New Insights into Current MS Treatment NMSS twentieth Annual Research Symposium Robert Shin, MD Maryland Center for MSSlide 2
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*Slide 3
MS treatment 1990Slide 4
MS treatment 1995 BetaseronSlide 5
MS treatment 2000 Betaseron Avonex CopaxoneSlide 6
MS treatment 2005 Betaseron Avonex Copaxone Rebif Novantrone TysabriSlide 9
MS backslide rates - 33% - 29% - 34% - 18% - 66% - 54%Slide 10
Current MS treatment Long-term adequacy Safety/Tolerability Early treatment Head-to-head correlationsSlide 11
Long-term viabilitySlide 12
Long-term adequacy Ideally exhibited by long haul, controlled, near trials Such studies are unreasonable and conceivably untrustworthySlide 13
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 yearsSlide 14
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 helpSlide 15
Long-term subsequent Copaxone at 26* years 46 took after 28 patients pulled back Average subsequent 10.5 years 26.7% obliged help to walkSlide 16
Long-term subsequent Betaseron at 16 years Identified 331/372 unique patients 51% (treated) versus 45% (placebo) mobile 95% (treated) versus 83% (placebo) aliveSlide 17
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%Slide 18
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 âneutralizing antibodiesâ (NAbs)Slide 19
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%Slide 20
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?Slide 21
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 interferonSlide 22
Safety issues: beta interferon Depression/self-destructive ideation Leukopenia/thrombocytopenia Liver protein rise/hepatic harm Thyroid brokenness Pregnancy classification CSlide 24
Safety issues: beta interferon CBC and liver board Thyroid capacity tests Monitor for discouragementSlide 25
Safety issues: glatiramer acetic acid derivation Pregnancy class BSlide 26
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%Slide 27
Conclusions Beta interferon and glatiramer are for the most part very much enduredSlide 28
Early treatmentSlide 29
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!Slide 30
MS medications Reduce backslide rate Reduce inability Reduce new/dynamic MRI sores Earlier treatment is better!Slide 31
Clinically Isolated Syndrome (CIS) A solitary scene of neurologic brokenness brought about by a solitary demyelinating injury Optic neuritis Brainstem disorder Spinal line disorderSlide 32
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 onSlide 33
Question Can MS medications advantage patients with CIS?Slide 34
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*Slide 35
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 CISSlide 36
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 CISSlide 37
Head-to-head correlationsSlide 38
Need for direct examination Different studies ought not be contrasted with one another Different consideration/prohibition criteria Different result measures Different populacesSlide 39
MS backslide rates - 33% - 29% - 34% - 18% - 66% - 54%Slide 40
Beta interferons Betaseron (beta interferon 1b) Avonex (beta interferon 1a) Rebif (beta interferon 1a)Slide 41
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)Slide 42
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 movementSlide 43
Interferon versus glatiramer? Rebif versus Copaxone Almost 800 patients randomized Followed for 96 weeks No critical difference*Slide 44
Interferon versus glatiramer? CombiRX Copaxone + Avonex Copaxone + placebo Avonex + placebo Is Copaxone + Avonex better than either tranquilize alone?Slide 45
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 powerfulSlide 46
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 treatmentSlide 48
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