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42 results on '"Cocco, E."'

1. Risk of multiple sclerosis relapses when switching from fingolimod to cell-depleting agents: the role of washout duration

Author

Ferraro, D., Iaffaldano, P., Guerra, T., Inglese, M., Capobianco, M., Brescia Morra, V., Zaffaroni, M., Mirabella, M., Lus, G., Patti, F., Cavalla, P., Cellerino, M., Malucchi, S., Pisano, E., Vitetta, F., Paolicelli, D., Sola, P., Trojano, M., Aguglia, U., Amato, M. P., Avolio, C., Balgera, R., Banfi, P., Bellantonio, P., Bergamaschi, R., Cargnelutti, D., Cartechini, E., Chiveri, L., Clerici, R., Cocco, E., Conte, A., Corea, F., Danni, M. C., De Luca, G., Di Sapio, A., Ferraro, E., Galgani, S., Gallo, A., Gatto, M., Gazzola, P., Granella, F., Lugaresi, A., Maimone, D., Maniscalco, G. T., Marfia, G. A., Montepietra, S., Paolo, C., Pesci, I., Pozzilli, C., Carlo, P., Protti, A., Quatrale, R., Realmuto, S., Romano, S., Romeo, M., Salemi, G., Leonardo, S., Rocco, T., Paola, V., Marika, V., Ferraro, D., Iaffaldano, P., Guerra, T., Inglese, M., Capobianco, M., Brescia Morra, V., Zaffaroni, M., Mirabella, M., Lus, G., Patti, F., Cavalla, P., Cellerino, M., Malucchi, S., Pisano, E., Vitetta, F., Paolicelli, D., Sola, P., Trojano, M., Aguglia, U., Amato, M. P., Avolio, C., Balgera, R., Banfi, P., Bellantonio, P., Bergamaschi, R., Cargnelutti, D., Cartechini, E., Chiveri, L., Clerici, R., Cocco, E., Conte, A., Corea, F., Danni, M. C., De Luca, G., Di Sapio, A., Ferraro, E., Galgani, S., Gallo, A., Gatto, M., Gazzola, P., Granella, F., Lugaresi, A., Maimone, D., Maniscalco, G. T., Marfia, G. A., Montepietra, S., Paolo, C., Pesci, I., Pozzilli, C., Carlo, P., Protti, A., Quatrale, R., Realmuto, S., Romano, S., Romeo, M., Salemi, G., Leonardo, S., Rocco, T., Paola, V., and Marika, V.

Subjects
Adult, medicine.medical_specialty, Relapsing-Remitting, Settore MED/26, Gastroenterology, Multiple sclerosis, Immunosuppressive Agent, Multiple Sclerosis, Relapsing-Remitting, Recurrence, Internal medicine, Multiple Sclerosi, medicine, Humans, Ocrelizumab, Cladribine, Alemtuzumab, Fingolimod, Rituximab, Fingolimod Hydrochloride, Immunosuppressive Agents, Middle Aged, Multiple Sclerosis, business.industry, Hazard ratio, Washout, Discontinuation, Settore MED/26 - NEUROLOGIA, Neurology, Neurology (clinical), business, medicine.drug, Human
Abstract

Background: Fingolimod (FTY) induces sequestration of lymphocytes in secondary lymphoid organs and the average lymphocyte recovery following discontinuation takes 1–2months. It has been hypothesized that the therapeutic effects of subsequent cell-depleting agents may be compromised if initiated before lymphocyte recovery has occurred. Objective: To assess the risk of relapses following FTY discontinuation and the initiation of a B/T cell-depleting agent in relation to washout duration using data from the Italian MS Register. Methods: The risk of relapses was assessed in relation to different washout durations (< 6, 6–11, 12–17 and > / = 18weeks) in patients starting alemtuzumab, rituximab, ocrelizumab or cladribine following FTY discontinuation. Results: We included 329 patients in the analysis (226F, 103M; mean age 41 ± 10years). During the cell-depleting treatment, the incidence rate ratio for a relapse was significantly greater in patients with a washout period of 12–17 and > / = 18weeks compared to the reference period (< 6weeks). The risk of a relapse was significantly influenced by the occurrence of relapses during FTY treatment and by washout length, with hazard ratios markedly increasing with the washout duration. Conclusion: The risk of relapses increases with the washout duration when switching from FTY to lymphocyte-depleting agents.

Published
2021

2. Effect of SARS-CoV-2 mRNA vaccination in MS patients treated with disease modifying therapies

Author

Sormani M. P., Schiavetti I., Carmisciano L., Inglese M., Laroni A., Lapucci C., Uccelli A., Da Rin G., Serrati C., Gandoglia I., Tassinari T., Perego G., Brichetto G., Gazzola P., Mannironi A., Stromillo M. L., Cordioli C., Landi D., Clerico M., Signoriello E., Frau J., Ferro M. T., Di Sapio A., Pasquali L., Ulivelli M., Marinelli F., Callari G., Iodice R., Liberatore G., Caleri F., Repice A. M., Cordera S., Battaglia M. A., Salvetti M., Franciotta D., Maglione A., Signori A., Iovino A., Nicoletti C. G., Mancinelli C. R., Bezzini D., Carmagnini D., Brogi D., Orazio E. N., Cocco E., Nako E., Assandri E., Baldi F., Ansaldi F., Bovis F., Siciliano G., Cola G., Lus G., Icardi G., bellucci G., Rin G. D., Marfia G. A., Vazzoler G., Trivelli G., Maietta I., Sticchi L., Lorefice L., Ruggiero L., Manzino M., Bragadin M. M., Buscarinu M. C., Gagliardi M., Rilla M. T., Ponzano M., Fronza M., Sette M. D., Scialabba M., Bedognetti M., De Rossi N., De Stefano N., Bigi R., Dubbioso R., Renie R., Fabbri S., Rasia S., Rolla S., Platzgummer S., Carlini V., Sormani, M. P., Schiavetti, I., Carmisciano, L., Inglese, M., Laroni, A., Lapucci, C., Uccelli, A., Da Rin, G., Serrati, C., Gandoglia, I., Tassinari, T., Perego, G., Brichetto, G., Gazzola, P., Mannironi, A., Stromillo, M. L., Cordioli, C., Landi, D., Clerico, M., Signoriello, E., Frau, J., Ferro, M. T., Di Sapio, A., Pasquali, L., Ulivelli, M., Marinelli, F., Callari, G., Iodice, R., Liberatore, G., Caleri, F., Repice, A. M., Cordera, S., Battaglia, M. A., Salvetti, M., Franciotta, D., Maglione, A., Signori, A., Iovino, A., Nicoletti, C. G., Mancinelli, C. R., Bezzini, D., Carmagnini, D., Brogi, D., Orazio, E. N., Cocco, E., Nako, E., Assandri, E., Baldi, F., Ansaldi, F., Bovis, F., Siciliano, G., Cola, G., Lus, G., Icardi, G., Bellucci, G., Rin, G. D., Marfia, G. A., Vazzoler, G., Trivelli, G., Maietta, I., Sticchi, L., Lorefice, L., Ruggiero, L., Manzino, M., Bragadin, M. M., Buscarinu, M. C., Gagliardi, M., Rilla, M. T., Ponzano, M., Fronza, M., Sette, M. D., Scialabba, M., Bedognetti, M., De Rossi, N., De Stefano, N., Bigi, R., Dubbioso, R., Renie, R., Fabbri, S., Rasia, S., Rolla, S., Platzgummer, S., and Carlini, V.

Subjects
Oncology, Male, Medicine (General), COVID-19 Vaccine, Immunosuppressive Agent, Multiple Sclerosi, Monoclonal, Prospective Studies, Humanized, biology, Coronavirus, Immunomodulatory therapies, Multiple sclerosis, General Medicine, Middle Aged, 2019-nCoV Vaccine mRNA-1273, Adult, Antibodies, Monoclonal, Humanized, Antibody Formation, BNT162 Vaccine, COVID-19, COVID-19 Vaccines, Cladribine, Female, Fingolimod Hydrochloride, Humans, Immunosuppressive Agents, Italy, Multiple Sclerosis, Rituximab, Treatment Outcome, Fingolimod, Vaccination, Immunomodulatory therapie, Medicine, Antibody, medicine.drug, Human, medicine.medical_specialty, Coronaviru, Context (language use), Settore MED/26, Article, General Biochemistry, Genetics and Molecular Biology, Antibodies, R5-920, Antigen, Internal medicine, medicine, business.industry, medicine.disease, Prospective Studie, biology.protein, Ocrelizumab, business
Abstract

Background: In patients with Multiple Sclerosis (pwMS) disease-modifying therapies (DMTs) affects immune response to antigens. Therefore, post-vaccination serological assessments are needed to evaluate the effect of the vaccine on SARS-CoV-2 antibody response. Methods: We designed a prospective multicenter cohort study enrolling pwMS who were scheduled for SARS-Cov-2 vaccination with mRNA vaccines (BNT162b2, Pfizer/BioNTech,Inc or mRNA-1273, Moderna Tx,Inc). A blood collection before the first vaccine dose and 4 weeks after the second dose was planned, with a centralized serological assessment (electrochemiluminescence immunoassay, ECLIA, Roche-Diagnostics). The log-transform of the antibody levels was analyzed by multivariable linear regression. Findings: 780 pwMS (76% BNT162b2 and 24% mRNA-1273) had pre- and 4-week post-vaccination blood assessments. 87 (11·2%) were untreated, 154 (19·7%) on ocrelizumab, 25 (3·2%) on rituximab, 85 (10·9%) on fingolimod, 25 (3·2%) on cladribine and 404 (51·7%) on other DMTs. 677 patients (86·8%) had detectable post-vaccination SARS-CoV-2 antibodies. At multivariable analysis, the antibody levels of patients on ocrelizumab (201-fold decrease (95%CI=128–317), p < 0·001), fingolimod (26-fold decrease (95%CI=16–42), p < 0·001) and rituximab (20-fold decrease (95%CI=10–43), p < 0·001) were significantly reduced as compared to untreated patients. Vaccination with mRNA-1273 resulted in a systematically 3·25-fold higher antibody level (95%CI=2·46–4·27) than with the BNT162b2 vaccine (p < 0·001). The antibody levels on anti-CD20 therapies correlated to the time since last infusion, and rituximab had longer intervals (mean=386 days) than ocrelizumab patients (mean=129 days). Interpretation: In pwMS, anti-CD20 treatment and fingolimod led to a reduced humoral response to mRNA-based SARS-CoV-2 vaccines. As mRNA-1273 elicits 3·25-higher antibody levels than BNT162b2, this vaccine may be preferentially considered for patients under anti-CD20 treatment or fingolimod. Combining our data with those on the cellular immune response to vaccines, and including clinical follow-up, will contribute to better define the most appropriate SARS-CoV-2 vaccine strategies in the context of DMTs and MS. Funding: FISM[2021/Special-Multi/001]; Italian Ministry of Health‘Progetto Z844A 5 × 1000′.

Published
2021

3. Long-term effectiveness in patients previously treated with cladribine tablets: a real-world analysis of the Italian multiple sclerosis registry (CLARINET-MS)

Author

Patti, F., Visconti, A., Capacchione, A., Roy, S., Trojano, M., Amato, M. P., Cocco, E., Danni, M. C., Filippi, M., Gasperini, C., Inglese, M., Luca, G. D., Lus, G., Mallucci, G., Marfia, G. A., Pesci, I., Petruzzo, M., Pozzilli, C., Tedeschi, G., and Zaffaroni, M.

Subjects
Pediatrics, medicine.medical_specialty, effectiveness, cladribine tablets, registry, multiple sclerosis, lcsh:RC346-429, long-term data, 03 medical and health sciences, 0302 clinical medicine, secondary progressive MS, medicine, In patient, 030212 general & internal medicine, Cladribine, clinically isolated syndrome, real-world data, real-world evidence, relapsing-remitting MS, lcsh:Neurology. Diseases of the nervous system, Original Research, Pharmacology, Clinically isolated syndrome, business.industry, Multiple sclerosis, medicine.disease, Term (time), Neurology, Long term data, Neurology (clinical), Previously treated, business, Real world data, 030217 neurology & neurosurgery, medicine.drug
Abstract

Background: The CLARINET-MS study assessed the long-term effectiveness of cladribine tablets by following patients with multiple sclerosis (MS) in Italy, using data from the Italian MS Registry. Methods: Real-world data (RWD) from Italian MS patients who participated in cladribine tablets randomised clinical trials (RCTs; CLARITY, CLARITY Extension, ONWARD or ORACLE-MS) across 17 MS centres were obtained from the Italian MS Registry. RWD were collected during a set observation period, spanning from the last dose of cladribine tablets during the RCT (defined as baseline) to the last visit date in the registry, treatment switch to other disease-modifying drugs, date of last Expanded Disability Status Scale recording or date of the last relapse (whichever occurred last). Time-to-event analysis was completed using the Kaplan–Meier (KM) method. Median duration and associated 95% confidence intervals (CI) were estimated from the model. Results: Time span under observation in the Italian MS Registry was 1–137 (median 80.3) months. In the total Italian patient population ( n = 80), the KM estimates for the probability of being relapse-free at 12, 36 and 60 months after the last dose of cladribine tablets were 84.8%, 66.2% and 57.2%, respectively. The corresponding probability of being progression-free at 60 months after the last dose was 63.7%. The KM estimate for the probability of not initiating another disease-modifying treatment at 60 months after the last dose of cladribine tablets was 28.1%, and the median time-to-treatment change was 32.1 (95% CI 15.5–39.5) months. Conclusion: CLARINET-MS provides an indirect measure of the long-term effectiveness of cladribine tablets. Over half of MS patients analysed did not relapse or experience disability progression during 60 months of follow-up from the last dose, suggesting that cladribine tablets remain effective in years 3 and 4 after short courses at the beginning of years 1 and 2.

Published
2020

4. No evidence of disease activity (NEDA-3) and disability improvement after alemtuzumab treatment for multiple sclerosis: a 36-month real-world study

Author

Prosperini, L, Annovazzi, P, Boffa, L, Buscarinu, Mc, Gallo, A, Matta, M, Moiola, L, Musu, L, Perini, P, Avolio, C, Barcella, V, Bianco, A, Farina, D, Ferraro, E, Pontecorvo, S, Granella, F, Grimaldi, Lme, Laroni, A, Lus, G, Patti, F, Pucci, E, Pasca, M, Sarchielli, P, Ghezzi, A, Zaffaroni, M, Baroncini, D, Buttari, F, Centonze, D, Fornasiero, A, Salvetti, M, Docimo, R, Signoriello, E, Tedeschi, G, Bertolotto, A, Capobianco, M, Comi, G, Cocco, E, Gallo, P, Puthenparampil, M, Grasso, R, Di Francescantonio, V, Rottoli, Mr, Mirabella, M, Lugaresi, A, De Luca, G, Di Ioia, M, Di Tommaso, V, Mancinelli, L, Di Battista, G, Francia, A, Ruggieri, S, Pozzilli, C, Curti, E, Tsantes, E, Palmeri, B, Lapucci, C, Mancardi, Gl, Uccelli, A, Chisari, C, D'Amico, E, Cartechini, E, Repice, Am, Magnani, E, Massaccesi, L, Calabresi, P, Di Filippo, M, Di Gregorio, M, Italian Alemtuzumab Study, Group., Prosperini, Luca, Annovazzi, Pietro, Boffa, Laura, Buscarinu, Maria Chiara, Gallo, Antonio, Matta, Manuela, Moiola, Lucia, Musu, Luigina, Perini, Paola, Avolio, Carlo, Barcella, Valeria, Bianco, Assunta, Farina, Deborah, Ferraro, Elisabetta, Pontecorvo, Simona, Granella, Franco, Grimaldi, Luigi M E, Laroni, Alice, Lus, Giacomo, Patti, Francesco, Pucci, Eugenio, Pasca, Matteo, and Sarchielli, Paola

Subjects
Adult, Male, medicine.medical_specialty, Neurology, Outcome measurement, Relapsing-Remitting, Follow-Up Studie, Multiple sclerosis, 03 medical and health sciences, Immunologic Factor, 0302 clinical medicine, Multiple Sclerosis, Relapsing-Remitting, Alemtuzumab, Multiple sclerosis, Outcome measurement, Retrospective Studie, Alemtuzumab, Internal medicine, Medicine, Humans, Immunologic Factors, Multiple sclerosi, 030212 general & internal medicine, Female, Follow-Up Studies, Magnetic Resonance Imaging, Retrospective Studies, Treatment Outcome, Neurology (clinical), Expanded Disability Status Scale, medicine.diagnostic_test, business.industry, Retrospective cohort study, Magnetic resonance imaging, Odds ratio, medicine.disease, alemtuzumab, multiple sclerosis, outcome measurement, neurology, Clinical trial, Settore MED/26 - NEUROLOGIA, business, 030217 neurology & neurosurgery, Human, medicine.drug
Abstract

In this retrospective, multicenter, real-world study we collected clinical and magnetic resonance imaging (MRI) data of all patients (n = 40) with relapsing-remitting multiple sclerosis (RRMS) treated with alemtuzumab according to a "free-of-charge" protocol available before the drug marketing approval in Italy. Almost all (39/40) started alemtuzumab after discontinuing multiple disease-modifying treatments (DMTs) because of either lack of response or safety concerns. We considered the proportion of alemtuzumab-treated patients who had no evidence of disease activity (NEDA-3) and disability improvement over a 36-month follow-up period. NEDA-3 was defined as absence of relapses, disability worsening, and MRI activity. Disability improvement was defined as a sustained reduction of ≥ 1-point in Expanded Disability Status Scale (EDSS) score. At follow-up, 18 (45%) patients achieved NEDA-3, 30 (75%) were relapse-free, 33 (82.5%) were EDSS worsening-free, and 25 (62.5%) were MRI activity-free. Eleven (27.5%) patients had a sustained disability improvement. We found no predictor for the NEDA-3 status, while the interaction of higher EDSS score by higher number of pre-alemtuzumab relapses was associated with a greater chance of disability improvement (odds ratio 1.10, p = 0.049). Our study provides real-world evidence that alemtuzumab can promote clinical and MRI disease remission, as well as disability improvement, in a significant proportion of patients with RRMS despite prior multiple DMT failures. The drug safety profile was consistent with data available from clinical trials.

Published
2018

5. Assessing response to interferon-β in a multicenter dataset of patients with MS

Author

Sormani, Mp, Gasperini, C, Romeo, M, Rio, J, Calabrese, M, Cocco, E, Enzingher, C, Fazekas, F, Filippi, M, Gallo, A, Kappos, L, Marrosu, Mg, Martinelli, V, Prosperini, Luca, Rocca, Ma, Rovira, A, Sprenger, T, Stromillo, Ml, Tedeschi, G, Tintorè, M, Tortorella, C, Trojano, M, Montalban, X, Pozzilli, Carlo, Comi, G, De Stefano, N, MAGNIMS study group, Sormani, Maria Pia, Gasperini, Claudio, Romeo, Marzia, Rio, Jordi, Calabrese, Massimiliano, Cocco, Eleonora, Enzingher, Christian, Fazekas, Franz, Filippi, Massimo, Gallo, Antonio, Kappos, Ludwig, Marrosu, Maria Giovanna, Martinelli, Vittorio, Prosperini, Luca, Rocca, Maria Assunta, Rovira, Alex, Sprenger, Till, Stromillo, Maria Laura, Tedeschi, Gioacchino, Tintorè, Mar, Tortorella, Carla, Trojano, Maria, Montalban, Xavier, Pozzilli, Carlo, Comi, Giancarlo, De Stefano, Nicola, Sormani, Mp, Gasperini, C, Romeo, M, Rio, J, Calabrese, M, Cocco, E, Enzingher, C, Fazekas, F, Gallo, A, Kappos, L, Marrosu, Mg, Martinelli, V, Prosperini, L, Rocca, Ma, Rovira, A, Sprenger, T, Stromillo, Ml, Tedeschi, G, Tintorè, M, Tortorella, C, Trojano, M, Montalban, X, Pozzilli, C, and De Stefano, N.

Subjects
Time Factors, multiple sclerosis, interferon-β therapy, Magnetic Resonance Imaging, assessment, follow-up, risk of treatment failure, Expanded Disability Status Scale, relapse, worsening, Datasets as Topic, Kaplan-Meier Estimate, Relapsing-Remitting, Disability Evaluation, 0302 clinical medicine, Adolescent, Adult, Aged, Child, Europe, Follow-Up Studies, Humans, Immunologic Factors, Interferon-beta, Middle Aged, Multiple Sclerosis, Relapsing-Remitting, Retrospective Studies, Risk, Treatment Failure, Young Adult, Neurology (clinical), 030212 general & internal medicine, Young adult, medicine.diagnostic_test, Hazard ratio, medicine.medical_specialty, 03 medical and health sciences, Internal medicine, medicine, Proportional hazards model, business.industry, Multiple sclerosis, Magnetic resonance imaging, Retrospective cohort study, medicine.disease, Confidence interval, multiple-sclerosis patients, treatment optimization, clinical-practice, ifn-beta, mri, recommendations, predictors, score, business, 030217 neurology & neurosurgery
Abstract

To provide new insights into the role of markers of response to interferon-β therapy in multiple sclerosis (MS) in a multicenter setting, focusing on the relevance of MRI lesions in combination with clinical variables.A large multicenter clinical dataset was collected within the Magnetic Resonance Imaging in MS (MAGNIMS) network. This included a large cohort of patients with relapsing-remitting MS on interferon-β treatment, MRI and clinical assessments during the first year of treatment, and clinical follow-up of at least 2 additional years. Heterogeneity among centers was assessed before pooling the data. The association of 1-year MRI or clinical relapses with the risk of treatment failure (defined as Expanded Disability Status Scale [EDSS] worsening or treatment switch for inefficacy) and of EDSS worsening alone was evaluated using multivariate Cox models.A pooled dataset of 1,280 patients with relapsing-remitting MS from 9 MAGNIMS centers was analyzed. The risk of failure had a relevant increase with 1 relapse (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.39-2.44, p0.001) and ≥3 new T2 lesions (HR 1.55, 95% CI 0.92-2.60, p = 0.09). In patients without relapses and less than 3 new T2 lesions, the 3-year risk of failure and EDSS worsening were 17% and 15%; in patients with 1 relapse or ≥3 new T2 lesions, the risks were 27% and 22%; in patients with both conditions or more than 1 relapse, the risks were 48% (p0.001) and 29% (p0.001).Substantial MRI activity, particularly if in combination with clinical relapses, during the first year of treatment with interferon-β indicates significant risk of treatment failure and EDSS worsening in the short term.

