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Schwab M, Chan A, Eser AK, Kallmann B, Pöhlau D, Richter J, Wagner TB, Grothe C. REBISTART: Adherence of Patients with Multiple Sclerosis to Treatment with Subcutaneous Interferon Beta in the Context of a Patient Support Program. Neurol Ther 2024:10.1007/s40120-024-00593-x. [PMID: 38530606 DOI: 10.1007/s40120-024-00593-x] [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: 09/12/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Treatment adherence is a critical success factor in the disease-modifying therapy (DMT) of multiple sclerosis (MS). The REBISTART study prospectively evaluated adherence in patients using components of a patient support program (PSP). METHODS The 12-month non-interventional multicenter study examined the real-world adherence to subcutaneously (sc) injected interferon beta-1a (Rebif®). Patient-assessed adherence was measured by a visual analog scale (VAS) and the Morisky Medication Adherence Scale (MMAS). Objective adherence data were obtained by readouts from the RebiSmart® injection device. RESULTS Of 333 patients, 70.9% used the nursing service as the core component of the PSP. Self-assessed VAS-based adherence was stable over time at 94.0-96.3%. Similarly, MMAS score (maximum 4) was 3.8-3.9 at all visits, also reflecting high self-assessed adherence. In 269 patients using the RebiSmart® injection device, mean readout-based objective adherence was similarly high (93.0-98.4% throughout visits). At last available visit, VAS-based adherence was independent of participation in the PSP nursing service (93.1% with participation versus 91.7% without it). Adherence was also independent of injection method or disease-related measures, including fatigue, depression, cognition, and quality of life. The most frequent reason for the premature discontinuations (38.7% of patients) was "change of treatment" (10.0%). DISCUSSION We suggest that subgroups that may specifically benefit from PSP include patients who live alone, use multiple comedications, and are affected by cognitive impairment, depression, and/or fatigue. Further studies should investigate the potential usefulness of PSPs in these populations. CONCLUSIONS Very high adherence rates independent of the PSP nursing service over 1 year of treatment indicate that IFN beta-1a sc is an easy-to-use and well-tolerated disease-modifying drug. TRIAL REGISTRATION NUMBER Vfa.de: No. 892. https://www.vfa.de/de/arzneimittel-forschung/datenbanken-zu-arzneimitteln/nisdb/nis-details/_892 .
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Affiliation(s)
- Matthias Schwab
- Department of Neurology, Jena University Hospital, 07740, Jena, Germany.
| | - Andrew Chan
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna-Katharina Eser
- Neurologisches Zentrum, Bezirksklinikum Mainkofen, 94469, Mainkofen, Germany
| | - Boris Kallmann
- Kallmann Neurologie, Luitpoldstraße 36, 96052, Bamberg, Germany
| | - Dieter Pöhlau
- DRK Kamillus Klinik, Hospitalstraße 6, 53567, Asbach, Germany
| | - Joachim Richter
- Merck Healthcare Germany GmbH, Waldstraße 3, 64331, Weiterstadt, Germany
| | - Torsten B Wagner
- Merck Healthcare Germany GmbH, Waldstraße 3, 64331, Weiterstadt, Germany.
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Meuth SG, Bayas A, Kallmann B, Linker R, Rieckmann P, Wattjes MP, Mäurer M, Kleinschnitz C. Long-term management of multiple sclerosis patients treated with cladribine tablets beyond year 4. Expert Opin Pharmacother 2022; 23:1503-1510. [PMID: 35930260 DOI: 10.1080/14656566.2022.2106783] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/04/2022]
Abstract
INTRODUCTION Oral cladribine is a highly effective pulsed selective immune reconstitution therapy licensed for relapsing multiple sclerosis (RMS) since 2017. A full treatment course comprises two treatment cycles given 1 year apart, followed by two treatment-free years. The management of cladribine-treated patients beyond year 4 needs to be addressed as patients have now passed the initial 4 years since European Medical Agency approval. AREAS COVERED A panel of neurologists and a neuroradiologist experienced in MS treatment/monitoring evaluated clinical trial data and real-world evidence and proposed recommendations for the management of cladribine-treated patients beyond year 4. EXPERT OPINION Continuous monitoring of disease activity during the treatment-free period is important. Subsequent management depends on the presence or absence of inflammatory disease activity, determined in the absence of consistent guidelines via practice-driven neurological decision criteria. Persisting or newly occurring inflammatory disease activity is an indication for further treatment, i.e. either re-initiation of cladribine or switching to another highly effective disease-modifying therapy. The decision to retreat or switch should be based on clinical and radiological evaluation considering disease course, treatment history, and safety aspects. In the absence of disease activity, either retreatment can be offered, or the treatment-free period can be extended under structured monitoring.
