Real-world persistence of multiple sclerosis disease-modifying therapies.

BACKGROUND AND PURPOSE: Treatment persistence is the continuation of therapy over time. It reflects a combination of treatment efficacy and tolerability. We aimed to describe real-world rates of persistence on disease-modifying therapies (DMTs) for people with multiple sclerosis (pwMS) and reasons for DMT discontinuation. METHODS: Treatment data on 4366 consecutive people with relapse-onset multiple sclerosis (MS) were pooled from 13 UK specialist centres during 2021. Inclusion criteria were exposure to at least one MS DMT and a complete history of DMT prescribing. PwMS in blinded clinical trials were excluded. Data collected included sex, age at MS onset, age at DMT initiation, DMT treatment dates, and reasons for stopping or switching DMT. For pwMS who had received immune reconstituting therapies (cladribine/alemtuzumab), discontinuation date was defined as starting an alternative DMT. Kaplan-Meier survival analyses were used to express DMT persistence. RESULTS: In 6997 treatment events (1.6 per person with MS), median time spent on any single maintenance DMT was 4.3 years (95% confidence interval = 4.1-4.5 years). The commonest overall reasons for DMT discontinuation were adverse events (35.0%) and lack of efficacy (30.3%). After 10 years, 20% of people treated with alemtuzumab had received another subsequent DMT, compared to 82% of people treated with interferon or glatiramer acetate. CONCLUSIONS: Immune reconstituting DMTs may have the highest potential to offer a single treatment for relapsing MS. Comparative data on DMT persistence and reasons for discontinuation are valuable to inform treatment decisions and in personalizing treatment in MS.

Salutary attributes of probiotic human gut lactobacilli for gut health.

Lactobacilli are GRAS organisms and are important members of gut microbiota. They have been strongly recommended as probiotics because of many benefits provided by them to overall human health. Human gut lactobacilli with salutary properties can provide additional advantages. Limosilactobacillus fermentumL1 MW600457, L. fermentumL3 MW600480, L. fermentumL4 MW600464, L. fermentumL5 MW600493, L. fermentumL6 MW600495, L. fermentumL7 MW600496, L. fermentumL8 MW485761, Lactiplantibacillus plantarumL9 MW485746, and Ligilactobacillus salivariusL10 MW600498 with in vitro probiotic properties were explored for salutogenic characteristics. Salutary properties like ß-galactosidase activity, anthelminthic property assay, anti-inflammatory assay, antidiabetic study, cholesterol assimilation assay, and biofilm assay were performed. All the isolates were positive for ß-galactosidase activity. The anthelminthic property with minimum paralysis time and death time between 16-25 min was shown by L.fermentumL8 MW485761. Anti-inflammatory activity with bovine serum albumin was maximum at 200 µg ml-1 concentration. α-amylase inhibitory activity was maximum for L. fermentumL8 MW485761 (51%). Maximum cholesterol assimilation was reported for L. fermentumL6 MW600495 (76%). Strong biofilm forming ability for all isolates improved the colonization and stability as probiotics. Human gut lactobacilli with salutary properties can make an efficient probiotic.

Serum tumor necrosis factor-alpha in Guillain-Barré syndrome and its relation to plasma exchange.

BACKGROUND: To correlate the serum tumor necrosis factor-alpha (TNFalpha) concentrations before, during and following plasma exchange in patients with Guillain-Barré syndrome (GBS). In this prospective study, 21 GBS patients were selected. Patients in clinical stages III to V were subjected to plasma exchange. The control group included equal numbers of age-matched patients with other neurological diseases and healthy voluntary blood donors. A sandwich ELISA method was applied to estimate serum TNFalpha concentrations in test and control groups. REVIEW SUMMARY: Twelve GBS patients had elevated serum TNFalpha levels that ranged between 74 and 182 pg/mL. All 12 GBS patients showed a steady decrease in the TNFalpha concentration following plasma exchange and also showed a positive correlation with neurological recovery. CONCLUSIONS: We conclude that serum TNFalpha concentrations are elevated in 57.1% of GBS patients and TNFalpha level decreases following plasma exchange.