scholarly journals GP.02 A population-based study of “no evident disease activity” (NEDA) in multiple sclerosis

2018 ◽  
Vol 45 (s2) ◽  
pp. S8-S8
Author(s):  
NE Parks ◽  
SJ Pittock ◽  
J Mandrekar ◽  
OH Kantarci ◽  
CF Lucchinetti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Disease Modifying Therapy ◽  
Disability Status ◽  
Relapsing Remitting ◽  
One Year ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Incident Cases ◽  
Referral Bias

Background: NEDA is a composite measure that may ultimately influence clinical decisions concerning switches of disease modifying therapy (DMT) for relapsing remitting multiple sclerosis (RRMS) patients. Cohort studies from MS clinics suggest NEDA is not sustained over time in most patients despite DMT but may be limited by referral bias. We investigated NEDA in a population-based RRMS cohort. Methods: We identified all incident cases of RRMS in Olmsted County from 01/01/2000-12/31/2011. Retrospective chart review was conducted to determine persistence of NEDA -following RRMS diagnosis. NEDA failure was defined as new MRI activity, relapse, or expanded disability status scale (EDSS) -worsening. Results: There were 93 incident cases of RRMS with 82 individuals having sufficient follow-up to determine persistence of NEDA. Prior to NEDA failure 44 were not on DMT, 37 were on first-tier, injectable DMT, and 1 received mitoxantrone. NEDA was maintained by 63% at 1 year, 38% at 2 years, 19% at 5 years, and 12% at 10 years. Disability measured by EDSS was no different at 10 years in patients maintaining NEDA versus those that failed NEDA at one year (p=0.3). Conclusions: Maintenance of NEDA beyond 2 years is infrequent among a population-based cohort of newly diagnosed RRMS patients and similar to prior clinic-based cohorts.

scholarly journals Population-based study of “no evident disease activity” in MS

2018 ◽  
Vol 5 (6) ◽  
pp. e495 ◽  
Author(s):  
Natalie E. Parks ◽  
Sean J. Pittock ◽  
Jay Mandrekar ◽  
Orhun H. Kantarci ◽  
Claudia F. Lucchinetti ◽  
...  
Keyword(s):  
Disease Activity ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Routine Care ◽  
Disease Modifying Therapy ◽  
Care Assessment ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Incident Cases

ObjectiveTo determine the persistence of no evident disease activity (NEDA) in a population-based relapsing-remitting MS (RRMS) cohort.MethodsAll incident cases of RRMS in Olmsted County between 2000 and 2011 were identified using a medical records linkage system. Persistence of NEDA after RRMS diagnosis was determined by retrospective chart review. MRI activity, relapse, or Expanded Disability Status Scale (EDSS) worsening resulted in failure of NEDA.ResultsWe identified 93 incident cases of RRMS including 82 individuals with sufficient follow-up to determine the persistence of NEDA. There were 44 individuals not on disease-modifying therapy (DMT), whereas 37 individuals were prescribed an injectable DMT and 1 received mitoxantrone during the interval over which NEDA was maintained. NEDA was maintained by 63% at 1 year, 38% at 2 years, 19% at 5 years, and 12% at 10 years according to routine care assessment. At 10 years, there was no difference in EDSS disability among patients who maintained NEDA vs those who failed NEDA at 1 year (p = 0.3).ConclusionsNEDA infrequently persists beyond 2 years in a population-based cohort of newly diagnosed patients with RRMS.

Response to interferon-beta therapy in relapsing-remitting multiple sclerosis: a comparison of different clinical criteria

2006 ◽  
Vol 12 (3) ◽  
pp. 281-286 ◽  
Author(s):  
E Portaccio ◽  
V Zipoli ◽  
G Siracusa ◽  
S Sorbi ◽  
M P Amato
Keyword(s):  
Multiple Sclerosis ◽  
Relapse Rate ◽  
Interferon Beta ◽  
Clinical Criteria ◽  
Predictors Of Response ◽  
Lower Baseline ◽  
Disability Status ◽  
Relapsing Remitting ◽  
One Year ◽  
Relapsing Remitting Multiple Sclerosis