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Affiliation(s)
- Sven G Meuth
- Klinik für Neurologie des Universitätsklinikums Düsseldorf, Düsseldorf, Germany
| | - Antonios Bayas
- Klinik für Neurologie und Klinische Neurophysiologie, Medizinische Fakultät, Universität Augsburg, Augsburg, Germany
| | | | - Ralf Linker
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Peter Rieckmann
- Abteilung für Neurologie, Medical Park Loipl, Regensburg, Germany
| | - Mike P Wattjes
- Department of diagnostic and interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Mathias Mäurer
- Klinik für Neurologie, Juliusspital Würzburg Klinikum Würzburg Mitte gGmbH, Würzburg, Germany
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Wiendl H, Gold R, Berger T, Derfuss T, Linker R, Mäurer M, Aktas O, Baum K, Berghoff M, Bittner S, Chan A, Czaplinski A, Deisenhammer F, Di Pauli F, Du Pasquier R, Enzinger C, Fertl E, Gass A, Gehring K, Gobbi C, Goebels N, Guger M, Haghikia A, Hartung HP, Heidenreich F, Hoffmann O, Kallmann B, Kleinschnitz C, Klotz L, Leussink VI, Leutmezer F, Limmroth V, Lünemann JD, Lutterotti A, Meuth SG, Meyding-Lamadé U, Platten M, Rieckmann P, Schmidt S, Tumani H, Weber F, Weber MS, Zettl UK, Ziemssen T, Zipp F. Multiple Sclerosis Therapy Consensus Group (MSTCG): position statement on disease-modifying therapies for multiple sclerosis (white paper). Ther Adv Neurol Disord 2021; 14:17562864211039648. [PMID: 34422112 PMCID: PMC8377320 DOI: 10.1177/17562864211039648] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [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] [Received: 05/27/2021] [Accepted: 07/28/2021] [Indexed: 12/20/2022] Open
Abstract
Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, and Switzerland).
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Affiliation(s)
- Heinz Wiendl
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster
| | - Ralf Gold
- Neurologie, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791 Bochum, Germany
| | - Thomas Berger
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Austria
| | - Tobias Derfuss
- Neurologische Klinik und Poliklinik, Universitätsspital Basel, Basel, Switzerland
| | - Ralf Linker
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Mathias Mäurer
- Neurologie und Neurologische Frührehabilitation, Klinikum Würzburg Mitte gGmbH, Standort Juliusspital, Würzburg, Germany
| | - Orhan Aktas
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Karl Baum
- Neurologie, Klinik Hennigsdorf, Hennigsdorf, Germany
| | | | - Stefan Bittner
- Klinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Andrew Chan
- Neurologie, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | | | | | | | | | - Christian Enzinger
- Universitätsklinik für Neurologie, Medizinische Universität Graz, Graz, Austria
| | - Elisabeth Fertl
- Wiener Gesundheitsverbund, Neurologische Abteilung, Wien, Austria
| | - Achim Gass
- Neurologische Klinik, Universitätsmedizin Mannheim/Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Klaus Gehring
- Berufsverband Deutscher Nervenärzte (BVDN), Neurozentrum am Klosterforst, Itzehoe, Germany
| | | | - Norbert Goebels
- Klinik für Neurologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Guger
- Klinik für Neurologie 2, Kepler Universitätsklinikum, Linz, Austria
| | | | - Hans-Peter Hartung
- Klinik für Neurologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany; Klinik für Neurologie, Medizinische Universität Wien, Wien, Austria
| | - Fedor Heidenreich
- Diakovere Krankenhaus, Henriettenstift, Klinik für Neurologie und klinische Neurophysiologie, Hannover, Germany
| | - Olaf Hoffmann
- Klinik für Neurologie, Alexianer St. Josefs-Krankenhaus Potsdam, Potsdam, Germany; NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany; Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Boris Kallmann
- Kallmann Neurologie, Multiple Sklerose Zentrum Bamberg, Bamberg, Germany
| | | | - Luisa Klotz
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Münster, Germany
| | | | - Fritz Leutmezer
- Neurologie, Universitäts-Klinik für Neurologie Wien, Wien, Austria
| | - Volker Limmroth
- Klinik für Neurologie, Krankenhaus Köln-Merheim, Köln, Germany
| | - Jan D Lünemann
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Münster, Germany
| | | | - Sven G Meuth
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | | | - Michael Platten
- Neurologische Klinik, Universitätsmedizin Mannheim/Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Peter Rieckmann
- Medical Park, Fachklinik für Neurologie, Zentrum für Klinische Neuroplastizität, Bischofswiesen, Germany
| | - Stephan Schmidt
- Neurologie, Gesundheitszentrum St. Johannes Hospital, Bonn, Germany
| | - Hayrettin Tumani
- Fachklinik für Neurologie Dietenbronn, Akademisches Krankenhaus der Universität Ulm, Ulm, Germany
| | - Frank Weber
- Neurologie, Sana Kliniken, Cham, Switzerland
| | - Martin S Weber
- Institut für Neuropathologie, Neurologische Klinik, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Uwe K Zettl
- Klinik und Poliklinik für Neurologie, Zentrum für Nervenheilkunde, Universitätsmedizin Rostock, Rostock, Germany
| | - Tjalf Ziemssen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Frauke Zipp
- Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
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Wiendl H, Gold R, Berger T, Derfuss T, Linker R, Mäurer M, Stangel M, Aktas O, Baum K, Berghoff M, Bittner S, Chan A, Czaplinski A, Deisenhammer F, Di Pauli F, Du Pasquier R, Enzinger C, Fertl E, Gass A, Gehring K, Gobbi C, Goebels N, Guger M, Haghikia A, Hartung HP, Heidenreich F, Hoffmann O, Hunter ZR, Kallmann B, Kleinschnitz C, Klotz L, Leussink V, Leutmezer F, Limmroth V, Lünemann JD, Lutterotti A, Meuth SG, Meyding-Lamadé U, Platten M, Rieckmann P, Schmidt S, Tumani H, Weber MS, Weber F, Zettl UK, Ziemssen T, Zipp F. [Multiple sclerosis treatment consensus group (MSTCG): position paper on disease-modifying treatment of multiple sclerosis 2021 (white paper)]. Nervenarzt 2021; 92:773-801. [PMID: 34297142 PMCID: PMC8300076 DOI: 10.1007/s00115-021-01157-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 12/16/2022]
Abstract
Die Multiple Sklerose ist eine komplexe, autoimmun vermittelte Erkrankung des zentralen Nervensystems, charakterisiert durch inflammatorische Demyelinisierung sowie axonalen/neuronalen Schaden. Die Zulassung verschiedener verlaufsmodifizierender Therapien und unser verbessertes Verständnis der Krankheitsmechanismen und -entwicklung in den letzten Jahren haben die Prognose und den Verlauf der Erkrankung deutlich verändert. Diese Aktualisierung der Behandlungsempfehlung der Multiple Sklerose Therapie Konsensus Gruppe konzentriert sich auf die wichtigsten Empfehlungen für verlaufsmodifizierende Therapien der Multiplen Sklerose im Jahr 2021. Unsere Empfehlungen basieren auf aktuellen wissenschaftlichen Erkenntnissen und gelten für diejenigen Medikamente, die in weiten Teilen Europas, insbesondere in den deutschsprachigen Ländern (Deutschland, Österreich, Schweiz), zugelassen sind.
