A drug used to treat multiple sclerosis (MS), alemtuzumab, was found to reverse some of the physical disability caused by the disease, according to new research led by Blizard Institute researchers.
Alemtuzumab is used in relapsing-remitting MS, the most common form of the disease, in which symptoms alternate between sudden worsening and remission. Because it can cause serious side effects, the drug is generally used in people who have not responded well to other drugs. In this study, however, it was used relatively early in the course of MS.
Professor Gavin Giovannoni from the Centre for Neuroscience and Trauma said: “While many MS drugs slow the progress of disability, there have been little data about the ability of treatments to help restore function previously lost due to MS.
“We saw improvements in many of our participants who received alemtuzumab treatment, including their mobility, coordination, bladder function and thinking skills. This suggests that the drug effects include restoring function.
“These benefits, however, were seen in patients relatively early on in the course of their disease and need to be confirmed in patients with more advanced MS. These benefits have to be weighed against the drug’s risks, which include serious, and rarely, life-threatening autoimmune problems, as well as infusion reactions and infections.”
In the study, published in Neurology, people with relapsing-remitting MS who did not respond well to at least one other MS drug were treated either with alemtuzumab (426 people) or the drug interferon beta-1a (202 people).
Researchers assessed the participants’ level of disability at the beginning of the study and again every three months for two years.
By the end of the study, nearly 28 percent of those receiving alemtuzumab had improved by at least one point on a disability test, compared to 15 percent of those receiving interferon. People receiving alemtuzumab were 2.5 times more likely to improve on the assessment of thinking skills than those receiving interferon, and were more than twice as likely to improve on the ability to move without tremor or clumsy movements known as ataxia.
The study was supported by Sanofi Genzyme and Bayer HealthCare Pharmaceuticals.
- Research paper: 'Alemtuzumab improves preexisting disability in active relapsing-remitting MS patients'. Gavin Giovannoni et al. Neurology 2016. DOI: 10.1212/WNL.0000000000003319
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In the media
MS drug 'may reverse some disability' - Boots WebMD
Multiple sclerosis drug could reverse physical symptoms - Medical News Today
Data on injuries can be collected relatively easily at A&E departments to help understand injury patterns in communities, a study by researchers at the Blizard Institute has found.
Since January 2012, injury data have been collected at the two main Accident & Emergency departments of the John Radcliffe Hospital in Oxford and the Horton General Hospital in Banbury by clerical staff with a good level of success.
In their analysis, the researchers found that out of the 63,877 injury attendances recorded, 26,536 were unintentional injuries. The most frequent location, mechanism and activity were home (39.1 per cent), low-level falls (47.1 per cent) and leisure (31.1 per cent), respectively.
There was a significant association between increasing levels of deprivation and an increasing incidence rate for all unintentional injuries, for those in the home, for low-level falls and for non-sport leisure injuries.
The data collection project at the two Oxfordshire hospitals was initiated to inform the current development of the NHS emergency care dataset project now underway across England. The existing NHS emergency care dataset has been in use since the 1970s.
Lead author Graham Kirkwood from the Centre for Primary Care and Public Health said: “This initiative in Oxfordshire shows both the feasibility of collecting enhanced injury data from patients and the usefulness of such data in understanding injury patterns in the community.”
The study, published in the Journal of Epidemiology and Community Health, found that people living in the most deprived parts of Oxfordshire were 70 per cent more likely to attend an emergency department with an unintentional injury than those living in the least deprived parts.
The researchers also found higher sport-related injury rates in areas with lower levels of deprivation, except for football injuries which were higher among the most deprived.
Unintentional injury, what used to be termed accidents, can lead to injuries from the trivial to the life threatening. Costs to the UK economy have been estimated by the Royal Society for the Prevention of Accidents to be as much as £160 billion a year, or 6.5 per cent of UK gross domestic product.
The authors say that unintentional injuries are in the main preventable, however to plan, implement and evaluate prevention initiatives requires good quality data.
Co-author Professor Allyson Pollock, also from the Centre for Primary Care and Public Health, added: “The government needs to ensure the success of the new NHS emergency care data set and its enhanced injury component.”
- Research paper: ‘Unintentional injury in England: an analysis of the emergency care data set pilot in Oxfordshire from 2012 to 2014'. Kirkwood, G., Hughes, T. C., Pollock, A. M. Journal of Epidemiology and Community Health. 2016.
Cure rates for multi-drug-resistant tuberculosis (MDR-TB) in Europe have been estimated to be twice as high as previously thought, according to a research team in the Centre for Immunobiology here at the Blizard Institute, Queen Mary University of London (QMUL).
The Tuberculosis Network Clinical Trials Group (TBNET), an international consortium of clinicians and scientists, documented the management of 380 patients with Multidrug-Resistant Tuberculosis (MDR-TB) at 23 different sites across Europe over five years.
The study, published as correspondence in the New England Journal of Medicine, found that cure rates in Europe were 61 per cent according to TBNET’s new definitions, compared to only 31 per cent when using the standard criteria proposed by the WHO.
MDR-TB has been on the increase worldwide over the past decade, with the largest number of patients living in the European WHO region. Despite treatment with expensive drugs, cure rates were thought to be very low.
The WHO definition for ‘cured’ patients includes having three cultures of sputum (mucus from the respiratory tract) that test negative for MDR-TB, taken at least 30 days apart during the continuation phase of treatment.
The researchers found that the WHO criterion for ‘cure’ could not be applied in the majority of patients. This was because most patients who had successful treatments did not produce sputum (normally produced as the result of infection) after eight months of therapy and therefore could not give a sample.
TBNET proposed new definitions for ‘cure’ and ‘failure’ of MDR-TB treatment based on the sputum culture status at six months after the initiation of therapy, and whether patients were free from disease recurrence one year after the end of therapy.
Dr Heinke Kunst, on behalf of the TB research group at QMUL's Blizard Institute, said: “The results from our study are very encouraging and may give hope to patients who are affected by MDR-TB. But there is still much to do to improve treatment outcomes, as 30 per cent of MDR-TB patients still cannot be cured in Europe.
“We need new drugs and shorter regimens which are more effective, less toxic and widely available in the European region. We are optimistic that outcomes can be improved with novel medicines and individually-tailored treatments, rather than programmatic one-for-all courses of therapy.”
Dr Simon Tiberi (Consultant in Infectious Diseases) was also involved in the study, and Dr Veronica White is TB lead for Barts Health NHS Trust.
- Correspondence: ‘Treatment Outcomes in Multidrug-Resistant Tuberculosis’. Gunar Günther, Christoph Lange et al. New England Journal of Medicine 2016. DOI: 10.1056/NEJMc1603274