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Gomez-Peralta F, Chico Ballesteros A, Marco Martínez A, Pérez Corral B, Conget Donlo I, Fuentealba Melo P, Zaragozá Arnáez F, Matabuena Rodríguez M. Insulin glargine 300 U/ml versus insulin degludec 100 U/ml improves nocturnal glycaemic control and variability in type 1 diabetes under routine clinical practice: A glucodensities-based post hoc analysis of the OneCare study. Diabetes Obes Metab 2024; 26:1993-1997. [PMID: 38379106 DOI: 10.1111/dom.15496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/19/2024] [Accepted: 01/28/2024] [Indexed: 02/22/2024]
Affiliation(s)
| | - Ana Chico Ballesteros
- Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Spain. CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain. Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Ignacio Conget Donlo
- Diabetes Unit, Department of Endocrinology and Nutrition, IDF Centre of Education and Excellence in Diabetes Care, ICMDM, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | | | | | - Marcos Matabuena Rodríguez
- CiTIUS (Centro Singular de Investigación en Tecnoloxías Intelixentes), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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Mercader-García P, Gatica-Ortega ME, González-Pérez R, Pastor-Nieto MA, Carrillo A, Borrego L. Cosmetovigilance for infrequent allergens in Spain using a national online registry: The example of allergic contact dermatitis caused by phenylethyl resorcinol. Contact Dermatitis 2024; 90:245-252. [PMID: 37987093 DOI: 10.1111/cod.14460] [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] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/24/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Monitoring of adverse events induced by cosmetics performed by health authorities, known as cosmetovigilance, has been relied on the collection of case notifications. OBJECTIVES We aimed to show how a contact dermatitis registry can contribute to the cosmetovigilance of emerging allergens. We used the example of phenylethyl resorcinol, an infrequent allergen with only 6 previous cases reported in Europe and Japan since 2013. METHODS A systematic search in the Spanish Registry of Contact Dermatitis and Cutaneous Allergy (REIDAC) database was performed to identify patients with positive patch test to phenylethyl resorcinol or cosmetics that contains it between June 2018 and January 2023. We collected the main clinical features of these patients and compared them with those of patients recorded in the registry with similar epidemiological features. RESULTS Thirteen patients with positive patch test to phenylethyl resorcinol were identified. All the patients were women with a mean age of 42 years (range 32-59) and their lesions were mainly in the face. CONCLUSION Assessing the importance of infrequent allergens based solely on a case series is difficult. Multicentre registries facilitate the collection of cases and provide appropriate background information for new allergens.
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Affiliation(s)
- Pedro Mercader-García
- Hospital General Universitario Morales Meseguer (Murcia), Universidad de Murcia, Murcia, Spain
| | | | | | | | - Andrés Carrillo
- Hospital General Universitario Morales Meseguer (Murcia), Universidad de Murcia, Murcia, Spain
| | - Leopoldo Borrego
- Complejo Hospitalario Universitario Insular Materno Infantil, Universidad de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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3
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Costa-Frossard França L, Meca Lallana V, Labiano-Fontcuberta A, Blasco R, Monreal E, Martínez Ginés ML, Aguirre C, Sabin Muñoz J, Sainz de la Maza S, Cuello JP, Díaz-Pérez C, Chico García JL, Lozano Ros A, Rodríguez Jorge F, Martínez Martínez S, García Domínguez JM. Real-World Retrospective Analysis of Alemtuzumab Outcomes in Relapsing-Remitting Multiple Sclerosis: The LEMCAM Study. CNS Drugs 2024; 38:231-238. [PMID: 38418770 PMCID: PMC10920415 DOI: 10.1007/s40263-024-01066-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Alemtuzumab is a high-efficacy treatment approved for relapsing-remitting multiple sclerosis (RRMS). Although clinical trials and observational studies are consistent in showing its efficacy and manageable safety profile, further studies under clinical practice conditions are needed to further support its clinical use. OBJECTIVE The aim of this observational retrospective study was to evaluate the effectiveness and safety of alemtuzumab to add to the current real-world evidence on the drug. METHODS A cohort of 115 adult patients with RRMS treated with alemtuzumab between 2014 and 2020 was retrospectively followed up in five centers in Spain. Analysis included annualized relapse rate (ARR), 6-month confirmed disability worsening (CDW), 6-month confirmed disability improvement (CDI), radiological activity, no evidence of disease activity (NEDA-3), and safety signals. Given the different follow-up periods among participants, ARR was calculated using the person-years method. CDI was defined as a ≥ 1.0-point decrease in Expanded Disability Status Scale (EDSS) score assessed in patients with a baseline EDSS score ≥ 2.0 confirmed 6 