25 results on '"Montalban, X"'
Search Results
2. Factors associated with treatment escalation among MS specialists and general neurologists: Results from an International cojoint study
- Author
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Saposnik, G., primary, Andhavarapu, S., additional, Fernández, Ó., additional, Kim, H.J., additional, Wiendl, H., additional, Foss, M., additional, Zuo, F., additional, Havrdová, E.K., additional, Celius, E., additional, Caceres, F., additional, Magyari, M., additional, Bermel, R., additional, Costa, A., additional, Terzaghi, M., additional, Kalincik, T., additional, Popescu, V., additional, Amato, M.P., additional, Montalban, X., additional, and Oh, J., additional
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- 2022
- Full Text
- View/download PDF
3. Long-term safety data from the cladribine tablets clinical development program in multiple sclerosis
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Leist, T., primary, Cook, S., additional, Comi, G., additional, Montalban, X., additional, Giovannoni, G., additional, Nolting, A., additional, Damian, D., additional, Syed, S., additional, and Galazka, A., additional
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- 2020
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4. Hemophagocytic syndrome following alemtuzumab treatment for multiple sclerosis: A case report
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Romero, A., primary, Midaglia, L., additional, Salcedo, M.T., additional, Viladomiu, L., additional, Guillén, E., additional, Bajaña, I., additional, Escolà-Vergé, L., additional, Tintoré, M., additional, Montalban, X., additional, and Len, O., additional
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- 2020
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5. Safety of Ocrelizumab in Multiple Sclerosis: Updated Analysis in Patients with Relapsing and Primary progressive Multiple Sclerosis
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Hauser, S.L., primary, Kappos, L., additional, Montalban, X., additional, Hughes, R., additional, Koendgen, H., additional, McNamara, J., additional, Pradhan, A., additional, WorMSer, D., additional, and Wolinsky, J.S., additional
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- 2018
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6. Long-term Reduction of Relapse Rate and Confirmed Disability progression after 5 years of Ocrelizumab Treatment in Patients with Relapsing Multiple Sclerosis
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Hauser, S.L., primary, Brochet, B., additional, Montalban, X., additional, Naismith, R.T., additional, Wolinsky, J.S., additional, Manfrini, M., additional, Garas, M., additional, Villoslada, P., additional, Model, F., additional, Hubeaux, S., additional, and Kappos, L., additional
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- 2018
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7. Pregnancy Outcomes During the Clinical Development of Cladribine in Multiple Sclerosis: An Integrated Analysis of Safety
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Galazka, A., primary, Nolting, A., additional, Cook, S., additional, Leist, T., additional, Comi, G., additional, Montalban, X., additional, Hicking, C., additional, and Dangond, F., additional
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- 2018
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- View/download PDF
8. Sustained Reduction in Confirmed Disability Progression in Patients with Primary Progressive Multiple Sclerosis Treated with Ocrelizumab in the Open-label Extension Period of the Phase III ORATORIO trial
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Hauser, S.L., primary, Wolinsky, J.S., additional, Brochet, B., additional, Montalban, X., additional, Naismith, R.T., additional, Manfrini, M., additional, Garas, M., additional, Villoslada, P., additional, Model, F., additional, Hubeaux, S., additional, and Kappos, L., additional
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- 2018
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9. No Increase in Malignancy Risk with Cladribine Tablets in Patients with Relapsing Multiple Sclerosis
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Galazka, A., primary, Nolting, A., additional, Cook, S., additional, Leist, T., additional, Comi, G., additional, Montalban, X., additional, Hicking, C., additional, and Dangond, F., additional
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- 2018
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10. Long-term Reduction in Brain MRI Disease Activity and Atrophy after 5 years of Ocrelizumab Treatment in Patients with Relapsing Multiple Sclerosis
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Arnold, D.L., primary, Kappos, L., additional, Hauser, S.L., additional, Montalban, X., additional, Traboulsee, A., additional, Wolinsky, J.S., additional, Manfrini, M., additional, Levesque, V., additional, Villoslada, P., additional, Belachew, S., additional, Model, F., additional, Hubeaux, S., additional, and Bar-Or, A., additional
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- 2018
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11. Phase 2 BOLD extension study efficacy results for siponimod (BAF312) in patients with relapsing-remitting multiple sclerosis
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Stuve, O., primary, Hartung, H.P., additional, Freedman, M., additional, Li, D., additional, Hemmer, B., additional, Kappos, L., additional, Rieckmann, P., additional, Montalban, X., additional, Ziemssen, T., additional, and Selmaj, K., additional
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- 2014
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12. Efficacy and safety of Alemtuzumab in treatment-naive patients with relapsing-remitting multiple sclerosis: Four-year follow-up of the Care-MS I study
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Montalban, X., primary, Inshasi, J.S., additional, Coles, A.J., additional, Hartung, H.P., additional, Havrdova, E., additional, Selmaj, K.W., additional, Margolin, D.H., additional, Palmer, J., additional, and Oyuela, P., additional
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- 2014
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13. P058 - Efficacy and safety of Alemtuzumab in treatment-naive patients with relapsing-remitting multiple sclerosis: Four-year follow-up of the Care-MS I study
- Author
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Montalban, X., Inshasi, J.S., Coles, A.J., Hartung, H.P., Havrdova, E., Selmaj, K.W., Margolin, D.H., Palmer, J., and Oyuela, P.
