A journey from the past to the future of multiple sclerosis

Transcription

1 REGIONAL WORKSHOP FINAL PROGRAMME A journey from the past to the future of multiple sclerosis São Paulo, Brazil - Tuesday, 22 August 2017 This live educational and scientific workshop is jointly developed by TOPEC Global and EXCEMED Foundation.

2

3 GENERAL INFORMATION GENERAL INFO

4 A JOURNEY FROM THE PAST TO THE FUTURE OF MULTIPLE SCLEROSIS OVERVIEW The clinical journey of multiple sclerosis is moving forward thanks to new immunological discoveries, technological innovation, as well as improvements in diagnosis and treatment. However, experience demonstrates that accurate evaluation of prognostic factors, early treatment, appropriate switching strategies and adherence to treatment guarantee disability prevention on long-term observation. These crucial elements have led to changes in the characteristics of MS populations with patients presenting less severe inflammation and disability. This workshop will retrace the steps of the MS journey, giving an overview of the immunological insights, treatment options and goals from the past to the future. The workshop includes a working group session in which experts will discuss clinical cases with participants. LEARNING OBJECTIVES By attending this live educational workshop, participants will be able to: Illustrate the key immunological mechanisms underpinning MS Understand the differences between maintenance therapies and emerging treatments that allow long treatment-free periods Describe the risk/benefit profile of prolonged treatment Illustrate how to manage treatment switches in clinical practice TARGET AUDIENCE Neurologists in Latin America involved in MS management. CHAIRS Óscar Fernández Neuroscience Institute Service of Neurology University Regional Hospital Carlos Haya Málaga, Spain Maria Regina Papais Alvarenga Hospital da Lagoa University of Rio de Janeiro (UNIRIO) Rio de Janeiro, Brazil 2

5 CME PROVIDERS TOPEC Global Bruder-Klausen - Weg Sachseln, Switzerland EXCEMED - Excellence in Medical Education 14, Rue du Rhône 1204 Geneva, Switzerland ACCREDITATION This workshop is accredited by the European Accreditation Council for Continuing Medical Education (EACCME ). The EACCME is an institution of the European Union of Medical Specialists (UEMS), The CME workshop A journey from the past to the future of multiple sclerosis held on 22 August 2017 in São Paulo, Brazil, is designated for a maximum of 6 (six) hours of European CME credits (ECMEC). Each medical specialist should claim only those credits that he/she actually spent in the educational activity. EACCME credits are recognized by the American Medical Association (AMA) towards the Physician's Recognition Award (PRA). To convert EACCME credit to AMA PRA category 1 credit, please contact the AMA. ACKNOWLEDGEMENTS This programme is supported by independent educational grants received from Merck KGaA, Darmstadt, Germany and San Raffaele Hospital, Milan, Italy. This programme has been endorsed by LACTRIMS and BCTRIMS. 3

6 VENUE This live educational workshop takes place at: Hilton Sao Paulo Morumbi Av. das Nações Unidas, Brooklin Paulista São Paulo, Brazil LANGUAGE The official language of this live educational workshop is English. Simultaneous translation to and from Spanish and Portuguese is provided. SCIENTIFIC ORGANIZING SECRETARIAT EXCEMED - Excellence in Medical Education Senior Programme Manager: Alessia Addessi T F alessia.addessi@excemed.org Medical Advisor: Doriana Landi doriana.landi@gmail.com For any logistic inquiry, please contact: Meridiano Congress International Event Management Team Leader: Sara Guglielmini T F sara.guglielmini@meridiano.it 4

7 FACULTY FACULTY

8 FACULTY Jefferson Becker President of BCTRIMS Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Porto Alegre, Brazil Giancarlo Comi Department of Neurology Institute of Experimental Neurology Vita-Salute San Raffaele University Milan, Italy Jorge Correale Department of Neurology Raul Carrea Institute for Neurological Research FLENI Buenos Aires, Argentina Alfredo Damasceno Neurology Department University of Campinas Campinas, Brazil Xavier Montalban Neurology-Neuroimmunology Department Multiple Sclerosis Centre of Catalonia (Cemcat) Vall d Hebron University Hospital Barcelona, Spain Carlos Navas Demyelinating Disease Unit and Multiple Sclerosis Clinic University Hospital of Colombia Bogotà, Colombia Maria Regina Papais Alvarenga Hospital da Lagoa University of Rio de Janeiro (UNIRIO) Rio de Janeiro, Brazil Antonio Pereira Gomes Neto São José University Hospital Santa Casa de Belo Horizonte Belo Horizonte, Brazil Óscar Fernández Neuroscience Institute Service of Neurology University Regional Hospital Carlos Haya Málaga, Spain José Flores Rivera Universidad Nacional Autónoma de México (UNAM) Mexico City, Mexico Yara Dadalti Fragoso NIMES Universidade Metropolitana de Santos São Paulo, Brazil 6

