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    <recommendedItem id="20100101_19_425"
                     title="AAN: Industrial Cleaner Again Tied to Parkinson Risk (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAN/tb/18338?impressionId=1265783075839"
                     
      TORONTO  --  The degreasing agent trichloroethylene (TCE) has been linked to increased rates of Parkinson&apos;s disease among industrial workers in yet another study, this time involving a large, well-studied group of World War II veterans.&lt;br&gt;
&lt;br&gt;Parkinson&apos;s disease developed in individuals with occupational exposure to TCE at more than five times the rate seen in those without such exposure (odds ratio 5.5, 95% CI 1.02 to 30), reported Samuel Goldman, MD, of the Parkinson&apos;s Institute in Sunnyvale, Calif.&lt;br&gt;
&lt;br&gt;Goldman described the research in a phone interview with &lt;em&gt;MedPage Today&lt;/em&gt;. It&apos;s scheduled for presentation here in April at the American Academy of Neurology&apos;s annual meeting.&lt;br&gt;
&lt;br&gt;A previous study in 2008 had fingered TCE as the most likely culprit behind a cluster of Parkinson&apos;s disease cases afflicting workers at a single industrial plant. (See &lt;a href=&quot;http://www.medpagetoday.com/Geriatrics/ParkinsonsDisease/7894&quot; mce_href=&quot;http://www.medpagetoday.com/Geriatrics/ParkinsonsDisease/7894&quot; target=&quot;_blank&quot;&gt;Trichloroethylene Implicated as Risk for Parkinsonism&lt;/a&gt;)&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Also, Goldman said, animal studies have found that TCE is selectively toxic to nigral dopaminergic neurons, the same type of nerve cell that progressively dies off in Parkinson&apos;s disease. He said the chemical&apos;s activity in rodent brains is very similar to that of MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine), a dopaminergic neurotoxin commonly used to simulate Parkinson&apos;s disease in preclinical research.&lt;/p&gt;
&lt;p&gt;Goldman said the new study was the first population-based analysis to link TCE to the disease.&lt;/p&gt;
&lt;p&gt;It focused on 198 twin pairs in the National Academy of Sciences-National Research Council&apos;s World War II Twins Cohort, which comprises some 16,000 twin pairs overall.&lt;/p&gt;
&lt;p&gt;Members of the all-male cohort, who were born from 1917 to 1927 and served in the war, have been followed since the 1960s. Occupational histories for participants are available along with medical records from the VA healthcare system.&lt;/p&gt;
&lt;p&gt;In those pairs chosen for the current study, records showed that one twin had developed Parkinson&apos;s disease and the other had not. This design largely eliminates genetics as a confounding factor in the analysis.&lt;/p&gt;
&lt;p&gt;Goldman explained that occupational histories for each participant were reviewed by a blinded industrial hygienist and a preventive medicine physician to identify likely exposures to TCE and four other industrial chemicals: xylene, toluene, carbon tetrachloride, and tetrachloroethylene.&lt;/p&gt;
&lt;p&gt;As a single source of exposure, only TCE was significantly associated with development of Parkinson&apos;s disease, Goldman said.&lt;/p&gt;
&lt;p&gt;People working as aircraft mechanics, machinists, plumbers, and electricians likely had regular exposure to TCE, Goldman said. The chemical was commonly used as a &quot;spot&quot; cleaner to remove grease and oils from metal surfaces. It was also used for a time as a dry cleaning solvent, although tetrachloroethylene was more common for that purpose.&lt;/p&gt;
&lt;p&gt;Goldman said no increased risk was seen with xylene or toluene, but there were near-significant trends toward increased Parkinson&apos;s disease risk from carbon tetrachloride and tetrachloroethylene: &lt;ul&gt; &lt;li&gt;Carbon tetrachloride: OR 2.8 (95% CI 0.97 to 7.8)&lt;/li&gt; &lt;li&gt;Tetrachloroethylene: OR 9.0 (95% CI 0.78 to 103)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Twins exposed to either TCE or tetrachloroethylene were at significantly increased risk, with an odds ratio of 8.1 (95% CI 1.43 to 43) relative to individuals with no exposure to either chemical.&lt;/p&gt;
