Managing MS and Another Medical Condition

Managing MS and Another Medical Condition

Overview

Being attentive to your overall health and choosing healthy lifestyle behaviors will help prevent common health conditions that can make living with MS more difficult. Many people living with MS also live with conditions (comorbidities) like diabetes, hypertension (high blood pressure), heart disease, lung disease, and certain mood disorders. Some people also live with other autoimmune conditions.

These comorbid conditions can negatively impact MS by delaying diagnosis, delaying treatment with a disease-modifying therapy, increasing the number of hospitalizations, speeding up disease progression and reducing quality of life. Treating these additional medical or psychiatric conditions is essential not only to your overall health and wellbeing, but to the effective management of your MS as well.

Don’t assume that everything is related to your MS

When something changes in your health, it’s tempting to attribute those changes to MS. While that may be true, it may not be. Any persistent change in your health deserves equal investigation— it’s important to discuss any changes with your MS or primary care provider.

Ensure your healthcare providers are communicating

When you are managing more than one disease or condition, it’s important for your healthcare providers to communicate with you and each other. The strategies to manage one condition may not be compatible with your other condition. For example, a medication to treat fatigue may worsen your high blood pressure or the chemotherapy to treat your cancer might interact with the medication you take for your MS.

Keep a list of all medications and supplements you take

Particularly in today’s world of specialized medicine—where each healthcare provider tends to focus on one particular area of your care—it’s important to keep all your providers informed about any treatments you are receiving. This information helps to ensure that you are not given medications that interfere with one another or combine in any harmful way. It’s also a good idea to use one pharmacy or pharmacy chain for as many of your medications as possible since the prescription software used by most pharmacists will automatically identify possible drug interactions.

The same recommendation holds for all over-the-counter products and complementary or alternative medicine (CAM) strategies you are using. Your providers need complete information about everything you are taking in order to make the best and safest possible treatment recommendations for you.

When coordinating your own care gets too complicated, ask for help

When managing your health care begins to feel like a full-time job, or you simply don’t have the energy or ability to manage the numerous providers, tests, appointments, prescriptions, and insurance plans, it may be time to look for some assistance. Call the National MS Society (1-800-344-4867) for information about care management resources.

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Diet, Exercise & Healthy Behaviors

Diet, Exercise & Healthy Behaviors


For a person living with MS, physical wellness involves much more than disease and symptom management. Research shows that a healthy diet, exercise, not smoking, ongoing preventive care and management of other medical conditions not only contribute to overall health but can also impact a person’s MS progression and lifespan.

MS management is an essential component of optimal physical wellness. Managing MS includes:
modifying the disease course,treating relapses (also called exacerbations or attacks),managing symptoms andongoing rehabilitation to promote functional mobility, safety, independence and participation at home, at work and in the community. 
An ongoing collaboration with your primary care provider and MS healthcare provider can help ensure a comprehensive health management plan that doesn't take a back seat to your MS, including — age-related preventive healthcare and vaccinations, and careful attention to any co-existing medical conditions that can affect overall health and lifespan, as well as the course of MS.

Integrating healthy behaviors into your lifestyle can be hard work even without the added challenges of MS. In addition to working with your health care team, recruit friends and family to support you. Talk to them about your goals and ask for their support in helping you eat well, engage in physical activity, stop smoking, get out of the house more frequently or to do whatever you are finding challenging. You may also want to explore working with a wellness coach. Professionally trained wellness coaches can offer you strategies to live your best life and support you along your wellness journey. Find out more in this resource.

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Videos concerning INVISIBLE SYMPTOMS of MS


To watch #MSViewsandNews', 4 min-36 sec video  
#MyInvisibleMS project - click here
Patients and Care partners, speak


To view (2) different videos on: Invisible symptoms of MS - created by #TheNationalMSSociety, plus the medical therapies available click:
              Invisible symptoms of MS Video 1    
and       Invisible Symptoms of MS - Video 2




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Boston Children's Hospital researchers seem to have pinpointed the cause of multiple sclerosis

