American Academy of Neurology Meeting: Monoclonal Antibodies Shine in Relapsing-Remitting MS but Not All to Same Degree 

 Genentech Inc. and Biogen Idec Inc.'s cancer drug Rituxan failed to slow the disabling effects of the most difficult-to-treat form of multiple sclerosis in a large clinical trial.

Rituxan didn't reach its main goal of slowing disability for people with primary progressive multiple sclerosis after almost two years of treatment, compared with a placebo, the companies said in a statement. If the trial had succeeded, it would have made Rituxan the first drug to work against the primary progressive form of MS, or PPMS.

Rituxan, a blood-cancer drug that's also approved for rheumatoid arthritis, generated $2.29 billion in U.S. sales in 2007. It is designed to work by killing inflammatory B cells, a different approach than approved MS drugs. About 400,000 people in the U.S. have MS, and one in 10 have the primary progressive form that gradually damages nerve fibers over time without remissions, according to the National MS Society.

``While the primary results are not what we had hoped, we continue to believe in the potential of B cell therapy for patients living with MS,'' said Michael Panzara, Biogen's vice president and chief medical officer of its neurology strategic business unit.

Genentech, majority-owned by Switzerland's Roche Holding AG, fell 63 cents, or less than 1 percent, to $74.06 at 4 p.m. on the New York Stock Exchange. Cambridge, Massachusetts-based Biogen, a co-promoter of the drug, rose $1.21, or 2 percent to $64.93 on the Nasdaq Stock Market.

Revenue Opportunity

``This would have presented a revenue opportunity of more than 500 million Swiss francs for Roche but was not included in our model or consensus estimates,'' Deutsche Bank analysts including Michael Leuchten said in a note to investors today. ``PPMS is a tough part of MS to treat and nothing has worked in this setting so far.''

Multiple sclerosis is diagnosed when the body's immune system goes awry and begins attacking the fatty insulating tissue around nerve fibers, called myelin, according to the National MS Society.

The Rituxan trial, called Olympus, followed 439 patients for two years after they took an infusion of Rituxan or a placebo. Patients took a repeat course of Rituxan every six months, said Craig Smith, neurology lead clinical scientist in the immunology department at Genentech, in a telephone interview before the announcement.

Side Effects

Patients were monitored for the status of their disability, to see, for example, whether they were losing their ability to walk, see clearly, or maintain strength in their arms, Smith said. A secondary goal of the study looked at whether the drug reduced brain lesions.

More patients had serious side effects on Rituxan than on placebo, Genentech and Biogen said. The rate of serious side effects was about 16.4 percent in the Rituxan group, compared with 13.6 percent on placebo. About 4.5 percent of Rituxan patients had serious infections, compared with 1 percent on placebo. There was some evidence that the drug was working biologically, although the companies didn't specify how much in the statement.

Genentech and Biogen plan to continue analyzing the results and submit them at a future medical meeting, the companies said.

Double Vision

People in the trial were about 48 years old on average, and had been diagnosed with primary progressive MS four to 10 years before enrolling in the study, Smith said. They entered the study with an average disability score of 4 on a scale of 1 to 10, meaning they lacked some coordination, or had some double vision or weakness, although were still able to walk without assistance, he said.

Previously, Rituxan was studied for patients with the most common form of MS, the relapsing, remitting form. That study, called Hermes, found that one in five patients on Rituxan relapsed, while twice as many on placebo had a recurrence in a 48-week clinical trial, according to research published in February in the New England Journal of Medicine.

Existing drugs, including Biogen's Avonex, Bayer AG's Betaseron, Merck KGaA's Rebif and Teva Pharmaceutical Industries Ltd.'s Copaxone, work differently than Rituxan by blunting the attack of immune system T cells. None of the drugs have shown a benefit for patients with the primary progressive form of the disease, Smith said.

Next Steps

The market for MS drugs exceeded $5.5 billion in 2006 and is expected to double by 2013, according to market-research firm Frost & Sullivan in New York. Rituxan costs $20,514 a year for two infusions for patients with rheumatoid arthritis, said Genentech spokeswoman Nikki Levy.

