Aspectos clínicos y demográficos de los pacientes con esclerosis múltiple secundaria progresiva en Argentina / Clinical and demographic aspects of secondary progressive multiple sclerosis in Argentina

Resumen El objetivo del estudio fue evaluar los aspectos clínicos y demográficos de los pacientes con esclerosis múltiple (EM) secundaria progresiva (EMSP) en los pacientes incluidos en el Registro Argentino de EM (RelevarEM, número de registro de Clinical Trials 03375177). RelevarEM es un registro longitudinal, estrictamente observacional, de pacientes con EM y trastornos del espectro de neuromielitis óptica. Los aspectos clínicos y demográficos fueron descriptos en pacientes con EMSP respecto a aquellos con EM recaída en remisión (EMRR). Se incluyeron 1723 pacientes con EM (1605, 93.2% EMRR y 118, 6.8%, EMSP). En el grupo con EMSP la mediana de edad fue de 53 (intervalo inter-cuartil [IIQ] 47-62) años, 67% eran mujeres, mediana de tiempo de evolución de enfermedad 19.5 (IIQ 14-26) años, EDSS (expanded disability status scale), 6.5 y 48.3% estaban en tratamiento para su EM. Solo el 23.7% con EMSP estaban trabajando activamente y el 86% tenía certificado de discapacidad. Un 35.6% con EMSP presentaron nuevas lesiones en resonancia magnética y 5% tuvo recaídas clínicas en los 12 meses previos al análisis, mostrando una actividad de la enfermedad significativamente menor respecto a la forma EMRR (p < 0.01).

Abstract The objective of the study was to describe the clinical and demographic aspects of patients with secondary progressive multiple sclerosis (SPMS) included in the Argentine MS Registry (RelevarEM, Clinical Trials registry number 03375177). RelevarEM is a longitudinal, strictly observational registry of patients with MS and neuromyelitis optica spectrum disorders. Clinical and demographic aspects were described in patients with SPMS and compared with relapsing remitting MS patients (RRMS). A total of 1723 patients with MS were included (1605, 93.2% RRMS and 118, 6.8%, SPMS). In SPMS, the median age was 53 (inter quartile range [IQR] 47-62) years, 67% were women, median disease duration of 19.5 (IQR 14-26) years, median EDSS (expanded disability status scale) 6.5 and 48.3% were under treatment for their MS. Only 23.7% of patients with SPMS were actively working and 86% had a disability certificate; 35.6% of patients with SPMS presented new lesions in MRI and 5% had clinical relapses during the past 12 months of the registry entry showing a significantly lower disease activity compared with RRMS (p < 0.01).

Benefit with methylprednisolone in continuous pulsetherapy in progressive primary form of multiple sclerosis: study of 11 cases in 11 years / Benefício do uso de pulsoterapia contínua com metilprednisolona na forma primária progressiva da esclerose múltipla: estudo de 11 casos em 11 anos

Primary progressive multiple sclerosis (PPMS) is defined clinically with a progressive course from onset. There is no approved treatment for the PPMS. Methylprednisolone IV (MP) hastens the recovery from MS relapses. We studied 11 patients that met the MacDonald's diagnostic criteria for PPMS. The dose of MP was 30 mg/kg in 250 mL of glucose solution in three consecutive days during the first week, two doses during the second and one dose in the third week. One weekly session for eight consecutive weeks was given. After, a once-a week/eight-week interval was maintained. The medium EDSS before treatment was 6.2, and after 11.2 years of treatment, the EDSS was 4.9. Although we studied a small sample of PPMS we may conclude that therapy with IVMP prevents clinical worsening of MS in the majority of patients with improvement in EDSS scores.

A forma progressiva da esclerose múltipla (FPEM) é definida como progressiva desde o início. Não há tratamento eficaz para esta forma. A metilprednisolona por via endovenosa (MPEV) é usada para os surtos de exacerbação da EM. Estudamos 11 pacientes que preenchiam os critérios de MacDonald para FPMS. A dose inicial de MPEV foi de 30 mg/kg em 250 mL de soro glicosado por três dias consecutivos na primeira semana, duas doses na segunda e uma dose na terceira semana. Seguiu-se uma sessão semanal por oito semanas. Após manteve-se uma dose semanal a cada oito semanas. A média do EDDS foi 9,6 antes e 4,9 após 11,2 anos de tratamento. Embora tenhamos estudado número reduzido de casos, podemos dizer que o uso de MPEV impede a progressão da FPEM na maioria dos pacientes estudados com melhora do EDDS.

Evaluation of ejection fraction changes during the course of treatment of mitoxantrone in patients with secondary progressive form of multiple sclerosis

Multiple sclerosis [MS] is one of the most common neurological disorders in young adults. Mitoxantrone, as an immunosuppressant and cytotoxic drug has shown a slight beneficial erect on the progressive form of the disease. However, it has been experienced that in cancer treatment this drug has caused cardiologic side effects such as congestive heart failure and decrease in ejection fraction. The aim of this study is to investigate the left ventricular ejection fraction changes induced by Mitoxantrone as administered in patients with secondary progressive form of multiple sclerosis. During the years of 2005-2007, the patients with secondary progressive MS who referred to the Neurological Clinic of Aria General Hospital in Mashhad were included in our cross-sectional study. These patients had no history of hematological, cardiac or hepatic disorders. Neither they had ever used immunosuppressant drugs. They were prescribed to intravenously take 12 mg/m2 of Mitoxantrone every 3 months for at least 2 years. Before each infusion of Mitoxantrone, the left ventricular ejection fraction [EF] was measured by echocardiography. After the treatment [8 infusions], the results of echocardiography were compared and analyzed through statistical methods using SPSS and Excel soft wares. Forty four patients with secondary progressive-MS were included in our study [24 females and 20 males]. Five of the subjects were younger than 30 year old, 27 patients were between 30 and 40, and 12 patients were above 40. The data was analyzed using the method of repeated measures. The results demonstrate that Mitoxantrone had no significant effect on the left ventricular ejection fraction. Also, the trend mean of EF during 8 months showed no significant drop. The mean of EF between sexes was not significant, either. As a whole, ten percent of the subjects treated with Mitoxanterone showed a decrease of EF which returned to its normal stage once the treatment was stopped. The benefit from using Mitoxanterone in multiple sclerosis was more than the complication caused by its usage. Multiple sclerosis, Mitoxantrone, Heart failure, echocardiography, Ejection fraction

Mitoxantrone in secondarily progressive multiple sclerosis: a series of 18 patients

Hidrocloridrato de mitoxantrone (Novantrone®) é um antracenedione utilizado como o agente mais recente de uma longa linha de imunossupressivos gerais estudados em esclerose múltipla (EM). Realizamos revisão de dados clínicos, laboratoriais, de neuroimagem e ecocardiografia de 18 pacientes, no período de fevereiro de 2001 a março de 2004, a partir de um total de 100 pacientes com EM definida. Quatorze pacientes eram do sexo feminino (77,7%) e quatro eram do sexo masculino. A idade média dos pacientes foi 41,6±10 anos (intervalo de confiança 95%: 36,4-46,7 anos). A duração média da doença foi 10,5±6,3 anos. Quatorze pacientes apresentavam a forma secundária progressiva de EM e quatro a forma surto-remissão. O mitoxantrone é uma droga útil e clinicamente eficaz , sendo a principal limitação sua potencial cardiotoxicidade devido à dose cumulativa (140 mg).