Recrudescence in Tysabri

[Cherie]

How's that for the word of the day? Recrudescence: According to the following article the basic meaning is that one starts to feel cruddy all over again prior to their next scheduled dose of Tysabri. Recrudescence

According to Taber's Cyclopedic Medical Dictionary the definition of Recrudescence is "Relapse". The definition of Recrudescent is "Assuming new or renewed activity after an inactive or dormant period."
Apt word for what it feels like when we have our off days or need a "rescue" therapy.

Multiple Sclerosis Symptom Recrudescence Is Common at the End of the Natalizumab Dosing Cycle
Source: International Journal of MS Care

Article Citation:John N. Ratchford, Regina Brock-Simmons, Amanda Augsburger, Sonya U. Steele, Kristie Mohn, Mandi Rhone, Jinyan Bo, and Kathleen Costello (2014) Multiple Sclerosis Symptom Recrudescence Is Common at the End of the Natalizumab Dosing Cycle. International Journal of MS Care In-Press.
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Article
Multiple Sclerosis Symptom Recrudescence Is Common at the End of the Natalizumab Dosing Cycle
John N. Ratchford , MD; Regina Brock-Simmons , BS; Amanda Augsburger , RN;Sonya U. Steele , MS; Kristie Mohn , RN; Mandi Rhone , RN; Jinyan Bo ; KathleenCostello , MS, ANP-BC

From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.


Objective: To study how frequently patients receiving natalizumab for multiple sclerosis (MS) experience recrudescence of their MS symptoms at the end of the dosing cycle.

Methods: One hundred consecutive MS patients receiving natalizumab completed a survey evaluating changes in symptoms during the natalizumab dosing cycle. Ninety-one patients also completed questionnaires at two time points: the first week after natalizumab infusion and the last week of the dosing cycle, including the MS Quality of Life–54 (MSQOL-54), Fatigue Visual Analog Scale (VAS), Fatigue Severity Scale (FSS), and Beck Depression Inventory–II (BDI-II).

Results: End of dosing interval (EDI) symptoms were reported as currently being experienced by 56% of respondents. An additional 10% reported that they previously experienced that phenomenon, but not currently, and 34% reported never experiencing this. In those with EDI symptoms, they began to occur a median of 21 days after infusion and improved again a median of 1 day after infusion. The most common symptoms reported were fatigue, weakness, walking impairment, and cognitive difficulties. No specific demographic or disease characteristics were associated with this phenomenon. In the subgroup with EDI symptoms, the MSQOL-54, Fatigue VAS, FSS, and BDI scores were all significantly worse in the last week of the dosing cycle when compared to the first week. No difference was seen in these scores between first and last week in the subgroup not experiencing symptom recrudescence.

Conclusions: Recrudescence of fatigue, weakness, walking impairment, or cognitive difficulties at the end of the dosing cycle occurs in about two-thirds of MS patients receiving natalizumab.



Published Online: April 9, 2014

Correspondence: John N. Ratchford, MD, Pathology 627, 600 N. Wolfe St., Baltimore, MD 21287-6985; e-mail: jratchf1@jhmi.edu.

[SalpalSally]

Thanks Cherie.
Anybody who can come up with the word Natalizumab, can,
most certainly, come up with Recrudescence. That gives them
the opening of saying, that some of you should take it more often.
Thus, increasing their sales and gigantic, sinful, shameful profits.

[Cherie]

Actually Sally, the study came out of people receiving it saying that they felt awful the last week before the upcoming dose was to be given and requesting their docs be flexible on dosing schedule....which of course they cannot due to FHA dosing regulation. This is a first step in showing that a large percentage of people taking it (66 out of 100) are reporting this dose response. If you read the article, you will see it was 100 consecutive patients chosen...not random and not filtered...and that all filled out a survey of how they were feeling one week after dosing and three weeks after dosing.

[agate]

Also, they seem so concerned about the PML risk that the trend is toward reducing the total amount of Tysabri a person would receive in a lifetime. One study suggests that reducing the dose frequency to every 8 weeks might reduce PML risk:



Presented at the annual AAN conference in Philadelphia, April 29, 2014--sorry there's no link for this:

Quote

[P2.251] Multicenter Retrospective Study Of Extended Dosing Of Natalizumab In Multiple Sclerosis: A Strategy For Mitigating Risk Of Progressive Multifocal Leukoencephalopathy While Maintaining Efficacy?


