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2. Signs and symptoms of COVID-19 in patients with multiple sclerosis

Author

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

Subjects
Multiple Sclerosis, Anosmia, Clinical Sciences, neurological disorders, Neurodegenerative, Settore MED/26, demyelinating disease, COVID-19, demyelinating diseases, disease-modifying treatment, multiple sclerosis, Humans, neurological disorder, Aged, Neurology & Neurosurgery, SARS-CoV-2, Pain Research, Neurosciences, Brain Disorders, Settore MED/26 - NEUROLOGIA, Good Health and Well Being, Neurology, multiple sclerosi, Neurology (clinical), MuSC-19 Study Group, Ageusia, Human
Abstract

Background and purpose: Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID-19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID-19 in MS patients and identify all factors associated with their manifestation. Method: Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number. Results: From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID-19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p=0.005) and more in smoker patients (OR 1.39; p=0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p=0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p=0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p=0.008). Some disease-modifying therapies were associated with greater frequencies of certain COVID-19 symptoms (association between anti-CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p=0.05). Differences in frequencies between the three waves were found for flu-like symptoms (G1, p=0.024), joint or muscle pain (G2, p=0.013) and ageusia and anosmia (G5, p < 0.001). All cases should be referred to variants up to Delta. Conclusion: Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID-19 symptoms.

Published
2022

3. Dimethyl fumarate in the management of multiple sclerosis: appropriate patient selection and special considerations

Author

Prosperini L and Pontecorvo S

Subjects
multiple sclerosis, dymethil fumarate, oral drugs, therapeutic algorithm, Therapeutics. Pharmacology, RM1-950
Abstract

Luca Prosperini, Simona Pontecorvo Department of Neurology and Psychiatry, Sapienza University, Rome, Italy Abstract: Delayed-release dimethyl fumarate (DMF), also known as gastroresistant DMF, is the most recently approved oral disease-modifying treatment (DMT) for relapsing multiple sclerosis. Two randomized clinical trials (Determination of the Efficacy and Safety of Oral Fumarate in Relapsing–Remitting MS [DEFINE] and Comparator and an Oral Fumarate in Relapsing-Remitting Multiple Sclerosis [CONFIRM]) demonstrated significant efficacy in reducing relapse rate and radiological signs of disease activity, as seen on magnetic resonance imaging. The DEFINE study also indicated a significant effect of DMF on disability worsening, while the low incidence of confirmed disability worsening in the CONFIRM trial rendered an insignificant reduction among the DMF-treated groups when compared to placebo. DMF also demonstrated a good safety profile and acceptable tolerability, since the most common side effects (gastrointestinal events and flushing reactions) are usually transient and mild to moderate in severity. Here, we discuss the place in therapy of DMF for individuals with relapsing multiple sclerosis, providing a tentative therapeutic algorithm to manage newly diagnosed patients and those who do not adequately respond to self-injectable DMTs. Literature data supporting the potential role of DMF as a first-line therapy are presented. The possibility of using DMF as switching treatment or even as an add-on strategy in patients with breakthrough disease despite self-injectable DMTs will also be discussed. Lastly, we argue about the role of DMF as an exit strategy from natalizumab-treated patients who are considered at risk for developing multifocal progressive leukoencephalopathy. Keywords: multiple sclerosis, dimethyl fumarate, oral drugs, therapeutic algorithm

Published
2016

4. The risk of infection in patients with multiple sclerosis treated with disease-modifying therapies: A Delphi consensus statement

Author

Moiola, L, Barcella, V, Benatti, S, Capobianco, M, Capra, R, Cinque, P, Comi, G, Fasolo, M, Franzetti, F, Galli, M, Gerevini, S, Meroni, L, Origoni, M, Prosperini, L, Puoti, M, Scarpazza, C, Tortorella, C, Zaffaroni, M, Riva, A, Moiola L., Barcella V., Benatti S., Capobianco M., Capra R., Cinque P., Comi G., Fasolo M. M., Franzetti F., Galli M., Gerevini S., Meroni L., Origoni M., Prosperini L., Puoti M., Scarpazza C., Tortorella C., Zaffaroni M., Riva A., Moiola, L, Barcella, V, Benatti, S, Capobianco, M, Capra, R, Cinque, P, Comi, G, Fasolo, M, Franzetti, F, Galli, M, Gerevini, S, Meroni, L, Origoni, M, Prosperini, L, Puoti, M, Scarpazza, C, Tortorella, C, Zaffaroni, M, Riva, A, Moiola L., Barcella V., Benatti S., Capobianco M., Capra R., Cinque P., Comi G., Fasolo M. M., Franzetti F., Galli M., Gerevini S., Meroni L., Origoni M., Prosperini L., Puoti M., Scarpazza C., Tortorella C., Zaffaroni M., and Riva A.

Abstract

The risk of infection associated with immunomodulatory or immunosuppressive disease-modifying drugs (DMDs) in patients with multiple sclerosis (MS) has been increasingly addressed in recent scientific literature. A modified Delphi consensus process was conducted to develop clinically relevant, evidence-based recommendations to assist physicians with decision-making in relation to the risks of a wide range of infections associated with different DMDs in patients with MS. The current consensus statements, developed by a panel of experts (neurologists, infectious disease specialists, a gynaecologist and a neuroradiologist), address the risk of iatrogenic infections (opportunistic infections, including herpes and cryptococcal infections, candidiasis and listeria; progressive multifocal leukoencephalopathy; human papillomavirus and urinary tract infections; respiratory tract infections and tuberculosis; hepatitis and gastrointestinal infections) in patients with MS treated with different DMDs, as well as prevention strategies and surveillance strategies for the early identification of infections. In the discussion, more recent data emerged in the literature were taken into consideration. Recommended risk reduction and management strategies for infections include screening at diagnosis and before starting a new DMD, prophylaxis where appropriate, monitoring and early diagnosis.

Published
2021

5. Vaccinations in patients with multiple sclerosis: A Delphi consensus statement

Author

Riva, A, Barcella, V, Benatti, S, Capobianco, M, Capra, R, Cinque, P, Comi, G, Fasolo, M, Franzetti, F, Galli, M, Gerevini, S, Meroni, L, Origoni, M, Prosperini, L, Puoti, M, Scarpazza, C, Tortorella, C, Zaffaroni, M, Moiola, L, Riva A., Barcella V., Benatti S. V., Capobianco M., Capra R., Cinque P., Comi G., Fasolo M. M., Franzetti F., Galli M., Gerevini S., Meroni L., Origoni M., Prosperini L., Puoti M., Scarpazza C., Tortorella C., Zaffaroni M., Moiola L., Riva, A, Barcella, V, Benatti, S, Capobianco, M, Capra, R, Cinque, P, Comi, G, Fasolo, M, Franzetti, F, Galli, M, Gerevini, S, Meroni, L, Origoni, M, Prosperini, L, Puoti, M, Scarpazza, C, Tortorella, C, Zaffaroni, M, Moiola, L, Riva A., Barcella V., Benatti S. V., Capobianco M., Capra R., Cinque P., Comi G., Fasolo M. M., Franzetti F., Galli M., Gerevini S., Meroni L., Origoni M., Prosperini L., Puoti M., Scarpazza C., Tortorella C., Zaffaroni M., and Moiola L.

Abstract

Background: Patients with multiple sclerosis (MS) are at increased risk of infection. Vaccination can mitigate these risks but only if safe and effective in MS patients, including those taking disease-modifying drugs. Methods: A modified Delphi consensus process (October 2017–June 2018) was used to develop clinically relevant recommendations for making decisions about vaccinations in patients with MS. A series of statements and recommendations regarding the efficacy, safety and timing of vaccine administration in patients with MS were generated in April 2018 by a panel of experts based on a review of the published literature performed in October 2017. Results: Recommendations include the need for an ‘infectious diseases card’ of each patient’s infectious and immunisation history at diagnosis in order to exclude and eventually treat latent infections. We suggest the implementation of the locally recommended vaccinations, if possible at MS diagnosis, otherwise with vaccination timing tailored to the planned/current MS treatment, and yearly administration of the seasonal influenza vaccine regardless of the treatment received. Conclusion: Patients with MS should be vaccinated with careful consideration of risks and benefits. However, there is an urgent need for more research into vaccinations in patients with MS to guide evidence-based decision making.

Published
2021

6. Telemedicine for management of patients with amyotrophic lateral sclerosis through COVID-19 tail

Author

Bombaci, A, Abbadessa, G, Trojsi, F, Leocani, L, Bonavita, S, Lavorgna, L, Tedeschi, G, Mancardi, G, Padovani, A, Clerico, M, Brigo, F, Lanzillo, R, Russo, A, Giometto, B, Straccia, G, Iodice, R, Bucello, S, Annovazzi, P, Moccia, M, Prosperini, L, Stromillo, M, Repice, A, Miele, G, Lerario, A, De Martino, A, Iodice, F, Di Lorenzo, F, Cuffaro, L, Romoli, M, Silvestro, M, Artusi, C, Bombaci A., Abbadessa G., Trojsi F., Leocani L., Bonavita S., Lavorgna L., Tedeschi G., Mancardi G., Padovani A., Clerico M., Brigo F., Lanzillo R., Russo A., Giometto B., Straccia G., Iodice R., Bucello S., Annovazzi P., Moccia M., Prosperini L., Stromillo M. L., Repice A. M., Miele G., Lerario A., De Martino A., Iodice F., Di Lorenzo F., Cuffaro L., Romoli M., Silvestro M., Artusi C. A., Bombaci, A, Abbadessa, G, Trojsi, F, Leocani, L, Bonavita, S, Lavorgna, L, Tedeschi, G, Mancardi, G, Padovani, A, Clerico, M, Brigo, F, Lanzillo, R, Russo, A, Giometto, B, Straccia, G, Iodice, R, Bucello, S, Annovazzi, P, Moccia, M, Prosperini, L, Stromillo, M, Repice, A, Miele, G, Lerario, A, De Martino, A, Iodice, F, Di Lorenzo, F, Cuffaro, L, Romoli, M, Silvestro, M, Artusi, C, Bombaci A., Abbadessa G., Trojsi F., Leocani L., Bonavita S., Lavorgna L., Tedeschi G., Mancardi G., Padovani A., Clerico M., Brigo F., Lanzillo R., Russo A., Giometto B., Straccia G., Iodice R., Bucello S., Annovazzi P., Moccia M., Prosperini L., Stromillo M. L., Repice A. M., Miele G., Lerario A., De Martino A., Iodice F., Di Lorenzo F., Cuffaro L., Romoli M., Silvestro M., and Artusi C. A.

