Neuroinflammation

Which MS neuromodulatory medication is cardiotoxic?

Mitoxantrone

Which MS meds can be taken pos?

Teriflunomide, dimethyl fumarate, Ozanimod, fingolimod, siponimod (SIP), cladribine

Cladribine dose and what should you look for before starting?

3.5mg/kg over 2 years, 2 cycles of 1.75/year. Look for lymphocyte count - it should be >= 800 cells/mm before the second cycle and normal before the first course and monitor for infections (>10%).

Pathology differences in MS, NMO, MOG

MS: microglial rims, well-defined

NMO: perivenous inflammation, necrosis of oligodendrocytes, granulocytic cell infiltrates

MOG: meningeal inflammation in association with topographically related cortical demyelination

How many years are roughly required for EDSS 6 in RRMS vs in PPMS?

EDSS 6 is typically reached in about 15 years in RRMS, while in PPMS it can occur in 8 years.

Which DMTs can be used in paediatric MS?

fingolimod, teriflunomide, and dimethyl fumarate, possibly also interferon beta, glatiramer acetate

FOr which DMT should you check CYP2C9 status?

Ozanimod

What receptors target the different S1P DMTs?

Fingolimod: 1, 3, 4, 5

Siponimod: 1, 5

Ozanimod: 1, 5

Ponesimod: 1

Treatment options for AQP4 NMO

high-dose corticosteroids, plasma exchange, or IVIg

IL-6 receptor inhibitors (eg, tocilizumab) and cyclophosphamide

Eculizumab

Relapse prevention in AQP4-NMOSD

rituximab (anti-CD20), inebilizumab (anti-CD19), satralizumab and tocilizumab (anti-IL-6), and eculizumab and ravulizumab (anti-C5)