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Tuesday, July 24, 2018

Shorter Washout Period Lessens Relapse Risk When Switching from Tysabri to Gilenya in RRMS

Shortening the washout period to four weeks when switching from Biogen’s Tysabri (natalizumab) to Novartis’ Gilenya (fingolimod) is safe and reduces the chances of experiencing a disease flare in patients with relapsing-remitting multiple sclerosis (RRMS), a small Swiss study found.
A four-week washout reduced the risk of having a disease relapse or an increase in disease activity, compared with an eight-week washout period, for two years after switching from Tysabri to Gilenya.


Shorter Washout Period Lessens Relapse Risk When Switching from Tysabri to Gilenya in RRMS, Study Finds

Although Tysabri effectively slows worsening of MS symptoms and the appearance of disease flares, its use is under a strict risk management plan as it heightens the risk of developing a rare and life-threatening brain infection called progressive multifocal leukoencephalopathy (PML).
Some patients may switch to Gilenya, an alternative disease-modifying therapy for RRMS. Gilenya has been associated with a lower risk of PML infection and seen to reduce relapses, disability worsening, and the appearance of new brain lesions on clinical trials. It also is the only therapy approved by the U.S. Food and Drug Administration (FDA) for children with MS as young as 10.
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Hypertension More Common in MS Patients Than General Public, Study Reports

People with multiple sclerosis are 48 percent more likely to have high blood pressure compared to the general population — and to people with other demyelinating diseases, a new study reports. Its researchers also emphasize that hypertension is already linked to poorer outcomes in MS patients.

The study, “Cardiovascular conditions in persons with multiple sclerosis, neuromyelitis optica and transverse myelitis,” was published in the journal Multiple Sclerosis and Related Disorders.

Like all demyelinating diseases, MS is marked  by damage to the protective cover – called myelin – that surrounds nerve fibers in the brain, optic nerves, and spinal cord.

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Two other diseases, neuromyelitis optica spectrum disorder (NMOSD), and transverse myelitis (TM), are also demyelinating disorders of the central nervous system. But the three have widely different clinical characteristics, and comorbidities — while common in MS patients —  have not been studied extensively in NMOSD and TM.

Researchers with Case Western Reserve University in Cleveland, Ohio, investigated the prevalence of cardiovascular conditions like hypertension in a group of MS, NMOSD, and TM patients in the U.S. Cardiovascular conditions, even those that develop in people with other diseases (as a comorbidity), are generally considered modifiable through diet and exercise. But few large-scale studies have looked into their prevalence or burden in people with demyelinating diseases.

Those that have suggest that cardiovascular conditions are either as prevalent or more prevalent in people with MS and NMOSD than healthy people.

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Doctors believe they have discovered the cause of multiple sclerosis

KATE FOSTER, SCOTTISH HEALTH EDITOR, The Daily Telegraph
July 23, 2018

Approximately 100,000 people in the UK live with multiple sclerosis. The neurological condition is triggered when the immune system attacks the nerves, causing pain, fatigue, vision problems and spasms.

What causes the body to begin attacking itself has never been identified. But scientists at the University of Glasgow and Harvard University in the US suggest exposure to two common infections — threadworms followed by the Epstein-Barr virus — may be the trigger.

The findings therefore suggest that developing a vaccine or drugs to stop people getting the Epstein-Barr virus could also make them immune to multiple sclerosis.

Professor John Paul Leach, consultant neurologist at the University of Glasgow, said: ‘MS is a condition where the body produces antibodies against itself for reasons that have never been understood and goes against its own nervous system. It is odd that we have never found out why some people are more prone than others.

There is already some evidence that exposure to the Epstein-Barr virus makes it more likely someone will develop MS but this does not offer the full explanation of why people develop this reaction. MS may be the result of not one but two infections in the right order.’

The researchers’ explanation is currently just a theory but they plan to carry out further research. Threadworms affect around one sixth of the world’s population and are a parasitic infection affecting the gut, common in children.

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