MS Medications: Which Multiple Sclerosis Drugs Need a Washout?
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- Опубликовано: 12 сен 2024
- MS Medications: Which Multiple Sclerosis Drugs Need a Washout? In this video I teach you about washout periods for each of the MS medications.
The Boster Center for Multiple Sclerosis accepts all major insurance carriers and accepts consults from around the globe, both in office and via telemedicine. www.BosterMS.com or call 614-304-3444 to schedule!
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NOTE: Make sure to talk to your provider before ANY treatment decision. We hope to educate, empower and energize those impacted by Multiple Sclerosis. This channel consists of a collection of formal lectures and informal video clips about MS to help education others. These videos do not provide medical advice and are for informational/educational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any of our videos. They are just to help educate you about the condition guys!
![Should We Still Use Aubagio to Treat Multiple Sclerosis? [2019]](http://i.ytimg.com/vi/Wi7Ta8z9uEk/mqdefault.jpg)
Wow, very informative Dr B.
I switched from rebif to ocrevus without any washout thanks to you.
Have an awesome week and thanks for your time.
#WeHaveMS
Wow, 6 am(unless you are in a different country lol) and Boster’s live and educating. We are in awe sir
#WeHaveMS
Thank G-d this problem doesn't involve me. I've started with Ocravus and it seems to be working well enough. But it's refreshing and relieving to hear a competent doctor say things like "I don't know yet. I'm still checking that out." Thanks from Jerusalem.
Hey Dr. B! Let's see...I started on Betaseron; felt like I wanted to DIE! My Neurologist at the time switched me to Copaxone. This was in '99. I don't recall any washout. I then was told that my Neurologist was concerned about brain atrophy and she recommended switching to Tysabri. I do not recall any washout. I LOVED Tysabri! After receiving a dose I felt 'normal' for a brief period. I found out that I was JC virus positive and after being on Tysabri for over 5 years, I was switched back to Copaxone. I do not recall any washout but I do remember that my Neurologist at the time was concerned that stopping Tysabri might cause a relapse. Thankfully it did not! Fast forward several years-I told my current Neurologist that I was tired of giving myself a shot(wish I would have never said this). I switched to Aubagio-WORST DRUG FOR ME besides Betaseron. I stayed sick with diarrhea and vomiting. After a year and a half I finally convinced my Neurologist to take me off Aubagio. I do not recall any washout . I am now two years into Ocrevus come this Friday with my infusion. Ocrevus is working for me, I seem to be tired this fifth month.
The thing that I love about you Dr. B is that you explain these things to us. I go to my Neurologist and it's like I have to do all the talking and try to squeeze talking out of him. I have more success with my Nurse Practitioner but still, they do not educate me like you do. I am sure that it's because they just really do not have the time. So I thank you for taking time out of your personal life to tell us things that we should know. I will say it until I am blue in the face-may God truly bless you!!!
This is very very interesting. I’m newly diagnosed and trying to understand everything I can in order to advocate for myself. What blows me away is that I’m profoundly shocked by the amount of information and your willingness to share it with us in such a simple and clear way. I am going to use some of your terminology with my doctor -“disease activity” in my mind is any new tingle that wasn’t there before. I’m scared to try the medication that is stronger, but I want all these new little tingles I get each day to stop. Even after walking, my body doesn’t feel like my body anymore. But with every step I am thankful I can walk.
My brain is hurting trying to digest all this "wash out" " but not if..." "or we could..." "in this situation we must..." WHEW! Dr. Boster you are amazing, I wish I could be a patient of yours but, I'm "stuck" here in beautiful Huntington Beach Ca. Again thank you for your concern with people(like me)which you have no personal invested interest in. Carry on.
How incredible! This topic is exactly what I needed today. Thank you Dr. Boster! I'm actually stopping Copaxone (5 new lesions...) and starting Gilenya in 3 days. I read about the risk of rebound when stopping this med. Never mind the fact that I'm scared of getting infections, I haven't even started Gilenya that I'm already worried about ending it, loll!
I asked the clinical nurse at my MS clinic (I'm in Montreal, Canada) about this issue and it seems that my neurologist does not include steroids are not part of the washout protocol.
