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Russo G, Di Bartolo P, Candido R, Lucisano G, Manicardi V, Giandalia A, Nicolucci A, Rocca A, Rossi MC, Di Cianni G. Corrigendum to "The AMD ANNALS: A continuous initiative for the improvement of type 2 diabetes care" [Diabetes Res. and Clin. Pract. 199 (2023) 110672]. Diabetes Res Clin Pract 2024; 210:111619. [PMID: 38580525 DOI: 10.1016/j.diabres.2024.111619] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
- G Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - P Di Bartolo
- Ravenna Diabetes Center - Romagna Local Health Authority, Ravenna, Italy
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | | | - A Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - A Rocca
- "G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy
| | - M C Rossi
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - G Di Cianni
- USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy
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Glaser A, Butzkueven H, van der Walt A, Gray O, Spelman T, Zhu C, Trojano M, Iaffaldano P, Battaglia MA, Lucisano G, Vukusic S, Vukusic I, Casey R, Horakova D, Drahota J, Magyari M, Joensen H, Pontieri L, Elberling F, Klyve P, Mouresan EF, Forsberg L, Hillert J. Big Multiple Sclerosis Data network: an international registry research network. J Neurol 2024:10.1007/s00415-024-12303-6. [PMID: 38561543 DOI: 10.1007/s00415-024-12303-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The Big Multiple Sclerosis Data (BMSD) network ( https://bigmsdata.org ) was initiated in 2014 and includes the national multiple sclerosis (MS) registries of the Czech Republic, Denmark, France, Italy, and Sweden as well as the international MSBase registry. BMSD has addressed the ethical, legal, technical, and governance-related challenges for data sharing and so far, published three scientific papers on pooled datasets as proof of concept for its collaborative design. DATA COLLECTION Although BMSD registries operate independently on different platforms, similarities in variables, definitions and data structure allow joint analysis of data. Certain coordinated modifications in how the registries collect adverse event data have been implemented after BMSD consensus decisions, showing the ability to develop together. DATA MANAGEMENT Scientific projects can be proposed by external sponsors via the coordinating centre and each registry decides independently on participation, respecting its governance structure. Research datasets are established in a project-to-project fashion and a project-specific data model is developed, based on a unifying core data model. To overcome challenges in data sharing, BMSD has developed procedures for federated data analysis. FUTURE PERSPECTIVES Presently, BMSD is seeking a qualification opinion from the European Medicines Agency (EMA) to conduct post-authorization safety studies (PASS) and aims to pursue a qualification opinion also for post-authorization effectiveness studies (PAES). BMSD aspires to promote the advancement of real-world evidence research in the MS field.
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Affiliation(s)
- Anna Glaser
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Orla Gray
- South Eastern Health and Social Care Trust, Belfast, UK
| | - Tim Spelman
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Maria Trojano
- School of Medicine, University "Aldo Moro", Bari, Italy
| | - Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences, DiBraiN University of Bari Aldo Moro, Bari, Italy
| | - Mario A Battaglia
- Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Giuseppe Lucisano
- Department of Translational Biomedicine and Neurosciences, DiBraiN University of Bari Aldo Moro, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology-CORESEARCH, Pescara, Italy
| | - Sandra Vukusic
- Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69677, Bron, France
- INSERM 1028 et CNRS UMR 5292, Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, 69003, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, 69000, Lyon, France
- Eugène Devic EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, 69677, Bron, France
| | - Irena Vukusic
- Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69677, Bron, France
- INSERM 1028 et CNRS UMR 5292, Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, 69003, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, 69000, Lyon, France
- Eugène Devic EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, 69677, Bron, France
| | - Romain Casey
- Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69677, Bron, France
- INSERM 1028 et CNRS UMR 5292, Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, 69003, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, 69000, Lyon, France
- Eugène Devic EDMUS Foundation Against Multiple Sclerosis, State-Approved Foundation, 69677, Bron, France
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jiri Drahota
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic
- IMPULS Endowment Fund, Prague, Czech Republic
| | - Melinda Magyari
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital Rigshospitalet, 2100, Copenhagen, Denmark
| | - Hanna Joensen
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Luigi Pontieri
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik Elberling
- The Danish Multiple Sclerosis Registry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pernilla Klyve
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | | | - Lars Forsberg
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
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Iaffaldano P, Lucisano G, Guerra T, Patti F, Cocco E, De Luca G, Brescia Morra V, Pozzilli C, Zaffaroni M, Ferraro D, Gasperini C, Salemi G, Bergamaschi R, Lus G, Inglese M, Romano S, Bellantonio P, Di Monte E, Maniscalco GT, Conte A, Lugaresi A, Vianello M, Torri Clerici VLA, Di Sapio A, Pesci I, Granella F, Totaro R, Marfia GA, Danni MC, Cavalla P, Valentino P, Aguglia U, Montepietra S, Ferraro E, Protti A, Spitaleri D, Avolio C, De Riz M, Maimone D, Cavaletti G, Gazzola P, Tedeschi G, Sessa M, Rovaris M, Di Palma F, Gatto M, Cargnelutti D, De Robertis F, Logullo FO, Rini A, Meucci G, Ardito B, Banfi P, Nasuelli D, Paolicelli D, Rocca MA, Portaccio E, Chisari CG, Fenu G, Onofrj M, Carotenuto A, Ruggieri S, Tortorella C, Ragonese P, Nica M, Amato MP, Filippi M, Trojano M. Evaluation of drivers of treatment switch in relapsing multiple sclerosis: a study from the Italian MS Registry. J Neurol 2024; 271:1150-1159. [PMID: 38135850 DOI: 10.1007/s00415-023-12137-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Active relapsing-remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) are currently defined as "relapsing MS" (RMS). The aim of this cross-sectional study was to assess drivers of treatment switches due to clinical relapses in a population of RMS patients collected in the Italian MS and Related Disorders Register (I-MS&RD). METHODS RRMS and SPMS patients with at least one relapse in a time window of 2 years before of data extraction were defined as RMS. Factors associated with disease-modifying therapy (DMT) switching due to clinical activity were assessed through multivariable logistic regression models in which treatment exposure was included as the last recorded DMT and the last DMT's class [moderate-efficacy (ME), high-efficacy (HE) DMTs and anti-CD20 drugs]. RESULTS A cohort of 4739 RMS patients (4161 RRMS, 578 SPMS) was extracted from the I-MS&RD. A total of 2694 patients switching DMTs due to relapses were identified. Switchers were significantly (p < 0.0001) younger, less disabled, more frequently affected by an RR disease course in comparison to non-switcher patients. The multivariable logistic regression models showed that Alemtuzumab (OR 0.08, 95% CI 0.02-0.37), Natalizumab (0.48, 0.30-0.76), Ocrelizumab (0.1, 0.02-0.45) and Rituximab (0.23, 0.06-0.82) exposure was a protective factor against treatment switch due to relapses. Moreover, the use of HE DMTs (0.43, 0.31-0.59), especially anti-CD20 drugs (0.14, 0.05-0.37), resulted to be a protective factor against treatment switch due to relapses in comparison with ME DMTs. CONCLUSIONS More than 50% of RMS switched therapy due to disease activity. HE DMTs, especially anti-CD20 drugs, significantly reduce the risk of treatment switch.
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Affiliation(s)
- Pietro Iaffaldano
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Giuseppe Lucisano
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Tommaso Guerra
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche E Chirurgiche E Tecnologie Avanzate, GF Ingrassia, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico-San Marco, Università di Catania, Catania, Italy
| | - Eleonora Cocco
- Department of Medical Science and Public Health, University of Cagliari/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy
| | - Giovanna De Luca
- Centro Sclerosi MultiplaClinica Neurologica, Policlinico SS Annunziata, Università "G. d'Annunzio", Chieti-Pescara, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Center, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Mauro Zaffaroni
- Neuroimmunology Unit and Multiple Sclerosis Center, ASST Della Valle Olona, Hospital of Gallarate, Via Pastori 4, 21013, Gallarate, VA, Italy
| | - Diana Ferraro
- Department of Neurosciences, Ospedale Civile di BaggiovaraAzienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Claudio Gasperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | | | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Matilde Inglese
- Dipartimento di NeuroscienzeRiabilitazioneOftalmologiaGenetica e Scienze Materno-Infantili (DINOGMI), Universita' di Genova, Genova, Italy
- IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, 00189, Rome, Italy
| | | | - Elisabetta Di Monte
- Center for Multiple Sclerosis, Hospital ASL 4 "Madonna delle Grazie", 75100, Matera, Italy
| | | | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy
- Neurophysiopatology Unit, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Marika Vianello
- MS Unit, OU Neurology "Ca' Foncello" Hospital, Treviso, Italy
| | | | - Alessia Di Sapio
- Department of Neurology, Regional Referral Multiple Sclerosis Center, University Hospital San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Ilaria Pesci
- Neurology Unit, Ospedale Vaio-Fidenza, Parma, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rocco Totaro
- Centro Malattie Demielinizzanti-Clinica Neurologica, Ospedale San Salvatore, L'Aquila, Coppito, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, 00133, Rome, Italy
| | - Maura Chiara Danni
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Paola Cavalla
- Centro Sclerosi Multipla e Neurologia 1 D.U, Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paola Valentino
- Istituto di neurologia, Università Magna Graecia Catanzaro, Catanzaro, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Sara Montepietra
- MS Centre, SMN Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
| | | | | | | | - Carlo Avolio
- MS Center, University of Neurology, Foggia, Italy
| | - Milena De Riz
- Centro Sclerosi Multipla-Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, ARNAS Garibaldi, Catania, Italy
| | | | - Paola Gazzola
- SC Neurologia, Ospedale P. Antero Micone-ASL 3 Genovese, Genoa, Italy
| | - Gioacchino Tedeschi
- I Division of Neurology, Universita della Campania "L. Vanvitelli", Naples, Italy
| | - Maria Sessa
- Centro Provinciale Sclerosi Multipla, ASST papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rovaris
- MS Center, Scientific Institute Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Franco Di Palma
- SM Center Neurology Department, ASST Lariana S. Anna Hospital, Como, Italy
| | - Maurizia Gatto
- Centro Malattie Demielinizzanti, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | | | | | | | - Augusto Rini
- Centro Sclerosi Multipla, Ospedale A. Perrino, Brindisi, Italy
| | - Giuseppe Meucci
- Ambulatorio Sclerosi MultiplaUnita' Operativa di Neurologia e Neurofisiopatologia, Spedali Riuniti di Livorno, Livorno, Italy
| | - Bonaventura Ardito
- Centro Sclerosi Mutipla UOC di Neurologia, Ospedale Della Murgia Fabio Perinei, Altamura, Italy
| | - Paola Banfi
- Dipartimento di Neurologia, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Davide Nasuelli
- ASST Della Valle Olona Presidio Ospedaliero di Saronno Ambulatorio Sclerosi Multipla, Saronno, Italy
| | - Damiano Paolicelli
- Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy
| | - Maria Assunta Rocca
- Neurology Unit and Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Emilio Portaccio
- Department of NEUROFARBA, University of Florence, Viale Pieraccini 6, Florence, Italy
| | - Clara Grazia Chisari
- Dipartimento di Scienze Mediche E Chirurgiche E Tecnologie Avanzate, GF Ingrassia, Università di Catania, Via Santa Sofia 78, 95123, Catania, Italy
- UOS Sclerosi Multipla, AOU Policlinico G Rodolico-San Marco, Università di Catania, Catania, Italy
| | - Giuseppe Fenu
- Department of Medical Science and Public Health, University of Cagliari/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy
| | - Marco Onofrj
- Centro Sclerosi MultiplaClinica Neurologica, Policlinico SS Annunziata, Università "G. d'Annunzio", Chieti-Pescara, Italy
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Multiple Sclerosis Clinical Care and Research Center, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Serena Ruggieri
- Department of Human Neurosciences, Sapienza University of Roma, Rome, Italy
| | - Carla Tortorella
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Paolo Ragonese
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | | | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Viale Pieraccini 6, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Massimo Filippi
- Neurology and Neurorehabilitation Units, Neurophysiology Service, Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Trojano
- School of Medicine, University "Aldo Moro" Bari, Piazza Giulio Cesare 11, Bari, Italy.
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Mameli C, Rigamonti A, Felappi B, Nicolucci A, Lucisano G, Baresi S, Florini G, Macedoni M, Petitti A, Hajro A, Tortu G, Pistone C, Guerraggio LP, Zampolli M, Zuccotti G, Bonfanti R. Performance of Tandem Control IQ During Outdoor Physical Activity in Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2024; 26:112-118. [PMID: 38032850 DOI: 10.1089/dia.2023.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Background: Few data are available in children with type 1 diabetes using automated insulin delivery systems during physical activity (PA). We evaluated the time in range (TIR) during 2-h of outdoor PA in children using t:slim X2 with Control-IQ® technology. Materials and Methods: Caucasian children and adolescents, aged 9-18 years using t:slim X2 with Control-IQ technology were recruited during a local sporting event. Participants were divided into two groups: Group A practiced endurance activities for 60 min (1000-meter run, a jump circuit) and then power activities for 60 min (80-meter run, long jump); Group B practiced power activities for 60 min and then followed by endurance activities for 60 min. Ninety minutes before the PA, participants had lunch and self-administered a low-dose insulin, reduced by 50% compared to their regularly calculated meal dose per pump calculator. DexcomG6® data were downloaded. Results: Twenty-six children were recruited, 2 refused PA. Participants were divided as follows: 13 in Group A (7 males, median age 14.6 years) and 11 in Group B (8 males, median age 13.5 year). The mean glucose level when PA started was similar between groups (P = 0.06). Subjects in Group B showed a higher TIR than those in Group A ([50.4%, 95% confidence interval, CI: 33.8-75] vs. 39.6% [95% CI: 26.9-58.3], respectively [P = 0.39]). A significantly better TIR in Group B (53.8%, 95% CI: 30.2-96.1) compared to Group A (17.4%, 95% CI: 7.3-41.7, P = 0.02) was recorded during the first session. During the second session, TIR increased in both groups. There were no episodes of serious or severe hypoglycemia. Conclusions: No serious or severe hypoglycemic episodes were recorded during PA performed 90 min after lunch. Future studies using t:slim X2 with Control-IQ technology are necessary.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Andrea Rigamonti
- Diabetology Unit, Ospedale San Raffaele, Diabetes Research Institute of Milan, Milan, Italy
| | - Barbara Felappi
- Department of Pediatrics, Spedali Civili di Brescia, Brescia, Italy
| | - Antonio Nicolucci
- CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Giuseppe Lucisano
- CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Stefano Baresi
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
| | - Giorgia Florini
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
| | | | - Agnese Petitti
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
| | - Adelina Hajro
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
| | | | - Carmelo Pistone
- Clinica Pediatrica, IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Maria Zampolli
- Department of Pediatrics, Ospedale Sant'Anna, Como, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Riccardo Bonfanti
- Diabetology Unit, Ospedale San Raffaele, Diabetes Research Institute of Milan, Milan, Italy
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5
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Iaffaldano P, Portaccio E, Lucisano G, Simone M, Manni A, Guerra T, Paolicelli D, Betti M, De Meo E, Pastò L, Razzolini L, Rocca MA, Ferrè L, Brescia Morra V, Patti F, Zaffaroni M, Gasperini C, De Luca G, Ferraro D, Granella F, Pozzilli C, Romano S, Gallo P, Bergamaschi R, Coniglio MG, Lus G, Vianello M, Banfi P, Lugaresi A, Totaro R, Spitaleri D, Cocco E, Di Palma F, Maimone D, Valentino P, Torri Clerici V, Protti A, Maniscalco GT, Salemi G, Pesci I, Aguglia U, Lepore V, Filippi M, Trojano M, Amato MP. Multiple Sclerosis Progression and Relapse Activity in Children. JAMA Neurol 2024; 81:50-58. [PMID: 38010712 PMCID: PMC10682937 DOI: 10.1001/jamaneurol.2023.4455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023]
Abstract
Importance Although up to 20% of patients with multiple sclerosis (MS) experience onset before 18 years of age, it has been suggested that people with pediatric-onset MS (POMS) are protected against disability because of greater capacity for repair. Objective To assess the incidence of and factors associated with progression independent of relapse activity (PIRA) and relapse-associated worsening (RAW) in POMS compared with typical adult-onset MS (AOMS) and late-onset MS (LOMS). Design, Setting, and Participants This cohort study on prospectively acquired data from the Italian MS Register was performed from June 1, 2000, to September 30, 2021. At the time of data extraction, longitudinal data from 73 564 patients from 120 MS centers were available in the register. Main Outcomes and Measures The main outcomes included age-related cumulative incidence and adjusted hazard ratios (HRs) for PIRA and RAW and associated factors. Exposures Clinical and magnetic resonance imaging features, time receiving disease-modifying therapy (DMT), and time to first DMT. Results After applying the inclusion and exclusion criteria, the study assessed 16 130 patients with MS (median [IQR] age at onset, 28.7 [22.8-36.2 years]; 68.3% female). Compared with AOMS and LOMS, patients with POMS had less disability, exhibited more active disease, and were exposed to DMT for a longer period. A first 48-week-confirmed PIRA occurred in 7176 patients (44.5%): 558 patients with POMS (40.4%), 6258 patients with AOMS (44.3%), and 360 patients with LOMS (56.8%) (P < .001). Factors associated with PIRA were older age at onset (AOMS vs POMS HR, 1.42; 95% CI, 1.30-1.55; LOMS vs POMS HR, 2.98; 95% CI, 2.60-3.41; P < .001), longer disease duration (HR, 1.04; 95% CI, 1.04-1.05; P < .001), and shorter DMT exposure (HR, 0.69; 95% CI, 0.64-0.74; P < .001). The incidence of PIRA was 1.3% at 20 years of age, but it rapidly increased approximately 7 times between 21 and 30 years of age (9.0%) and nearly doubled for each age decade from 40 to 70 years (21.6% at 40 years, 39.0% at 50 years, 61.0% at 60 years, and 78.7% at 70 years). The cumulative incidence of RAW events followed a similar trend from 20 to 60 years (0.5% at 20 years, 3.5% at 30 years, 7.8% at 40 years, 14.4% at 50 years, and 24.1% at 60 years); no further increase was found at 70 years (27.7%). Delayed DMT initiation was associated with higher risk of PIRA (HR, 1.16; 95% CI, 1.00-1.34; P = .04) and RAW (HR, 1.75; 95% CI, 1.28-2.39; P = .001). Conclusions and Relevance PIRA can occur at any age, and although pediatric onset is not fully protective against progression, this study's findings suggest that patients with pediatric onset are less likely to exhibit PIRA over a decade of follow-up. However, these data also reinforce the benefit for DMT initiation in patients with POMS, as treatment was associated with reduced occurrence of both PIRA and RAW regardless of age at onset.
