MS drug Aubagio is now available in India

Aubagio Teriflunomide is a patented drug for treating relapsing form of Multiple Sclerosis and now it is available in India.

Teriflunomide is the generic name of Aubagio. It is now available as Teru MS 14mg and Terigen Teriflunamide 14 mg tablets.

To read more information on the generic drug of Aubagio use the below links.

Terigen Teriflunomide 14mg tablets

Teru MS 14mg tablets

Teriflunomide affects the immune system and reduces swelling and inflammation in the nervous system. Teriflunomide is used to reduce flare-ups in people with relapsing Multiple Sclerosis (MS) 

Teriflunomide to treat Relapsing forms of Multiple Sclerosis

Teriflunomide is a prescription medication in the form of tablet used to treat relapsing forms of multiple sclerosis (MS) in adults. Teriflunomide belongs to a class of drugs called immunomodulatory drugs.

The exact way how it works is still not known, but involves in a reducing in the number of certain immune cells. Teriflunomide comes in tablet form in two strength 14 mg and 7 mg. The most desired dosage is 14 mg and taken once a day.

To know about Alternatives for Teriflunomide Aubagio click here.

Teriflunomide tablet can be taken with or without food.

Common side effects of Teriflunomide tablets may include hair thinning, diarrhea, flu, nausea and a burning or prickling feeling on the skin.

It is seen that these side effects does not matter after some time. For hair thinning a small dose of Biotin 5 mg can be taken.

Alternatives for Aubagio Teriflunomide

Generic Teriflunomide to treat relapsing forms of multiple sclerosis

The generic form of Aubagio Teriflunomide is now available from multiple pharmaceutical companies.

Alternatives for Aubagio Teriflunomide shown below:

Brand Name	Manufactured by
Terigen Teriflunomide 14 mg	Nuvigen Life Sciences Private Limited
Teru MS 14 mg / 7 mg	MSN Laboratories

Multiple Sclerosis a growing health concern

Multiple sclerosis is a disease where the immune system goes awry, our system thinks that the brain and spinal cord shouldn’t be there and tries to attack it. It is believed that there’s about a half a million people in the United States and may be over two million in the world.

What causes Multiple Sclerosis?

Just like other autoimmune diseases, the exact cause of multiple sclerosis is unknown, but is linked to genetic and environmental factors. Genetic risk factors include being a woman and having genes that encode a specific type of immune molecule.

Environmental risk factors might include infections as well as vitamin D deficiency, which is an interesting one because it might help explain why the rates of multiple sclerosis are higher at the northern and southern poles compared to the equator where there's a lot more sunlight. Together these genetic and environmental influences might lead to the body not killing off immune cells that target myelin.

What is Multiple Sclerosis?

Multiple sclerosis is a demyelinating disease of the central nervous system, which includes the brain and the spinal cord.

In other words, it is a idiopathic auto immune disorder and it primarily affects the white matter of brain. It is one disease almost exclusively of the central nervous system.

Myelin is the protective sheath that surrounds the axons of neurons, allowing them to quickly send electrical impulses. This myelin is produced by oligodendrocytes, which are a group of cells that support neurons.

In multiple sclerosis, demyelination happens when the immune system inappropriately attacks and destroys the myelin, which makes communication between neurons break down, ultimately leading to all sorts of sensory, motor and cognitive problems.

Now the brain including the neurons in the brain is protected by things in the blood by the blood brain barrier (BBB), which only lets certain molecules and cells through from the blood. For immune cells like T and B cells that means having the right ligand or surface molecule to get through the blood brain barrier. Once a T cell makes its way in it can get activated by something it encounters - in the case of multiple sclerosis, it is activated by myelin.