9 PROGRAMME PROGRAMME

10 Tuesday, 22 August Welcome and introduction G. Comi (Italy) Local welcome J. Becker (Brazil) SESSION I OLD AND NEW IMMUNOLOGICAL INSIGHTS INTO MS Chairs: Ó. Fernández (Spain) and M.R. Papais Alvarenga (Brazil) L1: Peripheral and central deregulation of the immune system in RRMS and PMS J. Correale (Argentina) L2: Maintenance therapies in RRMS: mechanisms of action, rationale and evidence M.R. Papais Alvarenga (Brazil) L3: The emerging concept of long-term remission in MS: mechanisms of action, rationale and evidence of new treatments with infrequent dosing Ó. Fernández (Spain) L4: Treatment of progressive MS: why, who, when, how G. Comi (Italy) Q&A Coffee break SESSION II OLD AND NEW RISKS OF TREATING MS Chairs: Ó. Fernández (Spain) and M.R. Papais Alvarenga (Brazil) L5: Risks of maintenance therapies: short and long-term observation J. Flores (Mexico) L6: Risks of treatments with infrequent dosing: short and long-term observations X. Montalban (Spain) L7: Burden of monitoring old and new treatments and long-term adherence to monitoring plan A. Pereira Gomes Neto (Brazil) Q&A Lunch Legend: L : Lecture : Question & Answer W : Working groups 8

11 SESSION III WORKING GROUPS H Chairs: Ó. Fernández (Spain) and M.R. Papais Alvarenga (Brazil) This session includes parallel working groups, each lasting 1 hour. Participants will be divided into groups and will attend both in rotation. Red group Yellow group Treatment switching: when and what G. Comi (Italy) and Y.D. Fragoso (Brazil) MRI monitoring: efficacy and safety A. Damasceno (Brazil) and X. Montalban (Spain) MRI monitoring: efficacy and safety A. Damasceno (Brazil) and X. Montalban (Spain) Treatment switching: when and what G. Comi (Italy) and Y.D. Fragoso (Brazil) Coffee break SESSION IV OLD AND NEW MS PATIENT POPULATIONS AND TREATMENT GOALS Chairs: Ó. Fernández (Spain) and M.R. Papais Alvarenga (Brazil) L8: Old and new populations: clinical trials and treatment goals Y.D. Fragoso (Brazil) L9: Guidelines for MS treatment in Brazil and the rest of the world J. Becker (Brazil) L10: Patients and doctors: past and future unmet needs in MS C. Navas (Colombia) Q&A Wrap up End of the workshop 9

12 FACULTY DISCLOSURES TOPEC Global and EXCEMED adhere to guidelines of the European Accreditation Council for Continuing Medical Education (EACCME ) and all other professional organizations, as applicable, which state that programmes awarding continuing education credits must be balanced, independent, objective and scientifically rigorous. Investigative and other uses for pharmaceutical agents, medical devices and other products (other than those uses indicated in approved product labeling/package insert for the product) may be presented in the programme (which may reflect clinical experience, the professional literature or other clinical sources known to the presenter). We ask all presenters to provide participants with information about relationships with pharmaceutical or medical equipment companies that may have relevance to their lectures. This policy is not intended to exclude faculty who have relationships with such companies; it is only intended to inform participants of any potential conflicts so that participants may form their own judgements, based on full disclosure of the facts. Further, all opinions and recommendations presented during the programme and all programme-related materials neither imply an endorsement nor a recommendation on the part of the CME providers. All presentations represent solely the independent views of the presenters/authors. The following faculty provided information regarding significant commercial relationships and/or discussions of investigational or non-emea/fda approved (off-label) uses of drugs: Jefferson Becker Declared receipt of grants and contract from Novartis and Teva. He declared receipt of honoraria or consultation fees from Biogen, Roche, Sanofi, Genzyme. He declared also to be member of a company advisory board, board of directors or other similar groups: Biogen, Merck, Roche, Sanofi and Genzyme. Giancarlo Comi Declared receipt of honoraria or consultation fees from Novartis, Teva, Sanofi, Genzyme, Merck, Biogen, Roche, Almirall, Receptos, Celgene, Forward Pharma, Medday. Jorge Correale Declared receipt of grants and contracts from Novartis, Biogen and Merck and honoraria or consultation fees from Novartis, Biogen, Merck and Genzyme. He declared also to be member of a company advisory board, board of directors or other similar groups: Novartis, Genzyme, Merck and Roche. Alfredo Damasceno Declared to be member of a company advisory board, board of directors or other similar groups: Sanofi, Genzyme. Óscar Fernández Declared no potential conflicts of interests. José Flores Rivera Declared receipt of honoraria and consultation fees from Sanofi, Genzyme, Biogen Idec. 10

