Supplementary appendix

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Supplementary appendix"

Transcription

1 Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Gold R, Giovannoni G, Selmaj K, et al, for the SELECT study investigators. Daclizumab high-yield process in relapsing-remitting multiple sclerosis (SELECT): a randomised, double-blind, placebo-controlled trial. Lancet 2013; published online April 2.

2 [[SUPPLEMENTARY APPENDIX MATERIALS (ONLINE ONLY)]] Eligibility criteria Eligibility criteria included patients aged 18 to 55 years with relapsing-remitting multiple sclerosis (MS) according to 2005 McDonald criteria #1 4 1 and a baseline Expanded Disability Status Scale (EDSS) score of 0 0 to Patients must have had at least one confirmed MS relapse in the 12 months before randomisation or had one new gadolinium-enhancing lesion on brain MRI performed within the 6 weeks prior to randomisation. Patients were excluded if they had primary-progressive, secondary-progressive, or progressive-relapsing MS; a history of malignancy, severe allergic or anaphylactic reactions or known drug hypersensitivity; or other significant medical conditions that, in the opinion of the investigator, would preclude administration of daclizumab high-yield process (HYP). Additional exclusion criteria included previous treatment with daclizumab HYP or the previous daclizumab brand (Zenapax ); total lymphoid irradiation; cladribine, mitoxantrone, T-cell, or T-cell receptor vaccination; or any therapeutic monoclonal antibody, except natalizumab or rituximab. At the time of randomisation, patients were excluded if they had received treatment with cyclophosphamide or rituximab within the previous year; natalizumab, cyclosporine, azathioprine, methotrexate, intravenous immunoglobulin, plasmapheresis, or cytapheresis within the previous 6 months; live virus vaccine, treatment with glatiramer acetate, interferon-β, or interferon-α in the previous 3 months; or corticosteroids, 4-aminopyridine, or related products within the previous 30 days. Statistical analyses Sample size power calculations The sample size with 90% power to detect a 50% reduction in the annualised relapse rate between a daclizumab HYP dose group and a rate of in the placebo group was estimated from simulations assuming a negative binomial distribution with a 10% dropout rate, a 0 05 type 1 error rate, and a twosided test. Clinical endpoints The effect of daclizumab HYP treatment on the annualised relapse rate was estimated using the negative binomial regression model adjusting for the number of relapses in the year before study entry, baseline EDSS score (EDSS 2 5 vs EDSS >2 5 points), and baseline age ( 35 vs >35 years). The adjusted annualized relapse rate, percentage reduction from placebo, 95% confidence intervals, and p-values comparing treatment groups were all estimated from this model. In the primary pre-specified analysis, relapses and follow-up time that occurred after rescue treatment with alternative MS medication were censored. For this analysis, relapses that were confirmed by the three members of the independent neurology committee were included. Consistent results were shown in a sensitivity analysis that included all investigator-reported relapses.

3 Both the time to first relapse and the time to disease progression were evaluated using a Cox proportional hazard model. The pre-specified model for the time to relapse included the same covariates as the primary analysis on annualised rate. The model for analysis on disease progression was adjusted for baseline EDSS score (EDSS 2 5 vs EDSS >2 5 points), and baseline age ( 35 vs >35 years). The estimated percentage of patients with a relapse or with sustained progression was estimated from the Kaplan Meier survival distribution. The change from baseline in EDSS score was estimated using an analysis of covariance (ANCOVA) model adjusted for baseline. MRI endpoints For the cumulative new gadolinium lesions between weeks 8 and 24 as well as the number of new or newly-enlarging T2 lesions the mean number of lesions, relative reduction, 95% confidence intervals and p-values were estimated using a negative binomial regression model adjusting for baseline. An ordinal logistic model was used to test differences in the number of gadolinium lesions at week 52 adjusting for baseline. P-values for other MRI endpoints were evaluated using nonparametric ANCOVA on ranked data adjusting for baseline. An imputed value was used if the results from the MRI scan were missing or if the scan was taken after the patients started alternative MS medications. For the cumulative number of new gadolinium lesions between weeks 8 and 24, if a patient missed one or two consecutive scans, or all scans, the last non-baseline observation was carried forward or the mean number of lesions within each treatment group was used, respectively. For other MRI endpoints, missing data were imputed using the mean within the treatment group. Quality of life endpoints Quality of life endpoints were evaluated using an ANCOVA model adjusting for baseline. For the 29-item Multiple Sclerosis Impact Scale, if the patient was missing less than 10 items (for the physical scale) or less than 5 items (for the psychological scale), the mean of the non-missing items was used to impute the score. For patients missing more items and for other quality of life measures, a random slope and intercept model was used to estimate missing data. Efficacy endpoints A sequential closed testing procedure was used to evaluate the dose groups and the secondary endpoints to control the overall type I error rate. Statistical testing for efficacy endpoints utilised separate comparisons of the daclizumab HYP 300-mg group versus placebo and the daclizumab HYP 150-mg group versus placebo. If the comparison of 300 mg versus placebo comparison was statistically significant (p 0 05) then the comparison of 150 mg versus placebo was also tested at the same significance level. However, if the first comparison was not statistically significant, then the second comparison was not considered statistically significant. Secondary endpoints were rank prioritised and if

4 statistical significance was not achieved for an endpoint, all endpoints(s) of a lower rank were not considered statistically significant. Tertiary analyses did not include adjustments made for multiple comparisons and endpoints. Futility analysis A preplanned futility analysis was performed by the Safety Monitoring Committee after 150 patients completed the week 24 visit in order to provide an opportunity to stop the study if the hypothesised effects of daclizumab HYP were not evident, or more importantly, if disease activity had increased. Since efficacy may change over the duration of a study, there was no plan to stop the study early for evidence of superiority at the time of the futility analysis. Futility was assessed by estimating separately the conditional power for both the cumulative number of new gadolinium-enhancing lesions between weeks 8 and 24, and the annualised relapse rate endpoint for each dose group. Sensitivity analysis Sensitivity analyses that included the 21 patients from the one excluded study site yielded similar results for all efficacy analyses. For the primary endpoint, the adjusted annualised relapse rate (ARR) was 0 21, 0 22, and 0 45 in the daclizumab HYP 150-mg, daclizumab HYP 300-mg, and placebo groups, respectively, when the patients from this centre were included, and 0 21, 0 23, and 0 46, respectively, when these patients were excluded.