Published
2016

6. Endovascular treatment of CCSVI in patients with multiple sclerosis: clinical outcome of 462 cases

Author

Ghezzi A, Annovazzi P, Cocco E, Coarelli G, Lugaresi A, Rovaris M, Patti F, Capello E, Rodegher ME, Moiola L, Malucchi S, Salemi G, De Rossi N, Provinciali L, Perini P, Bergamaschi R, Scarpini E, Lus G, Gallo A, Tola MR, Amato MP, Rottoli MR, Bianchi A, MS Study Group Italian Society of Neurology, COMI , GIANCARLO, Ghezzi, A, Annovazzi, P, Cocco, E, Coarelli, G, Lugaresi, A, Rovaris, M, Patti, F, Capello, E, Rodegher, Me, Moiola, L, Malucchi, S, Salemi, G, De Rossi, N, Provinciali, L, Perini, P, Bergamaschi, R, Scarpini, E, Lus, G, Gallo, A, Tola, Mr, Amato, Mp, Rottoli, Mr, Bianchi, A, Comi, Giancarlo, MS Study Group Italian Society of, Neurology, Ghezzi A, Annovazzi P, Cocco E, Coarelli G, Lugaresi A, Rovaris M, Patti F, Capello E, Rodegher ME, Moiola L, Malucchi S, Salemi G, De Rossi N, Provinciali L, Perini P, Bergamaschi R, Scarpini E, Lus G, Gallo A, Tola MR, Amato MP, Rottoli MR, Bianchi A, Comi G, The MS Study Group-Italian Society of Neurology, Lus, Giacomo, Gallo, Antonio, Comi, G, The MS Study Group Italian Society of, Neurology, Rodegher, ME, Tola, MR, Amato, MP, and Rottoli, MR

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Multiple Sclerosis, medicine.medical_treatment, endovascular, multiple sclerosis, treatment, venous, Dermatology, Balloon dilatation, Cohort Studies, Surveys and Questionnaires, Medicine, Humans, In patient, Endovascular treatment, Adverse effect, Beneficial effects, business.industry, Multiple sclerosis, Endovascular Procedures, Stent, Brain, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Surgery, Psychiatry and Mental health, Treatment Outcome, Spinal Cord, Venous Insufficiency, Settore MED/26 - Neurologia, Female, Neurology (clinical), business, Multiple sclerosis CCSVI Endovascular treatment, Follow-Up Studies
Abstract

Although it is still debated whether chronic cerebro-spinal venous insufficiency (CCSVI) plays a role in multiple sclerosis (MS) development, many patients underwent endovascular treatment (ET) of CCSVI. The objective of the study is to evaluate the outcome and safety of ET in Italian MS patients. Italian MS centers that are part of the Italian MS Study Group were all invited to participate to this retrospective study. A structured questionnaire was used to collect detailed clinical data before and after the ET. Data from 462 patients were collected in 33 centers. ET consisted of balloon dilatation (93 % of cases) or stent application. The mean follow-up duration after ET was 31 weeks. Mean EDSS remained unchanged after ET (5.2 vs. 4.9), 144 relapses occurred in 98/462 cases (21 %), mainly in RR-MS patients. Fifteen severe adverse events were recorded in 3.2 % of cases. Given the risk of severe adverse events and the lack of objective beneficial effects, our findings confirm that at present ET should not be recommended to patients with MS.

Published
2013

7. Acute myeloid leukemia in Italian patients with multiple sclerosis treated with mitoxantrone

Author

Martinelli, V., Cocco, E., Capra, R., Salemi, G., Gallo, P., Capobianco, M., Pesci, I., Ghezzi, A., Pozzilli, Carlo, Lugaresi, A., Bellantonio, P., Amato, M. P., Grimaldi, L. M., Trojano, M., Mancardi, G. L., Bergamaschi, R., Gasperini, Claudio, Rodegher, M., Straffi, L., Ponzio, M., Comi, G., For The Italian Mitoxantrone Group, Radaelli, M, Esposito, F, Moiola, L, Colombo, B, Rossi, P, Marrosu, Mg, Frau, J, Lorefice, L, Coghe, G, Savettieri, Giovanni, Ragonese, P, Cusimano, V, Perini, P, Rinaldi, F, Vidali, A, Bertolotto, A, Malucchi, S, Di Sapio, A, Montanari, E, Guareschi, A, Rizzo, A, Zaffaroni, M, Baldini, S, De Rossi, N, Cordioli, C, Rasia, S, Salvetti, M, Buttinelli, C, AUSILI CEFARO, Luca, De Luca, G, Tommaso, D, Farina, D, Fantozzi, R, Ruggieri, S, Amato, Mp, Hakiki, B, Zipoli, V, Portaccio, E, Bartolozzi, Ml, Scandellari, C, Stecchi, S, Marchello, Lp, Palmeri, B, Vitello, G, Iaffaldano, P, Lucchese, G, Dattola, V, Buccafusca, M, Sola, P, Simone, Am, Barreca, F, Patti, F, Laisa, P, Cavalla, P, Masera, S, Tavazzi, E, Galgani, S, Tedeschi, G, Sacco, R, Provinciali, L, Maura, D, Lus, G, Alfieri, G, Ticca, A, Piras, Ml, Maimone, D, Bianca, M, Iudice, A, Giro, Me, Galeotti, M, Florio, C, Spitalieri, P, La Mantia, L, Motti, L, Rottoli, Mr, Granella, F, Solaro, C, Scarpini, E, Servillo, G, Cavaletti, G., Martinelli, V., Cocco, E., Capra, R., Salemi, G., Gallo, P., Capobianco, M., Pesci, I., Ghezzi, A., Pozzilli, C., Lugaresi, A., Bellantonio, P., Amato, M. P., Grimaldi, L. M., Trojano, M., Mancardi, G. L., Bergamaschi, R., Gasperini, C., Rodegher, M., Straffi, L., Ponzio, M., Comi, G., Radaelli, M., Esposito, F., Moiola, L., Colombo, B., Rossi, P., Marrosu, M. G., Frau, J., Lorefice, L., Coghe, G., Savettieri, G., Ragonese, P., Cusimano, V., Perini, P., Rinaldi, F., Vidali, A., Bertolotto, A., Malucchi, S., Di Sapio, A., Montanari, E., Guareschi, A., Rizzo, A., Zaffaroni, M., Baldini, S., De Rossi, N., Cordioli, C., Rasia, S., Salvetti, M., Buttinelli, C., Ausili Cefaro, L., De Luca, Giovanna, Tommaso, D., Farina, D., Fantozzi, R., Ruggieri, S., Hakiki, B., Zipoli, V., Portaccio, E., Bartolozzi, M. L., Scandellari, C., Stecchi, S., Marchello, L. P., Palmeri, B., Vitello, G., Iaffaldano, P., Lucchese, G., Dattola, V., Buccafusca, M., Sola, P., Simone, A. M., Barreca, F., Patti, F., Laisa, P., Cavalla, P., Masera, S., Tavazzi, E., Galgani, S., Tedeschi, G., Sacco, R., Provinciali, L., Maura, D., Lus, G., Alfieri, G., Ticca, A., Piras, M. L., Maimone, D., Bianca, M., Iudice, A., Giro, M. E., Galeotti, M., Florio, C., Spitalieri, P., La Mantia, L., Motti, L., Rottoli, M. R., Granella, F., Solaro, C., Scarpini, E., Servillo, G., Cavaletti, G., Radaelli, M, Esposito, F, Moiola, L, Colombo, B, Rossi, P, Marrosu, MG, Frau, J, Lorefice, L, Coghe, G, Savettieri, G, Ragonese, P, Cusimano, V, Perini, P, Rinaldi, F, Vidali, A, Bertolotto, A, Malucchi, S, Di Sapio, A, Montanari, E, Guareschi, A, Rizzo, A, Zaffaroni, M, Baldini, S, De Rossi, N, Cordioli, C, Rasia, S, Salvetti, M, Buttinelli, C, Ausili Cefaro, L, De Luca, G, Tommaso, D, Farina, D, Fantozzi, R, Ruggieri, S, Amato, MP, Hakiki, B, Zipoli, V, Portaccio, E, Bartolozzi, ML, Scandellari, C, Stecchi, S, Marchello, LP, Palmeri, B, Vitello, G, Iaffaldano, P, Lucchese G, Dattola V, Buccafusca M, Sola, P, Simone, AM, Barreca, F, Patti, F, Laisa, P, Cavalla, P, Masera, S, Tavazzi, E, Galgani, S, Tedeschi, G, Sacco, R, Provinciali, L, Maura, D, Lus, G, Alfieri, G, Ticca, A, Piras, ML, Maimone, D, Bianca, M, Iudice, A, Giro, ME, Galeotti, M, Florio, C, Spitalieri, P, La Mantia, L, Motti, L, Rottoli, MR, Granella, F, Solaro, C, Scarpini, E, Servillo, G, Cavalletti, G, Salemi, G, Martinelli, V, Cocco, E, Capra, R, Gallo, P, Capobianco, M, Pesci, I, Ghezzi, A, Pozzilli, C, Lugaresi, A, Bellantonio, P, Amato, M, Grimaldi, L, Trojano, M, Mancardi, G, Bergamaschi, R, Gasperini, C, Rodegher, M, Straffi, L, Ponzio, M, Comi, G, Cavaletti, G, and DIPARTIMENTO DI SCIENZE BIOMEDICHE E NEUROMOTORIE

Subjects
Male, medicine.medical_specialty, Myeloid, mitoxantrone, acute myelocytic leukemia, multiple sclerosis, Population, Statistics, Nonparametric, Follow-Up Studie, Arts and Humanities (miscellaneous), Retrospective Studie, Internal medicine, Multiple Sclerosi, medicine, Humans, multiple sclerosis, leukemia, mitoxantrone, Prospective cohort study, education, Retrospective Studies, Aged, Analgesics, education.field_of_study, Mitoxantrone, Cumulative dose, business.industry, Multiple sclerosis, Incidence (epidemiology), leukemia, Myeloid leukemia, Retrospective cohort study, medicine.disease, Confidence interval, Surgery, Leukemia, Leukemia, Myeloid, Acute, medicine.anatomical_structure, Italy, Cohort, Settore MED/26 - Neurologia, Analgesic, Female, Neurology (clinical), business, Follow-Up Studies, medicine.drug, Human
Abstract

none 25 no Abstract OBJECTIVES: To evaluate the incidence and dose-dependency of mitoxantrone (MTX)-associated acute myelocytic leukemia (AML) in the network of Italian multiple sclerosis (MS) clinics. METHODS: We performed a multicenter retrospective cohort study of patients treated with MTX in MS centers under the Italian national health care system between 1998 and 2008. Demographic, disease, treatment, and follow-up information were collected using hospital records. RESULTS: Data were available for 3,220 patients (63% women) from 40 Italian centers. Follow-up (mean ± SD) was 49 ± 29 months (range 12-140 months). We observed 30 cases of AML (incidence 0.93% [95% confidence interval 0.60%-1.26%]). The mean cumulative dose was higher in patients with AML (78 vs 65 mg/m(2), p = 0.028). The median interval from the start of therapy to AML diagnosis was longer than expected at 33 months (range 13-84 months); 8 patients (27%) developed AML 4 years or more after the first MTX infusion. The rate of mortality associated with AML was 37%. CONCLUSIONS: This higher than expected risk of AML and related mortality requires that treatment decisions must be made jointly between clinicians and patients who understand their prognosis, treatment options, and treatment-related risks. The now large exposed MS population must be monitored for hematologic abnormalities for at least 6 years from the end of therapy, to ensure the rapid actions needed for early diagnosis and treatment of AML. none Martinelli V; Cocco E; Capra R; Salemi G; Gallo P; Capobianco M; Pesci I; Ghezzi A; Pozzilli C; Lugaresi A; Bellantonio P; Amato MP; Grimaldi LM; Trojano M; Mancardi GL; Bergamaschi R; Gasperini C; Rodegher M; Straffi L; Ponzio M; Comi G; For The Italian Mitoxantrone Group; De Luca G; Di Tommaso V; Farina D Martinelli V; Cocco E; Capra R; Salemi G; Gallo P; Capobianco M; Pesci I; Ghezzi A; Pozzilli C; Lugaresi A; Bellantonio P; Amato MP; Grimaldi LM; Trojano M; Mancardi GL; Bergamaschi R; Gasperini C; Rodegher M; Straffi L; Ponzio M; Comi G; For The Italian Mitoxantrone Group; De Luca G; Di Tommaso V; Farina D

Published
2011

8. Adverse events after endovascular treatment of chronic cerebro-spinal venous insufficiency (CCSVI) in patients with multiple sclerosis

Author

Ghezzi A, Annovazzi P, Amato MP, Capello E, Cavalla P, Cocco E, Falcini M, Patti F, Perini P, Rodegher ME, Rovaris M, Rottoli MR, Comi G, MS Study Group Italian Society of Neurology, GALLO, Antonio, Ghezzi, A, Annovazzi, P, Amato, Mp, Capello, E, Cavalla, P, Cocco, E, Falcini, M, Gallo, Antonio, Patti, F, Perini, P, Rodegher, Me, Rovaris, M, Rottoli, Mr, Comi, G, MS Study Group Italian Society of, Neurology, Gallo, A, and Comi, Giancarlo

Subjects
Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Status epilepticus, Aspiration pneumonia, Internal medicine, medicine, Humans, Myocardial infarction, Adverse effect, Stroke, business.industry, Multiple sclerosis, Endovascular Procedures, Brain, medicine.disease, Thrombosis, Hydrocephalus, Surgery, Spinal Cord, Venous Insufficiency, Neurology, Cardiology, Female, Neurology (clinical), medicine.symptom, business
Abstract

Although it is debated whether chronic cerebro-spinal venous insufficiency (CCSVI) plays a role in multiple sclerosis (MS) development, many patients undergo endovascular treatment (ET) of CCSVI. A study is ongoing in Italy to evaluate the clinical outcome of ET. Severe adverse events (AEs) occurred in 15/462 subjects at a variable interval after ET: jugular thrombosis in seven patients, tetraventricular hydrocephalus, stroke, paroxysmal atrial fibrillation, status epilepticus, aspiration pneumonia, hypertension with tachicardia, or bleeding of bedsore in the remaining seven cases. One patient died because of myocardial infarction 10 weeks after ET. The risk of severe AEs related to ET for CCSVI must be carefully considered.

Published
2013

9. Frequency and risk factors of mitoxantrone-induced amenorrhea in multiple sclerosis: the FEMIMS study

Author

Cocco, E, Sardu, C, Gallo, P, Capra, R, Amato, Mp, Trojano, M, Uccelli, A, Marrosu, Mg, Galeotti, M, Cordioli, C, Massole, S, Musu, L, Coghe, G, Patti, Francesco, Lugaresi, A, Tola, Mr, Zipoli, V, Mancardi, Gl, Capello, E, Solaro, C, Caputo, C, Cavarretta, R, Merelli, E, Perini, P, Francia, A, Batocchi, Ap, Ergamaschi, R, Tavazzi, E, Cavalla, P, Masera, S, Bertolotto, A, Capobianco, M, Zorzon, M, Ghezzi, A, Zaffaroni, M., COCCO E, SARDU C, GALLO P, CAPRA R, AMATO MP, TROJANO M, UCCELLI A, MARROSU MG, THE FEMIMS GROUP, and A. LUGARESI

Subjects
Adult, Male, Questionnaires, medicine.medical_specialty, Multiple Sclerosis, media_common.quotation_subject, Fertility, Young Adult, Risk Factors, Internal medicine, medicine, Humans, Risk factor, Young adult, Amenorrhea, media_common, Retrospective Studies, Menarche, Mitoxantrone, Cumulative dose, business.industry, Retrospective cohort study, medicine.disease, multiple sclerosis, mitoxantrone, treatment, amenorrhea, drug therapy/epidemiology, Menopause, Settore MED/26 - NEUROLOGIA, Endocrinology, Neurology, Adult, Amenorrhea, chemically induced/epidemiology, Female, Follow-Up Studies, Humans, Immunosuppressive Agents, adverse effects, Infertility, Female, chemically induced/epidemiology, Male, Menarche, Menopause, Mitoxantrone, adverse effects, Multiple Sclerosis, drug therapy/epidemiology, Questionnaires, Retrospective Studies, Risk Factors, Young Adult, Infertility, adverse effects, chemically induced/epidemiology, Neurology (clinical), medicine.symptom, business, Infertility, Female, Immunosuppressive Agents, medicine.drug, Follow-Up Studies
Abstract

Background Improved prognosis in women with multiple sclerosis (MS) undergoing immunosuppressive treatment with mitoxantrone (MITO) has led to an increased interest in the effect of such treatments on fertility. FErtility and Mitoxantrone In MS (FEMIMS) is a collaborative retrospective study aimed at evaluating the impact of MITO treatment on fertility in women with MS. Methods Occurrence of chemotherapy-induced amenorrhea (CIA) was evaluated in 189 women with MS treated with MITO before the age of 45. An “ad hoc” questionnaire, paying particular attention to onset of CIA either during or post-MITO treatment, was administered to each patient. The probability of CIA was calculated using a multivariate logistic regression analysis taking into account age at exposure, cumulative dose, and use of estroprogestinic (EP) drugs during treatment. Results Forty-eight (26%) patients presented CIA following MITO. The probability of CIA was increased by 2%/mg/m2 of cumulative dose and by 18% for each year of age, whereas it was reduced by administration of EP during treatment. Conclusions MITO treatment may affect reproductive capacity in women with MS. Patients of childbearing age should be properly counseled before MITO treatment and EP therapy should be administered to reduce the risk of CIA.

Published
2008

10. Intense immunosuppression followed by autologous stem cell transplantation in severe multiple sclerosis

Author

Capello E, Saccardi R, Murialdo A, Gualandi F, Pagliai F, Bacigalupo A, Marmont A, Uccelli A, Inglese M, Bruzzi P, Sormani MP, Cocco E, Meucci G, Massacesi L, Bertolotto A, Lugaresi A, Merelli E, Solari A, Filippi M, Mancardi GL, Italian GITMO-Neuro Intergroup on ASCT for Multiple Sclerosis, La Nasa G, Marrosu MG, Derchi V, Di Bartolomeo P, Farina D, Iarlori C, Tartaro A, Repice A, Pellicanò G, Dogliotti L, Parodi RC, Schenone A, Donelli A, Casoni F, Cavalleri F, Capobianco M, Guerrasio A, Duca S, Papineschi F, Scappini B, Mosti S, Abbruzzese A, Capello, E, Saccardi, R, Murialdo, A, Gualandi, F, Pagliai, F, Bacigalupo, A, Marmont, A, Uccelli, A, Inglese, M, Bruzzi, P, Sormani, Mp, Cocco, E, Meucci, G, Massacesi, L, Bertolotto, A, Lugaresi, A, Merelli, E, Solari, A, Filippi, M, Mancardi, Gl, Italian GITMO-Neuro Intergroup on ASCT for Multiple, Sclerosi, La Nasa, G, Marrosu, Mg, Derchi, V, Di Bartolomeo, P, Farina, D, Iarlori, C, Tartaro, A, Repice, A, Pellicanò, G, Dogliotti, L, Parodi, Rc, Schenone, A, Donelli, A, Casoni, F, Cavalleri, F, Capobianco, M, Guerrasio, A, Duca, S, Papineschi, F, Scappini, B, Mosti, S, and Abbruzzese, A

Subjects
Oncology, Adult, medicine.medical_specialty, Multiple Sclerosis, medicine.medical_treatment, Inflammation, Dermatology, Transplantation, Autologous, Severity of Illness Index, methods, Autologous stem-cell transplantation, Internal medicine, medicine, Humans, Severe disability, Salvage Therapy, Transplantation, Adult, Hematopoietic Stem Cell Transplantation, methods, Humans, Immunosuppressive Agents, therapeutic use, Italy, Magnetic Resonance Imaging, Multiple Sclerosis, diagnosis/immunology/therapy, Salvage Therapy, Severity of Illness Index, Transplantation, Autologous, Treatment Outcome, business.industry, Multiple sclerosis, Hematopoietic Stem Cell Transplantation, diagnosis/immunology/therapy, Immunosuppression, General Medicine, medicine.disease, Magnetic Resonance Imaging, Psychiatry and Mental health, Haematopoiesis, Treatment Outcome, Italy, therapeutic use, Neurology (clinical), medicine.symptom, Stem cell, business, Autologous, Immunosuppressive Agents
Abstract

Aggressive forms of multiple sclerosis (MS) represent a limited group of demyelinating diseases that rapidly progress to severe disability. Currently available therapies are poorly effective against these clinical entities. Recently, it has been demonstrated that intense immunosuppression followed by autologous haematopoietic stem cell transplantation (AHSCT) can affect the clinical course of individuals with severe MS and completely abrogate the inflammatory activity detected by MRI. We report the result of the Italian phase 2 GITMO study, a multicentre study in which 21 MS patients, who were rapidly deteriorating and not responding to the usual therapeutic strategies, were treated with this procedure. The clinical effect of the treatment is long lasting, with a striking abrogation of inflammation detected by MRI findings. These results support a role for intense immunosuppression followed by ASCT as treatment in rapidly evolving MS cases unresponsive to conventional therapies.

Published
2005

11. Cerebrospinal fluid findings in Devic?s neuromyelitis optica

Author

Zaffaroni, M, Trojano, M, Paolicelli, D, Capra, R, Salvi, F, Pastorelli, F, Marrosu, G, Cocco, E, Patti, Francesco, Tola, R, Caniatti, L, Amato, Mp, Ghezzi, A, Mancardi, Gl, Murialdo, A, Roccatagliata, L, Milanese, C, La Mantia, L, Comi, G, Martinelli, V, Filippi, M, Merelli, E, Sola, P, Bergamaschi, R, Tonietti, S, Gallo, P, Perini, P, and Bertolotto, A.

Subjects
Adult, Male, medicine.medical_specialty, Pathology, Neurology, Adolescent, Immunoglobulins, Lymphocytosis, Dermatology, Spinal Puncture, Diagnosis, Differential, White matter, Cerebrospinal fluid, medicine, Humans, Child, Pleocytosis, Aged, Neuromyelitis optica, medicine.diagnostic_test, business.industry, Lumbar puncture, Multiple sclerosis, Neuromyelitis Optica, General Medicine, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Psychiatry and Mental health, medicine.anatomical_structure, Child, Preschool, Female, Neurology (clinical), Differential diagnosis, business
Abstract

Relapsing Devic's neuromyelitis optica (DNO) may be clinically undistinguishable from multiple sclerosis (MS), thus the differential diagnosis relies mainly on neuroimaging and cerebrospinal fluid (CSF) findings. We studied CSF samples from 44 patients with DNO submitted to at least one lumbar puncture. Pleocytosis, IgG synthesis and blood brain barrier damage were the most frequent abnormalities, pleocytosis being very suggestive of DNO in patients fulfilling clinical and MRI diagnostic criteria. Pleocytosis > or =50 cells/mm3 is more frequent in the active phases of the disease. Oligoclonal bands (OBs) should be re-considered within the diagnostic criteria of DNO for possible variations in time: at variance with MS they may also disappear. Thus, more than one CSF examination should be done in the presence of suspected DNO, preferably in different disease phases. Although uncommon, OBs do not exclude DNO if optic nerve and spinal cord are the only sites of white matter damage, provided that cerebral MRI is normal at onset and during follow up.

Published
2004

12. The prevalence of pain in multiple sclerosis: a multicenter cross-sectional study

Author

Solaro, C., Brichetto, G., Amato, M. P., Cocco, E., Colombo, B., D Aleo, G., claudio gasperini, Ghezzi, A., Martinelli, V., Milanese, C., Patti, F., Trojano, M., Verdun, E., Mancardi, G. L., Annunziata, P., Baldini, S., Zaffaroni, M., Bertolotto, A., Bonavita, S., Bramanti, P., Sessa, E., Fiorilla, T., Fuiani, A., Mazzoni, M., Mendozzi, L., Merelli, E., Sola, P., Pozzilli, C., Pucci, E., Pugliatti, M., Scandellari, C., Tola, M. R., Uccelli, A., and Murialdo, A.

