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Tuesday, November 21, 2017

Ocrelizumab More Cost-Effective Than Interferon

J Med Econ; 2017 Oct; Yang, Duchesneau, et al

November 21, 2017

Ocrelizumab is more cost-effective than subcutaneous (SC) interferon beta-1a for the treatment of relapsing multiple sclerosis (RMS), a recent study found. A Markov cohort model with a 20-year horizon was developed to compare ocrelizumab with SC interferon beta-1a from a US payer perspective. A cohort of patients with relapsing-remitting MS (RRMS) and Expanded Disability Status Scale (EDSS) scores of 0–6, who initiated treatment with ocrelizumab or SC interferon beta-1a, were included. The model considered 21 health states: EDSS 0–9 in RRMS, EDSS 0–9 in secondary-progressive multiple sclerosis (SPMS), and death. Investigators found:

Ocrelizumab was associated with a cost savings of $63,822 and longer life years (LYs) (Δ=0.046) and quality-adjusted life years (QALYs) (Δ=0.556).

The results of the model were robust in the deterministic sensitivity analyses and probabilistic sensitivity analysis.

Yang H, Duchesneau E, Foster R, Guerin A, Ma E, Thomas NP. Cost-effectiveness analysis of ocrelizumab versus subcutaneous interferon beta-1a for the treatment of relapsing multiple sclerosis. J Med Econ. 2017;20(10):1056-1065. doi:10.1080/13696998.2017.1355310.



Motor, Cognitive Functions Interrelated in MS

J Neural Transm (Vienna); ePub 2017 Oct 25; Hsieh, et al
November 21, 2017

Motor and cognitive functions are interrelated in people with multiple sclerosis (MS), according to a recent study, and it is speculated that neural damage in people with MS impairs both cognitive processing speed and gait control. This investigation determined whether cognitive function, as measured by processing speed, is associated with gait variability in individuals with MS. This secondary analysis included 191 individuals with MS who underwent gait assessment and cognitive assessment. Cognitive processing speed was indexed by symbol digit modalities test (SDMT). Gait variability was indexed by step length and step time coefficient of variation (CV). Hierarchical linear regressions were performed to examine whether SDMT scores would predict step length and step time CV.
Researchers found:
After adjusting for age, gender, and disability, it was found that SDMT was a significant predictor of step time CV and step length CV.
Overall, slower cognitive processing speed was significantly associated with greater gait variability.

Hsieh KL, Sun R, Sosnoff JJ. Cognition is associated with gait variability in individuals with multiple sclerosis. [Published online ahead of print October 25, 2017]. J Neural Transm (Vienna). doi:10.1007/s00702-017-1801-0.

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Fatigue Index for MS Is Easy to Administer

November 21, 2017

The Neurological Fatigue Index for people with multiple sclerosis (NFI-MS) and the performance fatigability measures evaluated in a recent study are easy to administer, according to researchers. Therefore, they encourage wider use of these measures in clinical and research settings for comprehensive assessment of MS-related fatigue. 52 participants (mean ± SD age, 46.8 ± 10.1 years) completed the study. 3 measures of performance fatigability were used: percent change in meters walked from first to last minute of the 6-Minute Walk Test, percent change in force exerted from first to last trial on a repetitive maximal hand grip test, and response speed variability on the Continuous Performance Test. Perceived physical and cognitive fatigue were measured using the NFI-MS.

The state level of fatigue was examined immediately before and after performing the fatigability measures using a 1-item visual analog fatigue scale.

They found:  click to read more

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What is “Therapeutic Lag”? Why does it matter when treating Multiple Sclerosis?

Dr.B discusses the concept of therapeutic lag and its relevance when assessing the efficacy of MS disease modifying therapies.

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Protein May Be Marker of MS Disease Severity, Remyelination

Early work suggests beneficial effect of IL4I1 in multiple sclerosis

by Kristina Fiore, Deputy Managing Editor, MedPage TodayNovember 13, 2017

WASHINGTON -- A cytokine-related protein may be a marker of disease severity in multiple sclerosis, and may eventually prove to be a remyelinating therapeutic agent, researchers reported here.

