Journal Club

Promising New Treatment Regimens For Multiple Sclerosis

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Instructions

Take Another Course

Post-Test

References

Objectives:

Upon completion of this Journal Club the participant will be able to:

1. Describe two appropriate criteria for study endpoints as recommended by the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines groups.
2. List three categories of treatments described in treatment guidelines published by Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines.
3. Compare the effects of two different interferon β-1a regimens on MRI outcomes
4. Describe one benefit and one potential detrimental effect of a higher dose. interferon β-1a regimen in relapsing-remitting MS (RRMS) patients.
5. Describe the proposed mechanism for natalizumab in MS treatment.

List two potential benefits seen in the natalizumab study described in this Journal Club.

Introduction:

Multiple sclerosis (MS) is characterized by nerve damage in the central nervous system (CNS).  The inflammation seen in MS can result in damage mostly to oligodendrocytes and myelin sheaths with potential damage to axons and the actual nerve cells.  The result includes symptoms of functional problems in the following areas: sensory capacity of limbs, optic nerve, bladder, bowel, muscular coordination, motor cell (pyramidal tract), double vision, and sexual dysfunction.

There are four main types of MS:

1.      relapsing-remitting MS (RRMS)

2.      secondary progressive MS (SPMS)

3.      primary progressive MS (PPMS)

4.   progressive-relapsing MS (PRMS)

RRMS include “attacks” of neurologic dysfunction that are self-limiting.  SPMS occurs after RRMS.  During SPMS there are typically fewer attacks but the onset of a progressive deterioration in function.  PPMS is characterized by a progressive deterioration without acute attacks while PRMS includes a progressive decline with occasional acute attacks.