Näyttää MS:ltä, kuulostaa MS:ltä, tuntuu MS:ltä - muttei ole MS : MS-taudin erotusdiagnostiikka

Vertaisarvioitu. Teema : neuroimmunologia.MS-taudin diagnoosi pyritään varmentamaan jo ensioireiden jälkeen, jotta hoito päästään aloittamaan aikaisin. Diagnoosin on oltava täsmällinen, koska virhediagnoosi kuormittaa potilasta ja terveydenhuoltoa, ja sen perusteella aloitettu hoito voi huonontaa tilannetta. Keskeistä MS-taudin tunnistamisessa on luottaa anamneesin ja kliinisen tutkimuksen merkitykseen ja peilata näitä magneettikuvauksen ja aivo-selkäydinnestenäytteen tulehduksellisiin löydöksiin. Tyypillinen aaltomaisen MS-taudin oirejakso on toispuolinen näköhermotulehdus, aivorunko-oireisto tai osittainen selkäydinoireyhtymä. Oirejakso tulee tunneissa tai päivissä voimistuen, esiintyy jatkuvana ja lievittyy muutamissa viikoissa. Aaltomaisen MS-taudin erotusdiagnostiikassa tärkeitä ovat muut autoimmuunisairaudet, tulehdukset, syöpäsairaudet sekä geneettiset sairaudet. Suoraan etenevän MS-taudin tyyppioire puolestaan on etenevä kävelyvaikeus, jonka tutkimuksissa etsitään tulehduksellisen demyelinoivan sairauden piirteitä ja suljetaan pois erityisesti selkäydinsairauksia.Peer reviewe

Finnish multiple sclerosis patients treated with cladribine tablets : a nationwide registry study

Background: Cladribine tablets for adult patients with highly active relapsing multiple sclerosis (MS) have been available in Finland since 2018. Real-world data from different genetic and geographical backgrounds are needed to complement data from clinical trials.Methods: We investigated the use of cladribine tablets in Finland in a non-interventional cohort study, based on real-world data from the nationwide Finnish MS registry. All eligible patients who had initiated treatment with cladribine tablets in 2018-2020 were included. Descriptive analyses for outcomes were conducted using summary statistics. Time-dependent endpoints were analyzed using cumulated events analysis based on 1-Kaplan-Meier estimates and curves. Subgroups were analyzed separately according to the number of previous disease-modifying therapies (DMTs) and the most common last preceding therapies.Results: Data of 179 patients were analyzed. Median follow-up time was 19.0 months (interquartile range [IQR] 12.0-26.2). Of the 134 patients who were followed for at least 12 months, 112 patients (83.6%) remained relapse-free during follow-up. Mean annualized relapse rate (ARR) was 1.0 (standard deviation [SD] 0.89) at baseline, and 0.1 (SD 0.30) at follow-up. Patients with two or more previous DMTs had shorter time to first relapse (median 2.5 months, IQR 0.6-9.3) when compared to patients with 0-1 previous DMTs (median 11.4 months, IQR 8.7-13.1) (p=0.013). After excluding patients switching from fingolimod (n=33), a statistically significant difference in time to first relapse was no longer observed between the two groups (p=0.252). Adverse events (AEs) were reported in 30 patients (16.8%). The most frequent AE was headache (n=14, 7.8%). One patient (0.6%) died of cardiac arrest. Discontinuation of cladribine tablets was reported in nine patients (5.0%).Conclusion: The mean ARR observed in this cohort was similar to what has been reported in clinical trials. Approximately half of the patients had used two or more previous DMTs before cladribine tablets. These patients had a shorter time to first relapse when compared to patients with 0-1 previous DMTs, mostly driven by early relapses in patients switching from fingolimod.Peer reviewe

Erikoislääkärikoulutus uudistuu - missä mennään?

Erikoislääkärikoulutuksen uudistuksen ydin on osaamisperustaisuus. Sekä koulutusväylät että seurantajärjestelmä rakennetaan sitä tukeviksi

Erikoislääkärikoulutus uudistuu - missä mennään?

Erikoislääkärikoulutuksen uudistuksen ydin on osaamisperustaisuus. Sekä koulutusväylät että seurantajärjestelmä rakennetaan sitä tukeviksi

Finnish multiple sclerosis patients treated with cladribine tablets : a nationwide registry study

