Abstract:
BACKGROUND:Whilst there is a broad selection of drugs licensed as disease modifying treatments (DMTs) for people with relapsing multiple sclerosis (pwRMS), access to DMTs remains restricted, particularly for people with progressive MS (pwPMS). Cladribine has shown efficacy at all stages of MS. Following withdrawal from the market of oral cladribine in 2011, partly due to issues associated with lymphopenia, and following a thorough risk assessment, we started using subcutaneously injected cladribine (Litak®) to treat both pwRMS and pwPMS. Here, we report on the real life safety and tolerability of this treatment option. METHODS:Cladribine was offered to (i) pwRMS as a choice despite fulfilling NHS England (NHSE) criteria for licensed DMTs, and (ii) pwRMS and pwPMS not eligible for NHSE approved DMTs. To avoid lymphocyte depletion lower than 0.5 × 109/l (WHO grade 2) cladribine was administered using a personalised dosing scheme (30-40 mg in week 1; and another 0-30 mg in week 5 pending total lymphocyte count at week 4). Anti-viral prophylaxis was given from day 1 for 60 days. Patients approaching week 48 were given a second treatment cycle. Data collection included side effects, relapses, change in disability and MRI indices. RESULTS:Seventy-one pwMS (40 female, 31 male; 36 RMS, 35 PMS,) received at least one treatment cycle. Mean age for starting cladribine was 44 years (range 22-72 years), median EDSS was 5 (range 1-8.5). Maximum follow-up was 28 months. 35/71 pwMS were followed up for at least 20 weeks. These patients had a median EDSS of 5.0 (range 1.0-7.5) at baseline and 5.5 (range 1.0-8.0) after a mean follow-up of 11 months (range 5-28). Cladribine was well tolerated with very few treatment-related adverse events observed. Personalised dosing led to grade 1-2 lymphopenia in 50% of cases. A single patient developed transient grade 3 lymphopenia. No cases of varicella or other infections were observed. Four/17 people with relapsing MS, experienced a total of six relapses during a mean follow-up of 13 months (range 5-28 months). In people with PMS (n = 18) median EDSS was 5.5 (2.0-7.5) at baseline and 6.0 (2.5-7.5) after a median of 10 months (range 5-18). In pwPMS MRI showed that 25% had active scans at baseline, and 0% at follow-up. CONCLUSION:Personalised dosing of cladribine avoided severe lymphopenia in all but one patients and was very well tolerated across a large spectrum of disease severity. Our data suggests cladribine may offer benefit people with relapsing and progressive MS alike. The personalised protocol used appears safe, however warrants controlled studies to more definitively assess efficacy and safety, particularly in groups of pwMS who are not eligible for licensed DMT including oral cladribine (Mavenclad®).
journal_name
Mult Scler Relat Disordjournal_title
Multiple sclerosis and related disordersauthors
Mao Z,Álvarez-González C,Allen-Philbey K,De Trane S,Yildiz O,Campion T,Adams A,Turner BP,Marta M,Gnanapavan S,Espasandin M,Mathews J,Giovannoni G,Baker D,Schmierer Kdoi
10.1016/j.msard.2018.11.001subject
Has Abstractpub_date
2019-01-01 00:00:00pages
247-253eissn
2211-0348issn
2211-0356pii
S2211-0348(18)30486-3journal_volume
27pub_type
杂志文章abstract:BACKGROUND:Social support has been identified as a buffering or intervening variable in stressful life events. Research has demonstrated that greater social support is associated with better mental health in multiple sclerosis (MS), but little is known about its links to specific aspects of mental health. We therefore ...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2018.09.039
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:To describe a case of Listeria monocytogenes rhombencephalitis in a patient receiving fingolimod. METHODS:This is a case study. RESULTS:Our patient developed acute rhombencephalitis with hydrocephalus induced with Listeria monocytogenes while on fingolimod. Shunt surgery was performed for the hydrocephalus ...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2018.11.025
更新日期:2019-01-01 00:00:00
abstract::Multiple sclerosis (MS) is a complex chronic immune disease in the central nervous system, causing neurological disability among young and middle-aged adults. Impaired cognition is now emerging as a major clinical symptom being present in more than 50% of MS patients. Recent data support that neuroinflammation mediate...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章,评审
doi:10.1016/j.msard.2020.102622
更新日期:2020-11-14 00:00:00
abstract:BACKGROUND:Considering the multiple treatments approved for multiple sclerosis (MS) by the Food and Drug Administration (FDA) and European Medicines Agency (EMA), determining a treatment strategy for patients with clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS) can be challenging. To date, an overv...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章,评审
doi:10.1016/j.msard.2020.101929
更新日期:2020-01-02 00:00:00
abstract:IMPORTANCE:Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by relapses and a progressive course that may lead to accumulation of physical and cognitive disability. Cognitive training interventions seem to improve the cognitive performance of MS patients. The aim of ...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.msard.2017.12.017
