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Therapeutic Advances and Challenges in the Treatment of Multiple Sclerosis
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Therapeutic Advances and Challenges in the Treatment of Multiple Sclerosis

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 37396

Special Issue Editor

Dr. Emanuele D'Amico

E-Mail Website
Guest Editor
Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
Interests: multiple sclerosis; demyelinating disease of the central nervous system; neuroimmunology; motoneuron diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Currently, treatment options still rely heavily upon disease‐modifying treatments that do not treat the underlying cause but rather attempt to suppress and ameliorate the symptoms experienced.

However, with the advances in drug delivery methods and therapeutic regimen, newer treatment options have emerged, capable of tackling the demyelinating process of MS.

It is foreseen that these advances can eventually lead to vast improvements in the quality of life of patients, as well as improving the microenvironment of the CNS.

Personalized medicine in multiple sclerosis treatment will require a patient-focused approach, with disease taxonomy informed by characterization of pathophysiological processes. Newer evidence points to a disease spectrum and a therapeutic lag of several years for benefits to be observed from disease-modifying therapy. For personalized treatment, it is important to ascertain disease stage and any worsening of focal inflammatory lesions over time.

Papers addressing these topics are invited for this Special Issue, especially those combining a high academic standard coupled with a practical focus on providing therapeutic advances and challenges in the treatment of Multiple Sclerosis

Dr. Emanuele D'Amico
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • multiple sclerosis
  • therapeutic approaches
  • disease modifying therapies
  • personalized therapy
  • pathophysiological processes

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Published Papers (7 papers)

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Research

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11 pages, 801 KiB  
Article
CD19 Cell Count at Baseline Predicts B Cell Repopulation at 6 and 12 Months in Multiple Sclerosis Patients Treated with Ocrelizumab
by Gianmarco Abbadessa, Giuseppina Miele, Paola Cavalla, Paola Valentino, Girolama Alessandra Marfia, Elisabetta Signoriello, Doriana Landi, Chiara Bosa, Marco Vercellino, Antonio De Martino, Rosanna Missione, Maddalena Sparaco, Luigi Lavorgna, Giacomo Lus and Simona Bonavita
Int. J. Environ. Res. Public Health 2021, 18(15), 8163; https://doi.org/10.3390/ijerph18158163 - 2 Aug 2021
Cited by 15 | Viewed by 3601
Abstract
Background: The kinetics of B cell repopulation in MS patients treated with Ocrelizumab is highly variable, suggesting that a fixed dosage and time scheduling might be not optimal. We aimed to investigate whether B cell repopulation kinetics influences clinical and radiological outcomes and [...] Read more.
Background: The kinetics of B cell repopulation in MS patients treated with Ocrelizumab is highly variable, suggesting that a fixed dosage and time scheduling might be not optimal. We aimed to investigate whether B cell repopulation kinetics influences clinical and radiological outcomes and whether circulating immune asset at baseline affects B cell repopulation kinetics. Methods: 218 MS patients treated with Ocrelizumab were included. Every six months we collected data on clinical and magnetic resonance imaging (MRI) activity and lymphocyte subsets at baseline. According to B