Oct 30 2019 Vumerity: New Oral MS Medication FDA-approved
Vumerity is a twice a day oral medication for patients with multiple sclerosis. The active ingredient of Vumerity is diroximel fumarate, which is rapidly converted to monomethyl fumarate in the body. Similarly dimethyl fumarate (Tecfidera) is also converted to monomethyl fumarate. Therefore, Vumerity would be expected to the same benefits as Tecfidera on multiple sclerosis such as 53% reduction of relapses, 38% reduction in likelihood of disability progression and 90% reduction on active contrast MRI lesions (DEFINE trial).
Full results of the EVOLVE-MS trials are pending including the EVOLVE-MS-1 study, a Phase 3, open-label, two-year safety study and the EVOLVE-MS-2 study, a Phase 3, five-week randomized, prospective, double-blind, multi-center study that assessed the gastrointestinal (GI) tolerability of VUMERITY and TECFIDERA using self-administered GI questionnaires. Based on preliminary results of EVOLVE-MS-1 study that I presented at ECTRIMS in September 2019, approximately 30% of Vumerity had gastrointestinal side effect but less than 1% discontinue due to this side effect. Lymphocyte (type of white blood cell) monitor is important to reduce potential risk of PML, a brain viral infection. Thanks to all of our patients who participated in the clinical trials.
Multiple sclerosis experts share advice on how to substantially improve your care when interacting with your neurologist. Key insights to develop trust and understanding with your doctor reviewed. Compelling info to help you advocate and communicate your desires and needs. Specific ways to make the most of your appointments addressed. Difficult questions are tackled such as progressive disease and long-term planning. Managing MS symptoms and wellness highlighted. Benefits of reviewing MRI images in the exam room outlined. Excellent tips on how to access free medication and MRI programs for people who are uninsured or have high out-of-pocket costs.
Barry Singer MD, Director of The MS Center of Innovations in Care at Missouri Baptist Medical Center interviews:
Flavia Nelson MD, Associate Professor of Neurology, Director Multiple Sclerosis Division at University of Minnesota in Minneapolis. She completed her residency and multiple sclerosis fellowship at University of Texas Health Science Center in Houston, Texas. Dr. Nelson has served as Chair of Department of Defense Panel for Multiple Sclerosis Research Program, committee member on Consortium of MS Centers MRI Guidelines Committee and Chair of International Advisory Board on Brain Atrophy and MS (2016).
Timothy West MD, MS Neurologist, Rocky Mountain Multiple Sclerosis Clinic in Salt Lake City, Utah. Dr. West completed medical school at the University of California-San Francisco (UCSF) and fulfilled his residency in neurology at UCSF. He has had extensive experience and research in the area of MS, including at the Cleveland Clinic Lou Ruvo Center for Brain Health in Nevada, the Sansum Clinic in California, and the UCSF MS Center in California.
Oct 10 2019 MS Living Well Podcast 4: Cannabis & MS
Multiple sclerosis often causes nerve pain with burning and pins-needles sensations and spasticity associated with muscle tightness and cramping. The specific role of medical marijuana components including THC and CBD in MS in alleviating these MS symptoms addressed. Information regarding which MS patients are more likely to benefit from cannabis are reviewed in depth. Risks and concerns of cannabis use in MS addressed. All national, state and local laws should always be followed.
Barry Singer, MD, Director of The MS Center for Innovations in Care, interviews:
Allen Bowling, M.D., Ph.D. , MS neurologist at the Colorado Neurological Institute, Denver, Colorado
Jacob Sosnoff, Ph.D., Associate Professor in Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign.
At ECTRIMS in Stockholm in September 2019, Dr. Barry Singer was interviewed by Shift.ms about a way to routinely monitor someone’s cognition at regular neurology appointments. Using an iPad, the rate at which someone processes information (processing speed test) can be measured in just 2 minutes and then immediately compared to people without multiple sclerosis with same age and education background. Approximately half of people with MS had trouble with short-term memory loss, multitasking problems and/or word finding difficulties. If someone living with MS performs well, great news and continue treatment. If losing ground on the test, best to review MRI imaging and possibly consider other treatment options.
Country living far from large cities has wonderful advantages, but can present some unique challenges to receive optimal multiple sclerosis care. This podcast addresses when it’s time to drive to see a MS specialist. MS experts share their wisdom on various strategies to access the most current treatments while still enjoying life in countryside from the plains to the mountains. Creative ways of coordinating care between local heathcare providers and MS specialists in MS centers described. Emerging telemedicine options reviewed to get remote care.
Barry Singer, MD, Director of The MS Center for Innovations in Care, interviews:
Susan Scarberry, MD, Sanford Medical Center, Fargo, North Dakota. Clinical Associate Professor of Medicine at the University of North Dakota School of Medicine and Health Sciences.
Gabriel Pardo, MD, Director, OMRF Multiple Sclerosis Center of Excellence, Oklahoma City.
