The importance of early intervention clinician perspective. Øivind Grytten Torkildsen

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "The importance of early intervention clinician perspective. Øivind Grytten Torkildsen"

Transcription

1 The importance of early intervention clinician perspective Øivind Grytten Torkildsen

2 «You can never diagnose MS too late» Neuroradiologist from Norway, early 1990s

3 Prognosis in untreated MS

4 Early diagnosis RIS CIS RRMS SPMS Cerebral Volume Relapses and Disability MRI Lesion Load MRI Activity Trapp BD et al. Neuroscientist. 1999;5:48-57.

5 Probability Employment in untreated MS Probability of Remaining in Active Employment After Onset of MS 1.0 Control Persons MS Patients Time (years) Pfleger CC et al. Mult Scler. 2010;16:

6 Proportion of Patients 65 Years Old Working (%) Employment Change with EDSS Score Increase Austria Belgium Germany Italy Netherlands Spain Sweden Switzerland United Kingdom / /9.0 EDSS Score Adapted from Kobelt G et al. J Neurol Neurosurg Psychiatry. 2006;77:

7 Utility (EQ-5D: 0=Death; 1=Full Health) Quality of life decreases with increasing EDSS-score EDSS Score 1.00 Best Possible Health Status 0.00 Worst Possible Health Status 0.85 mean utility of normal population mean utility of aging patients with osteoporosis, no fracture mean utility of patients with rheumatoid arthritis at stage mean utility of patients with Parkinson s disease mean utility of patients with MS mean utility of severe hemophilia patients with inhibitors 5

8 Survival in untreated MS 8 years decreased survival

9 In other words 1977

10 After 10 years: 1/4 of MS-patients have died from the disease 1/4 are still employed 1/2 are not employed, with different degrees of disability

11 What happens in MS Acute damages

12

13 Normal White Matter Animasjon basert fra Trapp BD et al. N Engl J Med. 1998;338:278

14 Active Lesion Animasjon basert fra Trapp BD et al. N Engl J Med. 1998;338:278

15 Chronic Active Lesion Animasjon basert fra Trapp BD et al. N Engl J Med. 1998;338:278

16 Chronic Inactive Lesion Animasjon basert fra Trapp BD et al. N Engl J Med. 1998;338:278

17 Trapp BD et al. N Engl J Med. 1998;338:278

18 Trapp BD et al. N Engl J Med. 1998;338:278

19 Transected axons in different MSlesions Number of Transected Axons Per Mm Active 3138 Chronic Active Edge 875 Chronic Active Core 17 NAWM 0.7 Control Trapp BD et al. N Engl J Med. 1998;338:278

20 Number of damaged axons by disease duration Number of APP-Positive Axons per mm <1 Year 1 5 Years 5 10 Years >10 Years Disease Duration Increasing acute axonal damage Kuhlmann T et al. Brain. 2002;125(Pt 10):

21

22 What happens in progressive MS?

23 Ann Neurol Feb;71(2):227-44

24 Ann Neurol Feb;71(2):227-44

25 Ann Neurol Feb;71(2):227-44

26 Mitochondrial damage? Lassmann, 2013

27 Prognosis with treated MS

28 Early treatment significantly reduced the risk of EDSS-progression Ann Neurol Oct;66(4):513-20

29 Goodin DS, et al Neurology;78(17):

30 Ann Neurol Jan;73(1):95-103

31 New MRI-lesions during MS-treatment 100 predict disability progression None No. of New T2-Hyperintense Lesions After 1 Year of Therapy *Sustained disability progression was defined as a 1.0-point increase in EDSS score confirmed at 6 months. Mean follow-up was 4.8 years. Prosperini L et al. Eur J Neurol. 2009;16:

32 J Neurol Jan;253(1):98-108

33 Summary Early treatment most effective Disease activity during treatment poorer prognosis

34 Introduction of RRMS Therapies in the EU Outcome Measures Goals of Therapy Address Symptoms Slow Disease Progression Stop Disease Progression Repair No Evidence of Disease Activity (NEDA) Sustained improvement SC IFNβ-1b 1995 IM IFNβ-1a 1997 SC IFNβ-1a 1998 GA Natalizumab Fingolimod 2010 Mitoxantrone 2000 DMF Peginterferon Beta-1a 2014 Alemtuzumab Teriflunomide 2013?