``Right now we are reviewing all the data from Olympus and determining next steps regarding our development program,'' Levy said yesterday in an e-mail.

The company still plans a mid-stage clinical trial of ocrelizumab, a second-generation drug that blocks the same protein on B cells as Rituxan. The newer drug will be studied against the relapsing, remitting form of MS, Levy said.

To contact the reporters on this story: Luke Timmerman in San Francisco at ltimmerman@bloomberg.net

BIOGEN IDEC AND ELAN PRESENT NEW TYSABRI DATA AT THE 60th ANNUAL MEETING OF THE AMERICAN ACADEMY OF NEUROLOGY

Approximately 26,000 Patients on Commercial and Clinical Therapy Worldwide

Additional Analyses Show TYSABRI Significantly Increased the Proportion of Multiple Sclerosis (MS) Patients Who are Considered Disease Free for Over Two Years

Biogen Idec (NASDAQ: BIIB) and Elan Corporation, plc (NYSE: ELN) today announced new data on the global utilization, safety and overall patient exposure of TYSABRI® (natalizumab). As of the end of March 2008, approximately 26,000 patients were on commercial and clinical therapy worldwide with no cases of progressive multifocal leukoencephalopathy (PML) reported since re-launch in the U.S. and launch internationally in July 2006. Growth in global utilization plus increasing confidence in the favorable benefit-risk profile of TYSABRI indicate the companies are making great progress toward the goal of 100,000 patients on therapy by year-end 2010. These data were presented today at the 60th Annual Meeting
of the American Academy of Neurology (AAN).

"These data suggest that neurologists and patients are increasingly choosing TYSABRI for the treatment of their disease. The significant clinical benefits are established and TYSABRI continues to offer the potential for compelling efficacy and hope for those patients living with MS," said Michael Panzara, MD, MPH, Vice President and Chief Medical Officer, Neurology Strategic Business Unit, Biogen Idec.

"Positive outcomes for patients continue to support TYSABRI's strength as a valuable treatment for multiple sclerosis patients in more than 30 countries around the world. We are also excited that patients with Crohn's Disease are now enrolling in the TOUCH program and beginning to receive TYSABRI treatment in the U.S.," said Gordon Francis, MD, Senior Vice President, Global Clinical Development, Elan.

According to data available as of the end of March 2008:
In the U.S., approximately 15,300 patients were on TYSABRI therapy commercially and approximately 2,750 physicians have prescribed the therapy;

Outside of the U.S., more than 10,200 patients were on TYSABRI therapy commercially;
In global clinical trials, more than 600 patients were on TYSABRI therapy; and

There have been no cases of PML since re-launch in the US and launch internationally in July 2006.
Cumulatively, in the combined clinical trial and post-marketing settings:

More than 36,700 patients have been treated with TYSABRI; and

Of those patients, over 9,900 have received at least one year of TYSABRI therapy and more than 3,600 patients have been on therapy for 18 months or longer.

BOSTON (Dow Jones) -- A late-stage clinical trial of oncology drug Rituxan failed to show it was effective in treating a certain type of multiple sclerosis, according to Genentech Inc. and Biogen Idec Inc.

Late Monday, Genentech (DNA) and Biogen (BIIB) said that in a Phase II/III trial, Rituxan didn't show the antibody-based medication could effectively slow the progression of primary-progressive multiple sclerosis, or PPMS.

The companies added that currently there are no effective treatments for PPMS, a particularly hard to treat form of the disease.

Rituxan is already approved for the treatment of non-Hodgkin's lymphoma and rheumatoid arthritis.

Biogen Iden markets Avonex, one of the world's best-selling medications for treating multiple sclerosis. The company also co-markets with Elan Corp. (ELN) Tysabri as a multiple sclerosis therapy.

Genentech, a publicly traded division of Swiss conglomerate Roche, is a leading developer of oncology medications.

Biogen Iden markets Avonex, one of the world's best-selling medications for treating multiple sclerosis. The company also co-markets with Elan Corp. (ELN) Tysabri as a multiple sclerosis therapy.

