Management of Patients with Significant Disease Activity Despite MS Therapy
Jointly presented by The Johns Hopkins University School of Medicine
and The Institute for Johns Hopkins Nursing.
Summary
Multiple sclerosis (MS) is a clinically heterogeneous disorder with several distinct patterns of initial clinical presentation and long-term course. The progressive accumulation of irreversible neurologic disability is common among patients with MS, occurring either from the initial onset of disease (primary progressive MS) or after an initial period of acute relapses and remissions (secondary progressive MS). However, there are few good treatment options for patients with progressing forms of MS, and the management of these patients presents several significant challenges. The first-line disease-modifying agents used in the treatment of MS (interferon ß-1a, interferon ß-1b, and glatiramer acetate) are thought to produce their beneficial effects in MS by suppressing immune responses and reducing central nervous system inflammation. These first-line immunomodulators are generally more effective when used to treat patients with evidence of active inflammation on magnetic resonance imaging. In contrast, progressive MS is thought to reflect primarily a process of chronic axonal loss and neurodegeneration, with a much less prominent role for inflammation and demyelination.
This activity presents 2 case studies that examine the treatment of patients with MS who exhibit significant continuing disease activity despite MS therapy. The first case describes a patient with frequent continuing relapses and progression of disability despite therapy with glatiramer acetate and natalizumab. The second case discusses the management of a patient who is beginning to exhibit progressive MS after 6 years of treatment with interferon ß-1b. At the conclusion of this activity, participants should be better able to manage patients with MS who have significant disease activity or progression of disability despite treatment with first-line disease-modifying agents.
Goal
To provide neurologists, nurses, and healthcare professionals who care for patients with MS with up-to-date information on the treatment and management of MS.
Target Audience
This activity is designed for neurologists, nurses, and healthcare professionals who care for patients with MS. No prerequisites required.
Learning Objectives
At the conclusion of this activity, the participant should be able to:
- Discuss the biology of demyelination, axonal degeneration, and neuronal cell death in multiple sclerosis (MS).
- Describe current and emerging therapeutic strategies designed to promote neuroprotection in MS.
The Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing take responsibility for the content, quality, and scientific integrity of this CE activity.
CME Information
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of The Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide CME for physicians.
The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
Credit Designation Statement
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
This 1.6 contact hour Educational Activity is provided by The Institute for Johns Hopkins Nursing. Claim only those contact hours actually spent in the activity.
After reading this case module, participants may receive credit by completing the CE test, evaluation, and receiving a score of 70% or higher.
Release date: December 31, 2008. Expiration date: December 31, 2010.
Estimated time to complete activity: 1.6 hours
Full Disclosure Policy Affecting CME Activities
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The participating faculty reported the following:
Course Directors
Benjamin Greenberg, MD, MHS
Assistant Professor
The Johns Hopkins University School of Medicine
Department of Neurology
Co-Director, The Johns Hopkins Transverse Myelitis Center
Director, The Johns Hopkins Encephalitis Center
Baltimore, Maryland
Dr Greenberg reports receiving grants/research support from the Accelerated Cure Project, the National Multiple Sclerosis Society, and Novartis Pharmaceuticals Corporation; serving as a consultant for DioGenix, Inc and Gene Logic Inc; and receiving honoraria from Biogen Idec and Teva Neuroscience.
Michael K. Racke, MD
Professor and Chairman of Neurology
The Helen C. Kurtz Chair in Neurology
The Ohio State University Medical Center
Columbus, Ohio
Dr Racke reports receiving grants/research support from the Bayer, National Institutes of Health, and National Multiple Sclerosis Society; serving as a consultant for Genentech, Inc, Peptimmune, and Teva Neuroscience; and serving on the speakers’ bureau for Bayer, Serono, and Teva Neuroscience.
Participating Faculty
Mark J. Tullman, MD
Assistant Professor of Neurology
Director, Multiple Sclerosis Clinical Care Center
The Neurological Institute of New York
Columbia University Medical Center
New York, New York
Dr Tullman reports receiving research support from Genentech, Inc and Novartis Pharmaceuticals Corporation; serving as a consultant for Biogen Idec, EMD Serono, and Teva Neuroscience; and receiving honoraria from Biogen Idec, EMD Serono, Pfizer Inc, and Teva Neuroscience.
Off-Label Product Discussion: The audience is advised that a case in this CE activity contains reference(s) to unlabeled or unapproved uses of drugs or devices.
Dr Tullman—corticosteroids
All other faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.
This activity was reviewed by Barbara Fitzsimmons, MS, RN, CNRN, for the American Nurses Credentialing Center’s accreditation purposes.
Disclaimer Statement
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing names implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.
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