Abstract

Over the last months, due to coronavirus disease (COVID-19) pandemic, containment measures have led to important social restriction. Healthcare systems have faced a complete rearrangement of resources and spaces, with the creation of wards devoted to COVID-19 patients. In this context, patients affected by chronic neurological diseases, such as amyotrophic lateral sclerosis (ALS), are at risk to be lost at follow-up, leading to a higher risk of morbidity and mortality. Telemedicine may allow meet the needs of these patients. In this commentary, we briefly discuss the digital tools to remotely monitor and manage ALS patients. Focusing on detecting disease progression and preventing life-threatening conditions, we propose a toolset able to improve ALS management during this unprecedented situation.

Published
2021

8. Signs and symptoms of COVID-19 in patients with multiple sclerosis

Author

Schiavetti, I., Carmisciano, L., Ponzano, M., Cordioli, C., Cocco, E., Marfia, G. A., Inglese, M., Filippi, M., Radaelli, M., Bergamaschi, R., Immovilli, P., Capobianco, M., De Rossi, N., Brichetto, G., Scandellari, C., Cavalla, P., Pesci, I., Confalonieri, P., Perini, P., Trojano, M., Lanzillo, R., Tedeschi, G., Comi, G., Battaglia, M. A., Patti, F., Salvetti, M., Sormani, M. P., Abbadessa, G., Aguglia, U., Allegorico, L., Rossi Allegri, B. M., Alteno, A., Amato, M. P., Annovazzi, P., Antozzi, C., Appendino, L., Arena, S., Baione, V., Balgera, R., Barcella, V., Baroncini, D., Barrila, C., Bellacosa, A., Bellucci, G., Bergamaschi, V., Bezzini, D., Biolzi, B., Bisecco, A., Bonavita, S., Borriello, G., Bosa, C., Bosco, A., Bovis, F., Bozzali, M., Brambilla, L., Brescia Morra, V., Buccafusca, M., Bucciantini, E., Bucello, S., Buscarinu, M. C., Cabboi, M. P., Calabrese, M., Calabria, F., Caleri, F., Camilli, F., Caniatti, L. M., Cantello, R., Capra, R., Capuano, R., Carta, P., Celani, M. G., Cellerino, M., Cerqua, R., Chisari, C., Clerici, R., Clerico, M., Cola, G., Conte, A., Conti, M. Z., Cordano, C., Cordera, S., Corea, F., Correale, C., Cottone, S., Crescenzo, F., Curti, E., D'Ambrosio, A., D'Amico, E., Danni, M. C., D'Arma, A., Dattola, V., de Biase, S., De Luca, G., De Mercanti, S. F., De Mitri, P., De Stefano, N., Della Cava, F. M., Cava, M. D., Di Lemme, S., di Napoli, M., Di Sapio, A., Docimo, R., Dutto, A., Evangelista, L., Fanara, S., Fantozzi, R., Ferraro, D., Ferro, M. T., Fioretti, C., Fratta, M., Frau, J., Fronza, M., Furlan, R., Gajofatto, A., Gallo, A., Gallo, P., Gasperini, C., Ghazaryan, A., Giometto, B., Gobbin, F., Govone, F., Granella, F., Grange, E., Grasso, M. G., Grimaldi, L. M. E., Guareschi, A., Guaschino, C., Guerrieri, S., Guidetti, D., Juergenson, I. B., Iaffaldano, P., Ianniello, A., Iasevoli, L., Imperiale, D., Infante, M. T., Iodice, R., Iovino, A., Konrad, G., Landi, D., Lapucci, C., Lavorgna, L., L'Episcopo, M. R., Leva, S., Liberatore, G., Lo Re, M., Longoni, M., Lopiano, L., Lorefice, L., Lucchini, Matteo, Lus, G., Maimone, D., Malentacchi, M., Mallucci, G., Malucchi, S., Mancinelli, C. R., Mancinelli, L., Manganotti, P., Maniscalco, G. T., Mantero, V., Marangoni, S., Marastoni, D., Marinelli, F., Marti, A., Boneschi Martinelli, F., Masserano, Z. F., Matta, F., Mendozzi, L., Meucci, G., Miante, S., Miele, G., Milano, E., Mirabella, Massimiliano, Missione, R., Moccia, M., Moiola, L., Montepietra, S., Montibragadin, M., Montini, F., Motta, R., Nardone, R., Gabri Nicoletti, C., Nobile-Orazio, E., Nozzolillo, A., Onofrj, M., Orlandi, R., Palmieri, A., Paolicelli, D., Pasquali, L., Pasto, L., Pedrazzoli, E., Petracca, M., Petrone, A., Piantadosi, C., Pietroboni, A. M., Pinardi, F., Portaccio, E., Pozzato, M., Pozzilli, C., Prosperini, L., Protti, A., Ragonese, P., Rasia, S., Realmuto, S., Repice, A., Rigoni, E., Rilla, M. T., Rinaldi, F., Romano, C. M., Ronzoni, M., Rovaris, M., Ruscica, F., Sabattini, L., Salemi, G., Saraceno, L., Sartori, A., Sbragia, E., Scarano, G. I., Scarano, V., Sessa, M., Sgarito, C., Sibilia, G., Siciliano, G., Signori, A., Signoriello, E., Sinisi, L., Sireci, F., Sola, P., Solaro, C., Sotgiu, S., Sparaco, M., Stromillo, M. L., Strumia, S., Susani, E. L., Tabiadon, G., Teatini, F., Tomassini, V., Tonietti, S., Torri, V., Tortorella, C., Toscano, S., Totaro, R., Trotta, M., Turano, G., Ulivelli, M., Valentino, M., Vaula, G., Vecchio, D., Vercellino, M., Verrengia, E. P., Vianello, M., Virgilio, E., Vitetta, F., Vollaro, S., Zaffaroni, M., Zampolini, M., Zarbo, I. R., Zito, A., Zuliani, L., Lucchini M. (ORCID:0000-0002-0447-2297), Mirabella M. (ORCID:0000-0002-7783-114X), Schiavetti, I., Carmisciano, L., Ponzano, M., Cordioli, C., Cocco, E., Marfia, G. A., Inglese, M., Filippi, M., Radaelli, M., Bergamaschi, R., Immovilli, P., Capobianco, M., De Rossi, N., Brichetto, G., Scandellari, C., Cavalla, P., Pesci, I., Confalonieri, P., Perini, P., Trojano, M., Lanzillo, R., Tedeschi, G., Comi, G., Battaglia, M. A., Patti, F., Salvetti, M., Sormani, M. P., Abbadessa, G., Aguglia, U., Allegorico, L., Rossi Allegri, B. M., Alteno, A., Amato, M. P., Annovazzi, P., Antozzi, C., Appendino, L., Arena, S., Baione, V., Balgera, R., Barcella, V., Baroncini, D., Barrila, C., Bellacosa, A., Bellucci, G., Bergamaschi, V., Bezzini, D., Biolzi, B., Bisecco, A., Bonavita, S., Borriello, G., Bosa, C., Bosco, A., Bovis, F., Bozzali, M., Brambilla, L., Brescia Morra, V., Buccafusca, M., Bucciantini, E., Bucello, S., Buscarinu, M. C., Cabboi, M. P., Calabrese, M., Calabria, F., Caleri, F., Camilli, F., Caniatti, L. M., Cantello, R., Capra, R., Capuano, R., Carta, P., Celani, M. G., Cellerino, M., Cerqua, R., Chisari, C., Clerici, R., Clerico, M., Cola, G., Conte, A., Conti, M. Z., Cordano, C., Cordera, S., Corea, F., Correale, C., Cottone, S., Crescenzo, F., Curti, E., D'Ambrosio, A., D'Amico, E., Danni, M. C., D'Arma, A., Dattola, V., de Biase, S., De Luca, G., De Mercanti, S. F., De Mitri, P., De Stefano, N., Della Cava, F. M., Cava, M. D., Di Lemme, S., di Napoli, M., Di Sapio, A., Docimo, R., Dutto, A., Evangelista, L., Fanara, S., Fantozzi, R., Ferraro, D., Ferro, M. T., Fioretti, C., Fratta, M., Frau, J., Fronza, M., Furlan, R., Gajofatto, A., Gallo, A., Gallo, P., Gasperini, C., Ghazaryan, A., Giometto, B., Gobbin, F., Govone, F., Granella, F., Grange, E., Grasso, M. G., Grimaldi, L. M. E., Guareschi, A., Guaschino, C., Guerrieri, S., Guidetti, D., Juergenson, I. B., Iaffaldano, P., Ianniello, A., Iasevoli, L., Imperiale, D., Infante, M. T., Iodice, R., Iovino, A., Konrad, G., Landi, D., Lapucci, C., Lavorgna, L., L'Episcopo, M. R., Leva, S., Liberatore, G., Lo Re, M., Longoni, M., Lopiano, L., Lorefice, L., Lucchini, Matteo, Lus, G., Maimone, D., Malentacchi, M., Mallucci, G., Malucchi, S., Mancinelli, C. R., Mancinelli, L., Manganotti, P., Maniscalco, G. T., Mantero, V., Marangoni, S., Marastoni, D., Marinelli, F., Marti, A., Boneschi Martinelli, F., Masserano, Z. F., Matta, F., Mendozzi, L., Meucci, G., Miante, S., Miele, G., Milano, E., Mirabella, Massimiliano, Missione, R., Moccia, M., Moiola, L., Montepietra, S., Montibragadin, M., Montini, F., Motta, R., Nardone, R., Gabri Nicoletti, C., Nobile-Orazio, E., Nozzolillo, A., Onofrj, M., Orlandi, R., Palmieri, A., Paolicelli, D., Pasquali, L., Pasto, L., Pedrazzoli, E., Petracca, M., Petrone, A., Piantadosi, C., Pietroboni, A. M., Pinardi, F., Portaccio, E., Pozzato, M., Pozzilli, C., Prosperini, L., Protti, A., Ragonese, P., Rasia, S., Realmuto, S., Repice, A., Rigoni, E., Rilla, M. T., Rinaldi, F., Romano, C. M., Ronzoni, M., Rovaris, M., Ruscica, F., Sabattini, L., Salemi, G., Saraceno, L., Sartori, A., Sbragia, E., Scarano, G. I., Scarano, V., Sessa, M., Sgarito, C., Sibilia, G., Siciliano, G., Signori, A., Signoriello, E., Sinisi, L., Sireci, F., Sola, P., Solaro, C., Sotgiu, S., Sparaco, M., Stromillo, M. L., Strumia, S., Susani, E. L., Tabiadon, G., Teatini, F., Tomassini, V., Tonietti, S., Torri, V., Tortorella, C., Toscano, S., Totaro, R., Trotta, M., Turano, G., Ulivelli, M., Valentino, M., Vaula, G., Vecchio, D., Vercellino, M., Verrengia, E. P., Vianello, M., Virgilio, E., Vitetta, F., Vollaro, S., Zaffaroni, M., Zampolini, M., Zarbo, I. R., Zito, A., Zuliani, L., Lucchini M. (ORCID:0000-0002-0447-2297), and Mirabella M. (ORCID:0000-0002-7783-114X)

