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van Munster CE, Jessica B, Steinheimer S, Kamm CP, D’Souza M, Diederich M, Dorn J, Walsh L, Dahlke F, Kappos L, Uitdehaag BM. Assessment of Multiple Aspects of Upper Extremity Function Independent From Ambulation in Patients With Multiple Sclerosis. Int J MS Care 2023; 25:226-232. [PMID: 37720262 PMCID: PMC10503816 DOI: 10.7224/1537-2073.2021-069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Upper extremity function (UEF) is often compromised in multiple sclerosis (MS), although its importance is regularly underrecognized relative to ambulation. We explored the concurrent presence of impairment in UEF and ambulation by examining various aspects of UEF across different levels of ambulation. METHODS The cohort consisted of 247 patients with clinically definite MS or clinically isolated syndrome according to the revised 2010 McDonald criteria. The Nine-Hole Peg Test and the Expanded Disability Status Scale were used to stratify patients into clinically different subgroups. For UEF, cerebellar function (finger-to-nose test), pyramidal function (pronator drift test), and the ability to perform a task of activities of daily living (drinking-from-cup test) were examined. Patient-reported limitations of UEF in daily life were assessed using the Arm Function in Multiple Sclerosis Questionnaire. RESULTS Patients in more severely impaired ambulation groups displayed poorer performance on all UEF measures. Although most patients had normal to mild (n = 147) or moderate (n = 46) ambulatory impairment, 87.7% exhibited some level of UEF impairment as defined using the Nine-Hole Peg Test. Most patients had mild UEF impairment (n = 174), accounting for the largest proportion in all ambulation groups (51.9%-77.8%). CONCLUSIONS A distinct pattern of impairment was found for ambulation and multiple aspects of UEF. Independent assessment of multiple aspects of disability may be helpful in treatment decision-making and could support the development of rehabilitation strategies that specifically target UEF impairment.
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Affiliation(s)
- Caspar E.P. van Munster
- From the Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, the Netherlands (CEPvM, JB, BMJU)
| | - Burggraaff Jessica
- From the Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, the Netherlands (CEPvM, JB, BMJU)
| | - Saskia Steinheimer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland (SS, CPK)
| | - Christian P. Kamm
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland (SS, CPK)
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland (CPK)
| | - Marcus D’Souza
- Neurology, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital Basel, Basel, Switzerland (MD’S, MD, LK)
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany (MD’S)
| | - Manuela Diederich
- Neurology, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital Basel, Basel, Switzerland (MD’S, MD, LK)
| | - Jonas Dorn
- Novartis Pharma AG, Basel, Switzerland (JD, LW, FD)
| | - Lorcan Walsh
- Novartis Pharma AG, Basel, Switzerland (JD, LW, FD)
| | - Frank Dahlke
- Novartis Pharma AG, Basel, Switzerland (JD, LW, FD)
| | - Ludwig Kappos
- Neurology, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital Basel, Basel, Switzerland (MD’S, MD, LK)
| | - Bernard M.J. Uitdehaag
- From the Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, the Netherlands (CEPvM, JB, BMJU)
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Hach T, Shakeri-Nejad K, Bigaud M, Dahlke F, de Micco M, Petricoul O, Graham G, Piani-Meier D, Turrini R, Brinkmann V, Nicoletti F. Rationale for Use of Sphingosine-1-Phosphate Receptor Modulators in COVID-19 Patients: Overview of Scientific Evidence. J Interferon Cytokine Res 2022. [DOI: 10.1089/jir.2022.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Thomas Hach
- Patient Engagement, Novartis Pharma AG, Basel, Switzerland
| | - Kasra Shakeri-Nejad
- Department of Clinical Pharmacology; Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Marc Bigaud
- Department of Autoimmunity, Transplantation & Inflammation; Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Frank Dahlke
- Patient Engagement, Novartis Pharma AG, Basel, Switzerland
| | | | - Olivier Petricoul
- Department of Neuroscience; Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Gordon Graham
- Patient Engagement, Novartis Pharma AG, Basel, Switzerland
| | | | - Renato Turrini
- Department of Autoimmunity, Transplantation & Inflammation; Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | - Ferdinando Nicoletti
- Department of Physiology and Pharmacology, University Sapienza of Rome, Rome, Italy
- Department of Molecular Neuropharmacology, IRCCS Neuromed, Pozzilli, Italy
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Leppert D, Kropshofer H, Häring D, Dahlke F, Patil A, Meinert R, Tomic D, Kappos L, Kuhle J. Author Response: Blood Neurofilament Light in Progressive Multiple Sclerosis: Post Hoc Analysis of 2 Randomized Controlled Trials. Neurology 2022; 99:631. [PMID: 36192181 DOI: 10.1212/wnl.0000000000201277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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4
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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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Lam KH, van Munster CE, D’Souza M, Steinheimer S, Kamm CP, Burggraaff J, Johnson M, Zaykov Y, Dorn J, Dahlke F, Kappos L, Killestein J, Uitdehaag B. Improving Detection of Change in Motor Functioning in Multiple Sclerosis Using Video-Assisted Composite Measures. Int J MS Care 2022; 24:230-234. [DOI: 10.7224/1537-2073.2021-044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Abstract
Background:
Assessing motor functioning is important to monitor the disease course of multiple sclerosis (MS). Video-assisted rating of classic neurologic tests and activities of daily living may improve the detection of changes in motor functioning. We investigated the value of using video-assisted composite measures for the detection of changes in mobility and upper extremity function (UEF).
Methods:
Forty-three patients with MS were recorded performing motor function tests before and during treatment with fampridine. Patients were classified as improved or not improved on mobility composite (MOB-COM) and UEF composite (UEF-COM) measures based on neurologists’ ratings of the tests. The proportional agreements between the composite measures and the conventional measures—the Timed 25-Foot Walk test (T25FW) and the Nine-Hole Peg Test (NHPT)—were determined and compared with patient-perceived improvement, which was determined using patient-reported ratings of changes in mobility and UEF.
Results:
Agreement between MOB-COM and T25FW was 79.5%, and agreement between UEF-COM and NHPT was 82.1%. Twenty-six of 39 patients (66.7%) reported mobility improvement; 6 of these reports were confirmed by both T25FW and MOB-COM, 4 were confirmed by T25FW only, and 2 were confirmed by MOB-COM only. For UEF, 13 of 39 patients (33.3%) reported improvement; 3 of these were confirmed by the NHPT and 3 were confirmed by the UEF-COM.
Conclusions:
Compared with the conventional NHPT measure, the video-assisted composite measure of UEF detected additional patient-perceived improvement. This was less evident for mobility measures. Video-assisted composite measures may enhance the detection of treatment effects in MS clinical practice and trials.
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Affiliation(s)
- Ka-Hoo Lam
- From the Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K-HL, CEPvM, JB, JK, BU)
| | - Caspar E.P. van Munster
- From the Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K-HL, CEPvM, JB, JK, BU)
| | - Marcus D’Souza
- Neurologic Clinic and Polyclinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland (MD, LK)
| | - Saskia Steinheimer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland (SS, CPK)
| | - Christian P. Kamm
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland (SS, CPK)
- Department of Neurology, Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland (CPK)
| | - Jessica Burggraaff
- From the Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K-HL, CEPvM, JB, JK, BU)
| | | | | | - Jonas Dorn
- Novartis Pharma AG, Basel, Switzerland (JD, FD)
| | | | - Ludwig Kappos
- Neurologic Clinic and Polyclinic, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland (MD, LK)
| | - Joep Killestein
- From the Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K-HL, CEPvM, JB, JK, BU)
| | - Bernard Uitdehaag
- From the Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (K-HL, CEPvM, JB, JK, BU)
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Leppert D, Kropshofer H, Häring DAA, Dahlke F, Patil A, Meinert R, Tomic D, Kappos L, Kuhle J. Blood Neurofilament Light in Progressive Multiple Sclerosis: Post Hoc Analysis of 2 Randomized Controlled Trials. Neurology 2022; 98:e2120-e2131. [PMID: 35379762 DOI: 10.1212/wnl.0000000000200258] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 02/04/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the potential of plasma neurofilament light (pNfL) as a biomarker of disease progression and treatment response in progressive multiple sclerosis (PMS) with and without acute disease activity. METHODS Post hoc blinded analysis of pNfL levels in two placebo-controlled, phase 3 studies in secondary progressive MS (SPMS; EXPAND) and primary progressive MS (PPMS; INFORMS) using siponimod and fingolimod, respectively, as active compounds. pNfL levels were quantified using a single molecule array ("Homebrew" Simoa) immunoassay from stored EDTA plasma samples of all patients who consented for exploratory biomarker analysis in either study; pNfL levels were divided into high (≥30 pg/mL) and low (<30 pg/mL) at baseline (BL). We investigated the association of pNfL levels with disability progression, cognitive decline and brain atrophy, and their sensitivity to indicate treatment response vis-à-vis clinical measures. RESULTS We analyzed pNfL in 4185 samples from 1452 SPMS patients and 1172 samples from 378 PPMS patients. BL pNfL levels were higher in SPMS (geomean 32.1pg/mL) than in PPMS (22.0pg/mL; p<0.0001) patients. In both studies, higher BL pNfL levels were associated with older age, higher EDSS score, more Gd+ lesions, and higher T2 lesion load (all p<0.05). Independent of treatment, high versus low BL pNfL levels were associated with significantly higher risks of confirmed 3-month (SPMS [32%], HR [95%CI]: 1.32 [1.09;1.61]; PPMS [49%], 1.49 [1.05;2.12]) and 6-month disability progression (SPMS [26%], 1.26 [1.01;1.57]; PPMS [48%], 1.48 [1.01;2.17]), earlier wheelchair dependence (SPMS [50%], 1.50 [0.96;2.34]; PPMS [197%], 2.97 [1.44;6.10]), cognitive decline (SPMS [41%], 1.41 [1.09;1.84]) and higher rates of brain atrophy (mean change at month [M]24: SPMS, -0.92; PPMS, -1.39). BL pNfL levels were associated with future disability progression and the degree of brain atrophy regardless of presence or absence of acute disease activity (gadolinium-enhancing lesions or recent occurrence of relapses before BL). pNfL levels were lower in patients treated with siponimod or fingolimod versus placebo-treated patients and higher in those having experienced disability progression. CONCLUSION pNfL was associated with future clinical and radiological disability progression features at the group level. pNfL was reduced by treatment and may be a meaningful outcome measure in PMS studies.
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Affiliation(s)
- David Leppert
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital and 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 and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital and University of Basel, Basel, Switzerland
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Arnold DL, Piani-Meier D, Bar-Or A, Benedict RH, Cree BA, Giovannoni G, Gold R, Vermersch P, Arnould S, Dahlke F, Hach T, Ritter S, Karlsson G, Kappos L, Fox RJ. Effect of siponimod on magnetic resonance imaging measures of neurodegeneration and myelination in secondary progressive multiple sclerosis: Gray matter atrophy and magnetization transfer ratio analyses from the EXPAND phase 3 trial. Mult Scler 2022; 28:1526-1540. [PMID: 35261318 PMCID: PMC9315182 DOI: 10.1177/13524585221076717] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) measurements of gray matter (GM) atrophy and magnetization transfer ratio (MTR; correlate of myelination) may provide better insights than conventional MRI regarding brain tissue integrity/myelination in multiple sclerosis (MS). OBJECTIVE To examine the effect of siponimod in the EXPAND trial on whole-brain and GM atrophy, newly formed normalized magnetization transfer ratio (nMTR) lesions, and nMTR-assessed integrity of normal-appearing brain tissue (NABT), cortical GM (cGM), and normal-appearing white matter (NAWM). METHODS Patients with secondary progressive multiple sclerosis (SPMS) received siponimod (2 mg/day; n =1037) or placebo (n = 523). Endpoints included percentage change from baseline to months 12/24 in whole-brain, cGM, and thalamic volumes; change in nMTR from baseline to months 12/24 in NABT, cGM, and NAWM; MTR recovery in newly formed lesions. RESULTS Compared with placebo, siponimod significantly reduced progression of whole-brain and GM atrophy over 12/24 months, and was associated with improvements in brain tissue integrity/myelination within newly formed nMTR lesions and across NABT, cGM, and NAWM over 24 months. Effects were consistent across age, disease duration, inflammatory activity subgroups, and disease severity. CONCLUSION Siponimod reduced brain tissue damage in patients with SPMS as evidenced by objective measures of brain tissue integrity/myelination. This is consistent with central nervous system (CNS) effects observed in preclinical models. ClinicalTrials.gov number: NCT01665144.
