MS Flashcards
first episode of neurologic symptoms lasting at least 24 hours caused by inflammation & demyelination in 1 or more sites in the CNS
(1 attack & 1 lesion)
clinically isolated syndrome
most common MS, worsening of preexisting symptoms or onset of new symptoms for >48 hours without fever, contrasted by remission with no symptoms
relapsing-remitting
progression of RRMS steadily progressing with or without clear cut relapses
secondary-progressive
MS with steady decline without relapse, meds not effective
primary-progressive
steady progressing MS with periods of exacerbations
progressive relapsing
two options for MS relapse treatment
corticosteroids, corticotropin acthar gel
indication for ALL disease modifying MS treatments
RELAPSING FORMS
including CIS, RRMS, active SPMS
interferon beta-1a products
route of admin?
avonex IM
rebif SQ
plegridy SQ
interferon beta-1b products
route of admin?
betaseron, extavia SQ
major AE of interferon beta?
how to manage?
flu-like symptoms
premedicate with APAP or ibuprofen
non-interferon ABCR agent?
route of admin?
glatiramer acetate (copaxone, glatopa)
SQ
major AEs of glatiramer acetate
injection site rxn (masses, welts), vasodilation, chest pain, throat constriction.
sometimes fatal opportunistic infection from activation of latent JCV
demyelinating disease
progressive multifocal leukoencephalopathy (PML)
common AEs for MoAbs for MS
infusion rxn, infection (URTI, UTI), HA, fatigue, diarrhea, dizziness, chills, nausea, insomnia, PML.
MoAbs for MS?
Natalizumab (Tysabri)
Alemtuzumab (Lemtrada)
anti CD20 MoAbs for MS?
Ocrelizumab (ocrevus)
ublituximab (biumvi)
ofatunumab (kesimpta)
route of admin for tysabri
IV Q4W
alemtuzumab (lemtrada) is reserved for….
inadequate response to 2 or more other meds
which MoAbs recommend premedicating? with what?
lemtrada, ocrevus, biumvi
treat w/ antihistamine, steroid, antipyretics
major AEs of lemtrada
development of autoimmune thyroid disorders, rash
BBW for lemtrada
autoimmune condition, infusion reactions, malignancy
Contraindication for anti CD20 MoAbs?
Warnings?
CI- active HBV
Warn- HBV, herpes, infection, PML, malignancy, infusion rxn, immunizations
which MS therapy is the ONLY ONE APPROVED FOR PPMS
ocrelizumab (ocrevus)
special warning for ublituximab (biumvi) for hypersensitivity due to
polysorbate 80 in the formulation