5 [[Supplementary Materials]] Table 1: Changes in lymphocyte cell counts over 52 weeks Lymphocytes Placebo (n=179) Daclizumab HYP 150 mg (n=184) Daclizumab HYP 300 mg (n=186) Total lymphocytes, mean Baseline 1421 (450) 1444 (442) 1396 (471) Week (469) 1381 (426) 1315 (366) % change week (29 5) 1 3 (27 6)* 1 2 (29 0)* Week (414) 1333 (398) 1286 (447) % change week (26 6) 3 6 (28 0)* 3 7 (27 8) B cells, mean Baseline 174 (92) 176 (90) 167 (90) Week (110) 169 (107) 151 (95) % change week (69 8) 1 2 (42 5)** 3 4 (53 3)** Week (81) 157 (93) 141 (77) % change week (47) 4 3 (44)** 11 3 (38)** NK cells, mean Baseline 163 (77) 166 (111) 175 (96) Week (80) 199 (107) 205 (88) % change week (44 9) 32 7 (56 6)** 33 0 (65 1)** Week (83) 213 (114) 224 (118) % change week (43 1) 48 1 (82 1)** 50 5 (84 1)** CD4+ cells, mean Baseline 687 (248) 699 (241) 664 (261) Week (235) 646 (216) 607 (223) % change week (26 7) 4 4 (27 2)** 4 7 (28 2)** Week (220) 613 (203) 582 (260) % change week (26 5) 7 0 (30 3)** 8 9 (30 0)** CD8+ cells, mean Baseline 355 (156) 361 (146) 353 (166)

6 Week (177) 328 (140) 310 (133) % change week (40 7) 4 7 (30 7)** 6 5 (30 2)** Week (161) 316 (140) 296 (151) % change week (44 6) 9 1 (31 0)** 9 8 (33 9)** CD4/CD8 ratio Baseline 2 2 (0 9) 2 1 (0 9) 2 1 (0 9) Week (0 9) 2 2 (0 9) 2 2 (1 0) % change week (25 4) 2 9 (18 6) 4 1 (19 9) Week (1 0) 2 2 (0 9) 2 2 (0 9) % change week (30 0) 4 6 (18 8) 4 5 (20 6) HYP=high-yield process; NK=natural killer; SD=standard deviation. P-values comparing percent change in daclizumab HYP 150 mg and daclizumab HYP 300 mg groups to placebo estimated using a Wilcoxon rank sum test. *P-value v <0.05 ** P-value <0.01

7 References 1. Polman CH, Reingold SC, Edan G, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald Criteria". Ann Neurol 2005; 58: Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33:

Supplementary webappendix

Supplementary webappendix Supplementary webappendix This webappendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Giovannoni G, Gold R, Selmaj K, et al,

More information

Study Design. Date: March 11, 2003 Reviewer: Jawahar Tiwari, Ph.D. Ellis Unger, M.D. Ghanshyam Gupta, Ph.D. Chief, Therapeutics Evaluation Branch

Study Design. Date: March 11, 2003 Reviewer: Jawahar Tiwari, Ph.D. Ellis Unger, M.D. Ghanshyam Gupta, Ph.D. Chief, Therapeutics Evaluation Branch BLA: STN 103471 Betaseron (Interferon β-1b) for the treatment of secondary progressive multiple sclerosis. Submission dated June 29, 1998. Chiron Corp. Date: March 11, 2003 Reviewer: Jawahar Tiwari, Ph.D.

More information

Personalised Medicine in MS

Personalised Medicine in MS Personalised Medicine in MS Supportive Evidence from Therapeutic Trials Ludwig Kappos Neurology and Department of Biomedicine University Hospital CH-4031 Basel LKappos@uhbs.ch Established partially effective

More information

Version History. Previous Versions. for secondary progressive MS (SPMS) Policy Title. Drugs for MS.Drug facts box Interferon beta 1b

Version History. Previous Versions. for secondary progressive MS (SPMS) Policy Title. Drugs for MS.Drug facts box Interferon beta 1b Version History Policy Title Drugs for MS.Drug facts box Interferon beta 1b for secondary progressive MS (SPMS) Version 1.0 Author West Midlands Commissioning Support Unit Publication Date Jan 2013 Review

More information

Two-Year Phase III Data Presented at AAN 61st Annual Meeting Show Positive Outcome of Cladribine Tablets in Patients with Multiple Sclerosis

Two-Year Phase III Data Presented at AAN 61st Annual Meeting Show Positive Outcome of Cladribine Tablets in Patients with Multiple Sclerosis Your contact News Release Barbara Fry Phone +1 905 919 0163 April 29/30, 2009 Two-Year Phase III Data Presented at AAN 61st Annual Meeting Show Positive Outcome of Cladribine Tablets in Patients with Multiple

More information

Version History. Previous Versions. Drugs for MS.Drug facts box fingolimod Version 1.0 Author

Version History. Previous Versions. Drugs for MS.Drug facts box fingolimod Version 1.0 Author Version History Policy Title Drugs for MS.Drug facts box fingolimod Version 1.0 Author West Midlands Commissioning Support Unit Publication Date Jan 2013 Review Date Supersedes/New (Further fields as required

More information

Medication Policy Manual. Topic: Aubagio, teriflunomide Date of Origin: November 9, 2012

Medication Policy Manual. Topic: Aubagio, teriflunomide Date of Origin: November 9, 2012 Medication Policy Manual Policy No: dru283 Topic: Aubagio, teriflunomide Date of Origin: November 9, 2012 Committee Approval Date: December 12, 2014 Next Review Date: December 2015 Effective Date: January

More information

News on modifying diseases therapies. Michel CLANET CHU Toulouse France ECTRIMS

News on modifying diseases therapies. Michel CLANET CHU Toulouse France ECTRIMS News on modifying diseases therapies Michel CLANET CHU Toulouse France ECTRIMS Current treatment strategies Future oral treatments Future non oral treatments Drug safety and risks CIS at risk of MS Active

