Thursday, March 29, 2007

High dose copaxone

Randomized, double blind dose comparison study of glatiramer acetate in relapsing-remitting MS . Cohen JA et al. Neurology 2007; 68:939-944. The study screened treatment naive patients EDSS 1-5, one relapse in prior year, about 45 patients in each group. Compared 20 v 40 mg. Trend towards less relapses in higher dose group. More injection reactions in higher dose group. MRI scores showed a trend favoring the higher dose group.

Friday, March 23, 2007

predictors of disability in MS

Langer-Gould A, Popat RA, Huang SM, Cobb K, et al. Clinical and demographic predictors of long-term disability inpatients with relapsing remitting multiple sclerosis. A systematic review. Arch Neurol 63: 1686-91 2006

Study based on meta-analysis, including studies in the literature since 1966 that met preselected criteria, including differentiation of RRMS, enrollment of greater than 40 patients, observation > 5 years, and followup collection exceeding 80 percent.

The most important predictors were sphincter symptoms at onset and early disease course outcomes. Age at onset, sex, were weak factors.

High dose cytoxan for multiple sclerosis

Gladstone DE et al. High dose cyclophosphamide for moderate to severe refractory multiple sclerosis. Arch Neurol 2006; 63:1388-1393.

The authors studied refractory MS, defined as EDSS scores of 3.5 or higher after 2 or more FDA approved DMD's. 12 patients received 200 mg/kg over four days. No patients increased EDSS by more than one point. Five decreased by one or more points. Patients reported improvement in ll QOL measures.

Goal of therapy is to stop disease progression.
Procedure was 200 mg/kg based on IBW over f days. Hemorrhagic cystitis prevention was done with mesna and forced diruresis. Antibacterial, antiviral and antifungal prophylaxis was given. Evaluation included EDSS, neuro-opthalmologic evaluation and MRI and QOL eval using short form 36.

Patients suffered absolute neutropenia for nine days, received a median of i unit prbc's

Alternatives: mitoxantrone, stem cell mobilization (filgastrim)