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Multiple Sclerosis & Treatment

of Progression with Interferon-


Beta-1a
What is Multiple Sclerosis?
Most commonly defined as an
autoimmune disease that affects the CNS
Characterized by the loss and/or damage
of the myelin sheath
Loss of myelin sheath results in the
inability of neurons to transmit neural
signals properly, causing the many
symptoms of MS
Unpredictable and no known cures
Anatomy of the Neuron
Four Major Varieties of MS
Relapsing/remitting (RRMS)
Characterized by periods of flare-ups and
remission
Accounts for 85% of MS patients
Primary Progressive (PPMS)
Slow continuous worsening of disease from
onset
Only about 10%
Four Major Varieties of MS
(cont.)
Secondary Progressive (SPMS)
Initial period of relapsing-remitting, then
steady worsening of disease
50% of patients diagnosed with RRMS
develop into this variety within 10 yrs without
drug treatment
Progressive Relapsing (PRMS)
Steady worsening with acute relapses
Different from RRMS in that disease
progresses during relapses
What Causes MS?
Not exactly known
Several theories
Most commonmyelin damage results
from abnormal response in the immune
system
T cells (type of white blood cell) attack myelin
Though to be triggered by environmental
and/or genetic factors
Many other theories
MS is pathogen-mediated
Research suggests Chlamydia Pneumoniae
and other pathogens may trigger MS
Genetics
Identical twin studies-> one has MS, other has
30% chance
No specific gene/s found yet
Most likely involves a combination
MS Geography
Typical onset between ages 20-50
Reduces life expectancy by about 10-15 yrs
About patients survive 30+ yrs from onset
Affects 2-3 times as many women than men
Research suggests that genetic factors play a
role
More common among people of European
descent
About 400,000 Americans have MS
Symptoms of MS
Wide variety due to nature of disease
Different classifications of symptoms
Visual
Motor
Sensory
Cognitive
Coordination/Balance
Bowel, Bladder, and Sexual
Others
Diagnosis of MS
No single test for diagnosing MS
Usually diagnosed when all other
possibilities ruled out
Many tests
Medical history
Nervous system functioning
MRI, Evoked potential tests, spinal tap
Basic Rule for Diagnosis
Est. by committee sponsored by NMSS in
1965
Must have BOTH of the following:
Evidence of myelin loss in at least 2 areas
occurring in different places at different times
Any other diseases that could account for the
above have been ruled out
Revised in 1983 by Poser to take into
account advances in MRI technology
Treatments for MS
No known cure
Treatments involve relieving the symptoms
or slowing the progression of the disease
These are mostly drug treatments
Also CAMs- Complementary and
Alternative Medicine
CAMs
Used with or instead of conventional drug
treatments
Some include
Acupuncture
Herbal medicine
Yoga
Relaxation techniques
Hypnosis
Conventional Drug Treatments
Disease-modifying drugs*
ABC Treatments
Chemotherapeutic Agents
Corticosteroids & ACTH
Drugs that help with symptoms
Wide variety from anti-depressants
(depression) to laxatives (bowel dysfunction)
to anti-convulsants (pain/altered sensations)
ABC Treatments
Most popular drug treatments for
modifying course of disease
Work by regulating aspects of the
immune system
ABC refers to the 3 major brand names
of this category of drugs: Avonex,
Betaseron/Betaferon, and Copaxone
Also now added Rebif and Novantrone
ABC Treatments Cont.
Interferon beta-1a
Avonex, Rebif
Interferon beta-1b
Betaseron/Betaferon
Glatiramer acetate
Copaxone
Mitoxantrone
Novantrone
What are Interferons?
Occur naturally in human body
Proteins that prevent viral multiplication by
stimulating the production of antiviral
proteins in normal cells
Interferon-alpha, Interferon-beta, and
Intereron-gamma
Avonex
Interferon-beta-1a
Used for RRMS and SPMS w/relapses
Produced by recombinant DNA
technology using genetically engineered
Chinese Hamster Ovary cells into which
the human interferon beta gene has been
introduced
The resulting amino acid sequence is
identical to human interferon beta
Avonex
Mechanisms by which it exerts it effects
not fully understood
Pharmacokinetics in MS patients not
evaluated
Recommended dosage of 30 mcg to be
injected intramuscularly one weekly
Not recommended subcutaneously- adverse
reactions mainly at site of injection*
No known interactions with other drugs
Safet of doses abo e 60 mcg has not
Current Avonex Research
Avonex fairly new
Lots of research being done, few consistent
findings yet
Most research with Avonex focuses on:
Comparison with other drugs of its type
Testing properties of the drug by altering
dosages,etc.
Seeing how well drug modifies disease
course in placebo studies
Future Research on MS
Finding the cause
Stopping/slowing progress of disease
Repairing damage already done
Remyelination
Better ways of treating symptoms
Focusing on the social implications
Recommended Websites to
Learn More
http://www.avonex.com
http://www.nationalmssociety.org

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