Multiple Sclerosis in Practice An Expert Commentary with Fred D. Lublin, MD, FAAN A Clinical Context Report
Clinical Context: Multiple Sclerosis in Practice Expert Commentary Jointly Sponsored by: and
Clinical Context: Multiple Sclerosis in Practice Expert Commentary This activity is supported in part by an educational grant from Teva Pharmaceuticals
Multiple Sclerosis Clinical Context Series The goal of this program is to provide upto-date information and multiple perspectives on the pathogenesis, symptoms, risk factors, and complications of multiple sclerosis as well as current and emerging treatments and best practices in the management of multiple sclerosis.
Multiple Sclerosis Clinical Context Series Target Audience Multiple sclerosis physician specialists, community neurologists, advanced practice healthcare professionals, primary care physicians, multiple sclerosis nurse specialists, nurse practitioners, physician assistants, pharmacists and other allied health professionals involved in the care of patients with multiple sclerosis.
Activity Learning Objective Upon successful completion of this educational program, participants should be able to: Review the relevance and significance of the activity in the broader context of clinical care.
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Discussant Fred D. Lublin, MD,FAAN, Saunders Family Professor of Neurology Director, The Corinne Goldsmith Dickinson Center for Multiple Sclerosis Co-Chief Editor, Multiple Sclerosis and Related Disorders Mount Sinai School of Medicine New York, NY
Disclosure Information Fred D. Lublin, MD, FAAN, has disclosed the following relevant financial relationships: Received Research Support: Acorda Therapeutics; Biogen Idec; Celgene; Genzyme; NIH; NMSS; Novartis; sanofi-aventis; Teva Neuroscience Consulting/Advisory Board/DSMB: Acorda Therapeutics, Actelion; Bayer HealthCare; Biogen Idec; Bristol-Myers Squibb, Xenoport; Celgene; Coronado Bioscience, Genzyme, MedImmune; EMD Serono; Johnson & Johnson; Novartis; Pfizer; Questcor; Revalesio; Roche, Genentech; Teva Neuroscience; sanofi-aventis Shareholder: Cognition Pharmaceuticals This activity may review off-label or investigational information without any recommendation on their use.
Disclosure Information Robert Jasmer, Associate Clinical Professor of Medicine, University of California San Francisco; John Gever; and Dorothy Caputo, MA, BSN, RN, Nurse Planner, have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity. The staffs of Projects In Knowledge and MedPage Today have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
MS Classifications: Introduction Current major MS classifications: Relapsing-remitting Secondary progressive Primary progressive Progressive-relapsing Represent clinical phenotypes, not underlying biology NMSS/ECTRIMS committee to reexamine system
MS Classifications: Problems Failed to take into account clinical and radiologic isolated syndromes Different MRI findings in subgroups of patients within classifications Levels of axon loss, neuron loss, demyelination are not accounted for
Toward a New MS Classification System May add specifiers to major types E.g., RRMS stable for patients with relapsing-remitting MS but free of disease activity Would be helpful in clinical trials where homogeneous patient samples are desired
Clinical Impact May guide therapy, as evidence base accumulates to identify subtypes with differential responses to standard treatments Recent trials (e.g., CombiRx) may supply much of the needed data
Clinical Impact (cont d) Current research may help pinpoint when RRMS patients transition to secondary progressive disease Could trigger change in therapy if this were well defined
The Near Future Examining data from recent studies and those now ongoing Identifying additional research needs Securing funding for new studies when necessary Educating the MS community
Summary Recognize that current MS classifications are clinical phenotypes that do not take account of differences among patients in underlying biology Understand that MRI findings and other biomarkers may be useful in establishing additional specifiers or subtypes within major MS classifications Appreciate that a biologically based taxonomy of MS will improve research and eventually patient care