Subjects
Adult, Male, medicine.medical_specialty, Spasm, Multiple Sclerosis, Adolescent, Cross-sectional study, Pain, Disease course, Central nervous system disease, Trigeminal neuralgia, Internal medicine, Surveys and Questionnaires, Back pain, medicine, Prevalence, Humans, Aged, Analgesics, Expanded Disability Status Scale, business.industry, Multiple sclerosis, Middle Aged, Trigeminal Neuralgia, medicine.disease, Tonic spasms, Cross-Sectional Studies, Italy, Back Pain, Physical therapy, Female, Neurology (clinical), medicine.symptom, business
Abstract

In a multicenter cross-sectional study, the authors assessed pain in patients with multiple sclerosis (MS) using a symptom-oriented approach. Out of 2,077 questionnaires, we used 1,672 for data analysis. Pain and frequencies included trigeminal neuralgia 2%, Lhermitte's sign 9%, dysesthetic pain 18.1%, back pain 16.4%, and painful tonic spasms 11%. Comparison between different groups showed significant differences for age, Expanded Disability Status Scale, disease duration, and disease course, but not for sex. This study underlines the relevance of pain in the clinical history of MS.

Published
2004

13. The effect of air pollution on COVID‐19 severity in a sample of patients with multiple sclerosis

Author

Bergamaschi, Roberto, Ponzano, Marta, Schiavetti, Irene, Carmisciano, Luca, Cordioli, Cinzia, Filippi, Massimo, Radaelli, Marta, Immovilli, Paolo, Capobianco, Marco, De Rossi, Nicola, Brichetto, Giampaolo, Cocco, Eleonora, Scandellari, Cinzia, Cavalla, Paola, Pesci, Ilaria, Zito, Antonio, Confalonieri, Paolo, Marfia, Girolama Alessandra, Perini, Paola, Inglese, Matilde, Trojano, Maria, Brescia Morra, Vincenzo, Pisoni, Enrico, Tedeschi, Gioacchino, Comi, Giancarlo, Battaglia, Mario Alberto, Patti, Francesco, Salvetti, Marco, Sormani, Maria Pia, Gianmarco Abbadessa, Umberto Aguglia, Lia Allegorico, Rossi Beatrice Maria Allegri, Anastasia Alteno, Maria Pia Amato, Pietro Annovazzi, Carlo Antozzi, Lucia Appendino, Sebastiano Arena, Viola Baione, Roberto Balgera, Valeria Barcella, Damiano Baroncini, Caterina Barrilà, Mario A Battaglia, Alessandra Bellacosa, Gianmarco Bellucci, Roberto Bergamaschi, Valeria Bergamaschi, Daiana Bezzini, Beatrice Biolzi, Alvino Bisecco, Simona Bonavita, Giovanna Borriello, Chiara Bosa, Antonio Bosco, Francesca Bovis, Marco Bozzali, Laura Brambilla, Morra Vincenzo Brescia, Giampaolo Brichetto, Maria Buccafusca, Elisabetta Bucciantini, Sebastiano Bucello, Maria Chiara Buscarinu, Maria Paola Cabboi, Massimiliano Calabrese, Francesca Calabria, Francesca Caleri, Federico Camilli, Luisa Maria Caniatti, Roberto Cantello, Marco Capobianco, Ruggero Capra, Rocco Capuano, Luca Carmisciano, Patrizia Carta, Paola Cavalla, Maria Grazia Celani, Maria Cellerino, Raffaella Cerqua, Clara Chisari, Raffaella Clerici, Marinella Clerico, Eleonora Cocco, Gaia Cola, Giancarlo Comi, Paolo Confalonieri, Antonella Conte, Marta Zaffira Conti, Christian Cordano, Susanna Cordera, Cinzia Cordioli, Francesco Corea, Claudio Correale, Salvatore Cottone, Francesco Crescenzo, Erica Curti, Alessandro d'Ambrosio, Emanuele D'Amico, Maura Chiara Danni, Alessia d'Arma, Vincenzo Dattola, Stefano de Biase, Giovanna De Luca, Stefania Federica De Mercanti, Paolo De Mitri, Nicola De Rossi, Nicola De Stefano, Cava Marco Della, Mario di Napoli, Alessia Di Sapio, Renato Docimo, Anna Dutto, Luana Evangelista, Salvatore Fanara, Diana Ferraro, Maria Teresa Ferrò, Massimo Filippi, Cristina Fioretti, Mario Fratta, Jessica Frau, Marzia Fronza, Roberto Furlan, Alberto Gajofatto, Antonio Gallo, Paolo Gallo, Claudio Gasperini, Anna Ghazaryan, Bruno Giometto, Francesca Gobbin, Flora Govone, Franco Granella, Erica Grange, Maria Grazia Grasso, Angelica Guareschi, Clara Guaschino, Simone Guerrieri, Donata Guidetti, Pietro Iaffaldano, Antonio Ianniello, Luigi Iasevoli, Paolo Immovilli, Daniele Imperiale, Maria Teresa Infante, Matilde Inglese, Rosa Iodice, Aniello Iovino, Giovanna Konrad, Doriana Landi, Roberta Lanzillo, Caterina Lapucci, Luigi Lavorgna, Maria Rita L'Episcopo, Serena Leva, Giuseppe Liberatore, Re Marianna Lo, Marco Longoni, Leonardo Lopiano, Lorena Lorefice, Matteo Lucchini, Giacomo Lus, Davide Maimone, Maria Malentacchi, Giulia Mallucci, Simona Malucchi, Chiara Rosa Mancinelli, Luca Mancinelli, Paolo Manganotti, Giorgia Teresa Maniscalco, Vittorio Mantero, Sabrina Marangoni, Damiano Marastoni, Girolama Alessandra Marfia, Fabiana Marinelli, Alessandro Marti, Boneschi Filippo Martinelli, Zoli Federco Masserano, Francesca Matta, Laura Mendozzi, Giuseppe Meucci, Silvia Miante, Giuseppina Miele, Eva Milano, Massimiliano Mirabella, Rosanna Missione, Marcello Moccia, Lucia Moiola, Sara Montepietra, Margherita MontiBragadin, Federico Montini, Roberta Motta, Raffaele Nardone, Carolina Gabri Nicoletti, Eduardo Nobile-Orazio, Agostino Nozzolillo, Marco Onofrj, Riccardo Orlandi, Anna Palmieri, Damiano Paolicelli, Livia Pasquali, Luisa Pastò, Francesco Patti, Elisabetta Pedrazzoli, Paola Perini, Ilaria Pesci, Maria Petracca, Alfredo Petrone, Carlo Piantadosi, Anna M Pietroboni, Federica Pinardi, Marta Ponzano, Emilio Portaccio, Mattia Pozzato, Carlo Pozzilli, Luca Prosperini, Alessandra Protti, Marta Radaelli, Paolo Ragonese, Sarah Rasia, Sabrina Realmuto, Anna Repice, Eleonora Rigoni, Maria Teresa Rilla, Francesca Rinaldi, Calogero Marcello Romano, Marco Ronzoni, Marco Rovaris, Francesca Ruscica, Loredana Sabattini, Giuseppe Salemi, Marco Salvetti, Lorenzo Saraceno, Alessia Sartori, Arianna Sartori, Elvira Sbragia, Cinzia Scandellari, Giuditta Ilaria Scarano, Valentina Scarano, Irene Schiavetti, Maria Sessa, Caterina Sgarito, Grazia Sibilia, Gabriele Siciliano, Alessio Signori, Elisabetta Signoriello, Leonardo Sinisi, Francesca Sireci, Patrizia Sola, Claudio Solaro, Maria Pia Sormani, Stefano Sotgiu, Maddalena Sparaco, Maria Laura Stromillo, Silvia Strumia, Emanuela Laura Susani, Giulietta Tabiadon, Francesco Teatini, Gioacchino Tedeschi, Valentina Tomassini, Simone Tonietti, Clerici Valentina Torri, Carla Tortorella, Simona Toscano, Rocco Totaro, Maria Trojano, Maria Trotta, Gabriella Turano, Monica Ulivelli, Manzo Valentino, Giovanna Vaula, Domizia Vecchio, Marco Vercellino, Elena Pinuccia Verrengia, Marika Vianello, Eleonora Virgilio, Francesca Vitetta, Stefano Vollaro, Mauro Zaffaroni, Mauro Zampolini, Ignazio Roberto Zarbo, Antonio Zito, Luigi Zuliani, Bergamaschi, R, Ponzano, M, Schiavetti, I, Carmisciano, L, Cordioli, C, Filippi, M, Radaelli, M, Immovilli, P, Capobianco, M, De Rossi, N, Brichetto, G, Cocco, E, Scandellari, C, Cavalla, P, Pesci, I, Zito, A, Confalonieri, P, Marfia, Ga, Perini, P, Inglese, M, Trojano, M, Brescia Morra, V, Pisoni, E, Tedeschi, G, Comi, G, Battaglia, Ma, Patti, F, Salvetti, M, Sormani, Mp, Abbadessa, Gianmarco, Umberto, Aguglia, Lia, Allegorico, Rossi Beatrice Maria Allegri, Anastasia, Alteno, Maria Pia Amato, Pietro, Annovazzi, Carlo, Antozzi, Lucia, Appendino, Sebastiano, Arena, Viola, Baione, Roberto, Balgera, Valeria, Barcella, Damiano, Baroncini, Caterina, Barrilà, Mario, A Battaglia, Alessandra, Bellacosa, Gianmarco, Bellucci, Roberto, Bergamaschi, Valeria, Bergamaschi, Daiana, Bezzini, Beatrice, Biolzi, Bisecco, Alvino, Bonavita, Simona, Giovanna, Borriello, Chiara, Bosa, Bosco, Antonio, Francesca, Bovi, Marco, Bozzali, Laura, Brambilla, Morra Vincenzo Brescia, Giampaolo, Brichetto, Maria, Buccafusca, Elisabetta, Bucciantini, Sebastiano, Bucello, Maria Chiara Buscarinu, Maria Paola Cabboi, Massimiliano, Calabrese, Francesca, Calabria, Francesca, Caleri, Federico, Camilli, Luisa Maria Caniatti, Roberto, Cantello, Marco, Capobianco, Ruggero, Capra, Capuano, Rocco, Luca, Carmisciano, Patrizia, Carta, Paola, Cavalla, Maria Grazia Celani, Maria, Cellerino, Raffaella, Cerqua, Clara, Chisari, Raffaella, Clerici, Marinella, Clerico, Eleonora, Cocco, Gaia, Cola, Giancarlo, Comi, Paolo, Confalonieri, Antonella, Conte, Marta Zaffira Conti, Christian, Cordano, Susanna, Cordera, Cinzia, Cordioli, Corea, Francesco, Claudio, Correale, Salvatore, Cottone, Francesco, Crescenzo, Erica, Curti, Alessandro, D'Ambrosio, Emanuele, D'Amico, Maura Chiara Danni, Alessia, D'Arma, Vincenzo, Dattola, Stefano de Biase, Giovanna De Luca, Stefania Federica De Mercanti, Paolo De Mitri, Nicola De Rossi, Nicola De Stefano, Cava Marco Della, Mario di Napoli, Alessia Di Sapio, Docimo, Renato, Anna, Dutto, Luana, Evangelista, Salvatore, Fanara, Diana, Ferraro, Maria Teresa Ferrò, Massimo, Filippi, Cristina, Fioretti, Fratta, Mario, Jessica, Frau, Marzia, Fronza, Roberto, Furlan, Alberto, Gajofatto, Gallo, Antonio, Paolo, Gallo, Claudio, Gasperini, Anna, Ghazaryan, Bruno, Giometto, Francesca, Gobbin, Flora, Govone, Franco, Granella, Erica, Grange, Maria Grazia Grasso, Angelica, Guareschi, Clara, Guaschino, Simone, Guerrieri, Donata, Guidetti, Pietro, Iaffaldano, Antonio, Ianniello, Luigi, Iasevoli, Paolo, Immovilli, Daniele, Imperiale, Maria Teresa Infante, Matilde, Inglese, Rosa, Iodice, Aniello, Iovino, Giovanna, Konrad, Doriana, Landi, Roberta, Lanzillo, Caterina, Lapucci, Luigi, Lavorgna, Maria Rita L'Episcopo, Serena, Leva, Giuseppe, Liberatore, Re Marianna Lo, Marco, Longoni, Leonardo, Lopiano, Lorena, Lorefice, Matteo, Lucchini, Lus, Giacomo, Davide, Maimone, Maria, Malentacchi, Giulia, Mallucci, Simona, Malucchi, Chiara Rosa Mancinelli, Luca, Mancinelli, Paolo, Manganotti, Giorgia Teresa Maniscalco, Vittorio, Mantero, Sabrina, Marangoni, Damiano, Marastoni, Girolama Alessandra Marfia, Fabiana, Marinelli, Alessandro, Marti, Boneschi Filippo Martinelli, Zoli Federco Masserano, Francesca, Matta, Laura, Mendozzi, Giuseppe, Meucci, Silvia, Miante, Miele, Giuseppina, Eva, Milano, Massimiliano, Mirabella, Missione, Rosanna, Marcello, Moccia, Lucia, Moiola, Sara, Montepietra, Margherita, Montibragadin, Federico, Montini, Roberta, Motta, Raffaele, Nardone, Carolina Gabri Nicoletti, Eduardo, Nobile-Orazio, Agostino, Nozzolillo, Marco, Onofrj, Riccardo, Orlandi, Palmieri, Anna, Damiano, Paolicelli, Livia, Pasquali, Luisa, Pastò, Francesco, Patti, Elisabetta, Pedrazzoli, Paola, Perini, Ilaria, Pesci, Maria, Petracca, Alfredo, Petrone, Carlo, Piantadosi, Anna, M Pietroboni, Federica, Pinardi, Marta, Ponzano, Emilio, Portaccio, Mattia, Pozzato, Carlo, Pozzilli, Luca, Prosperini, Alessandra, Protti, Marta, Radaelli, Paolo, Ragonese, Sarah, Rasia, Sabrina, Realmuto, Anna, Repice, Eleonora, Rigoni, Maria Teresa Rilla, Francesca, Rinaldi, Calogero Marcello Romano, Marco, Ronzoni, Marco, Rovari, Francesca, Ruscica, Loredana, Sabattini, Giuseppe, Salemi, Marco, Salvetti, Lorenzo, Saraceno, Alessia, Sartori, Arianna, Sartori, Elvira, Sbragia, Cinzia, Scandellari, Giuditta Ilaria Scarano, Valentina, Scarano, Irene, Schiavetti, Maria, Sessa, Caterina, Sgarito, Grazia, Sibilia, Gabriele, Siciliano, Alessio, Signori, Signoriello, Elisabetta, Leonardo, Sinisi, Francesca, Sireci, Patrizia, Sola, Claudio, Solaro, Maria Pia Sormani, Stefano, Sotgiu, Sparaco, Maddalena, Maria Laura Stromillo, Silvia, Strumia, Emanuela Laura Susani, Giulietta, Tabiadon, Francesco, Teatini, Tedeschi, Gioacchino, Valentina, Tomassini, Simone, Tonietti, Clerici Valentina Torri, Carla, Tortorella, Simona, Toscano, Rocco, Totaro, Maria, Trojano, Trotta, Maria Consiglia, Gabriella, Turano, Monica, Ulivelli, Manzo, Valentino, Giovanna, Vaula, Domizia, Vecchio, Marco, Vercellino, Elena Pinuccia Verrengia, Marika, Vianello, Eleonora, Virgilio, Francesca, Vitetta, Stefano, Vollaro, Mauro, Zaffaroni, Mauro, Zampolini, Ignazio Roberto Zarbo, Zito, Guido Antonio, Bergamaschi, R., Ponzano, M., Schiavetti, I., Carmisciano, L., Cordioli, C., Filippi, M., Radaelli, M., Immovilli, P., Capobianco, M., De Rossi, N., Brichetto, G., Cocco, E., Scandellari, C., Cavalla, P., Pesci, I., Zito, A., Confalonieri, P., Marfia, G. A., Perini, P., Inglese, M., Trojano, M., Brescia Morra, V., Pisoni, E., Tedeschi, G., Comi, G., Battaglia, M. A., Patti, F., Salvetti, M., Sormani, M. P., Bergamaschi, Roberto, Ponzano, Marta, Schiavetti, Irene, Carmisciano, Luca, Cordioli, Cinzia, Filippi, Massimo, Radaelli, Marta, Immovilli, Paolo, Capobianco, Marco, De Rossi, Nicola, Brichetto, Giampaolo, Cocco, Eleonora, Scandellari, Cinzia, Cavalla, Paola, Pesci, Ilaria, Zito, Antonio, Confalonieri, Paolo, Marfia, Girolama Alessandra, Perini, Paola, Inglese, Matilde, Trojano, Maria, Brescia Morra, Vincenzo, Pisoni, Enrico, Comi, Giancarlo, Battaglia, Mario Alberto, Patti, Francesco, Salvetti, Marco, Sormani, Maria, Pia, Gianmarco, Abbadessa, Alvino, Bisecco, Simona, Bonavita, Antonio, Bosco, Rocco, Capuano, Francesco, Corea, Renato, Docimo, Mario, Fratta, Antonio, Gallo, Iodice, Rosa, Iovino, Aniello, Lanzillo, Roberta, Giacomo, Lu, Giuseppina, Miele, Rosanna, Missione, Moccia, Marcello, Anna, Palmieri, Elisabetta, Signoriello, Maddalena, Sparaco, Gioacchino, Tedeschi, Maria, Trotta, Antonio, Zito, and Luigi, Zuliani

Subjects
air pollution, coronavirus, multiple sclerosis, medicine.medical_specialty, Multivariate analysis, Coronavirus disease 2019 (COVID-19), Clinical Sciences, Air pollution, Sample (statistics), Neurodegenerative, Settore MED/26, medicine.disease_cause, Autoimmune Disease, law.invention, Sustainable Cities and Communities, Clinical Research, law, Humans, Medicine, Climate-Related Exposures and Conditions, Neurology & Neurosurgery, MuSC-19 study group, SARS-CoV-2, business.industry, Multiple sclerosis, Neurosciences, COVID-19, Retrospective cohort study, Original Articles, medicine.disease, Intensive care unit, Particulate Matter, Air Pollution, Multiple Sclerosis, Brain Disorders, coronaviru, Settore MED/26 - NEUROLOGIA, Good Health and Well Being, Neurology, multiple sclerosi, Emergency medicine, Original Article, Neurology (clinical), Ordered logit, business, Human
Abstract

Background and purpose Some studies have shown that air pollution, often assessed by thin particulate matter with diameter below 2.5 µg/m3 (PM2.5), may contribute to severe COVID‐19 courses, as well as play a role in the onset and evolution of multiple sclerosis (MS). However, the impact of air pollution on COVID‐19 has never been explored specifically amongst patients with MS (PwMS). This retrospective observational study aims to explore associations between PM2.5 and COVID‐19 severity amongst PwMS. Methods Data were retrieved from an Italian web‐based platform (MuSC‐19) which includes PwMS with COVID‐19. PM2.5 2016–2018 average concentrations were provided by the Copernicus Atmospheric Monitoring Service. Italian patients inserted in the platform from 15 January 2020 to 9 April 2021 with a COVID‐19 positive test were included. Ordered logistic regression models were used to study associations between PM2.5 and COVID‐19 severity. Results In all, 1087 patients, of whom 13% required hospitalization and 2% were admitted to an intensive care unit or died, were included. Based on the multivariate analysis, higher concentrations of PM2.5 increased the risk of worse COVID‐19 course (odds ratio 1.90; p = 0.009). Conclusions Even if several other factors explain the unfavourable course of COVID‐19 in PwMS, the role of air pollutants must be considered and further investigated., Air pollution, often assessed by particulate matter with diameter below 2.5 µg/m3, may contribute to severe COVID‐19 courses. 1087 patients were included, of whom 13% required hospitalization and 2% were admitted to an intensive care unit or died. Even if several other factors explain the unfavourable course of COVID‐19 in patients with multiple sclerosis, the role of air pollutants must be considered and further investigated.

Published
2021

14. Listening to the neurological teams for multiple sclerosis: the SMART project

Author

M. Rezzonico, Rocco Totaro, S. Bucello, Cinzia Cordioli, Alessandra Lugaresi, Alvino Bisecco, Martina Petruzzo, Paola Cavalla, Luisa Pastò, Eleonora Cocco, Giovanna Borriello, Roberta Fantozzi, S. Marangoni, M. Di Giuseppe, Edoardo Sessa, F. Caleri, Maria Liguori, W. Neri, M. G. Marini, L. Locatelli, G. L. Mancardi, C. Tortorella, K. Plewnia, S. Romano, P. Perini, Lucia Moiola, Francesco Patti, E. Mutta, Paola Chesi, Paola Valentino, A. Repice, Franco Granella, L. Alivernini, Marco Rovaris, M. Gattuso, Chesi P., Marini M.G., Mancardi G.L., Patti F., Alivernini L., Bisecco A., Borriello G., Bucello S., Caleri F., Cavalla P., Cocco E., Cordioli C., Di Giuseppe M., Fantozzi R., Gattuso M., Granella F., Liguori M., Locatelli L., Lugaresi A., Marangoni S., Moiola L., Mutta E., Neri W., Pasto L., Perini P., Petruzzo M., Plewnia K., Repice A.M., Rezzonico M., Romano S., Rovaris M., Sessa E., Tortorella C., Totaro R., Valentino P., Chesi, P., Marini, M. G., Mancardi, G. L., Patti, F., Alivernini, L., Bisecco, A., Borriello, G., Bucello, S., Caleri, F., Cavalla, P., Cocco, E., Cordioli, C., Di Giuseppe, M., Fantozzi, R., Gattuso, M., Granella, F., Liguori, M., Locatelli, L., Lugaresi, A., Marangoni, S., Moiola, L., Mutta, E., Neri, W., Pasto, L., Perini, P., Petruzzo, M., Plewnia, K., Repice, A. M., Rezzonico, M., Romano, S., Rovaris, M., Sessa, E., Tortorella, C., Totaro, R., and Valentino, P.

