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Amato MP, Bergamaschi R, Centonze D, Mirabella M, Marfia GA, Totaro R, Lus G, Brescia Morra V, Aguglia U, Comi C, Cavalla P, Zaffaroni M, Rovaris M, Grimaldi LM, Leoni S, Malucchi S, Baldi E, Romano M, Falcini M, Perini P, Assetta M, Portaccio E, Sommacal S, Olivieri N, Parodi F, Todaro DS, Grassivaro N, Farina A, Mondino MM, Filippi M, Trojano M. Effectiveness of teriflunomide on No Evidence of Disease Activity and cognition in relapsing remitting multiple sclerosis: results of the NEDA3PLUS study. J Neurol 2023; 270:4687-4696. [PMID: 37405689 PMCID: PMC10511573 DOI: 10.1007/s00415-023-11820-0] [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: 04/19/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Cognitive impairment (CI) is a prevalent and debilitating manifestation of multiple sclerosis (MS); however, it is not included in the widely used concept of No Evidence of Disease Activity (NEDA-3). We expanded the NEDA-3 concept to NEDA-3 + by encompassing CI assessed through the Symbol Digit Modality Test (SDMT) and evaluated the effect of teriflunomide on NEDA3 + in patients treated in a real-world setting. The value of NEDA-3 + in predicting disability progression was also assessed. METHODS This 96-weeks observational study enrolled patients already on treatment with teriflunomide for ≥ 24 weeks. The predictiveness of NEDA-3 and NEDA-3 + at 48 weeks on the change in motor disability at 96 weeks was compared through a two-sided McNemar test. RESULTS The full analysis set (n = 128; 38% treatment naïve) featured relatively low level of disability (baseline EDSS = 1.97 ± 1.33). NEDA-3 and NEDA-3 + statuses were achieved by 82.8% and 64.8% of patients, respectively at 48 weeks vs. baseline, and by 57.0% and 49.2% of patients, respectively at 96 weeks vs. baseline. All patients except one were free of disability progression at Week 96, and NEDA-3 and NEDA-3 + were equally predictive. Most patients were free of relapse (87.5%), disability progression (94.5%) and new MRI activity (67.2%) comparing 96 weeks with baseline. SDMT scores were stable in patients with baseline score ˃35 and improved significantly in those with baseline score ≤ 35. Treatment persistence was high (81.0% at Week 96). CONCLUSION Teriflunomide confirmed its real-world efficacy and was found to have a potentially beneficial effect on cognition.
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Affiliation(s)
- Maria Pia Amato
- Department of NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Diego Centonze
- Unit of Neurology and Neurorehabilitation, IRCCS Neuromed, Pozzilli, Italy
| | - Massimiliano Mirabella
- Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Neurology Unit, Rome, Italy
- Centro di Ricerca Sclerosi Multipla (CERSM), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rocco Totaro
- Demyelinating Disease Center, San Salvatore Hospital, L'Aquila, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive Science and Odontostomatology, University Federico II, Multiple Sclerosis Clinical Care and Research Centre, Naples, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Cristoforo Comi
- Department of Translational Medicine and Interdisciplinary Research Center of Autoimmune Diseases, University of Piemonte Orientale, Novara, Italy
| | - Paola Cavalla
- Department of Neuroscience and Mental Health, City of Health and Science University Hospital of Turin, Multiple Sclerosis Center, Turin, Italy
| | - Mauro Zaffaroni
- ASST della Valle Olona, Hospital of Gallarate, Neuroimmunology Unit, Gallarate, Italy
| | - Marco Rovaris
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Multiple Sclerosis Center, Milan, Italy
| | | | | | - Simona Malucchi
- University Hospital San Luigi Gonzaga, SCDO Neurologia-CRESM, Orbassano, Turin, Italy
| | - Eleonora Baldi
- Department of Neuroscience and Rehabilitation, S. Anna Hospital, Multiple Sclerosis Center, Ferrara, Italy
| | - Marcello Romano
- Neurology and Stroke Unit, Villa Sofia Cervello Hospital, Palermo, Italy
| | - Mario Falcini
- Santo Stefano Hospital, Neurology Unit, Prato, Italy
| | - Paola Perini
- University Hospital of Padua, Multiple Sclerosis Centre of the Veneto Region (CeSMuV), Padua, Italy
| | | | - Emilio Portaccio
- Department of NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | - Massimo Filippi
- IRCCS San Raffaele Scientific Institute, Neurology Unit, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Neurorehabilitation Unit, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Neurophysiology Service, Milan, Italy
- Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Neuroimaging Research Unit, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Trojano
- School of Medicine, University "Aldo Moro" of Bari, Bari, Italy.
