Cyclophosphamide (CTX) is an alkylating agent related to nitrogen mustards whose anti- inflammatory and immunosuppressive effects have been utilised to treat selected cases of multiple sclerosis with a progressive and...Cyclophosphamide (CTX) is an alkylating agent related to nitrogen mustards whose anti- inflammatory and immunosuppressive effects have been utilised to treat selected cases of multiple sclerosis with a progressive and worsening course. To halt the progression of disease in patients refractory to disease modifying drugs CTX has been given, and several open- label studies have recently shown clinical benefits. In a previous study we demonstrated the effectiveness of a combination of IV monthly pulses of CTX and interferon β .(IFN- β )in10 patients with “ rapidly transitional" form of multiple sclerosis characterised by severe and frequent attacks and rapid progression of disability. The present study reports the clinical and MRI follow- up 36 months after the discontinuation of CTX showing the maintenance of the results obtained in relapse rate (p < 0.001), EDSS (p < 0.001), T2 MRI total lesion load (p < 0.001) and T2 lesions number (p < 0.001) compared to the pre- treatment period. These encouraging findings and the absence of significant recorded side effects affirm that the association of CTX plus interferon- beta is amenable, safe and can be recommended in rapidly worsening MS patients.展开更多
Background: African Americans (AAs) with multiple sclerosis (MS) seem to have a more severe disease course than white Americans (WAs). To our knowledge, it is not known to what extent treatment with interferon beta-1a...Background: African Americans (AAs) with multiple sclerosis (MS) seem to have a more severe disease course than white Americans (WAs). To our knowledge, it is not known to what extent treatment with interferon beta-1a will effect the MS disease course within the AA population. Objective: To compare the response to treatment with interferon beta-1a between AA and WA MS patients. Design: This is an exploratory post hoc analysis of the Evidence of Interferon Dose-Response: European North American Comparative Efficacy (EVIDENCE) study. Setting: The EVID ENCE study is a randomized controlled trial that compared the efficacy of once weekly, intramuscular, 30-μg interferon beta-1a treatment with thrice weekly, subcutaneous, 44-μg interferon beta-1a therapy in treatment-nave MS subjects. Participants: Thirty-six AA subjects were compared with 616 WA subjects. Main Outcome Measures: The number of MS exacerbatio ns, the proportion of exacerbation-free subjects, and the number of new MS lesions present on brain magnetic resonance imaging were compared between AA and WA subjects at 24 and 48 weeks after initiating treatment with interferon beta-1a. Results: The AA subjects experienced more exacerbations and were less likely to remain exacerbation free (statistical trends). The AA subjects developed more new MS lesions on T2-weighted brain magnetic resonance imaging at 48 weeks (P=.04). Conclusions: Despite the small sample size, AA subjects appeared less responsive to treatment than WA subj ects on outcome measures, reaching significance only for T2-weighted lesion count at 48 weeks. However, it is difficult to base these differences solely on response to treatment given the potential differing in MS disease course in AA patients.展开更多
文摘Cyclophosphamide (CTX) is an alkylating agent related to nitrogen mustards whose anti- inflammatory and immunosuppressive effects have been utilised to treat selected cases of multiple sclerosis with a progressive and worsening course. To halt the progression of disease in patients refractory to disease modifying drugs CTX has been given, and several open- label studies have recently shown clinical benefits. In a previous study we demonstrated the effectiveness of a combination of IV monthly pulses of CTX and interferon β .(IFN- β )in10 patients with “ rapidly transitional" form of multiple sclerosis characterised by severe and frequent attacks and rapid progression of disability. The present study reports the clinical and MRI follow- up 36 months after the discontinuation of CTX showing the maintenance of the results obtained in relapse rate (p < 0.001), EDSS (p < 0.001), T2 MRI total lesion load (p < 0.001) and T2 lesions number (p < 0.001) compared to the pre- treatment period. These encouraging findings and the absence of significant recorded side effects affirm that the association of CTX plus interferon- beta is amenable, safe and can be recommended in rapidly worsening MS patients.
文摘Background: African Americans (AAs) with multiple sclerosis (MS) seem to have a more severe disease course than white Americans (WAs). To our knowledge, it is not known to what extent treatment with interferon beta-1a will effect the MS disease course within the AA population. Objective: To compare the response to treatment with interferon beta-1a between AA and WA MS patients. Design: This is an exploratory post hoc analysis of the Evidence of Interferon Dose-Response: European North American Comparative Efficacy (EVIDENCE) study. Setting: The EVID ENCE study is a randomized controlled trial that compared the efficacy of once weekly, intramuscular, 30-μg interferon beta-1a treatment with thrice weekly, subcutaneous, 44-μg interferon beta-1a therapy in treatment-nave MS subjects. Participants: Thirty-six AA subjects were compared with 616 WA subjects. Main Outcome Measures: The number of MS exacerbatio ns, the proportion of exacerbation-free subjects, and the number of new MS lesions present on brain magnetic resonance imaging were compared between AA and WA subjects at 24 and 48 weeks after initiating treatment with interferon beta-1a. Results: The AA subjects experienced more exacerbations and were less likely to remain exacerbation free (statistical trends). The AA subjects developed more new MS lesions on T2-weighted brain magnetic resonance imaging at 48 weeks (P=.04). Conclusions: Despite the small sample size, AA subjects appeared less responsive to treatment than WA subj ects on outcome measures, reaching significance only for T2-weighted lesion count at 48 weeks. However, it is difficult to base these differences solely on response to treatment given the potential differing in MS disease course in AA patients.
