Outline. References. Marshall,1

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1 Outline Multiple Sclerosis: More Than Your ABC s Janene L. Marshall, PharmD, BCPS Clinical Associate Professor Internal Medicine Clinical Pharmacist Chicago State University College of Pharmacy J-marshall@csu.edu 1. Epidemiology of 2. Etiology 3. Pathophysiology 4. Signs and Symptoms 5. Diagnosis 6. Subtypes a. Primary Progressive b. Remitting c. Secondary Progressive d. Progressive relapsing 7. Treatment a. Exacerbation Treatment b. Disease Modifying Therapy 8. Related Illnesses 9. CAM 10. Pharmacist and Technician Role 11. Resources References 1. Olek, Michael J. Clinically isolated syndromes suggestive of multiple sclerosis. UpToDate. Accessed: October Marshall JL. Multiple Sclerosis Treatment Update: Current and Emerging Therapies Power Pak CE. 3. Comer G, et al. Phase III dose-comparison study of glatiramer acetate for multiple sclerosis. Ann Neurol.2011;69(1): Gold R, et al. Placebo-Controlled Phase 3 Study of Oral BG-12 for Multiple Sclerosis. N Engl J Med 2012;367: Fox, et al. Placebo-Controlled Phase 3 Study of Oral BG-12 or Glatiramer in Multiple Sclerosis. N Engl J Med 2012;367: Habibi, et al. Management of multiple sclerosis and the integration of related specialty pharmacy programs within health systems. AJHP. 2016;73: Ayzenberg, et al. Fingolimod for multiple sclerosis and emerging indications: appropriate patient selection safety precautions, and special considerations. Ther Clin Risk Manag. 2016;12: Marshall,1

2 FDA approved Pharmacotherapy Table Generic Name Brand Name Indication Treatment Common Adverse Effects Dose Interferon beta-1a Avonex Rebif Peginterferon beta- 1a Interferon beta-1b Glatitramer (Glatopa), Dimethyl fumerate (BG-12) CIS 30mcg IM q week 44mcg SQ three times weekly Plegridy RR 125mg q 2 weeks Betaseron Extavia CIS 0.25mg SQ every other day Copaxone CIS, RR 20mg SQ daily 40mg SQ TIW Tecfidera 240 mg PO twice daily injection site reactions (SQ>IM), depression, liver abnormality, leukopenia injection site reactions, depression, liver abnormality, leukopenia injection site reactions, depression, liver abnormality, leukopenia Injection site reaction, transient immediate post injection reaction Flushing, GI side effects Terifluonmide Aubagio Alemtuzumab Lemtrada B-cell chronic lymphocytic leukemia, Fingolimod Gilenya 7 or 14mg PO daily 12 mg IV daily for 5 consecutive days, followed 12 months later by 12 mg daily for 3 consecutive days 0.5mg PO daily Daclizumab Zinbryta RR 150mg SQ monthly Hair loss/thinning, liver abnormality, *liver toxicity, GI side effects, infection, pregnancy category X Headache, fatigue, urticarial, UTI, candidiasis, arthralgia, URI, fever, thyroid disease Headache, diarrhea, influenza, back pain, liver abnormality, macular edema, *decreased HR and BP with first dose *severe liver injury, lymphadenopathy, skin reactions, nasopharyngitis, URI, depression Marshall,2

3 Natalizumab Tysabri Mitoxantrone Novantrone SP, worsening forms of relapsing Abbreviations: *Black box warning 300mg IV q4weeks 12mg/m 2 IV over 5-15 minutes q 3 months Lifetime maximum: 140mg/m 2 *PML, suppression of immune system, infections Blue-green urine for 24 hours, nausea, menstrual disorders, *cardiotoxicity, *liver toxicity, leukopenia, leukemia, infections CIS- Clinically Isolated Syndrome, PML Progressive multifocal leukoencephalopathy, SP- secondary progressive, RRrelapsing remitting Marshall,3

4 National Society Resources Avonex Rebif Copaxone Knowledge is Power (KIP) ActiveSource avonex.com msactivesource.com LifeLinesTM rebif.com mslifelines.com Shared Solutions sharedsolutions.com Plegridy/Tecfidera ABOVE Betaseron/Extavia betaseron.com extavia.com Extavia Go Program Novantrone Tysabari tysabri.com Marshall,4

5 Gilenya gilenya.com Go Program Aubagio one to one, One2One Marshall,5