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Zanchetti A, Cuspidi C, Comarella L, Rosei EA, Ambrosioni E, Chiariello M, Leonetti G, Mancia G, Pessina AC, Salvetti A, Trimarco B, Volpe M, Grassivaro N, Vargiu G. Left ventricular diastolic dysfunction in elderly hypertensives: results of the APROS-diadys study. J Hypertens 2008; 25:2158-67. [PMID: 17885561 DOI: 10.1097/hjh.0b013e3282eee9cf] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A number of patients with chronic heart failure (CHF) have diastolic but not systolic dysfunction. This occurs particularly in the elderly and in hypertension, but the prevalence of diastolic dysfunction in elderly hypertensives without CHF has never been investigated systematically. METHODS AND RESULTS The Assessment of PRevalence Observational Study of Diastolic Dysfunction (APROS-diadys) project was a cross-sectional observational study on elderly (age >/= 65 years) hypertensives without systolic dysfunction [left ventricular ejection fraction (LVEF) >/= 45%] consecutively attending hospital outpatient clinics in Italy, in order to establish the prevalence of echocardiographic signs of diastolic dysfunction according to various criteria, and to correlate them with a number of demographic and clinical characteristics. Primary criteria for diastolic dysfunction was an E/A ratio (ratio between transmitral peak velocities of E and A waves) < 0.7 or > 1.5 on echocardiographic Doppler examination. Secondary criteria were: E/A < 0.5 and deceleration time (DT) > 280 ms, or isovolumic relaxation time (IVRT) > 105 ms or pulmonary vein (PV) peak systolic/peak diastolic flow (S/D) ratio > 2.5 or PV atrial retrograde flow (PV A) > 35 cm/s. Throughout Italy, 27 447 patients were screened in 107 clinics, with 24 141 excluded according to protocol. Among the remaining 3336 patients, 754 (22.6%) had signs of CHF. After exclusion of 37 protocol violators, 2545 patients (49.0% men, mean age 70.3 years, 95.4% under antihypertensive treatment) were studied ultrasonographically. Diastolic dysfunction (primary criteria) was found in 649 (25.8%) patients. Multiple logistic regression analysis found age, gender, left ventricular mass, systolic and pulse pressures and midwall shortening fraction as significant covariates. Using secondary criteria, the prevalence of diastolic dysfunction was higher (45.6%), mostly because of IVRT > 105 ms or PVA flow > 35 cm/s. CONCLUSION CHF and diastolic dysfunction are highly prevalent in elderly hypertensives attending hospital clinics.
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Affiliation(s)
- Alberto Zanchetti
- Centro di Fisiologia Clinica, University of Milan, Ospedale Maggiore Milan, Italy.
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Toso V, Gandolfo C, Paolucci S, Provinciali L, Torta R, Grassivaro N. Post-stroke depression: research methodology of a large multicentre observational study (DESTRO). Neurol Sci 2004; 25:138-44. [PMID: 15300461 DOI: 10.1007/s10072-004-0247-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 05/18/2004] [Indexed: 10/26/2022]
Abstract
The heterogeneity of published data regarding post-stroke depression (PSD) prompted an Italian multicenter observational study (DESTRO), which took place in 2000-2003. The investigation involved 53 Italian neurology centers: of these, 50 treat acute patients and 3 provide rehabilitation care; 21 centres are in Northern Italy, 20 are in Central Italy, and 12 are in Southern Italy. The time schedule was articulated into three phases: registration of 6289 stroke patients; selection of 1817 cases and enrollment of 1074 patients; and follow-up for two years (1064 patients). Mood assessment was performed by evaluating depressive symptoms according to DSM IV and the Beck depression inventory (visual analog mood scale for aphasic patients). Depressed patients were also administered the Montgomery-Asberg depression rating scale. Scores were related to function (Barthel index, modified Rankin scale), cognition (MMSE), quality of life (SF-36), and clinical data. Data analysis will provide information on PSD prevalence, onset and evolution, correlation with ischemic clinical syndrome, impact on activities of daily living, cognitive level and quality of life. The few data available at the present time concern PSD prevalence in the first six months after stroke (33.6%). DESTRO is a longitudinal investigation of a large patient sample and is expected to provide insights into the relationship of PDS with the functional and clinical consequences of stroke.
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Affiliation(s)
- V Toso
- Division of Neurology, S. Bortolo Hospital, Vicenza, Italy.
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