scholarly journals Rapid Progression of Low-Grade Cervical Dysplasia into Invasive Cancer during Natalizumab Treatment for Relapsing Remitting Multiple Sclerosis

2019 ◽  
Vol 12 (1) ◽  
pp. 59-62
Author(s):  
King Man Wan ◽  
Martin K. Oehler
Keyword(s):  
Multiple Sclerosis ◽  
Cervical Screening ◽  
Cervical Dysplasia ◽  
Pelvic Lymphadenectomy ◽  
Rapid Progression ◽  
Low Grade ◽  
Increased Risk ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

A 25-year-old patient treated for relapsing remitting multiple sclerosis (RRMS) with natalizumab had a rapid progression of a low grade squamous intraepithelial lesion to a FIGO stage 1B1 squamous cell carcinoma of the uterine cervix within 2 years. She was treated with radical hysterectomy and pelvic lymphadenectomy and subsequently developed a vault recurrence within 2 years. The recurrence was treated with definitive synchronous chemo-radiotherapy and she has been disease free for 7 years. This case and existing evidence on increased risk of developing cervical dysplasia under natalizumab show that MS patients under immunosuppressive therapy require close annual cervical screening with immediate investigation of abnormal test results.

scholarly journals Acute Anterior Uveitis in a Patient Taking Fingolimod (FTY720) for Multiple Sclerosis

2016 ◽  
Vol 7 (3) ◽  
pp. 562-566 ◽  
Author(s):  
Heather Gwen Mack ◽  
Melissa Chih-Hui Tien ◽  
Owen Bruce White
Keyword(s):  
Multiple Sclerosis ◽  
Macular Edema ◽  
Anterior Uveitis ◽  
Cystoid Macular Edema ◽  
Low Grade ◽  
Acute Anterior Uveitis ◽  
Receptor Modulator ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Fingolimod is an oral sphingosine-1-phosphate (S1P) receptor modulator and the first oral therapy for relapsing-remitting multiple sclerosis. Its use has been complicated by a low rate of cystoid macular edema usually in the first 3 months after commencement of the medication. We report the case of a 34-year-old male with relapsing-remitting multiple sclerosis, who developed acute anterior uveitis on day 5 of fingolimod treatment. He responded to appropriate treatment and cessation of drug, but developed low-grade chronic anterior uveitis without cystoid macular edema. We discuss possible mechanisms of uveitis onset in this group of patients. Urgent ophthalmological review is recommended for patients receiving fingolimod therapy who develop a red, painful eye, which may occur within 5 days of fingolimod treatment initiation.

Single nucleotide polymorphisms in the FOXP3 gene are associated with increased risk of relapsing-remitting multiple sclerosis

2017 ◽  
Vol 24 (3-4) ◽  
pp. 85-90 ◽  
Author(s):  
Mohammad Mahdi Eftekharian ◽  
Arezou Sayad ◽  
Mir Davood Omrani ◽  
Masoud Sabouri Ghannad ◽  
Rezvan Noroozi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Single Nucleotide Polymorphisms ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Foxp3 Gene ◽  
Increased Risk ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

scholarly journals Use of Disease-Modifying Therapies in Pediatric Relapsing-Remitting Multiple Sclerosis in the United Kingdom

2021 ◽  
Vol 8 (4) ◽  
pp. e1008
Author(s):  
Omar A. Abdel-mannan ◽  
Celeste Manchoon ◽  
Thomas Rossor ◽  
Justine-Clair Southin ◽  
Carmen Tur ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Modifying Therapies ◽  
Increased Risk ◽  
Relapsing Remitting ◽  
Relapse Time ◽  
Disease Modifying ◽  
Edss Score ◽  
Remitting Multiple Sclerosis ◽  
Time To Relapse ◽  
Relapsing Remitting Multiple Sclerosis

