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Multiple Sclerosis & Treatment of Progression with Interferon-Beta-1a

Multiple Sclerosis & Treatment of Progression with Interferon- Beta-1a

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Multiple Sclerosis & Treatment of Progression with Interferon-

Beta-1a

What is Multiple Sclerosis?

• Most commonly defined as an autoimmune disease that affects the CNS

• Characterized by the loss and/or damage of the myelin sheath

• Loss of myelin sheath results in the inability of neurons to transmit neural signals properly, causing the many symptoms of MS

• Unpredictable and no known cures

Anatomy of the Neuron

Four Major Varieties of MS

• Relapsing/remitting (RRMS)– Characterized by periods of flare-ups and

remission– Accounts for 85% of MS patients

• Primary Progressive (PPMS)– Slow continuous worsening of disease from

onset– Only about 10%

Four Major Varieties of MS (cont.)

• Secondary Progressive (SPMS)– Initial period of relapsing-remitting, then steady

worsening of disease– 50% of patients diagnosed with RRMS develop into

this variety within 10 yrs without drug treatment

• Progressive Relapsing (PRMS)– Steady worsening with acute relapses– Different from RRMS in that disease progresses

during relapses– Only about 5 %

What Causes MS?

• Not exactly known

• Several theories

• Most common—myelin damage results from abnormal response in the immune system– T cells (type of white blood cell) attack myelin– Though to be triggered by environmental

and/or genetic factors

Many other theories

• MS is pathogen-mediated– Research suggests Chlamydia Pneumoniae

and other pathogens may trigger MS

• Genetics– Identical twin studies-> one has MS, other has

30% chance– No specific gene/s found yet

• Most likely involves a combination

MS Geography

• Typical onset between ages 20-50• Reduces life expectancy by about 10-15 yrs• About ½ patients survive 30+ yrs from onset• Affects 2-3 times as many women than men• Research suggests that genetic factors play a

role• More common among people of European

descent• About 400,000 Americans have MS

Symptoms of MS

• Wide variety due to nature of disease• Different classifications of symptoms

– Visual– Motor– Sensory– Cognitive– Coordination/Balance– Bowel, Bladder, and Sexual– Others

Diagnosis of MS

• No single test for diagnosing MS

• Usually diagnosed when all other possibilities ruled out

• Many tests – Medical history– Nervous system functioning– MRI, Evoked potential tests, spinal tap

Basic “Rule” for Diagnosis

• Est. by committee sponsored by NMSS in 1965

• Must have BOTH of the following:– Evidence of myelin loss in at least 2 areas

occurring in different places at different times– Any other diseases that could account for the

above have been ruled out

• Revised in 1983 by Poser to take into account advances in MRI technology

Treatments for MS

• No known cure

• Treatments involve relieving the symptoms or slowing the progression of the disease

• These are mostly drug treatments

• Also CAM’s- Complementary and Alternative Medicine

CAM’s

• Used with or instead of conventional drug treatments

• Some include– Acupuncture– Herbal medicine– Yoga– Relaxation techniques– Hypnosis

Conventional Drug Treatments

• Disease-modifying drugs*– ABC Treatments– Chemotherapeutic Agents– Corticosteroids & ACTH

• Drugs that help with symptoms– Wide variety from anti-depressants

(depression) to laxatives (bowel dysfunction) to anti-convulsants (pain/altered sensations)

ABC Treatments

• Most popular drug treatments for modifying course of disease

• Work by regulating aspects of the immune system

• ABC refers to the 3 major brand names of this category of drugs: Avonex, Betaseron/Betaferon, and Copaxone

• Also now added Rebif and Novantrone

ABC Treatments Cont.

• Interferon beta-1a– Avonex, Rebif

• Interferon beta-1b– Betaseron/Betaferon

• Glatiramer acetate– Copaxone

• Mitoxantrone– Novantrone

What are Interferons?

• Occur naturally in human body

• Proteins that prevent viral multiplication by stimulating the production of antiviral proteins in normal cells

• Interferon-alpha, Interferon-beta, and Intereron-gamma

Avonex

• Interferon-beta-1a

• Used for RRMS and SPMS w/relapses

• Produced by recombinant DNA technology using genetically engineered Chinese Hamster Ovary cells into which the human interferon beta gene has been introduced

• The resulting amino acid sequence is identical to human interferon-beta

Avonex

• Mechanisms by which it exerts it effects not fully understood

• Pharmacokinetics in MS patients not evaluated• Recommended dosage of 30 mcg to be

injected intramuscularly one weekly– Not recommended subcutaneously- adverse

reactions mainly at site of injection*

• No known interactions with other drugs• Safety of doses above 60 mcg has not been

evaluated-> do not know lethal dose

Current Avonex Research

• Avonex fairly new– Lots of research being done, few consistent

findings yet

• Most research with Avonex focuses on:– Comparison with other drugs of its type– Testing properties of the drug by altering

dosages,etc.– Seeing how well drug modifies disease

course in placebo studies

Future Research on MS

• Finding the cause

• Stopping/slowing progress of disease

• Repairing damage already done– Remyelination

• Better ways of treating symptoms

• Focusing on the social implications

Recommended Websites to Learn More

• http://www.avonex.com

• http://www.nationalmssociety.org