Closed Thread
 
Thread Tools Display Modes
Old 12-19-2008, 06:40 PM #1
lady_express_44's Avatar
lady_express_44 lady_express_44 is offline
Grand Magnate
 
Join Date: Aug 2006
Location: Vancouver, Canada
Posts: 3,300
15 yr Member
lady_express_44 lady_express_44 is offline
Grand Magnate
lady_express_44's Avatar
 
Join Date: Aug 2006
Location: Vancouver, Canada
Posts: 3,300
15 yr Member
Default Another PML Case in Europe, and US PML Patient #6 Dies

For those who don't follow the Tysabri thread, RW announced the 7th patient with PML had been discovered in Europe:

Quote:
Originally Posted by Riverwild View Post
For those who have not yet heard, Biogen filed another 8K this morning about another case of PML. I don't have any confirmed details yet, and will post when I know more.

This is what I have from a neuro:
"I haven't heard anything more about the case than is on the 8K. This patient was monotherapy for 26 months and in the EU. This patient's PML is confirmed using accepted definitions of positive PCR in individual with consistent MRI and history. Clinical vigilance seems to have caught this one early as well. FWIW, the last time I got an update, patient 1 (Sweden) was doing well and at home, Patient 2 (Germany) was still in ICU but able to be extubated and able to communicate some (expect permanent sequelae), Patient 3 (US -Florida?) was discharged and doing well. Haven't yet heard what symptoms this patient had. "
Also, the 6th patient (or 3rd since the re-introduction of the drug), from the US, has died recently:

Quote:
Originally Posted by lady_express_44 View Post

UPDATE:Patient On Biogen, Elan MS Drug Dies Of Brain Disease

DOW JONES NEWSWIRES

By Thomas Gryta
Of DOW JONES NEWSWIRES

NEW YORK (Dow Jones)--A multiple sclerosis patient being treated with Tysabri, from Biogen Idec Inc. (BIIB) and Elan Plc (ELN), has died of a previously disclosed occurrence of a rare brain infection.

Biogen originally reported the confirmed case of progressive multifocal leukoencephalopathy, or PML, in late October. Tysabri, key to the future growth of both companies, is very effective in fighting MS, but a suspected link to PML led to its withdrawal from the market for 18 months beginning in 2005.

Patients on the drug are now closely monitored and four cases of the often fatal infection have occurred since its July 2006 relaunch, but the death may quell hope that PML could be a treatable side effect of the drug.

Shares of Biogen were recently down $1.15, or 2.4%, to $46.86, while Elan dropped 32 cents, or 5%, to $5.96.

The patient who died was the third case and the only one in the U.S. The other three are in Europe and remain alive.

A Biogen spokeswoman said that the company was informed earlier this week of the death and wouldn't disclose more information out of respect for the patient and her family.

The patient received 14 monthly infusions of Tysabri as a monotherapy and was previously treated with Teva Pharmaceuticals Industries Inc.'s (TEVA) Copaxone, Bayer AG's (BAY.XE) Betaseron and Biogen's Avonex. She also took methotrexate for a rheumatolgical condition.

All of the patients that developed PML were given plasmapharesis, a process that removes large molecules from the blood, speeding up Tysabri's removal and allowing the immune system to fight the PML infection.

When the drug is removed from the system, patients often experience an inflammatory response as the immune system reconstitutes itself, which can lead to their condition getting worse before any improvement is seen.

The death of the patient may temper arguments that the intricate distribution and monitoring program used for Tysabri, and use of plasmapharesis may ease the risk of PML for patients. Biogen has hoped that PML could eventually could be a "survivable adverse event."
But given the severity of PML, some believe that the death of a patient shouldn't be a surprise.

"We think the odds of surviving PML are still better than initially thought," said analyst Geoffrey Meacham of JPMorgan.

Tysabri's label implies that one in every 1,000 patients could get PML, but the actual number remain well below that ratio. As of Sept. 30, more than 35,500 patients use Tysabri, with 9,500 patients on it for at least 18 months and 3,700 for more than two years.

Steven Harr, an analyst with Morgan Stanley, writes that the recent death may demonstrate that Tysabri's risk is consistent with the label, to the disappointment of some investors and physicians that thought it might actually be lower.

-By Thomas Gryta, Dow Jones Newswires; 201-938-2053; thomas.gryta@dowjones.com

http://www.djnewsplus.com/article/DN...Brain+Disease+
The ratio of PML cases now appears to be 7:9500 (or 1:1357), for those who've been on it for 18+ months. Still slightly less than the 1:1000 they predicted.