ObjectivesTo compare the real-world effectiveness of newer disease-modifying therapies (DMTs) vs injectables in children with relapsing-remitting multiple sclerosis (RRMS).MethodsIn this retrospective, multicenter study, from the UK Childhood Inflammatory Demyelination Network, we identified children with RRMS receiving DMTs from January 2012 to December 2018. Clinical and paraclinical data were retrieved from the medical records. Annualized relapse rates (ARRs) before and on treatment, time to relapse, time to new MRI lesions, and change in Expanded Disability Status Scale (EDSS) score were calculated.ResultsOf 103 children treated with DMTs, followed up for 3.8 years, relapses on treatment were recorded in 53/89 (59.5%) on injectables vs 8/54 (15%) on newer DMTs. The ARR was reduced from 1.9 to 1.1 on injectables (p < 0.001) vs 1.6 to 0.3 on newer DMTs (p = 0.002). New MRI lesions occurred in 77/89 (86.5%) of patients on injectables vs 26/54 (47%) on newer DMTs (p = 0.0001). Children on newer DMTs showed longer time to relapse, time to switch treatment, and time to new radiologic activity than patients on injectables (log-rank p < 0.01). After adjustment for potential confounders, multivariable analysis showed that injectables were associated with 12-fold increased risk of clinical relapse (adjusted hazard ratio [HR] = 12.12, 95% CI = 1.64–89.87, p = 0.015) and a 2-fold increased risk of new radiologic activity (adjusted HR = 2.78, 95% CI = 1.08–7.13, p = 0.034) compared with newer DMTs. At 2 years from treatment initiation, 38/103 (37%) patients had MRI activity in the absence of clinical relapses. The EDSS score did not change during the follow-up, and only 2 patients had cognitive impairment.ConclusionNewer DMTs were associated with a lower risk of clinical and radiologic relapses in patients compared with injectables. Our study adds weight to the argument for an imminent shift in practice toward the use of newer, more efficacious DMTs in the first instance.Classification of EvidenceThis study provides Class IV evidence that newer DMTs (oral or infusions) are superior to injectables (interferon beta/glatiramer acetate) in reducing both clinical relapses and radiologic activity in children with RRMS.

scholarly journals Diagnostic Dilemma: An Atypical Case of Astrocytoma in a Patient with Relapsing–Remitting Multiple Sclerosis

2021 ◽  
Vol 13 (2) ◽  
pp. 240-251
Author(s):  
Chantal Kahovec ◽  
Aman Saini ◽  
Michael C. Levin
Keyword(s):  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Brain Tumors ◽  
Resonance Spectroscopy ◽  
Low Grade ◽  
Relapsing Remitting ◽  
Mri Scans ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Progressive Course

Distinguishing between tumefactive demyelinating lesions (TDLs) and brain tumors in multiple sclerosis (MS) can be challenging. A progressive course is highly common with brain tumors in MS and no single neuroimaging technique is foolproof when distinguishing between the two. We report a case of a 41-year-old female with relapsing–remitting multiple sclerosis, who had a suspicious lesion within the left frontal hemisphere, without a progressive course. The patient experienced paresthesias primarily to her right hand but remained stable without any functional decline and new neurological symptoms over the four years she was followed. The lesion was followed with brain magnetic resonance imaging (MRI) scans, positron emission tomography–computed tomography scans, and magnetic resonance spectroscopy. Together, these scans favored the diagnosis of a TDL, but a low-grade tumor was difficult to rule out. Examination of serial brain MRI scans showed an enlarging lesion in the left middle frontal gyrus involving the deep white matter. Neurosurgery was consulted and an elective left frontal awake craniotomy was performed. Histopathology revealed a grade II astrocytoma. This case emphasizes the importance of thorough and continuous evaluation of atypical MRI lesions in MS and contributes important features to the literature for timely diagnosis and treatment of similar cases.