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Affiliation(s)
- Douglas L Arnold
- NeuroRx, Montreal, QC, Canada/Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bruce Ac Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ralf Gold
- Department of Neurology, St Josef-Hospital/Ruhr-University Bochum, Bochum, Germany
| | - Patrick Vermersch
- Univ. Lille, Inserm U1172 LilNCog, CHU Lille, FHU Precise, Lille, France
| | - Sophie Arnould
- Novartis Pharma AG, Basel, Switzerland; *at the time of writing
| | - Frank Dahlke
- Novartis Pharma AG, Basel, Switzerland; *at the time of writing
| | - Thomas Hach
- Novartis Pharma AG, Basel, Switzerland; *at the time of writing
| | - Shannon Ritter
- Novartis Pharma AG, Basel, Switzerland; *at the time of writing
| | - Göril Karlsson
- Novartis Pharma AG, Basel, Switzerland; *at the time of writing
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and MS Center, Departments of Head, Spine and Neuromedicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Robert J Fox
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Lublin FD, Häring DA, Ganjgahi H, Ocampo A, Hatami F, Čuklina J, Aarden P, Dahlke F, Arnold DL, Wiendl H, Chitnis T, Nichols TE, Kieseier BC, Bermel RA. OUP accepted manuscript. Brain 2022; 145:3147-3161. [PMID: 35104840 PMCID: PMC9536294 DOI: 10.1093/brain/awac016] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/01/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with multiple sclerosis acquire disability either through relapse-associated worsening (RAW) or progression independent of relapse activity (PIRA). This study addresses the relative contribution of relapses to disability worsening over the course of the disease, how early progression begins and the extent to which multiple sclerosis therapies delay disability accumulation. Using the Novartis-Oxford multiple sclerosis (NO.MS) data pool spanning all multiple sclerosis phenotypes and paediatric multiple sclerosis, we evaluated ∼200 000 Expanded Disability Status Scale (EDSS) transitions from >27 000 patients with ≤15 years follow-up. We analysed three datasets: (i) A full analysis dataset containing all observational and randomized controlled clinical trials in which disability and relapses were assessed (n = 27 328); (ii) all phase 3 clinical trials (n = 8346); and (iii) all placebo-controlled phase 3 clinical trials (n = 4970). We determined the relative importance of RAW and PIRA, investigated the role of relapses on all-cause disability worsening using Andersen-Gill models and observed the impact of the mechanism of worsening and disease-modifying therapies on the time to reach milestone disability levels using time continuous Markov models. PIRA started early in the disease process, occurred in all phenotypes and became the principal driver of disability accumulation in the progressive phase of the disease. Relapses significantly increased the hazard of all-cause disability worsening events; following a year in which relapses occurred (versus a year without relapses), the hazard increased by 31–48% (all P < 0.001). Pre-existing disability and older age were the principal risk factors for incomplete relapse recovery. For placebo-treated patients with minimal disability (EDSS 1), it took 8.95 years until increased limitation in walking ability (EDSS 4) and 18.48 years to require walking assistance (EDSS 6). Treating patients with disease-modifying therapies delayed these times significantly by 3.51 years (95% confidence limit: 3.19, 3.96) and 3.09 years (2.60, 3.72), respectively. In patients with relapsing-remitting multiple sclerosis, those who worsened exclusively due to RAW events took a similar length of time to reach milestone EDSS values compared with those with PIRA events; the fastest transitions were observed in patients with PIRA and superimposed relapses. Our data confirm that relapses contribute to the accumulation of disability, primarily early in multiple sclerosis. PIRA begins in relapsing-remitting multiple sclerosis and becomes the dominant driver of disability accumulation as the disease evolves. Pre-existing disability and older age are the principal risk factors for further disability accumulation. The use of disease-modifying therapies delays disability accrual by years, with the potential to gain time being highest in the earliest stages of multiple sclerosis.
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Affiliation(s)
- Fred D Lublin
- Correspondence to: Professor Fred D. Lublin The Corinne Goldsmith Dickinson Center for Multiple Sclerosis Icahn School of Medicine at Mount Sinai 5 East 98th Street, Box 1138 New York, NY 10029-6574, USA E-mail:
| | | | - Habib Ganjgahi
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Farhad Hatami
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | | | - Douglas L Arnold
- McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montréal, QC, Canada
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Thomas E Nichols
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Robert A Bermel
- Department of Neurology, Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
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Mallon AM, Häring DA, Dahlke F, Aarden P, Afyouni S, Delbarre D, El Emam K, Ganjgahi H, Gardiner S, Kwok CH, West DM, Straiton E, Haemmerle S, Huffman A, Hofmann T, Kelly LJ, Krusche P, Laramee MC, Lheritier K, Ligozio G, Readie A, Santos L, Nichols TE, Branson J, Holmes C. Advancing data science in drug development through an innovative computational framework for data sharing and statistical analysis. BMC Med Res Methodol 2021; 21:250. [PMID: 34773974 PMCID: PMC8590765 DOI: 10.1186/s12874-021-01409-4] [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: 07/27/2020] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background Novartis and the University of Oxford’s Big Data Institute (BDI) have established a research alliance with the aim to improve health care and drug development by making it more efficient and targeted. Using a combination of the latest statistical machine learning technology with an innovative IT platform developed to manage large volumes of anonymised data from numerous data sources and types we plan to identify novel patterns with clinical relevance which cannot be detected by humans alone to identify phenotypes and early predictors of patient disease activity and progression. Method The collaboration focuses on highly complex autoimmune diseases and develops a computational framework to assemble a research-ready dataset across numerous modalities. For the Multiple Sclerosis (MS) project, the collaboration has anonymised and integrated phase II to phase IV clinical and imaging trial data from ≈35,000 patients across all clinical phenotypes and collected in more than 2200 centres worldwide. For the “IL-17” project, the collaboration has anonymised and integrated clinical and imaging data from over 30 phase II and III Cosentyx clinical trials including more than 15,000 patients, suffering from four autoimmune disorders (Psoriasis, Axial Spondyloarthritis, Psoriatic arthritis (PsA) and Rheumatoid arthritis (RA)). Results A fundamental component of successful data analysis and the collaborative development of novel machine learning methods on these rich data sets has been the construction of a research informatics framework that can capture the data at regular intervals where images could be anonymised and integrated with the de-identified clinical data, quality controlled and compiled into a research-ready relational database which would then be available to multi-disciplinary analysts. The collaborative development from a group of software developers, data wranglers, statisticians, clinicians, and domain scientists across both organisations has been key. This framework is innovative, as it facilitates collaborative data management and makes a complicated clinical trial data set from a pharmaceutical company available to academic researchers who become associated with the project. Conclusions An informatics framework has been developed to capture clinical trial data into a pipeline of anonymisation, quality control, data exploration, and subsequent integration into a database. Establishing this framework has been integral to the development of analytical tools.
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Affiliation(s)
- Ann-Marie Mallon
- MRC Harwell Institute, Harwell Campus, Oxfordshire, OX11 0RD, UK.
| | | | | | | | - Soroosh Afyouni
- Big Data Institute, University of Oxford Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF, UK
| | - Daniel Delbarre
- MRC Harwell Institute, Harwell Campus, Oxfordshire, OX11 0RD, UK
| | - Khaled El Emam
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1J 8 L1, Canada
| | - Habib Ganjgahi
- Department of Statistics, University of Oxford, 24-29 St Giles', OX1 3LB, Oxford, UK
| | - Stephen Gardiner
- MRC Harwell Institute, Harwell Campus, Oxfordshire, OX11 0RD, UK
| | - Chun Hei Kwok
- MRC Harwell Institute, Harwell Campus, Oxfordshire, OX11 0RD, UK
| | - Dominique M West
- MRC Harwell Institute, Harwell Campus, Oxfordshire, OX11 0RD, UK
| | - Ewan Straiton
- MRC Harwell Institute, Harwell Campus, Oxfordshire, OX11 0RD, UK
| | | | - Adam Huffman
- Big Data Institute, University of Oxford Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF, UK
| | | | - Luke J Kelly
- Big Data Institute, University of Oxford Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF, UK.,Department of Statistics, University of Oxford, 24-29 St Giles', OX1 3LB, Oxford, UK
| | | | | | | | | | | | - Luis Santos
- MRC Harwell Institute, Harwell Campus, Oxfordshire, OX11 0RD, UK
| | - Thomas E Nichols
- Big Data Institute, University of Oxford Li Ka Shing Centre for Health Information and Discovery, Old Road Campus, Oxford, OX3 7LF, UK
| | | | - Chris Holmes
- Department of Statistics, University of Oxford, 24-29 St Giles', OX1 3LB, Oxford, UK
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10
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Dahlke F, Arnold DL, Aarden P, Ganjgahi H, Häring DA, Čuklina J, Nichols TE, Gardiner S, Bermel R, Wiendl H. Characterisation of MS phenotypes across the age span using a novel data set integrating 34 clinical trials (NO.MS cohort): Age is a key contributor to presentation. Mult Scler 2021; 27:2062-2076. [PMID: 33507835 PMCID: PMC8564259 DOI: 10.1177/1352458520988637] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 09/20/2020] [Revised: 12/14/2020] [Accepted: 12/24/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Oxford Big Data Institute, multiple sclerosis (MS) physicians and Novartis aim to address unresolved questions in MS with a novel comprehensive clinical trial data set. OBJECTIVE The objective of this study is to describe the Novartis-Oxford MS (NO.MS) data set and to explore the relationships between age, disease activity and disease worsening across MS phenotypes. METHODS We report key characteristics of NO.MS. We modelled MS lesion formation, relapse frequency, brain volume change and disability worsening cross-sectionally, as a function of patients' baseline age, using phase III study data (≈8000 patients). RESULTS NO.MS contains data of ≈35,000 patients (>200,000 brain images from ≈10,000 patients), with >10 years follow-up. (1) Focal disease activity is highest in paediatric patients and decreases with age, (2) brain volume loss is similar across age and phenotypes and (3) the youngest patients have the lowest likelihood (<25%) of disability worsening over 2 years while risk is higher (25%-75%) in older, disabled or progressive MS patients. Young patients benefit most from treatment. CONCLUSION NO.MS will illuminate questions related to MS characterisation, progression and prognosis. Age modulates relapse frequency and, thus, the phenotypic presentation of MS. Disease worsening across all phenotypes is mediated by age and appears to some extent be independent from new focal inflammatory activity.
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Affiliation(s)
| | - Douglas L Arnold
- Brain Imaging Centre, Montreal Neurological
Institute and Hospital, McGill University, Montréal, QC, Canada
| | | | - Habib Ganjgahi
- Oxford Big Data Institute, Li Ka Shing Centre
for Health Information and Discovery, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
| | | | | | - Thomas E Nichols
- Oxford Big Data Institute, Li Ka Shing Centre
for Health Information and Discovery, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
| | | | - Robert Bermel
- Department of Neurology, Mellen MS Center,
Cleveland Clinic, Cleveland, OH, USA
| | - Heinz Wiendl
- Department of Neurology, University Hospital
Münster, Münster, Germany
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11
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Samjoo IA, Worthington E, Haltner A, Spin P, Drudge C, Cameron C, Brennan R, Dahlke F, Adlard N. Indirect comparisons of siponimod with fingolimod and ofatumumab in multiple sclerosis: assessing the feasibility of propensity score matching analyses. Curr Med Res Opin 2021; 37:1933-1944. [PMID: 34384311 DOI: 10.1080/03007995.2021.1968362] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Head-to-head trials comparing siponimod with fingolimod or ofatumumab in patients with multiple sclerosis (MS) are lacking. Instead, the comparative efficacy of siponimod can be derived from indirect treatment comparisons (ITCs). We assessed the suitability of ITCs leveraging individual patient data from relevant phase III trials across different MS phenotypes. METHODS One siponimod trial in patients with secondary progressive MS (SPMS), four fingolimod trials (three in relapsing-remitting MS [RRMS], and one in primary progressive MS [PPMS]), and two ofatumumab trials in relapsing MS (RMS) were considered. The suitability of ITCs was evaluated based on trial design, patient eligibility criteria, baseline patient characteristics, placebo response, and outcome definitions for each trial. Analyses deemed feasible were conducted using one-to-one propensity score matching (PSM). RESULTS An ITC between siponimod in SPMS and either fingolimod in RRMS or ofatumumab in RMS was not feasible because of insufficient overlap in key patient characteristics (e.g. disability level and relapse history) and differences in placebo response. However, a comparison between siponimod in SPMS and fingolimod in PPMS was feasible because of sufficient overlap in eligibility criteria and baseline characteristics. One-to-one PSM demonstrated siponimod was favored relative to fingolimod for time to 6- and 3-month confirmed disability progression though not significantly different (hazard ratio 0.76 [95% confidence interval 0.48-1.20; p-value = .240] and hazard ratio 0.80 [95% confidence interval 0.52-1.22; p-value = .300], respectively). CONCLUSIONS For trials in MS, clinical phenotype is an important determinant of ITC feasibility. An ITC between siponimod in SPMS and either fingolimod in RRMS or ofatumumab in RMS was not feasible. The only feasible comparison was between siponimod in SPMS and fingolimod in PPMS.
