Publications by authors named "Maya M Zeineddine"

9 Publications

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Treatment of multiple sclerosis in special populations: The case of refugees.

Mult Scler J Exp Transl Clin 2020 Jan-Mar;6(1):2055217319848466. Epub 2020 Jan 9.

Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Lebanon.

Multiple sclerosis was long considered a relatively rare entity in the Middle East, but research over the past 10 years and the publication of the Middle East North Africa Committee for Treatment and Research in Multiple Sclerosis guidelines for multiple sclerosis have allowed diagnosis and treatment to occur more efficiently. Most of the first and second-line disease-modifying therapies approved by the Food and Drug Administration and the European Medicine Agency are available in the Middle East. However, the availability of disease-modifying therapies is quite variable, with some countries having access to all multiple sclerosis disease-modifying therapies, while in others there is only one therapeutic option. Economic limitations remain a challenge for the management of multiple sclerosis, especially in countries of war. Moreover, the burden of multiple sclerosis treatment in Syrian and Palestinian refugees is likely high due to the non-availability of funds to cover the high cost of disease-modifying therapies.
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http://dx.doi.org/10.1177/2055217319848466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956602PMC
January 2020

Safety and Efficacy of Rituximab in Multiple Sclerosis: A Retrospective Observational Study.

J Immunol Res 2018 12;2018:9084759. Epub 2018 Nov 12.

Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon.

Objective: To evaluate the efficacy and safety of rituximab in multiple sclerosis in a clinical practice setting.

Methods: Clinical data for all adult patients with multiple sclerosis (MS) treated with off-label rituximab at a single MS center in Lebanon between March 2008 and April 2017 were retrospectively collected from medical charts. The main efficacy outcomes assessed were annualized relapse rate (ARR) and proportion of patients free from relapses, disability progression, or magnetic resonance imaging (MRI) activity.

Results: A total of 89 rituximab-treated patients were included: 59 relapsing-remitting MS (RRMS) and 30 progressive MS (PMS). Patients were treated with 1000 or 2000 mg rituximab IV every 6-12 months for a mean duration of 22.2 ± 24.8 months. The subjects were 65.2% females with a mean age of 40.5 ± 12.3 years and a mean disease duration of 7.9 ± 6.2 years. During treatment, the ARR decreased from 1.07 at baseline to 0.11 in RRMS ( < 0.0001) and from 0.25 to 0.16 in PMS patients ( = 0.593). The mean Expanded Disability Status Scale (EDSS) remained unchanged in both RRMS and PMS patients. Between baseline and the last follow-up, the percent of patients free from any new MRI lesions increased from 18.6% to 92.6% in the RRMS group and from 43.3% to 82% in the PMS group. No evidence of disease activity (NEDA) was achieved in 74% of patients at 1 year of treatment. A total of 64 adverse events (AEs) (71.9%) were recorded with the most common being infusion-related reactions in 25.8% of patients, all mild in nature. Two of our rituximab-treated patients experienced serious AEs requiring surgical interventions: pyoderma gangrenosum vaginalis with perianal abscess and fistula and an increase in the size of a meningioma. No case of progressive multifocal leukoencephalopathy (PML) was detected.

Conclusion: In our real-world cohort, rituximab was well-tolerated and effective in reducing relapse rate and disability progression in relapsing-remitting and progressive MS patients.
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http://dx.doi.org/10.1155/2018/9084759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260423PMC
January 2019

Efficacy and safety of natalizumab extended interval dosing.

Mult Scler Relat Disord 2018 Aug 5;24:113-116. Epub 2018 Jul 5.

Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon.

Objective: It is postulated that extending the dosing interval of natalizumab (NTZ) from 4 to 5-8 weeks might decrease the risk of progressive multifocal leukoencephalopathy (PML). The aim of this study was to assess the effect of extended interval dosing (EID) on the therapeutic efficacy of natalizumab.

Methods: We reviewed 85 patients treated at two MS centers in the Middle East with natalizumab for at least 6 months using EID. Patients were shifted after an initial treatment period at standard interval dosing (SID) to an EID ranging from 5-8 weeks.

Results: The mean treatment duration on SID and EID was 15.4 ± 11.9 and 11.8 ± 7.0 months, respectively. By the end of SID and EID treatment 95.3% and 93.9% of patients were free of relapses (P = 0.41) with an annualized relapse rate (ARR) of 0.0006 and 0.001 respectively (P = 0.42). The mean EDSS at the end of SID and EID periods was 2.56 ± 1.62 and 2.59 ± 1.61 respectively (P = 0.84). A total of 97.6% and 94.7% of patients had no enhancing lesions on MRI during the SID and EID periods respectively (P = 0.18). There were no cases of PML and the rate of infections was lower during the EID period.

Conclusion: In patients treated with natalizumab, shifting from SID to EID has no negative effect on efficacy as evidenced by relapse rate, disability progression and MRI activity.
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http://dx.doi.org/10.1016/j.msard.2018.06.015DOI Listing
August 2018

Letter to the editor.

Mult Scler 2018 03 27;24(3):363. Epub 2017 Jul 27.

Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon.

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http://dx.doi.org/10.1177/1352458517717091DOI Listing
March 2018

Catastrophic relapses following initiation of dimethyl fumarate in two patients with neuromyelitis optica spectrum disorder.

Mult Scler 2017 Aug 10;23(9):1297-1300. Epub 2017 Apr 10.

