Faculty Opinions recommendation of Atorvastatin combined to interferon to verify the efficacy (ACTIVE) in relapsing-remitting active multiple sclerosis patients: a longitudinal controlled trial of combination therapy.

Tacrolimus is a calcineurin inhibitor which works to induce immune suppression by preventing cytokine transcription and lymphocyte activation. Combining the immunomodulator interferon beta-1b (Betaseron) with the immunosuppressant tacrolimus (Prograf) may have the potential of additive therapeutic benefit through the complementary mechanisms of action of these two therapeutics. In this randomized, open-label, multicenter, two-arm pilot study, the authors examined the safety and tolerability of the combination of interferon beta-1b and tacrolimus in relapsing remitting (RRMS) and secondary progressive (SPMS) multiple sclerosis patients who have failed one or more immunomodulatory therapies. Patients (n=25) received a combination of interferon beta-1b subcutaneously every other day and oral tacrolimus (low blood level tacrolimus, 1–5 ng/mL, or high blood level tacrolimus, 5–10 ng/mL) for a period of 38 weeks. The combination therapy of interferon beta-1b and tacrolimus over the 10-month period of the study was shown to be safe and relatively well tolerated. There were no unexpected adverse events occurring as the result of the combination therapy. Further study of this combination therapy in patients with multiple sclerosis unresponsive to conventional therapy is warranted.

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Switching treatments in clinically stable relapsing remitting multiple sclerosis patients planning for pregnancy

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/20552173211001571 ◽

2021 ◽

Vol 7 (1) ◽

pp. 205521732110015

Author(s):

Lubna Almouzain ◽

Fiona Stevenson ◽

Declan Chard ◽

Nur Abdul Rahman ◽

Fiona Hamilton

Keyword(s):

Multiple Sclerosis ◽

Case Reports ◽

Controlled Trial ◽

Current Evidence ◽

Cochrane Library ◽

Disease Modifying Drugs ◽

Increased Risk ◽

Relapsing Remitting ◽

Mother And Child ◽

Multiple Sclerosis Patients

Background The decision to have children can be complex, particularly for people with multiple sclerosis (MS). A key concern is the use of disease modifying drugs (DMDs) during pregnancy, and how continuing, stopping or switching them may affect the mother and child. In people with active MS, stopping medications puts the mother at risk of relapse and disease rebound. Objectives Review evidence on the effect of different switching strategies in people with stable relapsing remitting MS (RRMS). Methods We searched MEDLINE, EMBASE, EMCARE, CINAHL, SCOPUS, Cochrane Library up to March 2020. Only papers in English were included and no other limits were applied. Seven articles were included: four cohorts, two case reports and one randomized controlled trial (RCT). Results Two strategies were found: de-escalating, which was associated with an increased risk of relapses, and switching between first line injectables, with no change in relapse rate observed. Conclusion Evidence on the effect of switching strategy on disease course in stable RRMS patients planning for pregnancy is scarce, but when switching, current evidence suggests the risk of relapses mirrors known medication efficacy.

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