More information

Immunex Corporation Novantrone (Mitoxantrone HCL) P&CNS Advisory Committee Briefing Document. Page 020

Immunex Corporation Novantrone (Mitoxantrone HCL) P&CNS Advisory Committee Briefing Document. Page 020 Page 020 4.0 Efficacy of Mitoxantrone in Multiple Sclerosis The efficacy of mitoxantrone in MS was demonstrated in two well-designed, randomized trials: Studies 901 and 902. The study design and efficacy

More information

Economic Evaluation of Natalizumab (Tysabri) for the treatment of relapsing remitting multiple sclerosis that is rapidly evolving and severe or

Economic Evaluation of Natalizumab (Tysabri) for the treatment of relapsing remitting multiple sclerosis that is rapidly evolving and severe or Economic Evaluation of Natalizumab (Tysabri) for the treatment of relapsing remitting multiple sclerosis that is rapidly evolving and severe or sub-optimally treated Summary In January 2007 Biogen Idec

More information

Version History. Previous Versions. Policy Title. Drugs for MS.Drug facts box Glatiramer Acetate Version 1.0 Author

Version History. Previous Versions. Policy Title. Drugs for MS.Drug facts box Glatiramer Acetate Version 1.0 Author Version History Policy Title Drugs for MS.Drug facts box Glatiramer Acetate Version 1.0 Author West Midlands Commissioning Support Unit Publication Date Jan 2013 Review Date Supersedes/New (Further fields

More information

fingolimod, 0.5mg, hard capsules (Gilenya ) SMC No. (992/14) Novartis Pharmaceuticals UK

fingolimod, 0.5mg, hard capsules (Gilenya ) SMC No. (992/14) Novartis Pharmaceuticals UK fingolimod, 0.5mg, hard capsules (Gilenya ) SMC No. (992/14) Novartis Pharmaceuticals UK 08 August 2014 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises

More information

Revised (2009) Association of British Neurologists guidelines for prescribing in multiple sclerosis

Revised (2009) Association of British Neurologists guidelines for prescribing in multiple sclerosis Revised (2009) guidelines for prescribing in multiple sclerosis INTRODUCTION In January 2001, the (ABN) first published guidelines for the use of licensed disease modifying treatments (ß-interferon and

More information

Managing Relapsing Remitting MS Risks & benefits of emerging therapies. Dr Mike Boggild The Walton Centre

Managing Relapsing Remitting MS Risks & benefits of emerging therapies. Dr Mike Boggild The Walton Centre Managing Relapsing Remitting MS Risks & benefits of emerging therapies Dr Mike Boggild The Walton Centre MS: Facts and figures Affects 1 in 800 in the UK Commonest cause of acquired neurological disability

More information

ß-interferon and. ABN Guidelines for 2007 Treatment of Multiple Sclerosis with. Glatiramer Acetate

ß-interferon and. ABN Guidelines for 2007 Treatment of Multiple Sclerosis with. Glatiramer Acetate ABN Guidelines for 2007 Treatment of Multiple Sclerosis with ß-interferon and Glatiramer Acetate Published by the Association of British Neurologists Ormond House, 27 Boswell Street, London WC1N 3JZ Contents

More information

Medication Policy Manual. Topic: Aubagio, teriflunomide Date of Origin: November 9, 2012

Medication Policy Manual. Topic: Aubagio, teriflunomide Date of Origin: November 9, 2012 Medication Policy Manual Policy No: dru283 Topic: Aubagio, teriflunomide Date of Origin: November 9, 2012 Committee Approval Date: December 11, 2015 Next Review Date: December 2016 Effective Date: January

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Burt RK, Balabanov R, Han X, et al. Association of nonmyeloablative hematopoietic stem cell transplantation with neurological disability in patients with relapsing-remitting

More information

National MS Society Information Sourcebook www.nationalmssociety.org/sourcebook

National MS Society Information Sourcebook www.nationalmssociety.org/sourcebook National MS Society Information Sourcebook www.nationalmssociety.org/sourcebook Chemotherapy The literal meaning of the term chemotherapy is to treat with a chemical agent, but the term generally refers

More information

Dimethyl fumarate for treating relapsing-remitting multiple sclerosis

Dimethyl fumarate for treating relapsing-remitting multiple sclerosis Dimethyl fumarate for treating relapsing-remitting multiple Issued: August 2014 guidance.nice.org.uk/ta320 NICE has accredited the process used by the Centre for Health Technology Evaluation at NICE to

More information

1. Comparative effectiveness of alemtuzumab

1. Comparative effectiveness of alemtuzumab Cost-effectiveness of alemtuzumab (Lemtrada ) for the treatment of adult patients with relapsing remitting multiple sclerosis with active disease defined by clinical or imaging features The NCPE has issued

More information

Laquinimod Polman, C. et al. Neurology 2005;64:987-991

Laquinimod Polman, C. et al. Neurology 2005;64:987-991 Laquinimod Polman, C. et al. Neurology 2005;64:987-991 Multicenter, double-blind, randomized trial, patients with RR MS received 0.1 mg or 0.3 mg laquinimod or placebo as three daily tablets for 24 weeks

More information

New and Emerging Immunotherapies for Multiple Sclerosis: Oral Agents

New and Emerging Immunotherapies for Multiple Sclerosis: Oral Agents New and Emerging Immunotherapies for Multiple Sclerosis: Oral Agents William Tyor, M.D. Chief, Neurology Atlanta VA Medical Center Professor, Department of Neurology Emory University School of Medicine

More information

Recruitment Start date: April 2010 End date: Recruitment will continue until enrolment is fully completed

Recruitment Start date: April 2010 End date: Recruitment will continue until enrolment is fully completed Apitope study The study drug (ATX-MS-1467) is a new investigational drug being tested as a potential treatment for relapsing forms of multiple sclerosis (RMS). The term investigational drug means it has

More information

Dimethyl fumarate for treating relapsing remitting multiple sclerosis

Dimethyl fumarate for treating relapsing remitting multiple sclerosis NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Final appraisal determination Dimethyl fumarate for treating relapsing remitting multiple sclerosis This guidance was developed using the single technology

