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Gago-Veiga AB, Lopez-Alcaide N, Quintas S, Fernández Lázaro I, Casas-Limón J, Calle C, Latorre G, González-García N, Porta-Etessam J, Rodriguez-Vico J, Jaimes A, Gómez García A, García-Azorín D, Guerrero-Peral ÁL, Sierra Á, Lozano Ros A, Sánchez-Soblechero A, Díaz-de-Teran J, Membrilla JA, Treviño C, Gonzalez-Martinez A. Evaluation of the concomitant use of prophylactic treatments in patients with migraine under anti-calcitonin gene-related peptide therapies: The PREVENAC study. Eur J Neurol 2024; 31:e16215. [PMID: 38323742 DOI: 10.1111/ene.16215] [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: 08/30/2023] [Revised: 12/23/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND AND PURPOSE Anti-calcitonin gene-related peptide (CGRP) therapies are recent preventive therapies approved for both episodic and chronic migraine. One of the measures of effectiveness is the withdrawal of other preventive treatments. The objective of this study is to quantify the impact of anti-CGRP drugs in concomitant preventive treatment in patients with migraine. METHODS This was an observational, retrospective, multicenter cohort study with patients from nine national headache units. Patients with migraine undergoing treatment for at least 6 months with anti-CGRP antibodies, who were initially associated with some preventive treatment (oral and/or onabotulinumtoxinA) were included. Demographic and clinical variables were collected, as well as variables related to headache. Differences according to withdrawal or nonwithdrawal were evaluated. RESULTS A total of 408 patients were included, 86.52% women, 48.79 (SD = 1.46) years old. Preventive treatment was withdrawn in 43.87% (179/408), 20.83% partially and 23.04% totally. In 27.45% (112/408), it was maintained exclusively due to comorbidity and in 28.6% (117/408) due to partial efficacy. The most frequent time of withdrawal was between 3 and 5 months after the start of treatment. The baseline characteristics associated with nonwithdrawal were comorbidities: insomnia, hypertension and obesity, chronic migraine, and medication overuse. In the multivariate analysis, the absence of high blood pressure, a greater number of preventive treatments at the start, and a lower number of migraine days/month after anti-CGRP treatment were independently associated with withdrawal of the treatment (p < 0.05). CONCLUSIONS Anti-CGRP antibodies allow the withdrawal of associated preventive treatment in a significant percentage of patients, which supports its effectiveness in real-life conditions.
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Affiliation(s)
- Ana Beatriz Gago-Veiga
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Noelia Lopez-Alcaide
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Sonia Quintas
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Iris Fernández Lázaro
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | - Javier Casas-Limón
- Headache Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Carlos Calle
- Headache Unit, Hospital de Fuenlabrada, Madrid, Spain
| | | | | | | | | | - Alex Jaimes
- Headache Unit, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | | | - David García-Azorín
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Ángel Luis Guerrero-Peral
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Álvaro Sierra
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | | | | | | | - Cristina Treviño
- Headache Unit, Hospital Clínico Universitario de la Paz, Madrid, Spain
| | - Alicia Gonzalez-Martinez
- Headache Unit, Hospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
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Romero Del Rincón C, Gonzalez-Martinez A, Quintas S, García-Azorín D, Fernández Lázaro I, Guerrero-Peral AL, Gonzalez Osorio Y, Santos-Lasaosa S, González Oria C, Sánchez Rodríguez N, Iglesias Díez F, Echavarría Íñiguez A, Gil Luque S, Huerta-Villanueva M, Campoy Díaz S, Muñoz-Vendrell A, Lozano Ros A, Sánchez-Soblechero A, Velasco Juanes F, Kortazar-Zubizarreta I, Echeverría A, Rodríguez-Vico J, Jaimes Sánchez A, Gómez García A, Morollón Sánchez-Mateos N, Belvis R, Navarro Pérez MP, García-Moncó JC, Álvarez Escudero MR, Montes N, Gago-Veiga AB. RE-START: Exploring the effectiveness of anti-calcitonin gene-related peptide resumption after discontinuation in migraine. Eur J Neurol 2024; 31:e16203. [PMID: 38270379 DOI: 