scholarly journals Stopping Disease-Modifying Therapy in Nonrelapsing Multiple Sclerosis

2017 ◽  
Vol 19 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Gary Birnbaum
Keyword(s):  
Multiple Sclerosis ◽  
Acute Disease ◽  
Published Data ◽  
Secondary Progressive ◽  
Disease Modifying Therapy ◽  
Scale Scores ◽  
Group A ◽  
Multiple Variables ◽  
Disease Modifying ◽  
Group B

Background: Current disease-modifying therapies (DMTs) are of benefit only in people with relapsing forms of multiple sclerosis (RMS). Thus, safely stopping DMTs in people with secondary progressive MS may be possible. Methods: Two groups of patients with MS were studied. Group A consisted of 77 patients with secondary progressive MS and no evidence of acute central nervous system inflammation for 2 to 20 years. These patients were advised to stop DMTs. Group B consisted of 17 individuals with RMS who stopped DMTs on their own. Both groups were evaluated at treatment cessation and for a minimum of 1 year thereafter. Multiple variables were assessed to determine those that predicted recurrent acute disease. Results: Nine patients in group A (11.7%) and ten patients in group B (58.8%) had recurrent acute disease, almost always within 1 to 2 years of stopping treatment. The only variable of significance in group A distinguishing stable and relapsing patients was age (P = .0003), with relapsing patients being younger. Group B patients were younger and had significantly lower Expanded Disability Status Scale scores than group A, with no significant differences in age between relapsed and stable patients. Conclusions: The DMTs can be stopped safely in older patients with MS (≥7 decades) with no evidence of acute disease for 2 years or longer, with an almost 90% probability of remaining free of acute recurrence. The high proportion of untreated patients with RMS experiencing recurrent acute disease is consistent with published data.

scholarly journals Association of Initial Disease-Modifying Therapy With Later Conversion to Secondary Progressive Multiple Sclerosis

JAMA ◽  
2019 ◽  
Vol 321 (2) ◽  
pp. 175 ◽  
Author(s):  
J. William L. Brown ◽  
Alasdair Coles ◽  
Dana Horakova ◽  
Eva Havrdova ◽  
Guillermo Izquierdo ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Secondary Progressive ◽  
Disease Modifying Therapy ◽  
Disease Modifying

COVID-19 in two patients with multiple sclerosis treated with beta interferons

2021 ◽  
Vol 36 (4) ◽  
pp. 327-334
Author(s):  
Karolina Kania ◽  
Elżbieta Tokarz-Kupczyk ◽  
Alicja Kalinowska-Łyszczarz
Keyword(s):  
Multiple Sclerosis ◽  
Interferon Beta ◽  
Medical Literature ◽  
Case Reports ◽  
Published Data ◽  
Clinical Experiences ◽  
Disease Modifying Therapy ◽  
Increased Risk ◽  
Disease Modifying ◽  
Benign Course

Objectives. Treatment of multiple sclerosis (MS) in the era of the COVID-19 (coronavirus disease 2019) pandemic raises many questions for doctors. Case reports. We are presenting two cases of patients suffering from multiple sclerosis (MS) treated with interferon beta-1b and interferon beta-1a, who suffered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with a benign course in one case and an asymptomatic one in another. None of the patients required hospitalisation. Conclusions. MS treatment during coronavirus disease 2019 (COVID-19) pandemics poses several questions. Considering our own clinical experiences, we present a brief review of medical literature on the safety of MS immunotherapy. So far, the published data on MS and COVID-19 do not show increased risk associated with MS diagnosis or disease modifying therapy, even when associated with immunosuppression.

Randomized study of antibodies to IFN-g and TNF-a in secondary progressive multiple sclerosis

2001 ◽  
Vol 7 (5) ◽  
pp. 277-284 ◽  
Author(s):  
S Skurkovich ◽  
A Boiko ◽  
I Beliaeva ◽  
A Buglak ◽  
T Alekseeva ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Controlled Trial ◽  
Randomized Study ◽  
Progressive Multiple Sclerosis ◽  
Double Blind ◽  
Secondary Progressive ◽  
Number Of Patients ◽  
Scale Scores ◽  
Term Administration ◽  
Group A

Studies of cytokines in multiple sclerosis (MS) have shown that immune mechanisms connected with disturbance of the synthesis of cytokines probably play critical roles in the initiation and prolongation of MS. In a double-blind, placebo-controlled trial, 45 patients with active secondary progressive MS were randomized to three groups of 15 patients, each receiving a short course of antibodies to IFN-g, to tumor necrosis factor (TNF)-a, or a placebo. After 12 months with analysis of disability (Expanded Disability Status Scale scores), accompanied by interval determinations of lymphocyte subpopulations, cytokine production levels, MRI, and evoked potentials, it was found that only patients who received antibodies to IFN-g showed statistically significant improvement compared to the placebo group-a significant increase in the number of patients without confirmed disability progression. This was supported by MRI data (a decrease in the number of active lesions) and systemic changes in cytokine status (a decrease in IL-1b, TNF-a, and IFN-g concentrations in supernatants of activated blood cells of these MS patients and an increase in TGF-b production). Neutralization of IFN-g could be a new approach to treating secondary progressive MS. Long-term administration of humanized monoclonal antibodies to IFN-g and simultaneous use of antibodies to IFN-g together with IFN-b products are planned.

Discontinuing disease-modifying therapy in progressive multiple sclerosis: can we stop what we have started?