Remyelination: Repairing Multiple Sclerosis
Myelin is the coating on the nerve cells (neurons) of the nervous system that allows messages to travel rapidly in our body. Myelin wrapped around the neurons also keeps neurons healthy. In multiple sclerosis, the immune system attacks myelin disrupting electrical signals and making neurons vulnerable to chronic damage. Remyelination is the strategy to recoat the nerves with new myelin. Myelin-making cells called oligodendrocytes (“oligos”) are described. The podcast reviews recent laboratory breakthroughs in screening for new treatments to turn on immature oligos to repair myelin. The exciting initial steps are presented regarding the transition from the laboratory research into clinical trials with multiple sclerosis patients.
Barry Singer, MD, Director of The MS Center for Innovations in Care at Missouri Baptist Medical Center interviews:
Ari J. Green, MD, Chief of Division of Neuroinflammation and Glial Biology, Medical Director of the Multiple Sclerosis and Neuroinflammation Center, Debbie and Andy Rachleff Distinguished Professor of Neurology, Departments of Neurology and Ophthalmology, University of California San Francisco.
Sep 3 2019 MS Living Well Podcast 1. Winning Strategies in Multiple Sclerosis Treatment: Don’t Underestimate the Disease.
Treatment approaches to multiple sclerosis continue to change. Over the past quarter of a century, MS went from an untreatable disease to a disease responsive to a broad array of oral, intravenous and self-injected medications. Greater long-term disease control is now possible for more people living with MS. However, undertreatment can result in significant physical disability including imbalance, weakness, visual loss, incontinence and pain and significant cognitive impairment including short-term memory loss, multitasking impairment and word-finding problems. This podcast outlines different treatment strategies to maximize quality of life long-term to realize your individual goals with the least disability. Information is presented on which people with MS might be at increased risk of disability and need early use of a highly effective medication. Treatment safety is weighed against the treatment benefits and risk of long-term disability.
Barry Singer MD, Director of The MS Center for Innovations in Care, interviews two amazing MS specialists who are also phenomenal patient advocates:
Heidi Crayton MD, Director of The MS Center of Greater Washington in the Virginia suburbs of Washington, DC. Dr. Crayton completed her neurology residency and multiple sclerosis fellowship at Georgetown University Hospital. She is a national leader in MS treatment and clinical trial investigator. For more on Dr. Crayton.
Aaron Boster, MD, is an MS expert at Ohio Health in Columbus, Ohio. Dr. Boster completed his neurology residency at the University of Michigan in Ann Arbor and a fellowship focused on clinical neuroimmunology and multiple sclerosis at Wayne State University in Detroit. Dr. Boster continues to be active in clinical research, authoring academic publications and lecturing globally. For more on Dr. Boster.
Join us for a free educational evening at Missouri Baptist Medical Center for The MS Center for Innovations in Care annual “MS Breakthroughs” program on Oct 22, 2019. The latest groundbreaking global research including treatment updates will be presented. Future developments to better monitor MS disease activity in patients will be shared. Myelin-repair strategies will also be highlighted.
Representatives of the Multiple Sclerosis Association of America, National MS Society, Missouri Baptist Therapy Services and other MS care partners will be present.
Formal presentation will be from 6-7:30 PM followed by a 30 minute question and answer session. RSVP information coming…
Mavenclad is an oral medication approved for relapsing-remitting and secondary progressive multiple sclerosis. The oral treatment course consists of two yearly courses of 2 cycles of 1-2 tablets per day for 4-5 days depending on the patient’s weight.
In the CLARITY study, 1326 multiple sclerosis patients were randomized to a total dose of 3.5 mg/kg (FDA-approved dose), 5.25 mg/kg or placebo. Mavenclad 3.5 mg/kg total dose reduced relapses by 58% compared to placebo. Likelihood of progression of disability was reduced by 33% on Mavenclad. On MRI, Mavenclad reduced contrast-enhancing lesions by 86% and new or enlarging T2 lesions by 73% compared to placebo.
Risks of Mavenclad include low white blood cell counts, serious infections, anemia, potential fetal harm and possible malignancy. Per prescribing information, use of MAVENCLAD is generally recommended for patients who have had an inadequate response to, or are unable to tolerate, an alternate drug indicated for the treatment of MS due to its safety profile.
Mayzent (siponimod) is a tablet medication to treat people with both relapsing-remitting multiple sclerosis and secondary-progressive patients with active disease such with new relapses or new MRI activity.
In the EXPAND trial, 1651 multiple sclerosis patients with secondary-progressive multiple sclerosis were randomized to once-daily oral Mayzent 2 mg daily or placebo for up to 3 years (2/3 of patients received Mayzent). Patients on Mayzent had a 21% less risk of disability progression than those patients on placebo. Mayzent reduced relapses by 55% compared to placebo. Patients on Mayzent were more likely to be free of contrast-enhancing lesions (89% vs 67% on placebo) and free of new or enlarging T2 lesions (57% vs. 37% on placebo).
Medication risks include elevation of liver blood test, swelling back of eye (called macular edema), increase in blood pressure and potential serious infections.