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Fatigue, depression, and physical inactivity are common in multiple sclerosis (MS), but there is limited information on the bi-directional associations among those variables over a long period of time. OBJECTIVE:This study examined the hypothesis that fatigue and depression would predict change in physical ...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2011.08.003
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Natural history studies have typically focused on non-modifiable factors as predictors of disability progression in multiple sclerosis (MS). Weight status has emerged as a correlate of disability status in cross-sectional studies of persons with MS and represents a possible modifiable predictor of disability...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2012.02.004
更新日期:2012-07-01 00:00:00
abstract:INTRODUCTION:Natalizumab break exposes multiple sclerosis (MS) patients to a high risk of disease reactivation or rebound, whose prevention and treatment constitute a clinical challenge. CASE PRESENTATION:We describe a dramatic case of MS rebound, characterized by the development of severe neurological and psychiatric...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章,评审
doi:10.1016/j.msard.2019.03.002
更新日期:2019-05-01 00:00:00
abstract:INTRODUCTION:Some studies have indicated the importance of considering smoking, vitamin D deficiency and obesity as negative prognostic factors for clinical and MRI outcomes in multiple sclerosis (MS). This study aimed to evaluate the possible effects of these modifiable risk factors on brain MRI lesion burden of patie...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2019.101886
更新日期:2019-12-09 00:00:00
abstract:BACKGROUND:Elevation of CXCL13, a key regulator of B-cell recruitment in cerebrospinal fluid (CSF) is implicated in multiple sclerosis (MS). OBJECTIVE:to evaluate if measurement of CXCL13 using a highly sensitive assay is of value in acute optic neuritis (ON) patients for the prediction of later MS. METHOD:CXCL13 was...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2020.102281
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:The 2015 criteria for diagnosing neuromyelitis optica spectrum disorder (NMOSD) have encouraged several groups across the world to report on their patients using these criteria. The disease typically manifests with severe relapses of optic neuritis, longitudinally extensive myelitis and/or brainstem syndrome...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2018.11.031
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:Treatment decisions in patients with multiple sclerosis (MS) during the coronavirus disease 2019 (COVID-19) pandemic are challenging. It is not known whether and how various disease modifying therapies, especially immunosuppressive drugs, affect COVID-19 risk and disease course. METHODS:Case report RESULTS:...
journal_title:Multiple sclerosis and related disorders
pub_type:
doi:10.1016/j.msard.2020.102182
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Multiple reports have described the proportion of Th17 cells in peripheral blood and serum levels of Th17-related cytokines in patients with multiple sclerosis (MS). To clarify the status of Th17 cells and Th17-related cytokines in MS patients, we did a meta-analysis of the results published previously to as...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.msard.2017.09.003
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVES:To examine the association between vagotomy and multiple sclerosis. METHODS:We conducted a matched cohort study of all patients who underwent truncal or super-selective vagotomy and a comparison cohort, by linking Danish population-based medical registries (1977-1995). Hazard ratios (HRs) for multiple scler...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2017.04.009
更新日期:2017-07-01 00:00:00
abstract::Fibrinogen is a protein that plays a key role in blood coagulation and thrombosis and it is involved in several inflammatory processes; in multiple sclerosis (MS) may be related with blood-brain barrier (BBB) disruption. We analysed the relationship between plasma fibrinogen levels and the presence of active lesions o...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2017.09.033
更新日期:2017-11-01 00:00:00
abstract::Neoplasms and reactivation of latent viruses have been observed in individuals taking fingolimod. Merkel cell carcinoma (MCC), a rare neuroendocrine skin cancer, is associated with immunosuppression and can be triggered by the oncogenic Merkel cell polyoma virus (MCPyV). We report a case of a 61-year-old man with mult...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2017.06.004
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Peak width of skeletonized mean diffusivity (PSMD) is a novel and fully automated, MRI biomarker, which has shown clinical relevance in cerebral small vessel diseases (SVD). We aimed here to assess PSMD levels across the brain of patients with multiple sclerosis (MS), in comparison to normal controls (NC) an...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2018.11.011
