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1. Post-marketing of disease modifying drugs in multiple sclerosis: an exploratory analysis of gender effect in interferon beta treatment

Author

Trojano, M, Pellegrini, F, Paolicelli, D, Fuiani, A, Zimatore, Gb, Tortorella, C, Simone, Il, Patti, F, Ghezzi, A, Portaccio, E, Rossi, P, Pozzilli, C, Salemi, G, Lugaresi, A, Bergamaschi, R, Millefiorini, E, Clerico, Marinella, Lus, G, Vianello, M, Avolio, C, Cavalla, P, Iaffaldano, P, Direnzo, V, D'Onghia, M, Lepore, V, Livrea, P, Comi, G, Amato, Mp, Italian Multiple Sclerosis Database Network Group, Trojano, M., Pellegrini, F., Paolicelli, D., Fuiani, A., Zimatore, G., Tortorella, C., Simone, I., Patti, F., Ghezzi, A., Portaccio, E., Rossi, P., Pozzilli, C., Salemi, G., Lugaresi, A., Bergamaschi, R., Millefiorini, E., Clerico, M., Lus, Giacomo, Vianello, M., Avolio, C., Cavalla, P., Iaffaldano, P., Direnzo, V., D'Onghia, M., Lepore, V., Livrea, P., Comi, G., Amato, M., ITALIAN MULTIPLE SCLEROSIS DATABASE NETWORK, . ., Trojano M, Pellegrini F, Paolicelli D, Fuiani A, Zimatore GB, Tortorella C, Simone IL, Patti F, Ghezzi A, Portaccio E, Rossi P, Pozzilli C, Salemi G, Lugaresi A, Bergamaschi R, Millefiorini E, Clerico M, Lus G, Vianello M, Avolio C, Cavalla P, Iaffaldano P, Direnzo V, D'Onghia M, Lepore V, Livrea P, Comi G, Amato MP, M Trojano, F Pellegrini, D Paolicelli, A Fuiani, GB Zimatore, C Tortorella C, IL Simone, F Patti, A Ghezzi, E Portaccio, P Rossi, C Pozzilli, G Salemi, A Lugaresi, and on behalf of Italian Multiple Sclerosis Database Network (MSDN) group

Subjects
Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Propensity score, Disease, gender, interferon beta, multiple sclerosis, observational study, propensity score, Lower risk, Severity of Illness Index, Multiple sclerosis, Interferon beta, Gender, Observational study, Propensity score, Cohort Studies, Disability Evaluation, Young Adult, Sex Factors, gender, multiple sclerosis, treatment, interferon, Double-Blind Method, Internal medicine, Observational study, medicine, Confidence Intervals, Odds Ratio, Product Surveillance, Postmarketing, Humans, Immunologic Factors, Multiple sclerosi, Proportional Hazards Models, Expanded Disability Status Scale, Proportional hazards model, business.industry, Multiple sclerosis, Drug Administration Routes, Interferon-beta, medicine.disease, Interferon beta, Surgery, Neurology, Italy, Cohort, Propensity score matching, Regression Analysis, Settore MED/26 - Neurologia, Female, Neurology (clinical), business
Abstract

Background: There are a few and conflicting results from randomised controlled trials (RCTs) pertaining to the influence of gender in response to currently used disease modifying drugs in Multiple Sclerosis (MS). Observational studies may be especially valuable for answering effectiveness questions in subgroups not studied in RCTs. Objective: To conduct a post-marketing analysis aimed to evaluate the gender effect on Interferon beta (IFN beta) treatment response in a cohort of relapsing (RR) MS patients. Methods: A cohort of 2570 IFN beta-treated RRMS was prospectively followed for Lip to 7 years in 15 Italian MS Centers. Cox proportional hazards regression models were used to assess gender differences for risk of reaching 1st relapse and risk of progression by I point on Expanded Disability Status Scale (EDSS) score. Gender effects were also explored by a propensity score (PS) matching algorithm, and a tree-growing technique. Results: The multivariate Cox Regression analyses showed that male patients had a significant (p = 0.0097) lower risk for 1st relapse and a trend (p = 0.0897) for a higher risk to reach I point EDSS progression than females. The PS matched multivariate Cox Regression confirmed these results. The RECPAM analysis showed that male sex conferred a significant reduction in the risk for 1st relapse (HR = 0.86; 95% Cl = 0.76-0.98; p = 0.0226) in the subgroup with a low pre-treatment number of bouts, and a significant increase in the risk for I point EDSS progression (HR = 1.33; 95% Cl: 1.00-1.76; p