35 No Evidence of Disease Activity (NEDA) No relapses Relapses EDSS-progression No EDSS progression MRI activity No new T2-lesions No new Gd+-lesions Imitola J, Racke MK. JAMA Neurol. 2015;72: ; Stangel M et al. Ther Adv Neurol Disord. 2015;8:3-13.

36 Disability Early Treatment vs Later Treatment Late treatment Disease onset Time Adapted from Miller JR. J Manag Care Pharm. 2004;10(suppl S-b):S4-S11. 36

37 Disability Early Treatment vs Later Treatment Window of opportunity Late treatment Effective treatment at diagnosis Disease onset Time Adapted from Miller JR. J Manag Care Pharm. 2004;10(suppl S-b):S4-S11. 37

38 Summary MS is a serious disease, if untreated. Early and effective treatment can alter the prognosis.

39 "When you change the way you look at things, the things you look at change. Max Planck

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

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

Progress in the field: therapeutic improvements for all patients?

Progress in the field: therapeutic improvements for all patients? Progress in the field: therapeutic improvements for all patients? Krzysztof Selmaj, Department of Neurology, Medical University of Lodz, PL Warsaw 15 May, 2015 Main features of MS Inflammation Demyelination

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

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

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

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

Treatment in Relapsing MS: Choosing Among the Options. Donald Negroski, MD

Treatment in Relapsing MS: Choosing Among the Options. Donald Negroski, MD Treatment in Relapsing MS: Choosing Among the Options Donald Negroski, MD Disclosures Research Grants Educational activities and lectures Consulting or other services including Continuing Medical Education

More information

Multiple Sclerosis (MS) Aprile Royal, Novartis Pharma Canada Inc. September 21, 2011 Toronto, ON

Multiple Sclerosis (MS) Aprile Royal, Novartis Pharma Canada Inc. September 21, 2011 Toronto, ON Multiple Sclerosis (MS) Aprile Royal, Novartis Pharma Canada Inc. September 21, 2011 Toronto, ON First-line DMTs Reduce Relapse Frequency by ~30% vs. Placebo Frequency of relapse with various DMTs, based

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

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

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

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

Rational basis for early treatment in MS. Bonaventura Casanova Estruch Unitat d Esclerosi Múltiple Hospital Universitari la Fe València

Rational basis for early treatment in MS. Bonaventura Casanova Estruch Unitat d Esclerosi Múltiple Hospital Universitari la Fe València Rational basis for early treatment in MS Bonaventura Casanova Estruch Unitat d Esclerosi Múltiple Hospital Universitari la Fe València Bonaventura Casanova Department of Neurology University Hospital La

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

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

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 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

Treatments-related side effects

Treatments-related side effects Treatments-related side effects MS: from the diagnosis to the disease management MSc, MD, José Flores Rivera Instituto Nacional de Neurología y Neurocirugía Safety issues: beta interferon Depression/suicidal

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

Building on Leading Market Positions

Building on Leading Market Positions Building on Leading Market Positions Bharat Tewarie Head of Global Business Franchise Neurodegenerative Diseases Darmstadt, May 15, 2012 Agenda 1. Introduction 2. Rebif: Defending the franchise 3. Fertility:

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

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

Disease Modifying Therapies for Relapsing-Remitting Multiple Sclerosis: Effectiveness and Value

Disease Modifying Therapies for Relapsing-Remitting Multiple Sclerosis: Effectiveness and Value Disease Modifying Therapies for Relapsing-Remitting Multiple Sclerosis: Effectiveness and Value Stakeholder Input: Draft Background and Scope July 1, 2016 This draft scoping document was developed with

More information

Medication Policy Manual. Topic: Betaseron, Extavia, interferon beta-1b Date of Origin: June 18, 2004

Medication Policy Manual. Topic: Betaseron, Extavia, interferon beta-1b Date of Origin: June 18, 2004 Medication Policy Manual Policy No: dru108 Topic: Betaseron, Extavia, interferon beta-1b Date of Origin: June 18, 2004 Committee Approval Date: December 12, 2014 Next Review Date: December 2015 Effective