Targeting a rogue T cell prevents and reverses Multiple Sclerosis in mice




This could be a very significant development in medical research.  The press release about it just came out today.
I’m sorry I can’t go into as much detail as I’d like because I can’t get the actual paper (behind a paywall).  If you can get it and would like to comment further, please do!
It’s been known for quite some time that Multiple Sclerosis (MS) and other autoimmune diseases are driven by angry helper T cells (T lymphocytes) that somehow mistake your own tissues for an invader that needs to be attacked.  People with MS, in a sense, are allergic to their own nervous systems. 
A quick intro from the Boston Children’s Hospital press release:
Multiple Sclerosis is an autoimmune disease affecting both adults and children. It's driven by "helper" T cells, white blood cells that mount an inflammatory attack on the brain and spinal cord, degrading the protective myelin sheath that covers nerve fibers. But there are many different kinds of T helper cells, and up until now, no one knew which ones were the bad actors.
Researchers at Boston Children's Hospital have now pinpointed the specific helper T cells that cause MS, as well as a protein on their surface that marks them. As reported this week in PNAS, an antibody targeting this protein, CXCR6, both prevented and reversed MS in a mouse model.


A population of helper T cell that bear the protein CXCR6 on their surfaces seem to be the main antagonists in MS.  They attack and degrade the myelin sheath, which covers nerve fibers.  They also secrete GM-CSF, which recruits macrophages to come in and finish the job.
The Grrrreat! thing about CXCR6 being right out there on the surface of these cells is that it means you can specifically go after them with antibodies (Immune-system proteins that will stick specifically to them).  You can use that to recruit an immune response by the body or to deliver toxins to them and curb their population to get the disease under control.
Interestingly (though they didn’t say so in the press release), a similar small but aggressive population of helper T cells, also with CXCR6 on their surfaces, was spotted earlier this year in a paper that found that they seemed to be part of the rapid response to lung infections.  And yet blocking CXCR6 in those cells actually led to faster clearing of the infections.  There really seems to be something to this.

This particular MS-exacerbating population of helper T cells seems to depend on having a lot of a protein called Serpin B1:


the Serpin B1 protein
Now, you can’t just get rid of serpin B1, because it has other vital roles in the immune system.  But elevated levels of it could serve as another marker to find these particularly unhelpful T cells.
The researchers found that the CXCR6 connection appears relevant in humans, not just mice:

CLICK HERE to Continue Reading



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5 Ways to Have a Better MRI Experience With MS

Probably no one enjoys having an MRI, but the experience can be made more bearable.

Medically Reviewed by Samuel Mackenzie, MD, PhD

Selim Aksan/Getty Images
People often complain of feeling confined or claustrophobic during MRIs.


Magnetic resonance imaging (MRI) scans are commonly performed to establish a diagnosis of Multiple Sclerosis (MS) and to monitor its progression over time.

MRIs use strong magnets and radio waves to create images of internal structures of the body. An MRI scan of your brain and spinal cord can reveal the lesions, or areas where the myelin that normally protects nerve fibers has been damaged, that are typical of MS.

Over time, repeat MRIs show your doctor whether you have developed additional lesions and whether existing lesions have enlarged or otherwise changed.

Most healthcare professionals recommend that people with MS receive annual MRIs to track progression and assist in treatment decisions. Evidence of new or growing lesions, for example, may indicate that a change in treatment is needed.

Click to read more on Safety Issues, Anxiety and more


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Boster's Corner: Multiple Sclerosis Vlog: SUPPLEMENTS FOR MS? Vitamin D3 and much more

Boster's Corner: Multiple Sclerosis Vlog: SUPPLEMENTS FOR MS? Vitamin D3 and much more

September 2019

Supplements for Multiple Sclerosis? In this video I teach you about nutrition & dietary supplements for MS. Got Vitamin D3? If you want to up your food game, start watching this video! Content was originally recorded during a livestream on this channel. 

What supplements do you take? Please share in the comments section below! I look forward to reading and responding!



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a Boster Video: New MS Drug Results: #Ofatumumab vs #Teriflunomide (ASCLEPIOS trial)

a Boster Video: New MS Drug Results: #Ofatumumab vs #Teriflunomide (ASCLEPIOS trial)
In this video I share brand new MS drug results, comparing a new B-cell killer (Ofatumamab) to Aubagio (teriflunomide). If you'd like to learn the results and better understand Multiple Sclerosis research, then start watching this video right now!



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7 Home Modification to Empower People with Multiple Sclerosis

7 Home Modification to Empower People with Multiple Sclerosis




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Neuropsychological tests useful tool for real life activity in MS

Neuropsychological tests useful tool for real life activity in MS
Sept 23, 2019

A recent review of research literature explored the relationship between neuropsychological assessment and predictability of performance of everyday life activities among people with Multiple Sclerosis. Neuropsychological assessment was found to be among the tools useful for measuring the effect of MS on everyday activities.

