Using personalized prognosis in the treatment of relapsing multiple sclerosis: A practical guide

Wijmeersch, Bart Van; Hartung, Hans‐Peter; Vermersch, Patrick; Pugliatti, Maura; Pozzilli, Carlo; Grigoriadis, Nikolaos; Alkhawajah, Mona; Airas, Laura; Linker, Ralf A.; Oreja‐Guevara, Celia

doi:10.3389/fimmu.2022.991291

Cited by 18 publications

(5 citation statements)

References 99 publications

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“…Although some publications regarding the impact of gender on the prognosis of MS suggest that the male gender is among the poor prognostic factors, other publications state that the impact of gender on prognosis is not significant 28,29 . In a study that included 1,074 men and 2,025 women, it was observed that there was no difference between the genders when looking at the progressive MS phenotype 30 .…”

Section: Discussionmentioning

confidence: 99%

Multipl sklerozda uzun dönem yeti yitimi: 20 yıllık uzunlamasına bir çalışma

BÜNÜL

2023

Cukurova Medical Journal

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Purpose: This study investigated the long-term clinical and demographic characteristics of multiple sclerosis (MS) patients to predict disease prognosis. Materials and Methods: Two hundred and seventy-five MS patients diagnosed using the Poser or McDonald criteria were retrospectively analyzed. They were categorized based on their Expanded Disability Status Scale (EDSS) scores: below 4 (group 1) and 4 or above (group 2). Results: The average patient age was 55.45 ± 9.63 years, with a disease duration of 26.76 ± 6.08 years. The initial EDSS scores increased from 2.56 ± 2.36 to 4.23 ± 1.8 after 20 years. Of the patients, 69.1% had EDSS scores of 4 or higher after 20 years. Notably, patients with supratentorial and spinal cord involvement at onset had higher EDSS scores. Logistic regression analysis revealed that a higher initial EDSS score, no full recovery after the first attack, and a longer duration between attacks were associated with a higher risk of an EDSS score of 4 or above. Conclusion: Thisr study shows that an increase in the initial EDSS score is predictive of long-term disability in patients with MS. Having information on long-term, real-life data in MS is highly valuable in terms of understanding the course of the disease, its monitoring, and treatment selection.

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Section: Discussionmentioning

confidence: 99%

Multipl sklerozda uzun dönem yeti yitimi: 20 yıllık uzunlamasına bir çalışma

BÜNÜL

2023

Cukurova Medical Journal

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“…[28][29][30][31][32] In the scientific literature, a number of recent peer-reviewed publications, including studies, reviews, and opinion pieces, recommend the use of the early high-efficacy treatment strategy, especially in patients with high disease activity. [33][34][35][36][37][38] In clinical practice, an increasing number of neurologists prefer the treatment strategy of initiating high-efficacy therapies early for the appropriate patients (instead of following the traditional escalation treatment strategy), according to the clinical experts consulted.…”

Section: Additional Considerationsmentioning

confidence: 99%

Alemtuzumab, Cladribine, Fingolimod, Natalizumab, and Rituximab as First-Line Treatments in Adults With Highly Active Relapsing-Remitting Multiple Sclerosis

CADTH

2024

cjht

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What Is the Problem? Relapsing-remitting multiple sclerosis (RRMS), the most common disease course of multiple sclerosis (MS), is a chronic immune-mediated disease with clearly defined episodes of new or increasing neurologic symptoms followed by periods of relative stability. In contrast, the highly active, aggressive disease course leads to rapid disability, and these patients face an unmet need. The principal goal of MS treatment is to delay and prevent the accumulation of disability by reducing the frequency of relapses. Currently reimbursed first-line drugs fail to prevent the consequences of irreversible damage to the nervous system. There has been a paradigm shift in clinical practice toward the use of a high-efficacy treatment strategy as early as possible during the inflammatory process to provide optimal clinical benefits in preserving neurologic function in patients with highly active RRMS. What Did We Do? A systematic review of the clinical effectiveness and safety of alemtuzumab, natalizumab, cladribine, fingolimod, and rituximab relative to current first-line drugs in adults with highly active RRMS was conducted; it identified post hoc subgroup analyses from 5 randomized controlled trials (RCTs) and 1 prospective comparative cohort study. What Did We Find? Evidence was uncertain and conclusions were limited by risk of bias and small sample sizes; conclusions for some outcome comparisons were also limited by imprecision and incomplete reporting. Compared to placebo, cladribine and natalizumab may result in a clinically important reduction in relapses, disability, and key MRI lesions. Alemtuzumab may result in a clinically important reduction in relapses compared to interferon, while fingolimod may result in a clinically important reduction in relapses compared to placebo. The clinical evidence was insufficient to determine the effect of fingolimod on relapses when compared with interferon. Harms outcomes, when reported, appeared consistent with the known harms profile of the drugs. Assessment of the effectiveness and safety of rituximab could not be performed due to the lack of evidence. Evidence was also lacking for many important outcomes such as health-related quality of life (HRQoL), instrumental activities of daily living, symptoms, and cognitive outcomes. No evidence could be identified to inform on treatment sequencing. Two pragmatic RCTs (the TREAT-MS and DELIVER-MS trials) are currently ongoing, aiming to compare an early, high-efficacy treatment strategy versus a traditional escalation treatment strategy, which may inform treatment sequencing. Further research is needed to compensate for clinical data gaps to inform an appropriate and relevant economic evaluation. What Does This Mean? Jurisdictions may reconsider the current reimbursement criteria for drugs used in the first-line setting specifically for adults demonstrating highly active RRMS; however, caution should be taken given the gaps and uncertainty in evidence. Upon request from public drug plans, this review may inform a future implementation advice panel or expert committee recommendation.

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“…Moreover, patients with secondary or relapsed AML at the time of study initiation exhibited considerably impaired HRQoL compared to those with de novo AML [ 8 ]. It was found that changes in patients' quality of life were associated with long-term survival across various diseases, with diminished quality of life indicating a poor prognosis for patients [ [9] , [10] , [11] ]. Similarly, poor HRQoL at the time of patient diagnosis has been associated with reduced survival rates in cases of AML [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life in children with childhood acute myeloid leukemia in China: A five-year prospective study

Wu,

Fu,

Xue

et al. 2024

Heliyon

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Using personalized prognosis in the treatment of relapsing multiple sclerosis: A practical guide

Cited by 18 publications

References 99 publications

Multipl sklerozda uzun dönem yeti yitimi: 20 yıllık uzunlamasına bir çalışma

Multipl sklerozda uzun dönem yeti yitimi: 20 yıllık uzunlamasına bir çalışma

Alemtuzumab, Cladribine, Fingolimod, Natalizumab, and Rituximab as First-Line Treatments in Adults With Highly Active Relapsing-Remitting Multiple Sclerosis

Health-related quality of life in children with childhood acute myeloid leukemia in China: A five-year prospective study

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