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Saturday, April 28, 2012

The younger a woman is diagnosed with MS, the greater chance she has of going 2 or more decades without significant progression



Slow MS Progress Most Likely if Diagnosed Young


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Menopause Impact Negligible in MS


By Ed Susman, Contributing Writer, MedPage Today
Published: April 27, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
NEW ORLEANS -- The clinical course of multiple sclerosis does not appear to be affected by advent of menopause, researchers said here.
The two year change in the Expanded Disability Status Scale increased 0.139 points in a two-year period among pre-menopausal women and 0.122 points in menopausal women (P=0.83), according to Riley Bove, MD, a research fellow at the Multiple Sclerosis Center at Brigham & Women's Hospital and Harvard Medical School.
In reviewing data from the Partners Multiple Sclerosis Center in Boston, Bove and colleagues also found that changes in MRI scans were also similar for both groups of women -- the brain parenchymal fraction declined 0.001 in both groups (P=0.70), and T2 lesion volume decreased 0.002 in pre-menopausal women and increased 0.025 in menopausal women, (P=0.34). Neither change achieved statistical significance.
On the other hand, on the Short Form-36 self-assessment of physical functioning, menopausal women scored lower (P<0.001) than premenopausal women, Bove and colleagues noted in their poster presentation at the American Academy of Neurology meeting.
"There is a scientific rationale for menopause and worsening multiple sclerosis symptoms because menopause modulates other neurologic diseases including dementia, Alzheimer's disease, epilepsy, rheumatoid arthritis and lupus and other inflammatory diseases," Bove told MedPage Today. "So there would be an expectation that it might be similar in multiple sclerosis."
But when the research team looked at hard clinical outcomes such as MRI brain scans, the evidence was not there.



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The Latest Research is in, on combination therapy with both Copaxone and Interferon



MS Drug Combo No Better than Each One Alone

By John Gever, Senior Editor, MedPage Today
Published: April 27, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
NEW ORLEANS -- Among patients with relapsing-remitting multiple sclerosis (MS), little clinical benefit was seen for combining glatiramer acetate (Copaxone) with interferon beta-1a (Avonex) versus either drug alone in a large randomized trial.
Annualized relapse rates during the 3-year study, using a rigorous definition of exacerbation, were 0.12 in the so-called CombiRx trial with a combination of glatiramer acetate and interferon, compared with 0.11 for glatiramer acetate alone (P=0.27) and 0.18 for interferon alone (P=0.02), Fred Lublin, MD, of Mount Sinai Medical School in New York City reported here.
Proportions of patients relapsing during the 3-year study were as follows:
  • Combination: 23.1%
  • Glatiramer acetate alone: 20.5% (P=0.21 versus the combination)
  • Interferon alone: 26.0% (P=0.19 versus the combination)
Lublin reported the results Friday at the American Academy of Neurology's annual meeting. Unlike nearly every other study presented here, no outcomes data were included in the abstract released prior to the meeting.
The combination also failed to outperform the individual drugs in most other outcomes, including rates of disability progression and time to first relapse.
A report from the CombiRx trial earlier in the week focusing on MRI results was largely negative. The combination was better than either drug as monotherapy on a few measures of brain lesion counts and volumes, but for most there was no advantage over the best-performing monotherapy


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New TYSABRI Data Presented at 64th Annual AAN Meeting Highlight Biogen Idec & Elan Commitment to Improving Outcomes in Multiple Sclerosis


Published April 27, 2012

Biogen Idec (NASDAQ: BIIB) and Elan Corporation, plc (NYSE: ELN) today announced findings from several studies of TYSABRI® (natalizumab) evaluating its long-term safety and efficacy in the treatment of multiple sclerosis (MS) across the course of disease and impact on MS-related symptoms such as fatigue. These data, as well as data relating to the companies’ risk stratification algorithm as a way to help enable individual benefit risk assessment for patients with MS, were accepted for presentation at the 64th Annual Meeting of the American Academy of Neurology (AAN).

“We continue to build on the extensive data we have for TYSABRI and are committed to studying its long-term use and potential effect on symptoms like fatigue, which MS patients struggle with every day,” said Douglas E. Williams, Ph.D., executive vice president of Research and Development at Biogen Idec. “Our research is aimed at discovering additional ways TYSABRI can help physicians and patients best manage the symptoms of MS and make informed and personalized treatment choices.”