People with MS often undergo neuropsychological testing to evaluate the influence of cognitive effects on their ability to perform everyday life activities. To be a useful tool for the clinicians who care for these individuals, it is important that their performance on neuropsychological testing parallels their function in everyday life. Kessler Foundation researchers examined this issue, as well as the broader context for the question: Are neuropsychological tests ecologically valid?

The authors examined the literature on the relationships between cognitive and functional domains in the MS population. Cognitive functions included processing speed, executive function, visuospatial function, learning and memory, working memory, and verbal fluency. Functional domains included driving, employment, internet shopping and financial/medical decision-making. They found that neuropsychological tests do have predictive value for individuals' behavior in these real life settings.

Researchers note that to best serve the clinical needs of individuals with MS, neuropsychological testing needs to be viewed in larger context comprising noncognitive variables, such as motor ability and demographic values, fatigue and depression, and disease activity and level of disability, as well as person-specific factors such as personality and coping styles.

The article was published in the Multiple Sclerosis Journal.



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Novartis ofatumumab demonstrates superiority versus Aubagio® in two head-to-head Phase III multiple sclerosis studies

Novartis ofatumumab demonstrates superiority versus Aubagio® in two head-to-head Phase III multiple sclerosis studies

In ASCLEPIOS I and II, ofatumumab (OMB157) met primary endpoints to reduce the annualized relapse rate over Aubagio®* (teriflunomide) in patients with relapsing forms of MS (RMS)[1]
Key secondary endpoints of delaying time to confirmed disability progression were also met[1];  additional secondary endpoints will be presented at ECTRIMS
 Ofatumumab, a potent, fully-human antibody targeting CD20 positive B-cells, delivered sustained efficacy with a favorable safety profile[1]
 Novartis plans to initiate submissions to health authorities by end of 2019. If approved, ofatumumab will potentially become a treatment for a broad RMS population and the first B-cell therapy that can be self-administered at home
Basel, August 30, 2019 – Novartis, a global leader in neuroscience, today announced positive results for #ofatumumab (OMB157) from the Phase III ASCLEPIOS I and II studies. In both head-to-head studies, ofatumumab demonstrated superiority over Aubagio®* (teriflunomide) in patients with relapsing forms of Multiple Sclerosis (RMS)[1]. The ASCLEPIOS studies investigated the efficacy and safety of monthly subcutaneous ofatumumab 20mg versus once daily oral Aubagio® 14mg in adults with RMS[2],[3].
Both studies met the primary endpoints where ofatumumab showed a highly significant and clinically meaningful reduction in the number of confirmed relapses, evaluated as the annualized relapse rate (ARR)[1]. Key secondary endpoints of delaying time to confirmed disability progression were also met[1]. The top line results of the Phase III ASCLEPIOS studies will be presented at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), taking place September 11–13, 2019, in Stockholm, Sweden. Overall ofatumumab, a potent, fully-human antibody targeting CD20 positive B-cells, delivered sustained efficacy with a favorable safety profile[1]. The safety profile of ofatumumab as seen in the ASCLEPIOS studies is in line with the observations from Phase II results[1],[4]. Novartis plans to initiate submissions to health authorities by end of 2019.


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Puzzling It Out - a Podcast series for MS Patients

Puzzling It Out - a Podcast series for MS Patients

"Thoughts and Perspectives from a Clinical Psychologist"

Click the banner to view a podcast series created for MS Patients.






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The MS Coalition invites you to join us for the 2019 Multiple Sclerosis Summit on Saturday, November 9, 2019 at the Westin Lombard, Illinois

The MS Coalition invites you to join us for the 2019 Multiple Sclerosis Summit on Saturday, November 9, 2019 at the Westin Lombard, Illinois

2019 Multiple Sclerosis Summit

Saturday, November 9, 2019 – Lombard, Illinois


The MS Coalition invites you to join us for the 2019 Multiple Sclerosis Summit on Saturday, November 9, 2019 at the Westin Lombard located at 70 Yorktown Center in Lombard, Illinois.

This day-long event includes informative workshops and an interactive expo for people with MS and their care partners.

Access to ALL parts of the MS Summit, including breakfast, lunch, and parking are free-of-charge.