We assessed the proportion and potential predictors of response to interferon-beta (IFNβ) therapy in relapsing-remitting (RR) multiple sclerosis (MS) patients, comparing different definitions of response: a) lower relapse rate during therapy compared to the year and the two years before therapy, b) reduction of relapse rate during therapy of at least 30% compared to the two years before therapy, c) no relapse during treatment, d) no progression on the Expanded Disability Status Scale (EDSS). Among 147 RR patients treated for at least one year, 33 received IFNβ-1b subcutaneously (SC) (Betaferon), 59 IFNβ-1a intramuscularly (Avonex) and 55 IFNβ-1a SC (Rebif). Using definitions a), b) and d), 72%, 73% and 73% patients, respectively, were considered responders. Forty-four per cent of our patients were completely relapse free. In the logistic regression model, using definitions a) and b), a higher relapse rate in the two years preceding the therapy turned out to be a significant predictor of response. Considering definition c), lower baseline relapse rate was associated with a more favourable response.

Interferon beta in relapsing-remitting multiple sclerosis: an independent postmarketing study in southern Italy

2003 ◽  
Vol 9 (5) ◽  
pp. 451-457 ◽  
Author(s):  
Maria Trojano ◽  
Maria Liguori ◽  
Damiano Paolicelli ◽  
Giovanni Bosco Zimatore ◽  
Francesca De Robertis ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Adverse Events ◽  
Interferon Beta ◽  
Population Based ◽  
First Year ◽  
Independent Population ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

This independent, population-based surveillance study monitored the efficacy and safety of interferon beta (IFNb) products in 1033 patients with relapsing -remitting multiple sclerosis (RRMS) from 15 centres in Italy. Relapses, Expanded Disability Status Scale (EDSS) scores, and adverse events were evaluated for up to 24 months. Data of patients with a baseline EDSS score 5-3.5 are reported. The proportions of relapse-free patients were similar among the groups at 12 and 24 months (P =0.10). IFNb products produced significant reductio ns from baseline in relapse rates at 12 and 24 months (P B-0.001), with no differences among treatments (P =0.2). There were no significant differences in mean EDSS change among groups at 12 or 24 months. The IFNb-1b group showed a higher incidence of adverse events during the first year of treatment (P B-0.05) than IFNb-1a groups, and more withdrawals (10%) compared with Avonex (5%) at 24 months. IFNb products are equally effective in low disability RRMS, but IFNb-1a may have a more favorable efficacy/tolerability ratio.

Residual disability after severe relapse in people with multiple sclerosis treated with disease-modifying therapy

2018 ◽  
Vol 25 (13) ◽  
pp. 1746-1753 ◽  
Author(s):  
Anat Achiron ◽  
Ida Sarova-Pinhas ◽  
David Magalashvili ◽  
Yael Stern ◽  
Aviva Gal ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Neurological Status ◽  
High Rate ◽  
High Dose ◽  
Disease Modifying Drugs ◽  
Disease Modifying Therapy ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
Relapsing Remitting Multiple Sclerosis

Background: The rate of post-relapse residual disability in patients with relapsing–remitting multiple sclerosis (RRMS) treated with disease-modifying drugs (DMD) has not been studied. Objective: To assess relapse residual disability in DMD-treated RRMS patients. Methods: We followed DMD-treated RRMS patients presenting with acute relapse who received high-dose steroids. Increases in Expanded Disability Status Scale (EDSS) of at least 2.0, 1.0–1.5 or 0.5 were defined as severe, moderate or mild relapses, respectively. The proportions of patients with post-relapse residual disability defined as the failure to regain pre-relapse neurological status at 1, 4 and 12 months were evaluated. Results: Out of 1672 relapses in DMD-treated RRMS patients, 17% were severe. In patients who presented with a severe relapse, we observed post-relapse residual disability of at least 1.0 EDSS point in 60.1%, 55.9% and 48.2% of patients at 1, 2 and 12 months of follow-up, respectively. Post-relapse residual disability of at least 2.0 EDSS points was observed in 37.4%, 30.7% and 20.7% of patients after 1, 2 and 12 months, respectively. Conclusion: A high rate of incomplete recovery was seen 12 months following severe relapse among RRMS patients and may contribute to the accumulation of long-term disability.

