New Experiences into Current MS Treatment.

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New Bits of knowledge into Ebb and flow MS Treatment NMSS twentieth Yearly Research Symposium Robert Shin, MD Maryland Place for MS Effect of MS Driving non-traumatic reason for inability in youthful grown-ups 250,000 to 350,000 influenced in US* National expense of about $10 billion for each year* MS treatment 1990
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New Insights into Current MS Treatment NMSS twentieth Annual Research Symposium Robert Shin, MD Maryland Center for MS

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Impact of MS Leading non-traumatic reason for incapacity in youthful grown-ups 250,000 to 350,000 influenced in US* National expense of about $10 billion for every year*

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MS treatment 1990

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MS treatment 1995 Betaseron

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MS treatment 2000 Betaseron Avonex Copaxone

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MS treatment 2005 Betaseron Avonex Copaxone Rebif Novantrone Tysabri

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MS backslide rates - 33% - 29% - 34% - 18% - 66% - 54%

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Current MS treatment Long-term adequacy Safety/Tolerability Early treatment Head-to-head correlations

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Long-term viability

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Long-term adequacy Ideally exhibited by long haul, controlled, near trials Such studies are unreasonable and conceivably untrustworthy

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Extension studies PRISMS-4 (Rebif) 7 to 8 years Relapse rate 1.02 (hybrid) versus 0.72 (44mcg) Disability movement deferred by year and a half CHAMPS/CHAMPIONS (Avonex) 5 years (reached out to 10 years) 44% decrease in CDMS at 1.5 years 43% diminishment in CDMS at 5 years

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Long-term subsequent Copaxone at 10 years 108 on Copaxone treatment 47 patients pulled back yet were taken after 77 patients lost to catch up 92% as yet strolling without help

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Long-term subsequent Copaxone at 26* years 46 took after 28 patients pulled back Average subsequent 10.5 years 26.7% obliged help to walk

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Long-term subsequent Betaseron at 16 years Identified 331/372 unique patients 51% (treated) versus 45% (placebo) mobile 95% (treated) versus 83% (placebo) alive

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Long-term subsequent Avonex at 8 years 160 patients, no less than 2 years of Avonex Sustained inability at 6 months anticipated handicap at 8 years 67% obliged help versus 24%

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Neutralizing antibodies Protein or peptide based treatments may prompt the generation of antibodies When antibodies hinder the biologic impact of the protein/peptide they are alluded to as “neutralizing antibodies” (NAbs)

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NAbs to beta interferon Betaseron (beta interferon 1b) 28% to 47% Rebif (beta interferon 1a) 13% to 24% Avonex (beta interferon 1a) 2% to 6%

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NAbs to beta interferon Typically show up inside of 3 to year and a half of start of treatment Reduction in adequacy may be postponed Increased backslides Increased MRI ailment weight NAbs may vanish over the long haul?

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Conclusions Both beta interferon and glatiramer may be powerful even following 5 to 15 years of treatment Neutralizing antibodies may show up in a minority of patients taking beta interferon

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Safety issues: beta interferon Depression/self-destructive ideation Leukopenia/thrombocytopenia Liver protein rise/hepatic harm Thyroid brokenness Pregnancy classification C

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Safety issues: beta interferon CBC and liver board Thyroid capacity tests Monitor for discouragement

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Safety issues: glatiramer acetic acid derivation Pregnancy class B

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Rebif new plan (RNF) Human serum egg whites free Fetal ox-like sans serum Reduced infusion site responses 30.8% versus 85.8% Increase in influenza like reactions 71% versus 48%

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Conclusions Beta interferon and glatiramer are for the most part very much endured

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Early treatment

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Damage happens ahead of schedule in MS Loss of N-acetylaspartate (NAA) Diffusion tensor imaging (DTI) changes White and dim matter polarization exchange proportion (MTR) variations from the norm Cerebral decay Time is mind!

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MS medications Reduce backslide rate Reduce inability Reduce new/dynamic MRI sores Earlier treatment is better!

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Clinically Isolated Syndrome (CIS) A solitary scene of neurologic brokenness brought about by a solitary demyelinating injury Optic neuritis Brainstem disorder Spinal line disorder

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CIS and MRI Patients with CIS are at expanded danger to create MS later on An anomalous MRI is connected with an incredibly expanded danger to create MS later on

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Question Can MS medications advantage patients with CIS?

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MS medicines for CIS ETOMS (Early Treatment of MS) CHAMPS (Controlled High-chance Avonex MS Prevention Study) BENEFIT (Betaseron in Newly Emerging MS For Initial Treatment) PreCISe*

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MS prescriptions for CIS Randomized controlled trials reliably demonstrate less backslides among CIS patients treated with DMT Avonex and Betaseron now convey FDA signs for treatment of CIS

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Conclusions Early treatment of MS is desirable over a postponement in treatment CIS may be the first event of MS medications can be considered in CIS

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Head-to-head correlations

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Need for direct examination Different studies ought not be contrasted with one another Different consideration/prohibition criteria Different result measures Different populaces

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MS backslide rates - 33% - 29% - 34% - 18% - 66% - 54%

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Beta interferons Betaseron (beta interferon 1b) Avonex (beta interferon 1a) Rebif (beta interferon 1a)

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INCOMIN Beta interferon Betaseron versus Avonex 188 patients took after for a long time Betaseron 42% more inclined to be backslide free 51% (Betaseron) versus 36% (Avonex) Betaseon more prone to be free of MRI action 55% (Betaseron) versus 26% (Avonex)

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EVIDENCE Beta interferon 1a 44 mcg tiw (Rebif) versus 30 mcg week by week (Avonex) 677 patients took after for 48 weeks 27% less backslides in Rebif bunch 33% decrease in MRI movement

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Interferon versus glatiramer? Rebif versus Copaxone Almost 800 patients randomized Followed for 96 weeks No critical difference*

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Interferon versus glatiramer? CombiRX Copaxone + Avonex Copaxone + placebo Avonex + placebo Is Copaxone + Avonex better than either tranquilize alone?

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Conclusions Higher measurements, higher frequence beta interferon gives off an impression of being more viable than lower dosage interferon We don\'t know whether beta interferon or glatiramer acetic acid derivation is more powerful

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Summary There have been awesome advances in treating MS in the course of recent years Clinical examination has been essential in assisting us with betterring comprehend and refine MS treatment

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