To learn more and register, please visit: http://ms-coalition.org/2019mssummit/


 

 
This one-of-a-kind program is sponsored by the member organizations of the MS Coalition, a cooperative effort of nine national organizations working to benefit people with MS. Members include: Accelerated Cure Project, the Consortium of MS Centers, Can Do Multiple Sclerosis, the International Organization of MS Nurses, Multiple Sclerosis Association of America, Multiple Sclerosis Foundation, National Multiple Sclerosis Society, United Spinal Association and associate member MS Views and News.

Find the Multiple Sclerosis Coalition online at http://ms-coalition.org or visit MSC on Facebook and on Twitter @MS_Coalition.

Please note: member organizations of the MSC maintain separate mailing lists. As a result, you may receive this message more than once. We apologize for any duplication, but we don’t want you to miss this terrific opportunity!


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Arthritis group offers first guidelines for patients who use CBD for joint pain

Arthritis group offers first guidelines for patients who use CBD for joint pain
Sept 24, 2019
As seen on NBC's Today show

By Erika Edwards

CBD has exploded in popularity over the last year, with countless numbers of people trying it as a sleep aid or relief for pain and anxiety. One concern is, there's been no guidance on how to use CBD, or cannabidiol, safely. 

That's one reason why on Tuesday, the Arthritis Foundation released guidelines for people who want to try CBD — the first such guidance on using the cannabis-derived ingredient from any major patient advocacy group.



The recommendations are an attempt to provide some kind of clarity for CBD usage, despite a lack of scientific evidence proving that it works to treat pain.

"It was important to acknowledge the public's interest, and put out some guidelines on the state of the science," said Kevin Boehnke, a research investigator who works in anesthesiology at the University of Michigan. Boehnke helped develop and write the guidelines for the Arthritis Foundation.

The group makes it clear that patients should not abandon arthritis medications already prescribed by doctors.

"The guidelines are not saying, 'you should try this.' They're saying, 'if you want to try, here's how you should do it,'" said Boehnke.

CBD products became widely available after Congress passed the Farm Bill in 2018, which removed hemp from the controlled substance list. By itself, CBD does not cause a “high.” (Marijuana's psychoactive effects instead come from a different compound, THC, or tetrahydrocannabinol.)
Since then, the task of regulating CBD products has fallen on the Food and Drug Administration, but so far the agency has not done so.

The result has been a public frenzy around CBD products, which are marketed and sold with a variety of health claims, including relief for pain, insomnia and stress. Those assertions caught the attention of those suffering from arthritis, a condition for which there is no cure. 

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Sanofi and Happify Health solidify collaboration around prescription DTx designed to address mental health in people with MS

September 2019

– Companies plan to seek FDA clearance for digital therapeutics approach –

The list of physical symptoms of Multiple Sclerosis (MS) is long and varied, including fatigue, numb limbs and tremors. But many people living with MS also experience mental health conditions — particularly depression and anxiety. People with MS develop a form of major depression at a rate two to five times higher than the general population, depending on the country studied.

“Many patients with MS face significant burdens, and we have an obligation to help them not only maximize their physical health, but their mental health as well,” said Bozidar Jovicevic, Sanofi’s global head of digital medicine.

Sanofi is collaborating with Happify Health, which provides evidence-based mental health digital therapeutics, to develop and study an app to help manage and improve psychological outcomes in people with MS.

Digital therapeutics (DTx) deliver to patients evidence-based therapeutic interventions to patients that are driven by high quality software programs to help prevent, manage, and treat a medical disorder or disease. They are used independently or in concert with medications, devices, or other therapies to optimize patient care and health outcomes. Investment in such approaches is part of a broader strategic effort at Sanofi, which includes digital health innovations, such as software- or hardware-based interventions, virtual health care and partnerships with solution providers with the goal of improving outcomes and the patient experience.

Studies have shown that poor mental health during an MS journey has been associated with reduced quality of life and decreased treatment adherence.

“Physical health and mental health are linked,” said Ameet Nathwani, chief digital officer and chief medical officer of Sanofi. “Through its collaboration with Happify Health, Sanofi aims to provide real-time, constant support for mental health conditions and improve quality of life.”

The collaboration will create — and study via clinical trials — an app that introduces cognitive behavior therapy to help improve mental health through education and other activities.

“Patients are getting more interested in their own health and are looking for solutions. Developing technologies that can potentially help support their mental health management can be a perfect complement to traditional therapies,” Nathwani said.

