Efficacy of fingolimod and interferon beta-1b on cognitive, MRI, and clinical outcomes in relapsing-remitting multiple sclerosis: an 18-month, open-label, rater-blinded, randomised, multicentre study (the GOLDEN study)

: Cognitive impairment (CI) affects 40-65% of multiple sclerosis (MS) patients. This study attempted evaluating the effects of fingolimod and interferon beta-1b (IFN β-1b) on CI progression, magnetic resonance imaging (MRI) and clinical outcomes in relapsing-remitting MS (RRMS) patients over 18 months. The GOLDEN study was a pilot study including RRMS patients with CI randomised (2:1) to fingolimod (0.5 mg daily)/IFN β-1b (250 µg every other day). CI was assessed via Rao's Brief Repeatable Battery and Delis-Kaplan Executive Function System test. MRI parameters, Expanded Disability Status Scale scores and relapses were measured. Overall, 157 patients were randomised, of whom 30 discontinued the study (fingolimod, 8.49%; IFN β-1b, 41.18%; p ≤ 0.0001). Patients randomised to fingolimod had more severe clinical and MRI disease characteristics at baseline compared with IFN β-1b. At Month (M) 18, both treatment groups showed improvements in all cognitive parameters. At M18, relapse rate, total number and volume of T2/T1 gadolinium-enhancing lesions were higher with IFN β-1b, as well as the percentage brain volume change during the study. Safety and tolerability of both treatments were similar to previous studies. Both treatments showed improvements in cognitive parameters. Fingolimod demonstrated significantly better effects on MRI parameters and relapse rate. Imbalance in baseline characteristics and the drop-out pattern may have favoured IFN β-1b. A longer duration trial may be needed to observe the complete expression of differential effects on CI scales reflecting the between-groups differences on MRI. Although limited in size, the GOLDEN study confirms the favourable benefit-risk profile of fingolimod reported in previous studies

Effects of the Chemical Treatment on the Physical-Chemical and Electrochemical Properties of the Commercial Nafion™ NR212 Membrane

Polymer Electrolyte Fuel Cells (PEFCs) are one of the most promising power generation systems. The main component of a PEFC is the proton exchange membrane (PEM), object of intense research to improve the efficiency of the cell. The most commonly and commercially successful used PEMs are Nafion™ perfluorosulfonic acid (PFSA) membranes, taken as a reference for the development of innovative and alternative membranes. Usually, these membranes undergo different pre-treatments to enhance their characteristics. With the aim of understanding the utility and the effects of such pre-treatments, in this study, a commercial Nafion™ NR212 membrane was subjected to two different chemical pre-treatments, before usage. HNO3 or H2O2 were selected as chemical agents because the most widely used ones in the procedure protocols in order to prepare the membrane in a well-defined reference state. The pre-treated membranes properties were compared to an untreated membrane, used as-received. The investigation has showed that the pre-treatments enhance the hydrophilicity and increase the water molecules coordinated to the sulphonic groups in the membrane structure, on the other hand the swelling of the membranes also increases. As a consequence, the untreated membrane shows a better mechanical resistance, a good electrochemical performance and durability in fuel cell operations, orienting toward the use of the NR212 membrane without any chemical pre-treatment

Anionic Exchange Membrane for Photo-Electrolysis Application

Tandem photo-electro-chemical cells composed of an assembly of a solid electrolyte membrane and two low-cost photoelectrodes have been developed to generate green solar fuel from water-splitting. In this regard, an anion-exchange polymer–electrolyte membrane, able to separate H2 evolved at the photocathode from O2 at the photoanode, was investigated in terms of ionic conductivity, corrosion mitigation, and light transmission for a tandem photo-electro-chemical configuration. The designed anionic membranes, based on polysulfone polymer, contained positive fixed functionalities on the side chains of the polymeric network, particularly quaternary ammonium species counterbalanced by hydroxide anions. The membrane was first investigated in alkaline solution, KOH or NaOH at different concentrations, to optimize the ion-exchange process. Exchange in 1M KOH solution provided high conversion of the groups, a high ion-exchange capacity (IEC) value of 1.59 meq/g and a hydroxide conductivity of 25 mS/cm at 60 °C for anionic membrane. Another important characteristic, verified for hydroxide membrane, was its transparency above 600 nm, thus making it a good candidate for tandem cell applications in which the illuminated photoanode absorbs the highest-energy photons (< 600 nm), and photocathode absorbs the lowest-energy photons. Furthermore, hydrogen crossover tests showed a permeation of H2 through the membrane of less than 0.1%. Finally, low-cost tandem photo-electro-chemical cells, formed by titanium-doped hematite and ionomer at the photoanode and cupric oxide and ionomer at the photocathode, separated by a solid membrane in OH form, were assembled to optimize the influence of ionomer-loading dispersion. Maximum enthalpy (1.7%), throughput (2.9%), and Gibbs energy efficiencies (1.3%) were reached by using n-propanol/ethanol (1:1 wt.) as solvent for ionomer dispersion and with a 25 µL cm−2 ionomer loading for both the photoanode and the photocathode