months apart. CDW was defined as a ≥ 1.0-point increase in EDSS score assessed in patients with a baseline EDSS score ≥ 1.0 (≥ 1.5 if baseline EDSS = 0), confirmed 6 months apart. RESULTS ARR decreased from 1.9 (95% confidence interval 1.60-2.33) in the year prior to alemtuzumab initiation to 0.28 (0.17-0.37) after 1 year of treatment (87% reduction), and to 0.22 (0.13-0.35) after the second year. Over the entire follow-up period, ARR was 0.24 (0.18-0.30). At year 1, 75% of patients showed no signs of magnetic resonance imaging (MRI) activity and 70% at year 5. One percent of patients experienced 6-month CDW at year 1, 2.6% at year 2, 7.4% at year 3, and no patients over years 4 and 5. A total of 7.7% of patients achieved 6-month CDI in year 1, 3.6% in year 2, and maintained it at years 3 and 4. Most patients achieved annual NEDA-3: year 1, 72%; year 2, 79%; year 3, 80%; year 4, 89%; year 5, 75%. Infusion-related reactions were observed in 95% of patients and infections in 74%. Thyroid disorders occurred in 30% of patients, and only three patients developed immune thrombocytopenia. No cases of progressive multifocal leukoencephalopathy were reported. CONCLUSIONS This study shows that alemtuzumab reduced the relapse rate and disability worsening in real-world clinical practice, with many patients achieving and sustaining NEDA-3 over time. The safety profile of alemtuzumab was consistent with previous findings, and no new or unexpected safety signals were observed. As this was an observational and retrospective study, the main limitation of not having all variables comprehensively available for all patients should be considered when interpreting results.
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Affiliation(s)
| | - Virginia Meca Lallana
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Rosario Blasco
- Neuroimmunology Unit, Neurology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- IRYCIS (Ramón y Cajal Institute for Health Research), Madrid, Spain
- REEM (Spanish Network of Multiple Sclerosis), Universidad de Alcalá, Madrid, Spain
| | | | - Clara Aguirre
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | - Julia Sabin Muñoz
- Neuroimmunology Unit, Neurology Service, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- IRYCIS (Ramón y Cajal Institute for Health Research), Madrid, Spain
- REEM (Spanish Network of Multiple Sclerosis), Universidad de Alcalá, Madrid, Spain
| | - Juan Pablo Cuello
- Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Carolina Díaz-Pérez
- Demyelinating Diseases Unit, Neurology Service, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Alberto Lozano Ros
- Department of Neurology, Hospital Universitario Gregorio Marañón, Madrid, Spain
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Mestre-Ferrándiz J, Rivero A, Orrico-Sánchez A, Hidalgo Á, Abdalla F, Martín I, Álvarez J, García-Cenoz M, Del Carmen Pacheco M, Garcés-Sánchez M, Zozaya N, Ortiz-de-Lejarazu R. Evaluation of antibody-based preventive alternatives for respiratory syncytial virus: a novel multi-criteria decision analysis framework and assessment of nirsevimab in Spain. BMC Infect Dis 2024; 24:99. [PMID: 38238680 PMCID: PMC10797756 DOI: 10.1186/s12879-024-08988-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/06/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a highly infectious disease that poses a significant clinical and medical burden, as well as social disruption and economic costs, recognized by the World Health Organization as a public health issue. After several failed attempts to find preventive candidates (compounds, products, including vaccines), new alternatives might be available, one being nirsevimab, the first and only option approved for RSV prevention in neonates and infants during their first RSV season. The objective of this study was to develop a novel multi-criteria decision analysis (MCDA) framework for RSV antibody-based preventive alternatives and to use it to assess the value of nirsevimab vs. placebo as a systematic immunization approach to prevent RSV in neonates and infants during their first RSV season in Spain. METHODS Based on a pre-established model called Vaccinex, an ad-hoc MCDA framework was created to reflect relevant attributes for the assessment of current and future antibody-based preventive measures for RSV. The estimated value of nirsevimab was obtained by means of an additive linear model combining weights and scores assigned by a multidisciplinary committee of 9 experts. A retest and three sensitivity analyses were conducted. RESULTS Nirsevimab was evaluated through a novel framework with 26 criteria by the committee as a measure that adds value (positive final estimated value: 0.56 ± 0.11) to the current RSV scenario in Spain, by providing a high efficacy for prevention of neonates and infants. In addition, its implementation might generate cost savings in hospitalizations and to the healthcare system and increase the level of public health awareness among the general population, while reducing health inequities. CONCLUSIONS Under a methodology with increasing use in the health field, nirsevimab has been evaluated as a measure which adds value for RSV prevention in neonates and infants during their first RSV season in Spain.
