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15 results on '"Sanders, Donald B."'

1. Comparative effectiveness of azathioprine and mycophenolate mofetil for myasthenia gravis (PROMISE-MG): a prospective cohort study

Author

Juel, Vern C., Gable, Karissa L., Hobson-Webb, Lisa D., Massey, Janice M., Raja, Shruti, Emmet, C. Douglas, Li, Yuebing, Polston, David, Shook, Steven, Hastings, Debbie, Siddiqi, Zaeem A., Alvi, Muhammed Abid, Andonian, Haley, Nicolle, Michael, Hulley, Denise, Ciafaloni, Emma, Smith, Patricia, Bird, Shawn, Granit, Volkan, Benatar, Michael, Gringon, Anne-Laure, Johnson, Kristin M., Larriviere, Daniel, Brown, Kristina, Gutierrez, Hilda, Ruzhansky, Katherine, Choudhury, Aparna, Hehir, Michael K., Kolb, Noah, Waheed, Waqar, St. Sauveur, Avery B., Puwanant, Araya, Lacomis, David, Muppidi, Srikanth, Goyal, Neelam, Weinberg, David, Howard, Jr., James F., Chopra, Manisha, Malik, Rabia, Hoffmann, Gilles, Amato, Anthony A., Wolfe, Gil I., Patrick, Kara, Narayanaswami, Pushpa, Sanders, Donald B, Thomas, Laine, Thibault, Dylan, Blevins, Jason, Desai, Rishi, Krueger, Andrew, Bibeau, Kathie, Liu, Bo, and Guptill, Jeffrey T

Published
2024
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4. Comparative effectiveness of azathioprine and mycophenolate mofetil for myasthenia gravis (PROMISE-MG): a prospective cohort study.

Author

Narayanaswami, Pushpa, Sanders, Donald B, Thomas, Laine, Thibault, Dylan, Blevins, Jason, Desai, Rishi, Krueger, Andrew, Bibeau, Kathie, Liu, Bo, and Guptill, Jeffrey T

Subjects
*MYCOPHENOLIC acid, *MYASTHENIA gravis, *AZATHIOPRINE, *NEUROMUSCULAR diseases, *COHORT analysis, *DRUG monitoring
Abstract

Myasthenia gravis is an autoimmune disorder of the neuromuscular junction. Treatment typically includes symptomatic oral cholinesterase inhibitors, immunosuppression, and immunomodulation. In addition to corticosteroids, azathioprine and mycophenolate mofetil are the most frequently used immunosuppressants in North America. We aimed to evaluate the comparative effectiveness of these two drugs, and to assess the effect of the dose and duration of treatment. We did a prospective cohort study at 19 academic centres in Canada and the USA. We included patients (aged ≥18 years) with autoimmune myasthenia gravis, who were never treated with immunosuppressants. Treating clinicians determined the choice of medication, dose, follow-up intervals, and drug monitoring. Outcome measures and adverse events were recorded at each visit. We assessed two co-primary outcomes. The first was the patient-reported Myasthenia Gravis-Quality of Life 15-revised (MGQOL-15r) score, measured as the mean change from treatment initiation to the follow-up visit with the lowest score. A clinically meaningful reduction (CMR) in MGQOL-15r was defined as a 5-point decrease. The second was a composite clinical outcome of disease improvement (Myasthenia Gravis Foundation of America Post-Intervention Status Minimal Manifestations or better) and low adverse event burden (defined as grade ≤1 Common Terminology Criteria for Adverse Events). We also compared these outcomes in patients receiving an adequate dose and duration of azathioprine (≥2 mg/kg per day for at least 12 months) or mycophenolate mofetil (≥2 g per day for at least 8 months) and a lower dose or shorter duration of these agents. We used propensity score weighting with generalised linear regression models. This study is registered with ClinicalTrials.gov (NCT03490539). Between May 1, 2018, and Aug 31, 2020, 167 patients were enrolled; 85 did not receive azathioprine or mycophenolate mofetil and were excluded. Four were excluded from outcome analyses because they had scores of 0 on an outcome measure at treatment initiation. Of the 78 patients included in analyses, 47 received mycophenolate mofetil (median follow-up 25 months [IQR 13·5–31·5]) and 31 received azathioprine (median follow-up 20 months [IQR 13–30]). The mean change in MG-QOL15r was –10·4 (95% CI –18·9 to –1·3) with mycophenolate mofetil and –6·8 (–17·2 to 3·6) with azathioprine (mean difference –3·3, 95% CI –7·7 to 1·2; p=0·15). 38 (81%) of 47 patients receiving mycophenolate mofetil and 18 (57%) of 31 receiving azathioprine had a CMR in MG-QOL15r (risk difference 24·0%; 95% CI –0·2 to 48·0; p=0·052). The clinical composite outcome was achieved in 22 (47·7%) of 47 patients who received mycophenolate mofetil and nine (28·1%) of 31 who received azathioprine (risk difference 19·6%, 95% CI –4·9 to 44·2; p=0·12). Descriptive analysis did not find a difference in the proportion of patients reaching a CMR in MG-QOL15r between the adequate dose and duration group and the lower dose or shorter duration group. Adverse events occurred in 11 (32%) of 34 patients who received azathioprine and nine (19%) of 48 who received mycophenolate mofetil. The most frequent adverse events were hepatotoxicity with azathioprine (five [15%] of 34) and gastrointestinal disturbances (seven [15%] of 48) with mycophenolate mofetil. There were no study-related deaths. More than half of patients treated with azathioprine and mycophenolate mofetil felt their quality of life improved; no difference in clinical outcomes was noted between the two drugs. Adverse events associated with azathioprine were potentially more serious than those with mycophenolate mofetil, although mycophenolate mofetil is teratogenic. Lower than recommended doses of azathioprine might be effective, with reduced dose-dependent adverse events. More comparative effectiveness studies are required to inform treatment choices in myasthenia gravis. Patient-Centered Outcomes Research Institute, Myasthenia Gravis Foundation of America. [ABSTRACT FROM AUTHOR]

