Multiple Sclerosis Lecture Series: Treatment

Wednesday, June 15, 2022, 12:00 AM - Saturday, June 14, 2025, 11:59 PM

Internet Enduring Material sponsored by Stanford University School of Medicine. Presented by the Stanford University School of Medicine's Department of Neurology and Center for Continuing Medical Education.

How can providers best provide timely treatment to Multiple Sclerosis patients? Watch the fourth lecture in the MS Series to learn about how to choose disease-modifying treatment options, the importance of monitoring patients at regular intervals to evaluate signs of disease activity, and how to balance patients' risks and comorbidities with the advantages of treatments. Listen in to examine the available data about treating with the escalation approach or early induction approach.

     Release Date: June 15, 2022
     Expiration Date: June 14, 2025
     Estimated Time to Complete: 36 minutes 
     Registration Fee: FREE

AMA PRA Category 1 Credits™ (0.50 hours), Non-Physician Participation Credit (0.50 hours)

1. Summarize the benefits of early, high-efficacy treatments for Multiple Sclerosis.
2. Implement consistent disease activity and safety monitoring into clinical practice.

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

Credit Designation 
American Medical Association (AMA) 
Stanford Medicine designates this Enduring Material for a maximum of 0.50 AMA PRA Category 1 Credits^TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

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Cultural and Linguistic Competency
The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.  You are encouraged to visit the Multicultural Health Portal: https://laneguides.stanford.edu/multicultural-health