Genentech and Biogen Idec’s cancer drug Rituxan failed to slow the disabling effects of the most difficult form of multiple sclerosis in a large clinical trial, the companies said Monday.

Rituxan failed to reach its main goal of slowing disability for people with primary progressive multiple sclerosis after almost two years of treatment, compared with a placebo, the companies said. If the trial had succeeded, it would have made Rituxan the first drug to work against the primary progressive form of multiple sclerosis.

Rituxan, a blood-cancer drug that is also approved for rheumatoid arthritis, generated $2.29 billion in sales in the United States in 2007. It is designed to work by killing inflammatory B cells, a different approach from approved multiple sclerosis drugs. About 400,000 people in the United States have multiple sclerosis, and one in 10 have the primary progressive form that gradually damages nerve fibers over time without remissions, according to the National MS Society.

”While the primary results are not what we had hoped, we continue to believe in the potential of B cell therapy for patients living with MS,” said Michael Panzara, Biogen’s vice president and chief medical officer of its neurology strategic business unit.

The companies plan to continue analyzing the results and submit them at a medical meeting, the companies said.

Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases.


With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, like $10, $20 or $30 for a prescription, no matter what the drug’s actual cost. Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month.

The system means that the burden of expensive health care can now affect insured people, too.

No one knows how many patients are affected, but hundreds of drugs are priced this new way. They are used to treat diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers. There are no cheaper equivalents for these drugs, so patients are forced to pay the price or do without.

Insurers say the new system keeps everyone’s premiums down at a time when some of the most innovative and promising new treatments for conditions like cancer and rheumatoid arthritis and multiple sclerosis can cost $100,000 and more a year.

But the result is that patients may have to spend more for a drug than they pay for their mortgages, more, in some cases, than their monthly incomes.

The system, often called Tier 4, began in earnest with Medicare drug plans and spread rapidly. It is now incorporated into 86 percent of those plans. Some have even higher co-payments for certain drugs, a Tier 5.

Now Tier 4 is also showing up in insurance that people buy on their own or acquire through employers, said Dan Mendelson of Avalere Health, a research organization in Washington. It is the fastest-growing segment in private insurance, Mr. Mendelson said. Five years ago it was virtually nonexistent in private plans, he said. Now 10 percent of them have Tier 4 drug categories.

Private insurers began offering Tier 4 plans in response to employers who were looking for ways to keep costs down, said Karen Ignagni, president of America’s Health Insurance Plans, which represents most of the nation’s health insurers. When people who need Tier 4 drugs pay more for them, other subscribers in the plan pay less for their coverage.

But the new system sticks seriously ill people with huge bills, said James Robinson, a health economist at the University of California, Berkeley. “It is very unfortunate social policy,” Dr. Robinson said. “The more the sick person pays, the less the healthy person pays.”

Traditionally, the idea of insurance was to spread the costs of paying for the sick.

“This is an erosion of the traditional concept of insurance,” Mr. Mendelson said. “Those beneficiaries who bear the burden of illness are also bearing the burden of cost.”

And often, patients say, they had no idea that they would be faced with such a situation.

It happened to Robin Steinwand, 53, who has multiple sclerosis.

In January, shortly after Ms. Steinwand renewed her insurance policy with Kaiser Permanente, she went to refill her prescription for Copaxone. She had been insured with Kaiser for 17 years through her husband, a federal employee, and had had no complaints about the coverage.

She had been taking Copaxone since multiple sclerosis was diagnosed in 2000, buying 30 days’ worth of the pills at a time. And even though the drug costs $1,900 a month, Kaiser required only a $20 co-payment.

Not this time. When Ms. Steinwand went to pick up her prescription at a pharmacy near her home in Silver Spring, Md., the pharmacist handed her a bill for $325.

There must be a mistake, Ms. Steinwand said. So the pharmacist checked with her supervisor. The new price was correct. Kaiser’s policy had changed. Now Kaiser was charging 25 percent of the cost of the drug up to a maximum of $325 per prescription. Her annual cost would be $3,900 and unless her insurance changed or the drug dropped in price, it would go on for the rest of her life.

