4 posts tagged “MS treatments”

Marijuana and MS: Get the scoop

Posted October 23rd, 2017 by

From legality to availability, recreational use and potential use as treatment, marijuana is a hot topic. In the MS forum, members are talking about marijuana and its potential to relieve symptoms of MS like pain, tremor and spasticity. We wanted to know more, so we asked our Health Data Integrity team to take a look at this topic. So, what is marijuana and how can it impact health and MS? Take a look.

First, a quick refresher: What is Marijuana?

Marijuana is a mixture of dried flowers from the Cannabis sativa or Cannabis indica plants. The marijuana plant contains over 85 cannabinoids that are found in the leaves and buds of the female plant. Cannabinoids are classified as:

  • Phytocannabinoids: found in leaves, flowers, stems, and seeds of the plant.
  • Endogenous: made by the human body.
  • Purified: naturally occurring and purified from plant sources.
  • Synthetic: synthesized in a lab.

Cannabinoids create different effects depending on which receptors they bind to. These chemical compounds are responsible for marijuana’s effects on the body with the most common being delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Different strains with different combinations and levels of the various cannabinoids along with different methods of consumption give users varied effects.

How does marijuana impact MS?

Despite currently available FDA-approved treatments, many patients with MS still have symptoms. Recent studies suggest treatment with smoked cannabis and oral cannabis extract may improve patient perception of pain and spasticity.

The American Academy of Neurology, conducted a literature review and released a guideline on the use of marijuana in MS patients. This guideline reviews a number of studies where marijuana is used for MS and the findings of this review include:

  • Oral cannabis extract and synthetic THC may be effective for reducing patient-reported symptoms of spasticity and pain, but not bladder symptoms and neuropathic pain.
  • Nabiximols (Sativex®), an oromucosal spray, may be effective in reducing patient-reported spasticity, pain, and urinary frequency, but not urinary incontinence, anxiety symptoms, sleep problems, cognitive symptoms, or fatigue. However, it is important to note that this agent is not currently approved for use in the US.
  • There isn’t enough evidence to fully determine the safety or effectiveness of smoked marijuana in treating any MS symptoms.

If you are interested in reading more studies involving the use of marijuana in MS patients, check out these resources:

  • Long term effects of Sativex® on cognition (click here for more information)
  • Smoked cannabis for spasticity (click here for more information)
  • Dronabinol and pain (click here for more information)

So, what is the takeaway?

While preliminary research shows that marijuana may improve symptoms in patients with MS, more extensive clinical trials are in progress to evaluate the safety, efficacy, and dose of cannabis for patients with MS.

One of these studies is currently recruiting participants to investigate the effects of medical marijuana usage on physical functions on MS patients. To find out if you qualify and the location of the study, click here for more information.

Long-term safety of marijuana use for symptom management for patients with MS is not fully known. So, patients should be aware of the pros and cons of this treatment option and discuss the use of medical marijuana with their healthcare provider. While there are benefits that marijuana may provide for patients, there are many side effects that may limit the use of this therapy.

Most common side effects include:

  • Dizziness
  • Drowsiness
  • Difficulty concentrating
  • Memory disturbance
  • Changes in mood

Source: https://www.drugabuse.gov/publications/drugfacts/marijuana

Want to know more?

Sources:

https://www.cancer.gov/publications/dictionaries/cancer-terms/http://www.neurology.org/content/82/12/1083.full.pdf+htmlhttps://www.leafly.com/news/health/how-marijuana-affects-the-brainhttps://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Marijuanahttps://www.drugabuse.gov/drugs-abuse/marijuana/nih-research-marijuana-cannabinoids

Share this post on Twitter and help spread the word.


Ocrevus: You asked, we answered

Posted August 7th, 2017 by

Last month, we asked the MS community to share their questions about Ocrevus. Now, PatientsLikeMe’s Maria Lowe, Pharm.D., BCPS, sheds more light on what it is, how it works and what patients need to know. Maria’s rundown is meant to give you more context so you can have better conversations with your care team – as always, talk with your physician before starting any type of new treatment.

