Efectividad del acetato de glatiramero en la práctica clínica: un estudio observacional / The effectiveness of glatiramer acetate in clinical practice: an observational stud

Objetivos. Evaluar la efectividad clínica y la seguridad del acetato de glatiramero en las condiciones de la práctica diaria. Pacientes y métodos. Estudio retrospectivo, observacional, en pacientes con esclerosis múltiple tratados con acetato de glatiramero en las condiciones de la práctica clínica. El criterio principal de valoración fue la efectividad clínica del acetato de glatiramero. Resultados. En el estudio se incluyeron un total de 104 pacientes (mujeres: 59,6%; edad de inicio del acetato de glatiramero: 39,9 ± 10,9 años; tratamiento anterior para la esclerosis múltiple: 30,8%). Los pacientes recibieron acetato de glatiramero durante 3,6 ± 1,9 años. Durante el primer año de tratamiento con el acetato de glatiramero, la tasa de recidivas se redujo un 60%, en 47 pacientes (45,1%) se redujo el número de recidivas, 67 pacientes (68,4%) no sufrieron recidiva y 78 pacientes (75%) no mostraron progresión. Durante el segundo año de tratamiento con acetato de glatiramero, la tasa de recidivas había disminuido un 70%, en 43 pacientes (41,3%) se redujo el número de recidivas, 63 pacientes (75,9%) no sufrieron recidiva y 59 pacientes (56,7%) no mostraron progresión. No se notificaron recidivas ni progresión en 56 (53,8%) y 41 pacientes (39,4%) durante el primer y segundo año de tratamiento, respectivamente. La suspensión del acetato de glatiramero sólo fue necesaria en tres pacientes. Los acontecimientos adversos más frecuentes fueron cansancio (28,9%) y espasticidad (7,7%). Conclusión. La evaluación del acetato de glatiramero en las condiciones de la práctica clínica respalda el perfil de eficacia y seguridad observado en ensayos clínicos previamente publicados (AU)

Aim. To evaluate the clinical effectiveness and safety of glatiramer acetate for use in routine clinical practice. Patients and methods. A retrospective, observational study was conducted on patients with multiple sclerosis who were treated with glatiramer acetate in clinical practice. The primary outcome was the clinical effectiveness of glatiramer acetate treatment. Results. The study included a total of 104 patients (women, 59.6%; age at onset of glatiramer acetate treatment, 39.9 ± 10.9 years; prior treatment for multiple sclerosis, 30.8%). The patients had received glatiramer acetate treatment for an average of 3.6 ± 1.9 years. During the first year of glatiramer acetate treatment, the relapse rate decreased by 60%. At this time, the number of relapses had decreased for 47 patients (45.1%), 67 patients (68.4%) had not suffered a relapse and 78 patients (75.0%) showed no signs of progression. During the second year of glatiramer acetate treatment, the relapse rate decreased by 70%. At this time, the number of relapses had decreased for 43 patients (41.3%), 63 patients (75.9%) had not suffered a relapse and 59 patients (56.7%) showed no signs of progression. There were no reported relapses or progression in 56 patients (53.8%) and 41 patients (39.4%) during the first and second years of treatment, respectively. Discontinuation of glatiramer acetate was necessary in only three patients. The most common adverse effects included fatigue (28.9%) and spasticity (7.7%). Conclusion. This evaluation of glatiramer acetate use in clinical practice supports the effectiveness and the safety profile observed in previously published clinical trial studies (AU)

Multiple sclerosis prevalence in Malaga, Southern Spain estimated by the capture-recapture method.

BACKGROUND: Although not definitively proven, there is commonly accepted to be a latitudinal gradient in the distribution of multiple sclerosis (MS), which is more frequent in temperate zones. The European Mediterranean countries are situated in a zone of median frequency, although ever increasing figures have been noted in the last decades. OBJECTIVE: The objective of this study was to assess the current prevalence rate of MS in the province of Malaga, Southern Spain. METHODS: The capture-recapture method (CRM) uses independent sources of data and permits the number of non-registered cases of a given disease to be estimated, and by doing so, to avoid ascertainment bias. RESULTS: Use of this method showed the estimated prevalence rate of MS in the province of Malaga, Southern Spain, to be 125/10(5) (95% confidence interval: 102/10(5)-169/10(5)), higher than the figures published previously. CONCLUSIONS: Although we recognize that these data need to be confirmed in further studies and in other areas of the country using a similar method, we believe this study is the first to find such high figure of prevalence, being very similar to the figures reported in recent years in other southern European countries.

