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Moreau A, Kolitsi I, Kremer L, Fleury M, Lanotte L, Sellal F, Gaultier C, Ahle G, Courtois S, Fickl A, Mostoufizadeh S, Dentel C, Collongues N, de Seze J, Bigaut K. Early use of high efficacy therapies in pediatric forms of relapsing-remitting multiple sclerosis: A real-life observational study. Mult Scler Relat Disord 2023; 79:104942. [PMID: 37633034 DOI: 10.1016/j.msard.2023.104942] [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: 06/09/2023] [Revised: 07/24/2023] [Accepted: 08/12/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Pediatric forms of multiple sclerosis are more active than those in adults. Yet, the effectiveness of different therapeutic approaches is not well studied in this population. Our objective was to compare the effectiveness of the early use of high efficacy therapies (HETs) with the effectiveness of moderate efficacy therapies (METs) in children with MS. METHODS This observational study included patients diagnosed with pediatric MS, at 4 hospital centers in France, during a 10-year period. METs included: interferon β-1a, glatiramer acetate, dimethyl fumarate, teriflunomide; HETs included: fingolimod, natalizumab, ocrelizumab, alemtuzumab. The primary endpoint was the occurrence of a new relapse, the secondary endpoint was EDSS worsening. RESULTS Sixty-four patients were included in the analysis (80% women; mean age 15.5 years, 81% treated with MET) with a median follow-up of 22.5 months. At baseline, 52 patients were on MET (interferon β-1a, glatiramer acetate, dimethyl fumarate, teriflunomide) and 12 patients were on HET (natalizumab, ocrelizumab). The cumulative probability of being relapse-free at 6.5 years was 23.3% on MET, vs 90.9% on HET (p = 0.013). The cumulative probability of no EDSS worsening did not differ between the 2 groups. CONCLUSION Patients starting with METs had much higher clinical disease activity than those starting early with HETs. Rapid initiation of more aggressive treatment may allow better disease control; however, the data on EDSS worsening are not conclusive.
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Affiliation(s)
- Augustin Moreau
- Department of Neurology, Strasbourg University Hospitals, 1 avenue Molière, Strasbourg 67200, France.
| | - Ioanna Kolitsi
- Department of Neurology, Strasbourg University Hospitals, 1 avenue Molière, Strasbourg 67200, France
| | - Laurent Kremer
- Department of Neurology, Strasbourg University Hospitals, 1 avenue Molière, Strasbourg 67200, France; Clinical Investigation Center INSERM CIC 1434, Strasbourg University Hospitals, Strasbourg, France; INSERM U1119, University of Strasbourg, Strasbourg, France
| | - Marie Fleury
- Department of Neurology, Strasbourg University Hospitals, 1 avenue Molière, Strasbourg 67200, France
| | - Livia Lanotte
- Department of Neurology, Strasbourg University Hospitals, 1 avenue Molière, Strasbourg 67200, France
| | - François Sellal
- Department of Neurology, Civilian Hospitals Colmar, Colmar, France
| | - Claude Gaultier
- Department of Neurology, Civilian Hospitals Colmar, Colmar, France
| | - Guido Ahle
- Department of Neurology, Civilian Hospitals Colmar, Colmar, France
| | - Sylvie Courtois
- Department of Neurology, Mulhouse and South Alsace Region Hospital Group, Mulhouse, France
| | - Andreas Fickl
- Department of Neurology, Mulhouse and South Alsace Region Hospital Group, Mulhouse, France
| | - Sohrab Mostoufizadeh
- Department of Neurology, Mulhouse and South Alsace Region Hospital Group, Mulhouse, France
| | - Christel Dentel
- Department of Neurology, Hospital Centre Haguenau, Haguenau, France
| | - Nicolas Collongues
- Department of Neurology, Strasbourg University Hospitals, 1 avenue Molière, Strasbourg 67200, France; Clinical Investigation Center INSERM CIC 1434, Strasbourg University Hospitals, Strasbourg, France; INSERM U1119, University of Strasbourg, Strasbourg, France
| | - Jérôme de Seze
- Department of Neurology, Strasbourg University Hospitals, 1 avenue Molière, Strasbourg 67200, France; Clinical Investigation Center INSERM CIC 1434, Strasbourg University Hospitals, Strasbourg, France; INSERM U1119, University of Strasbourg, Strasbourg, France
| | - Kévin Bigaut
- Department of Neurology, Strasbourg University Hospitals, 1 avenue Molière, Strasbourg 67200, France; Clinical Investigation Center INSERM CIC 1434, Strasbourg University Hospitals, Strasbourg, France; INSERM U1119, University of Strasbourg, Strasbourg, France
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Le Goff L, Demuth S, Fickl A, Muresan L. Ischemic stroke risk factors not included in the CHADS-VASC score in patients with non-valvular atrial fibrillation. Arq Neuropsiquiatr 2023; 81:712-719. [PMID: 37567570 PMCID: PMC10468251 DOI: 10.1055/s-0043-1771167] [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] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/09/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND In patients with atrial fibrillation, the CHA2DS2-VASC score guides stroke prevention using anticoagulants, but it is an imperfect score. Other potential risk factors such as renal failure, the type of atrial fibrillation, active smoking, cancer, sleep apnea or systemic inflammation have less well been investigated. OBJECTIVE To assess the impact of these factors on ischemic stroke risk in patients with non-valvular atrial fibrillation. METHODS On a population of 248 patients (124 patients with acute ischemic stroke and 124 controls), we performed a logistic regression to assess the impact of multiple non-classic risk factors for the prediction of acute ischemic stroke. Their impact on mortality was assessed by performing a survival analysis. RESULTS A high CHA2DS2-VASc score (OR 1.75; 95% CI 1.13-2.70; p = 0.032), treatment with anticoagulants (OR 0.19; 95% CI 0.07-0.51; p < 0.001) and permanent atrial fibrillation (OR 6.31; 95% CI 2.46-16.19; p < 0.001) were independently associated with acute ischemic stroke. Renal failure and chronic obstructive pulmonary disease predicted a higher mortality. After adjusting for age, sex, the CHA2DS2-VASc score and the use of anticoagulants, the only risk factor predictive for acute ischemic stroke was the permanent type of AF (OR: 8.0 [95% CI 2.5-25.5], p < 0.001). CONCLUSIONS The CHA2DS2-VASc score, the absence of anticoagulants and the permanent type of atrial fibrillation were the main predictive factors for the occurrence of acute ischemic stroke. Larger studies are necessary for conclusive results about other factors.
