ABSTRACT
No disponible
Subject(s)
Adult , Humans , Male , Multiple Sclerosis/complications , Multiple Sclerosis/physiopathology , Multiple Sclerosis , Bulbar Palsy, Progressive/complications , Bulbar Palsy, Progressive , Pseudobulbar Palsy/complications , Pseudobulbar Palsy , Adrenal Cortex Hormones/therapeutic use , Neuroimaging/instrumentation , Neuroimaging/methods , Temporal Lobe/injuries , Temporal Lobe/pathology , Temporal Lobe , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy/methods , Methylprednisolone/therapeutic useSubject(s)
Deglutition Disorders/etiology , Dysarthria/etiology , Facial Paralysis/etiology , Multiple Sclerosis/complications , Adult , Brain/pathology , Combined Modality Therapy , Deglutition Disorders/drug therapy , Deglutition Disorders/therapy , Dysarthria/drug therapy , Dysarthria/therapy , Facial Paralysis/drug therapy , Facial Paralysis/therapy , Humans , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Multiple Sclerosis/diagnosis , Natalizumab/therapeutic use , Neuroimaging , Optic Neuritis/drug therapy , Optic Neuritis/etiology , PlasmapheresisABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Midline Thalamic Nuclei , Encephalitis/diagnosis , Q Fever/complications , Brain Stem/physiopathology , Coxiella burnetii/pathogenicityABSTRACT
Introducción. El tratamiento inmunomodulador modifica el curso de la enfermedad en los pacientes con esclerosis múltiple. Es fundamental que el paciente cumpla adecuadamente con el tratamiento pautado. Objetivo. Conocer la adhesión real al tratamiento inmunomodulador de primera línea e intentar averiguar qué factores pueden influir en el adecuado cumplimiento del tratamiento. Pacientes y métodos. Es un estudio longitudinal retrospectivo observacional de los pacientes en seguimiento por el Centre dEsclerosi Múltiple de Catalunya del Hospital Universitari Vall dHebron que recogieron tratamiento inmunomodulador de primera línea (interferones o acetato de glatiramero) entre el 1 de enero de 2010 y el 30 de septiembre de 2011. La adhesión se midió utilizando el índice de posesión de medicación -medication possession ratio (MPR)-: se consideraron adherentes los pacientes con MPR mayor o igual al 80%. Resultados. Estudiamos 975 pacientes. El tiempo medio de exposición a los inmunomoduladores durante el período de recogida fue de 13,4 ± 7,1 años. El 85,2% de los pacientes tuvo una adecuada adhesión al tratamiento inmunomodulador. De 975 pacientes tratados, 134 precisaron cambiar a un segundo fármaco y 12 pacientes a un tercero. El cambio de fármaco mejoró la adhesión (p = 0,001). La tasa anual de brotes fue de 0,23. Únicamente la presencia de brotes (p = 0,029) y el fármaco utilizado (p = 0,044) tuvieron influencia en la adhesión al tratamiento, de forma individual. Conclusiones. La proporción de pacientes con adecuada adhesión al tratamiento en nuestro centro es alta. La tasa de brotes y el fármaco empleado son determinantes para ello. Se requiere un seguimiento estrecho y asesoramiento individualizado para mantener un buen cumplimiento terapéutico (AU)
Introduction. Immunomodulator treatment modifies the course of the disease in patients with multiple sclerosis. The patients adequate adherence with the treatment regimen is absolutely essential. Aims. To determine the real adherence with first-line immunomodulator treatment and to try to find out what factors may influence adequate adherence with the treatment. Patients and methods. We conducted an observation-based, retrospective, longitudinal study of the patients being followed up by the Centre dEsclerosi Múltiple de Catalunya at the Hospital Universitari Vall dHebron that were given first-line immunomodulator treatment (interferons or glatiramer acetate) between 1st January 2010 and 30th September 2011. Adherence was measured using the medication possession ratio (MPR): patients with an MPR above or equal to 80% were considered to be compliers. Results. We studied 975 patients. The mean time of exposure to immunomodulators over the collected period was 13.4 ± 7.1 years. Altogether 85.2% of patients complied with the immunomodulator treatment adequately. Of a total of 975 patients treated, 134 needed to change to a second drug and 12 patients had to go on to a third. Changing the medication improved adherence (p = 0.001). The annual rate of attacks was 0.23. Only the presence of attacks (p = 0.029) and the drug used (p = 0.044) had any influence on treatment adherence, on an individual basis. Conclusions. The percentage of patients with adequate treatment adherence in our centre is high. The rate of attacks and the drug used play a decisive role. Close monitoring and personalised counselling are required to maintain good therapeutic adherence (AU)
Subject(s)
Humans , Male , Female , Multiple Sclerosis/diagnosis , Multiple Sclerosis/drug therapy , Multiple Sclerosis/immunology , Immunologic Factors/therapeutic use , Interferons/therapeutic use , Longitudinal Studies , Retrospective Studies , Analysis of VarianceABSTRACT
