Management Of Multiple Sclerosis Research Articles

Vitamin D supplementation and serum neurofilament light chain in interferon-beta-1b-treated MS patients.

ObjectivesSerum neurofilament light chain (sNfL) is a promising biomarker of MS activity, progression, and treatment response. The aim of the present study was to address whether sNfL concentrations are affected by supplementation of vitamin D and correlate with disease activity in interferon‐beta‐1b (IFNb‐1b)‐treated Finnish MS.Materials and MethodsSerum samples were available of 32 participants of the Finnish vitamin D randomized controlled trial (17 vitamin D/15 placebo). Serum 25 hydroxyvitamin D was measured using radioimmunoassay and sNfL using single‐molecule array (Simoa). Correlation of sNfL with brain magnetic resonance imaging (MRI) activity, burden of disease (BOD, mm3), and disability was assessed at the study baseline and at 52 weeks.ResultsSerum NfL concentrations were similar in the patients randomized to high‐dose vitamin D and placebo at the study baseline and at month 12 follow‐up (p‐value). Concentrations of sNfL were higher in patients with Gadolinium‐enhancing lesions in brain MRI: median (95% CI) sNfL was 14.84 (9.9–42.5) pg/ml and 11.39 (8.9–13.2) pg/ml in patients without Gd+ lesions (p = .0144) and correlated with enhancing lesion volume (Pearson r = .36, p = .037) at the study baseline but not at week 52. Serum NfL did not correlate with the MRI BOD or disability measured by expanded disability status scale and 25‐foot walk test.ConclusionIn this small cohort of clinically stable IFN‐treated Finnish MS patients, sNfL levels were similarly low in patients supplemented with high‐dose vitamin D or placebo. Subclinical disease activity in MRI was associated with higher sNfL levels.

Maize relay intercropping with fodder crops for small-scale farmers in central Brazil

AbstractRelay intercropping of maize with fodder crops is a promising option for sustainable intensification of dairy small-scale farms in the Cerrado of Brazil. Twenty-six intercropping trials were conducted on farmers’ fields with the following experimental treatments: sole maize crop cropping (MS), maize-Brachiaria intercropping (MB) and maize-pigeon pea intercropping (MP). The trials were managed by the farmers, i.e. choice of conventional tillage (CT) versus no-tillage (NT), sowing dates, fertilization and weed control. Maize grain yield varied strongly across the farmer fields, from 100 to 5900 kg ha−1 in the MS treatment, 500 to 6900 kg ha−1 in MP and 300 to 5500 kg ha−1 in MB. Intercropping did not significantly affect maize grain yields under NT, but yields were reduced under CT in one out of two seasons. Maize yields in the intercropped systems were also higher under NT than CT. Total biomass productivity was significantly higher in the maize-fodder than in the sole maize system. An increased interval between sowing of maize and fodder crop significantly reduced the fodder crop biomass. Relay intercropping, especially in combination with NT, is a promising option if crop calendars and fertilization are properly managed by farmers to reduce interspecific competition between the maize and fodder crop.

Comparison of first-line and second-line use of fingolimod in relapsing MS: The open-label EARLIMS study.

BackgroundTreatment of MS often begins with low-efficacy injectable disease-modifying therapy (iDMT).ObjectivesTo compare the effect of fingolimod 0.5 mg/day on clinical, MRI, patient-reported, and safety outcomes, in treatment-naïve and previously treated (≥1 iDMT) patients with early MS.MethodsEARLIMS was a multicentre, open-label, non-randomized, parallel-group phase 3 b/4 study in Australia and Spain. Patients with relapsing–remitting MS, Expanded Disability Status Scale (EDSS) score <4.0, and ≥1–5 years since diagnosis, received daily fingolimod for 48 weeks. The primary endpoint was annualized relapse rate (ARR).ResultsOf 347 patients enrolled at 51 sites (treatment-naïve, 200 [57.6%]; previously treated, 147 [42.4%]), 320 completed the study (treatment-naïve, 184 [92.0%]; previously treated, 136 [92.5%]), but the study remained underpowered (planned enrolment, n = 432). Fingolimod reduced ARR to similar levels in both treatment-naïve (mean ARR [95% confidence interval], 0.21 [0.14, 0.29]) and previously treated groups (0.30 [0.20, 0.41]; p = 0.1668). There were no new safety signals.ConclusionsFingolimod appeared equally effective as first- or second-line therapy in relapsing MS. There was a trend for better outcomes with fingolimod in treatment-naïve patients than in those previously treated with >1 iDMT.

