1) Welcome to a tweetorial on Long-Term Treatment and Effective Decisions for Switching Therapeutics in #MultipleSclerosis. Accredited for 0.5h by @academiccme: #physicians, #nurses, #pharmacists. I am @drbarrysinger . . . pic.twitter.com/XHontsud9O
— MultipleSclerosis_CME (@ms_cme) July 20, 2021
2) Let’s start with a case. Chelsea is a 29 y/o white woman with new onset RRMS. She has a normal exam, but MR shows four T2 supratentorial white matter lesions (3-5 mm each). There are no spinal cord lesions & + CSF OCB.
— MultipleSclerosis_CME (@ms_cme) July 20, 2021
4) She is single, works as a paralegal, has a contraceptive implant, and is not planning on a family in the near future. All too pertinent that she is both risk aversive and needle-phobic.
— MultipleSclerosis_CME (@ms_cme) July 20, 2021
6) Which of one of the following #DMTs would you consider for her?
— MultipleSclerosis_CME (@ms_cme) July 20, 2021
8) . . . and there is potential risk of fetal harm from teriflunomide per prescribing information so it’s important that Chelsea continuous her highly effective and reliable contraception. Teriflunomide use requires liver enzyme monitoring for hepatotoxicity.
— MultipleSclerosis_CME (@ms_cme) July 20, 2021
10) Bad news: she now has enhancing lesions in her right pons, right parietal centrum semiovale, and dorsal C3 cord.
— MultipleSclerosis_CME (@ms_cme) July 20, 2021
12) In the OPTIMUM study (N Engl J Med 2020;383:546-57), ponesimod reduced annualized relapse rate (ARR) by 31% vs teriflunomide. In ASCLEPIOS I & II (AMA Neurol. 2021;78(5):558-567), ofatumumab reduced ARR by 51 and 59% vs teriflunomide respectively.
— MultipleSclerosis_CME (@ms_cme) July 20, 2021
14) So what we have done is start with a modest-efficacy med with a favorable safety profile, then increase to a higher efficacy agent with potential greater risks at the first signs of breakthrough disease. This is called:
— MultipleSclerosis_CME (@ms_cme) July 20, 2021
16) Welcome back. We are talking Long-Term Treatment and Effective Decisions for Switching Therapeutics in #MultipleSclerosis. I am @drbarrysinger. Program chair @skriegermd and I invite you to follow us here on @MS_cme for accredited tweetorials by authorities in the MS space!
— MultipleSclerosis_CME (@ms_cme) July 21, 2021
18) Corey is a 22 y/o African-American man with h/o depression with new onset RRMS 3 months ago. Exam: Right internuclear ophthalmoplegia (INO), bilateral limb dysmetria, & mild ataxia.
— MultipleSclerosis_CME (@ms_cme) July 21, 2021
20) Corey has many risk factors for higher disability. Which of these factors does NOT predict worse prognosis?
a. African-American race
b. depression
c. incomplete recovery from 1st attack
d. young onset of disease— MultipleSclerosis_CME (@ms_cme) July 21, 2021
22) Starting with high-efficacy therapy (HET) may give Corey the best opportunity to minimize future disability. Which DMT would NOT be considered HET?
— MultipleSclerosis_CME (@ms_cme) July 21, 2021
24) In the @MSBase_Registry study (N Engl J Med 2006; 354:899-910), monoclonal antibody DMTs & mitoxantrone were HET. Natalizumab had demonstrated ARR reduction by 68% vs. placebo. Ofatumumab and ocrelizumab reduced relapses in approximately half compared to another DMT.
— MultipleSclerosis_CME (@ms_cme) July 21, 2021
26) Welcome back. You have rejoined an accredited #tweetorial on DMT in #MultipleSclerosis. I am @drbarrysinger and you are only a few clicks away from FREE CE/#CME! Nods to @KlausSchmierer @myelinMD @DrJNicholas @JennyFengMD @DanOntaneda @Brandon_Beaber @DocforMS
— MultipleSclerosis_CME (@ms_cme) July 22, 2021
28) She’s a married CPA with 2 children, s/p bilateral tubal ligation, is tired of injections, and is declining infusions. The concept of induction therapy was very attractive to her. Which medication would be the best fit?
— MultipleSclerosis_CME (@ms_cme) July 22, 2021
30) That's it! You made it! Free CE/#CME! Now go to https://t.co/rUou3c5Z2j and claim your credit! I am @drbarrysinger. Program chair @SKriegerMD and I invite you to follow @MS_CME for more tweetorials, and to visit us at . . .
— MultipleSclerosis_CME (@ms_cme) July 22, 2021
31) . . . https://t.co/B00BrmcAUi (from @nerdyneuro) and https://t.co/lwK5CUCmLU (from @DrJim4MS) for unrolled programs where credit opportunity is still active! #neurotwitter #MStwitter
— MultipleSclerosis_CME (@ms_cme) July 22, 2021