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- 2014
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14. P041 - Phase 2 BOLD extension study efficacy results for siponimod (BAF312) in patients with relapsing-remitting multiple sclerosis
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Stuve, O., Hartung, H.P., Freedman, M., Li, D., Hemmer, B., Kappos, L., Rieckmann, P., Montalban, X., Ziemssen, T., and Selmaj, K.
- Published
- 2014
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15. Factors associated with treatment escalation among MS specialists and general neurologists: Results from an International cojoint study
- Author
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Saposnik, G., Andhavarapu, S., Fernández, Ó., Kim, H.J., Wiendl, H., Foss, M., Zuo, F., Havrdová, E.K., Celius, E., Caceres, F., Magyari, M., Bermel, R., Costa, A., Terzaghi, M., Kalincik, T., Popescu, V., Amato, M.P., Montalban, X., and Oh, J.
- Abstract
•Therapeutic inertia (TI) is a common phenomenon affecting over 50% of neurologists who manage patients with multiple sclerosis (pwMS).•Factors associated with TI are not well understood.•In a study comprising 229 neurologist with expertise in the management of pwMS, the top 3 weighted factors associated with treatment escalation were: previous relapses (20%), baseline expanded disability status scale [EDSS] (18%), and MRI activity (13%).•Factors associated with treatment escalation differ between MS specialists and non-MS specialists.
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- 2021
- Full Text
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16. Treatment satisfaction, safety, and tolerability of cladribine tablets in patients with highly active relapsing multiple sclerosis
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Konrad Rejdak, Jeannette Lechner-Scott, Krzysztof Selmaj, Alessandra Solari, Eva Havrdova, Martin Vališ, Nektaria Alexandri, Raymond Hupperts, Fredrik Piehl, Bruno Brochet, Xavier Montalban, Birgit Keller, Axel Nolting, Dawn Langdon, Francesco Patti, MUMC+: MA Med Staf Spec Neurologie (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Klinische Neurowetenschappen, Institut Català de la Salut, [Brochet B] INSERM U 1215, University of Bordeaux, Bordeaux, France. [Hupperts R] Department of Psychology, Royal Holloway, University of London, Egham, United Kingdom. [Langdon D] Department of Psychology, Royal Holloway, University of London, Egham, United Kingdom. [Solari A] Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. [Piehl F] Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. [Lechner-Scott J] University of Newcastle, Newcastle, NSW, Australia. Division of Neurology, John Hunter Hospital, Newcastle, NSW, Australia. [Montalban X] Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (CEMCAT), Barcelona, Spain. Vall d'Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
Immunosuppressive Agents/adverse effects ,Personal Satisfaction ,Relapsing-Remitting ,Other subheadings::Other subheadings::/drug therapy [Other subheadings] ,DISEASE ,Quality of life ,Cladribine tablets ,Nervous System Diseases::Autoimmune Diseases of the Nervous System::Demyelinating Autoimmune Diseases, CNS::Multiple Sclerosis::Multiple Sclerosis, Relapsing-Remitting [DISEASES] ,Prospective Studies ,Cladribine ,education.field_of_study ,Cumulative dose ,General Medicine ,enfermedades del sistema nervioso::enfermedades autoinmunitarias del sistema nervioso::enfermedades autoinmunes desmielinizantes del SNC::esclerosis múltiple::esclerosis múltiple recurrente-remitente [ENFERMEDADES] ,Neurology ,Tolerability ,Local ,Patient Satisfaction ,Cohort ,Female ,Immunosuppressive Agents ,Qualitat de vida - Avaluació ,medicine.drug ,Tablets ,Adult ,medicine.medical_specialty ,Multiple Sclerosis ,Pacients - Satisfacció ,Population ,Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores] ,Multiple Sclerosis, Relapsing-Remitting ,Internal medicine ,medicine ,Humans ,education ,Adverse effect ,Treatment satisfaction ,business.industry ,Multiple Sclerosis, Relapsing-Remitting/drug therapy ,Interim analysis ,Cladribine/adverse effects ,Neoplasm Recurrence ,Relapsing multiple sclerosis ,Quality of Life ,Neurology (clinical) ,Neoplasm Recurrence, Local ,business ,Esclerosi múltiple - Tractament ,Relapsing-Remitting/drug therapy - Abstract
Cladribine tablets; Relapsing multiple sclerosis; Treatment satisfaction Comprimidos de cladribina; Esclerosis múltiple recurrente; Satisfacción con el tratamiento Comprimits de cladribina; Esclerosi múltiple recurrent; Satisfacció amb el tractament Background Multiple sclerosis (MS) is a chronic disabling disease that is associated with negative effects on health-related quality of life (HRQoL) due to reduced physical and psychosocial functioning. Cladribine tablets 10 mg (3.5 mg/kg cumulative dose over 2 years) have been approved for the treatment of adult patients with highly active relapsing multiple sclerosis (RMS). The ongoing CLARIFY-MS study (NCT03369665; EudraCT number: 2017-002632-17) aims to assess the effect of cladribine tablets 3.5 mg/kg on HRQoL of patients with highly active RMS. Objective To report on the design of the CLARIFY-MS study, baseline patient characteristics, and results of a pre-planned interim analysis focusing on treatment