Abstract

Background and purpose Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID-19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID-19 in MS patients and identify all factors associated with their manifestation. Method Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number. Results From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID-19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p = 0.005) and more in smoker patients (OR 1.39; p = 0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p = 0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p = 0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p = 0.008). Some disease-modifying therapies were associated with greater frequencies of certain COVID-19 symptoms (association between anti-CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p = 0.05). Differences in frequencies between the three waves were found for flu-like symptoms (G1, p = 0.024), joint or muscle pain (G2, p = 0.013) and ageusia and anosmia (G5, p < 0.001). All cases should be referred to variants up to Delta. Conclusion Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID-19 symptoms.

Published
2022

9. SARS-CoV-2 serology after COVID-19 in multiple sclerosis: An international cohort study

Author

Sormani, M. P., Schiavetti, I., Landi, D., Carmisciano, L., De Rossi, N., Cordioli, C., Moiola, L., Radaelli, M., Immovilli, P., Capobianco, M., Brescia Morra, V., Trojano, M., Tedeschi, G., Comi, G., Battaglia, M. A., Patti, F., Fragoso, Y. D., Sen, S., Siva, A., Furlan, R., Salvetti, M., Abbadessa, G., Aguglia, U., Allegorico, L., Allegri, R. B. M., Amato, M. P., Annovazzi, P., Antozzi, C., Appendino, L., Arena, S., Baione, V., Balgera, R., Barcella, V., Baroncini, D., Barrila, C., Bellacosa, A., Bellucci, G., Bergamaschi, R., Bergamaschi, V., Bezzini, D., Biolzi, B., Bisecco, A., Bonavita, S., Borriello, G., Bosa, C., Bosco, A., Bovis, F., Bozzali, M., Brambilla, L., Brescia, M. V., Brichetto, G., Buccafusca, M., Bucciantini, E., Bucello, S., Buscarinu, M. C., Cabboi, M. P., Calabrese, M., Calabria, F., Caleri, F., Camilli, F., Caniatti, L. M., Cantello, R., Capra, R., Capuano, R., Carta, P., Cavalla, P., Celani, M. G., Cellerino, M., Cerqua, R., Chisari, C., Clerici, R., Clerico, M., Cocco, E., Cola, G., Confalonieri, P., Conte, A., Conti, M. Z., Cordano, C., Cordera, S., Corea, F., Correale, C., Cottone, S., Crescenzo, F., Curti, E., D'Ambrosio, A., D'Amico, E., Danni, M. C., D'Arma, A., Dattola, V., de Biase, S., De Luca, G., De Mercanti, S. F., De Mitri, P., De Stefano, N., Della Cava, M., di Napoli, M., Di Sapio, A., Docimo, R., Dutto, A., Evangelista, L., Fanara, S., Ferraro, D., Ferro, M. T., Filippi, M., Fioretti, C., Fratta, M., Frau, J., Fronza, M., Gajofatto, A., Gallo, A., Gallo, P., Gasperini, C., Ghazaryan, A., Giometto, B., Gobbin, F., Govone, F., Granella, F., Grange, E., Grasso, M. G., Guareschi, A., Guaschino, C., Guerrieri, S., Guidetti, D., Iaffaldano, P., Ianniello, A., Iasevoli, L., Imperiale, D., Infante, M. T., Inglese, M., Iodice, R., Iovino, A., Konrad, G., Lanzillo, R., Lapucci, C., Lavorgna, L., L'Episcopo Maria, R., Leva, S., Liberatore, G., Lo Re, M., Longoni, M., Lopiano, L., Lorefice, L., Lucchini, Matteo, Lus, G., Maimone, D., Malentacchi, M., Mallucci, G., Malucchi, S., Mancinelli, C. R., Mancinelli, L., Manganotti, P., Maniscalco, T. G., Mantero, V., Marangoni, S., Marastoni, D., Marfia, A. G., Marinelli, F., Marti, A., Martinelli Boneschi, F., Masserano Zoli, F., Matta, F., Mendozzi, L., Meucci, G., Miante, S., Miele, G., Milano, E., Mirabella, Massimiliano, Missione, R., Moccia, M., Montepietra, S., Monti Bragadin, M., Montini, F., Motta, R., Nardone, R., Nicoletti, C. G., Nobile-Orazio, E., Nozzolillo, A., Onofrj, M., Orlandi, R., Palmieri, A., Paolicelli, D., Pasquali, L., Pasto, L., Pedrazzoli, E., Perini, P., Pesci, I., Petracca, M., Petrone, A., Piantadosi, C., Pietroboni, A. M., Pinardi, F., Ponzano, M., Portaccio, E., Pozzato, M., Pozzilli, C., Prosperini, L., Protti, A., Ragonese, P., Rasia, S., Realmuto, S., Repice, A., Rigoni, E., Rilla, M. T., Rinaldi, F., Romano, C. M., Ronzoni, M., Rovaris, M., Ruscica, F., Sabattini, L., Salemi, G., Saraceno, L., Sartori, A., Sbragia, E., Scandellari, C., Scarano Giuditta, I., Scarano, V., Schillaci, V., Sessa, M., Sgarito, C., Sibilia, G., Siciliano, G., Signori, A., Signoriello, E., Sinisi, L., Sireci, F., Sola, P., Solaro, C., Sotgiu, S., Sparaco, M., Stromillo, M. L., Strumia, S., Susani, L. E., Tabiadon, G., Teatini, F., Tomassini, V., Tonietti, S., Torri, C. V., Tortorella, C., Toscano, S., Totaro, R., Trotta, M., Turano, G., Ulivelli, M., Valentino, M., Vaula, G., Vecchio, D., Vercellino, M., Verrengia, E. P., Vianello, M., Virgilio, E., Vitetta, F., Vollaro, S., Zaffaroni, M., Zampolini, M., Zarbo, I. R., Zito, A., Zuliani, L., Lucchini M. (ORCID:0000-0002-0447-2297), Mirabella M. (ORCID:0000-0002-7783-114X), Sormani, M. P., Schiavetti, I., Landi, D., Carmisciano, L., De Rossi, N., Cordioli, C., Moiola, L., Radaelli, M., Immovilli, P., Capobianco, M., Brescia Morra, V., Trojano, M., Tedeschi, G., Comi, G., Battaglia, M. A., Patti, F., Fragoso, Y. D., Sen, S., Siva, A., Furlan, R., Salvetti, M., Abbadessa, G., Aguglia, U., Allegorico, L., Allegri, R. B. M., Amato, M. P., Annovazzi, P., Antozzi, C., Appendino, L., Arena, S., Baione, V., Balgera, R., Barcella, V., Baroncini, D., Barrila, C., Bellacosa, A., Bellucci, G., Bergamaschi, R., Bergamaschi, V., Bezzini, D., Biolzi, B., Bisecco, A., Bonavita, S., Borriello, G., Bosa, C., Bosco, A., Bovis, F., Bozzali, M., Brambilla, L., Brescia, M. V., Brichetto, G., Buccafusca, M., Bucciantini, E., Bucello, S., Buscarinu, M. C., Cabboi, M. P., Calabrese, M., Calabria, F., Caleri, F., Camilli, F., Caniatti, L. M., Cantello, R., Capra, R., Capuano, R., Carta, P., Cavalla, P., Celani, M. G., Cellerino, M., Cerqua, R., Chisari, C., Clerici, R., Clerico, M., Cocco, E., Cola, G., Confalonieri, P., Conte, A., Conti, M. Z., Cordano, C., Cordera, S., Corea, F., Correale, C., Cottone, S., Crescenzo, F., Curti, E., D'Ambrosio, A., D'Amico, E., Danni, M. C., D'Arma, A., Dattola, V., de Biase, S., De Luca, G., De Mercanti, S. F., De Mitri, P., De Stefano, N., Della Cava, M., di Napoli, M., Di Sapio, A., Docimo, R., Dutto, A., Evangelista, L., Fanara, S., Ferraro, D., Ferro, M. T., Filippi, M., Fioretti, C., Fratta, M., Frau, J., Fronza, M., Gajofatto, A., Gallo, A., Gallo, P., Gasperini, C., Ghazaryan, A., Giometto, B., Gobbin, F., Govone, F., Granella, F., Grange, E., Grasso, M. G., Guareschi, A., Guaschino, C., Guerrieri, S., Guidetti, D., Iaffaldano, P., Ianniello, A., Iasevoli, L., Imperiale, D., Infante, M. T., Inglese, M., Iodice, R., Iovino, A., Konrad, G., Lanzillo, R., Lapucci, C., Lavorgna, L., L'Episcopo Maria, R., Leva, S., Liberatore, G., Lo Re, M., Longoni, M., Lopiano, L., Lorefice, L., Lucchini, Matteo, Lus, G., Maimone, D., Malentacchi, M., Mallucci, G., Malucchi, S., Mancinelli, C. R., Mancinelli, L., Manganotti, P., Maniscalco, T. G., Mantero, V., Marangoni, S., Marastoni, D., Marfia, A. G., Marinelli, F., Marti, A., Martinelli Boneschi, F., Masserano Zoli, F., Matta, F., Mendozzi, L., Meucci, G., Miante, S., Miele, G., Milano, E., Mirabella, Massimiliano, Missione, R., Moccia, M., Montepietra, S., Monti Bragadin, M., Montini, F., Motta, R., Nardone, R., Nicoletti, C. G., Nobile-Orazio, E., Nozzolillo, A., Onofrj, M., Orlandi, R., Palmieri, A., Paolicelli, D., Pasquali, L., Pasto, L., Pedrazzoli, E., Perini, P., Pesci, I., Petracca, M., Petrone, A., Piantadosi, C., Pietroboni, A. M., Pinardi, F., Ponzano, M., Portaccio, E., Pozzato, M., Pozzilli, C., Prosperini, L., Protti, A., Ragonese, P., Rasia, S., Realmuto, S., Repice, A., Rigoni, E., Rilla, M. T., Rinaldi, F., Romano, C. M., Ronzoni, M., Rovaris, M., Ruscica, F., Sabattini, L., Salemi, G., Saraceno, L., Sartori, A., Sbragia, E., Scandellari, C., Scarano Giuditta, I., Scarano, V., Schillaci, V., Sessa, M., Sgarito, C., Sibilia, G., Siciliano, G., Signori, A., Signoriello, E., Sinisi, L., Sireci, F., Sola, P., Solaro, C., Sotgiu, S., Sparaco, M., Stromillo, M. L., Strumia, S., Susani, L. E., Tabiadon, G., Teatini, F., Tomassini, V., Tonietti, S., Torri, C. V., Tortorella, C., Toscano, S., Totaro, R., Trotta, M., Turano, G., Ulivelli, M., Valentino, M., Vaula, G., Vecchio, D., Vercellino, M., Verrengia, E. P., Vianello, M., Virgilio, E., Vitetta, F., Vollaro, S., Zaffaroni, M., Zampolini, M., Zarbo, I. R., Zito, A., Zuliani, L., Lucchini M. (ORCID:0000-0002-0447-2297), and Mirabella M. (ORCID:0000-0002-7783-114X)