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12
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Santos M, Baptista L, Hauptli L, Lima A, Netto D, Dahlke F, Moraes P. Development of baked biscuits containing propolis and pomegranate for oral health in dogs. Anim Feed Sci Technol 2021. [DOI: 10.1016/j.anifeedsci.2021.115056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Langdon DW, Tomic D, Penner IK, Calabrese P, Cutter G, Häring DA, Dahlke F, Kappos L. Baseline characteristics and effects of fingolimod on cognitive performance in patients with relapsing-remitting multiple sclerosis. Eur J Neurol 2021; 28:4135-4145. [PMID: 34431170 PMCID: PMC9292292 DOI: 10.1111/ene.15081] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 11/28/2022]
Abstract
Background and purpose Studies reporting the baseline determinants of cognitive performance and treatment effect on cognition in patients with multiple sclerosis (MS) are limited. We investigated the baseline correlates of cognition and the long‐term treatment effects of fingolimod 0.5 mg once daily on cognitive processing speed and attention in patients with relapsing‐remitting MS. Methods This post hoc analysis pooled data from the phase 3 FREEDOMS and FREEDOMS II trials (N = 1556). We assessed the correlation between baseline patient demographic and disease characteristics and baseline 3‐second Paced Auditory Serial Addition Test (PASAT‐3) scores (Spearman's rank test) and the changes from baseline in PASAT‐3 (mixed model repeated measures model) in the fingolimod and placebo (up to 24 months) or placebo‐fingolimod switched (from Month 24 up to 120 months) groups. Additionally, the predictive value of PASAT‐3 score for future disease outcomes was assessed (Cox or logistic regression models). Results Among the variables assessed, lower PASAT‐3 score at baseline correlated with higher disease burden (total brain volume, T2 lesion volume, and Expanded Disability Status Scale score), longer disease duration and older age (p < 0.0001 for all). Fingolimod significantly improved PASAT‐3 scores from baseline versus placebo at 6 (1.3; p = 0.0007), 12 (1.1; p = 0.0044) and 24 months (1.1; p = 0.0028), with a sustained effect (overall treatment effect p = 0.0012) up to 120 months. Improvements were seen regardless of baseline cognitive status (PASAT quartile). Baseline PASAT‐3 score was predictive of both clinical and magnetic resonance imaging measures of disease activity at Month 24 (p < 0.001 for all). Conclusion Early fingolimod treatment may offer long‐term cognitive benefit in patients with relapsing‐remitting MS.
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Affiliation(s)
- Dawn W Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | | | - Iris-Katharina Penner
- Medical Faculty, Department of Neurology, Heinrich Heine University, Düsseldorf, Germany.,COGITO Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany
| | - Pasquale Calabrese
- Neuropsychology and Behavioral Neurology Unit, Division of Cognitive and Molecular Neuroscience, University of Basel, Switzerland
| | - Gary Cutter
- Department of Biostatistics, University of Alabama, Birmingham, AL, USA
| | | | | | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and MS Center, Neurology, Departments of Head, Spine and Neuromedicine and Clinical Research, University Hospital and University of Basel, Spitalstrasse 2, Basel, Schweiz, 4031, Switzerland
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14
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Pereira GC, Moreno TB, Kuritza LN, Moraes PO, Rocha C, Maiorka A, Dahlke F. Egg Storage Time Affects Incubation Yield and Hatch Window in Pekin Ducks (Anas Boschas). Braz J Poult Sci 2021. [DOI: 10.1590/1806-9061-2020-1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | - TB Moreno
- Federal University of Paraná, Brazil
| | | | - PO Moraes
- Federal University of Santa Catarina, Brazil
| | - C Rocha
- Federal University of Paraná, Brazil
| | - A Maiorka
- Federal University of Paraná, Brazil
| | - F Dahlke
- Federal University of Santa Catarina, Brazil
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15
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Benedict RHB, Tomic D, Cree BA, Fox R, Giovannoni G, Bar-Or A, Gold R, Vermersch P, Pohlmann H, Wright I, Karlsson G, Dahlke F, Wolf C, Kappos L. Siponimod and Cognition in Secondary Progressive Multiple Sclerosis: EXPAND Secondary Analyses. Neurology 2020; 96:e376-e386. [PMID: 33328324 DOI: 10.1212/wnl.0000000000011275] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 08/20/2020] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To investigate the effects of siponimod on cognitive processing speed in patients with secondary progressive (SP) multiple sclerosis (MS), by means of a predefined exploratory and post hoc analysis of the Exploring the Efficacy and Safety of Siponimod in Patients With Secondary Progressive Multiple Sclerosis (EXPAND) study, a randomized controlled trial comparing siponimod and placebo. METHODS EXPAND was a double-blind, placebo-controlled phase 3 trial involving 1,651 patients with SPMS randomized (2:1) to either siponimod 2 mg/d or placebo. Cognitive function was assessed with the Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and Brief Visuospatial Memory Test-Revised (BVMT-R) administered at baseline, 6-month intervals, and end of treatment. RESULTS Between-group differences in mean change from baseline in SDMT scores were significantly better in siponimod- vs placebo-treated patients at month 12 (difference 1.08 [95% confidence interval 0.23-1.94]; p = 0.0132), month 18 (1.23 [0.25-2.21); p = 0.0135), and month 24 (2.30 [1.11-3.50]; p = 0.0002). Siponimod-treated patients were at significantly lower risk for having a 4-point sustained decrease in SDMT score (hazard ratio [HR] 0.79 [0.65-0.96]; p = 0.0157), while their chance for having a 4-point sustained increase in SDMT score was higher (HR 1.28 [1.05-1.55]; p = 0.0131). PASAT and BVMT-R scores did not differ significantly between the 2 treatment groups (all p > 0.28). CONCLUSION Siponimod had a significant benefit on SDMT in patients with SPMS. Siponimod-treated patients were at significantly lower risk for having a ≥4-point decrease in SDMT score and had a significantly higher chance for having a ≥4-point increase in SDMT score, a magnitude of change accepted as clinically meaningful. CLINICALTRIALSGOV IDENTIFIER NCT01665144. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that, for patients with SPMS, siponimod had a significant benefit on cognitive processing speed.
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Affiliation(s)
- Ralph H B Benedict
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland.
| | - Davorka Tomic
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Bruce A Cree
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Robert Fox
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Gavin Giovannoni
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Amit Bar-Or
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Ralf Gold
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Patrick Vermersch
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Harald Pohlmann
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Ian Wright
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Göril Karlsson
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Frank Dahlke
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Christian Wolf
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
| | - Ludwig Kappos
- From the Department of Neurology (R.H.B.B.), University at Buffalo, NY; Novartis Pharma AG (D.T., H.P., G.K., F.D.), Basel, Switzerland; Weill Institute for Neurosciences (B.A.C.), Department of Neurology, University of California San Francisco; Mellen Center for Treatment and Research in Multiple Sclerosis (R.F.), Neurological Institute, Cleveland Clinic, OH; Blizard Institute (GG), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK; Department of Neurology (A.B.-O.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Neurology (R.G.), St. Josef-Hospital/Ruhr-University Bochum, Germany; Department of Neurology (P.V.), University of Lille, INSERM U1172, CHU Lille, FHU Imminent, France; Novartis Ireland Ltd (I.W.), Dublin; Lycalis sprl (C.W.), Brussels, Belgium; and Neurologic Clinic and Policlinic (G.K., L.K.), Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital and University of Basel, Switzerland
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Cree BA, Magnusson B, Rouyrre N, Fox RJ, Giovannoni G, Vermersch P, Bar-Or A, Gold R, Piani Meier D, Karlsson G, Tomic D, Wolf C, Dahlke F, Kappos L. Siponimod: Disentangling disability and relapses in secondary progressive multiple sclerosis. Mult Scler 2020; 27:1564-1576. [PMID: 33205682 PMCID: PMC8414818 DOI: 10.1177/1352458520971819] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In multiple sclerosis, impact of treatment on disability progression can be
confounded if treatment also reduces relapses. Objective: To distinguish siponimod’s direct effects on disability progression from
those on relapses in the EXPAND phase 3 trial. Methods: Three estimands, one based on principal stratum and two on hypothetical
scenarios (no relapses, or equal relapses in both treatment arms), were
defined to determine the extent to which siponimod’s effects on 3- and
6-month confirmed disability progression were independent of on-study
relapses. Results: Principal stratum analysis estimated that siponimod reduced the risk of 3-
and 6-month confirmed disability progression by 14%–20% and 29%–33%,
respectively, compared with placebo in non-relapsing patients. In the
hypothetical scenarios, risk reductions independent of relapses were 14%–18%
and 23% for 3- and 6-month confirmed disability progression,
respectively. Conclusion: By controlling the confounding impact of on-study relapses on confirmed
disability progression, these statistical approaches provide a
methodological framework to assess treatment effects on disability
progression in relapsing and non-relapsing patients. The analyses support
that siponimod may be useful for treating secondary progressive multiple
sclerosis in patients with or without relapses.
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Affiliation(s)
- Bruce Ac Cree
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Robert J Fox
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA/Neuroimmunology Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | | | | | | | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
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Samjoo IA, Worthington E, Haltner A, Cameron C, Nicholas R, Dahlke F, Adlard N. The importance of considering differences in study and patient characteristics before undertaking indirect treatment comparisons: a case study of siponimod for secondary progressive multiple sclerosis. Curr Med Res Opin 2020; 36:1145-1156. [PMID: 32216597 DOI: 10.1080/03007995.2020.1747998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Indirect treatment comparisons (ITCs) provide valuable evidence on comparative efficacy where head-to-head clinical trials do not exist; however, differences in patient populations may introduce bias. Therefore, it is essential to assess between-trial heterogeneity to determine the suitability of synthesizing ITC results. We provide an illustrative case study in multiple sclerosis (MS) where we assess the feasibility of conducting ITCs between siponimod and interferon beta-1b (IFN β-1b) and between siponimod and ocrelizumab.Methods: We assessed the feasibility of conducting ITCs using standard unadjusted methods (e.g. Bucher or network meta-analysis [NMA]) as well as matching-adjusted indirect comparisons (MAICs) using individual patient data (IPD) from the siponimod (EXPAND) trial, based on guidance from NICE. Time to confirmed disability progression (CDP) at 3 or 6 months was assessed.Results: Bucher ITCs and NMAs, which rely on summary-level data, were not able to account for important cross-trial differences. Comparisons between siponimod and IFN β-1b were feasible using MAIC; the HRs (95% CI) for CDP-6 and CDP-3 were 0.55 (0.33-0.91) and 0.82 (0.42-1.63), respectively. ITCs were not feasible between siponimod and ocrelizumab because study designs and patient populations were too dissimilar to conduct a reliable ITC.Conclusions: This study highlights the importance of conducting a detailed feasibility assessment before undertaking ITCs to illuminate when excessive between-trial heterogeneity would cause biased results. MAIC was performed for siponimod and IFN β-1b in the absence of a head-to-head trial and was considered a more valid approach than a traditional ITC to examine comparative effectiveness.
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Samjoo IA, Worthington E, Haltner A, Cameron C, Nicholas R, Rouyrre N, Dahlke F, Adlard N. Matching-adjusted indirect treatment comparison of siponimod and other disease modifying treatments in secondary progressive multiple sclerosis. Curr Med Res Opin 2020; 36:1157-1166. [PMID: 32220214 DOI: 10.1080/03007995.2020.1747999] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Siponimod, interferon beta-1a (IFNβ-1a), IFNβ-1b and natalizumab have been evaluated as treatments for secondary progressive multiple sclerosis (SPMS) in separate randomized controlled trials (RCTs), but not head-to-head. These trials included heterogeneous patient populations, which limits the use of standard network meta-analysis (NMA) for indirect treatment comparison (ITC) of relative efficacy. Matching-adjusted indirect comparison (MAIC) aims to correct these cross-trial differences. We compared siponimod to other disease modifying treatments (DMTs) in SPMS using MAIC.Methods: Individual patient data (IPD) were available for siponimod (EXPAND), while only published summary data were available for IFNβ-1a (Nordic Study, SPECTRIMS, IMPACT), IFNβ-1b (North American Study, European Study) and natalizumab (ASCEND). MAICs were conducted between siponimod and the other DMTs by re-weighting patients in EXPAND based on logistic regression.Results: Siponimod was determined to be statistically significantly more effective for the outcome of time to 6 month confirmed disability progression (CDP) compared with 22 µg IFNβ-1a and 250 µg IFNβ-1b, and for the outcome of time to CDP-3 compared with 60 µg IFNβ-1a. Siponimod was numerically but not statistically superior for CDP in all other comparisons. For annualized relapse rate (ARR), with the exception of natalizumab, siponimod was numerically but not statistically superior to all comparators.Conclusions: EXPAND provides evidence of the efficacy of siponimod compared with placebo, and these MAICs complement this by demonstrating improved efficacy of siponimod relative to DMTs. Siponimod offers a significant therapeutic advance that may slow disease progression compared to other DMTs in an EXPAND-like population with secondary progressive disease.