13 Yara Dadalti Fragoso Declared receipt of honoraria and consultation fees from Genzyme, Roche, Teva, Novartis. She is member of a company advisory board, board of directors or other similar groups: Sanofi, Genzyme. Xavier Montalban Declared receipt of honoraria and consultation fees from: Almirall, Bayer, Biogen, Genzyme, Merck, Novartis, Receptos, Roche, Sanofi Genzyme, Teva. Carlos Navas Declared receipt of grants and contracts from Merck and honoraria and consultation fees from Merck, Roche, Stendhal, Sanofi, Novartis. He declared also to be a member of a company advisory board, board of directors and other similar groups: Merck, Roche, Sanofi. Antonio Pereira Gomes Neto Declared to be member of a company advisory board, board of directors or other similar groups: Merck, Genzyme. Maria Regina Papais Alvarenga Declared no potential conflicts of interests. 11

14

15 BIOGRAPHIES BIOGRAPHIES

16 Jefferson Becker President of BCTRIMS Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) Porto Alegre, Brazil Jefferson Becker graduated in Medicine from the Federal University of Rio Grande do Sul (UFRGS) in 1994 and completed a specialism in Neurology at the São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul (PUCRS), from 1995 to 1997, in Porto Alegre, Brazil. He subsequently undertook a Fellowship in Neurology at the National Hospital for Neurology and Neurosurgery, in London, UK, between 1998 and 1999, before completing an MSc and PhD in Neurosciences at PUCRS, in 2002 and 2005, respectively. He is currently an Assistant Professor of Neurology and Internal Medicine at PUCRS. Prof. Becker is the current President of the Brazilian Committee for Treatment and Research in Multiple Sclerosis (BCTRIMS) and is a member of the Scientific Committee in Neuroimmunology of the Brazilian Academy of Neurology. His main research interests focus are on Demyelinating Diseases and Neuromuscular Disorders. 14

17 Giancarlo Comi Department of Neurology Institute of Experimental Neurology Vita-Salute San Raffaele University Milan, Italy Giancarlo Comi is Professor of Neurology, Chairman of the Department of Neurology and Director of the Institute of Experimental Neurology at the Vita-Salute San Raffaele University, Milan. He is also the President of the European Charcot Foundation (ECF), member of the Board of Administration of the Italian Multiple Sclerosis (MS) Foundation and the Scientific Committee of Associazione Italiana Sclerosi Multipla and Co-chair of the Scientific Steering Committee of the Progressive MS Alliance. He joined the Department of Neurology, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, as a Clinical Assistant in 1974 and was appointed Assistant Professor in Clinical Neurophysiology in Professor Comi has served as President of the European Neurology Society, the Italian Society of Clinical Neurophysiology and the Italian Society of Neurology. In 2015 Prof. Comi has obtained, as the first Italian, the Charcot Award for MS research by the MS International Federation (MSIF) and also granted both honorary membership of the European Neurological Society (ENS) and fellow of the European Academy of Neurology (FEAN). Recently he has been awarded the Gold medal of Benemeranza Civica from the City of Milan. 15