In a small proof-of-concept study, interleukin-4 induced protein 1 (IL4I1) was detected in human peripheral blood mononuclear cells, and adding more of it to those cells in vitro tamped down levels of two key pro-inflammatory cytokines thought to be drivers of MS: interferon-gamma (IFNγ) and IL17, according to Stephanie Davis, an MD/PhD candidate at Georgetown University.

"This is telling us, just as we saw in mice, that even in humans, IL4I1 can have an immune-modulating effect," Davis told MedPage Today during a poster session at the Society for Neuroscience meeting here.
IL4I1 is a secreted L-amino acid oxidase expressed by immune cells. Its exact function isn't clear, and it has rarely been studied in the context of the central nervous system, but it does play a role in phenylalanine metabolism, Davis said.
The protein first appeared on her team's radar -- she works at Georgetown's Huang Lab -- in a microarray analysis of genes expressed from demyelination to remyelination in a rat model. IL4I1 was highly upregulated at the onset of remyelination, they found.
Subsequent work showed that treatment with IL4I1 diminished inflammation and boosted remyelination in molecular models of MS in mice, and behavioral mouse models showed a reduction in symptoms in treated animals.
To assess whether IL4I1 is detectable in human cells, Davis and colleagues assessed peripheral blood mononuclear cells in vitro. Cells were stimulated to isolate the T cell component, then the researchers added either IL4I1 or a saline control to assess effects on gene expression.

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Tuesday, November 14, 2017

A MS Patient's story: How I'm Living Well With MS, a Decade After My Diagnosis

I wanted to help myself win against MS, but I’m so glad I didn’t stop there.

     Kendra and David Lyons pose at their fitness and wellness center in Murrieta, California.
              Robert Randall

It’s been more than 11 years now since my diagnosis with multiple sclerosis (MS), and nearly 10 years since I stepped back into the gym on my mission to beat MS through bodybuilding and fitness.

So far, it’s been a remarkable ride, with highlights ranging from competing in a bodybuilding competition in 2009, to starting the MS Fitness Challenge (MSFC) charity in 2012 (in partnership with my wife, Kendra) and receiving the Health Advocate Lifetime Achievement Award from Arnold Schwarzenegger in 2015.

MS Fitness Challenge Reaches Across the Globe

I am particularly excited to see how far the MS Fitness Challenge — a charitable program created to educate people with multiple sclerosis on fitnessnutrition, and maintaining a positive mindset — has expanded since Kendra and I founded it.

I am now working with and helping people with MS as far away from my base in California as South Africa and Switzerland, designing personal fitness programs, motivating people to fight MS through changing their lifestyle, and supporting them in their efforts to conquer this disease.

At the same time, I am waging my own war with MS on my preferred battlefield — the gym — and training for an award I will be receiving from the International Bodybuilding & Fitness Federation as I head toward my 60th birthday in 2018.
It's an honor and a privilege to serve as an encouragement to so many people with MS worldwide and to be acknowledged for my accomplishments on this journey with and for MS.

I never look at this MS voyage as one I am on alone or that is about me. The thousands of amazing and courageous people with MS I have met along the way have made this a “family” effort to positively impact lives. I am humbled, I am grateful, and I am blessed beyond belief to have you all in my life. Sharing my life, my triumphs, and my struggles with you has had such a positive impact on me and continues to do so. It has inspired me to continue to create more ways to connect with and be of service to the MS community, as well as driven me to keep setting new goals in the gym.

MS Symptoms Continue to Pose Their Own Challenges

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Thanks to Caregivers Who Share Our MS Load

Nov 14, 2017

The MS load we carry is heavy. Some of us, unfortunately, must carry it alone. But many of us are fortunate to have someone with whom we can share the weight.
It’s National Family Caregivers Month and a new survey shows just how heavy that load can be. Caregivers, it will come as no surprise, are carrying their own problems and needs.