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D'Souza M, Van Munster CEP, Dorn JF, Dorier A, Kamm CP, Steinheimer S, Dahlke F, Uitdehaag BMJ, Kappos L, Johnson M. Autoencoder as a New Method for Maintaining Data Privacy While Analyzing Videos of Patients With Motor Dysfunction: Proof-of-Concept Study. J Med Internet Res 2020; 22:e16669. [PMID: 32191621 PMCID: PMC7244995 DOI: 10.2196/16669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 02/19/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022] Open
Abstract
Background In chronic neurological diseases, especially in multiple sclerosis (MS), clinical assessment of motor dysfunction is crucial to monitor the disease in patients. Traditional scales are not sensitive enough to detect slight changes. Video recordings of patient performance are more accurate and increase the reliability of severity ratings. When these recordings are automated, quantitative disability assessments by machine learning algorithms can be created. Creation of these algorithms involves non–health care professionals, which is a challenge for maintaining data privacy. However, autoencoders can address this issue. Objective The aim of this proof-of-concept study was to test whether coded frame vectors of autoencoders contain relevant information for analyzing videos of the motor performance of patients with MS. Methods In this study, 20 pre-rated videos of patients performing the finger-to-nose test were recorded. An autoencoder created encoded frame vectors from the original videos and decoded the videos again. The original and decoded videos were shown to 10 neurologists at an academic MS center in Basel, Switzerland. The neurologists tested whether the 200 videos were human-readable after decoding and rated the severity grade of each original and decoded video according to the Neurostatus-Expanded Disability Status Scale definitions of limb ataxia. Furthermore, the neurologists tested whether ratings were equivalent between the original and decoded videos. Results In total, 172 of 200 (86.0%) videos were of sufficient quality to be ratable. The intrarater agreement between the original and decoded videos was 0.317 (Cohen weighted kappa). The average difference in the ratings between the original and decoded videos was 0.26, in which the original videos were rated as more severe. The interrater agreement between the original videos was 0.459 and that between the decoded videos was 0.302. The agreement was higher when no deficits or very severe deficits were present. Conclusions The vast majority of videos (172/200, 86.0%) decoded by the autoencoder contained clinically relevant information and had fair intrarater agreement with the original videos. Autoencoders are a potential method for enabling the use of patient videos while preserving data privacy, especially when non–health-care professionals are involved.
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Affiliation(s)
- Marcus D'Souza
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Caspar E P Van Munster
- Department of Neurology, Multiple Sclerosis Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | | | - Christian P Kamm
- Neurocenter, Luzerner Kantonsspital, Luzern, Switzerland.,Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Saskia Steinheimer
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | | | - Bernard M J Uitdehaag
- Department of Neurology, Multiple Sclerosis Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
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Tolley C, Piani-Meier D, Bentley S, Bennett B, Jones E, Pike J, Dahlke F, Tomic D, Ziemssen T. A Novel, Integrative Approach for Evaluating Progression in Multiple Sclerosis: Development of a Scoring Algorithm. JMIR Med Inform 2020; 8:e17592. [PMID: 32286236 PMCID: PMC7189255 DOI: 10.2196/17592] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/14/2020] [Accepted: 02/22/2020] [Indexed: 01/08/2023] Open
Abstract
Background There is an unmet need for a tool that helps to evaluate patients who are at risk of progressing from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis (SPMS). A new tool supporting the evaluation of early signs suggestive of progression in multiple sclerosis (MS) has been developed. In the initial stage, concepts relevant to progression were identified using a mixed method approach involving regression on data from a real-world observational study and qualitative research with patients and physicians. The tool was drafted in a questionnaire format to assess these variables. Objective This study aimed to develop the scoring algorithm for the tool, using both quantitative and qualitative research methods. Methods The draft scoring algorithm was developed using two approaches: quantitative analysis of real-world data and qualitative analysis based on physician interviews and ranking and weighting exercises. Variables that were included in the draft tool and regarded as most clinically relevant were selected for inclusion in a multiple logistic regression. The analyses were run using physician-reported data and patient-reported data. Subsequently, a ranking and weighting exercise was conducted with 8 experienced neurologists as part of semistructured interviews. Physicians were presented with the variables included in the draft tool and were asked to rank them in order of strength of contribution to progression and assign a weight by providing a percentage of the overall contribution. Physicians were also asked to explain their ranking and weighting choices. Concordance between physicians was explored. Results Multiple logistic regression identified age, MS disease activity, and Expanded Disability Status Scale score as the most significant physician-reported predictors of progression to SPMS. Patient age, mobility, and self-care were identified as the strongest patient-reported predictors of progression to SPMS. In physician interviews, the variables ranked and weighted as most important were stability or worsening of symptoms, intermittent or persistent symptoms, and presence of ambulatory and cognitive symptoms. Across all physicians, the level of concordance was 0.278 (P<.001), indicating a low to moderate, but statistically significant, level of agreement. Variables were categorized as high (n=8), moderate (n=8), or low (n=10) importance based on the findings from the different approaches described above. Accordingly, the respective questions in the tool were assigned a weight of “three,” “two,” or “one” to inform the draft scoring algorithm. Conclusions This study further confirms the need for a tool to provide a consistent, comprehensive approach across physicians to support the early evaluation of signs indicative of progression to SPMS. The novel and comprehensive approach to develop the draft scoring algorithm triangulates data obtained from ranking and weighting exercises, qualitative interviews, and a real-world observational study. Variables that go beyond the clinically most obvious impairment in lower limbs have been identified as relevant subtle/sensitive signs suggestive of progressive disease.
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Affiliation(s)
- Chloe Tolley
- Adelphi Values Ltd, Macclesfield, United Kingdom
| | | | | | | | - Eddie Jones
- Adelphi Real World Ltd, Macclesfield, United Kingdom
| | - James Pike
- Adelphi Real World Ltd, Macclesfield, United Kingdom
| | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
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Ziemssen T, Piani-Meier D, Bennett B, Johnson C, Tinsley K, Trigg A, Hach T, Dahlke F, Tomic D, Tolley C, Freedman MS. A Physician-Completed Digital Tool for Evaluating Disease Progression (Multiple Sclerosis Progression Discussion Tool): Validation Study. J Med Internet Res 2020; 22:e16932. [PMID: 32049062 PMCID: PMC7055760 DOI: 10.2196/16932] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022] Open
Abstract
Background Defining the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS) can be challenging and delayed. A digital tool (MSProDiscuss) was developed to facilitate physician-patient discussion in evaluating early, subtle signs of multiple sclerosis (MS) disease progression representing this transition. Objective This study aimed to determine cut-off values and corresponding sensitivity and specificity for predefined scoring algorithms, with or without including Expanded Disability Status Scale (EDSS) scores, to differentiate between RRMS and SPMS patients and to evaluate psychometric properties. Methods Experienced neurologists completed the tool for patients with confirmed RRMS or SPMS and those suspected to be transitioning to SPMS. In addition to age and EDSS score, each patient’s current disease status (disease activity, symptoms, and its impacts on daily life) was collected while completing the draft tool. Receiver operating characteristic (ROC) curves determined optimal cut-off values (sensitivity and specificity) for the classification of RRMS and SPMS. Results Twenty neurologists completed the draft tool for 198 patients. Mean scores for patients with RRMS (n=89), transitioning to SPMS (n=47), and SPMS (n=62) were 38.1 (SD 12.5), 55.2 (SD 11.1), and 69.6 (SD 12.0), respectively (P<.001, each between-groups comparison). Area under the ROC curve (AUC) including and excluding EDSS were for RRMS (including) AUC 0.91, 95% CI 0.87-0.95, RRMS (excluding) AUC 0.88, 95% CI 0.84-0.93, SPMS (including) AUC 0.91, 95% CI 0.86-0.95, and SPMS (excluding) AUC 0.86, 95% CI 0.81-0.91. In the algorithm with EDSS, the optimal cut-off values were ≤51.6 for RRMS patients (sensitivity=0.83; specificity=0.82) and ≥58.9 for SPMS patients (sensitivity=0.82; specificity=0.84). The optimal cut-offs without EDSS were ≤46.3 and ≥57.8 and resulted in similar high sensitivity and specificity (0.76-0.86). The draft tool showed excellent interrater reliability (intraclass correlation coefficient=.95). Conclusions The MSProDiscuss tool differentiated RRMS patients from SPMS patients with high sensitivity and specificity. In clinical practice, it may be a useful tool to evaluate early, subtle signs of MS disease progression indicating the evolution of RRMS to SPMS. MSProDiscuss will help assess the current level of progression in an individual patient and facilitate a more informed physician-patient discussion.
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Affiliation(s)
- Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological University Clinic Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | | | | | | | | | | | | | | | | | - Mark S Freedman
- Ottawa Health Research Institute, University of Ottawa, Ottawa, ON, Canada
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Burggraaff J, Dorn J, D'Souza M, Morrison C, Kamm CP, Kontschieder P, Tewarie P, Steinheimer S, Sellen A, Dahlke F, Kappos L, Uitdehaag B. Video-Based Pairwise Comparison: Enabling the Development of Automated Rating of Motor Dysfunction in Multiple Sclerosis. Arch Phys Med Rehabil 2019; 101:234-241. [PMID: 31473205 DOI: 10.1016/j.apmr.2019.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/27/2018] [Revised: 06/20/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine the feasibility, reliability, granularity, and convergent validity of a video-based pairwise comparison technique that uses algorithmic support to enable automated rating of motor dysfunction in patients with multiple sclerosis (MS). DESIGN Feasibility and larger cross-sectional cohort study. SETTING The outpatient clinic of 2 specialist university medical centers. PARTICIPANTS Selected sample from a cohort of patients with MS participating in the Assess MS study (N=42). Videos were randomly drawn from each strata of the ataxia severity-degrees as defined in the Expanded Disability Status Scale (EDSS). In Basel: 19 videos of 17 patients (mean age, 43.4±11.6y; 10 women). In Amsterdam: 50 videos of 25 patients (mean age, 50.0±10.0y; 15 women). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES In each center, neurologists (n=13; n=10) viewed pairs of videos of patients performing standardized movements (eg, finger-to-nose test) to assess relative performance. A comparative assessment score was calculated for each video using the TrueSkill algorithm and analyzed for intrarater (test-retest; ratio of agreement) and interrater reliability (intraclass correlation coefficient [ICC] for absolute agreement) and convergent validity (Spearman ρ). Granularity was estimated from the average difference in comparative assessment scores at which 80% of neurologists considered performance to be different. RESULTS Intrarater reliability was excellent (median ratio of agreement≥0.87). The comparative assessment scores calculated from individual neurologists demonstrated good-excellent ICCs for interrater reliability (0.89; 0.71). The comparative assessment scores correlated (very) highly with their Neurostatus-EDSS equivalent (ρ=0.78, P<.001; ρ=0.91, P<.05), suggesting a more fine-grained rating. CONCLUSIONS Video-based pairwise comparison of motor dysfunction allows for reliable and fine-grained capturing of clinical judgment about neurologic performance, which can contribute to the development of a consistent quantified metric of motor ability in MS.