More information

Pros and cons in MS treatment: Are new drugs safe? Dr. Vladimiro Sinay

Pros and cons in MS treatment: Are new drugs safe? Dr. Vladimiro Sinay Pros and cons in MS treatment: Are new drugs safe? Dr. Vladimiro Sinay Seguro que nada es seguro (Nothing is safe, for sure) Reason 1 to prescribe new drugs: An extensive menu allows us to evaluate specific

More information

MRI in drug development: Lessons from MS

MRI in drug development: Lessons from MS MRI in drug development: Lessons from MS Douglas L. Arnold MD McConnel Brain Imaging Center, MNI, McGill NeuroRx Research Inc Drug development Pre-clinical Phase I Phase II Phase III Phase IV Candidate

More information

Natalizumab (Tysabri) and PMLthe current figures. Paul-Ehrlich-Institut Brigitte Keller Stanislawski Paul-Ehrlich-Str. 51-59 63225 Langen GERMANY

Natalizumab (Tysabri) and PMLthe current figures. Paul-Ehrlich-Institut Brigitte Keller Stanislawski Paul-Ehrlich-Str. 51-59 63225 Langen GERMANY Natalizumab (Tysabri) and PMLthe current figures Paul-Ehrlich-Institut Brigitte Keller Stanislawski Paul-Ehrlich-Str. 51-59 63225 Langen GERMANY Humanised MAB Natalizumab Specific binding to a4-integrin

More information

Multiple Sclerosis Update. Bridget A. Bagert, MD, MPH Director, Ochsner Multiple Sclerosis Center

Multiple Sclerosis Update. Bridget A. Bagert, MD, MPH Director, Ochsner Multiple Sclerosis Center Multiple Sclerosis Update Bridget A. Bagert, MD, MPH Director, Ochsner Multiple Sclerosis Center None Disclosures First of All. Why is my talk in the Neurodegenerative hour? I respectfully object! Case

More information

Drug Class Review Disease-modifying Drugs for Multiple Sclerosis

Drug Class Review Disease-modifying Drugs for Multiple Sclerosis Drug Class Review Disease-modifying Drugs for Multiple Sclerosis Final Update 3 Report May 2016 The purpose of reports is to make available information regarding the comparative clinical effectiveness

More information

LONG-TERM BENEFITS OF EARLY TREATMENT IN MULTIPLE SCLEROSIS: AN INVESTIGATION UTILIZING A NOVEL DATA COLLECTION TECHNIQUE DEVON S. CONWAY, M.D.

LONG-TERM BENEFITS OF EARLY TREATMENT IN MULTIPLE SCLEROSIS: AN INVESTIGATION UTILIZING A NOVEL DATA COLLECTION TECHNIQUE DEVON S. CONWAY, M.D. LONG-TERM BENEFITS OF EARLY TREATMENT IN MULTIPLE SCLEROSIS: AN INVESTIGATION UTILIZING A NOVEL DATA COLLECTION TECHNIQUE by DEVON S. CONWAY, M.D. Submitted in partial fulfillment of the requirements For

More information

Report on New Patented Drugs Tysabri

Report on New Patented Drugs Tysabri Report on New Patented Drugs Tysabri Under its transparency initiative, the PMPRB publishes the results of the reviews of new patented drug products conducted by Board Staff for purposes of applying the

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

In considering the managed care perspective of

In considering the managed care perspective of MANAGED CARE CONSIDERATIONS IN TREATING MULTIPLE SCLEROSIS * Sheldon J. Rich, RPh, PhD ABSTRACT The lifelong treatment that is required for patients with multiple sclerosis (MS) presents numerous managed

More information

PCORI Workshop on Treatment for Multiple Sclerosis. Breakout Group Topics and Questions Draft 3-27-15

PCORI Workshop on Treatment for Multiple Sclerosis. Breakout Group Topics and Questions Draft 3-27-15 PCORI Workshop on Treatment for Multiple Sclerosis Breakout Group Topics and Questions Draft 3-27-15 Group 1 - Comparison across DMTs, including differential effects in subgroups Consolidated straw man

