Faculty Opinions recommendation of Efficacy of treatment of MS with IFNbeta-1b or glatiramer acetate by monthly brain MRI in the BECOME study.

ObjectiveTo investigate the association between disease-modifying therapies (DMTs) and the rate of progressive retinal ganglion cell (RGC) and nerve fiber loss in MS.MethodsOne hundred five relapsing-remitting patients with MS were followed annually for a median of 4.0 years using optical coherence tomography. Twenty-five healthy subjects were also included as normal controls. The rates of global peripapillary retinal nerve fiber layer (pRNFL), temporal RNFL (tRNFL), and ganglion cell inner plexiform layer (GCIPL) thinning were analyzed according to DMT type using a linear mixed-effects model. Optic radiation lesion volume was measured on brain MRI and included as a covariate to minimize the effects of retrograde transsynaptic degeneration.ResultsThe annual rates of RNFL and GCIPL thinning were higher in patients treated with “platform” therapies (interferon-β and glatiramer acetate) compared with DMTs of higher clinical efficacy (including fingolimod, dimethyl fumarate, natalizumab, alemtuzumab, rituximab, and ocrelizumab) (difference = −0.22 μm/y, p = 0.02 for pRNFL; difference = −0.34 μm/y, p = 0.009 for tRNFL; and difference = −0.16 μm/y, p = 0.005 for GCIPL). Based on an analysis of individual treatments (interferon-β, glatiramer acetate, fingolimod, and natalizumab), interferon-β was associated with inferior RGC preservation, relative to the other drugs. No effect difference was found between glatiramer acetate, fingolimod, and natalizumab.ConclusionsProgressive loss of RGCs in patients with MS is more pronounced in patients treated with interferon-β than other DMTs. This finding may have implications for DMT selection in MS.Classification of EvidenceThis study provides Class IV evidence that for patients with MS, treatment with interferon-β compared with other DMTs leads to a more pronounced rate of retinal ganglion cell loss.

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Long-term follow-up of patients treated with glatiramer acetate: a multicentre, multinational extension of the European/Canadian double-blind, placebo-controlled, MRI-monitored trial

Multiple Sclerosis Journal ◽

10.1177/1352458506070704 ◽

2007 ◽

Vol 13 (4) ◽

pp. 502-508 ◽

Cited By ~ 39

Author(s):

M. Rovaris ◽

G. Comi ◽

MA Rocca ◽

P. Valsasina ◽

D. Ladkani ◽

...

Keyword(s):

Multiple Sclerosis ◽

Glatiramer Acetate ◽

Brain Mri ◽

Treatment Phase ◽

Double Blind ◽

Brain Volumes ◽

Disease Evolution ◽

Long Term Follow Up

Glatiramer acetate (GA) is effective in reducing clinical and magnetic resonance imaging (MRI) activity in relapsing-remitting multiple sclerosis (RRMS). Serial long-term MRI data are lacking for large cohorts of GA-treated patients. The European/Canadian GA study consisted of two consecutive phases, each lasting nine months. The first treatment phase was randomized, double-blind and placebo-controlled. The second was an open-label, active treatment phase with daily administration of 20 mg GA subcutaneously for all patients. For the long-term follow-up (LTFU), dual echo, pre- and postgadolinium T1-weighted brain MRI scans were obtained with the same acquisition scheme as for the original trial and a neurological assessment was performed. Lesion volumes, normalized brain volumes and percentage brain volume changes (PBVC) were measured. One hundred and forty-two (63.4%) of the 224 patients who completed the two phases of the European/Canadian study underwent the LTFU after a mean period of 5.8 years (range: 5.3-6.4); 73 were treated with GA from study initiation. MRI measures at LTFU did not significantly differ between patients originally assigned to placebo and those who were always treated with GA, but the proportion of patients who did not require walking aids at LTFU was lower in the latter group (P=0.034). PBVC between baseline and LTFU was significantly correlated with lesion load at study entry. An earlier initiation of GA treatment in patients with active RRMS might, at least partially, have a favourable impact on long-term disease evolution. Multiple Sclerosis 2007; 13: 502-508. http://msj.sagepub.com

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Clinical consequences of MRI activity in treated multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458511405375 ◽

2011 ◽

Vol 17 (9) ◽

pp. 1113-1121 ◽

Cited By ~ 12

Author(s):

Diego Cadavid ◽

Soyeon Kim ◽

Bo Peng ◽

Joan Skurnick ◽

Maha Younes ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cognitive Function ◽