Published
2024
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9. Single fiber electromyography and measuring jitter with concentric needle electrodes

Author

Sanders, Donald B., Kouyoumdjian, João A., Stålberg, Erik V., Sanders, Donald B., Kouyoumdjian, João A., and Stålberg, Erik V.

Abstract

This monograph contains descriptions of the single fiber electromyography (SFEMG) method and of the more recently implemented method of recording jitter with concentric needle electrodes (CNEs). SFEMG records action potentials from single muscle fibers (SFAPs), which permits measuring fiber density (FD), a sensitive measure of reinnervation, and jitter, a sensitive measure of abnormal neuromuscular transmission (NMT). With voluntary activation, jitter is measured between two SFAPs with acceptable amplitude and rise time. With activation by axon stimulation, jitter is measured between the stimulus and individual SFAPs. Pitfalls due to unstable triggers and inconstant firing rates during voluntary activation and subliminal stimulation during axon stimulation should be identified and avoided. In CNE recordings, spikes with shoulders or rising phases that are not parallel are produced by summation of SFAPS; these should be excluded and reference values for CNE jitter should be used. CNE and SFEMG have similar and very high sensitivity in detecting increased jitter, as in myasthenia gravis and other myasthenic conditions. However, jitter is also seen in ongoing reinnervation and some myopathic conditions. With SFEMG, these can be identified by increased FD; however, FD cannot be measured with CNE, and conventional electromyography should be performed in muscles with increased jitter to detect neurogenic or myogenic abnormalities. Jitter is abnormal after injections of botulinum toxin, even in muscles remote from the injection site, and can persist for 6 mo or more. This can complicate the detection or exclusion of abnormal NMT.

Published
2022
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12. Colaboradores