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Affiliation(s)
- Jessica Burggraaff
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | | | - Marcus D'Souza
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland; Neurocure Clinical Research Center, Charité Universitaetsmedizin, Berlin, Germany
| | | | - Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; Neurology and Neurorehabilitation Center, Luzerner Kantonsspital Lucerne, Switzerland
| | | | - Prejaas Tewarie
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Saskia Steinheimer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | | | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | - Bernard Uitdehaag
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Steinheimer S, Dorn JF, Morrison C, Sarkar A, D'Souza M, Boisvert J, Bedi R, Burggraaff J, Kontschieder P, Dahlke F, Sellen A, Uitdehaag BMJ, Kappos L, Kamm CP. Setwise comparison: efficient fine-grained rating of movement videos using algorithmic support - a proof of concept study. Disabil Rehabil 2019; 42:2640-2646. [PMID: 30782055 DOI: 10.1080/09638288.2018.1563832] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Clinical ordinal rating scales of movements, e.g., the Expanded Disability Status Scale, have poor intra- and interrater reliability, are insensitive to subtle differences and result in coarse-grained ratings compared to relative comparative rating methods. We therefore established video-based setwise comparison as a fine-grained, reliable and efficient rating method of motor dysfunction using algorithmic support.Materials and methods: Eight neurologists rated a set of 40 multiple sclerosis patient videos of the Finger-to-Nose-Test using both the newly developed setwise comparison and the established pairwise comparison techniques, which result in a continuous rating scale. Reliability was assessed by the intra-class correlation coefficient. Construct validity was estimated as Pearson's correlation between the continuous scale and severity ratings according to the Neurostatus scale for upper-extremity tremor/dysmetria and the Nine-hole-peg-test. Comparing the time needed for ratings assessed efficiency.Results: Intra-class correlation coefficient was 0.83 for setwise and 0.7 for pairwise comparison. Correlation to the tremor/dysmetria score of the Neurostatus was 0.86 for both rating procedures and correlation to the Nine-hole-peg-test was 0.64 (setwise) and 0.66 (pairwise). The time needed to rate 40 videos was 22.9 ± 6.9 minutes (setwise) and 77.8 ± 14.5 minutes (pairwise).Conclusions: Setwise comparison is an efficient, valid and reliable method for fine-grained rating of motor dysfunction that can be applied to larger datasets. It is substantially more efficient than pairwise comparison.Implications for rehabilitationDisability rating is crucial in clinical neurorehabilitation and in clinical trials.Humans are naturally inconsistent in rating items on ordinal scales leading to poor intra- and interrater reliability, insensitivity to subtle differences and coarse-grained ratings.Video-based setwise comparison is a new rating method enabling fine-grained, reliable and efficient ratings of motor dysfunction using algorithmic support.
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Affiliation(s)
- Saskia Steinheimer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Marcus D'Souza
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Germany
| | | | | | - Jessica Burggraaff
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | | | - Bernard M J Uitdehaag
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ludwig Kappos
- Neurology, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
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Kuhle J, Kropshofer H, Haering DA, Kundu U, Meinert R, Barro C, Dahlke F, Tomic D, Leppert D, Kappos L. Blood neurofilament light chain as a biomarker of MS disease activity and treatment response. Neurology 2019; 92:e1007-e1015. [PMID: 30737333 PMCID: PMC6442011 DOI: 10.1212/wnl.0000000000007032] [Citation(s) in RCA: 312] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 11/02/2018] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the value of blood neurofilament light chain (NfL) as a biomarker of recent, ongoing, and future disease activity and tissue damage and its utility to monitor treatment response in relapsing-remitting multiple sclerosis. Methods We measured NfL in blood samples from 589 patients with relapsing-remitting multiple sclerosis (from phase 3 studies of fingolimod vs placebo, FREEDOMS and interferon [IFN]-β-1a, TRANSFORMS) and 35 healthy controls and compared NfL levels with clinical and MRI-related outcomes. Results At baseline, NfL levels (pg/mL) were higher in patients than in healthy controls (30.5 and 27.0 vs 16.9, p = 0.0001) and correlated with T2 lesion load and number of gadolinium-enhancing T1 lesions (p < 0.0001, both). Baseline NfL levels, treatment, and number of new or enlarging T2 lesions during the studies predicted NfL levels at the end of study (all p < 0.01). High vs low baseline NfL levels were associated (estimate [95% confidence interval]) with an increased number of new or enlarging T2 lesions (ratio of mean: 2.64 [1.51–4.60]; p = 0.0006), relapses (rate ratio: 2.53 [1.67–3.83]; p < 0.0001), brain volume loss (difference in means: −0.78% [−1.02 to −0.54]; p < 0.0001), and risk of confirmed disability worsening (hazard ratio: 1.94 [0.97–3.87]; p = 0.0605). Fingolimod significantly reduced NfL levels already at 6 months (vs placebo 0.73 [0.656–0.813] and IFN 0.789 [0.704–0.884]), which was sustained until the end of the studies (vs placebo 0.628 [0.552–0.714] and IFN 0.794 [0.705–0.894]; p < 0.001, both studies at all assessments). Conclusions Blood NfL levels are associated with clinical and MRI-related measures of disease activity and neuroaxonal damage and have prognostic value. Our results support the utility of blood NfL as an easily accessible biomarker of disease evolution and treatment response.
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Affiliation(s)
- Jens Kuhle
- From the Neurologic Clinic and Policlinic (J.K., C.B., L.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.A.H., F.D., D.T., D.L.), Basel, Switzerland; Novartis Healthcare Pvt. Ltd. (U.K.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany.
| | - Harald Kropshofer
- From the Neurologic Clinic and Policlinic (J.K., C.B., L.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.A.H., F.D., D.T., D.L.), Basel, Switzerland; Novartis Healthcare Pvt. Ltd. (U.K.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Dieter A Haering
- From the Neurologic Clinic and Policlinic (J.K., C.B., L.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.A.H., F.D., D.T., D.L.), Basel, Switzerland; Novartis Healthcare Pvt. Ltd. (U.K.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Uma Kundu
- From the Neurologic Clinic and Policlinic (J.K., C.B., L.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.A.H., F.D., D.T., D.L.), Basel, Switzerland; Novartis Healthcare Pvt. Ltd. (U.K.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Rolf Meinert
- From the Neurologic Clinic and Policlinic (J.K., C.B., L.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.A.H., F.D., D.T., D.L.), Basel, Switzerland; Novartis Healthcare Pvt. Ltd. (U.K.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Christian Barro
- From the Neurologic Clinic and Policlinic (J.K., C.B., L.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.A.H., F.D., D.T., D.L.), Basel, Switzerland; Novartis Healthcare Pvt. Ltd. (U.K.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Frank Dahlke
- From the Neurologic Clinic and Policlinic (J.K., C.B., L.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.A.H., F.D., D.T., D.L.), Basel, Switzerland; Novartis Healthcare Pvt. Ltd. (U.K.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Davorka Tomic
- From the Neurologic Clinic and Policlinic (J.K., C.B., L.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.A.H., F.D., D.T., D.L.), Basel, Switzerland; Novartis Healthcare Pvt. Ltd. (U.K.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - David Leppert
- From the Neurologic Clinic and Policlinic (J.K., C.B., L.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.A.H., F.D., D.T., D.L.), Basel, Switzerland; Novartis Healthcare Pvt. Ltd. (U.K.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
| | - Ludwig Kappos
- From the Neurologic Clinic and Policlinic (J.K., C.B., L.K.), Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel, University of Basel; Novartis Pharma AG (H.K., D.A.H., F.D., D.T., D.L.), Basel, Switzerland; Novartis Healthcare Pvt. Ltd. (U.K.), Hyderabad, India; and DATAMAP GmbH (R.M.), Freiburg, Germany
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25
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van Munster CE, D'Souza M, Steinheimer S, Kamm CP, Burggraaff J, Diederich M, Kravalis K, Dorn J, Walsh L, Dahlke F, Kappos L, Uitdehaag BM. Tasks of activities of daily living (ADL) are more valuable than the classical neurological examination to assess upper extremity function and mobility in multiple sclerosis. Mult Scler 2018; 25:1673-1681. [PMID: 30168739 PMCID: PMC6764011 DOI: 10.1177/1352458518796690] [Citation(s) in RCA: 4] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accurate clinical assessment in multiple sclerosis (MS) is challenging. The Assess MS system is being developed to automatically quantify motor dysfunction in MS, including upper extremity function (UEF) and mobility. OBJECTIVE To determine to what extent combinations of standardized movements included in the Assess MS system explain accepted measures of UEF and mobility. METHODS MS patients were recruited at four European MS centres. Eight movements were selected, including tasks of activities of daily living (ADL) and classical neurological tests. Movements were recorded on video and rated by experienced neurologists (n = 5). Subsequently, multivariate linear regression models were performed to explain the variance of the Nine-Hole Peg Test (9HPT), Arm Function in Multiple Sclerosis Questionnaire (AMSQ) and Timed-25 Foot Walk test (T25WT). RESULTS In total, 257 patients were included. The movements explained 62.9% to 80.1% of the variance of the 9HPT models, 43.3% and 44.3% of the AMSQ models and 70.8% of the T25WT. In all models, tasks of ADL contributed most to the variance. CONCLUSION Combinations of movements are valuable to assess UEF and mobility. Incorporating ADL tasks into daily clinical practice and clinical trials may be more valuable than the classical neurological examination of UEF and mobility.
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Affiliation(s)
- Caspar Ep van Munster
- Department of Neurology, Amsterdameuroscience and MS Center Amsterdam, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Marcus D'Souza
- Department of Neurology, Universitätsspital Basel, Basel, Switzerland
| | - Saskia Steinheimer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland/Department of Neurology and Neurorehabilitation, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jessica Burggraaff
- Department of Neurology, Amsterdameuroscience and MS Center Amsterdam, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Manuela Diederich
- Department of Neurology, Universitätsspital Basel, Basel, Switzerland
| | - Kristina Kravalis
- Department of Neurology, Universitätsspital Basel, Basel, Switzerland
| | | | | | | | - Ludwig Kappos
- Department of Neurology, Universitätsspital Basel, Basel, Switzerland
| | - Bernard Mj Uitdehaag
- Department of Neurology, Amsterdameuroscience and MS Center Amsterdam, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
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26
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D'Souza M, Steinheimer S, Dorn J, Morrison C, Boisvert J, Kravalis K, Burggraaff J, van Munster CE, Diederich M, Sellen A, Kamm CP, Dahlke F, Uitdehaag BM, Kappos L. Reference videos reduce variability of motor dysfunction assessments in multiple sclerosis. Mult Scler J Exp Transl Clin 2018; 4:2055217318792399. [PMID: 30116550 PMCID: PMC6088490 DOI: 10.1177/2055217318792399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/27/2018] [Accepted: 07/09/2018] [Indexed: 11/27/2022] Open
Abstract
Motor dysfunction, particularly ataxia, is one of the predominant clinical manifestations in patients with multiple sclerosis (MS). Assessment of motor dysfunction suffers from a high variability. We investigated whether the clinical rating of ataxia can be improved through the use of reference videos, covering the spectrum of severity degrees as defined in the Neurostatus-Expanded Disability Status Scale. Twenty-five neurologists participated. The variability of their assessments was significantly lower when reference videos were used (SD = 0.12; range = 0.40 vs SD = 0.26; range = 0.88 without reference videos; p = 0.013). Reference videos reduced the variability of clinical assessments and may be useful tools to improve the precision and consistency in the clinical assessment of motor functions in MS.
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Affiliation(s)
- Marcus D'Souza
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Switzerland
| | - Saskia Steinheimer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | | | | | | | - Kristina Kravalis
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Switzerland
| | | | | | - Manuela Diederich
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Switzerland
| | | | - Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland.,Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
| | | | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Switzerland.,M.D.S. and S.S. contributed equally to this work
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27
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Kappos L, Bar-Or A, Cree BAC, Fox RJ, Giovannoni G, Gold R, Vermersch P, Arnold DL, Arnould S, Scherz T, Wolf C, Wallström E, Dahlke F. Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomised, phase 3 study. Lancet 2018; 391:1263-1273. [PMID: 29576505 DOI: 10.1016/s0140-6736(18)30475-6] [Citation(s) in RCA: 571] [Impact Index Per Article: 95.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/02/2018] [Accepted: 01/08/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND No treatment has consistently shown efficacy in slowing disability progression in patients with secondary progressive multiple sclerosis (SPMS). We assessed the effect of siponimod, a selective sphingosine 1-phosphate (S1P) receptor1,5 modulator, on disability progression in patients with SPMS. METHODS This event-driven and exposure-driven, double-blind, phase 3 trial was done at 292 hospital clinics and specialised multiple sclerosis centres in 31 countries. Using interactive response technology to assign numbers linked to treatment arms, patients (age 18-60 years) with SPMS and an Expanded Disability Status Scale score of 3·0-6·5 were randomly assigned (2:1) to once daily oral siponimod 2 mg or placebo for up to 3 years or until the occurrence of a prespecified number of confirmed disability progression (CDP) events. The primary endpoint was time to 3-month CDP. Efficacy was assessed for the full analysis set (ie, all randomly assigned and treated patients); safety was assessed for the safety set. This trial is registered with ClinicalTrials.gov, number NCT01665144. FINDINGS 1651 patients were randomly assigned between Feb 5, 2013, and June 2, 2015 (1105 to the siponimod group, and 546 to the placebo group). One patient did not sign the consent form, and five patients did not receive study drug, all of whom were in the siponimod group. 1645 patients were included in the analyses (1099 in the siponimod group and 546 in the placebo). At baseline, the mean time since first multiple sclerosis symptoms was 16·8 years (SD 8·3), and the mean time since conversion to SPMS was 3·8 years (SD 3·5); 1055 (64%) patients had not relapsed in the previous 2 years, and 918 (56%) of 1651 needed walking assistance. 903 (82%) patients receiving siponimod and 424 (78%) patients receiving placebo completed the study. 288 (26%) of 1096 patients receiving siponimod and 173 (32%) of 545 patients receiving placebo had 3-month CDP (hazard ratio 0·79, 95% CI 0·65-0·95; relative risk reduction 21%; p=0·013). Adverse events occurred in 975 (89%) of 1099 patients receiving siponimod versus 445 (82%) of 546 patients receiving placebo; serious adverse events were reported for 197 (18%) patients in the siponimod group versus 83 (15%) patients in the placebo group. Lymphopenia, increased liver transaminase concentration, bradycardia and bradyarrhythmia at treatment initiation, macular oedema, hypertension, varicella zoster reactivation, and convulsions occurred more frequently with siponimod than with placebo. Initial dose titration mitigated cardiac first-dose effects. Frequencies of infections, malignancies, and fatalities did not differ between groups. INTERPRETATION Siponimod reduced the risk of disability progression with a safety profile similar to that of other S1P modulators and is likely to be a useful treatment for SPMS. FUNDING Novartis Pharma AG.
