. . . and this tweetorial series is supported by educational grants from GW Pharma and Sanofi Genzyme. It is intended for an audience of healthcare providers. Thanks for joining!
— MultipleSclerosis_CME (@ms_cme) July 6, 2021
THREE: Discuss the evidence of medications targeting progression in MS.
Shout-outs to @GavinGiovannoni @StaceyLClardy @AaronBosterMD @KlausSchmierer @MSHSNeurology @MSUnites @MS_Focus @TheGirlWithMS @cobanmd @mssocietyHCP @MSheehanRI @mssociety @IntNatlWiMS @uconnhealth— MultipleSclerosis_CME (@ms_cme) July 6, 2021
4) Make your choice and return tomorrow for the answer and great discussion! @MustStopMS @mscare @mssociety @MSassociation @Shiftms @NerdyNeuroMD @SKriegerMD @RanyAburashed @MarTintore @XMontalban
— MultipleSclerosis_CME (@ms_cme) July 6, 2021
The Integration of clinical and MRI variables at 15 months predicted EDSS changes at 15 years better than clinical factors.
— MultipleSclerosis_CME (@ms_cme) July 7, 2021
(BRAIN 2017:140; 2814–2819) https://t.co/QH6jIDt9nP
— MultipleSclerosis_CME (@ms_cme) July 7, 2021
8) Although, we still lack definitive molecular biomarkers for Progressive MS, it is becoming clear that features at the onset of the disease or after a short period of observation, allow an estimation of disease progression.
— MultipleSclerosis_CME (@ms_cme) July 7, 2021
10) Additional work has indicated that the features early in the diagnosis can facilitate estimation of risk for progression. In the Barcelona Cohort of CIS (Mult Scler 2020;26:1658-1669) . . .
— MultipleSclerosis_CME (@ms_cme) July 7, 2021
12) Early treatment was associated with a decreased risk of EDSS, in this cohort patients with aggressive MS had increased number of T2 lesions and contrast-enhancing lesions.
— MultipleSclerosis_CME (@ms_cme) July 7, 2021
14) Recent studies indicate that African Americans have an increased age-adjusted prevalence, and increased incidence of progressive MS compared to other racial-ethnic groups. African Americans and Hispanics, when compared to Caucasians . . .
— MultipleSclerosis_CME (@ms_cme) July 7, 2021
(BTW, for more accredited discussion on this topic, see @NerdyNeuroMD ’s #tweetorial on health equity issues in MS at https://t.co/6HVYVekkTW)
— MultipleSclerosis_CME (@ms_cme) July 7, 2021
17) A 2019 study suggested smoking is associated with MS severity and progression, acting as disease modifier and independent risk factor (Front Neurol 2019 Aug 13;10:866). https://t.co/tgkuLrRdMZ
— MultipleSclerosis_CME (@ms_cme) July 7, 2021
19) What is the best approach to treat MS patients with mod-high risk for progression?
a. Start with a lower efficacy med such as injectables
b. Wait/see how patients evolve after starting a safer med
c. Autologous stem cell transplants
d. Highly effective infusion medications— MultipleSclerosis_CME (@ms_cme) July 7, 2021
21) Welcome back to our accredited tweetorial on progression in #MultipleSclerosis. I am @DrJim4MS The answer to yesterday’s question is d.
— MultipleSclerosis_CME (@ms_cme) July 8, 2021
22) More on yesterday’s poll: recent studies have shown that there is a window of opportunity to treat and modify the disease with early treatment. Traditionally, MS has been treated with an escalation approach, starting patients on a modestly effective medication . . .
— MultipleSclerosis_CME (@ms_cme) July 8, 2021
24). Two ongoing trials aim to provide definitive answers 1) TRaditional versus Early Aggressive Therapy for MS (TREAT-MS) trial and the Determining the Effectiveness of earLy Intensive Versus Escalation approaches for the treatment of Relapsing-remitting MS (DELIVER-MS).
— MultipleSclerosis_CME (@ms_cme) July 8, 2021
26) . . . reduced risk of conversion to secondary progressive MS (SPMS).A 2019 study support the notion that in a real-life setting, long-term outcomes were more favorable following early intensive therapy vs first-line moderate-efficacy DMT
— MultipleSclerosis_CME (@ms_cme) July 8, 2021
27) While we await confirmation from these trials in the type of approach, there is enough evidence to say that early and highly active therapy is beneficial for patients with aggressive phenotype, with severe burden of disease activity
— MultipleSclerosis_CME (@ms_cme) July 8, 2021
29) Similarly, gaps exist between developed and developing countries around and among minorities. Too many minority patients must endure hurdles to get access to care, or experience delayed diagnosis or initiation of DMTs due to healthcare disparities.
— MultipleSclerosis_CME (@ms_cme) July 8, 2021
31) . . . low neurology coverage, usually rural areas or "neurology deserts.” Among other real-world causes for modifiable risk for progression include delaying initiation of DMTs, not changing DMTs when they fail (therapeutic inertia), or reluctance to treat patients with . . .
— MultipleSclerosis_CME (@ms_cme) July 8, 2021
33) What is the best choice of medications for a newly diagnosed patient with primary progressive MS?
a.Oral medications
b.Injectables
c.Alpha4 beta1 blocker
d.Anti-CD20 depleting medications— MultipleSclerosis_CME (@ms_cme) July 8, 2021
35) Welcome back to the conclusion of our tweetorial on Progression in #MS. You’re almost there: FREE CE/#CME! I am @DrJim4MS, and I are so proud you have joined our accredited program. The answer to yesterday’s question is d. Anti-CD20 medications are approved to treat PPMS.
— MultipleSclerosis_CME (@ms_cme) July 9, 2021
37) Another FDA-approved medication that shown benefit in clinical trial for active secondary progressive #MS is Siponimod (Lancet 2018;391(10127):1263). https://t.co/K4Byp09Emn
— MultipleSclerosis_CME (@ms_cme) July 9, 2021
39) Trials are underway to determine the effectiveness of measures to target pathways in the brain that are associated with progression like microglia activation. @MarTintore @XMontalban
— MultipleSclerosis_CME (@ms_cme) July 9, 2021
41) The bottom line: There are biological difference that account for progression in MS, but there are real-world (modifiable) challenges that facilitate progression. Identification of challenges and risk factors is essential for tackling the disease . . .
— MultipleSclerosis_CME (@ms_cme) July 9, 2021
43) Supported by the results from phase II and III trials showing a short window of opportunity for treatment of progressive multiple sclerosis with anti-inflammatory drugs in the early phase of the progressive course when patients are younger . . .
— MultipleSclerosis_CME (@ms_cme) July 9, 2021
45) Congratulations! You made it! FREE CE/#CME! Go to https://t.co/QM0gGQ4NZ9 to receive your credit. Be sure to FOLLOW us for more accredited tweetorials in the #MS space! I am @DrJim4MS, and program chair @SKriegerMD and I thank you for joining us!
— MultipleSclerosis_CME (@ms_cme) July 9, 2021
