MS Physical Activity Recommendations, FDA Approves Celecoxib, Rituximab Effect on Myasthenia Gravis

May 9, 2020

Neurology News Network for the week ending May 9, 2020.

This week Neurology News Network covered the lifestyle physical activity recommendations from CMSC and the National MS Society, as well as the FDA approval of celecoxib, and the effects of rituximab in patients with myasthenia gravis.

Marco Meglio: Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus.

New recommendations created by the National MS Society and endorsed by the Consortium of Multiple Sclerosis Centers (CMSC) aimed at optimizing exercise and lifestyle physical activity for people with multiple sclerosis have been released. The recommendations are headlined by the general thought that physicians and other healthcare providers should endorse and promote the benefits and safety of exercise and a lifestyle of physical activity for every person with MS. A few of the major clinical recommendations include: early evaluation by a physical/occupational therapist or exercise/sports scientist experienced in MS to establish an individualized exercise and/or lifestyle physical activity plan, as well as taking into account comorbidities and symptom fluctuations, healthcare providers should encourage >150 min per week of exercise and/or >150 min per week of lifestyle physical activity.

The FDA has approved Dr. Reddy’s Laboratories’ celecoxib oral solution for the treatment of acute migraine in adults with or without aura. Notably, the non-steroidal anti-inflammatory drug was given the go-ahead with a boxed warning related to a risk of serious cardiovascular and gastrointestinal adverse events. The agency approval was granted based on the findings of 2 randomized, double-blind, placebo-controlled clinical trials. Both studies reported a significant percentage of patients with freedom from the most bothersome symptom at 2 hours compared with placebo, and in Study 1, a markedly greater percentage achieved pain freedom at 2 hours post-dose. This oral solution’s boxed warning notes that NSAIDs can increase the risk of serious cardiovascular thrombotic events, such as myocardial infarction and stroke, thus celecoxib is contra-indicated in the setting of coronary artery bypass graft surgery.

Data from a study of patients with myasthenia gravis who were exposed to rituximab at various points in the disease course, along with a control group, suggest that the anti-CD20 antibody performs better if initiated earlier after the onset of generalized symptoms. All told, those who were treated with rituximab early had a shorter median time to remission compared with those who had refractory disease. Additionally, rituximab was associated with a shortened median time to remission compared to conventional immunotherapy. They concluded that collectively, these data suggest that rituximab also should be considered earlier in the treatment algorithm for non-MuSK+ generalized myasthenia gravis, though the conclusions about its clinical effectiveness for patients with new-onset generalized disease must await results from an ongoing randomized clinical trial, the results of which are anticipated in 2021.

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