Abstract

Background: The MuSC-19 project is an Italian cohort study open to international partners that collects data on multiple sclerosis (MS) patients with COVID-19. During the second wave of the pandemic, serological tests became routinely available. Objective: To evaluate the seroprevalence of anti-SARS-CoV-2 antibodies according to the use of disease-modifying therapy (DMT) in a subset of patients included in the MuSC-19 data set who had undergone a serological test. Methods: We evaluated the association between positive serological test results and time elapsed since infection onset, age, sex, Expanded Disability Status Scale score, comorbidities and DMT exposure using a multivariable logistic model. Results: Data were collected from 423 patients (345 from Italy, 61 from Turkey and 17 from Brazil) with a serological test performed during follow-up. Overall, 325 out of 423 tested patients (76.8%) had a positive serological test. At multivariate analysis, therapy with anti-CD20 was significantly associated with a reduced probability of developing antibodies after COVID-19 (odds ratio (OR) = 0.20, p = 0.002). Conclusion: Patients with MS maintain the capacity to develop humoral immune response against SARS-COV-2, although to a lesser extent when treated with anti-CD20 drugs. Overall, our results are reassuring with respect to the possibility to achieve sufficient immunization with vaccination.

Published
2022

12. Real world experience with teriflunomide in multiple sclerosis: the TER-Italy study

Author

Bucello, S., Annovazzi, P., Ragonese, P., Altieri, M., Barcella, V., Bergamaschi, R., Bianchi, A., Borriello, G., Buscarinu, M. C., Callari, G., Capobianco, M., Capone, F., Cavalla, P., Cavarretta, R., Cortese, A., De Luca, G., Di Filippo, M., Dattola, V., Fantozzi, R., Ferraro, E., Filippi, M. M., Gasperini, C., Grimaldi, L. M. E., Landi, D., Re, M. L., Mallucci, G., Manganotti, P., Marfia, G. A., Mirabella, Massimiliano, Perini, P., Pisa, M., Realmuto, S., Russo, M., Tomassini, V., Torri-Clerici, V. L. A., Zaffaroni, M., Zuliani, C., Zywicki, S., Filippi, M., Prosperini, L., Mirabella M. (ORCID:0000-0002-7783-114X), Bucello, S., Annovazzi, P., Ragonese, P., Altieri, M., Barcella, V., Bergamaschi, R., Bianchi, A., Borriello, G., Buscarinu, M. C., Callari, G., Capobianco, M., Capone, F., Cavalla, P., Cavarretta, R., Cortese, A., De Luca, G., Di Filippo, M., Dattola, V., Fantozzi, R., Ferraro, E., Filippi, M. M., Gasperini, C., Grimaldi, L. M. E., Landi, D., Re, M. L., Mallucci, G., Manganotti, P., Marfia, G. A., Mirabella, Massimiliano, Perini, P., Pisa, M., Realmuto, S., Russo, M., Tomassini, V., Torri-Clerici, V. L. A., Zaffaroni, M., Zuliani, C., Zywicki, S., Filippi, M., Prosperini, L., and Mirabella M. (ORCID:0000-0002-7783-114X)

Abstract

Objective: To identify baseline factors associated with disease activity in patients with relapsing–remitting multiple sclerosis (RRMS) under teriflunomide treatment. Methods: This was an independent, multi-centre, retrospective post-marketing study. We analysed data of 1,507 patients who started teriflunomide since October 2014 and were regularly followed in 28 Centres in Italy. We reported the proportions of patients who discontinued treatment (after excluding 32 lost to follow-up) and who experienced clinical disease activity, i.e., relapse(s) and/or confirmed disability worsening, as assessed by the Expanded Disability Status Scale (EDSS). Decision tree-based analysis was performed to identify baseline factors associated with clinical disease activity during teriflunomide treatment. Results: At database lock (September 2020), approximately 29% of patients (430 out of 1,475) discontinued teriflunomide because of disease activity (~ 46%), adverse events (~ 37%), poor tolerability (~ 15%), pregnancy planning (~ 2%). Approximately 28% of patients experienced disease activity over a median follow-up of 2.75 years: ~ 9% had relapses but not disability worsening; ~ 13% had isolated disability worsening; ~ 6% had both relapses and disability worsening. The most important baseline factor associated with disease activity (especially disability worsening) was an EDSS > 4.0 (p < 0.001). In patients with moderate disability level (EDSS 2.0–4.0), disease activity occurred more frequently in case of ≥ 1 pre-treatment relapses (p = 0.025). In patients with milder disability level (EDSS < 2.0), disease activity occurred more frequently after previous exposure to ≥ 2 disease-modifying treatments (p = 0.007). Conclusions: Our study suggests a place-in-therapy for teriflunomide in naïve patients with mild disability level or in those who switched their initial treatment for poor tolerability. Adverse events related with teriflunomide were consistent with literat

Published
2021

15. Results from an Italian consensus conference on prevention and management of infections in MS patients treated with biological and non biological disease modifying drugs

Author

Moiola, L., Barcella, V., Benatti, S., Prosperini, L., Franzetti, F., Zaffaroni, M., Puoti, M., Tortorella, C., Fasolo, M., Origoni, M., Capra, R., Cinque, P., simonetta gerevini, Scarpazza, C., Capobianco, M., Meroni, L., Galli, M., Comi, G., Riva, A., Moiola, L, Barcella, V, Benatti, S, Prosperini, L, Franzetti, F, Zaffaroni, M, Puoti, M, Tortorella, C, Fasolo, M, Origoni, M, Capra, R, Cinque, P, Gerevini, S, Scarpazza, C, Capobianco, M, Meroni, L, Galli, M, Comi, G, and Riva, A

Published
2019

17. 'Posture second' strategy predicts disability progression in multiple sclerosis

Author

Castelli, L, De Giglio, L., Haggiag, S, DE LUCA, Francesca, Ruggieri, S, and Prosperini, L

Subjects
medicine.medical_specialty, Multiple Sclerosis, business.industry, Multiple sclerosis, Posture, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Cross-Sectional Studies, Neurology, medicine, Multiple sclerosis, posture analysis, posture analysis, Humans, Disability progression, Force platform, Disabled Persons, 030212 general & internal medicine, Neurology (clinical), business, Postural Balance, 030217 neurology & neurosurgery, Quiet standing, Balance (ability)
Abstract

We assessed 168 patients with multiple sclerosis (MS) by force platform to obtain the dual-task cost (DTC) of balance, that is, the change in postural sway from quiet standing to dual-task condition (Stroop test). After a median follow-up time of 3.5 years from this assessment, disability progression occurred in 45 (27%) patients. Disability progression was predicted by the adoption of a ‘posture second’ strategy, that is, values of DTC of balance exceeding those obtained from 62 healthy controls, even after controlling by demographic and clinical characteristics. The DTC of balance may potentially represent a novel and easy tool to predict MS progression.

