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Expert Interviews
Multiple Sclerosis, Neuroimmunology CE/CME accredited

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Experts answer questions with in-depth advice on the current clinical landscape and how new therapies and guidance might impact regional clinical practice. Useful tips below will show how to navigate the activity. Close

Optimizing the management of patients with relapsing forms of MS: An update on emerging treatment options

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Prof. Martin Weber is a classical clinician–scientist with a goal of translating high-class basic science into new therapeutic approaches for the treatment of multiple sclerosis (MS). 

At the University Medical Center Göttingen (UMG), Germany, Prof. Weber feels blessed with a unique setting to pursue this vision. As a tenured associate professor, he heads a large, entirely independent research group of scientists and physicians at the world-renowned Institute of Neuropathology, where they develop the experimental basis for a continuous improvement of therapeutic options for MS. read more

On the clinical side, Prof. Weber heads the section of inflammatory central nervous system disorders in the Department of Neurology, including a large outpatient clinic, a specialized MS day clinic and an independent laboratory for cerebrospinal fluid analyses, providing first-class MS patient care for the entire region of southern Lower Saxony. 

An interdisciplinary clinical MS centre has recently been established at the University of Göttingen, which combines scientific and clinical institutions working in the field of MS and related diseases. As the newly appointed head of this centre, Prof. Weber is in the privileged position to develop a clinical programme that can directly trial promising new therapies derived from their own laboratory and from the extended, traditionally strong, neuroscientific environment in Göttingen. 

Prof. Martin Weber has no interests/relationships or affiliations to disclose in relation to this activity.

Take CE/CME Test

Prof. Martin Weber is a classical clinician–scientist with a goal of translating high-class basic science into new therapeutic approaches for the treatment of multiple sclerosis (MS). 

At the University Medical Center Göttingen (UMG), Germany, Prof. Weber feels blessed with a unique setting to pursue this vision. As a tenured associate professor, he heads a large, entirely independent research group of scientists and physicians at the world-renowned Institute of Neuropathology, where they develop the experimental basis for a continuous improvement of therapeutic options for MS. read more

On the clinical side, Prof. Weber heads the section of inflammatory central nervous system disorders in the Department of Neurology, including a large outpatient clinic, a specialized MS day clinic and an independent laboratory for cerebrospinal fluid analyses, providing first-class MS patient care for the entire region of southern Lower Saxony. 

An interdisciplinary clinical MS centre has recently been established at the University of Göttingen, which combines scientific and clinical institutions working in the field of MS and related diseases. As the newly appointed head of this centre, Prof. Weber is in the privileged position to develop a clinical programme that can directly trial promising new therapies derived from their own laboratory and from the extended, traditionally strong, neuroscientific environment in Göttingen. 

Prof. Martin Weber has no interests/relationships or affiliations to disclose in relation to this activity.

Take CE/CME Test

Prof. Martin Weber is a classical clinician–scientist with a goal of translating high-class basic science into new therapeutic approaches for the treatment of multiple sclerosis (MS). 

At the University Medical Center Göttingen (UMG), Germany, Prof. Weber feels blessed with a unique setting to pursue this vision. As a tenured associate professor, he heads a large, entirely independent research group of scientists and physicians at the world-renowned Institute of Neuropathology, where they develop the experimental basis for a continuous improvement of therapeutic options for MS. read more

On the clinical side, Prof. Weber heads the section of inflammatory central nervous system disorders in the Department of Neurology, including a large outpatient clinic, a specialized MS day clinic and an independent laboratory for cerebrospinal fluid analyses, providing first-class MS patient care for the entire region of southern Lower Saxony. 

An interdisciplinary clinical MS centre has recently been established at the University of Göttingen, which combines scientific and clinical institutions working in the field of MS and related diseases. As the newly appointed head of this centre, Prof. Weber is in the privileged position to develop a clinical programme that can directly trial promising new therapies derived from their own laboratory and from the extended, traditionally strong, neuroscientific environment in Göttingen. 

Prof. Martin Weber has no interests/relationships or affiliations to disclose in relation to this activity.

Take CE/CME Test
  • Downloads including slides are available for this activity in the Toolkit
Learning Objectives

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

  • Recognize processes for reliable and early identification of individuals with MS at high risk of transition to secondary progressive MS
  • Discuss the evidence for B cells in the pathogenesis and progression of MS
  • Appraise the efficacy and safety of approved and emerging therapeutic agents for relapsing forms of MS that target B cells
Overview

In this activity, a leading multiple sclerosis (MS) specialist shares key considerations for a personalized treatment strategy for patients with relapsing forms of MS (RMS), and goes on to explore the key role that B cells play in the pathogenesis and progression of MS, including the therapeutic potential of B-cell–targeted agents.

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

Target Audience

Neurologists and MS specialists involved in the management of patients with RMS.

