 4.0: HR, 1.00; 95% CI, 0.98-1.02; EDSS 6.0: HR, 1.00; 95% CI, 0.98-1.02). Conclusions and Relevance Risk of reaching major disability milestones has significantly decreased over the last decade in patients with relapsing-onset MS in Sweden. Several factors could potentially be responsible for this observation. However, given that no change was seen in disability accrual of patients with progressive-onset MS and the absence of efficacious treatment option in this group, increased use of more efficacious disease-modifying treatments could be a possible driver of this change.
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Affiliation(s)
- Omid Beiki
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Cognizant Technology Solutions, Stockholm, Sweden.,Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Paolo Frumento
- Institute of Environmental Medicine, Unit of Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Institute of Environmental Medicine, Unit of Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ali Manouchehrinia
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Mallucci G, Patti F, Brescia Morra V, Buccafusca M, Moiola L, Amato MP, Ferraro E, Trojano M, Zaffaroni M, Mirabella M, Moscato G, Plewnia K, Zipoli V, Puma E, Bergamaschi R. A method to compare prospective and historical cohorts to evaluate drug effects. Application to the analysis of early treatment effectiveness of intramuscular interferon-β1a in multiple sclerosis patients. Mult Scler Relat Disord 2020; 40:101952. [PMID: 32007656 DOI: 10.1016/j.msard.2020.101952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Disease modifying therapy have changed the natural evolution of multiple sclerosis (MS), with efficacy demonstrated in randomized clinical trials. Standard-of-care effectiveness is needed to complement clinical trial data and highlight outcomes in real-world practice, but comparing prospective patients with historical cohorts likely introduces biases. To address these potential biases, assigning a patient with a score that expresses his/her disease prognosis before starting a therapy may make it possible to evaluate the unbiased ability of the therapy to modify disease natural history. Thus, we aimed at analyzing the effectiveness of intramuscular interferon-β1a (im IFN-β1a) matching by BREMSO score (Bayesian Risk Estimate for Multiple Sclerosis at Onset) a prospective real-world cohort of treated patients with a historical cohort of untreated patients. MATERIAL AND METHODS We observed 108 newly diagnosed, treatment naïve MS patients over 12 months of treatment with im IFN-β1a. BREMSO score was used to assign a value to each patient, giving the real-world treated patients comparable with the Historical untreated patients, on the basis of the same risk to have unfavorable evolution. RESULTS A significantly higher percentage of relapse-free patients is observed in IFN-β1a treated cohort vs. Historical untreated cohort (79.6% vs. 59.3%, p < 0.01). Clinical relapses risk is reduced by 2.2 times in treated patients (p = 0.01). CONCLUSIONS We propose a promising method to manage observational data in a relatively unbiased way, in order to analyze real-world treatment effectiveness.
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Affiliation(s)
- Giulia Mallucci
- IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | | | - Vincenzo Brescia Morra
- University of Naples Federico II, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Naples, Italy
| | - Maria Buccafusca
- University Hospital of Messina, Department of Clinical and Experimental Medicine, Messina, Italy
| | - Lucia Moiola
- IRCCS San Raffaele Scientific Institute, Neurology Unit, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Maria Trojano
- University of Bari, Department of Basic Medical Sciences, Neurosciences and Sense Organs, Bari, Italy
| | - Mauro Zaffaroni
- ASST della Valle Olona, Hospital of Gallarate, Multiple Sclerosis Center, Italy
| | - Massimiliano Mirabella
- Fondazione Policlinico Universitario A. Gemelli IRCCS; Università Cattolica del Sacro Cuore
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Cristiano E, Rojas JI, Alonso R, Alvez Pinheiro A, Bacile EA, Balbuena ME, Barboza AG, Bestoso S, Burgos M, Cáceres F, Carnero Contentti E, Curbelo MC, Deri N, Fernandez Liguori N, Gaitán MI, Garcea O, Giunta D, Halfon MJ, Hryb JP, Jacobo M, Kohler E, Luetic GG, Maglio I, Martínez AD, Míguez J, Nofal PG, Patrucco L, Piedrabuena R, Rotta Escalante R, Saladino ML, Silva BA, Sinay V, Tkachuk V, Villa A, Vrech C, Ysrraelit MC, Correale J. Consensus recommendations on the management of multiple sclerosis patients in Argentina. J Neurol Sci 2020; 409:116609. [DOI: 10.1016/j.jns.2019.116609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
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Abstract
Personalized treatment is ideal for multiple sclerosis (MS) owing to the heterogeneity of clinical features, but current knowledge gaps, including validation of biomarkers and treatment algorithms, limit practical implementation. The contemporary approach to personalized MS therapy depends on evidence-based prognostication, an initial treatment choice and evaluation of early treatment responses to identify the need to switch therapy. Prognostication is directed by baseline clinical, environmental and demographic factors, MRI measures and biomarkers that correlate with long-term disability measures. The initial treatment choice should be a shared decision between the patient and physician. In addition to prognosis, this choice must account for patient-related factors, including comorbidities, pregnancy planning, preferences of the patients and their comfort with risk, and drug-related factors, including safety, cost and implications for treatment sequencing. Treatment response has traditionally been assessed on the basis of relapse rate, MRI lesions and disability progression. Larger longitudinal data sets have enabled development of composite outcome measures and more stringent standards for disease control. Biomarkers, including neurofilament light chain, have potential as early surrogate markers of prognosis and treatment response but require further validation. Overall, attainment of personalized treatment for MS is complex but will be refined as new data become available.
