Brain health: time matters in multiple sclerosis

Giovannoni, Gavin; Butzkueven, Helmut; Dhib‐Jalbut, Suhayl; Hobart, Jeremy; Kobelt, Gisela; Pepper, George; Sormani, Maria Pia; Thalheim, Christoph; Traboulsee, Anthony; Vollmer, Timothy

doi:10.1016/j.msard.2016.07.003

Cited by 335 publications

(318 citation statements)

References 271 publications

(385 reference statements)

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“…5,10 Our results point towards the importance of starting effective DMT treatment early with stepwise escalation as needed, both from a clinical and a health economic perspective. 13 Although no causality can be shown in this study, ReMuS has shown that production losses are low in patients with early active MS and effective DMT therapy. 4 The challenge remains, however, to show how production losses and informal care -that is, costs outside the healthcare system -are better controlled by delaying disability progression.…”

Section: Discussionmentioning

confidence: 57%

New insights into the burden and costs of multiple sclerosis in Europe: Results of the Czech Republic

Havrdová

Kobelt²,

Berg³

et al. 2017

Mult Scler

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Introduction:In order to estimate the value of interventions in multiple sclerosis (MS) -where lifetime costs and outcomes cannot be observed -outcome data have to be combined with costs. This requires that cost data be regularly updated. Objectives and methods:This study is part of a cross-sectional retrospective study in 16 countries collecting data on resource consumption and work capacity, health-related quality of life (HRQoL) and prevalent symptoms for patients with MS. Descriptive analyses are presented by level of severity, in the societal perspective, in CZK 2015. Results: A total of 747 patients (mean age 47 years) participated; 86% were below retirement age and of these, 49% were employed. Employment was related to disease severity, and MS affected productivity at work for 82% of those working. Overall, 92% and 66% of patients experienced fatigue and cognitive difficulties as a problem. Mean utility and annual costs were 0.832 and 257,000CZK at Expanded Disability Status Scale (EDSS) 0-3, 0.530 and 425,500CZK at EDSS 4-6.5 and 0.141 and 489,000CZK at EDSS 7-9. The average cost of a relapse was estimated at 12,600CZK.

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Section: Discussionmentioning

confidence: 57%

New insights into the burden and costs of multiple sclerosis in Europe: Results of the Czech Republic

Havrdová

Kobelt²,

Berg³

et al. 2017

Mult Scler

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“…This suggests that once neurodegeneration is triggered within a neural circuit, probably through innate immune activation, it may no longer respond to the therapies that halt the relapses that trigger the damage (Compston and Coles, 2002, Giovannoni et al, 2017, Hampton et al, 2013). This neurodegenerative process is detectable from the initial attacks (De Stefano et al, 2010, Giovannoni et al, 2017), but clinical progressive deterioration may only become noticed once the compensating neural reserve within affected pathways become exhausted (Giovannoni et al, 2016a, Giovannoni et al, 2017). This can occur early as in primary progressive MS or following a number of attacks in secondary progressive MS (progressive worsening following a period of relapsing attacks) (Compston and Coles, 2002, Giovannoni et al, 2016a, Lublin et al, 2014).…”

Section: Inflammatory and Neurodegenerative Disease In Msmentioning

confidence: 99%

“…This neurodegenerative process is detectable from the initial attacks (De Stefano et al, 2010, Giovannoni et al, 2017), but clinical progressive deterioration may only become noticed once the compensating neural reserve within affected pathways become exhausted (Giovannoni et al, 2016a, Giovannoni et al, 2017). This can occur early as in primary progressive MS or following a number of attacks in secondary progressive MS (progressive worsening following a period of relapsing attacks) (Compston and Coles, 2002, Giovannoni et al, 2016a, Lublin et al, 2014). Importantly, this argues for early and effectively treatment to maintain brain health (Giovannoni et al, 2016a).…”

Section: Inflammatory and Neurodegenerative Disease In Msmentioning

confidence: 99%

Memory B Cells are Major Targets for Effective Immunotherapy in Relapsing Multiple Sclerosis

et al. 2017

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Although multiple sclerosis (MS) is considered to be a CD4, Th17-mediated autoimmune disease, supportive evidence is perhaps circumstantial, often based on animal studies, and is questioned by the perceived failure of CD4-depleting antibodies to control relapsing MS. Therefore, it was interestingly to find that current MS-treatments, believed to act via T cell inhibition, including: beta-interferons, glatiramer acetate, cytostatic agents, dimethyl fumarate, fingolimod, cladribine, daclizumab, rituximab/ocrelizumab physically, or functionally in the case of natalizumab, also depleted CD19 +, CD27 + memory B cells. This depletion was substantial and long-term following CD52 and CD20-depletion, and both also induced long-term inhibition of MS with few treatment cycles, indicating induction-therapy activity. Importantly, memory B cells were augmented by B cell activating factor (atacicept) and tumor necrosis factor (infliximab) blockade that are known to worsen MS. This creates a unifying concept centered on memory B cells that is consistent with therapeutic, histopathological and etiological aspects of MS.

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“…The development of new criteria leading to earlier diagnosis 8,9 and initiatives arguing for early diagnosis and early effective intervention to preserve brain loss reinforces this approach. 10 This raises, however, the question of the value to society of this early investment of public funds in view of the high cost of treatment, and this question can only be answered in the long term. In diseases such as MS, prevalence costs (i.e.…”

Section: Introductionmentioning

confidence: 99%

The burden of multiple sclerosis 2015: Methods of data collection, assessment and analysis of costs, quality of life and symptoms

Kobelt¹,

Eriksson²,

Phillips

et al. 2017

Mult Scler

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Introduction: This article describes the methods used to perform this large European-wide burden-ofillness study on multiple sclerosis (MS) using individual patient data. Methods:The study collected all MS-related resource consumption, workforce participation, prevalent disease symptoms and health-related quality of life (HRQoL). Patients were recruited by national patient associations and, after informed consent, completed a specific questionnaire either on-line or on paper. Analyses were performed by country as well as for the study overall. Costs were estimated from the societal perspective, using publicly available unit costs and reported in national currencies and in EUR 2015 adjusted for purchasing power parity. The results are reported by disease severity groups according to self-assessed Expanded Disability Status Scale (EDSS) (mild, moderate, severe) and by EDSS point to highlight the development of costs as disability progresses. Results: A total of 16,808 patients in 16 countries participated in the study: Austria, Belgium, Denmark, Czech Republic, France, Germany, Hungary, Italy, the Netherlands, Poland, Portugal, Russia, Spain, Sweden, Switzerland and the United Kingdom. Conclusion: This study, endorsed by the European Platform of MS Societies, provides up-to-date information on costs and expands the previously available information on HRQoL and symptoms.

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Brain health: time matters in multiple sclerosis

Abstract: The consensus findings of an international author group recommend a therapeutic strategy based on proactive monitoring and shared decision-making in MS. Early diagnosis and improved treatment access are also key components.

Cited by 335 publications

References 271 publications

New insights into the burden and costs of multiple sclerosis in Europe: Results of the Czech Republic

New insights into the burden and costs of multiple sclerosis in Europe: Results of the Czech Republic

Memory B Cells are Major Targets for Effective Immunotherapy in Relapsing Multiple Sclerosis

The burden of multiple sclerosis 2015: Methods of data collection, assessment and analysis of costs, quality of life and symptoms

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