satisfaction, safety, and tolerability that includes all data reported till 6 months after start of treatment. Methods The CLARIFY-MS study is a 2-year, open-label, single-arm, prospective, multicenter, phase IV study. Eligible patients with highly active RMS were assigned to receive cladribine tablets 3.5 mg/kg over 2 years. Treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM, v1.4; scale range from 0 to 100, higher values indicating higher satisfaction). Safety assessments, including occurrence of treatment-emergent adverse events (TEAEs; any adverse event reported after drug administration), serious adverse events (SAEs), and lymphocyte counts, were summarized descriptively. Results A total of 482 patients from 85 sites in Europe were treated with cladribine tablets. Mean patient age was 37.4 years, 338 (70.1%) were women, median EDSS was 2.5, and 345 (71.6%) were prior users of disease-modifying therapy (DMT). During the first 6 months after the start of treatment, and before reaching the full dose of cladribine tablets, mean TSQM global satisfaction score for the overall population was 70.4 (standard deviation, ± 18.48). The side effects score was 91.9 (± 17.68), convenience scored 86.6 (± 13.57), and effectiveness was 65.8 (± 21.14). A total of 275 patients (57.1%) reported at least one TEAE and 9 patients (1.9%) had a SAE. The majority of observed lymphopenia cases were of grade 1 or 2; 33 (6.8%) of the total study cohort had grade 3 lymphopenia, and no grade 4 lymphopenia was reported. Conclusion Patients reported high treatment satisfaction (TSQM) with cladribine tablets in this pre-planned interim analysis at 6 months. Few serious, and no unexpected, adverse events were reported, and there were no instances of grade 4 lymphopenia over the first 6 months. These preliminary data indicate good tolerability and convenience of administration of cladribine tablets in patients with highly active RMS. This study was sponsored by Merck Healthcare KGaA, Darmstadt, Germany
- Published
- 2022
17. Ozanimod in relapsing multiple sclerosis: Pooled safety results from the clinical development program
- Author
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Ludwig Kappos, Bruce A.C. Cree, Ning Ding, Jeffrey A. Cohen, Hans-Peter Hartung, Amit Bar-Or, Eva Havrdova, Giancarlo Comi, Krzysztof Selmaj, Xavier Montalban, Douglas L. Arnold, James K Sheffield, Neil Minton, Lawrence Steinman, Institut Català de la Salut, [Selmaj KW] Center for Neurology, 90-324 Łódź, Poland and Collegium Medicum, Department of Neurology, University of Warmia and Mazury, 11-082 Olsztyn, Poland. [Cohen JA] Department of Neurology, Mellen Center for MS Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, 44195, USA. [Comi G] Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy. [Bar-Or A] Center for Neuroinflammation and Experimental Therapeutics, and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA. [Arnold DL] NeuroRx Research and Montréal Neurological Institute, McGill University, Montreal, Quebec, H3A 2B4, Canada. [Steinman L] Department of Neurology and Neurological Sciences, Beckman Center for Molecular Medicine, Stanford University Medical Center, Stanford, California 94305, USA. [Montalban X] Servei de Neurologia-Neuroimmunologia, Centre d’Esclerosi Múltiple de Catalunya (CEMCAT), Barcelona, Spain. Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
medicine.medical_specialty ,Multiple Sclerosis ,Immune System Diseases::Autoimmune Diseases::Autoimmune Diseases of the Nervous System::Demyelinating Autoimmune Diseases, CNS::Multiple Sclerosis::Multiple Sclerosis, Relapsing-Remitting [DISEASES] ,Population ,Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores] ,Other subheadings::Other subheadings::/drug therapy [Other subheadings] ,Pulmonary function testing ,Multiple sclerosis ,Ozanimod ,03 medical and health sciences ,Multiple Sclerosis, Relapsing-Remitting ,Clinical trials ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,education ,Macular edema ,enfermedades del sistema inmune::enfermedades autoinmunes::enfermedades autoinmunitarias del sistema nervioso::enfermedades autoinmunes desmielinizantes del SNC::esclerosis múltiple::esclerosis múltiple recurrente-remitente [ENFERMEDADES] ,Oxadiazoles ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,diagnóstico::pronóstico::resultado del tratamiento [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,General Medicine ,Diagnosis::Prognosis::Treatment Outcome [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,medicine.disease ,Clinical trial ,Neurology ,Adverse events ,Pharmacodynamics ,Indans ,Avaluació de resultats (Assistència sanitària) ,Neurology (clinical) ,Safety ,business ,Esclerosi múltiple - Tractament ,030217 neurology & neurosurgery - Abstract
