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Multiple Sclerosis & Treatment of Progression with InterferonBeta-1a What is Multiple Sclerosis? • Most commonly defined as an autoimmune disease that affects the CNS • Characterized by the loss and/or damage of the myelin sheath • Loss of myelin sheath results in the inability of neurons to transmit neural signals properly, causing the many symptoms of MS • Unpredictable and no known cures Anatomy of the Neuron Four Major Varieties of MS • Relapsing/remitting (RRMS) – Characterized by periods of flare-ups and remission – Accounts for 85% of MS patients • Primary Progressive (PPMS) – Slow continuous worsening of disease from onset – Only about 10% Four Major Varieties of MS (cont.) • Secondary Progressive (SPMS) – Initial period of relapsing-remitting, then steady worsening of disease – 50% of patients diagnosed with RRMS develop into this variety within 10 yrs without drug treatment • Progressive Relapsing (PRMS) – Steady worsening with acute relapses – Different from RRMS in that disease progresses during relapses What Causes MS? • Not exactly known • Several theories • Most common—myelin damage results from abnormal response in the immune system – T cells (type of white blood cell) attack myelin – Though to be triggered by environmental and/or genetic factors Many other theories • MS is pathogen-mediated – Research suggests Chlamydia Pneumoniae and other pathogens may trigger MS • Genetics – Identical twin studies-> one has MS, other has 30% chance – No specific gene/s found yet • Most likely involves a combination MS Geography • • • • • Typical onset between ages 20-50 Reduces life expectancy by about 10-15 yrs About ½ patients survive 30+ yrs from onset Affects 2-3 times as many women than men Research suggests that genetic factors play a role • More common among people of European descent • About 400,000 Americans have MS Symptoms of MS • Wide variety due to nature of disease • Different classifications of symptoms – Visual – Motor – Sensory – Cognitive – Coordination/Balance – Bowel, Bladder, and Sexual Diagnosis of MS • No single test for diagnosing MS • Usually diagnosed when all other possibilities ruled out • Many tests – Medical history – Nervous system functioning – MRI, Evoked potential tests, spinal tap Basic “Rule” for Diagnosis • Est. by committee sponsored by NMSS in 1965 • Must have BOTH of the following: – Evidence of myelin loss in at least 2 areas occurring in different places at different times – Any other diseases that could account for the above have been ruled out • Revised in 1983 by Poser to take into account advances in MRI technology Treatments for MS • No known cure • Treatments involve relieving the symptoms or slowing the progression of the disease • These are mostly drug treatments • Also CAM’s- Complementary and Alternative Medicine CAM’s • Used with or instead of conventional drug treatments • Some include – Acupuncture – Herbal medicine – Yoga – Relaxation techniques – Hypnosis Conventional Drug Treatments • Disease-modifying drugs* – ABC Treatments – Chemotherapeutic Agents – Corticosteroids & ACTH • Drugs that help with symptoms – Wide variety from anti-depressants (depression) to laxatives (bowel dysfunction) to anti-convulsants (pain/altered sensations) ABC Treatments • Most popular drug treatments for modifying course of disease • Work by regulating aspects of the immune system • ABC refers to the 3 major brand names of this category of drugs: Avonex, Betaseron/Betaferon, and Copaxone • Also now added Rebif and Novantrone ABC Treatments Cont. • Interferon beta-1a – Avonex, Rebif • Interferon beta-1b – Betaseron/Betaferon • Glatiramer acetate – Copaxone • Mitoxantrone – Novantrone What are Interferons? • Occur naturally in human body • Proteins that prevent viral multiplication by stimulating the production of antiviral proteins in normal cells • Interferon-alpha, Interferon-beta, and Intereron-gamma Avonex • Interferon-beta-1a • Used for RRMS and SPMS w/relapses • Produced by recombinant DNA technology using genetically engineered Chinese Hamster Ovary cells into which the human interferon beta gene has been introduced • The resulting amino acid sequence is Avonex • Mechanisms by which it exerts it effects not fully understood • Pharmacokinetics in MS patients not evaluated • Recommended dosage of 30 mcg to be injected intramuscularly one weekly – Not recommended subcutaneously- adverse reactions mainly at site of injection* • No known interactions with other drugs Current Avonex Research • Avonex fairly new – Lots of research being done, few consistent findings yet • Most research with Avonex focuses on: – Comparison with other drugs of its type – Testing properties of the drug by altering dosages,etc. – Seeing how well drug modifies disease course in placebo studies Future Research on MS • Finding the cause • Stopping/slowing progress of disease • Repairing damage already done – Remyelination • Better ways of treating symptoms • Focusing on the social implications Recommended Websites to Learn More • http://www.avonex.com • http://www.nationalmssociety.org