Review on multiple sclerosis management in times of SARS-CoV-2 pandemic

The emergence of the novel coronavirus, SARS-CoV-2, has startled the entire world and created a genuine chaos inside the medical system. As the infection is spreading, the manifestations are becoming more diverse. The number of SARS-CoV-2-induced neurological cases described in the literature is increasing and the neurologists are experi-encing disturbing times in managing their patients, especially those diagnosed with autoimmune diseases, namely multiple sclerosis (MS). Disease-modifying therapies (DMTs) seem to enhance the susceptibility of MS patients to develop severe form of infections. Therefore, their utilization during COVID-19 pandemic is controversial. This review aims to summarise the available recommendations regarding the neurological management of MS patients, with an emphasis on the changes this pandemic has brought in the MS treatment.

Adherence to Therapeutic Recommendations in Patients Suffering from Multiple Sclerosis

Introduction. Multiple sclerosis is a chronic, inflammatory, immune demyelinating disease of the central nervous system. The effectiveness of MS treatment depends primarily on the effectiveness of drugs and the patient’s compliance with the principles of therapy.Aim. The main aim of the study was to assess the level of adherence to therapeutic recommendations in patients with multiple sclerosis.Material and Methods. The research was carried out at the Department of Neurology and Clinical Neuroimmunology of the Regional Specialist Hospital in Grudziądz. On average 165 patients suffering from multiple sclerosis were qualified for the study. The study was conducted using the method of diagnostic survey. The variables were measured using the proprietary questionnaire containing sociodemographic and medical data and the standardized adherence scale in chronic diseases (ACDS).Results. The analysis of own research showed that patients with high-level multiple sclerosis adhere to the therapeutic recommendations (p = 0.001). The study group reported the fatigue syndrome at all ACDS levels (p = 0.002). There was no relationship between the occurrence of adverse effects of pharmacotherapy and the level of compliance with therapeutic recommendations (p &gt; 0.05).Conclusions. It was found that the level of adherence to therapeutic recommendations in patients suffering from multiple sclerosis in the study group remained at a high level. (JNNN 2020;9(3):103–107)

Topical issues of esophageal cancer and gastroesophageal cancer surgery

Background. Esophageal cancer (MS) ranks 14th in the structure of can­cer in the population of Ukraine. Gastroesophageal cancer (GER) is sev­eral times more common. It is estimated that cancer in this area accounts for more than 20 % of all stomach cancers. The results of cancer treatment in this location are the worst among other cancers. This is due to high ne­glect in newly diagnosed patients, high postoperative mortality (15 %) and low five-year survival. Purpose. To analyze the literature sources related to esophageal cancer and gastroesophageal cancer surgery development in chronological terms and to define the main directions for further development of surgery of this pathology. Materials and methods. The literature review has involved available full-text contributions obtained via literature search in domestic and for­eign databases. The search was restricted to the studies published within the 1975–2020 timeframe. Special emphasis was placed on the effectiveness analysis of lymph node dissection and methods of esophagogastric anastomosis forming, in a comparative aspect. The paper also analyzes the materials of the authors’ own long-term studies related to this issue. From 1990 to 2018, 250 pa­tients with esophageal cancer and gastroesophageal cancer were treated at SO «IMR of the NAMS of Ukraine» and the regional clinical oncology dispensary. Results and discussion. Literature suggests that the failure of the esopha­geal-gastric anastomosis is secondary among complications. Cardiovascu­lar and pulmonary complications come first. When performing 3-zone lymph dissection increases five-year survival by 10 %. The inability of the esophagogastric anastomosis in leading clinics is from 3 to 9 %. Performing a plastic esophagogastric anastomosis in­creases its physiological properties. Conclusions. Thus, surgical treatment remains the main strategic direc­tion in the treatment of MS and GER. The primary goal of treatment is the survival of patients. Data from literature sources indicate the need for mandatory mediastinal and abdominal lymph dissection. The most successful results of treatment of esophageal cancer and gastroesophageal cancer were obtained in lead­ing specialized oncology clinics where the lowest postoperative mortality is observed. Treatment of cancer in this location requires the use of adju­vant treatments (chemotherapy and radiation therapy).

