July 8, 2019 News by Jose Marques Lopes, PhD Mayzent Boosts Cognitive Processing Speed in SPMS Patients, Phase 3 Trial Data Show Treatment with Mayzent (siponimod) led to significant improvement in cognitive processing speed in patients with secondary progressive multiple sclerosis (SPMS), according to updated results of a Phase 3 trial. Novartisā findings, presented at the European Academy of Neurology (EAN) congressĀ that ran June 29āJuly 2 in Oslo,…
July 2, 2019 News by Ana Pena PhD Neurologists Prefer Mayzent for SPMS and RRMS, But Mavenclad Could Be ‘Ideal’ First Switch, Report Suggests While neurologists favor Novartis‘ Mayzent (siponimod) for people with active secondary progressive multiple sclerosis (SPMS) and transitioning relapsing-remitting MS (RRMS), EMD Serono‘s Mavenclad (cladribine) could serve as a first option for patients with RRMS who failed initial therapy, Spherix Global Insights says in its…
June 3, 2019 News by Joana Carvalho, PhD Mavenclad May Surpass Gilenya as DMT of Choice for Treatment of MS in Canada Mavenclad (cladribine) may surpass Gilenya (fingolimod) in the category of oral disease-modifying therapy (DMT) of choice for the treatment of multiple sclerosis (MS) in Canada, according to a press release. The Canadian healthcare market for MS has grown considerably over the past two years. In November…
May 20, 2019 News by Santiago Gisler Study Testing Pear-006 Software Application for Treating Depression Symptoms Pear Therapeutics, in collaboration with Novartis,Ā has launched a study evaluating the clinical use of Pear-006, its software-based prescription digital therapeutics (PDT) product for treating depression symptoms in people with multiple sclerosis (MS). PDTs belong to a new class of treatment strategies in healthcare intended to treat diseases,…
May 16, 2019 News by Jose Marques Lopes, PhD #AANAM – Gilenya at 0.5 mg Superior to Copaxone at Lowering Relapses, Phase 3 Trial Shows Oral Gilenya (fingolimod) taken daily at a 0.5 mg dose is superior toĀ Copaxone (glatiramer acetate) injections at lowering relapses and disease activity over one year in patients with relapsing-remitting multiple sclerosis (RRMS), according to results of a Phase 3b trial. The research, āEfficacy and Safety…
May 9, 2019 News by Jose Marques Lopes, PhD #AANAM – Scoring Tool Helps Identify Patients with RRMS or Transitioning to SPMS, Study Reports A newly developed scoring tool enables better identification of patients with relapsing-remitting multiple sclerosis (RRMS) as well as those transitioning or already diagnosed with secondary progressive MSĀ (SPMS). The research about that finding, āValidation of the Scoring Algorithm for a Novel Integrative Secondary Progressive Multiple Sclerosis (SPMS) Screening Tool,ā…
May 9, 2019 News by Jose Marques Lopes, PhD #AANAM – Mayzent Improves Cognitive Processing Speed in SPMS Patients, Trial Results Show Treatment with Mayzent (siponimod) provided sustained improvements and prevented deterioration of cognitive processing speed in patients with secondary progressive multiple sclerosis (SPMS), regardless of their cognitive function prior to therapy, according to results of a Phase 3 clinical trial. The data were presented at the recent 2019Ā American…
May 7, 2019 News by Jose Marques Lopes, PhD #AANAM – Mayzent Lessens Inflammation at Brain Meninges, Prevents Migration of Lymphocytes to Reduce Demyelination, Mouse Study Suggests Treatment with Mayzent (siponomod) may reduce myelin deterioration by lessening the accumulation of immune cells in brain meninges, and preventing the migration of pro-inflammatory lymphocytes into the brain, according to a study in a mouse model of multiple sclerosis (MS). The research, āA Mouse Model of…
May 6, 2019 News by Marisa Wexler, MS #AANAM – IV Therapy May Be More Effective Than Oral Treatment in Younger RRMS Patients, Research Suggests Infusible disease-modifying treatment ā that is, therapies given intravenously ā might have greater benefits for younger people with multiple sclerosis (MS) than oral ones, new research suggests. The research was presented at the ongoing American Academy of Neurology (AAN)’s annual meeting (May 4-10) by Brandi Vollmer,…
April 18, 2019 Columns by Jennifer (Jenn) Powell The DMT Decision: Tried and True or Shiny and New? I spend a great deal of time in my head. I think. A lot. Perhaps I do so more than I should, but then again, it is a haven at times. My thoughts run the gamut from the serious to the inane. Today my thoughts…
