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Chisari CG, Aguglia U, Amato MP, Bergamaschi R, Bertolotto A, Bonavita S, Morra VB, Cavalla P, Cocco E, Conte A, Cottone S, De Luca G, Di Sapio A, Filippi M, Gallo A, Gasperini C, Granella F, Lus G, Maimone D, Maniscalco GT, Marfia G, Moiola L, Paolicelli D, Pesci I, Ragonese P, Rovaris M, Salemi G, Solaro C, Totaro R, Trojano M, Vianello M, Zaffaroni M, Lepore V, Patti F. Long-term effectiveness of natalizumab in secondary progressive multiple sclerosis: A propensity-matched study. Neurotherapeutics 2024:e00363. [PMID: 38714462 DOI: 10.1016/j.neurot.2024.e00363] [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: 03/08/2024] [Accepted: 04/12/2024] [Indexed: 05/09/2024] Open
Abstract
Treatment options for secondary progressive MS (SPMS) are limited, especially considering that the new drugs recently approved are licensed for actively relapsing patients. We aimed to compare the disability progression in a real-world cohort of SPMS patients treated with natalizumab (NTZ) or interferon beta-1b (IFNb-1b). This multicenter retrospective enrolled patients with a diagnosis of SPMS according to 2014 Lublin criteria, who received NTZ or IFNb-1b for at least 48 months between the 1st June 2012 and the 15th May 2018 at 33 Italian MS centers contributing to the Italian MS Registry NTZ or IFNb-1b. Confirmed Expanded Disability Status Scale worsening (CEW) and progression independent of relapse (PIRA) were evaluated. In order to correct for non-randomization, a propensity score matching of the groups was performed. Out of 5206 MS patients identified at the time of data extraction, 421 SPMS patients treated with NTZ (224 [53.2%] females, mean age 45.3 ± 25.4 years) and 353 with IFNb-1b (133 [37.8%] females, mean age 48.5 ± 19.8 years) were enrolled. After applying the matching procedure, 102 patients were retained in the NTZ group and 98 in the IFNb-2b group. The proportion of patients who reached the 48-month 1-point CEW was significantly higher in IFNb-1b compared to NTZ group (58.2% versus 30.4%, p = 0.01). The proportion of patients who developed PIRA at 48 months were significantly higher in IFNb-1b compared to NTZ (72.4% versus 40.2%, p = 0.01). EDSS before treatment initiation and SPMS duration were risk factors for disability progression in terms of PIRA (HR 2.54, 25%CI 1.67-5.7; p = 0.006 and HR 2.04, 25%CI 1.22-3.35; p = 0.01, respectively). Patients treated with IFNb-1b were 1.64 times more to likely to develop PIRA (HR 1.64, 25%CI 1.04-4.87; p = 0.001). Treatment with NTZ in SPMS patients showed more favorable disability outcomes compared to IFNb-1b with beneficial effects over 48 months.
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Affiliation(s)
- Clara G Chisari
- Department "GF. Ingrassia"; Section of Neurosciences, University of Catania, Italy; UOS Sclerosi Multipla, AOU Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Antonio Bertolotto
- Department of Neurology and Multiple Sclerosis Regional Referral Centre, AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Italy
| | | | - Paola Cavalla
- Multiple Sclerosis Center, Department of Neuroscience and Mental Health, City of Health and Science University Hospital of Torino, Torino, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Centre Binaghi Hospital, ATS Sardegna-University of Cagliari, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Italy; IRCCS Neuromed Pozzili, Italy
| | | | - Giovanna De Luca
- Multiple Sclerosis Center, Neurology Clinic, Policlinico SS Annunziata, University of Chieti-Pescara, Chieti, Italy
| | - Alessia Di Sapio
- Department of Neurology and Multiple Sclerosis Regional Referral Centre, AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Gallo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Claudio Gasperini
- Department of Neuroscience, UOC Neurology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Franco Granella
- Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, II Division of Neurology, Multiple Sclerosis Center, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, UOC Neurologia, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | | | - Girolama Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Paolicelli
- Department of Translational Biomedicines and Neurosciences University of Bari, A. Moro, Bari, Italy
| | - Ilaria Pesci
- Centro Sclerosi Multipla Unità Operativa Neurologia, Azienda Unità Sanitaria Locale, Ospedale Di Vaio, Fidenza, Parma, Italy
| | - Paolo Ragonese
- Unit of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Palermo University, Palermo, Italy
| | | | - Giuseppe Salemi
- Unit of Neurology, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Palermo University, Palermo, Italy
| | - Claudio Solaro
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone, Moncrivello, (VC), Italy
| | - Rocco Totaro
- Demyelinating Disease Center, Neurology Unit, University of L'Aquila, L'Aquila, Italy
| | - Maria Trojano
- School of Medicine, University "Aldo Moro", Bari, Italy
| | | | - Mauro Zaffaroni
- Multiple Sclerosis Center, ASST della Valle Olona, Ospedale di Gallarate, (VA), Italy
| | - Vito Lepore
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesco Patti
- Department "GF. Ingrassia"; Section of Neurosciences, University of Catania, Italy; UOS Sclerosi Multipla, AOU Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy.
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Gakis G, Angelopoulos I, Panagoulias I, Mouzaki A. Current knowledge on multiple sclerosis pathophysiology, disability progression assessment and treatment options, and the role of autologous hematopoietic stem cell transplantation. Autoimmun Rev 2024; 23:103480. [PMID: 38008300 DOI: 10.1016/j.autrev.2023.103480] [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: 10/31/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) that affects nearly 2.8 million people each year. MS distinguishes three main types: relapsing-remitting MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS). RRMS is the most common type, with the majority of patients eventually progressing to SPMS, in which neurological development is constant, whereas PPMS is characterized by a progressive course from disease onset. New or additional insights into the role of effector and regulatory cells of the immune and CNS systems, Epstein-Barr virus (EBV) infection, and the microbiome in the pathophysiology of MS have emerged, which may lead to the development of more targeted therapies that can halt or reverse neurodegeneration. Depending on the type and severity of the disease, various disease-modifying therapies (DMTs) are currently used for RRMS/SPMS and PPMS. As a last resort, and especially in highly active RRMS that does not respond to DMTs, autologous hematopoietic stem cell transplantation (AHSCT) is performed and has shown good results in reducing neuroinflammation. Nevertheless, the question of its potential role in preventing disability progression remains open. The aim of this review is to provide a comprehensive update on MS pathophysiology, assessment of MS disability progression and current treatments, and to examine the potential role of AHSCT in preventing disability progression.
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Affiliation(s)
- Georgios Gakis
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece
| | - Ioannis Angelopoulos
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece
| | - Ioannis Panagoulias
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece
| | - Athanasia Mouzaki
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece.
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Mallawaarachchi G, Rog DJ, Das J. Ethnic disparities in the epidemiological and clinical characteristics of multiple sclerosis. Mult Scler Relat Disord 2024; 81:105153. [PMID: 38043364 DOI: 10.1016/j.msard.2023.105153] [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: 05/11/2023] [Revised: 10/13/2023] [Accepted: 11/21/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a neuroinflammatory disorder which affects 2.8 million people world-wide. A growing body of evidence shows ethnic disparities in MS. This review aims to evaluate differences, based upon ethnic background, in the incidence, prevalence, disease course, and efficacy of disease-modifying therapies (DMTs) among people with MS (PwMS). METHOD Ethnicities were classified as White, Black, Hispanic, Asian, and Middle Eastern and North African (MENA). A literature search was conducted using the PubMed search engine to identify articles on MS and ethnicity that were published in the English language between 01/01/2005 and 31/05/2022. RESULTS 101 studies met all inclusion criteria. Although the incidence and prevalence of MS varied among ethnicities, findings were inconsistent and depended on the continent of the study. Ethnicity may have an impact on the disease course. PwMS from Black, Hispanic, and MENA, but not Asian ethnicities, appeared to accumulate physical disability at a faster rate than those from White ethnicity. Although there was a lack of studies evaluating the relative safety and efficacy of DMTs among various ethnicities, interferon-beta was found to be less efficacious in PwMS from Black ethnicity. CONCLUSIONS Further studies, with more uniform definitions of ethnicity are required to comprehensively understand ethnic disparities in MS, in particular to identify underlying causes, to facilitate the delivery of personalised medical care and avoid inequity.
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Affiliation(s)
| | - David J Rog
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, United Kingdom M6 8HD
| | - Joyutpal Das
- University of Manchester, Oxford Rd, Manchester, United Kingdom M13 9PL; Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, United Kingdom M6 8HD.
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Watson C, Thirumalai D, Barlev A, Jones E, Bogdanovich S, Kresa-Reahl K. Treatment Patterns and Unmet Need for Patients with Progressive Multiple Sclerosis in the United States: Survey Results from 2016 to 2021. Neurol Ther 2023; 12:1961-1979. [PMID: 37682512 PMCID: PMC10630256 DOI: 10.1007/s40120-023-00532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Much of the current literature on treatment patterns and disability progression in multiple sclerosis (MS) does not distinguish between the relapsing-remitting and progressive subtypes (including primary [PPMS] and secondary progressive MS [SPMS]), or between active/nonactive disease. Current treatment options for progressive MS are limited, with only one approved product for PPMS and none specifically for nonactive SPMS. Here we report treatment patterns, disability progression, and unmet needs among patients with active and nonactive PPMS and SPMS. METHODS The annual, cross-sectional survey from the Adelphi Disease Specific Program was used to collect physician-reported data on US adult patients with PPMS and SPMS, including active and nonactive disease. Treatment patterns (including the proportion of patients who were untreated with a disease-modifying therapy [DMT]), disability progression, and unmet need are described from 2016 to 2021. RESULTS Data were collected for 2067 patients with progressive MS (PPMS, 1583; SPMS, 484). A substantial proportion of patients were untreated across all groups, and this was highest for nonactive PPMS (~ 43%). The proportion of untreated patients generally declined over time but remained high in 2018-2021 (~ 10-38%). Among treated patients, the proportion receiving infusions increased over time to ~ 34-46%, largely driven by ocrelizumab use after approval. Disability progression was reported for most patients (> 50%), including many who were receiving a DMT. Across all disease subtypes, when physicians were asked about the greatest unmet need with current DMTs, they most frequently cited effectiveness (~ 63-87%), and specifically slowing disease progression (~ 32-59%). CONCLUSIONS This analysis of physician-reported data reveals that patients with progressive MS, particularly those with nonactive disease, frequently remain untreated or continue to decline despite treatment with available DMTs. Thus there is an enduring need for safe and effective treatments for this underserved population.
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Affiliation(s)
| | | | - Arie Barlev
- Atara Biotherapeutics, Thousand Oaks, CA, USA
| | - Eddie Jones
- Adelphi Real World, Bollington, Cheshire, UK
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Amezcua L, Livingston T, Hayward B, Zhou J, Williams MJ. Impact of adherence to disease modifying therapies on long-term clinical and economic outcomes in multiple sclerosis: A claims analysis of real-world data. Mult Scler Relat Disord 2023; 77:104866. [PMID: 37487345 DOI: 10.1016/j.msard.2023.104866] [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: 10/06/2022] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurodegenerative inflammatory disease that requires long-term commitment to treatment for optimal outcomes. A variety of disease-modifying therapies (DMTs) are now available that reduce relapses and delay disease progression in people with MS. However, adherence remains a significant issue, with a variety of mental, physical, and emotional factors contributing to non-adherence. In a large number of studies, non-adherence has been associated with worse clinical outcomes (relapses and disease severity), a higher economic burden, and loss of work productivity. However, many of these studies were short-term (1-2 years) or cross-sectional studies; thus, more data are needed on the long-term clinical and economic impacts of DMT non-adherence. The objective of this study was to determine the longer-term impact of adherence to DMTs on disease activity and healthcare resource utilization (HCRU) in people with MS. The study hypothesis was that non-adherence to DMTs would be associated long-term with worse clinical outcomes and a higher economic burden. METHODS A retrospective administrative claims analysis of the US MarketScan® Commercial database (2011-2017) in individuals (18-65 years) with MS (based on International Classification of Disease coding) was conducted. Adherence was classified by proportion of days covered (PDC) ≥0.8 and non-adherence by PDC <0.8; sensitivity analyses helped further categorize as moderately (PDC ≥0.6-<0.8) or highly (PDC <0.6) non-adherent. Cohorts were matched using propensity score matching. Time to first relapse, annualized relapse rate (ARR), time to use of assistive devices (cane/walker or wheelchair), and annual HCRU (inpatient, emergency room [ER], outpatient, and MRI visits and costs) were compared between cohorts. RESULTS 10,248 MS cases were identified; 58% met adherence criteria, and 42% met non-adherence criteria. Mean follow-up from diagnosis or first DMT claim was 5.3 years. Adherent individuals had a longer time to first relapse (hazard ratio [HR] 0.83; 95% confidence interval [CI]: 0.77-0.90; p<0.0001), a lower ARR (0.13 vs. 0.18, respectively; rate ratio [RR] 0.75 [95% CI: 0.71-0.79]; p<0.0001), and longer lag times to cane/walker use (HR 0.79 [95% CI: 0.66-0.94]; p=0.0067) and wheelchair use (HR 0.68 [95% CI: 0.55-0.83]; p=0.0002) than non-adherent individuals. Adherent individuals had fewer annual inpatient and ER visits and lower total costs than those who were non-adherent (p<0.0001). Sensitivity analyses showed that differences in disease activity and HCRU were generally more pronounced between matched adherent and highly non-adherent pairs than between matched adherent and moderately non-adherent pairs. CONCLUSION Significant differences in MS disease activity and HCRU were observed based on adherence to DMTs. Our study underscores the negative impact of non-adherence to DMTs on long-term clinical and economic outcomes in MS.
