scholarly journals Walk Your Talk: Real-World Adherence to Guidelines on the Use of MRI in Multiple Sclerosis

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1310
Author(s):  
Mario Tortora ◽  
Mario Tranfa ◽  
Anna Chiara D’Elia ◽  
Giuseppe Pontillo ◽  
Maria Petracca ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Real World ◽  
University Hospital ◽  
Slice Thickness ◽  
Adequate Quality ◽  
Standardized Reporting ◽  
On Line ◽  
Mri Sequences ◽  
Weighted Sequences

(1) Although guidelines about the use of MRI sequences for Multiple Sclerosis (MS) diagnosis and follow-up are available, variability in acquisition protocols is not uncommon in everyday clinical practice. The aim of this study was to evaluate the real-world application of MS imaging guidelines in different settings to clarify the level of adherence to these guidelines. (2) Via an on-line anonymous survey, neuroradiologists (NR) were asked about MRI protocols and parameters routinely acquired when MS patients are evaluated in their center, both at diagnosis and follow-up. Furthermore, data about report content and personal opinions about emerging neuroimaging markers were also retrieved. (3) A total of 46 participants were included, mostly working in a hospital or university hospital (80.4%) and with more than 10 years of experience (47.9%). We found a relatively good adherence to the suggested MRI protocols regarding the use of T2-weighted sequences, although almost 10% of the participants routinely acquired 2D sequences with a slice thickness superior to 3 mm. On the other hand, a wider degree of heterogeneity was found regarding gadolinium administration, almost routinely performed at follow-up examination (87.0% of cases) in contrast with the current guidelines, as well as a low use of a standardized reporting system (17.4% of cases). (4) Although the MS community is getting closer to a standardization of MRI protocols, there is still a relatively wide heterogeneity among NR, with particular reference to contrast administration, which must be overcome to guarantee an adequate quality of patients’ care in MS.

scholarly journals Ocrelizumab in Multiple Sclerosis: A Real-World Study From Spain

2021 ◽  
Vol 11 ◽  
Author(s):  
Angel P. Sempere ◽  
Leticia Berenguer-Ruiz ◽  
Ines Borrego-Soriano ◽  
Amparo Burgos-San Jose ◽  
Luis Concepcion-Aramendia ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Practice ◽  
Real World ◽  
Median Number ◽  
Progressive Multiple Sclerosis ◽  
Primary Progressive Multiple Sclerosis ◽  
Clinical Practice Setting ◽  
Number Of Treatment ◽  
Relapsing Multiple Sclerosis

Objectives: The aim of this study was to describe the tolerability, safety, and effectiveness of ocrelizumab for primary progressive multiple sclerosis (PPMS) and relapsing multiple sclerosis (RMS) in a clinical practice setting.Methods: In this retrospective observational study, we analyzed clinical and MRI data in all patients with PPMS and RMS who had received at least one infusion of ocrelizumab in two health areas in south-eastern Spain. Patients involved in any ocrelizumab trial and those patients with a follow-up shorter than 6 months were excluded.Results: The cohort included 70 patients (42 women) who had received ocrelizumab; 30% had PPMS and 70%, RMS. At baseline, patients' mean age was 47.1 years in the PPMS group and 39.2 years in the RMS group, while the median EDSS was 3.0 and 2.5, respectively. Median follow-up was 13.6 months. The median number of treatment cycles was three. Most patients remained free from clinical and MRI activity after ocrelizumab initiation. Baseline MRI showed T1 Gd-enhancing lesions in 57% of the patients; by the first MRI control at 4–6 months, all patients except one were free of T1 Gd-enhancing lesions (69/70, 98.6% P < 0.001). The proportion of patients with NEDA was 94% in the group of RMS patients who were followed for at least 1 year. Ocrelizumab was generally well-tolerated; the most common adverse events were infusion-related reactions and infections, none of which were serious.Conclusions: Our real-world study supports the tolerability, safety, and effectiveness of ocrelizumab in clinical practice.

scholarly journals An Automatic Segmentation of T2-FLAIR Multiple Sclerosis Lesions

2008 ◽  
Author(s):  
Jean-christophe Souplet ◽  
Christine Lebrun ◽  
Nicholas Ayache ◽  
Gregoire Malandain
Keyword(s):  
Multiple Sclerosis ◽  
Test Data ◽  
Automatic Segmentation ◽  
Challenge Test ◽  
Flair Sequence ◽  
Conventional Mri ◽  
Hyperintense Signal ◽  
Automatic Methods ◽  
Mri Sequences