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Affiliation(s)
- Heinz Wiendl
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Westfälische Wilhelms-Universität Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland. .,Steuerungsgruppe der MSTKG, Münster, Deutschland. .,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.
| | - Ralf Gold
- Steuerungsgruppe der MSTKG, Münster, Deutschland. .,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland. .,Neurologie, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
| | - Thomas Berger
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Österreich
| | - Tobias Derfuss
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Neurologische Klinik und Poliklinik, Universitätsspital Basel, Basel, Schweiz
| | - Ralf Linker
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Mathias Mäurer
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Neurologie und Neurologische Frührehabilitation, Klinikum Würzburg Mitte gGmbH, Standort Juliusspital, Würzburg, Deutschland
| | - Martin Stangel
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Klinische Neuroimmunologie und Neurochemie, Klinik für Neurologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Orhan Aktas
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Karl Baum
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Martin Berghoff
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Stefan Bittner
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Andrew Chan
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Adam Czaplinski
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | | | - Franziska Di Pauli
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Renaud Du Pasquier
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Christian Enzinger
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Elisabeth Fertl
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Achim Gass
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Klaus Gehring
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Claudio Gobbi
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Norbert Goebels
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Michael Guger
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Aiden Haghikia
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Hans-Peter Hartung
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Fedor Heidenreich
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Olaf Hoffmann
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Zoë R Hunter
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Boris Kallmann
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | | | - Luisa Klotz
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Verena Leussink
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Fritz Leutmezer
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Volker Limmroth
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Jan D Lünemann
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Andreas Lutterotti
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Sven G Meuth
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Uta Meyding-Lamadé
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Michael Platten
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Peter Rieckmann
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Stephan Schmidt
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Hayrettin Tumani
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Martin S Weber
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Frank Weber
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Uwe K Zettl
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Tjalf Ziemssen
- Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland
| | - Frauke Zipp
- Steuerungsgruppe der MSTKG, Münster, Deutschland.,Multiple Sklerose Therapie Konsensus Gruppe (MSTKG), Münster, Deutschland.,Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
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Meuth SG, Bayas A, Kallmann B, Kleinschnitz C, Linker R, Rieckmann P, Mäurer M. Long-term management of multiple sclerosis patients treated with cladribine tablets: an expert opinion. Expert Opin Pharmacother 2020; 21:1965-1969. [DOI: 10.1080/14656566.2020.1792885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Sven G. Meuth
- Abteilung für Neurologie, Universitätsklinikum Münster, Münster, Germany
| | - Antonios Bayas
- Klinik für Neurologie und Klinische Neurophysiologie, Universitätsklinikum Augsburg, Germany
| | | | | | - Ralf Linker
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg, Germany
| | | | - Mathias Mäurer
- Klinik für Neurologie, Juliusspital Würzburg Klinikum Würzburg Mitte gGmbH, Germany
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Freedman M, Inshasi J, Ramió-torrentà L, Zaffaroni M, De Seze J, Ahn S, Macdonell R, Miller A, Kallmann B, Rog D, Benamor M. Long-term Efficacy and Safety of Teriflunomide: An Analysis of Pooled Clinical Trials. Mult Scler Relat Disord 2018. [DOI: 10.1016/j.msard.2018.10.084] [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] [Indexed: 11/17/2022]