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Affiliation(s)
- Lilyana Amezcua
- Department of Neurology, Keck School of Medicine, University of Southern California, USA.
| | | | - Brooke Hayward
- One Technology Place, EMD Serono, Inc., Rockland, MA, USA
| | - Jia Zhou
- One Technology Place, EMD Serono, Inc., Rockland, MA, USA
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Abbadessa G, Ponzano M, Bile F, Miele G, Signori A, Cepparulo S, Sparaco M, Signoriello E, Maniscalco GT, Lanzillo R, Morra VB, Lus G, Sormani MP, Lavorgna L, Bonavita S. Health related quality of life in the domain of physical activity predicts confirmed disability progression in people with relapsing remitting multiple sclerosis. Mult Scler Relat Disord 2023; 75:104731. [PMID: 37163840 DOI: 10.1016/j.msard.2023.104731] [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: 01/13/2023] [Revised: 03/18/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION The diagnosis of the progression phase of Multiple Sclerosis (MS) is still retrospective and based on the objectivation of clinical disability accumulation. OBJECTIVES To assess whether the Patient Reported Outcomes Measures (PROMs) scores predict the occurrence of disease progression within three years of follow-up. METHODS Observational prospective multicenter study. Stable Relapsing-Remitting MS (RRMS) patients were enrolled. At enrollment, patients completed the following PROMs: Beck Depression Inventory- II, The Treatment Satisfaction Questionnaire for Medications, Medical Outcomes Study Short Form 36- Item (SF36), Fatigue Severity Scale. EDSS was assessed at enrollment and three years later. The outcome measure was defined as the occurrence of confirmed disability progression (CDP) within three years of follow-up. Univariable and multivariable logistic regression models were performed to study the association between the final score of each test and the outcome. RESULTS SF36-Physical Functioning (SF36-PF) was the only independent variable associated with the outcome. The ROC curve analysis determined a score of 77.5 at SF36-PF as the cut-off point identifying patients experiencing CDP within three years of follow-up [AUC: 0.66 (95% CI: 0.56-0.75)]. CONCLUSIONS RRMS patients scoring higher (>77.5) at SF36-PF subscale have a higher likelihood to experience CDP within the next three years.
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Affiliation(s)
- Gianmarco Abbadessa
- II Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marta Ponzano
- Department of Health Sciences - Section of Biostatistics University of Genoa, Italy
| | - Floriana Bile
- II Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppina Miele
- II Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessio Signori
- Department of Health Sciences - Section of Biostatistics University of Genoa, Italy
| | | | - Maddalena Sparaco
- II Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Elisabetta Signoriello
- MS Centre, II Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Roberta Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Giacomo Lus
- MS Centre, II Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Maria Pia Sormani
- Department of Health Sciences - Section of Biostatistics University of Genoa, Italy
| | - Luigi Lavorgna
- I Division of Neurology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Simona Bonavita
- II Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
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Maddess T, Carle CF, Rohan EM, Baird-Gunning J, van Kleef JP, Lueck CJ. Objective perimetry and progression of multiple sclerosis. eNeurologicalSci 2022; 29:100430. [PMID: 36254171 PMCID: PMC9568864 DOI: 10.1016/j.ensci.2022.100430] [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: 07/19/2022] [Revised: 09/07/2022] [Accepted: 10/07/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction We re-examined the per-region response amplitudes and delays obtained from multifocal pupillographic objective perimetry (mfPOP) after 10 years in 44 persons living with multiple sclerosis (PwMS), both to examine which parts of the visual field had progressed in terms of response properties and to examine if the baseline data could predict the overall progression of disease. Methods Expanded Disability Status Scale (EDSS) scores were assessed in 2009 and 2019. Both eyes of each participant were concurrently tested at 44 locations/eye on both occasions. Several measures of clinical progression were examined, using logistic regression to determine the odds of progression. Results At the second examination the 44 PwMS (31 females) were aged 61.0 ± 12.2 y. Mean EDSS had not changed significantly (3.69 ± 1.23 in 2009, 3.81 ± 2.00 in 2019). mfPOP delay increased progressively from inferior to superior regions of the visual fields while amplitudes demonstrated a temporal to nasal gradient. The mean of the 3 most delayed visual field regions was correlated with progression of MS by 2019 (p = 0.023). Logistic regression indicated a significant association between delay and odds of progression (p = 0.045): an individual with 3 regions at least 1 SD (40 ms) slower than the mean in 2009 had 2.05× (±SE: 1.43× to 2.95×) the odds of progression by 2019. A 1 SD shorter delay was associated with 2.05× lower odds of progression. Amplitude changes were not predictive of progression. Significance mfPOP may provide a rapid, convenient method of monitoring and predicting MS progression.
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Affiliation(s)
- Ted Maddess
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
| | - Corinne F. Carle
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
| | - Emilie M.F. Rohan
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
| | | | - Josh P. van Kleef
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
| | - Christian J. Lueck
- Department of Neurology, the Canberra Hospital, Canberra, ACT, Australia
- Australian National University Medical School, Acton, ACT, Australia
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Oship D, Jakimovski D, Bergsland N, Horakova D, Uher T, Vaneckova M, Havrdova E, Dwyer MG, Zivadinov R. Assessment of T2 lesion-based disease activity volume outcomes in predicting disease progression in multiple sclerosis over 10 years. Mult Scler Relat Disord 2022; 67:104187. [PMID: 36150263 DOI: 10.1016/j.msard.2022.104187] [Citation(s) in RCA: 2] [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: 05/17/2022] [Revised: 08/16/2022] [Accepted: 09/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND New/enlarging T2 lesion count and T2-lesion volume (LV) are used as conventional secondary endpoints in clinical trials of patients with multiple sclerosis (PwMS). However, those outcomes may have several limitations, such as inability to account for heterogeneity of lesion formation/enlargement frequency and their dynamic volumetric behavior. Measurement of volume rather than count of new/enlarging lesions may be more representative outcome of dynamic changes over time. OBJECTIVES To investigate whether new/enlarging T2-LV is more predictive of confirmed disability progression (CDP), compared to total T2-LV or new/enlarging T2 lesion count over long-term follow-up. METHODS We studied 176 early relapsing-remitting PwMS who were followed with annual MRI examinations over 10 years. T2-LV, new/enlarging T2-LV, and new/enlarging lesion count were determined. Cumulative count/volumes were obtained. 10-year CDP was confirmed after 48-weeks. ANCOVA analysis detected MRI outcome differences in stable (n = 76) and CDP (n = 100) groups at different time points, after correction for multiple comparisons. RESULTS PwMS with CDP had greater cumulative new/enlarging T2-LV at 4 years (p = 0.049), and enlarging T2-LV at 4- (p = 0.039) and 6-year follow-up (p = 0.032), compared to stable patients. PwMS with CDP did not differ from stable ones in new/enlarging T2 lesion count or total T2-LV at any of the study timepoints. PwMS with Expanded Disability Status Scale change >2.0 had significantly greater enlarging T2 lesion count (p = 0.01) and enlarging T2-LV (p = 0.038) over the 10-year follow-up. CONCLUSION Enlargement of T2 lesions is more strongly associated with long-term disability progression compared to other conventional T2 lesion-based outcomes.
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Affiliation(s)
- Devon Oship
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States; IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles and General University Hospital in Prague, Prague, Czech Republic
| | - Eva Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States; Center for Biomedical Imaging at Clinical Translational Research Center, The State University of New York, Buffalo, NY, United States
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 100 High St., Buffalo, NY 14203, United States; Center for Biomedical Imaging at Clinical Translational Research Center, The State University of New York, Buffalo, NY, United States.
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9
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Gold R, Piani-Meier D, Kappos L, Bar-Or A, Vermersch P, Giovannoni G, Fox RJ, Arnold DL, Benedict RHB, Penner IK, Rouyrre N, Kilaru A, Karlsson G, Ritter S, Dahlke F, Hach T, Cree BAC. Siponimod vs placebo in active secondary progressive multiple sclerosis: a post hoc analysis from the phase 3 EXPAND study. J Neurol 2022; 269:5093-5104. [PMID: 35639197 PMCID: PMC9363350 DOI: 10.1007/s00415-022-11166-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Siponimod is a sphingosine 1-phosphate receptor modulator approved for active secondary progressive multiple sclerosis (aSPMS) in most countries; however, phase 3 EXPAND study data are from an SPMS population with/without disease activity. A need exists to characterize efficacy/safety of siponimod in aSPMS. METHODS Post hoc analysis of participants with aSPMS (≥ 1 relapse in 2 years before study and/or ≥ 1 T1 gadolinium-enhancing [Gd +] magnetic resonance imaging [MRI] lesions at baseline) receiving oral siponimod (2 mg/day) or placebo for up to 3 years in EXPAND. ENDPOINTS 3-month/6-month confirmed disability progression (3mCDP/6mCDP); 3-month confirmed ≥ 20% worsening in Timed 25-Foot Walk (T25FW); 6-month confirmed improvement/worsening in Symbol Digit Modalities Test (SDMT) scores (≥ 4-point change); T2 lesion volume (T2LV) change from baseline; number of T1 Gd + lesions baseline-month 24; number of new/enlarging (N/E) T2 lesions over all visits. RESULTS Data from 779 participants with aSPMS were analysed. Siponimod reduced risk of 3mCDP/6mCDP vs placebo (by 31%/37%, respectively; p < 0.01); there was no significant effect on T25FW. Siponimod increased likelihood of 6-month confirmed SDMT improvement vs placebo (by 62%; p = 0.007) and reduced risk of 6-month confirmed SDMT worsening (by 27%; p = 0.060). Siponimod was associated with less increase in T2LV (1316.3 vs 13.3 mm3; p < 0.0001), and fewer T1 Gd + and N/E T2 lesions than placebo (85% and 80% reductions, respectively; p < 0.0001). CONCLUSIONS In aSPMS, siponimod reduced risk of disability progression and was associated with benefits on cognition and MRI outcomes vs placebo. TRIAL REGISTRATION ClinicalTrials.gov number: NCT01665144.
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Affiliation(s)
- Ralf Gold
- Department of Neurology, St. Josef Hospital and Ruhr University of Bochum, Bochum, Germany.
| | | | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and Multiple Sclerosis Center, Departments of Head, Spine and Neuromedicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics, and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick Vermersch
- University of Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Douglas L Arnold
- NeuroRx Research, Montreal, QC, Canada and Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - Iris-Katharina Penner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | | | | | | | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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10
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De Brouwer E, Becker T, Moreau Y, Havrdova EK, Trojano M, Eichau S, Ozakbas S, Onofrj M, Grammond P, Kuhle J, Kappos L, Sola P, Cartechini E, Lechner-Scott J, Alroughani R, Gerlach O, Kalincik T, Granella F, Grand'Maison F, Bergamaschi R, José Sá M, Van Wijmeersch B, Soysal A, Sanchez-Menoyo JL, Solaro C, Boz C, Iuliano G, Buzzard K, Aguera-Morales E, Terzi M, Trivio TC, Spitaleri D, Van Pesch V, Shaygannejad V, Moore F, Oreja-Guevara C, Maimone D, Gouider R, Csepany T, Ramo-Tello C, Peeters L. Longitudinal machine learning modeling of MS patient trajectories improves predictions of disability progression. Comput Methods Programs Biomed 2021; 208:106180. [PMID: 34146771 DOI: 10.1016/j.cmpb.2021.106180] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/08/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Research in Multiple Sclerosis (MS) has recently focused on extracting knowledge from real-world clinical data sources. This type of data is more abundant than data produced during clinical trials and potentially more informative about real-world clinical practice. However, this comes at the cost of less curated and controlled data sets. In this work we aim to predict disability progression by optimally extracting information from longitudinal patient data in the real-world setting, with a special focus on the sporadic sampling problem. METHODS We use machine learning methods suited for patient trajectories modeling, such as recurrent neural networks and tensor factorization. A subset of 6682 patients from the MSBase registry is used. RESULTS We can predict disability progression of patients in a two-year horizon with an ROC-AUC of 0.85, which represents a 32% decrease in the ranking pair error (1-AUC) compared to reference methods using static clinical features. CONCLUSIONS Compared to the models available in the literature, this work uses the most complete patient history for MS disease progression prediction and represents a step forward towards AI-assisted precision medicine in MS.