Joseph Herbert,1Lana Zhovtis Ryerson,2Carlo- Use #013651 Tornatore,3John Foley,4Bianca Weinstock-Guttman,5Ilya Kister,2Krupa Pandey,6Gina Remington,7Teresa Frohman,7Eugene Major,8Sara Qureshi,7Shin Beh,7Darin Okuda,7Puspa Utomo,2Channa Kolb,9David Hojnacki,5Elliot Frohman7

1Fair Lawn, NJ, USA, 2New York, NY, USA, 3Washington, DC, USA, 4Salt Lake City, UT, USA, 5Buffalo, NY, USA, 6Livingston, NJ, USA, 7Dallas, TX, USA, 8Bethesda, MD, USA, 9Williamsville, NY, USA

OBJECTIVE:

Investigate whether Natalizumab extended dosing schedule mitigates progressive multifocal leukoencephalopathy risk while maintaining clinical and radiological efficacy in multiple sclerosis.

BACKGROUND:

Progressive multifocal leukoencephalopathy (PML) caused by JC virus (JCV) is the most serious complication associated with use of Natalizumab (NTZ) in patients with Multiple Sclerosis (MS). PML risk after previous JCV exposure may be as high as 8.5/1,000 in long term NTZ recipients with high JCV antibody index. PML susceptibility may reflect, at least in part, excessive reduction in discrete tissue compartment trafficking of immune cells required for JCV surveillance. While current MS treatment guidelines utilize a standard 300 mg NTZ dose administered every 4 weeks, percentage saturation of α4β1 integrin receptor on circulating lymphocytes is contingent upon NTZ serum concentrations, which in turn may be influenced by individual metabolism, body mass, dosage, and dose frequency. Pivotal trial and postmarketing data suggest MRI and clinical activity generally recur 12-16 weeks following cessation of NTZ therapy. We hypothesized that transition to an 8-week dosing regimen would, in a sense, establish the phenomenon of oscillating and therapeutic anti-microbial immune reconstitution against a ubiquitous viral pathogen, JCV.

DESIGN/METHODS:

Retrospective analysis of data provided by six MS Centers for patients who received NTZ extended dosing (ED) schedules (every 6,7 or 8 weeks) will be presented.

RESULTS:

586 patients have received ED NTZ for at least 3 consecutive doses. Average age: 44 years; Male:female 32:68%; mean duration NTZ treatment (total): 37 doses; mean duration NTZ (ED): 12 doses; JCV immunopositivity: 63%.Relapse rate and MRI progression remained extremely low despite trend toincrease with increasing ED interval. Not a single case of PML was reported.

Subgroup analysis, tolerability data, annualized relapse rates and MRI analysis will be presented.

CONCLUSIONS:

Our collective observations support the hypothesis that extended dosing NTZ regimen may represent an effective strategy to mitigate PML risk, while maintaining clinical and radiological efficacy in MS. Prospective study is planned.

Category - MS and CNS Inflammatory Disease: Clinical Science

[Cherie]

I have to say......my ONLY reason for posting this was that I had never heard the word Recrudescence before and it seemed such an apt sounding word for how cruddy we can feel before or right after a treatment....and then I backed it up with the article so no one thought I was making up the word!

Guys...sometimes I'm not all serious and professional and this post represents one of those times I am not (serious). Love ya!

[Cat Dancer]

Recrudescence: bedsores that seemingly heal, and just when you think you're over them...they recrud the area, and their essence is most unpleasant...... (I may end up having to have surgery to get rid of these things.....:( )

[Jeanie Z]

:) Hi Cat, I hope not. I'm praying for you. Feel better Cherie, Gary, and all of you feeling not so good. Jeanie :)

[Gabriella7]

Why would I want to take something that is not going to help me feel better, only going to give me the same symptoms I already have, as well as risk getting a virus which could be fatal, is not a cure, and the only benefit is profit for the pharmaceutical company?

Recrudescence? Just makes me sick to my stomach!

Blessings,
Gabriella

[Cherie]

It is a good word. Cat, I like the way you use it but hate that you had to in that way. Hoping for quick healing. Good old unpasteurized honey works wonders on those sores. But you sort of have to stay off them several hours a day to allow them to heal.

[renee]

Funny Ick.

I thought "feeling _ _ _ _ _ _ " would mean the same thing
in fewer letters but I sit corrected.

[renee]

Not just crud, but recrdud.