PubMed Health⌕ Search

Biomedical subjects

T Jock Murray

Publications and source records attributed to T Jock Murray.

9 recordsLinked to original sources
PubMed2006

The cardiac effects of mitoxantrone: do the benefits in multiple sclerosis outweigh the risks?

Mitoxantrone, an immunosuppressant agent with potent anti-inflammatory activity, has been used to treat patients with multiple sclerosis (MS) who have worsening relapsing-remitting (RRMS) or secondary progressive multiple sclerosis (SPMS) despite prior therapy with interferons or glatiramer acetate. From previous experience of treating cancer with mitoxantrone, it was expected that cardiotoxic effects and occasional malignancy would develop in some patients treated with this agent. From the earliest trials, reduction of left ventricular ejection fraction (LVEF) was seen in 2-3% of cases, and in some this effect may persist and less commonly there can be congestive heart failure and even death. There are also occasional reports of leukaemia developing in MS patients treated with this agent. Mitoxantrone has been shown to reduce relapses, the number of new lesions visualised on magnetic resonance imaging and stop or reduce the progression of the disease in many patients treated. The drug has found a place in MS therapy because in this progressing group of MS patients who are failing on the disease-modifying therapies with interferons or glatiramer acetate, trials have shown that mitoxantrone may arrest or even improve many patients. Recognising the risks, mitoxantrone therapy is a reasonable option for MS patients with RRMS and SPMS who are progressing despite current disease-modifying therapy.

Disease Progression↗
PubMed2006

Complementary and alternative medicine for MS.

Neurologists are often uncertain how to view the many complementary and alternative medicine (CAM) approaches, used by their patients. This is an important issue, as studies show that 50-75% of MS patients use one or more CAM therapies, and see CAM therapists more than conventional physicians. Moreover, many MS patients do not tell their physicians what they are doing, especially if they feel the physician will be judgmental.

Complementary Therapies↗
PubMed2004

Strategies for managing the side effects of treatments for multiple sclerosis.

Disease-modifying therapies for multiple sclerosis (MS) are a mainstay of treatment. All of these agents are associated with side effects, most of which are easily managed with only minimal additional pharmacotherapy. Appropriate patient education and physician support are critical to achieve the best medical outcome and to maximize patient compliance with long-term therapies for this debilitating condition. Although many side effects subside shortly after initiation of treatment, such as flu-like symptoms with interferon treatment, some side effects are cumulative and can become life-threatening if they are unrecognized (e.g., cardiotoxicity with mitoxantrone). Therefore, physicians must be aware of appropriate laboratory monitoring schedules to prevent serious toxicities and to become familiar with less serious but more common side effects that often threaten patient compliance. Patients should be encouraged to communicate with their physicians so that side effects can be managed promptly. This article describes and provides management strategies for side effects associated with MS treatments.

Adrenal Cortex Hormones↗
PubMed2004

Timing of birth and risk of multiple sclerosis: population based study.

OBJECTIVES: To determine if risk of multiple sclerosis (MS) is associated with month of birth in countries in the northern hemisphere and if factors related to month of birth interact with genetic risk. DESIGN: Population based study with population and family based controls and a retrospective cohort identified from death certificates. A post hoc pooled analysis was carried out for large northern datasets including Sweden and Denmark. SETTING: 19 MS clinics in major cities across Canada (Canadian collaborative project on the genetic susceptibility to multiple sclerosis); incident cases of MS from a population based study in the Lothian and Border regions of Scotland; and death records from the UK Registrar General. POPULATIONS: 17,874 Canadian patients and 11,502 British patients with multiple sclerosis. MAIN OUTCOME MEASURE: Diagnosis of multiple sclerosis. RESULTS: In Canada (n = 17,874) significantly fewer patients with MS were born in November compared with controls from the population census and unaffected siblings. These observations were confirmed in a dataset of British patients (n = 11, 502), in which there was also an increase in the number of births in May. A pooled analysis of datasets from Canada, Great Britain, Denmark, and Sweden (n = 42,045) showed that significantly fewer (8.5%) people with MS were born in November and significantly more (9.1%) were born in May. For recent incident data, the effect of month of birth was most evident in Scotland, where MS prevalence is the highest. CONCLUSIONS: Month of birth and risk of MS are associated, more so in familial cases, implying interactions between genes and environment that are related to climate. Such interactions may act during gestation or shortly after birth in individuals born in the northern countries studied.

Canada↗
PubMed2004

A multicenter, open-label, phase II study of the immunogenicity and safety of a new prefilled syringe (liquid) formulation of Avonex in patients with multiple sclerosis.