[Tolosa-Hunt syndrome and orbital pseudotumour. Overlapping conditions in a case with an unusual clinical profile]. / Síndrome de Tolosa-Hunt y pseudotumor orbitario. Entidades solapadas en un caso con perfil clínico no habitual.

INTRODUCTION: The origin of Tolosa-Hunt syndrome (THS) and orbital pseudotumour (OP) is not fully understood. It is acknowledged as having an unspecific granulomatous inflammatory nature in different locations. Although there are differences between the clinical features of the two conditions, they also share a number of physiopathogenetic, therapeutic and, in some cases, iconographic similarities. Possible clinical recurrences are common in the two conditions and a broad differential diagnosis is required in all cases. Yet, the association of both processes in the same patient, with radiological proof of the migration of the inflammatory injury, is not frequent. CASE REPORT: We report the case of a male patient with a long history of recurring unilateral painful ophthalmoplegia that was sensitive to steroids; criteria for THS were fulfilled and there was later development of homolateral OP, six years after the onset of his symptoms. The findings in serial studies conducted with magnetic resonance imaging must be highlighted. The patient was submitted to a surgical intervention to treat the orbital injury and a chronic inflammatory process was observed in the fibrotic phase. CONCLUSIONS: Inflammatory pseudotumour and THS perhaps have more points in common than has traditionally been accepted. To our knowledge few cases of the above-mentioned association have been reported in the same patient. When confronted by cases of painful ophthalmoplegia with excessive recurrences the physician must consider the possibility of other alternative diagnoses.

Síndrome de Tolosa-Hunt y pseudotumor orbitario. Entidades solapadas en un caso con perfil clínico no habitual / Tolosa-hunt syndrome and orbital pseudotumour. Overlapping conditions in a case with an unusual clinical profile

Introducción. El origen del síndrome de Tolosa-Hunt (STH) y del pseudotumor orbitario (PO) no es del todo conocido. Se admite su naturaleza inflamatoria granulomatosa localizaciones diferentes. Aunque existen divergencias clínicas entre ambos, también comparten similitudes fisiopatogénicas, terapéuticas y, en algunos casos, iconográficas. Las posibles recurrencias clínicas en ambas entidades son comunes y requieren en todo caso un amplio diagnóstico diferencial. Sin embargo, no es frecuente la asociación de ambos procesos en el mismo paciente, con documentación radiológica de la migración de la lesión inflamatoria. Caso clínico. Se presenta un paciente con oftalmoplejía dolorosa unilateral recurrente de larga evolución, sensible a esteroides, con criterios de STH y posterior desarrollo de PO homolateral, seis años tras el comienzo de sus síntomas. Destacamos los hallazgos de neuroimagen en resonancias magnéticas seriadas. Se interviene al paciente a causa de la lesión orbitaria, y se evidencia unproceso inflamatorio crónico en fase fibrótica. Conclusión. Quizás el pseudotumor inflamatorio y el STH compartan más aspectos comunes de lo tradicionalmente aceptado. En nuestro conocimiento existen pocos casos documentados de la citada asociación en elm ismo paciente. Los casos de oftalmoplejía dolorosa con excesivas recurrencias deben suscitar al clínico la posibilidad de otras alternativas diagnósticas (AU)

Introduction. The origin of Tolosa-Hunt syndrome (THS) and orbital pseudotumour (OP) is not fully understood. Itis acknowledged as having an unspecific granulomatous inflammatory nature in different locations. Although there are differences between the clinical features of the two conditions, they also share a number of physiopathogenetic, therapeutic and, in some cases, iconographic similarities. Possible clinical recurrences are common in the two conditions and a broad differential diagnosis is required in all cases. Yet, the association of both processes in the same patient, with radiological proof of the migration of the inflammatory injury, is not frequent. Case report. We report the case of a male patient with a long history of recurring unilateral painful ophthalmoplegia that was sensitive to steroids; criteria for THS were fulfilled and there was later development of homolateral OP, six years after the onset of his symptoms. The findings in serial studies conducted with magnetic resonance imaging must be highlighted. The patient was submitted to a surgical intervention to treat the orbital injury and a chronic inflammatory process was observed in the fibrotic phase. Conclusions. Inflammatory pseudotumour and THSperhaps have more points in common than has traditionally been accepted. To our knowledge few cases of the above-mentioned association have been reported in the same patient. When confronted by cases of painful ophthalmoplegia with excessive recurrences the physician must consider the possibility of other alternative diagnoses (AU)