2) This program is supported by an educational grant from Bristol Myers Squibb and is intended for an audience of #healthcare providers. The accreditation statement for this program can be found at https://t.co/QO3HNwRSPJ.
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
4a) For 1st line tx, the usual terminology is #switching instead of failure, in recognition that because there are now several DMTs available & have demonstrated efficacy for prevention of clinical relapses & new MRI-detected lesions, perceived lack of efficacy . . .
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
4c) One standard sometimes applied is the number of clinical attacks or new #MRI-detected lesions in the preceding 12 months to define lack of response, says @AANmemberpractice guidelines from 2018: 🔓 https://t.co/uPJGzogQgf.
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
5a) #MS experts deem treatment failure w/ 2L tx's to be mainly due to disability progression in some pts, & in others, transition to secondary progressive multiple sclerosis (#SPMS).
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
5c) Disability progression is an essential indicator of 2L tx response, even if clinical relapses & MRI activity are to be considered. 2L tx failure criteria are thus defined by either a confirmed progression at 6 mos or clinical relapse + MRI activity after one year of tx. pic.twitter.com/7bL5wl9nQb
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
6) Next 🔑❓: Are there data on a mechanistic rationale for black patients having more severe #MS, despite evidence presented that high efficacy #DMT is initiated sooner, or is the thought that health disparities are driving the progression of disease in these populations?
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
7b) Altho the cause of #MS is unknown, it is a heterogeneous disease thought to result from complex interactions among genetic predisposition, sex, and environment. Race is another important factor, but overlaps with some of these elements, ➡️uncertainty around its role in MS.
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
7d) Those minority populations, tho, are often underrepresented in clinical trials in the 🇺🇸, which is also likely true for #MS-specific studies. It is therefore difficult to assess tx response in these populations, even in subgroup analyses, because of the small number of pts.
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
8) And so a follow-up ❓: How do we avoid minority patients "falling through the cracks" of #MS care when they sometimes first present to their #PCP or local ED?
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
9b) There is a compelling need to develop a robust cohort of #AAwMS to increase knowledge about and understanding of the disease in this population. A platform created in response to this need, the National African Americans with MS Registry (#NAAMSR), launched 9/1/2020.
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
9d) (cont)
(2) identify barriers & improve access to MS care; &(3) improve care for #AAwMS through patient and healthcare provider education. The registry was founded by #neurologists who specialize in MS care, inc leading African American MS neurologists located across the 🇺🇸.— MultipleSclerosis_CME (@ms_cme) February 7, 2024
9f) Such efforts are critical to understanding the special healthcare needs and burdens of all minority and underserved populations with #MS. Perhaps #supportgroups can help as well ❓❓
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
10b) "One must be conscious of the target audience. It is important that the support group be designed to meet the needs of the participants. The researchers have been told by some #pwMS that they attended a support group in the past when they were first diagnosed . . .
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
11) Finally, ❓ What are your thoughts on psychosocial strategies to preserve cognitive performance (e.g. cognitive rehabilitation) ❓
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
12b) The Cognitive Rehabilitation for Attention and Memory in #MS (#CRAMMS) trial showed some evidence of effectiveness of cognitive rehabilitation in improving cognitive function, again with some participants benefitting more than others.
See 🔓 https://t.co/KtasXDDBoC.— MultipleSclerosis_CME (@ms_cme) February 7, 2024
12d) Suffice it to say they did a very complex analysis! The bottom line of the bottom line is that it appears that younger patients, with medium to high education, diagnosed with #RRMS & #PPMS without recent relapses . . .
(cont)— MultipleSclerosis_CME (@ms_cme) February 7, 2024
13a) Harand et al agreed from their extensive review that data indicate the potential benefit of cognitive-behavioral therapies, mindfulness or physical exercise on varied psychological functions in #MS.🔓 https://t.co/dPxVLDIWfR
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
13c) Both practicing #mindfulness &⬆️ing physical exercise as tolerated have some supporting data and are being actively studied.
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
13e) Cognitive & physical disorders of MS can slow down personal investment in research studies.
🔓 https://t.co/1De8ZgG9IA— MultipleSclerosis_CME (@ms_cme) February 7, 2024
13g) What perhaps matters most is the interest #pwMS have for the intervention, what they can psychologically invest in their therapy and how they perceive their deficits.https://t.co/4zRv19RmvZ
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
14b) So it's kind of a trick question. Demographics are changing with #MS as the diagnosis is increasingly made. We'll give credit for a or c, citing 🔓 https://t.co/TBfiODm1nD: pic.twitter.com/OKiyWzHbg0
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
14d) More studies are needed to determine whether #MS is an emerging disease among US #Hispanic adults and whether MS susceptibility and prevalence vary among Hispanic or Asian individuals from different cultures or ancestral backgrounds.
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
15b) It's c. Patients living with a partner or other family are more likely to benefit from memory rehab.
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
17) Follow us here for more #accredited #tweetorials from expert authors. And register NOW for Advanced Curriculum for #MultipleSclerosis 2024, The 9th Annual Pre-ACTRIMS Comprehensive CME/CE Course, at https://t.co/EnPVYxNtPN!
— MultipleSclerosis_CME (@ms_cme) February 7, 2024
