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Smoot K, Marginean H, Gervasi-Follmar T, Chen C. Comparing the Risk of Infusion-Related Reactions and Tolerability in Patients Given Cetirizine or Diphenhydramine Prior to Ocrelizumab Infusion (PRECEPT). Medicina (Kaunas) 2024; 60:659. [PMID: 38674305 PMCID: PMC11051876 DOI: 10.3390/medicina60040659] [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] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
Background: Ocrelizumab is an effective medication for multiple sclerosis. However, infusion-related reactions (IRRs) are a concern for patients and may lead to discontinuation of ocrelizumab. To minimize IRRs, pre-medications are administered. However, from our experience, these medications, especially diphenhydramine, can cause marked drowsiness. The primary objective of this study was to evaluate whether cetirizine is non-inferior to diphenhydramine in limiting the proportion and severity of reactions from ocrelizumab infusions. Methods: Twenty participants were serially randomized in a 1:1 ratio to receive 10 mg of cetirizine or 25 mg of diphenhydramine orally prior to their first three ocrelizumab infusions. Results: The rate of IRRs in this study was similar across both treatment groups with no increase in the risk of severity, and no grade 3 IRRs. Further, patients receiving cetirizine experienced a reduction in fatigue. While there was not a significant difference in global satisfaction, this score increased over time in the cetirizine arm while it remained unchanged in the diphenhydramine arm. Conclusions: Overall, our results suggest that cetirizine does not increase the risk of infusion-related reactions compared to diphenhydramine.
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Affiliation(s)
- Kyle Smoot
- Providence Brain and Spine Institute, Portland, OR 97225, USA; (H.M.); (T.G.-F.); (C.C.)
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2
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Smoot K, Marginean H, Gervasi-Follmar T, Chen C, Repovic P, Cohan S. Evaluating the efficacy and safety of transitioning patients with multiple sclerosis from natalizumab to ocrelizumab (OCTAVE). Mult Scler 2023:13524585231175284. [PMID: 37317841 DOI: 10.1177/13524585231175284] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Natalizumab is associated with a risk of progressive multifocal leukoencephalopathy (PML) in multiple sclerosis (MS) patients infected with John Cunningham virus (JCV). Ocrelizumab has demonstrated efficacy to treat MS; however, its safety in patients previously treated with natalizumab is unclear. OBJECTIVE To evaluate the safety and efficacy of ocrelizumab in patients with relapsing MS (RMS) previously treated with natalizumab. METHODS Clinically and radiographically stable RMS patients, ages 18-65 treated with natalizumab for ⩾ 12 months, were enrolled in the study and initiated ocrelizumab 4-6 weeks after their final dose of natalizumab. Relapse assessment, expanded disability status scale, and brain magnetic resonance imaging (MRI) were performed prior to starting ocrelizumab and at months 3, 6, 9, and 12. RESULTS Forty-three patients were enrolled, and 41 (95%) completed the study. Two patients had a relapse while on ocrelizumab, one at month 9 and the other at month 12, without changes on brain MRI. Two additional patients had new brain MRI lesions detected at month 3, with no new symptoms. Thirteen serious adverse events (SAEs) were recorded, four of which were considered possibly related to ocrelizumab. CONCLUSION Overall, our study indicates clinical and MRI stability for most patients transitioning from natalizumab to ocrelizumab. CLINICALTRIALS.GOV IDENTIFIER NCT03157830.