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Affiliation(s)
- Pietro Iaffaldano
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Emilio Portaccio
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Giuseppe Lucisano
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Marta Simone
- Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica (DiMePRe-J), University of Bari Aldo Moro, Bari, Italy
| | - Alessia Manni
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Tommaso Guerra
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Damiano Paolicelli
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Matteo Betti
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Ermelinda De Meo
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Luisa Pastò
- Department of Neurofarba, University of Florence, Florence, Italy
| | | | - Maria A. Rocca
- Neurology Unit and MS Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Ferrè
- Neurology Unit and MS Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center, Department of Neuroscience (NSRO), Federico II University, Naples, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Catania, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate (Varese), Italy
| | - Claudio Gasperini
- Centro Sclerosi Multipla–Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS. Annunziata, Chieti, Italy
| | - Diana Ferraro
- Department of Neurosciences, Ospedale Civile di Baggiovara, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Department of Human Neuroscience, S. Andrea Hospital, Rome, Italy
| | - Silvia Romano
- Department of Neurosciences, Mental Health and Sensory Organs, Centre for Experimental Neurological Therapies (CENTERS), Sapienza University of Rome, Rome, Italy
| | - Paolo Gallo
- Department of Neurosciences, Multiple Sclerosis Centre–Veneto Region (CeSMuV), University Hospital of Padua, Padua, Italy
| | | | | | - Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | | | - Paola Banfi
- Neurology and Stroke Unit, University of Insubria, Varese, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Rocco Totaro
- San Salvatore Hospital, Demyelinating Disease Center, L’Aquila, Italy
| | - Daniele Spitaleri
- Department of Neurology, AORN San G. Moscati di Avellino, Avellino, Italy
| | - Eleonora Cocco
- University of Cagliari, Department of Medical Science and Public Health, Centro Sclerosi Multipla, Cagliari, Italy
| | - Franco Di Palma
- Department of Neurology, ASST Lariana Ospedale S. Anna, Como, Italy
| | - Davide Maimone
- Department of Neurology, Ospedale Garibaldi, Catania, Italy
| | - Paola Valentino
- Institute of Neurology, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | | | | | | | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, UO Neurology, Fidenza Hospital, Fidenza, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Vito Lepore
- Public Health Department, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Massimo Filippi
- Neurology Unit and MS Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Trojano
- Department of Translational Biomedicines and Neurosciences, University of Bari Aldo Moro, Bari, Italy
| | - Maria Pia Amato
- Department of Neurofarba, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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6
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D’Erasmo L, Di Martino M, Neufeld T, Fraum TJ, Kang CJ, Burks KH, Costanzo AD, Minicocci I, Bini S, Maranghi M, Pigna G, Labbadia G, Zheng J, Fierro D, Montali A, Ceci F, Catalano C, Davidson NO, Lucisano G, Nicolucci A, Arca M, Stitziel NO. ANGPTL3 Deficiency and Risk of Hepatic Steatosis. Circulation 2023; 148:1479-1489. [PMID: 37712257 PMCID: PMC10805521 DOI: 10.1161/circulationaha.123.065866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/24/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND ANGPTL3 (angiopoietin-like 3) is a therapeutic target for reducing plasma levels of triglycerides and low-density lipoprotein cholesterol. A recent trial with vupanorsen, an antisense oligonucleotide targeting hepatic production of ANGPTL3, reported a dose-dependent increase in hepatic fat. It is unclear whether this adverse effect is due to an on-target effect of inhibiting hepatic ANGPTL3. METHODS We recruited participants with ANGPTL3 deficiency related to ANGPTL3 loss-of-function (LoF) mutations, along with wild-type (WT) participants from 2 previously characterized cohorts located in Campodimele, Italy, and St. Louis, MO. Magnetic resonance spectroscopy and magnetic resonance proton density fat fraction were performed to measure hepatic fat fraction and the distribution of extrahepatic fat. To estimate the causal relationship between ANGPTL3 and hepatic fat, we generated a genetic instrument of plasma ANGPTL3 levels as a surrogate for hepatic protein synthesis and performed Mendelian randomization analyses with hepatic fat in the UK Biobank study. RESULTS We recruited participants with complete (n=6) or partial (n=32) ANGPTL3 deficiency related to ANGPTL3 LoF mutations, as well as WT participants (n=92) without LoF mutations. Participants with ANGPTL3 deficiency exhibited significantly lower total cholesterol (complete deficiency, 78.5 mg/dL; partial deficiency, 172 mg/dL; WT, 188 mg/dL; P<0.05 for both deficiency groups compared with WT), along with plasma triglycerides (complete deficiency, 26 mg/dL; partial deficiency, 79 mg/dL; WT, 88 mg/dL; P<0.05 for both deficiency groups compared with WT) without any significant difference in hepatic fat (complete deficiency, 9.8%; partial deficiency, 10.1%; WT, 9.9%; P>0.05 for both deficiency groups compared with WT) or severity of hepatic steatosis as assessed by magnetic resonance imaging. In addition, ANGPTL3 deficiency did not alter the distribution of extrahepatic fat. Results from Mendelian randomization analyses in 36 703 participants from the UK Biobank demonstrated that genetically determined ANGPTL3 plasma protein levels were causally associated with low-density lipoprotein cholesterol (P=1.7×10-17) and triglycerides (P=3.2×10-18) but not with hepatic fat (P=0.22). CONCLUSIONS ANGPTL3 deficiency related to LoF mutations in ANGPTL3, as well as genetically determined reduction of plasma ANGPTL3 levels, is not associated with hepatic steatosis. Therapeutic approaches to inhibit ANGPTL3 production in hepatocytes are not necessarily expected to result in the increased risk for hepatic steatosis that was observed with vupanorsen.
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Affiliation(s)
- Laura D’Erasmo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Michele Di Martino
- Department of Radiological Sciences, Oncology, Anatomical Pathology, Sapienza University of Rome, Rome, Italy
| | - Thomas Neufeld
- Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Tyler J. Fraum
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Chul Joo Kang
- McDonnell Genome Institute, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Kendall H. Burks
- Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alessia Di Costanzo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilenia Minicocci
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Simone Bini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marianna Maranghi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanni Pigna
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Labbadia
- Department of Internal Medicine, Anesthesiology, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | | | - Anna Montali
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabrizio Ceci
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology, Anatomical Pathology, Sapienza University of Rome, Rome, Italy
| | - Nicholas O. Davidson
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Giuseppe Lucisano
- CORESEARCH Srl - Center for Outcomes Research and Clinical Epidemiology, Pescara Italy
| | - Antonio Nicolucci
- CORESEARCH Srl - Center for Outcomes Research and Clinical Epidemiology, Pescara Italy
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Nathan O. Stitziel
- Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
- McDonnell Genome Institute, Washington University School of Medicine, Saint Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, Saint Louis, Missouri, USA
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7
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Giandalia A, Russo GT, Ruggeri P, Giancaterini A, Brun E, Cristofaro M, Bogazzi A, Rossi MC, Lucisano G, Rocca A, Manicardi V, Bartolo PD, Cianni GD, Giuliani C, Napoli A. The Burden of Obesity in Type 1 Diabetic Subjects: A Sex-specific Analysis From the AMD Annals Initiative. J Clin Endocrinol Metab 2023; 108:e1224-e1235. [PMID: 37247381 PMCID: PMC10584007 DOI: 10.1210/clinem/dgad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Obesity is a growing emergency in type 1 diabetes (T1D). Sex differences in obesity prevalence and its clinical consequences in adult T1D subjects have been poorly investigated. The aim of this study was to investigate the prevalence of obesity and severe obesity, clinical correlates, and potential sex differences in a large cohort of T1D subjects participating to the AMD (Associazione Medici Diabetologi) Annals Initiative in Italy. RESEARCH DESIGN AND METHODS The prevalence of obesity [body mass index(BMI) ≥30 kg/m2] and severe obesity (BMI ≥ 35 kg/m2) according to sex and age, as well as obesity-associated clinical variables, long-term diabetes complications, pharmacological treatment, process indicators and outcomes, and overall quality of care (Q-score) were evaluated in 37 436 T1D subjects (45.3% women) attending 282 Italian diabetes clinics during 2019. RESULTS Overall, the prevalence of obesity was similar in the 2 sexes (13.0% in men and 13.9% in women; mean age 50 years), and it increased with age, affecting 1 out of 6 subjects ages >65 years. Only severe obesity (BMI >35 kg/m2) was more prevalent among women, who showed a 45% higher risk of severe obesity, compared with men at multivariate analysis. Cardiovascular disease risk factors (lipid profile, glucose, and blood pressure control), and the overall quality of diabetes care were worse in obese subjects, with no major sex-related differences. Also, micro- and macrovascular complications were more frequent among obese than nonobese T1D men and women. CONCLUSIONS Obesity is a frequent finding in T1D adult subjects, and it is associated with a higher burden of cardiovascular disease risk factors, micro- and macrovascular complications, and a lower quality of care, with no major sex differences. T1D women are at higher risk of severe obesity.
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Affiliation(s)
- Annalisa Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | | | | | - Annalisa Giancaterini
- UOSD Endocrine, Metabolic and Nutrition Diseases, ASST Brianza, Desio Hospital, 20832 Desio, Italy
| | - Elisabetta Brun
- UOC Endocrine, Metabolic and Nutrition Diseases, Ospedale Civile di Vicenza, 36100 Vicenza, Italy
| | | | - Anna Bogazzi
- SSVD Diabetes and Endocrine Diseases, ASL TO 3, 10024 Torino, Italy
| | - Maria Chiara Rossi
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, 75100 Pescara, Italy
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, 75100 Pescara, Italy
| | - Alberto Rocca
- SS Diabetes and Metabolic disease, Bassini Hospital, Cinisello Balsamo, 20019 Milano, Italy
| | | | | | - Graziano Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit North-West Tuscany, 57100 Livorno, Italy
| | - Chiara Giuliani
- Department of Experimental Medicine, Sapienza University of Rome, 00044 Rome, Italy
| | - Angela Napoli
- Israelitico Hospital, 00044 Rome, Italy
- Cdc Santa Famiglia, 00044 Rome, Italy
- Human Nutrition Sciences, International Medical University Unicamillus, 00044 Rome, Italy
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8
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Ceriello A, Lucisano G, Prattichizzo F, La Grotta R, Frigé C, De Cosmo S, Di Bartolo P, Di Cianni G, Fioretto P, Giorda CB, Pontremoli R, Russo G, Viazzi F, Nicolucci A. The legacy effect of hyperglycemia and early use of SGLT-2 inhibitors: a cohort study with newly-diagnosed people with type 2 diabetes. Lancet Reg Health Eur 2023; 31:100666. [PMID: 37547276 PMCID: PMC10398589 DOI: 10.1016/j.lanepe.2023.100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 08/08/2023]
Abstract
Background A delay in reaching HbA1c targets in patients with newly-diagnosed type 2 diabetes (T2D) is associated with an increased long-term risk of developing cardiovascular diseases (CVD), a phenomenon referred to as legacy effect. Whether an early introduction of glucose-lowering drugs with proven benefit on CVD can attenuate this phenomenon is unknown. Methods Using data derived from a large Italian clinical registry, i.e. the AMD Annals, we identified 251,339 subjects with newly-diagnosed T2D and without CVD at baseline. Through Cox regressions adjusted for multiple risk factors, we examined the association between having a mean HbA1c between 7.1 and 8% or >8%, compared with ≤7%, for various periods of early exposure (0-1, 0-2, 0-3 years) and the development of later (mean subsequent follow-up 4.6 ± 2.9 years) CVD, evaluated as a composite of myocardial infarction, stroke, coronary or peripheral revascularization, and coronary or peripheral bypass. We performed this analysis in the overall cohort and then splitting the population in two groups of patients: those that introduced sodium-glucose transport protein 2 inhibitors (SGLT-2i) during the exposure phase and those not treated with these drugs. Findings Considering the whole cohort, subjects with both a mean HbA1c between 7.1 and 8% and >8%, compared with patients attaining a mean HbA1c ≤ 7%, showed an increased risk of developing the outcome in all the three early exposure periods assessed, with the highest risk observed in patients with mean HbA1c > 8% in the 3 years exposure period (hazard ratio [HR]1.33; 95% confidence interval [CI] 1.063-1.365). The introduction of SGLT-2i during the exposure periods of 0-1 and 0-2 years eliminated the association between poor glycemic control and the outcome (p for interaction 0.006 and 0.003, respectively, vs. patients with the same degree of glycemic control but not treated with these drugs). Interpretation Among patients with newly diagnosed T2D and free of CVD at baseline, a poor glycemic control in the first three years after diagnosis is associated with an increased subsequent risk of CVD. This association is no longer evident when SGLT-2i are introduced in the first two years, suggesting that these drugs attenuate the phenomenon of legacy effect. An early treatment with these drugs might thus promote a long-lasting benefit in patients not attaining proper glycemic control after T2D diagnosis. Funding This work was supported, in part, by the Italian Ministry of Health (Ricerca Corrente) to IRCCS MultiMedica.
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Affiliation(s)
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | | | | | - Salvatore De Cosmo
- Department of Medical Sciences, Scientific Institute “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, FG, Italy
| | - Paolo Di Bartolo
- Ravenna Diabetes Center, Department of Specialist Medicine, Romagna Local Health Authority, Italy
| | | | - Paola Fioretto
- Department of Medicine, University of Padua, Unit of Medical Clinic 3, Hospital of Padua, Padua, Italy
| | | | - Roberto Pontremoli
- IRCCS Ospedale Policlinico San Martino; Dipartimento di Medicina Interna, Università degli studi di Genova, Genoa, Italy
| | - Giuseppina Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesca Viazzi
- IRCCS Ospedale Policlinico San Martino; Dipartimento di Medicina Interna, Università degli studi di Genova, Genoa, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
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9
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Russo G, Di Bartolo P, Candido R, Lucisano G, Manicardi V, Giandalia A, Nicolucci A, Rocca A, Rossi MC, Di Cianni G. The AMD ANNALS: A continuous initiative for the improvement of type 2 diabetes care. Diabetes Res Clin Pract 2023; 199:110672. [PMID: 37084893 DOI: 10.1016/j.diabres.2023.110672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
AIMS Since 2006, the Italian AMD (Associations of Medical Diabetologists) Annals Initiative promoted a continuous monitoring of the quality of diabetes care, that was effective in improving process, treatment and outcome indicators through a periodic assessment of standardized measures. Here, we show the 2022 AMD Annals data on type 2 diabetes (T2D). METHODS A network involving ∼1/3 of diabetes centers in Italy periodically extracts anonymous data from electronic clinical records, by a standardized software. Process, treatment and outcome indicators, and a validated score of overall care, the Q-score, were evaluated. RESULTS 295 centers provided the annual sample of 502,747 T2D patients. Overall, HbA1c value ≤7.0% was documented in 54.6% of patients, blood pressure <130/80 mmHg in 23.0%, and LDL-cholesterol levels <70 mg/dl in 34.3%, but only 5.2% were at- target for all the risk factors. As for innovative drugs, 29.0% of patients were on SGLT2-i, and 27.5% on GLP1-RAs. In particular, 59.7% were treated with either GLP1-RAs or SGLT2-i among those with established cardiovascular disease (CVD), 26.6% and 49.3% with SGLT2-i among those with impaired renal function and heart failure, respectively. Notably, only 3.2% of T2D patients showed a Q score <15, which correlates with a 80% higher risk of incident CVD events compared to scores >25. CONCLUSIONS The 2022 AMD Annals data show an improvement in the use of innovative drugs and in the overall quality of T2D care in everyday clinical practice. However, additional efforts are needed to reach the recommended targets for HbA1c and major CVD risk factors.
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Affiliation(s)
- G Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - P Di Bartolo
- Ravenna Diabetes Center - Romagna Local Health Authority, Ravenna, Italy
| | - R Candido
- Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | | | - A Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - A Rocca
- "G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy
| | - M C Rossi
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - G Di Cianni
- USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy
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10
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Ceriello A, Lucisano G, Prattichizzo F, La Grotta R, Franzén S, Gudbjörnsdottir S, Eliasson B, Nicolucci A. Risk factors variability and cardiovascular risk among patients with diabetes: a nationwide observational study. Eur J Prev Cardiol 2023:7075632. [PMID: 36897149 DOI: 10.1093/eurjpc/zwad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Cardiovascular risk factors control is fluctuating, tends to change over time, and is potentially impacted by multifactorial interactions. Currently, the existence of risk factors, rather than their variability or interplay with one another, is used to define the population at risk. The association between variability of risk factors and cardiovascular morbidity and mortality risk among patients with T2DM remains debatable. METHODS Using registry-derived data, we identified 29,471 people with T2D, without CVD at baseline, and with at least five measurements of risk factors. Variability for each variable was expressed as quartiles of the standard deviation during three years (exposure). The incidence of myocardial infarction, stroke, and all-cause mortality was assessed during 4.80 (2.40-6.70) years following the exposure phase. The association between measures of variability and the risk of developing the outcome was investigated through multivariable Cox proportional-hazards regression analysis with stepwise variable selection. Then, the recursive partitioning and amalgamation (RECPAM) algorithm was used to explore the interaction among the variability of risk factors associated with the outcome. RESULTS An association between the variability of HbA1c, body weight, systolic blood pressure, and total cholesterol with the outcome considered was found. Among the 6 classes of risk identified by RECPAM, patients with a high variability of both body weight and blood pressure had the highest risk (Class 6, HR = 1.81; 95% CI 1.61-2.05) compared with patients with low variability of both body weight and total cholesterol (Class 1, reference), despite a progressive reduction in the mean level of risk factors during successive visits. Individuals with high weight variability but low-moderate systolic blood pressure variability (Class 5, HR = 1.57; 95% CI 1.28-1.68), patients with moderate/high weight variability associated with high/very high HbA1c variability (Class 4, HR = 1.33; 95%CI 1.20-1.49), subjects with moderate/high weight variability and with low/moderate HbA1c variability (Class 3, HR = 1.12; 95%CI 1.00-1.25), as well as those with low weight variability associated with high/very high total cholesterol variability (Class 2, HR = 1.14; 95%CI 1.00-1.30) also showed a significant increase in the risk of event. CONCLUSIONS Combined high variability of two risk factors, particularly body weight and blood pressure, is associated with cardiovascular risk among patients with T2DM. These findings highlight the importance of continuous balancing of multiple risk factors.
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Affiliation(s)
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | | | - Stefan Franzén
- Health Metrics, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Center of Registries, Västra Götaland, Sweden
| | | | - Björn Eliasson
- Center of Registries, Västra Götaland, Sweden.,Department of medicine, Sahlgrenska University Hospital, Gothenburg
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
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11
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Simone M, De Giacomo A, Palumbi R, Palazzo C, Lucisano G, Pompamea F, Micella S, Pascali M, Gabellone A, Marzulli L, Giordano P, Gargano CD, Margari L, Frigeri A, Ruggieri M. Serum Neurofilament Light Chain and Glial Fibrillary Acidic Protein as Potential Diagnostic Biomarkers in Autism Spectrum Disorders: A Preliminary Study. Int J Mol Sci 2023; 24:ijms24033057. [PMID: 36769380 PMCID: PMC9917818 DOI: 10.3390/ijms24033057] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Autism spectrum disorder (ASD) is one of the most common neurodevelopment disorders, characterized by a multifactorial etiology based on the interaction of genetic and environmental factors. Recent evidence supports the neurobiological hypothesis based on neuroinflammation theory. To date, there are no sufficiently validated diagnostic and prognostic biomarkers for ASD. Therefore, we decided to investigate the potential diagnostic role for ASD of two biomarkers well known for other neurological inflammatory conditions: the glial fibrillary acidic protein (GFAP) and the neurofilament (Nfl). Nfl and GFAP serum levels were analyzed using SiMoA technology in a group of ASD patients and in a healthy control group (CTRS), age- and gender-matched. Then we investigated the distribution, frequency, and correlation between serum Nfl and GFAP levels and clinical data among the ASD group. The comparison of Nfl and GFAP serum levels between ASD children and the control group showed a mean value of these two markers significantly higher in the ASD group (sNfL mean value ASD pt 6.86 pg/mL median value ASD pt 5.7 pg/mL; mean value CTRS 3.55 pg/mL; median value CTRS 3.1 pg; GFAP mean value ASD pt 205.7 pg/mL median value ASD pt 155.4 pg/mL; mean value CTRS 77.12 pg/mL; median value CTRS 63.94 pg/mL). Interestingly, we also found a statistically significant positive correlation between GFAP levels and hyperactivity symptoms (p-value <0.001). Further investigations using larger groups are necessary to confirm our data and to verify in more depth the potential correlation between these biomarkers and ASD clinical features, such as the severity of the core symptoms, the presence of associated symptoms, and/or the evaluation of a therapeutic intervention. However, these data not only might shed a light on the neurobiology of ASD, supporting the neuroinflammation and neurodegeneration hypothesis, but they also might support the use of these biomarkers in the early diagnosis of ASD, to longitudinally monitor the disease activity, and even more as future prognostic biomarkers.
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Affiliation(s)
- Marta Simone
- Regenerative and Precision Medicine Department and Jonic Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Andrea De Giacomo
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Roberto Palumbi
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
- Correspondence:
| | - Claudia Palazzo
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Giuseppe Lucisano
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Francesco Pompamea
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Stefania Micella
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Mara Pascali
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Alessandra Gabellone
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Lucia Marzulli
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Paola Giordano
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Concetta Domenica Gargano
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Lucia Margari
- Regenerative and Precision Medicine Department and Jonic Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Antonio Frigeri
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Maddalena Ruggieri
- Translational Biomedicine and Neuroscience Department (DiBraiN), University of Bari “Aldo Moro”, 70124 Bari, Italy
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12
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Russo GT, Andreozzi F, Calabrese M, Di Bartolo P, Di Cianni G, Bruno Giorda C, Lapice E, Manicardi E, Giandalia A, Lucisano G, Nicolucci A, Rocca A, Rossi MC, Spreafico E, Vespasiani G, Manicardi V. Role of telemedicine during COVID-19 pandemic in type 2 diabetes outpatients: The AMD annals initiative. Diabetes Res Clin Pract 2022; 194:110158. [PMID: 36400169 PMCID: PMC9663380 DOI: 10.1016/j.diabres.2022.110158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
AIMS Telemedicine is advocated as a fundamental tool in modern clinical management. However, data on the effects of telemedicine vs face-to-face consultation on clinical outcomes in type 2 diabetes (T2DM) are still uncertain. This paper describes the use of telemedicine during the 2020 COVID-19 emergency and compares volume activity and quality indicators of diabetes care between face-to-face vs telemedicine counseling in the large cohort of T2DM patients from the AMD Annals Initiative. METHODS Demographic and clinical characteristics, including laboratory parameters, rate of the screening of long-term complications, current therapies and the Q-score, a validated score that measures the overall quality of care, were compared between 364,898 patients attending face-to-face consultation and 46,424 on telemedicine, during the COVID-19 pandemic. RESULTS Patients on telemedicine showed lower HbA1c levels (7.1 ± 1.2 % vs 7.3 ± 1.3 %, p < 0.0001), and they were less frequently treated with metformin, GLP1-RAs and SGLT2i and more frequently with DPP4i. The telemedicine group showed reduced monitoring of the various parameters considered as process indicators, especially, eye and foot examination. The proportion of patients with a good quality of care (Q score > 25) was higher among those receiving face-to-face consultation. Moreover, in the telemedicine group, all major clinical outcomes remained stable when further compared to those collected in the year 2019, when the same patients underwent a regular face-to-face consultation, suggesting that the care provided through telemedicine did not negatively affect the most important parameters. CONCLUSIONS During the COVID-19 pandemic, telemedicine provided an acceptable quality of diabetes care, comparable to that of patients attending face-to-face consultation, although a less frequent screening of complications seems to have occurred in subjects consulted by telemedicine.
