b"Cognitive issues in MS do not seem toolderinjectablemedications,medications respond as well to brain games as they do ingiven by infusion, both monthly and every six individuals aging or diagnosed with dementia.months, as well as the injectable Kesimpta are However, individuals with MS who maintainall safe to take during conception, pregnancy, a regular exercise routine and remain activeand breast-feeding, thus reducing postdelivery throughout the day may have improvementrelapses considerably.in cognition. Regular physical activity is nowIn one case study presented, a woman who directly linked with a slower course of brainhad been on Ocrevus decided to go off of it atrophy (shrinking) than is seen in individualsto start her family (this was before we had who do not regularly exercise.enough data to know the drug was safe to be Medications and therapies dosedduringpregnancy).Sheconceived, We heard more updates on the real-worldhad an uneventful pregnancy, delivery, and useofsomemedicationsandbiomarkersperiod of nursing then had a second child. that were previously approved. SpecicallyWhen she returned to the MS clinic after her with patients on Ocrevus (and this seemed tofamily was complete, her B cells had fully be borne out in other B cell therapies as well),repopulated but were now normal B cells and eight out of every ten individuals taking thewere not triggering the T cells to attack the medication who had relapsing forms of MSCNS. Since then, this has also been noted in remained progression-free after 10 years. Inother individuals who have stopped their B those who were taking it for primary progressivecell therapy.MS, one in every three individuals had noThinking this may be a functional cure. further progression after ten years. there is now a study being started monitoring In clinical trial updates, the BTK inhibitors (anthose on Ocrevus for one year and two years oral medication designed to stop inammationto see if this is a phenomenon that can be and potentially repair myelin) still need toreplicated in most recipients on this DMT. meet endpoints and are still being preparedAgingwithMSandtheconversations for FDA approval. around when to stop a DMT are continuing None of the myelin repair therapies studiedtobediscussed.Historically,thegreatest to date work in humans as they do in animalamount of disease progression happens in studies. In animal studies where myelin wasthe fth decade of life, so it is thought we repaired in mice, the animals had controlledshouldprobablynotbediscussingtaking environments and diets, and we have not beensomeone off a DMT until they are past the age able to do that with humans. Myelin repairof 60 and have had no relapse, new disease cannot occur in an environment where CNSactivity, or MRI changes in at least ve years. inammationispresent,sothatmustbeIf patients are resistant to stopping a DMT eliminated before repair can begin. However,even though they have been stable for years, in some individuals on B cell therapies, somemedications such as teriunomide or Mavenclad natural myelin repair is taking place, so staymay be an option. New ndings with Mavenclad tuned for more information as it becomesshow that most individuals who did the available.two-year dosing course did not have any new Pregnancy and aging disease activity or progression for 15-years of As far as family planning, pregnancy, andpost dosing observation. breast-feeding are concerned, there is nowTo learn more about the ndings at this enough evidence available on pregnant womenyear's CMSC, watch our educational webinar taking DMTs to say with some certainty thatrecording at: msfocus.us/061824.35 msfocusmagazine.org"