More information

Treatment guidelines for relapsing MS and the two step approach for disease modifying therapy

Treatment guidelines for relapsing MS and the two step approach for disease modifying therapy Treatment guidelines for relapsing MS and the two step approach for disease modifying therapy Klaus Schmierer, PhD FRCP Blizard Institute, Barts and The London School of Medicine & Dentistry Barts Health

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

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

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

Using the MS Clinical Course Descriptions in Clinical Practice

Using the MS Clinical Course Descriptions in Clinical Practice Using the MS Clinical Course Descriptions in Clinical Practice Mark J. Tullman, MD Director of Clinical Research The MS Center for Innovations in Care Missouri Baptist Medical Center Disclosures Consultant/speaking

More information

Disease-modifying therapies in Chinese children with multiple sclerosis

Disease-modifying therapies in Chinese children with multiple sclerosis The Turkish Journal of Pediatrics 2014; 56: 482-486 Original Disease-modifying therapies in Chinese children with multiple sclerosis Fen Yang 1, De-hui Huang 2, Yang Yang 1, Wei-ping Wu 1 1 Department

More information

New Treatment Options for MS Patients: Understanding risks versus benefits

New Treatment Options for MS Patients: Understanding risks versus benefits New Treatment Options for MS Patients: Understanding risks versus benefits By Michael A. Meyer, MD Department of Neurology, Sisters Hospital, Buffalo, NY Objectives: 1. to understand fundamentals of MS

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

MRI diagnostic criteria in MS

MRI diagnostic criteria in MS Special Focus Session on Multiple Sclerosis MRI diagnostic criteria in MS Àlex Rovira Unidad de Resonancia Magnética Servicio de Radiología Hospital Vall d Hebron. Barcelona. alex.rovira@idi cat.org MAGNIMS

More information

Biogen Global Medical Grants Office Multiple Sclerosis: Areas of Interest

Biogen Global Medical Grants Office Multiple Sclerosis: Areas of Interest Biogen Global Medical Grants Office Multiple Sclerosis: Areas of Interest Cycle C June 2, 2015 1 Introduction The landscape for the treatment of relapsing Multiple Sclerosis (MS) has quickly evolved over

More information

PharmaPoint: Multiple Sclerosis - United Kingdom Drug Forecast and Market Analysis to 2022. Multiple

PharmaPoint: Multiple Sclerosis - United Kingdom Drug Forecast and Market Analysis to 2022. Multiple Brochure More information from http://www.researchandmarkets.com/reports/2541548/ PharmaPoint: Multiple Sclerosis - United Kingdom Drug Forecast and Market Analysis to 2022 Description: PharmaPoint: Multiple

More information

MS: The Treatment Paradigm, A Pathway to Success for Improved Patient Outcomes

MS: The Treatment Paradigm, A Pathway to Success for Improved Patient Outcomes MS: The Treatment Paradigm, Pathway to Success for Improved Patient Outcomes Jack Burks, MD For a CME/CEU version of this article please go to www.namcp.org/cmeonline.htm, and then click the activity title.

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

The Burden of Rheumatoid

The Burden of Rheumatoid The Burden of Rheumatoid Arthritis (RA) and Patient Access to Treatment by prof. Bengt Jönsson, DR. Gisela Kobelt and PROF. Josef Smolen summary of key findings Table of contents Introduction Introduction

More information

MULTIPLE SCLEROSIS Update. Disclosures. Multiple Sclerosis. I do not have any disclosures. E. Torage Shivapour, M.D.