cell counts at six and twelve months, we identified two groups of patients, those with fast repopulation rate (FR) and those with slow repopulation rate (SR). Results: A significant reduction in clinical and radiological activity was found. One hundred fifty-five patients had complete data and received at least three treatment cycles (twelve-month follow-up). After six months, the FR patients were 41/155 (26.45%) and 10/41 (29.27%) remained non-depleted after twelve months. FR patients showed a significantly higher percentage of active MRI scan at twelve months (17.39% vs. 2.53%; p = 0,008). Furthermore, FR patients had a higher baseline B cell count compared to patients with an SR (p = 0.02 and p = 0.002, at the six- and twelve-month follow-ups, respectively). Conclusion: A considerable proportion of MS patients did not achieve a complete CD19 cell depletion and these patients had a higher baseline CD19 cell count. These findings, together with the higher MRI activity found in FR patients, suggest that the Ocrelizumab dosage could be tailored depending on CD19 cell counts at baseline in order to achieve complete disease control in all patients. Full article
(This article belongs to the Special Issue Therapeutic Advances and Challenges in the Treatment of Multiple Sclerosis)
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11 pages, 599 KiB  
Article
Views of the Future of Partners of People with Multiple Sclerosis Who Attended a Lifestyle Modification Workshop: A Qualitative Analysis of Perspectives and Experiences
by Sandra L. Neate, Keryn L. Taylor, Nupur Nag, George A. Jelinek, Steve Simpson-Yap, William Bevens and Tracey J. Weiland
Int. J. Environ. Res. Public Health 2021, 18(1), 85; https://doi.org/10.3390/ijerph18010085 - 24 Dec 2020
Cited by 6 | Viewed by 2720
Abstract
People with multiple sclerosis (PwMS) often experience uncertainty and fear about their futures. Partners of PwMS may share their concerns and experience fears about their own futures, limitations on their lives, ability to work, and becoming a carer. For PwMS, modification of lifestyle-related [...] Read more.
People with multiple sclerosis (PwMS) often experience uncertainty and fear about their futures. Partners of PwMS may share their concerns and experience fears about their own futures, limitations on their lives, ability to work, and becoming a carer. For PwMS, modification of lifestyle-related risk factors has been associated with improved health outcomes. For PwMS who attended residential lifestyle modification workshops (RLMW), sustained improved health outcomes have been demonstrated. Whether improved outcomes for PwMS who engage with lifestyle modification translate to improved partner perceptions of the future, is yet to be explored. We explored the perspectives of partners of PwMS who had attended a RLMW and the impact that the person with MS’s illness and their engagement with lifestyle modification had on their partners’ views of the future. Analysis of 21 semi-structured interviews used a methodology informed by Heidegger’s Interpretive Phenomenology. Three themes emerged: ‘uncertainty’, ‘planning for the future’ and ‘control, empowerment and confidence’. Subthemes included MS and lifestyle modification being a catalyst for positive change; developing a sense of control and empowerment; and hope, optimism and positivity. Lifestyle modification may provide benefits, not only to PwMS, but also to their partners, and should be considered part of mainstream management of MS. Full article
(This article belongs to the Special Issue Therapeutic Advances and Challenges in the Treatment of Multiple Sclerosis)
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Review

