Transcript Multiple Sclerosis & Treatment of Progression with

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