Published
2020

20. Induction Versus Escalation in Multiple Sclerosis: A 10-Year Real World Study

Author

Prosperini, L., Mancinelli, C. R., Solaro, C. M., Nociti, Viviana, Haggiag, S., Cordioli, C., De Giglio, L., De Rossi, N., Galgani, S., Rasia, S., Ruggieri, S., Tortorella, C., Capra, R., Mirabella, Massimiliano, Gasperini, C., Nociti V. (ORCID:0000-0002-4607-3948), Mirabella M. (ORCID:0000-0002-7783-114X), Prosperini, L., Mancinelli, C. R., Solaro, C. M., Nociti, Viviana, Haggiag, S., Cordioli, C., De Giglio, L., De Rossi, N., Galgani, S., Rasia, S., Ruggieri, S., Tortorella, C., Capra, R., Mirabella, Massimiliano, Gasperini, C., Nociti V. (ORCID:0000-0002-4607-3948), and Mirabella M. (ORCID:0000-0002-7783-114X)

Abstract

In this independent, multicenter, post-marketing study, we directly compare induction immunosuppression versus escalation strategies on the risk of reaching the disability milestone of Expanded Disability Status Scale (EDSS) ≥ 6.0 over 10 years in previously untreated patients with relapsing-remitting multiple sclerosis. We collected data of patients who started interferon beta (escalation) versus mitoxantrone or cyclophosphamide (induction) as initial treatment. Main eligibility criteria included an EDSS score ≤ 4.0 at treatment start and either ≥ 2 relapses or 1 disabling relapse with evidence of ≥ 1 gadolinium-enhancing lesion at magnetic resonance imaging scan in the pre-treatment year. Since patients were not randomized to treatment group, we performed a propensity score (PS)–based matching procedure to select individuals with homogeneous baseline characteristics. Comparisons were then conducted using Cox models stratified by matched pairs. Overall, 75 and 738 patients started with induction and escalation, respectively. Patients in the induction group were older and more disabled than those in the escalation group (p < 0.05). The PS-matching procedure retained 75 patients per group. In the re-sampled population, a lower proportion of patients reached the outcome after induction (21/75, 28.0%) than escalation (29/75, 38.7%) (hazard ratio = 0.48; p = 0.024). Considering the whole sample, serious adverse events occurred more frequently after induction (8/75, 10.7%) than escalation (18/738, 2.4%) (odds ratio = 3.36, p = 0.015). These findings suggest that, in patients with poor prognostic factors, induction was more effective than escalation in reducing the risk of reaching the disability milestone, albeit with a worse safety profile. Future studies are warranted to explore if newer induction agents may provide a more advantageous long-lasting risk:benefit profile.

Published
2020

25. Box and block test, hand grip strength and nine‐hole peg test: correlations between three upper limb objective measures in multiple sclerosis

Author

Solaro, C., primary, Di Giovanni, R., additional, Grange, E., additional, Mueller, M., additional, Messmer Uccelli, M., additional, Bertoni, R., additional, Brichetto, G., additional, Tacchino, A., additional, Patti, F., additional, Pappalardo, A., additional, Prosperini, L., additional, Castelli, L., additional, Rosato, R., additional, Cattaneo, D., additional, and Marengo, D., additional

Published
2020
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26. The still under-investigated role of cognitive deficits in PML diagnosis

Author

Scarpazza, C, De Rossi, N, Moiola, L, Gerevini, S, Cosottini, M, Capra, R, Mattioli, F, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Bresciamorra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Clerico, M, Cordioli, C, D'Aleo, G, de Riz, M, Deotto, L, Durelli, L, Falcini, M, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Naldi, P, Pane, C, Perrone, P, Pizzorno, M, Pozzilli, C, Prosperini, L, Rezzonico, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza C., De Rossi N., Moiola L., Gerevini S., Cosottini M., Capra R., Mattioli F., Amato M. P., Artusi C. A., Bandini F., Barcella V., Bertolotto A., Bresciamorra V., Capobianco M., Cavaletti G., Cavalla P., Centonze D., Clerico M., Cordioli C., D'Aleo G., de Riz M., Deotto L., Durelli L., Falcini M., Ferrari E., Fusco M. L., Gasperini C., Ghezzi A., Grimaldi L., Guidotti M., Laroni A., Lugaresi A., Naldi P., Pane C., Perrone P., Pizzorno M., Pozzilli C., Prosperini L., Rezzonico M., Rovaris M., Salemi G., Salvetti M., Santuccio G., Scarpini E., Sessa E., Solaro C., Tabiadon G., Tortorella C., Trojano M., Valentino P., Scarpazza, C, De Rossi, N, Moiola, L, Gerevini, S, Cosottini, M, Capra, R, Mattioli, F, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Bresciamorra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Clerico, M, Cordioli, C, D'Aleo, G, de Riz, M, Deotto, L, Durelli, L, Falcini, M, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Naldi, P, Pane, C, Perrone, P, Pizzorno, M, Pozzilli, C, Prosperini, L, Rezzonico, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza C., De Rossi N., Moiola L., Gerevini S., Cosottini M., Capra R., Mattioli F., Amato M. P., Artusi C. A., Bandini F., Barcella V., Bertolotto A., Bresciamorra V., Capobianco M., Cavaletti G., Cavalla P., Centonze D., Clerico M., Cordioli C., D'Aleo G., de Riz M., Deotto L., Durelli L., Falcini M., Ferrari E., Fusco M. L., Gasperini C., Ghezzi A., Grimaldi L., Guidotti M., Laroni A., Lugaresi A., Naldi P., Pane C., Perrone P., Pizzorno M., Pozzilli C., Prosperini L., Rezzonico M., Rovaris M., Salemi G., Salvetti M., Santuccio G., Scarpini E., Sessa E., Solaro C., Tabiadon G., Tortorella C., Trojano M., and Valentino P.

Abstract

Background: Despite cognitive deficits frequently represent the first clinical manifestations of Progressive Multifocal Leukoencephalopathy (PML) in Natalizumab-treated MS patients, the importance of cognitive deficits in PML diagnosis is still under-investigated. The aim of the current study is to investigate the cognitive deficits at PML diagnosis in a group of Italian patients with PML. Methods: Thirty-four PML patients were included in the study. The demographic and clinical data, the lesion load and localization, and the longitudinal clinical course was compared between patients with (n = 13) and without (n = 15) cognitive deficit upon PML suspicion (the remaining six patients were asymptomatic). Clinical presentation of cognitive symptoms was described in detail. Result: After symptoms detection, the time to diagnosis resulted to be shorter for patients presenting with cognitive than for patients with non cognitive onset (p = 0.03). Within patients with cognitive onset, six patients were presenting with language and/or reading difficulties (46.15%); five patients with memory difficulties (38.4%); three patients with apraxia (23.1%); two patients with disorientation (15.3%); two patients with neglect (15.3%); one patients with object agnosia (7.7%), one patient with perseveration (7.7%) and one patient with dementia (7.7%). Frontal lesions were less frequent (p = 0.03), whereas temporal lesions were slightly more frequent (p = 0.06) in patients with cognitive deficits. The longitudinal PML course seemed to be more severe in cognitive than in non cognitive patients (F = 2.73, p = 0.03), but differences disappeared (F = 1.24, p = 0.29) when balancing for the incidence of immune reconstitution syndrome and for other treatments for PML (steroids, plasma exchange (PLEX) and other therapies (Mefloquine, Mirtazapine, Maraviroc). Conclusion: Cognitive deficits at PML onset manifest with symptoms which are absolutely rare in MS. Their appearance in MS patients should st

Published
2017

29. Early diagnosis of progressive multifocal leucoencephalopathy: Longitudinal lesion evolution

Author

Scarpazza, C, Signori, A, Prosperini, L, Sormani, M, Cosottini, M, Capra, R, Gerevini, S, Altieri, M, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Morra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Chiusole, M, Clerico, M, Cordioli, C, D'Aleo, G, De Luca, G, De Riz, M, De Rossi, N, Deotto, L, Durelli, L, Falcini, M, Ferrante, C, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Moiola, L, Naldi, P, Pane, C, Palmeri, B, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rottoli, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Stenta, G, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza, Cristina, Signori, Alessio, Prosperini, Luca, Sormani, Maria Pia, Cosottini, Mirco, Capra, Ruggero, Gerevini, Simonetta, Altieri, Marta, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Morra, Vincenzo Brescia, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Chiusole, Maurizia, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, De Luca, Giovanna, De Riz, Milena, De Rossi, Nicola, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrante, Claudio, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Moiola, Lucia, Naldi, Paola, Pane, Chiara, Palmeri, Barbara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Rezzonico, Monica, Rottoli, Maria Rosa, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Stenta, Gianola, Tabiadon, Giulietta, Tortorella, Carla, Trojano, Maria, Valentino, Paola, Rottoli, Maira Rosa, Scarpazza, C, Signori, A, Prosperini, L, Sormani, M, Cosottini, M, Capra, R, Gerevini, S, Altieri, M, Amato, M, Artusi, C, Bandini, F, Barcella, V, Bertolotto, A, Morra, V, Capobianco, M, Cavaletti, G, Cavalla, P, Centonze, D, Chiusole, M, Clerico, M, Cordioli, C, D'Aleo, G, De Luca, G, De Riz, M, De Rossi, N, Deotto, L, Durelli, L, Falcini, M, Ferrante, C, Ferrari, E, Fusco, M, Gasperini, C, Ghezzi, A, Grimaldi, L, Guidotti, M, Laroni, A, Lugaresi, A, Moiola, L, Naldi, P, Pane, C, Palmeri, B, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rottoli, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Stenta, G, Tabiadon, G, Tortorella, C, Trojano, M, Valentino, P, Scarpazza, Cristina, Signori, Alessio, Prosperini, Luca, Sormani, Maria Pia, Cosottini, Mirco, Capra, Ruggero, Gerevini, Simonetta, Altieri, Marta, Amato, Maria Pia, Artusi, Carlo Alberto, Bandini, Fabio, Barcella, Valeria, Bertolotto, Antonio, Morra, Vincenzo Brescia, Capobianco, Marco, Cavaletti, Guido, Cavalla, Paola, Centonze, Diego, Chiusole, Maurizia, Clerico, Marinella, Cordioli, Cinzia, D'Aleo, Giangaetano, De Luca, Giovanna, De Riz, Milena, De Rossi, Nicola, Deotto, Luciano, Durelli, Luca, Falcini, Mario, Ferrante, Claudio, Ferrari, Ernesta, Fusco, Maria Luisa, Gasperini, Claudio, Ghezzi, Angelo, Grimaldi, Luigi, Guidotti, Mario, Laroni, Alice, Lugaresi, Alessandra, Moiola, Lucia, Naldi, Paola, Pane, Chiara, Palmeri, Barbara, Perrone, Patrizia, Pizzorno, Matteo, Pozzilli, Carlo, Rezzonico, Monica, Rottoli, Maria Rosa, Rovaris, Marco, Salemi, Giuseppe, Salvetti, Marco, Santuccio, Giuseppe, Scarpini, Elio, Sessa, Edoardo, Solaro, Claudio, Stenta, Gianola, Tabiadon, Giulietta, Tortorella, Carla, Trojano, Maria, Valentino, Paola, and Rottoli, Maira Rosa

