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

Size: px
Start display at page:

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

Transcription

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

2 AIMS OF SESSION Relapsing/Remitting MS Definition of relapse/relapse rate Relapse Management NICE Guidelines Regional Clinical Guidelines

3 RRMS 80 85% of new cases will present with RRMS 40 75% RRMS will go on to develop SPMS Most widely recognised type of MS RRMS varies greatly in severity in individuals Frequent relapses at the onset of disease are associated with poorer prognosis (Weinshenker 1995)

4 Clinical course of RRMS Variable, intermittent disease course Attacks or exacerbation of symptoms (relapses) Followed by full or partial recovery (remission) Disability accumulation due to incomplete recovery from relapses

5 Relapse Episode of acute or sub acute neurological symptoms of variable severity Rapid appearance of new symptoms or reappearance of old over 1 2 weeks Relapse symptoms last more than 24 hours in the context of normal body temperature Typically 2 6 weeks May persist for 6 months or longer Annual relapse rate initially averages (Barnes 2000) gradually falling as the years progress

6 Remission Can last any length of time Spontaneous recovery generally within 8 12 weeks Degree of recovery unpredictable and variable May be complete (early in disease) or incomplete with residual disability

7 Relapse trigger factors? Stress Stress includes emotional stress, trauma, and medical interventions NICE recommend that if a person with MS needs surgery for any reason then the surgery should go ahead Injury / trauma Studies indicate that relapse is no more likely to happen (Thompson 2002)

8 Relapse trigger factors? Hormonal changes following child birth No evidence that pregnancy itself influences the overall course of MS over time Risk of relapse decreases during pregnancy, in the third trimester relapse is reduced by 60% (Thompson 2002) with same increase in relapse 3 months postpartum Vaccinations A number of studies are inconclusive but Flu vaccine is now confirmed safe (NICE 2003)

9

10 Confirmation of new relapse Establish: presence of new symptoms re occurrence of old symptoms for longer than 24hours Exclude pseudo exacerbating factors: Infection test urine menstrual cycle stress Confirm a period of 30 days from end of any previous relapse

11 Should You Treat if UTI Suspected? Steroids usually delayed if UTI suspected in local service UCL study Study of 249 relapsing MS patients If dipstick +ve abx started at same time as MP If culture neg then abx stopped Results UTI in 11% 67 patients commenced on abx with negative culture 7 patients negative dipstick but positive culture

12 Should You Treat if UTI Suspected?

13 Treatment of relapses Assessment Take history Confirm relapse Determine severity, functional disability / loss Exclude infection Medication Supportive therapy Physiotherapy; occupational therapy; counselling Care package Hospital admission for severe relapse

14 Relapse Management Decision Aids NICE Guidelines / Scottish Guidelines / Cochrane Review / EFNS Guidelines/Local Guidelines m

15 Relapse management NICE Recommendations: Any individual who experiences an acute episode sufficient to cause distressing symptoms or an increased limitation on activities should be offered a course of high dose corticosteroids intravenous methylprednisolone 500mg 1g for 3 to 5 days high dose methylprednisolone 500mg 2g daily for 3 to 5 days An individual should be given a clear explanation of the risks and benefits involved in taking corticosteroids Prolonged and frequent courses should not be used NICE MS Guidelines National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care

16 Steroids for relapses Anti inflammatory effect Suppress immune system Stabilise blood brain barrier Thought to speed recovery BUT do not influence degree of recovery or long term progression of disease Side effects minor but include weight gain, acne, cataracts, osteoporosis and diabetes The NICE Guideline recommends courses of steroids be limited to a maximum of three times a year NICE MS Guidelines National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care

17 Anti inflammatory effect Reduce inflammatory responses by inducing several effects on the immune system Inhibit lymphocyte proliferation and cell mediated immune response Decrease circulating T helper cells, eosinophils & monocytes Down regulate cytokine gene expression Suppress synthesis of prostaglandins & leukotrienes Block activation of T cells by IL 1 Inhibit expression of class II histocompatibility antigens on macrophage surface

18 Corticosteroids side effects Common : Oedema Raised glucose GI symptoms Metallic taste Anxiety / depression Reddening of face Altered sleep Usually well tolerated. Most SE transient Less common Infection HT Avascular necrosis Pancreatitis Herpes simplex Zoster Seizures Weight gain Anaphylaxis