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Affiliation(s)
- Kyle Smoot
- Providence Brain and Spine Institute, Portland, OR, USA
| | | | | | - Chiayi Chen
- Providence Brain and Spine Institute, Portland, OR, USA
| | - Pavle Repovic
- Multiple Sclerosis Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Stanley Cohan
- Providence Brain and Spine Institute, Portland, OR, USA
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Fitzgerald MA, Roberts K, Conley C, Lovell M, Wu Y, Kaiser K, Hosey R, Smoot K. Point Of Care Detection Of VILIP-1 For On-Field Diagnosis Of Sports-Related Concussion. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000883300.40241.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cohan S, Gervasi-Follmar T, Kamath A, Kamath V, Chen C, Smoot K, Baraban E, Edwards K. The results of a 24-month controlled, prospective study of relapsing multiple sclerosis patients at risk for progressive multifocal encephalopathy, who switched from prolonged use of natalizumab to teriflunomide. Mult Scler J Exp Transl Clin 2021; 7:20552173211066588. [PMID: 34950502 PMCID: PMC8689625 DOI: 10.1177/20552173211066588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Natalizumab (NTZ) is a highly effective disease modifying treatment for relapsing multiple sclerosis (RMS), but it increases risk of progressive multifocal leukoencephalopathy (PML) in patients with serum anti- John Cunningham virus (JCV) antibodies. Objective To assess the safety and efficacy of rapid transition, from NTZ to teriflunomide (TFM) in RMS patients. Methods Clinically stable NTZ-treated, anti-JCV antibody positive RMS patients were switched to TFM 28 ± 7 days after their last dose of NTZ. The primary endpoint was proportion of relapse free patients at 24 months. Results Median [IQR] age of the 55 enrolled patients was 47 [40.7, 56.3] years, 76% were female. The median [IQR] number of prior NTZ treatments was 34 [18, 64]. annualized relapse rate (ARR) was 0.07 and 77% of the patients were relapse free at 24 months. Mean time to first GAD + lesion was 19.6 months, and to new/enlarging T2 lesion was 19.2 months. Mean time to 3 month sustained disability worsening (SDW) was 22 months and proportion free of 3-month SDW was 0.87. There were no cases of PML. Conclusions The washout-free transition of NTZ to TFM was an efficacious and safe strategy for patients at risk of developing PML. ClinicalTrials.gov Identifier: NCT01970410
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Affiliation(s)
| | | | | | - Vineetha Kamath
- The MS Center of Northeastern New York, Latham, New York, NY, USA
| | | | | | - Elizabeth Baraban
- Providence Multiple Sclerosis Center, Providence Health & Services Portland, OR, USA
| | - Keith Edwards
- The MS Center of Northeastern New York, Latham, New York, NY, USA
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Smoot K, Chen C, Stuchiner T, Lucas L, Grote L, Cohan S. Clinical outcomes of patients with multiple sclerosis treated with ocrelizumab in a US community MS center: an observational study. BMJ Neurol Open 2021; 3:e000108. [PMID: 34308352 PMCID: PMC8264886 DOI: 10.1136/bmjno-2020-000108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/27/2021] [Indexed: 11/03/2022] Open
Abstract
Background To monitor long-term outcomes of ocrelizumab treatment. Objective To evaluate safety and treatment outcomes of ocrelizumab in a community-based multiple sclerosis (MS) population. Methods Adult patients with MS prescribed ocrelizumab were eligible. Chart reviews were conducted at the start of ocrelizumab treatment and every 6 months thereafter. Results Of the 355 patients enrolled, 71.9% were female; mean (SD) age was 51.8 (12.5) years; 78.3% had relapsing MS (RMS). Median baseline Expanded Disability Status Scale (EDSS) (IQR) was 3.0 (2.0-4.0) for RMS, 6.5 (6.0-7.5) for secondary progressive MS, and 6.5 (6.0-7.0) for primary progressive MS. Respiratory infections occurred in 40.1% and urinary tract infections in 33.1% of patients. There was no difference in the percentage of infections among patients <55 (68.5%, n=122), and those ≥55 of age (67.5%, n=104) (p=0.94). Twenty-five hospitalisations were due to infections; 69.2% of these patients were ≥55 with a mean EDSS of 5.7 (±1.86). Four patients have died. Serum IgM and IgG levels did not predict infection risk. Annualised relapse rate was 0.34 for the patients with RMS in the preceding 2 years and 0.09 in patients who received ≥2 ocrelizumab 600 mg courses. The first on-treatment MRI was stable in 262 (90.0%) patients, 6.9% had new T2 lesions, 2.7% had enlarging T2 lesions and 1.4% had gadolinium-enhancing lesions. Median EDSS at 12 months was unchanged. Conclusion Ocrelizumab effectively controlled relapse risk and disability worsening. Although only 12.1% of patients have discontinued ocrelizumab, infections resulting in hospitalisation are a concern, especially in older and disabled patients.
