June Halper: Troubles with Older PPMS Patients


How advanced biologic care and symptom management programs fail patients more advanced in their disease.

Advances in research and clinical development come at a benefit of newly or even recently diagnosed patients with primary progressive multiple sclerosis (PPMS). But they advances of understanding and bettered treatment plans come in hindsight of patients who have been managing the disease for decades now.

In an interview with MD Magazine®, June Halper, MSN, APN-C, chief executive officer of the Consortium of Multiple Sclerosis Centers (CMSC), explained the burdens and hurdles older patients with MS face even in the face of improved care.

MD Mag: What does the PPMS patient population that responds to ocrelizumab treatment look like?

Halper: Younger. I would say younger, and certainly not complicated by other problems. Many people with MS have other symptoms such as pain, spasticity, urinary dysfunction, where they have frequent UTIs.

A patient with just the MS would probably be the best responder to ocrelizumab. But if a person with MS has got neuropathic pain, or the person with MS has severe spasticity, or has frequent bladder or bowel problems—or emotional problems, depression—that person will not be as good a responder, unless those symptoms will manage first and then you get them on the drug.

So it's a whole package, you know. That's why the team approach is so very important. You just don't go for the end, the infusion. You’ve got to ask how they’re doing. You know, there was a mayor, Ed Koch, many years ago. He would ask that question. I think that's an important question we need to keep asking the patient: “How are you doing, how are you feeling, is there anything else bothering you?”

And sometimes symptomatic management should come first.

Is symptomatic care more difficult among the older patient population?

Now, that's right. That is right, because the older population has high risk of comorbidities, such as hypertension such as obesity, people that become sedentary.

Years ago, when I first started working in MS, people with MS were told to rest a lot—don't strain yourself, don't overheat yourself, it's a true story. Today, we know that's not a good idea, but the older generation that have had MS for 20 or 30 years may be obese, they may be smoking. We now know smoking is not good for MS.

They also don't take good care of their just general health—they don't eat well or they may go off on some weird diet that would cause them to have some nutritional insufficiency. Women with MS particularly could develop things like osteoporosis because of poor diet, lack of exercise, lack of activity, smoking again, hormonal changes.

So as the person ages, the problems of aging might interfere with the response to a drug like ocrelizumab, which is such a terrific drug. But these other comorbidities might interfere with that response.

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