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Treatment Approaches in MS

This document summarizes a presentation on treatment approaches in multiple sclerosis (MS). The presentation was given by two neurologists with expertise in MS and was supported by educational grants from several pharmaceutical companies. The presentation reviewed current MS disease-modifying therapies including injectables, oral therapies, and monoclonal antibodies. It discussed using biomarkers like MRI and optical coherence tomography findings to help determine prognosis, as well as using predictive biomarkers to help decide between escalating therapy or initiating induction treatment. The goal was to apply evidence on safety and efficacy of high-efficacy MS drugs to make informed treatment decisions for patients with relapsing and progressive forms of MS.

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Snezana Mihajlovic
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92 views15 pages

Treatment Approaches in MS

This document summarizes a presentation on treatment approaches in multiple sclerosis (MS). The presentation was given by two neurologists with expertise in MS and was supported by educational grants from several pharmaceutical companies. The presentation reviewed current MS disease-modifying therapies including injectables, oral therapies, and monoclonal antibodies. It discussed using biomarkers like MRI and optical coherence tomography findings to help determine prognosis, as well as using predictive biomarkers to help decide between escalating therapy or initiating induction treatment. The goal was to apply evidence on safety and efficacy of high-efficacy MS drugs to make informed treatment decisions for patients with relapsing and progressive forms of MS.

Uploaded by

Snezana Mihajlovic
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Treatment Approaches in MS:

Criteria for Decision-Making

Presented by:

Robert K. Shin, MD, FANA, FAAN


Professor, Department of Neurology
MedStar Georgetown University Hospital
Director, Georgetown Multiple Sclerosis and Neuroimmunology Center
Georgetown University Medical Center

Lilyana Amezcua, MD, MS, FAAN


Associate Professor of Neurology
Multiple Sclerosis Fellowship Program Director
Multiple Sclerosis Comprehensive Care and Research Group
University of Southern California, Keck School of Medicine

This activity is supported by educational grants from Bristol Myers Squibb, 1


Novartis Pharmaceuticals Corporation, and Sanofi Genzyme.
Faculty Disclosures

 Robert K. Shin, MD, FANA, FAAN


− Consulting Fee: Biogen, Bristol Myers Squibb, EMD Serono,
Genentech, Mallinckrodt, Novartis, and Sanofi Genzyme
− Speakers Bureau: Biogen, Bristol Myers Squibb, EMD
Serono, Genentech, Mallinckrodt, Novartis, and Sanofi
Genzyme

 Lilyana Amezcua, MD, MS, FAAN


− Consulting Fee: EMD Serono and Genentech

− Speakers Bureau: Alexion

− Contracted Research: Biogen and Genentech


2
Learning Objectives

 Summarize current and emerging biomarkers in


MS, their association with disease development
and progression, and their role in making
treatment decisions
 Apply current evidence about long-term safety and
efficacy outcomes of treatment with high-efficacy
DMTs in patients with relapsing and progressive
forms of MS

3
MS Disease-Modifying Therapies (DMTs)

 First generation injectables


− Interferons (beta interferon-1a, beta interferon-1b, peginterferon-1a)
− Glatiramer acetate
 Oral Therapies
− S1P agents (fingolimod, siponimod, ozanimod, ponesimod)
− Fumarates (dimethyl fumarate, diroximel fumarate, monomethyl
fumarate)
− Teriflunomide
− Cladribine
 Monoclonal antibodies
− Natalizumab
− Alemtuzumab
− Anti-CD20 agents (ocrelizumab, ofatumumab)
4
Treatment Decisions

 Lower efficacy DMTs vs higher efficacy DMTs

 Safety vs efficacy

a
5
Biomarkers

 Diagnostic

 Prognostic

 Predictive

a
6
Audience Polling Question

Which is a marker for the


differential diagnosis of MS?

A. Anti-AQP4
B. Optical coherence tomography
C. Oligoclonal bands
D. Unsure

7
Diagnostic Biomarkers

 Magnetic resonance imaging (MRI)


− Dissemination in space
− Dissemination in time
− Central vein sign?

 Oligoclonal bands
− Dissemination in time

 Anti-AQP4 and anti-MOG antibodies


− Neuromyelitis optica spectrum disorder (NMOSD)
− Myelin oligodendrocyte glycoprotein antibody disorder (MOGAD)
a
8
Prognostic Biomarkers

 MRI
− T2 lesions/T1 gad+ lesions/T1 “black holes”
− Volumetric MRI

 Optical coherence tomography (OCT)

 Serum neurofilament light (sNfL)

a
9
T2 FLAIR Lesions

Courtesy of RS Shin
10
T1 “black hole”
Gadolinium enhancing lesion

Courtesy of RS Shin
11
Predictive Biomarkers?

aa

12
Treatment Decisions

 Escalation vs induction
 Sequencing

a
13
Ontaneda D et al. Lancet Neurol. 2019;18(10):973-980.
Join us for Additional Modules on
Biomarkers, Race, Gender, and Genetics in MS:
Precision Medicine in 2021 and Beyond

Available August 27, 2021 – September 10, 2022


▪ Session 1: Racial and Genetic Implications for MS Treatment Selection

Available September 10, 2021 – September 10, 2022


▪ Session 2 – Bite 1: Treatment Approaches in MS: Criteria for Decision-
Making
▪ Session 2 – Case 1: Management of MS in African Americans/Blacks
▪ Session 2 – Case 2: Young Latina MS Patient and Family Planning
▪ Session 2 – Case 3: CIS: Treating or Not Treating and with What?

14
Thank you for
participating today!

Visit NeuroSeriesLive.com for Additional Live and


Endured CME/CE Neurology Activities.

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