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Affiliation(s)
| | - Thijs Becker
- I-Biostat, Data Science Institute, Hasselt University, Diepenbeek, Belgium.
| | - Yves Moreau
- ESAT-STADIUS, KU Leuven, Leuven 3001, Belgium.
| | | | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | - Jens Kuhle
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | | | | | | | - Tomas Kalincik
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia; CORe, Department of Medicine, University of Melbourne, Melbourne, Australia
| | | | | | | | - Maria José Sá
- Department of Neurology, Centro Hospitalar Universitario de So Joo and University Fernando Pessoa, Porto, Portugal
| | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | | | - Claudio Solaro
- Dept of Rehabilitation mons L Novarese Hospital, Moncrivello, Italy
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | | | | | | | | | | | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | | | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | | | | | | | | | - Liesbet Peeters
- I-Biostat, Data Science Institute, Hasselt University, Diepenbeek, Belgium; Department of Immunology, Biomedical Research Institute, Hasselt University, Diepenbeek 3590, Belgium; Department of Immunology, Biomedical Research Institute, Hasselt University, Diepenbeek 3590, Belgium; I-Biostat, Data Science Institute, Hasselt University, Diepenbeek, Belgium.
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11
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Barnett M, Bergsland N, Weinstock-Guttman B, Butzkueven H, Kalincik T, Desmond P, Gaillard F, van Pesch V, Ozakbas S, Rojas JI, Boz C, Altintas A, Wang C, Dwyer MG, Yang S, Jakimovski D, Kyle K, Ramasamy DP, Zivadinov R. Brain atrophy and lesion burden are associated with disability progression in a multiple sclerosis real-world dataset using only T2-FLAIR: The NeuroSTREAM MSBase study. Neuroimage Clin 2021; 32:102802. [PMID: 34469848 PMCID: PMC8408519 DOI: 10.1016/j.nicl.2021.102802] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/28/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Methodological challenges limit the use of brain atrophy and lesion burden measures in the follow-up of multiple sclerosis (MS) patients on clinical routine datasets. OBJECTIVE To determine the feasibility of T2-FLAIR-only measures of lateral ventricular volume (LVV) and salient central lesion volume (SCLV), as markers of disability progression (DP) in MS. METHODS A total of 3,228 MS patients from 9 MSBase centers in 5 countries were enrolled. Of those, 2,875 (218 with clinically isolated syndrome, 2,231 with relapsing-remitting and 426 with progressive disease subtype) fulfilled inclusion and exclusion criteria. Patients were scanned on either 1.5 T or 3 T MRI scanners, and 5,750 brain scans were collected at index and on average after 42.3 months at post-index. Demographic and clinical data were collected from the MSBase registry. LVV and SCLV were measured on clinical routine T2-FLAIR images. RESULTS Longitudinal LVV and SCLV analyses were successful in 96% of the scans. 57% of patients had scanner-related changes over the follow-up. After correcting for age, sex, disease duration, disability, disease-modifying therapy and LVV at index, and follow-up time, MS patients with DP (n = 671) had significantly greater absolute LVV change compared to stable (n = 1,501) or disability improved (DI, n = 248) MS patients (2.0 mL vs. 1.4 mL vs. 1.1 mL, respectively, ANCOVA p < 0.001, post-hoc pair-wise DP vs. Stable p = 0.003; and DP vs. DI, p = 0.002). Similar ANCOVA model was also significant for SCLV (p = 0.03). CONCLUSIONS LVV-based atrophy and SCLV-based lesion outcomes are feasible on clinically acquired T2-FLAIR scans in a multicenter fashion and are associated with DP over mid-term.
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Affiliation(s)
- Michael Barnett
- Sydney Neuroimaging Analysis Centre, Camperdown, Sydney, Australia; Brain and Mind Centre, University of Sydney, Sydney, Australia.
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA; IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Italy
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | | | - Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Melbourne, Australia; MS Centre, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Patricia Desmond
- Department of Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Frank Gaillard
- Department of Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | | | | | | | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Trabzon, Turkey
| | - Ayse Altintas
- Koç University School of Medicine, Koç University Research Center for Translational Medicine (KUTTAM), İstanbul, Turkey
| | - Chenyu Wang
- Sydney Neuroimaging Analysis Centre, Camperdown, Sydney, Australia; Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA; Center for Biomedical Imaging, Clinical Translational Science Institute, USA; University at Buffalo, NY, USA
| | - Suzie Yang
- Sydney Neuroimaging Analysis Centre, Camperdown, Sydney, Australia
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Kain Kyle
- Sydney Neuroimaging Analysis Centre, Camperdown, Sydney, Australia; Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Deepa P Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA; Center for Biomedical Imaging, Clinical Translational Science Institute, USA; University at Buffalo, NY, USA
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12
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Jakimovski D, Zivadinov R, Vaughn CB, Ozel O, Weinstock-Guttman B. Clinical effects associated with five-year retinal nerve fiber layer thinning in multiple sclerosis. J Neurol Sci 2021; 427:117552. [PMID: 34175775 DOI: 10.1016/j.jns.2021.117552] [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: 02/06/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurodegenerative changes in multiple sclerosis (MS) are associated with long-term disability progression (DP). Optical coherence tomography (OCT) measures may be used to monitor DP. OBJECTIVE To determine significant effects driving the changes in OCT-based peripapillary retinal nerve fiber layer (pRNFL) in heterogeneous group of MS patients. METHODS Total of 144 MS patients (109 relapsing-remitting MS and 35 progressive MS (PMS) with mean age at baseline of 47.6 and 56.5 years old, respectively) underwent clinical and OCT examination over 5-year follow-up. All OCT exams were reviewed using the OSCAR-IB criteria. The 5-year DP was determined based on Expanded Disability Status Scale (EDSS) changes and MS clinical trial criteria. Data regarding previous history of MS optic neuritis (MSON) and use of disease modifying treatment (DMT) was derived by in-person interview and review of electronic medical records. Mixed model-type of repeated measure analysis determined effects driving pRNFL change for analysis which utilized all eyes separately. RESULTS Over an average of 5.3-years follow-up, the MS population demonstrated significant pRNFL thinning (F = 16.108, p < 0.001). The pRNFL thinning was greater due to progressive MS subtype (F = 5.102, p = 0.025), greater age at baseline (F = 4.554, p = 0.034), occurrence of DP (F = 6.583, p = 0.011), and previous history of MSON (F = 7.053, p = 0.008). Use of any or highly potent DMT (natalizumab versus first-line injectable treatments versus no DMT) significantly reduced the pRNFL thinning (F = 8.367, p = 0.004) over the follow-up. Lastly, occurrence of DP in PMS patients older than 50 years old was associated with greater pRNFL thinning (F = 6.667, p = 0.013). CONCLUSION Longitudinal pRNFL changes are modified by age, disease subtype, disabiltiy progression, history of MSON, DMT use and their interactions.
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Affiliation(s)
- Dejan Jakimovski
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
| | - Robert Zivadinov
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Caila B Vaughn
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Osman Ozel
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
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13
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Fuchs TA, Dwyer MG, Jakimovski D, Bergsland N, Ramasamy DP, Weinstock-Guttman B, Hb Benedict R, Zivadinov R. Quantifying disease pathology and predicting disease progression in multiple sclerosis with only clinical routine T2-FLAIR MRI. Neuroimage Clin 2021; 31:102705. [PMID: 34091352 PMCID: PMC8182301 DOI: 10.1016/j.nicl.2021.102705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 12/17/2022]
Abstract
We explored five brain pathology measures from clinical-quality T2-FLAIR MRI in MS. These included LVV, thalamus volume, MOV, SCLV and network efficiency. T2-FLAIR measures predicted a majority of the variance in research-quality MRI. T2-FLAIR measures correlated with neurologic disability and cognitive function. T2-FLAIR measures predicted disability progression over five-years. T2-FLAIR measures can be used in legacy clinical datasets.
Background Although quantitative measures from research-quality MRI provide a means to study multiple sclerosis (MS) pathology in vivo, these metrics are often unavailable in legacy clinical datasets. Objective To determine how well an automatically-generated quantitative snapshot of brain pathology, measured only on clinical routine T2-FLAIR MRI, can substitute for more conventional measures on research MRI in terms of capturing multi-factorial disease pathology and providing similar clinical relevance. Methods MRI with both research-quality sequences and conventional clinical T2-FLAIR was acquired for 172 MS patients at baseline, and neurologic disability was assessed at baseline and five-years later. Five measures (thalamus volume, lateral ventricle volume, medulla oblongata volume, lesion volume, and network efficiency) for quantifying disparate aspects of neuropathology from low-resolution T2-FLAIR were applied to predict standard research-quality MRI measures. They were compared in regard to association with future neurologic disability and disease progression over five years. Results The combination of the five T2-FLAIR measures explained most of the variance in standard research-quality MRI. T2-FLAIR measures were associated with neurologic disability and cognitive function five-years later (R2 = 0.279, p < 0.001; R2 = 0.382, p < 0.001), similar to standard research-quality MRI (R2 = 0.279, p < 0.001; R2 = 0.366, p < 0.001). They also similarly predicted disability progression over five years (%-correctly-classified = 69.8, p = 0.034), compared to standard research-quality MRI (%-correctly-classified = 72.4%, p = 0.022) in relapsing-remitting MS. Conclusion A set of five T2-FLAIR-only measures can substitute for standard research-quality MRI, especially in relapsing-remitting MS. When only clinical T2-FLAIR is available, it can be used to obtain substantially more quantitative information about brain pathology and disability than is currently standard practice.
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Affiliation(s)
- Tom A Fuchs
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Deepa P Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ralph Hb Benedict
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
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14
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Tommasin S, Cocozza S, Taloni A, Giannì C, Petsas N, Pontillo G, Petracca M, Ruggieri S, De Giglio L, Pozzilli C, Brunetti A, Pantano P. Machine learning classifier to identify clinical and radiological features relevant to disability progression in multiple sclerosis. J Neurol 2021; 268:4834-4845. [PMID: 33970338 PMCID: PMC8563671 DOI: 10.1007/s00415-021-10605-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/16/2020] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 01/22/2023]
Abstract
Objectives To evaluate the accuracy of a data-driven approach, such as machine learning classification, in predicting disability progression in MS. Methods We analyzed structural brain images of 163 subjects diagnosed with MS acquired at two different sites. Participants were followed up for 2–6 years, with disability progression defined according to the expanded disability status scale (EDSS) increment at follow-up. T2-weighted lesion load (T2LL), thalamic and cerebellar gray matter (GM) volumes, fractional anisotropy of the normal appearing white matter were calculated at baseline and included in supervised machine learning classifiers. Age, sex, phenotype, EDSS at baseline, therapy and time to follow-up period were also included. Classes were labeled as stable or progressed disability. Participants were randomly chosen from both sites to build a sample including 50% patients showing disability progression and 50% patients being stable. One-thousand machine learning classifiers were applied to the resulting sample, and after testing for overfitting, classifier confusion matrix, relative metrics and feature importance were evaluated. Results At follow-up, 36% of participants showed disability progression. The classifier with the highest resulting metrics had accuracy of 0.79, area under the true positive versus false positive rates curve of 0.81, sensitivity of 0.90 and specificity of 0.71. T2LL, thalamic volume, disability at baseline and administered therapy were identified as important features in predicting disability progression. Classifiers built on radiological features had higher accuracy than those built on clinical features. Conclusions Disability progression in MS may be predicted via machine learning classifiers, mostly evaluating neuroradiological features. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10605-7.
