Rationale for off-label treatments use in primary progressive multiple sclerosis: A review of the literature

BackgroundUntil recently, few therapeutic options, other than symptomatic treatment, were available for patients with primary progressive multiple sclerosis (PPMS). Ocrelizumab is the only approved treatment in this indication, and only since 2017. However, many patients in France are receiving off-label treatments for PPMS, mainly rituximab, mycophenolate mofetil, methotrexate, cyclophosphamide, and azathioprine.ObjectiveTo evaluate published data concerning the efficacy of these five treatments frequently used as off-label disease-modifying therapies.MethodsWe reviewed and summarized the studies published in Pubmed since the inception of the database.ResultsEvidence from randomized controlled trials is lacking to support the use of these treatments as disease-modifying therapies in PPMS.ConclusionThe literature lacks dedicated studies to support the off-label use of these disease-modifying therapies in PPMS. However, some limited data are available in the literature suggesting that the use of rituximab and cyclophosphamide could potentially be of some interest in specific subpopulations.     

Pseudosyndrome de Meigs révélateur d’un goitre ovarien

The pseudosyndrome of Meigs is caracterised by a triad, which associates a solid benign tumor of the ovary, an ascitis and a pleural effusion. Surgical extraction of the tumor entails disappearance of the symptomatology. The authors report in this study a case of an ovarian goitre revealed by this syndrom.     

Virulence differences between albino and pigmented Sporothrix schenckii isolates

ObjectiveThis work compares the virulence between pigmented (P) and albino (A) filamentous forms of S. schenckii through experimental skin sporotrichosis.Material and methodsTwo original wild pigmented isolates (1 and 2) cultivated in yeast extract peptone dextrose (YEPD), were exposed to 300 erg/mm² of UV radiation in order to produce mutant albinos. Swiss albino mice were divided in four groups (P1, A1, P2 and A2) and inoculated in the right paw pad with 0.1 ml of solution (1 × 10⁶cells/ml) and observed during nine weeks.ResultsThe albino groups A1 (86%) and A2 (100%) presented intense inflammatory reactions in the inoculation point (p < 0.01) in Week 2 after inoculation, while in the pigmented groups, around 70% of the animals presented multiple skin lesions in Week 4 (p < 0.01). In the last three weeks of the experiment, 67% of the mice in group P1 demonstrated multiple skin lesions. S. schenckii was recovered from samples obtained in necropsy and the histological analysis revealed formation of granulomas with yeast-like cells in the central area of the lesion.ConclusionThe results obtained in this experimental model permit the conclusion that there are virulence differences between pigmented and mutant albino isolates of S. schenckii in the development of experimental skin sporotrichosis.