Tag: ms

04 Sep 2018

Latest Guidelines for MS Treatment

Evidence-based medicine calls for ongoing research and refinement of best practices for treating various diseases. In this spirit, a multi-disciplinary panel recently convened to develop recommendations for disease-modifying therapy for those with multiple sclerosis.

This panel certainly was busy, in all they developed 30 recommendations; 17 of which related to when/how to start on disease-modifying therapy (DMT), 10 related to switching DMTs in cases of disease progression, and the final 3 were about stopping DMTs. The panel presented these guidelines at the 2018 American Academy of Neurology Annual Meeting and then published them in Neurology.

First things first: disease-modifying therapies are a key part of MS treatment and are the best current strategy to slow the course of this disease. There are now approximately 17 medications in this category and they include medications that are injected (e.g., Copaxone and Zinbryta), infused (e.g., Lemtrada and Ocrevus), and taken orally (e.g., Gilenya and Tecfidera). None of these can cure MS but they do each have a proven record of effectiveness in controlling the disease. However, a medication that currently works for a patient may not work in the future, which is why medications sometimes need to be changed.

The following are some are the highlights about DMT use from this panel’s recommendations:

The earlier treatment for MS starts, the better the chances are for altering the disease course. Starting treatment sooner generally means fewer relapses and lessens the injuries to the brain.
Newly diagnosed patients do better when they hear their treatment options at a dedicated treatment visit. This is because patients can have trouble processing the large amount of new information at a diagnosis appointment.
It’s important to take patient preference into account regarding the different options of medications (cost, route of administration, safety, and so on).
Health care providers should take care to counsel patients about realistic expectations of what DMTs can achieve in treatment.
It’s important to continue monitoring patients on DMTs in terms of adherence, side effects, and safety.
Reproductive plans are an important part of the discussion with patients (e.g., male infertility and risks of DMT use in pregnancy).
Monitoring of disease activity (in terms of new lesions and relapses) can inform the decision to change DMTs. If a medication switch is warranted, consider changing to a medication with a different mechanism or efficacy profile as well as to a medication that is taken through a different route (injection vs. infusion vs oral).
If a patient discontinues taking DMT medications, counseling about the likelihood of relapse is important.
Cost can be a huge barrier to patients when accessing treatment. Providers should also guide patients in need to financial assistance sources.
Overcoming financial challenges is one of the ways BioPlus Specialty Pharmacy supports our patients, including those on medications for multiple sclerosis. Our patient financial assistance department works to ensure that financial barriers are overcome so patient treatment can both start and continue.

Source

Rae-Grant A, Day GS, Marrie RA, et al. Practice guideline: disease-modifying therapies for adults with multiple sclerosis. Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Presented at: 2018 American Academy of Neurology Annual Meeting. April 21-27, 2018; Los Angeles, CA.

Ciccone A. Multiple sclerosis guidelines: AAN’s recommendations for initiating, switching, stopping disease-modifying therapy. Neurol Adv April 23, 2018.

27 Mar 2018

Manly MS Resistance?

Multiple sclerosis is often thought of as more of a female disease. This is because women are twice or even three times as likely to develop multiple sclerosis compared to men. This gender difference has led researchers to explore the influence of sex hormones in this disease.

Testosterone – which men typically have in higher amounts than found in women – is thought to play a role in this autoimmune disease of the brain and spinal cord. New research in animal models suggests that the presence of testosterone can lead to a “guardian molecule” patrolling the body. This guardian molecule is an immune compound called cytokine IL-33 that can prevent damage to the myelin sheath. In the animal research, myelin damage was even reversed by the presence of this guardian molecule. This is exciting, since myelin sheath damage leads to the movement problems and cognitive symptoms of multiple sclerosis in humans.

While it is not viable to increase testosterone levels in all women, it is possible to work on ways to activate the guardian molecule. This is an interesting new area of multiple sclerosis research that could bring real benefits in the near future to multiple sclerosis patients.

While a potential new treatment for MS related to understanding testosterone continues to be developed, there are numerous medications for this disease that are already available, including Ocrevus which was discussed this this recent blog: A Look Back at 2017’s FDA Approvals.

Source

Russi AE, el al, Male-specific IL-33 expression regulates sex-dimorphic EAE susceptibility. PNAS 2018 http://www.pnas.org/cgi/doi/10.1073/pnas.1710401115

13 Feb 2018

Energy Drink Ingredient’s Surprising Role in Multiple Sclerosis

The amino acid taurine has caught the attention of multiple sclerosis researchers. Amino acids are the building blocks of protein. Taurine can be found in many places throughout the body, such as the cardiovascular system where it plays an essential role in heart function, but it also shows up in the central nervous system.

Taurine can be found in many animal-based foods, such as beef, eggs, and dairy products. Interestingly, another place that taurine shows up in significant amounts is in energy drinks, because it is thought to improve athletic performance.

But what about the connection between this amino acid and multiple sclerosis? Researchers at Scripps Research Institute have found evidence that taurine – when combined with multiple sclerosis medications – might make MS drugs work a bit better. The researchers suggest that adding taurine to MS therapy could bring benefits by encouraging remyelination.

In the autoimmune disease of multiple sclerosis, the protective myelin sheath that surrounds nerve cells is attacked by the body’s own immune system. When nerve cells are stripped of myelin, they no longer function properly and symptoms such as numbness, difficulty walking, slurred speech, and vision loss develop. Anything that supports remyelination is beneficial, which is why researchers are so interested in the potential of taurine to make current MS treatments more effective in this regard.

It is particularly promising that taurine is already safely consumed in a variety of ways by humans, so adding it to MS therapy is a low-risk way of hopefully improving outcomes.

Sources

Beyer BA, Fang M, Sadrian B, et al. Metabolomics-based discovery of a metabolite that enhances oligodentrocyte maturation. Nature Chem Bio 2018;14:22-8.

Press release. Taurine lends hand to repair cells damaged in multiple sclerosis. December 7, 2017.