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Affiliation(s)
- Giuseppina T Russo
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Italy.
| | | | - Paolo Di Bartolo
- Ravenna Diabetes Center, Dept of Specialist Medicine, Romagna Local Health Authority, Italy
| | | | | | | | | | - Annalisa Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Alberto Rocca
- Diabetology and Metabolic Diseases UOS, "G.Segalini", H.Bassini Cinisello Balsamo, ASST Nord Milan, Italy
| | - Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Emanuele Spreafico
- UOSD of Endocrine and Metabolic Disease and Nutrition, ASST Brianza, Pio XI Hospital, Desio, (MB), Italy
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13
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Russo GT, Giandalia A, Ceriello A, Di Bartolo P, Di Cianni G, Fioretto P, Giorda CB, Manicardi V, Pontremoli R, Viazzi F, Lucisano G, Nicolucci A, De Cosmo S. A prediction model to assess the risk of egfr loss in patients with type 2 diabetes and preserved kidney function: The amd annals initiative. Diabetes Res Clin Pract 2022; 192:110092. [PMID: 36167264 DOI: 10.1016/j.diabres.2022.110092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/05/2022] [Accepted: 09/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To develop and validate a model for predicting 5-year eGFR-loss in type 2 diabetes mellitus (T2DM) patients with preserved renal function at baseline. RESEARCH DESIGN AND METHODS A cohort of 504.532 T2DM outpatients participating to the Medical Associations of Diabetologists (AMD) Annals Initiative was splitted into the Learning and Validation cohorts, in which the predictive model was respectively developed and validated. A multivariate Cox proportional hazard regression model including all baseline characteristics was performed to identify predictors of eGFR-loss. A weight derived from regression coefficients was assigned to each variable and the overall sum of weights determined the 0 to 8-risk score. RESULTS A set of demographic, clinical and laboratory parameters entered the final model. The eGFR-loss score showed a good performance in the Validation cohort. Increasing score values progressively identified a higher risk of GFR loss: a score ≥ 8 was associated with a HR of 13.48 (12.96-14.01) in the Learning and a HR of 13.45 (12.93-13.99) in the Validation cohort. The 5 years-probability of developing the study outcome was 55.9% higher in subjects with a score ≥ 8. CONCLUSIONS In the large AMD Annals Initiative cohort, we developed and validated an eGFR-loss prediction model to identify T2DM patients at risk of developing clinically meaningful renal complications within a 5-years time frame.
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Affiliation(s)
- G T Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - A Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - A Ceriello
- Department of Cardiovascular and Metabolic Diseases, IRCCS Gruppo Multimedica, MI, Italy.
| | | | - G Di Cianni
- Diabetes and Metabolic Diseases Unit, Health Local Unit North-West Tuscany, Livorno, Italy.
| | - P Fioretto
- Department of Medicine, University of Padua, Unit of Medical Clinic 3, Hospital of Padua, Padua, Italy.
| | - C B Giorda
- Diabetes and Metabolism Unit ASL Turin 5 Chieri (TO), Italy.
| | - V Manicardi
- Diabetes Consultant, Salus Hospital, Reggio Emilia, Italy.
| | - R Pontremoli
- Università degli Studi and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - F Viazzi
- Università degli Studi and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Pescara, Italy.
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Pescara, Italy.
| | - S De Cosmo
- Department of Medical Sciences, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo (FG), Italy.
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14
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Portaccio E, Fonderico M, Iaffaldano P, Pastò L, Razzolini L, Bellinvia A, De Luca G, Ragonese P, Patti F, Brescia Morra V, Cocco E, Sola P, Inglese M, Lus G, Pozzilli C, Maimone D, Lugaresi A, Gazzola P, Comi G, Pesci I, Spitaleri D, Rezzonico M, Vianello M, Avolio C, Logullo FO, Granella F, Salvetti M, Zaffaroni M, Lucisano G, Filippi M, Trojano M, Amato MP. Disease-Modifying Treatments and Time to Loss of Ambulatory Function in Patients With Primary Progressive Multiple Sclerosis. JAMA Neurol 2022; 79:869-878. [PMID: 35877104 PMCID: PMC9315975 DOI: 10.1001/jamaneurol.2022.1929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/19/2022] [Indexed: 12/20/2022]
Abstract
Importance Except for ocrelizumab, treatment options in primary progressive multiple sclerosis (PPMS) are lacking. Objective To investigate the effectiveness of DMTs on the risk of becoming wheelchair dependent in a real-world population of patients with PPMS. Design, Setting, and Participants This was a multicenter, observational, retrospective, comparative effectiveness research study. Data were extracted on November 28, 2018, from the Italian multiple sclerosis register and analyzed from June to December 2021. Mean study follow-up was 11 years. Included in the study cohort were patients with a diagnosis of PPMS and at least 3 years of Expanded Disability Status Scale (EDSS) evaluations and 3 years of follow-up. Main Outcomes and Measures The risk of reaching an EDSS score of 7.0 was assessed through multivariable Cox regression models. Exposures Patients who received DMT before the outcome were considered treated. DMT was assessed as a time-dependent variable and by class of DMT (moderately and highly effective). Results From a total of 3298 patients with PPMS, 2633 were excluded because they did not meet the entry criteria for the phase 3, multicenter, randomized, parallel-group, double-blind, placebo-controlled study to evaluate the efficacy and safety of ocrelizumab in adults with PPMS (ORATORIO) trial. Among the remaining 665 patients (mean [SD] age, 43.0 [10.7] years; 366 female patients [55.0%]), 409 were further selected for propensity score matching (288 treated and 121 untreated patients). In the matched cohort, during the study follow-up, 37% of patients (152 of 409) reached an EDSS score of 7.0 after a mean (SD) follow-up of 10.6 (5.6) years. A higher EDSS score at baseline (adjusted hazard ratio [aHR], 1.32; 95% CI, 1.13-1.55; P < .001), superimposed relapses (aHR, 2.37; 95% CI, 1.24-4.54; P = .009), and DMT exposure (aHR, 1.75; 95% CI, 1.04-2.94; P = .03) were associated with a higher risk of an EDSS score of 7.0, whereas the interaction term between DMT and superimposed relapses was associated with a reduced risk of EDSS score of 7.0 (aHR, 0.33; 95% CI, 0.16-0.71; P = .004). Similar findings were obtained when treatment according to DMT class was considered and when DMT was included as a time-dependent covariate. These results were confirmed in the subgroup of patients with available magnetic resonance imaging data. Conclusions and Relevance Results of this comparative effectiveness research study suggest that inflammation also occurs in patients with PPMS, may contribute to long-term disability, and may be associated with a reduced risk of becoming wheelchair dependent by current licensed DMTs.
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Affiliation(s)
- Emilio Portaccio
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Mattia Fonderico
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro Policlinico, Bari, Italy
| | - Luisa Pastò
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Lorenzo Razzolini
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Angelo Bellinvia
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico Santissima Annunziata, Università G. d’Annunzio Chieti-Pescara, Abruzzo, Italia
| | - Paolo Ragonese
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, Gian Filippo Ingrassia, Sezione Neuroscienze, Centro Sclerosi Multipla, University of Catania, Catania, Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Napoli, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla; Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Patrizia Sola
- Centro Malattie Demielinizzanti, Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria, Unità Operativa Neurologia, University of Modena and Reggio Emilia, Modena, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genoa, Italia
| | - Giacomo Lus
- Università della Campania Luigi Vanvitelli, Naples, Italia
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Sant’Andrea Hospital, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Davide Maimone
- Centro Sclerosi Multipla, Unità Operativa Complessa Neurologia, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione, Garibaldi, Catania, Italia
| | - Alessandra Lugaresi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italia
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
| | - Paola Gazzola
- Struttura Complessa Neurologia, L’Ospedale Antero Micone di Sestri Ponente, Genovese, Italia
| | - Giancarlo Comi
- San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ilaria Pesci
- Centro Sclerosi Multipla Unità Operativa Neurologia, Ospedale Di Vaio, Fidenza, Azienda Unità Sanitaria Locale, Parma, Italia
| | - Daniele Spitaleri
- Centro Sclerosi Multipla, Unità Operativa Complessa di Neurologia, Azienda Ospedaliera di Rilievo Nazionale, San G. Moscati di Avellino, Avellino, Italia
| | - Marta Rezzonico
- Centro Sclerosi Multipla Unità Operativa Neurologia, Azienda Socio Sanitaria Territoriale, Lariana Ospedale Sant’Anna, Como, Italia
| | - Marika Vianello
- Centro Sclerosi Multipla, Ospedale Regionale ‘Ca’ Foncello, Neurology Unit, Treviso, Italia
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Multiple Sclerosis Intradipartimental Center, Department of Neurosciences, Policlinico Riuniti, Foggia, Italy
| | | | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, Sant’Andrea Hospital/Sapienza University, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico Mediterraneo, Neuromed, Pozzilli, Isernia, Italia
| | - Mauro Zaffaroni
- Centro Sclerosi Multipla, ASST della Valle Olona, Ospedale di Gallarate, Gallarate, Italia
| | - Giuseppe Lucisano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro Policlinico, Bari, Italy
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italia
| | - Massimo Filippi
- Neurology, Neurorehabilitation and Neurophysiology Units, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro Policlinico, Bari, Italy
| | - Maria Pia Amato
- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, University of Florence, Florence, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Florence, Italy
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15
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Iaffaldano P, Lucisano G, Guerra T, Patti F, Onofrj M, Brescia Morra V, Zaffaroni M, Pozzilli C, Cocco E, Sola P, Salemi G, Inglese M, Bergamaschi R, Gasperini C, Conte A, Salvetti M, Lus G, Maniscalco GT, Totaro R, Vianello M, Granella F, Ferraro E, Aguglia U, Gatto M, Sangalli F, Chisari CG, De Luca G, Carotenuto A, Baroncini D, Colombo D, Nica M, Paolicelli D, Comi G, Filippi M, Amato MP, Trojano M. Towards a validated definition of the clinical transition to secondary progressive multiple sclerosis: A study from the Italian MS Register. Mult Scler 2022; 28:2243-2252. [PMID: 35971322 DOI: 10.1177/13524585221114007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Definitions for reliable identification of transition from relapsing-remitting multiple sclerosis (MS) to secondary progressive (SP)MS in clinical cohorts are not available. OBJECTIVES To compare diagnostic performances of two different data-driven SPMS definitions. METHODS Data-driven SPMS definitions based on a version of Lorscheider's algorithm (DDA) and on the EXPAND trial inclusion criteria were compared, using the neurologist's definition (ND) as gold standard, in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Akaike information criterion (AIC) and area under the curve (AUC). RESULTS A cohort of 10,240 MS patients with ⩾5 years of follow-up was extracted from the Italian MS Registry; 880 (8.5%) patients were classified as SPMS according to the neurologist definition, 1806 (17.6%) applying the DDA and 1134 (11.0%) with the EXPAND definition. The DDA showed greater discrimination power (AUC: 0.8 vs 0.6) and a higher sensitivity (77.1% vs 38.0%) than the EXPAND definition, with similar specificity (88.0% vs 91.5%). PPV and NPV were higher using the DDA than considering EXPAND definition (37.5% vs 29.5%; 97.6% vs 94.0%). CONCLUSION Data-driven definitions demonstrated greater ability to capture SP transition than neurologist's definition and the global accuracy of DDA seems to be higher than the EXPAND definition.
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Affiliation(s)
- Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Giuseppe Lucisano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy/Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Tommaso Guerra
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Catania, Italy
| | - Marco Onofrj
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS Annunziata, Università 'G. d'Annunzio', Chieti-Pescara, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Sant' Andrea Hospital, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Eleonora Cocco
- Department Medical Science and Public health, University of Cagliari, Cagliari, Italy/Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy
| | - Patrizia Sola
- Neurology Unit, Department of Neurosciences, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino/Estense, Modena, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Matilde Inglese
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno - Infantili (DINOGMI), Universita' di Genova, Genova, Italy/Ospedale Policlinico San Martino, IRCCS, Genova, Italy
| | | | - Claudio Gasperini
- Centro Sclerosi Multipla, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy/IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Marco Salvetti
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy/Centro Neurologico Terapie Sperimentali (CENTERS), Sapienza Universita' Di Roma, Azienda Ospedaliera Sant' Andrea, Rome, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Rocco Totaro
- Centro Malattie Demielinizzanti, Clinica Neurologica, Ospedale San Salvatore, L'Aquila, Italy
| | - Marika Vianello
- MS Unit, O.U. Neurology 'Ca' Foncello' Hospital, Treviso, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Maurizia Gatto
- Centro Malattie Demielinizzanti, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Francesca Sangalli
- Neurology, Neurorehabilitation and Neuroimaging Research Units, Neurophysiology Service, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Clara Grazia Chisari
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Catania, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS Annunziata, Università 'G. d'Annunzio', Chieti-Pescara, Italy
| | - Antonio Carotenuto
- Multiple Sclerosis Clinical Care and Research Center, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Napoli, Italy
| | - Damiano Baroncini
- Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate, Italy
| | | | | | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Giancarlo Comi
- Università Vita Salute San Raffaele, Milano, Italy/Casa di Cura del Policlinico, Milano, Italy
| | - Massimo Filippi
- Neurology, Neurorehabilitation and Neuroimaging Research Units, Neurophysiology Service, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Pia Amato
- Department of NEUROFARBA, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro' Bari, Piazza G. Cesare, 11, 70124 Bari, Italy.,Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
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Iaffaldano P, Lucisano G, Manni A, Paolicelli D, Patti F, Capobianco M, Brescia Morra V, Sola P, Pesci I, Lus G, De Luca G, Lugaresi A, Cavalla P, Montepietra S, Maniscalco GT, Granella F, Ragonese P, Vianello M, Brambilla L, Totaro R, Toscano S, Malucchi S, Petracca M, Moiola L, Ferraro D, Lepore V, Mosconi P, Ponzio M, Tedeschi G, Comi G, Battaglia MA, Filippi M, Amato MP, Trojano M. Risk of Getting COVID-19 in People With Multiple Sclerosis: A Case-Control Study. Neurol Neuroimmunol Neuroinflamm 2022; 9:9/2/e1141. [PMID: 35046084 PMCID: PMC8771668 DOI: 10.1212/nxi.0000000000001141] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
Background and Objectives Several studies have assessed risk factors associated with the severity of COVID-19 outcomes in people with multiple sclerosis (PwMS). The potential role of disease-modifying therapies (DMTs) and demographic and clinical factors on the risk of acquiring SARS-CoV-2 infection has not been evaluated so far. The objective of this study was to assess risk factors of contracting SARS-CoV-2 infection in PwMS by using data collected in the Italian MS Register (IMSR). Methods A case-control (1:2) study was set up. Cases included PwMS with a confirmed diagnosis of COVID-19, and controls included PwMS without a confirmed diagnosis of COVID-19. Both groups were propensity score–matched by the date of COVID-19 diagnosis, the date of last visit, and the region of residence. No healthy controls were included in this study. COVID-19 risk was estimated by multivariable logistic regression models including demographic and clinical covariates. The impact of DMTs was assessed in 3 independent logistic regression models including one of the following covariates: last administered DMT, previous DMT sequences, or the place where the last treatment was administered. Results A total of 779 PwMS with confirmed COVID-19 (cases) were matched to 1,558 PwMS without COVID-19 (controls). In all 3 models, comorbidities, female sex, and a younger age were significantly associated (p < 0.02) with a higher risk of contracting COVID-19. Patients receiving natalizumab as last DMT (OR [95% CI]: 2.38 [1.66–3.42], p < 0.0001) and those who underwent an escalation treatment strategy (1.57 [1.16–2.13], p = 0.003) were at significantly higher COVID-19 risk. Moreover, PwMS receiving their last DMT requiring hospital access (1.65 [1.34–2.04], p < 0.0001) showed a significant higher risk than those taking self-administered DMTs at home. Discussion This case-control study embedded in the IMSR showed that PwMS at higher COVID-19 risk are younger, more frequently female individuals, and with comorbidities. Long-lasting escalation approach and last therapies that expose patients to the hospital environment seem to significantly increase the risk of SARS-CoV2 infection in PwMS. Classification of Evidence This study provides Class III evidence that among patients with MS, younger age, being female individuals, having more comorbidities, receiving natalizumab, undergoing an escalating treatment strategy, or receiving treatment at a hospital were associated with being infected with COVID-19. Among patients with MS who were infected with COVID-19, a severe course was associated with increasing age and having a progressive form of MS, whereas not being on treatment or receiving an interferon beta agent was protective.
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Affiliation(s)
- Pietro Iaffaldano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giuseppe Lucisano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Alessia Manni
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Damiano Paolicelli
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Francesco Patti
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Marco Capobianco
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Vincenzo Brescia Morra
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Patrizia Sola
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Ilaria Pesci
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giacomo Lus
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giovanna De Luca
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Alessandra Lugaresi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Paola Cavalla
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Sara Montepietra
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giorgia Teresa Maniscalco
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Franco Granella
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Paolo Ragonese
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Marika Vianello
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Laura Brambilla
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Rocco Totaro
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Simona Toscano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Simona Malucchi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Maria Petracca
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Lucia Moiola
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Diana Ferraro
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Vito Lepore
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Paola Mosconi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Michela Ponzio
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Gioacchino Tedeschi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Giancarlo Comi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Mario Alberto Battaglia
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Massimo Filippi
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Maria Pia Amato
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy
| | - Maria Trojano
- From the Department of Basic Medical Sciences (P.I., G.L., A.M., D.P., M.T.), Neurosciences and Sense Organs, University of Bari Aldo Moro; CORESEARCH (G.L.), Pescara; Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate (F.P., S.T.), GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania; SCDO Neurologia e Centro di Riferimento Regionale Sclerosi Multipla (CRESM) (M.C., S.M.), AOU San Luigi-Orbassano (TO); Department of Neurosciences (V.B.M., M.P.), Reproductive and Odontostomatological Sciences, 'Federico II' University of Naples; Centro malattie Demielinizzanti (P.S.), Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia; Centro SM UO Neurologia, Ospedale Di Vaio (I.P.), Fidenza, AUSL PR; Multiple Sclerosis Center (G. Lus), II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples; Centro Sclerosi Multipla (G.D.L.), Clinica Neurologica, Policlinico SS. Annunziata, Chieti; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.L.), UOSI Riabilitazione Sclerosi Multipla, Bologna; Dipartimento di Scienze Biomediche e Neuromotorie (A.L.), Università di Bologna; Centro SM (P.C.)-Neurologia 1 D.U.-AOU Citta' Della Salute E Della Scienza Di Torino; Centro SM (S.M.), S.O.C. Neurologia, Arcispedale Santa Maria Nuova, AUSL-IRCCS Reggio Emilia; Neurological Clinic and Multiple Sclerosis Center (G.T.M.), A Cardarelli Hospital, Naples; Centro Sclerosi Multipla (F.G.), Azienda Ospedaliero-Universitaria di Parma; Department of Biomedicine (P.R.), Neuroscience and Advanced Diagnostics, University of Palermo; Centro Sclerosi Multipla UO Neurologia-Ospedale (M.V.), Treviso; Fondazione IRCCS Istituto Neurologico "C. Besta" U.O. Neuroimmunologia e Malattie Neuromuscolari (L.B.); Centro Malattie Demielinizzanti (R.T.), Clinica Neurologica, Ospedale San Salvatore-L'Aquila; Dipartimento di Neurologia (L.M., M.F.), Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Biomedical (D.F.), Metabolic and Neurosciences, University of Modena and Reggio Emilia; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (V.L., P.M.), Milano, Italy; Scientific Research Area (M.P.), Italian Multiple Sclerosis Foundation, Genoa; First Division of Neurology (G.T.), Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, AOU, University of Campania "Luigi Vanvitelli," Naples; Institute of Experimental Neurology (G.C.), IRCCS San Raffaele Hospital, Milan; Department of Life Sciences (M.A.B.), University of Siena; Department NEUROFARBA (M.P.A.), University of Florence; and IRCCS Fondazione Don Carlo Gnocchi (M.P.A.), Florence, Italy.