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Affiliation(s)
- Dalia Rotstein
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Xavier Montalban
- Division of Neurology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. .,Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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Rojas JI, Pappolla A, Patrucco L, Cristiano E, Sánchez F. Do clinical trials for new disease modifying treatments include real world patients with multiple sclerosis? Mult Scler Relat Disord 2020; 39:101931. [PMID: 31924592 DOI: 10.1016/j.msard.2020.101931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 01/31/2023]
Abstract
We often see that clinical and demographic characteristics of real-world studies (RWS) do not differ from patients included in randomized controlled trials (RCT). OBJECTIVE to compare clinical and demographic aspects of patients included in RCT and RWS that evaluated new disease modifying treatment in multiple sclerosis (MS). METHODS a systematic non-language-restricted literature search of RCT and RWS that evaluated new disease modifying treatments (natalizumab, alemtuzumab, ocrelizumab, fingolimod, teriflunomide, dimethyl fumarate and cladribine) from January 2005 to January 2019. Demographic and clinical data were extracted, described and compared. RESULTS 18 RCT and 73 RWS were included. We found no differences in clinical and demographic aspects between RCT and RWS except in the frequency of naïve patients included in RCT vs. RWS 65.6% (95%CI 52-74) vs. 36.4% (95%CI 21-46), respectively, (p = 0.013) at study entry, as well as for the inclusion of patients that used previous treatment 34.4% (95%CI 22-41) vs. 63.6% (95%CI 53-74) in RCT and RWS, respectively,(p = 0.007) at study entry. CONCLUSION We did not observe significant differences in most clinical and demographic aspects of included patients in RCT and RWS. Studies that include the full spectrum of MS patients followed in clinical practice are needed.
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Affiliation(s)
- Juan Ignacio Rojas
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina.
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Francisco Sánchez
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
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Freedman MS, Comi G, Coyle PK, Aldridge J, Chen L, Marhardt K, Kappos L. No evidence of disease activity status in patients treated with early vs. delayed subcutaneous interferon β-1a. Mult Scler Relat Disord 2019; 39:101891. [PMID: 31864098 DOI: 10.1016/j.msard.2019.101891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/27/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Clinically isolated syndrome (CIS) is defined as a monophasic clinical episode highly suggestive of multiple sclerosis (MS). Regardless, studies have shown that treatment at this early stage of MS can delay a second event and prolong the transition to clinically diagnosed MS. The objective of this post-hoc analysis was to determine the effect of early CIS treatment with once weekly (qw) or three times weekly (tiw) subcutaneous interferon (scIFN) β-1a vs. delayed treatment (DT) on the composite endpoint of no evidence of disease activity (NEDA)-3. METHODS In REFLEX, patients with CIS were randomized to double-blind scIFN β-1a 44 µg tiw, qw, or placebo for 24 months. Upon clinically-definite MS, patients switched to open-label scIFN β-1a tiw. Patients who completed REFLEX entered an extension (REFLEXION). Patients initially randomized to placebo switched to tiw (DT); scIFN β-1a patients continued their initial qw/tiw regimen for up to 60-months post-randomization. This post-hoc analysis was conducted in the integrated intent-to-treat REFLEX plus REFLEXION population (tiw, n = =171; qw, n = =175; DT, n = =171). All p values are nominal. CIS was defined using the McDonald 2010 criteria. RESULTS Patients receiving early treatment (ET) with scIFN β-1a tiw and qw were more likely to achieve NEDA-3 than DT at year 2 (tiw vs. DT: OR 4.26, 95% CI 2.02-8.98, p = =0.0001; qw vs. DT: OR 2.99, 95% CI 1.39-6.43, p = =0.005). Compared with DT, ET with scIFN β-1a tiw was more likely to achieve NEDA-3 at year 3 (OR 3.73, 95% CI 1.63-8.55, p = =0.002) and year 5 (OR 12.96, 95% CI 1.66-101.04, p = =0.015). Between ET regimens, the odds of achieving NEDA-3 were not significantly improved by scIFN β-1a 44 µg tiw at year 2 (OR 1.42, 95% CI 0.81-2.50, p = =0.22) but were at year 3 (OR 2.26, 95% CI 1.11-4.60, p = =0.024) and year 5 (OR 3.22, 95% CI 1.01-10.22, p = =0.048), indicating that the beneficial effects of more frequent scIFN β-1a dosing become more apparent over time in patients with CIS. In the subgroup of patients with Gd+ lesions at baseline the odds for achieving NEDA-3 were higher for ET up to year 2 compared with DT (tiw: OR 10.21, 95% CI 1.23-84.82, p = =0.03; qw: OR 8.97, 95% CI 1.08-74.28, p = =0.04). In patients without Gd+ lesions at baseline, those receiving ET were more likely to achieve NEDA-3 at year 2 (OR 3.56, 95% CI 1.56-8.10, p = =0.003), year 3 (OR 2.54, 95% CI 1.05-6.18, p = =0.04) and year 5 (OR 9.63, 95% CI 1.19-77.79, p = =0.034) than patients who received DT. CONCLUSIONS ET with scIFN β-1a tiw was associated with a higher likelihood of achieving NEDA-3 not only at 2 but also at 3 and 5 years.
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Affiliation(s)
- Mark S Freedman
- University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8l6, Canada.
| | - Giancarlo Comi
- Università Vita Salute San Raffaele, Ospedale San Raffaele, Milan, Italy.
| | | | | | | | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Clinical Research and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland.
