Multiple Sclerosis CE/CME ACCREDITED Watch Time: 30 mins

touchTALKS Multiple sclerosis in older patients: A patient population with unique needs

Join Prof. Gavin Giovannoni as he discusses important considerations concerning the management of older patients with MS.

 
Video Chapters
What are immuno- and neuro-senescence and how do they impact older patients with MS?

Prof. Giovannoni describes how the process of normal ageing or senescence is hardwired and has the potential to impact how MS is managed.

view bio and disclosures
1/3 Next Chapter
 
What is the role for DMTs in older patients with MS?

Prof. Giovannoni summarizes the interactions between ageing and MS, and how the principles of treating MS with DMTs apply regardless of age, considering important factors such as safety and comorbidities.

view bio and disclosures
2/3 Next Chapter
 
How will practice change in the near future for older patients with MS?

Recapping the implications that natural immunosenescence with ageing has for the management of MS, Prof. Giovannoni highlights the urgent need for proactivity in terms of stopping and/or derisking immunosuppressive DMTs and the importance of combining holistic strategies.

view bio and disclosures
3/3 Take CE/CME Test
Take CE/CME Test
Learning Objectives & Overview
Overview

In this activity, Prof. Gavin Giovannoni shares his clinical expertise relating to the optimization of disease-modifying therapies for MS with a focus on the impact that immuno- and neuro-senescence place on patients as they age.

This activity has been jointly provided by Oakstone and touchIME for touchNEUROLOGY. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians. read more

Target Audience

This activity has been designed to meet the educational needs of neurologists, MS specialists, neurology nurses, primary care physicians and other relevant healthcare professionals involved in the multidisciplinary management of patients with MS.

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest have been mitigated. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relationships with ineligible entities.

Faculty

Prof. Gavin Giovannoni discloses: Consultation/advisory role fees from AbbVie, Almirall, Atara Bio, Bayer-Schering Healthcare, Biogen, Bristol-Myers Squibb, BMS-Celgene, Canbex, Eisai, Elan, Five Prime Therapeutics, Genentech, GlaxoSmithKline, GW Pharma, Ironwood, Janssen, Janssen-Actelion, Japan Tobacco, Merck, Merck-Serono, Novartis, Pfizer, Roche, Sanofi-Genzyme, Synthon BV, Teva, UCB Pharma and Vertex Pharmaceuticals.

Content Reviewer

Walter Murray Yarbrough, MD, FACP has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

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

Requirements for Successful Completion

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 the joint providership of Oakstone Publishing and touchIME. Oakstone Publishing is accredited by the ACCME to provide continuing medical education for physicians.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 Credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Oakstone Publishing designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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

Date of original release: 29 April 2021. Date credits expire: 29 April 2022.

Learning Objectives

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

  • Summarize the impact of immuno- and neuro-senescence on disease management for older patients with MS
  • Explain how to apply the data supporting the use of DMTs in daily practice
  • Discuss the data published in 2020 that will change the way older patients with MS are treated
About Prof. Gavin Giovannoni
Prof. Gavin Giovannoni

Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

Gavin Giovannoni is the Professor of Neurology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London and the Department of Neurology, Barts Health NHS Trust. His clinical interests are MS and other inflammatory disorders of the central nervous system. He is particularly interested in clinical issues related to optimizing MS disease-modifying therapies. His current research is focused on Epstein–Barr virus as a possible cause of MS, defining the ‘MS endophenotype’, MS-related neurodegeneration, biomarker discovery and validation, and MS clinical outcomes. His team focuses on translational research and therefore has an active clinical trial programme.

Prof. Gavin Giovannoni discloses: Consultation/advisory role fees from AbbVie, Almirall, Atara Bio, Bayer-Schering Healthcare, Biogen, Bristol-Myers Squibb, BMS-Celgene, Canbex, Eisai, Elan, Five Prime Therapeutics, Genentech, GlaxoSmithKline, GW Pharma, Ironwood, Janssen, Janssen-Actelion, Japan Tobacco, Merck, Merck-Serono, Novartis, Pfizer, Roche, Sanofi-Genzyme, Synthon BV, Teva, UCB Pharma and Vertex Pharmaceuticals.

Downloads

View and download resources from this activity to support your learning or share with colleagues.

