What To Know About Zinbryta

Disease-modifying therapies (DMTs) are important tools in the fight against multiple sclerosis. To date, the U.S. Food and Drug Administration (FDA) has approved 14 DMTs: 13 therapies for the treatment of relapsing forms of MS, some of which are also approved for clinically isolated syndrome; and one therapy, Novantrone, for the treatment of “worsening MS;” however, Novantrone is no longer customarily used in the United States.

In May 2016, daclizumab (under the brand name, Zinbryta) was approved by the FDA as the fourteenth DMT option for people diagnosed with MS in the U.S. In July 2016, Zinbryta was approved for use in Europe. The FDA suggests that because of its safety profile, the use of Zinbryta should generally be reserved for patients who have had an inadequate response to two or more drugs indicated for the treatment of MS.


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What You Need to Know About the Latest MS Drug Zinbryta

Comparing the Effects of Steroids with MS Symptoms

During relapses in multiple sclerosis, new or worsening symptoms exacerbate (or flare) as the disease ramps up. To qualify as a relapse, the symptoms must last for more than 24-48 hours (opinions differ among neurologists) and the attack must not occur within 30 days of a previous relapse, otherwise it might be considered a continuation of the first.

These problems are one of the hallmarks of relapsing forms of MS: relapsing-remitting MS, secondary progressive MS with relapses, and progressive-relapsing MS. Due to recommended changes in the words used to describe forms of MS and types of disease activity, you may see different terms used.

To qualify as a true relapse, there must not be another reason that symptoms might be flaring. Heat, illness, infection, fever, and severe exhaustion must first be ruled out, as they are among the causes of a pseudoexacerbation.

The treatment for an MS relapse is often a 3-day or 5-day course of high-dose (1 gram) intravenous (IV) corticosteroids such as Solu-Medrol or Decadron, followed by an oral taper of steroids such as prednisone.

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Are the Side-Effects of Steroids Almost as Bad as MS Symptoms?

Alemtuzumab and Infusion Reactions

Lemtrada (alemtuzumab 12 mg) is a humanized monoclonal antibody, targeting CD52+ T and B cells, delivered by IV infusion on five consecutive days (course 1) followed by another three consecutive days one year later (course 2). Lemtrada has been approved in several countries for treatment of relapsing-remitting multiple sclerosis (RRMS) and is generally reserved for people with MS who have failed other treatments.

In clinical trials, infusion-associated reactions (IARs) affected 90.1 percent of patients receiving alemtuzumab. The most common IARs were headache, rash, fever (pyrexia), nausea, and flushing; most were mild to moderate in severity. The two main types of IARs are allergic (hypersensitivity) and nonallergic (cytokine release) reactions.

IARs were more frequent during course 1 than during course 2 of treatment; IARs occurred in 84.7-96.3 percent of patients during course 1 compared with 68.6-81.9 percent of patients during course 2. In each treatment course, the greatest numbers of IARs occurred with the first infusion and decreased with each infusion thereafter.

Management of IARs

Nurses play an important role in the detection and management of IARs. Best practices for management of IARs associated with Lemtrada include patient and caregiver education, prophylactic medication—particularly corticosteroids, antihistamines, and antipyretics—to reduce IAR severity, infusion monitoring, and discharge planning.

Severe IARs can generally be managed by slowing the infusion rate or by temporarily stopping the infusion, allowing time for recovery of symptoms, and then restarting at a slower rate.

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Prevention of Infusion Reactions with Lemtrada

Does Vein Finder Technology Lead to Fewer Needle Sticks?

How does vein visualization technology work?

Several different companies produce devices designed to help find veins. A quick Google search shows that you can order your own device from Amazon or Ebay if you wanted to. There is even a DIY video on YouTube that teaches how to make your own device for under $50.

I’ve personally seen three different devices in action over the years. Each one worked in a similar fashion using LED infrared light. Hemoglobin in the blood absorbs infrared light; so when the device is held above the skin, veins appear in contrast to surrounding tissue (either darker or lighter depending). At least one company has taken the technology a step further and projects a digital image of the veins back onto the skin.

I have to say that even with vein visualization devices, nurses have to rely upon their skills, and a bit of faith, to access veins that simply cannot be seen by the naked eye or infrared light. These devices do not magically make the process simple. So often with me, the vein finder simply provided confirmation that there were indeed NOT sufficient veins in the area being searched.

One of my favorite moments was when someone pulled out a keychain with an infrared light on it to quickly peek under my skin. It wasn’t as powerful as the portable, handheld devices that are commercially available, but it did seem to work to find a few veins in a small area. I should have asked where he got the keychain; maybe it’s worth carrying something like that around in your purse just for those pesky IV/blood draw situations if you are a hard stick.

Have your healthcare professionals ever used a vein finder with you? Did it seem to help?

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Are Vein Finders the Answer to Fewer Needle Sticks?

Please, Let's Just Schedule Infusions at the Hospital

I wasn’t sure what to expect at the new office, but at least I knew that things shouldn’t change too much since the important relationship I already had was with my rheumatologist.  Of course, there was lots of paperwork to fill out and I brought a copy of my medical records which had been requested from the other medical center.  I realized that I would need to learn this office’s procedures, but it was a bit odd not recognizing any faces as I checked in.

When I did get back to see my rheumy, the visit went smoothly.  I didn’t really have many complaints which gave her the extra time to hound me about exercising more.  (I know that I need to do that for my own well-being, not just for my arthritis.)  We also talked about scheduling the next round of Rituxan infusions.

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Getting What You Need May Not Be So Simple When Your Doctor Moves Offices

Smart Nurses at the Infusion Center

I like “no drama,” really I do.  At the beginning of this month, I received my third round of Rituxan infusions.  I was really looking forward to treatment.

My wrists and fingers had begun flaring in January and weren’t letting up substantially.  My toes were tender and very “ouchy.”  And, I could no longer stretch my palms/fingers to reach an octave at the piano.  Now THAT was the final straw, what with rehearsals and performances coming up.

It was time for re-treatment.  The positive effect of the previous round of infusions from last summer were sustained for about eight months.  An improvement over the first round’s effectiveness of five months.  I’d be thrilled if this round lasted for one year.  How cool would that be?

Not only was I looking forward to treatment itself, I was anxious to try out a different hospital’s outpatient infusion center.  My experience at the previous location was rather negative and I basically refuse to go back there.  I had high hopes that this time would be different and go smooth as silk.


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What Does It Take to Feel "Cared For" by Medical Professionals?