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9 pages, 352 KiB  
Review
Adherence to Therapy in Patients with Multiple Sclerosis—Review
by Aleksandra Kołtuniuk and Justyna Chojdak-Łukasiewicz
Int. J. Environ. Res. Public Health 2022, 19(4), 2203; https://doi.org/10.3390/ijerph19042203 - 15 Feb 2022
Cited by 27 | Viewed by 4884
Abstract
Multiple sclerosis (MS) is a chronic, autoimmune, demyelinating disease of the central nervous system (CNS). MS is an incurable disease. The goal of disease-modifying therapies (DMT) is to slow the progression of the disease, prevent relapses and increase the patient’s overall quality of [...] Read more.
Multiple sclerosis (MS) is a chronic, autoimmune, demyelinating disease of the central nervous system (CNS). MS is an incurable disease. The goal of disease-modifying therapies (DMT) is to slow the progression of the disease, prevent relapses and increase the patient’s overall quality of life. According to the World Health Organisation definition, adherence means the extent to which a person’s medication-taking behaviour corresponds with the agreed upon treatment recommendations from a healthcare provider. Accurate adherence is necessary for efficient treatment. Non-adherence is related to unsuccessful treatments, the risk of relapses and increased healthcare costs. The aim of this study is to present the main factors relating to non-adherence in MS patients. Full article
(This article belongs to the Special Issue Therapeutic Advances and Challenges in the Treatment of Multiple Sclerosis)
21 pages, 1133 KiB  
Review
Vitamin D and Depressive Symptoms in Adults with Multiple Sclerosis: A Scoping Review
by Carmen Concerto, Alessandro Rodolico, Alessia Ciancio, Christian Messina, Antimo Natale, Ludovico Mineo, Fortunato Battaglia and Eugenio Aguglia
Int. J. Environ. Res. Public Health 2022, 19(1), 199; https://doi.org/10.3390/ijerph19010199 - 25 Dec 2021
Cited by 5 | Viewed by 3532
Abstract
Background. Vitamin D deficiency has been correlated with Multiple Sclerosis (MS) risk and disease activity. There is some controversy as to whether vitamin D could have an impact on depressive symptoms in people with MS (pwMS). The aim of this scoping review was [...] Read more.
Background. Vitamin D deficiency has been correlated with Multiple Sclerosis (MS) risk and disease activity. There is some controversy as to whether vitamin D could have an impact on depressive symptoms in people with MS (pwMS). The aim of this scoping review was to evaluate the association between vitamin D status and depressive symptoms in pwMS. Methods. We searched databases to include studies published up to March 2021 to provide an overview of the available evidence on the correlation between vitamin D status and depressive symptoms in pwMS. The eligibility criteria were as follows: studies evaluating the use of vitamin D measurement on depressive symptoms in patients suffering from MS, including randomized and non-randomized studies; studies written in English; and studies exploring an adult population over the age of 18. Results. Eleven studies met our inclusion criteria: two of them were abstracts only; the majority were cross-sectional studies; two were prospective longitudinal studies; one was a retrospective cohort study; and one was a randomized placebo-controlled trial (RCT). Of the eleven studies selected, seven showed a potential correlation between low vitamin D levels and depressive symptoms. Conclusion. Future RCT studies should include patients with greater severity of depressive symptoms and should consider confounding factors such as sun exposure and seasonal variation of vitamin D. Full article
(This article belongs to the Special Issue Therapeutic Advances and Challenges in the Treatment of Multiple Sclerosis)
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25 pages, 629 KiB  
Review
Occupational Therapy Interventions in Adults with Multiple Sclerosis or Amyotrophic Lateral Sclerosis: A Scoping Review
by Luis De-Bernardi-Ojuel, Laura Torres-Collado and Manuela García-de-la-Hera
Int. J. Environ. Res. Public Health 2021, 18(4), 1432; https://doi.org/10.3390/ijerph18041432 - 3 Feb 2021
Cited by 12 | Viewed by 14978
Abstract
This scoping review aims to describe occupational therapy interventions carried out with multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) patients in occupational therapy. A peer review of the literature was conducted in different databases: Pubmed, Scopus, Web of Science and Embase, and [...] Read more.
This scoping review aims to describe occupational therapy interventions carried out with multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) patients in occupational therapy. A peer review of the literature was conducted in different databases: Pubmed, Scopus, Web of Science and Embase, and in some occupational therapy journals. A search of the literature published was carried out before December 2019. The inclusion criteria were as follows: (1) articles evaluating the intervention of occupational therapy in MS or ALS including experimental, randomized, nonrandomized and exploratory studies; (2) written in English or Spanish; (3) adult population (over 18 years old). The initial search identified 836 articles of which we included 32 divided into four areas of intervention: fatigue-targeted interventions, cognitive interventions, physical interventions and others. Only 16 studies were carried out exclusively by occupational therapists. Most occupational therapy interventions are aimed at fatigue and physical rehabilitation. The majority of the studies in our review included MS patients, with little representation from the ALS population. These interventions have shown an improvement in perceived fatigue, manual dexterity, falls prevention and improvement in cognitive aspects such as memory, communication, depression and quality of life in the MS and ALS populations. Full article
(This article belongs to the Special Issue Therapeutic Advances and Challenges in the Treatment of Multiple Sclerosis)
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Other

