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Multiple Sclerosis & Treatment
of Progression with Interferon-
Beta-1a
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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 theinability of neurons to transmit neuralsignals properly, causing the manysymptoms of MS
Unpredictable and no known cures
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Anatomy of the Neuron
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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%
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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 withoutdrug treatment
Progressive Relapsing (PRMS)
Steady worsening with acute relapses
Different from RRMS in that diseaseprogresses during relapses
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What Causes MS? Not exactly known
Several theories
Most commonmyelin damage results
from abnormal response in the immunesystem
T cells (type of white blood cell) attack myelin
Though to be triggered by environmentaland/or genetic factors
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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
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MS Geography Typical onset between ages 20-50
Reduces life expectancy by about 10-15 yrs
About 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 Europeandescent
About 400,000 Americans have MS
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Symptoms of MS
Wide variety due to nature of disease
Different classifications of symptoms
Visual
Motor
Sensory Cognitive
Coordination/Balance
Bowel, Bladder, and Sexual
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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
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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 intoaccount advances in MRI technolo
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Treatments for MS No known cure
Treatments involve relieving the symptoms
or slowing the progression of the disease
These are mostly drug treatments Also CAMs- Complementary and
Alternative Medicine
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CAMs Used with or instead of conventional drug
treatments Some include
Acupuncture Herbal medicine
Yoga
Relaxation techniques
Hypnosis
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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)
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ABC Treatments
Most popular drug treatments for
modifying course of disease
Work by regulating aspects of theimmune system
ABC refers to the 3 major brand namesof this category of drugs: Avonex,
Betaseron/Betaferon, and Copaxone
Also now added Rebif and Novantrone
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ABC Treatments Cont.
Interferon beta-1a
Avonex, Rebif
Interferon beta-1b Betaseron/Betaferon
Glatiramer acetate Copaxone
Mitoxantrone
Novantrone
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What are Interferons? Occur naturally in human body
Proteins that prevent viral multiplication bystimulating the production of antiviral
proteins in normal cells Interferon-alpha, Interferon-beta, and
Intereron-gamma
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Avonex
Interferon-beta-1a
Used for RRMS and SPMS w/relapses
Produced by recombinant DNA
technology using genetically engineered
Chinese Hamster Ovary cells into whichthe human interferon beta gene has been
introduced
The resulting amino acid sequence is
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Avonex
Mechanisms by which it exerts it effectsnot fully understood
Pharmacokinetics in MS patients notevaluated
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
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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 diseasecourse in placebo studies
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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
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Recommended Websites to
Learn More http://www.avonex.com
http://www.nationalmssociety.org
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