Comment by Dr. Daniel Selchen – St. Michael’s Hospital, Toronto, Ontario
An estimated 70% of clinicians managing multiple sclerosis experience therapeutic inertia when faced with the decision to escalate therapy, according to a series of studies conducted by Saposnik and colleagues. This delay in the use of more effective therapies may result in worse clinical outcomes. Read More
Comment by Diane McIntosh, BSc Pharmacy, MD, FRCPC – Vancouver, British Columbia
Among the many clinical challenges in the management of bipolar I disorder, the need for effective treatments that maintain symptomatic remission and promote long-term adherence is paramount. Depending on the study population and the methodology employed, up to 60% of patients diagnosed with bipolar disorder do not adhere to treatment recommendations (Colom et al. Bipolar Disord 2005;7(suppl 5):24-31). A recent study reported that patients with bipolar disorder missed doses a mean of three days in the preceding week (Levin et al. J Nerv Ment Dis 2017;205:182-187). Treatment nonadherence is a major risk factor for relapse, readmission to hospital and suicidality (Rascati et al. Psychiatr Serv 2011;62:1032-1040) and is associated with higher rates of work absenteeism and disability (Bagalman et al. J Occup Environ Med 2010;52:478-485). Read More
This year marks the 25th anniversary of the publication of the Betaseron phase III study (Interferon-beta MS Study Group. Neurology 1993;43:655-661), which ushered in the era of disease-modifying therapies in the treatment of multiple sclerosis. In the usual course of things, first-generation agents – especially drugs administered by injection – would be superseded by novel therapies, either a more convenient oral agent (fingolimod, teriflunomide, dimethyl fumarate, cladribine) or a more potent infusion drug (natalizumab, alemtuzumab, ocrelizumab). Market shares have shifted but all treatments remain available, resulting in the present state of a surprisingly lengthy list of options. This raises the questions: are so many medications needed, and what is the role of injectable agents in MS management? Read More
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Calcitonin gene-related peptide (CGRP) inhibitors are emerging as an important class of agents for the prevention of episodic and chronic migraine (See Targeting CGRP in migraine, NeuroSens, March 28, 2018). Four monoclonal antibodies are currently in development: erenumab, a fully-human MAb targeting the CGRP receptor; and three humanized MAbs targeting the CGRP ligand (fremanezumab, eptinezumab, galcanezumab). Erenumab received FDA approval for the treatment of migraine this week. Read More