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Saturday, April 30, 2016

ClinicSpeak & NeuroSpeak: sequencing DMTs switching from natalizumab to alemtuzumab

                                                                  

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Information provided to us from Christine S. - thank you Christine


Saturday, 30 April 2016

ClinicSpeak & NeuroSpeak: sequencing DMTs switching from natalizumab to alemtuzumab

Can you switch from natalizumab to alemtuzumab safely? #ClinicSpeak #Neurospeak #MSBlog


"Finally, our algorithm for switching patients at high-risk of PML to other DMTs, in particular alemtuzumab, is in print. We originally published this algorithm on the blog way back in 2014 so why publish it in a journal now? Firstly, it is always good practice to get your work peer-reviewed and secondly it is not accepted practice to quote a blog."

"It is ironic that the day after the EMA announces a positive opinion on daclizumab as a treatment for relapsing forms of MS our paper comes out in print. Ironic in that I have being making the case for daclizumab being the agent of choice post-natalizumab. This means our recommendations will be out of date very soon. In anticipation of this I have already updated the recommendations by including both daclizumab and rituximab as potential switch agents. The daclizumab recommendation is based on scientific principles. Let's hope Biogen and Abbvie do a switch study to produce the necessary data to support this recommendation. In comparison the rituximab recommendation is based on real-life data from Sweden. Despite the latter, NHS England have already said no to rituximab off-label. However, the fact that we can't use rituximab in the NHS in England and Wales doesn't mean other neurologists reading this blog can't. So may be the blog is the best platform for keeping up-to-date with our thinking on this issue?"


Read MORE from Barts MS Blog



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ClinicSpeak: natalizumab or alemtuzumab?

                                                                  

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Friday, 15 August 2014

ClinicSpeak: natalizumab or alemtuzumab?

Wow, MS DMT counselling just got very complicated. Natalizumab vs. Alemtuzumab#ClinicSpeak #MSBlog #MSResearch

"In clinic on Tuesday I saw two  patients with rapidly-evolving severe MS who were eligible for natalizumab under the current NHS England's guidelines. One patient was a young man naive to first-line treatment with a poor prognostic profile (high lesion load on MRI, including posterior fossa lesions, and early disability in motor and cerebellar systems). The second patient is a young woman failing fingolinod (two disabling relapses in the last 6 months) having previously failed interferon-beta. Up until now the discussion for both of these patients would have been simple and I would have offered them natalizumab. I have a well-oiled summary of the risks and benefits of natalizumab and how we manage and de-risk the PML problem if they happen to be JCV-seropositive. But things have changed, we now have alemtuzumab as a therapeutic option for these patients. When I started discussing alemtuzumab next to natalizumab with these two patients things got very complicated."

"How do you compare a maintenance and an induction strategy with each other? When I mentioned the rates of long-term remission on alemtuzumab, and the potential an induction therapy offers regarding a cure, things got messy. I now realise that I can't mention the C-word without defining it. When I tried to define the C-word and discussed the potential of a cure, both patients were lost. Despite this it was clear that a potential cure is the alemtuzumab trump card. The promise of long-term remission, and a potential cure, is what outweighs the risks of being treated with alemtuzumab."




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Thursday, April 28, 2016

At-Home ‘Brain Training’ Program for MS Patients Reported to Improve Cognitive Skills by 29%


                                                                  

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Multiple sclerosis patients using a cognitive remediation computer training program, part of a controlled trial by researchers from NYU Langone Medical Center, had greater improvements in cognitive function than those who used a placebo-training program, according to a presentation at the recent American Academy of Neurology annual meeting in Vancouver, Canada. Problems in attention, memory, verbal fluency, and information processing can be common […]

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Promising Phase 1 Trial Results of Stem Cell Therapy in Progressive MS Patients Being Presented at AAN Meeting

                                                                  

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Potentially groundbreaking research by the Tisch Multiple Sclerosis Research Center of New York (MSRCNY) will be presented on April 19 at the 68th American Academy of Neurology (AAN) Annual Meeting taking place in Vancouver, Canada. Dr. Saud A. Sadiq, director and chief research scientist at the Tisch center, will present results of a Phase 1 clinical trial of a […]

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Sanofi Genzyme Presenting New Data on Lemtrada’s Beneficial Effects, Drawn from RRMS Extension Study, at AAN 2016

                                                                  

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Sanofi Genzyme is presenting promising data regarding brain volume and retinal nerve fibers in multiple sclerosis (MS) patients — drawn from an ongoing extension study into the disease-modifying drug alemtuzumab (Lemtrada) — at the 2016 American Academy of Neurology (AAN) Annual Meeting  taking place in Vancouver, Canada, through April 21.
The data is derived from an extension study (NCT00930553) that enrolled relapsing-remitting multiple sclerosis (RRMS) patients, previously treated with either alemtuzumabor the comparison agent, interferon beta-1a (Rebif), in the CARE-MS I Phase 3 clinical trial (NCT00530348) and the CARE-MS II Phase 3 trial (NCT00548405).
Findings indicated that trial participants who had received interferon beta-1a and switched to Lemtrada in the extension study experienced a reduced rate of brain volume loss over its three years of treatment. Previous findings in both CARE-MS studies had shown that median yearly brain volume loss was, in year two, -0.50% for CARE-MS I and -0.33% for CARE-MS II. In the extension study, the median brain volume loss was reduced in year one (CARE-MS I: -0.07%, and CARE-MS II: 0.02%), year two (CARE-MS I: -0.13% and CARE-MS II: -0.05%), and year three (CARE-MS I: -0.09% and CARE-MS II: -0.14%).
Moreover, researchers reported an improvement in retinal nerve fiber layer (RNFL) thickness in 26 Lemtrada-treated RRMS patients. Over the two years of treatment, the change in average RNFL thickness for all eyes was +1.5 micrometers, which might indicate a protection of retinal axons in these patients.
Lemtrada was previously shown to be significantly more effective than interferon beta-1a at reducing annualized relapse rates and slowing accumulation of disability, and is an approved treatment for RRMS.  However, it has been associated with serious side effects in clinical trials, including autoimmune disorders such as thyroid disease and nephropathies, infections and pneumonitis, and the U.S. Food and Drug Administration (FDA) recommends that its use be reserved for patients who have had an inadequate response to two or more MS drugs.

