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Multiple Sclerosis Centers of Excellence


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MSCOE Newsletter Announcement

MS Veteran Newsletter

Discusses symptom management, medications, and living well with MS. Check out our latest issue!

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Get Out and Play

Get Out & Play

Adaptive sports can help keep you in the game. No matter your skill level, there is a sport for you.

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MS Education & Awareness Month

Making a connection can help people to expand their knowledge, understanding, and support of individuals whose lives are affected by MS.

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Multiple Sclerosis Centers of Excellence

MSCoE LogoThe Multiple Sclerosis Centers of Excellence are dedicated to furthering the understanding of multiple sclerosis (MS), its impact on Veterans and effective treatments to help manage MS. By partnering with Veterans, caregivers, health care professionals, MS advocates, Veteran service organizations, and community health care institutes, MSCoE strives to minimize impairment and maximize quality of life for Veterans with MS.

MSCoE Network


VA MS Publications

map of USMSCoE Network

MSCoE East and West have developed a national network of MS Regional Programs and MS Support Programs within the VA.

Given the size of the population of Veterans with MS seeking treatment in VA and their distribution across the country, it is feasible to provide access to high quality subspecialty care through a hub and spoke network with designated MS Regional Programs supporting local facilities.

Each Veterans Integrated Service Network (VISN) will have at least one MS Regional Program that will serve as a source for MS specialty consultation and education. The primary care for individuals with MS will occur at their local VA medical facilities. MS Support Programs will collaborate with local MS Regional Programs. The MS Care Liaison at VA medical facilities with an MS Support Program will assist with coordination and referrals to the MS Regional Program as needed.

white figure talking through microphoneAnnouncements

November 26, 2018

The FDA has issued a safety alert, cautioning that when the MS medicine Gilenya (Fingolimod®) is stopped, the disease can become much worse than before the medicine was started or while it was being taken. This MS worsening is rare but can result in permanent disability.

There have been 35 such cases reported to the FDA and in published medical literature in the eight years since fingolimod was approved in September 2010. These reports describe severely increased disability accompanied by the presence of multiple new lesions on magnetic resonance imaging (MRI) that occurred 2 to 24 weeks after fingolimod was stopped. Most patients experienced this worsening in the first 12 weeks after stopping. The severe increase in disability in these patients was more severe than typical MS relapses, and in cases where baseline disability was known, appeared unrelated to the patients’ prior disease state.

Providers should discuss with patients the potential risk of severe increase in disability reported in this alert. When fingolimod is stopped, patients should be monitored for evidence of an exacerbation of their MS and treated appropriately. Patients should be advised to seek immediate medical attention if they experience new or worsened symptoms of MS.

Gilenya (Fingolimod®) Prescribing Information

November 26, 2018

The package labeling for ocrelizumab has been updated with results from a Phase 3b randomized, open-label study which examined the concomitant use of ocrelizumab and several non-live vaccines in adults 18-55 years of age with relapsing forms of MS. Patients on ocrelizumab demonstrated an attenuated antibody response to tetanus toxoid-containing vaccine, pneumococcal polysaccharide, pneumococcal conjugate vaccines, and seasonal inactivated influenza vaccines. The impact of the observed attenuation on vaccine effectiveness in this patient population is unknown. It is recommended that all immunizations according to immunization guidelines at given at least 4 weeks prior to initiation of ocrelizumab for live or live-attenuated vaccines and, whenever possible, at least 2 weeks prior to initiation of ocrelizumab for non-live vaccines. Vaccination with live-attenuated or live vaccines is not recommended during treatment with ocrelizumab and until B cell repletion has occurred.

An additional warning regarding infants born to mothers receiving ocrelizumab treatment is included in the updated labeling. In these infants, live or live-attenuated vaccines should not be administered before confirming the recovery of B-cell counts as measured by CD19+ B-cells; depletion of B-cells may increase the risks from live or live-attenuated vaccines. Non-live vaccines may be administered prior to recovery from B-cell depletion, however vaccine immune response assessment should be considered to see if a protective immune response has been mounted.