10.1111/ene.16203] [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] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/04/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND PURPOSE According to the latest European guidelines, discontinuation of monoclonal antibodies against calcitonin gene-related peptide (anti-CGRP MAb) may be considered after 12-18 months of treatment. However, some patients may worsen after discontinuation. In this study, we assessed the response following treatment resumption. METHODS This was a prospective study conducted in 14 Headache Units in Spain. We included patients with response to anti-CGRP MAb with clinical worsening after withdrawal and resumption of treatment. Numbers of monthly migraine days (MMD) and monthly headache days (MHD) were obtained at four time points: before starting anti-CGRP MAb (T-baseline); last month of first treatment period (T-suspension); month of restart due to worsening (T-worsening); and 3 months after resumption (T-reintroduction). The response rate to resumption was calculated. Possible differences among periods were analysed according to MMD and MHD. RESULTS A total of 360 patients, 82% women, with a median (interquartile range [IQR]) age at migraine onset of 18 (12) years. The median (IQR) MHD at T-baseline was 20 (13) and MMD was 5 (6); at T-suspension, the median (IQR) MHD was 5 (6) and MMD was 4 (5); at T-worsening, the median (IQR) MHD was 16 (13) and MMD was 12 (6); and at T-reintroduction, the median (IQR) MHD was 8 (8) and MHD was 5 (5). In the second period of treatment, a 50% response rate was achieved by 57.4% of patients in MHD and 65.8% in MMD. Multivariate models showed significant differences in MHD between the third month after reintroduction and last month before suspension of first treatment period (p < 0.001). CONCLUSION The results suggest that anti-CGRP MAb therapy is effective after reintroduction. However, 3 months after resumption, one third of the sample reached the same improvement as after the first treatment period.
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Affiliation(s)
- Celia Romero Del Rincón
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Alicia Gonzalez-Martinez
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Sonia Quintas
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - David García-Azorín
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Iris Fernández Lázaro
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Angel Luis Guerrero-Peral
- Headache Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | | | | | | | | | | | | | - Sendoa Gil Luque
- Headache Unit, Hospital Clínico Universitario de Burgos, Burgos, Spain
| | - Mariano Huerta-Villanueva
- Neurology Department of Neurology, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain
- Servicio de Neurología, Unidad de Cefaleas, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Campoy Díaz
- Neurology Department of Neurology, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain
- Servicio de Neurología, Unidad de Cefaleas, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Muñoz-Vendrell
- Servicio de Neurología, Unidad de Cefaleas, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - Izaro Kortazar-Zubizarreta
- Department of Neurology, Hospital de Álava, Bioaraba Health Research Institute, Araba University Hospital-Txagorritxu, Vitoria-Gasteiz, Spain
| | - Amaya Echeverría
- Department of Neurology, Hospital de Álava, Bioaraba Health Research Institute, Araba University Hospital-Txagorritxu, Vitoria-Gasteiz, Spain
| | | | | | | | | | - Robert Belvis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Nuria Montes
- Unidad de Metodología, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, Spain
- Servicio de Reumatología, Hospital Universitario La Princesa, Madrid, Spain
- Plant Physiology, Pharmaceutical and Health Sciences Department, Faculty of Pharmacy, Universidad San Pablo-CEU, CEU-Universities, Boadilla del Monte, Spain
| | - Ana Beatriz Gago-Veiga
- Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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Costa-Frossard França L, Meca Lallana V, Labiano-Fontcuberta A, Blasco R, Monreal E, Martínez Ginés ML, Aguirre C, Sabin Muñoz J, Sainz de la Maza S, Cuello JP, Díaz-Pérez C, Chico García JL, Lozano Ros A, Rodríguez Jorge F, Martínez Martínez S, García Domínguez JM. Real-World Retrospective Analysis of Alemtuzumab Outcomes in Relapsing-Remitting Multiple Sclerosis: The LEMCAM Study. CNS Drugs 2024; 38:231-238. [PMID: 38418770 PMCID: PMC10920415 DOI: 10.1007/s40263-024-01066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Alemtuzumab is a high-efficacy treatment approved for relapsing-remitting multiple sclerosis (RRMS). Although clinical trials and observational studies are consistent in showing its efficacy and manageable safety profile, further studies under clinical practice conditions are needed to further support its clinical use. OBJECTIVE The aim of this observational retrospective study was to evaluate the effectiveness and safety of alemtuzumab to add to the current real-world evidence on the drug. METHODS A cohort of 115 adult patients with RRMS treated with alemtuzumab between 2014 and 2020 was retrospectively followed up in five centers in Spain. Analysis included annualized relapse rate (ARR), 6-month confirmed disability worsening (CDW), 6-month confirmed disability improvement (CDI), radiological activity, no evidence of disease activity (NEDA-3), and safety signals. Given the different follow-up periods among participants, ARR was calculated using the person-years method. CDI was defined as a ≥ 1.0-point decrease in Expanded Disability Status Scale (EDSS) score assessed in patients with a baseline EDSS score ≥ 2.0 confirmed 6 months apart. CDW was defined as a ≥ 1.0-point increase in EDSS score assessed in patients with a baseline EDSS score ≥ 1.0 (≥ 1.5 if baseline EDSS = 0), confirmed 6 months apart. RESULTS ARR decreased from 1.9 (95% confidence interval 1.60-2.33) in the year prior to alemtuzumab initiation to 0.28 (0.17-0.37) after 1 year of treatment (87% reduction), and to 0.22 (0.13-0.35) after the second year. Over the entire follow-up period, ARR was 0.24 (0.18-0.30). At year 1, 75% of patients showed no signs of magnetic resonance imaging (MRI) activity and 70% at year 5. One percent of patients experienced 6-month CDW at year 1, 2.6% at year 2, 7.4% at year 3, and no patients over years 4 and 5. A total of 7.7% of patients achieved 6-month CDI in year 1, 3.6% in year 2, and maintained it at years 3 and 4. Most patients achieved annual NEDA-3: year 1, 72%; year 2, 79%; year 3, 80%; year 4, 89%; year 5, 75%. Infusion-related reactions were observed in 95% of patients and infections in 74%. Thyroid disorders occurred in 30% of patients, and only three patients developed immune thrombocytopenia. No cases of progressive multifocal leukoencephalopathy were reported. CONCLUSIONS This study shows that alemtuzumab reduced the relapse rate and disability worsening in real-world clinical practice, with many patients achieving and sustaining NEDA-3 over time. The safety profile of alemtuzumab was consistent with previous findings, and no new or unexpected safety signals were observed. As this was an observational and retrospective study, the main limitation of not having all variables comprehensively available for all patients should be considered when interpreting results.
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Affiliation(s)
| | - Virginia Meca Lallana
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Rosario Blasco
- Neuroimmunology Unit, Neurology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- IRYCIS (Ramón y Cajal Institute for Health Research), Madrid, Spain
- REEM (Spanish Network of Multiple Sclerosis), Universidad de Alcalá, Madrid, Spain
| | | | - Clara Aguirre
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | - Julia Sabin Muñoz
- Neuroimmunology Unit, Neurology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- IRYCIS (Ramón y Cajal Institute for Health Research), Madrid, Spain
- REEM (Spanish Network of Multiple Sclerosis), Universidad de Alcalá, Madrid, Spain
| | - Juan Pablo Cuello
- Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Carolina Díaz-Pérez
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Alberto Lozano Ros
- Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Cuello JP, Martínez Ginés ML, García Domínguez JM, Tejeda-Velarde A, Lozano Ros A, Higueras Y, Meldaña Rivera A, Goicochea Briceño H, Garcia-Tizon S, de León-Luis J, Medina Heras S, Fernández Velasco JI, Pérez-Pérez S, García-Martínez MÁ, Pardo-Rodríguez B, Domínguez-Mozo MI, García-Calvo E, Estévez H, Luque-García JL, Villar LM, Alvarez-Lafuente R. Short-chain fatty acids during pregnancy in multiple sclerosis: A prospective cohort study. Eur J Neurol 2021; 29:895-900. [PMID: 34662474 DOI: 10.1111/ene.15150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/27/2021] [Accepted: 10/07/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Short-chain