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3 results on '"Skromne E"'

1. International consensus on quality standards for brain health-focused care in multiple sclerosis.

Author

Hobart J, Bowen A, Pepper G, Crofts H, Eberhard L, Berger T, Boyko A, Boz C, Butzkueven H, Celius EG, Drulovic J, Flores J, Horáková D, Lebrun-Frénay C, Marrie RA, Overell J, Piehl F, Rasmussen PV, Sá MJ, Sîrbu CA, Skromne E, Torkildsen Ø, van Pesch V, Vollmer T, Zakaria M, Ziemssen T, and Giovannoni G

Subjects
Consensus, Delphi Technique, Humans, Brain pathology, Multiple Sclerosis diagnosis, Multiple Sclerosis pathology, Multiple Sclerosis therapy, Neurology standards
Abstract

Background: Time matters in multiple sclerosis (MS). Irreversible neural damage and cell loss occur from disease onset. The MS community has endorsed a management strategy of prompt diagnosis, timely intervention and regular proactive monitoring of treatment effectiveness and disease activity to improve outcomes in people with MS., Objectives: We sought to develop internationally applicable quality standards for timely, brain health-focused MS care., Methods: A panel of MS specialist neurologists participated in an iterative, online, modified Delphi process to define 'core', 'achievable' and 'aspirational' time frames reflecting minimum, good and high care standards, respectively. A multidisciplinary Reviewing Group (MS nurses, people with MS, allied healthcare professionals) provided insights ensuring recommendations reflected perspectives from multiple stakeholders., Results: Twenty-one MS neurologists from 19 countries reached consensus on most core (25/27), achievable (25/27) and aspirational (22/27) time frames at the end of five rounds. Agreed standards cover six aspects of the care pathway: symptom onset, referral and diagnosis, treatment decisions, lifestyle, disease monitoring and managing new symptoms., Conclusion: These quality standards for core, achievable and aspirational care provide MS teams with a three-level framework for service evaluation, benchmarking and improvement. They have the potential to produce a profound change in the care of people with MS.

Published
2019
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2. Predictors and dynamics of postpartum relapses in women with multiple sclerosis

Author

Steve Vucic, Fraser Moore, Vincent Van Pesch, Maria Edite Rio, Gerardo Iuliano, Norbert Vella, Pierre Duquette, Pierre Grammond, Giorgio Giuliani, Alessandra Lugaresi, Raymond Hupperts, Stella Hughes, Mark Slee, Tim Spelman, Guillermo Izquierdo, Norma Deri, Jeannette Lechner-Scott, Tatjana Petkovska-Boskova, Cameron Shaw, Stanley Hawkins, Maria Laura Saladino, Orla Gray, Eli Skromne, Maria Pia Amato, Michael Barnett, Aldo Savino, Joseph Herbert, Maria Trojano, Edgardo Cristiano, Gavin McDonnell, Cavit Boz, Marc Girard, Helmut Butzkueven, Freek Verheul, Jose Antonio Cabrera-Gomez, Ricardo Fernandez-Bolanos, Francois Grand'Maison, Frank Kee, Celia Oreja-Guevara, Roberto Bergamaschi, Dieter Poehlau, Hughes SE, Spelman T, Gray OM, Boz C, Trojano M, Lugaresi A, Izquierdo G, Duquette P, Girard M, Grand'maison F, Grammond P, Oreja-Guevara C, Hupperts R, Bergamaschi R, Giuliani G, Lechner-Scott J, Barnett M, Edite Rio M, van Pesch V, Amato MP, Iuliano G, Slee M, Verheul F, Cristiano E, Fernández-Bolaños R, Poehlau D, Saladino ML, Deri N, Cabrera-Gomez J, Vella N, Herbert J, Skromne E, Savino A, Shaw C, Moore F, Vucic S, Petkovska-Boskova T, McDonnell G, Hawkins S, Kee F, Butzkueven H, MSBase study group, MUMC+: MA Med Staf Spec Neurologie (9), Klinische Neurowetenschappen, and RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience

Subjects
Adult, Risk, medicine.medical_specialty, Multiple Sclerosis, Relapsing-Remitting, Logistic regression, Disability Evaluation, Multiple Sclerosis, Relapsing-Remitting, Pregnancy, multiple sclerosis, postpartum, relapses, medicine, Humans, Aged, Expanded Disability Status Scale, Obstetrics, business.industry, Multiple sclerosis, Postpartum Period, Case-control study, Middle Aged, medicine.disease, Surgery, Institutional repository, Clinical research, Neurology, Case-Control Studies, Female, Neurology (clinical), business, Postpartum period
Abstract

