1 Resources for the Patient Please print these out and give them to your patients with MS
2 An internet program for persons with MS on the FCM website Multiple Sclerosis: A Toolbox of Information and Resources for the Patient A patient education program to help you better understand and cope with your illness.
3 NMSS Resources for Patients Reliable information Webpage, on-line modules, brochures, local programs Social networking Support groups, retreats Networking sites for MS: Facebook, Real talk. Real answers., Young adults, Moms with MS Exercise and wellness Financial support Respite, durable medical equipment, home modifications, prescriptions, transportation Care management Comprehensive assessment of individual needs & resources
4 Proposal to introduce drugs to patients with following slides if you have a separated patient tool kit. I personally feel only giving them the drug slides is too dry. Would propose slide which gives overview of available drugs, such as the arrow slide but needs update as fingolimod now approved No formatting yet prior to decision Will need to include new oral drug Gilenya which was not available yet when I did this for other presentation Would propose slide to encourage and promote well being and not only to talk about drugs.
5 Emerging new drugs Betaseron Avonex Copaxone Rebif Mitoxantrone Tysabri Cladribine Fingolimod Laquinomod BG-12 Teriflunomide Rituximab Alemtuzumab (>70 MS drugs in development)
6 First-line treatments Interferons Avonex Betaseron Rebif Copaxone Have changed the face of MS Second-line treatments Tysabri Novantrone Don t work for everyone Optimal drug for the individual?
7 First-line treatments Interferons Avonex Betaseron Rebif Copaxone Very safe Long-term safety >15 years Effective in a lot of MS patients Needles, self-injections Tolerability Injection site reactions FLS and blood work for interferons Compliance
8 Second-line treatments Tysabri Novantrone Often work when other treatments failed or cannot be tolerated No self-injection required Less frequent dosing Limited safety data Safety risks: Tysabri: PML, opportunistic infections Novantrone: fertility, heart, leukemia
9 Want to know more? Speak to your doctor Look at accurate and updated information of these drugs and many other info about MS at the NMSS webpage:
10 The MS Disease- Modifying Medications Gener al information
11 Current as of December 8, This online brochure is updated with breaking news as required. If you have a printed a copy of this publication, please check nationalmssociety.org/dmd to assure that you have the most current edition. For some people, a diagnosis of MS is a relief, giving a name and a reason for a parade of strange symptoms. For others, a diagnosis of MS brings images of the worst possible future. Both reactions will likely change somewhat over time, but for many with MS, diagnosis is a day when life changes. Even before the news can be fully absorbed, people with MS face a decision about taking a disease-modifying medication. The Society s National Clinical Advisory Board agrees that disease-modifying medications are most effective when started early, before the disease has the opportunity to progress further. Disease-modifying medications: n Reduce the frequency and severity of clinical attacks (also called relapses or exacerbations), which are defined as the worsening of an MS symptom or symptoms, and/or the appearance of new symptoms, which lasts at least 24 hours and is separated from a previous exacerbation by at least one month. n Reduce the accumulation of lesions.(damaged or active disease areas) within the brain and spinal cord as seen on MRI (magnetic resonance imaging). n Appear to slow down the accumulation of disability. These medications, which are generally taken on a long-term basis, are the best defense currently available to slow the natural course of MS. Even though the disease-modifying medications don t generally make a person feel better, they can be looked upon as an investment in the future. Options There are currently eight disease-modifying medications approved by the U.S. Food and Drug Administration (FDA) for use in relapsing forms of MS (including secondaryprogressive MS for those people who are still experiencing relapses). Of these, one is also approved specifically for secondaryprogressive MS. None of these medications is a cure, and none will prevent recurring symptoms, such as fatigue or numbness. However each of them has a proven record of effectiveness. Unfortunately, no disease-modifying medication has yet been approved to treat primary progressive MS the type of MS that shows steady progression at onset. 1 The MS Disease-Modifying Medications General Information 2
12 Decisions about taking a disease-modifying medication are best made by carefully considering and weighing factors including individual lifestyle, disease course, known side effects, and the potential risks and benefits of the different therapies. A full discussion with a knowledgeable health care professional is the best guide for your decision. Each person s body or disease can respond to these medications in different ways. The following charts present important information about each of the medications, which are listed in alphabetical order. Brand (Generic Name) & Frequency/Route of Delivery/Usual Dose Avonex (interferon beta-1a) Once a week; intramuscular (into the muscle) injection; 30 mcg. Betaseron (interferon beta-1b) Every other day; subcutaneous (under the skin) injection; 250 mcg. Copaxone (glatiramer acetate) Every day; subcutaneous (under the skin) injection; 20 mg (20,000 mcg). Extavia (interferon beta-1b) Every other day; subcutaneous (under the skin) injection; 250 mcg. Gilenya (fingolimod) Every day; capsule taken orally. Novantrone (mitoxantrone; as of 2006, available as a generic drug) Four times a year by IV infusion in a medical facility. Lifetime cumulative dose limit of approximately 8 12 doses over 2 3 years (140 mg/m2). Rebif (interferon beta-1a) Three times a week; subcutaneous (under the skin) injection; 44 mcg. Tysabri (natalizumab) Every four weeks by IV infusion in a registered infusion facility; 300 mg. Manufacturer/Distributor & Year of FDA Approval Avonex Biogen Idec 1996 Betaseron Bayer HealthCare Pharmaceuticals, Inc Copaxone Teva Pharmaceuticals Industries, Ltd Extavia Novartis Pharmaceuticals Corp Gilenya Novartis Pharmaceuticals Corp Novantrone EMD Serono, Inc./Immunex Corporation 2000 Rebif EMD Serono, Inc./Pfizer, Inc Tysabri Biogen Idec/Elan Pharmaceuticals, Inc The MS Disease-Modifying Medications General Information 4