fatty acids (SCFAs) can have pro- or anti-inflammatory properties, but their relationship with multiple sclerosis (MS) relapses during pregnancy remains unknown. This study aimed to explore SCFA profiles in MS patients during pregnancy and to assess their association with the appearance of relapses during pregnancy and postpartum. METHODS We prospectively included 53 pregnant MS patients and 21 healthy control women. Patients were evaluated during pregnancy and puerperium. SCFAs were measured by liquid chromatography-mass spectrometry. RESULTS Sixteen patients (32%) had relapses during pregnancy or puerperium, and 37 (68%) did not. All MS patients showed significant increases in acetate levels during pregnancy and the postpartum period compared to non-MS women. However, propionate and butyrate values were associated with disease activity. Their values were higher in nonrelapsing patients and remained similar to the control group in relapsing patients. The variable that best identified active patients was the propionate/acetate ratio. Ratios of <0.36 during the first trimester were associated with higher inflammatory activity (odds ratio = 165, 95% confidence interval = 10.2-239.4, p < 0.01). Most nonrelapsing patients showed values of >0.36, which were similar to those in healthy pregnant women. CONCLUSIONS Low propionate/acetate ratio values during the first trimester of gestation identified MS patients at risk of relapses during pregnancy and the postpartum period.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Silvia Pérez-Pérez
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - María Ángel García-Martínez
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - Beatriz Pardo-Rodríguez
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - María Inmaculada Domínguez-Mozo
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
| | - Estefanía García-Calvo
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid, Spain
| | - Héctor Estévez
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid, Spain
| | - Jose Luis Luque-García
- Department of Analytical Chemistry, Faculty of Chemical Sciences, Complutense University of Madrid, Madrid, Spain
| | | | - Roberto Alvarez-Lafuente
- Research Group on Environmental Factors in Degenerative Diseases, Health Research Institute of the San Carlos Clinical Hospital/Spanish Multiple Sclerosis Network, Madrid, Spain
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Cuello JP, Martínez Ginés ML, Tejeda-Velarde A, Medina Heras S, García Domínguez JM, Fernández Velasco JI, Lozano Ros A, Higueras Y, Meldaña Rivera A, Goicochea Briceño H, Garcia-Tizon Larroca S, De León-Luis J, de Andrés C, Álvarez Lafuente R, Villar LM. Cytokine profile during pregnancy predicts relapses during pregnancy and postpartum in multiple sclerosis. J Neurol Sci 2020; 414:116811. [DOI: 10.1016/j.jns.2020.116811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/28/2020] [Accepted: 03/27/2020] [Indexed: 12/17/2022]
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Palacios-Mendoza MA, Martínez Ginés ML, Melgarejo Otálora PJ, Cuello JP, Sánchez-Soblechero A, Lozano Ros A, Aparcero-Suero JA, López Anguita S, Anaya F, García Domínguez JM. Plasma exchange in acute attacks of demyelinating diseases of the central nervous system: clinical outcomes and predictors of response. Neurol Sci 2020; 41:2569-2574. [DOI: 10.1007/s10072-020-04382-w] [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: 11/21/2019] [Accepted: 03/27/2020] [Indexed: 12/28/2022]
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Abarca-Zabalía J, García MI, Lozano Ros A, Marín-Jiménez I, Martínez-Ginés ML, López-Cauce B, Martín-Barbero ML, Salvador-Martín S, Sanjurjo-Saez M, García-Domínguez JM, López Fernández LA. Differential Expression of SMAD Genes and S1PR1 on Circulating CD4+ T Cells in Multiple Sclerosis and Crohn's Disease. Int J Mol Sci 2020; 21:ijms21020676. [PMID: 31968593 PMCID: PMC7014376 DOI: 10.3390/ijms21020676] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/07/2019] [Revised: 01/12/2020] [Accepted: 01/16/2020] [Indexed: 01/13/2023] Open
Abstract
