CombiRx Trial (sponsored by the National Institutes of Health):  1008 multiple sclerosis patients were followed over 3 years on either Avonex alone, Copaxone alone or the combination of Avonex and Copaxone.   The combination of treatments  was not better than Avonex alone or Copaxone alone in decreasing relapses or disability.  The percentage of patients relapsing on the combination was 23.1%, on Copaxone alone was 20.5% and Avonex alone was 26%.   The combination treatment did have an impact on some MRI results such as the percentage of patients free of new MRI activity at 3 years. 

CARE MS 2 Trial:  Alemtuzumab (Lemtrada) IV treatment one a year drop new relapses by half (49.4%) compared to Rebif in a 2 year trial.   People with MS treated with alemtuzumab also were less likely to progress in disabiltiy and have less MRI activity.  Some risks of this treatment are serious infections (3.7% risk), thyroid disorders,  and low platelets. 

More to come….

Further randomized trials are needed to confirm whether Vitamin D supplements can change the course of MS.   However,  it’s not a bad idea to be tested by your primary care provider or neurologist to see if you have low levels of Vitamin D that require oral supplements. Twenty minutes of sun is a great way to boost Vitamin D levels.  Dairy products (milk, yogurt), certain fish (salmon, tuna, mackerel), orange juice, eggs and fortified cereal are good dietary sources of Vitamin D.

Greater than 26,000 people globally have been treated with Gilenya.  Gilenya can lower the heart rate especially the first six hours after treatment.  One patient recently died within 24 hours of taking the first dose of Gilenya. The patient was also treated with two cardiac medications including a beta blocker and a calcium channel blocker, which can lower the heart rate.  However, this patient had completed 6 hours of monitoring after the first dose without problems, but died less than 24 hours after the first dose. The exact cause of death has not been established and an autopsy is pending.   Inform your neurologist if you have cardiac disease or take cardiac medications if considering Gilenya.

October 19-22 was the international multiple sclerosis meeting called ECTRIMS.  Over 7700 people including neurologists from around the globe convened at this meeting.  Many clinical trials were presented on new therapies with positive results.   Here are few of the meeting highlights:

BG-12, a new oral experimental medication for MS,  in the DEFINE trial reduced relapses 53% when taken twice a day and 48% when taken three times a day.  Those relapsing remitting MS patients treated with BG-12 were 38% less likely to have worsening disability while BG-12 three times a day reduced this risk by 34%.   BG-12 was also very effective in reducing MRI activity.  Some risks and side effects are flushing, nausea, diarrhea, low white blood counts, and high liver blood tests.

Neuromyelitis optica (NMO or Devic’s) is condition similar to MS in which an antibody attacks a water channel on the surface of cells called astrocytes.  This channel or “aquaporin”  is like a gate which lets water in and out of the surface of a cell.  In NMO, antibodies start attacking these channels.   The result is an immune attack against the optic nerves (nerves to the eyes) and spinal cord as well as sometimes the brain.  Although rituximab and azothioprine are often used,  no specific therapy is FDA-approved for the treatment of NMO .   Dr. Jeffrey Bennett presented work being done on animal models to develop a specific antibody therapy called Aquaporumab to help treat this condition.

Daclizumab, an antibody treatment given as an injection under the skin, was studied in 600 MS patients over 1 year.  The low dose reduced relpases by 54% and reduced the likelihood of worsening disability by 57% compared to placebo injections.  Some risks of treatment were skin reactions, elevation liver blood tests and serious infections, including one death beginning as a muscle infection.

Alemtuzumab annual infusions in the vein reduced new attacks by 55% compared to those patients on Rebif.  Only 8% alemtuzumab and 11% on  Rebif progressed over the 2 year trial in patients who never were treated with MS medications prior to the trial.  Some treatments risks for alemtuzumab were serious infections, thyroid problems and low platelet counts.

Dr. Barry Singer presented the one-year safety update on Gilenya after being approved one year ago by the FDA.  Over 20,000 MS patients have been treated with Gilenya globally.  Although Gilenya has known risks including slow heart rate with the first dose and swelling in the back of the eye (macular edema),   no new safety problems were reported including no cases of PML (a type of viral brain infection).

More to come….

Free annual educational program.  Sponsored by Missouri Baptist Medical Center and The MS Center for Innovations in Care.

Thanks to pioneering new oral and antibody multiple sclerosis treatment options, individuals living with MS can look forward to a brighter future.  Join us for a discussion on the latest research news including positive new clinical trial results and potential nervous system repair.  A Question & Answer session will follow the presentation.

Featured speakers:  Barry Singer, MD and Mark Tullman, MD

Refreshments will be provided.

6:30 PM to 8:30 PM

Wednesday, Sept 7, 2011

St. Louis Frontenac Hilton
1335 South Lindbergh Boulevard, St. Louis, MO 63131

TO REGISTER:   Please Call (314) 996-LIFE, (314) 996-5433 or toll-free (800) 392-0936.

After earning his medical degree from the University of Missouri-Columbia, he completed his residency in internal medicine at Albert Einstein College of Medicine, Bronx, New York. He completed his neurology residency and a postdoctoral fellowship in multiple sclerosis at Mount Sinai School of Medicine, New York.

Board-certified in neurology, he specializes in all aspects of MS patient care, including treatment with the disease-modifying drugs and symptomatic therapies. He has been principal investigator for numerous MS clinical trials and has published a variety of MS-related articles and book chapters.
 
Dr. Tullman’s dedication to the field of MS was recognized when he was honored with the Sylvia Lawry Physician Fellowship award from the National Multiple Sclerosis Society and with the Martin S. Davis Multiple Sclerosis Fellow by the New York City Chapter of the National Multiple Sclerosis Society.

In addition to his memberships in the American Medical Association and the American Academy of Neurology, Dr. Tullman serves on the Board of Directors of MS Hope for a Cure and the editorial board of Continuum, the continuing medical education publication of the American Academy of Neurology.

“I am extremely pleased to have Dr. Mark Tullman, a national leader in multiple sclerosis, joining our Center,” stated Barry Singer, MD, director, and a recognized leader in MS care. “Dr. Tullman will help us to broaden our ability to provide comprehensive, forward-thinking care to more multiple sclerosis patients throughout the region and beyond.”

Risks of alemtuzumab (Lemtrada) in the CARE-MS I were infusion reactions, infections (upper respiratory and bladder infections), thyroid problems and low platelet counts.  The MS Center for Innovations in Care has been a site for CARE-MS II which examined alemtuzumab in patients who have had relapses on current treatments.