18 Jorge Correale Department of Neurology Raul Carrea Institute for Neurological Research FLENI Buenos Aires, Argentina Jorge Correale, M.D., graduated with honors from Buenos Aires University School of Medicine in Between 1983 and 1988 he completed his Neurology Residency training at the José María Ramos Mejía Hospital in Buenos Aires and was appointed Chief Resident. During 1989 he was visiting physician at the Department of Neuropathology at the same center. Dr. Correale continued his training as Fellow in Neuroimmunology at the Karolinska Institute in Stockholm, Sweden between 1989 and In 1990 he moved to the United States where he completed a second fellowship between 1990 and 1993 in Neuroimmunology at the University of Southern California, receiving a postgraduate fellowship from the National MS Society of New York. In 1993 he was appointed Assistant Professor of Neurology at the University of Southern of California, and in 1995 Assistant Professor of Microbiology and Molecular Immunology. In 1997 Dr. Correale returned to Buenos Aires as Head of Neuroimmunology and Demyelinataing Diseases at the Institute for Neurological Research Dr. Raúl Carrea, position he holds to this day. Between 1999 and 2001 Dr. Correale was Head of the Department of Neurology at the same Institution. Between 1998 and 2010 he was Associate Professor at the Austral University in Buenos Aires where he teaches: Clinical Neurophysiology, Pain Physiopathology and Treatment, and Neurology. He is past Vicepresidente and President of the Argentine Neurological Society ( ), and President of LACTRIMS ( ), actual member of the Argentine Medical Advisory Board for Multiple Sclerosis, member of the Medical and Scientific Board of the International Federation of Multiple Sclerosis Societies (IFMSS), member of the International Advisory Board of the International Society of Neuroimmunology (ISNI). Dr. Correale is author of more than 150 papers published in Neurology and Immunology peer-review journals, and author of 47 chapters in books on MS and Neuroimmunology. 16

19 Alfredo Damasceno Neurology Department University of Campinas Campinas, Brazil Alfredo Damasceno, MD, PhD was born in Eskilstuna, Sweden and lives in the city of Campinas, Brazil. He is a Neurologist and Collaborator at the Multiple Sclerosis (MS) Center of the University of Campinas. His work has concentrated on neuroimaging and cognitive facets of MS, but his research also embraces neuroimmunology aspects of demyelinating diseases with studies in collaboration with the Neuroimmunology Unit of the University of Campinas. Currently he is involved in exploring neurodegenerative biomarkers of MS, coupling neuroimaging, clinical and cerebrospinal fluid analysis. 17

20 Óscar Fernández Neuroscience Institute Service of Neurology University Regional Hospital Carlos Haya Málaga, Spain Óscar Fernández is Senior Investigator of the Biomedical Research Institute of Malaga (IBIMA), Regional University Hospital of Malaga, since September 2015 and honorary Professor of the Faculty of Medicine of the University of Malaga since He has been consultant of the Neurology Section at the Regional University Hospital of Malaga, Head of Service of Neurology (and founder) at the Regional University Hospital of Malaga and Director of the Institute of Clinical Neurosciences at the Regional University Hospital of Malaga. He has more than 150 publications in peer review journals in the field of multiple sclerosis, more than 100 clinical trials with private/public financing participated in 10 projects of competitive research on multiple sclerosis, as principal investigator 18

21 José Flores Rivera Universidad Nacional Autónoma de México (UNAM) Mexico City, Mexico José Flores Rivera graduated in 1999 as general practitioner, in 2003 graduated by National Autonomous University of México (UNAM) in Internal Medicine after four years of postgraduate training; during 2003 to 2006 he completed a postgraduate training as Neurologist also by UNAM at National Institute of Neurology and Neurosurgery in Mexico City; in 2004 he complete a one year of formal training in clinical research, during 2006 to 2007 attained a high specialization training in multiple sclerosis and demyalinating diseases at the same Institute and recognized by UNAM, in 2008 attained a Master Degree in Clinical Research. He realized a postdoc clinical trainign at Clinic Hospital in Barcelona, Spain. Actually is a senior conusltant in demyalinating diseases and autoimmunity central nervous system diseases at national Institute of Neurology and Neurosurgery and Chief of Neurology department at same Institute. Is prof. of Neurology by UNAM and is part of academic staff of Master of Neuroimmunology by Barcelona University 9 years ago. Dr. Flores has more than 250 cites in JCI and has published a lot of articles in multiple sclerosis, NMO and related diseases. 19

22 Yara Dadalti Fragoso NIMES - Universidade Metropolitana de Santos São Paulo, Brazil Yara Dadalti Fragoso is coordinator of the MS Unit in the coastal region of the state of Sao Paulo, professor in Neurology, researcher in Neurology and Neuroscience. 20

