This content is for healthcare professionals only.

This activity is funded by an independent medical education grant from the Healthcare Business of Merck KGaA, Darmstadt, Germany.

This medical education is jointly provided by USF Health and touchIME.

Faculty & Disclosures

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    Faculty & Disclosures
    Dr Ruth Dobson

    Preventive Neurology Unit,
    Queen Mary University of London, UK

    Dr Ruth Dobson is a reader and an honorary consultant neurologist based at the Wolfson Institute of Population Health, Queen Mary University of London. read more

    Her current research interests are centred on the early identification and epidemiology of MS. She is also particularly interested in ensuring that all people with MS are represented in research, and is focused on the roles of ethnicity, deprivation and gender in MS. She led the publication of UK guidelines on pregnancy in MS, and leads the UK MS pregnancy register. She is principal investigator on a large UK-wide MS pharmacovigilance study, OPTIMISE:MS, and has examined serological response to COVID vaccination in people with MS.

    She was a Royal College of Physicians Emerging Women Leader Programme fellow in 2019. Current research projects are supported by the National MS Society, MS Society, Horne Family Foundation, Barts Charity, the BMA Foundation, Medical Research Council and the National Institute for Health and Care Research. She has over 100 peer reviewed publications. She is currently strategic lead for dementia at UCL Partners, a member of National Health Service England Neurology Clinical Reference Group, and a member of the Association of British Neurologists MS advisory group.

    Dr Ruth Dobson discloses: Advisory board or panel fees from Biogen, Janssen, Merck KGaA, Novartis, Roche and Sandoz. Grants/research support from Biogen, Celgene and Merck KGaA. Other financial or material support (royalties, patent, etc.) from Biogen, Janssen, Merck KGaA, Novartis, Roche and Sandoz.
    Dr Ide Smets

    Erasmus MC Hospital, MS Center ErasMS, Rotterdam, The Netherlands

    Dr Ide Smets works as a faculty neurologist specializing in MS and other neuroinflammatory diseases at Erasmus MC Hospital in Rotterdam. read more

    She did her neurology training in University Hospitals Leuven where she also obtained her PhD examining heterogeneity among people with MS using in-depth immunology and genetics. After graduating, she was awarded with a European Comittee for Treatment and Research in Multiple Sclerosis clinical fellowship grant to continue her training at Barts-MS in London under the supervision of Prof. Gavin Giovannoni. Working in this centre, she learned how to personalize treatment decisions in MS using neurofilament light chain levels, and developed an online decision tool on the ClinicSpeak website to guide people with MS when considering treatment choices.

    Dr Ide Smets discloses: Speakers bureau fees from EPG Health (relationship terminated).
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    touchNEUROLOGY touchNEUROLOGY
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    Factors guiding the use of high-efficacy DMTs in the management of active MS
    Current approaches and safety considerations relating to DMT switching and sequencing in MS
    Approaches needed to support women of child-bearing age living with MS
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    Multiple Sclerosis, Neuroimmunology CE/CME accredited

    touchIN CONVERSATION
    A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation. Close

    Individualizing long-term treatment and care in active MS: How are therapeutic sequencing options evolving to address unmet needs?

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    Learning Objectives

    After watching this activity, participants should be better able to:

    • Evaluate factors guiding the use of high-efficacy DMTs in the management of active MS
    • Summarize current approaches and safety considerations relating to DMT switching and sequencing in MS
    • Appraise the use of DMTs in women of child-bearing age with MS, including considerations for family planning and implications during pregnancy and beyond
    Overview

    In this activity, two experts in MS explore the evolving practicalities of therapeutic sequencing options in MS. They discuss when to consider high-efficacy DMTs, how to optimize a switch in DMT, and practical considerations surrounding the use of DMTs in women of child-bearing age living with MS.

    The discussion is guided by pre-canvassed questions provided by healthcare professionals involved in the management of people living with MS.

    This activity is jointly provided by USF Health and touchIME. read more

    Target Audience

    General neurologists and MS specialists, including specialist nurses, involved in the management of people with MS.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr Ruth Dobson discloses: Advisory board or panel fees from Biogen, Janssen, Merck KGaA, Novartis, Roche and Sandoz. Grants/research support from Biogen, Celgene and Merck KGaA. Other financial or material support (royalties, patent, etc.) from Biogen, Janssen, Merck KGaA, Novartis, Roche and Sandoz.

    Dr Ide Smets discloses: Speakers bureau fees from EPG Health (relationship terminated).

    Content reviewer

    John Ciotti, MD discloses: Advisory Board or Panel fees from EMD Serono, Genentech, Janssen, Novartis (All Relationships Terminated).

    Touch Medical Directors

    Christina Mackins-Crabtree has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu.

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Date of original release: 12 June 2023. Date credits expire: 12 June 2024.

    If you have any questions regarding credit please contact cpdsupport@usf.edu.