Cherie
__________________
I am not a Neurologist, Physician, Nurse, or Hairdresser ... but I have learned that it is not such a great idea to give oneself a haircut after three margaritas
.
lady_express_44 is offline  
"Thanks for this!" says:
dmplaura (12-19-2008), Kitty (12-21-2008), McGimpy (12-28-2008), Twinkletoes (12-19-2008)
Old 12-19-2008, 06:59 PM #2
ewizabeth's Avatar
ewizabeth ewizabeth is offline
Elder
 
Join Date: Sep 2006
Location: northern Illinois
Posts: 5,258
15 yr Member
ewizabeth ewizabeth is offline
Elder
ewizabeth's Avatar
 
Join Date: Sep 2006
Location: northern Illinois
Posts: 5,258
15 yr Member
Default

Quote:
The ratio of PML cases now appears to be 7:9500 (or 1:1357), for those who've been on it for 18+ months. Still slightly less than the 1:1000 they predicted.
The thing is that most patients are not monitored closely enough, according to my neuro. He comes in and speaks with me every month. They're very careful at his office. Many patients don't see a doctor each month and that troubles him. It troubles me too because they need to watch for signs of PML looming. It shouldn't just be a cash grab for the doctors and centers infusing it.

I had my 21st infusion today and he gave me the news of the most recent death.
__________________
Wiz

Turn Left at the next election.
.


RRMS DX 01/28/03 Started Copaxone again on 12/09/09
ewizabeth is offline  
"Thanks for this!" says:
Kitty (12-21-2008), Twinkletoes (12-19-2008)
Old 12-19-2008, 07:45 PM #3
lady_express_44's Avatar
lady_express_44 lady_express_44 is offline
Grand Magnate
 
Join Date: Aug 2006
Location: Vancouver, Canada
Posts: 3,300
15 yr Member
lady_express_44 lady_express_44 is offline
Grand Magnate
lady_express_44's Avatar
 
Join Date: Aug 2006
Location: Vancouver, Canada
Posts: 3,300
15 yr Member
Default

Quote:
Originally Posted by ewizabeth View Post
The thing is that most patients are not monitored closely enough, according to my neuro. He comes in and speaks with me every month. They're very careful at his office. Many patients don't see a doctor each month and that troubles him. It troubles me too because they need to watch for signs of PML looming. It shouldn't just be a cash grab for the doctors and centers infusing it.

I had my 21st infusion today and he gave me the news of the most recent death.
It is clearly still a better risk than they predicted, at least so far, so I don't see why this news would scare people into a different decision.

And I agree that people are probably being watched like hawks, especially as the number of cases increases. The ratio of 1:1000 was predicted for over 18 months of use, and we are getting to the point where there are a fair number who are reaching that timeline now . . . so no doubt the doctors will be more vigilant and/or hyper-sensitive to any news that comes out over the next 6 -12 months.

Originally it was thought that this Florida woman was sent home and doing ok, but then she dies! To date no one has died post-marketing, so I think they hoped that that wasn't going to happen if it was caught quickly enough under TOUCH safety protocol.

There are only 9500 who've been on it long enough (and a large % of those were in the trials), and who've come down with PML . . . so I don't think they claim to have any clear patterns emerging. At this point it seems to be luck of the draw whether we will get PML, and/or whether we will live through it.

But, like I said, everyone on it already accepts that risk.

Cherie
__________________
I am not a Neurologist, Physician, Nurse, or Hairdresser ... but I have learned that it is not such a great idea to give oneself a haircut after three margaritas
.
lady_express_44 is offline  
"Thanks for this!" says:
ewizabeth (12-19-2008), Kitty (12-21-2008), SallyC (12-19-2008)
Old 12-19-2008, 09:26 PM #4
dmplaura's Avatar
dmplaura dmplaura is offline
Magnate
 
Join Date: Jul 2008
Location: Moncton, NB, Canada
Posts: 2,195
15 yr Member
dmplaura dmplaura is offline
Magnate
dmplaura's Avatar
 
Join Date: Jul 2008
Location: Moncton, NB, Canada
Posts: 2,195
15 yr Member
Default

"Biogen has hoped that PML could eventually could be a "survivable adverse event." "

^^ This line REALLY bothered me from the article. 'Adverse event'? You kidding me? It's almost like they're downplaying the severity of PML... at least that's what I took home from their choice of words.
__________________
2004 to present - Trigeminal Neuralgia
2007 to present - Burning Mouth Syndrome
March 2008 - Multiple Sclerosis DX
05/2008 - Relapse
05/2008 to 02/2009 - Copaxone
10/2011 - Relapse - Optic Neuritis developed
9/2012 - Relapse - Balance issues 1 sided
8/2012 - Erythema Nodosum - diagnosed 10/2012, reaction to Topiramate (Topamax)
April 7/14 - Raynaud's Syndrome DX
dmplaura is offline  
"Thanks for this!" says:
Kitty (12-21-2008), SallyC (12-19-2008)
Old 12-19-2008, 09:59 PM #5
marcstck's Avatar
marcstck marcstck is offline
Junior Member
 
Join Date: Sep 2006
Location: NYC
Posts: 65
15 yr Member
marcstck marcstck is offline
Junior Member
marcstck's Avatar
 
Join Date: Sep 2006
Location: NYC
Posts: 65
15 yr Member
Default

My neuro insists that all of his patients on Tysabri undergo a spinal fluid analysis every six months, in an attempt to detect activated JC virus.

