Persistency of neutralizing antibodies depends on titer and interferon-beta preparation

2011 ◽  
Vol 18 (5) ◽  
pp. 610-615 ◽  
Author(s):  
Harald Hegen ◽  
Manuel Schleiser ◽  
Claudia Gneiss ◽  
Franziska Di Pauli ◽  
Rainer Ehling ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
Longitudinal Study ◽  
Neutralizing Antibodies ◽  
Interferon Beta ◽  
Treatment Decision ◽  
Individual Treatment ◽  
Treatment Decision Making ◽  
Mean Time

Background: Neutralizing antibodies (NAbs) affect the efficacy of interferon-beta (IFNβ) treatment in multiple sclerosis (MS) patients, particularly if NAbs persist. Persistency depends on NAb titers, which differ between IFNβ preparations. Objective: This study evaluated IFNβ preparation-specific NAb cut-off titers during early treatment for prediction of NAb persistency. Methods: Patients who had at least one NAb test between 12 and 30 months (baseline) as well as after more than 48 months (follow-up) on IFNβ treatment were included in this longitudinal study. Results: At baseline 1064 patients had a NAb test. Of those, 203 had a follow-up test. In the follow-up group 23.2% of patients were NAb positive during baseline. NAb frequency significantly decreased by 40.7% in the IFNβ-1a and by 60% in the IFNβ-1b group at follow-up after a mean time of 75.4 months on treatment, and median NAb titers decreased significantly in both groups. During baseline, NAb titers of >258 neutralizing units (NU) had a sensitivity of 81.3% and a specificity of 90.9% in the IFNβ-1a group, whereas titers of >460 NU had a sensitivity of 100% and a specificity of 91.7% in the IFNβ-1b group to predict persistency at follow-up. When these cut-off titers are applied, 10.2% of all treated patients developed persistent NAbs. Conclusion: IFNβ preparation-specific NAb cut-off titers for prediction of NAb persistency, which may be useful in individual treatment decision making, are provided.

Persistence of neutralizing antibodies after discontinuation of IFNβ therapy in patients with relapsing-remitting multiple sclerosis

2006 ◽  
Vol 12 (3) ◽  
pp. 247-252 ◽  
Author(s):  
Bodil Petersen ◽  
Klaus Bendtzen ◽  
Nils Koch-Henriksen ◽  
Mads Ravnborg ◽  
Christian Ross ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Neutralizing Antibodies ◽  
Interferon Beta ◽  
Cytopathic Effect ◽  
Serum Levels ◽  
Neutralizing Capacity ◽  
Relapsing Remitting ◽  
Long Time ◽  
Relapsing Remitting Multiple Sclerosis

Objective The main objective was to follow serum levels of neutralizing antibodies (NABs) against interferon-beta (IFNβ) after discontinuation of IFNβ therapy. Background A large proportion of patients treated with recombinant IFNβ for multiple sclerosis (MS) develop therapy-induced NABs. Knowledge of persistence of NABs after discontinuation of therapy is limited. Design/patients: A retrospective follow-up study of patients treated in Denmark for relapsing-remitting (RR) MS with IFNβ for at least 12 months. NAB-positive patients, who discontinued therapy, were followed up with measurements of NABs. Methods We measured NAB-neutralizing capacity and NAB titres a.m. Kawade using a clinically validated cytopathic effect assay. Results Thirty-seven patients were included. Mean follow-up time was 22 months. Of the 29 patients with a NAB titre at or above 25 prior to termination of therapy, only three patients reverted to a titre below 25. Of these, two had a titre below 200 and one patient a titre of 600 at the last examination before treatment stop. The longest post-treatment follow-up during which a patient maintained NAB positivity was 59 months. Conclusion NABs against IFNβ, especially with high titres, tend to persist for a long time after discontinuation of IFNβ therapy. NABs should always be measured before reinstitution of IFNβ treatment in NAB-positive patients.

Patient involvement in multidisciplinary treatment planning (MTP).