Author

Abou-Khalil, Bassel W., Adamczyk, Peter, Ajtai, Bela, Allen, Jeffrey C., Ally, Brandon, Almeida, Andrea A., Amato, Anthony A., Aminoff, Michael J., Anderson, Nicolaas C., Ashizawa, Tetsuo, Attar, Hatim, Avidan, Alon Y., Baehring, Joachim M., Bag, Asim K., Balcer, Laura J., Ballester, Leomar Y., Baloh, Robert W., Barkoudah, Elizabeth, Barker, Roger A., Barmore, Ryan, Bartleson, J.D., Batla, Amit, Beckham, John David, Beglinger, Leigh, Benninger, David H., Berger, Joseph R., Biller, José, Black, David F., Boulis, Nicholas, Bowley, Michael P., Braksick, Sherri A., Bramlett, Helen M., Bromley, Steven M., Bruni, Joseph, Brust, John C.M., Burnette, W. Bryan, Camfield, Carol, Camfield, Peter, Carson, Alan, Cassimatis, Dimitri, Cavaliere, Robert, Chad, David A., Chandran, Vijay, Chelimsky, Gisela, Chelimsky, Thomas, Chitnis, Tanuja, Chokroverty, Sudhansu, Chukwueke, Ugonma N., Cooper, Paul E., Cordeau, Dany, Courtois, Frédérique, Creutzfeldt, Claire J., Dalmau, Josep, Daroff, Robert B., DasGupta, Ranan, Deutsch, Mariel B., Devereaux, Michael W., DiBacco, Melissa, Dietrich, W. Dalton, Dinakar, Pradeep, Dobkin, Bruce H., Doty, Richard L., Duckwiler, Gary R., Emerson, Ronald G., Fabian, Michelle T., Faridar, Alireza, Fearon, Conor, Felker, Marcia V., Fessler, Richard D., Fessler, Richard G., Fitzgerald, Kathryn C., Flores-Sarnat, Laura, Fogel, Brent L., Forester, Brent P., Fugate, Jennifer E., Gallagher, Martin J., Gardner, Sharon L., Garfinkle, Jarred, Garza, Ivan, Gusmao, Claudio Melo de, Gehl, Carissa, Geiger, Christopher D., Geldmacher, David S., Gerard, Carter, Geschwind, Daniel H., Geschwind, Michael D., Gifford, Katherine A., Gibson, K. Michael, Golomb, Meredith R., Goode, Rachel, Graff-Radford, Jonathan, Groover, Olivia, Guptill, Jeffrey T., Hahn, Cecil D., Hall, Christine, Hallett, Mark, Hamati, Aline I., Hart, David, Hellwig, Sabine, Herholz, Karl, Hill, Alan, Hill, Benjamin D., Hochberg, Fred H., Huntoon, Kristin, Huse, Jason T., Islam, Monica P., Iv, Michael, Jehan, Reza, Jankovic, Joseph, Josephson, S. Andrew, Jovin, Tudor G., Kang, Min K., Karajannis, Matthias A., Kase, Carlos S., Katirji, Bashar, Kerber, Kevin A., Kerchner, Geoffrey A., Khanna, Ryan, Khoury, Samia J., Kirshner, Howard S., Klöppel, Stefan, Koshy, Anita A., Krieger, Stephen C., Kumar, Abhay, Kurtzke, John F., Kutcher, Jeffrey S., Kuo, Sheng-Han, Lang, Anthony E., Lavin, Patrick J.M., Lawrence, Alice, Lazzaro, Marc A., Langner, Sönke, Liebeskind, David S., Lin, Chih-Chun, Lindzen, Eric, Lockwood, Alan H., Lopate, Glenn, Lublin, Fred D., Lyerly, Michael J., Macdonald, Robert L., Mackay, Devin D., Mallery, Robert, Masdeu, Joseph C., Mazziotta, John C., Mendez, Mario F., Meyer, Philipp T., Michaud, Dominique S., Miller, Amanda, Misulis, Karl E., Mitsumoto, Hiroshi, Murray, Brian, Murray, E. Lee, Murray, Evan D., Nahab, Fadi, Nass, Ruth, Nayak, Lakshmi, Newman, Nancy J., Nguyen, Thanh N., Nogueira, Raul G., Nutt, John G., Nuwer, Marc R., O’Banion, D. David, Okun, Michael S., O’Rourke, Justin J.F., Padilla, Claudia R., Panicker, Jalesh N., Parand, Leila, Paulsen, Jane S., Pearl, Phillip L., Peng-Chen, Zhongxing, Perez, David L., Petersen, Ronald C., Pfeiffer, Ronald F., Pitceathly, Robert D.S., Pomeroy, Scott L., Prasad, Sashank, Price, Bruce H., Price, Raymond S., Ptáček, Louis J., Rabinstein, Alejandro A., Ramaswamy, Vijay, Reimschisel, Tyler, Remler, Bernd F., Rijntjes, Michel, Roach, E. Steve, Robertson, Carrie E., Robinson, Maisha T., Ronthal, Michael, Roos, Karen L., Roque, Ashley M., Rosenberg, Gary A., Rosenfeld, Myrna R., Rucker, Janet C., Ruland, Sean D., Safarpour, Delaram, Sanders, Donald B., Sarnat, Harvey B., Saver, Jeffrey L., Sawlani, Komal T., Schapira, Anthony H.V., Schiff, David, Schneck, Michael J., Scott, Kirsten M., Seay, Meagan D., Shaner, D. Malcolm, Sharzehi, Kaveh, Shoamanesh, Ashkan, Sidhu, Reet, Smith, Jonathan H., Snyder, Laura A., So, Yuen T., Solbrig, Marylou V., Srivastava, Siddharth, Stippler, Martina, Stone, Jon, Swanson, Jerry W., Szeder, Viktor, Tan, Lee A., Tateshima, Satoshi, Tee, Boon Lead, Teipel, Stefan J., Thomas, Reena P., Thompson, Philip D., Thurtell, Matthew J., Tomsak, Robert L., Tsao, Bryan, Turner, Chris, Tyler, Kenneth L., Uum, Stan H.M. Van, Verma, Ashok, Wall, Michael, Wallin, Mitchell T., Wang, Leo H., Weissenborn, Karin, Weiller, Cornelius, Wen, Patrick Y., Whealy, Mark A., Wijdicks, Eelco F.M., Wilson, Stephen M., Winkel, Daniel, Yerstein, Oleg Y., and Zaidat, Osama O.