BACKGROUND: A new liquid formulation of Avonex (interferon beta-1a [IFNbeta-1a]) in a prefilled syringe has been developed to make administration of the drug easier for patients with multiple sclerosis (MS). This formulation does not contain human serum albumin (HSA), often added to interferon (IFN) products for stabilization. However, formulation changes may alter the secondary, tertiary, and quaternary structures of IFNbeta products. These kinds of structural changes could lead to the formation of antibodies directed against IFNbeta. Some of these anti-IFN antibodies may neutralize the biologic activity of IFNbeta. OBJECTIVE: This study was designed to determine the immunogenicity and safety of the new prefilled syringe (liquid) HSA-free formulation of Avonex in patients with relapsing MS. METHODS: This was a multicenter, single-arm, open-label study. Patients with relapsing MS received liquid, HSA-free Avonex 30 microg by IM injection from a prefilled syringe once weekly for up to 24 months. Immunogenicity and safety were assessed every 3 months. Serum levels of neutralizing antibodies (NAbs) were measured at baseline and every 3 months using a 2-step enzyme-linked immunosorbent assay and antiviral cytopathic effect assay. RESULTS: A total of 153 patients (121 women, 32 men; mean [SD] age, 39.6 [9.9] years; age range, 19.0-59.0 years) were enrolled in the study. Sera were available for analysis from 125 and 119 patients after 18 and 24 months of treatment, respectively. By 18 months, 1 patient (1%) had > or =2 consecutive titers of > or =20, a level at which the persistent presence of NAbs has been shown in some studies to have clinical consequences. By 24 months, 1 additional patient (total 2%) had > or =2 consecutive titers of > or =20. At 18 months, 5 patients (4%) had > or =1 NAb titer of > or =5; at 24 months, 6 patients (5%) had > or =1 NAb titer of > or =5. The safety profile of liquid Avonex was comparable to the lyophilized form containing HSA. CONCLUSIONS: The prefilled syringe (liquid) HSA-free formulation of Avonex was well tolerated and showed a low level of immunogenicity. Over 24 months, 2% of patients developed persistent NAbs (> or =2 consecutive titers of > or =20).

Adjuvants, Immunologic↗
PubMed2004

Rationale and design of the prospective and retrospective observational study of Avonex and Rebif (PROOF) for the treatment of relapsing-remitting multiple sclerosis.

Previous studies comparing the two available interferon beta (IFNbeta)-1a products, Avonex and Rebif, for the treatment of relapsing-remitting multiple sclerosis (RRMS) have been limited and of short duration. Therefore, the Prospective and Retrospective Observational Study of Avonex and Rebif (PROOF) was designed to provide long-term (up to 5 years) comparative data on the efficacy, safety, and tolerability of these two agents. Patients with RRMS receiving treatment with either Avonex 30 microg intramuscularly once weekly or Rebif 44 microg subcutaneously three times weekly from 12 to 24 months are being enrolled and will continue their respective treatments for the 36-month duration of the study. The primary efficacy endpoint will be change in brain parenchymal fraction, which will be evaluated through magnetic resonance imaging scans by blinded radiologists. Secondary endpoints will include the following: relapse rates; intravenous steroid use; the proportion of patients with an increase of > or = 1 point on the Expanded Disability Status Scale (EDSS) and with an increase in EDSS score sustained for 6 months; mean change in EDSS score; cumulative number of new or enlarging T2 lesions; T2 and T1 lesion volumes; gadolinium-enhanced lesion number and volume; and safety and tolerability. The study design of PROOF will permit more meaningful conclusions regarding the optimal IFNbeta-1a product for the long-term treatment of patients with multiple sclerosis.

Adjuvants, Immunologic↗
PubMedDate not supplied

Samuel Johnson: his ills, his pills and his physician friends.

Samuel Johnson (1709-1784) was one of the greatest men of his age. Although famed for his writings, especially his Dictionary and his folio on Shakespeare, he is remembered for his tavern conversations, his literary clubs and the great biography of his life by Boswell. He always enjoyed having physicians as his friends, and took a great interest in all branches of medicine. He would advise and prescribe for friends who regularly consulted him, and he was not unhappy when mistaken for a physician. Particularly in his last years he had need of physicians for his own care, but held his own distinct views on whether to take their medicines and in what dose--usually much higher than prescribed. His many illnesses and his knowledge and views on medicine make him of continuing interest to physicians and give us insight into medical practice and beliefs in the Age of Enlightenment.

Famous Persons↗