Subjects
Male, medicine.medical_specialty, Multiple Sclerosis, Neurology, Dermatology, Burnout, Job Satisfaction, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Surveys and Questionnaires, Health care, medicine, Humans, Active listening, 030212 general & internal medicine, Compassion fatigue, Descriptive statistics, business.industry, General Medicine, Middle Aged, Narrative medicine, burnout, compassion fatigue, narrative medicine, Psychiatry and Mental health, Cross-Sectional Studies, Italy, Family medicine, Quality of Life, Anxiety, Original Article, Female, Neurology (clinical), Empathy, medicine.symptom, Psychology, business, 030217 neurology & neurosurgery
Abstract

Objective Aim of the research was to define the quality of life of Italian neurologists and nurses’ professional caring for multiple sclerosis, to understand their living the clinical practice and identify possible signals of compassion fatigue. Material and methods One hundred five neurologists and nurses from 30 Italian multiple sclerosis centres were involved in an online quali-quantitative survey on the organization of care, combined with the Satisfaction and Compassion Fatigue Test and a collection of narratives. Descriptive statistics of the quantitative data were integrated with the results obtained by the narrative medicine methods of analysis. Results Most of the practitioners were neurologists, 46 average years old, 69% women, 43% part time dedicated to multiple sclerosis. An increased number of patients in the last 3 years were referred in 29 centres. Differences were found between neurologists and nurses. Physicians showed higher risks of burnout, reporting intensive working paces, lack of medical personnel, and anxiety caused by the precarious employment conditions. Nurses appeared more satisfied, although the reference to the lack of spaces, and the cross professional roles risk of compassion fatigue. Both positive and negative relationships of care were depicted as influencing the professional quality of life. Conclusion The interviewed neurological teams need to limit the risk of compassion fatigue, which appeared from the first years of the career. The prevalence of the risk among neurologists suggests more awareness among scientific societies and health care managers on the risk for this category, as first step to prevent it. Electronic supplementary material The online version of this article (10.1007/s10072-020-04301-z) contains supplementary material, which is available to authorized users.

Published
2020

15. Transition to secondary progression in relapsing-onset multiple sclerosis: Definitions and risk factors

Author

Simonetta Galgani, Giuseppe Lucisano, Matilde Inglese, Giacomo Lus, M. Achille, V. Lovato, M. Zaffaroni, V. Brescia Morra, Giuseppe Salemi, Marco Salvetti, Carlo Pozzilli, G. T. Maniscalco, Maria Trojano, Francesco Patti, Diana Ferraro, Massimo Filippi, Maria Pia Amato, Pietro Iaffaldano, Alessandra Lugaresi, G. Marrazzo, Roberto Bergamaschi, G. De Luca, Antonella Conte, Marco Rovaris, F. O. Logullo, G. Comi, Damiano Paolicelli, Eleonora Cocco, Iaffaldano, Pietro, Lucisano, Giuseppe, Patti, Francesco, Brescia Morra, Vincenzo, De Luca, Giovanna, Lugaresi, Alessandra, Zaffaroni, Mauro, Inglese, Matilde, Salemi, Giuseppe, Cocco, Eleonora, Conte, Antonella, Ferraro, Diana, Galgani, Simonetta, Bergamaschi, Roberto, Pozzilli, Carlo, Salvetti, Marco, Lus, Giacomo, Rovaris, Marco, Maniscalco, Giorgia Teresa, Logullo, Francesco Ottavio, Paolicelli, Damiano, Achille, Mariaclara, Marrazzo, Giuseppina, Lovato, Valeria, Comi, Giancarlo, Filippi, Massimo, Amato, Maria Pia, Trojano, Maria, Iaffaldano P., Lucisano G., Patti F., Brescia Morra V., De Luca G., Lugaresi A., Zaffaroni M., Inglese M., Salemi G., Cocco E., Conte A., Ferraro D., Galgani S., Bergamaschi R., Pozzilli C., Salvetti M., Lus G., Rovaris M., Maniscalco G.T., Logullo F.O., Paolicelli D., Achille M., Marrazzo G., Lovato V., Comi G., Filippi M., Amato M.P., Trojano M., Iaffaldano, P., Lucisano, G., Patti, F., Brescia Morra, V., De Luca, G., Lugaresi, A., Zaffaroni, M., Inglese, M., Salemi, G., Cocco, E., Conte, A., Ferraro, D., Galgani, S., Bergamaschi, R., Pozzilli, C., Salvetti, M., Lus, G., Rovaris, M., Maniscalco, G. T., Logullo, F. O., Paolicelli, D., Achille, M., Marrazzo, G., Lovato, V., Comi, G., Filippi, M., Amato, M. P., and Trojano, M.

Subjects
Oncology, medicine.medical_specialty, Relapsing-Remitting, Multiple sclerosis, 03 medical and health sciences, Multiple Sclerosis, Relapsing-Remitting, 0302 clinical medicine, Disease registry, Recurrence, Risk Factors, big data, Internal medicine, medicine, Humans, data-driven algorithm, Multiple sclerosi, 030212 general & internal medicine, disease registry, prognosis, secondary progressive, Disease Progression, Multiple Sclerosis, Multiple Sclerosis, Chronic Progressive, Secondary progressive, Transition (genetics), business.industry, medicine.disease, Chronic Progressive, Neurology, Settore MED/26 - Neurologia, Neurology (clinical), business, prognosi, 030217 neurology & neurosurgery
Abstract

Background: No uniform criteria for a sensitive identification of the transition from relapsing–remitting multiple sclerosis (MS) to secondary-progressive multiple sclerosis (SPMS) are available. Objective: To compare risk factors of SPMS using two definitions: one based on the neurologist judgment (ND) and an objective data-driven algorithm (DDA). Methods: Relapsing-onset MS patients ( n = 19,318) were extracted from the Italian MS Registry. Risk factors for SPMS and for reaching irreversible Expanded Disability Status Scale (EDSS) 6.0, after SP transition, were estimated using multivariable Cox regression models. Results: SPMS identified by the DDA ( n = 2343, 12.1%) were older, more disabled and with a faster progression to severe disability ( p 40 years, higher baseline EDSS score and a higher number of relapses; the most consistent protective factor was the disease-modifying therapy (DMT) exposure. DMT exposure during SP did not impact the risk of reaching irreversible EDSS 6.0. Conclusion: A DDA definition of SPMS identifies more aggressive progressive patients. DMT exposure reduces the risk of SPMS conversion, but it does not prevent the disability accumulation after the SP transition.

Published
2021

16. Defining the course of tumefactive multiple sclerosis: A large retrospective multicentre study

Author

Lorenzo Gaetani, Doriana Landi, Diana Ferraro, Paolo Ragonese, Alberto Gajofatto, Caterina Di Carmine, Paola Cavalla, Maria Pia Amato, Eleonora Cocco, Roberta Lanzillo, Alessia Manni, Roberta Fantozzi, Claudio Gasperini, D. Farina, Giuseppe Fenu, Sara Zagaglia, Raffaella Cerqua, Claudio Solaro, Antonio Gallo, Carolina Gabri Nicoletti, Pietro Iaffaldano, Federica Pinardi, Valentina Torri Clerici, Isabella Righini, Fabio Buttari, Damiano Paolicelli, Pietro Annovazzi, Carla Tortorella, Rocco Totaro, Giovanna De Luca, Chiara De Fino, Valentina Tomassini, Luca Prosperini, Marcello Moccia, Viviana Nociti, Maria Chiara Buscarinu, Maria Di Gregorio, Massimiliano Di Filippo, Di Gregorio M., Torri Clerici V.L.A., Fenu G., Gaetani L., Gallo A., Cavalla P., Ragonese P., Annovazzi P., Gajofatto A., Prosperini L., Landi D., Nicoletti C.G., Di Carmine C., Totaro R., Nociti V., De Fino C., Ferraro D., Tomassini V., Tortorella C., Righini I., Amato M.P., Manni A., Paolicelli D., Iaffaldano P., Lanzillo R., Moccia M., Buttari F., Fantozzi R., Cerqua R., Zagaglia S., Farina D., De Luca G., Buscarinu M.C., Pinardi F., Cocco E., Gasperini C., Solaro C.M., Di Filippo M., Di Gregorio, M., Torri Clerici, V. L. A., Fenu, G., Gaetani, L., Gallo, A., Cavalla, P., Ragonese, P., Annovazzi, P., Gajofatto, A., Prosperini, L., Landi, D., Nicoletti, C. G., Di Carmine, C., Totaro, R., Nociti, V., De Fino, C., Ferraro, D., Tomassini, V., Tortorella, C., Righini, I., Amato, M. P., Manni, A., Paolicelli, D., Iaffaldano, P., Lanzillo, R., Moccia, M., Buttari, F., Fantozzi, R., Cerqua, R., Zagaglia, S., Farina, D., De Luca, G., Buscarinu, M. C., Pinardi, F., Cocco, E., Gasperini, C., Solaro, C. M., and Di Filippo, M.

Subjects
Male, tumefactive demyelinating lesions (TDLs), 0302 clinical medicine, Retrospective Studie, Interquartile range, differential diagnosis, 030212 general & internal medicine, Prospective Studies, Young adult, Prospective cohort study, Child, treatment, Tumefactive multiple sclerosi, Tumefactive demyelinating lesions, Demyelinating Disease, Middle Aged, Magnetic Resonance Imaging, Differential diagnosis, Multiple sclerosis, Tumefactive demyelinating lesions, Tumefactive multiple sclerosis, Neurology, Multiple sclerosis, Tumefactive multiple sclerosis, Female, Human, Adult, medicine.medical_specialty, Multiple Sclerosis, Adolescent, differential diagnosi, Settore MED/26, 03 medical and health sciences, Young Adult, Oligoclonal Band, Internal medicine, medicine, Humans, Multiple sclerosi, Tumefactive multiple sclerosis (TuMS), Aged, Retrospective Studies, Tumefactive demyelinating lesion, Expanded Disability Status Scale, business.industry, Oligoclonal Bands, Retrospective cohort study, Odds ratio, medicine.disease, Confidence interval, Prospective Studie, Demyelinating Diseases, prognosis, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background and purpose: Tumefactive multiple sclerosis (TuMS) (i.e., MS onset presenting with tumefactive demyelinating lesions [TDLs]) is a diagnostic and therapeutic challenge. We performed a multicentre retrospective study to describe the clinical characteristics and the prognostic factors of TuMS. Methods: One hundred two TuMS patients were included in this retrospective study. Demographic, clinical, magnetic resonance imaging (MRI), laboratory data and treatment choices were collected. Results: TuMS was found to affect women more than men (female:male: 2.4), with a young adulthood onset (median age: 29.5years, range: 11–68 years, interquartile range [IQR]: 38 years). At onset, 52% of TuMS patients presented with the involvement of more than one functional system and 24.5% of them with multiple TDLs. TDLs most frequently presented with an infiltrative MRI pattern (38.7%). Cerebrospinal fluid immunoglobulin G oligoclonal bands were often demonstrated (76.6%). In 25.3% of the cases, more than one acute-phase treatment was administered, and almost one-half of the patients (46.6%) were treated with high-efficacy treatments. After a median follow-up of 2.3years (range: 0.1–10.7 years, IQR: 3.4 years), the median Expanded Disability Status Scale (EDSS) score was 1.5 (range: 0–7, IQR: 2). Independent risk factors for reaching an EDSS score ≥3 were a higher age at onset (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.03–1.14, p&nbsp

Published
2021

17. Risk of Persistent Disability in Patients With Pediatric-Onset Multiple Sclerosis

Author

Paolo Ragonese, Marta Simone, Vincenzo Brescia Morra, Lucia Margari, Giuseppe Salemi, Eleonora Cocco, Massimo Filippi, Mauro Zaffaroni, Damiano Baroncini, Giuseppe Fenu, Matilde Inglese, Francesco Patti, Marzia Romeo, Pietro Iaffaldano, Italian Ms registry, Clara Grazia Chisari, Angelo Ghezzi, Maria Cellerino, Giancarlo Comi, Roberta Lanzillo, Baroncini, Damiano, Simone, Marta, Iaffaldano, Pietro, Brescia Morra, Vincenzo, Lanzillo, Roberta, Filippi, Massimo, Romeo, Marzia, Patti, Francesco, Chisari, Clara Grazia, Cocco, Eleonora, Fenu, Giuseppe, Salemi, Giuseppe, Ragonese, Paolo, Inglese, Matilde, Cellerino, Maria, Margari, Lucia, Comi, Giancarlo, Zaffaroni, Mauro, Ghezzi, Angelo, Baroncini D., Simone M., Iaffaldano P., Brescia Morra V., Lanzillo R., Filippi M., Romeo M., Patti F., Chisari C.G., Cocco E., Fenu G., Salemi G., Ragonese P., Inglese M., Cellerino M., Margari L., Comi G., Zaffaroni M., Ghezzi A., Baroncini, D, Simone, M, Iaffaldano, P, Brescia Morra, V, Lanzillo, R, Filippi, M, Romeo, M, Patti, F, Chisari, C, Cocco, E, Fenu, G, Salemi, G, Ragonese, P, Inglese, M, Cellerino, M, Margari, L, Comi, G, Zaffaroni, M, Ghezzi, A, and Cavaletti, G

Subjects
Male, Registrie, Pediatrics, Adolescent, Adult, Age of Onset, Aged, Child, Child, Preschool, Female, Humans, Italy, Middle Aged, Multiple Sclerosis, Registries, Retrospective Studies, Risk Factors, Young Adult, Disabled Persons, Disease Progression, Risk of Disability, 0302 clinical medicine, Retrospective Studie, Multiple Sclerosi, 030212 general & internal medicine, Original Investigation, Hazard ratio, Confounding, pediatric-onset MS (POMS), therapeutic and managing standards, Settore MED/26 - Neurologia, Disabled Person, Human, medicine.medical_specialty, MEDLINE, Profile of mood states, 03 medical and health sciences, medicine, In patient, Preschool, pediatric-onset MS (POMS), therapeutic and managing standards, Expanded Disability Status Scale, business.industry, Pediatric-Onset Multiple Sclerosis, Multiple sclerosis, Risk Factor, medicine.disease, Observational study, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Importance Availability of new disease-modifying therapies (DMTs) and changes of therapeutic paradigms have led to a general improvement of multiple sclerosis (MS) prognosis in adults. It is still unclear whether this improvement also involves patients with pediatric-onset MS (POMS), whose early management is more challenging. Objective To evaluate changes in the prognosis of POMS over time in association with changes in therapeutic and managing standards. Design, Setting, and Participants Retrospective, multicenter, observational study. Data were extracted and collected in May 2019 from the Italian MS Registry, a digital database including more than 59 000 patients. Inclusion criteria were MS onset before age 18 years, diagnosis before January 2014, and disease duration of at least 3 years. Exclusion criteria were primary progressive MS, Expanded Disability Status Scale (EDSS) score of at least 8 one year after onset, unavailability of diagnosis date, and less than 2 EDSS score evaluations. Eligible patients were 4704 patients with POMS. According to these criteria, we enrolled 3198 patients, excluding 1506. Exposures We compared time to reach disability milestones by epoch of MS diagnosis (

Published
2021

18. Characteristics and treatment of Multiple Sclerosis-related trigeminal neuralgia: An Italian multi-centre study

Author

Giorgia Teresa Maniscalco, Cinzia Cordioli, Maria Chiara Buscarinu, Diana Ferraro, Massimiliano Calabrese, Claudio Gasperini, Marcello Moccia, Alberto Gajofatto, Antonio Gallo, Eleonora Cocco, Valentina Camera, Pietro Annovazzi, Roberta Fantozzi, Marta Radaelli, Giovanna De Luca, Valentina Tomassini, Roberta Lanzillo, Claudio Solaro, Lorena Lorefice, Carla Tortorella, Federica Pinardi, Fabio Buttari, Paolo Ragonese, Paola Cavalla, Viviana Nociti, Salvatore Lo Fermo, Laura Boffa, Rirems, Damiano Paolicelli, Massimiliano Di Filippo, Ferraro, D., Annovazzi, P., Moccia, M., Lanzillo, R., De Luca, G., Nociti, V., Fantozzi, R., Paolicelli, D., Ragonese, P., Gajofatto, A., Boffa, L., Cavalla, P., Lo Fermo, S., Buscarinu, M. C., Lorefice, L., Cordioli, C., Calabrese, M., Gallo, A., Pinardi, F., Tortorella, C., Di Filippo, M., Camera, V., Maniscalco, G. T., Radaelli, M., Buttari, F., Tomassini, V., Cocco, E., Gasperini, C., Solaro, C., Ferraro D., Annovazzi P., Moccia M., Lanzillo R., De Luca G., Nociti V., Fantozzi R., Paolicelli D., Ragonese P., Gajofatto A., Boffa L., Cavalla P., Lo Fermo S., Buscarinu M.C., Lorefice L., Cordioli C., Calabrese M., Gallo A., Pinardi F., Tortorella C., Di Filippo M., Camera V., Maniscalco G.T., Radaelli M., Buttari F., Tomassini V., Cocco E., Gasperini C., and Solaro C.

Subjects
Pediatrics, medicine.medical_treatment, multiple sclerosis, microvascular decompression surgery, time factors, 0302 clinical medicine, Radiofrequency thermocoagulation, Trigeminal neuralgia, Multiple Sclerosi, Outcome Assessment, Health Care, italy, middle aged, pain, 030212 general & internal medicine, Oxcarbazepine, humans, education.field_of_study, trigeminal neuralgia, adult, Disability, Multiple Sclerosis, Pain, radiosurgery, General Medicine, Analgesics, Non-Narcotic, health care, follow-up studies, Settore MED/26 - NEUROLOGIA, aged, retrospective studies, female, Neurology, disability, analgesics, non-narcotic, male, severity of illness index, sex factors, neurosurgical procedures, outcome assessment, health care, analgesics, medicine.drug, medicine.medical_specialty, Population, Microvascular decompression, 03 medical and health sciences, medicine, education, outcome assessment, business.industry, Multiple sclerosis, Carbamazepine, medicine.disease, Discontinuation, non-narcotic, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background The prevalence of trigeminal neuralgia (TN) in Multiple Sclerosis (MS) patients is higher than in the general population and its management can be particularly challenging. Our aim is to describe the characteristics, treatment and prognostic factors of MS-related TN in a retrospective multicentre study. Methods Neurologists members of the RIREMS group (Rising Researchers in MS) enrolled MS patients with a TN diagnosis and filled out a spreadsheet comprising their clinical data. Results Population consisted of 298 patients. First-choice preventive treatments were carbamazepine and oxcarbazepine. A surgical procedure was performed in 81 (30%) patients, most commonly gamma knife stereotactic radiosurgery (37%), followed by microvascular decompression (22%) and radiofrequency thermocoagulation (21%); one third of patients underwent at least two procedures. Surgery was associated with higher disability, male sex and longer interval between MS and TN onset. Patients (77%) who stayed on at least one preventive medication at most recent follow-up, after a mean period of 8 years, had a higher disability compared to the untreated group. Furthermore, patients with higher disability at TN onset were less likely to discontinue their first preventive medication due to pain remission, had bilateral TN more frequently and underwent surgical interventions earlier. Conclusion MS patients with a higher disability at TN onset and with a longer interval between MS and TN onset had differing clinical features and outcomes: pain was more frequently bilateral, surgery was more frequent and anticipated, and preventive medication discontinuation due to pain remission was less common.

Published
2020

19. Harmonization of real-world studies in multiple sclerosis: Retrospective analysis from the rirems group

Author

Federica Pinardi, Simona Mallucchi, Paolo Ragonese, Eleonora Cocco, Valentina Tomassini, Alice Laroni, Lorena Lorefice, Claudio Solaro, Alberto Gajofatto, Cinzia Cordioli, Viviana Nociti, Maria Chiara Buscarinu, Claudio Gasperini, Marta Radaelli, Antonio Gallo, Luca Prosperini, Massimiliano Di Filippo, Massimiliano Calabrese, Damiano Paolicelli, Paola Cavalla, Diana Ferraro, Pietro Annovazzi, Roberta Lanzillo, Marcello Moccia, Carla Tortorella, Moccia, M., Annovazzi, P., Buscarinu, M. C., Calabrese, M., Cavalla, P., Cordioli, C., Di Filippo, M., Ferraro, D., Gajofatto, A., Gallo, A., Lanzillo, R., Laroni, A., Lorefice, L., Mallucchi, S., Nociti, V., Paolicelli, D., Pinardi, F., Prosperini, L., Radaelli, M., Ragonese, P., Tomassini, V., Tortorella, C., Cocco, E., Gasperini, C., Solaro, C., Moccia M., Annovazzi P., Buscarinu M.C., Calabrese M., Cavalla P., Cordioli C., Di Filippo M., Ferraro D., Gajofatto A., Gallo A., Lanzillo R., Laroni A., Lorefice L., Mallucchi S., Nociti V., Paolicelli D., Pinardi F., Prosperini L., Radaelli M., Ragonese P., Tomassini V., Tortorella C., Cocco E., Gasperini C., and Solaro C.

Subjects
Adult, Longitudinal study, medicine.medical_specialty, Harmonization, Outcome measures, Multiple sclerosis, Outcome measure, 03 medical and health sciences, 0302 clinical medicine, Real world, medicine, Humans, Multiple sclerosi, 030212 general & internal medicine, Age of Onset, Aged, Retrospective Studies, Expanded Disability Status Scale, business.industry, Retrospective cohort study, General Medicine, Variance (accounting), medicine.disease, Neurology, Italy, Family medicine, Observational study, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, Multiple Sclerosis
Abstract

Background: Worldwide multiple sclerosis (MS) centers have coordinated their efforts to use data acquired in clinical practice for real-world observational studies. In this retrospective study, we aim to harmonize outcome measures, and to evaluate their heterogeneity within the Rising Italian Researchers in MS (RIReMS) study group. Methods: RIReMS members filled in a structured questionnaire evaluating the use of different outcome measures in clinical practice. Thereafter, thirty-four already-published papers from RIReMS centers were used for heterogeneity analyses, using the DerSimonian and Laird random-effects method to compute the between-study variance (τ2). Results: Based on questionnaire results, we defined basic modules for diagnosis and follow-up, consisting of outcome measures recorded by all participating centers at the time of diagnosis, and, then, at least annually; we also defined more detailed/optional modules, with outcome measures recorded less frequently and/or in the presence of specific clinical indications. Looking at heterogeneity, we found 5-year variance in age at onset (ES=27.34; 95%CI=26.18, 28.49; p41.4 years (ES=4.37; 95%CI=3.40, 5.35; p2 years (ES=5.41; 95%CI=3.22, 7.60; p = 0.02; τ2=1.00). Discussion: We suggest common sets of biomarkers to be acquired in clinical practice, that can be used for research purposes. Also, we provide researchers with specific indications for improving inclusion criteria and data analysis, ultimately allowing data harmonization and high-quality collaborative studies.

Published
2020

20. A multicenter survey on access to care in Multiple Sclerosis-related trigeminal neuralgia

Author

Ilaria Pesci, Pietro Annovazzi, Claudio Solaro, Alberto Gajofatto, Cinzia Cordioli, G. T. Maniscalco, Eleonora Cocco, Roberta Fantozzi, Antonio Gallo, Marta Radaelli, Maria Chiara Buscarinu, Federica Pinardi, M. Di Filippo, Damiano Paolicelli, Valentina Tomassini, Diana Ferraro, Massimiliano Calabrese, G. De Luca, R Lanzillo, Paolo Ragonese, Paola Cavalla, S. Lo Fermo, C. Gasperini, Marcello Moccia, C. Tortorella, Viviana Nociti, Valentina Camera, Ferraro, D., Annovazzi, P., Lanzillo, R., Calabrese, M., Fantozzi, R., De Luca, G., Cordioli, C., Paolicelli, D., Ragonese, P., Gajofatto, A., Lo Fermo, S., Cavalla, P., Tortorella, C., Pesci, I., Gallo, A., Pinardi, F., Di Filippo, M., Maniscalco, G. T., Nociti, V., Radaelli, M., Tomassini, V., Buscarinu, M. C., Moccia, M., Camera, V., Cocco, E., Gasperini, C., Solaro, C., Ferraro D., Annovazzi P., Lanzillo R., Calabrese M., Fantozzi R., De Luca G., Cordioli C., Paolicelli D., Ragonese P., Gajofatto A., Lo Fermo S., Cavalla P., Tortorella C., Pesci I., Gallo A., Pinardi F., Di Filippo M., Maniscalco G.T., Nociti V., Radaelli M., Tomassini V., Buscarinu M.C., Moccia M., Camera V., Cocco E., Gasperini C., and Solaro C.

