Publications by authors named "Clavelou P"
Background: We hypothesized that differences in access to disease-modifying treatments (DMTs) could explain the association between socioeconomic status and disability progression in multiple sclerosis (MS).
Objective: This study aimed to analyze the association between education level and DMT use in France.
Methods: All patients from OFSEP network with MS onset over 1996-2014 and aged ⩾ 25 years at onset were included.
Background: Studies have reported an association between socioeconomic status and disability progression in multiple sclerosis (MS), but findings using the pre-MS individual socioeconomic status are missing.
Objective: The objective was to investigate the association between education level and disability progression.
Methods: All Observatoire Français de la Sclérose en Plaques (OFSEP) patients with MS clinical onset over 1960-2014, and aged ⩾25 years at MS onset were included.
Article Synopsis
- The study aimed to compare disability progression between primary progressive multiple sclerosis (PPMS) patients treated with anti-CD20 therapies (rituximab and ocrelizumab) and a control group that was untreated.
- Data was gathered retrospectively from the French MS registry, including factors like time to confirmed disability progression (CDP), relapse rates, and MRI activity in patients from 2016 to 2021.
- Results showed no significant difference in CDP or MRI activity between treated and untreated groups, although a trend suggested treated patients might experience fewer relapses, warranting further investigation.
Background And Objectives: People with multiple sclerosis (MS) have an increased risk of severe coronavirus infection due to their level of motor disability or exposure to certain immunosuppressive treatments. Thus, patients with MS have had priority access to coronavirus disease 2019 (COVID-19) vaccination. However, relapses after vaccination have been reported, leading some patients to not seek the recommended booster doses.
View Article and Find Full Text PDFBackground: The availability of mechanical thrombectomy (MT) is limited. Thus, there are two paradigms for patients living closer to a primary stroke center (PSC) than a comprehensive stroke center (CSC) capable of MT: "Mothership" (direct referral to a CSC) and "Drip-and-Ship" (referral to a PSC for imaging and thrombolysis and transfer to a CSC for thrombectomy or monitoring). We aimed to compare the prognosis of patients at three months between the two paradigms in a rural area.
View Article and Find Full Text PDFArticle Synopsis
- * Conducted over eight years (2015-2023) using data from a French MS registry, researchers categorized relapses based on MRI results to better understand their impact.
- * Findings indicate that certain factors, like treatment type and fatigue, increase the likelihood of clinically defined relapses without MRI evidence, suggesting a need for revised monitoring and treatment strategies for MS patients.
Background: The European literature has reported high variability in the incidence and prevalence rates of myasthenia gravis (MG), but no specific epidemiological data for France have been published. This study aimed to assess the incidence and prevalence rates of myasthenia gravis in France based on data extracted from the French National Health Insurance Claims Database (the SNIIRAM database).
Methods: We conducted a retrospective repeated cross-sectional population study from 2008 to 2018 using a representative sample of the French population (Échantillon généraliste des bénéficiaires) covered by health insurance.
Article Synopsis
- * The patient's uveitis included severe symptoms like decreased vision and inflammatory changes in both eyes, which did not improve with various standard treatments.
- * Tocilizumab successfully brought the patient's uveitis into remission and was effective even one year later while on a low dose of prednisone, suggesting its potential as a valuable treatment option for uveitis related to MS.
Article Synopsis
- A randomized clinical trial suggests that stopping medium-efficacy therapy for older patients with nonactive multiple sclerosis (MS) may be safe, but data is lacking for high-efficacy therapy (HET).
- This observational cohort study from the French MS registry examined 1857 older patients with relapsing-remitting MS on HET and aimed to find out if stopping HET increased relapse risks.
- The study included 1620 matched patients, with results indicating that both groups (continuing vs. discontinuing HET) were closely monitored over an average of 5.1 years to determine the time to first relapse.
Article Synopsis
- Moderately effective therapies (METs) have been the standard treatment for pediatric-onset multiple sclerosis (POMS), but there's still no clear consensus on treatment strategies as highly effective therapies (HETs) emerge.
- The study aimed to evaluate the effectiveness of HET compared to MET in reducing disease activity in treatment-naive children with relapsing-remitting POMS, using a retrospective cohort design over a median follow-up of 5.8 years.
- Results from 530 included patients indicated that both HET and MET reduced the risk of relapse within the first 2 years, with HET showing a significant 54% decrease in first relapses compared to MET.
Background: Epidemiologic studies on coronavirus disease 2019 (COVID-19) in patients with multiple sclerosis (pwMS) have focused on the first waves of the pandemic until early 2021.
Objectives: We aimed to extend these data from the onset of the pandemic to the global coverage by vaccination in summer 2022.
Methods: This retrospective, multicenter observational study analyzed COVISEP registry data on reported COVID-19 cases in pwMS between January 2020 and July 2022.
Article Synopsis
- This study compares two methods for estimating death probabilities in multiple sclerosis (MS) patients: the Cause-Specific Framework (CSF) which requires known causes of death, and the Excess Mortality Framework (EMF) which does not.
- Using data from a large MS registry and a subset with detailed death records, the researchers found that EMF generally estimated higher death probabilities than CSF across different age groups.
- Overall, the analysis revealed varying mortality probabilities for MS patients based on the initial disease type, sex, and age; with significant differences particularly noted between relapsing-onset MS and primary progressive patients over a 30-year follow-up.
Importance: Radiologically isolated syndrome (RIS) represents the earliest detectable preclinical phase of multiple sclerosis (MS) punctuated by incidental magnetic resonance imaging (MRI) white matter anomalies within the central nervous system.