19 Compared 1g MP iv with 1250mg prednisone orally (oral MP not available in Canada) No difference in bioavailability between steroids administered either iv or orally (approx 80%) Oral treatment is preferred by most patients, is cheaper, more convenient and has equivalent gastric safety profile

20

21 Forty patients with MS randomized to receive either 1 g/day for 5 days of omp (20 patients) or 1 g/day for 5 days of IV MP (20 patients) Expanded Disability Status Scale (EDSS) and brain MRI (dual echo and postcontrast T1 weighted scans) were assessed at baseline and at weeks 1 and 4 The 2 groups showed a reduction of Gd enhancing lesions over time with a non inferiority effect between the 2 routes of administration at week 1. Both groups showed an improvement of EDSS over time (p 0.001) without between group difference at week 4. Both treatments were well tolerated and adverse events were minimal and occurred similarly in the 2 treatment arms.

22 MS Relapse Guidelines NICE Guidelines (2003)

23 Innovation Regional MS relapse guidelines developed (2005) provide clear step by step guidance for treatment with oral steroids in a form that can be faxed to GP / pharmacy Avoids need to admit patients to hospital for intravenous steroids in the majority of cases PwMS receive treatment earlier and significant cost savings

24

25 Current Guidelines Treat only if relapse is distressing relapses or limiting activities Check for UTI (Multistix for protein / nitrites) and delay treatment if present Patient Information Sheet Oral Prednisolone 500mg x 5/7 od (taken in the morning with food) PPI if PUD / gastritis or concurrent aspirin / warfarin Follow up after 6 weeks Ennis M et al. BJNN 2008;4(6):

26

27 Published December 2005 Short term, high dose methylprednisolone treatment should be considered for the treatment of relapses of MS (level A recommendation) Intravenous or oral methylprednisolone in a dose of at least 500 mg daily for 5 days should be considered for treatment of relapses (level A recommendation). Treatment with IV methylprednisolone (1 g once daily for 3 days) should be considered as an alternative treatment (good practice point; Multiple Sclerosis Therapy Consensus Group, 2004) There is no evidence of major differences in the efficacy of methylprednisolone treatment given IV or orally in terms of clinical efficacy or side effects, but prolonged, oral treatment may possibly be associated with a higher prevalence of side effects

28 EFNS MS Relapse Guidelines Treatment Failure In patients who fail to respond to treatment with MP in the dose ranges used in placebo controlled trials higher doses should be considered (up to 2g / day for 5 days) (level C recommendation) [Multiple Sclerosis Therapy Consensus Group. J Neurol 2005;251: ] If patients do not respond to MP, one third may respond to PLEx Intense, interdisciplinary rehabilitation programme should be considered after treatment with MP No evidence to support ivig or Natalizumab

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

Intravenous Methyl Prednisolone in Multiple Sclerosis

Intravenous Methyl Prednisolone in Multiple Sclerosis Intravenous Methyl Prednisolone in Multiple Sclerosis Exceptional healthcare, personally delivered Relapse management in multiple sclerosis Relapses in multiple sclerosis (MS) are common and caused by

More information

Steroids. What are steroids?

Steroids. What are steroids? Steroids What are steroids? Also known as corticosteroids and glucocorticoids, steroids are hormones that are normally produced by the adrenal glands. They are mainly used in multiple sclerosis (MS) because

More information

NHS FORTH VALLEY Multiple Sclerosis Service Management of MS Relapses

NHS FORTH VALLEY Multiple Sclerosis Service Management of MS Relapses NHS FORTH VALLEY Multiple Sclerosis Service Management of MS Relapses Approved 22/06/2010 Version Version 2 Date of First Issue 2002 Review Date 10/05/2016 Date of Issue 01/02/2010 EQIA Yes 22.06.10 Author

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

Original Policy Date

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

More information

Relapsing-remitting multiple sclerosis Ambulatory with or without aid

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

More information

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

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

Use of oral steroids in Multiple Sclerosis

Use of oral steroids in Multiple Sclerosis Use of oral steroids in Multiple Sclerosis Information for patients and carers Neurology Department Aberdeen Royal Infirmary What are steroids? The steroids used to treat Multiple Sclerosis (MS) relapses

