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Rojas JI, Carnero Contentti E, Alonso R, Tavolini D, Burgos M, Federico B, Patrucco L, Cristiano E. Burden of treatment and quality of life in relapsing remitting multiple sclerosis patients under early high efficacy therapy in Argentina: Data from the Argentinean registry. Mult Scler Relat Disord 2024; 85:105543. [PMID: 38520948 DOI: 10.1016/j.msard.2024.105543] [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: 06/20/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/25/2024]
Abstract
The objective of this study was to describe and compare the burden of treatment (BOT) and the quality of life (QoL) in early high efficacy therapy (HET) vs. escalation therapy in relapsing remitting multiple sclerosis (RRMS) patients included in RelevarEM, the Argentinean registry of MS (RelevarEM, NCT 03,375,177). METHODS cross sectional study conducted between September and December 2022. Participating patients were adults, RRMS patients who initiated (during the last three years) their treatment with a HET (natalizumab, ocrelizumab, alemtuzumab, cladribine) or with escalation treatment (beta interferon, glatiramer acetate, teriflunomide, dimethyl fumarate or fingolimod). Clinical and demographic aspect were collected. QoL and BOT was measured with the validated to Spanish MusiQol and BOT questionnaire. Propensity score (PS)-based nearest-neighbor matching was applied to homogenize groups. Comparisons were be done using a linear regression analysis model stratified by matched pairs, with BOT and QoL assessments as main outcomes. RESULTS 269 patients were included in the analysis, mean age 33.7 ± 5.7 years, 193 (71.7 %) were female. A total of 136 patients were on early HET while 133 were on escalation therapy. In the entire group the mean total BOT score (±SD) was 48.5 ± 15.3 while in the group of patients receiving early HET we observed that the mean BOT score (±SD) was 43.5 ± 12.2 vs. 54.3 ± 13.3 in escalation treatment (p < 0.0001). Regarding the score QoL (±SD), in the entire sample we observed a global score of 77.4 ± 11.2. When we stratified groups, in HET (±SD) it was 81.3 ± 14 vs. 74.1 ± 18.3 in escalation therapy (p = 0.0003). CONCLUSION in this multicenter study that included 269 patients from Argentina we observed in early HET a significantly lower BOT and higher QoL than patients receiving escalation therapy.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Billinghurst 1611, Buenos Aires CP 1181, Argentina.
| | - Edgar Carnero Contentti
- Unidad de Neuroinmunología, Servicio de Neurología, Hospital Alemán de Buenos Aires, Argentina
| | - Ricardo Alonso
- Hospital Ramos Mejía, Buenos Aires, Argentina; Fundación Sanatorio Güemes, Buenos Aires, Argentina
| | | | | | | | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Billinghurst 1611, Buenos Aires CP 1181, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Billinghurst 1611, Buenos Aires CP 1181, Argentina
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Rojas JI, Gracia F, Parciak T, Alonso R, Becker J, Treviño-Frenk I, Alonso-Serena M, Giunta D, Abad P, Carnero-Contentti E, Carrá A, Correa-Díaz EP, Correale J, Cristiano E, Flores J, Fruns M, Galleguillos L, Garcea O, Hamuy F, Lana-Peixoto M, Navas C, Pappais-Alvarenga R, Patrucco L, Rivera V, Tenembaum S, Ysrraelit MC, Peeters LM. [Core data set for real world data in multiple sclerosis: customization for latin america from a global task force recommendation]. Rev Neurol 2024; 78:185-197. [PMID: 38502167 DOI: 10.33588/rn.7807.2023326] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
INTRODUCTION The primary objective of the core data set is to reduce heterogeneity and promote harmonization among data sources in EM, thereby reducing the time needed to execute real life data collection efforts. Recently, a group led by the Multiple Sclerosis Data Alliance has developed a core data set for collecting real-world data on multiple sclerosis (MS) globally. Our objective was to adapt this global data set to the needs of Latin America, so that it can be implemented by the registries already developed and in the process of development in the region. MATERIAL AND METHODS A working group was formed regionally, the core data set created globally was adapted (translation process into Spanish, incorporation of regional variables and consensus on variables to be used). Consensus was obtained through the remote Delphi methodology of a round of questionnaires and remote discussion of the core data set variables. RESULTS A total of 25 professionals from Latin America carried out the adaptation process between November 2022 and July 2023. Agreement was established on a core data set of nine categories and 45 variables, version 2023 to suggest its implementation in developed or developing registries, and MS cohorts in the region. CONCLUSION The core data set seeks to harmonize the variables collected by registries and cohorts in MS in Latin America in order to facilitate said collection and allow collaboration between sources. Its implementation will facilitate real life data collection and collaboration in the region.
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Affiliation(s)
- J I Rojas
- Hospital Alemán, Buenos Aires, Argentina
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - F Gracia
- Hospital Santo Tomás, Panamá, República de Panamá
| | - T Parciak
- Universidad Hasselt, Diepenbeek, Bélgica
| | - R Alonso
- Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
- Universidad de Buenos Aires, Buenos Aires, Argentina
- Sanatorio Güemes, Buenos Aires, Argentina
| | - J Becker
- Universidad Pontificia de Rio Grande do Sul, Porto Alegre, Brasil
| | - I Treviño-Frenk
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | - D Giunta
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - P Abad
- Hospital Metropolitano de Quito, Quito, Ecuador
| | | | - A Carrá
- Hospital Británico, Buenos Aires, Argentina
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - E P Correa-Díaz
- Hospital Carlos Andrade Marín. Universidad Central del Ecuador, Quito, Ecuador
| | | | - E Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - J Flores
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - M Fruns
- Clínica Las Condes , Santiago de Chile, Chile
| | - L Galleguillos
- Clinica Alemana, Santiago de Chile, Chile
- Universidad del Desarrollo, Santiago de Chile, Chile
| | - O Garcea
- Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - F Hamuy
- Hospital IMT, Asunción, Paraguay
| | - M Lana-Peixoto
- Universidad Federal de Minas Gerais, Belo Horizonte, Brasil
| | - C Navas
- Clínica Universitaria Colombia, Bogotá, Colombia
| | | | - L Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - V Rivera
- Universidad de Medicina Baylor, Houston, EE.UU
| | - S Tenembaum
- Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Camerlingo S, Rubinstein F, Celia Ysrraelit M, Correale J, Carnero Contentti E, Rojas JI, Patrucco L, Leguizamon FDV, Tkachuk V, Fernandez Liguori N, Cristiano E, Mainella C, Zanga G, Carra A, Marrodan M, Martinez AD, Silva BA, Alonso R. Clinical impact of gender and age at onset on disease trajectory in primary progressive multiple sclerosis patients. Mult Scler 2024; 30:336-344. [PMID: 38247138 DOI: 10.1177/13524585231219138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Primary-progressive multiple sclerosis (PPMS) is characterized by gradual neurological deterioration without relapses. This study aimed to investigate the clinical impact of gender and age at disease onset on disease progression and disability accumulation in patients with this disease phenotype. METHODS Secondary data from the RelevarEM registry, a longitudinal database in Argentina, were analyzed. The cohort comprised patients with PPMS who met inclusion criteria. Statistical analysis with multilevel Bayesian robust regression modeling was conducted to assess the associations between gender, age at onset, and Expanded Disability Status Scale (EDSS) score trajectories. RESULTS We identified 125 patients with a confirmed diagnosis of PPMS encompassing a total of 464 observations. We found no significant differences in EDSS scores after 10 years of disease progression between genders (-0.08; credible interval (CI): -0.60, 0.42). A 20-year difference in age at onset did not show significant differences in EDSS score after 10 years of disease progression (0.281; CI: -0.251, 0.814). Finally, we also did not find any clinically relevant difference between gender EDSS score with a difference of 20 years in age at onset (-0.021; CI: -0.371, 0.319). CONCLUSION Biological plausibility of gender and age effects does not correlate with clinical impact measured by EDSS score.
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Affiliation(s)
| | - Fernando Rubinstein
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | | | | | - Juan I Rojas
- Centro de Esclerosis Múltiple Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple Buenos Aires (CEMBA), Buenos Aires, Argentina
| | | | - Veronica Tkachuk
- Neurology Department, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | | | - Edgardo Cristiano
- Centro de Esclerosis Múltiple Buenos Aires (CEMBA), Buenos Aires, Argentina
| | | | - Gisela Zanga
- Neurology Department, Hospital Dr. César Milstein, Buenos Aires, Argentina
| | - Adriana Carra
- Neurology Department, Hospital Británico, Buenos Aires, Argentina
| | | | | | | | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple (CUEM), Hospital Ramos Mejía, Buenos Aires, Argentina; Neurology Department, Sanatorio Güemes, Buenos Aires, Argentina
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Deri N, Barboza A, Vrech C, Rey R, Burgos M, Fiol M, CalvoVildoso C, Patrucco L, Jose G, Aliberti P, Chirico D, Federico MB, Seifer G, Piedrabuena R. Clinical characterization of long-term multiple sclerosis (COLuMbus) patients in Argentina: A cross-sectional non-interventional study. Mult Scler Relat Disord 2024; 83:105421. [PMID: 38244525 DOI: 10.1016/j.msard.2023.105421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/19/2023] [Accepted: 12/30/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Most Multiple Sclerosis (MS) clinical trials fail to assess the long-term effects of disease-modifying therapies (DMT) or disability. METHODS COLuMbus was a single-visit, cross-sectional study in Argentina in adult patients with ≥10 years of MS since first diagnosis. The primary endpoint was to determine patient disability using the Expanded Disability Status Scale (EDSS). The secondary endpoints were to evaluate the distribution of diagnoses between relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS), patient demographics, disease history, and the risk of disability progression. The relationship between baseline characteristics and the current disability state and the risk of disability progression was assessed. RESULTS Out of the 210 patients included, 76.7 % had a diagnosis of RRMS and 23.3 % had been diagnosed with SPMS, with a mean disease duration of 17.9 years and 20.5 years, respectively. The mean delay in the initial MS diagnosis was 2.6 years for the RRMS subgroup and 2.8 years for the SPMS subgroups. At the time of cut-off (28May2020), 90.1 % (RRMS) and 75.5 % (SPMS) of patients were receiving a DMT, with a mean of 1.5 and 2.0 prior DMTs, respectively. The median EDSS scores were 2.5 (RRMS) and 6.5 (SPMS). In the RRMS and SPMS subgroups, 23 % and 95.9 % of patients were at high risk of disability, respectively; the time since first diagnosis showed a significant correlation with the degree of disability. CONCLUSIONS This is the first local real-world study in patients with long-term MS that highlights the importance of recognizing early disease progression to treat the disease on time and delay disability.
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Affiliation(s)
- Norma Deri
- Centro de Investigaciones Diabaid, Autonomous City of Buenos Aires, Argentina
| | | | - Carlos Vrech
- Centro Integral de Diagnóstico por Imágenes Marchegiani, Córdoba, Argentina
| | - Roberto Rey
- Neurology Department, Instituto Argentino de Investigación Neurológica (IADIN), Buenos Aires, Argentina
| | | | - Marcela Fiol
- Department of Neurology, Institute for Neurological Research (FLENI) Buenos Aires, Argentina
| | | | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - Gustavo Jose
- Centro Médico Privado de Reumatología, Tucumán, Argentina (currently known as Centro de Investigaciones Médicas Tucumán), Argentina
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Carnero Contentti E, López PA, Pappolla A, Alonso R, Silva B, Deri N, Balbuena ME, Burgos M, Luetic G, Alvez Pinheiro A, Cabrera M, Hryb J, Nofal P, Pestchanker C, Vrech C, Tavolini D, Tkachuk V, Zanga G, Marrodan M, Ysrraelit MC, Correale J, Carrá A, Federico B, Garcea O, Fernandez Liguori N, Patrucco L, Cristiano E, Giunta D, Alonso Serena M, Rojas JI. Incidence of SARS-CoV-2 infection in patients with multiple sclerosis who received SARS-CoV-2 vaccines and are under treatment with high-efficacy therapies in Argentina. Neurol Sci 2024; 45:379-389. [PMID: 38159147 DOI: 10.1007/s10072-023-07282-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
We aimed to evaluate the incidence of SARS-CoV-2 breakthrough infection of SARS-CoV-2 vaccines in people with MS (PwMS) on high-efficacy disease-modifying therapies (HET) included in the national MS registry in Argentina (RelevarEM). METHODS Non-interventional, retrospective cohort study that collected information directly from RelevarEM. Adult PwMS who had been treated for at least 6 months with a HET (ocrelizumab, natalizumab, alemtuzumab, cladribine) who had received at least two doses of SARS-CoV-2 vaccines available in Argentina were included. Full course of vaccination was considered after the second dose of the corresponding vaccines. Cumulative incidence of SARS-CoV-2 infection was reported for the whole cohort by Kaplan-Meier survival curves (which is expressed in percentage) as well as incidence density (which is expressed per 10.000 patients/day with 95% CI). RESULTS Two hundred twenty-eight PwMS were included. Most frequent first and second dose received was AstraZeneca vaccine, followed by Sputnik vaccine. Most frequent HETs used in included patients were cladribine in 79 (34.8%). We found an incidence density of breakthrough COVID-19 infection of 3.5 × 10.000 patients/day (95% CI 2.3-6.7) after vaccination in Argentina. We described the incidence rate after vaccination for every HET used, it being significantly higher for ocrelizumab compared with other HETs (p = 0.005). Only five patients presented a relapse during the follow-up period with no differences regarding the pre-vaccination period. CONCLUSIONS We found an incidence density of breakthrough COVID-19 infection of 3.5 × 10.000 patients/day (95% CI 2.3-6.7) after vaccination in Argentina.
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Affiliation(s)
- Edgar Carnero Contentti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Aleman, Buenos Aires, Argentina.
| | - Pablo A López
- Department of Neurosciences, Neuroimmunology Unit, Hospital Aleman, Buenos Aires, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
- Sanatorio Güemes, Buenos Aires, Argentina
| | - Berenice Silva
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, Buenos Aires, Argentina
- Hospital Fernandez, Buenos Aires, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Geraldine Luetic
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fé, Argentina
| | | | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, Tucumán, Argentina
| | - Claudia Pestchanker
- Neurology Department, Hospital Central Dr. Ramon Carrillo, San Luis, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades Desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | | | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Gisela Zanga
- Departamento de Neurología, Hospital Cesar Milstein, Buenos Aires, Argentina
| | | | | | - Jorge Correale
- Departamento de Neurología, FLENI, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes, Hospital Británico, Buenos Aires, Argentina
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | | | - Orlando Garcea
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina
| | | | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
- Servicio de Neurología, Unidad de EM y Enfermedades Desmielinizantes, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Alonso R, Casas M, Lazaro L, Liguori NF, Pita C, Cohen L, Rojas JI, Pappolla A, Patrucco L, Cristiano E, Burgos M, Vrech C, Piedrabuena R, Pablo L, Deri N, Luetic G, Miguez J, Cabrera M, Martinez A, Zanga G, Tkachuk V, Tizio S, Carnero Contentti E, Knorre E, Leguizamon F, Mainella C, Nofal P, Liwacki S, Hryb J, Menichini M, Pestchanker C, Garcea O, Silva B. Evaluation of the use of high-efficacy treatments (HETs) in patients with relapsing-remitting multiple sclerosis in Argentina. Mult Scler Relat Disord 2023; 79:104935. [PMID: 37634468 DOI: 10.1016/j.msard.2023.104935] [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: 07/27/2022] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Disease-modifying therapies (DMTs) in multiple sclerosis (MS) can be classified according to the efficacy in which they prevent inflammatory activity. To date, there are limited data regarding the use of high-efficacy treatments (HETs) in Latin America (LATAM). We aimed to analyze the use of HETs in Argentina, focusing on the clinical and sociodemographic characteristics of the patients who use these treatments and the changes in the trend of use over the years. METHODS A retrospective cohort study was done using the Argentina MS patient registry, RelevarEM. Patients diagnosed with relapsing-remitting MS (RRMS) according to validated diagnostic criteria and under treatment with natalizumab, alemtuzumab, cladribine, rituximab or ocrelizumab were included. RESULTS Out of 2450 RRMS patients under a DMT, 462 (19%) were on HETs. One third of those patients (35%) received HETs as the first treatment. The most frequent reason for switching to HETs was treatment failure to previous DMT (77%). The time from MS diagnosis to the first HET in treatment-naive patients was less than one year (IQR: 0-1 year) and in treatment-experienced patients it was 5 years (IQR: 3-9 years). Between 2015 and 2017 (P1), 729 patients included in RelevarEM started a new treatment, of which 85 (11.65%) were HETs. Between 2018 and 2020 (P2), 961 patients included in RelevarEM started a new treatment, of which 284 (29.55%) were HETs. When comparing P2 with P1, a significant increase in the use of HETs was observed (p < 0.01). The most frequently used HETs were alemtuzumab (50.59%) in P1, and cladribine (45.20%) in P2. CONCLUSION The demographic and clinical characteristics of patients under HET in Argentina were identified. Based on a real-world setting, we found a significant trend towards and a rapid increase in the use of HETs in clinical practice in patients with RRMS.