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 145-145
Author(s):  
Irene Prabhu Das ◽  
Heather Rozjabek ◽  
Mary L. Fennell ◽  
Katherine Mallin ◽  
E. Greer Gay ◽  
...  
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Patient Involvement ◽  
Treatment Plan ◽  
Multidisciplinary Treatment ◽  
Treatment Decision ◽  
Case Presentation ◽  
Patient Navigators ◽  
Treatment Decision Making

145 Background: Patient involvement in treatment decision-making has been well-studied. However, little is known about how patients are involved in the MTP process prior to their consideration of treatment options. Methods: An online survey was administered to 1,261 Commission on Cancer (CoC)-accredited programs to describe current MTP practice. Survey items addressed team structure and process, case presentation, and patient involvement. A total of 797 (63%) facilities responded. Multiple aspects of patient involvement focusing on the initial case presentation and post-meeting follow-up regarding information provision and communication are examined. Initial descriptive analyses are presented. Results: 97% of facilities reported patients are not invited to attend MTP meetings. Reasons for not inviting patients included: patients may find it overwhelming (62%), physicians not able to speak freely (58%), liability (43%) and privacy (42%) concerns. Of the facilities that do invite patients, 1/3 reported that patients often or always attend. Treatment recommendations from MTP meetings are shared with patients at 75% of facilities, 42% share treatment plans, and 28% give a meeting summary to patients. Nine percent of facilities do not give patients any information from the meeting. Prior to treatment, a written treatment plan is developed at 43% of facilities, and among these, 15% give the plan to patients. Regarding communication about MTP meetings, facilities reported pre-meeting discussions with attending physicians (95%) and patient navigators (21%). Post-meeting follow-up by 93% of facilities is usually done by physicians, 26% by patient navigators and 16% by PA/NPs, and 66% follow-up within 1 week. Conclusions: Initial findings suggest that even if facilities do not invite patients to MTP meetings, they engage patients in various ways at pre- and post-MTP meetings, providing information and having discussions. Physicians are integral in communicating with patients throughout the MTP process. Further study on the multiple facets of patient involvement in MTP is needed to better understand its influence on treatment decision-making.

Impact of a novel decision counseling program on treatment knowledge, decisional conflict, and choice in men with early-stage, low-risk prostate cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 9-9
Author(s):  
Jean H. Hoffman-Censits ◽  
Anett Petrich ◽  
Anna Quinn ◽  
Amy Leader ◽  
Leonard G. Gomella ◽  
...  
Keyword(s):  
Decision Making ◽  
Early Stage ◽  
Treatment Decision ◽  
Decisional Conflict ◽  
Counseling Program ◽  
Treatment Decision Making ◽  
Treatment Knowledge ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

9 Background: Active surveillance (AS - serial follow-up PSA, exam, and biopsy) is an option for men with early stage, low risk prostate cancer (LRPca). While data show comparable survival for AS vs active treatment (AT - surgery or radiation), currently most men with LRPca undergo AT. A pilot Decision Counseling Program (DCP) to assist men in making an informed, shared LRPca treatment decision was implemented. Methods: Men with LRPca seen at the Jefferson Genitourinary Multidisciplinary Cancer Center (JGUMDCC) were consented. A nurse educator (NE) reviewed risks/benefits of AS and AT; had the participant identify factors influencing treatment decision making and specify decision factor weights; entered data into an online DCP; and generated a report of participant treatment preference and decision factors. The report was used by the participant and clinicians in shared treatment decision making. A follow-up survey was administered 30 days after the visit, with treatment status assessed. Change in treatment-related knowledge and decisional conflict were measured using baseline and 30-day survey data. Results: Baseline decision counseling preference of 16 participants: 4 - AS, 8 equal for AS and AT, 4 - AT. At 30 days, 12 participants initiated AS, 4 chose AT; participant mean treatment knowledge scores (8-point scale) increased (+1.13 points); decisional conflict subscale scores (strongly disagree = 1, strongly agree = 5) decreased (uncertain: -1.15, uninformed: -1.36, unclear: -1.12; and unsupported: -1.15). Conclusions: Decision counseling and shared decision making helped participants become better informed about treatment choices and reduced uncertainty in treatment decision making. The combined intervention resulted in most participants choosing AS. Ongoing study recruitment, data collection, and analyses are planned.

Physician and patient treatment decision-making in relapsing-remitting multiple sclerosis in Europe and the USA

2019 ◽  
Author(s):  
Brown Hannah
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
Treatment Decision ◽  
Patient Treatment ◽  
Lead Author ◽  
Treatment Decision Making ◽  
Relapsing Remitting ◽  
The Usa ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

In this Publication Perspective, lead author Hannah Brown, Senior Research Executive at Ipsos Healthcare, London, UK, provides a summary of the recently published article 'Physician and patient treatment decision-making in relapsing-remitting multiple sclerosis in Europe and the USA', from Neurodegenerative Disease Management, that assessed factors used in treatment decision-making for relapsing-remitting multiple sclerosis in both the 5EU (UK/Germany/France/Italy/Spain) and the US.

