Progression of a series of patients with relapsing-remitting multiple sclerosis treated for 7 years with natalizumab using the "no evidence of disease activity" parameter

INTRODUCTION

The safety and effectiveness of natalizumab in patients with relapsing-remitting multiple sclerosis (RRMS) has been demonstrated in clinical trials. However, due to the limitations of these trials, it is important to know how the condition behaves under long-term clinical practice conditions.

OBJECTIVE

To determine the long-term effectiveness of natalizumab in patients with RRMS by means of annual evaluation of the "no evidence of disease activity" (NEDA) parameter, which includes number of relapses, disability (measured with the Expanded Disability Status Scale), and brain MRI parameters.

PATIENTS AND METHODS

We performed a retrospective study of patients with RRMS from 3 centres who were treated with one or more doses of natalizumab. Each year, we evaluated NEDA status and safety based on the percentage of patients who discontinued treatment with natalizumab and experienced adverse reactions.

RESULTS

The study included 89 patients, most of whom received treatment for 2 to 4 years, with a follow-up period of up to 7 years. Natalizumab significantly reduces the radiological and clinical progression of the disease, as well as the annual rate of relapses. The NEDA parameter demonstrates the effectiveness of the drug, with values of 75.28% for year one and 66.67% for year 7. Twenty-five patients (28.1%) dropped out after a median of 4 years. Fourteen of these patients (56%) dropped out due to the appearance of anti-JC virus antibodies, either in isolation or associated with another cause. Four dropouts (16%) were due to treatment ineffectiveness, with one patient dying due to progressive multifocal leukoencephalopathy.

CONCLUSIONS

Natalizumab is highly effective as measured by the NEDA long-term remission parameter.

[Sleep and women]

INTRODUCTION

There is a strong link between female sex hormones and sleep. This implies the existence of sex differences both in the structure of sleep as in the incidence of various sleep disorders.

AIM

To review the changes in the pattern of sleep experienced by women along different stages of their life cycle (fertile period, menstruation, pregnancy, menopause and postmenopause), as well as the most frequent sleeping pathologies in which there exist more gender differences (insomnia, obstructive sleep apnea syndrome, restless legs syndrome and narcolepsy).

DEVELOPMENT

About normal sleeping has been reported a higher quality of it, in women compared with men (increased sleeping time, reduced sleep onset latency, and a greater efficiency of sleeping), but they frequently complain of sleep problems. Moreover, different stages in the life of women are associated with significant physiological and hormonal changes that favour the disruption of normal sleep pattern and by this way, possibly, increase risk to suffer sleep disorders.

CONCLUSIONS

The reasons that underlie in gender differences in sleeping disorders are attributed to differences in normal sleep pattern, in the clinical manifestations and risk factors for sleep disorders, and in the results and optimal dose of treatments.

[A case-control study of the influence of the smoking behaviour in multiple sclerosis]

INTRODUCTION

Several epidemiological studies have demonstrated that there is a genetic factor of susceptibility in Multiple Sclerosis (MS) and that the environmental factors play an important important role in their development. Smoking is among the environment factors studied. In fact, several studies have established a relationship between smoking and multiple sclerosis, although most of them did not find significant results or found that these were contradictory.

OBJECTIVE

To evaluate the influence of the smoking habit on the risk of suffering MS.

METHODS

This was a case-control matched study with 138 patients diagnosed of MS according to the McDonald criteria who were paired with the same number of controls of the same gender, residents in the same city and having the same age +/-2 years. Demographic data, smoking status (never, always smokers, ex-smokers), Kurtzke disability status scale (EDSS) and type of MS were collected.

RESULTS

Out of a total of 138 MS patients (93 women, 43 men), 110 had relapsing-remitting MS, 20 secondary progressive MS and 7 primary progressive MS. Most of the patients were smokers and ex-smokers (63%). In the control group, only the 41,3% were smokers/ex-smokers. Moreover, the age of onset for smoking was earlier in the case group.

CONCLUSION

Being a smoker/ex-smoker implies a 27% greater risk of developing MS compared to those who have never smoked. This risk is statistically significant for women but not for men due to the low number of them in the sample.