Abstract

Objective early diagnosis of natalizumab-related progressive multifocal leucoencephalopathy (NTZ-pML) in multiple sclerosis has been deemed a major priority by the regulatory agencies but has yet to become a reality. The current paper aims to: (1) investigate whether patients with NTZ-pML pass through a prolonged presymptomatic phase with MRI abnormalities, (2) estimate the longitudinal pML lesion volume increase during the presymptomatic phase and (3) estimate the presymptomatic phase length and its impact on therapy duration as a risk stratification parameter. Methods all Italian patients who developed NTZ-pML between 2009 and 2018 were included. The data of patients with available prediagnostic MRI were analysed (n=41). Detailed clinical and neuroradiological information was available for each participant. results (1) pML lesions were detectable in the presymptomatic phase in 32/41 (78%) patients; (ii) the lesion volume increased by 62.8 % for each month spent in the prediagnostic phase; (3) the prediagnostic phase length was 150.8±74.9 days; (4) pML MRI features were detectable before the 24th month of therapy in 31.7 % of patients in our cohort. Conclusions considering the latency of pML clinical manifestation, the presymptomatic phase length supports the usefulness of MRI surveillance every 3-4 months. early diagnosis could prompt a better outcome for patients due to the relationship between lesion volume and Jc virus infection. The insight from this study might also have an impact on risk stratification algorithms, as therapy duration as a parameter of stratification appears to need reassessment.

Published
2019

30. Exit strategies for “needle fatigue” in multiple sclerosis: a propensity score-matched comparison study

Author

Prosperini, L., Cortese, A., Lucchini, Matteo, Boffa, L., Borriello, G., Buscarinu, M. C., Capone, F., Centonze, D., De Fino, Chiara, De Pascalis, D., Fantozzi, R., Ferraro, E., Filippi, M., Galgani, S., Gasperini, C., Haggiag, S., Landi, D., Marfia, G., Mataluni, G., Millefiorini, E., Mirabella, Massimiliano, Monteleone, F., Nociti, Viviana, Pontecorvo, S., Romano, S., Ruggieri, S., Salvetti, M., Tortorella, C., Zannino, S., Di Battista, G., Lucchini M. (ORCID:0000-0002-0447-2297), De Fino C., Mirabella M. (ORCID:0000-0002-7783-114X), Nociti V. (ORCID:0000-0002-4607-3948), Prosperini, L., Cortese, A., Lucchini, Matteo, Boffa, L., Borriello, G., Buscarinu, M. C., Capone, F., Centonze, D., De Fino, Chiara, De Pascalis, D., Fantozzi, R., Ferraro, E., Filippi, M., Galgani, S., Gasperini, C., Haggiag, S., Landi, D., Marfia, G., Mataluni, G., Millefiorini, E., Mirabella, Massimiliano, Monteleone, F., Nociti, Viviana, Pontecorvo, S., Romano, S., Ruggieri, S., Salvetti, M., Tortorella, C., Zannino, S., Di Battista, G., Lucchini M. (ORCID:0000-0002-0447-2297), De Fino C., Mirabella M. (ORCID:0000-0002-7783-114X), and Nociti V. (ORCID:0000-0002-4607-3948)

Abstract

Patients with multiple sclerosis on long-term injectable therapies may suffer from the so-called “needle fatigue”, i.e., a waning commitment to continue with the prescribed injectable treatment. Therefore, alternative treatment strategies to enhance patients’ adherence are warranted. In this independent, multicentre post-marketing study, we sought to directly compare switching to either teriflunomide (TFN), dimethyl fumarate (DMF), or pegylated interferon (PEG) on treatment persistence and time to first relapse over a 12-month follow-up. We analyzed a total of 621 patients who were free of relapses and gadolinium-enhancing lesions in the year prior to switching to DMF (n = 265), TFN (n = 160), or PEG (n = 196). Time to discontinuation and time to first relapse were explored in the whole population by Cox regression models adjusted for baseline variables and after a 1:1:1 ratio propensity score (PS)-based matching procedure. Treatment discontinuation was more frequent after switching to PEG (28.6%) than DMF (14.7%; hazard ratio [HR] = 0.25, p < 0.001) and TFN (16.9%; HR = 0.27, p < 0.001). We found similar results even in the re-sampled cohort of 222 patients (74 per group) derived by the PS-based matching procedure. The highest discontinuation rate observed in PEG recipient was mainly due to poor tolerability (p = 0.005) and pregnancy planning (p = 0.04). The low number of patients who relapsed over the 12-month follow-up (25 out of 621, approximately 4%) prevented any analysis on the short-term risk of relapse. This real-world study suggests that oral drugs are a better switching option than low-frequency interferon for promoting the short-term treatment persistence in stable patients who do not tolerate injectable drugs.

Published
2019

31. The influence of physiotherapy intervention on patients with multiple sclerosis–related spasticity treated with nabiximols (THC:CBD oromucosal spray)

Author

Grimaldi, Gabriela, De Giglio, L., Haggiag, S., Bianco, Assunta, Cortese, A., Crisafulli, S. G., Monteleone, F., Marfia, G., Prosperini, L., Galgani, S., Mirabella, Massimiliano, Centonze, D., Pozzilli, C., Castelli, L., Grimaldi A. E., Bianco A., Mirabella M. (ORCID:0000-0002-7783-114X), Grimaldi, Gabriela, De Giglio, L., Haggiag, S., Bianco, Assunta, Cortese, A., Crisafulli, S. G., Monteleone, F., Marfia, G., Prosperini, L., Galgani, S., Mirabella, Massimiliano, Centonze, D., Pozzilli, C., Castelli, L., Grimaldi A. E., Bianco A., and Mirabella M. (ORCID:0000-0002-7783-114X)

Abstract

Background Nabiximols (THC/CBD Oromucosal Spray, Sativex) is used as an add-on therapy to treat moderate to severe spasticity of Multiple Sclerosis (MS). Objectives To examine the impact of physiotherapy (PT) programs on effectiveness and persistence of nabiximols treatment in people with MS-related spasticity. Methods This is an observational multicenter study with a follow-up period of 12 weeks, conducted in routine care settings in Italy. Patients with moderate to severe MS-related spasticity who started nabiximols were included. Spasticity was evaluated by the patient-rated 0–10 numerical rating scale (NRS). Clinical data were collected at baseline (T0), 4 weeks (T1) and 12 weeks (T2) months after enrollment. Results A total of 297 MS patients were selected, 290 completed the 3 months follow-up period. Mean NRS scores were 7.6 ± 1.1 at T0, 5.8 ± 1.4 at T1 and 5.5 ± 1.5 at T2. At T1, 77% of patients reached 20% improvement (initial response, IR); 22% reached 30% improvement (clinically relevant response, CRR). At T1, patients undergoing PT had a higher probability to reach CRR (Odds Ratio = 2.6 95% CI 1.3–5.6, p = 0.01). Nabiximols was discontinued in 30/ 290 (10.3%) patients at T1 (early discontinuers) and in 71/290 (24.5%) patients at T2 (late discontinuers). The probability of being late discontinuers was reduced in patients undergoing PT (Hazard Ratio = 0.41; 95% CI 0.23–0.69, p = 0.001). Conclusions Our real-life study confirms nabiximols’ effectiveness in MS-related spasticity and suggests that the association of a PT program may improve overall response and persistence to nabiximols treatment.