MULTIPLE SCLEROSIS Update. Disclosures. Multiple Sclerosis. I do not have any disclosures. E. Torage Shivapour, M.D. MULTIPLE SCLEROSIS Update E. Torage Shivapour, M.D. Clinical Professor Department of Neurology University of Iowa Hospitals & Clinics Disclosures I do not have any disclosures. Multiple Sclerosis Most

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

Policy proposals to improve access to multiple sclerosis treatments in Europe

Policy proposals to improve access to multiple sclerosis treatments in Europe Policy proposals to improve access to multiple sclerosis treatments in Europe Key findings and conclusions EMSP Conference Oslo, 17 May 2016 This research builds on a study conducted by CRA in 2014 There

More information

Medical Information Services

Medical Information Services Medical Information Services (natalizumab) Safety Update: (17 August 2012) As part our commitment communicating information about (natalizumab), Biogen Idec wish inform you the following update. PML Incidence

More information

ACCESS TO INNOVATIVE TREATMENTS IN MULTIPLE SCLEROSIS IN EUROPE

ACCESS TO INNOVATIVE TREATMENTS IN MULTIPLE SCLEROSIS IN EUROPE ACCESS TO INNOVATIVE TREATMENTS IN MULTIPLE SCLEROSIS IN EUROPE October 2009 A REPORT PREPARED FOR THE EUROPEAN FEDERATION OF PHARMACEUTICAL INDUSTRY ASSOCIATIONS (EFPIA) Gisela Kobelt, PhD MBA Department

More information

New treatments in MS What s here and what s nearly here

New treatments in MS What s here and what s nearly here 5 th MS Research Day, June 14 th 2014 New treatments in MS What s here and what s nearly here David Miller Queen Square MS Centre at UCL and UCLH Course of MS and its treatment Relapsing remitting Disability

More information

Multiple Sclerosis: An imaging review and update on new treatments.

Multiple Sclerosis: An imaging review and update on new treatments. Multiple Sclerosis: An imaging review and update on new treatments. Dr Marcus Likeman Consultant Neuroradiologist North Bristol NHS Trust Bristol Royal Hospital for Children MRI appearances - White Matter

More information

Supplementary appendix

Supplementary appendix 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

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

ORIGINAL CONTRIBUTION. Effects of Interferon Beta-1b on Black Holes in Multiple Sclerosis Over a 6-Year Period With Monthly Evaluations

ORIGINAL CONTRIBUTION. Effects of Interferon Beta-1b on Black Holes in Multiple Sclerosis Over a 6-Year Period With Monthly Evaluations ORIGINAL CONTRIBUTION Effects of Interferon Beta-1b on Black Holes in Multiple Sclerosis Over a 6-Year Period With Monthly Evaluations Francesca Bagnato, MD; Shiva Gupta, BA; Nancy D. Richert, MD, PhD;

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

Sex Differences in Multiple Sclerosis: Clinical, Imaging, and Pathology

Sex Differences in Multiple Sclerosis: Clinical, Imaging, and Pathology Sex Differences in Multiple Sclerosis: Clinical, Imaging, and Pathology Sex Differences and Implications for Translational Neuroscience Research A Workshop Forum on Neuroscience and Nervous System Disorders

More information

Current and future options of MS treatment Prof. Dr. Karl Vass, AKH Wien

Current and future options of MS treatment Prof. Dr. Karl Vass, AKH Wien Current and future options of MS treatment Prof. Dr. Karl Vass, AKH Wien European Health Forum, Gastein 6 th October 2010 Multiple Sclerosis is the most common neurological disorder in young Caucasian

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

Our concept of multiple sclerosis (MS) as

Our concept of multiple sclerosis (MS) as MEASURING AND ASSESSING NEURODEGENERATION AND NEUROPROTECTION: THE ROLE OF MRI * Nancy Richert, MD, PhD ABSTRACT Multiple sclerosis is a complex disease involving inflammatory and neurodegenerative processes.

More information

MSTAC Initial Application

MSTAC Initial Application MSTAC Initial Application Please send applications to: Facsimile 04 916 7571 Further Contact Details: Address The Co-ordinator MSTAC PHARMAC P O Box 10-254 WELLINGTON Phone 04 460 4990 Email mstaccoordinator@pharmac.govt.nz

More information

Sensitive and reproducible clinical rating

Sensitive and reproducible clinical rating CLINICAL AND MRI MARKERS OF MS DISEASE PROGRESSION * Richard A. Rudick, MD ABSTRACT Sensitive and reproducible measures of multiple sclerosis (MS) severity and progression are important in the treatment

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

Summary chapter 2 chapter 2

Summary chapter 2 chapter 2 Summary Multiple Sclerosis (MS) is a chronic disease of the brain and the spinal cord. The cause of MS is unknown. MS usually starts in young adulthood. In the course of the disease progression of neurological

More information

MRI in Differential Diagnosis

MRI in Differential Diagnosis MRI in Differential Diagnosis Jill Conway, MD, MA, MSCE Director, Carolinas MS Center Clerkship Director, UNCSOM-Charlotte Campus Charlotte, NC DISCLOSURES Speaking, consulting, and/or advisory boards

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

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

Can pain be helpful as a quality indicator for health care systems?

