Program Overview
While current disease modifying therapies in multiple sclerosis are effective, many patients experience breakthrough and relapses while on treatment. As newer therapeutics utilizing selective adhesion molecule (SAM) inhibition for multiple sclerosis (MS) enter clinical trials and approach approval, physicians and health care professionals need to understand the basic science regarding these new therapeutic agents and their mechanisms of action. This multimedia course reviews current treatment needs in multiple sclerosis management and possible improvements via selective adhesion molecule (SAM) inhibition. Basic science behind current SAM inhibitors is presented, providing healthcare professionals a chance to familiarize themselves with this emerging area of therapeutics.

Target Audience
This program has been developed for neurologists, nurses, pharmacists and other healthcare professionals involved in the management and treatment of patients with MS. There are no prerequisites for this program.

Educational Objectives
To be able to apply the understanding of basic science mechanisms by which new selective adhesion molecules (SAM) inhibitors work to the appropriate selection of newer therapies for patients with MS as they become available.

At the conclusion of this activity, participants should be better able to:

• Understand the underlying pathology of MS, including causes that are amenable to therapeutic intervention
• Evaluate the role of impending therapies targeting SAM inhibition
• Evaluate the role of α4 integrins as therapeutic targets in MS
• Elaborate upon the broad range of newer therapeutics for MS utilizing SAM inhibition

Disclaimer
The opinions and recommendations expressed by faculty and other experts, whose input is included in this program, are their own. This enduring material is produced for educational purposes only. Uses of the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing names imply review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

CME/CE Information

Accreditation

Physicians: The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Nurses: The Institute for Johns Hopkins Nursing is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center Commission on Accreditation.

Pharmacists: The University of Tennessee College of Pharmacy (UTCOP) is approved by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmaceutical education.

Credit Designation
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The Institute for Johns Hopkins Nursing designates this activity for a maximum of 2.4 contact hours. Claim only those contact hours actually spent in the activity.

This program is approved for 2 hours credit (0.2 CEUs) and is co-sponsored with the University of Tennessee College of Pharmacy, which is approved by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmaceutical education. Program #: 064-999-04-256-H01

Grievance Policy
A participant, sponsor, faculty member or other individual wanting to file a grievance with respect to any aspect of a program sponsored or co-sponsored by the UTCOP may contact the Associate Dean for Continuing Education in writing. The grievance will be reviewed and a response will be returned within 45 days of receiving the written statement. If not satisfied, an appeal to the Dean of the College of Pharmacy can be made for a second level of review.

Date of Release and Expiration
This course was released on August 13, 2004 and will expire on August 13, 2005. Credit cannot be awarded after this date. Estimated Time to Complete This Educational Activity: 2 hours.

Statement of Responsibility
The Johns Hopkins University School of Medicine, The Institute for Johns Hopkins Nursing, and The University of Tennessee College of Pharmacy take responsibility for the content, quality and scientific integrity of this CME/CE activity.

Privacy Statement
The Johns Hopkins University School of Medicine (JHUSOM) and The Institute for Johns Hopkins Nursing (IJHN) are committed to protect the privacy of our participants. We maintain our internet site as an information resource and service for health professionals. The Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing will keep your personal information confidential when you participate in an internet based program. Your information will never be given to anyone outside of the JHUSOM and IJHN continuing education programs. The Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing collect only the information necessary to provide you with the services that you request.

Faculty

Peter Calabresi, MD (Program Co-Chair)
Associate Professor of Neurology
Johns Hopkins University School of Medicine
Director
Johns Hopkins Multiple Sclerosis (MS) Center

Dr. Calabresi is an associate professor of neurology and director of the Johns Hopkins Multiple Sclerosis (MS) Center. He specializes in the diagnosis and management of multiple sclerosis. As director of the MS clinic, Dr. Calabresi is the principal investigator on several clinical trials and also oversees translational laboratory research projects. Dr. Calabresi has designed and directed several clinical trials investigating combination drug therapies in MS. He is on the advisory board for 3 national multi-center clinical trials. Dr. Calabresi's specific laboratory research interest lies in understanding the mechanisms of T lymphocyte migration into the brain and spinal cord. He has published numerous articles on the adhesion molecules and chemokine receptors responsible for T cell homing to the brain in MS. He recently reported on a novel potassium channel, Kv1.3, which is specifically and highly expressed on chronically activated immune cells in the blood and brains of people with MS. The availability of Kv1.3 blocking drugs makes this an attractive future therapeutic target in MS. Dr. Calabresi was also recently awarded a 5-year collaborative MS center grant from the National Multiple Sclerosis Society to study mechanisms of neurodegeneration and strategies for neuroprotection in MS.