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

    Claim Credit
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    This Activity Is Funded By:

    An independent medical education grant from the Healthcare Business of Merck KGaA, Darmstadt, Germany. This activity is jointly provided by USF Health and touchIME.

    The information provided by this CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CE to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 12 June 2023. Date credits expire: 12 June 2024.

    Claim Credit
    touchIN CONVERSATION
    Individualizing long-term treatment and care in active MS: How are therapeutic sequencing options evolving to address unmet needs?
    1.0 CE/CME credit
    Question 1/5
    You are managing your patient who has recently been diagnosed with MS. How would you proceed when deciding if your patient may benefit from a high-efficacy DMT approach?

    DMT, disease-modifying therapy; MRI, magnetic resonance imaging; MRZ, measles, rubella and varicella zoster virus antibodies; MS, multiple sclerosis.

    The ECTRIMS/EAN guidelines on the pharmacological treatment of people with MS state that, when starting a new drug, clinicians should take into account that the greater the disease activity (clinical and MRI), the higher the need for high-efficacy DMTs.1 The 2021 MAGNIMS–CMSC–NAIMS consensus recommendations on the use of MRI in patients with MS recommend the use of MRI at diagnosis to predict future disease activity and, to some extent, disease progression.2

    Abbreviations

    CMSC, Consortium of Multiple Sclerosis Centres; DMT, disease-modifying therapy; EAN, European Academy of Neurology; ECTRIMS, European Committee for Treatment and Research in Multiple Sclerosis; MAGNIMS, Magnetic Resonance Imaging in MS; MRI, magnetic resonance imaging; MS, multiple sclerosis; NAIMS, North American Imaging in MS Cooperative.

    References

    1. Montalban X, et al. Mult Scler. 2018;24:96–120.
    2. Wattjes MP, et al. Lancet Neurol. 2021;20:653–70.
    Question 2/5
    Which of the following is a criterion for switching DMT in patients with MS who have been using a DMT long enough for the treatment to take full effect?

    DMT, disease-modifying therapy; MRI, magnetic resonance imaging; MS, multiple sclerosis.

    European consensus publications define treatment failure, where a patient may have their treatment switched, as ≥3 new T2 lesions and 1 relapse, or ≥2 relapses (independent of MRI activity) in the last 6 to 12 months. American consensus guidelines recommend the criteria of ≥1 relapse, ≥2 new MRI-detected lesions, or increase in disability over 1 year.

    Abbreviation

    MRI, magnetic resonance imaging.

    Reference

    Wiendl H, et al. Ther Adv Neurol Disord. 2021;14:17562864211039648.

    Question 3/5
    You are treating your patient with MS with natalizumab. Which of the following monitoring strategies would you implement to help decide if your patient needed to switch to another DMT?

    DMT, disease-modifying therapy; JCV, John Cunningham virus; MS, multiple sclerosis.

    Testing for serum anti-JCV antibodies prior to initiating, and every 6 months following, is recommended in patients receiving treatment with natalizumab. If JCV granule cell neuronopathy is suspected, further use of natalizumab should be suspended until progressive multifocal leukoencephalopathy is evaluated and, if confirmed, discontinued.

    Abbreviation

    JCV, John Cunningham virus.

    Reference

    EMA. Natalizumab SmPC. Available at: www.ema.europa.eu/en (accessed 15 May 2023).

    Question 4/5
    Exposure to anti-CD20 monoclonal antibodies in patients with MS during pregnancy has which of the following reported outcomes?

    MS, multiple sclerosis.

    Real-world data suggest that exposure to anti-CD20 monoclonal antibodies during pregnancy in women with MS led to a probable risk for reduced B-cell count in neonates.

    Abbreviation

    MS, multiple sclerosis.

    Reference

    Krysko KM, et al. Lancet Neurol. 2023;22:350–66.

    Question 5/5
    You are managing your patient with MS who discontinued their DMT during pregnancy and wishes to breastfeed, but whose disease activity suggests they would benefit from treatment resumption. Which of the following factors do you need to consider?

    DMT, disease-modifying therapy; IFN, interferon; MS, multiple sclerosis.

    DMTs can be excreted into breastmilk at varying rates dependent on factors such as molecular weight, plasma protein binding, lipophilicity and stage of lactogenesis. The safety of DMT use varies during breastfeeding. Approval in Europe has been given for use of interferon betas and glatiramer acetate by women with MS during breastfeeding. Ofatumumab may be used during breastfeeding if clinically needed.

    Abbreviations

    DMT, disease-modifying therapy; MS, multiple sclerosis.

    Reference

    Krysko KM, et al. Lancet Neurol. 2022;22:350–66.

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    This Activity Is Funded By:

    An independent medical education grant from the Healthcare Business of Merck KGaA, Darmstadt, Germany. This activity is jointly provided by USF Health and touchIME.

    The information provided by this CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CE to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 12 June 2023. Date credits expire: 12 June 2024.

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