Published
2009

2. post marketing of disease modifying drugs in multiple sclerosis: an exploratory analysis of gender effect in intereron beta treatment

Author

TROJANO M, PELLEGRINI F, PAOLICELLI D, FUIANI A, ZIMATORE GB, TORTORELLA C, SIMONE IL, PATTI F, GHEZZI A, PORTACCIO E, ROSSI P, POZZILLI C, SALEMI G, LUGARESI A, BERGAMASCHI R, MILLEFIORINI E, CLERICO M, LUS G, VIANELLO M, AVOLIO C, CAVALLA P, IAFFALDANO P, DIRENZO V, D'ONGHIA M, LEPORE V, LIVREA P, AMATO MP, ITALIAN MULTIPLE SCLEROSIS DATABASE NETWORK GROUP, COMI , GIANCARLO, Trojano, M, Pellegrini, F, Paolicelli, D, Fuiani, A, Zimatore, Gb, Tortorella, C, Simone, Il, Patti, F, Ghezzi, A, Portaccio, E, Rossi, P, Pozzilli, C, Salemi, G, Lugaresi, A, Bergamaschi, R, Millefiorini, E, Clerico, M, Lus, G, Vianello, M, Avolio, C, Cavalla, P, Iaffaldano, P, Direnzo, V, D'Onghia, M, Lepore, V, Livrea, P, Comi, Giancarlo, Amato, Mp, and ITALIAN MULTIPLE SCLEROSIS DATABASE NETWORK, Group

Published
2009

3. rel-life impact of early interferon beta therapy in relapsing multiple sclerosis

Author

TROJANO M, PELLEGRINI F, PAOLICELLI D, FUIANI A, ZIMATORE GB, TORTORELLA C, SIMONE IL, PATTI F, GHEZZI A, ZIPOLI V, ROSSI P, POZZILLI C, SALEMI G, LUGARESI A, BERGAMASCHI R, MILLEFIORINI E, CLERICO M, LUS G, VIANELLO M, AVOLIO C, CAVALLA P, LEPORE V, LIVREA P, AMATO MP, ITALIAN MULTIPLE SCLEROISS DATABASE NETWORK MSDN GROUP, COMI , GIANCARLO, Trojano, M, Pellegrini, F, Paolicelli, D, Fuiani, A, Zimatore, Gb, Tortorella, C, Simone, Il, Patti, F, Ghezzi, A, Zipoli, V, Rossi, P, Pozzilli, C, Salemi, G, Lugaresi, A, Bergamaschi, R, Millefiorini, E, Clerico, M, Lus, G, Vianello, M, Avolio, C, Cavalla, P, Lepore, V, Livrea, P, Comi, Giancarlo, Amato, Mp, and ITALIAN MULTIPLE SCLEROISS DATABASE NETWORK MSDN, Group

Published
2009

4. Real-life impact of early interferonβ therapy in relapsing multiple sclerosis

Author

Trojano, M1, Pellegrini, F, Paolicelli, D, Fuiani, A, Zimatore, Gb, Tortorella, C, Simone, Il, Patti, F, Ghezzi, A, Zipoli, V, Rossi, P, Pozzilli, C, Salemi, G, Lugaresi, A, Bergamaschi, R, Millefiorini, E, Clerico, M, Lus, G, Vianello, M, Avolio, C, Cavalla, P, Lepore, V, Livrea, P, Comi, G, Amato, Mp, Italian Multiple Sclerosis Database Network (MSDN) Group, Di Monte, E, Iaffaldano, P, Direnzo, V, D'Onghia, M, Lo Fermo, S, Messina, S, D'Amico, E, Rizzo, A, Zaffaroni, M, Portaccio, E, Martinelli, V, Prosperini, L, Onesti, E, Aridon, P, D'Amelio, M, Ragonese, P, De Luca, G, Farina, D, Di Tommaso, V, Tavazzi, E, Bargiggia, V, Crivelli, P, Cortese, A, Di Rezze, S, Durastanti, V, Alfieri, G Rosellini I, Modesto, M, Notariello, M, and Tortorella, P.