Factors Associated with Prescribing Oral Disease Modifying Agents in Multiple Sclerosis: a Real-world Analysis of Electronic Medical Records

BackgroundLittle is known about the factors associated with the selection of Disease Modifying Agents (DMA) for the management of Multiple Sclerosis (MS) since the introduction of oral DMAs in 2010. ObjectivesTo examine the factors associated with initiation of oral DMAs in patients with MS using data from electronic medical records (EMR). MethodsA retrospective longitudinal study was conducted using TriNetX, a federated EMR network of over 38 million patients from the US, from 2009–2019. Adult (≥18 years) patients with MS from the United States were identified using a MS diagnosis (ICD-9-CM: 340 or ICD-10-CM: G35) and a newly prescribed DMA with a one-year baseline period. Patients with new DMA prescriptions were classified as oral or injectable users based on their index medication. A multivariable logistic regression model was used to determine the predisposing (age category, sex, race, and ethnicity), enabling (time-period), and need factors (comorbidities, MS symptoms, symptomatic medication, and healthcare utilization) associated with initiation of an oral versus injectable DMA. ResultsThe study cohort consisted of 7,511 MS patients with a newly prescribed DMA, of whom most were 18-44 years old (48.33%), female (75.18%), and white (80.92%). About 42.32% of MS patients were diagnosed with at least one comorbidity (mean±SD: 0.86±1.37). Two thirds (66.32%) of the patients with MS started injectable DMAs, and the remaining one third (33.68%) started oral DMAs. Multivariable regression revealed that middle-aged (45–64 years; Adjusted Odds Ratio [aOR]=0.88; 95% Confidence Interval [CI]: 0.79–0.98) and older adults (≥65 years; aOR=0.67, 95% CI: 0.53–0.84) were associated with a decreased likelihood of receiving oral DMAs. The presence of general symptoms (aOR=1.26, 95% CI: 1.10-1.45) and cerebellar symptoms (aOR=1.56, 95% CI: 1.26-1.93) was associated with an increased likelihood of an oral DMA. However, the presence of sensory symptoms (aOR: 0.72, 95% CI: 0.59-0.88) was associated with a decreased likelihood of an oral DMA. Comorbidities such as renal failure (aOR=0.16, 95%% 0.04-0.62), obesity (aOR=0.60, 95% CI: 0.45-0.80), drug abuse (aOR=0.61, 95% CI: 0.38-0.99), and other neurological disorders (aOR=0.82, 95% CI: 0.69-0.96) were associated with a decreased likelihood of receiving an oral DMA prescription. While the use of analgesics (aOR=0.78, 95% CI: 0.69-0.88) was associated with decreased likelihood, the use of antispasmodics (aOR=1.14, 95% CI: 1.01-1.28) was associated with an increased likelihood of receiving an oral DMA. Relative to the time-period when first oral DMAs entered into the market (2010-11), with time, the likelihood of prescribing oral DMA increased by multiple folds (2012-13, aOR=4.30, 95% CI: 3.08-6.00; 2014-15, aOR=19.34, 95% CI: 14.10-26.54; 2016-17, aOR=17.63, 95% CI: 12.76-24.35; and 2018-19, aOR=20.73, 95% CI: 14.64-29.37). ConclusionsOral DMA use steadily increased over the years, with one in three MS patients receiving oral agents. Both demographic and clinical factors were associated with the initiation of oral DMA over injectable DMA.

Interferon-β-1a Inhibition of Severe Acute Respiratory Syndrome-Coronavirus 2 In Vitro When Administered After Virus Infection.

The ongoing coronavirus disease 2019 pandemic has forced the clinical and scientific community to try drug repurposing of existing antiviral agents as a quick option against severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2). Under this scenario, interferon (IFN) β-1a, whose antiviral potential is already known, and which is a drug currently used in the clinical management of multiple sclerosis, may represent as a potential candidate. In this report, we demonstrate that IFN-β-1a was highly effective in inhibiting in vitro SARS-CoV-2 replication at clinically achievable concentration when administered after virus infection.

