Battle of the Biomarkers: Assessing Key Factors in Prognosis, Monitoring, and Therapeutic Decision-Making for Disease Worsening in Multiple Sclerosis
Over the past several years, the image of multiple sclerosis (MS) has been changing from distinct categories of disease to a complicated spectrum of interwoven pathologies. As this knowledge evolves, so do approaches to prognosticating, monitoring, and responding to disease. With many markers of progression still under investigation and therefore not included in modern guidelines, MS clinicians are left on their own to decide which factors should hold the most weight in influencing clinical decisions. In this “debate-themed” lunch symposium, Drs Shin, Alvarez, and Oh will advocate for their preferred disease indicators and why they are the future of successful MS disease management. In the absence of professional guidelines, these expert perspectives may deepen understanding of exactly how and why these factors should be considered, improving clinician’s ability to navigate and optimize available tools and strategies for their own patients.
This activity is intended for neurodegenerative disease specialists, general neurologists, nurse practitioners, physician assistants, and other healthcare professionals involved in the diagnosis and long-term management of patients with MS.
Upon completion of the educational activity, participants should be able to:
- Assess the relative roles of existing (e.g., lesion topography, disability scales) and emerging (e.g., brain atrophy, cognitive impairment) predictors/indicators of disease progression to guide the prioritization of these factors in proactive assessment of patient changes
- Appraise the utility of clinical (e.g., timed 25-foot-walk) and radiologic (e.g., magnetic resonance imaging (MRI)) assessments of disease progression to select the most sensitive and clinically appropriate monitoring tools that will not disrupt current workflow
- Analyze the influence of prognostic factors and clinical indicators on treatment initiation and switching strategies to optimize therapeutic decision-making and maximize patient outcomes
- Evaluate published research and expert experience guiding initial and subsequent disease modifying therapy choices in patients with different disease presentations to optimize therapeutic decision-making and maximize patient outcomes
Part 1: Initial Treatment Selection: Weighting Prognostic Indicators (15 min)
|What is/are the most meaningful and actionable biomarker(s)/clinical indicator(s) at initial assessment other than conventional MRI and relapse?|
Group discussion: Do prognostic factors matter when choosing initial therapy?
Part 2: Monitoring for Disease Worsening (RAW) vs Progression (PIRA) (20 min)
(1) Are relapsing and progressive disease states separate entities?
(2) Does this influence how they should be evaluated?
|How do you tell relapse associated worsening (RAW) from progression independent of relapse activity (PIRA)?|
|Do any current MS therapies help patients with inactive disease progression?|
Group discussion: Is the transition from RMS to active SPMS clinically important?
Part 3: Assessing Treatment Effect and Making Therapeutic Changes (20 min)
|Which biomarkers/indicators are the most valuable for evaluating treatment effect?|
|Should radiologic activity accompanied by clinical relapse be approached differently than either radiologic activity or clinical relapse alone?|
Should you discontinue therapy in older patients with stable disease?
Group discussion: Should agents’ specific investigational outcomes influence individual therapeutic decisions?
Robert Shin, MD, FANA, FAAN (Moderator and Chair)
Director, Georgetown Multiple Sclerosis and Neuroimmunology Center
Professor, Department of Neurology
MedStar Georgetown University Hospital
Medical Director, Barlo MS Program
St. Michael’s Hospital
Scientist, Keenan Research Centre
Li Ka Shing Knowledge Institute
Associate Professor of Medicine
University of Toronto
Toronto, Ontario, Canada
This activity is jointly provided by Purdue University College of Pharmacy Office of Continuing Education and Professional Development and Efficient LLC.
This independent Industry Supported Satellite Symposium is not included in the ACTRIMS Forum 2023 accredited program.
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 the joint providership of the Purdue University College of Pharmacy Office of Continuing Education and Professional Development and Efficient LLC and was developed in partnership with the Accelerated Cure Project and Multiple Sclerosis Foundation. Purdue University is accredited by the ACCME to provide continuing medical education for physicians.
Purdue designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Disclosure of Conflict of Interest
To ensure compliance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education, Purdue University requires that all individuals in a position to control the content of an educational activity disclose all financial relationships with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. All relevant conflicts of interest identified are thoroughly assessed by Purdue University to ensure fair balance, scientific rigor, and accepted patient care recommendations of the educational activity.
Planners' and Managers' Disclosure
All additional planning committee members, staff and reviewers of Efficient LLC and Purdue University College of Pharmacy have no relationships to disclose.
Dr. Shin reported the following financial relationships:
- Consulting Fees: Alexion, BMS, EMD Serono, Genentech, Horizon, Icometrix, Novartis, Roche, Sanofi Genzyme, TG Therapeutics
- Speakers' Bureau: Alexion, BMS, EMD Serono, Genentech, Horizon, Novartis, Sanofi Genzyme, TG Therapeutics
Dr. Oh reported the following financial relationships:
- Consulting Fees: Alexion, Biogen, BMS, Novartis, Roche, Sanofi-Genzyme
- Grants/Research Support: Biogen, EMD Serono, Roche
Dr. Alvarez reported the following financial relationships:
- Advisory Board: Alexion, Biogen, Celgene/BMS, EMD Serono/Merck, Genentech/Roche, Novartis, Sanofi, TG Therapeutics
- Grants/Research Support: Biogen, Genentech/Roche, Novartis, National Institutes of Health, National Multiple Sclerosis Society, Patient-Centered Outcomes Research Initiative, Rocky Mountain MS Center, TG Therapeutics
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient's conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer's product information, and comparison with recommendations of other authorities.
Supported by an educational grant from Novartis Pharmaceuticals Corporation.
1.00 AMA PRA Category 1 Credit™
ACTRIMS Forum 2023 registration is required to attend this independent Industry Supported Satellite Symposium.
Register online at forum.actrims.org.