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

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

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

More information

Disease Modifying Therapies for MS

Disease Modifying Therapies for MS Disease Modifying Therapies for MS The term disease-modifying therapy means a drug that can modify or change the course of a disease. In other words a DMT should be able to reduce the number of attacks

More information

Patient Sticker Multiple Sclerosis Ambulatory Emergency Care Pathway

Patient Sticker Multiple Sclerosis Ambulatory Emergency Care Pathway Multiple Sclerosis Ambulatory Emergency Care Pathway 1 Consultant: Dr M Oldfield Consultant: Dr D Harris Lead Nurse: Catie Paterson Ambulatory Emergency Care (AEC) Unit Patient From ED (Emergency Department)

More information

NHS BOURNEMOUTH AND POOLE AND NHS DORSET

NHS BOURNEMOUTH AND POOLE AND NHS DORSET NHS BOURNEMOUTH AND POOLE AND NHS DORSET COMMISSIONING STATEMENT ON THE USE OF BETA-INTERFERON IN RELAPSING-REMITTING MULTIPLE SCLEROSIS OR SECONDARY PROGRESSIVE MULTIPLE SCLEROSIS, WHERE RELAPSES ARE

More information

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

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

More information

Disease Modifying Therapies for MS

Disease Modifying Therapies for MS Disease Modifying Therapies for MS The term disease-modifying therapy (DMT) means a drug that can modify or change the course of a disease. In other words a DMT should be able to reduce the number of attacks

More information

Nucala. (mepolizumab) New Product Slideshow

Nucala. (mepolizumab) New Product Slideshow Nucala (mepolizumab) New Product Slideshow Introduction Brand name: Nucala Generic name: Mepolizumab Pharmacological class: Interleukin-5 antagonist Strength and Formulation: 100mg per vial; lyophilized

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

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

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

Teriflunomide (Aubagio) 14mg once daily tablet

Teriflunomide (Aubagio) 14mg once daily tablet 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

More information

Stepping toward a different treatment option LEARN WHAT ACTHAR CAN DO FOR YOU

Stepping toward a different treatment option LEARN WHAT ACTHAR CAN DO FOR YOU 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

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

Coping with Symptoms of Multiple Sclerosis

Coping with Symptoms of Multiple Sclerosis Coping with Symptoms of Multiple Sclerosis Josée Poirier B. Sc. Nursing, MSCN Outline What Is a Pseudo exacerbation? Awareness Advancement of Treatments Treatment of Symptoms Uhthoff s Phenomenon What

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

Understanding Relapse in Multiple Sclerosis. A guide for people with MS and their families

Understanding Relapse in Multiple Sclerosis. A guide for people with MS and their families Understanding Relapse in Multiple Sclerosis A guide for people with MS and their families Introduction You have been given this booklet because you have been diagnosed with Multiple Sclerosis (MS) and

More information

An introduction to modern MS treatments

An introduction to modern MS treatments BETAFERON is a Prescription Medicine. Use strictly as directed. Consult your pharmacist or other health professional in case of side effects. BETAFERON is reimbursed for some patients. See your neurologist

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

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

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

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

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

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

More information

Understanding Relapse in Multiple Sclerosis

Understanding Relapse in Multiple Sclerosis Understanding Relapse in Multiple Sclerosis A guide for people with MS and their families Introduction Relapses are very common in MS and largely unpredictable in terms of how often they occur, how severe

More information

A Definition of Multiple Sclerosis

A Definition of Multiple Sclerosis 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:

More information

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

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

More information

Betaferon (interferon beta 1b)

Betaferon (interferon beta 1b) Betaferon (interferon beta 1b) What is Betaferon? Betaferon (interferon beta-1b) is a type of medicine known as an interferon, which is used to treat MS. Interferons are proteins found naturally in the

More information

Relapsing remitting MS

Relapsing remitting MS An introduction to Relapsing remitting MS What does it mean when you are diagnosed with relapsing remitting MS? There are three main types of MS: relapsing remitting MS, primary progressive MS and secondary