23 Xavier Montalban Neurology-Neuroimmunology Department Multiple Sclerosis Centre of Catalonia (Cemcat) Vall d Hebron University Hospital Barcelona, Spain Xavier Montalban is Chairman of the Department of Neurology-Neuroimmunology and Director of the Multiple Sclerosis Centre of Catalonia at the Vall d Hebron University Hospital in Barcelona, where he is former director of the Department of Neuroscience, and is also the chief of the Neuroimmunology Research Group at the Vall d Hebron Research Institute. He is Professor of Neurology at the Universitat Autònoma de Barcelona. Dr. Montalban received his medical license, trained as a Neurology specialist and completed his PhD in Neuroimmunology during the 1980s at the Universitat Autònoma de Barcelona. He went on to undertake a postdoctoral fellowship at the Lupus Research Institute, Guy s & St.Thomas Hospital plus additional clinical training at the National Hospital for Neurology and Neurosurgery, Queen Square in London, United Kingdom. Professor Montalban is Vice -president of Fundació Esclerosi Múltiple (MS Foundation), Former President of the Executive Committee of the European Committee for the Treatment and Research in ultiple Sclerosis (ECTRIMS), and Vice-president for Institutional Relations of the Spanish Neurological Society (SEN). He is a member of the US National Multiple Sclerosis Society Clinical Trials Committee and chairs the Medical & Scientific Board of the Multiple Sclerosis International Federation (MSIF), the Board of the European Charcot Foundation, and is a member of the European Magnetic Resonance Research Group, MAGNIMS. In the past twenty years, Prof. Montalban has been in the inception phases and on steering committees of many clinical trials related to multiple sclerosis. He has authored over 200 original and revision publications in international peer-reviewed journals as well as several book chapters. Recently, he has directed the development of the first Spanish (second worldwide) Multiple Sclerosis Clinical Practice Guidelines. He is the Director of the Neuroimmunology section of Revista de Neurología, and an editorial board member for several specialist neurology - related journals as well as Co-editor and Editor of the Clinical Cases Section of the Multiple Sclerosis Journal. In 2012 Prof. Montalban saw the culmination of over twenty years of constant strive to make MS management in Spain truly a continuous care process through the MS Centre of Catalonia: a newly built, 2000sq meter building for diagnosis, treatment, rehabilitation, research and teaching. The center is powered by 60+healthcare, research and other professionals. Together they cater for the needs of over 5,000 persons with MS and their families. His research interests include clinical trials, clinical aspects of MS, MR imaging and biological prognostic factors of disease evolution and treatment response, immunological mechanisms of the disease and other aspects of clinical management of MS. 21

24 Carlos Navas Demyelinating Disease Unit and Multiple Sclerosis Clinic University Hospital of Colombia Bogotà, Colombia Carlos Navas holds a degree in medicine from the Universidad del Rosario and then initiates Internal Medicine with specialization in Intensive Care. Done after this, initiate studies in Neurology and Neuroimmunology in Barcelona and EEEUU. He is currently director of the Demyelinization and Clinical Unit for Multiple Sclerosis in Colsanitas Colombia Clinic in Bogotà. 22

25 Maria Regina Papais Alvarenga Hospital da Lagoa University of Rio de Janeiro (UNIRIO) Rio de Janeiro, Brazil Maria Regina Papais Alvarenga graduated in Medicine from the School of Medicine and Surgery of Rio de Janeiro, she completed a medical residency, master's degree and doctorate (1990) at the Deolindo Couto Institute of Neurology of the Federal University of Rio de Janeiro and performed Postdoctoral (1999) on multiple sclerosis immunogenetics in the Service of Prof. Oscar Fernandez (Malaga, Spain). She is a neurologist, a Federal Public Service Physician and head of the neurology department of the Federal Hospital of Lagoa of the Ministry of Health since 1984, where she organized and coordinated the reference center for the treatment of patients with multiple sclerosis and other demyelinating diseases. At the Federal University of the State of Rio de Janeiro (UNIRIO) she is a Professor of Neurology, coordinates a specialization course in neurology, organized the Postgraduate Program stricto senso (Master and Doctorate), the first program sensu in Medicine recommended by CAPES at UNIRIO, where he currently coordinates the Master Course. She develops research on Natural History and Genetic and Environmental Risk Factors of Multiple Sclerosis and Optic Neuromyelitis in Rio de Janeiro, Brazil and Latin America and the results are published in journals of great impact in this area, such as Multiple Sclerosis Journal, Neurology, Journal Of Neurology, Journal of the Neurological Sciences and Neuroepidemiology. She has published partial results of this research in Congresses of Neurology in Brazil, Latin America (LACTRIMS), Europe (ECTRIMS), USA (ACTRIMS and American Academy of Neurology) and Congresses of the World Federation of Neurology. He has held Conferences in practically all Brazilian States, in all countries of Latin America, Europe and Japan. She is a Member of the Brazilian Academy of Neurology and Founder and First President-elect of the Association of Neurology of the State of Rio de Janeiro (ANERJ). 23