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Abstract
Interferon beta (IFNβ) was the first disease-modifying therapy available to treat multiple sclerosis (MS), providing patients with a treatment that resulted in reduced relapse rates and delays in the onset of disability. Four IFNβ drugs are currently approved to treat relapsing forms of MS: subcutaneous (SC) IFNβ-1b, SC IFNβ-1a, intramuscular IFNβ-1a, and, most recently, SC peginterferon beta-1a. Peginterferon beta-1a has an extended half-life and requires less frequent administration than other available treatments (once every 2 weeks vs every other day, 3 times per week, or weekly). Large randomized controlled clinical trials have confirmed the efficacy of interferons for the treatment of relapsing MS. The most frequent adverse events in patients receiving IFNs include injection site reactions and flu-like symptoms. Patient education and mitigation strategies are key to managing these adverse events and supporting therapy adherence. With fewer injections needed, peginterferon beta-1a is associated with less frequent discomfort, which may translate to improved adherence, a major factor in treatment efficacy. Because the available interferon therapies differ in administration route and frequency of injection, switching among these therapies may be a viable option for patients who experience issues with tolerability. Although a variety of disease-modifying therapies are now available to treat relapsing MS, the efficacy and long-term safety profile of interferons make them an important first-line option for treatment.
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Abstract
Multiple sclerosis is a chronic autoimmune disease of the central nervous system that results in varying degrees of disability. Progressive multiple sclerosis, characterized by a steady increase in neurological disability independently of relapses, can occur from onset (primary progressive) or after a relapsing-remitting course (secondary progressive). As opposed to active inflammation seen in the relapsing-remitting phases of the disease, the gradual worsening of disability in progressive multiple sclerosis results from complex immune mechanisms and neurodegeneration. A few anti-inflammatory disease-modifying therapies with a modest but significant effect on measures of disease progression have been approved for the treatment of progressive multiple sclerosis. The treatment effect of anti-inflammatory agents is particularly observed in the subgroup of patients with younger age and evidence of disease activity. For this reason, a significant effort is underway to develop molecules with the potential to induce myelin repair or halt the degenerative process. Appropriate trial methodology and the development of clinically meaningful disability outcome measures along with imaging and biological biomarkers of progression have a significant impact on the ability to measure the efficacy of potential medications that may reverse disease progression. In this issue, we will review current evidence on the physiopathology, diagnosis, measurement of disability, and treatment of progressive multiple sclerosis.
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Affiliation(s)
- Gabrielle Macaron
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Rommer PS, Milo R, Han MH, Satyanarayan S, Sellner J, Hauer L, Illes Z, Warnke C, Laurent S, Weber MS, Zhang Y, Stuve O. Immunological Aspects of Approved MS Therapeutics. Front Immunol 2019; 10:1564. [PMID: 31354720 PMCID: PMC6637731 DOI: 10.3389/fimmu.2019.01564] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 06/24/2019] [Indexed: 12/21/2022] Open
Abstract
Multiple sclerosis (MS) is the most common neurological immune-mediated disease leading to disability in young adults. The outcome of the disease is unpredictable, and over time, neurological disabilities accumulate. Interferon beta-1b was the first drug to be approved in the 1990s for relapsing-remitting MS to modulate the course of the disease. Over the past two decades, the treatment landscape has changed tremendously. Currently, more than a dozen drugs representing 1 substances with different mechanisms of action have been approved (interferon beta preparations, glatiramer acetate, fingolimod, siponimod, mitoxantrone, teriflunomide, dimethyl fumarate, cladribine, alemtuzumab, ocrelizumab, and natalizumab). Ocrelizumab was the first medication to be approved for primary progressive MS. The objective of this review is to present the modes of action of these drugs and their effects on the immunopathogenesis of MS. Each agent's clinical development and potential side effects are discussed.
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Affiliation(s)
- Paulus S. Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ron Milo
- Department of Neurology, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - May H. Han
- Neuroimmunology Division, Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Sammita Satyanarayan
- Neuroimmunology Division, Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Johann Sellner
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität, Munich, Germany
| | - Larissa Hauer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Clemens Warnke
- Department of Neurology, Medical Faculty, University of Köln, Cologne, Germany
| | - Sarah Laurent
- Department of Neurology, Medical Faculty, University of Köln, Cologne, Germany
| | - Martin S. Weber
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
- Department of Neurology, University Medical Center, Göttingen, Germany
| | - Yinan Zhang
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Olaf Stuve
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität, Munich, Germany
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Neurology Section, VA North Texas Health Care System, Medical Service Dallas, VA Medical Center, Dallas, TX, United States
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Lorefice L, Murgia F, Fenu G, Frau J, Coghe G, Murru MR, Tranquilli S, Visconti A, Marrosu MG, Atzori L, Cocco E. Assessing the Metabolomic Profile of Multiple Sclerosis Patients Treated with Interferon Beta 1a by 1H-NMR Spectroscopy. Neurotherapeutics 2019; 16:797-807. [PMID: 30820880 PMCID: PMC6694336 DOI: 10.1007/s13311-019-00721-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Metabolomic research has emerged as a promising approach to identify potential biomarkers in multiple sclerosis (MS). The aim of the present study was to determine the effect of interferon beta (IFN ß) on the metabolome of MS patients to explore possible biomarkers of disease activity and therapeutic response. Twenty-one MS patients starting IFN ß therapy (Rebif® 44 μg; s.c. 3 times per week) were enrolled. Blood samples were obtained at baseline and after 6, 12, and 24 months of IFN ß treatment and were analyzed by high-resolution nuclear magnetic resonance spectroscopy. Changes in metabolites were analyzed. After IFN ß exposure, patients were divided into responders and nonresponders according to the "no evidence of disease activity" (NEDA-3) definition (absence of relapses, disability progression, and magnetic resonance imaging activity), and samples obtained at baseline were analyzed to evaluate the presence of metabolic differences predictive of IFN ß response. The results of the investigation demonstrated differential distribution of baseline samples compared to those obtained during IFN ß exposure, particularly after 24 months of treatment (R2X = 0.812, R2Y = 0.797, Q2 = 0.613, p = 0.003). In addition, differences in the baseline metabolome between responder and nonresponder patients with respect to lactate, acetone, 3-OH-butyrate, tryptophan, citrate, lysine, and glucose levels were found (R2X = 0.442, R2Y = 0.768, Q2 = 0.532, p = 0.01). In conclusion, a metabolomic approach appears to be a promising, noninvasive tool that could potentially contribute to predicting the efficacy of MS therapies.