He's pulled a number of patients off of the drug who have come up positive for the activated virus but had not yet developed PML.

I'm on Rituxan, another drug associated with PML. I should be scheduled to have a spinal tap for spinal fluid analysis purposes sometime in the next few weeks...
marcstck is offline  
"Thanks for this!" says:
4boysmom (12-23-2008), dmplaura (12-19-2008), ewizabeth (12-19-2008), Kitty (12-21-2008), Lady (12-19-2008), Natalie8 (12-19-2008), SallyC (12-19-2008)
Old 12-20-2008, 04:12 PM #6
Harry Z Harry Z is offline
Member
 
Join Date: Sep 2006
Location: London, Canada
Posts: 241
15 yr Member
Harry Z Harry Z is offline
Member
 
Join Date: Sep 2006
Location: London, Canada
Posts: 241
15 yr Member
Default

Quote:
He's pulled a number of patients off of the drug who have come up positive for the activated virus but had not yet developed PML.
While this doc should be commended for following his patients so closely we know that he would be in the minority at this level of concern. What is disturbing is the fact that he has stopped givng Tysabri to several of his patients who are showing activated levels of the virus. You start to wonder how many other patients may be in this category and don't know it!

Harry
Harry Z is offline  
"Thanks for this!" says:
CayoKay (12-27-2008), Kitty (12-21-2008)
Old 12-19-2008, 10:14 PM #7
ewizabeth's Avatar
ewizabeth ewizabeth is offline
Elder
 
Join Date: Sep 2006
Location: northern Illinois
Posts: 5,258
15 yr Member
ewizabeth ewizabeth is offline
Elder
ewizabeth's Avatar
 
Join Date: Sep 2006
Location: northern Illinois
Posts: 5,258
15 yr Member
Default

Quote:
Originally Posted by dmplaura View Post
"Biogen has hoped that PML could eventually could be a "survivable adverse event." "

^^ This line REALLY bothered me from the article. 'Adverse event'? You kidding me? It's almost like they're downplaying the severity of PML... at least that's what I took home from their choice of words.

Apparently it is "survivable" if you have HIV or AIDS but not in this situation? (I remember reading that somewhere I think or my neuro told me.)

It isn't really something you recover from, not like you can go back to any semblance of your life before PML in these cases, if you happen to survive.
__________________
Wiz

Turn Left at the next election.
.


RRMS DX 01/28/03 Started Copaxone again on 12/09/09
ewizabeth is offline  
"Thanks for this!" says:
Kitty (12-21-2008), SallyC (12-19-2008)
Old 12-19-2008, 11:19 PM #8
lady_express_44's Avatar
lady_express_44 lady_express_44 is offline
Grand Magnate
 
Join Date: Aug 2006
Location: Vancouver, Canada
Posts: 3,300
15 yr Member
lady_express_44 lady_express_44 is offline
Grand Magnate
lady_express_44's Avatar
 
Join Date: Aug 2006
Location: Vancouver, Canada
Posts: 3,300
15 yr Member
Default

"Survivable adverse event" doesn't sound as tuned out as "treatable side-effect" . . .

"Patients on the drug are now closely monitored and four cases of the often fatal infection have occurred since its July 2006 relaunch, but the death may quell hope that PML could be a treatable side effect of the drug."

Like Wiz said, it's not like a person has a chance of EVER recovering from the damage that PML causes . . .

Cherie
__________________
I am not a Neurologist, Physician, Nurse, or Hairdresser ... but I have learned that it is not such a great idea to give oneself a haircut after three margaritas
.
lady_express_44 is offline  
"Thanks for this!" says:
CayoKay (12-27-2008), Kitty (12-21-2008)
Old 12-28-2008, 07:37 AM #9
komokazi komokazi is offline
Member
 
Join Date: Dec 2008
Posts: 192
15 yr Member
komokazi komokazi is offline
Member
 
Join Date: Dec 2008
Posts: 192
15 yr Member
Default stats

Your PML stats are wrong. Check page 14 of this link:

//library.corporate-ir.net/library/14/148/148682/items/278364/Q4-07%20Earnings%20Slides.pdf

The safety information lists 0 (zero) patients at 1 year of therapy until Dec 2007. The reference to trials does not include the trials for approval but the trials that were started upon Tysabri reintroduction.

