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Multiple Sclerosis Centers of Excellence


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MSCOE Newsletter Announcement

MS Veteran Newsletter

Discusses symptom management, medications, and living well with MS. Check out our latest issue!

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Get Out and Play

Get Out & Play

Adaptive sports can help keep you in the game. No matter your skill level, there is a sport for you.

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Vaccines and MS

Vaccines are important for preventing other illnesses. Preventive care is also an important part of MS management.

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Multiple Sclerosis Centers of Excellence

MSCoE LogoThe Multiple Sclerosis Centers of Excellence are dedicated to furthering the understanding of multiple sclerosis (MS), its impact on Veterans and effective treatments to help manage MS. By partnering with Veterans, caregivers, health care professionals, MS advocates, Veteran service organizations, and community health care institutes, MSCoE strives to minimize impairment and maximize quality of life for Veterans with MS.

MSCoE Network


VA MS Publications

map of USMSCoE Network

MSCoE East and West have developed a national network of MS Regional Programs and MS Support Programs within the VA.

Given the size of the population of Veterans with MS seeking treatment in VA and their distribution across the country, it is feasible to provide access to high quality subspecialty care through a hub and spoke network with designated MS Regional Programs supporting local facilities.

Each Veterans Integrated Service Network (VISN) will have at least one MS Regional Program that will serve as a source for MS specialty consultation and education. The primary care for individuals with MS will occur at their local VA medical facilities. MS Support Programs will collaborate with local MS Regional Programs. The MS Care Liaison at VA medical facilities with an MS Support Program will assist with coordination and referrals to the MS Regional Program as needed.

white figure talking through microphoneAnnouncements

September 26, 2018

The National MS Society has a quarterly magazine for people affected by MS. The fall 2018 issue has a great article, "At the Front", highlighting Veterans with MS and the VA healthcare system.

September 7, 2018

Dimethyl fumarate (DMF) has been associated with lymphopenia in clinical trials. To date, there have been five cases of PML in MS patients treated with DMF with an additional 14 cases reported in Europe where psoriasis patients were treated with a mixture of fumaric acid esters. Notably, 13 out of these 19 patients had grade 3 lymphopenia (ALC < 500-200/mm3). An integrated analysis of phase 2b/3/long-term extension studies of DMF in MS (N = 2,470) was conducted to characterize ALC profiles (Fox RJ, et al. Neurol Clin Pract. 2016 Jun;6(3):220-229). Mean absolute lymphocyte counts (ALC) decreased by 30% during the first year and then plateaued, remaining above the lower limit of normal (LLN). The majority of patients will develop low ALC in the first 9-10 months of DMF therapy (Baharnoori M, et al. Mult Scler Relat Disord. 2018 Feb;20:51-57., Khatri BO, et al. Mult Scler Rel Disord. 2015 Jul;4(4):377-379., and Gold R, et al. Mult Scler. 2017 Feb;23(2):253-265.). Current product labeling for DMF in the US recommends laboratory monitoring at baseline and every 6-12 months, European labeling recommends monitoring be conducted quarterly. Given the current evidence regarding the development of ALC within the first year of therapy and potential PML development, the DMF Criteria for Use (CFU) has been updated with the following monitoring statement; “Patients should have a CBC with differential at baseline and monitored quarterly for the first year of therapy and then every 6-12 months as clinically indicated by wbc or lymphocyte count.”

September 4, 2018

Team Northwest 2018, comprised of 11 Veteran athletes representing the VA Puget Sound Health Care System in Washington state, brought home 21 medals from the 2018 National Veterans Wheelchair Games, July 30 – August 4, 2018 in Orlando, Florida. To learn more, visit the VA Puget Sound website.

June 28, 2018

Based on equivalency data, starting Wednesday, July 25, 2018 VA pharmacy is substituting the generic Mylan 40mg TTW glatiramer acetate with Sandoz Glatopa 40mg TIW and VA pharmacy will begin distributing glatiramer acetate Glatopa to Veterans in both 20mg daily and 40mg TTW dosing formulas. The Glatopa 40mg TTW product requires a new autoinjector.

March 26, 2018

In November 2017, Zostavax was removed from the VA National Formulary and was replaced with Shingrix. Here is a short summary: (1) Shingrix is more effective than Zostavax in preventing cases of herpes zoster (shingles); (2) Shingrix contains an 'adjuvant', boosting vaccine effectiveness and reactions to the vaccine, while Zostavax does not; (3) Shingrix is NOT a live vaccine, unlike Zostavax, which is live; (4) Shingrix does NOT need to be stored frozen while Zostavax needs to be stored in the freezer; (5) Shingrix is given via an intramuscular injection while Zostavax is given via a subcutaneous injection; and (6) Shingrix is given as a two dose series, with doses spaced 2 to 6 months apart while Zostavax is given as a single dose.

Shingrix is not a live vaccine. The efficacy of Shingrix in MS and those on B-cell depleting therapies (rituximab, ocrelizumab) is not known but may be reduced. When possible, complete the Shingrix series prior to starting immunosuppressive or B-cell depleting therapies in people with MS. The safety of Shingrix in MS is not known. Adverse events with Shingrix are listed in the package insert.

FAQ document from VHA PBM
VHA PBM Criteria for Use

March 3, 2018

There is a voluntary withdrawl of daclizumab (Zinbryta®) from the market.

Disclaimer: Links are provided as a convenience and for informational purposes only. They do not constitute an endorsement or an approval by MSCoE of any of the products, services, or opinions of the organization. MSCoE bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

man reading a magazine while sitting at a tableVA MS Publications

The VA ranks as one of the nation’s leaders in health research. Thousands of studies are conducted at VA medical centers, outpatient clinics, and nursing homes each year. This research has significantly contributed to advancements in health care for Veterans and other Americans from every walk of life.

Learn about MSCoE research on our Professionals and Veterans research pages.

Recent VA Provider Publications

Genome Sequencing Uncovers Phenocopies in Primary Progressive MS

ADSTEP: Preliminary Investigation of a Multicomponent Walking Aid Program in People with MS

Using the Anterior Visual System to Assess Neuroprotection and Remyelination in MS Trials

Headache and Its Management in Patients with MS

Cognitive Impairment in MS

Optical Coherence Tomography Angiography Enhances the Detection of Optic Nerve Damage in MS

Effects of Lipoic Acid on Migration of Human B Cells and Monocyte-enriched Peripheral Blood Mononuclear Cells in Relapsing Remitting MS

Moderators of Treatment Outcomes Following Telehealth Self-Management and Education in Adults with MS: A Secondary Analysis of a Randomized Controlled Trial

A Multicenter Randomized Controlled Trial of Two Group Education Programs for Fatigue in MS: Short- and Medium-term Benefits

Predictors of Mortality in Veterans with MS in an Outpatient Clinic Setting

Disclaimer: Links are provided as a convenience and for informational purposes only. They do not constitute an endorsement or an approval by MSCoE of any of the products, services, or opinions of the organization. MSCoE bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.