I trust my neurologist, I really do. I would like to discuss this topic with him but I don't want him to feel like I don't trust his knowledge, I don't want to insult him. But I REALLY don't want a MS attack and the steroids option seems so very sensible to me...
So... you're a neurologist.... Any tips on how to discuss treatment methods with a neurologist?
Thank you for everything you do!
I was on Tecfidera with one new lesion in the first few months, and then my lymphocytes went very low, so we switched to Ocrevus. I was on Tecfidera for about a year total. My neurologist suggested a month washout, so when the infusion center called asking to schedule my appointment literally right away. Ha! I scheduled the first infusion the washout month later and have not had any new lesions since. woot! I have been on Ocrevus for about a year and a half. My lymphocytes are still not quite normal, but are starting to recover a year after stopping Tecfidera.
Great information Dr. B. A question that might be a topic for another video...the role and mechanism of steroids in treatment of MS. I was told that steroids were often used when a person had an exacerbation to help them recover faster and they would not minimize damage. You've mentioned in several videos how steroids would be deployed if a person was exposed to potential rebound activity...I'm curious as to those two situations and the why's etc....as always, that you and you are doing a tremendous service to all people, directly and indirectly, affected by this disease ! There are no words I can type that accurately convey my thanks to you!
Just started Aubagio from Copaxone. Went from injections to pills no washout and so far so good. No more shots! Yay!
Julieann Moore how’s it been going since. ?
Thanks Dr B. I switched from gilenya to ocrevus within 2 months without using steroid..a month after the 2nd half of ocrevus I got a new relapse.
I loved this video! Thank you!
I was in the 20% on Tecfidera that had their lymphocytes go too low. I also had breakthrough disease. So changing meds was a no brainer (no pun intended :) ). Instead of steroids, I was put on Copaxone until the lymphocyte count went back up as Copaxone doesn't interfere with the lymphocytes. That, until switching to Ocrevus. My lymphocytes have been stable since (except for the B lymphocytes, naturally).
My neurologist actually published a paper last year on sequencing DMTs based on clinical experience.
Thank you Dr. B, very informative, and educational
My experience with a washout period was the transition from Rebif to Tysabri. I was newly diagnosed and my first med was only amplifying my symptoms and doubling my lesions. The washout period was ok physically, but mentally it was terrifying for me because I had been off of Rebif longer than anyone realized because of insurance issues. It was terrifying only because I didn’t know what to expect.
Darla thanks for sharing this!!!! I never really “felt” MS until I started Rebif. After each injection, the following day, it was like I had traded my body in for a 98 year Old arthritic version of myself 😨
thank you for this, just got off aubagio after my valentines date with the mri machine and looking for a new dmt!
Amazing, thanks !
I'm currently in a "washout" from rebif. I know that's not typically a drug that requires one but my lymphocytes dropped significantly and we had to wait for them to raise. I'm just over 2 months between treatments and my next drug will be lemtrada. I feel fantastic being off of the rebif (other than having anxiety about not being on treatment). Bloodwork performed last week confirmed my lymphocytes and neutrophils are back to optimal range so I'll be able to start lemtrada as soon as possible 👌
Thanks again Doctor B
Thank you again Dr. B for your excellent knowledge on multiple sclerosis. Your videos are so knowledgeable thank you very much
Thanks Dr Boster . You share your experience to all
I find it interesting that you don’t talk at all about Rituxan, All MS patients in my health system in San Diego, and all of southern CA who had been on long term IVIG therapy, who had all had poor outcomes with the interferons, have been switched to Rituxin; I hear with much success. (Alas, not in my case). I have read that Octrevus is Genentech’s Attempt to repackage Rituxan, because the patent expired in Mid 2018 and here come the generics. Rituxan also was never FDA approved for the treatment of multiple sclerosis, although it certainly sounds like the mechanism is very, very similar. So why does Octrevus have a shorter half life than Rituxin? Is Octrevus considered a chemotherapy drug like Rituxan? Both do the same thing, kill off the mature B cells, But there’s obviously some kind of a twist. I know that in the last year there have been some cases of PLM in patients taking only Rituxan, which had not been the case before (NIH). Is PLM a possibility (however rare) in Octrevus? And finally, I wonder what your opinion is on the speed at which the FDA has pushed through new MS drugs. And let me note as well, that although Rituxan is FDA approved for other conditions than MS, it was one of the top grossing drugs manufactured in the United States last year. That causes me to pause and ponder what is going to get thrown at MS next-not so much for efficacy and safety, but for money. I guess I don’t ask simple questions!. But I do miss your fabulous artwork behind you! I hope you’re going somewhere wonderful on vacation and not on a work trip!
