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MS Blog

5/29 A New Era of Multiple Sclerosis Treatment

Prior to 1993, no approved treatments were available for multiple sclerosis (MS). People who developed MS prior to the first treatments, unfortunately, had damage to their brain and spinal cords which often led to progressive disability. MS relapses are bouts of neurological symptoms such as numbness, weakness, imbalance and visual loss that can last days to months.

The first generation of self-injected medications reduced relapses by about one-third and as much as 80% of new brain disease seen on MRI (magnetic resonance imaging) scans. These medications fight the immune attack on the brain and spinal cord without compromising the body’s ability to fight infections.  Tysabri (natalizumab), an infusion therapy  given in the vein monthly, dropped relapses by 68% compared to placebo in clinical trial and has been available for treatment for over a decade.

Over the past 7 years, an array of new oral and antibody treatments for MS have become available that have unique effects on the immune system to block MS.  Oral therapies are Aubagio, Gilenya and Tecfidera and new monoclonal antibody therapies are Lemtrada, Ocrevus, and Zinbryta.  Some oral therapies have been shown to reduce relapses by more than half compared to placebo.  Gilenya and Zinbryta demonstrated a superior reduction in relapses compared to Avonex.  The advantages of good disease control must be balanced against serious risks of these drugs even if some risks are uncommon or rare.

Lemtrada (alemtuzumab) is a highly effective antibody therapy that in clinical trials has  reduced relapses by half compared to Rebif. On Lemtrada, 43% of patients actually had less disability confirmed at end of 6 years compared to the onset of the study.  Another antibody treatment, Ocrevus (ocrelizumab), also showed in clinical trials to reduced relapses almost in half and reduced contrast MRI activity by 95% compared to Rebif. Lemtrada transiently depletes T and B cells and Ocrevus consistently depletes B cells with potential serious risks including serious infusion reactions and serious infections.

Treatment Stategies

One common approach to treating multiple sclerosis is starting with a self-injected medication with two decades of long-term safety information. These medications including Copaxone (glatiramer acetate) and interferons (including Avonex, Betaseron, Extavia and Rebif )have been effective for many patients without immune compromise. If new relapses, worsening disability or unchecked MRI activity occur, the first medication could be switched to another agent.   The strategy is often referred to as “escalation” of treatment. This approach may be the safest option, but waiting too long to switch therapies may result in irreversible disability.

Another strategy is to seize the moment.   People living with MS without new relapses and without new MRI activity have the best chance of preventing disability progression. One goal of MS treatment is achieving NEDA (No Evidence of Disease Activity) which means a patient is free of relapses, disability progression and MRI activity. Choosing a high-powered medication first to minimize risk of worsening disability to maximize quality of life is another treatment approach. Early in MS there can be changes such as nerve injury that may lead to irreversible disability. This earlier treatment approach  tackles the disease aggressively from the start.  Accepting potential long-term risks of these immune therapies with a lifelong disease is one concern. In addition, the use of some of these immune treatments might restrict the next treatment option. Not all therapies are indicated for first-line therapy in the United States.

Likely the best approach is a combination. This strategy involves stratifying the risk of disease, then matching with an appropriate medication. Some risk factors that increase risk for disability include being male, MS onset after age 40, incomplete recovery from first attack, frequent relapses the first 2 years of disease, spinal cord disease and higher amount of MS changes on initial MRI. Patients with lower risk of disability progression may choose a more conservative medication option. In contrast, someone at higher risk for disability may be willing to accept more risk for more effective treatment. It is critical for individuals living with MS to share their willingness to accept or not accept certain risks to control their disease. Neurologists also vary in their willingness to use higher risk medications which often influences the decision process. Each person living with MS should meet with their neurologist to clarify their individual risk of disability based on their disease.

Research advancements have led to a growing array of new MS therapies. To determine the best individualized treatment plan, being informed and open with healthcare providers is essential.

5/29 Team MoBap at Walk MS

Team MoBap 2017

Singer Tullman Planetarium Large EditDynamic Duo

Dr. Singer and Dr. Tullman co-chaired Walk MS this April to raise funds for the National Multiple Sclerosis Society (NMSS).  The funding is critical for new multiple sclerosis research to stop disease progression, restore function, and end MS forever.  Team MoBap was back in force to support NMSS and The MS Center for Innovations in Care in their mission to improve the lives of those living with multiple sclerosis.