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Affiliation(s)
- Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina; Servicio de Neurología, Sanatorio Güemes, Ciudad de Buenos Aires, Argentina
| | - Magdalena Casas
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina
| | - Luciana Lazaro
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina
| | - Nora Fernandez Liguori
- Servicio de Neurología, Sanatorio Güemes, Ciudad de Buenos Aires, Argentina; Servicio de Neurología, Hospital Tornú, Ciudad de Buenos Aires, Argentina
| | - Cecilia Pita
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina
| | - Leila Cohen
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina
| | - Juan Ignacio Rojas
- Centro de esclerosis Múltiple Buenos Aires, Ciudad de Buenos Aires, Argentina; Servicio de Neurología, CEMIC, Ciudad de Buenos Aires, Argentina
| | - Agustín Pappolla
- Centro de esclerosis Múltiple Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de esclerosis Múltiple Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de esclerosis Múltiple Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Carlos Vrech
- Servicio de Neurología, Sanatorio Allende, Córdoba, Spain
| | - Raul Piedrabuena
- Servicio de Neurología, Clínica Universitaria Reina Fabiola, Córdoba, Spain
| | - Lopez Pablo
- Sección de Neuroinmunología, Hospital Alemán, Ciudad de Buenos Aires, Argentina
| | | | | | - Jimena Miguez
- Servicio de neurología, Hospital Italiano, Argentina
| | - Mariela Cabrera
- Servicio de neurología, Hospital Militar, Campo de Mayo, Argentina
| | - Alejandra Martinez
- Servicio de neurología, Hospital Posadas, Ciudad de Buenos Aires, Argentina
| | - Gisela Zanga
- Servicio de neurología, Hospital Cesar Milstein, Ciudad de Buenos Aires, Argentina
| | - Verónica Tkachuk
- Servicio de neurología, Hospital de Clínica José de San Martín, Ciudad de Buenos Aires, Argentina
| | - Santiago Tizio
- Servicio de neurología, Hospital Español, La Plata, Argentina
| | | | - Eduardo Knorre
- Servicio de neurología, Hospital Álvarez, Ciudad de Buenos Aires, Argentina
| | - Felisa Leguizamon
- Servicio de neurología, Hospital Álvarez, Ciudad de Buenos Aires, Argentina
| | | | - Pedro Nofal
- Servicio de neurología, Hospital Nuestra Señora del Carmen, Tucumán, Argentina
| | - Susana Liwacki
- Servicio de neurología, Hospital Córdoba, Córdoba, Spain
| | - Javier Hryb
- Servicio de neurología, Hospital Durand, Ciudad de Buenos Aires, Argentina
| | | | | | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina; Servicio de neurología, Hospital Italiano, Argentina.
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Carnero Contentti E, Lopez PA, Tkachuk V, Vrech C, Zarate MA, Correale J, Deri N, Luetic G, Marrodan M, Pagani Cassara F, Tavolini D, Ysrraelit MC, Balbuena ME, Hryb J, Chiganer E, Leguizamon F, Knorre E, Zanga G, Pestchanker C, Barboza A, Nadur D, Cristiano E, Patrucco L, Alonso R, Alonso Serena M, Paul F, Rojas JI. Frequency of new asymptomatic MRI lesions during attacks and follow-up of patients with NMOSD in a real-world setting. Mult Scler 2023; 29:1240-1249. [PMID: 37491849 DOI: 10.1177/13524585231187120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND We aimed to assess the frequency of new asymptomatic lesions on brain and spinal imaging (magnetic resonance imaging (MRI)) and their association with subsequent relapses in a large cohort of neuromyelitis optica spectrum disorder (NMOSD) patients in Argentina. METHODS We retrospectively reviewed 675 MRI (225 performed during an attack and 450 during the relapse-free period (performed at least 3 months from the last attack)) of NMOSD patients who had at least 2 years of clinical and MRI follow-up since disease onset. Kaplan-Meier (KM) curves were used for depicting time from remission MRI to subsequent relapse. RESULTS We included 135 NMOSD patients (64.4% were aquaporin-4-immunoglobulin G (AQP4-IgG)-positive). We found that 26 (19.26%) and 66 (48.88%) of patients experienced at least one new asymptomatic MRI lesion during both the relapse-free period and attacks, respectively. The most frequent asymptomatic MRI lesions were optic nerves followed by short-segment myelitis during the relapse-free period and attacks. KM curves did not show differences in the time taken to develop a new relapse. CONCLUSION Our findings showed that new asymptomatic lesions are relatively frequent. However, the presence of new asymptomatic MRI lesions during the relapse-free period and at relapses was not associated with a shorter time to developing subsequent relapses.
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Affiliation(s)
| | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades Desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - María A Zarate
- Departamento de Enfermedades Desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - Jorge Correale
- Departamento de Neurología, Fleni, Buenos Aires, Argentina
| | - Norma Deri
- Centro de Especialidades Neurológicas y Rehabilitación, CENyR, Buenos Aires, Argentina
| | | | | | - Fátima Pagani Cassara
- Instituto de Neurociencias, Fundación Favaloro/INECO/Buenos Aires, Argentina Servicio de Neurología, Hospital Universitario Austral, Buenos Aires, Argentina
| | | | | | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Javier Hryb
- Consultorio de Neuroinmunología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Edson Chiganer
- Consultorio de Neuroinmunología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | | | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, Buenos Aires, Argentina
| | - Gisela Zanga
- Departamento de Neurología, Hospital Cesar Milstein, Buenos Aires, Argentina
| | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Freie Universität Berlin, Berlin, Germany
- Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina Servicio de Neurología, Unidad de EM y Enfermedades Desmielinizantes, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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8
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Carnero Contentti E, López PA, Criniti J, Pettinicchi JP, Cristiano E, Patrucco L, Bribiesca Contreras E, Gómez-Figueroa E, Flores-Rivera J, Correa-Díaz EP, Toral Granda AM, Ortiz Yepez MA, Gualotuña Pachacama WA, Piedra Andrade JS, Galleguillos L, Tkachuk V, Nadur D, Daccach Marques V, Soto de Castillo I, Casas M, Cohen L, Alonso R, Caride A, Lana-Peixoto M, Rojas JI. Clinical outcomes and prognostic factors in patients with optic neuritis related to NMOSD and MOGAD in distinct ethnic groups from Latin America. Mult Scler Relat Disord 2023; 72:104611. [PMID: 36907119 DOI: 10.1016/j.msard.2023.104611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Optic neuritis (ON) can be an initial manifestation of neuromyelitis optica spectrum disorder (NMOSD) associated with aquaporin 4-antibody (AQP4-Ab) or myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease (MOGAD). Additionally, both diseases may have overlapping paraclinical and radiological features. These diseases may have different outcomes and prognoses. We aimed to compare clinical outcomes and prognostic features of patients with NMOSD and MOGAD presenting ON as first attack, from different ethnic groups in Latin America. METHODS We conducted a retrospective observational multicenter study in patients from Argentina (n = 61), Chile (n = 18), Ecuador (n = 27), Brazil (n = 30), Venezuela (n = 10) and Mexico (n = 49) with MOGAD or NMOSD related ON. Predictors of disability outcomes at last follow-up, namely visual disability (Visual Functional System Score ≥4), motor disability (permanent inability to walk further than 100 m unaided) and wheelchair dependence based on EDSS score were evaluated. RESULTS After a mean disease duration of 42.7 (±40.2) months in NMOSD and 19.7 (±23.6) in MOGAD, 55% and 22% (p>0.001) experienced permanent severe visual disability (visual acuity from 20/100 to 20/200), 22% and 6% (p = 0.01) permanent motor disability and 11% and 0% (p = 0.04) had become wheelchair dependent, respectively. Older age at disease onset was a predictor of severe visual disability (OR=1,03 CI95%1.01-1.05, p = 0.03); older age at disease onset (OR=1,04 CI95%1.01-1.07, p = 0.01), higher number of relapses (OR=1,32 CI95%1.02-1.71, p = 0.03) and rituximab treatment (OR=0,36 CI95%0.14-0.90, p = 0.02) were predictors of permanent motor disability, whereas ON associated with myelitis at disease onset was a predictor of wheelchair dependency (OR=4,16, CI95%1.23-14.08, p = 0,02) in NMOSD patients. No differences were found when evaluating distinct ethnic groups (Mixed vs. Caucasian vs. Afro-descendant) CONCLUSIONS: NMOSD was associated with poorer clinical outcomes than MOGAD. Ethnicity was not associated with prognostic factors. Distinct predictors of permanent visual and motor disability and wheelchair dependency in NMOSD patients were found.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | | | - Enrique Gómez-Figueroa
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José Flores-Rivera
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | | | | | | | | | - Verónica Tkachuk
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Débora Nadur
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ibis Soto de Castillo
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Bolivarian Republic of Venezuela
| | - Magdalena Casas
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Leila Cohen
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Marco Lana-Peixoto
- Department of Neurology, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina; Service of Neurology, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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9
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Alonso R, Eizaguirre MB, López P, Silva B, Rojas JI, Sinay V, Tkachuk V, Patrucco L, Carra A, Bruno D, Cassara FP, Liguori NF, Tavolini D, Camerlingo S, Garcea O, Galiani A, Mainella C, Barboza A, Luetic G, Contentti EC. Correction to: Argentinean consensus recommendations for the use of telemedicine in clinical practice in adult people with multiple sclerosis. Neurol Sci 2023; 44:1135. [PMID: 36348171 PMCID: PMC10074526 DOI: 10.1007/s10072-022-06497-8] [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: 11/11/2022]
Affiliation(s)
- Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina. .,Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Buenos Aires, Argentina.
| | | | - Pablo López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina.,Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Ignacio Rojas
- Servicio de Neurología, Hospital Universitario CEMIC, CABA, Argentina.,Centro de Esclerosis Múltiple, Buenos Aires, Argentina
| | - Vladimiro Sinay
- Instituto de Neurociencias de Fundación Favaloro E INECO, Buenos Aires, Argentina
| | - Verónica Tkachuk
- Neurology Department, Neuroimmunology Unit, Hospital de Clinicas "José de San Martín", Buenos Aires, Argentina
| | | | - Adriana Carra
- MS Unit Hospital Británico Buenos Aires, Buenos Aires, Argentina
| | | | - Fátima Pagani Cassara
- Instituto de Neurociencias de Fundación Favaloro E INECO, Buenos Aires, Argentina.,Hospital Austral, Buenos Aires, Argentina
| | - Nora Fernández Liguori
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Buenos Aires, Argentina.,Hospital Enrique Tornú, CABA, Argentina
| | | | | | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Agostina Galiani
- Instituto de Neurociencias Cognitivas y Traslacional (INCyT), Fundación INECO, Universidad Favaloro, CONICET, Buenos Aires, Argentina
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10
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Alonso R, Casas M, Lazaro L, Fernandez Liguori N, Pita C, Cohen L, Rojas JI, Pappolla A, Patrucco L, Cristiano E, Burgos M, Vrech C, Piedrabuena R, Pablo L, Deri N, Luetic G, Miguez J, Cabrera M, Martinez A, Zanga G, Tkachuk V, Tizio S, Carnero Contentti E, Knorre E, Leguizamon F, Mainella C, Nofal P, Liwacki S, Hryb J, Menichini M, Pestchanker C, Alonso M, Garcea O, Silva B. Achieving no evidence of disease activity-3 in highly active multiple sclerosis patients treated with cladribine and monoclonal antibodies. Mult Scler J Exp Transl Clin 2023; 9:20552173231154712. [PMID: 36846108 PMCID: PMC9950613 DOI: 10.1177/20552173231154712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/01/2023] [Indexed: 02/24/2023] Open
Abstract
Background We aimed to determine the proportion of highly active multiple sclerosis patients under high-efficacy therapies (HETs) achieve no evidence of disease activity-3 (NEDA-3) at 1 and 2 years, and to identify factors associated with failing to meet no evidence of disease activity 3 at 2 years. Methods This retrospective cohort study based on Argentina Multiple Sclerosis patient registry (RelevarEM), includes highly active multiple sclerosis patients who received HETs. Results In total, 254 (78.51%) achieved NEDA-3 at year 1 and 220 (68.12%) achieved NEDA-3 at year 2. Patients who achieved NEDA-3 at 2 years had a shorter duration of multiple sclerosis (p < 0.01) and a shorter time between first treatment and current treatment (p = 0.01). Early high-efficacy strategy patients reached NEDA-3 more frequently (p < 0.01). Being a naïve patient (odds ratio: 3.78, 95% confidence interval 1.50-9.86, p < 0.01) was an independent predictor to reach NEDA-3 at 2 years. No association was found between type of HETs and NEDA-3 at 2 years when adjusted for potential confounders (odds ratio: 1.73; 95% confidence interval 0.51-6.06, p 0.57). Conclusion We found a high proportion of patients who achieved NEDA-3 at 1 and 2 years. Early high-efficacy strategy patients had a higher probability of achieving NEDA-3 at 2 years.
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Affiliation(s)
- Ricardo Alonso
- Ricardo Alonso, Centro Universitario
Esclerosis Múltiple CUEM, Hospital Ramos Mejía, Urquiza 609, CP (1221) Ciudad de
Buenos Aires, Argentina; Facultad de Medicina, Universidad de Buenos Aires,
Ciudad de Buenos Aires, Argentina.
| | | | - Luciana Lazaro
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos
Mejía, Buenos Aires, Argentina
| | - Nora Fernandez Liguori
- Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina,Servicio de Neurología, Hospital Tornú, Buenos
Aires, Argentina
| | | | - Leila Cohen
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos
Mejía, Buenos Aires, Argentina
| | - Juan Ignacio Rojas
- Centro de esclerosis Múltiple Buenos Aires,
Buenos Aires, Argentina,Servicio de Neurología, CEMIC, Buenos Aires,
Argentina
| | | | | | | | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo,
Salta, Argentina
| | - Carlos Vrech
- Servicio de Neurología, Sanatorio Allende,
Córdoba, Spain
| | - Raul Piedrabuena
- Servicio de Neurología, Clínica Universitaria
Reina Fabiola, Córdoba, Spain
| | - Lopez Pablo
- Sección de nueroinmunología, Hospital Alemán,
Buenos Aires, Argentina
| | | | | | - Jimena Miguez
- Servicio de neurología, Hospital Italiano,
Buenos Aires, Argentina
| | - Mariela Cabrera
- Servicio de neurología, Hospital Militar,
Campo de Mayo, Buenos Aires, Argentina
| | | | - Gisela Zanga
- Servicio de neurología, Hospital Cesar
Milstein, Buenos Aires, Argentina
| | - Verónica Tkachuk
- Servicio de neurología, Hospital de Clínica José de San
Martín, Buenos Aires, Argentina
| | - Santiago Tizio
- Servicio de neurología, Hospital Español, La Plata, Argentina
| | | | | | | | | | - Pedro Nofal
- Servicio de neurología, Hospital Nuestra
Señora del Carmen, Tucumán, Argentina
| | - Susana Liwacki
- Servicio de neurología, Hospital Córdoba,
Córdoba, Spain
| | - Javier Hryb
- Servicio de neurología, Hospital Durand,
Buenos Aires, Argentina
| | | | | | | | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos
Mejía, Buenos Aires, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos
Mejía, Buenos Aires, Argentina,Servicio de neurología, Hospital Italiano,
Buenos Aires, Argentina
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11
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Gisela Z, Carla P, Josefina B, Tomas I, Lucia B, Pappolla A, Miguez J, Patrucco L, Cristiano E, Norma D, Verónica T, Carlos V, Leila C, Alonso R, Garcea O, Silva B, Celica Y, Marrodan M, Gaitán MI, Correale J, Marcos B, Luciana L, Anibal C, Emanuel S, Eduardo K, Judith S, Dario T, Javier H, Pedro N, Felisa L, Pablo LA, Susana L, Patricio B, Raul P, Adriana C, Alejandra M, María Eugenia B, Contentti Edgar C, Amelia AP, Carolina M, Mariano C, Luciano R, Matias K, Eduardo K, María Celeste C, Maria Laura M, Santiago T, Mariela C, Fatima PC, Andres B, Geraldine L, Alonso Serena M, Juan Ignacio R, Marcos S. Disease activity after discontinuation of disease-modifying therapies in patients with multiple sclerosis in Argentina: data from the nationwide registry RelevarEM. Neurol Res 2023; 45:112-117. [PMID: 36184106 DOI: 10.1080/01616412.2022.2124792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The discontinuation of disease-modifying therapies (DMTs) in multiple sclerosis (MS) is commonly seen in real-world settings due to several factors. AREA COVER The aim of this study is to describe the frequency of disease activity after discontinuation of DMTs in MS patients included in the Argentinean MS and NMOSD registry. DISCUSION Patients with relapsing remitting MS (RRMS) and active secondary progressive MS (SPMS) were included based on the following criteria: they discontinued treatment for more than 6 months, they had been treated with a DMT for ≥2 years, and they had at least 6 months of follow-up in the registry after discontinuation. Demographic and clinical data were collected. Disease activity during follow-up was defined as the presence of a clinical relapse or a new magnetic resonance (MRI) lesion (either new lesions on T2-weighted sequence and/or contrast enhancement). Bivariate analysis was applied to identify clinical and demographic factors related to disease activity. CONCLUSION We included 377 patients (75.5% RRMS, 22.5% SPMS) who had discontinued DMTs. The mean (SD) follow-up after discontinuation was 15.7 (7.9) months. After discontinuation, the presence of relapse was detected in 18.8% and 3.5% in RRMS and SPMS, respectively; and new MRI activity in 22% and 3.5%, respectively. We found that higher risk of relapse and MRI activity was associated with younger age (p < 0.001), shorter disease duration (p < 0.001), and RRMS phenotype (p = 0.006). Males showed higher MRI activity (p 0.011). This study provides real-world data that can guide physicians when considering discontinuation of DMTs.