Can pain be helpful as a quality indicator for health care systems? Can pain be helpful as a quality indicator for health care systems? Brussels May. 4 th 2010 Dr. Alberto Grua Grunenthal Why is pain important? Pain is independent of social status, sex or ethnic origin

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

Multiple Sclerosis Drug Discoveries - What the Future Holds

Multiple Sclerosis Drug Discoveries - What the Future Holds Brochure More information from http://www.researchandmarkets.com/reports/1408035/ Multiple Sclerosis Drug Discoveries - What the Future Holds Description: The recent approval in the US of Novartis' orally

More information

MRI Case Studies: Multiple Sclerosis and MS Mimics

MRI Case Studies: Multiple Sclerosis and MS Mimics MRI Case Studies: Multiple Sclerosis and MS Mimics Jill Conway, MD, MA, MSCE Director, Carolinas MS Center Clerkship Director, UNCSOM-Charlotte Campus Charlotte, NC DISCLOSURES Speaking, consulting, and/or

More information

Advances in the Use of MRI in the Management of MS. The Role of MRI in MS Management. Jack H. Simon Portland, Oregon

Advances in the Use of MRI in the Management of MS. The Role of MRI in MS Management. Jack H. Simon Portland, Oregon Advances in the Use of MRI in the Management of MS The Role of MRI in MS Management Jack H. Simon Portland, Oregon Disclosures Dr. Simon has nothing to disclose. This continuing education activity is managed

More information

Novel therapeutic approaches in multiple sclerosis Neuroprotective and remyelinating agents, the future of clinical trials in MS?

Novel therapeutic approaches in multiple sclerosis Neuroprotective and remyelinating agents, the future of clinical trials in MS? Novel therapeutic approaches in multiple sclerosis Neuroprotective and remyelinating agents, the future of clinical trials in MS? Marie Trad, M.D., Lynne Hughes, Cathy VanBelle, Amy Del Medico 3rd International

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

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

Growth in revenue from MS drugs has been driven largely by price increases over the last several years.

Growth in revenue from MS drugs has been driven largely by price increases over the last several years. March 4, 2013 Ben Weintraub, PhD Are Injectable MS Drugs Finished? Market Ready for Tecfidera Companies: Biogen (BIIB) Sanofi (SNY) Teva (TEVA) Novartis (NVS) Merck Serono Bayer Schering Products: Tecfidera

More information

Risk of seizure recurrence after antiepileptic drug withdrawal in Thai children with epilepsy

Risk of seizure recurrence after antiepileptic drug withdrawal in Thai children with epilepsy Neurology Asia 2006; 11 : 25 29 Risk of seizure recurrence after antiepileptic drug withdrawal in Thai children with epilepsy Pairoj BOONLUKSIRI MD Hatyai Hospital, Hatyai, Songkhla, Thailand Abstract

More information

PCORI Scientific Program Area: Assessment of Prevention, Diagnosis and Treatment Options

PCORI Scientific Program Area: Assessment of Prevention, Diagnosis and Treatment Options Research Prioritization Topic Brief Topic 18: Multiple Sclerosis Comparative effectiveness of treatment programs for recurring/remitting multiple sclerosis (MS). PCORI Scientific Program Area: Assessment

More information

Approved Beta Interferons in Relapsing-Remitting Multiple sclerosis: Is There an Odd One Out?

Approved Beta Interferons in Relapsing-Remitting Multiple sclerosis: Is There an Odd One Out? Journal of Central Nervous System Disease Review Open Access Full open access to this and thousands of other papers at http://www.la-press.com. Approved Beta Interferons in Relapsing-Remitting Multiple

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

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

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

Normal pressure Hydrocephalus and Alzheimer Disease: Comorbidities and shunt response.