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Affiliation(s)
- Silvia Tommasin
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.
| | - Sirio Cocozza
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Alessandro Taloni
- Institute for Complex Systems, Italian National Research Council, Rome, Italy
| | - Costanza Giannì
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | | | - Giuseppe Pontillo
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Naples, Italy.,Dipartimento di Ingegneria Elettrica e delle Tecnologie dell'Informazione, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Maria Petracca
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.,Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.,Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Laura De Giglio
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.,Neurology Unit, Medicine Department, San Filippo Neri Hospital, Rome, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy
| | - Arturo Brunetti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, Italy.,Department of Radiology, IRCCS NEUROMED, Pozzilli, Italy
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15
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Guger M, Enzinger C, Leutmezer F, Di Pauli F, Kraus J, Kalcher S, Kvas E, Berger T. Long-term outcome and predictors of long-term disease activity in natalizumab-treated patients with multiple sclerosis: real life data from the Austrian MS Treatment Registry. J Neurol 2021; 268:4303-4310. [PMID: 33890167 PMCID: PMC8505366 DOI: 10.1007/s00415-021-10559-w] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/28/2021] [Accepted: 04/10/2021] [Indexed: 12/01/2022]
Abstract
Objectives To evaluate long-term effectiveness of natalizumab (NTZ) and to determine demographic, clinical, and radiological predictors regarding long-term disease activity (≥ 7 years) in a nationwide observational cohort, using data collected prospectively in a real-life setting. Materials and methods We analysed data from 230 patients from the Austrian Multiple Sclerosis Treatment Registry (AMSTR), who had started treatment with NTZ at any time since 2006 and stayed on NTZ for at least 7 years without treatment gap of more than three months. Results Estimated mean annualised relapse rates (ARR) over a mean treatment period of 9.3 years were 0.07 for NTZ. Sustained EDSS progression for 12 weeks was observed in 36 (19%) patients and for 24 weeks in 31 (16.3%) cases. Sustained EDSS regression for 12 and 24 weeks was seen in 45 (23.7%) and 42 (22.1%) cases. The baseline parameters ≥ 1 Gadolinium-enhancing MRI lesion(s) [incidence rate ratio (IRR) of 0.409 (95% CI 0.283–0.593), p = 0.001], ARR ≤ 1 in the prior 12 month before treatment initiation with NTZ [IRR of 0.353 (95% CI 0.200–0.623), p = 0.001] and EDSS ≤ 1 [incidence rate ratio (IRR) of 0.081 (95% CI 0.011–0.581), p = 0.012] were significantly associated with a reduced relapse risk, whereas a disease duration ≤ 5 years increased significantly the ARR [IRR of 1.851 (95% CI 1.249–2.743), p = 0.002]. The only predictive baseline parameter for experiencing EDSS progression (sustained for 12 and 24 weeks) was age > 35 years [HR of 2.482 (95% CI 1.110–5.549), p = 0.027, and HR of 2.492 (95% CI 1.039–5.978), p = 0.041, respectively]. Conclusions These real-life data show a stable disease course regarding relapse activity and disease progression under NTZ treatment for more than 7 years. The main predictors for disease activity were higher relapse rate before treatment initiation, higher disability, shorter disease duration and absence of Gadolinium-enhancing MRI lesions at baseline. Older age at NTZ start was the only significant risk factor for disease progression over long-term.
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Affiliation(s)
- Michael Guger
- Clinic for Neurology 2, Med Campus III, Kepler University Hospital GmbH, Krankenhausstr. 9, 4021, Linz, Austria. .,Medical Faculty, Johannes Kepler University Linz, Linz, Austria.
| | | | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Franziska Di Pauli
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jörg Kraus
- Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria.,Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | | | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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16
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Healy BC, Glanz BI, Swallow E, Signorovitch J, Hagan K, Silva D, Pelletier C, Chitnis T, Weiner H. Confirmed disability progression provides limited predictive information regarding future disease progression in multiple sclerosis. Mult Scler J Exp Transl Clin 2021; 7:2055217321999070. [PMID: 33953937 PMCID: PMC8042549 DOI: 10.1177/2055217321999070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Although confirmed disability progression (CDP) is a common outcome in multiple sclerosis (MS) clinical trials, its predictive value for long-term outcomes is uncertain. Objective To investigate whether CDP at month 24 predicts subsequent disability accumulation in MS. Methods The Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women's Hospital includes participants with relapsing-remitting MS or clinically isolated syndrome with Expanded Disability Status Scale (EDSS) scores ≤5 (N = 1214). CDP was assessed as a predictor of time to EDSS score 6 (EDSS 6) and to secondary progressive MS (SPMS) using a Cox proportional hazards model; adjusted models included additional clinical/participant characteristics. Models were compared using Akaike's An Information Criterion. Results CDP was directionally associated with faster time to EDSS 6 in univariate analysis (HR = 1.61 [95% CI: 0.83, 3.13]). After adjusting for month 24 EDSS, CDP was directionally associated with slower time to EDSS 6 (adjusted HR = 0.65 [0.32, 1.28]). Models including CDP had worse fit statistics than those using EDSS scores without CDP. When models included clinical and magnetic resonance imaging measures, T2 lesion volume improved fit statistics. Results were similar for time to SPMS. Conclusions CDP was less predictive of time to subsequent events than other MS clinical features.
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17
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Cheng C, Gomez D, McCombe JA, Smyth P, Giuliani F, Blevins G, Baker GB, Power C. Disability progression in multiple sclerosis is associated with plasma neuroactive steroid profile. Neurol Sci 2021; 42:5241-5247. [PMID: 33829329 DOI: 10.1007/s10072-021-05203-4] [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: 10/06/2020] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neuroactive steroids (NASs) exert multiple biological effects on development and inflammation. The effects of NASs on disease progression in multiple sclerosis (MS) are uncertain, prompting analyses of NAS profiles during the transition from clinically isolated syndrome (CIS) to relapsing-remitting (RR) MS. METHODS Subjects with CIS or RRMS and healthy controls (HCs) were recruited; demographic and clinical data as well as disability scores measured by the Expanded Disability Status Scale (EDSS) were recorded. Matched plasma NAS and amino acid (AA) concentrations were measured. RESULTS HC (n = 17), CIS (n = 31), and RRMS (n = 33) groups showed similar ages and sex distribution although disability scores were higher in the RRMS group. The conversion rate of CIS to RRMS group was 51.6% (n = 16) during a mean follow-up period of 1.85 years. The RRMS group showed significantly higher mean allopregnanolone, aspartate, and taurine concentrations with lower epiallopregnanolone concentrations than CIS patients, and higher L-serine-O-phosphate and lower alanine, arginine, and glutamine concentrations than the HC group. Among CIS and RRMS groups, multivariate hierarchical regressions revealed that higher concentrations of plasma tetrahydrodeoxycorticosterone (THDOC) may predict disability worsening. CONCLUSIONS RRMS and CIS patients exhibited differing concentrations of both NASs and AAs in plasma while both THDOC and pregnanolone might serve as biomarkers of disability worsening.
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Affiliation(s)
- C Cheng
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - D Gomez
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - J A McCombe
- Department of Medicine (Neurology), HMRC 6-11, University of Alberta, Edmonton, AB, Canada
| | - P Smyth
- Department of Medicine (Neurology), HMRC 6-11, University of Alberta, Edmonton, AB, Canada
| | - F Giuliani
- Department of Medicine (Neurology), HMRC 6-11, University of Alberta, Edmonton, AB, Canada
| | - G Blevins
- Department of Medicine (Neurology), HMRC 6-11, University of Alberta, Edmonton, AB, Canada
| | - G B Baker
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - C Power
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada. .,Department of Medicine (Neurology), HMRC 6-11, University of Alberta, Edmonton, AB, Canada.
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18
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Roura E, Maclair G, Andorrà M, Juanals F, Pulido-Valdeolivas I, Saiz A, Blanco Y, Sepulveda M, Llufriu S, Martínez-Heras E, Solana E, Martinez-Lapiscina EH, Villoslada P. Cortical fractal dimension predicts disability worsening in Multiple Sclerosis patients. Neuroimage Clin 2021; 30:102653. [PMID: 33838548 PMCID: PMC8045041 DOI: 10.1016/j.nicl.2021.102653] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/14/2021] [Accepted: 03/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fractal geometry measures the morphology of the brain and detects CNS damage. We aimed to assess the longitudinal changes on brain's fractal geometry and its predictive value for disease worsening in patients with Multiple Sclerosis (MS). METHODS We prospectively analyzed 146 consecutive patients with relapsing-remitting MS with up to 5 years of clinical and brain MRI (3 T) assessments. The fractal dimension and lacunarity were calculated for brain regions using box-counting methods. Longitudinal changes were analyzed in mixed-effect models and the risk of disability accumulation were assessed using Cox Proportional Hazard regression analysis. RESULTS There was a significant decrease in the fractal dimension and increases of lacunarity in different brain regions over the 5-year follow-up. Lower cortical fractal dimension increased the risk of disability accumulation for the Expanded Disability Status Scale [HR 0.9734, CI 0.8420-0.9125; Harrell C 0.59; Wald p 0.038], 9-hole peg test [HR 0.9734, CI 0.8420-0.9125; Harrell C 0.59; Wald p 0.0083], 2.5% low contrast vision [HR 0.4311, CI 0.2035-0.9133; Harrell C 0.58; Wald p 0.0403], symbol digit modality test [HR 2.215, CI 1.043-4.705; Harrell C 0.65; Wald p 0.0384] and MS Functional Composite-4 [HR 0.55, CI 0.317-0.955; Harrell C 0.59; Wald p 0.0029]. CONCLUSIONS Fractal geometry analysis of brain MRI identified patients at risk of increasing their disability in the next five years.
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Affiliation(s)
| | | | - Magí Andorrà
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | | | - Irene Pulido-Valdeolivas
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Albert Saiz
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Yolanda Blanco
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Maria Sepulveda
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Sara Llufriu
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Eloy Martínez-Heras
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Elisabeth Solana
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain
| | - Pablo Villoslada
- Institut d'Investigacions Biomèdiques August Pi Sunyer - Hospital Clinic, University of Barcelona, Spain; Stanford University, Stanford, CA, USA.
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19
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Pérez-Miralles F, Prefasi D, García-Merino A, Ara JR, Izquierdo G, Meca-Lallana V, Gascón-Giménez F, Martínez-Ginés ML, Ramió-Torrentà L, Costa-Frossard L, Fernández Ó, Moreno-García S, Medrano N, Maurino J, Casanova B. Short-term data on disease activity, cognition, mood, stigma and employment outcomes in a cohort of patients with primary progressive multiple sclerosis (UPPMS study). Mult Scler Relat Disord 2021; 50:102860. [PMID: 33647591 DOI: 10.1016/j.msard.2021.102860] [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: 12/18/2020] [Revised: 02/08/2021] [Accepted: 02/20/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary progressive multiple sclerosis (PPMS) has long been defined by progressive disability accrual in the absence of initial relapses. However, its underlying neurodegenerative process seems to be accompanied by central nervous system inflammation. A new classification defined multiple sclerosis courses according to clinical/radiological activity and progression. We provide further insight into PPMS activity according to this classification and other daily living aspects. METHODS This was a multicentre, prospective, cohort study including 55 adult patients with PPMS according to 2010 McDonald criteria, within ten years from neurologic symptom onset and not receiving disease-modifying therapies during the past six months, who were followed up for 12 months. The primary study endpoint was the percentage of patients with active disease based on clinical relapses and/or magnetic resonance activity. Disability progression, cognitive function, physical/psychological impact, depression symptoms, stigma and employment were secondary endpoints. RESULTS Eleven (25.6%) patients exhibited multiple sclerosis activity throughout the 12-month study follow-up. Fourteen showed non-active multiple sclerosis without progression, 11 non-active multiple sclerosis with progression, 6 active multiple sclerosis without progression and 4 active multiple sclerosis with progression; one patient with disease activity was not assessable for progression. Cognitive function scores remained unchanged or increased, disease physical impact was maintained and disease psychological impact significantly decreased. The proportion of patients with depression symptoms or stigma remained without significant changes as well as employment outcomes. CONCLUSION This study shows that one-fourth of PPMS patients may exhibit disease activity over one year, with disability progression in approximately one-third but without worsening of cognitive function, disease impact, depression, stigma or employment outcomes.
