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Multiple Sclerosis

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Multiple sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system (CNS) generally affecting the brain, spinal cord and optic nerves. It is characterized by demyelination of nerve fibers (axons) and subsequent loss of neuronal transmission. At least 400,000 Americans and over 2 million people worldwide have MS; it is not a rare disease. Its onset is usually between the ages of 20 and 50 years old, but it can appear in children as well as older adults. Women are affected 2 to 3 times more often than men. MS has a variable clinical course that is generally progressive, leading to some degree of disability over time in the majority of patients. It is the leading cause of non-traumatic disability in young adults; without treatment, about half of patients require a cane to walk 10 years following diagnosis and about 15% require a wheelchair. The cause of MS remains unknown; however, research in this area is rapidly growing. Current theories suggest a complex relationship among certain environmental and genetic factors and the immune system.

Before the release of the first disease-modifying drug (DMD), interferon beta 1b (IFN-ß1b) in 1993, the available medications for MS targeted only the relief of symptomatic problems. Today, a total of 9 DMDs are approved for use in the US for relapsing forms of MS. Research has suggested that neurological damage early in the course of MS results in long-term neurological impairment. Consequently, many experts recommend early initiation of treatment with DMDs, at the time of the first attack – even before a definite diagnosis can be made – if the patient has magnetic resonance imaging (MRI) findings consistent with MS.

DMDs are not a cure, but can reduce the frequency of relapses and may reduce the progression of disability. DMDs differ in their mechanisms of action, routes of administration, and side effects. Because treatment is usually lifelong, individualization of DMD therapy is critical to minimize side effects and maintain adherence.

This issue provides an overview of MS and an update on the drugs used to manage the disease, including DMDs and medications used to treat associated symptomatic conditions. The primary focus will be on relapsing forms of MS and the newer, orally administered agents: fingolimod (Gilenya®), teriflunomide (Aubagio®), and dimethyl fumarate (Tecfidera™).


Publication Date: 11/18/2013
Expiration Date: 12/18/2016
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


Expert Editorial Advisor: Kathryn Tortorice Pharm D, BCPS, National PBM Clinical Pharmacy Program Manager, VHA Pharmacy Benefits Management Services, Hines, IL.

Disclosure Statement

Target Audience

This accredited program is targeted to pharmacists .

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Describe the common features and typical course of MS. Discuss the use and benefits of disease-modifying drugs (DMDs) in MS management.
    2. List the 4 self-injectable and 3 oral DMDs; review their roles in therapy, their common and serious side effects, and monitoring parameters. Discuss the role of natalizumab and the main safety concern associated with its use. Counsel patients about the use of DMDs and the importance of adherence.
    3. Describe the recommended treatments for acute attacks. List at least 5 common symptomatic conditions in MS patients and discuss the medications used for their management.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

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Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

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Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-13-015-H01-P

Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator

Terry M. Baker, PharmD

Managing Editor

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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