More information

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

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

More information

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

Drug Class Review. Disease-modifying Drugs for Multiple Sclerosis. Single Drug Addendum: Fingolimod

Drug Class Review. Disease-modifying Drugs for Multiple Sclerosis. Single Drug Addendum: Fingolimod Drug Class Review Disease-modifying Drugs for Multiple Sclerosis Single Drug Addendum: Fingolimod Final Original Report February 2011 The Agency for Healthcare Research and Quality has not yet seen or

More information

Nephrotic Syndrome (Childhood Nephrosis)

Nephrotic Syndrome (Childhood Nephrosis) Nephrotic Syndrome (Childhood Nephrosis) This handout has been written to help you learn about nephrotic syndrome and how to take care of your child at home. If you have any questions, please be sure to

More information

Gilenya. Exceptional healthcare, personally delivered

Gilenya. Exceptional healthcare, personally delivered 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.

More information

MS Treatments Aubagio TM

MS Treatments Aubagio TM 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

More information

June Guide to Important Safety Information. Using GILENYA In Patients with Relapsing Forms of Multiple Sclerosis

June Guide to Important Safety Information. Using GILENYA In Patients with Relapsing Forms of Multiple Sclerosis June 2013 Guide to Important Safety Information Using GILENYA In Patients with Relapsing Forms of Multiple Sclerosis R GILENYA (fingolimod) is a sphingosine 1-phosphate receptor (S1P) modulator indicated

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

Biologic Treatments for Rheumatoid Arthritis

Biologic Treatments for Rheumatoid Arthritis Biologic Treatments Rheumatoid Arthritis (also known as cytokine inhibitors, TNF inhibitors, IL 1 inhibitor, or Biologic Response Modifiers) Description Biologics are new class of drugs that have been

More information

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

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

More information

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

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

Treatment of diseases affecting the kidney using steroids

Treatment of diseases affecting the kidney using steroids Treatment of diseases affecting the kidney using steroids Hope Building Renal 0161 206 5223 All Rights Reserved 2015. Document for issue as handout. This information has been written by the medical and

More information

Subject: Tecfidera (dimethyl fumarate): new measures to minimise the risk of PML enhanced monitoring and stopping rules

Subject: Tecfidera (dimethyl fumarate): new measures to minimise the risk of PML enhanced monitoring and stopping rules Date: 25 th November 2015 Subject: Tecfidera (dimethyl fumarate): new measures to minimise the risk of PML enhanced monitoring and stopping rules Dear Healthcare Professional In agreement with the European

More information

Program Transcript Recorded: January 16, 2013. 1. Brief Overview of Multiple Sclerosis

Program Transcript Recorded: January 16, 2013. 1. Brief Overview of Multiple Sclerosis A Closer Look at The Importance of Treating and Managing MS Relapses featuring Stephen Krieger, MD Assistant Professor of Neurology The Corinne Goldsmith Dickinson Center for MS Mount Sinai Hospital, New

More information

Eastern Health MS Service. Tysabri Therapy. Information for People with MS and their Families

Eastern Health MS Service. Tysabri Therapy. Information for People with MS and their Families 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

More information

Immune Thrombocytopenia (ITP)

Immune Thrombocytopenia (ITP) Immune Thrombocytopenia (ITP) ITP - What is it? ITP is a blood disorder affecting platelets in the blood. Platelets are small cells in your blood that help your blood to clot. In ITP the body s immune

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

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

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

More information

Voting for your top research questions Survey

Voting for your top research questions Survey MS Priority Setting Partnership Voting for your top research questions Survey Prioritising important research questions for multiple sclerosis a partnership between people affected by MS and healthcare

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

MS Treatments Gilenya

MS Treatments Gilenya 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,

More information

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

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

More information

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

AUBMC Multiple Sclerosis Center

AUBMC Multiple Sclerosis Center AUBMC Multiple Sclerosis Center 1 AUBMC Multiple Sclerosis Center The vision of the American University of Beirut Medical Center (AUBMC) is to be the leading academic medical center in Lebanon and the