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Trojano M, Butzkueven H, Kappos L, Wiendl H, Spelman T, Pellegrini F, Chen Y, Dong Q, Koendgen H, Belachew S, Correale J, Caride A, Deri NH, Ballario C, Broadley S, Kneebone C, Barnett M, Pollard J, Hodgkinson S, Kermode A, Macdonell R, King J, Butzkueven H, Lechner-Scott J, Saines N, Slee M, Plummer C, Willekens B, Vanopdenbosch L, Belachew S, Phan-Ba R, Delvaux V, Bissay V, Debruyne J, Decoo D, Crols R, Symons A, Nagels G, Van Pesch V, Sindic C, Dubois B, Medaer R, D'Hooghe M, Guillaume D, De Smet E, Seeldrayers P, Lysandropoulos A, Vokaer M, Geens K, Willems C, Denayer P, Bureau M, Retif C, Dupuis M, Bouquiaux O, Vanderdonckt P, van Landegem W, Caekebeke J, Van Ingelghem E, Peeters K, Gerard P, de Noordhout AM, Desfontaines P, Urbain E, Declercq I, Van Wijmeersch B, Vanroose E, Wibail A, Barthomolé E, Ursell M, Sweet ME, Howse D, Jichici D, Shawush M, Namaka M, Traboulsee A, Hashimoto S, Lo R, Marchetti P, Lapierre Y, Jacques F, MacLean G, Bhan V, Duquette P, Stewart B, Paulseth J, Kremenchutzky M, Vorobeychik G, O'Connor P, Grand'Maison F, Havrdova E, Meluzinová E, Valis M, Talab R, Stourac P, Zapletalová O, Dufek M, Sládková V, Novotna A, Vancurová R, Lhotaková L, Fiedler J, Vachova M, Dolezil D, Stetkarova I, Rehankova A, Psenica P, Ulehlova V, Feketova S, Skoda O, Färkkilä M, Taneli S, Koivisto K, Seppä JM, Airas L, Elovaara I, Hartikainen P, Pirttila T, Louchart P, Ille O, Thenint JP, Godet E, Vioud MM, Colamarino R, Gugenheim M, Grimaud J, Kopf A, Billy C, Huttin B, Borsotti JP, Devos P, Kendjuo JBN, Verier A, Chapuis S, Daluzeau N, Angibaud G, Uriot MSA, Ziegler F, Sellal F, Moulignier A, Lavenu I, Ismail S, Devy R, Suceveanu M, Wagner M, Marcel S, Derouiche F, Mostoufizadehghalamfarsa S, Delalande S, Ruggieri I, Van Nieuwenhuyse CB, Nifle C, Ondze B, Vasilescu CG, Vongsouthi C, Coustans M, Anne O, Amevigbe J, Servan J, Merienne M, Eck P, Berroir S, Busson P, Barroso B, Larrieu JM, Giendaj CL, Malkoun I, Hautecoeur P, Kwiatkowski A, Pouliquen A, Garrigues G, Delerue O, Giraud P, Gere J, Vaunaize J, Dereeper O, Seiller N, Alsassa R, Vlaicu M, Neuville V, Faucheux JM, Bernady P, Fanjaud G, Viallet F, Schroeter M, Schlemilch-Paschen S, Lange T, Bohr KA, Jendroska K, Rehkopf E, Bergmann A, Kleinschnitz C, Postert T, Scholz P, Mauz U, Stratmann H, Siefjediers V, Prantl M, Gehring K, Zellner R, Junge K, Zellner A, Bacay V, Schlegel E, Polzer U, Strauss E, Link A, Stenzel C, Freidel M, Drews J, Neudert C, Schmitz F, Jaeger J, Masri S, Heuberger W, Trausch B, Ruhnke O, Scarel S, Bach K, Ernst M, Landefeld H, Richter N, Schmidt S, Krause M, Dressel A, Ruth R, Anvari K, Gossling J, Schenk C, Tiedge O, Bode L, Eder HT, Pfeffer O, Krug R, Lassek C, Fleischer E, Meuth S, Klotz LH, Peglau I, Kukowski B, Herting B, Guthke K, Schierenbeck J, Brockmeier B, Albrecht H, Wuttke M, Augspach-Hofmann R, Gunther S, Redbrake M, Franke C, Buchner K, Gratz T, Horn R, Doemges F, Schreiber M, Brosch T, Horn M, Kittlitz M, Vulturius G, Hinse P, Malessa R, Wiehler S, Katsarava Z, Kastrup O, Kausch U, Gullekes M, Fickinger M, Wenzel W, Botefur IC, Reifschneider G, Rauer S, Lang M, Harms L, Eckhardt U, Cursiefen S, Linker R, Angstwurm K, Haas J, Schuetze I, Rohm E, Stienker-Fisse H, Sailer M, Bohringer J, Maurer M, Bause E, Wersching R, Dachsel R, Domke S, Hoffman F, Tackenberg B, Roch K, Ziebold U, Kallmann B, Buehler B, Faiss J, Faiss J, Schimrigk S, Menges C, Knop KC, Koehler W, Siever A, Bufler J, Gramsl G, Kuhnler B, Maschke M, Stogbauer F, Staude L, Bethke F, Bitsch A, Harmjanz AD, Windsheimer J, Kieseier BC, Berkenfeld R, Tumani H, Kirsch M, Wildemann B, Daniels R, Gottwald K, Elias WG, Hoffmann O, Schwab M, Pilz C, Klostermann F, Hellwig K, Berthele A, Bayas A, Molitor D, Grothe C, Wagner B, Karageorgiou K, Mitsikostas D, Kodounis A, Plaitakis A, Papadimitriou A, Grigoriadis N, Vlaikidis N, Koutlas E, Kyritsis A, Papathanassopoulos P, Makris N, Tavernarakis A, Scarpini E, Montanari E, Marrosu MG, Trojano M, Amato MP, Rottoli M, Lugaresi A, Florio C, Gasperini C, Grimaldi L, Millefiorini E, Koudriavtseva T, Perla F, Mantegazza R, Bertolotto A, Ghezzi A, Aguilar SQ, Eisenberg ES, Lopez LL, Estudillo RM, Schrijver H, Wittebol M, Baart J, van Golde A, Hengstman G, Pop P, Bos (Geldrop) M, Medaer R, Schyns-Soeterboek A, van der Zwart A, van Diepen A, Verheul G, Verhagen W, Bos (Helmond) M, Witjes R, Sinnige L, van Munster E, Sanders E, van Dijl R, Hupperts R, Frequin S, Visser L, Henselmans J, Moll J, Midgard R, Myhr KM, Edland A, Telstad W, Hognestad T, Lund C, Hovdal H, Kamaljit K, Schepel J, Hogenesch RI, Schüler S, Odeh F, Alstadhaug KB, Korsgaard O, Farbu E, Ingvaldsen TB, Soares (SCO) D, Rente J, Guerra JMC, Morganho A, Leitão A, de Sá J, Sá MJ, Marques P, Veloso M, Baptista MV, Szilasiová J, Copikova-Cudrakova D, Prochazkova L, Klimová E, Donath V, Brozman M, Ramo C, Ruiz DP, Hernández CC, Sola MEM, Moro RS, Vidal JA, Rodríguez ABC, Ozaeta GM, Nadal JB, Esquide AADA, Urtaza JO, Martínez-Yélamos S, Arbizu T, Torrenta LRI, Boggild M, Wilson M, Al-Araji A, Nicholas R, Harrower T, Redmond I, Wolf T, Osei-Bonsu M, Mazibrada G, Rog D, Cottrell D, Constantinescu C, Gray O, Belhag M, Shehu A, Rashid W, Duddy M. Natalizumab treatment shows low cumulative probabilities of confirmed disability worsening to EDSS milestones in the long-term setting. Mult Scler Relat Disord 2018; 24:11-19. [DOI: 10.1016/j.msard.2018.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 11/30/2022]
