Multiple sclerosis (MS) is a chronic, progressively disabling disease of the central nervous system (CNS) that is associated with a very high lifetime risk of permanent neurologic impairment. Although the clinical course of MS varies considerably from patient to patient, most patients exhibit 1 of 4 general clinical presentations.1
Approximately 85% of patients are initially diagnosed with relapsing-remitting MS (RRMS), which is characterized by alternating exacerbations and remissions of neurologic impairment.2
After an exacerbation, patients with RRMS will return to baseline. Most of these patients will eventually transition to secondary progressive MS, which is characterized by irreversible neurologic impairment without episodes of remission.3
Approximately 10% to 15% of patients are diagnosed with primary progressive MS, which is characterized by progressive permanent neurologic disability from the onset of disease. Finally, approximately 5% of patients are diagnosed with progressive relapsing MS, which includes both gradual progressive disability from disease onset and acute exacerbations resembling those of RRMS.2
Although these clinical presentations of MS have been recognized for decades, ongoing research continues to refine our understanding of the underlying pathophysiology of disease progression and the accumulation of disability. For example, although MS has traditionally been viewed primarily as a disorder of CNS white-matter inflammation, recent research has shown that gray-matter neurodegeneration and atrophy are also central components of the disease.4
Clinical studies have only begun to examine the treatment implications of these findings.
This University of Tennessee Advanced Studies in Pharmacy
journal club module provides managed care pharmacists with brief, focused reviews of recent publications that provide important new insights about the clinical course and underlying pathology of MS. The studies selected for this journal club describe the relationships between early MS exacerbations and the eventual progression of disability, the role of cognitive impairment in MS and its treatment, and the contribution of gray-matter disease to long-term progression of disability.
1. Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology. 1996;46:907-911.
2. Birnbaum G. Multiple Sclerosis Clinician’s Guide to Diagnosis and Treatment. New York, NY: Oxford University Press, Inc; 2009.
3. Confavreux C, Vukusic S. The clinical epidemiology of multiple sclerosis. Neuroimaging Clin N Am. 2008;18:589-622.
4. Geurts JJ, Stys PK, Minagar A, et al. Gray matter pathology in (chronic) MS: modern views on an early observation. J Neurol Sci. 2009;282:12-20.
To provide managed care pharmacists with up-to-date information on the treatment and management of patients with MS.
This activity is designed for managed care pharmacists. No prerequisites required.
The University of Tennessee College of Pharmacy takes responsibility for the content, quality, and scientific integrity of this CPE activity. Upon the conclusion of this activity, the participant should be able to:
- ASSESS data investigating the importance of initiating therapy early in the course of MS and the effects on slowing disease progression.
Accreditation Statement — The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education to provide continuing education for pharmacists.
Credit Designation Statement
The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Successful completion of this knowledge-based educational activity will provide 1.5 contact hours credit (0.15 CEUs). A statement of CPE credit will be available online immediately following successful completion of the activity. Successful completion includes taking the pre-test, attending the session, and completing the post-test and educational activity evaluation. ACPE Program #064-000-10-209-H01-P.
After reviewing this online activity, participants may receive credit by completing the CPE test, evaluation, and receiving a score of 70% or higher.
Release date: September 27, 2010. Expiration date: September 27, 2011.
Fee: There is no fee for this educational activity.
Full Disclosure Policy Affecting CPE Activities
As an accredited provider by the Accreditation Council for Pharmacy Education (ACPE), it is the policy of The University of Tennessee College of Pharmacy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation.
The Steering Committee reported the following:
Jacci Bainbridge, PharmD (Chair)
Department of Clinical Pharmacy
University of Colorado at Denver
Health Sciences Center
Dr Bainbridge reports receiving grants/research support from the National Institutes of Health; and serving on advisory boards for Bayer and TEVA Pharmaceuticals.
Melody Ryan, PharmD, MPH, BCPS, CGP
Department of Pharmacy Practice and Science
University of Kentucky College of Pharmacy
Department of Neurology
University of Kentucky College of Medicine
Dr Ryan reports having no significant financial or advisory relationships with corporate organizations related to this activity
Sheldon J. Rich, RPh, PhD
President – SJR Associates, LLC
Clinical Assistant Professor – University of Michigan
Adjunct Assistant Professor – Wayne State University
Palm Beach Gardens, Florida
Dr Rich reports serving as a consultant for Serono and TEVA Neuroscience.
Off-Label Product Discussion:
In accordance with ACPE Criteria for Quality, the audience is advised that authors in this CPE activity may include reference(s) to unlabeled, unapproved, or investigational uses of therapeutic agents or biomedical devices. The authors will inform the reader of when they discuss or reference an unapproved, unlabeled, or investigational use of therapeutic agent or biomedical device.
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of The University of Tennessee College of Pharmacy name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.
A participant, sponsor, faculty member, or other individual wanting to file a grievance with respect to any aspect of an educational activity sponsored or cosponsored by The University of Tennessee College of Pharmacy may contact the Associate Dean for Continuing Education in writing. The grievance will be reviewed and a response will be returned within 45 days of receiving the written statement. If not satisfied, an appeal to the Dean of the College of Pharmacy can be made for a second level review.
Please complete the pre-test, read the following journal clubs, and complete the post-test and evaluation to receive CPE credit for this activity.
Scalfari A, Neuhaus A, Degenhardt A, et al. The natural history of multiple sclerosis, a geographically based study 10: relapses and long-term disability. Brain . 2010;133(Pt 7):1914-1929.
Patti F, Amato MP, Bastianello S, et al. Effects of immunomodulatory treatment with subcutaneous interferon ß-1a on cognitive decline in mildly disabled patients with relapsing-remitting multiple sclerosis. Mult Scler. 2010;16:68-77.
Rudick RA, Lee JC, Nakamura K, Fisher E. Gray matter atrophy correlates with MS disability progression measured with MSFC but not EDSS. J Neurol Sci