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Affiliation(s)
| | - Agustín Rivero
- Department of Management, Bioregión de Salud y Bienestar (BioMad), Madrid, Spain
| | - Alejandro Orrico-Sánchez
- Department of Vaccines Research, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- Catholic University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Álvaro Hidalgo
- Weber Foundation, Madrid, Spain
- Department of Economic Analysis and Finances, University of Castilla-La Mancha, Toledo, Spain
| | - Fernando Abdalla
- Department of Health Affairs and Policy Research, Vivactis Weber, Madrid, Spain.
| | - Isabel Martín
- Department of Primary Care, Rochapea Healthcare Center, Navarra, Spain
| | - Javier Álvarez
- Department of Pediatrics, Hospital Costa del Sol, Málaga, Spain
| | | | | | | | - Néboa Zozaya
- Department of Health Affairs and Policy Research, Vivactis Weber, Madrid, Spain
- Department of Quantitative Methods in Economics and Management, University Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Raúl Ortiz-de-Lejarazu
- National Influenza Centre, School of Medicine, University of Valladolid, Castilla y León, Spain
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Meca-Lallana JE, Prieto González JM, Caminero Rodríguez AB, Olascoaga Urtaza J, Alonso AM, Durán Ferreras E, Espinosa R, Dotor J, Romera M, Ares Luque A, Pérez Ruiz D, Calles C, Hernández MA, Hervás García M, Mendoza Rodríguez A, Berdei Montero Y, Téllez N, Herrera Varó N, Sotoca J, Presas-Rodríguez S, Querol Gutierrez LA, Hervás Pujol M, Batlle Nadal J, Martín Ozaeta G, Gubieras Lillo L, Martínez Yélamos S, Ramió-Torrentà L, Mallada Frechin J, Belenguer Benavides A, Gascón-Giménez F, Casanova B, Landete Pascual L, Berenguer L, Navarro L, Gómez Gutierrez M, Durán C, Rodríguez Regal A, Álvarez E, García-Estévez DA, López Real AM, Llaneza González MA, Marzo Sola ME, Sánchez-Menoyo JL, Oterino A, Villaverde González R, Castillo-Triviño T, Álvarez de Arcaya A, Llarena C. Effectiveness and Safety of Teriflunomide in Relapsing-Remitting Multiple Sclerosis and Improvements in Quality of Life: Results from the Real-World TERICARE Study. Neurol Ther 2023; 12:2177-2193. [PMID: 37861931 PMCID: PMC10630277 DOI: 10.1007/s40120-023-00557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Teriflunomide is a once-daily oral immunomodulator approved for relapsing forms of multiple sclerosis (MS) or relapsing-remitting multiple sclerosis (RRMS; depending on the local label), based on extensive evidence from clinical trials and a real-world setting on efficacy, tolerability and patient-reported benefits. The TERICARE study assessed the impact of teriflunomide treatment over 2 years on health-related quality of life (HRQoL) and some of the most common and disabling symptoms of MS, such as fatigue and depression. METHODS This prospective observational study in Spain included RRMS patients treated with teriflunomide for ≤ 4 weeks. The following patient-reported outcomes (PROs) were collected at baseline and every 6 months for 2 years: the 29-item Multiple Sclerosis Impact Scale version 2 (MSIS-29), the 21-item Modified Fatigue Impact Scale (MFIS-21), the Beck Depression Inventory (BDI-II), the Short Form (SF)-Qualiveen and the Treatment Satisfaction Questionnaire for Medication v1.4 (TSQM). Annualised relapse rate (ARR), disability progression according to the Expanded Disability Status Scale (EDSS), and no evidence of disease activity (NEDA-3) were also assessed. RESULTS A total of 325 patients were analysed. Patients had a mean (SD) age of 43.2 years (10.4), a mean baseline EDSS score of 1.75 (1.5), a mean number of relapses in the past 2 years of 1.5 (0.7), and 64% had received prior disease-modifying therapy (DMT). Patients showed significant improvements in the psychological domain of MSIS-29 from 35.9 (26.6) at baseline to 29.4 (25.5) at 18 months (p = 0.004) and 29.0 (24.6) at 24 months (p = 0.002). Levels of fatigue and depression were also reduced. After 2 years of treatment with teriflunomide, ARR was reduced to 0.17 (95% CI 0.14-0.21) from the baseline of 0.42 (95% CI 0.38-0.48), representing a 60.1% reduction. Mean EDSS scores remained stable during the study, and 79.9% of patients showed no disability progression. 54.7% of patients achieved NEDA-3 in the first 12 months, which increased to 61.4% during months 12-24. Patients reported increased satisfaction with treatment over the course of the study, regardless of whether they were DMT naive or not. CONCLUSION Teriflunomide improves psychological aspects of HRQoL and maintains low levels of fatigue and depression. Treatment with teriflunomide over 2 years is effective in reducing ARR and disability progression.