You are also misinformed about the us TOUCH program. Part of the program is the screening for putting the proper patients on the drug. The more important part is the monthly pre-infusion checklist to monitor for any new or worsening symptoms. Let's see PML in 1 out of 19500 Tysabri patients in the US (with TOUCH) while there's been PML in 3 out of 16000 Tysabri patients in Europe. Seems like TOUCH could be making a difference.

Clearly you think you know and are correct about everything regarding Tysabri so there isn't much point in discussing this further.

Chris

Last edited by Chemar; 12-28-2008 at 11:07 AM. Reason: nt guidelines
komokazi is offline  
Old 12-28-2008, 10:23 PM #10
lady_express_44's Avatar
lady_express_44 lady_express_44 is offline
Grand Magnate
 
Join Date: Aug 2006
Location: Vancouver, Canada
Posts: 3,300
15 yr Member
lady_express_44 lady_express_44 is offline
Grand Magnate
lady_express_44's Avatar
 
Join Date: Aug 2006
Location: Vancouver, Canada
Posts: 3,300
15 yr Member
Default

Quote:
Originally Posted by komokazi View Post
Your PML stats are wrong. Check page 14 of this link:

//library.corporate-ir.net/library/14/148/148682/items/278364/Q4-07%20Earnings%20Slides.pdf
As per your link:

Quote:
Safety as of December 2007
Mid December: TYSABRI exposure in the clinical trial and post-marketing settings
• ~30,900 patients ever exposed
• ~6,300 patients exposed for at least one year
Late December: No new cases of PML since re-launch in US and launch Internationally in July 2006.
Do you see where they are referring to “ever exposed”, “in the clinical trial and post-marketing settings”, and “Cumulative total patient exposure”? They are talking about ALL persons who’ve EVER tried Tysabri, including those from the clinical trials.

As per my link (below), as at June/08 the numbers were:

Quote:
“As of the end of June 2008, more than 31,800 patients were receiving natalizumab. Specific to the TOUCH Prescribing Program, 21,099 patients were enrolled and had received natalizumab through the TOUCH program at the end of June 2008."

"Patients enrolled in the TOUCH program have received a median of 8 infusions (range: 1-28), with 7,538 patients receiving natalizumab for at least 1 year and 3,304 patients receiving the agent for at least 18 months.
The following paragraph refers to the "cummulative" numbers, just as your link did.

Quote:
"As of June 2008, approximately 43,300 patients have been exposed to natalizumab in clinical study and postmarketing settings combined, with approximately 13,900 patients with at least 1 year of natalizumab exposure and approximately 6,600 patients with at least 18 months' exposure."
The 3,304 patients are those that were enrolled in TOUCH (in June/08), and had recieved Tysabri for 18+ months. The 6600 number is how many have taken it for that long in total, cumulatively, including all the trials.

Therefore, the 6600 number (which is now 9500, or at least last we heard in Dec), includes the 3000 (or there-abouts) from the trials, just as the "announced" number in June/08 did.

There is additional info on the international participants (at that point in time) in this link:

http://www.neura.net/channels/1.asp?id=942

Chemar has asked that we don’t argue about this any more, and I will respect that. If you wish to debate your understanding of the numbers vs. what I have just provided . . . we can talk about this further by PM (or email, if you don’t have PM rights yet), I am happy to do that. Perhaps we can come to an agreement that way, then report back here ...?

Cherie
__________________
I am not a Neurologist, Physician, Nurse, or Hairdresser ... but I have learned that it is not such a great idea to give oneself a haircut after three margaritas
.
lady_express_44 is offline  
Closed Thread


Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Patient dies on floor braingonebad Social Chat 12 07-07-2008 06:17 AM
Heart stem cell patient dies and MS woman wants refund. wannabe Multiple Sclerosis 0 09-01-2006 12:11 PM


All times are GMT -5. The time now is 06:31 PM.


Powered by vBulletin • Copyright ©2000 - 2025, Jelsoft Enterprises Ltd.

vBulletin Optimisation provided by vB Optimise (Lite) - vBulletin Mods & Addons Copyright © 2025 DragonByte Technologies Ltd.
 

NeuroTalk Forums

Helping support those with neurological and related conditions.

 

The material on this site is for informational purposes only,
and is not a substitute for medical advice, diagnosis or treatment
provided by a qualified health care provider.


Always consult your doctor before trying anything you read here.