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Schmidt S, Koehler J, Winterstein C, Schicklmaier P, Kallmann B. An epidemiological study on the course of disease and therapeutic considerations in relapsing-remitting multiple sclerosis patients receiving injectable first-line disease-modifying therapies in Germany (EPIDEM). Ther Adv Neurol Disord 2018; 11:1756285617749802. [PMID: 29399053 PMCID: PMC5788096 DOI: 10.1177/1756285617749802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/17/2016] [Accepted: 07/16/2017] [Indexed: 11/30/2022] Open
Abstract
Background: In relapsing–remitting multiple sclerosis (RRMS), ‘no evidence of disease activity’ (NEDA) is regarded as a key treatment goal. The increasing number of treatments allows for individualized treatment optimization in patients with suboptimal response to first-line disease-modifying therapies (DMTs). Therefore, monitoring of clinical and subclinical disease activity on DMTs has been recognized as an important component of long-term patient management. Methods: EPIDEM was a multicenter non-interventional retrospective study in a large cohort of RRMS patients receiving injectable DMTs for at least 2 years in outpatient centers throughout Germany. It documented measures and ratings of disease activity on DMTs to characterize the factors that made the treating neurologists consider to switch therapy towards potentially more effective or better-tolerated drugs. Results: The cohort included predominantly female patients with a mean age of 45 years and a mean disease duration of 9.6 years, who had been continuously treated with an injectable DMT for a median duration of 54 months. Overall, 34.0% of the patients had experienced ⩾1 relapse on any DMT in the previous 2 years; 21.0% exhibited magnetic resonance imaging (MRI) activity, and the Kurtzke Expanded Disability Status Scale (EDSS) score increased by at least 0.5 points in 20.1%. Overall, 50.3% of the patients with EDSS progression and 70.6% of the patients with relapses were assessed as clinically stable by the neurologists. A change of treatment was considered in a fraction of patients with disease activity: in 22.8% of those with relapse activity, in 37.8% of those with MRI activity and in 20.1% of those with EDSS progression. Conclusion: The results of EPIDEM underline the importance of standardized evaluation and documentation of ongoing disease activity and disability deterioration. Judged from the present data, the current paradigm of low tolerance for disease activity and recommendations for early treatment optimization have not been turned fully into action as yet. More widespread implementation of current guideline recommendations may allow patients to more benefit from the growing panel of effective treatment options.
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Affiliation(s)
- Stephan Schmidt
- Neurologische Gemeinschaftspraxis, Kölnstr. 54, 53111 Bonn, Germany
| | - Jürgen Koehler
- Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke Gemeinnützige GmbH, Kempfenhausen, Germany
| | | | | | - Boris Kallmann
- Multiple Sklerose Zentrum Bamberg (MSZB), Bamberg, Germany
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Bayas A, Ouallet JC, Kallmann B, Hupperts R, Fulda U, Marhardt K. Adherence to, and effectiveness of, subcutaneous interferon β-1a administered by RebiSmart® in patients with relapsing multiple sclerosis: results of the 1-year, observational SMART study. Expert Opin Drug Deliv 2015; 12:1239-50. [PMID: 26098143 DOI: 10.1517/17425247.2015.1057567] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 11/05/2022]
Abstract
BACKGROUND Patients with multiple sclerosis who have poor adherence to treatment have a higher risk of relapse than adherent patients. This study assessed adherence to, and effectiveness and convenience of, treatment with subcutaneous (sc) interferon (IFN) β-1a (Rebif®, Merck Serono SA) 44 or 22 μg three times weekly in patients with relapsing multiple sclerosis (RMS) using the RebiSmart® electronic, multidose, autoinjector for 1 year. STUDY DESIGN European, multicentre, observational study among neurologists: inclusion criteria included RMS, Expanded Disability Status Scale score ≤ 6, sc IFN β-1a administered by RebiSmart for ≤ 6 weeks. The primary endpoint was cumulative adherence recorded by RebiSmart. RESULTS The safety population included 912 patients, 77.4% (n = 823) of whom completed the Month-12 visit. Mean (± standard deviation) cumulative adherence was 97.1 ± 7.3% (n = 791). The most common reason for missed injection was 'forgot to inject' (37.0%). At Month 12/ED, 79.5% of patients were relapse-free. Of 353 patients who rated the convenience of the device, 68.3% found injecting 'very easy'. No unknown safety issues were detected. CONCLUSIONS Patients with RMS self-injecting sc IFN β-1a with RebiSmart had excellent adherence at Month 12/ED, which was associated with good clinical outcomes and no unexpected safety issues. Patients rated RebiSmart as convenient and easy to use.
