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  "When and How to Switch Therapies in MS: Neurology Guideline Implementation and Expert Recommendation"
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Presented by: Johns Hopkins School of Medicine
Release Date: March 16, 2021
Expiration Date: March 16, 2022
Estimated time to complete this activity: 45 minutes for both .
Fees and Prerequisites: There are no fees or prerequisites.
Acknowledgement of Commercial Support: Supported by an independent educational grant from Novartis Pharmaceuticals Corporation
Target Audience
This activity is intended to meet the educational needs of clinicians managing patients with multiple sclerosis.
Learning Objectives
After participating in this activity, the learner will demonstrate the ability to:
  • Outline the 2018 AAN guidelines on DMTs to better monitor patients with MS and the efficacy and safety of their treatment.
  • Integrate 2018 AAN guideline recommendations to recognize when patients with MS may need to change their DMT therapy.
  • Apply the 2018 AAN guidelines and expert recommendations into DMT treatment sequencing when altering medications in patients with MS.
Accreditation Statement
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit Designation Statement
The Johns Hopkins University School of Medicine designates this enduring material for a maximum of 1.5TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Other Credits
American Nurses Credentialing Center (ANCC) accepts TM from organizations accredited by the ACCME.
American Association of Nurse Practitioners National Certification Program accepts TM from organizations accredited by the ACCME.
American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for TM from organizations accredited by the ACCME. PAs may receive a maximum of 1.5 AAPA Category 1 Credit for completing this program.
Statement of Need
Multiple sclerosis (MS) is a chronic central nervous system (CNS) disease that is progressive and has no current cure. In the United States (U.S.), MS affects nearly one million patients. More than 10,000 are newly diagnosed with MS annually. Due to its effects on movement, sensation, vision, and other domains, MS can severely hinder a person’s ability to walk, cook, work, enjoy hobbies, and achieve life goals, leading to significant impact on quality of life. Similarly, in studies of health, physical functioning, and social functioning, patients with MS have worse ratings compared with those with other chronic diseases.
Medications such as immunomodulatory and immunosuppressive disease-modifying therapies (DMTs) can delay this damage and slow the resulting progressive phase, thus helping maintain quality of life. Similarly, these DMTs can reduce frequency of attacks or breakthrough disease activity in RRMS. However, a one-size-fits-all approach does not work when appropriately treating patients with MS. Within a given patient and treatment course, new MS symptoms may become unmasked, adverse events may emerge, or a medication may simply lose effectiveness. From here, clinicians are signaled that a change in medication course may be needed. To make an informed decision, clinicians need to understand the rationale behind medication choices and the risks and benefits of DMTs available.
Johns Hopkins Chair and Course Director
Shiv Saidha, MBBCh, MD, MRCPI
Associate Professor of Neurology
Johns Hopkins University School of Medicine
Baltimore, Maryland
Christopher Eckstein, MD
Assistant Professor of Neurology
Division of Neuroimmunology
Director, Neurology Residency Program
Durham, North Carolina
Policy on Speaker and Provider Disclosure
It is the policy of the Johns Hopkins School of Medicine that the speaker and provider globally disclose conflicts of interest. The Johns Hopkins University School of Medicine OCME has established policies in place that will identify and resolve conflicts of interest prior to this educational activity. Detailed disclosure will be made prior to presentation of the education.
Johns Hopkins Statement of Responsibility
The Johns Hopkins School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
Internet CME Policy
The Office of Continuing Medical Education (OCME) at the Johns Hopkins School of Medicine is committed to protecting the privacy of its members and customers. Johns Hopkins School of Medicine OCME maintains its Internet site as an information resource and service for physicians, other health professionals and the public. OCME at the Johns Hopkins School of Medicine will keep your personal and credit information confidential when you participate in a CME Internet based program. Your information will never be given to anyone outside of the Johns Hopkins School of Medicine CME program. CME collects only the information necessary to provide you with the services that you request.
All rights reserved - The Johns Hopkins School of Medicine. No part of this program may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embodied in articles or reviews.
Format and Method of Participation
Review this internet-based CME activity. To take the post-test, please click on the post-test button below the video window of the player which will take you to the Johns Hopkins School of Medicine’s website. If you already have registered for other programs at this website, simply enter the requested information when prompted. Otherwise, complete the registration form to begin the testing process. The information you enter here will be used to generate your CME certificate. Please complete all fields to ensure accurate registration. 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.
Full Disclosure Policy Affecting CME Activities
As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), Johns Hopkins School of Medicine Office of Continuing Medical Education (OCME) requires attested and signed global disclosure of the existence of all financial interests or relationships with commercial interest from any individual in a position to control the content of a CME activity sponsored by OCME. The following relationships have been reported for this activity:

