Neuropharmacy Masterclass Case Studies Jan 19 Case 1 29 yr old - - PowerPoint PPT Presentation

Neuropharmacy Masterclass

Case Studies Jan 19

Case 1

• 29 yr old female
• RRMS diagnosed 10yrs ago
• Rebif started 2008
• Jan 2016 - experiencing injection fatigue
• What are her options ?

– dimethyl fumarate or teriflunomide

Case 1 (cont...)

• Switched to DMF
• Jan 2016 – Sept 17 - stable , no relapses
• Lymphocyte count on routine monitoring :

Date Lymphocyte count Mar 2016 – Dec 16 0.8 – 1.0 Dec 16 0.8 Mar 17 0.6 June 17 0.5 Sept 17 0.4

Case 1 (cont…)

What action do you recommend?

– Continue – Continue with increased monitoring – Withhold until counts rise – Stop

Date Lymphocyte count Sept 17 0.4 Oct 17 0.5 Nov 17 0.4

Case 1 (cont..)

• Drug stopped Nov 17
• What are her DMT options ?

.....Only teriflunomide

• When do we start teriflunomide ?

– Lymphocyte count? – >0.8

Case 2

• 32yr old male, RRMS
• Diagnosed RES MS 2014. Very active scan
• Alemtuzumab jan 2015 & jan 2016
• Jan 2017 – relapse – leg weakness
• Options?

– Steroids only & wait – Switch to another DMT? – 3rd dose alemtuzumab

• Brought to MDT to discuss options:
• Is a single relapse 6m after year 2 treatment failure?
• alemtuzumab not working – switch
• 1 relapse in 3 years – working , 3rd dose
• Switch options?

– Cladribine – Ocrelizumab?

Case 3

• 40yr old male
• Had 1st course alemtuzumab Jan 17
• Due for year 2, Jan 18
• Screening bloods show :

Date T4 T3 TSH

Case 4

• 41yr old male
• RRMS diagnosed 2014
• 2014-2016 – dimethyl fumarate
• July 2016 , relapse & new lesion on MRI
• Options?

– fingolimod – alemtuzumab – cladribine

Case 4 …

• Patient selects fingolimod
• Starts Sept 16
• Lymphocyte counts :

Date Lymphocyte count