Chapter 23
1 / 21

Chapter 23 - PowerPoint PPT Presentation

  • Uploaded on
  • Presentation posted in: General

Chapter 23. Drugs for Multiple Sclerosis. Multiple Sclerosis (MS). Chronic, inflammatory, autoimmune disorder that damages the myelin sheath of neurons in the CNS Exact cause is unknown MS causes a wide variety of sensory and motor deficits

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.

Download Presentation

Chapter 23

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript

Chapter 23

Drugs for Multiple Sclerosis

Multiple Sclerosis (MS)

  • Chronic, inflammatory, autoimmune disorder that damages the myelin sheath of neurons in the CNS

  • Exact cause is unknown

  • MS causes a wide variety of sensory and motor deficits

  • Most patients experience periods of acute clinical exacerbations (relapses) alternating with periods of complete or partial recovery (remissions)

  • Over time, symptoms usually grow progressively worse.

Multiple Sclerosis (MS)

  • Primary pathology of MS

  • Inflammation mechanism

  • Initiation of the autoimmune process

  • After an acute attack

  • Myelin sheaths of peripheral neurons

Drug Therapy for MS

  • 1993: dramatic change occurred

    • First disease-modifying agent approved

  • Now disease progression can be slowed, frequency and intensity of relapses decreased, and permanent neurologic loss delayed

  • Early treatment increases the chances of significantly improving prognosis.

Subtypes of MS

  • Relapsing-remitting MS

  • Secondary progressive MS

  • Primary progressive MS

  • Progressive-relapsing MS

Signs and Symptoms of MS

  • Symptoms vary depending on where CNS demyelination occurs and the size of the region of demyelination.

    • Paresthesias

    • Muscle or motor problems

    • Visual impairment

    • Bladder and bowel symptoms

    • Sexual dysfunction

    • Disabling fatigue

    • Emotional lability

    • Depression

Diagnostic Tools for MS

  • Diagnosis of MS

  • Diagnostic criteria: 1965, 2001, 2005, 2010

  • MRI

  • CSF testing

  • Visual evoked potential (VEP)

Fig. 23-1. Symptom patterns that define the four subtypes of MS.

Drug Therapy for MS

  • Disease-modifying therapy

    • Not a cure, but a delay and a decrease in intensity and frequency

    • Immunomodulators and immunosuppressants

Drug Therapy for MS

  • Relapsing-remitting MS

    • This type benefits the most from therapy.

    • Treatment should begin as soon as diagnosed and should continue indefinitely.

    • All patients (regardless of age) should receive immunomodulators.

      • Interferon beta-1a (Avonex)

      • Interferon beta-1a (Rebif)

      • Interferon beta-1b (Betaseron)

      • Glatiramer acetate (Copaxone)

      • Natalizumab (Tysabril)

Drug Therapy for MS

  • Secondary progressive MS

    • Interferon beta

    • Mitoxantrone

  • Primary progressive MS

    • No drugs have shown effectiveness

    • Promising studies (methotrexate, azathioprine, cyclophosphamide)

  • Progressive-relapsing MS

    • Mitoxantrone

Drug Therapy for MS

  • Treating an acute episode (relapse)

    • Short course of high-dose IV glucocorticoid

    • IV gamma globulin

  • Drug therapy of symptoms

    • All four subtypes have the same symptoms

Disease-Modifying Drugs I: Immunomodulators

  • Seven immunomodulators currently available

  • Four preparation of interferon beta

  • All except natalizumab are recommended as first-line therapy for all patients with relapsing-remitting MS and for those with secondary progressive MS who are experiencing acute exacerbations.

  • Decrease relapse rate about 30%

  • Self-injected (except for fingolimod)

Interferon Beta

  • Interferon is a naturally occurring glycoprotein with antiviral, antiproliferative, and immunomodulatory actions.

  • Therapeutic use

    • Reduces the frequency and severity of attacks

    • Reduces the number and size of MRI-detectable lesions

    • Delays progression of disability

Interferon Beta

  • Adverse effects and drug interactions

    • Flu-like reactions

    • Hepatotoxicity

    • Myelosuppression

    • Injection-site reactions

    • Depression

    • Drug interactions

  • Preparation, dosage, and administration

    • Dispensed as single-use syringes and vials

Glatiramer Acetate

  • Therapeutic use

    • For long-term therapy of relapsing-remitting MS

  • Description and mechanism

    • Protects myelin by inhibiting immune response to myelin basic protein

  • Adverse effects

    • Well tolerated

Natalizumab (Tysabril)

  • Introduced in 2004 and withdrawn a few months later owing to three reports of progressive multifocal leukoencephalopathy (severe brain infection)

  • Reintroduced in 2006 with protective restrictions on who can prescribe, dispense, administer, receive it

  • Therapeutic uses – MS and Crohn’s disease

  • Prevents circulating leukocytes from leaving the vasculature

  • Adverse effects – generally well tolerated (headache, fatigue, abdominal discomfort, arthralgia, depression, diarrhea, gastroenteritis, UTI, lower respiratory tract infection)

Disease-Modifying Drugs II: Immunosuppressants

  • Only one approved by the FDA: mitoxantrone

  • More toxic than immunomodulators

  • Produce greater suppression of immune function


  • Therapeutic use

    • Decreases neurologic disability and clinical relapses

  • Mechanism of action

    • Binds with DNA and inhibits topoisomerase

  • Adverse effects and drug interactions

    • Myelosuppression

    • Cardiotoxicity

    • Fetal harm

    • Reversible hair loss, injury to GI mucosa, nausea/vomiting, amenorrhea, allergy symptoms, blue-green tint to urine, skin, and sclera


  • Monitoring summary

    • Perform complete blood counts at baseline and before each dose

    • Perform liver function tests at baseline and before each dose

    • Perform a pregnancy test before each dose

    • Determine left ventricular ejection fraction (LVEF)

      • Before the first dose

      • Before all doses once cumulative dose has been reached

      • Whenever signs of congestive heart failure (CHF) develop

Symptom Management

  • Bladder dysfunction

  • Bowel dysfunction

  • Fatigue

  • Depression

  • Spasticity

  • Sexual dysfunction

  • Neuropathic pain

  • Ataxia and tremor

  • Cognitive dysfunction

  • Dizziness and vertigo

  • Login