- Liver injury with drugs used for multiple sclerosis: A contemporary analysis of the FDA Adverse Event Reporting System. [Journal Article]
- MSMult Scler 2018 Sep 19; :1352458518799598
- CONCLUSIONS: These real-world pharmacovigilance findings suggest that DILI might be a common feature of MS drugs and call for (1) formal population-based study to verify the risk of fampridine and (2) awareness by clinicians, who should assess the possible responsibility of MS drugs when they diagnose DILI.
- Childhood multiple sclerosis: clinical features and recent developments on treatment choices and outcomes. [Journal Article]
- EREur Rev Med Pharmacol Sci 2018; 22(17):5747-5754
- Multiple sclerosis (MS) is an inflammatory idiopathic autoimmune disease causing demyelination of central nervous system (CNS). The incidence of pediatric MS is relatively rare, affecting 0.2 to 0.64...
Multiple sclerosis (MS) is an inflammatory idiopathic autoimmune disease causing demyelination of central nervous system (CNS). The incidence of pediatric MS is relatively rare, affecting 0.2 to 0.64/100,000 subjects; cases with MS onset before age 10-12 years, account for less than 1% of all MS cases, while 2.7 to 10.5% of all MS cases worldwide are seen in children <18 years of age, with a strong female preponderance. The disease course of MS varies from a benign type with relatively low level of disability after a long duration (15 years) of the disease, to a malignant type of MS with severe disability or even death within few months following onset. Diagnostic criteria for pediatric MS include ≥ 2 clinical events involving more areas of CNS inflammation in the absence of encephalopathy, separated by > 30 days, along with the involvement of brainstem. Pediatric MS generally presents relapsing-remittent form of MS, with majority of the patients recovering from the first attack. Major histocompatibility complex, more specifically, mutations in the human leukocyte antigen (HLA) DRB1*15 allele, are considered most important genetic factors that are contributory to the disease. Treatment choices for pediatric MS include many disease-modifying therapies (DMT) that are currently being used for adult MS and these are interferon-β 1a/1b (IFN-β1a/1b), glatiramer acetate, teriflunomide, dimethyl fumarate, alemtuzumab, etc. However, most of these have not gone through complete testing in randomized, placebo-controlled clinical trials for pediatric MS and are being prescribed off-label by clinicians. As these studies are progressing, it is important to address if these approaches of treating pediatric MS patients have any long-term impact on patients, in particular, physical, cognitive, developmental and social outcomes of the children.
- Author response: Alemtuzumab CARE-MS II 5-year follow-up: Efficacy and safety findings. [Journal Article]
- NeurNeurology 2018 Sep 18; 91(12):581-582
- Reader response: Alemtuzumab CARE-MS II 5-year follow-up: Efficacy and safety findings. [Journal Article]
- NeurNeurology 2018 Sep 18; 91(12):580
- Editors' note: Alemtuzumab CARE-MS II 5-year follow-up: Efficacy and safety findings. [Journal Article]
- NeurNeurology 2018 Sep 18; 91(12):580
- Serum sickness (Like Reaction) in a patient treated with alemtuzumab for multiple sclerosis: A case report. [Journal Article]
- MSMult Scler Relat Disord 2018 Sep 11; 26:52-54
- CONCLUSIONS: SS/SSLR should be considered in patients treated with alemtuzumab developing delayed fever, rash and arthralgia and differentiated with Infusion Associated Reactions (IARs) and infections.
- Immunoglobulin prophylaxis in pediatric hematopoietic stem cell transplant. [Journal Article]
- PBPediatr Blood Cancer 2018 Sep 11; :e27348
- CONCLUSIONS: Dosing IVIG to maintain an IgG level > 400 mg/dl is a cost-effective and safe way to prevent viral infections in pediatric patients undergoing HSCT.
- Current and emerging treatment options for autoimmune hemolytic anemia. [Journal Article]
- ERExpert Rev Clin Immunol 2018 Sep 11
- Autoimmune hemolytic anemia (AIHA) is a heterogeneous disease mainly due to autoantibody-mediated destruction of erythrocytes but also involves complement activation, dysregulation of cellular and in...
Autoimmune hemolytic anemia (AIHA) is a heterogeneous disease mainly due to autoantibody-mediated destruction of erythrocytes but also involves complement activation, dysregulation of cellular and innate immunity, and defective bone marrow compensatory response. Several drugs targeting these mechanisms are under development in addition to standard therapies. Areas covered: The following targeted therapies are illustrated: drugs acting on CD20 (rituximab, alone or in association with bendamustine and fludarabine) and CD52 (alemtuzumab), B cell receptor and proteasome inhibitors (ibrutinib, bortezomib), complement inhibitors (eculizumab, BIVV009, APL-2), and other drugs targeting T lymphocytes (subcutaneous IL-2, belimumab, and mTOR inhibitors), IgG driven extravascular hemolysis (fostamatinib), and bone marrow activity (luspatercept). Expert opinion: Although AIHA is considered benign and often easy to treat, chronic/refractory cases represent a challenge even for experts in the field. Bone marrow biopsy is fundamental to assess one of the main mechanisms contributing to AIHA severity, i.e. inadequate compensation, along with lymphoid infiltrate, the presence of fibrosis or dyserythropoiesis. The latter may give hints for targeted therapies (either B or T cell directed) and for new immunomodulatory drugs. Future studies on the genomic landscape in AIHA will further help in designing the best choice, sequence and/or combination of targeted therapies.
- Alemtuzumab-containing reduced intensity conditioning allogenic hematopoietic stem cell transplantation in a case of primary progressive multiple sclerosis. [Journal Article]
- MSMult Scler Relat Disord 2018 Aug 31; 25:334-336
- Increasing evidence has emerged lately regarding the use of autologous hematopoietic stem cell transplantation (HSCT) in the treatment of aggressive multiple sclerosis (MS). However, data is scarce r...
Increasing evidence has emerged lately regarding the use of autologous hematopoietic stem cell transplantation (HSCT) in the treatment of aggressive multiple sclerosis (MS). However, data is scarce regarding the use of allogenic HSCT in treating MS. We present a 42 years old male with aplastic anemia who underwent allogenic HSCT for severe aplastic anemia. This patient was diagnosed with primary progressive multiple sclerosis (PPMS) one-year post transplant and had to undergo a second HSCT due to his hematological disorder. His second HSCT was conditioned with an alemtuzumab containing regimen, after which his MRI and expanded disability status scale (EDSS) remained to be stable for 18 months.
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- Efficacy and safety of monoclonal antibody therapies for relapsing remitting multiple sclerosis: A network meta-analysis. [Journal Article]
- MSMult Scler Relat Disord 2018 Aug 29; 25:322-328
- CONCLUSIONS: This network meta-analysis provided a comprehensive summary of efficacy and safety of monoclonal antibodies for RRMS, which might provide a reference for treatment. More direct comparison studies are warranted.