Published
2009

6. Real-life impact of early interferon beta therapy in relapsing multiple sclerosis

Author

Trojano, M., Pellegrini, F., Paolicelli, D., Fuiani, A., Zimatore, G., Tortorella, C., Simone, I., Patti, F., Ghezzi, A., Zipoli, V., Rossi, P., Pozzilli, C., Salemi, G., Lugaresi, A., Bergamaschi, R., Millefiorini, E., Clerico, M., Lus, G., Vianello, M., Avolio, C., Cavalla, P., Lepore, V., Livrea, P., Comi, G., Amato, M., Di Monte, E., Iaffaldano, P., Direnzo, V., D'Onghia, M., Lo Fermo, S., Messina, S., D'Amico, E., Rizzo, A., Zaffaroni, M., Portaccio, E., Martinelli, V., Prosperini, L., Onesti, E., Aridon, P., D'Amelio, M., Ragonese, P., De Luca, G., Farina, D., Di Tommaso, V., Tavazzi, E., Bargiggia, V., Crivelli, P., Cortese, A., Di Rezze, S., Durastanti, V., Alfieri, G., Rosellini, I., Modesto, M., Notariello, M., Tortorella, P., Trojano M, Pellegrini F, Paolicelli D, Fuiani A, Zimatore GB, Tortorella C, Simone IL, Patti F, Ghezzi A, Zipoli V, Rossi P, Pozzilli C, Salemi G, Lugaresi A, Bergamaschi R, Millefiorini E, Clerico M, Lus G, Vianello M, Avolio C, Cavalla P, Lepore V, Livrea P, Comi G, Amato MP, Di Monte E, Iaffaldano P, Direnzo V, D'Onghia M, Lo Fermo S, Messina S, D'Amico E, Rizzo A, Zaffaroni M, Portaccio E, Martinelli V, Prosperini L, Onesti E, Aridon P, D'Amelio M, Ragonese P, De Luca G, Farina D, Di Tommaso V, Tavazzi E, Bargiggia V, Crivelli P, Cortese A, Di Rezze S, Durastanti V, Alfieri G, Rosellini I, Modesto M, Notariello M, Tortorella P, Trojano, M, Pellegrini, F, Paolicelli, D, Fuiani, A, Zimatore, Gb, Tortorella, C, Simone, Il, Patti, F, Ghezzi, A, Zipoli, V, Rossi, P, Pozzilli, C, Salemi, G, Lugaresi, Alessandra, Bergamaschi, R, Millefiorini, E, Clerico, M, Lus, G, Vianello, M, Avolio, C, Cavalla, P, Lepore, V, Livrea, P, Comi, G, and Amato, Mp

Subjects
Adult, Male, Time Factors, Multiple Sclerosis, Interferon beta, Interferon-beta, Cohort Studies, Young Adult, Multiple Sclerosis, Relapsing-Remitting, Treatment Outcome, observational study, multiple sclerosis, interferon, treatment, early, Sickness Impact Profile, Multiple Sclerosi, Quality of Life, Humans, Female, Settore MED/26 - Neurologia, Prospective Studies, Follow-Up Studies
Abstract

OBJECTIVE: Recent findings support greater efficacy of early vs. delayed interferon beta (IFNbeta) treatment in patients with a first clinical event suggestive of multiple sclerosis (MS). We aimed to evaluate the effectiveness of early IFNbeta treatment in definite relapsing-remitting MS (RRMS) and to assess the optimal time to initiate IFNbeta treatment with regard to the greatest benefits on disability progression. METHODS: A cohort of 2,570 IFNbeta-treated RRMS patients was prospectively followed for up to 7 years in 15 Italian MS Centers. A Cox proportional hazards regression model adjusted for propensity score (PS) quintiles was used to assess differences between groups of patients with early vs. delayed IFNbeta treatment on risk of reaching a 1-point progression in the Expanded Disability Status Scale (EDSS) score, and the EDSS 4.0 and 6.0 milestones. A set of PS-adjusted Cox hazards regression models were calculated according to different times of treatment initiation (within 1 year up to within 5 years from disease onset). A sensitivity analysis was performed to assess the robustness of findings. RESULTS: The lowest hazard ratios (HRs) for the three PS quintiles-adjusted models were obtained by a cutoff of treatment initiation within 1 year from disease onset. Early treatment significantly reduced the risk of reaching a 1-point progression in EDSS score (HR = 0.63; 95% CI = 0.48-0.85; p < 0.002), and the EDSS 4.0 milestone (HR = 0.56; 95% CI = 0.36-0.90; p = 0.015). Sensitivity analysis showed the bound of significance for unmeasured confounders. INTERPRETATION: Greater benefits on disability progression may be obtained by an early IFNbeta treatment in RRMS.