&lt;p&gt;Goldman said the analysis also examined whether duration of exposure was associated with increased risk. He said the results were in the same pattern as for the yes-no exposure analysis, but the findings were very uncertain because of the relatively small sample size.&lt;/p&gt;
&lt;p&gt;Occupational histories were available for only 99 of the 198 discordant twin pairs and some of the information was obtained by proxy rather than from the participant himself.&lt;/p&gt;
&lt;p&gt;Because of the wide confidence intervals even for the yes-no exposure analysis, the findings need confirmation in a larger study, he said, noting that the best approach would be a cohort study involving people with known, long-term exposure to TCE, compared with well-chosen controls.&lt;/p&gt;
&lt;p&gt;&quot;The study wouldn&apos;t have to be large,&quot; Goldman said. He estimated that 1,000 to 2,000 participants would be adequate to determine if the connection to Parkinson&apos;s disease is real.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Institute of Neurological Disorders and Stroke, the Valley Foundation, and the James and Sharron Clark Family Fund.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_390"
                     title="Vegetative State May Still Harbor Consciousness (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/Neurology/GeneralNeurology/tb/18283?impressionId=1265783075839"
                     
      Researchers in England are reporting they have been able to establish limited communication with a man in a persistent vegetative state by using functional magnetic resonance imaging (fMRI).&lt;br&gt;
&lt;br&gt;The 34-year-old man was able to answer simple Yes or No questions by imagining different types of activity, which caused changes in brain activity that could be seen in the machine, according to Martin Monti, PhD, of the Medical Research Council Cognition and Brain Sciences Unit in Cambridge, England, and colleagues.&lt;br&gt;
&lt;br&gt;The finding shows that at least some patients who are otherwise unresponsive may have some residual awareness, the researchers reported online in the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;&quot;The incredible thing is that we could never do something like that at the bedside,&quot; Monti told &lt;em&gt;MedPage Today&lt;/em&gt;. Outside of the fMRI machine, he said, the patient remained unresponsive to standard tests.&lt;br&gt;
&lt;br&gt;The study is likely to arouse controversy, Monti conceded, especially in the light of such high-profile cases as that of Terry Schiavo, which eventually went to the U.S. Supreme Court.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;In the Schiavo case, relatives were bitterly divided on whether to withdraw&lt;strong&gt; &lt;/strong&gt;life support for the woman, who had been in a persistent vegetative state for several years.&lt;/p&gt;
&lt;p&gt;&quot;People will have a tendency to overinterpret this,&quot; Monti said, adding &quot;this finding in one patient does not imply that all patients may or may not have the ability to do this.&quot;&lt;/p&gt;
&lt;p&gt;Indeed, the researchers tested 54 people and found only five who could apparently respond to direction by imagining either motor or spatial activity. Imagining those activities uses different parts of the brain and their activation can be seen by the fMRI scan.&lt;/p&gt;
&lt;p&gt;Several of the responders were already what is called &quot;minimally responsive,&quot; meaning that occasionally they were able to react to external stimuli.&lt;/p&gt;
&lt;p&gt;Of those five, the researchers only tried to communicate with one  --  the man in a persistent vegetative state  --  using his ability to reliably activate different brain areas when asked to imagine either playing tennis or looking around a room in his house.&lt;/p&gt;
&lt;p&gt;While in the machine, he was asked simple questions, such whether his father&apos;s name was Alexander. To answer Yes, he was to imagine playing tennis, while for No he was to imagine looking around the room.&lt;/p&gt;
