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

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

2. 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

3. Anatomy of the Neuron

4. 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%

5. 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 %

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. CAM’s • Used with or instead of conventional drug treatments • Some include • Acupuncture • Herbal medicine • Yoga • Relaxation techniques • Hypnosis

14. 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)

15. 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

16. ABC Treatments Cont. • Interferon beta-1a • Avonex, Rebif • Interferon beta-1b • Betaseron/Betaferon • Glatiramer acetate • Copaxone • Mitoxantrone • Novantrone

17. 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

18. 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

19. 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

20. 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

21. 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

22. Recommended Websites to Learn More • http://www.avonex.com • http://www.nationalmssociety.org