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Affiliation(s)
- José E Meca-Lallana
- Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit, Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca)/Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio, Murcia, Spain.
| | - José M Prieto González
- Neurology Service, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Ana M Alonso
- Neurology Service, Hospital Regional Universitario Málaga, Málaga, Spain
| | | | - Raúl Espinosa
- Neurology Unit, Hospital Universitario Jerez de La Frontera, Cádiz, Spain
| | - Julio Dotor
- Neurology Service, Multiple Sclerosis Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Mercedes Romera
- Neurology Service, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | | | - Carmen Calles
- Neurology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Miguel A Hernández
- Neurology Service, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Miguel Hervás García
- Neurology Service, Hospital Insular Universitario de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Nieves Téllez
- Neurology Service, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | | | - Javier Sotoca
- Neurology Department, Hospital Mútua Terrassa, Barcelona, Spain
| | - Silvia Presas-Rodríguez
- MS-Neuroimmunology Unit, Department of Neurosciences, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Luis A Querol Gutierrez
- Neuromuscular Diseases Unit-Autoimmune Neurology-Neuromuscular Lab, Neurology Department-Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain
| | | | | | | | | | - Sergio Martínez Yélamos
- Multiple Sclerosis Unit, Hospital Universitario de Bellvitge, Institut Català de la Salut, Barcelona, Spain
| | - Lluís Ramió-Torrentà
- Neurology Department, Hospital Universitario Dr. Josep Trueta i Santa Caterina, Girona, Spain
| | | | | | | | | | | | | | - Laura Navarro
- Neurology Department, Hospital General Universitario de Elche, Alicante, Spain
| | | | - Carmen Durán
- Neurology Service, Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - Ana Rodríguez Regal
- Neurology Service, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Elena Álvarez
- Neurology Service, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | | | - Ana M López Real
- Neurology Service, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | | | | | - Agustín Oterino
- Neurology Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | - Cristina Llarena
- Neurology Service, Hospital Universitario Basurto, Bilbao, Spain
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Blanco-Aparicio M, Domínguez-Ortega J, Cisneros C, Colás C, Casas F, Del Cuvillo A, Alobid I, Quirce S, Mullol J. Consensus on the management of united airways disease with type 2 inflammation: a multidisciplinary Delphi study. Allergy Asthma Clin Immunol 2023; 19:34. [PMID: 37088840 PMCID: PMC10124060 DOI: 10.1186/s13223-023-00780-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/27/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Scientific evidence on patients with multimorbid type 2 asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) from a united airways disease (UAD) perspective remains scarce, despite the frequent coexistence of these entities. We aimed to generate expert consensus-based recommendations for the management of UAD patients. METHODS Using a two-round Delphi method, Spanish expert allergists, pulmonologists and otolaryngologists expressed their agreement on 32 statements (52 items) on a 9-point Likert scale, classified as appropriate (median 7-9), uncertain (4-6) or inappropriate (1-3). Consensus was considered when at least two-thirds of the panel scored within the range containing the median. RESULTS A panel of 30 experts reached consensus on the appropriateness of 43 out of the 52 (82.7%) items. The usefulness of certain biomarkers (tissue and peripheral blood eosinophil count, serum total IgE, and fraction of exhaled nitric oxide [FeNO]) in the identification and follow-up of type 2 inflammation, and assessment of the response to biologics, were agreed. Some of these biomarkers were also associated with disease severity and/or recurrence after endoscopic sinus surgery (ESS). Consensus was achieved on treatment strategies related to the prescription of anti-IL-4/IL-13 or anti-IgE agents, concomitant treatment with systemic corticosteroids, and combining or switching to biologics with a different mechanism of action, considering a number of UAD clinical scenarios. CONCLUSION We provide expert-based recommendations to assist in clinical decision-making for the management of patients with multimorbid type 2 asthma and CRSwNP. Specific clinical trials and real-world studies focusing on the single-entity UAD are required to address controversial items.