April 10, 2019 News by Jose Marques Lopes, PhD Different Ways of Working Tailor Mayzent for Early SPMS Patients, Novartis Says The effectiveness of MayzentĀ (siponimod) in both the brain and the body make it an oral therapy tailored for people with early secondary progressive multiple sclerosisĀ (SPMS), according to Dan Bar-Zohar, MD, top executive with Novartis, the treatmentās developer. Mayzent was recentlyĀ approvedĀ by the U.S. Food and Drug Administration…
April 8, 2019 News by Jose Marques Lopes, PhD Mayzent ‘Will Change Lives’ of MS Patients Transitioning to SPMS, Novartis Says The “regulatory environment” favoredĀ Mayzent (siponimod) beingĀ approved as an oral treatment for people withĀ relapsing multiple sclerosis (MS) ā specifically,Ā clinically isolated syndromeĀ (CIS),Ā relapsing-remitting multiple sclerosisĀ (RRMS), and activeĀ secondary progressive MSĀ (SPMS) ā a top executive with NovartisĀ said, althoughĀ the pharmaceutical company had requested a label covering all with SPMS. Dan…
April 3, 2019 News by Marisa Wexler, MS Cleveland Clinic Neurologist Applauds Mayzent’s FDA Approval, But Surprised by Those It May Not Treat When theĀ U.S. Food and Drug Administration approvedĀ the disease-modifying therapy Mayzent forĀ relapsing types of multiple sclerosis, itĀ specified in its label that the treatment was for people withĀ clinically isolated syndrome, relapsing-remitting MS, and ā importantly āĀ secondary progressive MSĀ provided they have "active" disease. The approval is good news, an MS researcher and physician saidĀ toĀ Multiple Sclerosis News TodayĀ in an interview, but "surprising" in that the FDA's decision was largely based on a trial that didn't involve CIS patients and wasn't focused on responses among particular types of SPMS. āIt's the first time that I've seen in the MSĀ field that regulatorsĀ made an approval designation ā activeĀ secondary progressive MS ā based on an underpowered subgroupĀ analysis,ā saidĀ Robert Fox, MD, a neurologist at the Mellen Center for Multiple Sclerosis at the Cleveland Clinic. Novartis'Ā medication, as a first oral therapy approved in the U.S. forĀ a form ofĀ SPMS,Ā is a big step forward in MS treatment, he said. But details of the FDA's decisionĀ caughtĀ him off guard. Fox served on the steering committee for the EXPAND Phase 3 clinical trial ,Ā on which the FDA decision was largely based.Ā His clinic was also one of the sites treating and evaluating patients in this pivotal study. Results of the EXPAND trial showed thatĀ Mayzent could reduce the risk of disability progression at three months (the trialās primary endpoint, or goal) by 21% in treatedĀ SPMS patients, compared to those given aĀ placebo. Among those with active SPMS (meaning with relapses), a 33% reduction was observed. The treatment, an S1P modulator that works in part to keep lymphocytes from entering the brain to trigger inflammation,Ā alsoĀ decreased the annualized relapse rate by 55% and improved cognitive processing speed in all treated patients.Ā āWhat was found, and I think quite clearly found in a large-size study, was that siponimod in patients with secondary progressive MS clearly slowed the progression of clinical disability over the course of the trial,ā Fox said. āIt's a statistical concept ā obviously patients either progress or they don't progress ā but on an overall basis there was a 21% slowing in the rate of progression of clinical disability.ā The FDAās decision is particularly important for SPMS patients. While Ocrevus (ocrelizumab) alsoĀ treats all relapsing MS forms and people with primary progressive disease (PPMS), it's an intravenous therapy given every six months. Mavenclad (cladribine), approved for relapsing patients in the U.S. just days after Mayzent, is another oral and active disease therapy. To Fox, Mayzent seemed to reach beyond only those secondary progressive patients with clinically active disease. āReally, this is the only drug that's been found to be effective in secondary progressive MS," he said. āTo that degree, it stands alone.ā That's why two points in the FDA's decisionĀ surprised him. The firstĀ is the label's specific mention of clinically isolated syndrome. CISĀ is defined asĀ theĀ first clinical presentationĀ of this diseaseĀ ā aĀ neurological episode that lasts at least 24 hours, and is characterized by inflammatory demyelination (the loss of myelin, the protective coat surrounding neurons). Ā For clinicians like Fox, CIS is a first manifestation of MS ā a kind of "mono sclerosis."