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Affiliation(s)
- Antonios Bayas
- Department of Neurology, Klinikum Augsburg , Stenglinstr 2, D-86156, Augsburg , Germany +49 821 400 3892 ; +49 821 400 2691 ;
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Stangel M, Penner I, Kallmann B, Lukas C, Kieseier B, Gold R. Multiple Sclerosis Decision Model (MSDM): Entwicklung eines Mehrfaktorenmodells zur Beurteilung des Therapie- und Krankheitsverlaufs bei schubförmiger Multipler Sklerose. Akt Neurol 2013. [DOI: 10.1055/s-0033-1349643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M. Stangel
- Klinische Neuroimmunologie und Neurochemie, Neurologische Klinik, Medizinische Hochschule Hannover
| | - I. Penner
- Kognitive Psychologie und Methodologie, Universität Basel, Schweiz
| | | | - C. Lukas
- Institut für diagnostische und interventionelle Radiologie, St. Josef Hospital, Ruhr-Universität Bochum
| | - B. Kieseier
- Neurologische Klinik, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf
| | - R. Gold
- Klinik für Neurologie, St. Josef Hospital, Ruhr-Universität Bochum
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Chan A, Walter U, Kallmann B, Wernsdoerfer C, Zingler V. Monitoring and management of MS patients starting natalizumab therapy in Germany — /INS;Final results of the prospective TYSTART study. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1386] [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] [Indexed: 10/26/2022]
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Valenza G, Kallmann B, Berend A, Mlynski R, Nöckler K, Kurzai O, Frosch M, Abele-Horn M. Isolation of Brucella melitensis from a patient with hearing loss. Eur J Clin Microbiol Infect Dis 2006; 25:67-8. [PMID: 16418830 DOI: 10.1007/s10096-006-0084-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G Valenza
- Institute of Hygiene and Microbiology, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany.
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Rieckmann P, Toyka KV, Bassetti C, Beer K, Beer S, Buettner U, Chofflon M, Götschi-Fuchs M, Hess K, Kappos L, Kesselring J, Goebels N, Ludin HP, Mattle H, Schluep M, Vaney C, Baumhackl U, Berger T, Deisenhammer F, Fazekas F, Freimüller M, Kollegger H, Kristoferitsch W, Lassmann H, Markut H, Strasser-Fuchs S, Vass K, Altenkirch H, Bamborschke S, Baum K, Benecke R, Brück W, Dommasch D, Elias WG, Gass A, Gehlen W, Haas J, Haferkamp G, Hanefeld F, Hartung HP, Heesen C, Heidenreich F, Heitmann R, Hemmer B, Hense T, Hohlfeld R, Janzen RWC, Japp G, Jung S, Jügelt E, Koehler J, Kölmel W, König N, Lowitzsch K, Manegold U, Melms A, Mertin J, Oschmann P, Petereit HF, Pette M, Pöhlau D, Pohl D, Poser S, Sailer M, Schmidt S, Schock G, Schulz M, Schwarz S, Seidel D, Sommer N, Stangel M, Stark E, Steinbrecher A, Tumani H, Voltz R, Weber F, Weinrich W, Weissert R, Wiendl H, Wiethölter H, Wildemann U, Zettl UK, Zipp F, Zschenderlein R, Izquierdo G, Kirjazovas A, Packauskas L, Miller D, Koncan Vracko B, Millers A, Orologas A, Panellus M, Sindic CJM, Bratic M, Svraka A, Vella NR, Stelmasiak Z, Selmaj K, Bartosik-Psujik H, Mitosek-Szewczyk K, Belniak E, Mochecka A, Bayas A, Chan A, Flachenecker P, Gold R, Kallmann B, Leussink V, Mäurer M, Ruprecht K, Stoll G, Weilbach FX. Escalating immunotherapy of multiple sclerosis--new aspects and practical application. J Neurol 2005; 251:1329-39. [PMID: 15592728 DOI: 10.1007/s00415-004-0537-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [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: 12/03/2003] [Revised: 05/07/2004] [Accepted: 05/17/2004] [Indexed: 11/24/2022]
Abstract
Recent clinical studies in multiple sclerosis (MS) provide new data on the treatment of clinically isolated syndromes, on secondary progression, on direct comparison of immunomodulatory treatments and on dosing issues. All these studies have important implications for the optimized care of MS patients. The multiple sclerosis therapy consensus group (MSTCG) critically evaluated the available data and provides recommendations for the application of immunoprophylactic therapies. Initiation of treatment after the first relapse may be indicated if there is clear evidence on MRI for subclinical dissemination of disease. Recent trials show that the efficacy of interferon beta treatment is more likely if patients in the secondary progressive phase of the disease still have superimposed bouts or other indicators of inflammatory disease activity than without having them. There are now data available, which suggest a possible dose-effect relation for recombinant beta-interferons. These studies have to be interpreted with caution, as some potentially important issues in the design of these studies (e. g. maintenance of blinding in the clinical part of the study) were not adequately addressed. A meta-analysis of selected interferon trials has been published challenging the value of recombinant IFN beta in MS. The pitfalls of that report are discussed in the present review as are other issues relevant to treatment including the new definition of MS, the problem of treatment failure and the impact of cost-effectiveness analyses. The MSTCG panel recommends that the new diagnostic criteria proposed by McDonald et al. should be applied if immunoprophylactic treatment is being considered. The use of standardized clinical documentation is now generally proposed to facilitate the systematic evaluation of individual patients over time and to allow retrospective evaluations in different patient cohorts. This in turn may help in formulating recommendations for the application of innovative products to patients and to health care providers. Moreover, in long-term treated patients, secondary treatment failure should be identified by pre-planned follow-up examinations, and other treatment options should then be considered.