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Affiliation(s)
- Lorena Lorefice
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy.
| | - Federica Murgia
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - Giuseppe Fenu
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - Jessica Frau
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - Maria Rita Murru
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - Stefania Tranquilli
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | | | - Maria Giovanna Marrosu
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
| | - Luigi Atzori
- Department of Biomedical Sciences, University of Cagliari, 09126, Cagliari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Centre, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, via Is Guadazzonis 2, 09126, Cagliari, Italy
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Kopp TI, Blinkenberg M, Chalmer TA, Petersen T, Ravnborg MH, Soelberg Sørensen P, Magyari M. Predictors of treatment outcome in patients with paediatric onset multiple sclerosis. Mult Scler 2019; 26:964-975. [PMID: 31081451 DOI: 10.1177/1352458519846100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Disease-modifying therapies (DMT) are increasingly used for children with multiple sclerosis (MS) even though most double-blinded randomized controlled trials evaluating efficacy, safety and dosing strategy of a specific drug have included adults. OBJECTIVE To investigate predictors of treatment outcomes in patients with paediatric onset MS treated with DMTs. METHODS Prospective cohort study from the nationwide Danish Multiple Sclerosis Registry including all patients with a MS diagnosis who initiated treatment with an approved DMT before the age of 18 (N = 137) and followed until their 25th birthday. Selected baseline predictors were tested in univariate and multivariate regression models. RESULTS Multivariate analyses showed that being female and having disease duration for 2 or more years prior to DMT initiation predicted a higher relapse rate. In addition, disease duration and baseline expanded disability status scale (EDSS) predicted both confirmed disability worsening and improvement. We found no difference in treatment outcome between children with MS onset before and after the age of 13 years. CONCLUSIONS The efficacy of DMT in paediatric onset MS patients is comparable to that seen in adult onset MS patients. Earlier treatment start is associated with a beneficial prognosis in the paediatric cohort.
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Affiliation(s)
- Tine Iskov Kopp
- The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark/Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Blinkenberg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thor Ameri Chalmer
- The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark/Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thor Petersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Per Soelberg Sørensen
- The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark/Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Melinda Magyari
- The Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark/Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Kalincik T, Kubala Havrdova E, Horakova D, Izquierdo G, Prat A, Girard M, Duquette P, Grammond P, Onofrj M, Lugaresi A, Ozakbas S, Kappos L, Kuhle J, Terzi M, Lechner-Scott J, Boz C, Grand'Maison F, Prevost J, Sola P, Ferraro D, Granella F, Trojano M, Bergamaschi R, Pucci E, Turkoglu R, McCombe PA, Pesch VV, Van Wijmeersch B, Solaro C, Ramo-Tello C, Slee M, Alroughani R, Yamout B, Shaygannejad V, Spitaleri D, Sánchez-Menoyo JL, Ampapa R, Hodgkinson S, Karabudak R, Butler E, Vucic S, Jokubaitis V, Spelman T, Butzkueven H. Comparison of fingolimod, dimethyl fumarate and teriflunomide for multiple sclerosis. J Neurol Neurosurg Psychiatry 2019; 90:458-468. [PMID: 30636699 DOI: 10.1136/jnnp-2018-319831] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/07/2018] [Accepted: 12/14/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Oral immunotherapies have become a standard treatment in relapsing-remitting multiple sclerosis. Direct comparison of their effect on relapse and disability is needed. METHODS We identified all patients with relapsing-remitting multiple sclerosis treated with teriflunomide, dimethyl fumarate or fingolimod, with minimum 3-month treatment persistence and disability follow-up in the global MSBase cohort study. Patients were matched using propensity scores. Three pairwise analyses compared annualised relapse rates and hazards of disability accumulation, disability improvement and treatment discontinuation (analysed with negative binomial models and weighted conditional survival models, with pairwise censoring). RESULTS The eligible cohorts consisted of 614 (teriflunomide), 782 (dimethyl fumarate) or 2332 (fingolimod) patients, followed over the median of 2.5 years. Annualised relapse rates were lower on fingolimod compared with teriflunomide (0.18 vs 0.24; p=0.05) and dimethyl fumarate (0.20 vs 0.26; p=0.01) and similar on dimethyl fumarate and teriflunomide (0.19 vs 0.22; p=0.55). No differences in disability accumulation (p≥0.59) or improvement (p≥0.14) were found between the therapies. In patients with ≥3-month treatment persistence, subsequent discontinuations were less likely on fingolimod than teriflunomide and dimethyl fumarate (p<0.001). Discontinuation rates on teriflunomide and dimethyl fumarate were similar (p=0.68). CONCLUSION The effect of fingolimod on relapse frequency was superior to teriflunomide and dimethyl fumarate. The effect of the three oral therapies on disability outcomes was similar during the initial 2.5 years on treatment. Persistence on fingolimod was superior to the two comparator drugs.