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17
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Ceriello A, Lucisano G, Prattichizzo F, La Grotta R, Franzén S, Svensson AM, Eliasson B, Nicolucci A. HbA1c variability predicts cardiovascular complications in type 2 diabetes regardless of being at glycemic target. Cardiovasc Diabetol 2022; 21:13. [PMID: 35073913 PMCID: PMC8788128 DOI: 10.1186/s12933-022-01445-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/28/2021] [Indexed: 01/09/2023] Open
Abstract
Background HbA1c variability has emerged as risk factor for cardiovascular diseases in diabetes. However, the impact of HbA1c variability on cardiovascular diseases in subjects within the recommended HbA1c target has been relatively unexplored. Methods Using data from a large database, we studied 101,533 people with type 2 diabetes without cardiovascular diseases. HbA1c variability was expressed as quartiles of the standard deviation of HbA1c during three years (exposure phase). The primary composite outcome included non-fatal myocardial infarction, non-fatal stroke, all-cause mortality and was assessed during five years following the first three years of exposure to HbA1c variability (longitudinal phase). An expanded composite outcome including non-fatal myocardial infarction, non-fatal stroke, coronary revascularization/reperfusion procedures, peripheral revascularization procedures, and all-cause mortality was also considered, as well as a series of specific cardiovascular complications. Cox models were adjusted for a large range of risk factors and results were expressed as adjusted hazard ratios. Results An association between HbA1c variability and all the outcomes considered was found. The correlation between HbA1c variability and cardiovascular complications development was confirmed in both the subgroups of subjects with a mean HbA1c ≤ 53 mmol/mol (recommended HbA1c target) or > 53 mmol/mol during the exposure phase. The risk related to HbA1c variability was higher in people with mean HbA1c ≤ 53 mmol/mol for the primary outcome (p for interaction 0.004), for the expanded secondary outcome (p for interaction 0.001) and for the stroke (p for interaction 0.001), even though HbA1c remained at the target during the follow-up. Conclusions These findings suggest that HbA1c variability may provide additional information for an optimized management of diabetes, particularly in people within the target of HbA1c. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01445-4.
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18
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Balducci S, Haxhi J, Sacchetti M, Orlando G, Cardelli P, Vitale M, Mattia L, Iacobini C, Bollanti L, Conti F, Zanuso S, Nicolucci A, Pugliese G, Pugliese G, Balducci S, Sacchetti M, Zanuso S, Cardelli P, Nicolucci A, Pugliese G, Ribaudo MC, Alessi E, Vitale M, Cirrito T, Bollanti L, Conti FG, Di Biase N, La Saracina F, Balducci S, Ranuzzi M, Haxhi J, D'Errico V, Sacchetti M, Orlando G, Milo L, Milo R, Balducci G, Spinelli E, Cardelli P, Cavallo S, Balducci S, Alessi E, Balducci G, Orlando G, Zanuso S, Cardelli P, Lucisano G. Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals With Type 2 Diabetes: The Italian Diabetes and Exercise Study 2 (IDES_2). Diabetes Care 2022; 45:213-221. [PMID: 34728529 DOI: 10.2337/dc21-1505] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In the Italian Diabetes and Exercise Study_2 (IDES_2), behavioral counseling promoted a sustained increase in physical activity (PA) volume (+3.3 MET h ⋅ week-1), moderate- to vigorous-intensity PA (MVPA) (+6.4 min ⋅ day-1), and light-intensity PA (LPA) (+0.8 h ⋅ day-1) and decrease in sedentary time (SED-time) (-0.8 h ⋅ day-1). Here, we investigated the relationships of changes in PA/SED-time with changes in physical fitness and cardiometabolic risk profile in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS In this 3-year randomized clinical trial, 300 physically inactive and sedentary patients were randomized 1:1 to receive 1-month theoretical and practical counseling once a year or standard care. Changes in physical fitness and cardiovascular risk factors/scores according to quartiles of accelerometer-measured changes in PA/SED-time were assessed, together with univariate and multivariable associations between these parameters, in the whole cohort and by study arm. RESULTS Physical fitness increased and HbA1c and coronary heart disease 10-year risk scores decreased with quartiles of MVPA and SED-time change. In quartile IV of MVPA increase and SED-time decrease, cardiorespiratory fitness increased by 5.23 and 4.49 mL ⋅ min-1 ⋅ kg-1 and HbA1c decreased by 0.73 and 0.85%, respectively. Univariate correlations confirmed these relationships, and mean changes in both MPVA and SED-time predicted changes in physical fitness and cardiovascular risk factors/scores independently of one another and of other confounders. Similar findings were observed with LPA and PA volume and in each group separately. CONCLUSIONS Even modest increments in MVPA may have a clinically meaningful impact, and reallocating SED-time to LPA may also contribute to improved outcomes, possibly by increasing total energy expenditure.
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Affiliation(s)
- Stefano Balducci
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy.,3Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy.,3Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Massimo Sacchetti
- 4Department of Human Movement and Sport Sciences, University of Rome "Foro Italico," Rome, Italy
| | - Giorgio Orlando
- 4Department of Human Movement and Sport Sciences, University of Rome "Foro Italico," Rome, Italy.,5Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, U.K
| | - Patrizia Cardelli
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,6Laboratory of Clinical Chemistry, Sant'Andrea University Hospital, Rome, Italy
| | - Martina Vitale
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lorenza Mattia
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Carla Iacobini
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lucilla Bollanti
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Conti
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Silvano Zanuso
- 7Center for Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, U.K.,8Centre for Human Performance and Sport, University of Greenwich, Chatham Maritime, U.K
| | - Antonio Nicolucci
- 9Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy.,10Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
| | - Giuseppe Pugliese
- 1Department of Clinical and Molecular Medicine, University of Rome La Sapienza, Rome, Italy.,2Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
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19
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Cucinotta D, Nicolucci A, Giandalia A, Lucisano G, Manicardi V, Mannino D, Rossi MC, Russo GT, Di Bartolo P. Temporal trends in intensification of glucose-lowering therapy for type 2 diabetes in Italy: Data from the AMD Annals initiative and their impact on clinical inertia. Diabetes Res Clin Pract 2021; 181:109096. [PMID: 34673085 DOI: 10.1016/j.diabres.2021.109096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022]
Abstract
AIMS Clinical inertia negatively affects type 2 diabetes (T2DM) management. We evaluated changes in prescription patterns of hypoglycemic drugs during a 15 year-observation period in a large population of T2DM outpatients and their effect on metabolic control. METHODS Data on all T2DM patients attending 258 Italian diabetes clinics between 2005 and 2019 were collected and analyzed for three 5-years periods. The addition of a second drug to metformin and the addition of a third agent to dual therapy were evaluated. RESULTS During the observation period, 437.179 patients added a second drug to metformin. The intensification occurred earlier over time: patients had a shorter duration of disease and a better cardiovascular risk profile in the last five years, compared to previous periods. During the same period, 208.767 patients added a third agent to dual therapy. Duration of diabetes at the time of intensification decreased, and cardiovascular risk profile improved over time. Also HbA1c levels at the time of intensification decreased over time. CONCLUSIONS in this large cohort of T2MD subjects during a long observation period an earlier treatment intensification and a better metabolic control were observed, suggesting an improved approach to clinical inertia.
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Affiliation(s)
- Domenico Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Italy.
| | | | - Annalisa Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | | | | | | | | | - Paolo Di Bartolo
- Ravenna Diabetes Clinic, Romagna Local Health Authority, Ravenna, Italy
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20
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Capristo E, Maione A, Lucisano G, Russo MF, Mingrone G, Nicolucci A. Effects of weight loss medications on mortality and cardiovascular events: A systematic review of randomized controlled trials in adults with overweight and obesity. Nutr Metab Cardiovasc Dis 2021; 31:2587-2595. [PMID: 34154892 DOI: 10.1016/j.numecd.2021.05.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/22/2022]
Abstract
AIMS Adults affected by obesity are at higher risk of premature mortality. Medications can help to lose weight and to maintain weight loss. Aim of this meta-analysis was to assess whether anti-obesity medications affect all-cause mortality, mortality due to cardiovascular events, cardiovascular risk factors and body weight. DATA SYNTHESIS A Medline search was performed to identify randomized controlled trials (RCTs) of anti-obesity medications in adults with overweight or obesity reporting data on all-cause mortality, cardiovascular mortality or non-fatal cardiovascular events, with a follow-up of at least 6 months. We identified 28 RCTs with 50,106 participants. The median follow-up was 52 weeks. Evidence did not show superiority of anti-obesity medications over placebo in reducing all-cause mortality (risk ratio 1.03, 95%Confidence Interval [CI] 0.87 to 1.21) or cardiovascular mortality (risk ratio 0.92, 95%CI 0.72 to 1.18). All-cause mortality rate was positively associated with weight loss (β = 0.0007; p = 0.045); hence, for each kg of body weight lost there was a 0.07% decrease of all-cause mortality. The pharmacological treatment reduced total-cholesterol (7.15 mg/dl; 95%CI 1.46-12.85), LDL-cholesterol (5.06 mg/dl; 95%CI 1.12-9.00), and triglycerides levels (9.88 mg/dl; 95%CI 5.02-14.75), while it increased HDL-cholesterol (1.37 mg/dl; 95%CI 0.17-2.57). Systolic blood pressure decreased (0.90 mmHg; 95%CI 0.15-1.64). CONCLUSIONS Although we were unable to demonstrate a superiority of anti-obesity medications over placebo on mortality, metaregression showed that even a small weight reduction tends to reduce all-cause mortality in obesity. Our data support public health measures to reduce the obesity burden by including the use of anti-obesity medications. REGISTRATION NUMBER (PROSPERO) CRD42020210329.
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Affiliation(s)
- Esmeralda Capristo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy and Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Ausilia Maione
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | - Maria F Russo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy and Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Geltrude Mingrone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy and Università Cattolica Del Sacro Cuore, Rome, Italy; Department of Diabetes, School of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy.
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21
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Ceriello A, Lucisano G, Prattichizzo F, Eliasson B, Franzén S, Svensson AM, Nicolucci A. Variability in body weight and the risk of cardiovascular complications in type 2 diabetes: results from the Swedish National Diabetes Register. Cardiovasc Diabetol 2021; 20:173. [PMID: 34446018 PMCID: PMC8394543 DOI: 10.1186/s12933-021-01360-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background There is a high incidence of cardiovascular disease in diabetes. Weight variability has been reported as independent risk factor for cardiovascular disease in the general population and preliminarily also in people with type 2 diabetes. Methods Using data from the Swedish National Diabetes Register the possible link between visit-to-visit body weight variability and the risk of cardiovascular complications among people with type 2 diabetes and without prevalent cardiovascular diseases at baseline has been evaluated. Overall, 100,576 people with type 2 diabetes, with at least five measurements of body weight taken over three consecutive years, were included. Variability was expressed as quartiles of the standard deviation of the measures during the three years. The primary composite outcome included non-fatal myocardial infarction, non-fatal stroke, and all-cause mortality and was assessed during five years following the first 3 years of exposure to weight variability. Results After adjusting for known cardiovascular risk factors, the risk of the primary composite outcome significantly increased with increasing body weight variability [upper quartile HR = 1.45; 95% confidence interval 1.39–1.52]. Furthermore, elevated body weight variability was associated with almost all the other cardiovascular complications considered (non-fatal myocardial infarction, non-fatal stroke, all-cause mortality, peripheral arterial disease, peripheral vascular angioplasty, hospitalization for heart failure, foot ulcer, and all-cause mortality). Conclusions High body weight variability predicts the development of cardiovascular complications in type 2 diabetes. These data suggest that any strategy to reduce the body weight in these subjects should be aimed at maintaining the reduction in the long-term, avoiding oscillations. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01360-0.
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Affiliation(s)
- Antonio Ceriello
- IRCCS MultiMedica, Via Gaudenzio Fantoli, 16/15, 20138, Milan, Italy.
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Björn Eliasson
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Franzén
- Health Metrics, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center for Registries, Västra Götaland, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Center for Registries, Västra Götaland, Gothenburg, Sweden
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
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22
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Iaffaldano P, Lucisano G, Caputo F, Paolicelli D, Patti F, Zaffaroni M, Brescia Morra V, Pozzilli C, De Luca G, Inglese M, Salemi G, Maniscalco GT, Cocco E, Sola P, Lus G, Conte A, Amato MP, Granella F, Gasperini C, Bellantonio P, Totaro R, Rovaris M, Salvetti M, Torri Clerici VLA, Bergamaschi R, Maimone D, Scarpini E, Capobianco M, Comi G, Filippi M, Trojano M. Long-term disability trajectories in relapsing multiple sclerosis patients treated with early intensive or escalation treatment strategies. Ther Adv Neurol Disord 2021; 14:17562864211019574. [PMID: 34104220 PMCID: PMC8170278 DOI: 10.1177/17562864211019574] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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: 03/01/2021] [Accepted: 05/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background and aims: No consensus exists on how aggressively to treat relapsing–remitting multiple
sclerosis (RRMS) nor on the timing of the treatment. The objective of this
study was to evaluate disability trajectories in RRMS patients treated with
an early intensive treatment (EIT) or with a moderate-efficacy treatment
followed by escalation to higher-efficacy disease modifying therapy
(ESC). Methods: RRMS patients with ⩾5-year follow-up and ⩾3 visits after disease modifying
therapy (DMT) start were selected from the Italian MS Registry. EIT group
included patients who received as first DMT fingolimod, natalizumab,
mitoxantrone, alemtuzumab, ocrelizumab, cladribine. ESC group patients
received the high efficacy DMT after ⩾1 year of glatiramer acetate,
interferons, azathioprine, teriflunomide or dimethylfumarate treatment.
Patients were 1:1 propensity score (PS) matched for characteristics at the
first DMT. The disability trajectories were evaluated by applying a
longitudinal model for repeated measures. The effect of early
versus late start of high-efficacy DMT was assessed by
the mean annual Expanded Disability Status Scale (EDSS) changes compared
with baseline values (delta-EDSS) in EIT and ESC groups. Results: The study cohort included 2702 RRMS patients. The PS matching procedure
produced 363 pairs, followed for a median (interquartile range) of 8.5
(6.5–11.7) years. Mean annual delta-EDSS values were all significantly
(p < 0.02) higher in the ESC group compared with the
EIT group. In particular, the mean delta-EDSS differences between the two
groups tended to increase from 0.1 (0.01–0.19, p = 0.03) at
1 year to 0.30 (0.07–0.53, p = 0.009) at 5 years and to
0.67 (0.31–1.03, p = 0.0003) at 10 years. Conclusion: Our results indicate that EIT strategy is more effective than ESC strategy in
controlling disability progression over time.
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Affiliation(s)
- Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Lucisano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Francesca Caputo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Catania, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate, ASST della Valle Olona, Gallarate (Varese), Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience (NSRO), Multiple Sclerosis Clinical Care and Research Center, Federico II University, Naples, Italy
| | - Carlo Pozzilli
- Department of Human Neuroscience, Multiple Sclerosis Center, S. Andrea Hospital, Rome, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS. Annunziata, Abruzzo, Chieti, Italy
| | - Matilde Inglese
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno - Infantili (DINOGMI), Universita' di Genova, Genova, Liguria, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Sicilia, Italy
| | | | - Eleonora Cocco
- Department of Medical Science and Public health, Centro Sclerosi Multipla, University of Cagliari, Italy
| | - Patrizia Sola
- Azienda Ospedaliera Universitaria di Modena/OCB, UO Neurologia, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Caserta, Campania, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Firenze, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Parma, Emilia-Romagna, Italy
| | - Claudio Gasperini
- Centro Sclerosi Multipla - Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | | | - Rocco Totaro
- Centro Malattie Demielinizzanti - Clinica Neurologica, Ospedale San Salvatore, L'Aquila, Abruzzo, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center, IRCCS Fondazione don Carlo Gnocchi ONLUS, Milan, Italy
| | - Marco Salvetti
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | | | | | - Davide Maimone
- Centro Sclerosi Multipla - UOC di Neurologia - ARNAS Garibaldi, Catania, Sicilia, Italy
| | - Elio Scarpini
- Centro Sclerosi Multipla - UOSD Malattie Neurodegenerative - IRCCS Ospedale Maggiore Policlinico, Università Milano, Milano, Lombardia, Italy
| | - Marco Capobianco
- Struttura Complessa Ospedaliera Neurologia & CRESM (Centro di Riferimento Regionale per la SM) - AOU San Luigi, Orbassano (Torino), Italy
| | - Giancarlo Comi
- Institute of Experimental Neurology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Filippi
- Dipartimento di Neurologia, Neurofisiologia e Neuroriabilitazione, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro" Bari, Piazza G. Cesare, 11, Bari, 70124, Italy
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23
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Iaffaldano P, Lucisano G, Butzkueven H, Hillert J, Hyde R, Koch-Henriksen N, Magyari M, Pellegrini F, Spelman T, Sørensen PS, Vukusic S, Trojano M. Early treatment delays long-term disability accrual in RRMS: Results from the BMSD network. Mult Scler 2021; 27:1543-1555. [PMID: 33900144 DOI: 10.1177/13524585211010128] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The optimal timing of treatment starts for achieving the best control on the long-term disability accumulation in multiple sclerosis (MS) is still to be defined. OBJECTIVE The aim of this study was to estimate the optimal time to start disease-modifying therapies (DMTs) to prevent the long-term disability accumulation in MS, using a pooled dataset from the Big Multiple Sclerosis Data (BMSD) network. METHODS Multivariable Cox regression models adjusted for the time to first treatment start from disease onset (in quintiles) were used. To mitigate the impact of potential biases, a set of pairwise propensity score (PS)-matched analyses were performed. The first quintile, including patients treated within 1.2 years from onset, was used as reference. RESULTS A cohort of 11,871 patients (median follow-up after treatment start: 13.2 years) was analyzed. A 3- and 12-month confirmed disability worsening event and irreversible Expanded Disability Status Scale (EDSS) 4.0 and 6.0 scores were reached by 7062 (59.5%), 4138 (34.9%), 3209 (31.1%), and 1909 (16.5%) patients, respectively. The risk of reaching all the disability outcomes was significantly lower (p < 0.0004) for the first quintile patients' group. CONCLUSION Real-world data from the BMSD demonstrate that DMTs should be commenced within 1.2 years from the disease onset to reduce the risk of disability accumulation over the long term.
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Affiliation(s)
- Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Lucisano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy/Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Helmut Butzkueven
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, VIC, Australia
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Nils Koch-Henriksen
- Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark
| | - Melinda Magyari
- Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark
| | | | - Tim Spelman
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, VIC, Australia/Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Soelberg Sørensen
- Department of Neurology, The Danish Multiple Sclerosis Registry, Rigshospitalet, Copenhagen, Denmark
| | - Sandra Vukusic
- Neurology, Multiple Sclerosis, Myelin Disorders and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon, France/Observatoire Français de la Sclérose en Plaques (OFSEP), Lyon, France
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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24
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Iaffaldano P, Lucisano G, Patti F, Brescia Morra V, De Luca G, Lugaresi A, Zaffaroni M, Inglese M, Salemi G, Cocco E, Conte A, Ferraro D, Galgani S, Bergamaschi R, Pozzilli C, Salvetti M, Lus G, Rovaris M, Maniscalco GT, Logullo FO, Paolicelli D, Achille M, Marrazzo G, Lovato V, Comi G, Filippi M, Amato MP, Trojano M. Transition to secondary progression in relapsing-onset multiple sclerosis: Definitions and risk factors. Mult Scler 2020; 27:430-438. [PMID: 33210986 DOI: 10.1177/1352458520974366] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 01/01/2023]
Abstract
BACKGROUND No uniform criteria for a sensitive identification of the transition from relapsing-remitting multiple sclerosis (MS) to secondary-progressive multiple sclerosis (SPMS) are available. OBJECTIVE To compare risk factors of SPMS using two definitions: one based on the neurologist judgment (ND) and an objective data-driven algorithm (DDA). METHODS Relapsing-onset MS patients (n = 19,318) were extracted from the Italian MS Registry. Risk factors for SPMS and for reaching irreversible Expanded Disability Status Scale (EDSS) 6.0, after SP transition, were estimated using multivariable Cox regression models. RESULTS SPMS identified by the DDA (n = 2343, 12.1%) were older, more disabled and with a faster progression to severe disability (p < 0.0001), than those identified by the ND (n = 3868, 20.0%). In both groups, the most consistent risk factors (p < 0.05) for SPMS were a multifocal onset, an age at onset >40 years, higher baseline EDSS score and a higher number of relapses; the most consistent protective factor was the disease-modifying therapy (DMT) exposure. DMT exposure during SP did not impact the risk of reaching irreversible EDSS 6.0. CONCLUSION A DDA definition of SPMS identifies more aggressive progressive patients. DMT exposure reduces the risk of SPMS conversion, but it does not prevent the disability accumulation after the SP transition.
