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Jointly Provided by: The University of Texas Southwestern Medical Center and Medical Logix, LLC
Release Date: October 23, 2020
Expiration Date: October 23, 2021
Estimated time to complete the activity: 60 minutes for the program, including video-play and pre/post-activity assessments. This activity has been approved for a maximum of 1.0 (TM).
Acknowledgement of Commercial Support: Supported by independent educational grants from Biogen, Novartis Pharmaceuticals Corporation, and EMD Serono.
Learning Objectives
After participating in this activity, the participant will demonstrate the ability to:
  • Discuss which DMTs are safe to start during COVID-19 and which deserve special consideration.
  • Outline strategies for delaying DMT initiation in patients due to COVID-19 concerns.
  • Outline the recommendations from various MS organizations and societies, comparing the recommendations on the use of DMTs in patients with MS during this COVID-19 pandemic.
  • Review individual and class characteristics of DMTs, specifically regarding risk of infection and management during active infection.
As an accredited provider, UT Southwestern Medical Center requires that the content of our activities are:
  • Independent, objective, scientifically rigorous, balanced and free of bias.
  • Based on scientific studies utilized or referenced from sources acceptable to the scientific and medical community.
  • Acceptable to the medical community as it relates to patient recommendations and do not recommend any unscientific modalities or those not supported by evidenced based sources.
Statement of Need
As coronavirus disease 19 (COVID-19) has become a worldwide issue, being declared a pandemic by the World Health Organization, it affects many aspects of healthcare. Specifically, many patients with multiple sclerosis (MS) take medications that alter or suppress their immune system. Rightly, they and their treatment team are concerned about the safest, but also most effective treatment strategy that considers both MS and the risk of COVID-19.
This balance is not simple. Those with comorbidities such as poor mobility and poor lung function are at increased risk of worse COVID-19 outcomes. The impact of immunosuppression is not clearly understood. MS itself is surprisingly common, with up to one million adults in the US diagnosed with this condition. Many of these patients take disease-modifying therapies (DMTs) to treat their MS and mitigate disease progression and prevent symptoms such as muscle weakness, poor coordination, impaired vision, etc. For many years, the treatment paradigm has been to “treat early and never stop,” but in the light of these recent world changes, this paradigm is much less clear.
Physicians caring for patients with MS during this period of COVID-19 risk require educational programs to stay informed of the proper use of DMTs and relevant guidelines to best treat their patients and reduce breakthroughs, while still mitigating the risk of COVID-19.
Intended Audience
This activity is intended to meet the educational needs of clinicians treating patients with MS during the current COVID-19 pandemic.
Contributors and Planners
Faculty:
Benjamin M. Greenberg, MD, MHS
Distinguished Teaching Professor
Vice Chair of Research
Department of Neurology
Director, Perot Foundation Neurosciences Translational Research Center
O’Donnell Brain Institute
University of Texas Southwestern
Dallas, Texas
Joseph R. Berger, MD, FACP, FAAN, FANA
Professor of Neurology
Associate Chief of the Multiple Sclerosis Division
Department of Neurology
Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
Reviewer:
Peter Sguigna, MD
Department of Neurology
UT Southwestern Medical Center
Dallas, Texas
Disclosure of Commercial Interest:
As an organization accredited by the Accreditation Council for Continuing Medical Education (ACCME), The University of Texas Southwestern Medical Center, Office of Continuing Medical Education (UTSW CME) requires that the content of CME activities and related materials provide balance, independence, objectivity, and scientific rigor. Planning must be free of the influence or control of a commercial entity, and promote improvements or quality in healthcare. All persons in the position to control the content of an education activity are required to disclose all relevant financial relationships in any amount occurring within the past 12 months with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients.  
The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The UTSW Office of CME has implemented a mechanism to identify and resolve all conflicts of interest prior to the activity. The intent of this policy is to identify potential conflicts of interest so participants can form their own judgments with full disclosure of the facts. Participants will evaluate whether the speaker’s outside interests reflect a possible bias in the planning or presentation of the activity.
Disclosures:
Faculty:
Benjamin M. Greenberg, MD, MHS
Independent Contractor: Abcam, Alexion, EMD Serono, Genentech, Greenwhich Bio, Novartis, Ruben Anders, Viela Bio
Grant or Contract: Clene Nanomedicine
Joseph R. Berger, MD, FACP, FAAN, FANA
Professional Services: Biogen, Celgene, Excision-Bio, Genentech/Roche, Genzyme/Sanofi, Johnson & Johnson/Janssen, Millennium/Takeda, Novartis
Reviewer:
Peter Sguigna, MD
No relevant financial relationships to disclose
No other planners have indicated that they have any financial interests or relationships with a commercial entity.
The following Medical Logix, LLC planners/managers, Megan Gentile, John Gentile, and Joshua Hwang, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.  
The following UT Southwestern employee, Reema Mustafa, hereby states that she or her spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
Off-Label Discussion
Discussion of studies for fingolimod and interferons as potential treatment for COVID-19 infection. This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the U.S. Food and Drug Administration. For additional information about approved uses, including approved indications, contraindications, and warnings, please refer to the prescribing information for each product, or consult the Physicians’ Desk Reference.
Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The University of Texas Southwestern Medical Center and Medical Logix LLC. The University of Texas Southwestern Medical Center is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation Statement
The University of Texas Southwestern Medical Center designates this enduring material for a maximum of 1.0 TM. Participants should claim only the credit commensurate with the extent of their participation in the activity.
Format and Method of Participation
There are no fees for participating and receiving CME credit for this activity. During the accreditation period, participants must read the learning objectives and faculty disclosures and review this internet-based activity. To take the post-test, please click on the post-test button below the slide window of the player. Complete the post-test and evaluation and attest to the amount of time spent in the activity. Upon receiving a score of 70% or above, print your CME certificate.
For CME questions, please contact the UTSW Office of CME at cmeregistrations@utsouthwestern.edu.
Technical Requirements
Processor Speed:  1.4 GHz P3
Memory:  256 MB RAM (20MB available)
Operating Systems Supported: Windows 2000/XP, MAC
Browsers Supported:  Internet Explorer 5.5 or greater, Mozilla Firefox and Safari 3.525 or greater
Additional Requirements: Flash player 8.0 or greater, 800x600 Resolution or higher with 32-bit color
Connection Speed:  128 Kbps or better
Adobe Acrobat 6.0 or greater
Technical Questions:
Please click on the Help button within the online player, or email MS-Leaders at support@ms-leaders.com
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