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Affiliation(s)
- Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland.
| | - Amit Bar-Or
- Center for Neuroinflammation and Neurotherapeutics, and Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neuroimmunology Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Bruce A C Cree
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Robert J Fox
- Mellen Centre for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gavin Giovannoni
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ralf Gold
- Department of Neurology, St Josef-Hospital/Ruhr-University Bochum, Bochum, Germany
| | | | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada; NeuroRx Research, Montreal, QC, Canada
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28
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D'Souza M, Yaldizli Ö, John R, Vogt DR, Papadopoulou A, Lucassen E, Menegola M, Andelova M, Dahlke F, Schnyder F, Kappos L. Neurostatus e-Scoring improves consistency of Expanded Disability Status Scale assessments: A proof of concept study. Mult Scler 2016; 23:597-603. [PMID: 27364325 DOI: 10.1177/1352458516657439] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To improve the consistency of standardized Expanded Disability Status Scale (EDSS) assessments, an electronic data capture tool and analysis tool was developed, Neurostatus e-Scoring (NESC). This tool allows real-time feedback by comparing entries with established scoring rules. OBJECTIVE To test whether using NESC reduces inconsistencies as compared to the paper-and-pencil version of the Expanded Disability Status Scale (pEDSS). METHODS In all, 100 multiple sclerosis (MS) patients were assessed in random order on the same day by pairs of neurologists, one using pEDSS and one NESC. We compared inter-rater reliability and frequency of inconsistencies in Neurostatus subscores, functional system (FS) scores, ambulation and EDSS steps. RESULTS Inconsistencies of any type were more likely to occur when using pEDSS (mean odds ratio (95% confidence interval (CI)) = 2.93 (1.62; 5.29)). This was also the case for FS score inconsistencies (2.54 (1.40; 4.61)) and more likely for patients in the lower EDSS range (⩽3.5 vs >3.5) (5.32 (1.19; 23.77)). Overall, inter-rater agreement for the assessed Neurostatus subscores was high (median and inter-quartile range = 0.84 (0.73, 0.81)). CONCLUSION Our data provide class II evidence that the use of NESC increases consistency of standardized EDSS assessments, and may thus have the potential to decrease noise and increase power of MS clinical trials.
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Affiliation(s)
- Marcus D'Souza
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | - Özgür Yaldizli
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | | | - Deborah R Vogt
- Clinical Trial Unit, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - Athina Papadopoulou
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | - Elisabeth Lucassen
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | - Milena Menegola
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | - Michaela Andelova
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | | | | | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine, and Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
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29
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Maiorka A, Silva AVF, Santin E, Dahlke F, Bruno LDG, Boleli IC, Macari M, Trautenmuller H. Effect of Broiler Breeder Age and Glutamine Supplementation on the Development of the Intestinal Mucosa of 7-Day-Old Chicks. Rev Bras Cienc Avic 2016. [DOI: 10.1590/1516-635x1801017-022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- A Maiorka
- Universidade Federal do Paraná, Brazil
| | - AVF Silva
- Universidade Federal do Paraná, Brazil
| | - E Santin
- Universidade Federal do Paraná, Brazil
| | - F Dahlke
- Universidade Federal do Paraná, Brazil
| | - LDG Bruno
- Universidade Estadual do Oeste do Paraná, Brazil
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30
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Bueno IJM, Surek D, Rocha C, Schramm VG, Muramatsu K, Dahlke F, Maiorka A. Effects of different limestone particle sizes in the diet of broiler breeders post molting on their performance, egg quality, incubation results, and pre-starter performance of their progeny. Poult Sci 2016; 95:860-6. [PMID: 26769267 DOI: 10.3382/ps/pev438] [Citation(s) in RCA: 2] [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: 05/29/2015] [Accepted: 11/13/2015] [Indexed: 11/20/2022] Open
Abstract
An experiment was conducted to test the hypothesis that a coarse limestone diet improves productivity, reproductive performance and the calcium utilization of molted broiler breeders. In total, 640 broiler breeder females, 73-week-old and sixty-four 27-week-old cockerels, Cobb 500, were evaluated during 10 weeks, according to a randomized block design composed of 4 treatments with 8 replicates each. Treatments consisted of diets with the inclusion of 100% fine limestone-fine PS (0.2 mm GMD-geometric mean diameter); PS1: 30% fine limestone+70% limestone with 1.0 mm GMD; PS2: 30% fine limestone+70% limestone with 2.0 mm GMD; and PS3: 30% fine limestone+70% limestone with 3.0 mm GMD. Calcium retention in the gizzard of the breeders, bone characteristics, and breeder performance, egg characteristics, eggshell quality, incubation performance, chick quality and yield, chick pre-starter live performance, and chick bone characteristics were determined. There was no significant difference (P>0.05) in the rate of lay, percentage of non-settable eggs, egg weight, egg shape index, egg specific gravity, eggshell weight, thickness, and percentage hatchability and egg weight loss of broiler breeders fed with diets with different limestone particle sizes. The chick quality and yield, chick pre-starter live performance, and chick bone characteristics were not affected (P>0.05) by any of the limestone particle sizes. It was concluded that live and reproductive performance parameters of broiler breeders post molting is not affected by limestone particle size in the feed.
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Affiliation(s)
- I J M Bueno
- Department of Animal Science, Federal University of Paraná, Curitiba, PR, Brazil
| | - D Surek
- Department of Animal Science, Federal University of Paraná, Curitiba, PR, Brazil
| | - C Rocha
- Department of Animal Science, Federal University of Paraná, Curitiba, PR, Brazil
| | - V G Schramm
- Department of Animal Science, Federal University of Paraná, Curitiba, PR, Brazil
| | - K Muramatsu
- Department of Animal Science, Federal University of Paraná, Curitiba, PR, Brazil
| | - F Dahlke
- Laboratório de Avicultura, Department of Animal Science, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - A Maiorka
- Department of Animal Science, Federal University of Paraná, Curitiba, PR, Brazil
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31
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Kappos L, Radue EW, Comi G, Montalban X, Butzkueven H, Wiendl H, Giovannoni G, Hartung HP, Derfuss T, Naegelin Y, Sprenger T, Mueller-Lenke N, Griffiths S, von Rosenstiel P, Gottschalk R, Zhang Y, Dahlke F, Tomic D. Switching from natalizumab to fingolimod: A randomized, placebo-controlled study in RRMS. Neurology 2015; 85:29-39. [PMID: 26024899 PMCID: PMC4501941 DOI: 10.1212/wnl.0000000000001706] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/21/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the effect of different natalizumab washout (WO) periods on recurrence of MRI and clinical disease activity in patients switching from natalizumab to fingolimod. METHODS In this multicenter, double-blind, placebo-controlled trial (TOFINGO), patients with relapsing-remitting multiple sclerosis (RRMS) were randomized 1:1:1 to 8-, 12-, or 16-week WO followed by fingolimod treatment over 32 weeks from last natalizumab infusion (LNI). Brain MRI was performed at baseline and weeks 8, 12, 16, 20, and 24. RESULTS Of 142 enrolled and randomized patients, 112 (78.9%) completed the study (8 weeks, n = 41/50; 12 weeks, n = 31/42; 16 weeks, n = 40/50). Number (95% confidence interval [CI]) of active (new/newly enlarged T2) lesions from LNI through 8 weeks of fingolimod treatment (primary outcome) was similar in the 8-week (2.1 [1.7-2.6]) and 12-week WO groups (1.7 [1.3-2.2]) and higher in the 16-week WO group (8.2 [7.3-9.1]). During the WO period only, the number (95% CI) of active lesions increased with increasing WO duration (8 weeks, 0.4 [0.2-0.6]; 12 weeks, 2.1 [1.6-2.6]; 16 weeks, 3.6 [3.0-4.2]). Over the 24 weeks from LNI, gadolinium-enhancing T1 lesion counts were lower in the 8-week WO group (14.1 [5.67-22.53]) than in the 12-week (21.3 [1.41-41.19]) or 16-week (18.5 [8.40-28.60]) WO groups. More patients were relapse-free in the 8-week (88%) and 12-week (91%) WO groups than the 16-week WO group (84%). Sixty-eight percent of patients experienced adverse events (mostly mild/moderate), with similar incidence across groups. No unusually severe relapses or opportunistic infections occurred. CONCLUSIONS Initiating fingolimod therapy 8-12 weeks after natalizumab discontinuation is associated with a lower risk of MRI and clinical disease reactivation than initiation after 16-week WO. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with RRMS switching from natalizumab to fingolimod, shorter natalizumab WO periods are associated with less MRI disease activity than are longer WO periods.
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Affiliation(s)
- Ludwig Kappos
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ.
| | - Ernst-Wilhelm Radue
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Giancarlo Comi
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Xavier Montalban
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Helmut Butzkueven
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Heinz Wiendl
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Gavin Giovannoni
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Hans-Peter Hartung
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Tobias Derfuss
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Yvonne Naegelin
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Till Sprenger
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Nicole Mueller-Lenke
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Sarah Griffiths
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Philipp von Rosenstiel
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Rebecca Gottschalk
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Ying Zhang
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Frank Dahlke
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
| | - Davorka Tomic
- From Neurology, the Departments of Medicine, Clinical Research and Biomedicine (L.K., T.D., Y.N., T.S.), the Medical Image Analysis Center (MIAC) (E.-W.R., T.S., N.M.-L.), and the Department of Radiology, Division of Neuroradiology (T.S.), University Hospital, University of Basel, Switzerland; the Department of Neuroscience (G.C.), Scientific Institute H. San Raffaele, University of Milan, Italy; Vall d'Hebron University Hospital (X.M.), Barcelona, Spain; Royal Melbourne Hospital (H.B.), Parkville, Australia; the Department of Neurology (H.W.), University of Münster, Germany; the Neuroscience and Trauma Centre (G.G.), Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK; the Department of Neurology (H.-P.H.), Heinrich Heine University, Düsseldorf, Germany; Oxford PharmaGenesis Ltd. (S.G.), Tubney Warren Barns, Oxford, UK; Novartis Pharma AG (P.v.R., Y.Z., F.D., D.T.), Basel, Switzerland; and Novartis Pharmaceutical Corporation (R.G.), East Hanover, NJ
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Morrison C, D'Souza M, Huckvale K, Dorn JF, Burggraaff J, Kamm CP, Steinheimer SM, Kontschieder P, Criminisi A, Uitdehaag B, Dahlke F, Kappos L, Sellen A. Usability and Acceptability of ASSESS MS: Assessment of Motor Dysfunction in Multiple Sclerosis Using Depth-Sensing Computer Vision. JMIR Hum Factors 2015; 2:e11. [PMID: 27025782 PMCID: PMC4797664 DOI: 10.2196/humanfactors.4129] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/09/2015] [Accepted: 05/07/2015] [Indexed: 11/13/2022] Open
Abstract
Background Sensor-based recordings of human movements are becoming increasingly important for the assessment of motor symptoms in neurological disorders beyond rehabilitative purposes. ASSESS MS is a movement recording and analysis system being developed to automate the classification of motor dysfunction in patients with multiple sclerosis (MS) using depth-sensing computer vision. It aims to provide a more consistent and finer-grained measurement of motor dysfunction than currently possible. Objective To test the usability and acceptability of ASSESS MS with health professionals and patients with MS. Methods A prospective, mixed-methods study was carried out at 3 centers. After a 1-hour training session, a convenience sample of 12 health professionals (6 neurologists and 6 nurses) used ASSESS MS to capture recordings of standardized movements performed by 51 volunteer patients. Metrics for effectiveness, efficiency, and acceptability were defined and used to analyze data captured by ASSESS MS, video recordings of each examination, feedback questionnaires, and follow-up interviews. Results All health professionals were able to complete recordings using ASSESS MS, achieving high levels of standardization on 3 of 4 metrics (movement performance, lateral positioning, and clear camera view but not distance positioning). Results were unaffected by patients’ level of physical or cognitive disability. ASSESS MS was perceived as easy to use by both patients and health professionals with high scores on the Likert-scale questions and positive interview commentary. ASSESS MS was highly acceptable to patients on all dimensions considered, including attitudes to future use, interaction (with health professionals), and overall perceptions of ASSESS MS. Health professionals also accepted ASSESS MS, but with greater ambivalence arising from the need to alter patient interaction styles. There was little variation in results across participating centers, and no differences between neurologists and nurses. Conclusions In typical clinical settings, ASSESS MS is usable and acceptable to both patients and health professionals, generating data of a quality suitable for clinical analysis. An iterative design process appears to have been successful in accounting for factors that permit ASSESS MS to be used by a range of health professionals in new settings with minimal training. The study shows the potential of shifting ubiquitous sensing technologies from research into the clinic through a design approach that gives appropriate attention to the clinic environment.
