ABSTRACT
OBJECTIVES: Cladribine tablets (CLAD) for adult patients with highly active relapsing multiple sclerosis (RMS) have been available in Italy since 2018. We aimed to assess predictors of no-evidence-of-disease-activity-3 (NEDA-3) status after 24 months of the last dose of CLAD. RESULTS: We included 88 patients (70.5% female, mean age at CLAD start 35.4 ± 11.4). Eighteen patients were treatment naïve, 48 switched to CLAD from a First line Disease Modifying Drug (DMD), and 22 from Second line DMDs. All patients were observed for a median follow-up time of 2.4 (1-4) years after the last dose of CLAD. Forty-nine patients (55.7%) showed NEDA at the last available follow-up. Naïve patients (p = 0.001), those with a lower number of previous DMDs (p < 0.001) and, even though not significantly, those switching from first line DMDs (p = 0.069) were more likely NEDA3 at the last available follow-up. In a subgroup of 30 patients (34%), Serum Light Neurofilaments (sNFL) levels showed a decrease from baseline to the 24 months of follow-up, statistically significant from baseline to the sixth month, and from the first to the second year detection. sNFL levels at 12th month showed a strong inverse correlation with the time to NEDA3 loss. CONCLUSIONS: Our experience provides information for the 2-years after the last dose of CLAD, confirming a higher effectiveness of CLAD when placed early in the treatment algorithm. Given the ongoing expansion of the therapeutic landscape in MS, sNfL could support individualized decision-making, used as blood-based biomarker for CLAD responses in clinical practice.
Subject(s)
Cladribine , Immunosuppressive Agents , Humans , Cladribine/therapeutic use , Cladribine/administration & dosage , Female , Male , Adult , Middle Aged , Immunosuppressive Agents/therapeutic use , Immunosuppressive Agents/administration & dosage , Treatment Outcome , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Multiple Sclerosis, Relapsing-Remitting/blood , Follow-Up Studies , Multiple Sclerosis/drug therapy , Multiple Sclerosis/bloodABSTRACT
SUMMARY: We describe an unconventional endovascular approach in a young patient with large highflow traumatic carotid cavernous fistula that could not be treated by detachable balloon procedure. Two coronary stent-grafts were used to close the large tear of internal carotid artery. After the failure of stenting procedure, the fistula was successfully treated by trapping with two detachable balloons.