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Affiliation(s)
- P Rieckmann
- Dept. of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
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Kallmann B, Büttner S, Toyka K, Reiners K, Rieckmann P. Prognostischer Wert von evozierten Potentialen für den Krankheitsverlauf bei der Multiplen Sklerose. Akt Neurol 2004. [DOI: 10.1055/s-2004-833093] [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] [Indexed: 10/28/2022]
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Spech E, Kallmann B, Kroner A, Petzold A, Miller D, Thompson A, Giovannoni G, Toyka K, Rieckmann P. Unterschiede im Genexpressionsmuster bei schubförmiger und primär progredienter Multipler Sklerose. Akt Neurol 2004. [DOI: 10.1055/s-2004-833320] [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] [Indexed: 10/28/2022]
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Abstract
Inflammation has always been thought of as detrimental in the pathophysiology of multiple sclerosis (MS). However, emerging genetic data, magnetic-resonance-imaging studies, and immunopathological evidence challenge this simplistic view. The evidence leads to the conclusion that inflammation is tightly regulated, and that its net effect may be beneficial in MS, thus explaining some of the results from recent trials of anti-inflammatory agents. We argue that the use of anti-inflammatory drugs to treat MS may not be appropriate in all cases. Precise identification of the inflammatory pathways to be targeted in the different phases of the disease and the timing of such interventions are therefore crucial.
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Affiliation(s)
- Gianvito Martino
- Department of Neuroscience, San Raffaele Scientific Institute, Milan, Italy.
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Michel U, Kallmann B, Rieckmann P, Isbrandt D. UM 9(5)h and UM 9(5)p, human and porcine noncoding transcripts with preferential expression in the cerebellum. RNA 2002; 8:1538-1547. [PMID: 12515386 PMCID: PMC1370359] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We compared the gene expression patterns of fetal and adult porcine brains and identified a sequence tag that was more abundant in adult than in fetal brain. The RNA corresponding to the sequence tag has the highest expression level in adult cerebellum. Lower expression levels of the transcript were found in adult cerebrum, pituitary, and uterus, as well as in fetal brain, heart, intestine, kidney, and liver. The sequence tag was used to screen a cDNA library from adult porcine brain. Two independent clones of 2,273 nt and 1,701 nt were isolated. The shorter cDNA is a 5'-truncated form of the longer clone, and both clones have almost identical sequences with multiple start and stop codons in all three reading frames. Screening of two different human brain cDNA libraries with porcine cDNA probes resulted in four overlapping cDNA fragments, which were assembled to one contig of 2,336 nt in length. Like noncoding RNAs, the porcine and human sequences have no common conserved open reading frame and share stretches of high homology interrupted by stretches with almost no homology. The human and porcine RNAs were named UM 9(5)h and UM 9(5)p, respectively. They are part of larger transcripts, which are transcribed from single-copy genes, they have very similar tissue distributions, and their sequences are colinear with the respective genomic fragment.
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Affiliation(s)
- Uwe Michel
- Neurologische Klinik, 37075 Göttingen, Germany.
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Flachenecker P, Kümpfel T, Kallmann B, Gottschalk M, Grauer O, Rieckmann P, Trenkwalder C, Toyka KV. Fatigue in multiple sclerosis: a comparison of different rating scales and correlation to clinical parameters. Mult Scler 2002; 8:523-6. [PMID: 12474995 DOI: 10.1191/1352458502ms839oa] [Citation(s) in RCA: 425] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Fatigue is one of the most common, yet poorly defined, disabling symptoms in patients with multiple sclerosis (MS). To delineate more clearly the frequency and type of fatigue, we first compared four widely used fatigue scales in consecutive MS patients. Secondly, to further clarify the nature of fatigue, we investigated its relation to physical disability, course of the disease, immunotherapy, and depression. PATIENTS AND METHODS Between February and September 2000, 151 consecutive MS patients entering our outpatient clinic (94 relapsing-remitting, 50 secondary progressive, and 7 primary progressive patients; mean age 29.0 +/- 7.3 years, mean disease duration 9.9 +/- 6.7 years, median EDSS 3.5) filled in a standardized questionnaire induding four fatigue scales--Fatigue Severity Scale (FSS), MS-specific FSS (MFSS), Modified Fatigue Impact Scale (MFIS), and Visual Analogue Scale (VAS). Patients were included in the 'MS-related fatigue group' (MS-F) when they stated in the questionnaire that fatigue: 1) is one of their three most disabling symptoms; 2) occurs daily or on most of the days; and 3) limits their activities at home or at work Patients fulfilling none of these criteria were classified as 'MS-related nonfatigue group' (MS-NF). Depression was measured by Beck's Depression Inventory (BDI). RESULTS Although all scales showed significant differences between MS-F and MS-NF, correlation between these scales was, at best moderate (correlation coeffcients ranging from 0.06 to 0.56). The most discriminative scales were FSS and MFIS, showing no overlap of the 10th and 90th percentiles for the MS-F and MS-NF groups, with cut-off values of 4.6 and 38, respectively. Depression (BDI > or = 18) was present in 24 of 148 patients who filled in the BDI (16%). FSS was significantly correlated with physical disability (r=0.33, p<0.0001) and BDI (r=0.41, p<0.0001), but not with age, disease duration, clinical activity, and treatment with interferon-beta. In multivariate analysis, however, only BDI independently predicted fatigue. CONCLUSIONS The association of fatigue and depression suggests that there might be either common underlying mechanisms or interdependence by a cause-and-effect relationship that requires further investigation. The weak correlation within various fatigue scales is best explained by the fact that fatigue is a multidimensional symptom and, therefore, the available tests measure and weight different aspects of fatigue. Our findings underline the necessity for a more exact definition of fatigue and the development of more valid tools if these are to be used to evaluate treatments.
