About This CME/CNE Activity

About This CME/CNE Activity

RATIONALE AND PURPOSE
Recent advances in the diagnosis and management of multiple sclerosis (MS) have made it possible for the majority of patients with MS to live longer than ever before but have also called increasing attention to the myriad of symptoms of the disease and the side effects—which sometimes can be life-threatening—of the immunoactive drugs used to treat it. This edition of The Neurology Report begins with a discussion of the normal human immune system, how it changes in patients with MS, and how our growing knowledge of those changes has led to more effective disease-modifying therapies (DMTs). The authors of this report then go on to describe the etiology and risk factors for development and progression of the disease, explain how DMTs work, and discuss the complications that can ensue from their use. The report also highlights the visual abnormalities associated with the disease and their diagnosis, the occasionally serious opportunistic infections associated with the use of certain DMTs, and current best practices for managing these complications. Finally, this edition investigates current critical controversies on managing MS in patients at different stages of the disease. The articles within are based upon presentations delivered during the joint 28th Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and the 19th Annual Meeting of the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS), held May 28–31, 2014, in Dallas, Texas.

The articles in this issue, written from the academic perspective of physicians-in-training at leading medical institutions, summarize the import of these new findings and place them into clinical context. This activity has been developed and approved by a planning committee of nationally recognized thought leaders to meet a perceived educational need to provide neurologists, other physicians, and nurses with diagnostic and therapeutic strategies to help them perform their medical roles.

LEARNING OBJECTIVES
After studying this issue of The Neurology Report, participants in this educational activity should be able to:

  • Review the normal immune response, the immunopathology of MS, how DMTs work, and how progressive MS differs from relapsing forms of MS.
  • Summarize the visual/ocular symptoms of MS, how they are assessed, and how they can provide an objective measure of fatigue and other neurologic impairments in MS.
  • Discuss the recognition, diagnosis, and treatment of infections associated with the use of DMTs in MS patients.
  • Describe the risk factors for the development and progression of MS, current treatment regimens, factors that affect optimal therapeutic outcomes, indications for changing therapy, and strategies to improve patient compliance.
  • Weigh the pros and cons of various treatment choices for newly diagnosed patients and for patients whose disease has progressed.

TARGET AUDIENCE
Neurologists, other physicians, and nurses significantly involved in the diagnosis and management of MS should find participating in this educational activity valuable.

ACCREDITATION AND CREDIT DESIGNATION
Physicians: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the University of Cincinnati and Direct One Communications, Inc. The University of Cincinnati is accredited by the ACCME to provide continuing medical education for physicians.

The University of Cincinnati designates this Enduring Material Activity for a maximum of 2.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Nurses: A total of 2.5 continuing education contact hours for nurses are approved by the Ohio Board of Nursing through the OBN Approver Unit at the University of Cincinnati College of Nursing, Continuing Education Program (OBN-011-93). Contact hours are valid in most states. Program #140829-1.

CREDIT AVAILABILITY
Activity release date: August 31, 2014
Expiration date: September 1, 2015

METHOD OF PARTICIPATION
This Enduring Material Activity is available in print and online at www.NeurologyReport.com and consists of an introduction, five articles, a postactivity assessment, and an evaluation. Estimated time to complete the activity is 2.5 hours.

To receive credit, participants must read the CME/CNE information on these two pages, including the learning objectives and disclosure statements, as well as the full content of this monograph, and then complete the post test and evaluation form online at www.NeurologyReport.com. Upon successful completion of the post test (80% correct) and evaluation form, a CME or CNE certificate of participation will be awarded automatically. The certificate may be printed directly from the Web site or e-mailed and printed later.

There are no fees for participating in or receiving credit for this activity.

CME REVIEWER
Rick Ricer, MD
Adjunct Professor of Family Medicine
University of Cincinnati
Cincinnati, Ohio

CME ACCREDITATION
Susan P. Tyler, MEd, CMP, CCMEP
Director, Continuing Medical Education
University of Cincinnati
Cincinnati, Ohio

FACULTY DISCLOSURES
All faculty members (or anyone else in a position to control content, such as activity planners) are required to complete a Disclosure of Commercial Interest and Resolution form and to cooperate with identified methods for resolving conflict of interest prior to participating in the activity. The University of Cincinnati requires disclosure to the learners of all relevant financial relationships and adheres strictly to the ACCME Standards for Commercial Support.