Subjects
medicine.medical_specialty, Multiple Sclerosis, multiple sclerosis, trigeminal neuralgia, Cross-sectional study, medicine.medical_treatment, Population, Microvascular decompression, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, Retrospective Studie, Trigeminal neuralgia, Multiple Sclerosi, medicine, Humans, 030212 general & internal medicine, Intensive care medicine, education, Oxcarbazepine, Retrospective Studies, Cross-Sectional Studie, education.field_of_study, business.industry, Multiple sclerosis, Retrospective cohort study, Trigeminal Neuralgia, medicine.disease, Cross-Sectional Studies, Treatment Outcome, Italy, Neurology, Multicenter survey, Neurology (clinical), business, 030217 neurology & neurosurgery, Human, medicine.drug
Abstract

The prevalence of trigeminal neuralgia (TN) in patients with Multiple Sclerosis (MS) is higher than in the general population and its management can be particularly challenging due to a number of reasons including high recurrence rates, lack of MS-specific treatment guidelines and uncertainties about pain pathophysiology. Aim of this cross-sectional, multicentre survey was to gather information on the current treatment modalities and options of MS-related TN across 23 Italian MS centres. Initial medical management (carbamazepine or oxcarbazepine) of MS-related TN was fairly homogeneous throughout Italian centres. The most commonly available surgical procedure was microvascular decompression, but the frequency and types of surgical procedures available locally differed considerably throughout MS centers, and were unavailable in one quarter of them. This survey reveals some of the issues that could hamper an optimal patient management and underlines the need for a consensus on MS-related TN to support health-care professionals in their approach to this challenging condition and to facilitate the development of local guidelines aimed at ensuring equity in access to care and treatment optimization.

Published
2021

21. Clinical activity after fingolimod cessation: Disease reactivation or rebound?

Author

S La Gioia, B Forci, Sabrina Realmuto, Pietro Annovazzi, Arianna Sartori, Roberta Grasso, Cinzia Cordioli, M. L. Stromillo, R Lanzillo, B. Frigeni, Eleonora Cocco, Elisabetta Signoriello, Alessio Signori, Sandro Rossi, Giuseppe Fenu, M. P. Sormani, Damiano Baroncini, G. T. Maniscalco, Sarah Rasia, Jessica Frau, Frau, J., Sormani, M. P., Signori, A., Realmuto, S., Baroncini, D., Annovazzi, P., Signoriello, E., Maniscalco, G. T., La Gioia, S., Cordioli, C., Frigeni, B., Rasia, S., Fenu, G., Grasso, R., Sartori, A., Lanzillo, R., Stromillo, M. L., Rossi, S., Forci, B., Cocco, E., Frau, J, Sormani, M P, Signori, A, Realmuto, S, Baroncini, D, Annovazzi, P, Signoriello, E, Maniscalco, G T, La Gioia, S, Cordioli, C, Frigeni, B, Rasia, S, Fenu, G, Grasso, R, Sartori, A, Lanzillo, R, Stromillo, M L, Rossi, S, Forci, B, and Cocco, E

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Disease, Cohort Studies, Multiple sclerosis, Immunosuppressive Agent, Young Adult, 03 medical and health sciences, Multiple Sclerosis, Relapsing-Remitting, 0302 clinical medicine, Recurrence, Internal medicine, Humans, Medicine, 030212 general & internal medicine, Fingolimod, Reactivation, Rebound, Neurology, Neurology (clinical), Natural course, Fingolimod Hydrochloride, business.industry, medicine.disease, Magnetic Resonance Imaging, Discontinuation, Italy, Withholding Treatment, multiple sclerosi, Cohort, Female, Cohort Studie, business, Immunosuppressive Agents, 030217 neurology & neurosurgery, Human, medicine.drug
Abstract

Background and purpose There is debate as to whether the apparent rebound after fingolimod discontinuation is related to the discontinuation itself or whether it is due to the natural course of highly active multiple sclerosis (MS). Our aim was to survey the prevalence of severe reactivation and rebound after discontinuation of fingolimod in a cohort of Italian patients with MS. Methods Patients with relapsing-remitting MS who were treated with fingolimod for at least 6 months and who stopped treatment for reasons that were unrelated to inefficacy were included in the analysis. Results A total of 100 patients who had discontinued fingolimod were included in the study. Fourteen patients (14%) had a relapse within 3 months after fingolimod discontinuation, and an additional 12 (12%) had a relapse within 6 months. According to this study's criteria, 10 patients (10%) had a severe reactivation. Amongst these patients, five (5%) had a reactivation that was considered to be a rebound. Conclusions The present study showed that more than 26% of patients are at risk of having a relapse within 6 months after fingolimod discontinuation. Nevertheless, the risk of severe reactivations and rebound is lower than has been previously described.

Published
2018

22. A real‐world study of alemtuzumab in a cohort of Italian patients

Author

Paola Cavalla, Laura Brambilla, Roberta Grasso, Cinzia Cordioli, Alice Laroni, Alessia Giugno, Valentina Torri Clerici, Maria Pia Sormani, Pietro Annovazzi, Francesco Saccà, Eleonora Cocco, Jessica Frau, Elisabetta Signoriello, Antonio Gallo, Marinella Clerico, Stefania Federica De Mercanti, Antonio Carotenuto, Simona Bonavita, Cinzia Valeria Russo, Giuseppe Fenu, Caterina Lapucci, Giorgia Teresa Maniscalco, Arianna Sartori, Francesca Caleri, Marco Capobianco, Alessio Signori, Rosa Iodice, Sara La Gioia, Giacomo Lus, Mauro Zaffaroni, Damiano Baroncini, Valeria Di Francescantonio, Russo, C. V., Sacca, F., Frau, J., Annovazzi, P., Signoriello, E., Bonavita, S., Grasso, R., Clerico, M., Cordioli, C., Laroni, A., Capobianco, M., Torri Clerici, V., Sartori, A., Cavalla, P., Maniscalco, G. T., La Gioia, S., Caleri, F., Giugno, A., Iodice, R., Carotenuto, A., Cocco, E., Fenu, G., Zaffaroni, M., Baroncini, D., Lus, G., Gallo, A., De Mercanti, S. F., Lapucci, C., Di Francescantonio, V., Brambilla, L., Sormani, M. P., Signori, A., Russo, CINZIA VALERIA, Sacca', Francesco, Frau, Jessica, Annovazzi, Pietro, Signoriello, Elisabetta, Bonavita, Simona, Grasso, Roberta, Clerico, Marinella, Cordioli, Cinzia, Laroni, Alice, Capobianco, Marco, Torri Clerici, Valentina, Sartori, Arianna, Cavalla, Paola, Teresa Maniscalco, Giorgia, La Gioia, Sara, Caleri, Francesca, Giugno, Alessia, Iodice, Rosa, Carotenuto, Antonio, Cocco, Eleonora, Fenu, Giuseppe, Zaffaroni, Mauro, Baroncini, Damiano, Lus, Giacomo, Gallo, Antonio, Federica De Mercanti, Stefania, Lapucci, Caterina, Di Francescantonio, Valeria, Brambilla, Laura, Pia Sormani, Maria, and Signori, Alessio

Subjects
Adult, safety, medicine.medical_specialty, efficacy, Multiple Sclerosis, Relapsing-Remitting, Natalizumab, Internal medicine, alemtuzumab, medicine, Humans, Glatiramer acetate, real-world evidence, Retrospective Studies, Expanded Disability Status Scale, Fingolimod Hydrochloride, business.industry, Multiple sclerosis, Glatiramer Acetate, cohort, medicine.disease, Fingolimod, Neurology, Relative risk, Cohort, Alemtuzumab, Neurology (clinical), business, medicine.drug
Abstract

Background and purpose: Real-world data on alemtuzumab are limited and do not provide evidence of its effectiveness after various disease-modifying therapies (DMTs). Our aim was to provide real-world data on the impact of clinical variables and previous DMTs on clinical response to alemtuzumab. Methods: Sixteen Italian multiple sclerosis centers retrospectively included patients who started alemtuzumab from January 2015 to December 2018, and recorded demographics, previous therapies, washout duration, relapses, Expanded Disability Status Scale (EDSS) score, and magnetic resonance imaging data. Negative binomial regression models were used to assess the effect of factors on annualized relapse (ARR) after alemtuzumab initiation. Results: We studied 322 patients (mean age 36.8years, median EDSS score 3, median follow-up 1.94years). Previous treatments were: fingolimod (106), natalizumab (80), first-line oral agents (56), first-line injectables (interferon/glatiramer acetate; 30), and other drugs (15). Thirty-five patients were treatment-naïve. The pre-alemtuzumab ARR was 0.99 and decreased to 0.13 during alemtuzumab treatment (p&nbsp

Published
2021

23. Moderate Exercise Improves Cognitive Function in Healthy Elderly People: Results of a Randomized Controlled Trial

Author

Gianmario Migliaccio, Stefano Lorrai, Goce Kalcev, Maria Pietronilla Penna, Mauro Giovanni Carta, Mirra Pintus, Dario Fortin, Giulia Cossu, Roberto Demontis, Eleonora Cocco, Elena Massa, Sofia Cosentino, Ferdinando Romano, Sergio Machado, Federico Cabras, Gioia Mura, Massimiliano Pau, Mario Musu, Alessandra Scano, Omar Callia, Franco Rongioletti, Antonio Preti, Antonio Crisafulli, Gabriele Finco, Valeria Ruggiero, Fernanda Velluzzi, Cesar Ivan Aviles Gonzalez, Luigi Minerba, Germano Orr, Rosanna Zaccheddu, Paolo Contu, Claudia Sardu, Andrea Loviselli, Maria Valeria Massidda, Giuliana Conti, Elisa Pintus, Enrico Cacace, Marco Monticone, Quirico Mela, Laura Atzori, Alberto Cauli, Carta, M. G., Cossu, G., Pintus, E., Zaccheddu, R., Callia, O., Conti, G., Pintus, M., Gonzalez, C. I. A., Massidda, M. V., Mura, G., Sardu, C., Contu, P., Minerba, L., Demontis, R., Pau, M., Finco, G., Cocco, E., Penna, M. P., Orr, G., Kalcev, G., Cabras, F., Lorrai, S., Loviselli, A., Velluzzi, F., Monticone, M., Cacace, E., Musu, M., Rongioletti, F., Cauli, A., Ruggiero, V., Scano, A., Crisafulli, A., Cosentino, S., Atzori, L., Massa, E., Mela, Q., Fortin, D., Migliaccio, G., Machado, S., Romano, F., and Preti, A.

Subjects
Quality of life, medicine.medical_specialty, Aging, Epidemiology, Cognition, Dementia, Physical activity, RCT, RCT [Invecchiamento, Article, law.invention, Demenza, Randomized controlled trial, law, Intervention (counseling), Medicine, Effects of sleep deprivation on cognitive performance, Cognitive decline, Cognizione, Attività fisica, Qualità della vita, RCT], business.industry, Psychiatry and Mental health, Physical therapy, Medical certificate, business, Anaerobic exercise
Abstract

Background: Physical activity in the elderly is recommended by international guidelines to protect against cognitive decline and functional impairment. Objective: This Randomized Controlled Trial (RCT) was set up to verify whether medium-intensity physical activity in elderly people living in the community is effective in improving cognitive performance. Design: RCT with parallel and balanced large groups. Setting: Academic university hospital and Olympic gyms. Subjects: People aged 65 years old and older of both genders living at home holding a medical certificate for suitability in non-competitive physical activity. Methods: Participants were randomized to a 12-week, 3 sessions per week moderate physical activity program or to a control condition focused on cultural and recreational activities in groups of the same size and timing as the active intervention group. The active phase integrated a mixture of aerobic and anaerobic exercises, including drills of “life movements”, strength and balance. The primary outcome was: any change in Addenbrooke's Cognitive Examination Revised (ACE-R) and its subscales. Results: At the end of the trial, 52 people completed the active intervention, and 53 people completed the control condition. People in the active intervention improved on the ACE-R (ANOVA: F(1;102)=4.32, p=0.040), and also showed better performances on the memory (F(1;102)=5.40 p=0.022) and visual-space skills subscales of the ACE-R (F(1;102)=4.09 p=0.046). Conclusion: A moderate-intensity exercise administered for a relatively short period of 12 weeks is capable of improving cognitive performance in a sample of elderly people who live independently in their homes. Clinical Trials Registration No: NCT03858114

Published
2021

24. Clinical effectiveness of different natalizumab interval dosing schedules in a large Italian population of patients with multiple sclerosis

Author

Chisari, CLARA GRAZIA, Grimaldi Luigi Maria, Salemi, Giuseppe, Ragonese, Paolo, Iaffaldano, Pietro, Bonavita, Simona, Sparaco, Maddalena, Rovaris, Marco, D'Arma, Alessia, Lugaresi, Alessandra, Ferrò Maria Teresa, Grossi, Paola, Di Sapio Alessia, Cocco, Eleonora, Granella, Franco, Curti, Erica, Lepore, Vito, Trojano, Maria, Patti, Francesco, on behalf of the Italian MS Register Study Group, Chisari, Clara Grazia, Grimaldi, Luigi Maria, Salemi, Giuseppe, Ragonese, Paolo, Iaffaldano, Pietro, Bonavita, Simona, Sparaco, Maddalena, Rovaris, Marco, D'Arma, Alessia, Lugaresi, Alessandra, Ferrò, Maria Teresa, Grossi, Paola, Di Sapio, Alessia, Cocco, Eleonora, Granella, Franco, Curti, Erica, Lepore, Vito, Trojano, Maria, Patti, Francesco, Chisari C.G., Grimaldi L.M., Salemi G., Ragonese P., Iaffaldano P., Bonavita S., Sparaco M., Rovaris M., D'Arma A., Lugaresi A., Ferro M.T., Grossi P., DI Sapio A., Cocco E., Granella F., Curti E., Lepore V., Trojano M., and Patti F.

Subjects
Adult, medicine.medical_specialty, Population, multiple sclerosis, Drug Administration Schedule, 03 medical and health sciences, Multiple Sclerosis, Relapsing-Remitting, natalizumab, 0302 clinical medicine, Natalizumab, Dosing schedules, Internal medicine, medicine, Humans, Immunologic Factors, natalizumab, risk stratification, multiple sclerosis, safety, effectiveness, Dosing, education, Proportional Hazards Models, Retrospective Studies, 030304 developmental biology, 0303 health sciences, education.field_of_study, Proportional hazards model, business.industry, Multiple sclerosis, Retrospective cohort study, Middle Aged, medicine.disease, Psychiatry and Mental health, Treatment Outcome, Italy, Tolerability, Settore MED/26 - Neurologia, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery, medicine.drug
Abstract

IntroductionNatalizumab (NTZ) is one of the most effective treatment options for multiple sclerosis (MS) treatment. Our study aimed to evaluate the effectiveness of NTZ when administered according to the extended dosing strategy compared with standard 4-weekly administration in a large Italian MS population.Materials and methodsThis retrospective multicentre study included patients with relapsing-remitting MS (RR-MS) who received NTZ administrations between the 1 June 2012 and the 15 May 2018 and were followed by the ‘Italian MS Register’. All patients with MS were stratified into two groups based on NTZ administration schedule: standard interval dosing (SID) patients who received infusions on average from 28 to 32 days (median 30) and extended interval dosing (EID) including patients who have been infused with interval between 33 and 49 days (median 43). Clinical data were assessed at baseline (before starting NTZ), after 12 (T1) and 24 months (T2) of treatment.ResultsOut of 5231 patients with RR-MS screened, 2092 (mean age 43.2±12.0, 60.6% women) were enrolled. A total of 1254 (59.9%) received NTZ according to SID, and 838 (40.1%) according to EID. At 12 and 24 months, no differences in terms of annualised relapse rate and disability status were found between the two groups. Progression index and confirmed disability worsening were similar between the two groups.DiscussionThe use of NTZ with an extended interval schedule showed similar effectiveness compared with SID. Unchanged clinical efficacy of EID schedule may raise the question of a possible advantage in terms of tolerability and safety.

Published
2020

25. 'Better explanations' in multiple sclerosis diagnostic workup

Author

Massimiliano Calabrese 1, Claudio Gasperini 2, Carla Tortorella 2, Gianmarco Schiavi 2, Giovanni Frisullo 2, Paolo Ragonese, Roberta Fantozzi 2, Luca Prosperini 2, Pietro Annovazzi 2, Cinzia Cordioli 2, Massimiliano Di Filippo 2, Diana Ferraro 2, Alberto Gajofatto 2, Simona Malucchi 2, Salvatore Lo Fermo 2, Giovanna De Luca 2, Maria L Stromillo 2, Eleonora Cocco 2, Antonio Gallo 2, Damiano Paolicelli 2, Roberta Lanzillo 2, Valentina Tomassini 2, Ilaria Pesci 2, Maria E Rodegher 2, Claudio Solaro 2, RIREMS group (Rising Italian Researchers in Multiple Sclerosis), Massimiliano Calabrese 1 , Claudio Gasperini 2 , Carla Tortorella 2 , Gianmarco Schiavi 2 , Giovanni Frisullo 2 , Paolo Ragonese , Roberta Fantozzi 2 , Luca Prosperini 2 , Pietro Annovazzi 2 , Cinzia Cordioli 2 , Massimiliano Di Filippo 2 , Diana Ferraro 2 , Alberto Gajofatto 2 , Simona Malucchi 2 , Salvatore Lo Fermo 2 , Giovanna De Luca 2 , Maria L Stromillo 2 , Eleonora Cocco 2 , Antonio Gallo 2 , Damiano Paolicelli 2 , Roberta Lanzillo 2 , Valentina Tomassini 2 , Ilaria Pesci 2 , Maria E Rodegher 2 , Claudio Solaro 2 , RIREMS group (Rising Italian Researchers in Multiple Sclerosis), Calabrese, M., Gasperini, C., Tortorella, C., Schiavi, G., Frisullo, G., Ragonese, P., Fantozzi, R., Prosperini, L., Annovazzi, P., Cordioli, C., Di Filippo, M., Ferraro, D., Gajofatto, A., Malucchi, S., Lo Fermo, S., De Luca, G., Stromillo, M. L., Cocco, E., Gallo, A., Paolicelli, D., Lanzillo, R., Tomassini, V., Pesci, I., Rodegher, M. E., Solaro, C., Calabrese, Massimiliano, Gasperini, Claudio, Tortorella, Carla, Schiavi, Gianmarco, Frisullo, Giovanni, Ragonese, Paolo, Fantozzi, Roberta, Prosperini, Luca, Annovazzi, Pietro, Cordioli, Cinzia, Di Filippo, Massimiliano, Ferraro, Diana, Gajofatto, Alberto, Malucchi, Simona, Lo Fermo, Salvatore, De Luca, Giovanna, Stromillo, Maria L, Cocco, Eleonora, Gallo, Antonio, Paolicelli, Damiano, Lanzillo, Roberta, Tomassini, Valentina, Pesci, Ilaria, Rodegher, Maria E, and Solaro, Claudio

Subjects
Male, Longitudinal Studie, Disease, 0302 clinical medicine, Multiple Sclerosi, Diagnosis, Medicine, 030212 general & internal medicine, Prospective Studies, Longitudinal Studies, Prospective cohort study, medicine.diagnostic_test, Magnetic Resonance Imaging, clinical practice, atypical MRI lesions, MS mimics, Disease Progression, Female, Settore MED/26 - Neurologia, Radiology, Human, Adult, multiple sclerosis, diagnostic criteria, medicine.medical_specialty, Multiple Sclerosis, omarkers / metabolism Diagnosis, Differential Female Follow-Up Studies Humans Longitudinal Studies Magnetic Resonance Imaging Male Multiple Sclerosis / diagnosis* Prospective Studies, Article, Follow-Up Studie, Diagnosis, Differential, 03 medical and health sciences, Humans, Neuromyelitis optica, business.industry, Multiple sclerosis, Biomarkers, Follow-Up Studies, Magnetic resonance imaging, Odds ratio, Biomarker, medicine.disease, Migraine, Differential, Neurology (clinical), Differential diagnosis, business, 030217 neurology & neurosurgery
Abstract

BackgroundThe exclusion of other diseases that can mimic multiple sclerosis (MS) is the cornerstone of current diagnostic criteria. However, data on the frequency of MS mimics in real life are incomplete.MethodsA total of 695 patients presenting with symptoms suggestive of MS in any of the 22 RIREMS centers underwent a detailed diagnostic workup, including a brain and spinal cord MRI scan, CSF and blood examinations, and a 3-year clinical and radiologic follow-up.FindingsA total of 667 patients completed the study. Alternative diagnoses were formulated in 163 (24.4%) cases, the most frequent being nonspecific neurologic symptoms in association with atypical MRI lesions of suspected vascular origin (40 patients), migraine with atypical lesions (24 patients), and neuromyelitis optica (14 patients). MS was diagnosed in 401 (60.1%) patients according to the 2017 diagnostic criteria. The multivariate analysis revealed that the absence of CSF oligoclonal immunoglobulin G bands (IgG-OB) (odds ratio [OR] 18.113), the presence of atypical MRI lesions (OR 10.977), the absence of dissemination in space (DIS) of the lesions (OR 5.164), and normal visual evoked potentials (OR 3.550) were all independent predictors of an alternative diagnosis.InterpretationThis observational, unsponsored, real-life study, based on clinical practice, showed that diseases that mimicked MS were many, but more than 45% were represented by nonspecific neurologic symptoms with atypical MRI lesions of suspected vascular origin, migraine, and neuromyelitis optica. The absence of IgG-OB and DIS, the presence of atypical MRI lesions, and normal visual evoked potentials should be considered suggestive of an alternative disease and red flags for the misdiagnosis of MS.