Published
2019

32. 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

35. Local dynamic stability of gait in people with early multiple sclerosis and minimal impairment. A cross-sectional study

Author

Caronni, A., primary, Gervasoni, E., additional, Ferrarin, M., additional, Anastasi, D., additional, Brichetto, G., additional, Confalonieri, P., additional, Di Giovanni, R., additional, Prosperini, L., additional, Tacchino, A., additional, Solaro, C., additional, Rovaris, M., additional, Cattaneo, D., additional, and Carpinella, I., additional

Published
2019
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36. WITHDRAWN: Local dynamic stability of gait in people with early multiple sclerosis and minimal impairment. A cross-sectional study

Author

Caronni, A., primary, Gervasoni, E., additional, Ferrarin, M., additional, Anastasi, D., additional, Brichetto, G., additional, Confalonieri, P., additional, Di Giovanni, R., additional, Prosperini, L., additional, Tacchino, A., additional, Solaro, C., additional, Rovaris, M., additional, Cattaneo, D., additional, and Carpinella, I., additional

Published
2019
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37. Natalizumab in pediatric multiple sclerosis: results of a cohort of 55 cases

Author

Ghezzi, A, Zaffaroni, M, Bianchi, A, Pozzilli, C, Prosperini, L, Borriello, G, Filippi, M, Moiola, L, Gerevini, S, Rocca, MA, Martinelli, V, Comi, G, Grimaldi, LM, Bucello, S, Lus, G, Rinaldi, F, Gallo, P, Trojano, M, Provinciali, L, Pucci, E, Bortolon, F, Capra, R, Coniglio, G, Gasperini, C, Lugaresi, A, Pietrolongo, E, Farina, D, Di Ioia, M, Milani, N, Rottoli, MR, Sarchielli, P., BRESCIA MORRA, VINCENZO, LANZILLO, ROBERTA, Ghezzi, A, Zaffaroni, M, Bianchi, A, Pozzilli, C, Prosperini, L, Borriello, G, Filippi, M, Moiola, L, Gerevini, S, Rocca, Ma, Martinelli, V, Comi, G, BRESCIA MORRA, Vincenzo, Lanzillo, Roberta, Grimaldi, Lm, Bucello, S, Lus, G, Rinaldi, F, Gallo, P, Trojano, M, Provinciali, L, Pucci, E, Bortolon, F, Capra, R, Coniglio, G, Gasperini, C, Lugaresi, A, Pietrolongo, E, Farina, D, Di Ioia, M, Milani, N, Rottoli, Mr, Sarchielli, P., Brescia Morra, V, Comi, Giancarlo, Filippi, Massimo, Italian MS Study, Group, Ghezzi A, Pozzilli C, Grimaldi L, Moiola L, Brescia-Morra V, Lugaresi A, Lus G, Rinaldi F, Rocca M, Trojano M, Bianchi A, Comi G, Filippi M, the Italian MS Study Group, and Lus, Giacomo

Subjects
Male, medicine.medical_specialty, Pediatrics, Adolescent, Antibodies, Monoclonal, Humanized, adolescence, childhood, Multiple sclerosis, natalizumab, Brain, Child, Cohort Studies, Female, Humans, Magnetic Resonance Imaging, Multiple Sclerosis, Relapsing-Remitting, Natalizumab, Neurology, Neurology (clinical), Female patient, Medicine, Multiple sclerosi, Cognitive skill, Expanded Disability Status Scale, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Mean age, medicine.disease, Surgery, Cohort, business, medicine.drug
Abstract

Background: Limited information is available on the use of natalizumab (NA) in pediatric multiple sclerosis (ped-MS) patients. Objective: The purpose of this study was to describe the long-term effects of NA in a large cohort of active ped-MS patients. Methods: Patients with definite ped-MS were treated with NA if in the previous year they had experienced at least two relapses or a severe relapse with incomplete recovery while on immunomodulating treatment, or at least two relapses and new magnetic resonance imaging (MRI) lesions regardless of any prior treatment. Results: The study included 55 patients (mean age: 14.4 years, mean number of relapses: 4.4, pre-treatment mean disease duration: 25.5 months). They received a median number of 26 infusions. Three relapses occurred during the follow-up, one female patient continued to deteriorate in cognitive functioning. Mean Expanded Disability Status Scale (EDSS) scores decreased from 2.7 to 1.9 at the last visit ( pConclusions: NA was well tolerated in all patients. A strong suppression of disease activity was observed in the majority of patients during the follow-up.

Published
2013

38. 2017 revisions of McDonald criteria shorten the time to diagnosis of multiple sclerosis in clinically isolated syndromes

Author

Gaetani, L., Prosperini, L., Mancini, A., Eusebi, P., Cerri, M. C., Pozzilli, C., Calabresi, Paolo, Sarchielli, P., Di Filippo, M., Calabresi P. (ORCID:0000-0003-0326-5509), Gaetani, L., Prosperini, L., Mancini, A., Eusebi, P., Cerri, M. C., Pozzilli, C., Calabresi, Paolo, Sarchielli, P., Di Filippo, M., and Calabresi P. (ORCID:0000-0003-0326-5509)

Abstract

Objectives: To investigate the impact of the 2017 revisions of McDonald criteria on the diagnosis of multiple sclerosis (MS) in a cohort of patients with clinically isolated syndrome (CIS) and dissemination in space (DIS) of demyelinating lesions. Methods: We retrospectively analyzed 137 patients with CIS + DIS from two Italian MS centers. Results: Application of the 2017 revisions of McDonald criteria in our cohort led to a diagnosis of MS in 82.5% of the patients who could have not been diagnosed with MS according to the previous criteria at the time of the first demyelinating event. After a follow-up of 3.8 ± 2.9 years, 85.8% of these patients eventually satisfied also the previous (2010) criteria. Conclusions: Application of the 2017 revisions of McDonald criteria results in an earlier diagnosis of MS in a large percentage of CIS patients destined to convert to MS.

Published
2018

39. Abortion induces reactivation of inflammation in relapsing-remitting multiple sclerosis

Author

Landi, D., Ragonese, P., Prosperini, L., Nociti, V., Haggiag, S., Cortese, A., Fantozzi, R., Pontecorvo, S., Ferraro, E., Buscarinu, M. C., Mataluni, G., Monteleone, F., Salvetti, M., Di Battista, G., Francia, A., Millefiorini, E., Gasperini, C., Mirabella, M., Salemi, G., Boffa, L., Pozzilli, C., Centonze, D., Marfia, G. A., Nociti V. (ORCID:0000-0002-4607-3948), Mirabella M. (ORCID:0000-0002-7783-114X), Landi, D., Ragonese, P., Prosperini, L., Nociti, V., Haggiag, S., Cortese, A., Fantozzi, R., Pontecorvo, S., Ferraro, E., Buscarinu, M. C., Mataluni, G., Monteleone, F., Salvetti, M., Di Battista, G., Francia, A., Millefiorini, E., Gasperini, C., Mirabella, M., Salemi, G., Boffa, L., Pozzilli, C., Centonze, D., Marfia, G. A., Nociti V. (ORCID:0000-0002-4607-3948), and Mirabella M. (ORCID:0000-0002-7783-114X)

Abstract

Objective: To investigate clinical and radiological outcomes of women with relapsing-remitting multiple sclerosis (RRMS) undergoing abortion. Methods: An independent, multicentre retrospective study was conducted collecting data from eight Italian MS centres. We compared the preconception and postabortion annualised relapse rate (ARR) and number of Gadolinium enhancing (Gd+) lesions, by analyses of covariance. Variables associated with postabortion clinical and MRI activity were investigated using Poisson regression models; each abortion was considered as a statistical unit. Results: From 1995 to 2017, we observed 188 abortions (17 elective) in 153 women with RRMS. Abortions occurred after a mean time of 9.5 (4.4) weeks from estimated conception date. In 86 events out of 188, conception happened during treatment with disease modifying drugs. The mean postabortion ARR (0.63±0.74) was significantly increased (p=0.037) compared with the preconception year (0.50±0.71) as well as the postabortion mean number of new Gd+ lesions (0.77±1.40 vs 0.39±1.04; p=0.004). Higher likelihood of relapses was predicted by higher preconception ARR, discontinuation of preconception treatment and elective abortion; the occurrence of new Gd+ lesions was associated with higher preconception number of active lesions, discontinuation of preconception treatment, shorter length of pregnancy maintenance and elective abortion. Conclusions: Abortion was associated with clinical and radiological inflammatory rebound remarkably in the first 12 months postevent. Deregulated proinflammatory processes arising at the early stages of pregnancy might play a role both in MS reactivation and abortion. Women with MS should be counselled about these risks of abortion and followed up accordingly.

Published
2018

40. 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, M. C., Gallo, A., Matta, M., Moiola, L., Musu, L., Perini, P., Avolio, C., Barcella, V., Bianco, Assunta, Farina, D., Ferraro, E., Pontecorvo, S., Granella, F., Grimaldi, L. M. E., 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, M. R., Mirabella, Massimiliano, 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., Lapicci, C., Mancardi, G. L., Uccelli, A., Chisari, C., D'Amico, E., Cartechini, E., Repice, A. M., Magnani, E., Massaccesi, L., Calabresi, Paolo, Di Filippo, Mario, Di Gregorio, M., Bianco A., Mirabella M. (ORCID:0000-0002-7783-114X), Calabresi P. (ORCID:0000-0003-0326-5509), Di Filippo M., Prosperini, L., Annovazzi, P., Boffa, L., Buscarinu, M. C., Gallo, A., Matta, M., Moiola, L., Musu, L., Perini, P., Avolio, C., Barcella, V., Bianco, Assunta, Farina, D., Ferraro, E., Pontecorvo, S., Granella, F., Grimaldi, L. M. E., 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, M. R., Mirabella, Massimiliano, 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., Lapicci, C., Mancardi, G. L., Uccelli, A., Chisari, C., D'Amico, E., Cartechini, E., Repice, A. M., Magnani, E., Massaccesi, L., Calabresi, Paolo, Di Filippo, Mario, Di Gregorio, M., Bianco A., Mirabella M. (ORCID:0000-0002-7783-114X), Calabresi P. (ORCID:0000-0003-0326-5509), and Di Filippo M.