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7 pages, 438 KiB  
Brief Report
Stopping Interferon Beta 1b Does Not Influence the Risk of Disability Accrual in Non-Active SPMS: Results from an Italian Real-World Study
by Aurora Zanghì, Emanuele D’Amico, Francesco Patti and Carlo Avolio
Int. J. Environ. Res. Public Health 2022, 19(10), 6069; https://doi.org/10.3390/ijerph19106069 - 17 May 2022
Cited by 2 | Viewed by 1627
Abstract
Background: No consensus exists on the possibility to stop disease modifying therapies (DMTs) in Secondary Progressive Multiple Sclerosis (SPMS). Methods: The primary outcome was the time to reach 24-weeks confirmed Expanded Disability Status Scale (EDSS) 7.0. We enrolled all patients with a confirmed [...] Read more.
Background: No consensus exists on the possibility to stop disease modifying therapies (DMTs) in Secondary Progressive Multiple Sclerosis (SPMS). Methods: The primary outcome was the time to reach 24-weeks confirmed Expanded Disability Status Scale (EDSS) 7.0. We enrolled all patients with a confirmed diagnosis of non-active SPMS (here, absence of clinical or radiological activity for at least 24 months before the conversion) between 1 January 2010 and 31 December 2015, at MS centers of Catania and Foggia, Italy. Patients were divided into two groups, according to the shared decision to stop DMTs (group A) or to maintain/switch to licensed interferon beta 1b for SPMS (group B). A Cox model adjusted with an inverse probability weighted propensity score (IPTW-PS) was employed. Results: A cohort of 311 patients was enrolled, 165 were in group A and 146 were in group B. Patients in the two groups were similar for baseline characteristics. The IPTW-PS adjusted Cox model for the event time to 24-weeks confirmed EDSS 7.0 did not show differences between the two groups (ExpB 0.96, CI 0.739–1.271, p = 0.819). Conclusions: In a real-world setting, in patients with non-active SPMS, the maintaining or switching to the licensed interferon beta 1b did not reduce the risk of reaching confirmed EDSS 7.0. Full article
(This article belongs to the Special Issue Therapeutic Advances and Challenges in the Treatment of Multiple Sclerosis)
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5 pages, 1601 KiB  
Case Report
Alopecia Universalis Occurring after Alemtuzumab Treatment for Multiple Sclerosis. A Two-Year Follow-Up of Two Patients
by Giovanna Borriello, Antonio Ianniello and Ahmed T Toosy
Int. J. Environ. Res. Public Health 2021, 18(14), 7338; https://doi.org/10.3390/ijerph18147338 - 9 Jul 2021
Cited by 5 | Viewed by 4870
Abstract
Alopecia Universalis (AU) is the most severe form of Alopecia Areata and is caused by cytotoxic T-cells reacting with follicular autoantigens, producing complete loss of scalp and body hair. Alemtuzumab is a highly efficacious monoclonal antibody used in the treatment of Multiple Sclerosis [...] Read more.
Alopecia Universalis (AU) is the most severe form of Alopecia Areata and is caused by cytotoxic T-cells reacting with follicular autoantigens, producing complete loss of scalp and body hair. Alemtuzumab is a highly efficacious monoclonal antibody used in the treatment of Multiple Sclerosis (MS), but it causes secondary autoimmunity in up to 40% of patients. Many factors are believed to contribute to this process, but pathogenic mechanisms are not well clear. To date, three cases of AU after treatment with Alemtuzumab have been reported. In this paper we report the cases of two patients who developed AU 12 months after the second cycle of Alemtuzumab, with a review of the literature. One year after the end of the second cycle, two female patients in their thirties experienced complete hair loss. The first case was temporally associated with a significant drop in vitamin D (VD) levels. The second case was accompanied by joint swelling. Both patients had thyroid alterations and showed no hair regrowth after a 2-year follow-up. AU must be considered among the secondary autoimmune manifestations of Alemtuzumab treatment. We emphasize the need for appropriate patient screening and thorough clinical surveillance for factors predisposing patients to secondary autoimmunity. Full article
(This article belongs to the Special Issue Therapeutic Advances and Challenges in the Treatment of Multiple Sclerosis)
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