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? – 3 rd 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 , 3 rd dose • Switch options? – Cladribine – Ocrelizumab?
Case 3 • 40yr old male • Had 1 st 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
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