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Affiliation(s)
- P Flachenecker
- Department of Neurology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.
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Rieckmann P, Jung S, Chan A, Kallmann B, Martin S. Pathogenesis and therapeutic concepts of organ-specific autoimmune diseases: report of an interdisciplinary workshop in Würzburg, April 29-30, 1999. Autoimmunity 2000; 31:283-8. [PMID: 10789994 DOI: 10.3109/08916939908994074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- P Rieckmann
- Department of Neurology, University of Würzburg, Germany
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Kallmann B, Hummel V, Toyka K, Rieckmann P. Interferon-b induces release of soluble adhesion molecules from human cerebral endothelial cells. J Neuroimmunol 1998. [DOI: 10.1016/s0165-5728(98)91311-x] [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] [Indexed: 10/26/2022]
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Rieckmann P, Altenhofen B, Riegel A, Kallmann B, Felgenhauer K. Correlation of soluble adhesion molecules in blood and cerebrospinal fluid with magnetic resonance imaging activity in patients with multiple sclerosis. Mult Scler 1998; 4:178-82. [PMID: 9762670 DOI: 10.1177/135245859800400317] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several studies have reported a positive correlation between levels of soluble adhesion molecules in serum or cerebrospinal fluid and cranial MRI activity. We performed a cross-sectional study in 46 patients with newly diagnosed MS and determined levels of soluble intercellular adhesion molecule-I (sICAM-I) as well as vascular cell adhesion molecule-I (sVCAM-I) in correlation to the number and area of gadolinium enhancing lesions on cranial magnetic resonance images (MRI). The data revealed a significant positive correlation between sVCAM-I serum levels and gadolinium enhancing lesions. In addition, CSF to serum ratios for sICAM-I and sVCAM-I correlated to MRI activity. In patients with a single enhancing lesion (SEL) there was a negative correlation between the QsCAM and the distance of the SEL to the ventricles. As these adhesion molecules are stable and markers of disease activity in MS, we further investigated sVCAM-I serum levels during treatment with interferon beta-Ib (Betaferon). Significant increases in serum levels for sVCAM-I in patients receiving Betaferon were associated with a favourable treatment response after 1 year in 17 out of 19 patients and correlated to decreased MRI activity, whereas stable or reduced sVCAM-I levels occurred more often in non-responders (five out of six patients). Therefore it can be hypothesized that soluble adhesion molecules are released from cerebral endothelial cells as an early immunoregulatory activity of the immune system to reduce cellular traffic across the blood brain barrier and this is further enhanced by IFN-beta treatment.
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Affiliation(s)
- P Rieckmann
- Department of Neurology, University of Würzburg, Germany
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Rieckmann P, Altenhofen B, Riegel A, Kallmann B, Felgenhauer K. Correlation of soluble adhesion molecules in blood and cerebrospinal fluid with magnetic resonance imaging activity in patients with multiple sclerosis. Mult Scler 1998. [DOI: 10.1191/135245898678909457] [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] [Indexed: 11/05/2022]
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Abstract
It has been shown earlier in an in-vitro model of inflammatory islet cell death that activated macrophages lyse islet cells via the release of nitric oxide. Here we report that cyclosporin A suppresses macrophage cytotoxicity. Control experiments showed that the immunosuppressive drug does not improve the defences of islet cells against nitric oxide but inhibits the release of nitric oxide from LPS-stimulated macrophages. This property of cyclosporin A may contribute to the preservation of beta cell function seen in cyclosporin A-treated patients with recent onset type I diabetes.
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Affiliation(s)
- V Burkart
- Diabetes-Forschungsinstitut, Universität Düsseldorf, Germany
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Kallmann B, Burkart V, Kröncke KD, Kolb-Bachofen V, Kolb H. Toxicity of chemically generated nitric oxide towards pancreatic islet cells can be prevented by nicotinamide. Life Sci 1992; 51:671-8. [PMID: 1386894 DOI: 10.1016/0024-3205(92)90240-p] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Previous studies have indicated that nitric oxide is involved in the lysis of pancreatic islet cells by inflammatory macrophages. Here we show that the incubation of islet cells with chemical NO-donors leads to cell lysis in a concentration and time dependent way. Islet cell death could be prevented by nicotinamide and 3-aminobenzamide, which are known to inhibit ADP-ribosylation, while several scavengers of oxygen radicals, N-acetylcysteine, dihydrolipoic acid, dimethylthiourea and citiolone, provided no protection.
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Affiliation(s)
- B Kallmann
- Diabetes Research Institute University of Düsseldorf, Germany
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