Esdeveniments adversos; Esclerosi múltiple; Ozanimod Eventos adversos; Esclerosis múltiple; Ozanimod Adverse events; Multiple sclerosis; Ozanimod Background Ozanimod, an oral sphingosine 1-phosphate receptor 1 and 5 modulator, is approved in multiple countries for the treatment of relapsing multiple sclerosis (RMS). In phase 3 trials, ozanimod was well tolerated and superior to interferon beta-1a 30 µg once-weekly in reducing clinical and radiologic disease activity. The objective of this integrated safety analysis was to evaluate the safety of extended ozanimod exposure in participants with RMS from all clinical trials and compare it with phase 3 trial data. Methods We report pooled incidence and study duration‒adjusted incidence rates (IR) of treatment-emergent adverse events (TEAEs) from an interim data cut (January 31, 2019) of RMS participants treated with ozanimod. Data were pooled from a phase 1 pharmacokinetic/pharmacodynamic trial, a placebo-controlled phase 2 trial with dose-blinded extension, 2 large active-controlled phase 3 trials, and an open-label extension (OLE). Results were compared with pooled phase 3 trial data. Results At the data cutoff, 2631 RMS participants had exposure to ozanimod 0.92 mg (mean 32.0 months) and 2787 had exposure to either ozanimod 0.46 or 0.92 mg (mean 37.1 months). The IRs per 1000 person-years (PY) for any TEAE (772.2) and serious TEAEs (33.2) in the overall population were similar to those in the phase 3 population (896.1 and 31.2, respectively). There were no serious opportunistic infections. There were no second-degree or higher atrioventricular blocks on electrocardiogram. Hepatic enzyme elevations declined over time. Malignancy rates remained low with longer exposure. Pulmonary function tests showed minimal reductions in lung function. Seven ozanimod-treated participants with comorbid risk factors had confirmed macular edema, including 3 in the ongoing OLE. Conclusions Safety results in this larger RMS population with greater ozanimod exposure demonstrated no new safety concerns and were consistent with phase 3 trial results.
- Published
- 2021
18. Validation of the Spanish version of DYsphagia in MUltiple Sclerosis questionnaire (DYMUS).
- Author
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Renom M, Galán I, Vidal X, Aldevert M, Curto G, Feliu P, García I, Gonzalo L, Sibera X, Anglada E, Meza R, García M, Najas V, Mongay-Ochoa N, Arévalo MJ, Vidal-Jordana Á, Tintoré M, Bascuñana H, Montalban X, Terré R, and Sastre-Garriga J
- Subjects
- Humans, Reproducibility of Results, Pilot Projects, Surveys and Questionnaires, Psychometrics, Deglutition Disorders etiology, Deglutition Disorders complications, Multiple Sclerosis complications, Multiple Sclerosis diagnosis
- Abstract
Background: Dysphagia is a common symptom in multiple sclerosis that can occur even early in the disease course and can lead to serious complications. Early recognition and treatment can promote comfort, safety and optimal nutritional status. Few dysphagia rating scales are available in Spanish. The aim of this study was to translate the Dysphagia in Multiple Sclerosis Questionnaire (DYMUS) into Spanish and to validate it., Methods: Forward and backward translation method was used to translate the original English version of DYMUS into Spanish. A pilot-study with 10 PwMS was carried on in order to improve the intelligibility of the instrument, comprehensibility and content validity of the questionnaire. The questionnaire was filled out by 100 PwMS who were asked a dichotomous question on their swallowing ("Do you have swallowing troubles?"). Descriptive data are presented as median and quartiles for continuous variables and frequency and percentage for categorical ones. Internal consistency reliability was estimated by Cronbach's alfa. Test-retest reliability was estimated by intraclass correlation coefficient. Concurrent validity with a speech and language therapy assessment (SLT-A) was measured with the weighted kappa statistic for the concordance for both dysphagia type and degree categories. Confirmatory factor analysis by means of structural equation models was used to verify the two-factor (solids and liquids) structure of the DYMUS questionnaire. As the goodness of fit evaluation was poor, an additional exploratory factor analysis was carried out., Results: Internal consistency was high. The globus sensation question and the weight loss questions (item 3 and 10) are the least specific with dysphagia symptomatology so they are worst correlated with the sum of the others (item-rest correlation, 0.243 and 0.248, respectively). The test-retest reliability of the DYMUS among 40 patients using ICC was 0.75 (95% CI 0.57 - 0.86). Concurrent validity with SLT-A was poor (weighted kappa 0.37 for dysphagia type and 0.38 for dysphagia degree). The DYMUS questionnaire detected three times more dysphagia (53% versus 17%) than the dichotomous question. Confirmatory factors analysis failed to confirm the bidimensional structure (solid and liquid items) often reported in other validation studies. The subsequent exploratory factor analysis also identified two factors, but with poor interpretability., Conclusion: DYMUS-SP scale is not a sufficiently useful scale to detect dysphagia in PwMS due to the poor concurrent validity and the probable overdiagnosis of the condition; however, it can be helpful as a screening tool when combined with other measures., Competing Interests: Declaration of Competing Interest Mar Tintoré has received compensation for consulting services, speaking honoraria and research support from Almirall, Bayer Schering Pharma, Biogen-Idec, Genzyme, Janssen, Merck-Serono, Novartis, Roche, Sanofi-Aventis, Viela Bio and Teva Pharmaceuticals. Data Safety Monitoring Board for Parexel and UCB Biopharma, (Copyright © 2023. Published by Elsevier B.V.)