Ā Since thereās only one documented attack, it canāt yet be considered multiple sclerosis, āas the multiple hasn't happened,ā Fox said, but many "in the field consider CIS to be ā¦ an early stage of MS." āIf the patient has a whole bunch of lesions on their brain [as seen on an MRI scan] and they had a single clinical event, ah, probably, they have MS,ā he said. Regulatory bodies like the FDA,Ā however,Ā have historically considered CIS to be its own separate entity. That makes this decision doubly surprising, according to Fox, since the EXPAND trial only enrolled patients with SPMS, not CIS. Ā āIt's the first time I've seen them approve for CIS specifically when there wasn't a trial in CIS,āĀ Fox said. āI agree with it ā I don't have a problem with it ā it just surprised me that the regulators were so progressive in their appreciation of MS.ā The second ā and far more unsettling ā surpriseĀ wasĀ the FDAās decision toĀ only approve Mayzent for āactiveā SPMS patients, instead of all SPMS patients. This decision didnāt come out of nowhere, he noted, but it remains puzzling in the context of the EXPAND trial.Ā InĀ compiling trial results, investigators did a subgroup analysis ā as they often do, almost as an aside for research reasons ā and found more favorableĀ responses to Mayzent treatmentĀ in patients with active inflammation beforeĀ the trial's start, those it determined to be with "active" disease. Ā āThere was a third of patients who had a relapse in the two years prior to enrollment, and those patients actually had a 30% slowing in disability progression, compared to the 21% overall,ā Fox said. This certainly does suggest that Mayzent can be more effective in people with active disease ā but there's a catch. The trial itself was not designed to make such a distinction. It enrolled SPMS patients regardless of activity, and its priority goal was changes in disease progression across all who were treated with Mayzent or given a placebo. Ā āWhat's important is that the trial was powered for the overall outcome. It was not powered for subgroup analysis,ā Fox said,Ā considering this a crucial point.Ā In clinical studies, being āpoweredā refers to theĀ enrollingĀ of whatever specific number of participants a study needs to ensureĀ itsĀ results will reach statistical significance. More people are redundant and, as such, an unnecessary cost; fewer could mean that trial's conclusions cannot be supported by rigorous scientific measures.Ā In other words, Fox said, the only conclusions that can be drawn from the EXPAND study reliably ā with rigor ā are based on data drawn from all its SPMSĀ patients, not aĀ subgroup with active disease. This trial āfollowed over 1,600 patients for the clinicalĀ disability. These are purposely powered so that you're not following twice as many people as you need toĀ ā¦ you're powered for that primary outcome,ā he said. āSo, how could they [the FDA] look at a subgroupĀ analysis and make an approval decision based on a subgroupĀ analysis that was underpowered?ā The neurologist gave as examplesĀ other subgroup differences found in trial analyses that didn't affect regulatory approval ā but to his mind, equally could have.Ā One was an analysis findingĀ female SPMS patients respondedĀ to the therapy better than males,Ā showing lesser disease progression. "So why didn't they just approve it for the females and not the males?" Fox asked. But, when asked, Fox did not think the labelĀ toĀ necessarily be an error. "My point is the absurdity of it," he said. "How could they make the regulatory approval based on a subgroupĀ analysis that wasn't powered for conclusions?" He was also particularly troubled becauseĀ the FDAĀ ādidn't define what āactiveā means āĀ is it just a relapse, or is it MRI disease activity?"Ā For many clinicians, āactiveā SPMS refers to ongoing inflammation that can be observed on MRI (magnetic resonance imaging) scans. In EXPAND, however, the active subgroup was defined as patients with clinical relapses within two years of being enrolled in the trial. Fox worries about this apparent lack of a regulatory definition of "active" SPMS, since āobviously, the insurance companies are going to seize upon that, and they're going to look for every way they can to avoid covering it for patients.ā Mayzent, Fox agreed,Ā is likely to be expensive. The therapy is reported to carry a U.S. list price ofĀ $88,500 a year. āI always have a concern about the cost of these drugs. They're all fearfully expensive,ā he said, noting he treats SPMS patients. His focus now is on working to ensure that possible regulatory and financial hurdles wonāt pose too much of an obstacle for patients, especially those with SPMS. āI don't know what the insurance companies are going to do with this, but I'm hoping that it is available for my patients, and I say that as their clinician,ā Fox concluded.
