Autoimmunity: Multiple Sclerosis

Question 1

MS: Potential molecular mimicry with myelin basic protein?
Mention the pathogens.

Answer 1

Question 2

Answer 2

Question 3

Diagnose

Answer 3

Question 4

what do you see

Answer 4

Question 5

Treatment of MS relapses?

Answer 5

Question 6

What to keep in mind when treating MS relapses with Methylprednisolone? (4 points)

Answer 6

Question 7

DISEASE MODIFYING DRUGS role in treating MS? (4 points)

Answer 7

Question 8

Therapies to prevent relapses?

Mention 3 examples, their routes and their doses.

Answer 8

Question 9

Mechanism of action for Glatiramer actetae?

Answer 9

Question 10

Advantages of Glatiramer actetae?

Answer 10

• Regulates immune system

• Reduces relapse rate by 30%

• No effect on primary progressive MS

• No trials in secondary progressiveMS

Question 11

Natalizumab mechanism of action?

Answer 11

• Recombinant, humanized antibody

• Binds to alpha-4 integrin on the immune cells and prevent their migration into the CNS via the blood brain barrier

Question 12

Dosage and route of Natalizumab?

Answer 12

Given once per month intravenously

Question 13

Advantages of Natalizumab? (3 points)

Answer 13

Advantages
• Reduces relapse rate by 68%
• 80-90% reduction in new MRI lesions
• Reduces rate of disability progression by 42%

Question 14

What is Teriflunomide?
-Mechanism
-Effectiveness
-Indications

Answer 14

Question 15

Main side effects of Teriflunomide? (5 points)

Answer 15

-slight thrombocyte and leukocyte reduction
- gastrointestinal symptoms
-hepatic impairment
-reversible hair thinning
-peripheral neuropathies and acute uric acid nephropathy

Question 16

Mechanism of action for Dimethyl fumarate (Tecfidera)?

Answer 16

-amplification of Th2 responses

-Has antioxidative and immunoregulatory effects

-Modulation of the differentiation of antigen presenting cells.

Question 17

Comment on the Effectiveness of Dimethyl fumarate (Tecfidera)

Answer 17

Effectiveness: reduction of relapse rate by approx. 50% vs. placebo

Question 18

Indication to use Dimethyl fumarate (Tecfidera)?

Answer 18

RRMS

Question 19

Main side effects for Dimethyl fumarate (Tecfidera)?

Answer 19

gastrointestinal side effects, flush and lymphopenia.

Question 20

The first oral FDA approved drug for relapsing form of MS?

Answer 20

Fingolimod (Gilenya)

Question 21

Mechanism of Fingolimod (Gilenya)?

Answer 21

Mechanism : Binds to SP1 receptor on lymphocyte , the receptor becomes internalized and it causes the lymphocyte to be sequestrated in lymphoid tissue.

Question 22

Comment on the effectiveness of Fingolimod (Gilenya)?

Answer 22

reduction in the rate of relapses by approx. 55% vs. placebo

Question 23

Indications of Fingolimod (Gilenya)?

Answer 23

RRMS

Question 24

Main side effects of Fingolimod (Gilenya)?

Answer 24

-VZV reactivation
-PML cases
-basal cell carcinoma
-transient bradycardia
-macular edema
-haemophagocytic syndrome.

Question 25

Identify the drug: ‘A monoclonal antibody binds to CD 20 a cell expressed on B cells and depletes B cell through antibody dependent cell mediated cytotoxicity.’

Answer 25

Ocrelizumab (Ocrevus)

Question 26

What is Ocrelizumab (Ocrevus)?

Answer 26

A monoclonal antibody binds to CD 20 a cell expressed on B cells and depletes B cell through antibody dependent cell mediated cytotoxicity.

Question 27

Comment on the Effectiveness of Ocrelizumab (Ocrevus)?

Answer 27

-Reduction in relapse rate of approx. 46-47% vs. IFN, reduction in disability progression by 24%

Question 28

What is Alemtuzumab?

Answer 28

• Alemtuzumab: Is a humanized monoclonal antibody directed against CD52 which depletes lymphocytes.

Question 29

Indication to use Alemtuzumab?

Answer 29

Indication: RRMS with at least two relapses over the past two years during at least six months of immunomodulatory therapy or untreated patients have suffered a very high rate of relapse.

Question 30

Drugs to reduce spasticity in MS?

Answer 30

Baclofen and diazepam can reduce spasticity.

Question 31

How are bladder symptoms in MS patients treated?

Answer 31

Bladder symptoms can be treated with anticholinergic drugs.

Question 32

How do we treat neuropathic pain in MS patients?

Answer 32

Cannabis - Sativex (cannabidiol+ tetrahydrocannabinol) symptomatic relief of neuropathic