Effectiveness of Ocrelizumab in Primary Progressive Multiple Sclerosis: a multicenter, retrospective, real-world study (OPPORTUNITY)

Ocrelizumab is a recombinant humanized monoclonal antibody selectively targeting CD20-expressing B cells. The effect of ocrelizumab on primary progressive multiple sclerosis (PPMS) has been evaluated during phase 3 trials that enrolled patients under 55 years with a maximum Expanded Disability Status Scale (EDSS) of 6.5. However, little is known on older disabled patients with longer disease duration. We aimed to assess the clinical effectiveness of ocrelizumab in PPMS patients out of the ORATORIO eligibility criteria. This multicenter retrospective study collected data about the effectiveness of ocrelizumab in PPMS patients who received treatment between May 2017 and June 2022 in the Italian MS centers contributing to the Italian MS Registry who adhered to the Compassionate Use Program. The confirmed EDSS worsening (CEW) (defined as either a ≥ 1-point or ≥ 2-point increase in EDSS score from baseline that was confirmed at T12 and T24) was calculated. At the date of data extraction, out of 887 PPMS patients who had received ocrelizumab, 589 (mean age 49.7 ± 10.7 years, 242 (41.1%) females) were enrolled. The mean follow-up period was 41.3 ± 12.3 months. A total of 149 (25.3%) received ocrelizumab according to the ORATORIO criteria (ORATORIO group) and 440 (74.7%) outside the ORATORIO criteria (non-ORATORIO group). No differences in terms of cumulative probabilities of 12 and 24 months of CEW of ≤ 1 point were found between ORATORIO and non-ORATORIO groups. Cox regression analyses showed that age older than 65 years (HR 2.51, 25% CI 1.07-3.65; p = 0.01) was associated with higher risk of CEW at 24 months. Patients not responding to ORATORIO criteria for reimbursability may benefit from ocrelizumab treatment, as disease activity, disease duration, and EDSS seem to not impact the disability outcome. Our results may suggest to extend the possible use of this powerful agent in selected patients under the age of 65 years

Efficacy of fingolimod and interferon beta-1b on cognitive, MRI, and clinical outcomes in relapsingâ\u80\u93remitting multiple sclerosis: an 18-month, open-label, rater-blinded, randomised, multicentre study (the GOLDEN study)

Cognitive impairment (CI) affects 40â\u80\u9365% of multiple sclerosis (MS) patients. This study attempted evaluating the effects of fingolimod and interferon beta-1b (IFN β-1b) on CI progression, magnetic resonance imaging (MRI) and clinical outcomes in relapsingâ\u80\u93remitting MS (RRMS) patients over 18 months. The GOLDEN study was a pilot study including RRMS patients with CI randomised (2:1) to fingolimod (0.5 mg daily)/IFN β-1b (250 µg every other day). CI was assessed via Raoâ\u80\u99s Brief Repeatable Battery and Delisâ\u80\u93Kaplan Executive Function System test. MRI parameters, Expanded Disability Status Scale scores and relapses were measured. Overall, 157 patients were randomised, of whom 30 discontinued the study (fingolimod, 8.49%; IFN β-1b, 41.18%; p â\u89¤Â 0.0001). Patients randomised to fingolimod had more severe clinical and MRI disease characteristics at baseline compared with IFN β-1b. At Month (M) 18, both treatment groups showed improvements in all cognitive parameters. At M18, relapse rate, total number and volume of T2/T1 gadolinium-enhancing lesions were higher with IFN β-1b, as well as the percentage brain volume change during the study. Safety and tolerability of both treatments were similar to previous studies. Both treatments showed improvements in cognitive parameters. Fingolimod demonstrated significantly better effects on MRI parameters and relapse rate. Imbalance in baseline characteristics and the drop-out pattern may have favoured IFN β-1b. A longer duration trial may be needed to observe the complete expression of differential effects on CI scales reflecting the between-groups differences on MRI. Although limited in size, the GOLDEN study confirms the favourable benefitâ\u80\u93risk profile of fingolimod reported in previous studies