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

Prof. Martin Weber has no interests/relationships or affiliations to disclose in relation to this activity.

Content reviewer

John Robert Ciotti, MD, discloses: Advisory board or panel fees from EMD Serono, Genentech, Janssen and Novartis (all relationships terminated).

Touch Medical Contributors

Christina Mackins-Crabtree has no financial interests/relationships or affiliations to disclose 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 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 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: 07 December 2023. Date credits expire: 07 December 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.

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Topics covered in this activity

Multiple Sclerosis / Neuroimmunology
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touchEXPERT OPINIONS
Optimizing the management of patients with relapsing forms of MS: An update on emerging treatment options
0.75 CE/CME credit

Question 1/5
Your 37-year-old female patient with relapsing MS presents at your clinic feeling frustrated and confused. Despite achieving NEDA in her follow-up, she is still experiencing progressive and persistent symptoms such as fatigue, pain and cognitive difficulties. How would you manage this patient?

MS, multiple sclerosis; NEDA, no evidence of disease activity; QoL, quality of life

The goal of MS therapy is the best possible disease control and the best possible QoL for the patient. In practice, disease control must be measured by clinical parameters (especially relapses and disability) and MRI activity (the so-called NEDA concept).1 There are limitations to NEDA in clinical practice, in that it may not capture subtle changes in inflammation and neurodegeneration that underlie disability.2 MRI results must be considered in tandem with the broader clinical picture to encompass patient symptoms and neurological exam changes, which are important elements that contribute to a clearer understanding of the overall disease activity status.2

Abbreviations

MRI, magnetic resonance imaging; MS, multiple sclerosis; NEDA, no evidence of disease activity; QoL, quality of life.

References

  1. Wiendl H, et al. Ther Adv Neurol Disord. 2021:14;17562864211039648.
  2. Newsome SD, et al. Neurol Ther. 2023;12:1909–35.
Question 2/5
BTK has emerged as a target of interest for B-cell function modulation during MS. How would you describe the rationale for modulating BTK in a patient with MS?

BCR, B-cell receptor; BTK, Bruton's tyrosine kinase; MS, multiple sclerosis.

Unlike anti-CD20 therapy, BTK inhibition reportedly disrupts B-cell maturation and signalling without causing widespread B-cell depletion. This is a potentially important benefit, as B-cell depletion can induce humoral immunosuppression that can impair the humoral response to vaccination and increase the risk of infection, such as COVID-19.

Abbreviations

BTK, Bruton’s tyrosine kinase; CD, cluster of differentiation.

 

Reference

Evonuk KS, et al. Acta Neuropathol Commun. 2023;11:115.

Question 3/5
Which of the following statements highlights a difference between BTK inhibitors and anti-CD20 agents for the treatment of MS?

BBB, blood–brain barrier; BTK, Bruton's tyrosine kinase; CD, cluster of differentiation; MS, multiple sclerosis.

BTK inhibitors differ in several ways compared to CD20 agents due to their relatively small size. For example, BKT inhibitors are able to cross the BBB, which is crucial for the efficacy in treating the CNS compartmentalized immune response involved in the pathogenesis of progressive types of MS.

Abbreviations:

BBB, blood–brain barrier; BTK, Bruton’s tyrosine kinase; CD, cluster of differentiation; CNS, central nervous system; MS, multiple sclerosis.

Reference:

Saberi D, et al. Expert Opin Ther Targets. 2023;27:347–59.

Question 4/5
You are in the process of prescribing an anti-CD20 monoclonal antibody to your 55-year-old male patient living with relapsing MS? What would you advise about most likely adverse events?

CD, cluster of differentiation; MS, multiple sclerosis.

Infusion-/injection-related reactions are the most common adverse events reported in patients treated with anti-CD20 monoclonal antibodies. Administration-related reactions generally occur within 24 hours of the first injection/infusion and decrease with subsequent doses.

Abbreviation:

CD, cluster of differentiation.

Reference: 

de Séze J, et al. Front Immunol. 2023:14;1004795.

 

Question 5/5
Which of the following are phase III trials that have met their primary endpoints in terms of demonstrating efficacy of anti-CD20 antibodies in relapsing MS?

BTK, Bruton’s tyrosine kinase; CD, cluster of differentiation.

OPERA,1 ASCLEPIOS2 and ULTIMATE3 are all phase III trials evaluating the efficacy of the anti-CD20 antibodies, ocrelizumab, ofatumumab and ublituximab, respectively, in patients with RMS.

Abbreviations:
CD, cluster of differentiation; RMS, relapsing multiple sclerosis.

References:

  1. Hauser SL, et al. N Engl J Med. 2017;376:221–34.
  2. Hauser SL, et al. N Engl J Med. 2020;383:546–57.
  3. Steinman L, et al. N Engl J Med. 2022;387:704–14.
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