Multiple sclerosis diagnosis and patient follow-up can be helped by an evaluation of the lesion load in MRI sequences. A lot of automatic methods to segment these lesions are available in the literature. The MICCAI workshop Multiple Sclerosis (MS) lesion segmentation Challenge 08 allows to test and compare these algorithms. This paper presents a method designed to detect hyperintense signal area on T2-FLAIR sequence and its results on the Challenge test data. The proposed algorithm uses only three conventional MRI sequences: T1, T2 and T2-FLAIR. First, images are cropped, spatially unbiased and skull-stripped. A segmentation of the brain into its different compartments is performed on the T1 and the T2 sequences. From these segmentations, a threshold for the T2-FLAIR sequence is automatically computed. Then postprocessing operations select the most plausible lesions in the obtained hyperintense signals. Global result on the test data (80/100) is close to the inter-expert variability (90/100).

scholarly journals Real-World Lab Data in Natalizumab Treated Multiple Sclerosis Patients Up to 6 Years Long-Term Follow Up

2018 ◽  
Vol 9 ◽  
Author(s):  
Maxi Kaufmann ◽  
Rocco Haase ◽  
Undine Proschmann ◽  
Tjalf Ziemssen ◽  
Katja Akgün
Keyword(s):  
Multiple Sclerosis ◽  
Real World ◽  
Long Term Follow Up ◽  
Multiple Sclerosis Patients

scholarly journals Effectiveness of sucroferric oxyhydroxide in patients on on-line hemodiafiltration in real-world clinical practice: A retrospective study

2019 ◽  
Vol 41 (2) ◽  
pp. 224-230
Author(s):  
Aníbal Ferreira ◽  
Bruno Pinto ◽  
David Navarro ◽  
João Aniceto ◽  
Pedro L Neves ◽  
...  
Keyword(s):  
Real World ◽  
Intravenous Iron ◽  
Routine Care ◽  
Serum Phosphorus ◽  
Phosphate Binders ◽  
Pill Burden ◽  
Increased Risk ◽  
On Line ◽  
Phosphorus Levels

Abstract Introduction: Hyperphosphatemia is a serious consequence of chronic kidney disease and has been associated with an increased risk for cardiovascular disease. Controlling serum phosphorus levels in patients on dialysis is a challenge for the clinicians and implies, in most cases, the use of phosphate binders (PB). Part of the reason for this challenge is poor adherence to treatment because of the high pill burden in this patient group. Objective: To assess the real-world effectiveness of sucroferric oxyhydroxide (SO) in controlling serum phosphorus levels and determine the associated pill burden. Methods: A multicenter, quantitative, retrospective, before-after study was conducted with patients receiving online hemodiafiltration. Patients who switched to SO as a part of routine care were included in the study. PB treatment, number of pills, serum phosphorus levels, and intravenous iron medication and dosage were collected monthly during the six months of treatment with either PB or SO. Results: A total of 42 patients were included in the study. After switching from a PB to SO, the prescribed pills/day was reduced 67% from 6 pills/day to 2 pills/day (p < 0.001) and the frequency of pill intake was lowered from 3 times/day to 2 times/day (p < 0.001). During the treatment with SO, the proportion of patients with serum phosphorus ≤ 5.5 mg/dL increased from 33.3% at baseline to 45% after six months of treatment. Conclusion: During the six-month follow-up with SO, serum phosphorus levels were controlled with one third of the pills/day compared to other PB.

scholarly journals Real-world effectiveness of dimethyl fumarate versus fingolimod in a cohort of patients with multiple sclerosis using standardized, quantitative outcome metrics

2022 ◽  
Vol 8 (1) ◽  
pp. 205521732110698
Author(s):  
Carrie M Hersh ◽  
Arman Altincatal ◽  
Nicholas Belviso ◽  
Shivani Kapadia ◽  
Carl de Moor ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Sensitivity Analysis ◽  
Real World ◽  
Dimethyl Fumarate ◽  
Neurofilament Light Chain ◽  
Neurofilament Light ◽  
Brain Volume Loss ◽  
Disability Status ◽  
Magnetic Resonance Imaging Mri

Background Prior studies suggest comparable effectiveness of dimethyl fumarate (DMF) and fingolimod (FTY) in multiple sclerosis (MS) using relapse, Expanded Disability Status Score (EDSS), and magnetic resonance imaging (MRI) lesion metrics. Objective Compare the real-world effectiveness of DMF versus FTY using quantitative, validated neuroperformance tests, MRI, and serum neurofilament light chain (sNfL) outcomes while controlling for between-group differences. Methods Patients were eligible if on DMF or FTY when first enrolled in the MS Partners Advancing Technology and Health Solutions (MS PATHS) network and had ≥1-year follow-up in MS PATHS. Sensitivity analysis included a subgroup who started DMF/FTY ≤2 years from enrolment. After propensity score weighting, differences in means and in mean 1-year change of neuroperformance and MRI outcomes were compared. sNfL levels were assessed. This was a non-randomized comparison. Results In the overall cohort, no significant differences were observed between DMF ( n = 702) and FTY ( n = 600) in neuroperformance or MRI outcomes including brain volume loss; mean time (SD) since treatment initiation was 1.98 (0.68) years for DMF and 2.02 (0.75) years for FTY. A sensitivity analysis controlling for DMF and FTY treatment duration yielded similar results. Conclusion In this study, DMF and FTY demonstrated similar effects on physical and cognitive neuroperformance and MRI outcomes. Direct comparisons to other fumarates and S1P receptor modulators were not conducted.