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- 2023
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19. The agenda of the global patient reported outcomes for multiple sclerosis (PROMS) initiative: Progresses and open questions.
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Zaratin P, Vermersch P, Amato MP, Brichetto G, Coetzee T, Cutter G, Edan G, Giovannoni G, Gray E, Hartung HP, Hobart J, Helme A, Hyde R, Khan U, Leocani L, Mantovani LG, McBurney R, Montalban X, Penner IK, Uitdehaag BMJ, Valentine P, Weiland H, Bertorello D, Battaglia MA, Baneke P, and Comi G
- Subjects
- Health Personnel, Humans, Patient Reported Outcome Measures, Multiple Sclerosis therapy
- Abstract
On 12 September 2019, the global Patient Reported Outcome for Multiple Sclerosis (PROMS) Initiative was launched at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). The multi-stakeholder PROMS Initiative is jointly led by the European Charcot Foundation (ECF) and the Multiple Sclerosis International Federation (MSIF), with the Italian Multiple Sclerosis Society (AISM) acting as the lead agency for and on behalf of the global MSIF movement. The initiative has the ambitious mission to (i) maximize the impact of science with and of patient input on the life of people affected by MS, and (ii) to represent a unified view on Patient-Reported Outcomes for MS to people affected by MS, healthcare providers, regulatory agencies and Health Technologies Assessments agencies. Equipped with an innovative participatory governance of an international and interdisciplinary network of different stakeholders, PROMS has the potential to guide future breakthroughs in MS patient-focused research and care. In this paper we present the progresses of the global PROMS Initiative and discuss the open questions that we aim to address., (Copyright © 2022 Elsevier B.V. All rights reserved.)
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- 2022
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20. Effect of desire for pregnancy on decisions to escalate treatment in multiple sclerosis care: Differences between MS specialists and non-MS specialists.
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Saposnik G, Andhavarapu S, Fernández Ó, Kim HJ, Wiendl H, Foss M, Zuo F, Havrdová EK, Celius EG, Caceres F, Magyari M, Bermel R, Costa A, Terzaghi M, Kalincik T, Popescu V, Amato MP, Montalban X, and Oh J
- Subjects
- Adult, Female, Humans, Middle Aged, Neurologists, Pregnancy, Specialization, Multiple Sclerosis drug therapy
- Abstract
Background: Therapeutic inertia (TI) is a worldwide phenomenon that affects 60 to 90% of neurologists and up to 25% of daily treatment decisions during management of multiple sclerosis (MS) patients. A large volume of MS patients are women of childbearing age, and desire for pregnancy is a complex variable often affecting MS care. The objective of this study was to determine the effect of desire for pregnancy on decisions to escalate treatment during management of MS patients., Methods: 300 neurologists with expertise in MS from 20 countries were invited to participate in the study. Participants were presented with 12 pairs of simulated MS patient profiles reflective of case scenarios encountered in clinical practice. Participants were asked to select the ideal candidate for treatment escalation from modest to higher-efficacy therapies. Disaggregated discrete choice experiments were used to estimate the weight of factors and attributes affecting physicians' decisions when considering treatment selection. An excel calculator that provides estimates as the percentage of participants that would escalate treatment for a simulated case-scenario was constructed., Results: 229 (76.3%) completed the study. The mean age (SD) of study participants was 44 (±10) years. The mean (SD) number of MS patients seen per month by each neurologist was 18 (±16). Non-MS specialists were significantly less likely to escalate treatment than MS specialists across mild, moderate, and severe patient cases. These differences were accentuated when case scenarios introduced a desire for pregnancy. The findings were consistent when MRI-lesions, severity of symptoms, and number of relapses were included., Conclusions: Desire for pregnancy differentially influences decisions to escalate treatment, suggesting knowledge-to-action gaps between MS and non-MS specialists. Our findings indicate the need for educational strategies to overcome these gaps and improve clinical outcomes for MS patients who desire pregnancy., (Copyright © 2021 Elsevier B.V. All rights reserved.)
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- 2022
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21. Treatment satisfaction, safety, and tolerability of cladribine tablets in patients with highly active relapsing multiple sclerosis: CLARIFY-MS study 6-month interim analysis.