More information

acquired chronic immune-mediated inflammatory condition of CNS. MS in children: 10% +secondary progressive MS: rare +primary progressive MS: rare

acquired chronic immune-mediated inflammatory condition of CNS. MS in children: 10% +secondary progressive MS: rare +primary progressive MS: rare Immunomodulatory Therapies in Pediatric MS Vuong Chinh Quyen Neurology Department Medscape Mar 8, 2013 Multiple Sclerosis in Children. Iran J Child Neurol. 2013 Spring Introduction acquired chronic immune-mediated

More information

Version History. Previous Versions. Drugs for MS.Drug facts box fampridine Version 1.0 Author

Version History. Previous Versions. Drugs for MS.Drug facts box fampridine Version 1.0 Author Version History Policy Title Drugs for MS.Drug facts box fampridine Version 1.0 Author West Midlands Commissioning Support Unit Publication Date Jan 2013 Review Date Supersedes/New (Further fields as required

More information

fingolimod (as hydrochloride), 0.5mg hard capsules (Gilenya ) SMC No. (763/12) Novartis Pharmaceuticals UK Ltd

fingolimod (as hydrochloride), 0.5mg hard capsules (Gilenya ) SMC No. (763/12) Novartis Pharmaceuticals UK Ltd fingolimod (as hydrochloride), 0.5mg hard capsules (Gilenya ) SMC No. (763/12) Novartis Pharmaceuticals UK Ltd 10 February 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the

More information

Oxford University Hospitals. NHS Trust. Department of Neurology Natalizumab (Tysabri) for Multiple Sclerosis. Information for patients

Oxford University Hospitals. NHS Trust. Department of Neurology Natalizumab (Tysabri) for Multiple Sclerosis. Information for patients Oxford University Hospitals NHS Trust Department of Neurology Natalizumab (Tysabri) for Multiple Sclerosis Information for patients page 2 What is Natalizumab and what is it used for? Natalizumab is an

More information

Natalizumab for the treatment of adults with highly active relapsing remitting multiple sclerosis

Natalizumab for the treatment of adults with highly active relapsing remitting multiple sclerosis Natalizumab for the treatment of adults with highly active relapsing remitting multiple sclerosis Premeeting briefing This briefing presents major issues arising from the manufacturer s submission, Evidence

More information

Clinical trials of multiple sclerosis monitored with enhanced MRI: new sample size calculations based on large data sets

Clinical trials of multiple sclerosis monitored with enhanced MRI: new sample size calculations based on large data sets 494 J Neurol Neurosurg Psychiatry 21;7:494 499 Clinical trials of multiple sclerosis monitored with enhanced MRI: new sample size calculations based on large data sets M P Sormani, D H Miller, G Comi,

More information

Disclosures. Consultant and Speaker for Biogen Idec, TEVA Neuroscience, EMD Serrono, Mallinckrodt, Novartis, Genzyme, Accorda Therapeutics

Disclosures. Consultant and Speaker for Biogen Idec, TEVA Neuroscience, EMD Serrono, Mallinckrodt, Novartis, Genzyme, Accorda Therapeutics Mitzi Joi Williams, MD Neurologist MS Center of Atlanta, Atlanta, GA Disclosures Consultant and Speaker for Biogen Idec, TEVA Neuroscience, EMD Serrono, Mallinckrodt, Novartis, Genzyme, Accorda Therapeutics

More information

chapter 3.1 Chapter 3.1 Clinical scales in progressive MS: predicting long-term disability LVAE Bosma, JJ Kragt, DL Knol, CH Polman, BMJ Uitdehaag

chapter 3.1 Chapter 3.1 Clinical scales in progressive MS: predicting long-term disability LVAE Bosma, JJ Kragt, DL Knol, CH Polman, BMJ Uitdehaag chapter 3.1 Chapter 3.1 Clinical scales in progressive MS: predicting long-term disability LVAE Bosma, JJ Kragt, DL Knol, CH Polman, BMJ Uitdehaag Multiple Sclerosis 2012;18:345-350 Chapter 3.1 Abstract

More information

Original Policy Date

Original Policy Date MP 5.01.20 Tysabri (natalizumab) Medical Policy Section Prescription Drug Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Local Policy/12:2013 Return to Medical Policy Index Disclaimer

More information

Relapsing-remitting multiple sclerosis Ambulatory with or without aid

Relapsing-remitting multiple sclerosis Ambulatory with or without aid AVONEX/BETASERON/COPAXONE/EXTAVIA/GILENYA/REBIF/TYSABRI Applicant must be covered on an Alberta Government sponsored drug program. Page 1 of 5 PATIENT INFMATION Surname First Name Middle Initial Sex Date

More information

Natalizumab (Tysabri)

Natalizumab (Tysabri) Natalizumab (Tysabri) Spirella Building, Letchworth, SG6 4ET 01462 476700 www.mstrust.org.uk reg charity no. 1088353 Natalizumab (Tysabri) Date of issue: July 2010 Review date: July 2011 Contents Section

More information

Committee Approval Date: December 12, 2014 Next Review Date: December 2015

Committee Approval Date: December 12, 2014 Next Review Date: December 2015 Medication Policy Manual Policy No: dru299 Topic: Tecfidera, dimethyl fumarate Date of Origin: May 16, 2013 Committee Approval Date: December 12, 2014 Next Review Date: December 2015 Effective Date: January

More information

Held, Heigenhauser, Shang, Kappos, Polman: Predicting the On-Study Relapse Rate for Multiple Sclerosis Patients in Clinical Trials

Held, Heigenhauser, Shang, Kappos, Polman: Predicting the On-Study Relapse Rate for Multiple Sclerosis Patients in Clinical Trials Held, Heigenhauser, Shang, Kappos, Polman: Predicting the On-Study Relapse Rate for Multiple Sclerosis Patients in Clinical Trials Sonderforschungsbereich 386, Paper 430 (2005) Online unter: http://epub.ub.uni-muenchen.de/

