A number of preliminary studies have investigated the possible effects of natalizumab in progressive MS. The latest is the open-label phase IIb NAPMS trial that examined the effect of treatment on osteopontin, an inflammatory marker, and CSF neurofilament (NfL) light chain, a marker of axonal damage (Romme Christensen et al. Neurology 2014;82:1499-1507). Read More
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Citalopram a mixed blessing for AD agitation
July 8, 2015The Citalopram for Agitation in Alzheimer Disease Study (CitAD) randomized 186 AD patients with clinically significant agitation to psychosocial intervention with or without citalopram 30 mg/day for nine weeks (Porsteinsson et al. JAMA 2014;311:682-691). The dose of citalopram was titrated from 10 mg/day to the planned dose of 30 mg/day over three weeks. Read More
ACTH revisited: melanocortins and MS
June 11, 2015
Melanocortin system
Immune effects of ACTH-MCR interactions
ACTH vs. steroids
Commentary by Dr. Daniel Selchen, University of Toronto, Canada
NeuroSens Survey
A few decades ago, adrenocorticotropic hormone (ACTH) was routinely used for managing acute relapses in patients with multiple sclerosis. The efficacy of this approach was demonstrated in what was perhaps the first multicentre placebo-controlled study in MS, which also introduced the Disability Status Scale (DSS) as an endpoint (Rose et al. Trans Am Neurol Assoc 1969;94:126-133). Read More
Use of high-efficacy agents in MS: Updated data from AAN 2015
June 3, 2015
REVIEWER: Paul Giacomini, MD, FRCPC, Associate Director, Multiple Sclerosis Clinic, Montreal Neurological Hospital and Institute, Assistant Professor, Department of Neurology and Neurosurgery, McGill University, Canada
Switching studies
Effect on brain volume change
Updated safety data
The high-efficacy disease-modifying therapies (DMT; natalizumab, fingolimod, alemtuzumab) used to treat relapsing-remitting multiple sclerosis are often reserved for patients with severe disease at presentation or those with an inadequate response to other agents. However, these therapies are increasingly being employed earlier in the disease course. In part this is due to the growing recognition that first-generation injectable DMTs appear to have less impact on disability progression. In addition, there is increasing evidence that more potent suppression of inflammatory disease activity has the potential to reduce CNS tissue damage, slow the rate of brain volume loss and improve long-term physical and cognitive outcomes. However, the benefits of this more aggressive approach need to be weighed against the risk of adverse effects with higher efficacy agents. Read More