13 Indication (FDA-approved Use) Avonex For the treatment of relapsing forms of MS to slow the accumulation of physical disability and reduce the frequency of clinical exacerbations, and for patients who have experienced a first clinical episode and have MRI features consistent with MS. Betaseron For the treatment of relapsing forms of MS to reduce the frequency of clinical exacerbations; and for patients who have experienced a first clinical episode and have MRI features consistent with MS. Copaxone For the treatment of relapsing-remitting MS to reduce the number of clinical exacerbations; and for patients who have experienced a first clinical episode and have MRI features consistent with MS. Extavia For the treatment of relapsing forms of MS to reduce the frequency of clinical exacerbations; and for patients who have experienced a first clinical episode and have MRI features consistent with MS. Gilenya For the treatment of relapsing forms of MS to reduce the frequency of clinical exacerbations and to delay the accumulation of physical disability. Novantrone For the treatment of worsening relapsing-remitting MS, progressive-relapsing MS or secondary-progressive MS to reduce neurologic disability and/or the frequency of clinical exacerbations. Rebif For the treatment of relapsing forms of MS to reduce the frequency of clinical exacerbations and delay the accumulation of physical disability. Tysabri To be used as a monotherapy (not in combination with any other disease-modifying medications) for the treatment of relapsing forms of MS to delay the accumulation of physical disability and reduce the frequency of clinical exacerbations; generally recommended for patients who have had inadequate response to, or are unable to tolerate, another disease modifying medication. NOTE: Patients taking interferon beta-1a (Avonex or Rebif) or interferon beta-1b (Betaseron or Extavia) medications may develop immunity to the treatment demonstrated by the presence of neutralizing antibodies detected in their blood. Some neurologists believe that this is an important factor in managing patients receiving interferon. Side Effects (always inform your health care professional of side effects) Avonex Flu-like symptoms following injection, which lessen over time for many. (See Managing side effects on page 8.) Less common: depression, mild anemia, liver abnormalities, allergic reactions, heart problems. (See Avonex Warnings on page 9.) 5 The MS Disease-Modifying Medications General Information 6
14 Betaseron Flu-like symptoms following injection, which lessen over time for many. (See Managing side effects below.) Injection site reactions, about 5% of which need medical attention. Less common: allergic reactions, depression, liver abnormalities, low white blood cell counts. (See Betaseron Warnings on page 10.) Copaxone Injection site reactions. Less common: vasodilation (dilation of blood vessels); chest pain; a reaction immediately after injection, which includes anxiety, chest pain, palpitations, shortness of breath, and flushing. This lasts minutes, typically passes without treatment, and has no known long-term effects. (See Copaxone Warnings on page 10.) Extavia Flu-like symptoms following injection, which lessen over time for many. (See Managing side effects below.) Injection site reactions, about 5% of which need medical attention. Less common: allergic reactions, depression, liver abnormalities, low white blood cell counts. (See Extavia Warnings on page 11.) Gilenya Headache, flu, diarrhea, back pain, liver enzyme elevations and cough. Less common: slowed heart rate following first dose, infections, swelling in the eye. (See Gilenya Warnings on page 11.) Rebif Flu-like symptoms following injection, which lessen over time for many. (See Managing side effects below.) Injection site reactions. Less common: liver abnormalities, depression, allergic reactions, and low red or white blood cell counts. (See Rebif Warnings on page 12.) Novantrone Blue-green urine 24 hours after administration; infections, bone marrow suppression (fatigue, bruising, low blood cell counts), nausea, hair thinning, bladder infections, mouth sores. Patients must be monitored for serious liver and heart damage. (See Novantrone Warnings on page 13.) Tysabri Headache, fatigue, urinary tract infections, depression, lower respiratory tract infections, joint pain, and chest discomfort. Less common: allergic or hypersensitivity reactions within two hours of infusion (dizziness, fever, rash, itching, nausea, flushing, low blood pressure, difficulty breathing, chest pain), liver abnormalities. Patients must be monitored for PML. (See Tysabri Warnings on page 13.) Managing side effects of disease-modifying medications Not everyone will experience every one of these side effects. Some adverse effects are common, and others are very infrequent but may be serious. Your health care provider can give you a better sense of how frequently problems occur with the specific agent he or she recommends for you. The industry-sponsored websites may also give you an idea of how frequently these effects occur. 7 The MS Disease-Modifying Medications General Information 8