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Affiliation(s)
- Zanga Gisela
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Portinari Carla
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Barber Josefina
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Ibañez Tomas
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Brolese Lucia
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de esclerosis múltiple de Buenos Aires, CABA, Buenos Aires, Argentina
| | | | - Tkachuk Verónica
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA
| | - Vrech Carlos
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba
| | - Cohen Leila
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, CABA
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, CABA
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, CABA
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, CABA
| | | | | | | | | | - Burgos Marcos
- Servicio de Neurología - Hospital San Bernardo, Salta
| | | | - Chertcoff Anibal
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA
| | | | | | - Steinberg Judith
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA
| | | | - Hryb Javier
- Servicio de Neurología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - Nofal Pedro
- Hospital de Clínicas Nuestra Señora del Carmen, Tucuman, Argentina
| | | | - Lopez A Pablo
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Liwacki Susana
- Clínica Universitaria Reina Fabiola, Córdoba.,Servicio de Neurología - Hospital Córdoba, Córdoba
| | - Blaya Patricio
- Hospital Presidente Perón de Avellaneda, Avellaneda, Argentina.,Neurocomp, Buenos Aires, Argentina
| | - Piedrabuena Raul
- Clínica Universitaria Reina Fabiola, Córdoba.,Instituto Lennox, Córdoba
| | - Carra Adriana
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA
| | - Martinez Alejandra
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA.,Servicio de Neurología, Hospital Posadas, Buenos Aires, Argentina
| | - Balbuena María Eugenia
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rojas Juan Ignacio
- Centro de esclerosis múltiple de Buenos Aires, CABA, Buenos Aires, Argentina.,Servicio de Neurología, Hospital Universitario de CEMIC, CABA
| | - Sorbara Marcos
- Departamento de Neurologia. Hospital Cesar Milstein, Buenos Aires, Argentina
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12
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Carnero Contentti E, López PA, Pettinicchi JP, Tkachuk V, Daccach Marques V, de Castillo IS, Cristiano E, Patrucco L, Caride A, Rojas JI. Neuromyelitis optica spectrum disorders with and without associated autoimmune diseases. Neurol Sci 2023; 44:1731-1737. [PMID: 36645533 DOI: 10.1007/s10072-023-06611-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/06/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We aimed to determinate the frequency of this association and compare the features of neuromyelitis optica spectrum disorder (NMOSD) with and without associated autoimmune diseases (AD) in a Latin American (LATAM) population in clinical practice. METHODS We retrospectively reviewed the medical records of patients with NMOSD according to the 2015 diagnostic criteria. Patients from Argentina (n=77), Brazil (n=46), and Venezuela (n=17) were enrolled and classified into two groups as follows: with AD or without AD. Clinical, paraclinical (including aquaporin-4 antibodies (AQP4-ab) status), magnetic resonance imaging (MRI), and prognosis data were analyzed and compared. Kaplan-Meier (KM) and the Nelson-Aalen estimator analyses were performed to estimate both time and the cumulative hazard risk of disability reaching an EDSS≥4; and time for the first recurrence. RESULTS Out of 140 patients, 33 (23.5%) patients had associated an AD at presentation. The most frequent associated AD was Hashimoto disease (n=10) followed by lupus (n=7) and Sjogren's syndrome (n=6). However, rituximab use (42.4% vs. 21.5%, p=0.02), female gender (82.2% vs. 100%, p=0.006), corticospinal lesions on MRI (0% vs. 12.5%, p=0.01) at onset, and positivity for antinuclear antibodies (21.2% vs. 48.4%, p=0.03) were significantly associated with NMOSD patients with AD in comparison to NMOSD patients without AD. No differences were found in other clinical and paraclinical aspects between groups. KM and Nelson-Aalen estimator analyses did not show differences between groups. CONCLUSION NMOSD patients associated with AD were observed in 23.5%. In addition, NMOSD patients with and without associated AD were similar in most evaluated features.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Verónica Tkachuk
- Seccion de Neuroinmunologia y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martin, Buenos Aires, Argentina
| | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ibis Soto de Castillo
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Bolivarian Republic of Venezuela
| | - Edgardo Cristiano
- Centro de esclerosis múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de esclerosis múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Ignacio Rojas
- Centro de esclerosis múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
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13
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Rojas JI, López PA, Criniti J, Pettinicchi JP, Caride A, Correa Díaz EP, Toral Granda AM, Ortiz Yepez MA, Gualotuña Pachacama WA, Andrade JSP, Daccach Marques V, Bribiesca Contreras E, Gómez Figueroa E, Flores Rivera J, Galleguillos L, Navas C, Soares Neto HR, Gracia F, Cristiano E, Patrucco L, Becker J, Hamuy F, Alonso R, Man F, Tkachuk V, Nadur D, Lana-Peixoto M, Castillo ISD, Carnero Contentti E. Therapeutic strategies in NMOSD and MOGAD patients: A multicenter cohort study in Latin America. Mult Scler Relat Disord 2023; 71:104508. [PMID: 36738691 DOI: 10.1016/j.msard.2023.104508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE This study describes the therapeutic strategies in NMOSD and MOGAD adopted by neurologists to treat both conditions in Latin America (LATAM) with main focus on rituximab (RTX) and the disease outcome. METHODS retrospective study in a cohort of NMOSD and MOGAD patients followed in specialized MS/NMOSD centers from eight countries and 14 LATAM reference centers. Demographics and clinical characteristics were collected. RTX strategies on naïve (for rituximab) patients were summarized as follows: scheme A: two 1000 mg infusions 15 days apart and repeated every 6 months; scheme B: four 375 mg/m2 infusions every week for 4 weeks and repeated every 6 months; scheme C: one 1000 mg infusions and repeated every 6 months; scheme D: other scheme used. Relapse rate and adverse events during follow-up were analyzed considering the different RTX schemes. Poisson and logistic regression analysis were used to assess baseline aspects and disease activity during follow-up. RESULTS A total of 217 patients were included. 197 were NMOSD patients (164, 83.2% AQP4-IgG seropositive and 16.7% seronegative) and 20 were MOGAD patients. The most frequent long-term treatment was RTX in both groups (48.2% and 65% for NMOSD and MOGAD patients, respectively). The most common RTX regimen used in 79 (83.1%) patients was two 1000 mg infusions 15 days apart and repeat every 6 months. Relapses under RTX treatment were observed in 21 (22.1%) patients. Relapses after RTX treatment were associated with higher EDSS (OR 1.75, 95%CI 1.44-2.34, p = 0.03) and higher ARR pre-RTX (OR = 2.17, 95% CI 1.72-3.12, p = 0.002) but not with RTX regimen (OR = 1.10, 95% CI 0.89-1.21, p = 0.60). CONCLUSION the most strategy used in LATAM was RTX with two 1000 mg infusions 15 days apart. Relapses during follow up were not associated with RTX regimen used.
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Affiliation(s)
- Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina; Service of Neurology, Hospital Universitario de CEMIC, Buenos Aires, Argentina.
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | | | | | | | | | | | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | - Enrique Gómez Figueroa
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José Flores Rivera
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Lorna Galleguillos
- Universidad Del Desarrollo y Clínica Alemana de Santiago de Chile, Chile
| | - Carlos Navas
- Clinica Enfermedad Desmielinizante Clinica Universitaria Colombia, Colombia
| | - Herval R Soares Neto
- Division of Neurology, Hospital do Servidor Estadual de São Paulo (IAMSPE), São Paulo, Brasil
| | - Fernando Gracia
- Clinica de Esclerosis Multiple, Servicio de Neurologia Hospital Santo Tomas, Universidad Interamericana de Panamá, Panamá
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Jefferson Becker
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brasil
| | | | - Ricardo Alonso
- Faculty of Medicine, Centro Universitario de Esclerosis Múltiple (CUEM), Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Federico Man
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Verónica Tkachuk
- CIEM MS Center, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Débora Nadur
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Marco Lana-Peixoto
- CIEM MS Center, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Ibis Soto de Castillo
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Bolivarian Republic of Venezuela
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Rojas JI, Pappolla A, Patrucco L, Cristiano E, Miguez J, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Fiol M, Leguizamon F, Luetic G, Menichini ML, Lopez PA, Pettinicchi JP, Criniti J, Caride A, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Silva B, Fernández Liguori N, Nadur D, Chercoff A, Martinez A, Steinberg J, Garcea O, Carrá A, Alonso Serena M, Carnero Contentti E. Disability outcomes in NMOSD and MOGAD patients: data from a nationwide registry in Argentina. Neurol Sci 2023; 44:281-286. [PMID: 36166174 DOI: 10.1007/s10072-022-06409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/13/2022] [Indexed: 01/10/2023]
Abstract
The objective was to evaluate time to reach an EDSS of 4, 6, and 7 in NMOSD and MOGAD patients included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03,375,177). METHODS NMOSD patients diagnosed according to 2015 criteria and with MOGAD were identified. Patients with at least 3 years of follow-up and periodic clinical evaluations with EDSS outcomes were included. AQP4-antibody and MOG-antibody status was recorded, and patients were stratified as seropositive and seronegative for AQP4-antibody. EDSS of 4, 6, and 7 were defined as dependent variables. Log rank test was used to identify differences between groups. RESULTS Registry data was provided for a total of 137 patients. Of these, seventy-five presented AQP4-ab-positive NMOSD, 45 AQP4-ab-negative NMOSD, and 11 MOGAD. AQP4-ab status was determined by cell-based assay (CBA) in 72% of NMOSD patients. MOG-ab status was tested by CBA in all cases. Mean time to EDSS of 4 was 53.6 ± 24.5 vs. 63.1 ± 32.2 vs. 44.7 ± 32 months in seropositive, seronegative NMOSD, and MOGAD, respectively (p = 0.76). Mean time to EDSS of 6 was 79.2 ± 44.3 vs. 75.7 ± 48.6 vs. 54.7 ± 50 months in seropositive, seronegative NMOSD, and MOGAD (p = 0.23), while mean time to EDSS of 7 was 86.8 ± 54 vs. 80.4 ± 51 vs. 58.5 ± 47 months in seropositive, seronegative NMOSD, and MOGAD (p = 0.39). CONCLUSION No differences were observed between NMOSD (seropositive and seronegative) and MOGAD in survival curves.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, CABA, Argentina. .,Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina. .,Centro de Esclerosis Múltiple de Buenos Aires, (CEMBA), Billinghurst 1611, CP 1181, Buenos Aires, Argentina.
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Cordoba, Argentina.,Servicio de Neurología - Hospital Córdoba, Cordoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades Desmielinizantes - Sanatorio Allende, Cordoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | | | | | | | - Marcela Fiol
- Departamento de Neurología - FLENI, CABA, Argentina
| | | | | | | | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Gisela Zanga
- Unidad Asistencial César Milstein, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | | | | | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina.,Sanatorio Güemes, CABA, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Débora Nadur
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina.,Hospital Naval, CABA, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Alejandra Martinez
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Judith Steinberg
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
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Rojas JI, Alonso R, Cabrera M, Carnero Contentti E, Cristiano E, Deri N, Hryb J, Lopez P, Luetic G, Patrucco L, Tkachuk V, Ysrraelit MC, Zanga G, Cruces L, Turk G, Longueira Y, Laufer N, Nuñez S. Serological response to SARS-CoV-2 vaccines in patients with multiple sclerosis in Argentina. Medicina (B Aires) 2023; 83:358-365. [PMID: 37379532] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION The objective was to assess the immunogenicity and effectiveness of vaccines against SARSCoV-2 in multiple sclerosis (MS) patients included in the Argentinean MS registry. METHODS A prospective cohort study between May and December 2021. The primary outcome was immunogenicity and effectiveness of vaccines during a three-month follow-up. Immunogenicity was evaluated based on detection of total antibodies (Ab) against spike protein and neutralizing Ab in serum 4 weeks after the second vaccine dose. A positive COVID-19 case was defined according to Argentinean Ministry of Health. RESULTS 94 patients were included, mean age: 41.7 ± 12.1 years. Eighty (85.1%) had relapsing remitting multiple sclerosis (RRMS); 30 (31.9%) were under fingolimod treatment. The Sputnik V vaccine was the first dose in 33 (35.1%), and AstraZeneca in 61 (64.9%). In 60 (63.8%), the vaccine elicited a specific humoral response. Immunological response according to the vaccination schemes showed no qualitative differences (p = 0.45). Stratified analysis according to the MS treatment showed that a significantly smaller number of subjects developed antibodies against spike antigen among those that were on ocrelizumab compared to other groups (p = 0.001), while a reduced number of patients under ocrelizumab where evaluated (n = 7). This was also observed for neutralizing antibodies in the ocrelizumab group (p < 0.001). During the three-month follow-up, two individuals were diagnosed with COVID-19. CONCLUSION We found that MS patients that received Sputnik V or AstraZeneca vaccines for SARS-CoV-2 developed a serological response with no differences between the vaccines used.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina. E-mail:
- Servicio de Neurología, Unidad de Esclerosis Múltiple y Enfermedades Desmielinizantes, Hospital Universitario de CEMIC, Buenos Aires, Argentina
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, Buenos Aires, Argentina
- Sanatorio Güemes, Buenos Aires, Argentina
| | | | - Edgar Carnero Contentti
- Unidad de Neuroimnunología, Departamento de Neurociencias, Hospital Alemán, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Norma Deri
- Servicio de Neurología, Hospital Fernández, Buenos Aires, Argentina
| | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Pablo Lopez
- Unidad de Neuroimnunología, Departamento de Neurociencias, Hospital Alemán, Buenos Aires, Argentina
| | - Geraldine Luetic
- Instituto de Neurociencias de Rosario, Rosario, Santa Fe, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Veronica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | | | - Gisela Zanga
- Departamento de Neurología, Hospital César Milstein, Buenos Aires, Argentina
| | - Leonel Cruces
- Universidad de Buenos Aires, Facultad de Medicina, Buenos Aires, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
| | - Gabriela Turk
- CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, Buenos Aires, Argentina
| | - Yesica Longueira
- Universidad de Buenos Aires, Facultad de Medicina, Buenos Aires, Argentina
- CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
| | - Natalia Laufer
- CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, Buenos Aires, Argentina
| | - Sebastian Nuñez
- Unidad de Infectología, Sanatorio Güemes, Departamento de Investigación Epidemiológica, Fundación Sanatorio Güemes, Buenos Aires, Argentina
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16
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Rojas JI, Luetic GG, Vrech C, Pappolla A, Patrucco L, Cristiano E, Marrodan M, Ysrraelit MC, Fiol M, Correale J, Cohen L, Alonso R, Silva B, Casas M, Garcea O, Deri N, Burgos M, Liwacki S, Tkachuk V, Barboza A, Piedrabuena R, Blaya P, Steinberg J, Martínez A, Carra A, Tavolini D, López P, Knorre E, Nofal P, Carnero Contentti E, Alves Pinheiro A, Leguizamon F, Silva E, Hryb J, Balbuena ME, Zanga G, Kohler M, Lazaro L, Tizio S, Mainella C, Blanche J, Parada Marcilla M, Fracaro ME, Menichini ML, Sgrilli G, Divi P, Jacobo M, Cabrera M, Míguez J, Fernandez Liguori N, Viglione JP, Nadur D, Alonso Serena M, Nuñez S. Incidence of COVID-19 after vaccination in people with multiple sclerosis in Argentina: Data from the nationwide registry RelevarEM. Mult Scler Relat Disord 2022; 68:104104. [PMID: 36057175 PMCID: PMC9371771 DOI: 10.1016/j.msard.2022.104104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/16/2022] [Accepted: 08/10/2022] [Indexed: 12/15/2022]
Abstract
The objective of the study was to evaluate the incidence of COVID-19 after complete vaccination in people with multiple sclerosis (PwMS) included in the Argentinean MS and NMOSD registry (RelevarEM, NCT03375177). METHODS cohort study conducted between May 2021 and December 2021. The primary outcome was the appearance of infection during the follow-up time (at least three months after complete vaccination (second dose)). Data was collected through the contact between the treating physician and the patient. Specific information was requested (date, symptoms, need for hospitalization, ventilatory assistance, treatment, and evolution). The contact was made every 30 days during the period of 3 months after the full dose vaccination. A positive COVID-19 case was defined according to the definition established by the Ministry of Health in Argentina. Cumulative incidence was reported by Kaplan Meier survival curves as well as incidence density. RESULTS A total of 576 PwMS were included, mean age 45.2 ± 13 years, 432 (75%) RRMS, 403 (70%) were female. The mean and median time of follow-up after the second dose was 91 ± 17 and 94 ± 21 days respectively. Most frequent first and second dose received was Astra-Zeneca vaccine, followed by Sputnik V vaccine. During follow-up a total of twenty COVID-19 cases were observed for a total exposure time of 39,557 days. The overall cumulative incidence for the observed period was 3.4% (SE 0.4%) with an overall incidence density of 5 × 10.000 patients/day (95%CI 0.7-12). We observed more cases in woman than men with an incidence density of 6 × 10.000 patients/day (95%CI 0.9-9) vs. 3 × 10.000 patients/day (95%CI 0.2-6) respectively, but not significantly different (IRR 1.7 95% CI 0.56-7.37 p = 0.15). CONCLUSION we found an incidence density of breakthrough COVID-19 infection of 5 × 10.000 patients/day (95%CI 0.7-12) after vaccination in Argentina.