2009 ◽  
Vol 15 (12) ◽  
pp. 1528-1531 ◽  
Author(s):  
Roisín Lonergan ◽  
Katie Kinsella ◽  
Marguerite Duggan ◽  
Sinead Jordan ◽  
Michael Hutchinson ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Rural Areas ◽  
Expert Knowledge ◽  
Significant Proportion ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive ◽  
Disease Modifying Therapy ◽  
Disease Modifying Therapies ◽  
Costs Of Disease ◽  
Disease Modifying

Disease-modifying therapy is ineffective in disabled patients (Expanded Disability Status Scale [EDSS] > 6.5) with secondary progressive multiple sclerosis (MS) without relapses, or in primary progressive MS. Many patients with secondary progressive MS who initially had relapsing MS continue to use disease-modifying therapies. The enormous associated costs are a burden to health services. Regular assessment is recommended to guide discontinuation of disease-modifying therapies when no longer beneficial, but this is unavailable to many patients, particularly in rural areas. The objectives of this study are as follows: 1. To observe use of disease-modifying therapies in patients with progressive multiple sclerosis and EDSS > 6.5. 2. To examine approaches used by a group of international MS experts to stopping-disease modifying therapies in patients with secondary progressive MS without relapses. During an epidemiological study in three regions of Ireland (southeast Dublin city, and Wexford and Donegal Counties), we recorded details of disease-modifying therapies in patients with progressive MS and EDSS > 6.5. An e-questionnaire was sent to 26 neurologists with expert knowledge of MS, asking them to share their approach to stopping disease-modifying therapies in patients with secondary progressive MS. Three hundred and thirty-six patients were studied: 88 from southeast Dublin, 99 from Wexford and 149 from Donegal. Forty-four had EDSS > 6.5: 12 were still using disease-modifying therapies. Of the surveyed neurologists, 15 made efforts to stop disease-modifying therapies in progressive multiple sclerosis, but most did not insist. A significant proportion (12 of 44 patients with progressive MS and EDSS > 6.5) was considered to be receiving therapy without benefit. Eleven of the 12 were from rural counties, reflecting poorer access to neurology services. The costs of disease-modifying therapies in this group (>170,000 yearly) could be re-directed towards development of neurology services to optimize their management.

scholarly journals Multiple sclerosis and pregnancy. Impact of multiple sclerosis disease-modifying therapy on the health of newborns

2021 ◽  
Vol 15 (3-4) ◽  
pp. 19-25
Author(s):  
T. I. Yakushina
Keyword(s):  
Multiple Sclerosis ◽  
Perinatal Period ◽  
Pulse Therapy ◽  
Reproductive Age ◽  
Published Data ◽  
Disease Modifying Therapy ◽  
Multiple Sclerosis Disease ◽  
Causal Therapy ◽  
History Of ◽  
Disease Modifying

Background. Due to the high prevalence of multiple sclerosis (MS) among women of reproductive age, special attention is paid to the management of pregnancy in them. The problem concerning the health of infants born to mothers with MS receiving disease-modifying therapy has not yet been addressed. It is necessary to identify the timing of cessation of drugs changing the course of MS, as well as to find the possibility of mitigating exacerbations during pregnancy using corticosteroid therapy.Objective: to analyze the effects of causal therapy for MS on the health of newborns.Materials and methods. This study included 154 women with MS residing in Moscow region and receiving disease-modifying therapy. We evaluated the course of pregnancy, delivery, and the condition of infants born to these mothers.Results and conclusions. Our findings are consistent with the earlier published data in the general cohort of pregnant women and allowed us to conclude that the presence of MS and history of immunomodulatory therapy do not significantly affect the outcome of pregnancy. The incidence and severity of disorders in infants born to MS mothers did not significantly differ from those in the general population. Prolongation of therapy with drugs that change the course of MS up to pregnancy is most appropriate, since it stabilizes the condition of women in the perinatal period, without causing significant harm to the health of newborns. Immunosuppressive therapy increases the risk of various disorders in infants (such as multiple malformations, low birth weight, prematurity). If a woman develops an exacerbation of MS during pregnancy, it is possible to prescribe a short course of pulse therapy with methylprednisolone.

Effect of parenteral cladribine on relapse rates in patients with relapsing forms of multiple sclerosis: results of a 2-year, double-blind, placebo-controlled, crossover study

2009 ◽  
Vol 15 (6) ◽  
pp. 767-770 ◽  
Author(s):  
Z Stelmasiak ◽  
J Solski ◽  
J Nowicki ◽  
B Jakubowska ◽  
M Ryba ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Crossover Study ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Sustained Reduction ◽  
Scale Scores ◽  
Group A ◽  
Group B ◽  
Favorable Safety ◽  
Relapse Rates

Objective This randomized, 2-year, double-blind, placebo-controlled, crossover study evaluated cladribine for relapsing forms of multiple sclerosis. Design Patients ( n = 84) received seven 5-day courses of subcutaneous cladribine at 5 mg/day (group A) or placebo (group B) in year 1; treatment was reversed in year 2. Results Cladribine was well tolerated and associated with a favorable safety profile. Mean Expanded Disability Status Scale scores remained stable. In group A, mean relapse rates were 0.15 in year 1 (cladribine) and 0.42 in year 2. In group B, relapse rates were 0.61 in year 1 and 0.50 in year 2 (cladribine). Patients required fewer steroid courses during cladribine periods. The therapeutic efficacy of cladribine was associated with a sustained reduction in lymphocyte count.

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