Once the T-cell gets activated, it changes the blood brain barrier cells to express more receptors, and this allows immune cells to more easily bind and get in, multiple sclerosis is a type IV hypersensitivity reaction, or cell-mediated hypersensitivity. And this means that those myelin specific T-cells release cytokines like IL-1, IL-6, TNF-alpha, and intereferon-gamma, and together dilate the blood vessels which allow more immune cells to get in, as well as directly cause damage to the oligodendrocytes. They cytokines also attract B-cells and macrophages as part of the inflammatory reaction. Those B-cells begin to make antibodies that mark the myelin sheath proteins, and then the macrophages use those antibody markers to engulf and destroy the oligodendrocytes. Without oligodendrocytes, there's no myelin to cover the neurons, and this leaves behind areas of scar tissue, also called plaques or sclera. In multiple sclerosis, these immune attacks typically happen in bouts. In other words, an autoimmune attack on the oligodendrocytes might happen, and then regulatory T cells will come in to inhibit or calm down the other immune cells, leading to a reduction in the inflammation. Early on in multiple sclerosis, the oligodendrocytes will heal and extend out new myelin to cover the neurons, which is a process called remyelination.

Unfortunately, though, over time as the oligodendrocytes die off the remyelination stops and the damage becomes irreversible with the loss of axons. 

Teriflunomide shows long term benefits in patients with Multiple Sclerosis

Mark Freedman, MD, FAAN of Ottawa Hospital has done some lengthy investigations on using Teriflunomide for the treatment of relapsing forms of Multiple Sclerosis. It has shown to reduce relapses slowing disability and reducing MRI activity.

It has been found that patients on 13 years trial period did good and shown very less relapse with no significant change in disability.

Teriflunomide is taken as a single dose of 14mg or as two times in a day as 7mg. 

The most desired dosage is of taking once a day 14mg with or without food. Preferably in the morning.

Teriflunomide Terigen 14mg

Teriflunomide is now manufactured in india as Teriflunomide Terigen 14mg. It can be taken once daily instead of Aubagio (teriflunomide)

Teriflunomide Terigen is manufactured by Nuvigen Life Sciences.

Teriflunomide Terigen is generic tablet for Aubagio (teriflunomide)

Generic capsules for Biogen's Tecfidera Dimethyl Fumarate

Lupin gets USFDA approval for manufacturing generic capsules for Biogen's Tecfidera Capsules.

Dimethyl Fumarate is known under the name of Tecfidera patented by Biogen Inc. The drug is indicated for the treatment of patients with relapsing forms of multiple sclerosis. 

Lupil company has received the tentative approval from USFDA to market generic version of Tecfidera to market in strengths of 120mg and 240mg.

New hope for MS patients having trouble with tremors

With new research on Focused ultrasound lesion surgery the clinical trial is promising for Multiple Sclerosis patients suffering tremors.

It is said that managing tremors among MS patients is difficult and it is categorized as intentional tremors. Whereas a tremor among Parkinson patient is known as unintentional tremor, these kind of tremors are seen while the patient is at rest. Fortunately unintentional tremors to some extent are can be treated and cured to lead a good life.

But tremors felt by MS patients are difficult to treat as it is intentional tremors. The patient suffers tremor while intending to do the job, for example trying to use a spoon or inserting a key into a key hole.

One of the risky procedure to manage serious tremors in MS patients now is perform Deep brain stimulation (DBS), this is considered a life threatening and can cause serious damage to brain nerves while performing the surgery in brain. Procedure involves implantation of medical device called neurostimulator which sends electrical impulses to manage the tremors.

Now the good news is with the research happening positive on Focused ultrasound lesion surgery on clinical trials done, it is promising.

The procedure is not as complicated it will be MRI guided focused ultrasound intervention for the treatment of the tremor.

Teriflunomide tablets to be marketed by Zydus Cadila in India

Zydus Cadila of India has received final approval to market Teriflunomide tablets from United States of Food and Drug Association (USFDA).

India pricing of Teriflunomide tablets is still not known. Though the market is now available with generic tablets for MS relapsing such as Teru MS 14mg and 7mg. We need to wait and see the tablet form Zydus Cadila for pricing.

Teriflunomide tablets is used to treat relapsing forms of multiple sclerosis (MS). However the tablets is not a cure for MS, it will work in decreasing certain immune system cells which could attack the nerve in brain and spinal cord. It will help in decreasing the number of relapses and help to slow down physical problems caused by multiple sclerosis.