scholarly journals Autologous Haematopoietic Stem Cell Transplantation in Active Multiple Sclerosis: a Real-world Case Series

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012449
Author(s):  
Richard S Nicholas ◽  
Elijah Edward Rhone ◽  
Alice Mariottini ◽  
Eli Silber ◽  
Omar Malik ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Real World ◽  
Haematopoietic Stem Cell ◽  
Expanded Disability Status Scale ◽  
Free Survival ◽  
Disability Status

Objective:to examine outcomes in people with multiple sclerosis (PwMS) treated with autologous hematopoietic stem cell transplantation (AHSCT) in a real-world setting.Methods:retrospective cohort study on PwMS treated with AHSCT at two centers in London, UK, consecutively between 2012 and 2019 who had ≥ 6 months of follow-up or died at any time. Primary outcomes were survival free of MS relapses, MRI new lesions and worsening of expanded disability status scale (EDSS). Adverse events rates were also examined.Results:the cohort includes 120 PwMS; 52% had progressive MS (primary or secondary) and 48% had relapsing-remitting MS (RRMS). At baseline, the median expanded disability status scale (EDSS) was 6.0; 90% of the evaluable cases showed MRI activity in the 12 months preceding AHSCT. Median follow-up after AHSCT was 21 months (range 6–85). MS relapse-free survival was 93% at 2 years and 87% at 4 years after AHSCT. No new MRI lesions were detected in 90% of subjects at 2 years and 85% at 4 years. EDSS progression-free survival (PFS) was 75% at 2 years and 65% at 4 years. EBV reactivation and monoclonal paraproteinemia were associated with worse PFS. There were 3 transplant-related deaths within 100 days (2.5%), all following fluid overload and cardiac or respiratory failure.Conclusions:efficacy outcomes of AHSCT in this real-world cohort are similar to those reported in more stringently selected clinical trial populations, although the risks may be higher.Classification of evidence:this study is rated Class IV because of the uncontrolled, open-label design.

Efficacy and safety of PCSK9-Inhibitors in the real-world: data from a clinical registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P.S Saba ◽  
A Murgia ◽  
E Gazale ◽  
P Terrosu ◽  
G.D Sanna ◽  
...  
Keyword(s):  
Side Effects ◽  
Real World ◽  
Ldl Cholesterol ◽  
Geographical Area ◽  
University Hospital ◽  
Efficacy And Safety ◽  
Pcsk9 Inhibitors ◽  
The Real ◽  
Number Of Patients

Abstract Background To date, little information is available on the real impact of PCSK9 inhibitors in terms of reducing cholesterolemia, events and the actual tolerability in the so-called “real world”. This lack of information is substantially related to the fact that these drugs have only been marketed recently. In Italy, few centres are licensed to prescribe these drugs. This, on the one hand, limited the number of patients to whom the new therapy was offered but, on the other hand, “concentrated” the observations in a few centres, making it possible to more easily collect the few data currently available. The Cardiology Unit of our university hospital is the only prescribing centre in the North Sardinia and therefore represents the natural collector of all the prescriptions of this drug in this wide geographical area. Purpose The aim of the study was to evaluate the efficacy and tolerability of PCSK9 inhibitors in the current clinical practice. Methods Data were collected reviewing all Alirocumab and Evolocumab prescriptions provided by the Cardiology Unit of our university hospital included in the Italian National Drug Agency (AIFA) registry from February 2017 to October 2019. In order to collect complete clinical information, all patients were interviewed regarding their health status, the on-treatment cholesterol levels and the possible appearance of side effects or cardiovascular events. Results In the reference period, 111 patients (58.9% males, age 63±10 years) received PCSK9-Inhibitors prescription (52.7% Evolocumab, 47.3% Alirocumab), 86.5% as secondary prevention. Statin intolerance was the indication for PCSK9-Inhibitors in the majority (73.3%) of patients. LDL cholesterol at eligibility evaluation was 175±50 mg/dl and reduced to 87±44 mg/dl (p&lt;0.0001) at last follow-up assessment (median 12.3 IQR 6.8–21.4 years). Maximal per cent variation of LDL-cholesterol was achieved already after 6 months of therapy (−45±3% vs basal). No attenuation in LDL-cholesterol lowering was observed; conversely, LDL levels continued to reduce during treatment (p for linear trend = 0.01; Figure 1). During follow-up, 8 patients (7.2%) stopped PCSK9 inhibitors: 2 subjects (1.8%) for side effects certainly related to the drug (flu-like syndrome, allergic reaction), 4 for possible side effects (myalgia, abdominal pain), the remaining for other reasons. Conclusions Clinical use of PCSK9 inhibitors confirms its efficacy and safety also in the “real world” setting. LDL reduction occurs early during the treatment and shows a significant trend in further reduction during the observation period. More than 90% of subjects tolerate and persist in PCSK9 inhibitors treatment in the long-term follow-up. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Telephone-based assessment of multiple sclerosis patients at Ain Shams University Hospital in the coronavirus disease 2019 pandemic

