Sunday, 17 July 2016

Predicting response to glatiramer

Valenzuela RM, Kaufman M, Balashov KE, Ito K, Buyske S, Dhib-Jalbut S. Predictive cytokine biomarkers of clinical response to glatiramer acetate therapy in multiple sclerosis J Neuroimmunol. 2016 Jul. pii: S0165-5728(16)30137-0.

A prospective study of 62 patients with relapsing-remitting multiple sclerosis (RRMS) treated with Glatiramer acetate (GA) was conducted to evaluate the value of baseline and treatment-modulated cytokines in predicting the clinical response to the drug after 2years of therapy. There were 32 responders and 30 non-responders. GA upregulated Th2/regulatory cytokines and inhibited Th1 cytokines in sera or PBMC supernatants 3 and 6months into treatment. We found two prognostic models with clinical utility. A model based on IL-18 at baseline, the change in TNFa from baseline to 3months, the change in IL-4 from baseline to 6months, and the change in the log of the ratio of TNFa/IL-4 from baseline to 6months had an area under the curve (AUC) of 0.80. A high IL-18 level at baseline and a reduction of TNF-alpha over time are associated with a response to GA. Although the study identified predictive biomarkers of clinical response to GA, the results will need to be validated in other data sets.

Can you predict who will respond to glaterimer acetate  and if you are non-responder you can switch. This study finds a few cytokines that may give a clue to who responds, which seems to be those with less evidence of inflammatory activity in their blood..go figure:-).

However, it is not sufficiently descriminatory as per ususal, even if it is repeated and so the way people will work out the failures is by the actual failure, I suspect. 

The good side effect profile makes this a popular approach, but as time is brain and in this group of sixty we had about 50% failures, one may ask if this. Is the way to go? 

4 comments:

  1. CRAB drugs do not have remarkable effect on BVL which correlates best the further disability.
    Time is brain! Took highly effective treatment (Ty or G and some new in the future...)

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  2. Smblogger, Is there evidence a CRAB doesn't slow BVL in responders? As a GA responder for 5 years, Ive never been clear on that.

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  3. I'm for exactly 02 years with GA.
    For now it seems that the "MS is still" but I'm fully aware that it's a weak drug and does not act on the progression.
    So how to convince my neurologist about it, she has the philosophy that "it is better to burn letters when necessary" that is, when I have a strong outbreak and to leave me with consequences...

    Another thing is that in fact was the moment where we apply the GA, only really MS makes me sure of her presence when I'm approaching the menstrual period, which is when I feel some symptoms, such as paresthesia or neuropathic pain.
    Then some recently published study on the contraceptives, the menstrual period and MS?

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  4. Very interesting. I met a lady at an MS convention who noticed she was having several MS flares as she was discontinuing her birth control pills because of age. Her Neuro put her back on the pills and she is doing very well. Also gets very high doses of Vitamin D injections.

    Definitely have noticed more progression in my own symptoms as I am having hormone issues due to menopause.

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