Surprisingly Bone Marrow Transplantation is happening in India for MS - Should we take a chance?

As part of visiting hospitals for regular checkups and talk with Neurologist for my MS, i actively read the internet for any hope on Multiple Sclerosis.

One of the press release of Fortis hospital has caught my eye for performing Bone Marrow Transplantation (BMT) and they claim to have done more than 100 cases. It really good to hear this positive advancement to control Multiple Sclerosis and give MS patients a good life.

Fortis hospital doctors say that clinical processes only helps in the slow progression of diesease and not stop the myelin attack. 

According to Dr Rahul Bhargava said, “The reason for multiple sclerosis remains an enigma. The clinical processes only help slow the progression of the disease and do not offer a sure shot cure. In an autologous BMT procedure, the healthy stem cells from the patient are taken out and preserved. Chemotherapy is then administered to reset the body’s immunity and then the stem cells are injected back to rescue the person from the side effects of chemotherapy.  After the surgery, the patient is kept under isolation for a few months to ensure they do not contract any infection.”

I am have moved from Primary to Secondary Progressive Multiple Scelorosis, i am not sure if Bone Marrow Transplantation will be of any help.

Please leave your comment. Great if any one can provide confidence to go for Bone marrow transplantation (BMT) in India.

Is it safe to have Natalizumab (Tysabri) or Ocrelizumab (Ocrevus) while you are tested JC Virus positive?

I had to under go the JC virus antibody test for CSF and Serum and found that i am JC virus positive. While my neurologist are evaluating my risk for undergoing the next level of treatment with Natalizumab (Tysabri) or Ocrelizumab (Ocrevus), i wanted to understand from other MS patients who are on these treatments.

I have heard a lot and seen video testimonials of patients going through Tysabri infusions and saying that they feel better. Also few of them are JC virus positive who are at risk of getting the PML (Progressive multifocal leukoencephalopathy) a rare disorder and fatal disease that affects the brain.

My understanding of breaking this medical acronym of PML is:

Progressive - Self understanding as Progressive

Multifocal - Lesions at multiple places in brain

Leuko - White matter of the brain

Encephalopathy - Disorder

When we visit these companies official websites the main page pops up with patient risk assessment. The information clearly mentions that MS patients who are undergoing treatment on Tysabri must be closely monitored for PML disease very often.

Let us understand how do we evaluate a patient before prescribing Tysabri:

1) He or she must undergo for JC Virus test (More information on this below). Few test to confirm are: JC Virus antibody, JC virus serum, IgG index values.

2) If you are JC virus positive, then the chances of getting PML disease is 1:1000 patients (Not sure from where this data is captured or mentioned in company website. Are they updating this regularly)

3) If you are JC virus negative, then the chances of getting PML disease is 1:10000 patients (But you cannot be happy that you are tested negative, you can get this virus anytime). So again you need to get tested every 6 months.

4) You cannot take Tysabri for life long like interferons (e.g Avonex). The company Biogen says it can be taken for 2 years safely, then every 6 months you must test JC virus activity in your body. Depending on the pros and cons the neurologist will decide whether to continue Tysabri or move on to some other disease modifying therapies.

More information about JC Virus:

JC Virus is present in most of the human population (approximately 90%). While this virus is harmless among people having good immunity (Majority of the population, except few MS patients) it is harmful among people having suppressed immunity. 

MS patients immunity is compromised since we have to undergo disease modifying therapies such as interferons and immuno suppressants. While you are on these therapies (Further adding Tysabri) your immunity is less and those people who are JC Virus positive tend to get PML since JC virus is main cause of it. JC Virus enters the blood brain barrier and affects the white matter.

It will be interesting to know from others real time experience and their confidence on taking Tysabri who are currently tested positive for JC Virus.

Can Biotin do the magic of Remyelination in Multiple Sclerosis?

While i have stopped injecting myself with Avonex weekly once till further evaluation is done for next DMT for multiple sclerosis, my neurologist feels that i should take Biotin tablets.