More information

Daclizumab HYP versus Interferon Beta-1a in Relapsing Multiple Sclerosis

Daclizumab HYP versus Interferon Beta-1a in Relapsing Multiple Sclerosis The new england journal of medicine Original Article versus Interferon Beta-1a in Relapsing Multiple Sclerosis L. Kappos, H. Wiendl, K. Selmaj, D.L. Arnold, E. Havrdova, A. Boyko, M. Kaufman, J. Rose,

More information

There are currently 4 US Food and Drug

There are currently 4 US Food and Drug DISEASE-MODIFYING THERAPIES IN RELAPSING-REMITTING MULTIPLE SCLEROSIS* Benjamin M. Greenberg, MD, MHS ABSTRACT Four major disease-modifying therapies are discussed within the context of relapsing and remitting

More information

Teriflunomide for treating relapsing remitting multiple sclerosis

Teriflunomide for treating relapsing remitting multiple sclerosis Teriflunomide for treating relapsing remitting multiple Issued: January 2014 last modified: June 2014 guidance.nice.org.uk/ta NICE has accredited the process used by the Centre for Health Technology Evaluation

More information

Department of Health. Rheynn Slaynt. Clinical Recommendations Committee

Department of Health. Rheynn Slaynt. Clinical Recommendations Committee Recommendation 06/13 Department of Health Rheynn Slaynt Clinical Recommendations Committee The Isle of Man Department of Health recommend Gilenya (fingolimod) as a HIGH PRIORITY - as an option for the

More information

peginterferon 63, 94 and 125 microgram solution for injection in pre-filled syringe (Plegridy ) SMC No. (1018/14) Biogen Idec Ltd.

peginterferon 63, 94 and 125 microgram solution for injection in pre-filled syringe (Plegridy ) SMC No. (1018/14) Biogen Idec Ltd. peginterferon 63, 94 and 125 microgram solution for injection in pre-filled syringe (Plegridy ) SMC No. (1018/14) Biogen Idec Ltd. 05 December 2014 The Scottish Medicines Consortium (SMC) has completed

More information

Integrating New Treatments: A Case Based Approach

Integrating New Treatments: A Case Based Approach Integrating New Treatments: A Case Based Approach JILL CONWAY, MD, MA, MSCE DIRECTOR, MS CENTER DIRECTOR, NEUROLOGY CLERKSHIP AT UNCSOM- CHARLOTTE CAMPUS CAROLINAS HEALTHCARE CENTER Objectives Provide

More information

Media Release. Basel, 8 October 2015

Media Release. Basel, 8 October 2015 Media Release Basel, 8 October 2015 Roche s ocrelizumab first investigational medicine to show positive pivotal study results in both relapsing and primary progressive forms of multiple sclerosis Ocrelizumab

More information

Review Date: March 2012. Issue Status: Approved Issue No: 2 Issue Date: March 2010

Review Date: March 2012. Issue Status: Approved Issue No: 2 Issue Date: March 2010 Title: Multiple Sclerosis guidelines for the use of beta-interferon, glatiramer acetate, natalizumab, mitoxantrone and other disease Authors Name: Dr P Talbot Contact Name: Dr Paul Talbot Contact Phone

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Proposed Health Technology Appraisal

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Proposed Health Technology Appraisal NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Proposed Health Technology Appraisal Daclizumab for treating relapsing-remitting multiple Draft scope (pre-referral) Draft remit/appraisal objective To

More information

Issues Regarding Use of Placebo in MS Drug Trials. Peter Scott Chin, MD Novartis Pharmaceuticals Corporation

Issues Regarding Use of Placebo in MS Drug Trials. Peter Scott Chin, MD Novartis Pharmaceuticals Corporation Issues Regarding Use of Placebo in MS Drug Trials Peter Scott Chin, MD Novartis Pharmaceuticals Corporation Context of the Guidance The draft EMA Guidance mentions placebo as a comparator for superiority

More information

Sequencing Disease-Modifying Therapies in Relapsing Remitting MS

Sequencing Disease-Modifying Therapies in Relapsing Remitting MS Sequencing Disease-Modifying Therapies in Relapsing Remitting MS Flavia M. Nelson, MD Assistant Professor of Neurology University of Texas Medical School at Houston Associate Director, MRI Analysis Center

More information

teriflunomide, 14mg, film-coated tablets (Aubagio ) SMC No. (940/14) Genzyme Ltd.

teriflunomide, 14mg, film-coated tablets (Aubagio ) SMC No. (940/14) Genzyme Ltd. teriflunomide, 14mg, film-coated tablets (Aubagio ) SMC No. (940/14) Genzyme Ltd. 10 January 2014 (Issued 07 February 2014) The Scottish Medicines Consortium (SMC) has completed its assessment of the above

More information

Peripheral and Central Nervous System (PCNS) Advisory Committee. Briefing Document. Biogen Idec. Biologics Marketing Application STN / 15

Peripheral and Central Nervous System (PCNS) Advisory Committee. Briefing Document. Biogen Idec. Biologics Marketing Application STN / 15 DEPARTMENT OF HEALTH & HUMAN SERVICES PUBLIC HEALTH SERVICE Food and Drug Administration Center for Drug Evaluation and Research 10903 New Hampshire Avenue Silver Spring, MD 20993 Division of Neurology

More information

NHS Suffolk Drug & Therapeutics Committee New Medicine Report (Adopted by the CCG until review and further notice)

NHS Suffolk Drug & Therapeutics Committee New Medicine Report (Adopted by the CCG until review and further notice) NHS Suffolk Drug & Therapeutics Committee New Medicine Report (Adopted by the CCG until review and further notice) This drug has been reviewed because it is a product that may be prescribed in primary

More information

Future therapies in multiple sclerosis

Future therapies in multiple sclerosis Neurology Asia 2008; 13 : 189 193 Future therapies in multiple sclerosis David Bates Department of Neurology, University of Newcastle upon Tyne, UK Abstract It is now 15 years since the first disease modifying

More information

Estimating long-term effects of disease-modifying drug therapy in multiple sclerosis patients

Estimating long-term effects of disease-modifying drug therapy in multiple sclerosis patients 2005; 11: 626 /634 www.multiplesclerosisjournal.com Estimating long-term effects of disease-modifying drug therapy in multiple sclerosis patients RA Rudick*,1, GR Cutter 2, M Baier 3, B Weinstock-Guttman