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Affiliation(s)
- Francisco Pérez-Miralles
- Neuroimmunology Unit, Neurology Department, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell, 106, 46026 Valencia, Spain.
| | - Daniel Prefasi
- Medical Department, Roche Farma S.A., Calle de la Ribera del Loira, 50, 28042 Madrid, Spain
| | - Antonio García-Merino
- Neurology Department, Hospital Universitario Puerta de Hierro, Calle Manuel de Falla, 1, 28222 Majadahonda Spain
| | - José Ramón Ara
- Neurology Department, Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Guillermo Izquierdo
- Neurology Department, Hospital Universitario Virgen Macarena, Calle Dr Fedriani, 3, 41009 Seville, Spain
| | - Virginia Meca-Lallana
- Neurology Department, Hospital Universitario La Princesa, Calle de Diego de León, 62, 28006 Madrid, Spain
| | - Francisco Gascón-Giménez
- Neurology Department, Hospital Clínico Universitario de Valencia, Avenida de Blasco Ibáñez, 17, 46010 Valencia, Spain
| | - María Luisa Martínez-Ginés
- Neurology Department, Hospital Universitario Gregorio Marañón, Calle del Dr Esquerdo, 46, 28007 Madrid, Spain
| | - Lluis Ramió-Torrentà
- Girona Neuroimmunology and Multiple Sclerosis Unit, Neurology Department, Hospital Universitari Josep Trueta and Hospital Santa Caterina, Avenida de Francia, S/N, 17007 Girona, Spain. IDIBGI Calle Dr. Castany s/n, Salt, 17190 Spain. Medical Sciences Department, Faculty of Medicine, University of Girona, Plaça Sant Domènec, 3 17400 Girona, Spain
| | - Lucienne Costa-Frossard
- Neurology Department, Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo km 9.100, 28034 Madrid, Spain
| | - Óscar Fernández
- Neurology Department, Hospital Regional Universitario Carlos Haya, Avenida de Carlos Haya, 84, 29010 Málaga, Spain
| | - Sara Moreno-García
- Neurology Department, Hospital Universitario 12 de Octubre, Avenida de Córdoba, S/N, 28041 Madrid, Spain
| | - Nicolás Medrano
- Medical Department, Roche Farma S.A., Calle de la Ribera del Loira, 50, 28042 Madrid, Spain
| | - Jorge Maurino
- Medical Department, Roche Farma S.A., Calle de la Ribera del Loira, 50, 28042 Madrid, Spain
| | - Bonaventura Casanova
- Neuroimmunology Unit, Neurology Department, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell, 106, 46026 Valencia, Spain
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20
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Alvarez E, Nair KV, Gorritz M, Bartolome L, Maloney H, Ding Y, Golan T, Wade RL, Kumar R, Su W, Shah R, Russo P. Identification and diagnosis of Secondary Progressive Multiple Sclerosis during the clinical encounter: Results from a physician survey. Mult Scler Relat Disord 2021; 50:102858. [PMID: 33799068 DOI: 10.1016/j.msard.2021.102858] [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: 12/10/2020] [Revised: 02/09/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is difficult to characterize the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive MS (SPMS), due to symptomatic variability across patients. Diagnosis of SPMS is prolonged and often established retrospectively, as it is based on patient clinical history and symptoms. This cross-sectional study aimed to identify MS neurologist reported clinical indicators deemed important in diagnosing SPMS in clinical practice. METHODS A web-based quantitative survey was conducted among MS-treating neurologists across the United States in January 2019. The questionnaire comprised of 17 questions evaluating primary clinical indicators used by neurologists in assessing patient progression to SPMS. Treatment approach and factors influencing treatment decision-making following SPMS diagnosis were also analyzed in the survey. RESULTS Overall, 300 neurologists completed the survey; most of the respondents were general MS-treating neurologists (63%) and from private care setting (58%). The overall respondents as well as MS-focused neurologists ranked patient history (45% and 42%, respectively) and patients' neurological exam (39% and 44%, respectively) as -primary clinical indicators of SPMS diagnosis. 57% of neurologists always or mostly switched disease modifying therapies after progression to SPMS, and mostly considered 3-6 months' assessment interval to diagnose SPMS. CONCLUSION The survey indicated that neurologists are able to recognize signs of SPMS within six months of symptomatic assessment. The diagnosis is primarily based on patient history among MS-treating neurologists. Therefore, continued education to neurologists may facilitate early diagnosis and timely introduction of effective treatment to manage the progression of SPMS.
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Affiliation(s)
- E Alvarez
- Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, USA
| | - K V Nair
- Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, USA
| | - M Gorritz
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - L Bartolome
- Thomas Jefferson University, Philadelphia, PA, USA
| | - H Maloney
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - Y Ding
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - T Golan
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - R L Wade
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - R Kumar
- IQVIA, Inc, Plymouth Meeting, PA, USA
| | - W Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - R Shah
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - P Russo
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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21
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Wesnes K, Myhr KM, Riise T, Kvistad SS, Torkildsen Ø, Wergeland S, Holmøy T, Midgard R, Bru A, Edland A, Eikeland R, Gosal S, Harbo HF, Kleveland G, Sørenes YS, Øksendal N, Bjørnevik K. Low vitamin D, but not tobacco use or high BMI, is associated with long-term disability progression in multiple sclerosis. Mult Scler Relat Disord 2021; 50:102801. [PMID: 33636616 DOI: 10.1016/j.msard.2021.102801] [Citation(s) in RCA: 4] [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: 12/18/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Low vitamin D levels, tobacco use and high body mass index (BMI) have been linked to adverse disease outcomes in multiple sclerosis (MS), but their influence on long-term disability progression remains unclear. Therefore, we explored whether these modifiable lifestyle factors were associated with 10-year clinical disability progression in patients with MS. METHODS In this prospective study, a cohort of 88 patients with relapsing-remitting MS completed a randomized controlled study on ω-3 fatty acids between 2004 and 2008. During 24 months, serum 25-hydroxyvitamin D (25(OH)D), serum cotinine (nicotine metabolite), and BMI were repeatedly measured. In 2017, a follow-up study was conducted among 80 of the participants, including disability assessment by the Expanded Disability Status Scale (EDSS). Linear regression was used to explore associations between the lifestyle factors and the EDSS change over 10 years. RESULTS Higher seasonally adjusted 25(OH)D levels were associated with lower 10-year EDSS progression (change in EDSS per 1 SD increase in 25(OH)D in a model adjusted for sex, age and baseline EDSS: -0.45 point, 95% CI: -0.75 to -0.16, p=0.003). Further adjustments for potential confounders related to lifestyle and disease status gave similar results. The association was mainly driven by low 25(OH)D levels during spring, as well as seasonally adjusted levels below 80 nmol/L. No clear association was found for BMI and cotinine. CONCLUSION Lower 25(OH)D levels, but apparently not tobacco use or higher BMI, were significantly associated with worse long-term disability progression in MS.
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Affiliation(s)
- Kristin Wesnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Neurology, St. Olav's University Hospital, Trondheim, Norway.
| | - Kjell-Morten Myhr
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Trond Riise
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Silje Stokke Kvistad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Immunology and Transfusion medicine, Haukeland University Hospital, Bergen, Norway
| | - Øivind Torkildsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Stig Wergeland
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; Norwegian Multiple Sclerosis Competence Center, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Trygve Holmøy
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Rune Midgard
- Department of Neurology, Molde Hospital, Molde, Norway
| | - Alla Bru
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Astrid Edland
- Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Randi Eikeland
- Department of Neurology and Department of Paediatrics, Sørlandet Hospital Trust, Arendal, Norway
| | - Sonia Gosal
- Department of Neurology, Østfold Hospital Kalnes, Grålum, Norway
| | - Hanne F Harbo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Neurology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Grethe Kleveland
- Department of Neurology, Innlandet Hospital Lillehammer, Lillehammer, Norway
| | | | - Nina Øksendal
- Department of Neurology, Nordland hospital trust, Bodø, Norway
| | - Kjetil Bjørnevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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22
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Sormani MP, Freedman MS, Aldridge J, Marhardt K, Kappos L, De Stefano N. MAGNIMS score predicts long-term clinical disease activity-free status and confirmed disability progression in patients treated with subcutaneous interferon beta-1a. Mult Scler Relat Disord 2021; 49:102790. [PMID: 33571946 DOI: 10.1016/j.msard.2021.102790] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Subcutaneous (sc) interferon (IFN) β-1a reduces relapse rates and delays disability progression in patients with MS. We examined the association of the year 1 Magnetic Resonance Imaging in MS (MAGNIMS) score with long-term clinical disease activity (CDA) -free status and confirmed disability progression in patients treated with sc IFN β-1a in PRISMS. METHODS Patients treated with sc IFN β-1a three-times-weekly (22 or 44 μg; pooled data) were classified by MAGNIMS score (0, n = 129; 1, n = 108; 2, n = 130) at year 1. Hazard ratios (HR; 95% confidence intervals [CI]) for risk of CDA and confirmed Expanded Disability Status Score (EDSS) progression were calculated by MAGNIMS score for up to 15 years of follow-up. RESULTS The risk of CDA was higher with a year 1 MAGNIMS score of 1 versus 0 (HR 1.82 [1.38-2.41]), 2 versus 0 (2.63 [2.01-3.45]) and 2 versus 1 (1.45 [1.11-1.89], all p < 0.0001). The same outcome was observed with the risk of confirmed EDSS progression (1 versus 0: 1.93 [1.23-3.02]; 2 versus 0: 2.95 [1.95-4.46]; 2 versus 1: 1.53 [1.05-2.23]; all p < 0.0001). CONCLUSION In PRISMS, MAGNIMS score at Year 1 predicted risk of CDA and confirmed disability progression in sc IFN β-1a-treated patients over up to 15 years. PRISMS-15 clinicaltrial.gov identifier: NCT01034644.
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Affiliation(s)
- Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa and Ospedale Policlinico San Martino IRCCS, Via Pastore 1, 16132, Genova, Italy.
| | - Mark S Freedman
- University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, ON K1H 8L6, Canada
| | - Julie Aldridge
- EMD Serono Research & Development Institute Inc., 45 Middlesex Turnpike, Billerica, MA 01821-3936, USA
| | | | - Ludwig Kappos
- Research Center Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
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23
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Jakimovski D, Zivadinov R, Bergsland N, Ramasamy DP, Hagemeier J, Genovese AV, Hojnacki D, Weinstock-Guttman B, Dwyer MG. Clinical feasibility of longitudinal lateral ventricular volume measurements on T2-FLAIR across MRI scanner changes. Neuroimage Clin 2021; 29:102554. [PMID: 33472143 PMCID: PMC7816007 DOI: 10.1016/j.nicl.2020.102554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
Central and whole brain atrophy are faster in MS patients with disability progression. These measures can be reliably assessed on clinically-available FLAIR images. They are meaningful even with longitudinal scanner and field strength changes.
Background Greater brain atrophy is associated with disability progression (DP) in patients with multiple sclerosis (PwMS). However, methodological challenges limit its routine clinical use. Objective To determine the feasibility of atrophy measures as markers of DP in PwMS scanned across different MRI field strengths. Methods A total of 980 PwMS were scanned on either 1.5 T or 3.0 T MRI scanners. Demographic and clinical data were retrospectively collected, and the presence of DP was determined according to standard clinical trial criteria. Lateral ventricular volume (LVV) change was measured with the NeuroSTREAM technique on clinical routine T2-FLAIR images. Percent brain volume change (PBVC) was measured using SIENA and ventricular cerebrospinal fluid (vCSF) % change was measured using VIENA and SIENAX algorithms on 3D T1-weighted images (WI). Stable vs. DP PwMS were compared using analysis of covariance (ANCOVA). Mixed modeling determined the effect of MRI scanner change on MRI-derived atrophy measures. Results Longitudinal LVV analysis was successful in all PwMS. SIENA-based PBVC and VIENA-based changes failed in 37.6% of cases, while SIENAX-based vCSF failed in 12.9% of cases. PwMS with DP (n = 241) had significantly greater absolute (20.9% vs. 8.7%, d = 0.66, p < 0.001) and annualized LVV % change (4.1% vs. 2.3%, d = 0.27, p < 0.001) when compared to stable PwMS (n = 739). In subjects with both analyses available, both 3D-T1 and T2-FLAIR-based analyses differentiated PwMS with DP (n = 149). However, only NeuroSTREAM and VIENA-based LVV/vCSF were able to show greater atrophy in PwMS that were scanned on different scanners. PBVC and SIENAX-based vCSF % changes were significantly affected by scanner change (Beta = −0.16, t-statistics = −2.133, p = 0.033 and Beta = −2.08, t-statistics = −4.084, p < 0.001), whereas no MRI scanner change effects on NeuroSTREAM-based PLVVC and VIENA-based vCSF % change were noted. Conclusions LVV-based atrophy on T2-FLAIR is a clinically relevant measure in spite of MRI scanner changes and mild disability levels.
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Affiliation(s)
- Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Deepa P Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Antonia Valentina Genovese
- Institute of Radiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David Hojnacki
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Comprehensive MS Treatment and Research Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, NY, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA; Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
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24
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Akaishi T, Misu T, Takahashi T, Takai Y, Nishiyama S, Fujimori J, Ishii T, Aoki M, Fujihara K, Nakashima I. Progression pattern of neurological disability with respect to clinical attacks in anti-MOG antibody-associated disorders. J Neuroimmunol 2020; 351:577467. [PMID: 33388541 DOI: 10.1016/j.jneuroim.2020.577467] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 12/22/2022]
Abstract
The progression pattern of neurological disability among patients with anti-myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD) was evaluated. Neurological disability was evaluated annually for 408 person-years in 50 patients. More than 30% of the patients had clinical relapses in the first 5 years. Disability progression independent of relapse activity (PIRA) was not seen, whereas a stepwise disability progression was observed after clinical attacks in some instances. Disability worsening was more frequent after relapses than after the onset episode (p < 0.01). Similar to patients with anti-aquaporin-4 antibodies, attack-related stepwise disability progression without PIRA is typical in MOGAD, suggesting the importance of relapse prevention.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurology, National Hospital Organization Yonezawa National Hospital, Yonezawa, Japan
| | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shuhei Nishiyama
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Juichi Fujimori
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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25
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Voskuhl RR, Patel K, Paul F, Gold SM, Scheel M, Kuchling J, Cooper G, Asseyer S, Chien C, Brandt AU, Meyer CE, MacKenzie-Graham A. Sex differences in brain atrophy in multiple sclerosis. Biol Sex Differ 2020; 11:49. [PMID: 32859258 PMCID: PMC7456053 DOI: 10.1186/s13293-020-00326-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Women are more susceptible to multiple sclerosis (MS) than men by a ratio of approximately 3:1. However, being male is a risk factor for worse disability progression. Inflammatory genes have been linked to susceptibility, while neurodegeneration underlies disability progression. Thus, there appears to be a differential effect of sex on inflammation versus neurodegeneration. Further, gray matter (GM) atrophy is not uniform across the brain in MS, but instead shows regional variation. Here, we study sex differences in neurodegeneration by comparing regional GM atrophy in a cohort of men and women with MS versus their respective age- and sex-matched healthy controls. METHODS Voxel-based morphometry (VBM), deep GM substructure volumetry, and cortical thinning were used to examine regional GM atrophy. RESULTS VBM analysis showed deep GM atrophy in the thalamic area in both men and women with MS, whereas men had additional atrophy in the putamen as well as in localized cortical regions. Volumetry confirmed deep GM loss, while localized cortical thinning confirmed GM loss in the cerebral cortex. Further, MS males exhibited worse performance on the 9-hole peg test (9HPT) than MS females. We observed a strong correlation between thalamic volume and 9HPT performance in MS males, but not in MS females. CONCLUSION More regional GM atrophy was observed in men with MS than women with MS, consistent with previous observations that male sex is a risk factor for worse disease progression.