In my case i have lot of demyelination in CNS and brain. When we have lot of lesions around the brain the cells require lot of energy to perform simple activities. In simple ways, when we perform work such as walking the lesions flare up leading to fatigue and weakness.

Large doses of Biotin can help in increase in energy levels and to repair the myelin. 

Currently i am on 150 mg of biotin daily and going on for a week . So far i have not felt any change that i can appreciate. But the current research and clinical trials on Biotin for Multiple Sclerosis is promising.

I hope by continuing Biotin for few more days, i should positively note some good effect on my fatigue and imbalance. This will happen if my remyelination happens and that will be wonderful.

Currently Biotin is marketed as beauty and health vitamin tablets to help grow hair and getting a glowing skin.

Hope biotin will be a inner healer of damaged brain nerves for MS patients and for others it will be external factor of growing hair and beauty. Anyways if it happens it is beauty inner side and outer side. :-)

Stopped Avonex, Next Evaluation for Natalizumab and Ocrelizumab

As i had written in my previous post, I am having a tough time with fatigue and weakness in both limbs. I was admitted for a week and administered Methylprednisolone iv for 5 days.

Though my MRI does not show any new lesions since 2016, my walking, imbalance and tremors are not stable. It is getting worsen day by day. Apart from this I also had my part of UTI and low hemoglobin levels to add to it.

Had few antibiotics for UTI and iron shots for getting my hemoglobin levels to the range. Still my hemoglobin levels (10.3) are not anywhere near 13 normal range.

Coming to keep my Multiple Sclerosis in control, my neurologist was evaluating me for Natalizumab (Tysabri) or Ocrelizumab (Ocrevus). Before starting any of these, I need to perform few tests as below.

JC virus anti body, JC virus CSF (Cerebro Spinal Fluid) & JC virus serum.

I was thinking at least I will be lucky to be JC virus negative, but as feared I turned out be JC virus positive. Though I am not able to make sense about the pathological reports that has 34.50 ml/copies of JC virus found. Not sure whether it is good amount of JC virus present or less.

Anyways my hope for going to Natalizumab or Ocrelizumab started fading since these results are out. My doctor informed me that there is a huge risk of getting PML (Progressive multifocal leukoencephalopathy) which is fatal viral disease.

Mutiple Sclerosis patients testing positive for JC virus are at huge risk if they are on Natalizumab / Ocrelizumab  as they can be infected by PML.

So I am currently still under evaluation whether to go for these medications. My next appointment falls next month. Till then i am off from Avonex, since 2009.

Keeping my fingers crossed to know my next step of medications to keep my MS in control.

Avonex Beta interferon not working after 9 years.

As informed earlier, I have been living with Multiple Sclerosis since 2009. It was only my initial 1-2 months i was on Methylprednisolone, Solumedrol on IV. After which I showed signs of weakness in limbs and difficulty in walking.

Soon i was put on Avonex beta interferon weekly injection since 2009. Gradually my walking distance reduced. This was followed by walking with support, holding some ones hand and reaching out to walls. My movement was restricted inside the house. Regular MRI’s were done for evaluating new lesions or enhancing lesions. All my lesions were inactive and new ones were not appearing in the brain.

My neurologist advised me to take a break from Avonex as my condition are stable clinically as there are no new findings in MRI. This was a biggest mistake that had to happen ever. I had serious problems on the third month of absenting Avonex, experienced vertical tremors while getting up, unable to walk without support, vision problems with more hand tremors.

I was immediately hospitalized and administered 5 day course of Methylprednisolone Solumedrol through IV. Followed by Omnacortil 10mg orally for 2 weeks after my discharge from hospital. Then again from 2014, after a gap of 3 months i am on Avonex weekly.

Now after 9 years on Avonex, my conditions are not any better as my walking, tremor has not been any better. Avonex just made more holes in my wallet. My neurologist has given me two options Natalizumab and Rituximab.