Background: Several studies have shown that pregnancy reduces multiple sclerosis (MS) relapses, which increase in the early postpartum period. Postpartum relapse risk has been predicted by pre-pregnancy disease activity in some studies. Objective: To re-examine effect of pregnancy on relapses using the large international MSBase Registry, examining predictors of early postpartum relapse. Methods: An observational case–control study was performed including pregnancies post-MS onset. Annualised relapse rate (ARR) and median Expanded Disability Status Scale (EDSS) scores were compared for the 24 months pre-conception, pregnancy and 24 months postpartum periods. Clustered logistic regression was used to investigate predictors of early postpartum relapses. Results: The study included 893 pregnancies in 674 females with MS. ARR (standard error) pre-pregnancy was 0.32 (0.02), which fell to 0.13 (0.03) in the third trimester and rose to 0.61 (0.06) in the first three months postpartum. Median EDSS remained unchanged. Pre-conception ARR and disease-modifying treatment (DMT) predicted early postpartum relapse in a multivariable model. Conclusion: Results confirm a favourable effect on relapses as pregnancy proceeds, and an early postpartum peak. Pre-conception DMT exposure and low ARR were independently protective against postpartum relapse. This novel finding could provide clinicians with a strategy to minimise postpartum relapse risk in women with MS planning pregnancy.

Published
2014

3. Persistence on therapy and propensity matched outcome comparison of two subcutaneous interferon beta 1a dosages for multiple sclerosis