The Th17 immune response plays a key role in autoimmune diseases such as multiple sclerosis (MS) and inflammatory bowel disease (IBD). Expression of Th17-related genes in inflamed tissues has been reported in autoimmune diseases. However, values are frequently obtained using invasive methods. We aimed to identify biomarkers of MS in an accessible sample, such as blood, by quantifying the relative expression of 91 Th17-related genes in CD4+ T lymphocytes from patients with MS during a relapse or during a remitting phase. We also compared our findings with those of healthy controls. After confirmation in a validation cohort, expression of SMAD7 and S1PR1 mRNAs was decreased in remitting disease (-2.3-fold and -1.3-fold, respectively) and relapsing disease (-2.2-fold and -1.3-fold, respectively). No differential expression was observed for other SMAD7-related genes, namely, SMAD2, SMAD3, and SMAD4. Under-regulation of SMAD7 and S1PR1 was also observed in another autoimmune disease, Crohn's disease (CD) (-4.6-fold, -1.6-fold, respectively), suggesting the presence of common markers for autoimmune diseases. In addition, expression of TNF, SMAD2, SMAD3, and SMAD4 were also decreased in CD (-2.2-fold, -1.4-fold, -1.6-fold, and -1.6-fold, respectively). Our study suggests that expression of SMAD7 and S1PR1 mRNA in blood samples are markers for MS and CD, and TNF, SMAD2, SMAD3, and SMAD4 for CD. These genes could prove useful as markers of autoimmune diseases, thus obviating the need for invasive methods.
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Affiliation(s)
- Judith Abarca-Zabalía
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.A.-Z.); (M.L.M.-B.); (S.S.-M.); (M.S.-S.)
| | - Ma Isabel García
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.A.-Z.); (M.L.M.-B.); (S.S.-M.); (M.S.-S.)
| | - Alberto Lozano Ros
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.L.R.); (M.L.M.-G.)
| | - Ignacio Marín-Jiménez
- Unidad de Enfermedad Inflamatoria Intestinal, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.M.-J.); (B.L.-C.)
| | - Maria L. Martínez-Ginés
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.L.R.); (M.L.M.-G.)
| | - Beatriz López-Cauce
- Unidad de Enfermedad Inflamatoria Intestinal, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (I.M.-J.); (B.L.-C.)
| | - María L. Martín-Barbero
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.A.-Z.); (M.L.M.-B.); (S.S.-M.); (M.S.-S.)
| | - Sara Salvador-Martín
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.A.-Z.); (M.L.M.-B.); (S.S.-M.); (M.S.-S.)
| | - María Sanjurjo-Saez
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.A.-Z.); (M.L.M.-B.); (S.S.-M.); (M.S.-S.)
| | - Jose M. García-Domínguez
- Servicio de Neurología, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (A.L.R.); (M.L.M.-G.)
- Correspondence: (J.M.G.-D.); (L.A.L.F.)
| | - Luis A. López Fernández
- Servicio de Farmacia, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (J.A.-Z.); (M.L.M.-B.); (S.S.-M.); (M.S.-S.)
- Correspondence: (J.M.G.-D.); (L.A.L.F.)
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8
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Cuello JP, Salgado Cámara P, García Domínguez JM, Lozano Ros A, Mas Serrano M, Martínez Ginés ML. Pregnancy exposure to disease-modifying drugs in multiple sclerosis: a prospective study. Med Clin (Barc) 2019; 154:214-217. [PMID: 31420082 DOI: 10.1016/j.medcli.2019.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/22/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In multiple sclerosis (MS), foetal exposure to disease-modifying drugs (DMDs) carries varying degrees of risk. We sought to analyse the clinical and obstetric outcomes of MS patients (MSp) exposed to DMDs during pregnancy. PATIENTS AND METHODS Observational study. We analysed the clinical-obstetric data of a cohort MSp, who became pregnant between 2007-2017. They were prospectively followed up during pregnancy and postpartum. CONTROL GROUP healthy pregnant women (HPW) and MSp unexposed to DMDs. RESULTS Sixty-eight pregnancies in MSp. Fifty-six HPW. Thirteen MSp were exposed to DMDs during pregnancy. Obstetric outcome: 2 (15%) infants had low birth weight, no preterm deliveries. Fifty-five MSp were not exposed to DMDs: 22 (40%) discontinued DMD before pregnancy, 33(60%) naïve. Five infants (9%) had low birth weight and 7 (12%) were preterm. HPW: 56. Low birth weight 6 (11%), preterm delivery 6 (11%). There were no differences in relapse incidence during pregnancy-puerperium between MSp groups. There were no differences in birth weight, gestation time, delivery-caesarean section. We found no special obstetric morbidity in women exposed to DMDs. CONCLUSIONS There were no significant differences in the clinical and obstetric variables analysed between pregnant women exposed to DMDs, unexposed, and HPW.
