Carole Bullock, MA

Experts examine conflicting evidence regarding the continuation of disease-modifying therapy in patients with secondary progressive multiple sclerosis.

Session at the 2014 Annual Meeting of the Consortium of Multiple Sclerosis Centers debates whether the side effects associated with alemtuzumab, a novel anti-CD52 monoclonal antibody, might ultimately prevent its approval for the treatment of multiple sclerosis, despite evidence of clinical effectiveness.

Low rates of immunogenicity observed in study support the potential benefits of subcutaneous peginterferon beta-1a in the treatment of patients with relapsing-remitting multiple sclerosis.

The reductions in brain volume often seen in patients with chronic relapsing–remitting multiple sclerosis may be reduced by treatment with interferon beta-1a, though treatment may be affected by the patient's immunologic status.

Analysis of NARCOMS data showed that switching from natalizumab to fingolimod or injectable therapy was associated with an increased likelihood of reported disability progression.

Primary MS is characterized by neurodegeneration with neuroaxonal injury and diffuse inflammation; disease progression is linked with age. Effective management calls for symptom-specific medical management combined with wellness and health maintenance measures.

Although there are more treatment options than ever before available to patients and clinicians, new approaches are needed to treat acute exacerbations, as well as new options that can help meet the long-term goals of symptomatic management and rehabilitation.

Coping strategies based on enhanced mindfulness and a greater sense of agency can help patients improve their quality of life.

Medication selection should be driven by rational polypharmacy and take into account such factors as pain type, underlying symptoms, comorbidities, patient preference, and medication side effects.

Some studies have shown benefit in reducing pain and spasticity in patients with multiple sclerosis, but the data is mixed and can be highly subjective.

A recent study of thienopyridine use among patients who had undergone percutaneous coronary intervention (PCI) in a large hospital network found that the antiplatelet drug ticagrelor was more frequently prescribed in higher risk, less stable patients.

Treatment with rivaroxaban reduced the long-term risk of cardiovascular death, myocardial infarction, or stroke in patients with ACS on a thienopyridine such as clopidogrel, regardless of PPI use.

Patients with non-ST-segment elevation (non-STEMI) acute coronary syndrome and peripheral artery disease (PAD) treated with the PAR-1 antagonist vorapaxar experienced a reduction in ischemic events and other outcomes compared to patients who received placebo, with no increased risk of bleeding compared to patients who did not have PAD.

Antiarrhythmic drug therapy was associated with increased risk of rehospitalization after one year in a population of elderly patients with atrial fibrillation and CAD.

Although they had more cardiovascular comorbidities, patients with atrial fibrillation and diabetes experienced rates of ischemic stroke comparable to those in AF patients without diabetes.

Analysis of health claims data indicates that physicians are underprescribing anticoagulant treatment in large numbers of patients with atrial fibrillation who are at high risk of stroke and low risk of bleeding.

Although oral antiplatelet therapy is broadly supported as preventive therapy for patients with established atherosclerotic vascular disease, researchers say emerging evidence for specific agents shows heterogeneous outcomes by symptomatic vascular bed, and patterns of use may vary by symptomatic territory.

Study results presented at AHA 2013 show that nearly half of patients with nonvalvular atrial fibrillation (NVAF) are at high risk of discontinuing their medications. However, patients taking novel anticoagulants such as dabigatran or rivaroxaban were less likely to stop their medications.

Long term survival after cardiac resynchronization therapy in patients with atrial fibrillation and atrioventricular junction ablation is similar to that observed in patients in sinus rhythm, but death rate is elevated for atrial fibrillation patients treated with rate-slowing drugs.