15 The flu-like side effects of the interferon products Avonex, Betaseron, Extavia, and Rebif can usually be managed successfully. Discuss this with your physician or other health care provider, and the patient support program of the pharmaceutical company (available through a toll-free number see chart entitled Industry-Sponsored Sites on page 16). Should unacceptable side effects continue, discuss possible change to another medication with your health care professional. The medications that are injected subcutaneously including Betaseron, Copaxone, Extavia, and Rebif, may cause injection site reactions, including bumps, bruises, pain, and infections. Good injection techniques can minimize problems. Autoinjecting devices may be helpful. The pharmaceutical company patient support programs offer injection training and helpful tips for avoiding or limiting site reactions (see chart entitled Industry-Sponsored Sites on page 16). Avonex Warnings In response to events reported by patients and clinicians following approval of this medication, the FDA has added the following warnings about Avonex (interferon beta-1a): Individuals with a history of depression, a seizure disorder, or cardiac problems should be closely monitored while on this medication; All patients on this medication should have baseline liver function testing and periodic testing thereafter; Periodic blood testing is recommended to check for a possible reduction in infection-fighting blood cells, red blood cells, and cells that help blood to clots; Rare but significant allergic reactions have been reported to this medication. Betaseron Warnings In response to events reported by patients and clinicians following approval of this medication, the FDA has added the following warning Betaseron (interferon beta-1b): Individuals with a history of depression or a seizure disorder should be closely monitored while on this medication; This medication should be used with caution in people with depression; Rare but significant allergic reactions have been reported with this medication; Because skin infections or areas of severe skin damage can occur, injection sites should be rotated on a regular basis. Copaxone Warnings The FDA labeling for Copaxone (glatiramer acetate) contains the following warnings: Approximately 16% of people will experience an immediate post-injection reaction that includes at least two of the following: flushing, chest pain, palpitations, anxiety, shortness of breath, constriction of the throat, and transient skin eruptions. These symptoms generally disappear 9 The MS Disease-Modifying Medications General Information 10
16 spontaneously after about 15 minutes and have no long-term effects. This post-injection reaction generally occurs after the first few months of treatment and may occur more than once in a given individual. Transient chest pain without any long-term effects may also occur one or more times, either as part of the post-injection reaction or separately. Permanent depressions under the skin at injection sites can occur because of destruction of the fatty tissue. In addition, areas of severe skin damage can occur. For these reasons, careful rotation of injection sites is recommended so that no single area is injected more than one time per week. Extavia Warnings Because Extavia (interferon beta-1b) is identical to Betaseron (interferon beta-1b), the FDA labeling includes the same warnings. Gilenya warnings Gilenya (fingolimod) has the following warnings included in its FDA label: If a person has not had chicken pox (varicella), his or her doctor may recommend the varicella vaccine prior to starting this medication; Because Gilenya can cause a person s heart rate to drop after the first dose, patients will be monitored for six hours in the doctor s office after taking the first dose of medication; Because this medication reduces the number of white blood cells, leading to an increased risk of infection, a blood test to measure white blood cell count is recommended prior to starting treatment; A vision test is recommended prior to starting treatment and 2 3 months later to look for evidence of macular swelling in the eye; Because Gilenya can cause liver problems, a liver function test is recommended prior to starting treatment. Rebif Warnings In response to events reported by patients and clinicians following approval of this medication, the FDA has added the following warnings about Rebif (interferon beta-1a): Individuals with a history of depression or a seizure disorder should be closely monitored while on this medication; All patients on this medication should have baseline liver function testing and periodic testing thereafter; Periodic blood testing is recommended to check for a possible reduction in infectionfighting blood cells, red blood cells, and cells that help blood to clots; Rare but significant allergic reactions have been reported to this medication. 11 The MS Disease-Modifying Medications General Information 12
17 Novantrone Warnings Novantrone (mitoxantrone) is a chemotherapeutic treatment originally developed to treat certain forms of cancer. The total lifetime dose is limited in order to avoid possible heart damage. People taking Novantrone should have tests of their heart function before each dose. It cannot be used in people with pre-existing heart problems, liver disease, and certain blood disorders. In addition to cardiac toxicity, acute myelogenous leukemia (AML), a type of cancer, has been reported in MS patients and cancer patients treated with Novantrone. AML can be fatal. Tysabri Warnings Tysabri (natalizumab) is a laboratory-produced monoclonal antibody that is given by intravenous (IV) infusion every four weeks. Tysabri cannot be infused at home, so your doctor will help you find an infusion center that is convenient to your home. When talking with your health care professional about starting treatment with Tysabri, it is important to consider the following information: Individuals taking Tysabri