INTRODUCTION: Immunomodulator treatment modifies the course of the disease in patients with multiple sclerosis. The patient's adequate adherence with the treatment regimen is absolutely essential. AIMS: To determine the real adherence with first-line immunomodulator treatment and to try to find out what factors may influence adequate adherence with the treatment. PATIENTS AND METHODS: We conducted an observation-based, retrospective, longitudinal study of the patients being followed up by the Centre d'Esclerosi Multiple de Catalunya at the Hospital Universitari Vall d'Hebron that were given first-line immunomodulator treatment (interferons or glatiramer acetate) between 1st January 2010 and 30th September 2011. Adherence was measured using the medication possession ratio (MPR): patients with an MPR above or equal to 80% were considered to be compliers. RESULTS: We studied 975 patients. The mean time of exposure to immunomodulators over the collected period was 13.4 ± 7.1 years. Altogether 85.2% of patients complied with the immunomodulator treatment adequately. Of a total of 975 patients treated, 134 needed to change to a second drug and 12 patients had to go on to a third. Changing the medication improved adherence (p = 0.001). The annual rate of attacks was 0.23. Only the presence of attacks (p = 0.029) and the drug used (p = 0.044) had any influence on treatment adherence, on an individual basis. CONCLUSIONS: The percentage of patients with adequate treatment adherence in our centre is high. The rate of attacks and the drug used play a decisive role. Close monitoring and personalised counselling are required to maintain good therapeutic adherence.
Subject(s)
Immunologic Factors/therapeutic use , Interferon-beta/therapeutic use , Medication Adherence , Multiple Sclerosis/drug therapy , Peptides/therapeutic use , Adult , Counseling , Drug Substitution , Female , Follow-Up Studies , Glatiramer Acetate , Humans , Injections, Intramuscular , Injections, Subcutaneous , Interferon beta-1a , Interferon beta-1b , Interferon-beta/administration & dosage , Male , Middle Aged , Multiple Sclerosis/psychology , Retrospective StudiesABSTRACT
Adalimumab es un anticuerpo monoclonal recombinante humano que bloquea el efecto del factor de necrosis tumoral alfa. Actualmente se emplea como tratamiento para la artritis reumatoide, siendo la desmielinización un potencial efecto adverso. Nuestro caso trata de un varón de 31 años con artritis reumatoide seropositiva que presentó un cuadro diarreico después de la segunda dosis de adalimumab. Tras tratamiento con ciprofloxacino el paciente desarrolló un síndrome de Guillain-Barrè confirmado por electromiografía. El estudio del líquido cefalorraquídeo sugirió un síndrome meníngeo o una posible meningitis bacteriana decapitada. El tratamiento con adalimumab puede asociarse con el desarrollo de enfermedades desmielinizantes e infecciosas y afectar simultáneamente al sistema nervioso central y al periférico (AU)
Adalimumab is a recombinant human monoclonal antibody that blocks the effects of tumor necrosis factor-alpha, and is presently used for treatment of rheumatoid arthritis, with demyelination being a potential adverse effect. A 31 year-old male with seropositive rheumatoid arthritis presented with diarrhea after the second injection of adalimumab. He was treated with ciprofloxacin. In a few days he developed a Guillain-Barrè syndrome confirmed by electromyography, and his cerebrospinal fluid was compatible with meningeal syndrome or partially treated bacterial meningitis. Adalimumab may be associated with the development of demyelination and infectious diseases. Moreover, both the central nervous system and the peripheral nervous system can be affected (AU)
Subject(s)
Humans , Male , Adult , Guillain-Barre Syndrome/complications , Guillain-Barre Syndrome/diagnosis , Arthritis, Rheumatoid/complications , Tumor Necrosis Factor-alpha/administration & dosage , Tumor Necrosis Factor-alpha , Guillain-Barre Syndrome/physiopathology , Demyelinating Diseases/complications , Demyelinating Diseases/therapy , Immunosuppression Therapy/methods , Immunosuppression Therapy/trends , Immunosuppression TherapyABSTRACT
Adalimumab is a recombinant human monoclonal antibody that blocks the effects of tumor necrosis factor-alpha, and is presently used for treatment of rheumatoid arthritis, with demyelination being a potential adverse effect. A 31 year-old male with seropositive rheumatoid arthritis presented with diarrhea after the second injection of adalimumab. He was treated with ciprofloxacin. In a few days he developed a Guillain-Barrè syndrome confirmed by electromyography, and his cerebrospinal fluid was compatible with meningeal syndrome or partially treated bacterial meningitis. Adalimumab may be associated with the development of demyelination and infectious diseases. Moreover, both the central nervous system and the peripheral nervous system can be affected.