Based on randomized clinical trial results, Sanofi and Happify aim to submit the app for U.S. Food and Drug Administration for clearance, subjecting it to a regulatory process for software as a medical device. This process includes more rigorous quality testing, privacy protection and security considerations than ordinary consumer apps undergo. If FDA clears the app, it would be available by prescription.

“The ubiquity of smartphones and PCs has the potential to introduce new self-care and augmented-care delivery models that are dynamic, highly personalized and engaging,” said Ofer Leidner, co-founder and president of Happify Health. “Further, our evidence-based digital platform is designed to maximize efficacy, safety and patient engagement at scale, three areas which are difficult to attain with one solution.”

Just as molecular understanding and adherence create the biologic basis for effective drug-based therapy, medical understanding and engagement provide the keys to success with a digitized cognitive behavior therapy program. This collaboration will marry Sanofi’s patient focus and medical and scientific expertise in MS with Happify Health’s skill in creating platforms designed for maximum engagement.

“This new intersection between tech companies and pharmaceutical companies requires a real effort to learn together, to build a new interface between industries,” Leidner said. “Sanofi has demonstrated a commitment to digital transformation, and we have found that our collaboration is ideal for the development of technologies with the potential to change our approach to anxiety and depression for people living with MS.”

“While there is no shortage of digital mental health interventions, our differentiation is in providing proven, efficacious digital therapies that fit seamlessly with pharmaceutical therapies to offer a true ‘beyond the pill’ experience for patients,” said Chris Wasden, Ed.D., Head of DTx, Happify Health. “Our interventions are tested in randomized clinical trials and published in peer-reviewed journals, testaments to our commitment to putting forward only evidence-based, safe and effective digital therapies.”

“We are working to create a future where rigorously vetted digital therapeutics can create behavioral change and work alongside traditional approaches to continue our focus on treating people holistically so they can live a better life,” Jovicevic said.........................................................................................................
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MS Patients Should Be Informed about Pregnancy Risks and Family Planning, Experts Say

MS Patients Should Be Informed about Pregnancy Risks and Family Planning, Experts Say
SEPTEMBER 11, 2019 - BY ANA PENA, PHD of Medical News Today
 
While pregnancy does not appear to affect the disease course of Multiple Sclerosis (MS), questions remain about the best time to stop or resume treatment before conception and after delivery, the safety of new medications, and the importance of family planning.
Pregnancy was the “hot topic” discussion today in a session, titled “MS Pregnancy in the treatment era,” at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), which is being held Sept. 11–13 in Stockholm, Sweden.
 
Three presentations focused on different aspects of pregnancy, including the risks for the mother and child, and the importance of early counseling for patients wishing to become parents.
Until the 1980s, women with MS were discouraged from having children due to the false belief that pregnancy would worsen their disease course.
A shift in knowledge occurred in 1998 when the PRIMS study (Pregnancy in Multiple Sclerosis multicenter European study) showed that, overall, pregnancy did not affect the long-term clinical course of MS. In fact, the study provided evidence that relapse rates go down during pregnancy in MS women, and then restart after giving birth — of note, relapses can get particularly worse in the first three months after delivery.
 
The PRIMS study also showed that disability progression is similar between pregnant MS women and the general MS population, suggesting that the overall impact of pregnancy on MS course seems to be neutral.
However, over the last three decades, the emergence of a variety of disease-modifying therapies (DMTs) has raised many questions about the risks of each therapy for the fetus, and about which medicines to stop or restart and when to do so.

The mother’s & Child's perspective, plus family planning




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Upcoming MS Patient Round Table with Aaron Boster, MD, in Columbus, OH and another event in Louisville, KY

Hear Ye, Hear Ye: FOR ALL within Driving distance to Columbus, Ohio, join Dr. Boster and Me, as we square off in a Round Table discussion that will concern "MANY" affected by MS..

This event is on Thursday evening, December 5th.
(www.events.msvn.org) - MS Views and News is providing this dinner event. -- 

Following this MS program, we will be driving to Louisville, KY to do another event on December 7th, a Saturday luncheon.

Also presenting in Louisville is Mindy Eisenberg on Adaptive Yoga for MS and Paul Pelland our patient advocate with his great story. 

For ALL wanting to see Dr. Boster in un-edited format, click here (www.events.msvn.org) to find the event and to register. 