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Affiliation(s)
- Laurine Le Goff
- “Emile Muller” Hospital, Department of Cardiology, Mulhouse, France.
| | - Stanislas Demuth
- Strasbourg University Hospital, Department of Neurology, France.
| | - Andreas Fickl
- “Emile Muller” Hospital, Department of Neurology, Mulhouse, France.
| | - Lucian Muresan
- “Emile Muller” Hospital, Department of Cardiology, Mulhouse, France.
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Godefroy O, Bugnicourt JM, Fickl A. Response to Letter by Blackburn et al Regarding Article, “Is the Montreal Cognitive Assessment Superior to the Mini-Mental State Examination to Detect Poststroke Cognitive Impairment? A Study With Neuropsychological Evaluation”. Stroke 2011. [DOI: 10.1161/strokeaha.111.630368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Olivier Godefroy
- Service de Neurologie
CHU Nord
Amiens, France (Godefroy,Bugnicourt,Fickl)
| | | | - Andreas Fickl
- Service de Neurologie
CHU Nord
Amiens, France (Godefroy,Bugnicourt,Fickl)
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Godefroy O, Fickl A, Roussel M, Auribault C, Bugnicourt JM, Lamy C, Canaple S, Petitnicolas G. Is the Montreal Cognitive Assessment Superior to the Mini-Mental State Examination to Detect Poststroke Cognitive Impairment? Stroke 2011; 42:1712-6. [DOI: 10.1161/strokeaha.110.606277] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Olivier Godefroy
- From the Departement of Neurology and the Laboratory of Functional Neurosciences (FRE CNRS 3291; O.G., M.R., J.M.B., C.L., S.C.), University Hospital of Amiens, Amiens, France; and the Department of Neurology (A.F., C.A., G.P.), Soissons Hospital, Soissons, France
| | - Andreas Fickl
- From the Departement of Neurology and the Laboratory of Functional Neurosciences (FRE CNRS 3291; O.G., M.R., J.M.B., C.L., S.C.), University Hospital of Amiens, Amiens, France; and the Department of Neurology (A.F., C.A., G.P.), Soissons Hospital, Soissons, France
| | - Martine Roussel
- From the Departement of Neurology and the Laboratory of Functional Neurosciences (FRE CNRS 3291; O.G., M.R., J.M.B., C.L., S.C.), University Hospital of Amiens, Amiens, France; and the Department of Neurology (A.F., C.A., G.P.), Soissons Hospital, Soissons, France
| | - Caroline Auribault
- From the Departement of Neurology and the Laboratory of Functional Neurosciences (FRE CNRS 3291; O.G., M.R., J.M.B., C.L., S.C.), University Hospital of Amiens, Amiens, France; and the Department of Neurology (A.F., C.A., G.P.), Soissons Hospital, Soissons, France
| | - Jean Marc Bugnicourt
- From the Departement of Neurology and the Laboratory of Functional Neurosciences (FRE CNRS 3291; O.G., M.R., J.M.B., C.L., S.C.), University Hospital of Amiens, Amiens, France; and the Department of Neurology (A.F., C.A., G.P.), Soissons Hospital, Soissons, France
| | - Chantal Lamy
- From the Departement of Neurology and the Laboratory of Functional Neurosciences (FRE CNRS 3291; O.G., M.R., J.M.B., C.L., S.C.), University Hospital of Amiens, Amiens, France; and the Department of Neurology (A.F., C.A., G.P.), Soissons Hospital, Soissons, France
| | - Sandrine Canaple
- From the Departement of Neurology and the Laboratory of Functional Neurosciences (FRE CNRS 3291; O.G., M.R., J.M.B., C.L., S.C.), University Hospital of Amiens, Amiens, France; and the Department of Neurology (A.F., C.A., G.P.), Soissons Hospital, Soissons, France
| | - Gil Petitnicolas
- From the Departement of Neurology and the Laboratory of Functional Neurosciences (FRE CNRS 3291; O.G., M.R., J.M.B., C.L., S.C.), University Hospital of Amiens, Amiens, France; and the Department of Neurology (A.F., C.A., G.P.), Soissons Hospital, Soissons, France
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