March 28, 2019 News by Larry Luxner MS Patient Groups React Favorably to Mayzent Approval, But Question Therapyās Price Tag National organizations that represent patients with multiple sclerosisĀ (MS) welcome the U.S. Food and Drug Administration’s March 26 approvalĀ of Novartis’Ā oral therapy MayzentĀ (siponimod) ā but they complain that, at $88,500 per year, the treatment is overpriced. The Multiple Sclerosis Society of AmericaĀ (MSSA) is clearly upbeat about the…
March 27, 2019 News by Patricia Inacio, PhD FDA Approves Novartis’ Mayzent for Relapsing Forms of Multiple Sclerosis, Including Active SPMS The U.S. Food and Drug Administration (FDA) has approved Novartis’ Mayzent (siponimod) oral tablets for adults with relapsing forms of multiple sclerosis (MS), including clinically isolated syndrome (CIS), relapsing-remitting disease (RRMS), and active secondary progressive disease (SPMS). Mayzent was designed to inhibit the activity of…
March 20, 2019 News by Jose Marques Lopes, PhD SPMS Treatment With Mayzent Better Than Best Supportive Care, ICER Report Says Treatment of secondary progressive multiple sclerosis (SPMS) patients with the investigational oral therapy Mayzent (siponimod) significantly reduced the risk of disability progression and decreased inflammation, compared to best supportive care, according to aĀ preliminary draft evidence reportĀ from the Institute for Clinical and Economic Review (ICER). The report…
March 10, 2019 News by Larry Luxner MS Patients Share Their Stories at NYC Event Featuring Montel Williams After months of preparation with storytelling experts, three ordinary Americans with multiple sclerosis (MS) took the stage in New York late last year to share their MS journeys. The three joined TV personality Montel Williams at an event inaugurating My MS: Second Act, a joint effort co-sponsored by…
February 15, 2019 News by Jonathan Grinstein Neurofilament Light Chain Levels in Blood of Value as Biomarker of MS Activity and Treatment Response, Study Finds Blood levels of a nerve cell-derived component known as neurofilament light chain (NfL) could be used as a biomarker of disease severity and treatment response in patients with relapsing-remitting multiple sclerosis (RRMS), a new study shows. The research article, āBlood neurofilament light chain as a biomarker of MS…
February 14, 2019 News by Santiago Gisler Continuous Use of Gilenya for Up to 3 Years Can Lead to 50% Drop in Annual Relapse Rates, Real-world Study Says Multiple sclerosis patients who began treatment withĀ Gilenya and stayed with it continuously showed a more than 50 percent reduction in annual relapse rates, a real-world study following these people for up to three years found. Gilenya,Ā marketed by Novartis, is an oral disease-modifying treatment forĀ relapsing-remitting multiple sclerosis , approved in 2010. It acts by binding and modulating receptors ā called sphingosine-1-phosphate receptor ā on lymphocytes (adaptive immune cells). By binding to these receptors, Gilenya prevents lymphocytes from leaving the lymph nodes and reaching the brain and spinal cord, and so lower lymphocyte-induced inflammation and damage. Although several clinical trials have reported reduced annualized relapse rates (ARRs) upon treatment with Gilenya, few long-term real-life studies have examined the relapse rate reductions over a long term. A team, led by Novartis researchers and a scientist atĀ Central Texas Neurology Consultants,Ā collected MS patient data from the MarketScan database, a U.S. claims database including medical and pharmacy claims (bills submitted to health insurance providers), between 2009 and 2016. Among 9,312 MS patients in the database with at least one filled Gilenya prescription, 1,599 adults (mean age, 46) met the study's inclusion criteria, including having at least one inpatient or two outpatient claims, and a total of four years of continuous health plan enrollment. Among theseĀ 1,599 patients, all usedĀ Gilenya for one year (cohort 1), 1,158 (72.4%) took Gilenya continuously up to the start of year two (cohort 2), and 937 (58.6%) used the therapy up to the start of year three (cohort 3). Baseline analysis ā measures taken at the study's start ā showed that the most common MS-linked symptoms were disorders of the optic nerve and visual pathways (reported in 22-24%), followed by fatigue/malaise (20-21%). Hypertension (20-21%) and depression (15-16%) were the most common physical and mental comorbidities, respectively. The mean annualized relapse rates (AARs) at baseline in these three groups of patients ā cohorts 1 to 3 ā ranged between 0.48 and 0.51. A consistent reduction in ARRs was seen in all three groups: cohort 1 had a 0.25 ARR at the close of the first year, for a 51% reduction from the baseline