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Multiple Sclerosis Lecture Series: Treatment

Learning Objectives
1. Summarize the benefits of early, high-efficacy treatments for multiple sclerosis
2. Implement consistent disease activity and safety monitoring into clinical practice
0.5 Credit CME

Internet Enduring Material sponsored by Stanford University School of Medicine. Presented by the Stanford University School of Medicine Department of Neurology and Center for Continuing Medical Education.

How can providers best provide timely treatment to Multiple Sclerosis patients? Watch the fourth lecture in the MS Series to learn about how to choose disease-modifying treatment options, the importance of monitoring patients at regular intervals to evaluate signs of disease activity, and how to balance patients' risks and comorbidities with the advantages of treatments. Listen in to examine the available data about treating with the escalation approach or early induction approach.

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Video Information

All Rights Reserved. The content of this activity is protected by U.S. and International copyright laws. Reproduction and distribution of its content without written permission of its creator(s) is prohibited.

Financial Support Disclosure Statement: Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education.

There are no relevant financial relationships with ACCME-defined ineligible companies for anyone who was in control of the content of this activity, except those listed in the table below. All of the relevant financial relationships listed for these individuals have been mitigated.

Lucas B. Kipp, MD

Stanford hospital & Clinics

Course Director, Faculty

Grant or research support-Roche/Genetech/ Grant or research support biogen Idec.

Ruth Adewuya, MD, CHCP

Managing Director, Center for Continuing Medical Education

Stanford University School of Medicine

Planner

Nothing to disclose

Marilyn Mejia, BA

Education Design Coordinator

Stanford University

Planner

Nothing to disclose.

Jamie McDonald, MD

Stanford Health Care

Reviewer

Nothing to disclose

Commercial Support Disclosure Statement: This educational activity is supported in part by an educational grant from Novartis Pharmaceuticals Corporation.

References:
1.
National Multiple Sclerosis Society.  Ask an MS Navigator.  Accessed June 3, 2022. https://www.nationalmssociety.org/Resources-Support/Find-Support/Ask-an-MS-Navigator
2.
Bergamaschi  R.  Prognostic factors in multiple sclerosis.  Int Rev Neurobiol. 2007;79:423–447. doi:10.1016/S0074-7742(07)79019-0Google Scholar
3.
Berger  JR.  Classifying PML risk with disease modifying therapies.  Mult Scler Relat Disord. 2017;12:59–63. doi:10.1016/j.msard.2017.01.006Google Scholar
4.
Bose  G, Freedman  MS.  Precision medicine in the multiple sclerosis clinic: Selecting the right patient for the right treatment.  Multiple Sclerosis Journal. 2020;26(5):540–547. doi:10.1177/1352458519887324Google Scholar
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Brown  JWL, Coles  A, Horakova  D,  et al.  Association of Initial Disease-Modifying Therapy With Later Conversion to Secondary Progressive Multiple Sclerosis [published correction appears in JAMA. 2020 Apr 7;323(13):1318].  JAMA. 2019;321(2):175–187. doi:10.1001/jama.2018.20588Google Scholar
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 Fig. 1: Timeline of Developments in the Treatment of Multiple Sclerosis.  |  Nature Reviews Neurology. Accessed June 3, 2022. https://www.nature.com/articles/s41582-018-0082-z/figures/1Google Scholar
10.
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Gross  RH, Corboy  JR.  Monitoring, Switching, and Stopping Multiple Sclerosis Disease-Modifying Therapies [published correction appears in Continuum (Minneap Minn). 2019 Aug;25(4):1175].  Continuum (Minneap Minn). 2019;25(3):715–735. doi:10.1212/CON.0000000000000738Google Scholar
13.
Harding  K, Williams  O, Willis  M,  et al.  Clinical Outcomes of Escalation vs Early Intensive Disease-Modifying Therapy in Patients With Multiple Sclerosis.  JAMA Neurol. 2019;76(5):536–541. doi:10.1001/jamaneurol.2018.4905Google Scholar
14.
Le Page  E, Veillard  D, Laplaud  DA,  et al.  Oral versus intravenous high-dose methylprednisolone for treatment of relapses in patients with multiple sclerosis (COPOUSEP): a randomised, controlled, double-blind, non-inferiority trial [published correction appears in Lancet. 2016 Jan 23;387(10016):340].  Lancet. 2015;386(9997):974–981. doi:10.1016/S0140-6736(15)61137-0Google Scholar
15.
Luna  G, Alping  P, Burman  J,  et al.  Infection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies [published correction appears in JAMA Neurol. 2021 Sep 7;:null ].  JAMA Neurol. 2020;77(2):184–191. doi:10.1001/jamaneurol.2019.3365Google Scholar
16.
Rae-Grant  A, Day  GS, Marrie  RA,  et al.  Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology [published correction appears in Neurology. 2019 Jan 8;92(2):112].  Neurology. 2018;90(17):777–788. doi:10.1212/WNL.0000000000005347Google Scholar
17.
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18.
Spelman  T, Magyari  M, Piehl  F,  et al.  Treatment Escalation vs Immediate Initiation of Highly Effective Treatment for Patients With Relapsing-Remitting Multiple Sclerosis: Data From 2 Different National Strategies.  JAMA Neurol. 2021;78(10):1197–1204. doi:10.1001/jamaneurol.2021.2738Google Scholar
19.
Sriwastava  S, Kataria  S, Srivastava  S,  et al.  Disease-modifying therapies and progressive multifocal leukoencephalopathy in multiple sclerosis: A systematic review and meta-analysis.  J Neuroimmunol. 2021;360:577721. doi:10.1016/j.jneuroim.2021.577721Google Scholar

Accreditation
In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credit Designation
Stanford Medicine designates this Enduring Material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

     
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