Published
2023
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14. Identifying a patient‐centered outcome measure for a comparative effectiveness treatment trial in myasthenia gravis.

Author

Narayanaswami, Pushpa, Sanders, Donald B., Bibeau, Kathie, Krueger, Andrew, Venitz, Jurgen, and Guptill, Jeffrey T.

Abstract

Introduction/Aims: Data regarding the comparative effectiveness of myasthenia gravis (MG) treatments is not available. We used patient input to identify a patient‐centered outcome measure (PCOM) for PROMISE‐MG, a comparative effectiveness trial of MG treatments. Methods: First, a questionnaire survey was administered to 58 people with MG at the patient meeting of the Myasthenia Gravis Foundation of America (MGFA), evaluating the impact of MG‐related symptoms and MG treatments on patients' lives. Second, an online focus group of 13 patients with MG was conducted. Third, a potential outcome measure was selected. Fourth, the selected PCOM was evaluated by patients to assess how completely and accurately it captured their experiences with MG. Results: The patient survey showed that limb weakness had the most impact on patients' lives. Weight gain, mood swings, insomnia, and diarrhea were the most bothersome treatment side effects. Avoiding hospitalization was very important. Focus group participants reported fatigue as one of the most bothersome symptoms and differentiated it from myasthenic weakness. They defined an ideal treatment as having minimal or no side effects and an 80% improvement in symptoms. Discussion Based on patient input, the 15‐item Myasthenia Gravis Quality of Life—Revised (MG‐QOL15R) scale, a validated patient‐reported outcome measure (PRO), was selected as the primary PCOM for PROMISE‐MG. Avoiding hospitalization and having minimal to no treatment adverse effects were selected as additional outcome measures. The patient‐centeredness of a PRO depends on the context of a study: PROs should be evaluated for appropriateness as a PCOM for every study. [ABSTRACT FROM AUTHOR]

Published
2022
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15. List of Contributors