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Affiliation(s)
- Kyle Smoot
- Providence Multiple Sclerosis Center, Providence Health and Services, Portland, Oregon, USA
| | - Chiayi Chen
- Providence Brain & Spine Institute, Providence Health and Services, Portland, Oregon, USA
| | - Tamela Stuchiner
- Providence Brain & Spine Institute, Providence Health and Services, Portland, Oregon, USA
| | | | - Lois Grote
- Providence Brain & Spine Institute, Providence Health and Services, Portland, Oregon, USA
| | - Stanley Cohan
- Providence Multiple Sclerosis Center, Providence Health and Services, Portland, Oregon, USA
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Cohan SL, Hendin BA, Reder AT, Smoot K, Avila R, Mendoza JP, Weinstock-Guttman B. Interferons and Multiple Sclerosis: Lessons from 25 Years of Clinical and Real-World Experience with Intramuscular Interferon Beta-1a (Avonex). CNS Drugs 2021; 35:743-767. [PMID: 34228301 PMCID: PMC8258741 DOI: 10.1007/s40263-021-00822-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 12/15/2022]
Abstract
Recombinant interferon (IFN) β-1b was approved by the US Food and Drug Administration as the first disease-modifying therapy (DMT) for multiple sclerosis (MS) in 1993. Since that time, clinical trials and real-world observational studies have demonstrated the effectiveness of IFN therapies. The pivotal intramuscular IFN β-1a phase III trial published in 1996 was the first to demonstrate that a DMT could reduce accumulation of sustained disability in MS. Patient adherence to treatment is higher with intramuscular IFN β-1a, given once weekly, than with subcutaneous formulations requiring multiple injections per week. Moreover, subcutaneous IFN β-1a is associated with an increased incidence of injection-site reactions and neutralizing antibodies compared with intramuscular administration. In recent years, revisions to MS diagnostic criteria have improved clinicians' ability to identify patients with MS and have promoted the use of magnetic resonance imaging (MRI) for diagnosis and disease monitoring. MRI studies show that treatment with IFN β-1a, relative to placebo, reduces T2 and gadolinium-enhancing lesions and gray matter atrophy. Since the approval of intramuscular IFN β-1a, a number of high-efficacy therapies have been approved for MS, though the benefit of these high-efficacy therapies should be balanced against the increased risk of serious adverse events associated with their long-term use. For some subpopulations of patients, including pregnant women, the safety profile of IFN β formulations may provide a particular benefit. In addition, the antiviral properties of IFNs may indicate potential therapeutic opportunities for IFN β in reducing the risk of viral infections such as COVID-19.
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Affiliation(s)
- Stanley L. Cohan
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Portland, OR USA
| | | | | | - Kyle Smoot
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Portland, OR USA
| | | | | | - Bianca Weinstock-Guttman
- Department of Neurology, Jacobs Comprehensive MS Treatment and Research Center, Jacobs School of Medicine and Biomedical Sciences, State University of New York, 1010 Main St., 2nd floor, Buffalo, NY, 14202, USA.