  • Nearly half (49%) of unpaid caregivers surveyed have feelings of depression.
  • Nearly half (45%) of unpaid caregivers surveyed feel that their physical health has suffered as a result of their caregiver duties.
  • Nearly half (45%) of unpaid caregivers surveyed often don’t have time to book or attend medical appointments for themselves.
  • 41% of female unpaid caregivers report that being a caregiver has put pressure on their financial situation, as compared to 28% of male caregivers.
  • Almost half (47%) of female unpaid caregivers do not feel supported at all by the local community, and a third (33%) of unpaid caregivers do not feel supported at all by their local health system. Just 40% of unpaid caregivers feel supported by their employer in their role as a caregiver.

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Sunday, November 12, 2017

Updated Clinical Trials @ Sunrise Neurology - in Sunrise, Florida

               Click banner to access Infinity Clinical Research Website


Friday, November 10, 2017

MS Teamworks – Voices from the MS Community

MS Teamworks – Voices from the MS Community

Personal and Candid Stories that Provide Hope and Insight for those Living with MS

(Hackensack, NJ, October 2017)—A new online collection of powerful multiple sclerosis (MS) stories has been launched by the Consortium of Multiple Sclerosis Centers (CMSC) and Catamount Medical Education.  MS Teamworks is a portal featuring 20 informal talks in which patients, clinicians, and care partners share their MS stories.

The unique format and innovative content of these talks reflects the public’s increasing need for new, more accessible information on a chronic neurological disorder that affects more than 2.3 million people worldwide.  More than 200 new cases of MS are diagnosed in the United States each week.

The MS Teamworks talks are free and accessible to the public.  Additional videos will be added to the website as they are produced.  MS Teamworks includes candid patients accounts from varying genders and demographic perspectives of MS patients including topics such as:

“The Beginning Of My MS Journey”
“I Wish My Healthcare Professional Knew”
“How I Manage My MS”
“I Wish I Knew”
“It Takes A Team”
This series of frank patient talks highlight the diagnostic experience, navigation of multiple healthcare providers and insurance companies, the importance of being your own healthcare advocate, living with and managing MS, and the often overlooked impact of MS on the patient’s family.  

The MS Teamworks clinician talks come from some of the top specialists and experts in MS care and include:
“What to Expect When You Have MS;” Dr. Robert Shin, a neurologist specializing in MS, shares how clinicians typically diagnose MS and discusses the importance of early treatment

“My Role in MS Care;” Lisa Fox, a PA, describes how her role as a primary care physician is important in MS care.

“Integrative Medicine;” Allen Bowling, MD, PhD, a neurologist, explains the benefits of using integrating conventional and alternative medicine in MS management

“MS Beyond the Physical—Effects on Mental Health;” Fred Foley, PhD, a psychologist specializing in MS, offers insight into the wide-ranging mental health challenges presented by MS.

“My Role in MS (Rehabilitation);” Patty Bobryk, MHS, PT, MSCS, ATP, a physical therapist, explains the role of each member of the rehabilitation team in the care of a MS patient.

“Debunking Myths and Misperceptions;” June Halper, MSN, APN-C, MSCN, FAN and David E. Jones, MD, converse about common myths and misperceptions about MS.

Additional clinician talks include: “Yes, you can get MS as a Child,” “A Missed Opportunity, Diet and MS,” “The Roadmap to Motherhood,” “The ABCs of MRIs,” “I am Getting Worse, What Does that Mean,” and “The MS Team.”

“The goal of MS Teamworks is to provide messages of hope to all members of the MS community and to illustrate the power of coming together as team to provide a future for those living with MS,” said June Halper, CEO, CMSC. 

MS Teamworks was made possible by a grant from EMD Serono.  To access and share the MS Teamworks video talks, visit:  Follow MS Teamworks on Instagram and Twitter: @msteamworks. 


