The clinical and cost impact of switching to fingolimod versus other first line injectable disease-modifying therapies in patients with relapsing multiple sclerosis

Background: There is limited evidence on the effectiveness and healthcare costs of switching to fingolimod versus another first line injectable therapy (FLIT) in patients with relapsing multiple sclerosis (RMS) who have already been treated with FLIT.

Objective: The objectives of the study were to assess the annualized relapse rate (ARR), socio-demographic and clinical characteristics, persistence and adherence rates, healthcare resource utilization and cost among patients with RMS who either switch to fingolimod or another FLIT in routine clinical practice.

Methods: A multicenter, observational, retrospective chart review was conducted across eight clinics in Canada between 1 May 2011 and 30 June 2013. The data was collected from two cohorts: patients who switched to fingolimod and patients who switched to FLIT from a previous FLIT.

Results and conclusions: A total of 124 patients were included in the study: 82 and 42 switched to fingolimod and FLIT, respectively. There were no significant differences in the patient characteristics at the date of switch except for number of previous disease-modifying therapies (DMTs) which was higher in the fingolimod cohort (fingolimod: 1.52; FLIT: 1.10, p?<?.001). The ARR during the first year of switching was numerically higher in the FLIT cohort compared to the fingolimod cohort (FLIT: 0.9 [95% CI 0.3–1.6]; fingolimod: 0.3 [95% CI 0.1–0.5]). The negative binomial model adjusted for the number of previous DMTs confirmed a statistically significant difference in ARR between the fingolimod and FLIT cohorts at 12?months of follow-up (p?=?.012). In the fingolimod cohort, 20.7% of patients experienced at least one relapse compared to 38.1% in the FLIT cohort. In both groups, a high proportion of patients (>90%) showed good treatment adherence (≥80% of prescribed doses).     

Clinical evaluation of a biodegradable collagen membrane in guided tissue regeneration

A bio-resorbable type I collagen membrane was investigated as a barrier for guided tissue regeneration. Ten human subjects with at least one pair of contralateral periodontal lesions with probing pocket depths of greater than or equal to 5 mm and radiographic evidence of greater than or equal to 40% bone loss were included. Each patient underwent contralateral surgical flap procedures. A collagen barrier was adapted to the tooth in the experimental defect and the flap replaced and sutured. The controls consisted of the same procedure without the placement of the barrier. Standardized measurements of change in probing attachment levels and fill of intrabony defects were obtained at the time of surgery and 1 year later at the time of surgical re-entry. The differences in change of probing attachment levels and amount of bone fill between individual test and control sites were compared utilizing the student's t-test for paired samples. The mean probing attachment gain in the test sites was 0.56 +/- 0.57 mm, and there was a mean probing attachment loss of 0.71 +/- 0.91 mm in the control sites (P less than 0.01). The gain of bone in test lesions was 1.16 +/- 0.95 mm, while no gain was observed in the control lesions (P less than 0.01). The results of this study demonstrated that sites treated with a collagen barrier comprised of cross-linked bovine Type I collagen exhibited significantly better healing as compared to control sites over the 1-year period of the study.     

Intranodal hemangioma of the oral soft tissues: a case report of a rare entity with review of the literature

The presentation of a primary vascular tumor in a lymph node is a rare occurrence. Only 16 documented cases have been reported to date, with none described in the oral soft tissues. This case report presents the first occurrence of an intra-nodal hemangioma of the oral soft tissue in an 11-year-old girl. A review of the literature is also presented.     

Alcohol and hamster buccal pouch carcinogenesis.

Alcohol was shown to enhance the carcinogenic effect of DMBA applied to hamster buccal pouch. DMBA animals given alcohol developed dysplastic leukoplakic lesions and epidermoid carcinomas 2 weeks ahead of water-drinking control animals. The tumors also grew to larger size, were more invasive, and were more anaplastic histologically. Forty young adult Syrian hamsters were divided into four groups (alcohol-DMBA, DMBA control, untreated control, and alcohol control) and were killed after 10, 12, and 14 weeks of DMBA applications three times weekly. Alcohol was given as a 10 percent solution instead of drinking water.     

Idiopathic isolated unilateral hypoglossal nerve palsy: a diagnosis of exclusion

This report describes the rare case of a 22-year-old male with persistent idiopathic isolated hypoglossal nerve palsy. Thorough history, examination, and investigation were needed to rule out the many causes of such a presentation. The clinical presentation showed unilateral atrophy and fibrillation of the affected side and mild deviation on protrusion to the affected side. The differential diagnosis included neoplasia, trauma, infection, endocrine, autoimmune, neurologic, and vascular causes. Investigations included magnetic resonance imaging, computerized tomography scan, chest x-ray, cerebrospinal fluid culture, and a range of hematologic tests. These led to a diagnosis of persistent idiopathic isolated hypoglossal nerve palsy.