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Cohan S, Lucassen E, Smoot K, Brink J, Chen C. Sphingosine-1-Phosphate: Its Pharmacological Regulation and the Treatment of Multiple Sclerosis: A Review Article. Biomedicines 2020; 8:biomedicines8070227. [PMID: 32708516 PMCID: PMC7400006 DOI: 10.3390/biomedicines8070227] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022] Open
Abstract
Sphingosine-1-phosphate (S1P), via its G-protein-coupled receptors, is a signaling molecule with important regulatory properties on numerous, widely varied cell types. Five S1P receptors (S1PR1-5) have been identified, each with effects determined by their unique G-protein-driven downstream pathways. The discovery that lymphocyte egress from peripheral lymphoid organs is promoted by S1P via S1PR-1 stimulation led to the development of pharmacological agents which are S1PR antagonists. These agents promote lymphocyte sequestration and reduce lymphocyte-driven inflammatory damage of the central nervous system (CNS) in animal models, encouraging their examination of efficacy in the treatment of multiple sclerosis (MS). Preclinical research has also demonstrated direct protective effects of S1PR antagonists within the CNS, by modulation of S1PRs, particularly S1PR-1 and S1PR-5, and possibly S1PR-2, independent of effects upon lymphocytes. Three of these agents, fingolimod, siponimod and ozanimod have been approved, and ponesimod has been submitted for regulatory approval. In patients with MS, these agents reduce relapse risk, sustained disability progression, magnetic resonance imaging markers of disease activity, and whole brain and/or cortical and deep gray matter atrophy. Future opportunities in the development of more selective and intracellular S1PR-driven downstream pathway modulators may expand the breadth of agents to treat MS.
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Roberts K, Hosey R, Smoot K. New Mole In A College Football Athlete. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000675780.82841.bb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Bowen JD, Brink J, Brown TR, Lucassen EB, Smoot K, Wundes A, Repovic P. COVID-19 in MS: Initial observations from the Pacific Northwest. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/5/e783. [PMID: 32457226 PMCID: PMC7286653 DOI: 10.1212/nxi.0000000000000783] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/07/2020] [Indexed: 01/08/2023]
Affiliation(s)
- James D Bowen
- From the Swedish Multiple Sclerosis Center (J.D.B., P.R), Seattle, WA; Providence Multiple Sclerosis Center (J.B., E.B.L., K.S.), Portland, Oregon; EvergreenHealth Multiple Sclerosis Center (T.R.B.), Kirkland; and University of Washington Multiple Sclerosis Center (A.W.), Seattle
| | - Justine Brink
- From the Swedish Multiple Sclerosis Center (J.D.B., P.R), Seattle, WA; Providence Multiple Sclerosis Center (J.B., E.B.L., K.S.), Portland, Oregon; EvergreenHealth Multiple Sclerosis Center (T.R.B.), Kirkland; and University of Washington Multiple Sclerosis Center (A.W.), Seattle
| | - Ted R Brown
- From the Swedish Multiple Sclerosis Center (J.D.B., P.R), Seattle, WA; Providence Multiple Sclerosis Center (J.B., E.B.L., K.S.), Portland, Oregon; EvergreenHealth Multiple Sclerosis Center (T.R.B.), Kirkland; and University of Washington Multiple Sclerosis Center (A.W.), Seattle
| | - Elisabeth B Lucassen
- From the Swedish Multiple Sclerosis Center (J.D.B., P.R), Seattle, WA; Providence Multiple Sclerosis Center (J.B., E.B.L., K.S.), Portland, Oregon; EvergreenHealth Multiple Sclerosis Center (T.R.B.), Kirkland; and University of Washington Multiple Sclerosis Center (A.W.), Seattle
| | - Kyle Smoot
- From the Swedish Multiple Sclerosis Center (J.D.B., P.R), Seattle, WA; Providence Multiple Sclerosis Center (J.B., E.B.L., K.S.), Portland, Oregon; EvergreenHealth Multiple Sclerosis Center (T.R.B.), Kirkland; and University of Washington Multiple Sclerosis Center (A.W.), Seattle
| | - Annette Wundes
- From the Swedish Multiple Sclerosis Center (J.D.B., P.R), Seattle, WA; Providence Multiple Sclerosis Center (J.B., E.B.L., K.S.), Portland, Oregon; EvergreenHealth Multiple Sclerosis Center (T.R.B.), Kirkland; and University of Washington Multiple Sclerosis Center (A.W.), Seattle
| | - Pavle Repovic
- From the Swedish Multiple Sclerosis Center (J.D.B., P.R), Seattle, WA; Providence Multiple Sclerosis Center (J.B., E.B.L., K.S.), Portland, Oregon; EvergreenHealth Multiple Sclerosis Center (T.R.B.), Kirkland; and University of Washington Multiple Sclerosis Center (A.W.), Seattle.