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Affiliation(s)
- Marina Blanco-Aparicio
- Department of Respiratory Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Javier Domínguez-Ortega
- Department of Respiratory Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Carolina Cisneros
- Department of Pulmonology, Hospital Universitario La Princesa, Health Research Institute (IP), Madrid, Spain
| | - Carlos Colás
- Department of Allergy, Hospital Clínico-Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Francisco Casas
- Department of Respiratory Medicine, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Alfonso Del Cuvillo
- Rhinology & Asthma Unit, ENT Department, Hospital Universitario de Jerez, Cádiz, Spain
| | - Isam Alobid
- Rhinology Unit & Smell Clinic, ENT Department, CIBERES, Hospital Clinic Barcelona, Universitat de Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, Institute for Health Research (IdiPAZ), CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, CIBERES, Hospital Clinic Barcelona, Universitat de Barcelona, C/ Villarroel 170, 08036, Barcelona, Spain.
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7
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Eichau S, López Ruiz R, Ruíz de Arcos M, Ruiz-Peña JL, Navarro G, Calleja MÁ, Moreno-Amador JL, Dotor García-Soto J. Results of treatment with alemtuzumab in a Spanish cohort of patients with multiple sclerosis in the real world: The RealMS study. Front Neurol 2023; 14:1112193. [PMID: 36998778 PMCID: PMC10044139 DOI: 10.3389/fneur.2023.1112193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023] Open
Abstract
Background Alemtuzumab (ALZ) is a humanized monoclonal antibody approved for the treatment of patients with highly active relapsing-remitting multiple sclerosis (RRMS) administered in two annual courses. The objective of this study was to describe the effectiveness and safety data of ALZ and to report the health resource utilization in patients receiving this treatment. Methods In this retrospective, non-interventional study, information was retrieved from patients' medical charts at one center in Spain. Included patients were ≥18 years old, and ALZ treatment was initiated between 1 March 2015 and 31 March 2019, according to routine clinical practice and local labeling. Results Of 123 patients, 78% were women. The mean (standard deviation, SD) age of patients at diagnosis was 40.3 (9.1) years, and the mean time since diagnosis was 13.8 (7.3) years. Patients were previously treated with a median (interquartile range; IQR) number of two (2.0-3.0) disease-modifying treatments (DMTs). Patients were treated with ALZ for a mean (SD) of 29.7 (13.8) months. ALZ reduced the annualized relapse rate (ARR) (1.5 before vs. 0.05 after; p < 0.001) and improved the median EDSS (4.63 before vs. 4.00 after; p < 0.001). Most (90.2%) patients were relapse-free while receiving ALZ. The mean number of gadolinium-enhancing [Gd+] T1 lesions was reduced (1.7 before vs. 0.1 after; p < 0.001), and the mean number of T2 hyperintense lesions was maintained (35.7 before vs. 35.4 after; p = 0.392). A total of 27 (21.9%) patients reported 29 autoimmune diseases: hyperthyroidism (12), hypothyroidism (11), idiopathic thrombocytopenic purpura (ITP) (3), alopecia areata (1), chronic urticaria (1), and vitiligo (1). The mean number of health resources (outpatient visits, emergency room visits, hospital admissions, and tests performed in the hospital) used while patients were treated with ALZ progressively decreased from year 1 to year 4, except for a slight increase at year 2 of outpatient visits. Conclusion The ReaLMS study provides real-world evidence that ALZ can promote clinical and magnetic resonance imaging disease remission, as well as disability improvement in patients with MS, despite several prior DMT failures. The ALZ safety profile was consistent with data available from clinical trials and other real-world studies. Healthcare resource use was reduced throughout the treatment period.
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Affiliation(s)
- Sara Eichau
- Multiple Sclerosis Unit, Neurology Service, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Rocío López Ruiz
- Multiple Sclerosis Unit, Neurology Service, Hospital Universitario Virgen Macarena, Seville, Spain
| | - María Ruíz de Arcos
- Multiple Sclerosis Unit, Neurology Service, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Juan Luis Ruiz-Peña
- Multiple Sclerosis Unit, Neurology Service, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Guillermo Navarro
- Multiple Sclerosis Unit, Neurology Service, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | - Julio Dotor García-Soto
- Multiple Sclerosis Unit, Neurology Service, Hospital Universitario Virgen Macarena, Seville, Spain
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