&lt;p&gt;He was able to answer five out of six questions, the researchers reported, adding it was unclear why he was unable to answer the sixth but no brain activity was seen in response to the question.&lt;/p&gt;
&lt;p&gt;Outside experts also cautioned against overinterpreting the results.&lt;/p&gt;
&lt;p&gt;&quot;The percentage of patients showing a response was low, and longer-term follow-up studies are needed to determine whether such fMRI findings by themselves have meaningful predictive value,&quot; argued Alan Faden, MD, of the University of Maryland School of Medicine in Baltimore.&lt;/p&gt;
&lt;p&gt;&quot;This study may well raise questions for some with regard to medical or legal decisions based upon state of consciousness,&quot; Faden said in an e-mail, &quot;but the findings primarily underscore the limitations of current categorizations for diminished states of consciousness.&quot;&lt;/p&gt;
&lt;p&gt;He said that as technology gets better, it will likely mean that doctors will have to modify their diagnostic categories for what he called &quot;states of diminished consciousness.&quot;&lt;/p&gt;
&lt;p&gt;In an accompanying editorial in the journal, Allan Ropper, MD, of Brigham and Women&apos;s Hospital in Boston, wrote that such research is &quot;easily subject to overinterpretation and sensationalism.&quot;&lt;/p&gt;
&lt;p&gt;He cautioned that brain activation was seen only in a few patients and only in those with a traumatic brain injury, rather than global ischemia and anoxia.&lt;/p&gt;
&lt;p&gt;And, he wrote, the brain activity seen in the patients is not evidence of such things as memory, self-awareness, anxiety, or despair. &quot;We cannot be certain whether we are interacting with a sentient, much less a competent, person&quot; Ropper wrote.&lt;/p&gt;
&lt;p&gt;Despite such caveats, the research is &quot;critically important,&quot; according to Michael DeGeorgia, MD, of University Hospitals Case Medical Center in Cleveland.&lt;/p&gt;
&lt;p&gt;It &quot;illustrates both the complexities of this area and the limitations of our bedside clinical examination,&quot; he said in an e-mail, adding that more research will be needed to figure out how to use the technology and how to interpret the results.&lt;/p&gt;
&lt;p&gt;The research &quot;does raise difficult medical and legal questions,&quot; DeGeorgia said.&lt;/p&gt;
&lt;p&gt;&quot;We always need to be upfront and honest with families about what we know for certain and what we do not know for certain,&quot; he said. &quot;In many of these cases, the honest answer is that we cannot be absolutely 100% certain that their loved one isn&apos;t &apos;in there somewhere.&apos;&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study had support from the Medical Research Council, the European Commission, Fonds de la Recherche Scientifique, the James S. McDonnell Foundation, the Mind Science Foundation, the Reine Elisabeth Medical Foundation, the Belgian French-Speaking Community Concerted Research Action, University Hospital of Liege, the University of Liege, and the National Institute for Health Research Biomedical Research Centre.&lt;/p&gt;&lt;p&gt;The researchers said they had no potential conflicts.&lt;/p&gt;&lt;p&gt;Hopper did not report any conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_252"
                     title="MS Walking Drug Gets FDA Nod"
                     score="-0.001"
                     href="http://www.medpagetoday.com/Neurology/MultipleSclerosis/tb/18112?impressionId=1265783075839"
                     
      &lt;p&gt;WASHINGTON  --  The FDA has approved the first drug that improves walking in patients with multiple sclerosis, the tablet dalfampridine (Ampyra).&lt;/p&gt;
&lt;p&gt;The approval was based on clinical trial data that found patients could walk better with the drug than those treated with placebo.&lt;/p&gt;
&lt;p&gt;Patients who exceed recommended dosage, 10 mg twice a day, or who have moderate to severe kidney disease, may experience seizures the FDA said.&lt;/p&gt;
&lt;p&gt;Adverse events reported during clinical trials include urinary tract infection, insomnia, dizziness, headache, nausea, weakness, back pain, balance disorder, swelling of the nose or throat, constipation, diarrhea, indigestion, throat pain, and burning, tingling, or itching skin.&lt;/p&gt;