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

Blau's Disease / Juvenile Sarcoidosis

Blau's Disease / Juvenile Sarcoidosis www.printo.it/pediatric-rheumatology/ie/intro Blau's Disease / Juvenile Sarcoidosis Version of 2016 1. WHAT IS BLAU S DISEASE/JUVENILE SARCOIDOSIS 1.1 What is it? Blau syndrome is a genetic disease. Patients

More information

TITLE: Treatment of Patients with Multiple Sclerosis: A Review of Guidelines

TITLE: Treatment of Patients with Multiple Sclerosis: A Review of Guidelines TITLE: Treatment of Patients with Multiple Sclerosis: A Review of Guidelines DATE: 13 March 2013 CONTEXT AND POLICY ISSUES Multiple sclerosis (MS) is an unpredictable, often disabling disease of the central

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

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

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

More information

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

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

What is Multiple Sclerosis? Gener al information

What is Multiple Sclerosis? Gener al information 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

More information

Guide to Claims against General Practitioners (GPs)

Guide to Claims against General Practitioners (GPs) Patients often build up a relationship of trust with their GP over a number of years. It can be devastating when a GP fails in his or her duty to a patient. Our medical negligence solicitors understand

More information

Multiple sclerosis disease-modifying drugs second line treatments

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

More information

REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD

REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD What is Rehabilitation Medicine? Rehabilitation Medicine (RM) is the medical specialty with rehabilitation as its primary strategy. It provides services

More information

MS ECHO: Update on MS treatment. Gary Stobbe, MD Medical Director, MS Project ECHO Clinical Assistant Professor, UW Neurology 10 14 2015

MS ECHO: Update on MS treatment. Gary Stobbe, MD Medical Director, MS Project ECHO Clinical Assistant Professor, UW Neurology 10 14 2015 MS ECHO: Update on MS treatment Gary Stobbe, MD Medical Director, MS Project ECHO Clinical Assistant Professor, UW Neurology 10 14 2015 Conflict of Interest Dr. Stobbe has no conflicts of interest to disclose

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

Keeping track of your MS relapse symptoms. record your experience. share with your doctor.

Keeping track of your MS relapse symptoms. record your experience. share with your doctor. FROM RELAPSE TO RELIEF Keeping track of your MS relapse symptoms record your experience. share with your doctor. Tracking your MS relapse symptoms No matter what MS relapse treatment you re on or considering,

More information

INITIATING ORAL AUBAGIO (teriflunomide) THERAPY

INITIATING ORAL AUBAGIO (teriflunomide) THERAPY FOR YOUR PATIENTS WITH RELAPSING FORMS OF MS INITIATING ORAL AUBAGIO (teriflunomide) THERAPY WARNING: HEPATOTOXICITY AND RISK OF TERATOGENICITY Severe liver injury including fatal liver failure has been

More information

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

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

More information

Corticosteroid Therapy in Inflammatory Bowel Disease

Corticosteroid Therapy in Inflammatory Bowel Disease 2014 Corticosteroid Therapy in Inflammatory Bowel Disease Corticosteroid Therapy in Inflammatory Bowel Disease What are corticosteroids? Corticosteroids (kor-ti-koh-ster-oids) are strong inhibitors of

More information

MS an Mental Health. Alison Carolan MS Mental Health Nurse Kings College Hospital. IMPARTS December 2013

MS an Mental Health. Alison Carolan MS Mental Health Nurse Kings College Hospital. IMPARTS December 2013 MS an Mental Health Alison Carolan MS Mental Health Nurse Kings College Hospital IMPARTS December 2013 MS and Mental Health MS is an autoimmune disease MS carries high risk of common mental disorders and

More information

a five-day medically supervised residential detoxification programme

a five-day medically supervised residential detoxification programme Substance PICU and Acute Misuse and Services Detox Services Psychiatric Cygnet Hospital Intensive Harrogate Care and Acute services a five-day medically supervised residential detoxification programme

More information

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

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

More information

Mellen Center for Multiple Sclerosis

Mellen Center for Multiple Sclerosis Mellen Center Cleveland Clinic Marie Namey, RN, MSN, MSCN Mellen Center Cleveland Clinic Cleveland, OH Home of. Mellen Center for Multiple Sclerosis Mellen Center Mission The Mellen Center remains committed