Author

Abou-Khalil, Bassel W., Adamczyk, Peter, Ajtai, Bela, Allen, Jeffrey C., Ally, Brandon, Almeida, Andrea A., Amato, Anthony A., Aminoff, Michael J., Anderson, Nicolaas C., Ashizawa, Tetsuo, Attar, Hatim, Avidan, Alon Y., Baehring, Joachim M., Bag, Asim K., Balcer, Laura J., Ballester, Leomar Y., Baloh, Robert W., Barkoudah, Elizabeth, Barker, Roger A., Barmore, Ryan, Bartleson, J.D., Batla, Amit, Beckham, John David, Beglinger, Leigh, Benninger, David H., Berger, Joseph R., Biller, José, Black, David F., Boulis, Nicholas, Bowley, Michael P., Braksick, Sherri A., Bramlett, Helen M., Bromley, Steven M., Bruni, Joseph, Brust, John C.M., Burnette, W. Bryan, Camfield, Carol, Camfield, Peter, Carson, Alan, Cassimatis, Dimitri, Cavaliere, Robert, Chad, David A., Chandran, Vijay, Chelimsky, Gisela, Chelimsky, Thomas, Chitnis, Tanuja, Chokroverty, Sudhansu, Chukwueke, Ugonma N., Cooper, Paul E., Cordeau, Dany, Courtois, Frédérique, Creutzfeldt, Claire J., Dalmau, Josep, Daroff, Robert B., DasGupta, Ranan, Deutsch, Mariel B., Devereaux, Michael W., DiBacco, Melissa, Dietrich, W. Dalton, Dinakar, Pradeep, Dobkin, Bruce H., Doty, Richard L., Duckwiler, Gary R., Emerson, Ronald G., Fabian, Michelle T., Faridar, Alireza, Fearon, Conor, Felker, Marcia V., Fessler, Richard D., Fessler, Richard G., Fitzgerald, Kathryn C., Flores-Sarnat, Laura, Fogel, Brent L., Forester, Brent P., Fugate, Jennifer E., Gallagher, Martin J., Gardner, Sharon L., Garfinkle, Jarred, Garza, Ivan, Melo de Gusmao, Claudio, Gehl, Carissa, Geiger, Christopher D., Geldmacher, David S., Gerard, Carter, Geschwind, Daniel H., Geschwind, Michael D., Gifford, Katherine A., Gibson, K. Michael, Golomb, Meredith R., Goode, Rachel, Graff-Radford, Jonathan, Groover, Olivia, Guptill, Jeffrey T., Hahn, Cecil D., Hall, Christine, Hallett, Mark, Hamati, Aline I., Hart, David, Hellwig, Sabine, Herholz, Karl, Hill, Alan, Hill, Benjamin D., Hochberg, Fred H., Huntoon, Kristin, Huse, Jason T., Islam, Monica P., Iv, Michael, Jehan, Reza, Jankovic, Joseph, Josephson, S. Andrew, Jovin, Tudor G., Kang, Min K., Karajannis, Matthias A., Kase, Carlos S., Katirji, Bashar, Kerber, Kevin A., Kerchner, Geoffrey A., Khanna, Ryan, Khoury, Samia J., Kirshner, Howard S., Klöppel, Stefan, Koshy, Anita A., Krieger, Stephen C., Kumar, Abhay, Kurtzke, John F., Kutcher, Jeffrey S., Kuo, Sheng-Han, Lang, Anthony E., Lavin, Patrick J.M., Lawrence, Alice, Lazzaro, Marc A., Langner, Sönke, Liebeskind, David S., Lin, Chih-Chun, Lindzen, Eric, Lockwood, Alan H., Lopate, Glenn, Lublin, Fred D., Lyerly, Michael J., Macdonald, Robert L., Mackay, Devin D., Mallery, Robert, Masdeu, Joseph C., Mazziotta, John C., Mendez, Mario F., Meyer, Philipp T., Michaud, Dominique S., Miller, Amanda, Misulis, Karl E., Mitsumoto, Hiroshi, Murray, Brian, Murray, E. Lee, Murray, Evan D., Nahab, Fadi, Nass, Ruth, Nayak, Lakshmi, Newman, Nancy J., Nguyen, Thanh N., Nogueira, Raul G., Nutt, John G., Nuwer, Marc R., O’Banion, D. David, Okun, Michael S., O’Rourke, Justin J.F., Padilla, Claudia R., Panicker, Jalesh N., Parand, Leila, Paulsen, Jane S., Pearl, Phillip L., Peng-Chen, Zhongxing, Perez, David L., Petersen, Ronald C., Pfeiffer, Ronald F., Pitceathly, Robert D.S., Pomeroy, Scott L., Prasad, Sashank, Price, Bruce H., Price, Raymond S., Ptáček, Louis J., Rabinstein, Alejandro A., Ramaswamy, Vijay, Reimschisel, Tyler, Remler, Bernd F., Rijntjes, Michel, Roach, E. Steve, Robertson, Carrie E., Robinson, Maisha T., Ronthal, Michael, Roos, Karen L., Roque, Ashley M., Rosenberg, Gary A., Rosenfeld, Myrna R., Rucker, Janet C., Ruland, Sean D., Safarpour, Delaram, Sanders, Donald B., Sarnat, Harvey B., Saver, Jeffrey L., Sawlani, Komal T., Schapira, Anthony H.V., Schiff, David, Schneck, Michael J., Scott, Kirsten M., Seay, Meagan D., Shaner, D. Malcolm, Sharzehi, Kaveh, Shoamanesh, Ashkan, Sidhu, Reet, Smith, Jonathan H., Snyder, Laura A., So, Yuen T., Solbrig, Marylou V., Srivastava, Siddharth, Stippler, Martina, Stone, Jon, Swanson, Jerry W., Szeder, Viktor, Tan, Lee A., Tateshima, Satoshi, Tee, Boon Lead, Teipel, Stefan J., Thomas, Reena P., Thompson, Philip D., Thurtell, Matthew J., Tomsak, Robert L., Tsao, Bryan, Turner, Chris, Tyler, Kenneth L., Van Uum, Stan H.M., Verma, Ashok, Wall, Michael, Wallin, Mitchell T., Wang, Leo H., Weissenborn, Karin, Weiller, Cornelius, Whealy, Mark A., Wen, Patrick Y., Wijdicks, Eelco F.M., Wilson, Stephen M., Winkel, Daniel, Yerstein, Oleg Y., and Zaidat, Osama O.

Published
2022
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