  1. What is Ocrevus (ocrelizumab)?

Ocrelizumab is a medication that was FDA approved for the treatment of adults with relapsing or primary progressive forms of multiple sclerosis in March, 2017. While the exact way ocrelizumab works isn’t fully understood, researchers believe it works by blocking certain types of B cells that appear to play a role in the autoimmune destruction of nerve cells in patients with MS.

Treatment with ocrelizumab begins with an initial intravenous (IV) infusion over a period of at least 2.5 hours followed by a second infusion two weeks later. After these first two doses, ocrelizumab is administered every six months via an IV infusion over at least 3.5 hours.

  1. Do you really need a washout period before starting ocrelizumab?

A number of MS treatments work by interfering with the body’s immune system in the hope of preventing autoimmune destruction of nerve cells. When more than one these treatments is used at the same time, it may result in additive effects which leaves the immune more suppressed than if those treatments were used alone. This may increase risk of infection. As a result, there are some instances where switching between certain treatments for MS would mean that you should have a “washout period” to help reduce the overlap of two immunosuppressive treatments and reduce the risk of infection.

This is especially important when you’re transitioning from one drug with prolonged immunosuppressive effects to another (such as: Zybrinta (daclizumab), Gilenya (fingolimod),Tysabri (natalizumab), Aubagio (teriflunomide), or Novantrone (mitoxantrone)). A washout period means that you would stop one immunosuppressive treatment for a period of time before starting the next one. While this does help reduce the risk of serious infections, it may increase the risk of a relapse because there’s a period without treatment where your body’s immune system is no longer suppressed.

Whether or not a washout period is needed depends on what treatment was tried previously and current disease status. According to the FDA-approved prescribing information for ocrelizumab, use with other immune-modulating or immunosuppressive therapies could increase the risk of further suppressing the immune system, leaving the body more vulnerable to infections. However, recommendations for a specific washout period or waiting time before switching from another disease-modifying MS treatment to ocrelizumab haven’t been decided. If you’re planning to switch from one MS treatment to another, it’s important to discuss this with your healthcare provider to determine if a washout period would be right for you.

  1. Could rebound relapses occur when starting ocrelizumab?

While a washout period may reduce the risk of immunosuppression, it may result in an MS relapse as a result of being without treatment and possibly as a result of a rebound overreaction of the body’s immune system. Research indicates that rebound relapses might be more common after stopping natalizumab and fingolimod when compared to other available disease modifying treatments for MS. Some data suggests that shorter (8-12 week) washout periods after stopping natalizumab treatment might be better than longer (16 weeks) ones when it comes to preventing rebound relapses.

So far, clinical trials have found that ocrelizumab is effective in reducing relapses and slowing the worsening of MS. However, there isn’t any data available about the risk of rebound relapses after stopping ocrelizumab. The approved prescribing information for ocrelizumab doesn’t describe a specific washout period requirement prior to starting treatment. If you’re considering switching to this treatment it’s crucial to consult with your healthcare provider to determine if such a transition would be beneficial to you and if so, how such a transition might work for you. 

  1. What are the most common side effects for ocrelizumab?

The most common adverse reactions observed in the three clinical trials used to support FDA approval of ocrelizumab include upper respiratory tract infections and infusion reactions. Patients with primary progressive MS (PPMS) also experienced skin reactions and lower respiratory tract infections. Other side effects that patients experienced with lesser frequency include:

  • Depression
  • Back pain
  • Pain in extremities
  • Skin reactions
  • Cough
  • Diarrhea
  • Swelling in the limbs

It’s important to note that ocrelizumab is associated with a handful of warnings regarding its use. These warnings are in the FDA-approved prescribing information and summarize specific adverse effects that might be important to consider when making choices about starting treatment.