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Affiliation(s)
- Rhonda R Voskuhl
- Department of Neurology, University of California, Los Angeles, 635 Charles E. Young Drive South, Gordon Neuroscience Research Building, Los Angeles, CA, 90095, USA.
| | - Kevin Patel
- Department of Neurology, University of California, Los Angeles, 635 Charles E. Young Drive South, Gordon Neuroscience Research Building, Los Angeles, CA, 90095, USA
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefan M Gold
- Institute for Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Medical Department, Division of Psychosomatic Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael Scheel
- Institute of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joseph Kuchling
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Departments of Neurology and Neuropsychiatry, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Graham Cooper
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Departments of Neurology and Neuropsychiatry, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Einstein Center for Neurosciences, Berlin, Germany
| | - Susanna Asseyer
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Chien
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department for Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Departments of Neurology and Neuropsychiatry, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Cassandra Eve Meyer
- Department of Neurology, University of California, Los Angeles, 635 Charles E. Young Drive South, Gordon Neuroscience Research Building, Los Angeles, CA, 90095, USA
| | - Allan MacKenzie-Graham
- Department of Neurology, University of California, Los Angeles, 635 Charles E. Young Drive South, Gordon Neuroscience Research Building, Los Angeles, CA, 90095, USA
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26
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Achiron A, Ben-David A, Gurevich M, Magalashvili D, Menascu S, Dolev M, Stern Y, Ziv-Baran T. Parity and disability progression in relapsing-remitting multiple sclerosis. J Neurol 2020; 267:3753-3762. [PMID: 32725314 DOI: 10.1007/s00415-020-10093-1] [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: 06/03/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
AIM It is unclear whether parity and increasing parity are risk factors for long-term disability progression in relapsing-remitting multiple sclerosis. Furthermore, data on the effects of immunomodulatory treatments in this context are limited. OBJECTIVES To examine the association between parity and long-term neurological sequela among relapsing-remitting multiple sclerosis patients. METHODS A cohort study including all women with relapsing-remitting multiple sclerosis in Israel registered in Sheba Medical Center Multiple Sclerosis data registry from 1995 to 2018. The risks of progression to moderate and severe disability according to parity after disease onset were evaluated. Cox regression models using childbirth as a time-dependent covariate were used to study the association between parity and disability progression. RESULTS During the 26,785 person-years of follow-up a total of 2281 women were included in the study. Parity was associated with decreased risk of progression to moderate (adj.HR, 0.68; 95% CI 0.54-0.85, P = 0.001) but not to severe disability (adj.HR, 0.88; 95% CI 0.68-1.14, P = 0.36). Hazard ratios for progression to moderate and severe disability were comparable between women with one, two, and three or more births. In a subgroup analysis of women who gave birth within 5 years of disease onset, immunomodulatory treatment did not affect moderate or severe disability-free survival. CONCLUSION This study suggests that childbirth after the onset of multiple sclerosis is associated with a decreased risk of progression to moderate neurological disability.
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Affiliation(s)
- Anat Achiron
- Multiple Sclerosis Center, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Alon Ben-David
- Department of Obstetrics and Gynecology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Gurevich
- Multiple Sclerosis Center, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Magalashvili
- Multiple Sclerosis Center, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mark Dolev
- Multiple Sclerosis Center, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Stern
- Multiple Sclerosis Center, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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27
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Ciampi E, Uribe-San-Martin R, Cárcamo C, Cruz JP, Reyes A, Reyes D, Pinto C, Vásquez M, Burgos RA, Hancke J. Efficacy of andrographolide in not active progressive multiple sclerosis: a prospective exploratory double-blind, parallel-group, randomized, placebo-controlled trial. BMC Neurol 2020; 20:173. [PMID: 32380977 PMCID: PMC7203851 DOI: 10.1186/s12883-020-01745-w] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/23/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic immune mediated disease and the progressive phase appears to have significant neurodegenerative mechanisms. The classification of the course of progressive MS (PMS) has been re-organized into categories of active vs. not active inflammatory disease and the presence vs. absence of gradual disease progression. Clinical trial experience to date in PMS with anti-inflammatory medications has shown limited effect. Andrographolide is a new class of anti-inflammatory agent, that has been proposed as a potential drug for autoimmune disorders, including MS. In the present trial, we perform an exploratory pilot study on the efficacy and safety of andrographolide (AP) compared to placebo in not active PMS. METHODS A pilot clinical trial using 140 mg oral AP or placebo twice daily for 24 months in patients with not active primary or secondary progressive MS was conducted. The primary efficacy endpoint was the mean percentage brain volume change (mPBVC). Secondary efficacy endpoints included 3-month confirmed disability progression (3-CDP) and mean EDSS change. RESULTS Forty-four patients were randomized: 23 were assigned to the AP group, and 21 were assigned to the placebo group. The median baseline EDSS of both groups was 6.0. Annualized mPBVC was - 0.679% for the AP group and - 1.069% for the placebo group (mean difference: -0.39; 95% CI [- 0.836-0.055], p = 0.08, relative reduction: 36.5%). In the AP group, 30% had 3-CDP compared to 41% in the placebo group (HR: 0.596; 95% CI [0.200-1.777], p = 0.06). The mean EDSS change was - 0.025 in the AP group and + 0.352 in the placebo group (mean difference: 0.63, p = 0.042). Adverse events related to AP were mild rash and dysgeusia. CONCLUSIONS AP was well tolerated and showed a potential effect in reducing brain atrophy and disability progression, that need to be further evaluated in a larger clinical trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02273635 retrospectively registered on October 24th, 2014.
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Affiliation(s)
- Ethel Ciampi
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile. .,Neurology, Hospital Dr. Sótero del Río, Av. Concha y Toro, 3459, Santiago, Chile.
| | - Reinaldo Uribe-San-Martin
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile.,Neurology, Hospital Dr. Sótero del Río, Av. Concha y Toro, 3459, Santiago, Chile
| | - Claudia Cárcamo
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile.
| | - Juan Pablo Cruz
- Radiology, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile
| | - Ana Reyes
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile
| | - Diego Reyes
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile
| | - Carmen Pinto
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile
| | - Macarena Vásquez
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, 5° floor, Santiago, Chile
| | - Rafael A Burgos
- Pharmacology and Morphophysiology, Faculty of Veterinary Sciences, Universidad Austral de Chile, Independencia, 613, Valdivia, Chile
| | - Juan Hancke
- Pharmacology and Morphophysiology, Faculty of Veterinary Sciences, Universidad Austral de Chile, Independencia, 613, Valdivia, Chile
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28
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Järvinen E, Murtonen A, Tervomaa M, Sumelahti ML. Interferon β-1a subcutaneously 3 times/week clinical outcome in relapsing multiple sclerosis in Finland. Neurol Int 2019; 11:8177. [PMID: 31871598 PMCID: PMC6908953 DOI: 10.4081/ni.2019.8177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/24/2019] [Indexed: 11/26/2022] Open
Abstract
Prognostic factors and long-term treatment response of interferon β-1a s.c tiw has not been studied in a real-life clinical cohort in Finland. The aim of the paper was to evaluate long-term treatment response, prognostic clinical factors and adherence among interferon β-1a s.c tiw treated patients in Finland. A retrospective review of medical records was performed. Confirmed relapsing multiple sclerosis patients treated with interferon β-1a s.c tiw 22μg or 44μg as their first treatment, from 1996 to 2010 in Western Finland, were included. Longitudinal generalized linear regression models were applied to assess risk of disability progression, using Expanded Disability Status Scale (EDSS), during the treatment period. Odd’s ratios with 95% confidence intervals (95% CI) were calculated for risk factors: gender, age at diagnosis, treatment delay, dose, baseline EDSS and EDSS change in one year. Kaplan-Meier was applied to study median time to discontinuation. Mean duration of treatment in 293 cases was 2.9 years (min 0.04, max 13.5). EDSS increase vs. no increase in one-year carried a significant risk for long-term disability progression (1.20, 1.08-1.33). Older age, defined by a 10-year increase in age at diagnosis (1.43, 1.07-1.91) and one-year delay to treatment start showed an increased risk for disability progression (1.05, 0.99-1.11), but gender (0.66, 0.38-1.15) or initial dose (1.00, 0.45-2.25) showed no risk. Treatment was stopped in 37% due to disease activation at median of 1.7 years, and in 25% due to side effects at 9.3 months. Our results show that young age, a short delay to treatment start and slower disability progression were identified as factors for better outcome among cases with interferon β-1a s.c tiw as their first disease modifying treatment.
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Affiliation(s)
- Elina Järvinen
- Merck Finland, Espoo; Department of Medicine, University of Helsinki
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29
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Gandhi S, Marr K, Mancini M, Caprio MG, Jakimovski D, Chandra A, Hagemeier J, Hojnacki D, Kolb C, Weinstock-Guttman B, Zivadinov R. No association between variations in extracranial venous anatomy and clinical outcomes in multiple sclerosis patients over 5 years. BMC Neurol 2019; 19:121. [PMID: 31185944 PMCID: PMC6560860 DOI: 10.1186/s12883-019-1350-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/31/2019] [Indexed: 01/08/2023] Open
Abstract
Background No longitudinal, long-term, follow-up studies have explored the association between presence and severity of variations in extracranial venous anatomy, and clinical outcomes in patients with multiple sclerosis (MS). Objective This prospective 5-year follow-up study assessed the relationship of variations in extracranial venous anatomy, indicative of chronic cerebrospinal venous insufficiency (CCSVI) on Doppler sonography, according to the International Society for Neurovascular Disease (ISNVD) proposed consensus criteria, with clinical outcomes and disease progression in MS patients. Methods 90 MS patients (52 relapsing-remitting, RRMS and 38 secondary-progressive, SPMS) and 38 age- and sex-matched HIs were prospectively followed for 5.5 years. Extracranial and transcranial Doppler-based venous hemodynamic assessment was conducted at baseline and follow-up to determine the extent of variations in extracranial venous anatomy. Change in Expanded Disability Status Scale (∆EDSS), development of disability progression (DP) and annualized relapse rate (ARR) were assessed. Results No significant differences were observed in MS patients, based on their presence of variations in extracranial venous anatomy at baseline or at the follow-up, in ∆EDSS, development of DP or ARR. While more MS patients had ISNVD CCSVI criteria fulfilled at baseline compared to HIs (58% vs. 37%, p = 0.03), no differences were found at the 5-year follow-up (61% vs. 56%, p = 0.486). Discussion This is the longest follow-up study assessing the longitudinal relationship between the presence of variations in extracranial venous anatomy and clinical outcomes in MS patients. Conclusion: The presence of variations in extracranial venous anatomy does not influence clinical outcomes over the 5-year follow-up in MS patients. Electronic supplementary material The online version of this article (10.1186/s12883-019-1350-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sirin Gandhi
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Karen Marr
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Marcello Mancini
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Rome, Italy
| | - Maria Grazia Caprio
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Rome, Italy
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Avinash Chandra
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - David Hojnacki
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Channa Kolb
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. .,Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA.