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Mohamed A. Abdel Hafeez ◽  
Dina A. Zamzam ◽  
Mahmoud S. Swelam ◽  
Alaa Abo Steit ◽  
Janet Masoud ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Motor Impairment ◽  
University Hospital ◽  
Healthcare Facilities ◽  
Significant Difference ◽  
Study Population ◽  
Psychological Impairment ◽  
Multiple Sclerosis Patients ◽  
Post Hoc

Abstract Background Assessment of multiple sclerosis (MS) patients during the era of the coronavirus disease 2019 (COVID-19) pandemic was confronted with the overwhelmed healthcare facilities in Egypt and fear of the patients to get infected while attending the follow-up visits. This study aimed to assess the value of telephone-based assessments in the follow-up of MS patients. It includes one hundred and five patients who participated in the study and completed 3 telephone-based assessments which are the Hauser Ambulation index, Multiple Sclerosis Neuropsychology Questionnaire (MSNQ), and Symptoms of Multiple Sclerosis Scale (SMSS). Results The Hauser Ambulation index was significantly correlated with the latest Expanded Disability Status Scale (EDSS) score done within 1 month from the telephone call (r=0.738, P<0.001). The analysis of MSNQ scores showed that one-third of the study population had evidence of cognitive and/or neuropsychological impairment. Post hoc analysis regarding the cognitive and psychological impairment component of SMSS revealed that the patients who answered “Never” had significantly lower MSNQ scores compared to those who answered “Sometimes” (P=0.016), “Often” (P=0.022), and “Always” (P=0.001). The comparison of the EDSS scores of the patients regarding the sensory-motor impairment component of SMSS showed a non-significant difference. Conclusion The Hauser Ambulation index may be a reliable telephone-based tool for the assessment of physical disability. The MSNQ and the cognitive and psychological impairment component of SMSS can be used for the assessment of cognitive and psychological impairment among patients with MS.

scholarly journals Predicting conversion to multiple sclerosis in patients with radiologically isolated syndrome: a retrospective study

2021 ◽  
Vol 14 ◽  
pp. 175628642110306
Author(s):  
Panagiotis Chaloulos-Iakovidis ◽  
Franca Wagner ◽  
Lea Weber ◽  
Lara Diem ◽  
Andrew Chan ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cell Count ◽  
Immune Cell ◽  
Univariate Analysis ◽  
Prediction Score ◽  
University Hospital ◽  
Cerebellar Hemisphere ◽  
Albumin Concentration ◽  
Radiologically Isolated Syndrome

Aims: To retrospectively analyse the Bernese radiologically isolated syndrome (RIS) cohort with the goal of developing a prediction score for conversion to multiple sclerosis (MS). Methods: A total of 31 patients with RIS were identified by screening medical records of neurological patients seen at the University Hospital of Bern between 2004 and 2017 for the diagnoses ‘radiologically isolated syndrome’ and ‘RIS’ adhering to 2009 Okuda recommendations. We analysed clinical, paraclinical and magnetic resonance imaging data during a maximum follow-up period of 3 years and identified significant predictors of conversion to MS. Results: Data were available for 31 patients meeting 2009 Okuda RIS criteria. During the 3 years of follow up, 5/31 RIS patients converted to relapsing-remitting (RR) MS. In our univariate analysis, gadolinium (Gd) enhancement, brainstem and cerebellar hemisphere lesions, immune cell count and albumin concentration in cerebrospinal fluid (CSF), and anti-nuclear antibody (ANA) positivity in serum were identified as significant predictors of conversion to MS. Integrating these factors into our ‘RIS–MS prediction score’ enabled us to calculate a cut-off for prediction of conversion to MS within 3 years with high specificity [1.0, 95% confidence interval (CI) 0.84–1.00) and acceptable sensitivity (0.6, 95% CI 0.17–0.93)]. Conclusion: Our RIS–MS prediction score, if validated in an independent cohort, integrating radiological (Gd enhancement, brainstem and cerebellar hemisphere lesions) and paraclinical factors (ANA in serum, cell count and albumin in CSF) could be a useful prognostic tool for early recognition of RIS patients with a high risk of clinical progression to MS.

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