Background: Cladribine tablets for adult patients with highly active relapsing multiple sclerosis (MS) have been available in Finland since 2018. Real-world data from different genetic and geographical backgrounds are needed to complement data from clinical trials. Methods: We investigated the use of cladribine tablets in Finland in a non-interventional cohort study, based on real-world data from the nationwide Finnish MS registry. All eligible patients who had initiated treatment with cladribine tablets in 2018-2020 were included. Descriptive analyses for outcomes were conducted using summary statistics. Time-dependent endpoints were analyzed using cumulated events analysis based on 1-Kaplan–Meier estimates and curves. Subgroups were analyzed separately according to the number of previous disease-modifying therapies (DMTs) and the most common last preceding therapies. Results: Data of 179 patients were analyzed. Median follow-up time was 19.0 months (interquartile range [IQR] 12.0-26.2). Of the 134 patients who were followed for at least 12 months, 112 patients (83.6%) remained relapse-free during follow-up. Mean annualized relapse rate (ARR) was 1.0 (standard deviation [SD] 0.89) at baseline, and 0.1 (SD 0.30) at follow-up. Patients with two or more previous DMTs had shorter time to first relapse (median 2.5 months, IQR 0.6-9.3) when compared to patients with 0-1 previous DMTs (median 11.4 months, IQR 8.7-13.1) (p=0.013). After excluding patients switching from fingolimod (n=33), a statistically significant difference in time to first relapse was no longer observed between the two groups (p=0.252). Adverse events (AEs) were reported in 30 patients (16.8%). The most frequent AE was headache (n=14, 7.8%). One patient (0.6%) died of cardiac arrest. Discontinuation of cladribine tablets was reported in nine patients (5.0%). Conclusion: The mean ARR observed in this cohort was similar to what has been reported in clinical trials. Approximately half of the patients had used two or more previous DMTs before cladribine tablets. These patients had a shorter time to first relapse when compared to patients with 0-1 previous DMTs, mostly driven by early relapses in patients switching from fingolimod.publishedVersionPeer reviewe

Finnish multiple sclerosis patients treated with cladribine tablets: a nationwide registry study

BACKROUNDCladribine tablets for adult patients with highly active relapsing multiple sclerosis (MS) have been available in Finland since 2018. Real-world data from different genetic and geographical backgrounds are needed to complement data from clinical trials.METHODSWe investigated the use of cladribine tablets in Finland in a non-interventional cohort study, based on real-world data from the nationwide Finnish MS registry. All eligible patients who had initiated treatment with cladribine tablets in 2018-2020 were included. Descriptive analyses for outcomes were conducted using summary statistics. Time-dependent endpoints were analyzed using cumulated events analysis based on 1-Kaplan-Meier estimates and curves. Subgroups were analyzed separately according to the number of previous disease-modifying therapies (DMTs) and the most common last preceding therapies.RESULTSData of 179 patients were analyzed. Median follow-up time was 19.0 months (interquartile range [IQR] 12.0-26.2). Of the 134 patients who were followed for at least 12 months, 112 patients (83.6%) remained relapse-free during follow-up. Mean annualized relapse rate (ARR) was 1.0 (standard deviation [SD] 0.89) at baseline, and 0.1 (SD 0.30) at follow-up. Patients with two or more previous DMTs had shorter time to first relapse (median 2.5 months, IQR 0.6-9.3) when compared to patients with 0-1 previous DMTs (median 11.4 months, IQR 8.7-13.1) (p=0.013). After excluding patients switching from fingolimod (n=33), a statistically significant difference in time to first relapse was no longer observed between the two groups (p=0.252). Adverse events (AEs) were reported in 30 patients (16.8%). The most frequent AE was headache (n=14, 7.8%). One patient (0.6%) died of cardiac arrest. Discontinuation of cladribine tablets was reported in nine patients (5.0%).CONCLUSIONThe mean ARR observed in this cohort was similar to what has been reported in clinical trials. Approximately half of the patients had used two or more previous DMTs before cladribine tablets. These patients had a shorter time to first relapse when compared to patients with 0-1 previous DMTs, mostly driven by early relapses in patients switching from fingolimod.</p

Safety of alemtuzumab in a nationwide cohort of Finnish multiple sclerosis patients

Background Alemtuzumab is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, safety concerns limit its use in clinical practice. Objectives To evaluate the safety of alemtuzumab in a nationwide cohort of Finnish MS patients. Methods In this retrospective case series study, we analyzed the data of all but two MS patients who had received alemtuzumab in Finland until 2019. Data were systematically collected from patient files. Results Altogether 121 patients were identified, most of whom had received previous DMTs (82.6%). Median follow-up time after treatment initiation was 30.3 months and exceeded 24 months in 78 patients. Infusion-associated reactions (IARs) were observed in 84.3%, 57.3%, and 57.1% of patients during alemtuzumab courses 1-3, respectively. Serious adverse events (SAEs) were observed in 32.2% of patients, serious IARs in 12.4% of patients, and SAEs other than IARs in 23.1% of patients. Autoimmune adverse events were observed in 30.6% of patients. One patient died of hemophagocytic lymphohistiocytosis, and one patient died of pneumonia. A previously unreported case of thrombotic thrombocytopenic purpura was documented. Conclusions SAEs were more frequent in the present cohort than in previous studies. Even though alemtuzumab is a highly effective therapy for MS, vigorous monitoring with a long enough follow-up time is advised.Peer reviewe

Safety of alemtuzumab in a nationwide cohort of Finnish multiple sclerosis patients