Treatment decision making and adjustment to breast cancer: A longitudinal study.

1998 ◽  
Vol 66 (2) ◽  
pp. 313-322 ◽  
Author(s):  
Annette L. Stanton ◽  
Melissa A. Estes ◽  
Norman C. Estes ◽  
Christine L. Cameron ◽  
Sharon Danoff-Burg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Longitudinal Study ◽  
Treatment Decision ◽  
Treatment Decision Making

Patient education program to enhance decision autonomy in multiple sclerosis relapse management: a randomized-controlled trial

2009 ◽  
Vol 15 (1) ◽  
pp. 96-104 ◽  
Author(s):  
S Köpke ◽  
J Kasper ◽  
I Mühlhauser ◽  
M Nübling ◽  
C Heesen
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Decision Making ◽  
Patient Education ◽  
Education Program ◽  
Treatment Decision ◽  
Treatment Decision Making ◽  
Patient Education Program ◽  
Disability Status

Background Contrary to strong recommendations for high-dose intravenous corticosteroid treatment for relapses in multiple sclerosis (MS), uncertainty remains about most aspects of relapse management. Oral corticosteroids administered by physicians or patients themselves or no corticosteroids also appear justifiable. Objective To evaluate an education program that aims to involve patients with MS in decisions on relapse management. Methods In three German MS centers, 150 patients with relapsing MS were randomly assigned to a single, 4-h group session or a standard information leaflet. The primary outcome measure was the proportion of relapses with oral or no corticosteroid therapy as an indicator of patient autonomy in treatment decision making. Other outcomes included perceived decision autonomy, quality of life, and disability status. Results In the intervention group (IG), 108/139 (78%) relapses were treated with oral or no corticosteroids compared with 101/179 (56%) in the control group; P < 0.0001. Patients’ perceived autonomy of treatment decision making was significantly higher in the IG; P < 0.0001. Quality of life, disability status, and adverse events of corticosteroid therapies were comparable. Conclusion The patient education program led to more autonomous decision making in patients with relapsing MS. Relevant changes in relapse management were observed.

scholarly journals Shared Decision Making and Autonomy Among US Participants with Multiple Sclerosis in the NARCOMS Registry

2017 ◽  
Vol 19 (6) ◽  
pp. 303-312 ◽  
Author(s):  
Stacey S. Cofield ◽  
Nina Thomas ◽  
Tuula Tyry ◽  
Robert J. Fox ◽  
Amber Salter
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
Shared Decision Making ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Shared Decision ◽  
Research Committee ◽  
Patient Centered ◽  
Related Factors ◽  
Treatment Decision Making

Background: Treatment decisions in multiple sclerosis (MS) are affected by many factors and are made by the patient, doctor, or both. With new disease-modifying therapies (DMTs) emerging, the complexity surrounding treatment decisions is increasing, further emphasizing the importance of understanding decision-making preferences. Methods: North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants completed the Fall 2014 Update survey, which included the Control Preferences Scale (CPS). The CPS consists of five images showing different patient/doctor roles in treatment decision making. The images were collapsed to three categories: patient-centered, shared, and physician-centered decision-making preferences. Associations between decision-making preferences and demographic and clinical factors were evaluated using multivariable logistic regression. Results: Of 7009 participants, 79.3% were women and 93.5% were white (mean [SD] age, 57.6 [10.3] years); 56.7% reported a history of relapses. Patient-centered decision making was most commonly preferred by participants (47.9%), followed by shared decision making (SDM; 42.8%). SDM preference was higher for women and those taking DMTs and increased with age and disease duration (all P &lt; .05). Patient-centered decisions were most common for respondents not taking a DMT at the time of the survey and were preferred by those who had no DMT history compared with those who had previously taken a DMT (P &lt; .0001). There was no difference in SDM preference by current MS disease course after adjusting for other disease-related factors. Conclusions: Responders reported most commonly considering their doctor's opinion before making a treatment decision and making decisions jointly with their doctor. DMT use, gender, and age were associated with decision-making preference.

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