26 Antonio Pereira Gomes Neto São José University Hospital Santa Casa de Belo Horizonte Belo Horizonte, Brazil Antonio Pereira Gomes Neto graduated in Medicine at the Faculty of Medicine of the Federal University of Minas Gerais. He is specialized in Neurology by the Hôspital Civil Strasbourg, France, and is a member of the Brazilian Neurology Academy. He is currently head of Neurology Clinic at Santa Casa de Belo Horizonte, one of the biggest Hospitals in Brazil, with approximately 1000 hospital beds. He is the coordinator of the research and training Multiple Sclerosis Center, CAPPEM (Centro de Atenção ao Portador de Esclerose Múltipla). 24

27 LEARNING OBJECTIVES LEARNING OBJECTIVES

28 L1 Peripheral and central deregulation of the immune system in RRMS and PMS J. Correale (Argentina) Learning objectives: Define the role of peripheral immune system in MS pathogenesis Describe the role of central immune system in MS progression NOTES 26

29 L2 Maintenance therapies in RRMS: mechanisms of action, rationale and evidence M.R. Papais Alvarenga (Brazil) Learning objectives: Describe the main mechanisms of action of maintenance therapies in MS Illustrate the main results of clinical trials and real life studies on the efficacy of maintenance therapies in MS NOTES 27

30 L3 The emerging concept of long-term remission in MS: mechanisms of action, rationale and evidence of new treatments with infrequent dosing Ó. Fernández (Spain) Learning objectives: Describe the main mechanisms of action of new treatments with infrequent dosing inducing long-term remission in MS Illustrate the main results of clinical trials and real life studies about new treatments with infrequent dosing inducing long-term remission in MS NOTES 28

31 L4 Treatment of progressive MS: why, who, when, how G. Comi (Italy) Learning objectives: Describe clinical course and diagnostic criteria of primary progressive MS Define how to measure disability progression Illustrate pharmacological and non pharmacological treatment approaches NOTES 29

32 L5 Risks of maintenance therapies: short and long-term observation J. Flores (Mexico) Learning objectives: Describe short and long-term risks associated to maintenance therapies Differentiate on target and off target risks NOTES 30

33 L6 Risks of treatments with infrequent dosing: short and long-term observations X. Montalban (Spain) Learning objectives: Describe short and long-term risks associated to treatments with infrequent dosing Differentiate on target and off target risks NOTES 31

34 L7 Burden of monitoring old and new treatments and long-term adherence to monitoring plan A. Pereira Gomes Neto (Brazil) Learning objectives: Illustrate the required monitoring plan of MS treatments Describe data about adherence and convenience of old and new MS treatments Illustrate challenges and strategies to motivate patients to long-term adherence to the monitoring plan NOTES 32

35 W1 Treatment switching: when and what G. Comi (Italy) and Y.D. Fragoso (Brazil) Learning objectives: Illustrate how to evaluate suboptimal response to first and second line MS treatments Describe pros and contra of escalation and induction switching algorithms NOTES 33

36 W2 MRI monitoring: efficacy and safety A. Damasceno (Brazil) and X. Montalban (Spain) Learning objectives: Illustrate old and new metrics to evaluate the efficacy of MS treatments Illustrate MRI protocols suitable to evaluate the safety of MS treatments NOTES 34

37 L8 Old and new populations: clinical trials and treatment goals Y.D. Fragoso (Brazil) Learning objectives: Explain differences among old and new populations included in clinical trials in MS Describe differences in trials design overtime Illustrate old and new treatment goals NOTES 35

38 L9 Guidelines for MS treatment in Brazil and the rest of the world J. Becker (Brazil) Learning objectives: Illustrate guidelines for MS treatment in Brazil Illustrate guidelines for MS treatment under development in the rest of the world NOTES 36

39 L10 Patients and doctors: past and future unmet needs in MS C. Navas (Colombia) Learning objectives: Describe past and future unmet needs of MS patients Describe past and future unmet needs of MS neurologists NOTES 37

40 38 NOTES

41 NOTES 39

42 40 NOTES

43

44