John Cunningham Virus Status, Seroconversion Rate, and the Risk of Progressive Multifocal Leukoencephalopathy in Polish John Cunningham Virus-Seronegative Patients with Relapsing-Remitting Multiple Sclerosis

2020 ◽  
Vol 83 (5) ◽  
pp. 487-492
Author(s):  
Katarzyna Kapica-Topczewska ◽  
Francois Collin ◽  
Joanna Tarasiuk ◽  
Agata Czarnowska ◽  
Monika Chorąży ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Jc Virus ◽  
Seroconversion Rate ◽  
John Cunningham Virus ◽  
Increased Risk ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

<b><i>Introduction:</i></b> Presence of anti-JC-virus antibodies (JCVAbs) is associated with the increased risk of natalizumab (NAT)-related progressive multifocal leukoencephalopathy (PML). Little is known about seroconversion rate and time to seroconversion in relapsing-remitting multiple sclerosis (RRMS) patients treated with NAT in Poland. The aim of the study was to assess the true risk of PML, seroconversion rate, and time to seroconversion in all JCVAb-negative RRMS patients treated with NAT in Poland. <b><i>Methods:</i></b> Demographic and clinical data of all Polish RRMS patients treated with NAT reimbursed by National Health Fund (NFZ) were prospectively collected in electronic files using the Therapeutic Programme Monitoring System provided by NFZ. The assessment of JCVAb presence (without collection of JCVAb index value) in serum (Unilabs, STRATIFY JCV: anti-JCV antibody ELISA) was done at the beginning of therapy and then repeated every 6 months. The maximum follow-up time was 4 years. In Poland, since 2013, according to the NFZ drug program guidance, only patients with negative JCVAb test have started treatment with NAT. <b><i>Results:</i></b> In all Polish multiple sclerosis centers, 210 negative JCVAb RRMS patients with at least 9 (±3) months of observation (146 females, 64 males, and the median age at baseline: 33 years) were included in the study. During the follow-up period, JCVAb status changed from negative to positive in 34 patients (16.2%). For half of the patients, the seroconversion was diagnosed 1 year after starting NAT treatment. In 4 patients (1.9%) during follow-up, JCVAb status changed again from positive to negative. In Poland, before establishment of NFZ drug program, 4 cases of PML in patients treated with NAT in clinical trials were diagnosed. In the NFZ drug program, since 2013, no patient treated with NAT has been diagnosed with PML. <b><i>Conclusions:</i></b> NAT therapy in JCV-seronegative RRMS patients is safe and results in the absence of PML cases. In Poland, JCV seroconversion rate is similar to that observed in other European countries.

A dose comparison study of IVIG in postpartum relapsing-remitting multiple sclerosis

2007 ◽  
Vol 13 (7) ◽  
pp. 900-908 ◽  
Author(s):  
Judith Haas ◽  
Otto Roelf Hommes
Keyword(s):  
Multiple Sclerosis ◽  
Ivig Treatment ◽  
Double Blind ◽  
Dose Comparison ◽  
Group I ◽  
Increased Risk ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Group Ii ◽  
Relapsing Remitting Multiple Sclerosis

Untreated patients with relapsing-remitting multiple sclerosis (RRMS) have an elevated risk of exacerbation in the first 3 months postpartum. Pregnant patients (n =173) with RRMS and with at least one relapse in the two years before pregnancy were enrolled in this multinational, multicentre, randomized double-blind clinical trial investigating different doses of intravenous immunoglobulin (IVIG) treatment in the 6 months postpartum. Group I (unloaded) received 150 mg/kg body weight (BW) IVIG on Day 1, then placebo infusions on Day 2 and Day 3. Group II (loaded) received 450, 300 and 150 mg/kg BW on Days 1, 2 and 3 respectively. Both groups then received 150 mg/kg BW five times in four-weekly intervals. The ratio of patients remaining relapse-free during the first 3 months postpartum did not differ significantly between both groups (81.5% in Group II versus 75.6% in Group I). The ratio of relapse-free patients was independent of dosage in the subgroup of patients breastfeeding for at least 3 months (89% in Group I versus 90% in Group II). The mean annualized relapse rate (ARR) after pregnancy did not show an increased risk for exacerbation, but returned to prepregnancy level within 3 months independent of dosage. The treatment was well tolerated. Multiple Sclerosis 2007; 13: 900-908. http://msj.sagepub.com

scholarly journals Neurofibromatosis Type 1 with Highly Active Relapsing-Remitting Multiple Sclerosis (RRMS)

2021 ◽  
Author(s):  
Silvia Ciotti ◽  
Antonella Cometa ◽  
Claudia De Carlo ◽  
Giancarlo Martini ◽  
Andrea Marona ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Neurofibromatosis Type 1 ◽  
Demyelinating Disease ◽  
Neurofibromatosis Type ◽  
Lower Limbs ◽  
Increased Risk ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disease which confers an increased risk of malignant tumour development. Relapsing remitting multiple sclerosis (RRMS) is an inflammatory demyelinating disease of the central nervous system. The coexistence of multiple sclerosis and NF1 is rare but has been reported. Here, we describe the case of a 31-year-old man with NF1 and subacute walking problems with proximal pain in the lower limbs who was successfully treated with natalizumab.