Singer St. CharlesTullman Forest Park

3/28 Ocrevus (ocrelizumab) Approved!

The FDA has approved Ocrevus tonight for primary progressive and relapsing forms of multiple sclerosis.  The approval is a major breakthrough since no treatments have previously been approved for primary progressive multiple sclerosis.  This monoclonal antibody treatment works by depleted B cells, a type of immune cell. Ocrevus  is given intravenously with half given the first day and a second half given 2 weeks later, followed by a single infusion every 6 months.

In 2 relapsing multiple sclerosis trials (OPERA I and II), patients treated with Ocrevus had 46 to 47% less relapses than Rebif.  In addition, patients treated with Ocrevus were 40% less likely to progress in disability compared to Rebif treated patients.  On MRI scans, the average number of active contrast-enhancing lesions were 94-95% less with Ocrevus treatment than Rebif.  In a primary progressive trial (ORATORIO) of 732 patients, treatment with Ocrevus reduced risk of disability progression by 24% compared to placebo treatment.  A 29% benefit was also seen on the time to walk 25 feet.

The most common side effects in clinical trials were infusion reactions and upper respiratory tract infections, which were mostly mild to moderate in severity. Although PML (progressive multifocal leukoencephalopathy) did not occur in Ocrevus clinical trials, this brain infection, which is potentially fatal, has occurred rarely with another B-cell depleting treatment.  Other serious infections including reactivation of a Hepatitis B infection are risks.  A higher rate of malignancies was seen on ocrelizumab than placebo or Rebif so possible risk of treatment with Ocrevus.

 

 

 

9/25 ECTRIMS Meeting in London: Interview with Dr. Barry Singer

Dr. Singer discusses great progress in multiple sclerosis including on progressive disease and preventing brain size loss.

9/11 Join us October 6, 2016 for MS Breakthroughs Program

You’re invited to our free annual program to hear about the latest in multiple sclerosis treatments including new exciting results in progressive disease.  Groundbreaking research from the world’s largest annual international MS conference in mid September will be presented.  An array of topics will be addressed including bone marrow transplant, stem cells and myelin repair.  Question and answer session will follow.  Light refreshments will be served.

Speakers:  Barry Singer, MD; Mark Tullman, MD; Melanie Huff, BSN, RN.

THURSDAY  October 6, 2016  6:30 to 8:30 PM,  St. Louis Frontenac Hilton, 1335 South Lindbergh

REGISTER: 314-996-LIFE (314-996-5433) or 800-392-0936.

MS Program Flyer

5/27 A New Option: Zinbryta (daclizumab) is FDA-approved

Zinbryta is an antibody therapy that binds onto a receptor (interleukin-2) on the surface of T immune cells.  The SELECT trial studied 621 relapsing-remitting multiple sclerosis patients randomized to placebo and Zinbryta 150 mg [daclizumab high-yield process (HYP)] injected under skin every 4 weeks for 1 year.  Relapses were reduced 54% for patients on Zinbryta compared to placebo. Zinbryta treatment was associated with 57% less disability progression compared to placebo.

In the DECIDE study of 1841 relapsing-remitting multiple sclerosis patients, Zinbryta under skin every 4 weeks was directly compared to Avonex weekly injections into muscle over 96 to 144 weeks of treatment.  Patients on Zinbryta had 45% less relapses than Avonex.  Less MRI activity was seen in people treated with Zinbryta (54% reduction on new or newly enlarging T2 lesions and 60% reduction on contrast-enhancing lesions).

Zinbryta can cause severe liver injury including liver failure and autoimmune hepatitis.  Liver blood tests are required monthly and up to 6 months after last dose. Other immune-mediated disorders can occur including skin reactions, enlarge lymph nodes, and colon inflammation (colitis). These conditions may require treatment with steroids or immunosuppressive medication.

Most common side effects from Zinbryta (compared to Avonex) included upper respiratory infections, rash (37% of patients) and enlarged lymph nodes. Before starting Zinbryta, testing should be performed for viral hepatitis B and C as well as tuberculosis. Because of its safety profile, Zinbryta should generally be reserved for patients who have had inadequate response to 2 or more MS treatments.

READ ABOUT OTHER TREATMENT OPTIONS

5/15 American Academy of Neurology Meeting Vancouver April 2016

IMG_0021Here’s a few highlights of the meeting:

Multiple sclerosis genetically clusters with other autoimmune diseases, especially Crohn’s and Celiac diseases.  Genetic research shows that T regulatory cells and B cells (both types of a white blood cells called lymphocytes) are important in multiple sclerosis.  High salt diet may cause immune dysregulation, leading to increased inflammation.