“I charged it, then got into my car and burst into tears,” Ms. Steinwand said.

She needed the drug, she said, because it can slow the course of her disease. And she knew she would just have to pay for it, but it would not be easy.

“It’s a tough economic time for everyone,” she said. “My son will start college in a year and a half. We are asking ourselves, can we afford a vacation? Can we continue to save for retirement and college?”

CLICK BELOW FOR FULL STORY:


Co-Payments Go Way Up for Drugs With High Prices - New York Times

LOST MY MEDICAID, MY JOB...SUFFERED WITH PROGRESSIVE MS EVERYDAY FOR 2 YEARS

I WANT OUT: I’ve been dealing with DEEP DEPRESSION-my grandmas death-my grandpas alzheimers....

after being a member of the ambulance for 12 years, Im taking the EMT course! Wish me luck!

My MS has been going haywire because my roommate & best friends ex wife is a vindictive person

I just wanted to share that I had my first shot today and it seems to have went well

"Tidying the House Soothes Mental Distress by 24%"

The MySpace Archives Do not work...

I'm Feeling Defeated-I just started a new job-Since starting I have fatigue & migraine headaches

I finally have mom in a good way-she doesnt have to feel bad anymore like shes an inconvenience

"The Perfect Gift" - Christina

I’ve started a new relationship & I’m paying the price: 1 night out=2 days of being a vegetable

(Tysabri-Pot-Vitamins) The pain has lessoned so much that I’m dancing again..I had energy -Tina

I got a new job stan - Amber

(UPDATE).....I’m just asking for hugs, prayers, or some words of encouragment.

(BREAKING NEWS) "Copaxone Significantly Reduced Annual Relapse Rates & Stabilized Disease

I’m getting pretty depressed-I broke up with my girlfriend..could it be the MS medicines I take

this past Saturday I was apart of my very first MS Walk.

does anyone take Rebif & Tysabri both? & how do you feel about it? anyone heard of Devics Synd

PLEASE PRAY FOR ME...I will not let MS, or being Single stand in my way..GOD BLESS YOU ALL !!!

Thanks Stan & everyone for the hugs & thoughts-It means a lot-It's good to know I'm not alone

(BREAKING NEWS: NEW MS DRUG FOR WOMEN ONLY) "Study uses hormones to treat multiple sclerosis"

(UPDATE)....The Blog averages about 1,000 visitors each day....BUT

INTERESTING STUDY ON ALCOHOL & MISSED DOSES OF MS MEDS - stan

i just made the dance team!!!

(CINDI'S DR UPDATE)...I don't know what to do anymore...I just wanna give up and say screw it!!

I would like to know if you would add me I have had M. S. since 86 was dg in 97

The muscle relaxant has taken the edge of the predisone so I'm not itchy anymore

I've seen improvement with Tysabri but Physical Therapy has helped immensely

"Physician battling multiple sclerosis shares her story" -Minneapolis Star Tribune

Have any of the angels mentioned loosing taste buds? I'm loosing mine & I wondered if it's MS

I would like to share the benefits of cranberry juice with you & our friends

I have heard wonderful things about your page Stan...I was only diagnosed in January

But im scared-i dont understand how life can be so cruel to a child!!!!!

Molly's poem might help you: convince those they love most that MS isn't all in your head

BECAUSE OF YOU & THIS SITE & THE ANGELS, I FEEL I CAN TAKE ON THE WORLD & MAKE IT THROUGH....

I did it..Yesterday I walked the MS Walk..I walked the entire 5.5 miles -Nena

They told me I need to start chemo-I am very scared and depressed about the thought of that!

Stan, We Might Have Some Good News! Diagnosed Joe with MS might have made a mistake

WOW...You gave our Friends 238 Hugs/Kudos yesterday - stan

THIS IS NOT ABOUT MS...BUT IT IS ABOUT THE COMPANY THAT MAKES TYSABRI...