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10
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Nithyanandam S, Smoot K, Schleich K, Slayman T. Sharp lower back pain • left-side paraspinal tenderness • anterior thigh sensory loss • Dx? J Fam Pract 2020; 69:150-153. [PMID: 32289129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
► Acute-onset, sharp nonradiating lower back pain ► Left-side paraspinal tenderness ► Anterior thigh sensory loss.
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Affiliation(s)
| | - Kyle Smoot
- University of Kentucky Family and Community Medicine, Lexington, USA
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11
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Cohan SL, Edwards K, Lucas L, Gervasi-Follmar T, O'Connor J, Siuta J, Kamath V, Garten L, Chen C, Thomas J, Smoot K, Kresa-Reahl K, Spinelli KJ. Reducing return of disease activity in patients with relapsing multiple sclerosis transitioned from natalizumab to teriflunomide: 12-month interim results of teriflunomide therapy. Mult Scler J Exp Transl Clin 2019; 5:2055217318824618. [PMID: 30729028 PMCID: PMC6350141 DOI: 10.1177/2055217318824618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/16/2022] Open
Abstract
Background Natalizumab is an effective treatment for relapsing multiple sclerosis.
Return of disease activity upon natalizumab discontinuance creates the need
for follow-up therapeutic strategies. Objective To assess the efficacy of teriflunomide following natalizumab discontinuance
in relapsing multiple sclerosis patients. Methods Clinically stable relapsing multiple sclerosis patients completing 12 or more
consecutive months of natalizumab, testing positive for anti-John Cunningham
virus antibody, started teriflunomide 14 mg/day, 28 ± 7 days after their
final natalizumab infusion. Physical examination, Expanded Disability Status
Scale, laboratory assessments, and brain magnetic resonance imaging were
performed at screening and multiple follow-up visits. Results Fifty-five patients were enrolled in the study. The proportion of patients
relapse-free was 0.94, restricted mean time to first gadolinium-enhancing
lesion was 10.9 months and time to 3-month sustained disability worsening
was 11.8 months. The mean number of new or enlarging T2 lesions per patient
at 12 months was 0.42. Exploratory analyses revealed an annualized relapse
rate of 0.08, and a proportion of patients with no evidence of disease
activity of 0.68. Forty-seven patients (85.5%) reported adverse events, 95%
of which were mild to moderate. Conclusions Teriflunomide therapy initiated without natalizumab washout resulted in a low
rate of return of disease activity. Clinicians may consider this a
worthwhile strategy when transitioning clinically stable patients off
natalizumab to another therapy. ClinicalTrials.gov Identifier: NCT01970410
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Affiliation(s)
- Stanley L Cohan
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, USA
| | - Keith Edwards
- Multiple Sclerosis Center of Northeastern New York, USA
| | - Lindsay Lucas
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, USA
| | | | - Judy O'Connor
- Multiple Sclerosis Center of Northeastern New York, USA
| | - Jessica Siuta
- Multiple Sclerosis Center of Northeastern New York, USA
| | | | - Lore Garten
- Multiple Sclerosis Center of Northeastern New York, USA
| | - Chiayi Chen
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, USA
| | - James Thomas
- ImageCare, Medical Imaging of Community Care Physicians, USA
| | - Kyle Smoot
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, USA
| | - Kiren Kresa-Reahl
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, USA
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Cohan S, Smoot K, Kresa-Reahl K, Garland R, Yeh WS, Wu N, Watson C. Outcomes of Stable Multiple Sclerosis Patients Staying on Initial Interferon Beta Therapy Versus Switching to Another Interferon Beta Therapy: A US Claims Database Study. Adv Ther 2018; 35:1894-1904. [PMID: 30341505 PMCID: PMC6223975 DOI: 10.1007/s12325-018-0799-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 12/21/2022]