Natalizumab in patients with multiple sclerosis in Colombia: a case series

INTRODUCTION:Natalizumab is a humanized monoclonal antibody prescribed in the treatment of multiple sclerosis, the most prevalent chronic and inflammatory disease of the central nervous system (CNS). NEDA (no evidence of disease activity) status is the goal of multiple sclerosis treatment. METHODOLOGY:The clinical records of 22 patients with multiple sclerosis, followed for a mean of 9.2 years (range: 1.9 -18.3 years) between 2000 and 2018 were analyzed. These patients received treatment with natalizumab in a high-complexity neurological outpatient clinic in Bogotá, Colombia. RESULTS:Eighteen patients (82%) reached NEDA status within a median time of six months. Seven patients (32%) tested positive for anti-JC virus antibodies. However, none of them developed progressive multifocal leukoencephalopathy. During the evaluation period, five patients (23%) presented new lesions and 17 patients (77%) had relapses before reaching NEDA status. CONCLUSIONS:This study gave an exploratory analysis of the characteristics of a series of patients with MS in the Colombian context. In the retrospective analysis, it was observed that more than 80% of the studied sample that received treatment with natalizumab, reached NEDA status. Despite the methodological limitations inherent to this type of study and sample size, it suggests that natalizumab could be an appropriate medication for the management of multiple sclerosis in Colombia.

Vitamin D for the management of multiple sclerosis.

Vitamin D for the management of multiple sclerosis.

Diagnosis and management of multiple sclerosis: MRI in clinical practice

BackgroundRecent changes in the understanding and management of multiple sclerosis (MS) have increased the role of MRI in supporting diagnosis and disease monitoring. However, published guidelines on the use of MRI in MS do not translate easily into different clinical settings and considerable variation in practice remains. Here, informed by published guidelines for the use of MRI in MS, we identified a clinically informative MRI protocol applicable in a variety of clinical settings, from district general hospitals to tertiary centres.MethodsMS specialists geographically representing the UK National Health Service and with expertise in MRI examined existing guidelines on the use of MRI in MS and identification of challenges in their applications in various clinical settings informed the formulation of a feasible MRI protocol.ResultsWe identified a minimum set of MRI information, based on clinical relevance, as well as on applicability to various clinical settings. This informed the selection of MRI acquisitions for scanning protocols, differentiated on the basis of their purpose and stage of the disease, and indication of timing for scans. Advice on standardisation of MRI requests and reporting, and proposed timing and frequency of MRI scans were generated.ConclusionsThe proposed MRI protocol can adapt to a range of clinical settings, aiding the impetus towards standardisation of practice and offering an example of research-informed service improvement to support optimisation of resources. Other neurological conditions, where a gap still exists between published guidelines and their clinical implementation, may benefit from this same approach.

Frailty in ageing persons with multiple sclerosis

Background: Recent progress in multiple sclerosis (MS) management has contributed to a greater life expectancy in persons with MS. Ageing with MS comes with unique challenges and bears the potential to greatly affect quality of life and socioeconomic burden. Objectives: To compare frailty in ageing persons with multiple sclerosis (pwMS) and controls; to correlate frailty with MS clinical characteristics. Methods: PwMS and controls over 50 years old were recruited in a cross-sectional study. Two validated frailty measures were assessed: the frailty index and the Fried’s phenotype. Several multiple linear regressions accounting for demographic and clinical characteristics were performed. Results: Eighty pwMS (57 females, mean age 58.5 ± 6 years old) and 37 controls (24 females, mean age 61 ± 6.5 years old) were recruited. Multivariable analysis identified significantly higher frailty index in pwMS (0.21 ± 0.12 vs 0.11 ± 0.08, p < 0.0001). Similarly, according to Fried’s phenotype, a significantly higher percentage of pwMS were frail compared to controls (28% vs 8%). In pwMS, frailty index was independently associated with expanded disability status scale (EDSS), comorbidities, education level and disease duration. Conclusion: Our results suggest that frailty can be routinely assessed in pwMS. Increased frailty in MS patients suggests that, along with MS therapeutics, a tailored multidisciplinary approach of ageing pwMS is needed.

Role of effector T cells in multiple sclerosis

AbstractMultiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system, and the imbalance between autoimmunity and immune tolerance is considered to be the key factor for its pathogenesis. Effector T cells are shown to be involved not only in the early relapsing–remitting phase of this disease but also in the later progressive phase, which is thought to further promote the disease pathogenesis. Given the clinical benefits of the immune‐modulating reagents, which are designated as disease‐modifying treatments, growing evidence has demonstrated their association with the amelioration of pathogenic T cells further suggesting their relevance in the treatment of MS, which is an immune‐mediated disease. T cells, a type of lymphocytes, play a central role in the immune response and have also been thought to play a pivotal role in MS. It has been well described that the effector CD4+ T cells, such as T helper (Th)1 and Th17 cells, orchestrate inflammation in the early phase including both infiltrating immune cells and brain‐resident glia cells and further disrupt the myelin sheath resulting in neurologic symptoms. Furthermore, recent reports have highlighted the role of CD8+ T cells as well as T cells in the progressive phase of this disease. In this review, an overview of effector T cells orchestrating pathogenesis of MS and recent advances in the field are discussed.