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Affiliation(s)
- Cecily Morrison
- Microsoft Research, Human Experience & Design, Cambridge, United Kingdom.
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Urso U, Dahlke F, Maiorka A, Bueno I, Schneider A, Surek D, Rocha C. Vitamin E and selenium in broiler breeder diets: Effect on live performance, hatching process, and chick quality. Poult Sci 2015; 94:976-83. [DOI: 10.3382/ps/pev042] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/20/2022] Open
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Capkun G, Lahoz R, Verdun E, Song X, Chen W, Korn JR, Dahlke F, Freitas R, Fraeman K, Simeone J, Johnson BH, Nordstrom B. Expanding the use of administrative claims databases in conducting clinical real-world evidence studies in multiple sclerosis. Curr Med Res Opin 2015; 31:1029-39. [PMID: 25661016 DOI: 10.1185/03007995.2015.1014029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Administrative claims databases provide a wealth of data for assessing the effect of treatments in clinical practice. Our aim was to propose methodology for real-world studies in multiple sclerosis (MS) using these databases. RESEARCH DESIGN AND METHODS In three large US administrative claims databases: MarketScan, PharMetrics Plus and Department of Defense (DoD), patients with MS were selected using an algorithm identified in the published literature and refined for accuracy. Algorithms for detecting newly diagnosed ('incident') MS cases were also refined and tested. Methodology based on resource and treatment use was developed to differentiate between relapses with and without hospitalization. RESULTS When various patient selection criteria were applied to the MarketScan database, an algorithm requiring two MS diagnoses at least 30 days apart was identified as the preferred method of selecting patient cohorts. Attempts to detect incident MS cases were confounded by the limited continuous enrollment of patients in these databases. Relapse detection algorithms identified similar proportions of patients in the MarketScan and PharMetrics Plus databases experiencing relapses with (2% in both databases) and without (15-20%) hospitalization in the 1 year follow-up period, providing findings in the range of those in the published literature. LIMITATION Additional validation of the algorithms proposed here would increase their credibility. CONCLUSIONS The methods suggested in this study offer a good foundation for performing real-world research in MS using administrative claims databases, potentially allowing evidence from different studies to be compared and combined more systematically than in current research practice.
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Kuhle J, Disanto G, Lorscheider J, Stites T, Chen Y, Dahlke F, Francis G, Shrinivasan A, Radue EW, Giovannoni G, Kappos L. Fingolimod and CSF neurofilament light chain levels in relapsing-remitting multiple sclerosis. Neurology 2015; 84:1639-43. [PMID: 25809304 PMCID: PMC4409586 DOI: 10.1212/wnl.0000000000001491] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 12/15/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We assessed CSF levels of the light chain subunit of neurofilaments (NfL) at baseline and after fingolimod therapy or placebo in patients with relapsing-remitting multiple sclerosis (RRMS). Changes in NfL levels were also correlated with relapse and MRI outcomes. METHODS CSF samples were available, at baseline and 12 months after treatment initiation, from a subset of 36 patients with RRMS (fingolimod 0.5 mg: n = 9; fingolimod 1.25 mg: n = 15; placebo: n = 12) participating in the 2-year, phase 3 Fingolimod (FTY720) Research Evaluating Effects of Daily Oral Therapy in Multiple Sclerosis (FREEDOMS) study. NfL levels were determined in a blinded fashion using a commercial ELISA kit. RESULTS Median NfL levels did not differ between treatment groups at baseline (0.5 mg: 644 pg/mL; 1.25 mg: 659 pg/mL; pooled 0.5/1.25 mg: 652 pg/mL, placebo: 886 pg/mL; p value [fingolimod vs placebo] = 0.619, 0.495, and 0.481, respectively). Following 12 months of treatment, median changes from baseline in NfL levels were lower than zero in the fingolimod groups (0.5 mg: -346 pg/mL, p = 0.039; 1.25 mg: -313 pg/mL, p = 0.035) and pooled 0.5/1.25 mg fingolimod group (-326 pg/mL, 83.3% with reduction, p = 0.002) but not in the placebo group (-214 pg/mL, 66.7% with reduction, p = 0.388). Reductions in NfL levels at month 12 correlated with an improvement in relapse and MRI outcomes. CONCLUSIONS Our results suggest a beneficial effect of fingolimod on this marker of axonal injury and support the utility of NfL as a quantitative biomarker in multiple sclerosis.
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Affiliation(s)
- Jens Kuhle
- From the Neuroimmunology Unit (J.K., G.D., G.G.), Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Neurology, Departments of Medicine, Clinical Research and Biomedicine (J.K., J.L., L.K.), and the Medical Image Analysis Center (MIAC) (E.-W.R.), University Hospital, Basel, Switzerland; Novartis Pharmaceuticals Corporation (T.S., Y.C., G.F.), East Hanover, NJ; Novartis Pharma AG (F.D.), Basel, Switzerland; and Novartis Healthcare Pvt Ltd (A.S.), Hyderabad, India.
| | - Giulio Disanto
- From the Neuroimmunology Unit (J.K., G.D., G.G.), Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Neurology, Departments of Medicine, Clinical Research and Biomedicine (J.K., J.L., L.K.), and the Medical Image Analysis Center (MIAC) (E.-W.R.), University Hospital, Basel, Switzerland; Novartis Pharmaceuticals Corporation (T.S., Y.C., G.F.), East Hanover, NJ; Novartis Pharma AG (F.D.), Basel, Switzerland; and Novartis Healthcare Pvt Ltd (A.S.), Hyderabad, India
| | - Johannes Lorscheider
- From the Neuroimmunology Unit (J.K., G.D., G.G.), Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Neurology, Departments of Medicine, Clinical Research and Biomedicine (J.K., J.L., L.K.), and the Medical Image Analysis Center (MIAC) (E.-W.R.), University Hospital, Basel, Switzerland; Novartis Pharmaceuticals Corporation (T.S., Y.C., G.F.), East Hanover, NJ; Novartis Pharma AG (F.D.), Basel, Switzerland; and Novartis Healthcare Pvt Ltd (A.S.), Hyderabad, India
| | - Tracy Stites
- From the Neuroimmunology Unit (J.K., G.D., G.G.), Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Neurology, Departments of Medicine, Clinical Research and Biomedicine (J.K., J.L., L.K.), and the Medical Image Analysis Center (MIAC) (E.-W.R.), University Hospital, Basel, Switzerland; Novartis Pharmaceuticals Corporation (T.S., Y.C., G.F.), East Hanover, NJ; Novartis Pharma AG (F.D.), Basel, Switzerland; and Novartis Healthcare Pvt Ltd (A.S.), Hyderabad, India
| | - Yu Chen
- From the Neuroimmunology Unit (J.K., G.D., G.G.), Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Neurology, Departments of Medicine, Clinical Research and Biomedicine (J.K., J.L., L.K.), and the Medical Image Analysis Center (MIAC) (E.-W.R.), University Hospital, Basel, Switzerland; Novartis Pharmaceuticals Corporation (T.S., Y.C., G.F.), East Hanover, NJ; Novartis Pharma AG (F.D.), Basel, Switzerland; and Novartis Healthcare Pvt Ltd (A.S.), Hyderabad, India
| | - Frank Dahlke
- From the Neuroimmunology Unit (J.K., G.D., G.G.), Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Neurology, Departments of Medicine, Clinical Research and Biomedicine (J.K., J.L., L.K.), and the Medical Image Analysis Center (MIAC) (E.-W.R.), University Hospital, Basel, Switzerland; Novartis Pharmaceuticals Corporation (T.S., Y.C., G.F.), East Hanover, NJ; Novartis Pharma AG (F.D.), Basel, Switzerland; and Novartis Healthcare Pvt Ltd (A.S.), Hyderabad, India
| | - Gordon Francis
- From the Neuroimmunology Unit (J.K., G.D., G.G.), Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Neurology, Departments of Medicine, Clinical Research and Biomedicine (J.K., J.L., L.K.), and the Medical Image Analysis Center (MIAC) (E.-W.R.), University Hospital, Basel, Switzerland; Novartis Pharmaceuticals Corporation (T.S., Y.C., G.F.), East Hanover, NJ; Novartis Pharma AG (F.D.), Basel, Switzerland; and Novartis Healthcare Pvt Ltd (A.S.), Hyderabad, India
| | - Anupama Shrinivasan
- From the Neuroimmunology Unit (J.K., G.D., G.G.), Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Neurology, Departments of Medicine, Clinical Research and Biomedicine (J.K., J.L., L.K.), and the Medical Image Analysis Center (MIAC) (E.-W.R.), University Hospital, Basel, Switzerland; Novartis Pharmaceuticals Corporation (T.S., Y.C., G.F.), East Hanover, NJ; Novartis Pharma AG (F.D.), Basel, Switzerland; and Novartis Healthcare Pvt Ltd (A.S.), Hyderabad, India
| | - Ernst-Wilhelm Radue
- From the Neuroimmunology Unit (J.K., G.D., G.G.), Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Neurology, Departments of Medicine, Clinical Research and Biomedicine (J.K., J.L., L.K.), and the Medical Image Analysis Center (MIAC) (E.-W.R.), University Hospital, Basel, Switzerland; Novartis Pharmaceuticals Corporation (T.S., Y.C., G.F.), East Hanover, NJ; Novartis Pharma AG (F.D.), Basel, Switzerland; and Novartis Healthcare Pvt Ltd (A.S.), Hyderabad, India
| | - Gavin Giovannoni
- From the Neuroimmunology Unit (J.K., G.D., G.G.), Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Neurology, Departments of Medicine, Clinical Research and Biomedicine (J.K., J.L., L.K.), and the Medical Image Analysis Center (MIAC) (E.-W.R.), University Hospital, Basel, Switzerland; Novartis Pharmaceuticals Corporation (T.S., Y.C., G.F.), East Hanover, NJ; Novartis Pharma AG (F.D.), Basel, Switzerland; and Novartis Healthcare Pvt Ltd (A.S.), Hyderabad, India
| | - Ludwig Kappos
- From the Neuroimmunology Unit (J.K., G.D., G.G.), Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK; Neurology, Departments of Medicine, Clinical Research and Biomedicine (J.K., J.L., L.K.), and the Medical Image Analysis Center (MIAC) (E.-W.R.), University Hospital, Basel, Switzerland; Novartis Pharmaceuticals Corporation (T.S., Y.C., G.F.), East Hanover, NJ; Novartis Pharma AG (F.D.), Basel, Switzerland; and Novartis Healthcare Pvt Ltd (A.S.), Hyderabad, India
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Muramatsu K, Maiorka A, Dahlke F, Lopes AS, Pasche M. Impact of particle size, thermal processing, fat inclusion, and moisture addition on starch gelatinization of broiler feeds. Rev Bras Cienc Avic 2014. [DOI: 10.1590/1516-635x1604367-374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - A Maiorka
- Universidade Federal do Paraná, Brazil
| | - F Dahlke
- Universidade Federal Santa Catarina, Brazil
| | - AS Lopes
- Animal Science Researchers, Brazil
| | - M Pasche
- Animal Science Researchers, Brazil
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Comi G, Gold R, Dahlke F, Sinha A, von Rosenstiel P, Tomic D, Kappos L. Relapses in patients treated with fingolimod after previous exposure to natalizumab. Mult Scler 2014; 21:786-90. [PMID: 25257618 DOI: 10.1177/1352458514549404] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/29/2014] [Indexed: 11/15/2022]
Abstract
In post hoc analyses of an open-label, phase 3b study (FIRST), relapse rates during 4 months of fingolimod therapy were compared in patients with and without previous natalizumab exposure. Reductions in the proportion of patients experiencing relapses and annualized relapse rates (ARRs) from years 1 and 1-2 pre-study were evident between months 1 and 2 of fingolimod treatment, and were most pronounced in natalizumab-naïve patients and those who discontinued natalizumab >6 months pre-study. Patients who discontinued natalizumab 3-6 months pre-study had a peak ARR during month 1 of fingolimod treatment, followed by a decrease during months 2-4. These data indicate that fingolimod has the potential to reduce disease reactivation but that timing of treatment initiation may be critical for achieving an optimal effect.
