MS treatment

Question 1

relpase of ms ttt

Answer 1

methypredinsalone
IV ; 1gm /day ; 3 - 5 days
po ; 50 mg/d for 5 dyas

Question 2

dmd aim

Answer 2

1. reduce relapse frequency and severity
2. prossive disaability to be avoided
   3.reduce disability from relapse

Question 3

first line treatment of dmd

Answer 3

interferone or galitramer acteate

Question 4

action of interferone

Answer 4

*Reduces leukocyte proliferation
*Reduces antigen presentation
*Modulates cytokine production
*Reduces T cell migration

Question 5

names of drugs of interferone

Answer 5

Avonex Intramuscular β-interferon-1a 30ug once/week
› Rebif Subcutaneous β-interferon-1a 22 or 44ug 3 times/week
› Betaferon Subcutaneous β-beta interferon-1b 250ug alternate days

Question 6

advantages of beta interferone

Answer 6

Modulates immune system
* Reduces relapse rate by 30%
* Reduces severe relapses by 50%
* Slows disability and cognitive impairment in relapsing remitting MS
by ~ 20%
* Reduces new MRI lesions by 50-70%
* No effect on primary orsecondary progression
* Long term effects (beyond 2-3 years) uncertain

Question 7

side effect beta interferone

Answer 7

Flu-like symptoms, muscle aches, headache
* Injection site reactions (subcutaneous β- IFNs)
* Decreased white cell count, liver dysfunction
* Hair loss
* Depression
* Thyroid diseases

Question 8

interferone must be followed up by

Answer 8

cbc and liverfunction because ; decrease wbcs and liver cell dysfunction

Question 9

glatriamer acetate [ copaxone ]

Answer 9

Mechanism of action: Shift the population from TH1 cells to Th2 regulatory cells to suppress
the immune response.
* Cause in situ bystander suppression of auto-aggressive TH1 T cells

Question 10

advantages of glatriamer

Answer 10

Regulates immune system
* Reduces relapse rate by 30%
* No effect on primary progressive MS
* No trials in secondary progressiveM

Question 11

side effect of capoxane

Answer 11

injection site reaction
hypersenstivity [ rare]
allergic reactions ; chest tightness , shortness of breath , palpitations
loss of fat under site lipoatrophy at injection site

Question 12

NHS “risk sharing scheme” guidelines for ß interferon & Galtiramer
actetate in RR M

Answer 12

• Two relapses in Two year
• Able to walk with or without assistance

Question 13

NHS “risk sharing scheme” guidelines for ß interferon (1-b) in RR MS

Answer 13

• Two relapses in two years
• Able to walk at least 10 m with or without assistance
• Minimal increase in disability due to slow progression over 2 years

Question 14

natluzimab [ biiological ]

Answer 14

humanized antibody

Question 15

natalizumab [tysabri]

Answer 15

given once per month

Question 16

adavntages of natalizumab

Answer 16

reduce relapse rate by 68 percent
80-90 percent reduce new mri lesion
reduce rate of disability progression by 42 percent

Question 17

side effect of natalizumab

Answer 17

Infections
* Infusion (allergic) and hypersensitivity
reactions
* Urticaria
* Headache
* Dizziness
* Vomiting, nausea
* Arthralgia
* Progressive multifocal
leukoencephalopathy (PML) (1:500)a

Question 18

natalizumab) increases the risk of PML, an opportunistic viral infection of the brain that usually leads to death or severe disability. Risk factors for the development of PML include the presence of anti-JCV antibodies, duration of therapy, and prior use of immunosuppressants.

Answer 18

serious side effect

Question 19

indications fo use natalizumab

Answer 19

1.Natalizumab is recommended by NICE for rapidly
evolving severe RRMS (first line treatment)
* 2 or mores disabling attacks per year AND
* One or more enhancing lesions or significant
increase in T2 load compared with previous MRi
2.Natalizumab is also recommended by
NICE for RR MS with high disease activity
despite ß interferon (second line
treatment)
* 1 relapse in previous year while on
therapy AND
* At least 9 T2 lesions or one enhancing
lesion

Question 20

Teriflunomide (Aubagio)

Answer 20

Mechanism of action: Decrease in lymphocytic profileration.
* Effectiveness: Relapse reduction rate of approx. 30%
* Indication: RRMS

Question 21

side effect of aubigo

Answer 21

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

Question 22

Dimethyl fumarate (Tecfidera):

Answer 22

Mechanism of action: amplification of Th2 responses
Has antioxidative and immunoregulatory effects
Modulation of the differentiation of antigen presenting cells.
* Effectiveness: reduction of relapse rate by approx. 50% vs. placebo
* Indication: RRMS

Question 23

side effects of tecfidera

Answer 23

GIT upset
lymphopenia
pml

Question 24

• Fingolimod (Gilenya

Answer 24

Was the first oral FDA approved drug for relapsing form of MS

Question 25

Fingolimod (Gilenya):

Answer 25

• Mechanism : Binds to SP1 receptor on lymphocyte , the receptor becomes
  internalized and it causes the lymphocyte to be sequestrated in lymphoid tissue.
• Effectiveness: reduction in the rate of relapses by approx. 55% vs. placebo
• Indication: RRMS (either insufficient response to existing immunomodulatory
  therapy or non-pretreated high-risk patients, i.e., at least two relapses with
  disability progression in the last year, and detection of new disease activity by MRI)
• Main side effects: VZV reactivation, PML cases, basal cell carcinoma, transient
  bradycardia, macular edema, haemophagocytic syndrome

Question 26

indications of gilenya

Answer 26

RRMS (either insufficient response to existing immunomodulatory
therapy or non-pretreated high-risk patients, i.e., at least two relapses with
disability progression in the last year, and detection of new disease activity by MRI)

Question 27

Ocrelizumab (Ocrevus)

Answer 27

Effectiveness: Reduction in relapse rate of approx. 46-47% vs. IFN, reduction
in disability progression by 24%
*
indications ; RRMS and PPMS

Question 28

Alemtuzumab

Answer 28

s a humanized monoclonal antibody directed against CD52
which depletes lymphocytes.

Question 29

ALEMTUZUMAB

Answer 29

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

Question 30

summary of the treatment dmd

Answer 30

First-line injectables such as beta-interferon and glatiramer
New oral agents such as dimethyl fumarate, teriflunomide and fingolimod
Biologics such as natalizumab and alemtuzumab.