Inhibition of CSF-1R curtails inflammation during experimental autoimmune encephalomyelitis

Abstract Multiple sclerosis (MS) and its animal model experimental autoimmune encephalomyelitis (EAE) are autoimmune diseases characterized by extensive infiltration of T cells and myeloid cells into the CNS. Treatments for MS are typically either non-specific immunosuppressive drugs or target adaptive immune cells. However, mounting evidence shows that myeloid cells have essential roles in MS/EAE pathology, but few, if any, MS drugs specifically target myeloid cells. A promising strategy for bridging this gap in treatment modalities for MS may be targeting CSF-1R, a receptor tyrosine kinase with important roles in myeloid cells, including survival and differentiation. We found that blocking CSF-1R signaling attenuated EAE and our analysis of the CNS these mice revealed substantially diminished numbers of inflammatory myeloid cells. These data demonstrate that inhibiting CSF-1R signaling is a viable strategy for attenuating myeloid cell responses during autoimmune neuroinflammation. These studies also suggest that targeting CSF-1R signaling may be an effective approach for treating MS.

Efficacy of cannabidiol treatment in experimental MS is due to immunosuppressive activity of myeloid cells in CNS downregulating recruitment of CD4+ T cells, proinflammatory chemokines and gasdermin D expression

Abstract Cannabidiol (CBD) is a nonpsychoactive ingredient from Cannabis that has garnered attention in the medical community due to its anti-inflammatory properties and therapeutic potential. CBD has in particular become a popular alternative medicine among individuals with autoimmune disorders due to CBD lacking the side effects and costs associated with immunosuppressants. To better define how CBD inhibits inflammation, we studied the effects of orally administering CBD (20mg/kg) in experimental autoimmune encephalomyelitis (EAE), a murine model of multiple sclerosis. Using single cell RNA sequencing on cells isolated from the central nervous system (CNS) of EAE mice, we demonstrated that CBD treatment inhibits neuroinflammation by regulating gene expression and infiltration of myeloid cells. Within the resident and infiltrating myeloid cells of the CNS, there was decreased expression of inflammatory cytokines and chemokines (CXCL9, CXCL10, IL-18) associated with neuroinflammation and CD4+ T cell recruitment, pyroptosis initiators (gasdermin D; Gsdmd), oxide synthesizers (Arg1) and antigen presentation mediators (CD40) in CBD-treatment group. Additionally, CBD yielded an increase in the polymorphonuclear myeloid derived suppressor cells in the CNS, signifying immunotolerance induction at the site of inflammation. In the VEH treated mice, we found CD4+ T cells that express the receptor for IL-18 (IL-18r1) that are absent in CBD treated mice, suggesting CBD affects T cell activity via inhibition of myeloid cell activity. This data shows that CBD treatment ameliorates EAE by inhibiting infiltration, pro-inflammatory cytokine production, antigen presentation, T cell recruitment and pyroptosis of myeloid cells in the CNS.

PND70 EVALUATING THE IMPORTANCE OF DRUG ADMINISTRATION AND MONITORING COSTS IN ECONOMIC EVALUATION FOR MANAGEMENT OF MULTIPLE SCLEROSIS IN THE UNITED KINGDOM

Estimation of healthcare resource utilization (HCRU) cost, like drug administration and drug monitoring costs, is a crucial part of an economic evaluation and slight variation can substantially impact the decision of the economic analysis. With more countries adopting economic evaluations as part of their Health Technology Assessment (HTA) submissions, identifying country specific HCRU costs has become an important process. The precise estimation of these costs through comprehensive methodology is essential for optimal decision making. The objective of this study was to estimate and assess drug administration and drug monitoring costs across different disease modifying therapies for the management of Multiple Sclerosis (MS) in the United Kingdom (UK). A Microsoft Excel® based HCRU cost calculator was developed for different multiple sclerosis drugs. The HCRU requirements were extracted from the Summary of Product Characteristics and Food and Drug Administration. The HCRU cost data was extracted from the National Health Service costs and Personal Social Service Research Unit. All HCRU requirements were interpreted to estimate annual cost in the real-world scenario. The annual administration cost per patient was estimated to be highest for natalizumab followed by alemtuzumab and ocrelizumab. The annual monitoring cost per patient was estimated to be highest for natalizumab followed by dimethyl fumarate and alemtuzumab. Overall, highest annual HCRU cost per patient was associated with natalizumab followed by alemtuzumab and ocrelizumab. The careful assessment of HCRU requirements in addition to drug cost should be assessed in order to have pragmatic economic evaluation in MS management. The HCRU cost calculator methodology could be useful to study real-world effectiveness & utilization patterns across different therapy areas, globally.