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Affiliation(s)
- Juan I. Rojas
- Centro de esclerosis múltiple de Buenos Aires, Billinghurst 1611, Buenos Aires CP 1181, Argentina,Servicio de Neurología, Unidad de EM y Enfermedades Desmielinizantes, Hospital Universitario de CEMIC, Buenos Aires, Argentina,Corresponding author
| | - Geraldine G. Luetic
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fé, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina,Departamento de Neurología, FLENI, CABA, Argentina
| | - Liliana Patrucco
- Centro de esclerosis múltiple de Buenos Aires, Billinghurst 1611, Buenos Aires CP 1181, Argentina
| | - Edgardo Cristiano
- Centro de esclerosis múltiple de Buenos Aires, Billinghurst 1611, Buenos Aires CP 1181, Argentina
| | - Mariano Marrodan
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - María C. Ysrraelit
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Marcela Fiol
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Jorge Correale
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | | | - Ricardo Alonso
- Sanatorio Güemes, CABA, Argentina,Centro de Investigaciones Diabaid, CABA, Argentina
| | - Berenice Silva
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Magdalena Casas
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Orlando Garcea
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | | | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | - Raúl Piedrabuena
- Clínica Universitaria Reina Fabiola, Cordoba, Argentina,Instituto Lennox, Cordoba, Argentina
| | | | | | - Alejandra Martínez
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina
| | - Adriana Carra
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina,Hospital Universitario Fundación on Favaloro, Buenos Aires, Argentina
| | | | - Pablo López
- Department of Neurosciences, Neuroimmunology Unit, Hospital Aleman, Buenos Aires, Argentina
| | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora ˜ del Carmen, Tucumán, Argentina
| | | | | | | | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - María Eugenia Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Gisela Zanga
- Departamento de Neurología, Hospital Cesar Milstein, Buenos Aires, Argentina
| | | | | | | | | | - Jorge Blanche
- IRNEC (Instituto Regional de Neurociencias), San Miguel de Tucumán, Tucuman, Argentina
| | | | | | | | | | - Pablo Divi
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | - Miguel Jacobo
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | | | - Jimena Míguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Debora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | - Sebastián Nuñez
- Unidad de Infectología, Sanatorio Güemes, Buenos Aires, Departamento de Investigación Epidemiológica, Fundación Sanatorio Güemes, Buenos Aires, Argentina
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Rojas JI, Patrucco L, Alonso R, Lopez PA, Deri N, Pettinicchi JP, Cristiano E, Carnero Contentti E. Preferences for Disease-Modifying Therapies in Argentina: Cross-Sectional Conjoint Analysis of Patients and Neurologist. Value Health Reg Issues 2022; 31:93-100. [DOI: 10.1016/j.vhri.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 03/11/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
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Rojas JI, Patrucco L, Pappolla A, Sánchez F, Cristiano E. Brain volume loss and physical and cognitive impairment in naive multiple sclerosis patients treated with fingolimod: prospective cohort study in Buenos Aires, Argentina. Arq Neuropsiquiatr 2022; 80:699-705. [PMID: 36254442 PMCID: PMC9685825 DOI: 10.1055/s-0042-1755277] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The percentage of brain volume loss (PBVL) has been classically considered as a biomarker in multiple sclerosis (MS). OBJECTIVE The objective of the present study was to analyze if the PBVL during the 1st year after the onset of the disease predicts physical and cognitive impairment (CI). METHODS Prospective study that included naïve patients without cognitive impairment who initiated MS treatment with fingolimod. Patients were followed for 3 years and relapses, expanded disability status scale (EDSS) progression (defined as worsening of 1 point on the EDSS), the annual PBVL (evaluated by structural image evaluation using normalization of atrophy [SIENA]), and the presence of CI were evaluated. Cognitive impairment was defined in patients who scored at least 2 standard deviations (SDs) below controls on at least 2 domains. The PBVL after 1 year of treatment with fingolimod was used as an independent variable, while CI and EDSS progression at the 3rd year of follow-up as dependent variables. RESULTS A total of 71 patients were included, with a mean age of 35.4 ± 3 years old. At the 3rd year, 14% of the patients were classified as CI and 6.2% had EDSS progression. In the CI group, the PBVL during the 1st year was - 0.52 (±0.07) versus -0.42 (±0.04) in the no CI group (p < 0.01; odds ratio [OR] = 2.24; 95% confidence interval [CI]: 1.72-2.44). In the group that showed EDSS progression, the PBVL during the 1st year was - 0.59 (±0.05) versus - 0.42 (±0.03) (p < 0.01; OR = 2.33; 95%CI: 1.60-2.55). CONCLUSIONS A higher PBVL during the 1st year in naïve MS patients was independently associated with a significant risk of CI and EDSS progression.
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Affiliation(s)
- Juan Ignacio Rojas
- Multiple Sclerosis Center of Buenos Aires, Buenos Aires, Argentina
- Hospital Universitario CEMIC, Neurology Service, Buenos Aires, Argentina
| | - Liliana Patrucco
- Hospital Italiano de Buenos Aires, Neurology Service, Buenos Aires, Argentina
| | - Agustín Pappolla
- Hospital Italiano de Buenos Aires, Neurology Service, Buenos Aires, Argentina
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Giménez MV, Pappolla A, Varela L, Brusztyn M, Kohan D, Patrucco L. Uveitis intermedia as the initial presentation of a primary lymphoma of the central nervous system. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:168-171. [PMID: 35248399 DOI: 10.1016/j.oftale.2020.12.013] [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: 10/06/2020] [Accepted: 12/15/2020] [Indexed: 06/14/2023]
Abstract
Primary central nervous system lymphoma is one of the most infrequent brain tumours, accounting for 3% of primary central nervous system neoplasms. In addition to its low prevalence, clinical presentation is usually nonspecific, leading to diagnostic delay. Intraocular involvement occurs in 15% of cases, and disease onset in this location is even rarer. We present a case of a patient with intermediate uveitis as the first clinical manifestation of this neoplasm.
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Affiliation(s)
- M V Giménez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina.
| | - A Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina
| | - L Varela
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina
| | - M Brusztyn
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina
| | - D Kohan
- Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina
| | - L Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina
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20
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Barboza A, Gaitán MI, Alonso R, Ysrraelit MC, Luetic G, Liwacki S, Patrucco L, Halfon MJ, Burgos M, Mainella C, Pierdabuena R, Recchia L, Steinberg J, Tkachuk VA, Zanga G, Carra A, Chertcoff A, Fernandez Liguori N, Lazaro L, Menichini ML, Miguez J, Orzuza G, Palavecino A, Pappolla A, Pigretti S, Pita C, Ruiz E, Silva B, Zentil G. Rebound activity after fingolimod cessation: A case - control study. Mult Scler Relat Disord 2022; 57:103329. [PMID: 35158443 DOI: 10.1016/j.msard.2021.103329] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND There has been an increase in the number of reports of multiple sclerosis (MS) rebound activity (RA), which is usually defined as a severe disease reactivation after natalizumab or fingolimod withdrawal that exceeds pre-treatment baseline inflammatory activity. The frequency and risk factors that could predict RA remain unknown. Fingolimod is currently the most frequently prescribed disease modifying therapy for MS in Argentina, so that there is a need to determine possible predictors of RA. OBJECTIVES To identify risk factors for developing RA after fingolimod cessation; to describe RA characteristics, management and evolution. METHODS The study was a multicenter, retrospective, case-control study of patients with MS who had discontinued fingolimod and were followed up to nine months after discontinuation. Demographic, clinical and paraclinical data was extracted, including age, gender, MS phenotype, reason for discontinuation, number of relapses during the year prior to suspension, time treated with fingolimod, EDSS before, during and after rebound, MRI findings. RESULTS 26 cases of RA were matched 1:1 with patients without RA. The median time elapsed to RA was 50 days. 68% showed worsening of the EDSS in the evaluation at 3 months of RA. When compared with the control group, no difference was found in terms of age, gender, phenotype, EDSS at the moment of suspension, reason for discontinuation, number of relapses in the previous year, and time on therapy. CONCLUSION In this case-controlled study, no risk factors could be identified to predict RA after fingolimod cessation. Further controlled, prospective, better powered studies are needed to confirm these findings.
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Affiliation(s)
- Andres Barboza
- Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina.
| | | | - Ricardo Alonso
- Centro Universitario de Esclerosis Multiple, Hospital Ramos Mejia, Buenos Aires, Argentina; Department of Neurology, Sanatorio Güemes, Buenos Aires, Argentina
| | | | | | - Susana Liwacki
- Department of Neurology, Hospital Cordoba, Cordoba, Argentina; Department of Neurology, Clinica Reina Fabiola. Cordoba, Argentina
| | - Liliana Patrucco
- Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mario Javier Halfon
- Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | - Marcos Burgos
- Department of Neurology, Hospital San Bernardo, Salta, Argentina
| | - Carolina Mainella
- Department of Neurology, Hospital Español de Rosario, Santa Fe, Argentina
| | - Raul Pierdabuena
- Department of Neurology, Clinica Reina Fabiola. Cordoba, Argentina
| | - Luciano Recchia
- Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina
| | - Judith Steinberg
- Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | | | - Gisela Zanga
- Department of Neurology, ENERI, Buenos Aires, Argentina
| | - Adriana Carra
- Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | - Aníbal Chertcoff
- Department of Neurology, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | | | - Luciana Lazaro
- Department of Neurology, Sanatorio Güemes, Buenos Aires, Argentina
| | | | - Jimena Miguez
- Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gabriela Orzuza
- Department of Neurology, Hospital San Bernardo, Salta, Argentina
| | | | - Agustin Pappolla
- Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago Pigretti
- Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina
| | - Cacilia Pita
- Centro Universitario de Esclerosis Multiple, Hospital Ramos Mejia, Buenos Aires, Argentina
| | - Emiliano Ruiz
- Department of Neurology, Clinica Reina Fabiola. Cordoba, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Multiple, Hospital Ramos Mejia, Buenos Aires, Argentina
| | - Guillermo Zentil
- Department of Neurology, Hospital Central de Mendoza, Mendoza, Argentina
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21
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Luetic GG, Menichini ML, Vrech C, Pappolla A, Patrucco L, Cristiano E, Marrodán M, Ysrraelit MC, Fiol M, Correale J, Cohen L, Alonso R, Silva B, Casas M, Garcea O, Deri N, Burgos M, Liwacki S, Tkachuk V, Barboza A, Piedrabuena R, Blaya P, Steinberg J, Martínez A, Carrá A, Tavolini D, López P, Knorre E, Nofal P, Volman G, Carnero Contentti E, Pinheiro AA, Leguizamon F, Silva E, Hryb J, Balbuena ME, Zanga G, Kohler M, Chertcoff A, Lazaro L, Tizio S, Mainela C, Reich E, Recchia L, Blanche J, Marcilla MP, Fracaro ME, Sgrilli G, Divi P, Jacobo M, Cabrera M, Pagani Cassara F, Sinay V, Curbelo C, Míguez J, Coppola M, Liguori NF, Martos I, Pettinicchi JP, Viglione JP, José G, Bestoso S, Manzi R, Vázquez G, Nadur D, Martínez C, Serena MA, Rojas JI. Clinical and demographic characteristics of male MS patients included in the national registry-RelevarEM. Does sex or phenotype make the difference in the association with poor prognosis? Mult Scler Relat Disord 2022; 58:103401. [PMID: 35216784 DOI: 10.1016/j.msard.2021.103401] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/27/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In multiple sclerosis demographics there is a well-known female prevalence and male patients have been less specifically evaluated in clinical studies, though some clinical differences have been reported between sexes. OBJECTIVE The objective of this study was to assess clinical and demographic differences between male and female patients included in the national Argentine MS Registry-RelevarEM. MATERIAL AND METHODS This study was observational, retrospective, and was based on the data of 3099 MS patients included as of 04 April 2021. The statistical analysis plan included bivariate analyses with the crude data and also after adjustment for the MS phenotype, further categorized as progressive-onset MS or relapsing-onset MS. In the adjusted analysis, the Mantel-Haenszel odds ratio was compared to the crude odds ratio, to account for the phenotype as a confounder. RESULTS The data from 1,074 (34.7%) men and 2,025 (65.3%) women with MS diagnosis were analysed. Males presented primary progressive disease two times more often than women (11% and 5%, respectively). In the crude analyses by sex, the presence of exclusively infratentorial lesions in the magnetic resonance imaging studies was more frequent in males than in females, but after adjustment by MS onset phenotype, such difference was only present in males with relapsing-onset MS (p = 0.00006). Similarly, worse Expanded Disability Status Scale scores were confirmed only in men with relapsing-onset disease after phenotype adjustment (p = 0.02). CONCLUSION We did not find any statistically significant clinical or demographic difference between sexes when the progressive MS phenotype was specifically considered. However, the differences we found between the clinical phenotypes are in line with the literature and highlight the importance of stratifying the analyses by sex and phenotype when designing MS studies.
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Affiliation(s)
- Geraldine G Luetic
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fe 3598, Argentina.
| | - María Laura Menichini
- Instituto de Neurociencias de Rosario, San Lorenzo, Rosario, Santa Fe 3598, Argentina; Sanatorio Británico, Rosario, Santa Fe, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | | | | | | | | | | | - Marcela Fiol
- Departamento de Neurología, FLENI, CABA, Argentina
| | | | - Leila Cohen
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Ricardo Alonso
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Berenice Silva
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Magdalena Casas
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Orlando Garcea
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, CABA, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología, Hospital Córdoba, Córdoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | - Raúl Piedrabuena
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Instituto Lennox, Córdoba, Argentina
| | | | - Judith Steinberg
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina
| | - Alejandra Martínez
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina; Hospital Nacional Alejandro Posadas, El Palomar, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina; Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | | | - Pablo López
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, Tucumán, Argentina
| | - Gabriel Volman
- Hospital Pte. Perón, Avellaneda, Buenos Aires, Argentina
| | | | | | | | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - María Eugenia Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Gisela Zanga
- Departamento de Neurología, Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Matías Kohler
- Axis Neurociencias, Bahía Blanca, Buenos Aires, Argentina
| | - Aníbal Chertcoff
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Argentina
| | | | | | | | - Edgardo Reich
- Instituto Médico Especializado, Buenos Aires, Argentina
| | | | - Jorge Blanche
- IRNEC (Instituto Regional de Neurociencias), San Miguel de Tucumán, Tucumán, Argentina
| | | | | | | | - Pablo Divi
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | - Miguel Jacobo
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | | | | | - Vladimiro Sinay
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Celeste Curbelo
- Policlínico Municipal Sofía T. de Santamarina, Buenos Aires, Argentina
| | | | | | - Nora Fernández Liguori
- Sanatorio Güemes, Buenos Aires, Argentina; Hospital Enrique Tornú, Buenos Aires, Argentina
| | - Iván Martos
- Clínica San Jorge, Ushuaia, Tierra del fuego, Argentina
| | - Juan Pablo Pettinicchi
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Buenos Aires, Argentina
| | | | - Gustavo José
- Sección de enfermedades desmielinizantes, Servicio de Neurología, Hospital Padilla, Tucumán, Argentina
| | - Santiago Bestoso
- Servicio Neurología, Hospital Escuela José F. de San Martín Corrientes, Corrientes, Argentina
| | | | - Guido Vázquez
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | | | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina
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22
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Carnero Contentti E, López PA, Criniti J, Pettinicchi JP, Cristiano E, Patrucco L, Lazaro L, Alonso R, Fernández Liguori N, Tkachuk V, Caride A, Rojas JI. Platelet-to-lymphocyte ratio differs between MS and NMOSD at disease onset and predict disability. Mult Scler Relat Disord 2022; 58:103507. [PMID: 35030372 DOI: 10.1016/j.msard.2022.103507] [Citation(s) in RCA: 8] [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] [Received: 08/18/2021] [Revised: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND We aimed to assess platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte ratios (NLR) for differentiating multiple sclerosis (MS) from aquaporin-4-antibody-positive neuromyelitis optica spectrum disorders (NMOSD) at disease onset. METHODS We retrospectively enrolled and reviewed the medical records of patients with MS (N = 50) and NMOSD (N = 33) followed in specialized MS/NMOSD centers from Argentina. Demographical and clinical (manifestation and disability) data and neuroradiological features (new/enlarging or contrast-enhancing lesions) were assessed at baseline, 1 and 2 years. Serum samples were obtained during the first relapse without a previous acute or chronic treatment, at 1 and 2 years. Mixed-effects model was used to identify independent associations between the log-transformed NLR or PLR and MS/NMOSD outcomes. RESULTS PLR is increased in NMOSD when compared to MS (229.4 ± 86.74 vs. 186.6 ± 70.17, P = 0.01), but no significant differences were found for NLR (3.51 ± 1.29 vs. 3.30 ± 1.17, P = 0.43). PLR was the only independent predictor of poor physical disability score (EDSS ≥ 4) in NMOSD patients at 2 years (β=0.28, p = 0.02) after applying multivariate mixed-effects regression analysis. Additionally, multivariate logistic regression analysis showed that the PLR was the only independent predictor of EDSS ≥ 4 at 2 years (OR 28.8, p = 0.041) in the NMOSD group. The area under the receiver-operating characteristic curve was 0.841. CONCLUSION PLR could be potentially useful as additional diagnostic tool in differentiating these two neuroinflammatory conditions at presentation. PLR can predict severity of neurological disability at 2 years in NMOSD patients.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Internal Medicine Department, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Luciana Lazaro
- Neurology Department, Sanatorio Güemes, Buenos Aires, Argentina
| | - Ricardo Alonso
- Neurology Department, Sanatorio Güemes, Buenos Aires, Argentina
| | | | - Verónica Tkachuk
- Neuroimmunology Section, Neurology Department, Hospital de Clínicas "José de San Martín", University of Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Ignacio Rojas
- Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Carnero Contentti E, Lopez PA, Pettinicchi JP, Criniti J, Pappolla A, Miguez J, Patrucco L, Cristiano E, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Leguizamon F, Luetic G, Menichini ML, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Fernández Liguori N, Nadur D, Chercoff A, Alonso Serena M, Caride A, Paul F, Rojas JI. Seasonal variation in attacks of neuromyelitis optica spectrum disorders and multiple sclerosis: Evaluation of 794 attacks from a nationwide registry in Argentina. Mult Scler Relat Disord 2021; 58:103466. [PMID: 34929456 DOI: 10.1016/j.msard.2021.103466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/12/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Identification of triggers that potentially instigate attacks in neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) has remained challenging. We aimed to analyze the seasonality of NMOSD and MS attacks in an Argentinean cohort seeking differences between the two disorders. METHODS A retrospective study was conducted in a cohort of NMOSD and MS patients followed in specialized centers from Argentina and enrolled in RelevarEM, a nationwide, longitudinal, observational, non-mandatory registry of MS/NMOSD patients. Patients with complete relapse data (date, month and year) at onset and during follow-up were included. Attack counts were analyzed by month using a Poisson regression model with the median monthly attack count used as reference. RESULTS A total of 551 patients (431 MS and 120 NMOSD), experiencing 236 NMOSD-related attacks and 558 MS-related attacks were enrolled. The mean age at disease onset in NMOSD was 39.5 ± 5.8 vs. 31.2 ± 9.6 years in MS (p < 0.01). Mean follow-up time was 6.1 ± 3.0 vs. 7.4 ± 2.4 years (p < 0.01), respectively. Most of the included patients were female in both groups (79% vs. 60%, p < 0.01). We found a peak of number of attacks in June (NMOSD: 28 attacks (11.8%) vs MS: 33 attacks (5.9%), incidence rate ratio 1.82, 95%CI 1.15-2.12, p = 0.03), but no differences were found across the months in both disorders when evaluated separately. Strikingly, we observed a significant difference in the incidence rate ratio of attacks during the winter season when comparing NMOSD vs. MS (NMOSD: 75 attacks (31.7%) vs MS: 96 attacks (17.2%), incidence rate ratio 1.82, 95%CI 1.21-2.01, p = 0.02) after applying Poisson regression model. Similar results were observed when comparing the seropositive NMOSD (n = 75) subgroup vs. MS. CONCLUSIONS Lack of seasonal variation in MS and NMOSD attacks was observed when evaluated separately. Future epidemiological studies about the effect of different environmental factors on MS and NMOSD attacks should be evaluated prospectively in Latin America population.