Remyelination (recoating the nerves with myelin) was a focus of  a great 4 hour afternoon session.  Approximately 5% of the cells in the brain are immature cells called OPCs (oligodendrocyte precursor cells) that potentially could make myelin.  These cells may be important for learning and not just remyelination.  Why does remyelination fail in MS?  May be due to factors that block remyelination,  damage to the nerve (axon section) itself, and the timing of repair.

To test compounds for myelin repair,  remyelination can actually be visualized in translucent Zebra fish.  Micropillars of immature myelin-making cells is another interesting approach to screen for effective compounds to increase new myelin production.  The technique involves upside down cones coated with OPCs.  Clemastine and benzatropine compounds worked in this model.  To see if remyelination works in humans, imaging techniques being examined include PET with MRI scans, myelin water imaging and magnetic transference ratio analyses.

More data was presented on high efficacy treatments.  In the OPERA trials of ocrelizumab (Orevus), 48% of patients had no evidence of disease activity (called NEDA) over 2 years in comparison to 25-29% of Rebif patients.  NEDA means no relapses, no change in disability and no new MRI activity.  Alemtuzumab (Lemtrada) was shown to very effective over 5 years in highly active MS patients whether previously treated with MS treatments or new to MS treatment.

 

5/14 Scientific Advancements: Center News

IMG_0024Barry Singer, MD, our center’s director, continues to work hard to further our understanding of multiple sclerosis and advance treatment.  He presented scientific posters at the Academy of Neurology Meeting in Vancouver in April 2016.   Topics were the efficacy of using Lemtrada (alemtuzumab) in patients with highly active multiple sclerosis and rapid  benefits of Gilenya (fingolimod) in relapsing forms of multiple sclerosis.

Dr. Singer also just published a chapter in Seminars in Neurology on FDA-approved and future monoclonal antibody treatments for multiple sclerosis.  Tysabri (natalizumab) and Lemtrada (alemtuzumab) are currently available.  Hopefully, both Ocrevus (ocrelizumab) and Zinbryta (daclizumab) will be available within the year.  His chapter also covers remyelination antibodies being studied in clinical trials including opicinumab (Anti-LINGO-1) and rHIgM22.

In addition,  Dr. Singer was extremely pleased to join the Board of Directors for the Multiple Sclerosis Association of America.  As a global patient advocate, this position will allow him to further press for options for those living with multiple sclerosis.

4/19 Team MoBap at MS Walk

From the MS Center for Innovations in Care, Danielle Scales, Dr. Singer, Vickie Kopf, and Delea Payne-Gates (left to right)

From the MS Center for Innovations in Care, Danielle Scales, Dr. Singer, Vickie Kopf, and Delea Payne-Gates (left to right)

On April 17, 2016,  Team MoBap had a great time participating in Walk MS with the Gateway Chapter of the National Multiple Sclerosis Society.  Our team consisted of patients and staff committed to fundraising for critical research to repair MS damage and ultimately curing MS.  Team MoBap was over 70 people strong and was the highest fundraising team.  Dr. Barry Singer, the Walk MS chair, thanked the walkers and volunteers for their dedication and support!

Walk MS Speakers: Barry Singer, MD, Rebecca Fehlig, Chapter President of theGateway Chapter of National MS Society and Evelyn Sanguinetti, Illinois' lieutenant governor living with MS.

Walk MS Speakers: Barry Singer, MD, Rebecca Fehlig, Chapter President of theGateway Chapter of National MS Society and Evelyn Sanguinetti, Illinois’ lieutenant governor living with MS (left to right)

3/21 Join Team MoBap for Walk MS April 17

Curing MS and repairing disease damage requires innovative, groundbreaking research. Funding for research is critical.  That’s why we need YOU!

Support the National Multiple Sclerosis Society by joining or donating to Team MoBap.  STAFF, PATIENTS, FRIENDS and FAMILY ARE INVITED on our team.

Walk MS is Sunday April 17 2016 at Forest Park Upper Muny Lot.  Registration 1 PM, Start 2 PM.

REGISTER OR DONATE HERE!

GATEWAYWALKMS.ORG | 1-800-344-4867
HTTP://BIT.LY/TEAMMOBAP

 

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