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First oral agent to reduce progression to multiple sclerosis after initial symptoms 

MD-FM Thursday October 10, 2013 





GENERIQUE

Carillon

 

Sarah:

MD-FM, Medical News from around the world with Peter Goodwin.

 

P1

PETER:

Hello, and with me is Sarah Maxwell. To begin with: news from the European Committee for Treatment and Research in Multiple Sclerosis, ECTRIMS congress, held in Copenhagen last week: in the TOPIC study a new oral agent delayed progression of MS for patients with clinically isolated syndrome, CIS.

SARAH:  

Yes, teriflunomide reduced the risk of conversion to clinically definite multiple sclerosis by 43% compared to placebo in a double-blind, randomized trial looking at 600 patients with a first clinical episode suggestive of MS

 

PETER:

Hmm, so what about side effects then? Teriflunomide’s already used for relapsing-remitting MS, but it does carry a risk of birth defects for pregnant women doesn’t it?

 

SARAH:

Well yes, and experts actually made that point during the session, reminding delegates that patients with CIS are usually of childbearing age, so it’s one important point to consider. Apart from that, adverse events, overall, were similar between the two treatment arms. Dr. Aaron Miller presented the results in Copenhagen

 

Miller: “I think we have already known, and most of us have felt, that it’s really important to treat multiple sclerosis at the earliest possible recognition. Now we have abundant evidence that those patients with clinically isolated syndrome, who have lesions on their MRI scans, are at such high risk of developing MS that they ought to have therapy initiated immediately. Teriflunomide is now an oral option that makes good sense to use in patients who would be less likely to want to take an injectable form of therapy.” 

 

SARAH:

That was Aaron Miller, from Mount Sinai Medical Center in New York.



P2

PETER:

Also at the ECTRIMS meeting, for patients with secondary progressive MS, for whom therapeutic options are very limited, French experts presented the long-awaited results of the PROMESS trial, comparing intravenous cyclophosphamide with methylprednisolone.

 

SARAH:

And the results were equivocal: while cyclophosphamide was associated with a lower risk of further disability, decreasing the risk of deterioration by 58%, it also failed to reach statistical significance as a superior treatment. The dropout rate of patients on cyclophosphamide was more than twice that of patients on the steroid:

 

Brochet: “Cyclophosphamide is associated with some side effects, usually vomiting and nausea, this explained most of the dropouts. But these are quite good results because it shows that the drug is effective to limit progression, but raises the question about improving the tolerability of the drug. It’s possible now, maybe, because we have new antiemetic drugs, like antagonists of serotonin-1 and so on. In France we’ve used it for many years so it was, for us, confirmatory that it is effective”

 

SARAH:

That was Bruno Brochet, from the University of Bordeaux who presented the results at ECTRIMS. Cyclophosphamide is also known to induce sterility, and not all experts were convinced by Professor Brochet’s data

 

Klaus : “I think based on that presentation no recommendation can be given, to be honest. I think we have to stick to the bottom line that there is a licensed treatment for patients with secondary progressive MS who have relapses, these are the interferons, and otherwise we’ll have to wait and see for new drugs coming along.” 

 

SARAH:

That was Dr. Klaus Schmierer from Queen Mary University of London.




VIRGULE MUSICALE



P3

PETER:

One more new finding about multiple sclerosis now: there’s no significant difference in rates of venous narrowing between people with and without MS. That’s according to results, published in The Lancet, which call into question the controversial theory that MS is associated with a disorder dubbed “chronic cerebrospinal venous insufficiency”




VIRGULE MUSICALE

 

P4  

PETER:

Patients who’ve had a drug-eluting coronary stent implanted, don’t have to wait the currently recommended 12 months after their procedure to have non-cardiac surgery. Six months is long enough to avoid major cardiac events

 

SARAH:

Yes, these are the conclusions of a large retrospective cohort study, published in JAMA, and lead study author, Mary Hawn, gave MDFM the details

Hawn : “Our main findings were that there is an increased rate of cardiac events in the first six months post-stenting, there wasn’t a significant difference in rate by stenting type, and after about six months following stenting, the rate of adverse cardiac events seemed to stabilize. Other factors were much more important, such as if a patient had a recent myocardial infarction that preceded the surgery, that was a highly important factor of whether they were going to have a major cardiac event after surgery.”  

 

SARAH:

Dr. Mary Hawn, from the University of Alabama in Birmingham, added that such underlying cardiac diseases should be used to determine which patients are at perioperative cardiac risk, rather than using the presence of a stent. Surprisingly, the data also showed no difference in adverse events whether patients stopped dual anti-platelet therapy before surgery or not. But Dr. Hawn warned that the study was underpowered for this finding

 

Hawn-2 : “I think regarding antiplatelet therapy management, what our study can say is antiplatelet therapy may be effective but it’s not sufficient. So just continuing antiplatelet therapy is not sufficient enough to prevent an adverse cardiac event in patients at high risk.”

 

SARAH:

Mary Hawn from Alabama.



P5

PETER:

For women with node positive breast cancer who respond well to neo-adjuvant chemotherapy, surgery on more than two sentinel lymph nodes could indicate they can avoid having axillary lymph node dissection!

 

SARAH:

Yes, a study, reported in JAMA, looked at the false-negative rate for sentinel lymph node surgery after chemotherapy, in over 700 women who initially presented with biopsy-proven node positive breast cancer. So far, false negatives have been about 20 to 25 per cent in this specific population, so surgeons haven’t been comfortable bypassing axillary lymph node dissection.

 

PETER:

Which, of course, is quite invasive isn’t it

 

SARAH:

Indeed and what’s more, it turns out that 40 to 50 per cent of women wouldn’t actually need it. This team from the USA says it’s found a way to maximize the accuracy of sentinel node surgery, to help better decide which women can avoid extensive surgery. Senior investigator, Kelly Hunt:

 

Hunt: “With only one sentinel node removed, the false negative rate was about 30 percent. As you go up, two or more nodes, the false negative rate drops below 10 percent, which is what our pre-specified endpoint was that we decided would be a good cut off for deciding that it was accurate enough to replace axillary lymph node dissection. The other factor that was very important was using both a blue dye and a radiolabeled material to identify the sentinel nodes. The other thing that we learned is that when surgeons put a clip in the node, when it was biopsied before neoadjuvant therapy, when they confirmed that the clipped node was removed at surgery, the false negative rate was lower as well.”

 

SARAH:

That was Dr. Kelly Hunt, from MD Anderson Cancer Center in Houston, Texas.




BREVE 1 Sur fond musical

 

PETER:

Finally, in brief:

Researchers in Asia have discovered a susceptibility gene for lumbar disc degeneration, in the largest systematic investigation so far of the genetic risk factors for this condition. It looked at a combination of genome-wide linkage analysis and association studies and identified the gene “carbohydrate sulfotransferase 3”, CHST3, involved with proteoglycan sulfation as responsible. That’s according to data, published in the Journal of Clinical Investigation, which implied CHST3 as a novel disease risk factor. The study results provide new insights into LDD, implicating an inter-play between genetic risk factors and micro-RNAs.

 

And...

 

BREVE 2

The current influenza vaccination policy in England and Wales should be expanded to target five to 16-year-olds to help further reduce the number of deaths from flu. That’s according to a modelling study, published in PLOS Medicine. It showed that offering the flu vaccine to children as well as to the elderly and high-risk groups, would have beneficial effects mostly because children are key "spreaders" of the flu virus.

 

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then from me Peter Goodwin, goodbye!

 

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