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
Axon can be damaged as well

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 Genetics
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 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)
* Hard to tell if drug is modifying the course of the disease because the disease is so unpredictable…

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 Interferon beta-1b
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
-Pharmacokinetics is what body does to drug- how it is absorbed, distributed, eliminated, etc
-Has been evaluated in healthy patients
-Injected because it’s a protein..if pill stomach would break it down
* Inflammation, atrophy, and hemmorhage

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