are at increased risk for a rare, generally fatal brain disease called PML (progressive multifocal leukoencephalopathy), which is caused by the common JC virus. There are no interventions that are known to cure PML once it occurs, but a course of plasma exchange to remove Tysabri from the bloodstream as quickly as possible may provide benefit. Although the initial cases of PML that occurred in the clinical trials were in patients who were also taking another disease-modifying medication, many additional cases of PML in people who were not taking another disease-modifying medication at the same time have been reported in the postmarketing phase. The absolute risk for PML in patients treated with Tysabri cannot be precisely estimated. However, the medication s sponsor has released data suggesting that the risk increases with increasing time on therapy, starting out lower than the one-in-one thousand level that was estimated at the time of Tysabri s re-approval in 2006, and rising after two years of infusions to about one in one thousand. At this time, there is insufficient information to determine the risk of PML in those who have been on therapy for three years or more. Because of the risk of PML, Tysabri is only available under a restricted distribution program, referred to as the TOUCH program, which was created to monitor patients for PML and other adverse effects. Prescribing physicians and patients must enroll in this mandatory registry program. Infusion centers must also be enrolled in the TOUCH program. Patients using Tysabri should promptly report any continuously worsening symptoms to their prescriber. 13 The MS Disease-Modifying Medications For Children General and Information Teenagers 14
18 Based on post-marketing experience with Tysabri, the FDA added an additional warning to the product s labeling information in February, Tysabri has been found to increase the risk of liver damage, even after a single dose. Any person experiencing symptoms of liver injury, including yellowing of the skin and eyes (jaundice) unusual darkening of the urine, nausea, feeling tired or weak, and vomiting, should contact his or her physician immediately. Blood tests can be done to check for liver damage. Tysabri is not recommended for use by any person whose immune system is weakened by disease or by the use of medications that alter the immune system, including other disease-modifying therapies. Currently, nothing is known about the safety of long-term use of Tysabri or whether additional side effects will emerge in time. Warnings about IV infusions All medications delivered by IV infusion pose risks of bruising, vein damage, blood clots and more. Infusions must be managed by a well-trained medical professional who is qualified to administer them. Industry-Sponsored Sites for Patient Information and/or Financial Assistance Avonex MS Active Source avonex.com msactivesource.com Betaseron BETAPLUS betaseron.com Copaxone Shared Solutions copaxone.com sharedsolutions.com mswatch.com Extavia extavia.com Patient Support Program Gilenya gilenya.com Patient Support Program Novantrone novantrone.com The MS Disease-Modifying Medications General Information 16
19 Rebif MS LifeLines rebif.com mslifelines.com Tysabri biogenidec.com tysabri.com Benefits of the Disease- Modifying Medications Reducing the frequency of attacks and new lesions as seen on MRI All of these medications have been shown to reduce the frequency of MS relapses and the development of new lesions. In individual clinical trials comparing a drug versus an inactive placebo treatment, MS attacks were reduced by percent by different agents. In the clinical trials, most people were also found to have fewer, smaller, or no new lesions developing within their central nervous system as visible in MRI scans. Preventing permanent damage Permanent damage to nerve fibers (called axons) occurs early in MS in association with the destruction of myelin. Overall brain shrinkage (or atrophy), can occur early in the disease, and damage can be ongoing even when the person has no symptoms of an attack and feels well. Therefore, MS specialists advise the early use of a medication that effectively limits lesion formation and brain atrophy, or shrinkage. In the opinion of the National MS Society s Clinical Advisory Board, limiting lesions may be a key to reducing future permanent disability for many people with MS. None of these medications is recommended for women who are pregnant or plan to become pregnant. Physicians should be consulted. Most women will be advised to avoid using these medications during pregnancy. The bottom line Many factors will influence the decision that you and your physician make about your choice of medication. One of them will be lifestyle issues that could affect your ability to stay with a treatment over time. Another factor is your response to the therapy, which should be carefully tracked. If your MS is not responding, you and your physician should discuss your options. 17 The MS Disease-Modifying Medications General Information 18
