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MS: Disease Management and Therapeutics

   
 
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Dr. Louisa Lavy, a neurologist specializing in Multiple Sclerosis (MS) at the Kootenai Medical Center in Coeur d'Alene, ID, spoke to MS/Cancer Support Group members about drug therapies for MS and why it is important to take charge of your disease.

Dr. Lavy said, “We know there is no cure for MS now, but many more therapies are available today to help manage the disease. These therapies may slow it down and help control symptoms.”

To help patients from a neurologist’s point of view, Lavy suggests that patients know how doctors determine if your drug is working and what they watch for. This knowledge will help you take charge in your treatment.

Lavy said, “Instead of a watch-and-wait approach, which is what we used to do before therapies were available, we are now much more proactive about preventing disease progression.”

Patients have different types and stages of MS, which determines treatment response and how we treat. Early MS patient treatment is different than late MS treatment.

“It is important to know what type and stage of MS you have,” Dr. Lavy explained.

Diagnosis of MS is a diagnosis of exclusion and can take a long time to rule out other diseases and processes that mimic MS. Some types of MS require a yearlong period of monitoring to confirm the diagnosis.

Physicians evaluate MS progression in several ways:
• Radiographic: Looking for new lesions, gadolinium-enhanced lesions, or loss of brain or spinal cord tissue on MRI
• Electrophysiological: Measuring changes in nerve conduction in sensory or visual pathways
• Neurologic Exam: Measuring functional changes on exam (strength, sensation, coordination, balance, cognition, etc.)
• Clinical monitoring: Assessing the patient’s stability in terms of new symptoms and relapses

In recent years, several FDA-approved disease-modifying agents have become available in MS therapy. Dr. Lavy explained that a common course of action is escalating therapy, when treatment starts with safest drugs. If that fails, doctors will move to more effective drugs that unfortunately may have more side effects.

The U.S. Food and Drug Administration (FDA) approved drugs for the treatment of MS, six are considered first-line options. Of these, five are delivered by injection: Avonex® (interferon beta-1a); Betaseron® (interferon beta-1b); Copaxone® (glatiramer acetate); Extavia® (interferon beta-1b) and Rebif® (interferon beta-1a). GilenyaTM (fingolimod) is a capsule taken by mouth.

Dr. Lavy said, “The more you know about your MS, the more informed and involved you will be in your therapy treatment.”

Additional source: www.nationalmssociety.org

Four Courses of MS

Relapsing-remitting MS (RRMS)
With RRMS, the periods of attacks often last three weeks followed by the patient experiencing full or partial recovery with some disability. After the attack, the patient is in remission until the next attack.

Primary Progressive MS (PPMS)
PPMS disability progresses from the onset, without remissions or with occasional leveling off and temporary minor improvements and no acute attacks. Of those diagnosed, only 10 percent have PPMS. Often the diagnosis is made long after the patient has neurological symptoms and significant disability.

Secondary-progressive MS (SPMS)
SPMS starts with a relapsing-remitting disease course and moves to a more progressive course. Patients have less recovery following attacks, persistently worsening functioning during and progressive disability. Of the 85 percent who start with relapsing-remitting disease, more than 50 percent will develop SPMS within 10 years and 90 percent within 25 years.

Progressive-Relapsing MS (PRMS)
PRMS is the least common disease course and shows disability progression from the start with acute relapses, with or without full recovery. Approximately five percent of people with MS have PRMS at diagnosis.

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