Published
2019

26. Injectable Versus Oral First-Line Disease-Modifying Therapies: Results from the Italian MS Register

Author

Marco Onofrj, Giacomo Lus, Damiano Paolicelli, Matilde Inglese, Giorgia Teresa Maniscalco, Massimo Filippi, Emanuele D'Amico, M. Vianello, Simonetta Galgani, Vincenzo Brescia Morra, Francesco Patti, Antonio Gallo, Aurora Zanghì, Paolo Confalonieri, Giuseppe Salemi, Giovanna De Luca, Maria Trojano, Carlo Avolio, Maria Pia Amato, Eleonora Cocco, Marzia Romeo, D'Amico, E., Zanghi, A., Romeo, M., Cocco, E., Maniscalco, G. T., Brescia Morra, V., Paolicelli, D., De Luca, G., Galgani, S., Amato, M. P., Salemi, G., Inglese, M., Confalonieri, P. A., Lus, G., Avolio, C., Gallo, A., Vianello, M., Onofrj, M., Filippi, M., Trojano, M., Patti, F., D'Amico, Emanuele, Zanghì, Aurora, Romeo, Marzia, Cocco, Eleonora, Maniscalco, Giorgia Teresa, Brescia Morra, Vincenzo, Paolicelli, Damiano, De Luca, Giovanna, Galgani, Simonetta, Amato, Maria Pia, Salemi, Giuseppe, Inglese, Matilde, Confalonieri, Paolo Agostino, Lus, Giacomo, Avolio, Carlo, Gallo, Antonio, Vianello, Marika, Onofrj, Marco, Filippi, Massimo, Trojano, Maria, and Patti, Francesco

Subjects
Male, oral DMTs, oral DMT, Administration, Oral, Disease, Relapsing-Remitting, Cohort Studies, 0302 clinical medicine, Immunologic, injectable DMT, Pharmacology (medical), 030212 general & internal medicine, Registries, Subcutaneous, Middle Aged, Italy, EDSS score, injectable DMTs, Multiple sclerosis, real-world setting, Adjuvants, Immunologic, Adult, Female, Follow-Up Studies, Glatiramer Acetate, Humans, Immunologic Factors, Injections, Subcutaneous, Interferon-beta, Multiple Sclerosis, Relapsing-Remitting, Retrospective Studies, Administration, Cohort, Settore MED/26 - Neurologia, Original Article, Neurosurgery, Cohort study, Oral, medicine.medical_specialty, Lower risk, Injections, 03 medical and health sciences, Internal medicine, medicine, Multiple sclerosi, Adjuvants, Pharmacology, business.industry, medicine.disease, Discontinuation, Observational study, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

The current study aims to compare injectable and oral first-line disease-modifying therapies (DMTs) for time to first relapse, time to confirmed disability progression (CDP), and time to discontinuation using a cohort of relapsing remitting multiple sclerosis (RRMS) patients, with data extracted from the Italian MS Register. This multicenter, observational, retrospectively acquired, and propensity-adjusted cohort study utilized RRMS-naïve patients from the Italian MS Register who started either injectable or oral first-line DMTs between January 1, 2010, and December 31, 2017, to evaluate the impact on disability outcomes in patients. Enrolled patients were divided into two groups, namely the injectable group (IG) and the oral group (OG). Of a cohort of 11,416 patients, 4602 were enrolled (3919 in the IG and 683 in the OG). The IG had a higher rate of women (67.3% vs 63.4%, p p p p = 0.941), while a lower risk of DMT was found in the OG (HR = 0.72; CI 95% 0.58–0.88, p = 0.002) for the event time to discontinuation. Real-world data from the Italian MS Register suggests that first-line oral DMTs are associated with a lower risk of experiencing a new relapse and of therapy discontinuation compared to injectable DMTs.

Published
2021

27. COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Author

Maria Pia Sormani, Irene Schiavetti, Luca Carmisciano, Cinzia Cordioli, Massimo Filippi, Marta Radaelli, Paolo Immovilli, Marco Capobianco, Nicola De Rossi, Giampaolo Brichetto, Eleonora Cocco, Cinzia Scandellari, Paola Cavalla, Ilaria Pesci, Antonio Zito, Paolo Confalonieri, Girolama Alessandra Marfia, Paola Perini, Matilde Inglese, Maria Trojano, Vincenzo Brescia Morra, Gioacchino Tedeschi, Giancarlo Comi, Mario Alberto Battaglia, Francesco Patti, Marco Salvetti, Gianmarco Abbadessa, Umberto Aguglia, Lia Allegorico, Beatrice Maria Allegri Rossi, Maria Pia Amato, Pietro Annovazzi, Carlo Antozzi, Lucia Appendino, Sebastiano Arena, Viola Baione, Roberto Balgera, Valeria Barcella, Damiano Baroncini, Caterina Barrilà, Alessandra Bellacosa, Gianmarco Bellucci, Roberto Bergamaschi, Valeria Bergamaschi, Daiana Bezzini, Beatrice Biolzi, Alvino Bisecco, Simona Bonavita, Giovanna Borriello, Chiara Bosa, Antonio Bosco, Francesca Bovis, Marco Bozzali, Laura Brambilla, Maria Buccafusca, Elisabetta Bucciantini, Sebastiano Bucello, Maria Chiara Buscarinu, Maria Paola Cabboi, Massimiliano Calabrese, Francesca Calabria, Francesca Caleri, Federico Camilli, Luisa Maria Caniatti, Roberto Cantello, Ruggero Capra, Rocco Capuano, Patrizia Carta, Maria Grazia Celani, Maria Cellerino, Raffaella Cerqua, Clara Chisari, Raffaella Clerici, Marinella Clerico, Gaia Cola, Antonella Conte, Marta Zaffira Conti, Christian Cordano, Susanna Cordera, Francesco Corea, Claudio Correale, Salvatore Cottone, Francesco Crescenzo, Erica Curti, Alessandro d'Ambrosio, Emanuele D'Amico, Maura Chiara Danni, Alessia d'Arma, Vincenzo Dattola, Stefano de Biase, Giovanna De Luca, Stefania Federica De Mercanti, Paolo De Mitri, Nicola De Stefano, Marco Della Cava, Mario di Napoli, Alessia Di Sapio, Renato Docimo, Anna Dutto, Luana Evangelista, Salvatore Fanara, Ferraro Diana, Maria Teresa Ferrò, Cristina Fioretti, Mario Fratta, Jessica Frau, Marzia Fronza, Roberto Furlan, Alberto Gajofatto, Antonio Gallo, Paolo Gallo, Claudio Gasperini, Anna Ghazaryan, Bruno Giometto, Francesca Gobbin, Flora Govone, Franco Granella, Erica Grange, Maria Grazia Grasso, Angelica Guareschi, Clara Guaschino, Simone Guerrieri, Donata Guidetti, Pietro Iaffaldano, Antonio Ianniello, Luigi Iasevoli, Daniele Imperiale, Maria Teresa Infante, Rosa Iodice, Aniello Iovino, Giovanna Konrad, Doriana Landi, Roberta Lanzillo, Caterina Lapucci, Luigi Lavorgna, Maria Rita L'Episcopo, Serena Leva, Giuseppe Liberatore, Marianna Lo Re, Marco Longoni, Leonardo Lopiano, Lorena Lorefice, Matteo Lucchini, Giacomo Lus, Davide Maimone, Maria Malentacchi, Giulia Mallucci, Simona Malucchi, Chiara Rosa Mancinelli, Luca Mancinelli, Paolo Manganotti, Giorgia Teresa Maniscalco, Vittorio Mantero, Sabrina Marangoni, Damiano Marastoni, Fabiana Marinelli, Alessandro Marti, Filippo Martinelli Boneschi, Federco Masserano Zoli, Francesca Matta, Laura Mendozzi, Giuseppe Meucci, Silvia Miante, Giuseppina Miele, Eva Milano, Massimiliano Mirabella, Rosanna Missione, Marcello Moccia, Lucia Moiola, Sara Montepietra, Margherita MontiBragadin, Federico Montini, Roberta Motta, Raffaele Nardone, Carolina Gabri Nicoletti, Eduardo Nobile-Orazio, Agostino Nozzolillo, Marco Onofrj, Riccardo Orlandi, Anna Palmieri, Damiano Paolicelli, Livia Pasquali, Luisa Pastò, Elisabetta Pedrazzoli, Maria Petracca, Alfredo Petrone, Carlo Piantadosi, Anna M Pietroboni, Federica Pinardi, Marta Ponzano, Emilio Portaccio, Mattia Pozzato, Carlo Pozzilli, Luca Prosperini, Alessandra Protti, Paolo Ragonese, Sarah Rasia, Sabrina Realmuto, Anna Repice, Eleonora Rigoni, Maria Teresa Rilla, Francesca Rinaldi, Calogero Marcello Romano, Marco Ronzoni, Marco Rovaris, Francesca Ruscica, Loredana Sabattini, Giuseppe Salemi, Lorenzo Saraceno, Alessia Sartori, Arianna Sartori, Elvira Sbragia, Giuditta Ilaria Scarano, Valentina Scarano, Valentina Schillaci, Maria Sessa, Caterina Sgarito, Grazia Sibilia, Gabriele Siciliano, Alessio Signori, Elisabetta Signoriello, Leonardo Sinisi, Francesca Sireci, Patrizia Sola, Claudio Solaro, Stefano Sotgiu, Maddalena Sparaco, Maria Laura Stromillo, Silvia Strumia, Emanuela Laura Susani, Giulietta Tabiadon, Francesco Teatini, Valentina Tomassini, Simone Tonietti, Clerici Valentina Torri, Carla Tortorella, Simona Toscano, Rocco Totaro, Maria Trotta, Gabriella Turano, Monica Ulivelli, Manzo Valentino, Giovanna Vaula, Domizia Vecchio, Marco Vercellino, Elena Pinuccia Verrengia, Marika Vianello, Eleonora Virgilio, Francesca Vitetta, Stefano Vollaro, Mauro Zaffaroni, Mauro Zampolini, Ignazio Roberto Zarbo, Luigi Zuliani, Pia Sormani, Maria, Schiavetti, Irene, Carmisciano, Luca, Cordioli, Cinzia, Filippi, Massimo, Radaelli, Marta, Immovilli, Paolo, Capobianco, Marco, De Rossi, Nicola, Brichetto, Giampaolo, Cocco, Eleonora, Scandellari, Cinzia, Cavalla, Paola, Pesci, Ilaria, Zito, Guido Antonio, Confalonieri, Paolo, Alessandra Marfia, Girolama, Perini, Paola, Inglese, Matilde, Trojano, Maria, Brescia Morra, Vincenzo, Tedeschi, Gioacchino, Comi, Giancarlo, Alberto Battaglia, Mario, Patti, Francesco, Salvetti, Marco, Abbadessa, Gianmarco, Aguglia, Umberto, Allegorico, Lia, Maria Allegri Rossi, Beatrice, Pia Amato, Maria, Annovazzi, Pietro, Antozzi, Carlo, Appendino, Lucia, Arena, Sebastiano, Baione, Viola, Balgera, Roberto, Barcella, Valeria, Baroncini, Damiano, Barrilà, Caterina, Bellacosa, Alessandra, Bellucci, Gianmarco, Bergamaschi, Roberto, Bergamaschi, Valeria, Bezzini, Daiana, Biolzi, Beatrice, Bisecco, Alvino, Bonavita, Simona, Borriello, Giovanna, Bosa, Chiara, Bosco, Antonio, Bovis, Francesca, Bozzali, Marco, Brambilla, Laura, Buccafusca, Maria, Bucciantini, Elisabetta, Bucello, Sebastiano, Chiara Buscarinu, Maria, Paola Cabboi, Maria, Calabrese, Massimiliano, Calabria, Francesca, Caleri, Francesca, Camilli, Federico, Maria Caniatti, Luisa, Cantello, Roberto, Capra, Ruggero, Capuano, Rocco, Carta, Patrizia, Grazia Celani, Maria, Cellerino, Maria, Cerqua, Raffaella, Chisari, Clara, Clerici, Raffaella, Clerico, Marinella, Cola, Gaia, Conte, Antonella, Zaffira Conti, Marta, Cordano, Christian, Cordera, Susanna, Corea, Francesco, Correale, Claudio, Cottone, Salvatore, Crescenzo, Francesco, Curti, Erica, D'Ambrosio, Alessandro, D'Amico, Emanuele, Chiara Danni, Maura, D'Arma, Alessia, Dattola, Vincenzo, de Biase, Stefano, De Luca, Giovanna, Federica De Mercanti, Stefania, De Mitri, Paolo, De Stefano, Nicola, Della Cava, Marco, di Napoli, Mario, Di Sapio, Alessia, Docimo, Renato, Dutto, Anna, Evangelista, Luana, Fanara, Salvatore, Diana, Ferraro, Teresa Ferrò, Maria, Fioretti, Cristina, Fratta, Mario, Frau, Jessica, Fronza, Marzia, Furlan, Roberto, Gajofatto, Alberto, Gallo, Antonio, Gallo, Paolo, Gasperini, Claudio, Ghazaryan, Anna, Giometto, Bruno, Gobbin, Francesca, Govone, Flora, Granella, Franco, Grange, Erica, Grazia Grasso, Maria, Guareschi, Angelica, Guaschino, Clara, Guerrieri, Simone, Guidetti, Donata, Iaffaldano, Pietro, Ianniello, Antonio, Iasevoli, Luigi, Imperiale, Daniele, Teresa Infante, Maria, Iodice, Rosa, Iovino, Aniello, Konrad, Giovanna, Landi, Doriana, Lanzillo, Roberta, Lapucci, Caterina, Lavorgna, Luigi, Rita L'Episcopo, Maria, Leva, Serena, Liberatore, Giuseppe, Lo Re, Marianna, Longoni, Marco, Lopiano, Leonardo, Lorefice, Lorena, Lucchini, Matteo, Lus, Giacomo, Maimone, Davide, Malentacchi, Maria, Mallucci, Giulia, Malucchi, Simona, Rosa Mancinelli, Chiara, Mancinelli, Luca, Manganotti, Paolo, Teresa Maniscalco, Giorgia, Mantero, Vittorio, Marangoni, Sabrina, Marastoni, Damiano, Marinelli, Fabiana, Marti, Alessandro, Martinelli Boneschi, Filippo, Masserano Zoli, Federco, Matta, Francesca, Mendozzi, Laura, Meucci, Giuseppe, Miante, Silvia, Miele, Giuseppina, Milano, Eva, Mirabella, Massimiliano, Missione, Rosanna, Moccia, Marcello, Moiola, Lucia, Montepietra, Sara, Montibragadin, Margherita, Montini, Federico, Motta, Roberta, Nardone, Raffaele, Gabri Nicoletti, Carolina, Nobile-Orazio, Eduardo, Nozzolillo, Agostino, Onofrj, Marco, Orlandi, Riccardo, Palmieri, Anna, Paolicelli, Damiano, Pasquali, Livia, Pastò, Luisa, Pedrazzoli, Elisabetta, Petracca, Maria, Petrone, Alfredo, Piantadosi, Carlo, M Pietroboni, Anna, Pinardi, Federica, Ponzano, Marta, Portaccio, Emilio, Pozzato, Mattia, Pozzilli, Carlo, Prosperini, Luca, Protti, Alessandra, Ragonese, Paolo, Rasia, Sarah, Realmuto, Sabrina, Repice, Anna, Rigoni, Eleonora, Teresa Rilla, Maria, Rinaldi, Francesca, Marcello Romano, Calogero, Ronzoni, Marco, Rovaris, Marco, Ruscica, Francesca, Sabattini, Loredana, Salemi, Giuseppe, Saraceno, Lorenzo, Sartori, Alessia, Sartori, Arianna, Sbragia, Elvira, Ilaria Scarano, Giuditta, Scarano, Valentina, Schillaci, Valentina, Sessa, Maria, Sgarito, Caterina, Sibilia, Grazia, Siciliano, Gabriele, Signori, Alessio, Signoriello, Elisabetta, Sinisi, Leonardo, Sireci, Francesca, Sola, Patrizia, Solaro, Claudio, Sotgiu, Stefano, Sparaco, Maddalena, Laura Stromillo, Maria, Strumia, Silvia, Laura Susani, Emanuela, Tabiadon, Giulietta, Teatini, Francesco, Tomassini, Valentina, Tonietti, Simone, Valentina Torri, Clerici, Tortorella, Carla, Toscano, Simona, Totaro, Rocco, Trotta, Maria Consiglia, Turano, Gabriella, Ulivelli, Monica, Valentino, Manzo, Vaula, Giovanna, Vecchio, Domizia, Vercellino, Marco, Pinuccia Verrengia, Elena, Vianello, Marika, Virgilio, Eleonora, Vitetta, Francesca, Vollaro, Stefano, Zaffaroni, Mauro, Zampolini, Mauro, Roberto Zarbo, Ignazio, Zuliani, Luigi, Sormani, M. P., Schiavetti, I., Carmisciano, L., Cordioli, C., Filippi, M., Radaelli, M., Immovilli, P., Capobianco, M., De Rossi, N., Brichetto, G., Cocco, E., Scandellari, C., Cavalla, P., Pesci, I., Zito, A., Confalonieri, P., Marfia, G. A., Perini, P., Inglese, M., Trojano, M., Brescia Morra, V., Tedeschi, G., Comi, G., Battaglia, M. A., Patti, F., Salvetti, M., Zito, Antonio, BRESCIA MORRA, Vincenzo, Trotta, Maria, Sormani, Maria Pia, Marfia, Girolama Alessandra, and Battaglia, Mario Alberto

Subjects
Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Coronavirus disease 2019 (COVID-19), Population, Intensive Care Unit, COVID-19, Cohort Studies, Comorbidity, Female, Hospitalization, Humans, Intensive Care Units, Italy, Middle Aged, Retrospective Studies, Risk Factors, Severity of Illness Index, Context (language use), Settore MED/26, Lower risk, Retrospective Studie, Internal medicine, Multiple Sclerosi, Medicine, In patient, National level, education, education.field_of_study, Expanded Disability Status Scale, business.industry, Risk Factor, Ethics committee, medicine.disease, Icu admission, Settore MED/26 - NEUROLOGIA, Neurology, Relative risk, Family medicine, Cohort, Honorarium, Observational study, Neurology (clinical), Cohort Studie, business, Human
Abstract

Background: It is unclear how multiple sclerosis (MS) affects the severity of Covid-19. Methods: Hospitalization, Intensive Care Unit (ICU) admission and death after Covid-19 diagnosis of 1362 MS patients were compared to the age and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher-risk: EDSS>3 or at least one comorbidity, lower-risk: EDSS

Published
2021

28. Cladribine vs other drugs in MS: Merging randomized trial with real-life data

Author

Domenico Ippolito, Sara La Gioia, Sabrina Esposito, Valentina Torri Clerici, Giorgia Teresa Maniscalco, Cinzia Cordioli, Lorena Pareja-Gutierrez, Elisabetta Signoriello, Cinzia Valeria Russo, Roberta Grasso, Doriana Landi, B. Frigeni, Andrea Visconti, Caterina Barrilà, Valeria Barcella, Raffaella Cerqua, Alice Laroni, Simona Bonavita, Stefania Barone, P. Perini, Sarah Rasia, Arianna Sartori, Maria Laura Stromillo, Roberta Lanzillo, Damiano Baroncini, Jessica Frau, Francesco Saccà, Luigi Lavorgna, Alessio Signori, Ignazio Roberto Zarbo, Giorgia Mataluni, Eleonora Cocco, Maria Pia Sormani, E Binello, Pietro Annovazzi, M Clerico, Simona Pontecorvo, Giuseppe Fenu, Alessia Di Sapio, Anna Maria Repice, Signori, A., Sacca, F., Lanzillo, R., Maniscalco, G. T., Signoriello, E., Repice, A. M., Annovazzi, P., Baroncini, D., Clerico, M., Binello, E., Cerqua, R., Mataluni, G., Perini, P., Bonavita, S., Lavorgna, L., Zarbo, I. R., Laroni, A., Pareja-Gutierrez, L., La Gioia, S., Frigeni, B., Barcella, V., Frau, J., Cocco, E., Fenu, G., Clerici, V. T., Sartori, A., Rasia, S., Cordioli, C., Stromillo, M. L., Di Sapio, A., Pontecorvo, S., Grasso, R., Barone, S., Barrila, C., Russo, C. V., Esposito, S., Ippolito, D., Landi, D., Visconti, A., Sormani, M. P., Signori, Alessio, Saccà, Francesco, Lanzillo, Roberta, Maniscalco, Giorgia Teresa, Signoriello, Elisabetta, Repice, Anna Maria, Annovazzi, Pietro, Baroncini, Damiano, Clerico, Marinella, Binello, Eleonora, Cerqua, Raffaella, Mataluni, Giorgia, Perini, Paola, Bonavita, Simona, Lavorgna, Luigi, Zarbo, Ignazio Roberto, Laroni, Alice, Pareja-Gutierrez, Lorena, La Gioia, Sara, Frigeni, Barbara, Barcella, Valeria, Frau, Jessica, Cocco, Eleonora, Fenu, Giuseppe, Clerici, Valentina Torri, Sartori, Arianna, Rasia, Sarah, Cordioli, Cinzia, Stromillo, Maria Laura, Di Sapio, Alessia, Pontecorvo, Simona, Grasso, Roberta, Barone, Stefania, Barrilà, Caterina, Russo, Cinzia Valeria, Esposito, Sabrina, Ippolito, Domenico, Landi, Doriana, Visconti, Andrea, and Sormani, Maria Pia

Subjects
Adult, Male, medicine.medical_specialty, Databases, Factual, Datasets as Topic, Settore MED/26, Placebo, Severity of Illness Index, law.invention, Multiple Sclerosis, Relapsing-Remitting, Natalizumab, Randomized controlled trial, law, Internal medicine, Outcome Assessment, Health Care, Severity of illness, medicine, Humans, Immunologic Factors, Multicenter Studies as Topic, Glatiramer acetate, Cladribine, Randomized Controlled Trials as Topic, Retrospective Studies, business.industry, Middle Aged, Fingolimod, Observational Studies as Topic, Neurology, Propensity score matching, Disease Progression, Female, Neurology (clinical), business, medicine.drug
Abstract

ObjectiveCladribine tablets were tested against placebo in randomized controlled trials (RCTs). In this study, the effectiveness of cladribine vs other approved drugs in patients with relapsing-remitting MS (RRMS) was compared by matching RCT to observational data.MethodsData from the pivotal trial assessing cladribine tablets vs placebo (CLARITY) were propensity score matched to data from the Italian multicenter database i-MuST. This database included 3,150 patients diagnosed between 2010 and 2018 at 24 Italian MS centers who started a disease-modifying drug. The annualized relapse rate (ARR) over 2 years from treatment start and the 24-week confirmed disability progression were compared between patients treated with cladribine and other approved drugs (interferon, glatiramer acetate, fingolimod, natalizumab, and dimethyl fumarate), with comparisons with placebo as a reference. Treatment effects were estimated by the inverse probability weighting negative binomial regression model for ARR and Cox model for disability progression. The treatment effect has also been evaluated according to baseline disease activity.ResultsAll weighted baseline characteristics were well balanced between groups. All drugs tested had an effect vs placebo close to that detected in the RCT. Patients treated with cladribine had a significantly lower ARR compared with interferon (relapse ratio [RR] = 0.48; p < 0.001), glatiramer acetate (RR = 0.49; p < 0.001), and dimethyl fumarate (RR = 0.6; p = 0.001); a similar ARR to that with fingolimod (RR = 0.74; p = 0.24); and a significantly higher ARR than natalizumab (RR = 2.13; p = 0.014), confirming results obtained by indirect treatment comparisons from RCTs (network meta-analyses). The relative effect of cladribine tablets 10 mg (cumulative dose 3.5 mg/kg over 2 years) was higher in patients with high disease activity vs all treatments except fingolimod and natalizumab. Effects on disability progression were largely nonsignificant, probably due to lack of power for such analysis.ConclusionIn patients with RRMS, cladribine tablets showed lower ARR compared with matched patients who started interferon, glatiramer acetate, or dimethyl fumarate; was similar to fingolimod; and was higher than natalizumab. The beneficial effect of cladribine tablets was generally amplified in the subgroup of patients with high disease activity.Classification of evidenceThis study provides Class III evidence that for patients with RRMS, cladribine-treated patients had lower ARR compared with interferon, glatiramer acetate, or dimethyl fumarate; similar ARR compared with fingolimod; and higher ARR compared with natalizumab.