20 Paying for a Disease- Modifying Medication: Some Help is Available Disease-modifying medications are costly. The actual cost to an individual or an insurance company will vary depending on the source. Because cost information is subject to frequent change, we recommend that you contact your healthcare plan and/or your pharmacy for cost information. Some private insurance plans do not cover prescription medications, although they may cover procedures such as IV infusions in a medical facility. Plans that do cover prescription medications often have a list of the specific drugs covered by the plan (known as a formulary). It is possible that some disease-modifying medications are covered by a plan and some are not. In addition, many formularies now distinguish between preferred and non-preferred drugs, or put drugs on different tiers. The co-insurance amounts you may have to pay as a result can vary significantly. Because Novantrone and Tysabri must be infused in a medical facility, they are covered under Medicare Part B. If Avonex is administered in a physician s office or clinic, it will be covered by Medicare Part B under most circumstances. For more detailed information, contact MS Active Source ( ). Medicare Part D covers prescription drugs through private plans approved by Medicare. For more information on Medicare prescription drug coverage, go to: nationalmssociety.org/ medicare, or call Medicaid includes prescription drug coverage. However, the list of specific medications covered may vary from state to state. Call your state Medicaid office for more information. Each of the pharmaceutical companies offers a program designed to help people apply for and use all the state and federal programs for which they are eligible. They also help some people who are uninsured or under-insured through patient assistance programs. The companies invite physicians and people with MS who might be deterred by the cost from considering a disease-modifier to call the toll-free numbers listed in the chart entitled Industry-Sponsored Sites. Ask for information on available assistance. For additional information on specific industry assistance, visit: nationalmssociety.org/assistanceprograms. 19 The MS Disease-Modifying Medications General Information 20
21 Help with the Cost of Medications for Symptom Management In addition to the disease-modifying medications discussed above, there are many other medications, treatments, and strategies to help manage specific MS symptoms such as bowel and bladder function, spasticity and pain. Symptom management medications make important contributions to keeping people with MS well and active. Finding Lower-Priced Prescription Drugs is a useful resource focused on making medications more affordable. Visit our website at nationalmssociety.org/insurance for more information. Avonex is a registered trademark of Biogen Idec. Betaplus is a registered trademark of Bayer Schering Pharma. Betaseron is a registered trademark of Bayer Schering Pharma Aktiengesellschaft. Copaxone is a registered trademark of Teva Pharmaceutical Industries Ltd. Extavia is a registered trademark of Novartis AG. Novantrone is a registered trademark of Immunex Corp. MS Active Source is a registered trademark Biogen, IDEC MA Inc. MS Lifelines is a trademark of Ares Trading S.A. Rebif is a registered trademark of Ares Trading, S.A. Shared Solutions is a registered trademark of Teva Neuroscience, Inc. Corporation. Tysabri is a registered trademark of Elan Pharmaceuticals, Inc. TOUCH is a trademark of Biogen Idec and Elan. For detailed information on patient assistance programs from drug manufacturers, visit needymeds.org. 21 The MS Disease-Modifying Medications General Information 22
22 MS stops people from moving. We exist to make sure it doesn t. Join the Movement nationalmssociety.org For Information: FIGHT MS ( ) 23 The MS Disease-Modifying Medications 2010 National MS Society. All rights reserved. ER /10
23 What is Multiple Sclerosis? Gener al information Kim, diagnosed in 1986
24 What is MS? Multiple sclerosis (or MS) is a chronic, often disabling disease that attacks the central nervous system (brain and spinal cord). Symptoms may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision. The progress, severity, and specific symptoms of MS vary among individuals and are unpredictable. Today, new treatments and advances in research are giving new hope to people who are affected by the disease. MS is thought to be an autoimmune disease. The body s own defense system attacks myelin, the fatty substance that surrounds and protects the nerve fibers of the brain, optic nerves, and spinal cord (the central nervous system). Beverly, diagnosed in 2001
25 The damaged myelin forms scar tissue (sclerosis). Often the nerve fiber is also damaged. When any part of the myelin sheath or nerve fiber is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted. MS is not a fatal disease. Most individuals with MS have near-normal life expectancies, and most learn to cope with the disease and are able to live productive lives. What are its symptoms? The symptoms of MS may include tingling, numbness, painful sensations, slurred speech, and blurred or double vision. Some people experience muscle weakness, poor balance, poor coordination, muscle tightness or spasticity, tremors, or paralysis, which may be temporary or permanent. Problems with bladder, bowel, or sexual function are common. Fatigue is a major concern for many. MS can cause forgetfulness or difficulty concentrating. It can also cause mood changes and may make people more susceptible to depression. Symptoms may come and go, appear in any combination, and be mild, moderate, or severe.
26 Can MS be treated? Yes. Today, there are eight disease-modifying medications approved by the Food and Drug Administration (FDA) to treat MS. Five of them Avonex, Betaseron, Copaxone, Extavia, and Rebif are given by injection, and have been shown to be effective in reducing disease activity in relapsing forms of MS. Gilenya the first oral diseasemodifying medication approved to treat relapsing forms of MS has also been shown to be effective in reducing disease activity. These six medications are considered to be first-line options for people with MS, meaning that the FDA does not recommend or require that a person try another medication before taking them. The National MS Society recommends that treatment with one of these disease modifiers be considered as soon as possible following a confirmed diagnosis of MS with a relapsing course. Treatment with a disease-modifying therapy may be recommended even before an individual is definitely diagnosed, if the person experienced one attack (also called a relapse or exacerbation) and has evidence of MS lesions as seen by MRI scanning.