Published
2009

7. Fingolimod versus interferon beta/glatiramer acetate after natalizumab suspension in multiple sclerosis

Author

Iaffaldano, Pietro, Lucisano, Giuseppe, Pozzilli, Carlo, Brescia Morra, Vincenzo, Ghezzi, Angelo, Millefiorini, Enrico, Patti, Francesco, Zimatore, Giovanni Bosco, Marrosu, Maria Giovanna, Amato, Maria Pia, Bertolotto, Antonio, Bergamaschi, Roberto, Granella, Franco, Coniglio, Gabriella, Tedeschi, Gioacchino, Sola, Patrizia, Lus, Giacomo, Ferrò, Maria Teresa, Iuliano, Gerardo, Corea, Francesco, Protti, Alessandra, Cavalla, Paola, Guareschi, Angelica, Rodegher, Mariaemma, Paolicelli, Damiano, Tortorella, Carla, Lepore, Vito, Prosperini, Luca, Saccà, Francesco, Baroncini, Damiano, Comi, Giancarlo, Trojano, Maria, Italian iMed Web database, LUGARESI, ALESSANDRA, Iaffaldano, Pietro, Lucisano, Giuseppe, Pozzilli, Carlo, Brescia Morra, Vincenzo, Ghezzi, Angelo, Millefiorini, Enrico, Patti, Francesco, Lugaresi, Alessandra, Zimatore, Giovanni Bosco, Marrosu, Maria Giovanna, Amato, Maria Pia, Bertolotto, Antonio, Bergamaschi, Roberto, Granella, Franco, Coniglio, Gabriella, Tedeschi, Gioacchino, Sola, Patrizia, Lus, Giacomo, Ferrò, Maria Teresa, Iuliano, Gerardo, Corea, Francesco, Protti, Alessandra, Cavalla, Paola, Guareschi, Angelica, Rodegher, Mariaemma, Paolicelli, Damiano, Tortorella, Carla, Lepore, Vito, Prosperini, Luca, Saccà, Francesco, Baroncini, Damiano, Comi, Giancarlo, Trojano, Maria, Italian iMed-Web database, Iaffaldano, P, Lucisano, G, Pozzilli, C, Brescia Morra, V, Ghezzi, A, Millefiorini, E, Patti, F, Lugaresi, A, Zimatore, Gb, Marrosu, Mg, Amato, Mp, Bertolotto, A, Bergamaschi, R, Granella, F, Coniglio, G, Tedeschi, G, Sola, P, Lus, G, Ferrò, Mt, Iuliano, G, Corea, F, Protti, A, Cavalla, P, Guareschi, A, Rodegher, M, Paolicelli, D, Tortorella, C, Lepore, V, Prosperini, L, Saccà, F, Baroncini, D, Trojano, M, Italian iMed Web, Database, BRESCIA MORRA, Vincenzo, Sacca', Francesco, and DIPARTIMENTO DI SCIENZE BIOMEDICHE E NEUROMOTORIE

Subjects
Registrie, Male, fingolimod, glatiramer acetate, interferon beta, multiple sclerosis, natalizumab discontinuation, Adult, Cohort Studies, Drug Substitution, Drug Therapy, Combination, Female, Fingolimod Hydrochloride, Glatiramer Acetate, Humans, Immunologic Factors, Immunosuppressive Agents, Interferon-beta, Italy, Middle Aged, Multiple Sclerosis, Relapsing-Remitting, Natalizumab, Poisson Distribution, Prospective Studies, Regression Analysis, Treatment Outcome, Registries, Medicine (all), Arts and Humanities (miscellaneous), Neurology (clinical), Relapsing-Remitting, Rate ratio, Gastroenterology, Immunosuppressive Agent, Immunologic Factor, Medicine, Prospective cohort study, Hazard ratio, Fingolimod, multiple sclerosi, Combination, medicine.drug, Human, medicine.medical_specialty, Multiple Sclerosis, Regression Analysi, Drug Therapy, Internal medicine, Glatiramer acetate, business.industry, Multiple sclerosis, medicine.disease, fingolimod, multiple sclerosis, Surgery, Prospective Studie, Cohort Studie, business
Abstract

