BACKGROUND: Alemtuzumab (ALEM) is a humanised monoclonal antibody that depletes circulating lymphocytes by selectively targeting CD52, which is expressed in high levels on T- and B-lymphocytes. This depletion is followed by lymphocyte repopulation and a cytokine expression shift towards a lesser inflammatory profile, both of which may contribute to prolonged efficacy. National recommendations for enrolling and treating multiple sclerosis (MS) patients with ALEM have been established. However, there are no recommendations in place for the treatment of MS reactivation after the ALEM treatment. OBJECTIVES: To evaluate the effectiveness and safety of the use of ALEM and to analyse subsequent disease-modifying treatments (DMTs). A multidimensional prediction model was developed to make a patient-specific prognosis regarding the response to ALEM. DESIGN: A multicentre, prospective, non-controlled, non-interventional, observational cohort study. METHODS: Relapsing multiple sclerosis patients (RMSp) who received ⩾1 dose of ALEM were enrolled. In each treatment year, the following baseline and prospective data were collected: age, MS history, number, type and duration of previous disease-modifying treatment (PDMT), relapse rate (REL), expanded disability status scale (EDSS), magnetic resonance imaging and serious adverse events (AE). In cases of reactivation of MS, all data about the subsequent DMT were collected. RESULTS: A total of 142 RMSp from 10 MS Slovak Centres fulfilled the inclusion criteria. The average age was 35 years (standard error 8.56). The overall average EDSS was 3.87 (1.46) when ALEM was started. The average duration of PDMT was 6.0 (4.04) years, and the median number of PDMTs was 3 (0-5), while the patients were mostly treated with 2 or 3 DMTs (>65.00%). Post-ALEM treatment was needed in 39 cases (27.46%). The most frequent post-ALEM treatment indicated was ocrelizumab, followed by natalizumab (NAT), siponimod and cladribine. The ocrelizumab and NAT treatment bring little benefit to patients. Siponimod showed less EDSS increase in contrast to ocrelizumab and NAT. Another repopulation therapy, cladribine, may also be an effective option. Statistically significant predictors for the expected EDSS are age (p-value <0.0001), number of ALEM cycles (0.0066), high number of PDMT (0.0459) and the occurrence of relapses (<0.0001). There was no statistically significant effect on the patient's gender (0.6038), duration of disease-modifying treatment before alemtuzumab (0.4466), or the occurrence of AE (0.6668). CONCLUSION: The study confirms the positive effect of ALEM on clinical and radiological outcomes. We need more data from long-term sequencing studies.
- Publikační typ
- časopisecké články MeSH
Sclerosis multiplex je chronické ochorenie postihujúce najmä mladých dospelých ľudí. Správne načasovanie liečby určuje ďalší priebeh ochorenia a pozitívne ovplyvňuje kvalitu života. Práca prináša nové pohľady na diagnostiku a liečbu tohto ochorenia.
Multiple sclerosis is a chronic disorder, which primarily affects young adults. Timing of treatment determines further evolution of the disorder and positively influences quality of life. The work brings new insides on diagnostics and treatment of the disorder.
- MeSH
- časná diagnóza MeSH
- lidé MeSH
- roztroušená skleróza * diagnóza farmakoterapie patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Diagnostika a liečba sekundárne progresívnej sclerosis multiplex (SPSM) je stále problematická. Súčasné možnosti imunomodulačnej liečby sekundárne progresívnej sclerosis multiplex sú obmedzené. Výsledky klinických štúdií ukazujú nádejné poznatky, prinášajúce možnosti efektívnej liečby aj pre pacientov s SPSM. Práca podáva prehľad súčasných názorov a poznatkov na danú tému.
Diagnostics and treatment of secondary progressive multiple sclerosis has been problematic. Current options of immunomodulatory treatment of secondary progressive sclerosis multiplex are limited. Results or clinical studies show promising knowledges, bringing possibilities for more effective treatment even for patients in secondary progressive multiple sclerosis. The work offers current opinions and knowledges of the topic.
- Klíčová slova
- siponimod,
- MeSH
- azetidiny farmakologie škodlivé účinky terapeutické užití MeSH
- chronicko-progresivní roztroušená skleróza * diagnostické zobrazování diagnóza farmakoterapie MeSH
- imunosupresiva terapeutické užití MeSH
- interferon beta 1b škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- mitoxantron škodlivé účinky terapeutické užití MeSH
- progrese nemoci MeSH
- rizikové faktory MeSH
- roztroušená skleróza diagnostické zobrazování diagnóza farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Epileptické záchvaty sú definované ako tranzientné prejavy dezinhibovanej, extrémne synchronizovanej kortikálnej aktivity. Ako izolovaný príznak môžu byť vyprovokované rôznymi procesmi, ktoré ovplyvňujú fungovanie mozgovej kôry. Opakovaný výskyt epileptických záchvatov však signalizuje ireverzibilné poškodenie časti mozgovej kôry, či už na makroskopickej alebo mikroskopickej úrovni. Aktívny zápalový proces v mozgovej kôre a rozsah pozápalových zmien súvisí s vývojom epileptických záchvatov a epilepsie pri roztrúsenej skleróze. V článku sa zaoberáme aktuálnymi poznatkami na tému epilepsie a sclerosis multiplex.
Epileptic seizures are defined as a transient occurrence of symptoms due to abnormal disinhibited or extremely synchronisedcortical activity. When they occurr in isolation, they can be provoked by different processes influencing brain cortex. However,repeated epileptic seizures signalise irreversible microscopic or macroscopic damage of the brain cortex. Intensity of inflammatoryprocess in the brain cortex and intensity of post-inflammatory changes correlate with epileptic seizures and epilepsy in multiplesclerosis. In this article we are dealing with current information about epilepsy and multiple sclerosis.
Evokované potenciály sú pomocnou vyšetrovacou metódou, ktorá má svoje nezastupiteľné miesto v komplexnej diagnostike a hodnotení postihnutia nervového systému pri ochoreniach centrálneho nervového systému, najmä demyelinizačných ochorení. Ide o vysoko senzitívnu metódu, ktorá dokáže zaznamenať subklinické zmeny vedenia nervovými dráhami. Napriek malej špecifickosti, je to metóda vysoko aktuálna pre jednoduchosť prevedenia, dostupnosť, rýchlu interpretovateľnosť výsledkov a opakovateľnosť. Evokované potenciály majú svoje miesto okrem diagnostiky aj v monitorovaní progresie senzitívneho, motorického či kognitívneho deficitu a v hodnotení účinnosti podávanej liečby.
An evoked potential study is an auxiliary examination method with an important place in the complex diagnostic process and evaluation of central nervous system impairment, particularly in the assesment of demyelinating disorders. This is a highly sensitive method, which is capable to detect subclinical changes of nerve tract conduction. Despite its low specificity it remains commonly used as it is widely available, easily performed and reproducible, and repeatable. Evoked potentials are effective not only in diagnostics but also in monitoring motor, sensitive or cognitive deficit progression, and in assessing the treatment efficacy.