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Affiliation(s)
- Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Giuseppe Lucisano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy/Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, Università di Catania, Catania, Italy
| | - Vincenzo Brescia Morra
- Multiple Sclerosis Clinical Care and Research Center, Department of Neuroscience (NSRO), Federico II University, Naples, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS Annunziata, Università G. D'Annunzio, Chieti, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Riabilitazione Sclerosi Multipla, Bologna, Italy/Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, S.Antonio Abate Hospital, Gallarate, Italy
| | - Matilde Inglese
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (DINOGMI), Genova, Italy/Ospedale Policlinico San Martino, IRCCS, Genova, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Eleonora Cocco
- Department Medical Science and Public health, University of Cagliari/ Centro Sclerosi Multipla, ATS Sardegna, Cagliari, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy/IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy
| | - Diana Ferraro
- Department of Neurosciences, Neurology Unit, University of Modena and Reggio Emilia, Nuovo Ospedale Civile S. Agostino/Estense, Modena, Italy
| | - Simonetta Galgani
- Centro Sclerosi Multipla-Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | | | - Carlo Pozzilli
- Multiple Sclerosis Center, S.Andrea Hospital, Dept. of Human Neuroscience, Sapienza University, Rome, Italy
| | - Marco Salvetti
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy/CENTERS Centro Neurologico Terapie Sperimentali-Sapienza University, S.Andrea Hospital, Rome, Italy
| | - Giacomo Lus
- Multiple Sclerosis Center, II Division of Neurology, Department of Clinical and Experimental Medicine, Second University of Naples, Caserta, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center, IRCCS Fondazione don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Mariaclara Achille
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | | | | | - Giancarlo Comi
- Department of Neurology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Department of Neurology, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Amato
- Department of Neurofarba, University of Florence, Florence, Italy/IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
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25
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Ragonese M, Larosa M, Angotti S, Annese S, Cruciani L, Dainelli M, Lucisano G, Prosperini G, Sacco M, Salomone E, Saponara C, Semprini R, Rossi MC, Nicolucci A. Clinical Outcomes of Switching to Insulin Glargine 300 U/ml from Other Basal Insulins in People with Type 2 Diabetes in Italy: A Real-World Study. Diabetes Ther 2020; 11:2283-2298. [PMID: 32813262 PMCID: PMC7509008 DOI: 10.1007/s13300-020-00902-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Primary aim was to provide real-world evidence of the outcomes after the switch to glargine 300 U/ml (Gla-300) from other basal insulins (first or second generation) in Italy. METHODS Multicenter, observational, retrospective study based on electronic medical records. RESULTS Overall, 953 T2DM insulin ± OAD treated people switched to Gla-300 or Gla-100 from January 2015 to July 2018. Three clinically relevant cohorts were identified: patients switching to Gla-300 from first-generation basal insulin (cohort 1), patients switching to Gla-300 from degludec-100 (Deg-100) (cohort 2), and those switching to Gla-100 from any basal insulin (cohort 3). The three cohorts differed in terms of age, diabetes duration, and metabolic control. HbA1c changes after 6 months from the switch were - 0.27% (95% CI - 0.38; - 0.16), - 0.06% (95% CI - 0.31; 0.19), and - 0.30% (95% CI - 0.51; - 0.09) in the three cohorts, respectively. FPG significantly decreased in cohort 1 (- 14.07 mg/dl, 95% CI - 20.25; - 7.89), while body weight significantly decreased in cohort 2 (- 1.47 kg, 95% CI - 2.55; - 0.39). Doses of insulin marginally changed during the follow-up (+ 0.89 U in basal insulin daily dose in cohort 1 and + 2.07 U in short-acting insulin daily dose in cohort 2). CONCLUSIONS Switching to Gla-300 from first-generation basal insulin in the real world is associated with improvements in metabolic control despite a suboptimal titration of both basal and short-acting insulins. Inertia in insulin titration documented in the Gla-100 cohort is also observed with the second-generation basal insulin. The switch to Gla-300 from Deg-100 was associated with a decrease in body weight of - 1.47 kg despite a slight increase in short-acting insulin daily doses of about + 2 U.
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Affiliation(s)
| | | | | | | | | | | | - Giuseppe Lucisano
- CORESEARCH-Center for Outcome Research and Clinical Epidemiology, Pescara, Italy
| | - Giuseppe Prosperini
- CORESEARCH-Center for Outcome Research and Clinical Epidemiology, Pescara, Italy
| | - Michele Sacco
- CORESEARCH-Center for Outcome Research and Clinical Epidemiology, Pescara, Italy
| | | | | | | | - Maria Chiara Rossi
- CORESEARCH-Center for Outcome Research and Clinical Epidemiology, Pescara, Italy
| | - Antonio Nicolucci
- CORESEARCH-Center for Outcome Research and Clinical Epidemiology, Pescara, Italy.
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26
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Masulli M, Lucisano G, Bonora E, Del Prato S, Rivellese AA, Signorini S, Mocarelli P, Riccardi G, Vaccaro O, Nicolucci A. A few clinical features improve the prediction of mortality and cardiovascular outcomes in patients with type 2 diabetes. Eur J Prev Cardiol 2020; 28:e1-e3. [PMID: 33624040 DOI: 10.1093/eurjpc/zwaa002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131 Naples, Italy
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, via Tiziano Vecellio 2, 65124 Pescara, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Piazzale Aristide Stefani 1, 37129 Verona, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa, Lungarno Pacinotti 43, 56126 Pisa, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131 Naples, Italy
| | - Stefano Signorini
- University Department of Laboratory Medicine, Hospital of Desio, via Giuseppe Mazzini 1, 20832 Desio (MB), Italy
| | - Paolo Mocarelli
- University Department of Laboratory Medicine, Hospital of Desio, via Giuseppe Mazzini 1, 20832 Desio (MB), Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131 Naples, Italy
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University, Via S. Pansini 5, 80131 Naples, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, via Tiziano Vecellio 2, 65124 Pescara, Italy
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27
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Amato MP, Fonderico M, Portaccio E, Pastò L, Razzolini L, Prestipino E, Bellinvia A, Tudisco L, Fratangelo R, Comi G, Patti F, De Luca G, Brescia Morra V, Cocco E, Pozzilli C, Sola P, Bergamaschi R, Salemi G, Inglese M, Millefiorini E, Galgani S, Zaffaroni M, Ghezzi A, Salvetti M, Lus G, Florio C, Totaro R, Granella F, Vianello M, Gatto M, Di Battista G, Aguglia U, Logullo FO, Simone M, Lucisano G, Iaffaldano P, Trojano M. Disease-modifying drugs can reduce disability progression in relapsing multiple sclerosis. Brain 2020; 143:3013-3024. [DOI: 10.1093/brain/awaa251] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/30/2020] [Accepted: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
An ever-expanding number of disease-modifying drugs for multiple sclerosis have become available in recent years, after demonstrating efficacy in clinical trials. In the real-world setting, however, disease-modifying drugs are prescribed in patient populations that differ from those included in pivotal studies, where extreme age patients are usually excluded or under-represented. In this multicentre, observational, retrospective Italian cohort study, we evaluated treatment exposure in three cohorts of patients with relapsing-remitting multiple sclerosis defined by age at onset: paediatric-onset (≤18 years), adult-onset (18–49 years) and late-onset multiple sclerosis (≥50 years). We included patients with a relapsing-remitting phenotype, ≥5 years follow-up, ≥3 Expanded Disability Status Scale (EDSS) evaluations and a first neurological evaluation within 3 years from the first demyelinating event. Multivariate Cox regression models (adjusted hazard ratio with 95% confidence intervals) were used to assess the risk of reaching a first 12-month confirmed disability worsening and the risk of reaching a sustained EDSS of 4.0. The effect of disease-modifying drugs was assessed as quartiles of time exposure. We found that disease-modifying drugs reduced the risk of 12-month confirmed disability worsening, with a progressive risk reduction in different quartiles of exposure in paediatric-onset and adult-onset patients [adjusted hazard ratios in non-exposed versus exposed >62% of the follow-up time: 8.0 (3.5–17.9) for paediatric-onset and 6.3 (4.9–8.0) for adult-onset, P < 0.0001] showing a trend in late-onset patients [adjusted hazard ratio = 1.9 (0.9–4.1), P = 0.07]. These results were confirmed for a sustained EDSS score of 4.0. We also found that relapses were a risk factor for 12-month confirmed disability worsening in all three cohorts, and female sex exerted a protective role in the late-onset cohort. This study provides evidence that sustained exposure to disease-modifying drugs decreases the risk of disability accumulation, seemingly in a dose-dependent manner. It confirms that the effectiveness of disease-modifying drugs is lower in late-onset patients, although still detectable.
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Affiliation(s)
- Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Emilio Portaccio
- SOC Neurologia, Ospedale San Giovanni di Dio, AUSL Toscana Centro1, Florence, Italy
| | - Luisa Pastò
- Department NEUROFARBA, University of Florence, Florence, Italy
| | | | - Elio Prestipino
- Department NEUROFARBA, University of Florence, Florence, Italy
| | | | - Laura Tudisco
- Department NEUROFARBA, University of Florence, Florence, Italy
| | | | - Giancarlo Comi
- San Raffaele Hospital - INSPE; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Patti
- Dipartimento di Scienze Mediche e Chirurgiche e Tecnologie Avanzate, GF Ingrassia, Sez. Neuroscienze, Centro Sclerosi Multipla, University of Catania, Catania, Sicily, Italy
| | - Giovanna De Luca
- Centro Sclerosi Multipla, Clinica Neurologica, Policlinico SS Annunziata, Università ‘G. d'Annunzio’, Chieti-Pescara, Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Napoli, Italy
| | - Eleonora Cocco
- Centro Sclerosi Multipla, ASSL Cagliari (ATS Sardegna); Dipartimento di Scienze Mediche e Sanità Pubblica, University of Cagliari, Cagliari, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, S. Andrea Hospital, Dept. of Human Neuroscience, Sapienza University, Rome, Italy
| | - Patrizia Sola
- Centro Malattie Demielinizzanti - Dipartimento di Neuroscienze, Azienda Ospedaliero-Universitaria/OCSAE, UO Neurologia, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Sicily, Italy
| | - Matilde Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Enrico Millefiorini
- Multiple Sclerosis Center, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Simonetta Galgani
- multiple sclerosis Centre, Department of Neurosciences, S. Camillo - Forlanini Hospital, Rome, Italy
| | - Mauro Zaffaroni
- ASST della Valle Olona, Multiple Sclerosis Center, S. Antonio Abate Hospital of Gallarate, Gallarate, Italy
| | - Angelo Ghezzi
- ASST della Valle Olona, Multiple Sclerosis Center, S. Antonio Abate Hospital of Gallarate, Gallarate, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Centre for Experimental Neurological Therapies, S. Andrea Hospital/Sapienza University, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Rome, Italy
| | - Giacomo Lus
- Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Ciro Florio
- Multiple Sclerosis Center, Cardarelli Hospital, Naples, Italy
| | - Rocco Totaro
- Demyelinating Diseases Center, Department of Neurology, San Salvatore Hospital, L'Aquila, Italy
| | - Franco Granella
- Unit of Neurosciences, Department of Medicine and Surgery, University of Parma, Italy
| | - Marika Vianello
- Centro Sclerosi Multipla - Ospedale Regionale ‘Ca’ Foncello', Neurology Unit, Treviso, Italy
| | - Maurizia Gatto
- Ospedale Generale Regionale ‘F. Miulli’, Neurology Unit, Acquaviva delle Fonti (BA), Italy
| | | | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Neurology Unit, Catanzaro, Italy
| | | | - Marta Simone
- Child Neuropsychiatric Unit, Department of Biomedical Sciences and Human Oncology, University ‘Aldo Moro’ of Bari, Policlinico Piazza G. Cesare, 11, 70121, Bari, Italy
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari ‘Aldo Moro’ Policlinico, Bari, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari ‘Aldo Moro’ Policlinico, Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari ‘Aldo Moro’ Policlinico, Bari, Italy
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Di Giovanni P, Di Martino G, Scampoli P, Cedrone F, Meo F, Lucisano G, Romano F, Staniscia T. Arsenic Exposure and Risk of Urothelial Cancer: Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2020; 17:ijerph17093105. [PMID: 32365627 PMCID: PMC7246722 DOI: 10.3390/ijerph17093105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/08/2023]
Abstract
Background: Arsenic is a toxic metalloid element widely distributed throughout the environment. Arsenic contaminated water has become an ongoing public health issue affecting hundred million people worldwide. The aim of this paper was to summarize the evidence in the association between arsenic metabolites and urinary tract cancer risk. Methods: A systematic review was conducted searching for observational studies that evaluated the association of arsenic metabolites and urinary tract cancer. Risk estimates from individual studies were pooled by using random effects models. Results: All the metabolites considered in this study resulted to be significantly associated to urothelial cancer, respectively: IA% 3.51 (1.21-5.82) (p = 0.003), MMA with WMD = 2.77 (1.67-3.87) (p < 0.001) and DMA with WMD = -4.56 (-7.91-1.22) (p = 0.008). Conclusions: Arsenic metabolites are significantly associated to urothelial cancer. Future studies will help to verify the independent association(s) between arsenic metabolites and urothelial cancer.
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Affiliation(s)
- Pamela Di Giovanni
- Department of Pharmacy, “G. d’Annunzio” University Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy;
| | - Giuseppe Di Martino
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy;
- Correspondence: ; Tel.: +3908713554118
| | - Piera Scampoli
- School of Hygiene and Preventive Medicine, “G. d’Annunzio” University Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (P.S.); (F.C.); (F.M.)
| | - Fabrizio Cedrone
- School of Hygiene and Preventive Medicine, “G. d’Annunzio” University Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (P.S.); (F.C.); (F.M.)
| | - Francesca Meo
- School of Hygiene and Preventive Medicine, “G. d’Annunzio” University Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (P.S.); (F.C.); (F.M.)
| | - Giuseppe Lucisano
- Centre for Outcomes Research and Clinical Epidemiology (CORESEARCH), Via Tiziano Veciello, 65100 Pescara, Italy;
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, “La Sapienza” University of Rome, P.zza Aldo Moro 5, 00100 Rome, Italy;
| | - Tommaso Staniscia
- Department of Medicine and Aging Sciences, “G. d’Annunzio” University Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy;
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Vaccaro O, Nicolucci A, Lucisano G, Masulli M, Riccardi G. Response to Letter to the Editor: "Cardiovascular Effects of Pioglitazone or Sulfonylureas According to Pretreatment Risk: Moving Toward Personalized Care". J Clin Endocrinol Metab 2020; 105:5731505. [PMID: 32036387 DOI: 10.1210/clinem/dgz135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Ceriello A, Rossi MC, De Cosmo S, Lucisano G, Pontremoli R, Fioretto P, Giorda C, Pacilli A, Viazzi F, Russo G, Nicolucci A. Erratum. Overall Quality of Care Predicts the Variability of Key Risk Factors for Complications in Type 2 Diabetes: An Observational, Longitudinal Retrospective Study. Diabetes Care 2019;42:514-519. Diabetes Care 2020; 43:497. [PMID: 31826863 PMCID: PMC6971781 DOI: 10.2337/dc20-er02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Heerspink HJL, Karasik A, Thuresson M, Melzer-Cohen C, Chodick G, Khunti K, Wilding JPH, Garcia Rodriguez LA, Cea-Soriano L, Kohsaka S, Nicolucci A, Lucisano G, Lin FJ, Wang CY, Wittbrodt E, Fenici P, Kosiborod M. Kidney outcomes associated with use of SGLT2 inhibitors in real-world clinical practice (CVD-REAL 3): a multinational observational cohort study. Lancet Diabetes Endocrinol 2020; 8:27-35. [PMID: 31862149 DOI: 10.1016/s2213-8587(19)30384-5] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [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: 09/27/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Cardiovascular and kidney outcome trials have shown that sodium-glucose co-transporter-2 (SGLT2) inhibitors slow progression of chronic kidney disease in patients with type 2 diabetes with or without chronic kidney disease. The aim of this study was to assess whether these benefits extend to patients with type 2 diabetes treated in routine clinical practice. METHODS CVD-REAL 3 was a multinational observational cohort study in which new users of SGLT2 inhibitors and other glucose-lowering drugs with measurements of estimated glomerular filtration rate (eGFR) before and after (within 180 days) initiation were identified via claims, medical records, and national registries in Israel, Italy, Japan, Taiwan, and the UK. Propensity scores for SGLT2 inhibitor initiation were developed in each country, with 1:1 matching with initiators of other glucose-lowering drugs. Propensity score included (in addition to other clinical and demographic variables) baseline eGFR and eGFR slope before SGLT2 inhibitor or other glucose-lowering drug initiation. The main outcome measure was rate of eGFR decline (slope) calculated with a linear mixed regression model. Differences in eGFR slope between SGLT2 inhibitors and other glucose-lowering drugs were calculated and pooled. We also assessed a composite outcome of 50% eGFR decline or end-stage kidney disease. FINDINGS After propensity matching, there were 35 561 episodes of treatment initiation in each group, from 65 231 individual patients. Dapagliflozin, empagliflozin, canagliflozin, ipragliflozin, tofogliflozin, and luseogliflozin accounted for 57·9%, 34·1%, 5·7%, 1·4%, 0·5%, and 0·4% of SGLT2 inhibitor initiation episodes, respectively. At baseline, 29 363 (41·3%) of 71 122 initiations were in women, mean age was 61·3 years, mean HbA1c was 72 mmol/mol (8·71%), and mean eGFR was 90·7 mL/min per 1·73 m2. During follow-up, SGLT2 inhibitor initiation was associated with reduced eGFR decline (difference in slope for SGLT2 inhibitors vs other glucose-lowering drugs 1·53 mL/min per 1·73 m2 per year, 95% CI 1·34-1·72, p<0·0001). During a mean follow-up of 14·9 months, 351 composite kidney outcomes occurred: 114 (3·0 events per 10 000 patient-years) among initiators of SGLT2 inhibitors and 237 (6·3 events per 10 000 patient-years) among initiators of other glucose-lowering drugs (hazard ratio 0·49, 95% CI 0·35-0·67; p<0·0001). These findings were consistent across countries (pheterogeneity 0·10) and prespecified subgroups. INTERPRETATION In this large, international, real-world study of patients with type 2 diabetes, initiation of SGLT2 inhibitor therapy was associated with a slower rate of kidney function decline and lower risk of major kidney events compared with initiation of other glucose-lowering drugs. These data suggest that the benefits of SGLT2 inhibitors on kidney function identified in clinical trials seem to be largely generalisable to clinical practice. FUNDING AstraZeneca.
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Affiliation(s)
- Hiddo J L Heerspink
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center, Groningen, Netherlands.
| | - Avraham Karasik
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel; Tel Aviv University, Tel Aviv, Israel
| | | | - Cheli Melzer-Cohen
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - John P H Wilding
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | | | - Lucia Cea-Soriano
- Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain; Department of Public Health and Maternal and Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Antonio Nicolucci
- Clinical Epidemiology Department, CORESEARCH, Centre for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Giuseppe Lucisano
- Clinical Epidemiology Department, CORESEARCH, Centre for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Fang-Ju Lin
- National Taiwan University, Taipei, Taiwan; National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Yuan Wang
- National Taiwan University, Taipei, Taiwan; National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Mikhail Kosiborod
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
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Ponzani P, Berra C, Di Lelio A, Del Sindaco P, Di Loreto C, Reggiani F, Lucisano G, Rossi MC. Switching Patients with Type 1 Diabetes to Insulin Degludec from Other Basal Insulins: Real-World Data of Effectiveness and Safety. Diabetes Ther 2020; 11:97-105. [PMID: 31707573 PMCID: PMC6965554 DOI: 10.1007/s13300-019-00722-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Real-world evidence on the effectiveness and safety of insulin degludec (IDeg) in patients with diabetes is a priority. We have therefore evaluated the effectiveness and safety of IDeg, including impact on metabolic control, glycemic variability, weight gain and hypoglycemia, in patients with type 1 diabetes under routine clinical practice conditions. METHODS This was an observational longitudinal multicenter study. A retrospective chart review of all patients with type 1 diabetes who were switched from basal insulin to IDeg was performed, and temporal trends in clinical outcomes were assessed. RESULTS Data obtained from 195 patients, with a median age of 42.8 [interquartile range (IQR) 24.6-56.4] years and a median diabetes duration of 16 (IQR 10.0-28) years, were analyzed. Median follow-up was 9.5 (IQR 7.7-11.3) months. Improvements were found in glycated hemoglobin (- 0.34%; p < 0.0001), fasting blood glucose (- 24.82 mg/dL; p < 0.0001), post-prandial glucose (- 17.23 mg/dL; p = 0.0009), glycemic variability as indicated by standard deviation of blood glucose (- 5.67 mg/dL; p < 0.0001) and high blood glucose index (- 3.77; p < 0.0001). Body weight and body mass index remained substantially stable during the follow-up (- 0.18 kg; p = 0.56 and - 0.12; p = 0.42, respectively). Risk of nocturnal hypoglycemia decreased by 52% [incidence rate ratio 0.48; 95% confidence interval (CI) 0.29-0.77] and risk of total hypoglycemic episodes by 41% (incidence ratio 0.59; 95% CI 0.45-0.83). Basal and short-acting insulin doses decreased by - 1.4 and - 3.1 IU, respectively. CONCLUSION Switching patients with type 1 diabetes to IDeg from other basal insulins was associated with relevant improvements in metabolic control and glycemic variability without weight gain; the risk of hypoglycemic episodes also significantly declined. FUNDING Novo Nordisk S.p.A. unconditional grant.
