Publications by authors named "Gilles Edan"
The development of disease-modifying therapies (DMTs) for the treatment of multiple sclerosis (MS) has been highly successful in recent decades. It is now widely accepted that early initiation of DMTs after disease onset is associated with a better long-term prognosis. However, the question of when and how to de-escalate or discontinue DMTs remains open and critical.
View Article and Find Full Text PDFBackground: CLASSIC-MS explored long-term outcomes of patients treated with cladribine tablets.
Objective: Assess long-term efficacy in patients previously enrolled in ORACLE-MS, a Phase III parent trial.
Methods: ORACLE-MS included patients with a first clinical demyelinating event (FCDE or clinically isolated syndrome) who received ⩾1 course of cladribine tablets or placebo.
Background And Objectives: The dynamics of microstructural spinal cord (SC) damage and repair in people with multiple sclerosis (pwMS) and their clinical relevance have yet to be explored. We set out to describe patient-specific profiles of microstructural SC damage and change during the first year after MS diagnosis and to investigate their associations with disability and SC atrophy at 5 years.
Methods: We performed a longitudinal monocentric cohort study among patients with relapsing-remitting MS: first relapse <1 year, no relapse <1 month, and high initial severity on MRI (>9 T2 lesions on brain MRI and/or initial myelitis).
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.
Article Synopsis
- - Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system, and while there are various treatment options, the lack of biomarkers hampers precise treatment strategies; computational tools like clinical decision support systems (CDSSs) may enhance treatment through information technology.
- - A systematic review of 24 articles led to the identification of 14 CDSS projects for MS, revealing diverse algorithmic methods and varying levels of software development; however, none have completed the full clinical certification process.
- - The findings highlight the untapped potential for integrating advanced technology in MS management and emphasize the need for a structured approach in developing clinical support tools, underscoring the complexity and interconnectivity of these projects.
Article Synopsis
- Early treatment with immunomodulating therapy improves short-term clinical outcomes in multiple sclerosis (MS) patients, reducing the risk of conversion to clinically definite MS (CDMS) by 30.5%.
- In a study of patients with clinically isolated syndrome (CIS), those who received early treatment demonstrated fewer relapses and maintained stable disability over 15 years compared to a delayed treatment group.
- By the 15-year mark, 66.3% of patients treated early remained employed, further indicating the benefits of starting treatment early in the disease course.
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.
Background: Automatic tools for detecting new lesions in patients with MS between two MRI scans are now available to clinicians. They have been assessed from the radiologist's point of view, but their impact on the therapeutic strategies that neurologists offer their patients has not yet been documented.
Objectives: To compare neurologist's decisions according to whether a lesion detection support system had been used and describe variability between neurologists on decision-making for the same clinical cases.
Article Synopsis
- There’s a growing focus on using high-efficacy therapies for early treatment of multiple sclerosis (MS), especially in younger patients with active disease and no irreversible disability.
- High-efficacy drugs can be used as a first-line treatment, while induction therapies, though usually second-line, are reserved for aggressive cases.
- While these treatments offer benefits, they come with increased risks of infections and cancer, necessitating careful long-term safety monitoring and consideration of regimen changes.
Article Synopsis
- Previous studies indicate that cladribine tablets help reduce the frequency of relapses and slow down disability progression in people with multiple sclerosis (MS).
- The CLASSIC-MS study confirmed that MS patients who took cladribine tablets maintained better mobility and experienced long-lasting benefits beyond the treatment period.
- Overall, the findings suggest that the advantages of cladribine tablets persist even after patients discontinue the medication.
Article Synopsis
- The CLASSIC-MS study focused on the long-term effectiveness of cladribine tablets in patients with relapsing multiple sclerosis.
- The analysis included 435 patients, assessing their mobility and disability status after treatment, with a primary goal of determining wheelchair use and secondary goal related to ambulatory device dependency.
- Results showed that after about 10.9 years, a high percentage of patients treated with cladribine tablets maintained good mobility and low disability levels compared to those who did not receive the treatment.
Background: In the context of the COVID-19 pandemic, French health authorities allowed the home administration of natalizumab by a healthcare-at-home service. We evaluated the patients' perception of care quality following the transition from day-hospital to home natalizumab administration.
Methods: Thirty relapsing-remitting multiple sclerosis (MS) patients treated with natalizumab were prospectively evaluated for one year after changing onto a home treatment procedure, using MusiCare, the first MS-specific questionnaire to evaluate patient experience and MusiQol.
Article Synopsis
- The study aims to utilize advanced computational tools to improve the management of multiple sclerosis (MS), particularly for relapsing-remitting MS (RRMS) patients.
- Researchers analyzed phase 3 clinical trial data to compare the effectiveness of peg-interferon beta-1a against a placebo using various measures of disease activity.
- They created a prototype decision support system called MS Vista that personalizes treatment efficacy information for patients and enhances communication between healthcare providers and patients.