Abstract
Introduction This study was designed to assess real-world outcomes of patients with multiple sclerosis (MS) who were stable on interferon (IFN) beta therapy in the year prior to switching to another IFN beta therapy versus those who continued on the initial treatment. Methods This study used administrative claims from MarketScan Commercial Claims and Encounters Database, from January 1, 2010, to March 31, 2015, to identify MS patients aged 18–64 years who remained relapse free for at least 1 year while continuously treated with an IFN beta therapy. Stable patients remaining on their initial IFN beta therapy (no-switch patients) were matched with stable patients who switched IFN beta therapy (switch patients) using propensity score matching (first claim = index date). Outcome measures included annualized relapse rate (ARR), the percentage of patients who relapsed, medication possession ratio, and the proportion of days covered and were measured during the year following the index date. Results This study identified 531 patients in the no-switch group and 177 patients in the switch group, with subsets of 270 patients in the no-switch group and 90 patients in the switch group stable on intramuscular (IM) IFN beta-1a therapy. All outcomes during the follow-up year were significantly better in the no-switch group than in the switch group. For all patients, ARR in the switch group was more than twice that in the no-switch group (P = 0.002). For patients stable on IM IFN beta-1a at baseline, ARR was twice as high in the switch group as in the no-switch group (P = 0.012). Conclusion Among all patients stable on IFN beta therapy and the subset stable on IM IFN beta therapy in particular, those who remained on therapy had significantly better outcomes than those who switched to another IFN beta therapy. Funding Biogen (Cambridge, MA, USA).
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Affiliation(s)
- Stanley Cohan
- Providence MS Center, 9135 SW Barnes Road, Suite 461, Portland, OR, 97225, USA.
| | - Kyle Smoot
- Providence MS Center, 9135 SW Barnes Road, Suite 461, Portland, OR, 97225, USA
| | - Kiren Kresa-Reahl
- Providence MS Center, 9135 SW Barnes Road, Suite 461, Portland, OR, 97225, USA
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Smoot K, Spinelli KJ, Stuchiner T, Lucas L, Chen C, Grote L, Baraban E, Kresa-Reahl K, Cohan S. Three-year clinical outcomes of relapsing multiple sclerosis patients treated with dimethyl fumarate in a United States community health center. Mult Scler 2017; 24:942-950. [PMID: 28537110 DOI: 10.1177/1352458517709956] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Following approval of dimethyl fumarate (DMF), we established a registry of relapsing multiple sclerosis (RMS) patients taking DMF at our community MS center. OBJECTIVE To track DMF patients' tolerability, disease progression, and lymphopenia. METHODS Patients prescribed DMF for RMS from March 2013 to March 2016 were prospectively enrolled ( N = 412). Baseline data, clinical relapses, magnetic resonance imaging (MRI) activity, discontinuation, and lymphocyte counts were captured through chart review. RESULTS The mean age of patients starting DMF was 49.4 ± 12.0 years and 70% transitioned from a previous disease-modifying therapy (DMT). Of the patients, 38% discontinued DMF, 76% of whom discontinued due to side effects. Clinical relapse and MRI activity were low. Comparing patients who transitioned from interferon-β (IFN), glatiramer acetate (GA), or natalizumab (NTZ), patients previously on NTZ had higher rates of relapse than those previously on GA (annualized relapse rate p = 0.039, percent relapse p = 0.021). Grade III lymphopenia developed in 11% of patients. Lymphopenia was associated with older age ( p < 0.001) and longer disease duration ( p < 0.001). CONCLUSION Given the high rates of lymphopenia and discontinuation, it has become our clinical practice to more closely scrutinize older patients and those with a longer disease duration who are potential candidates for initiating DMF therapy.