Register to touchNEUROLOGY for FREE
  • Peer-reviewed journals and expert opinions
  • Interactive CME and e-learning modules
  • Video conference highlights
Register For Free Now

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

Accept Decline
CE/CME Test (0.5 Points) Close
CE/CME Test

To obtain the CME credit(s), please complete this post-test. Please complete and click to see your results and continue.

Question 1/5
Immunosenescence during ageing in older patients leads to which of the following?

TCR, T-cell receptor
Correct

Thymic involution with age impairs the production of new naive T cells. Exposure to antigens throughout life results in a reduction in the size of the circulating naive T-cell reserve, and the expansion of the memory compartment. Expansion of the memory compartment involves the accumulation of oligoclonal T cell clones, largely reactive against CMV and EBV, rather than the maintenance of overall well-balanced TCR-repertoire diversity.

CMV, cytomegalovirus; EBV, Epstein-Barr virus; TCR, T-cell receptor

Reference
Vallejo AN. Trends Mol Med. 2007;13:94–102.

Question 2/5
Considering the results of the phase III EXPAND study, which of the following factors at baseline would you expect to provide a poorer response to treatment with siponimod in patients with SPMS?

EDSS, Expanded Disability Severity Scale; Gd+, gadolinium-enhancing; SPMS, secondary progressive multiple sclerosis
Correct

The EXPAND study reported that previous treatment with IFNβ1b had a HR of 0.9 for siponimod compared with placebo. Whereas, age of 20 years, EDSS score of 3 and ≥1 Gd+ T1 lesions (i.e. young, minimal disability) were associated with relatively better responses to siponimod treatment, with HRs of 0.61, 0.64 and 0.64, respectively, compared with placebo.

EDSS, Expanded Disability Severity Scale; Gd+, gadolinium-enhancing; HR, hazard ratio; SPMS, secondary progressive multiple sclerosis

Reference
Kappos L, et al. Lancet. 2018;391:1263–73.

Question 3/5
Following fingolimod discontinuation in patients with MS, which of the following is the highest risk factor for recurrence of disease activity?

MS, multiple sclerosis
Correct

A retrospective analysis of 1,726 patients from the Lausanne prospective MS registry investigated the incidence of recurrence and rebound disease activity after fingolimod discontinuation, especially in older patients with MS who were previously stable on treatment. Negative predictive factors for recurrence of disease activity were younger age at disease onset and higher baseline disease activity.

MS, multiple sclerosis

Reference
Pantazou V, et al. MSVirtual2020 ePoster P0092. Available at: https://library.msvirtual2020.org/ (accessed March 2021).

Question 4/5
In light of the results of the Covisep multicentre, retrospective, observational cohort study, which of the following factors places your patients with MS at the greatest risk of severe COVID-19 disease?

COVID-19, coronavirus disease 19; DMT, disease-modifying therapy; EDSS, Expanded Disability Severity Scale; MS, multiple sclerosis.
Correct

The Covisep study reported that high EDSS was associated with the greatest risk of severe COVID-19 (R2, 0.20), followed by age (additional R2, 0.06) and then obesity (additional R2, 0.01). The results of the study did not support an increased risk of severe outcome associated with DMTs.

COVID-19, coronavirus disease 19; DMT, disease-modifying therapy; EDSS, Expanded Disability Severity Scale; MS, multiple sclerosis

Reference
Louapre C, et al. JAMA Neurol. 2020;77:1079–88.

Question 5/5
A 47-year-old female patient with RRMS is starting treatment with 3.5 mg/kg cladribine tablets as a monotherapy. What short-term impact would you expect this to have on their lymphocyte population?

RRMS, relapsing–remitting multiple sclerosis
Correct

A pooled analysis of patients with RRMS from the CLARITY and CLARITY extension studies and the PREMIERE registry reported that treatment with cladribine tablets 3.5 mg/kg resulted in selective reductions in B and T lymphocytes. Lymphocyte recovery began soon after treatment and the median lymphocyte count recovered to the normal range approximately 30 weeks after the last dose of cladribine.

RRMS, relapsing–remitting multiple sclerosis

Reference
Giovannoni G. Neurotherapeutics. 2017;14:874–87.

Post Test Feedback Close
Step 1: Post CE/CME Test Feedback

Please note this feedback form is compulsory to complete your CE/CME evaluation

Please complete this short online feedback form.
Please indicate how well each statement met your expectations.

Accreditation Close
Accreditation

Please provide your details so that we can send you your certificate, which will be emailed to the address provided. All fields are required.

Your Accreditation Close
Copied to clipboard!
accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72