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Affiliation(s)
- Edgar Carnero Contentti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina.
| | - Pablo A Lopez
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Juan Pablo Pettinicchi
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Juan Criniti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología - Hospital Córdoba, Córdoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | | | | | | | | | | | | | | | | | - Gisela Zanga
- Unidad asistencial César Milstein, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | | | | | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina; Hospital Naval, CABA, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | | | - Alejandro Caride
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina
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Carnero Contentti E, López PA, Criniti J, Pettinicchi JP, Cristiano E, Patrucco L, Bribiesca Contreras E, Gómez-Figueroa E, Flores-Rivera J, Correa-Díaz EP, Toral Granda AM, Ortiz Yepez MA, Gualotuña Pachacama WA, Piedra Andrade JS, Galleguillos L, Tkachuk V, Nadur D, Daccach Marques V, Soto de Castillo I, Casas M, Cohen L, Alonso R, Caride A, Lana-Peixoto M, Rojas JI. Chiasmatic lesions on conventional magnetic resonance imaging during the first event of optic neuritis in patients with neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein-associated disease in a Latin American cohort. Eur J Neurol 2021; 29:802-809. [PMID: 34799965 DOI: 10.1111/ene.15178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Optic neuritis (ON) is often the initial symptom of neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-associated disease (MOGAD). We aimed to compare the frequency and pattern of chiasmatic lesions in MOGAD-related ON (MOGAD-ON) and NMOSD-related ON (NMOSD-ON) using conventional brain imaging (magnetic resonance imaging [MRI]) in Latin America (LATAM). METHODS We reviewed the medical records and brain MRI (≤30 days from ON onset) of patients with a first event of MOGAD-ON and NMOSD-ON. Patients from Argentina (n = 72), Chile (n = 21), Ecuador (n = 31), Brazil (n = 30), Venezuela (n = 10) and Mexico (n = 82) were included. Antibody status was tested using a cell-based assay. Demographic, clinical, imaging and prognostic (as measured by the Visual Functional System Score [VFSS] of the Expanded Disability Status Scale) data were compared. RESULTS A total of 246 patients (208 NMOSD and 38 MOGAD) were included. No differences were found in gender and ethnicity between the groups. We observed chiasmatic lesions in 66/208 (31.7%) NMOSD-ON and in 5/38 (13.1%) MOGAD-ON patients (p = 0.01). Of these patients with chiasmatic lesions, 54/66 (81.8%) and 4/5 had associated longitudinally extensive optic nerve lesions, 45/66 (68%) and 4/5 had bilateral lesions, and 31/66 (47%) and 4/5 showed gadolinium-enhancing chiasmatic lesions, respectively. A positive correlation was observed between VFSS and presence of bilateral (r = 0,28, p < 0.0001), chiasmatic (r = 0.27, p = 0.0001) and longitudinally extensive lesions (r = 0,25, p = 0.0009) in the NMOSD-ON group, but no correlations were observed in the MOGAD-ON group. CONCLUSIONS Chiasmatic lesions were significantly more common in NMOSD than in MOGAD during an ON attack in this LATAM cohort. Further studies are needed to assess the generalizability of these results.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | | | - Enrique Gómez-Figueroa
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José Flores-Rivera
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | | | | | | | | | - Verónica Tkachuk
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Debora Nadur
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Magdalena Casas
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Leila Cohen
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Marco Lana-Peixoto
- Department of Neurology, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina.,Service of Neurology, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Cristiano E, Abad P, Becker J, Carrá A, Correale J, Flores J, Fruns M, Garcea O, Garcia Bónitto J, Gracia F, Hamuy F, Navas C, Patrucco L, Rivera V, Velazquez M, Rojas JI. Multiple sclerosis care units in Latin America: Consensus recommendations about its objectives and functioning implementation. J Neurol Sci 2021; 429:118072. [PMID: 34509134 DOI: 10.1016/j.jns.2021.118072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/23/2021] [Accepted: 09/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Currently, there are several reasons to promote worldwide the concept of multiple sclerosis care units (MSCU) for a better management of affected patients. Ideally, the MSCU should have some human and technical resources that distinguish and improve the care of affected patients; however, local, and regional aspects should be considered when recommending how these units should operate. The objective of these consensus recommendations was to review how MSCU should work in Latin America to improve long-term outcomes in MS patients. METHODS A panel of neurology experts from Latin America dedicated to the diagnosis and care of MS patients gathered virtually during 2019 and 2020 to carry out a consensus recommendation about objectives and functioning implementation of MSCU in Latin America. To achieve consensus, the methodology of "formal consensus-RAND/UCLA method" was used. RESULTS Recommendations focused on the objectives, human and technical resources, and the general functioning that MSCU should have in Latin America. CONCLUSIONS The recommendations of these consensus guidelines attempt to optimize the health care and management of MS patients by setting how MSCU should work in our region.
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Affiliation(s)
- Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Patricio Abad
- Servicio Neurologia, Hospital Metropolitano de Quito, Ecuador, Profesor de Neurología PUCE, Ecuador
| | - Jefferson Becker
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Adriana Carrá
- MS Section Hospital Britanico Buenos Aires, Argentina; Neurociencias Fundación Favaloro/INECO, Buenos Aires, Argentina
| | | | - José Flores
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, Mexico; Centro Neurológico ABC Santa Fé, Ciudad de México, Mexico
| | | | - Orlando Garcea
- Clínica de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Fernando Gracia
- Clinica de Esclerosis Multiple, Servicio de Neurologia Hospital Santo Tomas, Panama. Universidad Interamericana de Panama, Panama
| | - Fernando Hamuy
- Departamento de Neurologia, Hospital IMT, Paraguay; Departamento de Neurologia de Diagnóstico Codas Thompson, Paraguay
| | - Cárlos Navas
- Clinica Enfermedad Desmielinizante Clinica Universitaria Colombia, Colombia
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina
| | | | | | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina.
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Rojas JI, Henestroza P, Giachello S, Patrucco L, Cristiano E, Carnero Contentti E. Influenza vaccination status in multiple sclerosis patients from Latin America. J Neurovirol 2021; 27:750-754. [PMID: 34586604 PMCID: PMC8480125 DOI: 10.1007/s13365-021-01011-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022]
Abstract
The objective of the present study was to identify the frequency of MS patients in Latin America (LATAM) that received the influenza vaccine during the most recent season and the reasons related to non-vaccination. Cross-sectional study between November and December 2020 in a large cohort of MS patients from LATAM. Patients responded about recommendation of receiving influenza vaccine and the use of it as well as reasons for not using the vaccine. Four hundred twelve MS patients were included in the analysis. 47.3% of patients were recommended to receive the vaccine from the treating physician. Nearly 54% of patients did not receive the influenza vaccine, and the most frequent cause was that it was neither recommended nor mentioned by the treating physician (27.4%). Female gender (OR = 2.3, 95%CI 1.4–3.8, p = 0.001) was associated with an increased risk of recommendation, while a progressive form of MS and higher EDSS decreased the risk (OR = 0.49, 95%CI 0.27–0.90, p = 0.023; OR = 0.65, 95%CI 0.55–0.97, p = 0.02, respectively). Despite the evidence to recommend the influenza vaccine in MS patients, a limited number of patients in clinical practice received such recommendation.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina. .,Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina.
| | - Paula Henestroza
- Asociación de Lucha Contra La Esclerosis Múltiple (ALCEM), Buenos Aires, Argentina
| | - Susana Giachello
- Asociación de Lucha Contra La Esclerosis Múltiple (ALCEM), Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina.,Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
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Contentti EC, Lopez PA, Pettinicchi JP, Criniti J, Pappolla A, Miguez J, Patrucco L, Carnero Contentti E, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Leguizamon F, Luetic G, Menichini ML, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Liguori NF, Nadur D, Chercoff A, Alonso Serena M, Caride A, Paul F, Rojas JI. Assessing attacks and treatment response rates among adult patients with NMOSD and MOGAD: Data from a nationwide registry in Argentina. Mult Scler J Exp Transl Clin 2021; 7:20552173211032334. [PMID: 34434560 PMCID: PMC8381444 DOI: 10.1177/20552173211032334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/24/2021] [Indexed: 11/15/2022] Open
Abstract
We aimed to examine treatment interventions implemented in patients experiencing
neuromyelitis optica spectrum disorders (NMOSD) attacks (frequency, types, and
response).
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Affiliation(s)
| | | | | | - Juan Criniti
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Buenos Aires, Argentina
| | | | | | | | - Felisa Leguizamon
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Buenos Aires, Argentina
| | | | | | | | | | - Gisela Zanga
- Unidad Asistencial César Milstein, CABA, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G. Durand, CABA, Buenos Aires, Argentina
| | | | | | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Buenos Aires, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, CABA, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, CABA, Buenos Aires, Argentina
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Rojas JI, Gracia F, Patrucco L, Alonso R, Carnero Contentti E, Cristiano E. Multiple sclerosis and neuromyelitis optica spectrum disorder testing and treatment availability in Latin America. Neurol Res 2021; 43:1081-1086. [PMID: 34240685 DOI: 10.1080/01616412.2021.1949686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The objective of our study was to describe the availability of diagnostic tests and treatment for MS and NMOSD in Latin America (LATAM). METHODS A survey instrument was used in a sample of physicians from LATAM countries. The goal of the survey was to understand availability of: 1) imaging tests for diagnosing MS and NMOSD and its barriers; 2) diagnostic laboratory tests for diagnosing MS and NMOSD and its barriers; and 3) treatments for MS and NMOSD in the acute and chronic phases of the disease. RESULTS Responses were received from 80 physicians. AQP4-ab test was available in 54% of the countries and MOG-ab test in 42%. All of countries had available use of high doses of intravenous methylprednisolone, oral steroids, plasmapheresis, and intravenous immunoglobulins for relapses. For NMOSD, 93% of the countries were able to use azathioprine and mycophenolate mofetil, and 87% rituximab. In MS, 93% of countries had available to them IFN beta, 69% glatiramer acetate, 75% teriflunomide, 93% fingolimod, 69% dimethyl-fumarate, 75% cladribine, 69% natalizumab, 93% ocrelizumab and 81% alemtuzumab. The most common challenge and barrier identified was the cost of medications. CONCLUSION The present study allows an understanding of the delivery of care for MS and NMOSD in the region.
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Affiliation(s)
- Juan I Rojas
- Department of Neurology, Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina.,Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
| | - Fernando Gracia
- Clinica de Esclerosis Multiple, Servicio de Neurología, Hospital Santo Tomas, Panamá City, Panama.,Department of Neurology, Universidad Interamericana de Panama, Panama City, Panama
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina.,Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Buenos Aires, Argentina
| | | | - Edgardo Cristiano
- Department of Neurology, Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina
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Rojas JI, Patrucco L, Fruns M, Hornung G, Flores J, Carnero Contentti E, Lopez PA, Pettinicchi JP, Caride A, Galleguillos L, Barahona J, Diaz V, Hernández M, Alonso R, Cristiano E. Real-world experience of ocrelizumab in multiple sclerosis patients in Latin America. Arq Neuropsiquiatr 2021; 79:305-309. [PMID: 34133511 DOI: 10.1590/0004-282x-anp-2020-0339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the abundance of information concerning ocrelizumab in phase III clinical trials, there is scarce evidence regarding real-world patient profiles. OBJECTIVE The aim of this study was to investigate patient profiles, effectiveness and persistence with treatment among patients who used ocrelizumab for treatment of multiple sclerosis in Latin America. METHODS This was a retrospective multicenter study in Argentina, Chile and Mexico. Medical record databases on patients who received ocrelizumab were analyzed. Demographic and clinical variables were described, along with effectiveness outcomes, which included the proportions of patients free from clinical relapses, from disability progression and from new or enlarging T2 or T1 gadolinium-enhancing lesions, on annual magnetic resonance imaging. RESULTS A total of 81 patients were included. The most frequent phenotype was relapsing-remitting MS, in 64.2% of the patients. The mean age at study entry was 41.3 ± 12.0 years and 51.8% were women. A total of 38% had had relapse activity during the 12 months before starting on ocrelizumab, with a mean relapse rate of 1.3 ± 0.6 during that period. 75% were free from clinical relapses and 91% were free from gadolinium-enhancing lesions in the relapsing-remitting course. Ocrelizumab discontinuation during the first 12 months was observed in three patients (3.7%). The mean persistence observed during the first-year follow-up was 338 ± 24 days. CONCLUSIONS Our study is in line with previous randomized clinical trials and recent real-world studies describing patient profiles, effectiveness and persistence regarding ocrelizumab treatment in multiple sclerosis patients in Latin America.
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Affiliation(s)
- Juan Ignacio Rojas
- Hospital Universitario de CEMIC, Servicio de Neurología, Buenos Aires, Argentina.,Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina.,Hospital Italiano de Buenos Aires, Servicio de Neurología, Buenos Aires, Argentina
| | | | | | - José Flores
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México.,Centro Neurológico ABC Santa Fé, Ciudad de México, México
| | | | - Pablo Adrian Lopez
- Hospital Alemán, Department of Neuroscience, Neuroimmunology Unit, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Hospital Alemán, Department of Neuroscience, Neuroimmunology Unit, Buenos Aires, Argentina
| | - Alejandro Caride
- Hospital Alemán, Department of Neuroscience, Neuroimmunology Unit, Buenos Aires, Argentina
| | - Lorna Galleguillos
- Clínica Alemana de Santiago, Unidad de Neuroinmunología, Santiago, Región Metropolitana, Chile
| | - Jorge Barahona
- Clínica Alemana de Santiago, Unidad de Neuroinmunología, Santiago, Región Metropolitana, Chile
| | - Violeta Diaz
- Clínica Alemana de Santiago, Unidad de Neuroinmunología, Santiago, Región Metropolitana, Chile
| | - Marianella Hernández
- Clínica Alemana de Santiago, Unidad de Neuroinmunología, Santiago, Región Metropolitana, Chile
| | - Ricardo Alonso
- Hospital Ramos Mejía, Centro Universitario de Esclerosis Múltiple, Buenos Aires, Argentina.,Hospital Universitario Sanatorio Guemes, Servicio de Neurología, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
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Alonso R, Patrucco L, Silva B, Quarracino C, Eizaguirre MB, Vrech C, López P, Carnero Contentti E, Deri N, Carrá A, Chercorff A, Tkachuk V, Balbuena ME, Pettinicchi JP, Tavolini D, Barboza A, Rojas JI, Cristiano E, Lázaro L, Garcea O, Fernández Liguori N. Family planning in Argentinian women with multiple sclerosis: An important yet seldom approached issue. Mult Scler J Exp Transl Clin 2021; 7:20552173211025312. [PMID: 34211724 PMCID: PMC8216353 DOI: 10.1177/20552173211025312] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of this study was to assess family planning (FP) among women with multiple sclerosis (WwMS). Methods We invited 604 WwMS to answer a survey focused on FP: a) Temporal relationship between pregnancy and the diagnosis of multiple sclerosis; b) History of FP; c) Childbearing desire; d) Information on family planning. Comparisons between pregnancy and not pregnancy after MS, as well as, planned and unplanned pregnancy were analyzed. Multivariate and univariate analyses were used to assess the impact of independent variables and FP Result 428 (71.7%) WwMS completed the survey. A 19.1% got pregnant after MS diagnosis and we evaluated FP in the last pregnancy, 56.1% patients had a planned pregnancy. Professional addressing FP (OR = 0.27, 95%-CI 0.08-0.92, p = 0.03) and non-injection drug treatment before pregnancy (OR = 2.88, 95%-CI 1.01-8.21, p = 0.047) were independent predictors of unplanned pregnancy in our multivariate model. Among WwMS ≤ 40 years, 48.7% had future childbearing desire. Young age (p < 0.001), PDDS <3 (p = 0.018), disease duration <5 years (p = 0.02), not childbearing before MS diagnosis (p < 0.001) and neurologist addressing family planning (p = 0.01) were significantly associated with childbearing desire. Conclusions This research highlights that pregnancy remains an important concern among WwMS.