27 Tysabri, another disease-modifying medication, is delivered by infusion. It is recommended for patients who have an inadequate response to, or are unable to tolerate, other MS therapies. Novantrone is a powerful immune system suppressor shown to be effective in slowing down MS that is rapidly worsening or becoming progressive. Novantrone is delivered by infusion. Steroids may be used to shorten acute attacks. Many other medications and combinations, including oral therapies, are in various stages of clinical trials or are under review by the FDA, and researchers are hopeful that more treatments for MS will be available in the near future. Please check nationalmssociety.org for updates. There are also many medications to relieve or moderate MS symptoms such as spasticity, bowel and urinary distress, pain, fatigue, or depression, including one MS-specific symptom management medication (Ampyra ) recently approved by the FDA to improve walking. Physical therapy, exercise, vocational and cognitive rehabilitation, attention to diet, adequate rest, and counseling are also valuable for managing symptoms and maintaining independence and quality of life. Prompt management of symptoms is vital and should be discussed with a knowledgeable physician.
28 AJ, diagnosed in 2000 Who gets MS? An estimated 400,000 Americans have MS. Most are diagnosed between the ages of 20 and 50, and about two thirds are women. The disease is more frequently found among people raised in colder climates. Studies indicate that genetic factors make certain individuals susceptible to the disease, but there is no evidence that MS is directly inherited. What happens in MS? MS is an unpredictable disease. Symptoms vary greatly from person to person and vary over time in the same person.
29 Periods of active MS symptoms are called attacks, exacerbations, or relapses. These can be followed by quiet periods called remissions. The disease ranges from very mild and intermittent to steadily progressive. Some people have few attacks and little, if any, accumulation of disability over time. At diagnosis, most people have relapsingremitting disease. This means they have attacks followed by periods of partial or total remission that may last months or even years. Others experience a progressive disease course with steadily worsening symptoms. The disease may worsen steadily from the onset (primary-progressive MS) or may become progressive after a relapsingremitting course (secondary-progressive MS). Because MS affects individuals so differently, it is difficult to make generalizations about disability. Statistics suggest that 2 out of 3 people with MS remain able to walk over their lifetime, though many of them will need a cane or other assistive device. Some will choose to use a scooter or wheelchair to conserve energy or manage balance problems. Others will require a wheelchair to maintain mobility. The disease-modifying treatments, which have been in use only since the 1990s, may favorably alter this projection.
30 Is MS easily diagnosed? MS is not always easy to diagnose because symptoms may come and go. In addition, other diseases of the central nervous system have some of the same symptoms. No single neurological or laboratory test can confirm or rule out MS. Medical imaging, particularly MRI (magnetic resonance imaging), helps to clarify the diagnosis. A conclusive or definitive diagnosis requires evidence of multiple patches of scar tissue in different parts of the central nervous system and evidence of at least two separate attacks of the disease. A definitive diagnosis can take several months. Sometimes it takes years. Do we know the cause of MS? The answer is no not yet. The cause of MS and how we can stop progression, restore function, and ultimately prevent it, are the subjects of intensive worldwide research. Over 325 research grants and fellowships are funded by the National MS Society each year. Knowledge about MS is expanding and many clinical trials are in progress. For information: nationalmssociety.org 2011 National MS Society. All rights reserved. BR /11
31 Join the Movement The National MS Society Information, local referrals, publications, programs, and volunteer opportunities are available from the National Multiple Sclerosis Society and our 50-state network of chapters. To reach the chapter nearest you, call or visit nationalmssociety.org. The Society helps bring together the MS movement, comprised of people who want to do something about MS now, including people with MS, their family members, concerned friends, neighbors, health care professionals, volunteers and staff. As the world s largest private funder of MS research, the Society supports local, state, and national advocacy programs. Ampyra is a trademark of Acorda Therapeutics, Inc. Avonex is a registered trademark of Biogen Idec. Betaseron is a registered trademark of Bayer Schering Pharma Aktiengesellschaft. Copaxone is a registered trademark of Teva Pharmaceutical Industries Ltd. Extavia is a registered trademark of Novartis AG Corporation. Gilenya is a trademark of Novartis AG Corporation. Novantrone is a registered trademark of Immunex Corp. Rebif is a registered trademark of Ares Trading S.A. Tysabri is a registered trademark of Elan Pharmaceuticals, Inc.
32 DHODA o YES! I want to join the movement to end MS. Please use my gift to push MS research, advocacy, educational initiatives and chapter programs further than ever before. Enclosed is a gift of: o $25 o $30 o $50 o $100 o $500 o Other Amount of gift $ Credit Card: o MC o Visa o AMEX o Discover Credit Card #: Expiration Date: Cardholder s Name (please print): Cardholder s Signature (required): I am: o A person living with MS o Family member o Healthcare professional o Other Clip and mail to your chapter of the National MS Society or to: National MS Society, Donor Services Center, P.O. Box 4444, Pittsfield, MA Name Address City State Zip o In an effort to keep costs down, the Society exchanges our donor list with other groups. Please check here if you do not want to be included. o I would like to receive Momentum magazine as a benefit of my gift of $30 or more.