&lt;p&gt;The drug is manufactured by Elan of Dublin, Ireland and distributed by Acorda Therapeutics Inc. of Hawthone, NY.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_219"
                     title="Oral MS Drugs Effective in Phase III Trials (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/Neurology/MultipleSclerosis/tb/18069?impressionId=1265783075839"
                     
      Two oral drugs under investigation for multiple sclerosis reduced relapse rates and delayed onset of disability in separate trials reported online this week in the &lt;em&gt;New England Journal of Medicine&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;Fingolimod, a novel agent also known as FTY-720, was more effective than both placebo and the standard of care for MS, interferon-beta-1a (Avonex), in two independent trials.&lt;br&gt;
&lt;br&gt;The studies, called FREEDOMS and TRANSFORMS, were reported by Ludwig Kappos, MD, of the University of Basel in Switzerland, and colleagues, and by Jeffrey Cohen, MD, of the Cleveland Clinic, and other researchers, respectively. Some researchers worked on both studies.&lt;br&gt;
&lt;br&gt;Cladribine, an oral drug already marketed for hematologic cancers under the trade name Leustatin, was clearly more effective than placebo in a third trial called CLARITY reported by Gavin Giovannoni, MB, BCh, PhD, of Queen Mary University in London, and colleagues.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;&quot;The studies in this issue of the [&lt;em&gt;NEJM&lt;/em&gt;] provide a new horizon for patients with relapsing-remitting multiple sclerosis and a welcome increase in the range of treatment options,&quot; William M. Carroll, MBBS, MD, of Sir Charles Gairdner Hospital in Perth, Australia, wrote in an accompanying editorial.&lt;/p&gt;
&lt;p&gt;Oral drugs for MS would not only improve patient acceptance of treatment, but also &quot;further support a change in treatment approach to directly prevent immune-mediated injury,&quot; Carroll wrote.&lt;/p&gt;
&lt;p&gt;Existing disease-modifying therapies  --  interferon, glatiramer acetate (Copaxone), and natalizumab (Tysabri)  --  are all injectable drugs.&lt;/p&gt;
&lt;p&gt;&quot;Patients hate the shots and have been waiting 17 years for an oral drug,&quot; John Corboy, MD, a neurologist of the University of Colorado in Denver who was not involved in the study, told &lt;em&gt;MedPage Today&lt;/em&gt; and ABC news when contacted for comment.&quot;&lt;/p&gt;
&lt;p&gt;The National Multiple Sclerosis Society also expressed delight at the reports.&lt;/p&gt;
&lt;p&gt;&quot;The published results ... are wonderful news for people with MS,&quot; wrote John Richert, MD, the group&apos;s executive vice president of research and clinical programs, in a report to local chapters.&lt;/p&gt;
&lt;p&gt;&quot;Having oral therapies in the MS pipeline is real progress, and it should increase the number of people who choose to begin therapy earlier and who stay on therapy, which our experts say is the best way to combat future disease activity.&quot;&lt;/p&gt;
&lt;p&gt;Most of the studies&apos; key results had been presented last spring at the American Academy of Neurology&apos;s annual meeting. (See &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/AAN/14013&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/AAN/14013&quot; target=&quot;_blank&quot;&gt;AAN: Oral MS Drug with Novel Mechanism Beats Interferon-Beta1a&lt;/a&gt; and &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/AAN/13996&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/AAN/13996&quot; target=&quot;_blank&quot;&gt;AAN: Cancer Drug Shows Promise as Oral MS Therapy&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;But the journal reports included additional details, especially on adverse effects, as well as peer review.&lt;/p&gt;
&lt;p&gt;The two drugs target different aspects of T-cell biology. These cells are key players in the autoimmune attack on the myelin sheaths surrounding nerve fibers, which, in turn, causes the slow loss of peripheral nerve function.&lt;/p&gt;
&lt;p&gt;Cladribine induces active T cells to undergo apoptosis, which explains its utility in hairy cell leukemia, lymphoma, and certain other hematologic malignancies.&lt;/p&gt;