Article Synopsis
- Research on the effects of stopping second-line disease-modifying treatments (DMT) in middle-aged multiple sclerosis (MS) patients is limited, and this study aims to analyze focal inflammatory activity after discontinuing either first or second-line DMT.
- The study included 232 patients, with findings showing a significant increase in relapse risk after ceasing natalizumab compared to first-line DMT, particularly notable with a 43% relapse rate for those who stopped natalizumab.
- The results suggest that, similar to younger patients, middle-aged patients should be cautious when discontinuing natalizumab due to higher inflammatory activity risk and should only do so with a suitable alternative treatment plan in place.
Background And Objectives: Certain demographic and clinical characteristics, including the use of some disease-modifying therapies (DMTs), are associated with severe acute respiratory syndrome coronavirus 2 infection severity in people with multiple sclerosis (MS). Comprehensive exploration of these relationships in large international samples is needed.
Methods: Clinician-reported demographic/clinical data from 27 countries were aggregated into a data set of 5,648 patients with suspected/confirmed coronavirus disease 2019 (COVID-19).
Background: In Multiple Sclerosis (MS) women, therapeutic management for pregnancy planning and during pregnancy still represents a challenge regarding timing of disease-modifying therapies (DMT) stop, risk of disease reactivation and potential fetal toxicity. The objective of this study was to describe disease activity during pregnancy and postpartum depending on treatment status before conception in women with MS.
Methods: 339 MS patients who have achieved a pregnancy between 2007 and 2017 were included.
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.
Background: Interferon-β, a disease-modifying therapy (DMT) for MS, may be associated with less severe COVID-19 in people with MS.
Results: Among 5,568 patients (83.4% confirmed COVID-19), interferon-treated patients had lower risk of severe COVID-19 compared to untreated, but not to glatiramer-acetate, dimethyl-fumarate, or pooled other DMTs.
Reactivation of Multiple Sclerosis (MS) activity has been described after fingolimod cessation. Because of its contra indication during pregnancy, switch towards lower efficacy treatments are frequent in MS patients with childbearing desire but expose them to a risk of disease reactivation. In this retrospective study including 44 women with MS, a significant increase of the median annualized relapse rate was found in the year following fingolimod discontinuation compared to the period before (p < 0.
View Article and Find Full Text PDFBackground: No specific treatment has demonstrated its effectiveness to prevent post-partum relapses for multiple sclerosis (MS) women.
Objective: To assess the effectiveness of preventive high-dose corticosteroids in the post-partum period by comparing two strategies: (1) no preventive treatment and (2) standardized preventive treatment.
Methods: We selected five French Multiple Sclerosis centers using the same post-partum strategy for their patients-either high-dose steroids (treating centers TC) or no treatment (non-treating centers NTC).
Article Synopsis
- The study investigated the effects of starting treatment early in patients with relapsing-remitting multiple sclerosis (RRMS) on disability progression.
- It compared two groups: those who began treatment within 12 months of MS symptoms (early group) and those who started later, analyzing data from over 5,000 patients.
- Findings showed that early treatment delayed disability progression by an average of 7 months compared to later treatment, benefiting both younger and older patients.
On 12 September 2019, the global Patient Reported Outcome for Multiple Sclerosis (PROMS) Initiative was launched at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). The multi-stakeholder PROMS Initiative is jointly led by the European Charcot Foundation (ECF) and the Multiple Sclerosis International Federation (MSIF), with the Italian Multiple Sclerosis Society (AISM) acting as the lead agency for and on behalf of the global MSIF movement. The initiative has the ambitious mission to (i) maximize the impact of science with and of patient input on the life of people affected by MS, and (ii) to represent a unified view on Patient-Reported Outcomes for MS to people affected by MS, healthcare providers, regulatory agencies and Health Technologies Assessments agencies.
View Article and Find Full Text PDFIn France, two therapeutic strategies can be offered after fingolimod (FNG) withdrawal to highly active relapsing-remitting multiple sclerosis (RRMS) patients: natalizumab (NTZ) or anti-CD20. We compared the effectiveness of these two strategies as a switch for FNG within the OFSEP database. The primary endpoint was the time to first relapse.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the link between obesity and the progression from clinically isolated syndrome (CIS) to multiple sclerosis (MS) in patients.
- Findings indicate that obese patients are 39% more likely to transition to MS and experience a 59% higher relapse rate compared to those of normal weight.
- However, obesity did not significantly affect sustained progression or MRI outcomes, except for a noted greater reduction in brain volume among obese smokers.
Article Synopsis
- Over the past decade, the number of approved drugs for treating Multiple Sclerosis (MS) has expanded from 3 to 10, allowing for more personalized treatment strategies aimed at minimizing clinical and radiological progression of the disease.
- The paper outlines a comprehensive workflow designed for monitoring new FLAIR lesions in MS patients using longitudinal MRI scans, targeting usability for neurologists and radiologists in France.
- Evaluation results indicate that the new workflow significantly improved lesion detection accuracy and reduced the analysis time for experts, suggesting enhanced capability in classifying MS patients' disease status.