What is Multiple Sclerosis? Gener al information Kim, diagnosed in 1986 What is MS? Multiple sclerosis (or MS) is a chronic, often disabling disease that attacks the central nervous system (brain and spinal
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How to S.E.A.R.C.H. SM for the Right MS Therapy For You! The Changing Landscape The first treatment for relapsing-remitting multiple sclerosis (RRMS) was approved by the United States Food and Drug Administration
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
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
CNS DEMYLINATING DISORDERS Multiple sclerosis A Dutch saint named Lidwina, who died in 1433, may have been one of the first known MS patients. After she fell while ice skating, she developed symptoms such
1 MSology Essentials Series Gilenya (fingolimod) Developed by MSology with the invaluable assistance of multiple sclerosis nurse advisors: Trudy Campbell Dalhousie MS Research Unit, Capital Health, Halifax,
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
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
Mellen Center Currently Enrolling Non-Treatment Trials STRATIFY-2 JCV Antibody Program in Patients with Relapsing Multiple Sclerosis Receiving or Considering Treatment with Tysabri Primary Investigator:
News Release Intended for U.S. Media Only Bayer Receives FDA Approval for BETACONNECT First and Only Electronic Autoinjector in Relapsing-Remitting Multiple Sclerosis (RRMS) Treatment Whippany, N.J., September
FOR MS RELAPSES Stepping toward a different treatment option LEARN WHAT ACTHAR CAN DO FOR YOU As a person with multiple sclerosis (MS), you know firsthand the profound impact MS relapses can have on your
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
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
Disease modifying drug therapy what you need to know Third Edition Karen Alldus Simon Webster SECTION 2 We hope you find the information in this book helpful. If you would like to speak with someone about
T H E F A C T S A B O U T The rising cost of prescription drugs to treat multiple sclerosis in upstate New York Per-person mean annual prescription drug cost to treat multiple sclerosis Annual drug cost
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.
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
What is Multiple Sclerosis? Multiple Sclerosis (MS) is a disease of the central nervous system (including the brain and spinal cord) in which the nerves degenerate. A disease of the central nervous system
St. Luke s MS Center New Patient Questionnaire Name: Date: Birth date: Right or Left handed? Who is your Primary Doctor? Who referred you to the MS Center? List any other doctors you see: Reason you have
Understanding Multiple Sclerosis Tim, diagnosed in 2004. What Is Multiple Sclerosis? Multiple sclerosis (MS) is a neurologic disorder that affects the central nervous system (CNS). The CNS includes the
1 MSology Essentials Series Aubagio TM (teriflunomide) Developed by MSology with the invaluable assistance of multiple sclerosis nurse advisors: Bonnie Blain Central Alberta MS Clinic, Red Deer, Alberta
English 182 READING PRACTICE by Alyx Meltzer, Spring 2009 Vocabulary Preview (see bolded, underlined words) gait: (n) a particular way of walking transient: (adj) temporary; synonym = transitory remission:
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
IF YOU ARE RECEIVING (NATALIZUMAB) TREATMENT WITH TYSABRI FOR RELAPSING-REMITTING MS Read the patient information leaflet that accompanies the medicine carefully. 1 This brochure is a supplement to the
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
1 It is the National MS Society s mission to mobilize people and resources to drive research for a cure and to address the challenges of everyone affected by MS. The National MS Society, Greater Northwest
Disease modifying drug therapy New edition for 2014-15 We hope you find the information in this book helpful. If you would like to speak with someone about any aspect of MS, contact the MS Trust information
Teriflunomide (Aubagio) 14mg once daily tablet Exceptional healthcare, personally delivered Your Consultant Neurologist has suggested that you may benefit from treatment with Teriflunomide. The decision
i InfoNEURO Montreal Neurological Hospital INFORMATION FOR PATIENTS Mitoxantrone For multiple sclerosis Centre universitaire de santé McGill McGill University Health Centre Collaborators: D. Lowden Clinical
1 2 3 If you ve been diagnosed with a relapsing form of multiple sclerosis (MS), or you are looking to learn about a treatment option, this guide outlines the key facts to remember about EXTAVIA (interferon
Multiple Sclerosis Multiple Sclerosis (MS) is a disease of the central nervous system (brain and spinal cord) that affects approximately 400,000 men and women in the prime of their lives. In its most serious
Eastern Health MS Service Tysabri Therapy Information for People with MS and their Families The Eastern Health MS Service has developed this information for you as a guide through what will happen to you
Treatments for MS: Immunotherapy There are currently several disease-modifying therapies approved for people with MS in Australia. These therapies, called immunotherapies, work to reduce disease activity
MEDICATION GUIDE mitoxantrone (mito-xan-trone) for injection concentrate Read this Medication Guide before you start receiving mitoxantrone and each time you receive mitoxantrone. There may be new information.