&lt;p&gt;Fingolimod has a different mechanism. It causes the sphingosine-1-phosphatase receptor, which normally sits on the surface of T and B cells, to withdraw into the cell interior.&lt;/p&gt;
&lt;p&gt;The effect is to leave the cells unresponsive to signals that instruct them to exit lymph nodes and head toward sites of inflammation. Keeping T cells bottled up in lymph nodes prevents them from attacking nerves in MS.&lt;/p&gt;
&lt;p&gt;The two placebo-controlled studies of fingolimod and cladribine both showed that relapse rates and disease progression were reduced.&lt;/p&gt;
&lt;p&gt;In the 1,272-patient fingolimod study, annualized relapse rates were 0.40 in the placebo group, 0.18 with 0.5 mg of the drug daily, and 0.16 with a 1.25-mg dose over a two-year period (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both doses versus placebo).&lt;/p&gt;
&lt;p&gt;The hazard ratios for disability progression relative to placebo at the two-year evaluation were 0.70 and 0.68 for the low and high doses of fingolimod, respectively (&lt;em&gt;P&lt;/em&gt;=0.02 for both comparisons).&lt;/p&gt;
&lt;p&gt;Cladribine, a more toxic drug, was given in short bursts of treatment over the 96-week study.&lt;/p&gt;
&lt;p&gt;Two dosing regimens were tested, delivering cumulative totals of 3.5 or 5.25 mg/kg, along with placebo. Patients took one or two 10-mg tablets daily for the first four or five days of either two or four monthly periods starting at week zero, followed by two additional monthly courses starting at week 48.&lt;/p&gt;
&lt;p&gt;Results for the primary outcome of annualized relapse rate were 0.33 for placebo, 0.14 for the low cladribine dose, and 0.15 for the higher dose (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both doses versus placebo).&lt;/p&gt;
&lt;p&gt;Hazard ratios for disability progression at week 96 for cladribine versus placebo were 0.67 with the low dose (&lt;em&gt;P&lt;/em&gt;=0.02) and 0.69 with the high dose (&lt;em&gt;P&lt;/em&gt;=0.03).&lt;/p&gt;
&lt;p&gt;Perhaps more striking were the findings in the other fingolimod trial, in which the drug was tested head-to-head against the current standard of care.&lt;/p&gt;
&lt;p&gt;The same two doses of fingolimod were used. Patients assigned to interferon received the drug in weekly intramuscular injections of 30 &amp;#956;g.&lt;/p&gt;
&lt;p&gt;The annualized relapse rate with interferon was 0.33, whereas it was significantly lower with fingolimod: 0.16 with the 0.5-mg dose and 0.20 for the 1.25-mg dose (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 versus interferon for both).&lt;/p&gt;
&lt;p&gt;But the risk of disease progression did not differ significantly between treatment groups.&lt;/p&gt;
&lt;p&gt;Moreover, two patients receiving the higher fingolimod dose died of herpes zoster infections, disseminated in one case and causing encephalopathy in the other. Increased rates of herpes zoster infections were also seen in the other fingolimod trial and with cladribine. In the cladribine trial, lymphocytopenia was seen in about 14% of patients taking the drug, compared with less than 2% of the placebo group.&lt;/p&gt;
&lt;p&gt;Fingolimod also seemed to be associated with cardiac rhythm disturbances, including bradycardia (2.7% with fingolimod, 0.7% placebo) and atrioventricular conduction block, though the latter was mostly confined to the higher drug dose (five cases versus two each for the low dose and placebo).&lt;/p&gt;
&lt;p&gt;Leukopenia and lymphocytopenia were also seen with fingolimod in the placebo-controlled study, though at lower rates than with cladribine  --  about 3% to 6%, compared with less than 1% in the control group.&lt;/p&gt;
&lt;p&gt;Lymphocytopenia was less frequent overall in the interferon-controlled study, seen in 0.2% of the low-dose group and 1.0% of the high-dose group, compared with no cases in the interferon-treated patients.&lt;/p&gt;
&lt;p&gt;Hillel Panitch, MD, of the University of Vermont in Burlington, Vt., told &lt;em&gt;MedPage Today&lt;/em&gt; and ABC News that the findings were actually reassuring.&lt;/p&gt;
