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MS treatment: What is Plan B?

December 5, 2013

Comment by Dr. Paul Steven Giacomini
NeuroSens survey on sequencing

The year 2013 was the twentieth anniversary of the first published trial of a disease-modifying therapy (DMT) in multiple sclerosis, an occasion marked by the arrival of two new oral agents in an expanding armamentarium of MS therapies. Teriflunomide got the green light in Canada and Europe (previously approved in the U.S.); and dimethyl fumarate (DMF) was approved in Canada and the U.S. (but is still pending in Europe).

Laquinimod, fast-tracked by the FDA four years ago, appears to be idling at the curb. Read More

No additive relapse risk with second pregnancy

December 2, 2013

REPORT FROM THE EUROPEAN CHARCOT FOUNDATION ANNUAL MEETING – BAVENO, ITALY, NOVEMBER 28-30, 2013 – It is well established that relapse frequency declines during pregnancy, followed by an increased relapse risk during the first three months postpartum (Vukusic et al. Brain 2004;127(Pt 6):1353-1360). A similar pattern appears to occur during a second pregnancy, so relapse risk is not additive, according to Dr. Sandra Vukusic, Lyons, France (Vukusic S. ECF 2013).

When faced with a patient who wants to become pregnant again, clinicians can offer the same advice as they gave for the first pregnancy. It should be noted that patients receiving in vitro fertilization have a higher risk of relapse following the procedure because of exposure to gonadotrophin releasing hormone (GnRH) agonists; the relapse risk is higher in women who do not become pregnant with IVF (Michel et al. J Neurol Neurosurg Psychiatry 2012;83:796-802).

Switching therapies: two approaches

December 2, 2013

REPORT FROM THE EUROPEAN CHARCOT FOUNDATION ANNUAL MEETING – BAVENO, ITALY, NOVEMBER 28-30, 2013 – The optimal strategy for managing patients with an inadequate response to an initial disease-modifying therapy (DMT) was the focus of discussion at a session of the ECF annual meeting and two somewhat different approaches were presented.

Prognostic value of CSF analysis

November 30, 2013

REPORT FROM THE EUROPEAN CHARCOT FOUNDATION ANNUAL MEETING – BAVENO, ITALY, NOVEMBER 28-30, 2013 – Lumbar puncture was once part of the routine work-up of MS patients but the usefulness of CSF oligoclonal bands (OCB) in the diagnosis of MS was de-emphasized following the publication of the revised McDonald criteria (Polman et al. Ann Neurol 2005;58:840-846).

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