Normal pressure Hydrocephalus and Alzheimer Disease: Comorbidities and shunt response. + Normal pressure Hydrocephalus and Alzheimer Disease: Comorbidities and shunt response. Vanessa Desmarais, MD; Ajaz Shawl, MD St. Joseph s Hospital Family Medicine Residency March 11 th, 2016 + Case CC:

More information

SammyJo s MS-LDN Timeline

SammyJo s MS-LDN Timeline SammyJo s MS-LDN Timeline Better 1 Stop all other meds 4/4 2 EDSS Disability Scale 3 3 3.5 3.5 3.5 3.5 4 4 4 4 4.5 5 5_ 6 7 8 Start LDN 2/4 6.5 7 9 Worse 1 Steroids Copaxone Novan trone Avonex Steroid

More information

What is MS? 1. disease that affects the central nervous. Is a disease that affects both white and gray matter

What is MS? 1. disease that affects the central nervous. Is a disease that affects both white and gray matter What is MS? 1 Neuron Damaged myelin due to inflammation MS is a chronic immunemediated disease that affects the central nervous system (CNS) Is a disease that affects both white and gray matter Interrupted

More information

Accuracy in Space and Time: Diagnosing Multiple Sclerosis. 2012 Genzyme Corporation, a Sanofi company.

Accuracy in Space and Time: Diagnosing Multiple Sclerosis. 2012 Genzyme Corporation, a Sanofi company. Accuracy in Space and Time: Diagnosing Multiple Sclerosis 2012 Genzyme Corporation, a Sanofi company. Brought All rights to reserved. you by www.msatrium.com, MS.US.PO876.1012 your gateway to MS knowledge.

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

MULTIMODAL THERAPY FOR MS- ASSOCIATED COGNITIVE DYSFUNCTION

MULTIMODAL THERAPY FOR MS- ASSOCIATED COGNITIVE DYSFUNCTION MULTIMODAL THERAPY FOR MS- ASSOCIATED COGNITIVE DYSFUNCTION Michael K. Racke, MD Professor and Chairman in Neurology The Helen C. Kurtz Chair in Neurology Department of Neurology Ohio State University

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

Use of Observa,onal Data to Make Causal Inferences About Treatment Decisions in Mul,ple Sclerosis. Brian Healy, PhD

Use of Observa,onal Data to Make Causal Inferences About Treatment Decisions in Mul,ple Sclerosis. Brian Healy, PhD Use of Observa,onal Data to Make Causal Inferences About Treatment Decisions in Mul,ple Sclerosis Brian Healy, PhD Disclosures n I receive research support from Merck Serono and Novar,s Outline n Background

More information

Alemtuzumab for the treatment of relapsing-remitting multiple sclerosis. Appendix D

Alemtuzumab for the treatment of relapsing-remitting multiple sclerosis. Appendix D Alemtuzumab for the treatment of relapsing-remitting multiple sclerosis Appendix D Response to consultee and commentator comments on the draft remit and draft scope & Response to consultee and commentator

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

Study Support Materials Cover Sheet

Study Support Materials Cover Sheet Study Support Materials Cover Sheet Document Title ESCALATE Patient Brochure Intended Audience This brochure is designed to be given to potentially eligible patients as a take-home summary of key information

More information

Exercise therapy and multiple sclerosis a powerful non-pharmacological intervention

Exercise therapy and multiple sclerosis a powerful non-pharmacological intervention Malmö, November 2014 Exercise therapy and multiple sclerosis a powerful non-pharmacological intervention Ulrik Dalgas, PhD Department of Public Health Section of Sport Science Aarhus University Denmark

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

Is hypoglycemia an issue in type 2 diabetes?

Is hypoglycemia an issue in type 2 diabetes? King s Diabetes Research Group Is hypoglycemia an issue in type 2 diabetes? Stephanie A Amiel RD Lawrence Professor of Diabetic Medicine King s College London Conflicts of interest None! (Currently working

More information