Adherence to interferon ß-1b treatment in patients with multiple sclerosis in Spain

Background: Adherence to interferon b-1b (INFb-1b) therapy is essential to maximize the beneficial effects of treatment in multiple sclerosis (MS). For that reason, the main objectives of this study are to assess adherence to INFb-1b in patients suffering from MS in Spain, and to identify the factors responsible for adherence in routine clinical practice. Methodology/Principal Findings: This was an observational, retrospective, cross-sectional study including 120 Spanish patients with MS under INFb-1b treatment. Therapeutic adherence was assessed with Morisky-Green test and with the percentage of doses received. The proportion of adherent patients assessed by Morisky-Green test was 68.3%, being indicative of poor adherence. Nevertheless, the percentage of doses received, which was based on the number of injected medication, was 94.3%. The main reason for missing INFb-1b injections was forgetting some of the administrations (64%). Therefore, interventions that diminish forgetfulness might have a positive effect in the proportion of adherent patients and in the percentage of doses received. In addition, age and comorbidities had a significant effect in the number of doses injected per month, and should be considered in the management of adherence in MS patients. Conclusion/Significance: Among all the available methods for assessing adherence, the overall consumption of the intended dose has to be considered when addressing adherence

Adherence to Interferon β-1b Treatment in Patients with Multiple Sclerosis in Spain

Adherence to interferon β-1b (INFβ-1b) therapy is essential to maximize the beneficial effects of treatment in multiple sclerosis (MS). For that reason, the main objectives of this study are to assess adherence to INFβ-1b in patients suffering from MS in Spain, and to identify the factors responsible for adherence in routine clinical practice.This was an observational, retrospective, cross-sectional study including 120 Spanish patients with MS under INFβ-1b treatment. Therapeutic adherence was assessed with Morisky-Green test and with the percentage of doses received. The proportion of adherent patients assessed by Morisky-Green test was 68.3%, being indicative of poor adherence. Nevertheless, the percentage of doses received, which was based on the number of injected medication, was 94.3%. The main reason for missing INFβ-1b injections was forgetting some of the administrations (64%). Therefore, interventions that diminish forgetfulness might have a positive effect in the proportion of adherent patients and in the percentage of doses received. In addition, age and comorbidities had a significant effect in the number of doses injected per month, and should be considered in the management of adherence in MS patients.Among all the available methods for assessing adherence, the overall consumption of the intended dose has to be considered when addressing adherence

Impacto del estrés y de las variables psicosociales en el curso clínico y en la calidad de vida de los afectados por la esclerosis múltiple

Los efectos del estrés sobre los sistemas nervioso, endocrino y especialmente sobre el inmune han generado la hipótesis de que podría ser un factor relevante en la evolución de la esclerosis múltiple, de manera que altos niveles de estrés podrían incrementar la probabilidad de una evolución negativa de la enfermedad y también empeorar la calidad de vida de los afectados. Se ha estudiado una cohorte de 18 meses de seguimiento de una muestra de 49 afectados de esclerosis múltiple remitente-recurrente. Se evaluó el estrés percibido de forma mensual. La calidad de vida al inicio y al final del estudio. Los acontecimientos vitales estresantes y su impacto emocional, las formas clínicas de estrés (ansiedad y depresión), el apoyo social percibido, la percepción de control, las estrategias de afrontamiento y el curso evolutivo, al inicio del estudio y cada 6 meses. Los resultados indicaron que los acontecimientos vitales estresantes, así como el impacto emocional que generan, eran buenos predictores del número de brotes padecidos durante los 18 meses. También señalaron que los mejores predictores de la calidad de vida al final de dicho período fueron los bajos niveles de ansiedad y depresión, ser hombre y un bajo número de pseudobrotes (R2=0,8 y p=0,0005). Se propone que la atención biopsicosocial proporcionada en la neurorehabilitación incluya intervenciones psicológicas dirigidas a manejar el estrés, tratar sus formas clínicas de ansiedad y depresión y modificar algunas estrategias de afrontamiento desadaptativas detectadas, con el objetivo de mejorar la evolución clínica de la enfermedad y la calidad de vida de los paciente

Adherence to INFβ-1b treatment according to the existence of an MS unit.