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Affiliation(s)
- Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia .,Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | - Alexandre Prat
- Montreal, Quebec, Hopital Notre-Dame, Canada.,CHUM and Universite de Montreal, Montreal, Quebec, Canada
| | - Marc Girard
- Montreal, Quebec, Hopital Notre-Dame, Canada.,CHUM and Universite de Montreal, Montreal, Quebec, Canada
| | - Pierre Duquette
- Montreal, Quebec, Hopital Notre-Dame, Canada.,CHUM and Universite de Montreal, Montreal, Quebec, Canada
| | | | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G d'Annunzio, Chieti, Italy
| | - Alessandra Lugaresi
- Bologna, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy.,Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Samsun, Turkey
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, Newcastle, New South Wales, Australia.,Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, New South Wales, Australia
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Emergency and General Medicine, Parma University Hospital, Parma, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | | | - Eugenio Pucci
- UOC Neurologia, Azienda Sanitaria Unica Regionale Marche-AV3, Macerata, Italy
| | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Pamela A McCombe
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Vincent Van Pesch
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Bart Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, Belgium
| | - Claudio Solaro
- Department of Neurology, ASL3 Genovese, and Department of Rehabilitation, ML Novarese Hospital Moncrivello, Genova, Italy
| | | | - Mark Slee
- Flinders University, Adelaide, South Australia, Australia
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait
| | - Bassem Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | | | | | | | | | - Ernest Butler
- Monash Medical Centre, Melbourne, Victoria, Australia
| | - Steve Vucic
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Vilija Jokubaitis
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tim Spelman
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Neurology, Box Hill Hospital, Monash University, Melbourne, Victoria, Australia
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Trojano M, Bergamaschi R, Amato MP, Comi G, Ghezzi A, Lepore V, Marrosu MG, Mosconi P, Patti F, Ponzio M, Zaratin P, Battaglia MA. The Italian multiple sclerosis register. Neurol Sci 2019; 40:155-165. [PMID: 30426289 PMCID: PMC6329744 DOI: 10.1007/s10072-018-3610-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/16/2018] [Indexed: 11/26/2022]
Abstract
The past decade has seen extraordinary increase in worldwide availability of and access to several large multiple sclerosis (MS) databases and registries. MS registries represent powerful tools to provide meaningful information on the burden, natural history, and long-term safety and effectiveness of treatments. Moreover, patients, physicians, industry, and policy makers have an active interest in real-world observational studies based on register data, as they have the potential to answer the questions that are most relevant to daily treatment decision-making. In 2014, the Italian MS Foundation, in collaboration with the Italian MS clinical centers, promoted and funded the creation of the Italian MS Register, a project in continuity with the existing Italian MS Database Network set up from 2001. Main objective of the Italian MS Register is to create an organized multicenter structure to collect data of all MS patients for better defining the disease epidemiology, improving quality of care, and promoting research projects in high-priority areas. The aim of this article is to present the current framework and network of the Italian MS register, including the methodology used to improve the quality of data collection and to facilitate the exchange of data and the collaboration among national and international groups.
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Affiliation(s)
- Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro" Policlinico, Italy Piazza Umberto I, Bari, Bari, Italy.
| | | | - Maria Pia Amato
- Department NEUROFARBA, MS Center AOU Careggi, University of Florence, Florence, Italy
| | - Giancarlo Comi
- Neurology Department and INSPE-Institute of Experimental Neurology, Vita-Salute San Raffaele University, Milan, Italy
| | - Angelo Ghezzi
- Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Gallarate, Va, Italy
| | - Vito Lepore
- Coreserach Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Paola Mosconi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesco Patti
- Department of Neurosciences G.F. Ingrassia, University of Catania, Catania, Italy
| | - Michela Ponzio
- Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, Italy
| | - Paola Zaratin
- Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, Italy
| | - Mario Alberto Battaglia
- Italian Multiple Sclerosis Foundation, Via Operai 40, Genoa, Italy.
- Department of Life Sciences, University of Siena, Siena, Italy.
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Hobart J, Bowen A, Pepper G, Crofts H, Eberhard L, Berger T, Boyko A, Boz C, Butzkueven H, Celius EG, Drulovic J, Flores J, Horáková D, Lebrun-Frénay C, Marrie RA, Overell J, Piehl F, Rasmussen PV, Sá MJ, Sîrbu CA, Skromne E, Torkildsen Ø, van Pesch V, Vollmer T, Zakaria M, Ziemssen T, Giovannoni G. International consensus on quality standards for brain health-focused care in multiple sclerosis. Mult Scler 2018; 25:1809-1818. [PMID: 30381987 PMCID: PMC6826858 DOI: 10.1177/1352458518809326] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Time matters in multiple sclerosis (MS). Irreversible neural damage and cell loss occur from disease onset. The MS community has endorsed a management strategy of prompt diagnosis, timely intervention and regular proactive monitoring of treatment effectiveness and disease activity to improve outcomes in people with MS. Objectives: We sought to develop internationally applicable quality standards for timely, brain health–focused MS care. Methods: A panel of MS specialist neurologists participated in an iterative, online, modified Delphi process to define ‘core’, ‘achievable’ and ‘aspirational’ time frames reflecting minimum, good and high care standards, respectively. A multidisciplinary Reviewing Group (MS nurses, people with MS, allied healthcare professionals) provided insights ensuring recommendations reflected perspectives from multiple stakeholders. Results: Twenty-one MS neurologists from 19 countries reached consensus on most core (25/27), achievable (25/27) and aspirational (22/27) time frames at the end of five rounds. Agreed standards cover six aspects of the care pathway: symptom onset, referral and diagnosis, treatment decisions, lifestyle, disease monitoring and managing new symptoms. Conclusion: These quality standards for core, achievable and aspirational care provide MS teams with a three-level framework for service evaluation, benchmarking and improvement. They have the potential to produce a profound change in the care of people with MS.
