Demographic Analysis of Patients With Multiple Sclerosis; Individual Variability Related to the Time Interval

Tolou-Ghamari, Zahra

doi:10.5812/archneurosci.21806

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…Therapeutic trials using rituximab for CD20-targeting and B-cell diminishing have specified the escalation to encourage the methods related to the duty of B-cells in the pathogenesis of MS in young adults. The monoclonal antibody, rituximab, by depleting CD20 + B-cells demonstrated efficacy in reducing disease activity in relapsing-remitting MS. Other developing therapies included alemtuzumab, daclizumab, laquinimod, estriol, 3-hydroxy-3methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins), and vitamin D (26)(27)(28)(29)(30)(31). In exceptional individuals with MS, mostly fulminant or types that fail to recover subsequent management with steroids and plasma exchange, cytotoxic drugs such as cyclophosphamide or B cell-depleting regimen such as rituximab might be prescribed (31).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Toxicity of Rituximab in Multiple Sclerosis

Tolou-Ghamari

2016

Arch Neurosci

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Context: Bothersome relapses or conditions that damage function in patients with multiple sclerosis (MS) need a well-focused strategy of appropriate management to return patients' function and decrease the disability. A large number of clinical studies are being accompanied to evaluate the effectiveness and adverse effects of rituximab. Deteriorations assist as significant signs of disorder activity. In such conditions B cell-depleting regimens such as rituximab may be considered. To attain major motivation and gather talented satisfying evidence, strong review articles and research could try to focus on the best time to prescribe rituximab in MS. Evidence Acquisition: Clinical trials and review articles to achieve efficacy and safety of rituximab in MS were searched. The current study first offered an outline of the rituximab pharmacokinetics parameters in overall, suggested mechanisms of action that contribute to the beneficial effects of rituximab and the perfect timing of prescription-based therapies for MS. Results: A total of 647 articles (1997 -2015) were found related to efficacy, safety and pharmacokinetics parameters of rituximab in MS. Six articles (3; 2009, 1; 2010 and 2; 2011) were related to the use of rituximab in: primary progressive MS, autoimmune disease, refractory and autoimmune pediatric disease, 52-week phase II clinical trials and relapsing neuromyelitis optica were studied further. In phase II clinical trials based on blinded radiological end-points pharmacotherapy using rituximab suggested to be effective. There is also report regarding to less increase in T2 lesion volume (P < 0.001) after two years of rituximab management. There was no change in brain volume (P = 0.62). There was a delay in patients less than 51 years related to the disease progression. Adverse effects were reported in < 5% of patients with rituximab. Also it has been reported that in 28 out of 30 patients with neuromyelitis optica, there was a significant reduction in the rate of relapse over two years. Conclusions: The current study aimed to evaluate the efficacy of rituximab in patients with MS. Due to inter and intra individual variability in disease presentation and its progression, rituximab should be prescribed cautiously.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Toxicity of Rituximab in Multiple Sclerosis

Tolou-Ghamari

2016

Arch Neurosci

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“…However, relapses are common and represent a major feature of MS but when relapses occurs, disability is accumulated and clinical management could face a big gap among different patients with MS (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). In patients with MS, those that receive disease-modifying drugs (DMDs) but still experience high disease activity, require different pharmacotherapy strategies (13)(14)(15)(16)(17)(18).…”

Section: Pharmacotherapy Strategy For Relapsing-remitting Multiple Scmentioning

confidence: 99%

Fingolimod for Multiple Sclerosis; Mechanism of Action, Safety and Toxicity

Tolou-Ghamari

Mazdak

2016

Arch Neurosci

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Context: From the year 2010, for patients with highly active relapsing-remitting (RR) multiple sclerosis (MS), fingolimod could be justified for prescription as an oral medication. Previous published clinical trials identified that the drug could reduce autoaggressive lymphocyte infiltration into the central nervous system (CNS) through the blood brain barrier (BBB), by stoppage of lymphocyte passage from lymphoid tissues.Evidence Acquisition: The aim of this study was to provide a comprehensive review related to the pharmacotherapy of fingolimod for MS, by gathering data related to previous clinical and laboratory trials. The key words relevant to the topic were searched through the United States national library of medicine. Significant manuscripts associated with fingolimod pharmacotherapy for MS were nominated and studied completely. Results:In patients with MS due to multifactorial pathogenesis, in both white and gray matter of CNS, multifocal lesions might be recognized. CD4+ and CD8 + effector T cells, sensitive to CNS myelin antigens, are assumed to facilitate the preliminary stage of injury formation. Fingolimod -therapy in patients at the RRMS phase, reserve lymphocyte egress from lymphocyte nodes and disturb its' recirculation in the CNS. Previous clinical trials confirmed that once-daily oral administration of 0.5 mg fingolimod for one year causes a decrease in annualized relapse rate. Reduction in the annualized relapse rate has been reported, related to the study of 249 patients with RRMS. Reduction in disability progression after three and six months has been reported, respectively. The numbers of new or newly enlarged T2 lesions were shown to have reduced. Head cold, headache, fatigue, macular edema, herpes and zoster infections, bradycardia, relapse and basal-cell carcinoma have been reported as side-effects related to finglimod-therapy for MS. Conclusions:However, fingolimod-therapy could provide flexibility regarding the ease of oral use for patients with RRMS, but rationalization related to the prescription are largely based on inter-and intra-individual variation. Due to unpredictability in disease manifestation and its' progression, caution must be taken with drug prescription. Additional studies based on advanced pharmacotherapy trials appear to be valuable.

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Demographic Analysis of Patients With Multiple Sclerosis; Individual Variability Related to the Time Interval

Cited by 2 publications

References 18 publications

Efficacy and Toxicity of Rituximab in Multiple Sclerosis

Efficacy and Toxicity of Rituximab in Multiple Sclerosis

Fingolimod for Multiple Sclerosis; Mechanism of Action, Safety and Toxicity

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