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Affiliation(s)
- Kyle Smoot
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence Health & Services, Portland, OR, USA
| | - Kateri J Spinelli
- Regional Research Department, Providence Health & Services, Portland, OR, USA
| | - Tamela Stuchiner
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence Health & Services, Portland, OR, USA
| | - Lindsay Lucas
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence Health & Services, Portland, OR, USA
| | - Chiayi Chen
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence Health & Services, Portland, OR, USA
| | - Lois Grote
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence Health & Services, Portland, OR, USA
| | - Elizabeth Baraban
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence Health & Services, Portland, OR, USA
| | - Kiren Kresa-Reahl
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence Health & Services, Portland, OR, USA
| | - Stanley Cohan
- Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence Health & Services, Portland, OR, USA
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Abstract
OBJECTIVE To outline a 4-phase progressive program that safely and successfully enabled athletes to return to sport without recurrence of exertional rhabdomyolysis symptoms. BACKGROUND In January 2011, a large cluster of National Collegiate Athletic Association Division I football athletes were evaluated and treated for exertional rhabdomyolysis. After the athletes were treated, the athletic trainers and sports medicine providers were challenged to develop a safe return-to-play program because of the lack of specific reports in the medical literature to direct such activities. TREATMENT A progressive 4-phase program based on existing recommendations, including guidelines for continued clinical and laboratory monitoring. CONCLUSIONS Although the actual process of reintegrating players will differ based on each athlete's unique circumstances, this program provides a safe and effective foundation that can be modified based on the response to activity and sport.
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Ofman P, Cook JR, Navaravong L, Levine RA, Peralta A, Gaziano JM, Djousse L, Curillova Z, Hoffmeister P, Smoot K, Jiang L, Tighe DA, Stoenescu ML. T-wave inversion and diastolic dysfunction in patients with electrocardiographic left ventricular hypertrophy. J Electrocardiol 2012; 45:764-9. [DOI: 10.1016/j.jelectrocard.2012.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Indexed: 12/25/2022]
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Smoot K, Kresa-Reahl K, Gaedeke L, Cohan S. Fingolimod Reduces Circulating CD4+ Counts in Patients with Relapsing Multiple Sclerosis (RMS) (P02.090). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Smoot K, Black S, Hosey RG. Exercise-associated Collapse In A Collegiate Volleyball Athlete. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000353916.63848.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Smith CD, Walton A, Slevin JT, Gerhardt GA, Umberger G, Smoot K, Schulze E, Gash D. Validation studies of the human movement analysis panel for hand/arm performance. J Neurosci Methods 2007; 165:287-96. [PMID: 17651810 PMCID: PMC2074932 DOI: 10.1016/j.jneumeth.2007.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 05/08/2007] [Accepted: 06/18/2007] [Indexed: 11/25/2022]
Abstract
The human movement analysis panel (HMAP) measures separable components of arm motion and simple and complex finger coordination. HMAP testing takes 30min to administer. In separate experiments we have validated the HMAP against the standard grooved pegboard and measures of gait speed, and demonstrated important learning effects over both short durations of days, and longer intervals of months to years in normal subjects of different ages. Stepwise regression demonstrated the strongest correlation between the HMAP complex motor times and pegboard both-hand removal (R(2)=0.52, p=0.002 for dominant and R(2)=0.33, p=0.02 for non-dominant hands). The most consistent and sensitive measure of HMAP motor performance overall was the complex motor time. The HMAP is a short-duration, easily administered, objective quantitative test of motor function, with potential applications in aging, and in Parkinson's Disease and related motor disorders. The HMAP has a smaller version used in primates, so that measurements made in primate models of disease and its treatment are directly comparable to analogous clinical measurements made in the corresponding human disease.