none 34 no studio multicentrico The comparative effectiveness of fingolimod versus interferon beta/glatiramer acetate was assessed in a multicentre, observational, prospectively acquired cohort study including 613 patients with relapsing multiple sclerosis discontinuing natalizumab in the Italian iMedWeb registry. First, after natalizumab suspension, the relapse risk during the untreated wash-out period and during the course of switch therapies was estimated through Poisson regression analyses in separated models. During the wash-out period an increased risk of relapses was found in patients with a higher number of relapses before natalizumab treatment (incidence rate ratio = 1.31, P = 0.0014) and in patients discontinuing natalizumab due to lack of efficacy (incidence rate ratio = 2.33, P = 0.0288), patient's choice (incidence rate ratio = 2.18, P = 0.0064) and adverse events (incidence rate ratio = 2.09, P = 0.0084). The strongest independent factors influencing the relapse risk after the start of switch therapies were a wash-out duration longer than 3 months (incidence rate ratio = 1.78, P < 0.0001), the number of relapses experienced during and before natalizumab treatment (incidence rate ratio = 1.61, P < 0.0001; incidence rate ratio = 1.13, P = 0.0118, respectively) and the presence of comorbidities (incidence rate ratio = 1.4, P = 0.0097). Switching to fingolimod was associated with a 64% reduction of the adjusted-risk for relapse in comparison with switching to interferon beta/glatiramer acetate (incidence rate ratio = 0.36, P < 0.0001). Secondly, patients who switched to fingolimod or to interferon beta/glatiramer acetate were propensity score-matched on a 1-to-1 basis at the switching date. In the propensity score-matched sample a Poisson model showed a significant lower incidence of relapses in patients treated with fingolimod in comparison with those treated with interferon beta/glatiramer acetate (incidence rate ratio = 0.52, P = 0.0003) during a 12-month follow-up. The cumulative probability of a first relapse after the treatment switch was significantly lower in patients receiving fingolimod than in those receiving interferon beta/glatiramer acetate (P = 0.028). The robustness of this result was also confirmed by sensitivity analyses in subgroups with different wash-out durations (less or more than 3 months). Time to 3-month confirmed disability progression was not significantly different between the two groups (Hazard ratio = 0.58; P = 0.1931). Our results indicate a superiority of fingolimod in comparison to interferon beta/glatiramer acetate in controlling disease reactivation after natalizumab discontinuation in the real life setting. none Iaffaldano, Pietro; Lucisano, Giuseppe; Pozzilli, Carlo; Brescia Morra, Vincenzo; Ghezzi, Angelo; Millefiorini, Enrico; Patti, Francesco; Lugaresi, Alessandra; Zimatore, Giovanni Bosco; Marrosu, Maria Giovanna; Amato, Maria Pia; Bertolotto, Antonio; Bergamaschi, Roberto; Granella, Franco; Coniglio, Gabriella; Tedeschi, Gioacchino; Sola, Patrizia; Lus, Giacomo; Ferrò, Maria Teresa; Iuliano, Gerardo; Corea, Francesco; Protti, Alessandra; Cavalla, Paola; Guareschi, Angelica; Rodegher, Mariaemma; Paolicelli, Damiano; Tortorella, Carla; Lepore, Vito; Prosperini, Luca; Saccà, Francesco; Baroncini, Damiano; Comi, Giancarlo; Trojano, Maria; Italian iMed-Web database Iaffaldano, Pietro; Lucisano, Giuseppe; Pozzilli, Carlo; Brescia Morra, Vincenzo; Ghezzi, Angelo; Millefiorini, Enrico; Patti, Francesco; Lugaresi, Alessandra; Zimatore, Giovanni Bosco; Marrosu, Maria Giovanna; Amato, Maria Pia; Bertolotto, Antonio; Bergamaschi, Roberto; Granella, Franco; Coniglio, Gabriella; Tedeschi, Gioacchino; Sola, Patrizia; Lus, Giacomo; Ferrò, Maria Teresa; Iuliano, Gerardo; Corea, Francesco; Protti, Alessandra; Cavalla, Paola; Guareschi, Angelica; Rodegher, Mariaemma; Paolicelli, Damiano; Tortorella, Carla; Lepore, Vito; Prosperini, Luca; Saccà, Francesco; Baroncini, Damiano; Comi, Giancarlo; Trojano, Maria; Italian iMed-Web database