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND/AIMS:Mesenchymal stem cells (MSCs) transplantation has been considered a possible therapeutic method for Multiple Sclerosis (MS). However, no quantitative data synthesis of MSCs therapy for MS exists. We conducted a systematic review and meta-analysis to evaluate the effects of MSCs in experimental autoimmun...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章,评审
doi:10.1016/j.msard.2020.102200
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Different walking capacity test formats are applied, but their impact on the gait pattern in persons with MS (pwMS) has not yet been investigated according to baseline velocity performance. OBJECTIVE:To assess, in pwMS with different ambulation dysfunction, the impact of speed instructions and previous walk...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2013.01.004
更新日期:2013-07-01 00:00:00
abstract::Multiple sclerosis (MS) is the most common acquired demyelinating disorder of the central nervous system (CNS). Diagnosing MS can be very challenging owing to its variable clinical features and lack of specific tests. Magnetic resonance imaging (MRI) is a key measure in this process. Although white matter lesions on b...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章,评审
doi:10.1016/j.msard.2019.101452
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:As vaccines for the coronavirus become available, it will be important to know the rate of COVID-19 vaccine acceptability in adults with multiple sclerosis (MS), given that vaccination will be a key strategy for preventing SARS-CoV-2 infections. Using a national sample of adults with MS in the United States ...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2021.102788
更新日期:2021-01-22 00:00:00
abstract:BACKGROUND:Fatigue is a common and disabling symptom of multiple sclerosis (MS) patients. Structural changes in several brain areas have been reported to correlate with fatigue in MS patients but none consistently. OBJECTIVE:To study the association between global and regional measures of brain atrophy and fatigue in ...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2015.10.006
更新日期:2016-01-01 00:00:00
abstract::Multiple Sclerosis (MS) is an autoimmune disease in which lymphocytes target putative myelin antigens in the CNS, causing inflammation and neurodegeneration. Fingolimod (FTY720) is an immunosuppressive drug used as a second line therapy for relapsing forms of MS due to its safety profile and good response to treatment...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2017.05.004
更新日期:2017-11-01 00:00:00
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journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2015.07.009
更新日期:2015-11-01 00:00:00
abstract::Elsberg syndrome (ES) refers to the combination of myelitis and lumbosacral radiculitis associated with infection caused by the virus of the Herpesviridae family. We present a case of a 52-year-old man with a 9 months diagnosis of Crohn's disease, in use of infliximab with good disease control, complaining of 2 months...
journal_title:Multiple sclerosis and related disorders
pub_type: 信件
doi:10.1016/j.msard.2020.102643
更新日期:2020-11-25 00:00:00
abstract:BACKGROUND:There is no evidence that disease modifying therapies (DMTs) are beneficial in progressive (non-relapsing) MS. However, these patients may benefit from multidiscipliniary interventions, and require financial and community support. Non-pharmacological needs of MS patients may be overlooked during fund allocat...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章,多中心研究
doi:10.1016/j.msard.2015.01.003
更新日期:2015-03-01 00:00:00
abstract::Neurosarcoidosis is a rare disease with various clinical phenotypes. Thus, case reports and series broaden the understanding of this entity (Ibitoye et al., 2017). We present a case of isolated intramedullary spinal cord sarcoidosis, an exceedingly rare phenotype, which needs to be distinguished especially from neurom...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2017.09.010
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:The role that dietary interventions can play in multiple sclerosis (MS) management is of huge interest amongst patients and researchers but data evaluating this is limited. Possible effects of a very-low-fat, plant-based dietary intervention on MS related progression and disease activity as measured by brain...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.msard.2016.07.001
更新日期:2016-09-01 00:00:00
abstract:OBJECTIVE:To investigate the predictive factors associated with good outcomes of plasma exchange in severe attacks through neuromyelitis optica spectrum disorder (NMOSD) and long extensive transverse myelitis (LETM). In addition, to review the literature of predictive factors associated with the good outcomes of plasma...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2017.02.015
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:The epidemiology of multiple sclerosis (MS) and neuromyelitis optica (NMO) remains to be clarified or updated in many parts of Asia. This study aims to investigate the epidemiology and comorbidities of MS and NMO during 2001-2015 in Taiwan. METHODS:We conducted a retrospective nationwide population-based st...
journal_title:Multiple sclerosis and related disorders
pub_type: 杂志文章
doi:10.1016/j.msard.2020.102425
更新日期:2020-10-01 00:00:00