I’m just asking for hugs, prayers, or some words of encouragment.

it has been 35 days since I had a Tysabri infusion and can I tell and feel the difference..

Fatigue is really being a bother-I'd like to know if any angels have had a sleep study

I wanted to ask the angels to please remember my daddy,,He is going to a MS clinic

THIS IS A GOOD VIDEO ON GIVING AN AVONEX INJECTION...send me yours & I'll post them too - stan

DO YOU HAVE A "NEURO-NIGHTMARE STORY"; LIKE DARA'S???

(News) MS & HEAT

Many Angels have asked me to have hats designed...so...here’s the initial design:

I saw my nero. She gave me 2 thumbs up -Susan

(UPDATE 2)...I asked John to leave...he has never been very supportive in my MS

Why is it that when you have MS and you can't work people think your lazy?

I would like to let the angles know i need a support system, i don't have any friends with MS

I just got diagnosed with MS on March 28th -Sidonia

I'm not doing good Stan..I'm having digestion and migraines do to emotional & physical stress

Update ~ Is Leona’s Doctor crazy or am I? I THOUGHT IT WAS A MEDICAL FACT THAT MS CAN CAUSE PAIN -stan

I've had MS since I was 14-it sucks! I don't feel like any of my friends & family understand me

My ongoing issue is keeping the optic nerve from causing problems-My memory is good some days..

BREAKING NEWS...(but is it laughable or important): "Man-cow hybrid embryo creates row"

Stan I am going crazy-I ask for something to help with pain-she says wait till next appt

Jason broke up with me because of the MS-i hate myself-Im sad-depressed-MS ruins everything

I just wanted to thank you for posting a blog about Hannah

I'm disappointed..I wanted to do the MS Walk..I have a Tysabri infusion the morning of the walk

Wonderful Words of Wisdom from Kimberly

(UPDATE)...Could anyone who's on Copaxone let me know when they started feeling better from it?

I went to my pcp & brought up the neuro issue=thanks to all the angels that keep pushing me

we are also planning our last baby..She said even after the 1st dose Novatrone can cause Cancer

a bit about my journey to my MS dx -Jessica

"Managing Work and MS: an employment teleconference series throughout April"

Our Ohio Angel needs congrats...plus good-luck-finding-job-prayers....STAN

I think I should give up on people,so I wont have to worry about disappointment or loosing them

"I accept...I fear...I reject...I hope..." - MEGAN

I just got done with a 3-day SoluMedrol run..I managed to pull an ’April Fools’ on the MonSter

My grandfather died in his sleep last night..I’m so sad..I’m really gonna miss him! -LISA

(UPDATE)......My grandmother passed away this a.m. - TINA

I’m wondering if any of the Angels have experienced these symptoms while on Lexapro:

(NEWS) "Fatigue in MS" - Eileen

I started smoking pot-NOW I’M ABLE TO DO THINGS: I’ve been walking around the lake-and NO PAIN!

:-) HAPPY APRIL FOOLS DAY!!

i need a hug..IM SO TIRED OF PEOPLE JUDGING MY ILLNESS BY HOW I LOOK-i want to give up but...

BREAKING NEWS FROM THE FDA: Possible Association Between Use Of Singulair...And Suicide

It’s a girl!! I am going to be a grandma - Laura

today i feel really lost and alone..ive been experiencing things with my body i keep to myself

STAN CHECK THIS OUT: "Gene sweeps yield discoveries" - LISA

my mom has ms..i have a very hard time dealing with it bc i can’t stand 2 c her in so much pain

I am terrified! Appointment with the Pulmonologist tomorrow..So please keep me in your thoughts

I thought that some of you might like to know that Tysabri website has been revamped -Lauren

Hope you’re having a GREAT weekend...I am now that my leg is working again;)

I need some hugs and listening ears of those who truly understand what MS is

Im doing ok but find myself at home feeling somewhat sorry for myself ,,,,,

I still have pneumonia and getting worse..

SAD & SCAREY STUDY-Most Patients arent going to Neuros & are getting the wrong treatment

My life is over-what do you do when you find out you have been cheated on???

