Neutralizing antibodies to interferon beta: Assessment of their clinical and radiographic impact: An evidence report - Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology
ABSTRACT The clinical and radiologic impact of developing neutralizing antibodies (NAbs) to interferon beta (IFNbeta) while on this therapy for multiple sclerosis (MS) is assessed. On the basis of Class II and III evidence, it is concluded that treatment of patients with MS with IFNbeta (Avonex, Betaseron, or Rebif) is associated with the production of NAbs (Level A). NAbs in the serum are probably associated with a reduction in the radiographic and clinical effectiveness of IFNbeta treatment (Level B). In addition, the rate of NAb production is probably less with IFNbeta-1a treatment than with IFNbeta-1b treatment, although the magnitude and persistence of this difference is difficult to determine (Level B). Finally, it is probable that there is a difference in seroprevalence due to variability in the dose of IFNbeta injected or in the frequency or route of its administration (Level B). Regardless of the explanation, it seems clear that IFNbeta-1a (as it is currently formulated for IM injection) is less immunogenic than the current IFNbeta preparations (either IFNbeta-1a or IFNbeta-1b) given multiple times per week subcutaneously (Level A). However, because NAbs disappear in some patients even with continued IFNbeta treatment (especially in patients with low titers), the persistence of this difference is difficult to determine (Level B). Although the finding of sustained high-titer NAbs (>100 to 200 NU/mL) is associated with a reduction in the therapeutic effects of IFNbeta on radiographic and clinical measures of MS disease activity, there is insufficient information on the utilization of NAb testing to provide specific recommendations regarding when to test, which test to use, how many tests are necessary, or which cutoff titer to apply (Level U).
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ABSTRACT: The name multiple sclerosis (MS) refers to 2 features of the disease: multiple describes the number of central nervous system lesions and sclerosis refers to the demyelinated nature of the lesions. Today, these lesions are usually called plaques rather than scleroses. Multiple sclerosis is a complex inflammatory disease of the central nervous system that is variable in terms of symptoms and presentation. The objectives of this article are to review briefly the epidemiology and pathophysiology of MS and to focus on the major categories of therapies currently in use to treat MS. Research is progressing at a rapid pace. The article also discusses some of the most promising new compounds in clinical trials.Journal of infusion nursing: the official publication of the Infusion Nurses Society 01/2009; 32(3):137-44. DOI:10.1097/NAN.0b013e3181a1a895
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ABSTRACT: We performed total TMJ replacement to improve respiratory status and correct occlusion in six patients with destruction of the temporomandibular joint (TMJ) caused by rheumatoid arthritis. Morphological changes were evaluated on lateral cephalograms before and after surgery. Respiratory function and mandibular movement were assessed with the use of an apnea-monitor and an LED mandibular tracking device, respectively. After surgery, symptoms such as snoring and daytime sleepiness improved, and solid food could be masticated. Postoperative cephalograms showed that both the posterior airway space and ramal height were significantly improved by surgery. Postoperative records of mandibular movement indicated stability of the occlusion and improvement of mandibular movement, as compared with the preoperative records. Mean oxygen saturation significantly improved 1 month after surgery, whereas apnea and apnea-hypopnea indices did not change significantly.International Journal of Oral and Maxillofacial Surgery 07/2003; 32(3):275-9. DOI:10.1054/ijom.2002.0369 · 1.36 Impact Factor