Published
2015

8. Safety of the first dose of fingolimod for multiple sclerosis: results of an open-label clinical trial

Author

Laroni A., Brogi D., Morra V. B., Guidi L., Pozzilli C., Comi G., Lugaresi A., Turrini R., Raimondi D., Uccelli A., Mancardi G. L., Amato M. P., Appendino L., Ardito B., Avolio C., Bandini F., Batocchi A. P., Bellantonio P., Benedetti M. D., Bergamaschi R., Bortolon F., Bosco A., Buccafusca M., Cargnelutti D., Cavalla P., Cavallo R., Centonze D., Coniglio M. G., Costantino G., Cottone S., Danni M. C., De Robertis F., Deotto L., Dotta M., Di Battista G., Filippi M. M., Florio C., Francia A., Galgani S., Gallo P., Ghezzi A., Giometto B., Giuliani G., Grimaldi L. M. E., Guidotti M., Iudice A., Lenzi G. L., Lorusso L., Lus G., Maimone D., Malentacchi G. M., Mantegazza R. E., Massacesi L., Melato M., Millefiorini E., Montanari E., Patti F., Perrone P. S. M., Protti A., Provera P., Quattrone A., Rasi F., Rosati G., Rovaris M., Sacca F., Salemi G., Sarchielli P., Scarpini E. A., Schoenhuber R., Serrati C., Sinisi L., Sola P., Spitaleri D. L. A., Tedeschi G., Tezzon F., Tinebra Asti M. C., Tola M. R., Totaro R., Trojano M., Ulivelli M., Vecchio M. M., Zimatore G. B., Alice Laroni, Davide Brogi, Vincenzo Brescia Morra, Leonello Guidi, Carlo Pozzilli, Giancarlo Comi, Alessandra Lugaresi, Renato Turrini, Debora Raimondi, Antonio Uccelli, Giovanni Mancardi, EAP Investigators, Laroni, A, Brogi, D, BRESCIA MORRA, Vincenzo, Guidi, L, Pozzilli, C, Comi, G, Lugaresi, A, Turrini, R, Raimondi, D, Uccelli, A, Macardi, G., Laroni A, Brogi D, Morra VB, Guidi L, Pozzilli C, Comi G, Lugaresi A, Turrini R, Raimondi D, Uccelli A, Mancardi GL, Amato MP, Appendino L, Ardito B, Avolio C, Bandini F, Batocchi AP, Bellantonio P, Benedetti MD, Bergamaschi R, Bortolon F, Bosco A, Buccafusca M, Cargnelutti D, Cavalla P, Cavallo R, Centonze D, Coniglio MG, Costantino G, Cottone S, Danni MC, De Robertis F, Deotto L, Dotta M, Di Battista G, Filippi MM, Florio C, Francia A, Galgani S, Gallo P, Ghezzi A, Giometto B, Giuliani G Grimaldi LME, Guidotti M, Iudice A, Lenzi GL, Lorusso L, Lus G, Maimone D, Malentacchi GM, Mantegazza RE, Massacesi L, Melato M, Millefiorini E, Montanari E, Patti F, Perrone PSM, Protti A, Provera P, Quattrone A, Rasi F, Rosati G, Rovaris M, Saccà F, Salemi G, Sarchielli P, Scarpini EA, Schoenhuber R, Serrati C, Sinisi L, Sola P, Spitaleri DLA, Tedeschi G, Tezzon F, Tinebra Asti MC, Tola MR, Totaro R, Trojano M, Ulivelli M, Vecchio MM, Zimatore GB, Laroni, A., Brogi, D., Morra, V. B., Guidi, L., Pozzilli, C., Comi, G., Lugaresi, A., Turrini, R., Raimondi, D., Uccelli, A., Mancardi, G. L., Amato, M. P., Appendino, L., Ardito, B., Avolio, C., Bandini, F., Batocchi, A. P., Bellantonio, P., Benedetti, M. D., Bergamaschi, R., Bortolon, F., Bosco, A., Buccafusca, M., Cargnelutti, D., Cavalla, P., Cavallo, R., Centonze, D., Coniglio, M. G., Costantino, G., Cottone, S., Danni, M. C., De Robertis, F., Deotto, L., Dotta, M., Di Battista, G., Filippi, M. M., Florio, C., Francia, A., Galgani, S., Gallo, P., Ghezzi, A., Giometto, B., Giuliani, G., Grimaldi, L. M. E., Guidotti, M., Iudice, A., Lenzi, G. L., Lorusso, L., Lus, G., Maimone, D., Malentacchi, G. M., Mantegazza, R. E., Massacesi, L., Melato, M., Millefiorini, E., Montanari, E., Patti, F., Perrone, P. S. M., Protti, A., Provera, P., Quattrone, A., Rasi, F., Rosati, G., Rovaris, M., Sacca, F., Salemi, G., Sarchielli, P., Scarpini, E. A., Schoenhuber, R., Serrati, C., Sinisi, L., Sola, P., Spitaleri, D. L. A., Tedeschi, G., Tezzon, F., Tinebra Asti, M. C., Tola, M. R., Totaro, R., Trojano, M., Ulivelli, M., Vecchio, M. M., Zimatore, G. B., Mancardi, Gl, Brescia Morra, V, on behalf of the EAP, Investigator, and Giometto, B