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Affiliation(s)
- Jeremy Hobart
- Plymouth University Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Amy Bowen
- NHS RightCare, NHS England, London, UK
| | | | | | | | - Thomas Berger
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexey Boyko
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russia/Demyelinating Diseases Center, Yusupov Hospital, Moscow, Russia
| | - Cavit Boz
- Department of Neurology, Karadeniz Technical University, Trabzon, Turkey
| | - Helmut Butzkueven
- MS and Neuroimmunology Unit, Alfred Health and Eastern Health, Monash University, Melbourne, VIC, Australia
| | | | - Jelena Drulovic
- Department for Immune-Mediated Disorders of the Central Nervous System, Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - José Flores
- National Institute of Neurology and Neurosurgery, ABC Medical Center, Mexico City, Mexico
| | - Dana Horáková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James Overell
- Glasgow MS Clinical Research Centre, Queen Elizabeth University Hospital, Glasgow, UK
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Maria José Sá
- MS Clinic, Department of Neurology, Centro Hospitalar São João, Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - Carmen-Adella Sîrbu
- Clinic of Neurology, Central Military Emergency University Hospital, Bucharest, Romania
| | - Eli Skromne
- Instituto Mexicano de Neurociencias, Hospital Angeles Lomas, Mexico City, Mexico
| | - Øivind Torkildsen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Vincent van Pesch
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Timothy Vollmer
- Department of Neurology, University of Colorado, Denver, CO, USA
| | - Magd Zakaria
- Department of Neurology, Ain Shams University, Cairo, Egypt
| | - Tjalf Ziemssen
- Department of Neurology, MS Center Dresden, Center of Clinical Neuroscience, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Gavin Giovannoni
- Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
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42
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Kim SH, Park MS, Kim W, Huh SY, Shin HJ, Hyun JW, Kim HJ. Real-World Effectiveness of Disease-Modifying Therapies in Korean Patients with Relapsing Multiple Sclerosis. J Clin Neurol 2018; 15:20-26. [PMID: 30375760 PMCID: PMC6325368 DOI: 10.3988/jcn.2019.15.1.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND PURPOSE This study assessed the long-term outcomes of disease-modifying therapies (DMTs) in Korean multiple sclerosis (MS) patients treated in real-world clinical settings in Korea. METHODS We retrospectively evaluated the medical records of 160 patients with an initial diagnosis of clinically isolated syndrome or relapsing-remitting MS who were treated for at least 2 years. A status of 3 for no evidence of disease activity (NEDA3) was defined as no relapse, disability progression, or active lesions in annual magnetic resonance imaging (MRI) evaluations. RESULTS Patients who were initially treated with interferon β (n=152), glatiramer acetate (n=6), or teriflunomide (n=2) were included. The mean disease duration was 8.2 years. Compared to pretreatment, annualized relapse rates were significantly reduced after treatment [from 1.0±0.8 to 0.2±0.4 (mean±standard deviation), p<0.001]. At the follow-up, 79 patients (49%) had changed their treatment regimen due to lack of efficacy (33%), side effects (14%), or other reasons (2%). Disability progression was observed in 18% of the patients over a mean treatment duration of 5.7 years. After 2 years, NEDA3 was observed in 38% of the patients. Loss of NEDA3 at 2 years was associated with long-term disability progression [odds ratio (OR)=17.975, p=0.003]. Poor response to first-line treatment was independently associated with a delay in treatment from disease onset (OR=1.238, p=0.049) and 10 or more brain lesions in the initial MRI (OR=3.648, p=0.047). CONCLUSIONS This study has provided real-world evidence that DMTs are effective in reducing disease activity and disability progression in Korean MS patients.
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Affiliation(s)
- Su Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Min Su Park
- Department of Neurology, College of Medicine, Yeungnam University, Gyeongsan, Korea
| | - Woojun Kim
- Department of Neurology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - So Young Huh
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
| | - Hyun June Shin
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Jae Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea.
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43
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Bove R, Chitnis T, Cree BA, Tintore M, Naegelin Y, Uitdehaag B, Kappos L, Khoury SJ, Montalban X, Hauser SL, Weiner HL. SUMMIT (Serially Unified Multicenter Multiple Sclerosis Investigation): creating a repository of deeply phenotyped contemporary multiple sclerosis cohorts. Mult Scler 2018; 24:1485-1498. [PMID: 28847219 PMCID: PMC5821573 DOI: 10.1177/1352458517726657] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a pressing need for robust longitudinal cohort studies in the modern treatment era of multiple sclerosis. OBJECTIVE Build a multiple sclerosis (MS) cohort repository to capture the variability of disability accumulation, as well as provide the depth of characterization (clinical, radiologic, genetic, biospecimens) required to adequately model and ultimately predict a patient's course. METHODS Serially Unified Multicenter Multiple Sclerosis Investigation (SUMMIT) is an international multi-center, prospectively enrolled cohort with over a decade of comprehensive follow-up on more than 1000 patients from two large North American academic MS Centers (Brigham and Women's Hospital (Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital (CLIMB; BWH)) and University of California, San Francisco (Expression/genomics, Proteomics, Imaging, and Clinical (EPIC))). It is bringing online more than 2500 patients from additional international MS Centers (Basel (Universitätsspital Basel (UHB)), VU University Medical Center MS Center Amsterdam (MSCA), Multiple Sclerosis Center of Catalonia-Vall d'Hebron Hospital (Barcelona clinically isolated syndrome (CIS) cohort), and American University of Beirut Medical Center (AUBMC-Multiple Sclerosis Interdisciplinary Research (AMIR)). RESULTS AND CONCLUSION We provide evidence for harmonization of two of the initial cohorts in terms of the characterization of demographics, disease, and treatment-related variables; demonstrate several proof-of-principle analyses examining genetic and radiologic predictors of disease progression; and discuss the steps involved in expanding SUMMIT into a repository accessible to the broader scientific community.