J. Theodore Phillips, MD, PhD (Program Co-Chair)
Clinical Associate Professor of Neurology
University of Texas Southwestern Medical Center

J. Theodore Phillips, MD, is the director of the Multiple Sclerosis Center at Texas Neurology in Dallas. He serves as a clinical associate professor of neurology at the University of Texas Southwestern Medical Center and as an attending neurologist at Baylor University Medical Center in Dallas.

Dr. Phillips is a graduate of the University of Texas at Austin with special honors in chemistry, and received his MD and his PhD in immunology, and neurology residency training from the University of Texas Southwestern Medical Center at Dallas.

He is a principal developer of a national registry for MS (MSTRAC) and is a principal investigator in several ongoing clinical treatment trials in MS.

Richard Rudick, MD
Director
Mellen Center for Multiple Sclerosis Treatment and Research
Cleveland Clinic Foundation

Richard A. Rudick, MD, is currently the director of the Mellen Center for Multiple Sclerosis Treatment and Research, the Hazel Prior Hostetler Professor of Neurology at the Cleveland Clinic Foundation in Ohio and chairman of the division of clinical research at the Cleveland Clinic Foundation. Dr. Rudick graduated from Case Western Reserve University School of Medicine in 1975. Following internship and residency in medicine at the University of Connecticut School of Medicine, Dr. Rudick trained in neurology at the University of Rochester. During a post-doctoral research fellowship in the Center for Brain Research at the University of Rochester, studies focused on neurologic consequences of immune complex disease in animal systems and immunologic abnormalities in MS patients. Dr. Rudick conducted studies of CSF abnormalities in MS patients in Rochester with support from an NIH clinical investigator career development award. In 1987, Dr. Rudick became medical director of the Mellen Center, and director of center in 1989. He has played key roles in several MS clinical trials, including a pivotal NIH-supported registration trial of IFNß-1a for relapsing-remitting MS. He has continued studies on immunologic changes in MS patients, led development of new clinical and imaging measures for MS trials, and maintains a consultative clinical practice at the Mellen Center.

As chairman of the division of clinical research, Dr. Rudick is responsible for institutional policies and procedures related to human subjects research, infrastructural academic and core facilities that support clinical research, and clinical investigator training and development.

Faculty Disclosures

Full Disclosure Policy Affecting CME/CE Activities
As sponsors accredited by the Accreditation Council for Continuing Medical Education and American Nursing Credentialing Center, it is the policy of the Johns Hopkins University School of Medicine and the Institute of Johns Hopkins Nursing to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an education presentation. This is also the policy of the University of Tennessee College of Pharmacy. The presenting faculty reported the following:

Dr. Peter Calabresi has received grant and research support and served as a consultant with Biogen Idec, Berlex Inc., Teva Neuroscience Inc. and Serono Inc.

Dr. Theodore Phillips has received grant and research support from Biogen Idec, Centocor, Neurocrine Biosciences and NIH Immune Tolerance Network (ITN). Dr. Phillips has also received consulting fees from Ilex Oncology, Inc.

Dr. Richard Rudick has no relationships to disclose.

Off-Label Discussion

NOTICE: In accordance with the ACCME Standards for Commercial Support,
the audience is advised that one or more presentations in this
continuing medical education activity does contain references to
unlabeled or unapproved uses of drugs or devices.

The following faculty members have disclosed that their presentation
will reference unlabelled/unapproved use of drugs or products:

Peter Calabresi, MD
J. Theodore Phillips, Jr., MD, PhD
Richard Rudick, MD

Natalizumab, Lenercept, Infliximab, Enbrel, Interleukin-10, Interleukin-4, TGF-beta 1 and 2, Roquinimex (linomide), Cladribine, Oral myelin, T-cell receptor peptides, Zenapax (daclizumab), CamPath (anti-CD52) , statins, altered peptide ligands, Rituximab (anti-CD20), Alefacept (Amevive), azathioprine, CellCept (mycophenolate mofetil), methotrexate, methylprednisolone, combination (Interferon b-1a, Methotrexate and IV Methylprednisolone), combination (Interferon b-1a and IV Methylprednisolone), combination (Interferon b-1a and Methotrexate), combination (Interferon b-1a and Glatiramer Acetate)

This educational program is supported through an educational grant from Biogen Idec and Elan Pharmaceuticals.

Copyright 2004, The Johns Hopkins University School of Medicine and The University of Tennessee College of Pharmacy. All rights reserved.