Published
2020

29. Extending the Interval of Natalizumab Dosing: Is Efficacy Preserved?

Author

Marco Iudicello, Cinzia Cordioli, Marinella Clerico, Giorgia Teresa Maniscalco, Luigi Lavorgna, Martina Petruzzo, Giorgia Mataluni, Giacomo Lus, Massimiliano Mirabella, Rita Frangiamore, Damiano Baroncini, Erica Curti, Alice Laroni, Paola Cavalla, Eleonora Cocco, Ruggero Capra, Alessio Signori, Roberta Lanzillo, Gianfranco Costantini, Maria Pia Sormani, Stefania Federica De Mercanti, Viviana Nociti, Simona Bonavita, Ilaria Gandoglia, Arianna Sartori, Doriana Landi, Lorena Lorefice, Elisabetta Signoriello, Clerico, Marinella, De Mercanti, Stefania Federica, Signori, Alessio, Iudicello, Marco, Cordioli, Cinzia, Signoriello, Elisabetta, Lus, Giacomo, Bonavita, Simona, Lavorgna, Luigi, Maniscalco, Giorgia Teresa, Curti, Erica, Lorefice, Lorena, Cocco, Eleonora, Nociti, Viviana, Mirabella, Massimiliano, Baroncini, Damiano, Mataluni, Giorgia, Landi, Doriana, Petruzzo, Martina, Lanzillo, Roberta, Gandoglia, Ilaria, Laroni, Alice, Frangiamore, Rita, Sartori, Arianna, Cavalla, Paola, Costantini, Gianfranco, Sormani, Maria Pia, Capra, Ruggero, Clerico, M., De Mercanti, S. F., Signori, A., Iudicello, M., Cordioli, C., Signoriello, E., Lus, G., Bonavita, S., Lavorgna, L., Maniscalco, G. T., Curti, E., Lorefice, L., Cocco, E., Nociti, V., Mirabella, M., Baroncini, D., Mataluni, G., Landi, D., Petruzzo, M., Lanzillo, R., Gandoglia, I., Laroni, A., Frangiamore, R., Sartori, A., Cavalla, P., Costantini, G., Sormani, M. P., and Capra, R.

Subjects
0301 basic medicine, Standard interval, Adult, Male, medicine.medical_specialty, efficacy, progressive multifocal leukoencephalopathy, law.invention, Cohort Studies, Multiple sclerosis, 03 medical and health sciences, 0302 clinical medicine, Natalizumab, natalizumab, Randomized controlled trial, law, Recurrence, Internal medicine, medicine, Humans, Immunologic Factors, Pharmacology (medical), Multiple sclerosi, extended dose, Dosing, Retrospective Studies, Pharmacology, business.industry, Progressive multifocal leukoencephalopathy, Leukoencephalopathy, Progressive Multifocal, Retrospective cohort study, medicine.disease, Settore MED/26 - NEUROLOGIA, 030104 developmental biology, Treatment Outcome, Italy, Observational study, Female, Original Article, Neurology (clinical), business, 030217 neurology & neurosurgery, medicine.drug, Cohort study
Abstract

Extending the natalizumab interval after the 24th administration could reduce the risk of progressive multifocal leukoencephalopathy (PML). The objective is to evaluate the noninferiority of the efficacy of an extended interval dosing (EID) compared with the standard interval dosing (SID) of natalizumab. It is an observational, multicenter (14 Italian centers), retrospective cohort study, starting from the 24th natalizumab infusion to the loss of follow-up or 2 years after baseline. Patients were grouped in 2 categories according to the mean number of weeks between doses

Published
2020

30. First therapy choice in newly diagnosed Multiple Sclerosis patients: A multicenter Italian study

Author

Roberta Grasso, Doriana Landi, Luca Carmisciano, Simona Bonavita, Domenico Ippolito, Sara La Gioia, Marinella Clerico, Cinzia Valeria Russo, A. Repice, Maria Laura Stromillo, Roberta Lanzillo, Raffaella Cerqua, Alice Laroni, Lorena Pareja Gutierrez, Stefania Barone, Maria Pia Sormani, Simona Pontecorvo, E Binello, Pietro Annovazzi, Valentina Torri Clerici, Giorgia Mataluni, Cinzia Cordioli, Elisabetta Signoriello, Jessica Frau, Alessio Signori, Sarah Rasia, Arianna Sartori, Gabriella Turano, Francesco Saccà, Damiano Baroncini, Alessia Di Sapio, Ignazio Roberto Zarbo, Eleonora Cocco, Paola Perini, Luigi Lavorgna, Caterina Barrilà, Giorgia Teresa Maniscalco, B. Frigeni, Maniscalco, G. T., Sacca, F., Lanzillo, R., Annovazzi, P., Baroncini, D., Binello, E., Repice, A., Perini, P., Clerico, M., Mataluni, G., Bonavita, S., La Gioia, S., Gutierrez, L. P., Laroni, A., Frau, J., Cocco, E., Torri Clerici, V., Zarbo, I. R., Sartori, A., Signoriello, E., Rasia, S., Cordioli, C., Stromillo, M. L., Cerqua, R., Pontecorvo, S., Di Sapio, A., Grasso, R., Barone, S., Lavorgna, L., Barrila, C., Landi, D., Russo, C. V., Frigeni, B., Ippolito, D., Turano, G., Carmisciano, L., Sormani, M. P., and Signori, A.

Subjects
Male, medicine.medical_specialty, Dimethyl Fumarate, Settore MED/26, Logistic regression, Multiple sclerosis, 03 medical and health sciences, chemistry.chemical_compound, Multiple Sclerosis, Relapsing-Remitting, 0302 clinical medicine, Natalizumab, Internal medicine, Teriflunomide, Immunomodulatory therapy, Humans, Medicine, Relapsing-remitting, Multiple sclerosi, 030212 general & internal medicine, Glatiramer acetate, Determinants first therapy, Naive, Aged, Dimethyl fumarate, Fingolimod Hydrochloride, business.industry, General Medicine, medicine.disease, Fingolimod, Italy, Neurology, chemistry, Cohort, Neurology (clinical), business, Immunosuppressive Agents, 030217 neurology & neurosurgery, medicine.drug
Abstract

Background: The approval of an increasing number of disease modifying drugs for the treatment of Multiple Sclerosis (MS) creates new challenges for patients and clinicians on the first treatment choice. The main aim of this study was to assess factors impacting first therapy choice in a large Italian MS cohort. Methods: Newly diagnosed relapsing-remitting (RR) MS patients (2010-2018) followed in 24 Italian MS centres were included in the study. We evaluated the association of baseline demographics, clinical and MRI characteristics to the first treatment choice by logistic regression models applied to pre-defined binary alternatives: dimethyl fumarate vs injectables (interferon and glatiramer acetate), teriflunomide vs injectables, fingolimod vs dimethyl fumarate and fingolimod vs natalizumab. Results: We enrolled 3025 patients in the period between January 2010 and June 2018. Relapses in the previous year (OR = 2.75; p = 0.001), presence of spinal cord lesions (OR = 1.80; p = 0.002) and higher number (>9) of T2 lesions on the baseline brain MRI scan (OR = 1.65; p = 0.022) were the factors associated to dimethyl fumarate choice as first therapy vs an injectable drug. Older age (OR = 1.06; p < 0.001), male sex (OR = 2.29; p = 0.001) and higher EDSS (OR = 1.36; p < 0.001) were the factors associated with the choice of teriflunomide vs injectables. In more recent years, dimethyl fumarate (OR = 3.23; p < 0.001) and teriflunomide (OR = 2.53; p < 0.001) were chosen more frequently than injectables therapies. The main determinant for the choice of fingolimod as compared with dimethyl fumarate was a higher EDSS (OR = 1.56; p = 0.001), while there was a weak association with a longer disease duration (p = 0.068) and a longer time from onset to diagnosis (p = 0.085). Compared to fingolimod, natalizumab was preferred in patients with a younger age (OR = 0.95; p = 0.003) and higher EDSS (OR = 1.45; p = 0.007) and a shorter disease duration (OR = 0.52; p = 0.076). Conclusion: Many factors guided therapeutic decision for our Italian cohort of MS patients; they are mainly related to MS disease activity, baseline EDSS, disease duration and age.

Published
2020

31. Cerebrospinal fluid analysis and the determination of oligoclonal bands

Author

Eleonora Cocco, Giovanna De Luca, Elisabetta Zardini, Davide Giavarina, Debora Giunti, Maurizio Leone, Gaetano Desina, Gaetano Bernardi, Emilio Ciusani, Rinaldo Brivio, Sara Mariotto, Maddalena Ruggieri, Diego Franciotta, Enrico Fainardi, Mauro Zaffaroni, Elena Bazzigaluppi, Ivana Cataldo, Arianna Sala, Antonio Bertolotto, Francesco Lolli, Elisabetta Capello, Tiziana Biagioli, Gianna Costa, Andreina Paternoster, Eduardo Nobile-Orazio, Gabriella Passerini, Clara Ballerini, Claudia Giannotta, R. Leante, Guido Cavaletti, Massimiliano Castellazzi, Patrizia Sola, Roberta Bedin, Matteo Gastaldi, Paola Pettini, Sergio Ferrari, Gastaldi, M, Zardini, E, Leante, R, Ruggieri, M, Costa, G, Cocco, E, De Luca, G, Cataldo, I, Biagioli, T, Ballerini, C, Castellazzi, M, Fainardi, E, Pettini, P, Zaffaroni, M, Giunti, D, Capello, E, Bernardi, G, Ciusani, E, Giannotta, C, Nobile-Orazio, E, Bazzigaluppi, E, Passerini, G, Bedin, R, Sola, P, Brivio, R, Cavaletti, G, Sala, A, Bertolotto, A, Desina, G, Leone, M, Mariotto, S, Ferrari, S, Paternoster, A, Giavarina, D, Lolli, F, and Franciotta, D

Subjects
0301 basic medicine, Pathology, medicine.medical_specialty, Neurology, Neuroimmunology, Demyelinating Autoimmune Diseases, CNS, Dermatology, Intrathecal, NO, Laboratory diagnostics, Multiple sclerosis, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, Internal medicine, Clinical information, Humans, Medicine, Intrathecal IgG synthesis, Isoelectric focusing, Laboratory diagnostics, Multiple sclerosis, Neuroimmunology, Intrathecal IgG synthesis, business.industry, Oligoclonal Bands, General Medicine, medicine.disease, Psychiatry and Mental health, 030104 developmental biology, Isoelectric focusing, Csf analysis, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

This document presents the guidelines for the cerebrospinal fluid (CSF) analysis and the determination of oligoclonal bands (OCBs) as pivotal tests in neuroin flammatory pathologies of the central nervous system. The guidelines have been developed following a consensus process built on questionnaire-based surveys, internet contacts, and discussions at workshops of the sponsoring Italian Association of Neuroimmunology (AINI) congresses. Essential clinical information on the pathologies in which the CSF analysis is indicated, and, particularly, on those characterized by the presence of OCBs in the intrathecal compartment, indications and limits of CSF analysis and OCB determination, instructions for result interpretation, and agreed laboratory protocols (Appendix) are reported for the communicative community of neurologists and clinical pathologists.

Published
2017

32. MRI activity and extended interval of Natalizumab dosing regimen: a multicentre Italian study

Author

Doriana Landi, Gianmarco Abbadessa, Gianfranco Costantini, Giacomo Lus, Stefania Federica De Mercanti, Cinzia Cordioli, Simona Bonavita, Giorgia Mataluni, Massimiliano Mirabella, Maria Pia Sormani, Ilaria Gandoglia, Giorgia Teresa Maniscalco, Martina Petruzzo, Rita Frangiamore, Eleonora Cocco, Erica Curti, Damiano Baroncini, Ruggero Capra, Elisabetta Signoriello, Paola Cavalla, Luigi Lavorgna, Lorena Lorefice, Alice Laroni, Marinella Clerico, Viviana Nociti, Alessio Signori, Arianna Sartori, Roberta Lanzillo, De Mercanti, Stefania Federica, Signori, Alessio, Cordioli, Cinzia, Signoriello, Elisabetta, Lus, Giacomo, Bonavita, Simona, Abbadessa, Gianmarco, Lavorgna, Luigi, Maniscalco, Giorgia Teresa, Curti, Erica, Lorefice, Lorena, Cocco, Eleonora, Nociti, Viviana, Mirabella, Massimiliano, Baroncini, Damiano, Mataluni, Giorgia, Landi, Doriana, Petruzzo, Martina, Lanzillo, Roberta, Gandoglia, Ilaria, Laroni, Alice, Frangiamore, Rita, Sartori, Arianna, Cavalla, Paola, Costantini, Gianfranco, Capra, Ruggero, Sormani, Maria Pia, Clerico, Marinella, De Mercanti, S. F., Signori, A., Cordioli, C., Signoriello, E., Lus, G., Bonavita, S., Abbadessa, G., Lavorgna, L., Maniscalco, G. T., Curti, E., Lorefice, L., Cocco, E., Nociti, V., Mirabella, M., Baroncini, D., Mataluni, G., Landi, D., Petruzzo, M., Lanzillo, R., Gandoglia, I., Laroni, A., Frangiamore, R., Sartori, A., Cavalla, P., Costantini, G., Capra, R., Sormani, M. P., and Clerico, M.

Subjects
medicine.medical_specialty, Efficacy, Progressive Multifocal, Relapsing-Remitting, Settore MED/26, law.invention, Multiple sclerosis, 03 medical and health sciences, Magnetic resonance imaging, Immunologic Factor, Multiple Sclerosis, Relapsing-Remitting, 0302 clinical medicine, Natalizumab, Randomized controlled trial, Leukoencephalopathy, Retrospective Studie, law, Internal medicine, Multiple Sclerosi, Humans, Immunologic Factors, Medicine, 030212 general & internal medicine, Dosing, Retrospective Studies, Extended dose, medicine.diagnostic_test, business.industry, Progressive multifocal leukoencephalopathy, Leukoencephalopathy, Progressive Multifocal, Retrospective cohort study, medicine.disease, Settore MED/26 - NEUROLOGIA, Regimen, Italy, Neurology, Magnetic Resonance Imaging, Multiple Sclerosis, Neurology (clinical), business, 030217 neurology & neurosurgery, Human, medicine.drug
Abstract

Background: To minimize the risk of Progressive Multifocal Leukoencephalopathy and rebound in JCV-positive multiple sclerosis (MS) patients after 24 natalizumab doses, it has been proposed to extend the administrations interval. The objective is to evaluate the EID efficacy on MRI activity compared with the standard interval dosing (SID). Methods: Observational, multicentre, retrospective cohort study, starting from the 24th natalizumab infusion to the loss of follow-up or 2 years after baseline. Three hundred and sixteen patients were enrolled. The median dose interval (MDI) following the 24th infusion was 5 weeks, with a bimodal distribution (modes at 4 and 6 weeks). Patients were grouped into 2 categories according to the mean number of weeks between doses: < 5 weeks, SID; ≥ 5 weeks, EID. Results: One hundred and eighty-seven patients were in the SID group (MDI = 4.5 weeks) and 129 in the EID group (MDI 6.1 weeks). The risk to develop active lesions on MRI is similar in SID and EID groups during the 6 and 12 months after the 24th natalizumab infusion, respectively 4.27% (95% CI:0.84–7.70) vs 4.71% (95% CI:0.16–9.25%) [p = 0.89] and 8.50% (95% CI:4.05–12.95) vs 6.55% (95% CI:2.11–11.00%) [p = 0.56]. The EID regimen does not appear to increase the occurrence of MRI activity during follow-up. Conclusion: There is no evidence of the reduced efficacy of natalizumab in an EID setting regarding the MRI activity. This observation supports the need for a bigger randomized study to assess the need to change the standard of the natalizumab dosing schedule, to better manage JCV-positive patients.

Published
2021

33. Outcomes after fingolimod to alemtuzumab treatment shift in relapsing–remitting MS patients: a multicentre cohort study

Author

Francesco Saccà, Giuseppe Fenu, Alessio Signori, Sara La Gioia, Simona Bonavita, Jessica Frau, Marinella Clerico, Cinzia Valeria Russo, Marco Capobianco, Arianna Sartori, Maria Pia Sormani, Damiano Baroncini, Pietro Annovazzi, Caterina Lapucci, Eleonora Cocco, Alice Laroni, Antonio Carotenuto, Elisabetta Signoriello, Antonio Gallo, Giorgia Teresa Maniscalco, Frau, J., Sacca, F., Signori, A., Baroncini, D., Fenu, G., Annovazzi, P., Capobianco, M., Signoriello, E., Laroni, A., La Gioia, S., Sartori, A., Maniscalco, G. T., Bonavita, S., Clerico, M., Russo, C. V., Gallo, A., Lapucci, C., Carotenuto, A., Sormani, M. P., and Cocco, E.

Subjects
Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Outcome Assessment, Alemtuzumab, Fingolimod, NEDA, Real life, Real life, NEDA, Relapsing-Remitting, Gastroenterology, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Multiple Sclerosis, Relapsing-Remitting, Fingolimod Hydrochloride, Internal medicine, Alemtuzumab, Fingolimod, Female, Humans, Immunologic Factors, Magnetic Resonance Imaging, Middle Aged, Retrospective Studies, Outcome Assessment, Health Care, medicine, 030212 general & internal medicine, Expanded Disability Status Scale, business.industry, Multiple sclerosis, Retrospective cohort study, medicine.disease, Discontinuation, Health Care, Neurology, Cohort, Neurology (clinical), business, 030217 neurology & neurosurgery, medicine.drug
Abstract

Background: A high reactivation of multiple sclerosis (MS) was reported in patients treated with alemtuzumab after fingolimod. We aimed to understand whether this shift enhanced the risk for reactivation in a real-life cohort. Methods: Subjects with relapsing MS, shifting from fingolimod to alemtuzumab were enrolled. We collected the following data: age, sex, disease duration, relapses after fingolimod withdrawal, new T2/gadolinium (Gd)-enhancing lesions in the last magnetic resonance imaging (MRI) during fingolimod and in the first, while on alemtuzumab, lymphocyte counts at alemtuzumab start, and Expanded Disability Status Scale (EDSS) before and after alemtuzumab. Results: We enrolled 77 patients (women 61 (79%); mean age 36.2years (SD 9.6), and disease duration 12.3years (SD 6.8) at fingolimod discontinuation; median washout 1.8months). The annualised relapse rate was 0.89 during fingolimod, 1.32 during washout, and 0.15 after alemtuzumab (p = 0.001). The EDSS changed from a median of 3 (IQR 2–4) at the end of fingolimod to 2.5 after alemtuzumab (IQR 1.5–4) (p = 0.013). The washout length and the lymphocyte count before alemtuzumab were not associated with EDSS change after alemtuzumab (p = 0.59 and p = 0.33, respectively). MRI activity decreased after alemtuzumab compared to that during fingolimod (p = 0.001). At alemtuzumab start, lymphocyte counts were < 0.8 × 103/mL in 21 patients. Conclusions: In our cohort, alemtuzumab reduced relapse, new T2/Gd-enhancing lesions, and EDSS score, as compared to the previous periods (fingolimod/washout). These results were not related to washout length or lymphocyte counts. Therefore, a rapid initiation of alemtuzumab after fingolimod does not seem to be a risk factor for MS reactivation.

Published
2019

34. A multicentRE observational analysiS of PErsistenCe to Treatment in the new multiple sclerosis era: the RESPECT study

Author

Massimiliano Calabrese, Eleonora Cocco, Roberta Fantozzi, Viviana Nociti, Antonio Gallo, Laura Boffa, Alice Laroni, Claudio Solaro, Valentina Torri Clerici, Giancarlo Coghe, Simona Malucchi, Massimiliano Di Filippo, Valentina Tomassini, Marcello Moccia, Pietro Annovazzi, Federica Pinardi, Carla Tortorella, Paola Cavalla, Ilaria Pesci, Luca Prosperini, Giorgia Teresa Maniscalco, Alberto Gajofatto, Claudio Gasperini, Roberta Lanzillo, Fabio Buttari, Paolo Ragonese, Marta Radaelli, Maria Chiara Buscarinu, Lanzillo, Roberta, Prosperini, Luca, Gasperini, Claudio, Moccia, Marcello, Fantozzi, Roberta, Tortorella, Carla, Nociti, Viviana, Annovazzi, Pietro, Cavalla, Paola, Radaelli, Marta, Malucchi, Simona, Clerici, Valentina Torri, Boffa, Laura, Buttari, Fabio, Ragonese, Paolo, Maniscalco, Giorgia Teresa, Di Filippo, Massimiliano, Buscarinu, Maria Chiara, Pinardi, Federica, Gallo, Antonio, Coghe, Giancarlo, Pesci, Ilaria, Laroni, Alice, Gajofatto, Alberto, Calabrese, Massimiliano, Tomassini, Valentina, Cocco, Eleonora, Solaro, Claudio, Lanzillo R., Prosperini L., Gasperini C., Moccia M., Fantozzi R., Tortorella C., Nociti V., Annovazzi P., Cavalla P., Radaelli M., Malucchi S., Clerici V.T., Boffa L., Buttari F., Ragonese P., Maniscalco G.T., Di Filippo M., Buscarinu M.C., Pinardi F., Gallo A., Coghe G., Pesci I., Laroni A., Gajofatto A., Calabrese M., Tomassini V., Cocco E., and Solaro C.

Subjects
Male, Injection, Time Factors, Patient Dropout, disease-modifying therapies, multiple sclerosis, outcome measurement, persistence to treatment, quality of life, Administration, Oral, Self Administration, Sex Factor, Kaplan-Meier Estimate, Relapsing-Remitting, Immunologic Factor, 0302 clinical medicine, Quality of life, Retrospective Studie, Risk Factors, Medicine, 030212 general & internal medicine, Disease-modifying therapie, Disease-modifying therapies, Multiple sclerosis, Outcome measurement, Persistence to treatment, Quality of life, Administration, Oral, Adult, Female, Follow-Up Studies, Humans, Immunologic Factors, Injections, Kaplan-Meier Estimate,Male, Multiple Sclerosis, Relapsing-Remitting, Patient Dropouts, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Factors, Self Administration, Sex Factors, Time Factors, Hazard ratio, Prognosis, Neurology, Tolerability, Administration, Settore MED/26 - Neurologia, Female, Human, Oral, Adult, medicine.medical_specialty, Patient Dropouts, Time Factor, Prognosi, Follow-Up Studie, Injections, 03 medical and health sciences, Route of administration, Multiple Sclerosis, Relapsing-Remitting, Sex Factors, Internal medicine, Humans, Immunologic Factors, Multiple sclerosi, Adverse effect, Proportional Hazards Models, Retrospective Studies, business.industry, Proportional hazards model, Risk Factor, Retrospective cohort study, Discontinuation, Disease-modifying therapies, Multiple sclerosis, Outcome measurement, Persistence to treatment, Follow-Up Studies, Proportional Hazards Model, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

In this independent, multicenter, retrospective study, we investigated the short-term persistence to treatment with first-line self-injectable or oral disease-modifying treatments (DMTs) in patients with relapsing–remitting multiple sclerosis. Data of patients regularly attending 21 Italian MS Centres who started a self-injectable or an oral DMT in 2015 were collected to: (1) estimate the proportion of patients discontinuing the treatment; (3) explore reasons for discontinuation; (3) identify baseline predictors of treatment discontinuation over a follow-up period of 12months. We analyzed data of 1832 consecutive patients (1289 women, 543 men); 374 (20.4%) of them discontinued the prescribed DMT after a median time of 6 months (range 3days to 11.5months) due to poor tolerability (n = 163; 43.6%), disease activity (n = 95; 25.4%), adverse events (n = 64; 17.1%), convenience (i.e. availability of new drug formulations) and pregnancy planning (n = 21; 1.1%). Although the proportion of discontinuers was higher with self-injectable (n = 107; 22.9%) than with oral DMT (n = 215; 16.4%), the Cox regression model revealed no significant between-group difference (p = 0.12). Female sex [hazard ratio (HR) = 1.39, p = 0.01] and previous exposure to ≥ 3 DMTs (HR = 1.71, p = 0.009) were two independent risk factors for treatment discontinuation, regardless of prescribed DMTs. Our study confirms that persistence to treatment represents a clinical challenge, irrespective of the route of administration.