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#ECTRIMS2019 – Tysabri During Pregnancy and After Delivery Seems Safe, Reduces Relapse Risk, Study Finds

Continuing Tysabri (natalizumab) treatment up to week 28 of pregnancy, and restarting soon after birth, reduces the risk of relapses in women with multiple sclerosis and appears to be safe for the mother and the baby, new research suggests.
Doriana Landi, MD, PhD, from Italy’s University of Rome Tor Vergata, presented the findings at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), held Sept. 11–13 in Stockholm, Sweden.
What therapy to choose, and for how long to take it, have been emerging issues for women with MS who are pregnant or planning to become pregnant.
“We all know that not all treatments are compatible with pregnancy planning, especially second-line treatments which are usually used for highly active MS women,” Landi said.
One problem is the lack of data that can elucidate the risks, and guide therapy choices before, during, and after pregnancy. In particular, there is a lack on information “on how to manage our highly active patients,” such as those treated with Tysabri (marketed by Biogen), Landi added.
Suspension of Tysabri treatment is currently discouraged in patients planning pregnancy, due to concerns of disease reactivation or Worsening — patients may become exposed to a higher risk of relapses, Landi said.
2018 study showed that “suspending natalizumab treatment before conception was associated with a higher risk of disease relapses during pregnancy,” Landi said, while “receiving the last natalizumab infusion after the onset of the last menstrual period led to an approximately 3-fold reduction of the risk of relapses during pregnancy.”
Data from the German MS registry suggested that the best option would be to continue Tysabri treatment until the 30th week of gestation, as a way to minimize flares in the mother while assuring the safety of the fetus.
Further, recent guidelines from the Association of British Neurologists recommend maintaining Tysabri up to approximately 34 weeks of gestation, and restarting treatment soon after birth to mitigate the risk of rebound disease activity. Those guidelines recommend treatment be restarted within 8-12 weeks after the last dose pre-delivery.
Prior studies suggested that Tysabri use over the first trimester of pregnancy is not tied to major fetal risks. However, the medicine can be found in the blood of newborns, and they commonly have blood alterations, especially in the third trimester, such as low red blood cell or platelet counts. These alterations are usually self-resolving, Landi said.
Given the lack of information, the researchers said more data was needed. They sought to confirm Tysabri’s safety and efficacy, and to find the best management strategy for women taking this medicine who plan to become mothers.
The team therefore analyzed data from a group of 86 pregnant women with MS (90 pregnancies), who were on Tysabri treatment, and were followed at 19 Italian MS centers. The patients’ mean age was 31 years, and median EDSS was 2.0, indicating minimal disability.
The women were divided into three groups according to the time of the last Tysabri infusion: before conception (31 newborns); within the first trimester of pregnancy (30 newborns); and those who continued treatment after the first trimester (31 newborns). All women were asked to restart Tysabri after delivery, and all have at least one year data of follow-up.
No difference in terms of demographic characteristics were found among the study groups.
Most women who remained on treatment beyond the first trimester continued up to at least the 28 week of gestation. They received a median of five — ranging from 3 to 5 — Tysabri infusions, with a mean interval of 33 days between doses.
Importantly, these women restarted Tysabri treatment significantly earlier after giving birth — a median of 25 days after delivery — compared with women in the other groups. The women who stopped Tysabri before conception restarted treatment a median of 55 days after delivery. Those who stopped Tysabri during the first trimester restarted a median of 50 days after delivery.
Researchers then compared the annualized relapse rate (ARR) during pregnancy, and one year after delivery, as well as newborn outcomes, across groups.
During pregnancy, there was a significantly higher relapse rate in the women with “wash-out” pregnancies — those who stopped Tysabri before getting pregnant. Conversely, the lowest ARR was observed in women who continued on Tysabri while pregnant.
ARR was 1.06 in women stopping Tysabri before conceiving, 0.49 in those prolonging treatment up to the first trimester of pregnancy, and 0.09 in those continuing beyond this period.
A similar trend was maintained in the postpartum period, one year after delivery, the results showed. The women stopping Tysabri earlier had the highest relapse rates (0.39), while those who remained on treatment had fewer relapses — 0.23 in those prolonging treatment up to the first trimester of pregnancy, and 0.10 in those continuing beyond this period.
Researchers believe that early treatment resumption was important to lessen the risk of relapses in the group of women who continued Tysabri treatment after the first trimester of pregnancy.
Landi emphasized that “relapses are really relevant in terms of disability accumulation.” She noted that women who stopped Tysabri before conception had the highest accumulation of disability, as measured by EDSS, in the postpartum period.
Regarding newborn outcomes and fetal safety, no significant changes were registered between the three groups of mothers, either on mean gestational age (the number of weeks of the pregnancy), birthweight, or length.
Anemia — low red blood cell counts — was more frequent in newborns exposed to Tysabri beyond the first trimester. Five newborns from that group had anemia, versus none in the other two groups. However, Landi noted that three of these five babies were premature newborns, and a link has previously been reported between prematurity and anemia.
Major birth defects only happened in pregnancies exposed to Tysabri — both up to the first trimester (one case of a major malformation called clubfoot), and beyond the first trimester (four cases, all heart defects, specifically patent foramen ovalepatent ductus arteriosuspulmonary valve stenosis, and coarctation of the aorta).
Nonetheless, Landi stressed that factors other than Tysabri treatment could have accounted for this higher number of birth defects. One such factor that raises the risk is the birth of twins — which occurred with two of the babies with heart defects.
Overall, the findings support that “continuation of natalizumab [Tysabri] beyond conception reduces the risk of relapse during pregnancy, and is not associated with major fetal risks,” Landi said.
“It is worth noting that in case of treatment prolongation up to the third trimester, it is desirable to resume infusions within 12 weeks from the last pre-partum infusion to minimize the risk of disease rebound,” she added.
Of note, more data on Tysabri was presented at ECTRIMS 2019. That data support Tysabri’s long-term benefit for people with early relapsing-remitting MS (RRMS). It also showed that Tysabri can reduce disease relapse rates when given at an extended interval dosing, specifically every six weeks, relative to standard dosing every four weeks.
In her presentation, Landi also said the question of whether “extending dosing [meaning at 6-week intervals] is as protective as regular dosing [4-week intervals] needs to be assessed by future studies, although no differences were seen in our cohort.”
Additional studies with larger patient samples also are needed “to correctly estimate the incidence of fetal complications in Tysabri-exposed pregnancies, and provide conclusive data useful for patient counseling,” Landi added.
Pregnancy was the topic of discussion in a large session on ECTRIMS’ first day. To learn more about that session, please see the following article.