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Affiliation(s)
- Paola Ponzani
- SSD Endocrinologia, Diabetologia e Malattie Metaboliche, ASL3 Genovese, Genoa, Italy
| | - Cesare Berra
- Humanitas Research Institute, Rozzano, MI, Italy
| | - Alessandra Di Lelio
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | | | - Chiara Di Loreto
- Servizio di Diabetologia del Perugino, USL Umbria 1, Perugia, Italy
| | | | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Maria Chiara Rossi
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy.
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Pintaudi B, Di Vieste G, Corrado F, Lucisano G, Giunta L, D'Anna R, Di Benedetto A. Effects of myo-inositol on glucose variability in women with gestational diabetes. Eur Rev Med Pharmacol Sci 2019; 22:6567-6572. [PMID: 30338829 DOI: 10.26355/eurrev_201810_16073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Myo-inositol supplementation prevents gestational diabetes (GDM) in women at risk and reduces insulin resistance in women with GDM. No data are available about its effect on glucose variability. The aim of this study was to evaluate the effects of a supplementation of myo-inositol on glucose variability in women with GDM. PATIENTS AND METHODS Myo-inositol effect on glucose variability was studied in a pilot case-control study involving 12 consecutive pregnant women (median age 34 years, 25.0% insulin-treated) with GDM. Six women received myo-inositol 2 g plus 200 mg folic acid twice a day, the others received only folic acid. Information on side effects was collected. A continuous glucose monitoring system was wore before and at the beginning of the supplementation. Mean amplitude of glucose excursion (MAGE), standard deviation (SD) and variability coefficient were the indexes of glucose variability. RESULTS Myo-inositol lowered glucose levels in the first days after the treatment was started. However, pre-post supplementation overall mean glucose difference was similar between groups (-4.8 vs. 5.0 mg/dL for controls and treated, respectively; p = 0.79). Pre-post differences in SD (13.7 vs. 6.0; p < 0.001), MAGE (3.5 vs.-1.5; p < 0.001) and variability coefficient (0.14 vs. 0.02; p < 0.001) were improved in myo-inositol group. No side effects were recorded. CONCLUSIONS Myo-inositol is effective in reducing glucose variability in women with GDM. It could be a useful strategy for treating GDM.
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Affiliation(s)
- B Pintaudi
- Diabetes Unit, Niguarda Cà Granda Hospital, Milan, Italy.
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Di Martino G, Di Giovanni P, Scampoli P, Meo F, Cedrone F, Lucisano G, Staniscia T. Arsenic metabolism and urothelial cancer risk: a systematic review and meta-analysis. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.247] [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: 11/12/2022] Open
Abstract
Abstract
Background
Arsenic is a toxic metalloid element frequently found in the environment. Chronic arsenic exposure is a critical public health issue in many countries since the identification of arsenic and its compounds as human carcinogens by the World Health Organization. After absorption, inorganic arsenic (iAs) is mainly methylated into monomethylated and dimethylated compounds (MMA, DMA), which are then excreted through the kidney together with unmethylated iAs. Whether the methylation process is to detoxify or potentiate arsenic toxicity, however, remains an ongoing debate. The purpose of this systematic review was to conduct a comprehensive meta-analysis to estimate the association between arsenic exposure and urothelial cancer.
Methods
10 observational studies met the inclusion criteria and were included in the systematic review. IAs%, MMA% and DMA% were extracted from each paper. Weighted Mean Differences with 95% confidence intervals were defined according to Cases minus Controls. Pooled risk estimates from individual studies were assessed using random effects models. Meta-regression analysis was performed to estimate the extent of urothelial cancer risk as a function of iAs%, MMA% and DMA%.
Results
Results showed as patients with urothelial cancer presented higher level of urinary iAs% (WMD 2.70, 95%CI 0.64-4.76), MMA% (WMD 2.81, 95%CI 1.43-4.20) and DMA% (WMD-3.44, 95%CI-6.57–0.30).
Conclusions
These findings suggest that higher level of iAs% and MMA% and lower level of DMA% were associated with an increased risk of urothelial cancer. Additional population based studies are needed to understand the role of arsenic in cancer development. Understanding the meaning of arsenic metabolism could improve the risk assessment of arsenic toxicity and provide a potential tool for disease prediction and prevention.
Key messages
Higher level of iAs%, MMA% and DMA% were associated with an increased risk of urothelial cancer. Understanding the meaning of arsenic metabolism could improve the risk assessment of arsenic toxicity.
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Affiliation(s)
- G Di Martino
- School of Hygiene and Preventive Medicine, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - P Di Giovanni
- Department of Pharmacy, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - P Scampoli
- School of Hygiene and Preventive Medicine, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - F Meo
- School of Hygiene and Preventive Medicine, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - F Cedrone
- School of Hygiene and Preventive Medicine, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | | | - T Staniscia
- Department of Medicine and Ageing Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
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Paolicelli D, Lucisano G, Manni A, Avolio C, Bonavita S, Brescia Morra V, Capobianco M, Cocco E, Conte A, De Luca G, De Robertis F, Gasperini C, Gatto M, Gazzola P, Lus G, Iaffaldano A, Iaffaldano P, Maimone D, Mallucci G, Maniscalco GT, Marfia GA, Patti F, Pesci I, Pozzilli C, Rovaris M, Salemi G, Salvetti M, Spitaleri D, Totaro R, Zaffaroni M, Comi G, Amato MP, Trojano M. Retrospectively acquired cohort study to evaluate the long-term impact of two different treatment strategies on disability outcomes in patients with relapsing multiple sclerosis (RE.LO.DI.MS): data from the Italian MS Register. J Neurol 2019; 266:3098-3107. [PMID: 31535270 DOI: 10.1007/s00415-019-09531-6] [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] [Received: 07/11/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND The increase in disease-modifying drugs (DMDs) allows individualization of treatment in relapsing multiple sclerosis (RMS); however, the long-term impact of different treatment sequences is not well established. This is particularly relevant for MS patients who may need to postpone more aggressive DMD strategies. OBJECTIVE To evaluate different therapeutic strategies and their long-term outcomes, measured as relapses and confirmed disability progression (CDP), in MS 'real-world' settings. METHODS Multicentre, observational, retrospectively acquired cohort study evaluating the long-term impact of different treatment strategies on disability outcomes in patients with RMS in the Italian MS Register. RESULTS We evaluated 1152 RMS-naïve patients after propensity-score adjustment. Patients included were receiving: interferon beta-1a (IFN-β1a) 44 µg switching to fingolimod (FTY; IFN-switchers; n = 97); FTY only (FTY-stayers; n = 157); IFN-β1a only (IFN-stayers; n = 849). CDP and relapses did not differ between FTY-stayers and IFN-switchers [HR (95% CI) 0.99 (0.48-2.04), p = 0.98 and 0.81 (0.42-1.58), p = 0.55, respectively]. However, IFN-stayers showed increased risk of relapses compared with FTY-stayers [HR (95% CI) 1.46 (1.00-2.12), p = 0.05]. CONCLUSION The ideal treatment option for MS is becoming increasingly complex, with the need to balance benefit and risks. Our results suggest that starting with FTY affects the long-term disease outcome similarly to escalating from IFN-β1a to FTY.
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Affiliation(s)
- Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy.
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Alessia Manni
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
| | - Carlo Avolio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University of Naples, Naples, Italy
| | - Marco Capobianco
- Department of Neurology and Regional Multiple Sclerosis Centre, University Hospital San Luigi, Orbassano, TO, Italy
| | - Eleonora Cocco
- Department of Medical Science and Public Health, University of Cagliari and Multiple Sclerosis Center, Cagliari, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza, University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, IS, Italy
| | - Giovanna De Luca
- Neurology Clinic, Multiple Sclerosis Centre, SS Annunziata Hospital, Chieti, Italy
| | | | | | - Maurizia Gatto
- Neurology Unit, "F. Miulli" Hospital, Acquaviva delle Fonti BA, Italy
| | - Paola Gazzola
- Departemental Center for the Diagnosis and Treatment of Demyelinating Diseases, Sestri Ponente, Genoa, Italy
| | - Giacomo Lus
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Antonio Iaffaldano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
| | - Davide Maimone
- Multiple Sclerosis Center, Garibaldi Hospital, Catania, Italy
| | - Giulia Mallucci
- Multiple Sclerosis Center of IRCCS Mondino Foundation, Pavia, Italy
| | | | - Girolama A Marfia
- Department of Systems Medicine, Multiple Sclerosis Clinical and Research Center, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Ilaria Pesci
- Multiple Sclerosis Center, Ospedale di Vaio (I.P.), Fidenza, PR, Italy
| | - Carlo Pozzilli
- Multiple Sclerosis Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.,Department of Neurology, University La Sapienza, Rome, Italy
| | - Marco Rovaris
- Multiple Sclerosis Center, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Giuseppe Salemi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, Palermo University, Palermo, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University, Rome, Italy.,Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Isernia, Italy
| | | | - Rocco Totaro
- Department of Neurology, Demyelinating Disease Center, San Salvatore Hospital, L'Aquila, Italy
| | - Mauro Zaffaroni
- Multiple Sclerosis Center, Hospital of Gallarate, Gallarate, Italy
| | - Giancarlo Comi
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy.,IRCCS and Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences, and Sense Organs, Multiple Sclerosis Center, University of Bari "Aldo Moro", Bari, Italy
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Frattari A, Savini V, Polilli E, Di Marco G, Lucisano G, Corridoni S, Spina T, Costantini A, Nicolucci A, Fazii P, Viale P, Parruti G. Control of Gram-negative multi-drug resistant microorganisms in an Italian ICU: Rapid decline as a result of a multifaceted intervention, including conservative use of antibiotics. Int J Infect Dis 2019; 84:153-162. [PMID: 31204003 DOI: 10.1016/j.ijid.2019.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Gram-negative Multi-Drug-Resistant Organisms (GNMDROs) cause an increasing burden of disease in Intensive Care Units (ICUs). We deployed a multifaceted intervention to control selection and transmission of GNMDROs and to estimate at which rate GNMDROs would decline with our interventional bundle. METHODS Interventions implemented in 2015: in-ward Antimicrobial-Stewardship-Program for appropriate management of antimicrobial prescription; infection monitoring with nasal/rectal swabs and repeated procalcitonin assays; 24 h microbiological support (since 2016); prevention of catheter-related infections, VAPs and in-ward GNMDROs transmission; education of ICU personnel. In May 2017, epidemiological, clinical and microbiological data were collected and retrospectively analyzed. Rates of resistance in Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, as well as percentages of resistance among all Gram-negative bacteria were compared during the study period. RESULTS Of 668 patients, at least one isolate was obtained from 399 patients. The proportions of patients with infection and with Gram-negative isolates were even across the 5 semesters (p = 0.8). For Klebsiella pneumoniae, the number of strains resistant to carbapenems fell from 94% to 6% (p < 0.001). Significant drops were also observed for Pseudomonas aeruginosa and Acinetobacter baumannii. Percentages of resistance for all Gram-negative isolates fell from 91% to 13% (p < 0.0001). The reduction in antibiotic prescription translated in a considerable reduction of pharmacy costs. Multivariate models confirmed that the hospitalization semester was the most relevant independent predictor of resistance among Gram-negative bacteria. CONCLUSIONS Our experience provides further evidence that a multi-faceted intervention, aimed to reduce selection and transmission of GNMDROs with efficient microbiological support, may yield remarkable results in a short time interval.
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Affiliation(s)
- Antonella Frattari
- Unit of Anesthesia and Intensive Care, Pescara General Hospital, Pescara, Italy
| | - Vincenzo Savini
- Unit of Clinical Microbiology, Pescara General Hospital, Pescara, Italy
| | - Ennio Polilli
- Unit of Clinical Pathology, Pescara General Hospital, Pescara, Italy
| | - Graziano Di Marco
- Unit of Management Control, Local Health Unit Direction, Pescara General Hospital, Pescara, Italy
| | - Giuseppe Lucisano
- Unit of Biostatistics, CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Tullio Spina
- Unit of Anesthesia and Intensive Care, Pescara General Hospital, Pescara, Italy
| | | | - Antonio Nicolucci
- Unit of Biostatistics, CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Paolo Fazii
- Unit of Clinical Microbiology, Pescara General Hospital, Pescara, Italy
| | - Pierluigi Viale
- Cathedra of Infectious Diseases, Alma Mater University, Boulogne, Italy
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy.
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Vaccaro O, Lucisano G, Masulli M, Bonora E, Del Prato S, Rivellese AA, Giorda CB, Mocarelli P, Squatrito S, Maggioni AP, Riccardi G, Nicolucci A. Cardiovascular Effects of Pioglitazone or Sulfonylureas According to Pretreatment Risk: Moving Toward Personalized Care. J Clin Endocrinol Metab 2019; 104:3296-3302. [PMID: 31058962 DOI: 10.1210/jc.2019-00361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/14/2019] [Accepted: 04/30/2019] [Indexed: 12/30/2022]
Abstract
CONTEXT Hypoglycemic drugs with proven cardiovascular (CV) benefits are recommended for patients with type 2 diabetes and CV disease. Whether the beneficial effects extend to those at lower risk remains unclear. AIM We investigated the long-term CV effects of pioglitazone or sulfonylureas (SUs) across the spectrum of pretreatment CV risk. METHODS Among 2820 participants of the TOSCA.IT trial, four subgroups with different risk of outcome-a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, urgent coronary revascularization-were identified by the RECursive Partitioning and AMalgamation (RECPAM) method. Within each group, the effect of SUs or pioglitazone on the outcome was evaluated. RESULTS Sex was the first splitting variable, followed by urinary albumin-to-creatinine ratio (UACR) (>9 mg/g or ≤9 mg/g) and body mass index (BMI) (>28.7 or ≤28.7 kg/m2). Female patients had the lowest risk (reference); male patients with UACR >9 mg/g and BMI >28.7 kg/m2 had the highest risk [hazard ratio (HR), 5.58; 95% CI, 3.32 to 9.69]. Patients in this group present a cluster of conditions suggestive of marked insulin resistance (higher BMI, waist circumference, triglycerides, blood pressure, and UACR and lower high-density lipoprotein cholesterol) than the other groups. Treatment with pioglitazone in this group was associated with a significantly lower occurrence of the outcome than SUs (HR, 0.48; 95% CI, 0.25 to 0.76). No significant difference between study treatments was observed in the other RECPAM classes. CONCLUSIONS It is possible to identify patients with type 2 diabetes early in the stage of their disease and who are largely free from evident CV disease in whom add-on pioglitazone to metformin confers CV protection as compared with SUs.
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Affiliation(s)
- Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Paolo Mocarelli
- University Department of Laboratory Medicine, Hospital of Desio, Desio (MB), Italy
| | | | | | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
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Rossi MC, Nicolucci A, Ozzello A, Gentile S, Aglialoro A, Chiambretti A, Baccetti F, Gentile FM, Romeo F, Lucisano G, Giorda CB. Impact of severe and symptomatic hypoglycemia on quality of life and fear of hypoglycemia in type 1 and type 2 diabetes. Results of the Hypos-1 observational study. Nutr Metab Cardiovasc Dis 2019; 29:736-743. [PMID: 31153746 DOI: 10.1016/j.numecd.2019.04.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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] [Received: 11/19/2018] [Revised: 04/04/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Hypoglycemia represents a relevant burden in people with diabetes. Consequences of hypoglycemia/fear of hypoglycemia on quality of life (QoL) and behaviors of patients with T1DM and T2DM were assessed. METHODS AND RESULTS HYPOS-1 was an observational retrospective study. Fear of hypoglycemia (Fear of Hypoglycemia Questionnaire, FHQ), general health status (visual analog scale of EuroQol questionnaire, EQ5D-VAS) psychological well-being (WHO-5 well being index, WHO-5), diabetes related distress (Problem Areas in Diabetes 5, PAID-5), and corrective/preventive behaviors following hypoglycemia were compared between people with and without previous experience of severe and symptomatic hypoglycemia and by tertiles of FHQ scores. A multivariate analysis was performed to identify factors associated with the likelihood of being in the third tertile of FHQ score. Overall, 2229 patients were involved. Severe hypoglycemia had statistically significant and clinically relevant (measured as effect sizes) negative impact on EQ5D-VAS, WHO-5, PAID-5, and FHQ both in T1DM and T2DM. In T2DM, symptomatic episodes had similar impact of severe hypoglycemia. Moving from the first to the third FHQ tertile, lower scores of EQ-5D VAS and WHO-5, and higher levels of PAID-5 were found. Patients in the third tertile performed more frequently corrective/preventive actions that negatively impact on metabolic control. Previous hypoglycemia, insulin treatment, female gender, age, and school education were the independent factors associated with increased likelihood to be in the third tertile. CONCLUSION Not only severe but also symptomatic hypoglycemia negatively affect patient QoL, especially in T2DM. Addressing fear of hypoglycemia should be a goal of diabetes education.
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Affiliation(s)
- Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Alessandro Ozzello
- Departmental Service of Diabetology and Metabolic Diseases, ASL TO3, Pinerolo, TO, Italy
| | - Sandro Gentile
- Campania University "Luigi Vanvitelli", Naples, Italy; Nefrocenter Research Network, Naples, Italy
| | | | | | - Fabio Baccetti
- Metabolism and Diabetes Unit, ASL 1, Massa, Carrara, Italy
| | | | | | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Carlo B Giorda
- Metabolism and Diabetes Unit, ASL TO5, Chieri, TO, Italy
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Manni A, Iaffaldano A, Lucisano G, D'Onghia M, Mezzapesa DM, Felica V, Iaffaldano P, Trojano M, Paolicelli D. Lymphocyte Count and Body Mass Index as Biomarkers of Early Treatment Response in a Multiple Sclerosis Dimethyl Fumarate-Treated Cohort. Front Immunol 2019; 10:1343. [PMID: 31258529 PMCID: PMC6587065 DOI: 10.3389/fimmu.2019.01343] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/28/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction: In relapsing Multiple Sclerosis (RMS) patients treated with disease modifying drugs (DMDs), few data are available regarding the biomarkers of treatment response. We aimed to assess the predictive value of lymphocyte count (LC) and Body Mass Index (BMI) for treatment response in a real life setting of dimethyl fumarate (DMF) treated patients. Materials and Methods: We included in our observational analysis 338 patients who were prescribed DMF in an Italian MS Center. We collected clinical and demographic data at the beginning of DMF (T0), and assessed White Blood Cells (WBC) and LC at T0 and at 3 (T3), 6 (T6), 9 (T9), and 12 (T12) months. Gadolinium enhancing (Gd+), new T2 lesions and relapses within the first year of treatment (T12) were recorded in order to evaluate clinical activity at 12 months. Analysis of correlation was performed to correlate WBC, LC and BMI with clinical and radiological responses. We evaluated whether BMI or LC can predict treatment response by using multivariate logistic regression models at each follow-up. Results: Our cohort was followed up for a mean period of 19.8 ± 6.8 months. The mean BMI at baseline was 24.19 ± 4.48. The multivariate models gave as predictive factors for Gd+ lesions at T12, LC at T3 (OR = 1.003, 95% CI = 1.00-1.07; p = 0.046) and baseline BMI (OR = 0.71, 95% CI = 0.52-0.98; p = 0.037). Predictive factors for new T2 lesions at T12 were LC at T3 (OR = 1.01 95%CI = 1.00-1.95; p = 0.005) and baseline BMI (OR = 0.99, 95% CI = 0.98-1.00; p = 0.026). Conclusions: In our real life-experience, BMI and LC may be early biomarkers to predict treatment response during DMF.