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Biogen Releases New Data Showing Effectiveness of Tecfidera in Newly Diagnosed MS Patients at AAN 2016

                                                                  

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Biogen reported new data describing the effectiveness of Tecfidera (dimethyl fumarate) in newly diagnosed relapsing-remitting multiple sclerosis (RRMS) patients in a recent presentation at the 68th annual meeting of the American Academy of Neurology (AAN). The conference, taking place in Vancouver, Canada, runs through April 21. Tecfidera is an oral medication taken twice daily. Although the biological activity of […]

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Lymphoma Drug, Rituximab, Highly Effective in Treating Relapsing MS, Study from Sweden Reports

                                                                  

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MS drug studyMabthera (rituximab), a widely approved drug for treating lymphoma and/or rheumatoid arthritis, is highly effective in treating multiple sclerosis (MS), researchers reported in an observational study in Sweden, where Mabthera is increasingly being used outside of its approved indications to treat relapsing-remitting MS patients. The study, published in the journal Annals of Neurology, is titled “Rituximab […]

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Biogen and AbbVie Present New Data Showing Zinbryta, an RRMS Drug Candidate, Aids Cognition Without Immune Depletion

                                                                  

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MS drug candidateNew data presented by Biogen and AbbVie at the recent 68th annual meeting of the American Academy of Neurology (AAN) showed that Zinbryta (daclizumab high-yield process) improved cognitive outcome measures in patients with relapsing forms of multiple sclerosis (RMS). Additional results — from post-hoc analyses of clinical trials — also offer a better understanding of Zinbryta’s targeted mechanism of action, showing the drug […]

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Gut Bacteria Affects Myelin Content and Induces MS-Like Depression in Mice, Study Reports

                                                                  

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Researchers at the Center of Excellence for Myelin Repair, a part of Mount Sinai, reported that gut bacteria produce compounds that were seen to affect the myelin content in mice and cause social avoidance behaviors. Study results indicated that targeting gut bacteria, or the gut metabolites, might help in treating neuropsychiatric disorders or complications, such as those caused by diseases like multiple sclerosis […]

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Cognitive Difficulties Known to MS Traced to Problems in Nerve Cell Activity in Hippocampus

                                                                  

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Cognitive Difficulties Known to MS Traced to Problems in Nerve Cell Activity in Hippocampus
 APRIL 28, 2016 Magdalena Kegel


In a study published in the International Neurology Journalresearchers showed that cognitive deficits, such as memory problems, in a rat model of multiple sclerosis (MS) are mirrored by changes in synaptic transmission and plasticity in the hippocampus, a brain region crucial for memory processing. The findings advance the understanding of disease mechanisms affecting cognition in MS patients.
Cognitive deficits such as learning and memory dysfunction are common in MS, affecting 40 percent to 60 percent of patients. While earlier studies reported that brain inflammation might alter the generation of neuroplasticity, particularly at the synaptic level, not much is known about the mechanisms leading to such changes.
Studies also show that the hippocampus is affected by nerve cell death in MS patients. Using the well-characterized experimental autoimmune encephalomyelitis (EAE) animal model of MS, researchers at Arak University of Medical Sciences, Iran, used recordings of nerve cell activity in live rats to study the impact of disease on memory processes.
Using behavioral tests to study memory processes in EAE animals can be challenging, since these mice often have motor symptoms that might impact the outcome of such tests. Instead, information of how signals are transmitted at neuronal connections, synapses, as well as long-term potentiation — the mechanism underlying changes in synaptic strength, and hence neuronal plasticity — can be used to understand the mechanisms behind changes in memory function.
The study, Changes in Synaptic Transmission and Long-term Potentiation Induction as a Possible Mechanism for Learning Disability in an Animal Model of Multiple Sclerosis, showed that the EAE mice had deficits in synaptic transmission and long-term potentiation in the hippo­campus.


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Wednesday, April 27, 2016

Gut Bacteria Affects Myelin Content and Induces MS-Like Depression in Mice, Study Reports

                                                                  

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April 27, 2016



Researchers at the Center of Excellence for Myelin Repair, a part of Mount Sinai, reported that gut bacteria produce compounds that were seen to affect the myelin content in mice and cause social avoidance behaviors. Study results indicated that targeting gut bacteria, or the gut metabolites, might help in treating neuropsychiatric disorders or complications, such as those caused by diseases like multiple sclerosis (MS).
Previous studies from the same research team described a reduction of myelin and myelinated fibers in preclinical models of depression, postulating a biological explanation for the high rate of depression in patients with MS.






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