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- Kalincik, Tomas, et al.
(author)
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Comparative Effectiveness of Autologous Hematopoietic Stem Cell Transplant vs Fingolimod, Natalizumab, and Ocrelizumab in Highly Active Relapsing-Remitting Multiple Sclerosis
- 2023
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In: JAMA Neurology. - : American Medical Association (AMA). - 2168-6149 .- 2168-6157. ; 80:7, s. 702-713
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Journal article (peer-reviewed)abstract
- Importance Autologous hematopoietic stem cell transplant (AHSCT) is available for treatment of highly active multiple sclerosis (MS).Objective To compare the effectiveness of AHSCT vs fingolimod, natalizumab, and ocrelizumab in relapsing-remitting MS by emulating pairwise trials.Design, Setting, and Participants This comparative treatment effectiveness study included 6 specialist MS centers with AHSCT programs and international MSBase registry between 2006 and 2021. The study included patients with relapsing-remitting MS treated with AHSCT, fingolimod, natalizumab, or ocrelizumab with 2 or more years study follow-up including 2 or more disability assessments. Patients were matched on a propensity score derived from clinical and demographic characteristics.Exposure AHSCT vs fingolimod, natalizumab, or ocrelizumab.Main outcomes Pairwise-censored groups were compared on annualized relapse rates (ARR) and freedom from relapses and 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening and improvement.Results Of 4915 individuals, 167 were treated with AHSCT; 2558, fingolimod; 1490, natalizumab; and 700, ocrelizumab. The prematch AHSCT cohort was younger and with greater disability than the fingolimod, natalizumab, and ocrelizumab cohorts; the matched groups were closely aligned. The proportion of women ranged from 65% to 70%, and the mean (SD) age ranged from 35.3 (9.4) to 37.1 (10.6) years. The mean (SD) disease duration ranged from 7.9 (5.6) to 8.7 (5.4) years, EDSS score ranged from 3.5 (1.6) to 3.9 (1.9), and frequency of relapses ranged from 0.77 (0.94) to 0.86 (0.89) in the preceding year. Compared with the fingolimod group (769 [30.0%]), AHSCT (144 [86.2%]) was associated with fewer relapses (ARR: mean [SD], 0.09 [0.30] vs 0.20 [0.44]), similar risk of disability worsening (hazard ratio [HR], 1.70; 95% CI, 0.91-3.17), and higher chance of disability improvement (HR, 2.70; 95% CI, 1.71-4.26) over 5 years. Compared with natalizumab (730 [49.0%]), AHSCT (146 [87.4%]) was associated with marginally lower ARR (mean [SD], 0.08 [0.31] vs 0.10 [0.34]), similar risk of disability worsening (HR, 1.06; 95% CI, 0.54-2.09), and higher chance of disability improvement (HR, 2.68; 95% CI, 1.72-4.18) over 5 years. AHSCT (110 [65.9%]) and ocrelizumab (343 [49.0%]) were associated with similar ARR (mean [SD], 0.09 [0.34] vs 0.06 [0.32]), disability worsening (HR, 1.77; 95% CI, 0.61-5.08), and disability improvement (HR, 1.37; 95% CI, 0.66-2.82) over 3 years. AHSCT-related mortality occurred in 1 of 159 patients (0.6%).Conclusion In this study, the association of AHSCT with preventing relapses and facilitating recovery from disability was considerably superior to fingolimod and marginally superior to natalizumab. This study did not find evidence for difference in the effectiveness of AHSCT and ocrelizumab over a shorter available follow-up time.
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| 2. |
- MacDonell, R. J., et al.
(author)
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Excited state dynamics of acrylonitrile: Substituent effects at conical intersections interrogated via time-resolved photoelectron spectroscopy and ab initio simulation
- 2016
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In: Journal of Chemical Physics. - : AIP Publishing. - 0021-9606 .- 1089-7690. ; 145:11
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Journal article (peer-reviewed)abstract
- We report a joint experimental and theoretical study on the photoinitiated ultrafast dynamics of acrylonitrile (AN) and two methylated analogs: crotonitrile (CrN) and methacrylonitrile (MeAN). Time-resolved photoelectron spectroscopy (TRPES) and ab initio simulation are employed to discern the conical intersection mediated vibronic dynamics leading to relaxation to the ground electronic state. Each molecule is pumped with a femtosecond pulse at 200 nm and the ensuing wavepackets are probed by means of one and two photon ionization at 267 nm. The predominant vibrational motions involved in the de-excitation process, determined by ab initio trajectory simulations, are an initial twisting about the C=C axis followed by pyramidalization at a carbon atom. The decay of the time-resolved photoelectron signal for each molecule is characterized by exponential decay lifetimes for the passage back to the ground state of 60 +/- 10, 86 +/- 11, and 97 +/- 9 fs for AN, CrN, and MeAN, respectively. As these results show, the excited state dynamics are sensitive to the choice of methylation site and the explanation for the observed trend may be found in the trajectory simulations. Specifically, since the pyramidalization motion leading to the conical intersection with the ground state is accompanied by the development of a partial negative charge at the central atom of the pyramidal group, the electron donation of the cyano group ensures that this occurs exclusively at the medial carbon atom. In this way, the donated electron density from the cyano group "directs" the wavepacket to a particular region of the intersection seam. The excellent agreement between the experimental and simulated TRPES spectra, the latter determined by employing trajectory simulations, demonstrates that this mechanistic picture is consistent with the spectroscopic results.
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