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Affiliation(s)
- Juan Pablo Cuello
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Paula Salgado Cámara
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - Alberto Lozano Ros
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Miguel Mas Serrano
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Miranda Acuña J, Hidalgo de la Cruz M, Ros AL, Tapia SP, Martínez Ginés ML, de Andrés Frutos CD. Elevated plasma fibrinogen levels in multiple sclerosis patients during relapse. Mult Scler Relat Disord 2017; 18:157-160. [PMID: 29141800 DOI: 10.1016/j.msard.2017.09.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 02/28/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 01/03/2023]
Abstract
Fibrinogen is a protein that plays a key role in blood coagulation and thrombosis and it is involved in several inflammatory processes; in multiple sclerosis (MS) may be related with blood-brain barrier (BBB) disruption. We analysed the relationship between plasma fibrinogen levels and the presence of active lesions on magnetic resonance imaging (MRI) during relapses of multiple sclerosis (MS) and clinically isolated syndrome (CIS) patients. METHODS We collected data of patients admitted to a tertiary-care hospital with relapse of MS and CIS from 2008 to 2013 and we analysed the relation between plasma fibrinogen levels (normal: 200mg/dl-417mg/dl) and the presence of active lesions on brain or spinal MRI. RESULTS A total of 58 patients were included, 45 (77%) CIS patients, 12 (21%) relapsing-remitting MS (RR-MS) and 1 (2%) active progressive MS (P-MS). 17 patients had high plasma fibrinogen levels (> 417mg/dl). Among total of patients with elevated plasma fibrinogen, 15 (88%) had active lesions on MRI and only 2 (12%) did not have active lesion on MRI (p = 0,013) with a specificity of 95%. All patients with fibrinogen > 417mg/dl were CIS (p = < 0.05). DISCUSSION We observed that high plasma fibrinogen levels had a high specificity high specificity, but low sensitivity (only 40%) for detection of active lesions on MRI during relapses of MS. These findings support the hypothesis that fibrinogen could play an important role on the development of MS lesions, however, additional studies are needed to confirm these results.
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Affiliation(s)
- Jahir Miranda Acuña
- Department of Neurology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
| | | | - Alberto Lozano Ros
- Department of Neurology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Saskia Prasca Tapia
- Hemostasis and Thrombosis Division, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Hidalgo de la Cruz M, Miranda Acuña JA, Lozano Ros A, Vega Catalina M, Salinero Paniagua E, Clemente Ricote G, De Andrés Frutos CD, Martínez Ginés ML. Hepatotoxicity after high-dose intravenous methylprednisolone in multiple sclerosis patients. Clin Case Rep 2017; 5:1210-1212. [PMID: 28781825 PMCID: PMC5538224 DOI: 10.1002/ccr3.1033] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/05/2017] [Accepted: 05/13/2017] [Indexed: 11/09/2022] Open
Abstract
Hepatotoxicity is a rare adverse event of methylprednisolone that should be considered in clinical practice. In patients at risk, we propose liver function surveillance, by measuring hepatic enzymes concentration 15-30 days after methylprednisolone administration. Additionally, we propose ACTH, dexamethasone, or plasma exchange as alternate treatment options for these patients.
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Affiliation(s)
| | | | - Alberto Lozano Ros
- Department of Neurology Gregorio Marañón General University Hospital Madrid Spain
| | - María Vega Catalina
- Department of Gastroenterology Gregorio Marañón General University Hospital Madrid Spain
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