Hammoud Hospital University Medical Center, Saida, Lebanon.

We report two cases of neuromyelitis optica spectrum disorder (NMOSD) who were misdiagnosed as multiple sclerosis (MS) and developed catastrophic relapses following initiation of dimethyl fumarate. Both patients developed a severe myelitis extending from the cervical cord to the medulla with significant cord swelling, resulting in complete quadriplegia and respiratory difficulties, in addition to severe bilateral visual loss in one patient. It is of note that both catastrophic relapses occurred 2 and 3 months following initiation of dimethyl fumarate.
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http://dx.doi.org/10.1177/1352458517694086DOI Listing
August 2017

Three cases of herpes zoster radiculitis in MS patients treated with natalizumab.

Mult Scler Relat Disord 2016 Sep 25;9:122-4. Epub 2016 Jul 25.

Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address:

Natalizumab was the first FDA-approved monoclonal antibody for the treatment of multiple sclerosis (MS). We report on 3 natalizumab-treated patients who developed herpes zoster infections. In addition to progressive multifocal leukoencephelopathy, other opportunistic infections have been rarely reported during Natalizumab treatment. We believe that clinicians need heightened awareness of these infections in view of the risks of serious complications.
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http://dx.doi.org/10.1016/j.msard.2016.07.012DOI Listing
September 2016

Safety and efficacy of fingolimod in clinical practice: The experience of an academic center in the Middle East.

J Neuroimmunol 2015 Dec 26;289:93-7. Epub 2015 Oct 26.

Nehme and Therese Tohme Multiple Sclerosis Center, Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address:

Background: Few published studies addressed real-world clinical experience with fingolimod especially in the Middle East region.

Objective: To review our clinical experience with fingolimod at a specialized academic MS center in Lebanon.

Methods: All patients treated with fingolimod at the MS Center between October 2011 and January 2015 were retrospectively identified.

Results: A total of 122 patients were included. The first dose observation was uneventful in 98.8% of patients. Annualized relapse rate decreased from 1.16 pre-treatment to 0.29 post-treatment representing a relative risk reduction of 75% (p<0.0001). The proportion of patients with no new T2 or enhancing lesions was 66.3%. Seventy-six (62.3%) patients experienced adverse events with lymphopenia, increase liver enzymes, urinary tract infections and fatigue being the most common.

Conclusion: Our cohort confirms the effectiveness and safety of fingolimod in a real world setting.
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http://dx.doi.org/10.1016/j.jneuroim.2015.10.015DOI Listing
December 2015

Safety and efficacy of reduced fingolimod dosage treatment.

J Neuroimmunol 2015 Aug 15;285:13-5. Epub 2015 May 15.

Multiple Sclerosis Center, Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address:

Background: Oral fingolimod is a sphingosine-1-phosphate-receptor modulator that prevents the egress of lymphocytes from lymph nodes. Fingolimod reduces relapse rate and delays disability progression in patients with relapsing forms of multiple sclerosis (MS). Elevation of liver function tests (LFTs) and reduction in peripheral-blood lymphocyte counts were among the most common adverse events reported in phase II, phase III, and extension studies.

Objective: To describe eight patients in whom fingolimod dose was reduced to every other day (n=6) or every third day (n=2) due to increased LFTs more than 3 times the upper limit of normal (ULN) (n=2) or decreased lymphocyte count by ≤0.2×10(9)/L (n=6).

Results: Fingolimod dose reduction resulted in reversal of laboratory abnormalities. Clinically, none of the 8 patients developed clinical relapses, but five patients had new lesions on magnetic resonance imaging (MRI), one of whom with disability progression, and one patient converted to secondary progressive MS (SPMS).

Conclusion: Reducing the frequency of fingolimod administration can reverse laboratory abnormalities but may have a negative impact on drug efficacy.
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http://dx.doi.org/10.1016/j.jneuroim.2015.05.012DOI Listing
August 2015

Effect of pharmacy practice program on pharmacy student learning, satisfaction, and efficiency: assessment of introductory pharmacy practice course.

J Pharm Pract 2014 Feb 26;27(1):89-100. Epub 2013 Jun 26.

Department of Pharmacy Practice, School of Pharmacy, LAU, Byblos, Lebanon.

Introduction: The Lebanese American University (LAU) offers first-year pharmacy students with Introductory Pharmacy Practice Experience (IPPE) courses comprising various activities that provide students with direct patient contact so that they can be geared up for "real-world" pharmacy practice. Routine assessment and improvement in these courses are imperative to ensure efficiency of these courses. This study was conducted to evaluate the quality of our IPPEs courses, determine its impact on student learning and satisfaction, and identify shortcomings in the program for quality improvement purposes.

Methods: A literature review-based questionnaire, consisting of 76 questions with a response options following a 4-point scale (strongly agree = 4 to strongly disagree = 1), was completed by 92 first professional year pharmacy students who finished their hospital and community IPPE at LAU.

Results: The students reported a high degree of satisfaction in community and hospital sites in terms of site selection, program schedule, site and school preceptors, and overall satisfaction with the experience. Compared to the hospital setting, students practicing in the community reported significantly higher scores in overall satisfaction. Besides the high satisfaction rate, our results identified improvement measures in some aspects of the program.

Conclusion: Our IPPE program serves as a successful experiential learning for pharmacy students.
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http://dx.doi.org/10.1177/0897190013489575DOI Listing
February 2014