More information

Lemtrada (alemtuzumab)

Lemtrada (alemtuzumab) Lemtrada (alemtuzumab) Policy Number: 5.02.517 Last Review: 08/2015 Origination: 08/2015 Next Review: 08/2016 Policy BCBSKC will provide coverage for Lemtrada (alemtuzumab) when it is determined to be

More information

Alemtuzumab for treating relapsing-remitting multiple sclerosis

Alemtuzumab for treating relapsing-remitting multiple sclerosis Alemtuzumab for treating relapsing-remitting multiple Issued: May 2014 guidance.nice.org.uk/ta NICE has accredited the process used by the Centre for Health Technology Evaluation at NICE to produce technology

More information

doi:10.1093/brain/awq118 Brain 2010: 133; 1914 1929 1914

doi:10.1093/brain/awq118 Brain 2010: 133; 1914 1929 1914 doi:10.1093/brain/awq118 Brain 2010: 133; 1914 1929 1914 BRAIN A JOURNAL OF NEUROLOGY The natural history of multiple sclerosis, a geographically based study 10: relapses and long-term disability Antonio

More information

The New England Journal of Medicine

The New England Journal of Medicine The New England Journal of Medicine Copyright, 2, by the Massachusetts Medical Society VOLUME 343 N OVEMBER 16, 2 NUMBER 2 RELAPSES AND PROGRESSION OF DISABILITY IN MULTIPLE SCLEROSIS CHRISTIAN CONFAVREUX,

More information

The submission positioned dimethyl fumarate as a first-line treatment option.

The submission positioned dimethyl fumarate as a first-line treatment option. Product: Dimethyl Fumarate, capsules, 120 mg and 240 mg, Tecfidera Sponsor: Biogen Idec Australia Pty Ltd Date of PBAC Consideration: July 2013 1. Purpose of Application The major submission sought an

More information

Measurement Issues in Short Term Clinical Trials. Brian Healy, PhD

Measurement Issues in Short Term Clinical Trials. Brian Healy, PhD Measurement Issues in Short Term Clinical Trials Brian Healy, PhD Overview n In order to iden>fy treatment effects or predictors of disease course, measurement of disease course is required n Although

More information

Cost-effectiveness of dimethyl fumarate (Tecfidera ) for the treatment of adult patients with relapsing remitting multiple sclerosis

Cost-effectiveness of dimethyl fumarate (Tecfidera ) for the treatment of adult patients with relapsing remitting multiple sclerosis Cost-effectiveness of dimethyl fumarate (Tecfidera ) for the treatment of adult patients with relapsing remitting multiple sclerosis The NCPE has issued a recommendation regarding the cost-effectiveness

More information

alemtuzumab, 12mg, concentrate for solution for infusion (Lemtrada ) SMC No. (959/14) Genzyme

alemtuzumab, 12mg, concentrate for solution for infusion (Lemtrada ) SMC No. (959/14) Genzyme alemtuzumab, 12mg, concentrate for solution for infusion (Lemtrada ) SMC No. (959/14) Genzyme 04 April 2014 (Issued 06 June 2014) The Scottish Medicines Consortium (SMC) has completed its assessment of

More information

Medication Policy Manual. Topic: Plegridy, peginterferon beta-1a Date of Origin: December 12, 2014

Medication Policy Manual. Topic: Plegridy, peginterferon beta-1a Date of Origin: December 12, 2014 Medication Policy Manual Policy No: dru376 Topic: Plegridy, peginterferon beta-1a Date of Origin: December 12, 2014 Committee Approval Date: December 11, 2015 Next Review Date: December 2016 Effective

More information

Prior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management

Prior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management Prior Authorization, Pharmacy and Health Case Management Information The purpose of this information sheet is to provide you with details on how Great-West Life will be assessing and managing your claim

More information

Progress in MS: Current and Emerging Therapies

Progress in MS: Current and Emerging Therapies Progress in MS: Current and Emerging Therapies Presented by: Dr. Kathryn Giles, MD MSc FRCPC The MS Society gratefully acknowledges the grant received from Biogen Idec Canada, which makes possible the

More information

Clinical Commissioning Policy: Disease Modifying Therapies For patients With Multiple Sclerosis (MS) December 2012. Reference : NHSCB/D4/c/1

Clinical Commissioning Policy: Disease Modifying Therapies For patients With Multiple Sclerosis (MS) December 2012. Reference : NHSCB/D4/c/1 Clinical Commissioning Policy: Disease Modifying Therapies For patients With Multiple Sclerosis (MS) December 2012 Reference : NHSCB/D4/c/1 NHS Commissioning Board Clinical Commissioning Policy: Disease

More information

PROCEEDINGS TREATING RELAPSING-REMITTING MULTIPLE SCLEROSIS II: STRATEGIES FOR PATIENTS NOT RESPONDING TO PRIMARY TREATMENTS *

PROCEEDINGS TREATING RELAPSING-REMITTING MULTIPLE SCLEROSIS II: STRATEGIES FOR PATIENTS NOT RESPONDING TO PRIMARY TREATMENTS * TREATING RELAPSING-REMITTING MULTIPLE SCLEROSIS II: STRATEGIES FOR PATIENTS NOT RESPONDING TO PRIMARY TREATMENTS * Jeffrey L. Bennett, MD, PhD ABSTRACT Many patients with multiple sclerosis (MS) will eventually

More information

Evidence Review Group Report commissioned by the NIHR HTA Programme on behalf of NICE

Evidence Review Group Report commissioned by the NIHR HTA Programme on behalf of NICE Evidence Review Group Report commissioned by the NIHR HTA Programme on behalf of NICE Alemtuzumab for the treatment of relapsing-remitting multiple sclerosis Produced by Southampton Health Technology Assessments

More information

New Therapies in MS: Filling up the spaces. Eli Silber Consultant Neurologist Kings College Hospital

New Therapies in MS: Filling up the spaces. Eli Silber Consultant Neurologist Kings College Hospital New Therapies in MS: Filling up the spaces Eli Silber Consultant Neurologist Kings College Hospital What is wrong with the current therapies? The current therapies have limited efficacy 1 st line relapse