Great information again. If Ocrevus doesn't work what's the next option?
No downplaying the seriousness of the video...but I need that tie!😹
Yes, I’ve been off of Gilenya for a month to try Lemtrada whenever we get the dates. Still waiting
I did a washout from Aubagio because my liver enzymes were elevated, ALT 410 and AST 560. My neurologist wanted me to do a washout. My levels are back to normal now and I will be starting "O" on Friday.
Hi Dr.B, my washout experience from Aubagio was not fun. My doc used Questran, I had to take it for I think 11 days, then it was still not out of my system so I took it 3 more days, and it was still not gone! I ended up taking the stuff like 3 weeks. 2-3 times per day. It tastes horrible and messed up my GI so bad, I still don’t think my GI has ever been the same! Gladly, once the Aubagio was finally out of my system, I started Ocrevus which I am very happy with 😀. Interesting though that it sounds like you wouldn’t even have done the Aubagio washout to go to Ocrevus. I am glad the Aubagio is out of my system though. That’s my story🐶
Hallo Aaron, you are awesome! Thanks for this informative video, filmed early in the morning....
When I had to stop Tysabri after four years due to the Jcvirus I got 2000mg of iVsteroids each month for half a year and then we turned to three days of iVsteroids 1000mg each day monthly. I am not relapse free, I have had two onset relapses end of last year which left my left side weaker than before and another onset relapse this spring which left me blurry vision and shaky hands.
Well, I would love to switch to Ocrevus, but my liver counts are terrible still, so I can't.
Thanks again for sharing this very interesting answer to someones question!
Have a great week, Aaron and hope to learn from you again soon!
Greetings from warm and humid southern Germany, Britta
Wow. This was very very helpful and informative. I’ll probably watch it a few times This really helps me form important questions when trying to make treatment decisions. Thank you so much!
You're welcome! #WeHaveMS
Very informative. Thank you Dr. Boster
Years ago I stopped Tysabri and relapsed three months later. My neuro thought three months was too late to be a Tysabri rebound effect, but I disagreed. I didn't go on another DMD for two years and had no flares during that time.
Thanks for the vlogs,I like to watch a few of them dealing with my symptoms before I see my doc in order to generate questions to get answers. I've been told to go to the new drug where I get a dose I think twice and that's it. Neuro explained it would do a total reset,the more I've read it's very much like chemo pills. What happens if I relapse and what about symptom mgmt? I am on Ty and after 4 weeks I'm absolutely no good so I worry about going to a reset drug that is not given often at all and not alot of statistics around this medication. Thank you for explaining the washouts as I'm on Tysabri now. Great vlog!!
Started on tecfidera. No wash out to tysabri, then tysabri to zynbrita, no wash out, zynbrita to Ocrevus technical washout because I tried for baby #1.
I had to stopped copaxone because of the effect daily injections took on my anxiety and relapse. I ended up waiting 8months to then start on Gilenya, I had to have the varicella vaccine so that did add 3months to the wait in itself. That was hellish and relapses were egnored because well your starting Gilenya soon , I think theyd have had to delay starting me on gilenya to do steriods, I wish they had my own was pissed they did this but life.
Then Gilenya my liver enzymes went out of whack and my white cell count dropped to 0.6 within the first month and my alt climbed to over 250 and my ggt seriously increased too so it was wash out and liver recovery. That was a three month wait. I was in a lot of pain so I was glad when the pain finally went away I was okay with waiting, I forced them to wait until my liver results were within normal range to make sure it had the best chance(only an extra two weeks). Now I'm on Tec a few months so it'll be blood checks to see if my liver is still coping (intermittent abdominal pain but not anywhere near bad as on gilenya).