Please let me know fellow MSers if any of you are undergoing treatment with Natalizumab or Rituximab. Your experience will be of great help and support.

Walking again after ten years with Multiple Sclerosis

This is really fantastic news and happy to find out that someone who was with Multiple Sclerosis was able to get back on his legs after ten years.

The recent research and development on Relapsing Multiple sclerosis has opened up new frontiers. Roy Palmer, 49 was diagnosed with Multiple Sclerosis ten years back. He and his doctor decided to go for HSCT (Hematopoietic stem cell transplantation) in the United Kingdom.

During the HSCT the patient’s stem cell is removed, frozen and stored. While this is being done. Removing a healthy stem cell is done from our own spinal cord, or if you have healthy sibling or going for a donor of stem cell.

Roy Palmer stem cell was harvested from the spinal cord and had to go through several rounds of Chemotherapy. This is done to bring down your immune system and to kill the unhealthy cells.

Precaution need to taken while your immune system is down, since even a small infection can prove to be fatal. Once the chemotherapy session is done, the healthy stem cell is transplanted again back to our human body.

HSCT (Hematopoietic stem cell transplantation) has proved to be very effective in case of Roy Palmer as today he is able to walk without any support.

The whole Multiple Sclerosis group and foundation is very happy on this break through treatment.

Does Avonex suppress the immune system and bring down your hemoglobin levels?

Avonex claims that it is not an immunity suppressant and it is an immunity modulator. But while you are on a long time therapy of Avonex beta interferons it brings down the immunity and infection fighting capability of the patient.

The most common infection Multiple Sclerosis patients suffer is Urinary tract infection due to less immunity. Bacteria thrives in the Urinary track and affects the bladder. Suppressed immunity creates less hemoglobin levels and RBC count. This leads to iron deficiency among the Multiple Sclerosis patients.

It is very much important to do the urine and blood routine among the MS patients. Also it is a good health check to get the liver function test (LFT) and  test among the  Serum glutamic pyruvic transaminase (SGPT) test among the MS patients to fing out if there has been a damage done on long time therapy of Avonex beta interferon injections.

Dalfampridine for Multiple Sclerosis

Dalfampridine is a drug used to improve imbalance and walking among multiple sclerosis.

Ampyra was the first approved branded oral tablet for Dalfampridine. Now recently from 2018 onwards USFDA approved Dalstep Dalfampridine 10mg extended release tablets are available from Sun Pharmaceuticals Pvt Ltd.

What is Dalfampridine?

Dalfampridine is a potassium channel blocker used to help multiple sclerosis patients to improve body imbalance and help in walking.

How does Dalfampridine work?

In multiple sclerosis the nerves are progressively demyelinated which exposes potassium channels. Due to this there is a leak of potassium which results in distortion of signals throughout the nerves. This results delay in signals and impairment of neuromuscular transmission.

Dalfampridine inhibits voltage-gated potassium channels in the Central Nerves System to maintain the transmembrane potential and prolong action potential. In simple language, dalfampridine works to make sure that the signal available is high enough to stimulate conduction in demyelinated nerves that are exposed in MS patients.

Is there a generic drug for Ampyra?

Yes, USFDA approved Dalstep Dalfampridine 10mg Extended Release tablets are now available as generic drug for Ampyra.

Dalfampridine Generic Drug Dalstep 10mg

Complete tiredness, legs paralyzed bedridden due to Multiple Sclerosis

Complete tiredness and fatigue. I have started feeling these symptoms happening with me for more often nowadays. Not able to move my legs really feel I am totally down.

These symptoms were usually experienced by me only after my weekly Avonex injection beta interferon. Next day of my injection I am kind of bedridden. Unable to walk or move my legs. I need support to more around my home.

Once I am administered avonex injection it has become habitual to go for Dolo 650 to bring down my fever that is caused by beta interferons. At times I need to continue medicine for fever the next day too.

When I am on Dolo 650 my muscles get relaxed and able to move around with less support. The tiredness nowadays hits from the second half of the day.

I have been told to go for blood routine test to find out if the cause of tiredness is something else.