Im ready to give up-Lots of prayers is what I’m asking for from the wonderful MS angels

You invite it (Avonex depression) in like an old friend-let it stay a while then kick it out

the nuero looked at my mri...he wants to pull me off my rebif and put me on tysabri

"Free Hoyer Lift with sling-Nothing is wrong with it, just needed to get a portable one"

"The Autoimmune Epidemic: Bodies Gone Haywire in a World Out of Balance" =SARAH

Update ~ im sad-i need help-i need advise-i need support-ive been crying for days-now im scared

I’m curious if anyone else has experienced weight loss with MS - Misty

I am begging your Angels to pray...I’m was getting worse everyday.

My MS Video Stan: "I am a soldier" - MEG

I deal with chronic everything! Chronic-depression,chronic-fatigue, chronic-life! hahahahahaha

I was DXed 3 1/2 years ago. my wife is one of your friends so I thought I should join - Joe

Important Social Security /Disability Info. - Cindi

she wrote "This patient have no fatiuge at this time." Oh bullhockey!!!

The cat’s outta’ the bag - eRsILiA

I’m asking for some hugs, positive thoughts and some major prayers sent my way please

...the angels have helped me so much!!! - Christina

Ive lost 54 pounds-I’d like to start running-the fact that I have MS makes me determined to try

After reading Sheena’s story of discrimination, I felt compelled to tell my story as well - Kim

Our Friend Pie plans to go off meds & "start trying for a kid" soon

Hannah needs our hugs right this second & her Mom needs our support - stan

Do any of the Angels have depression...Bipolar etc & still take one of the drugs for FATIGUE???

I have been EXTREMELY ILL with the MS funk and had to seek more intensive help -Jay

(AVONEX PROBS) I have an appt with my neuro in the morning to discuss another treatment -Cindi

I am so scared! I had my disability dr appointment..I started crying in the appt - Mandi

jealousy is such a waste of a human emotion-i don’t understand it-especially in relationships

"Fatigue in MS" (from the National MS Society)

"What is normal" - MEG

HAPPY EASTER TO ALL MY WONDERFUL ANGELS

I need hugs & prayers-I found out a short time ago that I have MS-Im having a hard time dealing

(CLICK ON HEADLINE FOR FULL STORY)

BACKGROUND: Long-term immunomodulatory drug (IMD) treatment is now common in multiple sclerosis (MS). However, predictors of adherence are not well understood; past studies lacked lifestyle factors such as alcohol use and predictors of missed doses have not been evaluated. We examined both levels of non-adherence-stopping IMD and missing doses.

. CONCLUSIONS: There were few strong predictors of missed doses, although people with MS consuming more alcoholic drinks per session are at a higher risk of missing doses. Divergent factors influenced the two levels of non-adherence indicating the need for a multifaceted approach to improving IMD adherence. In addition, missed doses should be assessed and incorporated into clinical trial design and clinical practice as poor adherers could impact on clinical outcomes. Copyright (c) 2008 John Wiley & Sons, Ltd.
PMID: 18395883 [PubMed - as supplied by publisher

SATIVEX

MySpaceTV Videos: My FOX News MS Interview (3/30/06) by Kyla

MySpaceTV Videos: What is Multiple Sclerosis by National Multiple Sclerosis Society

MySpaceTV Videos: EXPLANATION OF MULTIPLE SCLEROSIS by SHEP

B-cell depletion with rituximab in relapsing-remit...[N Engl J Med. 2008] - PubMed Result

Department of Neurology, University of California at San Francisco, San Francisco, CA 94143-0114, USA. hausers@neurology.ucsf.edu