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30
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Ackermans N, Taylor C, Tam R, Carruthers R, Kolind S, Kang H, Freedman MS, Li DK, Traboulsee AL. Effect of different doses of gadolinium contrast agent on clinical outcomes in MS. Mult Scler J Exp Transl Clin 2019; 5:2055217318823796. [PMID: 30800415 PMCID: PMC6378456 DOI: 10.1177/2055217318823796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/14/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 02/04/2023] Open
Abstract
Objective The objective of this paper is to evaluate potential dose-dependent adverse effects of gadolinium-based contrast agents (GBCAs) on MS progression. Methods Outcomes from a cohort of 612 secondary progressive MS (SPMS) patients, enrolled in a two-year, placebo-controlled (negative) trial assessing the efficacy of MBP8298, were acquired. Patients received one to four (infrequent cohort; IFR) or 5–11 (frequent cohort; FR) GBCA injections between week 4 and week 104. The primary outcome was the change in Expanded Disability Status Scale (EDSS) and time to confirmed EDSS progression. Secondary outcomes included the changes in the Multiple Sclerosis Functional Composite (MSFC), Timed 25-Foot Walk (T25FW), 9-Hole-Peg Test (9HPT), and Paced Auditory Serial Addition Test (PASAT) from baseline to week 104. Results The 512 IFR and 100 FR participants showed no differences in baseline demographics or disease history. The mean change from baseline to week 104 in EDSS was +0.21 (IFR) and +0.13 (FR); MSFC –0.38 (IFR) and –0.14 (FR); T25FW +1.28 (IFR) and +0.55 (FR); 9HPT –0.06 (IFR) and –0.08 (FR); and PASAT +0.22 (IFR) and +0.20 (FR). The FR to IFR progression hazard ratio equaled 0.68 (p = 0.09). There were no significant differences in any of the outcomes between the two cohorts. Conclusion There were no differences in the disability progression measures between the two cohorts, indicating that gadolinium does not result in greater clinical worsening in SPMS after a two-year period.
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Affiliation(s)
- Nathalie Ackermans
- University of British Columbia, Department of Medicine (Neurology), Canada
| | - Carolyn Taylor
- University of British Columbia, Department of Statistics, Canada
| | - Roger Tam
- University of British Columbia, Department of Radiology, Canada
| | - Robert Carruthers
- University of British Columbia, Department of Medicine (Neurology), Canada
| | - Shannon Kolind
- University of British Columbia, Department of Medicine (Neurology), Canada
| | - Heejun Kang
- University of British Columbia, Department of Radiology, Canada
| | - Mark S Freedman
- University of Ottawa and the Ottawa Hospital Research Institute, Canada
| | - David Kb Li
- University of British Columbia, Department of Medicine (Neurology), Canada.,University of British Columbia, Department of Radiology, Canada
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31
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Traboulsee A, Li DKB, Cascione M, Fang J, Dangond F, Miller A. Effect of interferon beta-1a subcutaneously three times weekly on clinical and radiological measures and no evidence of disease activity status in patients with relapsing-remitting multiple sclerosis at year 1. BMC Neurol 2018; 18:143. [PMID: 30217172 PMCID: PMC6137887 DOI: 10.1186/s12883-018-1145-x] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/30/2018] [Indexed: 11/29/2022] Open
Abstract
Background In the PRISMS study, interferon beta-1a subcutaneously (IFN β-1a SC) reduced clinical and radiological disease burden at 2 years in patients with relapsing–remitting multiple sclerosis. The study aimed to characterize efficacy of IFN β-1a SC 44 μg and 22 μg three times weekly (tiw) at Year 1. Methods Exploratory endpoints included annualized relapse rate (ARR), 3-month confirmed disability progression (1-point Expanded Disability Status Scale increase if baseline was < 6.0 [0.5-point if baseline was ≥6.0]), active T2 lesions, and no evidence of disease activity (NEDA; defined as no relapses [subanalyzed by relapse severity], 3-month confirmed progression, or active T2 lesions). Effect of IFN β-1a SC in prespecified patient subgroups was also assessed. Results Patients were randomized to IFN β-1a 22 μg (n = 189), 44 μg (n = 184), or placebo (n = 187). At 1 year, IFN β-1a SC tiw reduced ARR (p < 0.001), risk of disability progression (p ≤ 0.029), and mean number of active T2 lesions per patients per scan (p < 0.001) versus placebo. Clinical and radiological benefits were seen as early as Month 2 and 3. Outcomes in subgroups were consistent with those in the overall population. More patients treated with IFN β-1a SC tiw achieved NEDA status, versus placebo, regardless of relapse severity (p ≤ 0.006). Conclusion Clinical, radiological, and NEDA outcomes at Year 1 were consistent with Year 2 results. Treatment efficacy was consistent in pre-specified patient subgroups. Electronic supplementary material The online version of this article (10.1186/s12883-018-1145-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anthony Traboulsee
- University of British Columbia, S113-2211 Wesbrook Mall, Vancouver, BC, V6T 1Z7, Canada.
| | - David K B Li
- University of British Columbia, S113-2211 Wesbrook Mall, Vancouver, BC, V6T 1Z7, Canada
| | - Mark Cascione
- Tampa Neurology Associates, South Tampa Multiple Sclerosis Center, 2919 W. Swann Avenue, Suite 401, South Tampa, FL, 33609, USA
| | - Juanzhi Fang
- EMD Serono, Inc., One Technology Place, Rockland, MA, 02370, USA
| | | | - Aaron Miller
- Mount Sinai Hospital, 5 East 98th Street, 1st Floor, New York, NY, 10029, USA
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Alroughani R, Deleu D, El Salem K, Al-Hashel J, Alexander KJ, Abdelrazek MA, Aljishi A, Alkhaboori J, Al Azri F, Al Zadjali N, Hbahbih M, Sokrab TE, Said M, Rovira À. A regional consensus recommendation on brain atrophy as an outcome measure in multiple sclerosis. BMC Neurol 2016; 16:240. [PMID: 27881095 PMCID: PMC5121973 DOI: 10.1186/s12883-016-0762-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/15/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic autoimmune disease characterized by inflammatory and neurodegenerative processes leading to irreversible neurological impairment. Brain atrophy occurs early in the course of the disease at a rate greater than the general population. Brain volume loss (BVL) is associated with disability progression and cognitive impairment in patients with MS; hence its value as a potential target in monitoring and treating MS is discussed. METHODS A group of MS neurologists and neuro-radiologists reviewed the current literature on brain atrophy and discussed the challenges in assessing and implementing brain atrophy measurements in clinical practice. The panel used a voting system to reach a consensus and the votes were counted for the proposed set of questions for cognitive and brain atrophy assessments. RESULTS The panel of experts was able to identify recent studies, which demonstrated the correlation between BVL and future worsening of disability and cognition. The current evidence revealed that reduction of BVL could be achieved with different disease-modifying therapies (DMTs). BVL provided a better treatment and monitoring strategy when it is combined to the composite measures of "no evidence of disease activity" (NEDA). The panel recommended a set of cognitive assessment tools and MRI methods and software applications that may help in capturing and measuring the underlying MS pathology with high degree of specificity. CONCLUSION BVL was considered to be a useful measurement to longitudinally assess disease progression and cognitive function in patients with MS. Brain atrophy measurement was recommended to be incorporated into the concept of NEDA. Consequently, a consensus recommendation was reached in anticipation for implementation of the use of cognitive assessment and brain atrophy measurements on a regional level.
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Affiliation(s)
- Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait.
- Neurology Clinic, Dasman Diabetes Institute, Dasman, Kuwait.
| | - Dirk Deleu
- Division of Neurology (Neuroscience Institute), Hamad General Hospital, Doha, Qatar
| | - Khalid El Salem
- Department of Neurology, Jordan University of Science and Technology, King Abdullah University Hospital, Irbid, Jordan
| | - Jasem Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait City, Kuwait
| | | | | | - Adel Aljishi
- Department of Neurology, Salmaniya Hospital & AGU, Manama, Bahrain
| | | | - Faisal Al Azri
- Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | | | - Tag Eldin Sokrab
- Division of Neurology (Neuroscience Institute), Hamad General Center, Doha, Qatar
| | - Mohamed Said
- Medical Manger-Gulf Countries, Novartis pharmaceuticals, Dubai, United Arab Emirates
| | - Àlex Rovira
- Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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von Gumberz J, Mahmoudi M, Young K, Schippling S, Martin R, Heesen C, Siemonsen S, Stellmann JP. Short-term MRI measurements as predictors of EDSS progression in relapsing-remitting multiple sclerosis: grey matter atrophy but not lesions are predictive in a real-life setting. PeerJ 2016; 4:e2442. [PMID: 27688965 PMCID: PMC5036070 DOI: 10.7717/peerj.2442] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 08/13/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the best biomarker of inflammatory disease activity in relapsing remitting Multiple Sclerosis (RRMS) so far but the association with disability is weak. Appearance of new MRI-lesions is used to evaluate response to immunotherapies in individual patients as well as being the most common primary outcome in phase-2 trials. Measurements of brain atrophy show promising outcomes in natural cohort studies and some phase-2 trials. From a theoretical perspective they might represent irreversible neurodegeneration and be more closely associated with disability. However, these atrophy measurements are not yet established as prognostic factors in real-life clinical routine. High field MRI has improved image quality and resolution and new methods to measure atrophy dynamics have become available. OBJECTIVE To investigate the predictive value of MRI classification criteria in to high/low atrophy and inflammation groups, and to explore predictive capacity of two consecutive routine MRI scans for disability progression in RRMS in a real-life prospective cohort. METHODS 82 RRMS-patients (40 untreated, 42 treated with immunotherapies, mean age 40 years, median Expanded Disability Status Scale (EDSS) of 2, underwent two clinically indicated MRI scans (3 Tesla) within 5-14 months, and EDSS assessment after a mean of 3.0 (1.5-4.2) years. We investigated the predictive value of predefined classifications in low/high inflammatory and atrophy groups for EDSS progression (≥1.5 if baseline EDSS = 0, ≥1.0 if baseline EDSS <5, ≥0.5 for other) by chi-square tests and by analysis of variance (ANOVA). The classifications were based on current scientific or clinical recommendation (e.g., treatment response criteria). Brain atrophy was assessed with three different methods (SIENA, SIENAX, and FreeSurfer). Post-hoc analyses aimed to explore clinical data and dynamics of MRI outcomes as predictors in multivariate linear and logit models. RESULTS Progression was observed in 24% of patients and was independent from treatment status. None of the predefined classifications were predictive for progression. Explorative post-hoc analyses found lower baseline EDSS and higher grey matter atrophy (FreeSurfer) as best predictors (R (2) = 0.29) for EDSS progression and the accuracy was overall good (Area under the curve = 0.81). CONCLUSION Beside EDSS at baseline, short-term grey matter atrophy is predictive for EDSS progression in treated and untreated RRMS. The development of atrophy measurements for individual risk counselling and evaluation of treatment response seems possible, but needs further validation in larger cohorts. MRI-atrophy estimates from the FreeSurfer toolbox seem to be more reliable than older methods.
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Affiliation(s)
- Johanna von Gumberz
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mina Mahmoudi
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kim Young
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Roland Martin
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Christoph Heesen
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Siemonsen
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Čierny D, Michalik J, Škereňová M, Kantorová E, Sivák Š, Javor J, Kurča E, Dobrota D, Lehotský J. ApaI, BsmI and TaqI VDR gene polymorphisms in association with multiple sclerosis in Slovaks. Neurol Res 2016; 38:678-84. [PMID: 27338176 DOI: 10.1080/01616412.2016.1200287] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 12/21/2022]
Abstract
OBJECTIVE Vitamin D acts through vitamin D receptor (VDR) and has promising beneficial effects in the development and progression of multiple sclerosis (MS). The purpose of our study was to investigate the possible association of the VDR gene polymorphisms ApaI, BsmI and TaqI with the MS susceptibility and with the rate of disease disability progression in the Central European Slovak population. METHODS The allele and genotype variants of ApaI, TaqI and BsmI VDR gene polymorphisms were analysed in 270 clinically diagnosed MS patients and 303 healthy controls. Genotyping was performed by polymerase chain reaction and restriction analysis. Patients were stratified by the rate of disease disability progression using MSSS scores. RESULTS By logistic regression analysis, we revealed that genotype BB (AA) of BsmI VDR gene polymorphism is decreasing the risk of MS (BB (AA) vs Bb (AG) + bb (GG); OR = 0.59, 95% CI = 0.39-0.90, plog = 0.014). We did not identify any association of ApaI and TaqI polymorphisms neither with MS development nor with the disease progression. DISCUSSION We showed for the first time that BsmI genotype BB (AA) is associated with the decreased susceptibility to MS in Slovak population. We propose the BsmI gene polymorphism to be one of the important genetic markers in evaluation of the risk of MS. However, our data suggest that VDR gene polymorphisms ApaI, BsmI and TaqI are not useful in the prediction of disease disability progression rate in MS in Slovaks.