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Affiliation(s)
- Charles D Smith
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY 40536, USA.
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Edwards DS, Smoot K, Hosey R, Parish K. Musculoskeletal - Weightlifting. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000273500.52555.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lovera J, Bagert B, Smoot K, Morris CD, Frank R, Bogardus K, Wild K, Oken B, Whitham R, Bourdette D. Ginkgo biloba for the improvement of cognitive performance in multiple sclerosis. Mult Scler 2007; 13:376-85. [PMID: 17439907 DOI: 10.1177/1352458506071213] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To determine if Ginkgo biloba (GB) improves the cognitive performance of subjects with multiple sclerosis (MS). Methods Randomized, double-blind, placebo-controlled trial of GB, 120 mg twice a day or placebo for 12 weeks. The primary outcomes were: the long delay free recall from the California Verbal Learning Test-II; the Paced Auditory Serial Addition Test; the Controlled Oral Word Association Test; the Symbol Digit Modalities Test; Useful Field of View Test; and the color-word interference condition from the Stroop Color and Word Test. Results On completion, the GB group (n=20) was 4.5 seconds (95% confidence interval (CI) (7.6, 0.9), P=0.015) faster than the placebo group (n=18) on the color-word interference condition of the Stroop test. Subjects who were more impaired at baseline experienced more improvement with GB (treatment*baseline interaction, F=8.10, P=0.008). We found no differences on the other neuropsychological tests. Subjects on GB reported fewer cognitive difficulties in the Retrospective Memory Scale of the Perceived Deficits Questionnaire than subjects on placebo (1.5 points, 95% CI (2.6, 0.3), P=0.016). No serious drug related side-effects occurred and GB did not alter platelet function assays. Conclusion Overall, GB did not show a statistically significant improvement in cognitive function. A treatment effect trend, limited to the Stroop test, suggests that GB may have an effect on cognitive domains assessed by this test, such as susceptibility to interference and mental flexibility. Multiple Sclerosis 2007; 13: 376-385. http://msj.sagepub.com
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Affiliation(s)
- J Lovera
- Department of Veterans Affairs Medical Center, Portland, OR, USA.
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Kearns CM, Cass WA, Smoot K, Kryscio R, Gash DM. GDNF protection against 6-OHDA: time dependence and requirement for protein synthesis. J Neurosci 1997; 17:7111-8. [PMID: 9278545 PMCID: PMC6573260] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Glial cell line-derived neurotrophic factor (GDNF) injected intranigrally protects midbrain dopamine neurons against 6-hydroxydopamine (6-OHDA) toxicity. The timing between GDNF administration and exposure to 6-OHDA is critical in achieving optimal protection. When injected 6 hr before an intranigral injection of 6-OHDA, GDNF provides complete protection as measured by the number of surviving neurons in the substantia nigra of adult rats. The surviving neuronal population decreases by approximately 50% with 12 and 24 hr separating GDNF and 6-OHDA administrations. In controls with 6-OHDA lesions, there is <10% survival of nigral dopamine neurons. No significant increase in survival is seen with either concurrent injections of GDNF and 6-OHDA or 1 hr GDNF pretreatment. Based on HPLC measurements, striatal and midbrain dopamine levels are at least twofold higher on the lesioned side in animals receiving GDNF 6 hr before a 6-OHDA lesion compared with vehicle recipients. Protein synthesis is necessary for GDNF-induced neuroprotective effects because cycloheximide pretreatment that inhibits protein synthesis also blocks neuroprotection.
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Affiliation(s)
- C M Kearns
- Department of Anatomy and Neurobiology, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA
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