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Affiliation(s)
- Ricardo Alonso
- Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, Buenos Aires, Argentina
| | - Cecilia Quarracino
- Servicio de Neurología. Instituto Alfredo Lanari, Hospital Universitario, Buenos Aires, Argentina
| | - María Barbara Eizaguirre
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - Pablo López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | | | - Norma Deri
- Centro de Investigaciones Diabaid, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes, Hospital Británico, Buenos Aires, Argentina
| | - Aníbal Chercorff
- Sección de Enfermedades Desmielinizantes, Hospital Británico, Buenos Aires, Argentina
| | - Verónica Tkachuk
- Sección de Esclerosis Múltiple y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - María Eugenia Balbuena
- Sección de Esclerosis Múltiple y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Luciana Lázaro
- Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Facultad de Medicina - UBA, Buenos Aires, Argentina
| | - Nora Fernández Liguori
- Servicio de Neurología, Sanatorio Güemes, Buenos Aires, Argentina.,Servicio de Neurología. Hospital Enrique Tornú, Buenos Aires, Argentina
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Kohler M, Kohler E, Vrech C, Pappolla A, Miguez J, Patrucco L, Correale J, Marrodan M, Gaitán MI, Fiol M, Negrotto L, Ysrraelit MC, Cristiano E, Carrá A, Steinberg J, Martinez AD, Curbelo MC, Cohen L, Alonso R, Garcea O, Pita C, Silva B, Luetic G, Deri N, Balbuena ME, Tkachuk V, Carnero Contentti E, Lopez PA, Pettinicchi JP, Caride A, Burgos M, Leguizamon F, Knorre E, Piedrabuena R, Barboza A, Liwacki S, Nofal P, Volman G, Alvez Pinheiro A, Hryb J, Tavolini D, Blaya P, Recchia L, Mainella C, Silva E, Blanche J, Tizio S, Saladino ML, Caceres F, Fernandez Liguori N, Lazaro L, Zanga G, Parada Marcilla M, Fracaro ME, Pagani Cassara F, Vazquez G, Sinay V, Sgrilli G, Divi P, Jacobo M, Reich E, Cabrera LM, Menichini ML, Coppola M, Martos I, Viglione JP, Jose G, Bestoso S, Manzi R, Giunta D, Doldan ML, Alonso Serena M, Rojas JI. Aggressive multiple sclerosis in Argentina: Data from the nationwide registry RelevarEM. J Clin Neurosci 2021; 89:360-364. [PMID: 34088579 DOI: 10.1016/j.jocn.2021.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/09/2020] [Accepted: 05/23/2021] [Indexed: 11/16/2022]
Abstract
The objectives of the present study were to describe the frequency of aggressive multiple sclerosis (aMS) as well as to compare clinical and radiological characteristics in aMS and non-aMS patients included in RelevarEM (NCT03375177). METHODS The eligible study population and cohort selection included adult-onset patients (≥18 years) with definite MS. AMS were defined as those reaching confirmed EDSS ≥ 6 within 5 years from symptom onset. Confirmation was achieved when a subsequent EDSS ≥ 6 was recorded at least six months later but within 5 years of the first clinical presentation. AMS and non-aMS were compared using the χ2 test for categorical and the Mann-Whitney for continuous variables at MS onset and multivariable analysis was performed using forward stepwise logistic regression with baseline characteristics at disease onset. RESULTS A total of 2158 patients with MS were included: 74 aMS and 2084 non-aMS. The prevalence of aMS in our cohort was 3.4% (95%CI 2.7-4.2). AMS were more likely to be male (p = 0.003), older at MS onset (p < 0.001), have primary progressive MS (PPMS) phenotype (p = 0.03), multifocal presentation (p < 0.001), and spinal cord as well as infratentorial lesions at MRI during disease onset (p = 0.004 and p = 0.002, respectively). CONCLUSION 3.4% of our patient population could be considered aMS. Men, patients older at symptom onset, multifocal presentation, PPMS phenotype, and spinal cord as well as brainstem lesions on MRI at clinical presentation all had higher odds of having aMS.
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Affiliation(s)
| | | | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Marcela Fiol
- Departamento de Neurología - FLENI, CABA, Argentina
| | | | | | | | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina; Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, Argentina
| | - Judith Steinberg
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | | | - María C Curbelo
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Leila Cohen
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina; Sanatorio Güemes, CABA, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Cecilia Pita
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA, Argentina
| | | | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | - Maria E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | | | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Juan P Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | | | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Argentina
| | - Raúl Piedrabuena
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Instituto Lennox, Córdoba, Argentina
| | | | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología - Hospital Córdoba, Córdoba, Argentina
| | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, San Miguel de Tucumán, Tucumán, Argentina
| | - Gabriel Volman
- Hospital Presidente Perón de Avellaneda, Buenos Aires, Argentina
| | | | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | - Dario Tavolini
- INECO Neurociencias Oroño - Fundación INECO, Rosario, Santa Fe, Argentina
| | | | | | | | - Emanuel Silva
- Predigma - Centro de Medicina Preventiva, Posadas, Misiones, Argentina
| | - Jorge Blanche
- IRNEC (Instituto Regional de Neurociencias), San Miguel de Tucumán, Argentina
| | | | | | | | | | | | - Gisela Zanga
- Unidad asistencial César Milstein, CABA, Argentina
| | | | | | | | - Guido Vazquez
- Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, Argentina
| | - Vladimiro Sinay
- Instituto de Neurociencias - Fundación Favaloro/INECO, CABA, Argentina
| | | | - Pablo Divi
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | - Miguel Jacobo
- RIAPEM (Red Integral Asistencial al Paciente con Esclerosis Múltiple), Santiago del Estero, Argentina
| | - Edgardo Reich
- Servicio de Neurologia, Hospital Municipal Dr. Julio Méndez, CABA, Argentina
| | - Lorena M Cabrera
- Servicio de Neurología - Hospital Militar Central, CABA, Argentina; Hospital Militar Campo de Mayo, CABA, Argentina
| | | | - Mariano Coppola
- Servicio de Neurología, Hospital Ramón Santamarina, Tandil, Buenos Aires, Argentina
| | - Ivan Martos
- Clinica San Jorge, Ushuaia, Tierra del fuego, Argentina
| | | | - Gustavo Jose
- Sección de enfermedades desmielinizantes, Servicio de Neurología, Hospital Padilla, Tucumán, Argentina
| | - Santiago Bestoso
- Servicio Neurología - Hospital Escuela José F. de San Martín Corrientes, Corrientes, Argentina
| | | | - Diego Giunta
- Servicio de clínica médica, Hospital Italiano de Buenos Aires, CABA, Argentina
| | - Maria L Doldan
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina
| | | | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina.
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Rojas JI, Carnero Contentti E, Abad P, Aguayo A, Alonso R, Bauer J, Becker J, Bustos AK, Carcamo CA, Carra A, Correa Diaz EP, Correale J, Cristiano E, Diaz AJ, Fernandez Liguori N, Flores J, Fruns M, Garcea O, Giachello SM, Godoy MD, Gracia F, Hamuy VF, Henestroza PR, Navarra JA, Navas C, Patrucco L, Perez Bruno M, Prato AS, Rivera VM, Rosa Martinez AR, Vanotti S, Vazquez M, Vizcarra D, Ysrraelit MC, Alonso Serena M. Research priorities in multiple sclerosis in Latin America: A multi-stakeholder call to action to improve patients care: Research priorities in MS in LATAM. Mult Scler Relat Disord 2021; 53:103038. [PMID: 34090128 DOI: 10.1016/j.msard.2021.103038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
As human and economic resources are limited, especially in Latin America (LATAM), it is important to identify research priorities to improve multiple sclerosis (MS) patients care in the region. The objective was to generate a multidisciplinary consensus on research priorities in MS for patients care in LATAM by involving healthcare professionals and MS patient associations. METHODS: consensus was reached through a four-step modified Delphi method designed to identify and rate research priorities in MS in LATAM. The process consisted of two qualitative assessments, a general ranking phase and a consensus meeting followed by a more detailed ranking phase RESULTS: a total of 62 participants (35 neurologists, 4 nurses, 12 kinesiologists, 7 neuropsychologists and 4 patient association members) developed the process. At the final ranking stage following the consensus meeting, each participant provided their final rankings, and the top priority research questions were outlined. 11 research priorities were identified focusing on healthcare access, costs of the disease, physical and cognitive evaluation and rehabilitation, quality of life, symptoms management, prognostic factors, the need of MS care units and patient's management in emergencies like COVID-19. CONCLUSION: this work establishes MS research priorities in LATAM from multiple perspectives. To pursue the actions suggested could launch the drive to obtain information that will help us to better understand the disease in our region and, especially, to better care for affected patients.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario CEMIC, Buenos Aires, Argentina.
| | - Edgar Carnero Contentti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán de Buenos Aires, Argentina
| | - Patricio Abad
- Servicio Neurologia, Hospital Metropolitano de Quito, Ecuador
| | - Adriana Aguayo
- Departamento de Neurociencias. Centro Universitario Ciencias de la Salud. Universidad de Guadalajara, México
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Buenos Aires, Argentina
| | - Johana Bauer
- EMA, esclerosis múltiple Argentina, Buenos Aires, Argentina
| | - Jefferson Becker
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brasil
| | | | - Claudia A Carcamo
- Departamento de Neurologia, Pontificia Universidad Católica de Chile, Chile
| | - Adriana Carra
- MS Section. Hospital Britanico Buenos Aires, Argentina
| | | | - Jorge Correale
- Departamento de Neurologia, FLENI, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Servicio de Neurología, Hospital Universitario CEMIC, Buenos Aires, Argentina
| | | | - Nora Fernandez Liguori
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Buenos Aires, Argentina; Hospital Enrique Tornu, Buenos Aires, Argentina
| | - Jose Flores
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | | | - Orlando Garcea
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Buenos Aires, Argentina
| | - Susana M Giachello
- ALCEM - Asociacion de Lucha contra la Esclerosis Multiple, Buenos Aires, Argentina
| | | | - Fernando Gracia
- Clinica de Esclerosis Multiple, Servicio de Neurologia Hospital Santo Tomas, Panama
| | | | - Paula R Henestroza
- ALCEM - Asociacion de Lucha contra la Esclerosis Multiple, Buenos Aires, Argentina
| | | | - Carlos Navas
- Clinica Enfermedad Desmielinizante Clinica Universitaria Colombia, Colombia
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Unidad de Esclerosis Múltiple y enfermedades desmielinizantes, Hospital Italiano de Buenos Aires, Argentina
| | | | | | | | | | - Sandra Vanotti
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Macarena Vazquez
- Departamento de Neurología, Escuela de Medicina Pontificia Universidad Católica de Chile, Chile
| | - Darwin Vizcarra
- Hypnos Instituto del Sueño, Clínica San Felipe, Universidad Peruana Cayetano Heredia, Lima, Peru
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Rojas JI, Patrucco L, Pappolla A, Cristiano E. Improvement over previous decades in time of diagnosis but not in time of initiating DMD in MS patients in Argentina. Mult Scler Relat Disord 2021; 52:103007. [PMID: 34000685 DOI: 10.1016/j.msard.2021.103007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objective of the study was to compare the interval from first symptom of MS to diagnosis, and the interval between date of diagnosis and DMD initiation with the introduction of upgraded MS diagnosis criteria. METHODS retrospective cohort study. To be included, data concerning date of disease onset (first relapse), date of diagnosis (confirmed disease) and date of DMD initiation had to be available. Kaplan-Meier estimator and plots were applied. Survival probabilities were evaluated for the 2 diagnosis epoch groups according to the diagnostic criteria advised at the time: group 1, for diagnosis performed between 2005-2009 (2005 revised McDonald criteria) and group 2, for diagnosis performed between 2010-2017 (2010 revised McDonald criteria). RESULTS 654 patients were included (278 in group 1 and 308 in group 2). The mean time from disease onset to diagnosis in group 1 was 11 ± 4 vs. 7 ± 3 months (p = 0.001). Mean time from disease diagnosis to first DMD was 2.9 ± 1.1 months in group 1 vs. 6.8 ± 1.5 months in group 2 (p = 0.002). CONCLUSION although a shortening in time of diagnosis was described, a trend to increase the time to initiate a DMD was noted in group 2.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Argentina.
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina
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Ysrraelit MC, Caride A, Sinay V, Kindel MR, Halfon MJ, Patrucco L, Piedrabuena R, Aragunde VED. Real-world effectiveness of natalizumab treatment in patients with relapsing multiple sclerosis in Argentina and Chile. Arq Neuropsiquiatr 2021; 79:407-414. [PMID: 34161529 PMCID: PMC9394560 DOI: 10.1590/0004-282x-anp-2020-0303] [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: 07/02/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The real-world effectiveness of natalizumab in people with relapsing multiple sclerosis (PwRMS) in Argentina and Chile has not been reported. OBJECTIVE To evaluate the effectiveness of natalizumab treatment in PwRMS in Argentina and Chile, in clinical practice. METHODS We conducted a multicenter retrospective and observational study. We reviewed the medical records of PwRMS who had been treated with natalizumab for at least one year, without any interruption in MS treatment that lasted more than 12 weeks. We analyzed changes in annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) score and magnetic resonance imaging (MRI). RESULTS We enrolled 117 PwRMS treated with natalizumab. Natalizumab treatment was associated with a significant reduction in ARR from baseline after one year and two years of treatment (from 1.97 to 0.06 and 0.09 respectively; p<0.01 at each time point). From baseline, EDSS scores were reduced by 0.71 and 0.73 points at one and two years, respectively (p<0.01). No worsening of disability was observed in 82.9 and 67.5% of PwRMS at one and two years, respectively. The improvement in disability was 44.4% at one year and 39.3% at two years. During natalizumab treatment, the number of relapse-related hospitalizations was significantly reduced (p<0.01). MRI lesions (new/enlarging T2 or gadolinium-enhancing) were significantly reduced, compared with baseline. No evidence of disease activity was observed in 65% at two years of natalizumab treatment. CONCLUSIONS Natalizumab significantly reduced disease activity in PwRMS in Argentina and Chile, in clinical practice. Natalizumab also decreased the number of hospitalizations compared with pre-natalizumab treatment.
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Affiliation(s)
- Maria Celica Ysrraelit
- FLENIInstitute for Neurological Research Dr Raul CarreaNeurology DepartmentBuenos AiresArgentinaInstitute for Neurological Research Dr Raul Carrea, FLENI, Neurology Department, Buenos Aires, Argentina.
| | - Alejandro Caride
- Hospital AlemanDepartment of NeuroscienceNeuroimmunology UnitBuenos AiresArgentinaHospital Aleman, Department of Neuroscience, Neuroimmunology Unit, Buenos Aires, Argentina.
| | - Vladimiro Sinay
- Fundación Favaloro HospitalBuenos AiresArgentinaFundación Favaloro Hospital, Buenos Aires, Argentina.
| | - Mario Rivera Kindel
- Clínica DávilaRegión MetropolitanaChileClínica Dávila, Recoleta, Región Metropolitana, Chile.
| | - Mario Javier Halfon
- British Hospital of Buenos AiresBuenos AiresArgentinaBritish Hospital of Buenos Aires, Buenos Aires, Argentina.
| | - Liliana Patrucco
- Hospital Italiano de Buenos AiresBuenos AiresArgentinaHospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Raul Piedrabuena
- Clínica Universitaria Reina FabiolaServicio de NeurologíaCórdobaArgentinaClínica Universitaria Reina Fabiola, Servicio de Neurología, Córdoba, Argentina.
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Alonso R, Silva B, Garcea O, Diaz PEC, Dos Passos GR, Navarro DAR, Valle LAG, Salinas LCR, Negrotto L, Luetic G, Tkachuk VA, Míguez J, de Bedoya FHD, Goiry LG, Sánchez NER, Burgos M, Steinberg J, Balbuena ME, Alvarez PM, López PA, Ysrraelit MC, León RA, Cohen AB, Gracia F, Molina O, Casas M, Deri NH, Pappolla A, Patrucco L, Cristiano E, Tavolini D, Nadur D, Granda AMT, Weiser R, Cassará FP, Sinay V, Rodríguez CC, Lazaro LG, Menichini ML, Piedrabuena R, Escobar GO, Carrá A, Chertcoff A, Pujols BS, Vrech C, Tarulla A, Carvajal R, Mainella C, Becker J, Peeters LM, Walton C, Serena MA, Nuñez S, Rojas JI. COVID-19 in multiple sclerosis and neuromyelitis optica spectrum disorder patients in Latin America: COVID-19 in MS and NMOSD patients in LATAM. Mult Scler Relat Disord 2021; 51:102886. [PMID: 33744758 PMCID: PMC7937038 DOI: 10.1016/j.msard.2021.102886] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 12/31/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 12/27/2022]
Abstract
Background There is no data regarding COVID-19 in Multiple Sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients in Latin America. Objective The objective of this study was to describe the clinical characteristics and outcomes of patients included in RELACOEM, a LATAM registry of MS and NMOSD patients infected with COVID-19. Methods RELACOEM is a longitudinal, strictly observational registry of MS and NMOSD patients who suffer COVID-19 and Dengue in LATAM. Inclusion criteria to the registry were either: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a COVID-19 polymerase chain reaction (PCR) test on a nasopharyngeal swab; or (2) COVID-19–typical symptoms (triad of cough, fever, and asthenia) in an epidemic zone of COVID-19. Descriptive statistics were performed on demographic and clinical variables. The cohort was later stratified for MS and NMOSD and univariate and multivariate logistic regression analysis was performed to identify variables associated with hospitalizations/intensive critical units (ICU) admission. Results 145 patients were included in the registry from 15 countries and 51 treating physicians. A total of 129 (89%) were MS patients and 16 (11%) NMOSD. 81.4% patients had confirmed COVID-19 and 18.6% were suspected cases. 23 (15.8%) patients were hospitalized, 9 (6.2%) required ICU and 5 (3.4 %) died due to COVID-19. In MS patients, greater age (OR 1.17, 95% CI 1.05 – 1.25) and disease duration (OR 1.39, 95%CI 1.14-1.69) were associated with hospitalization/ICU. In NMOSD patients, a greater age (54.3 vs. 36 years, p=<0.001), increased EDSS (5.5 vs 2.9, p=0.0012) and disease duration (18.5 vs. 10.3 years, p=0.001) were significantly associated with hospitalization/ICU. Conclusion we found that in MS patients, age and disease duration was associated with hospitalization and ICU admission requirement, while age, disease duration and EDSS was associated in NMOSD.
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Affiliation(s)
- Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple. Hospital Ramos Mejía, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | - Berenice Silva
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | - Orlando Garcea
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | | | | | | | | | | | | | | | | | | | - Fernando Hamuy Diaz de Bedoya
- Departamento de Neurologia, Hospital IMT, Paraguay; Departamento de Neurologia de Diagnóstico Codas Thompson, Paraguay
| | | | | | | | | | - Maria E Balbuena
- Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Debora Nadur
- Hospital Naval - Hospital de Clínicas, Buenos Aires, Argentina
| | | | | | - Fátima Pagani Cassará
- Hospital Universitario Austral, Buenos Aires, Argentina; Fundación Favaloro, Buenos Aires, Argentina
| | | | | | - Luciana G Lazaro
- Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Argentina
| | | | - Raúl Piedrabuena
- Clinica Reina Fabiola, Córdoba, Argentina; Instituto Lennox, Córdoba, Argentina
| | | | | | | | | | | | | | | | | | - Jefferson Becker
- Hospital São Lucas - Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - Liesbet M Peeters
- University Multiple Sclerosis Center; Biomedical Research Institute & Data Science Institute, Hasselt University, Belgium
| | | | | | - Sebastián Nuñez
- Infectious Diseases Unit Sanatorio Güemes, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Giménez MV, Pappolla A, Varela L, Bursztyn M, Kohan D, Patrucco L. Uveitis intermedia as the initial presentation of a primary lymphoma of the central nervous system. Arch Soc Esp Oftalmol (Engl Ed) 2021; 97:S0365-6691(21)00015-0. [PMID: 33640210 DOI: 10.1016/j.oftal.2020.12.006] [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] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
Abstract
Primary central nervous system lymphoma is one of the most infrequent brain tumours, accounting for 3% of primary central nervous system neoplasms. In addition to its low prevalence, clinical presentation is usually nonspecific, leading to diagnostic delay. Intraocular involvement occurs in 15% of cases, and disease onset in this location is even rarer. We present a case of a patient with intermediate uveitis as the first clinical manifestation of this neoplasm.
