scholarly journals Multiple sclerosis: dimethyl fumarate and fingolimod - from clinical trials to clinical practice

2017 ◽  
Vol 18 (6) ◽  
pp. 399-402
Author(s):  
Martin Vališ ◽  
Zbyšek Pavelek
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Dimethyl Fumarate

scholarly journals Effect of tobacco use on disease activity and DMT discontinuation in multiple sclerosis patients treated with dimethyl fumarate or fingolimod

2020 ◽  
Vol 6 (4) ◽  
pp. 205521732095981
Author(s):  
Carrie M Hersh ◽  
Haleigh Harris ◽  
Malissa Ayers ◽  
Devon Conway
Keyword(s):  
Multiple Sclerosis ◽  
Risk Factor ◽  
Clinical Practice ◽  
Disease Activity ◽  
Tobacco Use ◽  
Dimethyl Fumarate ◽  
Tobacco Exposure ◽  
Disease Modifying Therapy ◽  
Patient Reported ◽  
Multiple Sclerosis Patients

Background Tobacco exposure is a modifiable risk factor for multiple sclerosis (MS). Studies evaluating the relationship between tobacco, disease activity, and disease modifying therapy (DMT) persistence yielded conflicting results. We sought to address this issue with data from clinical practice. Objective To compare 24-month disease outcomes in tobacco versus non-tobacco users treated with dimethyl fumarate (DMF) or fingolimod (FTY) in clinical practice. Methods We retrospectively identified 659 MS patients treated with DMF or FTY, stratified by patient-reported tobacco use. DMT discontinuation and measures of disease activity at 24 months were assessed using propensity score (PS) weighting. Outcome estimates were calculated as tobacco vs non-tobacco use. Results 164 tobacco users (DMF n = 101; FTY n = 63) and 495 non-tobacco users (DMF n = 294; FTY n = 201) were identified. Tobacco (39.4%) and non-tobacco (34.4%) users were equally likely to discontinue DMT (OR = 1.17, 95% CI 0.79, 1.75), but tobacco users discontinued therapy earlier (HR = 1.53, 95% CI 1.06, 2.43). There were no differences in ARR (rate ratio = 1.39, 95% CI 0.97, 1.96). However, tobacco users had decreased odds of NEDA-2 (OR = 0.61, 95% CI 0.44, 0.83). Conclusion Our findings suggest that tobacco is a negative risk factor for inflammatory disease activity and earlier DMF and FTY discontinuation.

scholarly journals Efficacy and tolerability of oral versus injectable disease-modifying therapies for multiple sclerosis in clinical practice

2016 ◽  
Vol 2 ◽  
pp. 205521731667786 ◽  
Author(s):  
Erin E Longbrake ◽  
Anne H Cross ◽  
Amber Salter
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Practice ◽  
Proportional Hazards ◽  
Dimethyl Fumarate ◽  
Cox Proportional Hazards ◽  
Oral Disease ◽  
Sensitivity Analyses ◽  
Drug Discontinuation ◽  
Disease Modifying Therapies ◽  
Disease Modifying

Background The advent of oral disease-modifying therapies fundamentally changed the treatment of multiple sclerosis. Nevertheless, impressions of their relative efficacy and tolerability are primarily founded on expert opinion. Objective The purpose of this study was to determine whether oral disease-modifying therapies were better tolerated and/or more effective for controlling multiple sclerosis compared to injectable therapies in clinical practice. Methods Single-center, retrospective cohort study. 480 patients initiated oral (fingolimod, teriflunomide, or dimethyl fumarate) or injectable therapy between March 2013–March 2015 and follow-up data was collected for 5–31 months. Outcomes included on-drug multiple sclerosis activity and drug discontinuation. Cox proportional hazards models were used to control for baseline differences and sensitivity analyses using propensity-weighted matching were performed. Results A higher proportion of teriflunomide-treated patients experienced multiple sclerosis activity compared to those treated with injectable therapies ( p = 0.0053) in the adjusted model. Breakthrough multiple sclerosis was equally prevalent among fingolimod and dimethyl fumarate-treated compared to injectable therapy-treated patients. Of patients initiating a disease-modifying therapy, 32–46% discontinued or switched treatments during the study. After controlling for baseline differences, discontinuation rates were comparable across treatment groups. Conclusions In this cohort, oral and injectable disease-modifying therapies were equally well tolerated, but teriflunomide appeared less effective for controlling multiple sclerosis activity than injectable therapies. Further study is needed.

scholarly journals Current and Future Therapies for Multiple Sclerosis

Scientifica ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Alireza Minagar
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Glatiramer Acetate ◽  
Side Effect ◽  
Dimethyl Fumarate ◽  
Mechanisms Of Action ◽  
Natural Course ◽  
Safety And Efficacy ◽  
Comprehensive Review ◽  
Incurable Disease

With the introduction of interferon-β1b in 1993 as the first FDA-approved treatment for multiple sclerosis, the era of treatment of this incurable disease began, and its natural course was permanently changed. Currently, seven different treatments for patients with multiple sclerosis with different mechanisms of action and dissimilar side effect profiles exist. These medications include interferon-β1a intramuscular (Avonex), interferon-β1a subcutaneous (Rebif), interferon-β1b subcutaneous (Betaseron/Extavia), glatiramer acetate (Copaxone), natalizumab (Tysabri), fingolimod (Gilenya), teriflunomide (Aubagio), and mitoxantrone (Novantrone). In addition, a large number of clinical trials are being conducted to assess the safety and efficacy of various experimental agents in patients with multiple sclerosis, including alemtuzumab, dimethyl fumarate, laquinimod, rituximab, daclizumab, and cladribine. In this paper, the author presents a concise and comprehensive review of present and potential treatments for this incurable disease.

scholarly journals Moving toward earlier treatment of multiple sclerosis: Findings from a decade of clinical trials and implications for clinical practice

2014 ◽  
Vol 3 (2) ◽  
pp. 147-155 ◽  
Author(s):  
Mark S. Freedman ◽  
Giancarlo Comi ◽  
Nicola De Stefano ◽  
Frederik Barkhof ◽  
Chris H. Polman ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Clinical Practice

Combination therapies for multiple sclerosis: scientific rationale, clinical trials, and clinical practice

2007 ◽  
Vol 20 (3) ◽  
pp. 281-285 ◽  
Author(s):  
Fiona Costello ◽  
Olaf Stüve ◽  
Martin S Weber ◽  
Scott S Zamvil ◽  
Elliot Frohman
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Combination Therapies ◽  
Scientific Rationale

Controlling Hypertension and Stroke Prevention – From Guideline to Clinical Practice

2011 ◽  
Vol 3 (1) ◽  
pp. 30
Author(s):  
Anding Xu ◽  
Zefeng Tan ◽  
◽  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Stroke Prevention ◽  
Modifiable Risk Factors ◽  
Cerebrovascular Events

Hypertension is the most important of the prevalent and modifiable risk factors for stroke. Based on evidence, blood pressure (BP) lowering is recommended in guidelines for the prevention of stroke. However, there are still some uncertainties in the guidelines for controlling BP and preventing stroke in patients with previous cerebrovascular events, such as the goal BP, who to treat and which class of BP-lowering drugs to use. This article discusses these questions by reviewing guidelines and corresponding clinical trials, with the aim of reducing the gap between guidelines and clinical practice.

Sign in / Sign up

Export Citation Format

Share Document