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

41. Safety, tolerability and effectiveness of dimethyl fumarate in multiple sclerosis: an independent, multicenter, real-world study

Author

Mirabella, M, Prosperini, L, Lucchini, M, Boffa, L, Borriello, G, Buscarinu, M, Centonze, D, Cortese, A, De Fino, C, De Giglio, L, Elia, G, Fantozzi, R, Ferraro, E, Francia, A, Galgani, S, Gasperini, C, Haggiag, S, Landi, D, Marfia, G, Millefiorini, E, Monteleone, F, Nociti, V, Salvetti, M, Sgarlata, E, and Pozzilli, C

Subjects
Settore MED/26 - Neurologia
Published
2017

45. No evidence of beneficial effects of plasmapheresis in natalizumab-associated PML

Author

Landi, D, De Rossi, N, Zagaglia, S, Scarpazza, C, Prosperini, L, Albanese, M, Buttari, F, Mori, F, Marfia, G, Sormani, M, Capra, R, Centonze, D, Amato, M, Bandini, F, Bertolotto, A, Brescia Morra, V, Cavaletti, G, Cavalla, P, Capobianco, M, Clerico, M, D'Aleo, G, de Riz, M, Deotto, L, Durelli, L, Falcini, M, Ferrari, E, Fusco, M, Gasperini, C, Gerevini, S, Ghezzi, A, Grimaldi, L, Guidotti, M, Lugaresi, A, Naldi, P, Moiola, L, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Tabiadon, G, Tortorella, C, Trojano, M, Amato, MP, Fusco, ML, Trojano, M., CAVALETTI, GUIDO ANGELO, Landi, D, De Rossi, N, Zagaglia, S, Scarpazza, C, Prosperini, L, Albanese, M, Buttari, F, Mori, F, Marfia, G, Sormani, M, Capra, R, Centonze, D, Amato, M, Bandini, F, Bertolotto, A, Brescia Morra, V, Cavaletti, G, Cavalla, P, Capobianco, M, Clerico, M, D'Aleo, G, de Riz, M, Deotto, L, Durelli, L, Falcini, M, Ferrari, E, Fusco, M, Gasperini, C, Gerevini, S, Ghezzi, A, Grimaldi, L, Guidotti, M, Lugaresi, A, Naldi, P, Moiola, L, Perrone, P, Pizzorno, M, Pozzilli, C, Rezzonico, M, Rovaris, M, Salemi, G, Salvetti, M, Santuccio, G, Scarpini, E, Sessa, E, Solaro, C, Tabiadon, G, Tortorella, C, Trojano, M, Amato, MP, Fusco, ML, Trojano, M., and CAVALETTI, GUIDO ANGELO

Abstract

Objective: To examine retrospectively the effects of plasmapheresis (PLEX) on the survival and clinical outcomes of patients with multiple sclerosis (MS) and natalizumab (NTZ)-associated progressive multifocal leukoencephalopathy (PML).Methods: The medical literature was searched for the terms natalizumab and progressive multifocal leukoencephalopathy. A total of 193 international and 34 Italian NTZ-PML cases were included. Clinical outcome was determined by comparing the patients' clinical status at PML diagnosis with status after PML resolution. The effects on survival and clinical outcome of PLEX, sex, age, country, pre-PML Expanded Disability Status Scale score, NTZ infusion number, prior immunosuppressant exposure, PML symptoms, PML lesion location at diagnosis, CSF JC virus status and copies, additional PML treatments and steroids, and PML immune reconstitution inflammatory syndrome ( IRIS) development were investigated with both univariate and multivariate analyses.Results: A total of 219 NTZ-PML cases were analyzed, and 184 (84%) underwent PLEX, which did not reduce the mortality risk or the likelihood of poor vs favorable outcomes. Country was predictive of mortality and poor outcome, while PML-IRIS development was predictive of poor outcome.Conclusions: PLEX did not improve the survival or clinical outcomes of Italian or international patients with MS and NTZ-PML, suggesting that this treatment should be performed cautiously in the future. Classification of evidence: This study provides Class III evidence that for patients with NTZ-PML, PLEX does not improve survival. The study lacks the statistical precision to exclude an important benefit or harm of PLEX.

Published
2017

46. High risk of early conversion to multiple sclerosis in clinically isolated syndromes with dissemination in space at baseline

Author

Gaetani, L., Fanelli, F., Riccucci, I., Eusebi, P., Sarchielli, P., Pozzilli, C., Calabresi, Paolo, Prosperini, L., Di Filippo, M., Calabresi P. (ORCID:0000-0003-0326-5509), Gaetani, L., Fanelli, F., Riccucci, I., Eusebi, P., Sarchielli, P., Pozzilli, C., Calabresi, Paolo, Prosperini, L., Di Filippo, M., and Calabresi P. (ORCID:0000-0003-0326-5509)

Abstract

Introduction Multiple sclerosis (MS) usually presents at onset with a clinically isolated syndrome (CIS). According to 2010 McDonald criteria, a diagnosis of MS can be made if CIS patients satisfy clinical/MRI criteria of both dissemination in time (DIT) and space (DIS). Objective The aim of this study was to analyze the follow-up data and possible prognostic factors of CIS patients satisfying DIS MRI criteria. Patients and methods We performed a retrospective, multicenter study across 2 Italian centers. Clinical, MRI, and laboratory assessments were performed according to real-life clinical workup. Results Out of the 137 enrolled patients, during a median follow-up time of 3.1 years, 116 (84.7%) converted to MS with the large majority (78.4%) of the converters developing MS within 1 year. In multivariate analysis, baseline predictors of an earlier conversion were a cerebellar/brainstem CIS (HR 2.00, 95% CI: 1.3–3.0, p = 0.001) and the presence of all the Barkhof-Tintore MRI criteria (HR 1.67, 95% CI: 1.1–2.6, p = 0.028). Conclusions Patients with CIS and DIS are at very high risk of an early conversion to MS. The onset with cerebellar/brainstem symptoms and the evidence of a higher MRI lesion load at baseline are the strongest independent predictors of an early conversion to MS.

Published
2017

47. The diagnosis of multiple sclerosis: pinpointing the concept of 'no better explanation'

Author

Calabrese, Massimiliano, Gasperin, C., Tortorella, C., Malucchi, S., Ragonese, P., De Luca, G., Fantozzi, R., Lo Fermo, S., Boffa, L., Paolicelli, D., Gajofatto, Alberto, Pesci, I., Annovazzi, P., Cordioli, C., Lanzillo, R., Giorgio, A., Gallo, A., Tomassini, V., Frisullo, G., Prosperini, L., Cocco, E., Rodegher, M., Solaro, C., CALABRESE, M, GASPERINI, C, TORTORELLA, C, MALUCCHI, S, RAGONESE, P, DE LUCA, G, FANTOZZI, R, LO FERMO, S, BOFFA, L, PAOLICELLI, D, GAJOFATTO, D, PESCI, I, ANNOVAZZI, P, CORDIOLI, C, LANZILLO, R, GIORGIO, A, GALLO, A, TOMASSINI, V, FRISULLO, G, PROSPERINI, L, COCCO, E, RODEGHER, M, and SOLARO C.

Subjects
diagnosis, Multiple sclerosi, Settore MED/26 - Neurologia, multiple sclerosis
Published
2014

48. Effects of rehabilitation treatment of the upper limb in Multiple Sclerosis patients and predictive value of neurophysiological measures

Author

Nociti, V., Prosperini, L., Ulivelli, M., Losavio, F. A., Bartalini, S., Caggiula, M., Cioncoloni, D., Caliandro, P., Minciotti, I., Mirabella, M., and Luca Padua

Subjects
Male, Upper extremity, Physical Therapy, Rehabilitation, Somatosensory, Sports Therapy and Rehabilitation, Middle Aged, Evoked potentials, Prognosis, Multiple sclerosis, Disability Evaluation, Treatment Outcome, Italy, Evoked Potentials, Somatosensory, Surveys and Questionnaires, Physical Therapy, Sports Therapy and Rehabilitation, Humans, Female, Prospective Studies, Psychomotor Performance
Abstract

Dysfunctions of the upper limbs occur in the 66% of multiple sclerosis (MS) patients. To date, no data, about the persistence of the effects of a rehabilitation treatment and no prognostic markers of functional improvement, have been established.The aim of this study was to define clinical data supporting the efficacy of a rehabilitation treatment in MS patients with upper limb impairment and to find prognostic factors for functional improvement.Pre-post comparison prospective study.Two tertiary Italian MS centres: Rome and Siena.Twenty-five consecutive MS patients were tested for eligibility.We multidimensionally evaluated 25 consecutive patients with MS-related upper limbs impairment through clinical objective, patient-oriented and neurophysiological measures pre and post a16-week rehabilitation treatment on upper limb sensorimotor function.We found a significant improvement in the Nine Hole Peg Test (9-HPT) at either sides, both at an immediate post-training visit (T1) (left: P=0.018, right: P=0.004) and at a 12-week postintervention assessment visit (T2) (left: P=0.033, right: P=0.022). We also found a positive correlation between the 12-week post-training changes in the 9-HPT and the N14-P20 interpeak of the somatosensory evoked potentials, (rho=0.374, P=0.008).Our study demonstrates that a rehabilitation treatment can lead to an improvement of the upper limb motor performance in MS patients which continues to persist even after 3 months of treatment-discontinuation suggesting a possible role of rehabilitation in neuroplasticity changes. Moreover, we found, in the latency of the N14-P20 interpeak, a possible prognostic marker for the effects of a upper limb rehabilitation treatment in MS patients.The N14-P20 interpeak could be used as a prognostic marker of the effects of rehabilitation of the upper limb.

Published
2016

49. To switch therapies in RRMS: why and when? A real-life multicentre study

Author

Marinella CLERICO, Signori, A., Maniscalco, G. T., Sacca, F., Lanzillo, R., Lo Fermo, S., Annovazzi, P., Prosperini, L., Cocco, E., Bonavita, S., Clerici, V. Torri, Laroni, A., Repice, A., Zarbo, I. R., Cerqua, R., Di Sapio, A., Pontecorvo, S., Lavorgna, L., Barilla, C., Cordioli, C., Sartori, A., Signoriello, E., La Gioia, S., Frigeni, B., Iaffaldano, P., Di Liberto, A., Frau, J., Gallo, F., and Sormani, M. P.

Published
2016

50. Corrigendum to “Is maraviroc useful in multiple sclerosis patients with natalizumab-related progressive multifocal leukoencephalopathy?” [J. Neurol. Sci. 378 (2017) 233–237]

Author

Scarpazza, C., primary, Prosperini, L., additional, Mancinelli, C.R., additional, De Rossi, N., additional, Lugaresi, A., additional, Capobianco, M., additional, Moiola, L., additional, Naldi, P., additional, Imberti, L., additional, Gerevini, S., additional, and Capra, R., additional

Published
2017
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