&lt;p&gt;&quot;The adverse events including herpes infections, malignancies, and bradycardia are much less of an issue than expected for these drugs, and with the proper oversight should not delay their use,&quot; Panitch wrote in an e-mail.&lt;/p&gt;
&lt;p&gt;Richert of the National MS Society also indicated that the reported adverse effects were not especially worrisome.&lt;/p&gt;
&lt;p&gt;&quot;Herpes infections are likely to occur with many different immune-modulating therapies, including some already approved for MS,&quot; he wrote in an e-mail to &lt;em&gt;MedPage Today&lt;/em&gt; and ABC News, adding that these usually respond to treatment.&lt;/p&gt;
&lt;p&gt;&quot;They should be something patients and doctors keep a lookout for,&quot; he wrote.&lt;/p&gt;
&lt;p&gt;Similarly, he said, the cardiac effects of fingolimod appeared transient and asymptomatic. But he suggested it may be necessary to avoid combining fingolimod with anti-arrhythmic drugs in at least some patients.&lt;/p&gt;
&lt;p&gt;But Colorado&apos;s Corboy was more concerned by the side effect profile. He pointed to the issue of progressive multifocal leukoencephalopathy (PML) seen with natalizumab (Tysabri) in MS patients, which kept the drug off the market for a time.&lt;/p&gt;
&lt;p&gt;&quot;The price you may have to pay for greater efficacy is greater risk,&quot; he wrote in an e-mail. He said some in the MS community would avoid the new oral drugs because of the risks, should they be approved.&lt;/p&gt;
&lt;p&gt;The manufacturers of both drugs have filed for FDA approval. Merck Serono was first to file, for cladribine, but the FDA informed the company in late November that it considered the application incomplete and refused to accept it.&lt;/p&gt;
&lt;p&gt;Company officials promised at the time that they would submit additional information requested by the agency. They did not respond to requests for an update.&lt;/p&gt;
&lt;p&gt;Novartis, maker of fingolimod, announced in mid-December that its FDA filing was imminent and a company representative confirmed that it had been submitted.&lt;/p&gt;
&lt;p&gt;Although the FDA has given both drugs fast-track status, the possibility that the agency will want an advisory committee review may push their final approvals into 2011.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The two fingolimod studies were funded by Novartis. The study of cladribine was funded by Merck Serono.&lt;/p&gt;&lt;p&gt;Authors of the placebo-controlled study of fingolimod reported relationships other than research funding with Novartis and many other firms including Accorda, Actelion, Allergan, Allozyne, Bayer Schering, Biogen Idec, Biogen-Dompe, Boehringer Ingelheim, Genmab, GlaxoSmithKline, Medicinova, Merck Serono, Roche, sanofi aventis, Santhera, Teva, UCB, Wyeth, Helvea, and Mediservice. Several co-authors were employees of Novartis.&lt;/p&gt;&lt;p&gt;Authors of the study of fingolimod versus interferon reported relationships other than research funding with Novartis and other firms including Biogen Idec, EMD Serono, Teva, sanofi aventis, Waterfront Media, Bayer Schering, AstraZeneca, Genentech, Lundbeck, Talecris, Roche, Wyeth, Medicinova, Biogen-Dompe, Medtronic, Accorda, Actelion, Allergan, Allozyne, Boehringer Ingelheim, Genmab, GlaxoSmithKline, Santhera, and UCB. Several co-authors were employees of Novartis.&lt;/p&gt;&lt;p&gt;Authors of the cladribine study reported relationships other than research funding with Merck Serono or EMD Serono and with other firms including Bayer Schering, Biogen Idec, Novartis, Teva-Aventis, UCB, Vertex, sanofi-aventis, Biogen-Dompe, Pfizer, and Genentech. Several co-authors were employees of Merck Serono.&lt;/p&gt;&lt;p&gt;Carroll reported relationships other than research funding with Biogen Idec, Bayer Schering, Merck Serono, and sanofi-a ventis. He also reported agreeing to serve on a Novartis advisory board but did not attend meetings and received no compensation.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
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                     title="Gene Variations Predict Beta-Interferon Response in Multiple Sclerosis"
                     score="-0.005"
                     href="