Background Alemtuzumab is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, safety concerns limit its use in clinical practice. Objectives To evaluate the safety of alemtuzumab in a nationwide cohort of Finnish MS patients. Methods In this retrospective case series study, we analyzed the data of all but two MS patients who had received alemtuzumab in Finland until 2019. Data were systematically collected from patient files. Results Altogether 121 patients were identified, most of whom had received previous DMTs (82.6%). Median follow-up time after treatment initiation was 30.3 months and exceeded 24 months in 78 patients. Infusion-associated reactions (IARs) were observed in 84.3%, 57.3%, and 57.1% of patients during alemtuzumab courses 1-3, respectively. Serious adverse events (SAEs) were observed in 32.2% of patients, serious IARs in 12.4% of patients, and SAEs other than IARs in 23.1% of patients. Autoimmune adverse events were observed in 30.6% of patients. One patient died of hemophagocytic lymphohistiocytosis, and one patient died of pneumonia. A previously unreported case of thrombotic thrombocytopenic purpura was documented. Conclusions SAEs were more frequent in the present cohort than in previous studies. Even though alemtuzumab is a highly effective therapy for MS, vigorous monitoring with a long enough follow-up time is advised.</p

Näyttää MS:ltä, kuulostaa MS:ltä, tuntuu MS:ltä — muttei ole MS

Tiivistelmä MS-taudin diagnoosi pyritään varmentamaan jo ensioireiden jälkeen, jotta hoito päästään aloittamaan aikaisin. Diagnoosin on oltava täsmällinen, koska virhediagnoosi kuormittaa potilasta ja terveydenhuoltoa, ja sen perusteella aloitettu hoito voi huonontaa tilannetta. Keskeistä MS-taudin tunnistamisessa on luottaa anamneesin ja kliinisen tutkimuksen merkitykseen ja peilata näitä magneettikuvauksen ja aivo-selkäydinnestenäytteen tulehduksellisiin löydöksiin. Tyypillinen aaltomaisen MS-taudin oirejakso on toispuolinen näköhermotulehdus, aivorunko-oireisto tai osittainen selkäydinoireyhtymä. Oirejakso tulee tunneissa tai päivissä voimistuen, esiintyy jatkuvana ja lievittyy muutamissa viikoissa. Aaltomaisen MS-taudin erotusdiagnostiikassa tärkeitä ovat muut autoimmuunisairaudet, tulehdukset, syöpäsairaudet sekä geneettiset sairaudet. Suoraan etenevän MS-taudin tyyppioire puolestaan on etenevä kävelyvaikeus, jonka tutkimuksissa etsitään tulehduksellisen demyelinoivan sairauden piirteitä ja suljetaan pois erityisesti selkäydinsairauksia

MS-potilaan uupumus:miksi ja miten hoidetaan?

Tiivistelmä Uupumus on merkittävä pesäkekovettumatautia (MS-tautia) sairastavan toimintakykyyn vaikuttava tekijä. Taudin kliininen oireisto ja vaikeusaste eivät korreloi uupumukseen. Uupumus on subjektiivista ja sen mittaaminen ja todentaminen esimerkiksi lausunnoissa on haastavaa. Tehokkaat oireenmukaiset hoidot tähän oireeseen puuttuvat.Summary Fatigue in multiple sclerosis (MS) is a highly debilitating symptom. About 80% of patients with MS suffer fatigue during their lifetime, some even before the diagnosis. The measuring of fatigue is difficult, because it is a very subjective symptom. Fatigue may be primary and/or secondary. Primary fatigue has been considered to be caused by the pathological mechanisms of multiple sclerosis. The exact pathologic mechanism is not known. Furthermore, both structural and functional mechanisms are involved. Secondary fatigue may coexist with primary fatigue. Secondary fatigue can result, for example, from drug side effects, co-existing diseases, pain, depression or impaired motor function. The Finnish version of the Fatigue Severity Scale questionnaire (FSS) has been shown to be a reliable method for measuring self-reported fatigue. Multiple Sclerosis Impact Scale (MSIS-29) can be used for measuring how patients experience fatigue affect their life both psychically and psychologically. Treatment of MS-related fatigue can be pharmacological or non-pharmacological. Non-pharmacological interventions are based on influencing lifestyle, nutritional and environmental factors. For example, good physical fitness, a regular lifestyle, a healthy diet and proper timing of work may relieve symptoms and help to manage fatigue. Although many drugs have been tested in clinical trials, only amantadine is currently recommended for this indication. However, so far effective drugs are lacking as even the effect of amantadine is only moderate. Antidepressant drugs such as venlafaxine, bupropion, milnacipran and duloxetine may also be used for treating fatigue. Modafinil, a stimulant currently indicated for the treatment of narcolepsy, has also been tested in many clinical trials for patients with MS-related fatigue. However, the results have been controversial and modafinil has not been approved for treating MS-related fatigue