Jul 14 2018 We’ve Moved! New Center Opens!
The MS Center for Innovations in Care has moved from the 2nd floor of Building B to our brand new space on the FIRST FLOOR of Building B, Suite 105 on the campus of Missouri Baptist Medical Center. The Center is now conveniently located across the hall from the outpatient lab and next door to the new MS Infusion Center, the region’s only MS-specific infusion center. With double the square feet, the new center features 10 large exam rooms with accessible exam tables, open nursing stations and clinical research space. The Center’s staff includes 3 highly-experienced MS specialists, a MS-certified nurse practitioner, 2 MS nurses, a research coordinator and 8 other support staff including medical assistants. Our phone number and fax number have not changed.
May 18 2018 Upcoming Program: Understanding MS Progression
The Multiple Sclerosis Association of America (MSAA) invites you to a free educational program on:
Understanding MS Progression: The Importance of Treatment Adherence
Presenter: Barry Singer, MD, Director of The MS Center for Innovations in Care at Missouri Baptist Medical Center
Tuesday June 19 2018 Registration 6:00-6:30 PM, Program 6:30 PM to 8:00 PM
Hilton St. Louis Frontenac, 1335 S. Lindbergh Blvd., St. Louis, MO 63131
Register by Wednesday June 13: 1-800-532-7667, ext. 188 or online at support.mymsaa.org/stlouis
We are extremely pleased to announce that Dr. Barbara Green will be joining our center February 15, 2018. Dr. Green is a true leader in multiple sclerosis with extensive experience in treating patients with multiple sclerosis including as a long-standing director of a multiple sclerosis center in St. Louis. She is passionate about superb MS patient care. As a committed advocate of those living with multiple sclerosis, Dr. Green has served as chair of the clinical advisory committee for the Gateway Chapter of the National Multiple Sclerosis Society.
SAVE THE DATE!! November 14, 2017 from 6:30 PM to 8:30 PM. Want the most cutting edge news after the largest global MS meeting called ECTRIMS in Paris? Barry Singer, MD and Mark Tullman, MD from The MS Center for Innovations in Care will present the most promising and impactful results. New information on multiple sclerosis treatment and myelin repair will be reviewed. RSVP at 314-996-LIFE.
This year the program will be on the CAMPUS of MISSOURI BAPTIST MEDICAL CENTER in the Clinical Learning Institute which is conveniently above the main garage next to the main entrance of the hospital (and in the same building at the Goldfarb School of Nursing).
May 29 2017 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.
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.
May 29 2017 Team MoBap at Walk MS
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.
Mar 28 2017 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.
Dr. Singer discusses great progress in multiple sclerosis including on progressive disease and preventing brain size loss.
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.
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.