rate; cohort 2 a 0.22 ARR at the start of year two, for a Ā 54% lowering in relapse rates from baseline; and cohort 3 had 0.23 ARR at the third year, amounting to a 53% reduction. As expected, when researchers calculated ARRs among patients with continuous Gilenya use over these three years, they found a greater reduction in annual relapse rates. Mean ARRs in continuous-use patients were 0.19 (a 61% reduction) during the first year, 0.18 (a 62% reduction) during the second year, and 0.18 (a 61% reduction) at the start of the third year. āThis retrospective claims database study found that patients with MS who received fingolimod [Gilenya] therapy experienced a durable and sustained reduction in relapse rates over a 3-year period,ā the researchers wrote, with findings representingĀ āa durable reduction in relapse rates by [more than] 50%.ā Reasons that some patients discontinued treatment were not a focus of this study, they added.
January 30, 2019 News by Jonathan Grinstein Canadian RRMS Patients Less Likely to Discontinue Treatment with Oral Gilenya, Compared to Injectable or Infusible Therapies Multiple sclerosisĀ (MS) patients in Canada are more likely to comply with their treatment plan and less likely to discontinue the use of the oral disease-modifying treatment Gilenya (fingolimod), compared to injectable or infusible treatment options, new research shows. The research article with that finding, āA…
January 29, 2019 News by Patricia Inacio, PhD Gilenya Better at Lowering Relapse Rate than Tecfidera or Aubagio, Study Suggests Gilenya is linked to significantly lower annualized relapse rates in relapsing-remitting multiple sclerosis (RRMS) patients compared to Tecfidera orĀ Aubagio, a study suggests. All three therapies showed similar effects on disability outcomes. Oral immunotherapies ā including Novartisā Gilenya, Biogenās Tecfidera, and Sanofi Genzymeās Aubagio ā are currently standard therapies for RRMS treatment. But while these therapies are highly effective at modulating MS activity, studies comparing their efficacy on relapse and disability are missing. This is an important point for MS patients, so that if a change in oral therapies is needed (due to lack of tolerance, for example), the decision on a more suitable therapy is based on scientific evidence. To address this matter, a group of researchers used the MsBase, an international observational MS cohort study, to identify RRMS patients who had been treated with Gilenya, Tecfidera, or Aubagio for at least three months. The team compared Tecfidera versus Aubagio, Gilenya versus Aubagio, and Gilenya versus Tecfidera, specifically for the therapyās impact on relapse activity, six-month disability worsening or improvement, and persistence of treatment. Relapse was defined as the occurrence of new symptoms or exacerbation of existing ones for a period of over 24 hours, at least 30 days after a previous relapse. Disability was assessed using the Expanded Disability Status Scale (EDSS); the six-month disability worsening or improvement were defined as an increase or a decrease by one value in EDSS. The study included 614 patients treated with Aubagio, 782 with Tecfidera, and 2,332 with Gilenya. Patients were followed over a median of 2.5 years. Patientsā characteristics at baseline differed among the three groups. Aubagio-treated patients tended to be older, with longer periods of disease, fewer relapses, and lower EDSS scores compared to the other two groups. Patients treated with Gilenya had higher EDSS and more relapses during the prior year, compared to those treated with Tecfidera. The majority of the patients had been treated with other immunotherapies prior to being given one of these three oral treatments. Results showed that Gilenya-treated patients had significantly lower annualized relapse rates than those treated with Tecfidera (0.20 versus 0.26) or Aubagio (0.18 versus 0.24), while patients taking either Tecfidera or Aubagio had a similar rate. However, during the 2.5-year period analyzed, researchers found no differences in disability accumulation or disability improvement among the three therapies. Regarding treatment persistence, Tecfidera and Aubagio were more likely to be discontinued than Gilenya. Overall, the results suggest that treatment with Gilenya may have a greater impact on relapse frequency in RRMS patients compared to Tecfidera and Aubagio, although the "effect of the three oral therapies on disability outcomes was similar during the initial 2.5 years on treatment," researchers said. āChoosing a therapy in individual patients remains a complex task that requires thorough and individualized evaluation of disease prognosis, and the corresponding risks and benefits of the increasing number of available therapies,ā they concluded.