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Affiliation(s)
- Daniel Čierny
- a Department of Clinical Biochemistry, Jessenius Faculty of Medicine , Comenius University in Bratislava and University Hospital Martin , Martin , Slovak Republic
| | - Jozef Michalik
- c Department of Neurology, Jessenius Faculty of Medicine , Comenius University in Bratislava and University Hospital Martin , Martin , Slovak Republic
| | - Mária Škereňová
- a Department of Clinical Biochemistry, Jessenius Faculty of Medicine , Comenius University in Bratislava and University Hospital Martin , Martin , Slovak Republic
| | - Ema Kantorová
- c Department of Neurology, Jessenius Faculty of Medicine , Comenius University in Bratislava and University Hospital Martin , Martin , Slovak Republic
| | - Štefan Sivák
- c Department of Neurology, Jessenius Faculty of Medicine , Comenius University in Bratislava and University Hospital Martin , Martin , Slovak Republic
| | - Juraj Javor
- d Institute of Immunology, Faculty of Medicine , Comenius University in Bratislava , Bratislava , Slovakia
| | - Egon Kurča
- c Department of Neurology, Jessenius Faculty of Medicine , Comenius University in Bratislava and University Hospital Martin , Martin , Slovak Republic
| | - Dušan Dobrota
- b Department of Medical Biochemistry and BioMed, Jessenius Faculty of Medicine in Martin , Comenius University in Bratislava , Martin , Slovak Republic
| | - Ján Lehotský
- b Department of Medical Biochemistry and BioMed, Jessenius Faculty of Medicine in Martin , Comenius University in Bratislava , Martin , Slovak Republic
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Fogarty E, Schmitz S, Tubridy N, Walsh C, Barry M. Comparative efficacy of disease-modifying therapies for patients with relapsing remitting multiple sclerosis: Systematic review and network meta-analysis. Mult Scler Relat Disord 2016; 9:23-30. [PMID: 27645339 DOI: 10.1016/j.msard.2016.06.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [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: 04/24/2015] [Revised: 04/29/2016] [Accepted: 06/07/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Randomised studies have demonstrated efficacy of disease-modifying therapies in relapsing remitting multiple sclerosis (RRMS). However it is unclear how the magnitude of treatment efficacy varies across all currently available therapies. OBJECTIVE To perform a systematic review and network meta-analysis to evaluate the comparative efficacy of available therapies in reducing relapses and disability progression in RRMS. METHODS A systematic review identified 28 randomised, placebo-controlled and direct comparative trials. A network meta-analysis was conducted within a Bayesian framework to estimate comparative annualised relapse rates (ARR) and risks of disability progression (defined by both a 3-month, and 6-month confirmation interval). Potential sources of treatment-effect modification from study-level covariates and baseline risk were evaluated through meta-regression methods. The Surface Under the Cumulative RAnking curve (SUCRA) method was used to provide a ranking of treatments for each outcome. RESULTS The magnitude of ARR reduction varied between 15-36% for all interferon-beta products, glatiramer acetate and teriflunomide, and from 50 to 69% for alemtuzumab, dimethyl fumarate, fingolimod and natalizumab. The risk of disability progression (3-month) was reduced by 19-28% with interferon-beta products, glatiramer acetate, fingolimod and teriflunomide, by 38-45% for pegylated interferon-beta, dimethyl fumarate and natalizumab and by 68% with alemtuzumab. Broadly similar estimates for the risk of disability progression (6-month), with the exception of interferon-beta-1b 250mcg which was much more efficacious based on this definition. Alemtuzumab and natalizumab had the highest SUCRA scores (97% and 95% respectively) for ARR, while ranking for disability progression varied depending on the definition of the outcome. Interferon-beta-1b 250mcg ranked among the most efficacious treatments for disability progression confirmed after six months (92%) and among the least efficacious when the outcome was confirmed after three months (30%). No significant modification of relative treatment effects was identified from study-level covariates or baseline risk. CONCLUSION Compared with placebo, clear reductions in ARR with disease-modifying therapies were accompanied by more uncertain changes in disability progression. The magnitude of the reduction and the uncertainty associated with treatment effects varied between DMTs. While natalizumab and alemtuzumab demonstrated consistently high ranking across outcomes, with older interferon-beta and glatiramer acetate products ranking lowest, variation in disability progression definitions lead to variation in the relative ranking of treatments. Rigorously conducted comparative studies are required to fully evaluate the comparative treatment effects of disease modifying therapies for RRMS.
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Affiliation(s)
- Emer Fogarty
- National Centre for Pharmacoeconomics, Dublin, Ireland.
| | - Susanne Schmitz
- Health Economics and Evidence Synthesis Research Unit, Department of Population Health, Luxembourg Institute of Health, Luxembourg
| | - Niall Tubridy
- Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Ireland
| | - Michael Barry
- National Centre for Pharmacoeconomics, Dublin, Ireland
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Liu Y, Morgan C, Hornung L, Tyry T, Salter AR, Agashivala N, Belletti DA, Kim E, Fox RJ, Cofield SS, Cutter GR. Relationship between symptom change, relapse activity and disability progression in multiple sclerosis. J Neurol Sci 2016; 362:121-6. [PMID: 26944131 DOI: 10.1016/j.jns.2016.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 01/01/2016] [Accepted: 01/18/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Symptom changes may serve as a risk factor for relapse activity (RA) and disability progression (DP), which could facilitate multiple sclerosis (MS) treatment decisions. OBJECTIVE To assess the relationship of symptom change with RA and DP. METHODS We evaluated the relationship of symptom change with subsequent RA and DP using NARCOMS registry data reported over a five-year period. Symptom change was evaluated using both symptom worsening (SW) and average of Performance Scales (APS) scores. Disability progression was defined as a one-point or more increase in Patient-Determined Disease Steps (PDDS) score between two consecutive updates. Repeated measures logistic regression was used to investigate the relationship between symptom change and RA and DP. RESULTS SW and APS were both significant predictors of subsequent RA and DP. Both SW and APS have a significant interaction with levels of disability (Mildly Impaired versus Highly Impaired) for the prediction of the subsequent RA or DP. For Mildly Impaired MS subjects, both SW and APS were significant predictors of both RA and DP. However, for Highly Impaired MS subjects, SW did not significantly predict future RA and neither SW nor APS predicted disability progression. CONCLUSION Changes in self-reported overall symptomatology may precede and predict clinical relapse and future disability progression. The predictive power of symptom changes may only be present at lower levels of disability.
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Signori A, Gallo F, Bovis F, Di Tullio N, Maietta I, Sormani MP. Long-term impact of interferon or Glatiramer acetate in multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord 2016; 6:57-63. [PMID: 27063624 DOI: 10.1016/j.msard.2016.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/20/2016] [Accepted: 01/29/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND In recent years the impact of disease-modifying drugs on long-term progression in multiple sclerosis (MS) was assessed both in observational studies and in extension of randomized controlled trial (RCT). Aim of this work was to quantitatively summarize by a meta-analysis the long-term impact of immunomodulatory drugs (Interferon-Beta (IFN-β) or Glatiramer Acetate (GA)) in relapsing-remitting (RR) MS patients. METHODS We collected all published observational studies reporting the long-term efficacy of IFN-β or GA in RRMS patients. The primary outcome was the treatment effect on progression to a sustained EDSS score of 6 or to the Secondary Progressive (SP) phase. A non-parametric approach was adopted to test the overall treatment effect significance, while a random effect model was used to obtain a pooled quantitative estimate of the treatment benefit, in terms of hazard-ratios (HR) or Relative Risks, with their 95% confidence interval (CI). RESULTS Fourteen studies, on a total of 13,238 RRMS patients, were included in the meta-analysis. All studies but two reported a consistent effect of immunomodulatory treatment on long-term disease progression; the pooled effect on progression to EDSS 6 or SP was significant (p<0.01) when tested by the non-parametric test. The quantitative estimate of the treatment effect in reducing progression to EDSS 6 in the subset of studies reporting this outcome was HRpooled=0.49 (95% CI: 0.34-0.69), p<0.001. CONCLUSIONS Treatment with immunomodulators seems to reduce long-term probability of disability progression. Additional well-designed observational studies could help to confirm these findings.
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Affiliation(s)
- Alessio Signori
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Fabio Gallo
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Francesca Bovis
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicolò Di Tullio
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Ilaria Maietta
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy.
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Jeffery DR, Di Cantogno EV, Ritter S, Meier DP, Radue EW, Camu W. The relationship between the rate of brain volume loss during first 24 months and disability progression over 24 and 48 months in relapsing MS. J Neurol 2015; 263:299-305. [PMID: 26568562 DOI: 10.1007/s00415-015-7959-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 08/05/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 11/30/2022]
Abstract
Clinical evidence in patients with relapsing-remitting multiple sclerosis suggests an association between MRI outcome measures and disability progression (DP). Post hoc analysis to investigate the association and potential predictive value of brain volume loss (BVL) with long-term DP in FREEDOMS. Patients were categorized into quartiles by SIENA-calculated percent brain volume change from baseline to month (M) 24. Patient characteristics at baseline were determined for each quartile, as were the proportions of patients at M24 and M48 reaching Expanded Disability Status Scale (EDSS) scores of ≥4.0 or ≥6.0 or DP confirmed at 3 months (CDP3) or 6 months (CDP6), and change in EDSS and Multiple Sclerosis Functional Composite. MS disease activity and severity as well as brain volume at baseline were predictive of subsequent BVL over 24 months. The quartiles of patients with greater BVL at 24 months were at highest risk (odds ratio, p value) for reaching EDSS ≥4 (2.8, p = 0.001) or ≥6 (5.73, p = 0.0005) and experienced more DP at M24 (CDP3 2.13, p = 0.002; CDP6 2.17, p = 0.003) and M48 (CDP3 1.98, p = 0.006; CDP6 1.87, p = 0.018) compared to the quartile of patients with the least amount of BVL. These findings confirm the clinical relevance of early brain volume changes for long-term DP.
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Affiliation(s)
| | | | - Shannon Ritter
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Ernst-Wilhelm Radue
- Medical Image Analysis Centre, University Hospital Basel, Basel, Switzerland
| | - William Camu
- Neurology Department, Hôpital Gui de Chauliac, Montpellier, France
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Gilli F, Li L, Campbell SJ, Anthony DC, Pachner AR. The effect of B-cell depletion in the Theiler's model of multiple sclerosis. J Neurol Sci 2015; 359:40-7. [PMID: 26671084 DOI: 10.1016/j.jns.2015.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/22/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
Abstract
B cell depletion (BCD) is being considered as a treatment for multiple sclerosis (MS), but there are many uncertainties surrounding the use of this therapy, such as its potential effect in individuals with concurrent viral infections. We sought to discover what effect BCD, induced by an anti-CD20 monoclonal antibody, would have on Theiler's murine encephalomyelitis virus-induced demyelinating disease (TMEV-IDD). Mice were injected with the anti-CD20 monoclonal antibody 5D2, 14 days before or 14 days after infection with TMEV. Efficacy of depletion of B cells was assessed by flow cytometry of CD19(+) cells. Mouse disability was measured by Rotarod, viral load was measured by real time PCR for TMEV RNA. Binding and neutralizing antibody levels were determined in sera and CSF by ELISA, and in CNS by real time PCR for IgG RNA. Inflammation, microglial activation, axonal damage and demyelination were assessed using immunohistochemistry. 5D2-induced BCD was confirmed by demonstration of nearly absent CD19(+) cells in the blood and lymphoid tissue. Systemic and CNS antibody responses were suppressed during 5D2 treatment. Higher viral loads were detected in 5D2-treated mice than in controls, and the viral levels correlated negatively with IgG production in the brain. Overall, 5D2 caused worsening of the early encephalitis and faster progression of disability, as well as exacerbation of the pathology of TMEV-IDD at the end stage of the disease. These data indicate that BCD in humans might worsen CNS viral infections and might not improve disability accrual in MS.
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Affiliation(s)
- Francesca Gilli
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Libin Li
- Department of Neurology, University of Medicine and Dentistry-New Jersey Medical School, Newark, NJ, USA
| | - Sandra J Campbell
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Daniel C Anthony
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Andrew R Pachner
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Neurology, University of Medicine and Dentistry-New Jersey Medical School, Newark, NJ, USA
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Fissolo N, Cantó E, Vidal-Jordana A, Castilló J, Montalban X, Comabella M. Levels of soluble TNF-RII are increased in serum of patients with primary progressive multiple sclerosis. J Neuroimmunol 2014; 271:56-9. [PMID: 24794503 DOI: 10.1016/j.jneuroim.2014.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/03/2014] [Accepted: 04/08/2014] [Indexed: 11/20/2022]
Abstract
The levels of soluble tumor necrosis factor receptor II (sTNF-RII) were determined in serum of 161 untreated multiple sclerosis (MS) patients with different clinical forms and 46 healthy controls (HC) by ELISA. Our results show that serum sTNF-RII levels were significantly increased in patients with primary progressive MS (PPMS) compared with other MS forms and HC. Although sTNF-RII levels significantly increased over a 2-year follow-up period in a subgroup of PPMS patients, they could not discriminate between patients with and without disability progression. Additional studies are needed to further implicate sTNF-RII in patients with PPMS.
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