Published
2018

35. Pregnancy decision-making in women with multiple sclerosis treated with natalizumab: I: Fetal risks

Author

Maria Giovanna Marrosu, Paola Cavalla, Claudio Solaro, Eleonora Cocco, Antonio Uccelli, Marta Giannini, Giancarlo Comi, Mauro Zaffaroni, Vittorio Martinelli, Lucia Moiola, Francesca Rinaldi, Vincenzo Brescia Morra, Roberta Lanzillo, Paolo Gallo, Francesco Patti, Alice Laroni, Pietro Annovazzi, Luisa Pastò, Laura De Giglio, Carla Tortorella, Carlo Pozzilli, Angelo Ghezzi, Maria Pia Amato, Maria Trojano, Paolo Bellantonio, Damiano Paolicelli, Emilio Portaccio, Portaccio, E, Annovazzi, P, Ghezzi, A, Zaffaroni, M, Moiola, L, Martinelli, V, Lanzillo, R, Brescia Morra, V, Rinaldi, F, Gallo, P, Tortorella, C, Paolicelli, D, Pozzilli, C, De Giglio, L, Cavalla, P, Cocco, E, Marrosu, Mg, Patti, F, Solaro, C, Bellantonio, P, Uccelli, A, Laroni, A, Pastò, L, Giannini, M, Trojano, M, Comi, G, Amato, Mp, MS Study Group of the Italian Neurological, Society, Radaelli, M, Portaccio, Emilio, Annovazzi, Pietro, Ghezzi, Angelo, Zaffaroni, Mauro, Moiola, Lucia, Martinelli, Vittorio, Lanzillo, Roberta, Brescia Morra, Vincenzo, Rinaldi, Francesca, Gallo, Paolo, Tortorella, Carla, Paolicelli, Damiano, Pozzilli, Carlo, De Giglio, Laura, Cavalla, Paola, Cocco, Eleonora, Marrosu, Maria Giovanna, Patti, Francesco, Solaro, Claudio, Bellantonio, Paolo, Uccelli, Antonio, Laroni, Alice, Pastò, Luisa, Giannini, Marta, Trojano, Maria, Comi, Giancarlo, and Amato, Maria Pia

Subjects
0301 basic medicine, Pregnancy, education.field_of_study, medicine.medical_specialty, business.industry, Obstetrics, Population, Odds ratio, Abortion, medicine.disease, Confidence interval, 03 medical and health sciences, 030104 developmental biology, Natalizumab, medicine, Gestation, Neurology (clinical), business, education, medicine.drug, Cohort study
Abstract

ObjectiveTo assess fetal risk after pregnancy exposure to natalizumab in women with multiple sclerosis (MS), with a specific focus on spontaneous abortion (SA) and congenital anomalies (CA).MethodsData of all pregnancies occurring between 2009 and 2015 in patients with MS treated with natalizumab and referring to 19 participating sites were collected and compared with those of pregnancies in untreated patients and patients treated with injectable immunomodulatory agents. Rates of SA and CA were also compared with those reported in the Italian population. Multivariable logistic and linear regression models were performed.ResultsA total of 92 pregnancies were tracked in 83 women. In the multivariable analysis, natalizumab exposure was associated with SA (odds ratio [OR] 3.9, 95% confidence interval [CI] 1.9–8.5, p < 0.001). However, the rate of SA (17.4%) was within the estimates for the general population, as well as the rate of major CA (3.7%). Moreover, exposure to natalizumab and interferon-β (IFN-β) was associated with lower length and weight of the babies (p < 0.001).ConclusionOur results showed that natalizumab exposure to up 12 weeks of gestation is associated with an increased risk of SA, although within the limits expected in the general population, whereas the risk of CA needs further investigation. Taking into account the high risk of disease reactivation after natalizumab suspension, pregnancy could be planned continuing natalizumab while strictly monitoring conception.Classification of evidenceThis study provides Class III evidence that in women with MS, natalizumab exposure increases the risk of spontaneous abortion as compared to IFN-β-exposed or untreated patients (OR 3.9, 95% CI 1.9–8.5).

Published
2018

36. Assessing association of comorbidities with treatment choice and persistence in MS: A real-life multicenter study

Author

Alice, Laroni, Alessio, Signori, Giorgia T, Maniscalco, Roberta, Lanzillo, Cinzia Valeria, Russo, Eleonora, Binello, Salvatore, Lo Fermo, Annamaria, Repice, Pietro, Annovazzi, Simona, Bonavita, Marinella, Clerico, Damiano, Baroncini, Luca, Prosperini, Sara, La Gioia, Silvia, Rossi, Eleonora, Cocco, Jessica, Frau, Valentina, Torri Clerici, Elisabetta, Signoriello, Arianna, Sartori, Ignazio Roberto, Zarbo, Sarah, Rasia, Cinzia, Cordioli, Raffaella, Cerqua, Alessia, Di Sapio, Luigi, Lavorgna, Simona, Pontecorvo, Caterina, Barrilà, Francesco, Saccà, Barbara, Frigeni, Sabrina, Esposito, Domenico, Ippolito, Fabio, Gallo, Maria Pia, Sormani, Laroni, Alice, Signori, Alessio, Maniscalco, Giorgia T., Lanzillo, Roberta, Russo, Cinzia Valeria, Binello, Eleonora, Lo Fermo, Salvatore, Repice, Annamaria, Annovazzi, Pietro, Bonavita, Simona, Clerico, Marinella, Baroncini, Damiano, Prosperini, Luca, La Gioia, Sara, Rossi, Silvia, Cocco, Eleonora, Frau, Jessica, Torri Clerici, Valentina, Signoriello, Elisabetta, Sartori, Arianna, Zarbo, Ignazio Roberto, Rasia, Sarah, Cordioli, Cinzia, Cerqua, Raffaella, Di Sapio, Alessia, Lavorgna, Luigi, Pontecorvo, Simona, Barrilà, Caterina, Saccà, Francesco, Frigeni, Barbara, Esposito, Sabrina, Ippolito, Domenico, Gallo, Fabio, Sormani, Maria Pia, Laroni, A, Signori, A, Maniscalco, Gt, Lanzillo, R, Russo, Cv, Binello, E, Lo Fermo, S, Repice, A, Annovazzi, P, Bonavita, S, Clerico, M, Baroncini, D, Prosperini, L, La Gioia, S, Rossi, S, Cocco, E, Frau, J, Torri Clerici, V, Signoriello, E, Sartori, A, Zarbo, Ir, Rasia, S, Cordioli, C, Cerqua, R, Di Sapio, A, Lavorgna, L, Pontecorvo, S, Barrilà, C, Saccà, F, Frigeni, B, Esposito, S, Ippolito, D, Gallo, F, and Sormani, Mp

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Cardiovascular Abnormalities, Cohort Studies, Comorbidity, Disability Evaluation, Female, Humans, Immunosuppressive Agents, Italy, Mental Disorders, Metabolic Diseases, Middle Aged, Nervous System Diseases, Severity of Illness Index, Drug Substitution, Neurology (clinical), Immunosuppressive Agent, 03 medical and health sciences, 0302 clinical medicine, Natalizumab, Internal medicine, Multiple Sclerosi, Severity of illness, medicine, Cardiovascular Abnormalitie, Glatiramer acetate, Nervous System Disease, business.industry, Odds ratio, medicine.disease, Fingolimod, Metabolic Disease, 030104 developmental biology, Cohort, Mental Disorder, Cohort Studie, business, 030217 neurology & neurosurgery, Human, Cohort study, medicine.drug
Abstract

Objective:To assess whether the presence of concomitant diseases at multiple sclerosis (MS) diagnosis is associated with the choice and the treatment persistence in an Italian MS cohort.Methods:We included newly diagnosed patients (2010–2016) followed in 20 MS centers and collected demographic and clinical data. We evaluated baseline factors related to the presence of comorbidities and the association between comorbidities and the clinical course of MS and the time to the first treatment switch.Results:The study cohort included 2,076 patients. Data on comorbidities were available for 1,877/2,076 patients (90.4%). A total of 449/1,877 (23.9%) patients had at least 1 comorbidity at MS diagnosis. Age at diagnosis (odds ratio 1.05, 95% confidence interval [CI] 1.04–1.06; p < 0.001) was the only baseline factor independently related to the presence of comorbidities. Comorbidities were not significantly associated with the choice of the first disease-modifying treatment, but were significantly associated with higher risk to switch from the first treatment due to intolerance (hazard ratio 1.42, CI 1.07–1.87; p = 0.014). Association of comorbidities with risk of switching for intolerance was significantly heterogeneous among treatments (interferon β, glatiramer acetate, natalizumab, or fingolimod; interaction test, p = 0.04).Conclusions:Comorbidities at diagnosis should be taken into account at the first treatment choice because they are associated with lower persistence on treatment.

Published
2017

37. Muscle MRI in female carriers of emerinopathy

Author

Eleonora Cocco, Marco Mura, Maria Giovanna Marrosu, Luisa Politano, G. Marrosu, Nicola Carboni, Carboni, N, Mura, M, Politano, Luisa, Cocco, E, Marrosu, G, and Marrosu, M. G.

Subjects
medicine.medical_specialty, Heterozygote, Muscle mri, business.industry, Magnetic Resonance Imaging, Muscular Dystrophy, Duchenne, Neurology, Physical therapy, medicine, Humans, Female, Neurology (clinical), business, Muscle, Skeletal
Published
2013

38. A cross-sectional, multicentre study of the therapeutic management of multiple sclerosis relapses in Italy

Author

Giovanni Frisullo, Simona Malucchi, Paolo Ragonese, Giovanna De Luca, Eleonora Cocco, Benedetta Bodini, Cinzia Cordioli, Damiano Paolicelli, Claudio Gasperini, Ilaria Pesci, Luca Roccatagliata, Mariaemma Rodegher, Antonio Gallo, Marta Radaelli, Massimiliano Calabrese, Valentina Tomassini, Valentina Zipoli, Carla Tortorella, Marco Vercellino, Claudio Solaro, Pietro Annovazzi, Laura Boffa, Annovazzi, P, Tomassini, V, Bodini, B, Boffa, L, Calabrese, M, Cocco, E, Cordioli, C, De Luca, G, Frisullo, G, Gallo, Antonio, Malucchi, S, Paolicelli, D, Pesci, I, Radaelli, M, Ragonese, P, Roccatagliata, L, Tortorella, C, Vercellino, M, Zipoli, V, Gasperini, C, Rodegher, M, Solaro, C., Annovazzi, Pietro, Tomassini, Valentina, Bodini, Benedetta, Boffa, Laura, Calabrese, Massimiliano, Cocco, Eleonora, Cordioli, Cinzia, De Luca, Giovanna, Frisullo, Giovanni, Malucchi, Simona, Paolicelli, Damiano, Pesci, Ilaria, Radaelli, Marta, Ragonese, Paolo, Roccatagliata, Luca, Tortorella, Carla, Vercellino, Marco, Zipoli, Valentina, Gasperini, Claudio, Rodegher, Mariaemma, Solaro, Claudio, Gallo, A, and Solaro, C

Subjects
Male, Pediatrics, Neurology, Cross-sectional study, multi center study, Adrenal Cortex Hormone, Adrenal Cortex Hormones, Recurrence, Surveys and Questionnaires, Multiple Sclerosi, Corticosteroid, Surveys and Questionnaire, Relapse, Survey, Neuroradiology, General Medicine, Middle Aged, Management, Psychiatry and Mental health, Methylprednisolone, Italy, Psychiatry and Mental Health, multiple sclerosi, Settore MED/26 - Neurologia, Female, Neurosurgery, medicine.drug, Human, Adult, medicine.medical_specialty, Multiple Sclerosis, Dermatology, medicine, Humans, Medical prescription, Cross-Sectional Studie, therapy, business.industry, Multiple sclerosis, medicine.disease, Management of multiple sclerosis, Cross-Sectional Studies, Health Care Survey, Health Care Surveys, Physical therapy, Neurology (clinical), business
Abstract

Despite the existence of therapeutic guidelines, management of multiple sclerosis relapse remains heterogeneous. Optimisation of relapse outcome demands an improved understanding of the neurologist's therapeutic attitude towards relapse management, which is the aim of this study. Neurologists from 13 multiple sclerosis centres completed a questionnaire every time they assessed multiple sclerosis relapses. The questionnaire requested a guided description of the relapse's clinical characteristics and an indication of the prescribed therapy, supported with up to 3 out of 20 suggested reasons. Over 3 months, 368 questionnaires were collected. Median percentage (%) of 21 relapses resulting in a prescription was 88.9%. Corticosteroids represented the most frequent prescription. A short-course of high-dose intravenous methylprednisolone was the most used corticosteroid (73.7%). Treatment was administrated mainly in day case unit (80.0%) and at home (13.6%). A tapered therapy was prescribed to 28.8% of patients. Neurologists' therapeutic decisions were driven mainly by relapse severity (45.3%) and symptom evolution (24.2%). Our study confirms the therapeutic attitude of multiple sclerosis specialists in treating relapses with high-dose intravenous corticosteroids in a day hospital setting, with a tapering in a proportion of cases. The main reasons for prescription are relapse severity and symptom evolution. © 2012 Springer-Verlag.

Published
2013

39. Disease re-activation during pregnancy after natalizumab suspension in patients with multiple sclerosis

Author

Alessandra Lugaresi, Alfonso Iudice, C. Tortorella, Rocco Totaro, A. Bosco, T.H.E. for, R Lanzillo, Eleonora Cocco, Paolo Bellantonio, Pietro Annovazzi, Antonio Uccelli, Carlo Pozzilli, A. Ghezzi, Emilio Portaccio, M. P. Amato, V. Brescia Morra, Paola Cavalla, Francesco Patti, Mg Marrosu, Claudio Gasperini, Maria Trojano, Amato, M., Tortorella, C., Trojano, M., Cocco, E., Marrosu, M. G., Lugaresi, A., Annovazzi, P., Ghezzi, A., Gasperini, C., Iudice, A., Bellantonio, P., Patti, F., Cavalla, P., Totaro, R., Pozzilli, C., Bosco, A., Uccelli, A., Lanzillo, Roberta, BRESCIA MORRA, Vincenzo, and Portaccio, E.

Subjects
Pregnancy, medicine.medical_specialty, business.industry, Multiple sclerosis, Disease, medicine.disease, Gastroenterology, Natalizumab, Neurology, Internal medicine, medicine, In patient, Neurology (clinical), Suspension (vehicle), business, medicine.drug
Published
2015

40. Cardiac and muscle imaging findings in a family with X-linked Emery-Dreifuss muscular dystrophy

Author

Eugenio Mercuri, Luisa Politano, Eleonora Cocco, Rachele Piras, Lai C, Vincenzo Nissardi, Nicola Carboni, Franco Isola, Anna Mateddu, Maria Antonietta Maioli, Marco Mura, Giovanni Marrosu, Elisabeta Solla, Stefano Marini, Valentina Oppo, Maria Giovanna Marrosu, Rosa C. Manzi, Carboni, N, Mura, M, Mercuri, E, Marrosu, G, Manzi, Rc, Cocco, E, Nissardi, V, Isola, F, Mateddu, A, Solla, E, Maioli, Ma, Oppo, V, Piras, R, Marini, S, Lai, C, Politano, Luisa, and Marrosu, Mg

Subjects
Adult, Male, medicine.medical_specialty, Weakness, Adolescent, Physical examination, Young Adult, Settore MED/39 - NEUROPSICHIATRIA INFANTILE, Internal medicine, medicine, Humans, Muscular Dystrophy, Longitudinal Studies, Young adult, Muscular dystrophy, Emery–Dreifuss muscular dystrophy, Muscle, Skeletal, Genetics (clinical), Emery-Dreifu, Intrafamilial variability, medicine.diagnostic_test, business.industry, Emery-Dreifuss, Heart, Skeletal, Anatomy, medicine.disease, Muscle imaging, Muscular Dystrophy, Emery-Dreifuss, Pedigree, medicine.anatomical_structure, Neurology, Ventricle, Sustained ventricular tachycardia, Pediatrics, Perinatology and Child Health, Mutation, Cardiology, Muscle, Female, Neurology (clinical), medicine.symptom, business, Cardiac imaging, Follow-Up Studies
Abstract

The following is a report on a large family with 5 males affected by the X-linked recessive form of Emery–Dreifuss muscular dystrophy with mutation in the STA gene. A detailed longitudinal cardiological evaluation and muscle imaging studies allowed for the assessment of intrafamilial variability of cardiac and muscle involvement. Long term cardiological follow up in the 5 affected males and in 7 female carriers revealed different degrees of severity, ranging from tachycardia–bradycardia syndrome and variable biatrial and left ventricle dilatation, to an episode of isolated symptomatic sustained ventricular tachycardia requiring a device implantation. Muscle imaging in the affected males showed involvement of the soleus and medial head of gastrocnemius on leg muscles and variable involvement on thigh muscles that have not been previously reported. In some cases, imaging showed clear signs of muscle involvement even when no overt signs of weakness could be detected during clinical examination.

Published
2011

41. Multiple sclerosis severity score: Using disability and disease duration to rate disease severity

Author

Maria José Sá, Justin P. Rubio, Bianca Miterski, S. R. Seaman, Jörg T. Epplen, Iuliana Achiti, Monica Marta, M. Coustans, Sandra Vukusic, G V McDonnell, Annette Bang Oturai, Richard Roxburgh, Maria Edite Rio, Pablo Villoslada, Bénédicte Dubois, Fabiana Tesser, Maurizio Leone, Christian Confavreux, T Masterman, Marcin P. Mycko, Gilles Edan, N. Téllez Lara, Ana Martins da Silva, Alexandra Weber, Stephen Sawcer, E. Le Page, Giuseppe Salemi, Giovanni Savettieri, P. Soelberg Sørensen, Anke Hensiek, Xavier Montalban, D. A. S. Compston, Maria Giovanna Marrosu, Helmut Butzkueven, Krzysztof Selmaj, Frauke Zipp, Maria Liguori, Isabel Leite, Stanley Hawkins, Elisabeth Gulowsen Celius, Jan Hillert, Maria Trojano, Trevor J. Kilpatrick, Eleonora Cocco, Chemical Biology 2, ROXBURGH RHSR, SEAMAN SR, MASTERMAN T, HENSIEK AE, SAWCER SJ, VUKUSIC S, ACHITI I, CONFAVREUX C, COUSTANS M, LE PAGE E, EDAN G, MCDONNELL GV, HAWKINS S, TROJANO M, LIGUORI M, COCCO E, MARROSU MG, TESSERE F, LEONE MA, WEBER A, ZIPP F, MITERSKI B, EPPLEN JT, OTURAI A, SOELBERG-SORENSEN P, CELIUS EG, TELLEZ LARA N, MONTALBAN X, VILLOSLADA P, SILVA AM, MARTA M, LEITE I, DUBOIS B, RUBIO J, BUTZKUEVEN H, KILPATRICK T, MYCKO MP, SELMAJ KW, RIO ME, SA M, SALEMI G, SAVETTIERI G, HILLERT J, and COMPSTON DAS

Subjects
Adult, Male, medicine.medical_specialty, Multiple Sclerosis, Databases, Factual, Cross-sectional study, Models, Neurological, Disease, SUSCEPTIBILITY, Severity of Illness Index, Cohort Studies, Disability Evaluation, Predictive Value of Tests, Recurrence, Severity of illness, medicine, Humans, Longitudinal Studies, Age of Onset, Models, Statistical, Expanded Disability Status Scale, business.industry, Multiple sclerosis, OUTCOME MEASURE, Reproducibility of Results, NATURAL-HISTORY, Middle Aged, Prognosis, medicine.disease, Cross-Sectional Studies, Predictive value of tests, Disease Progression, Physical therapy, Female, France, Neurology (clinical), Age of onset, business, Cohort study
Abstract

Background: There is no consensus method for determining progression of disability in patients with multiple sclerosis (MS) when each patient has had only a single assessment in the course of the disease. Methods: Using data from two large longitudinal databases, the authors tested whether cross-sectional disability assessments are representative of disease severity as a whole. An algorithm, the Multiple Sclerosis Severity Score (MSSS), which relates scores on the Expanded Disability Status Scale (EDSS) to the distribution of disability in patients with comparable disease durations, was devised and then applied to a collection of 9,892 patients from 11 countries to create the Global MSSS. In order to compare different methods of detecting such effects the authors simulated the effects of a genetic factor on disability. Results: Cross-sectional EDSS measurements made after the first year were representative of overall disease severity. The MSSS was more powerful than the other methods the authors tested for detecting different rates of disease progression. Conclusion: The Multiple Sclerosis Severity Score (MSSS) is a powerful method for comparing disease progression using single assessment data. The Global MSSS can be used as a reference table for future disability comparisons. While useful for comparing groups of patients, disease fluctuation precludes its use as a predictor of future disability in an individual.

Published
2005

42. Treatment of Parkinson's disease with proglumide, a CCK antagonist

Author

Ildebrando Appollonio, Lodovico Frattola, Alberto E. Panerai, Ennio Cocco, Carlo Ferrarese, Lucio C. Rovati, R. Piolti, Piolti, R, Appollonio, I, Cocco, E, Ferrarese, C, Frattola, L, Rovati, L, and Panerai, A

Subjects
Male, Levodopa, medicine.medical_specialty, Proglumide, Parkinson's disease, digestive system, Degenerative disease, Double-Blind Method, Cholecystokinin antagonist, Internal medicine, medicine, Humans, Aged, Cholecystokinin, business.industry, digestive, oral, and skin physiology, Antagonist, Parkinson Disease, Middle Aged, medicine.disease, nervous system diseases, Endocrinology, Gastrointestinal hormone, Drug Therapy, Combination, Female, Neurology (clinical), business, hormones, hormone substitutes, and hormone antagonists, Human, medicine.drug
Abstract

Proglumide, a cholecystokinin antagonist, did not improve Parkinson's disease in a preliminary drug treatment trial.

Published
1991

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