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Affiliation(s)
- M V Giménez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina.
| | - A Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina
| | - L Varela
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina
| | - M Bursztyn
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina
| | - D Kohan
- Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina
| | - L Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Oftalmología, Hospital Italiano de Buenos Aires, Argentina; Servicio de Hematología, Hospital Italiano de Buenos Aires, Argentina
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Carnero Contentti E, Lopez PA, Pettinicchi JP, Pappolla A, Miguez J, Patrucco L, Cristiano E, Vrech C, Tkachuk V, Liwacki S, Correale J, Marrodan M, Gaitán MI, Fiol M, Negrotto L, Ysrraelit MC, Burgos M, Leguizamon F, Tavolini D, Deri N, Balbuena ME, Mainella C, Luetic G, Blaya P, Hryb J, Menichini ML, Alvez Pinheiro A, Nofal P, Zanga G, Barboza A, Martos I, Lazaro L, Alonso R, Silva E, Bestoso S, Fracaro ME, Carrá A, Garcea O, Fernandez Liguori N, Alonso Serena M, Caride A, Rojas JI. What percentage of AQP4-ab-negative NMOSD patients are MOG-ab positive? A study from the Argentinean multiple sclerosis registry (RelevarEM). Mult Scler Relat Disord 2021; 49:102742. [PMID: 33454601 DOI: 10.1016/j.msard.2021.102742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/10/2020] [Accepted: 01/04/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibodies (MOG-ab) have been described in aquaporin-4-antibodies(AQP4-ab)-negative neuromyelitis optica spectrum disorder (NMOSD) patients. We aimed to evaluate the percentage of AQP4-ab-negative NMOSD patients who are positive for MOG-ab in a cohort of Argentinean patients included in RelevarEM (Clinical Trials registry number NCT03375177). METHODS RelevarEM is a longitudinal, strictly observational multiple sclerosis (MS) and NMOSD registry in Argentina. Of 3031 consecutive patients (until March 2020), 165 patients with phenotype of suspected NMOSD, whose relevant data for the purpose of this study were available, were included. Data on demographic, clinical, paraclinical and treatment in AQP4-ab (positive, negative and unknown) and MOG-ab (positive and negative) patients were evaluated. RESULTS A total of 165 patients (79 AQP4-Ab positive, 67 AQP4-Ab negative and 19 unknown) were included. Of these, 155 patients fulfilled the 2015 NMOSD diagnostic criteria. Of 67 AQP4-Ab-negative patients, 36 (53.7%) were tested for MOG-Ab and 10 of them (27.7%) tested positive. Serum AQP4-ab levels were tested by means of cell-based assay (CBA) in 48 (35.2%), based on tissue-based indirect immunofluorescence assays in 58 (42.6%) and enzyme-linked immunosorbent assay in 4 (2.9%). All MOG-ab were tested by CBA. Optic neuritis (90%) was the most frequent symptom at presentation and optic nerve lesions the most frequent finding (80%) in neuroimaging of MOG-ab-associated disease. Of these, six (60%) patients were under immunosuppressant treatments at latest follow-up. CONCLUSION We observed that 27.7% (10/36) of the AQP4-ab-negative patients tested for MOG-ab were positive for this antibody, in line with results from other world regions.
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Affiliation(s)
| | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires
| | | | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires
| | | | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA
| | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba; Servicio de Neurología - Hospital Córdoba, Córdoba
| | | | | | | | | | | | | | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta
| | | | - Dario Tavolini
- INECO Neurociencias Oroño - Fundación INECO, Rosario, Santa Fe
| | | | - Maria E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA
| | | | | | | | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA
| | | | | | - Pedro Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, San Miguel de Tucumán, Tucumán
| | | | | | - Ivan Martos
- Clinica San Jorge. Ushuaia. Tierra del fuego
| | | | | | - Emanuel Silva
- Predigma - Centro de Medicina Preventiva, Posadas, Misiones
| | - Santiago Bestoso
- Servicio Neurología - Hospital Escuela José F. de San Martín Corrientes, Corrientes
| | | | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA; Instituto de Neurociencias - Fundación Favaloro/INECO, CABA
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple - Hospital Dr. J. M. Ramos Mejía. Facultad de Medicina - UBA, CABA
| | | | | | - Alejandro Caride
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires
| | - Juan I Rojas
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA; Servicio de Neurología, Hospital Universitario de CEMIC, CABA
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Pappolla A, Sánchez F, Patrucco L, Varela L, Castañares C, Lopez PH, Cristiano E, Rojas JI. [Prognostic value of cerebrospinal fluid glutamate in multiple sclerosis]. Medicina (B Aires) 2021; 81:774-779. [PMID: 34633951] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
The objective of this study was to evaluate the association between glutamate (Glu) levels in cerebrospinal fluid (CSF) at disease onset and disease progression during follow up in a cohort of multiple sclerosis (MS) patients. Glu level was measured at disease onset (first relapse). MRI was obtained at baseline and follow-up (every 12 months) to determine the percent of brain volume change (PBVC), cortical thickness (CT), and T2 lesion volume (T2LV). The primary predictors of interest were baseline CSF Glu levels, PBVC and CT, as well as clinical disease progression [measured by Expanded Disability Status Scale (EDSS) and annualized relapse rate] during follow-up. A total of 26 MS patients were included. Mean concentration of Glu in CSF at diagnosis was 5.3 ± 0.4 uM/l. A significant association was observed between higher baseline levels of Glu and an increase in EDSS during follow up (b = 1.06, 95%CI 0.47-1.66, p = 0.003) as well as PBVC (b = -0.71 95%CI -0.56-1.38, p = 0.002) and CT (b = -0.15, 95%CI -0.06-0.33, p = 0.01). We did not observe an association between baseline Glu levels and relapse rate or T2LV during follow-up (b = 0.08, 95%CI -0.11-0.43, p = 0.11 and b = 195, 95%CI -39-330, p = 0.22, respectively). Higher Glu concentrations at disease onset were associated with an increase in PBVC and EDSS progression during follow-up in MS patients.
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Affiliation(s)
- Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina. E-mail:
| | | | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina
| | - Lucia Varela
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina
| | - Clara Castañares
- Laboratorio de Neurobiología, Instituto de Investigación Médica Mercedes y Martín Ferreyra, INIMEC-CONICET Universidad Nacional de Córdoba, Argentina
| | - Pablo H Lopez
- Laboratorio de Inmunomoduladores, CEFYBO-CONICET-UBA, Buenos Aires, Argentina
| | | | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Argentina
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Cristiano E, Patrucco L, Ysrraelit MC, Alonso R, Balbuena ME, Ballario C, Barboza AG, Bestoso S, Burgos M, Cáceres FJ, Carrá A, Carnero-Contentti E, Deri N, Fernández-Liguori N, Garcea O, Hryb JP, Jacobo M, Kohler E, Luetic GG, Mainella C, Menichini ML, Míguez J, Nofal PG, Piedrabuena R, Rugilo C, Saladino ML, Silva BA, Silva E, Sinay V, Tavolini D, Tkachuk VA, Villa A, Vrech C, Rojas JI. [Argentinean consensus guidelines on the identification and clinical care of secondary progressive multiple sclerosis]. Rev Neurol 2021; 72:23-32. [PMID: 33378076 DOI: 10.33588/rn.7201.2020379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The identification, diagnosis, follow-up, and treatment of patients with secondary progressive multiple sclerosis (SPMS) show significant differences between health care professionals in Argentina. AIM To provide consensus recommendations on the management of patients with SPMS in Argentina to optimize patient care. DEVELOPMENT A panel of expert neurologists from Argentina dedicated to the diagnosis and care of multiple sclerosis patients gathered during 2019 and 2020 to carry out a consensus recommendation on the diagnosis and treatment of SPMS patients in Argentina. To achieve consensus, the methodology of 'formal consensus-RAND/UCLA method' was used. Recommendations were established based on published evidence and the expert opinion. Recommendations focused on how to define SPMS and how to follow SPMS patients. CONCLUSION The recommendations of this consensus guidelines attempt to optimize the care of SPMS patients in Argentina.
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Affiliation(s)
- E Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - L Patrucco
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M C Ysrraelit
- Instituto de Investigaciones Neurológicas Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - R Alonso
- Hospital Ramos Mejía. Universidad de Buenos Aires, Buenos Aires, Argentina.,Hospital Universitario Sanatorio Güemes, Buenos Aires, Argentina
| | - M E Balbuena
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | | | - A G Barboza
- Hospital Central de Mendoza, Mendoza, Argentina
| | - S Bestoso
- Hospital Escuela de Corrientes. Universidad Nacional del Nordeste, Corrientes, Argentina
| | - M Burgos
- Hospital San Bernardo, Salta, Argentina
| | - F J Cáceres
- Instituto de Neurociencias de Buenos Aires (INEBA), Buenos Aires, Argentina
| | - A Carrá
- Hospital Británico, Buenos Aires, Argentina.,Fundación Favaloro/INECO, Buenos Aires, Argentina
| | | | - N Deri
- Hospital General de Agudos Juan A. Fernández, Buenos Aires, Argentina.,Centro de Investigaciones Diabaid, Buenos Aires, Argentina
| | - N Fernández-Liguori
- Hospital Universitario Sanatorio Güemes, Buenos Aires, Argentina.,Hospital Enrique Tornu, Buenos Aires, Argentina
| | - O Garcea
- Hospital Ramos Mejía. Universidad de Buenos Aires, Buenos Aires, Argentina
| | - J P Hryb
- Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - M Jacobo
- Red Integral Asistencial al Paciente con Esclerosis Múltiple (RIAPEM), Santiago del Estero, Argentina
| | - E Kohler
- Fundación Sinapsis, Santa Rosa, Argentina
| | - G G Luetic
- Instituto de Neurociencias de Rosario, Rosario, Argentina
| | - C Mainella
- Hospital Español de Rosario, Rosario, Argentina
| | - M L Menichini
- Sanatorio Británico, Rosario, Argentina.,Hospital Provincial del Centenario, Rosario, Argentina
| | - J Míguez
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - P G Nofal
- Hospital de Clínicas Nuestra Señora del Carmen, San Miguel de Tucumán, Argentina
| | - R Piedrabuena
- Instituto Lennox, Córdoba, Argentina.,Clínica Reina Fabiola, Córdoba, Argentina
| | - C Rugilo
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina.,Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - M L Saladino
- Instituto de Neurociencias de Buenos Aires (INEBA), Buenos Aires, Argentina
| | - B A Silva
- Hospital Ramos Mejía. Universidad de Buenos Aires, Buenos Aires, Argentina
| | - E Silva
- Predigma. Centro de Medicina Preventiva, Posadas, Argentina
| | - V Sinay
- Fundación Favoloro/INECO, Buenos Aires, Argentina
| | - D Tavolini
- Hospital Provincial del Centenario, Rosario, Argentina.,INECO Neurociencias Oroño, Rosario, Argentina
| | - V A Tkachuk
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - A Villa
- Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
| | - C Vrech
- Sanatorio Allende, Córdoba, Argentina
| | - J I Rojas
- Hospital Universitario de CEMIC, Buenos Aires, Argentina.,Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
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Alonso R, Garcea O, Eizaguirre MB, Man F, Bizzo AL, Cohen L, Rojas JI, Patrucco L, Cristiano E, Pita C, Tkachuk V, Balbuena ME, Carnero Contentti E, Lopez P, Pettinichi JP, Deri N, Miguez J, Pappolla A, Lazaro L, Liguori NF, Correale J, Carrá A, Silva BA. Usage trend of oral drugs for multiple sclerosis patients in Argentina. Mult Scler Relat Disord 2020; 47:102664. [PMID: 33291031 DOI: 10.1016/j.msard.2020.102664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/28/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Over the past decade, numerous disease modifying drugs (DMDs) for relapsing- remitting multiple sclerosis (RRMS) have been approved in Argentina. The use of oral DMDs (oDMDs) has increased in recent years, although real-life data in our region is limited. We aimed to describe the tendency in the use of oDMDs (as first treatment option or after switch) in relationship with their approval in Argentina. METHODS A retrospective study in a cohort of MS patients from five Argentinian MS centers was conducted. Regarding the availability of different oDMDs in Argentina, we define three periods (P1-3): P1: 2012 - 2014; P2: 2015 - 2017 and P3: 2018 - 2020. An analysis was performed comparing between these three periods to assess the tendency for oDMDs use over time. RESULT The most frequently prescribed treatment as first DMD was: interferon beta 1a (40%) in P1, fingolimod (37.3%) in P2 and also fingolimod (35%) in P3. We found an increase in the use of oDMTs as initial treatment over time (P1: 17.7%, P2: 63.9% and P3: 65.0%; Chi-square = 41.9 p <0.01). We also found a tendency to increase the use of oDMTs after a first switch (P1: 45.5%, P2: 60.1% and P3 78.3%). Multivariate analysis showed that disease evolution (OR=1.06, p=0.04), and year of treatment initiation (OR=1.01 p<0.01) were independently associated with choice of oDMTs. CONCLUSION This study identified an increasing tendency for the use of oDMDs as initial treatment of RMS in relationship with their approval in Argentina.
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Affiliation(s)
- Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital JM Ramos Mejía; Servicio de Neurología. Sanatorio Guemes
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital JM Ramos Mejía
| | | | | | | | - Leila Cohen
- Centro Universitario de Esclerosis Múltiple, Hospital JM Ramos Mejía
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA
| | | | | | - Cecilia Pita
- Centro Universitario de Esclerosis Múltiple, Hospital JM Ramos Mejía
| | - Veronica Tkachuk
- Sección de Esclerosis Múltiple y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA
| | - Maria Eugenia Balbuena
- Sección de Esclerosis Múltiple y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA
| | | | - Pablo Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires
| | | | | | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires
| | | | | | | | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA.; Instituto de Neurociencias - Fundación Favaloro/INECO, CABA
| | - Berenice A Silva
- Centro Universitario de Esclerosis Múltiple, Hospital JM Ramos Mejía.
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Luetic GG, Menichini ML, Deri N, Steinberg J, Carrá A, Cristiano E, Patrucco L, Curbelo MC, Rojas JI. High birth weight and risk of multiple sclerosis: A multicentre study in Argentina. Mult Scler Relat Disord 2020; 47:102628. [PMID: 33220566 DOI: 10.1016/j.msard.2020.102628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/11/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is now recognized as a multifactorial disease in which genetic and environmental factors intervene. Considerable efforts have been made to identify external risk factors present in childhood, adolescence and youth, though only a few perinatal risk factors have been positively associated with MS. Previously, we found an association between high birth weight and MS in male patients in a small study in Argentina. The present research was designed to further assess the association between high birth weight and MS in a larger sample of patients, using an extensive and validated general population database as control. METHODS We present an analytical observational, multicentre, population-based, and case-control study. A total of 637 patients (cases) with confirmed MS diagnosis attending five MS specialized centres in Argentina were included. Birth weight (BW) data was recalled by the patient's mother, which is a validated approach. A two-way comparison was performed. First, we used the standard categories of high, adequate and low BW in grams. Then, we applied the weight percentile distribution to provide reproducible results for further research. For a proper assessment and comparison of variables, we adopted the guidelines of the American Academy of Pediatrics for neonate classification according to gestational weeks and to BW in grams. The neonate's BW distribution of the general population was used as control. For the purposes of the study, we adapted Urquía's et al. curves, which are based on an extensive database of all the live births registered in the country from 2003 to 2007. To measure the magnitude of the proportional differences between low, adequate and high BW, the odds ratio (OR) and their 95% confidence interval (CI) were estimated. The mean BW and percentile values for each sex were compared using a z-Normal test. The respective MS patients and general population BW distribution curves by sex were compared between each other. RESULTS Cases and controls were comparable in their demographic, geographic and environmental characteristics. Males showed higher BW than females both in the MS patients and the general population groups. When we applied the sex stratified analysis separately, we found that males in the MS group showed an almost seven times higher risk of high birth weight than males from the general population (OR 6.58 [95% CI 4.81-8.99]). Female patients showed an almost five times higher risk of high BW than their respective controls (OR 4.5 [95% CI 3.06-6.58]). The comparison based on the BW percentile distribution confirmed that MS patients showed higher BW than the general population. This result reached statistical significance from the 75th percentile onwards for both sexes. CONCLUSION In summary, our findings suggested that high BW could be one of the earliest risk factors for MS in life. If this results were reproduced in other centres, high birth weight would emerge as a novel and very early risk factor, potentially modifiable in utero or immediately postpartum, representing a unique opportunity to prevent the disease in future generations.