New Arrival of Disease Modifying Drugs Initiates New Era in Multiple Sclerosis Treatment in Japan

Multiple sclerosis disease modifying drugs (MS-DMD) currently used in Japan are interferon β-1a, interferon β-1b and gratiramer acetate, fingolimod, dimethyl furmarate, and natalizumab. Ofatumumab and siponimod will be approved probably in 2021. Ofatumumab is an ant-CD20 human monoclonal antibody. A clinical trial revealed that the efficacy of ofatumumab is clearly superior to teriflunomide that has comparable efficacy to dimethyl fumarate. Siponimod, a selective sphingosine-1-phosphate receptor modulator, exhibited mild, but significant efficacy for secondary progressive form of MS. OCH, a synthetic glycolipid agent, is being tested in phase II clinical trials in Japan. What DMD is to select is challenging since MS prognosis varies and is unexpected. Only very few have truly benign course without treatment. Silent progression should be considered especially in cases with those with interferon β-1a, interferon β-1b and gratiramer acetate. Escalation therapy is more widely accepted than initiation of high efficacy therapy in Japan because emphasizing safety. In such strategy three injectables and dimethyl fumarate are regarded as first line therapies. On the other hand, initiation of high efficacy drugs may be reasonable to prevent from disease progression. Even if either is acceptable, early induction of DMD with sufficient efficacy is mandatory for MS treatment.

Neurotoxicity after hematopoietic stem cell transplant in multiple sclerosis.

ObjectiveAccelerated brain volume loss has been noted following immunoablative autologous hematopoietic stem cell transplantation (IAHSCT) for multiple sclerosis. As with other MS treatments, this is often interpreted as ‘pseudoatrophy’, related to reduced inflammation. Treatment‐related neurotoxicity may be contributory. We sought objective evidence of post‐IAHSCT toxicity by quantifying levels of Neurofilament Light Chain (sNfL) and Glial Fibrillary Acidic Protein (sGFAP) before and after treatment as markers of neuroaxonal and glial cell damage.MethodsSera were collected from 22 MS patients pre‐ and post‐IAHSCT at 3, 6, 9, and 12 months along with 28 noninflammatory controls. sNfL and sGFAP quantification was performed using the SiMoA single‐molecule assay.ResultsPre‐IAHSCT levels of sNfL and sGFAP were elevated in MS patients compared with controls (geometric mean sNfL 21.8 vs. 6.4 pg/mL, sGFAP 107.4 vs. 50.7 pg/mL, P = 0.0001 for both). Three months after IAHSCT, levels of sNfL and sGFAP increased from baseline by 32.1% and 74.8%, respectively (P = 0.0029 and 0.0004). sNfL increases correlated with total busulfan dose (P = 0.034), EDSS score worsening at 6 months (P = 0.041), and MRI grey matter volume loss at 6 months (P = 0.0023). Subsequent NfL levels reduced to less than baseline (12‐month geometric mean 11.3 pg/mL P = 0.0001) but were still higher than controls (P = 0.0001). sGFAP levels reduced more slowly but at 12 months were approaching baseline levels (130.7 pg/mL).InterpretationThere is direct evidence of transient CNS toxicity immediately after IAHSCT which may be chemotherapy mediated and contributes to transient increases in MRI atrophy.

Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy after alemtuzumab therapy in kidney transplant recipients.

Alemtuzumab is approved for the treatment of relapsing-remitting MS and is used off-label for patients with chronic lymphocytic leukemia and as induction and antirejection therapy in kidney transplant recipients.1 Guillain-Barre syndrome (GBS) or chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) complicating alemtuzumab treatment was reported in 9 patients with hematologic malignancy or MS.1–3 The risk of GBS or CIDP in solid organ transplant recipients treated with alemtuzumab is unknown.

Changes in Management of Pediatric-onset Multiple Sclerosis: Are We Really Modifying the Disease Course? Data from the Italian MS Registry (3938)

Changes in Management of Pediatric-onset Multiple Sclerosis: Are We Really Modifying the Disease Course? Data from the Italian MS Registry (3938)