scholarly journals New possibilities of siponimod therapy in patients with secondary progressive multiple sclerosis

2021 ◽  
Vol 13 (1) ◽  
pp. 138-144
Author(s):  
D. S. Kasatkin ◽  
N. V. Khachanova ◽  
V. M. Alifirova ◽  
A. N. Boyko ◽  
K. Z. Bakhtiyarova ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Practice ◽  
Early Detection ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Point Of View ◽  
Diagnostic Tools ◽  
Urgent Problem ◽  
Clinical Progression ◽  
Secondary Progressive

The process of neurodegeneration in multiple sclerosis (MS) remains an urgent problem of modern neurology; from the point of view of its therapy, it is especially important to identify this condition during the transition to secondary progression. This paper reflects the opinion of the Council of Leading MS Experts on the early detection of secondary progressive MS and its diagnostic tools, including the use of new online questionnaires. Special attention is paid to the concept of clinical progression verification using the indicator of the confirmed progression of disability and to the prospect for introducing siponimod (Kiendra® ) into clinical practice for the treatment of patients with secondary progressive MS.

Diagnostic uncertainty during the transition to secondary progressive multiple sclerosis

2014 ◽  
Vol 20 (12) ◽  
pp. 1654-1657 ◽  
Author(s):  
Ilana Katz Sand ◽  
Stephen Krieger ◽  
Colleen Farrell ◽  
Aaron E Miller
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Practice ◽  
Transition Period ◽  
Clinical Phenotype ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Diagnostic Uncertainty ◽  
Secondary Progressive ◽  
Relapsing Remitting

Secondary progressive multiple sclerosis (MS) is typically defined as deterioration independent of relapses for ≥ 6 months following an initial relapsing–remitting course; however, this definition is not always easily applied in clinical practice and the declaration of the change in clinical phenotype is often delayed. To identify the length of time required to re-classify relapsing–remitting MS (RRMS) patients whom have clinically transitioned to secondary progressive MS (SPMS) in clinical practice. We reviewed 123 patients with long-term follow-up and identified a sub-group whom transitioned from RRMS to SPMS, then characterized this transition period. There were 14/20 patients who transitioned during the follow-up period that had visits with uncertainty related to the clinical phenotype characterized by possible, but not definitive progression. The mean duration of this period of uncertainty was 2.9 ± 0.8 years. A period of diagnostic uncertainty regarding the transition from RRMS to SPMS existed in many of our patients. Potential reasons included the subtle nature of early progressive disease and caution in applying a progressive label, in light of the lack of evidence-based treatments as well as third-party payer concerns. Delay in definitive identification of an SPMS phenotype has a variety of implications related to patient care and research.

scholarly journals Conversion of diffusely abnormal white matter to focal lesions is linked to progression in secondary progressive multiple sclerosis

2020 ◽  
pp. 135245852091217
Author(s):  
Mahsa Dadar ◽  
Sridar Narayanan ◽  
Douglas L Arnold ◽  
D Louis Collins ◽  
Josefina Maranzano
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
White Matter Lesions ◽  
Progressive Multiple Sclerosis ◽  
Magnetic Resonance Images ◽  
Secondary Progressive Multiple Sclerosis ◽  
Clinical Progression ◽  
Focal Lesions ◽  
Secondary Progressive ◽  
Over Time

Background: Diffusely abnormal white matter (DAWM) regions are observed in magnetic resonance images of secondary progressive multiple sclerosis (SPMS) patients. However, their role in clinical progression is still not established. Objectives: To characterize the longitudinal volumetric and intensity evolution of DAWM and focal white matter lesions (FWML) and assess their associations with clinical outcomes and progression in SPMS. Methods: Data include 589 SPMS participants followed up for 3 years (3951 time points). FWML and DAWM were automatically segmented. Screening DAWM volumes that transformed into FWML at the last visit (DAWM-to-FWML) and normalized T1-weighted intensities (indicating severity of damage) in those voxels were calculated. Results: FWML volume increased and DAWM volume decreased with an increase in disease duration ( p < 0.001). The Expanded Disability Status Scale (EDSS) was positively associated with FWML volumes ( p = 0.002), but not with DAWM. DAWM-to-FWML volume was higher in patients who progressed (2.75 cm3 vs. 1.70 cm3; p < 0.0001). Normalized T1-weighted intensity of DAWM-to-FWML was negatively associated with progression ( p < 0.00001). Conclusion: DAWM transformed into FWML over time, and this transformation was associated with clinical progression. DAWM-to-FWML voxels had greater normalized T1-weighted intensity decrease over time, in keeping with relatively greater tissue damage. Evaluation of DAWM in progressive multiple sclerosis provides a useful measure for therapies aiming to protect this at-risk tissue with the potential to slow progression.

scholarly journals Living with secondary progressive multiple sclerosis in Europe: perspectives of multiple stakeholders

2021 ◽  
Vol 11 (1) ◽  
pp. 9-19
Author(s):  
Øivind Torkildsen ◽  
Ralf A Linker ◽  
Jose MM Sesmero ◽  
Simone Fantaccini ◽  
Rainel Sanchez-de la Rosa ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Diagnostic Tools ◽  
Patient Journey ◽  
Secondary Progressive ◽  
Relapsing Remitting ◽  
Assessment Guidelines ◽  
Research Findings ◽  
Relapsing Remitting Multiple Sclerosis

The transition from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis (SPMS) remains a clinical challenge owing to the heterogeneous course of the disease, indistinct disease progression and lack of availability of validated biomarkers and diagnostic tools. This article summarizes the outcomes from an international expert group meeting conducted to validate the preliminary research findings gathered through interviews with primary healthcare stakeholders and pharmaceutical representatives, and to understand the current and future patient journey of SPMS across seven European countries. We highlight the uncertainty in SPMS diagnosis and management and, consequently, the need for uniform assessment guidelines, enhanced awareness and a collaborative effort between the stakeholders associated with SPMS patient care and the pharmaceutical industry.

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