Glatiramer Acetate ◽

Interferon Beta ◽

Brain Mri ◽

Cognitive Testing ◽

Relapsing Remitting ◽

Treatment Naïve ◽

Clinical Consequences ◽

Disease Modifying Agents

Background: Inflammation on brain MRI is the most sensitive marker of disease activity in multiple sclerosis (MS) but its clinical consequences remain controversial. Objective: Here we investigated the clinical consequences of MRI activity in MS subjects treated with two different first line disease modifying agents. Methods: Seventy-five treatment-naïve subjects with relapsing–remitting MS ( N = 61) or clinically isolated syndromes at risk of MS ( N = 14) from the BECOME study that had been randomized to interferon beta-1b ( N = 39) or glatiramer acetate ( N = 36) and followed for up to two years by monthly brain MRI optimized to detect inflammatory activity were studied for the clinical consequences of lack of MRI remission. Results: MRI remission occurred in 46.4% of participants transiently and in 23.2% completely while it was never achieved in 30.4%. There was no difference by treatment in MRI remission, progression of physical disability, or cognitive function. The percentage of relapse-free subjects was 87.5% for the group in complete MRI remission, 47.6% in the group never in remission and 59.4% in the group in transient remission ( p = 0.017). Similar differences were observed for six-month-confirmed worsening of ambulatory function as measured by the timed 25 foot walk ( p = 0.026) and by Expanded Disability Status Scale (EDSS) ( p = 0.10). Cognitive function was lowest at baseline for the group that never reached MRI remission on treatment; this group improved the least upon repeated cognitive testing during the two years of treatment ( p < 0.001). Conclusions: Lack of MRI remission during treatment with interferon beta-1b or glatiramer acetate is associated with higher relapse rate and worsening of physical and cognitive function.

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Serum levels of CXCL13 are elevated in active multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458509107017 ◽

2009 ◽

Vol 15 (11) ◽

pp. 1271-1279 ◽

Cited By ~ 43

Author(s):

Eugene D Festa ◽

Karolina Hankiewicz ◽

Soyeon Kim ◽

Joan Skurnick ◽

Leo J Wolansky ◽

...

Keyword(s):

Multiple Sclerosis ◽

B Cell ◽

Glatiramer Acetate ◽

Interferon Beta ◽

Brain Mri ◽

Serum Levels ◽

Enzyme Linked Immunosorbent Assay ◽

Mri Scans ◽

Pre Treatment ◽

Active Multiple Sclerosis

There is increasing recognition of the important role that B cells play in the pathogenesis of multiple sclerosis (MS). Recently it was reported that the B cell chemokine CXCL13 is elevated in MS serum and cerebrospinal fluid. Here we study whether serum levels of CXCL13 are associated with active MS. We measured serum levels of CXCL13 by enzyme-linked immunosorbent assay in 74 patients with relapsing MS randomized to interferon beta 1b or glatiramer acetate and examined with monthly 3 T brain MRI scans optimized for detection of gadolinium-enhancement for up to 2 years. The median (range) serum levels of CXCL13 pre-treatment were 40 (3—171) pg/ml. Serum levels of CXCL13 were significantly higher at times of active brain MRI scans (p < 0.01). Furthermore, serum levels were higher in patients who never reached MRI remission compared with those in complete (p < 0.01) or partial (p = 0.01) remission. There was a significant positive correlation between the pattern of serum levels of CXCL13 and MRI activity during the first (r = 0.33, p < 0.05) and the full 2 years (r = 0.35, p < 0.01) of the study. Treatment with interferon beta 1b or glatiramer acetate did not affect serum CXCL13. We conclude that the serum levels of the B cell chemokine CXCL13 are associated with active MS.

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Analysis of Deliberate Self-Wrist-Cutting Episodes Presenting to the Emergency Department

Crisis ◽

10.1027/0227-5910/a000361 ◽

2016 ◽

Vol 37 (2) ◽

pp. 155-160 ◽

Cited By ~ 2

Author(s):

Jin Kim ◽

Han Joon Kim ◽

Soo Hyun Kim ◽

Sang Hoon Oh ◽

Kyu Nam Park

Keyword(s):

Emergency Department ◽

Medical Records ◽

Attempted Suicide ◽

Suicide Attempts ◽

Psychiatric Interview ◽

Clinical Variables ◽

Completed Suicide ◽

Number Of Patients ◽

Group A ◽

Efficacy Of Treatment

Abstract. Background: Previous suicide attempts increase the risk of a completed suicide. However, a large proportion of patients with deliberate self-wrist cutting (DSWC) are often discharged without undergoing a psychiatric interview. Aims: The aims of this study were to investigate the differences in the characteristics and outcomes of patients with DSWC and those with deliberate self-poisoning (DSP) episodes. The results of this study may be used to improve the efficacy of treatment for DSWC patients. Method: We retrospectively reviewed the medical records of 598 patients with DSWC and DSP who were treated at the emergency department of Seoul Saint Mary's Hospital between 2008 and 2013. We assessed sociodemographic information, clinical variables, the reasons for the suicide attempts, and the severity of the suicide attempts. Results: A total of 141 (23.6%) patients were included in the DSWC group, and 457 (76.4%) were included in the DSP group. A significantly greater number of patients in the DSWC group had previously attempted suicide (p = .014). A total of 63 patients (44.7%) in the DSWC group and 409 patients (89.5%) in the DSP group underwent psychiatric interviews. Conclusion: More DSWC patients had previously attempted suicide, but fewer of them underwent psychiatric interviews compared with the DSP patients.

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