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Ponesimod Bests Aubagio in Head-to-Head MS Trial

Ponesimod Bests Aubagio in Head-to-Head MS Trial
Investigational drug reduces annual relapse rate, shows effects on fatigue

by  Senior Staff Writer, MedPage TodaySeptember 12, 2019
STOCKHOLM -- Ponesimod, an investigational selective sphingosine-1-phosphate receptor 1 (S1P1) modulator, bested teriflunomide (Aubagio) in a head-to-head trial of adult relapsing Multiple Sclerosis (MS) patients, researchers for the OPTIMUM phase III trial reported here.
Compared with teriflunomide -- an approved first-line oral MS drug -- oral ponesimod reduced annual relapse rate (ARR) by 30.5% over about 2 years, according to Ludwig Kappos, MD, of University Hospital of Basel in Switzerland, and co-authors, in a presentation at the 2019 ECTRIMS Congress. At 108 weeks, ponesimod 20 mg had an ARR of 0.202, compared with an ARR for teriflunomide 14 mg of 0.290 (P=0.0003).
"This is the first head-to-head study comparing a new compound with one of the oral drugs," Kappos said in an interview with MedPage Today. Comparative studies had been conducted in the past with injectable MS drugs, he noted, but this trial aims to place ponesimod within the spectrum of the oral drugs, "which are getting to be, more and more, the standard treatment."
Ponesimod is a selective modulator of the sphingosine-1 phosphate receptor, like fingolimod (Gilenya) and siponimod (Mayzent). Binding of the drug to the receptor lowers the number of circulating lymphocytes by trapping them in the lymph nodes, reducing the number of lymphocytes that could enter the central nervous system and damage myelin.