Shiv Saidha, MBBCh, MD, MRCPI – Contracted Research: Biogen Idec, Genentech, Inc., Genzyme Corporation, MedDay Pharmaceuticals; Consulting Fee: Biogen Idec, Celgene, EMD Serono Genentech, Inc.; Other: JuneBrain

Christopher Eckstein, MD – Contracted Research: Biogen Idec, Genzyme Corporation

Note: Grants to investigators at The Johns Hopkins University are negotiated and administered by the institution which receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).
Off-Label Discussion
There are no references to off-label/unapproved uses of products in this program.
The opinions and recommendations expressed by faculty and other experts, whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of the Johns Hopkins School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.
I certify that I am participating in a Johns Hopkins School of Medicine CME activity for accredited training and/or educational purposes.
I understand that while I am participating in this capacity, I may be exposed to "protected health information," as that term is defined and used in Hopkins policies and in the federal HIPAA privacy regulations (the "Privacy Regulations"). Protected health information is information about a person’s health or treatment that identifies the person.
I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential. I agree not to post or discuss this protected health information, including pictures and/or videos, on any social media site (e.g. Facebook, Twitter, etc.), in any electronic messaging program or through any portable electronic device.
I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality. The contact information is:
Johns Hopkins Privacy Officer, telephone: 410-614-9900, e-mail:
“The Office of Continuing Medical Education at the Johns Hopkins School of Medicine, as provider of this activity, has relayed information with the CME attendees/participants and certifies that the visitor is attending for training, education and/or observation purposes only.”
For CME Questions, please contact the CME Office
(410) 955-2959 or e-mail
For CME Certificates, please call (410) 502-9636.
Johns Hopkins School of Medicine
Office of Continuing Medical Education
Turner 20/720 Rutland Avenue
Baltimore, Maryland 21205-2195
Reviewed & Approved by:
General Counsel, Johns Hopkins Medicine (4/1/03)
(Updated 4/09 and 3/14)
The Johns Hopkins School of Medicine fully complies with the legal requirements of the ADA and the rules and regulations thereof. Please notify us if you have any special needs.
To participate in additional CME activities presented by the Johns Hopkins School of Medicine Continuing Medical Education Office, please visit
Technical Requirements
Processor Speed: 1.4 GHz P4
Memory: 2 GB RAM (20MB available)
Operating Systems Supported: Windows 8 or greater
Browsers Supported: Internet Explorer 9 or greater, Mozilla Firefox and Chrome
Additional Requirements: Flash player 10.0 or greater, 1024 x 768 Resolution or higher with 32-bit color
Connection Speed: 2 Mbps or better
Adobe Acrobat 6.0 or greater
Processor Speed: G4 processor or higher
Memory: 2 GB RAM
Operating Systems Supported: OSX 10.7 or greater
Browsers Supported: Mozilla Firefox, Chrome and Safari 8 or greater
Additional Requirements: : Flash player 10.0 or greater
1024x768 Resolution or Higher with 32-bit color
Connection Speed: 512 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
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