title: Benefit of endermology on indurations and panniculitis/lipoatrophy during relapsing-remitting multiple sclerosis long-term treatment with glatiramer acetate.
abstract: BACKGROUND
  Use of endermology (Endermologie®), which consists of a deep mechanical massage, in patients with multiple sclerosis receiving glatiramer acetate suggested improvements in injection-site indurations and panniculitis/lipoatrophy in our previous pilot experience. We aimed to assess the effect of endermology in a larger population of patients with multiple sclerosis receiving glatiramer acetate in clinical practice.
  
  
  METHODS
  This was the extension phase of our pilot experience, carried out in patients with relapsing-remitting multiple sclerosis (RRMS) and indurations and/or panniculitis/lipoatrophy associated with long-term glatiramer acetate administration. Patients underwent endermology sessions twice per week, for 6 weeks, according to clinical practice.
  
  
  RESULTS
  Seventy evaluable patients were included (mean age, 42.7±9.3 years; female, 95.7%; mean multiple sclerosis duration, 9.2±8.6 years; mean glatiramer acetate duration, 46.7±29.9 months). Fifty (71.4%) patients showed indurations and 58 (82.9%) panniculitis/lipoatrophy. After 12 endermology sessions, the number of patients with indurations significantly decreased (71.4% vs. 28.6%; p<0.001), as did the number of their indurations (4.2±3.6 vs. 3.7±3.4; p<0.001). Although the number of patients with panniculitis/lipoatrophy did not significantly decrease, there was a significant reduction in the number of areas of panniculitis/lipoatrophy (4.3±2.6 vs. 3.9±2.2; p<0.05). Forty-nine (98.0%) patients with indurations and 57 (98.3%) patients with panniculitis/lipoatrophy felt satisfied/very satisfied with treatment and considered endermology useful/very useful. Endermology was well tolerated, as some pain was reported in eight (11.4%) patients, discomfort in three (4.3%) patients, and local blotch/swelling and transient bruise in one (1.4%) patient each. Endermology enabled glatiramer acetate tolerance to be enhanced in 42 (60.0%) patients.
  
  
  CONCLUSIONS
  This project represents the largest experience available supporting the benefit of endermology in the reduction/disappearance of indurations and improvement in panniculitis/lipoatrophy in patients with RRMS receiving long-term glatiramer acetate treatment. Moreover, these benefits also contributed to enhancing glatiramer acetate tolerance.
authors.affiliation: Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca, Carretera Madrid-Cartagena, S/N, 30120, El Palmar, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Márquez-Rebollo
authors.forename: Luisa
authors.initials: L
authors.lastname: Vergara-Carrasco
authors.forename: Rosa
authors.initials: R
authors.lastname: Díaz-Navarro
authors.forename: Delia
authors.initials: D
authors.lastname: Rubio-Fernández
authors.forename: Pablo
authors.initials: P
authors.lastname: Francoli-Martínez
authors.forename: Rainel
authors.initials: R
authors.lastname: Sánchez-De la Rosa
mesh_terms: D000328:Adult; D005260:Female; D000068717:Glatiramer Acetate / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007267:Injections / Q000009:adverse effects; D008134:Long-Term Care; D008297:Male; D008405:Massage / Q000379:methods*; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D015434:Panniculitis / Q000209:etiology / Q000628:therapy*
chemical_list: D007166:Immunosuppressive Agents; D000068717:Glatiramer Acetate