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Thread: ECTRIMS 2016: New approach to treating early active RRMS

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    Distinguished Community Member agate's Avatar
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    Default ECTRIMS 2016: New approach to treating early active RRMS

    Some of the MS experts at ECTRIMS are in favor of treating early active RRMS by zapping the patient with a strong drug at first:

    This treatment strategy involves the use of immunosuppressants for the minimum amount of time needed to gain adequate control over disease activity. Once disease control has been achieved, treatment can be switched to maintenance therapy with a better tolerated drug.
    The abstract of the paper presented at the conference (Sept. 14-17 in London) describes three levels of the MS drugs:

    The initial treatment of early active relapsing remitting MS should be with a potent induction therapy rather [than] standard immunomodulation, then escalation

    G. Edan Department of Neurology, CHU Rennes, Rennes, France

    There are two contrasting treatment regimens in MS : induction versus escalation.

    The rationale behind escalating therapy is that treatment starts with safe drugs and only moves on to more aggressive ones if the ongoing treatment fails. In the escalating approach, interferon betas, glatiramer acetate, , teriflunomide and BG12 [Tecfidera] are regarded as first-line drugs, and immunosuppressants (mitoxantrone, natalizumab, fingolimod, alemtuzumab, ocrelizumab ) as second-line ones, and very intensive immunosuppression (autologous bone marrow transplantation, high-dose cyclophosphamide [Cytoxan]) as third-line ones.

    The key to the success of escalation therapy is to define upfront with the patient the exact suboptimal response threshold at which the next-level therapeutic option should be introduced.

    Given that all the immunosuppressants that are currently available present potentially serious side effects, the induction strategy has generally been reserved for patients with very active and aggressive disease. In these patients, there is an acknowledged risk of early disability, and once neurological function is lost, it cannot be regained. This disease-inherent risk can be assumed to outweigh that associated with the use of powerful immunosuppressants.

    This treatment strategy involves the use of immunosuppressants for the minimum amount of time needed to gain adequate control over disease activity. Once disease control has been achieved, treatment can be switched to maintenance therapy with a better tolerated drug.

    A randomised study has demonstrated that induction with mitoxantrone followed by maintenance treatment affords better disease control than monotherapy with an interferon beta. Natalizumab is also effective, but has a propensity to result in rebound inflammatory disease activity on withdrawal.

    More recently, a mere 5-day course of intravenous perfusions of alemtuzumab was found to bring long-term clinical benefits in early relapsing MS patients. This approach may be a useful and conservative means of using these highly effective therapies whilst minimising exposure and the attendant safety risk.

    ___________________
    Disclosure: Dr. Edan reports grants and personal fees from Bayer, Merck , Teva Pharma, Novartis , personal fees from Biogenidec, Sanofi , LFB.








    Last edited by agate; 09-17-2016 at 03:43 PM.
    MS, diagnosed 1980. Avonex 2001-2004. Copaxone 2006-2009.

    "Always put off until tomorrow whatever you think you should do today." --Anonymous



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    Distinguished Community Member Howie's Avatar
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    Interesting.
    Evolution spans the Universe.

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    Distinguished Community Member agate's Avatar
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    I can't say it's ultra-interesting and certainly not entertaining, but the way I see it, this is an MS board, and MS isn't entertaining. It's so unentertaining that we have to take it seriously, and it won't hurt to give some attention to what the experts are doing in their attempts at solving the problems of MS.

    I promise not to impose very many of these conference abstracts on you.

    The person who used to post this kind of thing, xo++ (Mark), was much better at that than I am but right now he doesn't seem to be around.
    MS, diagnosed 1980. Avonex 2001-2004. Copaxone 2006-2009.

    "Always put off until tomorrow whatever you think you should do today." --Anonymous



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    Distinguished Community Member Howie's Avatar
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    It was ultra interesting to me, and I'll tell you why.

    With my second exacerbation, I decided to try, with my doctor's blessings, a new approach at combatting MS. I wanted to try the antiviral Valtrex. I did the Valtrex religiously for 2 years, then stopped taking it. Valtrex is used for coldsores which I had.

    I stopped taking it 16 years ago, and in that time, I've not had a coldsore, OR an exacerbation.

    MS meds, some if not all, have avtiviral qualities, and maybe that's why they work. But they are so strong, and a certain amount of damage to other organs occurs.

    Those drugs are like using a shotgun, where as I used a rifle, with no collateral damage, only damage to what I was aiming at, and it worked.

    So Agate, thanks for this report. It meant a great deal to me, and please keep posting the MS news for us.
    Last edited by Howie; 09-18-2016 at 06:08 AM.
    Evolution spans the Universe.

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    Distinguished Community Member Lazarus's Avatar
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    Quote Originally Posted by agate View Post
    This quote is hidden because you are ignoring this member. Show Quote
    I can't say it's ultra-interesting and certainly not entertaining, but the way I see it, this is an MS board, and MS isn't entertaining. It's so unentertaining that we have to take it seriously, and it won't hurt to give some attention to what the experts are doing in their attempts at solving the problems of MS.

    I promise not to impose very many of these conference abstracts on you.

    The person who used to post this kind of thing, xo++ (Mark), was much better at that than I am but right now he doesn't seem to be around.
    P.s.
    Mitoxantrone is novantrone, right? Novantrone was my favorite therapy. I was very strong while I was on it.

    I appreciate you posting the abstracts very much. Please, post away. What you posted is very interesting.
    Last edited by Lazarus; 09-19-2016 at 01:57 PM.
    Linda~~~~

    Be the kind of woman that when your feet hit the floor each morning the devil says:"Oh Crap, She's up!"

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    Distinguished Community Member agate's Avatar
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    Yes, mitoxantrone is Novantrone.

    It takes a bit of time to sift through the abstracts because there are many of them but I'll be posting a few more.
    MS, diagnosed 1980. Avonex 2001-2004. Copaxone 2006-2009.

    "Always put off until tomorrow whatever you think you should do today." --Anonymous



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  13. #7
    Distinguished Community Member Sunshine's Avatar
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    I very much appreciate these research threads.

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    Distinguished Community Member SalpalSally's Avatar
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    Me too, even though I'm way past RR.
    Love, Sally


    "The best way out is always through". Robert Frost







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