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Affiliation(s)
- Alessia Manni
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Antonio Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Lucisano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.,Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Domenico Maria Mezzapesa
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Vincenzo Felica
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Pietro Iaffaldano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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Ceriello A, Rossi MC, De Cosmo S, Lucisano G, Pontremoli R, Fioretto P, Giorda C, Pacilli A, Viazzi F, Russo G, Nicolucci A. Overall Quality of Care Predicts the Variability of Key Risk Factors for Complications in Type 2 Diabetes: An Observational, Longitudinal Retrospective Study. Diabetes Care 2019; 42:514-519. [PMID: 30765432 DOI: 10.2337/dc18-1471] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/15/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE An association between variability in clinical parameters (HbA1c, blood pressure, cholesterol, and uric acid) and risk of complications in type 2 diabetes has been reported. In this analysis, we investigated to what extent such variability is associated with overall quality of care. RESEARCH DESIGN AND METHODS The quality of care summary score (Q-score) represents a validated, overall quality of care indicator ranging between 0 and 40; the higher the score, the better the quality of care provided by the diabetes center. We identified patients with five or more measurements of clinical parameters after the assessment of the Q-score. Multiple linear regression analyses assessed the role of the Q-score in predicting the variability of the different parameters. RESULTS Overall, 273,888 patients were analyzed. The variability of all the parameters systematically increased with decreasing Q-score values. At multivariate linear regression analysis, compared with a Q-score >25, a score <15 was associated with a significantly larger variation in HbA1c, blood pressure, uric acid, total cholesterol, and LDL cholesterol and a lower variation in HDL cholesterol. The analysis of standardized β coefficients show that the Q-score has a larger impact on the variability of HbA1c (0.34; P < 0.0001), systolic blood pressure (0.21; P < 0.0001), total cholesterol (0.21; P < 0.0001), and LDL cholesterol (0.20; P < 0.0001). CONCLUSIONS The variability of risk factors for diabetic complications is associated with quality of care. Quality of care improvement initiatives should be targeted to increase the achievement of the recommended target while reducing such variability.
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Affiliation(s)
- Antonio Ceriello
- Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain .,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.,Department of Cardiovascular and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Maria Chiara Rossi
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Salvatore De Cosmo
- Department of Medical Sciences, Scientific Institute "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Foggia, Italy
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Roberto Pontremoli
- Department of Cardionephrology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - Paola Fioretto
- Department of Medicine, University of Padua, Padua, Italy
| | - Carlo Giorda
- Diabetes and Metabolism Unit, Department of Internal Medicine, ASL Turin 5, Chieri, Turin, Italy
| | - Antonio Pacilli
- Department of Medical Sciences, Scientific Institute "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Foggia, Italy
| | - Francesca Viazzi
- Department of Cardionephrology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - Giuseppina Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Balducci S, D'Errico V, Haxhi J, Sacchetti M, Orlando G, Cardelli P, Vitale M, Bollanti L, Conti F, Zanuso S, Lucisano G, Nicolucci A, Pugliese G. Effect of a Behavioral Intervention Strategy on Sustained Change in Physical Activity and Sedentary Behavior in Patients With Type 2 Diabetes: The IDES_2 Randomized Clinical Trial. JAMA 2019; 321:880-890. [PMID: 30835309 DOI: 10.1001/jama.2019.0922] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [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] [Indexed: 01/01/2023]
Abstract
IMPORTANCE There is no definitive evidence that changes in physical activity/sedentary behavior can be maintained long term in individuals with type 2 diabetes. OBJECTIVE To investigate whether a behavioral intervention strategy can produce a sustained increase in physical activity and reduction in sedentary time among individuals with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS The Italian Diabetes and Exercise Study 2 was an open-label, assessor-blinded, randomized clinical superiority trial, with recruitment from October 2012 to February 2014 and follow-up until February 2017. In 3 outpatient diabetes clinics in Rome, 300 physically inactive and sedentary patients with type 2 diabetes were randomized 1:1 (stratified by center, age, and diabetes treatment) to receive a behavioral intervention or standard care for 3 years. INTERVENTIONS All participants received usual care targeted to meet American Diabetes Association guideline recommendations. Participants in the behavioral intervention group (n = 150) received 1 individual theoretical counseling session and 8 individual biweekly theoretical and practical counseling sessions each year. Participants in the standard care group (n = 150) received only general physician recommendations. MAIN OUTCOMES AND MEASURES Co-primary end points were sustained change in physical activity volume, time spent in light-intensity and moderate- to vigorous-intensity physical activity, and sedentary time, measured by an accelerometer. RESULTS Of the 300 randomized participants (mean [SD] age, 61.6 [8.5] years; 116 women [38.7%]), 267 completed the study (133 in the behavioral intervention group and 134 in the standard care group). Median follow-up was 3.0 years. Participants in the behavioral intervention and standard care groups accumulated, respectively, 13.8 vs 10.5 metabolic equivalent-h/wk of physical activity volume (difference, 3.3 [95% CI, 2.2-4.4]; P < .001), 18.9 vs 12.5 min/dof moderate- to vigorous-intensity physical activity (difference, 6.4 [95% CI, 5.0-7.8]; P < .001), 4.6 vs 3.8 h/d of light-intensity physical activity (difference, 0.8 [95% CI, 0.5-1.1]; P < .001), and 10.9 vs 11.7 h/d of sedentary time (difference, -0.8 [95% CI, -1.0 to -0.5]; P < .001). Significant between-group differences were maintained throughout the study, but the between-group difference in moderate- to vigorous-intensity physical activity decreased during the third year from 6.5 to 3.6 min/d. There were 41 adverse events in the behavioral intervention group and 59 in the standard care group outside of the sessions; participants in the behavioral intervention group experienced 30 adverse events during the sessions (most commonly musculoskeletal injury/discomfort and mild hypoglycemia). CONCLUSIONS AND RELEVANCE Among patients with type 2 diabetes at 3 diabetes clinics in Rome who were followed up for 3 years, a behavioral intervention strategy compared with standard care resulted in a sustained increase in physical activity and decrease in sedentary time. Further research is needed to assess the generalizability of these findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01600937.
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Affiliation(s)
- Stefano Balducci
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Valeria D'Errico
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Jonida Haxhi
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
- Metabolic Fitness Association, Monterotondo, Rome, Italy
| | - Massimo Sacchetti
- Department of Human Movement and Sport Sciences, ''Foro Italico'' University, Rome, Italy
| | - Giorgio Orlando
- Department of Human Movement and Sport Sciences, ''Foro Italico'' University, Rome, Italy
| | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Laboratory of Clinical Chemistry, Sant'Andrea University Hospital, Rome, Italy
| | - Martina Vitale
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Lucilla Bollanti
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Francesco Conti
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Silvano Zanuso
- Centre for Human Performance and Sport, University of Greenwich, Chatham Maritime, United Kingdom
- Currently with Center for Applied Biological & Exercise Sciences, Faculty of Health & Life Sciences, Coventry University, Coventry, United Kingdom
| | - Giuseppe Lucisano
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
- Currently with Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Antonio Nicolucci
- Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
- Currently with Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, ''La Sapienza'' University, Rome, Italy
- Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy
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Ferrito L, Predieri B, Pjetraj D, Alessandrelli MC, Pagnini M, Iannilli A, Marino M, Tombolini S, Pintaudi B, Lucisano G, Zani F, Iughetti L, Nicolucci A, Cherubini V. Weekend-Based Parent-Group Intervention to Reduce Stress in Parents of Children and Adolescents with Type 1 Diabetes: A Pilot Study. J Diabetes Res 2019; 2019:7935945. [PMID: 31871949 PMCID: PMC6906866 DOI: 10.1155/2019/7935945] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/28/2019] [Accepted: 09/12/2019] [Indexed: 02/07/2023] Open
Abstract
Diagnosis of type 1 diabetes (T1D) in a child is often associated with anger, denial, fear, and depression from the parents. The aim of the study was to improve parents' adaptation to the diagnosis of diabetes of their child. Sixty-two parents (29 mothers, 33 fathers) of 36 children with type 1 diabetes (mean age = 11.3-3.3 years; diabetes duration > 1 year; HbA1c = 57 ± 11 mmol/mol) participated in a three-day educational working group pilot intervention study. Intervention was based on the reexamination of the traumatic event of diagnosis of T1D through spatial and time-line anchorage, retracing of the future, emotional awareness, and interactive discussion. Relaxing technique, diaphragmatic breathing, and guided visualization were used by 2 psychologists and 1 pediatric endocrinologist. The study was approved by EC and participants filled a consent form. At baseline and after intervention, parents filled in a questionnaire including Diabetes-Related Distress (DRD), Parent Health Locus of Control Scale (PHLOC), Parent Stress Index Short Form (PSI-SF), Hypoglycemia Fear Survey-Parents (HFS-P) and Hypoglycemia Fear Survey-Parents of Young Children (HFS-P-YC), and Health Survey Short Form-36 (SF-36). Three months after the intervention, both parents reported a reduction in the "difficult child" subscale of the PSI-SF (p < 0.05) and increased scores of social functioning of the SF-36 (p < 0.05). DRD score was significantly reduced in mothers (p = 0.03), while the "parental distress" subscale of the PSI-SF was significantly improved in fathers (p = 0.03). This weekend-based parent group intervention seems to reduce stress and improve social functioning of parents of children and adolescents with type 1 diabetes.
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MESH Headings
- Adaptation, Psychological
- Adolescent
- Adolescent Behavior
- Adult
- Age Factors
- Breathing Exercises
- Child
- Child Behavior
- Child, Preschool
- Cost of Illness
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Emotions
- Feasibility Studies
- Female
- Health Knowledge, Attitudes, Practice
- Humans
- Imagery, Psychotherapy
- Male
- Middle Aged
- Parents/education
- Parents/psychology
- Pilot Projects
- Psychotherapy, Group
- Relaxation Therapy
- Social Behavior
- Stress, Psychological/diagnosis
- Stress, Psychological/prevention & control
- Stress, Psychological/psychology
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Lucia Ferrito
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Dorina Pjetraj
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | | | - Manuela Pagnini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Antonio Iannilli
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Monica Marino
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | - Stefano Tombolini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
| | | | - Giuseppe Lucisano
- CORESEARCH SRL-Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Fabiana Zani
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children, and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Nicolucci
- CORESEARCH SRL-Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Valentino Cherubini
- SOD Pediatric Diabetology, Department of Women's and Children's, “G. Salesi” Children's Hospital, AOU Ospedali Riuniti Ancona, Italy
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Ponzani P, Berra C, Di Lelio A, Del Sindaco P, Di Loreto C, Reggiani F, Lucisano G, Rossi MC. Impact of Insulin Degludec in Type 2 Diabetes: Real-World Data on Effectiveness and Safety. Diabetes Ther 2018; 9:2209-2218. [PMID: 30242611 PMCID: PMC6250625 DOI: 10.1007/s13300-018-0511-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Real-world evidence on effectiveness and safety of insulin degludec (IDeg) in patients with diabetes is a priority. The aim of the study was to evaluate patterns of use and the long-term effectiveness and safety of IDeg in routine clinical practice. METHODS This was an observational longitudinal study. A retrospective chart review of all patients with type 2 diabetes treated with IDeg was performed and temporal trends in clinical outcomes were assessed. All data was stratified by treatment modality: the switch group consisted of patients already treated with another basal insulin before initiating IDeg; the add-on group consisted of basal insulin-naïve patients. RESULTS Overall, 247 patients were analyzed (55 in the add-on group and 192 in the switch group), mean age 67.0 ± 10.9 years ,and diabetes duration 16.3 ± 8.9 years. Median (interquartile range) follow-up was 9.7 (8.0-11.9) months. In the add-on group, improvements were found in glycated hemoglobin (HbA1c) (- 1.68%; p < 0.0001), fasting blood glucose (FBG) (- 64.7 mg/dL; p < 0.0001), post-prandial glucose (PPG) (- 81.1 mg/dl; p < 0.0001), and glycemic variability (i.e., standard deviation of blood glucose) (- 11.6 mg/dl; p = 0.04). Even in the switch group, improvements were found in HbA1c (- 0.57%; p < 0.0001), FBG (- 28.1 mg/dL; p < 0.0001), and PPG (- 22.6 mg/dl; p = 0.001). Body weight increase during the follow-up was not statistically significant vs. baseline in both groups. Benefits on overall, nocturnal, and severe hypoglycemia were found in the switch group. CONCLUSION These real-world data documented that initiating IDeg or switching to IDeg from other basal insulins in type 2 diabetes was associated with significant improvement in metabolic control without significant weight gain; a decrease in the risk of hypoglycemia was observed when switching to IDeg from another basal insulin.
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Affiliation(s)
- Paola Ponzani
- SSD Endocrinologia, Diabetologia e Malattie Metaboliche ASL3 Genovese, Genoa, Italy
| | - Cesare Berra
- Humanitas Research Institute, Rozzano, MI, Italy
| | - Alessandra Di Lelio
- CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Chiara Di Loreto
- Servizio di Diabetologia del Perugino USL Umbria 1, Perugia, Italy
| | | | - Giuseppe Lucisano
- CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Chiara Rossi
- CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
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Pintaudi B, Fresa R, Dalfrà M, Dodesini AR, Vitacolonna E, Tumminia A, Sciacca L, Lencioni C, Marcone T, Lucisano G, Nicolucci A, Bonomo M, Napoli A. The risk stratification of adverse neonatal outcomes in women with gestational diabetes (STRONG) study. Acta Diabetol 2018; 55:1261-1273. [PMID: 30221320 DOI: 10.1007/s00592-018-1208-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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] [Received: 05/25/2018] [Accepted: 08/06/2018] [Indexed: 01/10/2023]
Abstract
AIMS To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk. METHODS Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed. The main outcome measure was the occurrence of adverse neonatal outcomes in pregnancies complicated by GDM. RESULTS Among study participants (median age 36.8 years, pre-gestational BMI 24.8 kg/m2), six miscarriages, one neonatal death, but no maternal death was recorded. The occurrence of the cumulative adverse outcome (OR 2.48, 95% CI 1.59-3.87), large for gestational age (OR 3.99, 95% CI 2.40-6.63), fetal malformation (OR 2.66, 95% CI 1.00-7.18), and respiratory distress (OR 4.33, 95% CI 1.33-14.12) was associated with previous macrosomia. Large for gestational age was also associated with obesity (OR 1.46, 95% CI 1.00-2.15). Small for gestational age was associated with first trimester glucose levels (OR 1.96, 95% CI 1.04-3.69). Neonatal hypoglycemia was associated with overweight (OR 1.52, 95% CI 1.02-2.27) and obesity (OR 1.62, 95% CI 1.04-2.51). The RECPAM analysis identified high-risk subgroups mainly characterized by high pre-pregnancy BMI (OR 1.68, 95% CI 1.21-2.33 for obese; OR 1.38 95% CI 1.03-1.87 for overweight). CONCLUSIONS A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity.
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Affiliation(s)
- Basilio Pintaudi
- SSD Diabetes Unit, Niguarda Cà Granda Hospital, 20162, Milan, Italy.
| | - Raffaella Fresa
- Endocrinology and Diabetes Unit, ASL Salerno, Salerno, Italy
| | | | | | - Ester Vitacolonna
- Department of Medicine and Aging, D'Annunzio University, Chieti-Pescara, Italy
| | - Andrea Tumminia
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy
| | - Laura Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology Section, University of Catania, Catania, Italy
| | | | | | | | | | - Matteo Bonomo
- SSD Diabetes Unit, Niguarda Cà Granda Hospital, 20162, Milan, Italy
| | - Angela Napoli
- S. Andrea Hospital, Sapienza University, Rome, Italy
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Saglimbene V, Palmer SC, Ruospo M, Natale P, Maione A, Nicolucci A, Vecchio M, Tognoni G, Craig JC, Pellegrini F, Lucisano G, Hegbrant J, Ariano R, Lamacchia O, Sasso A, Morano S, Filardi T, De Cosmo S, Pugliese G, Procaccini DA, Gesualdo L, Palasciano G, Johnson DW, Tonelli M, Strippoli GFM. The Long-Term Impact of Renin-Angiotensin System (RAS) Inhibition on Cardiorenal Outcomes (LIRICO): A Randomized, Controlled Trial. J Am Soc Nephrol 2018; 29:2890-2899. [PMID: 30420421 DOI: 10.1681/asn.2018040443] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The comparative effectiveness of treatment with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or their combination in people with albuminuria and cardiovascular risk factors is unclear. METHODS In a multicenter, randomized, open label, blinded end point trial, we evaluated the effectiveness on cardiovascular events of ACE or ARB monotherapy or combination therapy, targeting BP<130/80 in patients with moderate or severe albuminuria and diabetes or other cardiovascular risk factors. End points included a primary composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for cardiovascular causes and a revised end point of all-cause mortality. Additional end points included ESRD, doubling of serum creatinine, albuminuria, eGFR, BP, and adverse events. RESULTS Because of slow enrollment, the trial was modified and stopped 41% short of targeted enrollment of 2100 participants, corresponding to 35% power to detect a 25% reduced risk in the primary outcome. Our analysis included 1243 adults, with median follow-up of 2.7 years. Efficacy outcomes were similar between groups (ACE inhibitor versus ARB, ACE inhibitor versus combination, ARB versus combination) as were rates of serious adverse events. The rate of permanent discontinuation for ARB monotherapy (6.3%) was significantly lower than for ACE inhibitor monotherapy (15.7%) or combined therapy (18.3%). CONCLUSIONS Patients may tolerate ARB monotherapy better than ACE inhibitor monotherapy. However, data from this trial and similar trials, although as yet inconclusive, show no trend suggesting differences in mortality and renal outcomes with ACE inhibitors or ARBs as dual or monotherapy in patients with albuminuria and diabetes or other cardiovascular risk factors.
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Affiliation(s)
- Valeria Saglimbene
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney, Australia.,Medical Scientific Office, Diaverum Renal Services Group, Lund, Sweden
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Marinella Ruospo
- Medical Scientific Office, Diaverum Renal Services Group, Lund, Sweden
| | - Patrizia Natale
- Medical Scientific Office, Diaverum Renal Services Group, Lund, Sweden.,Emergency and Organ Transplantation and
| | - Ausilia Maione
- Freelance Consultant (formerly Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S Maria Imbaro, Chieti, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Gianni Tognoni
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Jonathan C Craig
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney, Australia.,College of Medicine and Public Health, Flinders University, Health Sciences Building, Adelaide 5001, South Australia
| | | | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Jörgen Hegbrant
- Medical Scientific Office, Diaverum Renal Services Group, Lund, Sweden
| | - Rosario Ariano
- Department of Nephrology and Dialysis, Azienda Ospedaliera Instituti Ospedalieri di Cremona, Cremona, Italy
| | - Olga Lamacchia
- Department of Endocrinology, Azienda Ospedaliera Universitaria Foggia, Foggia, Italy
| | - Antonio Sasso
- Department of Medicine, Ospedale Civile S. Pellegrino, Trani, Italy
| | - Susanna Morano
- Department of Clinical Sciences, Azienda Policlinico Umberto I-Università La Sapienza, Rome, Italy
| | - Tiziana Filardi
- Department of Clinical Sciences, Azienda Policlinico Umberto I-Università La Sapienza, Rome, Italy
| | - Salvatore De Cosmo
- Department of Medical Sciences, Scientific Institute Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy
| | - Deni A Procaccini
- Division of Nephrology, University of Foggia, Foggia, Italy; Departments of
| | | | | | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Marcello Tonelli
- Research Office of the Vice-President, Cumming School of Medicine, University of Calgary, Calgary, Canada; and
| | - Giovanni F M Strippoli
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney, Australia; .,Medical Scientific Office, Diaverum Renal Services Group, Lund, Sweden.,Emergency and Organ Transplantation and.,Diaverum Academy, Bari, Italy
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Rossi MC, Lucisano G, Ceriello A, Mazzucchelli C, Musacchio N, Ozzello A, Nicolucci A, Di Bartolo P. Real-world use of self-monitoring of blood glucose in people with type 2 diabetes: an urgent need for improvement. Acta Diabetol 2018; 55:1059-1066. [PMID: 30062588 DOI: 10.1007/s00592-018-1186-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
AIMS To assess use of self-monitoring of blood glucose (SMBG) in type 2 diabetes (T2DM) in the context of a continuous quality improvement initiative (AMD Annals). METHODS 14 quality-of-care indicators were developed, including frequency of SMBG, fasting blood glucose (FBG), and post-prandial glucose (PPG) levels, and hypoglycemia and hyperglycemia episodes. Clinical data and SMBG values downloaded from any glucose meter were obtained from electronic medical records. The most frequently used glucose-lowering treatment regimens were identified and the indicators were assessed separately by regimen. RESULTS Overall, 21 Italian centers and 13,331 patients (accounting for 35,657 HbA1c tests and 8.44 million SMBG values collected during 2014 and 2015) were included in the analysis; 11 therapeutic regimens were selected. Patients in regimens not including insulin performed 15-23 measurements per patient-month, those treated with basal insulin 32.1 tests/patient-month, and those treated with basal and short-acting insulin 53-58 tests/patient-month. In all treatment regimens, PPG measurements represented a minority of all tests; pre-breakfast measurements accounted for about 50% of all FBG values. Mean FBG levels exceeded 130 mg/dl in 49.3-88.3% of the cases in the different treatment regimens, while PPG levels were over 140 mg/dl in 46.7-81.0%. From 5.7 to 32.7%, patients in the different regimens had at least one episode of hypoglycemia (< 70 mg/dl), while from 3.7 to 47.7% had at least one episode of hyperglycemia (> 300 mg/dl). CONCLUSIONS SMBG is underutilized in patients with T2DM treated or not with insulin. In all treatment groups, PPG is seldom investigated. Poor metabolic control and rates of hyper- and hypoglycemia deserve consideration in all treatment groups.