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#ECTRIMS2019 – Data Shows Ublituximab’s Long-term Safety in Relapsing MS, TG Therapeutics Announced

EXPERIMENTAL TREATMENTS FOR MS » UBLITUXIMAB (TGTX-1101)
Ublituximab (TGTX-1101) is a glycoengineered anti-CD20 monoclonal antibody being developed by TG Therapeutics  as a potential treatment for relapsing (RMS). Evidence shows that B-cells are activated during a relapse, and these immune system cells are found within acute lesions of the spinal cord, which suggests a role in MS flares.
Ublituximab targets a specific receptor on the CD20 antigen found on mature B-cells, depleting their number in the blood and central nervous system.
Originally developed to treat B-cell proliferative disorders like non-Hodgkin’s lymphoma and chronic lymphocytic leukemia, ublituximab is now also being studied in autoimmune diseases like MS, lupus and rheumatoid arthritis.

Ublituximab (TGTX-1101) research in RMS

TG Therapeutics released early data from a Phase 2 study (NCT0273877) assessing ublitiximab’s safety and efficacy in RMS patients in January 2017. The first part of the study, being led by Edward Fox, director of the Multiple Sclerosis Clinic of Central Texas and a professor at the University of Texas Medical Branch in Round Rock, evaluated ublitiximab at three different doses in three groups of patients (eight per group; infusions given on days 1 and 15 and week 24, and accelerated in two cohorts). In addition to safety and accelerated infusion tolerability, this initial part was to determine an optimal dosage by examining B-cell depletion up to week 24. (Data on other MS efficacy measures is still being collected and evaluated.)
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Handling Stress - Mind-Body Basics for People with MS

Handling Stress - Mind-Body Basics for People with MS

Learning how to get a handle on stress (so it doesn’t manhandle you!) not only helps you manage Multiple Sclerosis symptoms, it may help you prevent them too.


Mindy Eisenberg was just a child when her mother was diagnosed with Multiple Sclerosis (MS), an autoimmune disease that affects the brain and spinal cord. But she remembers like it was yesterday.
“The philosophy was very different at the time,” Eisenberg, 55, says. “My mother was told not to move, to stay as sedentary as possible.”
Over the next 25 years, Eisenberg watched her mother’s condition slowly deteriorate, until she was largely limited to using a wheelchair or staying in bed. She eventually ended up in a nursing home.
A lot has changed in the decades since Eisenberg’s mother was diagnosed. Not only has modern medicine improved the treatments available for MS, but there's also a much more holistic approach. “Now doctors tell you that you absolutely should move and do whatever you can to stay active,” says Eisenberg, who lives in Franklin, MI. We now know that in addition to improving overall health and quality of life, exercise can directly combat the symptoms of MS.
There’s also a growing awareness of how mind-body therapies can also help people living with MS, says Eisenberg, who runs a nonprofit group called Yoga Moves MS, which offers MS patients yoga and other complementary therapies like mindfulness meditation to help manage their symptoms and reduce stress.

How Exactly Can Mind-Body Therapy Help?

The term “mind-body therapy” refers to a group of healing techniques that can induce relaxation and improve overall health and well-being.
“Mind-body interventions may be an incredibly helpful, low-cost, and low-risk way to help cope with stress and anxiety,” says Kathy Zackowski, Ph.D., an occupational therapist and scientist who serves as senior director of patient management, care, and rehabilitation research for the National MS Society.
Numerous studies have shown the mind can have a big impact on a person’s physical symptoms, Zackowski explains. Stress and anxiety in particular can play a role in increasing MS symptoms, and many people may have a flare-up during especially trying times, she says.
“That’s why mindfulness and resilience training may be really important, because if we can develop strategies to harness the strength of the mind, maybe we can improve our ability to function or temper how our body reacts,” Zackowski explains. “More research is needed in this area, but one goal of such studies would be to see if mind-body therapy may help slow the progress of MS, in addition to improving symptoms.”
Still, even if new science reveals promising results from mind-body therapies, it won’t be a one-size-fits-all solution, Zackowski says. You may need to try several different techniques to see what works for you.

Want to Give Mind-Body Therapy a Try? Start Here

“We don’t know that there’s one mind-body strategy that works better than all the others, so it’s important that people figure out what feels good to them,” Zackowski says.
Options include:
YogaMeditationAcupunctureHypnosisMusic therapyTai chi or qi gong, which are both forms of moving meditationGuided imagery, in which you’re guided in imagining a relaxing scene or series of experiencesAromatherapy, which uses the scent of concentrated plant oils, known as essential oils, to improve feelings of well-beingMindfulness techniques, which may simply involve being present in the moment or focusing on your breath
READ MORE:
https://www.healthcentral.com/article/guided-imagery-may-reduce-depression-and-fatigue-in-ms

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