- Author
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Brochet B, Hupperts R, Langdon D, Solari A, Piehl F, Lechner-Scott J, Montalban X, Selmaj K, Valis M, Rejdak K, Havrdova EK, Patti F, Alexandri N, Nolting A, and Keller B
- Subjects
- Adult, Cladribine adverse effects, Female, Humans, Immunosuppressive Agents adverse effects, Neoplasm Recurrence, Local, Patient Satisfaction, Personal Satisfaction, Prospective Studies, Quality of Life, Tablets, Multiple Sclerosis, Multiple Sclerosis, Relapsing-Remitting drug therapy
- Abstract
Background Multiple sclerosis (MS) is a chronic disabling disease that is associated with negative effects on health-related quality of life (HRQoL) due to reduced physical and psychosocial functioning. Cladribine tablets 10 mg (3.5 mg/kg cumulative dose over 2 years) have been approved for the treatment of adult patients with highly active relapsing multiple sclerosis (RMS). The ongoing CLARIFY-MS study (NCT03369665; EudraCT number: 2017-002632-17) aims to assess the effect of cladribine tablets 3.5 mg/kg on HRQoL of patients with highly active RMS. Objective To report on the design of the CLARIFY-MS study, baseline patient characteristics, and results of a pre-planned interim analysis focusing on treatment satisfaction, safety, and tolerability that includes all data reported till 6 months after start of treatment. Methods The CLARIFY-MS study is a 2-year, open-label, single-arm, prospective, multicenter, phase IV study. Eligible patients with highly active RMS were assigned to receive cladribine tablets 3.5 mg/kg over 2 years. Treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM, v1.4; scale range from 0 to 100, higher values indicating higher satisfaction). Safety assessments, including occurrence of treatment-emergent adverse events (TEAEs; any adverse event reported after drug administration), serious adverse events (SAEs), and lymphocyte counts, were summarized descriptively. Results A total of 482 patients from 85 sites in Europe were treated with cladribine tablets. Mean patient age was 37.4 years, 338 (70.1%) were women, median EDSS was 2.5, and 345 (71.6%) were prior users of disease-modifying therapy (DMT). During the first 6 months after the start of treatment, and before reaching the full dose of cladribine tablets, mean TSQM global satisfaction score for the overall population was 70.4 (standard deviation, ± 18.48). The side effects score was 91.9 (± 17.68), convenience scored 86.6 (± 13.57), and effectiveness was 65.8 (± 21.14). A total of 275 patients (57.1%) reported at least one TEAE and 9 patients (1.9%) had a SAE. The majority of observed lymphopenia cases were of grade 1 or 2; 33 (6.8%) of the total study cohort had grade 3 lymphopenia, and no grade 4 lymphopenia was reported. Conclusion Patients reported high treatment satisfaction (TSQM) with cladribine tablets in this pre-planned interim analysis at 6 months. Few serious, and no unexpected, adverse events were reported, and there were no instances of grade 4 lymphopenia over the first 6 months. These preliminary data indicate good tolerability and convenience of administration of cladribine tablets in patients with highly active RMS., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
22. Ozanimod in relapsing multiple sclerosis: Pooled safety results from the clinical development program.
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Selmaj KW, Cohen JA, Comi G, Bar-Or A, Arnold DL, Steinman L, Hartung HP, Montalban X, Havrdova EK, Cree BAC, Minton N, Sheffield JK, Ding N, and Kappos L
- Subjects
- Humans, Indans, Oxadiazoles, Multiple Sclerosis, Multiple Sclerosis, Relapsing-Remitting drug therapy, Multiple Sclerosis, Relapsing-Remitting epidemiology
- Abstract
Background: Ozanimod, an oral sphingosine 1-phosphate receptor 1 and 5 modulator, is approved in multiple countries for the treatment of relapsing multiple sclerosis (RMS). In phase 3 trials, ozanimod was well tolerated and superior to interferon beta-1a 30 µg once-weekly in reducing clinical and radiologic disease activity. The objective of this integrated safety analysis was to evaluate the safety of extended ozanimod exposure in participants with RMS from all clinical trials and compare it with phase 3 trial data., Methods: We report pooled incidence and study duration‒adjusted incidence rates (IR) of treatment-emergent adverse events (TEAEs) from an interim data cut (January 31, 2019) of RMS participants treated with ozanimod. Data were pooled from a phase 1 pharmacokinetic/pharmacodynamic trial, a placebo-controlled phase 2 trial with dose-blinded extension, 2 large active-controlled phase 3 trials, and an open-label extension (OLE). Results were compared with pooled phase 3 trial data., Results: At the data cutoff, 2631 RMS participants had exposure to ozanimod 0.92 mg (mean 32.0 months) and 2787 had exposure to either ozanimod 0.46 or 0.92 mg (mean 37.1 months). The IRs per 1000 person-years (PY) for any TEAE (772.2) and serious TEAEs (33.2) in the overall population were similar to those in the phase 3 population (896.1 and 31.2, respectively). There were no serious opportunistic infections. There were no second-degree or higher atrioventricular blocks on electrocardiogram. Hepatic enzyme elevations declined over time. Malignancy rates remained low with longer exposure. Pulmonary function tests showed minimal reductions in lung function. Seven ozanimod-treated participants with comorbid risk factors had confirmed macular edema, including 3 in the ongoing OLE., Conclusions: Safety results in this larger RMS population with greater ozanimod exposure demonstrated no new safety concerns and were consistent with phase 3 trial results., (Copyright © 2021. Published by Elsevier B.V.)