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Affiliation(s)
- Riley Bove
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Tanuja Chitnis
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Bruce A.C. Cree
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mar Tintore
- Centre d’Esclerosi Mútiple de Catalunya (Cemcat), Barcelona, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Yvonne Naegelin
- Center for MS and Neuroimmunology, Universitätsspital Basel, Basel, Switzerland
| | - Bernard Uitdehaag
- MS Cetner Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Ludwig Kappos
- Center for MS and Neuroimmunology, Universitätsspital Basel, Basel, Switzerland
| | - Samia J. Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Xavier Montalban
- Centre d’Esclerosi Mútiple de Catalunya (Cemcat), Barcelona, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Stephen L. Hauser
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Howard L. Weiner
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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44
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Maresova P, Valis M, Novotny M, Pavelek Z, Kuca K. The direct costs of multiple sclerosis-study in the Czech Republic. Neurol Sci 2018; 39:2115-21. [PMID: 30178269 DOI: 10.1007/s10072-018-3551-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a progressive autoimmune disease of the central nervous system that is often disabling and for which there is currently no cure, though disease-modifying treatment is now available. The aim of this study is to describe the current values of the direct costs of multiple sclerosis (MS) in the Czech Republic. METHODS Attention is focused on direct medical costs. The costs were monitored in the Czech Republic among 5673 patients in the period between 2011 and 2015. These costs included complex, special and targeted visits at the neurologist, blood collection and the costs of hospitalisation. The results refer to the diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. The attention is focused on MS G35 (NS; brain stem; spinal cord; disseminated; generalised). RESULTS The average total direct costs per patient per year are 4838.1 €. Not every patient has to be hospitalised during the year, and not every patient has prescribed medication. According to the above data, 12% of patients are hospitalised and 55% of patients are prescribed medication. The minimum average cost per patient without medication and hospitalisation is 54.1 €. CONCLUSION Cost evaluation across countries is difficult due to the different evidence. If only selected direct costs considered in this study are compared, the absolute economics burden increases over time. The only statistically significant difference in the average price and the time spent is between 2012 and 2013, where the correlation value is 0.597.
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45
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Hyun JW, Kim W, Huh SY, Park MS, Ahn SW, Cho JY, Kim BJ, Lee SH, Kim SH, Kim HJ. Application of the 2017 McDonald diagnostic criteria for multiple sclerosis in Korean patients with clinically isolated syndrome. Mult Scler 2018; 25:1488-1495. [PMID: 30043667 DOI: 10.1177/1352458518790702] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the validity of the revised 2017 McDonald criteria for multiple sclerosis (MS) compared with the 2010 McDonald criteria to predict conversion to clinically definite multiple sclerosis (CDMS) in patients with clinically isolated syndrome (CIS). METHODS A total of 163 patients from seven referral hospitals in Korea, who experienced a first clinical event suggestive of MS between 2006 and 2017, were enrolled. Patients were stratified into two groups according to outcome at the last visit: CDMS converters who experienced a second clinical event and non-converters. RESULTS Of the 163 patients with a mean follow-up of 63 months, 60% converted to CDMS. The sensitivity, specificity, positive and negative predictive values and accuracy were, respectively, 88.8%, 43.1%, 70.2%, 71.8% and 70.6% for the 2017 McDonald criteria and 53.1%, 69.2%, 72.2%, 49.5% and 59.5% for the 2010 McDonald criteria. After exclusion of 82 patients who received disease-modifying agents before the second attack, the specificity of the 2017 and 2010 McDonald criteria increased to 85.0% and 95.0%, but sensitivity decreased to 83.6% and 47.5%, respectively. CONCLUSION The 2017 McDonald criteria afforded higher sensitivity and accuracy but lower specificity compared with the 2010 McDonald criteria for prediction of conversion to CDMS in Korean CIS patients.
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Affiliation(s)
- Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Woojun Kim
- Department of Neurology, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - So-Young Huh
- Department of Neurology, College of Medicine, Kosin University, Busan, Korea
| | - Min Su Park
- Department of Neurology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Suk-Won Ahn
- Department of Neurology, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Joong-Yang Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Seoul, Korea
| | - Sang-Hyun Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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46
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Iversen L, Eidsmo L, Austad J, Rie M, Osmancevic A, Skov L, Talme T, Bachmann I, Kerkhof P, Stahle M, Banerjee R, Oliver J, Fasth A, Frueh J. Secukinumab treatment in new‐onset psoriasis: aiming to understand the potential for disease modification – rationale and design of the randomized, multicenter
STEPI
n study. J Eur Acad Dermatol Venereol 2018; 32:1930-1939. [DOI: 10.1111/jdv.14979] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/06/2018] [Indexed: 12/14/2022]
Affiliation(s)
- L. Iversen
- Aarhus University Hospital Aarhus Denmark
| | - L. Eidsmo
- Department of Dermatology Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - J. Austad
- Oslo University Hospital Oslo Norway
| | - M. Rie
- Academisch Medisch Centrum Amsterdam The Netherlands
| | - A. Osmancevic
- Department of Dermatology Sahlgrenska University Hospital Gothenburg Sweden
| | - L. Skov
- Herlev and Gentofte Hospital University of Copenhagen Copenhagen Denmark
| | - T. Talme
- Department of Dermatology Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | | | - P. Kerkhof
- Radboud University Nijmegen Medical Centre Nijmegen The Netherlands
| | - M. Stahle
- Department of Dermatology Karolinska University Hospital Stockholm Sweden
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - R. Banerjee
- Novartis Healthcare Private Limited Hyderabad India
| | - J. Oliver
- Novartis Pharma AG Basel Switzerland
| | | | - J. Frueh
- Novartis Pharma AG Basel Switzerland
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Chalmer TA, Baggesen LM, Nørgaard M, Koch-Henriksen N, Magyari M, Sorensen PS. Early versus later treatment start in multiple sclerosis: a register-based cohort study. Eur J Neurol 2018; 25:1262-e110. [PMID: 29847005 DOI: 10.1111/ene.13692] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/23/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE To assess long-term treatment effectiveness of disease-modifying therapy (DMT) initiated early in disease course versus later treatment start. METHODS We included all Danish patients with multiple sclerosis (MS) treated with DMT through two nationwide population-based MS registries. Patients were categorized as early treated if treatment started within 2 years after the first MS symptom (n = 2316) and later treated if treatment started between 2 and 8 years after clinical onset (n = 1479). We compared time from treatment start to progression to an Expanded Disability Status Scale (EDSS) score of 6 and mortality between cohorts as hazard ratio (HR) using a Cox proportional hazards model with adjustment for stabilized inverse probability of treatment weights. Several sensitivity analyses were conducted. RESULTS The median follow-up time of 3795 patients was 7.0 (range 0.6-19.5) years for the EDSS score of 6 outcome and 10.4 (range 1.2-20.1) years for the mortality outcome. Patients with later treatment start showed a 42% increased hazard rate of reaching an EDSS score of 6 compared with the early-treated patients [HR, 1.42; 95% confidence interval (CI), 1.18-1.70; P < 0.001]. When stratified by sex, the increased hazard among later-treated women persisted (HR, 1.53; 95% CI, 1.22-1.93; P < 0.001), whereas the HR was lower in men (1.25; 95% CI, 0.93-1.69; P = 0.15). Mortality was increased by 38% in later starters (HR, 1.38; 95% CI, 0.96-1.99; P = 0.08). CONCLUSIONS Patients who started treatment with DMT later reached an EDSS score of 6 more quickly compared with patients who started early and the delay showed a tendency to shorten time to death. Our results support the use of early treatment.