George H. Kraft, MD, MS, is former director of the Western Multiple Sclerosis Center, Principal Investigator of the Multiple Sclerosis Research and Training Center, and Alvord Professor of Multiple Sclerosis Research at the University of Washington in Seattle, where he is currently Affiliate, Institute of Stem Cell and Regenerative Medicine, Medical Director of the Multiple Sclerosis Project ECHO, and Emeritus Professor of Rehabilitation Medicine and Neurology. Dr. Kraft is a member of the Scientific Advisory Board and Speakers Bureau of Acorda Therapeutics.

Kathleen Costello, MS, ANP-BC, MSCN, Associate Vice President of the Advocacy, Services and Research Department of the National Multiple Sclerosis Society; Adult Nurse Practitioner in the Johns Hopkins Multiple Sclerosis Center; and Adjunct Assistant Professor of Neurology at Johns Hopkins University School of Medicine, Baltimore, Maryland, has nothing to disclose.

Anne Gocke, PhD, Assistant Professor of Neurology at Johns Hopkins University School of Medicine, Baltimore, Maryland, has nothing to disclose.

Salim Chahin, MD, MSCE, a Multiple Sclerosis Fellow in the Department of Neurology at the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, has nothing to disclose.

Carrie M. Hersh, DO, a Clinical Neuroimmunology Fellow at the Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, has nothing to disclose.

Mirla Avila, MD, a Resident in the Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas, has nothing to disclose.

Sara S. Qureshi, MD, a Multiple Sclerosis Fellow in the Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical School, Dallas, Texas, has nothing to disclose.

Rick Ricer, MD, has nothing to disclose.

Susan P. Tyler, MEd, CMP, CCMEP, has nothing to disclose.

Jacqueline Keenan and Edwin Geffner of Direct One Communications, Inc., have nothing to disclose.

DISCLAIMER
This activity is an independent educational activity under the direction of the University of Cincinnati. The activity was planned and implemented in accordance with the accreditation requirements and policies of the ACCME, the Ethical Opinions/Guidelines of the American Medical Association, the US Food and Drug Administration (FDA), the Office of Inspector General of the US Department of Health and Human Services, and the Pharmaceutical Research and Manufacturers of America Code on Interactions With Healthcare Professionals, thus assuring the highest degree of independence, fair balance, scientific rigor, and objectivity.

However, the planning committee, faculty, University of Cincinnati, Biogen Idec, and Direct One Communications, Inc. shall in no way be liable for the currency of information or for any errors, omissions, or inaccuracies in this activity. The opinions and recommendations presented herein are those of the faculty and do not necessarily reflect the views of the provider, producer, or grantors.

Participants in this activity are encouraged to refer to primary references or full prescribing information resources.

DISCLOSURE OF UNAPPROVED / OFF-LABEL USE
Discussions concerning drugs, dosages, devices, and procedures may reflect the clinical experience of the planning committee or faculty, may be derived from the professional literature or other sources, or may suggest uses that are investigational and not approved labeling or indications.

In this edition of The Neurology Report, the off-label or unapproved use of several monoclonal antibodies, including alemtuzumab, rituximab, ocrelizumab, and daclizumab, in the treatment of relapsing MS is briefly described, as well as their current status. In addition, Dr. Hersh mentions several experimental treatments (including mirtazapine, mefloquine, cidofovir, and risperidone) for infectious complications of natalizumab, none of which is FDA approved for this use.

CONTACT INFORMATION
We would like to hear your comments regarding this or other educational activities produced by Direct One Communications, Inc. In addition, suggestions for future activities are welcome. Contact us at:

Direct One Communications, Inc.
1424 Ridge Road
Syosset, NY 11791
Phone: 516-364-1020
Fax: 516-364-4217
Website: www.CMEdirect.net

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