Managing the Symptoms of Multiple Sclerosis Yolanda Harris, MSN, CRNP-AC CPODD Nurse Practitioner What is Multiple Sclerosis An autoimmune disease that affects the central nervous system (CNS) The immune
0 A Letter From the MS Coalition The treatment of multiple sclerosis (MS) requires a comprehensive management strategy. One important component of that strategy is modifying the disease course. When deciding
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
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
MayoClinic.com reprints This single copy is for your personal, noncommercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, use the reprints
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
Disease modifying drug therapy what you need to know Contact information Neurologist s name: Neurologist s secretary: Telephone number: MS specialist nurse: Telephone number: Manufacturer helpline number:
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
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
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.,
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
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
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
Understandi your multipl sclerosis medications URAC All Walgreens specialty pharmacy locations are ACHC and URAC accredited. Table of contents Multiple sclerosis medications: an overview...1 Staying on
May 25, 2015 Contact: Shikha Virdi 905-919-0200 ext. 5504 Ontario Reimburses CIS Indication for REBIF, a First-Line Treatment for Multiple Sclerosis Rebif now reimbursed under Ontario Drug Benefit Program
MULTIPLE SCLEROSIS Mary Beth Rensberger, RN, BSN, MPH Author All rights reserved. Purchasers of this module are permitted to reproduce the forms contained herein for their individual internal use only.
Gilenya Exceptional healthcare, personally delivered Your Consultant Neurologist has suggested that you may benefit from treatment with Gilenya. The decision to start this form of treatment can be difficult.
Complementary and alternative medicine (CAM) CAM therapies can generally be divided into the following categories: Biologically based therapies (eg, dietary supplements, diets, bee venom therapy, hyperbaric
Erin-Marie Beals Phone 1-781-681-2850 September 9, 2014 EMD Serono Presents New Data on Rebif (Interferon beta-1a) and Multiple Sclerosis Pipeline at Joint ACTRIMS-ECTRIMS Meeting in Boston Data include
April 2013 Experts at your fingertips call now CBT IN THE CITY Check out our new services in you local area contents. A message from Susie, Information Multiple Sclerosis CBT can make a difference on the
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
Global Multiple Sclerosis Market: Trends and Opportunities (2013-18) Scope of the Report The report titled Global Multiple Sclerosis Market: Trends & Opportunities (2013-18) provides an insight into the
Multiple Sclerosis & MS Ireland Media Fact Sheet This fact sheets gives a summary of the main facts and issues relating to Multiple Sclerosis and gives an overview of the services offered by MS Ireland.
Multiple Sclerosis Treatment Experience Questionnaire (MSTEQ) Name: Today s date (mm/dd/yy): It is important that you take your as prescribed by your physician. However, from to you may find it difficult
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
September 10, 2014 Contact: Shikha Virdi 905-919-0200 ext. 5504 EMD Serono Presents New Data on Rebif (Interferon beta-1a) and Multiple Sclerosis Pipeline at Joint ACTRIMS-ECTRIMS Meeting in Boston Data
SOUTH TAMPA MULTIPLE SCLEROSIS CENTER PATIENT/CARE GIVER QUESTIONNAIRE DEMOGRAPHIC INFORMATION Patient's Name: City: State: Zip Code: Phone: Marital Status: Spouse/Care Giver Name: Phone (H) (W) Occupation:
Brochure More information from http://www.researchandmarkets.com/reports/1841621/ Product Profiles: Multiple Sclerosis - Gilenya Raises Bar for New Market Entrants Description: Introduction Beginning with
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
Treating Chronic Hepatitis C A Review of the Research for Adults Is This Information Right for Me? Yes, this information is right for you if: Your doctor* has told you that you have chronic hepatitis C.
Appendix 2 Questions included in patients questionnaire 1. What type of treatment do you use for your MS? a. Avonex b. Betaferon c. Copaxone d. Rebif 22 mcg e. Rebif 44 mcg 2. How is your medication delivered
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
ORAL MEDICATIONS FOR MS! Gilenya and Aubagio Champions against MS 4/20/13 Alexandra Goodyear, MD Stanford University Oral Medications Since 2010, 3 new oral medications for MS: Gilenya 2010 Aubagio 2012
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
Battles 1 Becky Battles Instructor s Name English 1013 21 November 2006 Muscular Dystrophy and Multiple Sclerosis Although muscular dystrophy and multiple sclerosis are both progressive diseases that ultimately
ISSUE DATE May 11, 2015 SUBJECT EFFECTIVE DATE May 18, 2015 MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Multiple Sclerosis Agents Pharmacy Service Leesa M. Allen, Deputy Secretary
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