Circulating lymphocyte levels and relationship with infection status in patients with relapsing–remitting multiple sclerosis treated with daclizumab beta

2017 ◽  
Vol 24 (13) ◽  
pp. 1725-1736 ◽  
Author(s):  
Gavin Giovannoni ◽  
Heinz Wiendl ◽  
Benjamin Turner ◽  
Kimberly Umans ◽  
Oksana Mokliatchouk ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
T Cell ◽  
Lymphocyte Count ◽  
Interferon Beta ◽  
Infection Status ◽  
Cell Counts ◽  
Increased Risk ◽  
Relapsing Remitting ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

Background: Reversible lymphocyte count reductions have occurred following daclizumab beta treatment for relapsing–remitting multiple sclerosis. Objective: To analyse total and differential lymphocyte levels and relationship with infection status. Methods: In DECIDE, blood samples were collected at 12-week intervals from daclizumab beta- ( n = 919) or intramuscular interferon beta-1a–treated ( n = 922) patients. Infections/serious infections were assessed proximate to grade 2/3 lymphopenia or low CD4+/CD8+ T-cell counts. Total safety population (TSP) data were additionally analysed from the entire clinical development programme ( n = 2236). Results: Over 96 weeks in DECIDE, mean absolute lymphocyte count (ALC), CD4+ and CD8+ T-cell counts decreased <10% (7.1% vs 1.6%, 9.7% vs 2.0%, 9.3% vs 5.9%: daclizumab beta vs interferon beta-1a, respectively); shifts to ALC below lower limit of normal occurred in 13% versus 15%, respectively. Grade 3 lymphopenia was uncommon (TSP: <1%) and transient. Lymphocyte changes generally occurred within 24 weeks after treatment initiation and were reversible within 12 weeks of discontinuation. In DECIDE, mean CD4+/CD8+ T-cell counts were similar regardless of infection status. TSP data were consistent with DECIDE. Conclusion: When observed, ALC and CD4+/CD8+ T-cell count decreases in daclizumab beta–treated patients were generally mild-to-modest, reversible upon treatment discontinuation and not associated with increased risk of infections, including opportunistic infections.

Hepatitis C during disease modifying therapy with Fingolimod for Relapsing Remitting Multiple Sclerosis: diagnosis and treatment

2021 ◽  
Vol 14 (2) ◽  
pp. e238167
Author(s):  
Aram Aslanyan ◽  
Zoheb Anwar-Hashim ◽  
Rekha Siripurapu ◽  
Tatiana Mihalova
Keyword(s):  
Multiple Sclerosis ◽  
Hepatitis C ◽  
Viral Reactivation ◽  
Genotype 3 ◽  
Disease Modifying Therapy ◽  
Increased Risk ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

We present a case of 48-year-old woman with relapsing remitting multiple sclerosis (MS), who switched disease modifying therapy from Copaxone to Fingolimod due to her clinical and radiological MS disease progression. Unexpectedly after 2.5 years of stable MS symptoms and liver function tests (LFTs), we noted deranged LFTs during routine testing. Additional investigations showed hepatitis C positivity, genotype 3. It is likely a case of hepatitis C reactivation secondary to prolonged immunosuppressive effects of Fingolimod. Although the increased risk of viral reactivation related to varicella zoster virus is known to occur with Fingolimod treatment, to our knowledge, this is only the second case of hepatitis C disease activity reported with Fingolimod treatment. We would like to raise the awareness of hepatitis C viral reactivation as a possible complication of prolonged immunosuppression with Fingolimod.

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