Real-world study of efficacy, risk management and reasons for discontinuation of natalizumab for treatment of multiple sclerosis in Russia.

BACKGROUND: NTZ is approved in Russia for the treatment of highly active relapsing remitting multiple sclerosis and is reimbursed via federal budget program. However, no data about NTZ treatment in Russia and the effect of federal reimbursement have been performed so far. OBJECTIVE: To characterize the population of patients receiving natalizumab and assess the efficacy and risk-management plan (RMP) implementation of NTZ therapy in routine clinical practice in Russia. METHODS: We analyzed data for 334 patients, who received at least one infusion of NTZ. Relapse rate, MRI activity, NEDA-3 status after 2 years were assessed. Anti-JC virus antibodies status and RMP implementation were evaluated. Drop-out rate and reasons for therapy discontinuation were analyzed. RESULTS: Patients switched to natalizumab in Russia are mainly female (63%), with median EDSS score of 3.5 and high disease activity: 93% had at least 1 relapse and 58% had both T1Gd+ and new T2 lesion a year before therapy initiation. Introduction of federal reimbursement allowed patients with less relapses to start therapy with natalizumab. The only predictor of 6-month progression was EDSS score at the baseline of therapy (HR = 2.1375, 95%CI 1.0026-4.5570, p = 0.0492). 82% patients reached NEDA-3 at 24 month of therapy. 25% of patients discontinued NTZ for reasons: tolerability (14.5%), JCV antibody status (61%), and patient's decision (17%). RMP was implemented in only 36% patients. CONCLUSION: Natalizumab appeared to have high efficacy in Russian clinical practice. Federal reimbursement allowed less active patients to start natalizumab. More efforts should be done to improve RMP implementation.

Quantification of 2,4-dichlorophenoxyacetic acid in oranges and mandarins by chemiluminescent ELISA.

Direct competitive enzyme-linked immunosorbent assay (ELISA) for 2,4-dichlorophenoxyacetic acid (2,4-D) was developed. Varying the concentrations of monoclonal anti-2,4-D-antibody and the conjugate of soybean peroxidase and 2,4-D the conditions of ELISA performance were optimised. The chemiluminescent method based on peroxidase-catalysed oxidation of luminol was applied to measure the enzyme activity of the conjugate. A mixture of 3-(10'-phenothiazinyl)propane-1-sulfonate and 4-morpholinopyridine was used as potent enhancer of chemiluminescence signal. It was shown that the values of the lower detection limit, IC50 and the working range were 1.5, 64.0, and 6.5-545ng/mL, respectively. The recovery values of CL-ELISA from 10 spiked samples of oranges (n=5) and mandarins (n=5) cultivated in green house without use of 2,4-D and containing different 2,4-D concentrations (10-300ng/mL) were ranged from 92% to 104% that indicated on the absence of matrix effect for the fruit extracts of interest. Determination of 2,4-D in peel of five oranges and five mandarins purchased from stores in Vietnam showed that 2,4-D content in oranges fruits (79-104µg/kg) was significantly higher than that in mandarins (1.66-2.82µg/kg).

Preconcentration of flavonoids on polyurethane foam and their direct determination by diffuse reflectance spectroscopy.

Sorption preconcentration of flavonoids quercetin, rutin, chrysin, morin, naringenin and naringin on polyurethane foam was investigated. Several parameters that could affect the preconcentration efficiency were evaluated. The preconcentration efficiency is more than 75% for all the flavonoids except for those that are carbohydrate substituted (preconcentration efficiency less than 11%). This can be used for the separation of these two types of flavonoids. An ability of some flavonoids to absorb light in PUF phase allows their direct determination by diffuse reflectance spectroscopy. Validation of calibration linearity, reproducibility, limits of detection and quantification was performed. The method developed allows to determine flavonoids with detection limits 0.01-0.2 µg mL(-1). The method was utilized for the determination of quercetin in some plant extracts.