More information

ANIMALS FORM & FUNCTION BODY DEFENSES NONSPECIFIC DEFENSES PHYSICAL BARRIERS PHAGOCYTES. Animals Form & Function Activity #4 page 1

ANIMALS FORM & FUNCTION BODY DEFENSES NONSPECIFIC DEFENSES PHYSICAL BARRIERS PHAGOCYTES. Animals Form & Function Activity #4 page 1 AP BIOLOGY ANIMALS FORM & FUNCTION ACTIVITY #4 NAME DATE HOUR BODY DEFENSES NONSPECIFIC DEFENSES PHYSICAL BARRIERS PHAGOCYTES Animals Form & Function Activity #4 page 1 INFLAMMATORY RESPONSE ANTIMICROBIAL

More information

A blood sample will be collected annually for up to 2 years for JCV antibody testing.

A blood sample will be collected annually for up to 2 years for JCV antibody testing. 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:

More information

Natalizumab and the Risk of PML

Natalizumab and the Risk of PML Natalizumab and the Risk of PML Gloria von Geldern, MD Multiple Sclerosis Center Assistant Professor of Neurology University of Washington May 13, 2015 Conflict of Interest Dr. von Geldern has nothing

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

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

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

ORAL MEDICATIONS FOR MS! Gilenya and Aubagio

ORAL MEDICATIONS FOR MS! Gilenya and Aubagio 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

More information

Managing the Symptoms of Multiple Sclerosis. Yolanda Harris, MSN, CRNP-AC CPODD Nurse Practitioner

Managing the Symptoms of Multiple Sclerosis. Yolanda Harris, MSN, CRNP-AC CPODD Nurse Practitioner 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

More information

Oral versus intravenous steroids for treatment of relapses in multiple sclerosis (Review)

Oral versus intravenous steroids for treatment of relapses in multiple sclerosis (Review) Oral versus intravenous steroids for treatment of relapses in multiple sclerosis (Review) Burton JM, O Connor PW, Hohol M, Beyene J This is a reprint of a Cochrane review, prepared and maintained by The

More information

Optic Neuritis. The optic nerve fibers are coated with myelin to help them conduct the electrical signals back to your brain.

Optic Neuritis. The optic nerve fibers are coated with myelin to help them conduct the electrical signals back to your brain. Optic Neuritis Your doctor thinks that you have had an episode of optic neuritis. This is the most common cause of sudden visual loss in a young patient. It is often associated with discomfort in or around

More information

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

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

More information

Performance Improvement Strategies in Multiple Sclerosis. Community of Practice Audioconference Recorded December 7, 2010

Performance Improvement Strategies in Multiple Sclerosis. Community of Practice Audioconference Recorded December 7, 2010 Performance Improvement Strategies in Multiple Sclerosis Community of Practice Audioconference Recorded December 7, 2010 Audioconference faculty: Bruce A. Cohen, MD Director, Multiple Sclerosis Program

More information

Wellness for People with MS: What do we know about Diet, Exercise and Mood And what do we still need to learn? March 2015

Wellness for People with MS: What do we know about Diet, Exercise and Mood And what do we still need to learn? March 2015 Wellness for People with MS: What do we know about Diet, Exercise and Mood And what do we still need to learn? March 2015 Introduction Wellness and the strategies needed to achieve it is a high priority

More information

AUBAGIO (teriflunomide) oral tablet

AUBAGIO (teriflunomide) oral tablet AUBAGIO (teriflunomide) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy

More information

About MS. An introduction to. An introduction to multiple sclerosis for people who have recently been diagnosed. What is MS? Is it common?

About MS. An introduction to. An introduction to multiple sclerosis for people who have recently been diagnosed. What is MS? Is it common? An introduction to multiple sclerosis for people who have recently been diagnosed When you have just been diagnosed with multiple sclerosis, you will probably have many questions about the condition and

More information

Victorian Nurse Practitioner Project Phase 4, Round 4.11 - Chronic Disease Management

Victorian Nurse Practitioner Project Phase 4, Round 4.11 - Chronic Disease Management Victorian Nurse Practitioner Project Phase 4, Round 4.11 - Chronic Disease Management Eastern Health Multiple Sclerosis Nurse Practitioner Service Model April 2014 Prepared by Jodi Haartsen and Deanna

More information