Mavenclad is an oral medication approved for relapsing-remitting and secondary progressive multiple sclerosis. The oral treatment course consists of two yearly courses of 2 cycles of 1-2 tablets per day for 4-5 days depending on the patient’s weight.
In the CLARITY study, 1326 multiple sclerosis patients were randomized to a total dose of 3.5 mg/kg (FDA-approved dose), 5.25 mg/kg or placebo. Mavenclad 3.5 mg/kg total dose reduced relapses by 58% compared to placebo. Likelihood of progression of disability was reduced by 33% on Mavenclad. On MRI, Mavenclad reduced contrast-enhancing lesions by 86% and new or enlarging T2 lesions by 73% compared to placebo.
Risks of Mavenclad include low white blood cell counts, serious infections, anemia, potential fetal harm and possible malignancy. Per prescribing information, use of MAVENCLAD is generally recommended for patients who have had an inadequate response to, or are unable to tolerate, an alternate drug indicated for the treatment of MS due to its safety profile.
Mayzent (siponimod) is a tablet medication to treat people with both relapsing-remitting multiple sclerosis and secondary-progressive patients with active disease such with new relapses or new MRI activity.
In the EXPAND trial, 1651 multiple sclerosis patients with secondary-progressive multiple sclerosis were randomized to once-daily oral Mayzent 2 mg daily or placebo for up to 3 years (2/3 of patients received Mayzent). Patients on Mayzent had a 21% less risk of disability progression than those patients on placebo. Mayzent reduced relapses by 55% compared to placebo. Patients on Mayzent were more likely to be free of contrast-enhancing lesions (89% vs 67% on placebo) and free of new or enlarging T2 lesions (57% vs. 37% on placebo).
Medication risks include elevation of liver blood test, swelling back of eye (called macular edema), increase in blood pressure and potential serious infections.
Available now! Dr. Susanne Bennett on RadioMD interviews Dr. Barry Singer on the symptoms and signs of multiple sclerosis. He discusses genetic and environment risk factors for MS. Wellness including exercise addressed. Impact of treatments on preventing disability reviewed.
JOIN US!! December 4, 2018 from 6:30 PM to 8:30 PM. Find out the latest in multiple sclerosis advancements after the largest global MS meeting called ECTRIMS which is Oct 10-12, 2018 in Berlin this year. Barry Singer, MD, Mark Tullman, MD, Barbara Green MD and Melanie Huff NP-C from The MS Center for Innovations in Care will present the most promising and impactful results. New information on multiple sclerosis treatment and myelin repair will be reviewed. Free program. RSVP at 314-996-LIFE or 1-800-392-0936.
The program will be on the CAMPUS of MISSOURI BAPTIST MEDICAL CENTER in the Clinical Learning Institute which is conveniently above the main garage next to the main entrance of the hospital (and in the same building at the Goldfarb School of Nursing).
Jul 14 2018 We’ve Moved! New Center Opens!
The MS Center for Innovations in Care has moved from the 2nd floor of Building B to our brand new space on the FIRST FLOOR of Building B, Suite 105 on the campus of Missouri Baptist Medical Center. The Center is now conveniently located across the hall from the outpatient lab and next door to the new MS Infusion Center, the region’s only MS-specific infusion center. With double the square feet, the new center features 10 large exam rooms with accessible exam tables, open nursing stations and clinical research space. The Center’s staff includes 3 highly-experienced MS specialists, a MS-certified nurse practitioner, 2 MS nurses, a research coordinator and 8 other support staff including medical assistants. Our phone number and fax number have not changed.
May 18 2018 Upcoming Program: Understanding MS Progression
The Multiple Sclerosis Association of America (MSAA) invites you to a free educational program on:
Understanding MS Progression: The Importance of Treatment Adherence
Presenter: Barry Singer, MD, Director of The MS Center for Innovations in Care at Missouri Baptist Medical Center
Tuesday June 19 2018 Registration 6:00-6:30 PM, Program 6:30 PM to 8:00 PM
Hilton St. Louis Frontenac, 1335 S. Lindbergh Blvd., St. Louis, MO 63131
Register by Wednesday June 13: 1-800-532-7667, ext. 188 or online at support.mymsaa.org/stlouis
We are extremely pleased to announce that Dr. Barbara Green will be joining our center February 15, 2018. Dr. Green is a true leader in multiple sclerosis with extensive experience in treating patients with multiple sclerosis including as a long-standing director of a multiple sclerosis center in St. Louis. She is passionate about superb MS patient care. As a committed advocate of those living with multiple sclerosis, Dr. Green has served as chair of the clinical advisory committee for the Gateway Chapter of the National Multiple Sclerosis Society.