More information

Advanced Multiple Sclerosis: Progressive MS Epidemiology

Advanced Multiple Sclerosis: Progressive MS Epidemiology Advanced Multiple Sclerosis: Progressive MS Epidemiology CMSC 2007-Washington, DC Mitchell T. Wallin, MD, MPH Associate Director-Clinical Care VA MS Center of Excellence-East East Associate Professor of

More information

Conflict of Interest Declaration. Overview of New Medications for Multiple Sclerosis. Assessment Question. Objectives 4/1/2011

Conflict of Interest Declaration. Overview of New Medications for Multiple Sclerosis. Assessment Question. Objectives 4/1/2011 Conflict of Interest Declaration Overview of New Medications for Multiple Sclerosis I or my spouse have no actual or potential conflict of interest in relation to this activity. Crystal Obering, Pharm.D.,

More information

Life with MS: Striving for Maximal Independence & Fulfillment

Life with MS: Striving for Maximal Independence & Fulfillment Life with MS: Striving for Maximal Independence & Fulfillment St. Louis, May 7, 2005 Florian P. Thomas, MA, MD, PhD MS Center, Department of Neurology Associate Professor, Saint Louis University Brain

More information

Prior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management

Prior Authorization, Pharmacy and Health Case Management Information. Prior Authorization. Pharmacy Information. Health Case Management Prior Authorization, Pharmacy and Health Case Management Information The purpose of this information sheet is to provide you with details on how Great-West Life will be assessing and managing your claim

More information

SECTION 2. Section 2 Multiple Sclerosis (MS) Drug Coverage

SECTION 2. Section 2 Multiple Sclerosis (MS) Drug Coverage SECTION 2 Multiple Sclerosis (MS) Drug Coverage Section 2 Multiple Sclerosis (MS) Drug Coverage ALBERTA HEALTH AND WELLNESS DRUG BENEFIT LIST Selected Drug Products used in the treatment of patients with

More information

Medication Policy Manual. Topic: Gilenya, fingolimod Date of Origin: November 22, 2010

Medication Policy Manual. Topic: Gilenya, fingolimod Date of Origin: November 22, 2010 Medication Policy Manual Policy No: dru229 Topic: Gilenya, fingolimod Date of Origin: November 22, 2010 Committee Approval Date: December 11, 2015 Next Review Date: December 2016 Effective Date: January

More information

New Developments in the Treatment and Management of Multiple Sclerosis

New Developments in the Treatment and Management of Multiple Sclerosis New Developments in the Treatment and Management of Multiple Sclerosis Myla D. Goldman, MD, MS For a CME/CEU version of this article, please go to www.namcp.org/cmeonline.htm, and then click the activity

More information

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP)

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) European Medicines Agency London, 16 November 2006 Doc. Ref. CPMP/EWP/561/98 Rev. 1 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON CLINICAL INVESTIGATION OF MEDICINAL PRODUCTS FOR THE

More information

Summary HTA. Interferons and Natalizumab for Multiple Sclerosis Clar C, Velasco-Garrido M, Gericke C. HTA-Report Summary

Summary HTA. Interferons and Natalizumab for Multiple Sclerosis Clar C, Velasco-Garrido M, Gericke C. HTA-Report Summary Summary HTA HTA-Report Summary Interferons and Natalizumab for Multiple Sclerosis Clar C, Velasco-Garrido M, Gericke C Health policy background Multiple sclerosis (MS) is a chronic inflammatory disease

More information

J.P. Morgan Cazenove Therapeutic Seminar

J.P. Morgan Cazenove Therapeutic Seminar Jannan, MS J.P. Morgan Cazenove Therapeutic Seminar David Meeker - CEO, Genzyme June 25, 2012 Forward Looking Statements This presentation contains forward-looking statements as defined in the Private

More information

Intravenous immunoglobulin G for the treatment of relapsing remitting multiple sclerosis: a meta-analysis

Intravenous immunoglobulin G for the treatment of relapsing remitting multiple sclerosis: a meta-analysis European Journal of Neurology 2002, 9: 557 563 REVIEW ARTICLE Intravenous immunoglobulin G for the treatment of relapsing remitting multiple sclerosis: a meta-analysis P. S. Sorensen a, F. Fazekas b and

More information

Disease Modifying Therapies (DMTs) in Multiple Sclerosis

Disease Modifying Therapies (DMTs) in Multiple Sclerosis Disease Modifying Therapies (DMTs) in Multiple Sclerosis Gary Stobbe, MD Medical Director, MS Project ECHO Clinical Assistant Professor, UW Neurology Conflict of Interest Dr. Stobbe has no conflicts of

More information

N Tubridy, H J Ader, F Barkhof, A J Thompson, D H Miller

N Tubridy, H J Ader, F Barkhof, A J Thompson, D H Miller 50 J Neurol Neurosurg Psychiatry 1998;64:50 55 Exploratory treatment trials in multiple sclerosis using MRI: sample size calculations for relapsing-remitting and secondary progressive subgroups using placebo

More information

Multiple Sclerosis (MS) Class Update

Multiple Sclerosis (MS) Class Update Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119 Multiple Sclerosis (MS) Class Update Month/Year of

More information

Treatment Optimization in MS: When to Start, When to Shift, when to Stop

Treatment Optimization in MS: When to Start, When to Shift, when to Stop Treatment Optimization in MS: When to Start, When to Shift, when to Stop Mark S. Freedman MSc MD FAAN FANA FRCPC Director, Multiple Sclerosis Research Unit University of Ottawa Sr. Scientist, Ottawa Hospital

More information

Which injectable medication should I take for relapsing-remitting multiple sclerosis?

Which injectable medication should I take for relapsing-remitting multiple sclerosis? Which injectable medication should I take for relapsing-remitting multiple sclerosis? A decision aid to discuss options with your doctor This decision aid is for you if you: Have multiple sclerosis Have

More information

RELAPSE MANAGEMENT. Pauline Shaw MS Nurse Specialist 25 th June 2010

RELAPSE MANAGEMENT. Pauline Shaw MS Nurse Specialist 25 th June 2010 RELAPSE MANAGEMENT Pauline Shaw MS Nurse Specialist 25 th June 2010 AIMS OF SESSION Relapsing/Remitting MS Definition of relapse/relapse rate Relapse Management NICE Guidelines Regional Clinical Guidelines

More information

A neurologist would assess your eligibility and suitability for the DMTs.

