Young Latina MS Patient

Young Latina MS Patient and
Family Planning
Presented by:
Robert K. Shin, MD, FANA, FAAN

Professor, Department of Neurology
MedStar Georgetown University Hospital
Director, Georgetown Multiple Sclerosis and Neuroimmunology Center
Georgetown University Medical Center
Lilyana Amezcua, MD, MS, FAAN

Associate Professor of Neurology
Multiple Sclerosis Fellowship Program Director
Multiple Sclerosis Comprehensive Care and Research Group
University of Southern California, Keck School of Medicine
This activity is supported by educational grants from Bristol Myers Squibb, 1

Novartis Pharmaceuticals Corporation, and Sanofi Genzyme.
Faculty Disclosures
 Robert K. Shin, MD, FANA, FAAN

− Consulting Fee: Biogen, Bristol Myers Squibb, EMD Serono,
Genentech, Mallinckrodt, Novartis, and Sanofi Genzyme
− Speakers Bureau: Biogen, Bristol Myers Squibb, EMD
Serono, Genentech, Mallinckrodt, Novartis, and Sanofi
Genzyme
 Lilyana Amezcua, MD, MS, FAAN

− Consulting Fee: EMD Serono and Genentech
− Speakers Bureau: Alexion
− Contracted Research: Biogen and Genentech

2
Learning Objectives
 Consider patient’s disease activity, patient

factors, and treatment goals and preferences
to identify patient populations and scenarios in
which high-efficacy DMTs are appropriate
 Implement strategies to address symptom
management in patients with MS
3
28-year-old Latina
 Diagnosed with relapsing MS 6 years ago

− Initiated treatment with injectable DMT shortly after diagnosis
 Complains of worsening symptoms

− Increased fatigue, memory issues, bladder symptoms
 Minimal changes on MRI

− A small increase in the number of non-enhancing T2 lesions
noted over time
 Not planning to become pregnant at this time

− But may consider this in the future
a
4
Audience Polling Question
Given this patient presentation,

which would you do?
A. No change in treatment
B. Switch to high efficacy DMT (if patient was
on low efficacy DMT)
C. Increase dose of current treatment (if
patient was on low efficacy DMT)
D. Unsure
5
Discussion Points
 What is this patient’s prognosis?
 Therapeutic decisions
 Interdisciplinary management of MS
 What if the patient wanted to become pregnant?
6
Clinical Characteristics of MS in
Hispanics
Percentage of Patients Presenting with
Optic Neuritis by Study Site
 Younger age of onset 40 38
35 32.5
 Optic neuritis most 30 26
common presentation 25
18.2
− Adults and Peds onset 20
15
 Higher disability scores 10
5
 Higher levels of 0
peripheral blood University of San Juan MS University of University of
Miami Center in Southern California, San
plasmablasts Puerto Rico California Francisco
Amezcua L et al. Ann Clin Transl Neurol. 2018;5(11):1362-1371.

7
MS Disease-Modifying Therapies (DMTs)
 First-generation injectables
− Interferons (beta interferon-1a, beta interferon-1b, peginterferon-1a)
− Glatiramer acetate
 Oral Therapies
− S1P agents (fingolimod, siponimod, ozanimod, ponesimod)
− Fumarates (dimethyl fumarate, diroximel fumarate, monomethyl
fumarate)
− Teriflunomide
− Cladribine
Therapeutic decisions?
 Monoclonal antibodies
− Natalizumab
− Alemtuzumab
− Anti CD20 agents (ocrelizumab, ofatumumab)
8
Discussion Points
 What is this patient’s prognosis?
 Therapeutic decisions
 Interdisciplinary management of MS
 What if the patient wanted to become pregnant?
9
FDA pregnancy
categories and
recommended
washout
periods for MS
DMTs
Tisovic K, Amezcua L. Biomedicines. 2019;7(2):32.

Pre-pregnancy Care in MS

11
Annualized Relapse Rates (ARR) in
Breastfeeding

12
Join us for Additional Modules on
Biomarkers, Race, Gender and Genetics in MS:
Precision Medicine in 2021 and Beyond
Available August 27, 2021 – September 10, 2022

▪ Session 1: Racial and Genetic Implications for MS Treatment Selection
Available September 10, 2021 – September 10, 2022

▪ Session 2 – Bite 1: Treatment Approaches in MS: Criteria for Decision Making
▪ Session 2 – Case 1: Management of MS in African Americans/Blacks
▪ Session 2 – Case 2: Young Latina MS Patient and Family Planning
▪ Session 2 – Case 3: CIS: Treating or Not Treating and with What?
13
Thank you for
participating today!
Visit NeuroSeriesLive.com for Additional Live and

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Young Latina MS Patient and

Robert K. Shin, MD, FANA, FAAN

Lilyana Amezcua, MD, MS, FAAN

This activity is supported by educational grants from Bristol Myers Squibb, 1

 Robert K. Shin, MD, FANA, FAAN

 Lilyana Amezcua, MD, MS, FAAN

− Speakers Bureau: Alexion

− Contracted Research: Biogen and Genentech

 Consider patient’s disease activity, patient

 Diagnosed with relapsing MS 6 years ago

 Complains of worsening symptoms

 Minimal changes on MRI

 Not planning to become pregnant at this time

Given this patient presentation,

 What is this patient’s prognosis?

 What if the patient wanted to become pregnant?

Amezcua L et al. Ann Clin Transl Neurol. 2018;5(11):1362-1371.

 What is this patient’s prognosis?

 What if the patient wanted to become pregnant?

Tisovic K, Amezcua L. Biomedicines. 2019;7(2):32.

Tisovic K, Amezcua L. Biomedicines. 2019;7(2):32.

Tisovic K, Amezcua L. Biomedicines. 2019;7(2):32.

Available August 27, 2021 – September 10, 2022

Available September 10, 2021 – September 10, 2022

Visit NeuroSeriesLive.com for Additional Live and

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