Ocrevus (Ocrelizumab®) Prescribing Information

November 19, 2018

Recently, a generic equivalent for Ampyra has been approved by the Food and Drug Administration (FDA). This medication is used to help with walking and balance problems which can be associated with MS. The generic medication is called Dalfampridine. As an FDA approved generic, the FDA ensures the generic medication provides the same clinical benefit and is as safe and effective as the brand-name medicine that it duplicates. A generic medication must have the same active ingredients, safety, effectiveness, strength, quality and benefits as the brand-name medication it copies.

Here are the important things you need to know; (1) Please do not start taking Dalfampridine until you have finished all of your Ampyra. (2) The Dalfampridine tablet may look different than the Ampyra tablet. (3) You should not feel any different with this change in product. (4) Please continue to take your Dalfampridine as instructed by your healthcare provider. (5) Call your VA pharmacy or healthcare provider if you have any questions or problems with this change in your medication.

September 26, 2018

The National MS Society has a quarterly magazine for people affected by MS. The fall 2018 issue has a great article, "At the Front", highlighting Veterans with MS and the VA healthcare system.

September 7, 2018

Dimethyl fumarate (DMF) has been associated with lymphopenia in clinical trials. To date, there have been five cases of PML in MS patients treated with DMF with an additional 14 cases reported in Europe where psoriasis patients were treated with a mixture of fumaric acid esters. Notably, 13 out of these 19 patients had grade 3 lymphopenia (ALC < 500-200/mm3). An integrated analysis of phase 2b/3/long-term extension studies of DMF in MS (N = 2,470) was conducted to characterize ALC profiles (Fox RJ, et al. Neurol Clin Pract. 2016 Jun;6(3):220-229). Mean absolute lymphocyte counts (ALC) decreased by 30% during the first year and then plateaued, remaining above the lower limit of normal (LLN). The majority of patients will develop low ALC in the first 9-10 months of DMF therapy (Baharnoori M, et al. Mult Scler Relat Disord. 2018 Feb;20:51-57., Khatri BO, et al. Mult Scler Rel Disord. 2015 Jul;4(4):377-379., and Gold R, et al. Mult Scler. 2017 Feb;23(2):253-265.). Current product labeling for DMF in the US recommends laboratory monitoring at baseline and every 6-12 months, European labeling recommends monitoring be conducted quarterly. Given the current evidence regarding the development of ALC within the first year of therapy and potential PML development, the DMF Criteria for Use (CFU) has been updated with the following monitoring statement; “Patients should have a CBC with differential at baseline and monitored quarterly for the first year of therapy and then every 6-12 months as clinically indicated by wbc or lymphocyte count.”

September 4, 2018

Team Northwest 2018, comprised of 11 Veteran athletes representing the VA Puget Sound Health Care System in Washington state, brought home 21 medals from the 2018 National Veterans Wheelchair Games, July 30 – August 4, 2018 in Orlando, Florida. To learn more, visit the VA Puget Sound website.

Disclaimer: Links are provided as a convenience and for informational purposes only. They do not constitute an endorsement or an approval by MSCoE of any of the products, services, or opinions of the organization. MSCoE bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

man reading a magazine while sitting at a tableVA MS Publications

The VA ranks as one of the nation’s leaders in health research. Thousands of studies are conducted at VA medical centers, outpatient clinics, and nursing homes each year. This research has significantly contributed to advancements in health care for Veterans and other Americans from every walk of life.

Learn about MSCoE research on our Professionals and Veterans research pages.

Recent VA Provider Publications

ADSTEP: Preliminary Investigation of a Multicomponent Walking Aid Program in People With MS

Positive Factors, Pain, and Function in Adults with MS

Sex Differences in Predictors of Illness Intrusiveness in Persons with MS

Phase 2 Trial of Ibudilast in Progressive MS

Genome Sequencing Uncovers Phenocopies in Primary Progressive MS

ADSTEP: Preliminary Investigation of a Multicomponent Walking Aid Program in People with MS

Using the Anterior Visual System to Assess Neuroprotection and Remyelination in MS Trials

Headache and Its Management in Patients with MS

Cognitive Impairment in MS

Optical Coherence Tomography Angiography Enhances the Detection of Optic Nerve Damage in MS

Disclaimer: Links are provided as a convenience and for informational purposes only. They do not constitute an endorsement or an approval by MSCoE of any of the products, services, or opinions of the organization. MSCoE bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.