BackgroundAdherence to disease-modifying drugs (DMDs) is one of the key factors for achieving optimal clinical outcomes. Rebismart® is an injection device for subcutaneous administration of interferon beta-1a (INF β-1a) that is also able to monitor adherence objectively. The aim of this study was to describe adherence to INF β-1a using the said electronic autoinjection device and to explore the relationship between adherence and relapses in a Spanish cohort.MethodsThis is a retrospective observational study in which 110 Spanish patients self-administered INF β-1a subcutaneously using an electronic autoinjection device between June 2010 and June 2015. The primary end point was the percentage of adherence measured by Rebismart® to subcutaneous INF β-1a injections calculated as number of injections received in time period versus number of injections scheduled in time period. Other variables recorded were demographic and clinical data. Statistical analysis was performed using SPSS 19.0 software.ResultsMedian adherence for the total study period was 96.5% (interquartile range [IQR]: 91.1–99.1). Similar values were observed during the first 6 months: 98.7% (IQR: 91.3–100), and the last 6 months: 97.6% (IQR: 91.1–99.8). Median duration of treatment was 979 days (IQR: 613.8–1,266.8). During the entire treatment period, 77.3% of patients were relapse free and mean annualized relapse rate was 0.14 (standard deviation: 0.33). Increased adherence was associated with better clinical outcomes, leading to lower relapse risk (odds ratio: 0.953; 95% confidence interval: 0.912–0.995). Specifically, every percentage unit increase in adherence resulted in a 4.7% decrease in relapse.ConclusionPatients with multiple sclerosis who self-injected INF β-1a with Rebismart® had excellent adherence, correlating with a high proportion of relapse-free patients and very low annualized relapse rate.
BackgroundProgressive multifocal leukoencephalopathy(PML) is caused by JC virus (JCV) and has severe consequences for the central nervous system. PML is an opportunistic infection, affecting HIV positive patients. There is no curative treatment, and the current approach is focused on immune reconstitution and antiviral therapy.1
PurposeThis is a case report of two patients with PML associated with HIV infection treated with aldesleukin/interleukin-2 (IL-2).Material and methodsWe report two cases, both men, aged 48 years (patient A) and 57 years (patient B), HIV diagnosed in 1992 and 1993, who developed LMP opportunistic JCV infection. Antiretrovirals were the only therapy previously employed. Patient A developed progressive neurological impairment, slow psychic reactions and right upper limb strength loss. Symptoms in patient B were progressive cognitive impairment, memory loss, lack of coordination, dysarthria, strength loss and right facial paralysis. Both patients showed hypodensity of white matter in the semi-oval centre on cranial CT.ResultsIL-2 was administered intravenously to both patients at 0.5 MU/m²/day for 4 weeks. Patient-A: IL-2 treatment (from 8 February 2010 to 7 March 2010) was well tolerated, although a self-limited fever and eosinophilia were reported without clinical correlations. The patient showed improvements in image tests (disappearance of signal hyperintensity and cytotoxic oedema on CT and MRI) and clinical outcomes (improvement of neurological symptoms), although progressive spasticity and dysarthria were maintained. JCV load was undetectable in February 2011. Patient A was treated for 1 year with mefloquine 250 mg/24 hours with good tolerance and stabilisation of PML, but without resolution. The patient died in December 2012 following intraparenchymal cerebral haemorrhage. Patient-B: therapy with IL-2 and mirtazapine (from 8 September 2016 to 5 October 2016) was well tolerated, but the infusion was discontinued once by a fever episode. Cranial CT showed no significant changes. The patient´s neurological impairment, hemiparesis and dysarthria persisted, but a slight improvement was observed. JCV load declined from >100 million to 12 million copies/mL, HIV from 645 to 147 copies/mL and CD4 T lymphocytes increased.ConclusionIL-2 could be an effective and well tolerated therapy in LMP, without severe adverse events. Patient A showed improvements in neurological and image tests, and undetectable viral load, whereas the response in patient B was only partial, with a decline in JCV and HIV, but maintaining neurological deterioration.References and/or acknowledgements1. Pavlovic D, et al. Ther Adv Neurol Disord2015;8:255–73.No conflict of interest
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