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Affiliation(s)
- Geraldine G Luetic
- Instituto de Neurociencias de Rosario, San Lorenzo 3598, Rosario, Santa Fe, 2000, Argentina.
| | - Maria L Menichini
- Instituto de Neurociencias de Rosario, San Lorenzo 3598, Rosario, Santa Fe, 2000, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | - Judith Steinberg
- Sección de enfermedades desmielinizantes, Hospital Británico; CABA, Argentina
| | - Adriana Carrá
- Sección de enfermedades desmielinizantes, Hospital Británico; CABA, Argentina
| | | | | | - Maria C Curbelo
- Sección de enfermedades desmielinizantes, Hospital Británico; CABA, Argentina; Hospital Municipal Sofía Santamarina, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, CABA, Argentina
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Carnero Contentti E, Delgado-García G, López PA, Criniti J, Pettinicchi JP, Correa-Díaz EP, Soto de Castillo I, Daccach Marques V, Tkachuk V, Cristiano E, Serva Braga Diéguez G, dos Santos AC, Castillo MC, Patrucco L, Álvarez Pucha MO, Miño Zambrano JE, Gómez-Figueroa E, Rivas-Alonso V, Flores-Rivera J, Caride A, Rojas JI. Acute optic nerve lesions in first-ever NMOSD-related optic neuritis using conventional brain MRI: A Latin American multicenter study. Mult Scler Relat Disord 2020; 46:102558. [DOI: 10.1016/j.msard.2020.102558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/12/2020] [Accepted: 10/01/2020] [Indexed: 12/31/2022]
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Cristiano E, Patrucco L, Rojas JI, Nuñez S. Estimating the risk of COVID-19 in multiple sclerosis patients in Buenos Aires, Argentina. Mult Scler Relat Disord 2020; 44:102307. [PMID: 32563927 PMCID: PMC7833342 DOI: 10.1016/j.msard.2020.102307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
- E Cristiano
- Centro de Esclerosis Múltiple Buenos Aires, Argentina
| | - L Patrucco
- Hospital Italiano Buenos Aires, Argentina.
| | - J I Rojas
- Centro de Esclerosis Múltiple, CEMIC, Argentina
| | - S Nuñez
- Infectious Diseases Unit Sanatorio Güemes, Buenos Aires Argentina
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44
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Rojas JI, Patrucco L, Alonso R, Garcea O, Deri N, Carnero Contentti E, Lopez PA, Pettinicchi JP, Caride A, Cristiano E. Diagnostic uncertainty during the transition to secondary progressive multiple sclerosis: Multicenter study in Argentina. Mult Scler 2020; 27:579-584. [PMID: 32484381 DOI: 10.1177/1352458520924586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A period of diagnostic uncertainty often characterizes the clinical transition from relapsing to secondary progressive multiple sclerosis (SPMS). OBJECTIVE The aim of this study was to describe the length of time required to reclassify relapsing-remitting MS (RRMS) patients who have clinically transitioned to SPMS (diagnosis uncertainty). METHODS This is a retrospective multicenter cohort study conducted in Argentina, identifying in every center all patients with diagnosis of MS who transitioned from RRMS to SPMS during the follow-up. We identified the dates of the last definitive RRMS and first definitive SPMS diagnoses for diagnostic uncertainty. The time required to reclassify RRMS who transitioned to SPMS and the time from disease onset to reclassify SPMS were calculated using the Kaplan-Meier method. RESULTS A total of 170 patients were included, where the mean age at disease onset (first symptom) was 36 ± 6 years; the length of time required to reclassify RRMS patients who transitioned to SPMS was 3.3 ± 1.1 years (range = 1-7 years); and the time from disease onset to classify SPMS was 19.4 ± 8.5 years (range = 16-35 years). CONCLUSION A period of diagnostic uncertainty regarding the transition from RRMS to SPMS was present in many of our patients, with a mean time of 3.3 years.
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Affiliation(s)
- Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina/Servicio de Neurología, Hospital Universitario CEMIC, Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina/Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina/Servicio de Neurología, Hospital Universitario Sanatorio Guemes, Buenos Aires, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Buenos Aires, Argentina
| | | | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
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Liguori NF, Alonso R, Pinheiro AA, Balbuena ME, Barboza A, Bestoso S, Burgos M, Cáceres F, Carnero Contentti E, Carrá A, Cristiano E, Curbelo MC, Deri N, Fiol M, Gaitán MI, Garcea O, Halfon M, Hryb J, Jacobo M, José G, Knorre E, López P, Luetic G, Mainella C, Martínez A, Miguez J, Nofal P, Pagani Cassará F, Marcilla MP, Piedrabuena R, Pita C, Quarracino C, Rojas JI, Silva B, Sinay V, Steinberg J, Tarulla A, Tavolini D, Tkachuk V, Tizio S, Villa A, Vrech C, Ysrraelit C, Patrucco L. Consensus recommendations for family planning and pregnancy in multiple sclerosis in argentina. Mult Scler Relat Disord 2020; 43:102147. [PMID: 32442883 DOI: 10.1016/j.msard.2020.102147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is the most common chronic immune-mediated neurological disorder in young adults, more frequently found in women than in men. Therefore, pregnancy-related issues have become an object of concern for MS professionals and patients. The aim of this work was to review the existing data to develop the first Argentine consensus for family planning and pregnancy in MS patients. METHODS A panel of expert neurologists from Argentina engaged in the diagnosis and care of MS patients met both virtually and in person during 2019 to carry out a consensus recommendation for family planning and pregnancy in MS. To achieve consensus, the procedure of the "formal consensus-RAND/UCLA method" was used. RESULTS Recommendations were established based on published evidence and expert opinion focusing on pre-pregnancy counseling, pregnancy, and postpartum issues. CONCLUSION The recommendations of these consensus guidelines are intended to optimize the management and treatment of MS patients during their reproductive age in Argentina.
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Affiliation(s)
- Nora Fernández Liguori
- Hospital Universitario Sanatorio Güemes, Buenos Aires, Argentina; Sección Neurología, Hospital Enrique Tornú, Buenos Aires, Argentina.
| | - Ricardo Alonso
- Hospital Universitario Sanatorio Güemes, Buenos Aires, Argentina; Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | | | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Argentina
| | | | | | | | | | | | - Adriana Carrá
- Fundación Favaloro/INECO, Buenos Aires, Argentina; MS Section Hospital Británico, Buenos Aires, Argentina
| | | | | | - Norma Deri
- Centro de Investigaciones Diabaid, Argentina; Hospital Fernández de Buenos Aires, Argentina
| | - Marcela Fiol
- Department of Neurology, Institute for Neurological Research Dr Raul Carrea, FLENI, Argentina
| | - María I Gaitán
- Department of Neurology, Institute for Neurological Research Dr Raul Carrea, FLENI, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | | | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G. Durand, CABA
| | - Miguel Jacobo
- RIAPEM (Red Integral Asistencial al Paciente con EM), Santiago del Estero, Argentina
| | - Gustavo José
- Servicio de Neurología, Hospital Ángel Padilla, Tucumán, Argentina
| | - Eduardo Knorre
- Servicio de Neurología, Hospital Teodoro Álvarez, Buenos Aires, Argentina
| | - Pablo López
- Department of Neuroscience - Neuroimmunology Unit, Hospital Alemán, Buenos Aires, Argentina
| | | | | | | | | | - Pedro Nofal
- Hospital de Clínicas Ntra. Sra. del Carmen, San Miguel de Tucumán, Argentina
| | | | | | | | - Cecilia Pita
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | - Cecilia Quarracino
- Departamento de neurología, Instituto de Investigaciones Médicas Alfredo Lanari
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Dr. J. M. Ramos Mejía, Buenos Aires, Argentina
| | | | | | - Adriana Tarulla
- Hospital de Agudos Parmenio Piñero, Municipalidad de Ciudad de Buenos Aires, MCBA, Argentina
| | - Darío Tavolini
- INECO Neurociencias Oroño. Fundación INECO Rosario, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Argentina
| | - Santiago Tizio
- Departamento de Neurología, Hospital Italiano y Español de La Plata, Argentina
| | - Andrés Villa
- Sección Neuroinmunología, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende Córdoba, Argentina
| | - Célica Ysrraelit
- Department of Neurology, Institute for Neurological Research Dr Raul Carrea, FLENI, Argentina
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Marrodan M, Bensi C, Pappolla A, Rojas JI, Gaitán MI, Ysrraelit MC, Negrotto L, Fiol MP, Patrucco L, Cristiano E, Farez MF, Correale J. Disease activity impacts disability progression in primary progressive multiple sclerosis. Mult Scler Relat Disord 2020; 39:101892. [PMID: 31846866 DOI: 10.1016/j.msard.2019.101892] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/15/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although solid information on the natural history of primary progressive multiple sclerosis (PPMS) is available, evidence regarding impact of disease activity on PPMS progression remains controversial. OBJECTIVE To describe the clinical characteristics, presence or absence of MRI activity, and natural history of a PPMS cohort from two referral centers in Argentina and assess whether clinical and/or radiological disease activity correlated with disability worsening. METHODS Retrospective study conducted at two MS clinics in Buenos Aires, Argentina, through comparative analysis of patients with and without evidence of disease activity. RESULTS Clinical and/or radiologic activity was presented in 56 (31%) of 178 patients. When stratified by age at onset, we found that for every 10 years of increase in age at onset, risk of reaching EDSS scores of 4 and 6 increased by 26% and 31%, respectively (EDSS 4: HR 1.26, CI 95%: 1.06-1.50; EDSS 6: HR 1.31, CI 95%: 1.06-1.62). Patients who presented clinical exacerbations reached EDSS scores of 6, 7 and 8 faster than those without associated exacerbations (p = 0.009, p = 0.016 and p = 0.001, respectively). Likewise, patients who presented gadolinium-enhancing lesions during the course of disease reached EDSS scores of 7 earlier (p = 0.002). CONCLUSION Older age at onset and presence of clinical and/or radiological disease activity correlated with accelerated disability progression in this cohort of PPMS patients.
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Affiliation(s)
- M Marrodan
- Department of Neurology, Fleni, Montañeses 2325 (1428), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - C Bensi
- Department of Neurology, Fleni, Montañeses 2325 (1428), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - A Pappolla
- Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J I Rojas
- Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - M I Gaitán
- Department of Neurology, Fleni, Montañeses 2325 (1428), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - M C Ysrraelit
- Department of Neurology, Fleni, Montañeses 2325 (1428), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - L Negrotto
- Department of Neurology, Fleni, Montañeses 2325 (1428), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - M P Fiol
- Department of Neurology, Fleni, Montañeses 2325 (1428), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - L Patrucco
- Department of Neurology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - E Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - M F Farez
- Department of Neurology, Fleni, Montañeses 2325 (1428), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina; Center for Biostatistics, Epidemiology and Public Health (CEBES). Fleni, Buenos Aires, Argentina
| | - J Correale
- Department of Neurology, Fleni, Montañeses 2325 (1428), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
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Silveira F, Pappolla A, Sánchez F, Marques VD, de Castillo IS, Tkachuk V, Caride A, Castillo MC, Cristiano E, Cruz CDA, Diégues Serva GB, Dos Santos AC, Moreira CL, López PA, Patrucco L, Molina O, Pettinicchi JP, Carnero Contentti E, Rojas JI. Brain magnetic resonance imaging features in multiple sclerosis and neuromyelitis optica spectrum disorders patients with or without aquaporin-4 antibody in a Latin American population. Mult Scler Relat Disord 2020; 42:102049. [PMID: 32251869 DOI: 10.1016/j.msard.2020.102049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/04/2020] [Accepted: 03/08/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is scarce evidence comparing the behavior in magnetic resonance (MRI) between positive and negative aquaporin-4 antibody neuromyelitis optica spectrum disorders (P-NMOSD and NNMOSD, respectively). The aim of this study was to describe and compare MRI features through a quantitative and qualitative analysis between P-NMOSD and NNMOSD patients in a cohort from Latin American (LATAM) patients. METHODS We retrospectively reviewed the MRI and medical records of NMOSD patients as defined by the 2015 validated diagnostic criteria, and with at least 3 years of follow-up from disease onset (first symptom). We included patients from Argentina, Brazil and Venezuela. To be included, NMOSD patients must have had AQP4-ab status measured by a cell-based assay. Brain MRIs were obtained for each participant at disease onset and every 12 months for 3 years. Demographics, clinical and MRI variables (T2 lesion volume [T2LV], lesion distribution, cortical thickness [CT] and percentage of brain volume loss [PBVL]) were analyzed and compared between groups (P-NMOSD; NNMOSD) at disease onset and follow-up. A multiple sclerosis (MS) control group of patients was also included. RESULTS We included 24 P-NMOSD, 15 NNMOSD and 35 MS patients. No differences in age, gender and follow-up time were observed between groups. Nor were differences found in lesion distribution at disease onset or in brain volumes during follow-up between P-NMOSD and NNMOSD patients (T2LV = 0.43, CT = 0.12, PBVL p = 0.45). Significant differences were observed in lesion distribution at disease onset, as well as in brain volumes during follow-up between NMOSD and MS (T2LV = p<0.001, CT = p<0.001, PBVL p = 0.01). CONCLUSION Different MRI features were observed between MS and NMOSD. However, no quantitative nor qualitative differences were observed between P-NMOSD and NNMOSD, not allowing us to differentiate NMOSD conditions by MRI.
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Affiliation(s)
- Facundo Silveira
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina, Gascón 450, Buenos Aires C 1181 Argentina.
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina, Gascón 450, Buenos Aires C 1181 Argentina
| | - Francisco Sánchez
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Hospital Italiano de Buenos Aires, Argentina
| | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Verónica Tkachuk
- Neuroimmunology Unit, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Maria C Castillo
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Venezuela
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Hospital Italiano de Buenos Aires, Argentina
| | - Camila de Aquino Cruz
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Gabriel Braga Diégues Serva
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Antonio Carlos Dos Santos
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Carolina Lavigne Moreira
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina, Gascón 450, Buenos Aires C 1181 Argentina
| | - Omaira Molina
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Venezuela
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | | | - Juan Ignacio Rojas
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Argentina, Gascón 450, Buenos Aires C 1181 Argentina
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Cristiano E, Rojas JI, Alonso R, Alvez Pinheiro A, Bacile EA, Balbuena ME, Barboza AG, Bestoso S, Burgos M, Cáceres F, Carnero Contentti E, Curbelo MC, Deri N, Fernandez Liguori N, Gaitán MI, Garcea O, Giunta D, Halfon MJ, Hryb JP, Jacobo M, Kohler E, Luetic GG, Maglio I, Martínez AD, Míguez J, Nofal PG, Patrucco L, Piedrabuena R, Rotta Escalante R, Saladino ML, Silva BA, Sinay V, Tkachuk V, Villa A, Vrech C, Ysrraelit MC, Correale J. Consensus recommendations on the management of multiple sclerosis patients in Argentina. J Neurol Sci 2020; 409:116609. [DOI: 10.1016/j.jns.2019.116609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
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Pappolla A, Sánchez F, Caro F, Miguez J, Patrucco L, Cristiano E, Rojas JI. Differential white and gray matter damage in highly active multiple sclerosis: A prospective cohort study. J Clin Neurosci 2020; 74:65-68. [PMID: 32001112 DOI: 10.1016/j.jocn.2020.01.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/12/2020] [Indexed: 11/30/2022]
Abstract
We analyze the differential brain volume changes in highly active multiple sclerosis (HAMS) vs. non-HAMS patients during the disease onset. METHODS HAMS was defined as: a) patients with 1 relapse in the previous year and at least 1 T1 gadolinium-enhancing lesion or 9 or more T2 lesions while on therapy with other disease modifying treatment (DMD); or b) patients with 2 or more relapses in the previous year, whether on DMD or not. High-resolution T1 weighted MRI scans were acquired at onset and every 12 months for 2 years. Lesion load and brain volume measurements were determined. At onset, gray matter volume (GMV) and white matter volume (WMV) tissue volumes were calculated using the SIENAX. Longitudinal changes were estimated by using SIENA to calculate the percentage of brain volume loss. Differences between volumes per group at onset and at the end of the follow up were established. RESULTS 64 patients, mean age 38.4 years, 35 (57%) women were included. A total of 14 (21%) were classified as HAMS. At onset, HAMS patients showed lower GMV and WMV volume compared with non-HAMS patients (p = 0.003 and p = 0.01, respectively). During the follow up, HAMS patients showed a higher decrease in GM volume compared with non-HAMS patients (-0.61 vs. - 0.77, p < 0.001) independent from new lesion as well as relapse rate activity during follow up. CONCLUSION HAMS increased rates of GMV atrophy over 24 months compared to non-HAMS patients independent from relapse rate and new T2 lesions.
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Affiliation(s)
- Agustín Pappolla
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - Francisco Sánchez
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina; Laboratory of Immunomodulators - Center for Pharmacological and Botanical Studies (CEFYBO), School of Medicine, University of Buenos Aires - National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Fiorella Caro
- Laboratory of Immunomodulators - Center for Pharmacological and Botanical Studies (CEFYBO), School of Medicine, University of Buenos Aires - National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Jimena Miguez
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina.
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Rojas JI, Alonso Serena M, Garcea O, Patrucco L, Carrá A, Correale J, Vrech C, Pappolla A, Miguez J, Doldan ML, Silveira F, Alonso R, Cohen L, Pita C, Silva BA, Fiol M, Gaitán MI, Marrodan M, Negrotto L, Ysrraelit MC, Deri N, Luetic G, Caride A, Carnero Contentti E, Lopez PA, Pettinicchi JP, Curbelo C, Martinez AD, Steinberg JD, Balbuena ME, Tkachuk V, Burgos M, Knorre E, Leguizamon F, Piedrabuena R, Liwacki SDV, Barboza AG, Nofal P, Volman G, Alvez Pinheiro A, Hryb J, Tavolini D, Blaya PA, Silva E, Blanche J, Tizio S, Caceres F, Saladino ML, Zanga G, Fracaro ME, Sgrilli G, Pagani Cassara F, Vazquez G, Sinay V, Menichini ML, Lazaro L, Cabrera LM, Bestoso S, Divi P, Jacobo M, Kohler E, Kohler M, Giunta D, Mainella C, Manzi R, Parada Marcilla M, Viglione JP, Martos I, Reich E, Jose G, Cristiano E, Fernández Liguori N. Multiple sclerosis and neuromyelitis optica spectrum disorders in Argentina: comparing baseline data from the Argentinean MS Registry (RelevarEM). Neurol Sci 2020; 41:1513-1519. [DOI: 10.1007/s10072-019-04230-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/24/2019] [Indexed: 12/27/2022]
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