SAVE THE DATE!! November 14, 2017 from 6:30 PM to 8:30 PM. Want the most cutting edge news after the largest global MS meeting called ECTRIMS in Paris? Barry Singer, MD and Mark Tullman, MD from The MS Center for Innovations in Care will present the most promising and impactful results. New information on multiple sclerosis treatment and myelin repair will be reviewed. RSVP at 314-996-LIFE.
This year the program will be on the CAMPUS of MISSOURI BAPTIST MEDICAL CENTER in the Clinical Learning Institute which is conveniently above the main garage next to the main entrance of the hospital (and in the same building at the Goldfarb School of Nursing).
May 29 2017 A New Era of Multiple Sclerosis Treatment
Prior to 1993, no approved treatments were available for multiple sclerosis (MS). People who developed MS prior to the first treatments, unfortunately, had damage to their brain and spinal cords which often led to progressive disability. MS relapses are bouts of neurological symptoms such as numbness, weakness, imbalance and visual loss that can last days to months.
The first generation of self-injected medications reduced relapses by about one-third and as much as 80% of new brain disease seen on MRI (magnetic resonance imaging) scans. These medications fight the immune attack on the brain and spinal cord without compromising the body’s ability to fight infections. Tysabri (natalizumab), an infusion therapy given in the vein monthly, dropped relapses by 68% compared to placebo in clinical trial and has been available for treatment for over a decade.
Over the past 7 years, an array of new oral and antibody treatments for MS have become available that have unique effects on the immune system to block MS. Oral therapies are Aubagio, Gilenya and Tecfidera and new monoclonal antibody therapies are Lemtrada, Ocrevus, and Zinbryta. Some oral therapies have been shown to reduce relapses by more than half compared to placebo. Gilenya and Zinbryta demonstrated a superior reduction in relapses compared to Avonex. The advantages of good disease control must be balanced against serious risks of these drugs even if some risks are uncommon or rare.
Lemtrada (alemtuzumab) is a highly effective antibody therapy that in clinical trials has reduced relapses by half compared to Rebif. On Lemtrada, 43% of patients actually had less disability confirmed at end of 6 years compared to the onset of the study. Another antibody treatment, Ocrevus (ocrelizumab), also showed in clinical trials to reduced relapses almost in half and reduced contrast MRI activity by 95% compared to Rebif. Lemtrada transiently depletes T and B cells and Ocrevus consistently depletes B cells with potential serious risks including serious infusion reactions and serious infections.
One common approach to treating multiple sclerosis is starting with a self-injected medication with two decades of long-term safety information. These medications including Copaxone (glatiramer acetate) and interferons (including Avonex, Betaseron, Extavia and Rebif )have been effective for many patients without immune compromise. If new relapses, worsening disability or unchecked MRI activity occur, the first medication could be switched to another agent. The strategy is often referred to as “escalation” of treatment. This approach may be the safest option, but waiting too long to switch therapies may result in irreversible disability.
Another strategy is to seize the moment. People living with MS without new relapses and without new MRI activity have the best chance of preventing disability progression. One goal of MS treatment is achieving NEDA (No Evidence of Disease Activity) which means a patient is free of relapses, disability progression and MRI activity. Choosing a high-powered medication first to minimize risk of worsening disability to maximize quality of life is another treatment approach. Early in MS there can be changes such as nerve injury that may lead to irreversible disability. This earlier treatment approach tackles the disease aggressively from the start. Accepting potential long-term risks of these immune therapies with a lifelong disease is one concern. In addition, the use of some of these immune treatments might restrict the next treatment option. Not all therapies are indicated for first-line therapy in the United States.
Likely the best approach is a combination. This strategy involves stratifying the risk of disease, then matching with an appropriate medication. Some risk factors that increase risk for disability include being male, MS onset after age 40, incomplete recovery from first attack, frequent relapses the first 2 years of disease, spinal cord disease and higher amount of MS changes on initial MRI. Patients with lower risk of disability progression may choose a more conservative medication option. In contrast, someone at higher risk for disability may be willing to accept more risk for more effective treatment. It is critical for individuals living with MS to share their willingness to accept or not accept certain risks to control their disease. Neurologists also vary in their willingness to use higher risk medications which often influences the decision process. Each person living with MS should meet with their neurologist to clarify their individual risk of disability based on their disease.
Research advancements have led to a growing array of new MS therapies. To determine the best individualized treatment plan, being informed and open with healthcare providers is essential.
May 29 2017 Team MoBap at Walk MS
Dr. Singer and Dr. Tullman co-chaired Walk MS this April to raise funds for the National Multiple Sclerosis Society (NMSS). The funding is critical for new multiple sclerosis research to stop disease progression, restore function, and end MS forever. Team MoBap was back in force to support NMSS and The MS Center for Innovations in Care in their mission to improve the lives of those living with multiple sclerosis.