January 23, 2019 News by Jonathan Grinstein Novartis, Oxfordās Big Data Institute Team to Better Understand, Treat Complex Diseases NovartisĀ and the University of Oxfordās Big Data Institute (BDI) have established an alliance to advance the use of medical data for spotting disease patterns and assessing patients’ responses to treatment. The initiative seeks to enable more informed clinical decision-making and improve the development of treatments for complex diseases.
January 17, 2019 News by Jose Marques Lopes, PhD Fewer RRMS Patients Relapse, Discontinue Treatment with Gilenya, Study Finds Relapsing-remitting multiple sclerosis (RRMS) patients on Gilenya (fingolimod) have fewer relapses and stay on treatment longer than those takingĀ Tecfidera (dimethyl fumarate) or Aubagio (teriflunomide), according to a new study. The research, āComparison of fingolimod, dimethyl fumarate and teriflunomide for multiple sclerosis,ā was published…
December 4, 2018 Columns by Ed Tobias How Worried Should We Be About MS Medication Side Effects? Over the past couple of weeks, two warnings have been issued about side effects of multiple sclerosis (MS) medications. First, the U.S. Food and Drug Administration warned about a slight risk of seriously worsening MS symptoms if someone who is using the disease-modifying therapy (DMT) Gilenya (fingolimod) stops using…
November 30, 2018 News by Alice MelĆ£o, MSc Gilenya Now Approved in Europe to Treat Children, Adolescents with RRMS Gilenya (fingolimod) was approved by the European Commission as a treatment for children and adolescents, ages 10 to 17, with relapsing-remitting multiple sclerosis (RRMS), Novartis announced. The therapy is already approved in Europe to treat RRMS patients 18 and older. With this newest decision, Gilenya has become…
November 27, 2018 Columns by Ed Tobias FDA Warns of Possible Dangers of Stopping Gilenya If you are being treated with Gilenya, take note. The U.S. Food and Drug Administration is warning that if you stop using Gilenya (fingolimod), there’s a chance your MS could become worse. The FDA issued a safety alert saying that this only happens rarely, but when it does, the…
November 26, 2018 News by Ana Pena PhD FDA Warns of Rare Risk of Severe Worsening in MS Disability After Stopping Gilenya Use The U.S. Food and Drug Administration (FDA) has issued a safety alert, warningĀ that people with relapsingĀ multiple sclerosis (MS)Ā who stop usingĀ Gilenya (fingolimod) may experience disease worsening beyond that when starting the medicine or while taking it. Reported cases of such increases in MS disability upon stopping treatment are…
November 26, 2018 News by Jose Marques Lopes, PhD Gilenya-induced Changes in Heart Rate May Predict Degree of Drop in Lymphocytes, Study Reports Assessing changes in a person’s heart rate can help to predict the degree to which lymphocyte numbers will decrease in relapsing-remitting multiple sclerosis (RRMS) patients usingĀ Gilenya (fingolimod), according to a small study. The research, āFingolimod-induced decrease in heart rate may predict subsequent decreasing degree of…
October 17, 2018 News by Jose Marques Lopes, PhD #ECTRIMS2018 – Blood Level of Neurofilament Light Chain May Predict Brain Atrophy in Progressive MS, Study Suggests Measuring the blood level of neurofilament light chain (NfL) may predict brain shrinkage in primary progressive (PPMS) and secondary progressive multiple sclerosis (SPMS), according to a new study. The findings also show that NfL levels are associated with brain lesion load in these patients. The research, ā…
October 16, 2018 News by Ana Pena PhD #ECTRIMS2018 – Shifting from Gilenya to Lemtrada Doesn’t Increase Risk of MS Reactivation, Study Says Shifting from treatment with Gilenya (fingolimod) to Lemtrada (alemtuzumab), and doing a short washout period between the two therapies, does not seem to increase the risk of disease reactivation in patients with multiple sclerosis (MS), an Italian study shows. Lemtrada, marketed by…