Long-Term Observational Study of TYSABRI
Initial results from the TYSABRI Observational Program (TOP) indicate that post-baseline annualized relapse rates (ARR) after four years for patients receiving TYSABRI therapy decreased from 1.99 at baseline to 0.28 (p<0.0001); disability, as measured by the Expanded Disability Status Scale (EDSS), remained stable over time. TOP is an ongoing open-label, multicenter, observational study designed to assess long-term outcomes in patients with relapsing-remitting MS (RRMS) in Europe, Australia, and Canada. TOP is expected to enroll more than 4,500 patients who will be followed for 10 years.

Neither reduction in ARR nor stabilization of a patient’s EDSS was affected by the type of treatment they were using before initiating TYSABRI therapy. However, ARR were lowest in immunosuppressant (IS) therapy-naïve patients and highest in patients who had used IS therapy (p<0.0001).

The incidence and type of serious adverse events (SAEs) seen in these patients after long-term use was consistent with TYSABRI’s known safety profile. There were no significant differences by baseline treatment history in the incidence of SAEs, infection-related SAEs, or progressive multifocal leukoencephalopathy (PML) during TYSABRI therapy, although there was a trend of higher incidence of PML in patients with prior IS use.

“TOP may help provide insight into the potential impact current treatment may have on long term efficacy and safety outcomes with TYSABRI,” said Professor Ludwig Kappos, MD, chair of Neurology, Research Group Leader Clinical Neuroimmunology and Neurobiology, Department of Biomedicine, University Hospital, Basel, Switzerland. “The reduction of MS relapse and stable disability progression that we observed with TYSABRI in the TOP study across naive and previously treated patients was sustained after four years of treatment.”

Risk-Stratification Initiatives
Read more: http://www.pharmiweb.com/pressreleases/pressrel.asp?ROW_ID=57730#ixzz1tM3YgXR9

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Protein block `could halt multiple sclerosis`



Protein block `could halt multiple sclerosis`
Washington: Scientists claim to have discovered that the progress of debilitating disease multiple sclerosis could be slowed or even stopped by blocking a protein which contributes to nerve damage.

An international team has shown that the key role played by the collapsing response mediator protein 2 (CRMP-2)) in the development of multiple sclerosis (MS), the `Brain` journal reported.



In their research, the scientists found that a modified version of CRMP-2 is present in active MS lesions, which indicate damage to the nervous system, in a laboratory model of MS.

The modified CRMP-2 interacts with another protein to cause nerve fibre damage that can result in numbness, blindness, difficulties with speech and motor skills, and cognitive impairments in sufferers.

When either the modified CRMP-2 or the interaction between the two proteins was blocked, using a method already approved in both the US and Australia, the progression of the disease was halted.

The scientists say that the discovery could lead to new treatments for MS.

"Blocking the same protein in people with MS could provide a `handbrake` to the progression of the disease," Prof Richard Boyd of Monash University, a team member, said.

Dr Steven Petratos, the team leader, said the method used to block the protein was approved for the treatment of other disease conditions by both the US Food and Drug Administration and Australia?s Therapeutic Goods Administration.

"This should mean that clinical trials -- once they start -- will be fast tracked as the form of administration has already been approved," he added.

PTI     - article source ZeeNews
First Published: Saturday, April 28, 2012, 12:54



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More Negative Results for Vein Blockage in MS



NEW ORLEANS -- Occlusions in cerebrospinal veins imaged with ultrasound and magnetic resonance venography do not appear to be related to multiple sclerosis, researchers said here.
In two reports from an ongoing study at the University of Texas Health Sciences Center in Houston, a significant proportion of participants -- including MS patients and non-MS controls -- showed abnormalities consistent with chronic cerebrospinal venous insufficiency (CCSVI), but it was not more common in the MS patients relative to controls.
Andrew Barreto, MD, who reported the ultrasound findings at the American Academy of Neurology's annual meeting, acknowledged that the results contrasted markedly with those originally reported by Paolo Zamboni, MD, of the University of Ferrara in Italy.
Zamboni had sparked the flurry of interest in CCSVI with a 2009 paper claiming that every MS patient he examined with ultrasound had CCSVI, whereas it was absent in all the controls.
"We used strict ultrasound criteria definitions," Barreto said. "With these strict definitions, the results are what we found."


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