- Published
- 2021
- Full Text
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23. Effect of Ozanimod on Symbol Digit Modalities Test Performance in Relapsing MS.
- Author
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DeLuca J, Schippling S, Montalban X, Kappos L, Cree BAC, Comi G, Arnold DL, Hartung HP, Sheffield JK, Liu H, Silva D, and Cohen JA
- Subjects
- Adolescent, Adult, Humans, Indans, Interferon beta-1a therapeutic use, Middle Aged, Neuropsychological Tests, Oxadiazoles, Young Adult, Multiple Sclerosis, Multiple Sclerosis, Relapsing-Remitting diagnostic imaging, Multiple Sclerosis, Relapsing-Remitting drug therapy
- Abstract
Background: Cognitive dysfunction, including slowed cognitive processing speed (CPS), is one of the most disabling symptoms of multiple sclerosis (MS). The Symbol Digit Modalities Test (SDMT) is a preferred measure of CPS for MS trials and routine screening. Based on encouraging SDMT results in the phase 3 SUNBEAM trial, these post hoc, exploratory analyses were conducted to further compare effects of the sphingosine 1-phosphate receptor modulator ozanimod versus intramuscular interferon β-1a on CPS in participants with relapsing multiple sclerosis (RMS)., Methods: In the phase 3, double-blind, double-dummy, SUNBEAM study, adults (aged 18‒55 years) with RMS (N=1,346) were randomized to once-daily oral ozanimod 0.92 or 0.46 mg, or weekly intramuscular interferon β-1a 30 µg. The study continued until the last participant was treated for 12 months. CPS was measured as part of a secondary endpoint using the SDMT. Exploratory, post hoc analyses evaluated SDMT change and percentages of participants with clinically meaningful (≥4-point) SDMT improvement or worsening at months 6 and 12, and relationship between SDMT and brain volume on magnetic resonance imaging., Results: Ozanimod improved SDMT scores compared with interferon β-1a at months 6 and 12. At month 12, least squares mean difference in SDMT z-scores for ozanimod 0.92 mg versus interferon β-1a was 0.102 (95% CI, 0.031‒0.174, nominal p = 0.0051; standardized mean difference = 0.1376). A greater percentage of ozanimod 0.92 mg‒treated participants had clinically meaningful improvements in SDMT scores versus interferon β-1a at month 6 (30.0% versus 22.2%) and month 12 (35.6% versus 27.9%). Of those with SDMT improvement at month 6, 66.4% of those treated with ozanimod 0.92 mg and 55.9% of those treated with interferon β-1a had sustained improvement at month 12. Brain volume loss was similar for those with SDMT improvement versus worsening at month 12., Conclusions: In these exploratory analyses, ozanimod had modestly beneficial effects on CPS in RMS participants. The effects of ozanimod on SDMT are being further evaluated in an ongoing 3-year clinical trial. SUNBEAM is registered on clinicaltrials.gov (NCT02294058) and the European Clinical Trials Database (EudraCT 2014-002320-27)., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2021
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24. Safety of cladribine tablets in the treatment of patients with multiple sclerosis: An integrated analysis.
- Author
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Cook S, Leist T, Comi G, Montalban X, Giovannoni G, Nolting A, Hicking C, Galazka A, and Sylvester E
- Subjects
- Adolescent, Adult, Aged, Cladribine administration & dosage, Cohort Studies, Female, Herpes Zoster chemically induced, Humans, Immunosuppressive Agents administration & dosage, Lymphopenia chemically induced, Male, Middle Aged, Young Adult, Cladribine adverse effects, Clinical Trials, Phase III as Topic, Drug-Related Side Effects and Adverse Reactions etiology, Immunosuppressive Agents adverse effects, Multiple Sclerosis, Relapsing-Remitting drug therapy, Registries
- Abstract
Background: Treating patients with relapsing multiple sclerosis (MS) with cladribine tablets (two times 4 or 5 days of treatment each year for 2 years) results in long-lasting efficacy, with continued stability in many patients for 4 or more years. Safety and tolerability outcomes from individual clinical studies with cladribine tablets have been reported previously., Objective: Report safety data from an integrated analysis of clinical trials and follow-up in patients with MS to further characterize the safety profile of cladribine tablets., Methods: Data for patients treated with cladribine tablets 10 mg (MAVENCLAD
® ; 3.5 mg/kg cumulative dose over 2 years, referred to as cladribine tablets 3.5 mg/kg) as monotherapy (n = 923) or placebo (n = 641) in Phase III clinical trials (CLARITY, CLARITY Extension and ORACLE-MS) and followed up in the PREMIERE registry were aggregated (Monotherapy Oral cohort). To better characterize rare events, additional data from earlier studies which involved the use of parenteral cladribine in patients with MS, and the ONWARD study, in which patients were given cladribine tablets in addition to interferon (IFN)-β or placebo plus IFN-β were included in an All Exposed cohort (cladribine, n = 1926; placebo, n = 802). Adjusted adverse events incidences per 100 patient-years (Adj-AE per 100 PY) were calculated for the integrated analyses., Results: The incidence rate of treatment-emergent adverse events (TEAEs) in the Monotherapy Oral cohort was 103.29 vs. 94.26 Adj-AEs