References/Bibliography
•National Multiple Sclerosis Society. “Ask an MS Navigator.” Accessed June 3, 2022. https://www.nationalmssociety.org/Resources-Support/Find-Support/Ask-an-MS-Navigator.
•Bergamaschi, Roberto. “Prognostic Factors in Multiple Sclerosis.” In International Review of Neurobiology, 79:423–47. Academic Press, 2007. https://doi.org/10.1016/S0074-7742(07)79019-0.
•Berger, Joseph R. “Classifying PML Risk with Disease Modifying Therapies.” Multiple Sclerosis and Related Disorders 12 (February 1, 2017): 59–63. https://doi.org/10.1016/j.msard.2017.01.006.
•Bose, Gauruv, and Mark S Freedman. “Precision Medicine in the Multiple Sclerosis Clinic: Selecting the Right Patient for the Right Treatment.” Multiple Sclerosis Journal 26, no. 5 (April 1, 2020): 540–47. https://doi.org/10.1177/1352458519887324.
•Brown, J. William L., Alasdair Coles, Dana Horakova, Eva Havrdova, Guillermo Izquierdo, Alexandre Prat, Marc Girard, et al. “Association of Initial Disease-Modifying Therapy With Later Conversion to Secondary Progressive Multiple Sclerosis.” JAMA 321, no. 2 (January 15, 2019): 175–87. https://doi.org/10.1001/jama.2018.20588.
•Burton, JM, PW O’Connor, M Hohol, and J Beyene. “Oral versus Intravenous Steroids for Treatment of Relapses in Multiple Sclerosis.” Cochrane Database of Systematic Reviews, no. 12 (2012). https://doi.org/10.1002/14651858.CD006921.pub3.
•Coles, Alasdair. “Newer Therapies for Multiple Sclerosis.” Annals of Indian Academy of Neurology 18, no. 5 (September 1, 2015): 30. https://doi.org/10.4103/0972-2327.164824.
•Dobson, R., and G. Giovannoni. “Multiple Sclerosis – a Review.” European Journal of Neurology 26, no. 1 (January 1, 2019): 27–40. https://doi.org/10.1111/ene.13819.
•“Fig. 1: Timeline of Developments in the Treatment of Multiple Sclerosis. | Nature Reviews Neurology.” Accessed June 3, 2022. https://www.nature.com/articles/s41582-018-0082-z/figures/1.
•Gasperini, Claudio, Luca Prosperini, Mar Tintoré, Maria Pia Sormani, Massimo Filippi, Jordi Rio, Jacqueline Palace, et al. “Unraveling Treatment Response in Multiple Sclerosis.” Neurology 92, no. 4 (January 22, 2019): 180. https://doi.org/10.1212/WNL.0000000000006810.
•Giovannoni, Gavin, Helmut Butzkueven, Suhayl Dhib-Jalbut, Jeremy Hobart, Gisela Kobelt, George Pepper, Maria Pia Sormani, Christoph Thalheim, Anthony Traboulsee, and Timothy Vollmer. “Brain Health: Time Matters in Multiple Sclerosis.” Multiple Sclerosis and Related Disorders 9 (September 1, 2016): S5–48. https://doi.org/10.1016/j.msard.2016.07.003.
•Gross, Robert H., and John R. Corboy. “Monitoring, Switching, and Stopping Multiple Sclerosis Disease-Modifying Therapies.” CONTINUUM: Lifelong Learning in Neurology 25, no. 3 (June 2019): 715. https://doi.org/10.1212/CON.0000000000000738.
•Harding, Katharine, Owain Williams, Mark Willis, James Hrastelj, Anthony Rimmer, Fady Joseph, Valentina Tomassini, et al. “Clinical Outcomes of Escalation vs Early Intensive Disease-Modifying Therapy in Patients With Multiple Sclerosis.” JAMA Neurology 76, no. 5 (May 1, 2019): 536–41. https://doi.org/10.1001/jamaneurol.2018.4905.
•Le Page, Emmanuelle, David Veillard, David A Laplaud, Stéphanie Hamonic, Rasha Wardi, Christine Lebrun, Fabien Zagnoli, et al. “Oral versus Intravenous High-Dose Methylprednisolone for Treatment of Relapses in Patients with Multiple Sclerosis (COPOUSEP): A Randomised, Controlled, Double-Blind, Non-Inferiority Trial.” The Lancet 386, no. 9997 (September 5, 2015): 974–81. https://doi.org/10.1016/S0140-6736(15)61137-0.
•Luna, Gustavo, Peter Alping, Joachim Burman, Katharina Fink, Anna Fogdell-Hahn, Martin Gunnarsson, Jan Hillert, et al. “Infection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies.” JAMA Neurology 77, no. 2 (February 1, 2020): 184–91. https://doi.org/10.1001/jamaneurol.2019.3365.
•Rae-Grant, Alexander, Gregory S. Day, Ruth Ann Marrie, Alejandro Rabinstein, Bruce A.C. Cree, Gary S. Gronseth, Michael Haboubi, et al. “Practice Guideline Recommendations Summary: Disease-Modifying Therapies for Adults with Multiple Sclerosis.” Neurology 90, no. 17 (April 24, 2018): 777. https://doi.org/10.1212/WNL.0000000000005347.
•Rotstein, Dalia L., Brian C. Healy, Muhammad T. Malik, Tanuja Chitnis, and Howard L. Weiner. “Evaluation of No Evidence of Disease Activity in a 7-Year Longitudinal Multiple Sclerosis Cohort.” JAMA Neurology 72, no. 2 (February 1, 2015): 152–58. https://doi.org/10.1001/jamaneurol.2014.3537.
•Spelman, Tim, Melinda Magyari, Fredrik Piehl, Anders Svenningsson, Peter Vestergaard Rasmussen, Matthias Kant, Finn Sellebjerg, Hanna Joensen, Jan Hillert, and Jan Lycke. “Treatment Escalation vs Immediate Initiation of Highly Effective Treatment for Patients With Relapsing-Remitting Multiple Sclerosis: Data From 2 Different National Strategies.” JAMA Neurology 78, no. 10 (October 1, 2021): 1197–1204. https://doi.org/10.1001/jamaneurol.2021.2738.
•Sriwastava, Shitiz, Saurabh Kataria, Samiksha Srivastava, Shaghayegh Kazemlou, Si Gao, Sijin Wen, Hamidreza Saber, et al. “Disease-Modifying Therapies and Progressive Multifocal Leukoencephalopathy in Multiple Sclerosis: A Systematic Review and Meta-Analysis.” Journal of Neuroimmunology 360 (November 15, 2021). https://doi.org/10.1016/j.jneuroim.2021.577721.

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     Name: Holly Meyer
     Title: CME Coordinator
     Email: [email protected]

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Mitigation of Relevant Financial Relationships

Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education. 

There are no relevant financial relationships with ACCME-defined ineligible companies for anyone who was in control of the content of this activity, except those listed in the table below. All of the relevant financial relationships listed for these individuals have been mitigated.

This educational activity is supported in part by an educational grant from Novartis Pharmaceuticals Corporation.