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Affiliation(s)
- Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Via Tiziano Vecellio 2, 65124, Pescara, Italy.
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Via Tiziano Vecellio 2, 65124, Pescara, Italy
| | - Antonio Ceriello
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centro de Investigación Biomedica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
- Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Sesto San Giovanni, MI, Italy
| | | | | | | | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Via Tiziano Vecellio 2, 65124, Pescara, Italy
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De Berardis G, Scardapane M, Lucisano G, Abbruzzese S, Bossi AC, Cipponeri E, D'Angelo P, Fontana L, Lancione R, Marelli G, Sciangula L, Nicolucci A. Efficacy, safety and acceptability of the new pen needle 34G × 3.5 mm: a crossover randomized non-inferiority trial; AGO 02 study. Curr Med Res Opin 2018; 34:1699-1704. [PMID: 29924641 DOI: 10.1080/03007995.2018.1491396] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Insulin injection aspects, such as fear of injection and pain, directly affect glycemic control, patient adherence and quality of life. Use of thinner and shorter needles could increase acceptance of injections. The aim of the study is to evaluate the non-inferiority of the new 34G × 3.5 mm needle compared to a 32G × 4 mm in patients with diabetes treated with insulin. METHODS This is an open, randomized, two-period crossover, non-inferiority trial. Every treatment period lasted 3 weeks. Patients with type 1 or type 2 diabetes, treated with multiple daily insulin injections, were randomly assigned to receive a 34G × 3.5 mm or a 32G × 4 mm pen needle. The primary endpoint was the non-inferiority of the 34G × 3.5 mm in comparison with the 32G × 4 mm pen needle in terms of percentage absolute change of blood fructosamine (% |ΔFru|), using a non-inferiority margin of 20%. RESULTS Overall 77 patients were randomized and 73 completed the study. Patients characteristics were: 52% male, 80.5% affected by type 1 diabetes, mean age 52 years (±14.6), mean BMI 24.5 kg/m2 (±5.6), HbA1c 8% (±1.1) and baseline fructosamine level 350 µmol/l (±84). Mean fructosamine levels increased by 0.56 µmol/l with the 34G needle, while a reduction of 7.29 μmol/l was documented with the 32G needle. The difference between the two groups (7.84 μmol/l) was not statistically significant (p = .27). The % |ΔFru| between the two groups was 7.55% (95% CI 5.67-9.44), meeting the non-inferiority criterion. Glycemic variability, expressed as standard deviation of fasting blood glucose and post-prandial glucose, was not different between the two treatment groups (p = .63 and p = .77, respectively). CONCLUSIONS The 34G × 3.5 mm needle was non-inferior to the 32G × 4 mm needle regarding fructosamine levels and glycemic variability supporting the suitability of the 34G × 3.5 mm needle for insulin injection in patients with diabetes. CLINICAL TRIAL REGISTRATION NCT02690467.
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Affiliation(s)
- Giorgia De Berardis
- a Center for Outcomes Research and Clinical Epidemiology - CORESEARCH , Pescara , Italy
| | - Marco Scardapane
- a Center for Outcomes Research and Clinical Epidemiology - CORESEARCH , Pescara , Italy
| | - Giuseppe Lucisano
- a Center for Outcomes Research and Clinical Epidemiology - CORESEARCH , Pescara , Italy
| | | | | | | | | | | | | | | | | | - Antonio Nicolucci
- a Center for Outcomes Research and Clinical Epidemiology - CORESEARCH , Pescara , Italy
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Lamartina L, Grani G, Arvat E, Nervo A, Zatelli MC, Rossi R, Puxeddu E, Morelli S, Torlontano M, Massa M, Bellantone R, Pontecorvi A, Montesano T, Pagano L, Daniele L, Fugazzola L, Ceresini G, Bruno R, Rossetto R, Tumino S, Centanni M, Meringolo D, Castagna MG, Salvatore D, Nicolucci A, Lucisano G, Filetti S, Durante C. 8th edition of the AJCC/TNM staging system of thyroid cancer: what to expect (ITCO#2). Endocr Relat Cancer 2018; 25:L7-L11. [PMID: 29192093 DOI: 10.1530/erc-17-0453] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Livia Lamartina
- Dipartimento di Medicina Interna e Specialità MedicheUniversità di Roma Sapienza, Roma, Italy
| | - Giorgio Grani
- Dipartimento di Medicina Interna e Specialità MedicheUniversità di Roma Sapienza, Roma, Italy
| | - Emanuela Arvat
- Dipartimento di Scienze MedicheUniversità di Torino, Torino, Italy
| | - Alice Nervo
- Dipartimento di Scienze MedicheUniversità di Torino, Torino, Italy
| | - Maria Chiara Zatelli
- Unità Operativa di Endocrinologia e Malattie del RicambioAzienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Roberta Rossi
- Unità Operativa di Endocrinologia e Malattie del RicambioAzienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Efisio Puxeddu
- Dipartimento di MedicinaUniversità di Perugia, Perugia, Italy
| | - Silvia Morelli
- Dipartimento di MedicinaUniversità di Perugia, Perugia, Italy
| | - Massimo Torlontano
- Dipartimento di Scienze MedicheOspedale Casa Sollievo della Sofferenza-IRCCS, San Giovanni Rotondo, Italy
| | - Michela Massa
- Dipartimento di Scienze MedicheOspedale Casa Sollievo della Sofferenza-IRCCS, San Giovanni Rotondo, Italy
| | - Rocco Bellantone
- Cattedra di Chirurgia EndocrinaArea di Endocrinologia e Malattie Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alfredo Pontecorvi
- Cattedra di EndocrinologiaArea di Endocrinologia e Malattie Metaboliche, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Teresa Montesano
- Unità di Medicina NucleareUniversità di Roma Sapienza, Roma, Italy
| | - Loredana Pagano
- Unità di EndocrinologiaDipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Lorenzo Daniele
- Unità di PatologiaOspedale Mauriziano Umberto I di Torino, Torino, Italy
| | - Laura Fugazzola
- Divisione di Malattie Endocrine e MetabolicheIstituto Auxologico Italiano IRCCS, Milano, Italy
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei TrapiantiUniversità degli Studi di Milano, Milano, Italy
| | - Graziano Ceresini
- Dipartimento di Medicina e ChirurgiaUniversità di Parma, Parma, Italy
| | - Rocco Bruno
- Unità di EndocrinologiaOspedale di Tinchi-Pisticci, Matera, Italy
| | - Ruth Rossetto
- Divisione di EndocrinologiaDiabetologia e Metabolismo, Dipartimento di Scienze Mediche, Ospedale Molinette, A.O.U. Città della Salute e della Scienza di Torino, Università di Torino, Torino, Italy
| | - Salvatore Tumino
- Dipartimento di Medicina Clinica e SperimentaleUniversità di Catania, Catania, Italy
| | - Marco Centanni
- Dipartimento di Scienze e Biotecnologie Medico-ChirurgicheUniversità di Roma Sapienza, Latina, Italia
| | - Domenico Meringolo
- Unità Operativa Semplice DipartimentaleOspedale Bentivoglio, Ausl Bologna, Bologna, Italy
| | - Maria Grazia Castagna
- Dipartimento di Scienze MedicheChirurgiche e Neurologiche, Università di Siena, Siena, Italy
| | - Domenico Salvatore
- Dipartimento di Medicina Clinica e ChirurgiaUniversità degli Studi di Napoli 'Federico II', Napoli, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical EpidemiologyPescara, Italy
| | - Giuseppe Lucisano
- Center for Outcomes Research and Clinical EpidemiologyPescara, Italy
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità MedicheUniversità di Roma Sapienza, Roma, Italy
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità MedicheUniversità di Roma Sapienza, Roma, Italy
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Cosmi F, Shen L, Magnoli M, Abraham WT, Anand IS, Cleland JG, Cohn JN, Cosmi D, De Berardis G, Dickstein K, Franzosi MG, Gullestad L, Jhund PS, Kjekshus J, Køber L, Lepore V, Lucisano G, Maggioni AP, Masson S, McMurray JJ, Nicolucci A, Petrarolo V, Robusto F, Staszewsky L, Tavazzi L, Teli R, Tognoni G, Wikstrand J, Latini R. Treatment with insulin is associated with worse outcome in patients with chronic heart failure and diabetes. Eur J Heart Fail 2018; 20:888-895. [DOI: 10.1002/ejhf.1146] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Franco Cosmi
- Department of Cardiology; Ospedale di Cortona; Cortona Italy
| | - Li Shen
- BHF Cardiovascular Research Centre; University of Glasgow; Glasgow Scotland UK
| | - Michela Magnoli
- Department of Cardiovascular Research; IRCCS Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - William T. Abraham
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute; Ohio State University; Columbus OH USA
| | - Inder S. Anand
- Division of Cardiovascular Medicine; University of Minnesota; Minneapolis MN USA
- Department of Cardiology; VA Medical Center; Minneapolis MN USA
| | - John G. Cleland
- Robertson Centre for Biostatistics and Clinical Trials; University of Glasgow; Scotland, and Imperial College London UK
| | - Jay N. Cohn
- Division of Cardiovascular Medicine; University of Minnesota; Minneapolis MN USA
| | - Deborah Cosmi
- Department of Cardiology; Ospedale di Gubbio; Gubbio Italy
| | - Giorgia De Berardis
- CORESEARCH - Center for Outcomes Research and clinical Epidemiology; Pescara Italy
| | - Kenneth Dickstein
- Stavanger University Hospital, Stavanger, and the Institute of Internal Medicine; University of Bergen; Bergen Norway
| | - Maria Grazia Franzosi
- Department of Cardiovascular Research; IRCCS Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Lars Gullestad
- Department of Cardiology; Oslo University Hospital; Rikshospitalet, Oslo Norway
- Faculty of Medicine; University of Oslo; Oslo Norway
| | - Pardeep S. Jhund
- BHF Cardiovascular Research Centre; University of Glasgow; Glasgow Scotland UK
| | - John Kjekshus
- Department of Cardiology; Oslo University Hospital; Rikshospitalet, Oslo Norway
| | - Lars Køber
- Department of Cardiology, Rigshospitalet; University Hospital; Copenhagen Denmark
| | - Vito Lepore
- CORESEARCH - Center for Outcomes Research and clinical Epidemiology; Pescara Italy
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and clinical Epidemiology; Pescara Italy
| | | | - Serge Masson
- Department of Cardiovascular Research; IRCCS Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - John J.V. McMurray
- BHF Cardiovascular Research Centre; University of Glasgow; Glasgow Scotland UK
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and clinical Epidemiology; Pescara Italy
| | | | - Fabio Robusto
- CORESEARCH - Center for Outcomes Research and clinical Epidemiology; Pescara Italy
| | - Lidia Staszewsky
- Department of Cardiovascular Research; IRCCS Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Luigi Tavazzi
- GVM Hospitals of Care and Research; E.S. Health Science Foundation; Cotignola Italy
| | - Roberto Teli
- Department of Cardiovascular Research; IRCCS Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | - Gianni Tognoni
- Department of Cardiovascular Research; IRCCS Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
| | | | - Roberto Latini
- Department of Cardiovascular Research; IRCCS Istituto di Ricerche Farmacologiche Mario Negri; Milan Italy
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Lamartina L, Durante C, Lucisano G, Grani G, Bellantone R, Lombardi CP, Pontecorvi A, Arvat E, Felicetti F, Zatelli MC, Rossi R, Puxeddu E, Morelli S, Torlontano M, Crocetti U, Montesano T, Giubbini R, Orlandi F, Aimaretti G, Monzani F, Attard M, Francese C, Antonelli A, Limone P, Rossetto R, Fugazzola L, Meringolo D, Bruno R, Tumino S, Ceresini G, Centanni M, Monti S, Salvatore D, Spiazzi G, Mian C, Persani L, Barbaro D, Nicolucci A, Filetti S. Are Evidence-Based Guidelines Reflected in Clinical Practice? An Analysis of Prospectively Collected Data of the Italian Thyroid Cancer Observatory. Thyroid 2017; 27:1490-1497. [PMID: 29020892 DOI: 10.1089/thy.2017.0299] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 01/10/2023]
Abstract
OBJECTIVES The goal of evidence-based practice guidelines is to optimize the management of emerging diseases, such as differentiated thyroid cancer (DTC). The aim of this study was to assess therapeutic approaches for DTC in Italy and to see how closely these practices conformed to those recommended in the 2009 American Thyroid Association (ATA) guidelines. METHODS The Italian Thyroid Cancer Observatory was established to collect data prospectively on thyroid cancers consecutively diagnosed in participating centers (uniformly distributed across the nation). Data on the initial treatment of all pathologically confirmed DTC cases present in the database from January 1, 2013 (database creation) to January 31, 2016, were analyzed. RESULTS A total of 1748 patients (77.2% females; median age 48.1 years [range 10-85 years]) were enrolled in the study. Most (n = 1640; 93.8%) were papillary carcinomas (including 84 poorly differentiated/aggressive variants); 6.2% (n = 108) were follicular and Hürthle cell carcinomas. The median tumor diameter was 11 mm (range 1-93 mm). Tumors were multifocal in 613 (35%) and presented extrathyroidal extension in 492 (28%) cases. Initial treatments included total thyroidectomy (involving one or two procedures; n = 726; 98.8%) and lobectomy (n = 22; 1.2%). A quarter of the patients who underwent total thyroidectomy had unifocal, intrathyroidal tumors ≤1 cm (n = 408; 23.6%). Neck dissection was performed in 40.4% of the patients (29.5% had central compartment dissection). Radioiodine remnant ablation (RRA) was performed in 1057 (61.2%) of the 1726 patients who underwent total thyroidectomy: 460 (41.2%) of the 983 classified by 2009 ATA guideline criteria as low-risk, 570 (87.1%) of the 655 as intermediate-risk, and 82 (93.1%) of the 88 as high-risk patients (p < 0.001). RRA was performed in 44% of the cases involving multifocal DTCs measuring ≤1 cm. CONCLUSIONS The treatment approaches for DTCs used in Italy display areas of inconsistency with those recommended by the 2009 ATA guidelines. Italian practices were characterized by underuse of thyroid lobectomy in intrathyroidal, unifocal DTCs ≤1 cm. The use of RRA was generally consistent with risk-stratified recommendations. However, its frequent use in small DTCs (≤1 cm) that are multifocal persists, despite the lack of evidence of benefit. These data provide a baseline for future assessments of the impact of international guidelines on DTC management in Italy. These findings also illustrate that the dissemination and implementation of guideline recommendations, and the change in practice patterns, require ongoing education and time.
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Affiliation(s)
- Livia Lamartina
- 1 Department of Internal Medicine and Medical Specialties, University of Rome Sapienza , Rome, Italy
| | - Cosimo Durante
- 1 Department of Internal Medicine and Medical Specialties, University of Rome Sapienza , Rome, Italy
| | - Giuseppe Lucisano
- 2 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy
| | - Giorgio Grani
- 1 Department of Internal Medicine and Medical Specialties, University of Rome Sapienza , Rome, Italy
| | - Rocco Bellantone
- 3 Division of Endocrine Surgery, Fondazione Policlinico Gemelli, Catholic University , Rome, Italy
| | - Celestino Pio Lombardi
- 3 Division of Endocrine Surgery, Fondazione Policlinico Gemelli, Catholic University , Rome, Italy
| | - Alfredo Pontecorvi
- 4 Division of Endocrinology and Metabolic Diseases, Fondazione Policlinico Gemelli, Catholic University , Rome, Italy
| | - Emanuela Arvat
- 5 Oncological Endocrinology Unit, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin , Turin, Italy
| | - Francesco Felicetti
- 5 Oncological Endocrinology Unit, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin , Turin, Italy
| | - Maria C Zatelli
- 6 Endocrine Unit, Azienda Ospedaliero Universitaria S. Anna , Ferrara, Italy
| | - Roberta Rossi
- 6 Endocrine Unit, Azienda Ospedaliero Universitaria S. Anna , Ferrara, Italy
| | - Efisio Puxeddu
- 7 Department of Medicine, University of Perugia , Perugia, Italy
| | - Silvia Morelli
- 7 Department of Medicine, University of Perugia , Perugia, Italy
| | - Massimo Torlontano
- 8 Department of Medical Science, Ospedale Casa Sollievo della Sofferenza-IRCCS , San Giovanni Rotondo, Italy
| | - Umberto Crocetti
- 8 Department of Medical Science, Ospedale Casa Sollievo della Sofferenza-IRCCS , San Giovanni Rotondo, Italy
| | - Teresa Montesano
- 9 Department of Nuclear Medicine, University of Rome Sapienza , Rome, Italy
| | - Raffaele Giubbini
- 10 Nuclear Medicine Unit, Spedali Civili Università degli Studi di Brescia , Brescia, Italy
| | - Fabio Orlandi
- 11 Department of Oncology, Division of Endocrinology and Metabolism, Humanitas-Gradenigo Hospital, University of Turin, Turin, Italy
| | - Gianluca Aimaretti
- 12 Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale , Novara, Italy
| | - Fabio Monzani
- 13 Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | - Marco Attard
- 14 Division of Endocrinology, Cervello Hospital , Palermo, Italy
| | - Cecilia Francese
- 15 Division of Endocrinology , Clinica Salus di Battipaglia, Salerno, Italy
| | - Alessandro Antonelli
- 16 Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | - Paolo Limone
- 17 Division of Endocrinology, Diabetology, and Metabolism, Mauriziano Umberto I Hospital , Turin, Italy
| | - Ruth Rossetto
- 18 Division of Endocrinology, Diabetology, and Metabolism, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin , Turin, Italy
| | - Laura Fugazzola
- 19 Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano , Milan, Italy
- 20 Department of Pathophysiology and Transplantation, University of Milan , Milan, Italy
| | - Domenico Meringolo
- 21 Simple Operating Unit, Department of Endocrinology, Bentivoglio Hospital , Bologna, Italy
| | - Rocco Bruno
- 22 Unit of Endocrinology, Tinchi-Pisticci Hospital , Matera, Italy
| | - Salvatore Tumino
- 23 Department of Clinical and Experimental Medicine, University of Catania , Catania, Italy
| | - Graziano Ceresini
- 24 Department of Medicine and Surgery, University of Parma , Parma, Italy
| | - Marco Centanni
- 25 Department of Medical and Surgical Sciences and Biotechnology, University of Rome Sapienza , Latina, Italy
| | - Salvatore Monti
- 26 Department of Endocrinology, Ospedale S. Andrea, Sapienza Università di Roma, Rome, Italy
| | - Domenico Salvatore
- 27 Department of Clinical Medicine and Surgery, University of Naples "Federico II ," Naples, Italy
| | - Giovanna Spiazzi
- 28 Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona , Verona, Italy
| | - Caterina Mian
- 29 Endocrinology Unit, Department of Medicine-DIMED, University Hospital of Padua , Padua, Italy
| | - Luca Persani
- 19 Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano , Milan, Italy
- 30 Department of Clinical Sciences and Community Health, University of Milan , Milan, Italy
| | - Daniele Barbaro
- 31 U.O. Endocrinologia, Livorno, ASL Nord Ovest Toscana , Livorno, Italy
| | - Antonio Nicolucci
- 2 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy
| | - Sebastiano Filetti
- 1 Department of Internal Medicine and Medical Specialties, University of Rome Sapienza , Rome, Italy
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