Objective: To determine the time to onset of symptoms consistent with MS.
Design, Setting, And Participants: From September 2017 to October 2022, this multicenter, double-blind, phase 3, randomized clinical trial investigated the efficacy of teriflunomide in delaying MS in individuals with RIS, with a 3-year follow-up.
Purpose: In the assessment of basic medical knowledge, the composition of the reference panel between specialists and primary care (PC) physicians is a contentious issue. We assessed the effect of panel composition on the scores of undergraduate medical students in a script concordance test (SCT).
Methods: The scale of an SCT on basic nephrology knowledge was set by a panel of nephrologists or a mixed panel of nephrologists and PC physicians.
Article Synopsis
- * Serious side effects like extreme lymphopenia are rare, but monitoring for infections and screening for liver function are recommended before starting CladT treatment.
- * The risk of developing malignancies with CladT is similar to general population rates and other treatments, and overall, CladT is considered to have a good safety profile for RMS management.
Importance: In patients with multiple sclerosis (MS), factors associated with severe COVID-19 include anti-CD20 therapies and neurologic disability, but it is still unclear whether these 2 variables are independently associated with severe COVID-19 or whether the association depends on MS clinical course.
Objective: To assess the association between anti-CD20 therapies and COVID-19 severity in patients with relapsing-remitting MS (RRMS) and progressive MS (PMS).
Design, Setting, And Participants: This multicenter, retrospective cohort study used data from the COVISEP study, which included patients with MS and COVID-19 from February 1, 2020, to June 30, 2022, at 46 French MS expert centers, general hospitals, and private neurology practices.
Article Synopsis
- Published studies on the impact of HFE polymorphisms on ALS (Amyotrophic Lateral Sclerosis) risk, phenotype, and survival remain inconclusive, prompting an evaluation of the p.H63D polymorphism in patients with -mutated ALS.
- The study involved 183 -mutated ALS patients, assessing mutation severity and conducting survival analyses using methods like Kaplan-Meier and Cox proportional hazards modeling.
- Results indicated that -mutated ALS patients with the p.H63D polymorphism had longer survival compared to non-carriers, regardless of factors like sex, age, and mutation severity, suggesting the polymorphism may influence disease progression.
The treatment strategy in relapsing multiple sclerosis (RMS) is a complex decision requiring individualization of treatment sequences to maximize clinical outcomes. Current local and international guidelines do not provide specific recommendation on the use of immune reconstitution therapy (IRT) as alternative to continuous immunosuppression in the management of RMS. The objective of the program was to provide consensus-based expert opinion on the optimal use of IRT in the management of RMS.
View Article and Find Full Text PDFBackground And Objectives: The question of the long-term safety of pregnancy is a major concern in patients with multiple sclerosis (MS), but its study is biased by reverse causation (women with higher disability are less likely to experience pregnancy). Using a causal inference approach, we aimed to estimate the unbiased long-term effects of pregnancy on disability and relapse risk in patients with MS and secondarily the short-term effects (during the perpartum and postpartum years) and delayed effects (occurring beyond 1 year after delivery).
Methods: We conducted an observational cohort study with data from patients with MS followed in the Observatoire Français de la Sclérose en Plaques registry between 1990 and 2020.
Background: The effects of socio-economic status on mortality in patients with multiple sclerosis is not well known. The objective was to examine mortality due to multiple sclerosis according to socio-economic status.
Methods: A retrospective observational cohort design was used with recruitment from 18 French multiple sclerosis expert centers participating in the All patients lived in metropolitan France and had a definite or probable diagnosis of multiple sclerosis according to either Poser or McDonald criteria with an onset of disease between 1960 and 2015.
Secondary progressive multiple sclerosis: A national consensus paper on diagnostic criteria.
Rev Neurol (Paris)
December 2022
Background: In clinical practice, the diagnosis of secondary progressive multiple sclerosis (SPMS) is often delayed, retrospective and non-reproducible, as there are no consensus criteria that define the advent of SPMS. Early identification of SPMS is essential to improve patient care.
Methods: Eight regional board meetings in France involving 56 multiple sclerosis (MS) experts (neurologists) were convened to discuss diagnostic criteria for SPMS.
Article Synopsis
- This study evaluates the rate of disease activity return in multiple sclerosis (MS) patients after they stop using disease-modifying therapy, focusing on relapse rates and factors influencing relapse.
- A large sample of 14,213 patients showed that relapse rates typically increased within 2 months after stopping treatment, with earlier commencement of new therapy reducing these rates significantly.
- Factors predicting relapse included having a higher relapse rate prior to stopping therapy, being younger, being female, and having a higher Expanded Disability Status Scale (EDSS) score, with subsequent therapy reducing both relapse risk and disability progression.
Rationale for off-label treatments use in primary progressive multiple sclerosis: A review of the literature.
Rev Neurol (Paris)
November 2022
Background: Until recently, few therapeutic options, other than symptomatic treatment, were available for patients with primary progressive multiple sclerosis (PPMS). Ocrelizumab is the only approved treatment in this indication, and only since 2017. However, many patients in France are receiving off-label treatments for PPMS, mainly rituximab, mycophenolate mofetil, methotrexate, cyclophosphamide, and azathioprine.
View Article and Find Full Text PDFBackground: Natalizumab and fingolimod are used as high-efficacy treatments in relapsing-remitting multiple sclerosis. Several observational studies comparing these two drugs have shown variable results, using different methods to control treatment indication bias and manage censoring. The objective of this empirical study was to elucidate the impact of methods of causal inference on the results of comparative effectiveness studies.
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