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Affiliation(s)
- G Comi
- University Vita-Salute San Raffaele, San Raffaele Scientific Institute, Italy
| | - R Gold
- Neurologische Klinik, Universitätsklinikum der Ruhr-Universität, Germany
| | | | - A Sinha
- Novartis Healthcare Pvt Ltd, India
| | | | - D Tomic
- Novartis Pharma AG, Switzerland
| | - L Kappos
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital, Switzerland
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Affiliation(s)
- ECO Sans
- Universidade Federal do Paraná, Brazil
| | | | - F Dahlke
- Universidade Federal de Santa Catarina, Brazil
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Rocha C, Durau J, Barrilli L, Dahlke F, Maiorka P, Maiorka A. The effect of raw and roasted soybeans on intestinal health, diet digestibility, and pancreas weight of broilers. J APPL POULTRY RES 2014. [DOI: 10.3382/japr.2013-00829] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Kontschieder P, Dorn JF, Morrison C, Corish R, Zikic D, Sellen A, D’Souza M, Kamm CP, Burggraaff J, Tewarie P, Vogel T, Azzarito M, Glocker B, Chin P, Dahlke F, Polman C, Kappos L, Uitdehaag B, Criminisi A. Quantifying Progression of Multiple Sclerosis via Classification of Depth Videos. Medical Image Computing and Computer-Assisted Intervention – MICCAI 2014 2014; 17:429-37. [DOI: 10.1007/978-3-319-10470-6_54] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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41
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Selmaj K, Li DKB, Hartung HP, Hemmer B, Kappos L, Freedman MS, Stüve O, Rieckmann P, Montalban X, Ziemssen T, Auberson LZ, Pohlmann H, Mercier F, Dahlke F, Wallström E. Siponimod for patients with relapsing-remitting multiple sclerosis (BOLD): an adaptive, dose-ranging, randomised, phase 2 study. Lancet Neurol 2013; 12:756-67. [PMID: 23764350 DOI: 10.1016/s1474-4422(13)70102-9] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Siponimod is an oral selective modulator of sphingosine 1-phosphate receptor types 1 and type 5, with an elimination half-life leading to washout in 7 days. We aimed to determine the dose-response relation of siponimod in terms of its effects on brain MRI lesion activity and characterise safety and tolerability in patients with relapsing-remitting multiple sclerosis. METHODS In this double-blind, adaptive dose-ranging phase 2 study, we enrolled adults (aged 18-55 years) with relapsing-remitting multiple sclerosis at 73 medical centres in Europe and North America. We tested two patient cohorts sequentially, separated by an interim analysis at 3 months. We randomly allocated patients in cohort 1 (1:1:1:1) to receive once-daily siponimod 10 mg, 2 mg, or 0·5 mg, or placebo for 6 months. We randomly allocated patients in cohort 2 (4:4:1) to siponimod 1·25 mg, siponimod 0·25 mg, or placebo once-daily for 3 months. Randomisation was done with a central, automated system and patients and investigators were masked to treatment assignment. The primary endpoint was dose-response, assessed by percentage reduction in monthly number of combined unique active lesions at 3 months for siponimod versus placebo; this endpoint was analysed by a multiple comparison procedure with modelling techniques in all patients with at least one MRI scan up to 3 months. We assessed safety in all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT00879658. FINDINGS Between March 30, 2009, and Oct 22, 2010, we recruited 188 patients into cohort 1 and 109 patients into cohort 2. We showed a dose-response relation (p=0·0001) across the five doses of siponimod, with reductions in combined unique active lesions at 3 months compared with placebo of 35% (95% CI 17-57) for siponimod 0·25 mg (51 patients included in the primary endpoint analysis), 50% (29-69) for siponimod 0·5 mg (43 patients), 66% (48-80) for siponimod 1·25 mg (42 patients), 72% (57-84) for siponimod 2 mg (45 patients), and 82% (70-90) for siponimod 10 mg (44 patients). In patients treated for 6 months, 37 (86%) of 43 patients who received siponimod 0·5 mg had adverse events (eight serious), as did 48 (98%) of 49 patients who received siponimod 2 mg (four serious), 48 (96%) of 50 patients who received siponimod 10 mg (three serious), and 36 (80%) of 45 controls (none serious). For individuals treated to 3 months, 38 (74%) of 51 patients who received siponimod 0·25 mg had adverse events (none serious), as did 29 (69%) of 42 patients who received siponimod 1·25 mg (two serious) and 13 (81%) of 16 controls (none serious). INTERPRETATION Therapeutic effects of siponimod on MRI lesion activity in model-based analyses and its tolerability in relapsing-remitting multiple sclerosis warrant investigation in a phase 3 trial. FUNDING Novartis Pharma AG.
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Affiliation(s)
- Krzysztof Selmaj
- Department of Neurology, Medical University of Lodz, Lodz, Poland.
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Francis G, Dahlke F, Von Rosenstiel P, Sfikas N. Assessment of Potential Risk of PML with Fingolimod in MS Treated for at Least 24 Months (P04.137). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Stuve O, Selmaj K, Li D, Hartung HP, Hemmer B, Kappos L, Freedman M, Rieckmann P, Montalban X, Zhang Auberson L, Pohlmann H, Mercier F, Dahlke F, Wallstrom E. BAF312, a Selective Sphingosine-1-Phosphate Receptor Modulator Improves MRI and Clinical Outcomes in Relapsing-Remitting Multiple Sclerosis (RRMS) (S30.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s30.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Willemsen H, Kamers B, Dahlke F, Han H, Song Z, Ansari Pirsaraei Z, Tona K, Decuypere E, Everaert N. High- and low-temperature manipulation during late incubation: effects on embryonic development, the hatching process, and metabolism in broilers. Poult Sci 2011; 89:2678-90. [PMID: 21076107 DOI: 10.3382/ps.2010-00853] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Temperatures continuously higher and lower than the standard incubation temperature by 3°C from embryonic d 16 until embryonic d 18.5 result in differential effects on embryonic development, the hatching process, and embryonic metabolism. Embryos in the high-temperature group were forced into a state of malnutrition by the temperature treatment, as reflected by reduced embryo growth and yolk consumption, resulting in a significantly lower chick weight at hatch. In addition, altered air cell and blood gases as well as a retarded hatching process further indicated reduced growth of embryos exposed to higher incubation temperatures during the latter part of incubation. In addition, hatchability was significantly reduced by the high-temperature treatment due to higher embryonic mortality during the treatment period and the hatching process. Levels of blood glucose, lactate, liver glycogen, plasma triglycerides, and nonesterified fatty acids indicated an altered carbohydrate and lipid metabolism for the high-temperature group. Although the hatching process of embryos exposed to lower incubation temperatures was also significantly retarded, their embryonic development and growth were strikingly similar to those of the control group.
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Affiliation(s)
- H Willemsen
- Departement of Biosystems, K. U. Leuven, Kasteelpark Arenberg 30, 3001 Leuven, Belgium.
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Favero A, Maiorka A, Dahlke F, Meurer R, Oliveira R, Sens R. Influence of feed form and corn particle size on the live performance and digestive tract development of turkeys. J APPL POULTRY RES 2009. [DOI: 10.3382/japr.2009-00069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gonzales E, Stringhini JH, Dahlke F, Cunha WCP, Xavier SAG. Productive consequences of fasting neonatal chicks of different genetic constitutions for growing. Rev Bras Cienc Avic 2008. [DOI: 10.1590/s1516-635x2008000400010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bockor L, Dahlke F, Maiorka A, Castro OS, Oliveira EG, Krabbe EL, Warpechowski MB. COMPARAÇÃO DE MEDIDAS DA CAPACIDADE TAMPONANTE DE MATÉRIAS–PRIMAS E DIETAS UTILIZADAS PARA LEITÕES. AVS 2007. [DOI: 10.5380/avs.v12i3.10930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Avaliou-se a capacidade tamponante(CT) de diferentes ingredientes e dietas para leitões,por meio de diferentes medidas: pH inicial (pHi),acidez ou alcalinidade tituláveis (AT) e CT. Foramutilizadas 32 amostras de diferentes ingredientes,pré-misturas e dietas, classificadas como aminoácidos,suplementos minerais, cereais e subprodutos,soja e subprodutos, ingredientes de origem animale dietas completas. O pHi foi mensurado em trêssoluções com 10 g de amostra diluídas em 90 ml deágua destilada e deionizada, nas quais foi adicionadoácido clorídrico, ou ácido fórmico ou um acidificantecomercial à base de ácido fórmico, para reduzir opH até 5,0, ou NaOH, quando o pHi foi menor que5,0. A AT foi definida como a quantidade de ácidoou base necessária para alterar o pH entre o pHie 5,0, expresso em mEq/100 g de matéria seca deamostra. A CT foi calculada dividindo-se os valoresde AT pelo intervalo de pH considerado, sendo osvalores obtidos com cada ácido considerados replicatasde cada amostra. Os resultados com cadamedida foram submetidos à ANOVA considerandoas classificações. A correlação entre o pHi e a CTfoi também avaliada. Os suplementos minerais e osaminoácidos apresentaram valores extremos emtodas as medidas, e foram separados em subgrupos.As classes soja, cereais e dietas mostraram valoressimilares de pHi, mas diferiram quanto às outras medidas(P<0,05). A CT demonstrou mais sensibilidadeque a AT. O pHi apresentou correlação inconsistentecom a CT, não sendo uma estimativa confiável destapropriedade físico-química.
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Gonçalves M, Maluta RP, Dahlke F, Maiorka A, Ávila FA. Avaliação da capacidade imunoestimulante e da estabilidade de um probiótico empregado em rações de cães. AVS 2007. [DOI: 10.5380/avs.v12i2.9905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Foi avaliado um probiótico termo-resistente,liofilizado e encapsulado, composto de Bacilluscereus (ATCC 9634) 4,0 x l08 UFC/g e Bacillus subtilis(CCT 3131) 4,0 x l08 UFC/g, incorporado emuma ração comercial para cães com o objetivo deavaliar sua viabilidade durante o período de umano, e o seu efeito imunoestimulante quando fornecidoàs dietas. No primeiro experimento, foi avaliadaa sobrevivência das bactérias quantitativamentee qualitativamente depois de 3, 6, 9, 12 meses deestocagem. No segundo ensaio, foram utilizados 10cães (machos e fêmeas) com peso variando de 10a 30 kg, sem raças definidas, divididos em dois gruposde cinco animais cada. Todos os animais semtítulo sorológico anti-leptospira, foram vacinadoscontra os sorovares canicola e icterohaemorrhagiaeno início do experimento e mantidos em canis individuaisdurante 60 dias. Os animais do grupo Ireceberam ração extrusada acrescida de ProbióticoTR e, os animais do grupo II receberam a mesmaração extrusada sem o Probiótico TR, sendo mantidoscomo controles. Os títulos de anticorpos contraos sorovares canicola e icterohaemorrhagiae foramdeterminados antes da vacinação, no 15o, 30o e 60odia após, utilizando a reação de soro-aglutinaçãomicroscópica com antígenos vivos. Pelos resultadosda contagem total de esporos nas rações extrusadae farelada, o probiótico TR é notadamente estávelpor período superior a 12 meses. O estímuloda resposta imune foi verificado pela elevação dostítulos dos animais do grupo I no 15o, 30o e 60o diaapós a vacinação. Este fato é atribuído à ingestãodo probiótico TR, uma vez que entre os animais quenão receberam ração com probiótico TR (grupo II), a resposta imune foi menor e instável.
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Rosa PS, Faria Filho DE, Dahlke F, Vieira BS, Macari M, Furlan RL. Performance and carcass characteristics of broiler chickens with different growth potential and submitted to heat stress. Rev Bras Cienc Avic 2007. [DOI: 10.1590/s1516-635x2007000300007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- PS Rosa
- Embrapa Suínos e Aves; Universidade do Contestado, Brasil; Universidade Estadual Paulista, Brasil
| | | | - F Dahlke
- Universidade Federal do Paraná, Brasil
| | - BS Vieira
- Universidade Estadual Paulista, Brasil
| | - M Macari
- Universidade Estadual Paulista, Brasil
| | - RL Furlan
- Universidade Estadual Paulista, Brasil
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Opalinski M, Maiorka A, Dahlke F, Cunha F, Vargas FSC, Cardozo E. On the use of a probiotic (Bacillus subtilis - strain DSM 17299) as growth promoter in broiler diets. Rev Bras Cienc Avic 2007. [DOI: 10.1590/s1516-635x2007000200004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | | | | | - F Cunha
- Universidade Federal do Paraná
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