BACKGROUND: There is increasing evidence that B lymphocytes are involved in the pathogenesis of multiple sclerosis, and they may be a therapeutic target. Rituximab, a monoclonal antibody, selectively targets and depletes CD20+ B lymphocytes. METHODS: In a phase 2, double-blind, 48-week trial involving 104 patients with relapsing-remitting multiple sclerosis, we assigned 69 patients to receive 1000 mg of intravenous rituximab and 35 patients to receive placebo on days 1 and 15. The primary end point was the total count of gadolinium-enhancing lesions detected on magnetic resonance imaging scans of the brain at weeks 12, 16, 20, and 24. Clinical outcomes included safety, the proportion of patients who had relapses, and the annualized rate of relapse. RESULTS: As compared with patients who received placebo, patients who received rituximab had reduced counts of total gadolinium-enhancing lesions at weeks 12, 16, 20, and 24 (P<0.001) and of total new gadolinium-enhancing lesions over the same period (P<0.001); these results were sustained for 48 weeks (P<0.001). As compared with patients in the placebo group, the proportion of patients in the rituximab group with relapses was significantly reduced at week 24 (14.5% vs. 34.3%, P=0.02) and week 48 (20.3% vs. 40.0%, P=0.04). More patients in the rituximab group than in the placebo group had adverse events within 24 hours after the first infusion, most of which were mild-to-moderate events; after the second infusion, the numbers of events were similar in the two groups.

CONCLUSIONS: A single course of rituximab reduced inflammatory brain lesions and clinical relapses for 48 weeks. This trial was not designed to assess long-term safety or to detect uncommon adverse events. The data provide evidence of B-cell involvement in the pathophysiology of relapsing-remitting multiple sclerosis. (ClinicalTrials.gov number, NCT00097188 [ClinicalTrials.gov].). Copyright 2008 Massachusetts Medical Society.

Rituximab in relapsing-remitting multiple sclerosi...[Ann Neurol. 2008] - PubMed Result

The Meaning of Women's Experiences of Living With ...[Health Care Women Int. 2008] - PubMed Result

We conducted a qualitative inquiry in order to describe the meaning of women's experiences of living with multiple sclerosis (MS). Multiple sclerosis is a chronic autoimmune disease of the central nervous system. The majority of persons living with MS are women. Living with MS has been described as difficult because of the uncertainty of the illness. Ten women with MS were interviewed and the interviews were analyzed with a phenomenological hermeneutic interpretation. In this study, we suggest that the meaning of living with MS for women can be understood as trying to maintain power and living with an unrecognizable body. The bodies of women with MS serve as hindrances in everyday life. Bodily changes evident to others impose feelings of being met in a different way, which can be understood as an expression of a violated dignity. At the same time, the women with MS struggle to protect their dignity.
PMID: 18389436 [PubMed - in process]

By JANE E. BRODY
Published: January 8, 2008

http://www.nytimes.com/

Scott McCredie is a Seattle-based health and science writer who says he “discovered” what he calls “the lost sense” of balance after he watched in horror as his 67-year-old father tumbled off a boulder and disappeared from sight during a hike in the Cascades.
Though his father hurt little more than his pride, Mr. McCredie became intrigued by what might have caused this experienced hiker, an athletic and graceful man, to lose his balance suddenly. His resulting science-and-history-based exploration led to a book, “Balance: In Search of the Lost Sense,” published last June by Little, Brown.
Noting that each year one in three Americans 65 and older falls, and that falls and their sometimes disastrous medical consequences are becoming more common as the population ages, Mr. McCredie wonders why balance is not talked about in fitness circles as often as strength training, aerobics and stretching. He learned that the sense of balance begins to degrade in one’s 20s and that it is downhill — literally and figuratively — from there unless steps are taken to preserve or restore this delicate and critically important ability to maintain equilibrium.
Vertigo, which can be caused by inner ear infections, low blood pressure, brain injuries, certain medications and some chronic diseases, is loss of balance in the extreme. Anyone who has experienced it — even if just from twirling in a circle — knows how disorienting and dangerous it can be. Really, without a sense of balance, just about everything else in life can become an insurmountable obstacle.
One normal consequence of aging is a steady decline in the three main sensory contributors to good balance — vision, proprioceptors on the bottoms of the feet that communicate position information to the brain, and the tiny hairs in the semicircular canals of the inner ear that relay gravity and motion information to the brain. Add to that the loss of muscle strength and flexibility that typically accompany aging and you have a fall waiting to happen.
But while certain declines with age are unavoidable, physical therapists, physiatrists and fitness experts have repeatedly proved that much of the sense of balance can be preserved and even restored through exercises that require no special equipment or training. These exercises are as simple as standing on one foot while brushing your teeth or walking heel-to-toe with one foot directly in front of the other.