scholarly journals MS TREATMENT OPTIMIZATION: FACTORS ASSOCIATED WITH POOR CLINICAL RESPONSE IN NAB POSITIVE PATIENTS

2016 ◽  
Vol 15 (3) ◽  
pp. 119-126
Author(s):  
A. Cornea ◽  
◽  
R. Tudor ◽  
A. Petre ◽  
M. Simu ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Neutralizing Antibodies ◽  
Clinical Decision ◽  
Treatment Optimization ◽  
T2 Lesions ◽  
Disease Modifying Therapy ◽  
Relapsing Remitting ◽  
One Year ◽  
Multiple Sclerosis Patients ◽  
Relapsing Remitting Multiple Sclerosis

Background and purpose. Interferon beta (IFN beta) belongs to the first line of disease modifying therapy drugs in the treatment of relapsing-remitting multiple sclerosis being widely used in the chronic treatment of this pathology. The serum presence of the neutralizing antibodies (Nabs) has been shown to alter the treatment response, its routine applicability being still debated. In an observational study, we aimed to determine in the Nabs positive patients, correlations with other clinical factors which contribute to IFN beta decreased efficacy. Methods. We measured Nabs in 104 patients who were on IFN beta therapy (29.8% on IFN beta 1a s.c., 27.88% on IFN beta 1a i.m. and 42,3 on IFN beta 1b s.c.) for at least one year in our clinic. Serum was collected at 24 h after treatment injection to avoid transitory antibody peak (12-18 h post administration). We considered positive the patients with a titer higher than 20 TRU. Results. The prevalence of Nabs in our group of patients was 13.43% (42.85% IFN Beta 1b s.c., 50% IFN beta 1a s.c. and 7.14% IFN beta 1 a i.m.). Nabs positivity was associated with an increase in the relapse rate (for IFB beta 1a and 1b s.c. groups) and progression for IFN beta 1 b s.c. patient group. Conclusions. The routine clinical testing for Nabs should impact the clinical decision of switching therapy in multiple sclerosis patients that present with an increased number of relapses, EDSS progression or a higher number of MRI T2 lesions.

scholarly journals Relationship between Expanded Disability Status Scale scores and the presence of temporomandibular disorders in patients with multiple sclerosis

2018 ◽  
Vol 12 (01) ◽  
pp. 144-148 ◽  
Author(s):  
Lucas Senra Correa Carvalho ◽  
Osvaldo José Moreira Nascimento ◽  
Luciane Lacerda Franco Rocha Rodrigues ◽  
Andre Palma Da Cunha Matta
Keyword(s):  
Multiple Sclerosis ◽  
Temporomandibular Disorders ◽  
Control Group ◽  
Expanded Disability Status Scale ◽  
Exact Test ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Scale Scores ◽  
Axis I ◽  
Relapsing Remitting Multiple Sclerosis

ABSTRACTObjectives: The objectives of this study were to assess the prevalence of temporomandibular disorders (TMDs) in patients with relapsing-remitting multiple sclerosis (MS) and to investigate whether an association exists between the presence of TMD symptoms and the degree of MS-related disability. Materials and Methods: In all, 120 individuals were evaluated: 60 patients with a diagnosis of relapsing-remitting MS and 60 age- and sex-matched controls without neurological impairments. A questionnaire recommended by the European Academy of Craniomandibular Disorders for the assessment of TMD symptoms was administered. For those who answered affirmatively to at least one of the questions, the RDC/TMD Axis I instrument was used for a possible classification of TMD subtypes. The Expanded Disability Status Scale (EDSS) was the measure of the degree of MS-related disability. Statistical Analysis Used: Fisher’s exact test was used to analyze the data. ANOVA was used to detect significant differences between means and to assess whether the factors influenced any of the dependent variables by comparing means from the different groups. Results: The prevalence of TMD symptoms in patients with MS was 61.7% versus 18.3% in the control group (CG). A diagnosis of TMD was established for 36.7% in the MS group and 3.3% in the CG (P = 0.0001). There were statistically significant differences between degrees of MS-related disability and the prevalence of TMD (P = 0.0288). Conclusions: The prevalence of both TMD and TMD symptoms was significantly greater in the MS group. EDSS scores and TMD prevalence rates were inversely related.