A neurologist would assess your eligibility and suitability for the DMTs. Choices Disease Modifying Treatments Disease modifying treatments (DMTs) are medications which modify the disease course. They target inflammation and are designed to reduce the damage caused by relapses.

More information

MR imaging is a sensitive tool for visualizing the characteristic

MR imaging is a sensitive tool for visualizing the characteristic ORIGINAL RESEARCH I.J. van den Elskamp D.L. Knol B.M.J. Uitdehaag F. Barkhof Modeling MR Imaging Enhancing-Lesion Volumes in Multiple Sclerosis: Application in Clinical Trials BACKGROUND AND PURPOSE: Although

More information

BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE (JPC)

BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE (JPC) BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE (JPC) September 2014 Review date: September 2017 Bulletin 203: Tocilizumab (subcutaneous) in combination with methotrexate or as monotherapy for the treatment

More information

Sponsor Novartis. Generic Drug Name Secukinumab. Therapeutic Area of Trial Psoriasis. Approved Indication investigational

Sponsor Novartis. Generic Drug Name Secukinumab. Therapeutic Area of Trial Psoriasis. Approved Indication investigational Clinical Trial Results Database Page 2 Sponsor Novartis Generic Drug Name Secukinumab Therapeutic Area of Trial Psoriasis Approved Indication investigational Clinical Trial Results Database Page 3 Study

More information

Multiple sclerosis disease-modifying drugs second line treatments

Multiple sclerosis disease-modifying drugs second line treatments Great Ormond Street Hospital for Children NHS Foundation Trust: Information for Families Multiple sclerosis disease-modifying drugs second line treatments The following information should be read in conjunction

More information

påçííáëü=jéçáåáåéë=`çåëçêíáìã==

påçííáëü=jéçáåáåéë=`çåëçêíáìã== påçííáëü=jéçáåáåéë=`çåëçêíáìã== adalimumab 40mg pre-filled syringe for subcutaneous injection (Humira ) No. (218/05) Abbott New indication: treatment of active and progressive psoriatic arthritis in adults

More information

Patients with confirmed relapse 111 26 (23.4 %) 104 16 (15.4 %) 1.52 [0.87; 2.67] p = 0.143 Probability of a relapse by week 96

Patients with confirmed relapse 111 26 (23.4 %) 104 16 (15.4 %) 1.52 [0.87; 2.67] p = 0.143 Probability of a relapse by week 96 Resolution by the Federal Joint Committee on an amendment to the Pharmaceutical Directive (AM-RL): Appendix XII Resolutions on the benefit assessment of pharmaceuticals with new active ingredients, in

More information

A Bayesian hierarchical surrogate outcome model for multiple sclerosis

A Bayesian hierarchical surrogate outcome model for multiple sclerosis A Bayesian hierarchical surrogate outcome model for multiple sclerosis 3 rd Annual ASA New Jersey Chapter / Bayer Statistics Workshop David Ohlssen (Novartis), Luca Pozzi and Heinz Schmidli (Novartis)

More information

The following MS experts were involved in the development of this Position Statement:

The following MS experts were involved in the development of this Position Statement: Position Statement for TYSABRI (natalizumab) and STRATIFY JCV TM in Multiple Sclerosis Rationale for this Position Statement This Position Statement was developed by ten Australian neurologists who specialise

More information

Ulf Kallweit, MD; Ilijas Jelcic, MD; Nathalie Braun, MD, PhD; Heike Fischer, MD; Björn Zörner,

Ulf Kallweit, MD; Ilijas Jelcic, MD; Nathalie Braun, MD, PhD; Heike Fischer, MD; Björn Zörner, Sustained efficacy of Natalizumab in the treatment of relapsing-remitting multiple sclerosis independent of disease activity and disability at baseline: real-life data from a Swiss cohort Ulf Kallweit,

More information

A Comprehensive Cost-Effectiveness Analysis of Treatments for Multiple Sclerosis. Ashley N. Newton, MHA, MAcc, CPA; Christina M.

A Comprehensive Cost-Effectiveness Analysis of Treatments for Multiple Sclerosis. Ashley N. Newton, MHA, MAcc, CPA; Christina M. A Comprehensive Cost-Effectiveness Analysis of Treatments for Multiple Sclerosis Ashley N. Newton, MHA, MAcc, CPA; Christina M. Stica, MHA The purpose of this study was to examine the cost-effectiveness

More information

PROPOSED REVISIONS TO THE CRITERIA. multiple sclerosis (RRMS)] Chapter 6 6 It is recognised that use is in only exceptional circumstances in RRMS.

PROPOSED REVISIONS TO THE CRITERIA. multiple sclerosis (RRMS)] Chapter 6 6 It is recognised that use is in only exceptional circumstances in RRMS. Specialist Working Group for Neurology Proposed changes to the Criteria for the clinical use of intravenous immunoglobulin in Australia, Second Edition ITEM Condition Name Multiple Sclerosis (MS) Multiple

More information

Immunoablative therapy with autologous hematopoietic stem cell transplantation in the treatment of poor risk multiple sclerosis

Immunoablative therapy with autologous hematopoietic stem cell transplantation in the treatment of poor risk multiple sclerosis Immunoablative therapy with autologous hematopoietic stem cell transplantation in the treatment of poor risk multiple sclerosis T Kozák, P Lhotáková Department of Clinical Haematology, 3r d School of Medicine,

More information

FastTest. You ve read the book... ... now test yourself

FastTest. You ve read the book... ... now test yourself FastTest You ve read the book...... now test yourself To ensure you have learned the key points that will improve your patient care, read the authors questions below. The answers will refer you back to

More information

Optimizing Therapy in Progressive MS: Treatment Options

Optimizing Therapy in Progressive MS: Treatment Options Optimizing Therapy in Progressive MS: Treatment Options Neeta Garg, MD Associate Professor of Neurology University of Massachusetts Medical School Associate Director, Multiple Sclerosis Center UMass Memorial

More information