I hate waiting between it can get me antsy but with them saying there was an issue and feeling clearly the pain, I was willing to wait.
I had a relapse when washing out Aubagio to start Ofatumumab phase 3 trial. I was so mad and it’s so frustrating that Aubagio takes so long to wash out and one has to take some nasty drug to wash it out. 😞
I’m on Tysabri now. Praying for success.
Aubagio gave me terrible nausea among other things, so I had to take that chalky stuffbto get it out, and the Aubagio continued to make me sick on the way out. The chalky stuff was like orange favored Metamucil (yuck). I start Ocrevus soon and hope for a better experience.
I hope ocrevus goes smoother for you! TY for sharing your washout experience!
So when I listened to this the first time, it wasn’t relevant. Now it is. I’m being taken off Rebif and was told to wait thirty days before starting Tecfidera. Too many side effects on Rebif. I was told it will stay in my body for sixty days. But shouldn’t do anymore doses. I experienced some weird symptoms.
Dr. Boster, could the difference in the washout between the DMD's, Tysabri to Ocrevus, be one of the reasons that "switchers" can have a resurgence of symptoms they had pre Tysabri? Excellent video with important information for all those who use DMD's.
If ocrevus is active for 4.5 months, why is it scheduled every 6 months?
I was forced into a 3 month washout from copaxzone to ocrevus due to misinformation, miscommunication scheduling issues. Wish I knew about this stuff then.
Thx and safe travels
drug sticks around in human body for ~4.5 months. The biologic impact (killing B cells) lasts 6 months. So for last 1.5 months no ocrevus in body BUT b cells haven't grown back yet.
@@AaronBosterMD Thanks. So helpful, as always.
Love your videos Dr. B!! I like your idea of pulsing with steroids if waiting for lymphs to return to normal but can/should you account for the possibility of the actual steroid administration affecting the white cells?
Another super helpful video. I liked your over lapping therapy tip when changing from betaseron to tecfidera. Strangely enough I felt more protected on betaseron vs tecfidera if I wish to go back on betaseron can overlapping still happen but this time in the reverse order; tecfidera to betaseron?
Like watching your videos. I'm on tecfidera. I have a lot more then MS going on. I stay in pain all the time. What is your opinion about using pain meds? I really would like to stop being in pain.
here you go: ruclips.net/video/-WEc2C916hg/видео.html
I'm on Fluoxetine for depression and when I came off it found that my pain increased to a level I found intolerable and the depression was creeping back. Back onto Fluoxetine, 1 pill a day and the pain is at a tolerable level and I'm feeling better.
Dr B. I took Aubagio 4.2.24 for 3 days and stopped bc of many reactions from severe GI distress, chills, feeling like I had a bad flu, et al. After stopping GI issues got significantly worse. On 4.16.24 began washout with cholestraymine. Got 1st dose in okay but overnight kept going to bathroom. 🤞🤞 Hoping these awful GI effects ease up soon in the 10 days course of treatment of 3x day. This wash out was not mentioned when you got to Teriflunomide. Is the wash out just as effective as chacoal? Thanks for all you teach us. You knowledge is so beneficial. Bless you.
I have mild ms and I'm taking aubagio I feel so tired is it so strong for my ms ?
Thxu
~div.
Aubagio washout but allergic to questran . Now what?
Sharing
As once on Avonex & I stopped taking it now for 8 months off. Should I decide on by myself which one I should be on? Suzanne Sesbreno/Sudbury,Ontario,Canada
So you do not do a washout if you switch from Ocrevus to Lemtrada?
if ocrevus stays in your system for 4 and a half months, why is it given every 6 months?
after 2 days i will change from gilenya to ocrevus , i stop gilenya now for one mounth ! do i have to wait more or do alc test to make sure its out ?!
... and thank you for every thing you are amazing 💐
make certain you coordinate your efforts with your doctor. This video is NOT medical advice it's just education on the topic.
@@AaronBosterMD after tests my wbc is still low so my doctor will make me wait more time before ocrevus
thanks again 😊