scholarly journals A comparative study of teriflunomide and dimethyl fumarate within the Swedish MS Registry

2021 ◽  
pp. 135245852110196
Author(s):  
Jan Hillert ◽  
Jon A Tsai ◽  
Mona Nouhi ◽  
Anna Glaser ◽  
Tim Spelman
Keyword(s):  
Multiple Sclerosis ◽  
Real World ◽  
Clinical Effectiveness ◽  
Dimethyl Fumarate ◽  
Population Based ◽  
Life Outcomes ◽  
Treatment Persistence ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis

Background: Teriflunomide and dimethyl fumarate (DMF) are first-line disease-modifying treatments for multiple sclerosis with similar labels that are used in comparable populations. Objectives: The objective of this study was to compare the effectiveness and persistence of teriflunomide and DMF in a Swedish real-world setting. Methods: All relapsing-remitting multiple sclerosis (RRMS) patients in the Swedish MS registry initiating teriflunomide or DMF were included in the analysis. The primary endpoint was treatment persistence. Propensity score matching was used to adjust comparisons for baseline confounders. Results: A total of 353 teriflunomide patients were successfully matched to 353 DMF. There was no difference in the rate of overall treatment discontinuation by treatment group across the entire observation period (hazard ratio (HR) = 1.12; 95% confidence interval (CI) = 0.91–1.39; p = 0.277; reference = teriflunomide). Annualised relapse rate (ARR) was comparable ( p = 0.237) between DMF (0.07; 95% CI = 0.05–0.10) and teriflunomide (0.09; 95% CI = 0.07–0.12). There was no difference in time to first on-treatment relapse (HR = 0.78; 95% CI = 0.50–1.21), disability progression (HR = 0.55; 95% CI = 0.27–1.12) or confirmed improvement (HR = 1.17; 95% CI = 0.57–2.36). Conclusion: This population-based real-world study reports similarities in treatment persistence, clinical effectiveness and quality of life outcomes between teriflunomide and dimethyl fumarate.

scholarly journals Assessment of Biochemical and Densitometric Markers of Calcium-Phosphate Metabolism in the Groups of Patients with Multiple Sclerosis Selected due to the Serum Level of Vitamin D3

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Natalia Niedziela ◽  
Krystyna Pierzchała ◽  
Jolanta Zalejska-Fiolka ◽  
Jacek T. Niedziela ◽  
Ewa Romuk ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Vitamin D ◽  
Calcium Phosphate ◽  
Serum Level ◽  
Clinical Stage ◽  
Phosphate Metabolism ◽  
Disability Status ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Calcium Phosphate Metabolism

Background. In addition to the widely known effect of vitamin D3 (vitD3) on the skeleton, its role in the regulation of the immune response was also confirmed. Aim. The assessment of biochemical and densitometric markers of calcium-phosphate metabolism in the groups of patients with relapsing-remitting multiple sclerosis (RRMS) selected due to the serum level of vitamin D3. Methods. The concentrations of biochemical markers and indices of lumbar spine bone densitometry (DXA) were determined in 82 patients divided into vitamin D3 deficiency (VitDd), insufficiency (VitDi), and normal vitamin D3 level (VitDn) subgroups. Results. The highest level of the parathyroid hormone (PTH) and the highest prevalence of hypophosphatemia and osteopenia were demonstrated in VitDd group compared to VitDi and VitDn. However, in VitDd, VitDi, and VitDn subgroups no significant differences were observed in the levels of alkaline phosphatase (ALP) and ionized calcium (Ca2+) and in DXA indices. A negative correlation was observed between the level of vitamin D3 and the Expanded Disability Status Scale (EDSS) in the whole MS group. The subgroups were significantly different with respect to the EDSS scores and the frequency of complaints related to walking according to the EQ-5D. Conclusions. It is necessary to assess calcium-phosphate metabolism and supplementation of vitamin D3 in RRMS patients. The higher the clinical stage of the disease assessed with the EDSS, the lower the level of vitamin D3 in blood serum. Subjectively reported complaints related to difficulties with walking were reflected in the EDSS in VitDd patients.

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