Author

Tobias Derfuss, Tomas Kalincik, Timothy Spelman, Maria Trojano, Pierre Duquette, Guillermo Izquierdo, Pierre Grammond, LUGARESI, ALESSANDRA, Raymond Hupperts, Edgardo Cristiano, Vincent Van Pesch, Francois Grand’Maison, Daniele La Spitaleri, Maria Edite Rio, Sholmo Flechter, Celia Oreja Guevara, Giorgio Giuliani, Aldo Savino, Maria Pia Amato, Thor Petersen, Ricardo Fernandez Bolanos, Roberto Bergamaschi, Gerardo Iuliano, Cavit Boz, Jeannette Lechner Scott, Norma Deri, Orla Gray, Freek Verheul, Marcela Fiol, Michael Barnett, Erik van Munster, Vetere Santiago, Fraser Moore, Mark Slee, Maria Laura Saladino, Raed Alroughani, Cameron Shaw, Krisztian Kasa, Tatjana Petkovska Boskova, Leontien den Braber Moerland, Joab Chapman, Eli Skromne, Joseph Herbert, Dieter Poehlau, Merrilee Needham, Elizabeth Alejandra Bacile Bacile, Walter Oleschko Arruda, Mark Paine, Bhim Singhal, Steve Vucic, Jose Antonio Cabrera Gomez, Helmut Butzkueven, MSBase Study Group, Klinische Neurowetenschappen, RS: MHeNs School for Mental Health and Neuroscience, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, Tobias Derfu, Tomas Kalincik, Timothy Spelman, Maria Trojano, Pierre Duquette, Guillermo Izquierdo, Pierre Grammond, Alessandra Lugaresi, Raymond Huppert, Edgardo Cristiano, Vincent Van Pesch, Francois Grand’Maison, Daniele La Spitaleri, Maria Edite Rio, Sholmo Flechter, Celia Oreja-Guevara, Giorgio Giuliani, Aldo Savino, Maria Pia Amato, Thor Petersen, Ricardo Fernandez-Bolano, Roberto Bergamaschi, Gerardo Iuliano, Cavit Boz, Jeannette Lechner-Scott, Norma Deri, Orla Gray, Freek Verheul, Marcela Fiol, Michael Barnett, Erik van Munster, Vetere Santiago, Fraser Moore, Mark Slee, Maria Laura Saladino, Raed Alroughani, Cameron Shaw, Krisztian Kasa, Tatjana Petkovska-Boskova, Leontien den Braber-Moerland, Joab Chapman, Eli Skromne, Joseph Herbert, Dieter Poehlau, Merrilee Needham, Elizabeth Alejandra Bacile Bacile, Walter Oleschko Arruda, Mark Paine, Bhim Singhal, Steve Vucic, Jose Antonio Cabrera-Gomez, Helmut Butzkueven, MSBase Study Group, The MSBase Study Group, [Karkincic,T, and Butzkueven,H] Departments of Medicine and Neurology, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia. [Spelman,T] Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia. [Trojano,M] Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy. [Duquette,P] Hòpital Notre Dame, Montreal, Canada. [Izquierdo,G] Hospital Universitario Virgen Macarena, Sevilla, Spain. [Grammond,P] Hotel-Dieu de Levis, Quebec, Canada. [Lugaresi,A] MS Center, Department of Neuroscience and Imaging, University ‘G. d’Annunzio’, Chieti, Italy. [Hupperts,R] Maaslandziekenhuis, Sittard, The Netherlands. [Cristiano,E] Hospital Italiano, Buenos Aires, Argentina. [Van Pesch,V] Cliniques Universitaires Saint-Luc, Brussels, Belgium. [Grand´Maison,F ]Neuro Rive-Sud, Hòpital Charles LeMoyne, Quebec, Canada. [La Spitaleri,D] AORN San Giuseppe Moscati, Avellino, Italy. [Rio,ME] Hospital S. Joao, Porto, Portugal. [Flechter,S] Assaf Harofeh Medical Center, Beer-Yaakov, Israel. [Oreja-Guevera,C] University Hospital San Carlos, IdISSC, Madrid, Spain. [Giuliani,G] Ospedale di Macerata, Macerata, Italy. [Savino,A] Consultorio Privado, Buenos Aires, Argentina. [Amato,MP] Department NEUROFARBA, Section of Neurology, University of Florence, Florence, Italy. [Petersen,T] Kommunehospitalet, Aarhus C, Denmark. [Fernandez-Bolanos,R] Hospital Universitario Virgen de Valme, Seville, Spain. [Bergamaschi,R] Neurological Institute IRCCS Mondino, Pavia, Italy. [Iuliano,G] Ospedali Riuniti di Salerno, Salerno, Italy. [Boz,C] Karadeniz Technical University, Trabzon, Turkey. [Lechner-Scott,J] John Hunter Hospital, Newcastle, Australia. [Deri,N] Hospital Fernandez, Buenos Aires, Argentina.[Gray,O] Craigavon Area Hospital, Portadown, United Kingdom. [Verheul,F] Groen Hart Ziekenhuis, Gouda, The Netherlands. [Fiol,M] FLENI, Buenos Aires, Argentina. [Barnett,M] Brain and Mind Research Institute, Sydney, Australia. [van Munster,E] Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, The Netherlands. [Santiago,V]HIGA Gral, San Martin La Plata, Argentina. [Moore,F] Jewish General Hospital, McGill University, Montreal, Canada. [Slee,M] Flinders University and Medical Centre, Adelaide, Australia. [Saladino,ML] INEBA, Buenos Aires, Argentina. [Alroughani,R] Amiri Hospital, Kuwait City, Kuwait. [Shaw,C] Geelong Hospital, Geelong, Australia. [Kasa,K] Jahn Ferenc Teaching Hospital, Budapest, Hungary. [Petkovska-Boskova,T] Clinic of Neurology Clinical Center, Skopje, Macedonia. [den Braber-Moerland,L] Francicus Ziekenhuis, Roosendaal, The Netherlands. [Chapman,J] Sheba Medical Center, Tel Hashomer, Israel. [Skromne,E] Hospital Angeles Mexico City, Lomas, Mexico. [Herbert,J] New York University Hospital for Joint Diseases, New York, New York, United States of America. [Poehlau,D] Multiple Sclerosis Centre Kamillus-Klinik, Asbach, Germany. [Needham,M] Royal North Shore Hospital, Sydney, Australi. [Bacile Bacile,EA] Instituto de Neurociencias Cordoba, Cordoba, Argentin. [Arruda,WO] Hospital Ecoville, Curitiba, Brazil. [Paine, M] St Vincent’s Hospital, Melbourne, Australia. [Sighal,B] Bombay Hospital Institute of Medical Sciences, Mumbai, India. [Vucic,S] Westmead Hospital, Sydney, Australia. [Cabrera-Gomez,JA] Centro Internacional de Restauracion Neurologica, Havana, Cuba. [Butzkueven,H] Department of Neurology, Box Hill Hospital and Monash University, Melbourne, Australia.