Ocrelizumab was approved with 3 different warnings:

  • Infusion reactions: Reactions to infusions might include symptoms like: itching, low blood pressure, difficulty breathing, or fever. Reactions may happen up to 24 hours following the administration of ocrelizumab. In order to help minimize the risk of reactions, patients should receive certain medications prior to their ocrelizumab infusions. These may include a steroid, an antihistamine, and an antipyretic (like acetaminophen) to help prevent infusion reactions. In addition, all patients receiving ocrelizumab infusions need to be monitored for at least an hour after they have completed their infusion to detect if such a reaction may be happening. If you’re receiving treatment with ocrelizumab and you experience any of these symptoms, be sure to let your healthcare provider know right away.
  • Infections: Because ocrelizumab affects your immune system, it may increase the risk of developing infections. The most common infections observed in the clinical trials of ocrelizumab include respiratory tract infections and herpes infections (such as cold sores, herpes zoster [also known as shingles] and genital herpes). Ocrelizumab shouldn’t be administered if you have an active infection. It’s important to tell your healthcare provider if you have any signs or symptoms of infection at any point during your treatment.
  • Increased risk of malignancy: Treatment with ocrelizumab may be associated with an increased risk of certain types of cancer, including breast cancer. It’s important to discuss your individual risk factors with your healthcare provider before deciding if starting ocrelizumab is a good choice for you.

As with all new drugs, we’ll continue to learn more about its side effects as it becomes more widely used.

  1. Is it safe to take acyclovir or Zostavax while using ocrelizumab?

There are no known drug interactions between acyclovir and ocrelizumab. If you’re prone to herpes outbreaks or if you’re concerned about the potential increased risk of herpes infections, be sure to discuss this with your healthcare provider before deciding if ocrelizumab is right for you and what steps you can take to minimize the risk of these outbreaks.

Zostavax is a vaccine that is used to prevent shingles, also known as zoster or herpes zoster. Shingles occurs as a result of the varicella zoster virus (the same virus that causes chicken pox) becoming reactivated in the body. Zostavax is a live vaccine which means it contains a weakened version of the varicella zoster virus. Because the virus is only weakened and not completely dead, patients with a compromised immune system may develop an active infection after receiving such a vaccine. Since ocrelizumab lowers the body’s immune response, it’s recommended that any live vaccines are administered at least 6 weeks before starting treatment.

  1. What is the role of low-dose naltrexone (LDN) for MS and can it be used with ocrelizumab?

Naltrexone is an opioid antagonist that is FDA-approved to treat drug and alcohol addiction. At significantly lower doses, naltrexone has also been used off-label (meaning outside of its FDA approved indications) to treat a variety of diseases including MS and Parkinson’s disease. Some studies with this treatment have shown that it might be helpful for certain aspects of MS (including improving patient quality of life) but the overall impact on MS progression and symptom control is not conclusively known.

Currently, there is no known drug interaction between ocrelizumab and naltrexone. Have you tried either treatment for your MS? Share your experience with the community by filling out a treatment evaluation.

For more information about ocrelizumab, check out the patient medication guide.

Sources:

http://www.nationalmssociety.org/Treating-MS/Complementary-Alternative-Medicines/Low-Dose-Naltrexone

http://onlinelibrary.wiley.com/doi/10.1002/ana.22006/abstract

https://www.accessdata.fda.gov/drugsatfda_docs/nda/2017/761053Orig1s000ClinPharmR.pdf

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/761053lbl.pdf

http://jamanetwork.com/journals/jamaneurology/fullarticle/2516773

http://www.medscape.com/viewarticle/863241 (You’ll need to make an account)

http://www.medscape.com/viewarticle/846498#vp_1 (You’ll need to make an account)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5087255/  

https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/761053lbl.pdf

https://www.fda.gov/downloads/drugs/guidances/ucm075096.pdf

https://www.gene.com/download/pdf/ocrevus_medguide.pdf 

http://www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_ppi.pdf

http://www.mayoclinic.org/diseases-conditions/shingles/basics/causes/con-20019574

https://www.cdc.gov/shingles/about/overview.html 

Share this post on Twitter and help spread the word.