Subjects
Oncology, Male, Neurology, fingolimod, multiple sclerosis, treatment, first dose, safety, administration /&/ dosage/adverse effects/analogs /&/ derivatives/therapeutic use, Immunosuppressive Agent, Sphingosine, Multiple Sclerosi, Atrioventricular Block, administration /&/ dosage/adverse effects/therapeutic use, General Medicine, Middle Aged, Tolerability, Propylene Glycol, Fingolimod, drug therapy, Anesthesia, Cohort, Adolescent, Adult, Atrioventricular Block, chemically induced/epidemiology, Drug Therapy, Combination, Female, Humans, Immunosuppressive Agents, administration /&/ dosage/adverse effects/therapeutic use, Male, Middle Aged, Multiple Sclerosis, drug therapy, Propylene Glycols, administration /&/ dosage/adverse effects/therapeutic use, Sphingosine, administration /&/ dosage/adverse effects/analogs /&/ derivatives/therapeutic use, Young Adult, Combination, Drug Therapy, Combination, Settore MED/26 - Neurologia, Female, Atrioventricular block, Bradycardia, Multiple sclerosis, Safety, Adolescent, Adult, Fingolimod Hydrochloride, Humans, Immunosuppressive Agents, Multiple Sclerosis, Propylene Glycols, Young Adult, Neurology (clinical), Atrioventricular block, Bradicardia, Multiple sclerosis, Fingolimod, Safety Tolerability, Research Article, Human, medicine.drug, medicine.medical_specialty, Clinical Neurology, Internal medicine, medicine, Neurochemistry, business.industry, medicine.disease, Clinical trial, Atrioventricular block, Bradycardia, Multiple sclerosis, Fingolimod, Safety, Tolerability, chemically induced/epidemiology, business
Abstract

BACKGROUND: In patients with relapsing-remitting MS (RRMS) fingolimod prevents disease relapses and delays disability progression. First dose administration of fingolimod is associated with a transient, dose-dependent decrease in heart rate (HR) in the 6 hours after drug intake.The aim of the study is to to assess safety and tolerability of the first dose of fingolimod in a cohort of Italian patients with RRMS without alternative therapeutic options. METHODS: Open-label, single arm, multicentre study. After the first dose of fingolimod, patients were observed for 6 hours and had their vital signs monitored hourly. Extended on-site monitoring was provided when required. RESULTS: Of the 906 patients enrolled in the study, most (95.2%) did not experience any adverse event (AE) following fingolimod administration. Cardiovascular AEs occurred in 18 patients and included bradycardia (1.3%), first-and second-degree atrioventricular block (0.1% and 0.2%), palpitations (0.1%), sinus arrhythmia (0.1%) and ventricular premature beats (0.1%). All events were self-limiting and did not require any intervention. Extended monitoring was required in 34 patients. CONCLUSIONS: These results, in a population who better resembled real-world clinical practice in terms of concomitant diseases and medications, are consistent with previous clinical trials and confirmed that the first dose administration of fingolimod is generally safe and well tolerated. TRIAL REGISTRATION: EudraCT 2011-000770-60.

Published
2014

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