Subjects
Male, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Patient Care::Withholding Treatment [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Magnetic Resonance Imaging [Medical Subject Headings], Kaplan-Meier Estimate, law.invention, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Randomized controlled trial, law, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models, Statistical::Likelihood Functions [Medical Subject Headings], Longitudinal Studies, Non-U.S. Gov't, Espectroscopía de resonancia magnética, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Drug Administration Schedule [Medical Subject Headings], Likelihood Functions, Multidisciplinary, Adulto, Subcutaneous, Research Support, Non-U.S. Gov't, Statistics, Drug Information, Magnetic Resonance Imaging, Clinical Trial, Funciones de verosimilitud, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Research Design::Reproducibility of Results [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Drug Therapy::Drug Administration Routes::Injections::Injections, Subcutaneous [Medical Subject Headings], Treatment Outcome, Relación dosis-respuesta a droga, Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Intercellular Signaling Peptides and Proteins::Cytokines::Interferons::Interferon Type I::Interferon-beta [Medical Subject Headings], Neurology, Observational Studies, Medicine, Female, Drug, Interferon beta-1a, Research Article, medicine.drug, Adult, Drugs and Devices, medicine.medical_specialty, Multiple Sclerosis, Clinical Research Design, Science, Injections, Subcutaneous, Cumplimiento y adherencia al tratamiento, Reproducibilidad de los resultados, Check Tags::Male [Medical Subject Headings], Biostatistics, Diseases::Nervous System Diseases::Autoimmune Diseases of the Nervous System::Demyelinating Autoimmune Diseases, CNS::Multiple Sclerosis [Medical Subject Headings], Research Support, Drug Administration Schedule, Autoimmune Diseases, Injections, Medication Adherence, Dose-Response Relationship, Adverse Reactions, Internal medicine, Covariate, Named Groups::Persons::Age Groups::Adult [Medical Subject Headings], medicine, Journal Article, Humans, Comparative Study, Statistical Methods, Adverse effect, Propensity Score, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings], Demography, Interferón beta, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Survival Analysis::Kaplan-Meier Estimate [Medical Subject Headings], Dose-Response Relationship, Drug, business.industry, Phenomena and Processes::Physiological Phenomena::Pharmacological Phenomena::Dose-Response Relationship, Drug [Medical Subject Headings], Multiple sclerosis, Reproducibility of Results, Inyecciones subcutáneas, multiple sclerosis drug therapy, Interferon-beta, medicine.disease, Disciplines and Occupations::Social Sciences::Demography [Medical Subject Headings], Demyelinating Disorders, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Propensity Score [Medical Subject Headings], Clinical trial, Check Tags::Female [Medical Subject Headings], Withholding Treatment, Esclerosis múltiple, Psychiatry and Psychology::Behavior and Behavior Mechanisms::Behavior::Health Behavior::Patient Compliance::Medication Adherence [Medical Subject Headings], Propensity score matching, Clinical Immunology, Observational study, Resultado del tratamiento, business, Privación del tratamiento, Mathematics
Abstract

Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; OBJECTIVES To compare treatment persistence between two dosages of interferon β-1a in a large observational multiple sclerosis registry and assess disease outcomes of first line MS treatment at these dosages using propensity scoring to adjust for baseline imbalance in disease characteristics. METHODS Treatment discontinuations were evaluated in all patients within the MSBase registry who commenced interferon β-1a SC thrice weekly (n = 4678). Furthermore, we assessed 2-year clinical outcomes in 1220 patients treated with interferon β-1a in either dosage (22 µg or 44 µg) as their first disease modifying agent, matched on propensity score calculated from pre-treatment demographic and clinical variables. A subgroup analysis was performed on 456 matched patients who also had baseline MRI variables recorded. RESULTS Overall, 4054 treatment discontinuations were recorded in 3059 patients. The patients receiving the lower interferon dosage were more likely to discontinue treatment than those with the higher dosage (25% vs. 20% annual probability of discontinuation, respectively). This was seen in discontinuations with reasons recorded as "lack of efficacy" (3.3% vs. 1.7%), "scheduled stop" (2.2% vs. 1.3%) or without the reason recorded (16.7% vs. 13.3% annual discontinuation rate, 22 µg vs. 44 µg dosage, respectively). Propensity score was determined by treating centre and disability (score without MRI parameters) or centre, sex and number of contrast-enhancing lesions (score including MRI parameters). No differences in clinical outcomes at two years (relapse rate, time relapse-free and disability) were observed between the matched patients treated with either of the interferon dosages. CONCLUSIONS Treatment discontinuations were more common in interferon β-1a 22 µg SC thrice weekly. However, 2-year clinical outcomes did not differ between patients receiving the different dosages, thus replicating in a registry dataset derived from "real-world" database the results of the pivotal randomised trial. Propensity score matching effectively minimised baseline covariate imbalance between two directly compared sub-populations from a large observational registry. This study was funded by MSBase Foundation, a not-for-profit organisation. The MSBase Foundation receives financial support from Merck Serono, Biogen Idec, Novartis Pharma, Bayer Schering and Sanofi Aventis. The study was also funded by Multiple Sclerosis Research Australia and MSAngels. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Yes

Published
2013

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