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Affiliation(s)
- T A Chalmer
- Department of Neurology, Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen.,Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen
| | - L M Baggesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - M Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - N Koch-Henriksen
- Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - M Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen.,Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen
| | - P S Sorensen
- Department of Neurology, Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen.,Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen
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48
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Riemenschneider M, Hvid LG, Stenager E, Dalgas U. Is there an overlooked “window of opportunity” in MS exercise therapy? Perspectives for early MS rehabilitation. Mult Scler 2018; 24:886-894. [DOI: 10.1177/1352458518777377] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While early medical treatment has proven effective in MS, early-phase MS rehabilitation has not gained much attention in MS research and clinical practice. Exercise therapy is one of the most promising treatment strategies in MS rehabilitation. Here, we provide a topical review investigating when exercise therapy is initiated in existing MS studies, showing that exercise is initiated at a rather late disease stage, where it predominantly serves as a symptomatic treatment. Recent findings in MS suggest that exercise may have neuroprotective and disease-modifying effects. Such findings along with the findings from medical trials that an early-stage “window of opportunity” exists leads to the proposal that early exercise therapy should be an increased focus in research and clinical practice for persons with MS. A further perspective relates to other rehabilitation interventions that are also initiated at a later disease stage, as these may also take advantage of an early-phase approach.
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Affiliation(s)
- Morten Riemenschneider
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark
| | - Lars G Hvid
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark
| | - Egon Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark/Department of Neurology, MS-Clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding), Sønderborg, Denmark
| | - Ulrik Dalgas
- Department of Public Health, Section of Sport Science, Aarhus University, Aarhus C, Denmark
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49
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Zéphir H. Progress in understanding the pathophysiology of multiple sclerosis. Rev Neurol (Paris) 2018; 174:358-363. [PMID: 29680179 DOI: 10.1016/j.neurol.2018.03.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 01/17/2023]
Abstract
Multiple sclerosis (MS) arises in people who have a genetic susceptibility to environmental factors and events, which ultimately trigger the disease. It is thought that peripheral immune cells are mobilized and enter the CNS through the impaired blood-brain barrier in the subarachnoid space, as acute lesions show large numbers of macrophages and CD8+ T cells and, to a lesser extent, CD4+ T cells, B cells and plasma cells. Demyelination is mostly localized to focal lesions in early relapsing-remitting (RR) MS, whereas other areas of white matter appear normal. Over time, T-cell and B-cell infiltration becomes more diffuse and axonal injury more widespread, leading to self-perpetuating atrophy in both white and gray matter. With disease progression, inflammatory processes are predominantly driven by the action of CNS resident microglia cells. In addition, there is evidence that meningeal lymphoid-like structures can form and contribute to late-stage inflammation. In general, however, despite dynamic changes over time in MS pathology, lesions do not appear to differ significantly in the different classic forms of MS already identified. While all treatments approved for MS management target inflammatory components of RRMS, the B-cell-depleting antibody ocrelizumab is the first such treatment approved recently for primary progressive (PP) MS. However, recent pathological and imaging findings have prompted reconsideration of the clinical phenotypes of MS patients proposed by Lublin's 2013 classification, including clinical and MRI signs of activity, and new imaging biomarkers of remyelination are now being investigated for new strategies of MS management.
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Affiliation(s)
- H Zéphir
- Pôle des Neurosciences et de l'Appareil Locomoteur, CHRU de Lille, LIRIC, U995, équipe 3, Université de Lille, 59037 Lille Cedex, France.
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50
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Abstract
PURPOSE OF REVIEW We discuss new paradigms for understanding the immunopathology of multiple sclerosis through the recent development of high throughput genetic analysis, emergence of numerous candidate biomarkers, and the broadening of the treatment arsenal. RECENT FINDINGS The recent use of genome wide association studies provide new tools for a better understanding of multiple sclerosis etiology. Genome-wide association studies have identified many genes implicated in immune regulation and the next step will be to elucidate how those genetic variations influence immune cell function to drive disease development and progression. Furthermore, patient care has seen the emergence of new biomarkers for monitoring disease progression and response to treatment. Finally, the introduction of numerous immunomodulatory treatments will likely improve clinical outcome of multiple sclerosis patients in the future. SUMMARY Breakthroughs in the field of multiple sclerosis have led to a better understanding of the physiopathology of the disease, follow up, and treatment of the patients that develop relapsing remitting multiple sclerosis. The next challenge for multiple sclerosis will be to press forward to model and decipher multiple sclerosis progression, which will help both to develop therapeutics and generate knowledge about mechanisms of neurodegeneration.
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