Effects of THC/CBD oromucosal spray on spasticity-related symptoms in people with multiple sclerosis: results from a retrospective multicenter study

Introduction: The approval of 9-δ-tetrahydocannabinol (THC)+cannabidiol (CBD) oromucosal spray (Sativex®) in Italy as an add-on medication for the management of moderate to severe spasticity in multiple sclerosis (MS) has provided a new opportunity for MS patients with drug-resistant spasticity. We aimed to investigate the improvement of MS spasticity-related symptoms in a large cohort of patients with moderate to severe spasticity in daily clinical practice. Materials and methods: MS patients with drug-resistant spasticity were recruited from 30 Italian MS centers. All patients were eligible for THC:CBD treatment according to the approved label: ≥ 18 years of age, at least moderate spasticity (MS spasticity numerical rating scale [NRS] score ≥ 4) and not responding to the common antispastic drugs. Patients were evaluated at baseline (T0) and after 4 weeks of treatment (T1) with the spasticity NRS scale and were also asked about meaningful improvements in 6 key spasticity-related symptoms. Results: Out of 1615 enrolled patients, 1432 reached the end of the first month trial period (T1). Of these, 1010 patients (70.5%) reached a ≥ 20% NRS score reduction compared with baseline (initial responders; IR). We found that 627 (43.8% of 1432) patients showed an improvement in at least one spasticity-related symptom (SRSr group), 543 (86.6%) of them belonging to the IR group and 84 (13.4%) to the spasticity NRS non-responders group. Conclusion: Our study confirmed that the therapeutic benefit of cannabinoids may extend beyond spasticity, improving spasticity-related symptoms even in non-NRS responder patients. © 2020, Fondazione Società Italiana di Neurologia

Nabiximols discontinuation rate in a large population of patients with multiple sclerosis: a 18-month multicentre study

Introduction: Delta-\u3b4-tetrahydrocannabinol and cannabidiol (THC:CBD) oromucosal spray is used as an add-on therapy option for moderate to severe multiple sclerosis (MS) spasticity resistant to other medications. Aims of this study were to provide real-life data on long-term clinical outcomes in a large population of Italian patients treated with THC:CBD and to evaluate predictors of THC:CBD therapy continuation. Materials and methods: This prospective observational multicentre Italian study screened all patients with MS consecutively included in the Agenzia Italiana del Farmaco e-registry at the start of THC:CBD treatment (baseline), after 4 weeks (T1), 12\ub13 weeks (T2), 24\ub13 weeks (T3), 48\ub13 weeks (T4) and 72\ub13 weeks (T5) from baseline. Results: A total of 1845 patients were recruited from 32 MS Italian centres. At T1, 1502 (81.4%) of patients reached a Numerical Rating Scale (NRS) improvement of 6520%, with an NRS reduction of 26.9% at T1 and of 34.4% at T5. At T5, 725 patients (48.3% of 1502) discontinued treatment with highest discontinuation rate at T2 and T3. Daily number of puffs was generally stable through the observation period. The multivariate analysis showed that higher NRS scores at baseline (OR 2.28, 95% CI 1.15 to 6.36, p<0.01) and higher differences of NRS between T0 and T1 (OR 2.11, 95% CI 1.08 to 8.26, p<0.05) were associated with an increased probability to continue therapy after 18 months. Discussion: THC:CBD effects were sustained for 18 months with a relatively stable number of puffs per day. About 50% of patients abandoned THC:CBD therapy for loss of efficacy or adverse events