Testing for Equilibrium
Marilyn Moffat and Carole B. Lewis, physical therapists in New York and Washington, respectively, agree with Mr. McCredie that “balance is an area of physical fitness that is often overlooked,” but they seek to correct that in their recent book “Age-Defying Fitness” (Peachtree Publishers). They define balance as “the ability of your body to maintain equilibrium when you stand, walk or perform any other daily activity” like putting on pants, walking on uneven ground or reaching for something on a shelf.
Dr. Moffat and Dr. Lewis suggest starting with a simple assessment of your current ability to maintain good balance. With a counter or sturdy furniture near enough to steady you if needed, perform this test:
1. Stand straight, wearing flat, closed shoes, with your arms folded across your chest. Raise one leg, bending the knee about 45 degrees, start a stopwatch and close your eyes.
2. Remain on one leg, stopping the watch immediately if you uncross your arms, tilt sideways more than 45 degrees, move the leg you are standing on or touch the raised leg to the floor.
3. Repeat this test with the other leg.

Now, compare your performance to the norms for various ages:

20 to 49 years old: 24 to 28 seconds.
50 to 59 years: 21 seconds.
60 to 69 years: 10 seconds.
70 to 79 years: 4 seconds.
80 and older: most cannot do it at all.

If you are wise, whatever your age, you will want to strive for the norm of those younger than 50. To increase stability and strengthen the legs, stand with feet shoulder-width apart and arms straight out in front. Lift one foot behind, bending the knee at 45 degrees. Hold that position for five seconds or longer, if possible.

Repeat this exercise five times. Then switch legs. As you improve, try one-leg stands with your eyes closed.
You can also incorporate one-leg stands into daily routines — while on the telephone, for example, brushing your teeth, waiting in line or for a bus, or cooking and washing dishes.

Exercises to Build a Motor Skill
“Remember, balance is a motor skill,” Dr. Moffat, professor of physical therapy at New York University, said in an interview. “To enhance it, you have to train your balance in the same way you would have to train your muscles for strength and your heart for aerobic capacity.”
Dr. Moffat pointed out that balance is twofold: static while standing still and dynamic when moving, as in walking and climbing stairs. Two main routes improve balance — exercises that increase the strength of the ankle, knee and hip muscles and exercises that improve the function of the vestibular system.
Like one-leg stands, many can be done as part of a daily routine. Dr. Moffat recommends starting with strength exercises and, as you improve, adding vestibular training by doing some of them with closed eyes.
Sit-to-stand exercises once or twice a day increase ankle, leg and hip strength and help the body adjust to changes in position without becoming dizzy after being sedentary for a long time. Sit straight in a firm chair (do not lean against the back) with arms crossed. Stand up straight and sit down again as quickly as you can without using your arms. Repeat the exercise three times and build to 10 repetitions.

Heel-to-toe tandem walking is another anytime exercise, resembling plank walking popular with young children. It is best done on a firm, uncarpeted floor. With stomach muscles tight and chin tucked in, place one foot in front of the other such that the heel of the front foot nearly touches the toe of the back foot. Walk 10 or more feet and repeat the exercise once or twice a day.
Also try walking on your toes and then walking on your heels to strengthen your ankles.

Another helpful exercise is sidestepping. Facing a wall, step sideways with one leg (bring the other foot to it) 10 times in each direction. After mastering that, try a dancelike maneuver that starts with sidestepping once to the right. Then cross the left leg behind, sidestep to the right again and cross the left leg in front. Repeat this 10 times. Then do it in the other direction.
In addition, the slow, continuous movements of tai chi, that popular Chinese exercise, have been shown in scientific studies to improve balance and reduce the risk of falls.
This is the first of two columns. The second will look at the vestibular system, which controls balance.