*<p>Chi-square test.</p>†<p>ANOVA.</p

Soluble Receptor Isoform of IFN-Beta (sIFNAR2) in Multiple Sclerosis Patients and Their Association With the Clinical Response to IFN-Beta Treatment

Purpose: Interferon beta receptor 2 subunit (IFNAR2) can be produced as a transmembrane protein, but also as a soluble form (sIFNAR2) generated by alternative splicing or proteolytic cleavage, which has both agonist and antagonist activities for IFN-b. However, its role regarding the clinical response to IFN-b for relapsing-remitting multiple sclerosis (RRMS) is unknown. We aim to evaluate the in vitro short-term effects and after 6 and 12 months of IFN-b therapy on sIFNAR2 production and their association with the clinical response in MS patients. Methods: Ninety-four RRMS patients were included and evaluated at baseline, 6 and 12 months from treatment onset. A subset of 41 patients were classified as responders and non-responders to IFN-b therapy. sIFNAR2 serum levels were measured by ELISA. mRNA expression for IFNAR1, IFNAR2 splice variants, MxA and proteases were assessed by RT-PCR. The short-term effect was evaluated in PBMC from RRMS patients after IFN-b stimulation in vitro. Results: Protein and mRNA levels of sIFNAR2 increased after IFN-b treatment. According to the clinical response, only non-responders increased sIFNAR2 significantly at both protein and mRNA levels. sIFNAR2 gene expression correlated with the transmembrane isoform expression and was 2.3-fold higher. While MxA gene expression increased significantly after treatment, IFNAR1 and IFNAR2 only slightly increased. After short-term IFN-b in vitro induction of PBMC, 6/7 patients increased the sIFNAR2 expression. Conclusions: IFN-b administration induces the production of sIFNAR2 in RRMS and higher levels might be associated to the reduction of therapeutic response. Thus, levels of sIFNAR2 could be monitored to optimize an effective response to IFN-b therapy.This research was funded by grants from the Instituto de Salud Carlos III and co-funded by European Regional Development Fund (ERDF), Technological Development Project in health DTS/1800045 to BO-M. BO-M holds a contract from Red Andaluza de Investigacion Clınica y Traslacional en Neurología (Neuro-reca) ́ (RIC-0111-2019). PA-G is supported by Promoción de Empleo Joven e Implantación de la Garantıa Juvenil 2018 (PEJ2018-002719- ́A). JR-B is supported by grantsfrom Red Temática de Investigación Cooperativa, Red Española de Esclerosis Multiple REEM (RD16/0015/0010). LL holds a Nicolás Monardes research contract (RC 002-2019) from the Andalusian Ministry of Health and Family. IB M holds a pFIS contract (FI19/00139)from the Spanish Science and Innovation Ministry.Ye

General health status variables and adverse events according to adherence as assessed by MG test.

a<p>N = 81.</p>*<p>Chi-square test.</p>†<p>ANOVA.</p

Brain region volumes and their relationship with disability progression and cognitive function in primary progressive multiple sclerosis.

Evidence on regional changes resulting from neurodegenerative processes underlying primary progressive multiple sclerosis (PPMS) is still limited. We assessed brain region volumes and their relationship with disability progression and cognitive function in PPMS patients. This was an MRI analysis of 43 patients from the prospective Understanding Primary Progressive Multiple Sclerosis (UPPMS) cohort study. MRI scans were performed within 3 months before enrollment and at month 12. Gray matter volume of declive and white matter volumes adjacent to left straight gyrus, right calcarine sulcus, and right inferior occipital gyrus significantly decreased from baseline to month 12. Baseline white matter volumes adjacent to right amygdala and left cuneus significantly differed between patients with and without disability progression, as well as baseline gray matter volumes of left cuneus, right parahippocampal gyrus, right insula, left superior frontal gyrus, declive, right inferior temporal gyrus, right superior temporal gyrus (pole), and right calcarine sulcus. Baseline gray matter volumes of right cuneus and right superior temporal gyrus positively correlated with 12-month Selective Reminding Test and Word List Generation performance, respectively. Gray matter changes in right superior semilunar lobe and white matter adjacent to left declive and right cerebellar tonsil also positively correlated with Word List Generation scores, while white matter change in left inferior semilunar lobe positively correlated with Symbol Digit Modalities Test performance after 12 months. White and gray matter volumes of specific brain regions could predict disability progression and cognitive performance of PPMS patients after one year

Comorbidity profile of the patients suffering from MS (N = 37).

<p>Patients might have more than one comorbidity.</p

Reasons for missing INFβ-1b injections (N = 25).

<p>Reasons for missing INFβ-1b injections (N = 25).</p