per 100 PY for placebo. TEAEs that occurred more frequently with cladribine tablets were mainly driven by the TEAEs of lymphopenia (Adj-AE per 100 PY 7.94 vs. 1.06 for placebo) and lymphocyte count decreased (Adj-AE per 100 PY 0.78 vs. 0.10 for placebo) as anticipated due to the mode of action of cladribine. An increase in TEAE incidence rate was also observed in the cladribine tablets 3.5 mg/kg group vs. placebo for herpes zoster (Adj-AE per 100 PY 0.83 vs. 0.20, respectively). There were no cases of systemic, serious disseminated herpes zoster attributed to treatment with cladribine tablets. In general there was no increase in the risk of infections including opportunistic infections with cladribine tablets versus placebo, except for herpes zoster. Periods of severe lymphopenia (< 0.5 × 109 cells/L) were associated with an increased frequency of infections, but the nature of these was not different to that observed in the overall patient group treated with cladribine tablets 3.5 mg/kg. Within the constraints of a limited sample size, malignancy rates in the overall clinical program for cladribine in MS did not show evidence of an increase compared to placebo-treated patients and there was no increase in the incidence of malignancies over time in cladribine-treated patients., Conclusion: The AE profile for cladribine tablets 3.5 mg/kg as a monotherapy has been well-characterized in a pooled population of patients from early to more advanced relapsing MS. There was no increased risk for infections in general except for a higher incidence of herpes zoster. Lymphopenia was amongst the most frequently observed TEAEs that occurred at a higher incidence with cladribine relative to placebo. There was also no increase in malignancy rates for cladribine relative to placebo., (Copyright © 2018. Published by Elsevier B.V.)- Published
- 2019
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25. Comparing outcomes from clinical studies of oral disease-modifying therapies (dimethyl fumarate, fingolimod, and teriflunomide) in relapsing MS: Assessing absolute differences using a number needed to treat analysis.
- Author
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Freedman MS, Montalban X, Miller AE, Dive-Pouletty C, Hass S, Thangavelu K, and Leist TP
- Subjects
- Administration, Oral, Adrenal Cortex Hormones therapeutic use, Adult, Disability Evaluation, Disease Progression, Evidence-Based Medicine methods, Female, Hospitalization, Humans, Hydroxybutyrates, Male, Nitriles, Numbers Needed To Treat, Recurrence, Severity of Illness Index, Treatment Outcome, Crotonates administration & dosage, Dimethyl Fumarate administration & dosage, Fingolimod Hydrochloride administration & dosage, Immunosuppressive Agents administration & dosage, Multiple Sclerosis, Relapsing-Remitting drug therapy, Toluidines administration & dosage
- Abstract
Dimethyl fumarate (DMF), fingolimod, and teriflunomide are oral disease-modifying therapies (DMTs) indicated for the treatment of relapsing-remitting multiple sclerosis. Despite well-established limitations of cross-trial comparisons, DMTs are still frequently compared in terms of relative reductions in specific endpoints, most commonly annualized relapse rate. Consideration of absolute risk reduction and number needed to treat (NNT) provides an alternative approach to assess the magnitude of treatment effect and can provide valuable additional information on therapeutic gain. Using data from pivotal studies of DMF (DEFINE, NCT00420212; CONFIRM, NCT00451451), fingolimod (FREEDOMS, NCT00289978; FREEDOMS II, NCT00355134), and teriflunomide (TEMSO, NCT00134563; TOWER, NCT00751881), we calculated NNTs to prevent any relapse, more severe relapses (such as those leading to hospitalization or requiring intravenous corticosteroids), and disability worsening. Higher relative reductions were reported for DMF and fingolimod vs placebo on overall relapse and relapses requiring intravenous corticosteroids in both individual and pooled studies (pooled data unavailable for fingolimod). However, NNTs for each outcome were similar for DMF and teriflunomide, with marginally lower NNTs observed with fingolimod. By contrast, for relapses requiring hospitalization, relative reductions were higher and NNTs were substantially lower for teriflunomide compared with DMF. For fingolimod, there were inconsistent outcomes between the two studies for relapses requiring hospitalization; thus, comparative conclusions against DMF or teriflunomide cannot be clearly established. The risk of disability worsening was significantly reduced in both teriflunomide studies, but only in a single study for DMF (DEFINE) and fingolimod (FREEDOMS). NNTs to prevent one patient from experiencing disability worsening were similar in DEFINE, FREEDOMS, and TEMSO and TOWER but were higher in CONFIRM and FREEDOMS II. This NNT analysis demonstrates broadly comparable effects for DMF, fingolimod, and teriflunomide across key clinical outcomes. These observations are clinically relevant and may help to inform treatment decisions by providing additional information on therapeutic gain beyond informal assessments of relative reductions alone., (Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2016
- Full Text
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