CMSC, the Consortium of Multiple Sclerosis Centers, is the leading educational, training, and networking organization for MS healthcare professionals and researchers. The CMSC mission is to promote high quality MS care through educational programming and accreditation including live and online events, research grants, technical journals and papers, and targeted advocacy efforts. The CMSC member network includes more than 11,000 international healthcare clinicians and scientists committed to MS care as well as more than 60 Veterans Administration MS Programs and 225 MS Centers in the US, Canada, and Europe. The 32nd CMSC Annual Meeting, the largest gathering of MS professionals in North America, will take place May 30 – June 2, 2018, in Nashville, TN. For more information visit: Follow CMSC on Twitter: and Facebook: CMSCmscare.

Catamount Medical Education’s mission is to create learning experiences that maximize the impact on patient care. Education is delivered through live programs, including satellite symposia, local and regional meetings, and online events, as well as through self-directed, enduring formats such as podcasts, videos, Webinars, monographs, newsfeeds, and other enduring formats. Catamount seeks to add value to its education and ensuring a direct impact on patient care by incorporating practical tools for the clinician (e.g., exam room posters, pocket cards, patient education materials) into every educational experience. Learn more at

Media Contact:  Annie Scully, 201-310-9252,

First Patient Enrolled in Mallinckrodt Phase 4 Trial of H.P. Acthar® Gel (Repository Corticotropin Injection) for Multiple Sclerosis Relapse

-- Mallinckrodt's OPTIONS Trial to Assess Efficacy and Safety of H.P. Acthar Gel in Patients with Relapsing-Remitting Multiple Sclerosis --

STAINES-UPON-THAMES, United KingdomMay 23, 2017 /PRNewswire/ -- Mallinckrodt plc a leading global specialty pharmaceutical company, today confirmed enrollment of the first patient in the company's Phase 4 pilot study assessing the efficacy of H.P. Acthar® Gel (repository corticotropin injection) for the management of exacerbations of relapsing and remitting multiple sclerosis (RRMS) in patients whose relapse symptoms have not responded to a course of high-dose corticosteroids.
"Some MS patients may have relapse symptoms that don't resolve with steroid therapy, and in my experience, H.P. Acthar Gel may provide benefit in these cases," said Aaron Miller, M.D., a program advisor and participating site investigator from the Icahn School of Medicine at Mount Sinai in New York. "This study is an important step to confirming the appropriate patient type for this product as an approved and appropriate treatment for MS exacerbations."
H.P. Acthar Gel is U.S. Food and Drug Administration (FDA)-approved for treatment of acute exacerbations of multiple sclerosis in adults.
"Mallinckrodt is committed to providing alternative treatment options to patients who need them," said Steven Romano, M.D., Chief Scientific Officer and Executive Vice President at Mallinckrodt. "Clinical experience and current labeling support the use of Acthar to speed recovery from relapses in MS. We are pleased to enroll the first patient in the OPTIONS trial to better understand the patients who will benefit from Acthar therapy, and to support its role in the management of RRMS."
About the OPTIONS Trial
The Phase 4 clinical study is titled "A Multicenter, Randomized, Double-Blind, Placebo-Controlled Parallel Group, Pilot Study to Assess the Efficacy and Safety of H.P. Acthar Gel in Subjects With Relapsing-Remitting Multiple Sclerosis". The study will enroll patients with MS relapses of moderate severity and symptoms that have not adequately improved following a typical course of high dose IV or oral corticosteroid therapy, then randomize them to receive additional treatment with H.P. Acthar Gel or placebo in blinded fashion. 
Improvement in relapse symptoms will be assessed using several standard MS disease activity measures, including the Expanded Disability Status Scale (EDSS), MS Impact Scale (MSIS-29), and Clinical Global Impressions-Improvement Scale (CGI-I). Because this trial targets only a subset of RRMS patients experiencing relapses who have not responded acutely to corticosteroid therapy, the study may take a number of years to recruit.
Find more information about the OPTIONS trial here on the website.